1
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Chornock R, Lewis D, Gabaud S, Fries M, Greenberg V, Kawakita T. Pregnancy Outcomes in Women with Arrhythmias following Surgical Repair of Cardiac Defects. Am J Perinatol 2022; 40:811-816. [PMID: 36347510 DOI: 10.1055/a-1973-7397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The goal of this study was to investigate whether preexisting cardiac arrhythmias are associated with adverse obstetrical outcomes in women with a history of open cardiac surgery. STUDY DESIGN This was a retrospective cohort study of women with a history of open cardiac surgery who delivered at MedStar Washington Hospital Center (Washington, DC) from January 2007 through December 2018. Women with the isolated percutaneous cardiac surgical repair were excluded. Maternal and neonatal outcomes were compared between patients with preexisting cardiac arrhythmias and patients without preexisting cardiac arrhythmias. Maternal outcomes studied were intensive care unit admission, postpartum blood loss greater than 1,000 mL, congestive heart failure development, preeclampsia with severe features, postpartum readmission, postpartum cardiac events, and postpartum length of stay >5 days. Neonatal outcomes investigated were low birth weight <2,500 g, Apgar's scores <7 at 5 minutes, and neonatal intensive care unit admission. Multivariate logistic regression model was used to calculate the adjusted odds ratio (aOR) and 95% confidence intervals. RESULTS The outcomes for 69 deliveries from 56 women with a history of open cardiac surgery were examined. Thirty-three women (48%) had arrhythmias after cardiac surgery with fourteen (20%) requiring implantable cardioverted defibrillators. Two women (6%) with preexisting arrhythmias after cardiac surgery developed postpartum volume overload requiring readmission (p = 0.06). After controlling for age, gestational age at delivery, and BMI, preeclampsia with severe features (p = 0.02) and low birth weight neonates (p = 0.02, aOR = 2.26 [0.56-9.03]) remained statistically more like to occur in patients with preexisting cardiac arrhythmias than in patients without preexisting arrhythmias. CONCLUSION Women with a history of open cardiac surgery and preexisting cardiac arrhythmias prior to pregnancy are more likely to develop preeclampsia with severe features and have low birth weight neonates compared with women with a history of open cardiac surgery without preexisting cardiac arrhythmias. KEY POINTS · Preexisting arrhythmias after cardiac surgery was associated with a risk of preeclampsia.. · Neonates of women with preexisting cardiac arrhythmias are more likely to be low birth weight.. · Forty-seven percent of women with open cardiac surgery developed subsequent arrhythmias..
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Affiliation(s)
- Rebecca Chornock
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Dana Lewis
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Stephany Gabaud
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Melissa Fries
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Victoria Greenberg
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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2
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Pinsker BL, Serfas JD, Awerbach JD, Dizon S, Spector ZZ, Campbell MJ, Krasuski RA. Utility of Cardiac Magnetic Resonance Imaging in Predicting Atrial Arrhythmias in Repaired Tetralogy of Fallot. Am J Cardiol 2022; 174:151-157. [PMID: 35473783 DOI: 10.1016/j.amjcard.2022.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
Arrhythmias are the leading cause of morbidity and mortality in repaired tetralogy of Fallot (TOF), and over 20% of these patients will develop a sustained atrial arrhythmia during their lifetimes. Cardiac magnetic resonance imaging (cMRI) is frequently performed in TOF, although its ability to identify patients at risk of atrial arrhythmias is uncertain. Adult TOF patients (n = 175) with no history of atrial arrhythmia who underwent cMRI between 2003 and 2020 at a single tertiary care center were identified. Clinical characteristics and imaging findings were evaluated to identify a predilection for atrial arrhythmias using Kaplan-Meier survival analysis and log-rank testing. Multivariable Cox regression was used to determine independent predictors of atrial arrhythmias. Over a median follow-up of 3.6 years, 29 patients (17%) developed atrial arrhythmias. Independent predictors of atrial arrhythmia included age (hazard ratio [HR] 1.06 per 1-year increase, 95% confidence interval [CI] 1.02 to 1.09, p = 0.002), diabetes mellitus (HR 4.26, 95% CI 1.26 to 14.41, p = 0.020), indexed right ventricular end-diastolic volume (RVEDVi), (HR 1.20 per 10-ml/m2 increase, 95% CI 1.05 to 1.39, p = 0.010), and moderate or greater tricuspid regurgitation (TR) (HR 6.32, 95% CI 2.15 to 18.60, p = 0.001). Utilizing Kaplan-Meier analysis, patients with at least mild right ventricular dilation (RVEDVi >100 ml/m2, p = 0.047) and greater than or equal to moderate TR (p <0.001) were found to be significantly more likely to develop atrial arrhythmias. In conclusion, cMRI can help to identify TOF patients at increased risk for atrial arrhythmia beyond standard clinical and imaging data by better quantifying RVEDVi and degree of TR.
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Affiliation(s)
- Bret L Pinsker
- Duke University School of Medicine, Durham, North Carolina
| | - John D Serfas
- Division of Cardiology, Department of Internal Medicine
| | - Jordan D Awerbach
- Division of Cardiology, Phoenix Children's Hospital, Phoenix, Arizona
| | | | - Zebulon Z Spector
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Michael J Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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3
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Zaidi AN. Tetralogy of Fallot: management of residual hemodynamic and electrophysiological abnormalities. Heart 2021; 108:1408-1414. [PMID: 34949687 DOI: 10.1136/heartjnl-2020-316668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ali N Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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4
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Ma S, Li Y, Liu Y, Xu C, Li H, Yao Q, Wang Y, Yang Z, Zuo P, Yang M, Mo X. Changes in Cortical Thickness Are Associated With Cognitive Ability in Postoperative School-Aged Children With Tetralogy of Fallot. Front Neurol 2020; 11:691. [PMID: 32765405 PMCID: PMC7380078 DOI: 10.3389/fneur.2020.00691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022] Open
Abstract
In children with tetralogy of Fallot (TOF), there is a risk of brain injury even if intracardiac deformities are corrected. This population follow-up study aimed to identify the correlation between cerebral morphology changes and cognition in postoperative school-aged children with TOF. Resting-state functional magnetic resonance imaging (rs-fMRI) and the Wechsler Intelligence Scale for Children–Chinese revised edition (WISC-CR) were used to assess the difference between children with TOF and healthy children (HCs). Multiple linear regression showed that the TOF group had a lower verbal intelligence quotient (VIQ, 95.000 ± 13.433, p = 0.001) than the HC group and that VIQ had significant positive correlations with the cortical thickness of both the left precuneus (p < 0.05) and the right caudal middle frontal gyrus (p < 0.05) after adjustment for preoperative SpO2, preoperative systolic blood pressure (SBP), preoperative diastolic blood pressure (DBP) and time of aortic override (AO). Our results suggested that brain injury induced by TOF would exert lasting effects on cortical and cognitive development at least to school age. This study provides direct evidence of the relationship between cortical thickness and VIQ and of the need for strengthened verbal training in school-aged TOF patients after corrective surgery.
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Affiliation(s)
- Siyu Ma
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yaping Li
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yuting Liu
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Xu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Huijun Li
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qiong Yao
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Wang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhaocong Yang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Pengcheng Zuo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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5
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How pulmonary valve regurgitation after tetralogy of fallot repair changes the flow dynamics in the right ventricle: An in vitro study. Med Eng Phys 2020; 83:48-55. [PMID: 32807347 DOI: 10.1016/j.medengphy.2020.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Abstract
Tetralogy of Fallot is the most common cyanotic congenital disease, affecting 10% of children with congenital heart disease. The surgical management of patients with Tetralogy of Fallot leads, however, to significant detrimental effects on the right ventricle including pulmonary valve regurgitation. This experiment aimed to simulate different cases of pulmonary valve regurgitation with varying degrees of severity in order to observe the changes in flow structures present in the right ventricle. Planar time-resolved particle image velocimetry measurements have been performed on a custom-made double activation simulator reproducing flow conditions in a model of a right ventricle. Changes in flow characteristics in the right ventricle have been evaluated in terms of velocity fields and profiles, tricuspid inflow jet orientation and viscous energy dissipation. Our results show that pulmonary valve regurgitation significantly alters the flow in the right ventricle mostly by impairing the diastolic inflow through the tricuspid valve and by increasing viscous energy loss. This fundamental work should allow for a better understanding of such changes in the RV flow dynamics. It may also help in developing new strategies allowing for a better follow-up of patients with repaired TOF and for decision-making in terms of pulmonary valve replacement.
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6
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Sandström A, Rinnström D, Kesek M, Thilén U, Dellborg M, Sörensson P, Nielsen NE, Christersson C, Johansson B. Implantable cardiac devices in adult patients with repaired tetralogy of Fallot. SCAND CARDIOVASC J 2020; 55:22-28. [PMID: 32672076 DOI: 10.1080/14017431.2020.1792973] [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: 10/23/2022]
Abstract
OBJECTIVES Implantable cardiac devices are common in patients with tetralogy of Fallot (ToF) (18.3-21.3%) according to previous reports from large centres. We conducted this study to investigate the prevalence and incidence of cardiac devices in a less selected population of patients with ToF and assess factors other than arrhythmia associated with having a device. Design: 530 adult (≥18 years) patients with repaired ToF were identified in the national registry of congenital heart disease (SWEDCON) and matched with data from the Swedish pacemaker registry. Patients with implantable cardiac devices were compared with patients without devices. Results: Seventy-five patients (14.2%) had a device; 51 (9.6%) had a pacemaker and 24 (4.5%) had an implantable cardioverter defibrillator. The incidence in adult age (≥18 years) was 5.9/1000 patient years. Estimated device free survival was 97.5% at twenty, 87.2% at forty and 63.5% at sixty years of age. Compared with previous studies, the prevalence of devices was lower, especially for ICD. In multivariate logistic regression, cardiovascular medication (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), impaired left ventricular function, (OR 2.6, 95%CI 1.3-5.0) and age (OR 1.02, 95%CI 1.002-1.05) were associated with having a device. Conclusion: The prevalence of devices in our population, representing a multicenter register cohort, was lower than previously reported, especially regarding ICD. This can be due to differences in treatment traditions with regard to ICD in this population, but it may also be that previous studies have reported selected patients with more severe disease.
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Affiliation(s)
- Anette Sandström
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Daniel Rinnström
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Milos Kesek
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Ulf Thilén
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Göteborg, Sweden
| | - Peder Sörensson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Niels-Erik Nielsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
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7
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Louvelle LM, Doyle MG, Van Arsdell GS, Amon CH. A Methodology to Assess Subregional Geometric Complexity for Tetralogy of Fallot Patients. ACTA ACUST UNITED AC 2019. [DOI: 10.1115/1.4044949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
During surgical repair of tetralogy of fallot (TOF), pulmonary valve preservation (preservative repair) has demonstrated improved long-term outcomes compared to repairs that incise into the valve annulus (nonpreservative repair). Given the influence of geometry on hemodynamics, the success of preservative repair may be linked to the suitability of the preoperative patient geometry. However, the specific patient anatomies that may be predisposed to successful preservative repair are unknown due to significant interpatient variability in right ventricular outflow tract (RVOT) and pulmonary artery geometries, as well as the limitations in current methods of subregional geometric analysis. As a first step toward understanding the link between geometry and hemodynamics in TOF patients at a subregion level, we characterize the TOF geometry from the right ventricular infundibulum (INF) to the left and right pulmonary arteries. Our process consists of segmentation of magnetic resonance (MR) images and analysis of cross-sectional slices of the geometries along the centerlines. For the INF, main, left, and right pulmonary arteries individually, we quantify geometric parameters important in determining hemodynamic characteristics such as flow separation and recirculation, which can influence the degree of regurgitation. Specifically, we calculate the diameter along the subregion length, the average diameter, length, and tortuosity for each segment, as well as the bifurcation, left pulmonary artery (LPA) and right pulmonary artery (RPA) branch angles. This approach enables direct geometric comparisons within and among patients and allows for observation of the range in anatomic presentation. We have applied this approach to a dataset of 11 postoperative TOF patients, repaired with both preservative and nonpreservative surgical techniques.
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Affiliation(s)
- Leslie M. Louvelle
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M5S 3E2, Canada
| | - Matthew G. Doyle
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3E2, Canada; Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, ON M5G 2N2, Canada
| | - Glen S. Van Arsdell
- Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, CA 90024; Division of Cardiac Surgery, University of Toronto, Toronto, ON M5S 3E2, Canada
| | - Cristina H. Amon
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3E2, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M5S 3E2, Canada
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8
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de Castilhos GM, Ley ALG, Daudt NS, Horowitz ESK, Leiria TLL. Routine Detection of Atrial Fibrillation/Flutter Predicts a Worse Outcome in a Cohort of Tetralogy of Fallot Patients During 23 Years of Follow-Up. Pediatr Cardiol 2019; 40:1009-1016. [PMID: 31062060 DOI: 10.1007/s00246-019-02106-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
Abstract
Atrial flutter/fibrillation (AFL/AF) is a late complication in adults with repaired tetralogy of Fallot (TOF). Its effects on long-term prognosis are not fully understood. We evaluate the impact of AFL/AF in adults with repaired TOF on global mortality and unplanned hospitalizations during follow-up, and the predictors for AFL/AF occurrence. The presence of AFL/FA was analysed in all exams performed during the last 10 years of outpatients follow up in a unicentric cohort of repaired TOF between 1980 and 2003. Two-hundred and six patients were included; at a mean follow-up of 21 ± 8.2 years, there were 5 deaths (19.2%) in the AFL/AF group and 2 (1.1%) in those without arrhythmia (p < 0.001). Patients with AFL/AF where older at the time of the surgical repair (p < 0.001) and had a higher rate of reinterventions (p = 0.003). No differences were observed between the groups regarding the use of a transannular patch, ventriculotomy and previous palliative shunt. QRS duration was longer in patients with AFL/AF (174 ± 33.4) when compared to those without arrhythmia (147 ± 39.6; p < 0.0001). Age at surgery, QRS duration, and tricuspid regurgitation ≥ moderate were independent risk predictors for AFL/AF. In the multivariate analysis, atrial flutter/fibrillation and QRS duration were predictors of death and hospitalization. AFL/AF is associated with an increased risk of death and hospitalization during the follow-up of patients with repaired TOF. Early detection of AFL/AF and their predictors is an essential step in the evaluation of such population.
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Affiliation(s)
- Gabriela Machado de Castilhos
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil
| | - Antonio Lessa Gaudie Ley
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil
| | - Nestor Santos Daudt
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil
| | - Estela Suzana Kleiman Horowitz
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil
| | - Tiago Luiz Luz Leiria
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil.
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9
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Ait Ali L, Lurz P, Ripoli A, Rossi G, Kister T, Aquaro GD, Passino C, Bonhoeffer P, Festa P. Implications of atrial volumes in surgical corrected Tetralogy of Fallot on clinical adverse events. Int J Cardiol 2019; 283:107-111. [DOI: 10.1016/j.ijcard.2019.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 11/28/2022]
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Brieger D, Amerena J, Attia J, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani H, Hendriks J, Hespe C, Hung J, Kalman JM, Sanders P, Worthington J, Yan TD, Zwar N. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart Lung Circ 2019; 27:1209-1266. [PMID: 30077228 DOI: 10.1016/j.hlc.2018.06.1043] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - David Brieger
- Department of Cardiology, Concord Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - John Amerena
- Geelong Cardiology Research Unit, University Hospital Geelong, Geelong, Australia
| | - John Attia
- University of Newcastle, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Beata Bajorek
- Graduate School of Health, University of Technology Sydney & Department of Pharmacy, Royal North Shore Hospital, Australia
| | - Kim H Chan
- Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Cia Connell
- The National Heart Foundation of Australia, Melbourne, Australia
| | - Ben Freedman
- Sydney Medical School, The University of Sydney, Sydney, Australia; Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Caleb Ferguson
- Western Sydney University, Western Sydney Local Health District, Blacktown Clinical and Research School, Blacktown Hospital, Sydney, Australia
| | | | - Haris Haqqani
- University of Queensland, Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
| | - Jeroen Hendriks
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia; Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth, Australia
| | - Jonathan M Kalman
- University of Melbourne, Director of Heart Rhythm Services, Royal Melbourne Hospital, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - John Worthington
- RPA Comprehensive Stroke Service, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Nicholas Zwar
- Graduate Medicine, University of Wollongong, Wollongong, Australia
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de Torres-Alba F, Kaleschke G, Baumgartner H. Impacto del implante percutáneo de válvula pulmonar en cuanto al momento de reintervenir por disfunción del tracto de salida del ventrículo derecho. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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de Torres-Alba F, Kaleschke G, Baumgartner H. Impact of Percutaneous Pulmonary Valve Implantation on the Timing of Reintervention for Right Ventricular Outflow Tract Dysfunction. ACTA ACUST UNITED AC 2018; 71:838-846. [PMID: 29859895 DOI: 10.1016/j.rec.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect. Early surgical repair has dramatically improved the outcome of this condition. However, despite the success of contemporary approaches with early complete repair, these are far from being curative and late complications are frequent. The most common complication is right ventricle outflow tract (RVOT) dysfunction, affecting most patients in the form of pulmonary regurgitation, pulmonary stenosis, or both, and can lead to development of symptoms of exercise intolerance, arrhythmias, and sudden cardiac death. Optimal timing of restoration of RVOT functionality in asymptomatic patients with RVOT dysfunction after TOF repair is still a matter of debate. Percutaneous pulmonary valve implantation, introduced almost 2 decades ago, has become a major game-changer in the treatment of RVOT dysfunction. In this article we review the pathophysiology, the current indications, and treatment options for RVOT dysfunction in patients after TOF repair with a focus on the role of percutaneous pulmonary valve implantation in the therapeutic approach to these patients.
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Affiliation(s)
- Fernando de Torres-Alba
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
| | - Gerrit Kaleschke
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
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13
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14
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Anesthesia for Congenital Heart Diseases in Adults. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Limongelli G, Sarubbi B. Atrial arrhythmias in adults with congenital heart disease. Listening to your heart sound can save your life. Int J Cardiol 2017; 248:159-160. [PMID: 28942871 DOI: 10.1016/j.ijcard.2017.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/09/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Giuseppe Limongelli
- Paediatric Cardiology Unit, AORN Colli, Department of Cardiotoracic Sciences, Università della Campania, Luigi Vanvitelli, Naples, Italy; UCL Institute of Cardiovascular Sciences, University College of London, London, UK.
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AORN Colli, Department of Cardiology, Naples, Italy
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16
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Qiao Y, Lipovsky C, Hicks S, Bhatnagar S, Li G, Khandekar A, Guzy R, Woo KV, Nichols CG, Efimov IR, Rentschler S. Transient Notch Activation Induces Long-Term Gene Expression Changes Leading to Sick Sinus Syndrome in Mice. Circ Res 2017; 121:549-563. [PMID: 28674041 DOI: 10.1161/circresaha.116.310396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 06/21/2017] [Accepted: 06/30/2017] [Indexed: 12/14/2022]
Abstract
RATIONALE Notch signaling programs cardiac conduction during development, and in the adult ventricle, injury-induced Notch reactivation initiates global transcriptional and epigenetic changes. OBJECTIVE To determine whether Notch reactivation may stably alter atrial ion channel gene expression and arrhythmia inducibility. METHODS AND RESULTS To model an injury response and determine the effects of Notch signaling on atrial electrophysiology, we transiently activate Notch signaling within adult myocardium using a doxycycline-inducible genetic system (inducible Notch intracellular domain [iNICD]). Significant heart rate slowing and frequent sinus pauses are observed in iNICD mice when compared with controls. iNICD mice have structurally normal atria and preserved sinus node architecture, but expression of key transcriptional regulators of sinus node and atrial conduction, including Nkx2-5 (NK2 homeobox 5), Tbx3, and Tbx5 are dysregulated. To determine whether the induced electrical changes are stable, we transiently activated Notch followed by a prolonged washout period and observed that, in addition to decreased heart rate, atrial conduction velocity is persistently slower than control. Consistent with conduction slowing, genes encoding molecular determinants of atrial conduction velocity, including Scn5a (Nav1.5) and Gja5 (connexin 40), are persistently downregulated long after a transient Notch pulse. Consistent with the reduction in Scn5a transcript, Notch induces global changes in the atrial action potential, including a reduced dVm/dtmax. In addition, programmed electrical stimulation near the murine pulmonary vein demonstrates increased susceptibility to atrial arrhythmias in mice where Notch has been transiently activated. Taken together, these results suggest that transient Notch activation persistently alters ion channel gene expression and atrial electrophysiology and predisposes to an arrhythmogenic substrate. CONCLUSIONS Our data provide evidence that Notch signaling regulates transcription factor and ion channel gene expression within adult atrial myocardium. Notch reactivation induces electrical changes, resulting in sinus bradycardia, sinus pauses, and a susceptibility to atrial arrhythmias, which contribute to a phenotype resembling sick sinus syndrome.
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Affiliation(s)
- Yun Qiao
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Catherine Lipovsky
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Stephanie Hicks
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Somya Bhatnagar
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Gang Li
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Aditi Khandekar
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Robert Guzy
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Kel Vin Woo
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Colin G Nichols
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Igor R Efimov
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.)
| | - Stacey Rentschler
- From the Department of Medicine, Cardiovascular Division (Y.Q., C.L., S.H., S.B., G.L., A.K., S.R.), Department of Biomedical Engineering (Y.Q., G.L., S.R.), Department of Developmental Biology (C.L., S.B., S.R.), Department of Pediatrics (K.V.W.), and Department of Cell Biology (C.G.N.), Washington University in St Louis, MO; Department of Medicine, University of Chicago, IL (R.G.); and Department of Biomedical Engineering, The George Washington University, Science and Engineering Hall, Washington DC (Y.Q., I.R.E.).
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Baggen VJ, Schut ARW, Cuypers JA, Witsenburg M, Boersma E, van den Bosch AE, Roos-Hesselink JW. Prognostic value of left atrial size and function in adults with tetralogy of Fallot. Int J Cardiol 2017; 236:125-131. [DOI: 10.1016/j.ijcard.2017.02.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/27/2017] [Accepted: 02/24/2017] [Indexed: 11/30/2022]
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18
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Havasi K, Domsik P, Kalapos A, McGhie JS, Roos-Hesselink JW, Forster T, Nemes A. Left Atrial Deformation Analysis in Patients with Corrected Tetralogy of Fallot by 3D Speckle-Tracking Echocardiography (from the MAGYAR-Path Study). Arq Bras Cardiol 2017; 108:129-134. [PMID: 28327874 PMCID: PMC5344657 DOI: 10.5935/abc.20170004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background Three-dimensional (3D) echocardiography coupled with speckle-tracking echocardiographic (STE) capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA) volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF). Objectives To compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls. Methods The study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years). They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men). Results Increased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls. Conclusions Significant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair.
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Affiliation(s)
- Kálmán Havasi
- 2nd Department of Medicine and Cardiology Center - Medical Faculty - Albert Szent-Györgyi Clinical Center - University of Szeged - Szeged - Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Center - Medical Faculty - Albert Szent-Györgyi Clinical Center - University of Szeged - Szeged - Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Center - Medical Faculty - Albert Szent-Györgyi Clinical Center - University of Szeged - Szeged - Hungary
| | - Jackie S McGhie
- Department of Cardiology - Erasmus MC - Rotterdam - The Netherlands
| | | | - Tamás Forster
- 2nd Department of Medicine and Cardiology Center - Medical Faculty - Albert Szent-Györgyi Clinical Center - University of Szeged - Szeged - Hungary
| | - Attila Nemes
- 2nd Department of Medicine and Cardiology Center - Medical Faculty - Albert Szent-Györgyi Clinical Center - University of Szeged - Szeged - Hungary
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19
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Radiofrequency ablation of atrial tachyarrhythmias in adults with tetralogy of Fallot - predictors of success and outcome. Cardiol Young 2017; 27:284-293. [PMID: 27225323 DOI: 10.1017/s1047951116000482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adults with tetralogy of Fallot experience atrial tachyarrhythmias; however, there are a few data on the outcomes of radiofrequency ablation. We examined the characteristics, outcome, and predictors of recurrence of atrial tachyarrhythmias after radiofrequency ablation in tetralogy of Fallot patients. Methods/results Retrospective data were collected from 2004 to 2013. In total, 56 ablations were performed on 37 patients. We identified two matched controls per case: patients with tetralogy of Fallot but no radiofrequency ablation and not known to have atrial tachyarrhythmias. Acute success was 98%. Left atrial arrhythmias increased in frequency over time. The mean follow-up was 41 months; 78% were arrhythmia-free. Number of cardiac surgeries, age, and presence of atrial fibrillation were predictors of recurrence. Lone cavo-tricuspid isthmus-dependent flutter reduced the likelihood of atrial fibrillation. Right and left atria in patients with tetralogy of Fallot were larger in ablated cases than controls. NYHA class was worse in cases and improved after ablation; baseline status predicted death. Of matched non-ablated controls, a number of them had atrial fibrillation. These patients were excluded from the case-control study but analysed separately. Most of them had died during follow-up, whereas of the matched ablated cases all were alive and the majority in sinus rhythm. CONCLUSION Patients with tetralogy of Fallot and atrial tachyarrhythmias have more dilated atria than those without atrial tachyarrhythmias. Radiofrequency ablation improves functional status. Left atrial ablation is more commonly required with repeat procedures. There is a high prevalence of atrial tachyarrhythmias, particularly atrial fibrillation, in patients with tetralogy of Fallot; early radiofrequency ablation may have a protective effect against this.
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20
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Dennis M, Moore B, Kotchetkova I, Pressley L, Cordina R, Celermajer DS. Adults with repaired tetralogy: low mortality but high morbidity up to middle age. Open Heart 2017; 4:e000564. [PMID: 28698799 PMCID: PMC5495176 DOI: 10.1136/openhrt-2016-000564] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/22/2016] [Indexed: 12/23/2022] Open
Abstract
Objective Survival of patients with repaired tetralogy of Fallot (rToF) into young adulthood is very good. Concerns exist, however, over long-term morbidity and mortality as these subjects reach middle age. We aimed to assess survival and the prevalence of complications in patients with rToF seen in our Adult Congenital Heart Disease (ACHD) service. Methods One hundred and sixty-eight consecutive patients with ‘simple rToF’, aged over 16 years, followed up at our tertiary-level ACHD service in Sydney, Australia since 2000, were included. We documented mortality and analysed the prospectively defined composite end points of (a) ‘Serious adverse events’, including death, heart failure hospitalisation and/or documented ventricular arrhythmia and (b) ‘Adverse events’ inclusive of the above and endocarditis, atrial arrhythmia, defibrillator and/or pacemaker implantation. Results Mean age at the last follow-up was 34±12 years, and 55% were men. There were 10 (6%) deaths, and 26 patients (16%) experienced a ‘serious adverse event’. Fifty-one patients (30%) experienced an ‘adverse event’ and 29 patients had atrial arrhythmias. One hundred and one (61%) patients had at least one pulmonary valve replacement. By age 40 years, 93% were free of serious adverse events, and 83% were free of any adverse event. By age 50 years, only 56% had not had an adverse event. Older age and history of atrial arrhythmia were predictive of serious adverse events. Conclusion Survival into mid-adulthood in patients with rToF is very good; however, a substantial number of survivors have adverse events by the age of 50 years.
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Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ben Moore
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Irina Kotchetkova
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lynne Pressley
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rachael Cordina
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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21
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LOOMBA ROHITS, BUELOW MATTHEWW, AGGARWAL SAURABH, ARORA ROHITR, KOVACH JOSHUA, GINDE SALIL. Arrhythmias in Adults with Congenital Heart Disease: What Are Risk Factors for Specific Arrhythmias? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:353-361. [DOI: 10.1111/pace.12983] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/24/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
Affiliation(s)
- ROHIT S. LOOMBA
- Children's Hospital of Wisconsin/Medical College of Wisconsin; Milwaukee Wisconsin
| | - MATTHEW W. BUELOW
- Children's Hospital of Wisconsin/Medical College of Wisconsin; Milwaukee Wisconsin
| | | | | | - JOSHUA KOVACH
- Children's Hospital of Wisconsin/Medical College of Wisconsin; Milwaukee Wisconsin
| | - SALIL GINDE
- Children's Hospital of Wisconsin/Medical College of Wisconsin; Milwaukee Wisconsin
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22
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Heggie J, Poirer N, Williams WG, Karski J. Anesthetic Considerations for Adult Cardiac Surgery Patients with Congenital Heart Disease. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1177/108925320300700203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of adults with congenital heart disease surviving into adulthood is increasing. The proportion of adults undergoing revision of a previous repair is increasing in comparison to those that present for a palliative or curative operation. At the Toronto Congenital Cardiac Centre for Adults, 528 patients underwent cardiac surgery between January 1, 1992 and December 31, 2001. The anesthetic management of the surgical correction of simple and complex congenital heart lesions includes general physiologic considerations such as dysrhythmias, hypoxemia, polycythemia, and pulmonary hypertension. Palliative shunts from early childhood have anatomical and physiologic implications for the adult. Preparation for the operating room and postoperative care are natural extensions of the anesthetic management of the surgical correction of the congenital heart lesions. Anesthetic management of septal lesions in the interventional suite and operating room is discussed. Complex lesions such as tetralogy of Fallot, transposition of the great arteries, Glenn anastomosis, and the Fontan operation are reviewed. The anesthetic management of these patients is rewarding but impossible without an integrated team approach involving cardiologists, surgeons, perfusionists, and nursing staff.
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Affiliation(s)
- Jane Heggie
- Department of Cardiovascular Anaesthesia, Toronto General Hospital, University Health Network, Ontario, Canada; Department of Anaesthesia, Eaton-North 3-425, Toronto General Hospital, 200 Elizabeth St., Toronto, Ontario M5G 2C4, Canada
| | - Nancy Poirer
- Department of Surgery, Montreal Heart Institute, University of Montreal, Quebec, Canada
| | | | - Jacek Karski
- Cardiovascular Anesthesia, Toronto General Hospital, University Health Network, Ontario, Canada
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23
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Wasmer K, Köbe J, Diller G, Eckardt L. [Arrhythmia in adults with congenital heart defects : Incidence, substrates, and mechanisms]. Herzschrittmacherther Elektrophysiol 2016; 27:75-80. [PMID: 27216033 DOI: 10.1007/s00399-016-0427-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/26/2016] [Indexed: 06/05/2023]
Abstract
Arrhythmia management is one of the main challenges in the treatment of adult patients with congenital heart disease (ACHD). Apart from heart failure, arrhythmias are mainly responsible for morbidity and mortality in these patients. Supraventricular tachycardia is more frequent than ventricular arrhythmias and is not only associated with debilitating symptoms, but is often as threatening as ventricular tachycardia. The incidence depends on the underlying defect, type, and time of repair. For the overall ACHD population the incidence of supraventricular tachycardia is up to 50 % and increases with age and time since surgery. Arrhythmia substrate relates to structural abnormalities due to the congenital defect and most importantly to the amount of incisions and material used for repair. In addition, poor hemodynamic conditions influence substrate through dilatation, hypertrophy, and fibrosis. Both supraventricular and ventricular arrhythmias are due to a macroreentrant mechanism in the vast majority of patients, but focal arrhythmias occasionally occur as well.
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Affiliation(s)
- Kristina Wasmer
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
| | - Julia Köbe
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - Gerhard Diller
- Zentrum für Erwachsene mit angeborenen Herzfehlern, Department für Kardiologie und Angiologie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - Lars Eckardt
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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24
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Miles S, Ahmad W, Bailey A, Hatton R, Boyle A, Collins N. Sleep-Disordered Breathing in Patients with Pulmonary Valve Incompetence Complicating Congenital Heart Disease. CONGENIT HEART DIS 2016; 11:678-682. [PMID: 27214563 DOI: 10.1111/chd.12369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Long standing pulmonary regurgitation results in deleterious effects on right heart size and function with late consequences of right heart volume overload including ventricular dilatation, propensity to arrhythmia and right heart failure. As sleep disordered breathing may predispose to elevations in pulmonary vascular resistance and associated negative effects on right ventricular function, we sought to assess this in patients with underlying congenital heart disease. DESIGN We performed a pilot study to evaluate the incidence of sleep-disordered breathing in a patient population with a history of long standing pulmonary valve incompetence in patients with congenital heart disease using overnight oximetry. PATIENTS Patients with a background of tetralogy of Fallot repair or residual pulmonary incompetence following previous pulmonary valve intervention for congenital pulmonary stenosis were included. RESULTS Twenty-two patients underwent overnight oximetry. The mean age of the cohort was 34.3 ± 15.2 years with no patients observed to have severe underlying pulmonary hypertension. Abnormal overnight oximetry was seen in 13/22 patients (59.1%) with 2/22 (9.1%) patients considered to have severe abnormalities. CONCLUSIONS An important proportion of patients with a background of pulmonary incompetence complicating congenital heart disease are prone to the development of sleep-disordered breathing as assessed by overnight oximetry. Further study into the prevalence and mechanisms of sleep-disordered breathing in a larger cohort are warranted.
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Affiliation(s)
- Susan Miles
- Department of General Medicine, John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Waheed Ahmad
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Amy Bailey
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Rachael Hatton
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Nicholas Collins
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
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25
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Postoperative residua and sequelae in adults with repaired tetralogy of Fallot. Gen Thorac Cardiovasc Surg 2016; 64:373-9. [DOI: 10.1007/s11748-016-0651-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023]
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Longitudinal development of psychopathology and subjective health status in CHD adults: a 30- to 43-year follow-up in a unique cohort. Cardiol Young 2016; 26:547-55. [PMID: 26076871 DOI: 10.1017/s1047951115000700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine longitudinal changes in psychopathology in a cohort of patients 30-43 years after their first cardiac surgery for Congenital Heart Disease (CHD) in childhood, to compare outcomes of the 30- to 43-year follow-up with normative data, and to identify medical predictors for psychopathology. METHODS This study is the third follow-up of this cohort. The first and second follow-ups of this same cohort were conducted in 1990 and 2001, respectively. At all three follow-ups, psychopathology was assessed with standardised, parallel questionnaires. In 2011, subjective health status was assessed by the Short Form-36. Medical predictor variables were derived from medical examinations and medical records. RESULTS In this third follow-up, a total of 252 patients participated. Of these, 152 patients participated in all three follow-ups. Over a 30-year period, proportions of patients showing psychopathology decreased significantly. At the 30- to 43-year follow-up, overall outcomes on psychopathology for the CHD sample were similar or even better compared with normative groups. Subjective health status was also better compared with normative data. No differences were found between cardiac diagnostic groups. Medical variables that predicted the course of psychopathology over time were as follows: the scar, as judged by the patient, results of the first cardiac surgery, and the number of hospitalisations. CONCLUSIONS Over a 30-year period, psychopathology decreased in patients with CHD. Levels of psychopathology in these patients, who are now aged between 30 and 54 years, were comparable or even better than normative data.
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Twomey DJ, Sanders P, Roberts-Thomson KC. Atrial macroreentry in congenital heart disease. Curr Cardiol Rev 2015; 11:141-8. [PMID: 25308809 PMCID: PMC4356721 DOI: 10.2174/1573403x10666141013122231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 05/04/2014] [Indexed: 12/04/2022] Open
Abstract
Macroreentrant atrial tachycardia is a common complication following surgery for congenital heart disease (CHD), and is often highly symptomatic with potentially significant hamodynamic consequences. Medical management is often unsuccessful, requiring the use of invasive procedures. Cavotricuspid isthmus dependent flutter is the most common circuit but atypical circuits also exist, involving sites of surgical intervention or areas of scar related to abnormal hemodynamics. Ablation can be technically challenging, due to complex anatomy, and difficulty with catheter stability. A thorough assessment of the pa-tients status and pre-catheter ablation planning is critical to successfully managing these patients.
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Affiliation(s)
| | | | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm Disorders, Level 5, McEwin Building, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
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Opić P, Utens EM, Cuypers JA, Witsenburg M, van den Bosch A, van Domburg R, Bogers AJ, Boersma E, Pelliccia A, Roos-Hesselink JW. Sports participation in adults with congenital heart disease. Int J Cardiol 2015; 187:175-82. [DOI: 10.1016/j.ijcard.2015.03.107] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/04/2015] [Accepted: 03/07/2015] [Indexed: 11/27/2022]
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31
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Opić P, Roos-Hesselink JW, Cuypers JAA, Witsenburg M, van den Bosch A, van Domburg RT, Bogers AJJC, Utens EMWJ. Psychosocial functioning of adults with congenital heart disease: outcomes of a 30–43 year longitudinal follow-up. Clin Res Cardiol 2014; 104:388-400. [DOI: 10.1007/s00392-014-0792-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022]
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Walsh EP. Sudden death in adult congenital heart disease: Risk stratification in 2014. Heart Rhythm 2014; 11:1735-42. [DOI: 10.1016/j.hrthm.2014.07.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Indexed: 10/25/2022]
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Horke A, Tzanavaros I. [Prevention and treatment of cardiac arrhythmia in patients with congenital heart defects: surgical aspects]. Herzschrittmacherther Elektrophysiol 2014; 25:188-97. [PMID: 25164600 DOI: 10.1007/s00399-014-0334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/12/2014] [Indexed: 12/01/2022]
Abstract
Catheter ablation procedures have become established over the years due to their effectiveness and low invasiveness and have changed the indications for surgical treatment. The main field of activity of cardiac surgery remains the treatment of patients with congenital heart defects which show arrhythmia and necessitate surgical treatment. The combination of surgical ablative measures with a good view of the site using modern ablation instruments, atrial reduction by tissue resection and correction of the defect with the resulting volume relief, bring the best conditions for a curative treatment of arrhythmia. The same applies to the treatment of ventricular tachycardia resulting from old scars and residual defects. Special attention should be given to patients who received a Fontan conversion. This operation is a unique opportunity to relieve volume which in turn reduces the atrial size and at the same time to take ablative measures to restore sinus rhythm. The results are promising with low mortality and morbidity, high efficiency and finally a clear improvement of the functional status of patients. In appropriate cases minimally invasive surgical procedures can help where pharmacological and catheter ablation therapies remain ineffective.
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Affiliation(s)
- Alexander Horke
- Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland,
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Hou J, Yu HK, Wong SJ, Cheung YF. Atrial mechanics after surgical repair of tetralogy of Fallot. Echocardiography 2014; 32:126-34. [PMID: 24697926 DOI: 10.1111/echo.12611] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Ventricular diastolic dysfunction in patients with repaired tetralogy of Fallot (TOF) may affect atrial mechanics. This study aimed to explore right atrial (RA) and left atrial (LA) mechanics in repaired TOF patients and their relationship with ventricular diastolic function. METHODS Fifty-four patients (36 males), aged 17.8 ± 8.3 years, who had undergone TOF repair at 3.9 ± 3.3 years and 40 healthy subjects aged 16.9 ± 6.3 years (P = 0.57) were studied. Right and LA peak positive, peak negative, and total strain, strain rate at ventricular systole (SRs ), early diastole (SRed ), and atrial contraction (SRac ), and electromechanical delay were determined using speckle tracking echocardiography (STE). Ventricular diastolic function was assessed by tissue Doppler imaging and STE. Ventricular volumes and pulmonary regurgitant volume were derived from 3D echocardiography. RESULTS Compared with controls, patients had significantly lower RA and LA peak positive and total strain, SRs , SRed , and SRac (all P < 0.001). The timing of RA (178 ± 33 msec vs. 152 ± 17 msec, P < 0.001) and LA (170 ± 32 msec vs. 152 ± 24 msec, P = 0.006) electromechanical coupling (EMC) was significantly longer in patients than in controls. The RA total strain, SRs , SRed , SRac , and EMC correlated positively with corresponding LA parameters (all P < 0.001). The RA and LA total strain and SRed were associated positively with diastolic annular velocities and strain rates of respective ventricles (all P < 0.05). The LA SRed correlated negatively with pulmonary regurgitant volume (r = -0.33, P = 0.016) and RV end-diastolic volume (r = -0.33, P = 0.015). CONCLUSION Mechanics of both atria are impaired in patients after repair of TOF and are associated with diastolic performance of the respective ventricles.
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Affiliation(s)
- Jia Hou
- Division of Paediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Le Gloan L, Guerin P, Mercier LA, Abbey S, Dore A, Marcotte F, Ibrahim R, Poirier NC, Khairy P. Clinical assessment of arrhythmias in tetralogy of Fallot. Expert Rev Cardiovasc Ther 2014; 8:189-97. [DOI: 10.1586/erc.09.156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kadner A, Tulevski II, Bauersfeld U, Prêtre R, Valsangiacomo-Buechel ER, Dodge-Khatami A. Chronic pulmonary valve insufficiency after repaired Tetralogy of Fallot: diagnostics, reoperations and reconstruction possibilities. Expert Rev Cardiovasc Ther 2014; 5:221-30. [PMID: 17338667 DOI: 10.1586/14779072.5.2.221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Complete correction of Tetralogy of Fallot, the most common cyanotic congenital heart defect, has now become routine. However, late residual lesions, primarily chronic pulmonary valve insufficiency, may have a negative impact on right-ventricular function, leading to the need for reoperation to insert a competent valve at the right-ventricular outflow. The diagnostic modalities pertaining to the failing right ventricle, the timing for eventual reintervention and the various surgical reconstruction possibilities of the right-ventricular outflow tract are still controversial and evolving, and are reviewed with a brief overview on current trends and future outlooks.
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Affiliation(s)
- Alexander Kadner
- University of Zürich, Division of Congenital Cardiovascular Surgery, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland.
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Yap SC, Harris L. Sudden cardiac death in adults with congenital heart disease. Expert Rev Cardiovasc Ther 2014; 7:1605-20. [DOI: 10.1586/erc.09.153] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Motonaga KS, Khairy P, Dubin AM. Electrophysiologic Therapeutics in Heart Failure in Adult Congenital Heart Disease. Heart Fail Clin 2014; 10:69-89. [DOI: 10.1016/j.hfc.2013.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Arya S, Kovach J, Singh H, Karpawich PP. Arrhythmias and Sudden Death among Older Children and Young Adults Following Tetralogy of Fallot Repair in the Current Era: Are Previously Reported Risk Factors Still Applicable? CONGENIT HEART DIS 2013; 9:407-14. [DOI: 10.1111/chd.12153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Swati Arya
- Section of Pediatric Cardiology; Carmen and Ann Adams Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Mich USA
| | - Julie Kovach
- Section of Pediatric Cardiology; Carmen and Ann Adams Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Mich USA
| | - Harinder Singh
- Section of Pediatric Cardiology; Carmen and Ann Adams Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Mich USA
| | - Peter P. Karpawich
- Section of Pediatric Cardiology; Carmen and Ann Adams Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Mich USA
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Abstract
Although arrhythmias are commonly found in patients with all different types of congenital heart disease, perhaps no patient is at higher risk of late development of arrhythmias that may result in sudden death than in the patient following tetralogy of Fallot repair. Despite major improvement in the surgical repair of this disease, a significant percentage of these patients continue to remain at risk for the late development of arrhythmias, and a small percentage will develop life-threatening arrhythmias and sudden death. Which patients remain at highest risk is still not clearly delineated. Diligent arrhythmia surveillance and aggressive treatment strategies are necessary to minimise this risk. This article highlights important strategies to manage arrhythmia development and prevention in this patient population.
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Villafañe J, Feinstein JA, Jenkins KJ, Vincent RN, Walsh EP, Dubin AM, Geva T, Towbin JA, Cohen MS, Fraser C, Dearani J, Rosenthal D, Kaufman B, Graham TP. Hot Topics in Tetralogy of Fallot. J Am Coll Cardiol 2013; 62:2155-66. [DOI: 10.1016/j.jacc.2013.07.100] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/26/2013] [Accepted: 07/01/2013] [Indexed: 12/13/2022]
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Luijnenburg SE, Helbing WA, Moelker A, Kroft LJ, Groenink M, Roos-Hesselink JW, de Rijke YB, Hazekamp MG, Bogers AJ, Vliegen HW, Mulder BJ. 5-year serial follow-up of clinical condition and ventricular function in patients after repair of tetralogy of Fallot. Int J Cardiol 2013; 169:439-44. [DOI: 10.1016/j.ijcard.2013.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/30/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
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Opić P, Roos-Hesselink JW, Cuypers JA, Witsenburg M, van den Bosch A, van Domburg RT, Bogers AJ, Utens EM. Sexual functioning is impaired in adults with congenital heart disease. Int J Cardiol 2013; 168:3872-7. [DOI: 10.1016/j.ijcard.2013.06.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
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47
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N-Terminal Pro-B-Type Natriuretic Peptide and Its Relationship With Cardiac Function in Adults With Congenital Heart Disease. J Am Coll Cardiol 2013; 62:1203-12. [DOI: 10.1016/j.jacc.2013.07.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/18/2013] [Accepted: 07/08/2013] [Indexed: 02/06/2023]
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48
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Mirror image atrial dilatation in adult patients with atrial fibrillation and congenital heart disease. Int J Cardiol 2013; 167:816-20. [DOI: 10.1016/j.ijcard.2012.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/20/2012] [Accepted: 02/04/2012] [Indexed: 11/22/2022]
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49
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Escudero C, Khairy P, Sanatani S. Electrophysiologic Considerations in Congenital Heart Disease and Their Relationship to Heart Failure. Can J Cardiol 2013; 29:821-9. [DOI: 10.1016/j.cjca.2013.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 10/26/2022] Open
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Walsh EP. The challenge of atrial tachycardia management in rheumatic heart disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:791-2. [PMID: 23668551 DOI: 10.1111/pace.12165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/28/2022]
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