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Akram I, Samiullah FNU. Comment on: Fate After the Mustard Procedure for d-Transposition of the Great Arteries: Impact of Age, Complexity, and Atrial Tachyarrhythmias: A Single Center Experience. Pediatr Cardiol 2024; 45:1610-1611. [PMID: 39066918 DOI: 10.1007/s00246-024-03594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Iman Akram
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan.
| | - F N U Samiullah
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari Karachi, Karachi, Pakistan
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Szaluś-Jordanow O, Barszcz K, Mądry W, Buczyński M, Czopowicz M, Gierulski A, Moroz-Fik A, Mickiewicz M, Grzegorczyk M, Jaroszewicz J. Hydrops fetalis caused by a complex congenital heart defect with concurrent hypoplasia of pulmonary blood vessels and lungs visualized by micro-CT in a French Bulldog. BMC Vet Res 2024; 20:189. [PMID: 38734649 PMCID: PMC11088049 DOI: 10.1186/s12917-024-04060-5] [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: 04/14/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Hydrops fetalis (HF) is fluid accumulation in fetus body cavities and subcutaneous tissue. The condition has been described in various farm and companion animal species, including dogs. Most of cases result from a heart defect. Exact nature of this defect is rarely clarified. CASE PRESENTATION A newborn, male French bulldog puppy with severe HF underwent a full anatomopathological examination to diagnose the primary cause of HF. Based on the anatomopathological examination, fetal ultrasound, and micro-computed tomography, transposition of the great arteries with hypoplasia of the ascending aorta, aortic arch interruption, ostium secundum atrial septal defect, severe tricuspid valve dysplasia, as well as hypoplasia of pulmonary vessels and lungs were diagnosed. CONCLUSIONS This is the first report of HF caused by severe, complex congenital heart defects with concurrent pulmonary vessel and lung hypoplasia.
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Affiliation(s)
- Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Str. 159c, Warsaw, 02-776, Poland.
| | - Karolina Barszcz
- Department of Morphological Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159, Warsaw, 02-776, Poland
| | - Wojciech Mądry
- Department of Heart, Chest and Transplant Surgery, Medical University of Warsaw, Żwirki i Wigury 63A, Warsaw, 02-091, Poland
| | - Michał Buczyński
- Department of Heart, Chest and Transplant Surgery, Medical University of Warsaw, Żwirki i Wigury 63A, Warsaw, 02-091, Poland
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, Warsaw, 02-776, Poland
| | - Adam Gierulski
- Private Practice, Animal Veterinary Clinic, Młynarska 29, Łódź, Poland
| | - Agata Moroz-Fik
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, Warsaw, 02-776, Poland
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, Warsaw, 02-776, Poland
| | - Michał Grzegorczyk
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Chałubińskiego 5, Warsaw, 02-004, Poland
| | - Jakub Jaroszewicz
- Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, Warsaw, 02-507, Poland
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Albertini M, Santens B, Fusco F, Sarubbi B, Gallego P, Rodriguez-Puras MJ, Prokselj K, Kauling RM, Roos-Hesselink J, Labombarda F, Van De Bruaene A, Budts W, Waldmann V, Iserin L, Woudstra O, Bouma B, Ladouceur M. External Validation of a Risk Score Model for Predicting Major Clinical Events in Adults After Atrial Switch. J Am Heart Assoc 2024; 13:e032174. [PMID: 38686874 PMCID: PMC11179903 DOI: 10.1161/jaha.123.032174] [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: 08/11/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND A risk model has been proposed to provide a patient individualized estimation of risk for major clinical events (heart failure events, ventricular arrhythmia, all-cause mortality) in patients with transposition of the great arteries and atrial switch surgery. We aimed to externally validate the model. METHODS AND RESULTS A retrospective, multicentric, longitudinal cohort of 417 patients with transposition of the great arteries (median age, 24 years at baseline [interquartile range, 18-30]; 63% men) independent of the model development and internal validation cohort was studied. The performance of the prediction model in predicting risk at 5 years was assessed, and additional predictors of major clinical events were evaluated separately in our cohort. Twenty-five patients (5.9%) met the major clinical events end point within 5 years. Model validation showed good discrimination between high and low 5-year risk patients (Harrell C index of 0.73 [95% CI, 0.65-0.81]) but tended to overestimate this risk (calibration slope of 0.20 [95% CI, 0.03-0.36]). In our population, the strongest independent predictors of major clinical events were a history of heart failure and at least mild impairment of the subpulmonary left ventricle function. CONCLUSIONS We reported the first external validation of a major clinical events risk model in a large cohort of adults with transposition of the great arteries. The model allows for distinguishing patients at low risk from those at intermediate to high risk. Previous episode of heart failure and subpulmonary left ventricle dysfunction appear to be key markers in the prognosis of patients. Further optimizing risk models are needed to individualize risk predictions in patients with transposition of the great arteries.
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Affiliation(s)
- Mathieu Albertini
- Université Paris Cité Inserm, PARCC France
- Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris France
- Adult Congenital Heart Disease Unit Hôpital Européen Georges Pompidou, APHP Paris France
| | - Beatrice Santens
- Division of Congenital and Structural Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit AORN dei Colli-Monaldi Hospital Naples Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit AORN dei Colli-Monaldi Hospital Naples Italy
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit Hospital Universitario Virgin del Rocio Seville Spain
- European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart-ERN GUARD Heart Seville Spain
| | - Maria-Jose Rodriguez-Puras
- Adult Congenital Heart Disease Unit Hospital Universitario Virgin del Rocio Seville Spain
- European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart-ERN GUARD Heart Seville Spain
| | - Katja Prokselj
- Department of Cardiology University Medical Centre Ljubljana Ljubljana Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Robert Martijn Kauling
- Department of Cardiology, Thoraxcenter, ErasmusMC University Medical Center Rotterdam Rotterdam the Netherlands
- European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart-ERN GUARD Heart Rotterdam the Netherlands
| | - Jolien Roos-Hesselink
- Department of Cardiology, Thoraxcenter, ErasmusMC University Medical Center Rotterdam Rotterdam the Netherlands
- European Reference Network for Rare Low Prevalence and Complex Diseases of the Heart-ERN GUARD Heart Rotterdam the Netherlands
| | - Fabien Labombarda
- Department of Cardiology CHU de Caen Caen France
- UNICAEN UR PSIR 4650 Caen France
| | - Alexander Van De Bruaene
- Division of Congenital and Structural Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Victor Waldmann
- Université Paris Cité Inserm, PARCC France
- Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris France
- Adult Congenital Heart Disease Unit Hôpital Européen Georges Pompidou, APHP Paris France
| | - Laurence Iserin
- Université Paris Cité Inserm, PARCC France
- Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris France
- Adult Congenital Heart Disease Unit Hôpital Européen Georges Pompidou, APHP Paris France
| | - Odilia Woudstra
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | - Berto Bouma
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | - Magalie Ladouceur
- Université Paris Cité Inserm, PARCC France
- Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris France
- Adult Congenital Heart Disease Unit Hôpital Européen Georges Pompidou, APHP Paris France
- Division of Cardiology University Hospital Geneva Geneva Switzerland
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Krause U, Teubener ST, Müller MJ, Schneider HE, Paul T. Fate After the Mustard Procedure for d-Transposition of the Great Arteries: Impact of Age, Complexity, and Atrial Tachyarrhythmias: A Single Center Experience. Pediatr Cardiol 2023; 44:1746-1753. [PMID: 37505269 PMCID: PMC10520136 DOI: 10.1007/s00246-023-03241-7] [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: 05/30/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
Patients with dextro transposition of the great arteries (d-TGA) after atrial switch procedure are at risk to develop heart failure and arrhythmias during long-term follow-up. The present study aims to add knowledge on the fate of subjects after Mustard procedure during long-term follow-up into adulthood. A single center, retrospective chart review analysis was conducted. All subjects who had Mustard-type atrial switch procedure between 1969 and 1994 at our institution were included. A total of 92 subjects were included. Early postoperative death was reported in 2 subjects. Long-term follow-up was available in 49 survivors. Of those, 6 individuals died during further follow-up. Sudden cardiac death was the most prevalent cause for fatal outcome. Mortality during long-term follow-up was associated with the presence of additional cardiovascular malformations (complex d-TGA). Sinus node dysfunction was observed in 65% of the patients and atrial tachyarrhythmias were common in adult survivors (63%). Implantation of a pacemaker or a cardioverter defibrillator was required in 31% and 45% of those surviving into adulthood. Complications were frequently observed during follow-up after either pacemaker or cardioverter defibrillator implantation (43%) with lead failure being the most frequent complication. The aging population of patients after Mustard procedure is facing challenging problems mainly resulting from a failing systemic right ventricle, presence of associated cardiac malformations and the presence of atrial baffles associated with relevant atrial scars. Age, associated cardiac malformations, and atrial tachyarrhythmias seem to play a major role in determining the fate of patients with d-TGA after atrial switch procedures.
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Affiliation(s)
- Ulrich Krause
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
| | - Sophie Theres Teubener
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Heike E Schneider
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
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Neijenhuis RML, Regeer MV, van der Kley F, Vliegen HW, Jongbloed MRM, Kiès P, Schalij MJ, Jukema JW, Egorova AD. Contemporary Management Strategies of Baffle Leaks in Adults with a Failing Systemic Right Ventricle Late after Atrial Switch: A Case Series and Literature Overview. J Cardiovasc Dev Dis 2023; 10:jcdd10030129. [PMID: 36975893 PMCID: PMC10056645 DOI: 10.3390/jcdd10030129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Baffle leaks are a frequently encountered and often overlooked complication after the atrial switch procedure for transposition of the great arteries. Baffle leaks are present in up to 50% of non-selected patients, and while they initially may not cause clear symptoms, they can complicate the hemodynamic course and influence the prognosis in this complex patient group. A shunt from the pulmonary venous atrium (PVA) to the systemic venous atrium (SVA) can lead to pulmonary overflow and subpulmonary left ventricular (LV) volume overload, while a shunt from the SVA to the PVA can result in (exercise-associated) cyanosis and paradoxical embolism. We report three cases of baffle leaks in patients with systemic right ventricular (sRV) failure late after the atrial switch procedure. Two symptomatic patients who presented with exercise-associated cyanosis due to SVA to PVA shunting over the baffle leak underwent successful percutaneous baffle leak closure with a septal occluder device. One patient with overt sRV failure and signs of subpulmonary LV volume overload due to PVA to SVA shunting was managed conservatively, as baffle leak closure was expected to lead to an increase in sRV end-diastolic pressure and aggravation of sRV dysfunction. These three cases illustrate the considerations made, challenges faced, and necessity of a patient-tailored approach when addressing baffle leaks.
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Affiliation(s)
- Ralph M L Neijenhuis
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Madelien V Regeer
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Frank van der Kley
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Martin J Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Netherlands Heart Institute, 3511 EP Utrecht, The Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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6
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Pizula J, Devera J, Ng TMH, Yeung SL, Thangathurai J, Herrick N, Chatfield AJ, Mehra A, Elkayam U. Outcome of Pregnancy in Women With D-Transposition of the Great Arteries: A Systematic Review. J Am Heart Assoc 2022; 11:e026862. [PMID: 36444833 PMCID: PMC9851445 DOI: 10.1161/jaha.122.026862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Information on maternal and fetal outcomes of pregnancy in women with D-transposition of the great arteries is limited. We conducted a systematic literature review on pregnancies in women with transposition of the great arteries after atrial and arterial switch operations to better define maternal and fetal risk. Methods and Results A systematic review was performed on studies between 2000 and 2021 that identified 676 pregnancies in 444 women with transposition of the great arteries. A total of 556 pregnancies in women with atrial switch operation were tolerated by most cases with low mortality (0.6%). Most common maternal complications, however, were arrhythmias (9%) and heart failure (8%) associated with serious morbidity in some patients. Worsening functional capacity, right ventricular function, and tricuspid regurgitation occurred in ≈20% of the cases. Rate of fetal and neonatal mortality was 1.4% and 0.8%, respectively, and rate of prematurity was 32%. A total of 120 pregnancies in women with arterial switch operation were associated with no maternal mortality, numerically lower rates of arrhythmias and heart failure (6% and 5%, respectively), significantly lower rate of prematurity (11%; P<0.001), and only 1 fetal loss. Conclusions Pregnancy is tolerated by most women with transposition of the great arteries and atrial switch operation with low mortality but important morbidity. Most common maternal complications were arrhythmias, heart failure, worsening of right ventricular function, and tricuspid regurgitation. There was also a high incidence of prematurity and increased rate of fetal loss and neonatal mortality. Outcome of pregnancy in women after arterial switch operations is more favorable, with reduced incidence of maternal complications and fetal outcomes similar to women without underlying cardiac disease.
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Affiliation(s)
- Jena Pizula
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Justin Devera
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Tien M. H. Ng
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Southern CaliforniaLos AngelesCA,School of PharmacyUniversity of Southern CaliforniaLos AngelesCA
| | | | - Jenica Thangathurai
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Nichole Herrick
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Amy J. Chatfield
- School of PharmacyUniversity of Southern CaliforniaLos AngelesCA
| | - Anil Mehra
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Uri Elkayam
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Southern CaliforniaLos AngelesCA,Department of Obstetrics and GynecologyUniversity of Southern CaliforniaLos AngelesCA
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7
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Walter CC, Escobar-Diaz MC, Cesar S, Garrido BAM, Sanchez-de-Toledo J. Functional and morphometric changes in children after neonatal arterial switch operation for transposition of the great arteries. Ann Pediatr Cardiol 2022; 15:447-452. [PMID: 37152511 PMCID: PMC10158475 DOI: 10.4103/apc.apc_46_22] [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: 03/23/2022] [Revised: 05/05/2022] [Accepted: 12/04/2022] [Indexed: 03/03/2023] Open
Abstract
Background The increase in the survival of patients with D-Transposition of the great arteries (TGA) after arterial switch operation (ASO) has now turned our focus to the evaluation of mid and long-term outcomes. Although most patients are followed by conventional echocardiography, the study of cardiac functionality and morphometric parameters in children with TGA after ASO is scarce. The present study aims to describe the functional and morphometric echocardiographic changes in children after ASO. Methods We performed an observational study in patients aged 1-5 years with TGA who underwent neonatal ASO. Morphometric and functional echocardiographic parameters were analyzed in 21 patients and compared with 52 age-matched healthy controls. Results We found morphological and functional changes, especially in the right ventricle, which is more globular (right ventricle [RV] basal sphericity index 1.5 vs. 1.8, P = 0.016), and with a decreased systolic function compared to healthy controls (fractional area change 51 vs. 58%, P = 0.006; tricuspid annular plane systolic excursion 13 vs. 20 mm, P = 0.001; s' 7 vs. 12 cm/s, P = 0.001). In the speckle-tracking strain imaging, there was a decrease in the longitudinal deformation of the apical septal myocardium (-23% vs. -27%; P = 0.005). Preoperative systemic overload to the right ventricle could be an important factor in the origin of these changes. Conclusions In patients with TGA after ASO, there are morphometric and functional echocardiographic changes, such as globular form and decreased function, especially in the RV; the effect of these changes on long-term outcomes would require prospective follow-up studies.
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Affiliation(s)
- Carin Cristina Walter
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | - Maria Clara Escobar-Diaz
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | - Sergi Cesar
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | | | - Joan Sanchez-de-Toledo
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Late outcome, therapy and systemic ventricular function in patients with a systemic right ventricle: data of the German National Register for Congenital Heart Defects. Cardiol Young 2022; 32:1235-1245. [PMID: 34658317 DOI: 10.1017/s1047951121003954] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adults with systemic right ventricle have a significant risk for long-term complications such as arrhythmias or heart failure. METHODS A nationwide retrospective study based on the German National Register for Congenital Heart Disease was performed. Patients with transposition of the great arteries after atrial switch operation or congenitally corrected TGA were included. RESULTS Two hundred and eight-five patients with transposition of the great arteries after atrial switch operation and 95 patients with congenitally corrected transposition of the great arteries were included (mean age 33 years). Systolic function of the systemic ventricle was moderately or severely reduced in 25.5 % after atrial switch operation and in 35.1% in patients with congenitally corrected transposition. Regurgitation of the systemic atrioventricular valve was present in 39.5% and 43.2% of the cases, respectively. A significant percentage of patients also had a history for supraventricular or ventricular arrhythmias. However, polypharmacy of cardiovascular drugs was rare (4.5%) and 38.5 % of the patients did not take any cardiovascular medication. The amount of cardiovascular drugs taken was associated with NYHA class as well as systemic right ventricular dysfunction. Patients with congenitally corrected transposition were more likely to receive pharmacological treatment than patients after atrial switch operation. CONCLUSION A significant portion of patients with systemic right ventricle suffer from a relevant systemic ventricular dysfunction, systemic atrioventricular valve regurgitation, and arrhythmias. Despite this, medication for heart failure treatment is not universally used in this cohort. This emphasises the need for randomised trials in patient with systemic right ventricle.
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10
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Gonzalez-Fernandez O, De Rita F, Coats L, Crossland D, Nassar MS, Hermuzi A, Santos Lopes B, Woods A, Robinson-Smith N, Petit T, Seller N, O'Sullivan J, McDiarmid A, Schueler S, Hasan A, MacGowan G, Jansen K. Ventricular assist devices in transposition and failing systemic right ventricle: role of tricuspid valve replacement. Eur J Cardiothorac Surg 2022; 62:6542520. [PMID: 35244691 DOI: 10.1093/ejcts/ezac130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/31/2022] [Accepted: 02/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Ventricular assist device (VAD) for systemic right ventricular (RV) failure patients post-atrial switch, for transposition of the great arteries (TGA), and those with congenitally corrected TGA has proven useful to reduce transpulmonary gradient and bridge-to-transplantation. The purpose of this study is to describe our experience of VAD in systemic RV failure and our move towards concomitant tricuspid valve replacement (TVR). METHODS This is a single-centre retrospective study of consecutive adult patients receiving HeartWare VAD for systemic RV failure between 2010 and 2019. From 2017, concomitant TVR was performed routinely. Demographic, clinical variables and echocardiographic and haemodynamic measurements pre- and post-VAD implantation were recorded. Complications on support, heart transplantation and survival rates were described. RESULTS Eighteen patients underwent VAD implantation. Moderate or severe systemic tricuspid regurgitation was present in 83.3% of patients, and subpulmonic left ventricular impairment in 88.9%. One-year survival was 72.2%. VAD implantation was technically feasible and successful in all but one. Post-VAD, transpulmonary gradient fell from 16 (15-22) to 10 (7-13) mmHg (P = 0.01). Patients with TVR (n = 6) also demonstrated a reduction in mean pulmonary and wedge pressures. Furthermore, subpulmonic left ventricular end-diastolic dimension (44.3 vs 39.6 mm; P = 0.03) and function improved in this group. After 1 year of support, 72.2% of patients were suitable for transplantation. CONCLUSIONS VAD is an effective strategy as bridge-to-candidacy and bridge-to-transplantation in patients with end-stage systemic RV failure. Concomitant TVR at the time of implant is associated with better early haemodynamic and echocardiographic results post-VAD.
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Affiliation(s)
- Oscar Gonzalez-Fernandez
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Universidad Autonoma de Madrid, Madrid, Spain
| | - Fabrizio De Rita
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Coats
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Crossland
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mohamed S Nassar
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antony Hermuzi
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Bruno Santos Lopes
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Woods
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Robinson-Smith
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thibault Petit
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,University Hospitals Leuven, Leuven, Belgium
| | - Neil Seller
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John O'Sullivan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Adam McDiarmid
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Asif Hasan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy MacGowan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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11
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Dorfman AL, del Nido PJ. The Right Ventricle and Tricuspid Valve in Fontan Failure: A Role for Early Surgical Management. J Am Coll Cardiol 2022; 79:1846-1848. [DOI: 10.1016/j.jacc.2022.03.003] [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: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
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12
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Agewall S. Treatment with dual antiplatelet therapy after an acute coronary event may often be tailor-made for the patient. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:1-3. [PMID: 34984441 DOI: 10.1093/ehjcvp/pvab078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Stefan Agewall
- Editor-in-Chief, Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
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13
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Gordon B, González-Fernández V, Dos-Subirà L. Myocardial fibrosis in congenital heart disease. Front Pediatr 2022; 10:965204. [PMID: 36467466 PMCID: PMC9715985 DOI: 10.3389/fped.2022.965204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/18/2022] [Indexed: 11/21/2022] Open
Abstract
Myocardial fibrosis resulting from the excessive deposition of collagen fibers through the myocardium is a common histopathologic finding in a wide range of cardiovascular diseases, including congenital anomalies. Interstitial fibrosis has been identified as a major cause of myocardial dysfunction since it distorts the normal architecture of the myocardium and impairs the biological function and properties of the interstitium. This review summarizes current knowledge on the mechanisms and detrimental consequences of myocardial fibrosis in heart failure and arrhythmias, discusses the usefulness of available imaging techniques and circulating biomarkers to assess this entity and reviews the current body of evidence regarding myocardial fibrosis in the different subsets of congenital heart diseases with implications in research and treatment.
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Affiliation(s)
- Blanca Gordon
- Integrated Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Víctor González-Fernández
- Integrated Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Laura Dos-Subirà
- Integrated Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Santa Creu i Sant Pau University Hospital, Barcelona, Spain
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14
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Moya A, De Meester P, Troost E, Roggen L, Weidemann F, Moons P, Eyskens B, Claus P, Budts W, Van De Bruaene A. 15-Year follow-up of regional right and left ventricular function after the Senning operation: a Colour-Doppler myocardial imaging study. Acta Cardiol 2021; 76:689-696. [PMID: 32539571 DOI: 10.1080/00015385.2020.1770459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Despite right ventricular (RV) dysfunction being a major concern in Senning patients, long-term follow-up data is lacking. This study aimed (1) at evaluating regional (base-mid-apex) RV and left ventricular (LV) function using Colour-Doppler myocardial imaging over a 15-year follow-up period and (2) at comparing results with matched controls. METHODS For the longitudinal analysis (2004-2019), we compared systolic and diastolic function in 10 Senning patients. For the cross-sectional analysis, we compared the subaortic RV (sRV) of Senning patients with the RV and LV of matched controls and the subpulmonary LV (spLV) of Senning patients with the LV of matched controls. RESULTS The longitudinal analysis of sRV function showed a significant decrease in apical peak systolic strain (-17 ± 7% vs -12 ± 4%; p = 0.025) and apical peak systolic strain rate (-1.1 ± 0.3s-1 vs -0.8 ± 0.4s-1; p = 0.012). spLV function showed a significant decrease in peak systolic velocity (mid; p = 0.013 and apex; p = 0.011) and peak systolic strain rate (mid; p = 0.048). The cross-sectional analysis revealed significant lower values for basal, mid and apical peak systolic velocity, peak systolic strain rate, peak systolic strain of the sRV of Senning patients when compared to both LV and RV of matched controls (all p < 0.05). CONCLUSION Our study showed that systolic and diastolic sRV function did not change over a 15-year follow-up period, except in the apical region. There was a decline in spLV systolic function, which may be of clinical value. On the other hand, when compared to age- and gender-matched controls, the sRV of Senning patients exhibits significantly decreased measurements of longitudinal systolic function.
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Affiliation(s)
- Ana Moya
- Faculty of Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Pieter De Meester
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Els Troost
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Leen Roggen
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Benedicte Eyskens
- Division of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Werner Budts
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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15
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Herzrhythmusstörungen und Langzeitprognose erwachsener Patienten mit angeborenem Herzfehler. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Zandstra TE, Nederend M, Jongbloed MRM, Kiès P, Vliegen HW, Bouma BJ, Tops LF, Schalij MJ, Egorova AD. Sacubitril/valsartan in the treatment of systemic right ventricular failure. Heart 2021; 107:1725-1730. [PMID: 33452121 PMCID: PMC8522462 DOI: 10.1136/heartjnl-2020-318074] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Pharmacological options for patients with a failing systemic right ventricle (RV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are not well defined. This study aims to investigate the feasibility and effects of sacubitril/valsartan treatment in a single-centre cohort of patients. Methods Data on all consecutive adult patients (n=20, mean age 46 years, 50% women) with a failing systemic RV in a biventricular circulation treated with sacubitril/valsartan in our centre are reported. Patients with a systemic RV ejection fraction of ≤35% who were symptomatic despite treatment with β-blocker and ACE-inhibitor/angiotensin II receptor-blockers were started on sacubitril/valsartan. This cohort underwent structural follow-up including echocardiography, exercise testing, laboratory investigations and quality of life (QOL) assessment. Results Six-month follow-up data were available in 18 out of 20 patients, including 12 (67%) patients with TGA after atrial switch and 6 (33%) patients with ccTGA. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) decreased significantly (950–358 ng/L, p<0.001). Echocardiographic systemic RV fractional area change and global longitudinal strain showed small improvements (19%–22%, p<0.001 and −11% to −13%, p=0.014, respectively). The 6 min walking distance improved significantly from an average of 564 to 600 m (p=0.011). The QOL domains of cognitive function, sleep and vitality improved (p=0.015, p=0.007 and p=0.037, respectively). Conclusions We describe the first patient cohort with systemic RV failure treated with sacubitril/valsartan. Treatment appears feasible with improvements in NT-pro-BNP and echocardiographic function. Our positive results show the potential of sacubitril/valsartan for this patient population.
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Affiliation(s)
- Tjitske E Zandstra
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Berto J Bouma
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
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17
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Ashton DJ, Greenberg SB. Post Repair Transposition of the Great Arteries: What You Need to Know. Semin Roentgenol 2020; 55:312-319. [PMID: 32859347 DOI: 10.1053/j.ro.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel J Ashton
- Department of Radiology and Department of Pediatrics, Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR.
| | - S Bruce Greenberg
- Department of Radiology and Department of Pediatrics, Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR
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18
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Scognamiglio G, Fusco F, Hankel TC, Bouma BJ, Greutmann M, Khairy P, Ladouceur M, Dimopoulos K, Niwa K, Broberg CS, Miranda B, Budts W, Bouchardy J, Schwerzmann M, Lipczyńska M, Tobler D, Tsai SF, Egbe AC, Aboulhosn J, Fernandes SM, Garr B, Rutz T, Mizuno A, Proietti A, Alonso-Gonzalez R, Mulder BJM, Sarubbi B. Safety and efficacy of non-vitamin K antagonist oral anticoagulants for prevention of thromboembolism in adults with systemic right ventricle: Results from the NOTE international registry. Int J Cardiol 2020; 322:129-134. [PMID: 32805330 DOI: 10.1016/j.ijcard.2020.08.034] [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: 03/11/2020] [Revised: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with systemic right ventricle (sRV), including transposition of great arteries (TGA) after atrial switch procedure and congenitally corrected transposition of great arteries (ccTGA), may require anticoagulation for thromboembolism (TE) prevention. In the absence of data on non-vitamin K antagonist oral anticoagulants (NOACs), vitamin K antagonists (VKAs) remain the agent of choice. We investigated the safety, efficacy and feasibility of NOACs treatment in adults with sRV in a worldwide study. METHODS This is an international multicentre prospective study, using data from the NOTE registry on adults with sRV taking NOACs between 2014 and 2019. The primary endpoints were TE and major bleeding (MB). The secondary endpoint was minor bleeding. RESULTS A total of 76 patients (42.5 ± 10.0 years, 76% male) with sRV (74% TGA, 26% ccTGA) on NOACs were included in the study. During a median follow-up of 2.5 years (IQR1.5-3.9), TE events occurred in 3 patients (4%), while no MB episodes were reported. Minor bleeding occurred in 9 patients (12%). NOAC treatment cessation rate was 1.4% (95%CI:0.3-4%) during the first year of follow-up. All the patients with TE events had a CHA2DS2-VASc score ≥ 2 and impaired sRV systolic function at baseline. The total incidence of major events during follow-up was significantly lower compared to historical use of VKAs or aspirin before study inclusion (1.4% (95%CI:0.29-4%) vs 6,9% (95%CI:2.5-15.2%); p = .01). CONCLUSIONS In this prospective study, NOACs appear to be well-tolerated, with excellent efficacy and safety at mid-term in patients with sRV.
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Affiliation(s)
- Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy.
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Tara C Hankel
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Matthias Greutmann
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Disease Centre, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Centre de Référence M3C, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital and Imperial College of London, London, United Kingdom
| | - Koichiro Niwa
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Craig S Broberg
- Department of Cardiology, Oregon Health & Science University Hospital, Portland, United States of America
| | - Berta Miranda
- Integrated Adult Congenital Heart Disease Unit of Vall d' Hebron-Sant Pau University Hospitals, Division of Cardiology, Vall d'Hebron Hospital, Barcelona, Spain
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Judith Bouchardy
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland; Department of Cardiology, University Hospital Geneva, Genève, Switzerland
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Magdalena Lipczyńska
- Adult Congenital Heart Center, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Shane F Tsai
- Department of Cardiology, University of Nebraska Medical Centre, NE, United States of America
| | - Alexander C Egbe
- Department of Cardiology, Mayo Clinic, Rochester, United States of America
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, LosAngeles, United States of America
| | - Susan M Fernandes
- Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital, Stanford Health Care, Stanford School of Medicine, Palo Alto, CA, United States of America
| | - BreAnn Garr
- Department of Cardiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, United States of America
| | - Tobias Rutz
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Anna Proietti
- Electrophysiology Service and Adult Congenital Heart Disease Centre, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Rafael Alonso-Gonzalez
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital and Imperial College of London, London, United Kingdom
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Netherlands Heart Institute, Utrecht, the Netherlands
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
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19
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Raissadati A, Haukka J, Pätilä T, Nieminen H, Jokinen E. Chronic Disease Burden After Congenital Heart Surgery: A 47-Year Population-Based Study With 99% Follow-Up. J Am Heart Assoc 2020; 9:e015354. [PMID: 32316818 PMCID: PMC7428561 DOI: 10.1161/jaha.119.015354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/25/2020] [Indexed: 01/15/2023]
Abstract
Background Postoperative morbidity is an increasingly important outcome measure of patients who have undergone congenital heart surgery (CHS). We examined late postoperative morbidity after CHS on the basis of patients' government-issued medical special reimbursement rights. Methods and Results Between 1953 and 2009, 10 635 patients underwent CHS at <15 years of age in Finland. We excluded early deaths and mental disabilities. Noncyanotic and cyanotic defects were divided into simple and severe groups, respectively. We obtained 4 age-, sex-, birth time-, and hospital district-matched control subjects per patient. The Social Insurance Institution of Finland provided data on all medical special reimbursement rights granted between 1966 and 2012. Follow-up started at the first operation and ended at death, date of emigration, or December 31, 2012. A total of 8623 patients met inclusion criteria. Follow-up was 99.9%. A total of 3750 patients (43%) required special reimbursements rights for a chronic disease. Cardiovascular disease was the most common late morbidity among patients (28%), followed by obstructive pulmonary disease (9%), neurologic disease (3%), and psychiatric disease (2%). Heart failure (simple hazard ratio [HR], 56.3 [95% CI, 35.4-89.7]; severe HR, 918.0 [95% CI, 228.9-3681.7]) and arrhythmia (simple HR, 11.0 [95% CI, 7.1-17.0]; severe HR, 248.0 [95% CI, 61.3-1002.7]) were the most common cardiovascular morbidities. Hypertension was common among patients with coarctation of the aorta (13%; incidence risk ratio [RR], 8.9; 95% CI, 7.5-10.7). Psychiatric disease was more common among simple defects, particularly ventricular septal defects. Conclusions Chronic cardiac and noncardiac sequelae are common after CHS regardless of the severity of the defect, underscoring the importance of long-term follow-up of all patients after CHS.
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Affiliation(s)
- Alireza Raissadati
- Department of Surgery and CardiologyNew Children’s HospitalUniversity of Helsinki and Helsinki University Central HospitalHelsinkiFinland
- Boston Children’s HospitalBostonMA
| | - Jari Haukka
- Department of Public HealthClinicumFaculty of MedicineUniversity of HelsinkiFinland
- Department of Health SciencesFaculty of Medicine and Health TechnologyUniversity of TampereFinland
| | - Tommi Pätilä
- Department of Surgery and CardiologyNew Children’s HospitalUniversity of Helsinki and Helsinki University Central HospitalHelsinkiFinland
| | - Heta Nieminen
- Department of Surgery and CardiologyNew Children’s HospitalUniversity of Helsinki and Helsinki University Central HospitalHelsinkiFinland
| | - Eero Jokinen
- Department of Surgery and CardiologyNew Children’s HospitalUniversity of Helsinki and Helsinki University Central HospitalHelsinkiFinland
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20
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Woudstra OI, van Dissel AC, van der Bom T, de Bruin-Bon RHACM, van Melle JP, van Dijk APJ, Vliegen HW, Mulder BJM, Tanck MWT, Meijboom FJ, Bouma BJ. Myocardial Deformation in the Systemic Right Ventricle: Strain Imaging Improves Prediction of the Failing Heart. Can J Cardiol 2019; 36:1525-1533. [PMID: 32553818 DOI: 10.1016/j.cjca.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/28/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Predicting heart failure events in patients with a systemic right ventricle (sRV) due to transposition of the great arteries (TGA) is important for timely intensification of follow-up. This study assessed the value of strain compared with currently used parameters as predictor for heart failure-free survival in patients with sRV. METHODS In participants of a multicentre trial, speckle-tracking echocardiography (STE) was performed to assess global longitudinal strain (GLS), mechanical dispersion (MD), and postsystolic shortening (PSS). Cox regression was used to determine the association of STE parameters with the combined end point of progression of heart failure and death, compared with cardiovascular magnetic resonance (CMR) and computed tomography (CT) derived parameters. RESULTS Echocardiograms of 60 patients were analyzed (mean age 34 ± 11 years, 65% male, 35% congenitally corrected TGA). Mean GLS was -13.5 ± 2.9%, median MD was 49 (interquartile range [IQR] 30-76) ms, and 14 patients (23%) had PSS. During a median 8 (IQR 7-9) years, 15 patients (25%) met the end point. GLS, MD, and PSS were all associated with heart failure-free survival in univariable analysis. After correction for age, only GLS (optimal cutoff > -10.5%) and CMR/CT-derived sRV ejection fraction (optimal cutoff < 30%) remained associated with heart failure-free survival: hazard ratio (HR) 8.27, 95% confidence interval (CI) 2.50-27.41 (P < 0.001), and HR 4.34, 95% CI 1.48-12.74 (P = 0.007), respectively). Combining GLS and ejection fraction improved prediction, with patients with both GLS > -10.5% and sRV ejection fraction < 30% at highest risk (HR 19.69, 95% CI 4.90-79.13; P < 0.001). CONCLUSIONS The predictive value of GLS was similar to that of CMR/CT-derived ejection fraction. The combination of GLS and ejection fraction identified patients at highest risk of heart failure and death. Easily available STE parameters can be used to guide follow-up intensity and can be integrated into future risk prediction scores.
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Affiliation(s)
- Odilia I Woudstra
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexandra C van Dissel
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Teun van der Bom
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rianne H A C M de Bruin-Bon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubert W Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Barbara J M Mulder
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Michael W T Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berto J Bouma
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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21
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Abstract
Adult patients with congenital heart disease are a complex population with a variety of pathophysiologic conditions based on the anatomy and type of surgery or intervention performed, usually during the first years of life. Nowadays, the majority of patients survive childhood and present for a number of noncardiac surgeries or interventions needing appropriate perioperative management. Heart failure is a major contributing factor to perioperative morbidity and mortality. In this review, we present an overview of the most common types of adult patients with congenital heart disease and actual knowledge on therapy and specific risks in this challenging patient population.
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Affiliation(s)
- Valérie M Smit-Fun
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
| | - Wolfgang F Buhre
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands
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22
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Nagdyman N, Mebus S, Kügel J, Zachoval R, Clevert DA, Braun SL, Haverkämper G, Opgen-Rhein B, Berger F, Horster S, Schoetzau J, Salvador CP, Bauer U, Hess J, Ewert P, Kaemmerer H. Non-invasive assessment of liver alterations in Senning and Mustard patients. Cardiovasc Diagn Ther 2019; 9:S198-S208. [PMID: 31737528 DOI: 10.21037/cdt.2019.07.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Adults with congenital heart disease and ventricular dysfunction are prone to liver congestion, leading to fibrosis or cirrhosis but little is known about the prevalence of liver disease in atrial switch patients. Liver impairment may develop due to increased systemic venous pressures. This prospective study aimed to assess non-invasively hepatic abnormalities in adults who underwent Senning or Mustard procedures. Methods Hepatic involvement was assessed non-invasively clinically by laboratory analysis, hepatic fibrotic markers, sonography, and liver stiffness measurements [transient elastography (TE) and acoustic radiation force impulse imaging (ARFI)]. Results Overall, 24 adults who had undergone atrial switch operation (13 Senning, 11 Mustard; four female; median age 27.8 years; range 24-45 years) were enrolled. In liver stiffness measurements, only three patients had values within the normal reference. All other patients showed mild, moderate or severe liver fibrosis or cirrhosis, respectively. Using imaging and laboratory analysis, 71% of the subjects had signs of liver fibrosis (46%) or cirrhosis (25%). Conclusions Non-invasive screening for liver congestion, fibrosis or cirrhosis could be meaningful in targeted screening for hepatic impairment in patients with TGA-ASO. As expert knowledge is essential, patients should be regularly controlled in highly specialised centres with cooperations between congenital cardiologists and hepatologists.
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Affiliation(s)
- Nicole Nagdyman
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Siegrun Mebus
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Johanna Kügel
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Reinhart Zachoval
- Department of Gastroenterology and Hepatology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dirk-André Clevert
- Department of Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Siegmund Lorenz Braun
- Institute of Laboratory Medicine, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Guido Haverkämper
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Opgen-Rhein
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Cardiovascular Research Centre), partner site Berlin, Berlin, Germany
| | - Sophia Horster
- Department of Gastroenterology and Hepatology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg Schoetzau
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Claudia Pujol Salvador
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Ulrike Bauer
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - John Hess
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany.,DZHK (German Cardiovascular Research Centre), Munich Heart Alliance, Munich, Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
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23
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Cesnjevar R, Dittrich S. Chirurgische Therapie angeborener Herzfehler im Erwachsenenalter. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-019-00330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Zengin E, Mueller G, Blankenberg S, von Kodolitsch Y, Rickers C, Sinning C. Pregnancy in adults with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S416-S423. [PMID: 31737546 DOI: 10.21037/cdt.2019.07.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Congenital heart disease (CHD) is present in 0.8-0.9% of live births. Prevalence of CHD is constantly increasing during the last decades in line with the treatment options for patients ranging from the surgical as well to the interventional spectrum. Most of the women with underlying CHD reach adulthood due to excellent surgical and interventional treatment options and most of them desire pregnancy. In Western countries, maternal heart disease is the major cause of mortality during pregnancy, thus risk estimation should be therefore individualized depending on the underlying CHD, functional class and treatment options. Pre-pregnancy counselling is mandatory in all women, especially in patients with high risk but even in patients with low risk, a plan for labor and delivery should be outlined in a heart pregnancy team. This review addresses the key element of pre-counselling, planning and successful disease management in patients with CHD during pregnancy.
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Affiliation(s)
- Elvin Zengin
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Götz Mueller
- Department of Pediatric Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Carsten Rickers
- Department of Pediatric Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Christoph Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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25
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Geenen LW, van Grootel RWJ, Akman K, Baggen VJM, Menting ME, Eindhoven JA, Cuypers JAAE, Boersma E, van den Bosch AE, Roos-Hesselink JW. Exploring the Prognostic Value of Novel Markers in Adults With a Systemic Right Ventricle. J Am Heart Assoc 2019; 8:e013745. [PMID: 31431113 PMCID: PMC6755830 DOI: 10.1161/jaha.119.013745] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Adults with a systemic right ventricle (sRV) have a high risk of cardiac complications. This study aimed to identify prognostic markers in adults with sRV based on clinical evaluation, echocardiography, and blood biomarkers. Methods and Results In this prospective cohort study, consecutive clinically stable adults with sRV caused by Mustard- or congenitally corrected transposition of the great arteries were included (2011-2013). Eighty-six patients were included (age 37±9 years, 65% male, 83% New York Heart Association functional class I, 76% Mustard transposition of the great arteries, 24% congenitally corrected transposition of the great arteries). Venous blood sampling was performed including N-terminal pro B-type natriuretic peptide, high-sensitive-troponin-T, high-sensitivity C-reactive protein, growth differentiation factor-15, galectin-3, red cell distribution width, estimated glomerular filtration rate, and hemoglobin. Besides conventional echocardiographic measurements, longitudinal, circumferential, and radial strain were assessed using strain analysis. During a median follow-up of 5.9 (interquartile range 5.3-6.3) years, 19 (22%) patients died or had heart failure (primary end point) and 29 (34%) patients died or had arrhythmia (secondary end point). Univariable Cox regression analysis was performed using dichotomous or standardized continuous variables. New York Heart Association functional class >I, systolic blood pressure, and most blood biomarkers were associated with the primary and secondary end point (galectin-3 not for primary, N-terminal pro B-type natriuretic peptide and high-sensitivity C-reactive protein not for secondary end point). Growth differentiation factor-15 showed the strongest association with both end points (hazard ratios; 2.44 [95% CI 1.67-3.57, P<0.001], 2.00 [95% CI 1.46-2.73, P<0.001], respectively). End-diastolic basal dimension of the subpulmonary ventricle was associated with both end points (hazard ratio: 1.95 [95% CI 1.34-2.85], P<0.001, 1.70 [95% CI 1.21-2.38, P=0.002], respectively). Concerning strain analysis, only sRV septal strain was associated with the secondary end point (hazard ratio 0.58 [95% CI 0.39-0.86], P=0.006). Conclusions Clinical, conventional echocardiographic, and blood measurements are important markers for risk stratification in adults with a sRV. The value of novel echocardiographic strain analysis seems limited.
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Affiliation(s)
- Laurie W Geenen
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Roderick W J van Grootel
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Korhan Akman
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Vivan J M Baggen
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Myrthe E Menting
- Department of Radiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Jannet A Eindhoven
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Eric Boersma
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands.,Department of Clinical Epidemiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
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26
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Zandstra TE, Palmen M, Hazekamp MG, Meyns B, Beeres SLMA, Holman ER, Kiès P, Jongbloed MRM, Vliegen HW, Egorova AD, Schalij MJ, Tops LF. Ventricular assist device implantation in patients with a failing systemic right ventricle: a call to expand current practice. Neth Heart J 2019; 27:590-593. [PMID: 31420818 PMCID: PMC6890896 DOI: 10.1007/s12471-019-01314-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ventricular assist device (VAD) implantation is an established treatment modality for patients with end-stage heart failure, and improves symptoms and survival. In the Netherlands, it is not yet routinely considered in patients with congenital heart disease and failing systemic right ventricle (SRV). Recently, a VAD was implanted in 2 SRV patients, one who underwent a Mustard procedure during infancy for transposition of the great arteries (male, 47 years old) and one with a congenitally corrected transposition of the great arteries (male, 54 years old). The first patient is doing well >1 year after implantation; the second patient will be discharged home soon. These examples and other reports demonstrate the feasibility of adopting VAD implantation into routine care for SRV failure. In conclusion, patients with SRV failure may be suitable candidates for VAD implantation: they are relatively young, usually have a preserved subpulmonary left ventricular function, and their specific anatomical and physiological characteristics often make them unsuitable for cardiac transplantation. Therefore it is important to recognise the possibility of VAD implantation early in the process of SRV failure, and to timely refer these patients to a heart failure clinic with experience in VAD implantation in this group of patients for optimisation, screening, and implantation.
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Affiliation(s)
- T E Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Palmen
- Department of Cardiothoracic surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M G Hazekamp
- Department of Cardiothoracic surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - B Meyns
- Department of Cardiothoracic surgery, University Hospital (UZ) Leuven, Leuven, Belgium
| | - S L M A Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E R Holman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - P Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - H W Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A D Egorova
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - L F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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