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Sorice D, Barracano R, Sarubbi B. Against all odds: successful pregnancy in an adult patient with unrepaired coarctation of the aorta. Cardiol Young 2024:1-3. [PMID: 38738395 DOI: 10.1017/s1047951124025113] [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] [Indexed: 05/14/2024]
Abstract
According to the modified World Health Organization classification, pregnant women with unrepaired aortic coarctation are at very high risk for both maternal and fetal complications and should, therefore, be counselled against pregnancy. The most frequent maternal complications include systemic hypertension, renal failure, preeclampsia, and aortic dissection. Herein, we describe a successful pregnancy in an adult patient with unrepaired aortic coarctation.
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Affiliation(s)
- Davide Sorice
- University of Campania Luigi Vanvitelli, Naples, Italy
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
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Fusco F, Scognamiglio G, Roma AS, Abbate M, Papaccioli G, Merola A, Palma M, Borrelli N, Barracano R, Correra A, Grimaldi N, Ciriello GD, D'Abbraccio M, Scavone C, Capuano A, Sarubbi B. Mid-term follow-up after COVID-19 vaccination in adults with CHD: a prospective study. Cardiol Young 2023; 33:2574-2580. [PMID: 37038838 DOI: 10.1017/s1047951123000689] [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] [Indexed: 04/12/2023]
Abstract
BACKGROUND Long-term data on COVID-19 vaccine safety, immunogenicity, and acceptance in adults with CHD are lacking. METHODS This is a prospective study including adults with CHD patients undergoing COVID-19 vaccination from January 2021 to June 2022. Data on adverse events, antispike IgG titre, previous or subsequent COVID-19 infection, booster doses, and patients' attitude towards vaccination were collected. RESULTS Four hundred and ninety CHD patients (36 ± 13 years, 53% male, 94% with moderate/complex defects) were prospectively included: 433 (88%) received a Pfizer-BioNTech mRNA vaccine, 31 (6%) Moderna mRNA vaccine, 23 (5%) AstraZeneca-Oxford ChAdOx1 nCov-19 vaccine, and 3 (0.6%) Janssen Vaccine; 310 (63%) received a booster dose. Median follow-up after vaccination was 1.53 [1.41-1.58] years. No major adverse event was reported. Eighty-two fully vaccinated patients contracted COVID-19 during follow-up after a median of 5.4 [4.3-6.5] months from the last dose. One patient with Ebstein's disease died from severe COVID-19. Symptoms' duration in patients who tested positive after vaccination was significantly shorter than in the group tested positive before vaccination (5.5 [3-8] versus 9 [2.2-15] days, p = 0.04). Median antispike IgG titre measured in 280 individuals (57%) at a median of 1.4 [0.7-3.3] months from the last dose was 2381 [901-8307] BAU/ml. Sixty patients (12%) also showed positive antinucleocapsid antibodies, demonstrating previous SARS-COV2 exposure. Twenty-nine percent appeared to have concerns regarding vaccine safety and 42% reported fearing potential effects of the vaccine on their cardiac disease before discussing with their CHD cardiologist. CONCLUSION COVID-19 vaccines appear safe in the mid-term follow-up in adults with CHD with satisfactory immunogenicity and reduction of symptoms' duration in case of infection.
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Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - Anna Selvaggia Roma
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Massimiliana Abbate
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Giovanni Papaccioli
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - Maurizio D'Abbraccio
- Vaccination Unit for Vulnerable Patients, AO dei Colli - Cotugno Hospital, Naples, Italy
| | - Cristina Scavone
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "LuigiVanvitelli", Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "LuigiVanvitelli", Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
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Borrelli N, Di Salvo G, Ciriello GD, Sabatino J, Avesani M, Leo I, Barracano R, Scognamiglio G, Russo MG, Sarubbi B. Myocardial work in children with Wolff-Parkinson-White syndrome. Int J Cardiovasc Imaging 2023; 39:1697-1705. [PMID: 37244886 DOI: 10.1007/s10554-023-02883-1] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardial deformation, and when left ventricular dysfunction is present, catheter ablation of the accessory pathway may be required, even in asymptomatic patients. We aimed to evaluate the diagnostic value of non-invasive myocardial work in predicting subtle abnormalities in myocardial performance in children with WPW.Seventy-five paediatric patients (age 8.7 ± 3.5 years) were retrospectively recruited for the study: 25 cases with manifest WPW and 50 age- and sex- matched controls (CTR). Global myocardial work index (MWI) was measured as the area of the left ventricle (LV) pressure-strain loops. From MWI, global Myocardial Constructive Work (MCW), Wasted Work (MWW), and Work Efficiency (MWE) were estimated. In addition, standard echocardiographic parameters of LV function were evaluated. Despite normal LV ejection fraction (EF) and global longitudinal strain (GLS), children with WPW had worse MWI, MCW, MWW, and MWE. At multivariate analysis, MWI and MCW were associated with GLS and systolic blood pressure, and QRS was the best independent predictor of low MWE and MWW. In particular, a QRS > 110 ms showed good sensitivity and specificity for worse MWE and MWW values. In children with WPW, myocardial work indices were found significantly reduced, even in the presence of normal LV EF and GLS. This study supports the systematic use of myocardial work during the follow-up of paediatric patients with WPW. Myocardial work analysis may represent a sensitive measure of LV performance and aid in decision-making.
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Affiliation(s)
- Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy.
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Giovanni Domenico Ciriello
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Jolanda Sabatino
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Isabella Leo
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Maria Giovanna Russo
- Division of Paediatric Cardiology, University of Campania 'Luigi Vanvitelli', AO Dei Colli, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
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Gagliardi MG, Formigari R, Perrone MA, Pomiato E, Fanisio F, Panebianco M, Barracano R, Guccione P, Palmieri R, Raponi M, Galletti L. Changes in the Cath Lab in the Treatment of Adult Patients with Congenital Heart Disease: A 12-Year Experience in a Single Referral Center with the Establishment of a Dedicated Working Group. J Cardiovasc Dev Dis 2023; 10:314. [PMID: 37623327 PMCID: PMC10455676 DOI: 10.3390/jcdd10080314] [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] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) are a growing population needing ongoing care. The aim of this study was to investigate if a dedicated ACHD team impacted the timing and indication of invasive cardiology procedures in these patients at our hospital. METHODS Our retrospective single-center study enrolled adult patients with moderate or complex congenital heart disease and with at least one cardiac catheterization between January 2010 and December 2021. According to the period, procedures were labeled as group A (2010 to 2015) or group B (2016 to 2021) and further divided into diagnostic (DCC) and interventional cardiac catheterizations (ICC). RESULTS 594 patients were eligible for the study. Both DCC (p < 0.05) and ICC increased between groups A and B (p < 0.05). In group B: Fontan patients accounted for the majority of DCC (p < 0.001), while DCC decreased in arterial switch repair (p < 0.001). In Fontan patients, conduit stenting was prevalent (p < 0.001), while fenestration closures dropped (p < 0.01). In patients with tetralogy of Fallot and native outflow tract, percutaneous pulmonary valve implantations (PPVI) increased, with a concurrent reduction in pulmonary valve replacements (p < 0.001 vs. surgical series). In right ventricular conduits, ICC increased (p < 0.01), mainly due to PPVI. Among Mustard/Senning patients, baffle stenting increased from Group A to Group B (p < 0.001). In patients with pulmonary atresia and biventricular repair, ICC often increased for pulmonary artery stenting. CONCLUSIONS A dedicated working group could improve ACHD patients' indications for interventional procedures, leading to tailored treatment, better risk stratification and optimizing time until heart transplantation.
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Affiliation(s)
- Maria Giulia Gagliardi
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
| | - Roberto Formigari
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
| | - Marco Alfonso Perrone
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
- Division of Cardiology and Cardio Lab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Elettra Pomiato
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
| | - Francesca Fanisio
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
| | - Mario Panebianco
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
| | - Rosaria Barracano
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
| | - Paolo Guccione
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
| | - Rosalinda Palmieri
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Lorenzo Galletti
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (R.F.); (E.P.); (F.F.); (M.P.); (R.B.); (P.G.); (R.P.); (L.G.)
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Barracano R, Ciriello GD, Sarubbi B. Pharmacological therapy in adult congenital heart disease with coronary artery disease and atrial fibrillation. International Journal of Cardiology Congenital Heart Disease 2023. [DOI: 10.1016/j.ijcchd.2023.100446] [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: 03/17/2023] Open
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Borrelli N, Di Salvo G, Ciriello GD, Sabatino J, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Romeo E, Colonna D, Palma M, Scognamiglio G, Russo MG, Sarubbi B. Myocardial work impairment in children with Wolff-Parkinson-White syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.028] [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
Wolf-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardium deformation during systole. According to guidelines, when the left ventricle (LV) dysfunction is present catheter ablation of the accessory pathway may be required, even in asymptomatic patients.
Purpose
The study aimed to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in children with WPW.
Methods
Eighty pediatric patients (age 7.91±3.2 years) were included in the study: 20 cases with manifest WPW and 60 age- and sex-matched controls (CTR). Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. In addition, standard echocardiographic parameters of LV function were evaluated.
Results
Patients characteristics are summarized in the table. Despite normal LV EF and GLS, children with WPW had worse MWI (WPW 1292.90±307.67 mmHg% vs CTR 1658.73±241.74 mmHg%, p=0.0000005), MCW (WPW 1844.15±267.96 mmHg% vs CTR 2104.90±237.85 mmHg%, p=0.00009), MWW (WPW 101.5 [85–148.25] mmHg% vs CTR 72 [54.75–109.25] mmHg%, p=0.004) and GWE (WPW 94 [91.75–95] mmHg% vs 96 [95–97] mmHg%, p=0.00012) (table). In the WPW group, MWE (r=−0.6, p=0.009) and MWW (r=0.6, p=0.01) was found to correlate with a prolonged QRS (figure).
A multiple regression model was generated to identify the relation between abnormal myocardial work indices (worst interquartile range as dependent variable) and several independent variables. QRS was the best independent predictor of impaired myocardial work. In particular, a QRS>110 msec showed an 86% sensibility and 85% specificity for abnormal MWE (AUC of 0.85), and a 75% sensibility and 83% specificity for abnormal MWW (AUC of 0.83) (figure).
Conclusion
In children with WPW, myocardial work indices were found significantly reduced, even in presence of normal LV EF and GLS. Prolonged QRS independently predicted myocardial impairment. In pediatric patients with WPW, myocardial work may represent a sensitive measure of LV dysfunction and help in the decision-making.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Borrelli
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - G Di Salvo
- University Hospital of Padova , Padua , Italy
| | - G D Ciriello
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - J Sabatino
- University Hospital of Padova , Padua , Italy
| | - N Grimaldi
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - R Barracano
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - F Fusco
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - A Merola
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - A Correra
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - E Romeo
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - D Colonna
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - M Palma
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | | | - M G Russo
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - B Sarubbi
- AO dei Colli - Monaldi Hospital , Naples , Italy
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Roma AS, Fusco F, Papaccioli G, Abbate M, Scognamiglio G, Merola A, Palma M, Correra A, Borrelli N, Barracano R, Grimaldi N, Colonna D, Romeo E, Sarubbi B. COVID-19 vaccination in adults with congenital heart disease: results of 1-year prospective study. Eur Heart J 2022. [PMCID: PMC9619553 DOI: 10.1093/eurheartj/ehac544.1857] [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: 11/26/2022] Open
Abstract
Background Adults with congenital heart disease (ACHD) are a vulnerable population. Routine vaccination is the only strategy to prevent a life-threatening infection. However, concerns on the cardiac safety and efficacy of COVID-19 vaccines have been raised. Aim To assess safety and efficacy of available COVID-19 vaccines in ACHD patients. Methods Data on COVID-19 infection and vaccines including booster doses and any suspected or confirmed adverse events were prospectively collected for all ACHD patients attending our tertiary centre from the beginning of the vaccination campaign (March 2021). A group of 75 healthy volunteers, matched per age and sex, was included for comparison. Antispike IgG titre was routinely obtained at the ACHD clinic. Patients' attitude towards COVID-19 was explored with a questionnaire. Results As of February 2022, 498 ACHD patients (36.7±16 years, 54% male,69% with moderate-complex defects, 48% with advanced physiological stage) were enrolled. Four hundred and sixty-one (92%) were fully vaccinated: the type of vaccine was Pfizer-BioNTech for 399 (86%) patients, Moderna for 20 (4%) and AstraZeneca for 26 (6%), 9 received a mixed vaccine regimen (2%). Forty-two (9%) had a history of previous COVID-19 infection and therefore received only one dose. Two-hundred and sixty-nine (58%) patients received a booster dose. Adverse events were mainly mild and transient. One patient complaining of chest pain following administration of mRNA-based vaccination was diagnosed with acute pericarditis, which made full remission after appropriate therapy. Two patients reported a non-specific increment of inflammatory markers. No other severe adverse events were reported. Thirty-seven (7%) refused COVID-19 vaccination being scared of potential cardiac/extra-cardiac adverse events. Among those not-vaccinated, 9 (24%) had a history of previous mild COVID-19 infection. IgG titre was measured in 243 patients at 1915 [835–5934] BAU/ml, which was significantly higher compared to controls (1196 [827–2048] BAU/ml, p=0.002). Three ACHD patients contracted COVID-19 infection after the first dose, while 65 (14%) fully vaccinated patients tested positive for COVID-19, all with mild to moderate symptoms. COVID-19 symptoms duration was significantly longer in case of infection before vaccination (10 [2.7–15] vs 3 [1.2–7], p=0.03). One Fontan patient was tested positive for COVID-19 twice, before and after COVID-19 vaccination, requiring hospitalization in both cases. Four hundred and seven patients completed the questionnaire: 128 (31%) declared to be scared of potential cardiac effects of the vaccine and that the discussion with the ACHD cardiologist was crucial to decide to undergo COVID-19 vaccination. Conclusions Our data provide real-world evidence on COVID-19 vaccines safety and efficacy in ACHD patients. Patients' education from the ACHD team may play a key role in vaccine acceptance in this vulnerable population. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- A S Roma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - G Papaccioli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - M Abbate
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
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8
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Fusco F, Scognamiglio G, Merola A, Iannuzzi A, Palma M, Borrelli N, Barracano R, Correra A, Ciriello GD, Grimaldi N, Colonna D, Romeo E, Sarubbi B. Effects of sacubitril/valsartan in patients with a systemic right ventricle. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1849] [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
Sacubitril/valsartan has been proved to reduce mortality in heart failure and reduced ejection fraction (EF) and is currently recommended as first-line therapy. However, effects in patients with a systemic right ventricle (sRV) have not been systematically investigated yet.
Purpose
We aimed to assess safety and efficacy of sacubitril/valsartan in patients with a sRV
Methods
From September 2020 to April 2021, all patients with congenitally corrected transposition of the great arteries (TGA) or TGA after Senning/Mustard repair attending our tertiary centre were prospectively enrolled. Inclusion criteria were: age ≥18 years, 3-months of optimal medical therapy including ACEi/ARB and sRV EF≤40%. Patients with univentricular physiology, systolic blood pressure (SBP) <90 mmHg, glomerular filtration rate (GFR) <30 ml/min or K >5.5 mEq/L were excluded. SBP and blood samples were obtained at 1-month of treatment. Other clinical and echocardiographic variables were reassessed at 6 and 12-month follow-up and the medication was progressively up-titrated to the highest tolerated dose.
Results
Fifty-one patients (38±11 years, 60% male, 34% ccTGA) were included. Up to March 2022, 48 (92%) patients were reviewed after 6 months of therapy and 35 (68%) completed the first year of follow-up. Baseline patients' characteristics are summarized in Table 1. At 1 month, treatment did not impact on the serum potassium values (4.5±0.3 vs 4.4±0.3 mEq/L, p=0.9) and GFR (112±33 vs 112±31 ml/min, p=0.3), while SBP dropped significantly (119±13 vs 108±18 mmHg, p=0.003). Two patients ceased the treatment due to symptomatic hypotension during the first month. One patient developed a nephrotic syndrome at 4 months of follow-up, which was likely unrelated to the treatment. No other major adverse events were reported. One patient was lost to follow-up after 3 months. Despite no significant change in the NYHA class (p=0.9), the 6-minute walking distance increased significantly at 6-month (Table 2). Nt pro BNP values were significantly decreased at 6-month, and returned to baseline at 12-month. Improved sRV systolic function was demonstrated at 6 and 12-month by significant increase in fractional area change, RV global longitudinal strain and sRV EF measured with 3D echocardiography.
Conclusions
Our mid-term results showed that sacubitril/valsartan is well tolerated in patients with a sRV and leads to signficant improvement of sRV systolic function, supporting its use in this complex population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Iannuzzi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - G D Ciriello
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
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Calcagni G, Calvieri C, Baban A, Bianco F, Barracano R, Caputo M, Madrigali A, Silva Kikina S, Perrone MA, Digilio MC, Pozzi M, Secinaro A, Sarubbi B, Galletti L, Gagliardi MG, de Zorzi A, Drago F, Leonardi B. Syndromic and Non-Syndromic Patients with Repaired Tetralogy of Fallot: Does It Affect the Long-Term Outcome? J Clin Med 2022; 11:jcm11030850. [PMID: 35160301 PMCID: PMC8836447 DOI: 10.3390/jcm11030850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 12/10/2022] Open
Abstract
Background: The impact of genetic syndromes on cardiac magnetic resonance imaging (cMRI) parameters, particularly on right and/or left ventricular dysfunction, associated with clinical parameters following the repair of Tetralogy of Fallot (rToF) is not well known. Therefore, this study aimed to assess the differences in clinical, surgical, and cMRI data in syndromic and non-syndromic rToF patients. Methods: All syndromic rToF patients undergoing a cMRI without general anesthesia between 2010 and 2020 who were able to match with non-syndromic ones for birth date, sex, type of surgery, timing of cMRI, and BSA were selected. Demographic, clinical, surgical, MRI, ECG, and Holter ECG data were collected. Results: A total of one hundred and eight rToF patients equally subdivided into syndromic and non-syndromic, aged 18.7 ± 7.3 years, were studied. Del22q11.2 and Down syndrome (DS) were the most frequent syndromes (42.6% and 31.5%, respectively). Regarding the cMRI parameters considered, left ventricular (LV) dysfunction (LVEF < 50%) was more frequently found in syndromic patients (p = 0.040). In addition, they were older at repair (p = 0.002) but underwent earlier pulmonary valve replacement (PVR) (15.9 ± 5.6 vs. 19.5 ± 6.0 years, p = 0.049). On multivariate Cox regression analysis, adjusted for age at first repair, LV dysfunction remained significantly more associated with DS than del22q11.2 and non-syndromic patients (HR of 5.245; 95% CI 1.709–16.100, p = 0.004). There were only four episodes of non-sustained ventricular tachycardia in our cohort. Conclusions: Among the cMRI parameters commonly taken into consideration in rToF patients, LV dysfunction seemed to be the only one affected by the presence of a genetic syndrome. The percentage of patients performing PVR appears to be similar in both populations, although syndromic patients were older at repair and younger at PVR. Finally, the number of arrhythmic events in rToF patients seems to be low and unaffected by chromosomal abnormalities.
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Affiliation(s)
- Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Camilla Calvieri
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Anwar Baban
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Francesco Bianco
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, AOU Ospedali Riuniti Ancona “Umberto I, G. M. Lancisi, G. Salesi”, 60123 Ancona, Italy; (F.B.); (M.P.)
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, Monaldi Hospital, 80131 Naples, Italy; (R.B.); (B.S.)
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS2 8 HW, UK;
| | - Andrea Madrigali
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Stefani Silva Kikina
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Marco Alfonso Perrone
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Marco Pozzi
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, AOU Ospedali Riuniti Ancona “Umberto I, G. M. Lancisi, G. Salesi”, 60123 Ancona, Italy; (F.B.); (M.P.)
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, 80131 Naples, Italy; (R.B.); (B.S.)
| | - Lorenzo Galletti
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Maria Giulia Gagliardi
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Andrea de Zorzi
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
| | - Benedetta Leonardi
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (G.C.); (C.C.); (A.B.); (A.M.); (S.S.K.); (M.A.P.); (L.G.); (M.G.G.); (A.d.Z.); (F.D.)
- Correspondence: ; Tel.: +39-06-68594979
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10
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Borrelli N, Di Salvo G, Ciriello GD, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Colonna D, Palma M, Scognamiglio G, Russo MG, Sarubbi B. Blood flow vortices adapt their behaviour to the presence of kent accessory pathway. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.099] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Blood speckle imaging (BSI) is a new speckle-tracking-based technique for the evaluation of blood flow. Ventricular flow vortices have been studied in sinus rhythm in normal and dysfunctional hearts, however, data are lacking in patients with Kent accessory pathway (KAP) and short atrio-ventricular (AV) conduction.
Purpose
We aimed to evaluate the characteristics of left ventricle blood vortices in children with KAP.
Methods
Nineteen paediatric patients (age 7 ± 2.9 years) were included in the study: 13 patients with manifest KAP (KAP group) and 6 age and sex -matched controls with normal AV conduction (CTR group). A thorough echocardiographic evaluation with 2D, color doppler and BSI was performed in all the included patients. BSI was recorded in apical 3-chamber view with a 6S-D probe. Vortices characteristic were analysed during filling phase of the left ventricle. We focused on the anterior vortex generated by mitral valve, which persisted longer during the cardiac cycle and is assumed to contribute to optimizing cardiac function. A standard 12-lead ECG was also recorded for each child in KAP group to esteem KAP localization.
Results
According to Arruda criteria for KAP localization, all patients in KAP group manifested the accessory pathway in the septal region. All patients in CTR group presented one major anterior vortex during filling phase, while in KAP group 10 patients out of 13 (p= 0.009) lacked of this main anterior vortex, showing instead fragmented different vortices. There were no differences in term of left ventricle function (KAPg 59.8 ± 4.02% vs CTRg 59.0 ± 2.5%, p= 0.6) and global longitudinal strain (KAPg -18.6 ± 1.0% vs CTRg -19.6 ± 3.1%, p= 0.5) between the two groups.
Conclusion
In our preliminary analysis, in patients with septal KAP, blood vortices adapted their diastolic traces to the septal dyssynchrony showing a fragmented pattern. We speculate this fragmentation may contribute to impair the performance of the left ventricle. Abstract Figure. BSI in control vs patient with WPW
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Affiliation(s)
- N Borrelli
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - G Di Salvo
- University Hospital of Padova, Padua, Italy
| | - GD Ciriello
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - N Grimaldi
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - R Barracano
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - F Fusco
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - A Merola
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - A Correra
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - D Colonna
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - M Palma
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - MG Russo
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - B Sarubbi
- AO dei Colli - Monaldi Hospital, Naples, Italy
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11
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Fusco F, Scognamiglio G, Merola A, Roma AS, Del Giudice C, Abbate M, Palma M, Correra A, Borrelli N, Barracano R, Grimaldi N, Colonna D, Romeo E, Sarubbi B. Myocardial work indices and ventricular dyssynchrony in adults with aortic coarctation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.282] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Adults with coarctation of the aorta (CoA) may present residual aortic obstruction and develop arterial vasculopathy and subclinical left ventricular (LV) dysfunction. Myocardial work (MW) is a novel non-invasive index of myocardial efficiency calculated from echocardiographic LV pressure-strain loops, which yields incremental information over ejection fraction and global longitudinal strain. (GLS)
Purpose
Aim of the present study is to analyze LVMW in a cohort of adult patients with operated aortic CoA
Methods
CoA patients aged > 18 years who underwent transthoracic echocardiography between September 2020 and July 2021 at our tertiary centre were included. Exclusion criteria were significant recoarctation, impaired LVEF, significant valvular disease and suboptimal image quality. A group of healthy individuals with no cardiac abnormalities. GLS and peak strain dispersion(PSD) were measured. MW indices were calculated using the blood pressure measured in the right arm at the time of the exam.
Results
Sixty patients (26[22-33]years, 66%male) were included. Data on previous medical history, clinical status at last assessment and Coa-related echocardiographic findings are showed in table 1. No significant differences in traditional parameters of LV systolic and diastolic function were found between groups (EF 60[57-64] vs 57[53-61],p = 0.6), however Coa patients had higher LVmass (84[75-97] vs 68[56-75]g). GLS and MW indices in the study population and in the control group are reported in table 2. Coa group showed lower GLS values and higher PSD (p < 0.0001 for both). Global work index(GWI) and global constructive work(GCW) values were not significantly different between groups, whereas CoA group showed significant increase of global wasted work(GWW) and impaired global work efficiency(GWE,p = 0.003 and 0.0005 respectively). Spearman’s linear method illustrated that both GCW and GWI had a moderate positive relation with mean gradient across the descending aorta at continuous wave Doppler. PSD was positively related to GWW and inversely related to GWE(Figure 1). Using linear regression model with the log of GWE values as dependent variable,PSD,age(β:-0.002,p = 0.03) and LVmass(β:-0.06,p = 0.004)were related to GWE. However, only PSD retained a significant relation on multivariable analysis(β:-0.002,p > 0.0001).
Conclusion
MW indices assessment is feasible in Coa patients may provide a more comprehensive understanding of the overall myocardial mechanics and performance. In particular, MW demonstrated impaired LV efficiency, which was strongly related to increased mechanical dispersion in Coa patients. Abstract Figure. Abstract Figure.
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - AS Roma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - C Del Giudice
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - M Abbate
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
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12
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Borrelli N, Di Salvo G, Ciriello GD, Sabatino J, Bucciarelli V, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Romeo E, Palma M, Scognamiglio G, Russo MG, Sarubbi B. Impaired myocardial work in paediatric patients with wolff-parkinson-white syndrome. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.098] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardium deformation during systole. Left ventricle (LV) dysfunction due to electrical dyssynchrony may require catheter ablation of the accessory pathway, even in asymptomatic patients.
Purpose
The study aimed to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in patients with WPW.
Methods
Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in the study: 12 cases with manifest WPW and 32 age-, sex- and arterial pressure- matched controls (CTR). LV ejection fraction (EF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated.
Results
Despite normal LV systolic function by standard echocardiographic parameters, patients with WPW had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs 1624.0 ± 305.8 mmHg% in CTR, p = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs 2069.0 ± 319.9 mmHg% in CTR, p= 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs 90.9 ± 58.9 mmHg% in CTR, p= 0.0008) and GWE (90.5 ± 4.8% in WPW vs 95.2 ± 2.2% in CTR, p= 0.00006). There were no significant differences in GLS and EF between patients with WPW and controls.
Conclusion
Myocardial work indices were found significantly reduced in patients with WPW, even in presence of normal LV EF and GLS. In patients with WPW, MWI may represent a sensitive measure of myocardial dysfunction and help in the decision-making for catheter ablation. Abstract Figure. Myocardial work in WPW Abstract Figure. Myocardial work in control patient
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Affiliation(s)
- N Borrelli
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - G Di Salvo
- University Hospital of Padova, Padua, Italy
| | - GD Ciriello
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - J Sabatino
- University Hospital of Padova, Padua, Italy
| | | | - N Grimaldi
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - R Barracano
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - F Fusco
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - A Merola
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - A Correra
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - E Romeo
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - M Palma
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - MG Russo
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - B Sarubbi
- AO dei Colli - Monaldi Hospital, Naples, Italy
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13
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Borrelli N, Di Salvo G, Ciriello GD, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Colonna D, Romeo E, Palma M, Scognamiglio G, Russo MG, Sarubbi B. 136 Blood vortices analysis in children with Wolff–Parkinson–White syndrome. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.001] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Wolff–Parkinson–White syndrome (WPW) is a clinical condition characterized by pre-excitation on electrocardiogram (ECG) and symptoms of arrhythmias. It has been described that premature ventricular activation induces septal wall motion abnormalities and ventricular dyssynchrony, causing detrimental effects on cardiac performance. The new speckle-tracking-based technique, blood speckle imaging (BSI), has been previously used to evaluate blood flow characteristics in normal and dysfunctional hearts in patients with normal atrio-ventricular (AV) conduction. We aimed to study the features of left ventricle blood vortices in patients with WPW and short AV conduction by using BSI.
Methods and results
Nineteen paediatric patients (age 7 ± 2.9 years) were included in the study: 13 patients with manifest WPW (WPW group) and 6 age and sex -matched controls with normal AV conduction (CTR group). A complete echocardiographic evaluation with 2D, color Doppler, and BSI was performed in all the included patients. BSI was recorded in apical 3-chamber view with a 6S-D probe. Vortices characteristics were analysed during the filling phase of the left ventricle. We focused on the anterior vortex generated by the mitral valve, which persisted longer during the cardiac cycle and is assumed to contribute to optimizing cardiac function. For each child in the WPW group, Arruda criteria were used to esteem accessory pathway localization from a 12-lead surface ECG. All patients in the WPW group manifested the accessory pathway in the septal region. All patients in the CTR group presented one major anterior vortex along the septal wall during the filling phase (Figure A), while in the WPW group, 10 patients out of 13 (P = 0.009) lacked this main anterior vortex, showing instead fragmented vortices (Figure B). Interestingly, the main differences in blood vortices pattern were showed in the last part of filling phase, when blood flow could be affected by premature activation of the septal wall. There were no differences in terms of left ventricle function (WPWg 59.8 ± 4.02% vs. CTRg 59.0 ± 2.5%, P = 0.6) and global longitudinal strain (WPWg −18.6 ± 1.0% vs. CTRg −19.6 ± 3.1%, P = 0.5) between the two groups. 136 Figure A and B
Conclusions
In our preliminary study, patients with WPW showed a fragmented pattern of diastolic blood vortices that adapted to septal dyssynchrony. We speculate this fragmentation may contribute to impair the performance of the left ventricle.
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14
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Ciriello GD, Borrelli N, Di Salvo G, Sabatino J, Bucciarelli V, Avesani M, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Romeo E, Colonna D, Palma M, Scognamiglio G, Russo MG, Sarubbi B. 276 Wolff–Parkinson–White syndrome was associated with reduced myocardial work. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.010] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Paediatric patients with a diagnosis of Wolff–Parkinson–White (WPW) Syndrome may develop a reduction of local myocardial deformation because of accessory pathway-related electrical dyssynchrony, which may lead to an impairment of left ventricular systolic function. The presence of ventricular dysfunction may be an indication for these patients to undergo radiofrequency catheter ablation (RFCA), even if asymptomatic. However, myocardial abnormalities are sometimes subtle and cannot be detected by standard echocardiographic evaluation. The purpose of this study was to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in paediatric patients with WPW Syndrome.
Methods and results
Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in this study: 12 cases with manifest WPW Syndrome and 32 age-, sex-, and arterial pressure-matched controls (CTR). Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global constructive work (MCW), wasted work (MWW), and work efficiency (MWE) were estimated. Despite normal LV systolic function by standard echocardiographic parameters, paediatric patients with WPW Syndrome had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs. 1624.0 ± 305.8 mmHg% in CTR, P = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs. 2069.0 ± 319.9 mmHg% in CTR, P = 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs. 90.9 ± 58.9 mmHg% in CTR, P = 0.0008), and GWE (90.5 ± 4.8% in WPW vs. 95.2 ± 2.2% in CTR, P = 0.00006). There were no significant differences in GLS and LVEF between patients with WPW Syndrome and controls.
Conclusions
WPW Syndrome was found to be associated with a significant reduction of myocardial work indices in the paediatric population. The assessment of MWI may represent a sensitive measure to identify a subtle myocardial dysfunction in an early stage, even when LVEF and GLS are normal. It might be considered a further diagnostic parameter for referring little patients to RFCA.
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Affiliation(s)
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | | | | | | | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | - Maria Giovanna Russo
- University of Campania Luigi Vanvitelli, Naples, Italy
- Paediatric Cardiology Unit, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
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15
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Fusco F, Scognamiglio G, Merola A, Roma AS, Nicastro C, Spatarella M, D'Abbraccio M, Di Mauro G, Atripaldi U, Atripaldi L, Correra A, Palma M, Barracano R, Borrelli N, Capuano A, Sarubbi B. COVID-19 vaccination in adults with congenital heart disease: Real-world data from an Italian tertiary centre. Int J Cardiol Congenit Heart Dis 2021; 6:100266. [PMID: 35360668 PMCID: PMC8552781 DOI: 10.1016/j.ijcchd.2021.100266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 11/01/2022] Open
Abstract
Background real-world data on COVID-19 vaccine safety, immunogenicity and acceptance in adults with congenital heart disease (ACHD) are lacking. Methods ACHD patients who were offered COVID-19 vaccination from January to June 2021 were included. Data on adverse events, on patients' attitude towards vaccination and antispike IgG titre were retrospectively collected. A group of healthy individuals with similar age and sex undergoing vaccination was included for comparison. Results 208 patients followed in a single ACHD tertiary centre (33.3 [26-45] years, 54% male) received COVID-19 vaccine, 65% vaccinated at our institution: 199 (96%) received Pfizer-BioNTech BNT162b2 vaccine, 4 (2%) Moderna-1273 and 5 (2%) AstraZeneca-ChAdOx1. Median follow-up after vaccination was 79 [57-96] days. No major adverse event was reported and the incidence of minor events was not different between ACHD patients and the control group. One patient was diagnosed with acute pericarditis. There were two deaths unrelated to the vaccine during follow-up. Three (1.5%) vaccinated patients tested positive for COVID-19. Antispike IgG titre, available in 159 (76%) patients, was 1334 [600-3401] BAU/ml, not significantly different from the control group (p=0.2). One patient with Fontan failure was seronegative. Advanced physiological stage was associated with lower antibody response, independently from previous viral exposure (p<0.0001). Fourteen percent refused COVID-19 vaccination at our institution. However, 50% of vaccinated patients declared to have been influenced by the discussion with the ACHD cardiologist and 66% of those vaccinated in situ reported that undergoing COVID-19 vaccination at the ACHD centre made them feel safer. Conclusion COVID-19 vaccines appear safe in ACHD with satisfactory immunogenicity. However, the most vulnerable patients showed lower antibody response. ACHD team may play a key role in vaccine acceptance.
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Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - Assunta Merola
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Anna Selvaggia Roma
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Carmine Nicastro
- Department for Laboratory Medicine, AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - Maurizio D'Abbraccio
- Vaccination Unit for Vulnerable Patients, AORN dei Colli - Cotugno Hospital, Naples, Italy
| | - Gabriella Di Mauro
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Umberto Atripaldi
- Department for Laboratory Medicine, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Lidia Atripaldi
- Department for Laboratory Medicine, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Berardo Sarubbi
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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16
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Fusco F, Merola A, Scognamiglio G, Palma M, Correra A, Barracano R, Borrelli N, Grimaldi N, Spinelli Barrile C, Puzone N, Ciriello GD, Colonna D, Romeo E, Sarubbi B. Effects of sacubitril/valsartan in patients with a systemic right ventricle: early evidence of exercise tolerance and systolic function improvement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1877] [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
Sacubitril/valsartan has been shown to reduce mortality and morbidity inpatients with heart failure and reduced systolic function. However, the effects of this novel association in patients with congenital heart disease and a systemic right ventricle (sRV) have not been investigated yet.
Purpose
We aimed to assess tolerability and efficacy of sacubitril/valsartan in patients with a sRV
Methods
From September 2020 to March 2021, 38 patients with congenitally corrected transposition of the great arteries or transposition of the great arteries after Senning or Mustard repair were prospectively enrolled. Inclusion criteria were: age ≥18 years, optimal medical therapy including ACEi/ARB for at least 6 months and EF of the sRV ≤40%. Patients with univentricular physiology, systolic blood pressure (SBP) <90mmHg, glomerular filtration rate (GFR) <30ml/min or K >5.5mEq/L were excluded. RV systolic function was assessed on echocardiography using a multiparametric evaluation. The study protocol contemplates serial assessments at 1, 3, 6 and 12 months after treatment initiation.
Results
Up to March 31th, 23 patients completed 1-month and 15 completed 3-month assessment after treatment initiation. Baseline patients' characteristics are summarized in table 1. The medication dose was up-titrated to the highest tolerated dose during follow-up. During early follow-up, no major adverse events were reported. Treatment did not impact significantly on the values of serum potassium (basal K+ 4.4 [4.2–4.6] mEq/L, K+ at 3 months 4.4 [4.3–4.6] mEq/L, p=0.7) and GFR (basal GFR 113.9±35ml/min, GFR at 3 months 107.8±21 ml/min, p=0.7). Although SBP did not change significantly (114±12 vs 113.9±19 mmHg at 1-month and 117.3±12 mmHg at 3 months; p=0.9 for both), 2 (5%) patients ceased the treatment due to symptomatic hypotension during the first month of treatment. There was no significant change in the NYHA class. However, the 6-minute walking distance increased significantly after 3 months (365±120 vs 498.3±71 min; p=0.01). Furthermore, while traditional echocardiographic parameters of RV systolic function (TAPSE, s wave and FAC) did not change significantly, RV global longitudinal strain (GLS) and RV free wall GLS demonstrated subclinical improvement in right ventricular systolic function (table 2).
Conclusions
Our short-term results from an ongoing prospective study showed that sacubitril/valsartan is well tolerated in patients with a sRV with early evidence of improvement in exercise tolerance and sRV systolic function. Longer follow-up is warranted to confirm these data.
Funding Acknowledgement
Type of funding sources: None. Table 1Table 2
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - C Spinelli Barrile
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Puzone
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G D Ciriello
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
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17
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Fusco F, Scognamiglio G, Guarguagli S, Merola A, Palma M, Borrelli N, Barracano R, Grimaldi N, Correra A, Piccolo G, La Rocca F, Del Giudice C, Colonna D, Romeo E, Sarubbi B. Prognostic relevance of thyroid disease in adults with congenital heart disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1879] [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: 11/13/2022] Open
Abstract
Abstract
Background
Adults with congenital heart disease (ACHD) are frequently affected by thyroid diseases (TD). However, the clinical relevance of TD in ACHD remains unknown.
Purpose
We aimed to describe the prevalence of TD in the ACHD population and to ascertain whether TD are associated with worse outcome.
Methods
Clinical data on all consecutive patients aged >18 years attending our ACHD unit for a day-case between 2014 and 2019 were retrospectively collected. For statistical analysis, a composite endpoint was created combining the following events at follow-up: hospitalization for heart failure, new-onset tachyarrhythmic or bradyarrhythmic events and death.
Results
Four hundred ninety-five ACHD patients with a median age of 32.2 [24.5–45.6] years (46% male) were included. There was an overall prevalence of patients with moderate or complex lesions (414=84%). Compared to the group with no history of TD, patients in the TD were older, (41.9 [29.7–53.5] vs 30.2 [24.3–39] years; p<0.0001) and mainly female (77% vs 46%; p<0.0001) and more likely to have undergone at least two cardiac catheterization procedures (29 vs 13%; p<0.0001). Genetic disorders including Down syndrome were more prevalent in the group with TD (p<0.0001). Moreover, at last follow-up, those with TD had higher pro-BNP-nt values (243.5 [96.5–523] pg/ml Vs 94 [45–207] pg/ml; p<0.0001) and were in a more advanced NYHA class (27% vs 13% in class III-IV; p=0.0002). Echocardiography showed lower EF in the TD group (55 [55–60]% vs 60 [55–65]%; p=0.0002).
Median follow-up was 9.4 [4.5–13.1] years. Patients with TD had a higher unadjusted mortality rate, with a trend towards statistical significance (p=0.07). Sixty-four (42%) patients in the TD group and 43 (12.5%) met our composite endpoint, leading to a 10-year survival free from events of 53.7% Vs 86.5%, respectively (p<0.0001, Figure1). Multivariate analysis showed that age, ejection fraction, previous surgical palliation, advanced physiological stage and TD were independent predictors of our composite endpoint, even after stratification for genetic disorders as reported in table1. After adjustment for baseline differences between groups with propensity matching score using age, sex, disease complexity, physiological stage, previous palliative or reparative surgery, normal or reduced systemic ventricle ejection fraction, pulmonary arterial hypertension, cyanosis and presence of systemic right ventricle as independent variables, TD remained a strong predictor of cardiac events at follow-up with an hazard ratio of 4.47 (95% CI 2.42–8.28; p<0.0001).
Conclusion
TD is a strong predictor of adverse outcome in the ACHD population after exclusion of potential confounding factors, being related to a fourfold increased risk of events at follow-up.
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - S Guarguagli
- Ospedale SS Giovanni e Paolo AULSS3 Serenissima Venezia, Venice, Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G Piccolo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - F La Rocca
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - C Del Giudice
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
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18
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Barracano R, Scognamiglio G, Palma M, Sica G, Merola A, Borrelli N, Fusco F, Correra A, Ciriello GD, Sarubbi B. Chylothorax Due to Superior Vena Cava Obstruction in a Patient With Complex Congenital Heart Disease. JACC Case Rep 2021; 3:736-739. [PMID: 34317616 PMCID: PMC8311179 DOI: 10.1016/j.jaccas.2021.03.002] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/11/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Obstruction of the superior vena cava represents an under-recognized cause of chylothorax in the adult population. Our case report describes the successful conservative management of chylothorax due to bilateral superior vena cava obstruction in an adult patient with complex congenital heart disease. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Rosaria Barracano
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Giacomo Sica
- Division of Radiology, Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
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19
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Sarubbi B, Correra A, Colonna D, Romeo E, Palma M, Merola A, D'Alto M, Scognamiglio G, Fusco F, Barracano R, Borrelli N, Grimaldi N, D'Onofrio A, Russo MG. Subcutaneous implantable cardioverter defibrillator in complex adult congenital heart disease. Results from the S-ICD “Monaldi Care” registry. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Barracano R, Nashat H, Constantine A, Dimopoulos K. Heart and lung transplantation in pulmonary arterial hypertension related to congenital heart disease: an unusual indication. J Congenit Heart Dis 2020. [DOI: 10.1186/s40949-020-00047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Eisenmenger syndrome is a multisystem disorder, characterised by a significant cardiac defect, severe pulmonary hypertension and long-standing cyanosis. Despite the availability of pulmonary hypertension therapies and improved supportive care in specialist centres, Eisenmenger patients are still faced with significant morbidity and mortality.
Case presentation
We describe the case of a 44-year-old woman with Eisenmenger syndrome secondary to a large secundum atrial septal defect. Her pulmonary vascular disease was treated with pulmonary vasodilators, but she experienced a progressive decline in exercise tolerance, increasing atrial arrhythmias, resulting in referral for transplantation. Her condition was complicated by significant recurrent haemoptysis in the context of extremely dilated pulmonary arteries and in-situ thrombosis, which prompted successful heart and lung transplantation. She made a slow recovery but remains well 3 years post-transplant.
Conclusions
Patients with Eisenmenger syndrome secondary to a pre-tricuspid lesion, such as an atrial septal defect have a natural history that differs to patients with post-tricuspid shunts; the disease tends to present later in life but is more aggressive, prompting early and aggressive medical intervention with pulmonary arterial hypertension therapies. This case illustrates that severe recurrent haemoptysis can be an indication for expediting transplantation in Eisenmenger syndrome patients.
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21
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Barracano R, Brida M, Guarguagli S, Palmieri R, Diller GP, Gatzoulis MA, Wong T. Implantable cardiac electronic device therapy for patients with a systemic right ventricle. Heart 2020; 106:1052-1058. [PMID: 32269130 DOI: 10.1136/heartjnl-2019-316202] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 11/04/2022] Open
Abstract
The systemic right ventricle (SRV), defined as the morphological right ventricle supporting the systemic circulation, is relatively common in congenital heart disease (CHD). Our review aimed at examining the current evidence, knowledge gaps and technical considerations regarding implantable cardiac electronic device therapy in patients with SRV. The risk of sinus node dysfunction (SND) after atrial switch repair and/or complete heart block in congenitally corrected transposition of great arteries requiring permanent pacing increases with age. Similar to acquired heart disease, indication for pacing includes symptomatic bradycardia, SND and high degree atrioventricular nodal block. Right ventricular dysfunction and heart failure also represent important complications in SRV patients. Cardiac resynchronisation therapy (CRT) has been proposed to improve systolic function in SRV patients, although indications for CRT are not well defined and its potential benefit remains uncertain. Amongst adult CHD, patients with SRV are at the highest risk for sudden cardiac death (SCD). Nevertheless, risk stratification for SCD is scarce in this cohort and implantable cardioverter-defibrillator indication is currently limited to secondary prevention. Vascular access and the incidence of device-related complications, such as infections, inappropriate shocks and device system failure, represent additional challenges to implantable cardiac electronic device therapy in patients with SRV. A multidisciplinary approach with tertiary expertise and future collaborative research are all paramount to further the care for this challenging nonetheless ever increasing cohort of patients.
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Affiliation(s)
- Rosaria Barracano
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Division of Pediatric Cardiology, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital-IRCSS, Rome, Italy
| | - Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Silvia Guarguagli
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
| | - Rosalinda Palmieri
- Division of Pediatric Cardiology, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital-IRCSS, Rome, Italy
| | - Gerhard Paul Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tom Wong
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
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22
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Brida M, Diller GP, Nashat H, Barracano R, Kempny A, Uebing A, Rigby ML, Gatzoulis MA. Cardiac catheter intervention complexity and safety outcomes in adult congenital heart disease. Heart 2020; 106:1432-1437. [PMID: 32205313 DOI: 10.1136/heartjnl-2019-316148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the intervention spectrum, complexity, and safety outcomes of catheter-based interventions in a contemporary adult congenital heart disease (ACHD) tertiary cohort. METHODS All patients over 16 years who underwent a catheter-based intervention for ACHD in our centre between 2000 and 2016 were included. Baseline demographics, clinical characteristics, indications for and complexity of intervention, procedural complications and early and mid-term mortality were analysed. RESULTS Overall, 1644 catheter-based interventions were performed. Intervention complexity ranged from simple (67.5%) to intermediate (26.4%) and to high (6.1%). Commonly performed procedures were atrial septal defect (33.4%) and patent foramen ovale closure (26.1%) followed by coarctation of the aorta (11.1%) and pulmonary artery interventions (7.0%). Age at index intervention was 40±16 years, 758 (46.1%) patients were male, 73.2% in New York Heart Association (NYHA) class I, 20.2% in NYHA class II, whereas 6.6% in NYHA class III/IV. In-hospital mortality was 0.7%. Median postinterventional length of stay was 1 day. Complications occurred in 129 (7.9%) with major adverse events in 21 (1.3%). One-year postintervention survival rates were 98.7% (95% CI 98.2 to 99.2). Over the study period, there was a notable shift in intervention complexity, with a predominance of simple procedures performed in early years and more complex procedures in later years. Furthermore, the case mix during the study broadened (p<0.001) with new catheter-based interventions and a more individualised approach to therapy. CONCLUSION This study shows an increasing complexity and expanding variability of ACHD catheter-based interventions, associated with low major complications, short hospital stays and low early and mid-term mortality. Ongoing investment in ACHD catheter interventions is warranted.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK .,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Gerhard Paul Diller
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
| | - Heba Nashat
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Rosaria Barracano
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Anselm Uebing
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Michael L Rigby
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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23
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Kavouras C, Dimopoulos K, La Leggia A, Barracano R, Brida M, Cazzoli I, Gatzoulis M, Li W. P1446 Correlation of B-Type natriuretic peptide with LV and RV function assessed by echocardiography in adults congenital heart diseases patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.874] [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
Introduction
Brain natriuretic peptide (BNP) is a well-established marker for heart failure in the general population however limited data are available on the value of BNP as a diagnostic and prognostic marker in adults with congenital heart disease (ACHD). The purpose of our study is to evaluate the relation between BNP levels and biventricular systolic and diastolic function in patients with ACHD.
Methods
We evaluated clinically stable ACHD patients who underwent echocardiography from May 2015 until January 2018. We studied the correlation of BNP with the degree of systolic and diastolic dysfunction of the left ventricle. Moreover we also investigate the relation of BNP with the right tricuspid annular plane systolic excursion (TAPSE), the fractional area change (FAC) and the pulmonary arterial systolic pressure (PASP).
Results
In total, 385 patients were included in our study (median age, 43 ±12 years; 61% male). Of the 385 patients, 193 (50%) had tetralogy of Fallot, 94 (24%) had systemic RV, including patients with transposition of the great arteries (TGA) after atrial switch operation (Mustard or Senning) and congenitally corrected TGA -ccTGA , 43 (11%) had univentricular hearts and Fontan physiology, 55 (14%) had other lesions. BNP levels were 66 ± 26 pg/mL and 93, ±31pg/mL, for patients with EF > 50% and 50%> EF >35% respectively (p = 0.003). BNP levels correlate with parameters reflecting LV filling pressure, including transmitral early diastolic velocity (E) 81 ± 29pg/mL and its ratio to early diastolic annular myocardial tissue velocity (E/Ea) 77 ± 17pg/mL. (r=-0.607, p = 0.003 r=-0.598, p = 0.005, respectively) BNP levels were also significantly higher in patients with impaired tricuspid annular plane systolic excursion 87 ± 21 pg/mL (TAPSE < 14mm; p = 0.002) and decreased RV FAC 81 ± 18 pg/mL (FAC <35% P= 0.004) and in patients with PASP≥35 mmHg (p = 0.003). The ROC curve and logistic regression analysis spotted the role of BNP in identifying systolic and diastolic dysfunction patterns in ACHD patients. Conclusion: In clinical stable ACHD patiens BNP levels correlate well with LV systolic dysfunction as well as with impaired diastolic function. Furthermore patients with impaired RV function and increased PASP have raised BNP levels. Therefore monitoring BNP levels plays an important role in management of clinical stable ACHD patients
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Affiliation(s)
- C Kavouras
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - K Dimopoulos
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A La Leggia
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Barracano
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Brida
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - I Cazzoli
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Constantine AH, Segura T, Nicol E, Kempny AH, Rafiq I, Barradas Pires A, Barracano R, Gatzoulis MA, Rubens M, Semple T, Dimopoulos K. P3654Location of the coronary origins in transposition patients following anatomical repair: Implications for invasive coronary angiography and intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0511] [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
Surgical repair of transposition of the great arteries (TGA) is most commonly via the arterial switch operation (ASO). This involves translocation of the aorta and pulmonary trunk, typically with anastomosis of the branch pulmonary arteries anteriorly (LeCompte manoeuvre) and re-implantation of the coronary arteries onto the posterior neo-aorta. As such, the position of the coronary ostia may differ from their expected locations.
Purpose
To use ECG-gated CT angiography to describe the anatomic position of coronary ostia in post-switch TGA patients guiding potential catheter interventions in this population.
Methods
All post ASO patients who underwent CT imaging between 2008–2018 were identified. Patients with complex anatomy such as double outlet right ventricle were excluded. The positions of the coronary ostia were measured in degrees from vertical on a double-oblique reconstruction in the aortic valve plane. Ostium positions were compared to those of patients with no congenital heart disease via Watson's two-sample test of homogeneity for circular data. Angular dispersion was compared between groups via the Wallraff test. P<0.05 indicated statistical significance.
Results
Of 206 adult patients with TGA and ASO followed in our adult congenital heart disease centre, 38 (18.4%) had CT imaging available for analysis during the study period (mean age 24±6.8, 75% male).
The control group consisted of 15 patients investigated for chest pain (mean age 54±15.1, 73% male). In the control group, the right and left coronary ostia arose at a mean angle of −19 and +125 degrees from vertical (figure 1a). This was significantly different to the mean ASO coronary ostia clustered at mean angles of −70 and +29 degrees from vertical (Watson p<0.001) (figure 1b, with stenosis at the left coronary anastomosis).
There was no significant difference in spread of left ostia (Rho 0.9 vs 0.99, p=0.12), but right ostia were significantly more variable in ASO patients than controls (0.71 vs 0.96, p=0.003).
Figure 1
Conclusions
Coronary ostial positions in the neo-aorta of post-ASO patients differ significantly from those of normal controls, with considerable variability, especially in right coronary position. CT can demonstrate coronary ostia in 3D space and derive appropriate tube angles to guide catheterisation in post-operative congenital cardiac patients, optimise catheter selection, reduce catheterisation tome, radiation and contrast dose.
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Affiliation(s)
- A H Constantine
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - T Segura
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - E Nicol
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - A H Kempny
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - I Rafiq
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - A Barradas Pires
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - R Barracano
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - M A Gatzoulis
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - M Rubens
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - T Semple
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
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Barracano R, Guarguagli S, Kavouras C, Brida M, Griffith S, Wong T, Gatzoulis MA. 2401Cardiac resinchronization therapy for the systemic right ventricle: a single center experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0154] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiac resynchronization therapy (CRT) has become a treatment of choice in patients with chronic heart failure (HF). About 25% of patients with systemic right ventricle (SRV) progress to symptomatic HF, which may be refractory to drug therapy and is commonly associated with significant morbidity and mortality. For these reasons, CRT has been emerging as an effective treatment strategy for patients with SRV failure and electrocardiographic signs of ventricular dyssynchrony. Few studies have reported the acute and long - term effects of CRT in SRV subjects, with different findings. Our study aimed to describe the experience with CRT in SRV patients in a single tertiary centre.
Purpose
Assess the long term efficacy of CRT in patient with SRV
Materials and methods
All consecutive SRV patients who underwent CRT implantation and/or upgrading between 1994 and 2018 at our tertiary centre were included. Clinical and echocardiographic parameters before and after CRT implantation were collected and analyzed.
Results
A total of 21 patients (mean age 47.8±14.8 years, 13 M) were implanted with CRT-P (12, 57%) or CRT-D (9,43%) during the study period. 90% of patients showed an anatomy of congenitally corrected transposition of the great arteries (CCTGA), whereas 9.5% underwent Mustard procedure for transposition of the great arteries (TGA). Among CCTGAs, 11 (52.5%) subjects underwent previous surgical procedures, including implant of a conduit between the left ventricle (LV) and the pulmonary artery (PA) in 8 (38%) patients, tricuspid valve repair in 2 (9.5%) and surgical closure of atrial septal defect in 1 (5%). Before CRT implant/upgrading, 10 (48%) patients had a moderate to severe reduction in the SRV ejection fraction (EF) and 7 (33%) had a moderate to severe tricuspid regurgitation (TR). Overall, 15 (71%) patients referred a NYHA II or III. After a median follow up of 57 months (IQR 35–83), 43% of patients showed an improvement in their functional status, which was associated with an improvement of SRV EF and TR only in 22% and 33% of these patients. On the contrary, no patient reported a worsening in NYHA class, while SRV EF decreased in 28.5% and the grade of TR worsen in 23.8% of patients.
Conclusions
CRT is emerging as an effective treatment for SRV dysfunction. However, criteria for implantation are not well defined and the deterioration of SRV function related to subpulmonary univentricular pacing should be considered. Moreover, TR did not improve in this study, suggesting that concurrent tricuspid valve interventions may be necessary in patients with severe TR and may facilitate the improvement in RV function achieved with CRT. Proper planning, tertiary expertise and international collaborations are all paramount in this field.
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Affiliation(s)
- R Barracano
- Bambino Gesu Children's Hospital, Rome, Italy
| | | | - C Kavouras
- Royal Brompton Hospital, London, United Kingdom
| | - M Brida
- Royal Brompton Hospital, London, United Kingdom
| | - S Griffith
- Royal Brompton Hospital, London, United Kingdom
| | - T Wong
- Royal Brompton Hospital, London, United Kingdom
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26
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Guarguagli S, Kempny A, Cazzoli I, Barracano R, Gatzoulis MA, Dimopoulos K, Ernst S. Efficacy of catheter ablation for atrial fibrillation in patients with congenital heart disease. Europace 2019; 21:1334-1344. [DOI: 10.1093/europace/euz157] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/04/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Aims
Advances in surgical techniques allow an increasing number of children with congenital heart disease (CHD) to reach adulthood. As patients grow older, atrial fibrillation (AF) is evolving into a major clinical concern and can be difficult to manage medically. Primary AF catheter ablation may, therefore, have a role in this setting but few reports have evaluated its efficacy in CHD patients.
Methods and results
We retrospectively reviewed 58 consecutive patients [median age 51, interquartile range (IQR) 44–63 years, 57% male] with AF (45% paroxysmal) who underwent 122 ablation procedures in our tertiary centre in the last decade. The majority had CHD of moderate or severe complexity (57%, Bethesda Class 2 or 3) with a dilated left atrium (LA) (81%) and/or right atrium (86%). At 1-year from the first ablation, 32.8% of patients remained in sinus rhythm. Multiple procedures were required in 35 (60%) patients. Freedom from AF at 1-year after the 2nd and 3rd ablation was 40.9% and 36.5%, respectively. Multivariable predictors of AF recurrence were underlying anatomic complexity [hazard ratio (HR) in Bethesda 3 1.98, P = 0.006], type of AF (HR for persistent 1.87, P = 0.004), and indexed LA dimensions (HR for cm2/m2 1.06, P = 0.03).
Conclusion
While ablation may be a valid option for the treatment of AF in CHD patients, multiple procedures are likely to be required. Early referral and careful patient selection are essential to optimize the results of AF ablation, achieving a low rate of recurrence. Further studies are needed to validate our prognostic model and guide clinical practice.
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Affiliation(s)
- Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aleksander Kempny
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Rosaria Barracano
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
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27
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Guarguagli S, Barracano R, Cazzoli I, Dimopoulos K, Ernst S. P5746Impact of the use of advance mapping and navigation techniques on radiation exposure in catheter ablation in adult congenital heart disease patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5746] [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)
- S Guarguagli
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - R Barracano
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - I Cazzoli
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - S Ernst
- Royal Brompton Hospital, Cardiology, London, United Kingdom
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28
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Kavouras C, Khokhar A, Dimopoulos K, La Leggia A, Barracano R, Ilagan L, Gatzoulis M, Li M. P1618Usefulness of exercise stress echocardiography in adults with congenital heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1618] [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)
- C Kavouras
- Hippokration General Hospital, Athens, Greece
| | - A Khokhar
- Royal Brompton Hospital, London, United Kingdom
| | | | - A La Leggia
- Royal Brompton Hospital, London, United Kingdom
| | - R Barracano
- Royal Brompton Hospital, London, United Kingdom
| | - L Ilagan
- Royal Brompton Hospital, London, United Kingdom
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom
| | - M Li
- Royal Brompton Hospital, London, United Kingdom
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29
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Kavouras C, Li W, Dimopoulos K, Efstathiou M, Giannakoulias G, Brida M, Barracano R, Ntiloudi D, Lallegia A, Gatzoulis M. P1235Non compaction cardiomyopathy. Prevalence and relation to outcome among patients with congenital heart diseases. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1235] [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: 11/15/2022] Open
Affiliation(s)
- C Kavouras
- Hippokration General Hospital, Athens, Greece
| | - W Li
- Royal Brompton Hospital, London, United Kingdom
| | | | | | | | - M Brida
- Royal Brompton Hospital, London, United Kingdom
| | - R Barracano
- Royal Brompton Hospital, London, United Kingdom
| | - D Ntiloudi
- Ahepa University Hospital, Thessaloniki, Greece
| | - A Lallegia
- Royal Brompton Hospital, London, United Kingdom
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom
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30
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Scognamiglio G, Barracano R, Colonna D, Mattera Iacono A, Santoro G, Spadafora A, Nappi G, Russo MG, Sarubbi B. A Very Late Life-Threatening Complication After Percutaneous Closure of an Atrial Septal Defect. Can J Cardiol 2016; 33:293.e1-293.e2. [PMID: 27955820 DOI: 10.1016/j.cjca.2016.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 11/24/2022] Open
Abstract
Percutaneous closure is widely recognized as the first therapeutic option in the majority of cases of secundum atrial septal defect (ASD) because of its high effectiveness and safety. Nonetheless, with the progressive increase of implanted devices and follow-up duration, several adverse events, some of them potentially life-threatening, have been reported. We report the case of an asymptomatic aortic erosion that occurred 13 years after the procedure. The main feature of our case is the very late occurrence of a life-threatening asymptomatic complication of ASD percutaneous closure, which should prompt lifelong surveillance in this population.
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Affiliation(s)
- Giancarlo Scognamiglio
- Paediatric Cardiology and GUCH Unit, AORN "Ospedali dei Colli," Second University of Naples, Naples, Italy.
| | - Rosaria Barracano
- Paediatric Cardiology and GUCH Unit, AORN "Ospedali dei Colli," Second University of Naples, Naples, Italy
| | - Diego Colonna
- Paediatric Cardiology and GUCH Unit, AORN "Ospedali dei Colli," Second University of Naples, Naples, Italy
| | - Agostino Mattera Iacono
- Paediatric Cardiology and GUCH Unit, AORN "Ospedali dei Colli," Second University of Naples, Naples, Italy
| | - Giuseppe Santoro
- Paediatric Cardiology and GUCH Unit, AORN "Ospedali dei Colli," Second University of Naples, Naples, Italy
| | - Andrea Spadafora
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Gianantonio Nappi
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology and GUCH Unit, AORN "Ospedali dei Colli," Second University of Naples, Naples, Italy
| | - Berardo Sarubbi
- Paediatric Cardiology and GUCH Unit, AORN "Ospedali dei Colli," Second University of Naples, Naples, Italy
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