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Abdul-Khaliq H, Gomes D, Meyer S, von Kries R, Wagenpfeil S, Pfeifer J, Poryo M. Trends of mortality rate in patients with congenital heart defects in Germany-analysis of nationwide data of the Federal Statistical Office of Germany. Clin Res Cardiol 2024; 113:750-760. [PMID: 38436738 PMCID: PMC11026207 DOI: 10.1007/s00392-023-02370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/30/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Congenital heart defects (CHD) are still associated with an increased morbidity and mortality. The aim of this study was to analyze trends of mortality rates in patients with CHD between 1998 and 2018 in Germany. METHODS Data of registered deaths with an underlying diagnosis of CHD were used to evaluate annual mortality between 1998 and 2018. Polynomial regressions were performed to assess annual changes in CHD-associated mortality rates by age groups. RESULTS During the 21-year study period, a total of 11,314 deaths were attributed to CHD with 50.9% of deaths in infants (age < 1 year) and 28.2% in neonates (age ≤ 28 days). The most frequent underlying CHDs associated with death were hypoplastic left heart syndrome (n = 1498, 13.2%), left ventricular outflow tract obstruction (n = 1009, 8.9%), atrial septal defects (n = 771, 6.8%), ventricular septal defects (n = 697, 6.2%), and tetralogy of Fallot (n = 673, 5.9%), and others (n = 6666, 58.9%). Among all patients, annual CHD-related mortality rates declined significantly between 1998 and 2010 (p < 0.0001), followed by a significant annual increase until 2018 (p < 0.0001). However, mortality rates in 2018 in all ages were significantly lower than in 1998. CONCLUSION Mortality in CHD patients decreased significantly between 1998 and 2010, but a substantial number of deaths still occurred and even significantly increased in the last 3 years of the observation period particularly in neonates and infants. This renewed slight increase in mortality rate during the last years was influenced mainly by high-risk neonates and infants. Assessment of factors influencing the mortality rate trends in association with CHD in Germany is urgently needed. Obligatory nationwide registration of death cases in relation to surgical and catheter interventions in CHD patients is necessary to provide additional valuable data on the outcome of CHD.
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Affiliation(s)
- Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany.
- Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
| | - Delphina Gomes
- Institute of Social Pediatrics and Adolescent Medicine, Division of Pediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sascha Meyer
- Department of Pediatrics and Neonatology, Section of Intensive Care, Saarland University Medical Center, Homburg/Saar, Germany
| | - Rüdiger von Kries
- Institute of Social Pediatrics and Adolescent Medicine, Division of Pediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jochen Pfeifer
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany
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Derridj N, Calderon J, Bonnet D, Khoshnood B, Monier I, Guedj R. Neurodevelopmental outcomes of preterm and growth-restricted neonate with congenital heart defect: a systematic review and meta-analysis. Eur J Pediatr 2024; 183:1967-1987. [PMID: 38353800 DOI: 10.1007/s00431-023-05419-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 04/23/2024]
Abstract
The purpose of the study is to assess the risks of neurodevelopmental morbidity among preterm and growth restricted youth with congenital heart defects (CHD). This systematic review and meta-analysis included observational studies assessing neurodevelopmental outcomes among children with CHD born preterm (i.e., before 37 weeks of gestation) or growth restricted (small-for-gestational age (SGA) with a birthweight < the 10th percentile or with low birthweight (LBW) < 2500 g). Studies were identified in Medline and Embase databases from inception until May 2022, with data extracted by two blinded reviewers. Risk of bias was assessed using the Critical Appraisal Skills Programme cohort checklist. Meta-analysis involved the use of random-effects models. Main outcome measures were neurodevelopmental outcomes including overall cognitive impairment and intellectual disability, IQ, communication, and motor skills scores. From 3573 reports, we included 19 studies in qualitative synthesis and 6 meta-analysis studies. Risk of bias was low in 8/19 studies. Cognitive impairment and intellectual disability were found in 26% (95% CI 20-32, I2 = 0%) and 19% (95% CI 7-35, I2 = 82%) of preterm children with CHD, respectively. Two studies documented a lower IQ score for SGA children who underwent CHD operations in comparison to non-SGA children who also underwent CHD operations. Two studies have reported lower IQ, communication, and motor skills in children with hypoplastic left heart syndrome (HLHS) and low birth weight compared to those with HLHS and expected birth weight. CONCLUSIONS Based on a low level of evidence, prematurity and/or growth retardation appear to accentuate specific neurodevelopmental outcomes in certain CHD subgroups. Further evidence is needed to confirm these findings. TRIAL REGISTRATION PROSPERO [CRD42020201414]. WHAT IS KNOWN • Children born with CHD, preterm birth, or growth restriction at birth are independently at higher risk for neurodevelopmental impairment. • The additional effect of preterm birth and/or growth restriction on neurodevelopmental outcomes in children with CHD remains unclear. WHAT IS NEW • Prematurity and/or growth retardation appear to accentuate specific neurodevelopmental outcomes in certain CHD subgroups. • Children with CHD, particularly those born preterm or with growth restriction, should undergo lifelong systematic comprehensive neurodevelopmental assessment.
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Affiliation(s)
- Neil Derridj
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, CRESS, INSERM U1153, INRA, 53 avenue de l'Observatoire, 75014, F-75004, Paris, France.
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université de Paris Cité, Paris, France.
| | - Johanna Calderon
- UMR 1046 INSERM CNRS PhyMedExp, Université de Montpellier, Montpellier, France
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, USA
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université de Paris Cité, Paris, France
| | - Babak Khoshnood
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, CRESS, INSERM U1153, INRA, 53 avenue de l'Observatoire, 75014, F-75004, Paris, France
| | - Isabelle Monier
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, CRESS, INSERM U1153, INRA, 53 avenue de l'Observatoire, 75014, F-75004, Paris, France
| | - Romain Guedj
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, CRESS, INSERM U1153, INRA, 53 avenue de l'Observatoire, 75014, F-75004, Paris, France
- Pediatric Emergency Department, AP-HP, Armand Trousseau Hospital, Sorbonne Université, Paris, France
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Amedro P, Gavotto A, Huguet H, Souilla L, Huby AC, Matecki S, Cadene A, De La Villeon G, Vincenti M, Werner O, Bredy C, Lavastre K, Abassi H, Cohen S, Hascoet S, Dauphin C, Chalard A, Dulac Y, Souletie N, Bouvaist H, Douchin S, Lachaud M, Ovaert C, Soulatges C, Combes N, Thambo JB, Iriart X, Bajolle F, Bonnet D, Ansquer H, Delpey JG, Cohen L, Picot MC, Guillaumont S. Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial. Eur Heart J 2024; 45:1458-1473. [PMID: 38430485 PMCID: PMC11032713 DOI: 10.1093/eurheartj/ehae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND AND AIMS Cardiopulmonary fitness in congenital heart disease (CHD) decreases faster than in the general population resulting in impaired health-related quality of life (HRQoL). As the standard of care seems insufficient to encourage and maintain fitness, an early hybrid cardiac rehabilitation programme could improve HRQoL in CHD. METHODS The QUALIREHAB multicentre, randomized, controlled trial evaluated and implemented a 12-week centre- and home-based hybrid cardiac rehabilitation programme, including multidisciplinary care and physical activity sessions. Adolescent and young adult CHD patients with impaired cardiopulmonary fitness were randomly assigned to either the intervention (i.e. cardiac rehabilitation) or the standard of care. The primary outcome was the change in HRQoL from baseline to 12-month follow-up in an intention-to-treat analysis. The secondary outcomes were the change in cardiovascular parameters, cardiopulmonary fitness, and mental health. RESULTS The expected number of 142 patients was enroled in the study (mean age 17.4 ± 3.4 years, 52% female). Patients assigned to the intervention had a significant positive change in HRQoL total score [mean difference 3.8; 95% confidence interval (CI) 0.2; 7.3; P = .038; effect size 0.34], body mass index [mean difference -0.7 kg/m2 (95% CI -1.3; -0.1); P = .022; effect size 0.41], level of physical activity [mean difference 2.5 (95% CI 0.1; 5); P = .044; effect size 0.39], and disease knowledge [mean difference 2.7 (95% CI 0.8; 4.6); P = .007; effect size 0.51]. The per-protocol analysis confirmed these results with a higher magnitude of differences. Acceptability, safety, and short-time effect of the intervention were good to excellent. CONCLUSIONS This early hybrid cardiac rehabilitation programme improved HRQoL, body mass index, physical activity, and disease knowledge, in youth with CHD, opening up the possibility for the QUALIREHAB programme to be rolled out to the adult population of CHD and non-congenital cardiac disease.
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Affiliation(s)
- Pascal Amedro
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Arthur Gavotto
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
| | - Luc Souilla
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Anne-Cecile Huby
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Stefan Matecki
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Anne Cadene
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
| | - Gregoire De La Villeon
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie Vincenti
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Oscar Werner
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Charlene Bredy
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Fontfroide Cardiac Rehabilitation Center, 1800 rue de Saint-Priest, 34097 Montpellier, France
| | - Kathleen Lavastre
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Sarah Cohen
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
| | - Sebastien Hascoet
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
| | - Claire Dauphin
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Aurelie Chalard
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Yves Dulac
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Nathalie Souletie
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Helene Bouvaist
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Stephanie Douchin
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Matthias Lachaud
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Caroline Ovaert
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, APHM La Timone Hospital, Marseille, France
| | - Camille Soulatges
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, APHM La Timone Hospital, Marseille, France
| | - Nicolas Combes
- Pediatric and Congenital Cardiology Department, Pasteur Clinic, Toulouse, France
| | - Jean-Benoit Thambo
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Xavier Iriart
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Fanny Bajolle
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, APHP Necker Hospital, Paris, France
| | - Damien Bonnet
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, APHP Necker Hospital, Paris, France
| | - Helene Ansquer
- Pediatric and Congenital Cardiology Department, Brest University Hospital, Brest, France
| | - Jean-Guillaume Delpey
- Pediatric and Congenital Cardiology Department, Brest University Hospital, Brest, France
| | - Laurence Cohen
- Fetal, Pediatric and Congenital Private Practice, 8 rue du Conseil de l'Europe, 91300 Massy, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
- Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
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Qiu M, Chen J, Liu M, Shi Y, Nie Z, Dong G, Li X, Chen J, Ou Y, Zhuang J. Reprogramming of DNA methylation patterns mediates perfluorooctane sulfonate-induced fetal cardiac dysplasia. Sci Total Environ 2024; 919:170905. [PMID: 38350568 DOI: 10.1016/j.scitotenv.2024.170905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/15/2024]
Abstract
Prenatal exposure to perfluorooctane sulfonate (PFOS) is associated with adverse health effects, including congenital heart disease, yet the underlying mechanisms remain elusive. Herein, we aimed to evaluate the embryotoxicity of PFOS using C57BL/6 J mice to characterize fetal heart defects after PFOS exposure, with the induction of human embryonic stem cells (hESC) into cardiomyocytes (CMs) as a model of early-stage heart development. We also performed DNA methylation analysis to clarify potential underlying mechanisms and identify targets of PFOS. Our results revealed that PFOS caused septal defects and excessive ventricular trabeculation cardiomyopathy at 5 mg/kg/day in embryonic mice and inhibited the proliferation and pluripotency of ESCs at concentrations >20 μM. Moreover, it decreased the beating rate and the population of CMs during cardiac differentiation. Decreases were observed in the abundances of NPPA+ trabecular and HEY2+ compact CMs. Additionally, DNA methyl transferases and ten-eleven translocation (TET) dioxygenases were regulated dynamically by PFOS, with TETs inhibitor treatment inducing significant decreases similar as PFOS. 850 K DNA methylation analysis combined with expression analysis revealed several potential targets of PFOS, including SORBS2, FHOD1, SLIT2, SLIT3, ADCY9, and HDAC9. In conclusion, PFOS may reprogram DNA methylation, especially demethylation, to induce cardiac toxicity, causing ventricular defects in vivo and abnormal cardiac differentiation in vitro.
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Affiliation(s)
- Min Qiu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jing Chen
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Mingqin Liu
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yan Shi
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhiqiang Nie
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Guanghui Dong
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaohong Li
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yanqiu Ou
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Epidemiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
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Benouhiba A, Walter A, Jahren SE, Martinez T, Clavica F, Heinisch PP, Obrist D, Civet Y, Perriard Y. Dielectric elastomer actuator-based valveless pump as Fontan failure assist device: introduction and preliminary study. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae041. [PMID: 38514398 PMCID: PMC11001492 DOI: 10.1093/icvts/ivae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Fontan failure refers to a condition in which the Fontan circulation, a surgical procedure used to treat certain congenital heart defects, becomes insufficient, leading to compromised cardiac function and potential complications. This in vitro study therefore investigates the feasibility of bladeless impedance-driven cavopulmonary assist device via dielectric elastomer actuator (DEA) as a means to address Fontan failure. METHODS A cavopulmonary assist device, constructed using DEA technologies and employing the impedance pump concept, is subjected to in vitro testing within a closed-loop setup. This study aims to assess the device's functionality and performance under controlled conditions, providing valuable insights into its potential application as a cavopulmonary assistive technology. RESULTS The DEA-based pump, measuring 50 mm in length and 30 mm in diameter, is capable of achieving substantial flow rates within a closed-loop setup, reaching up to 1.20 l/min at an activation frequency of 4 Hz. It also provides a broad range of working internal pressures (<10 to >20 mmHg). Lastly, the properties of the flow (direction, magnitude, etc.) can be controlled by adjusting the input signal parameters (frequency, amplitude, etc.). CONCLUSIONS In summary, the results suggest that the valveless impedance-driven pump utilizing DEA technology is promising in the context of cavopulmonary assist devices. Further research and development in this area may lead to innovative and potentially more effective solutions for assisting the right heart, ultimately benefiting patients with heart-related health issues overall, with a particular focus on those experiencing Fontan failure.
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Affiliation(s)
- Amine Benouhiba
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Armando Walter
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Silje Ekroll Jahren
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Martinez
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Francesco Clavica
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Paul Philipp Heinisch
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Yoan Civet
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Yves Perriard
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
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Kim AY, Tchah N, Lin CY, Park JM, Woo W, Kim CS, Jung SY, Choi JY, Jung JW. Predictive Scoring System for Spontaneous Closure of Infant Ventricular Septal Defect: The P-VSD Score. Pediatr Cardiol 2024:10.1007/s00246-024-03434-8. [PMID: 38438790 DOI: 10.1007/s00246-024-03434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Ventricular septal defect (VSD) is a common congenital heart disease. However, consensus on the utility of echocardiography in predicting spontaneous closure (SC) of VSD remains lacking. This study aimed to identify and validate significant predictors of SC through a predictive scoring system. This retrospective study included medical records of 712 echocardiography instances performed on 304 patients diagnosed with VSD from 2016 to 2020 in their first year of life. A novel scoring system for predicting the SC of VSD was developed and validated using another dataset from different hospitals. Of the 304 patients, 215 (70.7%) had perimembranous (PM) VSDs and 89 had muscular (29.3%) VSDs. The median follow-up periods were 36.2 (interquartile range [IQR], 13-59) months and 13.7 9 (IQR, 5-37.4) days for PM and muscular VSDs, respectively. The overall SC rate during follow-up was 29.3%. Pulmonary hypertension (HTN), concomitant left ventricle (LV)-right atrium (RA) shunt, VSD size to aortic valve (AV) annulus size ratio, and left ventricular end-diastolic dimension (LVEDD) z-score were significant risk factors affecting SC of VSD. The "P-VSD" score, a new scoring system, demonstrated an area under the curve for predictability of 0.769. Pulmonary HTN, concomitant LV-RA shunt, LVEDD z-score, and VSD size-to-AV annulus size ratio at diagnosis were significantly associated with non-SC VSD after infancy. The P-VSD score can predict the SC of VSD in clinical settings and simplify the identification and appropriate management of high-risk patients.
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Affiliation(s)
- Ah Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, C.P.O. Box 8044, Seoul, 03722, Korea
| | - Nuri Tchah
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, C.P.O. Box 8044, Seoul, 03722, Korea
| | - Ching-Yu Lin
- Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Min Park
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Sin Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, C.P.O. Box 8044, Seoul, 03722, Korea
| | - Se Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, C.P.O. Box 8044, Seoul, 03722, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, C.P.O. Box 8044, Seoul, 03722, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, C.P.O. Box 8044, Seoul, 03722, Korea.
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Hock J, Bessar M, Ewert P, Hager A. Body plethysmography - additional information on exercise capacity in patients with congenital heart disease? Clin Res Cardiol 2024:10.1007/s00392-024-02385-7. [PMID: 38315211 DOI: 10.1007/s00392-024-02385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/11/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
AIMS In each cardiopulmonary exercise test (CPET), resting spirometry is performed in advance. In patients with a congenital heart defect (CHD), lung volumes are often impaired. This study investigates correlations between lung volumes and CPET parameters and determines, whether body plethysmography provides substantial additional information for these patients. METHODS Data from 102 patients (23.8 ± 10.4 years of age, 39 female) with various forms of CHD were examined from April 2018 to October 2022. All patients underwent spirometry (measuring forced vital capacity, FVC and forced expiratory volume in 1 s, FEV1), body plethysmography (measuring total lung capacity, TLC) and an exhausting CPET. Data is presented as the median and interquartile range (z-scores) and correlated with Spearman's rho. RESULTS Fifty-five% of all patients had normal results in lung function and 45% had normal peak oxygen uptake (≥ 80% predicted in peak VO2). Patients with impaired lung function were significantly more likely to have low exercise capacity (Fisher's exact test: p = 0.028). FVC z-values and %predicted peak VO2 (r = 0.365, p < 0.001) correlated significantly as well as FEV1_z and %predicted peak VO2 (r = 0.320, p = 0.001), and TLC z-values and %predicted peak VO2 (r = 0.249, p = 0.012). No correlation was found between FEV1/FVC z-values and %predicted peak VO2 (r = -0.043, p = 0.670). CONCLUSION Spirometry and exercise capacity positively correlate, also in CHD patients. However, body plethysmography does not provide additional or improved prediction and is therefore only recommended in noteworthy results in spirometry to exclude further lung co-morbidities.
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Affiliation(s)
- Julia Hock
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.
| | - Mohammed Bessar
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
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Yang Y, Xi L, Li H. A Retrospective Study in Occluding Sub-arterial Ventricular Septal Defect. Pediatr Cardiol 2024; 45:410-415. [PMID: 37803227 DOI: 10.1007/s00246-023-03309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
To assess the safety and effectiveness of utilizing eccentric occlusion for the treatment of sub-arterial ventricular septal defects, we performed a retrospective study on the classification and analysis of relevant cases. A total of 105 patients with a minimally invasive incision were enrolled in this study, from April 2018 to September 2022. All patients underwent treatment of transthoracic sub-arterial ventricular septal defect occlusion. We analyzed the causes of closure failure, indication, and complication. Briefly, the closure device was successfully implanted in 78 cases (74.2%) with a mean age of 31.4 ± 31.8 months, VSD size of 4.3 ± 0.9 mm, and device size of 6.0 ± 1.1 mm. However, 27 cases (25.8%) required cardiopulmonary bypass due to failure of occlusion. The reasons for failure included 13 cases with worsened aortic regurgitation, two cases with worsened aortic valve prolapse, one case with worsened mitral regurgitation, eight cases with significant residual shunt, and three cases with deviated occlusion morphology. During the 1-36-month follow-up visit, no cases experienced displacement of the eccentric umbrella, shedding, or arrhythmia. All residual shunts resolved during the visit. We concluded that occlusion for sub-arterial VSD has sufficient security and feasibility, under the strict control of surgical indications, appropriate choice of occluder and precise perioperative management.
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Affiliation(s)
- Yan Yang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Linyun Xi
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China.
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China.
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Naiyananon F, Dissaneevate S, Thatrimontrichai A, Janjindamai W, Maneenil G, Praditaukrit M, Roymanee S, Chittithavorn V, Geater A. Predictors of high maintenance prostaglandin E1 doses in neonates with critical congenital heart disease-ductal-dependent pulmonary circulation during preoperative care. Pediatr Neonatol 2024:S1875-9572(24)00011-1. [PMID: 38378302 DOI: 10.1016/j.pedneo.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/26/2023] [Revised: 12/12/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Neonates with critical congenital heart disease of the ductal-dependent pulmonary circulation type (CCHD-DDPC) require prostaglandin E1 (PGE1) to maintain oxygen saturation until surgery. However, the factors contributing to the maintenance doses of PGE1 remain unclear. This study aimed to determine the predictors of high maintenance PGE1 doses in these neonates. METHODS This retrospective cohort study included neonates with CCHD-DDPC at Songklanagarind Hospital between January 1, 2006, and December 31, 2021. Factors associated with high maintenance PGE1 doses (> 0.01 mcg/kg/min) were analyzed to identify predictors. Odds ratios were calculated using tabulation and logistic regression analysis. A prediction score was developed for high maintenance PGE1 doses. RESULTS Among 96 neonates with CCHD-DDPC, 55 % required high maintenance doses of PGE1. Three factors significantly associated with high maintenance PGE1 doses were patent ductus arteriosus (PDA) size-to-birthweight ratio ≤1.3 mm/kg, initial PGE1 dose >0.03 mcg/kg/min, and preoperative invasive mechanical ventilation. The area under the receiver operating characteristic curve for these three predictors was 0.7409. A predictive score of 0-3 was created based on these factors. The probabilities of receiving a high maintenance dose of PGE1 for patients with overall scores of 0, 1, 2, and 3 were 0.19 (95 % CI: 0.04-0.33), 0.42 (95 % CI: 0.30-0.54), 0.69 (95 % CI: 0.57-0.81), and 0.87 (95 % CI: 0.76-0.99), respectively. CONCLUSIONS In neonates with CCHD-DDPC, a PDA size-to-birth weight ratio ≤1.3 mm/kg, an initial dose of PGE1 > 0.03 mcg/kg/min, and preoperative invasive mechanical ventilation were predictors of high maintenance PGE1 doses during the preoperative period.
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Affiliation(s)
- Fonthip Naiyananon
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Supaporn Dissaneevate
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| | - Anucha Thatrimontrichai
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Waricha Janjindamai
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Gunlawadee Maneenil
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Manapat Praditaukrit
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Supaporn Roymanee
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Voravit Chittithavorn
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Alan Geater
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Carrasco D, Guedes-Martins L. Cardiac Axis in Early Gestation and Congenital Heart Disease. Curr Cardiol Rev 2024; 20:CCR-EPUB-137797. [PMID: 38279755 DOI: 10.2174/011573403x264660231210162041] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/07/2023] [Revised: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 01/28/2024] Open
Abstract
Congenital heart defects represent the most common structural anomalies observed in the fetal population, and they are often associated with significant morbidity and mortality. The fetal cardiac axis, which indicates the orientation of the heart in relation to the chest wall, is formed by the angle between the anteroposterior axis of the chest and the interventricular septum of the heart. Studies conducted during the first trimester have demonstrated promising outcomes with respect to the applicability of cardiac axis measurement in fetuses with congenital heart defects as well as fetuses with extracardiac and chromosomal anomalies, which may result in improved health outcomes and reduced healthcare costs. The main aim of this review article was to highlight the cardiac axis as a reliable and powerful marker for the detection of congenital heart defects during early gestation, including defects that would otherwise remain undetectable through the conventional four-chamber view.
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Affiliation(s)
- D Carrasco
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
| | - L Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação-Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Portugal
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Feng W, Zhang M, Hou J, Die X, Wang Y, Liu R. Clinical characteristics of congenital heart defects in mild congenital anorectal malformation: single-centre experience. BMC Pediatr 2024; 24:71. [PMID: 38245711 PMCID: PMC10799376 DOI: 10.1186/s12887-023-04518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/29/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To analyze the clinical characteristics and types of congenital heart defect (CHD) in mild congenital anorectal malformation (CARM), namely the rectoperineal and rectovestibular fistulas. METHODS The retrospective study of 183 patients with mild CARM was conducted with assessments of demographic information, color Doppler echocardiography results, and follow-up data. We performed an analysis of the clinical characteristics of CHD, grouping them based on sex and type of mild CARM. RESULTS Of the 183 patients, rectoperineal fistula occurred in 133 patients (72.7%), while the frequency of CHD was 79.8% (146/183). Ventricular septal defects (VSDs) occur more frequently in patients with rectoperineal fistula compared to those with rectovestibular fistula (1.5% vs. 10%), while the opposite trend was observed for patent ductus arteriosus (PDAs) (39.8% vs. 22.0%). Additionally, males presented higher frequency of PDA (42.7% vs. 26.4%) and self-healing (6 months: 87.2% vs. 42.6%; 12 months: 91.0% vs. 63.2%) than females. However, males had a lower rate of undergoing cardiac surgery (6.4% vs. 17.6%) and a younger median diagnosis age (1 day vs. 9 days). CONCLUSION Our study indicates that there is a necessity for meticulous cardiac assessment and follow-up in neonates diagnosed with mild CARM.
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Affiliation(s)
- Wei Feng
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Minjie Zhang
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Jinping Hou
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Xiaohong Die
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yi Wang
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
| | - Rong Liu
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
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12
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Dong BB, Li YJ, Liu XY, Huang RT, Yang CX, Xu YJ, Lv HT, Yang YQ. Discovery of BMP10 as a new gene underpinning congenital heart defects. Am J Transl Res 2024; 16:109-125. [PMID: 38322548 PMCID: PMC10839403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Aggregating evidence convincingly establishes the predominant genetic basis underlying congenital heart defects (CHD), though the heritable determinants contributing to CHD in the majority of cases remain elusive. In the current investigation, BMP10 was selected as a prime candidate gene for human CHD mainly due to cardiovascular developmental abnormalities in Bmp10-knockout animals. The objective of this retrospective study was to identify a new BMP10 mutation responsible for CHD and characterize the functional effect of the identified CHD-causing BMP10 mutation. METHODS Sequencing assay of BMP10 was fulfilled in a cohort of 276 probands with various CHD and a total of 288 non-CHD volunteers. The available family members from the proband harboring an identified BMP10 mutation were also BMP10-genotyped. The effect of the identified CHD-causative BMP10 mutation on the transactivation of TBX20 and NKX2.5 by BMP10 was quantitatively analyzed in maintained HeLa cells utilizing a dual-luciferase reporter assay system. RESULTS A novel heterozygous BMP10 mutation, NM_014482.3:c.247G>T;p.(Glu83*), was identified in one proband with patent ductus arteriosus (PDA), which was confirmed to co-segregate with the PDA phenotype in the mutation carrier's family. The nonsense mutation was not observed in 288 non-CHD volunteers. Functional analysis unveiled that Glu83*-mutant BMP10 had no transactivation on its two representative target genes TBX20 and NKX2.5, which were both reported to cause CHD. CONCLUSION These findings provide strong evidence indicating that genetically compromised BMP10 predisposes human beings to CHD, which sheds light on the new molecular mechanism that underlies CHD and allows for antenatal genetic counseling and individualized precise management of CHD.
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Affiliation(s)
- Bin-Bin Dong
- Department of Cardiology, Children’s Hospital of Soochow UniversitySuzhou 215003, Jiangsu, China
| | - Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200030, China
| | - Xing-Yuan Liu
- Department of Pediatrics, Tongji Hospital, Tongji University School of MedicineShanghai 200065, China
| | - Ri-Tai Huang
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
| | - Chen-Xi Yang
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
| | - Hai-Tao Lv
- Department of Cardiology, Children’s Hospital of Soochow UniversitySuzhou 215003, Jiangsu, China
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
- Department of Cardiovascular Research Laboratory, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
- Department of Central Laboratory, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
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Lin S, Shi S, Lu J, He Z, Li D, Huang L, Huang X, Zhou Y, Luo Y. Contribution of genetic variants to congenital heart defects in both singleton and twin fetuses: a Chinese cohort study. Mol Cytogenet 2024; 17:2. [PMID: 38178226 PMCID: PMC10768341 DOI: 10.1186/s13039-023-00664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/09/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The contribution of genetic variants to congenital heart defects (CHDs) has been investigated in many postnatal cohorts but described in few prenatal fetus cohorts. Overall, specific genetic variants especially copy number variants (CNVs) leading to CHDs are somewhat diverse among different prenatal cohort studies. In this study, a total of 1118 fetuses with confirmed CHDs were recruited from three units over a 5-year period, composing 961 of singleton pregnancies and 157 of twin pregnancies. We performed chromosomal microarray analysis on all cases to detect numerical chromosomal abnormalities (NCAs) and pathogenic/likely pathogenic CNVs (P/LP CNVs) and employed whole-exome sequencing for some cases without NCAs and P/LP CNVs to detect P/LP sequence variants (P/LP SVs). RESULTS Overall, NCAs and P/LP CNVs were identified in 17.6% (197/1118) of cases, with NCA accounting for 9.1% (102/1118) and P/LP CNV for 8.5% (95/1118). Nonisolated CHDs showed a significantly higher frequency of NCA than isolated CHD (27.3% vs. 4.4%, p < 0.001), but there was no significant difference in the frequency of P/LP CNVs between isolated and nonisolated CHD (11.7% vs. 7.7%). A total of 109 P/LP CNVs were identified in 95 fetuses, consisting of 97 (89.0%) de novo, 6 (5.5%) parental inherited and 6 (5.5%) with unavailable parental information. The 16p11.2 proximal BP4-BP5 deletion was detected in 0.9% (10/1118) of all cases, second only to the most common 22q11.21 proximal A-D deletion (2.1%, 23/1118). Most of the 16p11.2 deletions (8/10) detected were de novo, and were enriched in CHD cases compared with a control cohort from a previous study. Additionally, SV was identified in 12.9% (8/62) of cases without NCA and P/LP CNV, most of which were de novo with autosomal dominant inheritance. CONCLUSIONS Our cohort study provides a deep profile of the contribution of genetic variants to CHDs in both singleton and twin fetuses; NCA and P/LP CNV contribute to 9.1% and 8.5% of CHD in fetuses, respectively. We confirmed the 16p11.2 deletion as a CHD-associated hotspot CNV, second only to the 22q11.21 deletion in frequency. Most 16p11.2 deletions detected were de novo. Additionally, P/LP SV was identified in 12.9% (8/62) of fetuses without NCA or P/LP CNV.
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Affiliation(s)
- Shaobin Lin
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China
| | - Shanshan Shi
- Fetal Medicine Center, The First Affiliated Hospital, Jinan University, No. 613 Huangpu West Road, Guangzhou, 510630, Guangdong, China
| | - Jian Lu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, No.521, Xingnan Road, Panyu District, Guangzhou, 511400, Guangdong, China
| | - Zhiming He
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China
| | - Danlun Li
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China
| | - Linhuan Huang
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China
| | - Xuan Huang
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China
| | - Yi Zhou
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China.
| | - Yanmin Luo
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China.
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Ochoa CO, Navarro JC, Ávila OS, Bellorín AF, Gonzalez SA, Aixelá AM, Aragón CJ, Badia GS. Prognosis factors in heart-lung transplantation: 30 years experience in a reference center. Cir Esp 2024; 102:11-18. [PMID: 37984725 DOI: 10.1016/j.cireng.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/08/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Heart-lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital. METHODS We performed a retrospective study of a historical cohort of heart-lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ2 test or Fisher's exact test. Survival was analyzed using the Kaplan-Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method. RESULTS A decrease in the number of procedures performed in the last decade was observed [2000-2009: 19 procedures (44.2%); 2010-2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010. Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005). Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005). CONCLUSIONS There has been a progressive decrease in the number of heart-lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.
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Affiliation(s)
- Carlos Ordoñez Ochoa
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Jose Cerón Navarro
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain.
| | - Olga Salamea Ávila
- Servicio de Neumología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Alilis Fontana Bellorín
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Stephania Aguilar Gonzalez
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Alfonso Morcillo Aixelá
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Carlos Jorda Aragón
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Gabriel Sales Badia
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
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Chiperi LE, Tecar C, Huţanu A. Serum tau protein and myelin basic protein in pediatric patients with congenital heart defects undergoing cardiac surgery: preliminary assessment as novel neuromarkers of brain injury. Ir J Med Sci 2023:10.1007/s11845-023-03582-5. [PMID: 38104046 DOI: 10.1007/s11845-023-03582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Neurological impairment is a big concern in the development of patients with congenital heart defects (CHD). A number of neuromarkers have been studied in search of a diagnostic or prognostic marker for brain injury during the vulnerable perioperative period. Our aim was to assess two novel neuromarkers, myelin basic protein (MBP) and protein Tau (pTau), as diagnostic markers for brain injury in perioperative period in children with CHD. METHODS Forty patients were enrolled and dichotomized based on peripheric oxygen saturation in cyanotic and non-cyanotic group. Blood samples were collected preoperative, after the induction of anesthesia, and in postoperative day 1. Neuromarker concentrations were measured using commercially available ELISA kits. RESULTS Neuromarkers' values were increased postoperative, with statistical significance reached only in non-cyanotic group (p < 0.0001). A significant positive correlation was observed between preoperatory MBP and albumin level, hemoglobin level, height, and weight of patients. Association with cerebral saturations were analyzed by a coefficient defined as ≥ 20% reduction in cerebral saturation measured by near-infrared spectroscopy during perioperative period. An acceptable predicting model was observed with pTau in cyanotic group (AUC = 0.7). CONCLUSION We evaluated MBP and pTau as potential biomarkers of brain injury in children with CHD undergoing cardiac surgery. Elevated postoperative pTau and MBP concentrations were observed in both groups. Elevated pTau values were associated with perioperative hypoxemia.
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Affiliation(s)
- Lacramioara Eliza Chiperi
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Heart Transplant, 50 Gheorghe Marinescu Street, 540136, Târgu Mureș, Romania.
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania.
| | - Cristina Tecar
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adina Huţanu
- Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
- Laboratory of Humoral Immunology, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
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Vogt A, Meyer S, Schäfers HJ, Weise JJ, Wagenpfeil S, Abdul-Khaliq H, Poryo M. Standardized Treatment and Diagnostic Approach to Reduce Disease burden in the early postoperative phase in children with congenital heart defects-STANDARD study: a pilot randomized controlled trial. Eur J Pediatr 2023; 182:5325-5340. [PMID: 37733115 PMCID: PMC10746759 DOI: 10.1007/s00431-023-05191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
To explore the effect of a daily goal checklist on pediatric cardiac intensive care unit (PCICU) length of stay (LOS) after congenital heart surgery. This study is a prospective randomized single-center study. Group characteristics were as follows: STANDARD group: n = 30, 36.7% female, median age 0.9 years; control group: n = 33, 36.4% female, median age 1.1 years. Invasive ventilation time, STAT categories, mean vasoactive-inotropic score (VIS)24h, maximal (max.) VIS24h, mean VIS24-48h, max. VIS24-48h, VIS category, number of sedatives, analgesics, diuretics, number of deployed diagnostic modalities, morbidities, and mortality did not differ between both groups. Median PCICU LOS was 96.0 h (STANDARD group) versus 101.5 h (control group) (p = 0.63). In the overall cohort, univariate regression analysis identified age at surgery (b = -0.02), STAT category (b = 18.3), severity of CHD (b = 40.6), mean VIS24h (b = 3.5), max. VIS24h (b = 2.2), mean VIS24-48h (b = 6.5), and VIS category (b = 13.8) as significant parameters for prolonged PCICU LOS. In multivariate regression analysis, age at surgery (b = -0.2), severity of CHD (b = 44.0), and mean VIS24h (b = 6.7) were of significance. Within the STANDARD sub-group, univariate regression analysis determined STAT category (b = 32.3), severity of CHD (b = 70.0), mean VIS24h (b = 5.0), mean VIS24-48h (b = 5.9), number of defined goals (b = 2.6), number of achieved goals (b = 3.3), number of not achieved goals (b = 10.8), and number of unevaluated goals (b = 7.0) as significant parameters for prolonged PCICU LOS. Multivariate regression analysis identified the number of defined goals (b = 2.5) and the number of unevaluated goals (b = -3.0) to be significant parameters. Conclusion: The structured realization and recording of daily goals is of advantage in patients following pediatric cardiac surgery by reducing PCICU LOS. What is known: • Communication errors are the most frequent reasons for adverse events in intensive care unit patients. • Improved communication can be achieved by discussion and documentation of the patients' goals during daily rounds. What is new: • In the overall cohort age at surgery, severity of congenital heart defect and mean vasoactive inotropic score within the first 24 hours had significant impact on pediatric cardiac intensive care unit (PCICU) length of stay (LOS). • In the intervention group, the number of defined goals and the number of unevaluated goals were significant parameters for prolonged PCICU LOS.
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Affiliation(s)
- Antonia Vogt
- Medical School, University of Saarland, Homburg/Saar, Germany
| | - Sascha Meyer
- Franz-Lust Klinik für Kinder- und Jugendmedizin, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Julius Johannes Weise
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, Building 9, D-66421, Homburg/Saar, Germany
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, Building 9, D-66421, Homburg/Saar, Germany.
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17
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Amedro P, Mura T, Matecki S, Guillaumont S, Requirand A, Jeandel C, Kollen L, Gavotto A. Use of new paediatric VO2max reference equations to evaluate aerobic fitness in overweight or obese children with congenital heart disease. Eur J Prev Cardiol 2023; 30:1865-1873. [PMID: 37314435 DOI: 10.1093/eurjpc/zwad201] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
AIMS Overweight and obesity in children with congenital heart disease (CHD) represent an alarming cardiovascular risk. Promotion of physical activity and cardiac rehabilitation in this population requires assessing the level of aerobic fitness (VO2max) by a cardiopulmonary exercise test (CPET). Nevertheless, the interpretation of CPET in overweight/obese children with CHD remains challenging as VO2max is affected by both the cardiac condition and the body mass index (BMI). The new paediatric VO2max Z-score reference equations, based on a logarithmic function of VO2max, height and BMI, were applied to overweight/obese children with a CHD and compared with overweight/obese children without any other chronic condition. METHODS AND RESULTS In this cross-sectional controlled study, 344 children with a BMI > 85th percentile underwent a CPET (54% boys; mean age 11.5 ± 3.1 years; 100 CHD; 244 controls). Using the VO2max Z-score equations, aerobic fitness was significantly lower in obese/overweight CHD children than that in matched obese/overweight control children (-0.43 ± 1.27 vs. -0.01 ± 1.09; P = 0.02, respectively), and the proportion of children with impaired aerobic fitness was significantly more important in obese/overweight CHD children than in matched controls (17% vs.6%, P = 0.02, respectively). The paediatric VO2max Z-score reference equations also identified specific complex CHD at risk of aerobic fitness impairment (univentricular heart and right outflow tract anomalies). Using Cooper's weight- and height-based linear equations, similar matched-comparisons analyses found no significant group differences. CONCLUSIONS As opposed to the existing linear models, the new paediatric VO2max Z-score equations can discriminate the aerobic fitness of obese/overweight children with CHD from that of obese/overweight children without any chronic disease. REGISTRATION ClinicalTrials.gov NCT04815577.
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Affiliation(s)
- Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France
| | - Thibault Mura
- INSERM, U1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, 39 Av. Charles Flahault, 34090, Montpellier, France
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Place du Professeur Debré, 30029, Nimes, France
| | - Stefan Matecki
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Claire Jeandel
- Paediatric Endocrine Unit, Department of Paediatrics, Hôpital A. de Villeneuve, CHU Montpellier, Montpellier Cedex 34295, France
| | - Laura Kollen
- Department of Paediatric gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Arthur Gavotto
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Giraud, Montpellier 34295, France
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18
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Abbaszadeh R, Askari-Moghadam R, Moradian M, Mortazaeian H, Qomi MRS, Omidi N, Khalili Y, Tahouri T. The Nakata index and McGoon ratio: correlation with the severity of pulmonary regurgitation after the repair of paediatric tetralogy of Fallot. Egypt Heart J 2023; 75:95. [PMID: 38017289 PMCID: PMC10684472 DOI: 10.1186/s43044-023-00423-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/01/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Pulmonary regurgitation is the most common complication after the complete repair of tetralogy of Fallot, and severe pulmonary regurgitation after surgery requires pulmonary valve replacement. In this retrospective observational, cross-sectional study, we included a total of 56 children aged 6 years or younger who underwent complete repair of TOF at Shahid Rajaei Cardiovascular Medical and Research Center in Tehran, Iran. Preoperative dual-source computed tomography was used to measure the McGoon ratio and Nakata index. The patients were divided into two groups based on the severity of postoperative pulmonary regurgitation, as estimated by trans-thoracic echocardiography: the severe pulmonary regurgitation group and the non-severe pulmonary regurgitation group. The McGoon ratio and Nakata index were then compared between the two groups. RESULTS When comparing the two groups, we found that the corrected right pulmonary artery diameter, main pulmonary artery diameter, and McGoon ratio in the non-severe pulmonary regurgitation group were higher than in the severe pulmonary regurgitation group. However, none of these differences were statistically significant. Additionally, other variables, including the corrected left pulmonary artery diameter and Nakata index, showed higher measurements in children with severe pulmonary regurgitation, but again, the differences were not statistically significant. CONCLUSIONS This study indicates that pulmonary arteries diameter, Nakata index, and McGoon ratio were not significantly correlated with the severity of pulmonary regurgitation after the complete repair of tetralogy of Fallot.
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Affiliation(s)
- Reza Abbaszadeh
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Raheleh Askari-Moghadam
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Moradian
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hojat Mortazaeian
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Negar Omidi
- Cardiac primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Khalili
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Tahmineh Tahouri
- Shahid Modarres Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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19
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Pihl C, Pærregaard MM, Sillesen AS, Vøgg ROB, Pietersen A, Raja AA, Iversen KK, Bundgaard H, Christensen AH. Electrocardiographic characteristics of newborns with ventricular septal defects: a Copenhagen Baby Heart Study. Eur J Pediatr 2023; 182:5149-5158. [PMID: 37695415 PMCID: PMC10640423 DOI: 10.1007/s00431-023-05187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
Ventricular septal defects (VSD) represent the most common congenital heart defect in newborns. We assessed the electrocardiographic characteristics of newborns with VSDs in a general population sample. The Copenhagen Baby Heart Study is a prospective population-based cohort study offering cardiac evaluation of newborns. Echocardiograms and electrocardiograms were obtained within 30 days after birth and systematically analysed. A VSD was identified in 530 newborns (mean age 11 ± 7 days, 42% boys). Newborns with VSDs had a more left-shifted QRS axis (116 ± 34 vs. 120 ± 3°, p = 0.02), and a higher S-wave amplitude in V1 (721 ± 584 vs. 636 ± 549 µV, p = 0.001) than controls. The largest differences were found in newborns with large or perimembraneous VSDs with a higher frequency of left axis deviation, higher S-wave amplitudes in V1, and higher R- and S-wave amplitudes in V6 compared with controls. R-waves in V1 and V6 were significantly associated to left ventricular mass, whereas S-waves in V1 and V6 were dependent on left ventricular end-diastolic diameter on echocardiography. Conclusion: Newborns with VSDs showed significant differences in QRS axis, and R- and S-wave precordial amplitudes compared to matched controls. Perimembranous and large VSDs had the greatest effect on the neonatal ECG. What is Known: • Ventricular septal defects in newborns are prevalent and may affect cardiac function and structure. What is New: • The Copenhagen Baby Heart Study is the largest study including a cohort of unselected newborns undergoing postnatal cardiac examination. • We found that newborns with VSD showed significant electrocardiographic differences depending on size and type of VSD compared with healthy newborns.
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Affiliation(s)
- Christian Pihl
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Copenhagen, Denmark.
| | - Maria Munk Pærregaard
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Copenhagen, Denmark
| | - Ruth Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Copenhagen, Denmark
| | - Adrian Pietersen
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Boutaleb AM, Tabat M, Mekouar Y, Bennani G, Drighil A, Habbal R. Rare case series of adult interrupted aortic arch. J Cardiol Cases 2023; 28:206-209. [PMID: 38024110 PMCID: PMC10658337 DOI: 10.1016/j.jccase.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/21/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 12/01/2023] Open
Abstract
Interrupted aortic arch (IAA) is a rare congenital heart condition where there is a complete discontinuation between the ascending and descending aorta. The association with a patent ductus arteriosus or developed arterial collateral allows survival until adulthood in extremely rare cases. We report a case series of adult forms of IAA. Even if the incidence is very rare, IAA should be could excluded in the setting of resistant asymmetrical hypertension. The first case is singular regarding its association with a bicuspid aortic valve and aortic aneurysm, while the second case is characterized by massive left ventricular hypertrophy. The diagnosis was suspected on echocardiographic findings and confirmed by computed tomography angiography. Both patients refused surgical repair given the high operative risk. Learning objectives -The evaluation of severe resistant high blood pressure should include complementary investigation for adult form interrupted aortic arch.-To understand the major impact of multimodality imaging for the recognition, localization, and stratification of interrupted aortic arch.
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Affiliation(s)
| | - Meryem Tabat
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Younes Mekouar
- Radiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Ghita Bennani
- Radiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Abdenasser Drighil
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Rachida Habbal
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
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21
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Mouat JS, Li S, Myint SS, Laufer BI, Lupo PJ, Schraw JM, Woodhouse JP, de Smith AJ, LaSalle JM. Epigenomic signature of major congenital heart defects in newborns with Down syndrome. Hum Genomics 2023; 17:92. [PMID: 37803336 PMCID: PMC10559462 DOI: 10.1186/s40246-023-00540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Congenital heart defects (CHDs) affect approximately half of individuals with Down syndrome (DS), but the molecular reasons for incomplete penetrance are unknown. Previous studies have largely focused on identifying genetic risk factors associated with CHDs in individuals with DS, but comprehensive studies of the contribution of epigenetic marks are lacking. We aimed to identify and characterize DNA methylation differences from newborn dried blood spots (NDBS) of DS individuals with major CHDs compared to DS individuals without CHDs. METHODS We used the Illumina EPIC array and whole-genome bisulfite sequencing (WGBS) to quantitate DNA methylation for 86 NDBS samples from the California Biobank Program: (1) 45 DS-CHD (27 female, 18 male) and (2) 41 DS non-CHD (27 female, 14 male). We analyzed global CpG methylation and identified differentially methylated regions (DMRs) in DS-CHD versus DS non-CHD comparisons (both sex-combined and sex-stratified) corrected for sex, age of blood collection, and cell-type proportions. CHD DMRs were analyzed for enrichment in CpG and genic contexts, chromatin states, and histone modifications by genomic coordinates and for gene ontology enrichment by gene mapping. DMRs were also tested in a replication dataset and compared to methylation levels in DS versus typical development (TD) WGBS NDBS samples. RESULTS We found global CpG hypomethylation in DS-CHD males compared to DS non-CHD males, which was attributable to elevated levels of nucleated red blood cells and not seen in females. At a regional level, we identified 58, 341, and 3938 CHD-associated DMRs in the Sex Combined, Females Only, and Males Only groups, respectively, and used machine learning algorithms to select 19 Males Only loci that could distinguish CHD from non-CHD. DMRs in all comparisons were enriched for gene exons, CpG islands, and bivalent chromatin and mapped to genes enriched for terms related to cardiac and immune functions. Lastly, a greater percentage of CHD-associated DMRs than background regions were differentially methylated in DS versus TD samples. CONCLUSIONS A sex-specific signature of DNA methylation was detected in NDBS of DS-CHD compared to DS non-CHD individuals. This supports the hypothesis that epigenetics can reflect the variability of phenotypes in DS, particularly CHDs.
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Affiliation(s)
- Julia S Mouat
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA
- Perinatal Origins of Disparities Center, University of California, Davis, CA, USA
- Genome Center, University of California, Davis, CA, USA
- MIND Institute, University of California, Davis, CA, USA
| | - Shaobo Li
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Swe Swe Myint
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Benjamin I Laufer
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA
- Perinatal Origins of Disparities Center, University of California, Davis, CA, USA
- Genome Center, University of California, Davis, CA, USA
- MIND Institute, University of California, Davis, CA, USA
| | - Philip J Lupo
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jeremy M Schraw
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - John P Woodhouse
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Janine M LaSalle
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA.
- Perinatal Origins of Disparities Center, University of California, Davis, CA, USA.
- Genome Center, University of California, Davis, CA, USA.
- MIND Institute, University of California, Davis, CA, USA.
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22
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Khattab MN, Alhalabi MM, Alkounsol K, Othman M, Hujair N. Lutembacher's Syndrome Accompanied by Partial Anomalies of Pulmonary Veins in a 70-Year-Old Male: A Case of Congenital Heart Disease in the Elderly. Eur J Case Rep Intern Med 2023; 10:004089. [PMID: 37920223 PMCID: PMC10619523 DOI: 10.12890/2023_004089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 11/04/2023] Open
Abstract
Lutembacher's syndrome is a rare disease defined as the combination of atrial septal defect and mitral stenosis, which relieves the progression of symptoms resulting from mitral stenosis. We present a case of a previously asymptomatic 70-year-old man having Lutembacher's syndrome with sinus venosus type of interatrial defect associated with partial anomalous pulmonary venous drainage. Our patient's only complaint was of mild exertional dyspnea, which started six months prior to referral. Clinical suspicion of the combination of defects arose during transthoracic echocardiography. The patient underwent transesophageal echocardiography and multi-slice computed tomography for defect confirmation. The combination of Lutembacher's syndrome with this complex deformity of pulmonary venous drainage has rarely been described. Such complex congenital defects with multifaceted physiological repercussions can go largely undiagnosed for the patients affected for most of their lifetimes. LEARNING POINTS Despite the complexity of Lutembacher's syndrome, including the involvement of several deformities and pathological mechanisms of mitral stenosis, sinus venosus type of interatrial defects with partial anomalous return in the pulmonary veins, the multiplicity of mechanisms involved contribute to altered hemodynamics.Multiple intersecting mechanisms can further contribute to delaying congenital heart disease presentation. Congenital heart disease remains a plausible differential in the evaluation of elderly patients presenting with exertional dyspnea.Adult congenital heart defects can have very late onset for presentation, especially with physiological processes that paradoxically reduce the severity and progression of symptoms.
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Affiliation(s)
| | | | - Karam Alkounsol
- Department of Cardiology, Al Bassel Heart institute, Damascus, Syria
| | - Majed Othman
- Department of Cardiac Surgery, Al Bassel Heart institute, Damascus, Syria
| | - Nizar Hujair
- Department of Cardiology, Al Bassel Heart institute, Damascus, Syria
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23
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Ashiq S, Sabar MF, Hyder SN. Genetic Risk Score Constructed from Polymorphisms in the VEGFA, TBX5, and SMAD7 Genes Provides Novel Insights into the Molecular Mechanisms of the Tetralogy of Fallot and Ventricular Septal Defect (Case-Control Study from the Pakistani Population). Am J Cardiol 2023; 203:368-375. [PMID: 37523935 DOI: 10.1016/j.amjcard.2023.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 08/02/2023]
Abstract
Congenital heart defects are common and complex birth-defect malformations in developed and developing countries. It is a multifactorial disease that involves the interaction of either gene-gene or gene-environment. This comparative study was the first report on the genotypic-phenotypic correlation in the Pakistani population. The single nucleotide polymorphisms (SNPs) were further tested for association with maternal diabetes mellitus or hypertension. In addition, the cumulative genetic risk score (GRS) for low to moderately-associated SNPs was calculated for each study subject, which can ultimately guide us for better therapeutic options and prevention strategies. According to the predefined selection criteria, 376 subjects were recruited. The multiplex mini-sequencing genotyping technique opted for the cost-effective genotyping of selected loci. The association of variants with the disease was examined using logistic regression analysis. The statistical and graphical analysis was conducted using SPSS, Haploview, SNPStats, and GraphPad Prism. The results for all SNPs analysis suggested a nonsignificant association with overall congenital heart defect risk except rs3809923. However, interestingly on stratified analysis variants, rs3809923 and rs3809922 showed an association only with tetralogy of Fallot. The remaining risk factor analysis for maternal hypertension and diabetes mellitus association with SNPs were nonsignificant. The GRS was the first time constructed for this low to moderately-associated variants. Interestingly, the cumulative GRS was significantly different from the control group revealing the cumulative effect of these polymorphisms panel in patients. In conclusion, the use of GRS in the clinical setting can predict better risk association and patient outcomes.
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Affiliation(s)
- Sana Ashiq
- Centre for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan
| | | | - Syed Najam Hyder
- Department of Pediatric Cardiology, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
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Wilson VC, Jacob A, van der Walt LM, Sasse A. A multimodality approach to a rare case of ruptured sinus of Valsalva aneurysm with tricuspid valve involvement: a case report. Eur Heart J Case Rep 2023; 7:ytad454. [PMID: 37743896 PMCID: PMC10516659 DOI: 10.1093/ehjcr/ytad454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Abstract
Background Ruptured sinus of Valsalva aneurysm is a rare disease entity that is potentially life-threatening if left untreated. While imaging is the mainstay of diagnosis, resultant tricuspid valve involvement may mask typical findings providing a diagnostic challenge. Disruption of the tricuspid valve during ruptured sinus of Valsalva aneurysm with consequent tricuspid regurgitation is rare and infrequently described in the literature. Description of the utility and limitations of multimodality imaging in this scenario is equally scarce. Case summary We review the case of a young patient presenting with acute ruptured sinus of Valsalva aneurysm and involvement of the tricuspid valve on a background of severe aortic regurgitation requiring multimodality imaging for diagnostic and pre-surgical assessment. Discussion In young patients presenting with acute decompensation and pre-existing bicuspid aortic valve regurgitation, an increased clinical suspicion of a sinus of Valsalva aneurysm rupture is imperative. Doppler and 3D transoesophageal echocardiographic assessment should be pursued to characterize abnormal flows and clarify aetiology in the context of tricuspid involvement and resultant tricuspid regurgitation. A large-volume left-right shunt in proximity to the tricuspid annulus may result in disproportionately severe tricuspid regurgitation in the absence of annular disruption due to forced systolic opening of the leaflets by shunt flow and 'windsock' prolapse. Multimodality imaging can be essential in these cases to adequately assess the extent of the ruptured sinus of Valsalva aneurysm and overcome limitations of single modality imaging.
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Affiliation(s)
- Vindhya C Wilson
- Hutt Valley Hospital, 638 High street, Boulcott, Lower Hutt 5010, New Zealand
- Wellington Regional Hospital, 49 Riddiford street, Newtown, Wellington 6021, New Zealand
| | - Anita Jacob
- Wellington Regional Hospital, 49 Riddiford street, Newtown, Wellington 6021, New Zealand
| | - Liezl M van der Walt
- Wellington Regional Hospital, 49 Riddiford street, Newtown, Wellington 6021, New Zealand
| | - Alexander Sasse
- Wellington Regional Hospital, 49 Riddiford street, Newtown, Wellington 6021, New Zealand
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Álvaro-Sánchez E. Nursing care in the postoperative period after Glenn surgery. A case report. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00047-2. [PMID: 37648600 DOI: 10.1016/j.enfie.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/09/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 09/01/2023]
Abstract
Glenn surgery is used as a palliative procedure in children with Hypoplastic Left Heart Syndrome (HLHS) and its objective is to partially redirect the systemic venous return. An individualized care plan is presented for a 7-month-old infant, admitted to the Pediatric Intensive Care Unit (PICU), after undergoing Glenn procedure. And is shown her evolution during admission. Marjorie Gordon's 11 functional health patterns are used for the nursing assessment, highlighting among the altered patterns, the nutritional-metabolic and the activity-exercise, due to their implication in hemodynamic changes derived from the surgery. Due to their association with the most common postoperative complications in this type of surgery, 8 diagnoses were prioritised according to NANDA-I taxonomy: risk for infection, excess fluid volume, risk for shock, risk for bleeding, risk for decreased cardiac output, impaired gas exchange, ineffective airway clearance and risk for ineffective cerebral tissue perfusion. In each of them, expected patient outcomes and nursing interventions, were selected using the NOC and NIC taxonomies, respectively. Outcome criteria scores showed a favourable evolution after 7 days from admission, only 3 of the diagnoses selected at the beginning remain active. The development and reassessment of the nursing care plan has made it possible to make an effective monitoring of patient's postoperative evolution and to standardize nursing care, ensuring safe and quality health care. The lack of similar case reports in available bibliography has prevented us from comparing actions, therefore it has been necessary to disclose these scientific articles to guarantee best evidence-based practice.
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Affiliation(s)
- Ester Álvaro-Sánchez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Reina Sofía, Córdoba, Spain.
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Vasquez Choy AL, Zonana Amkie R, Adebo DA. Role of Cardiac CTA to Evaluate Branch Pulmonary Artery Stenosis and Ductal Insertion Pattern in Right-Sided Congenital Heart Defects. Pediatr Cardiol 2023:10.1007/s00246-023-03234-6. [PMID: 37477698 DOI: 10.1007/s00246-023-03234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
There is limited experience in evaluating abnormal ductus arteriosus (DA) insertion pattern by contrast-enhanced cardiac computed tomography (cardiac CT) in patients with right-sided obstructive cardiac defects. Retrospective review of 38 infants with right-sided obstructive cardiac defects who underwent a preoperative cardiac CT between 2016 and 2021. We reviewed the types of cardiac lesions, patterns of ductal insertion, frequency of pulmonary artery (PA) stenosis requiring intervention, total dose length product (DLP), and effective radiation dose. Of 38 infants, 45% were female, the median gestational age and weight were 37 (range 34-40) weeks and 2.95 (range 2-4) kg. The most common pathologies were pulmonary atresia with ventricular septal defect (24%) and tetralogy of Fallot (24%). The abnormal ductal insertion patterns were DA inserting into the left PA in 39%, DA bifurcating into branch PA in 32%, and DA inserting into the right PA in 13%. Of the 38 infants, 76% developed branch PA stenosis requiring intervention. Among patients with abnormal DA insertion, 44% required branch PA arterioplasty during their index surgery compared to 17% without abnormal DA insertion. Regardless of the type of abnormal DA insertion, 67% developed bilateral branch PA stenosis over time. The mean DLP was 8 mGy-cm and the mean calculated effective radiation dose was 0.312 mSv. The utilization of contrast-enhanced cardiac CT in infants with right-sided obstructive heart defects can offer crucial insights into abnormal ductus arteriosus insertion patterns. This information is valuable for effective procedure planning and for monitoring the development of branch pulmonary artery stenosis.
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Affiliation(s)
- Ana L Vasquez Choy
- Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, 6410 Fannin Street, UTPB Suite 425, Houston, TX, 77030, USA.
| | - Rafael Zonana Amkie
- Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, 6410 Fannin Street, UTPB Suite 425, Houston, TX, 77030, USA
| | - Dilachew A Adebo
- Section of Pediatric Cardiac MRI And Pediatric Cardiac CT, Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Karikoski E, Sarkola T, Blomqvist M. Early Counseling to Improve Oral Health Behavior in Children with Major Congenital Heart Defects: A Randomized Controlled Trial. Caries Res 2023; 57:563-574. [PMID: 37442113 DOI: 10.1159/000531817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Maintaining optimal oral health behavior in children with a congenital heart defect (CHD) is important in managing the risk for caries development and infective endocarditis. The aim of this study was to evaluate the impact of an early and repeat oral health promotion intervention (OHPI) among children with major CHD. Randomized controlled trial including 72 out of 91 children born in Finland April 1, 2017-October 31, 2020 with (a) major CHD potentially included in the criteria of endocarditis prophylaxis or (b) any CHD with surgical repair combined with a chromosomal syndrome. A parallel passive control (C) group of 87 healthy children were recruited at birth. CHD children were randomized 1:1 to intervention (CHD-I) and control (CHD-C) groups. The OHPI included counseling by motivational interviewing, home delivered toothpaste and toothbrushes, and written information, and was provided at baseline, 6, 12, and 18 months of age to CHD-I group. The primary outcome measure at 24 months was child's oral health behavior (toothbrushing, sugar intake, and dental care contact). The secondary outcome measures were parents' awareness of the importance of oral health behavior, and oral health behavior as a predictor for child behavior. At 24 months, toothbrushing was performed twice a day in 20/27 (74%) among CHD-I, in 13/30 (43%) among CHD-C (CHD-I vs. CHD-C p = 0.03), and in 37/50 (74%) among healthy comparisons (CHD-C vs. C p = 0.01). Electric toothbrush use was 12/27 (44%) in CHD-I, 5/30 (17%) in CHD-C (CHD-I vs. CHD-C p = 0.04), and 7/50 (14%) in healthy comparison (CHD-C vs. C p = 0.76) children. Among CHD-I, toothbrushing and use of electric toothbrush improved between 12 months and 24 months. Sugar drink intake was more common among CHD-C (CHD-C vs. C p = 0.02), but comparable to CHD-I children. Parental toothbrushing predicted child toothbrushing twice a day. There were no statistical group differences in dental care contact. Children with CHD are at risk for poor oral health behavior. This could be improved with early and repeat oral health promotion parental counseling.
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Affiliation(s)
- Essi Karikoski
- Department of Children and Adolescents, Children's Hospital, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Taisto Sarkola
- Department of Children and Adolescents, Children's Hospital, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - My Blomqvist
- Department of Children and Adolescents, Children's Hospital, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Tuiskula A, Rahikkala E, Kero A, Haanpää MK, Avela K. Jansen de Vries syndrome: Report of four new patients and review of the literature. Eur J Med Genet 2023:104807. [PMID: 37385405 DOI: 10.1016/j.ejmg.2023.104807] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/07/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
Jansen de Vries syndrome (JDVS, OMIM: 617450) is a rare neurodevelopmental disorder associated with hypotonia, behavioral features, high threshold to pain, short stature, ophthalmological abnormalities, dysmorphism and occasionally a structural cardiac condition. It is caused by truncating variants of the last and penultimate exons of PPM1D. So far, 21 patients with JVDS have been reported in the literature. Here, we describe four novel cases of JVDS and review the current literature. Notably, our patients 1, 3 and 4 do not have intellectual disability albeit they have significant developmental difficulties. Thus, the phenotype may span from a classic intellectual disability syndrome to a milder neurodevelopmental disorder. Interestingly, two of our patients have received successful growth hormone treatment. Considering the phenotype of all the known JDVS patients, a cardiological consultation is recommended, as at least 7/25 patients showed a structural cardiac defect. Episodic fever and vomiting may associate with hypoglycemia and may even mimic a metabolic disorder. We also report the first JDVS patient with a mosaic gene defect and a mild neurodevelopmental phenotype.
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Affiliation(s)
- Anna Tuiskula
- Department of Pediatrics, Children's Hospital, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland.
| | - Elisa Rahikkala
- PEDEGO Research Unit, University of Oulu, Oulu, Finland; Department of Clinical Genetics and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Andreina Kero
- Department of Clinical Genetics, Turku University Hospital, Turku, Finland
| | - Maria K Haanpää
- Department of Clinical Genetics, Turku University Hospital, Turku, Finland; Genomics Department, Turku University Hospital, Turku, Finland
| | - Kristiina Avela
- Department of Clinical Genetics, Helsinki University Hospital (HUH), Helsinki, Finland
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Mariager AF, Hammeken A, Malham M, Raja AA, Sellmer A, Skjellerup SL, Raja RA, Navne J, Sillesen AS, Vejlstrup N, Bundgaard H, Iversen KK, Garne E, Jeppesen DL. Age-Related Prevalence of Open Ductus Arteriosus in Full-Term Newborns. Neonatology 2023; 120:527-531. [PMID: 37285834 DOI: 10.1159/000529842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The ductus arteriosus is part of the fetal circulation. Normally, the vessel closes during the cardiac transition. Delayed closure is associated with complications. The aim of this study was to evaluate the age-related prevalence of open ductus arteriosus in full-term neonates. METHODS Echocardiograms were collected in the population study, the Copenhagen Baby Heart Study. The present study included full-term neonates with an echocardiogram performed within 28 days after birth. All echocardiograms were reviewed to assess ductus arteriosus patency. RESULTS A total of 21,649 neonates were included. In neonates examined at day zero and day seven, an open ductus arteriosus was found in 36% and 0.6%, respectively. Beyond day seven, the prevalence remained stable at 0.6%. CONCLUSION More than one-third of full-term neonates had an open ductus arteriosus on the first day of life, declining rapidly within the first week and stabilizing below 1% after day seven.
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Affiliation(s)
- Anton Friis Mariager
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alberte Hammeken
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Malham
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Centre Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Sellmer
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine Aarhus University Hospital, Aarhus, Denmark
| | - Signe Levring Skjellerup
- Department of Internal Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Raheel Altaf Raja
- Department of Pediatrics and Adolescents, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Johan Navne
- Department of Intensive Care Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Capital Region's Unit of Inherited Cardiac Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ester Garne
- Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Dorthe Lisbeth Jeppesen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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30
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Everaert E, Vorstman JAS, Selten IS, Slieker MG, Wijnen F, Boerma TD, Houben ML. Executive functioning in preschoolers with 22q11.2 deletion syndrome and the impact of congenital heart defects. J Neurodev Disord 2023; 15:15. [PMID: 37173621 PMCID: PMC10181926 DOI: 10.1186/s11689-023-09484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Executive functioning (EF) is an umbrella term for various cognitive functions that play a role in monitoring and planning to effectuate goal-directed behavior. The 22q11.2 deletion syndrome (22q11DS), the most common microdeletion syndrome, is associated with a multitude of both somatic and cognitive symptoms, including EF impairments in school-age and adolescence. However, results vary across different EF domains and studies with preschool children are scarce. As EF is critically associated with later psychopathology and adaptive functioning, our first aim was to study EF in preschool children with 22q11DS. Our second aim was to explore the effect of a congenital heart defects (CHD) on EF abilities, as CHD are common in 22q11DS and have been implicated in EF impairment in individuals with CHD without a syndromic origin. METHODS All children with 22q11DS (n = 44) and typically developing (TD) children (n = 81) were 3.0 to 6.5 years old and participated in a larger prospective study. We administered tasks measuring visual selective attention, visual working memory, and a task gauging broad EF abilities. The presence of CHD was determined by a pediatric cardiologist based on medical records. RESULTS Analyses showed that children with 22q11DS were outperformed by TD peers on the selective attention task and the working memory task. As many children were unable to complete the broad EF task, we did not run statistical analyses, but provide a qualitative description of the results. There were no differences in EF abilities between children with 22q11DS with and without CHDs. CONCLUSION To our knowledge, this is the first study measuring EF in a relatively large sample of young children with 22q11DS. Our results show that EF impairments are already present in early childhood in children with 22q11DS. In line with previous studies with older children with 22q11DS, CHDs do not appear to have an effect on EF performance. These findings might have important implications for early intervention and support the improvement of prognostic accuracy.
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Affiliation(s)
- Emma Everaert
- Institute for Language Sciences, Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands.
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - Jacob A S Vorstman
- Program in Genetics and Genome Biology, Research Institute, and Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Iris S Selten
- Institute for Language Sciences, Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Frank Wijnen
- Institute for Language Sciences, Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands
| | - Tessel D Boerma
- Institute for Language Sciences, Utrecht University, Trans 10, 3512 JK, Utrecht, The Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Michiel L Houben
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
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Al-Dairy A. Long-term outcomes of surgical repair of isolated coarctation of the aorta in different age groups. BMC Surg 2023; 23:120. [PMID: 37170310 PMCID: PMC10176930 DOI: 10.1186/s12893-023-02031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/25/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) is one of the most common congenital heart defects (5-8% of all CHD). Treatment of native CoA may be accomplished surgically, or through an interventional approach. Surgical repair of CoA remains an important option for treatment of aortic coarctation during childhood, although it is mostly performed in neonates and young infants. OBJECTIVES In this retrospective study, we sought to share the long-term outcomes of different surgical techniques for repair of coarctation of the aorta in different age groups. MATERIALS AND METHODS This is a retrospective single-center clinical study that included 228 consecutive patients (age: 1 day- 41years) in whom surgical repair of isolated native coarctation of the aorta was performed with different surgical techniques. RESULTS Immediate results were excellent; however, the mortality rate were higher in the infants. Complications rate and incidence of recoarctation, both were comparable between different age groups and different surgical techniques. CONCLUSIONS Surgical repair of CoA remains an important option for treatment of aortic coarctation in different age groups with low morbidity and mortality. We did not find any significant difference between different surgical techniques regarding the development of recoarctation.
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Affiliation(s)
- Alwaleed Al-Dairy
- Faculty of Medicine, Damascus University, Children University Hospital, Damascus, Syria.
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Ashiq S, Sabar MF. Association of maternal hypertension and diabetes with variants of the NKX2-5, LEFTY1 and LEFTY2 genes in children with congenital heart defects: a case-control study from Pakistani Population. Mol Biol Rep 2023; 50:5013-5020. [PMID: 37097539 DOI: 10.1007/s11033-023-08418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/05/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Globally, congenital heart defect (CHD) is the most common congenital malformation, responsible for higher morbidity and mortality in the pediatric population. It is a complex multifactorial disease influenced by gene-environment and gene-gene interactions. The current study was the first attempt to study these polymorphisms in common clinical phenotypes of CHD in Pakistan and the association between maternal hypertension and diabetes with single nucleotide polymorphisms (SNPs) in children. METHODS A total of 376 subjects were recruited in this current case-control study. Six variants from three genes were analyzed by cost-effective multiplex PCR and genotyped by minisequencing. Statistical analysis was done by GraphPad prism and Haploview. The association of SNPs and CHD was determined using logistic regression. RESULTS The risk allele frequency was higher in cases as compared to healthy subjects, but the results were not significant for rs703752. However, stratification analysis suggested that rs703752 was significantly associated with the tetralogy of Fallot. The rs2295418 was significantly associated with maternal hypertension (OR = 16.41, p = 0.003), while a weak association was present between maternal diabetes and rs360057 (p = 0.08). CONCLUSION In conclusion, variants in transcriptional and signaling genes were associated with Pakistani pediatric CHD patients that showed varied susceptibility between different clinical phenotypes of CHD. In addition, this study was the first report regarding the significant association between maternal hypertension and the LEFTY2 gene variant.
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Affiliation(s)
- Sana Ashiq
- Centre for Applied Molecular Biology, University of the Punjab, 87-West Canal Bank Road, Thokar Niaz Baig, Lahore, 53700, Pakistan
| | - Muhammad Farooq Sabar
- Centre for Applied Molecular Biology, University of the Punjab, 87-West Canal Bank Road, Thokar Niaz Baig, Lahore, 53700, Pakistan.
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Luo S, Deng MX, Honjo O. Modified central shunt in pulmonary atresia with diminutive pulmonary arteries. Asian Cardiovasc Thorac Ann 2023:2184923231168468. [PMID: 37020336 DOI: 10.1177/02184923231168468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
The commonly used central shunt (i.e. direct connection of the divided main pulmonary artery to the ascending aorta) to facilitate the growth of the diminutive branch pulmonary artery in patients with pulmonary atresia with major aortopulmonary collateral arteries can cause main pulmonary artery distortion, and subsequent disproportional branch pulmonary artery flow and growth. This report describes a novel technique of shunt construction to minimize pulmonary artery torque and tension by using a modified central shunt constructed from autologous pericardium that is anastomosed in an end-to-side fashion to the lateral aspect of the ascending aorta. This shunt will serve as an intermediary conduit to facilitate the main pulmonary artery anastomosis while minimizing torque and tension on the main pulmonary artery. The tension-free connection between the main pulmonary artery and the aorta enabled by the modified central shunt supports proportional pulmonary artery flow and growth in patients with pulmonary atresia, ventricular septal defect, or multiple aortopulmonary collateral arteries and concomitant diminutive native pulmonary arteries.
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Affiliation(s)
- Shuhua Luo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
- Department of Cardiovascular Surgery, 34753West China Hospital of Sichuan University, Chengdu, China
| | - Mimi X Deng
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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Hamad A, Sherlaw-Sturrock CA, Glover K, Salmon R, Low K, Nair R, Sansbury FH, Rawlins L, Carmichael J, Horton R, Wedderburn S, Edgerley K, Irving R, Callaghan M, Mercer C, McGowan R, Robert L, Titheradge H, Naik S. Expanding the phenotypic spectrum of Chromosome 16p13.11 microduplication: A multicentric analysis of 206 patients. Eur J Med Genet 2023; 66:104714. [PMID: 36724812 DOI: 10.1016/j.ejmg.2023.104714] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/11/2022] [Revised: 11/23/2022] [Accepted: 01/24/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Recurrent chromosome 16p13.11 microduplication has been characterised in the literature as a cause of developmental delay, learning difficulties and behavioural abnormalities. It is a neurosusceptibility locus and has incomplete penetrance and variable expression. Other clinical features, such as cardiac abnormalities have also been reported. The duplicated region contains the MYH11 gene, which encodes the protein myosin-11 and is a component of the myosin heavy chain in smooth muscle. Recent literature has suggested 16p13.11 microduplication as one of the possible risk factors for thoracic aortic aneurysms and dissection (TAAD). Therefore, we studied the detailed phenotype of cases of chromosome 16p13.11 microduplication from seven centres in the United Kingdom (UK) to expand the phenotype, focusing on the cardiac abnormalities. METHODS All individuals with a chromosome 16p13.11 microduplication seen in Clinical Genetics prior to June 2017 in 6 centres (prior to 2018 in the seventh centre) were identified through the regional genetics laboratory databases. A Microsoft Excel® proforma was created and clinical data was collected retrospectively from clinical genetics databases from the seven genetics services in the UK. The data was collated and analysed collectively. RESULTS The majority of the individuals presented with (72%) developmental delay and (62%) behavioural abnormalities, in keeping with the published literature. 27% had some dysmorphic features, 14% had visual impairment and 8% had congenital cardiac abnormalities. Echocardiograms were performed in 50% of patients, and only 3.8% patients had aortic dilatation and no one had aortic dissection. 9.7% of patients were found to have a second genetic/chromosomal diagnosis, especially where there were additional phenotypic features. CONCLUSION 16p13.11 microduplication is a neurosusceptibility locus and is associated with variable expression. It may be helpful to refer children with 16p13.11 microduplication for a cardiac review for congenital cardiac abnormalities and also for ophthalmological assessment. Further prospective studies with cardiac assessments are recommended in this cohort of patients to determine whether ongoing aortic surveillance is indicated. Guidelines about the frequency of surveillance are indicated, especially in individuals with normal cardiac findings. We also highlight the importance of considering a second diagnosis if the phenotype is inconsistent with that reported.
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Affiliation(s)
- Asma Hamad
- West Midlands Genetics Services, Birmingham Women and Childrens NHS Foundation Trust, Birmingham. UK
| | | | - Kate Glover
- West Midlands Genetics Services, Birmingham Women and Childrens NHS Foundation Trust, Birmingham. UK
| | - Rachel Salmon
- West Midlands Genetics Services, Birmingham Women and Childrens NHS Foundation Trust, Birmingham. UK
| | - Karen Low
- Clinical Genetics Department, University Hospitals Bristol and Weston NHS Foundation Trust St Michael's Hospital, Bristol, UK
| | - Ramya Nair
- West Midlands Genetics Services, Birmingham Women and Childrens NHS Foundation Trust, Birmingham. UK
| | - Francis H Sansbury
- Clinical Genetics Department, University Hospitals Bristol and Weston NHS Foundation Trust St Michael's Hospital, Bristol, UK; All Wales Medical Genomics Service, NHS Wales Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - LettieE Rawlins
- Peninsula Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Jenny Carmichael
- Clinical Genetics Department, Oxford Centre for Genomic Medicine, Oxford, UK; Department of Clinical Genetics, Addenbrooke's Hospital, Cambridge, UK
| | - Rachael Horton
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Katherine Edgerley
- Clinical Genetics Department, University Hospitals Bristol and Weston NHS Foundation Trust St Michael's Hospital, Bristol, UK
| | - Rachel Irving
- Peninsula Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Mary Callaghan
- Peninsula Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Catherine Mercer
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ruth McGowan
- West of Scotland Centre for Genomic Medicine, Glasgow, UK
| | - Leema Robert
- Clinical Genetics Department, Guy's and St Thomas' Hospital, London, UK
| | - Hannah Titheradge
- West Midlands Genetics Services, Birmingham Women and Childrens NHS Foundation Trust, Birmingham. UK.
| | - Swati Naik
- West Midlands Genetics Services, Birmingham Women and Childrens NHS Foundation Trust, Birmingham. UK
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Long DA, Slaughter E, Mihala G, Macfarlane F, Ullman AJ, Keogh S, Stocker C. Patient blood management in critically ill children undergoing cardiac surgery: A cohort study. Aust Crit Care 2023; 36:201-207. [PMID: 35221230 DOI: 10.1016/j.aucc.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to audit current patient blood management practice in children throughout cardiac surgery and paediatric intensive care unit (PICU) admission. DESIGN This was a prospective observational cohort study. SETTING This was a single-centre study in the cardiac operating room (OR) and PICU in a major tertiary children's hospital in Australia. PATIENTS Children undergoing corrective cardiac surgery and requiring admission to PICU for postoperative recovery were included in the study. MEASUREMENTS AND MAIN RESULTS Fifty-six patients and 1779 blood sampling episodes were audited over a 7-month period. The median age was 9 months (interquartile range [IQR] = 1-102), with the majority (n = 30 [54%]) younger than 12 months. The median number of blood sampling episodes per patient per day was 6.6 (IQR = 5.8-8.0) in total, with a median of 5.0 (IQR = 4.0-7.5) episodes in the OR and 5.0 (IQR = 3.4-6.2) episodes per day throughout PICU admission. The most common reason for blood tests across both OR and PICU settings was arterial blood gas analysis (total median = 86%, IQR = 79-96). The overall median blood sampling volume per kg of bodyweight, patient, and day was 0.63 mL (IQR = 0.20-1.14) in total. Median blood loss for each patient was 3.5 mL/kg per patient per day (IQR = 1.7-5.6) with negligible amounts in the OR and a median of 3.6 mL/kg (IQR = 1.7-5.7) in the PICU. The median Cell Saver® transfusion volume was 9.9 mL/kg per patient per day (IQR = 4.0-19.1) in the OR. The overall median volume of other infusion products (albumin 4%, albumin 20%, packed red blood cells) received by each patient was 20.1 mL/kg (IQR = 10.7-36.4) per day. Sampling events and blood loss were positively associated with PICU stay. CONCLUSIONS Patient blood management practices observed in this study largely conform to National Blood Authority guidelines. Further implementation projects and research are needed to accelerate implementation of known effective blood conservation strategies within paediatric critical care environments.
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Affiliation(s)
- Debbie A Long
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Eugene Slaughter
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Fiona Macfarlane
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia; Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
| | - Christian Stocker
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
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DeVore GR, Satou G, Sklansky M, Cuneo B. Speckle Tracking Analysis in Fetuses with D-Transposition: Predicting the Need for Urgent Neonatal Balloon Atrial Septostomy. Pediatr Cardiol 2023. [PMID: 36853336 DOI: 10.1007/s00246-023-03131-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Speckle tracking analysis of the endocardium of the right (RV) and left (LV) ventricles was used to evaluate the size, shape, and contractility of these chambers in fetuses with D-Transposition of the great arteries (D-TGA) to identify fetuses that would require emergent balloon atrial septostomy (BAS) after birth. METHODS This was a retrospective analysis of fetuses with D-TGA and intact ventricular septum that were divided into 2 groups. Group 1 underwent urgent BAS after birth because of a restrictive atrial septum and group 2 did not. Using speckle tracking analysis, the end-diastolic and end-systolic RV and LV areas, lengths, widths, sphericity indices, and contractility were computed. Logistic regression analysis was performed to identify fetuses who would require urgent neonatal BAS. RESULTS Of the 39 fetuses with D-TGA, 55% (n = 22) required urgent neonatal BAS (group 1) and 45% (n = 17) (group 2) did not. When comparing D-TGA groups 1 and 2, differences were seen in RV and LV area, sphericity index for segment 1 of the LV, LV fractional area of change and free wall annular plane systolic excursion, fractional shortening for LV segment 12, and RV free wall strain. Regression analysis of these measurements identified 91% of neonates who underwent BAS, with a false-positive rate of 12%. CONCLUSION Using speckle tracking analysis to evaluate the RV and LV, measurable differences were identified for the RV and LV size, shape, and contractility between fetuses who underwent neonatal urgent BAS vs. those who did not require this procedure.
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Palma A, Morais S, Silva PV, Pires A. Congenital heart defects and preterm birth: Outcomes from a referral center. Rev Port Cardiol 2023; 42:403-410. [PMID: 36828187 DOI: 10.1016/j.repc.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/20/2021] [Accepted: 05/17/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Preterm birth and congenital heart defects are two major causes of neonatal and infant mortality. However, the relationship between them has not yet been fully clarified. OBJECTIVE To determine the prevalence and spectrum of congenital heart defects in preterms, the specific associations between categories of congenital heart defects and preterm birth and to establish the influence on outcomes. METHODS Observational, case-control analysis that included 448 live births with congenital heart defects born between 2003 and 2017. Preterm with congenital heart defects were the case subjects and term neonates with congenital heart defects the control subjects. RESULTS Of the newborns with congenital heart defects, 23% were preterm. The odds of congenital heart defects in preterm were twofold higher than for term neonates (p<0.0001), even when considering only those with severe congenital heart defects (p=0.0002). The odds in preterm were 9.2-fold higher for abnormalities of the atria and atrial septum (p<0.0001) and two-fold higher for abnormalities of the ventricles and ventricular septum (p<0.0001) compared with term neonates. The neonatal mortality rate in the preterm group was not statistically different from that of the term group with congenital heart defects (p=0.799) or severe congenital heart defects (p=0.554). CONCLUSION Preterm have more than twice as many congenital heart defects as term neonates. Although the etiology of prematurity between infants with congenital heart defects is still uncertain, our findings highlight a possible relationship between prematurity and congenital heart defects.
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Affiliation(s)
- Andreia Palma
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Sofia Morais
- Department of Neonatology, Bissaya Barreto Maternity, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Patrícia V Silva
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Pires
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Delaney RK, Thorpe A, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Tanner K, Fagerlin A. Parents' quality of life and health after treatment decision for a fetus with severe congenital heart defect. J Pediatr Nurs 2023; 70:20-25. [PMID: 36791586 PMCID: PMC10182246 DOI: 10.1016/j.pedn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/03/2023] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE This exploratory study examines differences in parents' quality of life by treatment decision and the child's survival outcome in the context of life-threatening congenital heart disease (CHD). DESIGN AND METHODS Parents of a fetus or neonate diagnosed with severe CHD enrolled in the observational control group of a clinical trial (NCT04437069) and completed quality of life (i.e., contact with clinicians, social support, partner relationship, state of mind), mental and physical health survey measures. Comparisons were made between parents who chose comfort-directed care or surgery and between those whose child did and did not survive. RESULTS Parents who chose surgery and their child did not survive reported the most contact with their clinicians. Parents who chose comfort-directed care reported lower social support than parents who chose surgery and their child did not survive as well as poorer state of mind compared to parents who chose surgery. CONCLUSIONS Some aspects of parents' quality of life differed based on their treatment decision. Parents who choose comfort-directed care are vulnerable to some negative outcomes. PRACTICE IMPLICATIONS Decision support tools and bereavement resources to assist parents with making and coping with a complex treatment decision is important for clinical care.
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Affiliation(s)
- Rebecca K Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA.
| | - Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Nelangi M Pinto
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Elissa M Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Mandy L Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Lisa M Hansen
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Linda M Lambert
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Kirstin Tanner
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, USA.
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Uhl S, Grieshaber P, Arnold R, Loukanov T, Gorenflo M. Impact of hybrid procedure on pulmonary arterial dimensions and right ventricular load after biventricular repair. J Cardiothorac Surg 2023; 18:65. [PMID: 36750898 PMCID: PMC9906912 DOI: 10.1186/s13019-023-02162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Hybrid procedure with ductal stenting and bilateral pulmonary banding offers a temporary approach in high-risk neonates with complex congenital heart defects aiming biventricular repair. This procedure may also have negative impact concerning post-banding pulmonary stenosis resulting in right ventricular pressure load. METHODS Between 2010 and 2021 we identified 5 patients with interrupted aortic arch and complex congenital heart defect who underwent hybrid procedure and staged biventricular repair ("hybrid-group"). Other 7 cases with interrupted aortic arch were corrected in the neonatal phase without hybrid procedure ("nonhybrid-group"). Detailed intra- and extracardiac features and surgical procedures were documented as well as pulmonary interventions during follow up. Pulmonary vessel size was assessed by diameter of left and right pulmonary artery in absolute and indexed values. RV pressure was evaluated invasively via catheterization. RESULTS Survival in cases with hybrid procedure and staged biventricular repair was 91% for a follow-up time of 40.7 months (95% CI 26-55 months) and 100% in the non-hybrid-group. Postoperative results concerning left ventricular function showed normal LV dimensions and systolic function without relevant stenosis on distal aortic arch. Hybrid procedure was associated with impaired local pulmonary arterial diameter after debanding resulting in increased right ventricular pressure and need for interventions (number intervention per patient: hybrid group 1.7 ± 0.95, non-hybrid group 0.17 ± 0.41; P 0.003). CONCLUSIONS Hybrid procedure in high-risk cases with interrupted aortic arch and staged biventricular repair shows good postoperative results with low perioperative mortality and normal left ventricular function. Due to potential risk of relevant pulmonary stenosis and right ventricular pressure load, follow up examinations must not only focus on left but also on the right heart.
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Affiliation(s)
- Sebastian Uhl
- Department of Pediatric Cardiology/Congenital Cardiology, Heidelberg University Medical Center, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - Philippe Grieshaber
- grid.5253.10000 0001 0328 4908Cardiovascular Surgery Department, Heidelberg University Medical Center, Heidelberg, Germany
| | - Raoul Arnold
- grid.5253.10000 0001 0328 4908Department of Pediatric Cardiology/Congenital Cardiology, Heidelberg University Medical Center, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Tsvetomir Loukanov
- grid.5253.10000 0001 0328 4908Cardiovascular Surgery Department, Heidelberg University Medical Center, Heidelberg, Germany
| | - Matthias Gorenflo
- grid.5253.10000 0001 0328 4908Department of Pediatric Cardiology/Congenital Cardiology, Heidelberg University Medical Center, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
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Watanabe S, Nakata T, Suehiro S, Yasuda K, Nakashima S, Oda T. Primary sutureless repair concomitant with the Warden procedure. Asian Cardiovasc Thorac Ann 2023; 31:142-144. [PMID: 36544270 DOI: 10.1177/02184923221147833] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 12/24/2022]
Abstract
A 2-month-old girl who had supracardiac total anomalous pulmonary venous connection (Darling classification type 1b) was referred to our institution. Computed tomography showed that multiple right upper pulmonary veins drained into the vertical vein, near the entry to the superior vena cava. The common pulmonary venous chamber was located lower right than usual, and right upper pulmonary veins were far from the common chamber. We successfully performed primary sutureless repair concomitant with the Warden procedure. Postoperative computed tomography showed unobstructed pulmonary veins and superior vena cava routes, and the vertical vein between right upper and lower pulmonary veins shrank slightly.
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Affiliation(s)
- Seito Watanabe
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Tomohiro Nakata
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Syoichi Suehiro
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kenji Yasuda
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shigeki Nakashima
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Teiji Oda
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Izumo, Japan
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Di Nardo A, Louvelle L, Romero DA, Doyle M, Forbes TL, Amon CH. A Comparison of Vessel Patch Materials in Tetralogy of Fallot Patients Using Virtual Surgery Techniques. Ann Biomed Eng 2023. [PMID: 36723833 DOI: 10.1007/s10439-023-03144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/25/2022] [Indexed: 02/02/2023]
Abstract
Tetralogy of Fallot (ToF) is characterized by stenosis causing partial obstruction of the right ventricular outflow tract, typically alleviated through the surgical application of a vessel patch made from a biocompatible material. In this study, we use computational simulations to compare the mechanical performance of four patch materials for various stenosis locations. Nine idealized pre-operative ToF geometries were created by imposing symmetrical stenoses on each of three anatomical sub-regions of the pulmonary arteries of three patients with previously repaired ToF. A virtual surgery methodology was implemented to replicate the steps of vessel de-pressurization, surgical patching, and subsequent vessel expansion after reperfusion. Significant differences in patch average stress (p < 0.001) were found between patch materials. Biological patch materials (porcine xenopericardium, human pericardium) exhibited higher patch stresses in comparison to synthetic patch materials (Dacron and PTFE). Observed differences were consistent across the various stenosis locations and were insensitive to patient anatomy.
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Bazarov DV, Gritsiuta AI, Evseev EP, Petrov RV. Simultaneous minimally invasive uniportal atrial septal defect repair and pulmonary lobectomy: a case report. Shanghai Chest 2023; 7:8. [PMID: 37200778 PMCID: PMC10191362 DOI: 10.21037/shc-22-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Combination of non-oncological pulmonary and cardiac conditions is common entity in modern thoracic surgery, allowing concurrent surgical correction. Multiple publications in the literature address the success of simultaneous interventions for combined conditions, however almost all are performed with an open approach. Case Description A 49-year-old male with past medical history significant for bronchiectasis, complicated by fibrosis of the middle lobe, presented with dyspnea, recurrent hemoptysis, and nonproductive cough. Echocardiography revealed a large atrial septal defect (ASD), biventricular enlargement with severe mitral and tricuspid regurgitation. After multidisciplinary evaluation, patient was taken to the operating room for simultaneous cardiac intervention with right middle lobectomy. The total duration of surgery was 332 min, with cross-clamp time of 79 min. Estimated blood loss was 800 mL. Patient was extubated 3 h postoperatively, chest tube was removed on postoperative day 4 and the patient was discharged home on postoperative day 8 without postoperative complications. Conclusions In this article, we describe the first case of simultaneous thoracoscopic uniportal intervention with cardiopulmonary bypass (CPB) in the treatment of multiple congenital heart defects and pulmonary complications of bronchiectasis. Presented case demonstrates potential advantage and feasibility of minimally invasive simultaneous procedures in patients with concurrent pulmonary and cardiac conditions. The described approach allowed radical surgical intervention to address both problems in the single setting, while retaining advantage of minimally invasive intervention.
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Affiliation(s)
- Dmitry V. Bazarov
- Department of Thoracic Surgery and Oncology Petrovsky National Research Center of Surgery, Moscow, Russia
| | - Andrei I. Gritsiuta
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Evgeny P. Evseev
- Department of Cardiac Surgery, Petrovsky National Research Center of Surgery, Moscow, Russia
| | - Roman V. Petrov
- Division of Cardiothoracic Surgery, University of Texas Medical Branch (UTMB) John Sealy School of Medicine, Galveston, TX, USA
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Chiperi LE, Tecar C, Toganel R. Neuromarkers which can predict neurodevelopmental impairment among children with congenital heart defects after cardiac surgery: A systematic literature review. Dev Neurorehabil 2023; 26:206-215. [PMID: 36710475 DOI: 10.1080/17518423.2023.2166618] [Citation(s) in RCA: 1] [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] [Indexed: 01/31/2023]
Abstract
The aim of this systematic literature review was to assess the data regarding neuromarkers used to evaluate the impact of cardiovascular surgery on neurodevelopmental pattern of children with congenital heart defects. A systematic search was performed on PubMed and Google Scholar databases. Out of 713 publications screened, 10 studies (471 patients) met the inclusion criteria. The included studies were coded on several variables: number and heterogeneity of patients (age, congenital heart defects), exclusion of patients with conditions that predispose to neurological impairment, neuroimaging workup pre- and post-surgery, neurodevelopmental assessment, interventions (part of a different study), and follow-up period. Results were reported according to PRISMA guidelines. Findings include: neuron-specific enolase and brain-derived neurotrophic factor are not reliable neuromarkers, for protein S100B different results were reported, for activin A there is lack of evidence, and glial fibrillary acidic protein could represent a reliable neuromarker for acute brain-injury. Directions for future research are discussed.
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Affiliation(s)
- Lacramioara Eliza Chiperi
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Heart Transplant, Targu Mures, Romania.,Doctoral School of I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Cristina Tecar
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rodica Toganel
- Department of Pediatrics, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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Harvey K. Parents of children with congenital heart defects during the COVID-19 pandemic: An examination of mental health variables, risk factors, and protective factors. Heart Lung 2023; 57:130-9. [PMID: 36194947 DOI: 10.1016/j.hrtlng.2022.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/05/2022] [Accepted: 09/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about the mental health burden or the factors that contribute to mental health variables in parents of children with congenital heart defects (CHD) during the COVID-19 pandemic. OBJECTIVE The purpose of this study was to examine risk and protective factors associated with anxiety symptoms, depression symptoms, and perceived stress in parents of young children with CHD during the COVID-19 pandemic. METHODS A nonexperimental design was used in this study of 127 parents of children aged newborn to five years with CHD during the COVID-19 pandemic. Regression analyses were conducted to examine associations between COVID-19 stressors, CHD care-related factors, parental resilience, external support, and mental health variables. RESULTS Parental resilience, emotional support, and informational support were key protective factors for anxiety, depression, and stress. However, resilience was remarkably low in CHD parents. Increased levels of anxiety symptoms, depression symptoms, and perceived stress were associated with 1) Exposure to a greater number of COVID-19-related stressors, 2) Distress from family visitation restrictions during healthcare encounters, 3) Worry related to the perceived risk of their CHD child's exposure to COVID-19 during healthcare encounters, and 4) Worry about their CHD child's risk of death or serious illness from COVID-19. CONCLUSIONS The additive impact of the COVID-19 pandemic plus CHD care-related worries on this parent population's mental health is significant. Interventions that promote resilience, address the effect of healthcare system changes, and support the needs of parents of young children with CHD during this and future pandemics are needed.
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Tabib A, Talebi T, Ghasemi S, Pourirahim M, Naderi N, Maleki M, Kalayinia S. A novel stop-gain pathogenic variant in FLT4 and a nonsynonymous pathogenic variant in PTPN11 associated with congenital heart defects. Eur J Med Res 2022; 27:286. [PMID: 36496429 PMCID: PMC9737984 DOI: 10.1186/s40001-022-00920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Congenital heart defects (CHDs) are the most common congenital malformations, including structural malformations in the heart and great vessels. CHD complications such as low birth weight, prematurity, pregnancy termination, mortality, and morbidity depend on the type of defect. METHODS In the present research, genetic analyses via whole-exome sequencing (WES) was performed on 3 unrelated pedigrees with CHDs. The candidate variants were confirmed, segregated by PCR-based Sanger sequencing, and evaluated by bioinformatics analysis. RESULTS A novel stop-gain c.C244T:p.R82X variant in the FLT4 gene, as well as a nonsynonymous c.C1403T:p.T468M variant in the PTPN11 gene, was reported by WES. FLT4 encodes a receptor tyrosine kinase involved in lymphatic development and is known as vascular endothelial growth factor 3. CONCLUSIONS We are the first to report a novel c.C244T variant in the FLT4 gene associated with CHDs. Using WES, we also identified a nonsynonymous variant affecting protein-tyrosine phosphatase, the non-receptor type 11 (PTPN11) gene. The clinical implementation of WES can determine gene variants in diseases with high genetic and phenotypic heterogeneity like CHDs.
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Affiliation(s)
- Avisa Tabib
- grid.411746.10000 0004 4911 7066Heart Valve Diseases Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Taravat Talebi
- grid.411746.10000 0004 4911 7066Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Serwa Ghasemi
- grid.411463.50000 0001 0706 2472Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Maryam Pourirahim
- grid.411746.10000 0004 4911 7066Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Naderi
- grid.411746.10000 0004 4911 7066Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- grid.411746.10000 0004 4911 7066Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Kalayinia
- grid.411746.10000 0004 4911 7066Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Lee JH, Song IS, Kang P, Ji SH, Jang YE, Kim EH, Kim HS, Kim JT. Validation of the Masimo O3™ regional oximetry device in pediatric patients undergoing cardiac surgery. J Clin Monit Comput 2022; 36:1703-1709. [PMID: 35169968 DOI: 10.1007/s10877-022-00815-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/28/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
We assessed the accuracy of Masimo O3™ regional cerebral oxygen saturation (rSO2) readings by comparing them with reference values and evaluated the relationship between rSO2 and somatic tissue oxygen saturation (StO2) in children undergoing cardiac surgery. After anesthesia induction, pediatric sensors were applied to the forehead and foot sole, and rSO2 and StO2 values were monitored continuously. Before cardiopulmonary bypass (CPB), FIO2 was set to 0.2, 0.5, and 0.8 serially every 15 min. After CPB, FIO2 was reversed. The reference values (SavO2) were calculated by combining arterial (SaO2) and central venous oxygen saturation (SvO2) readings from the arterial and central lines, respectively (0.7 [Formula: see text] SvO2 + 0.3 [Formula: see text] SaO2). In total, 265 pairs of rSO2/StO2 and SavO2 from 49 patients were analyzed. The bias, standard deviation (SD), standard error (SE), and root mean squared error (RMSE) of rSO2 were 2.6%, 4.5%, 0.3%, and 4.3%, respectively. The limits of agreement ranged from -6.3% to 11.6%. Trend accuracy analysis yielded a relative mean error of -1.4%, with an SD of 4.3%, SE of 0.2%, and RMSE of 3.9%. According to multiple linear regression analysis, the application of CPB, FIO2, Hb level, and tip location of the central venous catheter influenced the bias (all P < 0.05). Furthermore, the correlation between rSO2 and StO2 was weak (r = 0.254). rSO2 readings by the Masimo O3™ device and pediatric sensor had good absolute and trending accuracies with respect to the calculated reference values in children undergoing cardiac surgery. rSO2 and StO2 cannot be used interchangeably.Clinical trial registration http://clinicaltrials.gov (number: NCT04208906).
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - In-Sun Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.
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Kolcz J, Karnas E, Madeja Z, Zuba-Surma EK. The cardioprotective and anti-inflammatory effect of inhaled nitric oxide during Fontan surgery in patients with single ventricle congenital heart defects: a prospective randomized study. J Intensive Care 2022; 10:48. [PMID: 36229863 DOI: 10.1186/s40560-022-00639-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Fontan surgery with cardiopulmonary bypass (CPB) causes tremendous systemic stress and inflammatory responses, affecting postoperative organ function, morbidity, and mortality. Although this reaction triggers partially protective anti-inflammatory responses, it is harmful in patients with single ventricle congenital heart defects. Despite decades of research, an effective anti-inflammatory and stress defense strategy is lacking. This study investigated the influence of inhaled nitric oxide (NO) during CPB on early clinical results, including the duration of postoperative respiratory support as a primary outcome and a panel of laboratory analytes. Methods In this study, 115 patients were randomized to the Fontan-NO group (n = 48) and the Fontan group (n = 49). Eighteen patients were excluded from the study. The Fontan-NO group received NO inhaled directly into the oxygenator during CPB. Clinical data were collected, and blood samples were drawn for analysis at repeated intervals. Multiplex assays were used to analyze a proteome profile of molecules involved in stress response, inflammation, metabolic reactions, as well as heart and lung protection. Results Fontan-NO patients had significantly shorter respiratory support time with a median of 9.3 h (7.0; 13,2) vs 13.9 h (3.7; 18.5) by the absolute difference of 4.6 h [95% confidence interval, − 30.9 to 12.3; (p = 0.03)]. In addition, they have a shorter time in intensive care (p = 0.04) and lower pulmonary artery pressure after CPB discontinuation (p = 0.04), 4 h (p = 0.03) and 8 h (p = 0.03) after surgery. Fontan-NO patients also had a lower concentration of lactates (p = 0.04) and glucose after separation from CPB (p = 0.02) and lower catecholamine index (p = 0.042). Plasma factors analysis has shown a significantly higher concentration of interleukin-10, and a lower concentration of interleukin-6, interleukin-8, interleukin-1β, pentraxin, matrix metalloproteinase-8, troponin-I, creatine kinase myocardial band (CK-MB), and insulin in Fontan-NO group. Conclusions NO inhaled into the oxygenator during CPB can improve short-term clinical outcomes. It shortens intubation time and intensive care time. It reduces inflammatory response, improves myocardial and lung protection, and diminishes metabolic stress in patients with a single ventricle undergoing Fontan surgery. Trial registration number: The trial was preregistered, supervised, and supported by The Polish National Science Center (NCN/01/B/NZ5/04246). Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00639-y.
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Tulzer A, Arzt W, Scharnreitner I, Hochpoechler J, Bauer C, Tulzer G. Complications Associated with Fetal Cardiac Interventions: Prevalence and Management - Experience from 213 Procedures. Fetal Diagn Ther 2022; 49:434-441. [PMID: 36198280 DOI: 10.1159/000527121] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/12/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Fetal cardiac interventions (FCIs) were introduced to change the natural history of some congenital heart defects. The aim of this study was to analyze the complications and management strategies associated with FCI at our institution. METHODS The local FCI database was retrospectively reviewed for all fetuses who underwent FCI in our center since 2000 regarding complications and fetal outcome. RESULTS 213 FCIs have been performed in 165 fetuses since October 2000: 60 with fetal pulmonary valvuloplasty, 4 with atrial septostomy, 7 with atrial septal stents, and 142 with fetal aortic valvuloplasty (FAV). The median gestational age at intervention was 27+1/7 weeks (21+4/7-38+3/7) for all interventions. The most common complications needing treatment were bradycardia (37%) and pericardial effusions (12%). FAV procedure-related mortality was significantly lower in the recent period since 2014 (14% early vs. 4% recent era, p = 0.03) due to a learning curve and improved management strategies. There were no relevant maternal complications. Premature deliveries occurred in 22.8% percent of all patients. CONCLUSIONS Complications during FCI were frequent and must be expected. Strategies to reduce their prevalence as well as timely and correct treatment are mandatory to keep mortality rates low.
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Affiliation(s)
- Andreas Tulzer
- Children's Heart Center Linz, Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Wolfgang Arzt
- Institute of Prenatal Medicine, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
| | - Iris Scharnreitner
- Institute of Prenatal Medicine, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
| | - Julian Hochpoechler
- Children's Heart Center Linz, Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria
| | - Christoph Bauer
- Children's Heart Center Linz, Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria
| | - Gerald Tulzer
- Children's Heart Center Linz, Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria
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Zheng S, Huang H, Ma L, Zhu T. RASopathies due to de novo pathogenic variants: clinical features, genetic findings and outcomes in nine neonates born with congenital heart defects. BMC Med Genomics 2022; 15:184. [PMID: 36002837 PMCID: PMC9400306 DOI: 10.1186/s12920-022-01336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background There are limited information available related to neonatal characteristics of RASopathies, a group of autosomal dominant syndromes with considerable phenotypic overlap. Methods The retrospective review revealed 9 neonates born with congenital heart defects (CHDs) and diagnosed as RASopathies due to de novo mutations (DNMs) by trio-based exome sequencing (ES) between January 2017 and December 2020. We report in details of the neonatal course, molecular analysis and 180-days of age follow-up in affected individuals. Results The early clinical spectrum included various types of CHDs, less noticeable multiple extracardiac anomalies and unspecific symptoms like poor feeding. Of the 8 variants identified from 6 genes, 2 in RASA1 were novel: (NM_002890.2: c.2828 T > C (p.Leu943Pro)) and (NM_002890.2: c.2001del (p.Pro668Leufs*10)), which functionally impaired the protein structure. There was a relatively high mortality rate of 33.33% (3/9) for all the defects combined. A RAF1-deficient male and a RASA1-deficient male survived from severe heart failure by surgical interventions in early life. Conclusions Our results revealed that family-based ES was useful in identifying DNMs and causal genes for sporadic diseases and screening Rasopathies shortly after birth. We recommended a family-based ES and a full phenotypic evaluation including echocardiogram, magnetic resonance imaging, ultrasonography and coagulation screening in neonates with CHDs and a suspected genetic etiology.
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Affiliation(s)
- Simin Zheng
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huanyang Huang
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Ma
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianwen Zhu
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Karazisi C, Dellborg M, Mellgren K, Giang KW, Skoglund K, Eriksson P, Mandalenakis Z. Risk of cancer in young and older patients with congenital heart disease and the excess risk of cancer by syndromes, organ transplantation and cardiac surgery: Swedish health registry study (1930-2017). Lancet Reg Health Eur 2022; 18:100407. [PMID: 35663362 PMCID: PMC9156800 DOI: 10.1016/j.lanepe.2022.100407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Increasing survival of patients with congenital heart disease (CHD) will result in an increased risk of age-dependent acquired diseases later in life. We aimed to investigate the risk of cancer in young and older patients with CHD and to evaluate the excess risk of cancer by syndromes, organ transplantation and cardiac surgery. Methods Patients with CHD born between 1930 and 2017 were identified using Swedish Health Registers. Each patient with CHD (n = 89,542) was matched by sex and birth year with ten controls without CHD (n = 890,472) from the Swedish Total Population Register. Findings 4012 patients with CHD (4·5%) and 35,218 controls (4·0%) developed cancer. The median follow-up time was 58·8 (IQR 42·4-69·0) years. The overall cancer risk was 1·23 times higher (95% confidence interval (CI) 1·19-1·27) in patients with CHD compared with matched controls, and remained significant when patients with syndromes and organ transplant recipients were excluded. The risk of cancer was higher in all CHD age groups, and in patients that underwent cardiac surgery during the first year after birth (Hazard Ratio 1·83; 95% CI 1·32-2·54). The highest risk was found in children (0-17 years), HR 3·21 (95% CI 2·90-3·56). Interpretation The cancer risk in patients with CHD was 23% higher than in matched controls without CHD. The highest risk was found in children and in the latest birth cohort (1990-2017). Funding Funding by the Swedish state (Grant Number: 236611), the Swedish Research Council (Grant Number: 2019-00193), the Swedish Childhood Cancer Fund (Grant Number: SP2017-0012) and the Swedish Heart-Lung Foundation (Grant Number: 20190724).
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Affiliation(s)
- Christina Karazisi
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Mellgren
- Department of Pediatric Oncology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kok Wai Giang
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
| | - Kristofer Skoglund
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
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