1
|
Zafar F, Conway J, Bleiweis MS, Al-Aklabi M, Ameduri R, Barnes A, Bearl DW, Buchholz H, Church S, Do NL, Duffy V, Dykes JC, Eghtesady P, Fisher L, Friedland-Little J, Fuller S, Fynn-Thompson F, George K, Gossett JG, Griffiths ER, Griselli M, Hawkins B, Honjo O, Jeewa A, Joong A, Kindel S, Kouretas P, Lorts A, Machado D, Maeda K, Maurich A, May LJ, McConnell P, Mehegan M, Mongé M, Morales DLS, Murray J, Niebler RA, O'Connor M, Peng DM, Phelps C, Philip J, Ploutz M, Profsky M, Reichhold A, Rosenthal DN, Said AS, Schumacher KR, Si MS, Simpson KE, Sparks J, Louis JS, Steiner ME, VanderPluym C, Villa C. Berlin Heart EXCOR and ACTION post-approval surveillance study report. J Heart Lung Transplant 2021; 40:251-259. [PMID: 33579597 DOI: 10.1016/j.healun.2021.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/04/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Berlin Heart EXCOR Pediatric (EXCOR) ventricular assist device (VAD) was introduced in North America nearly 2 decades ago. The EXCOR was approved under Humanitarian Device Exemption status in 2011 and received post-market approval (PMA) in 2017 from Food and Drug Administration. Since the initial approval, the field of pediatric mechanical circulatory support has changed, specifically with regard to available devices, anticoagulation strategies, and the types of patients supported. This report summarizes the outcomes of patients supported with EXCOR from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry. These data were part of the PMA surveillance study (PSS) required by the Food and Drug Administration. METHODS ACTION is a learning collaborative of over 40 pediatric heart failure programs worldwide, which collects data for all VAD implantations as one of its initiatives. All patients in North America with EXCOR implants reported to ACTION from 2018 to 2020 (n = 72) who had met an outcome were included in the EXCOR PSS group. This was compared with a historical, previously reported Berlin Heart EXCOR study group (Berlin Heart study [BHS] group, n = 320, 2007‒2014). RESULTS Patients in the PSS group were younger, were smaller in weight/body surface area, were more likely to have congenital heart disease, and were less likely to receive a bi-VAD than those in the BHS group. Patients in the PSS group were less likely to be in Interagency Registry for Mechanically Assisted Circulatory Support Profile 1 and were supported for a longer duration. The primary anticoagulation therapy for 92% of patients in the PSS group was bivalirudin. Success, defined as being transplanted, being weaned for recovery, or being alive on a device at 180 days after implantation, was 86% in the PSS group compared with 76% in the BHS group. Incidence of stroke was reduced by 44% and the frequency of pump exchange by 40% in the PSS group compared with those in the BHS group. Similarly, all other adverse events, including major bleeding, were reduced in the PSS group. CONCLUSIONS The PSS data, collected through ACTION, highlight the improvement in outcomes for patients supported with EXCOR compared with the outcomes in a historical cohort. These findings may be the result of changes in patient care practices over time and collaborative learning.
Collapse
Affiliation(s)
- Farhan Zafar
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
| | - Jennifer Conway
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Mark S Bleiweis
- University of Florida Health Shands Children's Hospital, Gainesville, Florida
| | - Mohammed Al-Aklabi
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Ameduri
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - David W Bearl
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Holger Buchholz
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Nhue L Do
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Vicky Duffy
- Nationwide Children's Hospital, Columbus, Ohio
| | - John C Dykes
- Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, California
| | | | | | | | | | | | - Kristen George
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Massimo Griselli
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Beth Hawkins
- Boston Children's Hospital, Boston, Massachusetts
| | - Osami Honjo
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aamir Jeewa
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anna Joong
- Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Steven Kindel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Herma Heart Institute, Children's Wisconsin, Milwaukee, Wisconsin
| | - Peter Kouretas
- UCSF Benioff Children's Hospital, San Francisco, California
| | - Angela Lorts
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Desiree Machado
- University of Florida Health Shands Children's Hospital, Gainesville, Florida
| | - Katsuhide Maeda
- Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, California
| | - Andrea Maurich
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Mary Mehegan
- St. Louis Children's Hospital, St. Louis, Missouri
| | - Michael Mongé
- Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - David L S Morales
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Jenna Murray
- Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, California
| | - Robert A Niebler
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Herma Heart Institute, Children's Wisconsin, Milwaukee, Wisconsin
| | | | - David M Peng
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Joseph Philip
- University of Florida Health Shands Children's Hospital, Gainesville, Florida
| | | | | | | | - David N Rosenthal
- Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, California
| | - Ahmed S Said
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Kurt R Schumacher
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Ming-Sing Si
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Kathleen E Simpson
- Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Jim St Louis
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Marie E Steiner
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Chet Villa
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | |
Collapse
|
2
|
Raskin A, Borsheim K, Kim M, Brickler M, Jarzembowski J, Punnoose A, Chin C, Kindel S, Hessner M. Plasma Induced Transcriptional Analysis Assessment of Rejection in Pediatric Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
3
|
Woods RK, Kindel S, Mitchell ME, Hraska V, Niebler RA. Evolving understanding of total artificial heart support of young infants and children. J Thorac Cardiovasc Surg 2020; 159:1075-1082. [DOI: 10.1016/j.jtcvs.2019.09.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/19/2019] [Accepted: 09/15/2019] [Indexed: 11/26/2022]
|
4
|
Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
Collapse
Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
| |
Collapse
|
5
|
Sparks JD, Cantor RS, Pruitt E, Kirklin JK, Carboni M, Dreyer W, Kindel S, Ryan TD, Morrow WR. New-onset diabetes after pediatric heart transplantation: A review of the Pediatric Heart Transplant Study. Pediatr Transplant 2019; 23:e13476. [PMID: 31124221 DOI: 10.1111/petr.13476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/25/2019] [Accepted: 02/16/2019] [Indexed: 11/30/2022]
Abstract
NDT is a well-defined complication after solid organ transplantation. Little has been published describing the incidence, risk factors, and effect on outcome after pediatric heart transplantation. We performed a retrospective evaluation of pediatric patients from the PHTS registry from 2004 to 2014. Group comparison, associated factors, incidence using Kaplan-Meier method, and risk factor and outcome analysis for NDT at 1 year post-transplant. Of the 2185 recipients, 1756 were alive and followed at 1 year. Overall freedom from NDT was 98.9%, 94.7%, and 92.6% at 1, 5, and 10 years, respectively. Patients with NDT were more likely to be black (non-Hispanic; P = 0.002), older at time of transplant (P < 0.0001), and have a higher BMI percentile at time of transplant (P < 0.0001). Adjusted risk factors for NDT at 1 year were older age at transplant (years; >12 years, OR: 8.8 and 5-12 years, HR: 8.0), obese BMI percentile at time of transplant (OR: 3.8), and steroid use at 30 days after transplant (OR: 4.7). Though uncommon, NDT occurs with a constant hazard after pediatric heart transplant; it occurs more often in older patients at transplant, those who are of black race, those who are obese, and those who use steroids. Therefore, targeted weight reduction and selective steroid use in at-risk populations could reduce the incidence of early NDT. Further data are needed to determine the risk imparted by transplantation, factors that predict late-onset NDT, and whether NDT alters the outcome after transplant.
Collapse
Affiliation(s)
| | - Ryan S Cantor
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Thomas D Ryan
- University Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | |
Collapse
|
6
|
Villa C, Peng D, Auerbach S, Kindel S, Law S, Lorts A, Mehegan M, O'Connor M, Ploutz M, Rosenthal D, VanderPluym C, Zinn M, Sutcliffe D. Speaking the Same Language? Assessing Blood Pressure Measurement and Effectiveness in Pediatric VAD Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
7
|
Schubert J, Tariq M, Geddes G, Kindel S, Miller EM, Ware SM. Back Cover, Volume 39, Issue 12. Hum Mutat 2018. [DOI: 10.1002/humu.23685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
8
|
Schubert J, Tariq M, Geddes G, Kindel S, Miller EM, Ware SM. Novel pathogenic variants in filamin C identified in pediatric restrictive cardiomyopathy. Hum Mutat 2018; 39:2083-2096. [DOI: 10.1002/humu.23661] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/29/2018] [Accepted: 09/25/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Jeffrey Schubert
- Department of Molecular Genetics, Microbiology, and Biochemistry; University of Cincinnati College of Medicine; Cincinnati Ohio
- Departments of Pediatrics and Medical and Molecular Genetics; Indiana University School of Medicine; Indianapolis Indiana
| | - Muhammad Tariq
- Faculty of Applied Medical Science; University of Tabuk; Tabuk Kingdom of Saudi Arabia
| | - Gabrielle Geddes
- Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Steven Kindel
- Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Erin M. Miller
- Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Stephanie M. Ware
- Departments of Pediatrics and Medical and Molecular Genetics; Indiana University School of Medicine; Indianapolis Indiana
| |
Collapse
|
9
|
Zangwill S, Stamm K, Kindel S, Mahnke D, Goetsch M, Liang H, Ziegler E, Tomita-Mitchell A, Mitchell M. Endomyocardial Biopsy - A Source of Heartache. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Singh N, Grosshuesch C, Johnson W, DeVogel N, Yin Z, Wang T, Kindel S, Woods R. Prolonged Management in Donors with Reduced Ejection Fraction is a Risk Factor for Graft Loss in Pediatric Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
11
|
Woods RK, Ghanayem NS, Mitchell ME, Kindel S, Niebler RA. Mechanical Circulatory Support of the Fontan Patient. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 20:20-27. [PMID: 28007060 DOI: 10.1053/j.pcsu.2016.09.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 12/30/2022]
Abstract
Because of the inadequacies inherent to a circulation supported by a single ventricle, many Fontan patients will experience failure of their circulation. To date, there is no medical regimen that reliably and consistently restores circulatory function in these patients. Because of the shortage of donor organs and the fact that many of these patients present with features that either preclude or render heart transplantation a high risk, there is an intense need to better understand how mechanical circulatory support (MCS) may benefit these patients. In this report, we share our experience of successful MCS and transplantation of three patients. Our experience and that of others is very encouraging, but also preliminary. In general, a systemic ventricular assist device, with or without a Fontan fenestration, is a reasonable consideration for a patient presenting with predominantly systolic dysfunction. A pulmonary/systemic venous assist device may be sufficient for the patient with preserved systolic function and failure of the systemic venous/lymphatic system; however, this remains speculative. The more comprehensive approach of a total artificial heart or bilateral support is attractive in theory, but beset by the need for a more complex operation. In all scenarios, early referral, before organ failure, is paramount to successful MCS.
Collapse
Affiliation(s)
- Ronald K Woods
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, WI.
| | - Nancy S Ghanayem
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI
| | - Michael E Mitchell
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Steven Kindel
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Robert A Niebler
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, WI
| |
Collapse
|
12
|
Tariq M, Le TT, Putnam P, Kindel S, Keddache M, Ware SM. Targeted Capture and Massively Parallel Sequencing in Pediatric Cardiomyopathy: Development of Novel Diagnostics. Cardiogenetics 2012. [DOI: 10.4081/cardiogenetics.2012.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pediatric cardiomyopathy is a genetically heterogeneous disease associated with significant morbidity. Although identification of underlying etiology is important for management, therapy, and screening of at risk family members, molecular diagnosis is difficult due to the large number of causative genes, the high rate of private mutations, and cost. In this study, we aimed to define the genetic basis of pediatric cardiomyopathy and test a novel diagnostic tool using a custom targeted microarray coupled to massively parallel sequencing. Three patients with cardiomyopathy were screened using a custom NimbleGen sequence capture array containing 110 genes and providing 99.9% coverage of the exons of interest. The sensitivity and specificity was over 99% as determined by comparison to long-range polymerase chain reaction (PCR)- based massively parallel sequencing, Sanger sequencing of missense variants, and single nucleotide polymorphisms genotyping using the Illumina Infinium Omni1 array. Overall, 99.73% of the targeted regions were captured and sequenced at over 10x coverage, allowing reliable mutation calling in all patients. Analysis identified a total of 165 non-synonymous coding single nucleotide polymorphisms (cSNPs) of which 89 were unique and 14 were novel. On average, each patient had 4 cSNPs predicted to be pathogenic. In conclusion, we report a cardiomyopathy sequencing array that allows simultaneous assessment of 110 genes. Comparison of targeted sequence capture versus PCR-based enrichment methods demonstrates that the former is more sensitive and efficient. Array-based sequence capture technology followed by massively parallel sequencing is promising as a robust and comprehensive tool for genetic screening of cardiomyopathy. These results provide important information about genetic architecture and indicate that improved annotation of variants and interpretation of clinical significance, particularly in cases with multiple rare variants, are important for clinical practice.
Collapse
|
13
|
Abstract
The endoscopic view offers a new anatomical dimension to the neurosurgeon. The fact makes it basically necessary to study the topographic anatomy under endoscopic conditions. In this paper attention was drawn to the ventricles because they are the most common region of clinical application. In 25 specimens neuroendoscopic explorations of the ventricles have been done. The dissections have been carried out through one- and two burr hole approaches (two working endoscopes at the same time). The instrumentation includes rigid 4 mm and 6 mm endoscopes. The procedures have been documented by continuous video recording and parallel photography.
Collapse
Affiliation(s)
- K D Resch
- Department of Neurosurgery, University of Mainz, Federal Republic of Germany
| | | | | | | |
Collapse
|
14
|
Abstract
In immunocompetent patients, infection by the measles (rubeola) paramyxovirus produces fever, cough, coryza, Koplik's spots, and, on the skin, a macular erythema that can become confluent. The erythema has a striking cephalocaudal spread and clearing. The diagnosis of measles on a skin biopsy and the distinction from an erythema multiforme type of drug eruption can be difficult. We studied a skin biopsy from a patient with the acquired immunodeficiency syndrome (AIDS) who presented with measles. In contrast to erythema multiforme, the measles biopsy has necrosis of clusters of keratinocytes in the high spinous layer and granular layer of the epidermis, whereas erythema multiforme has necrosis of basal keratinocytes. Multinucleated keratinocytes may or may not be prominent in the measles biopsy. Cytoplasmic swelling of the keratinocytes in the granular layer may be present even when multinucleated cells are sparse. Immunoperoxidase reactivity for measles virus protein is present in intranuclear inclusions and in the cytoplasm of infected upper spinous keratinocytes. There were more cells with positive staining in the biopsy from the AIDS patient than in another biopsy from an immunocompetent patient with measles. The AIDS patient was seronegative for measles throughout the course of the illness. The examination of the skin biopsy can be very important in the diagnosis of measles in AIDS patients or immunocompromised patients who may not develop the usual diagnostic serology.
Collapse
Affiliation(s)
- N S McNutt
- Department of Pathology, New York Hospital, Cornell University Medical Center, NY 10021
| | | | | |
Collapse
|
15
|
Varghese M, Kindel S. Pigmentary disorders and inflammatory lesions of the external genitalia. Urol Clin North Am 1992; 19:111-21. [PMID: 1736470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many cutaneous processes can involve the external genitalia as a part of the general involvement of the skin. Other processes may affect only the genitalia, such as several pigmentary disorders and inflammations. As a result, these conditions may be mistaken for sexually transmitted diseases. It is important to include these conditions in the differential diagnosis.
Collapse
Affiliation(s)
- M Varghese
- Department of Dermatology, New York Hospital-Cornell Medical Center, New York
| | | |
Collapse
|
16
|
Affiliation(s)
- B R Smoller
- Department of Pathology, New York Hospital-Cornell University Medical Center, New York
| | | | | | | | | |
Collapse
|