{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:25:34Z","timestamp":1769387134943,"version":"3.49.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T00:00:00Z","timestamp":1596067200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T00:00:00Z","timestamp":1596067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Hj\u00e4rt-Lungfonden","doi-asserted-by":"publisher","award":["20160377"],"award-info":[{"award-number":["20160377"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012558","name":"Sk\u00e5ne County Council's Research and Development Foundation","doi-asserted-by":"publisher","award":["629341"],"award-info":[{"award-number":["629341"]}],"id":[{"id":"10.13039\/100012558","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In children with single ventricle physiology, increased pulmonary vascular resistance may impede surgical progression or result in failing single ventricle physiology. The use of pulmonary vasodilators has been suggested as a potential therapy. However, knowledge on indication, dosage, and effect is limited. A retrospective case notes review of all (<jats:italic>n<\/jats:italic>\u2009=\u200936) children with single ventricle physiology, treated with pulmonary vasodilators by the UK Pulmonary Hypertension Service for Children 2004\u20132017. Therapy was initiated in Stage 1 (<jats:italic>n<\/jats:italic>\u2009=\u200912), Glenn (<jats:italic>n<\/jats:italic>\u2009=\u20098), or TCPC (<jats:italic>n<\/jats:italic>\u2009=\u200916). Treatment indications were high mean pulmonary arterial pressure, cyanosis, reduced exercise tolerance, protein-losing enteropathy, ascites, or plastic bronchitis. Average dose of sildenafil was 2.0\u00a0mg\/kg\/day and bosentan was 3.3\u00a0mg\/kg\/day. 56% had combination therapy. Therapy was associated with a reduction of the mean pulmonary arterial pressure from 19 to 14\u00a0mmHg (<jats:italic>n<\/jats:italic>\u2009=\u200917, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Initial therapy with one or two vasodilators was associated with an increase in the mean saturation from 80 to 85%, (<jats:italic>n<\/jats:italic>\u2009=\u200916, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Adding a second vasodilator did not give significant additional effect. 5 of 12 patients progressed from Stage 1 to Glenn, Kawashima, or TCPC, and 2 of 8 from Glenn to TCPC during a mean follow-up time of 4.7\u00a0years (0\u201312.8). Bosentan was discontinued in 57% and sildenafil in 14% of treated patients and saturations remained stable. Pulmonary vasodilator therapy was well tolerated and associated with improvements in saturation and mean pulmonary arterial pressure in children with single ventricle physiology. It appears safe to discontinue when no clear benefit is observed.<\/jats:p>","DOI":"10.1007\/s00246-020-02424-w","type":"journal-article","created":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T14:44:45Z","timestamp":1596120285000},"page":"1651-1659","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Pulmonary Vasodilator Therapy in Children with Single Ventricle Physiology: Effects on Saturation and Pulmonary Arterial Pressure"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5947-4759","authenticated-orcid":false,"given":"Ida","family":"Jeremiasen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Tran-Lundmark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikmah","family":"Idris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phan-Kiet","family":"Tran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahin","family":"Moledina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,30]]},"reference":[{"issue":"14","key":"2424_CR1","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1136\/heartjnl-2015-307467","volume":"102","author":"M Gewillig","year":"2016","unstructured":"Gewillig M, Brown SC (2016) The Fontan circulation after 45 years: update in physiology. Heart 102(14):1081\u20131086","journal-title":"Heart"},{"key":"2424_CR2","first-page":"559","volume-title":"Paediatric cardiology","author":"AFF Choussat","year":"1978","unstructured":"Choussat AFF, Besse P, Vallot F (1978) Selection criteria for Fontan\u00b4s procedure. In: Shinebourne EA, Andersson RH (eds) Paediatric cardiology. Churchill Livingstone, Edinburgh, pp 559\u2013566"},{"issue":"3","key":"2424_CR3","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.ejcts.2006.11.043","volume":"31","author":"RBM Hosein","year":"2007","unstructured":"Hosein RBM, Clarke AJB, McGuirk SP, Griselli M, Stumper O, De Giovanni JV et al (2007) Factors influencing early and late outcome following the Fontan procedure in the current era. The \u2018Two Commandments\u2019? Eur J Cardiol-Thorac Surg. 31(3):344\u2013353","journal-title":"Eur J Cardiol-Thorac Surg."},{"issue":"6","key":"2424_CR4","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1016\/j.jtcvs.2013.02.036","volume":"146","author":"R Henaine","year":"2013","unstructured":"Henaine R, Vergnat M, Mercier O, Serraf A, De Montpreville V, Ninet J et al (2013) Hemodynamics and arteriovenous malformations in cavopulmonary anastomosis: the case for residual antegrade pulsatile flow. J Thorac Cardiovasc Surg 146(6):1359\u20131365","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"3","key":"2424_CR5","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.jtcvs.2012.11.031","volume":"146","author":"R Henaine","year":"2013","unstructured":"Henaine R, Vergnat M, Bacha EA, Baudet B, Lambert V, Belli E et al (2013) Effects of lack of pulsatility on pulmonary endothelial function in the Fontan circulation. J Thorac Cardiovasc Surg 146(3):522\u2013529","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"3","key":"2424_CR6","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/j.healun.2015.01.005","volume":"34","author":"FJ Ridderbos","year":"2015","unstructured":"Ridderbos FJ, Wolff D, Timmer A, van Melle JP, Ebels T, Dickinson MG et al (2015) Adverse pulmonary vascular remodeling in the Fontan circulation. J Heart Lung Transpl 34(3):404\u2013413","journal-title":"J Heart Lung Transpl"},{"issue":"6","key":"2424_CR7","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1136\/hrt.2006.096412","volume":"93","author":"AE Lammers","year":"2007","unstructured":"Lammers AE, Hislop AA, Flynn Y, Haworth SG (2007) Epoprostenol treatment in children with severe pulmonary hypertension. Heart 93(6):739\u2013743","journal-title":"Heart"},{"key":"2424_CR8","doi-asserted-by":"publisher","first-page":"3274","DOI":"10.1161\/CIRCULATIONAHA.104.473371","volume":"111","author":"T Humple","year":"2005","unstructured":"Humple T, Reyes JT, Holtby H, Stephens D, Adatia I (2005) Beneficial effect of oral sildenafil therapy on childhood pulmonary arterial hypertension. Circulation 111:3274\u20133280","journal-title":"Circulation"},{"issue":"1","key":"2424_CR9","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1183\/09031936.00053510","volume":"38","author":"AA Hislop","year":"2010","unstructured":"Hislop AA, Moledina S, Foster H, Schulze-Neick I, Haworth SG (2010) Long-term efficacy of bosentan in treatment of pulmonary arterial hypertension in children. Eur Respir J 38(1):70\u201377","journal-title":"Eur Respir J"},{"issue":"21","key":"2424_CR10","doi-asserted-by":"publisher","first-page":"2037","DOI":"10.1161\/CIR.0000000000000329","volume":"132","author":"SH Abman","year":"2015","unstructured":"Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK et al (2015) Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation 132(21):2037\u20132099","journal-title":"Circulation"},{"issue":"1","key":"2424_CR11","doi-asserted-by":"publisher","first-page":"1801916","DOI":"10.1183\/13993003.01916-2018","volume":"53","author":"EB Rosenzweig","year":"2019","unstructured":"Rosenzweig EB, Abman SH, Adatia I, Beghetti M, Bonnet D, Haworth S et al (2019) Paediatric pulmonary arterial hypertension: updates on definition, classification, diagnostics and management. Eur Respir J 53(1):1801916","journal-title":"Eur Respir J"},{"issue":"9","key":"2424_CR12","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1016\/j.healun.2019.06.022","volume":"38","author":"G Hansmann","year":"2019","unstructured":"Hansmann G, Koestenberger M, Alastalo T-P, Apitz C, Austin ED, Bonnet D et al (2019) 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: the European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT. J Heart Lung Transpl 38(9):879\u2013901","journal-title":"J Heart Lung Transpl"},{"issue":"Suppl 2","key":"2424_CR13","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1136\/heartjnl-2015-309132","volume":"102","author":"G Hansmann","year":"2016","unstructured":"Hansmann G, Apitz C, Abdul-Khaliq H, Alastalo TP, Beerbaum P, Bonnet D et al (2016) Executive summary. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart 102(Suppl 2):86\u2013100","journal-title":"Heart"},{"issue":"3","key":"2424_CR14","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1016\/j.ahj.2004.10.030","volume":"150","author":"K Inai","year":"2005","unstructured":"Inai K, Nakanishi T, Nakazawa M (2005) Clinical correlation and prognostic predictive value of neurohumoral factors in patients late after the Fontan operation. Am Heart J 150(3):588\u2013594","journal-title":"Am Heart J"},{"issue":"1","key":"2424_CR15","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.ijcard.2011.02.021","volume":"159","author":"H Ishida","year":"2012","unstructured":"Ishida H, Kogaki S, Ichimori H, Narita J, Nawa N, Ueno T et al (2012) Overexpression of endothelin-1 and endothelin receptors in the pulmonary arteries of failed Fontan patients. Int J Cardiol 159(1):34\u201339","journal-title":"Int J Cardiol"},{"issue":"11","key":"2424_CR16","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1161\/CIRCULATIONAHA.110.981746","volume":"123","author":"DJ Goldberg","year":"2011","unstructured":"Goldberg DJ, French B, McBride MG, Marino BS, Mirarchi N, Hanna BD et al (2011) Impact of oral sildenafil on exercise performance in children and young adults after the fontan operation: a randomized, double-blind, placebo-controlled, crossover trial. Circulation 123(11):1185\u20131193","journal-title":"Circulation"},{"key":"2424_CR17","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.ijcard.2016.06.322","volume":"221","author":"H Mori","year":"2016","unstructured":"Mori H, Park IS, Yamagishi H, Nakamura M, Ishikawa S, Takigiku K et al (2016) Sildenafil reduces pulmonary vascular resistance in single ventricular physiology. Int J Cardiol 221:122\u2013127","journal-title":"Int J Cardiol"},{"issue":"Suppl","key":"2424_CR18","doi-asserted-by":"publisher","first-page":"S26","DOI":"10.1536\/ihj.14-392","volume":"56","author":"IS Park","year":"2015","unstructured":"Park IS (2015) Efficacy of pulmonary vasodilator therapy in patients with functionally single ventricle. Int Heart J 56(Suppl):S26\u201330","journal-title":"Int Heart J"},{"issue":"6","key":"2424_CR19","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1016\/j.jtcvs.2017.01.051","volume":"153","author":"G Agnoletti","year":"2017","unstructured":"Agnoletti G, Gala S, Ferroni F, Bordese R, Appendini L, Pace Napoleone C et al (2017) Endothelin inhibitors lower pulmonary vascular resistance and improve functional capacity in patients with Fontan circulation. J Thorac Cardiovasc Surg 153(6):1468\u20131475","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"8","key":"2424_CR20","doi-asserted-by":"publisher","first-page":"552","DOI":"10.2459\/JCM.0b013e328361390a","volume":"16","author":"R Giordano","year":"2015","unstructured":"Giordano R, Palma G, Poli V, Palumbo S, Russolillo V, Cioffi S et al (2015) First experience with sildenafil after Fontan operation: short-term outcomes. J Cardiovasc Med (Hagerstown) 16(8):552\u2013555","journal-title":"J Cardiovasc Med (Hagerstown)"},{"issue":"5","key":"2424_CR21","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1017\/S1047951110000648","volume":"20","author":"Z Reinhardt","year":"2010","unstructured":"Reinhardt Z, Uzun O, Bhole V, Ofoe V, Wilson D, Onuzo O et al (2010) Sildenafil in the management of the failing Fontan circulation. Cardiol Young 20(5):522\u2013525","journal-title":"Cardiol Young"},{"issue":"2","key":"2424_CR22","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1111\/chd.12570","volume":"13","author":"LS Kverneland","year":"2018","unstructured":"Kverneland LS, Kramer P, Ovroutski S (2018) Five decades of the Fontan operation: a systematic review of international reports on outcomes after univentricular palliation. Congenit Heart Dis 13(2):181\u2013193","journal-title":"Congenit Heart Dis"},{"issue":"2 Suppl","key":"2424_CR23","doi-asserted-by":"publisher","first-page":"S57","DOI":"10.1097\/PCC.0b013e3181d10cce","volume":"11","author":"TM Giglia","year":"2010","unstructured":"Giglia TM, Humpl T (2010) Preoperative pulmonary hemodynamics and assessment of operability: is there a pulmonary vascular resistance that precludes cardiac operation? Pediatr Crit Care Med 11(2 Suppl):S57\u201369","journal-title":"Pediatr Crit Care Med"},{"issue":"8","key":"2424_CR24","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1055\/s-0030-1250124","volume":"58","author":"Y Zongtao","year":"2010","unstructured":"Zongtao Y, Huishan W, Zengwei W, Hongyu Z, Minhua F, Xinmin L et al (2010) Experimental study of nonpulsatile flow perfusion and structural remodeling of pulmonary microcirculation vessels. Thorac Cardiovasc Surg 58(8):468\u2013472","journal-title":"Thorac Cardiovasc Surg"},{"issue":"2","key":"2424_CR25","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1067\/mtc.2002.119697","volume":"123","author":"M L\u00e9vy","year":"2002","unstructured":"L\u00e9vy M, Danel C, Tamisier D, Vouh\u00e9 P, Leca F (2002) Histomorphometric analysis of pulmonary vessels in single ventricle for better selection of patients for the Fontan operation. J Thorac Cardiovasc Surg 123(2):263\u2013270","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"4","key":"2424_CR26","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1016\/j.athoracsur.2004.02.131","volume":"78","author":"K Maeda","year":"2004","unstructured":"Maeda K, Yamaki S, Kado H, Asou T, Murakami A, Takamoto S (2004) Reevaluation of histomorphometric analysis of lung tissue in decision making for better patient selection for Fontan-type operations. Ann Thorac Surg 78(4):1371\u20131381","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"2424_CR27","doi-asserted-by":"publisher","first-page":"e12314","DOI":"10.1111\/1755-5922.12314","volume":"36","author":"B Castaldi","year":"2018","unstructured":"Castaldi B, Bordin G, Padalino M, Cuppini E, Vida V, Milanesi O (2018) Hemodynamic impact of pulmonary vasodilators on single ventricle physiology. Cardiovasc Ther 36(1):e12314","journal-title":"Cardiovasc Ther"},{"issue":"2","key":"2424_CR28","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/j.1747-0803.2008.00237.x","volume":"4","author":"GS Morchi","year":"2009","unstructured":"Morchi GS, Ivy DD, Duster MC, Claussen L, Chan KC, Kay J (2009) Sildenafil increases systemic saturation and reduces pulmonary artery pressure in patients with failing Fontan physiology. Congenit Heart Dis 4(2):107\u2013111","journal-title":"Congenit Heart Dis"},{"issue":"4","key":"2424_CR29","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1017\/S1047951109990023","volume":"19","author":"C Ovaert","year":"2009","unstructured":"Ovaert C, Thijs D, Dewolf D, Ottenkamp J, Dessy H, Moons P et al (2009) The effect of bosentan in patients with a failing Fontan circulation. Cardiol Young 19(4):331\u2013339","journal-title":"Cardiol Young"},{"issue":"4","key":"2424_CR30","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1007\/s11596-016-1621-8","volume":"36","author":"XK Shang","year":"2016","unstructured":"Shang XK, Lu R, Zhang X, Zhang CD, Xiao SN, Liu M et al (2016) Efficacy of Bosentan in patients after Fontan procedures: a double-blind, randomized controlled trial. J Huazhong Univ Sci Technol Med Sci = Hua zhong ke ji da xue xue bao Yi xue Ying De wen ban = Huazhong keji daxue xuebao Yixue Yingdewen ban. 36(4):534\u2013540","journal-title":"J Huazhong Univ Sci Technol Med Sci = Hua zhong ke ji da xue xue bao Yi xue Ying De wen ban = Huazhong keji daxue xuebao Yixue Yingdewen ban."},{"issue":"2","key":"2424_CR31","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.jtcvs.2010.03.023","volume":"140","author":"K Hirono","year":"2010","unstructured":"Hirono K, Yoshimura N, Taguchi M, Watanabe K, Nakamura T, Ichida F et al (2010) Bosentan induces clinical and hemodynamic improvement in candidates for right-sided heart bypass surgery. J Thorac Cardiovasc Surg 140(2):346\u2013351","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2424_CR32","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.healun.2017.09.008","volume":"37","author":"SS Handler","year":"2017","unstructured":"Handler SS, Ogawa MT, Hopper RK, Sakarovitch C, Feinstein JA (2017) Subcutaneous treprostinil in pediatric patients with failing single-ventricle physiology. J Heart Lung Transpl 37:306","journal-title":"J Heart Lung Transpl"},{"key":"2424_CR33","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1161\/CIRCULATIONAHA.119.044352","volume":"141","author":"DJ Goldberg","year":"2019","unstructured":"Goldberg DJ et al (2019) Results of the Fontan Udenafil Exercise Longitudinal (FUEL) Trial. Circulation 141:641\u2013651","journal-title":"Circulation"},{"issue":"9815","key":"2424_CR34","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/S0140-6736(11)61621-8","volume":"379","author":"RMF Berger","year":"2012","unstructured":"Berger RMF, Beghetti M, Humpl T, Raskob GE, Ivy DD, Jing Z-C et al (2012) Clinical features of paediatric pulmonary hypertension: a registry study. Lancet 379(9815):537\u2013546","journal-title":"Lancet"},{"issue":"12","key":"2424_CR35","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1164\/rccm.201406-1052OC","volume":"190","author":"MJDC Mar\u00edn","year":"2014","unstructured":"Mar\u00edn MJDC, Rot\u00e9s AS, Ogando AR, Soto AM, Jim\u00e9nez MQ, Camacho JLG et al (2014) Assessing pulmonary hypertensive vascular disease in childhood. Data from the Spanish Registry. Am J Respir Crit Care Med 190(12):1421\u20131429","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"2424_CR36","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1183\/13993003.00907-2015","volume":"46","author":"JL Vachiery","year":"2015","unstructured":"Vachiery JL, Rubin LJ (2015) Navigating the uncharted waters of combination therapy in pulmonary arterial hypertension: COMPASS or dead-reckoning. Eur Respir J 46(2):297\u2013298","journal-title":"Eur Respir J"},{"issue":"1","key":"2424_CR37","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1186\/s12931-019-1180-1","volume":"20","author":"RJ White","year":"2019","unstructured":"White RJ, Vonk-Noordegraaf A, Rosenkranz S, Oudiz RJ, McLaughlin VV, Hoeper MM et al (2019) Clinical outcomes stratified by baseline functional class after initial combination therapy for pulmonary arterial hypertension. Respir Res 20(1):208","journal-title":"Respir Res"}],"container-title":["Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-020-02424-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00246-020-02424-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-020-02424-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T23:17:41Z","timestamp":1627600661000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00246-020-02424-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,30]]},"references-count":37,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["2424"],"URL":"https:\/\/doi.org\/10.1007\/s00246-020-02424-w","relation":{},"ISSN":["0172-0643","1432-1971"],"issn-type":[{"value":"0172-0643","type":"print"},{"value":"1432-1971","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,30]]},"assertion":[{"value":"1 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with Ethical Standards"}},{"value":"All the authors declared that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by an institutional review board, and consent was waived due to the retrospective nature of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}}]}}