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Dasgupta S, Thomas K, Johnsrude C. Subcutaneous cardioverter-defibrillator implantation in an adult with congenital heart disease and left infra-mammary pacemaker. Indian Pacing Electrophysiol J 2024; 24:111-113. [PMID: 38169171 PMCID: PMC11010441 DOI: 10.1016/j.ipej.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 01/05/2024] Open
Abstract
The approach/type of an implantable cardioverter defibrillator (ICD) is determined by the underlying cardiac anatomy, venous access, and pre-existing cardiac implantable electronic devices. We describe a case of subcutaneous ICD implantation in an adult with congenital heart disease (CHD) with a pre-existing inframammary transvenous pacemaker. This was preferred over adding a defibrillator coil to existing pacing leads, extraction/replacement of pacing system, or a sternotomy/epicardial ICD placement. The procedure was accomplished uneventfully with successful defibrillation threshold testing. Innovative approaches are required to manage arrhythmias in adults with CHD, with shared decision making playing a critical role.
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Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, USA.
| | - Kevin Thomas
- Division of Cardiology, Department of Internal Medicine, Norton Hospital, USA
| | - Christopher Johnsrude
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, USA
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2
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Sherwin ED, Shah MJ. Leadless Pacemakers in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:421-432. [PMID: 37865516 DOI: 10.1016/j.ccep.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Transcatheter leadless pacemakers have benefits in congenital heart disease because they eliminate the risks of lead malfunction, venous occlusions, and pocket complications. This newest pacemaker's utility in this population has been limited by the large sheath and delivery system, need for atrioventricular synchronous pacing, lack of explantation options, and possible lack of adequate access to the subpulmonary ventricle. With careful planning, leadless pacing can be successfully performed in these patients. Consideration of nonfemoral access, alternative implant sites to avoid myocardial scar or prosthetic material, anticoagulation for patients with persistent intracardiac shunts or systemic ventricular implantation, and operator experience are critical.
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Affiliation(s)
- Elizabeth D Sherwin
- Division of Pediatric Cardiology, Children's National Hospital, Division of Cardiology Washington, 111 Michigan Avenue, NW, Washington, DC 20010, USA
| | - Maully J Shah
- Cardiac Electrophysiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Baffle Complications in Adults After Atrial Switch for Transposition of the Great Arteries. Can J Cardiol 2021; 38:68-76. [PMID: 34634378 DOI: 10.1016/j.cjca.2021.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Baffle complications, ie, leakage or stenosis, after an atrial switch operation (AtrSO) for transposition of the great arteries (TGA) are difficult to detect with the use of routine transthoracic echocardiography (TTE). We examined baffle interventions and the prevalence of baffle complications. METHODS This dual-centre study followed TGA-AtrSO patients for the occurrence of baffle interventions. In addition, in 2017-2019, prevalence of baffle complications was determined in patients undergoing routine contrast-enhanced (CE) TTE including various hemodynamic conditions and computed tomography (CT). Baffle leaks were defined as right-to-left shunting on CE-TTE and baffle stenosis as a systemic venous baffle diameter of < 10 mm on CT. RESULTS In total, 67 TGA-AtrSO patients were followed to a median age of 38 (interquartile range 34-42) years, for a median of 9 (6-13) years. Baffle interventions were documented in 24 patients (36%). Cumulative risk of baffle interventions was 25% after 15 years of follow-up. Prevalence of baffle complications was determined in 29/67 patients. In total, 4 (14%) had patent baffles, 11 (38%) had leakage only, 5 (17%) had stenosis only, and 9 (31%) had both, while 24/29 (84%) were asymptomatic. Although baffle leaks were not associated with clinical characteristics, peak work rate during exercise TTE was lower in patients with vs without stenosis (89 ± 24 W vs 123 ± 21 W; P < 0.001). CONCLUSIONS Baffle complications are common in TGA-AtrSO. The cumulative risk of baffle interventions was 25% after 15 years of follow-up. CE-TTE uncovered asymptomatic baffle leakage in the majority of patients, especially with examination during exercise. CT revealed baffle stenosis in almost half of the patients, which was associated with decreased exercise tolerance. Awareness of these findings may alter clinical follow-up.
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Arthur L, Schoeneberg L, Angtuaco M, Greenberg SB, Renno MS, Das S. Advanced imaging improves detection of baffle leaks and stenoses after atrial switch compared with transthoracic echocardiography. Int J Cardiovasc Imaging 2021; 37:2767-2772. [PMID: 33864562 DOI: 10.1007/s10554-021-02236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/03/2021] [Indexed: 11/25/2022]
Abstract
Current guidelines for adults with atrial switch repair recommend baseline cardiovascular magnetic resonance (CMR) for assessment of ventricular size and function, systemic and venous baffle obstruction and leaks, and valvular function. It also recommends transthoracic echocardiography (TTE) for outpatient follow up. Many such patients with implanted cardiac devices may need cardiac computed tomography (CCT) when CMR is not feasible. This study reviews and compares CMR, transesophageal echocardiography (TEE), CCT, cardiac catheterization with angiography and TTE in detection of baffle problems in patients after atrial switch operation. The medical records of patients who had at least one imaging study performed after atrial switch operation at our center from 2010 to 2020 were retrospectively reviewed. Results are reported as descriptive statistics for demographics and imaging findings. The principal outcome measure was detection of baffle leak and/or baffle stenosis. Fifty-seven patients had at least one cardiac imaging study after atrial switch operation (36 Senning and 21 Mustard operations) during the study period. Nearly 33% (19/57) had baffle complications of stenosis and/or baffle leaks identified. All 57 patients had TTE performed but baffle problems were noted by TTE in only 8 (14%) patients (7 baffle stenosis and 1 baffle leak). Of the 49 patients without known baffle problems by TTE, 24 had advanced imaging (TEE/CCT/CMR/angiography). Advanced imaging identified baffle problems in nearly half (11/24, 46%) of them (7 baffle leaks and 4 baffle stenosis). Baffle problems were present in (8/23) patients with transvenous cardiac devices. Baffle complications are common after atrial switch operations and in our study occur in 1/3rd of the patients. However, TTE is not sensitive enough to recognize these complications. Advanced imaging for detection of baffle complications should be considered in all patients after atrial switch operation.
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Affiliation(s)
- Lindsay Arthur
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Laura Schoeneberg
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael Angtuaco
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Bruce Greenberg
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Markus S Renno
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Srikant Das
- Arkansas Children's Hospital, Little Rock, AR, USA.
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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5
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Merrill M, Krebsbach A, Przybylowicz R, Broberg CS, Burch G, Henrikson CA. Extract-stent-replace for treatment of upper baffle stenosis with pacing leads after atrial switch procedures for transposition of the great arteries: An approach to avoid "jailing" the lead. J Cardiovasc Electrophysiol 2020; 31:2744-2750. [PMID: 32776621 DOI: 10.1111/jce.14710] [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: 07/15/2020] [Accepted: 08/01/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Venous stenosis is a late complication of the atrial switch (Mustard/Senning) procedure seen in patients with transposition of the great arteries ( d-TGA). Many atrial switch patients require cardiac implantable electronic devices (CIEDs) which further increases the incidence of venous stenosis. Stenosis of the superior limb of the systemic venous pathway (SLSVP) in the presence of CIED leads presents a management challenge. We propose a method for navigating SLSVP stenosis in atrial switch patients with CIEDs. METHODS The pulse generator and leads were removed using standard extraction techniques. Axillary access was retained via existing leads or new access was obtained. The interventional cardiology team, via groin access, performed stent-angioplasty of the stenotic SLSVP. After stent deployment, the axillary access wire was snared from below, guided through the stent, and pulled into a long groin sheath. A sheath was then advanced over the axillary wire and into the groin sheath creating a path for passage of leads through the stent. New leads were advanced through the axillary sheath into the heart. Leads were secured using standard techniques. RESULTS All patients had a history of d-TGA and prior atrial switch procedures. In each case, there was stenosis of the SLSVP in the setting of a CIED lead. There were no immediate complications and there was no restenosis on follow-up. CONCLUSION Post-atrial switch patients with CIEDs can develop stenosis of the SLSVP. A collaboration between electrophysiology and interventional cardiology can allow for device extraction, stent-angioplasty, and lead reimplantation to avoid "jailing" the leads.
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Affiliation(s)
- Miranda Merrill
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Angela Krebsbach
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Ryle Przybylowicz
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Craig S Broberg
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Grant Burch
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Charles A Henrikson
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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Do-Nguyen CC, Ochman A, Kilcoyne MF, Kovach R, Abraham BP, Kazemian P, McGrath L, Stevens RM. Efficient approach to superior vena cava baffle stenosis following the Mustard procedure: Expanding the role of a mechanical rotating dilator sheath for lead extraction. J Card Surg 2020; 35:1664-1668. [PMID: 32383229 DOI: 10.1111/jocs.14608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In adult congenital patients with transposition of the great arteries originally treated with the Mustard (atrial switch) procedure, the most common reason for re-intervention is baffle stenosis. This may be exacerbated by permanent transvenous pacemaker lead placement across the baffle. CASE REPORT A 47-year-old female status post Mustard procedure performed at 15 months old presented with a high-grade stenosis of the superior vena cava (SVC) baffle from the SVC to the left atrium, with a nonfunctional permanent pacemaker lead passing through the baffle. A mechanical rotating dilator sheath was used for attempted lead extraction, relieving the baffle stenosis almost completely as a secondary effect, before the placement of a 10 × 27 mm Visipro balloon-expandable stent in the SVC baffle. CONCLUSIONS Use of the mechanical rotating dilator sheath is an evolving treatment strategy in adult congenital heart disease to minimize the risk of bleeding, trauma to surrounding structures, and death. Its ability to fully alleviate baffle stenosis even when full lead extraction is not feasible or is associated with significant procedural risk, further demonstrates its expanded role in this patient population. A multidisciplinary approach and great diligence must be employed to avoid potential complications.
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Affiliation(s)
- Chi Chi Do-Nguyen
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Alexander Ochman
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, New Jersey
| | - Maxwell F Kilcoyne
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Richard Kovach
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, New Jersey
| | - Boban P Abraham
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, New Jersey.,Department of Cardiothoracic Surgery, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Pedram Kazemian
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, New Jersey
| | - Lynn McGrath
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, New Jersey
| | - Randy M Stevens
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, New Jersey.,Department of Cardiothoracic Surgery, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
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Lead Extraction With Baffle Stenting in Adults With Transposition of the Great Arteries. JACC Clin Electrophysiol 2019; 5:671-680. [DOI: 10.1016/j.jacep.2019.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/20/2018] [Accepted: 01/17/2019] [Indexed: 11/22/2022]
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8
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Abstract
Superior caval vein obstruction in children after congenital heart surgery has been more associated with thrombosis formation as result of single-ventricle palliation, infection, indwelling devices/catheters, or external compression. Many of these patients will present to the cardiac catheterisation laboratory for evaluation and possible intervention. We present an unusual case of superior caval vein obstruction in a patient after Tetralogy of Fallot repair.
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Abstract
PURPOSE OF REVIEW Patients with complete and congenitally corrected transposition of the great arteries commonly survive into adulthood and present with a vast array of clinical residua. RECENT FINDINGS Echocardiography remains the primary imaging modality in the routine assessment of the adult with transposition of the great arteries. It provides a comprehensive anatomic and hemodynamic evaluation. Limitations to echocardiography include evaluation of the following: the systemic right ventricle, baffle patency following atrial switch procedure, coronary arteries following arterial switch procedure or Nikadoh, and multilevel right ventricular outflow tract obstruction. SUMMARY Each form of palliation for transposition of the great arteries results in unique long-term sequelae that affect outcomes. A multimodality approach to imaging is required for a complete evaluation.
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Dvir-Orgad M, Anand M, De Souza AM, Zadorsky MT, Kiess MC, Potts JE, Sandor GGS. Stress Echocardiographic Evaluation for D-Transposition of the Great Arteries after Atrial Redirection: Unmasking Early Signs of Myocardial Dysfunction and Baffle Stenosis. J Am Soc Echocardiogr 2017; 30:80-89. [PMID: 28341033 DOI: 10.1016/j.echo.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors used semisupine cycle ergometry stress echocardiography to assess cardiac function and unmask baffle stenosis in patients with d-transposition of the great arteries after atrial redirection surgery. METHODS This was a retrospective review of semisupine cycle ergometry stress echocardiography performed in 53 patients (64% male; mean age, 24.0 years; 90% Mustard procedure) and 56 healthy control subjects. Incremental exercise to volitional fatigue was performed. Hemodynamic data, echocardiographic cardiac dimensions, area change, tissue Doppler velocities, strain, ventricular synchronization, and superior vena cava flow velocities before and immediately after exercise are reported. RESULTS Patients had lower exercise capacity (870 vs 1,854 J/kg, P < .001) and peak heart rates (132 vs 167 beats/min, P < .001). Stroke volume index did not increase with exercise (45 vs 47 mL/m2, P = .400). Cardiac index increased in both groups with exercise (3.0 vs 6.1 and 2.9 vs 7.0 L/min/m2, P < .001) and was higher in control subjects (P = .006). Right ventricular diastolic and systolic areas decreased significantly with exercise in both the short-axis and four-chamber views. Right and left ventricular contraction time shortened with exercise (405 vs 247 and 338 vs 217 msec, P < .001) and remained synchronous (ratio of right ventricular to left ventricular contraction time = 0.080). Doppler velocities in patients with baffle obstruction were higher in the lower superior vena cava with exercise compared with nonobstructed patients (1.87 vs 1.46 m/sec, P = .020) and normalized after catheter intervention (1.49 vs 1.46 m/sec, P = .800). CONCLUSIONS Patients with d-transposition of the great arteries have lower exercise capacity and peak heart rates. The systemic right ventricle presents a lesser but qualitatively normal systolic response and decreased diastolic filling. Semisupine cycle ergometry stress echocardiography unmasked SVC obstruction.
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Affiliation(s)
- Merav Dvir-Orgad
- Division of Cardiology, Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Meera Anand
- Division of Cardiology, Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Astrid M De Souza
- Division of Cardiology, Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Mary T Zadorsky
- Division of Cardiology, Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Marla C Kiess
- Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - James E Potts
- Division of Cardiology, Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - George G S Sandor
- Division of Cardiology, Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
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Cohen MS, Eidem BW, Cetta F, Fogel MA, Frommelt PC, Ganame J, Han BK, Kimball TR, Johnson RK, Mertens L, Paridon SM, Powell AJ, Lopez L. Multimodality Imaging Guidelines of Patients with Transposition of the Great Arteries: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2016; 29:571-621. [DOI: 10.1016/j.echo.2016.04.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Wilhelm CM, Sisk TL, Roble SL, Chisolm JL, Janevski I, Cheatham JP, Cua CL. Accuracy of Imaging Modalities in Detection of Baffle Leaks in Patients Following Atrial Switch Operation. Echocardiography 2015; 33:437-42. [DOI: 10.1111/echo.13097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | - Tracey L. Sisk
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio
| | - Sharon L. Roble
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio
| | | | - Ilija Janevski
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio
| | | | - Clifford L. Cua
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30:e1-e63. [PMID: 25262867 DOI: 10.1016/j.cjca.2014.09.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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15
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm 2014; 11:e102-65. [PMID: 24814377 DOI: 10.1016/j.hrthm.2014.05.009] [Citation(s) in RCA: 380] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 02/07/2023]
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16
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Cuypers JAAE, Eindhoven JA, Slager MA, Opi P, Utens EMWJ, Helbing WA, Witsenburg M, van den Bosch AE, Ouhlous M, van Domburg RT, Rizopoulos D, Meijboom FJ, Bogers AJJC, Roos-Hesselink JW. The natural and unnatural history of the Mustard procedure: long-term outcome up to 40 years. Eur Heart J 2014; 35:1666-74. [DOI: 10.1093/eurheartj/ehu102] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Steinberg C, Calvaruso D, Guimond J, Bédard E, Perron J. Surgical lead extraction for total occlusion of the superior vena cava by chronic lead infection after mustard procedure. J Card Surg 2014; 29:406-9. [PMID: 24438576 DOI: 10.1111/jocs.12290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a case of total occlusion of the superior vena cava (SVC) with extensive thrombosis of the adjacent large veins secondary to multiple abandoned pacemaker leads with a superimposed chronic lead infection by Corynebacterium jeikeium. A surgical lead extraction was performed with an extensive en-bloc resection of the SVC together with the right subclavian vein and the right innomate vein. No venous reconstruction was required because of an unobstructed runoff via a well-developed azygos system.
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Affiliation(s)
- Christian Steinberg
- Division of Cardiology, Institut Universitaire De Cardiologie Et Pneumologie de Québec (IUCP), Quebec Heart and Lung Institute, Quebec, Canada
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Cardiac imaging in adults with congenital heart disease: unknowns and issues related to diagnosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:663-74. [PMID: 24101413 DOI: 10.1007/s11936-013-0270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OPINION STATEMENT Many adults with simple and complex congenital heart disease (CHD) survive to adulthood. The goal of imaging is to diagnose the underlying anomalies and to detect late complications of their CHD and past surgical repair, in order to assess the need for further intervention and better prepare for endovascular or open-heart surgery. Cardiac magnetic resonance imaging (MRI) and computerized tomography (CT) are increasingly utilized in this patient population, due to the technical advances made to these modalities in the past decade regarding image acquisition and reconstruction, spatial and temporal resolution, and radiation dose reduction. Here, we aim to review the role of cardiac MR in initial diagnosis, pre-treatment planning and post-surgical follow-up of adults with CHD, and to discuss the ancillary role of cardiac CT in these patients.
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Windram JD, Siu SC, Wald RM, Silversides CK. New Directives in Cardiac Imaging: Imaging the Adult With Congenital Heart Disease. Can J Cardiol 2013; 29:830-40. [DOI: 10.1016/j.cjca.2013.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 11/16/2022] Open
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20
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Singh HS, Nagy C, Wan AW, Osten MD, Benson LN, Horlick EM. Complex Interventions in the Adult with Congenital Heart Disease: Percutaneous Solutions for Venous Baffles, Coronary Artery Fistulas, and Ruptured Sinus of Valsalva Aneurysms. Interv Cardiol Clin 2013; 2:153-172. [PMID: 28581980 DOI: 10.1016/j.iccl.2012.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe 3 distinct ACHD lesions amenable to percutaneous repair: (1) venous baffle obstruction in transposition of the great arteries, (2) coronary artery fistulas, and (3) ruptured sinus of Valsalva aneurysms. For each entity, we chronicle the typical clinical scenario and indications for intervention to supplement the technical approach and potential pitfalls with treatment.
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Affiliation(s)
- Harsimran S Singh
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA; Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Christian Nagy
- Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Andrea W Wan
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Mark D Osten
- Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Lee N Benson
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Eric M Horlick
- Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto School of Medicine, Toronto, Ontario, Canada.
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Burchill LJ, Ross HJ. Heart transplantation in adults with end-stage congenital heart disease. Future Cardiol 2012; 8:329-42. [PMID: 22413990 DOI: 10.2217/fca.12.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Residual abnormalities in cardiac structure and function predispose adults with congenital heart disease to late-onset heart failure and its complications. Evaluation of this population requires collaboration between adult congenital and heart failure specialists. In addition to assessing heart transplant eligibility, clinicians must balance the risks of premature listing against progressive heart failure and increased waiting list mortality. Following heart transplantation, adults with congenital heart disease have higher mortality due to an increased risk of bleeding, infection and donor right heart failure secondary to pulmonary hypertension. Concerns relating to increased early mortality should be balanced against superior long-term survival in adult congenital heart disease patients surviving beyond the first year after heart transplantation.
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Affiliation(s)
- Luke J Burchill
- University of Toronto, Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Canada
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Grothoff M, Hoffmann J, Abdul-Khaliq H, Lehmkuhl L, Dähnert I, Berger F, Mende M, Gutberlet M. Right ventricular hypertrophy after atrial switch operation: normal adaptation process or risk factor? A cardiac magnetic resonance study. Clin Res Cardiol 2012; 101:963-71. [PMID: 22714955 PMCID: PMC3501162 DOI: 10.1007/s00392-012-0485-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/08/2012] [Indexed: 11/25/2022]
Abstract
Background Systemic right ventricle (RV) hypertrophy and impaired function occur after atrial switch for dextro-transposition of the great arteries (d-TGA). Echocardiography is limited in its ability to assess the RV. We sought to evaluate systemic RV myocardial-mass index (MMI) and function after atrial switch and to analyse the role of hypertrophy for ventricular function with special consideration of the interventricular septal (IVS) movement. Methods Thirty-seven consecutive patients (median age 22.9 years) after atrial switch were studied using cardiac magnetic resonance imaging (1.5T Intera, Philips) with a dedicated 5-channel phased-array surface cardiac coil. Cine steady-state free-precession sequences were acquired to obtain myocardial masses and function. The systolic movement of the IVS was defined as positive when moving towards the centroid of the RV and was defined as non-positive otherwise. Patient parameters were compared to controls. Results The systemic RVs were significantly larger (p < 0.001) than the left ventricles of the control group, systolic function was significantly impaired (p < 0.001) and MMI including the IVS was comparable (p = n.s.). RV-MMI excluding the IVS and RV ejection fraction (EF) demonstrated a quadratic correlation (r = 0.6, p < 0.001), meaning that patients with RV-MMI ≤29 g/m2 and >68 g/m2 had a reduced level of systolic function. Positive septal movement improved RV function compared with non-positive septal movement (p = 0.024). Conclusions There seems to be a range of beneficial RV hypertrophy after atrial switch in which a sufficient RV-EF can be expected. A positive septal movement, probably the result of hypertrophic septal RV fibres, improves RV function and might be regarded as a beneficial contraction pattern.
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Affiliation(s)
- Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
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Lu JC, Dorfman AL, Attili AK, Ghadimi Mahani M, Dillman JR, Agarwal PP. Evaluation with Cardiovascular MR Imaging of Baffles and Conduits Used in Palliation or Repair of Congenital Heart Disease. Radiographics 2012; 32:E107-27. [DOI: 10.1148/rg.323115096] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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