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1
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Ahmed HS. Research designs for cardiothoracic surgeons: part 1 - a primer for evidence-based practice. Indian J Thorac Cardiovasc Surg 2024; 40:737-751. [PMID: 39416325 PMCID: PMC11473461 DOI: 10.1007/s12055-024-01836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 10/19/2024] Open
Abstract
Understanding research designs is crucial for cardiothoracic surgeons to enhance their clinical practice and decision-making. This article provides a comprehensive overview of different research study types, including observational and experimental studies, and their relevance to cardiothoracic surgery. Detailed explanations of cohort, case-control, and cross-sectional studies, as well as various types of randomized controlled trials, are presented. Key terms and concepts like bias, validity, and reliability are discussed. Practical case examples from the literature illustrate the application of these research designs, aiding clinicians in selecting the appropriate study design for their research questions.
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Affiliation(s)
- H Shafeeq Ahmed
- Bangalore Medical College and Research Institute, K.R Road, Bangalore, 560002 Karnataka India
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Ahmed HS, Jayaram PR, Gupta D. Clinical presentation and surgical outcomes in patients with Shone's complex: a systematic review. Gen Thorac Cardiovasc Surg 2024; 72:621-640. [PMID: 39090433 DOI: 10.1007/s11748-024-02067-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE Shone's complex comprises of a combination of congenital cardiac anomalies causing obstructions in the left ventricle's inflow and outflow tracts. This systematic review aims to evaluate the clinical features and surgical outcomes of Shone's complex. METHODS An electronic literature search of PubMed and Scopus was performed to identify relevant studies related to the presentation, management, and outcomes of Shone's complex. Two reviewers independently performed selection. Data on study characteristics, participant demographics, interventions, outcomes, and follow-up durations were extracted and analyzed. RESULTS A total of 691 papers were identified, with 18 studies included in the final analysis. The majority of the studies (n = 12) focused on the pediatric age group. The most common clinical presentations were coarctation of the aorta (n = 17) and mitral stenosis (n = 12). Surgical interventions often involved staged approaches, prioritizing outflow before inflow obstructions. Mitral valve repair was preferred over replacement due to better long-term outcomes (n = 8). Biventricular repair was recommended due to improved postoperative outcomes, but often needed reoperations. Reoperations were common, primarily due to recurrent coarctation (n = 10), subaortic stenosis (n = 8), and mitral valve dysfunction (n = 7). Pulmonary hypertension (n = 10) and arrhythmias (n = 11) were significant complications. Most patients were in modified Ross/NYHA functional class 1 on follow-up. Mortality rates ranged from 4 to 28%, with better outcomes associated with early and strategic surgical interventions. CONCLUSION Early diagnosis and biventricular repair were associated with better outcomes while transplantation was often an eventuality. Standardized diagnostic criteria, long-term follow-up, and consensus guidelines are needed to improve the management of this congenital heart disease.
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Affiliation(s)
- H Shafeeq Ahmed
- Department of Medicine, Bangalore Medical College and Research Institute, K.R Road, Bangalore, 560002, Karnataka, India.
| | - Purva Reddy Jayaram
- Department of Medicine, Bangalore Medical College and Research Institute, K.R Road, Bangalore, 560002, Karnataka, India
| | - Deeksha Gupta
- Department of Medicine, Bangalore Medical College and Research Institute, K.R Road, Bangalore, 560002, Karnataka, India
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3
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Yang L, Zheng S, Xiao F, Xiao B, Zheng GM, Li T, Jing HX. Double-orifice mitral valve associated with mild mitral stenosis and coarctation of the aortic isthmus: A rare case of incomplete form of Shone's syndrome. Echocardiography 2024; 41:e15916. [PMID: 39215451 DOI: 10.1111/echo.15916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/09/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Shone's syndrome (SS) is a rare congenital cardiac anomaly characterized by a spectrum of developmental abnormalities. It predominantly presents as consisting of a variety of left ventricular inflow and outflow tract lesions, with inflow tract lesions typically including parachute mitral valve and supravalvular mitral ring. However, reports of SS involving double-orifice mitral valve are scarce.
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Affiliation(s)
- Lei Yang
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Shuang Zheng
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Fei Xiao
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Bin Xiao
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Guang-Mei Zheng
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Tiantian Li
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Hong-Xia Jing
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
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4
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Yang R, Greene CL. Surgical Considerations in Shone Complex. Semin Cardiothorac Vasc Anesth 2023; 27:260-272. [PMID: 37750051 DOI: 10.1177/10892532231203372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Shone complex is defined by 4 anomalies: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and coarctation of the aorta. Establishing a clear definition is one of the principal challenges in the study of Shone complex as not all patients have all lesions. The essential feature of Shone complex is multilevel left-sided obstruction involving both the left ventricular inflow and outflow. This anatomic variability is reflected in the clinical presentation as signs of left ventricular inflow obstruction are often masked by outflow obstruction and the multilevel nature of the condition is thus underappreciated. Surgical treatment is often stepwise addressing the outflow obstruction first. In this review, geared to the pediatric cardiac anesthesiologist, we review the pathophysiology, diagnosis, treatment, and outcomes of Shone complex.
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Affiliation(s)
- Roderick Yang
- Congenital Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Christina L Greene
- Congenital Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, USA
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Yousef AA, Elmahrouk AF, Hamouda TE, Helal AM, Dohain AM, Alama A, Shihata MS, Al-Radi OO, Jamjoom AA, Mashali MH. Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center. Egypt Heart J 2023; 75:53. [PMID: 37378691 DOI: 10.1186/s43044-023-00381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Despite the improved management of patients with a single ventricle, the long-term outcomes are not optimal. We reported the outcomes of the bidirectional Glenn procedure (BDG) and factors affecting the length of hospital stay, operative mortality, and Nakata index before Fontan completion. RESULTS This retrospective study included 259 patients who underwent BDG shunt from 2002 to 2020. The primary study outcomes were operative mortality, duration of hospital stay, and Nakata index before Fontan. Mortality occurred in 10 patients after BDG shunt (3.86%). By univariable logistic regression analysis, postoperative mortality after BDG shunt was associated with high preoperative mean pulmonary artery pressure (OR: 1.06 (95% CI 1.01-1.23); P = 0.02). The median duration of hospital stay after BDG shunt was 12 (9-19) days. Multivariable analysis indicated that Norwood palliation before BDG shunt was significantly associated with prolonged hospital stay (β: 0.53 (95% CI 0.12-0.95), P = 0.01). Fontan completion was performed in 144 patients (50.03%), and the pre-Fontan Nataka index was 173 (130.92-225.34) mm2/m2. Norwood palliation (β: - 0.61 (95% CI 62.63-20.18), P = 0.003) and preoperative saturation (β: - 2.38 (95% CI - 4.49-0.26), P = 0.03) were inversely associated with pre-Fontan Nakata index in patients who had Fontan completion. CONCLUSIONS BDG had a low mortality rate. Pulmonary artery pressure, Norwood palliation, cardiopulmonary bypass time, and pre-BDG shunt saturation were key factors associated with post-BDG outcomes in our series.
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Affiliation(s)
- Aly A Yousef
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Tamer E Hamouda
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
- Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Abdelmonem M Helal
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed M Dohain
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulhadi Alama
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Mohammad S Shihata
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
- Cardiac Surgery Section, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Mohamed H Mashali
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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6
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Tan-Recep BZ, Hatemi AC, Yavuz Y, Yildirim AI, Ceyran H. Comparison of early-stage stenosis and regurgitation results among patients who underwent aortic valve repair. Cardiol Young 2023; 33:904-909. [PMID: 35712756 DOI: 10.1017/s1047951122001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION This study aimed to analyse the results of paediatric aortic valve repairs in our institution. METHOD The data of 57 patients under 18 years of age who underwent aortic valve repair between 2014 and 2019 were retrospectively analysed. Early postoperative reoperation and hospital mortality rates were evaluated based on the ages of the patients, their preoperative diagnoses, and the surgical techniques used. Survival curves for groups of patients were calculated by Kaplan-Meier analysis. RESULTS The rate of reoperation was 14% (n = 8), and there were no significant differences regarding valve pathologies and preoperative diagnoses (p > 0.05). Among the repair techniques, tricuspidisation was considered to be a risk factor for reoperation (p < 0.05). Augmentation, the material used (0.1 PTFE or pericardium), and the number of cusps were not found to have significant effects on reoperation or mortality. The mean follow-up period was 29.86 ± 21.30 months. The survival rates of the patients were 88%, 100%, and 88.2% for those with aortic stenosis, aortic insufficiency, and mixed disease, respectively, and no significant difference was found when these rates were evaluated with the log-rank test (p > 0.05). The mortality rate was 8.8% (n = 5), and undergoing surgery before the age of 1 year was found to be significant in terms of mortality (p = 0.032, p < 0.05). The bicuspid aortic valve group had the lowest mortality risk, while the Shone complex group had the highest. CONCLUSION With its acceptable reoperation and mortality rates, aortic valve repair should be the first choice of treatment in the paediatric age group. Early results were satisfactory in all groups.
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Affiliation(s)
- Berra Zumrut Tan-Recep
- Department of Pediatric Cardiac Surgery, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Ali Can Hatemi
- Department of Pediatric Cardiac Surgery, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Yasemin Yavuz
- Department of Anesthesiology and Reanimation, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Ayse Inci Yildirim
- Department of Pediatric Cardiology, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Hakan Ceyran
- Department of Pediatric Cardiac Surgery, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
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7
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Altin FH, Korun O, Yurdakok O, Cicek M, Kilic Y, Selcuk A, Bulut O, Yilmaz EH, Ergin SO, Sasmazel A, Aydemir NA. Evaluation of midterm outcomes after Shone's complex surgery: Analysis of reoperation and mortality risk factors. J Card Surg 2022; 37:5153-5161. [PMID: 36595965 DOI: 10.1111/jocs.17163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The midterm results of patients who underwent biventricular repair surgery for Shone's complex were examined, and mortality and reoperation risk factors were evaluated. METHODS This retrospective study included 34 patients with Shone's complex who underwent mitral valve (MV) surgery between 2005 and 2020. RESULTS A total of 19 patients (56%) had coarctation, 10 (29%) patients had subaortic stenosis, 9 (26.5%) patients had a hypoplastic aortic arch (AA), and 9 (26.5%) patients had aortic valve (AV) stenosis. Twenty-four (70.6%) patients had bileaflet AV. Associated left-sided in-flow stenotic lesions included parachute MV in 19 (56%) patients and supramitral ring in 18 (53%) patients. The estimated freedom from reoperation rate on the 6th month, 1 year and 2 years after surgery was 84.4%, 79.5%, and 71.5%, respectively. The overall mortality rate was 20.6% (seven patients) with a median follow-up of 10 months (0-41). The estimated survival rate on the 6th month, 1 year, and 3 years after surgery was 83.8%, 79.4%, and 79.4 respectively. Bicuspid aortic valve (p = .017) (HR (95% CI) = 0.130 (0.025-0.695) and hammock mitral valve (p = .038) (HR (95% CI) = 11,008 (1,146->100) were associated with mortality. CONCLUSION The presence of a bicuspid aortic valve hammock mitral valve might have an effect on negative effect on the outcome.
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Affiliation(s)
- Firat Husnu Altin
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Oktay Korun
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Okan Yurdakok
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Cicek
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yigit Kilic
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Arif Selcuk
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Orhan Bulut
- Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emine Hekim Yilmaz
- Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Selma Oktay Ergin
- Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Sasmazel
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Numan Ali Aydemir
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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8
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Moras P, Pasquini L, Rizzo G, Campanale CM, Masci M, Di Chiara L, Falasconi G, Bagolan P, Toscano A. Prenatal prediction of Shone's complex. The role of the degree of ventricular disproportion and speckle-tracking analysis. J Perinat Med 2022; 51:550-558. [PMID: 36420537 DOI: 10.1515/jpm-2022-0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Shone's complex (SC) is characterized by sequential obstructions of left ventricular (LV) inflow and outflow. It can be associated with poor long-term prognosis when compared to Simple-Aortic Coarctation (S-CoA). We aimed to assess whether the degree of ventricular disproportion and 2D-speckle-tracking echocardiography (2D-STE) could improve the accuracy of prenatal prediction of SC. METHODS 75 consecutive fetuses were retrospectively enrolled from January 2010 to June 2021. Fetuses were divided into 4 groups (Group 1: SC; Group 2: S-CoA; Group 3: False Positive-Coarctation of the Aorta [FP-CoA]; group 4: controls). Comparisons for echocardiographic measures and myocardial deformation indices were performed. A receiver operating characteristic (ROC) analysis was performed on the MV/TV (mitral valve/tricuspid valve ratio) and LV GLS (global longitudinal strain) values to identify cut-offs to separate group 1 and 2 fetuses. RESULTS SC fetuses showed a significant reduction in MV/TV when compared to S-CoA and FP-CoA fetuses (p<0.001). LV GLS in SC fetuses was significantly reduced compared to S-CoA fetuses (-13.3 ± 2.1% vs. -17.0 ± 2.2%, p=0.001). A cut-off value of 0.59 for MV/TV and -15.35% for LV GLS yielded a sensitivity of 76 and 82% and a specificity of 71 and 83% respectively in separating SC vs. S-CoA fetuses. CONCLUSIONS SC fetuses showed a more severe degree of ventricular disproportion and a lower LV GLS compared to S-CoA, FP-CoA and control fetuses. MV/TV and GLS are both predictors of SC. These findings may improve the quality of prenatal parental counselling.
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Affiliation(s)
- Patrizio Moras
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy.,Pediatric Department, University of Tor Vergata, Rome, Italy
| | - Luciano Pasquini
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università Roma Tor Vergata, Rome, Italy
| | - Cosimo Marco Campanale
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Masci
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luca Di Chiara
- Pediatric Cardiac Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy
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Usefulness of Three-Dimensional Transthoracic Echocardiographic Planimetry in a 4-Month-Old Infant with Comorbid Aortic Stenosis and Coarctation of the Aorta Complicated with Low Left Ventricular Ejection Fraction. CASE 2022; 6:324-329. [PMID: 36172472 PMCID: PMC9510673 DOI: 10.1016/j.case.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Comorbid valvular AS, CoA, and LV dysfunction can complicate the order of interventions. Continuity equation cannot be used to assess AS severity in the setting of decreased LVEF. 3D-TTE planimetry can evaluate AS severity in infants with good acoustic windows.
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10
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Li YD, Meng H, Pang KJ, Li MZ, Xu N, Wang H, Li SJ, Yan J. Echocardiography in the diagnosis of Shone’s complex and analysis of the causes for missed diagnosis and misdiagnosis. World J Clin Cases 2022; 10:3369-3378. [PMID: 35611202 PMCID: PMC9048561 DOI: 10.12998/wjcc.v10.i11.3369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shone’s complex is a rare syndrome characterized by congenital left heart defects that can differ among the patients.
AIM To use echocardiography in the diagnosis of Shone’s complex and analyze the causes of missed diagnosis and misdiagnosis.
METHODS This was a retrospective study of patients who underwent echocardiography and repair surgery from February 14, 2008, to November 22, 2019. The patients were followed once a year at the outpatient clinic after surgery.
RESULTS Sixty-six patients were included. The patients were 2.7 (0.8-5.6) years of age, and 54.5% were male. Ten (15.2%) had a history of heart surgery. The most common heart defect was the Annulo-Leaflet mitral ring (ALMR) (50/66, 75.8%), followed by coarctation of the aorta (CoA) (43/66, 65.2%). The patients had a variety of combinations of defects. Only two (3.0%) patients had all four defects. None of the patients had a family history of congenital heart disease. The preoperative echocardiographic findings were examined against the intraoperative findings. Echocardiography missed an ALMR in 31 patients (47.0%), a parachute mitral valve (PMV) in one patient (1.5%), subaortic stenosis in one patient (1.5%), and CoA in two patients (3.0%).
CONCLUSION Echocardiography is an effective method to diagnose the Shone’s complex. Due to this disease’s complexity and interindividual variability, Improving the understanding of the disease can reduce misdiagnosis and missed diagnosis.
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Affiliation(s)
- Ye-Dan Li
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Hong Meng
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Kun-Jing Pang
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Mu-Zi Li
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Nan Xu
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Hao Wang
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Shou-Jun Li
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing 100037, China
| | - Jun Yan
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing 100037, China
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11
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Long-term surgical outcomes after repair of multiple ventricular septal defects in pediatrics. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Surgical closure of multiple ventricular septal defects (VSDs) is challenging and associated with a high complication rate. Several factors may affect the outcomes after surgical repair of multiple VSDs. We aimed to report the outcomes after surgical repair of multiple VSDs before and after 1 year and identify the factors affecting the outcomes. We have studied forty-eight patients between 2016 and 2017 who had surgical repair of multiple VSDs. We grouped them according to the age at the time of repair. Study outcomes were hospital complications, prolonged hospital stay, and reoperation.
Results
There were 18 females (60%) in group 1 and 13 (72.22%) in group 2 (P = 0.39). There were no differences in the operative outcomes between the groups. Prolonged postoperative stay was associated with group 1 (OR 0.23 (0.055–0.96); P = 0.04) and lower body weight (OR 0.76 (0.59–0.97); P = 0.03). Hospital mortality occurred in 2 patients (6.67%) in group 1 and 1 patient (5.56%) in group 2 (P > 0.99). Five patients had reoperations: two for residual VSDs, two for subaortic membrane resection, and one for epicardial pacemaker implantation. All reoperations occurred in group 1 (log-rank P = 0.08). Two patients had transcatheter closure of the residual muscular VSDs; both were in group 2.
Conclusions
Surgical repair of multiple VSDs was associated with good hospital outcomes. The outcomes were comparable in patients younger or older than 1 year of age. Young age at repair could lead to prolonged postoperative stay and a higher reoperation rate.
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12
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Galeotti A, Ciribè M, Matarazzo G, Antonielli G, Festa P, Inserra A, Garret-Bernardin A, Callea M, Raponi M. Dental and Periodontal Care at the Bedside Using a Portable Dental Unit in Hospitalized Special Needs Patients: The Experience of an Italian Pediatric Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7987. [PMID: 34360280 PMCID: PMC8345768 DOI: 10.3390/ijerph18157987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
Patients with special needs (SNPs) include individuals who are disabled due to physical limitations, medical complications, developmental problems, and cognitive impairments. SNPs may be at an increased risk of oral diseases throughout their lifetime. These patients have difficulties in accessing traditional dental studios or clinics. Moreover, orodental problems may cause local and generalized infections, leading to worrisome complications when not properly treated. In this paper, we describe the preliminary experience of treating dental problems in a series of nine hospitalized patients with special needs. This innovative protocol at the Bambino Gesù Children's Hospital (Rome, Italy) provides an introduction to a portable dental unit in order to perform oral care for hospitalized patients at the bedside. A multidisciplinary team composed of pediatric dentists, dental hygienists, nursing staff, and the patient's case manager was involved in the operative protocol. The SNPs described were affected by congenital heart or oncohematological diseases and neurodisabilities, and they were all hospitalized for different reasons: Open heart surgery, chemotherapy, organ transplantation, and rehabilitation. The oral evaluation was mandatory for ruling out or treating problems that could cause complications. Dental extractions, caries and fracture fillings, sealing, and oral hygiene procedures were performed at the bedside of the patients in the reference unit of their pediatric hospital. The results of this protocol confirm the feasibility of dental procedures at patients' bedside with portable dental units, encourage implementation of their use, and may represent an actionable model for oral care management in hospitalized SNPs.
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Affiliation(s)
- Angela Galeotti
- Unit of Dentistry, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy; (A.G.); (M.C.); (G.M.); (G.A.); (P.F.); (A.G.-B.)
| | - Massimiliano Ciribè
- Unit of Dentistry, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy; (A.G.); (M.C.); (G.M.); (G.A.); (P.F.); (A.G.-B.)
| | - Giorgio Matarazzo
- Unit of Dentistry, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy; (A.G.); (M.C.); (G.M.); (G.A.); (P.F.); (A.G.-B.)
| | - Giancarlo Antonielli
- Unit of Dentistry, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy; (A.G.); (M.C.); (G.M.); (G.A.); (P.F.); (A.G.-B.)
| | - Paola Festa
- Unit of Dentistry, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy; (A.G.); (M.C.); (G.M.); (G.A.); (P.F.); (A.G.-B.)
| | - Alessandro Inserra
- Department of General and Thoracic Surgery, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy;
| | - Annelyse Garret-Bernardin
- Unit of Dentistry, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy; (A.G.); (M.C.); (G.M.); (G.A.); (P.F.); (A.G.-B.)
| | - Michele Callea
- Unit of Dentistry, Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy; (A.G.); (M.C.); (G.M.); (G.A.); (P.F.); (A.G.-B.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
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Abstract
Data on mitral valve replacement (MVR) in young children is still limited. Our objective was to evaluate MVR in children below 5 years and identify factors affecting the outcomes. This retrospective study included 29 patients who had MVR from 2002 to 2020. We grouped the patients into two groups according to their age: age ≤ 24 months (n = 18) and > 24 months (n = 11). Primary cardiac diagnoses were Shone complex (n = 7; 24%), isolated congenital mitral valve abnormality (n = 11; 38%), and complete atrioventricular septal defect (n = 3; 10%). The median age was 19 month (25th–75th percentile: 11–32) and 59% were females (n = 17). The hemodynamic lesions were mitral regurgitation in 66%, mitral stenosis in 10%, and combined mitral stenosis and regurgitation in 24% of the patients. St. Jude mitral valve was the most common valve implanted (n = 19, 66%), followed by CarboMedics in 21% of the patients (n = 6). The mitral valve was implanted in the supra-annular position in 6 cases (21%). Preoperative and operative data were comparable between both groups. There was no association between valve size and position with postoperative heart block (P > 0.99, for both). The median follow-up duration was 19.4 months (8.6–102.5). Nine patients had mitral valve reoperation, six had MVR, and three had clot removal from the mitral valve. There was no effect for age group on reoperation (SHR 0.89 (95% CI 0.27–2.87), P = 0.84). Valve size significantly affected reoperation (SHR 0.39 (95% CI 0.18–0.87), P = 0.02). The supra-annular position was associated with an increased risk of reoperation (SHR 3.1 (95% CI 1.003–9.4), P = 0.049). There was no difference in survival according to the age (Log-rank P = 0.57) or valve size (Log-rank P = 0.66). Mitral valve replacement in children is associated with low morbidity and mortality. The risk of reoperation could be affected by the valve size and position rather than the age.
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