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Outcomes after common arterial trunk repair in children
10 — Pediatrics and congenital cardiopathies Methods Medical records of all children < 15 kg who underwent isolated secundum ASD surgical closure between 2010 and 2017 in 2 French tertiary centers (Bordeaux University Hospital, Necker Hospital, Paris, France) were reviewed retrospectively. Results Fifty-six children were included (mean age 19 ± 10 months and mean weight 9 ± 3 kg at time of surgery). The mean ASD size was 17 ± 4 mm. Indications for surgical closure were the right heart enlargement (56/56, 100%), failure to thrive (26/56, 46.4%), dyspnea (18/56, 32.1%) and recurrent respiratory infections (7/56, 12.5%). Thirteen children (23%) underwent cardiac catheterization before surgery which showed a mean Qp/Qs of 2.3 ± 0.7 and mean RVPi of 1.3 ± 0.8 UW.m2 . The surgical approach was sternotomy in 83.9% of cases (mean duration of extracorporeal circulation = 61 ± 3 and aortic cross-clamping = 23 ± 8 minutes). The mean duration of hospital stay was 7 ± 5 days. No complications were observed during the perioperative period. After discharge, 54/56 (96.4%) were asymptomatic in the first month. After a median follow-up of 8 months (range: 0—90), no long-term complications were noted. Conclusion Surgical closure of a secundum ASD in children < 15 kg of body weight is a safe technique which allows clinical improvement of patients. Randomized and comparative studies between surgery and catheterization are needed to assess the value of percutaneous closure in this population. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.298 090
Effects of celastrol in a mouse model of pulmonary hypertension associated with bronchopulmonary dysplasia induced by hyperoxia C. Pilard 1,2,∗ , M. Dubois 1,3 , L. Renesme 1,2 , J. Quignard 1,3 , R. Marthan 1,3 , B. Muller 1,3 , C. Guibert 1,3 , E. Dumas De La Roque 1,2 1 Inserm, Centre de recherche Cardiothoracique de Bordeaux, U1045 2 CHU de Bordeaux, Service de Soins Intensifs de Néonatologie, Centre Aliénor d’Aquitaine 3 Université de Bordeaux, Centre de recherche Cardiothoracique de Bordeaux, U1045, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (C. Pilard) Introduction Bronchopulmonary dysplasia is a common disease of premature newborns caused by oxidative stress and mechanical ventilation in these immature lungs, resulting in hypoalveolization and impaired angiogenesis. It can be complicated by pulmonary hypertension (HTP-DBP), and then right heart failure associated with excess mortality at 2 years of age. Celastrol has anti-inflammatory and antioxidant properties. Furthermore, in a mouse model of systemic hypertension, it decreases systemic blood pressure and inhibits vascular remodeling and myocardial hypertrophy by reducing inflammation and oxidative stress in vascular smooth muscle cells (VSMCs). It is therefore a molecule of choice for the study of a preventive treatment of HTP-DBP. Materials/Methods We studied the influence of celastrol in a mouse model of hyperoxic HTP-DBP by evaluating survival, HTP with measurement of pulmonary artery acceleration time (PAAT), right vascular remodeling, alveolization as well pulmonary vascular density, reactivity and remodeling. We also evaluated calcium response of human fetal pulmonary VSMCs. Results Celastrol reduced mortality at doses of 1 and 0.5 mg/kg/d. At 1 mg/kg/d, it normalized PAAT and reduced vascular hyperreactivity with no effect on the alteration of the response to acetylcholine induced by hyperoxia. It decreased cardiac and pulmonary vascular remodeling at all concentrations
135 tested but had no effect on alveolization and pulmonary vascular density. Finally, it decreased also calcium hyperreactivity of human fetal pulmonary VSMCs exposed to hyperoxia. Conclusion Celastrol had a preventive effect on HTP but not on DBP itself. However, mechanisms involved remain unknown. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.299 024
Outcomes after common arterial trunk repair in children N. Derridj 1 , O. Villemain 1,∗ , Z. Belhadjer 1 , A. Neuraz 2 , O. Raisky 1 , D. Bonnet 1 1 M3C-Necker—Enfants-Malades, AP—HP, Paris, France 2 Department of Medical informatics, Hôpital Necker—Enfant-Malades, Paris, France ∗ Corresponding author. E-mail address: [email protected] (O. Villemain) Introduction The persisting controversy on the repair of the right outflow tract in common arterial trunk led us to analyze the outcomes of children operated at our institution. Methods We identified 153 children diagnosed with CAT between 2000 and 2017. Six patients died before first surgery and were excluded. Types of CAT were classified according to the modified Van Praagh classification. Results We included 147 patients: CAT A1 (n = 89, 60.6%), CAT A2 (n = 32, 21.7%), CAT A3 (n = 8, 5.4%), and CAT A4 (n = 18, 12.3%). The mean follow-up was 10 ± 4.4 years. Seventeen patients (11.6%) died after surgery. Mean survival was 88.2% at 5 years. Survival of CAT A4 was significantly lower than for other types (65% at 5 years; P < 0.01). In multivariate analysis, quadricuspid truncal valve anatomy (P = 0.02, HR = 3.15, 95% CI [1.1961 to 8.3066]) and bovine xenograft valve conduit for the right ventricle outflow tract (RVOT) repair (P = 0.04, HR = 2.34 [0.8584 to 6.4221]) were the two risk factors for mortality. Seventy-nine patients (53.7%) needed reintervention (surgery or percutaneous). Freedom from reintervention at 5 years was 51.7%. The risk for reintervention was similar in different types of CATs (P = 0.65). The vast majority of reinterventions were done in the RVOT (96.2%). In univariate analysis, the use of bovine xenografts valve conduit (P = 0.047, HR = 1.62 [1.12 to 2.51]) and porcine xenografts (P < 0.01, HR = 2.46 [1.54 to 3.92]) were associated with a higher risk of reinterventions, while autologous connections of the pulmonary artery with the left atrial appendage or pericardial patch were associated with a reduced risk (P < 0.0001, HR = 0.25 [0,1267 to 0,4779]). Conclusion The anatomical type of CAT did not influence the risk for reintervention after repair. Autologous reconstruction of the pulmonary artery with autologous tissue limits the risk for reintervention on the RVOT during childhood. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.300 098
Lessons from prenatal diagnosis and in utero transfer of fetuses with transposition of the great arteries K. Mellul , M. Meot , O. Villemain , Z. Belhadjer , B. Stos , M. Levy , J. Le Bidois , D. Laux , E. Hery , Myriam Bensemlali , F. Bajolle , S. Malekzadeh-Milani , P. Vouhe , O. Raisky , D. Bonnet ∗ Service de Cardiologie Congénitale et Prédiatrique, Hôpital Necker—Enfants-Malades, Paris, France ∗ Corresponding author. E-mail address: [email protected] (D. Bonnet)
Effects of celastrol in a mouse model of pulmonary hypertension associated with bronchopulmonary dysplasia induced by hyperoxia C. Pilard 1,2,∗ , M. Dubois 1,3 , L. Renesme 1,2 , J. Quignard 1,3 , R. Marthan 1,3 , B. Muller 1,3 , C. Guibert 1,3 , E. Dumas De La Roque 1,2 1 Inserm, Centre de recherche Cardiothoracique de Bordeaux, U1045 2 CHU de Bordeaux, Service de Soins Intensifs de Néonatologie, Centre Aliénor d’Aquitaine 3 Université de Bordeaux, Centre de recherche Cardiothoracique de Bordeaux, U1045, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (C. Pilard) Introduction Bronchopulmonary dysplasia is a common disease of premature newborns caused by oxidative stress and mechanical ventilation in these immature lungs, resulting in hypoalveolization and impaired angiogenesis. It can be complicated by pulmonary hypertension (HTP-DBP), and then right heart failure associated with excess mortality at 2 years of age. Celastrol has anti-inflammatory and antioxidant properties. Furthermore, in a mouse model of systemic hypertension, it decreases systemic blood pressure and inhibits vascular remodeling and myocardial hypertrophy by reducing inflammation and oxidative stress in vascular smooth muscle cells (VSMCs). It is therefore a molecule of choice for the study of a preventive treatment of HTP-DBP. Materials/Methods We studied the influence of celastrol in a mouse model of hyperoxic HTP-DBP by evaluating survival, HTP with measurement of pulmonary artery acceleration time (PAAT), right vascular remodeling, alveolization as well pulmonary vascular density, reactivity and remodeling. We also evaluated calcium response of human fetal pulmonary VSMCs. Results Celastrol reduced mortality at doses of 1 and 0.5 mg/kg/d. At 1 mg/kg/d, it normalized PAAT and reduced vascular hyperreactivity with no effect on the alteration of the response to acetylcholine induced by hyperoxia. It decreased cardiac and pulmonary vascular remodeling at all concentrations
135 tested but had no effect on alveolization and pulmonary vascular density. Finally, it decreased also calcium hyperreactivity of human fetal pulmonary VSMCs exposed to hyperoxia. Conclusion Celastrol had a preventive effect on HTP but not on DBP itself. However, mechanisms involved remain unknown. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.299 024
Outcomes after common arterial trunk repair in children N. Derridj 1 , O. Villemain 1,∗ , Z. Belhadjer 1 , A. Neuraz 2 , O. Raisky 1 , D. Bonnet 1 1 M3C-Necker—Enfants-Malades, AP—HP, Paris, France 2 Department of Medical informatics, Hôpital Necker—Enfant-Malades, Paris, France ∗ Corresponding author. E-mail address: [email protected] (O. Villemain) Introduction The persisting controversy on the repair of the right outflow tract in common arterial trunk led us to analyze the outcomes of children operated at our institution. Methods We identified 153 children diagnosed with CAT between 2000 and 2017. Six patients died before first surgery and were excluded. Types of CAT were classified according to the modified Van Praagh classification. Results We included 147 patients: CAT A1 (n = 89, 60.6%), CAT A2 (n = 32, 21.7%), CAT A3 (n = 8, 5.4%), and CAT A4 (n = 18, 12.3%). The mean follow-up was 10 ± 4.4 years. Seventeen patients (11.6%) died after surgery. Mean survival was 88.2% at 5 years. Survival of CAT A4 was significantly lower than for other types (65% at 5 years; P < 0.01). In multivariate analysis, quadricuspid truncal valve anatomy (P = 0.02, HR = 3.15, 95% CI [1.1961 to 8.3066]) and bovine xenograft valve conduit for the right ventricle outflow tract (RVOT) repair (P = 0.04, HR = 2.34 [0.8584 to 6.4221]) were the two risk factors for mortality. Seventy-nine patients (53.7%) needed reintervention (surgery or percutaneous). Freedom from reintervention at 5 years was 51.7%. The risk for reintervention was similar in different types of CATs (P = 0.65). The vast majority of reinterventions were done in the RVOT (96.2%). In univariate analysis, the use of bovine xenografts valve conduit (P = 0.047, HR = 1.62 [1.12 to 2.51]) and porcine xenografts (P < 0.01, HR = 2.46 [1.54 to 3.92]) were associated with a higher risk of reinterventions, while autologous connections of the pulmonary artery with the left atrial appendage or pericardial patch were associated with a reduced risk (P < 0.0001, HR = 0.25 [0,1267 to 0,4779]). Conclusion The anatomical type of CAT did not influence the risk for reintervention after repair. Autologous reconstruction of the pulmonary artery with autologous tissue limits the risk for reintervention on the RVOT during childhood. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.300 098
Lessons from prenatal diagnosis and in utero transfer of fetuses with transposition of the great arteries K. Mellul , M. Meot , O. Villemain , Z. Belhadjer , B. Stos , M. Levy , J. Le Bidois , D. Laux , E. Hery , Myriam Bensemlali , F. Bajolle , S. Malekzadeh-Milani , P. Vouhe , O. Raisky , D. Bonnet ∗ Service de Cardiologie Congénitale et Prédiatrique, Hôpital Necker—Enfants-Malades, Paris, France ∗ Corresponding author. E-mail address: [email protected] (D. Bonnet)