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BMC Pharmacol Toxicol 2018 Dec 29;19(1):88. Epub 2018 Dec 29.

Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, 44307, Kaunas, LT, Lithuania.

Background: Amiodarone is an antiarrhythmic drug which is used to treat and prevent several dysrhythmias. This includes ventricular tachycardia and fibrillation, wide complex tachycardia, as well as atrial fibrillation (AF) and paroxysmal supraventricular tachycardia. Amiodarone may prove to be the agent of choice where the patient is hemodynamically unstable and unsuitable for direct current (DC) cardioversion. Read More

J Cardiovasc Electrophysiol 2018 Dec 21. Epub 2018 Dec 21.

St. Vincent Medical Group, Indianapolis, Indiana.

A 15-year-old girl with a history of paroxysmal supraventricular tachycardia underwent an electrophysiology study (EPS) for diagnosis and ablation. Her baseline electrocardiogram and echocardiogram were normal. At EPS, she had dual atrioventricular nodal (AVN) conduction, but isoproterenol was needed to initiate the slow-fast form of AVN reentry. Read More

Medicine (Baltimore) 2018 Dec;97(50):e13629

Department of Neurology, The Second Hospital of Jilin University, Changchun, China.

Rationale: Co-occurrence of headache and arrhythmia is not rare. However, their causal relationship remains unclear. Here, we described a case of migraine-like headache relieving with pacemaker implantation. Read More

Saudi J Anaesth 2018 Oct-Dec;12(4):521-528

Department Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.

Purpose: The present study aimed to compare the demographic, medical history, clinical features, and treatment management of paroxysmal supraventricular tachycardia (PSVT) in the emergency department of a teaching hospital in Riyadh, Saudi Arabia. A secondary purpose was to evaluate Adenosine response among numerous variables that might be used as predictors of the conversion.

Methods: All PSVT cases presented to the Department of Emergency Medicine at King Khalid University Hospital, during the period from January 1, 2016, until December 31, 2016, were included in the study. Read More

Case Rep Emerg Med 2018 23;2018:1387207. Epub 2018 Sep 23.

Cardiology Department, Changi General Hospital, Singapore.

The first-line recommended treatment for stable paroxysmal supraventricular tachycardia (PSVT) is the use of vagal maneuvers. Often the Valsalva maneuver is conducted. We describe two patients who converted to sinus rhythm without complications, using a head down deep breathing (HDDB) technique. Read More

Geriatr Gerontol Int 2018 Oct;18(10):1520-1521

Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Oxf Med Case Reports 2018 Oct 10;2018(10):omy064. Epub 2018 Sep 10.

Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania.

We present the case of a 14-year-old female patient with recurrent episodes of paroxysmal supraventricular tachycardia (PSVT). Her ECG showed a PR interval of 160 ms in lead II, and a delta wave pattern in leads V2 and V3, with a normal QRS interval of 100 ms. We analyzed the three criteria for confirmation of minimal pre-excitation: (i) absence of a Q wave in V6; (ii) presence of an R wave in V1 and (iii) absence of an R wave in avR. Read More

J Cardiovasc Electrophysiol 2019 Jan 22;30(1):78-88. Epub 2018 Oct 22.

Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.

Introduction: Fluoroscopy use during catheter ablation procedures increases the cumulative lifetime radiation exposure of patients and operators, potentially leading to a higher risk of cancer and radiation-related injuries. Nonfluoroscopic ablation (NFA) has been described for supraventricular tachycardia, typical atrial flutter, paroxysmal atrial fibrillation (AF), and outflow-tract ventricular tachycardia (VT). Complete transition to NFA of more complex arrhythmias, including persistent AF, left atrial (LA) flutter, and structural VT, has not been previously described. Read More

Ann Med 2018 Oct 15:1-9. Epub 2018 Oct 15.

a Center for Primary Health Care Research, Lund University/Region Skåne , Malmö , Sweden.

Introduction: The hospitalization rate of paroxysmal supraventricular tachycardia (PSVT) in a nationwide study is not established. We determined age- and sex-specific hospitalization rates and time trends for hospitalized PSVT in the Swedish population between 1987 and 2010.

Methods: This nationwide study is based on the Swedish Hospital Discharge Register. Read More

Turk J Emerg Med 2018 Sep 13;18(3):131-133. Epub 2018 Apr 13.

Sisli Hamidiye Etfal Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of reentrant paroxysmal supraventricular tachycardia that occurs in the presence of dual AV nodal physiology. Wolff-Parkinson-White (WPW) syndrome is another type of supraventricular tachycardia characterized by short PR intervals, delta waves and wide QRS complexes on the surface electrocardiogram (ECG), reflecting atrioventricular pre-excitation. Uncommonly, AV nodal reentry and accessory pathways can coexist. Read More

Zhonghua Xin Xue Guan Bing Za Zhi 2018 Aug;46(8):617-621

Cardiology Department of First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.

To evaluate the efficacy and safety of three-dimensional electroanatomical mapping system for catheter ablation of paroxysmal supraventricular tachycardiain (PSVT) children. Clinical data from 187 children with paroxysmal supraventricular tachycardia undergoing radiofrequency catheter ablation in our department between January 2012 and April 2016 were analyzed. Among the patients, 91 cases were treated with traditional two-dimensional X-ray radiofrequency ablation, 96 cases were treated with radiofrequency ablation guided by three-dimensional electroanatomical mapping system. Read More

Herz 2018 Aug 20. Epub 2018 Aug 20.

Pasteur Institute of Tunis, University of Tunis El Manar and Genomics Platform, Tunis, Tunisia.

Objectives: Little is known about cardiac involvement in m.3243A>G variant carriers. Thus, this study aimed to assess type and frequency of cardiac disease in symptomatic and asymptomatic m. Read More

Heart Rhythm 2018 Aug 18. Epub 2018 Aug 18.

Heart Rhythm Management Center, Postgraduate Course in Clinical EP and Pacing, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address:

Background: The second-generation cryoballoon (CB) is effective in achieving pulmonary vein isolation. Continuous monitoring would eliminate any over- or underestimated freedom from atrial fibrillation (AF) postablation.

Objective: The purpose of this study was to differentiate between arrhythmias occurring after cryoballoon ablation (CBA), detecting true AF in symptomatic patients and detecting silent subclinical AF. Read More

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2018 Jun;43(6):604-609

Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.

Objective: To explore the safety and efficacy for radiofrequency ablation of paroxysmal supraventricular tachycardia (PSVT) guided by Carto Univu three-dimensional mapping system.
 Methods: A total of 99 patients with PSVT underwent radiofrequency catheter ablation (RFCA) were assigned to a Carto Univu group (51 patients) and a two-dimensional X-ray group (48 patients) according to the mapping method. The operation time, X-ray exposure time, X-ray exposure dose, dose area product (DAP), operation success rate and complication rate were compared between the two groups. Read More

Hepatol Commun 2018 Aug 6;2(8):884-892. Epub 2018 Aug 6.

Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Suita Japan.

Combination treatment of ledipasvir and sofosbuvir (LDV/SOF) is first-line treatment for patients with chronic hepatitis C genotype 1 in the United States, Europe, and Japan. However, the influence of LDV/SOF on the cardiovascular system is poorly characterized. A total of 470 chronic hepatitis C patients who started LDV/SOF treatment between September 2015 and February 2016 at nine hospitals in Japan were prospectively enrolled in this study. Read More

J Am Coll Cardiol 2018 Jul;72(5):498-500

Electrophysiology Program, Penn State University Heart and Vascular Institute, Penn State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania.

J Am Coll Cardiol 2018 Jul;72(5):489-497

Milestone Pharmaceuticals, Montreal St.-Laurent, Quebec, Canada. Electronic address:

Background: There is no nonparenteral medication for the rapid termination of paroxysmal supraventricular tachycardia.

Objectives: The purpose of this study was to assess the efficacy and safety of etripamil nasal spray, a short-acting calcium-channel blocker, for the rapid termination of paroxysmal supraventricular tachycardia (SVT).

Methods: This phase 2 study was performed during electrophysiological testing in patients with previously documented SVT who were induced into SVT prior to undergoing a catheter ablation. Read More

J Am Heart Assoc 2018 Jul 7;7(14). Epub 2018 Jul 7.

Division of Research, Kaiser Permanente Northern California, Oakland, CA.

Background: Contemporary data about symptomatic paroxysmal supraventricular tachycardia (PSVT) epidemiology are limited. We characterized prevalence and correlates of symptomatic PSVT within a large healthcare delivery system and estimated national PSVT burden.

Methods And Results: We identified adults with an encounter for potential PSVT between 2010 and 2015 in Kaiser Permanente Northern California, excluding those with prior known atrial fibrillation or atrial flutter. Read More

Pacing Clin Electrophysiol 2018 09 26;41(9):1123-1128. Epub 2018 Jul 26.

School of Medicine, Tsinghua University & Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Beijing, China.

Background: Radiofrequency catheter ablation (RFCA) in the septum close to the atrioventricular node or His bundle has an increased risk of irreversible complications. Cryothermal energy has the advantages of reversible cryomapping and increased catheter stability. The study aims to evaluate the efficacy and safety of cryoablation of the right anteroseptal or midseptal accessory pathways (APs) in pediatric patients. Read More

East Asian Arch Psychiatry 2018 Jun;28(2):68-70

Department of Psychiatry, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea.

Clozapine is considered to be more effective than other antipsychotic drugs for treating treatmentresistant schizophrenia. However, side effects of clozapine include agranulocytosis and, less commonly, cardiovascular disease, which is occasionally fatal. We describe a 56-year-old woman who developed clozapine-related paroxysmal supraventricular tachycardia during clozapine dose titration and had a recurrence despite being treated with verapamil. Read More

G Ital Cardiol (Rome) 2018 Apr;19(4):222-231

Reparto di Cardiologia, Città di Lecce Hospital, GVM Care&Research, Lecce.

The atrioventricular (AV) node is an anatomically well-defined structure, conveniently housed in the triangle of Koch. There are two distinct atrial impulse approaches to the AV node, one of which (in the anterior portion of triangle of Koch) has a faster conduction, while the other one (in the posterior portion) has a slower conduction. However, it is not said that such a conductive duality translates into any arrhythmic phenomena. Read More

Proc (Bayl Univ Med Cent) 2018 Jul 9;31(3):328-330. Epub 2018 May 9.

Department of Cardiology, State University of New York Upstate Medical University, Syracuse, New York.

Flecainide, a class Ic antiarrhythmic, is used for the prevention of paroxysmal supraventricular tachycardia, paroxysmal atrial fibrillation/flutter, and sustained ventricular tachycardia. Flecainide is primarily metabolized by the liver and to a lesser extent (30%) is excreted unchanged in the kidney. We present a case of flecainide toxicity in the setting of renal impairment that was successfully treated with intravenous sodium bicarbonate. Read More

J Interv Card Electrophysiol 2018 May 15. Epub 2018 May 15.

Department of Electrophysiology, Electrophysiology Center Bremen, Senator-Weßling-Str. 1, 28277, Bremen, Germany.

Purpose: Radiofrequency current energy (RFC) ablation is still considered as the gold standard for atrioventricular nodal reentrant tachycardia (AVNRT). Success-rates for AVNRT ablation vary irrespective of the ablation technology and strategy. This study aimed to access safety, efficacy, and long-term outcome of RFC catheter ablation for the treatment of AVNRT in children and adolescents aged < 19 years with special focus on modulation versus ablation of the AV nodal slow pathway (SP). Read More

Anesth Analg 2018 Apr 11. Epub 2018 Apr 11.

Division of Cardiology, Veterans Affairs Portland Health Care System, Portland, Oregon.

Background: Dexmedetomidine (Dex) is an attractive agent for procedural sedation due to its unique pharmacodynamic profile, specifically affording predictable sedation without concurrent respiratory depression. However, Dex has previously been reported to prevent or terminate arrhythmias. The purpose of this study was to investigate paroxysmal supraventricular tachycardia (PSVT) inducibility and homeostatic stability during electrophysiology studies (EPSs) and ablation when a standardized Dex protocol was used as the primary sedation agent. Read More

Cardiovasc Drugs Ther 2018 04;32(2):169-173

Department of Invasive Cardiology and Cardiac Arrhythmias, University Clinical Hospital Military Memorial Medical Academy - Central Veterans' Hospital in Lodz, Żeromskiego 113, 90-549, Łódź, Poland.

Purpose: Antazoline is a first-generation antihistaminic agent with additional anticholinergic properties and antiarrhythmic potential. Recent data shows its high effectiveness in sinus rhythm restoration among patients with paroxysmal atrial fibrillation. The effect of antazoline on electrophysiological parameters of the heart in vivo has not yet been examined. Read More

Georgian Med News 2018 Feb(Issue):58-60

Jo Ann Medical Center; David Tvildiani Medical University, Tbilisi, Georgia; Hospital Clinic, University of Barcelona, Spain.

The aim of the study was to investigate the influence of catheter ablation of paroxysmal supraventricular tachycardia on patients' anxiety levels. We investigated 70 consecutive patients with paroxysmal supraventricular tachycardia (AV Nodal Reentrant Tachycardia (AVNRT), AV Reentrant Tachycardia (AVRT) or Atrial Tachycardia (AT)) who underwent a catheter ablation. The patients filled out the State and Trait Anxiety Inventory (STAI) before the ablation on the day of the procedure and after 3 months of a successful catheter ablation. Read More

Georgian Med News 2018 Feb(Issue):54-57

Jo Ann Medical Center; David Tvildiani Medical University, Tbilisi, Georgia; Hospital Clinic, University of Barcelona, Spain.

The aim of the study was to investigate the effect of catheter ablation on different aspects of health-related quality of life in association with patients' age, gender and the type of paroxysmal supraventricular tachycardia. We investigated 70 consecutive patients with paroxysmal supraventricular tachycardia (AV Nodal Reentrant Tachycardia (AVNRT), AV Reentrant Tachycardia (AVRT) or Atrial Tachycardia (AT)) who underwent a catheter ablation. The patients were asked to fill out the short form (SF-36) health questionnaire before the ablation on the day of the procedure and after 3 months of a successful catheter ablation and eight health concept scores (1. Read More

J Dermatol 2018 Oct 22;45(10):e275-e276. Epub 2018 Mar 22.

Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Anatol J Cardiol 2018 Apr 13;19(4):E7. Epub 2018 Mar 13.

Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey.

Heart Lung 2018 May - Jun;47(3):237-242. Epub 2018 Feb 14.

Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Pradnicka 80, Kraków, Poland. Electronic address:

Background: Right atrial (RA) enlargement is a common finding in patients with pulmonary arterial hypertension (PAH) and an important predictor of mortality, however its relation to the risk of atrial arrhythmias has not been assessed.

Objectives: To assess whether RA enlargement is associated with supraventricular arrhythmias (SVA) and whether it predicts new clinically significant SVA (csSVA).

Methods: Patients with PAH were recruited between January 2010 and December 2014 and followed until January 2017. Read More

J Neurol 2018 Apr 10;265(4):885-895. Epub 2018 Feb 10.

Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.

Cardiac conduction and/or rhythm abnormalities (CCRA) are the most frequent and life-threatening complications in DM1. In order to determine prevalence, incidence, characteristics, age of onset and predictors of CCRA, CCRA progression and sudden cardiac death (SCD) in DM1, we collected ECG/24hECG-Holter data from a yearly updated 34-year database of a cohort of 103 DM1 patients without cardiac abnormalities at baseline, followed for at least 1 year. Fifty-five patients developed CCRA [39 developed conduction abnormalities (CCA) and 16 rhythm abnormalities (CRA)], which progressed in 22. Read More

Eur J Hum Genet 2018 05 2;26(5):660-668. Epub 2018 Feb 2.

Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark.

Atrioventricular nodal reentry tachycardia (AVNRT) is the most common form of regular paroxysmal supraventricular tachycardia. This arrhythmia affects women twice as frequently as men, and is often diagnosed in patients <40 years of age. Familial clustering, early onset of symptoms and lack of structural anomaly indicate involvement of genetic factors in AVNRT pathophysiology. Read More

Medicine (Baltimore) 2017 Dec;96(51):e9210

Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.

This study aimed to evaluate the relationship between serum transforming growth factor-β1 (TGF-β1) concentration and atrial fibrosis and to determine whether plasma TGF-β1 concentration is an independent predictor of atrial fibrillation (AF) recurrence after catheter ablation.We included 98 consecutive patients who underwent catheter ablation, including 38 with paroxysmal AF (AF group) and 60 with paroxysmal supraventricular tachycardia (control group). We compared their preablation serum concentration of biomarkers and clinical and echocardiographic findings. Read More

Zhonghua Er Ke Za Zhi 2018 Jan;56(1):13-18

Heart Center, Division of Pediatric Cardiology, First Hospital of Tsinghua University, Beijing 100016, China.

The study assessed the clinical characteristics and response to acute intravenous antiarrhythmic drug therapy of supraventricular tachycardia (SVT) in children. This was a multicenter prospective descriptive study including 257 children from First Hospital of Tsinghua University, Peking University First Hospital, Children's Hospital Affiliated to Capital Institute of Pediatrics and Beijing Anzhen Hospital who received intravenous antiarrhythmic drug therapy for SVT from July 2014 to February 2017. The clinical and tachycardia features, response to intravenous antiarrhythmic drug therapy of these children were characterized. Read More

J Int Med Res 2018 Mar 11;46(3):1271-1276. Epub 2018 Jan 11.

1 Department of Cardiology, First Affiliated Hospital, 26441 School of Medicine, Zhejiang University , Hangzhou, Zhejiang Province, China.

A 54-year-old Chinese woman presented with a 10-year history of repeated paroxysmal palpitations. She was diagnosed with paroxysmal supraventricular tachycardia by 12-lead electrocardiogram and was advised to undergo catheter-based radiofrequency ablation. During the procedure, a rare complication occurred that was diagnosed as a right internal mammary artery penetrating injury. Read More

PLoS One 2018 5;13(1):e0187895. Epub 2018 Jan 5.

Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.

Aim: To investigate the influence of increasing age on clinical presentation, treatment and long-term outcome in patients with inducible paroxysmal supraventricular tachycardia (SVT) without pre-excitation syndromes.

Methods: Clinical and electrophysiological study (EPS) data, as well as long-term clinical outcome (mean follow-up 2.4±4. Read More

Kardiologiia 2017 SJan;57(S1):345-354

Federal State Budgetary Educational Institution of Higher Education "Kuban State Medical University" of the Ministry of Health of the Russian Federation.

Aim: To determine efficacy of bisoprolol and sotalol treatments in patients with paroxysmal supraventricular tachycardia (SVT) and essential hypertension (EH) considering effects of these treatments on the regulatory adaptive status (RAS).

Materials And Methods: The study included 49 patients with paroxysmal SVT associated with stage II-III EH randomized to two groups of either bisoprolol (6.9±2. Read More

Tex Heart Inst J 2017 Oct 1;44(5):306-311. Epub 2017 Oct 1.

We studied the predictors and patterns of high-sensitivity cardiac troponin T (hs-cTnT) elevation in patients with paroxysmal supraventricular tachycardia (PSVT) in the presence and absence of ischemic heart disease. During calendar year 2013, we enrolled 70 of 72 consecutive adult patients with PSVT who presented at our center within 4 hours after the onset of tachycardia. On the basis of increased hs-cTnT at either of 2 initial measurements, we divided patients into groups (hs-cTnT-positive and hs-cTnT-negative), to study the predictors of enzyme elevation. Read More

J Atr Fibrillation 2016 Dec 31;9(4):1506. Epub 2016 Dec 31.

This essay is a brief review of advances in treatment of patients with supraventricular tachycardia (SVT) over the past 55 years. We review the knowledge base available in terms of arrhythmia diagnosis and the limited availability of drug therapy. Significant advances resulted in the introduction of direct-current defibrillators as well as introduction of ambulatory ECG recordings. Read More

J Geriatr Cardiol 2017 Oct;14(10):652-653

Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik hospital, Busan, South Korea.

Heart Rhythm 2017 12;14(12):1896-1897

Cardiovascular Research Institute, Maastricht, The Netherlands. Electronic address:

Int J Cardiol 2018 Feb 14;252:106-109. Epub 2017 Nov 14.

Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Background: The upside-down position is a little known modified Valsalva manoeuvre (VM). The aim of this study was to investigate the safety and the efficacy of the upside-down position for the treatment of paroxysmal SVT in children.

Methods: Twenty-four paediatric patients followed for SVT were enrolled. Read More

Zhonghua Xin Xue Guan Bing Za Zhi 2017 Nov;45(11):935-939

First Affiliated Hospital of Dalian Medical University, Dalian 116000, China.

To compare the outcome of radiofrequency catheter ablation under local anesthesia/sedation (S) or general anesthesia(GA) in atrial fibrillation patients. Data of 498 patients with atrial fibrillation undergoing radiofrequency catheter ablation in our departmentfrom January 2014 to December 2015 were retrospectively analyzed. Two hundred and twenty patients assigned to the GA group, the other 278 patients to the S group. Read More

PLoS One 2017 16;12(11):e0188326. Epub 2017 Nov 16.

Yonsei University Health System, Seoul, Republic of Korea.

Introduction: The ablation gaps have been known as the main mechanism of recurrence as atrial tachycardia (AT) rather than atrial fibrillation (AF) after AF catheter ablation. However, AF organization due to reduction of critical mass or focal trigger may also be the mechanism of AT recurrence. We sought to find out the main clinical factors of recurrence as AT rather than AF after AF ablation in the absence of antiarrhythmic drug effect. Read More

J Interv Card Electrophysiol 2017 Nov 13;50(2):141-147. Epub 2017 Nov 13.

Department of Cardiovascular Medicine, Staten Island University Hospital, 475 Seaview Ave., New York, 10305, USA.

Purpose: Paroxysmal supraventricular tachycardia (PSVT) ablation can result in injury to the atrioventricular (AV) node causing complete heart block requiring permanent pacemaker (PPM) implantation. Few studies have examined the impact of hospital PSVT ablation volume and PPM implantation rates post ablation.

Methods: We included adult patients from the Nationwide Inpatient Sample (NIS) database, from 1998 to 2011, using ICD-9 diagnoses codes 427. Read More

J Korean Med Sci 2017 Dec;32(12):2069-2072

Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea.

Congenital cardiovascular anomalies, such as dextrocardia, persistent left superior vena cava (SVC), and pulmonary artery (PA) sling, are rare disorders. These congenital anomalies can occur alone, or coincide with other congenital malformations. In the majority of cases, congenital anomalies are detected early in life by certain signs and symptoms. Read More