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O'Byrne ML. Patient-Reported Outcomes in Tetralogy of Fallot: The Potential of the CORRELATE Cohort. J Am Coll Cardiol 2023; 81:1951-1953. [PMID: 37164528 DOI: 10.1016/j.jacc.2023.03.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology and Clinical Futures, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Yuen CS, Lee KFL, Bhatia I, Yam N, Rocha BA, Yung TC, Chow PC, Au WKT. Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes. World J Pediatr Congenit Heart Surg 2019; 10:197-205. [DOI: 10.1177/2150135118825113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. Method: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 ± 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 ± 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n = 32) and pericardial valves (group 2, n = 50) were used. Cardiac magnetic resonance imaging was performed (n = 54) at a mean of 18 ± 13 months before and 24 ± 21 months after pulmonary valve replacement. Results: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 ± 2.06 vs 4.08 ± 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups ( P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P = .129; group 2, P = .675) . Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P = .070; group 2, P = .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement ( P = .407). Conclusion: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.
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Affiliation(s)
- Chi Sum Yuen
- Department of Surgery, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong
| | | | - Inderjeet Bhatia
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong
| | - Nicholson Yam
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong
| | | | - Tak-cheung Yung
- Department of Paediatric Cardiology, Queen Mary Hospital, Hong Kong
| | - Pak-cheong Chow
- Department of Paediatric Cardiology, Queen Mary Hospital, Hong Kong
| | - Wing-Kuk Timmy Au
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong
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Rasmussen J, Skov SN, Nielsen DB, Jensen IL, Tjørnild MJ, Johansen P, Hjortdal VE. In-vitro and in-vivo evaluation of a novel bioprosthetic pulmonary valve for use in congenital heart surgery. J Cardiothorac Surg 2019; 14:6. [PMID: 30626416 PMCID: PMC6327610 DOI: 10.1186/s13019-019-0830-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/02/2019] [Indexed: 12/03/2022] Open
Abstract
Background Management of congenital malformations of the pulmonary artery and valve can be challenging. The severity often demands early intervention, which is rarely definitive due to the natural growth and multiple surgeries may be required. An artificial valve made entirely from biodegradable materials that will serve as a bioscaffold for host recellularization would be an attractive solution for these patients. Such valves have been experimentally evaluated with various results. In this study, a simple valve design supported by an absorbable proximal stabilization ring is evaluated both in-vitro and in-vivo. Methods From a 6.7 × 5.0 cm sheet of CorMatrix® tissue we created the valve as an inverted tubegraft with three sutured commissures. A non-closed ring of LactoSorb® basally supported the valve. The commissure height was 2 cm. Inserted as an interposition graft the valve was tested in an in-vitro model and an acute porcine model. Right ventricular and pulmonary artery pressures were recorded. Results The in-vitro testing indicated a proper opening and closure function of valve at physiological simulated hemodynamic conditions. The in-vivo evaluation showed a peak right ventricular pressure of 38 mmHg and a peak pulmonary artery pressure of 27 mmHg and thereby a peak valve gradient of 11 mmHg. The pulmonary pressure wave demonstrated a dicrotic notch indicating competence of the valve. Conclusion This new pulmonary valve made entirely from biodegradable tissue worked in an acute setting and displayed a good hemodynamic profile. The valve gradient observed is equal to or superior of today’s surgical treatment options.
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Affiliation(s)
- Jonas Rasmussen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, 8200, Aarhus, Denmark. .,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Søren Nielsen Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Marcell Juan Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Johansen
- Department of Engineering, Aarhus University, Aarhus, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Mouws EMJP, de Groot NMS, van de Woestijne PC, de Jong PL, Helbing WA, van Beynum IM, Bogers AJJC. Tetralogy of Fallot in the Current Era. Semin Thorac Cardiovasc Surg 2018; 31:496-504. [PMID: 30395964 DOI: 10.1053/j.semtcvs.2018.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Abstract
Only few studies have reported long-term outcome of the transatrial-transpulmonary approach in the current era of management of tetralogy of Fallot (ToF). We investigated 15-year outcome of correction via a transatrial-transpulmonary approach in a large cohort of successive patients operated in the 21st century. All infant ToF patients undergoing transatrial-transpulmonary ToF correction between 2000 and 2015 were included (N = 177, 106 male, median follow-up 7.1 (interquartile range 3.0-10.9) years. Data regarding postoperative complications, reinterventions, development of atrial and ventricular arrhythmia, cardiac function, and survival were evaluated. Prior shunting was performed in 10 patients (6%). The transatrial-transpulmonary approach resulted in valve-sparing surgery in 57 patients (32%). Postoperative surgical complications included junctional ectopic tachycardia (N = 12, 7%), pericardial (N = 10, 6%) or pleural effusion (N = 7, 3%), chylothorax (N = 7, 4%), bleeding requiring reoperation (N = 4, 3%), and superficial wound infection (N = 1). Fifty-one patients underwent 68 reinterventions, mainly due to pulmonary restenosis (PS) (N = 57). ToF correction at age <2 months and double outlet or double-chambered right ventricle variants of the ToF spectrum were independent predictors for reintervention. Patients undergoing valve-sparing ToF correction had a significant longer PR-free survival than those with a transannular patch (8.5 [95% confidence interval 6.8-10.3] years vs 1.1 [95% confidence interval 0.8-1.5] years; P < 0.001). Overall mortality was 2.8%; mortality rates were higher in premature/dysmature newborns (0.7% vs 9.5%; P < 0.001). Although the 15-year outcome of the transatrial-transpulmonary approach in terms of postoperative complications and mortality rates is excellent, the high incidence of moderate and severe PR is worrisome. Valve-sparing surgery was associated with a substantially lower incidence of PR, yet was surgically not possible in the majority of patients.
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Affiliation(s)
- Elisabeth M J P Mouws
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Peter L de Jong
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wim A Helbing
- Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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The value of right ventricular longitudinal strain in the evaluation of adult patients with repaired tetralogy of Fallot: a new tool for a contemporary challenge. Cardiol Young 2017; 27:498-506. [PMID: 27226193 DOI: 10.1017/s1047951116000810] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The role of right ventricular longitudinal strain for assessing patients with repaired tetralogy of Fallot is not fully understood. In this study, we aimed to evaluate its relation with other structural and functional parameters in these patients. METHODS Patients followed-up in a grown-up CHD unit, assessed by transthoracic echocardiography, cardiac MRI, and treadmill exercise testing, were retrospectively evaluated. Right ventricular size and function and pulmonary regurgitation severity were assessed by echocardiography and MRI. Right ventricular longitudinal strain was evaluated in the four-chamber view using the standard semiautomatic method. RESULTS In total, 42 patients were included (61% male, 32±8 years). The mean right ventricular longitudinal strain was -16.2±3.7%, and the right ventricular ejection fraction, measured by MRI, was 42.9±7.2%. Longitudinal strain showed linear correlation with tricuspid annular systolic excursion (r=-0.40) and right ventricular ejection fraction (r=-0.45) (all p<0.05), which in turn showed linear correlation with right ventricular fractional area change (r=0.50), pulmonary regurgitation colour length (r=0.35), right ventricular end-systolic volume (r=-0.60), and left ventricular ejection fraction (r=0.36) (all p<0.05). Longitudinal strain (β=-0.72, 95% confidence interval -1.41, -0.15) and left ventricular ejection fraction (β=0.39, 95% confidence interval 0.11, 0.67) were independently associated with right ventricular ejection fraction. The best threshold of longitudinal strain for predicting a right ventricular ejection fraction of <40% was -17.0%. CONCLUSIONS Right ventricular longitudinal strain is a powerful method for evaluating patients with tetralogy of Fallot. It correlated with echocardiographic right ventricular function parameters and was independently associated with right ventricular ejection fraction derived by MRI.
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Tarzia P, Conforti E, Giamberti A, Varrica A, Giugno L, Micheletti A, Negura D, Piazza L, Saracino A, Carminati M, Chessa M. Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects. J Cardiovasc Med (Hagerstown) 2016; 18:430-435. [PMID: 27828833 DOI: 10.2459/jcm.0000000000000486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We reviewed our center experience in the field of transcatheter pulmonary valve-in-valve implantation (TPViV), that is emerging as a treatment option for patients with pulmonary bioprosthetic valve (BPV) dysfunction. METHODS Between April 2008 and September 2015, a total of six patients with congenital heart disease (four men) underwent TPViV due to stenosis of preexisting BPV. Four patients received a Melody Medtronic Transcatheter Pulmonary Valve and two an Edward Sapien Valve. RESULTS No procedural-related complications occurred. After valve implantation, right ventricular systolic pressure (RVSP, 80.5 ± 25.3-41.2 ± 8.35 mmHg, P < 0.05), right ventricular outflow tract (RVOT) gradient (55.3 ± 23.4-10.6 ± 3.8 mmHg, P < 0.05), and RVSP-to-aortic pressure (0.75 ± 0.21-0.38 ± 0.21, P = 0.01) fell significantly. Echocardiograms at follow-up revealed a significant reduction in estimated RVSP (88.7 ± 22-21.7 ± 4.7 mmHg, P < 0.05), in RVOT (76.2 ± 17.9-25.7 ± 6.1 mmHg, P = 0.005), and in mean RVOT (40.7 ± 9.9-15.5 ± 4.8 mmHg, P < 0.05) gradients. Cardiac magnetic resonance showed no significant change in biventricular dimensions and function. Symptomatic patients reported improvement of symptoms, although cardiopulmonary exercise did not show any significant differences. CONCLUSION TPViV is an effective and well tolerated treatment for BPV dysfunction, improving freedom from surgical reintervention. Long-term studies will redefine the management of dysfunctional RVOT, either native or surrogate.
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Affiliation(s)
- Pierpaolo Tarzia
- aPediatric and Adult Congenital Heart Centre, IRCCS, Policlinico San Donato, University Hospital, Via Morandi, 30, San Donato M.se, Milan 20097, Italy bInstitute of Cardiology, Catholic University of the Sacred Heart, IRCCS Policlinico Universitario 'Agostino Gemelli', Rome, Italy
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Jones TK, Rome JJ, Armstrong AK, Berger F, Hellenbrand WE, Cabalka AK, Benson LN, Balzer DT, Cheatham JP, Eicken A, McElhinney DB. Transcatheter Pulmonary Valve Replacement Reduces Tricuspid Regurgitation in Patients With Right Ventricular Volume/Pressure Overload. J Am Coll Cardiol 2016; 68:1525-35. [DOI: 10.1016/j.jacc.2016.07.734] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/29/2016] [Accepted: 07/05/2016] [Indexed: 11/16/2022]
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Cuypers JAA, Menting ME, Opić P, Utens EMW, Helbing WA, Witsenburg M, van den Bosch AE, van Domburg RT, Baart SJ, Boersma E, Meijboom FJ, Bogers AJJ, Roos-Hesselink JW. The unnatural history of pulmonary stenosis up to 40 years after surgical repair. Heart 2016; 103:273-279. [PMID: 27515953 DOI: 10.1136/heartjnl-2015-309159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/29/2016] [Accepted: 07/13/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To provide prospective information on long-term outcome after surgical correction of valvular pulmonary stenosis (PS). METHODS Fifty-three consecutive patients operated for PS during childhood between 1968 and 1980 in one centre are followed longitudinally for 37±3.4 years, including extensive in-hospital examination every 10 years. RESULTS Survival information was available in 100% of the original 53 patients. Cumulative survival was 94% at 20 years and 91% at 40 years. Excluding perioperative mortality (<30 days), survival was 94% at 40 years. Of 46 eligible survivors, 29 participated in the in-hospital examination and 15 gave permission to use their hospital records (96% participation). Cumulative event-free survival was 68% after 40 years: 25% needed a reintervention, 12% underwent pacemaker implantation and 9% had supraventricular arrhythmias. Early reinterventions were mainly for residual PS, late reinterventions for pulmonary regurgitation. Subjective health status was good. Exercise capacity was normal in 74% (median 96 (82-107)% of expected workload). Right ventricular and left ventricular (LV) dysfunction was found in 13% and 41%, respectively. The use of a transannular patch and younger age at surgery were predictive for late events (HR 3.02 (95% CI 1.09 to 8.37) and HR 0.81/year (95% CI 0.66 to 0.98), respectively). Use of inflow occlusion compared with cardiopulmonary bypass showed a trend towards more reinterventions (HR 3.19 (95% CI 0.97 to 10.47)). CONCLUSIONS Survival up to 40 years after successful PS repair is nearly normal. Subjective health status is good and there is a low incidence of arrhythmias. Reinterventions, however, are necessary in one-quarter and 40 years postoperatively several patients show LV dysfunction.
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Affiliation(s)
| | - Myrthe E Menting
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Petra Opić
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Elisabeth M Wj Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | | - Sara J Baart
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ad J Jc Bogers
- Department of Cardio-thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
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Giamberti A, Varrica A, Pomè G, Micheletti A, Negura D, Ranucci M, Carminati M, Frigiola A, Chessa M. The care for adults with congenital heart disease: organization and function of a grown-up congenital heart disease unit. Eur Heart J Suppl 2016; 18:E15-E18. [DOI: 10.1093/eurheartj/suw011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chan SS, Whitehead KK, Kim TS, Fu GL, Keller MS, Fogel MA, Harris MA. Repaired tetralogy of Fallot with coexisting unrepaired partial anomalous pulmonary venous connection is associated with diminished right ventricular ejection fraction and more severe right ventricular dilation. Pediatr Radiol 2015; 45:1465-71. [PMID: 25935212 DOI: 10.1007/s00247-015-3358-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/14/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is an established association between tetralogy of Fallot and partial anomalous pulmonary venous connections. This association is important because surgically repaired tetralogy patients have increased risk of right heart failure. We hypothesize that partial anomalous venous connections increase right ventricular volumes and worsen right ventricular failure. MATERIALS AND METHODS We reviewed cardiac MRI exams performed at a tertiary pediatric hospital from January 2005 to January 2014. We identified patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection. We used age- and gender-matched repaired tetralogy patients without partial anomalous pulmonary venous connection as controls. We analyzed the MRI results and surgical course and performed comparative statistics to identify group differences. RESULTS There were eight patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection and 16 controls. In all cases, the partial anomalous pulmonary venous connection was not detected on preoperative echocardiography. There were no significant differences in surgical course and body surface area between the two groups. Repaired tetralogy patients with unrepaired partial anomalous pulmonary venous connection showed significantly higher indexed right ventricular end diastolic volume (149 ± 33 mL/m(2) vs. 118 ± 30 mL/m(2)), right ventricle to left ventricle size ratios (3.1 ± 1.3 vs. 1.9 ± 0.5) and a higher incidence of reduced right ventricular ejection fraction compared to controls (3/8 vs. 0/16). CONCLUSION Repaired tetralogy of Fallot with unrepaired partial anomalous pulmonary venous connection is associated with reduced right ventricular ejection fraction and more significant right ventricular dilation.
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Affiliation(s)
- Sherwin S Chan
- Department of Radiology, Children's Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA,
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Carminati M, Pluchinotta FR, Piazza L, Micheletti A, Negura D, Chessa M, Butera G, Arcidiacono C, Saracino A, Bussadori C. Echocardiographic assessment after surgical repair of tetralogy of fallot. Front Pediatr 2015; 3:3. [PMID: 25699243 PMCID: PMC4313781 DOI: 10.3389/fped.2015.00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/14/2015] [Indexed: 11/19/2022] Open
Abstract
Surgical correction of tetralogy of Fallot is still one of the most frequently performed intervention in pediatric cardiac surgery, and in many cases, it is far from being a complete and definitive correction. It is rather an excellent palliation that solves the problem of cyanosis, but predisposes the patients to medical and surgical complications during follow-up. The decision-making process regarding the treatment of late sequel is among the most discussed topics in adult congenital cardiology. In post-operative Fallot patients, echocardiography is used as the first method of diagnostic imaging and currently allows both a qualitative observation of the anatomical alterations and a detailed quantification of right ventricular volumes and function, of the right ventricular outflow tract, and of the pulmonary valve and pulmonary arteries. The literature introduced many quantitative echocardiographic criteria useful for the understanding of the pathophysiological mechanisms involving the right ventricle and those have made much more objective any decision-making processes.
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Affiliation(s)
- Mario Carminati
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Francesca R Pluchinotta
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Luciane Piazza
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Angelo Micheletti
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Diana Negura
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Massimo Chessa
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Gianfranco Butera
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Carmelo Arcidiacono
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Antonio Saracino
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Claudio Bussadori
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
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Zdradzinski MJ, Qureshi AM, Stewart R, Pettersson G, Krasuski RA. Comparison of long-term postoperative sequelae in patients with tetralogy of Fallot versus isolated pulmonic stenosis. Am J Cardiol 2014; 114:300-4. [PMID: 24878128 DOI: 10.1016/j.amjcard.2014.04.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 01/18/2023]
Abstract
Patients with tetralogy of Fallot (TOF) after complete repair and pulmonic stenosis (PS) after surgical valvotomy often develop significant pulmonic regurgitation (PR) that eventually requires valve replacement. Although criteria exist for the timing of pulmonary valve replacement in TOF, it remains less clear when to intervene in valvotomy patients and whether TOF recommendations can be applied. Our aim was to compare the structural and functional sequelae of valvotomy for PS with complete repair for TOF. We compared the clinical characteristics, electrocardiograms, echocardiograms, cardiac magnetic resonance imaging (MRI), and invasive hemodynamics of 109 adults (34 PS and 75 TOF) newly referred to a congenital heart disease center for evaluation of PR between 2005 and 2012. Both cohorts were similar in terms of baseline demographics and presenting New York Heart Association function class. Valvotomy patients had a slightly greater degree of PR by echocardiogram, although it was similar by cardiac MRI. Electrocardiography QRS width was greater in patients with TOF (114±27 vs 150±28 ms, p<0.001). MRI right ventricular ejection fraction (49±8 vs 41±11%, p=0.001) and left ventricular ejection fraction (59±7 vs 52±10%, p=0.002) were lower in patients with TOF. Pacemaker or defibrillator implantation was significantly greater in patients with TOF (3% vs 23%, p=0.011). In conclusion, patients postvalvotomy and complete repair present with similar degrees of PR and severity of symptoms. Biventricular systolic function and electrocardiography QRS width appear less affected, suggesting morphologic changes in TOF and its repair that extend beyond the effects of PR. These findings suggest the need for developing disease-specific guidelines for patients with PR postvalvotomy.
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Bussadori C, Salvo GD, Pluchinotta FR, Piazza L, Gaio G, Russo MG, Carminati M. Evaluation of Right Ventricular Function in Adults with Congenital Heart Defects. Echocardiography 2014; 32 Suppl 1:S38-52. [DOI: 10.1111/echo.12566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Claudio Bussadori
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Giovanni Di Salvo
- Heart Institute; Pediatric Cardiology; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
| | - Francesca R. Pluchinotta
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Luciane Piazza
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Giampiero Gaio
- Department of Cardiology; Division of Pediatric Cardiology; Second University of Naples-Monaldi Hospital; Naples Italy
| | - Maria Giovanna Russo
- Department of Cardiology; Division of Pediatric Cardiology; Second University of Naples-Monaldi Hospital; Naples Italy
| | - Mario Carminati
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
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14
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Carminati M, Agnifili M, Arcidiacono C, Brambilla N, Bussadori C, Butera G, Chessa M, Heles M, Micheletti A, Negura DG, Piazza L, Saracino A, Testa L, Tusa M, Bedogni F. Role of imaging in interventions on structural heart disease. Expert Rev Cardiovasc Ther 2014; 11:1659-76. [DOI: 10.1586/14779072.2013.854166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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