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Spaziani G, Surace FC, Girolami F, Bianco F, Bucciarelli V, Bonanni F, Bennati E, Arcieri L, Favilli S. Hereditary Thoracic Aortic Diseases. Diagnostics (Basel) 2024; 14:112. [PMID: 38201421 PMCID: PMC10795846 DOI: 10.3390/diagnostics14010112] [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: 09/28/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Advances in both imaging techniques and genetics have led to the recognition of a wide variety of aortic anomalies that can be grouped under the term 'hereditary thoracic aortic diseases'. The present review aims to summarize this very heterogeneous population's clinical, genetic, and imaging characteristics and to discuss the implications of the diagnosis for clinical counselling (on sports activity or pregnancy), medical therapies and surgical management.
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Affiliation(s)
- Gaia Spaziani
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Francesca Chiara Surace
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Francesca Girolami
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Francesca Bonanni
- Department of Experimental and Clinical Medicine, School of Cardiology, Faculty of Medicine, University of Study of Florence, 50121 Florence, Italy;
| | - Elena Bennati
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Luigi Arcieri
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Silvia Favilli
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
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Dasgupta MN, Kaplinski MA, Reddy CD, Collins RT. Patterns of Aortic Dilation in Tetralogy of Fallot: An Analysis of 100 Fetal Echocardiograms Compared With Matched Controls. J Am Heart Assoc 2023; 12:e030083. [PMID: 37929767 PMCID: PMC10727408 DOI: 10.1161/jaha.123.030083] [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: 03/07/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
Background Although aortic dilation is common in tetralogy of Fallot (TOF), its progression and risk of dissection are not well understood. The mechanism of dilation is primarily attributed to increased flow in utero; an alternative is unequal septation of the truncus arteriosus resulting in a larger aorta and inherently hypoplastic pulmonary artery (PA). If the latter is true, we hypothesize the aorta to PA ratio in TOF is stable throughout gestation, and sums of great artery dimensions are similar to controls. Methods and Results We performed a single-center retrospective study of fetuses with TOF (2014-2020) and matched controls. We compared sums of diameters, circumferences, and cross-sectional areas of the aorta and PA and evaluated the aorta to PA ratio across gestation in 2 TOF subtypes: pulmonary stenosis and atresia (TOF-PA). There were 100 echocardiograms with TOF (36% TOF-PA) with median gestational age of 31 weeks (interquartile range 26.5-34.4) and median maternal age of 34 years (interquartile range 30-37). There were no differences in sums of great artery dimensions between TOF-pulmonary stenosis and controls. In TOF-PA, sums were significantly lower than controls (P values <0.01). The aorta to PA ratio was stable throughout gestation (Pearson's r=0.08 [95% CI, -0.12 to 0.27], -0.06 [95% CI, -0.25 to 0.14]). Conclusions The aorta in fetal TOF is large but grows proportionally throughout gestation, with sums of great artery dimensions similar to controls. TOF-PA appears distinct from TOF-pulmonary stenosis (with smaller sums), warranting further investigation. In conclusion, our findings suggest an intrinsic developmental mechanism contributes to aortic dilation in TOF.
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Affiliation(s)
- Minnie N. Dasgupta
- Department of Pediatrics (Division of Cardiology)Stanford University School of MedicinePalo AltoCAUSA
| | - Michelle A. Kaplinski
- Department of Pediatrics (Division of Cardiology)Stanford University School of MedicinePalo AltoCAUSA
| | - Charitha D. Reddy
- Department of Pediatrics (Division of Cardiology)Stanford University School of MedicinePalo AltoCAUSA
| | - R. Thomas Collins
- Department of Pediatrics (Division of Cardiology)University of Kentucky College of MedicineLexingtonKYUSA
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Tan Y, Li Y, Shi J, Zhang Y, Huang L, Zhao R, Deng W, Liu T, Fang L, Zhang L, Xie M, Wang J. Noninvasive left ventricular pressure-strain myocardial work in patients with well-functioning bicuspid aortic valves and aortic dilation: a preliminary study. Quant Imaging Med Surg 2023; 13:6517-6527. [PMID: 37869319 PMCID: PMC10585504 DOI: 10.21037/qims-23-294] [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: 03/08/2023] [Accepted: 07/28/2023] [Indexed: 10/24/2023]
Abstract
Background Noninvasive left ventricular pressure-strain myocardial work (MW) is a novel method for evaluating left ventricular function that integrates myocardial deformation and afterload and has certain advantages over global longitudinal strain (GLS). The study aimed to analyze MW in patients with well-functioning bicuspid aortic valve (BAV) and explore the influences of aortic dilation and arterial stiffness on left ventricular function. Methods A total of 104 patients with well-functioning BAVs and 50 controls were enrolled in our study. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), GLS, and aortic stiffness index were measured. Based on the ascending aortic diameter, patients with BAV were divided into 3 subgroups (nondilated, mildly dilated, and moderately dilated). Results GWI, GCW, GWW, and aortic stiffness index were significantly increased (P<0.001, P=0.023, P<0.001, and P<0.001, respectively), while GWE and GLS were significantly decreased among patients with BAV compared with controls (all P values <0.001). Patients with BAV and mildly and moderately dilated aortas had an increased GWW and aortic stiffness index but a decreased GWE compared with patients with BAV and nondilated aortas (all P values <0.05); meanwhile, GCW and GLS did not differ among the BAV subgroups (all P values >0.05). GWI was elevated in patients with BAV and moderately dilated aortas compared with patients with BAV and nondilated aortas (P<0.05). On multivariable analysis, the aortic stiffness index was an independent influencer of GWI, GCW, GWW, and GWE (P=0.025, P=0.049, P<0.001, and P=0.001, respectively). The aortic diameter was highly correlated with the aortic stiffness index (r=0.863; P<0.001). Conclusions MW could assess early myocardial impairment in patients with well-functioning BAV. MW may help to differentiate the detrimental effect of aortic dilation on left ventricular function, whereas GLS may not.
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Affiliation(s)
- Yuting Tan
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiawei Shi
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yichan Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lei Huang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ruohan Zhao
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenhui Deng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tianshu Liu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lingyun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Laks JA, Lynch A, Honjo O, Grosse-Wortmann L, Chitayat D, Dipchand AI. Heart transplantation in neonatal Marfan syndrome: Saving life in a rare and fatal condition. Pediatr Transplant 2023; 27:e14560. [PMID: 37377051 DOI: 10.1111/petr.14560] [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: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Neonatal Marfan syndrome is a rare disease with mortality in the first year of life reported as high as 95% predominantly due to progressive heart failure from valvar regurgitation and cardiomyopathy. Multisystem involvement and uncertain prognosis have historically precluded transplant candidacy, and current management options are of limited success. CASE REPORT We present a baby girl with a postnatal diagnosis of neonatal Marfan syndrome who at 1 year of age underwent mitral valve and tricuspid valve repair with postoperative profound left ventricular and moderate right ventricular dysfunction necessitating biventricular assist device (BiVAD) support and subsequent heart transplant. A number of noncardiac issues persisted in our patient; however, she enjoyed a good quality of life for the initial 3 years posttransplant. Unfortunately, she subsequently developed rapidly progressive coronary allograft vasculopathy (CAV) with progressive deterioration in function and cardiac arrest. CONCLUSION To our best knowledge, this is only the second case of neonatal Marfan syndrome to undergo heart transplant reported in the literature and the first with BiVAD support as a bridge to candidacy. This is also the first case of neonatal Marfan syndrome associated with intragenic duplication. This case though demonstrating that earlier listing, ventricular assist device (VAD) support and even primary transplant as treatment in neonatal Marfan syndrome should all be considered viable options but also portends a cautionary tale given the spectrum of comorbidities in this rare and severe disorder.
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Affiliation(s)
- Jessica A Laks
- Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Aine Lynch
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiovascular Surgery, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Anne I Dipchand
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Rodríguez-Palomares JF, Dux-Santoy L, Guala A, Galian-Gay L, Evangelista A. Mechanisms of Aortic Dilation in Patients With Bicuspid Aortic Valve: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:448-464. [PMID: 37495282 DOI: 10.1016/j.jacc.2022.10.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 05/31/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 07/28/2023]
Abstract
Bicuspid aortic valve is the most common congenital heart disease and exposes patients to an increased risk of aortic dilation and dissection. Aortic dilation is a slow, silent process, leading to a greater risk of aortic dissection. The prevention of adverse events together with optimization of the frequency of the required lifelong imaging surveillance are important for both clinicians and patients and motivated extensive research to shed light on the physiopathologic processes involved in bicuspid aortic valve aortopathy. Two main research hypotheses have been consolidated in the last decade: one supports a genetic basis for the increased prevalence of dilation, in particular for the aortic root, and the second supports the damaging impact on the aortic wall of altered flow dynamics associated with these structurally abnormal valves, particularly significant in the ascending aorta. Current opinion tends to rule out mutually excluding causative mechanisms, recognizing both as important and potentially clinically relevant.
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Affiliation(s)
- Jose F Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | | | - Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain.
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
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Spaziani G, Bonanni F, Girolami F, Bennati E, Calabri GB, Di Filippo C, Porcedda G, Passantino S, Nistri S, Olivotto I, Favilli S. Aortic Dilatation in Pediatric Patients with Bicuspid Aortic Valve: How the Choice of Nomograms May Change Prevalence. Diagnostics (Basel) 2023; 13:diagnostics13081490. [PMID: 37189592 DOI: 10.3390/diagnostics13081490] [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: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Aortic dilation (AoD) is commonly reported in patients with bicuspid aortic valve (BAV) and has been related to flow abnormalities and genetic predisposition. AoD-related complications are reported to be extremely rare in children. Conversely, an overestimate of AoD related to body size may lead to excess diagnoses and negatively impact quality of life and an active lifestyle. In the present study, we compared the diagnosis performance of the newly introduced Q-score (based on a machine-learning algorithm) versus the traditional Z-score in a large consecutive pediatric cohort with BAV. MATERIALS AND METHODS Prevalence and progression of AoD were evaluated in 281 pediatric patients ages > 5 and < 18 years at first observation, 249 of whom had isolated BAV and 32 had BAV associated with aortic coarctation (CoA-BAV). An additional group of 24 pediatric patients with isolated CoA was considered. Measurements were made at the level of the aortic annulus, Valsalva sinuses, sinotubular aorta, and proximal ascending aorta. Both Z-scores using traditional nomograms and the new Q-score were calculated at baseline and at followup (mean 4.5 years). RESULTS A dilation of the proximal ascending aorta was suggested by traditional nomograms (Z-score > 2) in 31.2% of patients with isolated BAV and 18.5% with CoA-BAV at baseline and in 40.7% and 33.3%, respectively, at followup. No significant dilation was found in patients with isolated CoA. Using the new Q-score calculator, ascending aorta dilation was detected in 15.4% of patients with BAV and 18.5% with CoA-BAV at baseline and in 15.8% and 3.7%, respectively, at followup. AoD was significantly related to the presence and degree of aortic stenosis (AS) but not to aortic regurgitation (AR). No AoD-related complications occurred during the followup. CONCLUSIONS Our data confirm the presence of ascending aorta dilation in a consistent subgroup of pediatric patients with isolated BAV, with progression during followup, while AoD was less common when CoA was associated with BAV. A positive correlation was found with the prevalence and degree of AS, but not with AR. Finally, the nomograms used may significantly influence the prevalence of AoD, especially in children, with a possible overestimation by traditional nomograms. This concept requires prospective validation in long-term followup.
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Affiliation(s)
- Gaia Spaziani
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Francesca Bonanni
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Firenze, Italy
| | - Francesca Girolami
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Elena Bennati
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Giovanni Battista Calabri
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Chiara Di Filippo
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Giulio Porcedda
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Silvia Passantino
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Stefano Nistri
- Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy
| | - Iacopo Olivotto
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Firenze, Italy
| | - Silvia Favilli
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
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7
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Auer A, Callegari A, Sitte V, Pretre R, Dave H, Christmann M. Realignment of the ventricular septum in tetralogy of Fallot using (partial) direct closure of the ventricular septal defect: Long-term follow-up and comparison to conventional patch repair. Ann Pediatr Cardiol 2023; 16:18-24. [PMID: 37287846 PMCID: PMC10243664 DOI: 10.4103/apc.apc_90_22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/16/2022] [Accepted: 01/19/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives Aortic dilatation and regurgitation after surgical repair of tetralogy of Fallot (TOF) is known, and beside other factors, mainly addressed to an intrinsic aortopathy. In 2011, we reported the influence of realingement of the left ventricular outflow tract (LVOT) by (partial) direct closure of the ventricular septal defect (VSD) in TOF on aortic structures and function. We now evaluated the further follow-up of this cohort and compared the results to a matched group of TOF patients with classical VSD patch closure. Patients and Methods Forty patients with TOF treated between 2003 and 2008 are included in the study, with 20 patients each in the VSD (a) (partial) direct closure and (b) patch closure group. Follow-up time after surgery was 12.3 years (11.3-13.0). Results Patient characteristics, echocardiographic measurements, and surgical and intensive care unit parameters were not significantly different between both groups. After surgery and during long-term follow-up, realignement of the LVOT, shown by the angle between the interventricular septum and the anterior aortic annulus in long axis view in echocardiography, was lower in Group A (34 vs. 45°, P < 0.0001). No differences in LVOT or aortic annulus size, aortic regurgitation, or dilation of the ascending aorta and right ventricular outflow tract gradients were found. Transient rhythm disturbances were found in 3 patients in each group, with only one persistent complete atrioventricular block in Group B. Conclusion (Partial) direct closure of the VSD in TOF leads to a better realignement of the LVOT and showed comparable short- and long-term results without higher risk for rhythm disturbances during follow-up.
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Affiliation(s)
- Alexander Auer
- Department of Paediatric Cardiology, University Children’s Hospital, Zurich, Switzerland
- Children’s Research Center, University of Zurich, Zurich, Switzerland
| | - Alessia Callegari
- Department of Paediatric Cardiology, University Children’s Hospital, Zurich, Switzerland
- Children’s Research Center, University of Zurich, Zurich, Switzerland
| | - Vanessa Sitte
- Department of Paediatric Cardiology, University Children’s Hospital, Zurich, Switzerland
- Children’s Research Center, University of Zurich, Zurich, Switzerland
| | - Rene Pretre
- Children’s Research Center, University of Zurich, Zurich, Switzerland
- Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zurich, Switzerland
| | - Hitendu Dave
- Children’s Research Center, University of Zurich, Zurich, Switzerland
- Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zurich, Switzerland
| | - Martin Christmann
- Department of Paediatric Cardiology, University Children’s Hospital, Zurich, Switzerland
- Children’s Research Center, University of Zurich, Zurich, Switzerland
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8
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Gorton AJ, Keshavamurthy S, Saha SP. Diagnosis and Management of Aortic Valvular Disease in the Elderly. Int J Angiol 2022; 31:232-243. [PMID: 36588869 PMCID: PMC9803555 DOI: 10.1055/s-0042-1759527] [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: 12/03/2022] Open
Abstract
Aortic valvular disease, including aortic stenosis and aortic regurgitation, is increasingly common with age. Due to the aging population, more elderly patients are presenting with aortic valve pathology and expectations for prompt diagnosis and efficacious treatment. The current paradigm for aortic valve disease is based on surgical or interventional therapy. In this review, we discuss the approach to diagnosing aortic valvular disease and the different options for treatment based on the most recent evidence.
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Affiliation(s)
- Andrew J. Gorton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Suresh Keshavamurthy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Sibu P. Saha
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
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9
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Gheewalla GM, Luther J, Das S, Kreher JB, Scimone ER, Wong AW, Lindsay ME, Lin AE. An additional patient with SMAD4-Juvenile Polyposis-Hereditary hemorrhagic telangiectasia and connective tissue abnormalities: SMAD4 loss-of-function and gain-of-function pathogenic variants result in contrasting phenotypes. Am J Med Genet A 2022; 188:3084-3088. [PMID: 35869926 DOI: 10.1002/ajmg.a.62915] [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: 04/10/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 01/31/2023]
Abstract
Loss-of-function pathogenic variants in somatic and germline cells in SMAD4 may cause cancer and juvenile polyposis-Hereditary Hemorrhagic Telangiectasia (SMAD4-JP-HHT), respectively. In a similar manner, gain-of-function somatic and germline pathogenic variants in SMAD4 can cause various forms of cancer as well as Myhre syndrome. The different SMAD4 molecular mechanisms result in contrasting clinical phenotypes demonstrated by SMAD4-JP-HHT and Myhre syndrome. We report an additional patient with SMAD4-JP-HHT and aortopathy, and expand the phenotype to include severe valvulopathy, cutaneous, ophthalmologic, and musculoskeletal features consistent with an inherited disorder of connective tissue. We compared this 70-year-old man with SMAD4-JP-HHT to 18 additional literature cases, and also compared patients with SMAD4-JP-HHT to those with Myhre syndrome. In contrast to aorta dilation, hypermobility, and loose skin in SMAD4-JP-HHT, Myhre syndrome has aorta hypoplasia, stiff joints, and firm skin representing an intriguing phenotypic contrast, which can be attributed to different molecular mechanisms involving SMAD4. We remind clinicians about the possibility of significant cardiac valvulopathy and aortopathy, as well as connective tissue disease in SMAD4-JP-HHT. Additional patients and longer follow-up will help determine if more intensive surveillance improves care amongst these patients.
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Affiliation(s)
- Gregory M Gheewalla
- Tufts University School of Medicine, Boston, Massachusetts, USA.,Cardiovascular Genetics Program, Cardiology Division, Department of Medicine, Mass General Brigham, Boston, Massachusetts, USA.,Pediatric Cardiology Division, Department of Pediatrics, Mass General Brigham, Boston, Massachusetts, USA
| | - Jay Luther
- Division of Gastroenterology, Department of Internal Medicine, MGB Alcohol Liver Center, Mass General Brigham, Boston, Massachusetts, USA
| | - Saumya Das
- Department of Medicine, Cardiovascular Research Center, Mass General Brigham, Boston, Massachusetts, USA
| | - Jeffrey B Kreher
- Division of Pediatric Orthopaedics, Department of Orthopaedics, Mass General Brigham, Boston, Massachusetts, USA
| | - Eleanor R Scimone
- Department of Pediatrics, Genetics Unit, Mass General Brigham for Children, Boston, Massachusetts, USA
| | - Ashley W Wong
- Department of Pediatrics, Genetics Unit, Mass General Brigham for Children, Boston, Massachusetts, USA
| | - Mark E Lindsay
- Cardiovascular Genetics Program, Cardiology Division, Department of Medicine, Mass General Brigham, Boston, Massachusetts, USA.,Pediatric Cardiology Division, Department of Pediatrics, Mass General Brigham, Boston, Massachusetts, USA
| | - Angela E Lin
- Department of Pediatrics, Genetics Unit, Mass General Brigham for Children, Boston, Massachusetts, USA
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de Boysson H, Aouba A. An Updated Review of Cardiovascular Events in Giant Cell Arteritis. J Clin Med 2022; 11:1005. [PMID: 35207277 DOI: 10.3390/jcm11041005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Giant cell arteritis (GCA) is a systemic vasculitis with a direct and indirect increased risk of acute and chronic vascular events, affecting large and medium vessels, and responsible for most of the morbidity and mortality of this disease. We aimed in this review to provide an updated synthesis of knowledge regarding cardiovascular events observed in GCA. By definition, GCA patients are over 50 and often over 70 years old, and subsequently also present age-related cardiovascular risk factors. In addition, the systemic and vascular inflammation as well as glucocorticoids (GC) probably contribute to an accelerated atherosclerosis and to vascular changes leading to arterial stenoses and aortic dilations and/or dissections. GCA-related ischemic complications, especially ophthalmologic events, stroke or myocardial infarcts are mostly observed within the first months after the diagnosis, being mainly linked to the vasculitic process. Conversely, aortic complications, including dilations or dissections, generally occur several months or years after the diagnosis, mainly in patients with large-vessel vasculitis. In these patients, other factors such as atherosclerosis, GC-related endothelial damage and vascular wall remodeling/healing probably contribute to the vascular events. GCA management includes the detection and treatment of these previous and newly induced cardiovascular risk factors. Hence, the use of cardiovascular treatments (e.g., aspirin, anticoagulation, statins, anti-hypertensive treatments) should be evaluated individually. Aortic structural changes require regular morphologic evaluations, especially in patients with previous aortitis. The initial or secondary addition of immunosuppressants, especially tocilizumab, an anti-IL-6 receptor antibody, is discussed in patients with GCA-related cardiovascular complications and, more consensually, to limit GC-mediated comorbidities.
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11
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Minderhoud SCS, Roos-Hesselink JW, Chelu RG, Bons LR, van den Hoven AT, Korteland SA, van den Bosch AE, Budde RPJ, Wentzel JJ, Hirsch A. Wall shear stress angle is associated with aortic growth in bicuspid aortic valve patients. Eur Heart J Cardiovasc Imaging 2022; 23:1680-1689. [PMID: 34977931 DOI: 10.1093/ehjci/jeab290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/24/2021] [Accepted: 12/18/2021] [Indexed: 02/01/2023] Open
Abstract
AIMS Aortic wall shear stress (WSS) distributions in bicuspid aortic valve (BAV) patients have been associated with aortic dilatation, but prospective, longitudinal data are missing. This study assessed differences in aortic WSS distributions between BAV patients and healthy controls and determined the association of WSS with aortic growth in patients. METHODS AND RESULTS Sixty subjects underwent four-dimensional (4D) flow cardiovascular magnetic resonance of the thoracic aorta (32 BAV patients and 28 healthy controls). Peak velocity, pulse wave velocity, aortic distensibility, peak systolic WSS (magnitude, axial, and circumferential), and WSS angle were assessed. WSS angle is defined as the angle between the WSSmagnitude and WSSaxial component. In BAV patients, three-year computed tomography angiography-based aortic volumetric growth was determined in the proximal and entire ascending aorta. WSSaxial was significantly lower in BAV patients compared with controls (0.93 vs. 0.72 Pa, P = 0.047) and WSScircumferential and WSS angle were significantly higher (0.29 vs. 0.64 Pa and 18° vs. 40°, both P < 0.001). Significant volumetric growth of the proximal ascending aorta occurred in BAV patients (from 49.1 to 52.5 cm3, P = 0.003). In multivariable analysis corrected for baseline aortic volume and diastolic blood pressure, WSS angle was the only parameter independently associated with proximal aortic growth (P = 0.031). In the entire ascending aorta, besides the WSS angle, the WSSmagnitude was also independently associated with growth. CONCLUSION Increased WSScircumferential and especially WSS angle are typical in BAV patients. WSS angle was found to predict aortic growth. These findings highlight the potential role of WSS measurements in BAV patients to stratify patients at risk for aortic dilation.
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Affiliation(s)
- Savine C S Minderhoud
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Raluca G Chelu
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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12
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Soulat G, Scott M, Allen BD, Avery R, Bonow RO, Malaisrie C, McCarthy P, Fedak P, Barker AJ, Markl M. Association of Regional Wall Shear Stress and Progressive Ascending Aorta Dilation in Bicuspid Aortic Valve. JACC Cardiovasc Imaging 2022; 15:33-42. [PMID: 34419402 PMCID: PMC8741630 DOI: 10.1016/j.jcmg.2021.06.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the role of wall shear stress (WSS) as a predictor of ascending aorta (AAo) growth at 5 years or greater follow-up. BACKGROUND Aortic 4-dimensional flow cardiac magnetic resonance (CMR) can quantify regions exposed to high WSS, a known stimulus for arterial wall dysfunction. However, its association with longitudinal changes in aortic dilation in patients with bicuspid aortic valve (BAV) is unknown. METHODS This retrospective study identified 72 patients with BAV (age 45 ± 12 years) who underwent CMR for surveillance of aortic dilation at baseline and ≥5 years of follow-up. Four-dimensional flow CMR analysis included the calculation of WSS heat maps to compare regional WSS in individual patients with population averages of healthy age- and sex-matched subjects (database of 136 controls). The relative areas of the AAo and aorta (in %) exposed to elevated WSS (outside the 95% CI of healthy population averages) were quantified. RESULTS At a median follow-up duration of 6.0 years, the mean AAo growth rate was 0.24 ± 0.20 mm/y. The fraction of the AAo exposed to elevated WSS at baseline was increased for patients with higher growth rates (>0.24 mm/y, n = 32) compared with those with growth rates <0.24 mm/y (19.9% [IQR: 10.2%-25.5%] vs 5.7% [IQR: 1.5%-21.3%]; P = 0.008). Larger areas of elevated WSS in the AAo and entire aorta were associated with higher rates of AAo dilation >0.24 mm/y (odds ratio: 1.51; 95% CI: 1.05-2.17; P = 0.026 and odds ratio: 1.70; 95% CI: 1.01-3.15; P = 0.046, respectively). CONCLUSIONS The area of elevated AAo WSS as assessed by 4-dimensional flow CMR identified BAV patients with higher rates of aortic dilation and thus might determine which patients require closer follow-up.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Department of Biomedical Engineering, McCormick, School of Engineering, Northwestern University, Evanston, IL, USA
| | - Bradley D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert O. Bonow
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Chris Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Paul Fedak
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA,Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Alex J Barker
- Department of Radiology and Bioengineering, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Department of Biomedical Engineering, McCormick, School of Engineering, Northwestern University, Evanston, IL, USA
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13
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Abstract
BACKGROUND Prior to the recent release of appropriate use criteria for imaging valvulopathies in children, follow-up of valvular lesions, including isolated bicuspid aortic valve, was not standardised. We describe current follow up, treatment, and intervention strategies for isolated bicuspid aortic valve with varying degrees of stenosis, regurgitation, and dilation in children up to 18 years old and compare them with newly released appropriate use criteria. METHODS Online survey was sent to members of the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and PediHeartNet. RESULTS Totally, 106 responses with interpretable data were received. For asymptomatic patients with isolated BAV without stenosis, regurgitation, or dilation follow-up-intervals increased from 7+/-4 months in the newborn period to 28 +/- 14 months at 18 years of age. Respondents recommended more frequent follow-up for younger patients and those with greater disease severity. More than 80% of respondents treat aortic regurgitation or aortic dilation in the setting of bicuspid aortic valve medically. In general, intervention was recommended once stenosis or regurgitation became severe (stenosis of >4 m/s; regurgitation with LV Z score 4) regardless of age, but was not routinely recommended for younger children (newborn - age 6 years) with severe dilation. Exercise was restricted at 38+/-11 mmHg echocardiographic mean gradient. CONCLUSIONS Current follow-up, treatment, and intervention strategies for isolated bicuspid aortic valve deviate from appropriate use criteria. Differences between the two highlight the need to better delineate the disease course, clarify recommendations for care, and encourage wider adoption of guidelines.
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14
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Heidemann A, Dall'Oglio L, Bertoldi EG, Foppa M. Increased Mobility of the Atrial Septum in Aortic Root Dilation: An Observational Study on Transesophageal Echocardiography. Front Physiol 2021; 12:701399. [PMID: 34504436 PMCID: PMC8421672 DOI: 10.3389/fphys.2021.701399] [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: 04/27/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: There is a growing interest in the relationship between atrial septal anatomy and cardioembolic stroke. Anecdotal reports suggest that the enlargement of the aortic root could interfere with atrial septal mobility (ASM). We sought to investigate the association between ASM and aortic root dilation. Methods and Findings: From all consecutive clinically requested transesophageal echocardiogram (TEE) studies performed during the study period in a single institution, we were able to review and evaluate the ASM and anteroposterior length, aortic root diameter, and the prevalence of atrial septal aneurysm (ASA) and of patent foramen ovale (PFO) in 336 studies. Additional variables, such as left ventricular ejection fraction, left atrial diameter, diastolic dysfunction, age, sex, weight, height, previous stroke, atrial fibrillation, and TEE indication, were extracted from patient medical records and echocardiographic clinical reports. In 336 patients, we found a mean ASM of 3.4 mm, ranging from 0 to 21 mm; 15% had ASA and 14% had PFO. There was a 1.0 mm increase in ASM for every 10-mm increase in aortic root diameter adjusted for age, sex, weight, height, ejection fraction, and left atrial size (B = 0.1; P = 0.04). Aortic diameter was not associated with a smaller septal length (B = 0.03; P = 0.7). Conclusion: An increased motion of the atrial septum can occur in association with aortic dilation. These findings deserve attention for the relevance of aortic root anatomy in future studies involving atrial septal characteristics and embolic stroke risk.
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Affiliation(s)
- Altair Heidemann
- Graduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,NUPIC (Núcleo de Pesquisa em Imagem Cardiovascular), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lorença Dall'Oglio
- NUPIC (Núcleo de Pesquisa em Imagem Cardiovascular), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Luterana do Brasil, Porto Alegre, Brazil
| | - Eduardo Gehling Bertoldi
- Graduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Murilo Foppa
- Graduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,NUPIC (Núcleo de Pesquisa em Imagem Cardiovascular), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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15
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Ma W, Zhang J, Xu K, Yan S, Liu D, Huang H, Tang Y, Yan G, Sun Y, Li J, Zhang W, Wang C, Zhu K, Lai H. Plasma proteomic profiling reveals biomarkers associated with aortic dilation in patients with bicuspid aortic valve. Ann Transl Med 2021; 9:1182. [PMID: 34430623 PMCID: PMC8350663 DOI: 10.21037/atm-21-3378] [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] [Received: 05/18/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
Background Bicuspid aortic valve (BAV) is the most common congenital heart anomaly and is prone to cause complications, such as valvular stenosis and thoracic aortic dilation. There is currently no reliable way to predict the progression rate to thoracic aortic aneurysm. Here, we aimed to characterize the proteomic landscape in the plasma of stenotic BAV patients and provide potential biomarkers to predict progressive aortic dilation. Methods Plasma samples were obtained from 45 subjects (30 stenotic BAV patients and 15 healthy controls). All samples were properly prepared and analyzed using mass spectrometry (MS)-based label-free quantitative proteomics. Results A total of 748 plasma proteins had missingness <50%, and 193 (25.8%) were differentially expressed in the BAV patients. Functions regarding cell junction and actin cytoskeleton were largely enriched. NOTCH3, a Notch receptor known to interact with the BAV-causing gene NOTCH1, was negatively correlated with aortic diameter and was downregulated in BAV patients' plasma and aortic smooth muscle cells. Further, a subset of plasma proteins, including ADAM10, was associated with rapidly progressive aortic dilation in BAV patients. Conclusions Our data reveal unique features in the proteomic architecture of stenotic BAV patients' plasma, and we propose the potential of Notch signaling proteins NOTCH3 and ADAM10 in predicting aortic dilation.
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Affiliation(s)
- Wenrui Ma
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingjing Zhang
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kehua Xu
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shiqiang Yan
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dingqian Liu
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Huang
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuyi Tang
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guoquan Yan
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yongxin Sun
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weijia Zhang
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Zhu
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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Liu J, Yan C, Li L, Feng H, Xie S, Zhang G, Cheng W, Guo M, Liu M. Extended Stent Coverage Decreases Distal Aortic Segmental Enlargement After the Endovascular Repair of Acute Complicated Type B Aortic Dissection: A Multi-Center Retrospective Study of 814 Patients. J Endovasc Ther 2021; 29:96-108. [PMID: 34399592 DOI: 10.1177/15266028211036479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/15/2022]
Abstract
PURPOSE This study aimed to investigate the effect of distal aortic segmental enlargement (DASE) after thoracic endovascular aortic repair for complicated type B aortic dissection (cTBAD). MATERIALS AND METHODS From March 2003 to October 2018, 814 patients with acute cTBAD from 5 medical centers were retrospectively identified. DASE is indicated as the enlargement of distal aortic segmental volume ≥1.6 fold of the preoperative volume compared with the most recent postoperative computed tomography angiography (CTA) scan. Of these patients, 635 (78%) were identified as non-DASE, and 179 (22%) were identified as DASE. Competing risk analysis was performed to compare late death and distal aortic reintervention between the groups. The morphological variables and false lumen thrombosis at 7 aortic levels were measured based on the preoperative CTA and the most recent CTA. Univariate and multivariate Cox regression analyses were used to assess the independent predictors of DASE. RESULTS The mean follow-up time of the entire cohort was 5.6 years (interquartile range: 2.4-8.3 years). There were total of 208 late deaths, including 94 (14.8%) deaths in non-DASE group versus 114 (63.7%) deaths in the DASE group. Distal aortic reintervention was observed in 89 patients, with 43(6.7%) in the non-DASE group versus 46 (25.7%) in the DASE group. The cumulative incidence of late death and distal aortic reintervention were significantly higher in the DASE than in the non-DASE group (p<0.001). In morphological analysis, significant incomplete false lumen thrombosis was observed in all distal aortic segments above the aortic level of celiac artery (p<0.01). According to multivariate analysis, the Marfan syndrome, stent coverage to the level of diaphragm and the level of celiac artery were independent predictors of the DASE (p<0.001). Patients with extended stent coverage to the level of celiac artery have shown a lower incidence of DASE (p<0.010). CONCLUSION Compared with the non-DASE group, patients with DASE demonstrated a higher rate of late death and distal aortic reintervention. For the cTBAD population, extended stent-graft coverage to the aortic section between diaphragm and celiac artery might serve as a "cost-efficient" cutoff point aiming to reduce the risk of DASE.
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Affiliation(s)
- Junjun Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chaojun Yan
- Department of Cardiac Surgery, The Southwest Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, China
| | - Lubin Li
- Department of Vascular Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Hai Feng
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shengmao Xie
- Department of Critical Care Medicine, The 969th Hospital of the Joint Logistics Support Force of PLA, Huhehaote, China
| | - Guohui Zhang
- Department of Dermatology & STD, Nancheng People's Hospital, Fuzhou, China
| | - Wei Cheng
- Department of Cardiac Surgery, The Southwest Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, China
| | - Mingjin Guo
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - MingYuan Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
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Abstract
Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. BAV aortic dilatation is associated with an increased risk of adverse aortic events and represents a potentially lethal disease and hence a considerable medical burden. BAV with aortic dilatation warrants frequent monitoring, and elective surgical intervention is the only effective method to prevent dissection or rupture. The predictive value of the aortic diameter is known to be limited. The aortic diameter is presently still the main reference standard for surgical intervention owing to the lack of a comprehensive understanding of BAV aortopathy progression. This article provides a brief comprehensive review of the current knowledge on BAV aortopathy regarding clinical definitions, epidemiology, natural course, and pathophysiology, as well as hemodynamic and clinically significant aspects on the basis of the limited data available.
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Affiliation(s)
- Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenhui Deng
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tianshu Liu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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18
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Rinnström D, Dellborg M, Thilén U, Sörensson P, Nielsen NE, Christersson C, Johansson B. High prevalence of ascending aortic dilation in adults with repaired coarctation of the aorta. Cardiol Young 2021; 31:992-7. [PMID: 33597051 DOI: 10.1017/S1047951121000111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ascending aortic dilation is a feared complication in adults with repaired coarctation of the aorta, as the condition is associated with life-threatening complications such as aortic dissection and rupture. However, the data are currently limited regarding factors associated with ascending aortic dilation in these patients. METHODS AND RESULTS From the national register of congenital heart disease, 165 adult patients (≥ 18 years old) with repaired coarctation of the aorta, and echocardiographic data on aortic dimensions, were identified (61.2% male, mean age 35.8 ± 14.5 years). Aortic dilation (aortic diameters > 2 SD above reference mean) was found in 55 (33.3%) of the 165 included patients, and was associated with manifest aortic valve disease in univariable logistic regression analysis (OR 2.44, 95% CI [1.23, 4.83]). CONCLUSIONS Aortic dilation is common post-repair of coarctation of the aorta, and is associated with manifest aortic valve disease and thus indirectly with the presence of a bicuspid aortic valve. However, no association was found between aortic dilation and age or blood pressure.
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19
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Surak A, Filler G, Sharma AP, Torres Canchala LA, Grattan M. Lower prevalence of aortic dilatation among preemptive pediatric renal transplant recipients - A cross-sectional cohort study. Pediatr Transplant 2020; 24:e13716. [PMID: 32390244 DOI: 10.1111/petr.13716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/04/2020] [Revised: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aortic dilatation is a cardiovascular complication in pediatric renal transplant recipients and may have an increased risk of aortic dissection, aortic rupture, and death. Studies failed to show an association between blood pressure and aortic dilatation; however, 24-hours ambulatory blood pressure monitoring (ABPM) was not performed. There was also no comparison between preemptive transplantation and dialysis. METHODS After ethics approval, a retrospective cross-sectional study was performed on all prevalent pediatric renal transplant recipients from a single tertiary care center. The presence of aortic dilatation was determined using standard echocardiographic measurements, and those with other risk factors for aortic dilatation were excluded. Associations between 24-hours ABPM, renal function, dialysis history, and aortic dimensions were determined. RESULTS We enrolled 37 participants with the following characteristics: 46% female, mean age 14.5 ± 3.7 years, 16% preemptive transplantation, and median end-stage renal disease (ESRD) combined vintage (time from ESRD onset to echocardiogram) 597 days (range 289-1290 days). We found 16/37 patients (43%) with aortic dilatation at any level, mostly mild. There was no association between 24-hours ABPM measurements and aortic dilatation. None of the preemptively transplanted children had aortic dilatation. CONCLUSION This study confirms a high prevalence of aortic dilatation among pediatric renal transplant recipients, which appears to be independent of hypertension on 24-hour ABPM. Patients with preemptive renal transplantation did not have aortic dilatation, suggesting that the effects of dialysis may contribute to the high prevalence of this complication. Pediatric cardiologists need to carefully assess aortic dimensions in these at-risk patients.
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Affiliation(s)
- Aimann Surak
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Guido Filler
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,Departments of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,The Lilibeth Caberto Kidney Clinical Research Unit, Western University, London, ON, London, ON, Canada
| | - Ajay Parkash Sharma
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Laura Alejandra Torres Canchala
- The Lilibeth Caberto Kidney Clinical Research Unit, Western University, London, ON, London, ON, Canada.,Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Michael Grattan
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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20
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Paige SL, Lechich KM, Tierney ESS, Collins RT. Cardiac involvement in classical or hypermobile Ehlers-Danlos syndrome is uncommon. Genet Med 2020; 22:1583-1588. [PMID: 32518415 DOI: 10.1038/s41436-020-0856-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/02/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Cardiac-valvular and vascular Ehlers-Danlos syndrome (EDS) have significant cardiovascular issues. The prevalence and significance of such abnormalities in classical (cEDS) or hypermobile EDS (hEDS) remain unclear. We report the prevalence of cardiac abnormalities in patients with cEDS and hEDS. METHODS We identified 532 pediatric patients with potential EDS evaluated at our institution from January 2014 through April 2019 by retrospective chart review. Ninety-five patients (12 cEDS and 83 hEDS patients) met 2017 EDS diagnostic criteria and had an echocardiogram. One patient was excluded due to complex congenital heart disease, and two were excluded due to lack of images. We reviewed echocardiograms for all structural abnormalities. RESULTS Of these 95 patients, 1 had mild aortic root dilation, and 1 had mild ascending aorta dilation in the setting of a bicuspid aortic valve. Eleven patients (11.6%) had a cardiac valve abnormality, all of which were trivial to mild. None of the patients required cardiac intervention. CONCLUSION Our results demonstrate that aortic dilation and valvular anomalies are uncommon in cEDS or hEDS patients. Given the lack of evidence, we do not recommend echocardiographic evaluation and surveillance in patients with cEDS and hEDS in the absence of clinical findings or positive family history.
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Affiliation(s)
- Sharon L Paige
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA, USA. .,Cardiovascular Institute, Stanford University, Stanford, CA, USA.
| | - Kirstie M Lechich
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elif Seda Selamet Tierney
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA, USA.,Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - R Thomas Collins
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA, USA.,Cardiovascular Institute, Stanford University, Stanford, CA, USA.,Division of Cardiovascular Medicine, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA, USA
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21
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Parrott A, Lombardo R, Brown N, Tretter JT, Riley L, Weaver KN. Cantu syndrome: A longitudinal review of vascular findings in three individuals. Am J Med Genet A 2020; 182:1243-1248. [PMID: 32065455 DOI: 10.1002/ajmg.a.61521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 11/10/2022]
Abstract
Cantu syndrome is a rare autosomal dominant disorder caused by missense variants in ABCC9 and KCNJ8. It is characterized by hypertrichosis, neonatal macrosomia, coarse facial features, and skeletal anomalies. Reported cardiovascular anomalies include cardiomegaly, structural defects, collateral vessels, and rare report of arteriovenous malformation (AVM). Arterial dilation is reported in a few individuals including one with surgical intervention for a thoracic aortic aneurysm. The natural history of this aortopathy including the rate of progression or risk for dissection is unknown and longitudinal patient data is unavailable. We present data from vascular imaging in three individuals with genetically confirmed Cantu syndrome over 3 to 14 years of follow-up. All patients had generally stable aortic dilation, which did not reach the surgical threshold, including one individual followed closely through pregnancy. In adulthood, one individual had a maximum ascending aortic measurement of 4.2 cm. Two pediatric patients had aortic root or ascending z-scores of approximately +3. A large asymptomatic pelvic AVM was identified in one individual on head-pelvis MRI. While the data reported in these individuals is reassuring regarding the risk for progressive disease, further data from additional individuals with Cantu syndrome is needed to best inform screening recommendations, improve understanding of dissection risk, and guide management.
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Affiliation(s)
- Ashley Parrott
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachel Lombardo
- Department of Medical Genetics, UT Southwestern Medical Center, Dallas, Texas
| | - Nicole Brown
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Justin T Tretter
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura Riley
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathryn Nicole Weaver
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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22
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Duijnhouwer A, van den Hoven A, Merkx R, Schokking M, van Kimmenade R, Kempers M, Dijk AV, de Boer MJ, Roos-Hesselink J. Differences in Aortopathy in Patients with a Bicuspid Aortic Valve with or without Aortic Coarctation. J Clin Med 2020; 9:E290. [PMID: 31972995 DOI: 10.3390/jcm9020290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/15/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 01/16/2023] Open
Abstract
Objective: The combination of aortic coarctation (CoA) and bicuspid aortic valve (BAV) is assumed to be associated with a higher risk of ascending aortic dilatation and type A dissection, and current European Society of Cardiology (ESC) guidelines advise therefore to operate at a lower threshold in the presence of CoA. The aim of our study is to evaluate whether the coexistence of CoA in BAV patients is indeed associated with a higher risk of ascending aortic events (AAE). Methods: In a retrospective study, all adult BAV patients visiting the outpatient clinic of our tertiary care center between February 2003 and February 2019 were included. The primary end point was an ascending aortic event (AAE) defined as ascending aortic dissection/rupture or preventive surgery. The secondary end points were aortic dilatation and aortic growth. Results: In total, 499 BAV patients (43.7% female, age 40.3 ± 15.7 years) were included, of which 121 (24%) had a history of CoA (cBAV). An aortic event occurred in 38 (7.6%) patients at a mean age of 49.0 ± 13.6 years. In the isolated BAV group (iBAV), significantly more AAE occurred, but this was mainly driven by aortic valve dysfunction as indication for aortic surgery. There was no significant difference in the occurrence of dissection or severely dilated ascending aorta (>50 mm) between the iBAV and cBAV patients (p = 0.56). The aortic diameter was significantly smaller in the cBAV group (30.3 ± 6.9 mm versus 35.7 ± 7.6 mm; p < 0.001). The median aortic diameter increase was 0.23 (interquartile range (IQR): 0.0–0.67) mm/year and was not significantly different between both groups (p = 0.74). Conclusion: Coexistence of CoA in BAV patients was not associated with a higher risk of aortic dissection, preventive aortic surgery, aortic dilatation, or more rapid aorta growth. This study suggests that CoA is not a risk factor in BAV patients, and the advice to operate at lower diameter should be reevaluated.
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23
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Lv WY, Zhao ZG, Li SJ, Li YJ, Liao YB, Ou YW, Feng Y, Chen M. Progression of the Ascending Aortic Diameter After Transcatheter Aortic Valve Implantation: Based on Computed Tomography Images. J Invasive Cardiol 2019; 31:E234-E241. [PMID: 31368894] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The natural history of ascending aortic diameter after transcatheter aortic valve implantation (TAVI) has not been investigated. Our aim was to determine the progression of ascending aortic diameter in patients undergoing TAVI. METHODS We retrospectively included 134 patients undergoing TAVI for aortic stenosis at our institution from June 2012 to November 2016, including 79 patients with bicuspid aortic valve (BAV) and 55 patients with tricuspid aortic valve (TAV). Preoperative measurements of the ascending aorta were compared with aortic measurements at 1-year follow-up based on computed tomography images. RESULTS A very slight decrease in median aortic diameter was identified in overall patients: 4.07 cm (interquartile range [IQR], 3.76-4.54 cm) vs 4.06 cm (IQR, 3.74-4.51 cm); P=.04. Further subgroup analysis found that the decrease remained statistically significant in the subgroup of TAV and mild aortic dilation. In addition, no aortic events occurred during long-term follow-up (median, 27 months; IQR, 20-42 months). CONCLUSIONS TAVI could prevent a further progression of aortic diameter for both BAV or TAV patients by correcting hemodynamic derangements, especially for patients with TAV, mild aortic dilation, and small annulus angles. Aortic events appeared rarely during long-term follow-up after TAVI. However, our results need further confirmation with future investigations in a larger population with longer-term follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, #37 Guo Xue Alley, Chengdu, 610041, China.
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24
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van de Pol V, Bons LR, Lodder K, Kurakula KB, Sanchez-Duffhues G, Siebelink HJ, Roos-Hesselink JW, DeRuiter MC, Goumans MJ. Endothelial Colony Forming Cells as an Autologous Model to Study Endothelial Dysfunction in Patients with a Bicuspid Aortic Valve. Int J Mol Sci 2019; 20:E3251. [PMID: 31269711 DOI: 10.3390/ijms20133251] [Citation(s) in RCA: 5] [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: 06/06/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023] Open
Abstract
Bicuspid aortic valve (BAV), the most common congenital heart defect, is associated with an increased prevalence of aortic dilation, aortic rupture and aortic valve calcification. Endothelial cells (ECs) play a major role in vessel wall integrity. Little is known regarding EC function in BAV patients due to lack of patient derived primary ECs. Endothelial colony forming cells (ECFCs) have been reported to be a valid surrogate model for several cardiovascular pathologies, thereby facilitating an in vitro system to assess patient-specific endothelial dysfunction. Therefore, the aim of this study was to investigate cellular functions in ECFCs isolated from BAV patients. Outgrowth and proliferation of ECFCs from patients with BAV (n = 34) and controls with a tricuspid aortic valve (TAV, n = 10) were determined and related to patient characteristics. Interestingly, we were only able to generate ECFCs from TAV and BAV patients without aortic dilation, and failed to isolate ECFC colonies from patients with a dilated aorta. Analyzing EC function showed that while proliferation, cell size and endothelial-to-mesenchymal transition were similar in TAV and BAV ECFCs, migration and the wound healing capacity of BAV ECFCs is significantly higher compared to TAV ECFCs. Furthermore, calcification is blunted in BAV compared to TAV ECFCs. Our results reveal ECs dysfunction in BAV patients and future research is required to unravel the underlying mechanisms and to further validate ECFCs as a patient-specific in vitro model for BAV.
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25
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Oliveira D, Rosa SA, Tiago J, Ferreira RC, Agapito AF, Sequeira A. Bicuspid aortic valve aortopathies: An hemodynamics characterization in dilated aortas. Comput Methods Biomech Biomed Engin 2019; 22:815-826. [PMID: 30957542 DOI: 10.1080/10255842.2019.1597860] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/25/2022]
Abstract
Bicuspid aortic valve (BAV) aortopathy remains of difficult clinical management due to its heterogeneity and further assessment of related aortic hemodynamics is necessary. The aim of this study was to assess systolic hemodynamic indexes and wall stresses in patients with diverse BAV phenotypes and dilated ascending aortas. The aortic geometry was reconstructed from patient-specific images while the aortic valve was generated based on patient-specific measurements. Physiologic material properties and boundary conditions were applied and fully coupled fluid-structure interaction (FSI) analysis were conducted. Our dilated aortic models were characterized by the presence of abnormal hemodynamics with elevated degrees of flow skewness and eccentricity, regardless of BAV morphotype. Retrograde flow was also present. Both features, predicted by flow angle and flow reversal ratios, were consistently higher than those reported for non-dilated aortas. Right-handed helical flow was present, as well as elevated wall shear stress (WSS) on the outer ascending aortic wall. Our results suggest that the abnormal flow associated with BAV may play a role in aortic enlargement and progress it further on already dilated aortas.
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Affiliation(s)
- Diana Oliveira
- a Department of Mathematics and CEMAT , Instituto Superior Técnico, University of Lisbon , Lisbon , Portugal
| | - Sílvia Aguiar Rosa
- b Cardiology Department , Hospital de Santa Marta (CHLC) , Lisboa , Portugal
| | - Jorge Tiago
- a Department of Mathematics and CEMAT , Instituto Superior Técnico, University of Lisbon , Lisbon , Portugal
| | - Rui Cruz Ferreira
- b Cardiology Department , Hospital de Santa Marta (CHLC) , Lisboa , Portugal
| | | | - Adélia Sequeira
- a Department of Mathematics and CEMAT , Instituto Superior Técnico, University of Lisbon , Lisbon , Portugal
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26
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Deibert E, Crenshaw M, Miller MS. A patient with Phelan-McDermid syndrome and dilation of the great vessels. Clin Case Rep 2019; 7:607-611. [PMID: 30997046 PMCID: PMC6452459 DOI: 10.1002/ccr3.2003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/03/2018] [Revised: 09/28/2018] [Accepted: 12/15/2018] [Indexed: 01/22/2023] Open
Abstract
We present a patient with Phelan-McDermid syndrome, a rare neurodevelopmental disorder caused by a 22q13 deletion, with the previously undescribed finding of progressive dilation of the great arteries. While congenital heart defects have been identified in patients previously, dilation of the great arteries has not been described to our knowledge.
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Affiliation(s)
- Emily Deibert
- Florida State University College of MedicineTallahasseeFlorida
| | - Melissa Crenshaw
- Clinical GeneticsJohns Hopkins All Children’s HospitalSaint PetersburgFlorida
| | - Michelle S. Miller
- Pediatric CardiologyJohns Hopkins All Children’s HospitalSaint PetersburgFlorida
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27
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Muriello M, Kim AY, Schatz KS, Beck N, Gunay-Aygun M, Hoover-Fong JE. Growth hormone deficiency, aortic dilation, and neurocognitive issues in Feingold syndrome 2. Am J Med Genet A 2019; 179:410-416. [PMID: 30672094 PMCID: PMC7038632 DOI: 10.1002/ajmg.a.61037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/14/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 11/07/2022]
Abstract
We report three patients with Feingold 2 syndrome with the novel features of growth hormone deficiency associated with adenohypophyseal compression, aortic dilation, phalangeal joint contractures, memory, and sleep problems in addition to the typical features of microcephaly, brachymesophalangy, toe syndactyly, short stature, and cardiac anomalies. Microdeletions of chromosome 13q that include the MIR17HG gene were found in all three. One of the patients was treated successfully with growth hormone. In addition to expanding the phenotype of Feingold 2 syndrome, we suggest management of patients with Feingold 2 syndrome include echocardiography at the time of diagnosis in all patients and consideration of evaluation for growth hormone deficiency in patients with short stature.
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Affiliation(s)
- Michael Muriello
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alexander Y. Kim
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Natalie Beck
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
- Greenberg Center for Skeletal Dysplasia, Johns Hopkins University, Baltimore, Maryland
| | - Meral Gunay-Aygun
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Julie E. Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
- Greenberg Center for Skeletal Dysplasia, Johns Hopkins University, Baltimore, Maryland
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28
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Ha H, Ziegler M, Welander M, Bjarnegård N, Carlhäll CJ, Lindenberger M, Länne T, Ebbers T, Dyverfeldt P. Age-Related Vascular Changes Affect Turbulence in Aortic Blood Flow. Front Physiol 2018; 9:36. [PMID: 29422871 PMCID: PMC5788974 DOI: 10.3389/fphys.2018.00036] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 10/20/2017] [Accepted: 01/10/2018] [Indexed: 02/06/2023] Open
Abstract
Turbulent blood flow is implicated in the pathogenesis of several aortic diseases but the extent and degree of turbulent blood flow in the normal aorta is unknown. We aimed to quantify the extent and degree of turbulece in the normal aorta and to assess whether age impacts the degree of turbulence. 22 young normal males (23.7 ± 3.0 y.o.) and 20 old normal males (70.9 ± 3.5 y.o.) were examined using four dimensional flow magnetic resonance imaging (4D Flow MRI) to quantify the turbulent kinetic energy (TKE), a measure of the intensity of turbulence, in the aorta. All healthy subjects developed turbulent flow in the aorta, with total TKE of 3–19 mJ. The overall degree of turbulence in the entire aorta was similar between the groups, although the old subjects had about 73% more total TKE in the ascending aorta compared to the young subjects (young = 3.7 ± 1.8 mJ, old = 6.4 ± 2.4 mJ, p < 0.001). This increase in ascending aorta TKE in old subjects was associated with age-related dilation of the ascending aorta which increases the volume available for turbulence development. Conversely, age-related dilation of the descending and abdominal aorta decreased the average flow velocity and suppressed the development of turbulence. In conclusion, turbulent blood flow develops in the aorta of normal subjects and is impacted by age-related geometric changes. Non-invasive assessment enables the determination of normal levels of turbulent flow in the aorta which is a prerequisite for understanding the role of turbulence in the pathophysiology of cardiovascular disease.
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Affiliation(s)
- Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea.,Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Magnus Ziegler
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Martin Welander
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Thoracic and Vascular Surgery, Linköping University, Linköping, Sweden
| | - Niclas Bjarnegård
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marcus Lindenberger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Toste Länne
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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29
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Wang Y, Lin Y, Yin K, Zhu K, Yang Z, Sun Y, Lai H, Wang C. Should sinus of Valsalva be preserved in patients with bicuspid aortic valve and aortic dilation? J Thorac Dis 2017; 9:3148-3153. [PMID: 29221290 DOI: 10.21037/jtd.2017.08.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/16/2023]
Abstract
Background It is recommended that dilated ascending aortas (≥45 mm) should be replaced at the time of aortic valve replacement (AVR) for bicuspid aortic valve (BAV). The risk of progressive sinus of Valsalva dilatation after AVR and ascending aorta replacement is less clear. Methods We identified 156 patients (age 56.2±10.8 years, 46 females) who underwent AVR and ascending aorta replacement in our institution from 2010-2014, 124 (79%) of whom had BAV. Aortic root and ascending aorta sizes were determined from preoperative and the most recent echocardiograms. The mean follow-up time was 34.4±22.3 months, and 97% of patients completed the follow-up. Results The operative mortality rate was 1.3%. During a follow-up of up to 75.2 months, there were no late reoperations for aortic root dissection or rupture. The mean preoperative aortic root diameters in the tricuspid aortic valve (TAV) and BAV groups were 42.2±5.4 and 37.5±5.4 mm, respectively (P=0.69). After operation, most of the patients had reduced aortic root sizes, as the mean postoperative root diameters in the TAV and BAV groups were 39.6±5.2 and 35.7±5.1 mm, respectively (P=0.99). Conclusions To avoid the risks associated with aortic root replacement, it is reasonable to spare the aortic roots in the setting of AVR and ascending aorta replacement for BAV with a dilated ascending aorta and relatively normal sinuses of Valsalva.
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Affiliation(s)
- Yulin Wang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi Lin
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Kanhua Yin
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Kai Zhu
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhaohua Yang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yongxin Sun
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hao Lai
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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30
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Sulejmani F, Pokutta-Paskaleva A, Ziganshin B, Leshnower B, Iannucci G, Elefteriades J, Sun W. Biomechanical properties of the thoracic aorta in Marfan patients. Ann Cardiothorac Surg 2017; 6:610-624. [PMID: 29270373 DOI: 10.21037/acs.2017.09.12] [Citation(s) in RCA: 14] [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] [Indexed: 01/20/2023]
Abstract
Background Marfan syndrome (MFS), a genetic disorder of the connective tissue, has been strongly linked to dilation of the thoracic aorta, among other cardiovascular complications. As a result, MFS patients frequently suffer from aortic dissection and rupture, contributing to the high rate of mortality and morbidity among MFS patients. Despite the significant effort devoted to the investigation of mechanical and structural properties of aneurysmal tissue, studies on Marfan aneurysmal biomechanics are scarce. Ex vivo mechanical characterization of MFS aneurysmal tissue can provide a better insight into tissue strength outside the physiologic loading range and serve as a basis for improved risk assessment and failure prediction. Methods The mechanical and microstructural properties of MFS aneurysmal thoracic aorta (MFS, n=15, 39.5±3.91 years), non-MFS aneurysmal thoracic aorta (TAA, n=8, 52.8±4.9 years), healthy human thoracic aorta (HH, n=8, 75.4±6.1 years), and porcine thoracic aorta (n=10) are investigated. Planar biaxial tensile testing and uniaxial failure testing were utilized to characterize the mechanical and failure properties of the tissue, respectively. Verhoeff-Van Gieson (VVG) and PicroSirius Red stains were utilized to visualize the elastin and collagen fiber architecture, respectively. Results MFS tissue was found to have age-dependent but diameter-independent mechanical, structural, and morphological properties, also showing extensive elastin fiber degradation. Non-MFS thoracic aneurysmal aorta was thicker and stiffer than age-matched MFS tissue. Moreover, non-MFS thoracic aneurysmal mechanics resembled closely the mechanics of older healthy human tissue. Younger MFS tissue (<40 years) exhibited similar mechanical and structural properties to aged porcine tissue. Conclusions Both age and aneurysmal presence were found to be factors associated with increased stiffness in aortic tissue, and aortic diameter was not a significant determinant of mechanical property deterioration. Additionally, the presence of MFS was found to induce stiffening of the thoracic aorta, although not to the extent of the non-MFS aneurysm.
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Affiliation(s)
- Fatiesa Sulejmani
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Anastassia Pokutta-Paskaleva
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Bulat Ziganshin
- Aortic Institute of Yale-New Haven Hospital, New Haven, CT, USA
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Glen Iannucci
- Sibley Heart Center Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Wei Sun
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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31
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Martínez-Micaelo N, Beltrán-Debón R, Aragonés G, Faiges M, Alegret JM. MicroRNAs Clustered within the 14q32 Locus Are Associated with Endothelial Damage and Microparticle Secretion in Bicuspid Aortic Valve Disease. Front Physiol 2017; 8:648. [PMID: 28928672 PMCID: PMC5591958 DOI: 10.3389/fphys.2017.00648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 03/31/2017] [Accepted: 08/16/2017] [Indexed: 01/03/2023] Open
Abstract
Background: We previously described that PECAM+ circulating endothelial microparticles (EMPs) are elevated in bicuspid aortic valve (BAV) disease as a manifestation of endothelial damage. In this study, we hypothesized that this endothelial damage, is functionally related to the secretion of a specific pattern of EMP-associated miRNAs. Methods: We used a bioinformatics approach to correlate the PECAM+ EMP levels with the miRNA expression profile in plasma in healthy individuals and BAV patients (n = 36). In addition, using the miRNAs that were significantly associated with PECAM+ EMP levels, we inferred a miRNA co-expression network using a Gaussian graphical modeling approach to identify highly co-expressed miRNAs or miRNA clusters whose expression could functionally regulate endothelial damage. Results: We identified a co-expression network composed of 131 miRNAs whose circulating expression was significantly associated with PECAM+ EMP levels. Using a topological analysis, we found that miR-494 was the most important hub within the co-expression network. Furthermore, through positional gene enrichment analysis, we identified a cluster of 19 highly co-expressed miRNAs, including miR-494, that was located in the 14q32 locus on chromosome 14 (p = 1.9 × 10−7). We evaluated the putative biological role of this miRNA cluster by determining the biological significance of the genes targeted by the cluster using functional enrichment analysis. We found that this cluster was involved in the regulation of genes with various functions, specifically the “cellular nitrogen compound metabolic process” (p = 2.34 × 10−145), “immune system process” (p = 2.57 × 10−6), and “extracellular matrix organization” (p = 8.14 × 10−5) gene ontology terms and the “TGF-β signaling pathway” KEGG term (p = 2.59 × 10−8). Conclusions: Using an integrative bioinformatics approach, we identified the circulating miRNA expression profile associated with secreted PECAM+ EMPs in BAV disease. Additionally, we identified a highly co-expressed miRNA cluster that could mediate crucial biological processes in BAV disease, including the nitrogen signaling pathway, cellular activation, and the transforming growth factor beta signaling pathway. In conclusion, EMP-associated and co-expressed miRNAs could act as molecular effectors of the intercellular communication carried out by EMPs in response to endothelial damage.
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Affiliation(s)
- Neus Martínez-Micaelo
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain
| | - Raúl Beltrán-Debón
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain
| | - Gerard Aragonés
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain
| | - Marta Faiges
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain
| | - Josep M Alegret
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain.,Servei de Cardiologia, Hospital Universitari de Sant Joan, Universitat Rovira i VirgiliReus, Spain
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Somerville S, Rosolowsky E, Suntratonpipat S, Girgis R, Goot BH, Tham EB. Cardiac Magnetic Resonance Imaging in Pediatric Turner Syndrome. J Pediatr 2016; 175:111-115.e1. [PMID: 27233524 DOI: 10.1016/j.jpeds.2016.04.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/14/2016] [Revised: 03/17/2016] [Accepted: 04/22/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To compare the detection of cardiac lesions with the use of cardiac magnetic resonance imaging (CMR) and conventional echocardiography in children with Turner syndrome. STUDY DESIGN Twenty-four girls with Turner syndrome, 8-18 years of age, were recruited through the Pediatric Endocrinology Program. Participants underwent CMR and echocardiography within a 2-year period, and discrepancies between the results of each modality were identified. RESULTS Fifteen of 24 (63%) girls had a cardiac lesion identified on CMR or echocardiography. Both modalities identified the same lesion in 10 of 15 (67%); however, 6 of 15 (40%) participants had a lesion identified on CMR but not echocardiography. Participants with a missed lesion had a trend towards greater body mass index. Aortic dilation and bicuspid aortic valve were the most commonly missed lesions by echocardiography. CONCLUSIONS CMR identifies significant cardiac lesions missed by echocardiography in pediatric patients with Turner syndrome, particularly along the aorta. These findings support the current guidelines that recommend screening CMR in addition to echocardiogram. Early identification of cardiac abnormalities in patients with Turner syndrome will allow for a greater understanding of the natural history in these patients and potentially identify candidates for earlier intervention.
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Affiliation(s)
- Scott Somerville
- Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Somjate Suntratonpipat
- Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Rose Girgis
- Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin H Goot
- Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Edythe B Tham
- Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
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de Boysson H, Liozon E, Lambert M, Parienti JJ, Artigues N, Geffray L, Boutemy J, Ollivier Y, Maigné G, Ly K, Huglo D, Hachulla E, Hatron PY, Aouba A, Manrique A, Bienvenu B. 18F-fluorodeoxyglucose positron emission tomography and the risk of subsequent aortic complications in giant-cell arteritis: A multicenter cohort of 130 patients. Medicine (Baltimore) 2016; 95:e3851. [PMID: 27367985 PMCID: PMC4937899 DOI: 10.1097/md.0000000000003851] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Previous studies reported a 2- to 17-fold higher risk of aortic complications (dilation or dissection) in patients with giant-cell arteritis (GCA). We aimed to determine whether or not GCA patients with large-vessel involvement demonstrated by positron emission tomography with F-fluorodeoxyglucose combined with computed tomography (FDG-PET/CT) have a higher risk of aortic complications. We conducted a retrospective multicenter study between 1995 and 2014. Patients were included if they fulfilled at least 3 American College of Rheumatology criteria for GCA, or 2 criteria associated with extratemporal biopsy-proven giant-cell vasculitis; they underwent at least 1 FDG-PET/CT scan at diagnosis or during follow-up; and the morphology of the aorta was assessed by medical imaging at diagnosis. Patients with an aortic complication at the time of diagnosis were excluded. Of the 130 patients included [85 women (65%), median age 70 (50-86)], GCA was biopsy proven in 77 (59%). FDG-PET/CT was performed at diagnosis in 63 (48%) patients and during the follow-up period in the 67 (52%) remaining patients. FDG-PET/CT was positive in 38/63 (60%) patients at diagnosis and in 31/67 (46%) patients when performed during follow-up (P = NS). One hundred four patients (80%) underwent at least 1 morphological assessment of the aorta during follow-up. Nine (9%) patients developed aortic complications (dilation in all and dissection in 1) at a median time of 33 (6-129) months after diagnosis. All of them displayed large-vessel inflammation on previous FDG-PET/CT. A positive FDG-PET/CT was significantly associated with a higher risk of aortic complications (P = 0.004).In our study, a positive FDG-PET/CT was associated with an increased risk of aortic complications at 5 years.
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Affiliation(s)
- Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Basse-Normandie University
- Correspondence: Hubert de Boysson, Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France (e-mail: )
| | - Eric Liozon
- Department of Internal Medicine, Limoges University Hospital
| | - Marc Lambert
- Department of Internal Medicine, Lille University Hospital
| | | | | | - Loïk Geffray
- Department of Internal Medicine, Lisieux Hospital
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Basse-Normandie University
| | - Yann Ollivier
- Department of Internal Medicine, Caen University Hospital, Basse-Normandie University
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Basse-Normandie University
| | - Kim Ly
- Department of Internal Medicine, Limoges University Hospital
| | - Damien Huglo
- Department of Nuclear Medicine, Lille University Hospital
| | - Eric Hachulla
- Department of Internal Medicine, Lille University Hospital
| | | | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Basse-Normandie University
| | - Alain Manrique
- Department of Nuclear Medicine, Caen University Hospital, Normandie University France
| | - Boris Bienvenu
- Department of Internal Medicine, Caen University Hospital, Basse-Normandie University
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Seki M, Kuwata S, Kurishima C, Nakagawa R, Inuzuka R, Sugimoto M, Saiki H, Iwamoto Y, Ishido H, Masutani S, Senzaki H. Mechanism of aortic root dilation and cardiovascular function in tetralogy of Fallot. Pediatr Int 2016; 58:323-30. [PMID: 26809655 DOI: 10.1111/ped.12932] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 09/09/2015] [Revised: 01/05/2016] [Accepted: 01/20/2016] [Indexed: 01/19/2023]
Abstract
The aortic root dilation in tetralogy of Fallot (TOF) is a long-term clinical problem, because a severely dilated aorta can lead to aortic regurgitation, dissection, or rupture, which can be fatal, necessitating surgical intervention. The details of the mechanism of aortic root dilation, however, are unclear. We have shown that aortic stiffness is increased in patients with repaired TOF, and may mirror the histological abnormality of elastic fiber disruption and matrix expansion. This aortic stiffness is related closely to the aortic dilation, indicating that aortic stiffness may be a predictor of outcome of aortic dilation. Furthermore, the aortic volume overload is a very important determinant of aortic diameter in TOF patients before corrective surgery. In addition, a chromosomal abnormality and the transforming growth factor-β signaling pathway, a major contributor to aortic dilation in Marfan syndrome, also affect this mechanism. In this way, aortic dilation in TOF patients is suggested to be a multifactorial disorder. The aim of this review was therefore to clarify the mechanism of aortic dilation in TOF, focusing on recent research findings. Studies linking histopathology, mechanical properties, molecular/cellular physiology, and clinical manifestations of aortic dilation facilitate appropriate treatment intervention and improvement of long-term prognosis of TOF.
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Affiliation(s)
- Mitsuru Seki
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.,Department of Pediatrics, Gunma University School of Medicine, Maebashi, Gunma, Japan
| | - Seiko Kuwata
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Clara Kurishima
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.,Department of Pediatric Cardiology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Ryo Nakagawa
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.,Johns Hopkins Medical Institute, Baltimore, Maryland, USA
| | - Ryo Inuzuka
- Department of Pediatrics, University of Tokyo Hospital, Bunkyo, Tokyo, Japan
| | - Masaya Sugimoto
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hirofumi Saiki
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.,Mayo Clinic, Rochester, Minnesota, USA
| | - Yoichi Iwamoto
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Hirotaka Ishido
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Satoshi Masutani
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Hideaki Senzaki
- Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Somers AE, Hinton RB, Pilipenko V, Miller E, Ware SM. Analysis of TGFBR1*6A variant in individuals evaluated for Marfan syndrome. Am J Med Genet A 2016; 170:1786-90. [PMID: 27112580 DOI: 10.1002/ajmg.a.37668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/23/2015] [Accepted: 04/07/2016] [Indexed: 11/11/2022]
Abstract
Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS) are genetic disorders that affect connective tissue as a result of dysregulated TGF-β signaling. MFS is most frequently caused by mutations in FBN1 whereas Loeys-Dietz syndrome results from mutations in TGFBR1 or TGFBR2. There is substantial inter- and intra-familial phenotypic variability among these disorders, suggesting the presence of genetic modifiers. Previously, a polymorphism in the TGFβR1 protein termed the TFGBR1*6A allele was found to be overrepresented in patients with MFS and was identified as a low penetrance allele with suggestion as a possible modifier. To further investigate the importance of this variant, a retrospective review of genetic and phenotypic findings was conducted for 335 patients evaluated for suspicion of MFS or related disorders. In patients with a diagnosis of MFS, the presence of the TFGBR1*6A allele was not associated with phenotypic differences. Similarly, careful phenotyping of patients who carried the TFGBR1*6A allele but did not have MFS did not identify an altered frequency of specific connective tissue features. In this small cohort, the results did not reach significance to identify the TFGBR1*6A allele as a major modifier for aortic dilation, ectopia lentis, or systemic features associated with MFS or other connective tissue disorders. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Robert B Hinton
- University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Valentina Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin Miller
- University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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36
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Morris CA, Mervis CB, Paciorkowski AP, Abdul-Rahman O, Dugan SL, Rope AF, Bader P, Hendon LG, Velleman SL, Klein-Tasman BP, Osborne LR. 7q11.23 Duplication syndrome: Physical characteristics and natural history. Am J Med Genet A 2015; 167A:2916-35. [PMID: 26333794 PMCID: PMC5005957 DOI: 10.1002/ajmg.a.37340] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 06/04/2015] [Accepted: 08/08/2015] [Indexed: 01/17/2023]
Abstract
In order to describe the physical characteristics, medical complications, and natural history of classic 7q11.23 duplication syndrome [hereafter Dup7 (MIM 609757)], reciprocal duplication of the region deleted in Williams syndrome [hereafter WS (MIM 194050)], we systematically evaluated 53 individuals aged 1.25-21.25 years and 11 affected adult relatives identified in cascade testing. In this series, 27% of probands with Dup7 had an affected parent. Seven of the 26 de novo duplications that were examined for inversions were inverted; in all seven cases one of the parents had the common inversion polymorphism of the WS region. We documented the craniofacial features of Dup7: brachycephaly, broad forehead, straight eyebrows, broad nasal tip, low insertion of the columella, short philtrum, thin upper lip, minor ear anomalies, and facial asymmetry. Approximately 30% of newborns and 50% of older children and adults had macrocephaly. Abnormalities were noted on neurological examination in 88.7% of children, while 81.6% of MRI studies showed structural abnormalities such as decreased cerebral white matter volume, cerebellar vermis hypoplasia, and ventriculomegaly. Signs of cerebellar dysfunction were found in 62.3%, hypotonia in 58.5%, Developmental Coordination Disorder in 74.2%, and Speech Sound Disorder in 82.6%. Behavior problems included anxiety disorders, ADHD, and oppositional disorders. Medical problems included seizures, 19%; growth hormone deficiency, 9.4%; patent ductus arteriosus, 15%; aortic dilation, 46.2%; chronic constipation, 66%; and structural renal anomalies, 18%. We compare these results to the WS phenotype and offer initial recommendations for medical evaluation and surveillance of individuals who have Dup7.
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Affiliation(s)
- Colleen A. Morris
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV
| | - Carolyn B. Mervis
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
| | - Alex P. Paciorkowski
- Center for Neural Development and Disease, Departments of Neurology, Pediatrics, and Biomedical Genetics, University of Rochester Medical Center, Rochester, NY
| | - Omar Abdul-Rahman
- Department of Pediatrics University of Mississippi Medical Center, Jackson, MS
| | - Sarah L. Dugan
- Division of Medical Genetics, University of Utah, Salt Lake City, UT
| | - Alan F. Rope
- Department of Medical Genetics, Kaiser Permanente, Portland OR
| | | | - Laura G. Hendon
- Department of Pediatrics University of Mississippi Medical Center, Jackson, MS
| | - Shelley L. Velleman
- Department of Communication Sciences and Disorders, University of Vermont, Burlington, VT
| | | | - Lucy R. Osborne
- Departments of Medicine and Molecular Genetics and Institute of Medical Science, University of Toronto, Toronto ON, Canada
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37
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Prakash A, Adlakha H, Rabideau N, Hass CJ, Morris SA, Geva T, Gauvreau K, Singh MN, Lacro RV. Segmental Aortic Stiffness in Children and Young Adults With Connective Tissue Disorders: Relationships With Age, Aortic Size, Rate of Dilation, and Surgical Root Replacement. Circulation 2015; 132:595-602. [PMID: 26115544 DOI: 10.1161/circulationaha.114.014934] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 12/15/2014] [Accepted: 06/15/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic diameter is an imperfect predictor of aortic complications in connective tissue disorders (CTDs). Novel indicators of vascular phenotype severity such as aortic stiffness and vertebral tortuosity index have been proposed. We assessed the relation between aortic stiffness by cardiac MRI, surgical root replacement, and rates of aortic root dilation in children and young adults with CTDs. METHODS AND RESULTS Retrospective analysis of cardiac MRI data on children and young adults with a CTD was performed to derive aortic stiffness measures (strain, distensibility, and β-stiffness index) at the aortic root, ascending aorta, and descending aorta. Vertebral tortuosity index was calculated as previously described. Rate of aortic root dilation before cardiac MRI was calculated as change in echocardiographic aortic root diameter z score per year. In 83 CTD patients (median age, 24 years; range, 1-55; 17% <18 years of age; 60% male), ascending aorta distensibility was reduced in comparison with published normative values: median z score, -1.93 (range, -8.7 to 1.3; P<0.0001 versus normals). Over a median follow-up period of 2.7 years, there were no aortic dissections or deaths, but 16 of 83 (19%) patients underwent surgical aortic root replacement. In multivariable analysis, lower aortic root strain (P=0.05) and higher vertebral tortuosity index (P=0.01) were independently associated with aortic root replacement. Lower ascending aorta strain (P=0.02) was associated with a higher rate of aortic root dilation. CONCLUSIONS Higher aortic stiffness is associated with higher rates of surgical aortic replacement and aortic root dilation in children and young adults with CTDs.
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Affiliation(s)
- Ashwin Prakash
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.).
| | - Himanshu Adlakha
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.)
| | - Nicole Rabideau
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.)
| | - Cara J Hass
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.)
| | - Shaine A Morris
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.)
| | - Tal Geva
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.)
| | - Kimberlee Gauvreau
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.)
| | - Michael N Singh
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.)
| | - Ronald V Lacro
- From Department of Cardiology, Boston Children's Hospital, MA (A.P., H.A., N.R., C.J.H., S.A.M., T.G., K.G., M.N.S., R.V.L); and Department of Pediatrics, Harvard Medical School, Boston, MA (A.P., T.G., M.N.S., R.V.L.)
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Villafañe J, Lantin-Hermoso MR, Bhatt AB, Tweddell JS, Geva T, Nathan M, Elliott MJ, Vetter VL, Paridon SM, Kochilas L, Jenkins KJ, Beekman RH, Wernovsky G, Towbin JA. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol 2014; 64:498-511. [PMID: 25082585 DOI: 10.1016/j.jacc.2014.06.1150] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 01/25/2023]
Abstract
This paper aims to update clinicians on "hot topics" in the management of patients with D-loop transposition of the great arteries (D-TGA) in the current surgical era. The arterial switch operation (ASO) has replaced atrial switch procedures for D-TGA, and 90% of patients now reach adulthood. The Adult Congenital and Pediatric Cardiology Council of the American College of Cardiology assembled a team of experts to summarize current knowledge on genetics, pre-natal diagnosis, surgical timing, balloon atrial septostomy, prostaglandin E1 therapy, intraoperative techniques, imaging, coronary obstruction, arrhythmias, sudden death, neoaortic regurgitation and dilation, neurodevelopmental (ND) issues, and lifelong care of D-TGA patients. In simple D-TGA: 1) familial recurrence risk is low; 2) children diagnosed pre-natally have improved cognitive skills compared with those diagnosed post-natally; 3) echocardiography helps to identify risk factors; 4) routine use of BAS and prostaglandin E1 may not be indicated in all cases; 5) early ASO improves outcomes and reduces costs with a low mortality; 6) single or intramural coronary arteries remain risk factors; 7) post-ASO arrhythmias and cardiac dysfunction should raise suspicion of coronary insufficiency; 8) coronary insufficiency and arrhythmias are rare but are associated with sudden death; 9) early- and late-onset ND abnormalities are common; 10) aortic regurgitation and aortic root dilation are well tolerated; and 11) the aging ASO patient may benefit from "exercise-prescription" rather than restriction. Significant strides have been made in understanding risk factors for cardiac, ND, and other important clinical outcomes after ASO.
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Affiliation(s)
- Juan Villafañe
- Department of Pediatrics (Cardiology), University of Kentucky, Lexington, Kentucky.
| | | | - Ami B Bhatt
- Adult Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James S Tweddell
- Cardiothoracic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin J Elliott
- Department of Pediatric Cardiothoracic Surgery, The Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Victoria L Vetter
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Paridon
- Department of Exercise Physiology, Perlman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lazaros Kochilas
- University of Minnesota Children's Hospital, Minneapolis, Minnesota
| | - Kathy J Jenkins
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert H Beekman
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gil Wernovsky
- The Heart Program, Miami Children's Hospital, Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Jeffrey A Towbin
- The Heart Institute, Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Garcia J, Barker AJ, van Ooij P, Schnell S, Puthumana J, Bonow RO, Collins JD, Carr JC, Markl M. Assessment of altered three-dimensional blood characteristics in aortic disease by velocity distribution analysis. Magn Reson Med 2014; 74:817-25. [PMID: 25252029 DOI: 10.1002/mrm.25466] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 06/17/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE To test the feasibility of velocity distribution analysis for identifying altered three-dimensional (3D) flow characteristics in patients with aortic disease based on 4D flow MRI volumetric analysis. METHODS Forty patients with aortic (Ao) dilation (mid ascending aortic diameter MAA = 40 ± 7 mm, age = 56 ± 17 years, 11 females) underwent cardiovascular MRI. Four groups were retrospectively defined: mild Ao dilation (n = 10; MAA < 35 mm); moderate Ao dilation (n = 10; 35 < MAA < 45 mm); severe Ao dilation (n = 10; MAA > 45 mm); Ao dilation+aortic stenosis AS (n = 10; MAA > 35 mm and peak velocity > 2.5 m/s). The 3D PC-MR angiograms were computed and used to obtain a 3D segmentation of the aorta which was divided into four segments: root, ascending aorta, arch, descending aorta. Radial chart displays were used to visualize multiple parameters representing segmental changes in the 3D velocity distribution associated with aortic disease. RESULTS Changes in the velocity field and geometry between cohorts resulted in distinct hemodynamic patterns for each aortic segment. Disease progression from mild to Ao dilation + AS resulted in significant differences (P < 0.05) in flow parameters across cohorts and increased radial chart size for root and ascending aorta segments by 146% and 99%, respectively. CONCLUSION Volumetric 4D velocity distribution analysis has the potential to identify characteristic changes in regional blood flow patterns in patients with aortic disease.
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Affiliation(s)
- Julio Garcia
- Department of Radiology, Northwestern University, Chicago, USA
| | - Alex J Barker
- Department of Radiology, Northwestern University, Chicago, USA
| | - Pim van Ooij
- Department of Radiology, Northwestern University, Chicago, USA
| | - Susanne Schnell
- Department of Radiology, Northwestern University, Chicago, USA
| | - Jyothy Puthumana
- Department of Medicine - Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Robert O Bonow
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | | | - James C Carr
- Department of Radiology, Northwestern University, Chicago, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, USA.,Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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Tilton RK, Wilkens A, Krantz ID, Izumi K. Cardiac manifestations of Pallister-Killian syndrome. Am J Med Genet A 2014; 164A:1130-5. [PMID: 24504854 DOI: 10.1002/ajmg.a.36413] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 02/08/2013] [Accepted: 12/07/2013] [Indexed: 11/10/2022]
Abstract
Pallister-Killian syndrome (PKS) is a sporadic multisystem genetic diagnosis characterized by facial dysmorphia, variable developmental delay and intellectual impairment, hypotonia, hearing loss, seizures, differences in skin pigmentation, temporal alopecia, diaphragmatic hernia, congenital heart defects, and other systemic abnormalities. Although congenital heart defects have been described in association with PKS, the full spectrum of heart disease is still not entirely known. Here, we describe the pattern of cardiac findings of 81 probands with PKS who have had at least one cardiac evaluation, demonstrating structural heart difference in 37% of our cohort (n = 30). Septal defects such as atrial or ventricular septal defects (n = 12) were the most commonly seen congenital heart differences. Additional findings included the occasional occurrence of bicuspid aortic valve, aortic dilatation, and cardiac hypertrophy/cardiomyopathy. We suggest cardiac evaluation for all individuals with PKS at the time of diagnosis as well as subsequent longitudinal follow-up to monitor for the development of cardiomyopathy and aortic dilatation.
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Affiliation(s)
- Richard K Tilton
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Temple University School of Medicine, Philadelphia, Pennsylvania
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