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Roos-Hesselink JW, Pelosi C, Brida M, De Backer J, Ernst S, Budts W, Baumgartner H, Oechslin E, Tobler D, Kovacs AH, Di Salvo G, Kluin J, Gatzoulis MA, Diller GP. Surveillance of adults with congenital heart disease: Current guidelines and actual clinical practice. Int J Cardiol 2024; 407:132022. [PMID: 38636602 DOI: 10.1016/j.ijcard.2024.132022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND AIM Congenital heart disease (CHD) is the most common birth defect with prevalence of 0.8%. Thanks to tremendous progress in medical and surgical practice, nowadays, >90% of children survive into adulthood. Recently European Society of Cardiology (ESC), American College of Cardiology (ACC)/ American Heart Association (AHA) issued guidelines which offer diagnostic and therapeutic recommendations for the different defect categories. However, the type of technical exams and their frequency of follow-up may vary largely between clinicians and centres. We aimed to present an overview of available diagnostic modalities and describe current surveillance practices by cardiologists taking care of adults with CHD (ACHD). METHODS AND RESULTS A questionnaire was used to assess the frequency cardiologists treating ACHD for at least one year administrated the most common diagnostic tests for ACHD. The most frequently employed diagnostic modalities were ECG and echocardiography for both mild and moderate/severe CHD. Sixty-seven percent of respondents reported that they routinely address psychosocial well-being. CONCLUSION Differences exist between reported current clinical practice and published guidelines. This is particularly true for the care of patients with mild lesions. In addition, some differences exist between ESC and American guidelines, with more frequent surveillance suggested by the Americans.
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Affiliation(s)
- Jolien W Roos-Hesselink
- Department of Adult Congenital Cardiology, Erasmus Medical Center, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
| | - Chiara Pelosi
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Margarita Brida
- Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Croatia; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Julie De Backer
- Department of Cardiology and Center for Medical Genetics, Ghent University Hospital, Belgium
| | - Sabine Ernst
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Herestraat 49, Leuven B-3000, Belgium
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, University Health Network, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Giovanni Di Salvo
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; Paediatric Cardiology and CHD, University Hospital of Padua, Italy
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK; Aristotle University Medical School, Thessaloniki, Greece
| | - Gerhard P Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany; School of Cardiovascular Medicine & Sciences, Kings College, London WC2R 2LS, UK
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Jin C, Wu Y, Wang Z, Liu X, Wang Q. Isolated Partial Anomalous Pulmonary Veins: A 10-Year Experience at a Single Center. J Surg Res 2024; 298:63-70. [PMID: 38574463 DOI: 10.1016/j.jss.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/29/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Isolated partial anomalous pulmonary venous connection (PAPVC) is difficult to diagnose, and surgical indications remain controversial. We reviewed 10 y of isolated PAPVC cases. METHODS The data of patients with isolated PAPVC admitted to the Anzhen Congenital Heart Disease Department from 2010 to 2019 were reviewed retrospectively. RESULTS Thirty patients, aged between 4 mo and 32 y, were included in this study. Significant correlations were found between the right ventricle (RV), end-diastolic dimension Z-score (RVED-z) and age (r = 0.398, P = 0.03), and between estimated pulmonary pressure and age (r = 0.423, P = 0.02). However, no significant correlations were found between the RVED-z and the number of anomalous pulmonary veins (r = 0.347, P = 0.061), between estimated pulmonary pressure and the RVED-z (r = 0.218, P = 0.248), and between estimated pulmonary pressure and the number of anomalous veins (r = 0.225, P = 0.232). Transthoracic echocardiography (TTE) confirmed 90% of isolated PAPVC cases. Surgical repair was performed in 29 patients with RV enlargement, persistent low weight, pulmonary hypertension, or respiratory symptoms. Among the surgical patients, nine had elevated pulmonary pressure before surgery, which decreased postoperatively; no mortality or reintervention was observed. The mean duration of echocardiographic follow-up was 1.9 y. CONCLUSIONS TTE is recommended for routine assessments, and further clarification can be obtained with computed tomography when TTE proves inconclusive for diagnosis. Transesophageal echocardiography and computed tomography are further recommended for adult patients if TTE fails to provide clear results. PAPVC should be considered as an underlying cause when unexplained RV enlargement is observed. Surgery is recommended for patients with RV enlargement, pulmonary hypertension, or respiratory symptoms.
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Affiliation(s)
- Can Jin
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Yongtao Wu
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Zhiyi Wang
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Xiaoran Liu
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Qiang Wang
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China.
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Buckley BJR, Kerstens TP, France-Ratcliffe M, Lip GY, Thijssen DHJ. Cardiac rehabilitation and adverse events among adult patients with simple congenital heart disease and heart failure. Am J Prev Cardiol 2024; 18:100677. [PMID: 38764779 PMCID: PMC11101941 DOI: 10.1016/j.ajpc.2024.100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/17/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024] Open
Abstract
Aims Improved care has resulted in prolonged survival of patients with congenital heart disease (ConHD), increasing age-related cardiovascular comorbidities. Although cardiovascular rehabilitation (CR) represents evidence-based care for heart failure (HF), the clinical impact of CR in patients with ConHD who developed HF during adulthood is unclear. We investigated 12-month mortality and morbidity in patients with simple ConHD diagnosed with HF with CR versus without CR. Methods A retrospective cohort study was conducted for the time period February 2004 - February 2024. Utilizing TriNetX, a global federated health research network, a real-world dataset of simple ConHD patients was acquired to compare patients with vs. without (controls) prescription for exercise-based CR. Patients were propensity-score matched for age, sex, ethnicity, comorbidities, procedures, and medication. The primary outcome was a composite of all-cause mortality, ischemic stroke, and acute coronary syndrome (major adverse cardiovascular events; MACE) within 12 months. Results Following propensity score matching, the total cohort consisted of 6,866 simple ConHD patients with HF. CR was associated with significantly lower odds for MACE (odds ratio (OR) 0.61 [95 % confidence interval (CI): 0.54-0.69]) and its individual components all-cause mortality (OR 0.40 [95 % CI 0.33-0.47]) and ischemic stroke (OR 0.75 [95 % CI 0.64-0.88]), but not acute coronary syndrome (OR 1.24 [95 % CI 0.91-1.69]). Conclusion CR was associated with significantly lower 12-month MACE in patients with simple ConHD with concomitant HF compared to usual care.
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Affiliation(s)
- Benjamin JR Buckley
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
| | - Thijs P. Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Madeleine France-Ratcliffe
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dick HJ Thijssen
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
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Oehlman LB, Opotowsky AR, Weaver KN, Brown NM, Barnett CL, Miller EM, He H, Shikany AR. Current approach to genetic testing and genetic evaluation referrals for adults with congenital heart disease. Front Genet 2024; 15:1398887. [PMID: 38803543 PMCID: PMC11128592 DOI: 10.3389/fgene.2024.1398887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background Congenital heart disease (CHD) is the most common congenital anomaly. Up to 33% have an identifiable genetic etiology. Improved medical and surgical management of CHD has translated into longer life expectancy and a rapidly growing population of adults living with CHD. The adult CHD (ACHD) population did not have access during childhood to the genetic technologies available today and therefore have not had a robust genetic evaluation that is currently recommended for infants with CHD. Given this potential benefit; the aims of this study were to determine how ACHD cardiologists offer genetics services to patients and identify the indications that influence decision-making for genetics care. Methods We performed a descriptive cross-sectional study of ACHD cardiologists. A study-developed questionnaire was distributed via emailed REDCap link. The recruitment email was sent to 104 potential respondents. The survey was open from 06/2022 to 01/2023. Results Thirty-five cardiologists participated in the study (response rate of 34%). Most cardiologists identified as white (77%) and male (66%). Cardiologists were more likely to refer patients to genetics (91%) than to order testing themselves (57%). Of the testing ordered, chromosomal testing (55%) was ordered more than gene sequencing (14%). Most cardiologists would refer a patient with a conotruncal lesion (interrupted aortic arch) over other indications for a genetics evaluation. There were more reported barriers to ordering genetic testing (66%) compared to referring to genetics for a genetics evaluation (23%). Cardiologists were more confident recognizing features suggestive of a genetic syndrome than ordering the correct test (p = 0.001). Regarding associations between clinical factors and current practices, more years in practice trended towards less referrals and testing. Evaluating a greater number of patients (p = 0.11) and greater confidence recognizing syndromic features (p = 0.12) and ordering the correct test (p = 0.09) were all associated with ordering more testing. Conclusion Testing for microdeletion syndromes is being offered and completed in the ACHD population, however testing for single-gene disorders associated with CHD is being under-utilized. Developing guidelines for genetic testing in adults with CHD could increase access to genetic services, impact medical management, reduce uncertainty regarding prognosis, and inform recurrence risk estimates.
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Affiliation(s)
- Laura B. Oehlman
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Alexander R. Opotowsky
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Kathryn N. Weaver
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Nicole M. Brown
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Cara L. Barnett
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Erin M. Miller
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Hua He
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Amy R. Shikany
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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Montanaro C, Dahill K, Frigiola A, Boyle S, Gatzoulis MA. The Fontan-infective endocarditis paradox: should patients with a Fontan circulation be counselled for antibiotic prophylaxis? Eur J Prev Cardiol 2024; 31:e47-e48. [PMID: 37556721 DOI: 10.1093/eurjpc/zwad260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital Part of Guy's and St Thomas' NHS Foundation Trust, Sydney St, London, SW3 6NP, UK
- National Heart & Lung Institute, Imperial College London, Exhibition Rd, London, SW7 2BX, UK
| | - Katherine Dahill
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital Part of Guy's and St Thomas' NHS Foundation Trust, Sydney St, London, SW3 6NP, UK
| | - Alessandra Frigiola
- Adult Congenital Heart Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Cardiovascular Imaging Science, King's College, London, UK
| | - Siobhan Boyle
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital Part of Guy's and St Thomas' NHS Foundation Trust, Sydney St, London, SW3 6NP, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital Part of Guy's and St Thomas' NHS Foundation Trust, Sydney St, London, SW3 6NP, UK
- National Heart & Lung Institute, Imperial College London, Exhibition Rd, London, SW7 2BX, UK
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6
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Ivey LC, Ahmad A, Chen J, Rodriguez Iii FH, Raskind-Hood C, Book WM. Anatomic and physiologic classification of adults with congenital heart disease to predict adverse outcomes: Use of administrative codes compared to clinical staging. Am Heart J 2024; 271:12-19. [PMID: 38367894 DOI: 10.1016/j.ahj.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The 2018 anatomic physiologic (AP) classification American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for Adults with Congenital Heart Disease (ACHD) encompasses both native and post-operative anatomy and physiology to guide care management. As some physiologic conditions and post-operative states lack specific International Classification of Diseases (ICD) 9- Clinical Modification (CM) and 10-CM codes, an ICD code-based classification approximating the ACHD AP classification is needed for population-based studies. METHODS A total of 232 individuals, aged ≥ 18 years at the time of a health encounter between January 1, 2010 and December 31, 2019 and identified with at least one of 87 ICD codes for a congenital heart defect were validated through medical chart review. Individuals were assigned one of 4 mutually exclusive modified AP classification categories: (1) severe AB, (2) severe CD, (3) non-severe AB, or (4) non-severe CD, based on native anatomy "severe" or "non-severe" and physiology AB ("none" or "mild") or CD ("moderate" or "severe") by two methods: (1) medical record review, and (2) ICD and Current Procedural Terminology (CPT) code-based classification. The composite outcome was defined as a combination of a death, emergency department (ED) visits, or any hospitalizations that occurred at least 6 months after the index date and was assessed by each modified AP classification method. RESULTS Of 232 cases (52.2% male, 71.1% White), 28.4% experienced a composite outcome a median of 1.6 years after the index encounter. No difference in prediction of the composite outcome was seen based on modified AP classification between chart review and ICD code-based methodology. CONCLUSION Modified AP classification by chart review and ICD codes are comparable in predicting the composite outcome at least 6 months after classification. Modified AP classification using ICD code-based classification of CHD native anatomy and physiology is an important tool for population-based ACHD surveillance using administrative data.
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Affiliation(s)
- Lindsey C Ivey
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Attila Ahmad
- Gill Heart & Vascular Institute, Pavilion-G UK Albert B. Chandler Hospital, Department of Medicine and department of Pediatrics, Lexington, KY
| | | | | | - Cheryl Raskind-Hood
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Wendy M Book
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA; Emory University School of Medicine, Cardiology, Atlanta, GA.
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7
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Miyake T, Inoue T, Mushiake S. Right Ventricular Outflow Tract Obstruction by an Aneurysm of the Ventricular Membranous Septum: A Systematic Review of Case Reports. World J Pediatr Congenit Heart Surg 2024; 15:380-388. [PMID: 38263669 DOI: 10.1177/21501351231215258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
We performed a literature search to identify the details of patients with right ventricular outflow tract obstruction caused by an aneurysm of the ventricular membranous septum in a perimembranous ventricular septal defect. Thirty-one cases with a median age of 29 years (range, 1-69 years) were studied. A right ventricle-pulmonary artery systolic pressure gradient ranged from 35 to 107 mm Hg (mean 69 mm Hg). An interventricular shunt was absent in eight patients: two children and six adults. It is necessary to monitor the size of an aneurysm of the ventricular membranous septum, whether or not an interventricular shunt is present.
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Affiliation(s)
- Toshiharu Miyake
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Tomohiro Inoue
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Sotaro Mushiake
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Nara, Japan
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8
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Ruperti-Repilado FJ, Haag N, Fischer T, Santos Lopes B, Meier L, Wustmann K, Bonassin F, Attenhofer Jost C, Schwitz F, Schwerzmann M, Tobler D, von Felten S, Greutmann M. Impact of pulmonary valve replacement on ventricular function and cardiac events in patients with tetralogy of Fallot. A retrospective cohort study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:408-417. [PMID: 38048843 DOI: 10.1016/j.rec.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Our aim was to assess the impact of prosthetic pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) on changes in biventricular volumes and function and on adverse cardiac events. METHODS Adults with rTOF were identified from the SACHER-registry. Data from serial cardiac magnetic resonance imaging, echocardiography, exercise capacity and n-terminal pro b-type natriuretic peptide (NT-proBNP) were collected. The primary endpoint was right ventricular ejection fraction (RVEF) as measured by cardiac magnetic resonance. Secondary endpoints were biventricular volumes, left ventricular ejection fraction, exercise capacity and NT-proBNP levels, and time to adverse cardiac outcomes (atrial and ventricular arrhythmia, endocarditis). Associations between previous PVR and longitudinal changes in functional outcomes and time to adverse cardiac outcomes were analyzed using linear mixed-effects models and Cox proportional hazards models, respectively. RESULTS A total of 308 patients (153 with and 155 without PVR) with 887 study visits were analyzed. Previous PVR was not significantly associated with changes in RVEF (CE, -1.33; 95%CI, -5.87 to 3.21; P=.566). Previous PVR was associated with lower right ventricular end-diastolic volume but had no significant effect on left ventricular ejection fraction, exercise capacity, or NT-proBNP-levels. Previous PVR was associated with an increased hazard of atrial arrhythmias (HR, 2.09; 95%CI, 1.17-3.72; P=.012) and infective endocarditis (HR, 12.72; 95%CI, 4.69-34.49; P<.0001) but not with an increased hazard of sustained ventricular arrhythmias (HR, 0.64; 95%CI, 0.18-2.27; P=.490). CONCLUSIONS Previous PVR was not significantly associated with changes in RVEF but was associated with an increased risk of atrial arrhythmias and infective endocarditis.
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Affiliation(s)
| | - Nora Haag
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Fischer
- Master Program in Biostatistics, University of Zurich, Switzerland
| | - Bruno Santos Lopes
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiology, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Meier
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kerstin Wustmann
- Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Francesca Bonassin
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christine Attenhofer Jost
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabienne Schwitz
- Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. https://twitter.com/@DDaniel_Tobler
| | - Stefanie von Felten
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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9
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Duarte VE, Yamamura K, Economy KE, Graf JA, Lu M, Assenza GE, Karur GR, Marenco A, Ishikita A, Duncan ME, Geva T, Wald RM, Valente AM. THE EFFECTS OF PREGNANCY IN SUBJECTS WITH REPAIRED TETRALOGY OF FALLOT. Am Heart J 2024:S0002-8703(24)00102-9. [PMID: 38677503 DOI: 10.1016/j.ahj.2024.04.015] [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] [Received: 12/28/2023] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Previous reports reveal inconsistent findings of right ventricular (RV) changes following pregnancy in subjects with repaired tetralogy of Fallot (rTOF). METHODS A two-center, retrospective cohort study which included women with rTOF who completed pregnancy that were matched to nulliparous women with rTOF by age at the time of baseline cardiac magnetic resonance (CMR), RV ejection fraction (RVEF), and indexed RV end-diastolic volume (RVEDVi). Pre-pregnancy and postpartum cardiac magnetic resonance (CMR) were analyzed and compared to sequential CMR of nulliparous subjects with rTOF. RESULTS Thirty-six women with rTOF who completed pregnancy were matched to 72 nulliparous women with rTOF. Over a mean period of 3.1 years for the pregnancy group and 2.7 years for the comparison group, there was no significant change in the RVEDVi, RVEF, RV mass, pulmonary regurgitation severity, left ventricular (LV) volumes, LV ejection fraction (LVEF), or LV mass when comparing the baseline CMR and the follow-up CMR in either of the groups. There was a slight increase in RV indexed end-systolic volume (RVESVi) when comparing the baseline CMR and the follow-up CMR in the pregnancy group (68.93, SD 23.34 ml/m2 at baseline vs. 72.97, SD 25.24 ml/m2 at follow-up, p= 0.028). Using a mixed effects model for CMR parameters change over time; when adjusted for time between baseline and follow-up CMR there was no significant difference in rate of change between the pregnancy and comparison groups. CONCLUSIONS Most ventricular remodeling parameters measured by CMR did not significantly change in subjects with rTOF who completed pregnancy or in nulliparous subjects with rTOF. In the pregnancy group, RVESVi is larger in those individuals who have undergone pregnancy without a significant change in ventricular function. These patients should be followed longitudinally to determine the long-term ventricular and clinical effects of pregnancy.
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Affiliation(s)
- Valeria E Duarte
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Kenichiro Yamamura
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katherine E Economy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Julia A Graf
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Gabriele Egidy Assenza
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gauri R Karur
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Anais Marenco
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ayako Ishikita
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Madeline E Duncan
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Rachel M Wald
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
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10
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Neijenhuis RML, MacDonald ST, Zemrak F, Mertens BJA, Dinsdale A, Hunter A, Walker NL, Swan L, Reddy S, Rotmans JI, Jukema JW, Jongbloed MRM, Veldtman GR, Egorova AD. Effect of Sodium-Glucose Cotransporter 2 Inhibitors in Adults With Congenital Heart Disease. J Am Coll Cardiol 2024; 83:1403-1414. [PMID: 38530688 DOI: 10.1016/j.jacc.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Heart failure (HF) is the principal cause of morbidity and mortality in adults with congenital heart disease (ACHD). Robust evidence-based treatment options are lacking. OBJECTIVES This study aims to evaluate the safety, tolerability, and short-term HF-related effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in a real-world ACHD population. METHODS All patients with ACHD treated with SGLT2i in 4 European ACHD centers were included in this retrospective study. Data were collected from 1 year before starting SGLT2i to the most recent follow-up. Data on side effects, discontinuation, mortality, and hospitalizations were collected. RESULTS In total, 174 patients with ACHD were treated with SGLT2i from April 2016 to July 2023. The mean age was 48.7 ± 15.3 years, 72 (41.4%) were female, and 29 (16.7%) had type 2 diabetes mellitus. Ten (5.7%) patients had mild, 75 (43.1%) moderate, and 89 (51.1%) severe congenital heart disease. HF was the most frequent starting indication (n = 162, 93.1%), followed by type 2 diabetes (n = 11, 6.3%) and chronic kidney disease (n = 1, 0.6%). At median follow-up of 7.7 months (Q1-Q3: 3.9-13.2 months), 18 patients (10.3%) reported side effects, 12 (6.9%) permanently discontinued SGLT2i, and 4 (2.3%) died of SGLT2i-unrelated causes. A significant reduction in the HF hospitalization rate was observed from 6 months before to 6 months after starting SGLT2i (relative rate = 0.30; 95% CI: 0.14-0.62; P = 0.001). CONCLUSIONS SGLT2i generally seem safe, well-tolerated, and potentially beneficial in patients with ACHD. SGLT2i was associated with a 3-fold reduction in the 6-month HF hospitalization rate. These results warrant prospective randomized investigation of the potential benefits of SGLT2i for patients with ACHD.
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Affiliation(s)
- Ralph M L Neijenhuis
- CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, location Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Simon T MacDonald
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Filip Zemrak
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Bart J A Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna Dinsdale
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Amanda Hunter
- Scottish Adult Congenital Cardiac Service (SACCS), Golden Jubilee University National Hospital, Glasgow, United Kingdom
| | - Niki L Walker
- Scottish Adult Congenital Cardiac Service (SACCS), Golden Jubilee University National Hospital, Glasgow, United Kingdom
| | - Lorna Swan
- Scottish Adult Congenital Cardiac Service (SACCS), Golden Jubilee University National Hospital, Glasgow, United Kingdom
| | - Sushma Reddy
- Department of Pediatrics (Cardiology), Lucile Packard Children's Hospital, Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Joris I Rotmans
- Department of Internal Medicine and Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, location Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gruschen R Veldtman
- Scottish Adult Congenital Cardiac Service (SACCS), Golden Jubilee University National Hospital, Glasgow, United Kingdom
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, location Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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11
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Koole MA, de Jong S, Mulder BJ, Bouma BJ, Schuuring MJ. Value of Extended Arrhythmia Screening in Adult Congenital Heart Disease Patients. Arrhythm Electrophysiol Rev 2024; 13:e07. [PMID: 38807745 PMCID: PMC11131155 DOI: 10.15420/aer.2023.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/27/2023] [Indexed: 05/30/2024] Open
Abstract
The European Society of Cardiology guidelines for the management of adult congenital heart disease patients recommend screening for arrhythmias and bradycardias in symptomatic patients, often being done by means of an ambulatory 24-48-hour Holter or implantable loop recorder (ILR). However, nowadays non-invasive instruments, such as patches, smartwatches and smartphones based on single-lead ECGs that perform extended monitoring, are also available. The aim of this narrative review was to assess whether these instruments, when they detect arrhythmias and bradycardias in patients with adult congenital heart disease, will lead to meaningful changes in clinical care. Clinically meaningful changes include adjustment of medication, cardioversion, electrophysiology study, ablation or implantation of a cardiovascular implantable electronic device. The following monitoring instruments are discussed: cumulative Holter, 2-week continuous monitor, smartwatchand smartphone-based single-lead ECG, and ILR. The diagnostic yield of extended rhythm monitoring is high, and varies between 18% (smartphone-based single-lead ECG) and 41% with ILR. In conclusion, contemporary arrhythmia screening includes various new non-invasive technologies that are promising new tools as an alternative to Holter monitoring or ILR. However, the optimal mode of detection is still unclear due to the lack of head-to-head comparisons.
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Affiliation(s)
- Maarten Antonius Koole
- Department of Cardiology, Amsterdam UMC Amsterdam, the Netherlands
- Cardiology Centres of the Netherlands Amsterdam, the Netherlands
- Department of Cardiology, Rode Kruis Ziekenhuis Beverwijk, the Netherlands
| | - Sanne de Jong
- Department of Cardiology, Amsterdam UMC Amsterdam, the Netherlands
| | - Barbara J Mulder
- Department of Cardiology, Amsterdam UMC Amsterdam, the Netherlands
| | | | - Mark Johan Schuuring
- Department of Cardiology, Amsterdam UMC Amsterdam, the Netherlands
- Department of Cardiology, Medisch Spectrum Twente Enschede, the Netherlands
- Circulatory Health, UMC Utrecht Utrecht, the Netherlands
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12
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Mikulski MF, Well A, Shmorhun D, Mery CM, Fenrich AL, Fraser CD. Impact of electrophysiologists at daily multidisciplinary report in a paediatric cardiac care unit. Cardiol Young 2024:1-7. [PMID: 38577782 DOI: 10.1017/s1047951124000738] [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: 04/06/2024]
Abstract
BACKGROUND Paediatric cardiac electrophysiologists are essential in CHD inpatient care, but their involvement is typically limited to consultation with individual patients. In our integrated heart centre, an electrophysiologist reviews all cardiac inpatient telemetry over the preceding 24 hours and participates in daily multidisciplinary morning report. This study investigates the impact of the strategy of consistent, formalised electrophysiologist presence at multidisciplinary morning report. METHODS This is a single-centre, prospective, observational study of electrophysiologist participation in patient encounters during heart centre multidisciplinary morning report from 10/20/2021 to 10/31/2022. Multidisciplinary morning report includes discussion of all intensive care and non-intensive care cardiac patients. An encounter was defined as reporting on one patient for one day. Electrophysiologists were initially blinded to observations. RESULTS Two electrophysiologists were observed over 215 days encompassing 6413 patient encounters. Electrophysiologists made comments on 581(9.1%) encounters in 234 unique patients with diverse diagnoses, equating to a median of 3[interquartile range:1-4] encounters per day. These included identifications of arrhythmias and describing electrocardiographic findings. Recommendation to change management occurred in 282(48.5%) encounters, most commonly regarding medications (n = 142, 24.4%) or pacemaker management (n = 48, 8.3%). Of the 581 encounters, there were 61(10.5%) in which they corrected another physician's interpretation of rhythm or electrocardiogram. CONCLUSION Routine electrophysiologist involvement in multidisciplinary morning report provides significant, frequent, and timely input in patient management by identifying precise rhythm-related diagnoses and allowing nuanced, patient-specific medication and pacemaker management of all cardiac patients, not just those consulted. Electrophysiologist presence at multidisciplinary morning report is a vital resource and this practice should be considered at integrated paediatric cardiac centres.
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Affiliation(s)
- Matthew F Mikulski
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Daniel Shmorhun
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Arnold L Fenrich
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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13
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Situ Y, Weir L, Feneley M, Watson A, Subbiah R. Coronary Artery Fistula Involving the RCA, LAD, and the Main Pulmonary Artery. JACC Case Rep 2024; 29:102256. [PMID: 38645296 PMCID: PMC11031659 DOI: 10.1016/j.jaccas.2024.102256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/05/2024] [Accepted: 01/22/2024] [Indexed: 04/23/2024]
Abstract
We present a case of a complex congenital coronary artery fistula between the right coronary artery, left anterior descending artery, and the main pulmonary artery complicated by massive aneurysms and a left-to-right shunt. We highlight the multimodality approach to assessment and the importance of individualized management of complex coronary fistulas.
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Affiliation(s)
- Yiling Situ
- St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Lachlan Weir
- St Vincent’s Hospital, Sydney, New South Wales, Australia
| | | | | | - Rajesh Subbiah
- St Vincent’s Hospital, Sydney, New South Wales, Australia
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14
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Egbe AC, Miranda WR, Jain CC, Burchill LJ, Jokhadar M, Brown RD, Connolly HM. Low Incidence of New Intracranial Aneurysms in Adults With Coarctation of Aorta on Serial Brain Imaging. Am J Cardiol 2024; 216:46-47. [PMID: 38373680 DOI: 10.1016/j.amjcard.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Luke J Burchill
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maan Jokhadar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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15
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Aher P, Saad N, Aher A, Priya S, Albini A. Pulmonary Artery Stenosis After an Orthotopic Heart Transplantation: A Case Report With Cardiac Imaging Findings and a Literature Review. Cureus 2024; 16:e57416. [PMID: 38694640 PMCID: PMC11062755 DOI: 10.7759/cureus.57416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
Pulmonary artery stenosis is a rare complication of heart transplantation. It is typically a congenital condition or can be secondary to rheumatic fever, systemic vasculitis like Behcet's disease, or Takayasu's arteritis. It can also occur as a rarity of a delayed complication post-heart transplant. In this report, we describe the imaging findings of pulmonary artery stenosis in a patient who underwent an orthotopic heart transplant more than 10 years prior. Dynamic cardiac magnetic resonance imaging (MRI), phase contrast imaging, and MR angiography in the management of pulmonary artery stenosis helped in heart and pulmonary circulation. Functional evaluation can be achieved with current multichannel transmit-receive coils. Cardiac gated pre- and dynamic contrast-enhanced MR was performed with phase-contrast imaging for further evaluation confirming the diagnosis of pulmonary artery stenosis.
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Affiliation(s)
- Pritish Aher
- Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Nini Saad
- Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Aman Aher
- Nutrition and Exercise Physiology, University of Missouri, Columbia, USA
| | - Sarv Priya
- Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Alessandra Albini
- Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
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16
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Hillani A, El Yamani MEM, Ouazani Chahdi H, Matteau A. A Case of Refractory Hypoxemia Secondary to Intracardiac Shunt Diagnosed in the Catheterization Laboratory. CJC Open 2024; 6:666-669. [PMID: 38708053 PMCID: PMC11065724 DOI: 10.1016/j.cjco.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/19/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Ali Hillani
- Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | - Alexis Matteau
- Division of Cardiology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
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17
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Adebiyi E, Munoz Pareja JC, Alba-Sandoval M, Almodovar M. Impact of congenital heart disease on mortality and other associated outcomes in children hospitalised for acute asthma exacerbation. Cardiol Young 2024; 34:884-890. [PMID: 37946520 DOI: 10.1017/s1047951123003803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Acute asthma exacerbation is one of the most common reasons for paediatric emergency room visits and hospital admissions in the United States of America. OBJECTIVE To assess the impact of CHD on outcomes of children hospitalised for acute asthma exacerbation. METHODS Children primarily admitted for acute asthma exacerbation were sampled from 2006, 2009, 2012, and 2016 kid inpatient database of the Healthcare Cost and Utilization Project using ICD codes. The disease outcomes were compared between those with and without CHD using multivariate logistic regressions in Stata version 17. RESULTS There were a total of 639,280 acute asthma exacerbation admissions, of which 5,907 (0.92%) had CHD. The mortality rate was 0.079% for patients without CHD and 0.72% for those with co-existing CHD. Children with CHD had higher odds of mortality (5.51, CI 3.40-8.93, p < 0.001), acute respiratory failure (2.84, CI 2.53-3.20; p < 0.001), need for invasive mechanical ventilation (4.58, CI 3.80-5.52; p < 0.001), acute kidney injury (adjusted odds ratio 3.03, CI 3.03-7.44; p < 0.001), and in-hospital cardiac arrest (adjusted odds ratio 4.52, CI 2.49-8.19; p < 0.001) when compared with those without CHD. The adjusted mean length of hospital stays (CI 2.91-3.91; p < 0.001) and hospital charges (95% CI $31060-$47747) among children with acute asthma exacerbation and CHD were significantly higher than in those without CHD. CONCLUSION AND SIGNIFICANCE CHD is an independent predictor of mortality, more severe disease course, and higher hospital resource utilisation. Strategies that improve CHD care will likely improve the overall health outcomes of children with CHD hospitalised for acute asthma exacerbation.
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Affiliation(s)
- Ebenezer Adebiyi
- Pediatric Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Monica Alba-Sandoval
- Department of Pediatric Critical Care Medicine, University of Miami/Jackson Health System, Miami, FL, USA
| | - Melvin Almodovar
- Department of Pediatric Cardiology, University of Miami/Jackson Health System, Miami, FL, USA
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18
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Nicolarsen J, Mudd J, Coletti A. Medical Therapy and Monitoring in Adult Congenital Heart Disease Heart Failure. Heart Fail Clin 2024; 20:137-146. [PMID: 38462318 DOI: 10.1016/j.hfc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heart failure (HF) in adult congenital heart disease (ACHD) is an increasingly common problem facing ACHD and advanced heart disease and transplant providers. Patients are highly nuanced, and therapies are poorly studied. Standard HF medications are often used in patients who are not targets of large clinical trials. HF management in this data-free zone requires focused, comprehensive team-based care and close follow-up and communication with patients.
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Affiliation(s)
- Jeremy Nicolarsen
- Providence Adult and Teen Congenital Heart Program (PATCH), Providence Sacred Heart Medical Center and Children's Hospital, 101 West 8th Avenue, Suite 4300, Spokane, WA 99204, USA.
| | - James Mudd
- Center for Advanced Heart Disease and Transplantation, Providence Spokane Heart Institute, 62 West 7th Avenue, Suite 232, Spokane, WA 99204, USA
| | - Andrew Coletti
- Center for Advanced Heart Disease and Transplantation, Providence Spokane Heart Institute, 62 West 7th Avenue, Suite 232, Spokane, WA 99204, USA
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19
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Egbe AC, Connolly HM. Heart Failure Staging and Indications for Advanced Therapies in Adults with Congenital Heart Disease. Heart Fail Clin 2024; 20:147-154. [PMID: 38462319 DOI: 10.1016/j.hfc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heart failure (HF) is common in adults with congenital heart disease (CHD), and it is the leading cause of death in this population. Adults with CHD presenting with stage D HF have a poor prognosis, and early recognition of signs of advanced HF and referral for advanced therapies for HF offer the best survival as compared with other therapies. The indications for advanced therapies for HF outlined in this article should serve as a guide for clinicians to determine the optimal time for referral. Palliative care should be part of the multidisciplinary care model for HF in patients with CHD.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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20
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Tinsay MAFM, Halpern DG, Feinberg JL, Vorsanger M, Keller N, Small AJ. Adult congenital heart disease care in a municipal public health system. Cardiol Young 2024; 34:859-864. [PMID: 37909409 DOI: 10.1017/s1047951123003682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Specialty care is associated with improved outcomes for adults with adult CHD and must be extended to the underserved. A retrospective cohort study was performed to describe the provision of care to adult CHD patients in America's largest municipal public health system including patient demographics, diagnostic and therapeutic procedures, and adherence to guideline-recommended surveillance. We identified 229 adult CHD patients aged >18 years through electronic medical records. The most common diagnoses were atrial septal defect, ventricular septal defect, patent ductus arteriosus, and valvular pulmonary stenosis. In total, 65% had moderate or greater anatomic complexity. A large number of patients were uninsured (45%), non-white (96%), and non-English speaking (44%). One hundred forty-six patients (64%) presented with unrepaired primary defects. Fifty eight patients underwent primary repair during the study period; 48 of those repairs were surgical and 10 were transcatheter. Collaboration with an affiliated Comprehensive Care Center was utilised for 28% of patients. A high proportion of patients received adult CHD speciality visits (78%), echocardiograms (66%), and electrocardiograms (56%) at the guideline-recommended frequency throughout the study period. There was no significant difference in the rate of adherence to guideline-recommended surveillance based on insurance status, race/ethnicity, or primary language status. The proportion of patients who had guideline-recommended adult CHD visits, echocardiograms, and electrocardiograms was significantly lower for those with more advanced physiological stages. These results can inform the provision of adult CHD care in other public health system settings.
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Affiliation(s)
| | - Dan G Halpern
- Division of Cardiology, Department of Medicine, Adult Congenital Heart Disease, NYU Grossman School of Medicine, New York, NY, USA
| | - Jodi L Feinberg
- Division of Cardiology, Department of Medicine, Adult Congenital Heart Disease, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Vorsanger
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Norma Keller
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Adam J Small
- Division of Cardiology, Department of Medicine, Adult Congenital Heart Disease, NYU Grossman School of Medicine, New York, NY, USA
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21
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Yamano M, Yamano T, Matoba S. Right ventricular dilatation: echocardiographic differential diagnosis. J Med Ultrason (2001) 2024; 51:275-282. [PMID: 38228943 DOI: 10.1007/s10396-023-01399-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/15/2023] [Indexed: 01/18/2024]
Abstract
The initial means of detecting right ventricular (RV) dilatation is often transthoracic echocardiography (TTE), and once the presence of RV dilatation is suspected, there is the possibility of RV volume overload, RV pressure overload, RV myocardial disease, and even nonpathological RV dilatation. With respect to congenital heart disease with RV volume overload, defects or valvular abnormalities can be easily detected with TTE, with the exception of some diseases. Volumetric assessment using three-dimensional echocardiography may be useful in determining the intervention timing in these diseases. When the disease progresses in patients with pulmonary hypertension as a result of RV pressure overload, RV dilatation becomes more prominent than hypertrophy, and RV functional parameters predict the prognosis at this stage of maladaptive remodeling. The differential diagnosis of cardiomyopathy or comparison with nonpathological RV dilatation may be difficult in the setting of RV myocardial disease. The characteristics of RV functional parameters such as two-dimensional speckle tracking may help differentiate RV cardiomyopathy from other conditions. We review the diseases presenting with RV dilatation, their characteristics, and echocardiographic findings and parameters that are significant in assessing their status or intervention timing.
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Affiliation(s)
- Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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22
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Brouwer C, Hebe J, Nürnberg JH, Cosedis Nielsen J, Lukac P, de Riva M, Blom N, Zeppenfeld K. Incidence of Atrial Fibrillation After Radiofrequency Catheter Ablation for Atrial Tachycardia in Congenital Heart Disease. JACC Clin Electrophysiol 2024:S2405-500X(24)00163-4. [PMID: 38613544 DOI: 10.1016/j.jacep.2024.02.020] [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: 05/30/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Atrial tachycardia (AT) and atrial fibrillation (AF) coexist in 30% of congenital heart disease (CHD) patients. Successful atrial tachycardia catheter ablation (ATCA) might prevent AF. Data on new-onset AF after ATCA in CHD is scarce. OBJECTIVES This study aimed to evaluate the incidence of new-onset AF after ATCA and to assess clinical characteristics associated with new-onset AF after ATCA in CHD. METHODS CHD patients referred for ATCA to 3 European centers were included. New occurrence of AF was defined as electrocardiographic documentation of AF after any ATCA procedure in patients without history of AF. RESULTS In 277 CHD patients (median age 37 years [Q1, Q3: 23, 49 years], 58% men, 59 [21%] simple, 111 [40%] moderate, and 107 [39%] complex CHD), AF occurred in 25 patients (9%) a median of 8 months (Q1, Q3: 4, 27 months) after ATCA. New-onset AF was persistent in the majority of the patients (17 of 25 [63%]). Patients with new-onset AF were older (44 years [Q1, Q3: 29, 55 years] vs 36 years [Q1, Q3: 23, 49 years]; P = 0.009) and more frequently had simple CHD (13 of 25 [52%] vs 46 of 252 [18%], respectively; P < 0.0001). Acute ATCA success rates were similar in patients with and without AF (52% vs 48%; P = 0.429). Simple CHD was an independent predictor of new-onset AF during follow-up. CONCLUSIONS In our large cohort of patients with congenital heart disease, new-onset AF after ablation for AT occurred in only 9% of the patients. AF occurred without AT recurrence and was persistent in the majority of patients.
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Affiliation(s)
- Charlotte Brouwer
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marta de Riva
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Nico Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands.
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Daelman B, Van Bulck L, Luyckx K, Kovacs AH, Van De Bruaene A, Ladouceur M, Yang HL, Moon JR, Schmidt A, Lykkeberg B, Callus E, de Hosson M, Sandberg C, Johansson B, Hlebowicz J, Areias ME, Amedro P, Coats L, Mandalenakis Z, Kaneva A, Moons P, Goossens E. Frailty and Cognitive Function in Middle-Aged and Older Adults With Congenital Heart Disease. J Am Coll Cardiol 2024; 83:1149-1159. [PMID: 38508848 DOI: 10.1016/j.jacc.2024.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential. OBJECTIVES The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits. METHODS Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment. RESULTS In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income. CONCLUSIONS Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.
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Affiliation(s)
- Bo Daelman
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium
| | - Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium. https://twitter.com/BulckLiesbet
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven-University of Leuven, Leuven, Belgium; Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Adrienne H Kovacs
- Equilibria Psychological Health, Toronto, Ontario, Canada. https://twitter.com/AdrienneK_PhD
| | - Alexander Van De Bruaene
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium. https://twitter.com/alexvdbruaene
| | - Magalie Ladouceur
- Centre de recherche Cardiovasculaire de Paris, INSERM U970, Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France. https://twitter.com/Mag_Ladouceur
| | - Hsiao-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ju Ryoung Moon
- Department of Nursing, Cardiac Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea
| | - André Schmidt
- Adult Congenital Heart Disease Unit, Hospital das Clínicas, Facultdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Birgitte Lykkeberg
- The Cardiology Clinic, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Edward Callus
- Clinical Psychology Service, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Michèle de Hosson
- Department of Adult Congenital Heart Disease Ghent, Ghent University Hospital, Ghent, Belgium
| | - Camilla Sandberg
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Joanna Hlebowicz
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden. https://twitter.com/JoannaHlebowicz
| | | | - Pascal Amedro
- University of Bordeaux, Liryc Institute, Hôpital cardiologique Haut-Leveque, Bordeaux, France; Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France. https://twitter.com/Pascal_Amedro
| | - Louise Coats
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom. https://twitter.com/LouiseCoats7
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Kaneva
- Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium. https://twitter.com/EvaGoossens_PhD
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Ghorbannia A, Jurkiewicz H, Nasif L, Ahmed A, Co-Vu J, Maadooliat M, Woods RK, LaDisa JF. Coarctation duration and severity predict risk of hypertension precursors in a preclinical model and hypertensive status among patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.30.23297766. [PMID: 37961634 PMCID: PMC10635238 DOI: 10.1101/2023.10.30.23297766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Coarctation of the aorta (CoA) often leads to hypertension (HTN) post-treatment. Evidence is lacking for the current >20 mmHg peak-to-peak blood pressure gradient (BPGpp) guideline, which can cause aortic thickening, stiffening and dysfunction. This study sought to find the BPGpp severity and duration that avoid persistent dysfunction in a preclinical model, and test if predictors translate to HTN status in CoA patients. Methods Rabbits (N=75; 5-12/group) were exposed to mild, intermediate or severe CoA (≤12, 13-19, ≥20 mmHg BPGpp) for ~1, 3 or 22 weeks using dissolvable and permanent sutures with thickening, stiffening, contraction and endothelial function evaluated via multivariate regression. Relevance to CoA patients (N=239; age=0.01-46 years; median 3.7 months) was tested by retrospective review of predictors (preoperative BPGpp, surgical age, etc.) vs follow-up HTN status. Results CoA duration and severity were predictive of aortic remodeling and active dysfunction in rabbits, and HTN in CoA patients. Interaction between patient age and BPGpp at surgery contributed significantly to HTN, similar to rabbits, suggesting preclinical findings translate to patients. Machine learning decision tree analysis uncovered that pre-operative BPGpp and surgical age predict risk of HTN along with residual post-operative BPGpp. Conclusions These findings suggest the current BPGpp threshold determined decades ago is likely too high to prevent adverse coarctation-induced aortic remodeling. The results and decision tree analysis provide a foundation for revising CoA treatment guidelines considering the interaction between CoA severity and duration to limit the risk of HTN.
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Affiliation(s)
- Arash Ghorbannia
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Pratt School of Engineering, Duke University, Durham, NC USA
| | - Hilda Jurkiewicz
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lith Nasif
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, Florida, USA
| | - Abdillahi Ahmed
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, Florida, USA
| | - Jennifer Co-Vu
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, Florida, USA
| | - Mehdi Maadooliat
- Department of and Statistical Sciences, Marquette University, Milwaukee, Wisconsin, USA
| | - Ronald K. Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - John F. LaDisa
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Departments of Physiology, and Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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25
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Gelaw TT, Yehuala AA, Mengste SZ, Yimer YA, Engida HB, Alem AT. Two-Dimensional and Doppler trans-thoracic echocardiographic patterns of suspected pediatric heart diseases at Tibebe--Ghion specialized Teaching Hospital and Adinas General Hospital, Bahir Dar, North-west Ethiopia:-An experience from an LMIC. PLoS One 2024; 19:e0292694. [PMID: 38466681 PMCID: PMC10927071 DOI: 10.1371/journal.pone.0292694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Transthoracic Echocardiography is the first-line, non-invasive, and accessible imaging modality to evaluate heart disease anatomy, physiology, and hemodynamics. We aim to describe the trans-thoracic echocardiography pattern of pediatric heart diseases and reasons for referral in children referred to Bahir Dar University Tibebe-Ghion Hospital and Adinas General Hospital. METHOD A descriptive cross-sectional study of the archived Transthoracic, Two Dimensional, and Doppler Echocardiography assessments of children from birth to fifteen years of age performed between June 2019 to May 2023 was done. Data were collected retrospectively from February 01, 2023 -May 31, 2023. Categorical variables like gender, referral reasons for echocardiography, and patterns of pediatric heart lesions were analyzed in the form of proportions and presented in tables and figures. Discrete variables including age were summarized as means (SD) and medians(IQR). RESULTS Out of 3,647 Children enrolled; 1,917 (52.6%) were males and 1,730 (47.4%) were females. The median (IQR) age of children enrolled was 24 months (5 to 96). Cardiac murmur (33%) was the most common reason for echocardiography followed by, Respiratory Distress (18%), Syndromic Child (15%), easy fatigability/ Diaphoresis (14.3%), congestive heart failure (14%), and rheumatic fever (13.2%). Congenital heart defect (CHD) accounts for 70% of all heart diseases, followed by rheumatic heart disease (21%). Isolated ventricular septal defect(VSD) was the most common CHD (21%) followed by isolated Patent ductus arteriosus (15%), isolated atrial septal defect (10%), Isolated atrioventricular septal defect (6%) and isolated pulmonary stenosis (5%). Cyanotic CHD accounts for 11.5% of all heart diseases. Tetralogy of Fallot (30%), d-TGA (20%), and double outlet right ventricle (19%) were the most common cyanotic CHDs. CONCLUSIONS In our study, congenital heart lesions are the most common diagnosis and cardiac murmurs are the most common presenting reasons for echocardiography evaluation.
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Affiliation(s)
- Tesfaye Taye Gelaw
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Aschalew Yehuala
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Senay Zerihun Mengste
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yalemwork Anteneh Yimer
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habtamu Bayih Engida
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abiot Tefera Alem
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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26
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Butt M, Halim H, Qureshi A, Koene R, Aung S, Karamlou T, Saini A. A Tale of Three Chambers: Cor Triatriatum Sinistrum. CASE (PHILADELPHIA, PA.) 2024; 8:221-225. [PMID: 38524992 PMCID: PMC10954656 DOI: 10.1016/j.case.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Cor triatriatum is an important cause of HF and atrial arrhythmias in young adults. •Misdiagnosis can cause inappropriate interventions and delay in surgical treatment. •Integrated imaging is useful in describing anatomy and associated abnormalities. •Collaboration between hospitals and cardiac specialties helps prevent poor outcomes.
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Affiliation(s)
- Maliha Butt
- Department of Cardiology, Aultman Hospital, Canton, Ohio
| | - Husban Halim
- Department of Cardiology, Aultman Hospital, Canton, Ohio
| | - Ataul Qureshi
- Department of Cardiology, Aultman Hospital, Canton, Ohio
| | - Ryan Koene
- Department of Cardiology, Aultman Hospital, Canton, Ohio
| | - Su Aung
- Department of Cardiology, Aultman Hospital, Canton, Ohio
| | - Tara Karamlou
- Department of Cardiothoracic Surgery, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Ashish Saini
- Adult Congenital Heart Service, Akron Children’s Hospital Heart Center, Akron, Ohio
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27
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Veillette S, Beaudouin J, Couture EJ. A Case of Abnormal Right Ventricular Color-Flow Doppler Jet. J Cardiothorac Vasc Anesth 2024; 38:843-847. [PMID: 37953175 DOI: 10.1053/j.jvca.2023.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Transthoracic echocardiography is used routinely during the follow-up after heart transplant surgery to screen possible complications and adverse events such as rejection. It often results in incidental findings that bring diagnostic challenges for sonographers. This E-challenge shows a Doppler flow abnormality associated with a rare cardiovascular diagnosis. Its physiopathology and its association with echocardiography findings are reviewed.
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Affiliation(s)
- Simon Veillette
- Department of Anesthesiology and Intensive Care Medicine, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jonathan Beaudouin
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Etienne J Couture
- Department of Anesthesiology and Intensive Care Medicine, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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28
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Dehn AM, Pærregaard MM, Sellmer A, Dannesbo S, Blixenkrone-Møller E, Sillesen AS, Raja AA, Iversen KK, Bundgaard H, Christensen AH, Hjortdal V. Electrocardiographic Characteristics in 438 Neonates with Atrial Septal Defects. Pediatr Cardiol 2024; 45:580-587. [PMID: 37914855 PMCID: PMC10891263 DOI: 10.1007/s00246-023-03324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023]
Abstract
Arrhythmias and electrocardiographic (ECG) abnormalities are common among patients with atrial septal defects (ASDs). We studied a large cohort of neonates with ASDs to investigate whether ECG abnormalities are present at this early stage or develop later, secondary to hemodynamic changes. We analyzed the echocardiograms and ECGs from the Copenhagen Baby Heart Study, a population-based cohort study. We compared ECG characteristics of 438 neonates with secundum ASDs to 1314 matched controls. In subgroup analyses, we investigated whether electrocardiographic characteristics were associated with age at examination. Neonates with ASDs (median age, 11 days; males, 51%) had longer P-wave durations (58 vs. 56 ms, p < 0.001), PR intervals (100 vs. 96 ms, p < 0.001), and a more rightward-shifted QRS axis (116 vs. 114 degrees, p = 0.032) compared to controls (median age, 10 days; males, 51%). There were no differences between cases and controls in the P-wave area, amplitude, or axis. Subgroup analyses showed that the differences in P-wave duration and PR interval were present in neonates examined in the first week after birth. The difference in the QRS axis was not found in neonates examined this early but was found in neonates examined at age two to four weeks. In conclusion, ASDs are associated with ECG changes from the neonatal phase. The P-wave duration and PR interval are longer in neonates with ASDs when compared to controls as early as the first week after birth, indicating that these changes are not purely secondary, but that neonates with an ASD have altered cardiac electrical activity.ClinicalTrials.gov Identifier NCT02753348 (April 27, 2016).
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Affiliation(s)
- Anna Maria Dehn
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Maria Munk Pærregaard
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Sellmer
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Sofie Dannesbo
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anne-Sophie Sillesen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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29
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Park WY, Kim GB, Lee SY, Kim AY, Choi JY, Jang SI, Kim SH, Cha SG, Wang JK, Lin MT, Chen CA. The adaptability of the Pulsta valve to the diverse main pulmonary artery shape of native right ventricular outflow tract disease. Catheter Cardiovasc Interv 2024; 103:587-596. [PMID: 38341624 DOI: 10.1002/ccd.30968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Pulsta valve is increasingly used for percutaneous pulmonary valve implantation (PPVI) in patients with a large native right ventricular outflow tract (RVOT). This study aims to elucidate the outcomes of Pulsta valve implantation within the native RVOT and assess its adaptability to various native main pulmonary artery (PA) anatomies. METHODS A multicenter retrospective study included 182 patients with moderate to severe pulmonary regurgitation in the native RVOT who underwent PPVI with Pulsta valves® between February 2016 and August 2023 at five Korean and Taiwanese tertiary referral centers. RESULTS Pulsta valve implantation was successful in 179 out of 182 patients (98.4%) with an average age of 26.7 ± 11.0 years. The median follow-up duration was 29 months. Baseline assessments revealed enlarged right ventricle (RV) volume (mean indexed RV end-diastolic volume: 163.1 (interquartile range, IQR: 152.0-180.3 mL/m²), which significantly decreased to 123.6(IQR: 106.6-137.5 mL/m2 after 1 year. The main PA types were classified as pyramidal (3.8%), straight (38.5%), reverse pyramidal (13.2%), convex (26.4%), and concave (18.1%) shapes. Pulsta valve placement was adapted, with distal main PA for pyramidal shapes and proximal or mid-PA for reverse pyramidal shapes. Two patients experienced Pulsta valve embolization to RV, requiring surgical removal, and one patient encountered valve migration to the distal main PA, necessitating surgical fixation. CONCLUSIONS Customized valve insertion sites are pivotal in self-expandable PPVI considering diverse native RVOT shape. The rather soft and compact structure of the Pulsta valve has characteristics to are adaptable to diverse native RVOT geometries.
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Affiliation(s)
- Woo Young Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ah Young Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Young Choi
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Ick Jang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Seong Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Seul Gi Cha
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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30
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VanDolah H, Moe T. Complex Congenital Heart Disease and Congenital Uterine Anomalies Impacting Pregnancy Outcomes. JACC Case Rep 2024; 29:102203. [PMID: 38379655 PMCID: PMC10874897 DOI: 10.1016/j.jaccas.2023.102203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 02/22/2024]
Abstract
Complex congenital heart disease is often accompanied by extracardiac manifestations; , the significance of genitourinary involvement remains unclear. We present 3 patients with palliated complex congenital heart disease and with pregnancies complicated by premature delivery who were found to have congenital uterine anomalies that may have contributed to their obstetrical complications.
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Affiliation(s)
- Harrison VanDolah
- Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
- Department of Pediatrics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Tabitha Moe
- Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
- Department of Pediatrics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
- Department of Adult Congenital Heart Disease, Arizona Cardiology Group, Phoenix, Arizona, USA
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31
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Massarella D, McCrindle BW, Runeckles K, Fan S, Dahdah N, Dallaire F, Drolet C, Grewal J, Hancock-Friesen CL, Hickey E, Karur GR, Khairy P, Leonardi B, Keir M, Nadeem SN, Ng MY, Shah A, Tham EB, Therrien J, Warren AE, Vonder Muhll IF, Van de Bruane A, Yamamura K, Farkouh M, Wald RM. Adherence to clinical practice guidelines for pulmonary valve intervention after tetralogy of Fallot repair: A nationwide cohort study. JTCVS OPEN 2024; 17:215-228. [PMID: 38420530 PMCID: PMC10897679 DOI: 10.1016/j.xjon.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/13/2023] [Accepted: 10/28/2023] [Indexed: 03/02/2024]
Abstract
Objectives To determine guideline adherence pertaining to pulmonary valve replacement (PVR) referral after tetralogy of Fallot (TOF) repair. Methods Children and adults with cardiovascular magnetic resonance imaging scans and at least moderate pulmonary regurgitation were prospectively enrolled in the Comprehensive Outcomes Registry Late After TOF Repair (CORRELATE). Individuals with previous PVR were excluded. Patients were classified according to presence (+) versus absence (-) of PVR and presence (+) versus absence (-) of contemporaneous guideline satisfaction. A validated score (specific activity scale [SAS]) classified adult symptom status. Results In total, 498 participants (57% male, mean age 32 ± 14 years) were enrolled from 14 Canadian centers (2013-2020). Mean follow-up was 3.8 ± 1.8 years. Guideline criteria for PVR were satisfied for the majority (n = 422/498, 85%), although referral for PVR occurred only in a minority (n = 167/498, 34%). At PVR referral, most were asymptomatic (75% in SAS class 1). One participant (0.6%) received PVR without meeting criteria (PVR+/indication-). The remainder (n = 75/498, 15%) did not meet criteria for and did not receive PVR (PVR-/indication-). Abnormal cardiovascular imaging was the most commonly cited indication for PVR (n = 61/123, 50%). The SAS class and ratio of right to left end-diastolic volumes were independent predictors of PVR in a multivariable analysis (hazard ratio, 3.33; 95% confidence interval, 1.92-5.8, P < .0001; hazard ratio, 2.78; 95% confidence interval, 2.18-3.55, P < .0001). Conclusions Although a majority of patients met guideline criteria for PVR, only a minority were referred for intervention. Abnormal cardiovascular imaging was the most common indication for referral. Further research will be necessary to establish the longer-term clinical impact of varying PVR referral strategies.
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Affiliation(s)
- Danielle Massarella
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Brian W. McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyle Runeckles
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Steve Fan
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Frédéric Dallaire
- Division of Pediatrics, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christian Drolet
- Division of Pediatric and Congenital Cardiology, Department of Pediatrics, Laval University Hospital, Quebec, Quebec, Canada
| | - Jasmine Grewal
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Edward Hickey
- Division of Cardiovascular Surgery, Texas Children's Hospital, Houston, Tex
| | - Gauri Rani Karur
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Paul Khairy
- Adult Congenital Center, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Hospital and Research Institute, Scientific Institute for Research, Hospitalization, and Health Care, Rome, Italy
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Disease Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Syed Najaf Nadeem
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ashish Shah
- Division of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edythe B. Tham
- Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Judith Therrien
- MAUDE Unit (McGill University Health Network/Beth Raby Adult Congenital Heart Disease Clinic, Jewish General Hospital), Montreal, Quebec, Canada
| | - Andrew E. Warren
- Division of Pediatric Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Michael Farkouh
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Rachel M. Wald
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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Deniwar A, Hernandez J, Aregullin EO, Khan SK, Huang S, Finn MT, Vettukattil JJ. Atrial septal defect-associated pulmonary hypertension with decompensated heart failure: outcomes after fenestrated device closure. Cardiol Young 2024; 34:395-400. [PMID: 37466020 DOI: 10.1017/s104795112300152x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Up to 90% of adults with untreated atrial septal defect will be symptomatic by 4th decade, and 30-49% will develop heart failure. 8-10% of these patients have pulmonary arterial hypertension with a female predominance regardless of age. We aimed to demonstrate that fenestrated closure can be safely performed in patients with decompensated heart failure and atrial septal defect-associated pulmonary arterial hypertension with improved outcome. METHODS Transcatheter fenestrated atrial septal defect closures (Occlutech GmbH, Jena, Germany) were performed on a compassionate-use basis in 5 consecutive adult patients with atrial septal defect-associated pulmonary arterial hypertension and severe heart failure with prohibitive surgical mortality risks. Change in systemic oxygen saturation, 6-minute walk test, NYHA class, echocardiographic and haemodynamic parameters were used as parameters of outcome. RESULTS All patients were female, mean age 48.8 ± 13.5 years, followed up for a median of 29 months (max 64 months). Significant improvements observed in the 6-minute walk test, and oxygen saturation comparing day 0 time point to all other follow-up time points data (B = 1.32, SE = 0.28, t (22.7) = -4.77, p = 0.0001); and in the haemodynamic data (including pulmonary vascular resistance and pulmonary pressure) (B = -0.60, SE = 0.22, t (40.2) = 2.74, p = .009). All patients showed improved right ventricular size and function along with NYHA class. There were no procedure-related complications. CONCLUSION Fenestrated atrial septal defect closure is feasible in adults with decompensated heart failure and atrial septal defect-associated pulmonary arterial hypertension. It results in sustained haemodynamic and functional improvement.
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Affiliation(s)
- Ahmed Deniwar
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
| | - Jason Hernandez
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Enrique O Aregullin
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Sana K Khan
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
| | - Sihong Huang
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Michael T Finn
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Joseph J Vettukattil
- Betz Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health Hospital, Grand Rapids, MI, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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Kagawa S, Matsumoto K, Kodama Y, Ito S, Fujiwara R, Shiroyama Y, Kajio K, Kasamatsu K, Murata E, Kawase Y. Persistent iatrogenic muscular ventricular septal lead perforation after pacemaker implantation using delivery sheath system. J Cardiol Cases 2024; 29:82-84. [PMID: 38362577 PMCID: PMC10865116 DOI: 10.1016/j.jccase.2023.10.013] [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: 07/09/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 02/17/2024] Open
Abstract
Ventricular septal perforation is a rare complication of pacemaker implantation. Here, we describe the case of a 69-year-old man with complete atrioventricular block and heart failure. The right ventricular pacemaker was implanted with a long pre-shaped delivery sheath. A new systolic murmur appeared after the procedure. Transthoracic echocardiography revealed a ventricular septal perforation, with a Qp/Qs of 1.09, which was a small shunt rate and required no intervention. The persistent ventricular septal perforation was observed, and the shunt rate remained at 8-month follow-up. Learning objective Ventricular septal lead perforation (VSP) is a rare complication of pacemaker implantation. Although iatrogenic VSP generally close spontaneously without adverse clinical outcomes, clinicians should pay attention to the possibility of its persistence.
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Affiliation(s)
- Shunsuke Kagawa
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Kenji Matsumoto
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Yuka Kodama
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Shinji Ito
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Ryosuke Fujiwara
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Yuka Shiroyama
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Keiko Kajio
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Keiko Kasamatsu
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Eriko Murata
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Yoshio Kawase
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
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Abell BR, Eagleson K, Auld B, Bora S, Justo R, Parsonage W, Sharma P, Kularatna S, McPhail SM. Implementing neurodevelopmental follow-up care for children with congenital heart disease: A scoping review with evidence mapping. Dev Med Child Neurol 2024; 66:161-175. [PMID: 37421232 PMCID: PMC10953404 DOI: 10.1111/dmcn.15698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023]
Abstract
AIM To identify and map evidence describing components of neurodevelopmental follow-up care for children with congenital heart disease (CHD). METHOD This was a scoping review of studies reporting components of neurodevelopmental follow-up programmes/pathways for children with CHD. Eligible publications were identified through database searches, citation tracking, and expert recommendations. Two independent reviewers screened studies and extracted data. An evidence matrix was developed to visualize common characteristics of care pathways. Qualitative content analysis identified implementation barriers and enablers. RESULTS The review included 33 studies. Twenty-one described individual care pathways across the USA (n = 14), Canada (n = 4), Australia (n = 2), and France (n = 1). The remainder reported surveys of clinical practice across multiple geographical regions. While heterogeneity in care existed across studies, common attributes included enrolment of children at high-risk of neurodevelopmental delay; centralized clinics in children's hospitals; referral before discharge; periodic follow-up at fixed ages; standardized developmental assessment; and involvement of multidisciplinary teams. Implementation barriers included service cost/resourcing, patient burden, and lack of knowledge/awareness. Multi-level stakeholder engagement and integration with other services were key drivers of success. INTERPRETATION Defining components of effective neurodevelopmental follow-up programmes and care pathways, along with enhancing and expanding guideline-based care across regions and into new contexts, should continue to be priorities. WHAT THIS PAPER ADDS Twenty-two different neurodevelopmental follow-up care pathways/programmes were published, originating from four countries. Twelve additional publications described broad practices for neurodevelopmental follow-up across regions Common attributes across eligibility, service structure, assessment processes, and care providers were noted. Studies reported programme acceptability, uptake, cost, and effectiveness. Implementation barriers included service cost/resourcing, patient burden, and lack of knowledge/awareness.
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Affiliation(s)
- Bridget R. Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Karen Eagleson
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Benjamin Auld
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
| | - Samudragupta Bora
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
- University Hospitals Rainbow Babies & Children's HospitalCase Western Reserve University School of MedicineClevelandOHUSA
| | - Robert Justo
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
- Royal Brisbane and Women's HospitalMetro North HealthBrisbaneQLDAustralia
| | - Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
- Digital Health and Informatics Directorate, Metro South HealthBrisbaneQLDAustralia
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Williams JL, Dodeja AK, Boe B, Samples S, Alexander R, Hor K, Lee S. Impact of pulmonary stenosis on right ventricular global longitudinal strain in repaired tetralogy of Fallot patients post transcatheter pulmonary valve replacement. Echocardiography 2024; 41:e15765. [PMID: 38341768 DOI: 10.1111/echo.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Mixed pulmonary disease with pulmonary regurgitation (PR) and stenosis (PS) in repaired tetralogy of Fallot (rTOF) can negatively impact ventricular health. Myocardial strain has been shown to be more sensitive at detecting occult ventricular dysfunction compared to right ventricular ejection fraction (RV EF). We hypothesize that rTOF patients with predominant PS will have lower RV global longitudinal strain (RV GLS) prior to and post-transcatheter pulmonary valve replacement (TPVR). METHODS A retrospective cohort of rTOF patients who underwent cardiac magnetic resonance (CMR) and cardiac catheterization for right ventricular pressure (RVSP) measurement were analyzed at three time points: before valve implantation, at discharge and within 18 months post-TPVR. Patients were dichotomized into three groups based on RVSP: 0%-49%, 50%-74%, and >75%. RV GLS and left ventricular (LV) GLS by speckle tracking echocardiography (STE) were obtained from the apical 4-chamber using TomTec software (TOMTEC IS, Germany). RESULTS Forty-eight patients were included. Every 14.3% increase in preimplantation RVSP above 28% was associated with an absolute magnitude 1% lower RV GLS (p = .001). Preimplantation RVSP when 75% or higher had 3.36% worse RV GLS than the lowest bin (p = .014). Overall, average RV strain magnitude was higher when preimplantation RVSP was less than 50% and had greater improvement over the three time points. Higher post implantation RVSP correlated with lower strain magnitude. CONCLUSION Patients with significant PS (>50%) may benefit from earlier PVR and not depend solely on RV size and EF. Myocardial strain may be a more sensitive marker of function; however, larger, prospective studies are needed.
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Affiliation(s)
- Jason L Williams
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Anudeep K Dodeja
- Division of Pediatric Cardiology, Connecticut Children's Hospital, Hartford, Connecticut, USA
| | - Brian Boe
- Division of Pediatric Cardiology, Joe DiMaggio Children's Hospital Heart Institute, Hollywood, Florida, USA
| | - Stefani Samples
- Division of Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Robin Alexander
- Center for Biostatistics, The Ohio State College of Medicine, Columbus, Ohio, USA
| | - Kan Hor
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Simon Lee
- Division of Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Egbe AC, Younis A, Miranda WR, Jain CC, Connolly HM, Borlaug BA. Determinants and prognostic implications of left atrial reverse remodelling after coarctation of aorta repair in adults. Eur Heart J Cardiovasc Imaging 2024; 25:249-256. [PMID: 37585542 PMCID: PMC10824485 DOI: 10.1093/ehjci/jead203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023] Open
Abstract
AIMS Left atrial (LA) dysfunction and atrial fibrillation are also relatively common in adults with coarctation of aorta (COA), and the severity of LA dysfunction is associated with a higher risk of atrial fibrillation in this population. The purpose of this study was to determine whether LA function improved after COA repair (LA reverse remodelling), and the relationship between LA reverse remodelling and atrial fibrillation. METHODS AND RESULTS Retrospective cohort study of adults undergoing COA repair (2003-20). LA reservoir strain was assessed pre intervention and 12-24 months post intervention, using speckle tracking echocardiography. Incident atrial fibrillation was assessed from COA repair to last follow-up. Of 261 adults who underwent COA repair [age 37 ± 13 years; males 148 (57%)], 124 (47%) and 137 (53%) presented with native vs. recurrent COA, respectively. Of 261 patients, 231 (82%) and 48 (18%) underwent surgical and transcatheter COA repair, respectively. The LA reservoir strain increased from 32 ± 8% (pre intervention) to 39 ± 7% (post intervention), yielding a relative increase of 21 ± 5%. Older age [β ± standard error (SE) -0.16 ± 0.09 per 5 years, P = 0.02], higher systolic blood pressure (β ± SE -0.12 ± 0.04 per 5 mmHg, P = 0.005), and higher residual COA mean gradient (β ± SE -0.17 ± 0.06 per 5 mmHg, P = 0.002) post intervention were associated with less LA reverse remodelling, after adjustment for sex, hypertension diagnosis, and left ventricular indices. LA reverse remodelling (hazard ratio 0.97, 95% confidence interval 0.96-0.98 per 1% increase from pre-intervention LA function, P = 0.006) was associated with a lower risk of atrial fibrillation after adjustment for age, sex, pre-intervention LA reservoir strain, and history of atrial fibrillation. CONCLUSION COA repair resulted in improved LA function and decreased risk for atrial fibrillation, especially in patients without residual hypertension or significant residual COA gradient.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ahmed Younis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Egbe AC, Salama AA, Miranda WR, Karnakoti S, Anderson JH, Jain CC, Burchill LJ, Connolly HM. Right Heart Reverse Remodeling and Prosthetic Valve Function After Transcatheter vs Surgical Pulmonary Valve Replacement. JACC Cardiovasc Interv 2024; 17:248-258. [PMID: 38267139 DOI: 10.1016/j.jcin.2023.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND There are limited data about postprocedural right heart reverse remodeling and long-term prosthesis durability after transcatheter pulmonary valve replacement (TPVR) and how these compare to surgical pulmonary valve replacement (SPVR). OBJECTIVES This study sought to compare right heart reverse remodeling, pulmonary valve gradients, and prosthetic valve dysfunction after TPVR vs SPVR. METHODS Patients with TPVR were matched 1:2 to patients with SPVR based on age, sex, body surface area, congenital heart lesion, and procedure year. Right heart indexes (right atrial [RA] reservoir strain, RA volume index, RA pressure, right ventricular [RV] global longitudinal strain, RV end-diastolic area, and RV systolic pressure) were assessed at baseline (preintervention), 1 year postintervention, and 3 years postintervention. Pulmonary valve gradients were assessed at 1, 3, 5, 7, and 9 years postintervention. RESULTS There were 64 and 128 patients in the TPVR and SPVR groups, respectively. Among patients with TPVR, 46 (72%) and 18 (28%) received Melody (Medtronic) vs SAPIEN (Edwards Lifesciences) valves, respectively. The TPVR group had greater postprocedural improvement in RA reservoir strain and RV global longitudinal strain at 1 and 3 years. The TPVR group had a higher risk of prosthetic valve dysfunction mostly because of a higher incidence of prosthetic valve endocarditis compared to SPVR but a similar risk of pulmonary valve reintervention because some of the patients with endocarditis received medical therapy only. Both groups had similar pulmonary valve mean gradients at 9 years postintervention. CONCLUSIONS These data suggest a more favorable right heart outcome after TPVR. However, the risk of prosthetic valve endocarditis and prosthetic valve dysfunction remains a major concern.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA.
| | - Abdalla A Salama
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA; Department of Cardiovascular Diseases, Suez Canal University, Ismailia, Egypt
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Jason H Anderson
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Luke J Burchill
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
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Stefanescu Schmidt AC, Armstrong AK, Aboulhosn JA, Kennedy KF, Jones TK, Levi DS, McElhinney DB, Bhatt AB. Transcatheter Pulmonary Valve Replacement With Balloon-Expandable Valves: Utilization and Procedural Outcomes From the IMPACT Registry. JACC Cardiovasc Interv 2024; 17:231-244. [PMID: 38267137 DOI: 10.1016/j.jcin.2023.10.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) has expanded and evolved since its initial commercial approval in the United States in 2010. OBJECTIVES This study sought to characterize real-world practice, including patient selection, procedural outcomes, complications, and off-label usage. METHODS Characteristics and outcomes for patients undergoing balloon-expandable TPVR were collected from the American College of Cardiology National Cardiovascular Data Registry IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry. RESULTS Between April 2016 and March 2021, 4,513 TPVR procedures were performed in patients with a median age of 19 years, 57% with a Melody (Medtronic Inc) and 43% with a SAPIEN (Edwards Lifesciences) valve. Most implanting centers performed <10 cases annually. One-third of transcatheter pulmonary valve implants were into homograft conduits, one-third were into bioprosthetic valves (BPVs), 25% were in native or patched right ventricular outflow tracts (RVOTs), and 6% were into Contegra (Medtronic Inc) conduits. Over the course of the study period, SAPIEN valve use grew from ∼25% to 60%, in large part because of implants in patients with a native/patched RVOT. Acute success was achieved in 95% of patients (95.7% in homografts, 96.2% in BPVs, 94.2% in native RVOTs, and 95.4% in Contegra conduits). Major adverse events occurred in 2.4% of procedures, more commonly in patients with a homograft (2.9%) or native RVOT (3.4%) than a prior BPV (1.4%; P = 0.004). CONCLUSIONS This study describes novel population data on the use and procedural outcomes of TPVR with balloon-expandable valves. Over time, there has been increasing use of TPVR to treat regurgitant native RVOT anatomy, with the SAPIEN valve more commonly used for this application.
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Affiliation(s)
- Ada C Stefanescu Schmidt
- Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | | | - Jamil A Aboulhosn
- Ahmanson/University of California, Los Angeles Adult Congenital Heart Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
| | | | - Thomas K Jones
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Daniel S Levi
- Mattel Children's Hospital at University of California-Los Angeles, Los Angeles, California, USA
| | | | - Ami B Bhatt
- Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; American College of Cardiology, Washington, DC, USA
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Rao PS. Recent Advances in the Diagnosis and Management of Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2024; 11:84. [PMID: 38255397 PMCID: PMC10814956 DOI: 10.3390/children11010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
Congenital heart defects (CHDs) are structural abnormalities of the heart or blood vessels that occur while cardiac structures are being formed in utero [...].
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Affiliation(s)
- P Syamasundar Rao
- Children's Heart Institute, University of Texas at Houston McGovern Medical School, Children's Memorial Hermann Hospital, 6410 Fannin Street, Suite #425, Houston, TX 77030, USA
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40
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Lindor RA, Heller K, Hodgson NR, Kishi P, Monas J, Rappaport D, Thomas A, Urumov A, Walker LE, Majdalany DS. Adult Congenital Heart Disease in the Emergency Department. J Pers Med 2024; 14:66. [PMID: 38248767 PMCID: PMC10817528 DOI: 10.3390/jpm14010066] [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: 11/11/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
While congenital heart disease historically was a pathology primarily restricted to specialized pediatric centers, advances in technology have dramatically increased the number of people living into adulthood, the number of complications faced by these patients, and the number of patients visiting non-specialized emergency departments for these concerns. Clinicians need to be aware of the issues specific to patients' individual congenital defects but also have an understanding of how typical cardiac pathology may manifest in this special group of patients. This manuscript attempts to provide an overview of this diverse but increasingly common group of adult patients with congenital heart diseases, including a review of their anatomical variants, the complications they face at the highest rates, and ways that emergency physicians may need to manage these patients differently to avoid causing harm.
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Affiliation(s)
- Rachel A. Lindor
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Kim Heller
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Nicole R. Hodgson
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Patrick Kishi
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Jessica Monas
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Douglas Rappaport
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Aaron Thomas
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Andrej Urumov
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Laura E. Walker
- Mayo Clinic Department of Emergency Medicine, Rochester, MN 55905, USA
| | - David S. Majdalany
- Mayo Clinic Department of Cardiovascular Diseases, Phoenix, AZ 85054, USA;
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Kagiyama Y, Kenny D, Hijazi ZM. Current status of transcatheter intervention for complex right ventricular outflow tract abnormalities. Glob Cardiol Sci Pract 2024; 2024:e202407. [PMID: 38404661 PMCID: PMC10886730 DOI: 10.21542/gcsp.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/11/2023] [Indexed: 02/27/2024] Open
Abstract
Various transcatheter interventions for the right ventricular outflow tract (RVOT) have been introduced and developed in recent decades. Transcatheter pulmonary valve perforation was first introduced in the 1990s. Radiofrequency wire perforation has been the approach of choice for membranous pulmonary atresia in newborns, with high success rates, although complication rates remain relatively common. Stenting of the RVOT is a novel palliative treatment that may improve hemodynamics in neonatal patients with reduced pulmonary blood flow and RVOT obstruction. Whether this option is superior to other surgical palliative strategies or early primary repair of tetralogy of Fallot remains unclear. Transcatheter pulmonary valve replacement has been one of the biggest innovations in the last two decades. With the success of the Melody and SAPIEN valves, this technique has evolved into the gold standard therapy for RVOT abnormalities with excellent procedural safety and efficacy. Challenges remain in managing the wide heterogeneity of postoperative lesions seen in RVOT, and various technical modifications, such as pre-stenting, valve ring modification, or development of self-expanding systems, have been made. Recent large studies have revealed outcomes comparable to those of surgery, with less morbidity. Further experience and multicenter studies and registries to compare the outcomes of various strategies are necessary, with the ultimate goal of a single-step, minimally invasive approach offering the best longer-term anatomical and physiological results.
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Affiliation(s)
- Yoshiyuki Kagiyama
- Department of Pediatric Cardiology, Children’s Health Ireland at Crumlin, Dublin 12, Republic of Ireland
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Damien Kenny
- Department of Pediatric Cardiology, Children’s Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Ziyad M. Hijazi
- Department of Cardiovascular Diseases, Sidra Medicine, and Weill Cornell Medical College, Doha, Qatar
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Franceschi P, Balducci A, Nardi E, Niro F, Attinà D, Russo V, Donti A, Angeli E, Gargiulo GD, Lovato L. Predictive value of Cardiac Magnetic Resonance: new and old parameters in the natural history of repaired Tetralogy of Fallot. BMC Cardiovasc Disord 2024; 24:15. [PMID: 38172687 PMCID: PMC10765701 DOI: 10.1186/s12872-023-03671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with repaired Tetralogy of Fallot (rTOF) often develop pulmonary regurgitation (PR) and right ventricle (RV) dysfunction, experiencing increased mortality and morbidity rates in adulthood. Pulmonary valve replacement (PVR) timing to address PR is controversial. Cardiac Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of complex cardiopathies. This study aims to identify CMR parameters predictive of adverse outcomes to help defining the best therapeutic management of rTOF patients. METHODS 130 rTOF patients who underwent CMR (2006-2019) were enrolled in this retrospective single-center study. CMR, clinical, ECG and exercise data were analyzed. Univariate and multivariate analyses identified clinical and CMR parameters predictive of adverse outcomes both individually (e.g., death, arrhythmias, heart failure (HF), pharmacological therapy, QRS ≥ 160ms) and as composite outcome. RESULTS Univariate analysis confirmed RV volumes and RV ejection fraction corrected for PR as adverse outcome predictors and identified interesting correlations: pulmonary artery bifurcation geometry and abnormal interventricular septum (IVS) motion with arrhythmias (p < .001; p = .037), HF (p = .049; p = .005), composite outcome (p = .039; p = .009); right atrium (RA) dimensions with the composite outcome and the outcomes individually (p < .001). The best predictive models by multivariate analysis included sex (male), RV and RA dilation for QRS ≥ 160ms, time form repair to CMR, age at TOF repair and IVS fibrosis for pharmacological therapy. CONCLUSIONS Besides RV volumes, new adverse prognostic factors could guide rTOF therapeutic management: pulmonary arteries morphology, abnormal IVS motion, RV dysfunction, RA dilation. Perspective multicentric evaluation is needed to specify their effective role.
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Affiliation(s)
- Paola Franceschi
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy.
| | - A Balducci
- Pediatric Cardiology, Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - E Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - F Niro
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - D Attinà
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - V Russo
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - A Donti
- Pediatric Cardiology, Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - E Angeli
- Pediatric Cardiology, Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - G D Gargiulo
- Pediatric Cardiology, Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - L Lovato
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Siondalski P, Kołaczkowska M, Bieńkowski M, Pęksa R, Kowalik MM, Dawidowska K, Vandendriessche K, Meuris B. Bacterial cellulose as a promising material for pulmonary valve prostheses: In vivo study in a sheep model. J Biomed Mater Res B Appl Biomater 2024; 112:e35355. [PMID: 38247240 DOI: 10.1002/jbm.b.35355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES Currently, no consensus exists regarding the most durable prosthesis for pulmonary valve replacement. Bacterial cellulose is a resistant, nonbiodegradable, nonpyrogenic bioimplant with low hemolysis and clotting properties. We hypothesized that bacterial cellulose heart valve prostheses could be an attractive alternative for pulmonary valve replacement. METHODS We conducted a large animal model experiment in three adult sheep. The animals underwent open-heart surgery and cardiopulmonary bypass for bacterial cellulose conduit implantation in the pulmonary position. The sheep were followed for seven months, and clinical and laboratory parameters were analyzed. Echocardiographic evaluations were performed at 3 and 7 months. After seven months, the sheep were sacrificed and an autopsy was performed. The explanted conduits were radiologically and histopathologically analyzed. RESULTS All sheep survived the operation, showing good recovery and normal health status; no adverse events were noted during the 7-month postoperative follow-up. Interval laboratory findings were normal with no signs of hemolysis or infection. Echocardiographic analysis after 7 months revealed a normal mean pressure gradient with excellent cusp motion and coaptation; a trace of regurgitation was found in two sheep. X-ray analysis of the explanted conduits revealed no structural defects in the leaflets with minimal calcification. Histological examination showed slight thickening of the conduit by pannus formation. No material failure, no calcification inside the material, and only minor calcification extrinsic to the matrix were observed. CONCLUSIONS This pilot study provides evidence that bacterial cellulose may be suitable for pulmonary valve prostheses and surgical pulmonary artery plasty. Further studies on the high pressure side of the left heart are needed.
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Affiliation(s)
- Piotr Siondalski
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Magdalena Kołaczkowska
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Bieńkowski
- Department of Patomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Rafał Pęksa
- Department of Patomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Maciej M Kowalik
- Department of Cardiac Anesthesiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Kinga Dawidowska
- Medical Engineering Division, Maritime Advanced Research Centre, Gdańsk, Poland
| | | | - Bart Meuris
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Egbe AC, Abozied O, Miranda WR, Younis A, Burchill L, Kandlakunta S, Ahmed MH, Karnakoti S, Connolly HM. Prognostic role of inferior vena collapsibility index in congenital heart disease: A validation study. Int J Cardiol 2024; 394:131399. [PMID: 37774925 DOI: 10.1016/j.ijcard.2023.131399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/28/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND A recent study showed that inferior vena cava collapsibility index (IVCCI) <60% had better prognostic performance as compared to the American Society of Echocardiogram (ASE) criteria for estimating right atrial pressure (RAP). However, this study was based on a selected cohort of adults with congenital heart disease (CHD) that underwent right heart catheterization and limiting the generalizability of the results. The purpose of this study was, therefore, to validate the prognostic performance of IVCCI in a more representative sample of adults with CHD, which would in turn, improve generalizability of the results. METHODS Retrospective cohort study of adults with CHD that underwent echocardiogram at Mayo Clinic (2003-2021). Elevated RAP was defined as RAP >10 mmHg, and was estimated using IVCCI <60% or the ASE criteria (maximum IVC diameter < 2.1 cm and IVCCI <50%). Cardiovascular event was defined as heart failure hospitalization, heart transplant or cardiovascular death. RESULTS Of the 4029 patients, 754 (19%) and 601 (15%) had elevated RAP (RAP >10 mmHg) based on IVCCI <60%, and the ASE criteria, respectively. Of the 4029 patients, 374 (9%) had cardiovascular events during 7.6 (4.4-10.5) years of follow-up. IVCCI <60% was independently associated with cardiovascular events (adjusted HR 2.08, 95% CI 1.75-2.42; C-statistic 0.708, 95%CI 0.688-0.728), and provided improved prognostic performance as compared to the ASE criteria (C-statistic difference 0.036, 95%CI 0.017-0.055, P = 0.008). CONCLUSIONS IVCCI had superior prognostic performance as compared to the ASE criteria.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America.
| | - Omar Abozied
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Ahmed Younis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Luke Burchill
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Sriharsha Kandlakunta
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Marwan H Ahmed
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
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Ahmed MH, Miranda WR, Kamath PS, Jain CC, Burchill LJ, Connolly HM, Egbe AC. Screening of Esophageal Varices in Patients With Fontan Palliation. Am J Cardiol 2024; 210:11-12. [PMID: 38682710 DOI: 10.1016/j.amjcard.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 05/01/2024]
Affiliation(s)
| | | | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota
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Jokhadar M, Hardin JT. Congenital Heart Disease in the Adult Cardiac Intensive Care Unit. Crit Care Clin 2024; 40:179-191. [PMID: 37973353 DOI: 10.1016/j.ccc.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
This article provides a broad overview of key concepts and more commonly encountered critical illness presentations in adult congenital heart disease (ACHD) patients. General principles are discussed, and the need for ACHD subspecialty consultation is emphasized. ACHD is categorized based on hemodynamic profile, and common clinical presentations are reviewed, including common pitfalls. Many ACHD lesions are associated with predictable complications, and awareness of these associations can guide evaluation and management, which are listed in this article.
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Affiliation(s)
- Maan Jokhadar
- Department of Cardiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Joel T Hardin
- Emory Adult Congenital Heart Center, Emory University, 1365 A Clifton Road Northeast, Atlanta, GA 30322, USA
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48
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Ducas RA, Mao T, Beauchesne L, Silversides C, Dore A, Ganame J, Alonso-Gonzalez R, Keir M, Muhll IV, Grewal J, Williams A, Dehghani P, Siu S, Johri A, Bedard E, Therrien J, Hayami D, Kells C, Marelli A. Adult Congenital Heart Disease Care in Canada: Has Quality of Care Improved in the Last Decade? Can J Cardiol 2024; 40:138-147. [PMID: 37924967 DOI: 10.1016/j.cjca.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/12/2023] [Accepted: 08/04/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Patients with adult congenital heart disease (ACHD) are at increased risk of comorbidity and death compared with the age-matched population. Specialized care is shown to improve survival. The purpose of this study was to analyze current measures of quality of care in Canada compared with those published by our group in 2012. METHODS A survey focusing on structure and process measures of care quality in 2020 was sent to 15 ACHD centres registered with the Canadian Adult Congenital Heart Network. For each domain of quality, comparisons were made with those published in 2012. RESULTS In Canada, 36,708 patients with ACHD received specialized care between 2019 and 2020. Ninety-five cardiologists were affiliated with ACHD centres. The median number of patients per ACHD clinic was 2000 (interquartile range [IQR]: 1050, 2875). Compared with the 2012 results, this represents a 68% increase in patients with ACHD but only a 19% increase in ACHD cardiologists. Compared with 2012, all procedural volumes increased with cardiac surgeries, increasing by 12% and percutaneous intervention by 22%. Wait time for nonurgent consults and interventions all exceeded national recommendations by an average of 7 months and had increased compared with 2012 by an additional 2 months. Variability in resources were noted across provincial regions. CONCLUSIONS Over the past 10 years, ACHD care gaps have persisted, and personnel and infrastructure have not kept pace with estimates of ACHD population growth. Strategies are needed to improve and reduce disparity in ACHD care relative to training, staffing, and access to improved care for Canadians with ACHD.
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Affiliation(s)
- Robin A Ducas
- Department of Internal Medicine, Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Tony Mao
- Department of Internal Medicine, Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Luc Beauchesne
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Candice Silversides
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Rafael Alonso-Gonzalez
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jasmine Grewal
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Williams
- Memorial University, St John's, Newfoundland, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Adult Congenital Heart Disease, Regina, Saskatchewan, Canada
| | - Samuel Siu
- Western University, London, Ontario, Canada
| | - Amer Johri
- Queen's University, Kingston, Ontario, Canada
| | - Elisabeth Bedard
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Judith Therrien
- Jewish General Hospital, McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), McGill University, Montréal, Québec, Canada
| | - Doug Hayami
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Ariane Marelli
- Jewish General Hospital, McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), McGill University, Montréal, Québec, Canada
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Gheyath B, Chau E, Latif S, Smith TW. The Interventional Imager: How Do We Train the Next Interventional Imagers? Interv Cardiol Clin 2024; 13:29-38. [PMID: 37980065 DOI: 10.1016/j.iccl.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
With the increase in structural heart procedural volume, interventional imagers are required. Multiple imaging modalities exist to guide these procedures. With comprehensive understanding of pathology, anatomy, and procedures, an advanced imager plays an important role in the heart team. Imaging training is part of general cardiology fellowship. Current structures do not provide adequate procedural time to fill the role. Interested graduates pursue advanced training by either focusing on echocardiography and procedural imaging or multidetector computed tomography and cardiac magnetic resonance. This yields individuals with different expertise.
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Affiliation(s)
- Bashaer Gheyath
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Taper, A238, Los Angeles, CA 90048, USA. https://twitter.com/bgheyath
| | - Edward Chau
- Division of Cardiovascular Medicine, University of California Davis Medical Center, 4680 Y Street, Suite 2820, Sacramento, CA 95817, USA
| | - Syed Latif
- Heart and Vascular Institute, Sutter Medical Center, Sacramento, CA, USA
| | - Thomas W Smith
- Division of Cardiovascular Medicine, University of California Davis Medical Center, 4680 Y Street, Suite 2820, Sacramento, CA 95817, USA.
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Han BK, Garcia S, Aboulhosn J, Blanke P, Martin MH, Zahn E, Crean A, Overman D, Craig CH, Hanneman K, Semple T, Armstrong A. Technical recommendations for computed tomography guidance of intervention in the right ventricular outflow tract: Native RVOT, conduits and bioprosthetic valves:: A white paper of the Society of Cardiovascular Computed Tomography (SCCT), Congenital Heart Surgeons' Society (CHSS), and Society for Cardiovascular Angiography & Interventions (SCAI). J Cardiovasc Comput Tomogr 2024; 18:75-99. [PMID: 37517984 DOI: 10.1016/j.jcct.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023]
Abstract
This consensus document for the performance of Cardiovascular Computed Tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital disease (CHD) was developed collaboratively by pediatric and adult interventionalists, surgeons and cardiac imagers with expertise specific to this patient subset. The document summarizes definitions of RVOT dysfunction as assessed by multi-modality imaging techniques and reviews existing consensus statements and guideline documents pertaining to indications for intervention. In the context of this background information, recommendations for CCT scan acquisition and a standardized approach for reporting prior to surgical or transcatheter pulmonary valve replacement are proposed and presented. It is the first Imaging for Intervention collaboration for CHD patients and encompasses imaging and reporting recommendations prior to both surgical and percutaneous pulmonary valve replacement.
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Affiliation(s)
- B Kelly Han
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA.
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education and the Christ Hospital, Cincinnati, Ohio, USA
| | - Jamil Aboulhosn
- University of California Los Angeles (UCLA) Health, Los Angeles, California, USA
| | - Phillip Blanke
- St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Mary Hunt Martin
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Evan Zahn
- Cedars-Sinai, Smidt Heart Institute, Los Angeles, California, USA
| | - Andrew Crean
- University of Ottawa Heart Institute, Ottawa, Canada
| | - David Overman
- The Children's Heart Clinic, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota, USA
| | - C Hamilton Craig
- University of Queensland and Griffith University, Queensland, New Zealand
| | | | - Thomas Semple
- The Royal Brompton Hospital, London, England, United Kingdom
| | - Aimee Armstrong
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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