301
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Skoglund K, Heimdahl J, Mandalenakis Z, Thilén U, Johansson B, Christersson C, Sörensson P, Dellborg M. Effect of medical treatment in patients with systemic right ventricle. SCAND CARDIOVASC J 2020; 54:300-305. [PMID: 32274953 DOI: 10.1080/14017431.2020.1751266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Congenitally corrected and surgical atrial redirected transposition of the great arteries (TGA) represents states where the morphological right ventricle serves as a systemic ventricle (S-RV). The S-RV is prone to failure, but data on medical treatment on this problem is limited. The purpose of this study was to evaluate the survival in adults with S-RV, with or without heart failure treatment. Design: The SWEDCON registry was used to collect data. All adults with S-RV and minimum follow-up of 1 year were included retrospectively. Medical treatment was defined as taking beta-blockers and/or ACE inhibitors and/or ARBs for more than 50% of the time. Results: We identified 343 patients with S-RV (median age: 21 years). Surgical atrial redirected TGA was present in 58% and congenitally corrected TGA in 42% of patients. The medically treated group (n = 126) had higher rates of impaired S-RV function, use of diuretics, pacemaker and higher NYHA functional class at baseline compared to controls. The proportion of patients with impaired functional class did not change over time in the medically treated group, but increased in controls (21% vs. 30%, p = .015). In Kaplan-Meier analysis, the mean follow-up was 10.3 years, no difference in survival was seen between the groups. Conclusions: Medical treatment may be beneficial in patients with S-RV and impaired functional class and appears to be safe in the long term. The treatment group had equal survival to controls, despite worse baseline characteristics, which might be a result of slower progression of disease in this group.
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Affiliation(s)
- Kristofer Skoglund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Goteborg, Sweden
| | - Joel Heimdahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Goteborg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Goteborg, Sweden
| | - Ulf Thilén
- Department of Cardiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Peder Sörensson
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Goteborg, Sweden
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302
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Aboulhosn JA, Hijazi ZM, Kavinsky CJ, McElhinney DB, Asgar AW, Benson LN, Daniels CJ, Ghobrial J, Horlick E, Ing FF, Inglessis I, Kay J, Levi DS. SCAI position statement on adult congenital cardiac interventional training, competencies and organizational recommendations. Catheter Cardiovasc Interv 2020; 96:643-650. [PMID: 32272495 DOI: 10.1002/ccd.28885] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | | | | | - Doff B McElhinney
- Stanford University, Lucile Packard Children's Hospital, Stanford, California, USA
| | - Anita W Asgar
- Institut de Cardiologie de Montreal, Montreal, Quebec, Canada
| | - Lee N Benson
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Curt J Daniels
- Columbus Ohio Adolescent and Adult Congenital Heart Disease and the Pulmonary Hypertension Program, The Ohio State University, Columbus, Ohio, USA
| | | | - Eric Horlick
- Toronto General Hospital, Toronto, Ontario, Canada
| | - Frank F Ing
- UC Davis Medical Center, Sacramento, California, USA
| | | | - Joseph Kay
- University of Colorado Denver, Denver, Colorado, USA
| | - Daniel S Levi
- Mattel Children's Hospital at UCLA, Los Angeles, California, USA
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303
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Arvind B, Relan J, Kothari SS. "Treat and repair" strategy for shunt lesions: a critical review. Pulm Circ 2020; 10:2045894020917885. [PMID: 32313642 DOI: 10.1177/2045894020917885] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/18/2020] [Indexed: 11/15/2022] Open
Abstract
The issue of operability in patients with shunt lesions and raised pulmonary vascular resistance is contentious. Several reports suggest that patients traditionally considered inoperable may be operated after treatment with targeted drug therapy for pulmonary arterial hypertension. We reviewed all the published literature of "treat and repair" approach to gain more insights into the utility of this approach. A critical appraisal of the published literature suggests that this approach is less established for patients with post tricuspid shunts, and for patients with pre-tricuspid shunts with modestly elevated indexed pulmonary vascular resistance (possibly greater than 11 WU.m2). Targeted drug therapy may be able to extend the therapeutic window in carefully selected patients, but its use as a routine in this setting seems unwarranted.
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Affiliation(s)
- Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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304
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What Every Cardiologist Should Know About the 2018 Updated Adult Congenital Cardiology Guidelines. Curr Cardiol Rep 2020; 22:24. [DOI: 10.1007/s11886-020-1272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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305
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Ting CT, Chen JW, Chang MS, Yin FC. Pulmonary hemodynamics and wave reflections in adults with atrial septal defects. Am J Physiol Heart Circ Physiol 2020; 318:H925-H936. [DOI: 10.1152/ajpheart.00534.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Using high-fidelity micromanometers and flow velocity sensors at right heart catheterization, we compared pulmonary hemodynamics and wave reflections in age-matched normal adults and those with atrial septal defects, separated into three subgroups based on levels of mean pulmonary artery pressure: low (<17 mmHg), intermediate (17–26 mmHg), high (>26 mmHg). We made baseline measurements in all groups and after intravenous sodium nitroprusside in the subgroups. All of the subgroups had higher than normal baseline pulmonary flows and corresponding power that did not differ among the subgroups. The pulmonary vascular resistance, input resistance, and characteristic impedance in the subgroups did not differ from normal. Aside from the elevated flow and power, the hemodynamics in the low subgroup did not differ from normal. The intermediate subgroup had significantly higher than normal right ventricular and pulmonary artery pressures, wave reflections, and shorter wave reflection time, which all reverted to normal after nitroprusside. The high subgroup had similar changes as the intermediate subgroup. Unlike that subgroup, however, the pressures, wave reflections, and reflection return time did not revert to normal after nitroprusside. Hence, elevated wave reflections, but not resistance or characteristic impedance, are the hallmark of pulmonary hypertension in adults with atrial septal defects. Our results demonstrate that detailed measurements of hemodynamics and assessment of responsiveness to vasodilators provide important information about the pulmonary circulation in atrial septal defect. Coupled with studies after defect closure, those results may be a better foundation than current ones for clinical decisions.
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Affiliation(s)
- Chih-Tai Ting
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jaw-Wen Chen
- Department of Medical Research, Veterans General Hospital, Taipei, Taiwan
- Department of Medicine and Cardiovascular Research Center, National Yang Ming University School of Medicine, Taipei, Taiwan
- Cardiology Division, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
| | - Mau-Song Chang
- Cardiology Division, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
| | - Frank C.P. Yin
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
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306
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Simeone S, Guillari A, Pucciarelli G, Stile F, Gargiulo G, Esposito M, Alvaro R, Rea T. Sexual Health After Acute Myocardial Infarction: The Lived Experience of Women During the First-Year Post Discharge. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09627-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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307
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Cho MY, Weidenbach M, Sinzobahamvya N, Gräfe K, Murin P, Berger F, Photiadis J. Adult congenital open-heart surgery: emergence of a new mortality score. Eur J Cardiothorac Surg 2020; 58:171-176. [DOI: 10.1093/ejcts/ezaa024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/23/2019] [Accepted: 01/04/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
OBJECTIVES
In revised 2018 American Heart Association/American College of Cardiology guideline for the management of adults with congenital heart disease (ACHD), the committee introduced a classification that combines lesion anatomy and physiological status: ACHD anatomic physiological (AP) classification. Anatomy is described as of simple (I), moderate (II) or great (III) complexity, whereas physiology is listed in 4 categories of increasing severity (A, B, C and D). Can this classification predict early postoperative mortality?
METHODS
ACHD AP classification was determined for 339 adults who underwent open-heart surgery between September 2012 and August 2018. In addition, the adult congenital heart surgery (ACHS) and Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery (STAT) mortality scores were calculated. A model based on binary logistic regression was applied. The event was early postoperative death. Mortality scores were estimated for each ACHD AP class.
RESULTS
All patients could be categorized by the ACHD AP classification. The 354 procedures were performed with an early mortality of 3.4% (12/354). The mortality risk for the new mortality score, simply called ACAP score, ranged from 0.2% (95% confidence interval 0.08–0.41%) for ACHD AP class IA to 20% (16.04–24.64%) for IIID class. Observed over expected ratios of early mortality amounted to 0.87, 1.54 and 1.14, whereas areas under the curve of receiver operator characteristic were found to be 0.78, 0.64 and 0.88 for STAT, ACHS and ACAP scores, respectively.
CONCLUSIONS
ACHD AP classification could embrace all procedures. In our setting, the ACAP score was more predictive of early mortality than the ACHS and STAT mortality scores. It should be validated by further studies and other centres.
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Affiliation(s)
- Mi-Young Cho
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
| | - Michael Weidenbach
- Department of Pediatric Cardiology, Helios Leipzig Heart Center, Leipzig, Germany
| | | | - Katharina Gräfe
- Department of Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Peter Murin
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
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308
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Pastor TA, Geva T, Lu M, Duarte VE, Drakeley S, Sleeper LA, Valente AM. Relation of Right Ventricular Dilation After Pulmonary Valve Replacement to Outcomes in Patients With Repaired Tetralogy of Fallot. Am J Cardiol 2020; 125:977-981. [PMID: 31959431 DOI: 10.1016/j.amjcard.2019.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/08/2019] [Accepted: 12/13/2019] [Indexed: 01/10/2023]
Abstract
The rationale for timing of pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rTOF) has focused on pre-PVR threshold values of indexed right ventricular end-diastolic volume (RVEDVi) that lead to normalization of right ventricular (RV) size after valve implantation. The goal of this study was to determine whether persistent RV dilation after PVR is associated with adverse clinical outcomes. Subjects with rTOF who underwent PVR and had a cardiac magnetic resonance (CMR) exam after valve implantation at a single center from 2001 to 2017 were included. The composite clinical outcome after PVR included: death, aborted sudden cardiac death, sustained ventricular tachycardia (VT), or NYHA class ≥3. In 189 rTOF subjects, the mean age at PVR was 23.5 ± 11.7 years, median follow-up was 6.0 years (IQR 3.4 to 8.7), and the primary outcome occurred in 14 subjects (7%). The 5- and 10-year event-free rates were 97% and 91%, respectively. Post-PVR RVEDVi was not associated with the composite outcome (p = 0.59). Independent predictors of the outcome were older age at PVR (hazard ratios [HR] 1.06; 95% confidence interval [CI] 1.02 to 1.11; p = 0.004), post-PVR lower RV ejection fraction (HR 0.91; 95% CI 0.86 to 0.97; p = 0.002), and post-PVR atrial tachyarrhythmia (HR 7.60, 95% CI 1.65 to 35.05, p = 0.009). Our study shows that post-PVR RV dilation as measured by CMR-derived RVEDVi was not associated with the composite adverse clinical outcome in this cohort. These findings challenge the validity of current guidelines for PVR, which are based on pre-procedural threshold values of RVEDVi aimed at achieving normal post-procedural RV volumes.
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309
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Martínez-Quintana E, Girolimetti A, Jiménez-Rodríguez S, Fraguela-Medina C, Rodríguez-González F, Tugores A. Prevalence and predictors of psychological distress in congenital heart disease patients. J Clin Psychol 2020; 76:1705-1718. [PMID: 32149405 DOI: 10.1002/jclp.22948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine psychological distress in congenital heart disease (CHD) patients. METHODS Cross-sectional study among consecutive CHD patients recruited from a single hospital outpatient clinic to determine anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS) questionnaire. RESULTS One hundred and sixty-nine CHD patients [29 (19-39) years old, 100 (59%) males] were studied. A total of 25% and 9% of CHD patients showed anxiety and depression symptoms, respectively. Patients with an HADS score ≥ 8 had a significantly worse New York Heart Association (NYHA) functional class, needed more psychological support, had more mental health history, and took more anxiolytic/antidepressant medication than the CHD patients with an HADS score below 8. A worse NYHA functional class [OR, 1.88 (1.01-3.52)] proved to be a predictor of a borderline/abnormal HADS score. CONCLUSION Psychological distress has a high prevalence among CHD patients and having an NYHA Class II and III is a significant predictor of an HADS score ≥ 8.
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Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.,Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Angela Girolimetti
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara Jiménez-Rodríguez
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carla Fraguela-Medina
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Fayna Rodríguez-González
- Ophthalmology Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Antonio Tugores
- Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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310
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Guglin M, Zucker MJ, Borlaug BA, Breen E, Cleveland J, Johnson MR, Panjrath GS, Patel JK, Starling RC, Bozkurt B. Evaluation for Heart Transplantation and LVAD Implantation. J Am Coll Cardiol 2020; 75:1471-1487. [DOI: 10.1016/j.jacc.2020.01.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
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311
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Pan M, Ojeda S, Hidalgo F, Suárez de Lezo J, Lostalo A, Mazuelos F, Segura J, Pericet C, Luque A, González R, Fernández A, Gomez E, Romero M. Percutaneous reintervention on aortic coarctation stenting. EUROINTERVENTION 2020; 15:1464-1470. [DOI: 10.4244/eij-d-18-00923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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312
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Chan A, Aijaz A, Zaidi AN. Surgical outcomes in complex adult congenital heart disease: a brief review. J Thorac Dis 2020; 12:1224-1234. [PMID: 32274204 PMCID: PMC7139079 DOI: 10.21037/jtd.2019.12.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Life expectancy of patients with congenital heart disease (CHD) continues to increase dramatically over the last few decades, primarily due to significant medical and surgical advancements in the field. Adult congenital heart disease (ACHD) patients are now living longer but continue to face morbidity and reduced long-term survival when compared to the general population. We briefly describe the growth of ACHD with a focus on surgical procedures and outcomes in the more complex lesions including Tetralogy of Fallot, Ebsteins Anomaly of the tricuspid valve, Coarctation of the Aorta, Transposition of the Great Arteries and single ventricle lesions. The advancing role of mechanical circulatory support and cardiac transplantation in ACHD patients is also highlighted. Cardiac surgery in these patients continues to improve with low surgical mortality rate and outstanding long-term outcomes and efficacy.
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Affiliation(s)
- Alice Chan
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amna Aijaz
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Ali N Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, Children's Heart Center Kravis Children's Hospital, New York, NY, USA
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313
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El‐Sabawi B, Al‐Hijji MA, Eleid MF, Cabalka AK, Ammash NM, Dearani JA, Bjarnason H, Holmes DR, Rihal CS. Transcatheter closure of coronary artery fistula: A 21‐year experience. Catheter Cardiovasc Interv 2020; 96:311-319. [DOI: 10.1002/ccd.28721] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Mackram F. Eleid
- Department of Cardiovascular Diseases Mayo Clinic Rochester Minnesota
| | | | - Naser M. Ammash
- Department of Cardiovascular Diseases Mayo Clinic Rochester Minnesota
| | - Joseph A. Dearani
- Department of Cardiovascular Surgery Mayo Clinic Rochester Minnesota
| | | | - David R. Holmes
- Department of Cardiovascular Diseases Mayo Clinic Rochester Minnesota
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314
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Alsaied T. From Other Journals: A Review of Recent Articles in Pediatric Cardiology. Pediatr Cardiol 2020; 41:1532-1537. [PMID: 32813029 PMCID: PMC7434847 DOI: 10.1007/s00246-020-02438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our aim is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) cardiac resynchronization in children with symptomatic ventricular dysfunction and dyssynchrony which seems to result in higher transplant-free survival, (2) outcomes of aortic leaflet reconstruction including Ozaki procedure to repair aortic valve disease in adolescents, (3) meta-analysis for risk factors of ventricular tachycardia and death after repaired tetralogy of Fallot which reiterates the known risk factors and showed that the severity of pulmonary regurgitation is not in itself associated with outcomes although the ventricular response to regurgitation (dilation and dysfunction) is, (4) preschool promotion of healthy life style did not associate with sustained effect when evaluated later in childhood although repeated intervention seems to have a dose-related effect to promote healthy life style, (5) the lack of beneficial effects of angiotensin-converting enzyme inhibitors in the interstage period, and (6) a new phenomenon of acute heart failure and multisystem inflammatory syndrome in children temporarily related to the COVID-19 pandemic.
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Affiliation(s)
- Tarek Alsaied
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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315
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Nichay NR, Zhuravleva IY, Kulyabin YY, Zubritskiy AV, Voitov AV, Soynov IA, Gorbatykh AV, Bogachev-Prokophiev AV, Karaskov AM. Diepoxy- Versus Glutaraldehyde-Treated Xenografts: Outcomes of Right Ventricular Outflow Tract Reconstruction in Children. World J Pediatr Congenit Heart Surg 2019; 11:56-64. [PMID: 31835985 DOI: 10.1177/2150135119885900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Xenografts used for right ventricular outflow tract (RVOT) reconstruction are typically treated with glutaraldehyde. However, potential benefit of epoxy treatment was demonstrated in experimental studies. We aimed to compare diepoxy-treated bovine pericardial valved conduits (DE-PVCs) and glutaraldehyde-treated bovine pericardial valved conduits (GA-PVCs) for RVOT reconstruction in pediatric patients. METHODS Between 2002 and 2017, 117 patients underwent RVOT reconstruction with PVC in single center: DE-PVC group, n = 39; and GA-PVC group, n = 78. After performing propensity score analysis (1:1) for the entire sample, 29 patients from the DE-PVC group were matched with 29 patients from the GA-PVC group. RESULTS There were no conduit-related deaths. In the DE-PVC group, the freedom from conduit failure was 90.9% at four years and 54.3% at eight years postoperatively. In the GA-PVC group, it was 46.3% and 33.1%, respectively. The difference was significant (P = .037). Conduit failure was typically caused by stenosis in both groups. In the DE-PVC group, the main cause of stenosis was xenograft calcification (27.6%); while in the GA-PVC group, it was mostly due to neointimal proliferation (25.0%) and, less often, calcification (14.3%). Conduit thrombosis was the cause of replacement in 6.9% of patients from the GA-PVC group. CONCLUSIONS Diepoxy-treated bovine pericardial valved conduit is a suitable alternative to GA-PVC for RVOT reconstruction in pediatric patients. Diepoxy-treated bovine pericardial valved conduits may be less prone to conduit failure and more resistant to neointimal proliferation and conduit thrombosis than GA-PVCs.
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Affiliation(s)
- Nataliya R Nichay
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Irina Y Zhuravleva
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Yuriy Y Kulyabin
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexey V Zubritskiy
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexey V Voitov
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Ilia A Soynov
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Artem V Gorbatykh
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexander V Bogachev-Prokophiev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexander M Karaskov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
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316
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Girolineto BMP, de Oliveira AM, Gonçalves AMRF, Campos MSDA, Pereira LRL. INSAF-HAS: a tool to select patients with hypertension for pharmaceutical care. EINSTEIN-SAO PAULO 2019; 18:eAO4858. [PMID: 31851225 PMCID: PMC6905168 DOI: 10.31744/einstein_journal/2020ao4858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 07/02/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To develop and validate the content of a tool aimed to select patients with hypertension for pharmaceutical care, based on identification of individuals in greater need of attention. METHODS The tool was developed and assessed for face and content validity, which was carried out in three stages. Phase I consisted of comprehensive literature review, which prompted the development of the first version of the tool. Phase II consisted of validation by an expert panel. Phase III consisted of a pilot study with hypertensive patients and preparation of the final version of the instrument. RESULTS Literature review yielded 30 studies, out of which 13 factors associated with hypertension and cardiovascular disease control and complications were selected. Once the initial version of the tool named INSAF-HAS was obtained, four expert meetings were held, each leading to instrument improvement until a final consensus was reached. In the pilot study, INSAF-HAS was applied to 30 patients with a diagnosis of hypertension for applicability pretest; adjustments were made and the final version of INSAF-HAS obtained. CONCLUSION The INSAF-HAS tool developed in this study has face and content validity, and may contribute to the selection of patients with hypertension in greater need of pharmaceutical care services.
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Affiliation(s)
| | - Alan Maicon de Oliveira
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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317
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Mongeon FP, Macle L, Beauchesne LM, Bouma BJ, Schwerzmann M, Mulder BJ, Khairy P. Non-Vitamin K Antagonist Oral Anticoagulants in Adult Congenital Heart Disease. Can J Cardiol 2019; 35:1686-1697. [DOI: 10.1016/j.cjca.2019.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/14/2022] Open
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318
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Nguyen VP, Dolgner SJ, Dardas TF, Verrier ED, McMullan DM, Krieger EV. Improved Outcomes of Heart Transplantation in Adults With Congenital Heart Disease Receiving Regionalized Care. J Am Coll Cardiol 2019; 74:2908-2918. [DOI: 10.1016/j.jacc.2019.09.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022]
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319
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Wichert-Schmitt B, Oechslin E. Misperception of Survival in Adult Congenital Heart Disease and Importance of Both Anatomic and Functional Indices: Educate Your Patients! Can J Cardiol 2019; 35:1635-1639. [DOI: 10.1016/j.cjca.2019.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 01/28/2023] Open
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320
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Egbe AC, Adigun R, Anand V, West CP, Montori VM, Murad HM, Akintoye E, Osman K, Connolly HM. Left Ventricular Systolic Dysfunction and Cardiovascular Outcomes in Tetralogy of Fallot: Systematic Review and Meta-analysis. Can J Cardiol 2019; 35:1784-1790. [DOI: 10.1016/j.cjca.2019.07.634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/27/2019] [Accepted: 07/27/2019] [Indexed: 12/11/2022] Open
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321
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Abstract
The field of congenital cardiac electrophysiology is growing rapidly due to the rapid growth in the population of survivors of childhood critical congenital heart disease surgery. Chronic arrhythmias pose one of the biggest challenges in this patient population, and catheter ablation, despite its challenges, is still the most desirable and acceptable approach when successful. Clinicians who propose catheter ablation in such patients need to understand the congenital anatomy, should carefully review the details of all prior cardiac surgery, and should be prepared to deal with the various challenges posed by lack of normal cardiac access and the possibility of poor hemodynamics. Still, experienced laboratories can achieve excellent results in this difficult patient population.
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Affiliation(s)
- George F Van Hare
- Washington University School of Medicine, One Children's Place, Campus Box 8116, Saint Louis, MO 63110, USA.
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322
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Outcomes of Bioprosthetic Valves in the Pulmonary Position in Adults With Congenital Heart Disease. Ann Thorac Surg 2019; 108:1410-1415. [DOI: 10.1016/j.athoracsur.2019.05.068] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 11/23/2022]
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323
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Waldmann V, Ladouceur M, Bougouin W, Combes N, Maltret A, Dumas F, Iserin L, Cariou A, Marijon E, Jouven X. Sudden Cardiac Arrest in Adults With Congenital Heart Disease. JACC Clin Electrophysiol 2019; 5:1355-1356. [DOI: 10.1016/j.jacep.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022]
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324
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Neidenbach R, Achenbach S, Andonian C, Beckmann J, Biber S, Dittrich S, Ewert P, Freilinger S, Huntgeburth M, Nagdyman N, Oberhoffer R, Pieper L, von Kodolitsch Y, Weyand M, Bauer UMM, Kaemmerer H. [Medical care of adults with congenital heart diseases : Present and future]. Herz 2019; 44:553-572. [PMID: 31263905 DOI: 10.1007/s00059-019-4820-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Congenital heart diseases (CHD) are the most common types of congenital organ defects. Thanks to medical progress in congenital cardiology and heart surgery, most children with CHD reach adulthood. Despite primarily successful treatment residual and subsequent conditions as well as (non)cardiac comorbidities can influence the chronic course of the disease and lead to a higher morbidity and mortality. Adults with congenital heart disease (ACHD) in Germany are not tied to the healthcare structure despite the great need for aftercare. According to the results of the medical care of ACHD (MC-ACHD) study, ACHD centers and specialists in Germany are insufficiently perceived despite increased complication rates and the great need for specialist guidance. General practitioners and patients are not adequately informed about existing ACHD facilities. A better awareness of the ACHD problem should be created at the level of primary medical supply in order to optimize care and to reduce morbidity and mortality. Improved future-oriented patient care includes lifelong regular follow-up and the possibility of interdisciplinary, integrated medical care of CHD.
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Affiliation(s)
- R Neidenbach
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland.
| | - S Achenbach
- Medizinische Klinik 2, Kardiologie und Angiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - C Andonian
- Lehrstuhl für Sportpsychologie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Georg-Brauchle-Ring 60-62, 80992, München, Deutschland
| | - J Beckmann
- Lehrstuhl für Sportpsychologie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Georg-Brauchle-Ring 60-62, 80992, München, Deutschland
| | - S Biber
- Lehrstuhl für Sportpsychologie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Georg-Brauchle-Ring 60-62, 80992, München, Deutschland
| | - S Dittrich
- Medizinische Klinik 2, Kardiologie und Angiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - P Ewert
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland
| | - S Freilinger
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland
| | - M Huntgeburth
- Klinik III für Innere Medizin, Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Herzzentrum, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - N Nagdyman
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland
| | - R Oberhoffer
- Lehrstuhl für Präventive Pädiatrie, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992, München, Deutschland
| | - L Pieper
- Professur für behaviorale Epidemiologie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
| | - Y von Kodolitsch
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Allgemeine und Interventionelle Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Weyand
- Medizinische Klinik 2, Kardiologie und Angiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - U M M Bauer
- Nationales Register für angeborene Herzfehler, Berlin, Deutschland
| | - H Kaemmerer
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland.
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325
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Davis A, Stafford J, Wilson G, Costa S. A delayed diagnosis of aortic coarctation. Proc AMIA Symp 2019; 32:559-560. [PMID: 31656419 DOI: 10.1080/08998280.2019.1646593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022] Open
Abstract
Coarctation of the aorta is most often diagnosed in early childhood, with infrequent recorded presentations of previously undiagnosed adults. We present a young female hospitalized with hypertensive emergency who was then diagnosed with a stenotic bicuspid aortic valve requiring surgical intervention. Subsequent preoperative coronary angiogram led to discovery of an undiagnosed coarctation of the aorta, which is commonly a forgotten cause of secondary hypertension.
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Affiliation(s)
- Arthur Davis
- Department of Medicine, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Joseph Stafford
- Department of Cardiology, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Gibbs Wilson
- Department of Cardiology, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Steven Costa
- Department of Cardiology, Baylor Scott & White Medical Center-TempleTempleTexas
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326
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Almarzooq Z, Patel B, McGregor PC, Aragam J. Partial Atrioventricular Canal Defect With an Anomalous Left Circumflex Coronary Artery in an Elderly Veteran. JACC Case Rep 2019; 1:291-296. [PMID: 34316810 PMCID: PMC8288597 DOI: 10.1016/j.jaccas.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/11/2019] [Accepted: 08/07/2019] [Indexed: 11/16/2022]
Abstract
This study reports a case of partial atrioventricular canal defect with an anomalous left circumflex coronary artery in an elderly veteran presenting with unexplained dyspnea on exertion. This is a rare finding in this population and emphasizes the importance of a broad differential diagnosis and meticulous evaluation when more common conditions have been excluded. (Level of Difficulty: Intermediate.)
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327
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Gupta A, Kumar V, Gupta R, Samarany S. A Case of Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva with a Malignant Course. Cureus 2019; 11:e5794. [PMID: 31728241 PMCID: PMC6827849 DOI: 10.7759/cureus.5794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Congenital heart disease in adults, including congenital anomalies of the coronary arteries, can be asymptomatic and diagnosed incidentally, but they can also be a cause of sudden cardiac death. The recent guidelines on the management of adults with congenital heart disease from the American Heart Association (AHA) and the American College of Cardiologists (ACC) identify that an anomalous coronary artery origin can lead to myocardial ischemia, arrhythmias, or sudden cardiac death. When the course of the coronary artery runs between the aorta and pulmonary trunk, it is described as having a "malignant course." Emergency surgical correction is required to restore the normal anatomy of the aberrant coronary artery. This report is of a 57-year-old man with a history of hypertension who had a normal electrocardiogram (ECG). A nuclear exercise stress test showed a resting and exercise ejection fraction (EF) of 56% with transient ischemic dilatation (TID) of the left ventricle. Coronary artery computed tomography angiography (CTA) identified an anomalous right coronary artery (AORCA) originating from the left sinus of Valsalva and coursing between the aorta and pulmonary trunk. TID on nuclear imaging is usually associated with left ventricular hypertrophy, microvascular disease, or multivessel macrovascular disease and has not been previously described in AORCA.
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Affiliation(s)
- Amol Gupta
- Cardiology, Heart, Vascular, and Leg Center, Bakersfield, USA
| | - Vinod Kumar
- Cardiology, Heart, Vascular, and Leg Center, Bakersfield, USA
| | - Ravi Gupta
- Cardiology, Heart, Vascular, and Leg Center, Bakersfield, USA
| | - Samir Samarany
- Cardiology, Heart, Vascular, and Leg Center, Bakersfield, USA
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328
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Pregnancy Outcomes in Women After the Arterial Switch Operation. Heart Lung Circ 2019; 29:1087-1092. [PMID: 31522930 DOI: 10.1016/j.hlc.2019.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/20/2019] [Accepted: 07/06/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pregnancy outcomes after the arterial switch operation (ASO) are rare. We sought to determine outcomes of ASO survivors who underwent pregnancy. METHODS Female patients who had an ASO and underwent pregnancy were identified from the congenital heart disease pregnancy clinic at The Royal Melbourne Hospital. All follow-up data were collected retrospectively by medical record review. RESULTS Eleven (11) women were identified as having undergone medical care during pregnancy, from the adult congenital database, at The Royal Melbourne Hospital. There were 17 successful pregnancies, and nine women have been followed post pregnancy. Of the 17 successful deliveries, eight were delivered by Caesarean section, seven were vaginal deliveries and two were instrumented vaginal deliveries. Of the eight Caesarean sections, five were emergency and three were elective. The indications for emergency Caesarean section were obstructed labour (n = 2), abnormal cardiotocography (n = 1), obstructed labour and abnormal cardiotocography (n = 1) and congestive cardiac failure (n = 1). There was one neonatal complication (respiratory distress requiring intubation) in a child born at 31 weeks. There were maternal obstetric complications in 10 patients. There were two maternal cardiac complications during pregnancy (heart failure and rapid atrial fibrillation/flutter). There was no change in left ventricular function post-pregnancy. There was progression of severity of neo-aortic valve regurgitation in two patients post pregnancy (trivial to mild and moderate-severe to severe respectively). CONCLUSION Pregnancy post ASO appears to be safe in the majority of women. Maternal cardiac complications are uncommon in patients without residual significant haemodynamic lesions, although maternal obstetric complications may be common.
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329
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Salciccioli KB, Oluyomi A, Lupo PJ, Ermis PR, Lopez KN. A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:752-759. [PMID: 31361081 PMCID: PMC7463421 DOI: 10.1111/chd.12819] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Follow-up at a regional adult congenital heart disease (ACHD) center is recommended for all ACHD patients at least once per the 2018 ACC/AHA guidelines. Other specialties have demonstrated poorer follow-up and outcomes correlating with increased distance from health care providers, but driving time to regional ACHD centers has not been examined in the US population. OBJECTIVE To identify and characterize potential disparities in access to ACHD care in the US based on drive time to ACHD centers and compounding sociodemographic factors. METHODS Mid- to high-volume ACHD centers with ≥500 outpatient ACHD visits and ≥20 ACHD surgeries annually were included based on self-reported, public data. Geographic Information System mapping was used to delineate drive times to ACHD centers. Sociodemographic data from the 2012-2016 American Community Survey (US Census) and the Environmental Systems Research Institute were analyzed based on drive time to nearest ACHD center. Previously established CHD prevalence estimates were used to estimate the similarly located US ACHD population. RESULTS Nearly half of the continental US population (45.1%) lives >1 hour drive to an ACHD center. Overall, 39.7% live 1-4 hours away, 3.4% live 4-6 hours away, and 2.0% live >6 hours away. Hispanics were disproportionately likely to live a >6 hour drive to a center (p < .001). Compared to people with <1 hour drive, those living >6 hours away have higher proportions of uninsured adults (29% vs. 18%; p < .001), households below the federal poverty level (19% vs. 13%; p < .001), and adults with less than college education (18% vs. 12%; p < .001). CONCLUSIONS We estimate that ~45% of the continental US population lives >1 hour to an ACHD center, with 5.4% living >4 hours away. Compounding barriers exist for Hispanic, uninsured, lower socioeconomic status, and less-educated patients. These results may help drive future policy changes to improve access to ACHD care.
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Affiliation(s)
- Katherine B. Salciccioli
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Abiodun Oluyomi
- Environmental Health Service, Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Philip J. Lupo
- Section of Hematology and Oncology, Department of Pediatrics,Baylor College of Medicine, Houston, TX
| | - Peter R. Ermis
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Keila N. Lopez
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
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330
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Harky A, Noshirwani A, Karadakhy O, Ang J. Comprehensive literature review of anomalies of the coronary arteries. J Card Surg 2019; 34:1328-1343. [DOI: 10.1111/jocs.14228] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Arish Noshirwani
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | | | - Juliana Ang
- School of MedicineUniversity of LiverpoolLiverpool UK
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331
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Darki A, Motiwala A, Bakhos L, Lewis BE, Lopez JJ, Steen LH, Mathew V, Leya FS. Technical success and long-term outcomes after anomalous right coronary artery stenting with cardiac computed tomography angiography correlation. Catheter Cardiovasc Interv 2019; 96:320-327. [PMID: 31430026 DOI: 10.1002/ccd.28453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 07/02/2019] [Accepted: 08/01/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Anomalous origin of coronary arteries has been observed in about 0.35-2.10% of the population. Patients with anomalous right coronary artery (ARCA) may present with significant symptoms, arrhythmias or ACS, and at times sudden death. Traditionally, surgical correction has been the recommended treatment. However, these may be technically challenging, and bypass grafting for such anomalies has the potential for graft failure because of competitive flow. We sought to determine the intermediate and long-term outcomes of drug-eluting stent placement for patients with symptomatic ARCA. We also looked at angiographic findings suggestive of interarterial course as confirmed by subsequent computed tomography (CT) findings. METHODS Between January 2005 and December 2012, we enrolled 11 patients for elective percutaneous coronary intervention (PCI) of ARCA in a single center, prospective, nonrandomized fashion. Patients were followed up in clinic at 1 week, 3 months, 6 months, and 1 year, and then annually or more frequently if needed. All patients underwent a cardiac CT, as well as functional stress testing when needed to assess for recurrence of disease. RESULTS All 11 of our patients, who presented with significant symptomatic stenosis with an ARCA, were successfully treated with PCI. Mean follow-up duration was 8.5 years. The only two deaths during follow-up were related to noncardiac causes (sepsis), with a mortality rate of 18.2%. Two patients had a positive functional study and on subsequent coronary angiography, one of them had significant in-stent restenosis (target lesion revascularization of 9.1%) and one distal to the stent (target vessel revascularization 9.1%). We found the observation of a "slit-like lesion" on angiography to have a sensitivity of 100% and specificity of 86% for the diagnosis of interarterial course of the anomalous vessel seen on subsequent CT. CONCLUSIONS Our study results suggest that PCI of ARCA is an effective and low-risk alternative to surgical correction, with good procedural success and long-term outcomes. It can provide symptomatic relief in such patients and may reduce the risk of sudden death in younger patients, without the inherent risks associated with surgical repair.
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Affiliation(s)
- Amir Darki
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Afaq Motiwala
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Lara Bakhos
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Bruce E Lewis
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - John J Lopez
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Lowell H Steen
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Verghese Mathew
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Ferdinand S Leya
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
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332
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Danieli C, Cohen S, Liu A, Pilote L, Guo L, Beauchamp ME, Marelli AJ, Abrahamowicz M. Flexible Modeling of the Association Between Cumulative Exposure to Low-Dose Ionizing Radiation From Cardiac Procedures and Risk of Cancer in Adults With Congenital Heart Disease. Am J Epidemiol 2019; 188:1552-1562. [PMID: 31107497 DOI: 10.1093/aje/kwz114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 12/26/2022] Open
Abstract
Adults with congenital heart disease are increasingly being exposed to low-dose ionizing radiation (LDIR) from cardiac procedures. In a recent study, Cohen et al. (Circulation. 2018;137(13):1334-1345) reported an association between increased LDIR exposure and cancer incidence but did not explore temporal relationships. Yet, the impact of past exposures probably accumulates over years, and its strength may depend on the amount of time elapsed since exposure. Furthermore, LDIR procedures performed shortly before a cancer diagnosis may have been ordered because of early symptoms of cancer, raising concerns about reversal causality bias. To address these challenges, we combined flexible modeling of cumulative exposures with competing-risks methodology to estimate separate associations of time-varying LDIR exposure with cancer incidence and all-cause mortality. Among 24,833 patients from the Quebec Congenital Heart Disease Database, 602 had incident cancer and 500 died during a follow-up period of up to 15 years (1995-2010). Initial results suggested a strong association of cancer incidence with very recent LDIR exposures, likely reflecting reverse causality bias. When exposure was lagged by 2 years, an increased cumulative LDIR dose from the previous 2-6 years was associated with increased cancer incidence, with a stronger association for women. These results illustrate the importance of accurate modeling of temporal relationships between time-varying exposures and health outcomes.
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Affiliation(s)
- Coraline Danieli
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Sarah Cohen
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montréal, Quebec, Canada
| | - Aihua Liu
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montréal, Quebec, Canada
| | - Louise Pilote
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Liming Guo
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montréal, Quebec, Canada
| | - Marie-Eve Beauchamp
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Ariane J Marelli
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montréal, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW Aortic coarctation is a common congenital abnormality causing significant morbidity and mortality if not corrected. Re-coarctation or restenosis of the aorta following treatment is a relatively common long-term problem and the optimal therapy has not been elucidated. In this review, we identify the challenges associated with and the optimal management for recurrent aortic coarctation and the most appropriate therapy for different patient cohorts. RECENT FINDINGS Open surgery provides a durable long-term aortic repair, however, given the complex nature of the procedure, has a somewhat higher rate of serious complications. Endovascular repair, although less invasive and relatively safe, has limitations in treated complex anatomy and is more likely to require repeat intervention. Open surgical repair is more appropriate for infants that have not been intervened on and endovascular therapy should be reserved for older children and adults and those that require repeat intervention.
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334
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Diagnostic and Therapeutic Approach to Arrhythmias in Adult Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:44. [PMID: 31342289 DOI: 10.1007/s11936-019-0749-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients. RECENT FINDINGS Macro-reentrant atrial tachyarrhythmia is the most common arrhythmia encountered in adults with CHD. Approximately 25% of hospitalizations associated with arrhythmia. The risk of ventricular arrhythmia is estimated as high as 25-100 times that for the general population and increased after two decades. Routine ambulatory monitoring is important for arrhythmia risk assessment in adults with CHD. There are limitations, potential adverse effects, and risk of recurrence with antiarrhythmic drugs, catheter ablation, and surgical approaches. Adults with CHD suffer various forms of arrhythmia, are at increased risk of sudden death, and require special consideration for medical and interventional therapy.
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335
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Kwon SJ, Choi EK, Lee KH, Im YM. Factors Influencing Physical Activity in Adolescents with Complex Congenital Heart Disease. CHILD HEALTH NURSING RESEARCH 2019; 25:262-272. [PMID: 35004419 PMCID: PMC8650962 DOI: 10.4094/chnr.2019.25.3.262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/27/2022] Open
Abstract
Purpose We aimed to identify factors influencing physical activity in adolescents with complex congenital heart disease. Methods We recruited 92 adolescents with complex congenital heart disease from a tertiary medical center in Seoul, measured their levels of physical activity, and identified factors that influenced their physical activity levels using the Global Physical Activity Questionnaire, the New York Heart Association classification, congenital heart disease complexity, the Self-Efficacy Scale, and the Parental Bonding Instrument scale. Stepwise multiple linear regression was used to determine factors influencing physical activity. Results Total physical activity was higher in males than in females (t=4.46, p<.001). Adolescents who participated in school physical education classes engaged in more physical activity than those who did not (t=6.77, p<.001). Higher self-efficacy (β=.41, p<.001), male gender (β=.37, p<.001) and participation in school physical education classes (β=.19, p=.042) were associated with a higher likelihood of engagement in physical activity. Conclusion It is necessary to develop nursing interventions that enhance self-efficacy in order to promote physical activity in adolescents with complex congenital heart disease. Physical activity should also be promoted in an individualized manner, taking into account gender, disease severity, and parental attitude.
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Affiliation(s)
- Su Jin Kwon
- Advanced Practice Nurse, Congenital Heart Disease Center, Asan Medical Center, Seoul, Korea
| | - Eun Kyoung Choi
- Assistant Professor, College of Nursing · Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Kyung Hee Lee
- Assistant Professor, College of Nursing · Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Yu-Mi Im
- Assistant Professor, Seoul Women's College of Nursing, Seoul, Korea
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336
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Farooqi M, Stickley J, Dhillon R, Barron DJ, Stumper O, Jones TJ, Clift PF, Brawn WJ, Drury NE. Trends in surgical and catheter interventions for isolated congenital shunt lesions in the UK and Ireland. Heart 2019; 105:1103-1108. [PMID: 30772822 PMCID: PMC6613741 DOI: 10.1136/heartjnl-2018-314428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate time trends in the use of catheter and surgical procedures, and associated survival in isolated congenital shunt lesions. METHODS Nationwide, retrospective observational study of the UK National Congenital Heart Disease Audit database from 2000 to 2016. Patients undergoing surgical or catheter procedures for atrial septal defect (including sinus venosus defect), patent foramen ovale, ventricular septal defect and patent arterial duct were included. Temporal changes in the frequency of procedures, and survival at 30 days and 1 year were determined. RESULTS 40 911 procedures were performed, 16 604 surgical operations and 24 307 catheter-based interventions. Transcatheter procedures increased over time, overtaking surgical repair in 2003-2004, while the number of operations remained stable. Trends in interventions differed according to defect type and patient age. Catheter closure of atrial septal defects is now more common in children and adults, although surgical interventions have also increased. Patent foramen ovale closure in adults peaked in 2009-2010 before falling significantly since. Surgery remains the mainstay for ventricular septal defect in infants and children. Duct ligation is most common in neonates and infants, while transcatheter intervention is predominant in older children. Excluding duct ligation, survival following surgery was 99.4% and ≈98.7%, and following catheter interventions was 99.7% and ≈99.2%, at 30 days and 1 year, respectively. CONCLUSIONS Trends in catheter and surgical techniques for isolated congenital shunt lesions plot the evolution of the specialty over the last 16 years, reflecting changes in clinical guidelines, technology, expertise and reimbursement, with distinct patterns according to lesion and patient age.
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Affiliation(s)
- Mehreen Farooqi
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - John Stickley
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Rami Dhillon
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - David J Barron
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Oliver Stumper
- Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Timothy J Jones
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Paul F Clift
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Adult Congenital Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - William J Brawn
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Nigel E Drury
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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337
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Awh K, Venuti MA, Gleason LP, Rogers R, Denduluri S, Kim YY. Clinic nonattendance is associated with increased emergency department visits in adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:726-734. [DOI: 10.1111/chd.12784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Katherine Awh
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Morgan A. Venuti
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Lacey P. Gleason
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Rachel Rogers
- Biostatistics and Data Management Core The Children's Hospital of Philadelphia Research Institute Philadelphia Pennsylvania
| | - Srinivas Denduluri
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Yuli Y. Kim
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
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338
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Egbe AC, Pislaru SV, Kothapalli S, Jadav R, Masood M, Angirekula M, Pellikka PA. The role of echocardiography for quantitative assessment of right ventricular size and function in adults with repaired tetralogy of Fallot. CONGENIT HEART DIS 2019; 14:700-705. [DOI: 10.1111/chd.12783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/09/2019] [Accepted: 04/21/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Sorin V. Pislaru
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | | | - Raja Jadav
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Muhammad Masood
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
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339
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Menachem JN, Reza N, Mazurek JA, Burstein D, Birati EY, Fox A, Kim YY, Molina M, Partington SL, Tanna M, Tobin L, Wald J, Goldberg LR. Cardiopulmonary Exercise Testing-A Valuable Tool, Not Gatekeeper When Referring Patients With Adult Congenital Heart Disease for Transplant Evaluation. World J Pediatr Congenit Heart Surg 2019; 10:286-291. [PMID: 30832541 PMCID: PMC6520115 DOI: 10.1177/2150135118825263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Treatment of patients with adult congenital heart disease (ACHD) with advanced therapies including heart transplant (HT) is often delayed due to paucity of objective prognostic markers for the severity of heart failure (HF). While the utility of Cardiopulmonary Exercise Testing (CPET) in non-ACHD patients has been well-defined as it relates to prognosis, CPET for this purpose in ACHD is still under investigation. METHODS We performed a retrospective cohort study of 20 consecutive patients with ACHD who underwent HT between March 2010 and February 2016. Only 12 of 20 patients underwent CPET prior to transplantation. Demographics, standard measures of CPET interpretation, and 30-day and 1-year post transplantation outcomes were collected. RESULTS Patient Characteristics. Twenty patients with ACHD were transplanted at a median of 40 years of age (range: 23-57 years). Of the 12 patients who underwent CPET, 4 had undergone Fontan procedures, 4 had tetralogy of Fallot, 3 had d-transposition of the great arteries, and 1 had Ebstein anomaly. Thirty-day and one-year survival was 100%. All tests included in the analysis had a peak respiratory quotient _1.0. The median peak oxygen consumption per unit time (_VO2) for all diagnoses was 18.2 mL/kg/min (46% predicted), ranging from 12.2 to 22.6. CONCLUSION There is a paucity of data to support best practices for patients with ACHD requiring transplantation. While it cannot be proven based on available data, it could be inferred that outcomes would have been worse or perhaps life sustaining options unavailable if providers delayed referral because of the lack of attainment of CPET-specific thresholds.
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Affiliation(s)
- Jonathan N. Menachem
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nosheen Reza
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy A. Mazurek
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle Burstein
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Edo Y. Birati
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Arieh Fox
- Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Yuli Y. Kim
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Maria Molina
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L. Partington
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Monique Tanna
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lynda Tobin
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce Wald
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lee R. Goldberg
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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340
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Smith JMC, Andrade JG, Human D, Field TS. Adults With Complex Congenital Heart Disease: Cerebrovascular Considerations for the Neurologist. Front Neurol 2019; 10:329. [PMID: 31019488 PMCID: PMC6458261 DOI: 10.3389/fneur.2019.00329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/18/2019] [Indexed: 01/15/2023] Open
Abstract
As infant and childhood mortality has decreased in congenital heart disease, this population is increasingly reaching adulthood. Adults with congenital heart disease (ACHD) represent a group with increased risk of stroke, silent brain infarcts, and vascular cognitive impairment. Cyanotic and other complex cardiac lesions confer the greatest risk of these cerebrovascular insults. ACHD patients, in addition to having an increased risk of stroke from structural cardiac issues and associated physiological changes, may have an accelerated burden of conventional vascular risk factors, including hypertension and impaired glucose metabolism. Adult neurologists should be aware of the risks of clinically evident and subclinical cerebrovascular disease in this population. We review the existing evidence on primary and secondary stroke prevention in individuals with complex congenital heart disease, and identify knowledge gaps in need of further research, including treatment of acute stroke in this population. Multisystemic genetic syndromes are outside the scope of this review.
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Affiliation(s)
- Jonathan M C Smith
- M.D. Senior Pediatric Neurology Resident, University of British Columbia, Vancouver, BC, Canada
| | - Jason G Andrade
- FRCPC Clinical Associate Professor of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Derek Human
- FRCPC, Clinical Professor of Pediatric Cardiology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- M.D. Senior Pediatric Neurology Resident, University of British Columbia, Vancouver, BC, Canada.,FRCPC Clinical Associate Professor of Cardiology, University of British Columbia, Vancouver, BC, Canada.,FRCPC, Clinical Professor of Pediatric Cardiology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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341
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Levine GN, O'Gara PT, Beckman JA, Al-Khatib SM, Birtcher KK, Cigarroa JE, de las Fuentes L, Deswal A, Fleisher LA, Gentile F, Goldberger ZD, Hlatky MA, Joglar JA, Piano MR, Wijeysundera DN. Recent Innovations, Modifications, and Evolution of ACC/AHA Clinical Practice Guidelines: An Update for Our Constituencies: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73:1990-1998. [PMID: 30904245 DOI: 10.1016/j.jacc.2019.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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342
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Hong KL, Glover BM. Iatrogenic Atrial Septal Defects After Transseptal Access for Atrial Fibrillation Ablations. Can J Cardiol 2019; 35:368-369. [PMID: 30935624 DOI: 10.1016/j.cjca.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Kathryn L Hong
- Schulich Heart Center, Sunnybrook Hospital, University of Toronto, Ontario, Canada
| | - Benedict M Glover
- Schulich Heart Center, Sunnybrook Hospital, University of Toronto, Ontario, Canada.
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343
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Malahfji M, Chamsi-Pasha MA. Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases. Methodist Debakey Cardiovasc J 2019; 15:99-104. [PMID: 31384372 DOI: 10.14797/mdcj-15-2-99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The population of patients with adult congenital heart disease has grown and is currently estimated to include approximately 1 million people in the United States. Cardiologists and imagers frequently encounter complex patients who have undergone multiple prior operations and interventions. A myriad of imaging tests are currently available, including echocardiography, cardiovascular magnetic resonance imaging, and computed tomography, all of which collectively provide invaluable information on cardiac anatomy and hemodynamics. Advanced imaging plays a role in diagnosis and preprocedural planning and also determines the need and frequency of follow-up. This article provides a contemporary review of the current role of cardiac imaging in patients with complex congenital heart disease.
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Affiliation(s)
- Maan Malahfji
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Mohammed A Chamsi-Pasha
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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344
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Misra A, Sriram C, Gupta P, Humes R. The Adult with Post-operative Congenital Heart Disease: a Systematic Echocardiographic Approach. Curr Cardiol Rep 2019; 21:29. [PMID: 30887232 DOI: 10.1007/s11886-019-1116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW This article attempts to review some of the commonly seen repaired congenital heart defects in the adult population (ACHD), with a focus on important echocardiographic findings that may assist a practitioner in recognizing and managing this group of patients. RECENT FINDINGS The prevalence of ACHD population is increasing, and currently, there are over 1 million adults with congenital heart disease. At the current time, the total number of ACHD patients exceeds the total number of pediatric patients with CHD. The recently released 2018 American College of Cardiology/American Heart Association guidelines for the management of adults with congenital heart disease (ACHD) recommends transthoracic echocardiography for all ACHD patients for initial assessment and serial assessment as needed (class of recommendation: I) and echocardiography remains the mainstay for diagnosing and managing these patients in adjunct with other available imaging modalities. It is imperative for all cardiologists to be familiar with the echocardiographic features of the commonly seen repaired CHD in adult population.
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Affiliation(s)
- Amrit Misra
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
| | - Chenni Sriram
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA.
| | - Pooja Gupta
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
| | - Richard Humes
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
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345
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Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation. Can J Cardiol 2019; 35:914-922. [PMID: 31292091 DOI: 10.1016/j.cjca.2019.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We hypothesized that noninvasively measured right ventricular (RV) to pulmonary arterial (RV-PA) coupling would be abnormal in chronic pulmonary regurgitation (PR) even in the setting of normal RV ejection fraction, and that RV-PA coupling indices would have a better correlation with peak oxygen consumption (VO2) compared with RV systolic indices alone. METHODS This was a retrospective study of 129 adults (repaired tetralogy of Fallot [TOF] n = 84 and valvular pulmonic stenosis [VPS] with previous intervention n = 45) with ≥ moderate native PR and RV ejection fraction > 50%. The 84 TOF patients were propensity matched with 84 patients with normal echocardiogram (control); age 28 ± 7 years and male sex n = 39 (46%). RV-PA coupling was measured according to fractional area change (FAC)/RV systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE)/RVSP. RESULTS RV systolic function indices were similar between TOF and control groups (FAC 43 ± 6% vs 41 ± 5% [P = 0.164] and TAPSE 22 ± 5 mm vs 24 ± 6 mm [P = 0.263]). However, RV-PA coupling was lower in the TOF group (FAC/RVSP 1.10 ± 0.29 vs 1.48 ± 0.22 [P < 0.001]; TAPSE/RVSP 0.51 ± 0.15 vs 0.78 ± 0.11 [P < 0.001]) because of higher RV afterload (RVSP 42 ± 3 mm Hg vs 31 ± 3 mm Hg [P = 0.012]). FAC/RVSP (r = 0.61; P < 0.001) and TAPSE/RVSP (r = 0.69; P < 0.001) correlated with peak VO2 especially in the patients with impaired exercise capacity whereas FAC and TAPSE were independent of peak VO2. Similar comparisons between VPS and control groups showed no difference in TAPSE and FAC between groups, but lower FAC/RVSP and TAPSE/RVSP in the VPS group. CONCLUSIONS There is abnormal RV-PA coupling in chronic PR, and noninvasively measured RV-PA coupling might potentially be prognostic because of its correlation with exercise capacity.
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346
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Rogers T, Ratnayaka K. CMR in Transcatheter Valve Interventions: State of the Art and Future Directions. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9486-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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347
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Bedair R, Iriart X. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Tetralogy of Fallot: diagnosis to long-term follow-up. Echo Res Pract 2019; 6:R9-R23. [PMID: 30557849 PMCID: PMC6301192 DOI: 10.1530/erp-18-0049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022] Open
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect, affecting 3 in 10,000 live births. Surgical correction in early childhood is associated with good outcomes, but lifelong follow-up is necessary to identify the long-term sequelae that may occur. This article will cover the diagnosis of TOF in childhood, the objectives of surveillance through adulthood and the value of multi-modality imaging in identifying and guiding timely surgical and percutaneous interventions.
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Affiliation(s)
- R Bedair
- Department of Adult Congenital Cardiology, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - X Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
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348
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Apostolopoulou SC, Manginas A, Kelekis NL, Noutsias M. Cardiovascular imaging approach in pre and postoperative tetralogy of Fallot. BMC Cardiovasc Disord 2019; 19:7. [PMID: 30616556 PMCID: PMC6323806 DOI: 10.1186/s12872-018-0996-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Advances in the medical and surgical management of Tetralogy of Fallot have led to marked increase of the number and age of survivors. Imaging in patients with Tetralogy of Fallot plays a crucial role in the diagnosis and follow up, and essentially guides management and intervention in this entity. This study systematically reviews the imaging modalities used in patients with Tetralogy of Fallot in the evaluation of preoperative and postoperative anatomic and hemodynamic lesions, as well as disease progression in this diagnosis. Various invasive and noninvasive imaging modalities, most commonly echocardiography and cardiovascular magnetic resonance, computed tomography and angiocardiography provide the imaging information required for diagnosis, management and follow up in Tetralogy of Fallot. The choice of the appropriate imaging tool or their combination is guided by the clinical question, the patient's clinical condition and contraindications as well as the strengths and weaknesses of each imaging modality. Tetralogy of Fallot is the most common complex congenital heart disease with long term survivors that need close follow up and complicated management, including multiple surgical and transcatheter interventions. Knowledge of the role and protocols of imaging in Tetralogy of Fallot is extremely important for the clinical as well as the imaging physician in order to optimize patients' management and long-term prognosis.
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Affiliation(s)
- Sotiria C. Apostolopoulou
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 356 Syngrou Ave, 176 74 Athens, GR Greece
| | - Athanassios Manginas
- Interventional Cardiology and Cardiology Department, Mediterraneo Hospital, Athens, Greece
| | - Nikolaos L. Kelekis
- 2nd Department of Radiology, General University Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120 Halle (Saale), Germany
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349
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Neidenbach R, Niwa K, Oto O, Oechslin E, Aboulhosn J, Celermajer D, Schelling J, Pieper L, Sanftenberg L, Oberhoffer R, de Haan F, Weyand M, Achenbach S, Schlensak C, Lossnitzer D, Nagdyman N, von Kodolitsch Y, Kallfelz HC, Pittrow D, Bauer UMM, Ewert P, Meinertz T, Kaemmerer H. Improving medical care and prevention in adults with congenital heart disease-reflections on a global problem-part I: development of congenital cardiology, epidemiology, clinical aspects, heart failure, cardiac arrhythmia. Cardiovasc Diagn Ther 2018; 8:705-715. [PMID: 30740318 PMCID: PMC6331379 DOI: 10.21037/cdt.2018.10.15] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/02/2018] [Indexed: 01/10/2023]
Abstract
Today most patients with congenital heart defects (CHD) survive into adulthood. Unfortunately, despite relevant residua and sequels, follow-up care of adults with congenital heart disease (ACHD) is not performed in specialized and/or certified physicians or centres. Major problems in the long-term course encompass heart failure, cardiac arrhythmias, heart valve disorders, pulmonary vascular disease, infective endocarditis, aortopathy and non-cardiac comorbidities. Many of them manifest themselves differently from acquired heart disease and therapy regimens from general cardiology cannot be transferred directly to CHD. It should be noted that even simple, postoperative heart defects that were until recently considered to be harmless can lead to problems with age, a fact that had not been expected so far. The treatment of ACHD has many special features and requires special expertise. Thereby, it is important that treatment regimens from acquired heart disease are not necessarily transmitted to CHD. While primary care physicians have the important and responsible task to set the course for adequate diagnosis and treatment early and to refer patients to appropriate care in specialized ACHD-facilities, they should actively encourage ACHD to pursue follow-up care in specialized facilities who can provide responsible and advanced advice. This medical update emphasizes the current data on epidemiology, heart failure and cardiac arrhythmia in ACHD.
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Affiliation(s)
- Rhoia Neidenbach
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St Luke’s International Hospital, Tokyo, Japan
| | - Oeztekin Oto
- Dokuz Eylul University Hospital air Esref Cad, Izmir, Turkey
| | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, USA
| | - David Celermajer
- Central Clinical School Heart Research Institute C39 - Royal Prince Alfred Hospital, The University of Sydney, NSW 2006, Australia
| | - Joerg Schelling
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lars Pieper
- Chair of Behavioral Epidemiology, Institute for Clinical Psychology und Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
- Preventive Pediatrics, Technical University Munich, Munich, Germany
| | | | - Michael Weyand
- Department of Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | | | - Christian Schlensak
- Clinic for Thorax-, Heart- and Vessel Surgery, German Heart Competence Center, Tübingen, Germany
| | | | - Nicole Nagdyman
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Yskert von Kodolitsch
- University Heart Center Hamburg, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Carlo Kallfelz
- Clinic for Pediatric Cardiology und Intensive medicine, Medical School Hannover, Hannover, Germany
| | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University Carl Gustav Carus, Dresden, Germany
| | | | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Thomas Meinertz
- University Heart Center Hamburg, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
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Deen JF, Prutkin JM. Shock to the heart: cardiac implantable devices' bad name in adults with tetralogy of Fallot. Heart 2018; 105:508-509. [PMID: 30455176 DOI: 10.1136/heartjnl-2018-314235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jason F Deen
- Division of Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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