Pub Date : 2023-01-01DOI: 10.32604/chd.2023.042344
François-Xavier Van Vyve, Karlien Carbonez, Jelena Hubrechts, Geoffroy de Beco, Jean E. Rubay, Mona Momeni, Thierry Detaille, Alain J. Poncelet
Objectives: Over the last decade, neonatal repair has been advocated for many congenital heart diseases. However, specific subgroups of complex congenital heart disease still require temporary palliation for which both surgical and endovascular techniques are currently available. We reviewed our institutional experience with shunt palliation with an emphasis on risk factors for early mortality. Methods: This is a single-center retrospective study on 175 patients undergoing surgery for central shunt or modified Blalock-Taussig shunt. All data were extracted from a prospectively collected computerized database. We identified risk factors for early mortality by uni- and multi-variable analysis. All data were censored at the time of death or shunt take-down operation. Results: Mean age and weight at surgery were 24 days (IQR [7–95]) and 3.4 kg (IQR [2.9–4.8]), respectively, with 96 neonates (55%). Most patients had a biventricular heart disease (115 patients, 66%), and 51 patients (29.1%) had univentricular heart disease. Thoracotomy was performed in 129 patients (74%). Cardiopulmonary bypass was used in 23 patients (13%). The median intensive care and overall length of stay were 4 days (IQR [2–9]) and 18 days (IQR [13–29]), respectively. In-hospital mortality was 8.6% (15/175). By multivariable regression analysis, prematurity (HR 5.6 [2.1–14.7]), CPB use (HR 6.7 [2.2–18.6]), unplanned <30-day reoperation (HR 3.5 [1.2–10]) or catheterization (HR 4.5 [1.2–16.9]) were all significant predictors of early mortality. Conclusions: Procedural-related mortality remains high (8.6%) in surgical shunt palliation. For patients with prematurity, low weight at birth, or if the use of cardiopulmonary bypass is contemplated, alternative endovascular techniques of palliation should be considered together with longitudinal follow-up studies.
目的:在过去的十年中，新生儿修复被提倡用于许多先天性心脏病。然而，复杂先天性心脏病的特定亚群仍然需要暂时的缓解，目前可以使用手术和血管内技术。我们回顾了我们在分流姑息治疗方面的机构经验，重点是早期死亡的危险因素。方法:这是一项单中心回顾性研究，175例接受中央分流术或改良Blalock-Taussig分流术手术的患者。所有数据均从前瞻性收集的计算机数据库中提取。我们通过单变量和多变量分析确定了早期死亡的危险因素。在死亡或分流拆除操作时，所有数据都被删除。结果:手术时平均年龄24天(IQR[7-95])，平均体重3.4 kg (IQR[2.9-4.8])，新生儿96例(55%)。大多数患者患有双室心脏病(115例，66%)，51例(29.1%)患有单室心脏病。129例(74%)患者行开胸手术。体外循环23例(13%)。重症监护的中位数和总住院时间分别为4天(IQR[2-9])和18天(IQR[13-29])。住院死亡率为8.6%(15/175)。通过多变量回归分析，早产(HR 5.6 [2.1-14.7])， CPB使用(HR 6.7[2.2-18.6])，计划外结论:手术相关死亡率仍然很高(8.6%)。对于早产、出生时体重过轻或考虑使用体外循环的患者，应考虑采用其他血管内缓解技术并进行纵向随访研究。
{"title":"Analysis of Risk Factors for Early Mortality in Surgical Shunt Palliation: Time for a Change?","authors":"François-Xavier Van Vyve, Karlien Carbonez, Jelena Hubrechts, Geoffroy de Beco, Jean E. Rubay, Mona Momeni, Thierry Detaille, Alain J. Poncelet","doi":"10.32604/chd.2023.042344","DOIUrl":"https://doi.org/10.32604/chd.2023.042344","url":null,"abstract":"<b>Objectives:</b> Over the last decade, neonatal repair has been advocated for many congenital heart diseases. However, specific subgroups of complex congenital heart disease still require temporary palliation for which both surgical and endovascular techniques are currently available. We reviewed our institutional experience with shunt palliation with an emphasis on risk factors for early mortality. <b>Methods:</b> This is a single-center retrospective study on 175 patients undergoing surgery for central shunt or modified Blalock-Taussig shunt. All data were extracted from a prospectively collected computerized database. We identified risk factors for early mortality by uni- and multi-variable analysis. All data were censored at the time of death or shunt take-down operation. <b>Results:</b> Mean age and weight at surgery were 24 days (IQR [7–95]) and 3.4 kg (IQR [2.9–4.8]), respectively, with 96 neonates (55%). Most patients had a biventricular heart disease (115 patients, 66%), and 51 patients (29.1%) had univentricular heart disease. Thoracotomy was performed in 129 patients (74%). Cardiopulmonary bypass was used in 23 patients (13%). The median intensive care and overall length of stay were 4 days (IQR [2–9]) and 18 days (IQR [13–29]), respectively. In-hospital mortality was 8.6% (15/175). By multivariable regression analysis, prematurity (HR 5.6 [2.1–14.7]), CPB use (HR 6.7 [2.2–18.6]), unplanned <30-day reoperation (HR 3.5 [1.2–10]) or catheterization (HR 4.5 [1.2–16.9]) were all significant predictors of early mortality. <b>Conclusions:</b> Procedural-related mortality remains high (8.6%) in surgical shunt palliation. For patients with prematurity, low weight at birth, or if the use of cardiopulmonary bypass is contemplated, alternative endovascular techniques of palliation should be considered together with longitudinal follow-up studies.","PeriodicalId":10666,"journal":{"name":"Congenital Heart Disease","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135559344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32604/chd.2023.023542
Wen Qian, Xinzhu Zhou, K. Shi, Li Jiang, Xi Liu, Liting Shen, Zhi Yang
{"title":"Assessment of Intracardiac and Extracardiac Deformities in Patients with Various Types of Pulmonary Atresia by Dual-Source Computed Tomography","authors":"Wen Qian, Xinzhu Zhou, K. Shi, Li Jiang, Xi Liu, Liting Shen, Zhi Yang","doi":"10.32604/chd.2023.023542","DOIUrl":"https://doi.org/10.32604/chd.2023.023542","url":null,"abstract":"","PeriodicalId":10666,"journal":{"name":"Congenital Heart Disease","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69720051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32604/chd.2023.031075
Nerejda Shehu, Christian Meierhofer, Anja Hennemuth, Markus H黮lebrand, Pavlo Yevtushenko, Peter Ewert, Stefan Martinoff, Heiko Stern
{"title":"Minor Pressure Differences within the Fontan-Anastomosis in Patients with Total Cavopulmonary Connection by 4D-Flow Magnetic Resonance Imaging","authors":"Nerejda Shehu, Christian Meierhofer, Anja Hennemuth, Markus H黮lebrand, Pavlo Yevtushenko, Peter Ewert, Stefan Martinoff, Heiko Stern","doi":"10.32604/chd.2023.031075","DOIUrl":"https://doi.org/10.32604/chd.2023.031075","url":null,"abstract":"","PeriodicalId":10666,"journal":{"name":"Congenital Heart Disease","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135401627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32604/chd.2023.042341
François-Xavier Van Vyve, Karlien Carbonez, Geoffroy de Beco, Stéphane Moniotte, Jean E. Rubay, Mona Momeni, Laurent Houtekie, Alain J. Poncelet
Objective: Despite increasing enthusiasm for neonatal repair, patients with ductal-dependent circulation (pulmonary/systemic) or restrictive pulmonary blood flow still require initial palliation. Ductal stenting has emerged as an endovascular approach whereas modified-Blalock-Taussig and central shunt remain surgical references. In this study, we analyzed the relationship between pulmonary artery growth, sites of shunt connection, or antegrade pulmonary blood flow in surgically placed shunts. The need for secondary catheter-based interventions or pulmonary arterioplasty was also investigated. Methods: A retrospective single-center study analyzing 175 patients undergoing surgery for a central or modified-Blalock-Taussig shunt. Outcome growth variables were right pulmonary artery/left pulmonary artery diameters/Z scores, the indexed sum area (right pulmonary artery + left pulmonary artery), and the pulmonary symmetry index. Three imaging modalities were used: angiography, computed tomography, and echocardiography. Results: At baseline, pulmonary arteries were larger in patients with antegrade pulmonary blood flow (Nakata index 137 vs. 114, p = 0.047) as well as in patients receiving a modified-Blalock-Taussig shunt (Nakata index 138 vs. 84, p < 0.001). At the time of shunt takedown, both the right pulmonary artery and left pulmonary artery had normalized their diameter. The Nakata index increased from 134 to 233 mm2/m2 (p < 0.001). The pulmonary artery index remained stable (0.86) over time. During the inter-stage period, shunt-related pulmonary artery stenosis and juxta-ductal stenosis were diagnosed in 16 (10%) and 17 patients (11%), respectively. Conclusions: Surgical shunt palliation allows normal pulmonary artery growth. Pulmonary artery stenosis was either shunt-related (10%) or secondary to juxta-ductal stenosis (11%). Close echographic follow-up allows early diagnosis and treatment of juxta-ductal stenosis.
目的:尽管对新生儿修复的热情越来越高，但导管依赖循环(肺/全身)或肺血流受限的患者仍然需要初始姑息治疗。导管支架置入术已成为血管内入路，而改良的blalock - taussig和中央分流术仍然是手术参考。在这项研究中，我们分析了肺动脉生长、分流器连接部位或手术放置分流器中顺行肺血流之间的关系。是否需要二次导管介入或肺动脉成形术也进行了研究。方法:一项回顾性单中心研究分析了175例接受中央或改良blalock - taussig分流术手术的患者。结果增长变量为右肺动脉/左肺动脉直径/Z评分、指标面积之和(右肺动脉+左肺动脉)和肺对称性指数。使用三种成像方式:血管造影、计算机断层扫描和超声心动图。结果:在基线时，顺行肺血流患者(Nakata指数137 vs. 114, p = 0.047)和接受改良blalock - taussig分流术的患者(Nakata指数138 vs. 84, p < 0.001)的肺动脉更大。取下分流管时，右肺动脉和左肺动脉的直径均已正常化。Nakata指数从134 mm2/m2增加到233 mm2/m2 (p < 0.001)。随着时间的推移，肺动脉指数保持稳定(0.86)。在期中，分别有16例(10%)和17例(11%)患者被诊断为分流相关性肺动脉狭窄和导管旁狭窄。结论:手术分流姑息可使正常肺动脉生长。肺动脉狭窄要么与分流相关(10%)，要么继发于导管旁狭窄(11%)。密切的超声随访可以早期诊断和治疗导管旁狭窄。
{"title":"Analysis of Pulmonary Arteries Growth after Initial Shunt Palliation in Neonates and Infants","authors":"François-Xavier Van Vyve, Karlien Carbonez, Geoffroy de Beco, Stéphane Moniotte, Jean E. Rubay, Mona Momeni, Laurent Houtekie, Alain J. Poncelet","doi":"10.32604/chd.2023.042341","DOIUrl":"https://doi.org/10.32604/chd.2023.042341","url":null,"abstract":"<b>Objective:</b> Despite increasing enthusiasm for neonatal repair, patients with ductal-dependent circulation (pulmonary/systemic) or restrictive pulmonary blood flow still require initial palliation. Ductal stenting has emerged as an endovascular approach whereas modified-Blalock-Taussig and central shunt remain surgical references. In this study, we analyzed the relationship between pulmonary artery growth, sites of shunt connection, or antegrade pulmonary blood flow in surgically placed shunts. The need for secondary catheter-based interventions or pulmonary arterioplasty was also investigated. <b>Methods:</b> A retrospective single-center study analyzing 175 patients undergoing surgery for a central or modified-Blalock-Taussig shunt. Outcome growth variables were right pulmonary artery/left pulmonary artery diameters/Z scores, the indexed sum area (right pulmonary artery + left pulmonary artery), and the pulmonary symmetry index. Three imaging modalities were used: angiography, computed tomography, and echocardiography. <b>Results:</b> At baseline, pulmonary arteries were larger in patients with antegrade pulmonary blood flow (Nakata index 137 <i>vs</i>. 114, <i>p</i> = 0.047) as well as in patients receiving a modified-Blalock-Taussig shunt (Nakata index 138 <i>vs</i>. 84, <i>p</i> < 0.001). At the time of shunt takedown, both the right pulmonary artery and left pulmonary artery had normalized their diameter. The Nakata index increased from 134 to 233 mm2/m2 (<i>p</i> < 0.001). The pulmonary artery index remained stable (0.86) over time. During the inter-stage period, shunt-related pulmonary artery stenosis and juxta-ductal stenosis were diagnosed in 16 (10%) and 17 patients (11%), respectively. <b>Conclusions:</b> Surgical shunt palliation allows normal pulmonary artery growth. Pulmonary artery stenosis was either shunt-related (10%) or secondary to juxta-ductal stenosis (11%). Close echographic follow-up allows early diagnosis and treatment of juxta-ductal stenosis.","PeriodicalId":10666,"journal":{"name":"Congenital Heart Disease","volume":"274 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135560790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32604/chd.2023.025853
Norman Aiad, Mark V. Sherrid, Adam J. Small, Youssef Elnabawi, Jodi L. Feinberg, L. Axel, R. Mosca, T. K. Susheel Kumar, M. Argilla, Dan G. Halpern
{"title":"Anatomic Correlates of Mitral Systolic Anterior Motion in Transposition of the Great Arteries Following Atrial Switch Operation","authors":"Norman Aiad, Mark V. Sherrid, Adam J. Small, Youssef Elnabawi, Jodi L. Feinberg, L. Axel, R. Mosca, T. K. Susheel Kumar, M. Argilla, Dan G. Halpern","doi":"10.32604/chd.2023.025853","DOIUrl":"https://doi.org/10.32604/chd.2023.025853","url":null,"abstract":"","PeriodicalId":10666,"journal":{"name":"Congenital Heart Disease","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69719861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32604/chd.2023.026598
Andrei George Iosifescu, R. Enache, I. Marinică, C. Radu, Vlad Anton Iliescu
{"title":"“Treat-Repair-Treat”: Management of Left Main Coronary Compression by a Pulmonary Artery Aneurysm in a Patient with Atrial Septal Defect and Significant Pulmonary Hypertension","authors":"Andrei George Iosifescu, R. Enache, I. Marinică, C. Radu, Vlad Anton Iliescu","doi":"10.32604/chd.2023.026598","DOIUrl":"https://doi.org/10.32604/chd.2023.026598","url":null,"abstract":"","PeriodicalId":10666,"journal":{"name":"Congenital Heart Disease","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69720127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Research on fetal congenital heart defect (CHD) mostly focuses on etiology and mechanisms. However, studies on maternal complications or pathophysiology are limited. Our objective was to determine whether vascular dysfunction exists in pregnant women carrying a fetus with congenital heart defects. Methods: We conducted a case-control study. 27 cases of pregnant women carrying a fetus with major CHD admitted to our hospital for delivery between April 2021 and August 2022 were selected. Every case was matched with about 2 pregnant complication-free controls without fetal abnormalities. The proangiogenic and anti-angiogenic factors and pregnancy outcomes were compared. Results: The proangiogenic factors include vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). The anti-angiogenic factors involve soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng). No differences were found in maternal plasma concentrations of PlGF, VEGF, and sFlt-1 between case-control groups when analyzed at 36 weeks ≤ gestational age (GA) < 39 weeks and 39 weeks ≤ GA ≤ 41 weeks. The concentrations of sEng in maternal plasma in the fetal CHD group were significantly higher than those in the control group: 0.60 (0.77) vs. 0.32 (0.26) ng/ml at 36 weeks ≤ GA < 39 weeks, p = 0.001 and 0.75 (0.55) vs. 0.28 (0.27) ng/ml at 39 weeks ≤ GA ≤ 41 weeks, p < 0.001. Conclusion: Vascular dysfunction exists in pregnant women with fetal congenital heart defects, manifesting significantly elevated sEng concentration at delivery.
{"title":"Maternal Vascular Dysfunction in Congenital Heart Defects","authors":"Yanli Liu, Fengzhen Han, Jian Zhuang, Yanqiu Ou, Yanji Qu, Yanyan Lin, Weina Zhang, Haiping Wang, Liping Huang","doi":"10.32604/chd.2023.030511","DOIUrl":"https://doi.org/10.32604/chd.2023.030511","url":null,"abstract":"<b>Background:</b> Research on fetal congenital heart defect (CHD) mostly focuses on etiology and mechanisms. However, studies on maternal complications or pathophysiology are limited. Our objective was to determine whether vascular dysfunction exists in pregnant women carrying a fetus with congenital heart defects. <b>Methods:</b> We conducted a case-control study. 27 cases of pregnant women carrying a fetus with major CHD admitted to our hospital for delivery between April 2021 and August 2022 were selected. Every case was matched with about 2 pregnant complication-free controls without fetal abnormalities. The proangiogenic and anti-angiogenic factors and pregnancy outcomes were compared. <b>Results:</b> The proangiogenic factors include vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). The anti-angiogenic factors involve soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng). No differences were found in maternal plasma concentrations of PlGF, VEGF, and sFlt-1 between case-control groups when analyzed at 36 weeks ≤ gestational age (GA) < 39 weeks and 39 weeks ≤ GA ≤ 41 weeks. The concentrations of sEng in maternal plasma in the fetal CHD group were significantly higher than those in the control group: 0.60 (0.77) <i>vs.</i> 0.32 (0.26) ng/ml at 36 weeks ≤ GA < 39 weeks, <i>p</i> = 0.001 and 0.75 (0.55) <i>vs.</i> 0.28 (0.27) ng/ml at 39 weeks ≤ GA ≤ 41 weeks, <i>p < </i> 0.001. <b>Conclusion:</b> Vascular dysfunction exists in pregnant women with fetal congenital heart defects, manifesting significantly elevated sEng concentration at delivery.","PeriodicalId":10666,"journal":{"name":"Congenital Heart Disease","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135560795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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