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Wilkes JK, Doan TT, Morris SA, Altman CA, Ayres NA, Schoppe L, Nguyen M, Pignatelli R, Furtun BY. Right Ventricular Global Longitudinal Strain in Fetuses with Hypoplastic Left Heart Syndrome Does Not Differ Between Those With and Without Genetic Conditions. Pediatr Cardiol 2022; 43:655-664. [PMID: 34812908 DOI: 10.1007/s00246-021-02770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
The presence of a genetic condition is a risk factor for increased mortality in hypoplastic left heart syndrome (HLHS). Speckle tracking strain analysis in interstage echocardiograms have shown promise in identifying patients with HLHS at increased risk of mortality. We hypothesized that fetuses with a genetic condition and HLHS have impaired right ventricular global longitudinal strain compared with fetuses with HLHS and no evident genetic condition. We performed a retrospective analysis of 60 patients diagnosed in fetal life with HLHS from 11/2015 to 11/2019. We evaluated presenting echocardiograms and calculated right ventricular global longitudinal strain (RV GLS) and fractional area of change (FAC) using post-processing software. We first compared RV GLS and FAC between those with genetic conditions to those without. We examined the secondary outcome of mortality among those with and without genetic conditions and among HLHS subgroups. Of the 60 patients with available genetic testing, 11 (18%) had an identified genetic condition. Neither RV GLS nor FAC was significantly different between patients with and without genetic conditions. There was no difference in RV GLS or FAC among HLHS phenotype or those who died or survived as infants. However, patients with a genetic syndrome had increased neonatal and overall mortality. In this cohort, RV GLS did not differ between those with and without a genetic diagnosis, among HLHS phenotypes, or between those surviving and dying as infants. Further analysis of strain throughout gestation and after birth could provide insight into the developing heart in fetuses with HLHS.
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Affiliation(s)
- J Kevin Wilkes
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA.
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, E1920, Houston, TX, 77030, USA.
| | - Tam T Doan
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Shaine A Morris
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Carolyn A Altman
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Nancy A Ayres
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Lacey Schoppe
- Texas Children's Hospital Fetal Center, 6651 Main St, Suite 420, Houston, TX, 77030, USA
| | - Magnolia Nguyen
- Texas Children's Hospital Fetal Center, 6651 Main St, Suite 420, Houston, TX, 77030, USA
| | - Ricardo Pignatelli
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Betul Yilmaz Furtun
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
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Donepudi R, Belfort MA, Shamshirsaz AA, Lee TC, Keswani SG, King A, Ayres NA, Fernandes CJ, Sanz-Cortes M, Nassr AA, Espinoza AF, Style CC, Espinoza J. Fetal endoscopic tracheal occlusion and pulmonary hypertension in moderate congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2021; 35:6967-6972. [PMID: 34096456 DOI: 10.1080/14767058.2021.1932806] [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: 10/21/2022]
Abstract
OBJECTIVE To study the role of fetal endoscopic tracheal occlusion (FETO) on resolution of pulmonary hypertension (PH) in fetuses with isolated moderate left-sided diaphragmatic hernia (CDH). METHODS This retrospective study included fetuses with CDH evaluated between February 2004 and July 2017. Using the tracheal occlusion to accelerate lung growth (TOTAL) trial definition, we classified fetuses into moderate left CDH if O/E-LHR (observed/expected-lung head ratio) was 25-34.9% regardless of liver position or O/E-LHR of 35-44.9% if liver was in the chest. Postnatal echocardiograms were used to diagnose PH. Logistic regression analyses were performed to determine the relationship of FETO with study outcomes. RESULTS Of 184 cases with no other major anomalies, 30 (16%) met criteria. There were nine FETO and 21 non-FETO cases. By hospital discharge, a higher proportion of infants in the FETO group had resolution of PH (87.5 (7/8) vs. 40% (8/20); p=.013). FETO was associated with adjusted odds ratio of 17.3 (95% CI: 1.75-171; p=.015) to resolve PH by hospital discharge. No significant differences were noted in need for ECMO or survival to discharge between groups. CONCLUSIONS Infants with moderate left-sided CDH according to O/E-LHR, FETO is associated with resolution of PH by the time of hospital discharge.
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Affiliation(s)
- Roopali Donepudi
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alireza A Shamshirsaz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Timothy C Lee
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sundeep G Keswani
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alice King
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nancy A Ayres
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics - Cardiology Section, Baylor College of Medicine, Houston, TX, USA
| | - Caraciolo J Fernandes
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Newborn Section, Baylor College of Medicine, Houston, TX, USA
| | - Magdalena Sanz-Cortes
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Ahmed A Nassr
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Andres F Espinoza
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Candace C Style
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jimmy Espinoza
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Style CC, Olutoye OO, Belfort MA, Ayres NA, Cruz SM, Lau PE, Shamshirsaz AA, Lee TC, Olutoye OA, Fernandes CJ, Cortes MS, Keswani SG, Espinoza J. Fetal endoscopic tracheal occlusion reduces pulmonary hypertension in severe congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2019; 54:752-758. [PMID: 30640410 DOI: 10.1002/uog.20216] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/19/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Fetal endoscopic tracheal occlusion (FETO) is associated with increased perinatal survival and reduced need for extracorporeal membrane oxygenation (ECMO) in fetuses with severe congenital diaphragmatic hernia (CDH). This study evaluates the impact of FETO on the resolution of pulmonary hypertension (PH) in fetuses with isolated CDH. METHODS We reviewed retrospectively the medical records of all fetuses evaluated for CDH between January 2004 and July 2017 at a single institution. Fetuses with additional major structural or chromosomal abnormalities were excluded. CDH cases were classified retrospectively into mild, moderate and severe groups based on prenatal magnetic resonance imaging indices (observed-to-expected total fetal lung volume and percentage of intrathoracic liver herniation). Presence of PH was determined based on postnatal echocardiograms. Logistic regression analyses were performed to evaluate the relationship between FETO and resolution of PH by 1 year of age while controlling for side of the CDH, use of ECMO, gestational age at diagnosis, gestational age at delivery, fetal gender, sildenafil use at discharge and CDH severity. Resolution of PH by 1 year of age was compared between a cohort of fetuses with severe CDH that underwent FETO and a cohort that did not have the procedure (non-FETO). A subanalysis was performed restricting the analysis to isolated left CDH. Parametric and non-parametric tests were used for comparisons. RESULTS Of 257 CDH cases evaluated, 72% (n = 184) had no major structural or chromosomal anomalies of which 58% (n = 107) met the study inclusion criteria. The FETO cohort consisted of 19 CDH cases and the non-FETO cohort (n = 88) consisted of 31 (35%) mild, 32 (36%) moderate and 25 (28%) severe CDH cases. All infants with severe CDH, regardless of whether they underwent FETO, had evidence of neonatal PH. FETO (OR, 3.57; 95% CI, 1.05-12.10; P = 0.041) and ECMO (OR, 5.01; 95% CI, 2.10-11.96; P < 0.001) were independent predictors of resolution of PH by 1 year of age. A higher proportion of infants with severe CDH that underwent FETO had resolution of PH by 1 year after birth compared with infants with severe CDH in the non-FETO cohort (69% (11/16) vs 28% (7/25); P = 0.017). Similar results were observed when the analysis was restricted to cases with left-sided CDH (PH resolution in 69% (11/16) vs 28% (5/18); P = 0.032). CONCLUSION In infants with severe CDH, FETO and ECMO are independently associated with increased resolution of PH by 1 year of age. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C C Style
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - O O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - N A Ayres
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Cardiology Section, Baylor College of Medicine, Houston, TX, USA
| | - S M Cruz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - P E Lau
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - A A Shamshirsaz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - T C Lee
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - O A Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - C J Fernandes
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Newborn Section, Baylor College of Medicine, Houston, TX, USA
| | - M Sanz Cortes
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - S G Keswani
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - J Espinoza
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
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Belfort MA, Morris SA, Espinoza J, Shamshirsaz AA, Sanz Cortes M, Justino H, Ayres NA, Qureshi AM. Thulium laser-assisted atrial septal stent placement: first use in fetal hypoplastic left heart syndrome and intact atrial septum. Ultrasound Obstet Gynecol 2019; 53:417-418. [PMID: 30353586 DOI: 10.1002/uog.20161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Affiliation(s)
- M A Belfort
- Departments of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - S A Morris
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - J Espinoza
- Departments of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - A A Shamshirsaz
- Departments of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - M Sanz Cortes
- Departments of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - H Justino
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - N A Ayres
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - A M Qureshi
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Buffie AW, Belfort MA, Shamshirsaz AA, Justino H, Qureshi AM, Ayres NA, Morris SA, Espinoza J. Two- and Four-dimensional Ultrasonography of an Interatrial Stent in a Fetus With Hypoplastic Left Heart Syndrome. J Ultrasound Med 2019; 38:549-551. [PMID: 30058144 DOI: 10.1002/jum.14718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Michael A Belfort
- Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Alireza A Shamshirsaz
- Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Henri Justino
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Nancy A Ayres
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Shaine A Morris
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Jimmy Espinoza
- Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Edwards LA, Lara DA, Sanz Cortes M, Hunter JV, Andreas S, Nguyen MJ, Schoppe LJ, Zhang J, Smith EM, Maskatia SA, Sexson-Tejtel SK, Lopez KN, Lawrence EJ, Wang Y, Challman M, Ayres NA, Altman CA, Aagaard K, Becker JA, Morris SA. Chronic Maternal Hyperoxygenation and Effect on Cerebral and Placental Vasoregulation and Neurodevelopment in Fetuses with Left Heart Hypoplasia. Fetal Diagn Ther 2018; 46:45-57. [PMID: 30223262 DOI: 10.1159/000489123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/19/2018] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In a pilot study of chronic maternal hyperoxygenation (CMH) in left heart hypoplasia (LHH), we sought to determine effect estimates of CMH on head size, vascular resistance indices, and neurodevelopment compared to controls. MATERIAL AND METHODS Nine gravidae meeting the inclusion criteria (fetal LHH, ≥25.9 weeks' gestation, and ≥10% increase in percent aortic flow after acute hyperoxygenation) were prospectively enrolled. Controls were 9 contemporary gravidae with fetal LHH without CMH. Brain growth and Doppler-derived estimates of fetal cerebrovascular and placental resistance were blindly evaluated and compared using longitudinal regression. Postnatal anthropomorphic and neurodevelopmental assessments were compared. RESULTS There was no difference in baseline fetal measures between groups. There was significantly slower biparietal diameter (BPD) growth in the CMH group (z-score change -0.03 ± 0.02 vs. +0.09 ± 0.05 units/week, p = 0.02). At 6 months postnatal age, the mean head circumference z-score in the CMH group was smaller than that of controls (-0.20 ± 0.58 vs. +0.85 ± 1.11, p = 0.048). There were no differences in neurodevelopmental testing at 6 and 12 months. DISCUSSION In this pilot study, relatively diminished fetal BPD growth and smaller infant head circumference z-scores at 6 months were noted with in utero CMH exposure.
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Affiliation(s)
- Lindsay A Edwards
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Diego A Lara
- Division of Pediatric Cardiology, Ochsner Hospital for Children, New Orleans, Louisiana, USA
| | - Magdalena Sanz Cortes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Jill V Hunter
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Shelley Andreas
- Cardiovascular Clinical Research Core, Baylor College of Medicine, Houston, Texas, USA
| | | | - Lacey J Schoppe
- Fetal Center, Texas Children's Hospital, Houston, Texas, USA
| | - Jianhong Zhang
- Fetal Center, Texas Children's Hospital, Houston, Texas, USA
| | - Eboni M Smith
- Section of Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Shiraz A Maskatia
- Section of Cardiology, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - S Kristen Sexson-Tejtel
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Keila N Lopez
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Emily J Lawrence
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Yunfei Wang
- Cardiovascular Clinical Research Core, Baylor College of Medicine, Houston, Texas, USA
| | - Melissa Challman
- Cardiovascular Clinical Research Core, Baylor College of Medicine, Houston, Texas, USA
| | - Nancy A Ayres
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Carolyn A Altman
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Kjersti Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Judith A Becker
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Shaine A Morris
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,
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Kailin JA, Dhillon GS, Maskatia SA, Cass DL, Shamshirsaz AA, Mehollin-Ray AR, Cassady CI, Ayres NA, Wang Y, Belfort MA, Olutoye OO, Ruano R. Fetal left-sided cardiac structural dimensions in left-sided congenital diaphragmatic hernia - association with severity and impact on postnatal outcomes. Prenat Diagn 2017; 37:502-509. [PMID: 28370263 DOI: 10.1002/pd.5045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/30/2017] [Accepted: 03/23/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Fetuses with congenital diaphragmatic hernia (CDH) demonstrate varying degrees of left heart hypoplasia. Our study assesses the relationship between fetal left-sided cardiac structural dimensions, lung size, percentage liver herniation, lung-to-head ratio, postnatal left-sided cardiac structural dimensions, and postnatal outcomes. METHODS We performed a retrospective cohort study of fetuses with left-sided CDH who had prenatal echocardiographic, ultrasound, and magnetic resonance imaging examinations at our institution between January 2007 and March 2015. Postnatal outcomes assessed include use of inhaled nitric oxide (iNO), use of extracorporeal membrane oxygenation, and death. RESULTS Fifty-two fetuses with isolated left-sided CDH were included. Multivariate logistic regression models indicated that smaller fetal aortic valve z-score was associated with postnatal use of iNO (p = 0.03). Fetal mitral valve z-score correlated with lung-to-head ratio (p = 0.04), postnatal mitral valve z-score correlated with percent liver herniation (p = 0.03), and postnatal left ventricular end-diastolic dimension z-score correlated with liver herniation <20% (p = 0.04). CONCLUSION We identified associations between smaller fetal left-sided cardiac structural dimensions and classic CDH indices. Smaller aortic valve z-score was associated with iNO use; however, left heart dimensions showed no association with extracorporeal membrane oxygenation or mortality. Further study into the impact of left-sided hypoplasia on outcomes in CDH is worthy of evaluation in a larger, prospective study. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joshua A Kailin
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Gurpreet S Dhillon
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Shiraz A Maskatia
- Section of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Darrell L Cass
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alireza A Shamshirsaz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Amy R Mehollin-Ray
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Christopher I Cassady
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Nancy A Ayres
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Yunfei Wang
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
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Maskatia SA, Lee W, Altman CA, Ayres NA, Feagin DK, Pignatelli RH. Left ventricular rotational mechanics in early infancy: Normal reference ranges and reproducibility of peak values and time to peak values. Early Hum Dev 2017; 104:39-44. [PMID: 28042971 DOI: 10.1016/j.earlhumdev.2016.11.004] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Left ventricular cardiac twist and torsion values have been described in premature and term neonates, but not in early infancy. Early and late peak untwist rates and time to peak (TTP) values have not been described in infants. METHODS 53 term infants were enrolled prospectively. The following parameters were obtained by two blinded observers at 1-2months postnatal age: peak twist and torsion (twist indexed to LV length), peak twist rate and torsion rate, TTP twist, early peak untwist rate, TTP early untwist rate, late peak untwist rate, TTP late untwist rate. Reproducibility was assessed using intraclass correlation and Bland Altman analysis. RESULTS Intraclass correlation was ≥0.87 for all peak rotational mechanics values. Measures of TTP values had intraclass correlation (ICC) values ≤0.77, with TTP twist rate demonstrating the lowest ICC (0.69). The only measure which demonstrated significant bias was TTP twist rate. Peak twist demonstrated modest correlation (R=0.52, p<0.001) with global circumferential strain, and no correlation with ejection fraction, global longitudinal strain, or left ventricular myocardial performance index. CONCLUSIONS Measurements of rotational mechanics and timing to peak values have acceptable reproducibility. Peak twist, twist rate, and early untwist rate values in early infancy are similar to those reported in premature neonates, and higher than those reported in older children. Twist indexed to LV length (torsion) is lower in early infancy than in premature neonates, but higher than in term neonates.
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Affiliation(s)
- Shiraz A Maskatia
- Section of Cardiology, Department of Pediatrics, Stanford University Medical School, Palo Alto, CA, USA.
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Carolyn A Altman
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Nancy A Ayres
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Douglas K Feagin
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ricardo H Pignatelli
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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9
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Maskatia SA, Ruano R, Shamshirsaz AA, Javadian P, Kailin JA, Belfort MA, Altman CA, Ayres NA. Estimated combined cardiac output and laser therapy for twin-twin transfusion syndrome. Echocardiography 2016; 33:1563-1570. [PMID: 27759174 DOI: 10.1111/echo.13304] [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] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Twin-twin transfusion syndrome (TTTS) is the major cause for fetal demise in monochorionic diamniotic pregnancies. Estimated combined cardiac output (CCO) has not been studied in this setting. The primary aims of this study were to compare CCO in twin donor and recipient fetuses and assess differences in CCO before and after laser coagulation therapy. A secondary aim was to evaluate the relationship of CCO with perinatal mortality, defined as intrauterine or neonatal mortality (≤30 days of age) in fetuses that underwent laser coagulation therapy. METHODS We performed a retrospective review of fetuses with TTTS who received echocardiograms prior to laser therapy. Prelaser echocardiograms were performed in 66 fetuses, of which 45 (21 donor and 24 recipient) survived to the postlaser echocardiogram. RESULTS Donor CCO increased from a mean of 487±137 mL/min/kg prelaser to 592±128 mL/min/kg postlaser (P=.025). There was no significant change in mean recipient CCO from prelaser 551±165 mL/min/kg to postlaser 575±112 mL/min/kg (P=.564). In recipient fetuses, higher prelaser CCO correlated with increasing Quintero stage (P=.010) and perinatal mortality (P=.003). Thirty-day postnatal outcome data were available for 38 fetuses, of whom 34 (89%) survived. Amongst survivors, 25 (74%) experienced an increase in CCO, while 9 (26%) experienced a decrease in CCO (P=.010). Donor fetuses had higher CCO after laser therapy. CONCLUSIONS Higher prelaser CCO in recipient fetuses may indicate more advanced disease. Fetuses who exhibit a decrease in CCO after therapy laser may be at higher risk for perinatal mortality.
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Affiliation(s)
- Shiraz A Maskatia
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas. .,Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Alireza A Shamshirsaz
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Pouya Javadian
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Joshua A Kailin
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.,Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Michael A Belfort
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Carolyn A Altman
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.,Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Nancy A Ayres
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.,Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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10
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Lara DA, Morris SA, Maskatia SA, Becker J, Challman M, Nguyen M, Feagin DK, Schoppe L, Zhang J, Bhatt A, Sexson-Tejtel SK, Lopez KN, Lawrence EJ, Andreas S, Wang Y, Belfort MA, Ruano R, Ayres NA, Altman CA, Aagaard KM. Reply. Ultrasound Obstet Gynecol 2016; 48:405-406. [PMID: 27593405 DOI: 10.1002/uog.15909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- D A Lara
- Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., MC 19345-C, Houston, TX, 77030, USA
- Fetal Center, Texas Children's Hospital, Houston, TX, USA
| | - S A Morris
- Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., MC 19345-C, Houston, TX, 77030, USA
- Fetal Center, Texas Children's Hospital, Houston, TX, USA
| | - S A Maskatia
- Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J Becker
- Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., MC 19345-C, Houston, TX, 77030, USA
- Fetal Center, Texas Children's Hospital, Houston, TX, USA
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11
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Lara DA, Morris SA, Maskatia SA, Challman M, Nguyen M, Feagin DK, Schoppe L, Zhang J, Bhatt A, Sexson-Tejtel SK, Lopez KN, Lawrence EJ, Andreas S, Wang Y, Belfort MA, Ruano R, Ayres NA, Altman CA, Aagaard KM, Becker J. Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia. Ultrasound Obstet Gynecol 2016; 48:365-372. [PMID: 26700848 DOI: 10.1002/uog.15846] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Acute maternal hyperoxygenation (AMH) results in increased fetal left heart blood flow. Our aim was to perform a pilot study to determine the safety, feasibility and direction and magnitude of effect of chronic maternal hyperoxygenation (CMH) on mitral and aortic valve annular dimensions in fetuses with left heart hypoplasia (LHH) after CMH. METHODS Gravidae with fetal LHH were eligible for inclusion in a prospective evaluation of CMH. LHH was defined as: sum of aortic and mitral valve annuli Z-scores < -4.5, arch flow reversal and left-to-right or bidirectional atrial level shunting without hypoplastic left heart syndrome or severe aortic stenosis. Gravidae with an affected fetus and with ≥ 10% increase in aortic/combined cardiac output flow after 10 min of AMH at 8 L/min 100% fraction of inspired oxygen were offered enrollment. Nine gravidae were enrolled from February 2014 to January 2015. The goal therapy was ≥ 8 h daily CMH from enrollment until delivery. Gravidae who were cared for from July 2012 to October 2014 with fetal LHH and no CMH were identified as historical controls (n = 9). Rates of growth in aortic and mitral annuli over the final trimester were compared between groups using longitudinal regression. RESULTS There were no significant maternal or fetal complications in the CMH cohort. Mean gestational age at study initiation was 29.6 ± 3.2 weeks for the intervention group and 28.4 ± 1.8 weeks for controls (P = 0.35). Mean relative increase in aortic/combined cardiac output after AMH was 35.3% (range, 18.1-47.9%). Median number of hours per day on CMH therapy was 9.3 (range, 6.5-14.6) and median duration of CMH was 48 (range, 33-84) days. Mean mitral annular growth was 0.19 ± 0.05 mm/week compared with 0.14 ± 0.05 mm/week in CMH vs controls (mean difference 0.05 ± 0.05 mm/week, P = 0.33). Mean aortic annular growth was 0.14 ± 0.03 mm/week compared with 0.13 ± 0.03 mm/week in CMH vs controls (mean difference 0.01 ± 0.03 mm/week, P = 0.75). More than 9 h CMH daily (n = 6) was associated with better growth of the aortic annulus in intervention fetuses (0.16 ± 0.03 vs 0.08 ± 0.02 mm/week, P = 0.014). CONCLUSIONS CMH is both safe and feasible for continued research. In this pilot study, the effect estimates of annular growth, using the studied method of delivery and dose of oxygen, were small. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D A Lara
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - S A Morris
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - S A Maskatia
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA
| | - M Challman
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - M Nguyen
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA
| | - D K Feagin
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - L Schoppe
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA
| | - J Zhang
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA
| | - A Bhatt
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - S K Sexson-Tejtel
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - K N Lopez
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - E J Lawrence
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - S Andreas
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Y Wang
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - M A Belfort
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - R Ruano
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - N A Ayres
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - C A Altman
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - K M Aagaard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - J Becker
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Ezon DS, Ayres NA, Altman CA, Denfield SW, Morris SA, Maskatia SA. Echocardiographic Parameters and Outcomes in Primary Fetal Cardiomyopathy. J Ultrasound Med 2016; 35:1949-1955. [PMID: 27466259 DOI: 10.7863/ultra.15.05059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/23/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Primary fetal cardiomyopathy is a rare entity, with a poor prognosis. We sought to describe its echocardiographic characteristics and outcomes. METHODS We performed a 12-year retrospective review of fetuses with primary cardiomyopathy. RESULTS Of more than 6000 fetuses evaluated, 25 met criteria for primary cardiomyopathy, and 18 had sufficient echocardiographic and pregnancy outcome data for inclusion. At echocardiography, the median gestational age was 29.6 weeks (range, 21.0-36.4 weeks); median cardiovascular profile score was 6 (range, 1-9); median right ventricular Tei index was 0.52 (range, 0.32-0.94); and median left ventricular Tei index was 0.40 (range, 0.15-0.88). Two had fetal demise, and 16 survived to delivery. The median cardiovascular profile score in those with fetal demise was 3.0 and in those who survived to delivery was 6.5 (range, 3-9; P = .14). The median right ventricular Tei index in those with fetal demise was 0.39 and in those surviving to delivery was 0.53 (range, 0.38-0.94; P = .49). The median left ventricular Tei index in those with fetal demise was 0.29 and in those surviving to delivery was 0.42 (range, 0.15-0.88; P = .50). Sixty-day survival was available in 11 of 16 fetuses. In addition to the 2 with fetal demise, 4 had postnatal demise, and 5 were alive at a median follow-up of 39 months. Hydrops (P = .01), skin edema (P = .01), and mild or greater mitral regurgitation (P = .02) were associated with fetal or postnatal demise, with a trend toward an association between moderate or greater tricuspid regurgitation (P = .07) and fetal or postnatal demise. CONCLUSIONS Hydrops and atrioventricular valvar regurgitation are ominous signs in primary fetal cardiomyopathy. Although other commonly used methods for assessing cardiovascular performance may help in diagnosing primary cardiomyopathy, these data suggest limited predictive value.
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Affiliation(s)
- David S Ezon
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas USA
| | - Nancy A Ayres
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas USA
| | - Carolyn A Altman
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas USA
| | - Susan W Denfield
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas USA
| | - Shaine A Morris
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas USA
| | - Shiraz A Maskatia
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas USA
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13
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Maskatia SA, Pignatelli RH, Ayres NA, Altman CA, Sangi-Haghpeykar H, Lee W. Fetal and Neonatal Diastolic Myocardial Strain Rate: Normal Reference Ranges and Reproducibility in a Prospective, Longitudinal Cohort of Pregnancies. J Am Soc Echocardiogr 2016; 29:663-9. [DOI: 10.1016/j.echo.2016.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Indexed: 10/22/2022]
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Hanchard NA, Swaminathan S, Bucasas K, Furthner D, Fernbach S, Azamian MS, Wang X, Lewin M, Towbin JA, D'Alessandro LCA, Morris SA, Dreyer W, Denfield S, Ayres NA, Franklin WJ, Justino H, Lantin-Hermoso MR, Ocampo EC, Santos AB, Parekh D, Moodie D, Jeewa A, Lawrence E, Allen HD, Penny DJ, Fraser CD, Lupski JR, Popoola M, Wadhwa L, Brook JD, Bu'Lock FA, Bhattacharya S, Lalani SR, Zender GA, Fitzgerald-Butt SM, Bowman J, Corsmeier D, White P, Lecerf K, Zapata G, Hernandez P, Goodship JA, Garg V, Keavney BD, Leal SM, Cordell HJ, Belmont JW, McBride KL. A genome-wide association study of congenital cardiovascular left-sided lesions shows association with a locus on chromosome 20. Hum Mol Genet 2016; 25:2331-2341. [PMID: 26965164 DOI: 10.1093/hmg/ddw071] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/26/2016] [Indexed: 12/28/2022] Open
Abstract
Congenital heart defects involving left-sided lesions (LSLs) are relatively common birth defects with substantial morbidity and mortality. Previous studies have suggested a high heritability with a complex genetic architecture, such that only a few LSL loci have been identified. We performed a genome-wide case-control association study to address the role of common variants using a discovery cohort of 778 cases and 2756 controls. We identified a genome-wide significant association mapping to a 200 kb region on chromosome 20q11 [P= 1.72 × 10-8 for rs3746446; imputed Single Nucleotide Polymorphism (SNP) rs6088703 P= 3.01 × 10-9, odds ratio (OR)= 1.6 for both]. This result was supported by transmission disequilibrium analyses using a subset of 541 case families (lowest P in region= 4.51 × 10-5, OR= 1.5). Replication in a cohort of 367 LSL cases and 5159 controls showed nominal association (P= 0.03 for rs3746446) resulting in P= 9.49 × 10-9 for rs3746446 upon meta-analysis of the combined cohorts. In addition, a group of seven SNPs on chromosome 1q21.3 met threshold for suggestive association (lowest P= 9.35 × 10-7 for rs12045807). Both regions include genes involved in cardiac development-MYH7B/miR499A on chromosome 20 and CTSK, CTSS and ARNT on chromosome 1. Genome-wide heritability analysis using case-control genotyped SNPs suggested that the mean heritability of LSLs attributable to common variants is moderately high ([Formula: see text] range= 0.26-0.34) and consistent with previous assertions. These results provide evidence for the role of common variation in LSLs, proffer new genes as potential biological candidates, and give further insight to the complex genetic architecture of congenital heart disease.
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Affiliation(s)
- Neil A Hanchard
- Department of Molecular and Human Genetics, Department of Pediatrics
| | | | - Kristine Bucasas
- Department of Molecular and Human Genetics, Center for Statistical Genetics
| | - Dieter Furthner
- Department of Paediatrics, Children's Hospital, Linz, Austria
| | | | | | | | - Mark Lewin
- Division of Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Jeffrey A Towbin
- Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | | | | | - Nancy A Ayres
- Division of Cardiology, Department of Pediatrics, and
| | | | - Henri Justino
- Division of Cardiology, Department of Pediatrics, and
| | | | | | | | - Dhaval Parekh
- Division of Cardiology, Department of Pediatrics, and
| | | | - Aamir Jeewa
- Division of Cardiology, Department of Pediatrics, and
| | | | - Hugh D Allen
- Division of Cardiology, Department of Pediatrics, and
| | | | - Charles D Fraser
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - James R Lupski
- Department of Molecular and Human Genetics, Department of Pediatrics
| | | | - Lalita Wadhwa
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - J David Brook
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Frances A Bu'Lock
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
| | - Shoumo Bhattacharya
- Radcliffe Department of Medicine, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | | | - Sara M Fitzgerald-Butt
- Department of Pediatrics and Center for Cardiovascular and Pulmonary Research, The Heart Center, and
| | | | - Don Corsmeier
- Department of Pediatrics and Center for Microbial Pathogenesis, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter White
- Department of Pediatrics and Center for Microbial Pathogenesis, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kelsey Lecerf
- College of Medicine, Ohio State University, Columbus, OH, USA
| | - Gladys Zapata
- Department of Molecular and Human Genetics, Department of Pediatrics
| | | | - Judith A Goodship
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK and
| | - Vidu Garg
- Department of Pediatrics and Center for Cardiovascular and Pulmonary Research, The Heart Center, and
| | - Bernard D Keavney
- Institute of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Suzanne M Leal
- Department of Molecular and Human Genetics, Center for Statistical Genetics
| | - Heather J Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK and
| | - John W Belmont
- Department of Molecular and Human Genetics, Department of Pediatrics,
| | - Kim L McBride
- Department of Pediatrics and Center for Cardiovascular and Pulmonary Research,
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Maskatia SA, Pignatelli RH, Ayres NA, Altman CA, Sangi-Haghpeykar H, Lee W. Longitudinal Changes and Interobserver Variability of Systolic Myocardial Deformation Values in a Prospective Cohort of Healthy Fetuses across Gestation and after Delivery. J Am Soc Echocardiogr 2016; 29:341-9. [PMID: 26797677 DOI: 10.1016/j.echo.2015.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 06/24/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Normative data for fetal myocardial deformation values have not been comprehensively described in a longitudinal cohort. The effect of gestational age on these values and on interobserver variability require further investigation. METHODS Sixty gravid women were prospectively enrolled before 20 weeks' gestation. The following measures were obtained by two blinded observers at five time points across gestation and also at 4 to 8 weeks' postnatal age: global circumferential strain and strain rate, global longitudinal left ventricular strain and strain rate, global longitudinal right ventricular strain and strain rate, and left and right ventricular myocardial performance indices. Optimal myocardial visualization and frame rate (≥100 frames/sec) were ensured. RESULTS For gestational age groups ≥24 weeks, intraclass correlation coefficients between observers were >0.70 for all measures and >0.85 for the majority of measures of myocardial deformation. At 20 to 21 weeks' gestation, intraclass correlation coefficients were 0.35 to 0.52 for longitudinal measures and 0.74 to 0.82 for circumferential measures. Myocardial performance index intraclass correlation coefficients were <0.80 at all time points and <0.70 for most time points. Global longitudinal left ventricular strain and global circumferential strain values remained stable across gestational age groups. Global longitudinal right ventricular strain values remained stable across gestation and increased after birth. Global circumferential strain rate, global longitudinal left ventricular strain rate, and global longitudinal right ventricular strain rate decreased from 20 to 21 weeks' gestation to the remainder of gestation and then remained stable until delivery. Upon delivery, global circumferential strain rate and global longitudinal left ventricular strain rate decreased, and global longitudinal right ventricular strain rate increased. CONCLUSIONS Interobserver variability of fetal strain and strain rate measured at ≥24 weeks' gestation was lower in comparison with values obtained at 20 to 21 weeks' gestation and lower in comparison with left ventricular and right ventricular myocardial performance indices using the described protocol. Gestational changes in fetal myocardial deformation values likely reflect changes in preload and/or afterload on the fetal heart.
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Affiliation(s)
- Shiraz Arif Maskatia
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Ricardo H Pignatelli
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Nancy A Ayres
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carolyn A Altman
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Haleh Sangi-Haghpeykar
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Wesley Lee
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Maskatia SA, Shamshirsaz AA, Altman CA, Ayres NA, Bateni ZH, Cassidy C, Espinoza J, Hosseinzadeh P, Melhollin-Ray A, Olutoye OO, Ruano R, Welty S, Whitehead WE, Belfort M. 257: Short term effects of fetoscopic vs open in-utero repair of myelomeningocele on fetal cardiovascular performance. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kaul B, Sheikh F, Zamora IJ, Mehollin-Ray AR, Cassady CI, Ayres NA, Cass DL, Olutoye OO. 5, 4, 3, 2, 1: embryologic variants of pentalogy of Cantrell. J Surg Res 2015; 199:141-8. [DOI: 10.1016/j.jss.2015.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/21/2015] [Accepted: 04/03/2015] [Indexed: 11/28/2022]
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Akinkuotu AC, Sheikh F, Olutoye OO, Lee TC, Fernandes CJ, Welty SE, Ayres NA, Cass DL. Giant omphaloceles: surgical management and perinatal outcomes. J Surg Res 2015; 198:388-92. [DOI: 10.1016/j.jss.2015.03.060] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 11/16/2022]
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Ruano R, Javadian P, Kailin JA, Maskatia SA, Shamshirsaz AA, Cass DL, Zamora IJ, Sangi-Haghpeykar H, Lee TC, Ayres NA, Mehollin-Ray A, Cassady CI, Fernandes C, Welty S, Belfort MA, Olutoye OO. Congenital heart anomaly in newborns with congenital diaphragmatic hernia: a single-center experience. Ultrasound Obstet Gynecol 2015; 45:683-688. [PMID: 25158239 DOI: 10.1002/uog.14648] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/31/2014] [Accepted: 08/07/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the impact of the presence of a congenital heart anomaly (CHA) and its potential contribution to morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). METHODS In this retrospective cohort study, prenatal and postnatal data of all newborns diagnosed with CDH between January 2004 and December 2012 in a single center were reviewed. Cases were classified into two groups: those with 'isolated' CDH and those with both CDH and CHA. Patients with CHA were further subclassified into those with a major or minor CHA based on the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) scoring systems. Patients with associated non-cardiac anomalies, including 'syndromic cases', were excluded from the analysis. Primary and secondary outcomes were survival up to 1 year of age and a need for extracorporeal membrane oxygenation (ECMO), respectively. RESULTS Of the 180 infants with CDH, 41 were excluded because of the presence of non-cardiac associated anomalies, 118 had isolated CDH and 21 had CDH with CHA (16 with minor and five with major CHA). Receiver-operating characteristics curve analysis demonstrated that the best cut-off for survival was when the score for CHA was ≤ 2 for both RACHS-1 (area under the curve (AUC), 0.74 (P = 0.04); sensitivity, 80.0%; specificity, 87.5%) and STS-EACTS (AUC, 0.83 (P = 0.03); sensitivity, 100%; specificity, 87.5%). Survival rate at 1 year was significantly lower in those with CHD and a major CHA (40.0%; P = 0.04) than in those with isolated CDH (77.1%) and those with CDH and a minor CHA (81.3%). We found no significant differences among the groups with regard to the need for ECMO. CONCLUSIONS In general, a milder form of CHA does not appear to have a negative impact on the survival of infants with CDH. However, mortality appears to be significantly higher in infants with CDH and a major form of CHA. The scoring systems appear to be useful as predictors for classifying the effects of CHA in this population of patients.
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Affiliation(s)
- R Ruano
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - P Javadian
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - J A Kailin
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - S A Maskatia
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - D L Cass
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - I J Zamora
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - H Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - T C Lee
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - N A Ayres
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - A Mehollin-Ray
- Department of Radiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - C I Cassady
- Department of Radiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - C Fernandes
- Department of Pediatrics, Division of Neonatology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - S Welty
- Department of Pediatrics, Division of Neonatology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - O O Olutoye
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
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Pignatelli RH, Texter KM, Denfield SW, Grenier MA, Altman CA, Ayres NA, Chandra-Bose Reddy S. LV Noncompaction in Ebstein's anomaly in infants and outcomes. JACC Cardiovasc Imaging 2014; 7:207-9. [PMID: 24524749 DOI: 10.1016/j.jcmg.2013.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/08/2013] [Accepted: 05/09/2013] [Indexed: 10/25/2022]
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Cass DL, Olutoye OO, Cassady CI, Zamora IJ, Ivey RT, Ayres NA, Olutoye OA, Lee TC. EXIT-to-resection for fetuses with large lung masses and persistent mediastinal compression near birth. J Pediatr Surg 2013; 48:138-44. [PMID: 23331806 DOI: 10.1016/j.jpedsurg.2012.10.067] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/13/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To identify prenatal diagnostic features that will help select fetuses with lung masses (LM) who may benefit from ex-utero intrapartum treatment (EXIT procedure) as the preferred mode of delivery. METHODS The CCAM-volume ratio (CVR), fetal treatment, and outcomes of all fetuses with LM evaluated between 2001 and 2011 were reviewed retrospectively. Fetuses with hydrops or CVR>1.6 were classified as high risk. Indications for fetal interventions included hydrops and heart failure, and indication for EXIT-to-resection was the finding of persistent mediastinal compression (PMC) near birth. RESULTS Of 110 fetuses evaluated for LM, 78 were classified as low-risk. No fetus in this group had PMC near birth and none required perinatal treatment. Of 32 high-risk fetuses, 8 developed heart failure of which 4 survived (3 following fetal surgery). Nine high-risk fetuses with no PMC near birth were asymptomatic postnatally and treated electively. Sixteen high-risk fetuses had PMC near birth. All 9 babies with PMC treated with EXIT-to-resection did well with discharge at a median of 10 days post-operatively. All 7 fetuses treated without an EXIT developed respiratory distress following birth requiring an urgent operation; 2 died. CONCLUSION The EXIT-to-resection procedure is a favorable delivery approach for those fetuses with large LM and PMC near birth.
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Affiliation(s)
- Darrell L Cass
- Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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Knudson JD, Goldberg JF, Ayres NA. Fibrolamellar hepatocellular carcinoma with cardiac spread causing severe inferior vena cava obstruction in a 9-year-old child. Pediatr Cardiol 2012; 33:872-3. [PMID: 22447385 DOI: 10.1007/s00246-012-0305-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/14/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Jarrod D Knudson
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, MC-19345-C, Houston, TX 77030, USA.
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Cass DL, Olutoye OO, Ayres NA, Moise KJ, Altman CA, Johnson A, Cassady CI, Lazar DA, Lee TC, Lantin MRL. Defining hydrops and indications for open fetal surgery for fetuses with lung masses and vascular tumors. J Pediatr Surg 2012; 47:40-5. [PMID: 22244390 DOI: 10.1016/j.jpedsurg.2011.10.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 10/06/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to identify the most accurate prenatal predictors of outcomes and need for fetal surgery for fetuses with high-risk lung masses and vascular tumors. METHODS The records of all fetuses with high-risk lung mass (congenital cystic adenomatoid malformation-volume ratio > 1.6 or findings of hydrops) and vascular tumor evaluated between July 2001 and March 2011 were reviewed retrospectively. Hydrops was defined as accumulation of fluid in 2 or more compartments. RESULTS Of fetuses with high-risk lung mass, hydrops was identified in 46% (11/24). Fetuses with hydrops and an abnormal echocardiogram (n = 8) demonstrated poor survival without fetal surgery (13%) compared with 100% survival in fetuses with hydrops and a normal echocardiogram (n = 3; P = .02). Of 21 fetuses with vascular tumor (11 sacrococcygeal and 8 cervical teratomas; 2 hemangioendotheliomas), hydrops was identified in 29% and an abnormal echocardiogram in 57%. All fetuses with hydrops had an abnormal echocardiogram and either died (n = 5) or required fetal surgery (n = 1). However, all fetuses with abnormal echocardiograms alone (n = 7) survived without fetal intervention. CONCLUSIONS For fetuses with lung mass, an abnormal echocardiogram in the setting of hydrops is the best predictor of mortality and need for fetal surgery. For fetuses with vascular tumor, hydrops in the setting of high-output physiology best predicts demise and need for fetal surgery.
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Affiliation(s)
- Darrell L Cass
- Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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Lazar DA, Cass DL, Dishop MK, Adam K, Olutoye OA, Ayres NA, Cassady CI, Olutoye OO. Fetal lung interstitial tumor: a cause of late gestation fetal hydrops. J Pediatr Surg 2011; 46:1263-6. [PMID: 21683234 DOI: 10.1016/j.jpedsurg.2011.02.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 02/17/2011] [Accepted: 02/18/2011] [Indexed: 11/16/2022]
Abstract
Most fetal lung masses present by mid gestation, grow during the canalicular phase of lung development (18-26 weeks of gestation), and plateau in growth or shrink after 26 weeks of gestation. We describe the unique case of a fetal lung mass presenting at 37 weeks of gestation with hydrops and fetal heart failure. The late growth of this lesion and resultant hydrops prompted resection as part of the ex utero intrapartum treatment. Histopathology revealed a rare, recently described fetal lung interstitial tumor. This case demonstrates that a subset of fetal lung masses may continue to grow later in gestation and emphasizes the need for late gestation imaging and close follow-up in this patient cohort.
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Affiliation(s)
- David A Lazar
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX 77030, USA
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Cass DL, Olutoye OO, Cassady CI, Moise KJ, Johnson A, Papanna R, Lazar DA, Ayres NA, Belleza-Bascon B. Prenatal diagnosis and outcome of fetal lung masses. J Pediatr Surg 2011; 46:292-8. [PMID: 21292076 DOI: 10.1016/j.jpedsurg.2010.11.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
Abstract
AIM The purpose of this study is to evaluate the accuracy of prenatal diagnostic features, particularly congenital cystic adenomatoid malformation volume ratio (CVR), in predicting outcomes for fetuses with lung masses. METHODS The records and imaging features of all fetuses referred to the Texas Children's Fetal Center with a fetal lung mass between July 2001 and May 2010 were reviewed retrospectively. Data collected included gestational age (GA) at diagnosis, fetal magnetic resonance imaging findings, CVR, mass size, nature of fetal treatment, surgical findings, pathology, and outcome. Data were analyzed for predicting development of hydrops or the need for fetal therapy using receiver operating characteristic curves. RESULTS Of 82 fetuses (41 male) evaluated for a lung mass, 53 (65%) were left-sided (1 bilateral), and the mean (SD) GA at diagnosis was 21.5 (4.3) weeks. Seventy-three fetuses underwent fetal magnetic resonance imaging at a mean (SD) GA of 26.1 (4.6) weeks. Thirteen fetuses (16%) had fetal treatment. Four fetuses with hydrops underwent open fetal surgical resection, and 3 survived. Six fetuses with large lung masses and persistent mediastinal compression near term underwent ex-utero intrapartum therapy-to-resection procedures, and 3 fetuses with hydrops underwent serial thoracentesis. Congenital cystic adenomatoid malformation volume ratio correlated strongly with the development of hydrops and the need for fetal therapy with an area under the receiver operating characteristic curve of 0.96 (P < .0001) and 0.88 (P < .0001), respectively. Of 18 fetuses with a CVR greater than 2.0 compared with 2 (3%) of 60 with a CVR of 2.0 or less, 10 (56%) required fetal intervention (P < .0001). CONCLUSION Congenital cystic adenomatoid malformation volume ratio correlates strongly with the development of fetal hydrops and the need for fetal intervention. A threshold value of 2.0 yields the most powerful statistical results.
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Affiliation(s)
- Darrell L Cass
- Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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Naik-Mathuria B, Chang S, Fitch ME, Westhoff J, Brandt ML, Ayres NA, Olutoye OO, Cass DL. Patent ductus arteriosus ligation in neonates: preoperative predictors of poor postoperative outcomes. J Pediatr Surg 2008; 43:1100-5. [PMID: 18558190 DOI: 10.1016/j.jpedsurg.2008.02.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 02/09/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to identify preoperative predictors of adverse outcomes in infants undergoing surgical ligation of patent ductus arteriosus (PDA). METHODS Charts of all neonates who underwent PDA ligation at Texas Children's Hospital (Houston, TX) between 2001 and 2006 were retrospectively reviewed with specific attention to preoperative clinical characteristics, echocardiographic details, operative morbidity, and postoperative outcomes. Infants with other cardiac anomalies or right-to-left or bidirectional PDA shunt were excluded. RESULTS Eighty-two neonates were included (mean gestational age, 27 weeks; mean birth weight, 1000 g). There were no intraoperative complications. Preoperative symptoms related to respiratory insufficiency, hypotension, apnea, and pulmonary edema improved after ligation (P < .001). Birth weight, age at ligation, and indomethacin use did not correlate with postoperative outcome; however, lower gestational age, lower blood pressure, and lower shunt peak velocity predicted longer time to extubation by multiple analysis techniques (P < .0001). Linear regression (controlling for gestation, birth weight, and mean arterial pressure) showed inverse correlation between peak velocity and postoperative days on the ventilator (95% confidence interval, 47.18 to -12.25; P = .001). CONCLUSION The PDA ligation can be accomplished safely; however, some neonates have prolonged recovery. Lower gestational age and low peak velocity (<2.6 m/s) at the PDA shunt correlate with lengthened ventilator requirement after surgery.
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Affiliation(s)
- Bindi Naik-Mathuria
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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Falkensammer CB, Ayres NA, Altman CA, Ge S, Bezold LI, Eidem BW, Kovalchin JP. Fetal cardiac malposition: incidence and outcome of associated cardiac and extracardiac malformations. Am J Perinatol 2008; 25:277-81. [PMID: 18401841 DOI: 10.1055/s-2008-1066874] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiac malposition is a rare but important finding when detected on fetal ultrasound. The purpose of this study was to evaluate the incidence of fetal cardiac malposition, associated abnormalities, and clinical outcome in a tertiary-care medical center. Records of fetuses (1993 to 2006) with dextroposition, dextrocardia, mesocardia, ectopia cordis, or heterotaxy were reviewed. The presence of congenital heart disease (CHD), extracardiac anomalies, and outcome were noted. Cardiac malposition was present in 101 fetuses among a total of 3313 (3%) pregnancies. In 78 (78%) patients, the heart was positioned in the right hemithorax. Of those, 26 (33%) had dextrocardia (CHD = 21), and 52 (67%) had dextroposition (CHD = 14). Sixteen (16%) patients had mesocardia (CHD = 8), and 7 (7%) had ectopia cordis (CHD = 6). The majority (58%) of fetal cardiac malposition was caused by intrathoracic masses. Concomitant CHD occurred in 50%. Outcome was available in 97%. The perinatal and neonatal mortality rate was 30%; the elective termination rate was 4%. Patients with CHD had higher mortality rates. The highest mortality rates occurred in ectopia cordis and combined disease of diaphragmatic hernia and CHD.
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Lu X, Nadvoretskiy V, Klas B, Bu L, Stolpen A, Ayres NA, Sahn DJ, Ge S. Measurement of Volumetric Flow by Real-time 3-Dimensional Doppler Echocardiography in Children. J Am Soc Echocardiogr 2007; 20:915-20. [PMID: 17555931 DOI: 10.1016/j.echo.2007.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND We sought to assess the accuracy and reproducibility of an automated real-time (RT) 3-dimensional (3D) Doppler echocardiography (RT3DDE) technique for measuring volumetric flow (VF) in children. METHODS A total of 19 healthy children (age = 11.5 +/- 3.5 years) were studied to measure VF through mitral valve (MV), aortic valve (AV), pulmonary valve (PV), and tricuspid valve (TV) by RT3DDE. RT 3D echocardiography was also performed to measure left ventricular (LV) end-systolic volume, LV end-diastolic volume, and stroke volume (stroke volume = LV end-diastolic volume--LV end-systolic volume), which served as a reference standard for comparison with VF by RT3DDE. RESULTS Compared with stroke volume by RT 3D echocardiography, the correlation with VF was excellent for MV (r = 0.91), good for AV (r = 0.89) and PV (r = 0.89), but poor for TV (r = 0.20) by RT3DDE. There were good agreements for AV (bias = 0.9 +/- 5.0 mL), PV (bias = -0.4 +/- 5.7 mL), and MV (bias = 4.1 +/- 4.7 mL), and marked underestimation for TV (bias = -24.4 +/- 14.6 mL). CONCLUSIONS Our data demonstrated that VF measurement by RT3DDE is feasible and reasonably accurate for MV, AV, and PV but problematic for TV.
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Affiliation(s)
- Xiuzhang Lu
- Baylor College of Medicine, Houston, Texas 77030, USA
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Stapleton GE, Stapleton SL, Martinez A, Ayres NA, Kovalchin JP, Bezold LI, Pignatelli R, Eidem BW. Evaluation of Longitudinal Ventricular Function with Tissue Doppler Echocardiography in Children Treated with Anthracyclines. J Am Soc Echocardiogr 2007; 20:492-7. [PMID: 17484989 DOI: 10.1016/j.echo.2006.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Indexed: 11/20/2022]
Affiliation(s)
- Gary E Stapleton
- Department of Pediatrics at Section of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
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Slesnick TC, Ayres NA, Altman CA, Bezold LI, Eidem BW, Fraley JK, Kung GC, McMahon CJ, Pignatelli RH, Kovalchin JP. Characteristics and outcomes of fetuses with pericardial effusions. Am J Cardiol 2005; 96:599-601. [PMID: 16098320 DOI: 10.1016/j.amjcard.2005.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Revised: 04/05/2005] [Accepted: 04/05/2005] [Indexed: 10/25/2022]
Abstract
Little is known about the characteristics and outcomes of fetuses with pericardial effusions (PEs); therefore, this study sought to identify factors associated with fetal PEs and the natural histories and outcomes of fetuses with PEs. Large PEs are associated with a greater likelihood of structural heart disease, impaired cardiac function, and chromosomal abnormalities, and PEs with hydrops or extracardiac malformations are associated with death. Most fetal PEs resolve, and fetuses with isolated PEs have a very good prognosis.
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Affiliation(s)
- Timothy C Slesnick
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, USA
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Eidem BW, McMahon CJ, Ayres NA, Kovalchin JP, Denfield SW, Altman CA, Bezold LI, Pignatelli RH. Impact of Chronic Left Ventricular Preload and Afterload on Doppler Tissue Imaging Velocities: A Study in Congenital Heart Disease. J Am Soc Echocardiogr 2005; 18:830-8. [PMID: 16084335 DOI: 10.1016/j.echo.2004.09.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Doppler tissue imaging (DTI) velocities have been reported to be relatively independent of changes in ventricular loading conditions in adult studies. The clinical impact of altered left ventricular (LV) preload and afterload on DTI velocities in children with congenital heart disease has not been adequately evaluated. The purpose of this study was to evaluate the impact of chronic LV preload and afterload on DTI velocities in children with isolated ventricular septal defect and aortic valve stenosis compared with age-matched normal and abnormal (dilated cardiomyopathy) control groups. METHODS From an apical 4-chamber view, DTI velocities were obtained at the cardiac base at the lateral mitral annulus, lateral tricuspid annulus, and interventricular septum in early diastole, late diastole, and ventricular systole. RESULTS The majority of DTI velocities did not change significantly in patients with increased LV preload. Patients with increased LV afterload had significantly decreased systolic and early diastolic DTI velocities at both the lateral mitral annulus and ventricular septum compared with control subjects. Children with dilated cardiomyopathy had significantly decreased DTI velocities at all myocardial annular locations. CONCLUSIONS We conclude that increases in chronic LV preload do not significantly affect the majority of DTI velocities in children with ventricular septal defects. In addition, significantly increased chronic LV afterload in children with aortic valve stenosis is associated with decreased DTI velocities in the absence of other identifiable abnormalities of LV function. Decreased DTI velocity may be secondary to increased afterload or may alternatively be an early marker of subclinical LV longitudinal dysfunction.
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Affiliation(s)
- Benjamin W Eidem
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
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McMahon CJ, Ayres NA, Bezold LI, Lewin MB, Alonzo M, Altman CA, Kovalchin JP, Eidem BW, Pignatelli RH. Safety and efficacy of intravenous contrast imaging in pediatric echocardiography. Pediatr Cardiol 2005; 26:413-7. [PMID: 16374692 DOI: 10.1007/s00246-004-0795-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was performed to determine the safety and efficacy of intravenous contrast echocardiography in children attending a tertiary cardiac center. This was a prospective study to evaluate the use of Optison contrast agent in children with severely limited transthoracic echocardiographic windows. Twenty children (median age, 15 years; range, 9-18) underwent fundamental imaging (FI), harmonic imaging (HI), and HI with intravenous contrast (Optison FS-069). Endocardial border delineation was determined based on a visual qualitative scoring system (0, none: 4, excellent). Endocardial border definition was significantly improved in all patients using contrast echocardiography (FI vs Optison, p < 0.001 for each). Improved border definition was most dramatic in the apical and left ventricular (LV) free wall regions. Left ventricular ejection fraction (LVEF) was measurable in 20 patients (100%) using contrast compared to 11 (55%) with FI or HI (p < 0.05). The echocardiographic diagnosis was correctly delineated in 1 patient with a severely dyskinetic LV segment only with use of intravenous contrast and HI. No patients suffered adverse hemodynamic effects, changes in taste, or flushing episodes. Three patients experienced transient headaches. Intravenous contrast echocardiography offers an additional tool in evaluating children with very poor transthoracic echocardiographic windows. Such a strategy increases diagnostic accuracy and allows accurate LVEF determination. Adverse hemodynamic effects related to intravenous contrast are exceedingly rare.
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Affiliation(s)
- C J McMahon
- Noninvasive Imaging Cardiac Laboratory, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin MC 19345-C, Houston, TX 77030, USA
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Ikemba CM, Eidem BW, Fraley JK, Eapen RS, Pignatelli R, Ayres NA, Bezold LI. Mitral valve morphology and morbidity/mortality in Shone's complex. Am J Cardiol 2005; 95:541-3. [PMID: 15695151 DOI: 10.1016/j.amjcard.2004.10.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Revised: 09/30/2004] [Accepted: 09/30/2004] [Indexed: 11/29/2022]
Abstract
Early echocardiographic studies of 50 patients with Shone's complex were retrospectively examined to identify left-sided cardiac features associated with progressive mitral valve (MV) disease requiring intervention, as well as mortality. Thickened MV leaflets, shortened MV chordae coupled with either thickened MV leaflets or turbulence at or below the MV noted by color Doppler, left ventricular outflow tract obstruction without coarctation of the aorta, and mild or moderate aortic insufficiency were associated with a poor prognosis.
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Affiliation(s)
- Catherine M Ikemba
- University of Texas Southwestern, Children's Medical Center of Dallas, Division of Cardiology, Dallas, Texas, USA.
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Ayres NA, Miller-Hance W, Fyfe DA, Stevenson JG, Sahn DJ, Young LT, Minich LL, Kimball TR, Geva T, Smith FC, Rychik J. Indications and guidelines for performance of transesophageal echocardiography in the patient with pediatric acquired or congenital heart disease. J Am Soc Echocardiogr 2005; 18:91-8. [PMID: 15637497 DOI: 10.1016/j.echo.2004.11.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Eidem BW, McMahon CJ, Cohen RR, Wu J, Finkelshteyn I, Kovalchin JP, Ayres NA, Bezold LI, O'Brian Smith E, Pignatelli RH. Impact of cardiac growth on Doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiogr 2004; 17:212-21. [PMID: 14981417 DOI: 10.1016/j.echo.2003.12.005] [Citation(s) in RCA: 292] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Doppler tissue imaging (DTI) is a useful modality to quantitatively assess regional myocardial function. Studies attempting to establish reference values for DTI velocities in healthy children have been limited by small sample sizes and limited age distribution. In addition, the clinical effect of cardiac growth and other demographic and echocardiographic parameters on DTI velocities during childhood has not been adequately evaluated. METHODS Pulsed wave DTI velocities were obtained in 325 healthy children at the lateral mitral annulus, interventricular septum, and lateral tricuspid annulus during early diastole, late diastole, and ventricular systole and were compared with demographic and echocardiographic study variables. RESULTS In healthy children, parameters of cardiac growth, most notably left ventricular end-diastolic dimension, have the most significant correlation with the majority of DTI velocities. Age was also significantly correlated with most DTI velocities whereas sex, heart rate, and other echocardiographic parameters demonstrated minimal or no correlation. CONCLUSIONS This study establishes reference values for DTI velocities and demonstrates the important clinical effects of cardiac growth and age on DTI velocities in neonates and children.
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Affiliation(s)
- Benjamin W Eidem
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin-MC 19-345C, Houston, TX 77030, USA.
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McMahon CJ, Ravekes WJ, Smith EO, Denfield SW, Pignatelli RH, Altman CA, Ayres NA. Risk factors for neo-aortic root enlargement and aortic regurgitation following arterial switch operation. Pediatr Cardiol 2004; 25:329-35. [PMID: 14727099 DOI: 10.1007/s00246-003-0483-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objectives of this study were to evaluate changes in dimension of the neo-aortic annulus, aortic root, and aortic anastomosis following arterial switch operation (ASO) and to identify risk factors for developing abnormal neo-aortic root enlargement and aortic regurgitation (AR). Prior studies report development of neo-aortic root dilatation and AR in a small subset of patients after ASO. Predisposing factors for neo-aortic root dilatation and development of moderate/severe AR are poorly understood. We performed a retrospective review of all patients with d-transposition of the great arteries (d-TGA) or double-outlet right ventricle with subpulmonary ventricular septal defect (VSD) who underwent ASO from May 1986 to January 2001. Serial echocardiograms were reviewed to measure neo-aortic annulus, root, and anastomosis diameter (z scores) and to determine progression of AR. Potential risk factors were assessed for developing neo-aortic root enlargement and AR. There were 119 patients (44 female and 75 male): 73 patients had simple d-TGA, 36 had d-TGA with ventricular septal defect, and 10 had a Taussig-Bing heart. The median duration of follow-up was 65 months (range, 12-180). The median neo-aortic root (z = 0.55+/-2.2; p < 0.01) and aortic annulus dimensions (z = 1.57+/-1.75; p < 0.01) were significantly increased over the study period. Aortic anastomosis diameter correlated with growth of the ascending aorta (z = 0.55+/-1.24). Development of severe neo-aortic root enlargement was associated with prior pulmonary artery (PA) banding (p < 0.01), the presence of a VSD (p = 0.03), and Taussig-Bing anatomy (p < 0.01) but was independent of coronary arterial anatomy, coronary arterial transfer technique, or associated lesions (p > 0.05). At latest follow-up, there was no or trivial AR in 88 patients, mild AR in 29 patients, and moderate to severe AR in 3 patients. Risk factors for developing mild or worse AR included severe or rapid neo-aortic root dilatation (p < 0.01). Only 3 patients required surgical intervention for AR. Despite the significant prevalence of neo-aortic root enlargement at intermediate follow-up after ASO, there is a low incidence of significant AR. Prior PA banding, the presence of VSD, and Taussig-Bing anatomy are risk factors for severe root enlargement. Surgical intervention for AR was rare (2%), however, serial surveillance of such patients is vital to monitor for neo-aortic root enlargement and potential aortic valve dysfunction.
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Affiliation(s)
- C J McMahon
- Lillie Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA.
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Ikemba CM, Eldem BW, Kennard Fraley J, Eapen RS, Pignatelli RH, Ayres NA, Bezold LI. Mitral valve disease progression in shones complex: Are there echocardiographic predictors? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82684-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Franklin WJ, Arora G, Ayres NA. Pneumopericardium and pneumomediastinum in an adolescent after blunt chest trauma. Tex Heart Inst J 2003; 30:338-9. [PMID: 14677752 PMCID: PMC307727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Wayne J Franklin
- The Department of Pediatrics, Cardiology Section, Texas Children's Hospital, Houston, Texas 77030, USA.
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John JB, Bricker JT, Fenrich AL, Vick GW, El-Said HG, Ayres NA, Bezold LI. Images in cardiovascular medicine. Fetal diagnosis of right ventricular aneurysm associated with supraventricular tachycardia with left bundle-branch block aberrancy. Circulation 2002; 106:141-2. [PMID: 12093784 DOI: 10.1161/01.cir.0000017558.99923.e2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J Blaine John
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston 77030, USA
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Abstract
Cardiac rhabdomyoma represents the commonest primary cardiac tumour. Its natural history is generally favourable, with resolution in the majority of cases. Surgical resection has been described for intractable arrhythmia, severe obstruction of the inflow or outflow tracts sufficient to compromise cardiac output, and systemic embolization. We describe an alternative palliative strategy, which was associated with regression of the tumour.
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Affiliation(s)
- C J McMahon
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston 77030, USA.
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Abstract
Noncontrast harmonic imaging (HI) has been shown to improve image quality in adults with poor acoustic windows. The utility of fetal echocardiography may be limited by suboptimal acoustic windows, and the use of HI in fetal echocardiography has not previously been defined. The purpose of this study was to compare the quality of fundamental imaging (FI) and HI in fetal echocardiography. Sixty-two fetal echocardiograms, including 44 (71%) with limited acoustic windows, were performed with the use of FI and HI. Image quality and visualization of the ventricles, valves, and the aortic and ductal arches were evaluated and compared between FI and HI. Mean HI scores were higher than mean FI scores for all the structures evaluated. Compared with FI, HI improved the image quality and visualization of cardiac structures in this group of fetuses with predominantly suboptimal acoustic windows. Harmonic imaging is a useful adjunct to FI in echocardiography, and the benefits of HI extend to cardiac imaging in the fetus.
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Affiliation(s)
- J P Kovalchin
- Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA. johnk2bcm.tmc.edu
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Hornberger LK, Lipshultz SE, Easley KA, Colan SD, Schwartz M, Kaplan S, Starc TJ, Ayres NA, Lai WW, Moodie DS, Kasten-Sportes C, Sanders SP. Cardiac structure and function in fetuses of mothers infected with HIV: the prospective PCHIV multicenter study. Am Heart J 2000; 140:575-84. [PMID: 11011330 PMCID: PMC4309555 DOI: 10.1067/mhj.2000.109645] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study was designed to determine if vertically transmitted HIV infection and maternal infection with HIV are associated with altered cardiovascular structure and function in utero. METHODS Fetal echocardiography was performed in 173 fetuses of 169 HIV-infected mothers (mean gestational age, 33.0 weeks; SD = 3.7 weeks) at 5 centers. Biparietal diameter, femur length, cardiovascular dimensions, and Doppler velocities through atrioventricular and semilunar valves and the umbilical artery were measured. Measurements were converted to z scores based on published normal data. RESULTS Fetuses determined after birth to be HIV-infected had similar echocardiographic findings as fetuses later determined to be HIV-uninfected except for slightly smaller left ventricular diastolic dimensions (P =.01). The femur length (P =.03) was also smaller in the fetuses postnatally identified as HIV-infected. Differences in cardiovascular dimensions and Doppler velocities were identified between fetuses of HIV-infected women and previously published normal fetal data. The reason for the differences may be a result of maternal HIV infection, maternal risk factors, or selection bias in the external control data. CONCLUSIONS Vertically transmitted HIV infection may be associated with reduced left ventricular size but not with altered cardiac function in utero. Fetuses of HIV-infected mothers may have abnormal cardiovascular structure and function and increased placental vascular resistance, regardless of whether the fetuses are subsequently found to be infected with HIV.
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Affiliation(s)
- L K Hornberger
- Department of Cardiology, Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Nowlen TT, Ayres NA, Kearney DL, Nihill MR, Grifka RG. Premature closure of the foramen ovale associated with aortic stenosis, left ventricular dilation with thrombus, and early mortality. Am J Cardiol 2000; 85:1159-61, A9. [PMID: 10781774 DOI: 10.1016/s0002-9149(00)00718-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Premature foramen ovale (FO) closure has been postulated as a cause of hypoplastic left heart syndrome. We suggest that premature FO closure is also associated with left ventricular (LV) dilation and LV thrombus formation, and that FO closure in patients with aortic stenosis and LV dilation is a secondary event that occurs later in gestation than that seen with the hypoplastic left heart.
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Affiliation(s)
- T T Nowlen
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Dallas, TX 77030, USA
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Andropoulos DB, Ayres NA, Stayer SA, Bent ST, Campos CJ, Fraser CD. The effect of transesophageal echocardiography on ventilation in small infants undergoing cardiac surgery. Anesth Analg 2000; 90:47-9. [PMID: 10624975 DOI: 10.1097/00000539-200001000-00011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Transesophageal echocardiography (TEE) is frequently used during congenital cardiac surgery. Complications are infrequent, but interference with ventilation has been reported, especially in small infants. Ventilation variables were measured prospectively in 22 infants, 2-5 kg, undergoing heart surgery with TEE. Measurements were made preoperatively before and after TEE probe insertion and postoperatively before and after TEE probe removal. The variables measured included arterial blood gases, expired tidal volume, peak inspiratory pressure, positive end-expiratory pressure, minute ventilation, airway resistance, dynamic compliance, and peak inspiratory and expiratory flow rates. No significant change in any ventilatory variable at either time period was noted in the infants. IMPLICATIONS Ventilatory compromise is infrequent in small infants undergoing transesophageal echocardiography (TEE) examination. Careful ventilatory monitoring rapidly detects changes in ventilation during TEE examination. Small infants who benefit from TEE during heart surgery should not be excluded from receiving a TEE examination because of concern of ventilatory compromise.
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Affiliation(s)
- D B Andropoulos
- Division of Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston 77030-2399, USA.
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Bowles NE, Kearney DL, Ni J, Perez-Atayde AR, Kline MW, Bricker JT, Ayres NA, Lipshultz SE, Shearer WT, Towbin JA. The detection of viral genomes by polymerase chain reaction in the myocardium of pediatric patients with advanced HIV disease. J Am Coll Cardiol 1999; 34:857-65. [PMID: 10483970 DOI: 10.1016/s0735-1097(99)00264-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the frequency of viral nucleic acid detection in the myocardium of human immunodeficiency virus (HIV)-infected children to determine whether an association exists with the development of heart disease. BACKGROUND As improved medical interventions increase the life expectancy of HIV-infected patients, increased incidences of myocarditis and dilated cardiomyopathy (DCM) are becoming more apparent, even in patients without clinical symptoms. METHODS Myocardial samples were obtained from the postmortem hearts of 32 HIV-infected children and from 32 age-matched controls consisting of patients with structural congenital heart disease and no myocardial inflammation and no cardiac or systemic viral infection. The hearts were examined histologically and analyzed for the presence of viral sequences by polymerase chain reaction (PCR) or reverse transcription-PCR. RESULTS Myocarditis was detected histologically in 11 of the 32 HIV-infected patients, and borderline myocarditis was diagnosed in another 13 cases. Infiltrates were confined to the epicardium in two additional hearts. Virus sequences were detected by PCR in 11 of these 26 cases (42.3%); adenovirus in 6, CMV in 3 and both adenovirus and CMV in 2. Two cases without infiltrates were also positive for adenovirus: one had congestive heart failure (CHF) and the other adenoviral pneumonia. No other viruses were detected by PCR, including HIV proviral DNA. All control samples were negative for all viruses tested. CONCLUSIONS These data suggest that the presence of viral nucleic acid in the myocardium is common in HIV-infected children, and may relate to the development of myocarditis, DCM or CHF and may contribute to the rapid progression of HIV disease.
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Affiliation(s)
- N E Bowles
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA
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Abstract
In Project HeartBeat!, a longitudinal study of cardiovascular disease risk factors in healthy children and adolescents, 3 samples of 40, 80, and 182 echocardiograms, respectively, were randomly selected and reread to evaluate intraobserver and interobserver variabilities and comparability between measurements of field echocardiographic technicians and reference readings at Texas Children's Hospital. Included in the evaluation were 8 M-mode echocardiographic measurements, ie, aortic root diameter, left atrial diameter, and end-diastolic and end-systolic measurements of interventricular septal thickness, left ventricular (LV) diameter, and LV posterior wall thickness; 8 Doppler measurements; and a calculated LV mass. Means and SDs of the differences of the paired measurements were used to assess the relative bias and random error of the measurements. For the intraobserver comparison, means and SDs of the differences were very small, indicating that the echo measurements were performed consistently by each project echo technician. Interobserver comparison showed statistically but not clinically significant differences between the paired readings of end-diastolic septal thickness, end-systolic LV posterior wall thickness, and 5 Doppler measurements. Comparison with reference readings at Texas Children's Hospital showed significant differences in diastolic LV diameter, systolic septal thickness, and right ventricular ejection time. These differences, however, were minimal with limited clinical significance. Mean differences in LV mass for the corresponding comparisons were -1.82, 4.50, and 0.0013 g, and the SDs were 18.79, 24.16, and 12.35 g, respectively. We conclude that the echocardiographic measurements taken from healthy children in a longitudinal study can be made accurately with acceptable reproducibility.
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Affiliation(s)
- S Dai
- University of Texas-Houston Health Science Center, School of Public Health, Houston, Texas, USA.
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Riskin-Mashiah S, Moise KJ, Wilkins I, Ayres NA, Fraser CD. In utero diagnosis of intrapericardial teratoma: a case for in utero open fetal surgery. Prenat Diagn 1998; 18:1328-30. [PMID: 9885028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We present a case of intrapericardial teratoma diagnosed by ultrasound at 26 weeks of gestation presenting as a large tumour mass and rapid development of hydrops fetalis. The fetus died in utero one day before scheduled open fetal surgery.
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Affiliation(s)
- S Riskin-Mashiah
- Department of Obstetrics and Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, USA
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49
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Abstract
There are limited data regarding the outcome of pregnancy in women after intervention for coarctation of the aorta (CoA). The Texas Children's Hospital Cardiac Database was used to identify female patients with CoA born before 1980 who had undergone balloon angioplasty or surgery. Patients with Turner's syndrome and cyanotic congenital heart disease were excluded. A chart review and telephone interview were performed. Data collected included age at intervention, type of intervention, the need for reintervention, functional status, number of pregnancies, and pregnancy outcomes. Seventy-four patients met our criteria and we were able to contact 52. Eighteen patients (39%) were pregnant a total of 36 times. There were 3 spontaneous and 4 elective abortions. Preeclampsia complicated 4 pregnancies in 3 women (17% of primigravidas). One patient had systemic hypertension. Eleven infants were delivered by Cesarean section. There were 29 births, with an average weight of 3.0 kg. There were 5 preterm births, 4 to a teenage mother. Only 1 child (3%) had a congenital heart defect. Thus, in women with an arm-to-leg blood pressure gradient of <20 mm Hg after CoA repair, pregnancy is successful. The occurrence of congenital heart disease in the offspring was 3%. Preeclampsia was similar to that in the general population.
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Affiliation(s)
- A S Saidi
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston 77030, USA
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Goodrum LA, Moise KJ, Saade GR, Belfort MA, Ayres NA, Carpenter RJ. Effects of intravascular transfusion for red cell alloimmunization on fetal arterial blood pressure. Fetal Diagn Ther 1997; 12:149-52. [PMID: 9313072 DOI: 10.1159/000264456] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the effects of intravascular transfusion (IVT) on the fetal umbilical arterial pressure (UAP) in pregnancies complicated by red cell alloimmunization. STUDY DESIGN UAP and amniotic fluid pressures (AFP) were measured immediately before and after IVT. Mean UAP was calculated by computing 1/3 (systolic blood pressure - diastolic blood pressure) + diastolic blood pressure. The fractional increase in fetoplacental blood volume with transfusion was calculated by dividing the net volume of blood transfused by the sum of the net volume transfused and the fetoplacental volume based on the estimated fetal weight by ultrasound. Statistical techniques included paired t-test, and the Pearson product correlation. Significance was defined as p < 0.05. RESULTS The fetal umbilical artery was punctured during a total of 27 procedures in 21 patients. Pre- and posttransfusion mean UAPs were recorded in 16 of these procedures. Mean UAP increased from 34.0 +/- 14.2 mm Hg pretransfusion to 38.6 +/- 12.8 mm Hg posttransfusion (p = 0.34). There was no correlation between the fractional change in fetoplacental blood volume and the calculated difference between pre- and posttransfusion blood pressure. Bradycardia occurred during 5 procedures (31.2%). Fetal demise occurred after 2 procedures (12.5%). CONCLUSION IVT appears to have a minimal effect on the fetal UAP. Fetal bradycardia occurs in a significant percentage of these cases.
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Affiliation(s)
- L A Goodrum
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex., USA
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