101
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Tay EL, Papaphylactou M, Diller GP, Alonso-Gonzalez R, Inuzuka R, Giannakoulas G, Harries C, Wort SJ, Swan L, Dimopoulos K, Gatzoulis MA. Quality of life and functional capacity can be improved in patients with Eisenmenger syndrome with oral sildenafil therapy. Int J Cardiol 2011; 149:372-6. [DOI: 10.1016/j.ijcard.2010.02.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 10/20/2009] [Accepted: 02/14/2010] [Indexed: 10/19/2022]
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102
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Chronická plicní hypertenze. Doporučený diagnostický a léčebný postup České kardiologické společnosti, 2010. COR ET VASA 2011. [DOI: 10.33678/cor.2011.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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103
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Affiliation(s)
- Iris Ma
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, USA
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104
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Abstract
Pulmonary arterial hypertension (PAH) is a common problem in adult patients with congenital heart disease. We review available data on aetiology, clinical presentation, prognosis and management of PAH in this setting. In addition, we discuss general management strategies and emerging disease-targeting therapies.
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Affiliation(s)
- G-P Diller
- Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Centre (EMAH Zentrum), University Hospital Muenster, University of Muenster, Muenster, Germany.
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105
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Silversides CK, Salehian O, Oechslin E, Schwerzmann M, Vonder Muhll I, Khairy P, Horlick E, Landzberg M, Meijboom F, Warnes C, Therrien J. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: complex congenital cardiac lesions. Can J Cardiol 2010; 26:e98-117. [PMID: 20352139 DOI: 10.1016/s0828-282x(10)70356-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. They have distinctive forms of heart failure and their cardiac disease can be associated with pulmonary hypertension, thromboemboli, complex arrhythmias and sudden death. Medical aspects that need to be considered relate to the long-term and multisystemic effects of single ventricle physiology, cyanosis, systemic right ventricles, complex intracardiac baffles and failing subpulmonary right ventricles. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. Part III of the guidelines includes recommendations for the care of patients with complete transposition of the great arteries, congenitally corrected transposition of the great arteries, Fontan operations and single ventricles, Eisenmenger's syndrome, and cyanotic heart disease. Topics addressed include genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy risk and follow-up requirements. The complete document consists of four manuscripts, which are published online in the present issue of The Canadian Journal of Cardiology. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.
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106
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Echocardiographic Indexes for the Non-Invasive Evaluation of Pulmonary Hemodynamics. J Am Soc Echocardiogr 2010; 23:225-39; quiz 332-4. [DOI: 10.1016/j.echo.2010.01.003] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Indexed: 11/20/2022]
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107
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Dimopoulos K, Inuzuka R, Goletto S, Giannakoulas G, Swan L, Wort SJ, Gatzoulis MA. Improved Survival Among Patients With Eisenmenger Syndrome Receiving Advanced Therapy for Pulmonary Arterial Hypertension. Circulation 2010; 121:20-5. [DOI: 10.1161/circulationaha.109.883876] [Citation(s) in RCA: 265] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Advanced therapy (AT) for pulmonary arterial hypertension in the context of congenital heart disease (Eisenmenger syndrome) improves pulmonary hemodynamics, functional class, and the 6-minute walk test. We examined the potential effect of AT on survival in this population.
Methods and Results—
Data on all Eisenmenger patients attending our center over the past decade were collected. Survival rates were compared between patients on and off AT with the use of a modified version of the Cox model, which treats AT as a time-varying covariate. Baseline differences were adjusted for the use of propensity scores. A total of 229 patients (aged 34.5±12.6 years; 35.4% male) were included. The majority had complex anatomy, and 53.7% were in New York Heart Association class ≥III at baseline assessment. Mean resting saturations were 84.3%. Sixty-eight patients (29.7%) either were on AT or had AT initiated during follow-up. During a median follow-up of 4.0 years, 52 patients died, only 2 of them while on AT. Patients on AT were at a significantly lower risk of death, both unadjusted and after adjustment for baseline clinical differences by propensity score regression adjustment (
C
statistic=0.80; hazard ratio, 0.16; 95% confidence interval, 0.04 to 0.71;
P
=0.015) and propensity score matching (hazard ratio, 0.10; 95% confidence interval, 0.01 to 0.78;
P
=0.028).
Conclusions—
AT for pulmonary arterial hypertension in a contemporary cohort of adults with Eisenmenger syndrome was associated with a lower risk of death. Survival benefits should be considered together with improved hemodynamics and functional class when decisions are made about AT in this population.
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Affiliation(s)
- Konstantinos Dimopoulos
- From the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK (K.D., R.I., S.G., G.G., L.S., S.J.W., M.A.G.); and National Heart and Lung Institute, Imperial College School of Medicine, London, UK (K.D., M.A.G.)
| | - Ryo Inuzuka
- From the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK (K.D., R.I., S.G., G.G., L.S., S.J.W., M.A.G.); and National Heart and Lung Institute, Imperial College School of Medicine, London, UK (K.D., M.A.G.)
| | - Sara Goletto
- From the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK (K.D., R.I., S.G., G.G., L.S., S.J.W., M.A.G.); and National Heart and Lung Institute, Imperial College School of Medicine, London, UK (K.D., M.A.G.)
| | - Georgios Giannakoulas
- From the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK (K.D., R.I., S.G., G.G., L.S., S.J.W., M.A.G.); and National Heart and Lung Institute, Imperial College School of Medicine, London, UK (K.D., M.A.G.)
| | - Lorna Swan
- From the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK (K.D., R.I., S.G., G.G., L.S., S.J.W., M.A.G.); and National Heart and Lung Institute, Imperial College School of Medicine, London, UK (K.D., M.A.G.)
| | - Stephen J. Wort
- From the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK (K.D., R.I., S.G., G.G., L.S., S.J.W., M.A.G.); and National Heart and Lung Institute, Imperial College School of Medicine, London, UK (K.D., M.A.G.)
| | - Michael A. Gatzoulis
- From the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK (K.D., R.I., S.G., G.G., L.S., S.J.W., M.A.G.); and National Heart and Lung Institute, Imperial College School of Medicine, London, UK (K.D., M.A.G.)
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108
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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.
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Affiliation(s)
- Aysenur Pac
- Department of Pediatric Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, Kizilay S, No: 4, 06100 Sihhiye, Ankara, Turkey.
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109
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Duffels MGJ, Mulder KM, Trip MD, de Groot E, Gort J, van Dijk APJ, Hoendermis ES, Daliento L, Zwinderman AH, Berger RMF, Mulder BJM. Atherosclerosis in Patients With Cyanotic Congenital Heart Disease. Circ J 2010; 74:1436-41. [DOI: 10.1253/circj.cj-09-0858] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Mieke D Trip
- Department of Cardiology, Academic Medical Center
- Department of Vascular Medicine, Academic Medical Center
| | - Erik de Groot
- Department of Vascular Medicine, Academic Medical Center
| | - Johan Gort
- Department of Vascular Medicine, Academic Medical Center
| | - Arie PJ van Dijk
- Department of Cardiology, Radboud University Nijmegen Medical Center
| | | | | | - Aeiko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center
| | - Rolf MF Berger
- Department of Paediatric Cardiology, University Medical Center Groningen
| | - Barbara JM Mulder
- Department of Cardiology, Academic Medical Center
- Department of Cardiology, University Medical Center Utrecht
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110
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Kulik T, Mullen M, Adatia I. Pulmonary arterial hypertension associated with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2009. [DOI: 10.1016/j.ppedcard.2009.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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111
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112
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113
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Januszewska K, Malec E, Juchem G, Kaczmarek I, Sodian R, Uberfuhr P, Reichart B. Heart-lung transplantation in patients with pulmonary atresia and ventricular septal defect. J Thorac Cardiovasc Surg 2009; 138:738-43. [PMID: 19698864 DOI: 10.1016/j.jtcvs.2008.12.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 11/18/2008] [Accepted: 12/25/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Heart-lung transplantation for patients with pulmonary atresia and ventricular septal defect is challenging. The aim of the study was to present a single-center experience with heart-lung transplantation in this difficult group of patients. METHODS A retrospective review identified 9 patients aged 4.1 to 45.6 years (median, 25.4 years) with pulmonary atresia and ventricular septal defect who underwent heart-lung transplantation. Four (44.4%) patients had previous heart operations: 3 of them had palliative procedures (systemic-to-pulmonary shunts), and 1 had multistage correction. A standard transplantation method was used, with the exception of 1 patient with heterotaxy syndrome who underwent a modified operation. Major aortopulmonary collateral arteries were controlled by using various techniques. RESULTS Follow-up ranged between 2 days and 12.6 years (median, 1.2 years). The hospital mortality rate was 22.2% (n = 2). In the late postoperative period, 3 patients died. The survival curve was similar to that of patients with other diagnoses undergoing heart-lung transplantation. The median length of intensive care unit stay was 58 days (range, 22-82 days), and the median length of hospital stay was 83 days (range, 35-136 days). The most common early complication was bleeding requiring re-exploration. In all cases the bleeding was proved to be from collateral vessels. CONCLUSIONS Heart-lung transplantation in patients with pulmonary atresia and ventricular septal defect requires carefully planned and meticulously performed surgical intervention. This management should be taken into consideration as a future option if the specific anatomy is uncorrectable in early childhood, and the palliative procedures should be avoided.
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Affiliation(s)
- Katarzyna Januszewska
- Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
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114
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115
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Fine N, Dias B, Shoemaker G, Mehta S. Endothelin receptor antagonist therapy in congenital heart disease with shunt-associated pulmonary arterial hypertension: a qualitative systematic review. Can J Cardiol 2009; 25:e63-8. [PMID: 19279988 DOI: 10.1016/s0828-282x(09)70041-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) with systemic-topulmonary shunting is associated with pulmonary arterial hypertension (PAH). There are similar clinical and pathophysiological features between CHD with shunt-associated PAH and idiopathic PAH. Endothelin-receptor antagonists (ERAs) are oral medications that improve pulmonary hemodynamics, symptoms and functional capacity in many PAH patients. However, the role of ERAs in CHD with shunt-associated PAH is unclear. METHODS MEDLINE, EMBASE and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases were searched for articles published from 1966 through September 2006, as well as bibliographies of all retrieved papers. All published English-language studies of adult CHD patients with shunt-associated PAH treated with ERAs were reviewed for clinical, functional and hemodynamic outcomes. RESULTS Ten studies of 174 adult CHD subjects with shunt-associated PAH were identified. Other than one placebo-controlled, randomized clinical trial, all studies were open-label, uncontrolled observational trials. Subjects were treated with the ERA bosentan for a mean (+/- SD) of 9+/-7 months. Nine studies reported improved World Health Organization (WHO) modification of the New York Heart Association functional class, with 95 of 164 subjects (58%) improving by at least one functional class. The 6 min walk distance improved in all eight studies in which it was assessed. Bosentan was generally well tolerated; 2.3% of subjects withdrew because of elevated liver enzymes. Two patients with WHO functional class IV PAH died during bosentan therapy. CONCLUSION Treatment of CHD patients with shunt-associated PAH with the ERA bosentan is associated with an improvement in functional class and objectively measured exercise capacity. The consistency of the uncontrolled data and the positive results of a single randomized clinical trial suggest a role for ERA therapy in CHD patients with shunt-associated PAH. Caution is suggested when considering bosentan therapy for CHD patients with WHO functional class IV PAH.
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Affiliation(s)
- N Fine
- Department of Medicine, University of Western Ontario, London, Canada
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116
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117
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Duffels MG, Vis JC, van Loon RL, Berger RM, Hoendermis ES, van Dijk AP, Bouma BJ, Mulder BJ. Down patients with Eisenmenger syndrome: Is bosentan treatment an option? Int J Cardiol 2009; 134:378-83. [DOI: 10.1016/j.ijcard.2008.02.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 02/27/2008] [Indexed: 12/01/2022]
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118
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119
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Abstract
Pulmonary hypertension comprises a family of disorders occurring as a primary disease or as a complication of a large number of respiratory and cardiac diseases. Pulmonary hypertension is present when pulmonary artery pressure or mean pressure exceeds 30 mmHg or 20 mmHg, respectively. Underlying the hemodynamic changes that result in pulmonary hypertension, whether from hypoxia, acidosis, increased pulmonary blood flow, increased shear stress, or idiopathic causes, is a dysfunctional vascular endothelium. In this review, the role of the history and physical examination in the initial assessment is emphasized. Newer diagnostic modalities, such as subselective pulmonary angiography and ultrafast computed tomography scanning, are reviewed. Low-flow oxygen, anticoagulation, and calcium-channel blockade are presented as accepted therapeutic modalities. Inhaled nitric oxide and prostacyclin infusion are presented as newer therapies that may be useful given the limited availability of donor organs for hear-lung transplantation. Future therapeutic strategies are likely to develop from advances in vascular biology.
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Affiliation(s)
- D Moraes
- Whitaker Cardiovascular Institute, Boston, Massachusetts, USA
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120
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Chung KH, Kim SH, Chun DH, Lee JY, Park SC, Park CH, Kim MG. Anesthetic management for emergent craniotomy in a patient with Eisenmenger's syndrome - A case report -. Korean J Anesthesiol 2009; 57:666-669. [DOI: 10.4097/kjae.2009.57.5.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kum Hee Chung
- Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Pocheon, Korea
| | - Seung Ho Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Duk Hee Chun
- Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Pocheon, Korea
| | - Jong Yun Lee
- Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Pocheon, Korea
| | - Seong Cheol Park
- Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Pocheon, Korea
| | - Chung Hyun Park
- Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Pocheon, Korea
| | - Min Goo Kim
- Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Pocheon, Korea
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121
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Besterman E. ATRIAL SEPTAL DEFECT WITH PULMONARY HYPERTENSION. BRITISH HEART JOURNAL 2008; 23:587-98. [PMID: 18610164 DOI: 10.1136/hrt.23.5.587] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- E Besterman
- Department of Cardiology, the Middlesex Hospital
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122
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Pulmonary arterial hypertension in congenital cardiac disease--the need for refinement of the Evian-Venice classification. Cardiol Young 2008; 18:10-7. [PMID: 18205971 DOI: 10.1017/s1047951107001849] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary hypertension associated with congenital systemic-to-pulmonary shunts has been classified, in the Evian-Venice classification, as Pulmonary Arterial Hypertension, which includes a heterogeneous group of conditions. Emerging options for treatment of patients with pulmonary arterial hypertension are related to those with the idiopathic form of the disease, but may also improve quality of life and survival in patients with pulmonary arterial hypertension associated with congenital cardiac disease. Despite the evident similarities in pulmonary vascular disease, it is important also to recognise the differences between patients in whom pulmonary arterial hypertension is the consequence of systemic-to-pulmonary shunts as opposed to those with other conditions. Patients with pulmonary hypertension associated with congenital cardiac disease themselves constitute a heterogeneous population, in which generalisation may be hazardous. Specific considerations need to be given to the type of cardiac diagnosis, the prognosis and evolution of pulmonary vascular disease, and the circulatory physiology before embarking on new strategies for medical treatment in the individual patient. In this review, we highlight the features that require specific attention in these patients. In addition, we discuss briefly the data currently available on the effectiveness of the new anti-proliferative drugs in patients with the Eisenmenger syndrome.
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123
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Diller GP, Dimopoulos K, Kafka H, Ho SY, Gatzoulis MA. Model of chronic adaptation: right ventricular function in Eisenmenger syndrome. Eur Heart J Suppl 2007. [DOI: 10.1093/eurheartj/sum019] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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124
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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: 236] [Impact Index Per Article: 13.9] [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.
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Affiliation(s)
- M G J Duffels
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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125
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Abstract
Cardiac disorders complicate less than 1% of all pregnancies. Physiologic changes in pregnancy may mimic heart disease. In order to differentiate these adaptations from pathologic conditions, an in-depth knowledge of cardiovascular physiology is mandatory. A comprehensive history, physical examination, electrocardiogram, chest radiograph, and echocardiogram are sufficient in most cases to confirm the diagnosis. Care of women with cardiac disease begins with preconception counseling. Severe lesions should be taken care of prior to contemplating pregnancy. Management principles for pregnant women are similar to those for the non-pregnant state. A team approach comprised of a maternal fetal medicine specialist, cardiologist, neonatologist, and anesthesiologist is essential to assure optimal outcome for both the mother and the fetus. Although fetal heart disease complicates only a small percentage of pregnancies, congenital heart disease causes more neonatal morbidity and mortality than any other congenital malformation. Unfortunately, screening approaches for fetal heart disease continue to miss a large percentage of cases. This weakness in fetal screening has important clinical implications, because the prenatal detection and diagnosis of congenital heart disease may improve the outcome for many of these fetal patients. In fact, simply the detection of major heart disease prenatally can improve neonatal outcome by avoiding discharge to home of neonates with ductal-dependent congenital heart disease. Fortunately, recent advances in screening techniques, an increased ability to change the prenatal natural history of many forms of fetal heart disease, and an increasing recognition of the importance of a multidisciplinary, team approach to the management of pregnancies complicated with fetal heart disease, together promise to improve the outcome of the fetus with congenital heart disease.
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Affiliation(s)
- Afshan B Hameed
- Maternal Fetal Medicine and Cardiology, University of California, Irvine, USA
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126
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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]
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127
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Griffin N, Allen D, Wort J, Rubens M, Padley S. Eisenmenger syndrome and idiopathic pulmonary arterial hypertension: do parenchymal lung changes reflect aetiology? Clin Radiol 2007; 62:587-95. [PMID: 17467397 DOI: 10.1016/j.crad.2007.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Revised: 12/30/2006] [Accepted: 01/05/2007] [Indexed: 01/15/2023]
Abstract
AIM To document the pulmonary vascular changes on thin-section computed tomography (CT) in patients with Eisenmenger syndrome and idiopathic pulmonary arterial hypertension, and to determine whether there is any correlation with pulmonary arterial pressures or the aetiology of pulmonary hypertension. MATERIAL AND METHODS From the National Pulmonary Hypertension Database, we identified eight patients with idiopathic pulmonary arterial hypertension and 20 patients with Eisenmenger syndrome (secondary to a ventriculoseptal defect) who had also undergone contrast-enhanced thin-section CT. CT studies were reviewed for the presence of centrilobular nodules, mosaicism, neovascularity, and bronchial artery hypertrophy. Haemodynamic data were also reviewed. RESULTS Centrilobular nodules, mosaicism, and neovascularity were seen in both patient groups (p>0.05). A significantly higher number of enlarged bronchial arteries were seen in patients with Eisenmenger syndrome. There was no correlation with pulmonary arterial pressures. CONCLUSION Patients with idiopathic pulmonary arterial hypertension and Eisenmenger syndrome demonstrated similar pulmonary vascular changes on CT. These changes did not predict the underlying cause of pulmonary hypertension or its severity.
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Affiliation(s)
- N Griffin
- Royal Brompton and Harefield NHS Trust, London, UK.
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128
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Salehian O, Schwerzmann M, Rambihar S, Silver D, Siu S, Webb G, Liu P. Left Ventricular Dysfunction and Mortality in Adult Patients with Eisenmenger Syndrome. CONGENIT HEART DIS 2007; 2:156-64. [DOI: 10.1111/j.1747-0803.2007.00092.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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129
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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.
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130
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Ibrahim R, Granton JT, Mehta S. An open-label, multicentre pilot study of bosentan in pulmonary arterial hypertension related to congenital heart disease. Can Respir J 2007; 13:415-20. [PMID: 17149459 PMCID: PMC2683328 DOI: 10.1155/2006/746176] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bosentan has been shown to be a safe and efficacious treatment for idiopathic pulmonary arterial hypertension (PAH) and PAH associated with connective tissue disease. However, there are limited studies examining the benefits of bosentan in PAH associated with congenital heart disease (CHD). OBJECTIVE The aim of the present pilot study was to explore the safety and efficacy of bosentan in patients with PAH associated with CHD. PATIENTS AND METHODS In the present study, 11 patients with PAH associated with CHD were enrolled to receive bosentan for a minimum of 16 weeks (62.5 mg twice a day for four weeks; thereafter 125 mg twice a day). Safety was assessed by monitoring adverse events, oxygen saturation, systemic blood pressure, pulse, complete blood count and liver function tests. Efficacy was assessed by the World Health Organization functional class, 6 min walk test (6-MWT), modified Borg dyspnea index, echocardiography and the 36-item short form health survey. RESULTS Ten patients completed the 16-week treatment period (one patient withdrew). Bosentan was not associated with a deterioration in resting oxygen saturation (83.0+/-4.6% at week 16 versus 81.9+/-6.1% at baseline; P = 0.402), or a deterioration in post-6-MWT oxygen saturation (70.1+/-10.9% at week 16 versus 68.7+/-15.1% at baseline; P = 0.747). Two patients experienced three serious adverse events. The distance walked in 6 min improved significantly by 28 m (P = 0.005) at week 16 compared with baseline, and the modified Borg dyspnea index also improved at week 16 compared with baseline (P = 0.050). The World Health Organization functional class improved from class III to class II for five of 10 patients (50%). Patients' self-rated quality of life (36-item short form health survey) demonstrated a nonsignificant improvement in each of the eight domains. Obtaining reliable echocardiographic measurements was difficult. Most echocardiographic parameters were only measurable on few patients, and none were measured on all patients, questioning the usefulness of echocardiography as a measuring tool for patients with complex CHD. CONCLUSION Bosentan was not associated with worsening of resting oxygen saturation or exercise systemic oxygen saturation, suggesting its potential as a safe treatment option for patients with PAH associated with CHD. Improved 6-MWT and the modified Borg dyspnea index also suggested the possibility of bosentan as an efficacious treatment option for these patients. The results of the present study provide evidence for the need and feasibility of a large randomized, placebo-controlled clinical trial.
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Affiliation(s)
- Reda Ibrahim
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada.
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131
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Jung JW. Pulmonary Arterial Hypertension of Congenital Heart Diseases: From Reversible Pulmonary Hypertension to Eisenmenger Syndrome. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.7.287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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132
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Therrien J, Rambihar S, Newman B, Siminovitch K, Langleben D, Webb G, Granton J. Eisenmenger syndrome and atrial septal defect: nature or nurture? Can J Cardiol 2006; 22:1133-6. [PMID: 17102831 PMCID: PMC2569052 DOI: 10.1016/s0828-282x(06)70950-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It has long been debated whether patients with atrial septal defect (ASD) Eisenmenger syndrome have idiopathic pulmonary arterial hypertension with an incidental ASD or severe pulmonary hypertension on the basis of their ASD shunt magnitude alone. HYPOTHESIS It was hypothesized that if ASD Eisenmenger patients had idiopathic pulmonary arterial hypertension with an incidental ASD, a mutation in the bone morphogenetic protein receptor-2 (BMPR2) would be found in some of these patients. PATIENTS AND METHODS All adult patients with ASD Eisenmenger syndrome were identified from the databases of two adult congenital cardiac units, and were matched to a control group with similar types of ASDs and no pulmonary hypertension. Gene coding for BMPR2 was examined for mutation using denaturing high-performance liquid chromatography of the entire coding sequence. RESULTS Eighteen adult patients with ASD Eisenmenger syndrome and 18 control patients were identified. ASD Eisenmenger patients had significantly larger ASDs than the control patients (3.7+/-1.2 cm versus 1.9+/-0.7 cm, P<0.01). A mutation in BMPR2 was not detected in either group. CONCLUSION ASD Eisenmenger syndrome may occur without BMPR2 mutation. Whether shunt magnitude alone or in combination with yet another genetic mutation is responsible for the development of pulmonary hypertension in these patients remains to be determined.
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Affiliation(s)
- Judith Therrien
- Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Canada.
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133
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Jones HG, Stoneham MD. Continuous cervical plexus block for carotid body tumour excision in a patient with Eisenmenger's syndrome. Anaesthesia 2006; 61:1214-8. [PMID: 17090246 DOI: 10.1111/j.1365-2044.2006.04860.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A patient with Eisenmenger's syndrome presented for removal of a carotid body tumour. Continuous cervical plexus blockade was successfully used to provide peri-operative and postoperative analgesia. The risks and benefits of regional and general anaesthesia in this high risk patient are discussed.
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Affiliation(s)
- H G Jones
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
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134
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D'Alto M, Vizza CD, Romeo E, Badagliacca R, Santoro G, Poscia R, Sarubbi B, Mancone M, Argiento P, Ferrante F, Russo MG, Fedele F, Calabrò R. Long term effects of bosentan treatment in adult patients with pulmonary arterial hypertension related to congenital heart disease (Eisenmenger physiology): safety, tolerability, clinical, and haemodynamic effect. Heart 2006; 93:621-5. [PMID: 17135220 PMCID: PMC1955562 DOI: 10.1136/hrt.2006.097360] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Oral bosentan is an established treatment for pulmonary arterial hypertension (PAH). OBJECTIVE To evaluate safety, tolerability, and clinical and haemodynamic effects of bosentan in patients with PAH related to congenital heart disease (CHD). PATIENTS 22 patients with CHD related PAH (8 men, 14 women, mean (SD) age 38 (10) years) were treated with oral bosentan (62.5 mg x 2/day for the first 4 weeks and then 125 mg x 2/day). MAIN OUTCOME MEASURES Clinical status, liver enzymes, World Health Organisation (WHO) functional class, resting oxygen saturations and 6-min walk test (6MWT) were assessed at baseline and at 1, 3, 6, and 12 months. Haemodynamic evaluation with cardiac catheterisation was performed at baseline and at 12 month follow-up. RESULTS 12 patients had ventricular septal defect, 5 atrioventricular canal, 4 single ventricle, and 1 atrial septal defect. All patients tolerated bosentan well. No major side effects were seen. After a year of treatment, an improvement was seen in WHO functional class (2.5 (0.7) v 3.1 (0.7); p<0.05), oxygen saturation at rest (87 (6%) v 81 (9); p<0.001), heart rate at rest (81 (10) v 87 (14) bpm; p<0.05), distance travelled in the 6MWT (394 (73) v 320 (108) m; p<0.001), oxygen saturation at the end of the 6MWT (71 (14) v 63 (17%); p<0.05), Borg index (5.3 (1.8) v 6.5 (1.3); p<0.001), pulmonary vascular resistances index (14 (9) v 22 (12) WU m(2); p<0.001), systemic vascular resistances index (23 (11) v 27 (10) WU.m(2); p<0.01), pulmonary vascular resistances index/systemic vascular resistances index (0.6 (0.5) v 0.9 (0.6); p<0.05); pulmonary (4.0 (1.3) v 2.8 (0.9) l/min/m2; p<0.001) and systemic cardiac output (4.2 (1.4) v 3.4 (1.1) l/min/m2; p<0.05). CONCLUSIONS Bosentan was safe and well tolerated in adults with CHD related PAH during 12 months of treatment. Clinical status, exercise tolerance, and pulmonary haemodynamics improved considerably.
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Affiliation(s)
- M D'Alto
- Second University of Naples, A O Monaldi, Naples, Italy.
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135
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Haworth SG. Role of the endothelium in pulmonary arterial hypertension. Vascul Pharmacol 2006; 45:317-25. [PMID: 17005453 DOI: 10.1016/j.vph.2006.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Accepted: 08/05/2006] [Indexed: 11/21/2022]
Abstract
Pulmonary hypertension represents a significant disease burden in both the developed and developing worlds. Certain forms of pulmonary hypertension are more common in some countries than others but people of all races, all ages and both sexes are affected. Treatment options are limited and expensive. The development of new therapies will be determined by improved understanding of endothelial cell biology.
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Affiliation(s)
- S G Haworth
- Department of Vascular Biology, Institute of Child Health, University College London, London, WC1N 1EH, UK.
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136
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Abstract
Heart failure (HF) and pulmonary hypertension (PH) coexist frequently and contribute to each other. Because PH often is an insidious disease, the cornerstone of management is the early identification and treatment of its underlying causes, such as left-sided heart disease, left to right shunts, and pulmonary disorders. A practical clinical classification has been proposed by the Third World Symposium on Pulmonary Arterial Hypertension for the purpose of diagnosis and treatment of PH. Thromboembolic pulmonary hypertension should always be considered. Recent studies using vasodilators such as prostacyclins and endothelin antagonists give new hope in the otherwise poor prognosis of idiopathic pulmonary arterial hypertension and its related conditions. Despite optimum medical management, transplantation (lung/heart-lung) remains the choice in severely symptomatic patients.
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Affiliation(s)
- Mohammed Najeeb Osman
- Research Service, 151W, Louis B. Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
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137
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Apostolopoulou SC, Manginas A, Cokkinos DV, Rammos S. Long-term oral bosentan treatment in patients with pulmonary arterial hypertension related to congenital heart disease: a 2-year study. Heart 2006; 93:350-4. [PMID: 16980516 PMCID: PMC1861451 DOI: 10.1136/hrt.2006.100388] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the long-term clinical and exercise effect of chronic oral administration of the non-selective endothelin receptor antagonist bosentan in patients with pulmonary arterial hypertension (PAH) related to congenital heart disease (CHD). DESIGN Extension of a preceding prospective non-randomised open clinical study on bosentan treatment in PAH related to CHD. SETTING A tertiary referral centre for cardiology. PATIENTS 19 of the original 21 patients of mean (standard deviation (SD)) age 22 (3) years (13 with Eisenmenger syndrome) in World Health Organization (WHO) class II-IV and having a mean (SD) oxygen saturation of 87 (2) %. INTERVENTION Patients received bosentan treatment for 2.4 (0.1) years and underwent clinical and exercise evaluation at baseline, 16 weeks and 2 years of treatment, with haemodynamic assessment at baseline and 16 weeks. RESULTS All patients remained stable with sustained subjective clinical and WHO class improvement (p<0.01) at 16 weeks and 2 years of treatment without significant side effects or changes in oxygen saturation. After the initial 16-week improvement (p<0.05) in peak oxygen consumption and exercise duration at treadmill test, and walking distance and Borg dyspnoea index at 6-min walk test, all exercise parameters appeared to return to their baseline values at 2 years of follow-up. CONCLUSIONS Long-term bosentan treatment in patients with PAH related to CHD is safe and induces clinical stability and improvement, but the objective exercise values appear to slowly return to baseline. Larger studies on long-term endothelin receptor antagonism including quality of life assessment are needed to evaluate the therapeutic role of bosentan in this population.
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Affiliation(s)
- S C Apostolopoulou
- Department of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece.
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138
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Sinha PK, Suneel PR, Unnikrishnan KP. Possible Explanation for Why Blue Blushed. J Cardiothorac Vasc Anesth 2006; 20:471-2. [PMID: 16750762 DOI: 10.1053/j.jvca.2005.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Indexed: 11/11/2022]
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139
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Schulze-Neick I, Gilbert N, Ewert R, Witt C, Gruenig E, Enke B, Borst MM, Lange PE, Hoeper MM. Adult patients with congenital heart disease and pulmonary arterial hypertension: first open prospective multicenter study of bosentan therapy. Am Heart J 2005; 150:716. [PMID: 16209972 DOI: 10.1016/j.ahj.2005.07.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 07/12/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endothelin receptor antagonism has been introduced as an effective oral therapy of patients with idiopathic pulmonary arterial hypertension. In view of the pathophysiologic and histologic similarities between idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), there is a rationale for treating these patients with the oral dual (ET(A)/ET(B)) endothelin receptor antagonist bosentan. METHODS Thirty-three patients with PAH-CHD (43 +/- 14 years, 23 with Eisenmenger syndrome) were treated with bosentan for a mean of 2.1 +/- 0.5 years. Efficacy was assessed by a panel of tests, including New York Heart Association functional class, 6-minute walking distance, and echocardiographic and hemodynamic parameters. RESULTS Mean 6-minute walking distance increased from 362 +/- 105 to 434 +/- 68 m (P = .001). New York Heart Association class also improved significantly (3.1 to 2.4, P = .0001). This was associated with slight trends in improvements of transcutaneous oxygen saturation (86% +/- 7% to 88% +/- 7%, P = .13) and maximum oxygen uptake (13.2 +/- 4.0 to 14.9 +/- 2.5, P = .18). Right ventricular systolic pressure measured by echocardiographic decreased from 111 +/- 32 to 106 +/- 22 mm Hg (P = .001). Bosentan treatment was well tolerated by all patients. CONCLUSIONS Long-term bosentan treatment in adult patients with PAH-CHD was well tolerated and improved functional status as well as exercise capacity. These findings have to be corroborated by controlled studies that are presently ongoing.
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140
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Haskal ZJ. SIR 2005 Annual Meeting Film Panel Case: Hemoptysis and Bronchial Artery Embolization in an Adult with Uncorrected Truncus Arteriosus and Eisenmenger Syndrome. J Vasc Interv Radiol 2005; 16:635-8. [PMID: 15872317 DOI: 10.1097/01.rvi.0000161372.87971.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ziv J Haskal
- Division of Vascular and Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Columbia University, New York, 10032, USA.
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141
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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.
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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.
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142
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Kopka A, McMenemin IM, Serpell MG, Quasim I. Anaesthesia for cholecystectomy in two non-parturients with Eisenmenger's syndrome. Acta Anaesthesiol Scand 2004; 48:782-6. [PMID: 15196113 DOI: 10.1111/j.1399-6516.2004.00405.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular or atrial level. We describe the anaesthetic management of two adult females with Eisenmenger's syndrome admitted for laparoscopic cholecystectomy. One patient suffered post-operative complications, but the other case was uncomplicated. We used sevoflurane and total intravenous anaesthesia to provide general anaesthesia. Both techniques were tolerated.
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Affiliation(s)
- A Kopka
- Department of Anesthesia, Western Infirmary, Dumbarton Road, Glasgow, UK.
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143
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Silversides CK, Granton JT, Konen E, Hart MA, Webb GD, Therrien J. Pulmonary thrombosis in adults with Eisenmenger syndrome. J Am Coll Cardiol 2003; 42:1982-7. [PMID: 14662263 DOI: 10.1016/j.jacc.2003.07.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to determine the prevalence of pulmonary artery thrombosis in patients with Eisenmenger syndrome and to identify individuals at highest risk. BACKGROUND Eisenmenger syndrome is associated with pulmonary arterial thrombus formation. Both the prevalence and the determinants of pulmonary arterial thrombosis are unknown. METHODS This is a review of patients with Eisenmenger syndrome seen at the Toronto Congenital Cardiac Centre for Adults, Canada. Patients underwent a contrast-enhanced computed tomographic (CT) scan of the thorax. RESULTS Forty-nine consecutive patients with Eisenmenger syndrome were seen in our hospital. Fifteen patients did not undergo CT angiograms; therefore, 34 patients (mean age 42 +/- 10 years) were included in the study. Responsible shunts included ventricular septal defect (65%), atrial septal defect (15%), patent ductus arteriosus (9%), and other (11%). The prevalence of proximal pulmonary artery thrombus was 21% (7/34) of patients. Evidence of more distal vessel thrombosis was observed in 43% (3/7) of the patients who had visible thrombus in the proximal pulmonary arteries. Patients with thrombus were more likely to be female (86% vs. 37%, p = 0.04) and to have lower oxygen saturations (72% +/- 9% vs. 85% +/- 6%, p = 0.01). Differences in functional status did not identify patients at highest risk for thrombosis. CONCLUSIONS Patients with Eisenmenger syndrome have a substantial risk of pulmonary artery thrombus formation. Women and patients with lower oxygen saturations are at the highest risk of developing thrombosis. In the context of an increased bleeding tendency in these patients, the role of anticoagulation treatment needs to be determined.
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144
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Abstract
Eisenmenger's syndrome describes the elevation of pulmonary arterial pressure to the systemic level caused by increased pulmonary vascular resistance with reversal or bi-directional shunting through a large intracardiac or extracardiac congenital heart defect. This article reviews the natural history and pathophysiology of Eisenmenger's syndrome untreated and medical and surgical treatment options presently available. Although there is no cure for this condition at present, recent advances in management have improved the quality of life for many patients with Eisenmenger's syndrome.
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Affiliation(s)
- Erika Berman Berman
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
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145
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Berman Rosenzweig E, Gersony WM, Barst RJ. Eisenmenger syndrome in ventricular septal defect patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2001. [DOI: 10.1016/s1058-9813(01)00130-8] [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: 11/30/2022]
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146
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Oya H, Nagaya N, Satoh T, Sakamaki F, Kyotani S, Fujita M, Nakanishi N, Miyatake K. Haemodynamic correlates and prognostic significance of serum uric acid in adult patients with Eisenmenger syndrome. Heart 2000; 84:53-8. [PMID: 10862589 PMCID: PMC1729410 DOI: 10.1136/heart.84.1.53] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess haemodynamic correlates and prognostic significance of serum uric acid in adult patients with Eisenmenger syndrome. DESIGN Retrospective observational study. SETTING Tertiary referral centre. PATIENTS 94 adult patients with Eisenmenger syndrome who were diagnosed between September 1982 and July 1998. MAIN OUTCOME MEASURES Serum uric acid was measured in all patients, together with clinical and haemodynamic variables related to mortality. RESULTS Serum uric acid was raised in patients with Eisenmenger syndrome compared with age and sex matched control subjects (7.0 v 4.7 mg/dl, p < 0.0001) and increased in proportion to the severity of New York Heart Association functional class. Serum uric acid was positively correlated with mean pulmonary arterial pressure (r = 0.30, p = 0.0052) and total pulmonary resistance index (r = 0.55, p < 0.0001), and negatively correlated with cardiac index (r = -0.50, p < 0.0001). During a mean follow up period of 97 months, 38 patients died of cardiopulmonary causes. Among various clinical, echocardiographic, and laboratory variables, serum uric acid remained predictive in multivariate analysis. Kaplan-Meier survival curves based on median serum uric acid showed that patients with high values had a significantly worse survival rate than those with low values (log-lank test: p = 0.0014 in male patients, p = 0.0034 in female patients). CONCLUSIONS Serum uric acid increases in proportion to haemodynamic severity in adult patients with Eisenmenger syndrome and is independently associated with long term mortality.
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Affiliation(s)
- H Oya
- Department of Internal Medicine, National Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
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147
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Franklin RC, Anderson HR, Daniëls O, Elliott M, Gewillig MH, Ghisla R, Krogmann ON, Ulmer HE, Stocker FP. Report of the Coding Committee of the Association for European Paediatric Cardiology. Cardiol Young 1999; 9:633-58. [PMID: 10593279 DOI: 10.1017/s1047951100005734] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- R C Franklin
- Harefield Site, Royal Beompton and Harefield NHS Trust, Middlesex, UK
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148
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Cantor WJ, Harrison DA, Moussadji JS, Connelly MS, Webb GD, Liu P, McLaughlin PR, Siu SC. Determinants of survival and length of survival in adults with Eisenmenger syndrome. Am J Cardiol 1999; 84:677-81. [PMID: 10498138 DOI: 10.1016/s0002-9149(99)00415-4] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A retrospective study of adults with Eisenmenger syndrome assessed at a tertiary referral center was performed to identify clinical characteristics and establish prognostic determinants. Mortality and cause of death are reported with baseline clinical data correlated with mortality to identify predictors of death. Clinical events during follow-up, including heart failure, atrial arrhythmia, hemoptysis, and syncope were also reviewed. A total of 109 adults with Eisenmenger syndrome (mean +/- SD age 29 +/- 11 years, 43% men) were followed for a median of 6.3 years. Sixty-six patients (61%) had simple cardiac anatomy (13 atrial septal defect, 43 ventricular septal defect, 10 patent ductus arteriosus). The remainder (43 patients) had complex cardiac anatomy (including atrioventricular septal defect, truncus arteriosus, univentricular heart, and transposition of the great arteries). There were 33 deaths and 9 transplantations during follow-up. Median survival was 53 years. Multivariate Cox regression analysis identified age at presentation (hazard ratio [HR] 0.90), supraventricular arrhythmia (HR 3.44), precordial electrocardiogram voltage (HR 1.61/mV increase), and poor New York Heart Association functional class (HR 2.60) as independent predictors of mortality. There is a large variation in the life expectancy for adults with Eisenmenger syndrome. Baseline characteristics associated with increased mortality include younger age at presentation (associated with complex anatomy), functional class, supraventricular arrhythmia, and an electrocardiogram index for right ventricular hypertrophy.
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Affiliation(s)
- W J Cantor
- The University of Toronto Congenital Cardiac Centre for Adults, The Toronto Hospital, University of Toronto, Ontario, Canada
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149
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Lust KM, Boots RJ, Dooris M, Wilson J. Management of labor in Eisenmenger syndrome with inhaled nitric oxide. Am J Obstet Gynecol 1999; 181:419-23. [PMID: 10454694 DOI: 10.1016/s0002-9378(99)70572-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Administration of nitric oxide by means of inhalation during the labor of a woman with Eisenmenger's syndrome caused by an atrial septal defect resulted in improved oxygenation and initial pulmonary arterial pressure. She gave birth to a live infant at 34 weeks' gestation but died of worsening pulmonary hypertension and heart failure 21 days post partum.
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Affiliation(s)
- K M Lust
- Royal Brisbane Hospital, Herston, Queensland, Australia
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150
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EVANS DW, HEATH D. Disappearance of the continuous murmur in a case of patent ductus arterious. BRITISH HEART JOURNAL 1998; 23:469-72. [PMID: 13697564 PMCID: PMC1017794 DOI: 10.1136/hrt.23.4.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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