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Langes N, Maurer SJ, Meierhofer C, Nagdyman N, Bourier F, Holdenrieder S, Ewert P, Tutarel O. Adults with congenital heart disease and COVID-19. Eur Heart J 2022. [PMCID: PMC9619566 DOI: 10.1093/eurheartj/ehac544.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Adults with congenital heart disease (ACHD) are considered at increased risk for complications due to COVID-19, especially in those with cyanosis or heart failure. However, data regarding the rate of infection as well as regarding a myocardial involvement of a COVID-19 infection in ACHD patients are currently lacking. Purpose To study the rate of COVID-19 infections in ACHD patients from a tertiary centre as well as the rate of myocardial involvement of a COVID-19 infection. Methods All consecutive ACHD patients (over the age of 18 years) who attended the outpatient clinic of a tertiary centre from January 2021 to June 2021 were eligible to participate. Demographic data, as well as medical/surgical data including a history of a COVID-19 infection were collected. All patients had an antibody test for COVID-19. Patients with a positive antibody test were offered cardiovascular magnetic resonance imaging (CMR). Results Altogether, 420 patients (44.8% female, mean age 36.4±11.6 years) were included in the study. Congenital heart defect (CHD) complexity according to the Bethesda classification was simple in 96 (22.9%), moderate in 186 (44.3%), complex in 117 (27.9%), and miscellaneous in 21 (5.0%) patients. A positive antibody test for COVID-19 was present in 28 (6.7%) patients (CHD complexity: simple n=5, moderate n=14, severe n=7, miscellaneous n=2). Out of these 28 patients, 14 had no symptoms at all. Those with symptoms had mainly mild symptoms and were all managed in the outpatient setting. While 11 patients (39.3%) were not at all aware of their infection, 17 already knew that they had COVID-19. There was no significant difference between ACHD patients with a positive test vs those with a negative test regarding age, gender, New York Heart Association class, or complexity of CHD. Out of the 28 patients with a positive antibody test, 14 agreed to a CMR. A myocardial involvement, i.e. signs of active or healed myocarditis, was not present in any of these. Conclusions In this single-centre study, 6.7% of ACHD patients attending the outpatient clinic had positive antibodies for COVID-19. Out of these, 50% were asymptomatic and 39.3% were not aware of their infection. A myocardial involvement was not found in any of the patients that underwent a CMR. These results indicate a large number of undetected cases of COVID-19 in the ACHD population and offer reassurance that in the vast majority of cases the infection has a mild course. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Bayerisches Staatsministerium für Wissenschaft und Kunst
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Affiliation(s)
- N Langes
- German Heart Center Munich - Technical University of Munich , Munich , Germany
| | - S J Maurer
- German Heart Center Munich - Technical University of Munich , Munich , Germany
| | - C Meierhofer
- German Heart Center Munich - Technical University of Munich , Munich , Germany
| | - N Nagdyman
- German Heart Center Munich - Technical University of Munich , Munich , Germany
| | - F Bourier
- German Heart Center Munich - Technical University of Munich , Munich , Germany
| | - S Holdenrieder
- German Heart Center Munich - Technical University of Munich , Munich , Germany
| | - P Ewert
- German Heart Center Munich - Technical University of Munich , Munich , Germany
| | - O Tutarel
- German Heart Center Munich - Technical University of Munich , Munich , Germany
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Van Der Zande JA, Tutarel O, Ramlakhan KP, Johson MR, Hall R, Roos-Hesselink JW. Pregnancy outcomes in women with Ebstein's anomaly: data from the EORP Registry of Pregnancy and Cardiac Disease (ROPAC). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Abstract
Abstract
Background
Ebstein's anomaly is a rare congenital cardiac condition characterized by displacement of the posterior and septal leaflets of the tricuspid valve towards the apex of the right ventricle. The ESC Guidelines for the management of cardiovascular diseases during pregnancy categorize women with uncomplicated Ebstein's anomaly as modified World Health Organization (mWHO) risk class II. However, data regarding pregnancy outcomes in women with Ebstein's anomaly are scarce.
Purpose
To evaluate the maternal and perinatal risks of pregnancy in women with Ebstein's anomaly.
Methods
All patients with Ebstein's anomaly who had been included in the Registry of Pregnancy and Cardiac Disease (ROPAC), which is an international, prospective, observational registry of pregnant women with underlying cardiac disease (n=5739), were evaluated. The primary outcome was the occurrence of a major adverse cardiac event, defined as maternal mortality, heart failure, arrhythmia, thromboembolic events or endocarditis. The secondary outcomes were obstetric and perinatal outcomes and the influence of pregnancy on tricuspid valve regurgitation.
Results
Thirty-six hospitals in 22 countries enrolled 81 women with Ebstein's anomaly (mean age 29.7 years, 46.9% nulliparous). Seven (8.6%) women had a history of tricuspid valve repair and a further eight (9.9%) of tricuspid replacement. Most women (67.9%) were in NYHA class I. At least one major adverse cardiac event occurred in 8 (9.9%) pregnancies, including heart failure (n=6), supraventricular arrhythmia (n=3) and thromboembolic events (n=2). There was no maternal death. Almost half of the women underwent a Caesarean section (49%) and preterm delivery occurred in 24.7%. Neonatal mortality was 2.5% and four (4.9%) infants had neonatal congenital heart disease. Serial echocardiographic data pre- and postpregnancy were available in 14 women. There was no clear deterioration in tricuspid regurgitation (see Picture 1).
Conclusion
Although mortality was zero, in 10% of the pregnant women with Ebstein's anomaly a major adverse cardiac event occurred, most frequently heart failure or arrhythmia. Therefore, women with Ebstein's anomaly should be categorized as mWHO risk class II at least, but perhaps more correctly as II–III. Preconception counseling is crucial, so that women are aware of the potential risks of maternal morbidity, preterm delivery and congenital heart disease and the need for careful monitoring during pregnancy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J A Van Der Zande
- Erasmus University Medical Centre, Department of Cardiology / Department of Obstetric and Gynecology , Rotterdam , The Netherlands
| | - O Tutarel
- German Heart Center Muenchen Technical University of Munich, Department of Congenital Heart Disease and Pediatric Cardiology , Munich , Germany
| | - K P Ramlakhan
- Erasmus University Medical Centre, Department of Cardiology / Department of Obstetric and Gynecology , Rotterdam , The Netherlands
| | - M R Johson
- Imperial College London, Department of Obstetric Medicine , London , United Kingdom
| | - R Hall
- University of East Anglia, Department of Cardiology , Norwich , United Kingdom
| | - J W Roos-Hesselink
- Erasmus University Medical Centre, Department of Cardiology , Rotterdam , The Netherlands
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Tutarel O, Baris L, Johnson M, Hall R, Roos-Hesselink J. Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries. Results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Cardiac disease is one of the major causes of maternal mortality. We studied pregnancy outcomes in women with a systemic right ventricle (sRV) after the atrial switch procedure for transposition of the great arteries (TGA) or congenitally corrected TGA (CCTGA).
Methods
The ESC-EORP Registry of Pregnancy and Cardiac Disease is an international prospective registry of pregnant women with cardiac disease. Pregnancy outcomes (maternal and fetal) in women with a sRV are described. The primary endpoint was a major cardiovascular event (MACE) defined as maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary event and other thromboembolic events.
Results
Altogether, 163 women with a sRV (TGA n=121, CCTGA n=42, mean age 28.8±4.6 years) were included. Maternal mortality did not occur. At least one MACE occurred in 26 women (heart failure in 16 (9.8%), arrhythmias (atrial 5, ventricular 6) in 11 (6.7%), and others in 4 (2.5%)). Predictors of MACE were pre-pregnancy signs of heart failure [Odds ratio (OR) 6.05, 95% CI: 1.41–25.97, p=0.02] as well as a sRV ejection fraction below 40% [OR 2.81, 95% CI: 1.18–6.69, p=0.02]. One woman experienced fetal loss, while no neonatal mortality was observed. No significant differences were found between women with CCTGA and TGA. In the subset of women who had an echocardiogram before and after pregnancy, no clear deterioration in sRV was observed.
Conclusion
The majority of women with a sRV tolerated pregnancy well with a favorable maternal and fetal outcome. Heart failure and arrhythmias were the most common MACE.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Tutarel
- German Heart Centre Munich - Technical University of Munich, Munich, Germany
| | - L Baris
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - M Johnson
- Imperial College London, London, United Kingdom
| | - R Hall
- University of East Anglia, Norwich, United Kingdom
| | - J.W Roos-Hesselink
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
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Remmele J, Pringsheim M, Nagdyman N, Tutarel O, Kaemmerer H, Oberhoffer R, Ewert P. P2604Cognitive function in adults with congenital heart (ACHD) and its association with cyanosis duration, a pilot study in adults with congenital heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- J Remmele
- German Heart Center of Munich, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - M Pringsheim
- German Heart Center of Munich, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - N Nagdyman
- German Heart Center of Munich, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - O Tutarel
- German Heart Center of Munich, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - H Kaemmerer
- German Heart Center of Munich, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - R Oberhoffer
- Technical University of Munich, Chair of Preventive Pediatrics, Munich, Germany
| | - P Ewert
- German Heart Center of Munich, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
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Diller GP, Helm P, Tutarel O, Bauer UMM, Baumgartner H. P5479Optimizing care for adults with congenital heart disease: results of a conjoint analysis based on a nationwide sample of patients included in the German National Register. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- G P Diller
- University Hospital of Munster, Division of Adult Congenital and Valvular Heart Disease, Dept. of Cardiovascular Medicine, Munster, Germany
| | - P Helm
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - O Tutarel
- German Heart Center of Munich, Congenital Heart Disease, Munich, Germany
| | - U M M Bauer
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - H Baumgartner
- University Hospital of Munster, Division of Adult Congenital and Valvular Heart Disease, Dept. of Cardiovascular Medicine, Munster, Germany
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Rumpf PM, Tutarel O, Michl J, Frangieh A, Kasel AM, Kaemmerer H, Schunkert H, Kastrati A, Ewert P, Ott I. P1590Percutaneous systemic av-valve repair for the treatment of severe tricuspid regurgitation in patients with congenitally corrected transposition of the great arteries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Affiliation(s)
- P M Rumpf
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - O Tutarel
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - J Michl
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - A Frangieh
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - A M Kasel
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - H Kaemmerer
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - H Schunkert
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - A Kastrati
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - P Ewert
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - I Ott
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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Tutarel O, Diller G, Helm P, Asfour B, Abdul-Khaliq H, Ewert P, Bauer U, Lammers A. P4527The evolving use of mechanical circulatory support in pediatric and congenital heart disease patients: an analysis from the German National Register for Congenital Heart Defects. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4527] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Helm P, Diller GP, Kaemmerer H, Bauer U, Asfour B, Tutarel O. Are Adults with Congenital Heart Disease Informed about Their Risk for Infective Endocarditis and Treated in Accordance to Current Guidelines? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1599005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P.C. Helm
- Nationales Register für angeborene Herzfehler e. V., DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - G.-P. Diller
- Universitätsklinikum Münster, Kardiologisches Zentrum für Erwachsene mit angeborenen (EMAH) and erworbenen Herzfehlern, Münster, Germany
| | - H. Kaemmerer
- Department of Paediatric Cardiology and Congenital Heart Defects, Technical University of Munich, German Heart Centre Munich, DZHK (German Centre for Cardiovascular Research), Partner Site Munich, München, Germany
| | - U.M.M. Bauer
- Nationales Register für angeborene Herzfehler e. V., DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - B. Asfour
- Asklepios Klinik Sankt Augustin GmbH, German Pediatric Heart Center, Sankt Augustin, Germany
| | - O. Tutarel
- Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hannover, Germany
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Tutarel O, Diller GP, Helm P, Asfour B, Kaemmerer H, Bauer U, Lammers A. Mechanical Circulatory Support in Pediatric and Congenital Heart Disease Patients: Evolving Use and Outcome in 325 Patients from the German National Register for Congenital Heart Defects. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1599042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- O. Tutarel
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - G.-P. Diller
- Universitätsklinikum Münster, Kardiologisches Zentrum für Erwachsene mit angeborenen (EMAH) & erworbenen Herzfehlern, Münster, Germany
| | - P.C. Helm
- Nationales Register für angeborene Herzfehler e. V., DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - B. Asfour
- Asklepios Klinik Sankt Augustin GmbH, German Pediatric Heart Center, Sankt Augustin, Germany
| | - H. Kaemmerer
- Technische Universität München, Deutsches Herzzentrum München, Department of Paediatric Cardiology and Congenital Heart Defects, München, Germany
| | - U.M.M. Bauer
- Nationales Register für angeborene Herzfehler e. V., DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - A. Lammers
- Department of Paediatric Cardiology, Universitätsklinikum Münster, Münster, Germany
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Helm P, Körten MA, Diller GP, Sticker E, Tutarel O, Bauer U. Transition, Ein Gelungenes Konzept? Wer Behandelt Erwachsene Mit Angeborenem Herzfehler in Deutschland? Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571891] [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: 10/22/2022]
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Westhoff-Bleck M, Podewski E, Tutarel O, Wenzel D, Capello C, Bertram H, Bauersachs J, Widder J. Prognostic Value of NT-proBNP after Atrial Redirection Surgery. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1556028] [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: 10/23/2022]
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Körten M, Diller G, Baumgartner H, de Haan F, Helm P, Bauersachs J, Bauer UMM, Tutarel O. Kardiovaskuläre Risikofaktoren bei Erwachsenen mit angeborenen Herzfehlern - erkannt aber nicht behandelt? Eine Analyse der Daten des Nationalen Registers für angeborene Herzfehler e.V. (NRAHF). Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555988] [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: 10/23/2022]
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Westhoff-Bleck M, Briest J, Widder J, Tutarel O, Winter L, Bleich S, Bauersachs J, Kahl K. Psychiatric morbidity in adults with congenital heart disease: Rare disease or frequent problem? Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394050] [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: 10/24/2022]
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Tutarel O, Röntgen P, Bode-Böger SM, Martens-Lobenhoffer J, Westhoff-Bleck M, Diller GP, Bauersachs J, Kielstein JT. Symmetrical Dimethylarginine Is a Better Biomarker for Systemic Ventricular Dysfunction in Adults after Atrial Repair for Transposition of the Great Arteries Than NT-proBNP. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354508] [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: 10/26/2022]
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Lukasz A, Beutel G, Kümpers P, Denecke A, Westhoff-Bleck M, Bauersachs J, Kielstein JT, Tutarel O. Angiopoietin-2 as a Biomarker for Heart Failure in Adults with Congenital Heart Disease. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354509] [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: 10/26/2022]
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Uebing A, Kempny A, Tutarel O, Gatzoulis MA, Diller GP. Einfluss des Interventionellen oder chirurgischen ASD-Verschlusses im Erwachsenenalter auf das Überleben. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354432] [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: 10/26/2022]
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Kempny A, Dimopoulos K, Tutarel O, Tutaj A, Marchewka D, Piatek P, Swan L, Diller GP, Wort SJ, Gatzoulis MA. Prognostic value of ECG parameters in patients with Eisenmenger syndrome. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kempny A, Dimopoulos K, Tutarel O, Tutaj A, Marchewka D, Li W, Uebing A, Swan L, Gatzoulis MA, Diller GP. Impact of socioeconomic status and gender on access to healthcare and outcome in adults with congenital heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Shiina Y, Li W, Bouzas B, Rydman R, Kempny A, Karonis T, Tutarel O, Gatzoulis MA, Kilner PJ, Babu-Narayan SV. Cardiac index, left ventricular longitudinal systolic function and atrialised right ventricle size affect exercise capacity in adults with Ebsteins anomaly. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.130] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tutarel O, Roentgen P, Bode-Boeger SM, Martens-Lobenhoffer J, Westhoff-Bleck M, Diller GP, Bauersachs J, Kielstein JT. Symmetrical dimethylarginine is superior to NT-proBNP for detecting systemic ventricular dysfunction in adults after atrial repair for transposition of the great arteries. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2101] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tutarel O, Schiff R, Alonso-Gonzalez R, Kempny A, Uebing A, Swan L, Diller GP, Gatzoulis MA, Dimopoulos K. Infective endocarditis in adults with congenital heart disease: still a potentially lethal disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2135] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Radke RM, Kempny A, Tutarel O, Gatzoulis M, Diller GP. Cardiopulmonary exercise testing predicts death and hospitalisation in adult patients with cyanotic congenital heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kempny A, Gruebler M, Dimopoulos K, Tutarel O, Agra-Bermejo RM, Piatek P, Swan L, Diller GP, Wort SJ, Gatzoulis MA. Qrs duration predicts life-threatening ventricular arrhythmia and death in adults with a systemic right ventricle. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tutarel O, Kempny A, Alonso-Gonzalez R, Jabbour R, Li W, Uebing A, Dimopoulos K, Swan L, Gatzoulis MA, Diller GP. Congenital heart disease beyond the age of 60: emergence of a new population with high resource utilization, high morbidity, and high mortality. Eur Heart J 2013; 35:725-32. [DOI: 10.1093/eurheartj/eht257] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Tutarel O, Meyer GP, Lotz J, Westhoff-Bleck M. Serial evaluation of the thoracic aorta in patients with a bicuspid aortic valve: a magnetic resonance angiography study. VASA 2010; 39:140-4. [PMID: 20464669 DOI: 10.1024/0301-1526/a000019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is associated with an arteriopathy leading to a progressive dilatation of the aortic root. Recent studies have shown that the whole thoracic aorta is affected by this arteriopathy. Longitudinal data regarding the progression of this arteriopathy in the whole thoracic aorta has not been reported before. PATIENTS AND METHODS In this retrospective study 40 patients (mean age 28.5 +/- 9.1 years) had 2 MR-angiographies (mean interval 37.1 +/- 15.2 months). In 23 patients the aortic valve was regurgitant, in 1 stenotic, in 4 combined aortic stenosis / regurgitation was found, while in 12 the valve function was normal. Aortic diameters were measured at 6 different, standardized anatomical points. The influence of demographic and clinical parameters was assessed. RESULTS A significant increase of the diameter was observed at the aortic root (35.4 +/- 5.6 mm --> 39.1 +/- 6.5 mm, p < 0.001), the ascending aorta (37.3 +/- 8.0 mm --> 39.5 +/- 8.5 mm, p = 0.001), proximal to the innominate artery (29.4 +/- 6.1 mm --> 31.6 +/- 6.8 mm, p = 0.008), and the descending aorta (20.2 +/- 2.4 mm --> 21.6 +/- 4.2 mm, p = 0.03). There was no significant increase proximal (24.0 +/- 5.7 mm --> 24.6 +/- 5.3 mm, p = 0.44) and distal to the left subclavian artery (21.4 +/- 4.6 mm --> 21.9 +/- 4.5 mm, p = 0.19). These observations were independent of the presence of arterial hypertension, a previous operation, gender, and functional status of the aortic valve. CONCLUSIONS The progressive dilatation of the aortic root and ascending aorta that can be observed in patients with BAV was not found in the more distal parts of the thoracic aorta with the exception of the descending aorta in this study. If the dilatation of the descending aorta bears any clinical significance can't be answered with the current data. A prospective study should be performed to confirm these results.
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Affiliation(s)
- O Tutarel
- Medizinische Hochschule Hannover, Hannover, Germany.
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Pischke S, Tutarel O, Greten T, Heim A, Wedemeyer J, Herzog P, Saddekni N, Barg-Hock H, Strassburg C, Manns M, Rifai K, Gebel M. CMV-Enterokolitis bei einer erwachsenen lebertransplantierten Patientin als Ursache rezidivierender Invaginationen? Z Gastroenterol 2010; 48:688-92. [DOI: 10.1055/s-0028-1109770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stange MA, Tutarel O, Pischke S, Schneider A, Strassburg CP, Becker T, Barg-Hock H, Bastürk M, Wursthorn K, Cornberg M, Ott M, Greten TF, Manns MP, Wedemeyer H. Fulminant hepatic failure due to chemotherapy-induced hepatitis B reactivation: role of rituximab. Z Gastroenterol 2010; 48:258-63. [PMID: 20127601 DOI: 10.1055/s-0028-1109782] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hepatitis B virus reactivation during immunosuppressive therapies can lead to liver failure with very limited treatment options available. We report here on two cases of severe hepatitis B reactivation during chemotherapy including rituximab for B cell lymphoma which were treated with liver or liver-cell transplantation. Liver function was normal and HBV infection was unknown in both patients before chemotherapy was started. Impaired liver function became apparent after 4 and 6 courses of chemotherapy, respectively, and both patients experienced fulminant hepatic failure despite antiviral treatment with lamivudine or entecavir. Patient A underwent liver transplantation after documentation of complete remission of the lymphoma and survived without any evidence for hepatitis B recurrence. Patient B received 4 courses of hepatocyte transplantation but did not survive. These cases underline the importance of anti-HBc screening in patients receiving immunosuppressive treatments in particular when rituximab is given. Pre-emptive antiviral treatments should be administered since delayed antiviral treatment is frequently unable to prevent liver failure.
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Affiliation(s)
- M A Stange
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany
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Westhoff-Bleck M, Meyer GP, Lotz J, Tutarel O, Weiss T, Rafflenbeul W, Drexler H, Schröder E. Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study. VASA 2005; 34:181-5. [PMID: 16184837 DOI: 10.1024/0301-1526.34.3.181] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.
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Affiliation(s)
- M Westhoff-Bleck
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
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Abstract
The composition of the editorial boards of leading general paediatric journals was assessed. The board members' country of current affiliation was classified according to the Human Development Index. The results showed that only a very small number of the board members are based in the developing world.
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Tutarel O, Luedemann W, Nautrup CP, Jahn K, Wilke M, Berens von Rautenfeld D. Introduction and evaluation of a modular seminar system in gross anatomy teaching at the Hannover Medical School. Ann Anat 2000; 182:393-6. [PMID: 10932331 DOI: 10.1016/s0940-9602(00)80021-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a new modular seminar system which has been introduced into the gross anatomy teaching at the Hannover Medical School. It consists of seven modules with a clinical emphasis. The new modular seminar system was evaluated by an anonymous questionnaire. The results showed that the seminar system as a whole, and the different modules with one exception were highly appreciated by the students. The evaluation also revealed that the main reason for the success of a module is the manner of the teaching and learning rather than the clinical relevance. Taking into account the results of this evaluation we describe the appropriate style of teaching for use in a seminar. The success of this new approach to small group instruction in Germany should encourage other teachers of anatomy and other undergraduate subjects to consider new methods of teaching.
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Affiliation(s)
- O Tutarel
- Department of Functional and Applied Anatomy, Hannover Medical School, Germany
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