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Valdeolmillos E, Le Pavec J, Audié M, Savale L, Jais X, Montani D, Sitbon O, Feuillet S, Mercier O, Petit J, Humbert M, Fadel E, Belli E, Hascoët S. Thirty years of surgical management of pediatric pulmonary hypertension: Mid-term outcomes following reverse Potts shunt and transplantation. J Thorac Cardiovasc Surg 2024; 168:943-954. [PMID: 38052251 DOI: 10.1016/j.jtcvs.2023.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Reverse Potts shunt (RPS) and lung or heart-lung transplantation are life-extending surgical interventions for pediatric patients with severe pulmonary arterial hypertension (PAH). Robust criteria for identifying patients who will benefit from these procedures remain elusive. Based on 30 years of experience, we sought to refine the surgical indications. METHODS This single-center retrospective cohort study included 61 consecutive pediatric patients with PAH managed by RPS (2004-2020) or transplantation (1988-2020). Their mid-term outcomes were assessed. RESULTS Compared with the 20 patients managed by RPS, the 41 transplant waitlist patients, of whom 28 were transplanted, were older (14.9 vs 8.0 years, P = .0001), had worse right ventricular impairment (tricuspid annular plane systolic excursion, 12.5 mm vs 18.0 mm, P = .03), and were managed later in the evolution of the disease (6.0 vs 1.7 years, P = .002). After implementation of a high-priority allocation program in 2007, waitlist mortality decreased from 52.6% to 13.6% (P = .02) and 5-year survival increased from 57.1% to 74.7% after RPS and 55.6% to 77.2% after transplantation. At a median follow-up of 8.6 years after RPS and 5.9 years after transplantation, functional capacity had improved significantly, and PAH-specific drug requirements had diminished markedly in the RPS group. Two patients successfully underwent double-lung transplant 6 and 9 years after RPS. CONCLUSIONS In selected children with suprasystemic PAH, RPS is associated with functional capacity improvements and decreased pharmacotherapy needs over the midterm. RPS deserves consideration earlier in the course of pediatric PAH, with transplantation being performed in the event of refractory RV failure.
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Affiliation(s)
- Estibaliz Valdeolmillos
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Jérôme Le Pavec
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Marion Audié
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Laurent Savale
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - David Montani
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Séverine Feuillet
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Olaf Mercier
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Jérôme Petit
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Marc Humbert
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Elie Fadel
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Emre Belli
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France.
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2
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Boucly A, Beurnier A, Turquier S, Jevnikar M, de Groote P, Chaouat A, Cheron C, Jaïs X, Picard F, Prévot G, Roche A, Solinas S, Cottin V, Bauer F, Montani D, Humbert M, Savale L, Sitbon O. Risk stratification refinements with inclusion of haemodynamic variables at follow-up in patients with pulmonary arterial hypertension. Eur Respir J 2024; 64:2400197. [PMID: 38663975 PMCID: PMC11375514 DOI: 10.1183/13993003.00197-2024] [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: 01/27/2024] [Accepted: 04/09/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Haemodynamic variables are prognostic factors in pulmonary arterial hypertension (PAH). However, right heart catheterisation (RHC) is not systematically recommended to assess the risk status during follow-up. This study aimed to assess the added value of haemodynamic variables in prevalent patients to predict the risk of death or lung transplantation according to their risk status assessed by the non-invasive four-strata model as recommended by the European guidelines. METHODS We evaluated incident patients with PAH enrolled in the French pulmonary hypertension registry between 2009 and 2020 who had a first follow-up RHC. Cox regression identified, in each follow-up risk status, haemodynamic variables significantly associated with transplant-free survival. Optimal thresholds were determined by time-dependent receiver operating characteristics. Several multivariable Cox regression models were performed to identify the haemodynamic variables improving the non-invasive risk stratification model. RESULTS We analysed 1240 incident patients reassessed within 1 year by RHC. None of the haemodynamic variables were significantly associated with transplant-free survival among low-risk (n=386) or high-risk (n=71) patients. Among patients at intermediate (intermediate-low, n=483 and intermediate-high, n=300) risk at first follow-up, multivariable models including either stroke volume index (SVI) or mixed venous oxygen saturation (S vO2 ) were the best. The prognostic performance of a refined six-strata risk stratification model including the non-invasive four-strata model and SVI >37 mL·m-2 and/or S vO2 >65% for patients at intermediate risk (area under the curve (AUC) 0.81; c-index 0.74) was better than that of the four-strata model (AUC 0.79, p=0.009; c-index 0.72). CONCLUSION Cardiopulmonary haemodynamics may improve risk stratification at follow-up in patients at intermediate risk.
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Affiliation(s)
- Athénaïs Boucly
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Antoine Beurnier
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- AP-HP, Service de Physiologie et Explorations Fonctionnelles Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Ségolène Turquier
- CHU de Lyon HCL, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Groupement Hospitalier Est, Hôpital Louis Pradel, Bron, France
| | - Mitja Jevnikar
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Pascal de Groote
- Université de Lille, Service de Cardiologie, CHU Lille, Institut Pasteur de Lille, Inserm U1167, Lille, France
| | - Ari Chaouat
- INSERM UMR_S1116, Faculté de Médecine de Nancy, Université de Lorraine, Département de Pneumologie, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Céline Cheron
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Xavier Jaïs
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - François Picard
- Université Bordeaux, Hôpital Cardiologique du Haut-Lévêque, Heart Failure Unit and Pulmonary Hypertension Expert Centre, Bordeaux, France
| | - Grégoire Prévot
- CHU de Toulouse, Hôpital Larrey, Service de Pneumologie, Toulouse, France
| | - Anne Roche
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Sabina Solinas
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Vincent Cottin
- CHU de Lyon HCL, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Groupement Hospitalier Est, Hôpital Louis Pradel, Bron, France
| | - Fabrice Bauer
- INSERM U1096, Normandie Université, UNIROUEN, Department of Cardiac Surgery, CHU de Rouen, Rouen France
| | - David Montani
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marc Humbert
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Laurent Savale
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- These authors contributed equally to this work
| | - Olivier Sitbon
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- These authors contributed equally to this work
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3
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Chin KM, Gaine SP, Gerges C, Jing ZC, Mathai SC, Tamura Y, McLaughlin VV, Sitbon O. Treatment algorithm for pulmonary arterial hypertension. Eur Respir J 2024:2401325. [PMID: 39209476 DOI: 10.1183/13993003.01325-2024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024]
Abstract
Pulmonary arterial hypertension leads to significant impairment in haemodynamics, right heart function, exercise capacity, quality of life and survival. Current therapies have mechanisms of action involving signalling via one of four pathways: endothelin-1, nitric oxide, prostacyclin and bone morphogenetic protein/activin signalling. Efficacy has generally been greater with therapeutic combinations and with parenteral therapy compared with monotherapy or nonparenteral therapies, and maximal medical therapy is now four-drug therapy. Lung transplantation remains an option for selected patients with an inadequate response to therapies.
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Affiliation(s)
- Kelly M Chin
- Division of Pulmonary and Critical Care Medicine, UT Southwestern, Dallas, TX, USA
| | - Sean P Gaine
- Department of Respiratory Medicine, National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christian Gerges
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Zhi-Cheng Jing
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yuichi Tamura
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Vallerie V McLaughlin
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, Ann Arbor, MI, USA
| | - Olivier Sitbon
- Department of Respiratory Medicine, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Le Kremlin-Bicêtre, France
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4
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Savale L, Benazzo A, Corris P, Keshavjee S, Levine DJ, Mercier O, Davis RD, Granton JT. Transplantation, bridging, and support technologies in pulmonary hypertension. Eur Respir J 2024:2401193. [PMID: 39209471 DOI: 10.1183/13993003.01193-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 09/04/2024]
Abstract
Despite the progress made in medical therapies for treating pulmonary hypertension (PH), a subset of patients remain susceptible to developing a maladaptive right ventricular phenotype. The effective management of end-stage PH presents substantial challenges, necessitating a multidisciplinary approach and early identification of patients prone to acute decompensation. Identifying potential transplant candidates and assessing the feasibility of such a procedure are pivotal tasks that should be undertaken early in the treatment algorithm. Inclusion on the transplant list is contingent upon a comprehensive risk assessment, also considering the specific type of PH and various factors affecting waiting times, all of which should inform the decision-making process. While bilateral lung transplantation is the preferred option, it demands expert intra- and post-operative management to mitigate the heightened risks of pulmonary oedema and primary graft dysfunction in PH patients.Despite the availability of risk assessment tools, the occurrence of acute PH decompensation episodes can be unpredictable, potentially leading to refractory right ventricular failure even with optimal medical intervention, necessitating the use of rescue therapies. Advancements in right ventricular assist techniques and adjustments to graft allocation protocols for the most critically ill patients have significantly enhanced the survival in intensive care, affording the opportunity to endure while awaiting an urgent transplant. Given the breadth of therapeutic options available, specialised centres capable of delivering comprehensive care have become indispensable for optimising patient outcomes. These centres are instrumental in providing holistic support and management tailored to the complex needs of PH patients, ultimately enhancing their chances of a successful transplant and improved long-term prognosis.
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Affiliation(s)
- Laurent Savale
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculté de Médecine, HPPIT, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Alberto Benazzo
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Paul Corris
- Newcastle University and Institute of Transplantation, Freeman Hospital, Newcastle, UK
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Deborah Jo Levine
- Division of Pulmonary, Critical Care and Allergy, Stanford University, Palo Alto, CA, USA
| | - Olaf Mercier
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculté de Médecine, HPPIT, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- Marie Lannelongue Hospital, Dept of Thoracic Surgery and Heart-Lung Transplantation, Le lessis Robinson, France
| | - R Duane Davis
- Thoracic and Cardiac Surgery, AdventHealth Transplant Institute, Orlando, FL, USA
| | - John T Granton
- Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada
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5
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Ferrero P, Krishnathasan K, Constantine A, Chessa M, Dimopoulos K. Pulmonary arterial hypertension in congenital heart disease. Heart 2024; 110:1145-1152. [PMID: 37963728 DOI: 10.1136/heartjnl-2023-322890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Affiliation(s)
- Paolo Ferrero
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Milan, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, Rome, Italy
| | - Kaushiga Krishnathasan
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Massimo Chessa
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Milan, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, Rome, Italy
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Lokhorst C, van der Werf S, Berger RMF, Douwes JM. Prognostic Value of Serial Risk Stratification in Adult and Pediatric Pulmonary Arterial Hypertension: A Systematic Review. J Am Heart Assoc 2024; 13:e034151. [PMID: 38904230 PMCID: PMC11255703 DOI: 10.1161/jaha.123.034151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/10/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND In pulmonary arterial hypertension, it is recommended to base therapeutic decisions on risk stratification. This systematic review aims to report the prognostic value of serial risk stratification in adult and pediatric pulmonary arterial hypertension and to explore the usability of serial risk stratification as treatment target. METHODS AND RESULTS Electronic databases PubMed, Embase, and Web of Science were searched up to January 30, 2023, using terms associated with pulmonary arterial hypertension, pediatric pulmonary hypertension, and risk stratification. Observational studies and clinical trials describing risk stratification at both baseline and follow-up were included. Sixty five studies were eligible for inclusion, including only 2 studies in a pediatric population. C-statistic range at baseline was 0.31 to 0.77 and improved to 0.30 to 0.91 at follow-up. In 53% of patients, risk status changed (42% improved, 12% worsened) over 168 days (interquartile range, 137-327 days; n=22 studies). The average proportion of low-risk patients increased from 18% at baseline to 36% at a median follow-up of 244 days (interquartile range, 140-365 days; n=40 studies). In placebo-controlled drug studies, risk statuses of the intervention groups improved more and worsened less compared with the placebo groups. Furthermore, a low-risk status, but also an improved risk status, at follow-up was associated with a better outcome. Similar results were found in the 2 pediatric studies. CONCLUSIONS Follow-up risk stratification has improved prognostic value compared with baseline risk stratification, and change in risk status between baseline and follow-up corresponded to a change in survival. These data support the use of serial risk stratification as treatment target in pulmonary arterial hypertension.
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Affiliation(s)
- Chantal Lokhorst
- Department of Pediatric Cardiology, Center for Congenital Heart Diseases, Beatrix Children’s HospitalUniversity Medical Center Groningen, University of Groningenthe Netherlands
| | - Sjoukje van der Werf
- Central Medical LibraryUniversity Medical Center Groningen, University of Groningenthe Netherlands
| | - Rolf M. F. Berger
- Department of Pediatric Cardiology, Center for Congenital Heart Diseases, Beatrix Children’s HospitalUniversity Medical Center Groningen, University of Groningenthe Netherlands
| | - Johannes M. Douwes
- Department of Pediatric Cardiology, Center for Congenital Heart Diseases, Beatrix Children’s HospitalUniversity Medical Center Groningen, University of Groningenthe Netherlands
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7
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Zhou Z, Gu Y, Tian L, Zheng H, Li S. Development and Validation of a Nomogram of Persistent Pulmonary Hypertension in Adult Pretricuspid Shunts After Correction. J Am Heart Assoc 2024; 13:e032412. [PMID: 38639332 PMCID: PMC11179888 DOI: 10.1161/jaha.123.032412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/05/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Pretricuspid shunts have been associated with poorer survival rates in patients with Eisenmenger syndrome compared with postricuspid shunts and complex lesions. However, the risk stratification for persistent pulmonary hypertension (PH) in this population remains uncertain. METHODS AND RESULTS We retrospectively enrolled 103 patients with pretricuspid shunts with high total pulmonary resistance >4.5 Wood units (estimated pulmonary vascular resistance ≥3 Wood units). During a mean±SD follow-up of 20.95±24.84 months, 32 patients developed postoperative persistent PH after shunt correction. We identified 3 significant predictors of postoperative persistent PH, including mean pulmonary artery pressure after inhaled oxygen ≥40.5 mm Hg (odds ratio [OR], 7.78 [95% CI, 2.02-30.03]; P<0.01), total pulmonary resistance after inhaled oxygen ≥6.5 Wood units (estimated pulmonary vascular resistance ≥5 Wood units; OR, 12.23 [95% CI, 2.12-70.46]; P<0.01), and artery oxygen saturation at rest <95% (OR, 3.34 [95% CI, 1.07-10.44]; P=0.04). We established the prediction model with the C-statistics of 0.85 (95% CI, 0.77-0.93; P<0.01), and the C-statistic was 0.83 (95% CI, 0.80-0.86) after bootstrapping 10 000 times with a good performance of the nomogram calibration curve for predicting persistent PH. CONCLUSIONS Our study presents a multivariable risk stratification model for persistent PH after shunt correction in adults with pretricuspid shunts. This model, based on 3 hemodynamic predictors after inhaled oxygen, may assist in identifying individuals at higher risk of persistent PH after shunt correction.
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Affiliation(s)
- Zeming Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Yuanrui Gu
- Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Lili Tian
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Hong Zheng
- Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Shiguo Li
- Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
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8
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Valdeolmillos E, Foray C, Albenque G, Batteux C, Petit J, Lecerf F, Jaïs X, Sitbon O, Montani D, Savale L, Humbert M, Hascoët S. Percutaneous atrial septal defect closure in patients with pulmonary arterial hypertension. Eur Respir J 2024; 63:2301649. [PMID: 38754963 DOI: 10.1183/13993003.01649-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/04/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Estibaliz Valdeolmillos
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Claire Foray
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
| | - Gregoire Albenque
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Clément Batteux
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Jerome Petit
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
| | - Florence Lecerf
- Research and Innovation Department, Marie Lannelongue Hospital, Paris Saclay University, Le Plessis-Robinson, France
| | - Xavier Jaïs
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations, Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe, Hospitalier Paris-Saint Joseph, Paris, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremin-Bicêtre, France
- Inserm UMR-S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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Aldweib N, Broberg C. Failing with Cyanosis-Heart Failure in End-Stage Unrepaired or Partially Palliated Congenital Heart Disease. Heart Fail Clin 2024; 20:223-236. [PMID: 38462326 DOI: 10.1016/j.hfc.2023.12.008] [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: 03/12/2024]
Abstract
Heart failure in cyanotic congenital heart disease (CHD) is diagnosed clinically rather than relying solely on ventricular function assessments. Patients with cyanosis often present with clinical features indicative of heart failure. Although myocardial injury and dysfunction likely contribute to cyanotic CHD, the primary concern is the reduced delivery of oxygen to tissues. Symptoms such as fatigue, lassitude, dyspnea, headaches, myalgias, and a cold sensation underscore inadequate tissue oxygen delivery, forming the basis for defining heart failure in cyanotic CHD. Thus, it is pertinent to delve into the components of oxygen delivery in this context.
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Affiliation(s)
- Nael Aldweib
- Knight Cardiovascular Institute, Oregon Health and Science University, UHN-623181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Craig Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, UHN-623181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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10
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Kusner J, Krasuski RA. Pulmonary Hypertension in Adult Congenital Heart Disease-Related Heart Failure. Heart Fail Clin 2024; 20:209-221. [PMID: 38462325 DOI: 10.1016/j.hfc.2023.12.010] [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: 03/12/2024]
Abstract
Already a challenging condition to define, adult congenital heart disease (ACHD) -associated heart failure (HF) often incorporates specific anatomies, including intracardiac and extracardiac shunts, which require rigorous diagnostic characterization and heighten the importance of clinicians proactively considering overall hemodynamic impacts of using specific therapies. The presence of elevated pulmonary vascular resistance dramatically increases the complexity of managing patients with ACHD-HF. Total circulatory management in patients with ACHD-HF requires input from multidisciplinary care teams and thoughtful and careful utilization of medical, interventional, and surgical approaches.
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Affiliation(s)
- Jonathan Kusner
- Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27705, USA
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Medical Center, Box 3012, Durham, NC 27710, USA.
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11
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D'Alto M, Bassareo PP. Raising the bar: triple therapy for pulmonary arterial hypertension associated with congenital heart disease. Heart 2024; 110:309-310. [PMID: 37903554 DOI: 10.1136/heartjnl-2023-323462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
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12
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Gordon B, Buendía-Fuentes F, Rueda-Soriano J, Merás Colunga P, Gallego P, González García AE, Prieto-Arévalo R, Segura de la Cal T, Rodríguez-Puras MJ, Montserrat S, Sarnago-Cebada F, Alonso-García A, Oliver JM, Dos-Subirà L. Univentricular hearts not undergoing Fontan: the type of palliation matters. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:6-16. [PMID: 36898520 DOI: 10.1016/j.rec.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is scarce information on patients with single ventricle physiology (SVP) and restricted pulmonary flow not undergoing Fontan circulation. This study aimed to compare survival and cardiovascular events in these patients according to the type of palliation. METHODS SVP patient data were obtained from the databases of the adult congenital heart disease units of 7 centers. Patients completing Fontan circulation or developing Eisenmenger syndrome were excluded. Three groups were created according to the source of pulmonary flow: G1 (restrictive pulmonary forward flow), G2 (cavopulmonary shunt), and G3 (aortopulmonary shunts±cavopulmonary shunt). The primary endpoint was death. RESULTS We identified 120 patients. Mean age at the first visit was 32.2 years. Mean follow-up was 7.1 years. Fifty-five patients (45.8%) were assigned to G1, 30 (25%) to G2, and 35 (29.2%) to G3. Patients in G3 had worse renal function, functional class, and ejection fraction at the first visit and a more marked ejection fraction decline during follow-up, especially when compared with G1. Twenty-four patients (20%) died, 38 (31.7%) were admitted for heart failure, and 21 (17.5%) had atrial flutter/fibrillation during follow-up. These events were more frequent in G3 and significant differences were found compared with G1 in terms of death (HR, 2.9; 95%CI, 1.14-7.37; P=.026) and atrial flutter/fibrillation (HR, 2.9; 95%CI, 1.11-7.68; P=.037). CONCLUSIONS The type of palliation in patients with SVP and restricted pulmonary flow not undergoing Fontan palliation identifies distinct profiles. Patients palliated with aortopulmonary shunts have an overall worse prognosis with higher morbidity and mortality.
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Affiliation(s)
- Blanca Gordon
- Unidad Integrada de Cardiopatías Congénitas del Adolescente y Adulto Vall d'Hebron-Sant Pau, Departamento de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Departamento de Cardiología, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Francisco Buendía-Fuentes
- Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Joaquín Rueda-Soriano
- Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Pablo Merás Colunga
- Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Pastora Gallego
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario Virgen del Rocío, Instituto de BioMedicina de Sevilla (IBIS), Seville, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
| | - Ana Elvira González García
- Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Prieto-Arévalo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Segura de la Cal
- Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María J Rodríguez-Puras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario Virgen del Rocío, Instituto de BioMedicina de Sevilla (IBIS), Seville, Spain
| | - Silvia Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Clinic Barcelona, Institut Clinic Cardiovascular (ICCV), Universidad de Barcelona, Instituto de Investigaciones BiomédicasAugust Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Fernando Sarnago-Cebada
- Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Andrés Alonso-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Oliver
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Dos-Subirà
- Unidad Integrada de Cardiopatías Congénitas del Adolescente y Adulto Vall d'Hebron-Sant Pau, Departamento de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
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13
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Wang Z, Li X, Li M, Peng J, Zhang H. The efficacy of the treat-repair-treat strategy for severe pulmonary arterial hypertension associated with congenital heart disease: a meta-analysis. BMC Cardiovasc Disord 2023; 23:569. [PMID: 37986143 PMCID: PMC10662905 DOI: 10.1186/s12872-023-03606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to evaluate the efficacy of the treat-repair-treat (TRT) strategy in the treatment of severe pulmonary arterial hypertension with congenital heart disease (PAH-CHD). METHODS PubMed, EMBASE, Cochrane and Web of Science online databases were searched by two independent investigators for studies that used the TRT strategy for PAH-CHD, and the retrieved studies were reviewed by a third investigator. The main outcomes were pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), 6-minute walk distance (6MWD), and transcutaneous oxygen saturation (SpO2). The changes were compared between follow-up and baseline. Stata version 14.0 was used for data analysis. A random-effects model was selected for meta-analysis. Subgroup analysis and meta-regression were used to find the source of heterogeneity. RESULTS A total of 335 patients from 9 single-arm studies were included. Meta-analysis showed significant reductions in PAP and PVR and improvements in 6MWD and SpO2 (PAP: SMD -2.73 95% CI -2.97, - 2.50 p = < 0.001; PVR: SMD -1.27 95% CI -1.53, - 1.02 p = < 0.001; 6MWD: SMD 1.88 95% CI 1.49, 2.27 p = < 0.001; SpO2: SMD 3.72 95% CI 3.13, 4.32 p = < 0.001). Subgroup analysis showed that younger patients had better efficacy, and the change in SpO2 was an indication for patient selection. The combined mortality rate was 5% at follow-up. CONCLUSIONS In this meta-analysis, we demonstrated that the TRT strategy may have positive effects on haemodynamics and cardiac function in patients with severe PAH-CHD at short-term follow-up. Our analysis suggests that changes in age and SpO2 may be related to patient prognosis. TRIAL REGISTRATION The protocol was registered on the PROSPERO website with the registration number CRD42022366552. The relevant registration information can be obtained from the website https://www.crd.york.ac.uk/prospero/#searchadvanced .
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Affiliation(s)
- Zhiyuan Wang
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89, Donggang Road, Yuhua District, Shijiazhuang City, Hebei Province, China
| | - Xiaobing Li
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89, Donggang Road, Yuhua District, Shijiazhuang City, Hebei Province, China
| | - Mengxuan Li
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89, Donggang Road, Yuhua District, Shijiazhuang City, Hebei Province, China
| | - Jun Peng
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89, Donggang Road, Yuhua District, Shijiazhuang City, Hebei Province, China
| | - Huijun Zhang
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, No. 89, Donggang Road, Yuhua District, Shijiazhuang City, Hebei Province, China.
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14
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Kaemmerer H, Diller GP, Dähnert I, Eichstaedt CA, Eicken A, Freiberger A, Freilinger S, Geiger R, Gorenflo M, Grünig E, Hager A, Herberg U, Huntgeburth M, Kaemmerer AS, Kozlik-Feldmann R, Lammers A, Nagdyman N, Michel S, Schmidt KH, Uebing A, von Scheidt F, Apitz C. [Pulmonary arterial hypertension in congenital heart disease - Part I]. Pneumologie 2023; 77:956-961. [PMID: 37963485 DOI: 10.1055/a-2146-7434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The number of adults with congenital heart disease (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary arterial hypertension (PAH), which may develop early in untreated CHD. Despite timely treatment of CHD, PAH often persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart defects" is addressed only relatively superficially in these guidelines. Therefore, this article addresses the perspective of congenital cardiology in greater depth.
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Affiliation(s)
- Harald Kaemmerer
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Gerhard Paul Diller
- Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Deutschland
| | - Ingo Dähnert
- Universitätsklinik für Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Christina A Eichstaedt
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Institut für Humangenetik, Universität Heidelberg, INF 366, Heidelberg, Deutschland
| | - Andreas Eicken
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Annika Freiberger
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Sebastian Freilinger
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Ralf Geiger
- Univ.-Klinik für Pädiatrie III, Kardiologie, Pneumologie, Allergologie, Cystische Fibrose, Innsbruck, Österreich
| | - Matthias Gorenflo
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Alfred Hager
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Ulrike Herberg
- Klinik für Kinderkardiologie und Angeborene Herzfehler, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Michael Huntgeburth
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | | | - Rainer Kozlik-Feldmann
- Klinik und Poliklinik für Kinderkardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Deutschland
| | - Astrid Lammers
- Klinik für Pädiatrische Kardiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Nicole Nagdyman
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Sebastian Michel
- LMU Klinikum, Herzchirurgische Klinik und Poliklinik, Sektion für Chirurgie angeborener Herzfehler und Kinderherzchirurgie, Campus Großhadern, München
| | - Kai Helge Schmidt
- Universitätsmedizin Mainz, Zentrum für Kardiologie - Kardiologie I, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Anselm Uebing
- Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler und Kinderkardiologie, Kiel, Deutschland
| | - Fabian von Scheidt
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin Ulm, Ulm, Deutschland
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15
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Liu Y, Li H, Li Y, Zhang J, Gu H, Wang J, Wang Q. Outcomes of pregnancy in women with different types of pulmonary hypertension. BMC Cardiovasc Disord 2023; 23:391. [PMID: 37558980 PMCID: PMC10410774 DOI: 10.1186/s12872-023-03423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is considered to increase maternal and fetal risk, and we attempt to explore pregnancy outcomes in women with different types of PH. METHODS We retrospectively analyzed the clinical data of pregnant women with PH who were admitted to Anzhen Hospital from January 2010 to December 2019, and followed up on these parturients and their offspring. RESULTS Three hundred and sixty-six pregnant women with PH were collected, including 265 pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD), 65 PH caused by left heart disease, 12 idiopathic PH, and 24 PH associated with other diseases. Maternal mean age was 28.4 ± 4.4 years and 72.1% were nulliparous. The estimated systolic pulmonary artery pressure was < 50 mmHg in 40.2% of patients, 50-70 mmHg in 23.2%, and > 70 mmHg in 36.6%. In more than 94% of women, a diagnosis of PH was made before pregnancy. During pregnancy, heart failure occurred in 15% of patients. Cesarean section was performed in 90.5% (20.4% emergency). Complications included fetal mortality (0.5%), preterm delivery (40.4%), and low birth weight (37.7%). A total of 20 mothers died (5.5%). The highest mortality rate was found in patients with idiopathic PH (4/12, 33.3%). A total of 12 children died (3.3%), 5 (1.4%) of them after discharge from the hospital, and 7 (1.9%) were in hospital. CONCLUSIONS Although most of these women are fertile, PH does increase maternal and fetal risk. Women with idiopathic PH and Eisenmenger syndrome are not recommended to have children.
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Affiliation(s)
- Yang Liu
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China
| | - Haitao Li
- Department of Adult Cardiac Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China
| | - Yanna Li
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China
| | - Hong Gu
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China
| | - Jiangang Wang
- Department of Adult Cardiac Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China.
- Capital Medical University, Beijing Anzhen Hospital, No.2 An Zhen Road, Chaoyang District, Beijing, 100029, China.
| | - Qiang Wang
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China.
- Capital Medical University, Beijing Anzhen Hospital, No.2 An Zhen Road, Chaoyang District, Beijing, 100029, China.
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16
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Yang L, Guan L, Chen D, Zhang X, Zhang Y, Chen S, Li W, Qi Y, Zhou D, Pan W, Ge J. Impact of current targeted drug therapy on the prognosis of Eisenmenger syndrome: A large-scale retrospective analysis. Hellenic J Cardiol 2023; 72:9-14. [PMID: 36924996 DOI: 10.1016/j.hjc.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/21/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Data regarding the prognosis of Eisenmenger syndrome (ES) and effect of targeted drugs are limited. This study aimed to analyze the prognosis and impact of targeted drug therapy on the survival rate of patients with ES in the Chinese population. METHODS The data of patients with ES referred to our hospital between January 2010 and December 2020 were retrospectively analyzed. Data included baseline demographics, echocardiographic parameters, and clinical diagnoses. All patients were followed up via telephone interviews in February 2022. The primary endpoint was mortality. RESULTS Overall, 1,021 patients with ES were included. The 1-, 3-, 5-, 7-, 10-, and 12-year survival rates were 91.6%, 84.2%, 80.7%, 73.8%, 71.4%, and 69.9%, respectively. Patients with atrial septal defects had the best prognosis than those with ventricular septal defects, patent ductus arteriosus, and complex congenital heart disease (CHD) (P < 0.0001). Patients who visited between 2016 and 2020 received increased targeted drug therapy and had a better prognosis than those who visited between 2010 and 2015 (all P < 0.05). Cox regression analysis revealed age, pulmonary arterial systolic pressure, post-tricuspid shunt CHD, targeted drugs, and year of the first hospital visit to be predictors of death (P < 0.05). CONCLUSIONS Survival rates associated with an increased use of combined targeted drugs significantly improved in patients with ES. However, numerous factors that predict increased mortality remain to be elucidated.
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Affiliation(s)
- Lifan Yang
- Shanghai Xuhui District Central Hospital, Shanghai, China
| | - Lihua Guan
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dandan Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaochun Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiming Qi
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Wenzhi Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
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17
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Maurer SJ, Habdank V, Hörer J, Ewert P, Tutarel O. NT-proBNP Is a Predictor of Mortality in Adults with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease. J Clin Med 2023; 12:3101. [PMID: 37176542 PMCID: PMC10179459 DOI: 10.3390/jcm12093101] [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: 01/31/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND About 5-10% of adults with congenital heart disease (ACHD) will develop pulmonary arterial hypertension (PAH), which is associated with significant mortality. Studies on risk factors for poor outcome in a contemporary cohort of these patients with PAH associated with CHD (PAH-CHD) are rare. METHODS In this retrospective, single-center study, adult patients with the diagnosis PAH-CHD who had at least one contact as an outpatient or inpatient at the German Heart Centre Munich during the period January 2010-September 2019 were included. Patients with PAH without a CHD were excluded. The primary endpoint was all-cause mortality. RESULTS Altogether, 158 patients (mean age 39.9 ± 15.4 years, female 64.6%) were included in the study. A pre-tricuspid shunt was present in 17.7%, other shunts in 51.3%, PAH associated with complex CHD in 22.8%, and segmental PAH in 8.2%. An NT-proBNP measurement at baseline was available in 95 patients (60.1%). During a median follow-up of 5.37 years [IQR 1.76-8.63], the primary endpoint occurred in 10 patients (6.7%). On univariate analysis, CRP (log) (HR 3.35, 95% CI (1.07-10.48), p = 0.037), NT-proBNP (log) (HR: 7.10, 95% CI: 1.57-32.23, p = 0.011), and uric acid (HR: 1.37, 95% CI: 1.05-1.79, p = 0.020) were predictors of the primary endpoint. On multivariate analysis, only NT-proBNP (log) (HR: 6.91, 95% CI: 1.36-35.02, p = 0.0196) remained as an independent predictor. CONCLUSION NT-proBNP is an independent predictor of all-cause mortality in a contemporary cohort of PAH-CHD patients. The role of CRP and uric acid should be further assessed in future studies.
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Affiliation(s)
- Susanne J. Maurer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany
| | - Veronika Habdank
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technical University of Munich, 80636 Munich, Germany
- Division of Congenital and Paediatric Heart Surgery, University Hospital Munich, Ludwig-Maximilians Universität, 81377 Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80992 Munich, Germany
| | - Oktay Tutarel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80992 Munich, Germany
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18
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Ladouceur M, Valdeolmillos E, Karsenty C, Hascoet S, Moceri P, Le Gloan L. Cardiac Drugs in ACHD Cardiovascular Medicine. J Cardiovasc Dev Dis 2023; 10:190. [PMID: 37233157 PMCID: PMC10219196 DOI: 10.3390/jcdd10050190] [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: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Adult congenital heart disease (ACHD) is a growing population that requires life-long care due to advances in pediatric care and surgical or catheter procedures. Despite this, drug therapy in ACHD remains largely empiric due to the lack of clinical data, and formalized guidelines on drug therapy are currently lacking. The aging ACHD population has led to an increase in late cardiovascular complications such as heart failure, arrhythmias, and pulmonary hypertension. Pharmacotherapy, with few exceptions, in ACHD is largely supportive, whereas significant structural abnormalities usually require interventional, surgical, or percutaneous treatment. Recent advances in ACHD have prolonged survival for these patients, but further research is needed to determine the most effective treatment options for these patients. A better understanding of the use of cardiac drugs in ACHD patients could lead to improved treatment outcomes and a better quality of life for these patients. This review aims to provide an overview of the current status of cardiac drugs in ACHD cardiovascular medicine, including the rationale, limited current evidence, and knowledge gaps in this growing area.
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Affiliation(s)
- Magalie Ladouceur
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 75015 Paris, France
- Centre de Recherche Cardiovasculaire de Paris, INSERM U970, Université de Paris Cité, 75015 Paris, France
| | - Estibaliz Valdeolmillos
- Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery Department, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C Groupe Hospitalier Saint-Joseph, Paris-Saclay University, 92350 Le Plessis Robinson, France
- UMRS 999, INSERM, Marie-Lannelongue Hospital, Paris-Saclay University, 92350 Le Plessis Robinson, France
| | - Clément Karsenty
- Pediatric and Congenital Cardiology, Children’s Hospital CHU Toulouse, 31300 Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, 31300 Toulouse, France
| | - Sébastien Hascoet
- Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery Department, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C Groupe Hospitalier Saint-Joseph, Paris-Saclay University, 92350 Le Plessis Robinson, France
- UMRS 999, INSERM, Marie-Lannelongue Hospital, Paris-Saclay University, 92350 Le Plessis Robinson, France
| | - Pamela Moceri
- UR2CA, Equipe CARRES, Faculté de Médecine, Université Côte d’Azur, 06000 Nice, France
| | - Laurianne Le Gloan
- Cardiologie Congénitale Adulte, Institut du Thorax, CHU de Nantes, 44000 Nantes, France
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19
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Duncan E, Small A, Sulica R, Halpern D. Undiagnosed ventricular septal defect with resultant Eisenmenger syndrome presenting with diplopia. Am J Emerg Med 2023; 65:218.e1-218.e3. [PMID: 36456362 DOI: 10.1016/j.ajem.2022.11.029] [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: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
Ventricular septal defect (VSD) is the most common congenital heart lesion among children. In most cases, however, it is identified and corrected in childhood, before long-term sequelae such as pulmonary hypertension develop. In this case report, we present a young man with an undiagnosed VSD with consequent Eisenmenger syndrome who initially presented to medical attention with diplopia found to be caused by cerebral infarcts.
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Affiliation(s)
- Ellen Duncan
- Departments of Emergency Medicine and Pediatrics, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America.
| | - Adam Small
- Department of Medicine, Leon H. Charney Division of Cardiology, Adult Congenital Heart Disease Program, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America.
| | - Roxana Sulica
- Pulmonary Hypertension, Department of Medicine, Pulmonary Critical Care and Sleep Division, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America.
| | - Dan Halpern
- Department of Medicine, Leon H. Charney Division of Cardiology, Adult Congenital Heart Disease Program, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America.
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20
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Liu Y, Li Y, Zhang J, Zhao Y, Liu K, Li J, Zhao M, Gu H, Fan X, Wang J. Pregnancy outcomes of women with Eisenmenger syndrome: A single-center study. Int J Cardiol 2023; 374:35-41. [PMID: 36526021 DOI: 10.1016/j.ijcard.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 11/26/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND To explore the outcomes of mothers with Eisenmenger syndrome (ES) and their offspring. METHODS Pregnant women with ES admitted to the Beijing Anzhen Hospital between 2010 and 2019 were retrospectively analyzed and followed up. RESULTS Forty-two parturient women with ES were recruited, with an average age of 26.7 years (standard deviation [SD], ±4.0 years). The average gestational age was 33.7 weeks (SD, ±2.5 weeks). The average percutaneous oxygen saturation was 84.1 (±9.2), and 40 (95.2%) had caesarean delivery. The average pulmonary artery systolic pressure was 107.5 mmHg (SD, ±20.3 mmHg). Twelve (28.6%) women experienced pulmonary hypertensive crisis; 11 (26.2%) of these women died. Regarding the offspring, the average fetal weight was 1778.1 g (SD, ±555.3 g), six (14.3%) died, and congenital heart disease was diagnosed in three (7.1%). There were significant differences in age, gestational age, percutaneous oxygen saturation, Apgar score, and heart failure between the maternal death and non-death groups (P < 0.05). Death was mainly related to pulmonary hypertensive crisis and heart failure. CONCLUSIONS We recommend pregnancy termination if ES occurs during early pregnancy; however, patients should be informed of the risks if it occurs during late pregnancy. Multidisciplinary cooperation should be strengthened to improve the prognosis of the mothers and their offspring.
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Affiliation(s)
- Yang Liu
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road, Chaoyang District, 100029 Beijing, China
| | - Yanna Li
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road, Chaoyang District, 100029 Beijing, China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road, Chaoyang District, 100029 Beijing, China
| | - Yichen Zhao
- Department of Valvular Cardiac Surgery Center, Beijing Anzhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road, Chaoyang District, 100029 Beijing, China
| | - Kemin Liu
- Department of Valvular Cardiac Surgery Center, Beijing Anzhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road, Chaoyang District, 100029 Beijing, China
| | - Jiachen Li
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road, Chaoyang District, 100029 Beijing, China
| | - Mingming Zhao
- Department of Surgery, Hebei General Hospital, No. 348 Heping West Road, Xinhua District, 050055 Shijiazhuang City, Hebei Province, China
| | - Hong Gu
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road, Chaoyang District, 100029 Beijing, China
| | - Xiangming Fan
- Department of Pediatric Cardiac Surgery, Zhejiang Children's Hospital, Hangzhou City, Zhejiang Province, China
| | - Jiangang Wang
- Department of Valvular Cardiac Surgery Center, Beijing Anzhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road, Chaoyang District, 100029 Beijing, China.
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21
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Dimopoulos K, Constantine A, Clift P, Condliffe R, Moledina S, Jansen K, Inuzuka R, Veldtman GR, Cua CL, Tay ELW, Opotowsky AR, Giannakoulas G, Alonso-Gonzalez R, Cordina R, Capone G, Namuyonga J, Scott CH, D’Alto M, Gamero FJ, Chicoine B, Gu H, Limsuwan A, Majekodunmi T, Budts W, Coghlan G, Broberg CS, Constantine A, Clift P, Condliffe R, Moledina S, Jansen K. Cardiovascular Complications of Down Syndrome: Scoping Review and Expert Consensus. Circulation 2023; 147:425-441. [PMID: 36716257 PMCID: PMC9977420 DOI: 10.1161/circulationaha.122.059706] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in individuals with Down syndrome. Congenital heart disease is the most common cardiovascular condition in this group, present in up to 50% of people with Down syndrome and contributing to poor outcomes. Additional factors contributing to cardiovascular outcomes include pulmonary hypertension; coexistent pulmonary, endocrine, and metabolic diseases; and risk factors for atherosclerotic disease. Moreover, disparities in the cardiovascular care of people with Down syndrome compared with the general population, which vary across different geographies and health care systems, further contribute to cardiovascular mortality; this issue is often overlooked by the wider medical community. This review focuses on the diagnosis, prevalence, and management of cardiovascular disease encountered in people with Down syndrome and summarizes available evidence in 10 key areas relating to Down syndrome and cardiac disease, from prenatal diagnosis to disparities in care in areas of differing resource availability. All specialists and nonspecialist clinicians providing care for people with Down syndrome should be aware of best clinical practice in all aspects of care of this distinct population.
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Affiliation(s)
- Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.D., A.C.).,National Heart and Lung Institute, Imperial College London, United Kingdom (K.D., A.C.)
| | - Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.D., A.C.).,National Heart and Lung Institute, Imperial College London, United Kingdom (K.D., A.C.)
| | - Paul Clift
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, United Kingdom (P.C.)
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C.)
| | - Shahin Moledina
- National Paediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom (S.M.).,Institute of Cardiovascular Science, University College London, United Kingdom (S.M.)
| | - Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (K.J.).,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (K.J.)
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital, Japan (R.I.)
| | - Gruschen R. Veldtman
- Scottish Adult Congenital Cardiac Service, Golden Jubilee Hospital, Glasgow, Scotland, United Kingdom (G.R.V.)
| | - Clifford L. Cua
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH (C.L.C.)
| | - Edgar Lik Wui Tay
- Department of Cardiology, National University Hospital Singapore (E.T.L.W.)
| | - Alexander R. Opotowsky
- The Heart Institute, Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, OH (A.R.O.)
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital School of Medicine, Aristotle University of Thessaloniki, Greece (G.G.)
| | - Rafael Alonso-Gonzalez
- Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Canada (R.A.-G.).,Toronto Adult Congenital Heart Disease Program, Canada (R.A.-G.)
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, New South Wales, Australia (R.C.)
| | - George Capone
- Down Syndrome Clinical and Research Center, Kennedy Krieger Institute, Baltimore, MD (G. Capone).,Johns Hopkins School of Medicine, Baltimore, MD (G. Capone)
| | - Judith Namuyonga
- Department of Paediatric Cardiology, Uganda Heart Institute, Kampala (J.N.).,Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda (J.N.)
| | | | - Michele D’Alto
- Department of Cardiology, University “L. Vanvitelli”–Monaldi Hospital, Naples, Italy (M.D.)
| | - Francisco J. Gamero
- Department of Cardiovascular Surgery, Benjamin Bloom Children’s Hospital, El Salvador (F.J.G.)
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL (B.C.)
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (H.G.)
| | - Alisa Limsuwan
- Division of Pediatric Cardiology, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (A.L.)
| | - Tosin Majekodunmi
- Department of Cardiology, Euracare Multi-specialist Hospital, Nigeria (T.M.)
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Science, Catholic University Leuven, Belgium (W.B.)
| | - Gerry Coghlan
- Department of Cardiology, Royal Free Hospital, London, United Kingdom (G. Coghlan)
| | - Craig S. Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.S.B.)
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22
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Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 2023; 61:13993003.00879-2022. [PMID: 36028254 DOI: 10.1183/13993003.00879-2022] [Citation(s) in RCA: 517] [Impact Index Per Article: 517.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Marc Humbert
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France, Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Gabor Kovacs
- University Clinic of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Marius M Hoeper
- Respiratory Medicine, Hannover Medical School, Hanover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease (BREATH), member of the German Centre of Lung Research (DZL), Hanover, Germany
| | - Roberto Badagliacca
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
- Dipartimento Cardio-Toraco-Vascolare e Chirurgia dei Trapianti d'Organo, Policlinico Umberto I, Roma, Italy
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, Dept of Paediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Margarita Brida
- Department of Sports and Rehabilitation Medicine, Medical Faculty University of Rijeka, Rijeka, Croatia
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guys and St Thomas's NHS Trust, London, UK
| | - Jørn Carlsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrew J S Coats
- Faculty of Medicine, University of Warwick, Coventry, UK
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - Pilar Escribano-Subias
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV (Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Pisana Ferrari
- ESC Patient Forum, Sophia Antipolis, France
- AIPI, Associazione Italiana Ipertensione Polmonare, Bologna, Italy
| | - Diogenes S Ferreira
- Alergia e Imunologia, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, University Hospital Giessen, Justus-Liebig University, Giessen, Germany
- Department of Pneumology, Kerckhoff Klinik, Bad Nauheim, Germany
- Department of Medicine, Imperial College London, London, UK
| | - George Giannakoulas
- Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute, University of Sheffield, Sheffield, UK
| | - Eckhard Mayer
- Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Gergely Meszaros
- ESC Patient Forum, Sophia Antipolis, France
- European Lung Foundation (ELF), Sheffield, UK
| | - Blin Nagavci
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Karen M Olsson
- Clinic of Respiratory Medicine, Hannover Medical School, member of the German Center of Lung Research (DZL), Hannover, Germany
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Göran Rådegran
- Department of Cardiology, Clinical Sciences Lund, Faculty of Medicine, Lund, Sweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO. Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden
| | - Gerald Simonneau
- Faculté Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Centre de Référence de l'Hypertension Pulmonaire, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Olivier Sitbon
- INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
- Faculté Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mark Toshner
- Dept of Medicine, Heart Lung Research Institute, University of Cambridge, Royal Papworth NHS Trust, Cambridge, UK
| | - Jean-Luc Vachiery
- Department of Cardiology, Pulmonary Vascular Diseases and Heart Failure Clinic, HUB Hôpital Erasme, Brussels, Belgium
| | | | - Marion Delcroix
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium
- The two chairpersons (M. Delcroix and S. Rosenkranz) contributed equally to the document and are joint corresponding authors
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Department of Cardiology, Pulmonology and Intensive Care Medicine), and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University Hospital Cologne, Köln, Germany
- The two chairpersons (M. Delcroix and S. Rosenkranz) contributed equally to the document and are joint corresponding authors
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Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43:3618-3731. [PMID: 36017548 DOI: 10.1093/eurheartj/ehac237] [Citation(s) in RCA: 1170] [Impact Index Per Article: 585.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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24
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Liu Y, Li Y, Zhang J, Zhang D, Li J, Zhao Y, Liu K, Ma X, Bai C, Gu H, Fan X, Wang J. Maternal and fetal outcomes of pregnant women with pulmonary arterial hypertension associated with congenital heart disease in Beijing, China: a retrospective study. Pulm Circ 2022; 12:e12079. [PMID: 35514772 PMCID: PMC9063973 DOI: 10.1002/pul2.12079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/11/2022] Open
Abstract
As pulmonary arterial hypertension associated with congenital heart disease (PAH‐CHD) may increase maternal and fetal risk, this study explored the pregnancy outcomes of Chinese women with PAH‐CHD. The clinical data of pregnant women with PAH‐CHD admitted to the Beijing Anzhen Hospital from 2010 to 2019 were retrospectively analyzed; these patients and their offspring were followed up, with a mean period of 5.9 ± 2.7 years. Overall, 260 patients with PAH‐CHD were included. The mean maternal age was 27.7 ± 4.1 years, and 205 (78.8%) patients were nulliparous. The estimated systolic pulmonary artery pressure was 40–50 mmHg in 34.6% of the patients, 50–70 mmHg in 23.1%, and >70 mmHg in 42.3%. More than 96% of patients were diagnosed with PAH‐CHD before pregnancy. During pregnancy, heart failure occurred in 19.2% of the patients. Cesarean delivery was performed in 88.1% (15.0% emergency) of the patients. Complications included fetal distress (5.8%), preterm delivery (34.2%), and low birth weight (33.8%). A total of 15 mothers (5.8%) died, with the highest mortality rate in those with Eisenmenger syndrome (10/43, 23.3%), and 10 offspring died (3.8%), two (0.8%) following hospital discharge and eight (3.1%) while in hospital. Although most pregnant women with PAH‐CHD were able to have children, PAH increased the maternal and fetal risk. Thus, an individualized risk‐based approach with shared decision‐making may be more appropriate in pregnant women with PAH‐CHD.
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Affiliation(s)
- Yang Liu
- Department of Pediatric Cardiac Center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Yanna Li
- Department of Obstetrics and Gynecology Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Jun Zhang
- Department of Obstetrics and Gynecology Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Dawei Zhang
- Department of Obstetrics and Gynecology Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Jiachen Li
- Department of Pediatric Cardiac Center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Yichen Zhao
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Kemin Liu
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Xiaolong Ma
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Chen Bai
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Hong Gu
- Department of Pediatric Cardiac Center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Xiangming Fan
- Department of Pediatric Cardiac Center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Jiangang Wang
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
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25
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Arvanitaki A, Gatzoulis MA, Opotowsky AR, Khairy P, Dimopoulos K, Diller GP, Giannakoulas G, Brida M, Griselli M, Grünig E, Montanaro C, Alexander PD, Ameduri R, Mulder BJM, D'Alto M. Eisenmenger Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:1183-1198. [PMID: 35331414 DOI: 10.1016/j.jacc.2022.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 12/12/2022]
Abstract
Although major breakthroughs in the field of pediatric cardiology, cardiac surgery, intervention, and overall care improved the outlook of congenital heart disease, Eisenmenger syndrome (ES) is still encountered and remains a complex clinical entity with multisystem involvement, including secondary erythrocytosis, increased thrombotic and bleeding diathesis, high arrhythmogenic risk, progressive heart failure, and premature death. Clearly, care for ES is best delivered in multidisciplinary expert centers. In this review, we discuss the considerable recent progress in understanding the complex pathophysiology of ES, means of prognostication, and improvement in clinical outcomes achieved with pulmonary arterial hypertension-targeted therapies. Additionally, we delineate areas of uncertainty in various aspects of care, discuss gaps in current evidence, and review current status in less privileged countries and propose initiatives to reduce disease burden. Finally, we propose the application of emerging technologies to enhance the delivery and quality of health care related to ES and beyond.
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Affiliation(s)
- Alexandra Arvanitaki
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom; First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom.
| | - Alexander R Opotowsky
- The Cincinnati Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom
| | - Gerhard-Paul Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Margarita Brida
- Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Massimo Griselli
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom; Pediatric Cardiac Surgery and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, and German Center of Lung Research (DZL), TLRC Heidelberg, Heidelberg, Germany
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom
| | - Peter David Alexander
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom
| | - Rebecca Ameduri
- Pediatric Cardiac Surgery and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital - "L. Vanvitelli" University, Naples, Italy.
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26
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Chiu S, Lu C, Lin M, Chen C, Wu M, Wang J. Pulmonary Hypertension in Adult Congenital Heart Disease in Asia: A Distinctive Feature of Complex Congenital Heart Disease. J Am Heart Assoc 2022; 11:e022596. [PMID: 35285668 PMCID: PMC9075472 DOI: 10.1161/jaha.121.022596] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background The epidemiology of pulmonary hypertension (PH) in patients with adult congenital heart disease in Western countries is already known. We investigate clinical characteristics of PH in adult congenital heart disease with emphasis on complex congenital heart disease (CHD) from an Asian cohort in Taiwan. Methods and Results All adult patients (aged >18 years) diagnosed with CHD between January 2007 and July 2018 qualified for the study. PH was determined by cardiac catheterization data or echocardiography reports. In accord with the World Symposia on Pulmonary Hypertension, CHD was further categorized as simple, severe, or complex CHD (including pulmonary atresia‐ventricular septal defect and single‐ventricle anomalies). There were 4301 patients (55.6% women), 15.7% with severe and 3.9% with complex CHD. The cumulative incidence of PH was 4.4% (95% CI, 3.8–5.0). Our multivariable regression model indicated 4.2‐fold mortality increase (95% CI, 3.0–5.9) in the presence of PH, with age, female sex, and severe or complex CHD linked to higher incidence of PH. Only 49% of patients received PH‐specific therapy. Five‐ and 10‐year survival rates of patients with PH (n=190) were 72.3% (95% CI, 65.1%–78.4%) and 58.8% (95% CI, 50.1%–66.5%), respectively. Survival rates in those with Eisenmenger syndrome, PH after defect correction, and complex CHD were similar. Low oxygen saturation and high uric acid levels were associated with increased mortality. Conclusions In this sizable Asian adult CHD cohort, the cumulative incidence of PH was aligned with that of Western countries. Mortality proved higher in patients with PH versus without PH. Although complex CHD carried greater risk of PH compared with other adult CHD subsets, survival rate was similar.
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Affiliation(s)
- Shuenn‐Nan Chiu
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Chun‐Wei Lu
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Ming‐Tai Lin
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Chun‐An Chen
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Mei‐Hwan Wu
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
| | - Jou‐Kou Wang
- Department of Pediatrics National Taiwan University Hospital and Medical CollegeNational Taiwan University Taipei Taiwan
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27
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Exercise ventilatory reserve predicts survival in adult congenital heart disease associated pulmonary arterial hypertension with Eisenmenger physiology. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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28
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Leczycki P, Banach M, Maciejewski M, Bielecka-Dabrowa A. Heart Failure Risk Predictions and Prognostic Factors in Adults With Congenital Heart Diseases. Front Cardiovasc Med 2022; 9:692815. [PMID: 35282364 PMCID: PMC8907450 DOI: 10.3389/fcvm.2022.692815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
In recent decades the number of adults with congenital heart diseases (ACHD) has increased significantly. This entails the need for scrupulous evaluation of the current condition of these patients. The ACHD population is one of the most challenging in contemporary medicine, especially as well-known scales such as the NYHA classification have very limited application. At the moment, there is a lack of universal parameters or scales on the basis of which we can easily capture the moment of deterioration of our ACHD patients' condition. Hence it is crucial to identify factors that are widely available, cheap and easy to use. There are studies showing more and more potential prognostic factors that may be of use in clinical practice: thorough assessment with echocardiography and magnetic resonance imaging (e.g., anatomy, ventricular function, longitudinal strain, shunt lesions, valvular defects, pericardial effusion, and pulmonary hypertension), cardiopulmonary exercise testing (e.g., peak oxygen uptake, ventilatory efficiency, chronotropic incompetence, and saturation) and biomarkers (e.g., N-terminal pro-brain type natriuretic peptide, growth-differentiation factor 15, high-sensitivity troponin T, red cell distribution width, galectin-3, angiopoietin-2, asymmetrical dimethylarginine, and high-sensitivity C-reactive protein). Some of them are very promising, but more research is needed to create a specific panel on the basis of which we will be able to assess patients with specific congenital heart diseases.
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Affiliation(s)
- Patryk Leczycki
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland
- *Correspondence: Patryk Leczycki
| | - Maciej Banach
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Łodź, Poland
| | - Marek Maciejewski
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland
| | - Agata Bielecka-Dabrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Łodź, Poland
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29
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Anesthetic Management in Adults with Congenital Heart Disease. Curr Cardiol Rep 2022; 24:235-246. [PMID: 35080704 DOI: 10.1007/s11886-022-01639-y] [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] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Adults with congenital heart disease (ACHD) are a complex and growing population that presents numerous challenges for anesthetic management. This review summarizes special considerations for anesthetic management in ACHD. RECENT FINDINGS The adult patient with congenital heart disease may require anesthetic care for multiple surgeries and interventions throughout their lifetime. The cardiac and extracardiac manifestations of ACHD have important perioperative implications that affect anesthetic management. Recent American Heart Association/American College of Cardiology and European Society of Cardiology guidelines endorse a multidisciplinary, team-based approach to care. The cardiac anesthesiologist, endorsed as part of this multidisciplinary team, must have a thorough understanding of congenital heart disease pathophysiology and common extra-cardiac manifestations of ACHD. Safe anesthetic management in adult congenital heart disease should incorporate a multi-disciplinary approach to patient care. Anesthesiologists and centers with special expertise in ACHD care should be utilized or consulted whenever possible.
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30
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Arvanitaki A, Diller GP. The use of pulmonary arterial hypertension therapies in Eisenmenger syndrome. Expert Rev Cardiovasc Ther 2021; 19:1053-1061. [PMID: 34958619 DOI: 10.1080/14779072.2021.2021069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION For many years, treatment options for patients with Eisenmenger physiology had been restricted to conservative measures to alleviate multi-system complications. The use of pulmonary arterial hypertension (PAH)-targeted therapies in patients with Eisenmenger syndrome (ES) changed the course of the disease, since they substantially improved clinical outcomes and increased survival. AREAS COVERED In this review, we primarily focus on the use of PAH pharmacotherapies in ES. A literature search was carried out in PubMed, Scopus and Cochrane Database up to May 2021. We thoroughly discuss current evidence about mechanisms of action, safety, and efficacy of these agents and present challenges and gaps in literature regarding the recommended treatment approach. EXPERT OPINION Unlike other forms of PAH, we usually treat patients with ES more conservatively as we lack evidence that aggressive management is safe and effective in this complex population. Several issues on the time of initiation of PAH-targeted therapies, choice between monotherapy vs. upfront combination therapy, and time of escalation still remain challenging and require further investigation. Therapeutic management should be guided by patients' individual evaluation based on available prognostic markers. More well-designed trials are warranted to assess the benefits of new PAH-targeted agents and combination therapies.
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Affiliation(s)
- Alexandra Arvanitaki
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert‑Schweitzer‑Campus 1, Muenster, Germany.,Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Nhs Foundation Trust, Nhli, Imperial College, London, UK
| | - Gerhard-Paul Diller
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert‑Schweitzer‑Campus 1, Muenster, Germany.,Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Nhs Foundation Trust, Nhli, Imperial College, London, UK.,National Register for Congenital Heart Defects, Berlin, Germany
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31
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Kaemmerer AS, Gorenflo M, Huscher D, Pittrow D, Ewert P, Pausch C, Delcroix M, Ghofrani HA, Hoeper MM, Kozlik-Feldmann R, Skride A, Stähler G, Vizza CD, Jureviciene E, Jancauskaite D, Gumbiene L, Ewert R, Dähnert I, Held M, Halank M, Skowasch D, Klose H, Wilkens H, Milger K, Jux C, Koestenberger M, Scelsi L, Brunnemer E, Hofbeck M, Ulrich S, Vonk Noordegraaf A, Lange TJ, Bruch L, Konstantinides S, Claussen M, Löffler-Ragg J, Wirtz H, Apitz C, Neidenbach R, Freilinger S, Nemes A, Opitz C, Grünig E, Rosenkranz S. Medical treatment of pulmonary hypertension in adults with congenital heart disease: updated and extended results from the International COMPERA-CHD Registry. Cardiovasc Diagn Ther 2021; 11:1255-1268. [PMID: 35070795 PMCID: PMC8748472 DOI: 10.21037/cdt-21-351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 08/26/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is common in congenital heart disease (CHD). Because clinical-trial data on PAH associated with CHD (PAH-CHD) remain limited, registry data on the long-term course are essential. This analysis aimed to update information from the COMPERA-CHD registry on management strategies based on real-world data. METHODS The prospective international pulmonary hypertension registry COMPERA has since 2007 enrolled more than 10,000 patients. COMPERA-CHD is a sub-registry for patients with PAH-CHD. RESULTS A total of 769 patients with PAH-CHD from 62 specialized centers in 12 countries were included into COMPERA-CHD from January 2007 through September 2020. At the last follow-up in 09/2020, patients [mean age 45.3±16.8 years; 512 (66%) female] had either post-tricuspid shunts (n=359; 46.7%), pre-tricuspid shunts (n=249; 32.4%), complex CHD (n=132; 17.2%), congenital left heart or aortic valve or aortic disease (n=9; 1.3%), or miscellaneous CHD (n=20; 2.6%). The mean 6-minute walking distance was 369±121 m, and 28.2%, 56.0%, and 3.8% were in WHO functional class I/II, III or IV, respectively (12.0% unknown). Compared with the previously published COMPERA-CHD data, after 21 months of follow-up, the number of included PAH-CHD patients increased by 91 (13.4%). Within this group the number of Eisenmenger patients rose by 39 (16.3%), the number of "Non-Eisenmenger PAH" patients by 45 (26.9%). Currently, among the 674 patients from the PAH-CHD group with at least one follow-up, 450 (66.8%) received endothelin receptor antagonists (ERA), 416 (61.7%) PDE-5 inhibitors, 85 (12.6%) prostacyclin analogues, and 36 (5.3%) the sGC stimulator riociguat. While at first inclusion in the COMPERA-CHD registry, treatment was predominantly monotherapy (69.3%), this has shifted to favoring combination therapy in the current group (53%). For the first time, the nature, frequency, and treatment of significant comorbidities requiring supportive care and medication are described. CONCLUSIONS Analyzing "real life data" from the international COMPERA-CHD registry, we present a comprehensive overview about current management modalities and treatment concepts in PAH-CHD. There was an trend towards more aggressive treatment strategies and combination therapies. In the future, particular attention must be directed to the "Non-Eisenmenger PAH" group and to patients with complex CHD, including Fontan patients. TRIAL REGISTRATION www.clinicaltrials.gov, study identifier: Clinicaltrials.gov NCT01347216.
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Affiliation(s)
- Ann-Sophie Kaemmerer
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Matthias Gorenflo
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Angelika-Lautenschläger-Klinik, Heidelberg, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin, Berlin, Germany
| | - David Pittrow
- Medical Faculty, Institute for Clinical Pharmacology, Technical University, Dresden, Germany
| | - Peter Ewert
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | | | - Marion Delcroix
- UZ Leuven, Campus Gasthuisberg, Department of Pneumology, Leuven, Belgium
| | - Hossein A. Ghofrani
- Universitätsklinikum Gießen und Marburg GmbH, Medizinische Klinik II/V, Gießen, Germany
| | - Marius M. Hoeper
- Medizinische Hochschule Hannover, Abt. Pneumologie, Hannover, Germany
| | - Rainer Kozlik-Feldmann
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Germany
| | - Andris Skride
- Riga Stradins University, Clinical University Hospital, Riga, Lativa
| | - Gerd Stähler
- Klinik Löwenstein, Medizinische Klinik I, Löwenstein, Germany
| | - Carmine Dario Vizza
- Pulmonary Hypertension Center, Department of Clinical Anestesiologic and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Elena Jureviciene
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dovile Jancauskaite
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Gumbiene
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Ralf Ewert
- Universitätsmedizin Greifswald, Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, Greifswald, Germany
| | - Ingo Dähnert
- Herzzentrum Leipzig GmbH, Klinik für Kinderkardiologie, Leipzig, Germany
| | - Matthias Held
- Med. Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Standort Missioklinik, Würzburg, Germany
| | - Michael Halank
- Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Dirk Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Innere Medizin - Kardiologie/Pneumologie, Bonn
| | - Hans Klose
- Abteilung für Pneumologie, Zentrum für Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Heinrike Wilkens
- Universitätsklinikum des Saarlandes, Innere Medizin V, Homburg, Germany
| | - Katrin Milger
- LMU Klinikum, Medizinische Klinik und Poliklinik V, München, Germany
| | - Christian Jux
- Kinderherzzentrum und Zentrum für angeborene Herzfehler, Justus-Liebig-Universität, Zentrum für Kinderheilkunde, Abteilung Kinderkardiologie, Gießen, Germany
| | - Martin Koestenberger
- LKH - Univ. Klinikum Graz, Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Kardiologie, Graz, Austria
| | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo University of Pavia, Pavia, Italy
| | - Eva Brunnemer
- Medizinische Universitätsklinik (Krehl-Klinik), Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III), Heidelberg, Germany
| | - Michael Hofbeck
- Universitätsklinik für Kinder- und Jugendmedizin Tübingen, Kinderkardiologie, Pulmologie, Intensivmedizin, Tübingen, Germany
| | - Silvia Ulrich
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich, Switzerland
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, dept of Pulmonary Medicine, Amsterdam, Netherlands
| | - Tobias J. Lange
- Universitätsklinikum Regensburg, Medizinische Klinik und Poliklinik II, Regensburg, Germany
| | - Leonhard Bruch
- Unfallkrankenhaus Berlin, Klinik für Innere Medizin, Berlin, Germany
| | | | - Martin Claussen
- LungenClinic Grosshansdorf, Fachabteilung Pneumologie, Großhansdorf, Germany
| | | | - Hubert Wirtz
- Universitätsklinikum Leipzig, Medizinische Klinik und Poliklinik I, Abteilung für Pneumologie, Leipzig, Germany
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Kardiologie, Ulm, Germany
| | - Rhoia Neidenbach
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Sebastian Freilinger
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Attila Nemes
- University of Szeged, Department of Medicine, Szeged, Hungary
| | - Christian Opitz
- DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Schwerpunkt Kardiologie, Berlin, Germany
| | - Ekkehard Grünig
- Thoraxklinik Heidelberg gGmbH, Zentrum für Pulmonale Hypertonie, Heidelberg, and German Centre for Lung Research, Heidelberg, Germany
| | - Stephan Rosenkranz
- Universitätsklinik Köln – Herzzentrum, Klinik III für Innere Medizin, Köln, Germany
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Abstract
Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5% to 10% of adults with CHD and is associated with significant morbidity and mortality. PAH-CHD develops as a consequence of intracardiac or extracardiac systemic-to-pulmonary shunts that lead to pulmonary vascular remodeling through a pathologic process that is similar to other causes of PAH. Eisenmenger syndrome is the most severe phenotype of PAH-CHD and is characterized by severe elevation in pulmonary vascular resistance, with shunt reversal causing hypoxemia and central cyanosis. The primary management strategy for most patients with PAH-CHD is medical therapy, although defect closure is considered in select cases.
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Affiliation(s)
- Sarah A Goldstein
- Section of Adult Congenital Heart Disease, Division of Cardiology, Duke University Medical Center, Box 3331, Durham, NC 27710, USA
| | - Richard A Krasuski
- Section of Adult Congenital Heart Disease, Division of Cardiology, Duke University Medical Center, Box 3331, Durham, NC 27710, USA.
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Wals-Rodriguez AJ, Rodriguez-Puras MJ, Garcia-Orta R, Robledo J, Moreno E, Federero C, Camacho R, Manso B, Hernandez N, Cubero JM, Abia RL, Ramos PC, Ordoñez A, Gallego P. Pulmonary hypertension in adults with congenital heart disease. Clinical phenotypes and outcomes in the advanced pulmonary vasodilator era. Heart Lung 2021; 51:75-81. [PMID: 34768115 DOI: 10.1016/j.hrtlng.2021.09.003] [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: 04/01/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mortality of pulmonary hypertension associated with congenital heart disease (PAH-CHD) in adults remains high. OBJECTIVES To identify predictors of death and to assess the impact of treatment on outcome. METHODS Retrospective, multicenter cohort study of 103 adults with PAH-CHD followed-up for 8.6 ± 4.6 years. Patients were grouped according to underlying shunt type into pre-tricuspid, post-tricuspid and complex. Survival rates were analyzed and predictors of death were investigated with Cox regression models. RESULTS In the post-tricuspid and complex groups (38 and 37 patients, respectively), the most common clinical PAH-CHD subgroup was Eisenmenger syndrome (76.3% and 59.5%, respectively) whereas, in the pre-tricuspid group (28 patients), 46.5% of patients had small or corrected defects. Overall, 88 patients received vasodilators; 39% required combination-therapy. Overall survival at 10 years was 65%. Mortality was highest in the pre-tricuspid group, FC-III-IV and amongst patients receiving monotherapy (p < 0.050). On multivariate analysis, predictors of poor outcome were pericardial effusion (HR: 4,520 [1,470-13,890]; p = 0,008), oxygen saturation(HR: 0.940 [0,900 - 0,990]; p = 0,018) and genetic syndromes(HR: 3,280 [1,098-9,780]; p = 0,033). CONCLUSIONS Patients in advanced stages at initiation of treatment were at high risk of death and strong consideration should be given for more aggressive therapy.
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Affiliation(s)
- Amadeo-José Wals-Rodriguez
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain
| | - Maria-Jose Rodriguez-Puras
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain
| | - Rocío Garcia-Orta
- Unidad de Cardiopatías Congénitas del Adulto, Hospitales Virgen de las Nieves y Clínico San Cecilio, Granada, Spain
| | - Juan Robledo
- Unidad de Cardiopatías Congénitas del Adulto, Hospital Universitario Virgen de la Victoria y CIBERCV, Málaga, Spain
| | - Eduardo Moreno
- Unidad de Cardiopatías Congénitas del Adulto, Hospitales Virgen de las Nieves y Clínico San Cecilio, Granada, Spain
| | - Carmen Federero
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain
| | - Rocio Camacho
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain
| | - Begoña Manso
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain; Cardiología Pediatrica, Hospital Infantil Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Sevilla, Spain
| | - Nuria Hernandez
- Unidad de Cardiopatías Congénitas del Adulto, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Jose María Cubero
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain
| | - Raquel Ladrón Abia
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain
| | - Pilar Cejudo Ramos
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain; UGC Médico-Quirùrgica de Enfermedades Respiratorias, Hospital General Universitario Virgen del Rocio, Sevilla, Spain
| | - Antonio Ordoñez
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain
| | - Pastora Gallego
- Unidad de Cardiopatías Congénitas del Adulto, Hospital General Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) y CIBERCV, Avenida Manuel Siurot S/N, Sevilla 41013, Spain.
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Gazengel P, Hascoët S, Amsallem M, Savale L, Montani D, Mercier O, Humbert M, Fadel E, Le Pavec J. Double-lung transplantation followed by delayed percutaneous repair for atrial septal defect-associated pulmonary arterial hypertension. Eur Respir J 2021; 59:13993003.02388-2021. [PMID: 34737221 DOI: 10.1183/13993003.02388-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Pierre Gazengel
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.,Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Sébastien Hascoët
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Service de cardiopathie congénitale de l'enfant et de l'adulte, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Myriam Amsallem
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Service de cardiologie, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Laurent Savale
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olaf Mercier
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.,Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marc Humbert
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Elie Fadel
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.,Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Jérôme Le Pavec
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France .,Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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35
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Hascoët S, Pontailler M, Le Pavec J, Savale L, Mercier O, Fabre D, Mussot S, Simonneau G, Jais X, Feuillet S, Stephan F, Cohen S, Bonnet D, Humbert M, Dartevelle P, Fadel E. Transplantation for pulmonary arterial hypertension with congenital heart disease: Impact on outcomes of the current therapeutic approach including a high-priority allocation program. Am J Transplant 2021; 21:3388-3400. [PMID: 33844424 DOI: 10.1111/ajt.16600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/25/2023]
Abstract
Patients with end-stage pulmonary arterial hypertension due to congenital heart disease have limited access to heart-lung transplantation or double-lung transplantation. We aimed to assess the effects of a high-priority allocation program established in France in 2007. We conducted a retrospective study to compare waitlist and posttransplantation outcomes before versus after implementation of the high-priority allocation program. We included 67 consecutive patients (mean age at listing, 33.2 ± 10.5 years) with pulmonary arterial hypertension due to congenital heart disease listed for heart-lung transplantation or double-lung transplantation from 1997 to 2016. At one month, the incidences of transplantation and death before transplantation were 3.5% and 24.6% in 1997-2006, 4.8% and 4.9% for patients on the regular list in 2007-2016, and 41.2% and 7.4% for patients listed under the high-priority allocation program (p < .001 and p = .0001, respectively). Overall survival was higher in patients listed in 2007-2016 (84.2% and 61.2% at 1 and 10 years vs. 36.8% and 22.1%, p = .0001). Increased incidence of transplantation, decreased waiting list mortality, and improved early and long-term outcomes were observed in patients with pulmonary arterial hypertension due to congenital heart disease listed for transplantation in the recent era, characterized by implementation of a high-priority allocation program.
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Affiliation(s)
- Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France.,UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France
| | - Margaux Pontailler
- Department of Congenital Heart Diseases, Centre de référence Malformations Cardiaques Congénitales Complexes M3C, Centre de Compétence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Universitaire Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jérôme Le Pavec
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Laurent Savale
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olaf Mercier
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Dominique Fabre
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Sacha Mussot
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Gérald Simonneau
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Séverine Feuillet
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Francois Stephan
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Sarah Cohen
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France
| | - Damien Bonnet
- Department of Congenital Heart Diseases, Centre de référence Malformations Cardiaques Congénitales Complexes M3C, Centre de Compétence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Universitaire Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marc Humbert
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Dartevelle
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Elie Fadel
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
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36
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Lachtrupp CL, Valente AM, Gurvitz M, Landzberg MJ, Brainard SB, Wu FM, Pearson DD, Taillie K, Opotowsky AR. Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System. J Am Heart Assoc 2021; 10:e021345. [PMID: 34482709 PMCID: PMC8649495 DOI: 10.1161/jaha.120.021345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background American Heart Association and American College of Cardiology consensus guidelines introduce an adult congenital heart disease anatomic and physiological (AP) classification system. We assessed the association between AP classification and clinical outcomes. Methods and Results Data were collected for 1000 outpatients with ACHD prospectively enrolled between 2012 and 2019. AP classification was assigned based on consensus definitions. Primary outcomes were (1) all‐cause mortality and (2) a composite of all‐cause mortality or nonelective cardiovascular hospitalization. Cox regression models were developed for AP classification, each component variable, and additional clinical models. Discrimination was assessed using the Harrell C statistic. Over a median follow‐up of 2.5 years (1.4–3.9 years), the composite outcome occurred in 185 participants, including 49 deaths. Moderately or severely complex anatomic class (class II/III) and severe physiological stage (stage D) had increased risk of the composite outcome (AP class IID and IIID hazard ratio, 4.46 and 3.73, respectively, versus IIC). AP classification discriminated moderately between patients who did and did not suffer the composite outcome (C statistic, 0.69 [95% CI, 0.67–0.71]), similar to New York Heart Association functional class and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide); it was more strongly associated with mortality (C statistic, 0.81 [95% CI, 0.78–0.84]), as were NT‐proBNP and functional class. A model with AP class and NT‐proBNP provided the strongest discrimination for the composite outcome (C statistic, 0.73 [95% CI, 0.71–0.75]) and mortality (C statistic, 0.85 [95% CI, 0.82–0.88]). Conclusions The addition of physiological stage modestly improves the discriminative ability of a purely anatomic classification, but simpler approaches offer equivalent prognostic information. The AP system may be improved by addition of key variables, such as circulating biomarkers, and by avoiding categorization of continuous variables.
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Affiliation(s)
- Cara L Lachtrupp
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Anne Marie Valente
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA
| | - Michelle Gurvitz
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA
| | - Michael J Landzberg
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA
| | | | - Fred M Wu
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA
| | | | - Keith Taillie
- Department of Cardiology Boston Children's Hospital Boston MA
| | - Alexander R Opotowsky
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA.,Department of Pediatrics Heart Institute Cincinnati Children's HospitalUniversity of Cincinnati College of Medicine Cincinnati OH
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37
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Diller GP, Lammers AE, Oechslin E. Treatment of adults with Eisenmenger syndrome-state of the art in the 21st century: a short overview. Cardiovasc Diagn Ther 2021; 11:1190-1199. [PMID: 34527543 DOI: 10.21037/cdt-21-135] [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: 03/02/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
Eisenmenger syndrome (ES) develops in association with unrepaired, non-restrictive cardiac shunt lesions at the atrial, ventricular or arterial level over time. In developed countries, cardiac defects are being operated on in a timely manner, before pulmonary vascular disease develops. However, with rising immigration from underserved countries, we increasingly see patients with shunt lesions, that are not amenable for repair as pulmonary vascular disease has already established. ES describes a symptom complex and patients present with heterogeneous problems involving many organ systems (multisystem disorder). Care in tertiary specialist cardiac centers with access to multidisciplinary subspecialities is required. Central cyanosis with secondary erythrocytosis is one of the key features of patients with ES. Clinical consequences of longstanding hypoxia can lead to other organ complications, that involve other organs than the heart alone. Although ES patients have a better prognosis compared to other patients with pulmonary arterial hypertension, ES grossly affects quality of life and morbidity is frequent. Follow-up and care at specialist congenital heart disease centers is highly recommended to prevent, to early diagnose and to timely manage complications of ES. This is necessary to maintain functional capacity, decrease morbidity and increase life expectancy for these vulnerable patients. The leading reasons for mortality are sudden cardiac death, progressive heart failure, and infectious diseases. Various factors have been shown to be associated with mortality like decreased arterial oxygen saturation, functional class, impaired exercise tolerance, syncopal events, iron deficiency, presence of pre-tricuspid shunts, arrhythmias, increased (NT-pro) brain natriuretic peptide, echocardiographic variables of right ventricular dysfunction and hospitalization for heart failure. Although to date there is no causal therapy to reverse pulmonary vascular disease, a greater armamentarium of targeted therapies is available, which have been shown to be beneficial in patients with ES.
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Affiliation(s)
- Gerhard-Paul Diller
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Astrid E Lammers
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.,Division of Paediatric Cardiology, University Hospital Muenster, Münster, Germany
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
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38
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Jansen K, Constantine A, Condliffe R, Tulloh R, Clift P, Moledina S, Wort SJ, Dimopoulos K. Pulmonary arterial hypertension in adults with congenital heart disease: markers of disease severity, management of advanced heart failure and transplantation. Expert Rev Cardiovasc Ther 2021; 19:837-855. [PMID: 34511015 DOI: 10.1080/14779072.2021.1977124] [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: 10/20/2022]
Abstract
INTRODUCTION Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is a progressive, life-limiting disease. AREAS COVERED In this paper, we review the classification and pathophysiology of PAH-CHD, including the mechanisms of disease progression and multisystem effects of disease. We evaluate current strategies of risk stratification and the use of biological markers of disease severity, and review principles of management of PAH-CHD. The indications, timing, and the content of advanced heart failure assessment and transplant listing are discussed, along with a review of the types of transplant and other forms of available circulatory support in this group of patients. Finally, the integral role of advance care planning and palliative care is discussed. EXPERT OPINION/COMMENTARY All patients with PAH-CHD should be followed up in expert centers, where they can receive appropriate risk assessment, PAH therapy, and supportive care. Referral for transplant assessment should be considered if there continue to be clinical high-risk features, persistent symptoms, or acute heart failure decompensation despite appropriate PAH specific therapy. Expert management of PAH-CHD patients, therefore, requires vigilance for these features, along with a close relationship with local advanced heart failure services and a working knowledge of listing criteria, which may disadvantage congenital heart disease patients.
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Affiliation(s)
- Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle upon Tyne Hospitals Nhs Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, UK
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Robert Tulloh
- Department of Congenital Heart Disease, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Paul Clift
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Shahin Moledina
- National Paediatric Pulmonary Hypertension Service Uk, Great Ormond Street Hospital for Children Nhs Foundation Trust, London, UK.,Institute of Cardiovascular Science, University College London, UK
| | - S John Wort
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, UK
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Arvanitaki A, Ntiloudi D, Giannakoulas G, Dimopoulos K. Prediction Models and Scores in Adult Congenital Heart Disease. Curr Pharm Des 2021; 27:1232-1244. [PMID: 33430742 DOI: 10.2174/1381612827999210111181554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022]
Abstract
Nowadays, most patients with congenital heart disease survive to adulthood due to advances in pediatric cardiac surgery but often present with various comorbidities and long-term complications, posing challenges in their management. The development and clinical use of risk scores for the prediction of morbidity and/or mortality in adults with congenital heart disease (ACHD) is fundamental in achieving optimal management for these patients, including appropriate follow-up frequency, treatment escalation, and timely referral for invasive procedures or heart transplantation. In comparison with other fields of cardiovascular medicine, there are relatively few studies that report prediction models developed in the ACHD population, given the small sample size, heterogeneity of the population, and relatively low event rate. Some studies report risk scores originally developed in pediatric congenital or non-congenital population, externally validated in ACHD with variable success. Available risk scores are designed to predict heart failure or arrhythmic events, all-cause mortality, post-intervention outcomes, infective endocarditis, or atherosclerosis-related cardiovascular disease in ACHD. A substantial number of these scores are derived from retrospective studies and are not internally or externally validated. Adequately validated risk scores can be invaluable in clinical practice and an important step towards personalized medicine. Multicenter collaboration, adequate study design, and the potential use of artificial intelligence are important elements in the effort to develop reliable risk scores for the ACHD population.
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Affiliation(s)
- Alexandra Arvanitaki
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer- Campus 1, 48149, Muenster, Germany
| | - Despoina Ntiloudi
- 1st Department of Cardiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki St. Kiriakidi 1, 54636, Greece
| | - George Giannakoulas
- 1st Department of Cardiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki St. Kiriakidi 1, 54636, Greece
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, United Kingdom
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40
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Hungerford SL, Bart NK. Editorial for "Diverse Right Ventricular Remodelling Evaluated by Cardiac Magnetic Resonance Imaging and Prognosis in Eisenmenger Syndrome with Different Shunt Locations". J Magn Reson Imaging 2021; 55:1489-1490. [PMID: 34164883 DOI: 10.1002/jmri.27799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sara L Hungerford
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Cardiology, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Nicole K Bart
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Cardiology, Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
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Gong C, He S, Chen X, Wang L, Guo J, He J, Yin L, Chen C, Han Y, Chen Y. Diverse Right Ventricular Remodeling Evaluated by MRI and Prognosis in Eisenmenger Syndrome With Different Shunt Locations. J Magn Reson Imaging 2021; 55:1478-1488. [PMID: 34152058 DOI: 10.1002/jmri.27791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital shunt location is related to Eisenmenger syndrome (ES) survival. Moreover, right ventricular (RV) remodeling is associated with poor survival in pulmonary hypertension. PURPOSE To investigate RV remodeling using comprehensive magnetic resonance imaging (MRI) techniques and identify its relationship with prognosis in ES subgroups classified by shunt location. STUDY TYPE Prospective observational study. POPULATION Fifty-four adults with ES (16 with pre-tricuspid shunt and 38 with post-tricuspid shunt). FIELD STRENGTH/SEQUENCE 3.0 T/cine MRI with balanced steady-state free precession sequence, late gadolinium enhancement with inversion recovery segmented gradient echo sequence and phase-sensitive reconstruction, and T1 mapping with modified Look-Locker inversion recovery sequence. ASSESSMENT Demographics, clinical characteristics, hemodynamics, RV remodeling features (morphology, systolic function, RV-pulmonary artery (PA) coupling and myocardial fibrosis), and prognosis were compared between ES subgroups. The adverse endpoint was all-cause mortality or readmission for heart failure. STATISTICAL TESTS The independent samples t-test, Fisher's exact test or Chi-squared test, and the Kaplan-Meier method were used. P < 0.05 was considered significant. RESULTS Compared to patients with post-tricuspid shunt, patients with pre-tricuspid shunt were significantly older and had higher N-terminal pro-B-type natriuretic peptide concentrations and poorer exercise tolerance. Pre-tricuspid shunt showed significantly larger RV dimensions (end-diastolic volume index: 185.81 ± 37.49 vs. 98.20 ± 36.26 mL/m2 ), worse RV ejection fraction (23.54% ± 12.35% vs. 40.82% ± 10.77%), and RV-PA decoupling (0.35 ± 0.31 vs. 0.72 ± 0.29). Biventricular myocardial fibrosis was significantly more severe in pre-tricuspid shunt than post-tricuspid shunt (extracellular volume, left ventricle: 35.85% ± 2.58% vs. 29.10% ± 5.20%; RV free wall: 30.93% ± 5.65% vs. 26.75% ± 5.15%). In addition, pre-tricuspid shunt demonstrated a significantly increased risk of adverse endpoint (hazard ratio: 2.938, 95% confidence interval: 1.204-7.172). DATA CONCLUSION ES with pre-tricuspid shunt might be a unique subtype with worse clinically decompensated RV remodeling and poor prognosis. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 5.
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Affiliation(s)
- Chao Gong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Shuai He
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiaoling Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Lili Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jiajuan Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Juan He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Lidan Yin
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chen Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
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Buendía-Fuentes F, Gordon-Ramírez B, Subirà LD, Merás P, Gallego P, González A, Prieto-Arévalo R, Segura T, Rodríguez-Puras MJ, Montserrat S, Sarnago-Cebada F, Alonso-García A, Oliver JM, Rueda-Soriano J. LONG TERM OUTCOMES OF ADULTS WITH SINGLE VENTRICLE PHYSIOLOGY NOT UNDERGOING FONTAN REPAIR: A MULTICENTRE EXPERIENCE. Can J Cardiol 2021; 38:1111-1120. [PMID: 34118376 DOI: 10.1016/j.cjca.2021.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND To describe long-term survival and cardiovascular events in adult patients with single ventricle physiology (SVP) without Fontan palliation, focusing on predictors of mortality and comparing groups according to their cardiovascular physiology. METHODS Multicentre, observational and retrospective study including adult patients with SVP without Fontan palliation since their first adult clinic visit. The cohort was subdivided into three groups. (Eisenmenger - Restricted Pulmonary flow - Aortopulmonary shunt) Death was considered the main endpoint. Other clinical outcomes occurring during follow-up were considered as secondary endpoints. RESULTS 146 patients, mean age 32.5±11.1 years were analysed. Over a mean follow-up of 7.3 ± 4.1 years, 33 patients (22.6%) died. Survival was 86% and 74% at 5 and 10 years, respectively. Right ventricular morphology was not associated with higher mortality. Four variables at baseline were related to a higher mortality (at least moderate AV valve regurgitation, platelet count <150 × 10 3 /mm 3 , GFR <60 ml/min/1.73m 2 and QRS >120ms). 34.2% of patients were admitted to the hospital due to heart failure, and 7.5% received a heart transplant. Other cardiovascular outcomes were also frequent (atrial arrhythmias: 19.2%, stroke: 15.1%, pacemaker/ICD: 6.2%/2.7%). CONCLUSIONS Adult patients with SVP who had not undergone Fontan exhibit a high mortality rate and frequent major cardiovascular events. At least moderate AV valve regurgitation, thrombocytopenia, renal dysfunction and QRS duration >120 ms at baseline visit allow identification of a cohort of patients at higher risk of mortality.
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Affiliation(s)
- Francisco Buendía-Fuentes
- ACHD Unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe. Instituto de Investigación Sanitaria La Fe. CIBERCV, Valencia, Spain
| | - Blanca Gordon-Ramírez
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i l'Adult Vall d'Hebron-Sant Pau. Department of Cardiology. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Laura Dos Subirà
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i l'Adult Vall d'Hebron-Sant Pau. Department of Cardiology. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain; CIBERCV. Barcelona, Spain.
| | - Pablo Merás
- ACHD Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Pastora Gallego
- ACHD Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio. Instituto de BioMedicina de Sevilla. CIBERCV, Sevilla, Spain
| | - Ana González
- ACHD Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Prieto-Arévalo
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - Teresa Segura
- ACHD Unit, Department of Cardiology, Hospital Universitario 12 Octubre, Madrid, Spain
| | - María J Rodríguez-Puras
- ACHD Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio. Instituto de BioMedicina de Sevilla. CIBERCV, Sevilla, Spain
| | - Silvia Montserrat
- ACHD Unit, Department of Cardiology, Hospital Clinic Barcelona. Institut clinic Cardiovascular. IDIBAPS. CIBERCV. Barcelona, Spain
| | | | - Andrés Alonso-García
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - José M Oliver
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - Joaquín Rueda-Soriano
- ACHD Unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe. Instituto de Investigación Sanitaria La Fe. CIBERCV, Valencia, Spain
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Constantine A, Condliffe R, Clift P, Tulloh R, Dimopoulos K. Palliative care in pulmonary hypertension associated with congenital heart disease: systematic review and expert opinion. ESC Heart Fail 2021; 8:1901-1914. [PMID: 33660435 PMCID: PMC8120400 DOI: 10.1002/ehf2.13263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Pulmonary arterial hypertension (PAH) is common amongst patients with congenital heart disease (CHD). It is a severe and complex condition that adversely affects quality of life and prognosis. While quality of life questionnaires are routinely used in clinical pulmonary hypertension practice, little is known on how to interpret their results and manage PAH-CHD patients with evidence of impaired health-related quality of life, especially those with advanced disease and palliative care needs. METHODS AND RESULTS We performed a systematic review of studies concerning palliative care for people with PAH-CHD, also reviewing the health-related quality of life literature pertaining to these patients. Of 330 papers identified through initial screening, 17 were selected for inclusion. Underutilization of advance care planning and palliative care resources was common. Where palliative care input was sought, this was frequently late in the course of the disease. No studies provided evidence-based clinical criteria for triggering referral to palliative care, a framework for providing tailored care in this patient group, or how to manage the risk of sudden cardiac death and implantable cardioverter defibrillators in advanced PAH-CHD. We synthesize this information into eight important areas, including the impact of PAH-CHD on quality of life, barriers to and benefits of palliative care involvement, advance care planning discussions, and end-of-life care issues in this complex patient group, and provide expert consensus on best practice in this field. CONCLUSIONS This paper presents the results of a systematic review and expert statements on the preferred palliative care strategy for patients with PAH-CHD.
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Affiliation(s)
- Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary HypertensionRoyal Brompton HospitalSydney StreetLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Robin Condliffe
- Pulmonary Vascular Disease UnitRoyal Hallamshire HospitalSheffieldUK
| | - Paul Clift
- Department of CardiologyQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Robert Tulloh
- Bristol Heart InstituteUniversity Hospitals Bristol, Weston NHS Foundation TrustBristolUK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary HypertensionRoyal Brompton HospitalSydney StreetLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonUK
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Barradas-Pires A, Constantine A, Dimopoulos K. Preventing disease progression in Eisenmenger syndrome. Expert Rev Cardiovasc Ther 2021; 19:501-518. [PMID: 33853494 DOI: 10.1080/14779072.2021.1917995] [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: 10/21/2022]
Abstract
Introduction: Eisenmenger syndrome describes a condition in which a congenital heart defect has caused severe pulmonary vascular disease, resulting in reversed (right-left) or bidirectional shunting and chronic cyanosis.Areas covered: In this paper, the progression of congenital heart defects to Eisenmenger syndrome, including early screening, diagnosis and operability are covered. The mechanisms of disease progression in Eisenmenger syndrome and management strategies to combat this, including the role of pulmonary arterial hypertension therapies, are also discussed.Expert opinion/commentary: Patients with congenital heart disease (CHD) are at increased risk of developing pulmonary arterial hypertension with Eisenmenger syndrome being its extreme manifestation. All CHD patients should be regularly assessed for pulmonary hypertension. Once Eisenmenger syndrome develops, shunt closure should be avoided. The clinical manifestations of Eisenmenger syndrome are driven by the systemic effects of the pulmonary hypertension, congenital defect and long-standing cyanosis. Expert care is essential for avoiding pitfalls and preventing disease progression in this severe chronic condition, which is associated with significant morbidity and mortality. Pulmonary arterial hypertension therapies have been used alongside supportive care to improve the quality of life, exercise tolerance and the outcome of these patients, although the optimal timing for their introduction and escalation remains uncertain.
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Affiliation(s)
- Ana Barradas-Pires
- Department of Cardiology, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Andrew Constantine
- Department of Cardiology, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,Biomedical Research Unit, National Heart & Lung Institute, Imperial College London, UK
| | - Konstantinos Dimopoulos
- Department of Cardiology, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,Biomedical Research Unit, National Heart & Lung Institute, Imperial College London, UK
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45
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kearney K, Lau EM, Darley D, Romfh A, Bart N, Kotlyar E, Hayes D, Khush K, Keogh A. Waitlist and post-transplant outcomes for eisenmenger syndrome: A comparison of transplant strategies. J Heart Lung Transplant 2021; 40:841-849. [PMID: 34112578 DOI: 10.1016/j.healun.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/30/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND End-stage Eisenmenger syndrome (ES) due to unrepaired atrial septal defect (ASD) or ventricular septal defect (VSD) is an indication for lung transplantation (LTx) or heart-lung transplantation (HLTx). Limited evidence exists as to the optimal transplant strategy for this unique population. AIM To describe waitlist characteristics and post-transplant outcomes in patients with ES-ASD or ES-VSD. METHODS Using the ISHLT Registry, data were extracted for all ES-ASD or ES-VSD patients who underwent transplantation between 1987 and 2018. Additional data were sought for patients listed for LTx or HLTx in the OPTN Registry during the same period. Early era was defined as 1987-2004, and current era was defined as 2005-2018. RESULTS In the current era, patients with ES-ASD or ES-VSD represented a lessening proportion of all LTx and HLTx. Compared to LTx for other indications, the odds of transplantation were significantly less for both ES-ASD 0.18 [0.07-0.50] and ES-VSD 0.03 [0.004-0.22]. In the early era, an equivalent survival was observed for ES-ASD who underwent HLTx versus LTx (p = 0.47), and superior survival for ES-VSD (p = 0.015). In contrast, ES-ASD patients who underwent LTx from the current era displayed better survival compared with HLTx, 10-year survival 52% vs 30% p = 0.036. Similar survival were observed for ES-VSD for both transplant strategies (p = 0.68). CONCLUSION LTx shows superior survival outcomes in the current era for ES ASD patients, and equivalent outcomes for ES-VSD. In the current era, ES-ASD or ES-VSD patients were less likely to be transplanted than other candidates for LTx.
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Affiliation(s)
- Katherine Kearney
- Heart Transplant and Pulmonary Hypertension Unit, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
| | - Edmund M Lau
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - David Darley
- Lung Transplant Unit, St Vincent's Hospital, Sydney, Australia
| | - Anitra Romfh
- Department of Cardiology, Stanford University, California
| | - Nicole Bart
- Heart Transplant and Pulmonary Hypertension Unit, St Vincent's Hospital, Sydney, Australia
| | - Eugene Kotlyar
- Heart Transplant and Pulmonary Hypertension Unit, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Don Hayes
- Lung Transplant Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kiran Khush
- Department of Cardiology, Stanford University, California
| | - Anne Keogh
- Heart Transplant and Pulmonary Hypertension Unit, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
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Hou Y, Wen L, Shu T, Dai R, Huang W. Efficacy and safety of pulmonary vasodilators in the patients with Eisenmenger syndrome: a meta-analysis of randomized controlled trials. Pulm Circ 2021; 11:20458940211015823. [PMID: 34164108 PMCID: PMC8191088 DOI: 10.1177/20458940211015823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
Few meta-analyses evaluated the efficacy and safety of pulmonary vasodilators in patients with Eisenmenger syndrome. Recently, some studies have reported conflicting results regarding improvements in exercise capacity. This study evaluated the efficacy and safety of pulmonary vasodilators in patients with Eisenmenger syndrome. Relevant studies were identified by searching major databases. Pooled outcomes were used to assess the efficacy and safety of pulmonary vasodilators. In total, five studies with 508 patients were included. Meta-analysis indicated that the pulmonary vasodilators reduced the mortality (odd risk (OR) = 0.35; 95% CI, 0.13 to 0.95; P = 0.04), slashed the mean pulmonary artery pressure (mean difference (MD) = -4.35 mmHg; 95% CI, -7.19 to -1.50; P = 0.003), decreased pulmonary vascular resistance index (MD = -480.08 dyn · s · cm-5 · m2; 95% CI, -753.51 to -206.64; P = 0.0006), increased the 6-min walk distance (MD = 28.38 m; 95% CI, 2.99 to 53.77; P = 0.03), and elevated the systemic oxygen saturation at rest (MD = 1.00%; 95% CI, 0.12 to 1.88; P = 0.03). Four studies reported side effects, but only two studies reported serious adverse effects which were mostly rare and curable. The present meta-analysis indicated that pulmonary vasodilators decrease mortality and improve hemodynamics and exercise capacity in patients with Eisenmenger syndrome. Overall, pulmonary vasodilators are well tolerated.
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Affiliation(s)
- Yulin Hou
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Wen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Shu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Dai
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lancaster TS, Shahanavaz S, Balzer DT, Sweet SC, Grady RM, Eghtesady P. Midterm outcomes of the Potts shunt for pediatric pulmonary hypertension, with comparison to lung transplant. J Thorac Cardiovasc Surg 2021; 161:1139-1148. [DOI: 10.1016/j.jtcvs.2020.10.163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 10/22/2022]
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Thrombocytopaenia in cyanotic CHD. Cardiol Young 2021; 31:429-434. [PMID: 33261686 DOI: 10.1017/s1047951120004230] [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: 11/06/2022]
Abstract
INTRODUCTION Thrombocytopaenia is common in adults with cyanotic heart disease. Our aim was to explore potential mechanisms for thrombocytopaenia in these vulnerable patients. METHODS Adults with cyanotic heart defects were identified from our clinical database. Haemoglobin levels, platelet counts, and resting oxygen saturations were determined at baseline and during follow-up. Associations between patient characteristics and cardiac physiology with these parameters at baseline and during follow-up were analysed using regression models. Survival estimates were determined by the Kaplan-Meier method. RESULTS We included 79 patients (mean age 32.2 ± 12.4, 48 (61%) Eisenmenger syndrome, 20 (25%) Down syndrome). Mean oxygen saturation was 84.1 ± 5.9%; 38 (48%) had thrombocytopaenia. There was a strong inverse correlation between platelet count and haemoglobin level (R = -0.655, R2 = 0.429, p < 0.0001) and a weaker but significant positive correlation between platelet count and oxygen saturation (R = 0.345, R2 = 0.119, p = 0.002). There was a significant inverse correlation between decrease in platelet count and increase in haemoglobin level during follow-up (R = -0.401, R2 = 0.161, p = 0.001) but not to changes in oxygen saturation (R = 0.043, R2 = 0.002, p = 0.726). Survival estimates were lower for patients with thrombocytopaenia at baseline (log-rank test p < 0.0001). CONCLUSIONS Our findings suggest a direct inverse correlation between platelet counts and haemoglobin levels in adults with cyanotic heart disease. Further studies are required to explore the mechanisms of thrombocytopaenia in cyanotic heart disease and its potential role as an independent marker of risk.
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42:563-645. [PMID: 32860028 DOI: 10.1093/eurheartj/ehaa554] [Citation(s) in RCA: 890] [Impact Index Per Article: 296.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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