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Sebastian SA, Sethi Y, Mathews AM, Santhosh T, Lorraine Co E, Padda I, Johal G. Cardiovascular complications during pregnancy: Advancing cardio-obstetrics. Dis Mon 2024; 70:101780. [PMID: 38910052 DOI: 10.1016/j.disamonth.2024.101780] [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: 06/25/2024]
Abstract
As the incidence of cardiovascular diseases (CVDs) continues to rise among women of childbearing age, the pregnant population with pre-existing heart conditions presents a complex and heterogeneous profile. These women face varying degrees of risk concerning maternal cardiovascular, obstetric, and fetal complications. Effectively managing adverse cardiovascular events during pregnancy presents substantial clinical challenges. The uncertainties surrounding diagnostic and therapeutic approaches create a dynamic landscape with potential implications for maternal and fetal health. Cardio-obstetrics has become increasingly recognized as a vital multidisciplinary field necessitating a collaborative approach to managing cardiovascular conditions during pregnancy. In this review, we aim to provide a thorough and up-to-date examination of the existing evidence, offering a comprehensive overview of strategies and considerations in the management of cardiovascular complications during pregnancy. Special emphasis is placed on the safety assessment of diagnostic procedures and the exploration of treatment options designed to prioritize the well-being of the mother and fetus. We also explore the significance of a multidisciplinary cardio-obstetrics team in providing comprehensive care for women of childbearing age with or at risk for CVD.
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Affiliation(s)
- Sneha Annie Sebastian
- Department of Internal Medicine, Azeezia Medical College, Kollam, Kerala, India; Research Nexus, Philadelphia, United States.
| | - Yashendra Sethi
- Department of Internal Medicine, Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun, India
| | | | - Tony Santhosh
- Department of Internal Medicine, Dr. Somervell Memorial CSI Medical College, KUHS, Kerala, India
| | - Edzel Lorraine Co
- Research Nexus, Philadelphia, United States; Department of Internal Medicine, University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, USA
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2
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Gomez YM, Sharp LK, Martyn-Nemeth P, Park LG, Vuckovic KM. Health Literacy and Its Impact on Self-Care of Children With Congenital Heart Disease. J Cardiovasc Nurs 2024:00005082-990000000-00220. [PMID: 39259597 DOI: 10.1097/jcn.0000000000001149] [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: 09/13/2024]
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3
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Pula G, Harris KC. Optimal Timing of Pulmonary Valve Replacement - The Holy Grail in Tetralogy of Fallot. Can J Cardiol 2024:S0828-282X(24)00941-3. [PMID: 39244152 DOI: 10.1016/j.cjca.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/04/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024] Open
Affiliation(s)
- Giulia Pula
- Children's Heart Centre, BC Children's Hospital, Division of Cardiology, University of British Columbia
| | - Kevin C Harris
- Children's Heart Centre, BC Children's Hospital, Division of Cardiology, University of British Columbia.
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Parker DM, Stabler ME, MacKenzie TA, Zimmerman MS, Shi X, Everett AD, Bucholz EM, Brown JR. Population-Based Estimates of the Prevalence of Children With Congenital Heart Disease and Associated Comorbidities in the United States. Circ Cardiovasc Qual Outcomes 2024; 17:e010657. [PMID: 39185543 DOI: 10.1161/circoutcomes.123.010657] [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: 10/24/2023] [Accepted: 06/19/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Congenital heart defects (CHD) are the most common birth defects and previous estimates report the disease affects 1% of births annually in the United States. To date, CHD prevalence estimates are inconsistent due to varied definitions, data reliant on birth registries, and are geographically limited. These data sources may not be representative of the total prevalence of the CHD population. It is therefore important to derive high-quality, population-based estimates of the prevalence of CHD to help care for this vulnerable population. METHODS We performed a descriptive, retrospective 8-year analysis using all-payer claims data from Colorado from 2012 to 2019. Children with CHD were identified by applying International Classification of Diseases-Ninth Revision (ICD-9) and International Classification of Diseases-Tenth Revision (ICD-10) diagnosis codes from the American Heart Association-American College of Cardiology harmonized cardiac codes. We included children with CHD <18 years of age who resided in Colorado, had a documented zip code, and had at least 1 health care claim. CHD type was categorized as simple, moderate, and severe disease. Association with comorbid conditions and genetic diagnoses were analyzed using χ2 test. We used direct standardization to calculate adjusted prevalence rates, controlling for age, sex, primary insurance provider, and urban-rural residence. RESULTS We identified 1 566 328 children receiving care in Colorado from 2012 to 2019. Of those, 30 512 children had at least 1 CHD diagnosis, comprising 1.95% (95% CI, 1.93-1.97) of the pediatric population. Over half of the children with CHD also had at least 1 complex chronic condition. After direct standardization, the adjusted prevalence rates show a small increase in simple severity diagnoses across the study period (adjusted rate of 11.5 [2012]-14.4 [2019]; P<0.001). CONCLUSIONS The current study is the first population-level analysis of pediatric CHD in the United States. Using administrative claims data, our study found a higher CHD prevalence and comorbidity burden compared with previous estimates.
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Affiliation(s)
- Devin M Parker
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), L'Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France (D.M.P.)
| | - Meagan E Stabler
- Department of Family and Community Medicine, Northern New England CO-OP Practice and Community Based Research Network, Dartmouth Hitchcock, Lebanon, NH (M.E.S.)
| | - Todd A MacKenzie
- Department of Biomedical Data Science (T.A.M.), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Meghan S Zimmerman
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.S.Z.)
| | - Xun Shi
- Department of Geography, Dartmouth College, Hanover, NH (X.S.)
| | - Allen D Everett
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD (A.D.E.)
| | - Emily M Bucholz
- Department of Pediatrics, University of Colorado, Aurora (E.M.B.)
| | - Jeremiah R Brown
- Department of Epidemiology (J.R.B.), Geisel School of Medicine at Dartmouth, Hanover, NH
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5
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Aubry P, du Fretay XH, Boudvillain O, Bejar A, Ettagmouti Y, Degrell P. [Angioplasty of an anomalous coronary artery : A complex procedure ?]. Ann Cardiol Angeiol (Paris) 2024; 73:101781. [PMID: 39059043 DOI: 10.1016/j.ancard.2024.101781] [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] [Received: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
Coronary artery anomalies (ANOCOR) are congenital anomalies with various anatomical forms. Percutaneous treatment can be offered in certain situations, most often to address associated atherosclerotic disease or, more rarely, to correct a congenital stenosis. Due to the frequent difficulties of catheterization, percutaneous coronary interventions for ANOCOR are recognized as complex procedures. A thorough anatomical understanding facilitates the identification of the connection site and the initial ectopic course of an ANOCOR during coronary angiography. Selecting an appropriate catheter is a crucial step in the procedure. There is a higher prevalence of atherosclerotic disease along retroaortic courses compared to other ectopic courses. When treating atherosclerotic stenosis downstream of an ectopic course, techniques typically used for complex coronary procedures can be helpful. While angioplasty for congenital stenosis is technically feasible, its role in management algorithms remains to be defined. Currently, this type of percutaneous treatment may be offered to right ANOCOR with interarterial course in adults over 35 years old and with ischemic symptoms or myocardial ischemia.
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Affiliation(s)
- P Aubry
- Département de cardiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude-Bernard, 75018 Paris, France; Service de cardiologie, Centre Hospitalier de Gonesse, 95500 Gonesse, France.
| | - X Halna du Fretay
- Département de cardiologie, Pôle Santé Oreliance, 45770 Saran, France
| | - O Boudvillain
- Département de cardiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude-Bernard, 75018 Paris, France; Service de cardiologie, Hôpital Foch, 92150 Suresnes, France
| | - A Bejar
- Service de cardiologie, Centre Hospitalier de Gonesse, 95500 Gonesse, France
| | - Y Ettagmouti
- Service de cardiologie, Centre Hospitalier de Gonesse, 95500 Gonesse, France
| | - P Degrell
- Département de cardiologie, Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, L-1210 Luxembourg, Luxembourg
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Williams V, Rahaghi FF, Drexler IR, Sakr L. A 76-Year-Old-Man With Dyspnea and Abnormal Oximetry Run. Chest 2024; 166:e83-e87. [PMID: 39260951 DOI: 10.1016/j.chest.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/21/2024] [Accepted: 05/08/2024] [Indexed: 09/13/2024] Open
Abstract
CASE PRESENTATION A 76-year-old male Vietnam veteran with a medical history of OSA on CPAP, mild COPD, Parsonage-Turner syndrome (a rare neurologic syndrome manifesting with shoulder and arm pain), hypertension, gastroesophageal reflux, hiatal hernia, and prior endocarditis presented with 1 year duration progressive exertional dyspnea with minimal activity by referral from an outside pulmonologist. The patient reported possible exposure to Agent Orange during his service but was otherwise without significant occupational or environmental exposures. His exercise tolerance was well-maintained up until the last 12 months. Aside from marginal cigarette use, he denied any recreational drug use or any anorectic use. The patient provided records from a recent right heart catheterization (RHC) months earlier for review.
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Affiliation(s)
- Veronica Williams
- Department of Pulmonary Critical Care, Cleveland Clinic Weston, Weston, FL.
| | - Franck F Rahaghi
- Department of Pulmonary Critical Care, Cleveland Clinic Weston, Weston, FL
| | - Ian R Drexler
- Lang Family Department of Imaging, Cleveland Clinic Weston, Weston, FL
| | - Lewjain Sakr
- Department of Pulmonary Critical Care, Cleveland Clinic Weston, Weston, FL
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Estep JD, Nicoara A, Cavalcante J, Chang SM, Cole SP, Cowger J, Daneshmand MA, Hoit BD, Kapur NK, Kruse E, Mackensen GB, Murthy VL, Stainback RF, Xu B. Recommendations for Multimodality Imaging of Patients With Left Ventricular Assist Devices and Temporary Mechanical Support: Updated Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:820-871. [PMID: 39237244 DOI: 10.1016/j.echo.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Affiliation(s)
| | | | - Joao Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | | | | | - Brian D Hoit
- Case Western Reserve University, Cleveland, Ohio
| | | | - Eric Kruse
- University of Chicago, Chicago, Illinois
| | | | | | | | - Bo Xu
- Cleveland Clinic, Cleveland, Ohio
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8
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Torres-Castro R, Hinojosa W, Martínez-Meñaca A, Sala Llinas E, Jiménez Arjona J, Rueda Soriano J, Aurtenetxe A, Barberà JA, Escribano-Subías P, Blanco I. Epidemiology of supplemental oxygen in patients with pulmonary hypertension. Respirology 2024. [PMID: 39210654 DOI: 10.1111/resp.14821] [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: 03/17/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Patients with pulmonary hypertension (PH) may present with hypoxaemia at rest or during daily activities. There is no epidemiological data on the prescription of long-term oxygen therapy (LTOT) in patients with PH. The study sought to analyse the prevalence and incidence of LTOT prescription among patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Spain and to determine predictors for this prescription. METHODS A retrospective analysis was performed from the Spanish Registry of Pulmonary Arterial Hypertension (REHAP). Collected data included demographics and anthropometric measurements, functional class (FC), arterial blood gases, pulmonary function tests, haemodynamic measurements, six-minute walking distance (6MWD) and LTOT prescription. In addition, we assessed the prevalence and incidence of LTOT prescription by PH group and subtype and potential predictors for LTOT initiation in the first 5 years after diagnosis. RESULTS We analysed 4533 patients (69.9% PAH and 30.1% CTEPH), mostly female (64.5%), with a mean age of 53.0 ± 18.3 years. The prevalence of LTOT was 19.3% for all patients. The incidence of LTOT prescriptions decreased from 5.6% to 1.6% between 2010 and 2019, respectively. Predictors for LTOT prescription, excluding those that represent the indication for oxygen therapy were: FC (HR: 1.813), 6MWD (HR: 1.002), mean pulmonary arterial pressure (mPAP) (HR: 1.014), cardiac index (CI) (HR: 1.253), pulmonary vascular resistance (PVR) (HR: 1.023) and diffusing capacity of carbon monoxide (DLCO) (HR: 1.294). CONCLUSION The prevalence of LTOT in PAH and CTEPH patients is close to 20%. FC, 6MWD, mPAP, CI, PVR and DLCO were predictors for LTOT prescription.
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Affiliation(s)
- Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Williams Hinojosa
- Pulmonary Hypertension Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Amaya Martínez-Meñaca
- Department of Pneumology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
- ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
| | - Ernest Sala Llinas
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Department of Pneumology, Hospital Universitario Son Espases, Balearic Islands, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Joaquín Rueda Soriano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Agueda Aurtenetxe
- Depatrment of Pneumology, Hospital Universitario Basurto, Bilbao, Spain
| | - Joan Albert Barberà
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain
- ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Pilar Escribano-Subías
- Pulmonary Hypertension Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de investigación del Hospital 12 de Octubre ( i+12), Madrid, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain
- ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Chang Y, Lim J, Yoon HW. Association of nurse-mother partnerships with parenting stress and family resilience among South Korean mothers of children with congenital heart disease. J Pediatr Nurs 2024; 79:16-23. [PMID: 39190966 DOI: 10.1016/j.pedn.2024.08.021] [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: 01/13/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Advances in the management of congenital heart disease (CHD) have significantly decreased mortality rates, indicating a need for continuous care as a chronic condition throughout the child's lifespan. This study examined the association of nurse-mother partnerships with parenting stress and family resilience among South Korean mothers of children with CHD. DESIGN AND METHODS This descriptive study involved 93 mothers of children aged six years or younger with CHD admitted to a hospital. Data were collected from September to November 2020 and analyzed using SPSS/WIN (version 29.0) for t-tests, analyses of variance, Pearson's correlation coefficient, and multiple regression analyses. RESULTS The means and standard deviations of the nurse-mother partnership, parenting stress, and family resilience were 4.13 ± 0.47, 76.98 ± 16.6, and 56.54 ± 7.86 points, respectively. Parenting stress increased as the number of hospitalizations and surgeries increased and with complex types of CHD. Nurse-mother partnerships were stronger with longer hospital stays. Family resilience was higher with younger children, fewer rehospitalizations, and shorter hospital stays. A positive correlation was found between nurse-mother partnerships and family resilience, and a negative correlation between parenting stress and family resilience. Factors influencing parenting stress included family resilience, rehospitalizations, and complex types of CHD, and those affecting family resilience were nurse-mother partnerships, parenting stress, and the child's age. CONCLUSION Nurse-mother partnerships significantly affect family resilience. PRACTICAL IMPLICATIONS Enhancing nurse-mother partnerships can improve family resilience, which in turn can reduce parenting stress, thus offering guidance for future nursing interventions.
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Affiliation(s)
- Youna Chang
- Nursing Department, ASAN Medical Center, Seoul, Republic of Korea
| | - Jiyoung Lim
- College of Nursing, CHA University, Pocheon-si, Republic of Korea
| | - Hye Won Yoon
- College of Nursing, CHA University, Pocheon-si, Republic of Korea.
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Laubham M, Dodeja AK, Kumthekar R, Shay V, D'Emilio N, Conroy S, Mah ML, Alvarado C, Kamp A. Patient Driven EKG Device Performance in Adults with Fontan Palliation. Pediatr Cardiol 2024:10.1007/s00246-024-03614-6. [PMID: 39152263 DOI: 10.1007/s00246-024-03614-6] [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: 04/11/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024]
Abstract
The aim of this study was to evaluate the accuracy of the KardiaMobile (KM) device in adults with a Fontan palliation, and to assess the KM function as a screening tool for atrial arrhythmias. While patient driven electrocardiogram (EKG) devices are becoming a validated way to evaluate cardiac arrhythmias, their role for patients with congenital heart disease is less clear. Patients with single ventricle Fontan palliation have a high prevalence of atrial arrhythmias and represent a unique cohort that could benefit from early detection of atrial arrhythmias. This single center prospective study enrolled adult patients with Fontan palliation to use the KM heart rhythm monitoring device for both symptomatic episodes and asymptomatic weekly screening over a 1-year period. Accuracy was assessed by comparing the automatic KM interpretation (KM-auto) to an electrophysiologist overread (KM-EP) and traditional EKG. Fifty patients were enrolled and 510 follow-up transmissions were received. The sensitivity and specificity of enrollment KM-auto compared to EKG was 65% and 100%, respectively. The sensitivity and specificity of enrollment KM-auto compared to the KM-EP was 75% and 96%, respectively. In the adult Fontan palliation, the accuracy of the KM device to detect a normal rhythm was reliable and best with a physician overread. Abnormal or uninterpretable KM-auto device interpretations, symptomatic transmissions, and any transmissions with a high heart rate compared to a patient's normal baseline should warrant further review.
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Affiliation(s)
- Matthew Laubham
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- The Ohio State University Medical Center, Columbus, OH, 43210, USA.
| | - Anudeep K Dodeja
- University of Connecticut School of Medicine and Connecticut Children's Hospital Hartford, Hartford, CT, 06106, USA
| | - Rohan Kumthekar
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- The Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Victoria Shay
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
| | - Nathan D'Emilio
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Sara Conroy
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
- Biostatistics Resource, Nationwide Children's Hospital, Abigail Wexner Research Institute, Columbus, OH, 43205, USA
| | - May Ling Mah
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- The Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Chance Alvarado
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
- Biostatistics Resource, Nationwide Children's Hospital, Abigail Wexner Research Institute, Columbus, OH, 43205, USA
| | - Anna Kamp
- Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- The Ohio State University Medical Center, Columbus, OH, 43210, USA
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Saraç İ, Birdal O. Perioperative Assessment and Clinical Outcomes of Percutaneous Atrial Septal Defect Closure with Three-Dimensional Transesophageal Echocardiography. Diagnostics (Basel) 2024; 14:1755. [PMID: 39202243 PMCID: PMC11353277 DOI: 10.3390/diagnostics14161755] [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: 06/20/2024] [Revised: 07/25/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND/OBJECTIVES To close the atrial septal defect (ASD) with the transcatheter method, correctly defining the defect and selecting the appropriate closure device size are the most critical steps for the procedure's success. Although ASD can be successfully closed under the guidance of three-dimensional (3D) transesophageal echocardiography (TEE) and two-dimensional (2D) TEE, measurement comparisons between different types of defects are still needed. METHODS Our study was designed retrospectively. Sixty-one patients who underwent transcatheter ASD closure with 2D TEE and 3D TEE between 2020 and 2024 were included. The patients were divided into three groups according to the defect shape: circular, oval, and complex; and the measurement results, perioperative process, and clinical outcomes were compared in each group. RESULTS The average age of the patients was 35.05 ± 13.87 years, and 41 (67.2%) were women. The average follow-up period of the patients was 15.3 ± 9.18 months. No statistical significance was observed in the comparison of measurements obtained with 3D TEE and 2D TEE in the circular and oval defect groups. The differences between the minimum defect diameters of complex defects measured by 2D TEE and 3D TEE (p: 0.037), IVC rims (p < 0.001), aortic rims (p: 0.012), and the differences between implanted device dimensions and the maximum defect diameters measured by both methods were compared; statistical significance was observed (p: 0.025). CONCLUSIONS In circular and non-complex oval defects, it has been observed that the size of the closure device selected with 2D TEE or 3D TEE is optimal, and the procedure is practical and feasible. While the closure of complex ASDs with 3D TEE provides reliable and optimal results, using only 2D TEE in complex ASDs may lead to selecting a smaller-sized device.
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Affiliation(s)
- İbrahim Saraç
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum 25010, Türkiye;
- Department of Physiology, Faculty of Medicine, Atatürk University, Erzurum 25010, Türkiye
| | - Oğuzhan Birdal
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum 25010, Türkiye;
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Kawada S, Chakraborty P, Kakarla J, Nanthakumar J, Mondésert B, Khairy P, Nair K. Role of subpulmonary right ventricle in sudden cardiac death in adults with congenital heart disease. Heart Rhythm 2024:S1547-5271(24)03127-8. [PMID: 39127230 DOI: 10.1016/j.hrthm.2024.08.016] [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: 06/29/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Despite improved childhood survival of congenital heart disease (CHD) as a result of advances in management, late-onset sudden cardiac death (SCD) from malignant ventricular arrhythmias remains a leading cause of mortality in adults with CHD. Preventing SCD in these patients requires an understanding of the underlying pathophysiological mechanisms. Many CHD patients experience significant hemodynamic stress on the subpulmonary right ventricle (RV), leading to pathologic remodeling. Unlike acquired heart disease in which left ventricular pathology is prevalent, RV pathologies are crucial in the SCD pathogenesis in CHD patients. This review examines the mechanisms and management of SCD related to subpulmonary RV pathologies in CHD patients.
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Affiliation(s)
- Satoshi Kawada
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada
| | - Praloy Chakraborty
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada
| | - Jayant Kakarla
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada
| | - Jared Nanthakumar
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada; Michael De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Disease Centre, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Adult Congenital Heart Disease Centre, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Krishnakumar Nair
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada.
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Keane RR, Carnicelli AP, Loriaux DB, Kendsersky P, Krasuski RA, Brown KM, Arps K, Baird-Zars V, Dixson JA, Echols E, Granger CB, Harrison RW, Kontos M, Newby LK, Park JG, Shah KS, Ternus BW, Van Diepen S, Katz JN, Morrow DA. Characteristics and Outcomes of Adults With Congenital Heart Disease in the Cardiac Intensive Care Unit. JACC. ADVANCES 2024; 3:101077. [PMID: 39135920 PMCID: PMC11318473 DOI: 10.1016/j.jacadv.2024.101077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 03/04/2024] [Accepted: 05/07/2024] [Indexed: 08/15/2024]
Abstract
Background Little is known regarding the characteristics, treatment patterns, and outcomes in patients with adult congenital heart disease (ACHD) admitted to cardiac intensive care units (CICUs). Objectives The authors sought to better define the contemporary epidemiology, treatment patterns, and outcomes of ACHD admissions in the CICU. Methods The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Participating centers contributed prospective data from consecutive admissions during 2-month annual snapshots from 2017 to 2022. We analyzed characteristics and outcomes of admissions with ACHD compared with those without ACHD. Multivariable logistic regression was used to assess mortality in ACHD vs non-ACHD admissions. Results Of 23,299 CICU admissions across 42 sites, there were 441 (1.9%) ACHD admissions. Shunt lesions were most common (46.1%), followed by right-sided lesions (29.5%) and complex lesions (28.7%). ACHD admissions were younger (median age 46 vs 67 years) than non-ACHD admissions. ACHD admissions were more commonly for heart failure (21.3% vs 15.7%, P < 0.001), general medical problems (15.6% vs 6.0%, P < 0.001), and atrial arrhythmias (8.6% vs 4.9%, P < 0.001). ACHD admissions had a higher median presenting Sequential Organ Failure Assessment score (5.0 vs 3.0, P < 0.001). Total hospital stay was longer for ACHD admissions (8.2 vs 5.9 days, P < 0.01), though in-hospital mortality was not different (12.7% vs 13.6%; age- and sex-adjusted OR: 1.19 [95% CI: 0.89-1.59], P = 0.239). Conclusions This study illustrates the unique aspects of the ACHD CICU admission. Further investigation into the best approach to manage specific ACHD-related CICU admissions, such as cardiogenic shock and acute respiratory failure, is warranted.
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Affiliation(s)
- Ryan R. Keane
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anthony P. Carnicelli
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel B. Loriaux
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Payton Kendsersky
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Richard A. Krasuski
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Kelly M. Brown
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Kelly Arps
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Vivian Baird-Zars
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey A. Dixson
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Emily Echols
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Christopher B. Granger
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Robert W. Harrison
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Michael Kontos
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - L. Kristin Newby
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Jeong-Gun Park
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin S. Shah
- Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Bradley W. Ternus
- Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean Van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Alberta, Canada
| | - Jason N. Katz
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - David A. Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Brown PJ, Jokerst CE, Stib M, Panse PM, Gotway MB, Rojas CA. Anomalous origin of the circumflex artery from the right pulmonary artery. Radiol Case Rep 2024; 19:3080-3083. [PMID: 38770385 PMCID: PMC11103357 DOI: 10.1016/j.radcr.2024.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Anomalous origin of the circumflex artery from the pulmonary artery (ACxAPA) is a rare but clinically significant condition in which the circumflex artery arises from either the main pulmonary artery or one of its main branches. Untreated patients with ACxAPA may develop severe heart failure or sudden cardiac death. Diagnosis is established with either catheter or CT angiography. We present a case of an adult male with no prior known cardiac history who was found to have ACxAPA after presenting to our institution in acute decompensated heart failure.
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Affiliation(s)
- Parker J. Brown
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Clinton E. Jokerst
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Matthew Stib
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Prasad M. Panse
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Michael B. Gotway
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Carlos A. Rojas
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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15
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Jiang L, Li Y, Huang S, Han PL, Yan WF, Fang H, Yang ZG. Right-Left Ventricular Interdependence in Repaired Tetralogy of Fallot Patients With Right Ventricular Heart Failure. J Magn Reson Imaging 2024; 60:628-639. [PMID: 37873997 DOI: 10.1002/jmri.29080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (rTOF) continue to face a heightened risk of deteriorating cardiac function, and quantitative techniques of cardiac MRI-derived cardiac structure and function provide an opportunity to explore the causes and mechanisms of cardiac deterioration. PURPOSE To explore right-left ventricular interdependence in rTOF patients before and after the onset of right ventricular (RV) heart failure. STUDY TYPE Retrospective. POPULATION One hundred eighteen rTOF patients (21.85 [16.74, 29.20] years, 58 females) and 34 controls (23.5 [21, 26.5] years, 17 females) that underwent cardiac MRI were analyzed, with rTOF patients being further subdivided into those with preserved RV function (N = 54) and those that experienced RV heart failure (N = 64). FIELD STRENGTH/SEQUENCE 3.0 T/balanced steady-state free precession sequence. ASSESSMENT RV, left ventricular (LV), and septal strain; RV and LV volume. STATISTICAL TESTS Chi-squared tests or Fisher's exact test, One-way ANOVAs with Bonferroni's post hoc test, Pearson/Spearman correlation, and multivariate backward linear regression analysis. A two-tailed P < 0.05 was deemed as the significance threshold. RESULTS The MRI-derived RV, LV, and septal strain decreased sequentially in controls, patients with preserved RV function, and patients with RV heart failure, with a good intra-observer (0.909-0.964) and inter-observer (0.879-0.937) agreement. Correlations between LV and RV strain were found to change sequentially with RV function and were the closest in rTOF patients with RV heart failure (r = -0.270 to 0.506). Correlations between RV volume and septal strain was variable in controls (r = 0.483 to -0.604), patients with preserved RV function (r = -0.034 to -0.295), and patients with RV heart failure (r = -0.026 to 0.500). Multivariate analyses revealed that the RV longitudinal strain was independently correlated with LV strain in three directions in rTOF patients with RV heart failure (Radial -0.70 [-1.33, -0.06]; Circumferential 0.44 [0.17, 0.72]; Longitudinal 0.54 [0.26, 0.81]). DATA CONCLUSION In rTOF patients, the coupling between RV volume and septal strain was broken during RV function compensation, and the adverse effect of RV on LV deformation was highest in patients with RV heart failure. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Li Jiang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shan Huang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pei-Lun Han
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han Fang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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16
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Feyissa TR, Akter S, Harris ML. Contraceptive counselling and uptake of contraception among women with cardiovascular diseases: a systematic review and meta-analysis. Clin Res Cardiol 2024; 113:1151-1170. [PMID: 38985159 PMCID: PMC11269356 DOI: 10.1007/s00392-024-02472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/24/2024] [Indexed: 07/11/2024]
Abstract
To address the lack of clarity regarding contraceptive counselling and uptake of contraception among women with cardiovascular disease (CVD), this study aimed to conduct a systematic review and meta-analysis on contraceptive counselling and the subsequent uptake of contraception among women with CVD. A search across six databases identified 1228 articles, with 11 studies (2580 participants) included. The pooled prevalence of contraceptive counselling was 63%, varying from 36 to 94% in individual studies. Inconsistent delivery and documentation of counselling were noted, along with a lack of knowledge about pregnancy complications and misconceptions regarding CVD severity. For contraceptive uptake (n = 5), the pooled prevalence was 64% (95% confidence interval, 45 to 82%). Women with CVD were also found to use less effective methods as well as methods not recommended for their condition (e.g., combined hormonal methods among participants with absolute or relative contraindications). Improving contraceptive counselling and choices for women with CVD can not only enhance knowledge and decision-making for women with CVD in line with their reproductive goals and preferences but reduce high-risk unintended pregnancies and adverse pregnancy outcomes.
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Affiliation(s)
- Tesfaye Regassa Feyissa
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia.
- Geohealth Laboratory, Dasman Diabetes Institute, 15462, Kuwait City, Kuwait.
| | - Shahinoor Akter
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia
| | - Melissa L Harris
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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17
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Zergoune N, Benabdellah M, Hara L, Ech-Chenbouli A, Raissouni Z. Stable angina revealing a post-traumatic coronary cameral fistula: A case report. Radiol Case Rep 2024; 19:3522-3524. [PMID: 38881622 PMCID: PMC11179562 DOI: 10.1016/j.radcr.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Coronary-cameral fistulas are abnormal connections between coronary arteries and any of the heart chambers, It may be acquired or congenital (whether isolated or along with congenital heart diseases); It is usually asymptomatic in younger patients; but with increasing age, symptoms begin to appear, and the incidence of complication rises. Coronary angiography is the gold standard in diagnosis but echography and cardiac magnetic resonance imaging may be also useful. It can be treated medically with β-blockers or calcium channel blockers, but large fistulas with hemodynamic significant shunts should be closed by transcatheter or surgical means. We present a 57-year-old patient with a history of chest trauma, that present fistulas connecting the 3 coronary arteries to the left ventricle chamber complicated by myocardial ischemia causing stable angina.
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Affiliation(s)
- Nabil Zergoune
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Malak Benabdellah
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Loubna Hara
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Amine Ech-Chenbouli
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Zainab Raissouni
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
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18
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Sang Z, Ji Q, Tong H, Shen L, Wang X, He B. The functional impact on donor vessel following transcatheter closure of coronary artery fistulas-a retrospective study using QFR analysis. Front Cardiovasc Med 2024; 11:1435025. [PMID: 39145280 PMCID: PMC11322071 DOI: 10.3389/fcvm.2024.1435025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Background The impact of transcatheter closure of coronary artery fistula (CAF) and residual shunt after occlusion on improving blood flow in the donor vessel remains uncertain. Objectives To evaluate the functional impact on the donor vessel following CAFs closure using QFR (Quantitative Flow Ratio) analysis. Methods A total of 46 patients with 48 CAFs who underwent transcatheter closure at Shanghai Chest Hospital and Shuguang Hospital between March 2015 and August 2023 were included in the review. The clinical, angiographic details, and QFR data were subjected to analysis. The size of the fistulae was defined according to the ratio between the diameters of the fistulae and the largest diameter of the coronary vessel not feeding the coronary fistula. Results Among 48 CAFs, the average diameter of the fistulae ostium was 3.19 ± 1.04 mm, while the mean diameter of the donor vessel segment following fistulae was 3.45 ± 1.01 mm. The mean QFR value of the donor vessels with medium CAFs was found to be significantly lower than those with small CAFs (0.93 ± 0.10 vs. 0.98 ± 0.03; p < 0.05). Furthermore, the mean QFR value of donor vessels with medium CAFs was observed to be significantly improved after occlusion (0.99 ± 0.01 vs. 0.93 ± 0.10; p = 0.01). However, there was no statistical difference in the mean QFR value of donor vessels with small CAFs before and after occlusion (0.98 ± 0.03 vs. 0.98 ± 0.02; p > 0.05). Moreover, the changes in QFR were more pronounced in donor vessels with medium CAFs compared to those with small CAFs after occlusion (0.06 ± 0.10 vs. 0.005 ± 0.012; p = 0.01). There is no statistical difference in the mean QFR variation and QFR variation rate between donor vessels with CAFs that occurred residual shunt and those without residual shunt after occlusion (p > 0.05). Conclusions The presence of medium CAFs has a significant impact on the blood flow of the donor vessel, as compared to small CAFs, and may benefit from occlusion. A small residual shunt has no significant impact on the effectiveness of CAFs occlusion in enhancing donor blood flow.
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Affiliation(s)
- Zhenchi Sang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingqi Ji
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Tong
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linghong Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolong Wang
- Department of Cardiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Small AJ, Dai M, Halpern DG, Tan RB. Updates in Arrhythmia Management in Adult Congenital Heart Disease. J Clin Med 2024; 13:4314. [PMID: 39124581 PMCID: PMC11312906 DOI: 10.3390/jcm13154314] [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: 06/17/2024] [Revised: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
Arrhythmias are highly prevalent in adults with congenital heart disease. For the clinician caring for this population, an understanding of pathophysiology, diagnosis, and management of arrhythmia is essential. Herein we review the latest updates in diagnostics and treatment of tachyarrhythmias and bradyarrhythmias, all in the context of congenital anatomy, hemodynamics, and standard invasive palliations for congenital heart disease.
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Affiliation(s)
- Adam J. Small
- Medicine NYU Grossman School of Medicine, 530 First Ave, HCC 5, New York, NY 10016, USA; (M.D.); (D.G.H.); (R.B.T.)
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20
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Zamani-Aliabadi SM, Qanadli SD, Fatehi-Feyzabad SH, Ghasemnezhad M, Ghaemi H, Azarine A, Mohammadzadeh A, Bitarafan-Rajabi A, Mortezaeian H, Rezaei-Kalantari K. Assessment of 4D flow MRI for quantification of left-to-right shunt in pediatric patients with ventricular septal defect: comparison with right heart catheterization. Front Cardiovasc Med 2024; 11:1399110. [PMID: 39105074 PMCID: PMC11298441 DOI: 10.3389/fcvm.2024.1399110] [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: 03/11/2024] [Accepted: 07/10/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives The percentage of shunt fraction significantly impacts the management of patients with congenital shunts, influencing strategic choices such as surgical or interventional procedures. This study compared the estimated shunt fraction (the ratio of pulmonary-to-systemic flow, Qp/Qs) for quantifying the left-to-right shunt in children with ventricular septal defect (VSD) using heart catheterization, four-dimensional (4D) flow, and two-dimensional (2D) flow magnetic resonance imaging (MRI). The goal was to establish a non-invasive and reliable measurement ratio between pulmonary and systemic blood flow in these patients. Methods Between July 2022 and June 2023, patients scheduled to undergo invasive right heart catheterization were included in this study. MRI was performed one hour before the catheterization procedure. The correlation of shunt fraction was assessed between all methods after calculating the Qp/Qs ratio from 2D and 4D flow MRI and catheterization. Results A total of 24 patients (aged 3-15 years, eight females) were ultimately included in the study. The Qp/Qs ratios obtained from 4D flow had a robust correlation (correlation coefficient r = 0.962) compared to those obtained during catheterization. Cardiac catheterization recorded the mean shunt fraction at 1.499 ± 0.396, while 4D flow measured it at 1.403 ± 0.344, with no significant difference between the two techniques. Moreover, there was a reasonable correlation (r = 0.894) between 2D flow measurements of Qp/Qs and the results obtained from catheterization, with a mean shunt fraction of 1.326 ± 0.283. Conclusion 4D flow MRI has the potential to be a non-invasive method for accurately measuring the left-to-right shunt in children with VSD.
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Affiliation(s)
| | - Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Seyed Hasan Fatehi-Feyzabad
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ghasemnezhad
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Ghaemi
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arshid Azarine
- Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, Paris, France
| | - Ali Mohammadzadeh
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Bitarafan-Rajabi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hojjat Mortezaeian
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kiara Rezaei-Kalantari
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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21
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Shiina Y, Inai K, Itatani K, Shimada E, Nagao M. Increased Diastolic Energy Loss Associated with Cardiac Events in Adults with Pulmonary Atresia Suffering from Intact Ventricular Septum. Magn Reson Med Sci 2024:mp.2023-0130. [PMID: 39034145 DOI: 10.2463/mrms.mp.2023-0130] [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: 07/23/2024] Open
Abstract
PURPOSE To assess right heart diastolic energy loss (EL) as a cardiac workload and evaluate its association with major cardiac events (MACE) in adult patients with pulmonary atresia with an intact ventricular septum (PAIVS). METHODS We retrospectively enrolled and compared 30 consecutive adult patients (18 with PAIVS and 12 with pulmonary stenosis [PS] as controls) who underwent right ventricular (RV) outflow tract reconstruction and 4D flow MRI. EL, conventional parameters on MRI, and the severity of tricuspid regurgitation (TR) on echocardiography were assessed. We also evaluated the association between MACE including arrhythmias, heart failure, surgical intervention, and imaging parameters in adults with PAIVS. RESULTS Patients with PAIVS were younger, had a higher diastolic EL/cardiac output (CO) ratio, and had a more significant TR than those with PS (controls). However, RV volume, ejection fraction (EF), and pulmonary regurgitation (PR) severity did not differ between the two groups. Higher RV end-diastolic pressure (EDP) and lower cardiac index (CI) correlated with the diastolic EL/CO in patients with PAIVS. Univariate logistic analysis demonstrated that older age and a higher diastolic EL/CO ratio were important factors for MACE in adults with PAIVS (P = 0.048, 0.049). CONCLUSION A higher diastolic EL/CO ratio was associated with a higher RV EDP and lower CI. A high diastolic EL/CO ratio is also associated with MACE in adults with PAIVS. Even in adults with normal RV volume and EF, the right heart EL was elevated, suggesting an excessive right-sided cardiac workload that integrated both afterload and preload beyond the RV size in adult patients with PAIVS.
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Affiliation(s)
- Yumi Shiina
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
- Cardiovascular Center, St.Luke's International Hospital, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Eriko Shimada
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Michinobu Nagao
- Department of Diagnostic imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
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22
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Albenque G, Bessière F, Iserin L, Azarine A, Boussel L, Bruguière E, Albertini M, Hascoët S, Maltret A, Soulat G, Combes N, Waldmann V. CMR Predictors of Ventricular Arrhythmias Inducibility Before Pulmonary Valve Replacement in Tetralogy of Fallot. Circ Arrhythm Electrophysiol 2024; 17:e012649. [PMID: 38828616 DOI: 10.1161/circep.123.012649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Affiliation(s)
- Grégoire Albenque
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France (G.A., A.A., S.H., A.M., N.C.)
| | - Francis Bessière
- Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., L.B.)
| | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France (L.I., M.A., G.S., V.W.)
| | - Arshid Azarine
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France (G.A., A.A., S.H., A.M., N.C.)
| | - Loïc Boussel
- Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., L.B.)
| | | | - Mathieu Albertini
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France (L.I., M.A., G.S., V.W.)
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France (G.A., A.A., S.H., A.M., N.C.)
| | - Alice Maltret
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France (G.A., A.A., S.H., A.M., N.C.)
| | - Gilles Soulat
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France (L.I., M.A., G.S., V.W.)
- Université Paris Cité, Inserm, PARCC, F-75015, France (G.S., V.W.)
| | - Nicolas Combes
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France (G.A., A.A., S.H., A.M., N.C.)
- Pasteur Clinic, Toulouse, France (E.B., N.C.)
| | - Victor Waldmann
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France (L.I., M.A., G.S., V.W.)
- Université Paris Cité, Inserm, PARCC, F-75015, France (G.S., V.W.)
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France (V.W.)
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Karakasis P, Giannakoulas G, Theofilis P, Patoulias D, Fragakis N. Direct oral anticoagulants or vitamin K antagonists in adult patients with congenital heart disease? Eur J Intern Med 2024:S0953-6205(24)00269-3. [PMID: 38906776 DOI: 10.1016/j.ejim.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece.
| | - George Giannakoulas
- First Department of Cardiology, Aristotle University Medical School, Thessaloniki, AHEPA University General Hospital, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, General Hospital of Athens "Hippocratio", University of Athens Medical School, Athens, Greece
| | - Dimitrios Patoulias
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece; Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
| | - Nikolaos Fragakis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
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24
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Choi MH, Greathouse F, Darki A. Medical Management of Isolated Partial Anomalous Pulmonary Venous Connection With Symptomatic Right Ventricular Failure and Pulmonary Hypertension. Cureus 2024; 16:e62779. [PMID: 39036244 PMCID: PMC11260183 DOI: 10.7759/cureus.62779] [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] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital heart disease in which one or more pulmonary veins drain into the systemic venous circulation. The abnormal connection between the pulmonary vein and the right atrium can result in a right-sided volume overload due to a left-to-right shunt, followed by eventual right-sided pressure overload and right ventricular failure. PAPVC is usually associated with an atrial septal defect but can present as an isolated finding. We present a case of isolated PAPVC resulting in right heart failure and predominantly pre-capillary pulmonary hypertension. We discuss the challenges in the diagnosis and medical management of isolated PAPVC and highlight the clinical and hemodynamic indications for pulmonary vasodilators and diuretics.
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Affiliation(s)
- Myoung Hyun Choi
- Internal Medicine-Pediatrics, Loyola University Medical Center, Maywood, USA
| | | | - Amir Darki
- Cardiology, Loyola University Medical Center, Maywood, USA
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25
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Shiina Y, Nagao M, Itatani K, Shimada E, Inai K. 4D flow MRI-derived energy loss and RV workload in adults with tetralogy of Fallot. J Cardiol 2024; 83:382-389. [PMID: 37827218 DOI: 10.1016/j.jjcc.2023.10.003] [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: 04/04/2023] [Revised: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE To assess flow energy loss (EL) pattern inside the pulmonary circulation in adult patients with repaired tetralogy of Fallot (TOF), particularly in TOF with pulmonary stenosis (PS) and pulmonary regurgitation (PR), as a cardiac workload parameter and its relationship to symptoms and major adverse cardiovascular events (MACE). METHODS Prospectively, 51 consecutive TOF adults after intracardiac repair, who underwent four-dimensional flow magnetic resonance imaging, were enrolled. All of them had significant PR (PR regurgitant fraction >25 %). TOF patients who had already reached the conventional criteria were excluded. We defined MACE as the following: 1) fatal arrhythmias, 2) sudden cardiac death, 3) surgical pulmonary valvular repair (PVR), 4) right heart failure (HF) needing diuretics and/or hospitalization within 2 years. RESULTS A total of 15 patients had MACE; 1) 10 patients underwent PVR within 2 years, 2) 2 patients had ventricular tachycardia, and 3) 6 patients developed right HF (overlapped). Right ventricular (RV) end diastolic volume index (EDVI), RV end systolic volume index (ESVI), average EL/cardiac output (CO), and diastolic EL/CO in patients with MACE were greater than ones without MACE. On a multivariate logistic analysis, the diastolic EL/CO ratio and RVEDVI had the highest odds with MACE in all TOF (odds ratio, 40.7 and 1.15. 95%CI, 1.83-905 and 1.02-13.0; p-value, 0.02 and 0.03). In sub-analysis within 29 patients with moderate PS with PR, and 10 patients with MACE showed higher diastolic EL/CO. Average and diastolic EL/CO negatively correlated with RV ejection fraction (EF) in this sub-analysis. CONCLUSIONS High EL, particularly, high diastolic EL/CO, were the important factors for MACE in adult TOF. Higher diastolic EL/CO was also related to lower RV EF and deteriorated RV function in adult TOF with PS and PR. Right-sided EL can be a sensitive marker of excessive cardiac workload which integrates both afterload and preload in adult patients with TOF, beyond the RV size.
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Affiliation(s)
- Yumi Shiina
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Eriko Shimada
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
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26
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Hayama H, Makino K, Yazaki Y, Hara H. Upsizing of GORE® Cardioform ASD Occluder for Atrial Septal Defect With Atrial Septal Aneurysm. Cureus 2024; 16:e63281. [PMID: 39070307 PMCID: PMC11283311 DOI: 10.7759/cureus.63281] [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] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Atrial septal defects (ASDs) often present with multiple foramina, including a patent foramen ovale (PFO) and atrial septal aneurysms (ASAs). Transcatheter device closure of an ASD may require additional supportive techniques in complex cases. Here, we report a case of a secundum ASD complicated by an ASA and a PFO in a man in his 50s. A GORE® Cardioform ASD Occluder (GCA) device of the optimal size for balloon sizing was implanted. However, edge leakage occurred from the front of the device because of a large, moving ASA. Implantation of a two-size-up GCA device successfully closed the ASD under controlled ASA movement.
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Affiliation(s)
- Hiromasa Hayama
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Kenji Makino
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Yoshiyuki Yazaki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, JPN
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27
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Gondal MUR, Jyothi Ramachandran Nair DP, Shah S, Zafar M, Hanif MA, McCauley B, Hope E. Myocardial Infarction and Complete Heart Block in a Patient With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery (ALCAPA). Cureus 2024; 16:e62016. [PMID: 38984014 PMCID: PMC11233174 DOI: 10.7759/cureus.62016] [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] [Accepted: 06/09/2024] [Indexed: 07/11/2024] Open
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. We present a case of an elderly patient with ALCAPA presenting with complete heart block and non-ST-elevation myocardial infarction years after diagnosis and surgical correction. An 81-year-old female with a history of ALCAPA presented to the emergency department with chest pain and progressive mental deterioration. She was bradycardic and hypotensive. An electrocardiogram revealed a complete heart block. Troponin was 4.04 ng/mL. She received atropine and underwent transcutaneous pacing. Left heart catheterization revealed complete occlusion of the mid-left circumflex artery, which was intervened with balloon angioplasty and chronic total occlusion of the right coronary artery. She was supported with temporary transvenous pacing, did not require further pacing support, and was discharged home. Previous records unearthed that in 1988 she had presented with syncope and was diagnosed with ALCAPA, filling from right-to-left collaterals with large and ectatic coronaries. At the time, she underwent surgical correction with excision of the left coronary from the pulmonary artery and reimplantation in the left coronary cusp along the posterior aorta. She had remained asymptomatic after her surgery until this presentation. ALCAPA is extremely rare in adults. Insufficient collaterals to the left ventricle cause inadequate blood supply, leading to ischemia in adults, predisposing them to arrhythmias and risk of sudden death. Adults with ALCAPA remain at increased risk of adverse cardiac events later in life, requiring long-term monitoring.
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Affiliation(s)
| | | | - Smit Shah
- Cardiology, Reading Hospital/Tower Health, West Reading, USA
| | | | | | | | - Earl Hope
- Cardiology, Reading Hospital, West Reading, USA
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28
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Prakash A, Goel S. Acute Coronary Syndrome in an Anomalous Left Main Coronary Artery. Cureus 2024; 16:e61971. [PMID: 38984008 PMCID: PMC11232917 DOI: 10.7759/cureus.61971] [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] [Accepted: 06/05/2024] [Indexed: 07/11/2024] Open
Abstract
Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSV) is a rare congenital anomaly that can cause myocardial ischemia, ventricular arrhythmia, and sudden cardiac death. We report the case of a 74-year-old male with a history of hyperlipidemia and hypertension who presented with non-ST elevation myocardial infarction (NSTEMI). On coronary angiogram, the patient was found to have LMCA originating from the RSV and a 90% stenosis of the left anterior descending (LAD) artery. The patient subsequently underwent computed tomography angiography (CTA) to assess the course of the LMCA, which was found to be intramyocardial with no compression. The echocardiogram reported a reduced ejection fraction (EF) of 40% and wall motion abnormalities in the anterior wall. The patient had a successful staged percutaneous coronary intervention (PCI). The patient on follow-up reported no symptoms and EF improved to 50%. Anomalous origin of the LMCA from the RSV is a rare but potentially life-threatening congenital anomaly. Once the course of the anomalous artery is established, immediate reperfusion using PCI is being increasingly used in place of surgical unroofing, noting a change in clinical practice. Further research is needed to determine the optimal treatment for this anomaly and to improve the long-term outcomes of affected individuals.
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Affiliation(s)
- Anjali Prakash
- Internal Medicine, Icahn School of Medicine at Mount Sinai South Nassau, New York, USA
| | - Sunny Goel
- Cardiovascular Disease, Mount Sinai Hospital, New York, USA
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29
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Ahmadi A, Mansourian M, Sabri MR, Ghaderian M, Karimi R, Roustazadeh R. Follow-up outcomes and effectiveness of stent implantation for aortic coarctation: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102513. [PMID: 38556144 DOI: 10.1016/j.cpcardiol.2024.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The authors aim to investigate the clinical implications of stent use for the management of CoA. METHODS All observational studies on stent implantation for the treatment of aortic coarctation and the relevant RCTs were systematically retrieved. Outcomes included the immediate success rate, pre- and post-stent gradient, survival, minor and major complications, restenosis, post-stent systolic blood pressure, and reintervention rate. The analysis was further stratified by CoA type, stent type, and the mean age of the patients. RESULTS Our meta-analysis incorporated 66 eligible studies involving 3,880 patients. The success rates for stent placement, defined as achieving post-treatment gradients of ≤20 mmHg and 10 mmHg, 0.96 (95% CI: 0.95 - 0.97; I2 = 59.83%) and 0.92 (95% CI: 0.89 - 0.95, I2 = 77.63%) respectively. The complication rates were quite low, with minor and major complication rates of 0.017 (95% CI: 0.013 - 0.021) and 0.007 (95% CI: 0.005 - 0.009), respectively. Unplanned reinterventions were required at a rate of 0.021 (95% CI: 0.015 - 0.026). At a mean follow-up of 2.9 years, 97% of the patients survived and 28% remained on antihypertensive therapy. While immediate effectiveness was consistent across age groups, complications were more prevalent in patients aged <20 years, and long-term efficacy was lower in those aged >20 years. Encouragingly, in neonates and infants, CoA stenting yielded results comparable to those observed in older children. CONCLUSION These findings underscore the overall favorable outcomes of stent placement for aortic coarctation, with considerations for age-related variations in complications and long-term efficacy.
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Affiliation(s)
- Alireza Ahmadi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Ghaderian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Karimi
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roshanak Roustazadeh
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany
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30
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Arias Rivera AS, Rubio K, Gonzalez Solano LS, Gomez Gonzalez MD, Ledu Lara A, Carrillo Cornejo M, Calderon Abbo MC. A 24-Year-Old Male Patient With an Ostium Secundum Complex Atrial Defect Secondary to a Perforated Aneurysm With Inferior Vena Cava Agenesis. Cureus 2024; 16:e61624. [PMID: 38966450 PMCID: PMC11222714 DOI: 10.7759/cureus.61624] [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] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
The article describes a successful clinical outcome in the case of a 24-year-old male with a diagnosis of an ostium secundum atrial defect secondary to a perforated aneurysm associated with vena cava agenesis. During hospitalization, an echocardiogram revealed the presence of ostium secundum inter-atrial communication with a left to right shunt, a left ventricular ejection fraction (LVEF) of 60%, and mild pulmonary hypertension, measured at 40 mmHg. CT imaging showed anomalous dilation of the azygos vein (16.8 mm), associated with interruption of the vena cava in the intrahepatic and adrenal portion, continuing through the azygos system and draining into the superior vena cava. Open-heart surgery was performed with pericardium patch placement on the defect. Postoperative transthoracic echocardiography revealed a tracking of the interatrial septum, with adequate placement of the surgical patch and no evidence of residual short circuits. The postoperative recovery was favorable, and the patient was discharged five days after surgery. Outpatient monitoring at the first and third months showed no complications during physical examination and echocardiogram imaging.
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Affiliation(s)
| | | | | | | | - Alain Ledu Lara
- Cardiothoracic Surgery, Hospital Angeles Lomas, Huixquilucan, MEX
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31
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Fabbri M, Sahu A. Challenges and opportunities in patients with adult congenital heart disease, a narrative review. Front Cardiovasc Med 2024; 11:1366572. [PMID: 38873271 PMCID: PMC11171728 DOI: 10.3389/fcvm.2024.1366572] [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: 01/06/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Adult congenital heart disease Pregnancy Transition of care Challenges heart failure.
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Affiliation(s)
- Matteo Fabbri
- Department of Cardiovascular Disease, Inova Heart and Vascular Institute, Falls Church, VA, United States
| | - Anurag Sahu
- Department of Cardiovascular Disease, Inova Heart and Vascular Institute, Falls Church, VA, United States
- Department of Cardiovascular Imaging, NIH/NHLBI Cardiovascular Imaging Lab, Bethesda, MD, United States
- Department of Cardiovascular Disease, University of Virginia School of Medicine, Charlottesville, VA, United States
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32
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Gräni C, Stark AW, Lo Rito M, Frigiola A, Siepe M, Tchana B, Cipriani A, Zorzi A, Pergola V, Crea D, Sarris G, Protopapas E, Sirico D, Di Salvo G, Pegoraro C, Sarto P, Francois K, Frigiola A, Cristofaletti A, Accord RE, Gonzalez Rocafort A, Debeco G, Padalino M. First report from the European registry for anomalous aortic origin of coronary artery (EURO-AAOCA). INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae074. [PMID: 38648747 PMCID: PMC11101283 DOI: 10.1093/icvts/ivae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/21/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Anomalous aortic origin of a coronary artery (AAOCA) is a group of rare congenital heart defects with various clinical presentations. The lifetime-risk of an individual living with AAOCA is unknown, and data from multicentre registries are urgently needed to adapt current recommendations and guide optimal patient management. The European AAOCA Registry (EURO-AAOCA) aims to assess differences with regard to AAOCA management between centres. METHODS EURO-AAOCA is a prospective, multicentre registry including 13 European centres. Herein, we evaluated differences in clinical presentations and management, treatment decisions and surgical outcomes across centres from January 2019 to June 2023. RESULTS A total of 262 AAOCA patients were included, with a median age of 33 years (12-53) with a bimodal distribution. One hundred thirty-nine (53.1%) were symptomatic, whereas chest pain (n = 74, 53.2%) was the most common complaint, followed by syncope (n = 21, 15.1%). Seven (5%) patients presented with a myocardial infarction, 2 (1.4%) with aborted sudden cardiac death. Right-AAOCA was most frequent (150, 57.5%), followed by left-AAOCA in 51 (19.5%), and circumflex AAOCA in 20 (7.7%). There were significant differences regarding diagnostics between age groups and across centres. Seventy-four (28.2%) patients underwent surgery with no operative deaths; minor postoperative complications occurred in 10 (3.8%) cases. CONCLUSIONS Currently, no uniform agreement exists among European centres with regard to diagnostic protocols and clinical management for AAOCA variants. Although surgery is a safe procedure in AAOCA, future longitudinal outcome data will hopefully shed light on how to best decide towards optimal selection of patients undergoing revascularization versus conservative treatment.
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Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Center, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Bertrand Tchana
- Struttura Semplice Dipartimentale di Cardiologia Pediatrica, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiology Clinic, University of Padova, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiology Clinic, University of Padova, Padova, Italy
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiology Clinic, University of Padova, Padova, Italy
| | - Domenico Crea
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - George Sarris
- 2nd Department of Pediatric and Congenital Cardiac Surgery, Mitera Children’s Hospital, Athens Heart Surgery Institute, Athens, Greece
| | - Elephterios Protopapas
- 2nd Department of Pediatric and Congenital Cardiac Surgery, Mitera Children’s Hospital, Athens Heart Surgery Institute, Athens, Greece
| | - Domenico Sirico
- Pediatric Cardiology, Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology, Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Cinzia Pegoraro
- UOC Medicina dello Sport, Ospedale Ca’ Foncello, Treviso, Italy
| | - Patrizio Sarto
- UOC Medicina dello Sport, Ospedale Ca’ Foncello, Treviso, Italy
| | - Katrien Francois
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Alessandra Frigiola
- Guy and St Thomas Hospital, NHS foundation Trust and King’s College, London, UK
| | | | - Ryan E Accord
- Pediatric and Congenital Cardiothoracic Surgery, Thoraxcenter/Center for Pediatric and Congenital Heart Disease, Groningen, Netherlands
| | | | | | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
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Agha MS, Ermis PR, Franklin WJ, Parekh DR, Opina AD, Kim JJ, Miyake CY, Valdes SO, Lam WW. Dronedarone for the Treatment of Atrial Arrhythmias in Adults With Congenital Heart Disease. Tex Heart Inst J 2024; 51:e227993. [PMID: 38686681 DOI: 10.14503/thij-22-7993] [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: 05/02/2024]
Abstract
BACKGROUND Atrial tachyarrhythmias are common and difficult to treat in adults with congenital heart disease. Dronedarone has proven effective in patients without congenital heart disease, but data are limited about its use in adults with congenital heart disease of moderate to great complexity. METHODS A single-center, retrospective chart review of 21 adults with congenital heart disease of moderate to great complexity who were treated with dronedarone for atrial tachyarrhythmias was performed. RESULTS The median (IQR) age at dronedarone initiation was 35 (27.5-39) years. Eleven patients (52%) were male. Ten patients (48%) had New York Heart Association class I disease, 10 (48%) had class II disease, and 1 (5%) had class III disease. Ejection fraction at initiation was greater than 55% in 11 patients (52%), 35% to 55% in 9 patients (43%), and less than 35% in 1 patient (5%). Prior treatments included β-blockers (71%), sotalol (38%), amiodarone (24%), digoxin (24%), and catheter ablation (38%). Rhythm control was complete in 5 patients (24%), partial in 6 (29%), and inadequate in 10 (48%). Two patients (10%) experienced adverse events, including nausea in 1 (5%) and cardiac arrest in 1 (5%), which occurred 48 months after initiation of treatment. There were no deaths during the follow-up period. The median (IQR) follow-up time for patients with complete or partial rhythm control was 20 (1-54) months. CONCLUSION Dronedarone can be effective for adult patients with congenital heart disease and atrial arrhythmias for whom more established therapies have failed, and with close monitoring it can be safely tolerated.
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Affiliation(s)
- Mahdi S Agha
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Peter R Ermis
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Wayne J Franklin
- Department of Pediatrics, Division of Cardiology, The University of Arizona College of Medicine, Phoenix, Arizona
| | - Dhaval R Parekh
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Angeline D Opina
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jeffrey J Kim
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Christina Y Miyake
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Santiago O Valdes
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Wilson W Lam
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
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34
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Robu M, Radulescu B, Nayyerani R, Enache R, Stiru O, Iosifescu A, Olaru G, Ciomag (Ianula) R, Iliescu VA, Moldovan H. Management of a Rare Case of Multiple Coronary Artery Fistulas Associated with Ascending Aortic and Root Aneurysm: Case Report and Review of Literature. J Clin Med 2024; 13:2297. [PMID: 38673570 PMCID: PMC11050765 DOI: 10.3390/jcm13082297] [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: 02/20/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Coronary artery fistulas draining into the left ventricle is a rare finding. They can be associated with other congenital cardiac anomalies like ventricular septal defect or tetralogy of Fallot. While most of them are asymptomatic, they can lead to severe cardiac complications like infective endocarditis, heart failure, or myocardial ischemia. Symptomatic coronary artery fistulas can be managed surgically or percutaneously. We present a case of a 61-year-old male patient with both left anterior descending artery and right coronary artery fistulas draining into the left ventricle associated with ascending aorta and root aneurysm. Preoperative assessment for myocardial ischemia and the size and location of the fistulas was performed. The echocardiography stress test was negative. Surgery consisted of replacement of the ascending aorta and reconstruction of the noncoronary sinus with a Dacron patch with aortic valve preservation and no intervention for the coronary artery fistulas. The surgical strategy was adapted for cardioplegia administration to compensate for the volume of coronary blood drained into the left ventricle and for better protection of the distal myocardium.
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Affiliation(s)
- Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Bogdan Radulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Reza Nayyerani
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Robert Enache
- Radiology Department, Fundeni Clinical Institute, 022322 Bucharest, Romania;
| | - Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Andrei Iosifescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Georgiana Olaru
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Raluca Ciomag (Ianula)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Horatiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 050711 Bucharest, Romania
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Avesani M, Sabatino J, Borrelli N, Cattapan I, Leo I, Pelaia G, Moscatelli S, Bianco F, Bassareo P, Martino F, Leonardi B, Oreto L, Guccione P, Di Salvo G. The mechanics of congenital heart disease: from a morphological trait to the functional echocardiographic evaluation. Front Cardiovasc Med 2024; 11:1301116. [PMID: 38650919 PMCID: PMC11033364 DOI: 10.3389/fcvm.2024.1301116] [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: 09/24/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Advances in pediatric cardiac surgery have resulted in a recent growing epidemic of children and young adults with congenital heart diseases (CHDs). In these patients, congenital defects themselves, surgical operations and remaining lesions may alter cardiac anatomy and impact the mechanical performance of both ventricles. Cardiac function significantly influences outcomes in CHDs, necessitating regular patient follow-up to detect clinical changes and relevant risk factors. Echocardiography remains the primary imaging method for CHDs, but clinicians must understand patients' unique anatomies as different CHDs exhibit distinct anatomical characteristics affecting cardiac mechanics. Additionally, the use of myocardial deformation imaging and 3D echocardiography has gained popularity for enhanced assessment of cardiac function and anatomy. This paper discusses the role of echocardiography in evaluating cardiac mechanics in most significant CHDs, particularly its ability to accommodate and interpret the inherent anatomical substrate in these conditions.
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Affiliation(s)
- Martina Avesani
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
| | - Jolanda Sabatino
- Paediatric Cardiology and Congenital Heart Disease Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, Naples, Italy
| | - Irene Cattapan
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Giulia Pelaia
- Paediatric Unit, Department of Science of Health, Magna Graecia University, Catanzaro, Italy
| | - Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Francesco Bianco
- Department of Pediatrics and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
| | - PierPaolo Bassareo
- Department of Cardiology, Mater Misericordiae University Hospital and Our Lady’s Children’s Hospital, University College of Dublin, Crumlin, Ireland
| | - Francesco Martino
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesu Children’s Hospital and Research Institute, IRCCS, Rome, Italy
| | - Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesu Children’s Hospital and Research Institute, IRCCS, Rome, Italy
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
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Kim KM, Moon CH, Lee WJ, Kim WJ, Kim M, Jeong J, Lee HB, Jeong SM, Choi HJ, Hwang TS, Lee HC, Yu JH, Nam A, Kim DH. Surgical Correction of a Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Connections Using Cardiac Computed Tomography Imaging and a 3D-Printed Model. Animals (Basel) 2024; 14:1094. [PMID: 38612332 PMCID: PMC11010815 DOI: 10.3390/ani14071094] [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: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Sinus venosus atrial septal defects (SVASDs), concurrent with partial anomalous pulmonary venous connections (PAPVCs), are a rare congenital heart disease in dogs. Surgical correction is essential when clinical signs or significant hemodynamic changes are present. We aimed to report on the successful surgical correction of an SVASD with PAPVCs, using a computed tomography (CT)-based customized 3D cardiac model. A 10-month-old male poodle was referred for corrective surgery for an ASD. Echocardiography confirmed a hemodynamically significant left-to-right shunting flow through an interatrial septal defect and severe right-sided heart volume overload. For a comprehensive diagnosis, a CT scan was performed, which confirmed an SVASD with PAPVCs. A customized 3D cardiac model was used for preoperative decision-making and surgical rehearsal. The defect was repaired using an autologous pericardial patch under a cardiopulmonary bypass (CPB). Temporary pacing was applied for sinus bradycardia and third-degree atrioventricular block. The patient recovered from the anesthesia without further complications. The pacemaker was removed during hospitalization and the patient was discharged without complications 2 weeks post-surgery. At the three-month follow-up, there was no shunting flow in the interatrial septum and the right-sided volume overload had been resolved. The cardiac medications were discontinued, and there were no complications. This report indicates the validity of surgical correction under CPB for an SVASD with PAPVCs, and the advantages of utilizing a CT-based 3D cardiac model for preoperative planning to increase the surgical success rate.
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Affiliation(s)
- Kyung-Min Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Chang-Hwan Moon
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Won-Jong Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Woo-Jin Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Mihyung Kim
- Chungnam National University Sejong Hospital, 20 Bodeum 7-ro, Sejong-si 30099, Republic of Korea;
| | - Jaemin Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Hae-Beom Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Seong-Mok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Ho-Jung Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea;
| | - Tae Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, 501 Jinju-daero, Jinju-si 52828, Republic of Korea; (T.S.H.); (H.C.L.)
| | - Hee Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, 501 Jinju-daero, Jinju-si 52828, Republic of Korea; (T.S.H.); (H.C.L.)
| | - Jae Hyeon Yu
- Department of Cardiothoracic Surgery, Chungnam National University Hospital, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea;
| | - Aryung Nam
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Dae-Hyun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
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Nelson JS. Accounting for Physiologic Severity in Risk Prediction: ACAP-tivating Topic. Ann Thorac Surg 2024; 117:811-812. [PMID: 37839540 DOI: 10.1016/j.athoracsur.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Jennifer S Nelson
- Department of Cardiovascular Services, Nemours Children's Hospital, Florida, 6535 Nemours Pkwy, Orlando, FL 32827.
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Pan M, Pericet C, González-Manzanares R, Díaz MA, Suárez de Lezo J, Hidalgo F, Alvarado M, Dueñas G, Gómez E, Espejo S, Perea J, Romero M, Ojeda S. Very long-term follow-up after aortic stenting for coarctation of the aorta. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:332-341. [PMID: 37981191 DOI: 10.1016/j.rec.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. METHODS We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. RESULTS A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. CONCLUSIONS This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.
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Affiliation(s)
- Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
| | - Cristina Pericet
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Rafael González-Manzanares
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Manuel A Díaz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Javier Suárez de Lezo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Francisco Hidalgo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Marco Alvarado
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Guillermo Dueñas
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Elena Gómez
- Servicio de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Simona Espejo
- Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jorge Perea
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Miguel Romero
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
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Ait Mokhtar O, Hamidouche K, Amini N, Boudjemline Y, Azzouz A, Benkhedda S. [Anomalous origin of right coronary artery from pulmonary artery associated to left main coronary stenosis]. Ann Cardiol Angeiol (Paris) 2024; 73:101737. [PMID: 38341990 DOI: 10.1016/j.ancard.2024.101737] [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] [Received: 07/19/2023] [Revised: 12/16/2023] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
We describe herein a case of a 16 years-old female patient referred to our department for further exploration of a chest pain. Color Doppler echocardiography revealed an abnormal flow at the level of the pulmonary artery. Exercise testing was abnormal leading to further imaging including computed cardiac tomography followed by coronary angiography which showed anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) associated with mid shaft left main stenosis. We discuss this uncommon association and therapeutic options.
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Affiliation(s)
- Omar Ait Mokhtar
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria.
| | | | | | | | - Abdelmalek Azzouz
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria
| | - Salim Benkhedda
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria
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Freilinger S, Kaemmerer H, Pittrow RD, Achenbach S, Baldus S, Dewald O, Ewert P, Freiberger A, Gorenflo M, Harig F, Hohmann C, Holdenrieder S, Hörer J, Huntgeburth M, Hübler M, Kohls N, Klawonn F, Kozlik-Feldmann R, Kaulitz R, Loßnitzer D, Mellert F, Nagdyman N, Nordmeyer J, Pittrow BA, Pittrow LB, Rickers C, Rosenkranz S, Schelling J, Sinning C, Suleiman MN, von Kodolitsch Y, von Scheidt F, Kaemmerer-Suleiman AS. PATHFINDER-CHD: prospective registry on adults with congenital heart disease, abnormal ventricular function, and/or heart failure as a foundation for establishing rehabilitative, prehabilitative, preventive, and health-promoting measures: rationale, aims, design and methods. BMC Cardiovasc Disord 2024; 24:181. [PMID: 38532336 DOI: 10.1186/s12872-024-03833-y] [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: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Adults with congenital heart defects (ACHD) globally constitute a notably medically underserved patient population. Despite therapeutic advancements, these individuals often confront substantial physical and psychosocial residua or sequelae, requiring specialized, integrative cardiological care throughout their lifespan. Heart failure (HF) is a critical challenge in this population, markedly impacting morbidity and mortality. AIMS The primary aim of this study is to establish a comprehensive, prospective registry to enhance understanding and management of HF in ACHD. Named PATHFINDER-CHD, this registry aims to establish foundational data for treatment strategies as well as the development of rehabilitative, prehabilitative, preventive, and health-promoting interventions, ultimately aiming to mitigate the elevated morbidity and mortality rates associated with congenital heart defects (CHD). METHODS This multicenter survey will be conducted across various German university facilities with expertise in ACHD. Data collection will encompass real-world treatment scenarios and clinical trajectories in ACHD with manifest HF or at risk for its development, including those undergoing medical or interventional cardiac therapies, cardiac surgery, inclusive of pacemaker or ICD implantation, resynchronization therapy, assist devices, and those on solid organ transplantation. DESIGN The study adopts an observational, exploratory design, prospectively gathering data from participating centers, with a focus on patient management and outcomes. The study is non-confirmatory, aiming to accumulate a broad spectrum of data to inform future hypotheses and studies. PROCESSES Regular follow-ups will be conducted, systematically collecting data during routine clinical visits or hospital admissions, encompassing alterations in therapy or CHD-related complications, with visit schedules tailored to individual clinical needs. ASSESSMENTS Baseline assessments and regular follow-ups will entail comprehensive assessments of medical history, ongoing treatments, and outcomes, with a focus on HF symptoms, cardiac function, and overall health status. DISCUSSION OF THE DESIGN The design of the PATHFINDER-CHD Registry is tailored to capture a wide range of data, prioritizing real-world HF management in ACHD. Its prospective nature facilitates longitudinal data acquisition, pivotal for comprehending for disease progression and treatment impacts. CONCLUSION The PATHFINDER-CHD Registry is poised to offer valuable insights into HF management in ACHD, bridging current knowledge gaps, enhancing patient care, and shaping future research endeavors in this domain.
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Affiliation(s)
- Sebastian Freilinger
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Harald Kaemmerer
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Robert D Pittrow
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Achenbach
- Department of Cardiology, Medizinische Klinik 2 - Kardiologie und Angiologie University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Baldus
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Ewert
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Annika Freiberger
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Matthias Gorenflo
- Department of Paediatric Cardiology and Congenital Heart Disease Center for Child and Adolescent Health, Medical Center-University of Heidelberg, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Frank Harig
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Christopher Hohmann
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Deutsches Herzzentrum München, Technical University Munich, München, Germany
| | - Jürgen Hörer
- Department for Congenital and Paediatric Surgery, German Heart Center Munich, Technical University Munich, München, Germany
- Division for Congenital and Pediatric Heart Surgery, University Hospital of Munich (LMU), Munich, Germany
- European Pediatric Heart Center, Munich, Germany
| | - Michael Huntgeburth
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | | | - Niko Kohls
- Faculty of Applied Natural Sciences and Health, Division of Health Promotion, University of Applied Sciences and Arts Coburg, Coburg, Germany
| | - Frank Klawonn
- Helmholtz Centre for Infection Research, Biostatistics Research Group, Brunswick, Germany
| | | | - Renate Kaulitz
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Dirk Loßnitzer
- Department of Paediatric Cardiology and Congenital Heart Disease Center for Child and Adolescent Health, Medical Center-University of Heidelberg, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Friedrich Mellert
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Nicole Nagdyman
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Johannes Nordmeyer
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Benjamin A Pittrow
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Leonard B Pittrow
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Stefan Rosenkranz
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Mathieu N Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Fabian von Scheidt
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Ann-Sophie Kaemmerer-Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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Venkatesh P, Garg R. Multimodality Imaging in the Diagnosis of Unroofed Coronary Sinus in the Adult. CASE (PHILADELPHIA, PA.) 2024; 8:74-82. [PMID: 38524994 PMCID: PMC10954671 DOI: 10.1016/j.case.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Unroofed CS is a rare cause of atrial-level shunting and right heart dilatation. •Unroofed CS is commonly diagnosed in adulthood. •TTE is the primary modality to recognize and diagnose unroofed CS. •CCT and/or magnetic resonance imaging should be done as complementary studies before CS repair.
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Affiliation(s)
| | - Ruchira Garg
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California
- Guerin Children’s, Los Angeles, California
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Yu P, Xiong J, Tong Z, Chen L, Hu L, Liu J, Liu J. Hemodynamic-based virtual surgery design of double-patch repair for pulmonary arterioplasty in tetralogy of Fallot. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108012. [PMID: 38246096 DOI: 10.1016/j.cmpb.2024.108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Surgical correction of pulmonary artery stenosis (PAS) is essential to the prognosis of patients with tetralogy of Fallot (TOF). The double-patch method of pulmonary arterioplasty is usually applied in case of multiple stenosis in TOF patients' pulmonary artery (PA) and when PAS cannot be relieved by the single-patch method. The surgical planning for the double-patch design remains challenging. The purpose of this study is to investigate the double-patch design with different angulations between the left pulmonary artery (LPA) and the right pulmonary artery (RPA), and to understand postoperative hemodynamic alterations by the application of computer-aided design (CAD) and computational fluid dynamics (CFD) techniques. METHODS The three-dimensional model of the PA was reconstructed based on preoperative computed tomography imaging data obtained from the patient with TOF. Three postoperative models with different designs of double-patch were created by "virtual surgery" using the CAD technique. Double-Patch 120 Model was created with double patches implanted in the main pulmonary artery (MPA) and the PA bifurcation and without changing the spatial position of PA. The angulation between the LPA and the RPA was defined as θ, which equaled to 120° in Pre-Operative Model and Double-Patch 120 Model. Based on Double-Patch 120 Model, Double-Patch 110 Model and Double-Patch 130 Model were generated with θ equaled to 110° and 130°, respectively. Combined with CFD, the differences of velocity streamlines, wall shear stress (WSS), flow distribution ratio (FDR), and energy loss (EL) were compared to analyze postoperative pulmonary flow characteristics. RESULTS The values of velocity and WSS decreased significantly after virtual surgery. Obvious vortices and swirling flows were observed downstream of the stenosis of RPA and LPA in Pre-Operative Model, while fewer vortices developed along the anterior wall of the expanded lumens of RPA, especially in Double-Patch 110 Model. With the relief of PAS, two relatively higher WSS regions were observed at the posterior walls of RPA and LPA. The maximum WSS values in these regions of Double-Patch 110 Model were lower than those in Double-Patch 120 Model and Double-Patch 130 Model. Furthermore, the FDRs were elevated and the ELs were greatly reduced. It was found that Double-Patch 110 Model with the angulation between the LPA and the RPA equaled to 110° showed relatively better properties of hemodynamics than other models. CONCLUSIONS The angulation between the LPA and the RPA is an important factor that should be integrated in the double-patch design for TOF repair. Virtual surgery based on patient-specific vascular model and computational hemodynamics can be used to provide assistance for individualized surgical planning of double-patch arterioplasty.
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Affiliation(s)
- Pingping Yu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jiwen Xiong
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Zhirong Tong
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Lijun Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jinfen Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jinlong Liu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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43
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Marshall V WH, Daniels CJ. Progression of Valvular Pulmonic Stenosis in Adulthood: Never Say Never. CASE (PHILADELPHIA, PA.) 2024; 8:142-150. [PMID: 38524967 PMCID: PMC10954571 DOI: 10.1016/j.case.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Historic data indicate mild valvar PS in adults does not progress. •The prevalence of older adults with CHD is increasing. •Valvular calcification may lead to progression of PS in later life. •Echocardiography should be used for routine follow-up for PS.
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Affiliation(s)
- William H. Marshall V
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Curt J. Daniels
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
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Verrall CE, Tran DL, Kasparian NA, Williams T, Oxenham V, Ayer J, Celermajer DS, Cordina RL. Cognitive Functioning and Psychosocial Outcomes in Adults with Complex Congenital Heart Disease: A Cross-sectional Pilot Study. Pediatr Cardiol 2024; 45:529-543. [PMID: 38261061 PMCID: PMC10891231 DOI: 10.1007/s00246-023-03376-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024]
Abstract
Adults with complex congenital heart disease (CHD) are at risk for cognitive dysfunction. However, associations between cognitive dysfunction and psychosocial outcomes are poorly defined. Between June and November 2022, we prospectively recruited 39 adults with complex CHD who completed a computerized cognitive assessment (Cogstate) and validated psychosocial scales measuring psychological distress, health-related quality of life (HRQOL), and resilience. Participants had a mean age of 36.4 ± 11.2 years. Over half (62%) were women, most (79%) had complex biventricular CHD, and 21% had Fontan physiology. Prevalence of cognitive dysfunction was greatest in the domains of attention (29%), working memory (25%), and psychomotor speed (21%). Adjusting for age and sex, Pearson partial correlations between Cogstate z-scores and self-reported cognitive problems were small. Participants who lived in the most disadvantaged areas and those with a below-average annual household income had lower global cognitive z-scores (p = 0.02 and p = 0.03, respectively). Two-thirds (64%) reported elevated symptoms of depression, anxiety, and/or stress. Small correlations were observed between psychological distress and cognitive performance. Greater resilience was associated with lower psychological distress (r ≥ -0.5, p < 0.001) and higher HRQOL (r = 0.33, p = 0.02). Our findings demonstrate that adults with complex CHD have a high risk of cognitive dysfunction, though may not recognize or report their cognitive challenges. Lower socioeconomic status may be an indicator for those at risk of poorer cognitive functioning. Psychological distress is common though may not be a strong correlate of performance-based cognitive functioning. Formal cognitive evaluation in this patient population is essential. Optimizing resilience may be a protective strategy to minimize psychological distress and bolster HRQOL.
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Affiliation(s)
- Charlotte E Verrall
- The University of Sydney School of Medicine, Sydney, NSW, Australia.
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia.
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Derek L Tran
- The University of Sydney School of Medicine, Sydney, NSW, Australia
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tracey Williams
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Vincent Oxenham
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Julian Ayer
- The University of Sydney School of Medicine, Sydney, NSW, Australia
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David S Celermajer
- The University of Sydney School of Medicine, Sydney, NSW, Australia
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rachael L Cordina
- The University of Sydney School of Medicine, Sydney, NSW, Australia
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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45
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Momcilovic D, Reznakova B, Bosse F, Begrich C, Bernhardt C, Hamiko M, Bakhtiary F, Nickenig G, Skowasch D, Pizarro C. Sleep-disordered breathing and lung function abnormalities in adults with congenital heart disease. Sleep Breath 2024; 28:241-250. [PMID: 37552390 PMCID: PMC10954938 DOI: 10.1007/s11325-023-02899-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Advances in treatment enables most patients with congenital heart diseases (CHD) to survive into adulthood, implying the need to address comorbid conditions in this growing cohort of patients. The aim of this study was to evaluate the prevalence of sleep-disordered breathing (SDB) and lung function abnormalities in patients with adult congenital heart disease (ACHD). METHODS Patients with ACHD underwent level 3 sleep testing (Embletta MPR polygraphy) and pulmonary function testing. Results were stratified by the underlying haemodynamic ACHD lesion group. RESULTS Patients with ACHD (n = 100) were middle-aged (42.3 ± 14.6 years), 54% male and slightly overweight (BMI 25.9 ± 5.5 kg/m2). Polygraphy revealed a prevalence of sleep apnoea of 39% with 15% of patients presenting with predominantly obstructive apnoeic episodes, while 23% of patients presenting primarily with central sleep apnoea. The distribution of mild, moderate, and severe sleep apnoea in the total study population was 26%, 7% and 6%, respectively. Comparison of apnoea-hypopnoea index, presence of sleep apnoea, and apnoea severity did not offer significant differences between the four ACHD lesion groups (p = 0.29, p = 0.41 and p = 0.18, respectively). Pulmonary function testing revealed obstructive lung disease in 19 of 100 patients. Concomitant chronic obstructive pulmonary disease and obstructive sleep apnoea were diagnosed in 3% of patients and were associated with profound nocturnal desaturation. CONCLUSION The findings suggest a mild propensity amongst patients with ACHD to develop SDB that seems to be unaffected by the specific underlying congenital lesion.
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Affiliation(s)
- D Momcilovic
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - B Reznakova
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - F Bosse
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Begrich
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Bernhardt
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - M Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - F Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - D Skowasch
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Atherton M, Levitan B, Ramachandran P. "Mind Your Arch"-An Unusual Cause of Systemic Hypertension in Pregnancy. CASE (PHILADELPHIA, PA.) 2024; 8:210-214. [PMID: 38524972 PMCID: PMC10954578 DOI: 10.1016/j.case.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•CoA must be considered in a young patient with severe uncontrolled hypertension. •Presentation may be delayed due to extensive collateral circulation. •Multimodality imaging is often necessary for preprocedural planning. •Despite treatment there is continued risk for long-term vascular disease.
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Affiliation(s)
- Mara Atherton
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Bryana Levitan
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Preeti Ramachandran
- Division of Pediatric Cardiology, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
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47
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Huang T, Yang L, Wen S, Fei H. Interventricular Septal Hematoma Following Correction of Ebstein Anomaly. CASE (PHILADELPHIA, PA.) 2024; 8:170-173. [PMID: 38524965 PMCID: PMC10954574 DOI: 10.1016/j.case.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•IVSH is a rare complication of cardiac surgery. •TTE with UEA is valuable in the diagnosis and follow-up of the hematoma. •Conservative management is allowed under intensive supervision.
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Affiliation(s)
- Taoran Huang
- Shantou University Medical College, Shantou, Guangdong, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou, China
| | - Lifang Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou, China
| | - Shusheng Wen
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou, China
| | - Hongwei Fei
- Shantou University Medical College, Shantou, Guangdong, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou, China
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48
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Condos GJ, McCabe JM, Joffe DC, Sheu RD. Novel Transcatheter Approach to Treat Primum Atrial Septal Defects. CASE (PHILADELPHIA, PA.) 2024; 8:180-185. [PMID: 38524970 PMCID: PMC10954577 DOI: 10.1016/j.case.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Degenerative common AVC defect can mimic rheumatic MV stenosis.•Closure of primum ASD can be achieved percutaneously.•Live 3D multiplanar TEE is crucial for procedural guidance.
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Affiliation(s)
- Gregory J. Condos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - James M. McCabe
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Denise C. Joffe
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, Seattle, Washington
| | - Richard D. Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Massarella D, McCrindle BW, Runeckles K, Fan S, Dahdah N, Dallaire F, Drolet C, Grewal J, Hancock-Friesen CL, Hickey E, Karur GR, Khairy P, Leonardi B, Keir M, Nadeem SN, Ng MY, Shah A, Tham EB, Therrien J, Warren AE, Vonder Muhll IF, Van de Bruane A, Yamamura K, Farkouh M, Wald RM. Adherence to clinical practice guidelines for pulmonary valve intervention after tetralogy of Fallot repair: A nationwide cohort study. JTCVS OPEN 2024; 17:215-228. [PMID: 38420530 PMCID: PMC10897679 DOI: 10.1016/j.xjon.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/13/2023] [Accepted: 10/28/2023] [Indexed: 03/02/2024]
Abstract
Objectives To determine guideline adherence pertaining to pulmonary valve replacement (PVR) referral after tetralogy of Fallot (TOF) repair. Methods Children and adults with cardiovascular magnetic resonance imaging scans and at least moderate pulmonary regurgitation were prospectively enrolled in the Comprehensive Outcomes Registry Late After TOF Repair (CORRELATE). Individuals with previous PVR were excluded. Patients were classified according to presence (+) versus absence (-) of PVR and presence (+) versus absence (-) of contemporaneous guideline satisfaction. A validated score (specific activity scale [SAS]) classified adult symptom status. Results In total, 498 participants (57% male, mean age 32 ± 14 years) were enrolled from 14 Canadian centers (2013-2020). Mean follow-up was 3.8 ± 1.8 years. Guideline criteria for PVR were satisfied for the majority (n = 422/498, 85%), although referral for PVR occurred only in a minority (n = 167/498, 34%). At PVR referral, most were asymptomatic (75% in SAS class 1). One participant (0.6%) received PVR without meeting criteria (PVR+/indication-). The remainder (n = 75/498, 15%) did not meet criteria for and did not receive PVR (PVR-/indication-). Abnormal cardiovascular imaging was the most commonly cited indication for PVR (n = 61/123, 50%). The SAS class and ratio of right to left end-diastolic volumes were independent predictors of PVR in a multivariable analysis (hazard ratio, 3.33; 95% confidence interval, 1.92-5.8, P < .0001; hazard ratio, 2.78; 95% confidence interval, 2.18-3.55, P < .0001). Conclusions Although a majority of patients met guideline criteria for PVR, only a minority were referred for intervention. Abnormal cardiovascular imaging was the most common indication for referral. Further research will be necessary to establish the longer-term clinical impact of varying PVR referral strategies.
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Affiliation(s)
- Danielle Massarella
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Brian W. McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyle Runeckles
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Steve Fan
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Frédéric Dallaire
- Division of Pediatrics, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christian Drolet
- Division of Pediatric and Congenital Cardiology, Department of Pediatrics, Laval University Hospital, Quebec, Quebec, Canada
| | - Jasmine Grewal
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Edward Hickey
- Division of Cardiovascular Surgery, Texas Children's Hospital, Houston, Tex
| | - Gauri Rani Karur
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Paul Khairy
- Adult Congenital Center, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Hospital and Research Institute, Scientific Institute for Research, Hospitalization, and Health Care, Rome, Italy
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Disease Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Syed Najaf Nadeem
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ashish Shah
- Division of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edythe B. Tham
- Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Judith Therrien
- MAUDE Unit (McGill University Health Network/Beth Raby Adult Congenital Heart Disease Clinic, Jewish General Hospital), Montreal, Quebec, Canada
| | - Andrew E. Warren
- Division of Pediatric Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Michael Farkouh
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Rachel M. Wald
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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50
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Dorobantu DM, Amir NH, Wadey CA, Sharma C, Stuart AG, Williams CA, Pieles GE. The Role of Speckle-Tracking Echocardiography in Predicting Mortality and Morbidity in Patients With Congenital Heart Disease: A Systematic Review and Meta-analysis. J Am Soc Echocardiogr 2024; 37:216-225. [PMID: 37972793 DOI: 10.1016/j.echo.2023.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Speckle-tracking echocardiography (STE) is now routinely included in cardiac evaluations, but its role in predicting mortality and morbidity in congenital heart disease (CHD) is not well described. We conducted a systematic review to evaluate the prognostic value of STE in patients with CHD. METHODS The EMBASE, Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to January 2023 for terms related to all CHD, STE, and prognosis. Meta-analysis of association of right ventricle and left ventricle strain (RV Sl and LV Sl, respectively) with major adverse cardiovascular events (MACEs) was performed in atrial switch transposition of the great arteries (asTGA)/congenitally corrected TGA (ccTGA), tetralogy of Fallot (ToF), and congenital aortic stenosis (cAS)/bicuspid aortic valve (BAV). P-value combination analysis was additionally performed for all CHD groups. RESULTS A total of 33 studies (30 cohorts, n = 8,619 patients, children, and adults) were included. Meta-analysis showed the following parameters as being associated with MACE: RV Sl in asTGA/ccTGA (hazard ratio [HR] = 1.1/%; CI, [1.03; 1.18]), RV Sl and LV Sl in ToF (HR = 1.14/%; CI, [1.03; 1.26] and HR = 1.14/%; CI, [1.08; 1.2], respectively), and LV Sl in cAS/BAV (HR = 1.19/%; CI, [1.15; 1.23]). The RV Sl and strain rate were associated with outcomes also in single ventricle/hypoplastic left heart syndrome (at all palliation stages except before Norwood stage 1) and LV Sl in Ebstein's anomaly. CONCLUSIONS This systematic review and meta-analysis showed that biventricular strain and strain rate were associated with outcomes in a variety of CHD, highlighting the need for updated recommendations on the use of STE in the current guidelines, specific to disease types.
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Affiliation(s)
- Dan M Dorobantu
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom; Department of Population and Translational Health Science, University of Bristol, Bristol, United Kingdom
| | - Nurul H Amir
- Department of Population and Translational Health Science, University of Bristol, Bristol, United Kingdom; Faculty of Sport Science and Recreation, Universiti Teknologi Majlis Amanah Rakyat, Arau, Malaysia
| | - Curtis A Wadey
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
| | - Chetanya Sharma
- Congenital Heart Unit, Bristol Heart Institute and Royal Hospital for Children, Bristol, United Kingdom
| | - A Graham Stuart
- Department of Population and Translational Health Science, University of Bristol, Bristol, United Kingdom; Congenital Heart Unit, Bristol Heart Institute and Royal Hospital for Children, Bristol, United Kingdom
| | - Craig A Williams
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom.
| | - Guido E Pieles
- Congenital Heart Unit, Bristol Heart Institute and Royal Hospital for Children, Bristol, United Kingdom; Institute of Sport, Exercise and Health, University College London, London, United Kingdom; Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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