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Driesen BW, Voskuil M, Grotenhuis HB. Current Treatment Options for the Failing Fontan Circulation. Curr Cardiol Rev 2022; 18:e060122200067. [PMID: 34994331 PMCID: PMC9893132 DOI: 10.2174/1573403x18666220106114518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 10/22/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
The Fontan operation was introduced in 1968. For congenital malformations, where biventricular repair is unsuitable, the Fontan procedure has provided a long-term palliation strategy with improved outcomes compared to the initially developed procedures. Despite these improvements, several complications merely due to a failing Fontan circulation, including myocardial dysfunction, arrhythmias, increased pulmonary vascular resistance, protein-losing enteropathy, hepatic dysfunction, plastic bronchitis, and thrombo-embolism, may occur, thereby limiting the life-expectancy in this patient cohort. This review provides an overview of the most common complications of Fontan circulation and the currently available treatment options.
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Affiliation(s)
- Bart W. Driesen
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardiology, Laurentius Ziekenhuis, Roermond, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Utrecht, The Netherlands
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2
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Koppel CJ, Driesen BW, de Winter RJ, van den Bosch AE, van Kimmenade R, Wagenaar LJ, Jukema JW, Hazekamp MG, van der Kley F, Jongbloed MRM, Kiès P, Egorova AD, Verheijen DBH, Damman P, Schoof PH, Wilschut J, Stoel M, Speekenbrink RGH, Voskuil M, Vliegen HW. The first multicentre study on coronary anomalies in the Netherlands: MuSCAT. Neth Heart J 2021; 29:311-317. [PMID: 33683666 PMCID: PMC8160042 DOI: 10.1007/s12471-021-01556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 01/16/2023] Open
Abstract
Background Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group. Supplementary Information The online version of this article (10.1007/s12471-021-01556-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C J Koppel
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - B W Driesen
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R J de Winter
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Amsterdam University Medical Centres, location AMC, Amsterdam Zuidoost, The Netherlands
| | - A E van den Bosch
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - R van Kimmenade
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L J Wagenaar
- Thorax Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J W Jukema
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - M G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - F van der Kley
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - M R M Jongbloed
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Kiès
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - A D Egorova
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - D B H Verheijen
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Damman
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - P H Schoof
- Department of Cardiothoracic Surgery, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - J Wilschut
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M Stoel
- Thorax Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R G H Speekenbrink
- Thorax Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H W Vliegen
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands.
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Warmerdam EG, Magni F, Leiner T, Doevendans PA, Sieswerda GT, van Wijk SW, Breur HM, Driesen BW, Grotenhuis HB, Takken T. Echocardiography and MRI parameters associated with exercise capacity in patients after the arterial switch operation. J Cardiol 2020; 76:280-286. [PMID: 32402667 DOI: 10.1016/j.jjcc.2020.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/30/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The arterial switch operation (ASO) for transposition of the great arteries has excellent survival, but a substantial number of patients suffer from a reduced exercise capacity. The goal of this study was to identify imaging parameters associated with a reduced exercise capacity in patients after ASO. METHODS A retrospective analysis was performed of ASO patients who underwent cardiopulmonary exercise testing (CPET) between 2007 and 2017. Reduced exercise performance was defined as a reduced workload peak (Wpeak) with Z-score <-2 or a peak oxygen uptake indexed for weight (VO2peak/kg) with Z-score <-2. Data on echocardiography and cardiac magnetic resonance performed within 1 year of the CPET were collected for comparison. RESULTS A total of 81 ASO patients (age 17±7 years) were included. Reduced exercise performance was found in 22 patients (27%) as expressed by either a reduced Wpeak and/or a reduced VO2peak/kg. Main pulmonary artery gradient and tricuspid regurgitation gradient by echocardiography were found to be associated with reduced Wpeak (p=0.031; p=0.020, respectively). The main pulmonary artery gradient and tricuspid regurgitation gradient by echocardiography were found to be associated with reduced VO2peak/kg (p=0.009; p=0.019, respectively). No left ventricular parameters were found to be associated with abnormal exercise performance. CONCLUSION This study demonstrates that ASO patients frequently experience reduced exercise capacity. Echocardiographic evidence of main pulmonary artery stenosis and increased right ventricular pressure were associated with reduced exercise capacity, and are therefore key to monitor during serial follow-up of ASO patients.
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Affiliation(s)
| | | | - Tim Leiner
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- University Medical Center Utrecht, Utrecht, The Netherlands; Central Military Hospital, Utrecht, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | | | | | - Hans M Breur
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart W Driesen
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Tim Takken
- University Medical Center Utrecht, Utrecht, The Netherlands.
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van der Zwaan HB, Driesen BW, Meijboom FJ. Reparación de la estenosis aislada de la válvula pulmonar: ¿es curativa? Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van der Zwaan HB, Driesen BW, Meijboom FJ. Repaired isolated pulmonary valve stenosis: living happily ever after? Rev Esp Cardiol (Engl Ed) 2020; 73:107-109. [PMID: 31585848 DOI: 10.1016/j.rec.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | - Bart W Driesen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Warmerdam EG, Krings GJ, Meijs TA, Franken AC, Driesen BW, Sieswerda GT, Meijboom FJ, Doevendans PAF, Molenschot MMC, Voskuil M. Safety and efficacy of stenting for aortic arch hypoplasia in patients with coarctation of the aorta. Neth Heart J 2019; 28:145-152. [PMID: 31784885 PMCID: PMC7052107 DOI: 10.1007/s12471-019-01353-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Despite a successful repair procedure for coarctation of the aorta (CoA), up to two-thirds of patients remain hypertensive. CoA is often seen in combination with abnormal aortic arch anatomy and morphology. This might be a substrate for persistent hypertension. Therefore, we performed endovascular aortic arch stent placement in patients with CoA and concomitant aortic arch hypoplasia or gothic arch morphology. The goal of this retrospective analysis was to investigate the safety and efficacy of aortic arch stenting. Methods A retrospective analysis was performed in patients who underwent stenting of the aortic arch at the University Medical Center Utrecht. Measurements collected included office blood pressure, use of antihypertensive medication, invasive peak-to-peak systolic pressure over the arch, and aortic diameters on three-dimensional angiography. Data on follow-up were obtained at the date of most recent outpatient visit. Results Twelve patients underwent stenting of the aortic arch. Mean follow-up duration was 14 ± 11 months. Mean peak-to-peak gradient across the arch decreased from 39 ± 13 mm Hg to 7 ± 8 mm Hg directly after stenting (p < 0.001). There were no major procedural complications. Mean systolic blood pressure decreased from 145 ± 16 mm Hg at baseline to 128 ± 9 mm Hg at latest follow-up (p = 0.014). Conclusion This retrospective study shows that stenting of the aortic arch is successful when carried out in a state-of-the-art manner. A direct optimal angiographic and haemodynamic result was shown. No major complications occurred during or after the procedure. At short- to medium-term follow-up a decrease in mean systolic blood pressure was observed.
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Affiliation(s)
- E G Warmerdam
- University Medical Center Utrecht, Utrecht, The Netherlands.
| | - G J Krings
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - T A Meijs
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - A C Franken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - B W Driesen
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - G T Sieswerda
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - F J Meijboom
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A F Doevendans
- University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | | | - M Voskuil
- University Medical Center Utrecht, Utrecht, The Netherlands
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Driesen BW, Warmerdam EG, Sieswerda GJ, Meijboom FJ, Molenschot MMC, Doevendans PA, Krings GJ, van Dijk APJ, Voskuil M. Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives. Curr Cardiol Rev 2019; 15:262-273. [PMID: 30582483 PMCID: PMC8142351 DOI: 10.2174/1573403x15666181224113855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023] Open
Abstract
Patients with congenital heart disease (CHD) with right ventricle outflow tract (RVOT) dysfunction need sequential pulmonary valve replacements throughout their life in the majority of cases. Since their introduction in 2000, the number of percutaneous pulmonary valve implantations (PPVI) has grown and reached over 10,000 procedures worldwide. Overall, PPVI has been proven safe and effective, but some anatomical variations can limit procedural success. This review discusses the current status and future perspectives of the procedure.
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Affiliation(s)
- Bart W Driesen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Cardiology, Radboudumc, Nijmegen, Netherlands
| | | | - Gert-Jan Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands.,Central Military Hospital, Utre cht, Netherlands
| | - Gregor J Krings
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
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Driesen BW, Warmerdam EG, Sieswerda GJT, Schoof PH, Meijboom FJ, Haas F, Stella PR, Kraaijeveld AO, Evens FCM, Doevendans PAFM, Krings GJ, van Dijk APJ, Voskuil M. Anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), fractional flow reserve- and intravascular ultrasound-guided management in adult patients. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27578] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bart W. Driesen
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
- Department of Cardiology; Radboudumc Nijmegen; Nijmegen GA 6525 The Netherlands
| | - Evangeline G. Warmerdam
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Gert-Jan T. Sieswerda
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Paul H. Schoof
- Department of Pediatric Cardiothoracic Surgery, Division Children; Wilhelmina Children's Hospital, University Medical Center Utrecht; Utrecht EA 3584 The Netherlands
| | - Folkert J. Meijboom
- Department of Cardiology, Division Heart and Lungs, and Department of Pediatric Cardiology; Wilhelmina Children's Hospital, University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Felix Haas
- Department of Pediatric Cardiothoracic Surgery, Division Children; Wilhelmina Children's Hospital, University Medical Center Utrecht; Utrecht EA 3584 The Netherlands
| | - Pieter R. Stella
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Adriaan O. Kraaijeveld
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Fabiola C. M. Evens
- Department of Pediatric Cardiothoracic Surgery, Division Children; Wilhelmina Children's Hospital, University Medical Center Utrecht; Utrecht EA 3584 The Netherlands
| | - Pieter A. F. M. Doevendans
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Gregor J. Krings
- Department of Pediatric Cardiology, Division Children; University Medical Center Utrecht; Utrecht EA 3584 The Netherlands
| | - Arie P. J. van Dijk
- Department of Cardiology; Radboudumc Nijmegen; Nijmegen GA 6525 The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
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