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Harrison DJ, Kay J, Jacobsen RM, Londono-Obregon C, Yeung E, Kelly SL, Poteet A, Levek C, Landzberg MJ, Wallrich M, Khanna A. The burden of psychological trauma and post-traumatic stress disorder among adults with congenital heart disease: PTSD in ACHD. Am J Cardiol 2024:S0002-9149(24)00163-2. [PMID: 38458583 DOI: 10.1016/j.amjcard.2024.03.007] [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: 12/11/2023] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
Psychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in research examining PTSD in ACHD using the current Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria in assessing patient characteristics and experiences with trauma-focused treatment. Surveys were offered to outpatients over a 6-month enrollment period to be completed by way of a QR code on their personal smart phone. Patient-reported items include a detailed medical and psychosocial history, the Oslo social support scale, adverse childhood experiences survey, and the PTSD checklist for DSM-5. Of 158 patients (77% moderate or complex heart disease) who provided complete data, a provisional diagnosis of PTSD was found in 48 patients (30%) using a PTSD checklist for DSM-5 cut-off score of ≥31. A positive PTSD screen was associated with younger age, nonwhite race, presence of heart failure, lower New York Heart Association functional class, lower linear quality of life score, lower Oslo social support scale score, an insecure caregiver relation, period of unemployment, emergency department visits, medication nonadherence, and coexisting mental health disorders. Complexity of heart disease and number of surgical and/or catheter-based interventions were not associated with PTSD, although having undergone no cardiac surgeries until adulthood (aged ≥18 years) was associated with a lower prevalence of PTSD. Those who screened positive for PTSD were more likely to report multiple traumatic events, including noncardiac traumatic events. Only 14 of 48 patients (29%) reported a known diagnosis of PTSD, although 44 patients (92%) reported having ever seen a mental health provider. A total of 18 patients (38%) reported currently having a mental health provider. A total of 30 patients (62%) had heard of at least 1 evidence-based trauma-informed therapy, and 14 (29%) had tried at least 1. In conclusion, using the DSM-5 criteria, we observed a high prevalence of potential PTSD in ACHD associated with several novel cardiac and psychosocial patient factors. Future longitudinal studies will be necessary to establish causality. Few patients with ACHD have been formally diagnosed with PTSD or have experience with evidence-based trauma-informed therapies.
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Affiliation(s)
- David J Harrison
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | - Joseph Kay
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Roni M Jacobsen
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Camila Londono-Obregon
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth Yeung
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah L Kelly
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Ann Poteet
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Claire Levek
- University of Colorado School of Medicine, Aurora, Colorado
| | - Michael J Landzberg
- Boston Adult Congenital Heart (B.A.C.H.) Program, Boston Children's Hospital, Brigham and Women's Hospital, Boston, Massachisetts
| | - Molly Wallrich
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Amber Khanna
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
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Harrison DJ, Prada F, Nokoff NJ, Iwamoto SJ, Pastor T, Jacobsen RM, Yeung E. Considerations for Gender-Affirming Hormonal and Surgical Care Among Transgender and Gender Diverse Adolescents and Adults With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e031004. [PMID: 38293963 DOI: 10.1161/jaha.123.031004] [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: 05/17/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals and long-term survivors with adult congenital heart disease (ACHD) are both growing populations with specialized needs. No studies assess temporal trends or evaluate the care of TGD individuals with ACHD. METHODS AND RESULTS Meetings between congenital cardiology and gender-affirming care specialists identified unique considerations in TGD individuals with ACHD. A retrospective chart review was then performed to describe patient factors and outpatient trends in those with an ACHD diagnosis undergoing gender-affirming hormonal or surgical care (GAHT/S) at 1 adult and 1 pediatric tertiary care center. Thirty-three TGD individuals with ACHD were identified, 21 with a history of GAHT/S. Fourteen (66%) had moderate or complex ACHD, 8 (38%) identified as transgender male, 9 (43%) transgender female, and 4 (19%) other gender identities. Three had undergone gender-affirming surgery. There were zero occurrences of the composite end point of unplanned hospitalization or thrombotic event over 71.1 person-years of gender-affirming care. Median age at first gender-affirming appointment was 16.8 years [interquartile range 14.8-21.5]. The most common treatment modification was changing estradiol administration from oral to transdermal to reduce thrombotic risk (n=3). An increasing trend was observed from zero TGD patients with ACHD attending a gender diversity appointment in 2012 to 14 patients in 2022. CONCLUSIONS There is a growing population of TGD patients with ACHD and unique medical and psychosocial needs. Future studies must fully evaluate the reassuring safety profile observed in this small cohort. We share 10 actionable care considerations for providers with a goal of overseeing a safe and fulfilling gender transition across all TGD patients with ACHD.
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Affiliation(s)
- David J Harrison
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program University of Colorado School of Medicine, UCHealth Hospital System and Children's Hospital Colorado Aurora CO USA
| | - Francisco Prada
- Division of Adolescent Medicine Children's Hospital Colorado Aurora CO USA
| | - Natalie J Nokoff
- Division of Endocrinology Children's Hospital Colorado Aurora CO USA
| | - Sean J Iwamoto
- UCHealth Integrated Transgender Program, Division of Endocrinology, Metabolism and Diabetes University of Colorado School of Medicine, Rocky Mountain Regional VA Medical Center Aurora CO USA
| | - Tony Pastor
- Division of Cardiology, Yale New Haven Hospital New Haven CT USA
| | - Roni M Jacobsen
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program University of Colorado School of Medicine, UCHealth Hospital System and Children's Hospital Colorado Aurora CO USA
| | - Elizabeth Yeung
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program University of Colorado School of Medicine, UCHealth Hospital System and Children's Hospital Colorado Aurora CO USA
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Fernie JC, Wylie L, Schäfer M, Carnegie K, Miyamoto SD, Jacobsen RM. Pilot Project: Heart Chargers-A Successful Model for a Home-Based Physical Activity Program Utilizing Telemedicine for Fontan Patients. Pediatr Cardiol 2023; 44:1506-1513. [PMID: 37347244 DOI: 10.1007/s00246-023-03215-9] [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: 03/03/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
Fontan patients have decreased exercise capacity which further declines throughout adolescence. A positive exercise capacity trajectory in children predicts better adult Fontan outcomes. Hospital-based physical activity programs improve exercise capacity and attenuate the age-expected decline in Fontan patients. The purpose of this project was to investigate the feasibility and safety of a partially reimbursable 12-month, home-based, individualized physical activity program (Heart Chargers) for Fontan patients utilizing telemedicine. The Heart Chargers team included a cardiologist, nurse coordinator, and exercise physiologists. Eligible participants with a Fontan completed a baseline cardiopulmonary exercise test (CPET) and consented to participate in Heart Chargers, a 12-month home-based exercise prescription. The individualized exercise prescription focused on skeletal and respiratory muscle strength training and aerobic activities. Participants received a Garmin© device to monitor adherence. Telephone check-ins ranged from weekly to monthly as participants gained independence. Pre- and post-program CPET and informal surveys of physical activity self-efficacy were completed. Nine participants have completed the Heart Chargers program. There was no pre-post difference in maximal or submaximal oxygen consumption (VO2), peak heart rate, or oxygen saturation. There was a significant pre-post increase in systolic blood pressure (p-value 0.004) and minute ventilation (p-value 0.012) at peak exercise. Per subjective report, exercise-related self-efficacy increased after program completion. There were no adverse events. At present, 7 participants remain actively enrolled in the program. Heart Chargers, a novel, home-based, partially reimbursable, 12-month individualized exercise program using telemedicine was successfully implemented in Fontan patients with no adverse events. The lack of decline in exercise capacity for participants is encouraging.
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Affiliation(s)
- Julie C Fernie
- Children's Hospital Colorado, Heart Institute, Aurora, Colorado, USA
| | - Lisette Wylie
- Children's Hospital Colorado, Heart Institute, Aurora, Colorado, USA
| | - Michal Schäfer
- Children's Hospital Colorado, Heart Institute, Aurora, Colorado, USA
| | - Kara Carnegie
- Children's Hospital Colorado, Heart Institute, Aurora, Colorado, USA
| | - Shelley D Miyamoto
- Children's Hospital Colorado, Heart Institute, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Roni M Jacobsen
- Children's Hospital Colorado, Heart Institute, Aurora, Colorado, USA.
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
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Lewis MJ, Reardon LC, Aboulhosn J, Haeffele C, Chen S, Kim Y, Fuller S, Forbess L, Alshawabkeh L, Urey MA, Book WM, Rodriguez F, Menachem JN, Clark DE, Valente AM, Carazo M, Egbe A, Connolly HM, Krieger EV, Angiulo J, Cedars A, Ko J, Jacobsen RM, Earing MG, Cramer JW, Ermis P, Broda C, Nugaeva N, Ross H, Awerbach JD, Krasuski RA, Rosenbaum M. Clinical Outcomes of Adult Fontan-Associated Liver Disease and Combined Heart-Liver Transplantation. J Am Coll Cardiol 2023; 81:2149-2160. [PMID: 37257950 DOI: 10.1016/j.jacc.2023.03.421] [Citation(s) in RCA: 1] [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: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/27/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The impact of Fontan-associated liver disease (FALD) on post-transplant mortality and indications for combined heart-liver transplant (CHLT) in adult Fontan patients remains unknown. OBJECTIVES The purpose of this study was to assess the impact of FALD on post-transplant outcomes and compare HT vs CHLT in adult Fontan patients. METHODS We performed a retrospective-cohort study of adult Fontan patients who underwent HT or CHLT across 15 centers. Inclusion criteria were as follows: 1) Fontan; 2) HT/CHLT referral; and 3) age ≥16 years at referral. Pretransplant FALD score was calculated using the following: 1) cirrhosis; 2) varices; 3) splenomegaly; or 4) ≥2 paracenteses. RESULTS A total of 131 patients (91 HT and 40 CHLT) were included. CHLT recipients were more likely to be older (P = 0.016), have a lower hemoglobin (P = 0.025), require ≥2 diuretic agents pretransplant (P = 0.051), or be transplanted in more recent decades (P = 0.001). Postmatching, CHLT demonstrated a trend toward improved survival at 1 year (93% vs 74%; P = 0.097) and improved survival at 5 years (86% vs 52%; P = 0.041) compared with HT alone. In patients with a FALD score ≥2, CHLT was associated with improved survival (1 year: 85% vs 62%; P = 0.044; 5 years: 77% vs 42%; P = 0.019). In a model with transplant decade and FALD score, CHLT was associated with improved survival (HR: 0.33; P = 0.044) and increasing FALD score was associated with worse survival (FALD score: 2 [HR: 14.6; P = 0.015], 3 [HR: 22.2; P = 0.007], and 4 [HR: 27.8; P = 0.011]). CONCLUSIONS Higher FALD scores were associated with post-transplant mortality. Although prospective confirmation of our findings is necessary, compared with HT alone, CHLT recipients were older with higher FALD scores, but had similar survival overall and superior survival in patients with a FALD score ≥2.
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Affiliation(s)
- Matthew J Lewis
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
| | - Leigh C Reardon
- Department of Medicine, Division of Cardiology, Ahmason/UCLA Adult Congenital Heart Disease Center, University of California Los Angeles, Los Angeles, California, USA
| | - Jamil Aboulhosn
- Department of Medicine, Division of Cardiology, Ahmason/UCLA Adult Congenital Heart Disease Center, University of California Los Angeles, Los Angeles, California, USA
| | - Christiane Haeffele
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Yuli Kim
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa Forbess
- Division of Pediatric Cardiology, Department of Pediatrics, Northwestern University, Ann and Robert Lurie Children's Hospital, Chicago, Illinois, USA
| | - Laith Alshawabkeh
- Division of Cardiology, Department of Medicine, University of California, San Diego, California, USA
| | - Marcus A Urey
- Division of Cardiology, Department of Medicine, University of California, San Diego, California, USA
| | - Wendy M Book
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Fred Rodriguez
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jonathan N Menachem
- Division of Cardiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel E Clark
- Division of Cardiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Matthew Carazo
- Department of Cardiology, Boston Children's Hospital, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Alexander Egbe
- Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Heidi M Connolly
- Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric V Krieger
- Division of Cardiology, Department of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Jilian Angiulo
- Division of Cardiology, Department of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Ari Cedars
- Division of Cardiology, Department of Medicine, UT Southwestern, Dallas, Texas, USA
| | - Jong Ko
- Division of Cardiology, Department of Medicine, UT Southwestern, Dallas, Texas, USA
| | - Roni M Jacobsen
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael G Earing
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan W Cramer
- Department of Pediatrics and Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Peter Ermis
- Division of Pediatric Cardiology and Adult Congenital Heart Disease, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Christopher Broda
- Division of Pediatric Cardiology and Adult Congenital Heart Disease, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Natalia Nugaeva
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Jordan D Awerbach
- Division of Cardiology, Phoenix Children's, Phoenix, AZ, Divisions of Child Health and Internal Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Richard A Krasuski
- Division of Cardiology, Department of Medicine, Duke University, Raleigh Durham, North Carolina, USA
| | - Marlon Rosenbaum
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Lewis MJ, Reardon LC, Aboulhosn J, Haeffele C, Chen S, Kim Y, Fuller S, Forbess L, Alshawabkeh L, Urey MA, Book WM, Rodriguez F, Menachem JN, Clark DE, Valente AM, Carazo M, Egbe A, Connolly HM, Krieger EV, Angiulo J, Cedars A, Ko J, Jacobsen RM, Earing MG, Cramer JW, Ermis P, Broda C, Nugaeva N, Ross H, Awerbach JD, Krasuski RA, Rosenbaum M. Morbidity and Mortality in Adult Fontan Patients After Heart or Combined Heart-Liver Transplantation. J Am Coll Cardiol 2023; 81:2161-2171. [PMID: 37257951 DOI: 10.1016/j.jacc.2023.03.422] [Citation(s) in RCA: 1] [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: 01/03/2023] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND An increasing number of adult Fontan patients require heart transplantation (HT) or combined heart-liver transplant (CHLT); however, data regarding outcomes and optimal referral time remain limited. OBJECTIVES The purpose of this study was to define survivorship post-HT/CHLT and predictors of post-transplant mortality, including timing of referral, in the adult Fontan population. METHODS A retrospective cohort study of adult Fontan patients who underwent HT or CHLT across 15 centers in the United States and Canada was performed. Inclusion criteria included the following: 1) Fontan; 2) HT/CHLT referral; and 3) age ≥16 years at the time of referral. Date of "failing" Fontan was defined as the earliest of the following: worsening fluid retention, new ascites, refractory arrhythmia, "failing Fontan" diagnosis by treating cardiologist, or admission for heart failure. RESULTS A total of 131 patients underwent transplant, including 40 CHLT, from 1995 to 2021 with a median post-transplant follow-up time of 1.6 years (Q1 0.35 years, Q3 4.3 years). Survival was 79% at 1 year and 66% at 5 years. Survival differed by decade of transplantation and was 87% at 1 year and 76% at 5 years after 2010. Time from Fontan failure to evaluation (HR/year: 1.23 [95% CI: 1.11-1.36]; P < 0.001) and markers of failure, including NYHA functional class IV (HR: 2.29 [95% CI: 1.10-5.28]; P = 0.050), lower extremity varicosities (HR: 3.92 [95% CI: 1.68-9.14]; P = 0.002), and venovenous collaterals (HR: 2.70 [95% CI: 1.17-6.20]; P = 0.019), were associated with decreased post-transplant survival at 1 year in a bivariate model that included transplant decade. CONCLUSIONS In our multicenter cohort, post-transplant survival improved over time. Late referral after Fontan failure and markers of failing Fontan physiology, including worse functional status, lower extremity varicosities, and venovenous collaterals, were associated with post-transplant mortality.
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Affiliation(s)
- Matthew J Lewis
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
| | - Leigh C Reardon
- Department of Medicine, Division of Cardiology, Ahmason/UCLA Adult Congenital Heart Disease Center, University of California Los Angeles, Los Angeles, California, USA
| | - Jamil Aboulhosn
- Department of Medicine, Division of Cardiology, Ahmason/UCLA Adult Congenital Heart Disease Center, University of California Los Angeles, Los Angeles, California, USA
| | - Christiane Haeffele
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Yuli Kim
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa Forbess
- Division of Pediatric Cardiology, Department of Pediatrics, Northwestern University, Ann and Robert Lurie Children's Hospital, Chicago, Illinois, USA
| | - Laith Alshawabkeh
- Division of Cardiology, Department of Medicine, University of California, San Diego, California, USA
| | - Marcus A Urey
- Division of Cardiology, Department of Medicine, University of California, San Diego, California, USA
| | - Wendy M Book
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Fred Rodriguez
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jonathan N Menachem
- Division of Cardiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel E Clark
- Division of Cardiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Matthew Carazo
- Department of Cardiology, Boston Children's Hospital, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Alexander Egbe
- Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Heidi M Connolly
- Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric V Krieger
- Division of Cardiology, Department of Medicine University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Jilian Angiulo
- Division of Cardiology, Department of Medicine University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Ari Cedars
- Division of Cardiology, Department of Medicine, UT Southwestern, Dallas, Texas, USA
| | - Jong Ko
- Division of Cardiology, Department of Medicine, UT Southwestern, Dallas, Texas, USA
| | - Roni M Jacobsen
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael G Earing
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan W Cramer
- Department of Pediatrics and Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Peter Ermis
- Division of Pediatric Cardiology and Adult Congenital Heart Disease, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Christopher Broda
- Division of Pediatric Cardiology and Adult Congenital Heart Disease, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Natalia Nugaeva
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Jordan D Awerbach
- Division of Cardiology, Phoenix Children's, Phoenix, AZ, Divisions of Child Health and Internal Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Richard A Krasuski
- Division of Cardiology, Department of Medicine, Duke University, Raleigh Durham, North Carolina, USA
| | - Marlon Rosenbaum
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Holzemer NF, Silveira LJ, Kay J, Khanna AD, Jacobsen RM. Submaximal Exercise Response is Associated with Future Hypertension in Patients with Coarctation of the Aorta. Pediatr Cardiol 2023:10.1007/s00246-023-03176-z. [PMID: 37219586 DOI: 10.1007/s00246-023-03176-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
Hypertension (HTN) is common in patients with a history of coarctation of the aorta (CoA) and remains underrecognized and undertreated. Studies in the non-coarctation otherwise healthy adult population have correlated an exaggerated blood pressure response during mild to moderate exercise with subsequent diagnosis of HTN. The goal of this study was to determine if blood pressure response to submaximal exercise in normotensive CoA patients correlated with development of HTN.Retrospective chart review was performed in individuals ≥ 13 years old with CoA and no diagnosis of HTN at time of cardiopulmonary exercise testing (CPET). Systolic blood pressure (SBP) during CPET at rest, submax 1 (stage 1 Bruce or minute 2 bicycle ramp), submax 2 (stage 2 Bruce or minute 4 bicycle ramp), and peak were recorded. The primary composite outcome was HTN diagnosis or initiation of anti-hypertensive medications at follow up.There were 177 patients (53% female, median age 18.5 years), of whom 38 patients (21%) met composite outcome during a median follow up of 46 months. Men were more likely to develop hypertension. Age at repair and age at CPET were not significant covariates. At each stage of CPET, SBP was significantly higher in those who met the composite outcome. Submax 2 SBP ≥ 145 mmHg was 75% sensitive, 71% specific in males and 67% sensitive, 76% specific in females for development of composite outcome.Our study shows an exaggerated SBP response to submaximal exercise may portend an increased risk of developing hypertension during short- to mid-term follow up.
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Affiliation(s)
- Nicholas F Holzemer
- Department of Internal Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Lori J Silveira
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph Kay
- Departments of Internal Medicine and Pediatrics, Divisions of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amber D Khanna
- Departments of Internal Medicine and Pediatrics, Divisions of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Roni M Jacobsen
- Departments of Internal Medicine and Pediatrics, Divisions of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
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Harrison D, Prada F, Nokoff N, Iwamoto S, Pastor T, Yeung E, Jacobsen RM. CONSIDERATIONS FOR GENDER-AFFIRMING CARE AMONG TRANSGENDER ADULTS AND ADOLESCENTS WITH CONGENITAL HEART DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02041-7] [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: 03/06/2023]
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Freddo AM, Jacobsen RM, Yeung E, Stone ML, Kay JD, Khanna AD. Surgical management and outcomes of endocarditis in adolescents and adults with congenital heart disease. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100364] [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: 11/30/2022] Open
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Abstract
There is a growing population of patients living with congenital heart disease (CHD), now with more adults living with CHD than children. Adults with CHD have unique health care needs, requiring a thoughtful approach to cardiac, neurocognitive, mental, and physical health issues. They have increased risk of anxiety, depression, pragmatic language impairment, limited social cognition, worse educational attainment and unemployment, and delayed progression into independent adulthood. As a result, it is important to establish an individualized approach to obtain successful transition and transfer of care from the pediatric to adult health care world in this patient population.
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Affiliation(s)
- Roni M Jacobsen
- Pediatric and Adult Congenital Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, University of Colorado Hospital, Aurora, CO, USA.
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10
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Abstract
PURPOSE OF REVIEW The goal of this paper is to provide an overview of contemporary knowledge specific to the causes, management, and outcome of heart failure in children. RECENT FINDINGS While recently there have been subtle improvements in heart failure outcomes in children, these improvements lag significantly behind that of adults. There is a growing body of literature suggesting that pediatric heart failure is a unique disease process with age- and disease-specific myocardial adaptations. In addition, the heterogenous etiologies of heart failure in children contribute to differential response to therapies and challenge the ability to obtain meaningful results from prospective clinical trials. Consideration of novel clinical trial designs with achievable but clinically relevant endpoints and focused study of the mechanisms underlying pediatric heart failure secondary to cardiomyopathies and structural heart disease are essential if we hope to advance care and identify targeted and effective therapies.
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Affiliation(s)
| | - Anastacia M Garcia
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Roni M Jacobsen
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Shelley D Miyamoto
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.
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11
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Fernie JC, Patel SS, Jacobsen RM, Rausch CM. Comparison of Peak Cardiopulmonary Exercise Parameters in Recumbent Bicycle Versus Treadmill Exercise Testing. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561380.10316.21] [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: 11/21/2022]
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12
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Hill GD, Ghanayem NS, Hraska V, Jacobsen RM, Mitchell ME, Woods RK, Ginde S. Variation in the use of Fontan fenestration in the current surgical era. Progress in Pediatric Cardiology 2019. [DOI: 10.1016/j.ppedcard.2018.08.007] [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: 10/28/2022]
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13
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Jacobsen RM. Response to Comment on the original paper entitled “Can a home-based cardiac physical activity program improve and sustain quality of life and exercise capacity in children with Fontan circulation?”. Progress in Pediatric Cardiology 2019. [DOI: 10.1016/j.ppedcard.2018.11.006] [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: 10/27/2022]
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14
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Sachdeva S, Jacobsen RM, Woods RK, Mitchell ME, Cava JR, Ghanayem NS, Frommelt PC, Bartz PJ, Tweddell JS. Anatomic Repair of Congenitally Corrected Transposition of the Great Arteries: Single-Center Intermediate-Term Experience. Pediatr Cardiol 2017; 38:1696-1702. [PMID: 28918529 DOI: 10.1007/s00246-017-1715-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/26/2017] [Accepted: 08/31/2017] [Indexed: 01/15/2023]
Abstract
We present our experience for patients who have undergone an anatomic repair (AR) for congenitally corrected transposition of the great arteries (CCTGA) at the Children's Hospital of Wisconsin. A retrospective chart review of patients who underwent AR for CCTGA from 2001 to 2015 was performed. The cohort consisted of 15 patients (74% male). Median age of anatomic repair was 15 months (range 4.5-45.6 months). Four patients had a bidirectional Glenn (BDG) prior to AR. At the time of AR,-9 (60%) underwent Senning/Rastelli procedure, 4 (26.6%) had double switch operation, and 2 (13.3%) underwent only Senning with VSD closure. Median duration of follow-up was 5.5 years (0.05-14 years). Reoperations prior to discharge included BDG, revision of pulmonary venous baffle, closure of residual VSD, and pacemaker placement. Late reoperations included left ventricular outflow tract obstruction repair, conduit replacement, melody valve placement, and pacemaker implantation. At their most recent follow-up, no patient had heart failure symptoms and only 1 had severely diminished function that improved with cardiac resynchronization therapy. Moderate mitral regurgitation was noted in 15% (2/13), and severe in 7% (1/13). Moderate tricuspid regurgitation was noted in 15% (2/13). One patient, 7% (1/13), developed moderate aortic insufficiency. There was a 100% survival at the time of the most recent follow-up. Patients with CCTGA who have undergone AR have excellent functional status and mid-term survival but reinterventions are common. Longer term studies are needed to determine both the extent and spectrum of reinterventions as well as long term survival.
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Affiliation(s)
| | | | | | | | - Joseph R Cava
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | | | | | - Peter J Bartz
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - James S Tweddell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
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15
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Jacobsen RM, Ginde S, Mussatto K, Neubauer J, Earing M, Danduran M. Can a Home-based Cardiac Physical Activity Program Improve the Physical Function Quality of Life in Children with Fontan Circulation? CONGENIT HEART DIS 2016; 11:175-82. [DOI: 10.1111/chd.12330] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Roni M. Jacobsen
- Division of Pediatric Cardiology; Department of Pediatrics, Medical College of Wisconsin; Milwaukee Wis USA
| | - Salil Ginde
- Division of Pediatric Cardiology; Department of Pediatrics, Medical College of Wisconsin; Milwaukee Wis USA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Medical College of Wisconsin; Milwaukee Wis USA
| | - Kathleen Mussatto
- Division of Pediatric Cardiology, Department of Pediatrics; Children's Hospital of Wisconsin; Milwaukee Wis USA
| | - Jennifer Neubauer
- Division of Pediatric Cardiology; Department of Pediatrics, Medical College of Wisconsin; Milwaukee Wis USA
| | - Michael Earing
- Division of Pediatric Cardiology; Department of Pediatrics, Medical College of Wisconsin; Milwaukee Wis USA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Medical College of Wisconsin; Milwaukee Wis USA
| | - Michael Danduran
- Division of Pediatric Cardiology, Department of Pediatrics; Children's Hospital of Wisconsin; Milwaukee Wis USA
- Program in Exercise Science, College of Health Sciences, Marquette University; Milwaukee Wis USA
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16
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Jacobsen RM, Earing MG, Hill GD, Barnes M, Mitchell ME, Woods RK, Tweddell JS. The Externally Supported Ross Operation: Early Outcomes and Intermediate Follow-Up. Ann Thorac Surg 2015; 100:631-8. [PMID: 26141776 DOI: 10.1016/j.athoracsur.2015.04.123] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 04/17/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The externally supported Ross (supported Ross), consisting of a Dacron (DuPont, Wilmington, DE) graft to support the neoaortic root, has been used in adolescent and adult patients to prevent neoaortic dilatation. Outcomes after the supported Ross technique were compared with the Ross procedure using the standard aortic root replacement technique (standard Ross). METHODS This was a retrospective analysis of 36 adolescent and young adult patients who underwent the Ross procedure between 1992 and 2013. The outcomes of supported Ross procedures in 26 patients were compared with the Ross procedure in 10 patients. End points included survival, neoaortic root dilatation, development of neoaortic regurgitation, and the need for reintervention. RESULTS The median age at operation was 14 years (range, 11 to 31 years), and indications for the operation were mixed lesions (47%), followed by aortic regurgitation (42%) and stenosis (11%). There were no early deaths. The mean follow-up was 2.2 years (range, 1 to 11 years). At the 1-year (p = 0.01) and 3-year (p < 0.05) follow-up, patients in the supported Ross cohort had a smaller neoaortic root z-score. Neither cohort had a large number of patients with significant neoaortic regurgitation, with 1 patient in the supported cohort compared with 3 patients in the standard cohort. Overall, 4 patients (40%) in the standard Ross cohort had required reintervention, including 3 directed at the neoaortic root. One patient in the supported Ross cohort required early reintervention for revision of the right coronary artery. CONCLUSIONS At intermediate follow-up, patients who underwent the supported Ross technique were less likely to have neoaortic root dilatation compared with patients who underwent a standard Ross procedure. Further studies are needed to evaluate the long-term durability of this technique, particularly in regards to the development of significant aortic regurgitation, the rate of reintervention, and application to younger and smaller patients.
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Affiliation(s)
- Roni M Jacobsen
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Michael G Earing
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Garick D Hill
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Barnes
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael E Mitchell
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ronald K Woods
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James S Tweddell
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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