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Robb C, Rajput MZ, Raptis D, Bhalla S. Don't skip a beat! Critical findings in imaging studies performed in adults with congenital heart disease. Curr Probl Diagn Radiol 2024; 53:297-307. [PMID: 38272749 DOI: 10.1067/j.cpradiol.2024.01.005] [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: 03/06/2023] [Revised: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
With ongoing advances in both medical and surgical management, the population of adults with congenital heart disease (CHD) continues to grow each year and has surpassed the number of pediatric cases. These adult patients will present to adult emergency departments with increasing frequency. Adults with CHD are at increased risk of developing not only cardiovascular complications, such as aortic dissection and thromboemboli, but also abdominopelvic and neurologic processes at younger ages. These individuals are also more likely to develop less urgent but clinically significant complications including end-organ dysfunction, baffle leaks, or bleeding collateral vessels. Ultimately, imaging can play a critical role in determining the triage, diagnosis, and management of adult CHD patients. To accomplish this goal, radiologists must be able to distinguish acute and chronic complications of treated CHD from benign processes, including expected post-surgical changes or imaging artifacts. Radiologists also need to be familiar with the various long-term risks and complications associated with both treated and untreated forms of CHD, particularly those in adults with complex lesions.
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Affiliation(s)
- Caroline Robb
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Boulevard, Campus Box 8131, St. Louis, MO 63110, USA
| | - M Zak Rajput
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Boulevard, Campus Box 8131, St. Louis, MO 63110, USA.
| | - Demetrios Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Boulevard, Campus Box 8131, St. Louis, MO 63110, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Boulevard, Campus Box 8131, St. Louis, MO 63110, USA
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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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Mikulski MF, Well A, Mery CM, Johnson G, Gottlieb EA, Fraser CD, Beckerman Z. Outcomes of thoracic aortic interventions in Marfan syndrome in the state of Texas over 11 years. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad128. [PMID: 37584655 PMCID: PMC10438956 DOI: 10.1093/icvts/ivad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Marfan syndrome is a heritable connective tissue disorder with significant aortopathy and conveys substantial cardiovascular morbidity. This study characterizes the mortality and morbidities of thoracic aortic interventions (TAI) in the Marfan syndrome population in the state of Texas from 2009 to 2019. METHODS A retrospective review of the Texas Inpatient Discharge Dataset from 1 January 2009 to 31 December 2019. Discharges from acute care hospitals with a Marfan syndrome diagnosis by the International Classification of Diseases 9/10 codes and a procedure code for TAI were analysed utilizing descriptive, univariate and multivariable regression statistics. RESULTS There were 4641 Marfan syndrome discharges identified, of whom 644 (13.9%) underwent TAI. Thoracic or thoraco-abdominal aortic dissection or rupture was noted in 223 (34.6%). Thirty-three (5.1%) had a concomitant coronary artery intervention. There were 30 (4.7%) in-hospital mortalities, 126 (19.6%) diagnoses of acute renal failure (ARF), 52 (8.1%) had mechanical ventilation >96 h and the median length of stay was 10 [interquartile range (IQR) 7-16] days. After adjustment, concomitant coronary artery intervention was associated with in-hospital mortality [odds ratio (OR) 3.69 [IQR 1.15-11.90], P = 0.029] and ARF (OR 2.66 [IQR 1.19-5.94], P = 0.017). Aortic dissections/ruptures were associated with ARF (OR 1.73 [IQR 1.14-2.63], P = 0.010), ventilation >96 h (OR 2.19 [IQR 1.21-3.97], P = 0.010), and 15% longer length of stay (95% confidence interval 2.4-29.1%, P = 0.038). CONCLUSIONS TAI are frequent among the hospitalized Marfan Syndrome population. Concomitant coronary intervention is associated with increased risk of death and aortic dissections/ruptures are associated with increased morbidity. The high prevalence of aortic dissections/ruptures points to a potential target for improving imaging surveillance, adherence to treatment guidelines and preventative management of Marfan syndrome aortopathy.
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Affiliation(s)
- Matthew F Mikulski
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Andrew Well
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Gregory Johnson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Erin A Gottlieb
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Charles D Fraser
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Ziv Beckerman
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
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Zafar MA, Ziganshin BA, Elefteriades JA. Getting to the root of aortic dissection in congenital heart disease. Eur J Cardiothorac Surg 2021; 61:318-319. [PMID: 34718492 DOI: 10.1093/ejcts/ezab464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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