Background: Congenital anomalies are among the leading causes of fetal loss, despite it can be identified prior to birth through advanced technology in expert hands. Our research aimed at estimating the prevalence of ...Background: Congenital anomalies are among the leading causes of fetal loss, despite it can be identified prior to birth through advanced technology in expert hands. Our research aimed at estimating the prevalence of congenital anomalies in Sudan. Methods: A facility-based retrospective cross-sectional study combined with a community-based survey through a telephone interview was implemented on a purposive convenient sample of 138 participants. The data were computerized in Epi Info 7. Google Earth Pro enabled to collect the geographical coordinates for the residence of the participants. Descriptive statistics were performed through SPSS 23 and ArcGIS 10.3 was used to generate the geographical distribution map of congenital defects to visualize the catchment areas of Soba Ultrasonography Unit. Results: Of the 138 participants, the estimated prevalence of congenital defects was 2.2/10,000 live births. The ultrasonography screening revealed that neural tube defects were the most prevalent anomalies with 13.0% (18/138), which represented 47.4% (18/38) of all defects. Concerning children, a mortality rate of 23.2% (32/138) was reported. Conclusions: The child mortality rate post ultrasound screening of 23.2%, and the neural tube defects being the most common anomalies appealed to Sudan health authorities for focusing on more preventive antenatal practices to strengthen and promote maternal and child health.展开更多
BACKGROUND Necrotizing enterocolitis(NEC)remains a prominent gastrointestinal emergency among infants,particularly term infants with congenital heart defects(CHD)being at high risk.The molecular processes that contrib...BACKGROUND Necrotizing enterocolitis(NEC)remains a prominent gastrointestinal emergency among infants,particularly term infants with congenital heart defects(CHD)being at high risk.The molecular processes that contribute to NEC have yet to be completely understood.The high mortality rates necessitate an active search for noninvasive biomarkers that can aid in the preclinical diagnosis and prognosis of NEC.MicroRNAs(miRs),which are involved in many biological processes in both health and disease,have been discovered to play an important role in regulating inflammation and immune responses via various signaling pathways.AIM To determine the plasma levels of miR-155,miR-221,miR-223,miR-320a,miR-451a as potential NEC biomarkers in term newborns with CHD.METHODS This prospective cohort study included twenty-tree term newborns with CHD who underwent cardiac surgery on the median day of life(DOL)=7.Nine of them developed NEC(Bell’s stage IIA and IIIA)within 1 week of cardiac surgery(NEC newborns).Blood samples were collected before(median DOL=5)and following(median DOL=13)cardiac surgery.Levels of plasma miR-155-5p,miR-221-3p,miR-223-3p,miR-320a-3p,and miR-451a were determined using real-time polymerase chain reaction.The functional analysis was executed using the DIANA-miRPath v4.0.RESULTS Preoperatively,NEC newborns had significantly lower plasma levels of miR-155(2.70-fold,P=0.020),miR-223(2.42-fold,P=0.030),and miR-320a(3.62-fold,P=0.006)than newborns without NEC.Postoperatively,miR-451a levels differed significantly between the newborn groups,showing a 4.70-fold decrease(P=0.014)in expression when clinical NEC symptoms appeared.According to receiver operating characteristic analysis,miR-320a was found to be the most effective predictive biomarker for NEC[area under the curve(AUC)=0.835,63%sensitivity,100%specificity],while miR-451a was identified as a NEC biomarker(AUC=0.835,85.7%sensitivity,76.9%specificity).Preoperatively,miR-155-5p,miR-223-3p,and miR-320a-3p were differentially expressed and targeted the forkhead box O and Hippo pathways(P<0.01).CONCLUSION Our study demonstrates,for the first time,that plasma miR-320a-3p levels can be used as a preclinical biomarker for NEC in term newborns with CHD.展开更多
BACKGROUND: Micro RNAs are small non-coding RNAs of approximately 22 nucleotides in length, and play important regulatory roles in normal heart development and the pathogenesis of heart diseases. Recently, a few prosp...BACKGROUND: Micro RNAs are small non-coding RNAs of approximately 22 nucleotides in length, and play important regulatory roles in normal heart development and the pathogenesis of heart diseases. Recently, a few prospective studies have implicated the diagnostic role of micro RNAs in congenital heart defects(CHD).DATA RESOURCES: This review retrieved the research articles in Pub Med focusing on the altered microR NAs in cardiac tissue or serum of patients with CHD versus healthy normal controls, as well as the studies exploring circulating microR NAs as potential biomarkers for(fetal) CHD.RESULTS: Most of the studies of interest were conducted in recent years, implicating that the topic in this review is a newly emerging field and is drawing much attention. Moreover, a number of differentially expressed microR NAs between CHD specimens and normal controls have been reported.CONCLUSION: Circulating micro RNAs may serve as potential biomarkers for diagnosis of CHD in the future, with more efforts paving the road to the aim.展开更多
Objective This study aimed to assess the associations between maternal drug use,cytochrome P450(CYP450)genetic polymorphisms,and their interactions with the risk of congenital heart defects(CHDs)in offspring.Methods A...Objective This study aimed to assess the associations between maternal drug use,cytochrome P450(CYP450)genetic polymorphisms,and their interactions with the risk of congenital heart defects(CHDs)in offspring.Methods A case-control study involving 569 mothers of CHD cases and 652 controls was conducted from November 2017 to January 2020.Results After adjusting for potential confounding factors,the results show that mothers who used ovulatory drugs(adjusted odds ratio[a OR]=2.12;95% confidence interval[CI]:1.08-4.16),antidepressants(a OR=2.56;95%CI:1.36-4.82),antiabortifacients(a OR=1.55;95%CI:1.00-2.40),or traditional Chinese drugs(a OR=1.97;95%CI:1.26-3.09)during pregnancy were at a significantly higher risk of CHDs in offspring.Maternal CYP450 genetic polymorphisms at rs1065852(A/T vs.A/A:OR=1.53,95%CI:1.10-2.14;T/T vs.A/A:OR=1.57,95%CI:1.07-2.31)and rs16947(G/G vs.C/C:OR=3.41,95%CI:1.82-6.39)were also significantly associated with the risk of CHDs in offspring.Additionally,significant interactions were observed between the CYP450 genetic variants and drug use on the development of CHDs.Conclusions In those of Chinese descent,ovulatory drugs,antidepressants,antiabortifacients,and traditional Chinese medicines may be associated with the risk of CHDs in offspring.Maternal CYP450 genes may regulate the effects of maternal drug exposure on fetal heart development.展开更多
Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tio...Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tional,and gestational maternal diabetes,and their potential impact on the occurrence of congenital heart defects(CHD)during neonatal development.Methods:Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico,we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020.Our assessment encompassed a range of variables,including maternal age,gestational age,BMI,pregestational diabetes,gestational diabetes,hypertension,history of abortion,and presence of preeclampsia.Results:A cohort of 673 patients was included in our study.The average maternal age was 26 years,within a range of 22 to 32 years.The mean gestational age measured 39 weeks,with a median span of 38 to 39 weeks.Of the 673 patients,274(41%)mothers gave birth to neonates diagnosed with CHD.Within this group,22 cases were linked to pre-gestational diabetes,while 202 were not;20 instances were associated with gestational diabetes,compared to 200 without;and 148 cases exhibited an overweight or obese BMI,whereas 126 displayed a normal BMI.Conclusion:We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD.However,our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD.These results may aid in developing effective strategies to prevent and manage CHD in neonates.展开更多
Background:The management of suspected critical congenital heart defects(CCHD)relies on timely echocardiographic diagnosis.The availability of experienced echocardiographers is limited or even non-existent in many hos...Background:The management of suspected critical congenital heart defects(CCHD)relies on timely echocardiographic diagnosis.The availability of experienced echocardiographers is limited or even non-existent in many hospitals with obstetric units.This study evaluates remote-mentored echocardiography performed by physicians without experience in imaging of congenital heart defects(CHD).Methods:The setup included a pediatric cardiologist in a separate room,guiding a physician without experience in echocardiographic imaging of CHD in the examination of a symptomatic newborn.This remote-mentoring pair was blinded to the diagnosis of the newborn and presented with a simplified patient history.The echocardiographic images were streamed to the laptop of the mentor,along with a webcam feed showing the probe position.The task was to identify CCHD in need of immediate transfer to a pediatric cardiac surgical center.The result was compared to the previously completed echocardiographic report and the clinical decision of the patient-responsible pediatric cardiologist.Results:During 17 months,15 newborns were recruited.All six newborns with CCHD were correctly labeled by the remotementoring pair.One newborn with Tetralogy of Fallot was erroneously labeled as needing immediate transfer.Eight newborns without CCHD were correctly labeled.Conclusions:Remote-mentored echocardiography performed by examiners without experience in imaging CHD identified all newborns with CCHD in need of immediate transfer for specialist care.The setup shows promising results for improving the management of CCHD in hospitals without continuous pediatric cardiology service.展开更多
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 vascul...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.展开更多
This review aims to sum up the improvements witnessed in the field of interventional cardiology during recent times. The last decade has witnessed significant technical advances in the field of radiological imaging an...This review aims to sum up the improvements witnessed in the field of interventional cardiology during recent times. The last decade has witnessed significant technical advances in the field of radiological imaging and also in interventional cardiology which has helped to offer more non-invasive solutions for the management of congenital heart defects. This has resulted from the use of advanced 3-dimensional fusion imaging instead of conventional 2-dimensional angiography, applying interactive real-time enhancement and using computed tomography and Magnetic Resonance Imaging for interventional procedures. Similarly the introduction of next generation devices, have not only improved the final outcome of the procedure but also has helped in reducing the challenges that were faced before and with the initial generation of devices. These advances have helped not only in reducing the radiation exposure, the use of contrast medium dose but also have resulted in improved early survival. The field of neonatal cardiology has advanced at an unprecedented pace. The transcatheter closure of patent ductus arteriosus has evolved over time and now it has been made possible at much lower body weight. Similarly, early use of stents for aortic coarctation has been found effective in some patients, especially when surgical intervention had been denied. The application of the hybrid approach for the management of complex congenital heart defects has also been effectively applied. More recently transcatheter placement of the pulmonary valve has been introduced for severely stenotic and/or regurgitant pulmonary valve in adolescents and adults. It is anticipated that in near future, this procedure would be available for relatively younger patients. In conclusion: last 2 decades have improvised pediatric interventional cardiology to incorporate less invasive solutions for CHD. The current advances in radio-diagnostic imaging, gadgetry and technical expertise have improved significantly and led to manage many of such defects by trans-catheter approach. This has led also, to replace the early surgical intervention with a more subtle hybrid approach, thus reducing not only the major surgical trauma but also been found to be cost-effective due to a shorter hospital stay. But a learning curve for performers is required for optimum results and also such procedures should be performed in a fully developed facility with an optimum surgical backup.展开更多
The objective of the work is to study the topographic and anatomical characteristics of the atrioventricular node’s artery in complex congenital heart defects.The material for the work was the following:44 specimens ...The objective of the work is to study the topographic and anatomical characteristics of the atrioventricular node’s artery in complex congenital heart defects.The material for the work was the following:44 specimens including hearts of fetuses and children of the first three years having congenital defects and 50 specimens of the hearts of a similar age with normal development as the control.A complex of generally accepted morphological methods was used to identify the conductive system of the heart,its blood supply.According to the data obtained given congenital heart defects,the artery of the atrioventricular node arises from an artery,that determines the type of blood supply to the heart.With the full form of the common atrioventricular canal,the presence of the“U”-shaped bend of the coronary artery at the point of departure of the atrioventricular artery from it is inconstant,which is apparently due to the localization of the atrioventricular node in the embryonic position.The intensity of the lateral branches from the artery of the atrioventricular node to the heart partitions is determined by the hemodynamic features with congenital heart defects.展开更多
Aim: To assess basic trends in epidemiology of congenital heart defects (CHDs). Method: Population based prospective observational study. Material: CHDs in infants born alive in a Norwegian county 1982-2011. Results: ...Aim: To assess basic trends in epidemiology of congenital heart defects (CHDs). Method: Population based prospective observational study. Material: CHDs in infants born alive in a Norwegian county 1982-2011. Results: In 828/71 217 infants (12 per 1000) a CHD was diagnosed. The prevalence increased from 8 to 12 per 1000 after introduction of early echocardiography in newborns with suspected CHD from 1986 (p = 0.0001). Ventricular septal defect (VSD) was the dominating CHD (474;57%). In 222 (27%) the CHDs were missed and diagnosed after discharge from hospital after birth. Twelve critical CHDs (causing death or requiring invasive procedures before 28 days of life) were missed. Prenatal diagnosis of critical CHDs increased from 4/67 (6%) born 1997-2006 to 4/11 (36%) born 2007-2011 (p = 0.01). In 177 (21%) a syndrome or extracardial defect occurred. The occurrence of CHDs associated with chromosomal disorders (60/73 (82%) trisomies) more than doubled from the cohort born in the first 10-year period 1982-1991 (0.6 per 1000) to the last 2002-2011 (1.4 per 1000) (p < 0.0001) in parallel with increasing births in women ≥ 35 years old in the population. 237 (29%) underwent therapeutic procedures (203 (86%) surgery, of whom 16 after initial catheter intervention, and 34 (14%) catheter intervention alone). 39/237 (16%) died, 101 (43%) were repaired and 97 (41%) had some minor residual defect. The death rate declined significantly from 65/532 (12%) born 1982-2001 to 11/296 (4%) born 2002-2011 (p = 0.0001). 37/76 (49%) deaths occurred within 28 days after birth. Conclusions: The rate of detection of CHDs increased substantially after introduction of echocardiography in newborns with suspected CHD, especially VSDs. Some critical CHDs were overlooked. The prenatal detection rate of such defects increased. The prevalence of CHDs with associated chromosomal disorders increased in parallel with increasing maternal age in the population. Most deaths occurred during the neonatal period. Increasing survival increases the load on long-term follow-up programmes.展开更多
Objective:Vertical right thoracotomy(VRAT)has become an alternative to sternotomy for the repair of non-complex congenital heart defects in our infants and children.Summary Background Data:Limited data exists on the c...Objective:Vertical right thoracotomy(VRAT)has become an alternative to sternotomy for the repair of non-complex congenital heart defects in our infants and children.Summary Background Data:Limited data exists on the comparison of the two approaches.Methods:The present study consisted of two groups;Group Ⅰ:(sternotomy;33 patients)and Group Ⅱ:(VRAT;35 patients).We compared the two groups on operative data,hours of invasive lines,narcotics used,length of stay,and total variable cost of stay.Results:The most frequent procedures were atrial and ventricular septal defect closure(25 patients,75.8%in Group Ⅰ)and(14 patients,40%in Group Ⅱ).The average age and weight were 33.43±53 months,and 14.7±16.9 kg for Group I,and 75.3±60.2 months and 24.9±18 kg for Group Ⅱ,respectively,(p<0.001).We found no differences in aortic cross-clamp/bypass times between groups(p=0.39 and 0.42,respectively).The use of narcotics was not significantly different between the two study groups(p=0.37)as was the total variable cost(p=0.115).Group Ⅱ had a lower time without invasive lines(p<0.001).In Group Ⅱ the total length of stay was significantly less as well(p<0.001).Conclusions:VRAT is a useful technique for repairing a wide range of heart defects and does not result in prolonged cardiopulmonary bypass or aortic cross-clamp times.Although total opioid use and total cost of stay are no different as with sternotomy,the shortened duration of invasive line use,and shorter length of stay make this approach worthy of consideration.展开更多
Background Di George syndrome（DGS） is the most common microdeletion syndrome in humans and a disorder caused by a defect in chromosome 22. Almost 80% of DGS patients manifest congenital heart defects（CHD）, which a...Background Di George syndrome（DGS） is the most common microdeletion syndrome in humans and a disorder caused by a defect in chromosome 22. Almost 80% of DGS patients manifest congenital heart defects（CHD）, which are highly variable and severe. However, the genetics of CHD in DGS remain elusive. This review concludes that the TBX1 gene plays a critical role in cardiovascular defects, involving many additional genes, such as Six1, Eya1, Fgf8, Fox, and Shh. Concerning the variable manifestations of CHD in DGS,additional modifiers have been shown of involvement, such as Wnt, MOZ, micro RNAs, VEGF, and CRK.Knowledge of the genetics underlying CHD in DGS has the potential to early detection and treatment of this disease.展开更多
Background:The neutrophil-lymphocyte ratio(NLR)is a simple,cost-effective marker of systemic inflammation.This study aims to evaluate the association between perioperative NLR and postoperative outcomes in pediatric p...Background:The neutrophil-lymphocyte ratio(NLR)is a simple,cost-effective marker of systemic inflammation.This study aims to evaluate the association between perioperative NLR and postoperative outcomes in pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass(CPB).Methods:We retrospectively reviewed 70 patients under 18 years of age who underwent surgery between 2018 and 2023.NLR was measured preoperatively and on postoperative days(POD)0,1,2,3,and 6.Receiver operating characteristic analysis identified optimal cutoffs,and associations with postoperative outcomes were assessed.Results:The preoperative NLR cutoff of 1.14(AUC=0.75)was associated with prolonged mechanical ventilation(>72 h)(p=0.02),extended intensive care unit(ICU)stay(p=0.004),and longer hospital stay(p=0.006).NLR values on POD3(AUC=0.74)and POD6(AUC=0.78)also demonstrated strong predictive ability for these outcomes.Conclusions:Elevated perioperative NLR-particularly preoperative values≥1.14-is associated with prolonged mechanical ventilation,longer ICU admission,and extended hospitalization in pediatric congenital heart surgery.NLR may serve as a practical biomarker for early risk stratification and postoperative management.展开更多
The changes of adrenomedullin (ADM), endothelin-1 (ET-1) and nitric oxide (NO) levels before and after operation in congenital heart disease (CHD) associated with pulmonary hypertension (PH) were observed in order to ...The changes of adrenomedullin (ADM), endothelin-1 (ET-1) and nitric oxide (NO) levels before and after operation in congenital heart disease (CHD) associated with pulmonary hypertension (PH) were observed in order to investigate their role in CHD with PH and their clinical significance. The CHD patients were divided into 3 groups according to pulmonary artery systolic pressure (PASP): Non-PH group: PASP≤30 mmHg ( n =11); mild-PH group: PASP 31-49 mmHg ( n =10); moderate or severe-PH group: PASP≥50 mmHg ( n =12). The control group consisted of 15 health children. Plasma ADM, ET-1 and NO levels were determined by radioimmunoassay and colorimetry methods. The correlation between ADM and ET-1, NO, PASP was analyzed. The changes in plasma ADM, ET-1 and plasma NO on the 7th day after operation among the groups were compared. The results showed that plasma ADM levels in non-PH group were significantly higher than that in control group ( P <0.05), but there was no significant difference in ET-1 and NO levels between the two groups ( P >0.05). ADM and ET-1 levels in mild-PH group were significantly elevated as compared with those in non-PH group (both P <0.05), but NO levels were decreased ( P <0.05). ADM and ET-1 levels in moderate or severe-PH groups were increased as compared with those in mild-PH group (both P <0.01), but NO level significantly declined ( P <0.05). On the 7th day after operation, plasma ADM and ET-1 levels in PH group were significantly decreased ( P <0.05, P <0.01) as compared with those before operation, but there was no significant difference in NO levels ( P >0.05). But NO levels in non-PH group were significantly increased ( P <0.05). Plasma ADM levels in CHD were positively correlated with PASP and ET-1 ( r =0.77, P <0.01; r =0.82, P <0.01), negatively correlated with NO ( r =-0.56, P <0.05). It was concluded that during the progression of PH in the cases of CHD, plasma ADM, ET-1 and NO might play an important role in the development of PH. The increased ADM may represent a compensatory mechanism. It can interact with NO and ET-1 to regulate pulmonary circulation in the pathophysiology of PH with CHD. ADM may be involved in the defence mechanism against further increase of pulmonary arterial pressure. ADM could be used as a reliable indicator of the severity of CHD associated PH.展开更多
Objective To examine the resilience of parents of children with congenital heart disease and to investigate socio-demographic factors that may influence parents’resilience.Methods This is a web-based survey study usi...Objective To examine the resilience of parents of children with congenital heart disease and to investigate socio-demographic factors that may influence parents’resilience.Methods This is a web-based survey study using a cross-sectional design.A purposive sampling method was utilized to recruit 515 parents who care for children with congenital heart disease.Resilience was assessed using the Dispositional Resilience Scale-Ⅱ.Based on expert-interviews,a questionnaire was designed to collect socio-demographic data.Descriptive statistics,factor analysis,and linear regressions were used to analyze data.Results A total of 413 parents completed the survey study.The mean resilience score was 3.75(SD=0.61;range=1.89–4.89)with higher scores indicating higher resilience.The linear regression models demonstrated that parents who had lower education levels and lower gross household income had lower resilience(P<0.05).Conclusions Parents reported resilience that reflected their ability to cope with stressful events and mitigate stressors associated with having and caring for children with congenital heart disease.Lower education levels and lower gross household income are associated with lower resilience.To increase parents’resilience,nursing practice and nurse-led interventions should target screening and providing support for parents at-risk for lower resilience.As lower education level and financial hardship are factors that are difficult to modify through personal efforts,charitable foundations,federal and state governments should consider programs that would provide financial and health literacy support for parents at-risk for lower resilience.展开更多
We present a case report about percutaneous closure of a congenital Gerbode defect using Nit-Occlud~?LêVSD coil.The patient was referred to our hospital with a diagnosis of ventricular septal defect(VSD)and sever...We present a case report about percutaneous closure of a congenital Gerbode defect using Nit-Occlud~?LêVSD coil.The patient was referred to our hospital with a diagnosis of ventricular septal defect(VSD)and severe pulmonary arterial hypertension.But transthoracic echocardiography revealed a communication between the left ventricle(LV)and the right atrial(RA),called Gerbode defect.Catheterization confirmed the shunt from the LV to the RA.We successfully closed the defect with a VSD coil.After uneventful 6 mo follow-up,the patient was out of dyspnea,the symptom urged him to have medical attention.This case report is to discuss the diagnosis and percutaneous treatment approach for this rare congenital heart disease.展开更多
Objective To explore the multiple risk factors for family lifestyle of children with congenital heart defects(CHDs)in Shaanxi Province,China.Methods A 1∶1 case-control study was carried out to investigate 60 pairs of...Objective To explore the multiple risk factors for family lifestyle of children with congenital heart defects(CHDs)in Shaanxi Province,China.Methods A 1∶1 case-control study was carried out to investigate 60 pairs of children and their parents.The univariate and multivariable logistic regression models were used to analyze the influence of risk factors related to parents’lifestyle on CHDs.Results Several possible risk factors were found for CHDs,including fever(OR=4.465,P=0.017),pesticides contact(OR=2.234,P=0.083),passive smoking during pregnancy(OR=20.529,P=0.007)and father’s smoking(OR=3.342,P=0.005);fever(OR=2.428,P=0.012)and passive smoking during pregnancy(OR=1.201,P=0.037)were also correlated with ventricular sepal defect(VSD).Conclusion Fever,pesticides contact and passive smoking are associated with CHDs during pregnancy.We should focus our attention on health care during pregnancy to avoid the above-mentioned risk factors and call on parents to hold on to a good healthy lifestyle.展开更多
Objective:The objective of this analysis is to describe the characteristics and morbidity during hospitalizations among adolescents with congenital heart disease(AdoCHD)from the Pediatric Health Information System(PHI...Objective:The objective of this analysis is to describe the characteristics and morbidity during hospitalizations among adolescents with congenital heart disease(AdoCHD)from the Pediatric Health Information System(PHIS)database.Methods:The PHIS database was queried for all AdoCHD admissions aged 12–18 years(1/1/2004–12/31/2013).Major forms of CHD were identified by their International Classification of Diseases,ninth revision codes,further verified based on their secondary diagnosis and/or procedure codes.Patient characteristics,diagnoses,procedures and vital status were assessed.Results:In total,there were 4,267 adolescents admitted to 42 Children’s Hospitals,58.3%were males,24.6%single ventricle(SV)patients,64.1%bi-ventricle(BV),and 11.3%could not be classified.They accounted for 8,512 hospitalizations(41,240 total hospital days),of which 31.6%were intensive care unit(ICU)stays.ICU stay was similar for the SVand BV patients with similar duration of mechanical ventilation between the two groups.Overall,the most common CHD among in-patients was tetralogy of Fallot(TOF,36.4%).Larger proportion of the BVAdoCHD admissions were for elective surgical and electrophysiological procedures.There were 109(2.5%)heart transplantations(1.3%SV vs.0.6%BV)and 120 in-hospital deaths(2.8%)(1.1%SV vs.1.3%BV).Hypoplastic left heart syndrome was the most common diagnosis in transplanted patients(46%)and those who died(28%);TOF(29%)was frequent in 91(2.1%)patients who had cardiac arrests.Conclusions:Different hospitalization patterns exist for BV and SV AdoCHD.Recognizing this risk may encourage directing resources toward optimizing long-term care of CHD patients.展开更多
Early intervention to prevent premature mortality is vital for adults with congenital heart defects(CHD).Anatomic complexity and comorbid conditions are thought to contribute to CHD mortality.Since hypertension(HTN)an...Early intervention to prevent premature mortality is vital for adults with congenital heart defects(CHD).Anatomic complexity and comorbid conditions are thought to contribute to CHD mortality.Since hypertension(HTN)and heart failure(HF)are the comorbid conditions among the most prevalent causes of death in the United States,and commonly accompany CHD,it is crucial to evaluate whether they are reliable predictors of mortality for adults with CHD(ACHD)independent of anatomic CHD complexity.A retrospective cross-sectional analysis of ACHD,aged 18–64,with concomitant HTN and/or HF and at least one health care encounter during 2008–2010 were assessed.Of 5,397 ACHD patients(18.3%HTN without HF,4.4%HF without HTN,8.3%with both),3.0%died(n=163)during the study period.Overall,the sample was 45.1%white,61.4%female,and 29.0%had a complex CHD.Among those who died,23.3%had HTN without HF,17.2%had HF without HTN,and 42.3%had both.Crude analyses revealed that older age,male gender,black race,and having public health insurance were associated with increased mortality during the three-year study period compared to ACHD patients who were younger,female gender,white race,and covered by private health insurance.ACHD patients diagnosed with non-complex CHD lesions(i.e.,shunts,valves,or shunts+valves)were at greater risk of dying compared to those with severe complex CHDs.When CHD type was assessed separately,those with valve lesions were more likely to die compared to those with complex CHD lesions.After adjustment for age,gender,race,insurance and CHD complexity,ACHD patients with HF,with or without HTN,were equally likely to die during the study period.However,ACHD patients with HF,without or without HTN,who had valve defects were more likely to die during the three-year study period compared to patients with complex CHDs.展开更多
Congenital ventricular aneurysm is a very rare cardiac anomaly.A diagnosis can be made during the prenatal period using fetal echocardiography.This study presents a very rare apically located left ventricular aneurysm...Congenital ventricular aneurysm is a very rare cardiac anomaly.A diagnosis can be made during the prenatal period using fetal echocardiography.This study presents a very rare apically located left ventricular aneurysm case,and the relevant literature was reviewed and discussed.In this case,a 35-year-old,gravida 2,parity 1 preg-nant woman at 24 weeks of gestation,displayed a wide aneurysmal image in the left ventricular apical wall on fetal echocardiography.There was a 1.79 mm muscular ventricular septal defect at the apical region of the interven-tricular septum.In the course of the color Doppler ultrasonography examination,an aberrantfibrous band within the left ventricle and consequent turbulentflow during systole were observed.The baby,born via cesarean section at 37 weeks of gestation,is now in its postnatal seventh month.However,during echocardiographic follow-ups,changes have been observed,including mild to moderate mitral insufficiency and a decrease in systolic function.Despite thesefindings,the clinical condition remains asymptomatic.It is of great importance to use a multidis-ciplinary approach in managing these rare cases that could lead to potential adverse outcomes during the antena-tal or postnatal periods.展开更多
文摘Background: Congenital anomalies are among the leading causes of fetal loss, despite it can be identified prior to birth through advanced technology in expert hands. Our research aimed at estimating the prevalence of congenital anomalies in Sudan. Methods: A facility-based retrospective cross-sectional study combined with a community-based survey through a telephone interview was implemented on a purposive convenient sample of 138 participants. The data were computerized in Epi Info 7. Google Earth Pro enabled to collect the geographical coordinates for the residence of the participants. Descriptive statistics were performed through SPSS 23 and ArcGIS 10.3 was used to generate the geographical distribution map of congenital defects to visualize the catchment areas of Soba Ultrasonography Unit. Results: Of the 138 participants, the estimated prevalence of congenital defects was 2.2/10,000 live births. The ultrasonography screening revealed that neural tube defects were the most prevalent anomalies with 13.0% (18/138), which represented 47.4% (18/38) of all defects. Concerning children, a mortality rate of 23.2% (32/138) was reported. Conclusions: The child mortality rate post ultrasound screening of 23.2%, and the neural tube defects being the most common anomalies appealed to Sudan health authorities for focusing on more preventive antenatal practices to strengthen and promote maternal and child health.
基金Supported by The Russian Science Foundation,No.19-75-20076.
文摘BACKGROUND Necrotizing enterocolitis(NEC)remains a prominent gastrointestinal emergency among infants,particularly term infants with congenital heart defects(CHD)being at high risk.The molecular processes that contribute to NEC have yet to be completely understood.The high mortality rates necessitate an active search for noninvasive biomarkers that can aid in the preclinical diagnosis and prognosis of NEC.MicroRNAs(miRs),which are involved in many biological processes in both health and disease,have been discovered to play an important role in regulating inflammation and immune responses via various signaling pathways.AIM To determine the plasma levels of miR-155,miR-221,miR-223,miR-320a,miR-451a as potential NEC biomarkers in term newborns with CHD.METHODS This prospective cohort study included twenty-tree term newborns with CHD who underwent cardiac surgery on the median day of life(DOL)=7.Nine of them developed NEC(Bell’s stage IIA and IIIA)within 1 week of cardiac surgery(NEC newborns).Blood samples were collected before(median DOL=5)and following(median DOL=13)cardiac surgery.Levels of plasma miR-155-5p,miR-221-3p,miR-223-3p,miR-320a-3p,and miR-451a were determined using real-time polymerase chain reaction.The functional analysis was executed using the DIANA-miRPath v4.0.RESULTS Preoperatively,NEC newborns had significantly lower plasma levels of miR-155(2.70-fold,P=0.020),miR-223(2.42-fold,P=0.030),and miR-320a(3.62-fold,P=0.006)than newborns without NEC.Postoperatively,miR-451a levels differed significantly between the newborn groups,showing a 4.70-fold decrease(P=0.014)in expression when clinical NEC symptoms appeared.According to receiver operating characteristic analysis,miR-320a was found to be the most effective predictive biomarker for NEC[area under the curve(AUC)=0.835,63%sensitivity,100%specificity],while miR-451a was identified as a NEC biomarker(AUC=0.835,85.7%sensitivity,76.9%specificity).Preoperatively,miR-155-5p,miR-223-3p,and miR-320a-3p were differentially expressed and targeted the forkhead box O and Hippo pathways(P<0.01).CONCLUSION Our study demonstrates,for the first time,that plasma miR-320a-3p levels can be used as a preclinical biomarker for NEC in term newborns with CHD.
文摘BACKGROUND: Micro RNAs are small non-coding RNAs of approximately 22 nucleotides in length, and play important regulatory roles in normal heart development and the pathogenesis of heart diseases. Recently, a few prospective studies have implicated the diagnostic role of micro RNAs in congenital heart defects(CHD).DATA RESOURCES: This review retrieved the research articles in Pub Med focusing on the altered microR NAs in cardiac tissue or serum of patients with CHD versus healthy normal controls, as well as the studies exploring circulating microR NAs as potential biomarkers for(fetal) CHD.RESULTS: Most of the studies of interest were conducted in recent years, implicating that the topic in this review is a newly emerging field and is drawing much attention. Moreover, a number of differentially expressed microR NAs between CHD specimens and normal controls have been reported.CONCLUSION: Circulating micro RNAs may serve as potential biomarkers for diagnosis of CHD in the future, with more efforts paving the road to the aim.
基金supported by the National Natural Science Foundation Program of China[82073653,81803313,and 81974019]China Postdoctoral Science Foundation[2020M682644]+6 种基金Hunan Provincial Science and Technology Talent Support Project(2020TJ-N07)Natural Science Foundation of Hunan Province[2018JJ2551]Hunan Provincial Key Research and Development Program[2018SK2063 and 2018SK2062]Open Project from NHC Key Laboratory of Birth Defect for Research and Prevention[KF2020006]National Key Research and Development Program of China[2018YFA0108700 and2017YFA0105602]Postgraduate Scientific Research Innovation Project of Hunan Province[grant number CX20200271]Fundamental Research Funds for the Central Universities of Central South University[grant number 2020zzts798]。
文摘Objective This study aimed to assess the associations between maternal drug use,cytochrome P450(CYP450)genetic polymorphisms,and their interactions with the risk of congenital heart defects(CHDs)in offspring.Methods A case-control study involving 569 mothers of CHD cases and 652 controls was conducted from November 2017 to January 2020.Results After adjusting for potential confounding factors,the results show that mothers who used ovulatory drugs(adjusted odds ratio[a OR]=2.12;95% confidence interval[CI]:1.08-4.16),antidepressants(a OR=2.56;95%CI:1.36-4.82),antiabortifacients(a OR=1.55;95%CI:1.00-2.40),or traditional Chinese drugs(a OR=1.97;95%CI:1.26-3.09)during pregnancy were at a significantly higher risk of CHDs in offspring.Maternal CYP450 genetic polymorphisms at rs1065852(A/T vs.A/A:OR=1.53,95%CI:1.10-2.14;T/T vs.A/A:OR=1.57,95%CI:1.07-2.31)and rs16947(G/G vs.C/C:OR=3.41,95%CI:1.82-6.39)were also significantly associated with the risk of CHDs in offspring.Additionally,significant interactions were observed between the CYP450 genetic variants and drug use on the development of CHDs.Conclusions In those of Chinese descent,ovulatory drugs,antidepressants,antiabortifacients,and traditional Chinese medicines may be associated with the risk of CHDs in offspring.Maternal CYP450 genes may regulate the effects of maternal drug exposure on fetal heart development.
基金The San Juan Bautista School of Medicine’s Institutional Review Board approved the study(EMSJBIRB-7-2021).
文摘Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tional,and gestational maternal diabetes,and their potential impact on the occurrence of congenital heart defects(CHD)during neonatal development.Methods:Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico,we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020.Our assessment encompassed a range of variables,including maternal age,gestational age,BMI,pregestational diabetes,gestational diabetes,hypertension,history of abortion,and presence of preeclampsia.Results:A cohort of 673 patients was included in our study.The average maternal age was 26 years,within a range of 22 to 32 years.The mean gestational age measured 39 weeks,with a median span of 38 to 39 weeks.Of the 673 patients,274(41%)mothers gave birth to neonates diagnosed with CHD.Within this group,22 cases were linked to pre-gestational diabetes,while 202 were not;20 instances were associated with gestational diabetes,compared to 200 without;and 148 cases exhibited an overweight or obese BMI,whereas 126 displayed a normal BMI.Conclusion:We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD.However,our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD.These results may aid in developing effective strategies to prevent and manage CHD in neonates.
基金This study was funded through a grant from the European Union's Project Horizon 2020 and 5G HEART,under Grant Agreement Number 857034[15]the Norwegian Association for Children with Congenital Heart Disease.
文摘Background:The management of suspected critical congenital heart defects(CCHD)relies on timely echocardiographic diagnosis.The availability of experienced echocardiographers is limited or even non-existent in many hospitals with obstetric units.This study evaluates remote-mentored echocardiography performed by physicians without experience in imaging of congenital heart defects(CHD).Methods:The setup included a pediatric cardiologist in a separate room,guiding a physician without experience in echocardiographic imaging of CHD in the examination of a symptomatic newborn.This remote-mentoring pair was blinded to the diagnosis of the newborn and presented with a simplified patient history.The echocardiographic images were streamed to the laptop of the mentor,along with a webcam feed showing the probe position.The task was to identify CCHD in need of immediate transfer to a pediatric cardiac surgical center.The result was compared to the previously completed echocardiographic report and the clinical decision of the patient-responsible pediatric cardiologist.Results:During 17 months,15 newborns were recruited.All six newborns with CCHD were correctly labeled by the remotementoring pair.One newborn with Tetralogy of Fallot was erroneously labeled as needing immediate transfer.Eight newborns without CCHD were correctly labeled.Conclusions:Remote-mentored echocardiography performed by examiners without experience in imaging CHD identified all newborns with CCHD in need of immediate transfer for specialist care.The setup shows promising results for improving the management of CCHD in hospitals without continuous pediatric cardiology service.
基金supported by grants from the Guangzhou Municipal Science and Technology Bureau(Nos.202102080466,202201011423,202206010049,2023B03J0596,2023B03J1254,2023B03J1255)Department of Science and Technology of Guangdong Province(Nos.2020B1111170011,2023A1515012501)+1 种基金the Natural Science Foundation of Guangdong Province(Nos.2023A1515010801,2021A1515011445)the National Natural Science Foundation of China(Nos.82100371,81903287).
文摘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.
文摘This review aims to sum up the improvements witnessed in the field of interventional cardiology during recent times. The last decade has witnessed significant technical advances in the field of radiological imaging and also in interventional cardiology which has helped to offer more non-invasive solutions for the management of congenital heart defects. This has resulted from the use of advanced 3-dimensional fusion imaging instead of conventional 2-dimensional angiography, applying interactive real-time enhancement and using computed tomography and Magnetic Resonance Imaging for interventional procedures. Similarly the introduction of next generation devices, have not only improved the final outcome of the procedure but also has helped in reducing the challenges that were faced before and with the initial generation of devices. These advances have helped not only in reducing the radiation exposure, the use of contrast medium dose but also have resulted in improved early survival. The field of neonatal cardiology has advanced at an unprecedented pace. The transcatheter closure of patent ductus arteriosus has evolved over time and now it has been made possible at much lower body weight. Similarly, early use of stents for aortic coarctation has been found effective in some patients, especially when surgical intervention had been denied. The application of the hybrid approach for the management of complex congenital heart defects has also been effectively applied. More recently transcatheter placement of the pulmonary valve has been introduced for severely stenotic and/or regurgitant pulmonary valve in adolescents and adults. It is anticipated that in near future, this procedure would be available for relatively younger patients. In conclusion: last 2 decades have improvised pediatric interventional cardiology to incorporate less invasive solutions for CHD. The current advances in radio-diagnostic imaging, gadgetry and technical expertise have improved significantly and led to manage many of such defects by trans-catheter approach. This has led also, to replace the early surgical intervention with a more subtle hybrid approach, thus reducing not only the major surgical trauma but also been found to be cost-effective due to a shorter hospital stay. But a learning curve for performers is required for optimum results and also such procedures should be performed in a fully developed facility with an optimum surgical backup.
文摘The objective of the work is to study the topographic and anatomical characteristics of the atrioventricular node’s artery in complex congenital heart defects.The material for the work was the following:44 specimens including hearts of fetuses and children of the first three years having congenital defects and 50 specimens of the hearts of a similar age with normal development as the control.A complex of generally accepted morphological methods was used to identify the conductive system of the heart,its blood supply.According to the data obtained given congenital heart defects,the artery of the atrioventricular node arises from an artery,that determines the type of blood supply to the heart.With the full form of the common atrioventricular canal,the presence of the“U”-shaped bend of the coronary artery at the point of departure of the atrioventricular artery from it is inconstant,which is apparently due to the localization of the atrioventricular node in the embryonic position.The intensity of the lateral branches from the artery of the atrioventricular node to the heart partitions is determined by the hemodynamic features with congenital heart defects.
基金the Vestfold Hospital Trust,supporting the study financially.
文摘Aim: To assess basic trends in epidemiology of congenital heart defects (CHDs). Method: Population based prospective observational study. Material: CHDs in infants born alive in a Norwegian county 1982-2011. Results: In 828/71 217 infants (12 per 1000) a CHD was diagnosed. The prevalence increased from 8 to 12 per 1000 after introduction of early echocardiography in newborns with suspected CHD from 1986 (p = 0.0001). Ventricular septal defect (VSD) was the dominating CHD (474;57%). In 222 (27%) the CHDs were missed and diagnosed after discharge from hospital after birth. Twelve critical CHDs (causing death or requiring invasive procedures before 28 days of life) were missed. Prenatal diagnosis of critical CHDs increased from 4/67 (6%) born 1997-2006 to 4/11 (36%) born 2007-2011 (p = 0.01). In 177 (21%) a syndrome or extracardial defect occurred. The occurrence of CHDs associated with chromosomal disorders (60/73 (82%) trisomies) more than doubled from the cohort born in the first 10-year period 1982-1991 (0.6 per 1000) to the last 2002-2011 (1.4 per 1000) (p < 0.0001) in parallel with increasing births in women ≥ 35 years old in the population. 237 (29%) underwent therapeutic procedures (203 (86%) surgery, of whom 16 after initial catheter intervention, and 34 (14%) catheter intervention alone). 39/237 (16%) died, 101 (43%) were repaired and 97 (41%) had some minor residual defect. The death rate declined significantly from 65/532 (12%) born 1982-2001 to 11/296 (4%) born 2002-2011 (p = 0.0001). 37/76 (49%) deaths occurred within 28 days after birth. Conclusions: The rate of detection of CHDs increased substantially after introduction of echocardiography in newborns with suspected CHD, especially VSDs. Some critical CHDs were overlooked. The prenatal detection rate of such defects increased. The prevalence of CHDs with associated chromosomal disorders increased in parallel with increasing maternal age in the population. Most deaths occurred during the neonatal period. Increasing survival increases the load on long-term follow-up programmes.
文摘Objective:Vertical right thoracotomy(VRAT)has become an alternative to sternotomy for the repair of non-complex congenital heart defects in our infants and children.Summary Background Data:Limited data exists on the comparison of the two approaches.Methods:The present study consisted of two groups;Group Ⅰ:(sternotomy;33 patients)and Group Ⅱ:(VRAT;35 patients).We compared the two groups on operative data,hours of invasive lines,narcotics used,length of stay,and total variable cost of stay.Results:The most frequent procedures were atrial and ventricular septal defect closure(25 patients,75.8%in Group Ⅰ)and(14 patients,40%in Group Ⅱ).The average age and weight were 33.43±53 months,and 14.7±16.9 kg for Group I,and 75.3±60.2 months and 24.9±18 kg for Group Ⅱ,respectively,(p<0.001).We found no differences in aortic cross-clamp/bypass times between groups(p=0.39 and 0.42,respectively).The use of narcotics was not significantly different between the two study groups(p=0.37)as was the total variable cost(p=0.115).Group Ⅱ had a lower time without invasive lines(p<0.001).In Group Ⅱ the total length of stay was significantly less as well(p<0.001).Conclusions:VRAT is a useful technique for repairing a wide range of heart defects and does not result in prolonged cardiopulmonary bypass or aortic cross-clamp times.Although total opioid use and total cost of stay are no different as with sternotomy,the shortened duration of invasive line use,and shorter length of stay make this approach worthy of consideration.
基金supported by the Major International(Regional)Joint Research Project of Ministry of Science and Technology of China(No.2010DFA32260/No.2008DFA31140)National Natural Science Foundation of China(No.81370230)+2 种基金Technology Foundation for Selected Overseas Chinese Scholar of Ministry of Human Resources and Social Security of China(Ping Zhu)Key Technologies Research and Development Program of China(No.2011BAI11B22)Guangdong Province Natural Science Fund(No.S2013010014009)
文摘Background Di George syndrome（DGS） is the most common microdeletion syndrome in humans and a disorder caused by a defect in chromosome 22. Almost 80% of DGS patients manifest congenital heart defects（CHD）, which are highly variable and severe. However, the genetics of CHD in DGS remain elusive. This review concludes that the TBX1 gene plays a critical role in cardiovascular defects, involving many additional genes, such as Six1, Eya1, Fgf8, Fox, and Shh. Concerning the variable manifestations of CHD in DGS,additional modifiers have been shown of involvement, such as Wnt, MOZ, micro RNAs, VEGF, and CRK.Knowledge of the genetics underlying CHD in DGS has the potential to early detection and treatment of this disease.
文摘Background:The neutrophil-lymphocyte ratio(NLR)is a simple,cost-effective marker of systemic inflammation.This study aims to evaluate the association between perioperative NLR and postoperative outcomes in pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass(CPB).Methods:We retrospectively reviewed 70 patients under 18 years of age who underwent surgery between 2018 and 2023.NLR was measured preoperatively and on postoperative days(POD)0,1,2,3,and 6.Receiver operating characteristic analysis identified optimal cutoffs,and associations with postoperative outcomes were assessed.Results:The preoperative NLR cutoff of 1.14(AUC=0.75)was associated with prolonged mechanical ventilation(>72 h)(p=0.02),extended intensive care unit(ICU)stay(p=0.004),and longer hospital stay(p=0.006).NLR values on POD3(AUC=0.74)and POD6(AUC=0.78)also demonstrated strong predictive ability for these outcomes.Conclusions:Elevated perioperative NLR-particularly preoperative values≥1.14-is associated with prolonged mechanical ventilation,longer ICU admission,and extended hospitalization in pediatric congenital heart surgery.NLR may serve as a practical biomarker for early risk stratification and postoperative management.
文摘The changes of adrenomedullin (ADM), endothelin-1 (ET-1) and nitric oxide (NO) levels before and after operation in congenital heart disease (CHD) associated with pulmonary hypertension (PH) were observed in order to investigate their role in CHD with PH and their clinical significance. The CHD patients were divided into 3 groups according to pulmonary artery systolic pressure (PASP): Non-PH group: PASP≤30 mmHg ( n =11); mild-PH group: PASP 31-49 mmHg ( n =10); moderate or severe-PH group: PASP≥50 mmHg ( n =12). The control group consisted of 15 health children. Plasma ADM, ET-1 and NO levels were determined by radioimmunoassay and colorimetry methods. The correlation between ADM and ET-1, NO, PASP was analyzed. The changes in plasma ADM, ET-1 and plasma NO on the 7th day after operation among the groups were compared. The results showed that plasma ADM levels in non-PH group were significantly higher than that in control group ( P <0.05), but there was no significant difference in ET-1 and NO levels between the two groups ( P >0.05). ADM and ET-1 levels in mild-PH group were significantly elevated as compared with those in non-PH group (both P <0.05), but NO levels were decreased ( P <0.05). ADM and ET-1 levels in moderate or severe-PH groups were increased as compared with those in mild-PH group (both P <0.01), but NO level significantly declined ( P <0.05). On the 7th day after operation, plasma ADM and ET-1 levels in PH group were significantly decreased ( P <0.05, P <0.01) as compared with those before operation, but there was no significant difference in NO levels ( P >0.05). But NO levels in non-PH group were significantly increased ( P <0.05). Plasma ADM levels in CHD were positively correlated with PASP and ET-1 ( r =0.77, P <0.01; r =0.82, P <0.01), negatively correlated with NO ( r =-0.56, P <0.05). It was concluded that during the progression of PH in the cases of CHD, plasma ADM, ET-1 and NO might play an important role in the development of PH. The increased ADM may represent a compensatory mechanism. It can interact with NO and ET-1 to regulate pulmonary circulation in the pathophysiology of PH with CHD. ADM may be involved in the defence mechanism against further increase of pulmonary arterial pressure. ADM could be used as a reliable indicator of the severity of CHD associated PH.
基金Sigma Theta Tau Chi Chapter,American Association of Nurse Practitioners,and Ethan M.Lindberg Foundation.
文摘Objective To examine the resilience of parents of children with congenital heart disease and to investigate socio-demographic factors that may influence parents’resilience.Methods This is a web-based survey study using a cross-sectional design.A purposive sampling method was utilized to recruit 515 parents who care for children with congenital heart disease.Resilience was assessed using the Dispositional Resilience Scale-Ⅱ.Based on expert-interviews,a questionnaire was designed to collect socio-demographic data.Descriptive statistics,factor analysis,and linear regressions were used to analyze data.Results A total of 413 parents completed the survey study.The mean resilience score was 3.75(SD=0.61;range=1.89–4.89)with higher scores indicating higher resilience.The linear regression models demonstrated that parents who had lower education levels and lower gross household income had lower resilience(P<0.05).Conclusions Parents reported resilience that reflected their ability to cope with stressful events and mitigate stressors associated with having and caring for children with congenital heart disease.Lower education levels and lower gross household income are associated with lower resilience.To increase parents’resilience,nursing practice and nurse-led interventions should target screening and providing support for parents at-risk for lower resilience.As lower education level and financial hardship are factors that are difficult to modify through personal efforts,charitable foundations,federal and state governments should consider programs that would provide financial and health literacy support for parents at-risk for lower resilience.
文摘We present a case report about percutaneous closure of a congenital Gerbode defect using Nit-Occlud~?LêVSD coil.The patient was referred to our hospital with a diagnosis of ventricular septal defect(VSD)and severe pulmonary arterial hypertension.But transthoracic echocardiography revealed a communication between the left ventricle(LV)and the right atrial(RA),called Gerbode defect.Catheterization confirmed the shunt from the LV to the RA.We successfully closed the defect with a VSD coil.After uneventful 6 mo follow-up,the patient was out of dyspnea,the symptom urged him to have medical attention.This case report is to discuss the diagnosis and percutaneous treatment approach for this rare congenital heart disease.
基金supported by the Tackling Project for Social Development of Committee of Science and Technology of Shaanxi Province(2003K10-G83)
文摘Objective To explore the multiple risk factors for family lifestyle of children with congenital heart defects(CHDs)in Shaanxi Province,China.Methods A 1∶1 case-control study was carried out to investigate 60 pairs of children and their parents.The univariate and multivariable logistic regression models were used to analyze the influence of risk factors related to parents’lifestyle on CHDs.Results Several possible risk factors were found for CHDs,including fever(OR=4.465,P=0.017),pesticides contact(OR=2.234,P=0.083),passive smoking during pregnancy(OR=20.529,P=0.007)and father’s smoking(OR=3.342,P=0.005);fever(OR=2.428,P=0.012)and passive smoking during pregnancy(OR=1.201,P=0.037)were also correlated with ventricular sepal defect(VSD).Conclusion Fever,pesticides contact and passive smoking are associated with CHDs during pregnancy.We should focus our attention on health care during pregnancy to avoid the above-mentioned risk factors and call on parents to hold on to a good healthy lifestyle.
文摘Objective:The objective of this analysis is to describe the characteristics and morbidity during hospitalizations among adolescents with congenital heart disease(AdoCHD)from the Pediatric Health Information System(PHIS)database.Methods:The PHIS database was queried for all AdoCHD admissions aged 12–18 years(1/1/2004–12/31/2013).Major forms of CHD were identified by their International Classification of Diseases,ninth revision codes,further verified based on their secondary diagnosis and/or procedure codes.Patient characteristics,diagnoses,procedures and vital status were assessed.Results:In total,there were 4,267 adolescents admitted to 42 Children’s Hospitals,58.3%were males,24.6%single ventricle(SV)patients,64.1%bi-ventricle(BV),and 11.3%could not be classified.They accounted for 8,512 hospitalizations(41,240 total hospital days),of which 31.6%were intensive care unit(ICU)stays.ICU stay was similar for the SVand BV patients with similar duration of mechanical ventilation between the two groups.Overall,the most common CHD among in-patients was tetralogy of Fallot(TOF,36.4%).Larger proportion of the BVAdoCHD admissions were for elective surgical and electrophysiological procedures.There were 109(2.5%)heart transplantations(1.3%SV vs.0.6%BV)and 120 in-hospital deaths(2.8%)(1.1%SV vs.1.3%BV).Hypoplastic left heart syndrome was the most common diagnosis in transplanted patients(46%)and those who died(28%);TOF(29%)was frequent in 91(2.1%)patients who had cardiac arrests.Conclusions:Different hospitalization patterns exist for BV and SV AdoCHD.Recognizing this risk may encourage directing resources toward optimizing long-term care of CHD patients.
基金Cheryl Raskind-Hood and Wendy M.Book are supported by a Cooperative Agreement from the Centers for Disease Control and Prevention Cooperative Agreement,Public Health Pilot Project Surveillance of Congenital Heart Defects(CHDs)Focusing on Adolescents and AdultsFOA#DD12-1207.
文摘Early intervention to prevent premature mortality is vital for adults with congenital heart defects(CHD).Anatomic complexity and comorbid conditions are thought to contribute to CHD mortality.Since hypertension(HTN)and heart failure(HF)are the comorbid conditions among the most prevalent causes of death in the United States,and commonly accompany CHD,it is crucial to evaluate whether they are reliable predictors of mortality for adults with CHD(ACHD)independent of anatomic CHD complexity.A retrospective cross-sectional analysis of ACHD,aged 18–64,with concomitant HTN and/or HF and at least one health care encounter during 2008–2010 were assessed.Of 5,397 ACHD patients(18.3%HTN without HF,4.4%HF without HTN,8.3%with both),3.0%died(n=163)during the study period.Overall,the sample was 45.1%white,61.4%female,and 29.0%had a complex CHD.Among those who died,23.3%had HTN without HF,17.2%had HF without HTN,and 42.3%had both.Crude analyses revealed that older age,male gender,black race,and having public health insurance were associated with increased mortality during the three-year study period compared to ACHD patients who were younger,female gender,white race,and covered by private health insurance.ACHD patients diagnosed with non-complex CHD lesions(i.e.,shunts,valves,or shunts+valves)were at greater risk of dying compared to those with severe complex CHDs.When CHD type was assessed separately,those with valve lesions were more likely to die compared to those with complex CHD lesions.After adjustment for age,gender,race,insurance and CHD complexity,ACHD patients with HF,with or without HTN,were equally likely to die during the study period.However,ACHD patients with HF,without or without HTN,who had valve defects were more likely to die during the three-year study period compared to patients with complex CHDs.
文摘Congenital ventricular aneurysm is a very rare cardiac anomaly.A diagnosis can be made during the prenatal period using fetal echocardiography.This study presents a very rare apically located left ventricular aneurysm case,and the relevant literature was reviewed and discussed.In this case,a 35-year-old,gravida 2,parity 1 preg-nant woman at 24 weeks of gestation,displayed a wide aneurysmal image in the left ventricular apical wall on fetal echocardiography.There was a 1.79 mm muscular ventricular septal defect at the apical region of the interven-tricular septum.In the course of the color Doppler ultrasonography examination,an aberrantfibrous band within the left ventricle and consequent turbulentflow during systole were observed.The baby,born via cesarean section at 37 weeks of gestation,is now in its postnatal seventh month.However,during echocardiographic follow-ups,changes have been observed,including mild to moderate mitral insufficiency and a decrease in systolic function.Despite thesefindings,the clinical condition remains asymptomatic.It is of great importance to use a multidis-ciplinary approach in managing these rare cases that could lead to potential adverse outcomes during the antena-tal or postnatal periods.
