51
|
|
52
|
Gulati GS, Hoey ETD, Gopalan D, Agrawal BSK, Screaton NJ. Sinus venosus atrial septal defect in adults: utility of cardiovascular MRI in resolving this diagnostic dilemma. Heart Lung Circ 2010; 19:615-9. [PMID: 20655279 DOI: 10.1016/j.hlc.2010.06.666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/27/2010] [Accepted: 06/07/2010] [Indexed: 12/01/2022]
Abstract
Sinus venosus atrial septal defect (SV-ASD) can be a challenging diagnostic problem. It can present with non-specific signs and symptoms and, on imaging, can mimic other causes of right heart dilatation. Transthoracic echocardiography using standard scan planes may be limited, due to the defect and any associated anomalous pulmonary venous drainage lying outside the confines of the fossa ovalis. At our institution, we use cardiovascular magnetic resonance imaging (CMRI) as a problem-solving tool in these patients. In this article, we discuss the utility of CMRI in establishing the diagnosis by presenting our recent experience and illustrating it with sample cases. We wish to highlight the problems relating to making a diagnosis of SV-ASD in adult patients, and how CMRI has contributed to overcoming these in our practice.
Collapse
|
53
|
Rajiah P, Kanne JP. Computed tomography of septal defects. J Cardiovasc Comput Tomogr 2010; 4:231-45. [DOI: 10.1016/j.jcct.2010.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/27/2010] [Accepted: 05/20/2010] [Indexed: 11/28/2022]
|
54
|
Akhtar NJ, Markowitz AH, Gilkeson RC. Multidetector Computed Tomography in the Preoperative Assessment of Cardiac Surgery Patients. Radiol Clin North Am 2010; 48:117-39. [DOI: 10.1016/j.rcl.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
55
|
Pac A, Polat TB, Vural K, Pac M. Successful two-stage correction of ventricular septal defect and patent ductus arteriosus in a patient with fixed pulmonary hypertension. Pediatr Cardiol 2010; 31:111-3. [PMID: 19812882 DOI: 10.1007/s00246-009-9534-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
Abstract
We report a case of a 6-year-old boy with fixed severe pulmonary artery hypertension secondary to a ventricular septal defect (VSD) together with a patent ductus arteriosus (PDA). As a preliminary step, PDA embolization was performed following therapy with inhaled prostacyclin over a period of 6 months. Further, the patient underwent successful surgical VSD closure. We postulate that a staged procedure with long-term prostaglandin therapy might be capable of reducing pulmonary artery resistance and permitting total correction in a patient once considered to have inoperable pulmonary arteriopathy.
Collapse
Affiliation(s)
- Aysenur Pac
- Department of Pediatric Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, Kizilay S, No: 4, 06100 Sihhiye, Ankara, Turkey.
| | | | | | | |
Collapse
|
56
|
Yong G, Khairy P, De Guise P, Dore A, Marcotte F, Mercier LA, Noble S, Ibrahim R. Pulmonary arterial hypertension in patients with transcatheter closure of secundum atrial septal defects: a longitudinal study. Circ Cardiovasc Interv 2009; 2:455-62. [PMID: 20031756 DOI: 10.1161/circinterventions.108.826560] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) may develop in patients with atrial septal defects (ASD); however, little is known about associated risk factors and its evolution after transcatheter ASD closure. METHODS AND RESULTS We conducted a cohort study on 215 adults with attempted transcatheter ASD closure from 1999 to 2006. Patients were classified according to baseline systolic pulmonary artery pressures as having no (I, <40 mm Hg), mild (II, 40 to 49 mm Hg), moderate (III, 50 to 59 mm Hg), or severe (IV, >or=60 mm Hg) PAH. Independent predictors of moderate or severe PAH were older age (odds ratio [OR], 1.10 per year; P<0.0001), larger ASD (OR, 1.13 per millimeter; P=0.0052), female sex (OR, 3.9; P=0.0313), and at least moderate tricuspid regurgitation (OR, 3.6; P=0.0043). At 15 (interquartile range, 8 to 43) months post-ASD closure, patients with higher baseline pressures were more likely to experience a >or=5-mm Hg decrease (33.7%, 73.9%, 79.2%, and 100.0% in groups I to IV, P<0.0001), with a larger magnitude of reduction (0, 8, 17, and 22 mm Hg; P<0.0001). However, normalization of pressures (<40 mm Hg) occurred less frequently in patients with more advanced PAH (90.2%, 71.7%, 66.7%, and 23.5%, P<0.0001). Among patients with moderate or severe PAH, independent predictors of normalization were lower baseline pressures (OR, 0.91 per mm Hg; P=0.0418) and no more than mild tricuspid regurgitation (OR, 0.14; P=0.0420). CONCLUSIONS In adults with ASDs, severity of PAH is modulated by age, sex, defect size, and degree of tricuspid regurgitation. Patients with moderate or severe PAH may benefit from substantial reductions in pulmonary artery pressures after transcatheter ASD closure, although the PAH values remain elevated in a sizeable proportion.
Collapse
Affiliation(s)
- Gerald Yong
- Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Canada
| | | | | | | | | | | | | | | |
Collapse
|
57
|
Lee YS, Jeng MJ, Tsao PC, Yang CF, Soong WJ, Hwang B, Tang RB. Pulmonary function changes in children after transcatheter closure of atrial septal defect. Pediatr Pulmonol 2009; 44:1025-32. [PMID: 19768807 DOI: 10.1002/ppul.21100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study was performed to assess changes in pulmonary function test (PFT) and pulmonary outcome after transcatheter closure of atrial septal defect (ASD) in pediatric patients. A total 55 pediatric patients undergoing transcatheter ASD closure received PFT at baseline (day before ASD closure), and at 3 days and 6 months after procedure. Forced vital capacity (FVC), forced expired volume in 1 sec (FEV(1)), FEV(1) to FVC ratio (FEV(1)/FVC), peak expiratory flow (PEF), and mean forced expiratory flow during the middle half of FVC (FEF(25-75)) were measured. Individually, subjects were classified by spirometry as normal, obstructive or restrictive, to evaluate the effect of transcatheter closure on pulmonary outcome. These 55 children had significantly reduced mean PEF and FEF(25-75) (84 +/- 24%, P = 0.040 and 76 +/- 22%, P = 0.010, respectively) at baseline, with FEF(25-75) reduced significantly at 3 days and 6 months (78 +/- 24%, P = 0.010 and 81 +/- 24%, P = 0.040, respectively) after transcatheter closure. Six months after transcatheter closure of ASD, significant improvement was observed in mean FVC (94 +/- 19% vs. 98 +/- 15%, P = 0.034) and FEV(1) (90 +/- 20% vs. 96 +/- 19%, P = 0.008). Assessed individually, better pulmonary outcome was found in patients without pulmonary hypertension (PH) (chi(2) = 8.333, P = 0.044). PFT disturbance was observed in significant flow limitation in the peripheral airway of ASD patients. Improved PFT was found after transcatheter closure and better pulmonary outcome was observed in patients without PH. ASD children need monitoring pulmonary function and should receive transcatheter closure before PH develops.
Collapse
Affiliation(s)
- Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
58
|
Toyono M, Krasuski RA, Pettersson GB, Matsumura Y, Yamano T, Shiota T. Persistent tricuspid regurgitation and its predictor in adults after percutaneous and isolated surgical closure of secundum atrial septal defect. Am J Cardiol 2009; 104:856-61. [PMID: 19733724 DOI: 10.1016/j.amjcard.2009.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 05/02/2009] [Accepted: 05/02/2009] [Indexed: 10/20/2022]
Abstract
The fate of functional tricuspid regurgitation (TR) after closure of a secundum atrial septal defect (ASD) without any corrective tricuspid valve (TV) surgery remains unclear. We investigated this and the predictors of persistent TR after ASD closure. Thirty-two consecutive patients with moderate or severe TR before ASD closure were examined. Of these, 23 underwent percutaneous ASD closure, and 9 underwent isolated surgical ASD closure. The left ventricular end-diastolic volume, left ventricular ejection fraction, right ventricular end-diastolic area, right ventricular fractional area change, right ventricular spherical index, right atrial area, TV annular diameter, TV tethering height, pulmonary artery systolic pressure, and pulmonary/systemic blood flow ratio were determined by echocardiography before and early after ASD closure. The color Doppler maximal jet area was used to assess the severity of TR. After ASD closure, the jet area decreased for all patients (p = 0.009); however, 16 patients (50%) had persistent TR. Multivariate analysis revealed that only pulmonary artery systolic pressure before ASD closure was related to the TR jet area after ASD closure (p = 0.003). A pulmonary artery systolic pressure of >60 mm Hg predicted persistent TR with 100% sensitivity and 63% specificity. In conclusion, functional TR was ameliorated after percutaneous and isolated surgical ASD closure, although persistent TR was common. The presence of pulmonary hypertension before ASD closure predicted persistent TR; therefore, corrective TV surgery should be considered at ASD closure in adult patients with moderate or severe TR and concomitant pulmonary hypertension.
Collapse
|
59
|
Hoey ETD, Gopalan D, Ganesh V, Agrawal SKB, Screaton NJ. Atrial septal defects: Magnetic resonance and computed tomography appearances. J Med Imaging Radiat Oncol 2009; 53:261-70. [DOI: 10.1111/j.1754-9485.2009.02079.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
60
|
Hoey ETD, Gopalan D, Agrawal SKB, Screaton NJ. Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT. Eur Radiol 2009; 19:2557-68. [DOI: 10.1007/s00330-009-1460-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/19/2009] [Accepted: 04/27/2009] [Indexed: 11/29/2022]
|
61
|
Riesenkampff EMC, Schmitt B, Schnackenburg B, Huebler M, Alexi-Meskishvili V, Hetzer R, Berger F, Kuehne T. Partial anomalous pulmonary venous drainage in young pediatric patients: the role of magnetic resonance imaging. Pediatr Cardiol 2009; 30:458-64. [PMID: 19184180 DOI: 10.1007/s00246-008-9367-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/22/2008] [Indexed: 11/25/2022]
Abstract
Studies of larger patient groups for systematic assessment of the anatomical accuracy of magnetic resonance imaging (MRI) for partial anomalous pulmonary venous drainage (PAPVD) have been performed so far only in adults. This study was undertaken to evaluate whether MRI can precisely depict pulmonary venous anatomy in infants and young children. Data on 26 children under 10 years old that underwent MRI over the past 2 years for suspected PAPVD were assessed. The MRI protocol included shunt quantification by velocity-encoded cine as well as morphological and functional assessment by multislice multiphase and contrast-enhanced MR techniques. MRI was performed in the compliant patient in breath-hold (n = 8; age range, 4.6-9.5 years) and in the noncompliant patient in conscious-sedation free breathing (n = 18; age range, 0.4 to 7.5 years). In 22 patients, PAPVD was diagnosed with MRI and confirmed during surgery. In four patients with large atrial septal defects not accessible to percutaneous closure, normal pulmonary venous return was demonstrated by MRI and confirmed during surgery. MRI under conscious sedation accurately specifies the anatomy of pulmonary veins in infants and small children. Therefore, we suggest performing MRI in patients with inconclusive transthoracic echocardiographic results in the preoperative assessment of PAPVD.
Collapse
|
62
|
Pulmonary atherosclerosis associated with an atrial septal defect in old age: Case report of an elderly autopsied patient. Pathol Res Pract 2009; 205:137-41. [DOI: 10.1016/j.prp.2008.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 06/25/2008] [Accepted: 07/10/2008] [Indexed: 11/23/2022]
|
63
|
Cho HJ, Chung WJ, Bong JM, Shin KC, Shin MS, Kang WC, Han SH, Moon CI, Koh KK, Ahn TH, Choi IS, Shin EK. Inferior Sinus Venosus Type Atrial Septal Defect Initially Presenting Pulmonary Hypertension on Transthoracic Echocardiography. J Cardiovasc Ultrasound 2009. [DOI: 10.4250/jcu.2009.17.1.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hyon Joung Cho
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Jeong Min Bong
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Kwen-Chul Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Chan Il Moon
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Kwang Kon Koh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Tae Hoon Ahn
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - In Suck Choi
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Eak Kyun Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| |
Collapse
|
64
|
Pulmonary arterial hypertension in adults with congenital heart disease: distinct differences from other causes of pulmonary arterial hypertension and management implications. Curr Opin Cardiol 2008; 23:545-54. [DOI: 10.1097/hco.0b013e3283126954] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
65
|
Dimopoulos K, Peset A, Gatzoulis MA. Evaluating operability in adults with congenital heart disease and the role of pretreatment with targeted pulmonary arterial hypertension therapy. Int J Cardiol 2008; 129:163-71. [DOI: 10.1016/j.ijcard.2008.02.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 02/22/2008] [Indexed: 11/29/2022]
|
66
|
Goetschmann S, Dibernardo S, Steinmann H, Pavlovic M, Sekarski N, Pfammatter JP. Frequency of severe pulmonary hypertension complicating "isolated" atrial septal defect in infancy. Am J Cardiol 2008; 102:340-2. [PMID: 18638598 DOI: 10.1016/j.amjcard.2008.03.061] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 03/19/2008] [Accepted: 03/19/2008] [Indexed: 11/19/2022]
Abstract
Atrial septal defects (ASDs) are typically asymptomatic in infancy and early childhood, and elective defect closure is usually performed at ages of 4 to 6 years. Severe pulmonary hypertension (PH) complicating an ASD is seen in adulthood and has only occasionally been reported in small children. A retrospective study was undertaken to evaluate the incidence of severe PH complicating an isolated ASD and requiring early surgical correction. During a 10-year period (1996 to 2006), 355 pediatric patients underwent treatment for isolated ASDs either surgically or by catheter intervention at 2 tertiary referral centers. Two hundred ninety-seven patients had secundum ASDs, and 58 had primum ASDs with mild to moderate mitral regurgitation. Eight infants were found with isolated ASDs (6 with secundum ASDs and 2 with primum ASDs) associated with significant PH, accounting for 2.2% of all patients with ASDs at the centers. These 8 infants had invasively measured pulmonary artery pressures of 50% to 100% of systemic pressure. They were operated in the first year of life and had complicated postoperative courses requiring specific treatment for PH for up to 16 weeks postoperatively. The ultimate outcomes in all 8 infants were good, with persistent normalization of pulmonary pressures during midterm follow-up of up to 60 months (median 28). All other patients with ASDs had normal pulmonary pressures, and the mean age at defect closure was significantly older, at 6.2 years for secundum ASDs and 3.2 years for primum ASDs. In conclusion, ASDs were rarely associated with significant PH in infancy but then required early surgery and were associated with excellent midterm outcomes in these patients.
Collapse
Affiliation(s)
- Sora Goetschmann
- Department of Pediatrics, Division of Pediatric Cardiology, University Children's Hospital, Bern, Switzerland
| | | | | | | | | | | |
Collapse
|
67
|
Luciani GB, Viscardi F, Pilati M, Crepaz R, Faggian G, Mazzucco A. Age at Repair Affects the Very Long-Term Outcome of Sinus Venosus Defect. Ann Thorac Surg 2008; 86:153-9. [DOI: 10.1016/j.athoracsur.2008.03.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 03/18/2008] [Accepted: 03/21/2008] [Indexed: 10/21/2022]
|
68
|
Kharouf R, Luxenberg DM, Khalid O, Abdulla R. Atrial septal defect: spectrum of care. Pediatr Cardiol 2008; 29:271-80. [PMID: 17955282 DOI: 10.1007/s00246-007-9052-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 05/15/2007] [Accepted: 07/03/2007] [Indexed: 11/25/2022]
Abstract
Atrial septal defect (ASD) is a common congenital heart defect. Variability in management of this lesion exists among clinicians. A review of the literature reveals that there is lack of standard guidelines for the evaluation and management of patients with different types of ASDs. This survey-based study was conducted to test the uniformity of diagnostic and therapeutic approach to management of children with secundum, sinus venosus, and primum ASDs. Survey questionnaires were prepared to include questions regarding follow-up, diagnosis, and therapeutic intervention of different types and sizes of ASDs. Questions addressed follow-up visitations, type and frequency of investigative studies, pharmacological therapy, and choice of repair method. Surveys were sent out to all pediatric cardiology academic programs in the United States (n=48) and randomly selected international programs from Europe, Asia, and Australia (n=19). A total of 23 programs (34%) responded to the survey (15 from the United States and 8 internationally). A separate questionnaire was prepared for secundum, primum, and sinus venosus ASD. In each questionnaire, lesion types were subdivided into small, moderate, and large defect sizes to address differences of management approaches to each defect type and size. Results indicate that in secundum ASD, most participants use size of the defect and/or evidence of right-sided volume overload as criteria for defining small, moderate, and large defects. Frequency of follow-up does not vary with the type of lesion but is more frequent with larger defects. Most participants see patients with small defects at intervals of 6 months to 1 year and those with large defects at 3- to 6-month intervals. Age of patient and presence of symptoms determined the frequency of follow-up across all defects. Echocardiography was the most frequently used investigative modality in all defect sizes and types during follow-up visits (used by >80% for follow-up), followed by electrocardiography (ECG). There is a striking preference for the use of pharmacological therapy in primum ASD compared with secundum and sinus venosus ASD. The timing of repair was mainly dependent on patient age and symptomatology in different defects, with the presence of associated anomalies contributing to that in primum and sinus venosus ASD. Most participants use percutaneous approach to close secundum ASD (either as a first choice or as one of two choices depending on the presence of certain features). Before repair, participants use MRI or cardiac catheterization to fully evaluate a secundum ASD if it is large. These investigative modalities are not commonly used in primum and sinus venosus ASD. There is agreement on postoperative follow-up in different types of defects, with most participants continuing follow-up indefinitely, especially in larger defects.
Collapse
Affiliation(s)
- R Kharouf
- The University of Chicago, MC 4051, Chicago, Illinois 60637-1470, USA.
| | | | | | | |
Collapse
|
69
|
Affiliation(s)
- Robert J. Sommer
- From the Center for Interventional Vascular Therapy, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY (R.J.S.); Department of Pediatrics and Medicine, Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Ill (Z.M.H.); and Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC (J.F.R.)
| | - Ziyad M. Hijazi
- From the Center for Interventional Vascular Therapy, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY (R.J.S.); Department of Pediatrics and Medicine, Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Ill (Z.M.H.); and Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC (J.F.R.)
| | - John F. Rhodes
- From the Center for Interventional Vascular Therapy, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY (R.J.S.); Department of Pediatrics and Medicine, Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Ill (Z.M.H.); and Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC (J.F.R.)
| |
Collapse
|
70
|
Abstract
Pulmonary hypertension is a frequently encountered problem in older patients. True idiopathic pulmonary arterial hypertension can also be seen and requires careful exclusion in older patients. Institution of therapies must be tempered with an appreciation of individual comorbidities and functional limitations that may affect patients' ability to comply and benefit from the complex treatments available for pulmonary arterial hypertension. This article reviews the existing data on the various forms of pulmonary hypertension presenting in older patients and on appropriate therapy in this challenging population.
Collapse
Affiliation(s)
- John R McArdle
- Division of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Pulmonary Hypertension Center, Yale University School of Medicine, 333 Cedar Street, LCI 105D, P.O. Box 208057, New Haven, CT 06520-8057, USA.
| | | | | |
Collapse
|
71
|
Arat N, Sökmen Y, Altay H, Özcan F, İlkay E. Left and Right Atrial Myocardial Deformation Properties in Patients with an Atrial Septal Defect. Echocardiography 2008; 25:401-7. [DOI: 10.1111/j.1540-8175.2007.00614.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
72
|
|
73
|
Galie N, Manes A, Palazzini M, Negro L, Marinelli A, Gambetti S, Mariucci E, Donti A, Branzi A, Picchio FM. Management of Pulmonary Arterial Hypertension Associated with Congenital Systemic-to-Pulmonary Shunts and Eisenmenger???s Syndrome. Drugs 2008; 68:1049-66. [PMID: 18484798 DOI: 10.2165/00003495-200868080-00004] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Nazzareno Galie
- Institute of Cardiology, University of Bologna, Bologna, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
74
|
Lim DS, Bergin JD, Ragosta M. Hypertrophic cardiomyopathy complicated by atrial septal defect and pulmonary hypertension. Catheter Cardiovasc Interv 2008; 71:659-64. [DOI: 10.1002/ccd.21426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
75
|
Bruch L, Winkelmann A, Sonntag S, Scherf F, Rux S, Grad MO, Kleber FX. Fenestrated occluders for treatment of ASD in elderly patients with pulmonary hypertension and/or right heart failure. J Interv Cardiol 2007; 21:44-9. [PMID: 18086135 DOI: 10.1111/j.1540-8183.2007.00324.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Atrial septal defect (ASD) occlusion in adult patients with advanced age and left or right heart diastolic or systolic heart failure and in patients with pulmonary arterial hypertension bears a considerable risk of deterioration of heart failure. Therefore, we conducted this feasibility trial in 15 ASD patients with pulmonary hypertension and/or right heart failure using a fenestrated Amplatzer septal occluder (AGA Medical Corporation, Golden Valley, MN), allowing an overflow of blood in both directions in case of univentricular diastolic or systolic heart failure. In all patients, the device could be implanted without complications. All symptomatic patients showed an improvement in the New York Heart Association (NYHA) class, and no right or left heart decompensation occurred. On echocardiography, right ventricular end diastolic dimension (RVEDD) and pulmonary artery pressure (PAP) decreased significantly, whereas left ventricular end diastolic dimension (LVEDD) increased. Our series of 15 patients with fenestrated ASD occlusion shows that high-risk ASD occlusion can safely be accomplished with excellent clinical results and without complications by a fenestrated occluder.
Collapse
Affiliation(s)
- Leonhard Bruch
- From the Department of Internal Medicine/Cardiology, Unfallkrankenhaus Berlin Academic Teaching Hospital, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
76
|
Dimopoulos K, Gatzoulis MA. Evaluating Operability in Adults with Congenital Heart Disease and the Role of Pretreatment with Targeted Pulmonary Arterial Hypertension Therapy. ACTA ACUST UNITED AC 2007. [DOI: 10.21693/1933-088x-6.3.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Despite recent advances in cardiac surgery that have allowed repair of congenital heart defects at a very young age, pulmonary arterial hypertension (PAH) secondary to congenital heart disease (CHD) remains a major problem. In its most severe form, the Eisenmenger syndrome, PAH and its complications result in a significant increase in morbidity and mortality and also greatly affect the quality of life of patients.
Collapse
Affiliation(s)
| | - Michael A. Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom
| |
Collapse
|
77
|
Duffels MGJ, Engelfriet PM, Berger RMF, van Loon RLE, Hoendermis E, Vriend JWJ, van der Velde ET, Bresser P, Mulder BJM. Pulmonary arterial hypertension in congenital heart disease: An epidemiologic perspective from a Dutch registry. Int J Cardiol 2007; 120:198-204. [PMID: 17182132 DOI: 10.1016/j.ijcard.2006.09.017] [Citation(s) in RCA: 210] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Revised: 08/25/2006] [Accepted: 09/24/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) associated with congenital heart disease is usually the result of a large systemic-to-pulmonary shunt, and often leads to right ventricular failure and early death. The purpose of this study was to determine the prevalence of PAH among adult patients included in a national registry of congenital heart disease and to assess the relation between patient characteristics and PAH. METHODS Patients with PAH associated with a septal defect were identified from the registry. Gender, age, underlying diagnosis, previous closure, age at repair and NYHA classification were recorded. PAH was defined as a systolic pulmonary arterial pressure (sPAP) greater than 40 mm Hg, estimated by means of echocardiographical evaluation. RESULTS The prevalence of PAH among all 5970 registered adult patients with congenital heart disease was 4.2%. Of 1824 patients with a septal defect in the registry, 112 patients (6.1%) had PAH. Median age of these patients was 38 years (range 18-81 years) and 40% were male. Of these patients, 58% had the Eisenmenger syndrome. Among the patients with a previously closed septal defect, 30 had PAH (3%). Ventricular septal defect (VSD) was the most frequent underlying defect (42%) among patients with PAH and a septal defect. Female sex (Odds ratio=1.5, p=0.001) and sPAP (Odds ratio=0.04, p<0.001) were independently associated with a decreased functional class. CONCLUSION PAH is common in adult patients with congenital heart disease. In our registry the prevalence of PAH in septal defects is around 6%. More than half of these patients have the Eisenmenger syndrome, which accounts for 1% of the total population in the CONCOR registry. Whether the prevalence of PAH will decrease in the future as a result of early detection and intervention remains to be awaited.
Collapse
Affiliation(s)
- M G J Duffels
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Duffels M, van Loon L, Berger R, Boonstra A, Vonk-Noordergraaf A, Mulder B. Pulmonary Arterial Hypertension Associated with a Congenital Heart Defect: Advanced Medium-term Medical Treatment Stabilizes Clinical Condition. CONGENIT HEART DIS 2007; 2:242-9. [DOI: 10.1111/j.1747-0803.2007.00104.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
79
|
Ussia GP, Mulè M, Caruso E, Aiello R, Tamburino C. Combined endothelin receptor antagonist and transcatheter interventional therapy of patent ductus arteriosus with severe pulmonary artery hypertension. Int J Cardiol 2007; 116:427-9. [PMID: 16875749 DOI: 10.1016/j.ijcard.2006.03.080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Accepted: 03/25/2006] [Indexed: 11/21/2022]
Abstract
The natural history of congenital heart disease (CHD) with left to right shunt and high pulmonary blood flow, is characterized by development of severe Pulmonary Artery Hypertension (PAH); this condition usually contraindicates any type of surgical or interventional cardiac correction because of bad results. We here report the case of an adult patient with a patent ductus arteriosus and severe PAH, treated uneventfully with a staged combined therapy: Bosentan for 3 months and then percutaneous closure with amplatzer duct occluder (AGA Med. Co. Golden Valley, MN). The patient showed a dramatic improvement both of pulmonary hemodynamics and functional capacity at 8 months follow up confirming the efficacy of pulmonary vasodilator therapy in PAH associated to congenital heart disease.
Collapse
|
80
|
Michelakis ED, Archer SL. Pulmonary Arterial Hypertension. CARDIOVASCULAR MEDICINE 2007. [PMCID: PMC7123519 DOI: 10.1007/978-1-84628-715-2_108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The first description of the circulation of blood through the lungs has been attributed to Ibn Nafis (1210–1288).1 The concept was rediscovered by Michael Servetus, a Spanish physician during the Renaissance (1511–1553) and recorded, oddly enough, in two pages of his religious treatise, Christianismi Restitutio (1553).2 The definitive exposition of the pulmonary circulation was made by William Harvey in DeMotu Cordis (1628).3 The first observation of the pulmonary capillaries was first reported by Marcellus Malpighi (1661).4 Heart catheterization in humans, driven by a desire to obtain the perfect mixed venous specimen and measure cardiac output, was first performed in 1929 by the German urologist Forssmann,5 using a ureteral catheter to access his own right atrium. Over a decade later, Cournand and Richards at Columbia University in New York subsequently used right heart catheterization to record pulmonary artery pressure (PAP) in patients with shock and secondary forms of pulmonary hypertension (PHT). For these accomplishments, which were inspired by an interest in the pulmonary circulation and PHT related to mitral stenosis, Forssmann, Cournand, and Richards received the Nobel Prize in 1956.
Collapse
|
81
|
MESH Headings
- Adolescent
- Adult
- Aged
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Exercise/physiology
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/genetics
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/therapy
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Male
- Middle Aged
- Pregnancy
- Pregnancy Complications, Cardiovascular
- Pregnancy Outcome
- Prevalence
- Ventricular Remodeling/physiology
Collapse
Affiliation(s)
- Gary Webb
- University of Pennsylvania School of Medicine, 6 Penn Tower, 3400 Spruce St, Philadelphia, PA 19104-4283, USA.
| | | |
Collapse
|
82
|
Schwerzmann M, Zafar M, McLaughlin PR, Chamberlain DW, Webb G, Granton J. Atrial septal defect closure in a patient with “irreversible” pulmonary hypertensive arteriopathy. Int J Cardiol 2006; 110:104-7. [PMID: 15992947 DOI: 10.1016/j.ijcard.2005.05.062] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Accepted: 05/21/2005] [Indexed: 10/25/2022]
Abstract
The presence of irreversible pulmonary hypertension in patients with atrial septal defect (ASD) is thought to preclude shunt closure. We report the case of a woman with plexiform pulmonary arteriopathy secondary to an ostium secundum ASD who was able to successfully undergo percutaneous shunt closure following therapy with chronic intravenous prostacyclin (Flolan). One year after closure, the patient was weaned off Flolan over a period of 7 months following the institution of oral Bosentan therapy. Our case illustrates how aggressive vasodilator therapy with prostaglandins may be capable of reducing pulmonary artery pressure and permitting shunt closure in a patient once considered to have "inoperable" pulmonary arteriopathy.
Collapse
|
83
|
Sachweh JS, Daebritz SH, Hermanns B, Fausten B, Jockenhoevel S, Handt S, Messmer BJ. Hypertensive pulmonary vascular disease in adults with secundum or sinus venosus atrial septal defect. Ann Thorac Surg 2006; 81:207-13. [PMID: 16368366 DOI: 10.1016/j.athoracsur.2005.07.053] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 07/12/2005] [Accepted: 07/18/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The development of hypertensive pulmonary vascular disease (HPVD) is considered a risk factor in the long-term course of patients with secundum atrial septal defects (ASD). The aim of this study was to assess the prevalence and histologic degree of HPVD and pulmonary hypertension in relation to preoperative clinical and hemodynamic data, intraoperative findings, and operative outcome in adults. METHODS Lung biopsies of 75 patients, mean age 44 +/- 14 years (18-71 years), with secundum ASD or sinus venosus defect including ten patients with partial anomalous pulmonary venous return were analyzed in accordance with preoperative and intraoperative findings as well as operative outcome. Lung biopsy was performed at the time of defect closure and was classified according to Heath and Edwards. RESULTS Structural changes of the pulmonary vasculature were found in 59% of patients; grade 3 and higher changes were present in 19%. There were no statistically significant relations between histologic findings and preoperative clinical and hemodynamic data, intraoperative findings, and operative outcome. The prevalence of moderate (32-50 mm Hg) and severe (> 50 mm Hg) systolic pulmonary hypertension was 27% and 17%, respectively. Increased systolic pulmonary arterial pressure was associated with increased pulmonary vascular resistance (p < 0.000) and patients' age (p = 0.001). Patients with a lower functional capacity had a higher prevalence of pulmonary hypertension (p = 0.011). CONCLUSIONS The prevalence of HPVD and pulmonary hypertension in adult patients with secundum ASD or sinus venosus defect is considerable. Preoperative hemodynamic data do not predict the degree of HPVD in lung biopsy. Closure is generally advised to prevent increasing pulmonary arterial pressure and decreasing functional capacity over time.
Collapse
Affiliation(s)
- Joerg S Sachweh
- Department of Thoracic and Cardiovascular Surgery, University Hospital, RWTH Aachen University, Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
84
|
Trojnarska O, Szyszka A, Gwizdala A, Oko-Sarnowska Z, Katarzynski S, Siniawski A, Chmara E, Cieslinski A. Evaluation of Exercise Capacity with Cardiopulmonary Exercise Testing and Type B Natriuretic Peptide Concentrations in Adult Patients with Patent Atrial Septal Defect. Cardiology 2006; 106:154-60. [PMID: 16636545 DOI: 10.1159/000092770] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 02/13/2006] [Indexed: 11/19/2022]
Abstract
UNLABELLED Adults with patent atrial septal defect (ASD) usually find their exercise capacity satisfactory, and therefore hesitate to accept proposed surgical treatment of the heart disease. The aim of our study was to evaluate both the exercise capacity, using the cardio-pulmonary stress test, and brain natriuretic peptide (BNP) levels in asymptomatic adults with ASD. Thirty-six patients with patent secundum type ASD (aged mean 44.7 +/- 8.2 years) were studied. The control group consisted of 25 healthy subjects at the mean age of 45.6 +/- 6.1 years. Echocardiography and CPST were performed and BNP levels measured in all subjects. Oxygen uptake (VO2 max) was lower in ASD patients than in controls (22.1 +/- 5.6 vs. 30.0 +/- 6.8 ml/kg/min, p = 0.00001); the VE/VO2 slope was elevated in ASD patients compared with healthy subjects (31.3 +/- 6.6 vs. 26.9 +/- 3.3, p = 0.001), and exceeded 34 in 5 patients. VO2 max showed a negative correlation with the pulmonary to systemic flow ratio Qp:Qs (r = -0.46, p = 0.004), and a positive correlation was found between the VE/VO2 slope and Qp:Qs (r = 0.32, p = 0.05). BNP levels were higher in the ASD group than in the controls (60.6 +/- 49.9 vs. 32.6 +/- 24.5 pg/ml, p = 0.02). BNP correlated positively with RV diameter and Qp:Qs (r = 0.38 and 0.39 respectively, p = 0.03) and negatively with maximum VO2 (r = -0.5, p = 0.004) and VO2% (r = -0.32, p = 0.07). CONCLUSIONS Although most adult patients with ASD perceive their exercise capacity as satisfactory, objective assessment reveals that in fact it is significantly decreased. BNP levels are increased comparing to healthy individuals. Decreased exercise capacity and increased BNP levels seem to result from right ventricular volume overload.
Collapse
Affiliation(s)
- Olga Trojnarska
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland.
| | | | | | | | | | | | | | | |
Collapse
|
85
|
Provencher S, Martel S, Jais X, Sitbon O, Humbert M, Simonneau G. Diagnostic et classification des hypertensions artérielles pulmonaires. Presse Med 2005; 34:1435-44. [PMID: 16301975 DOI: 10.1016/s0755-4982(05)84205-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The clinical classification of types of pulmonary hypertension has made it possible to better standardize the approach to the diagnosis and treatment of patients, to perform clinical studies among homogeneous patients, and to discover common laboratory abnormalities that may serve as markers or help elucidate mechanisms of disease. Pulmonary arterial hypertension groups together different diseases that affect the small-caliber pulmonary arteries and lead to a progressive increase in pulmonary arterial resistance and right heart failure. A specific diagnosis of pulmonary arterial hypertension is generally based on a detailed and methodical clinical evaluation. Pulmonary biopsy is rarely indicated. Work-up in a center specialized in the management of this disease is frequently appropriate when the cause of the hypertension is not clear or when a specific treatment is envisaged.
Collapse
Affiliation(s)
- S Provencher
- Institut de cardiologie et de pneumologie de l'université Laval, service de pneumologie, Hôpital Laval, Québec, Canada.
| | | | | | | | | | | |
Collapse
|
86
|
Galiè N, Torbicki A, Barst R, Dartevelle P, Haworth S, Higenbottam T, Olschewski H, Peacock A, Pietra G, Rubin LJ, Simonneau G. Guías de Práctica Clínica sobre el diagnóstico y tratamiento de la hipertensión arterial pulmonar. Rev Esp Cardiol 2005; 58:523-66. [PMID: 15899198 DOI: 10.1157/13074846] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
87
|
Abstract
Pulmonary arterial hypertension (PAH) is a term used to classify a variety of conditions that share in common an injury to the pulmonary vasculature that produces elevations in pulmonary arterial pressure. However, it is the integrity of right ventricular function, rather than the degree of vascular injury, that is the major determinant of symptoms and survival in PAH. The article will review the normal structure and function of the right ventricle and summarize the impact of PAH and its treatments on right ventricular function.
Collapse
Affiliation(s)
- Kelly M Chin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, California, USA
| | | | | |
Collapse
|
88
|
Abstract
POSSIBLITIES FOR PROGNOSTIC IMPROVEMENT: The inter-auricular communication (IAC) is the most frequent of congential malformations in adults and is responsible for enhanced morbidity and rduction in life expectancy. The closure of an IAC with volumic overload eradicates such morbidity and mortality. The technical progress in the conception of prosthesises that obstrue the interauricular communications via the percutaneous route make this technique a reliable alternative to surgery that, itself, leads to a certain degree of discomfort and considerable morbidity. DEPENDING ON THE ECHOCARDIOGRAPHICAL DATA: The selection of patients is crucial and relies on trans-thoracic echocardiography. It is indicated in isolated ostium secundum-type inter-auricular communications with a border of at least 4 mm separating it from the adjacent structures of the heart; the size on the echocardiography must not exceed 30 mm. FROM A TECHNICAL POINT OF VIEW: The closure is made under fluoroscopic and echocardiographic control via the trans-oesophageal route. It is rapid, simple, and induces a low rate of morbidity. With Amplatz's prosthesis, the percentage of complete closure is equivalent to that obtained with surgery but with less morbidity with regard to arrhythmia. Today the reliable percutaneous closure of an IAC will probably permit the extension of the indications for the closure of this congenital abnormality in adults.
Collapse
Affiliation(s)
- Jean Losay
- Unité de cardiologie pédiatrique, laboratoire d'hémodynamique et d'angiographie, Hôpital Marie Lannelongue, Le Plessis-Robinson.
| | | |
Collapse
|
89
|
Abstract
Pulmonary hypertension is a complex disease that can be idiopathic, familial, or associated with a wide range of disease processes. This article outlines the classification of primary pulmonary hypertension and discusses the various types of the disease.
Collapse
Affiliation(s)
- Vallerie V McLaughlin
- Pulmonary Hypertension Program, Division of Cardiovascular Medicine, University of Michigan, Woman's RM. L3119, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0273, USA.
| |
Collapse
|
90
|
Avdalovic M, Sandrock C, Hoso A, Allen R, Albertson TE. Epoprostenol in Pregnant Patients with Secondary Pulmonary Hypertension. ACTA ACUST UNITED AC 2004; 3:29-34. [PMID: 15174891 DOI: 10.2165/00151829-200403010-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Women who present with pulmonary hypertension during gestation have traditionally been persuaded to terminate their pregnancy. Historically, the mortality associated with this group is very high. Certain patients with a secondary cause of pulmonary hypertension are believed to share similar pathophysiology with primary pulmonary hypertension patients. Recently, new treatments have become available that have slowed disease progression. We present the successful treatment of two patients who presented during late gestation with moderate pulmonary hypertension. Both patients were managed with intravenous vasodilators and anticoagulants without complication. Each patient successfully delivered a healthy child via spontaneous vaginal delivery. The review of the historical management of similar patients including new insights into the etiology of pulmonary arterial hypertension is also included. It highlights the complexity involved in managing such patients and the requirement of a multidisiplinary team approach.
Collapse
Affiliation(s)
- Mark Avdalovic
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California 95817, USA.
| | | | | | | | | |
Collapse
|
91
|
Moore J, Doyle TP. Interventional catheter therapy in adults with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2003. [DOI: 10.1016/s1058-9813(03)00013-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
92
|
Fox JM, Bjornsen KD, Mahoney LT, Fagan TE, Skorton DJ. Congenital heart disease in adults: catheterization laboratory considerations. Catheter Cardiovasc Interv 2003; 58:219-31. [PMID: 12552548 DOI: 10.1002/ccd.10433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Congenital heart defects are the most common birth defects and represent an increasing proportion of adolescent and adult patients followed by cardiologists. While many of these patients have undergone successful palliative or corrective surgery with excellent functional results, most of them still require careful follow-up. Further, even complex lesions may first be diagnosed in adolescence and adulthood. Therefore, cardiologists caring for adults need to become more familiar with these defects. Assessment of the patient with known or suspected congenital heart defects requires a careful history, physical examination, and noninvasive assessment. In addition, the catheterization laboratory remains a critical venue for diagnosis and, increasingly, therapy. Pressure measurements, oximetry, and angiography remain cornerstones of diagnosis in selected patients and a variety of interventional procedures have become viable therapeutic alternatives in both pre- and postoperative patients.
Collapse
MESH Headings
- Adult
- Aortic Coarctation/diagnosis
- Aortic Coarctation/physiopathology
- Aortic Valve Stenosis/diagnosis
- Aortic Valve Stenosis/physiopathology
- Cardiac Catheterization
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/physiopathology
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/surgery
- Heart Septal Defects, Ventricular/diagnosis
- Heart Septal Defects, Ventricular/physiopathology
- Heart Septal Defects, Ventricular/surgery
- Hemodynamics
- Humans
- Pulmonary Valve Stenosis/diagnosis
- Pulmonary Valve Stenosis/physiopathology
- Tetralogy of Fallot/diagnosis
- Tetralogy of Fallot/physiopathology
- Transposition of Great Vessels/diagnosis
- Transposition of Great Vessels/physiopathology
- Tricuspid Atresia/diagnosis
- Tricuspid Atresia/physiopathology
Collapse
Affiliation(s)
- James M Fox
- Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, USA
| | | | | | | | | |
Collapse
|
93
|
Abstract
Pulmonary arterial hypertension (PAH) is a recognized complication of congenital systemic to pulmonary arterial cardiac shunts. The prognosis of PAH in this situation is better than primary or other secondary forms of PAH. Our knowledge of the pathophysiology of PAH complicating congenital heart disease has evolved over the past decade. Despite differences in etiology and pathobiology, therapies that have proven successful for primary PAH may benefit this group of patients.
Collapse
Affiliation(s)
- John T Granton
- Department of Medicine, University of Toronto, Division of Respirology and Critical Care Medicine Programme, University Health Network, 10 EN-220, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4.
| | | |
Collapse
|
94
|
Steiner RM, Reddy GP, Flicker S. Congenital cardiovascular disease in the adult patient: imaging update. J Thorac Imaging 2002; 17:1-17. [PMID: 11828207 DOI: 10.1097/00005382-200201000-00001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert M Steiner
- Department of Radiology, the Weill Medical College of Cornell University, New York, NY.
| | | | | |
Collapse
|
95
|
|