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Situs Inversus Totalis and Schizophrenia Comorbidity.

Turk Psikiyatri Derg. 2017;28(4):287-290

Authors: Ulusoy Kaymak S, Kabadayı Şahin E, Karakaş Uğurlu G, Ünal Ö, Atagün Mİ, Can SS, Çayköylü A

The comorbidity of structural or genetic diseases with schizophrenia is seen as an opportunity to understand the formation of schizophrenia. This case report presents a patient with comorbidity of schizophrenia, tetralogy of Fallot (TOF) and total situs inversus. TOF is a cyanotic heart disease, which can be linked to 22q11 deletion and trisomy 21. Situs inversus totalis (SIT) is a congenital condition in which the major visceral organs, including the heart, are positioned in a mirror image from normal conditions. The comorbidity of TOF and SIT is quite rare. In our case report, schizophrenia is added to this rare comorbidity. This case report discussed the comorbidity and probable causal relationships. Furthermore, the research method of how transposition in internal organs is reflected in brain lateralization is also presented.

PMID: 29730866 [PubMed - indexed for MEDLINE]

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"There's no acknowledgement of what this does to people": A qualitative exploration of mental health among parents of children with critical congenital heart defects.

J Clin Nurs. 2018 Jul;27(13-14):2785-2794

Authors: Woolf-King SE, Arnold E, Weiss S, Teitel D

AIMS AND OBJECTIVES: The purpose of this study was to explore the psychological impact of parenting a child with a critical congenital heart defect and the feasibility and acceptability of integrating psychological services into paediatric cardiology care.
BACKGROUND: Children with critical congenital heart defect are at an increased risk for long-term behavioural, social and emotional difficulties. Data suggest that this risk is partially attributable to parental mental health, which is a stronger predictor of long-term behavioural problems in congenital heart defect children than disease-specific and surgical factors. Parental stress and mental health are thus important intervention targets, especially among high-risk families.
DESIGN: This article presents data from a qualitative study with 25 congenital heart defect parents (n = 15) and providers (n = 10).
METHODS: Using thematic analysis, semi-structured in-depth interviews were transcribed and coded by the first and second author to identify major themes and subthemes.
RESULTS: Results of the interviews were organised into four major themes: (i) the psychological impact of parenting a child with critical congenital heart defect, (ii) factors that influence the psychological impact of parenting a child with critical congenital heart defect, (iii) how and when to psychologically support congenital heart defect parents and (iv) feasibility and acceptability of integrating psychological support into congenital heart defect care. Providers and parents endorsed the integration of mental health treatment into routine congenital heart defect care and identified several practical issues related to feasibility (e.g., funding and space) that should be considered prior to implementation.
CONCLUSIONS: Parents of children with critical congenital heart defect need access to mental health services, and integrating these services into routine paediatric cardiology care is a novel and practical way for parents to receive the treatment they need.
RELEVANCE TO CLINICAL PRACTICE: Suggestions for how the field of paediatric cardiology could begin to integrate mental health services into congenital heart defect treatment are provided.

PMID: 29345005 [PubMed - indexed for MEDLINE]

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French national survey on infective endocarditis and the Melody™ valve in percutaneous pulmonary valve implantation.

Arch Cardiovasc Dis. 2018 Aug - Sep;111(8-9):497-506

Authors: Malekzadeh-Milani S, Houeijeh A, Jalal Z, Hascoet S, Bakloul M, Aldebert P, Piéchaud JF, Heitz F, Bouvaist H, Dauphin C, Guérin P, Villemain O, Petit J, Godart F, Thambo JB, Boudjemline Y, French working group of Cardiac Catheterization in Congenital Heart Disease Patients

BACKGROUND: Percutaneous pulmonary valve implantation (PPVI) is a routine treatment for dysfunctional right ventricular outflow tract. Infective endocarditis (IE) is a major concern.
AIM: To report French experience with the Melody™ valve (Medtronic Inc., Minneapolis, MN, USA).
METHODS: All patients who underwent PPVI were recorded in a multicentre French national survey. Demographic and procedural data were collected from patients with IE. Bacterial identification, diagnostic tools and outcome were recorded.
RESULTS: Forty-five cases of IE were diagnosed in 43 patients. The cumulative IE incidence was 11.8% (95% confidence interval [CI] 8.5-15.9). The annualized IE incidence was 3.6% (95% CI 0-4.8). Freedom from IE was 96.3% and 85.8% at 12 months and 60 months, respectively. IE incidence did not change during the study period. The mean interval between PPVI and IE was 2.6±2.1 years (range, 5 days to 7.3 years). Fifteen patients with IE required intravenous antibiotics only. Seven patients had early interventional cardiac catheterization to relieve severe right ventricular outflow tract obstruction. Twenty-four patients had surgical valve replacement (six urgently; nine semi-urgently; nine electively). Staphylococcus aureus IE required surgery in all but one patient. Three patients died before any treatment. Three additional patients died, giving a mortality rate of 14%. Global survival in the total cohort of patients who received a Melody valve was excellent (96.5% at 5 years). When comparing survival curves between the IE and non-IE groups, death and cardiovascular events were statistically significantly higher in the IE group (log-rank P<0.0001).
CONCLUSION: Melody valve IE is a severe complication following PPVI. The annualized IE incidence in this cohort was similar to rates reported in other studies. With rapid diagnosis and adequate treatment, outcome has improved, and unfavourable outcome is mainly associated with S. aureus.

PMID: 29530718 [PubMed - indexed for MEDLINE]

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Role of cardiac imaging and three-dimensional printing in percutaneous appendage closure.

Arch Cardiovasc Dis. 2018 Jun - Jul;111(6-7):411-420

Authors: Iriart X, Ciobotaru V, Martin C, Cochet H, Jalal Z, Thambo JB, Quessard A

Atrial fibrillation is the most frequent cardiac arrhythmia, affecting up to 13% of people aged>80 years, and is responsible for 15-20% of all ischaemic strokes. Left atrial appendage occlusion devices have been developed as an alternative approach to reduce the risk of stroke in patients for whom oral anticoagulation is contraindicated. The procedure can be technically demanding, and obtaining a complete left atrial appendage occlusion can be challenging. These observations have emphasized the importance of preprocedural planning, to optimize the accuracy and safety of the procedure. In this setting, a multimodality imaging approach, including three-dimensional imaging, is often used for preoperative assessment and procedural guidance. These imaging modalities, including transoesophageal echocardiography and multislice computed tomography, allow acquisition of a three-dimensional dataset that improves understanding of the cardiac anatomy; dedicated postprocessing software integrated into the clinical workflow can be used to generate a stereolithography file, which can be printed in a rubber-like material, seeking to replicate the myocardial tissue characteristics and mechanical properties of the left atrial appendage wall. The role of multimodality imaging and 3D printing technology offers a new field for implantation simulation, which may have a major impact on physician training and technique optimization.

PMID: 29886007 [PubMed - indexed for MEDLINE]

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Cardiac resynchronization therapy in congenital heart disease: Results from the German National Register for Congenital Heart Defects.

Int J Cardiol. 2018 Oct 04;:

Authors: Flügge AK, Wasmer K, Orwat S, Abdul-Khaliq H, Helm PC, Bauer U, Baumgartner H, Diller GP, German Competence Network for Congenital Heart Defects Investigators

BACKGROUND: Cardiac resynchronization therapy (CRT) is an established option for patients with heart failure. Limited data exists on indications and outcome of CRT in contemporary congenital heart disease (CHD) patients.
METHODS AND RESULTS: All patients with CRT registered in the German National Register for Congenital Heart Defects were systematically identified. We analysed data on demographics, type of congenital defect as well as repair, associated conditions, indication for CRT, heart failure medication, combination with a defibrillator or pacemaker and outcome. Overall, 65 patients with CRT were identified. The most common congenital diagnoses were Tetralogy of Fallot (n = 11), congenitally corrected transposition of the great arteries (ccTGA) (n = 9) and double outlet right ventricle (n = 6). The majority of patients (n = 48, 87%) had conventional antibradycardia pacing or ICD indications. Of these, the majority (n = 44) underwent an upgrade to a CRT system to avoid the detrimental consequences of longstanding conventional ventricular single-site pacing, whereas four patients required an ICD due to heart failure and a history of malignant ventricular tachycardia. During a median follow-up of 6.9 years 19 patients developed complications: 16 patients experienced pacemaker lead dysfunction and 3 patients pacemaker infection.
CONCLUSIONS: The current study based on a large national register for CHD shows that CRT is feasible and can be used as an adjunct in the heart failure treatment of selected CHD patients. Uptake of this therapy proved to be low in this nationwide study and CRT implantation was largely used in patients with a pre-existing pacing indication or those requiring an ICD.

PMID: 30297188 [PubMed - as supplied by publisher]

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Use of Pulmonary Inhalants Remains Remarkably High After Atrial Septal Defect Closure.

Circ J. 2018 Oct 06;:

Authors: Nassif M, Woudstra OI, Kuijpers JM, Sterk PJ, van Steenwijk RP, Zwinderman AH, Bouma BJ, Mulder BJ, de Winter RJ

BACKGROUND: Post-repair atrial septal defects (ASD) patients are frequently discharged from follow-up, but the extent of pulmonary symptoms long-term post-repair is unknown. Methods and Results: The national CONgenital CORvitia registry was linked to the national Drug Registry to investigate all ambulatory-dispensed pulmonary inhalants for 2006-2014. ASD patients were compared with age- and sex-matched referents from the general population. A total of 1,959 adult patients (age 42±17 years; 66% female; 1,223 [62%] repaired) were included. Compared with the referents, ASD patients had more inhalant use, even at long-term post-repair follow-up (OR=1.81 [95% CI 1.62-2.03]; P<0.001).
CONCLUSIONS: ASD patients had 2-fold higher inhalant use compared with referents even at long-term post-repair follow-up, suggesting persistent pulmonary functional impairment.

PMID: 30298834 [PubMed - as supplied by publisher]

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Right thoracotomy for aortic valve replacement in the adolescents with bicuspid aortic valve.

Congenit Heart Dis. 2018 Oct 09;:

Authors: Giordano R, Cantinotti M, Comentale G, Di Tommaso L, Iannelli G, Pilato E, Palma G

BACKGROUND: In this study, we compared our experience about early and midterm follow-up outcomes for right anterolateral minithoracotomy (RAMT) vs full sternotomy (FS) in surgical aortic valve replacement (AVR) among adolescents with bicuspid aortic valve (BAV).
METHODS: Patients were retrospectively enrolled from January 2008 to December 2017. Inclusion criteria were patients with BAV who had to undergo to AVR. They were divided in two groups: RAMT and FS. The choice of RAMT was based on individual surgeon's preferences or when expressly requested by patient that was informed of nonconventional approach.
RESULTS: We enrolled 61 patients, 23 in RAMT group and 38 in FS group. The mean age was 15.6 ± 1.7 years for RAMT group and 16.1 ± 1.5 years for FS group (P = .23). The RAMT group had a higher prevalence of female gender (P = .04). The patients in the RAMT group had longer cardiopulmonary bypass (115.2 ± 18.5 vs 102.2 ± 16.5 min; P = .006) and cross-clamp time (78.6 ± 18.1 vs 74.3 ± 15.2 min; P = .01). No patients required intraoperative conversion to FS. No differences were found in ventilation times, postoperative intensive care unit (ICU), and hospital length of stay for both groups. Follow-up echocardiograms were available for all patients at median of 5.2 years (range 0.5-9.6 years, median 5.4 years for RAMT and 5.1 for FS) and no patient required reoperation for aortic prosthesis malfunction.
CONCLUSIONS: Our study shows that RAMT is safe and effective as FS. Although the RAMT operation takes slightly more operation time, it is not associated with major adverse effects.

PMID: 30298987 [PubMed - as supplied by publisher]

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Prenatal Diagnosis of Dextrocardia with Complex Congenital Heart Disease Using Fetal Intelligent Navigation Echocardiography (FINE) and a Literature Review.

Fetal Diagn Ther. 2018;43(4):304-316

Authors: Yeo L, Luewan S, Markush D, Gill N, Romero R

Fetal dextrocardia is a type of cardiac malposition where the major axis from base to apex points to the right side. This condition is usually associated with a wide spectrum of complex cardiac defects. As a result, dextrocardia is conceptually difficult to understand and diagnose on prenatal ultrasound. The advantage of four-dimensional sonography with spatiotemporal image correlation (STIC) is that this modality can facilitate fetal cardiac examination. A novel method known as fetal intelligent navigation echocardiography (FINE) allows automatic generation of nine standard fetal echocardiography views in normal hearts by applying intelligent navigation technology to STIC volume datasets. In fetuses with congenital heart disease, FINE is also able to demonstrate abnormal cardiac anatomy and relationships when there is normal cardiac axis and position. However, this technology has never been applied to cases of cardiac malposition. We report herein for the first time, a case of fetal dextrocardia and situs solitus with complex congenital heart disease in which the FINE method was invaluable in diagnosing multiple abnormalities and defining complex anatomic relationships. We also review the literature on prenatal sonographic diagnosis of dextrocardia (with an emphasis on situs solitus), as well as tricuspid atresia with its associated cardiac features.

PMID: 28641300 [PubMed - indexed for MEDLINE]

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Fetal lung volume and pulmonary artery changes in congenital heart disease with decreased pulmonary blood flow: Quantitative ultrasound analysis.

Echocardiography. 2018 01;35(1):85-89

Authors: Guo Y, Liu X, Gu X, Zhang Y, Sun L, He Y

BACKGROUND: It has been reported that congenital heart disease with decreased pulmonary blood flow (CHD-DPBF) may affect postnatal lung morphogenesis and function. However, there has been a lack of information regarding the impact of CHD-DPBF on prenatal fetal lung development.
METHODS: Fifty-four fetuses with CHD-DPBF were compared with 110 controls. Fetal lung volume (FLV) was estimated using three-dimensional ultrasonography (3D-US). Estimated fetal weight (EFW) and McGoon index (MGI) were estimated using two-dimensional ultrasonography (2D-US).
RESULTS: FLV/EFW and MGI values measured using sonography for the CHD-DPBF group were significantly reduced compared to those of the control group (P < .05). Pearson correlation analysis indicated that the summed diameter of the right pulmonary artery and left pulmonary artery (RPA + LPA) measured by 2D-US correlated well with FLV measured by 3D-US.
CONCLUSIONS: In our study, FLV/EFW and MGI values for fetuses with CHD-DPBF tended to be decreased and FLV was associated with RPA + LPA. We concluded that CHD-DPBF might delay fetal lung development. The summed diameter of the RPA + LPA measurement could be used as an alternative to FLV for assessing fetal lung development.

PMID: 28994140 [PubMed - indexed for MEDLINE]

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Use of linear and convex ultrasound transducers for evaluation of retrosternal area in patients after cardiac surgery.

Echocardiography. 2018 01;35(1):100-103

Authors: Cantinotti M, Giordano R, Corana G, Franchi E, Koestenberger M, Kutty S

The use of linear and convex transducers is usually reserved for ultrasound imaging of vessels, abdominal organs, and lungs. However, the use of these transducers may be extended for the evaluation of thoracic structures. We describe our experience with the use of linear and convex transducers in the evaluation of the retrosternal area, which is usually difficult to visualize by conventional echocardiography and so could provide improved diagnostic information in patients after cardiac surgery.

PMID: 29266466 [PubMed - indexed for MEDLINE]