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Arthur L, Schoeneberg L, Angtuaco M, Greenberg SB, Renno MS, Das S. Advanced imaging improves detection of baffle leaks and stenoses after atrial switch compared with transthoracic echocardiography. Int J Cardiovasc Imaging 2021; 37:2767-2772. [PMID: 33864562 DOI: 10.1007/s10554-021-02236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/03/2021] [Indexed: 11/25/2022]
Abstract
Current guidelines for adults with atrial switch repair recommend baseline cardiovascular magnetic resonance (CMR) for assessment of ventricular size and function, systemic and venous baffle obstruction and leaks, and valvular function. It also recommends transthoracic echocardiography (TTE) for outpatient follow up. Many such patients with implanted cardiac devices may need cardiac computed tomography (CCT) when CMR is not feasible. This study reviews and compares CMR, transesophageal echocardiography (TEE), CCT, cardiac catheterization with angiography and TTE in detection of baffle problems in patients after atrial switch operation. The medical records of patients who had at least one imaging study performed after atrial switch operation at our center from 2010 to 2020 were retrospectively reviewed. Results are reported as descriptive statistics for demographics and imaging findings. The principal outcome measure was detection of baffle leak and/or baffle stenosis. Fifty-seven patients had at least one cardiac imaging study after atrial switch operation (36 Senning and 21 Mustard operations) during the study period. Nearly 33% (19/57) had baffle complications of stenosis and/or baffle leaks identified. All 57 patients had TTE performed but baffle problems were noted by TTE in only 8 (14%) patients (7 baffle stenosis and 1 baffle leak). Of the 49 patients without known baffle problems by TTE, 24 had advanced imaging (TEE/CCT/CMR/angiography). Advanced imaging identified baffle problems in nearly half (11/24, 46%) of them (7 baffle leaks and 4 baffle stenosis). Baffle problems were present in (8/23) patients with transvenous cardiac devices. Baffle complications are common after atrial switch operations and in our study occur in 1/3rd of the patients. However, TTE is not sensitive enough to recognize these complications. Advanced imaging for detection of baffle complications should be considered in all patients after atrial switch operation.
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Affiliation(s)
- Lindsay Arthur
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Laura Schoeneberg
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael Angtuaco
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Bruce Greenberg
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Markus S Renno
- Arkansas Children's Hospital, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Srikant Das
- Arkansas Children's Hospital, Little Rock, AR, USA.
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Canan A, Ashwath R, Agarwal PP, François C, Rajiah P. Multimodality Imaging of Transposition of the Great Arteries. Radiographics 2021; 41:338-360. [PMID: 33481689 DOI: 10.1148/rg.2021200069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transposition of the great arteries (TGA) is a congenital conotruncal abnormality characterized by discordant connections between the ventricles and great arteries, with the aorta originating from the right ventricle (RV), and the pulmonary artery (PA) originating from the left ventricle (LV). The two main types of TGA are complete transposition or dextro-transposition of the great arteries (D-TGA), commonly referred to as d-loop, and congenitally corrected transposition (CCTGA), commonly referred to as l-loop or L-TGA. In D-TGA, the connections between the ventricles and atria are concordant, whereas in CCTGA they are discordant, with the left atrium connected to the RV, and the right atrium connected to the LV. D-TGA manifests during the neonatal period and can be surgically managed by atrial switch operation (AtrSO), arterial switch operation (ASO), Rastelli procedure, or Nikaidoh procedure. Arrhythmia, systemic ventricular dysfunction, baffle stenosis, and baffle leak are the common complications of AtrSO, whereas supravalvular pulmonary or branch PA stenosis, neoaortic dilatation, and coronary artery narrowing are the common complications of ASO. CCTGA may manifest late in life, even in adulthood. Surgeries for associated lesions such as tricuspid regurgitation, subpulmonic stenosis, and ventricular septal defect may be performed. A double-switch operation that includes both the atrial and arterial switch operations constitutes anatomic correction for CCTGA. Imaging plays an important role in the evaluation of TGA, both before and after surgery, for helping define the anatomy, quantify hemodynamics, and evaluate complications. Transthoracic echocardiography is the first-line imaging modality for presurgical planning in children with TGA. MRI provides comprehensive morphologic and functional information, particularly in adults after surgery. CT is performed when MRI is contraindicated or expected to generate artifacts. The authors review the imaging appearances of TGA, with a focus on pre- and postsurgical imaging. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Ravi Ashwath
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Prachi P Agarwal
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Christopher François
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Prabhakar Rajiah
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
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Yoshida A, Kaji T, Yamada H, Yonetani N, Sogawa E, Yamao M, Maeda K, Sata M, Irahara M. Measurement of hemodynamics immediately after vaginal delivery in healthy pregnant women by electrical cardiometry. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:75-80. [PMID: 31064959 DOI: 10.2152/jmi.66.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Few reports have focused on hemodynamics around delivery in pregnant women because of the difficulty of continuous and noninvasive measurement. Electrical cardiometry allows noninvasive continuous monitoring of hemodynamics and has recently been used in non-pregnant subjects. We compared the use of electrical cardiometry versus transthoracic echocardiography in healthy pregnant women and evaluated hemodynamics immediately after vaginal delivery. In Study 1, electrical cardiometry and transthoracic echocardiography were used to measure cardiac output in 20 pregnant women with threatened premature delivery. A significant correlation was found between the two methods, with electrical cardiometry showing the higher cardiac output. In Study 2, heart rate, stroke volume, and cardiac output were continuously measured in 15 women during vaginal delivery up to 2 h postpartum. Cardiac output increased markedly because of an increased heart rate and stroke volume at the time of newborn delivery. The heart rate then immediately returned to baseline, while cardiac output remained elevated for at least 2 h after delivery because of a sustained high stroke volume. Electrical cardiometry was as readily available as transthoracic echocardiography for evaluating hemodynamics and allowed for continuous measurement during labor. High intrapartum cardiac output was sustained for at least 2 h after vaginal delivery. J. Med. Invest. 66 : 75-80, February, 2019.
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Affiliation(s)
- Atsuko Yoshida
- Department of Obstetrics and Gynecology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima
| | - Takashi Kaji
- Department of Obstetrics and Gynecology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Medicine, Tokushima, Japan.,Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Naoto Yonetani
- Department of Obstetrics and Gynecology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima
| | - Eishi Sogawa
- Department of Obstetrics and Gynecology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima
| | - Masami Yamao
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Kazuhisa Maeda
- Department of Obstetrics and Gynecology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima.,Perinatal Medical Center, Shikoku Medical Center for Children and Adults, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima
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Srivastava NT, Hurwitz R, Kay WA, Eckert GJ, Kuhlenhoelter A, DeGrave N, Ebenroth ES. The long-term functional outcome in Mustard patients study: Another decade of follow-up. CONGENIT HEART DIS 2018; 14:176-184. [PMID: 30468301 DOI: 10.1111/chd.12698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE For over 20 years, we have followed a cohort of patients who underwent the Mustard procedure for d-transposition of the great arteries. The current study follows the same cohort from our last study in 2007 to reassess their functional capacity and quality of life. PARTICIPANTS Of the original 45 patients, six patients have required cardiac transplant and 10 patients have died, including two of the transplanted patients. Twenty-five of the remaining patients agreed to participate in this current study. DESIGN Patients underwent comparable testing to the previous studies when possible including exercise stress testing, echocardiography, MRI or CT evaluation of cardiac anatomy and function, Holter monitor, and quality of life questionnaire. RESULTS Thirty-one percent of patients have experienced cardiac death either in the form of mortality or cardiac transplantation. The major cause of death was systemic right ventricular failure. Sixty-five percent have continuing abnormalities of rhythm. Exercise time and workload showed a statistically significant decrease from the original study (Time 1) to both 10-year (Time 2) and 20-year (Time 3) follow-up points. Right ventricular ejection fraction decreased significantly from the Time 1 to Time 2, and again to this current follow-up. Quality of life measures of energy level decreased significantly from the original study to both the Time 2 and Time 3. CONCLUSION Cardiac mortality for Mustard patients remains high, and over time, systemic right ventricular ejection fraction, rhythm, exercise tolerance, and quality of life assessments show deterioration. There does not appear to be a single clear predictor of poor outcome.
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Affiliation(s)
- Nayan T Srivastava
- Department of Pediatrics, Eskenazi Health, Indianapolis, Indiana.,Pediatric Cardiology, Riley Hospital for Children, Indianapolis, Indiana
| | - Roger Hurwitz
- Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - W Aaron Kay
- Indiana University School of Medicine, Indianapolis, Indiana
| | - George J Eckert
- Department of Biostatistics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Alisha Kuhlenhoelter
- Department of Pediatrics, Pediatric Cardiology, Indiana University, Indianapolis, Indiana
| | - Nicole DeGrave
- Pediatric Cardiology, Riley Hospital for Children, Indianapolis, Indiana
| | - Eric S Ebenroth
- Pediatric Cardiology, Riley Hospital for Children, Indianapolis, Indiana.,Department of Pediatrics, Pediatric Cardiology, Indiana University, Indianapolis, Indiana
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Seckeler MD, Thomas ID, Andrews J, Joiner K, Klewer SE. A review of the economics of adult congenital heart disease. Expert Rev Pharmacoecon Outcomes Res 2016; 16:85-96. [DOI: 10.1586/14737167.2016.1140575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wilhelm CM, Sisk TL, Roble SL, Chisolm JL, Janevski I, Cheatham JP, Cua CL. Accuracy of Imaging Modalities in Detection of Baffle Leaks in Patients Following Atrial Switch Operation. Echocardiography 2015; 33:437-42. [DOI: 10.1111/echo.13097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | - Tracey L. Sisk
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio
| | - Sharon L. Roble
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio
| | | | - Ilija Janevski
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio
| | | | - Clifford L. Cua
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio
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Turner J, Preston L, Booth A, O’Keeffe C, Campbell F, Jesurasa A, Cooper K, Goyder E. What evidence is there for a relationship between organisational features and patient outcomes in congenital heart disease services? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe purpose of this rapid evidence synthesis is to support the current NHS England service review on organisation of services for congenital heart disease (CHD). The evidence synthesis team was asked to examine the evidence on relationships between organisational features and patient outcomes in CHD services and, specifically, any relationship between (1) volume of cases and patient outcomes and (2) proximity of colocated services and patient outcomes. A systematic review published in 2009 had confirmed the existence of this relationship, but cautioned this was not sufficient to make recommendations on the size of units needed.ObjectivesTo identify and synthesise the evidence on the relationship between organisational features and patient outcomes for adults and children with CHD.Data sourcesA systematic search of medical- and health-related databases [MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library and Web of Science] was undertaken for 2009–14 together with citation searching, reference list checking and stakeholder recommendations of evidence from 2003 to 2014.Review methodsThis was a rapid review and, therefore, the application of the inclusion and exclusion criteria to retrieved records was undertaken by one reviewer, with 10% checked by a second reviewer. Five reviewers extracted data from included studies using a bespoke data extraction form which was subsequently used for evidence synthesis. No formal quality assessment was undertaken, but the usefulness of the evidence was assessed together with limitations identified by study authors.ResultsThirty-nine papers were included in the review. No UK-based studies were identified and 36 out of 39 (92%) studies included only outcomes for paediatric patients. Thirty-two (82%) studies investigated the relationship between volume and mortality and seven (18%) investigated other service factors or outcomes. Ninety per cent were from the USA, 92% were multicentre studies and all were retrospective observational studies. Twenty-five studies (64%) included all CHD conditions and 14 (36%) included single conditions or procedures. Although the evidence does demonstrate a relationship between volume and outcome in the majority of studies, this relationship is not consistent. The relationship was stronger for single-complex conditions or procedures. A mixed picture emerged revealing a range of factors as well as volume that influence outcome, including condition severity, individual centre and surgeon effects and clinical advances over time. We found limited (seven studies) evidence about the impact of proximity and colocation of services on outcomes, and about volume on non-mortality outcomes.LimitationsThis was a rapid review that followed standard methods to ensure transparency and reproducibility. The main limitations of the included studies were the retrospective nature, reliance on routine data sets, completeness, selection bias and lack of data on key clinical and service-related processes.ConclusionsThis review identified a substantial number of studies reporting a positive relationship between volume and outcome, but the complexity of the evidence requires careful interpretation. The heterogeneity of findings from observational studies suggests that, while a relationship between volume and outcome exists, this is unlikely to be a simple, independent and directly causal relationship. The effect of volume on outcome relative to the effect of other as yet undetermined health system factors remains a complex and unresolved research question.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Colin O’Keeffe
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Fiona Campbell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Amrita Jesurasa
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Cooper
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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De Caro E, Bondanza S, Calevo MG, Trocchio G, Lupi G, Domenicucci S, Marasini M. Tricuspid annular plane systolic excursion for the assessment of ventricular function in adults operated on with mustard procedure for complete transposition of the great arteries. CONGENIT HEART DIS 2013; 9:252-8. [PMID: 24010728 DOI: 10.1111/chd.12135] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND In adult patients with d-transposition of the great arteries after atrial switch operation, dysfunction of the systemic right ventricle (RV) is a well-known complication. Echocardiographic variables may provide adequate estimation of subpulmonary RV function, but their applicability to the subaortic RV is not straightforward. We evaluate the concordance between tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging-derived ejection fraction of the RV (MRI-RVEF) in these patients. METHODS Patients were recruited from those evaluated at the adult congenital clinic of our department between 2010 and 2012. All patients who had an echocardiographic assessment within 6 months of their MRI examination were selected. Patients clinically unstable, not in sinus rhythm, with a prosthetic systemic atrioventricular valve, permanent pacemaker, or more than moderate systemic atrioventricular valve regurgitation were excluded. RESULTS Eighteen Mustard-operated patients aged 22 ± 3.7 years were studied. The mean values of TAPSE and RVEF were 13.22 ± 1.7 mm and 49.7 ± 6%, respectively. TAPSE and RVEF were normal in 1 (5.5%) and 10 (55.5%) patients, respectively. Seventeen (94.4%) patients showed reduced TAPSE (12.9 ± 1.3 mm): RVEF was reduced in eight (47%) of these subjects, and normal in nine (53%). In patients with normal RVEF, both the MRI-RV end-diastolic and the MRI-RV end-systolic volumes were significantly lower than in patients with reduced RVEF. There were no other statistically significant differences between these patients. No correlation was found between TAPSE and both the MRI-RV end-diastolic and the end-systolic volumes. Globally, agreement between TAPSE and RVEF was slight (K = 0.09 ± 0.089). CONCLUSIONS Our results indicate that in these patients TAPSE is not a useful measure of RV function.
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Affiliation(s)
- Enrico De Caro
- Department of Cardiology, Istituto Giannina Gaslini, Genoa, Italy
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Singh HS, Nagy C, Wan AW, Osten MD, Benson LN, Horlick EM. Complex Interventions in the Adult with Congenital Heart Disease: Percutaneous Solutions for Venous Baffles, Coronary Artery Fistulas, and Ruptured Sinus of Valsalva Aneurysms. Interv Cardiol Clin 2013; 2:153-172. [PMID: 28581980 DOI: 10.1016/j.iccl.2012.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe 3 distinct ACHD lesions amenable to percutaneous repair: (1) venous baffle obstruction in transposition of the great arteries, (2) coronary artery fistulas, and (3) ruptured sinus of Valsalva aneurysms. For each entity, we chronicle the typical clinical scenario and indications for intervention to supplement the technical approach and potential pitfalls with treatment.
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Affiliation(s)
- Harsimran S Singh
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA; Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Christian Nagy
- Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Andrea W Wan
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Mark D Osten
- Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Lee N Benson
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Eric M Horlick
- Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto School of Medicine, Toronto, Ontario, Canada.
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Bibliography. Cardiovascular medicine (CM). Current world literature. Curr Opin Pediatr 2012; 24:656-60. [PMID: 22954957 DOI: 10.1097/mop.0b013e328358bc78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grothoff M, Hoffmann J, Abdul-Khaliq H, Lehmkuhl L, Dähnert I, Berger F, Mende M, Gutberlet M. Right ventricular hypertrophy after atrial switch operation: normal adaptation process or risk factor? A cardiac magnetic resonance study. Clin Res Cardiol 2012; 101:963-71. [PMID: 22714955 PMCID: PMC3501162 DOI: 10.1007/s00392-012-0485-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/08/2012] [Indexed: 11/25/2022]
Abstract
Background Systemic right ventricle (RV) hypertrophy and impaired function occur after atrial switch for dextro-transposition of the great arteries (d-TGA). Echocardiography is limited in its ability to assess the RV. We sought to evaluate systemic RV myocardial-mass index (MMI) and function after atrial switch and to analyse the role of hypertrophy for ventricular function with special consideration of the interventricular septal (IVS) movement. Methods Thirty-seven consecutive patients (median age 22.9 years) after atrial switch were studied using cardiac magnetic resonance imaging (1.5T Intera, Philips) with a dedicated 5-channel phased-array surface cardiac coil. Cine steady-state free-precession sequences were acquired to obtain myocardial masses and function. The systolic movement of the IVS was defined as positive when moving towards the centroid of the RV and was defined as non-positive otherwise. Patient parameters were compared to controls. Results The systemic RVs were significantly larger (p < 0.001) than the left ventricles of the control group, systolic function was significantly impaired (p < 0.001) and MMI including the IVS was comparable (p = n.s.). RV-MMI excluding the IVS and RV ejection fraction (EF) demonstrated a quadratic correlation (r = 0.6, p < 0.001), meaning that patients with RV-MMI ≤29 g/m2 and >68 g/m2 had a reduced level of systolic function. Positive septal movement improved RV function compared with non-positive septal movement (p = 0.024). Conclusions There seems to be a range of beneficial RV hypertrophy after atrial switch in which a sufficient RV-EF can be expected. A positive septal movement, probably the result of hypertrophic septal RV fibres, improves RV function and might be regarded as a beneficial contraction pattern.
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Affiliation(s)
- Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
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