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Kartas A, Papazoglou AS, Moysidis DV, Despotopoulos S, Baroutidou A, Kosmidis D, Koutsakis A, Liori S, Apostolopoulou S, Frogoudaki A, Tzifa A, Galatas A, Alexandridis G, Spiridonidis E, Doundoulakis I, Karagiannidis E, Karvounis H, Ziakas A, Giannakoulas G. Use of apixaban in adults with congenital heart disease and atrial arrhythmias: The PROTECT-AR study. Int J Cardiol 2024; 406:131993. [PMID: 38565389 DOI: 10.1016/j.ijcard.2024.131993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/29/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) and atrial arrhythmias (AA) face an increased risk of thromboembolic events. Limited data exist on the use of non-vitamin K oral anticoagulants for thromboprophylaxis in ACHD. We aimed to assess the effectiveness and safety of apixaban in ACHD patients with AA. METHODS PROTECT-AR (NCT03854149) was a prospective, multicenter, observational study conducted from 2019 to 2023. ACHD patients with atrial fibrillation, atrial flutter, or intra-atrial re-entrant tachycardia on routine apixaban treatment were included. The historical control group consisted of patients previously on vitamin K antagonist (VKA), who were analyzed prior to their transition to apixaban. The primary effectiveness endpoint was the composite of stroke or thromboembolism. The primary safety endpoint was major bleeding. RESULTS The study enrolled 218 ACHD patients with AA on apixaban, of which 73 were previous VKA users. The analysis covered 527 patient-years of prospective exposure to apixaban and 169 patient-years of retrospective exposure to VKA. The annualized rate of stroke or thromboembolism was 0.6% in the apixaban group and 1.8% in the VKA group (absolute difference - 1.2%; upper limit of one-sided 95% confidence interval [CI] 0.9%, lower than the predefined non-inferiority margin of +1.8%, Pnon-inferiority < 0.001). The annualized rate of major bleeding was 1.5% in the apixaban group and 2.4% in the VKA group (hazard ratio 0.64; 95% CI 0.19-2.10, P = 0.48). CONCLUSION In ACHD patients with AA, routine apixaban use exhibited a non-inferior rate of stroke or thromboembolism compared to historical VKA use, alongside a similar rate of major bleeding.
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Affiliation(s)
- Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Andreas S Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Stefanos Despotopoulos
- Department of Pediatric and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece
| | - Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Diamantis Kosmidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Athanasios Koutsakis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Sotiria Liori
- Second Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Afrodite Tzifa
- Department of Congenital Heart Disease, Mitera Childrens' Hospital, Athens, Greece
| | - Apostolos Galatas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Georgios Alexandridis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Efstathios Spiridonidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | | | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece.
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Despotopoulos S, Apostolopoulou S, Vagenakis G, Kanakis M, Samanidis G, Zachos P, Chatziantoniou A, Papagiannis J, Rammos S, Tsoutsinos A. Descending aorta to right atrial fistula: Transcatheter embolization of a very rare anomaly with coils. Clin Case Rep 2024; 12:e8529. [PMID: 38352918 PMCID: PMC10863355 DOI: 10.1002/ccr3.8529] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/03/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024] Open
Abstract
Key Clinical Message Descending aorta to right atrial (RA) fistula is a rare and distinct clinical entity mimicking patent ductus arteriosus (PDA) and it may lead to rapid development of pulmonary vascular disease. Correct diagnosis and treatment, especially in the presence of other congenital heart defects, is very important. Interventional management is the treatment of choice. Abstract We present a case report of a trisomy 21 infant with atrial and ventricular septal defects and small patent ductus arteriosus (PDA) complicated by the presence of descending aorta to right atrial (RA) fistula with large left to right shunt leading to rapid increase in pulmonary vascular resistance. Transcatheter occlusion of the fistula followed by closure of the PDA with Nit-Occlud coil systems led to decreased pulmonary pressure and resistance permitting successful surgical repair of the patient's intracardiac defects with good outcome over 3 years of follow-up. Descending aorta to RA fistula is a rare and distinct clinical entity mimicking PDA and its correct diagnosis and treatment, especially in the presence of other congenital heart defects, is very important as it may lead to rapid development of pulmonary vascular disease.
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Affiliation(s)
- Stefanos Despotopoulos
- Department of Pediatric Cardiology and Adult Congenital Heart DiseaseOnassis Cardiac Surgery CenterAthensGreece
| | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and Adult Congenital Heart DiseaseOnassis Cardiac Surgery CenterAthensGreece
| | - George Vagenakis
- Department of Pediatric Cardiology and Adult Congenital Heart DiseaseOnassis Cardiac Surgery CenterAthensGreece
| | - Meletios Kanakis
- Department of Pediatric and Adult Congenital Heart SurgeryOnassis Cardiac Surgery CenterAthensGreece
| | - George Samanidis
- 1 Department of Cardiac SurgeryOnassis Cardiac Surgery CenterAthensGreece
| | - Panagiotis Zachos
- Pediatric Cardiology & Adult Congenital Heart Disease DepartmentGeneral Hospital of KarditsaKarditsaGreece
| | - Anastasios Chatziantoniou
- Department of Pediatric Cardiology and Adult Congenital Heart DiseaseOnassis Cardiac Surgery CenterAthensGreece
| | - John Papagiannis
- Department of Pediatric Cardiology and Adult Congenital Heart DiseaseOnassis Cardiac Surgery CenterAthensGreece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart DiseaseOnassis Cardiac Surgery CenterAthensGreece
| | - Alexandros Tsoutsinos
- Department of Pediatric Cardiology and Adult Congenital Heart DiseaseOnassis Cardiac Surgery CenterAthensGreece
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3
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Kourelis G, Kanakis M, Loukas C, Kakava F, Kyriakoulis K, Bobos D, Apostolopoulou S, Rammos S, Giannopoulos N. Efficiency and Safety of Patent Ductus Arteriosus Surgical Ligation in Extremely Low Birth Weight Infants Without Chest Tube Placement. J Pediatr Intensive Care 2023; 12:264-270. [PMID: 37970142 PMCID: PMC10631836 DOI: 10.1055/s-0041-1731786] [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: 03/15/2021] [Accepted: 05/28/2021] [Indexed: 10/20/2022] Open
Abstract
Patent ductus arteriosus (PDA) has been associated with increased morbidity and mortality in preterm infants. Surgical ligation (SL) is generally performed in symptomatic infants when medical management is contraindicated or has failed. We retrospectively reviewed our institution's experience in surgical management of PDA for extremely low birth weight (ELBW) infants without chest tube placement assessing its efficiency and safety. We evaluated 17 consecutive ELBW infants undergoing SL for symptomatic PDA (January 2012-January 2018) with subsequent follow-up for 6 months postdischarge. Patients consisted of 9 (53%) females and 8 (47%) males. Mean gestational age (GA) at birth was 27.9 ± 2.1 weeks. Median values for surgical age (SA) from birth to operation was 10 days (interquartile range [IQR]: 8-12); PDA diameter 3.4 mm (IQR: 3.2-3.5); surgical weight (SW) 750 g (IQR: 680-850); and days of mechanical ventilation (DMV) as estimated by Kaplan-Meier curve 22 days (95% confidence interval: 14.2-29.8). We observed a statistically significant negative association between DMV and GA at birth (rho = - 0.587, p = 0.017), SA (rho = - 0.629, p = 0.009) and SW (rho = - 0.737, p = 0.001). One patient experienced left laryngeal nerve palsy confirmed by laryngoscopy. Otherwise, there were no adverse events to include surgical-related mortality, recurrence of PDA, or need for chest tube placement during follow-up. SL of PDA in ELBW infants without chest tube placement is both efficient and safe. Universal consensus recommendations for the management of PDA in ELBW neonates are needed. Further study is required regarding the use of the less invasive option of percutaneous PDA closure in ELBW infants.
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Affiliation(s)
- Georgios Kourelis
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Meletios Kanakis
- Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Constantinos Loukas
- Medical School, Medical Physics Lab, National and Kapodistrian University of Athens, Athens, Greece
| | - Felicia Kakava
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Konstantinos Kyriakoulis
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Dimitrios Bobos
- Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Nikolaos Giannopoulos
- Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Kallithea, Greece
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4
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Kourelis G, Kanakis M, Samanidis G, Tzannis K, Bobos D, Kousi T, Apostolopoulou S, Kakava F, Kyriakoulis K, Bounta S, Rammos S, Papagiannis J, Giannopoulos N, Orfanos SE, Dimopoulos G. Acute Kidney Injury Predictors and Outcomes after Cardiac Surgery in Children with Congenital Heart Disease: An Observational Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12102397. [PMID: 36292086 PMCID: PMC9601135 DOI: 10.3390/diagnostics12102397] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Acute Kidney Injury (AKI) commonly complicates cardiac surgery in children with congenital heart disease (CHD). In this study we assessed incidence, risk factors, and outcomes of postoperative AKI, while testing the hypothesis that, depending on the underlying diagnosis, there would be significant differences in AKI incidence among different diagnostic groups. We conducted an observational cohort study of children with CHD undergoing cardiac surgery in a single tertiary center between January 2019 and August 2021 (n = 362). Kidney Disease Improving Global Outcome (KDIGO) criteria were used to determine the incidence of postoperative AKI. Diagnosis was incorporated into multivariate models using an anatomic-based CHD classification system. Overall survival was estimated using Kaplan−Meier curves. Log-rank test and adjusted Cox proportional hazard modelling were used to test for differences in survival distributions and determine AKI effect on survival function, respectively. AKI occurred in 70 (19.3%), with 21.4% in-hospital mortality for AKI group. Younger age, lower weight, longer cardiopulmonary bypass time, preoperative mechanical ventilation and diagnostic category were associated with postoperative AKI. Resolution rate was 92.7% prior to hospital discharge for survivors. AKI was associated with longer duration of mechanical ventilation, ICU and hospital length of stay. AKI patients had significantly higher probability of all-cause mortality postoperatively when compared to the non-AKI group (log-rank test, p < 0.001). Adjusted hazard ratio for AKI versus non-AKI group was 11.08 (95% CI 2.45−50.01; p = 0.002). Diagnostic category was associated with cardiac surgery-related AKI in children with CHD, a finding supporting the development of lesion specific models for risk stratification. Postoperative AKI had detrimental impact on clinical outcomes and was associated with decreased survival to hospital discharge.
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Affiliation(s)
- Georgios Kourelis
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
- Correspondence: or ; Tel.: +30-210-9493-210
| | - Meletios Kanakis
- Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - George Samanidis
- Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
- Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Kimon Tzannis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, 1 Rimini Street, 12462 Athens, Greece
| | - Dimitrios Bobos
- Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - Theofili Kousi
- Department of Anesthesiology, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - Felicia Kakava
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - Konstantinos Kyriakoulis
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - Stavroula Bounta
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - John Papagiannis
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - Nickolas Giannopoulos
- Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece
| | - Stylianos E. Orfanos
- 1st Department of Critical Care, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece
| | - George Dimopoulos
- 3rd Department of Critical Care, “EVGENIDIO” Hospital, National and Kapodistrian University of Athens (NKUA), 12462 Athens, Greece
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5
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Spyratou E, Ploussi A, Alafogiannis P, Katifelis H, Apostolopoulou S, Bagenakis G, Rammos S, Papagiannis I, Gazouli M, Seimenis I, Georgakilas AG, Efstathopoulos EP. FDXR Gene Expression after in Vivo Radiation Exposure of Pediatric Patients Undergoing Interventional Cardiology Procedures. FRONT BIOSCI-LANDMRK 2022; 27:255. [PMID: 36224003 DOI: 10.31083/j.fbl2709255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 09/11/2023]
Abstract
BACKGROUND Ferredoxin reductase (FDXR) has already been reported as a promising biomarker for estimating radiation doses in radiotherapy. This study aimed to investigate the responsiveness of FDXR on pediatric population exposed to ionizing radiation (X-rays) during pediatric interventional cardiology (IC) procedures. PATIENTS AND METHODS Peripheral blood was collected by venipuncture from 24 pediatric donors before and 24 hours after the IC procedure. To estimate the effective dose, demographic data and Air Kerma-Area Product (PKA) were recorded for each patient. The relative quantification (RQ) of the FDXR gene in irradiated patient blood samples compared to the non-irradiated blood samples was determined using qPCR analysis. The relative values of FDXR were log- transformed. RESULTS The effective dose ranged from 0.002 mSv to 8.004 mSv. Over this radiation exposure range, the FDXR gene expression varied randomly with the effective dose. Up-regulation in FDXR expression was observed in 17 patients and down-regulation in 7 patients. CONCLUSIONS Further studies in a larger cohort of pediatric patients along with the record of clinical data are needed to determine whether FDXR gene expression is an effective biomarker for radiation exposure estimation in pediatric imaging.
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Affiliation(s)
- Ellas Spyratou
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Agapi Ploussi
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Alafogiannis
- Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, 15780 Zografou, Athens, Greece
| | - Hector Katifelis
- Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sotiria Apostolopoulou
- Paediatric Cardiology and Adult with Congenital Heart Disease Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Georgios Bagenakis
- Paediatric Cardiology and Adult with Congenital Heart Disease Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Spyridon Rammos
- Paediatric Cardiology and Adult with Congenital Heart Disease Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ioannis Papagiannis
- Paediatric Cardiology and Adult with Congenital Heart Disease Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Maria Gazouli
- Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Medical Physics, Medical School, National and Kapodistrian University, 11527 Athens, Greece
- Department of Sciences, Hellenic Open University, 26335 Patra, Greece
| | - Ioannis Seimenis
- Department of Medical Physics, Medical School, National and Kapodistrian University, 11527 Athens, Greece
| | - Alexandros G Georgakilas
- DNA Damage Laboratory, Department of Physics, School of Applied Mathematical and Physical Sciences, Zografou Campus, National Technical University of Athens (NTUA), 15780 Athens, Greece
| | - Efstathios P Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Sciences, Hellenic Open University, 26335 Patra, Greece
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6
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Arvanitaki A, Vrana E, Boutsikou M, Anthi A, Apostolopoulou S, Avgeropoulou A, Demerouti E, Patrianakos A, Karyofyllis P, Mitrouska I, Mouratoglou SA, Naka KK, Orfanos SE, Panagiotidou E, Pitsiou G, Rammos S, Stanopoulos I, Thomaidi A, Frogoudaki A, Boutou A, Anastasiadis G, Brili S, Tsangaris I, Tsiapras D, Voudris V, Manginas A, Giannakoulas G. The impact of cardiovascular comorbidities associated with risk for left heart disease on idiopathic pulmonary arterial hypertension: Data from the Hellenic Pulmonary Hypertension Registry (HOPE). Pulm Circ 2022; 12:e12086. [PMID: 35685948 PMCID: PMC9171835 DOI: 10.1002/pul2.12086] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 04/10/2022] [Accepted: 04/22/2022] [Indexed: 11/11/2022] Open
Abstract
Whereas younger female patients were diagnosed with idiopathic pulmonary arterial hypertension (IPAH) in 1980s, it is now frequently encountered in elderly patients with cardiovascular comorbidities (CVCs) associated with increased risk for left heart disease. We present data until November 2019 regarding specific features and clinical outcomes of IPAH population from the Hellenic Pulmonary Hypertension Registry (HOPE). Patients were divided into two groups based on the presence of ≥ or <3 CVCs, arterial hypertension, diabetes mellitus, obesity, presence of coronary artery disease, or atrial fibrillation. Overall, 77 patients with IPAH (55.1 [interquartile range, IQR: 24.1] years, 62.8% women) have been recorded. Fifteen patients (19.2%) had ≥3 CVCs, while 25 (32%) were over 65 years old. Patients with ≥3 CVCs were older, presented an almost equal female to male ratio, walked less in 6‐min walk test, and had lower mean arterial pulmonary pressure and pulmonary vascular resistance at baseline than patients with less CVCs. Fewer patients with ≥3 CVCs received PAH‐specific treatment compared to patients with less comorbidities (n = 11 [73.3%] versus n = 58 [95.5%], p = 0.02). During a median follow‐up period of 3.8 (IQR: 2.7) years, 18 patients died (all‐cause mortality 24.3%). Male sex and older age were independent predictors of mortality and/or lung transplantation, while CVCs did not have a significant impact on clinical outcomes. In this nationwide, register‐based study, the epidemiology of IPAH involves older patients with CVCs, who seem to have less hemodynamic compromise, but worse functional impairment and are treated less aggressively with PAH pharmacotherapy.
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Affiliation(s)
- Alexandra Arvanitaki
- Cardiology Department AHEPA University Hospital, Aristotle University of Thessaloniki Greece
| | - Elena Vrana
- Cardiology Department AHEPA University Hospital, Aristotle University of Thessaloniki Greece
| | - Maria Boutsikou
- Cardiology Department Mediterraneo Hospital Glyfada, Athens Greece
| | - Anastasia Anthi
- 1st Department of Critical Care and Pulmonary Hypertension Clinic National & Kapodistrian University of Athens Medical School, Evaggelismos General Hospital Athens Greece
| | - Sotiria Apostolopoulou
- Cardiology‐ Pediatric Cardiology Department Onassis Cardiac Surgery Center Athens Greece
| | | | - Eftychia Demerouti
- Cardiology‐ Pediatric Cardiology Department Onassis Cardiac Surgery Center Athens Greece
| | - Alexandros Patrianakos
- Department of Thoracic Medicine University Hospital of Heraklion Heraklion, Crete Greece
| | - Panagiotis Karyofyllis
- Cardiology‐ Pediatric Cardiology Department Onassis Cardiac Surgery Center Athens Greece
| | - Ioanna Mitrouska
- Department of Thoracic Medicine University Hospital of Heraklion Heraklion, Crete Greece
| | | | - Katerina K. Naka
- 2 Department of Cardiology University of Ioannina Medical School, University Hospital of Ioannina Ioannina Greece
| | - Stylianos E. Orfanos
- 1st Department of Critical Care and Pulmonary Hypertension Clinic National & Kapodistrian University of Athens Medical School, Evaggelismos General Hospital Athens Greece
| | | | - Georgia Pitsiou
- Respiratory Failure Unit, "G. Papanikolaou" Hospital Exohi, Thessaloniki Greece
| | - Spyridon Rammos
- Cardiology‐ Pediatric Cardiology Department Onassis Cardiac Surgery Center Athens Greece
| | - Ioannis Stanopoulos
- Respiratory Failure Unit, "G. Papanikolaou" Hospital Exohi, Thessaloniki Greece
| | - Adina Thomaidi
- Cardiology Department Democritus University of Thrace Alexandroupolis Greece
| | - Alexandra Frogoudaki
- Multidisciplinary Pulmonary Hypertension Center Attikon University General Hospital Athens Greece
| | - Afroditi Boutou
- Respiratory Failure Unit, "G. Papanikolaou" Hospital Exohi, Thessaloniki Greece
| | - George Anastasiadis
- Cardiology Department Laiko General Hospital, Athens, Greece, on behalf of the Hellenic Society for the Study of Pulmonary Hypertension (HSSPH)
| | - Styliani Brili
- Cardiology Department Hippokration General Hospital Athens Greece
| | - Iraklis Tsangaris
- Multidisciplinary Pulmonary Hypertension Center Attikon University General Hospital Athens Greece
| | - Dimitrios Tsiapras
- Cardiology‐ Pediatric Cardiology Department Onassis Cardiac Surgery Center Athens Greece
| | - Vassilios Voudris
- Cardiology‐ Pediatric Cardiology Department Onassis Cardiac Surgery Center Athens Greece
| | | | - George Giannakoulas
- Cardiology Department AHEPA University Hospital, Aristotle University of Thessaloniki Greece
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7
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Kartas A, Papazoglou AS, Kosmidis D, Moysidis DV, Baroutidou A, Doundoulakis I, Despotopoulos S, Vrana E, Koutsakis A, Rampidis GP, Ntiloudi D, Liori S, Mousiama T, Avramidis D, Apostolopoulou S, Frogoudaki A, Tzifa A, Karvounis H, Giannakoulas G. The Adult Congenital Heart Disease Anatomic and Physiological Classification: Associations with Clinical Outcomes in Patients with Atrial Arrhythmias. Diagnostics (Basel) 2022; 12:diagnostics12020466. [PMID: 35204557 PMCID: PMC8870966 DOI: 10.3390/diagnostics12020466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
The implications of the adult congenital heart disease anatomic and physiological classification (AP-ACHD) for risk assessment have not been adequately studied. A retrospective cohort study was conducted using data from an ongoing national, multicentre registry of patients with ACHD and atrial arrhythmias (AA) receiving apixaban (PROTECT-AR study, NCT03854149). At enrollment, patients were stratified according to Anatomic class (AnatC, range I to III) and physiological stage (PhyS, range B to D). A follow-up was conducted between May 2019 and September 2021. The primary outcome was a composite of death from any cause, any major thromboembolic event, major or clinically relevant non-major bleeding, or hospitalization. Cox proportional-hazards regression modeling was used to evaluate the risks for the outcome among AP-ACHD classes. Over a median 20-month follow-up period, 47 of 157 (29.9%) ACHD patients with AA experienced the composite outcome. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for the outcome in PhyS C and PhyS D were 1.79 (95% CI 0.69 to 4.67) and 8.15 (95% CI 1.52 to 43.59), respectively, as compared with PhyS B. The corresponding aHRs in AnatC II and AnatC III were 1.12 (95% CI 0.37 to 3.41) and 1.06 (95% CI 0.24 to 4.63), respectively, as compared with AnatC I. In conclusion, the PhyS component of the AP-ACHD classification was an independent predictor of net adverse clinical events among ACHD patients with AA.
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Affiliation(s)
- Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Andreas S Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Diamantis Kosmidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Ioannis Doundoulakis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Stefanos Despotopoulos
- Department of Pediatric and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Elena Vrana
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Athanasios Koutsakis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Georgios P Rampidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Despoina Ntiloudi
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Sotiria Liori
- Second Department of Cardiology, Attikon University Hospital, 12462 Athens, Greece
| | - Tereza Mousiama
- Department of Congenital Heart Disease, Mitera Childrens' Hospital, 15123 Athens, Greece
| | - Dimosthenis Avramidis
- Department of Congenital Heart Disease, Mitera Childrens' Hospital, 15123 Athens, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Alexandra Frogoudaki
- Second Department of Cardiology, Attikon University Hospital, 12462 Athens, Greece
| | - Afrodite Tzifa
- Department of Congenital Heart Disease, Mitera Childrens' Hospital, 15123 Athens, Greece
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece
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Ploussi A, Brountzos E, Rammos S, Apostolopoulou S, Efstathopoulos EP. Radiation Exposure in Pediatric Interventional Procedures. Cardiovasc Intervent Radiol 2021; 44:857-865. [PMID: 34009422 DOI: 10.1007/s00270-020-02752-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023]
Abstract
The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. The expanding applications of interventional procedures coupled with the potential harmful effects of ionizing radiation highlight the need to assess the delivered radiation dose and establish an effective radiation protection program, particularly in the radiosensitive pediatric population. Given the complexity and heterogeneity of interventional procedures as well as the unique characteristics of children, the management of radiation dose is proving to be quite challenging. The aim of the current article is to provide an overview of the radiation exposure in pediatric patients during interventional procedures focusing on the importance of radiation protection in the pediatric population, the reported radiation doses and the techniques of minimizing radiation dose.
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Affiliation(s)
- Agapi Ploussi
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Andrea Siggrou 356 Av., 17674, Kallithea, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Andrea Siggrou 356 Av., 17674, Kallithea, Greece
| | - Efstathios P Efstathopoulos
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece.
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Kartas A, Doundoulakis I, Ntiloudi D, Koutsakis A, Kosmidis D, Rampidis G, Apostolopoulou S, Frogoudaki A, Tzifa A, Avramidis D, Ntzoyvara O, Liori S, Mousiama T, Mouratoglou SA, Karvounis H, Giannakoulas G. Rationale and design of a prospective, observational, multicentre study on the safety and efficacy of apixaban for the prevention of thromboembolism in adults with congenital heart disease and atrial arrhythmias: the PROTECT-AR study. BMJ Open 2020; 10:e038012. [PMID: 32963069 PMCID: PMC7509965 DOI: 10.1136/bmjopen-2020-038012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The risk for stroke in adults with congenital heart disease (ACHD) is increased, especially in the setting of commonly ensuing atrial arrhythmias (AA), namely atrial fibrillation, atrial flutter or intra-atrial re-entrant tachycardia. Data are limited regarding treatment with non-vitamin K oral anticoagulants in long-term studies involving patients with ACHD and AA. METHODS AND ANALYSIS PReventiOn of ThromboEmbolism in Adults with Congenital HearΤ disease and Atrial aRrhythmias is a prospective, multicenter, single-arm, non-interventional cohort study designed to investigate the safety and efficacy of apixaban for the prevention of thromboembolism in ACHD with AA in a 'real-world' setting. Eligible patients will be evaluated by the means of available registries and clinical counter. The study aims to accumulate approximately 500 patient-years of exposure to apixaban as part of routine care. Enrolment will take place at four ACHD centres in Greece. The first patient was enrolled in July 2019. The primary efficacy endpoint is a composite of stroke, systemic or pulmonary embolism and intracardiac thrombosis. The primary safety endpoint is major bleeding, according to the International Society on Thrombosis and Haemostasis bleeding criteria. ETHICS AND DISSEMINATION The study protocol has been approved by the institutional review board/independent ethics committee at each site prior to study commencement. All patients will provide written informed consent. Results will be disseminated at scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03854149; Pre-results.
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Affiliation(s)
- Anastasios Kartas
- Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Ioannis Doundoulakis
- Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Despoina Ntiloudi
- Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Athanasios Koutsakis
- Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Diamantis Kosmidis
- Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Georgios Rampidis
- Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | | | | - Afrodite Tzifa
- Paediatric Cardiology & Adult Congenital Heart Disease, Mitera, Hygeia Group, Athens, Attica, Greece
- Division of Biomedical Engineering and Imaging Sciences, King's College, London, England
| | - Dimosthenis Avramidis
- Paediatric Cardiology & Adult Congenital Heart Disease, Mitera, Hygeia Group, Athens, Attica, Greece
| | - Olga Ntzoyvara
- Cardiology, Onassis Cardiac Surgery Centre, Athens, Attica, Greece
| | - Sotiria Liori
- Cardiology, General University Hospital Attikon, Athens, Attica, Greece
| | - Tereza Mousiama
- Paediatric Cardiology & Adult Congenital Heart Disease, Mitera, Hygeia Group, Athens, Attica, Greece
| | | | - Haralambos Karvounis
- Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - George Giannakoulas
- Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
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Arvanitaki A, Boutsikou M, Anthi A, Apostolopoulou S, Avgeropoulou A, Demerouti E, Farmakis D, Feloukidis C, Giannakoulas G, Karvounis H, Karyofyllis P, Mitrouska I, Mouratoglou S, Naka KK, Orfanos SE, Panagiotidou E, Pitsiou G, Rammos S, Stagaki E, Stanopoulos I, Thomaidi A, Triantafyllidi H, Tsangaris I, Tsiapras D, Voudris V, Manginas A. Epidemiology and initial management of pulmonary arterial hypertension: real-world data from the Hellenic pulmOnary hyPertension rEgistry (HOPE). Pulm Circ 2019; 9:2045894019877157. [PMID: 31662847 PMCID: PMC6792282 DOI: 10.1177/2045894019877157] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a heterogenous clinical entity with poor prognosis, despite recent major pharmacological advances. To increase awareness about the pathophysiology, epidemiology, and management of the disease, large national registries are required. The Hellenic pulmOnary hyPertension rEgistry (HOPE) was launched in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. Baseline epidemiologic, diagnostic, and initial treatment data of consecutive patients with PAH are presented in this article. In total, 231 patients with PAH were enrolled from January 2015 until April 2018. At baseline, about half of patients with PAH were in World Health Organization functional class II. The majority of patients with PAH (56.7%) were at intermediate 1-year mortality risk, while more than one-third were low-risk patients, according to an abbreviated risk stratification score. Half of patients with PAH were on monotherapy, 38.9% received combination therapy, while prostanoids were used only in 12.1% of patients. In conclusion, baseline data of the Greek PAH population share common characteristics, but also have some differences with other registries, the most prominent being a better functional capacity. This may reflect earlier diagnosis of PAH that in conjunction with the increased proportion of patients with atypical PAH could partially explain the preference for monotherapy and the limited use of prostanoids in Greece. Nevertheless, early, advanced specific therapy is strongly recommended.
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Affiliation(s)
- Alexandra Arvanitaki
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Boutsikou
- Cardiology Department, Mediterraneo Hospital, Athens, Greece
| | - Anastasia Anthi
- Multidisciplinary Pulmonary Hypertension Center, Attikon University General Hospital; National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotiria Apostolopoulou
- Cardiology-Pediatric Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Eftychia Demerouti
- Cardiology-Pediatric Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitrios Farmakis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Feloukidis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Karyofyllis
- Cardiology-Pediatric Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ioanna Mitrouska
- Department of Thoracic Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Sophia Mouratoglou
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina K Naka
- 2nd Department of Cardiology, University of Ioannina Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Stylianos E Orfanos
- Multidisciplinary Pulmonary Hypertension Center, Attikon University General Hospital; National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Georgia Pitsiou
- Respiratory Failure Unit, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Spyridon Rammos
- Cardiology-Pediatric Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleni Stagaki
- Multidisciplinary Pulmonary Hypertension Center, Attikon University General Hospital; National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Adina Thomaidi
- Cardiology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Helen Triantafyllidi
- Multidisciplinary Pulmonary Hypertension Center, Attikon University General Hospital; National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Iraklis Tsangaris
- Multidisciplinary Pulmonary Hypertension Center, Attikon University General Hospital; National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Tsiapras
- Cardiology-Pediatric Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vassilios Voudris
- Cardiology-Pediatric Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
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Fragoulis S, Contrafouris C, Thanopoulos A, Kyriakoulis K, Apostolopoulou S. Reversible right heart failure after redo operation of a post-traumatic Gerbode defect. Perfusion 2019; 35:166-168. [PMID: 31328690 DOI: 10.1177/0267659119859122] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Gerbode defect is a rare entity and represents a small percent of all congenital defects. If left untreated, right heart failure may occur. CASE REPORT We describe a redo case of a 47-year-old patient complaining about the signs and symptoms of decompensating right heart failure after a surgically treated post-traumatic Gerbode defect 8 years prior. DISCUSSION Although it is described as a congenital defect, in clinical practice, results mostly as an iatrogenic complication after heart valve surgery, endocarditis, nodal ablation, or post-traumatic defect. Surgical correction is the treatment of choice independently of the provided cause. Dimensions, the position of the defect, are very important factors for the interventional approach. At 12 months post-operatively, the patient remained completely asymptomatic. He has an active life and presents all the echocardiographic metrics within normal values. CONCLUSION We strongly recommend that in cardiac areas where high wall tension is applied, durable materials such as Dacron should be used. We also believe that a well-documented discussion with the patient, about his medical condition and his therapeutic alternatives, is imperative.
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Affiliation(s)
- Socrates Fragoulis
- 1st Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and Department of Pediatric Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
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Ntiloudi D, Apostolopoulou S, Vasiliadis K, Frogoudaki A, Tzifa A, Ntellos C, Brili S, Manginas A, Pitsis A, Kolios M, Karvounis H, Tsioufis C, Goudevenos J, Rammos S, Giannakoulas G. Hospitalisations for heart failure predict mortality in pulmonary hypertension related to congenital heart disease. Heart 2018; 105:465-469. [PMID: 30269081 DOI: 10.1136/heartjnl-2018-313613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 05/18/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Despite the progress in the management of patients with adult congenital heart disease (ACHD), a significant proportion of patients still develop pulmonary hypertension (PH). We aimed to highlight the rate of the complications in PH-ACHD and the predicting factors of cumulative mortality risk in this population. METHODS Data were obtained from the cohort of the national registry of ACHD in Greece from February 2012 until January 2018. RESULTS Overall, 65 patients receiving PH-specific therapy were included (mean age 46.1±14.4 years, 64.6% females). Heavily symptomatic (New York Heart Association (NYHA) class III/IV) were 53.8% of patients. The majority received monotherapy, while combination therapy was administered in 41.5% of patients. Cardiac arrhythmia was reported in 30.8%, endocarditis in 1.5%, stroke in 4.6%, pulmonary arterial thrombosis in 6.2%, haemoptysis in 3.1% and hospitalisation due to heart failure (HF) in 23.1%. Over a median follow-up of 3 years (range 1-6), 12 (18.5%) patients died. On univariate Cox regression analysis history of HF hospitalisation emerged as a strong predictor of mortality (HR 8.91, 95% CI 2.64 to 30.02, p<0.001), which remained significant after adjustment for age and for NYHA functional class. CONCLUSIONS Long-term complications are common among patients with PH-ACHD. Hospitalisations for HF predict mortality and should be considered in the risk stratification of this population.
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Affiliation(s)
- Despoina Ntiloudi
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and ACHD, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | - Aphrodite Tzifa
- Department of Congenital Heart Disease, Mitera Children's Hospital, Athens, Greece
| | - Christos Ntellos
- Department of Cardiology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Styliani Brili
- Department of Cardiology, Ippokrateion University Hospital, Athens, Greece
| | | | - Antonios Pitsis
- Department of Cardiothoracic Surgery, St Luke's Hospital, Thessaloniki, Greece
| | - Marios Kolios
- Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Costas Tsioufis
- Department of Cardiology, Ippokrateion University Hospital, Athens, Greece
| | - John Goudevenos
- Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and ACHD, Onassis Cardiac Surgery Center, Athens, Greece
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Kollaros N, Kottou S, Apostolopoulou S, Mastorakou I, Theocharis S, Tsapaki V. [P035] Dose optimization in pediatric interventional cardiology. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sidiropoulou N, Filippousis P, Apostolopoulou S, Tsangaridou I, Thanos L. Tumor-like pulmonary sarcoidosis diagnosed by CT-guided transthoracic lung biopsy. Cases J 2009; 2:6607. [PMID: 19829830 PMCID: PMC2740031 DOI: 10.1186/1757-1626-2-6607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 03/04/2009] [Indexed: 11/26/2022]
Abstract
Introduction Most patients referred for lung biopsy have a focal lesion that is likely to be a carcinoma and fine needle aspiration (FNA) is usually sufficient to confirm diagnosis. Percutaneous cutting needle biopsy (CNB) is an important and potential diagnostic technique when non carcinomatous disease is suspected or when the pulmonary disease is unclear, so tissue architecture is very important. Case presentation We present a case of a 24 year old male arrived at our hospital with dyspnea and unusual computed tomography (CT) findings of sarcoidosis. Chest X-ray and CT scan revealed multiple masses in both lungs suggesting lung metastasis. Bronchoscopy and bronchoalveolar lavage did not reveal any malignant cells. None of the laboratory examinations revealed any primary extrapulmonary tumor. The patient underwent CT-guided core needle biopsy. Histopathological examination confirmed the diagnosis of sarcoidosis. Conclusion CT-guided core needle biopsy is a very helpful diagnostic tool in order to determine the benign or malignant nature of a thoracic lesion.
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Affiliation(s)
- N Sidiropoulou
- "Sotiria", Athens General Hospital of Chest Diseases, Department of Medical Imaging and Interventional Radiology Athens Greece.
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Manginas A, Sfyrakis P, Stavridis G, Louka L, Zarkalis D, Tsourelis L, Adamopoulos S, Karavolias G, Apostolopoulou S, Antoniou T, Thanopoulos A, Rellia P, Kaklamanis L, Melissari E, Mastorakou I, Degiannis D, Manoli E, Saroglou G, Geroulanos S, Alivizatos PA. Orthotopic heart transplantation: ten years' clinical experience. Hellenic J Cardiol 2008; 49:227-237. [PMID: 18935709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Heart transplantation is the "gold standard" in the treatment of patients with end-stage heart failure who satisfy strict selection criteria. METHODS We reviewed ten years' clinical experience (1996-2006) from 53 orthotopic transplants in our centre. RESULTS Low perioperative (3.7%) and long-term (7.5%) mortality rates yielded a 95% survival rate in the first year, 92% at five years, and 70% at ten years--significantly better than the corresponding rates worldwide. In addition, excellent functional recovery was achieved in all transplant recipients. CONCLUSIONS The strict application of international criteria in the selection of both candidates and donors, together with uninterrupted, multidisciplinary follow up, have made it feasible to perform heart transplantation with excellent results, despite the curiously low number of potential recipients and the shortage of acceptable donor hearts.
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Affiliation(s)
- Athanassios Manginas
- First Division of Cardiothoracic Surgery and Transplantation Services, Onassis Cardiac Surgical Centre, Athens, Greece
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Papagiannis J, Tsoutsinos A, Kirvassilis G, Sofianidou I, Koussi T, Laskari C, Kiaffas M, Apostolopoulou S, Rammos S. Nonfluoroscopic Catheter Navigation for Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Children. Pacing Clin Electro 2006; 29:971-8. [PMID: 16981921 DOI: 10.1111/j.1540-8159.2006.00472.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation (RCA) of supraventricular tachycardia (SVT) in children is highly successful but requires exposure to radiation. Nonfluoroscopic mapping systems may significantly reduce fluoroscopy time. METHODS Forty consecutive pediatric patients who underwent RCA for accessory pathways (AP) or AV nodal reentrant tachycardia (AVNRT) with use of a nonfluoroscopic navigation system (Ensite NavX) (group A) were compared retrospectively to 40 consecutive patients with similar diagnoses who underwent RCA with fluoroscopic guidance only (group B). RESULTS Group A (mean age 12.1+/-2.9 years, mean weight 47+/-13.9 kg) consisted of 11 patients (27.7%) with AVNRT and 29 (72.5%) with AP. Group B (mean age 10.9+/-3.1 years, mean weight 47.1+/-17.1 kg) consisted of 7 patients (17.5%) with AVNRT and 33 (82.5%) with AP. There were no significant differences in AP location, patients with congenital heart disease, and number of radiofrequency lesions. Fluoroscopy time was significantly shorter in group A than in group B (10.4+/-6.1, range 3.1-28.8 minutes, vs 24.9+/-16.0, range 4.4-82.0 minutes, P<0.0001). Procedure duration was also significantly shorter in group A than in group B (170+/-68.5, range 90-420 minutes, vs 218+/-69.3, range 90-360 minutes, P<0.0001). Initial success was 95% in group A and 100% in group B. Tachycardia recurrences occurred in two patients in group A (5%) and six patients in group B (15%). Final success, including repeat ablations for recurrences or failures, was 100% in both groups. CONCLUSIONS The use of a nonfluoroscopic system for catheter navigation significantly reduced fluoroscopy exposure and total procedure duration of RCA of common SVT substrates in children.
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Affiliation(s)
- John Papagiannis
- Division of Pediatric Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
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Brountzos EN, Kelekis NL, Danassi-Afentaki D, Nikolaou V, Apostolopoulou S, Kelekis DA. Congenital subclavian artery-to-subclavian vein fistula in an adult: treatment with transcatheter embolization. Cardiovasc Intervent Radiol 2004; 27:675-77. [PMID: 15578145 DOI: 10.1007/s00270-004-0027-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Papagiannis J, Apostolopoulou S, Sarris GE, Rammos S. Diagnosis and management of pulmonary arteriovenous malformations. Images Paediatr Cardiol 2002; 4:33-49. [PMID: 22368610 PMCID: PMC3232512] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pulmonary arteriovenous malformation is a rare anomaly that presents in several different ways. It can present as an isolated finding, or more often in the context of hereditary haemorrhagic telangiectasia. It can also complicate palliative surgery such as the Glenn operation for complex congenital heart disease with single ventricle physiology. Its management includes transcatheter embolization, which is the preferred mode of therapy, surgery (including resection of the affected lobe, segment, or the fistula itself), or rarely, medical therapy. Complications of the disease itself and of various modes of treatment are relatively common, and patients require close surveillance for possible recurrence, or development of new fistulas. In cases related to the Glenn operation, redirection of hepatic venous flow or heart transplantation may cure the problem.
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Affiliation(s)
- J Papagiannis
- Division of Pediatric Cardiology and Pediatric Cardiac Surgery, Onassis Cardiac Surgery Center,Contact information: Dr. John Papagiannis, Division of Pediatric Cardiology, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 176 74 Kallithea-Athens, GREECE Telephone #: +3010-9493865 Fax #: +3010-9403853
| | - S Apostolopoulou
- Division of Pediatric Cardiology and Pediatric Cardiac Surgery, Onassis Cardiac Surgery Center
| | - GE Sarris
- Division of Pediatric Cardiology and Pediatric Cardiac Surgery, Onassis Cardiac Surgery Center
| | - S Rammos
- Division of Pediatric Cardiology and Pediatric Cardiac Surgery, Onassis Cardiac Surgery Center
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Abstract
BACKGROUND This study examined the results of a Fontan operation for patients with acquired atresia of one main branch pulmonary artery. METHODS The data for 7 patients identified as having a hypoplastic left pulmonary artery discontinuous from the right pulmonary artery were compared with those for 65 patients with continuous pulmonary arteries who consecutively underwent a completion Fontan procedure. RESULTS No significant differences were found preoperatively with respect to right atrial pressure, aortic saturation, ventricular end-diastolic pressure, pulmonary artery pressure, pulmonary blood flow, or pulmonary vascular resistance. In the first 24 postoperative hours, there were no significant differences in heart rate, urine output, systemic venous pressure, or pulmonary venous pressure. Also, data regarding hospitalization length, effusions, and mortality were similar between the two groups. Postoperative systemic arterial saturation was lower in the one-lung group. There were no early postoperative deaths in the one-lung group, and 5 of the 7 patients are long-term survivors. CONCLUSIONS A completion Fontan procedure can be successfully performed in patients with a hypoplastic and discontinuous left pulmonary artery, although postoperative systemic arterial saturation is not as high as in patients with continuous pulmonary arteries.
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Affiliation(s)
- C H Zachary
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Pennsylvania, USA
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Jacobs ML, Rychik J, Rome JJ, Apostolopoulou S, Pizarro C, Murphy JD, Norwood WI. Early reduction of the volume work of the single ventricle: the hemi-Fontan operation. Ann Thorac Surg 1996; 62:456-61; discussion 461-2. [PMID: 8694605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In hearts with a functional single ventricle, cavity volume and myocardial muscle mass increase as a consequence of the excessive volume work associated with parallel pulmonary and systemic circulations. The hemi-Fontan operation was conceived as a means of accomplishing early reduction of the volume work of the single ventricle. METHODS All patients presenting in infancy with single-ventricle physiology were managed by early hemi-Fontan operation in anticipation of a subsequent completion Fontan operation. Between May 1989 and August 1995, 400 patients less than 2 years of age underwent hemi-Fontan operations. Mean age at operation was 8.5 months (range, 2 months to 24 months). The hemi-Fontan operation included association of superior vena(e) cava(e) with the branch pulmonary arteries, augmentation of the central pulmonary arteries, occlusion of the inflow of the superior vena cava into the right atrium, and elimination of other sources of pulmonary blood flow. RESULTS Operative mortality ( < 30 days) was 31 of 400 patients (7.8%). For the last 200 patients, operative mortality was 8 of 200 (4.0%). Younger age at operation was not an independent risk factor for operative mortality. Urgent operation in the presence of a hemodynamic burden requiring concomitant procedures was associated with increased mortality. CONCLUSIONS The hemi-Fontan operation can be accomplished with low operative mortality in young patients, achieving early reduction of the volume work of the single-ventricle heart.
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Affiliation(s)
- M L Jacobs
- Department of Surgery, Deborah Heart and Lung Center, Browns Mills, New Jersey 08015, USA
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