51
|
Catena G, Rempel GR, Kovacs AH, Rankin KN, Muhll IV, Mackie AS. "Not such a kid thing anymore": Young adults' perspectives on transfer from paediatric to adult cardiology care. Child Care Health Dev 2018; 44:592-598. [PMID: 29574895 DOI: 10.1111/cch.12564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Transfer of adolescents with congenital heart disease from paediatric cardiology providers to specialized adult congenital heart disease (ACHD) care providers is becoming a standard practice. However, some paediatric cardiologists continue to provide care for their patients into adult life. Little is known about the perspectives of young adult patients who have been transferred to ACHD clinics versus those who continue to receive their cardiology care in paediatric settings. METHODS Content and thematic analysis of structured telephone interviews with 21 young adults age 18-25 (13 transferred to ACHD clinic and 8 who had not transferred) was conducted to identify similarities and differences in patient characteristics of those in ACHD versus paediatric settings. RESULTS There were no appreciable differences in gender, age, heart disease type, and independence between those transferred to ACHD care versus those not transferred. Participants in both groups were aware of differences between the paediatric and ACHD care settings and providers, with some favouring the familiarity offered by the paediatric setting and providers. Participants had varying views on parental involvement in their care; most of them had attended clinic appointments on their own. Those who had transferred to ACHD care acknowledged that it would take time to adjust to new relationships. Positive perspectives on actual or anticipated transfer to ACHD care included a growing sense of autonomy and responsibility, as well as access to reproductive information relevant to ACHD patients. CONCLUSIONS The absence of patient characteristics distinguishing those in ACHD care versus those still followed in paediatric care suggests that system, provider, and parent factors, rather than patient factors, may account for patients' perspectives on transfer to ACHD care.
Collapse
Affiliation(s)
- G Catena
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - G R Rempel
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - A H Kovacs
- Peter Munk Cardiac Centre, Toronto Congenital Cardiac Centre for Adults, University of Toronto, Toronto, ON, Canada
| | - K N Rankin
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - I V Muhll
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - A S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Division of Cardiology, Stollery Children's Hospital, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
52
|
El-Harasis MA, Connolly HM, Miranda WR, Qureshi MY, Sharma N, Al-Otaibi M, DeSimone CV, Egbe A. Progressive right ventricular enlargement due to pulmonary regurgitation: Clinical characteristics of a "low-risk" group. Am Heart J 2018; 201:136-140. [PMID: 29793063 DOI: 10.1016/j.ahj.2018.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal interval between serial cardiac magnetic resonance imaging (CMRI) scans for monitoring right ventricular (RV) enlargement in the setting of severe pulmonic valve regurgitation (PR) is unknown. The purposes of this study were to (1) determine the annual change in RV volume on serial CMRI scans and (2) identify the risk factors for rapid progression of RV enlargement. METHODS A retrospective study of adults with postintervention native valve PR and ≥2 CMRI scans at Mayo Clinic Rochester from 2000 to 2015 was conducted. Rapid progression of RV enlargement was defined as first upper quartile of annual increase in RV end-diastolic volume index (RVEDVi) for the cohort. RESULTS Of the 63 patients (age, 36 ± 9 years) in the study, 43 (68%) had tetralogy of Fallot, whereas 20 (32%) had valvular pulmonic stenosis. Right ventricular outflow tract interventions that resulted in PR were balloon pulmonary valvuloplasty (n = 4; 7%), transannular patch repair (n = 30; 58%), and nontransannular patch repair (n = 18; 35%). Interval between baseline and second CMRI was 2 (1-4) years. In comparison to baseline CMRI, RVEDVi increased from 130 (109-141) to 135 (126-155) mL/m2 and median annual change in RVEDVi was 3.1 (1.7-5.9) mL/m2. Univariate risk factors for rapid progression of RV enlargement (annual increase in RVEDVi >6 mL/m2) were ≥moderate tricuspid regurgitation and RVEDVi >130 mL/m2. Among the 24 patients without these risk factors (low-risk subgroup), RVEDVi increased by only 3 (0-7) mL/m2 over 7 (5-9) years. CONCLUSIONS Patients with PR without RVEDVi >130 mL/m2 and/or ≥moderate tricuspid regurgitation represent a low-risk subgroup that may be appropriate for clinical and echo follow-up but may potentially require infrequent CMRI follow-up.
Collapse
Affiliation(s)
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Nandini Sharma
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Alexander Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
53
|
Warnes CA. Adult congenital heart disease: the challenges of a lifetime. Eur Heart J 2018; 38:2041-2047. [PMID: 28011704 DOI: 10.1093/eurheartj/ehw529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
The growing population of adults with congenital heart disease (CHD) poses challenges for cardiac surgeons, general cardiologists and CHD sub specialists. The patients themselves, often believing themselves to be 'totally corrected' following operative repair, also face challenges with re-operations and lifelong cardiac problems. This review examines the challenges of the past, present and future for both medical providers and patients.
Collapse
Affiliation(s)
- Carole A Warnes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
54
|
Sullivan WF, Diepstra H, Heng J, Ally S, Bradley E, Casson I, Hennen B, Kelly M, Korossy M, McNeil K, Abells D, Amaria K, Boyd K, Gemmill M, Grier E, Kennie-Kaulbach N, Ketchell M, Ladouceur J, Lepp A, Lunsky Y, McMillan S, Niel U, Sacks S, Shea S, Stringer K, Sue K, Witherbee S. Soins primaires aux adultes ayant des déficiences intellectuelles et développementales. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e137-e166. [PMID: 29650617 PMCID: PMC5897083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objectif Mettre à jour les Lignes directrices consensuelles canadiennes 2011 en matière de soins primaires aux adultes ayant une déficience développementale. Méthodes Des médecins de famille et d’autres professionnels de la santé expérimentés dans les soins aux personnes ayant des DID ont examiné et synthétisé les récentes connaissances empiriques, d’écosystèmes, expertes et expérientielles. Un système a été conçu pour catégoriser la qualité des recommandations. Recommandations Les adultes ayant des DID sont un groupe hétérogène de patients qui présentent des affections médicales et des facteurs qui influent sur leur santé, qui diffèrent de ceux qui touchent les autres membres de la communauté de par leur nature, leurs manifestations, leur gravité ou leur complexité. Ces personnes nécessitent une approche de soins et des interventions adaptées à leurs besoins. Les présentes lignes directrices offrent des conseils en matière de normes de soins. Nous avons incorporé des références à des outils cliniques et à d’autres ressources pratiques. Les approches de soins décrites ici s’appliquent aussi à d’autres groupes de patients ayant un déficit cognitif ou de la communication, ou d’autres déficits des fonctions adaptatives. Conclusion À titre de fournisseurs de soins de première ligne, les médecins de famille jouent un rôle vital de promotion de la santé et de bien-être auprès des adultes ayant des DID. Ces lignes directrices peuvent les aider à prendre des décisions avec les patients et les aidants naturels.
Collapse
Affiliation(s)
- William F Sullivan
- Professeur agrégé au département de médecine familiale et communautaire à l'Université de Toronto, en Ontario, médecin membre du personnel de services médicaux au Surrey Place Centre et à l'unité de pratique familiale de l'Hôpital St Michael, et directeur du programme de soins de première ligne des patients qui présentent un retard développemental au Surrey Place Centre.
| | | | - John Heng
- Professeur adjoint au département de philosophie et au département d'études interdisciplinaires du Collège universitaire King à London, Ont
| | - Shara Ally
- Infirmière en pratique avancée au Surrey Place Centre, chargée de cours à la faculté de soins infirmiers Lawrence S. Bloomberg de l'Université de Toronto, et candidate au MBA
| | - Elspeth Bradley
- Professeure agrégée au département de psychiatrie de l'Université de Toronto et psychiatre consultante et psychothérapeute auprès de patients ayant des déficiences intellectuelles
| | - Ian Casson
- Professeur agrégé à la faculté de médecine familiale de l'Université Queen's, à Kingston, Ont
| | - Brian Hennen
- Professeur émérite à l'Université Western à London et à l'Université Dalhousie à Halifax, N.-É
| | | | - Marika Korossy
- Bibliothécaire à la retraite au Surrey Place Centre à Toronto
| | - Karen McNeil
- Professeure adjointe au département de médecine familiale de l'Université Dalhousie
| | - Dara Abells
- Médecin de famille au Forest Hill Family Health Centre et aux Integrated Services for Autism and Neurodevelopmental Disorders à Toronto, et chargée d'enseignement au Department of Family and Community Medicine à l'Université de Toronto, en Ontario
| | - Khush Amaria
- Psychologue clinique et de la santé et chef d'équipe du Good 2 Go Transition Program à l'Hôpital Sick Children de Toronto
| | - Kerry Boyd
- Professeure clinique agrégée au département de psychiatrie et de neurosciences comportementales à l'Université McMaster à Hamilton et directrice clinicienne au Bethesda Community Services à Thorold, Ontario
| | - Meg Gemmill
- Professeure adjointe au département de médecine familiale de l'Université Queen's
| | - Elizabeth Grier
- Professeure adjointe au département de médecine familiale de l'Université Queen's
| | - Natalie Kennie-Kaulbach
- Attachée d'enseignement universitaire et coordonnatrice au laboratoire de compétences du Collège de pharmacie de l'Université Dalhousie
| | - Mackenzie Ketchell
- Analyste du comportement et professeure à l'école de services sociaux et communautaires au Humber Institute of Technology and Advanced Learning à Toronto
| | - Jessica Ladouceur
- Professeure auxiliaire au Centre de médecine familiale de l'Université Queen's à Belleville
| | - Amanda Lepp
- Résidente dans la discipline de médecine familiale à l'Université McMaster
| | - Yona Lunsky
- Scientifique principale au Centre de toxicomanie et de santé mentale à Toronto, et professeure et chef du département de retards du développement à l'Université de Toronto
| | - Shirley McMillan
- Infirmière clinicienne spécialisée dans les programmes pour adultes au Surrey Place Centre
| | - Ullanda Niel
- Médecin de famille au Scarborough Centre for Healthy Communities, en Ontario
| | - Samantha Sacks
- Chargée d'enseignement clinique au département de médecine familiale de l'Université McGill à Montréal au Québec, et médecin de famille au Centre d'innovation pour l'autisme et les déficiences intellectuelles Voyez les choses à ma façon
| | - Sarah Shea
- Professeure au département de pédiatrie à l'Université Dalhousie
| | - Katherine Stringer
- Professeure agrégée et présidente de la discipline de médecine familiale à l'Université Memorial of Newfoundland à St.John
| | - Kyle Sue
- Professeur clinique adjoint de la discipline de médecine familiale à l'Université Memorial of Newfoundland à St.John
| | - Sandra Witherbee
- Infirmière en pratique familiale à la clinique Dalhousie Family Medicine Clinic
| |
Collapse
|
55
|
Sullivan WF, Diepstra H, Heng J, Ally S, Bradley E, Casson I, Hennen B, Kelly M, Korossy M, McNeil K, Abells D, Amaria K, Boyd K, Gemmill M, Grier E, Kennie-Kaulbach N, Ketchell M, Ladouceur J, Lepp A, Lunsky Y, McMillan S, Niel U, Sacks S, Shea S, Stringer K, Sue K, Witherbee S. Primary care of adults with intellectual and developmental disabilities: 2018 Canadian consensus guidelines. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:254-279. [PMID: 29650602 PMCID: PMC5897068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To update the 2011 Canadian guidelines for primary care of adults with intellectual and developmental disabilities (IDD). METHODS Family physicians and other health professionals experienced in the care of people with IDD reviewed and synthesized recent empirical, ecosystem, expert, and experiential knowledge. A system was developed to grade the strength of recommendations. RECOMMENDATIONS Adults with IDD are a heterogeneous group of patients and have health conditions and factors affecting their health that can vary in kind, manifestation, severity, or complexity from those of others in the community. They require approaches to care and interventions that are adapted to their needs. These guidelines provide advice regarding standards of care. References to clinical tools and other practical resources are incorporated. The approaches to care that are outlined here can be applied to other groups of patients that have impairments in cognitive, communicative, or other adaptive functioning. CONCLUSION As primary care providers, family physicians play a vital role in promoting the health and well-being of adults with IDD. These guidelines can aid their decision making with patients and caregivers.
Collapse
Affiliation(s)
- William F Sullivan
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario, a staff physician in Medical Services at Surrey Place Centre and the Family Practice Unit at St Michael's Hospital, and Director of the Developmental Disabilities Primary Care Program at Surrey Place Centre.
| | | | - John Heng
- Assistant Professor in the Department of Philosophy and the Department of Interdisciplinary Studies at King's University College in London, Ont
| | - Shara Ally
- An advanced practice nurse at Surrey Place Centre, Adjunct Lecturer in the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto, and an MBA candidate
| | - Elspeth Bradley
- Associate Professor in the Department of Psychiatry at the University of Toronto and a consulting psychiatrist and psychotherapist in intellectual disabilities
| | - Ian Casson
- Associate Professor in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - Brian Hennen
- Professor Emeritus at Western University in London and Dalhousie University in Halifax, NS
| | | | | | - Karen McNeil
- Assistant Professor in the Department of Family Medicine at Dalhousie University
| | - Dara Abells
- Family physician at Forest Hill Family Health Centre in Toronto and the Integrated Services for Autism and Neurodevelopmental Disorders, and Lecturer in the Department of Family and Community Medicine at the University of Toronto
| | - Khush Amaria
- Clinical and health psychologist and team lead for the Good 2 Go Transition Program at the Hospital for Sick Children in Toronto
| | - Kerry Boyd
- Associate Clinical Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, Ont, and Chief Clinical Officer for Bethesda Community Services in Thorold, Ont
| | - Meg Gemmill
- Assistant Professor in the Department of Family Medicine at Queen's University
| | - Elizabeth Grier
- Assistant Professor in the Department of Family Medicine at Queen's University
| | - Natalie Kennie-Kaulbach
- University Teaching Fellow and a coordinator in the Skills Lab in the College of Pharmacy at Dalhousie University
| | - Mackenzie Ketchell
- Behaviour analyst and Professor in the School of Social and Community Services at Humber Institute of Technology and Advanced Learning in Toronto
| | - Jessica Ladouceur
- Adjunct Professor in the Belleville Queen's University Family Medicine Centre
| | - Amanda Lepp
- Resident in the Discipline of Family Medicine at McMaster University
| | - Yona Lunsky
- Senior Scientist at the Centre for Addiction and Mental Health in Toronto and Professor and Developmental Disability Lead at the University of Toronto
| | - Shirley McMillan
- Clinical nurse specialist in the adult program at Surrey Place Centre
| | - Ullanda Niel
- Family physician at the Scarborough Centre for Healthy Communities in Ontario
| | - Samantha Sacks
- Clinical Faculty Lecturer in the Department of Family Medicine at McGill University in Montreal, Que, and a family physician at See Things My Way Centre for Innovation in Autism and Intellectual Disabilities
| | - Sarah Shea
- Professor in the Department of Pediatrics at Dalhousie University
| | - Katherine Stringer
- Associate Professor and Chair of Family Medicine at Memorial University of Newfoundland in St John's
| | - Kyle Sue
- Clinical Assistant Professor in the Discipline of Family Medicine at Memorial University of Newfoundland
| | | |
Collapse
|
56
|
Grier E, Abells D, Casson I, Gemmill M, Ladouceur J, Lepp A, Niel U, Sacks S, Sue K. Managing complexity in care of patients with intellectual and developmental disabilities: Natural fit for the family physician as an expert generalist. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:S15-S22. [PMID: 29650740 PMCID: PMC5906780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To delineate the factors inherent in caring for patients with intellectual and developmental disabilities (IDD) that lead to complexity and to provide perspectives and techniques mapped to the phases of the clinical encounter. SOURCES OF INFORMATION The authors of the physical health section of the 2018 Canadian consensus guidelines on the primary care of adults with IDD consisted of family physicians, all of whom practise comprehensive family medicine with additional clinical experience in care of adults with IDD. These authors reviewed evidence on which their recommendations are based and these recommendations have undergone a rigorous peer review to ensure that they deserve special attention because they highlight what is different from what a family physician would consider to constitute "normal care" for the general population. MAIN MESSAGE Additional factors across the phases of clinical encounters with patients with IDD include the need for the following: an initial assessment that identifies genetic or neurologic conditions to guide anticipatory care and isolates unique barriers to health promotion and chronic disease management; adaptations to history taking, particularly for patients who are unable to describe symptoms owing to cognitive and communication deficits; overcoming challenges to performing physical examinations and certain investigations; addressing uncertainty in the formulation of hypotheses to establish an appropriate diagnosis; and involvement of resources of the developmental services sector to provide a management plan as well as an adapted empathetic approach in order to integrate the patient's illness experience. CONCLUSION Although each patient with IDD is unique, and care of patients with IDD requires knowledge of certain conditions, these considerations are readily identifiable, and family physicians as expert generalists are well equipped to provide excellent care to patients with IDD.
Collapse
Affiliation(s)
- Elizabeth Grier
- Assistant Professor in the Department of Family Medicine at Queen's University in Kingston, Ont.
| | - Dara Abells
- Family physician at Forest Hill Family Health Centre in Toronto, Ont, and the Integrated Services for Autism and Neurodevelopmental Disorders, and Lecturer in the Department of Family and Community Medicine at the University of Toronto
| | - Ian Casson
- Associate Professor in the Department of Family Medicine at Queen's University
| | - Meg Gemmill
- Assistant Professor, in the Department of Family Medicine at Queen's University
| | - Jessica Ladouceur
- Adjunct Professor in the Belleville Queen's University Family Medicine Centre
| | - Amanda Lepp
- Resident in the Discipline of Family Medicine at McMaster University in Hamilton, Ont
| | - Ullanda Niel
- Family physician at the Scarborough Centre for Healthy Communities in Ontario
| | - Samantha Sacks
- Clinical Faculty Lecturer in the Department of Family Medicine at McGill University in Montreal, Que, and a family physician at See Things My Way Centre for Innovation in Autism and Intellectual Disabilities
| | - Kyle Sue
- Clinical Assistant Professor in the Discipline of Family Medicine at Memorial University of Newfoundland in St John's
| |
Collapse
|
57
|
Transition Intervention for Adolescents With Congenital Heart Disease. J Am Coll Cardiol 2018; 71:1768-1777. [DOI: 10.1016/j.jacc.2018.02.043] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 01/30/2023]
|
58
|
Abstract
PURPOSE OF REVIEW The past couple of decades have brought tremendous advances to the field of pediatric and adult congenital heart disease (CHD). Percutaneous valve interventions are now a cornerstone of not just the congenital cardiologist treating patients with congenital heart disease, but also-and numerically more importantly-for adult interventional cardiologists treating patients with acquired heart valve disease. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfunction. This review aims to summarize (1) the current state of the art for tPVR, (2) the expanding indications, and (3) the technological obstacles to optimizing tPVR. RECENT FINDINGS Since its introduction in 2000, more than ten thousands tPVR procedures have been performed worldwide. Although the indications for tPVR have been adapted earlier from those accepted for surgical intervention, they remain incompletely defined. The new imaging modalities give better assessment of cardiac anatomy and function and determine candidacy for the procedure. The procedure has been shown to be feasible and safe when performed in patients who received pulmonary conduit and or bioprosthetic valves between the right ventricle and the pulmonary artery. Fewer selected patients post trans-annular patch repair for tetralogy of Fallot may also be candidates for this technology. Size restrictions of the currently available valves limit deployment in the majority of patients post trans-annular patch repair. Newer valves and techniques are being developed that may help such patients. Refinements and further developments of this procedure hold promise for the extension of this technology to other patient populations.
Collapse
|
59
|
Gregory SH, Zoller JK, Shahanavaz S, Chilson KL, Ridley CH. Anesthetic Considerations for Transcatheter Pulmonary Valve Replacement. J Cardiothorac Vasc Anesth 2018; 32:402-411. [DOI: 10.1053/j.jvca.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 12/27/2022]
|
60
|
Bianco JC, Mc Loughlin S, Denault AY, Marenchino RG, Rojas JI, Bonofiglio FC. Heart Transplantation in Patients >60 Years: Importance of Relative Pulmonary Hypertension and Right Ventricular Failure on Midterm Survival. J Cardiothorac Vasc Anesth 2018; 32:32-40. [DOI: 10.1053/j.jvca.2017.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 11/11/2022]
|
61
|
Bolliger D, Bouchez S, Mauermann E. Re-examining Factors Associated With Mortality After Heart Transplantation: A Focus on Recipient Age and Relative Pulmonary Hypertension. J Cardiothorac Vasc Anesth 2017; 32:41-43. [PMID: 29221977 DOI: 10.1053/j.jvca.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel Bolliger
- Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Stefaan Bouchez
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Ghent, Belgium
| | - Eckhard Mauermann
- Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland; Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
62
|
Abstract
Over the past decades, survival of patients with CHD improved significantly, making it a life-cycle disease. Hence, there is a need for a workforce that can take up the care for afflicted individuals in the different phases of the life spectrum. Each life phase is associated with specific challenges. Topics that should receive more attention in clinical care or in CHD research are parenting styles of parents of children, transfer and transition of adolescents, cumulative burden of injury in the brain in adults, and geriatric care for older persons with CHD. Nurses, along with other healthcare professionals, will play a pivotal role in building up expertise in these areas and taking up these challenges.
Collapse
|
63
|
Moroney E, Posma E, Dennis A, d'Udekem Y, Cordina R, Zentner D. Pregnancy in a woman with a Fontan circulation: A review. Obstet Med 2017; 11:6-11. [PMID: 29636807 DOI: 10.1177/1753495x17737680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/23/2017] [Indexed: 11/15/2022] Open
Abstract
More women with congenital heart disease survive to childbearing ages, due to improvements in surgical practice and postoperative care. This review discusses pregnancy in women with a single ventricle, describing maternal obstetric and cardiovascular complications and the increased risks of prematurity and adverse neonatal outcomes. Recommendations are made based on current understanding, guidelines and published literature, with recognition that there is much knowledge yet to be gained.
Collapse
Affiliation(s)
- Emily Moroney
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Elske Posma
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Victoria, Australia
| | - Alicia Dennis
- Department of Anaesthesia, The Royal Women's Hospital, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.,Department of Pharmacology, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,7Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Dominica Zentner
- Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia.,Department of Medicine Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| |
Collapse
|
64
|
Abstract
UNLABELLED Introduction The adult CHD population is increasing and ageing and remains at high risk for morbidity and mortality. In a retrospective single-centre study, we conducted a comprehensive review of non-elective hospitalisations of adults with CHD and explored factors associated with length of stay. METHODS We identified adults (⩾18 years) with CHD admitted during a 12-month period and managed by the adult CHD service. Data regarding demographics, cardiac history, hospital admission, resource utilisation, and length of stay were extracted. RESULTS There were 103 admissions of 91 patients (age 37±10 years; 52% female). Of 91 patients, 96% had moderate or complex defects. Of 103 admissions, 45% were through the emergency department. The most common reasons for admission were arrhythmia (37%) and heart failure (28%); 29% of admissions included a stay in the ICU. The mean number of consultations by other services was 2.0. Electrophysiology and anaesthesiology departments were most frequently consulted. After removing outliers, the mean length of stay was 7.9±7.4 days (median=5 days). The length of stay was longer for patients admitted for heart failure (12.2±10.3 days; p=0.001) and admitted directly to the ward (9.6±8.9 days; p=0.009). CONCLUSIONS Among non-electively hospitalised adults with CHD in a tertiary-care centre, management often entails an interdisciplinary approach, and the length of stay is longest for patients admitted with heart failure. The healthcare system must ensure optimal resources to maintain high-quality care for this expanding patient population.
Collapse
|
65
|
Villafane J, Edwards TC, Diab KA, Satou GM, Saarel E, Lai WW, Serwer GA, Karpawich PP, Cross R, Schiff R, Chowdhury D, Hougen TJ. Development of quality metrics for ambulatory care in pediatric patients with tetralogy of Fallot. CONGENIT HEART DIS 2017; 12:762-767. [PMID: 28880457 DOI: 10.1111/chd.12523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to develop quality metrics (QMs) relating to the ambulatory care of children after complete repair of tetralogy of Fallot (TOF). DESIGN A workgroup team (WT) of pediatric cardiologists with expertise in all aspects of ambulatory cardiac management was formed at the request of the American College of Cardiology (ACC) and the Adult Congenital and Pediatric Cardiology Council (ACPC), to review published guidelines and consensus data relating to the ambulatory care of repaired TOF patients under the age of 18 years. A set of quality metrics (QMs) was proposed by the WT. The metrics went through a two-step evaluation process. In the first step, the RAND-UCLA modified Delphi methodology was employed and the metrics were voted on feasibility and validity by an expert panel. In the second step, QMs were put through an "open comments" process where feedback was provided by the ACPC members. The final QMs were approved by the ACPC council. RESULTS The TOF WT formulated 9 QMs of which only 6 were submitted to the expert panel; 3 QMs passed the modified RAND-UCLA and went through the "open comments" process. Based on the feedback through the open comment process, only 1 metric was finally approved by the ACPC council. CONCLUSIONS The ACPC Council was able to develop QM for ambulatory care of children with repaired TOF. These patients should have documented genetic testing for 22q11.2 deletion. However, lack of evidence in the literature made it a challenge to formulate other evidence-based QMs.
Collapse
Affiliation(s)
- Juan Villafane
- Department of Pediatrics (Cardiology), University of Kentucky, Lexington, Kentucky, USA
| | - Thomas C Edwards
- Department of Pediatric Cardiology, University of Central Florida, Orlando, Florida, USA
| | - Karim A Diab
- Department of Pediatric Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Gary M Satou
- Department of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Elizabeth Saarel
- Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Wyman W Lai
- Division of Pediatric Cardiology, Children's Hospital of Orange County, Orange, California, USA
| | - Gerald A Serwer
- Department of Pediatric Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Peter P Karpawich
- Department of Pediatric Cardiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Russell Cross
- Department of Pediatric Cardiology, George Washington University, Washington, DC, USA
| | - Russell Schiff
- Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, Queens, New York, USA
| | | | - Thomas J Hougen
- Department of Cardiology, Children's National Heart Institute, Arlington, Virginia, USA
| |
Collapse
|
66
|
Fredriksson A, Trzebiatowska‐Krzynska A, Dyverfeldt P, Engvall J, Ebbers T, Carlhäll C. Turbulent kinetic energy in the right ventricle: Potential MR marker for risk stratification of adults with repaired Tetralogy of Fallot. J Magn Reson Imaging 2017; 47:1043-1053. [DOI: 10.1002/jmri.25830] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/18/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexandru Fredriksson
- Division of Cardiovascular MedicineDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
| | - Aleksandra Trzebiatowska‐Krzynska
- Division of Cardiovascular MedicineDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
- Department of CardiologyDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
| | - Petter Dyverfeldt
- Division of Cardiovascular MedicineDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
- Center for Medical Image Science and Visualization (CMIV)Linköping UniversityLinköping Sweden
| | - Jan Engvall
- Division of Cardiovascular MedicineDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
- Center for Medical Image Science and Visualization (CMIV)Linköping UniversityLinköping Sweden
- Department of Clinical PhysiologyDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
| | - Tino Ebbers
- Division of Cardiovascular MedicineDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
- Center for Medical Image Science and Visualization (CMIV)Linköping UniversityLinköping Sweden
| | - Carl‐Johan Carlhäll
- Division of Cardiovascular MedicineDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
- Center for Medical Image Science and Visualization (CMIV)Linköping UniversityLinköping Sweden
- Department of Clinical PhysiologyDepartment of Medical and Health Sciences, Linköping UniversityLinköping Sweden
| |
Collapse
|
67
|
Sathananthan G, Harris L, Nair K. Ventricular Arrhythmias in Adult Congenital Heart Disease: Mechanisms, Diagnosis, and Clinical Aspects. Card Electrophysiol Clin 2017; 9:213-223. [PMID: 28457236 DOI: 10.1016/j.ccep.2017.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The risk of ventricular arrhythmias in the adult congenital heart disease population increases with age. The mechanism, type, and frequency vary depending on the complexity of the defect, whether it has been repaired, and the type and timing of repair. Risk stratification for sudden death in patients with congenital heart disease is often challenging. Current recommendations provide a useful guide for management of these patients and risk stratification continues to evolve. Internal cardiac defibrillator implantation is often challenging due to limited transvenous access, often resulting in the need for epicardial or subcutaneous devices.
Collapse
Affiliation(s)
- Gnalini Sathananthan
- Department of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada
| | - Louise Harris
- Department of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada
| | - Krishnakumar Nair
- Department of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada.
| |
Collapse
|
68
|
Nicolarsen J. Transition of Adolescents and Young Adults with Congenital Heart Disease: Challenges, Progress, and Future Improvements. Pediatr Ann 2017; 46:e224-e228. [PMID: 28599027 DOI: 10.3928/19382359-20170519-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Congenital heart disease (CHD) is the most common and perhaps most widely variable birth defect. Decades of improved CHD care has resulted in a steady growth in the number and complexity of adults with CHD, and many of these patients require lifelong, specialized follow-up care. This begins with successful transition from pediatric-based to adult-based care. Despite the remarkable advances in this field, many adults with CHD still experience lapses in care that have significant health consequences. This review outlines some of the challenges, progress, and areas for improvement in CHD transition medicine. [Pediatr Ann. 2017;46(6):e224-e228.].
Collapse
|
69
|
Schuiteman E, Verrill T, Mina N, Dalal B. Constrictive pericarditis-induced shunting through a PFO: Persistence despite pericardiectomy. Respir Med Case Rep 2017; 22:28-30. [PMID: 28649486 PMCID: PMC5470528 DOI: 10.1016/j.rmcr.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/29/2017] [Indexed: 11/22/2022] Open
Abstract
A patent foramen ovale (PFO) is found in around 25-30% of patients. The discovery is often made only on autopsy, as most PFOs are clinically silent and any inter-atrial blood exchange typically shunts from the left to right heart [1]. Thus, when a patient presents with hypoxic respiratory failure, concern for presence of a PFO is rarely at the top of the differential. However, in the setting of elevated right heart pressures, PFOs can become of great hemodynamic importance and can lead to deadly complications, including right to left shunting and refractory hypoxic respiratory failure. We present an unusual care of constrictive pericarditis leading to significant shunting through a PFO, and resultant hypoxic respiratory failure which only resolved with PFO closure.
Collapse
Affiliation(s)
- Emily Schuiteman
- Department of Internal Medicine, Beaumont Hospital – Royal Oak, Royal Oak, MI, 48073, USA
| | - Thomas Verrill
- Department of Cardiology, Beaumont Hospital – Royal Oak, Royal Oak, MI, 48073, USA
| | - Nader Mina
- Department of Pulmonary and Critical Care Medicine, Beaumont Hospital – Royal Oak, Royal Oak, MI, 48073, USA
| | - Bhavinkumar Dalal
- Department of Pulmonary and Critical Care Medicine, Beaumont Hospital – Royal Oak, Royal Oak, MI, 48073, USA
| |
Collapse
|
70
|
Patel PA, Hall A, Augoustides JGT, Patel S, Feinman JW, Weber B, Gutsche JT, Fabbro M, Maldonado Y. Dynamic Shunting Across a Patent Foramen Ovale in Adult Cardiac Surgery-Perioperative Challenges and Management. J Cardiothorac Vasc Anesth 2017; 32:542-549. [PMID: 29223721 DOI: 10.1053/j.jvca.2017.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Hall
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Saumil Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Beth Weber
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Fabbro
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Yasdet Maldonado
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| |
Collapse
|
71
|
Mbaye A, Bodian M, Ngaïdé AA, Abdourafiq H, Leye MCBO, Savodogo S, Aw F, Ndiaye M, Kouamé I, Babaka K, Dioum M, Gaye ND, Sarr SA, Ndiaye MB, Kane AD, Kane A. [Congenital heart disease in adolescents and adults: Management in a general cardiology department in Senegal]. Ann Cardiol Angeiol (Paris) 2017; 66:217-222. [PMID: 28506578 DOI: 10.1016/j.ancard.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 02/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital heart diseases in adults include malformations treated in childhood that decompensate secondarily and those asymptomatic at birth, appear later. This study aims to identify congenital heart diseases in adults in general cardiology department of Senegal and to assess clinical presentations, treatment and outcomes. METHODS We conducted a cross-sectional and descriptive study based on the records of patients aged at least 16 years and followed for congenital heart disease in the cardiology department of the General Hospital of Grand-Yoff in Dakar between May 2003 and March 2015. Diagnosis of heart disease was based on echocardiography. RESULTS We have registered 50 dossiers of patients equivalent to a prevalence of 0.75%, with a female predominance (64%). The average age of patients was 36.2±18.4 years (16-79 years), and mean age of diagnosis was 29.76±22.58 years. Dyspnea was the main sign (60%). Main malformations were the atrial septal defect (38%), pulmonary stenosis (14%), the ventricular septal defect (12%) and patent ductus arteriosus (10%). According to the classification of Bethesda, heart disease was simple complexity (42%), intermediate (58%) or severe (10%). The treatment was medical in 43 patients and 7 patients had surgical repair. Main complications were infective endocarditis (10%), atrial fibrillation (12%), heart failure (24%) and pulmonary arterial hypertension (50%). CONCLUSION Congenital heart diseases in adults seem underestimated in our countries. Surgical repair is rare. It is necessary to ensure a good management of the transition between pediatric and adult age.
Collapse
Affiliation(s)
- A Mbaye
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal.
| | - M Bodian
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - A A Ngaïdé
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - H Abdourafiq
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - M C B O Leye
- Service de cardiologie, centre hospitalier national de Fann, BP 3053, Dakar-Fann, Sénégal
| | - S Savodogo
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - F Aw
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - M Ndiaye
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - I Kouamé
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - K Babaka
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - M Dioum
- Service de cardiologie, centre hospitalier national de Fann, BP 3053, Dakar-Fann, Sénégal
| | - N D Gaye
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - S A Sarr
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - M B Ndiaye
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - A D Kane
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - A Kane
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| |
Collapse
|
72
|
Noly PE, Legris-Falardeau V, Ibrahim R, El-Hamamsy I, Cartier R, Lamarche Y, Bouchard D, Dorval JF, Poirier N, Demers P. Results of a multimodal approach for the management of aortic coarctation and its complications in adults. Interact Cardiovasc Thorac Surg 2017; 25:335-342. [DOI: 10.1093/icvts/ivx039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/23/2017] [Indexed: 01/23/2023] Open
|
73
|
Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, Koos BJ, Mital S, Rose C, Silversides C, Stout K. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2017; 135:e50-e87. [PMID: 28082385 DOI: 10.1161/cir.0000000000000458] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Today, most female children born with congenital heart disease will reach childbearing age. For many women with complex congenital heart disease, carrying a pregnancy carries a moderate to high risk for both the mother and her fetus. Many such women, however, do not have access to adult congenital heart disease tertiary centers with experienced reproductive programs. Therefore, it is important that all practitioners who will be managing these women have current information not only on preconception counseling and diagnostic evaluation to determine maternal and fetal risk but also on how to manage them once they are pregnant and when to refer them to a regional center with expertise in pregnancy management.
Collapse
|
74
|
Helm PC, Kaemmerer H, Breithardt G, Sticker EJ, Keuchen R, Neidenbach R, Diller GP, Tutarel O, Bauer UMM. Transition in Patients with Congenital Heart Disease in Germany: Results of a Nationwide Patient Survey. Front Pediatr 2017; 5:115. [PMID: 28580351 PMCID: PMC5437851 DOI: 10.3389/fped.2017.00115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/02/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A growing number of adults with congenital heart disease (ACHD) pose a particular challenge for health care systems across the world. Upon turning into 18 years, under the German national health care system, ACHD patients are required to switch from a pediatric to an adult cardiologist or an ACHD-certified provider. To date, reliable data investigating the treatment situation of ACHD patients in Germany are not available. MATERIALS AND METHODS An online survey was conducted in collaboration with patient organizations to address the life situation and the conditions of health care provision for ACHD patients in Germany. ACHD patients were recruited from the database of the National Register for Congenital Heart Defects (NRCHD) and informed about the survey via email, websites, and social networks. A total of 1,828 ACHD patients (1,051 females) participated in this study. The mean age was 31.7 ± 11.7 years. Participants were surveyed about treating physicians and the institution mainly involved in the treatment of their CHD. In addition, participants were asked questions to assess the level of trust toward their treating physician and their familiarity with the term "ACHD-certified provider." RESULTS Among the surveyed patients, 25.4% stated that they attended a specific ACHD clinic at a heart center regularly, 32.7% were treated in a private practice setting by a pediatric cardiologist, 32.4% in a private practice (adult) cardiology setting, and 9.5% were treated by an "other physician." Only 24.4% of the male and 29.7% of the female ACHD patients were familiar with the term "ACHD-certified provider." CONCLUSION The transfer from pediatric cardiology to ACHD care requires further attention as many adult patients have not transferred to certified ACHD providers. The question of whether ACHD patients in Germany are offered consistent and adequate care should also be investigated in more detail. The answers regarding the ACHD certification are particularly disappointing and indicative of a large information gap and inadequate education in clinical practice.
Collapse
Affiliation(s)
- Paul C Helm
- National Register for Congenital Heart Defects, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Harald Kaemmerer
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Günter Breithardt
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine University Hospital of Münster, Münster, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
| | | | | | - Rhoia Neidenbach
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine University Hospital of Münster, Münster, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Oktay Tutarel
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
| |
Collapse
|
75
|
Burström Å, Bratt EL, Frenckner B, Nisell M, Hanséus K, Rydberg A, Öjmyr-Joelsson M. Adolescents with congenital heart disease: their opinions about the preparation for transfer to adult care. Eur J Pediatr 2017; 176:881-889. [PMID: 28508990 PMCID: PMC5486562 DOI: 10.1007/s00431-017-2917-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/21/2016] [Accepted: 04/27/2017] [Indexed: 12/24/2022]
Abstract
UNLABELLED The aim of the study was to explore what adolescents with congenital heart disease (CHD) view as important in the preparation for the transfer to adult care. We performed interviews in four focus groups with adolescents (14-18 years old) at four university hospitals in Sweden. Data was analysed using qualitative content analysis. The analysis revealed one main category; Becoming a manager of the condition and four subcategories; Sufficient knowledge about the health, Be a participant in the care, Parental support, and Communicate with others about the health. The adolescents' ages differentiated the discussion in the groups. The older adolescents seemed to have more interest in transition planning, information and transfer. The younger described more frustrations about communication and handling the disease. CONCLUSION To become a manager of the CHD in daily life, the adolescents want disease specific knowledge, which should be communicated in a developmentally appropriate way. Adolescents want to participate and be involved in the transition process. They need support and guidance in how to communicate their CHD. Parental support is fundamental but it change over time. Moreover, peer-support is becoming more significant during the transition process. What is Known: • Transition during adolescence and transfer to adult care for adolescents with CHD is complex, and there is a shift in roles. • Adolescents often have poor knowledge and understanding about their heart condition and the consequences. What is New: • Adolescents call for disease specific information regarding health issues of importance for them in daily life. • Communicating the disease with other is a challenge- peer support from other adolescents with CHD could be a facilitator.
Collapse
Affiliation(s)
- Åsa Burström
- Institution for Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. .,Department of Paediatric Cardiology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
| | - Ewa-Lena Bratt
- Institution of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden ,Department of Pediatric Cardiology, The Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Björn Frenckner
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| | - Margret Nisell
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,The Red Cross University College, Stockholm, Sweden
| | - Katarina Hanséus
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Maria Öjmyr-Joelsson
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| |
Collapse
|
76
|
Groves DW, Olivieri LJ, Shanbhag SM, Bronson KC, Yu JH, Nelson EA, Rollison SF, Stagliano MS, John AS, Kuehl K, Chen MY. Feasibility of low radiation dose retrospectively-gated cardiac CT for functional analysis in adult congenital heart disease. Int J Cardiol 2016; 228:180-183. [PMID: 27865183 PMCID: PMC6323633 DOI: 10.1016/j.ijcard.2016.11.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 11/28/2022]
Abstract
Background: The use of cardiac computed tomography (CT) in the evaluation of adult congenital heart disease patients is limited due to concerns of high radiation doses. The purpose of this study was to prospectively assess whether low radiation dose cardiac CT is feasible to evaluate ventricular systolic function in adults with congenital heart disease. Methods: The study group included 30 consecutive patients with significant congenital heart disease who underwent a total of 35 ECG-gated cardiac CT scans utilizing a 320-detector row CT scanner. Each study included a non-contrast scan and subsequent contrast-enhanced retrospectively-gated acquisition. Effective radiation dose was estimated by multiplying the dose length product by a k-factor of 0.014 mSv/mGy cm. Results: The mean age of the patients was 34.4 ± 8.9 years, 60% were men, and mean body mass index was 24.2 ± 4.3 kg/m2. A majority of patients (n = 28, 93.3%) had contraindications to cardiac MRI. A tube potential of 80 kV was used in 27 (77.1%) of the contrast-enhanced scans. The mean signal-to-noise and contrast-to-noise ratios were 11.5 ± 3.9 and 10.3 ± 3.7, respectively. The median radiation dose for non-contrast and contrast-enhanced images were 0.1 mSv (0.07–0.2 mSv) and 0.94 mSv (0.5–2.1 mSv), respectively. All 35 CT scans were successfully analyzed for ventricular systolic function. Conclusions: A low radiation contrast-enhanced, retrospectively-gated cardiac CT with a median radiation dose of less than 1 mSv was successful in evaluating ventricular systolic function in 30 consecutive adult congenital heart disease patients who underwent a total of 35 scans.
Collapse
Affiliation(s)
- Daniel W Groves
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura J Olivieri
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Sujata M Shanbhag
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathie C Bronson
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeannie H Yu
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Evan A Nelson
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shirley F Rollison
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael S Stagliano
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anitha S John
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Karen Kuehl
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Marcus Y Chen
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
77
|
|
78
|
Defining and refining indications for transcatheter pulmonary valve replacement in patients with repaired tetralogy of Fallot: Contributions from anatomical and functional imaging. Int J Cardiol 2016; 221:916-25. [DOI: 10.1016/j.ijcard.2016.07.120] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/24/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022]
|
79
|
Polo López ML, Aroca Peinado Á, González Rocafort Á, Bret Zurita M, Rey Lois J, Sánchez Pérez R, Villagrá Blanco F, Oliver Ruiz JM, Sánchez Recalde Á. Reintervenciones quirúrgicas en adultos con situación Fallot: una población emergente. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
80
|
|
81
|
Transcatheter closure of atrial septal defect protects from pulmonary edema: septal occluder device gradually reduces LR shunt. Heart Vessels 2016; 32:101-104. [PMID: 27314266 DOI: 10.1007/s00380-016-0863-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
A 56-year-old woman was diagnosed as atrial septal defect (ASD) with pulmonary hypertension; pulmonary blood flow/systemic blood flow (Qp/Qs) of 2.3, pulmonary artery pressure (PAP) of 71/23(39) mmHg and diastolic dysfunction of left ventricle. PAP was improved after medical therapy; therefore, transcatheter ASD closure was performed. Seven days later, left-sided heart failure occurred, however, the improvement of Qp/Qs (1.7) and PAP of 51/21(32) was confirmed. Diuretic therapy was introduced which led to further decrease of PAP 40/12(25) and Qp/Qs (1.1). Because of gradual decrease of Qp/Qs, this patient appeared to be protected from acute pulmonary edema.
Collapse
|
82
|
Mackie AS, Rempel GR, Kovacs AH, Kaufman M, Rankin KN, Jelen A, Manlhiot C, Anthony SJ, Magill-Evans J, Nicholas D, Sananes R, Oechslin E, Dragieva D, Mustafa S, Williams E, Schuh M, McCrindle BW. A cluster randomized trial of a transition intervention for adolescents with congenital heart disease: rationale and design of the CHAPTER 2 study. BMC Cardiovasc Disord 2016; 16:127. [PMID: 27266868 PMCID: PMC4896011 DOI: 10.1186/s12872-016-0307-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/30/2016] [Indexed: 12/27/2022] Open
Abstract
Background The population of adolescents and young adults with congenital heart disease (CHD) is growing exponentially. These survivors are at risk of late cardiac complications and require lifelong cardiology care. However, there is a paucity of data on how to prepare adolescents to assume responsibility for their health and function within the adult health care system. Evidence-based transition strategies are required. Methods The Congenital Heart Adolescents Participating in Transition Evaluation Research (CHAPTER 2) Study is a two-site cluster randomized clinical trial designed to evaluate the efficacy of a nurse-led transition intervention for 16–17 year olds with moderate or complex CHD. The primary endpoint is excess time to adult CHD care, defined as the time interval between the final pediatric cardiology appointment and the first adult CHD appointment, minus the recommended time interval between these appointments. Secondary endpoints include the MyHeart score (CHD knowledge), Transition Readiness Assessment Questionnaire score, and need for catheter or surgical re-intervention. Participants are enrolled in clusters based on week of attendance in the pediatric cardiology clinic. The intervention consists of two one-hour individualized sessions between a cardiology nurse and study participant. Session One focuses on knowledge of the participant’s CHD, review of their cardiac anatomy and prior interventions, and potential late cardiac complications. Session Two focuses on self-management and communication skills through review and discussion of videos and role-play. The study will recruit 120 participants. Discussion Many adolescents and young adults experience a gap in care predisposing them to late cardiac complications. The CHAPTER 2 Study will investigate the impact of a nurse-led transition intervention among adolescents with CHD. Fidelity of the intervention is a major focus and priority. This study will build on our experience by (i) enrolling at two tertiary care programs, (ii) including a self-management intervention component, and (iii) evaluating the impact of the intervention on time to ACHD care, a clinically relevant outcome. The results of this study will inform pediatric cardiology programs, patients and policy makers in judging whether a structured intervention program provides clinically meaningful outcomes for adolescents and young adults living with CHD. Trial registration ClinicalTrials.gov ID NCT01723332
Collapse
Affiliation(s)
- Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. .,Division of Cardiology, Stollery Children's Hospital, 4C2 Walter C. Mackenzie Center, 8440-112th St. NW, Edmonton, Alberta, T6G 2B7, Canada.
| | | | - Adrienne H Kovacs
- University Health Network, Peter Munk Cardiac Centre, Toronto Congenital Cardiac Centre for Adults, and University of Toronto, Toronto, Ontario, Canada
| | - Miriam Kaufman
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn N Rankin
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ahlexxi Jelen
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Joyce Magill-Evans
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Renee Sananes
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Erwin Oechslin
- University Health Network, Peter Munk Cardiac Centre, Toronto Congenital Cardiac Centre for Adults, and University of Toronto, Toronto, Ontario, Canada
| | - Dimi Dragieva
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sonila Mustafa
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elina Williams
- Division of Cardiology, Stollery Children's Hospital, 4C2 Walter C. Mackenzie Center, 8440-112th St. NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Michelle Schuh
- Division of Cardiology, Stollery Children's Hospital, 4C2 Walter C. Mackenzie Center, 8440-112th St. NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Brian W McCrindle
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
83
|
Postoperative residua and sequelae in adults with repaired tetralogy of Fallot. Gen Thorac Cardiovasc Surg 2016; 64:373-9. [DOI: 10.1007/s11748-016-0651-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023]
|
84
|
Lima FV, Koutrolou-Sotiropoulou P, Yen TYM, Stergiopoulos K. Clinical characteristics and outcomes in pregnant women with Ebstein anomaly at the time of delivery in the USA: 2003-2012. Arch Cardiovasc Dis 2016; 109:390-8. [PMID: 27079467 DOI: 10.1016/j.acvd.2016.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/14/2015] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ebstein anomaly is an uncommon congenital cardiac lesion that may be associated with cyanosis, arrhythmias and right heart dysfunction. Investigation into patient characteristics and outcomes in pregnant women with Ebstein anomaly has been limited. AIMS To characterize patient characteristics and clinical events for pregnant women with Ebstein anomaly during hospitalization for delivery in the USA; also, to determine the effect of Ebstein anomaly on maternal clinical outcomes and individual predictors of poor outcome at time of delivery. METHODS We screened the Healthcare Cost and Utilization Project's National Inpatient Sample for hospital admissions of pregnant women for delivery (vaginal or caesarean section) in the USA from 2003-2012, and identified a cohort of 7,850,381. Clinical characteristics and maternal outcomes were identified in those with and without Ebstein anomaly. The primary outcome of interest was major adverse cardiac events (MACE), a composite of in-hospital death, acute myocardial infarction, cerebrovascular events, embolic events, cardiac complications of labour and delivery heart failure or arrhythmia. RESULTS Our study population consisted of 82 hospitalizations of pregnant women with Ebstein anomaly and 7,850,299 without. The Ebstein cohort more frequently had ostium secundum-type atrial septal defect and/or patent foramen ovale and anomalous atrioventricular excitation (P<0.001 for both). The MACE rate was significantly higher among Ebstein patients (P<0.001). Preterm delivery, postpartum haemorrhage and caesarean delivery occurred more frequently among the Ebstein cohort (19.5% vs 7.2%, 8.5% vs 2.8% and 47.6% vs 31.1%, respectively; P≤0.001). In a multivariable analysis, anomalous atrioventricular excitation (odds ratio [OR] 21.75, 95% confidence interval [CI] 1.03-457.91) and preterm delivery (OR 11.71, 95% CI 1.39-98.89) were associated with MACE among those with Ebstein anomaly. CONCLUSIONS Pregnant women with Ebstein anomaly are at higher risk of MACE during pregnancy and delivery. Preterm delivery occurred more frequently in women with Ebstein anomaly.
Collapse
Affiliation(s)
- Fabio V Lima
- Department of Medicine, Division of Cardiovascular Medicine, State University of New York at Stony Brook, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Paraskevi Koutrolou-Sotiropoulou
- Department of Medicine, Division of Cardiovascular Medicine, State University of New York at Stony Brook, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Tzyy Yun M Yen
- Department of Preventive Medicine and Graduate Program in Public Health, State University of New York at Stony Brook, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Kathleen Stergiopoulos
- Department of Medicine, Division of Cardiovascular Medicine, State University of New York at Stony Brook, Stony Brook University Medical Center, Stony Brook, NY, USA.
| |
Collapse
|
85
|
Reparación completa quirúrgica en adultos con situación Fallot no operada o solamente paliada: ¿ficción o realidad? CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2015.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
86
|
Kempny A, Diller GP, Dimopoulos K, Alonso-Gonzalez R, Uebing A, Li W, Babu-Narayan S, Swan L, Wort SJ, Gatzoulis MA. Determinants of outpatient clinic attendance amongst adults with congenital heart disease and outcome. Int J Cardiol 2016; 203:245-50. [DOI: 10.1016/j.ijcard.2015.10.081] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/15/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
|
87
|
Baliulis G, Ropponen JO, Salmon TP, Kaarne MO. Valve-sparing aortic root replacement in adult patients previously operated for congenital heart defects: an initial experience: Table 1:. Eur J Cardiothorac Surg 2015; 50:155-9. [DOI: 10.1093/ejcts/ezv446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/26/2015] [Indexed: 11/13/2022] Open
|
88
|
Shafer K, Gurvitz M. Evaluation of Health Care Quality in Adults with Congenital Heart Disease. Cardiol Clin 2015; 33:635-41, ix-x. [DOI: 10.1016/j.ccl.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
89
|
Al-Mallah MH, Aljizeeri A, Villines TC, Srichai MB, Alsaileek A. Cardiac computed tomography in current cardiology guidelines. J Cardiovasc Comput Tomogr 2015; 9:514-23. [DOI: 10.1016/j.jcct.2015.09.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 01/06/2023]
|
90
|
|
91
|
Webb G, Mulder BJ, Aboulhosn J, Daniels CJ, Elizari MA, Hong G, Horlick E, Landzberg MJ, Marelli AJ, O'Donnell CP, Oechslin EN, Pearson DD, Pieper EP, Saxena A, Schwerzmann M, Stout KK, Warnes CA, Khairy P. The care of adults with congenital heart disease across the globe: Current assessment and future perspective. Int J Cardiol 2015; 195:326-33. [DOI: 10.1016/j.ijcard.2015.04.230] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/29/2015] [Indexed: 11/30/2022]
|
92
|
Olivieri LJ, Cross RR, O'Brien KE, Ratnayaka K, Hansen MS. Optimized protocols for cardiac magnetic resonance imaging in patients with thoracic metallic implants. Pediatr Radiol 2015; 45:1455-64. [PMID: 26040508 PMCID: PMC7610221 DOI: 10.1007/s00247-015-3366-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/31/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (MR) imaging is a valuable tool in congenital heart disease; however patients frequently have metal devices in the chest from the treatment of their disease that complicate imaging. Methods are needed to improve imaging around metal implants near the heart. Basic sequence parameter manipulations have the potential to minimize artifact while limiting effects on image resolution and quality. OBJECTIVE Our objective was to design cine and static cardiac imaging sequences to minimize metal artifact while maintaining image quality. MATERIALS AND METHODS Using systematic variation of standard imaging parameters on a fluid-filled phantom containing commonly used metal cardiac devices, we developed optimized sequences for steady-state free precession (SSFP), gradient recalled echo (GRE) cine imaging, and turbo spin-echo (TSE) black-blood imaging. We imaged 17 consecutive patients undergoing routine cardiac MR with 25 metal implants of various origins using both standard and optimized imaging protocols for a given slice position. We rated images for quality and metal artifact size by measuring metal artifact in two orthogonal planes within the image. RESULTS All metal artifacts were reduced with optimized imaging. The average metal artifact reduction for the optimized SSFP cine was 1.5+/-1.8 mm, and for the optimized GRE cine the reduction was 4.6+/-4.5 mm (P < 0.05). Quality ratings favored the optimized GRE cine. Similarly, the average metal artifact reduction for the optimized TSE images was 1.6+/-1.7 mm (P < 0.05), and quality ratings favored the optimized TSE imaging. CONCLUSION Imaging sequences tailored to minimize metal artifact are easily created by modifying basic sequence parameters, and images are superior to standard imaging sequences in both quality and artifact size. Specifically, for optimized cine imaging a GRE sequence should be used with settings that favor short echo time, i.e. flow compensation off, weak asymmetrical echo and a relatively high receiver bandwidth. For static black-blood imaging, a TSE sequence should be used with fat saturation turned off and high receiver bandwidth.
Collapse
Affiliation(s)
- Laura J Olivieri
- Division of Cardiology, Children's National Health System, W3-200, 111 Michigan Ave. NW, Washington, DC, 20010, USA,
| | | | | | | | | |
Collapse
|
93
|
Broberg C, Sklenar J, Burchill L, Daniels C, Marelli A, Gurvitz M. Feasibility of Using Electronic Medical Record Data for Tracking Quality Indicators in Adults with Congenital Heart Disease. CONGENIT HEART DIS 2015; 10:E268-77. [PMID: 26239748 DOI: 10.1111/chd.12289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND In order to determine the feasibility of tracking quality of care in adults with congenital heart disease (ACHD), we aimed to estimate the availability of relevant data in electronic medical records (EMR) used in North American ACHD centers. METHODS Previously proposed quality indicators (QIs) were reviewed to consider what types of data would be required for each. ACHD program directors were surveyed about the nature of electronic data in existing EMRs. From the survey, the availability of data types needed for the denominator and numerator of each QI were estimated, and an overall estimate of data availability was calculated for each QI. These estimates were adjusted by the sensitivity of identifying the patients through administrative codes. Analysis was repeated for scenarios in which various data type estimates were hypothetically dropped by half to determine the overall impact of each data type. RESULTS A total of 64 ACHD program directors responded to the survey. Of 55 QIs, average estimated data availability was 67%. QIs for tetralogy of Fallot had the highest estimated data availability (mean 88%), whereas those for atrial septal defect were lowest (mean 23%), reflecting both the need for interpretation of imaging studies and the lower reliability of billing codes for identification of ACHD patients. QIs with highest estimates were based largely on administrative data, which had the biggest impact on overall estimates. QIs needing interpretation of imaging findings had the lowest estimates, as well as certain overuse measures. CONCLUSIONS For a wide range of ACHD programs, data for proposed QIs based on administrative data are most likely to be obtainable through EMR. Data related to imaging interpretation or overuse measures are least likely. Our findings can inform future efforts to establish registry efforts or data reporting tools to track these indicators.
Collapse
Affiliation(s)
- Craig Broberg
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore, USA
| | - Jiri Sklenar
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore, USA
| | - Luke Burchill
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore, USA
| | - Curt Daniels
- Columbus Ohio Adult Congenital Heart Disease Program, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA.,Departments of Pediatrics and Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Arianne Marelli
- MAUDE Unit (McGill Adult Unit for Congenital Heart Disease), McGill University Health Center, Montreal, QC, Canada
| | - Michelle Gurvitz
- Boston Adult Congenital Heart Disease and Pulmonary Hypertension Program, Boston Children's Hospital, Boston, Mass, USA.,Department of Cardiology, and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA
| |
Collapse
|
94
|
Wald RM, Marie Valente A, Marelli A. Heart failure in adult congenital heart disease: Emerging concepts with a focus on tetralogy of Fallot. Trends Cardiovasc Med 2015; 25:422-32. [DOI: 10.1016/j.tcm.2014.11.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 01/12/2023]
|
95
|
Learning and evolving. Cardiol Young 2015; 25:984-90. [PMID: 25789419 DOI: 10.1017/s1047951115000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It is an honour to present the Anthony Chang lecture at this 10th International Conference of the Pediatric Cardiac Intensive Care Society. I have had the privilege of knowing Dr Chang for over 20 years, and although we only worked for a short period of time together at the Children's Hospital, Boston, in the Cardiac Intensive Care Unit, we have remained close colleagues and friends since that time. The contributions of Dr Chang to the development of paediatric cardiac intensive care are very clear, based on his clinical expertise, research and scholarship, and the development of the Pediatric Cardiac Intensive Care Society in its early days. More than this, Dr Chang is an individual with vision; in many respects, he has been ahead of the curve, anticipating and leading the direction of paediatric cardiac intensive care.
Collapse
|
96
|
|
97
|
Bhatt AB, Foster E, Kuehl K, Alpert J, Brabeck S, Crumb S, Davidson WR, Earing MG, Ghoshhajra BB, Karamlou T, Mital S, Ting J, Tseng ZH. Congenital Heart Disease in the Older Adult. Circulation 2015; 131:1884-931. [DOI: 10.1161/cir.0000000000000204] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
98
|
Schwerzmann M, Pfammatter JP. Approaching atrial septal defects in pulmonary hypertension. Expert Rev Cardiovasc Ther 2015; 13:693-701. [DOI: 10.1586/14779072.2015.1047763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
99
|
López MLP, Peinado ÁA, Rocafort ÁG, Zurita MB, Lois JR, Blanco FV, Ruiz JMO, Recalde ÁS. Reparación completa quirúrgica en adultos con situación Fallot no operada o solamente paliada: ¿ficción o realidad? CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
100
|
Choudhary P, Canniffe C, Jackson DJ, Tanous D, Walsh K, Celermajer DS. Late outcomes in adults with coarctation of the aorta. Heart 2015; 101:1190-5. [PMID: 25810155 DOI: 10.1136/heartjnl-2014-307035] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/25/2015] [Indexed: 12/15/2022] Open
Abstract
AIMS Previous cohort studies of patients with coarctation of the aorta (CoA) demonstrate reduced long-term survival. Improved surgical outcomes in children and evolution of adult congenital heart disease (ACHD) services have resulted in improved survival in patients with other CHDs. We hypothesise that for young adult patients with CoA long-term outcomes have improved in the contemporary era. METHODS 151 patients (58% men) with simple CoA followed up at a tertiary ACHD service in Sydney, Australia, from 1993 to 2013 were included. We documented mortality and major morbidity such as the need for re-intervention for re-coarctation or aneurysms. RESULTS 140 patients (mean age 35±15 years) underwent CoA repair at median age of 5 (IQR 0-10) years. Initial surgical strategy included end-to-end repair in 43, subclavian flap aortoplasty in 28 and patch aortoplasty in 31 patients (and was not documented in 28 cases). 6 patients had endovascular repair, 4 had interposition tube grafts and 11 were unrepaired. There were a total of seven deaths at a median age of 60 years. Actuarial survival was 98% at 40, 98% at 50 and 89% at 60 years of age. Re-coarctation occurred in 34% and descending aortic aneurysms were noted in 18%. Patients with end-to-end repair had lower rates of significant re-coarctation or descending aortic aneurysms (p=0.026 and <0.001, respectively). 66% had bicuspid aortic valve and 44% were hypertensive. CONCLUSIONS Patients with CoA who reach adolescence demonstrate very good long-term survival up to age 60 years. Long-term morbidity is common, however, related largely to aortic complications and late hypertension.
Collapse
Affiliation(s)
- P Choudhary
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - C Canniffe
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Department of Cardiology, Mater Misericordiae Hospital, Dublin, Ireland
| | - D J Jackson
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - D Tanous
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - K Walsh
- Department of Cardiology, Mater Misericordiae Hospital, Dublin, Ireland
| | - D S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|