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Pubblicazioni recenti - pediatric cardiac
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Twelve Years of Complete Atrioventricular Septal Defect Repair.
Rev Port Cir Cardiotorac Vasc;26(3):187-193.
Sena André, Sheytanov Ventsislav, Liebrich Markus, Narr Anita, Schweigmann Ulrich, Uhlemann Frank, Doll Nicolas, Tzanavaros Ioannis,
Abstract
BACKGROUND:
Surgical repair is the standard treatment for complete atrioventricular septal defect. At our institution, this repair is performed by single patch, modified single patch or two patch techniques, according to the surgeon preferences and the surgical anatomy of the defect. The goal of this study was to evaluate our results from the last twelve years.
METHODS:
From June 2006 to June 2018, 81 children with complete atrioventricular septal defect (without tetralogy of Fallot or unbalanced ventricles) were submitted to surgical repair at our institution. Data from all patients was retrospectively collected and evaluated.
RESULTS:
The average age was 6.9 ± 13.7 months and 84% had Down syndrome. Eighty percent were symptomatic and 6 patients were previously submitted to pulmonary artery banding. No more that mild left atrioventricular valve insufficiency was found in 84% and 89% of the patients, at discharge and follow-up, respectively. Small residual septal defects were present in 27% at discharge; during follow-up, 41% of these closed spontaneously. Pulmonary hypertension at discharge and follow-up appeared in 3.7% and 1.3%, respectively. Permanente pacemaker was implanted in 3 patients. Left ventricle outflow tract obstruction was found in 3 patients and 2 needed surgical correction. At follow-up (40 ± 38 months), 90% of the patients presented NYHA functional class I. No significant differences in the main repair outcomes were found between techniques, with the exception of small residual septal defects, although the groups were unmatched.
CONCLUSIONS:
Overall and regardless of the technique used for the repair of complete AVSD, good early and midterm outcomes were achieved.
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"The heart supporters": systematic review for ventricle assist devices in congenital heart surgery.
Heart Fail Rev2019 Nov;():. doi: 10.1007/s10741-019-09892-0.
Comentale Giuseppe, Giordano Raffaele, Pilato Emanuele, D'Amore Anna, Romano Roberta, Simeone Silvio, Browning Rosie, Palma Gaetano, Iannelli Gabriele,
Abstract
Ventricular assist device (VAD) implantation is a widely used procedure in children with cardiac failure refractory to medical therapy as a long-term bridge to recovery or transplant. This strategy has proved to be of an enormous advantage in the cure of these children. The aim of this review is to evaluate the current strategies used for clinical monitoring of paediatric patients with a VAD, focusing on the management of several aspects such as anticoagulant and antiplatelet therapy, haemorrhagic and thrombotic complications, as well as the effects that VADs have on the exposure, effectiveness and the safety of drugs. The sources used for this research are MEDLINE, PubMed and Cochrane Library. The use of key words such as "paediatric ventricular assist device", "clinical management", "anticoagulant therapy" and "infections" retrieved 146 papers. With the application of the inclusion criteria, 42 articles have been selected, but following further analysis, only 21 were eligible. The post-implant process is still complicated due to the lack of guidelines regarding clinical management and for the frequent occurrence of adverse events including bleeding, infection and thromboembolic episodes. From these findings, we can highlight the importance of establishing a suitable antithrombotic therapy, as well as ensuring that the prevention and treatment of infection are paramount during the management of these patients. The clinical management of VAD paediatric children is complex and challenging. At the moment, there are no guidelines regarding strategies to adopt, but from the analysed surveys, it has been possible to highlight a relative coherence between adopted therapies in different centres worldwide.
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Valve Replacement in Children with Single Ventricle Physiology.
Pediatr Cardiol2019 Nov;():. doi: 10.1007/s00246-019-02234-9.
Alshami Noor, Sarvestani Amber Leila, Thomas Amanda S, St Louis James, Kochilas Lazaros, Raghuveer Geetha,
Abstract
Severe atrioventricular valve (AVV) or semilunar valve (SLV) regurgitation in the setting of a single ventricle physiology may proceed to valve replacement if repair strategies fail. Outcome data for these children are limited. We present transplant-free survival of a case series of children with single ventricle physiology undergoing either atrioventricular replacement (AVVR) or semilunar valve replacement (SLVR) from a multi-institutional, US-based registry (Pediatric Cardiac Care Consortium-PCCC). Outcomes were derived from PCCC and by linkage with the National Death Index (NDI) and Organ Procurement Transplant Network (OPTN). Fifty children with single ventricle physiology were identified to have received either AVVR (n?=?38) or SLVR (n?=?12). There were 17 in-hospital deaths including 8 intraoperative deaths (all intraoperative deaths were among children requiring AVVR). The in-hospital mortality was 42% and 8% for AVVR and SLVR, respectively. Among the 33 children surviving to hospital discharge, follow-up was available in 15 (46%). Death or cardiac transplant after hospital discharge occurred in 10-death in 4 (all among those requiring AVVR), cardiac transplant in 6 (2 following AVVR, 4 following SLVR). Valve replacement in children with single ventricle physiology, especially AVVR, is associated with poor outcomes. Alternative palliation strategies should be considered in children with single ventricle physiology with significant AVV or SLV regurgitations.
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Grisel syndrome, sigmoid sinus thrombosis and rheumatic carditis: Case report of a rare association.
Int J Pediatr Otorhinolaryngol2019 Nov;129():109774. doi: S0165-5876(19)30527-0.
Cucuzza Maria Elena, D'Ambra Angela, Evola Francesco Roberto, Greco Filippo, Smilari Pierluigi,
Abstract
Grisel's syndrome (GS) is a non traumatic atlanto-axial rotatory subluxation of C1-C2 joint. A six year old girl, 20 days after an episode of fever, developed a torticollis and a 3/6 heart murmur. The echocardiography showed a Rheumatic Carditis. The Brain and cervical spine Magnetic resonance imaging (MRI) and the Computerized Tomography (CT) showed rotary dislocation of C1-C2 vertebrae, compatible with GS, and cerebral venous thrombosis (CVT). An antibiotic therapy, Prednisone and a low molecular weight heparin for 7 days was prescribedfollowed by an oral anticoagulant for 6 months. After a month the MRI showed a reduction of the dislocation and cerebral venous recanalization.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Successful cardiopulmonary resuscitation following minimally invasive pectus excavatum repair: A case report.
Int J Surg Case Rep2019 Oct;65():255-258. doi: S2210-2612(19)30601-7.
Glithero Kyle J, Tackett John J, DeMason Kenneth, Burnweit Cathy A,
Abstract
INTRODUCTION:
Pectus excavatum is the most common congenital chest wall deformity. The minimally invasive repair of pectus excavatum (MIRPE) is the most commonly practiced method of surgical treatment and there is concern that the pectus bar will prevent effective CPR. There are no recorded cases of successful cardiopulmonary resuscitation with pectus bars in place.
PRESENTATION OF CASE:
A 17-year-old male with pectus excavatum underwent MIRPE. Two years later, he experienced out-of-hospital cardiac arrest and underwent successful cardiopulmonary resuscitation (CPR) in the field with a pectus bar in place.
DISCUSSION:
Successful CPR is possible after MIRPE. Clear identification of patients who have undergone MIRPE and education of CPR providers in providing effective chest compressions and defibrillation for this patient population is necessary.
CONCLUSION:
This is the first documented case of successful CPR in a patient with a pectus bar in place who experienced out-of-hospital cardiac arrest.
Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Integration of polarized spatial frequency domain imaging (pSFDI) with a biaxial mechanical testing system for quantification of load-dependent collagen architecture in soft collagenous tissues.
Acta Biomater2019 Nov;():. doi: S1742-7061(19)30778-0.
Jett Samuel V, Hudson Luke T, Baumwart Ryan, Bohnstedt Bradley N, Mir Arshid, Burkhart Harold M, Holzapfel Gerhard A, Wu Yi, Lee Chung-Hao,
Abstract
Collagen fiber networks provide the structural strength of tissues such as tendons, skin, and arteries. Quantifying the response of the fiber architecture to mechanical loads is essential towards a better understanding of the tissue-level mechanical behaviors, especially in assessing disease-driven functional changes. To enable novel investigations into these load-dependent fiber structures, a polarized spatial frequency domain imaging (pSFDI) device was developed and, for the first time, integrated with a biaxial mechanical testing system. The integrated instrument is capable of a wide-field quantification of the fiber orientation and degree of optical anisotropy (DOA), representing the local degree of fiber alignment. The opto-mechanical instrument's performance was assessed through uniaxial loading on tendon tissues with known collagen fiber microstructures. Our results revealed that the bulk fiber orientation angle of the tendon tissue changed minimally with loading (median±0.5*IQR of 52.7°±3.3° and 51.9°±3.3° under 0 and 3% longitudinal strains, respectively), whereas on a micro-scale the fibers became better aligned with the direction of loading: the DOA (mean±SD) increased from 0.149±0.032 to 0.198±0.056 under 0 and 3% longitudinal strains, respectively, p<0.001. The integrated instrument was further applied to study two representative mitral valve anterior leaflet (MVAL) tissues subjected to various biaxial loads. The fiber orientations within these representative MVAL tissue specimens demonstrated noticeable heterogeneity, with local fiber orientations dependent upon the sample, the spatial and transmural locations, and the applied loading. Our results also showed that fibers were generally better aligned under equibiaxial (DOA=0.089±0.036) and circumferentially-dominant loading (DOA=0.086±0.037) than under the radially-dominant loading (DOA=0.077±0.034), indicating circumferential predisposition. These novel findings exemplify a deeper understanding of the load-dependent collagen fiber microstructures obtained through the use of the integrated opto-mechanical instrument.
Copyright © 2019. Published by Elsevier Ltd.
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Transcatheter Electrosurgery Rescue: Jailed Pulmonary Artery Following Melody Pulmonary Valve Replacement.
JACC Cardiovasc Interv2019 Nov;():. doi: S1936-8798(19)31886-2.
Nageotte Stephen J, Lee Jesse W, El-Said Howaida G, Moore John W, Ratnayaka Kanishka,
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Pondering Higher Risk Pediatric Heart Donors: Can We Use More?
Ann Thorac Surg2019 Nov;():. doi: S0003-4975(19)31695-9.
Riggs Kyle W, Kroslowitz Benjamin J, Chin Clifford, Zafar Farhan, Morales David Ls,
Abstract
BACKGROUND:
Pediatric heart transplantation (PHT) is challenged with long waitlist times and high waitlist mortality, mostly due to a continuing organ shortage and high rates of non-utilization. This analysis uniquely aims to determine the outcomes associated with high-risk donors when recipient variability is neutralized.
METHODS:
The United Network for Organ Sharing (UNOS) thoracic organ transplant database was searched for PHT (17 years old or younger at time of listing) between January 2006 and December 2015. High-risk donors were identified using two previously published methods based on donor utilization (DUB) and recipient survival (RSB). Within each of the populations, which were not mutually exclusive, low and high-risk donor cohorts were propensity matched on recipient characteristics and outcomes (graft survival) were analyzed using Kaplan Meier methods.
RESULTS:
When recipient variability was harmonized, the DUB population (n=3,048) did not have different graft survival times between the high-risk graft recipients (n=1,016) and low-risk graft recipients (n=2,032) (p-value=0.713). Likewise, the RSB population (n=1,053) also did not have different graft survival times between the high-risk graft recipients (n=351) and low-risk graft recipients (n=702) (p-value=0.706).
CONCLUSIONS:
Cardiac allografts deemed high-risk by utilization and survival based methods led to equivalent post-transplant survival as matched recipients with low-risk donors. This study demonstrates that traditionally high-risk donors may have been associated with worst post-transplant survival because of the recipients that utilized them. Therefore, accepting these "high-risk" donor grafts should be considered as a potential approach to reduce waiting list times and mortality while maintaining comparable post-transplant survival.
Copyright © 2019. Published by Elsevier Inc.
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Pediatric In-Hospital CPR Quality at Night and on Weekends.
Resuscitation2019 Nov;():. doi: S0300-9572(19)30693-8.
Esangbedo Ivie, Yu Priscilla, Raymond Tia, Niles Dana E, Hanna Richard, Zhang Xuemei, Wolfe Heather, Griffis Heather, Nadkarni Vinay, ,
Abstract
INTRODUCTION:
Survival after in-hospital cardiac arrest (IHCA) has been reported to be worse for arrests at night or during weekends.This study aimed to determine whether measured cardiopulmonary resuscitation (CPR) quality metrics might explain this difference in outcomes.
METHODS:
IHCA data was collected by the Pediatric Resuscitation Quality (pediRES-Q) collaborative for patients <18 years. Metrics of CPR quality [chest compression rate, depth and fraction] were measured using monitordefibrillator pads, and events were compared by time of day and day of week.
RESULTS:
We evaluated 6915 sixty-second epochs of chest compression (CC) data from 239 subjects between October 2015 and March 2019, across 18 hospitals. There was no significant difference in CPR quality metrics during day (07:00-22:59) versus night (23:00-06:59), or weekdays (Monday 07:00 to Friday 22:59) versus weekends (Friday 23:00 to Monday 06:59).There was also no difference in rate of return of circulation. However, survival to hospital discharge was higher for arrests that occurred during the day (39.1%) vs. nights (22.4%, p?=?0.015), as well as on weekdays (39.9%) vs. weekends (19.1%, p?=?0.003).
CONCLUSIONS:
For pediatric IHCA where CC metrics were obtained, there was no significant difference in CPR quality metrics or rate of return of circulation by time of day or day of week. There was higher survival to hospital discharge when arrests occurred during the day (vs. nights), or on weekdays (vs. weekends), and this difference was not related to disparities in CC quality.
Copyright © 2019. Published by Elsevier B.V.
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Ultrafast Ultrasound Imaging in Pediatric and Adult Cardiology: Techniques, Applications, and Perspectives.
JACC Cardiovasc Imaging2019 Nov;():. doi: S1936-878X(19)30943-X.
Villemain Olivier, Baranger Jérôme, Friedberg Mark K, Papadacci Clément, Dizeux Alexandre, Messas Emmanuel, Tanter Mickael, Pernot Mathieu, Mertens Luc,
Abstract
Ultrasound techniques currently used in echocardiography are limited by conventional frame rates. Ultrafast ultrasound imaging is able to capture images at frame rates up to 100 times faster compared with conventional imaging. Specific applications of this technology have been developed and tested for clinical use in pediatric and adult cardiac imaging. These include ultrafast Doppler or vector flow imaging, shear wave imaging, electromechanical wave imaging, and backscatter tensor imaging. The principles of these applications are explained in this manuscript with illustrations on how these methods could be applied in clinical practice. Ultrafast ultrasound has great clinical potential in the assessment of cardiac function, in noninvasive hemodynamic analysis, while providing novel techniques for imaging coronary perfusion and evaluating rhythm disorders.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Clinical Update in Pediatric Sepsis: Focus on Children With Pre-Existing Heart Disease.
J Cardiothorac Vasc Anesth2019 Oct;():. doi: S1053-0770(19)31103-6.
Weiss Scott L, Nicolson Susan C, Naim Maryam Y,
Abstract
SEPSIS REMAINS one of the most common causes of childhood morbidity, mortality, and higher healthcare costs, with over 75,000 hospital admissions in the United States and an estimated 4 million cases worldwide per year. While standardized criteria to define sepsis are in flux, the general concept of sepsis is a severe infection that results in organ dysfunction. Although sepsis can affect previously healthy children, those with certain pre-existing comorbid conditions, including congenital and acquired heart disease, are at higher risk for both developing sepsis and having a poor outcome after sepsis. Multiple specialists including intensivists, cardiologists, surgeons, and anesthesiologists commonly contribute to the management and outcome of sepsis in children. In this article, the authors examine the evolving epidemiology of pediatric sepsis, including the subset of patients with underlying heart disease; contrast pediatric and adult sepsis; review the latest hemodynamic guidelines for management of pediatric septic shock and their application to children with heart disease; discuss the role of mechanical circulatory support; and review key aspects of anesthetic management for children with sepsis.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Diagnostic tools for early detection of cardiac dysfunction in childhood cancer survivors: Methodological aspects of the Dutch late effects after childhood cancer (LATER) cardiology study.
Am Heart J2019 Nov;219():89-98. doi: S0002-8703(19)30292-3.
Leerink Jan M, Feijen E Lieke A M, van der Pal Helena J H, Kok Wouter E M, Mavinkurve-Groothuis Annelies M C, Kapusta Livia, Pinto Yigal M, Maas Angela H E M, Bellersen Louise, Teske Arco J, Ronckers Cécile M, Louwerens Marloes, van Dalen Elvira C, van Dulmen-den Broeder Eline, Batenburg Lilian, van der Heiden-van der Loo Margriet, van den Heuvel-Eibrink Marry M, van Leeuwen Flora E, de Vries Andrica C H, Weijers Gert, de Korte Chris L, Loonen Jacqueline J, Neggers Sebastian J C M M, Versluys A B Birgitta, Tissing Wim J E, Kremer Leontien C M, ,
Abstract
BACKGROUND:
Cancer therapy-related cardiac dysfunction and heart failure are major problems in long-term childhood cancer survivors (CCS). We hypothesize that assessment of more sensitive echo- and electrocardiographic measurements, and/or biomarkers will allow for improved recognition of patients with cardiac dysfunction before heart failure develops, and may also identify patients at lower risk for heart failure.
OBJECTIVE:
To describe the methodology of the Dutch LATER cardiology study (LATER CARD).
METHODS:
The LATER CARD study is a cross-sectional study in long-term CCS treated with (potentially) cardiotoxic cancer therapies and sibling controls. We will evaluate 1) the prevalence and associated (treatment related) risk factors of subclinical cardiac dysfunction in CCS compared to sibling controls and 2) the diagnostic value of echocardiography including myocardial strain and diastolic function parameters, blood biomarkers for cardiomyocyte apoptosis, oxidative stress, cardiac remodeling and inflammation and ECG or combinations of them in the surveillance for cancer therapy-related cardiac dysfunction. From 2017 to 2020 we expect to include 1900 CCS and 500 siblings.
CONCLUSIONS:
The LATER CARD study will provide knowledge on different surveillance modalities for detection of cardiac dysfunction in long-term CCS at risk for heart failure. The results of the study will enable us to improve long-term follow-up surveillance guidelines for CCS at risk for heart failure.
Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.
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Differentially expressed microRNA profiles in exosomes from vascular smooth muscle cells associated with coronary artery calcification.
Int J Biochem Cell Biol2019 Nov;():105645. doi: S1357-2725(19)30222-5.
Pan Wei, Liang Jianwen, Tang Huili, Fang Xingrui, Wang Feng, Ding Yan, Huang Hui, Zhang Huanji,
Abstract
OBJECTIVE:
The pathogenesis of coronary artery calcification (CAC) in coronary heart disease (CHD) is mediated by exosomes derived from vascular smooth muscle cells (VSMCs). However, little is known about their underlying mechanism. In this study, we aimed to investigate the differentially expressed miRNAs in VSMCs undergoing induced calcification.
METHODS:
A cellular calcification model was established using the mouse VSMC line MOVAS-1. Calcium deposition was evaluated by Alizarin Red staining. Exosome sizes were determined by Nanoparticle Tracking Analysis (NTA), and exosome morphology was examined by transmission electron microscopy (TEM). The expression of exosome and calcification biomarkers was analyzed by quantitative real-time PCR (qPCR) and western blotting. Differential miRNA profiles were determined by deep sequencing and bioinformatics. Protein levels in VSMCs experiencing interference by a miR-324-3p inhibitor were detected by western blotting.
RESULTS:
The MOVAS-1 calcification model was confirmed by Alizarin Red staining and expressional alteration of ?-SMA, BMP-2, OPN, and MGP. Exosomes from the calcification model showed expression of exosomal biomarkers and regular exosome diameters, which caused significant calcification in MOVAS-1 cells. In total, 987 and 92 miRNAs were significantly upregulated and downregulated in exosomes from the cellular calcification model as compared with those from MOVAS-1 cells, respectively. Target genes of differential miRNAs were involved in various biological processes such as development, metabolism, and cellular component organization and biogenesis as well as multiple signaling pathways such as protein kinase B (AKT) signaling. The most differentially expressed miRNAs were validated by qPCR, which showed that mmu-let-7e-5p was downregulatedandmmu-miR-324-3p was upregulated in exosomes from the MOVAS-1 cellular calcification model. The expression of IGF1R was increased, and the expressions of PIK3CA and MAP2K1 were reduced in MOVAS-1 transfected with a miR-324-3p inhibitor.
CONCLUSION:
microRNA profiles were significantly altered in exosomes from VSMCs undergoing calcification.
Copyright © 2019. Published by Elsevier Ltd.
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Impact of phrenic nerve palsy on late Fontan circulation.
Ann Thorac Surg2019 Nov;():. doi: S0003-4975(19)31690-X.
Komori Motoki, Hoashi Takaya, Shimada Masatoshi, Kitano Masataka, Ohuchi Hideo, Kurosaki Kenichi, Ichikawa Hajime,
Abstract
BACKGROUND:
Although adverse effects of phrenic nerve palsy (PNP) on early Fontan circulation have been reported, detailed late impact remains unclear.
METHODS:
Of 218 patients undergoing extracardiac total cavo-pulmonary connection (EC-TCPC) between 1995 and 2008, 160 who all underwent cardiac catheter examination, spirometry, and exercise capacity testing 10 years after the operation were enrolled. The cohort was divided into two groups: with (n=21) or without PNP (control group, n=139). The patients with PNP were further divided into the recovered PNP group (n=10) and the persistent PNP group (n=11). All but two patients who developed PNP (90.9%) underwent diaphragmatic plication. There was no difference in hemodynamic indices at pre-Fontan evaluation among the three groups.
RESULTS:
Ten years after the Fontan procedure, the averaged forced vital capacity was 81 ± 18 % of predicted in the control group, 86 ± 17 % in the recovered PNP group, and 56 ± 12 % in the persistent PNP group (p < 0.0001). Peak oxygen consumption was linearly correlated to the forced vital capacity (r = 0.222, p = 0.009). There was no significant difference in the peak oxygen consumption between groups. Significant veno-venous collaterals into the diaphragm from lower body to pulmonary vein(s) or atria more frequently developed in patients who underwent diaphragmatic plication compared to those who did not (p<0.0001).
CONCLUSIONS:
Persistent PNP resulted in reduced forced vital capacity; however, its influence on exercise intolerance could not be identified. Diaphragmatic plication should be reserved for patients who experience clinically-significant respiratory or haemodynamic sequelae of PNP.
Copyright © 2019. Published by Elsevier Inc.
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Effect of ketamine combined with lidocaine in pediatric anesthesia.
J Clin Lab Anal2019 Nov;():e23115. doi: 10.1002/jcla.23115.
Fang Hua, Li Hua-Feng, Yang Miao, Zhang Fang-Xiang, Liao Ren, Wang Ru-Rong, Wang Quan-Yun, Zheng Peng-Cheng, Zhang Jian-Ping,
Abstract
BACKGROUND:
We conducted a randomized clinical trial to determine whether adjunctive lidocaine diminishes the incidence of adverse effects in pediatric patients sedated with ketamine.
METHODS:
This case-control study involved 586 consecutive pediatric patients necessitating anesthesia. Then systolic blood pressure, heart rate, respiratory rate, and blood oxygen saturation were observed. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen (BUN), and creatinine (Cr) levels were tested. General dose of ketamine, the time of onset and duration of anesthesia and postoperative recovery, anesthesia effect, and adverse reaction were subsequently compared. High-performance liquid chromatography was employed to detect ketamine concentration at different time points after administration, and the postoperative cognition function was further evaluated.
RESULTS:
Intra- and post-operation, the rising degree of ALT, AST, BUN, and Cr in patients treated with ketamine was higher than those in patients treated with the ketamine-lidocaine complex. General dose of ketamine, the time of onset and duration of anesthesia, postoperative recovery time, and the incidence rate of adverse reaction in patients treated with ketamine-lidocaine complex were lower, but the concentration of ketamine was higher compared to the patients treated with ketamine. In patients treated with the ketamine-lidocaine complex, elimination half-life of ketamine was prolonged, the area under curve was increased, and the plasma clearance rate was decreased relative to those with ketamine alone.
CONCLUSIONS:
Ketamine combined with lidocaine may be beneficial in shortening the onset of anesthesia, promoting postoperative awake, prolonging elimination half-life, increasing area under curve, and decreasing plasma clearance rate and incidence of adverse reactions.
© 2019 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals, Inc.
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Preoperative miRNA-208a as a Predictor of Postoperative Complications in Children with Congenital Heart Disease Undergoing Heart Surgery.
J Cardiovasc Transl Res2019 Nov;():. doi: 10.1007/s12265-019-09921-1.
Zloto Keren, Tirosh-Wagner Tal, Bolkier Yoav, Bar-Yosef Omer, Vardi Amir, Mishali David, Paret Gidi, Nevo-Caspi Yael,
Abstract
Major perioperative cardiovascular events are important causes of morbidity in pediatric patients with congenital heart disease who undergo reparative surgery. Current preoperative clinical risk assessment strategies have poor accuracy for identifying patients who will sustain adverse events following heart surgery. There is an ongoing need to integrate clinical variables with novel technology and biomarkers to accurately predict outcome following pediatric heart surgery. We tested whether preoperative levels of miRNAs-208a can serve as such a biomarker. Serum samples were obtained from pediatric patients immediately before heart surgery. MiRNA-208a was quantified by RQ-PCR. Correlations between the patient's clinical variables and miRNA levels were tested. Lower levels of preoperative miRNA-208a correlated with and could predict the appearance of postoperative cardiac and inflammatory complications. MiRNA-208a may serve as a biomarker for the prediction of patients who are at risk to develop complications following surgery for the repair of congenital heart defects.
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Prenatal Identification of Restrictive and Non-restrictive Ventricular Septal Defects Based on End-Systolic Flow Patterns in the Fetal Aortic Isthmus.
Pediatr Cardiol2019 Nov;():. doi: 10.1007/s00246-019-02257-2.
Fouron Jean-Claude, Thomas-Chabaneix Julie, Brisebois Sophie, Berger Annie, Dahdah Nagib,
Abstract
Fetuses with large ventricular septal defects (VSDs) must be closely monitored during the perinatal period. Intrauterine assessment of size of septal defects with bidimensional echocardiography are unreliable. The objective of the present study is to document the contribution of flow pattern analysis in the fetal aortic isthmus for prenatal identification of large non-restrictive VSDs requiring immediate postnatal attention. We conducted a cross-sectional retrospective study of Doppler recordings from patients referred to our Fetal Cardiology Unit and diagnosed with one or multiple VSDs from January 2006 to November 2015. Three groups were defined: (1) large non-restrictive VSDs (n?=?11) with postnatal cardiac failure (2) small restrictive VSDs (n?=?28) asymptomatic, and (3) absence of cardiac abnormality (n?=?66). The Isthmic end-Systolic Index (ISI) was computed to quantify aortic isthmus flow and compared between the three groups. Fetuses with restrictive VSD and control group showed similar ISI: stable at 0.20?±?0.01 up to 27 weeks of gestation and dropping later due to the fall of end-systolic velocities in the aortic isthmus. By 35 weeks, a brief end-systolic retrograde flow was present, associated with a further fall of ISI down to -0.26?±?0.05. In contrast, ISI of fetuses with large non-restrictive VSDs were unchanged throughout gestation (0.18?±?0.06), becoming significantly higher during the last weeks of gestation compared to the two other groups (p?
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Risk Factors and Predictors of Cardiac Erosion Discovered from 12 Japanese Patients Who Developed Erosion After Atrial Septal Defect Closure Using Amplatzer Septal Occluder.
Pediatr Cardiol2019 Nov;():. doi: 10.1007/s00246-019-02256-3.
Kitano Masataka, Yazaki Satoshi, Sugiyama Hisashi, Ohtsuki Shin-Ichi, Tomita Hideshi,
Abstract
Cardiac erosion is a rare serious complication following Amplatzer septal occluder (ASO) placement for atrial septal defect. Although multiple risk factors have been found, a useful predictor to prevent it has not been established yet. In 12 patients who developed erosion between 2005 and 2016 in Japan, we retrospectively observed patients' characteristics and transesophageal echocardiography findings immediately before and after ASO placement and at erosion onset. We compared risk factors of erosion, including absent aortic rim, device size/body weight ratio, device shape, or Valsalva sinus wall deformation pressed by either disk-edge, the maximum depth of which from the standard curve of the Valsalva wall was defined as Dent, between the 12 patients and 95 patients with Valsalva sinus wall deformation immediately after placement who did not develop erosion for 5?±?3 years. Of the 12 patients, nine developed pericardial effusion with eight cardiac tamponade and three aorta-atrium fistula; all were surgically rescued. Surgical findings revealed that erosion in all patients occurred at the right and/or left atrial roof beside the Valsalva in the non-coronary cusp on which the disk-edge seemed to be pressing. The mean Dent immediately after the placement in patients with erosion was significantly deeper than without (2.48?±?0.32 vs. 1.28?±?0.38; p??2.0 mm, it is desirable to change the size or to replace the device.
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Race and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.
Am J Kidney Dis2019 Nov;():. doi: S0272-6386(19)30974-6.
Ku Elaine, Yang Wei, McCulloch Charles E, Feldman Harold I, Go Alan S, Lash James, Bansal Nisha, He Jiang, Horwitz Ed, Ricardo Ana C, Shafi Tariq, Sondheimer James, Townsend Raymond R, Waikar Sushrut S, Hsu Chi-Yuan, ,
Abstract
RATIONALE & OBJECTIVES:
Few studies have investigated racial disparities in survival among dialysis patients in a manner that considers risk factors and mortality during the phase of kidney disease before maintenance dialysis. Our objective was to explore racial variations in survival among dialysis patients and relate them to racial differences in comorbid conditions and rates of death in the setting of kidney disease not yet requiring dialysis therapy.
STUDY DESIGN:
Retrospective cohort study.
SETTINGS & PARTICIPANTS:
3,288 black and white participants in the Chronic Renal Insufficiency Cohort (CRIC), none of whom were receiving dialysis at enrollment.
EXPOSURE:
Race.
OUTCOME:
Mortality.
ANALYTIC APPROACH:
Cox proportional hazards regression was used to examine the association between race and mortality starting at: (1) time of dialysis initiation and (2) entry into the CRIC.
RESULTS:
During 7.1 years of median follow-up, 678 CRIC participants started dialysis. Starting from the time of dialysis initiation, blacks had lower risk for death (unadjusted HR, 0.67; 95% CI, 0.51-0.87) compared with whites. Starting from baseline CRIC enrollment, the strength of the association between some risk factors and dialysis was notably stronger for whites than blacks. For example, the HR for dialysis onset in the presence (vs absence) of heart failure at CRIC enrollment was 1.30 (95% CI, 1.01-1.68) for blacks versus 2.78 (95% CI, 1.90-4.50) for whites, suggesting differential severity of these risk factors by race. When we included deaths occurring both before and after dialysis, risk for death was higher among blacks (vs whites) starting from CRIC enrollment (HR, 1.41; 95% CI, 1.22-1.64), but this finding was attenuated in adjusted models (HR, 1.08; 95% CI, 0.91-1.28).
LIMITATIONS:
Residual confounding.
CONCLUSIONS:
The apparent survival advantage among blacks over whites treated with dialysis may be attributed to selected transition of a subset of whites with more severe comorbid conditions onto dialysis.
Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Tissue-Specific Macrophage Responses to Remote Injury Impact the Outcome of Subsequent Local Immune Challenge.
Immunity2019 Nov;():. doi: S1074-7613(19)30454-6.
Hoyer Friedrich Felix, Naxerova Kamila, Schloss Maximilian J, Hulsmans Maarten, Nair Anil V, Dutta Partha, Calcagno David M, Herisson Fanny, Anzai Atsushi, Sun Yuan, Wojtkiewicz Gregory, Rohde David, Frodermann Vanessa, Vandoorne Katrien, Courties Gabriel, Iwamoto Yoshiko, Garris Christopher S, Williams David L, Breton Sylvie, Brown Dennis, Whalen Michael, Libby Peter, Pittet Mikael J, King Kevin R, Weissleder Ralph, Swirski Filip K, Nahrendorf Matthias,
Abstract
Myocardial infarction, stroke, and sepsis trigger systemic inflammation and organism-wide complications that are difficult to manage. Here, we examined the contribution of macrophages residing in vital organs to the systemic response after these injuries. We generated a comprehensive catalog of changes in macrophage number, origin, and gene expression in the heart, brain, liver, kidney, and lung of mice with myocardial infarction, stroke, or sepsis. Predominantly fueled by heightened local proliferation, tissue macrophage numbers increased systemically. Macrophages in the same organ responded similarly to different injuries by altering expression of tissue-specific gene sets. Preceding myocardial infarction improved survival of subsequent pneumonia due to enhanced bacterial clearance, which was caused by IFN? priming of alveolar macrophages. Conversely, EGF receptor signaling in macrophages exacerbated inflammatory lung injury. Our data suggest that local injury activates macrophages in remote organs and that targeting macrophages could improve resilience against systemic complications following myocardial infarction, stroke, and sepsis.
Copyright © 2019 Elsevier Inc. All rights reserved.
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