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Neijenhuis RML, Regeer MV, van der Kley F, Vliegen HW, Jongbloed MRM, Kiès P, Schalij MJ, Jukema JW, Egorova AD. Contemporary Management Strategies of Baffle Leaks in Adults with a Failing Systemic Right Ventricle Late after Atrial Switch: A Case Series and Literature Overview. J Cardiovasc Dev Dis 2023; 10:jcdd10030129. [PMID: 36975893 PMCID: PMC10056645 DOI: 10.3390/jcdd10030129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Baffle leaks are a frequently encountered and often overlooked complication after the atrial switch procedure for transposition of the great arteries. Baffle leaks are present in up to 50% of non-selected patients, and while they initially may not cause clear symptoms, they can complicate the hemodynamic course and influence the prognosis in this complex patient group. A shunt from the pulmonary venous atrium (PVA) to the systemic venous atrium (SVA) can lead to pulmonary overflow and subpulmonary left ventricular (LV) volume overload, while a shunt from the SVA to the PVA can result in (exercise-associated) cyanosis and paradoxical embolism. We report three cases of baffle leaks in patients with systemic right ventricular (sRV) failure late after the atrial switch procedure. Two symptomatic patients who presented with exercise-associated cyanosis due to SVA to PVA shunting over the baffle leak underwent successful percutaneous baffle leak closure with a septal occluder device. One patient with overt sRV failure and signs of subpulmonary LV volume overload due to PVA to SVA shunting was managed conservatively, as baffle leak closure was expected to lead to an increase in sRV end-diastolic pressure and aggravation of sRV dysfunction. These three cases illustrate the considerations made, challenges faced, and necessity of a patient-tailored approach when addressing baffle leaks.
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Affiliation(s)
- Ralph M L Neijenhuis
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Madelien V Regeer
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Frank van der Kley
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Martin J Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Netherlands Heart Institute, 3511 EP Utrecht, The Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Bou-Chaaya RG, Zhu Z, Duarte VE, Lin CH. Percutaneous Structural Interventions in Adult Congenital Heart Disease: State-of-the-Art Review. Methodist Debakey Cardiovasc J 2023; 19:78-90. [PMID: 37213883 PMCID: PMC10198245 DOI: 10.14797/mdcvj.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023] Open
Abstract
Structural interventions play a crucial role in the management of adult congenital heart disease (ACHD). In recent years, this field has seen significant advancements in catheter-based procedures despite limited investment from industry and lack of device development specific to this population. Because each patient is unique in their anatomy, pathophysiology, and surgical repair, many devices are used off-label with a "best fit" strategy. Therefore, continuous innovation is needed to adapt what is available to ACHD and to increase collaboration with industry and regulatory bodies to develop dedicated equipment. These innovations will further advance the field and offer this growing population less invasive options with fewer complications and faster recovery times. In this article, we summarize some of the contemporary structural interventions performed in adults with congenital defects and present cases performed at Houston Methodist to better illustrate them. We aim to offer a greater understanding of the field and stimulate interest in this rapidly growing specialty.
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Affiliation(s)
- Rody G. Bou-Chaaya
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Zhihao Zhu
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Valeria E. Duarte
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Chun Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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Effect of Chronic Heart Failure Complicated with Type 2 Diabetes Mellitus on Cognitive Function in the Elderly. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4841205. [PMID: 35800008 PMCID: PMC9256388 DOI: 10.1155/2022/4841205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of chronic heart failure complicated with type 2 diabetes mellitus on cognitive function in the elderly. Methods 600 patients with chronic heart failure were selected from January 2018 to January 2021. All patients were divided into observation group (A) and control group (B). A was chronic heart failure complicated with type 2 diabetes mellitus group. B was chronic heart failure group. The clinical effects of the two groups were observed. Results Compared with the clinical indexes during and after operation, there were differences in operation time, postoperative recovery time, and treatment cost between A and B, but the difference is not significant (all P > 0.05). LVEF cardiac function index score, LVEF score of A compared with B, the difference was statistically significant (P < 0.05). The MMSE score and MoCA score of the two groups were compared. Before operation, the MMSE score and MoCA score of A were lower than those of B, and the difference was statistically significant (P < 0.05). After operation, the MMSE score and MoCA score in B were significantly higher than those in B, but the increasing trend of MMSE score and MoCA score in B was significantly higher than that in A (P < 0.05). Comparison of HAMA score and HAMD score: before operation, the HAMA score and HAMD score were higher in A, but the difference is not significant (P > 0.05). After operation, the scores of HAMA and HAMD in A and B decreased significantly, but the difference is not significant (P > 0.05). Multivariate analysis showed that the fasting blood glucose and glycosylated hemoglobin were the risk factors of cognitive impairment. Conclusion Type 2 diabetes mellitus in elderly patients with chronic heart failure will further aggravate cognitive impairment, and type 2 diabetes is an important independent risk factor affecting cognitive function, which accelerates cognitive impairment and significantly reduces the executive ability of elderly patients with chronic heart failure, resulting in a significant decline in patients' ability to understand and apply information.
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