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Wacker J, Humpl T, Berger RMF, Ivy D, Bowers D, Bonnet D, Beghetti M. Application of a modified clinical classification for pulmonary arterial hypertension associated with congenital heart disease in children: emphasis on atrial septal defects and transposition of the great arteries. An analysis from the TOPP registry. Front Cardiovasc Med 2024; 11:1344014. [PMID: 38370158 PMCID: PMC10870771 DOI: 10.3389/fcvm.2024.1344014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
Aims A proportion of patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) do not fit in the current classification. We aimed to analyse the applicability of an adapted clinical classification of PAH-CHD to pediatric patients using the TOPP-1 registry (Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension) and focus on atrial septal defects (ASD) and transposition of the great arteries (TGA). Methods and results Hemodynamic and clinical data of all patients with PAH-CHD in the TOPP cohort were reviewed. Patients were classified according to predefined ABCDE categories (A: Eisenmenger syndrome, B: left-to-right shunt, C: coincidental defects, including all ASDs, D: corrected CHD, E: TGA), or as complex CHD (group 5), by 2 independent investigators. In case of disagreement, a third reviewer could either settle a final decision, or the patient was deemed not classifiable. Survival curves were calculated for each group and compared to idiopathic PAH patients of the registry. A total of 223 out of 531 patients in the registry had PAH-CHD, and 193 were categorized to the following groups: A 39(20%), B 27(14%), C 62(32%) including 43 ASDs, D 58(30%), E 7(4%), whereas 6 patients were categorized as group 5, and 10 patients were unable to be classified. No survival difference could be demonstrated between the groups. Conclusions This modified classification seems to be more applicable to pediatric PAH-CHD patients than the previous classification, but some patients with PAH-CHD who never had a shunt remain unclassifiable. The role of ASD in pediatric PH should be reconsidered.
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Affiliation(s)
- Julie Wacker
- Pediatric Cardiology Unit, Department of Women, Child and Adolescent, Children’s University Hospital, and University of Geneva, Geneva, Switzerland
| | - Tilman Humpl
- Pediatric Cardiology and Critical Care Medicine, The Hospital for Sick Children University of Toronto, Toronto, ON, Canada
| | - Rolf M. F. Berger
- Centre for Congenital Heart Diseases, Pediatric Cardiology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Dunbar Ivy
- Pediatric Cardiology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - David Bowers
- School of Allied Health Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C-Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Women, Child and Adolescent, Children’s University Hospital, and University of Geneva, Geneva, Switzerland
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Zhang F, Lin D, Jin Q, Fan J, Chen D, Guan L, Pan W, Zhou D. Noninvasive Monitoring of Severe Pulmonary Artery Hypertension in Atrial Septal Defect Patients: Role of Serum Bilirubin Combined with Uric Acid. Rev Cardiovasc Med 2024; 25:50. [PMID: 39077349 PMCID: PMC11263178 DOI: 10.31083/j.rcm2502050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 07/31/2024] Open
Abstract
Background Atrial septal defect (ASD) patients commonly experience severe pulmonary arterial hypertension (SPAH), which is frequently associated with a poor prognosis. While serum bilirubin levels, indicative of liver function, are known predictors of right heart failure (RHF), their potential to differentiate SPAH in ASD patients is yet to be ascertained. The purpose of this study was to discover the potential correlations between serum bilirubin levels and ASD patients with SPAH. Methods In this cross-sectional study, 102 ASD patients admitted from December 2019 to November 2020 were enrolled and divided into two cohorts: those with SPAH and those without. Blood tests were conducted to measure serum direct bilirubin (DBIL), total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA) and N-terminal pro B-type natriuretic peptide (NT-proBNP). Additionally, all participants underwent transthoracic echocardiography, and invasive hemodynamic data were gathered through right heart catheterization. Results ASD patients with SPAH exhibited significantly elevated serum DBIL (5.2 ± 3.0 vs. 2.4 ± 1.5 µmol/L, p < 0.001) and TBIL (24.6 ± 20.7 vs. 10.1 ± 4.8 µmol/L, p < 0.001) levels in comparison to those without SPAH. However, ALT and AST levels remained comparable between the cohorts. Additionally, the SPAH cohort displayed higher serum UA (403.5 ± 131.6 vs. 317.8 ± 67.9 µmol/L, p < 0.001) and NT-proBNP levels. Serum DBIL levels, when analyzed independently of other variables, correlated with an increased risk of mean pulmonary arterial pressure (mPAP) in ASD patients ( β = 1.620, p = 0.010). A DBIL concentration of 2.15 mg/dL effectively differentiated ASD patients with SPAH from those without, with a sensitivity of 92.9% and a specificity of 51.4% (area under the curve [AUC]: 0.794, 95% confidence interval [CI]: 0.701-0.886, p < 0.001). Notably, the combination of DBIL and UA had a higher sensitivity of 92.9% and specificity of 71.6% (AUC: 0.874, 95% CI: 0.799-0.949, p < 0.001). Conclusions Elevated serum DBIL and TBIL levels in ASD patients with SPAH were correlated with poor cardiac function and heightened pulmonary artery pressure. The combination of DBIL and UA has emerged as a strong noninvasive predictor for SPAH in ASD patients, presenting a potentially novel therapeutic biomarker.
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Affiliation(s)
- Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
- Department of Cardiology, Jinshan Hospital, Fudan University, 201508 Shanghai, China
| | - Dawei Lin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Qi Jin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Jianing Fan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Dandan Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Lihua Guan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China
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Deniwar A, Hernandez J, Aregullin EO, Khan SK, Huang S, Finn MT, Vettukattil JJ. Atrial septal defect-associated pulmonary hypertension with decompensated heart failure: outcomes after fenestrated device closure. Cardiol Young 2024; 34:395-400. [PMID: 37466020 DOI: 10.1017/s104795112300152x] [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] [Indexed: 07/20/2023]
Abstract
BACKGROUND Up to 90% of adults with untreated atrial septal defect will be symptomatic by 4th decade, and 30-49% will develop heart failure. 8-10% of these patients have pulmonary arterial hypertension with a female predominance regardless of age. We aimed to demonstrate that fenestrated closure can be safely performed in patients with decompensated heart failure and atrial septal defect-associated pulmonary arterial hypertension with improved outcome. METHODS Transcatheter fenestrated atrial septal defect closures (Occlutech GmbH, Jena, Germany) were performed on a compassionate-use basis in 5 consecutive adult patients with atrial septal defect-associated pulmonary arterial hypertension and severe heart failure with prohibitive surgical mortality risks. Change in systemic oxygen saturation, 6-minute walk test, NYHA class, echocardiographic and haemodynamic parameters were used as parameters of outcome. RESULTS All patients were female, mean age 48.8 ± 13.5 years, followed up for a median of 29 months (max 64 months). Significant improvements observed in the 6-minute walk test, and oxygen saturation comparing day 0 time point to all other follow-up time points data (B = 1.32, SE = 0.28, t (22.7) = -4.77, p = 0.0001); and in the haemodynamic data (including pulmonary vascular resistance and pulmonary pressure) (B = -0.60, SE = 0.22, t (40.2) = 2.74, p = .009). All patients showed improved right ventricular size and function along with NYHA class. There were no procedure-related complications. CONCLUSION Fenestrated atrial septal defect closure is feasible in adults with decompensated heart failure and atrial septal defect-associated pulmonary arterial hypertension. It results in sustained haemodynamic and functional improvement.
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Affiliation(s)
- Ahmed Deniwar
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
| | - Jason Hernandez
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Enrique O Aregullin
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Sana K Khan
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
| | - Sihong Huang
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Michael T Finn
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Joseph J Vettukattil
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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Cool CJ, Kamarullah W, Pranata R, Putra ICS, Khalid AF, Akbar MR, Setiabudiawan B, Rahayuningsih SE. A Meta-Analysis of Atrial Septal Defect Closure in Patients With Severe Pulmonary Hypertension: Is There a Room for Poking Holes Amid Debate? Curr Probl Cardiol 2024; 49:102121. [PMID: 37802163 DOI: 10.1016/j.cpcardiol.2023.102121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
Severe pulmonary arterial hypertension (PAH) associated with atrial septal defect (ASD) poses a challenge to a closure of ASD, particularly severe PAH that persists even after pharmacological therapeutic strategy. Our study was aimed to evaluate this matter. A systematic literature search from several databases was conducted up until August 1st, 2023. A meta-analysis was undertaken on studies that reported hemodynamic measurements in ASD patients with severe PAH before and after closure. The primary objectives were the extent of improvement in all hemodynamic parameters following closure, and the secondary outcomes were major adverse cardiac events (MACEs) during follow-up. Our study comprised 10 studies with a total of 207 participants. Patients were divided into treat-and-repair and straight-to-repair groups based on the therapeutic strategy. Meta-analysis of all studies demonstrated significant improvement in mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), pulmonary vascular resistance index (PVRI), 6-minutes walking distance (6MWD), and lower prevalence of World Health Organization functional classes (WHO fc), particularly in the treat-and-repair strategy subgroup. Additionally, merely 4 of the 156 individuals died from cardiac causes, and only 1 required rehospitalization, indicating a low likelihood of MACEs arising. Our new findings support the notion that effective shunt closure can improve various hemodynamic parameters in carefully chosen patients with noncorrectable ASD-PAH. Further large and prospective observational studies are still warranted to validate these findings.
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Affiliation(s)
- Charlotte Johanna Cool
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | | | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Iwan Cahyo Santosa Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Achmad Fitrah Khalid
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Sri Endah Rahayuningsih
- Department of Child Health, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
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Seol JH, Jung SY, Lee HB, Kim AY, Kim EH, Min IK, Kim NK, Choi JY. Outcomes in Patients with Pulmonary Arterial Hypertension Underwent Transcatheter Closure of an Atrial Septal Defect. J Clin Med 2023; 12:jcm12072540. [PMID: 37048624 PMCID: PMC10095540 DOI: 10.3390/jcm12072540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) related to an atrial septal defect (ASD) poses a challenge to transcatheter closure of an ASD (tcASD). We aimed to determine the predictors for remaining PAH (rPAH) post-tcASD. This retrospective study was conducted at a single tertiary university hospital. Adult patients with an ASD and PAH were divided into three groups according to pulmonary vascular resistance (PVR). Normalization of pulmonary atrial systolic pressure (PASP) was defined as an estimated right ventricular systolic pressure < 40 mmHg and was determined using transthoracic echocardiography. Among 119 patients, 80% showed PAH normalization post-tcASD. Normalization of PAH post-tcASD was observed in 100%, 56.2%, and 28.6% of patients in mild, moderate, and severe PVR groups, respectively. The patients’ New York Heart Association functional class improved. Multivariate logistic regression analysis showed that age and high PVR were significant risk factors for rPAH. A receiving operator curve analysis showed a PASP cutoff value > 67.5 mmHg to be predictive of rPAH post-tcASD, with an area under the curve value of 0.944 (sensitivity, 0.922; specificity 0.933). Most patients, including moderate-to-severe PAH patients, improved hemodynamically and clinically with tcASD. Since patients with severe PAH are at a risk of rPAH, tcASD should be performed by selecting the patient carefully based on pre-procedure medication, a vasoreactivity test, and a balloon occlusion test.
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Affiliation(s)
- Jae-Hee Seol
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Se-Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Han-Byul Lee
- Division of Pediatrics, Soonchunhyang University College of Medicine, Seoul 04401, Republic of Korea
| | - Ah-Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Eun-Hwa Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - In-Kyung Min
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Nam-Kyun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Correspondence: (N.-K.K.); (J.-Y.C.); Tel.: +82-2-2228-8280 (J.-Y.C.)
| | - Jae-Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Correspondence: (N.-K.K.); (J.-Y.C.); Tel.: +82-2-2228-8280 (J.-Y.C.)
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Fu L, Wang R, Zhao J, Ni Y, Chen Z, Li F. 'Two-step' percutaneous procedure for repairing the atrial septal defect with severe pulmonary hypertension: a case report. J Surg Case Rep 2023; 2023:rjac612. [PMID: 36636648 PMCID: PMC9831650 DOI: 10.1093/jscr/rjac612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/11/2022] [Indexed: 01/11/2023] Open
Abstract
Atrial septal defect is the most common type of congenital heart disease. Interventional closure is currently the best treatment for the atrial septal defect. However, the repair strategy for atrial septal defect accompanies by severe pulmonary hypertension remains controversial. We report a case of an atrial septal defect with severe pulmonary hypertension in which we applied a perforated occlude for atrial septal defect percutaneously at first. After 6 months, when the pulmonary pressure gradually went down, we completely blocked the reserved hole with a closure device percutaneously. We suggest that the stepwise procedure is an important treatment option for select patients with atrial septal defect accompanied by severe pulmonary hypertension.
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Affiliation(s)
| | | | - Jinlong Zhao
- Department of Cardiovascular Surgery, Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Yinkai Ni
- Department of Cardiovascular Surgery, Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Zonghui Chen
- Department of Cardiovascular Surgery, Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Feng Li
- Correspondence address. Department of Cardiovascular Surgery, Shanghai Sixth People’s Hospital, 600 Yishan Rd, Shanghai 200233, People’s Republic of China. Tel: +86-137-0174-6812; E-mail:
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Romfh A, Lui GK. PAPVR – An incidental finding that may not be so benign. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Lee SH, Shin YR, Kim DY, Seo J, Cho I, Lee S, Kim JS, Hong GR, Ha JW, Shim CY. Clinical significance of right ventricular-pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect. Front Cardiovasc Med 2022; 9:896711. [PMID: 36451927 PMCID: PMC9702057 DOI: 10.3389/fcvm.2022.896711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/20/2022] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Functional tricuspid regurgitation (TR) usually decreases after atrial septal defect (ASD) closure; however, it may persist and cause heart failure that requires treatment. We aimed to investigate clinical and echocardiographic factors predicting persistent TR after ASD closure. METHODS Among 348 adults who underwent isolated ASD closure between January 2010 and September 2020, 91 (26.1%) patients with significant TR (at least moderate degree) before ASD closure were included. Persistent TR was defined as significant TR on echocardiography at 6 months to 1 year after ASD correction. We comprehensively analyzed the echocardiogram before ASD closure, including speckle-tracking imaging. Right ventricular (RV)-pulmonary arterial (PA) (RV-PA) coupling was assessed by the ratio of RV global longitudinal strain (RV GLS) and tricuspid annular S' velocity to PA systolic pressure (PASP). RESULTS Persistent TR was observed in 22 (24.2%) patients. Patients with persistent TR were significantly older and had larger TR jet areas and lower RV-PA coupling parameters than those without persistent TR. On multivariable regression, persistent TR was independently associated with age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.14, p = 0.030) and |RV GLS|/PASP (OR 0.001, 95% CI 0.00-0.017, p = 0.012). ROC curves analysis showed that |RV GLS|/PASP's best cut-off for persistent TR was 0.46 (cut-off 0.46, the area under the curve 0.789, p < 0.001). CONCLUSION Persistent TR after ASD closure is not rare. Old age and RV-PA uncoupling could be associated with persistent TR after ASD closure. In older patients with abnormal RV-PA coupling, careful evaluation and concomitant or subsequent TR intervention may be considered.
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Affiliation(s)
- Seon Hwa Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yu Rim Shin
- Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae-Young Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jiwon Seo
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sak Lee
- Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Predictors of pulmonary hypertension after atrial septal defect closure: Impact of atrial fibrillation. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:344-353. [PMID: 36303690 PMCID: PMC9580293 DOI: 10.5606/tgkdc.dergisi.2022.23639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
Abstract
Background
In this study, we aimed to evaluate the course of pulmonary artery systolic pressure, to identify factors associated with pulmonary arterial hypertension, and to determine the impact of atrial septal defect closure on clinical outcomes in long-term follow-up.
Methods
Between March 2008 and August 2020, a total of 547 adult patients (193 males, 354 females; median age: 37 years; range, 27.5 to 47 years) with secundum atrial septal defect were retrospectively analyzed. Of these patients, 304 underwent percutaneous defect closure and 243 underwent isolated surgical repairs. Pulmonary arterial hypertension was defined as a noninvasively estimated pulmonary artery systolic pressure of ≥40 mmHg at the final follow-up after atrial septal defect closure. Factors associated with pulmonary arterial hypertension were analyzed.
Results
Sixty-nine (12.6%) patients presented with pulmonary arterial hypertension at the final follow-up. A total of 35 (6.4%) patients had persistent atrial fibrillation before atrial septal defect closure, and 22 of these 35 patients had pulmonary arterial hypertension during long-term follow-up. Older age at the time of atrial septal defect closure (HR: 4.76; 95% CI: 2.68-8.44; p<0.001), the presence of persistent atrial fibrillation (HR: 2.18; 95% CI: 1.21-3.91; p=0.009), and greater right ventricular basal diameter (HR: 4.78; 95% CI: 2.57-8.84; p<0.001) were found to be associated with late pulmonary arterial hypertension.
Conclusion
The presence of persistent atrial fibrillation may be used to predict patients at higher risk for pulmonary arterial hypertension after atrial septal defect closure.
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10
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Van Praagh R. Interatrial Communications. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00009-3] [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: 11/29/2022]
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11
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Chinawa JM, Chinawa AT, Ossai EN, Duru CO. Predictors of pulmonary hypertension among children with atrial septal defects (ASD). Libyan J Med 2021; 17:2007603. [PMID: 34813403 PMCID: PMC8635614 DOI: 10.1080/19932820.2021.2007603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Atrial septal defect (ASD) is a common congenital heart disease in children that uncommonly presents with pulmonary hypertension. Much is not known about the exact predictor of PAH in children with ASD. Objectives: This study aimed to determine the predictors of pulmonary hypertension in children with ASD. Patients and Methods: This was a descriptive analysis of children with ASD carried out in three different institutions over a five-year period. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software, version 25. Results: The majority of the participants, 52.2%, had pulmonary hypertension and 62.5% of them occurred as mild pulmonary hypertension. There was a very weak positive correlation between pulmonary hypertension and the size of atrial septal defect, increases in size of atrial septal defect correlate with increases in pulmonary hypertension and this was found not to be statistically significant (n = 67, r = 0.193, p = 0.118). There was a positive correlation between the size of atrial septal defect and the age of participants in months, increases in age correlate with increases in size of atrial septal defect and this was found to be statistically significant (n = 67, r = 0.357, p = 0.003).The highest proportion of respondents who had pulmonary hypertension, 64.7%, was seen among children less than 1 year old while the least proportion, 27.3%, was within 1–5 years, and the difference in proportions was found to be statistically significant (χ2 = 8.187, p = 0.017). Conclusion: Pulmonary hypertension in children with ASD occur usually in the mild form. Age is the only strong predictor of PAH in children with isolated ASD.
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Affiliation(s)
- Josephat M Chinawa
- Professor and Pediatric Cardiologist, College of Medicine, Department of pediatrics, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku- Ozalla, Enugu State, Nigeria
| | - Awoere T Chinawa
- Senior Lecturer, Department of Paediatrics and Child health, Niger Delta University Teaching Hospital, Nigeria
| | - Edmund N Ossai
- Senior Lecturer, Department of Community Medicine, College of Health Sciences, Ebonyi State University Abakaliki, Nigeria
| | - Chika O Duru
- Lecturer, Enugu state University Teaching hospital, Nigeria
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Brida M, Chessa M, Celermajer D, Li W, Geva T, Khairy P, Griselli M, Baumgartner H, Gatzoulis MA. Atrial septal defect in adulthood: a new paradigm for congenital heart disease. Eur Heart J 2021; 43:2660-2671. [PMID: 34535989 DOI: 10.1093/eurheartj/ehab646] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/09/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. surgical closure, consideration of pre-closure ablation for patients with atrial tachycardia and suitability for closure or/and targeted therapy for patients with PAH. This review serves to update the clinician on the latest evidence, the nuances of optimal diagnostics, treatment options, and long-term follow-up care for patients with an ASD.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Kispaticeva ul. 12, Zagreb 10000, Croatia.,Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Ul. Braće Branchetta 20/1, Rijeka 51000, Croatia
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Piazza Edmondo Malan, 2, Milan 20097, Italy.,UniSR - Vita Salute San Raffaele University, Via Olgettina, 58, Milan 20132, Italy
| | - David Celermajer
- Heart Research Institute, University of Sydney, Camperdown, NSW 2050, Australia
| | - Wei Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.,Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
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A Woman with a Repaired Atrial Septal Defect and Pulmonary Hypertension with Worsening Dyspnea. Ann Am Thorac Soc 2021; 18:1052-1058. [PMID: 34076557 DOI: 10.1513/annalsats.202007-825cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Wang JK, Chiu SN, Lin MT, Chen CA, Lu CW, Wu MH. Transcatheter Closure of Atrial Septal Defect Associated With Pulmonary Artery Hypertension using Fenestrated Devices. Am J Cardiol 2021; 147:122-128. [PMID: 33667439 DOI: 10.1016/j.amjcard.2021.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
In patients with pulmonary artery hypertension (PAH) associated with atrial septal defect (ASD), closure of ASD may carry significant risks. We aimed to evaluate the safety and efficacy of transcatheter closure of ASD in selected patients with PAH using a fenestrated device followed by pulmonary vasodilator therapy. During the 14.8-year period, 51 ASD patients (10 males, age 46 ± 18 years) with a mean pulmonary artery pressure (PAP) ≥ 35 mm Hg and/or systolic PAP ≥ 60 mm Hg, underwent closure with a fenestrated device. Of them, mean Qp/Qs ratio, systolic PAP and mean PAP were 2.6 ± 1.2, 73 ± 14 mm Hg, and 44 ± 8 mm Hg, respectively. A total of 35 patients received pulmonary vasodilator therapy. The New York Heart Association (NYHA) functional class improved at 3 to 6 months follow-up. (p < 0.001) Nineteen patients underwent repeated catheterization. A comparison of the hemodynamic parameters between baseline and repeated catheterization revealed significant decreases in both systolic and mean PAP (77 ± 11 vs 55 ± 14 mm Hg, p < 0.0001 & 48 ± 7 vs 37 ± 8 mm Hg, p = 0.001, respectively), pulmonary vascular resistance (PVR) (5.1 ± 2.3 vs 4.0 ± 1.7 WU, p = 0.011) and PVRi (7.7 ± 3.3 vs 6.2 ± 2.4 WU*m2, p = 0.024). After a follow-up period of 84 ± 45 months, 6 mortalities were noted in which 2 were due to cardiac causes. In conclusion, catheter closure of ASD in patients with PAH using a fenestrated device followed by vasodilator therapy is safe and effective.
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15
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Pan W, Zhang Y, Guan L, Zhang X, Zhang L, Yang L, Ge J, Zhou D. Usefulness of mean pulmonary artery pressure for predicting outcomes of transcatheter closure of atrial septal defect with pulmonary arterial hypertension. EUROINTERVENTION 2020; 16:e1029-e1035. [PMID: 31217146 DOI: 10.4244/eij-d-19-00172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to provide a simple index for predicting the definitive indication for transcatheter closure of atrial septal defect (ASD) with pulmonary arterial hypertension (PAH). METHODS AND RESULTS A positive response after attempted occlusion was defined as mean pulmonary artery pressure (MPAP) ≤30 mmHg or the decrement percentage of it ≥20% compared with baseline. If a positive response was achieved, the occluder would be released, and the procedure was defined as successful. In 209 patients who underwent a successful procedure without PAH-specific medicine, there was a dramatic decrease in the percentage of patients with pulmonary arterial systolic pressure (PASP) ≥50 mmHg from baseline to the one-year follow-up (79.4% to 14.0%, p<0.001). The optimal cut-off value of MPAP to predict a positive response without PAH-specific medicine was 35.0 mmHg, with an area under the curve (AUC) of 0.919 (p<0.001). Administration of inhaled iloprost extended the cut-off point to 50.0 mmHg to reach a positive response, with an AUC of 0.774 (p=0.003). CONCLUSIONS This large-scale study indicated that MPAP could be a simple but powerful index to predict benefit from closure in adult ASD patients with PAH.
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Affiliation(s)
- Wenzhi Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
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16
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Patel MD, Balasubramanian S, Dorfman AL, Joshi A, Lu JC, Ghadimi Mahani M, Agarwal PP. Biatrial Drainage of the Right Superior Vena Cava: Imaging Findings. Radiol Cardiothorac Imaging 2020; 2:e200414. [PMID: 33778643 DOI: 10.1148/ryct.2020200414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/02/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022]
Abstract
Biatrial drainage of the right superior vena cava (SVC) is a rare form of interatrial shunting that can have substantial clinical consequences. Cross-sectional imaging techniques (CT and MRI) are well suited for evaluation and surgical planning. This review article focuses on the embryologic development, hemodynamics, and imaging features to enable a timely diagnosis. Biatrial drainage of the right SVC has important clinical implications, and knowledge of its imaging appearance and hemodynamics is essential in diagnosis and treatment planning. © RSNA, 2020.
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Affiliation(s)
- Mehul D Patel
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, 7000 Fannin Suite 1200, Houston, TX 77030 (M.D.P.); Division of Pediatric Cardiology, Department of Pediatrics (S.B., A.L.D., J.C.L.), Section of Pediatric Radiology, Department of Radiology (S.B., A.L.D., A.J., J.C.L., M.G.M.), and Division of Cardiothoracic Radiology, Department of Radiology (M.G.M., P.P.A.), Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Sowmya Balasubramanian
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, 7000 Fannin Suite 1200, Houston, TX 77030 (M.D.P.); Division of Pediatric Cardiology, Department of Pediatrics (S.B., A.L.D., J.C.L.), Section of Pediatric Radiology, Department of Radiology (S.B., A.L.D., A.J., J.C.L., M.G.M.), and Division of Cardiothoracic Radiology, Department of Radiology (M.G.M., P.P.A.), Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Adam L Dorfman
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, 7000 Fannin Suite 1200, Houston, TX 77030 (M.D.P.); Division of Pediatric Cardiology, Department of Pediatrics (S.B., A.L.D., J.C.L.), Section of Pediatric Radiology, Department of Radiology (S.B., A.L.D., A.J., J.C.L., M.G.M.), and Division of Cardiothoracic Radiology, Department of Radiology (M.G.M., P.P.A.), Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Aparna Joshi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, 7000 Fannin Suite 1200, Houston, TX 77030 (M.D.P.); Division of Pediatric Cardiology, Department of Pediatrics (S.B., A.L.D., J.C.L.), Section of Pediatric Radiology, Department of Radiology (S.B., A.L.D., A.J., J.C.L., M.G.M.), and Division of Cardiothoracic Radiology, Department of Radiology (M.G.M., P.P.A.), Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Jimmy C Lu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, 7000 Fannin Suite 1200, Houston, TX 77030 (M.D.P.); Division of Pediatric Cardiology, Department of Pediatrics (S.B., A.L.D., J.C.L.), Section of Pediatric Radiology, Department of Radiology (S.B., A.L.D., A.J., J.C.L., M.G.M.), and Division of Cardiothoracic Radiology, Department of Radiology (M.G.M., P.P.A.), Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Maryam Ghadimi Mahani
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, 7000 Fannin Suite 1200, Houston, TX 77030 (M.D.P.); Division of Pediatric Cardiology, Department of Pediatrics (S.B., A.L.D., J.C.L.), Section of Pediatric Radiology, Department of Radiology (S.B., A.L.D., A.J., J.C.L., M.G.M.), and Division of Cardiothoracic Radiology, Department of Radiology (M.G.M., P.P.A.), Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Prachi P Agarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, 7000 Fannin Suite 1200, Houston, TX 77030 (M.D.P.); Division of Pediatric Cardiology, Department of Pediatrics (S.B., A.L.D., J.C.L.), Section of Pediatric Radiology, Department of Radiology (S.B., A.L.D., A.J., J.C.L., M.G.M.), and Division of Cardiothoracic Radiology, Department of Radiology (M.G.M., P.P.A.), Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
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17
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Abstract
Purpose of Review This review focuses on the therapeutic management and individualized approach to Group 1 pulmonary arterial hypertension (PAH), utilizing Food and Drug Administration-approved PAH-specific therapies and various interventional and surgical options for PAH. Recent Findings The paradigm for the optimal management of PAH has shifted in recent years. Upfront combination therapy with an endothelin receptor antagonist and a phosphodiesterase 5 inhibitor is now widely accepted as standard of care. In addition, there is increasing emphasis on starting prostanoids early in order to delay time to clinical worsening. However, less is known regarding which prostanoid agent to initiate and the optimum time to do so. In order to facilitate shared decision-making, there is an increasing need for decision tools based on guidelines and collective clinical experiences to navigate between pharmacologic and interventional treatments, as well as explore innovative, therapeutic pathways for PAH. Summary The management of PAH has become increasingly complex. With a growing number of PAH-specific therapies, intimate knowledge of the therapeutics and the potential barriers to adherence are integral to providing optimal care for this high-risk patient population. While current PAH-specific therapies largely mediate their effects through pulmonary vasodilation, ongoing research efforts are focused on ways to disrupt the mechanisms leading to pulmonary vascular remodeling. By targeting aberrations identified in the metabolism and proliferative state of pulmonary vascular cells, novel PAH treatment pathways may be just on the horizon.
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Hidayati F, Gharini PPR, Hartopo AB, Anggrahini DW, Dinarti LK. The effect of oral sildenafil therapy on health-related quality of life in adults with pulmonary arterial hypertension related to uncorrected secundum atrial septal defect: a quasi experimental study. Health Qual Life Outcomes 2020; 18:278. [PMID: 32795300 PMCID: PMC7427875 DOI: 10.1186/s12955-020-01498-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessment of health-related quality of life (HRQoL) are often measured as an important patient-reported outcome (PRO) in clinical studies. Pulmonary arterial hypertension (PAH) is a common complication of atrial septal defect (ASD). This study aimed to compare the HRQoL of PAH related uncorrected secundum ASD at pre and post therapy with oral sildenafil therapy. METHODS We conducted quasi experimental study at Sardjito General Hospital Yogyakarta since April 2016 to August 2017. Adults with PAH related uncorrected secundum ASD, listed on Congenital Heart Disease and Pulmonary Hypertension (COHARD-PH) registry, and met the inclusion and exclusion criteria were recruited as subject. Interview was done at pre and 12 weeks post oral sildenafil therapy 3 × 20 mg using the EQ-5D-3L questionnaire. Statistical analysis was done using Wilcoxon test and paired T-test to determine the differences of EQ-5D utility and EQ-VAS score at pre and post therapy. RESULTS A total of 18 adult patients with PAH related to uncorrected secundum ASD were enrolled in this study (83.33% female; mean age 38.72 ± 10.81 years old). The most frequent reported problems pre therapy were pain/discomfort (83%) and anxiety/depression (78%). Wilcoxon test showed the median of EQ-5D utility score were increased after sildenafil therapy (before = 0.604, after = 0.664; Z = - 2703; p:0.007), respectively. Meanwhile, the paired T-test results showed an increase of EQ-VAS mean difference 6.67 ± 8.75 (p:0.005; 95% CI 2.32-11.02) after sildenafil therapy. CONCLUSION The administration of oral sildenafil therapy 3 × 20 mg during 12 weeks in adult patients with PAH related uncorrected secundum ASD gives better HRQoL.
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Affiliation(s)
- Fera Hidayati
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia.
| | - Putrika P R Gharini
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Anggoro Budi Hartopo
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Dyah Wulan Anggrahini
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Lucia Kris Dinarti
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
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19
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Atrial Septal Defect with Eisenmenger Syndrome: A Rare Presentation. Case Rep Cardiol 2020; 2020:8681761. [PMID: 32231807 PMCID: PMC7085360 DOI: 10.1155/2020/8681761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 11/18/2022] Open
Abstract
Atrial septal defects (ASDs) are common congenital heart defects (CHD). The clinical course in patients without closure of the ASD is associated with significant morbidity and mortality in advanced age. A small percentage of patients may develop pulmonary arterial hypertension (PAH) due to left to right shunting that impacts morbidity and mortality. Advances in prenatal screening and fetal echocardiography have allowed timely interventions. Nonetheless, some patients still may be diagnosed with ASD in adulthood as an incidental finding or presenting with clinical symptoms such as shortness of breath from right heart failure. We report a case of an adult female presenting with shortness of breath due to ASD causing PAH with Eisenmenger physiology.
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20
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Huang S, Aregullin EO, Gosnell JM, Samuel BP, Kaley VR, Castiaux A, Pinger C, Apkinar MH, Chinnadurai P, Spence DM, Contag CH, Vettukattil JJ. Rapid Prototyping and Image Fusion Guidance for Transcatheter Closure of Superior Sinus Venosus Atrial Septal Defect. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42399-019-00169-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Celermajer DS. Atrial septal defects: even simple congenital heart diseases can be complicated. Eur Heart J 2019; 39:999-1001. [PMID: 29194471 DOI: 10.1093/eurheartj/ehx633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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22
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Bradley EA, Ammash N, Martinez SC, Chin K, Hebson C, Singh HS, Aboulhosn J, Grewal J, Billadello J, Chakinala MM, Daniels CJ, Zaidi AN. "Treat-to-close": Non-repairable ASD-PAH in the adult: Results from the North American ASD-PAH (NAAP) Multicenter Registry. Int J Cardiol 2019; 291:127-133. [PMID: 31031077 DOI: 10.1016/j.ijcard.2019.03.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adults presenting with an unrepaired atrial septal defect and pulmonary arterial hypertension (ASD-PAH) are typically classified as "correctable" or "non-correctable". The use of directed PAH medical therapy in non-correctable ASD-PAH leading to favorable closure candidacy, repair status and long-term follow-up is not well studied. We therefore sought to characterize response to PAH targeted therapy in 'non-correctable' ASD-PAH. METHODS AND RESULTS Nine North American tertiary care centers submitted retrospective data from adults with unrepaired ASD-PAH that did not meet recommendations for repair at initial presentation (1996-2017). Sixty-nine patients (women 51(74%), 40 ± 15 years, mean pulmonary artery pressure (mPA) 51 ± 13 mm Hg, pulmonary vascular resistance (PVR) 8.7 ± 4.9 Wood units, Qp:Qs 1.6 ± 0.4) were enrolled. All patients were prescribed PAH targeted therapy and late shunt repair occurred in 19(28%) (Women 15(29%) vs. Men 4(22%), p = 0.6). At late follow-up (4.4 ± 2.9 years) 6-minute walk test distance (6MWTD) was significantly better in the group that underwent repair (486 ± 89 m vs. 375 ± 139 m, p < 0.05). Transthoracic echo showed significant improvement in right ventricular (RV) function (severe dysfunction in repaired 8(40%) vs. unrepaired groups 35(69%), p < 0.05). Divergent survival curves suggest that with larger studies and more follow-up, differences in survival between repaired and unrepaired groups may be important. (repaired: 17(94%) vs. unrepaired: 32(81%), p = 0.18). CONCLUSIONS This is the first and largest multicenter study evaluating the "treat-to-close" approach in non-correctable ASD-PAH. Our new data supports further study of this strategy in patients who have reversibility of PAH in response to targeted therapy. We demonstrate that in the carefully selected patient with non-correctable ASD-PAH, successful shunt repair is possible if post-therapy PVR is ≤6.5 Wood units. Patients who underwent repair had improved RV function following PAH targeted therapy. Divergent survival curves suggest that with further study, defect repair may affect medium-term to late survival.
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Affiliation(s)
- Elisa A Bradley
- The Ohio State University & Nationwide Children's Hospital, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America.
| | - Naser Ammash
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Sara C Martinez
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, United States of America
| | - Kelly Chin
- University of Texas Southwestern, Division of Pulmonary Medicine, Dallas, TX, United States of America
| | - Camden Hebson
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Harsimran S Singh
- Weill Cornell Medicine New York Presbyterian Hospital, Division of Cardiovascular Medicine, New York, NY, United States of America
| | - Jamil Aboulhosn
- Ahmanson/University of California, Los Angeles, David Geffen School of Medicine at UCLA, Divisions of Adult and Pediatric Cardiology, Los Angeles, CA, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Jasmine Grewal
- University of British Columbia, St. Paul's Hospital and Vancouver General Hospital, Division of Cardiovascular Medicine, Vancouver, BC, Canada; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Joseph Billadello
- Washington University, Division of Cardiovascular Medicine, St. Louis, MO, United States of America
| | - Murali M Chakinala
- Washington University, Division of Pulmonary and Critical Care Medicine, St. Louis, MO, United States of America
| | - Curt J Daniels
- The Ohio State University & Nationwide Children's Hospital, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Ali N Zaidi
- Montefiore Einstein Center for Heart & Vascular Care & The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
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Zwijnenburg RD, Baggen VJ, Witsenburg M, Boersma E, Roos-Hesselink JW, van den Bosch AE. Risk Factors for Pulmonary Hypertension in Adults After Atrial Septal Defect Closure. Am J Cardiol 2019; 123:1336-1342. [PMID: 30709596 DOI: 10.1016/j.amjcard.2019.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Atrial septal defect (ASD) closure is performed to prevent pulmonary hypertension (PH), which is associated with poor outcome. This study investigated the prevalence of PH in adults before and after ASD closure and explored associations between patient characteristics and PH after ASD closure. Consecutive adult patients who underwent surgical or percutaneous ASD closure in the Erasmus MC, the Netherlands, were included (2000 to 2014). Echocardiograms before and after ASD closure were retrospectively assessed. Patients were categorized into 3 groups (no PH, possible PH, and PH) based on tricuspid regurgitation velocity (<2.9, 2.9 to 3.4, and ≥3.4 m/s) or mean pulmonary arterial pressure (<20, 20 to 24, and ≥25 mm Hg). Cox regression was performed to identify associations between patient characteristics and PH after ASD closure. Of the 244 eligible patients who underwent ASD closure, 198 (81%) had echocardiograms both before and median 15 (interquartile range 12 to 35) months after ASD closure (median age at closure 45 [interquartile range 30 to 57] years, 75% woman). The prevalence of PH was 13.1% (n = 26) before ASD closure and 5.0% (n = 10) after closure. New York Heart Association III to IV (hazard ratio [HR] 11.07, 95% confidence interval [CI] 3.12 to 39.29, p <0.001), pulmonary disease (HR 10.43, 95% CI 2.12 to 51.21, p = 0.004), cardiac medication use (HR 3.96, 95% CI 1.02 to 15.34, p = 0.047), right ventricular fractional area change (HR 0.87, 95% CI 0.81 to 0.93, p <0.001), and tricuspid annular plane systolic excursion (HR 0.75, 95% CI 0.59 to 0.95, p = 0.018) were significantly associated with PH. In conclusion, adult patients with low pulmonary pressures before ASD closure are not at risk of PH after closure. Nevertheless, PH remained prevalent in approximately 5% of patients. Especially those patients with high New York Heart Association functional class, presence of pulmonary disease, cardiac medication use and impaired RV function at baseline are at risk.
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24
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Mullen MP. Challenges in the Patient With Pulmonary Hypertension and Atrial Septal Defect: Understanding When and How to Close the Defect. ACTA ACUST UNITED AC 2019. [DOI: 10.21693/1933-088x-18.1.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Atrial septal defects (ASDs) are common congenital heart defects in children and adults. Pulmonary arterial hypertension (PAH) is found in subsets of both pediatric and adult patients with atrial defects under varied clinical contexts. The pulmonary hypertension specialist is often faced with questions surrounding timing and method of defect closure, which may have significant impact on procedural and long-term morbidity and survival. This review highlights important differences in management between children and adults with ASDs associated with PAH, highlighting indications for closure, operability, types of closure, and long-term outcomes.
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Affiliation(s)
- Mary P. Mullen
- Associate Director of Pulmonary Hypertension Service, Attending Physician Boston Adult Congenital Heart Service, Assistant Professor of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Lee JS, Cha SG, Kim GB, Lee SY, Song MK, Kwon HW, Bae EJ, Kwak JG, Kim WH, Lee JR. Reversibility of Pulmonary Hypertension Following Surgical Atrial Septal Defect Closure in Children with Down Syndrome. J Cardiovasc Imaging 2019; 27:247-253. [PMID: 31614394 PMCID: PMC6795567 DOI: 10.4250/jcvi.2019.27.e33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Many Down syndrome (DS) patients have an atrial septal defect (ASD) and associated pulmonary hypertension (PH) from early childhood. ASD closure in DS patients with PH is often controversial due to concerns regarding exacerbation of PH. The aim of this study was to investigate the clinical outcome following surgical ASD closure in children with DS. METHODS We retrospectively reviewed the medical records of DS patients who underwent surgical ASD patch closure from January 2000 to December 2016. RESULTS A total of 15 patients underwent surgery for ASD. Prior to ASD patch closure, nine patients were diagnosed with PH, three of whom took medications for PH. The mean age of patients at ASD patch closure was 17.3 months, and the mean diameter of the ASD was 10.2 mm. Three patients who took medications for severe PH underwent ASD patch closure at ages 7, 12, and 25 months. Two patients continued medication for an additional 13 and 21 months, and one patient remained on medication 52 months after ASD closure. PH did not recur following discontinuation of selective pulmonary vasodilators in two patients. Although a moderate degree of PH remained in one patient due to a chronic lung problem, it was improved compared to before ASD closure. No PH was observed in the remaining 12 patients following ASD closure. CONCLUSIONS A large ASD can be closed even in DS patients with severe PH during early childhood with the support of multiple selective pulmonary vasodilators.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Seul Gi Cha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hye Won Kwon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Woong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
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Dalvi B, Jain S, Pinto R. Device closure of atrial septal defect with severe pulmonary hypertension in adults: Patient selection with early and intermediate term results. Catheter Cardiovasc Interv 2018; 93:309-315. [DOI: 10.1002/ccd.27853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/28/2018] [Accepted: 08/04/2018] [Indexed: 11/05/2022]
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Jain S, Dalvi B. Atrial septal defect with pulmonary hypertension: when/how can we consider closure? J Thorac Dis 2018; 10:S2890-S2898. [PMID: 30305949 DOI: 10.21037/jtd.2018.07.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients having atrial septal defect (ASD) with moderate and more importantly severe pulmonary arterial hypertension (PAH) pose a clinical dilemma. Closing ASD in those with irreversible PAH and not closing it when the PAH is reversible can cost patients dearly, both in terms of quality of life and longevity. In our experience, there is no single parameter that can help in decision making in this difficult subset of patients and therefore we recommend a multi-dimensional approach, which takes into consideration clinical, radiological, electrocardiographic and hemodynamic variables as a whole. ASD with restrictive left ventricular (LV) physiology can lead to pulmonary venous hypertension, which can manifest as life threatening acute pulmonary edema following device closure. All high-risk candidates prone to having this combination should be prepared with diuretics and vasodilators prior to bringing them to catheterization laboratory and should be assessed with temporary balloon/device occlusion prior to permanent closure of the defect. In those cases of ASD with borderline operability either due to severe PAH or LV restrictive physiology, perforated device may be helpful in preventing acute or long-term complications of complete closure.
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Affiliation(s)
- Shreepal Jain
- Department of Pediatric Cardiology, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Bharat Dalvi
- Glenmark Cardiac Center, Mumbai, Maharashtra, India
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Bredy C, Mongeon FP, Leduc L, Dore A, Khairy P. Pregnancy in adults with repaired/unrepaired atrial septal defect. J Thorac Dis 2018; 10:S2945-S2952. [PMID: 30305955 DOI: 10.21037/jtd.2017.10.130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Atrial septal defect (ASD) is the most common form of congenital heart disease. Left-to-right shunting leads to right ventricular (RV) volume overload with excessive pulmonary blood flow. Complications include exercise intolerance, pulmonary vascular disease, RV dysfunction, paradoxical thromboemboli, and atrial arrhythmias. Women with coexisting severe pulmonary hypertension should be counselled against pregnancy due to high incidence of maternal and fetal morbidity and mortality. In the absence of pulmonary hypertension, pregnancy is generally well tolerated in the setting of an ASD. Nevertheless, hemodynamic changes throughout gestation may increase the risk for complications, particularly in those with unrepaired ASDs. Arrhythmias are the most common cardiac event and occur in 4-5%, followed by paradoxical emboli in 2-5%. Obstetrical and neonatal complications include preeclampsia, a higher incidence of infants born small for gestational age, and higher fetal/perinatal mortality. Although there is no definitive evidence demonstrating superiority of an aggressive approach to ASD closure prior to pregnancy, it is currently common practice to electively close asymptomatic but large and/or hemodynamically significant ASDs prior to childbearing. Cardiology follow up during pregnancy should be adapted to clinical circumstances and includes transthoracic echocardiography during the second trimester and arrhythmia monitoring in the event of symptoms.
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Affiliation(s)
- Charlène Bredy
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Line Leduc
- Department of Obstetrics, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Annie Dore
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
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Fathallah M, Krasuski RA. A Multifaceted Approach to Pulmonary Hypertension in Adults With Congenital Heart Disease. Prog Cardiovasc Dis 2018; 61:320-327. [PMID: 30031003 DOI: 10.1016/j.pcad.2018.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023]
Abstract
Advances in the management of congenital heart disease (CHD) in children have resulted in growing numbers of adults with CHD. Pulmonary arterial hypertension related to CHD (PAH-CHD) is a common complication, affecting up to 10% of patients; and can arise even after successful and complete defect repair, with severe and potentially fatal consequences. Careful work-up in these patients is essential, particularly hemodynamic assessment, and can help define the most appropriate therapeutic approach. Management can be challenging, but the therapeutic armamentarium is continually expanding and now includes surgical, transcatheter and medical options. Timely correction of defects along with early treatment with advanced medical therapies appears to improve quality of life and possible even improve survival. Interestingly most studies of PAH-CHD have focused on its most severely afflicted patients, those with Eisenmenger Syndrome, making it less certain how to manage PAH-CHD of milder degrees. This review summarizes our current understanding of PAH-CHD and emphasizes the need for close follow-up in specialized centers of care where close collaboration is common practice.
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Affiliation(s)
- Mouhammad Fathallah
- Department of Cardiovascular Medicine, Duke University Health System, Durham, NC
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Health System, Durham, NC.
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30
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Idiopathic pulmonary arterial hypertension with coexisting CHD. Cardiol Young 2018; 28:743-746. [PMID: 29316988 DOI: 10.1017/s1047951117002876] [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
Sinus venosus atrial septal defect can result in an increase in pulmonary blood flow and vascular resistance, leading to pulmonary hypertension. Rarely, the degree of pulmonary hypertension is out of proportion to the degree of intra-cardiac shunting. This case outlines the differences between pulmonary hypertension secondary to CHD and idiopathic pulmonary hypertension, and illustrates the investigation and management strategy used in a patient with features of both.
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31
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Rapid Improvement of Pulmonary Functions in Children After Transcatheter Closure of an Atrial Septal Defect. Pediatr Cardiol 2018; 39:329-334. [PMID: 29090353 DOI: 10.1007/s00246-017-1759-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
There are very few studies in the literature on respiratory system functions and complications of children with an atrial septal defect (ASD). The aim of this study is to investigate the pulmonary functions and pulmonary complications before and after transcatheter closure in children with an ASD. In this study, pulmonary function test parameters of 30 ASD patients between 5 and 18 years of age who were eligible to be treated by transcatheter ASD closure were compared with 30 healthy children. The patients undergoing transcatheter ASD closure received pulmonary function tests (PFT) at baseline (1 day before ASD closure), and 3 months after the procedure. Forced vital capacity (FVC), forced expired volume in 1 s (FEV1), peak expiratory flow, and mean forced expiratory flow during the middle half of FVC were measured. The mean age of the 30 ASD patients was 9.59 ± 3.1 years; and 20 (66.6%) were female and 10 (33.3%) were male. The mean age of the control group was 10.15 ± 2.21 years, and 19 (63.3%) were girls and 11 (36.6%) were males. ASD patients had significantly reduced FVC (73.11 ± 24.6%; 86.05 ± 26.1; p = 0.001, respectively), and FEV1 (81.34 ± 26.2% and 99.2 ± 19.6%; p = 0.001; respectively) at baseline. But significant improvement was observed in FVC values in the 3rd-month post-closure comparison of the patient group with the control group (73.11 ± 24.6%; and 88.36 ± 14.5%; p = 0.01, respectively); FEV1 values (81.34 ± 26% and 99.54 ± 18.2%; p = 0.005, respectively) and mean forced expiratory flow between 25 and 75% of vital capacity (MEF25-75) values (94.6 ± 33.4% and 124.2 ± -24.1%; p = 0.01, respectively) were also improved. There was no statistically significant relationship between the PFT measurements at baseline and after closure of the defect and age at transcatheter closure, gender, body height, body weight, ASD diameter, Q p/Q s, right ventricle systolic pressure, or mean pulmonary artery pressure values. At the 3rd month of ASD closure, there was no significant difference in the comparison of the PFT values of the patient and control group. Disturbance in the significant flow limitation of the peripheral airway of ASD patients was observed with PFT. Better pulmonary outcomes were observed in ASD patients after transcatheter closure.
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32
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Chen L, Shen J, Shan X, Wang F, Kan T, Tang X, Zhao X, Qin Y. Improvement of tricuspid regurgitation after transcatheter ASD closure in older patients. Herz 2017; 43:529-534. [DOI: 10.1007/s00059-017-4594-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 05/13/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022]
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Kaya MG, Elcik D, Calapkorur B, Lam YY. Enhanced platelet activity in atrial septal defect. J Cardiovasc Med (Hagerstown) 2016; 17:870-874. [DOI: 10.2459/jcm.0000000000000217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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35
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Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, Lang RM, Rome JJ, Wang Y. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 2016; 28:910-58. [PMID: 26239900 DOI: 10.1016/j.echo.2015.05.015] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Frank E Silvestry
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Laurie B Armsby
- Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, Oregon
| | | | - Craig E Fleishman
- Arnold Palmer Hospital for Children, University of Central Florida College of Medicine, Orlando, Florida
| | | | - Roberto M Lang
- University of Chicago Hospital, University of Chicago School of Medicine, Chicago, Illinois
| | - Jonathan J Rome
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yan Wang
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
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Yamasaki Y, Nagao M, Kamitani T, Yamanouchi T, Kawanami S, Yamamura K, Sakamoto I, Yabuuchi H, Honda H. Clinical impact of left ventricular eccentricity index using cardiac MRI in assessment of right ventricular hemodynamics and myocardial fibrosis in congenital heart disease. Eur Radiol 2016; 26:3617-25. [PMID: 26795615 DOI: 10.1007/s00330-015-4199-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/22/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the utility of eccentricity index (EI) using cardiac cine MRI for the assessment of right ventricular (RV) hemodynamics in congenital heart disease (CHD). METHODS Fifty-five patients with CHD (32 women; mean age, 40.7 ± 20.9 years) underwent both cardiac MRI and right heart catheterization. EI was defined as the ratio of the distance between the anterior-posterior wall and the septal-lateral wall measured in the short-axis of mid-ventricular cine MRI. Correlations between EIs and RV hemodynamic parameters were analyzed. EIs were compared between patients with and without late gadolinium enhancement (LGE). RESULTS A strong correlation between mean pulmonary artery pressure (PAP) and systolic EI (r = 0.81, p < 0.0001) and a moderate negative correlation between diastolic EI and RV ejection fraction (EF) (r = -0.62, p < 0.0001) were observed. Receiver operating characteristic analysis revealed optimal EI thresholds for detecting patients with mean PAP ≥40 mmHg with C-statistics of 0.90 and patients with RVEF <40 % with C-statistics of 0.78. Systolic EIs were significantly greater for patients with LGE (1.45 ± 0.05) than for those without LGE (1.15 ± 0.07; p < 0.001). CONCLUSIONS EI offers a simple, comprehensive index that can predict pulmonary hypertension and RV dysfunction in CHD. KEY POINTS • EI offers a simple and comprehensive index of RV hemodynamics. • EI could predict pulmonary hypertension and RV dysfunction. • Left ventricular deformation expressed as high EI is related to myocardial fibrosis.
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Affiliation(s)
- Yuzo Yamasaki
- Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Michinobu Nagao
- Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Kamitani
- Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Torahiko Yamanouchi
- Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Kawanami
- Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ichiro Sakamoto
- Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetake Yabuuchi
- Health SciencesGraduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thébaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL. Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society. Circulation 2015; 132:2037-99. [PMID: 26534956 DOI: 10.1161/cir.0000000000000329] [Citation(s) in RCA: 706] [Impact Index Per Article: 78.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension is associated with diverse cardiac, pulmonary, and systemic diseases in neonates, infants, and older children and contributes to significant morbidity and mortality. However, current approaches to caring for pediatric patients with pulmonary hypertension have been limited by the lack of consensus guidelines from experts in the field. In a joint effort from the American Heart Association and American Thoracic Society, a panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension. This publication presents the results of extensive literature reviews, discussions, and formal scoring of recommendations for the care of children with pulmonary hypertension.
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MESH Headings
- Cardiovascular Agents/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Diagnostic Imaging/methods
- Disease Management
- Extracorporeal Membrane Oxygenation
- Genetic Counseling
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/therapy
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/genetics
- Hypertension, Pulmonary/therapy
- Infant
- Infant, Newborn
- Lung/embryology
- Lung Transplantation
- Nitric Oxide/administration & dosage
- Nitric Oxide/therapeutic use
- Oxygen Inhalation Therapy
- Persistent Fetal Circulation Syndrome/diagnosis
- Persistent Fetal Circulation Syndrome/therapy
- Postoperative Complications/therapy
- Respiration, Artificial/adverse effects
- Respiration, Artificial/methods
- Ventilator-Induced Lung Injury/prevention & control
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39
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Pagel PS, De Vry DJ, Ferron DR, Price BN, Murtaza G, Rashid ZA. An Unusual Cause for New Right Bundle-Branch Block. J Cardiothorac Vasc Anesth 2015; 30:564-8. [PMID: 26475390 DOI: 10.1053/j.jvca.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Brittany N Price
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Ghulam Murtaza
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zahir A Rashid
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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40
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Krieger EV, Leary PJ, Opotowsky AR. Pulmonary Hypertension in Congenital Heart Disease: Beyond Eisenmenger Syndrome. Cardiol Clin 2015; 33:599-609, ix. [PMID: 26471823 DOI: 10.1016/j.ccl.2015.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with adult congenital heart disease have an increased risk of developing pulmonary hypertension. There are several mechanisms of pulmonary hypertension in patients with adult congenital heart disease, and understanding them requires a systematic approach to define the patient's hemodynamics and physiology. This article reviews the updated classification of pulmonary hypertension in patients with adult congenital heart disease with a focus on pathophysiology, diagnostics, and the evaluation of pulmonary hypertension in special adult congenital heart disease populations.
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Affiliation(s)
- Eric V Krieger
- Seattle Adult Congenital Heart Service, Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
| | - Peter J Leary
- Pulmonary Vascular Disease Program, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Alexander R Opotowsky
- Boston Adult Congenital Heart and Pulmonary Hypertension Service, Department of Cardiology, Boston Children's Hospital and Brigham and Women's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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41
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Lopes AA, Barst RJ, Haworth SG, Rabinovitch M, Al Dabbagh M, Del Cerro MJ, Ivy D, Kashour T, Kumar K, Harikrishnan S, D'Alto M, Thomaz AM, Zorzanelli L, Aiello VD, Mocumbi AO, Santana MVT, Galal AN, Banjar H, Tamimi O, Heath A, Flores PC, Diaz G, Sandoval J, Kothari S, Moledina S, Gonçalves RC, Barreto AC, Binotto MA, Maia M, Al Habshan F, Adatia I. Repair of congenital heart disease with associated pulmonary hypertension in children: what are the minimal investigative procedures? Consensus statement from the Congenital Heart Disease and Pediatric Task Forces, Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2014; 4:330-41. [PMID: 25006452 DOI: 10.1086/675995] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 11/04/2022] Open
Abstract
Standardization of the diagnostic routine for children with congenital heart disease associated with pulmonary arterial hypertension (PAH-CHD) is crucial, in particular since inappropriate assignment to repair of the cardiac lesions (e.g., surgical repair in patients with elevated pulmonary vascular resistance) may be detrimental and associated with poor outcomes. Thus, members of the Congenital Heart Disease and Pediatric Task Forces of the Pulmonary Vascular Research Institute decided to conduct a survey aimed at collecting expert opinion from different institutions in several countries, covering many aspects of the management of PAH-CHD, from clinical recognition to noninvasive and invasive diagnostic procedures and immediate postoperative support. In privileged communities, the vast majority of children with congenital cardiac shunts are now treated early in life, on the basis of noninvasive diagnostic evaluation, and have an uneventful postoperative course, with no residual PAH. However, a small percentage of patients (older at presentation, with extracardiac syndromes or absence of clinical features of increased pulmonary blood flow, thus suggesting elevated pulmonary vascular resistance) remain at a higher risk of complications and unfavorable outcomes. These patients need a more sophisticated diagnostic approach, including invasive procedures. The authors emphasize that decision making regarding operability is based not only on cardiac catheterization data but also on the complete diagnostic picture, which includes the clinical history, physical examination, and all aspects of noninvasive evaluation.
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Affiliation(s)
- Antonio Augusto Lopes
- Heart Institute, University of São Paulo, São Paulo, Brazil ; Leader of the Congenital Heart Disease Task Force, PVRI
| | - Robyn J Barst
- Columbia University College of Physicians and Surgeons, New York, New York, USA ; In memoriam
| | | | - Marlene Rabinovitch
- Stanford University School of Medicine, Stanford, California, USA ; Leader of the Congenital Heart Disease Task Force, PVRI
| | | | - Maria Jesus Del Cerro
- La Paz Children's Hospital, Madrid, Spain ; Leader of the Pediatric Task Force, PVRI
| | - Dunbar Ivy
- Children's Hospital Colorado, Aurora, Colorado, USA
| | | | | | - S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | - Vera D Aiello
- Heart Institute, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Hanaa Banjar
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Omar Tamimi
- King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia
| | | | | | - Gabriel Diaz
- Universidad Nacional de Colombia, Bogota, Colombia
| | | | - Shyam Kothari
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | - Margarida Maia
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ian Adatia
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Leader of the Pediatric Task Force, PVRI
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Atrial shunts: presentation, investigation, and management, including recent advances in magnetic resonance imaging. Cardiol Young 2014; 24:403-16. [PMID: 24397877 DOI: 10.1017/s1047951113002321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Atrial shunts are a common finding in both paediatric and adult populations. Recent developments in advanced imaging have widened the options for diagnosis and evaluation of such shunts. This paper reviews the various types of interatrial communications, discusses the features of clinical presentation in adults and children, and provides an overview of the clinical assessment including physical examination, electrocardiography, echocardiography, cardiac catheterisation, computed tomography, and magnetic resonance imaging. Focus will be placed on recent developments in magnetic resonance imaging that may improve the non-invasive evaluation of atrial shunts.
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Lanigan MJ, Chaney MA, Tissot C, Beghetti M, Dimopoulos K. CASE 10--2014 Eisenmenger syndrome: close the hole? J Cardiothorac Vasc Anesth 2013; 28:1146-53. [PMID: 24094563 DOI: 10.1053/j.jvca.2013.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Megan J Lanigan
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL.
| | - Cecile Tissot
- Department of the Child and Adolescent, University of Geneva, Geneva, Switzerland
| | - Maurice Beghetti
- Department of the Child and Adolescent, University of Geneva, Geneva, Switzerland
| | - Kostas Dimopoulos
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, England
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Affiliation(s)
- M C Post
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands,
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Pulmonary Arterial Hypertension Associated with Congenital Heart Disease. CURRENT PEDIATRICS REPORTS 2013. [DOI: 10.1007/s40124-013-0015-7] [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: 10/27/2022]
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Rodriguez Y, Ghannam M, Katz A, Shea M. Conservative management of an elderly patient with Eisenmenger syndrome. J Cardiol Cases 2013; 7:e114-e116. [PMID: 30533138 DOI: 10.1016/j.jccase.2012.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/07/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022] Open
Abstract
Background Eisenmenger syndrome (ES) in the adult population has become exceedingly rare in developed countries owing to better recognition and treatment of congenital malformations of the heart. In the absence of transplantation, most patients survive an average of 20-30 years before succumbing to the cardiovascular and hemostatic sequelae. We present a rare case of an elderly woman with ES secondary to an uncorrected atrial-septum defect. She continues to have a high functional capacity despite impressive hemodynamic parameters. Case A 69-year-old woman with ES presented to our facility with atrial fibrillation and volume overload. She has a known sinus venosus atrial septal defect and associated severe pulmonary hypertension. She was managed conservatively and discharged on bosentan given her intricate physiology. Conclusion Given the similarity of the pathology with idiopathic pulmonary arterial hypertension (IPAH) and ES, drugs that are usually reserved for IPAH such as prostanoids and phosphodiesterase type 5 inhibitors may be beneficial in the management of ES. This case highlights that with our improving understanding of ES, non-operative management may have an expanding role in the care of these complex patients.<Learning objective: Advanced therapy for Eisenmenger syndrome (ES) is geared toward the endothelin-1 mediated pulmonary arterial plexus. Given the similarity of the pathology with idiopathic pulmonary arterial hypertension (IPAH) and ES, drugs that are usually reserved for IPAH such as prostanoids and phosphodiesterase type 5 inhibitors may be beneficial in the management of ES. Conservative management can achieve a favorable outcome, even in elderly patients with advanced disease.>.
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Affiliation(s)
- Yasser Rodriguez
- Department of Internal Medicine, University of Michigan, 2F208 UH, 1500 E. Medical Center Dr., SPC 5052, Ann Arbor, MI 48109-5052, USA
| | - Michael Ghannam
- Department of Internal Medicine, University of Michigan, 2F208 UH, 1500 E. Medical Center Dr., SPC 5052, Ann Arbor, MI 48109-5052, USA
| | - Alexander Katz
- Department of Internal Medicine, University of Michigan, 2F208 UH, 1500 E. Medical Center Dr., SPC 5052, Ann Arbor, MI 48109-5052, USA
| | - Michael Shea
- Department of Internal Medicine, University of Michigan, 2F208 UH, 1500 E. Medical Center Dr., SPC 5052, Ann Arbor, MI 48109-5052, USA.,Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Pagel PS, Johnson KR, Nicolosi AC. Dizziness Leads to an Unexpected Diagnosis. J Cardiothorac Vasc Anesth 2012; 26:975-7. [DOI: 10.1053/j.jvca.2012.01.026] [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: 08/30/2011] [Indexed: 11/11/2022]
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Cho YH, Jun TG, Yang JH, Park PW, Huh J, Kang IS, Lee HJ. Surgical strategy in patients with atrial septal defect and severe pulmonary hypertension. Heart Surg Forum 2012; 15:E111-5. [PMID: 22543336 DOI: 10.1532/hsf98.20111085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to review our experience with atrial septal defect (ASD) closure with a fenestrated patch in patients with severe pulmonary hypertension. Between July 2004 and February 2009, 16 patients with isolated ASD underwent closure with a fenestrated patch. All patients had a secundum type ASD and severe pulmonary hypertension. Patients ranged in age from 6 to 57 years (mean ± SD, 34.9 ± 13.5 years). The follow-up period was 9 to 59 months (mean, 34.5 ± 13.1 months). The ranges of preoperative systolic and pulmonary arterial pressures were 63 to 119 mm Hg (mean, 83.8 ± 13.9 mm Hg) and 37 to 77 mm Hg (mean, 51.1 ± 10.1 mm Hg). The ranges of preoperative values for the ratio of the pulmonary flow to the systemic flow and for pulmonary arterial resistance were 1.1 to 2.7 (mean, 1.95 ± 0.5) and 3.9 to 16.7 Wood units (mean, 9.8 ± 2.9 Wood units), respectively. There was no early or late mortality. Tricuspid annuloplasty was performed in 14 patients (87.5%). The peak tricuspid regurgitation gradient and the ratio of the systolic pulmonary artery pressure to the systemic arterial pressure were decreased in all patients. The New York Heart Association class and the grade of tricuspid regurgitation were improved in 13 patients (81.2%) and 15 patients (93.7%), respectively. ASD closure in patients with severe pulmonary hypertension can be performed safely if we create fenestration. Tricuspid annuloplasty and a Cox maze procedure may improve the clinical result. Close observation and follow-up will be needed to validate the long-term benefits.
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Affiliation(s)
- Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
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Franklin WJ, Parekh DR, Safdar Z. Adult congenital heart disease and pulmonary arterial hypertension: the Texas Adult Congenital Heart Program experience. Postgrad Med 2012; 123:32-45. [PMID: 22104452 DOI: 10.3810/pgm.2011.11.2493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Congenital heart disease (CHD) is a common structural defect of the heart or major blood vessels. Patients with adult congenital heart disease (ACHD) have medical needs that are distinct from those of pediatric patients with CHD, and the transition into adult health care is important for management of the patient with ACHD. A large proportion of patients with CHD develop diseases and complications associated with the long-term stress of intracardiac shunts. Pulmonary arterial hypertension (PAH) is a significant complication of some CHD lesions. The treatment of these patients remains challenging due to their combined heart and lung disease, and multidisciplinary care is ofen necessitated for a variety of secondary conditions. A number of treatment options are available for the management of PAH associated with CHD, including prostanoids, phosphodiesterase type-5 inhibitors, and endothelin receptor antagonists. This article discusses the diagnosis and management of such ACHD patients with PAH.
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Affiliation(s)
- Wayne J Franklin
- Baylor College of Medicine, Department of Medicine, Cardiology Section, Houston, TX 77030, USA.
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Abstract
OBJECTIVE MRI plays an important role in the morphologic and functional evaluation of cardiovascular shunts. Good spatiotemporal resolution, inherent contrast resolution, wide FOV, and multiplanar imaging capabilities make MRI an ideal tool in the investigation of cardiovascular shunts. The velocity-encoded phase-contrast sequence is used in the quantification of a shunt and the steady-state free precession (SSFP) sequence is used in the assessment of the functional impact of a shunt. In this article, the role of MRI in the evaluation of cardiovascular shunts and their respective MRI appearances are described and illustrated. CONCLUSION MRI can identify and characterize septal defects, quantify shunts and their impact on cardiac function, and help in the selection of appropriate candidates for percutaneous device placement.
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