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Spaziani G, Bennati E, Marrone C, Lucà F, Iorio A, Rao CM, Di Fusco SA, Russo MG, Colivicchi F, Gabrielli D, Santoro G, Favilli S, Gulizia MM. Pathophysiology and clinical presentation of paediatric heart failure related to congenital heart disease. Acta Paediatr 2021; 110:2336-2343. [PMID: 33948967 DOI: 10.1111/apa.15904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
Congenital heart disease (CHD) and cardiomyopathies represent the two most important causes of paediatric heart failure (HF) in developed countries. We made a review of the literature on pathophysiology and clinical presentation of paediatric HF in children with CHD. Two main pathophysiologic models can be identified: the 'over-circulation failure', characterised by signs and symptoms of congestion or hypoperfusion, due respectively to volume or pressure overload, and the 'pump failure'. CONCLUSIONS: The comprehension of the HF pathophysiology in paediatric patients with CHD is of paramount importance for the optimal management and for addressing the best therapeutic choices.
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Affiliation(s)
- Gaia Spaziani
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
| | - Elena Bennati
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
| | - Chiara Marrone
- Pediatric Cardiology Fondazione G. Monasterio CNR‐Regione Toscana Massa Italy
| | - Fabiana Lucà
- Division of Cardiology Big Metropolitan Hospital Reggio Calabria Italy
| | - Annamaria Iorio
- Division of Cardiology Azienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | | | | | - Maria Giovanna Russo
- Pediatric Cardiology Department of Cardiology Monaldi Hospital, “L. Vanvitelli” University Naples Italy
| | - Furio Colivicchi
- UOC Cardiologia Clinica e Riabilitativa San Filippo Neri Hospital Rome Italy
| | | | - Giuseppe Santoro
- Pediatric Cardiology Fondazione G. Monasterio CNR‐Regione Toscana Massa Italy
| | - Silvia Favilli
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
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Vaikunth SS, Lui GK. Heart failure with reduced and preserved ejection fraction in adult congenital heart disease. Heart Fail Rev 2021; 25:569-581. [PMID: 31873841 DOI: 10.1007/s10741-019-09904-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is common in patients with adult congenital heart disease. Many of the most common congenital defects have a high prevalence of HFrEF, including left-sided obstructive lesions (aortic stenosis, coarctation of the aorta, Shone complex), tetralogy of Fallot, Ebstein anomaly, lesions in which there is a systemic right ventricle, and lesions palliated with a Fontan circulation. However, heart failure with preserved ejection fraction (HFpEF) is also prevalent in all these lesions. Comprehensive evaluation includes physical exam, biomarkers, echocardiography and advanced imaging, exercise stress testing, and, in some cases, invasive hemodynamics. Guideline-directed medical therapy for HFrEF can be applied to left-sided lesions and may be considered on an individual basis for systemic right ventricle and single-ventricle patients. Medical therapy is limited for HFpEF. However, in both HFrEF and HFpEF, ventricular dyssynchrony and arrhythmias play an important role, and medications for rhythm control, ablation, and cardiac resynchronization therapy should be considered. Finally, aggressive management of cardiovascular risk factors and comorbidities, including, but not limited to, hypertension, obesity, diabetes, dyslipidemia, and obstructive sleep apnea, cannot be overemphasized.
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Affiliation(s)
- Sumeet S Vaikunth
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
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4
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Naimi E, Eilami O, Babuei A, Rezaei K, Moslemirad M. The Effect of Religious Intervention Using Prayer for Quality of Life and Psychological Status of Patients with Permanent Pacemaker. JOURNAL OF RELIGION AND HEALTH 2020; 59:920-927. [PMID: 30218372 DOI: 10.1007/s10943-018-0698-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The development of heart disease, followed by the pacemaker implantation, has reduced the quality and psychological problems for patients. Thus, the present study was conducted to determine the effect of prayer on the quality of life and the psychological status of patients with permanent pacemaker. This is a quasi-experimental study in which 75 patients were assigned to experimental and control groups. Religious intervention was conducted for the experimental group, including the Tavasol prayer and four recommended (mustahab) remembrances in 7 sessions. Before and after the intervention, the patients were provided with the quality of life questionnaire and psychological status. Then, the questionnaires were analyzed using descriptive and analytical tests. Before intervention, there was no difference between quality of life status and psychological status of patients, but after intervention, their quality of life increased and their psychological status improved significantly. The implementation of religious intervention based on prayer positively affects the quality of life and psychological status of patients; thus, implementing this intervention is necessary for patients.
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Affiliation(s)
- Ebrahim Naimi
- Department of Public Health, Faulty of Health, Yasuj University of Medical Science, Yasuj, Iran
| | - Owrang Eilami
- School of Medicine Social, Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Amin Babuei
- Deputy of Development of Management, Yasuj University of Medical Science, Yasuj, Iran
| | - Karim Rezaei
- Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Moslem Moslemirad
- Department of Nursing, Faculty of Nursing and Midwifery, Yasuj University of Medical Sciences, Yasuj, Iran.
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5
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Mardy C, Blumenfeld YJ, Arunamata AA, Girsen AI, Sylvester KG, Halabi S, Rubesova E, Hintz SR, Tacy TA, Maskatia SA. In fetuses with congenital lung masses, decreased ventricular and atrioventricular valve dimensions are associated with lesion size and clinical outcome. Prenat Diagn 2019; 40:206-215. [PMID: 31742724 DOI: 10.1002/pd.5612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/02/2019] [Accepted: 10/30/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The clinical importance of mass effect from congenital lung masses on the fetal heart is unknown. We aimed to report cardiac measurements in fetuses with congenital lung masses and to correlate lung mass severity/size with cardiac dimensions and clinical outcomes. METHODS Cases were identified from our institutional database between 2009 and 2016. We recorded atrioventricular valve (AVVz) annulus dimensions and ventricular widths (VWz) converted into z scores, ratio of aortic to total cardiac output (AoCO), lesion side, and congenital pulmonary airway malformation volume ratio (CVR). Respiratory intervention (RI) was defined as intubation, extracorporeal membrane oxygenation (ECMO), or use of surgical intervention prior to discharge. RESULTS Fifty-two fetuses comprised the study cohort. Mean AVVz and VWz were below expected for gestational age. CVR correlated with ipsilateral AVVz (RS = -.59, P < .001) and ipsilateral VWz (-0.59, P < .001). Lower AVVz and AoCO and higher CVR were associated with RI. No patient had significant structural heart disease identified postnatally. CONCLUSION In fetuses with left-sided lung masses, ipsilateral cardiac structures tend to be smaller, but in our cohort, there were no patients with structural heart disease. However, smaller left-sided structures may contribute to the need for RI that affects a portion of these fetuses.
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Affiliation(s)
- Christopher Mardy
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yair J Blumenfeld
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alisa A Arunamata
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Anna I Girsen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Karl G Sylvester
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Safwan Halabi
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Erika Rubesova
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Susan R Hintz
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Theresa A Tacy
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Shiraz A Maskatia
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
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Gaeta SA, Ward C, Krasuski RA. Extra-cardiac manifestations of adult congenital heart disease. Trends Cardiovasc Med 2016; 26:627-36. [PMID: 27234354 DOI: 10.1016/j.tcm.2016.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/05/2016] [Accepted: 04/11/2016] [Indexed: 12/28/2022]
Abstract
Advancement in correction or palliation of congenital cardiac lesions has greatly improved the lifespan of congenital heart disease patients, resulting in a rapidly growing adult congenital heart disease (ACHD) population. As this group has increased in number and age, emerging science has highlighted the systemic nature of ACHD. Providers caring for these patients are tasked with long-term management of multiple neurologic, pulmonary, hepatic, renal, and endocrine manifestations that arise as syndromic associations with congenital heart defects or as sequelae of primary structural or hemodynamic abnormalities. In this review, we outline the current understanding and recent research into these extra-cardiac manifestations.
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Affiliation(s)
- Stephen A Gaeta
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Cary Ward
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Richard A Krasuski
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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Update on the challenges facing the adult with congenital heart disease community: for both the patient and provider. Curr Opin Pediatr 2014; 26:521-6. [PMID: 25102108 DOI: 10.1097/mop.0000000000000134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The success in the management of congenital heart disease has resulted in a growing population now expected to reach adulthood. The declining mortality during childhood results in adults with decades of cardiovascular disease burden. The purpose of this review is to provide an update on some of the common issues encountered when caring for the adult with congenital heart disease through a review of recently published articles. RECENT FINDINGS This review focuses on addressing the lack of information, gaps in clinical care, single ventricle complications, and heart failure in the adults with congenital heart disease population. SUMMARY The advancing age of the congenital heart population comes with a substantial life cardiovascular risk. Despite this, they typically experience and report a good quality of life. Providing care to adults with congenital heart disease requires a comprehensive team to address the many complications that are known to arise. This comprehensive team should be available to all.
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