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Muroke V, Jalanko M, Haukka J, Anttila V, Pätilä T, Sinisalo J. Long-term outcome after surgical correction of sinus venosus defect in a nationwide register-based cohort study. Int J Cardiol 2024; 395:131433. [PMID: 37827284 DOI: 10.1016/j.ijcard.2023.131433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Long-term results after sinus venosus defect (SVD) closure are sparse and many studies lack a proper control cohort. This nationwide cohort evaluated the long-term outcome after SVD surgery. METHODS The study enrolled every surgical SVD correction from the nationwide hospital discharge registry (FHDR) and surgical registries of two tertiary centers. Patients with more complex congenital heart defects were excluded. Surgeries were performed from 1969 to 2019. Five sex and birth-year-matched controls per SVD patient were gathered from the general population. RESULTS In total, 182 surgical SVD corrections were performed during the study period. The median age at the time of surgery was 8.3 years (range 0.06-75.7), and the majority (77.5%, n = 141) were under 18 years old. The median follow-up period was 18 years (range 0.1-53). There was no significant difference in mortality during the follow-up (logrank p = 0.62, MRR 0.78, 95% CI: 0.30-2.0). However, SVD patients had elevated risk for new-onset atrial fibrillation (RR 4.9, 95% CI: 2.2-10.9), heart failure (RR 4.0, 95% CI: 1.2-13.2), ischemic heart disease (4.3, 95% CI, 1.5-11.7), migraine (RR 3.6, 95% CI: 1.5-9.1) and sick sinus syndrome, II- or III-degree AV-block or pacemaker implantation (RR 11.3, 95% CI: 2.9-43.8). CONCLUSION Young patients with SVD have an excellent survival prognosis after the surgery. Risk for sick sinus syndrome or conduction disorders, atrial fibrillation, and heart failure remains elevated in the long-term follow-up.
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Affiliation(s)
- V Muroke
- Department of Cardiology, Helsinki University Hospital, Finland.
| | - M Jalanko
- Department of Cardiology, Helsinki University Hospital, Finland
| | - J Haukka
- Department of Public Health, University of Helsinki, Finland
| | - V Anttila
- Department of Cardiothoracic Surgery, Turku University Hospital, Finland
| | - T Pätilä
- Department of Cardiac Surgery, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Finland
| | - J Sinisalo
- Department of Cardiology, Helsinki University Hospital, Finland
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Muroke V, Jalanko M, Haukka J, Pätilä T, Hartikainen J, Tahvanainen A, Ukkonen H, Ylitalo K, Anttila V, Pihkala J, Sinisalo J. Atrial septal defect patients have an elevated risk for infective endocarditis. SCAND CARDIOVASC J 2023; 57:2215490. [PMID: 37264780 DOI: 10.1080/14017431.2023.2215490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background. It has been unclear whether simple atrial septal defect (ASD) is an independent risk factor for infective endocarditis (IE). This study aimed to untangle the risk of endocarditis in a large nationwide cohort. Methods. We acquired data from the Finnish hospital discharge register on all individuals with ASD diagnosis from 1969 to 2019. Patients with complex congenital cardiac abnormalities were ruled out. Five individualized controls from the general population were matched to the ASD patient's birth year, sex, and residence at the index date. All the patients with ICD-8, -9, or -10 diagnosis codes for IE were gathered from the hospital discharge registry. Results. Altogether, 8322 patients with ASD and 39,237 individualized controls were enrolled in the study. Median follow-up was 21.6 years (IQR 11.8-36.9) from the first hospital contact. In total, 24 (16 male) cases of infective endocarditis among ASD patients and 10 (8 male) cases among controls were diagnosed during the follow-up. The incidence of endocarditis was 0.11 per 1000 person-years in the patients with ASD and 0.011 per 1000 person-years in the controls. The adjusted risk ratio for endocarditis was 13.51 (95% CI: 6.20-29.46) in patients with ASD compared to the control cohort. Patients with ASD and endocarditis had higher long-term mortality than individualized control patients (MRR 2.25, 95% CI: 1.23-4.11). Conclusions. The incidence of IE in patients with ASD was higher than in the general population. Mortality associated with IE was higher in patients with ASD compared to controls.
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Affiliation(s)
- Valtteri Muroke
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - Mikko Jalanko
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tommi Pätilä
- Department of Cardiac Surgery, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Anna Tahvanainen
- Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | | | - Kari Ylitalo
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Vesa Anttila
- Department of Cardiology, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jaana Pihkala
- Department of Cardiothoracic Surgery, Turku University Hospital, Turku, Finland
| | - Juha Sinisalo
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
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Muroke V, Jalanko M, Haukka J, Hartikainen J, Tahvanainen A, Ukkonen H, Ylitalo K, Pihkala J, Sinisalo J. Outcome of transcatheter atrial septal defect closure in a nationwide cohort. Ann Med 2023; 55:615-623. [PMID: 36786506 PMCID: PMC9930864 DOI: 10.1080/07853890.2023.2178669] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Transcatheter (TC) atrial septal defect (ASD) closure has been the mainstay of therapy for secundum-type ASDs for over 20 years. AIMS This nationwide cohort evaluated the long-term outcome of transcatheter-closed ASDs. METHODS The study enrolled every transcatheter ASD closure performed in Finland from 1999 to 2019. Five age, sex, and municipality-matched controls per ASD patient were gathered from the general population. The median follow-up period was 5.9 years (range 0-20.8). We used the hospital discharge register to gather all hospital visits and diagnoses. Closure complications and echocardiographic changes were collected from the electronic health records. RESULTS Transcatheter ASD closure was performed in 1000 patients (68.5% females) during the study period. The median (range) age at the time of the procedure was 37.9 (1.8-87.5) years. ASD patients had an increased risk for new-onset atrial fibrillation (RR 2.45, 95% CI: 1.84-3.25), migraine (RR 3.61, 95% CI: 2.54-5.14), ischemic heart disease (RR 1.73, 95% CI: 1.23-2.45), ventricular fibrillation/tachycardia (RR 3.54 (95% CI: 1.48-8.43) and AV conduction disorder (RR 3.60, 95% CI: 1.94-6.70) compared to the control cohort. Stroke risk was not increased (RR 1.36, 95% CI: 0.91-2.03). Adverse events occurred in 6.3% (n = 63) of the patients, including four erosions and ten device embolizations. CONCLUSION After TC closure of ASD, patients had a higher risk of new-onset atrial fibrillation and migraine than controls without ASD. As novel findings, we found an increased risk for ischemic heart disease, AV conduction disorders, and ventricular fibrillation/tachycardia.Key messagesEven though patients have an excellent overall prognosis after percutaneous ASD closure, the increased incidence of major comorbidities like atrial fibrillation and heart failure prompts more thorough lifelong follow-up.This study's novel findings revealed the increased risk for ischemic heart disease, AV conduction disorders, or ventricular tachycardia/fibrillation during the follow-up.Major complications after the closure are rare; erosion is seen in 0.4% of the patients and embolization in 1.0% of the patients.
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Affiliation(s)
- V Muroke
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - M Jalanko
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - J Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Hartikainen
- Department of Cardiology, Kuopio University Hospital, Kuopio, Finland
| | - A Tahvanainen
- Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - H Ukkonen
- Heart Centre, Turku University Hospital, Turku, Finland
| | - K Ylitalo
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - J Pihkala
- Department of Cardiology, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - J Sinisalo
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
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Muroke V, Tuohinen S, Jalanko M, Sinisalo J. Anatomical variability of transverse sinus and its implication on atrial septal defect closure device erosion. Eur Heart J Cardiovasc Imaging 2023; 24:1563-1565. [PMID: 37379417 DOI: 10.1093/ehjci/jead148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- V Muroke
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - S Tuohinen
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - M Jalanko
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - J Sinisalo
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
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Muroke V, Jalanko M, Ruotsalainen S, Perola M, Helle E, Sinisalo J. Phenotype of ASDs Associated With 4p16 Risk Locus and Novel Genome-Wide Associations of ASD Patients in the Finnish Population. Circ Genom Precis Med 2023; 16:486-489. [PMID: 37577800 PMCID: PMC10581411 DOI: 10.1161/circgen.123.004070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Affiliation(s)
- Valtteri Muroke
- Department of Cardiology, Helsinki University Hospital (V.M., M.J., J.S.), University of Helsinki, Finland
| | - Mikko Jalanko
- Department of Cardiology, Helsinki University Hospital (V.M., M.J., J.S.), University of Helsinki, Finland
| | - Sanni Ruotsalainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE (S.R.), University of Helsinki, Finland
| | - Markus Perola
- Finnish Institute for Health and Welfare, Helsinki, Finland (M.P.)
| | - Emmi Helle
- Stem Cells and Metabolism Research Program, Faculty of Medicine (E.H.), University of Helsinki, Finland
- New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Finland (E.H.)
| | - Juha Sinisalo
- Department of Cardiology, Helsinki University Hospital (V.M., M.J., J.S.), University of Helsinki, Finland
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Abstract
Background This study aimed to evaluate the long-term mortality and cause-specific mortality of patients with atrial septal defect (ASD) in a nationwide cohort. Methods and Results All patients diagnosed with simple ASD in the hospital discharge registry from 1969 to 2019 were included in the study. Complex congenital defects were excluded. Each subject was matched with 5 controls according to sex, age, and municipality at the index time. Adjusted mortality risk ratios (MRRs) were calculated using Poisson regression models. The median follow-up time was 11.1 years. Patients with ASD had higher overall mortality during follow-up, with an adjusted MRR of 1.72 (95% CI, 1.61-1.83). Patients with closed ASDs also had higher total mortality (MRR, 1.29 [95% CI, 1.10-1.51]). However, no difference in mortality was detected if the defect was closed before the age of 30 (MRR, 1.58 [95% CI, 0.90-2.77]), and transcatheter closed defects had lower mortality than the control cohort (MRR, 0.65 [95% CI, 0.42-0.99]). Patients with ASD had significantly more deaths due to congenital malformations (MRR, 54.61 [95% CI, 34.03-87.64]), other diseases of the circulatory system (MRR, 2.90 [95% CI, 2.42-3.49]), stroke (MRR, 1.89 [95% CI, 1.52-2.33]), diseases of the endocrine (MRR, 1.88 [95% CI, 1.10-3.22]) and respiratory system (MRR, 1.71 [95% CI, 1.19-2.45]), ischemic heart disease (MRR, 1.62 [95% CI, 1.41-1.86]), and accidents (MRR, 1.41 [95% CI, 1.05-1.89]). Conclusions Patients with ASD had higher overall mortality compared with a matched general population cohort. Increased cause-specific mortality was seen in congenital malformations, stroke, and heart diseases.
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Affiliation(s)
- Valtteri Muroke
- Department of CardiologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Mikko Jalanko
- Department of CardiologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Jari Haukka
- Department of Public Health, ClinicumUniversity of HelsinkiHelsinkiFinland
| | - Juha Sinisalo
- Department of CardiologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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Muroke V, Jalanko M, Pihkala J, Hartikainen J, Tahvanainen A, Airaksinen J, Ukkonen H, Kervinen K, Ylitalo K, Sinisalo J. Outcome of device atrial septal defect closure in different age groups: a nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1832] [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
Catheter based ASD closure has been a mainstay therapy for secundum type ASD for over 20 years and up to 80–90% of defects are deemed eligible for catheter closure. We are starting to get long term results for the outcome of the procedure. Numerous studies have reported excellent prognosis and low complication rates in patients with TC closed defects. However, little is known about the disease burden in the long run after the closure.
Objectives
This nationwide cohort aimed to evaluate long-term outcome of transcatheter closed atrial septal defects (ASD) by evaluating 1) hospitalisations and disease burden, 2) complications and 3) echocardiographic changes.
Material and methods
We gathered every transcatheter ASD closure done in Finland during 1999–2019. Mean follow-up time was 6.8 years (SD 5.1). We used hospital discharge register to study the incidence of new onset atrial fibrillation, stoke and migraine after the closure. Closure complications and echocardiographic changes were gathered from the electronic health records.
Results
Overall transcatheter ASD closure was performed for 1000 patients (68.5% females) during the study period. ASD patients had increased risk for new-onset atrial fibrillation (RR 2.55, 95% CI: 1.94–3.36), migraine (RR 3.41, 95% CI: 2.40–4.84) and heart failure. Stroke risk was not increased during the follow-up (p=0.19). Hospitalisations were more common in the ASD group in the following 12 months after the closure (RR 2.52, 95% CI: 2.14–2.98). Adverse events occurred in 6.9% (n=69) of the patients, including 4 erosions and 10 device embolisations.
Right heart size was enlarged in 83.9% of the patients before the closure and in 24.4% after the closure. Rate of mild mitral regurgitation increased 21.2% vs. 27.6%, p=0.005) and rate of sever to moderate tricuspid regurgitation decreased (9.4% vs. 5.6%, p=0.009) during the follow-up.
Conclusion
Catheter based Atrial septal defect closure is a safe procedure with low complication rates. TC closed ASD patients had more new-onset atrial fibrillation, heart failure and migraine during the follow-up.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Emil Aaltonen Foundation, Tampere, Finland
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Affiliation(s)
- V Muroke
- Helsinki University Central Hospital, Heart and Lung Center , Helsinki , Finland
| | - M Jalanko
- Helsinki University Central Hospital, Heart and Lung Center , Helsinki , Finland
| | - J Pihkala
- Helsinki University Central Hospital , Helsinki , Finland
| | | | | | | | - H Ukkonen
- Turku University Hospital , Turku , Finland
| | - K Kervinen
- Oulu University Hospital , Oulu , Finland
| | - K Ylitalo
- Oulu University Hospital , Oulu , Finland
| | - J Sinisalo
- Helsinki University Central Hospital, Heart and Lung Center , Helsinki , Finland
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Muroke V, Jalanko M, Simonen P, Holmström M, Ventilä M, Sinisalo J. Non-invasive dye dilution method for measuring an atrial septal defect shunt size. Open Heart 2020; 7:openhrt-2020-001313. [PMID: 33020256 PMCID: PMC7537437 DOI: 10.1136/openhrt-2020-001313] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/26/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
Aims Objective of this study was to evaluate the feasibility of the non-invasive dye dilution method to quantify shunt size related to atrial septal defects (ASD). The diagnostic accuracy of shunt size determination in ASD’s has been suboptimal with common non-invasive methods. We have previously developed a cost-effective and time-effective non-invasive dye dilution method. In this method, the indocyanine green solution is injected into the antecubital vein and the appearance of the dye is detected with an earpiece densitometer. Methods and results We studied 192 patients with an ASD. Mean pulmonary blood flow/systemic blood flow (Qp/Qs) was measured with dye dilution technique and compared with following methods: Fick’s invasive oximetry (n=49), transoesophageal echocardiography (TEE) measuring ASD size (n=143) and cardiac MR (CMR) (n=9). For the first 49 patients, Qp/Qs was 2.05±0.70 with the Fick’s invasive oximetry and 2.12±0.68 with dye dilution method with an excellent correlation between the two methods (R=0.902, p<0.001). In the second study sample, the ASD size by TEE was 15±6 mm on average, and the mean Qp/Qs 2.16±0.65 measured with dye dilution method with a good correlation between the methods (R=0.674, p<0.001). Qp/Qs measured with CMR was 1.87±0.40 resulting in a good correlation with the dye dilution method (R=0.696, p=0.037). Conclusion The dye dilution method with earpiece densitometer recording is a clinically feasible and reliable method to assess shunt size in ASDs.
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