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Bevilacqua F, Pasqualin G, Ferrero P, Micheletti A, Negura DG, D'Aiello AF, Giamberti A, Chessa M. Overview of Long-Term Outcome in Adults with Systemic Right Ventricle and Transposition of the Great Arteries: A Review. Diagnostics (Basel) 2023; 13:2205. [PMID: 37443599 DOI: 10.3390/diagnostics13132205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/10/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
The population of patients with a systemic right ventricle (sRV) in biventricular circulation includes those who have undergone an atrial switch operation for destro-transposition of the great arteries (d-TGA) and those with congenitally corrected transposition of the great arteries (ccTGA). Despite the life expectancy of these patients is significantly increased, the long-term prognosis remains suboptimal due to late complications such as heart failure, arrhythmias, and premature death. These patients, therefore, need a close follow-up to early identify predictive factors of adverse outcomes and to implement all preventive therapeutic strategies. This review analyzes the late complications of adult patients with an sRV and TGA and clarifies which are risk factors for adverse prognosis and which are the therapeutic strategies that improve the long-term outcomes. For prognostic purposes, it is necessary to monitor sRV size and function, the tricuspid valve regurgitation, the functional class, the occurrence of syncope, the QRS duration, N-terminal pro B-type natriuretic peptide levels, and the development of arrhythmias. Furthermore, pregnancy should be discouraged in women with risk factors. Tricuspid valve replacement/repair, biventricular pacing, and implantable cardioverter defibrillator are the most important therapeutic strategies that have been shown, when used correctly, to improve long-term outcomes.
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Affiliation(s)
- Francesca Bevilacqua
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Giulia Pasqualin
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Paolo Ferrero
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Angelo Micheletti
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Diana Gabriela Negura
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Angelo Fabio D'Aiello
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Alessandro Giamberti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
- Congenital Cardiac Surgery Unit, IRCCS-Policlinico San Donato, 20097 Milano, Italy
| | - Massimo Chessa
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
- Vita Salute San Raffaele University, 20132 Milano, Italy
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2
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Sabbah BN, Arabi TZ, Shafqat A, Abdul Rab S, Razak A, Albert-Brotons DC. Heart failure in systemic right ventricle: Mechanisms and therapeutic options. Front Cardiovasc Med 2023; 9:1064196. [PMID: 36704462 PMCID: PMC9871570 DOI: 10.3389/fcvm.2022.1064196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
d-loop transposition of the great arteries (d-TGA) and congenitally corrected transposition of the great arteries (cc-TGA) feature a right ventricle attempting to sustain the systemic circulation. A systemic right ventricle (sRV) cannot support cardiac output in the long run, eventually decompensating and causing heart failure. The burden of d-TGA patients with previous atrial switch repair and cc-TGA patients with heart failure will only increase in the coming years due to the aging adult congenital heart disease population and improvements in the management of advanced heart failure. Clinical data still lags behind in developing evidence-based guidelines for risk stratification and management of sRV patients, and clinical trials for heart failure in these patients are underrepresented. Recent studies have provided foundational data for the commencement of robust clinical trials in d-TGA and cc-TGA patients. Further insights into the multifactorial nature of sRV failure can only be provided by the results of such studies. This review discusses the mechanisms of heart failure in sRV patients with biventricular circulation and how these mediators may be targeted clinically to alleviate sRV failure.
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Affiliation(s)
| | | | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Adhil Razak
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Dimpna Calila Albert-Brotons
- Department of Pediatric Cardiology, Pediatric Heart Failure and Heart Transplant, Heart Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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3
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Ventricular assist device implantation in a patient with systemic right ventricle and pectus excavatum. J Cardiol Cases 2022; 26:122-125. [PMID: 35949576 PMCID: PMC9352421 DOI: 10.1016/j.jccase.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
Systemic right ventricular failure is a common finding in patients with transposition of the great arteries. Some of these patients require ventricular assist device implantation. We describe the feasibility of HeartMate 3 [Abbott, Illinois, United States] implantation in a patient with transposition of the great arteries, high human leukocyte antigen sensitization, and severe pectus excavatum using a two-stage approach. Learning objectives To notice the challenges faced while implanting HeartMate 3 [Abbott, Illinois, United States] in patients with congenital heart disease and anatomical limitations. To understand that despite the difficulties, HeartMate 3 implantation is possible, worthwhile, and sometimes the only choice in a patient with end-stage heart failure and congenital heart disease.
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Koolbergen DR. Mechanical circulatory support in the failing systemic right ventricle: a step towards better outcome. Eur J Cardiothorac Surg 2022; 62:6565875. [PMID: 35396989 DOI: 10.1093/ejcts/ezac240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- David R Koolbergen
- Amsterdam UMC, University of Amsterdam, Department of Cardiothoracic Surgery, Heart Center, Amsterdam, Netherlands.,Leiden University Medical Center, Department of Cardiothoracic Surgery, Leiden, Netherlands.,Centrum voor Aangeboren Hartafwijkingen Amsterdam Leiden (CAHAL), Leiden, Netherlands
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5
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Egorova AD, Nederend M, Tops LF, Vliegen HW, Jongbloed MRM, Kiès P. The first experience with sodium-glucose cotransporter 2 inhibitor for the treatment of systemic right ventricular failure. ESC Heart Fail 2022; 9:2007-2012. [PMID: 35355435 PMCID: PMC9065858 DOI: 10.1002/ehf2.13871] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 01/10/2023] Open
Abstract
In congenitally corrected transposition of the great arteries, the morphological right ventricle supports the systemic circulation. This chronic exposure to pressure overload ultimately leads to systemic right ventricular (sRV) dysfunction and heart failure. Pharmacological options for the treatment of sRV failure are poorly defined and no solid recommendations are made in the most recent guidelines. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a new class of antihyperglycaemic drugs that have been demonstrated to significantly reduce the risk of worsening heart failure and death from cardiovascular causes in patients with chronic heart failure with reduced left ventricular ejection fraction, yet no data are available in sRV patients. We report on the treatment and clinical follow-up of a patient with advanced heart failure and poor sRV function in the context of congenitally corrected transposition of the great arteries, who did not tolerate sacubitril/valsartan and had a high burden of heart-failure-related hospitalizations. Treatment with dapagliflozin was well tolerated and resulted in (small) subjective and objective functional and echocardiographic improvement and a reduction in heart-failure-related hospitalizations.
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Affiliation(s)
- Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
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Tops LF, Coats AJS, Ben Gal T. The ever-changing field of mechanical circulatory support: new challenges at the advent of the 'single device era'. Eur J Heart Fail 2021; 23:1428-1431. [PMID: 34296495 PMCID: PMC9290740 DOI: 10.1002/ejhf.2314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Nederend M, van Erven L, Zeppenfeld K, Vliegen HW, Egorova AD. Failing systemic right ventricle in a patient with dextrocardia and complex congenitally corrected transposition of the great arteries: a case report of successful transvenous cardiac resynchronization therapy. Eur Heart J Case Rep 2021; 5:ytab068. [PMID: 34124542 PMCID: PMC8188871 DOI: 10.1093/ehjcr/ytab068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/30/2020] [Accepted: 02/11/2021] [Indexed: 12/02/2022]
Abstract
Background Patients with congenitally corrected transposition of the great arteries (ccTGA) are prone to the development of advanced atrio-ventricular block requiring chronic ventricular pacing. The morphological right ventricle (RV) often develops systolic dysfunction as it is unable to withstand the chronic pressure overload it is exposed to when supporting the systemic circulation. Case summary A 56-year-old woman with dextrocardia and complex ccTGA with a history of dual-chamber implantable cardioverter-defibrillator (DDD-ICD, high degree atrio-ventricular-block and syncopal ventricular tachycardia), presented with progressive heart failure and symptomatic atrial arrhythmias. She underwent a successful ablation and concomitant invasive haemodynamic evaluation of potential alternative/biventricular pacing modalities. During biventricular pacing, the QRS narrowed and the systemic RV intraventricular pressure (Dp/Dt) increased with 30%. She underwent a successful transvenous upgrade to cardiac resynchronization therapy (CRT). The electrocardiogram post-implantation showed biventricular capture and patient showed subjective and objective clinical improvement. Discussion Systemic RV dysfunction in ccTGA can be aggravated by chronic pacing-induced dyssynchrony, contributing to progression of heart failure in this patient group. Transvenous CRT is feasible in ccTGA anatomy and may be pursued in order to improve or preserve the functional status of pacing-dependent ccTGA patients. Invasive haemodynamic contractility evaluation can help assess the potential benefit of CRT in patients with complex anatomy.
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Affiliation(s)
- Marieke Nederend
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Hubert W Vliegen
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Anastasia D Egorova
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center , Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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8
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Zandstra TE, Nederend M, Jongbloed MRM, Kiès P, Vliegen HW, Bouma BJ, Tops LF, Schalij MJ, Egorova AD. Sacubitril/valsartan in the treatment of systemic right ventricular failure. Heart 2021; 107:1725-1730. [PMID: 33452121 PMCID: PMC8522462 DOI: 10.1136/heartjnl-2020-318074] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Pharmacological options for patients with a failing systemic right ventricle (RV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are not well defined. This study aims to investigate the feasibility and effects of sacubitril/valsartan treatment in a single-centre cohort of patients. Methods Data on all consecutive adult patients (n=20, mean age 46 years, 50% women) with a failing systemic RV in a biventricular circulation treated with sacubitril/valsartan in our centre are reported. Patients with a systemic RV ejection fraction of ≤35% who were symptomatic despite treatment with β-blocker and ACE-inhibitor/angiotensin II receptor-blockers were started on sacubitril/valsartan. This cohort underwent structural follow-up including echocardiography, exercise testing, laboratory investigations and quality of life (QOL) assessment. Results Six-month follow-up data were available in 18 out of 20 patients, including 12 (67%) patients with TGA after atrial switch and 6 (33%) patients with ccTGA. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) decreased significantly (950–358 ng/L, p<0.001). Echocardiographic systemic RV fractional area change and global longitudinal strain showed small improvements (19%–22%, p<0.001 and −11% to −13%, p=0.014, respectively). The 6 min walking distance improved significantly from an average of 564 to 600 m (p=0.011). The QOL domains of cognitive function, sleep and vitality improved (p=0.015, p=0.007 and p=0.037, respectively). Conclusions We describe the first patient cohort with systemic RV failure treated with sacubitril/valsartan. Treatment appears feasible with improvements in NT-pro-BNP and echocardiographic function. Our positive results show the potential of sacubitril/valsartan for this patient population.
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Affiliation(s)
- Tjitske E Zandstra
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Berto J Bouma
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation(s)
- Leigh Reardon
- Medicine, University of California Los Angeles, Los Angeles, California, USA.,Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Jeannette Lin
- Medicine, University of California Los Angeles, Los Angeles, California, USA
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Leusveld EM, Kauling RM, Geenen LW, Roos-Hesselink JW. Heart failure in congenital heart disease: management options and clinical challenges. Expert Rev Cardiovasc Ther 2020; 18:503-516. [DOI: 10.1080/14779072.2020.1797488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elsbeth M. Leusveld
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert M. Kauling
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laurie W. Geenen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Nakamura M, Imamura T, Kuwahara H, Nakagaito M, Yokoyama S, Doi T, Fukahara K, Yoshimura N, Kinugawa K. Paracorporeal Ventricular Assist Device Implantation in a Patient with Transposition of the Great Arteries After Senning Operation. Int Heart J 2020; 61:616-619. [PMID: 32418970 DOI: 10.1536/ihj.19-670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We experienced a 33-year-old patient with D-looped transposition of the great arteries (D-TGA) and a history of Senning operation who was referred to our institute with cardiogenic shock and subsequently underwent urgent paracorporeal ventricular assist device (VAD) implantation, which was a first in Japan, that was eventually converted to a durable VAD. Central venous pressure was maintained relatively high to obtain VAD filling and recover end-organ dysfunction, given the migration of the inflow cannula due to rich trabeculae carneae of the anatomical right ventricle (systemic ventricle in this case).
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Affiliation(s)
- Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
| | | | | | | | | | - Toshio Doi
- Department of Cardiovascular Surgery, University of Toyama
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