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Chivers S, Cleary A, Knowles R, Babu-Narayan SV, Simpson JM, Nashat H, Dimopoulos K, Gatzoulis MA, Wilson D, Prica M, Anthony J, Clift PF, Jowett V, Jenkins P, Khodaghalian B, Jones CB, Hardiman A, Head C, Miller O, Chung NA, Mahmood U, Bu'Lock FA, Ramcharan TK, Chikermane A, Shortland J, Tometzki A, Crossland DS, Reinhardt Z, Lewis C, Rittey L, Hares D, Panagiotopoulou O, Smith B, Najih L M, Bharucha T, Daubeney PE. COVID-19 in congenital heart disease (COaCHeD) study. Open Heart 2023; 10:e002356. [PMID: 37460271 PMCID: PMC10357297 DOI: 10.1136/openhrt-2023-002356] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care. OBJECTIVE Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes. METHODS Multicentre UK study undertaken 1 March 2020-30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation. RESULTS There were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)). CONCLUSIONS Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD.
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Affiliation(s)
- Sian Chivers
- Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Aoife Cleary
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
- Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Rachel Knowles
- Department of Public Health Medicine, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Sonya V Babu-Narayan
- Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - John M Simpson
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Heba Nashat
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Konstantinos Dimopoulos
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Michael A Gatzoulis
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Dirk Wilson
- Department of Congenital Cardiology, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Milos Prica
- Department of Adult Congenital heart disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Anthony
- Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul F Clift
- Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Victoria Jowett
- Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Petra Jenkins
- Department of Adult Congenital heart disease, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Bernadette Khodaghalian
- Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Caroline B Jones
- Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Antonia Hardiman
- Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Catherine Head
- Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Owen Miller
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Natali Ay Chung
- Department of Adult Congenital heart disease, St Thomas' Hospital, London, UK
| | - Umar Mahmood
- Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK
| | - Frances A Bu'Lock
- Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK
| | - Tristan Kw Ramcharan
- Department of Congenital Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ashish Chikermane
- Department of Congenital Cardiology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jennifer Shortland
- Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Andrew Tometzki
- Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - David S Crossland
- Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Zdenka Reinhardt
- Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Clive Lewis
- Department of Adult Congenital heart disease, Papworth Hospital, Cambridge, UK
| | - Leila Rittey
- Department of Congenital Cardiology, Leeds Children's Hospital, Leeds, UK
| | - Dominic Hares
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Olga Panagiotopoulou
- Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK
| | - Benjamin Smith
- Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK
| | - Muhammad Najih L
- Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK
| | - Tara Bharucha
- Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK
| | - Piers Ef Daubeney
- Department of Congenital Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
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2
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Norrish G, Chubb H, Field E, McLeod K, Ilina M, Spentzou G, Till J, Daubeney PEF, Stuart AG, Matthews J, Hares D, Brown E, Linter K, Bhole V, Pillai K, Bowes M, Jones CB, Uzun O, Wong A, Yue A, Sadagopan S, Bharucha T, Yap N, Rosenthal E, Mathur S, Adwani S, Reinhardt Z, Mangat J, Kaski JP. Clinical outcomes and programming strategies of implantable cardioverter-defibrillator devices in paediatric hypertrophic cardiomyopathy: a UK National Cohort Study. Europace 2021; 23:400-408. [PMID: 33221861 DOI: 10.1093/europace/euaa307] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/18/2020] [Indexed: 01/23/2023] Open
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in paediatric hypertrophic cardiomyopathy (HCM). This study describes the implant and programming strategies with clinical outcomes following implantable cardioverter-defibrillator (ICD) insertion in a well-characterized national paediatric HCM cohort. METHODS AND RESULTS Data from 90 patients undergoing ICD insertion at a median age 13 (±3.5) for primary (n = 67, 74%) or secondary prevention (n = 23, 26%) were collected from a retrospective, longitudinal multi-centre cohort of children (<16 years) with HCM from the UK. Seventy-six (84%) had an endovascular system [14 (18%) dual coil], 3 (3%) epicardial, and 11 (12%) subcutaneous system. Defibrillation threshold (DFT) testing was performed at implant in 68 (76%). Inadequate DFT in four led to implant adjustment in three patients. Over a median follow-up of 54 months (interquartile range 28-111), 25 (28%) patients had 53 appropriate therapies [ICD shock n = 45, anti-tachycardia pacing (ATP) n = 8], incidence rate 4.7 per 100 patient years (95% CI 2.9-7.6). Eight inappropriate therapies occurred in 7 (8%) patients (ICD shock n = 4, ATP n = 4), incidence rate 1.1/100 patient years (95% CI 0.4-2.5). Three patients (3%) died following arrhythmic events, despite a functioning device. Other device complications were seen in 28 patients (31%), including lead-related complications (n = 15) and infection (n = 10). No clinical, device, or programming characteristics predicted time to inappropriate therapy or lead complication. CONCLUSION In a large national cohort of paediatric HCM patients with an ICD, device and programming strategies varied widely. No particular strategy was associated with inappropriate therapies, missed/delayed therapies, or lead complications.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Henry Chubb
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Lucile Packard Children's Hospital, Stanford University, CA, USA
| | - Ella Field
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | | | | | | | - Jan Till
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Harefield, UK
| | - Piers E F Daubeney
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Harefield, UK
| | | | - Jane Matthews
- University Hospitals Bristol NHS Foundation Trust, UK
| | | | | | | | - Vinay Bhole
- Birmingham Women and Children's NHS Foundation Trust, UK
| | | | | | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, UK
| | - Amos Wong
- University Hospital of Wales, Cardiff, UK
| | - Arthur Yue
- University Hospital Southampton NHS Foundation Trust, UK
| | | | - Tara Bharucha
- University Hospital Southampton NHS Foundation Trust, UK
| | - Norah Yap
- University Hospital Southampton NHS Foundation Trust, UK
| | - Eric Rosenthal
- Evelina London Children's Hospital, Guys and St Thomas', NHS Foundation Trust, UK
| | - Sujeev Mathur
- Evelina London Children's Hospital, Guys and St Thomas', NHS Foundation Trust, UK
| | | | | | - Jasveer Mangat
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
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3
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Norrish G, Chubb H, Field E, McCleod K, Till J, Stuart G, Hares D, Linter K, Bhole V, Bowes M, Uzun O, Sadagopan S, Rosenthal E, Mangat J, Kaski J. Clinical outcomes and programming strategies of implantable cardioverter defibrillator (ICD) devices during childhood in hypertrophic cardiomyopathy: a UK national cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). ICDs have been shown to be effective at terminating malignant ventricular arrhythmias but at the expense of a high incidence of complications. The optimal device and programming strategies to reduce complications in this patient group are unknown.
Purpose
To describe the programming strategies and clinical outcomes of ICD implantation in childhood HCM.
Methods
Anonymised, non-invasive clinical data were collected from a retrospective, longitudinal multi-centre cohort of children (<16 years) with HCM (n=687) and an ICD in-situ from the United Kingdom.
Results
96 patients (61 male (64%), 6 non-sarcomeric (6%)) underwent ICD implantation at a median age 14yr (IQR 11–16, range 3–16) and weight 52.3 kg (IQR 34.8–63.1). Indication for ICD was primary prevention in 72 (75%). 82 (85%) had an endovascular system, 3 (3%) epicardial and 11 (12%) subcutaneous system. 61 patients (74%) were receiving one or more cardioactive medications at implantation [B blockers n=66, 70%, disopyramide n=14, 15%, amiodarone n=7, 7%, calcium channel blocker n=7, 9%, other n=5, 6%]. Programming practices varied: all had VF therapies activated (median 220bpm, IQR 212–230); 70 (73%) had a VT zone programmed (median rate 187 bpm, SD 20.9), of which 26 (27%) had therapies activated. 50 patients (61%) had antitachycardia pacing (ATP) activated. Over a median follow up of 53.6 months (IQR 27.3,108.4), 4 patients (4.2%) died following arrhythmic events despite a functioning device. 25 patients had 53 appropriate therapies (ICD shock n=47, ATP n=8), incidence rate 5.22 (95% CI 3.5–7.8). On univariable analysis, secondary prevention indication for ICD implantation was the only predictor of therapy [16 (64%) vs 8 (11.3%), p value <0.001]. 8 (8.3%) patients had 9 inappropriate therapies (ICD shock n=4, ATP n=5), incidence rate 1.37 (95% CI 0.65–2.8), caused by T wave oversensing (n=2), lead migration (n=1), supraventricular tachycardia (n=1). Device complications were seen in 30 patients (31%), including lead complications (n=16) and infection (n=10). No clinical characteristics predicted time to inappropriate therapy or lead complication.
Conclusions
In a contemporary cohort of children with HCM, the incidence of inappropriate therapies is lower than previously reported, yet complication rates remain higher than reported in adult patients. No clinical, device or programming strategies were associated with inappropriate therapies or lead complications.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): British Heart Foundation
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Affiliation(s)
- G Norrish
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - H Chubb
- Stanford University Medical Center, Paediatric Heart Centre, Stanford, United States of America
| | - E Field
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - K McCleod
- Royal Hospital for Children, Glasgow, United Kingdom
| | - J Till
- Stanford University Medical Center, Paediatric Heart Centre, Stanford, United States of America
| | - G Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - D Hares
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - K Linter
- Glenfield Hospital, Leicester, United Kingdom
| | - V Bhole
- Birmingham Children's Hospital, Birmingham, United Kingdom
| | - M Bowes
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - O Uzun
- Children's Hospital for Wales, Cardiff, United Kingdom
| | - S Sadagopan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - E Rosenthal
- Guy's and St Thomas' NHS Foundation Trust, Greater London, United Kingdom
| | - J.P Mangat
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - J.P Kaski
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
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4
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Slater TA, Cupido B, Parry H, Drozd M, Blackburn ME, Hares D, Pepper CB, Birkitt L, Cullington D, Witte KK, Oliver J, English KM, Sengupta A. Implantable cardioverter-defibrillator therapy to reduce sudden cardiac death in adults with congenital heart disease: A registry study. J Cardiovasc Electrophysiol 2020; 31:2086-2092. [PMID: 32583559 DOI: 10.1111/jce.14633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/11/2020] [Revised: 06/01/2020] [Accepted: 06/21/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The adult congenital heart disease (ACHD) population is rapidly expanding. However, a significant proportion of these patients suffer sudden cardiac death. Recommending implantable cardioverter-defibrillator (ICD) insertion requires balancing the need for appropriate therapy in malignant arrhythmia against the consequences of inappropriate therapy and procedural complications. Here we present long-term follow-up data for ICD insertion in patients with ACHD from a large Level 1 congenital cardiac center. METHODS AND RESULTS All patients with ACHD undergoing ICD insertion over an 18-year period were identified. Data were extracted for baseline characteristics including demographics, initial diagnosis, ventricular function, relevant medication, and indication for ICD insertion. Details regarding device insertion were gathered along with follow-up data including appropriate and inappropriate therapy and complications. A total of 136 ICDs were implanted during this period: 79 for primary and 57 for secondary prevention. The most common congenital cardiac conditions in both groups were tetralogy of Fallot and transposition of the great arteries. Twenty-two individuals in the primary prevention group received appropriate antitachycardia pacing (ATP), 14 underwent appropriate cardioversion, 17 received inappropriate ATP, and 15 received inappropriate cardioversion. In the secondary prevention group, 18 individuals received appropriate ATP, 8 underwent appropriate cardioversion, 8 received inappropriate ATP, and 7 were inappropriately cardioverted. Our data demonstrate low complication rates, particularly with leads without advisories. CONCLUSION ICD insertion in the ACHD population involves a careful balance of the risks and benefits. Our data show a significant proportion of patients receiving appropriate therapy indicating that ICDs were inserted appropriately.
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Affiliation(s)
- Thomas A Slater
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Blanche Cupido
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK.,Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Helen Parry
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Michael E Blackburn
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Dominic Hares
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Christopher B Pepper
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Linda Birkitt
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Damien Cullington
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Klaus K Witte
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James Oliver
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Kate M English
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Anshuman Sengupta
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
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Abstract
We describe the case of a novel PRKAG2 mutation that manifested with a ventricular fibrillation cardiac arrest in a child. The previously healthy 13-year old boy, was subsequently diagnosed with Wolff-White-Parkinson syndrome, mild left ventricular hypertrophy and atrial fibrillation. His father had also been diagnosed in the past with Wolff-White-Parkinson syndrome and developed left ventricular hypertrophy. A novel heterozygous likely pathogenic variant, c.911C>G, p.Ala304Gly was identified in the father and his son, which is absent from population databases. PRKAG2 gene variants have previously been shown to cause a familial syndrome of ventricular hypertrophy, ventricular pre-excitation, supraventricular tachycardia, and conduction abnormalities. However, to the best of our knowledge, this is the first description of this rare syndrome manifesting with a more severe phenotype in a second generation relative within the same family.
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Affiliation(s)
- Georgia Spentzou
- Department of Pediatric Cardiology, Royal Hospital for Children, 1345 Govan Rd, Glasgow, G51 4TF, UK.
| | - Ruth McGowan
- Department of Clinical Genetics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Dominic Hares
- Department of Cardiology, The Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - Karen McLeod
- Department of Pediatric Cardiology, Royal Hospital for Children, 1345 Govan Rd, Glasgow, G51 4TF, UK
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6
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Bentham J, English K, Hares D, Gibbs J, Thomson J. Effect of transcatheter closure of baffle leaks following senning or mustard atrial redirection surgery on oxygen saturations and polycythaemia. Am J Cardiol 2012; 110:1046-50. [PMID: 22728003 DOI: 10.1016/j.amjcard.2012.05.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study was to describe the clinical importance and methods of transcatheter closure of systemic venous baffle leaks after atrial redirection procedures for transposed great vessels. Until the late 1970s, atrial redirection surgery was the principal surgical palliative approach to manage transposed great vessels. Baffle leaks are among the many long-term complications of this type of surgery, and their prevalence increases over time. The clinical consequences of baffle leaks in this population are poorly understood, and the indications for closure are incompletely defined. During outpatient follow-up of 126 patients after atrial redirection surgery, 15 baffle leaks were detected in 11 patients. All underwent transcatheter closure using either an occluding device or a covered stent if there was concomitant baffle obstruction. The average age at the time of the procedure was 26 years (range 6 to 42). Ten of 11 patients were cyanosed at rest or on a simple walk test (median oxygen saturation level 80%, range 65% to 96%). Six of 11 patients were polycythemic before leak closure (median hemoglobin concentration 19 g/dl, range 13.8 to 23). After closure, there was a significant improvement in saturation (median 97%, p <0.0001) and a significant reduction in hemoglobin concentration at 6 months after the procedure (median 14.8 g/dl, p <0.05). There were no procedural adverse events. One patient experienced late device embolization necessitating surgical removal. In conclusion, transcatheter closure of baffle leaks is a technically feasible although frequently complex and lengthy procedure. Closure is associated with an improvement in oxygen saturations and a reduction in polycythaemia.
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7
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Kenny D, Hares D, Uzun O. Ventricular non-compaction in the setting of double-outlet right ventricle (tetralogy of Fallot type) with doubly committed subarterial ventricular septal defect. Heart 2007; 93:647. [PMID: 17435076 PMCID: PMC1955545 DOI: 10.1136/hrt.2006.090480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Patole SK, McGlone L, Hares D. Improving oxygenation in preterm neonates with respiratory distress. Indian Pediatr 2003; 40:376. [PMID: 12736421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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