1
|
Salahuddin A, Harris IS, Sabanayagam A. Double Whammy Complicating Management of Pulmonary Hypertension. Circulation 2024; 149:1770-1774. [PMID: 38805576 DOI: 10.1161/circulationaha.123.066807] [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] [Indexed: 05/30/2024]
Affiliation(s)
- Ayesha Salahuddin
- Department of Medicine, Division of Cardiology, University of California San Francisco
| | - Ian S Harris
- Department of Medicine, Division of Cardiology, University of California San Francisco
| | - Aarthi Sabanayagam
- Department of Medicine, Division of Cardiology, University of California San Francisco
| |
Collapse
|
2
|
Lagerstrand K, Nyström A, Svensson PA, De Lange C, Dangardt F. Accurate quantification of pulmonary perfusion ratio in children with congenital heart disease using partial volume corrected 4D flow cardiac magnetic resonance. Front Pediatr 2024; 12:1339679. [PMID: 38818350 PMCID: PMC11137306 DOI: 10.3389/fped.2024.1339679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Background In children with congenital heart disease (CHD), lung scintigraphy is the reference standard for evaluation of pulmonary perfusion. 4D flow CMR offers a non-ionizing alternative. Due to the intrinsic limitation in the spatial resolution, however, 4D flow may display clinically unacceptable differences compared to the reference standard. This case study aims to highlight the importance of correcting for such partial volume errors to accurately evaluate pulmonary perfusion in small pulmonary arteries. Methods Children with CHD, mainly those with transposition of the great arteries or tetralogy-of-Fallot, referred to CMR from 2020 to 2022 at our clinic, were retrospectively reviewed; n = 37. All patients had been examined with a free breathing, motion-corrected 4D flow protocol. Comparison in pulmonary perfusion (PPR: relative flow through right and left pulmonary arteries) with scintigraphy were performed both for 4D flow before and after partial volume correction. Results Patients with large pulmonary arteries, 76%, displayed small differences in PPR between modalities (<20%), while patients with arteries of only a few pixels, 24%, displayed differences up to 178%, depending on the relative difference in size between the right and left pulmonary artery. Differences were effectively reduced after partial volume correction (<21%). Conclusion The present report shows that 4D flow is a promising tool to accurately evaluate the pulmonary perfusion in children with CHD, but that partial volume correction is warranted to overcome its limitation in the spatial resolution. Without such correction, lung scintigraphy is still recommended to ensure high diagnostic certainty in children with small pulmonary arteries.
Collapse
Affiliation(s)
- Kerstin Lagerstrand
- Department of Medical Physics and Biomedical Engineering, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Nyström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pär-Arne Svensson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotte De Lange
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frida Dangardt
- Children's Heart Center, The Queen Silvia Children's Hospital, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
3
|
Cohen J, Duong SQ, Arivazhagan N, Barris DM, Bebiya S, Castaldo R, Gayanilo M, Hopkins K, Kailas M, Kong G, Ma X, Marshall M, Paul EA, Tan M, Yau JL, Nadkarni GN, Ezon D. Machine Learning Quantification of Pulmonary Regurgitation Fraction from Echocardiography. Pediatr Cardiol 2024:10.1007/s00246-024-03511-y. [PMID: 38730015 DOI: 10.1007/s00246-024-03511-y] [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: 01/15/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024]
Abstract
Assessment of pulmonary regurgitation (PR) guides treatment for patients with congenital heart disease. Quantitative assessment of PR fraction (PRF) by echocardiography is limited. Cardiac MRI (cMRI) is the reference-standard for PRF quantification. We created an algorithm to predict cMRI-quantified PRF from echocardiography using machine learning (ML). We retrospectively performed echocardiographic measurements paired to cMRI within 3 months in patients with ≥ mild PR from 2009 to 2022. Model inputs were vena contracta ratio, PR index, PR pressure half-time, main and branch pulmonary artery diastolic flow reversal (BPAFR), and transannular patch repair. A gradient boosted trees ML algorithm was trained using k-fold cross-validation to predict cMRI PRF by phase contrast imaging as a continuous number and at > mild (PRF ≥ 20%) and severe (PRF ≥ 40%) thresholds. Regression performance was evaluated with mean absolute error (MAE), and at clinical thresholds with area-under-the-receiver-operating-characteristic curve (AUROC). Prediction accuracy was compared to historical clinician accuracy. We externally validated prior reported studies for comparison. We included 243 subjects (median age 21 years, 58% repaired tetralogy of Fallot). The regression MAE = 7.0%. For prediction of > mild PR, AUROC = 0.96, but BPAFR alone outperformed the ML model (sensitivity 94%, specificity 97%). The ML model detection of severe PR had AUROC = 0.86, but in the subgroup with BPAFR, performance dropped (AUROC = 0.73). Accuracy between clinicians and the ML model was similar (70% vs. 69%). There was decrement in performance of prior reported algorithms on external validation in our dataset. A novel ML model for echocardiographic quantification of PRF outperforms prior studies and has comparable overall accuracy to clinicians. BPAFR is an excellent marker for > mild PRF, and has moderate capacity to detect severe PR, but more work is required to distinguish moderate from severe PR. Poor external validation of prior works highlights reproducibility challenges.
Collapse
Affiliation(s)
- Jennifer Cohen
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Son Q Duong
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA.
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Naveen Arivazhagan
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David M Barris
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Surkhay Bebiya
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Rosalie Castaldo
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Marjorie Gayanilo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Kali Hopkins
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Adult Congenital Heart Disease, Mount Sinai Heart, The Mount Sinai Hospital, New York, NY, USA
| | - Maya Kailas
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Grace Kong
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Xiye Ma
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Molly Marshall
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Erin A Paul
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Melanie Tan
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Jen Lie Yau
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Girish N Nadkarni
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Ezon
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| |
Collapse
|
4
|
Ferrero P, Constantine A, Chessa M, Dimopoulos K. Pulmonary arterial hypertension related to congenital heart disease with a left-to-right shunt: phenotypic spectrum and approach to management. Front Cardiovasc Med 2024; 11:1360555. [PMID: 38784170 PMCID: PMC11111857 DOI: 10.3389/fcvm.2024.1360555] [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: 12/23/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Patients with pulmonary hypertension associated with a left-right shunt include a wide spectrum of pathophysiological substrates, ranging from those characterized by pulmonary over-circulation to those with advanced pulmonary vascular disease. The former group may benefit from shunt repair in carefully selected cases but, when advanced pulmonary vascular disease has developed, defect closure should be avoided, and pulmonary vasodilators may be used to improve effort tolerance and hemodynamics. There is a paucity of evidence, however, to support decision-making in the care of these patients. We discuss the principles of management in patients with pulmonary hypertension and a predominant left-right shunt. The recommendations and statements made in this paper are based on pathophysiological considerations and expert opinion.
Collapse
Affiliation(s)
- Paolo Ferrero
- ACHD Unit, IRCCS-Policlinico San Donato, Milan, Italy
| | - Andrew Constantine
- Adult Congenital Heart Disease Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Massimo Chessa
- ACHD Unit, IRCCS-Policlinico San Donato, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
5
|
Fox KR, Rausch JR, Grant VR, Ferketich AK, Groner JA, Garg V, Cua CL, Jackson JL. Associations of Impulsivity and Risky Decision-Making with E-Cigarette-Related Outcomes Among Adolescents with Congenital Heart Disease: Variable- and Person-Oriented Approaches. Behav Med 2024:1-12. [PMID: 38706412 DOI: 10.1080/08964289.2024.2347226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/01/2024] [Indexed: 05/07/2024]
Abstract
Adolescents with congenital heart disease (CHD) have elevated risk for acquired cardiovascular complications, increasing their vulnerability to e-cigarette-related health harms. Impulsivity and risky decision-making have been associated with adolescent substance use, but the relationships between these factors and e-cigarette-related outcomes among cardiovascular at-risk adolescents with CHD are unknown. This cross-sectional study aimed to (a) determine the associations of impulsivity and risky decision-making with e-cigarette-related outcomes (i.e. susceptibility, ever use, perceptions of harm and addictiveness) via variable-oriented analysis (logistic regression), (b) identify groups of adolescents with similar profiles of impulsivity and risky decision-making via exploratory person-oriented analysis (latent profile analysis; LPA), and (c) examine differences on e-cigarette-related outcomes between profile groups. Adolescents aged 12 to 18 years with CHD (N = 98) completed a survey assessing impulsivity facets (Short UPPS-P) and e-cigarette-related outcomes and were administered a risky decision-making task (Iowa Gambling Task, Version 2; IGT2). In variable-oriented analyses, impulsivity facets (negative urgency, positive urgency, lack of premeditation) but not risky decision-making were associated with e-cigarette susceptibility and ever use. The exploratory LPA identified two groups with similar patterns of responding on the Short UPPS-P and IGT2 labeled "Low Impulsivity" and "High Impulsivity," which were primarily characterized by significant differences in negative and positive urgency. Adolescents in the High Impulsivity group had increased odds of e-cigarette susceptibility but not ever use compared to the Low Impulsivity group. This work indicates that strategies to prevent e-cigarette use among adolescents with CHD may be enhanced by addressing impulsivity, particularly negative and positive urgency.
Collapse
Affiliation(s)
- Kristen R Fox
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Victoria R Grant
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Judith A Groner
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vidu Garg
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
6
|
Agarwal A, Duan R, Sobhani NC, Sabanayagam A, Marcus GM, Gurvitz M. Health Service Use and Costs During Pregnancy Among Privately Insured Individuals With Congenital Heart Disease. JAMA Netw Open 2024; 7:e2410763. [PMID: 38739390 DOI: 10.1001/jamanetworkopen.2024.10763] [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] [Indexed: 05/14/2024] Open
Abstract
Importance Individuals with congenital heart disease (CHD) are increasingly reaching childbearing age, are more prone to adverse pregnancy events, and uncommonly undergo recommended cardiac evaluations. Data to better understand resource allocation and financial planning are lacking. Objective To examine health care use and costs for patients with CHD during pregnancy. Design, Setting, and Participants This retrospective cohort study was performed from January 1, 2010, to December 31, 2016, using Merative MarketScan commercial insurance data. Participants included patients with CHD and those without CHD matched 1:1 by age, sex, and insurance enrollment year. Pregnancy claims were identified for all participants. Data were analyzed from September 2022 to March 2024. Exposures Baseline characteristics (age, US region, delivery year, insurance type) and pregnancy-related events (obstetric, cardiac, and noncardiac conditions; birth outcomes; and cesarean delivery). Main Outcomes and Measures Health service use (outpatient physician, nonphysician, emergency department, prescription drugs, and admissions) and costs (total and out-of-pocket costs adjusted for inflation to represent 2024 US dollars). Results A total of 11 703 pregnancies (mean [SD] maternal age, 31.5 [5.4] years) were studied, with 2267 pregnancies in 1785 patients with CHD (492 pregnancies in patients with severe CHD and 1775 in patients with nonsevere CHD) and 9436 pregnancies in 7720 patients without CHD. Compared with patients without CHD, pregnancies in patients with CHD were associated with significantly higher health care use (standardized mean difference [SMD] range, 0.16-1.46) and cost (SMD range, 0.14-0.55) except for out-of-pocket inpatient and ED costs. After adjustment for covariates, having CHD was independently associated with higher total (adjusted cost ratio, 1.70; 95% CI, 1.57-1.84) and out-of-pocket (adjusted cost ratio, 1.40; 95% CI, 1.22-1.58) costs. The adjusted mean total costs per pregnancy were $15 971 (95% CI, $15 480-$16 461) for patients without CHD, $24 290 (95% CI, $22 773-$25 806) for patients with any CHD, $26 308 (95% CI, $22 788-$29 828) for patients with severe CHD, and $23 750 (95% CI, $22 110-$25 390) for patients with nonsevere CHD. Patients with vs without CHD incurred $8319 and $700 higher total and out-of-pocket costs per pregnancy, respectively. Conclusions and Relevance This study provides novel, clinically relevant estimates for the cardio-obstetric team, patients with CHD, payers, and policymakers regarding health care and financial planning. These estimates can be used to carefully plan for and advocate for the comprehensive resources needed to care for patients with CHD.
Collapse
Affiliation(s)
- Anushree Agarwal
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Rong Duan
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Nasim C Sobhani
- Division of Maternal-Fetal Medicine, University of California, San Francisco
| | - Aarthi Sabanayagam
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Michelle Gurvitz
- Department of Cardiology, Boston Adult Congenital Heart Service, Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
7
|
Font CM, Fernandez AB, Kadariya D. Unveiling sinus venosus atrial septal defect and partial anomalous pulmonary venous return in an elderly patient. J Geriatr Cardiol 2024; 21:462-464. [PMID: 38800542 PMCID: PMC11112156 DOI: 10.26599/1671-5411.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Cristina M Font
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Anamarys Blanco Fernandez
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Dinesh Kadariya
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| |
Collapse
|
8
|
Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [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] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| |
Collapse
|
9
|
Wood G, Scheer A, Saundankar J, Tran D, Cordina R, Maiorana A. The effects of telerehabilitation in adults with complex biventricular congenital heart conditions: protocol for a multi-centre, randomised controlled trial-CH-FIT. Trials 2024; 25:239. [PMID: 38581070 PMCID: PMC10998335 DOI: 10.1186/s13063-024-08019-7] [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: 10/04/2023] [Accepted: 02/26/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Accumulated evidence suggests that exercise training exerts beneficial effects on people with congenital heart conditions. These findings are predominantly derived from small, single-centre exercise trials conducted in outpatient rehabilitation facilities. In recent years, the delivery of exercise interventions remotely has increased through digital communications technology (telerehabilitation). However, very little research to date has been conducted into the efficacy of telerehabilitation in people with a congenital heart condition. AIMS To evaluate the effects of a telehealth-delivered exercise intervention in people with a history of a surgical biventricular repair due to a congenital heart condition. METHODS One hundred eligible adolescent (≥ 16 years) and adult participants living with a complex biventricular congenital heart condition will be recruited from four Australian sites and randomised to either (1) a 16-week telehealth-delivered combined (aerobic and resistance) exercise training programme of moderate-to-vigorous intensity or (2) usual care (control group), in a 1:1 allocation, with an 8-month follow-up. OUTCOMES OF INTEREST The primary outcome will be the change in aerobic capacity expressed as peak oxygen uptake (VO2peak). Secondary outcomes will include changes in vascular function, muscle oxygenation, metabolic profile, body composition and musculoskeletal fitness, neurohormonal activation, neurocognitive function, physical activity levels, dietary and nutritional status, and quality of life. Outcomes will be assessed at baseline, 16 weeks, and 12 months (to determine longer-term maintenance potential). DISCUSSION If found to be efficacious, telerehabilitation may be an alternative option for delivering exercise, improving health outcomes, and increasing accessibility to exercise programmes. Efficacy data is required to quantify the clinical significance of this delivery mode of exercise. TRIAL REGISTRATION ACTRN12622000050752 Trial registration date: 17 January 2022 Trial registration URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382635&showOriginal=true&isReview=true Trial registry name: Australian and New Zealand Clinical Trials Registry.
Collapse
Affiliation(s)
- Gina Wood
- School of Allied Health, Curtin University, Perth, WA, Australia.
- School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, Australia.
| | - Anna Scheer
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Jelena Saundankar
- Perth Children's Hospital, Cardiology, Nedlands, Australia
- Sir Charles Gairdner Hospital, Cardiology, Nedlands, Australia
| | - Derek Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew Maiorana
- School of Allied Health, Curtin University, Perth, WA, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
| |
Collapse
|
10
|
Apithanung L, Sethasathien S, Silvilairat S, Sittiwangkul R, Makonkawkeyoon K, Saengsin K, Woragidpoonpol S. Correlation between pressure gradient from echocardiography and peak-to-peak pressure gradient from cardiac catheterization or surgery in patients with coarctation of aorta. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03086-y. [PMID: 38558331 DOI: 10.1007/s10554-024-03086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
The gold standard for assessing pressure gradients (PG) across coarctation involves measurements obtained through cardiac catheterization or surgical intervention. There has been ongoing discussion regarding the accuracy of non-invasive methods for estimating these gradients. This study sought to establish the correlation and agreement between the systolic blood pressure (SBP) gradient between the upper and lower extremities, as well as, the mean and maximum PG derived from echocardiography, in comparison to the peak-to-peak pressure gradient obtained from either cardiac catheterization or surgery. We conducted a retrospective study on patients < 18 years diagnosed with coarctation at Chiang Mai University Hospital from 2011 to 2022. The study involved the measurement of the SBP gradient between the upper and lower extremities, mean and maximum PG using echocardiography, peak-to-peak pressure gradient obtained from cardiac catheterization, and pressure gradient recorded during surgical procedures. The Spearman's correlation and Bland-Altman analysis were employed to assess correlation and agreement. Fifty-four patients with aortic coarctation were enrolled. The mean PG measured by echocardiography showed a significantly moderate correlation (r = 0.78, p < 0.001) and the highest level of agreement according to Bland Altman plots, in comparison to the peak-to-peak pressure gradient measured during both cardiac catheterization and surgical procedure. The max PG demonstrated a notable overestimation compared to the gold standard (mean difference + 13.14 with a slope of biases + 0.64, p < 0.001). The mean PG obtained through echocardiography has more potential to be applied in practical application in predicting pressure gradient in patients with coarctation.
Collapse
Affiliation(s)
- Lalitpat Apithanung
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saviga Sethasathien
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Suchaya Silvilairat
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rekwan Sittiwangkul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krit Makonkawkeyoon
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kwannapas Saengsin
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surin Woragidpoonpol
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
11
|
Zaidi AH, Saleeb SF, Gurvitz M, Bucholz E, Gauvreau K, Jenkins KJ, de Ferranti SD. Social Determinants of Health Including Child Opportunity Index Leading to Gaps in Care for Patients With Significant Congenital Heart Disease. J Am Heart Assoc 2024; 13:e028883. [PMID: 38353239 PMCID: PMC11010070 DOI: 10.1161/jaha.122.028883] [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: 11/23/2022] [Accepted: 10/11/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Gaps in care (GIC) are common for patients with congenital heart disease (CHD) and can lead to worsening clinical status, unplanned hospitalization, and mortality. Understanding of how social determinants of health (SDOH) contribute to GIC in CHD is incomplete. We hypothesize that SDOH, including Child Opportunity Index (COI), are associated with GIC in patients with significant CHD. METHODS AND RESULTS A total of 8554 patients followed at a regional specialty pediatric hospital with moderate to severe CHD seen in cardiology clinic between January 2013 and December 2015 were retrospectively reviewed. SDOH factors including race, ethnicity, language, and COI calculated based on home address and zip code were analyzed. GIC of >3.25 years were identified in 32% (2709) of patients. GIC were associated with ages 14 to 29 years (P<0.001), Black race or Hispanic ethnicity (P<0.001), living ≥150 miles from the hospital (P=0.017), public health insurance (P<0.001), a maternal education level of high school or less (P<0.001), and a low COI (P<0.001). Multivariable analysis showed that GIC were associated with age ≥14 years, Black race or Hispanic ethnicity, documenting <3 caregivers as contacts, mother's education level being high school or less, a very low/low COI, and insurance status (C statistic 0.66). CONCLUSIONS One-third of patients followed in a regional referral center with significant CHD experienced a substantial GIC (>3.25 years). Several SDOH, including a low COI, were associated with GIC. Hospitals should adopt formal GIC improvement programs focusing on SDOH to improve continuity of care and ultimately overall outcomes for patients with CHD.
Collapse
Affiliation(s)
- Abbas H. Zaidi
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
- Present address:
Nemours Children's Hospital‐DelawareWilmingtonDE
| | - Susan F. Saleeb
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Michelle Gurvitz
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Emily Bucholz
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
- Present address:
University of Colorado DenverDenverCO
- Present address:
Children’s Hospital ColoradoAuroraCO
| | - Kimberlee Gauvreau
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Kathy J. Jenkins
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Sarah D. de Ferranti
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| |
Collapse
|
12
|
Falk ZE, Aldous AM, Ito S, Moak JP. Predictors of Atrial Arrhythmia in Adults with Repaired Tetralogy of Fallot. Pediatr Cardiol 2024:10.1007/s00246-024-03436-6. [PMID: 38319318 DOI: 10.1007/s00246-024-03436-6] [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: 11/25/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease in adults, has excellent long-term survival. However, many patients (30-45%) develop late arrhythmias. Previous studies have identified predictors of arrhythmia (atrial or ventricular) using clinical markers that predate arrhythmia onset by many years. Our objective was to develop a predictive model for incident atrial arrhythmias within two years of clinical evaluation and diagnostic testing. A single-center nested unmatched case-control study of 174 adults with repaired TOF. We included only patients with results from ECG and echocardiogram data in the required time interval (3-24 months before first arrhythmia for cases; 24 months of follow-up for controls). A predictive multivariable model for risk of incident atrial arrhythmia was developed using logistic regression with a least absolute shrinkage and selection operator (LASSO). Of 41 demographic, surgical, and diagnostic variables, six were selected as having predictive value for atrial arrhythmia based on cross validation. The factors with the greatest predictive value in decreasing order were moderate / severe tricuspid regurgitation (adjusted odds ratio (OR) 149.42), QRS fragmentation (OR 28.08), severe pulmonary regurgitation (OR 8.22), RV systolic dysfunction (OR 2.95), 1st degree AV block (OR 2.59), and age at time of surgical repair (OR 1.02). Predictors for atrial arrhythmia in our study suggested abnormal right ventricle anatomical function and electrophysiologic properties (conduction and repolarization) as the primary underlying substrate.
Collapse
Affiliation(s)
- Zachary E Falk
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Annette M Aldous
- Department of Biostatistics and Bioinformatics, George Washington University Milken Institute of Public Health, Washington, DC, USA
| | - Seiji Ito
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA
| | - Jeffrey P Moak
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
| |
Collapse
|
13
|
Lu X, Li G, Wu Q, Ni W, Pan S, Xing Q. Prenatal Diagnosis of Congenital Heart Disease and Voluntary Termination of Pregnancy: A Population-Based Study in Qingdao, China. Risk Manag Healthc Policy 2024; 17:205-212. [PMID: 38269397 PMCID: PMC10807305 DOI: 10.2147/rmhp.s447493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
Objective The outcomes of fetuses with isolated congenital heart disease (CHD) diagnosed prenatally have not been investigated in a population-based study in China. This population-based study aimed to evaluate the rate of voluntary termination of pregnancy after the prenatal diagnosis of isolated CHD in Qingdao, China. Methods This was a population-based retrospective study in which data were collected from all pregnant women in Qingdao (eastern China) from August 2018 to July 2020; fetal data, maternal data and data on pregnancy outcomes were extracted from medical records regarding prenatal diagnosis of CHD. The inclusion criteria were as follows: pregnant women or their husbands who had a household registration in Qingdao and who underwent regular prenatal screening in Qingdao. The exclusion criterion was the failure to sign an informed consent form. Counseling for all parents of fetuses with CHD was provided by a multidisciplinary team of experienced pediatric cardiologists, obstetricians, geneticists, etc. According to the type and severity of CHD, the pregnancy termination rate was analyzed. Results Among the 126,843 pregnant women, 1299 fetuses with a prenatal diagnosis of CHD were included in the study. Among the included fetuses, 1075 were diagnosed with isolated CHD, and the overall pregnancy termination rate was 22.8%. Termination rates varied according to the complexity of CHD (low complexity vs moderate complexity, P=0.000; low complexity vs high complexity, P=0.000; moderate complexity vs high complexity, P=0.000), with rates of 6.0% for low complexity, 54.2% for moderate complexity, and 99.1% for high complexity. The decision to terminate the pregnancy in cases of isolated CHD was unrelated to maternal age (P=0.091) but was related to gestational age (p=0.000). Conclusion In Qingdao, 99.1% of parents whose fetuses were diagnosed with isolated high-complexity CHD chose to voluntarily terminate the pregnancy. The pregnancy termination rate increased with increasing complexity of prenatally diagnosed CHD.
Collapse
Affiliation(s)
- Xuning Lu
- Heart Center, Qingdao Women and Children’s Hospital, Shandong University, Qingdao, Shandong Province, People’s Republic of China
- Heart Center, Dalian Municipal Women and Children’s Medical Center (Group), Dalian, Liaoning Province, People’s Republic of China
| | - Guoju Li
- Heart Center, Qingdao Women and Children’s Hospital, Shandong University, Qingdao, Shandong Province, People’s Republic of China
| | - Qin Wu
- Heart Center, Qingdao Women and Children’s Hospital, Shandong University, Qingdao, Shandong Province, People’s Republic of China
| | - Wei Ni
- Heart Center, Qingdao Women and Children’s Hospital, Shandong University, Qingdao, Shandong Province, People’s Republic of China
| | - Silin Pan
- Heart Center, Qingdao Women and Children’s Hospital, Shandong University, Qingdao, Shandong Province, People’s Republic of China
| | - Quansheng Xing
- Heart Center, Qingdao Women and Children’s Hospital, Shandong University, Qingdao, Shandong Province, People’s Republic of China
| |
Collapse
|
14
|
Wen Y, Liu X, Zhao Y, Liu J, Miao Q. Quadruple valve replacement for patient with infective endocarditis 16 years after Fallot's Tetralogy Repair procedure: A case report. Heliyon 2024; 10:e23351. [PMID: 38192818 PMCID: PMC10772569 DOI: 10.1016/j.heliyon.2023.e23351] [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: 01/10/2023] [Revised: 11/15/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024] Open
Abstract
A 33-year-old man, who had previously undergone repair for Tetralogy of Fallot, presented with extensive infective endocarditis. Following thorough preoperative preparation and evaluation, we performed a simultaneous quadruple valve replacement alongside the repatching of the remaining defect. We posit that this comprehensive one-stage surgical intervention not only enhanced the patient's quality of life but also reduced the necessity for future reoperations. Our approach offers valuable insights for managing adult patients with repaired congenital heart diseases and multiple valve pathologies.
Collapse
Affiliation(s)
- Yulin Wen
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinpei Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanxue Zhao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianzhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
15
|
Nagasawa M, Ikehara S, Aochi Y, Tanigawa K, Kitamura T, Sobue T, Iso H. Maternal diabetes and risk of offspring congenital heart diseases: the Japan Environment and Children's Study. Environ Health Prev Med 2024; 29:23. [PMID: 38583985 PMCID: PMC11016373 DOI: 10.1265/ehpm.23-00358] [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: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Few prospective cohort studies have examined the association between maternal diabetes, including pre-pregnancy and gestational diabetes, and the risk of congenital heart disease (CHD) in Asian offspring. METHODS We examined the association between maternal diabetes and offspring CHD among 97,094 mother-singleton infant pairs in the Japan Environment and Children's Study (JECS) between January 2011 and March 2014. Odds ratios (OR) and 95% confidence intervals (CI) of offspring CHD based on maternal diabetes (pre-pregnancy diabetes and gestational diabetes) were estimated using logistic regression after adjusting for maternal age at delivery, pre-pregnancy body mass index (BMI), maternal smoking habits, alcohol consumption, annual household income, and maternal education. The diagnosis of CHD in the offspring was ascertained from the transcript of medical records. RESULTS The incidence of CHD in the offspring was 1,132. Maternal diabetes, including both pre-pregnancy diabetes and gestational diabetes, was associated with a higher risk of offspring CHD: multivariable OR (95%CI) = 1.81 (1.40-2.33) for maternal diabetes, 2.39 (1.05-5.42) for pre-pregnancy diabetes and 1.77 (1.36-2.30) for gestational diabetes. A higher risk of offspring CHD was observed in pre-pregnancy BMI ≥25.0 kg/m2 (OR = 2.55, 95% CI: 1.74-3.75) than in pre-pregnancy BMI <25.0 kg/m2 (OR = 1.49, 95% CI: 1.05-2.10, p for interaction = 0.04). CONCLUSIONS Maternal diabetes, including both pre-pregnancy and gestational, was associated with an increased risk of CHD in offspring.
Collapse
Affiliation(s)
- Maiko Nagasawa
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
- Osaka Regional Center for Japan Environment and Children’s Study (JECS), Osaka University
| | - Satoyo Ikehara
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
- Osaka Regional Center for Japan Environment and Children’s Study (JECS), Osaka University
| | - Yuri Aochi
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
- Osaka Regional Center for Japan Environment and Children’s Study (JECS), Osaka University
| | - Kanami Tanigawa
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
- Osaka Regional Center for Japan Environment and Children’s Study (JECS), Osaka University
- Osaka Maternal and Child Health Information Center, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
- Osaka Regional Center for Japan Environment and Children’s Study (JECS), Osaka University
| | - Hiroyasu Iso
- Osaka Regional Center for Japan Environment and Children’s Study (JECS), Osaka University
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine
| | - the Japan Environment and Children’s Study (JECS) Group
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
- Osaka Regional Center for Japan Environment and Children’s Study (JECS), Osaka University
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine
- Osaka Maternal and Child Health Information Center, Osaka Women’s and Children’s Hospital, Osaka, Japan
| |
Collapse
|
16
|
Kuraoka A, Ishizu T, Nakai M, Sumita Y, Kawamatsu N, Machino-Ohtsuka T, Masuda K, Ieda M. Trends in Unplanned Admissions of Patients With Adult Congenital Heart Disease Based on the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination Study. Circ J 2023; 88:83-89. [PMID: 37880107 DOI: 10.1253/circj.cj-23-0015] [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] [Indexed: 10/27/2023]
Abstract
BACKGROUND The prevalence of adult congenital heart disease (ACHD) is increasing rapidly and in particular, patients who underwent complicated surgeries are reaching their youth and middle age. Therefore, the need for ACHD treatment will increase, but the current medical situation is unknown. In this study we assessed trends in unplanned admissions in patients with ACHD in Japan.Methods and Results: From the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination, a nationwide claim-based database, we selected patients aged >15 years with CHD defined by the International Classification of Diseases, 10th Revision codes. We identified 39,676 admissions between April 2012 and March 2018; 10,444 (26.3%) were unplanned. Main diagnoses were categorized into 3 degrees of complexity (severe, moderate, and mild) and other. Among unplanned admissions, the proportion of the severe group increased with time. Patients in the mild group were significantly older than those in the moderate and severe groups (median age: 70.0, 39.0, and 32.0 years, respectively). There were 765 deaths during hospitalization (overall mortality rate, 7.3%). The odds ratio of death during admission was significantly higher in patients aged >50 years, especially in the moderate group. CONCLUSIONS Patients with moderate or severe ACHD tended to experience unplanned admissions at a younger age. In anticipation of greater numbers of new, severe patients, we need to prepare for their increasing medical demands.
Collapse
Affiliation(s)
- Ayako Kuraoka
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Clinical Research Support Center, University of Miyazaki Hospital
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Naoto Kawamatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Keita Masuda
- Department of Cardiology, St. Luke's International Hospital
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| |
Collapse
|
17
|
Marshall WH, Rajpal S, Mah ML, Armstrong AK, Salavitabar A, Hickey J, Metzger R, Sisk T, Daniels CJ. Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation. J Am Heart Assoc 2023; 12:e031836. [PMID: 38063189 PMCID: PMC10863767 DOI: 10.1161/jaha.123.031836] [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: 07/18/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Data on the use of implanted hemodynamic monitoring (IHM) in patients with Fontan circulation are limited. This study reports our experience using the CardioMEMS HF system in adults with Fontan circulation. METHODS AND RESULTS This single-center, retrospective study evaluated heart failure hospitalizations, procedural complications, and device-related complications in patients with Fontan circulation referred for IHM placement (2015-2022). The association of pulmonary artery pressure (by most recent catheterization and median IHM pressure within 30 days of placement) with both death and follow-up Model for End-Stage Liver Disease Excluding International Normalized Ratio score were evaluated. Of 18 patients referred for IHM placement, 17 were successful (median age, 30 [range 21-48] years, 6 women). Procedural complications (access site hematomas, pulmonary artery staining) occurred in 3 patients, without device-related procedural complications. In follow-up (median, 35 [range, 6-83] months), 1 patient developed a pulmonary embolism (possibly device-related). Heart failure hospitalizations/year were similar before and after IHM (median, 1 [interquartile range, 0-1.0] versus 0.6 [0-2.3]; P=0.268), though only 46% of heart failure hospitalizations had associated IHM transmissions. IHM pressures were associated with Model for End-Stage Liver Disease Excluding International Normalized Ratio scores (R2=0.588, P<0.001), though catheterization pressures were not (R2=0.140, P=0.139). The long-term mortality rate was 53% in this cohort. On unadjusted survival analysis, IHM pressures ≥18 mm Hg were associated with mortality (log rank P=0.041), which was not reproduced with catheterization pressures (log rank P=0.764). CONCLUSIONS In patients with Fontan circulation, IHM did not reduce heart failure hospitalizations, though patient adherence to transmission was low. Device-related complications were low. IHM pressures may better represent real-life conditions compared with catheterization given associations with mortality and Model for End-Stage Liver Disease Excluding International Normalized Ratio score.
Collapse
Affiliation(s)
- William H. Marshall
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Saurabh Rajpal
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - May Ling Mah
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | | | | | - Jenne Hickey
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Rachel Metzger
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Tracey Sisk
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Curt J. Daniels
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| |
Collapse
|
18
|
Danford DA, Yetman AT, Haynatzki G. Derivation and Validation of a General Predictive Model for Long Term Risks for Mortality and Invasive Interventions in Congenital and Acquired Cardiac Conditions Encountered in the Young. Pediatr Cardiol 2023; 44:1763-1777. [PMID: 37069273 DOI: 10.1007/s00246-023-03154-5] [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: 08/15/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
Accurate prognostic assessment is a key driver of clinical decision making in heart disease in the young (HDY). This investigation aims to derive, validate, and calibrate multivariable predictive models for time to surgical or catheter-mediated intervention (INT) and for time to death in HDY. 4108 unique subjects were prospectively and consecutively enrolled, and randomized to derivation and validation cohorts. Total follow-up was 26,578 patient-years, with 102 deaths and 868 INTs. Accelerated failure time multivariable predictive models for the outcomes, based on primary and secondary diagnoses, pathophysiologic severity, age, sex, genetic comorbidities, and prior interventional history, were derived using piecewise exponential methodology. Model predictions were validated, calibrated, and evaluated for sensitivity to changes in the independent variables. Model validity was excellent for predicting mortality and INT at 4 months, 1, 5, 10, and 22 years (areas under receiver operating characteristic curves 0.813-0.915). Model calibration was better for INT than for mortality. Age, sex, and genetic comorbidities were significant independent factors, but predicted outcomes were most sensitive to variations in composite predictors incorporating primary diagnosis, pathophysiologic severity, secondary diagnosis, and prior intervention. Despite 22 years of data acquisition, no significant cohort effects were identified in which predicted mortality and intervention varied by study entry date. A piecewise exponential model predicting survival and freedom from INT is derived which demonstrates excellent validity, and performs well on a clinical sample of HDY outpatients. Objective model-based predictions could educate both patient and provider, and inform clinical decision making in HDY.
Collapse
Affiliation(s)
- David A Danford
- University of Nebraska Medical Center, Omaha, NE, USA.
- Criss Heart Center at Children's Hospital and Medical Center, Omaha, NE, USA.
- , 804 S. 129th Ave, Omaha, NE, 68154, USA.
| | - Anji T Yetman
- University of Nebraska Medical Center, Omaha, NE, USA
- Criss Heart Center at Children's Hospital and Medical Center, Omaha, NE, USA
| | - Gleb Haynatzki
- School of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
19
|
Shi H, Book W, Raskind-Hood C, Downing KF, Farr SL, Bell MN, Sameni R, Rodriguez FH, Kamaleswaran R. A machine learning model for predicting congenital heart defects from administrative data. Birth Defects Res 2023; 115:1693-1707. [PMID: 37681293 PMCID: PMC10841295 DOI: 10.1002/bdr2.2245] [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: 07/08/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION International Classification of Diseases (ICD) codes recorded in administrative data are often used to identify congenital heart defects (CHD). However, these codes may inaccurately identify true positive (TP) CHD individuals. CHD surveillance could be strengthened by accurate CHD identification in administrative records using machine learning (ML) algorithms. METHODS To identify features relevant to accurate CHD identification, traditional ML models were applied to a validated dataset of 779 patients; encounter level data, including ICD-9-CM and CPT codes, from 2011 to 2013 at four US sites were utilized. Five-fold cross-validation determined overlapping important features that best predicted TP CHD individuals. Median values and 95% confidence intervals (CIs) of area under the receiver operating curve, positive predictive value (PPV), negative predictive value, sensitivity, specificity, and F1-score were compared across four ML models: Logistic Regression, Gaussian Naive Bayes, Random Forest, and eXtreme Gradient Boosting (XGBoost). RESULTS Baseline PPV was 76.5% from expert clinician validation of ICD-9-CM CHD-related codes. Feature selection for ML decreased 7138 features to 10 that best predicted TP CHD cases. During training and testing, XGBoost performed the best in median accuracy (F1-score) and PPV, 0.84 (95% CI: 0.76, 0.91) and 0.94 (95% CI: 0.91, 0.96), respectively. When applied to the entire dataset, XGBoost revealed a median PPV of 0.94 (95% CI: 0.94, 0.95). CONCLUSIONS Applying ML algorithms improved the accuracy of identifying TP CHD cases in comparison to ICD codes alone. Use of this technique to identify CHD cases would improve generalizability of results obtained from large datasets to the CHD patient population, enhancing public health surveillance efforts.
Collapse
Affiliation(s)
- Haoming Shi
- Department of Biomedical Engineering, Georgia Institute Technology, Atlanta, Georgia, USA
| | - Wendy Book
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cheryl Raskind-Hood
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary N. Bell
- Department of Biomedical Engineering, Georgia Institute Technology, Atlanta, Georgia, USA
| | - Reza Sameni
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H. Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Engineering, Georgia Institute Technology, Atlanta, Georgia, USA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
20
|
Farjat‐Pasos JI, Guedeney P, Houde C, Alperi A, Robichaud M, Côté M, Montalescot G, Rodés‐Cabau J. Sex Differences in Patients With Cryptogenic Cerebrovascular Events Undergoing Transcatheter Closure of Patent Foramen Ovale. J Am Heart Assoc 2023; 12:e030359. [PMID: 37776218 PMCID: PMC10727268 DOI: 10.1161/jaha.123.030359] [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: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 10/02/2023]
Abstract
Background Scarce data exist on sex differences in patients with cryptogenic cerebrovascular events undergoing patent foramen ovale (PFO) closure. This study aimed to determine the sex differences in clinical profile, procedural characteristics, and long-term outcomes of patients with cryptogenic cerebrovascular events undergoing PFO closure. Methods and Results A retrospective cohort was used, including 1076 consecutive patients undergoing PFO closure because of a cryptogenic cerebrovascular event. Patients were divided into 2 groups: 469 (43.6%) women and 607 (56.4%) men. The median follow-up was 3 years (interquartile range, 2-8 years). Women were younger (46±13 versus 50±12 years; P<0.01) and had a higher risk of paradoxical embolism score (6.9±1.7 versus 6.6±1.6; P<0.01). Procedural characteristics and postprocedural antithrombotic therapy were similar. At follow-up, there were no differences in atrial fibrillation (women versus men: 0.47 versus 0.97 per 100 patient-years; incidence rate ratio [IRR], 0.55 [95% CI, 0.27-1.11]; P=0.095; adjusted P=0.901), stroke (0.17 versus 0.07 per 100 patient-years; IRR, 2.58 [95% CI, 0.47-14.1]; P=0.274; adjusted P=0.201), or transient ischemic attack (0.43 versus 0.18 per 100 patient-years; IRR, 2.58 [95% CI, 0.88-7.54]; P=0.084; adjusted P=0.121); nevertheless, women exhibited a higher incidence of combined ischemic cerebrovascular events (0.61 versus 0.26 per 100 patient-years; IRR, 2.58 [95% CI, 1.04-6.39]; P=0.041; adjusted P=0.028) and bleeding events (1.04 versus 0.45 per 100 patient-years; IRR, 2.82 [95% CI, 1.41-5.65]; P=0.003; adjusted P=0.004). Conclusions Compared with men, women with cryptogenic cerebrovascular events undergoing PFO closure were younger and had a higher risk of paradoxical embolism score. After a median follow-up of 3 years, there were no differences in stroke events, but women exhibited a higher rate of combined (stroke and transient ischemic attack) cerebrovascular events and bleeding complications. Additional studies are warranted to clarify sex-related outcomes after PFO closure further.
Collapse
Affiliation(s)
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP‐HP)ParisFrance
| | - Christine Houde
- Centre Hospitalier Universitaire de QuebecLaval UniversityQuebec CityQuebecCanada
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval UniversityQuebec CityQuebecCanada
| | - Mathieu Robichaud
- Quebec Heart and Lung Institute, Laval UniversityQuebec CityQuebecCanada
| | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval UniversityQuebec CityQuebecCanada
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP‐HP)ParisFrance
| | - Josep Rodés‐Cabau
- Quebec Heart and Lung Institute, Laval UniversityQuebec CityQuebecCanada
- Centre Hospitalier Universitaire de QuebecLaval UniversityQuebec CityQuebecCanada
| |
Collapse
|
21
|
Salciccioli KB, Zachariah JP. Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension 2023; 80:1970-1979. [PMID: 37476999 PMCID: PMC10530495 DOI: 10.1161/hypertensionaha.123.19454] [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] [Indexed: 07/22/2023]
Abstract
While coarctation of the aorta varies greatly in both severity and age at presentation, all patients are at increased risk of hypertension both before and after repair. Despite advances in knowledge about genetic etiologies, pathophysiologic mechanisms, and optimal repair strategies, patients with repaired coarctation of the aorta remain at increased risk of acquired cardiovascular disease. The aims of this review are to describe the management of coarctation of the aorta at all ages before and after repair, highlight pathophysiologic mechanisms of hypertension, and review long-term follow-up considerations.
Collapse
Affiliation(s)
- Katherine B Salciccioli
- Section of Pediatric Cardiology, Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston TX USA
| | - Justin P Zachariah
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston TX USA
| |
Collapse
|
22
|
Marchini F, Meossi S, Passarini G, Campo G, Pavasini R. Pulmonary Valve Stenosis: From Diagnosis to Current Management Techniques and Future Prospects. Vasc Health Risk Manag 2023; 19:379-390. [PMID: 37416511 PMCID: PMC10320808 DOI: 10.2147/vhrm.s380240] [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: 03/28/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
Pulmonary stenosis (PS) is mainly a congenital defect that accounts for 7-12% of congenital heart diseases (CHD). It can be isolated or, more frequently, associated with other congenital defects (25-30%) involving anomalies of the pulmonary vascular tree. For the diagnosis of PS an integrated approach with echocardiography, cardiac computed tomography and cardiac magnetic resonance (CMR) is of paramount importance for the planning of the interventional treatment. In recent years, transcatheter approaches for the treatment of PS have increased however, meaning surgery is a possible option for complicated cases with anatomy not suitable for percutaneous treatment. The present review aims to summarize current knowledge regarding diagnosis and treatment of PS.
Collapse
Affiliation(s)
- Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Sofia Meossi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Giulia Passarini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| |
Collapse
|
23
|
Neijenhuis RML, Nederend M, Jongbloed MRM, Kiès P, Rotmans JI, Vliegen HW, Jukema JW, Egorova AD. The potential of sodium-glucose cotransporter 2 inhibitors for the treatment of systemic right ventricular failure in adults with congenital heart disease. Front Cardiovasc Med 2023; 10:1093201. [PMID: 37435053 PMCID: PMC10330719 DOI: 10.3389/fcvm.2023.1093201] [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: 11/08/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
Aims Given the compelling evidence on the effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the conventional heart failure population, SGLT2i deserve exploration in systemic right ventricular (sRV) failure. The initial experience with dapagliflozin in sRV failure patients is described, with a focus on tolerability and short-term effects on clinical outcomes. Methods and results Ten patients (70% female, median age 50 years [46.5-52]) with symptomatic sRV failure who received dapagliflozin 10 mg per day on top of optimal medical therapy between 04-2021 and 01-2023 were included. Within 4 weeks, no significant changes in blood pressure, electrolytes, or serum glucose occurred. Creatinine and estimated glomerular filtration rate (eGFR) showed a slight decline (88 ± 17 to 97 ± 23 µmol/L, p = 0.036, and 72 ± 14 vs. 66 ± 16 ml/min/1.73m2, p = 0.020, respectively). At 6 months follow-up (n = 8), median NT-proBNP decreased significantly from 736.6 [589.3-1193.3] to 531.6 [400.8-1018] ng/L (p = 0.012). Creatinine and eGFR recovered to baseline levels. There were no significant changes in echocardiographic systolic sRV or left ventricular function. New York Heart Association class improved significantly in 4 out of 8 patients (p = 0.046), who also showed an improvement in the 6-minute walk test or bicycle exercise test performance. One female patient developed an uncomplicated urinary tract infection. No patients discontinued treatment. Conclusion Dapagliflozin was well-tolerated in this small cohort of sRV failure patients. While the early results on the reduction of NT-proBNP and clinical outcome parameters are encouraging, large-scale prospective studies are warranted to thoroughly evaluate the effects of SGLT2i in the growing sRV failure population.
Collapse
Affiliation(s)
- Ralph M L Neijenhuis
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine & Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
24
|
Doan TT, Wilkes JK, Reaves O'Neal DL, Bonilla-Ramirez C, Sachdeva S, Masand P, Mery CM, Binsalamah Z, Heinle JS, Molossi S. Clinical Presentation and Medium-Term Outcomes of Children With Anomalous Aortic Origin of the Left Coronary Artery: High-Risk Features Beyond Interarterial Course. Circ Cardiovasc Interv 2023; 16:e012635. [PMID: 37192311 DOI: 10.1161/circinterventions.122.012635] [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: 12/28/2022] [Accepted: 04/04/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Anomalous aortic origin of the left coronary artery (AAOLCA) confers a rare, but significant, risk of sudden cardiac death in children. Surgery is recommended for interarterial AAOLCA, and other subtypes considered benign. We aimed to determine the clinical characteristics and outcomes of 3 AAOLCA subtypes. METHODS All patients with AAOLCA <21 years old were prospectively enrolled (December 2012-November 2020), including group 1: AAOLCA from the right aortic sinus with interarterial course, group 2: AAOLCA from the right aortic sinus with intraseptal course, and group 3: AAOLCA with a juxtacommissural origin between the left and noncoronary aortic sinus. Anatomic details were assessed using computed tomography angiography. Provocative stress testing (exercise stress testing and stress perfusion imaging) was performed in patients >8 years old or younger if concerning symptoms. Surgery was recommended for group 1 and in select cases in group 2 and group 3. RESULTS We enrolled 56 patients (64% males) with AAOLCA (group 1, 27; group 2, 20; group 3, 9) at median age of 12 years (interquartile range, 6-15). Intramural course was common in group 1 (93%) compared with group 3 (56%) and group 2 (10%). Seven (13%) presented with aborted sudden cardiac death (group 1, 6/27; group 3, 1/9); 1 (group 3) with cardiogenic shock. Fourteen/42 (33%) had inducible ischemia on provocative testing (group 1, 32%; group 2, 38%; group 3, 29%). Surgery was recommended in 31/56 (56%) patients (group 1, 93%; group 2, 10%; and group 3, 44%). Surgery was performed in 25 patients at a median age 12 (interquartile range, 7-15) years; all have been asymptomatic and free from exercise restrictions at median follow-up of 4 (interquartile range, 1.4-6.3) years. CONCLUSIONS Inducible ischemia was noted in all 3 AAOLCA subtypes while most aborted sudden cardiac deaths occurred in interarterial AAOLCA (group 1). Aborted sudden cardiac death and cardiogenic shock may occur in AAOLCA with left/nonjuxtacommissural origin and intramural course, thus also deemed high-risk. A systematic approach is essential to adequately risk stratify this population.
Collapse
Affiliation(s)
- Tam T Doan
- Division of Cardiology, Department of Pediatrics (T.T.D., D.L.R.O., S.S., S.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - J Kevin Wilkes
- Pediatric Cardiology, Cook Children's Medical Center, Fort Worth, TX (J.K.W.)
| | - Dana L Reaves O'Neal
- Division of Cardiology, Department of Pediatrics (T.T.D., D.L.R.O., S.S., S.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Carlos Bonilla-Ramirez
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.S.H.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Shagun Sachdeva
- Division of Cardiology, Department of Pediatrics (T.T.D., D.L.R.O., S.S., S.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Prakash Masand
- Pediatric Radiology (P.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin (C.M.M.)
| | - Ziyad Binsalamah
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.S.H.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Jeffrey S Heinle
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.S.H.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Silvana Molossi
- Division of Cardiology, Department of Pediatrics (T.T.D., D.L.R.O., S.S., S.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| |
Collapse
|
25
|
Aoki S, Takaoka H, Ito R, Ikeuchi H, Suzuki-Eguchi N, Sasaki H, Kinoshita M, Takahashi M, Yashima S, Suzuki K, Goto H, Kitahara H, Moriya J, Matsumiya G, Kobayashi Y. Importance of the Multimodality Evaluation of a Double-chambered Right Ventricle for Surgical Indications on Admission for Acute Myocardial Infarction. Intern Med 2023; 62:1017-1022. [PMID: 35989275 PMCID: PMC10125821 DOI: 10.2169/internalmedicine.0483-22] [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: 11/06/2022] Open
Abstract
We treated a female patient known to have a double-chambered right ventricle (DCRV) who presented with symptoms of an acute myocardial infarction (AMI). Emergent coronary artery catheterization revealed acute right coronary artery (RCA) occlusion and proximal left anterior descending (LAD) stenosis. We performed percutaneous coronary intervention (PCI) for the RCA occlusion. Right heart catheterization revealed a pressure gradient across the mid-RV of 58 mmHg. Computed tomography and magnetic resonance imaging revealed no other congenital cardiac abnormalities. She underwent surgical repair of the RV stenosis and coronary artery bypass surgery for LAD stenosis.
Collapse
Affiliation(s)
- Shuhei Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Ryo Ito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Hiroki Ikeuchi
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Japan
| | - Noriko Suzuki-Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Haruka Sasaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Makiko Kinoshita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Manami Takahashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Satomi Yashima
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Katsuya Suzuki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Hiroki Goto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Junji Moriya
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| |
Collapse
|
26
|
Doan TT, Sachdeva S, Bonilla-Ramirez C, Reaves-O'Neal DL, Masand P, Mery CM, Binsalamah Z, Heinle JH, Molossi S. Ischemia in Anomalous Aortic Origin of a Right Coronary Artery: Large Pediatric Cohort Medium-Term Outcomes. Circ Cardiovasc Interv 2023; 16:e012631. [PMID: 37071720 DOI: 10.1161/circinterventions.122.012631] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Anomalous aortic origin of a right coronary artery may cause myocardial ischemia and sudden death in the young. Data on myocardial ischemia or longitudinal outcomes are sparse in pediatric anomalous aortic origin of a right coronary artery population. METHODS Patients <21 years with anomalous aortic origin of a right coronary artery were prospectively enrolled. Computerized tomography angiography defined morphology. Exercise stress test and stress perfusion imaging (sPI) were performed if >7 years or younger with concern for ischemia. High-risk features included intramural length, slit-like/hypoplastic ostium, exertional symptoms, or evidence of ischemia. RESULTS A total of 220 patients (60% males) were enrolled December 2012 to April 2020 at a median age 11.4 years (interquartile range, 6.1-14.5), including 168 (76%) with no/nonexertional symptoms (group 1) and 52 (24%) with exertional chest pain/syncope (group 2). Computerized tomography angiography was available in 189/220 (86%), exercise stress test in 164/220 (75%), and sPI in 169/220 (77%). Exercise stress test was positive in 2/164 (1.2%) patients in group 1, both had positive sPI. Inducible ischemia (sPI) was detected in 11/120 (9%) in group 1 and 9/49 (18%) in group 2 (P=0.09). Intramural length was similar in patients with/without ischemia (5 [interquartile range, 4-7] versus 5 [interquartile range, 4-7] mm; P=0.65). Surgery was recommended in 56/220 (26%) patients with high-risk features. In 52 surgical patients (38 unroofing, 14 reimplantation), all subjects were alive and have returned to exercise at last median follow-up of 4.6 (interquartile range, 2.3-6.5) years. CONCLUSIONS Anomalous aortic origin of a right coronary artery patients can present with inducible ischemia on sPI despite symptoms or intramural length. Exercise stress test is a poor predictor of ischemia and caution should be given to determine low-risk based solely on this assessment. All patients are alive at medium-term follow-up.
Collapse
Affiliation(s)
- Tam T Doan
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Carlos Bonilla-Ramirez
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.H.H.), Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Dana L Reaves-O'Neal
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Prakash Masand
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)
- Department of Pediatric Radiology (P.M.), Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin (C.M.M.)
| | - Ziyad Binsalamah
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.H.H.), Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Jeffrey H Heinle
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.H.H.), Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children's Hospital, Houston
| |
Collapse
|
27
|
Vô C, Bartoletti S, Benali K, Gonzalez CM, Mondésert B, Gagnon MH, Dyrda K, Fourier A, Khairy P. Robotic magnetic-guided catheter ablation in patients with congenital heart disease: a systematic review and pooled analysis. Expert Rev Cardiovasc Ther 2023; 21:227-236. [PMID: 36852632 DOI: 10.1080/14779072.2023.2184798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Robotic magnetic navigation (RMN) has emerged as a potential solution to overcome challenges associated with catheter ablation of arrhythmias in patients with congenital heart disease (CHD). OBJECTIVES To assess safety and efficacy of RMNguided catheter ablation in patients with CHD. DESIGN AND METHODS A systematic review and pooled analysis was conducted on patients with CHD who underwent RMNguided catheter ablation. Random effects models were used to generate pooled estimates with the inverse variance method used for weighting studies. RESULTS Twentyfour nonoverlapping records included 167 patients with CHD, mean age 36.5 years, 44.6% female. Type of CHD was simple in 27 (16.2%), moderate in 32 (19.2%), and complex in 106 (63.5%). A total of 202 procedures targeted 260 arrhythmias, the most common being macroreentrant atrial circuits. The mean procedural duration was 207.5 minutes, with a mean fluoroscopy time of 12.1 minutes. The pooled acute success rate was 89.2% [95% CI (77.8%, 97.4%)]. Freedom from arrhythmia recurrence was 84.5% [95% CI (72.5%, 94.0%)] over a mean follow-up of 24.3 months. The procedural complication rate was 3.5% with no complication attributable to RMN technology. CONCLUSION RMN-guided ablation appears to be safe and effective across a variety of arrhythmia substrates and types of CHD.
Collapse
Affiliation(s)
- Christophe Vô
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Stefano Bartoletti
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Karim Benali
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Cardiology, Saint-Etienne University Hospital Center, SaintEtienne, France
| | - Cecilia M Gonzalez
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Hélène Gagnon
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Katia Dyrda
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Anne Fourier
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Paul Khairy
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| |
Collapse
|
28
|
Staged Percutaneous Management of Pulmonary Atresia and Intact Interventricular Septum: Stretching the Limits. J Interv Cardiol 2023; 2023:9709227. [PMID: 36793670 PMCID: PMC9908361 DOI: 10.1155/2023/9709227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/24/2022] [Accepted: 12/12/2022] [Indexed: 02/04/2023] Open
Abstract
Aims Pulmonary atresia with intact ventricular septum (PA/IVS) can be treated by catheter-based interventions and complemented by various surgical procedures. We aim to determine a long-term treatment strategy to enable patients to be surgery free, depending solely on percutaneous interventions. Methods and Results We selected five patients from among a cohort of patients with PA/IVS treated at birth with radiofrequency perforation and dilatation of the pulmonary valve. Patients had reached a pulmonary valve annulus of 20 mm or larger on their biannual echocardiographic follow-up, with right ventricular dilatation. The findings, together with the right ventricular outflow tract and pulmonary arterial tree, were confirmed by multislice computerised tomography. Based on the angiographic size of the pulmonary valve annulus, all patients were successfully implanted with either Melody® or Edwards® pulmonary valves percutaneously, regardless of their small weights and ages. No complications were encountered. Conclusion We managed to stretch the age and weight limitations for performing percutaneous pulmonary valve implantation (PPVI): interventions were attempted whenever a pulmonary annulus size of >20 mm was reached, which was rationalised by the prevention of progressive right ventricular outflow tract dilatation and accommodating valves between 24 and 26 mm, which is enough to sustain a normal pulmonary flow in adulthood.
Collapse
|
29
|
Orii M, Sone M, Osaki T, Kikuchi K, Sugawara T, Zhu X, Janich MA, Nozaki A, Yoshioka K. Reliability of respiratory-gated real-time two-dimensional cine incorporating deep learning reconstruction for the assessment of ventricular function in an adult population. Int J Cardiovasc Imaging 2023; 39:1001-1011. [PMID: 36648573 DOI: 10.1007/s10554-023-02793-2] [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: 10/26/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
This study aimed to assess the image quality and accuracy of respiratory-gated real-time two-dimensional (2D) cine incorporating deep learning reconstruction (DLR) for the quantification of biventricular volumes and function compared with those of the standard reference, that is, breath-hold 2D balanced steady-state free precession (bSSFP) cine, in an adult population. Twenty-four patients (15 men, mean age 50.7 ± 16.5 years) underwent cardiac magnetic resonance for clinical indications, and 2D DLR and bSSFP cine were acquired on the short-axis view. The image quality scores were based on three main criteria: blood-to-myocardial contrast, endocardial edge delineation, and presence of motion artifacts throughout the cardiac cycle. Biventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and left ventricular mass (LVM) were analyzed. The 2D DLR cine had significantly shorter scan time than bSSFP (41.0 ± 11.3 s vs. 327.6 ± 65.8 s; p < 0.0001). Despite an analysis of endocardial edge definition and motion artifacts showed significant impairment using DLR cine compared with bSSFP (p < 0.01), the two sequences demonstrated no significant difference in terms of biventricular EDV, ESV, SV, and EF (p > 0.05). Moreover, the linear regression yielded good agreement between the two techniques (r ≥ 0.76). However, the LVM was underestimated for DLR cine (109.8 ± 34.6 g) compared with that for bSSFP (116.2 ± 40.2 g; p = 0.0291). Respiratory-gated 2D DLR cine is a reliable technique that could be used in the evaluation of biventricular volumes and function in an adult population.
Collapse
Affiliation(s)
- Makoto Orii
- Department of Radiology, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Iwate, Japan.
| | - Misato Sone
- Department of Radiology, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Iwate, Japan
| | - Takeshi Osaki
- Department of Radiology, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Iwate, Japan
| | - Kei Kikuchi
- Department of Radiology Service, Iwate Medical University, Iwate, Japan
| | - Tsuyoshi Sugawara
- Department of Radiology Service, Iwate Medical University, Iwate, Japan
| | | | | | | | - Kunihiro Yoshioka
- Department of Radiology, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Iwate, Japan
| |
Collapse
|
30
|
Samarai D, Isma N, Lindstedt S, Hlebowicz J. Novel oral anticoagulant use in adults with congenital heart disease: a single-center experience report. Egypt Heart J 2023; 75:3. [PMID: 36624331 PMCID: PMC9829939 DOI: 10.1186/s43044-022-00326-1] [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: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) are a group with an increased risk of thromboembolic complications and arrhythmias. Vitamin K antagonists are the most commonly used thromboprophylaxis therapy in this population. Studies on the efficacy and safety of novel oral anticoagulants (NOAC) are scare in ACHD. A retrospective study on ACHD patients on NOAC treatment registered in the National Quality Registry for Congenital Heart Disease, SWEDCON, and National Quality Registry for Atrial fibrillation and Anticoagulation, AuriculA, from Southern Sweden. RESULTS Thirty patients who had been taking NOAC treatment for a minimum of 3 months were included. Their median age was 55 years (SD 17 years) and 57% were male. Median follow-up was 17 months (IQR: 10-41). Eliquis was the most used NOAC (47%). Median CHA2DS2-VASc score was 2 (IQR: 0-3) and HAS-BLED was 1 (IQR: 0-2). Complex ACHD was prevalent in 27% of the patients. No thromboembolic events were recorded; however, one major bleeding, unspecified, was reported during the total cumulative patient follow-up time of 64 years. CONCLUSIONS The results of our study, although limited in size, suggest that NOAC appear safe and effective in ACHD patients. Further and larger studies on NOAC in ACHD patients are warranted.
Collapse
Affiliation(s)
- Daniel Samarai
- grid.4514.40000 0001 0930 2361Clinical Sciences, Lund University, Lund, Sweden
| | - Nazim Isma
- grid.4514.40000 0001 0930 2361Clinical Sciences, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Cardiology, Skåne University Hospital, Lund University, Entrégatan 7, 221 85 Lund, Sweden
| | - Sandra Lindstedt
- grid.4514.40000 0001 0930 2361Clinical Sciences, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Cardiothoracic Surgery, Lund University, Lund University Hospital, Lund, Sweden
| | - Joanna Hlebowicz
- grid.4514.40000 0001 0930 2361Clinical Sciences, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Cardiology, Skåne University Hospital, Lund University, Entrégatan 7, 221 85 Lund, Sweden
| |
Collapse
|
31
|
Bassareo PP, Mcmahon CJ, Prendiville T, James A, Roberts P, Oslizlok P, Walsh MA, Kenny D, Walsh KP. Planning Transition of Care for Adolescents Affected by Congenital Heart Disease: The Irish National Pathway. Pediatr Cardiol 2023; 44:24-33. [PMID: 35737012 DOI: 10.1007/s00246-022-02955-4] [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: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 01/24/2023]
Abstract
At some point in their life, adolescent patients with a congenital heart disease (CHD) transition from paediatric services to adult care facilities. The process is not without any risks, as it is often linked with a significantly progressive deterioration in adolescents' health and loss of follow-up. In fact, transition patients often encounter troubles in finding a care giver who is comfortable managing their condition, or in re-establishing trust with the new care provider. Planning the rules of transition is pivotal in preventing these risks. Unfortunately, the American and European guidelines on CHD provide just generic statements about transition. In a recently published worldwide inter-societies consensus document, a hybrid model of transition, which should be adapted for use in high- and low- resource settings, has been suggested. Currently, in literature there are a few models of transition for CHD patients, but they are by far local models and cannot be generalized to other regions or countries. This paper describes the Irish model for transition of care of CHD patients. Due to the peculiarity of the healthcare organization in the Republic of Ireland, which is centralized with one main referral centre for paediatric cardiology (in Dublin, with a few smaller satellite centres all around, according to the "hub and spoke" model) and one centre for adult with CHD (in Dublin), the model can be considered as a national one and the first to be released in the old continent.
Collapse
Affiliation(s)
- Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland. .,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland. .,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland.
| | - Colin Joseph Mcmahon
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Terence Prendiville
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Phil Roberts
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Paul Oslizlok
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Mark Anthony Walsh
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Damien Kenny
- Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland.,Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kevin Patrick Walsh
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| |
Collapse
|
32
|
Goto I, Okamoto R, Sato Y, Tsuji A, Tanigawa T, Dohi K. Moyamoya Disease Complicating Ebstein's Anomaly. Intern Med 2022; 61:3683-3686. [PMID: 35569986 PMCID: PMC9841108 DOI: 10.2169/internalmedicine.9516-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Ebstein's anomaly is an uncommon congenital disorder affecting the tricuspid valve. We herein report a 38-year-old woman who experienced consciousness and sensory disturbance during treatment for heart failure caused by Ebstein's anomaly. Urgent magnetic resonance imaging and cerebral angiography demonstrated acute cerebral infarction and internal carotid artery obstruction with the development of collateral arteries. We diagnosed her with multiple cerebral infarctions due to moyamoya disease. Ebstein's anomaly concomitant with moyamoya disease is extremely rare. However, we should consider the possibility of this rare but important concurrence when treating patients with heart failure due to Ebstein's anomaly to avoid excessive diuresis and vasodilation and irreversible brain injury.
Collapse
Affiliation(s)
- Itaru Goto
- Department of Cardiology, Matsusaka Chuo General Hospital, Japan
| | - Ryuji Okamoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
- Regional Medical Support Center, Mie University Hospital, Japan
| | - Yu Sato
- Department of Neurosurgery, Matsusaka Chuo General Hospital, Japan
| | - Akihiro Tsuji
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Takashi Tanigawa
- Department of Cardiology, Matsusaka Chuo General Hospital, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| |
Collapse
|
33
|
Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 296] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
| |
Collapse
|
34
|
Chau AK. Transcatheter pulmonary valve replacement in congenital heart diseases. Pediatr Investig 2022; 6:280-290. [PMID: 36582274 PMCID: PMC9789934 DOI: 10.1002/ped4.12359] [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: 09/11/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Surgical repair of a variety of congenital heart diseases involves repair of the right ventricular outflow tract (RVOT) with valved or non-valved conduit to connect the right ventricle (RV) to the pulmonary artery (PA) or just patch enlargement of the native RVOT. With time, this RV-PA conduit will degenerate with deterioration of function, either causing pulmonary stenosis or pulmonary regurgitation. This RVOT dysfunction may result in RV dilation, RV dysfunction, and eventual RV failure and arrhythmias. Multiple surgical pulmonary valve replacement (PVR) is often required throughout the patient's lifetime. Patients are subjected to increased risks with each additional cardiac operation. Transcatheter PVR (TPVR) has been developed over the past two decades as a valuable non-surgical alternative to restore the RVOT and RV function, and hence reduce patients' lifetime risks related to surgery. This article will discuss the long-term results of TPVR which are demonstrated to be comparable to surgical results and the latest development of large pulmonary valves which will allow TPVR to be performed on native or larger RVOT.
Collapse
Affiliation(s)
- Adolphus Kai‐Tung Chau
- Department of PaediatricsThe Chinese University of Hong Kong Medical CentreHong KongChina
| |
Collapse
|
35
|
Kharbanda RK, Moore JP, Lloyd MS, Galotti R, Bogers AJJC, Taverne YJHJ, Madhavan M, McLeod CJ, Dubin AM, Mah DY, Chang PM, Kamp AN, Nielsen JC, Aydin A, Tanel RE, Shah MJ, Pilcher T, Evertz R, Khairy P, Tan RB, Czosek RJ, Shivkumar K, de Groot NMS. Cardiac Resynchronization Therapy for Adult Patients With a Failing Systemic Right Ventricle: A Multicenter Study. J Am Heart Assoc 2022; 11:e025121. [DOI: 10.1161/jaha.121.025121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background
The objective of this international multicenter study was to investigate both early and late outcomes of cardiac resynchronization therapy (CRT) in patients with a systemic right ventricle (SRV) and to identify predictors for congestive heart failure readmissions and mortality.
Methods and Results
This retrospective international multicenter study included 13 centers. The study population comprised 80 adult patients with SRV (48.9% women) with a mean age of 45±14 (range, 18–77) years at initiation of CRT. Median follow‐up time was 4.1 (25th–75th percentile, 1.3–8.3) years. Underlying congenital heart disease consisted of congenitally corrected transposition of the great arteries and dextro‐transposition of the great arteries in 63 (78.8%) and 17 (21.3%) patients, respectively. CRT resulted in significant improvement in functional class (before CRT: III, 25th–75th percentile, II–III; after CRT: II, 25th–75th percentile, II–III;
P
=0.005) and QRS duration (before CRT: 176±27; after CRT: 150±24 milliseconds;
P
=0.003) in patients with pre‐CRT ventricular pacing who underwent an upgrade to a CRT device (n=49). These improvements persisted during long‐term follow‐up with a marginal but significant increase in SRV function (before CRT; 30%, 25th–75th percentile, 25–35; after CRT: 31%, 25th–75th percentile, 21–38;
P
=0.049). In contrast, no beneficial change in the above‐mentioned variables was observed in patients who underwent de novo CRT (n=31). A quarter of all patients were readmitted for heart failure during follow‐up, and mortality at latest follow‐up was 21.3%.
Conclusions
This international experience with CRT in patients with an SRV demonstrated that CRT in selected patients with SRV dysfunction and pacing‐induced dyssynchrony yielded consistent improvement in QRS duration and New York Heart Association functional status, with a marginal increase in SRV function.
Collapse
Affiliation(s)
- Rohit K. Kharbanda
- Department of Cardiology Erasmus MC, University Medical Center Rotterdam The Netherlands
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Jeremy P. Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center Los Angeles CA
| | - Michael S. Lloyd
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA
| | - Robert Galotti
- Ahmanson/UCLA Adult Congenital Heart Disease Center Los Angeles CA
| | - Ad J. J. C. Bogers
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Yannick J. H. J. Taverne
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Malini Madhavan
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Anne M. Dubin
- Division of Pediatric Cardiology, Department of Pediatrics Stanford University School of Medicine Stanford CA
| | - Douglas Y. Mah
- Department of Cardiology Boston Children’s Hospital and Harvard Medical School Boston MA
| | - Philip M. Chang
- Congenital Heart Center University of Florida Health Gainesville FL
| | - Anna N. Kamp
- The Heart Center Nationwide Children’s Hospital Colombus OH
| | - Jens C. Nielsen
- Department of Clinical Medicine, Aarhus University and Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Alper Aydin
- Division of Cardiology University of Ottawa Heart Institute Ottawa Canada
| | - Ronn E. Tanel
- Division of Pediatric Cardiology, UCSF Benioff Children’s Hospital University of California San Francisco CA
| | - Maully J. Shah
- Division of Cardiology Children’s Hospital of Philadelphia PA
| | - Thomas Pilcher
- Division of Pediatric Cardiology, Department of Internal Medicine University of Utah Salt Lake City UT
| | - Reinder Evertz
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute Université de Montréal Montreal Quebec Canada
| | - Reina B. Tan
- Division of Pediatric Cardiology New York University Langone Medical Center New York NY
| | - Richard J. Czosek
- Division of Pediatric Cardiology Cincinnati Children’s Hospital Medical Center Cincinnati OH
| | | | - Natasja M. S. de Groot
- Department of Cardiology Erasmus MC, University Medical Center Rotterdam The Netherlands
| |
Collapse
|
36
|
Corbett L, Forster J, Gamlin W, Duarte N, Burgess O, Harkness A, Li W, Simpson J, Bedair R. A practical guideline for performing a comprehensive transthoracic echocardiogram in the congenital heart disease patient: consensus recommendations from the British Society of Echocardiography. Echo Res Pract 2022; 9:10. [PMID: 36253815 PMCID: PMC9578224 DOI: 10.1186/s44156-022-00006-5] [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: 01/26/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Transthoracic echocardiography is an essential tool in the diagnosis, assessment, and management of paediatric and adult populations with suspected or confirmed congenital heart disease. Congenital echocardiography is highly operator-dependent, requiring advanced technical acquisition and interpretative skill levels. This document is designed to complement previous congenital echocardiography literature by providing detailed practical echocardiography imaging guidance on sequential segmental analysis, and is intended for implementation predominantly, but not exclusively, within adult congenital heart disease settings. It encompasses the recommended dataset to be performed and is structured in the preferred order for a complete anatomical and functional sequential segmental congenital echocardiogram. It is recommended that this level of study be performed at least once on all patients being assessed by a specialist congenital cardiology service. This document will be supplemented by a series of practical pathology specific congenital echocardiography guidelines. Collectively, these will provide structure and standardisation to image acquisition and reporting, to ensure that all important information is collected and interpreted appropriately.
Collapse
Affiliation(s)
- Liam Corbett
- grid.437500.50000 0004 0489 5016Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Jan Forster
- grid.415967.80000 0000 9965 1030Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Wendy Gamlin
- grid.498924.a0000 0004 0430 9101Manchester University NHS Foundation Trust, Manchester, UK
| | - Nuno Duarte
- grid.410421.20000 0004 0380 7336University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Owen Burgess
- grid.410421.20000 0004 0380 7336University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Allan Harkness
- grid.507581.e0000 0001 0033 9432East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Wei Li
- grid.7445.20000 0001 2113 8111Royal Brompton and Harefield NHS Foundation Trust, Imperial College of London, London, UK
| | - John Simpson
- grid.483570.d0000 0004 5345 7223Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Radwa Bedair
- grid.410421.20000 0004 0380 7336University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
37
|
Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation. J Imaging 2022; 8:jimaging8100278. [PMID: 36286372 PMCID: PMC9605303 DOI: 10.3390/jimaging8100278] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/25/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
The pulmonary valve (PV) is the least imaged among the heart valves. However, pulmonary regurgitation (PR) and pulmonary stenosis (PS) can occur in a variety of patients ranging from fetuses, newborns (e.g., tetralogy of Fallot) to adults (e.g., endocarditis, carcinoid syndrome, complications of operated tetralogy of Fallot). Due to their complexity, PR and PS are studied using multimodality imaging to assess their mechanism, severity, and hemodynamic consequences. Multimodality imaging is crucial to plan the correct management and to follow up patients with pulmonary valvulopathy. Echocardiography remains the first line methodology to assess patients with PR and PS, but the information obtained with this technique are often integrated with cardiac magnetic resonance (CMR) and computed tomography (CT). This state-of-the-art review aims to provide an updated overview of the usefulness, strengths, and limits of multimodality imaging in patients with PR and PS.
Collapse
|
38
|
Zuo JY, Chen HX, Liu ZG, Yang Q, He GW. Identification and functional analysis of variants of MYH6 gene promoter in isolated ventricular septal defects. BMC Med Genomics 2022; 15:213. [PMID: 36209093 PMCID: PMC9548206 DOI: 10.1186/s12920-022-01365-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background Ventricular septal defect is the most common form of congenital heart diseases. MYH6 gene has a critical effect on the growth and development of the heart but the variants in the promoter of MYH6 is unknown. Patients and methods In 604 of the subjects (311 isolated and sporadic ventricular septal defect patients and 293 healthy controls), DNA was extracted from blood samples and MYH6 gene promoter region variants were analyzed by sequencing. Further functional verification was performed by cellular experiments using dual luciferase reporter gene analysis, electrophoretic mobility shift assays, and bioinformatics analysis. Results Nine variants were identified in the MYH6 gene promoter and two of those variants [g.4085G>C(rs1222539675) and g.4716G>A(rs377648095)] were only found in the ventricular septal defect patients. Cellular function experiments showed that these two variants reduced the transcriptional activity of the MYH6 gene promoter (p < 0.001). Further analysis with online JASPAR database suggests that these variants may alter a set of putative transcription factor binding sites that possibly lead to changes in myosin subunit expression and ventricular septal defect formation. Conclusions Our study for the first time identifies variants in the promoter region of the MYH6 gene in Chinese patients with isolated and sporadic ventricular septal defect. These variants significantly reduced MYH6 gene expression and affected transcription factor binding sites and therefore are pathogenic. The present study provides new insights in the role of the MYH6 gene promoter region to better understand the genetic basis of VSD formation. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01365-y.
Collapse
Affiliation(s)
- Ji-Yang Zuo
- Department of Cardiovascular Surgery, The Institute of Cardiovascular Diseases, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave., Tianjin, 300457, China.,Clinical School of Cardiovascular Disease, Tianjin Medical University, Tianjin, China
| | - Huan-Xin Chen
- Department of Cardiovascular Surgery, The Institute of Cardiovascular Diseases, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave., Tianjin, 300457, China
| | - Zhi-Gang Liu
- Department of Cardiovascular Surgery, The Institute of Cardiovascular Diseases, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave., Tianjin, 300457, China
| | - Qin Yang
- Department of Cardiovascular Surgery, The Institute of Cardiovascular Diseases, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave., Tianjin, 300457, China
| | - Guo-Wei He
- Department of Cardiovascular Surgery, The Institute of Cardiovascular Diseases, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave., Tianjin, 300457, China.
| |
Collapse
|
39
|
Bigler MR, Kadner A, Räber L, Ashraf A, Windecker S, Siepe M, Padalino MA, Gräni C. Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing. J Am Heart Assoc 2022; 11:e027098. [PMID: 36205254 DOI: 10.1161/jaha.122.027098] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are a challenge because of their various anatomic and clinical presentation. Although the prevalence is low, the absolute numbers of detected ACAOS are increasing because of the growing use of noninvasive anatomical imaging for ruling out coronary artery disease. As evidence-based guidelines are lacking, treating physicians are left in uncertainty for the optimal management of such patients. The sole presence of ACAOS does not justify surgical correction, and therefore a thorough anatomic and hemodynamic assessment is warranted. Invasive and noninvasive multimodality imaging provides information to the clinical question whether the presence of ACAOS is an innocent coincidental finding, is responsible for the patient's symptoms, or even might be a risk for sudden cardiac death. Based on recent clinical data, focusing on the pathophysiology of patients with ACAOS, myocardial ischemia is dependent on both the extent of fixed and dynamic components, represented by anatomic high-risk features. These varying combinations should be considered individually in the decision making for the different therapeutic options. This state-of-the-art review focuses on the advantages and limitations of the common contemporary surgical, interventional, and medical therapy with regard to the anatomy and pathophysiology of ACAOS. Further, we propose a therapeutic management algorithm based on current evidence on multimodality invasive and noninvasive imaging findings and highlight remaining gaps of knowledge.
Collapse
Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Alexander Kadner
- Centre for Congenital Heart Disease, Department of Cardiovascular Surgery Inselspital Bern Switzerland
| | - Lorenz Räber
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Afreed Ashraf
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Matthias Siepe
- Centre for Congenital Heart Disease, Department of Cardiovascular Surgery Inselspital Bern Switzerland
| | - Massimo Antonio Padalino
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardio-Thoracic and Vascular Sciences, and Public Health University of Padova, Medical School Padova Italy
| | - Christoph Gräni
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| |
Collapse
|
40
|
von Alvensleben JC, Sandhu A, Chang S, Runciman DM, Wehrmann M, Tzou DW, Schäfer M, Collins KK. High-density electroanatomic mapping with grid catheter in pediatrics and congenital heart disease. J Interv Card Electrophysiol 2022; 66:611-619. [PMID: 36104612 DOI: 10.1007/s10840-022-01364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The Advisor™ HD Grid mapping catheter (Abbott Laboratories; Chicago, IL) allows for bipolar electrogram collection in both orthogonal and perpendicular planes, unique when compared to traditional and branch catheters. Experience in pediatric patients and congenital heart disease (CHD) is limited. The purpose of this work was to evaluate the utility and safety of the Advisor™ HD Grid mapping catheter in pediatric and CHD populations. METHODS Retrospective review of all pediatric patients and those with CHD (regardless of age) at Children's Hospital Colorado and University of Colorado undergoing electrophysiologic study in which the Advisor™ HD Grid mapping catheter was utilized. RESULTS Sixty-five procedures in 60 patients (N = 31 female (47.6%), median age 17 years (15-24.1)) were included. Patients had CHD in 30 procedures (46.1%). Eight-eight arrhythmia substrates were mapped including atrial flutter/intra-atrial reentrant tachycardia (N = 33), focal atrial tachycardia (N = 20), isolated PVCs (N = 10), accessory pathways (N = 9), atrioventricular nodal reentrant tachycardia (N = 7), right ventricular substrate mapping (N = 7), and ventricular tachycardia (N = 2). Median time per map was 11.8 (7.5-20.1) min with 3.2 (± 1.7) maps per procedure and a median of 2634 (1767-7654) points used per map. Patients with CHD required more maps (p < 0.001) and points per map (p < 0.001). Ablation was successful in 92.4% of procedures. CONCLUSIONS The Advisor™ HD Grid mapping catheter is safe and effective in the pediatric and congenital heart disease population. A wide variety of arrhythmia substrates can be mapped with high point density and low mapping time.
Collapse
|
41
|
Backes CH, Hill KD, Shelton EL, Slaughter JL, Lewis TR, Weisz DE, Mah ML, Bhombal S, Smith CV, McNamara PJ, Benitz WE, Garg V. Patent Ductus Arteriosus: A Contemporary Perspective for the Pediatric and Adult Cardiac Care Provider. J Am Heart Assoc 2022; 11:e025784. [PMID: 36056734 PMCID: PMC9496432 DOI: 10.1161/jaha.122.025784] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The burden of patent ductus arteriosus (PDA) continues to be significant. In view of marked differences in preterm infants versus more mature, term counterparts (viewed on a continuum with adolescent and adult patients), mechanisms regulating ductal patency, genetic contributions, clinical consequences, and diagnostic and treatment thresholds are discussed separately, when appropriate. Among both preterm infants and older children and adults, a range of hemodynamic profiles highlighting the markedly variable consequences of the PDA are provided. In most contemporary settings, transcatheter closure is preferable over surgical ligation, but data on longer-term outcomes, particularly among preterm infants, are lacking. The present review provides recommendations to identify gaps in PDA diagnosis, management, and treatment on which subsequent research can be developed. Ultimately, the combination of refined diagnostic thresholds and expanded treatment options provides the best opportunities to address the burden of PDA. Although fundamental gaps remain unanswered, the present review provides pediatric and adult cardiac care providers with a contemporary framework in PDA care to support the practice of evidence-based medicine.
Collapse
Affiliation(s)
- Carl H Backes
- Center for Perinatal Research The Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus OH
- Division of Neonatology Nationwide Children's Hospital Columbus OH
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH
- The Heart Center Nationwide Children's Hospital Columbus OH
| | - Kevin D Hill
- Duke University Pediatric and Congenital Heart Disease Center Durham NC
- Duke Clinical Research Institute Durham NC
| | - Elaine L Shelton
- Department of Pediatrics Vanderbilt University Medical Center Nashville TN
- Department of Pharmacology Vanderbilt University Medical Center Nashville TN
| | - Jonathan L Slaughter
- Center for Perinatal Research The Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus OH
- Division of Neonatology Nationwide Children's Hospital Columbus OH
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH
- Division of Epidemiology, College of Public Health The Ohio State University Columbus OH
| | - Tamorah R Lewis
- Division of Neonatology Children's Mercy-Kansas City Kansas City MO
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation Children's Mercy-Kansas City Kansas City MO
- Department of Pediatrics University of Missouri-Kansas City School of Medicine Kansas City MO
| | - Dany E Weisz
- Department of Paediatrics University of Toronto Ontario Canada
- Department of Newborn and Developmental Paediatrics Sunnybrook Health Science Center Toronto Ontario Canada
| | - May Ling Mah
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH
- The Heart Center Nationwide Children's Hospital Columbus OH
| | - Shazia Bhombal
- Division of Neonatal and Developmental Medicine, Department of Pediatrics Stanford University School of Medicine, Lucille Packard Children's Hospital Stanford CA
| | - Charles V Smith
- Center for Integrated Brain Research University of Washington School of Medicine Seattle WA
| | - Patrick J McNamara
- Department of Pediatrics University of Iowa Iowa City IA
- Department of Internal Medicine University of Iowa Iowa City IA
| | - William E Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics Stanford University School of Medicine, Lucille Packard Children's Hospital Stanford CA
| | - Vidu Garg
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH
- The Heart Center Nationwide Children's Hospital Columbus OH
- Center for Cardiovascular Research The Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus OH
- Department of Molecular Genetics The Ohio State University Columbus OH
| |
Collapse
|
42
|
Anomalous Coronary Artery Presented with Typical Chest Pain: What is Define The Malignant from Benign Anomalous Coronary Artery (A Case Series). COR ET VASA 2022. [DOI: 10.33678/cor.2021.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
43
|
Dodeja AK, Tan Y, Ackley T, Russell J, Kertesz N, Daniels CJ, Kamp A. PentaRay® Multielectrode Mapping Catheter for Atrial Tachyarrhythmia in Adults With Congenital Heart Disease. Tex Heart Inst J 2022; 49:e207535. [PMID: 36269883 PMCID: PMC9632387 DOI: 10.14503/thij-20-7535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Ablation of atrial tachyarrhythmia in adults with congenital heart disease (ACHD) is challenging because of complex anatomy and high scar burden. We proposed that the addition of high-density mapping with the PentaRay® (Biosense Webster, Inc) mapping catheter (EAM+P) to 3-dimensional electroanatomic mapping (EAM) allows for rapid acquisition of high-resolution maps and shorter procedure times. METHODS In this single-center, retrospective cohort study of patients with ACHD who underwent atrial arrhythmia ablation, patients were divided those who underwent ablation with EAM and those who underwent ablation with EAM+P. RESULTS Fifteen ablations were performed in 13 patients using standard EAM, and 11 ablations were performed in 10 patients using EAM+P. There was no difference in mean age or complexity of congenital heart disease. The procedure duration was 1.5 times longer in the EAM than in the EAM+P group (P = .015). The dose area product was 12 times higher in the EAM than in the EAM+P group (P = .001). A higher number of venous access sites were used for EAM cases than for EAM+P cases (P = .008). Acute success rates of ablation and recurrence rates at 1 year were similar in the 2 groups. There were no procedure-related complications in either group. CONCLUSION This is the first study to evaluate the use of the PentaRay® high-density mapping catheter for ablation of atrial tachyarrhythmia in patients with ACHD. The use of the PentaRay® high-density mapping catheter results in shorter procedure time, decreased radiation exposure, and fewer venous access sites.
Collapse
Affiliation(s)
- Anudeep K. Dodeja
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yubo Tan
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Tamara Ackley
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer Russell
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Naomi Kertesz
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Curt J. Daniels
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anna Kamp
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
44
|
Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
| | | |
Collapse
|
45
|
Zhuang B, Yu S, Feng Z, He F, Jiang Y, Zhao S, Lu M, Li S. Left ventricular strain derived from cardiac magnetic resonance can predict outcomes of pulmonary valve replacement in patients with repaired tetralogy of Fallot. Front Cardiovasc Med 2022; 9:917026. [PMID: 36061553 PMCID: PMC9433663 DOI: 10.3389/fcvm.2022.917026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeSeveral adults with repaired tetralogy of Fallot (rToF) undergo pulmonary valve replacement (PVR) to reduce the right ventricular volume and retain right ventricular function. However, there is currently no consensus on the ideal time for PVR surgery in asymptomatic patients with rTOF with pulmonary regurgitation (PR). Clinical outcomes after PVR are also indeterminate. Recently, myocardial strain and strain rate derived from cardiac magnetic resonance (CMR) feature tracking were found to be more sensitive to right ventricular dysfunction than conventional parameters and therefore may add prognostic value in patients with rToF. We aimed to analyze whether pre-PVR left ventricular (LV) strain and strain rate detected by CMR feature tracking are associated with midterm outcomes after PVR in patients with rToF.MethodsSeventy-eight asymptomatic patients with rToF who required PVR due to moderate or severe PR were prospectively enrolled between January 2014 and June 2020. CMR cine sequences were obtained, and feature tracking parameters were measured preoperatively. Adverse events were documented during the follow-up. Receiver operating characteristic analysis was performed to determine the cutoff value. Kaplan–Meier curves were drawn with log-rank statistics; moreover, univariate and multivariate Cox proportional hazards regression analyses and Harrel C-indices were analyzed.ResultsDuring 3.6 ± 1.8 years of follow-up, 25 adverse events were recorded. Kaplan–Meier survival curves and univariate Cox analysis verified that patients with significantly reduced radial strain (RS), circumferential strain (CS), longitudinal strain (LS), RS rate at systole and diastole (RSRs and RSRe), and circumferential and LS rates at diastole (CSRe and LSRe) had worse event-free survival. After multivariate correction, only LS and LSRe remained significantly associated with adverse outcomes (hazard ratio = 1.243 [1.083–1.428] and 0.067 [0.017–0.258], respectively, all p < 0.05). The cutoff values of LS and LSRe were −12.30 (%) and 1.07 (s–1), respectively.ConclusionThe LV strain and strain rate prior to PVR are important prognostic factors for adverse events after PVR in rToF.
Collapse
Affiliation(s)
- Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiqin Yu
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zicong Feng
- Pediatric Cardiac Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengpu He
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Yong Jiang
- Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Echocardiography, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Minjie Lu,
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Shoujun Li,
| |
Collapse
|
46
|
Zhao CZ, Yan Y, Cui Y, Zhu N, Ding XY. Sequential multidisciplinary minimally invasive therapeutic strategy for heart failure caused by four diseases: A case report. World J Clin Cases 2022; 10:8255-8261. [PMID: 36159518 PMCID: PMC9403706 DOI: 10.12998/wjcc.v10.i23.8255] [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: 12/08/2021] [Revised: 06/18/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coexistence with patent ductus arteriosus (PDA), mitral valve prolapse (MVP), atrial fibrillation (AF) and hyperthyroidism is extremely rare and complex. The optimal therapeutic strategy is difficult to develop.
CASE SUMMARY A 27-year-old female with PDA, MVP, AF and hyperthyroidism presented with severe dyspnea. Given that a one-stage operation for PDA, MVP and AF is high risk, we preferred a sequential multidisciplinary minimally invasive therapeutic strategy. First, PDA transcatheter closure was performed. Hyperthyroidism and heart failure were simultaneously controlled via medical treatment. Video-assisted thoracoscopic mitral valve repair and left atrial appendage occlusion were performed when heart failure was controlled. Under this therapeutic strategy, the patient’s sinus rhythm was restored and maintained. Two years after the treatment, the symptoms of heart failure were relieved, and the enlarged heart was reversed.
CONCLUSION Sequential multidisciplinary therapeutic strategies, which take advantage of both internal medicine and surgical approaches, might be reasonable for this type of disease.
Collapse
Affiliation(s)
- Chen-Ze Zhao
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Yan Yan
- Department of Cardiothoracic Surgery, No. 903 Hospital of Chinese People's Liberation Army, Hangzhou 310043, Zhejiang Province, China
| | - Yong Cui
- Department of Cardiothoracic Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Ni Zhu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou 310003, Zhejiang Province, China
| | - Xue-Yan Ding
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China
| |
Collapse
|
47
|
Mok T, Woods A, Small A, Canobbio MM, Tandel MD, Kwan L, Lluri G, Reardon L, Aboulhosn J, Lin J, Afshar Y. Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term. J Am Heart Assoc 2022; 11:e025791. [PMID: 35943056 PMCID: PMC9496287 DOI: 10.1161/jaha.122.025791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Current recommendations for delivery timing of pregnant persons with congenital heart disease (CHD) are based on expert opinion. Justification for early-term birth is based on the theoretical concern of increased cardiovascular stress. The objective was to evaluate whether early-term birth with maternal CHD is associated with lower adverse maternal or neonatal outcomes. Methods and Results This is a retrospective cohort study of pregnant persons with CHD who delivered a singleton after 37 0/7 weeks gestation at a quaternary care center with a multidisciplinary cardio-obstetrics care team between 2013 and 2021. Patients were categorized as early-term (37 0/7 to 38 6/7 weeks) or full-term (≥39 0/7) births and compared. Multivariable logistic regression was conducted to calculate the adjusted odds ratio for the primary outcomes. The primary outcomes were composite adverse cardiovascular, maternal obstetric, and adverse neonatal outcome. Of 110 pregnancies delivering at term, 55 delivered early-term and 55 delivered full-term. Development of adverse cardiovascular and maternal obstetric outcome was not significantly different by delivery timing. The rate of composite adverse neonatal outcomes was significantly higher in early-term births (36% versus 5%, P<0.01). After adjusting for confounding variables, early-term birth remained associated with a significantly increased risk of adverse neonatal outcomes (adjusted odds ratio 11.55 [95% CI, 2.59-51.58]). Conclusions Early-term birth for pregnancies with maternal CHD was associated with an increased risk of adverse neonatal outcomes, without an accompanying decreased rate in adverse cardiovascular or obstetric outcomes. In the absence of maternal or fetal indications for early birth, induction of labor before 39 weeks for pregnancies with maternal CHD should be reserved for routine obstetrical indications.
Collapse
Affiliation(s)
- Thalia Mok
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology University of California Los Angeles CA
| | - Allison Woods
- Department of Anesthesiology and Perioperative Medicine University of California Los Angeles CA
| | - Adam Small
- Division of Cardiology, Department of Medicine New York University Langone Health New York NY
| | - Mary M Canobbio
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CA.,UCLA School of Nursing University of California Los Angeles CA
| | - Megha D Tandel
- Department of Urology University of California Los Angeles CA
| | - Lorna Kwan
- Department of Urology University of California Los Angeles CA
| | - Gentian Lluri
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CA
| | - Leigh Reardon
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CA
| | - Jamil Aboulhosn
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CA
| | - Jeannette Lin
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CA
| | - Yalda Afshar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology University of California Los Angeles CA
| |
Collapse
|
48
|
Sierra-Galan LM, Bhatia M, Alberto-Delgado AL, Madrazo-Shiordia J, Salcido C, Santoyo B, Martinez E, Soto ME. Cardiac Magnetic Resonance in Rheumatology to Detect Cardiac Involvement Since Early and Pre-clinical Stages of the Autoimmune Diseases: A Narrative Review. Front Cardiovasc Med 2022; 9:870200. [PMID: 35911548 PMCID: PMC9326004 DOI: 10.3389/fcvm.2022.870200] [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: 02/06/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Autoimmune diseases (ADs) encompass multisystem disorders, and cardiovascular involvement is a well-known feature of autoimmune and inflammatory rheumatic conditions. Unfortunately, subclinical and early cardiovascular involvement remains clinically silent and often undetected, despite its well-documented impact on patient management and prognostication with an even more significant effect on severe and future MACE events as the disease progresses. Cardiac magnetic resonance imaging (MRI), today, commands a unique position of supremacy versus its competition in cardiac assessment and is the gold standard for the non-invasive evaluation of cardiac function, structure, morphology, tissue characterization, and flow with the capability of evaluating biventricular function; myocardium for edema, ischemia, fibrosis, infarction; valves for thickening, large masses; pericardial inflammation, pericardial effusions, and tamponade; cardiac cavities for thrombosis; conduction related abnormalities and features of microvascular and large vessel involvement. As precise and early detection of cardiovascular involvement plays a critical role in improving the outcome of rheumatic and autoimmune conditions, our review aims to highlight the evolving role of CMR in systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), rheumatoid arthritis (RA), systemic sclerosis (SSc), limited sclerosis (LSc), adult-onset Still's disease (AOSD), polymyositis (PM), dermatomyositis (DM), eosinophilic granulomatosis with polyangiitis (EGPA) (formerly Churg-Strauss syndrome), and DRESS syndrome (DS). It draws attention to the need for concerted, systematic global interdisciplinary research to improve future outcomes in autoimmune-related rheumatic conditions with multiorgan, multisystem, and cardiovascular involvement.
Collapse
Affiliation(s)
- Lilia M. Sierra-Galan
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Mona Bhatia
- Department of Imaging, Fortis Escorts Heart Institute, New Delhi, India
| | | | - Javier Madrazo-Shiordia
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Carlos Salcido
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Bernardo Santoyo
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Eduardo Martinez
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Maria Elena Soto
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
- Immunology Department of the National Institute of Cardiology, “Ignacio Chavez”, Mexico City, Mexico
| |
Collapse
|
49
|
Meidell Blylod V, Rinnström D, Pennlert J, Ostenfeld E, Dellborg M, Sörensson P, Christersson C, Thilén U, Johansson B. Interventions in Adults With Repaired Coarctation of the Aorta. J Am Heart Assoc 2022; 11:e023954. [PMID: 35861813 PMCID: PMC9707821 DOI: 10.1161/jaha.121.023954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Coarctation of the aorta coexists with other cardiac anomalies and has long‐term complications, including recoarctation, which may require intervention after the primary coarctation repair. This study aims to clarify the prevalence of and risk factors for interventions related to the coarctation complex as well as late mortality in a large contemporary patient population.
Methods and Results
The Swedish National Register of Congenital Heart Disease was used, which comprised 683 adults with repaired coarctation of the aorta. Analysis was performed on freedom from intervention thereafter at the coarctation site, aortic valve, left ventricular outflow tract, or ascending aorta. One hundred ninety‐six (29%) patients had at least 1 of these interventions. Estimated freedom from either of these interventions was 60% after 50 years. The risk of undergoing such an intervention was higher among men (hazard ratio, 1.6 [95% CI, 1.2–2.2]). Estimated freedom from another intervention at the coarctation site was 75% after 50 years. In women, there was an increase in interventions at the coarctation site after 45 years. Patients who underwent one of the previously mentioned interventions after the primary coarctation repair had poorer left ventricular function. Eighteen patients (3%) died during follow‐up in the register. The standardized mortality ratio was 2.9 (95% CI, 1.7–4.3).
Conclusions
Interventions are common after coarctation repair. The risk for and time of interventions are affected by sex. Our results have implications for planning follow‐up and giving appropriate medical advice to the growing population of adults with repaired coarctation of the aorta.
Collapse
Affiliation(s)
| | - Daniel Rinnström
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
- Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
| | - Johanna Pennlert
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund Clinical Physiology, Lund University Lund Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine University of Gothenburg Gothenburg Sweden
| | - Peder Sörensson
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | | | - Ulf Thilén
- Department of Clinical Sciences Lund Cardiology, Lund University Lund Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
- Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
| |
Collapse
|
50
|
Shang X, Dong N, Zhang C, Wang Y. The Clinical Trial Outcomes of Med-Zenith PT-Valve in the Treatment of Patients With Severe Pulmonary Regurgitation. Front Cardiovasc Med 2022; 9:887886. [PMID: 35783837 PMCID: PMC9243481 DOI: 10.3389/fcvm.2022.887886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Nearly 2/3 of patients with dilated right ventricular outflow tract (RVOT) were excluded from pulmonary valves transplantation due to the lack of size-matched valves. Here, we explored the safety and efficacy of the Med-Zenith PT-Valve for the treatment of patients with severe pulmonary regurgitation. Methods 22 Patients with severe PR (grade 3+,4+) were enrolled based on the anatomical features of native RVOT and the valve design. The immediate, 3-months and 1-year post-procedural follow-up data were analyzed. Results The baseline mean systolic diameters in the distal main pulmonary artery (MPA), MPA sinus junction, MPA sinus, pulmonary annulus, RVOT aneurysm and muscular outlet measured with computed tomography were 33.6 ± 6.1, 34.0 ± 5.8, 37.9 ± 6.0, 32.4 ± 7.3, 41.9 ± 9.3, and 34.4 ± 8.0 mm, respectively. The PT-Valve landing zone was set within these levels. Successful valve implantations were achieved in all patients without noticeable device malposition, coronary artery compression, pulmonary branch obstruction or paravalvular leak during follow-ups. Post-procedural pulmonary artery diastolic pressure increased from 5.8 ± 3.1 to 11.3 ± 2.5 mmHg. In the 3-month and 1-year follow-up, the right ventricular end diastolic volume index reduced from the baseline 181.6 ± 29.0 to 143.7 ± 29.7 ml/m2 and 123.4 ± 31.2 ml/m2, and the trans-pulmonary valve gradient decreased from 25.6 ± 22.2 to 10.64 ± 3.54 mmHg and 11.16 ± 3.0 mmHg, respectively. The 6-min walk distance increased from 416.6 ± 97.9 to 455.9 ± 64.6 m and 467.8 ± 61.2 m, respectively. Conclusion This clinical trial revealed favorable outcomes for the safety, efficacy and feasibility of the Med-Zenith PT-Valve in the treatment of severe PR with significantly enlarged RVOT.
Collapse
Affiliation(s)
- Xiaoke Shang
- Department of General Medicine and Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changdong Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanggan Wang
- Department of General Medicine and Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Medical Research Institute of Wuhan University, Wuhan University, Wuhan, China
- *Correspondence: Yanggan Wang
| |
Collapse
|