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Rosamilia MB, Williams J, Bair CA, Mulder H, Chiswell KE, D'Ottavio AA, Hartman RJ, Sang CJ, Welke KF, Walsh MJ, Hoffman TM, Landstrom AP, Li JS, Sarno LA. Risk Factors and Outcomes Associated with Gaps in Care in Children with Congenital Heart Disease. Pediatr Cardiol 2024; 45:976-985. [PMID: 38485760 PMCID: PMC11056317 DOI: 10.1007/s00246-024-03414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
Adults with congenital heart disease (CHD) benefit from cardiology follow-up at recommended intervals of ≤ 2 years. However, benefit for children is less clear given limited studies and unclear current guidelines. We hypothesize there are identifiable risks for gaps in cardiology follow-up in children with CHD and that gaps in follow-up are associated with differences in healthcare utilization. Our cohort included children < 10 years old with CHD and a healthcare encounter from 2008 to 2013 at one of four North Carolina (NC) hospitals. We assessed associations between cardiology follow-up and demographics, lesion severity, healthcare access, and educational isolation (EI). We compared healthcare utilization based on follow-up. Overall, 60.4% of 6,969 children received cardiology follow-up within 2 years of initial encounter, including 53.1%, 58.1%, and 79.0% of those with valve, shunt, and severe lesions, respectively. Factors associated with gaps in care included increased drive time to a cardiology clinic (Hazard Ratio (HR) 0.92/15-min increase), EI (HR 0.94/0.2-unit increase), lesion severity (HR 0.48 for shunt/valve vs severe), and older age (HR 0.95/month if < 1 year old and 0.94/year if > 1 year old; p < 0.05). Children with a care gap subsequently had more emergency department (ED) visits (Rate Ratio (RR) 1.59) and fewer inpatient encounters and procedures (RR 0.51, 0.35; p < 0.05). We found novel factors associated with gaps in care for cardiology follow-up in children with CHD and altered health care utilization with a gap. Our findings demonstrate a need to mitigate healthcare barriers and generate clear cardiology follow-up guidelines for children with CHD.
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Affiliation(s)
| | - Jason Williams
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
| | | | - Hillary Mulder
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Karen E Chiswell
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Alfred A D'Ottavio
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Robert J Hartman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, NC, USA
| | - Charlie J Sang
- Department of Pediatrics, Division of Pediatric Cardiology, East Carolina University, Greenville, NC, USA
| | - Karl F Welke
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Michael J Walsh
- Department of Pediatrics, Division of Pediatric Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Timothy M Hoffman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, NC, USA
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
- Department of Cell Biology, Duke School of Medicine, Durham, NC, USA
| | - Jennifer S Li
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Lauren A Sarno
- Department of Pediatrics, Division of Pediatric Cardiology, East Carolina University, Greenville, NC, USA.
- Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA.
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Ivey LC, Ahmad A, Chen J, Rodriguez Iii FH, Raskind-Hood C, Book WM. Anatomic and physiologic classification of adults with congenital heart disease to predict adverse outcomes: Use of administrative codes compared to clinical staging. Am Heart J 2024; 271:12-19. [PMID: 38367894 DOI: 10.1016/j.ahj.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The 2018 anatomic physiologic (AP) classification American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for Adults with Congenital Heart Disease (ACHD) encompasses both native and post-operative anatomy and physiology to guide care management. As some physiologic conditions and post-operative states lack specific International Classification of Diseases (ICD) 9- Clinical Modification (CM) and 10-CM codes, an ICD code-based classification approximating the ACHD AP classification is needed for population-based studies. METHODS A total of 232 individuals, aged ≥ 18 years at the time of a health encounter between January 1, 2010 and December 31, 2019 and identified with at least one of 87 ICD codes for a congenital heart defect were validated through medical chart review. Individuals were assigned one of 4 mutually exclusive modified AP classification categories: (1) severe AB, (2) severe CD, (3) non-severe AB, or (4) non-severe CD, based on native anatomy "severe" or "non-severe" and physiology AB ("none" or "mild") or CD ("moderate" or "severe") by two methods: (1) medical record review, and (2) ICD and Current Procedural Terminology (CPT) code-based classification. The composite outcome was defined as a combination of a death, emergency department (ED) visits, or any hospitalizations that occurred at least 6 months after the index date and was assessed by each modified AP classification method. RESULTS Of 232 cases (52.2% male, 71.1% White), 28.4% experienced a composite outcome a median of 1.6 years after the index encounter. No difference in prediction of the composite outcome was seen based on modified AP classification between chart review and ICD code-based methodology. CONCLUSION Modified AP classification by chart review and ICD codes are comparable in predicting the composite outcome at least 6 months after classification. Modified AP classification using ICD code-based classification of CHD native anatomy and physiology is an important tool for population-based ACHD surveillance using administrative data.
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Affiliation(s)
- Lindsey C Ivey
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Attila Ahmad
- Gill Heart & Vascular Institute, Pavilion-G UK Albert B. Chandler Hospital, Department of Medicine and department of Pediatrics, Lexington, KY
| | | | | | - Cheryl Raskind-Hood
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Wendy M Book
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA; Emory University School of Medicine, Cardiology, Atlanta, GA.
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Ghorbannia A, Jurkiewicz H, Nasif L, Ahmed A, Co-Vu J, Maadooliat M, Woods RK, LaDisa JF. Coarctation Duration and Severity Predict Risk of Hypertension Precursors in a Preclinical Model and Hypertensive Status Among Patients. Hypertension 2024; 81:1115-1124. [PMID: 38501250 PMCID: PMC11023794 DOI: 10.1161/hypertensionaha.123.22142] [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: 10/12/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Coarctation of the aorta (CoA) often leads to hypertension posttreatment. Evidence is lacking for the current >20 mm Hg peak-to-peak blood pressure (BP) gradient (BPGpp) guideline, which can cause aortic thickening, stiffening, and dysfunction. This study sought to find the BPGpp severity and duration that avoid persistent dysfunction in a preclinical model and test if predictors translate to hypertension status in patients with CoA. METHODS Rabbits (n=75; 5-12/group) were exposed to mild, intermediate, or severe CoA (≤12, 13-19, ≥20 mm Hg BPGpp) for ≈1, 3, or 22 weeks using dissolvable and permanent sutures with thickening, stiffening, contraction, and endothelial function evaluated via multivariate regression. Relevance to patients with CoA (n=239; age, 0.01-46 years; median 3.7 months) was tested by retrospective review of predictors (preoperative BPGpp, surgical age, etc.) versus follow-up hypertension status. RESULTS CoA duration and severity were predictive of aortic remodeling and active dysfunction in rabbits, and hypertension in patients with CoA. Interaction between patient age and BPGpp at surgery contributed significantly to hypertension, similar to rabbits, suggesting preclinical findings translate to patients. Machine learning decision tree analysis uncovered that preoperative BPGpp and surgical age predict risk of hypertension along with residual postoperative BPGpp. CONCLUSIONS These findings suggest the current BPGpp threshold determined decades ago is likely too high to prevent adverse coarctation-induced aortic remodeling. The results and decision tree analysis provide a foundation for revising CoA treatment guidelines considering the interaction between CoA severity and duration to limit the risk of hypertension.
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Affiliation(s)
- Arash Ghorbannia
- Division of Cardiology, Department of Pediatrics, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, (A.G., H.J., J.F.L.D.)
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, (A.G., J.F.L.D.)
- Pratt School of Engineering, Duke University, Durham, NC (A.G.)
| | - Hilda Jurkiewicz
- Division of Cardiology, Department of Pediatrics, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, (A.G., H.J., J.F.L.D.)
| | - Lith Nasif
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, (L.N., A.A., J.C.-V.)
| | - Abdillahi Ahmed
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, (L.N., A.A., J.C.-V.)
| | - Jennifer Co-Vu
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, (L.N., A.A., J.C.-V.)
| | - Mehdi Maadooliat
- Department of and Statistical Sciences, Marquette University, Milwaukee, Wisconsin (M.M.)
| | - Ronald K. Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Children’s Wisconsin, Milwaukee, (R.K.W.)
| | - John F. LaDisa
- Division of Cardiology, Department of Pediatrics, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, (A.G., H.J., J.F.L.D.)
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, (A.G., J.F.L.D.)
- Departments of Physiology, and Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, (J.F.L.D.)
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Kanduri J, Falk Z, Singh HS. Diagnosis and Management of Congenital Coronary Artery Fistulas in Adults. Curr Cardiol Rep 2024; 26:373-379. [PMID: 38466533 DOI: 10.1007/s11886-024-02038-1] [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] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE OF REVIEW This review describes the presentation, diagnosis, and management of congenital coronary artery fistulas (CAFs) in adults. RECENT FINDINGS CAFs are classified as coronary-cameral or coronary arteriovenous fistulas. Fistulous connections at the distal coronary bed are more likely to be aneurysmal with higher risk of thrombosis and myocardial infarction (MI). Medium-to-large or symptomatic CAFs can manifest as ischemia, heart failure, and arrhythmias. CAF closure is recommended when there are attributable symptoms or evidence of adverse coronary remodeling. Closure is usually achievable using transcatheter techniques, though large fistulas may require surgical ligation with bypass. Given their anatomic complexity, cardiac CT with multiplanar 3-D reconstruction can enhance procedural planning of CAF closure. Antiplatelet and anticoagulation are essential therapies in CAF management. CAFs are rare cardiac anomalies with variable presentations and complex anatomy. CAF management strategies include indefinite medical therapy, percutaneous or surgical CAF closure, and lifelong patient surveillance.
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Affiliation(s)
- Jaya Kanduri
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70 Street, New York, NY, 10021, USA.
| | - Zachary Falk
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70 Street, New York, NY, 10021, USA
| | - Harsimran S Singh
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70 Street, New York, NY, 10021, USA
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Kiyoshima D, Tanaka O, Terayama H, Qu N, Nagahori K, Ueda Y, Yamamoto M, Suyama K, Hayashi S, Sakabe K. Right and Left Coronary and Conus Arteries Originating from Three Separate Ostia in the Right Valsalva Sinus in a Japanese Cadaver: A Case Study with Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:730. [PMID: 38792913 PMCID: PMC11123433 DOI: 10.3390/medicina60050730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
A rare case of an anomalous location of the orifice of the coronary artery was found in a 99-year-old male cadaver undergoing routine dissection. The presence of the right coronary artery (RCA), left coronary artery (LCA), and conus artery (conus branch) originating from the right Valsalva sinus are the characteristic findings of this case. Then, the LCA passed through the aorta and the pulmonary artery. The LCA and RCA branches were normal. These findings are useful for future surgical procedures, including cardiac catheterization.
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Affiliation(s)
- Daisuke Kiyoshima
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
| | - Osamu Tanaka
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
| | - Hayato Terayama
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Ning Qu
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Kenta Nagahori
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
| | - Yoko Ueda
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
| | - Masahito Yamamoto
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
| | - Kaori Suyama
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Kou Sakabe
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-si 259-1193, Kanagawa, Japan; (D.K.); (O.T.); (N.Q.); (K.N.); (Y.U.); (M.Y.); (K.S.); (S.H.)
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
- Department of Environmental Preventive Medicine, Yamada Bee Company, Inc., Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba-si 263-8522, Chiba, Japan
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Akiyama N, Ochiai R, Nitta M, Shimizu S, Kaneko M, Kuraoka A, Nakai M, Sumita Y, Ishizu T. In-Hospital Death and End-of-Life Status Among Patients With Adult Congenital Heart Disease - A Retrospective Study Using the JROAD-DPC Database in Japan. Circ J 2024; 88:631-639. [PMID: 38072440 DOI: 10.1253/circj.cj-23-0537] [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: 04/26/2024]
Abstract
BACKGROUND The end-of-life (EOL) status, including age at death and treatment details, of patients with adult congenital heart disease (ACHD) remains unclear. This study investigated the EOL status of patients with ACHD using a nationwide Japanese database.Methods and Results: Data on the last hospitalization of 26,438 patients with ACHD aged ≥15 years, admitted between 2013 and 2017, were included. Disease complexity (simple, moderate, or great) was classified using International Classification of Diseases, 10th Revision codes. Of the 853 deaths, 831 patients with classifiable disease complexity were evaluated for EOL status. The median age at death of patients in the simple, moderate, and great disease complexity groups was 77.0, 66.5, and 39.0 years , respectively. The treatments administered before death to patients in the simple, moderate, and great complexity groups included cardiopulmonary resuscitation (30.1%, 35.7%, and 41.9%, respectively), percutaneous cardiopulmonary support (7.2%, 16.5%, and 16.3%, respectively), and mechanical ventilation (58.7%, 72.2%, and 75.6%, respectively). Overall, 70% of patients died outside of specialized facilities, with >25% dying after ≥31 days of hospitalization. CONCLUSIONS Nationwide data showed that patients with ACHD with greater disease complexity died at a younger age and underwent more invasive treatments before death, with many dying after ≥1 month of hospitalization. Discussing EOL options with patients at the appropriate time is important, particularly for patients with greater disease complexity.
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Affiliation(s)
- Naomi Akiyama
- Department of Nursing, School of Medicine, Yokohama City University
| | - Ryota Ochiai
- Department of Nursing, School of Medicine, Yokohama City University
| | - Manabu Nitta
- Department of Cardiology, Yokohama City University Graduate School of Medicine
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital
| | - Sayuri Shimizu
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University
| | - Makoto Kaneko
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University
| | - Ayako Kuraoka
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - 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
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba
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Roy J, Reynolds W, Panigrahy A, Ceschin R. Functional network organization is locally atypical in children and adolescents with congenital heart disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.19.24306106. [PMID: 38699341 PMCID: PMC11065028 DOI: 10.1101/2024.04.19.24306106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Children and adolescents with congenital heart disease (CHD) frequently experience neurodevelopmental impairments that can impact academic performance, memory, attention, and behavioral function, ultimately affecting overall quality of life. This study aims to investigate the impact of CHD on functional brain network connectivity and cognitive function. Using resting-state fMRI data, we examined several network metrics across various brain regions utilizing weighted networks and binarized networks with both absolute and proportional thresholds. Regression models were fitted to patient neurocognitive exam scores using various metrics obtained from all three methods. Our results unveil significant differences in network connectivity patterns, particularly in temporal, occipital, and subcortical regions, across both weighted and binarized networks. Furthermore, we identified distinct correlations between network metrics and cognitive performance, suggesting potential compensatory mechanisms within specific brain regions.
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Lopez C, Glassberg B, Dembar A, Riasat M, Chan A, Govindarajulu U, Hopkins KA, Zaidi AN. Transition of care in CHD: a single-centre experience: an enigma remains. Cardiol Young 2024; 34:727-733. [PMID: 37771146 DOI: 10.1017/s1047951123002548] [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: 09/30/2023]
Abstract
Transition of care refers to the continuity of health care during the movement from one healthcare setting to another as care needs change during a chronic illness. We sought to describe social, demographic, and clinical factors related to successful transition in a tertiary urban care facility in patients with CHD. Patients were identified utilising the electronic medical record. Inclusion criteria were patients with CHDs aged ≥15 years seen in the paediatric cardiology clinic between 2013 and 2014. Deceased patients were excluded. Clinical and demographic variables were collected. Patient charts were reviewed in 2015-2021 to determine if included patients were a) still in paediatric cardiology care, b) transitioned to adult cardiology/adult CHD, or were c) lost to follow-up. A total of 322 patients, 53% male (N:172), 46% female (N:149) were included. Majority had moderately complex lesions (N:132, 41%). Most patients had public insurance (N:172, 53%), followed by private insurance (N:67, 21%), while 15% of patients (N:47) were uninsured. Only 49% (N = 159) had successful transition, while 22% (N = 70) continued in care with paediatric cardiology, and 29% (N = 93) were lost to follow-up. Severity of CHD (p = 0.0002), having healthcare insurance (p < .0001), presence of a defibrillator (p = 0.0028), and frequency of paediatric cardiology visits (p = 0.0005) were significantly associated with successful transition. Most patients lost to follow-up (N:42,62%) were either uninsured or had public insurance. Lack of successful transition is multifactorial, and further efforts are needed to improve the process in patients with CHD.
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Affiliation(s)
| | | | | | - Maria Riasat
- Department of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Alice Chan
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, New York, NY, USA
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kali A Hopkins
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, New York, NY, USA
| | - Ali N Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, New York, NY, USA
- Mount Sinai Children's Heart Center, Kravis Children's Hospital, New York, NY, USA
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Ghorbannia A, Jurkiewicz H, Nasif L, Ahmed A, Co-Vu J, Maadooliat M, Woods RK, LaDisa JF. Coarctation duration and severity predict risk of hypertension precursors in a preclinical model and hypertensive status among patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.30.23297766. [PMID: 37961634 PMCID: PMC10635238 DOI: 10.1101/2023.10.30.23297766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Coarctation of the aorta (CoA) often leads to hypertension (HTN) post-treatment. Evidence is lacking for the current >20 mmHg peak-to-peak blood pressure gradient (BPGpp) guideline, which can cause aortic thickening, stiffening and dysfunction. This study sought to find the BPGpp severity and duration that avoid persistent dysfunction in a preclinical model, and test if predictors translate to HTN status in CoA patients. Methods Rabbits (N=75; 5-12/group) were exposed to mild, intermediate or severe CoA (≤12, 13-19, ≥20 mmHg BPGpp) for ~1, 3 or 22 weeks using dissolvable and permanent sutures with thickening, stiffening, contraction and endothelial function evaluated via multivariate regression. Relevance to CoA patients (N=239; age=0.01-46 years; median 3.7 months) was tested by retrospective review of predictors (preoperative BPGpp, surgical age, etc.) vs follow-up HTN status. Results CoA duration and severity were predictive of aortic remodeling and active dysfunction in rabbits, and HTN in CoA patients. Interaction between patient age and BPGpp at surgery contributed significantly to HTN, similar to rabbits, suggesting preclinical findings translate to patients. Machine learning decision tree analysis uncovered that pre-operative BPGpp and surgical age predict risk of HTN along with residual post-operative BPGpp. Conclusions These findings suggest the current BPGpp threshold determined decades ago is likely too high to prevent adverse coarctation-induced aortic remodeling. The results and decision tree analysis provide a foundation for revising CoA treatment guidelines considering the interaction between CoA severity and duration to limit the risk of HTN.
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Affiliation(s)
- Arash Ghorbannia
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Pratt School of Engineering, Duke University, Durham, NC USA
| | - Hilda Jurkiewicz
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lith Nasif
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, Florida, USA
| | - Abdillahi Ahmed
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, Florida, USA
| | - Jennifer Co-Vu
- Pediatric Cardiology, University of Florida Health Congenital Heart Center, Gainesville, Florida, USA
| | - Mehdi Maadooliat
- Department of and Statistical Sciences, Marquette University, Milwaukee, Wisconsin, USA
| | - Ronald K. Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - John F. LaDisa
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Departments of Physiology, and Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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10
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Tsukioka Y, Jeevanandam V. Successful Heart Transplantation Without Blood Transfusion in a Jehovah's Witness Patient With Congenitally Corrected Transposition of the Great Arteries: A Case Report. Cureus 2024; 16:e56997. [PMID: 38681389 PMCID: PMC11045670 DOI: 10.7759/cureus.56997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
We report a case of heart transplantation in a 68-year-old Jehovah's Witness patient with congenitally corrected transposition of the great arteries (ccTGA) who developed heart failure due to right ventricular dysfunction. The patient underwent successful heart transplantation without the use of blood products, employing meticulous hemostasis and careful surgical planning. This case highlights the anatomical considerations and challenges in transplanting a heart in a patient with ccTGA, including the reversed positions of the pulmonary artery and the ascending aorta. It also emphasizes the importance of tailored surgical strategies to achieve hemostasis and avoid blood transfusion in Jehovah's Witness patients. This case adds to the limited literature on heart transplantation in patients with ccTGA and demonstrates that heart transplantation can be successfully performed without blood transfusion in Jehovah's Witness patients.
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Affiliation(s)
- Yusuke Tsukioka
- Cardiothoracic Surgery, University of Chicago Medicine, Chicago, USA
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11
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Soma K, Yao A. Hospitalizations in Adult Patients With Congenital Heart Disease in Japan. Circ J 2023; 88:90-92. [PMID: 38044146 DOI: 10.1253/circj.cj-23-0822] [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: 12/05/2023]
Affiliation(s)
- Katsura Soma
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Atsushi Yao
- Division for Health Service Promotion, The University of Tokyo
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12
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Bou Chaaya RG, Barron E, Herrmann JL, Brown JW, Ephrem G. QRS Duration After Pulmonary Valve Replacement in Adults with Repaired Tetralogy of Fallot: Association with Ventricular Arrhythmia and Correlation with Right Ventricular Size. Pediatr Cardiol 2023; 44:1658-1666. [PMID: 37624409 DOI: 10.1007/s00246-023-03272-0] [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: 05/13/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
The aim of this study is to analyze the relationship between QRS duration after pulmonary valve replacement (PVR) and ventricular arrhythmias (VA) in patients with repaired tetralogy of Fallot (ToF). ToF patients may face complications such as heart failure and VA after primary repair, often mitigated by PVR. Prior studies have shown a decrease in QRS duration and right ventricular (RV) size following PVR. It remains unclear whether a lack of QRS duration reduction identifies patients at risk of VA. We retrospectively identified adult patients with repaired ToF who underwent surgical or transcatheter PVR. EKG data (pre-PVR, 30 days to 1-year post-PVR, and closest to CMR) was collected. The primary endpoint was sustained ventricular tachycardia (VT), ICD shock for sustained VT, or inducible VT on EP study. 85 patients were included (median follow-up 3.6 years; median age 34 years; 51% females). The primary outcome was noted in 8 patients. Mean QRS duration decreased by 5 ms following PVR (p = 0.0001). Increased age at PVR, QRS ≥ 180 ms post-PVR, no reduction in QRS after PVR, and a history of VT were associated with higher risk of the primary endpoint. The change in QRS was linearly correlated with the change in RVEDVi (R = 0.66). Adults with repaired ToF experience a reduction in QRS duration post-PVR that correlates with the change of the RV size. Patients with QRS ≥ 180 ms post-PVR, no reduction in QRS, increased age at repair, and a history of VT are at risk for recurrent VT and warrant closer monitoring/ICD consideration.
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Affiliation(s)
- Rody G Bou Chaaya
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Emily Barron
- Cardiovascular Institute, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN, USA
| | - Jeremy L Herrmann
- Section of Pediatric Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children's Health, Indiana University Health, Indianapolis, IN, USA
| | - John W Brown
- Section of Pediatric Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children's Health, Indiana University Health, Indianapolis, IN, USA
| | - Georges Ephrem
- University of Tennessee Health Science Center, Memphis, TN, USA
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13
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Schäfer M, Mawad W. Advanced Imaging Technologies for Assessing Tetralogy of Fallot: Insights Into Flow Dynamics. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:380-392. [PMID: 38161669 PMCID: PMC10755841 DOI: 10.1016/j.cjcpc.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart defect requiring surgical repair. Although surgical interventions have significantly reduced mortality, postrepair complications, such as pulmonary valve regurgitation and stenosis, may lead to adverse outcomes, including right ventricular dysfunction and increased risks of morbidity and mortality. This review explores the potential of advanced imaging technologies, including 4-dimensional-flow magnetic resonance imaging and high-frame-rate echocardiography, in providing valuable insights into blood flow dynamics and energy parameters. Quantitative measures, such as energy loss and vorticity, along with qualitative flow analysis, can provide additional insights into adverse haemodynamics at a potentially earlier and more reversible stage. Furthermore, personalized patient-specific information from these imaging modalities aids in guiding treatment decisions and monitoring postoperative interventions effectively. By characterizing flow patterns, these advanced imaging techniques hold great promise in improving the assessment and management of tetralogy of Fallot, providing tailored insights. However, further research and longitudinal studies are required to fully establish their clinical utility and potential impact on patient care.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Wadi Mawad
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Québec, Canada
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14
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Crofton AE, Kovacs SL, Stern JA. Subvalvular Aortic Stenosis: Learning From Human and Canine Clinical Research. Cardiol Res 2023; 14:319-333. [PMID: 37936623 PMCID: PMC10627371 DOI: 10.14740/cr1547] [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: 07/12/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
Subvalvular aortic stenosis (SAS) is the most common congenital heart disease (CHD) in dogs and is also prevalent in human children. A fibrous ridge below the aortic valve narrows the left ventricular outflow tract (LVOT) and increases blood flow velocity, leading to devastating side effects in diseased patients. Due to the similarities in presentation, anatomy, pathophysiology, cardiac development, genomics, and environment between humans and dogs, canine SAS patients represent a critical translational model of human SAS. Potential adverse outcomes of SAS include arrhythmias, left-sided congestive heart failure, endocarditis, exercise intolerance, syncope, and sudden cardiac death. The greatest divergence between canine and human SAS clinical research has been the standard of care regarding treatment of these outcomes, with pharmacological intervention dominating best practices in veterinary medicine and surgical intervention comprising the standard practice for human SAS patients. Regardless of the species, the field has yet to identify a treatment option to prevent disease progression or permanently remove the fibrous ridge, but historical leaps in SAS research support a continued translational approach as the most promising method for achieving this goal.
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Affiliation(s)
- Amanda E. Crofton
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA
| | - Samantha L. Kovacs
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA
| | - Joshua A. Stern
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
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15
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Azarnoosh J, Ghorbannia A, Ibrahim ESH, Jurkiewicz H, Kalvin L, LaDisa JF. Temporal evolution of mechanical stimuli from vascular remodeling in response to the severity and duration of aortic coarctation in a preclinical model. Sci Rep 2023; 13:8352. [PMID: 37221191 PMCID: PMC10205817 DOI: 10.1038/s41598-023-34400-8] [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: 11/04/2022] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
Coarctation of the aorta (CoA) is one of the most common congenital cardiovascular diseases. CoA patients frequently undergo surgical repair, but hypertension (HTN) is still common. The current treatment guideline has revealed irreversible changes in structure and function, yet revised severity guidelines have not been proposed. Our objective was to quantify temporal alterations in mechanical stimuli and changes in arterial geometry in response to the range of CoA severities and durations (i.e. age of treatment) seen clinically. Rabbits were exposed to CoA resulting in peak-to-peak blood pressure gradient (BPGpp) severities of ≤ 10, 10-20, and ≥ 20 mmHg for a duration of ~ 1, 3, or 20 weeks using permanent, dissolvable, and rapidly dissolvable sutures. Elastic moduli and thickness were estimated from imaging and longitudinal fluid-structure interaction (FSI) simulations were conducted at different ages using geometries and boundary conditions from experimentally measured data. Mechanical stimuli were characterized including blood flow velocity patterns, wall tension, and radial strain. Experimental results show vascular alternations including thickening and stiffening proximal to the coarctation with increasing severity and/or duration of CoA. FSI simulations indicate wall tension in the proximal region increases markedly with coarctation severity. Importantly, even mild CoA induced stimuli for remodeling that exceeds values seen in adulthood if not treated early and using a BPGpp lower than the current clinical threshold. The findings are aligned with observations from other species and provide some guidance for the values of mechanical stimuli that could be used to predict the likelihood of HTN in human patients with CoA.
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Affiliation(s)
- Jamasp Azarnoosh
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Arash Ghorbannia
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
| | - El-Sayed H Ibrahim
- Departments of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hilda Jurkiewicz
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lindsey Kalvin
- Departments of Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John F LaDisa
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
- Departments of Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Departments of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
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16
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Vanreusel I, Taeymans J, Van Craenenbroeck E, Segers VFM, Van Berendoncks A, Briedé JJ, Hens W. Elevated oxidative stress in patients with congenital heart disease and the effect of cyanosis: a meta-analysis. Free Radic Res 2023; 57:470-486. [PMID: 38000042 DOI: 10.1080/10715762.2023.2284639] [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: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Oxidative stress is an important pathophysiological mechanism in the development of numerous cardiovascular disorders. To improve therapy and preventive strategies, clinicians need a better understanding of the underlying pathophysiological mechanisms of congenital heart diseases (CHD). The objective of this meta-analysis was to determine whether oxidative stress is elevated in patients with CHD compared to healthy controls, and to evaluate whether a difference in oxidative stress parameters can be observed between patients with cyanotic (cCHD) and acyanotic CHD (aCHD). Therefore, 21 studies investigating oxidative stress in peripheral blood of both children and adults with CHD were reviewed. Different methods to assess the oxidant status were compared and divided into three categories: pro-oxidative or anti-oxidative stress markers and the ratio of pro-to-anti oxidative stress markers. This meta-analysis showed elevated oxidative stress levels in patients with CHD, and more specifically in patients with cCHD. Moreover, this indicates that there could be potential in oxidative stress measurements as a new biomarker of disease severity. Further research will be needed to clarify the exact role of oxidative stress and its contributors in CHD in order to get a better and more in-depth understanding of the underlying pathophysiology of CHD, especially the higher susceptibility of the right ventricle (RV) to progress to heart failure (HF). This could facilitate the development of antioxidant treatments and RV-specific HF therapies, which are necessary to improve survival in these patients and could be of particular importance in cCHD.
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Affiliation(s)
- Inne Vanreusel
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Jan Taeymans
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | - Emeline Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Vincent F M Segers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - An Van Berendoncks
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Jacob J Briedé
- Department of Toxicogenomics, School of Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| | - Wendy Hens
- Cardiac Rehabilitation Centre, Antwerp University Hospital, Edegem, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT Research Group, University of Antwerp, Antwerp, Belgium
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17
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Goo HW, Park SH. Identification of rapid progression of right ventricular functional measures using three-dimensional cardiac computed tomography after total surgical correction of tetralogy of Fallot. Eur J Radiol 2023; 164:110856. [PMID: 37150106 DOI: 10.1016/j.ejrad.2023.110856] [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: 10/25/2022] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To identify subsets of patients with tetralogy of Fallot (TOF) after total surgical correction demonstrating the rapid progression of right ventricle (RV) functional measures using cardiac computed tomography (CT) ventricular volumetry. METHODS Rapid or slow progression of RV functional measures was determined in 109 patients with TOF who underwent cardiac CT ventricular volumetry more than twice after total surgical correction. Patient age, body surface area, postoperative days, the time interval between the first and last cardiac CT examinations, and CT-based functional measures were evaluated using binary logistic regression to determine the predictors of the rapid progression. Receiver operating characteristic curve analysis was performed to evaluate diagnostic performance of the potential predictors. RESULTS The rapid progression of indexed RV end-systolic volume (ESV) (≥2.7 mL/m2/year) and indexed RV end-diastolic volume (≥0.9 mL/m2/year) could be predicted by RV ejection fraction (EF) at the last cardiac CT with an odds ratio of 1.340 (95 % confidence interval [CI], 1.122-1.600; p = 0.001) and age at the last cardiac CT with an odds ratio of 8.255 (95 % CI, 1.531-44.513; p = 0.014), respectively. RV EF at the last cardiac CT showed the highest diagnostic performance (area under the curve = 0.799; p < 0.002) for the rapid progression of indexed RV ESV. CONCLUSION Cardiac CT ventricular volumetry can be used to identify patients demonstrating the rapid progression of RV functional measures after total surgical correction of TOF and follow-up imaging protocols can be individually optimized based on initial progression rate.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Sang Hyub Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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18
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Chu HX, Wang XL, Alsalenhi M, Liu ZG, Li JM. Anomalous origin of the left coronary artery from the pulmonary artery: The role of CZT camera. J Nucl Cardiol 2023; 30:830-834. [PMID: 34873642 DOI: 10.1007/s12350-021-02863-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Hong-Xin Chu
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Xiu-Li Wang
- Department of Cardiac Surgery, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Mahmoud Alsalenhi
- Department of Cardiac Surgery, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Zhi-Gang Liu
- Department of Cardiac Surgery, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Jian-Ming Li
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
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19
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Stokes N, Stransky OM, West SC, Hoskoppal A, Talabi MB, Kazmerski TM. Sexual and Reproductive Health Care Experiences and Perceptions of Women with Congenital Heart Disease. Pediatr Cardiol 2023; 44:564-571. [PMID: 35732955 DOI: 10.1007/s00246-022-02951-8] [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: 04/12/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Abstract
Due to medical advances, women with congenital heart disease (CHD) are living longer, healthier lives and many are considering pregnancy. The hemodynamic changes of pregnancy present high risks of morbidity and mortality for many women with CHD. As little is known about these women's reproductive health experiences, this study explores their perceptions of pregnancy and family planning care as related to CHD. Women ages 18-45 years with a diagnosis of CHD associated with a World Health Organization (WHO) classification II-IV for pregnancy morbidity and mortality participated in individual, semi-structured interviews exploring their experiences, attitudes, and preferences toward parenthood, pregnancy, contraception and family planning care provision. Interviews were audio-recorded, transcribed verbatim. Two independent coders performed analysis using deductive and inductive coding approaches. Twenty women with CHD participated in interviews (average age 30.1 years, SD 5.85). Nine women had a prior pregnancy and 14 considered becoming a parent in the future. We identified 5 key themes among the women: (1) CHD impacted their reproductive health goals and decisions; (2) Women with CHD perceived a lack of safe contraceptive methods for their condition; (3) Women desired tailored, disease-specific sexual and reproductive health (SRH) information; (4) Women viewed their cardiologist as the primary source for SRH information and prefer provider-initiated discussions starting in adolescence; and (5) Women desire coordinated pre-pregnancy and intrapartum care between their cardiologists and women's health providers. These results provide a foundation for interventions to improve patient-centered interdisciplinary reproductive healthcare for this population.
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Affiliation(s)
- Natalie Stokes
- Division of Cardiology, Department of Internal Medicine, School of Medicine and Heart & Vascular Institute, University of Pittsburgh, UPMC, 201 Lothrup St., Pittsburgh, PA, 15211, USA.
| | - Olivia M Stransky
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn C West
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Arvind Hoskoppal
- Division of Cardiology, Department of Internal Medicine, School of Medicine and Heart & Vascular Institute, University of Pittsburgh, UPMC, 201 Lothrup St., Pittsburgh, PA, 15211, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mehret Birru Talabi
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA.,UPMC, Pittsburgh, PA, USA
| | - Traci M Kazmerski
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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20
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Zhao K, Zhang L, Wang L, Zeng J, Zhang Y, Xie X. Benign incidental cardiac findings in chest and cardiac CT imaging. Br J Radiol 2023; 96:20211302. [PMID: 35969186 PMCID: PMC9975525 DOI: 10.1259/bjr.20211302] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 02/01/2023] Open
Abstract
With the continuous expansion of the disease scope of chest CT and cardiac CT, the number of these CT examinations has increased rapidly. In addition to their common indications, many incidental cardiac findings can be observed when carefully evaluating the coronary arteries, valves, pericardium, ventricles, and large vessels. These findings may have clinical significance or risk of complications, but they are sometimes overlooked or may not be described in the final reports. Although most of the incidental findings are benign, timely detection and treatment can improve the management of chronic diseases or reduce the possibility of severe complications. In this review, we summarized the imaging findings, incidence rate, and clinical relevance of some benign cardiac findings such as coronary artery calcification, aortic and mitral valve calcification, aortic calcification, cardiac thrombus, myocardial bridge, aortic dilation, cardiac myxoma, pericardial cyst, and coronary artery fistula. Reporting incidental cardiac findings will help reduce the risk of severe complications or disease deterioration and contribute to the recovery of patients.
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Affiliation(s)
- Keke Zhao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Lu Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Lingyun Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Jinghui Zeng
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Yaping Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Xueqian Xie
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
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21
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Pedometer Efficacy for Clinical Care in Pediatric Cardiology. J Phys Act Health 2023; 20:418-422. [PMID: 36848901 DOI: 10.1123/jpah.2022-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Physical activity is essential to the long-term health of children living with cardiac disease. The simplicity and cost of pedometers make them an attractive alternative to accelerometers for monitoring the physical activity behaviors of these children. This study compared measures obtained from commercial-grade pedometers and accelerometers. METHODS Pediatric cardiology outpatients (n = 41, mean age = 8.4 [3.7] y, 61% female) wore a pedometer and accelerometer daily for 1 week. Step counts and minutes of moderate to vigorous physical activity were compared between devices, accounting for age group, sex, and diagnostic severity, using univariate analysis of variance. RESULTS While pedometer data were significantly correlated with accelerometers (r > .74, P < .001), measurements obtained were significantly different between devices. Overall, pedometers overestimated physical activity data. The overestimation of moderate to vigorous physical activity was significantly less among adolescents than younger age groups (P < .01, ηp2=.38). For step counts, there was a significant age by sex interaction observed where preschool and adolescent males tended to have greater differences between accelerometer and step count data than females (P < .01, ηp2=.33). Differences between devices were not associated with severity of diagnosis. CONCLUSIONS The distribution of pedometers in a pediatric outpatient clinic was feasible, yet the data collected significantly overestimated physical activity, especially among younger children. Practitioners who want to introduce objective measurements as part of their physical activity counseling practice should use pedometers to monitor individual changes in physical activity and consider patient age before administering these devices for clinical care.
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22
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Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Mediation of Self-Management and Treatment Adherence Health-Related Quality of Life for Adolescents With Congenital Heart Disease. Nurs Res 2022; 71:353-359. [PMID: 36007227 DOI: 10.1097/nnr.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Improved autonomy, relatedness, competence, self-management, and treatment adherence have been linked to better health-related quality of life (HRQOL) in adolescents with chronic illnesses. Nonetheless, potential mediating relationships among these concepts have not been investigated. Mediation research is necessary to fully examine ways to improve health and other outcomes for adolescents living with chronic illnesses. OBJECTIVES The purpose of this study was to examine the relationship among the three innate needs (autonomy, relatedness, and competence) of the self-determination theory (SDT)-self-management and treatment adherence-and its relationship to HRQOL for adolescents with congenital heart disease (CHD). The current study examined the potential mediation effects of self-management and treatment adherence on the relationship between the three SDT variables on HRQOL. METHODS Ninety-two adolescents with CHD completed self-report surveys (Basic Psychological Needs Autonomy and Relatedness subscales, Generalized Self-Efficacy Scale, UNC TRxANSITION Scale, and Pediatric Quality of Life 4.0 Generic Core Scale). Exploratory multiple regression and the bootstrap method were used to examine the relationship between the SDT variables and HRQOL and test whether these relationships were mediated by self-management and treatment adherence after controlling for covariates. RESULTS The mediation hypothesis was not supported, indicating that self-management and treatment adherence do not mediate the relationship between the SDT variables and HRQOL for adolescents with CHD. However, multiple regression findings suggest optimizing autonomy and competence contributes to better self-management and treatment adherence and that better autonomy, competence, and relatedness improves HRQOL. DISCUSSION The findings in this study indicate that studies with larger samples are needed if self-management and treatment adherence mediates the innate needs and HRQOL in adolescents with CHD. Future research focusing on other potential mediators affecting the relationship with HRQOL is warranted to improve the transition into adulthood.
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Lin H, Chang Y, Qian X, Yu C, Sun X. Outcomes of one-staged procedures to treat aortic coarctation complicated by cardiac anomalies. BMC Cardiovasc Disord 2022; 22:302. [PMID: 35786318 PMCID: PMC9250724 DOI: 10.1186/s12872-022-02739-x] [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: 02/16/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE One-staged surgical treatment of aortic coarctation combined with cardiac anomalies is challenging. We aim to evaluate the feasibility of bilateral aortofemoral bypass technique in one-staged surgery treating coractation by comparing surgical outcomes with catheter intervention plus stent (hybrid). METHODS Between January 2012 and December 2017, 50 patients underwent one-staged surgical procedures to treat coarctation and repair concomitant cardiac anomalies, like aortic root dilatation, cardiac valvular disease and so on. Among them, 30 patients underwent bilateral aortofemoral bypass and 20 patients underwent hybrid procedure to treat coarctation. We retrospectively analyzed the data of these patients and compared the early and late results. RESULTS All the baseline clinical characteristics were comparable between groups except that the mean age of bypass group was 39.5 ± 14.0 years which was older than hybrid group (27.9 ± 8.5 years, P = 0.002). Technical success was achieved in all patients, with no hospital death or other severe complications. Immediately after surgery, in bypass and hybrid group, the mean upper-limb systolic blood pressure decreased from 159.4 to 119.7 mmHg and 148.4 to 111.6 mmHg, the median peak systolic gradient decreased from 68.0 to 10 mmHg and 46.5 to 10 mmHg respectively (P = 0.09). And the mean upper-lower limbs gradient decreased from 21.7 to 5.9 mmHg and 21.0 to 2.7 mmHg respectively (P = 0.104). The mean follow-up time was 76.92 ± 18.7 in bypass group and 85.4 ± 20.6 months in hybrid group. There were 4 late deaths in bypass group (one died of gastrointestinal bleeding, one died of pulmonary embolism and the other two died of heart failure caused by mechanical prosthetic valve dysfunction). The follow-up peak systolic gradient and other blood pressure parameters showed stable and no differences between two groups. CONCLUSIONS The bilateral aortofemoral bypass surgery is a safe and effective method which can be used in one-staged surgical strategy to treat coarctation complicated by cardiac anomalies and can be an alternative to the hybrid method.
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Affiliation(s)
- Hongyuan Lin
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China
| | - Yi Chang
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China
| | - Xiangyang Qian
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China.
| | - Cuntao Yu
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China
| | - Xiaogang Sun
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China
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Kumar P, Bhatia M. Role of CT in the Pre- and Postoperative Assessment of Conotruncal Anomalies. Radiol Cardiothorac Imaging 2022; 4:e210089. [PMID: 35923747 PMCID: PMC9308465 DOI: 10.1148/ryct.210089] [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: 03/27/2021] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
Conotruncal anomalies, also referred to as outflow tract anomalies, are congenital heart defects that result from abnormal septation of the great vessels' outflow tracts. The major conotruncal anomalies include tetralogy of Fallot, double-outlet right ventricle, transposition of the great arteries, truncus arteriosus, and interrupted aortic arch. Other defects, which are often components of the major anomalies, include pulmonary atresia with ventricular septal defect, pulmonary valve agenesis, aortopulmonary window, and double-outlet left ventricle. CT has emerged as a robust diagnostic tool in preoperative and postoperative assessment of various congenital heart diseases, including conotruncal anomalies. The data provided with multidetector CT imaging are useful for treatment planning and follow-up monitoring after surgery or intervention. Unlike echocardiography and MRI, CT is not limited by a small acoustic window, metallic devices, and need for sedation or anesthesia. Major advances in CT equipment, including dual-source scanners, wide-detector scanners, high-efficiency detectors, higher x-ray tube power, automatic tube current modulation, and advanced three-dimensional postprocessing, provide a low-risk, high-quality alternative to diagnostic cardiac catheterization and MRI. This review explores the various conotruncal anomalies and elucidates the role of CT imaging in their pre- and postoperative assessment. Keywords: CT, CT Angiography, Stents, Pediatrics © RSNA, 2022.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
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Tekeli Sengul S, Karasu BB. Prevalence and characteristics of coronary artery fistula in adults: coronary angiographic analysis of 18,106 patients. KARDIOLOGIIA 2022; 62:62-66. [PMID: 35692175 DOI: 10.18087/cardio.2022.5.n1901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/22/2021] [Accepted: 02/03/2022] [Indexed: 06/15/2023]
Abstract
Aim Coronary artery fistula (CAF) is a rarely encountered anomaly that is characterized by an abnormal connection between a coronary artery and a cardiac chamber or a great thoracic vessel. Its incidence has not been precisely established due to the large number of undiagnosed cases and it shows heterogeneity in its anatomic configuration and clinical consequences. We aimed to assess the frequency, imaging findings, and clinical features of CAF among patients in our tertiary medical center.Material and methods The angiographic data of 18,106 consecutive adult patients who underwent coronary angiography between January 2011 and June 2013 were retrospectively analyzed.Results CAF was detected in 22 patients (0.14 %). Of these, 5 patients had bilateral fistulas (23 %). 65 % of the fistulas originated from the left anterior descending coronary artery,and 53 % drained into the pulmonary artery. The left ventricle and left atrium were the only drainage sites for left-sided coronary artery fistulas. One patient with a CAF presented with non-ST elevated myocardial infarction in the absence of an evident thrombosis.Conclusion Unlike previous reports, bilateral CAFs were more commonly encountered in this study. Contrary to most of the data in the literature, more than half of the CAFs originated from the left anterior descending coronary artery and most drained into the pulmonary artery. Rare anatomic types of CAFs were also detected.
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27
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Bhatt AB, Lantin-Hermoso MR, Daniels CJ, Jaquiss R, Landis BJ, Marino BS, Rathod RH, Vincent RN, Keller BB, Villafane J. Isolated Coarctation of the Aorta: Current Concepts and Perspectives. Front Cardiovasc Med 2022; 9:817866. [PMID: 35694677 PMCID: PMC9174545 DOI: 10.3389/fcvm.2022.817866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Current management of isolated CoA, localized narrowing of the aortic arch in the absence of other congenital heart disease, is a success story with improved prenatal diagnosis, high survival and improved understanding of long-term complication. Isolated CoA has heterogenous presentations, complex etiologic mechanisms, and progressive pathophysiologic changes that influence outcome. End-to-end or extended end-to-end anastomosis are the favored surgical approaches for isolated CoA in infants and transcatheter intervention is favored for children and adults. Primary stent placement is the procedure of choice in larger children and adults. Most adults with treated isolated CoA thrive, have normal daily activities, and undergo successful childbirth. Fetal echocardiography is the cornerstone of prenatal counseling and genetic testing is recommended. Advanced 3D imaging identifies aortic complications and myocardial dysfunction and guides individualized therapies including re-intervention. Adult CHD program enrollment is recommended. Longer follow-up data are needed to determine the frequency and severity of aneurysm formation, myocardial dysfunction, and whether childhood lifestyle modifications reduce late-onset complications.
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Affiliation(s)
- Ami B. Bhatt
- Departments of Internal Medicine and Pediatrics and Division of Cardiology, Harvard Medical School, Boston, MA, United States
| | - Maria R. Lantin-Hermoso
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Curt J. Daniels
- Departments of Pediatrics and Internal Medicine, The Ohio State University Medical Center, Columbus, OH, United States
| | - Robert Jaquiss
- Department of Cardiovascular and Thoracic Surgery and Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin John Landis
- Department of Pediatrics and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, United States
| | - Rahul H. Rathod
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Robert N. Vincent
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Bradley B. Keller
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
- *Correspondence: Bradley B. Keller
| | - Juan Villafane
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
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28
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Recommendations for cardiovascular magnetic resonance and computed tomography in congenital heart disease: a consensus paper from the CMR/CCT working group of the Italian Society of Pediatric Cardiology (SICP) and the Italian College of Cardiac Radiology endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) Part I. Radiol Med 2022; 127:788-802. [PMID: 35608758 PMCID: PMC9308607 DOI: 10.1007/s11547-022-01490-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
Abstract
Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. Nevertheless, correct execution and interpretation require in-depth knowledge of all technical and clinical aspects of CHD, a careful assessment of risks and benefits before each exam, proper imaging protocols to maximize diagnostic information, minimizing harm. This position paper, written by experts from the Working Group of the Italian Society of Pediatric Cardiology and from the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, is intended as a practical guide for applying CCT and CMR in children and adults with CHD, wishing to support Radiologists, Pediatricians, Cardiologists and Cardiac Surgeons in the multimodality diagnostic approach to these patients. The first part provides a review of the most relevant literature in the field, describes each modality's advantage and drawback, making considerations on the main applications, image quality, and safety issues. The second part focuses on clinical indications and appropriateness criteria for CMR and CCT, considering the level of CHD complexity, the clinical and logistic setting and the operator expertise.
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Kumar D, Ponna PK, Po JR, Jamoua R, Kalavakunta JK. Coronary Arteriovenous Fistula Originating From the Left Main Coronary Artery. Cureus 2022; 14:e24824. [PMID: 35693371 PMCID: PMC9172806 DOI: 10.7759/cureus.24824] [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] [Accepted: 05/08/2022] [Indexed: 11/25/2022] Open
Abstract
We report a case of coronary artery fistula arising from the left main coronary artery in a 62-year-old patient presenting with atrial fibrillation. He underwent a transthoracic echocardiogram which suggested a possible coronary artery fistula. Cardiac computed tomographic angiography and cardiac catheterization confirmed the diagnosis. Coronary artery fistula originated from the left main coronary artery, which is rare and terminated in the coronary sinus. Multi-modality imaging helps to delineate anatomy and decide treatment options. Small asymptomatic fistulas do not require treatment, and large or symptomatic fistulas need closure. Our patient was asymptomatic, and we opted for conservative management with close outpatient echocardiographic monitoring.
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Ozkok S, Sorkun M, Erdemli S, Dogan MB, Aslan A, Yucel IK, Celebi A. Liver parenchymal changes and association with cardiac magnetic resonance imaging findings in repaired tetralogy of Fallot: an intravoxel incoherent motion magnetic resonance imaging study. Pediatr Radiol 2022; 52:892-902. [PMID: 35147715 DOI: 10.1007/s00247-021-05271-w] [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: 02/22/2021] [Revised: 11/01/2021] [Accepted: 12/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Liver disease can develop in repaired tetralogy of Fallot (TOF) from hepatic congestion caused by volume and pressure overload of the right ventricle. Noninvasive assessment of the liver is important for diagnosing and managing children with TOF. OBJECTIVE To evaluate subclinical hepatic changes without liver function test abnormality in adolescents with repaired TOF using intravoxel incoherent motion (IVIM) MRI and cardiac MRI findings. MATERIALS AND METHODS We included 106 young adults (75 with repaired TOF and 31 healthy individuals) in the study. Liver IVIM MRI examinations were performed with 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, 800 s/mm2). Two observers measured IVIM MRI parameters D true, D* and f, as well as apparent diffusion coefficient (ADC) values in liver segments 5-8. RESULTS D* and f values were significantly lower in adolescents with TOF (P = 0.003 vs. P = 0.05, respectively). ADC values were higher in adolescents with TOF (P = 0.005). However, we found no significant difference between adolescents with and without TOF in terms of Dtrue (P = 0.53). There was a significant correlation between f value and right ventricular ejection fraction. The intraclass correlation coefficient (ICC) analysis of the two observers showed substantial-to-excellent agreement for D, f, D true and ADC (0.7, 0.8, 0.9 and 0.8, respectively). CONCLUSION The results of our study suggest that impaired microperfusion with increased ADC values in adolescents with repaired TOF reflect hepatic congestion rather than fibrosis. Hepatic congestion characterized by decreased ADC values can be easily differentiated before fibrotic changes occur by using IVIM MRI to assess diffusion and microcapillary perfusion separately.
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Affiliation(s)
- Sercin Ozkok
- Goztepe Training and Research Hospital, Department of Radiology, Istanbul Medeniyet University, Dr. Erkin Street, No:6, Kadikoy, Istanbul, Turkey.
| | - Mine Sorkun
- Goztepe Training and Research Hospital, Department of Radiology, Istanbul Medeniyet University, Dr. Erkin Street, No:6, Kadikoy, Istanbul, Turkey
| | - Servet Erdemli
- Goztepe Training and Research Hospital, Department of Radiology, Istanbul Medeniyet University, Dr. Erkin Street, No:6, Kadikoy, Istanbul, Turkey
| | - Mahmut B Dogan
- Goztepe Training and Research Hospital, Department of Radiology, Istanbul Medeniyet University, Dr. Erkin Street, No:6, Kadikoy, Istanbul, Turkey
| | - Ahmet Aslan
- Goztepe Training and Research Hospital, Department of Radiology, Istanbul Medeniyet University, Dr. Erkin Street, No:6, Kadikoy, Istanbul, Turkey
| | - Ilker K Yucel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Celebi
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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31
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Slater ED, Lewis MJ, Zemer-Wassercug N, Rosenbaum MS. Timing of pulmonary valve replacement: can we use the same volumetric thresholds in repaired tetralogy of Fallot and pulmonary stenosis? Cardiol Young 2022; 33:1-6. [PMID: 35232516 DOI: 10.1017/s1047951122000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The timing of pulmonary valve replacement in patients with pulmonary regurgitation following treatment of pulmonary stenosis is undefined. Although cardiac magnetic resonance-based right ventricular volumes in tetralogy of Fallot patients have been used as a guide in pulmonary stenosis patients, anatomic differences between tetralogy of Fallot and pulmonary stenosis patients complicate their application to pulmonary stenosis patients and could result in late referral for pulmonary valve replacement. We sought to determine if pulmonary stenosis patients referred for pulmonary valve replacement were at greater risk for morbidity or need for tricuspid valve intervention at the time of pulmonary valve replacement. A retrospective cohort study was performed on all adult patients with a diagnosis of pulmonary stenosis or tetralogy of Fallot followed at our centre. Clinical and imaging-based exposures were collected. Pre-specified endpoints included need for concomitant tricuspid valve repair or replacement and pre- and post-pulmonary valve replacement cardiac magnetic resonance-based volumetric measurements. Between 1/1999 and 1/2020, 235 patients underwent pulmonary valve replacement for pulmonary regurgitation (52 with pulmonary stenosis, 183 with tetralogy of Fallot). Pulmonary stenosis patients were more likely to have at least moderate tricuspid regurgitation (p = 0.010), undergo concomitant tricuspid valve intervention (p = 0.003), and require tricuspid valve repair or replacement secondary to annular dilation (p = 0.027) compared to tetralogy of Fallot patients. There was no difference in pre-pulmonary valve replacement right ventricular size between pulmonary stenosis and tetralogy of Fallot patients. These findings suggest that referral for pulmonary valve replacement may be occurring later in the disease course for pulmonary stenosis patients.
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Affiliation(s)
- Emily D Slater
- Schneeweiss Adult Congenital Heart Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew J Lewis
- Schneeweiss Adult Congenital Heart Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Noa Zemer-Wassercug
- Schneeweiss Adult Congenital Heart Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Marlon S Rosenbaum
- Schneeweiss Adult Congenital Heart Center, Columbia University Irving Medical Center, New York, NY, USA
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Lindow A, Kennbäck C, Åkesson A, Nilsson PM, Weismann CG. Common carotid artery characteristics in patients with repaired aortic coarctation compared to other cardiovascular risk factors. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Klehs S, Schneider HE, Backhoff D, Müller MJ, Paul T, Krause U. Repeat Radiofrequency Catheter Ablation of Atrial Tachycardias in Patients with Congenital Heart Disease. J Cardiovasc Electrophysiol 2022; 33:943-952. [PMID: 35199408 DOI: 10.1111/jce.15422] [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: 12/09/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Atrial tachycardias (AT) in patients with congenital heart disease (CHD) are significantly contributing to morbidity and mortality. Aim of this study was to evaluate the long-term course of CHD patients requiring repeat ablation procedures (RAP) of AT. PATIENTS AND METHODS All 144 patients with CHD who had undergone ablation of AT at our center between January 2003 and October 2018 were enrolled. Patients were classified according to complexity of CHD: complex CHD (cCHD), moderate CHD (mCHD) and simple CHD (sCHD). RESULTS A total of 101 RAP were performed in 64 patients. One RAP was performed in n=40, two in n=13, three in n=10 and 5 in n=1. Acute success rate was 82% (83/101) and was not associated with complexity of CHD (p=1.0). Number of procedures was lower in patients with sCHD than in patients with mCHD and cCHD (sCHD 1.3±0.6, mCHD 1.8±1.0 and cCHD 1.8±1.1, p=0.04). RAP were most frequent in patients after Fontan palliation or Atrial switch procedure (2.0±1.1 (n=41) vs. 1.6±0.9 all others, p=0.016) and in patients with multiple unstable AT´s (2.5±1.1 (n=11) vs. 1.7±1.0, p=0.008). Major complications occurred in 4/101 procedures. Complete follow-up was available in 125 patients. Since last RAP 73% of the patients were in sinus/atrial rhythm and 34/125 patients (27%) with AT recurrence did not require re-ablation with mean follow-up of 52±40 months. CONCLUSIONS Recurrences after ablation of AT in CHD patients were frequent. After RAP promising long-term results could be achieved. Data encourage repetitive ablation procedures in this patient population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- S Klehs
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen
| | - H E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen
| | - D Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen
| | - M J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen
| | - T Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen
| | - U Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen
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Shimajiri H, Harada Y, Kinoshita M, Mikami S. Sinus venosus atrial septal defect and partial anomalous pulmonary venous connection in a patient with dextrocardia. BMJ Case Rep 2022; 15:15/2/e245523. [PMID: 35228216 PMCID: PMC8886361 DOI: 10.1136/bcr-2021-245523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
An 85-year-old woman presenting with symptomatic pulmonary hypertension (PH) with a history of dextrocardia was referred to our facility for treatment of heart failure. Significant shunting was detected by measuring oxygen saturation during right heart catheterisation (RHC). CT with contrast revealed sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous connection (PAPVC), in which the left upper and middle lobar pulmonary veins returned to the superior vena cava and right atrium. Despite medical treatment, the patient died, and an autopsy was performed. SVASD and PAPVC are rare congenital anomalies. RHC with measurement of oxygen saturation and CT with contrast should be considered in patients with unexplained right atrial and ventricular enlargement or suspected PH.
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Affiliation(s)
- Hiroto Shimajiri
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Yu Harada
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Mirai Kinoshita
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Shinsuke Mikami
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
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Somers T, Nies HMJM, van Kimmenade RRJ, Bosboom DGH, Geuzebroek GSC, Morshuis WJ. Necessity of life-long follow-up after surgery for coarctation of the aorta: a case series of very late false aneurysm formation. Eur Heart J Case Rep 2022; 6:ytac073. [PMID: 35233500 PMCID: PMC8881378 DOI: 10.1093/ehjcr/ytac073] [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: 05/05/2021] [Revised: 06/15/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Coarctation of the aorta accounts for 5-7% of congenital defects of the heart and great vessels. It requires treatment in the form of open surgical or percutaneous repair. Common long-term complications include re-stenosis and aneurysm formation. The formation of a false aneurysm is a complication with a significant morbidity and mortality. CASE SUMMARY We reviewed six cases of late false aneurysm after repair of a coarctation of the aorta. Our six cases developed a false aneurysm after an open surgical repair of a coarctation more than 30 years after initial surgical repair. All aneurysms were located at the aortic repair site. DISCUSSION The symptoms or risk factors in the described cases are not uniform and are difficult to include in a general follow-up protocol. Guidelines recommend frequent evaluation, but do not specify duration or intervals of imaging follow-up. Our cases support the necessity of life-long follow-up in patients with open aortic repairs irrespective of symptomatology.
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Affiliation(s)
- Tim Somers
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Hedwig M J M Nies
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Roland R J van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Dennis G H Bosboom
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
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Chen K, Zeng Z, Li T, Chen R, Luo J, Zhou Z. Coronary artery-left ventricular multiple microfistulas, a rare disease that is easily missed: case report and literature review. J Int Med Res 2022; 50:3000605221082882. [PMID: 35225046 PMCID: PMC8894615 DOI: 10.1177/03000605221082882] [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] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Coronary artery-left ventricular multiple microfistulas (CALVMMFs) are a very rare type of coronary artery fistula. Because of their special anatomical structure and hemodynamics, CALVMMFs often result in no obvious symptoms and signs. Most patients are diagnosed by coronary angiography; however, as a routine noninvasive screening method, Doppler echocardiography is a potential first-choice diagnostic technique for patients with CALVMMFs. Although satisfactory results of CALVMMF closure are difficult to achieve, the clinical symptoms of these patients are not obvious, and drug therapy has a clear therapeutic effect on most patients. We herein introduce seven cases of CALVMMFs confirmed by our hospital and briefly review the related literature.
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Affiliation(s)
| | - Zhihuan Zeng
- Zhihuan Zeng, Cardiovascular Department,
The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19
Nonglinxia Road, Guangzhou, Guangdong 510080, People’s Republic of China.
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Simeone RM, Downing KF, Bobo WV, Grosse SD, Khanna AD, Farr SL. Post-traumatic stress disorder, anxiety, and depression among adults with congenital heart defects. Birth Defects Res 2022; 114:124-135. [PMID: 34935303 PMCID: PMC8828688 DOI: 10.1002/bdr2.1971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Due to invasive treatments and stressors related to heart health, adults with congenital heart defects (CHDs) may have an increased risk of post-traumatic stress disorder (PTSD), anxiety, and/or depressive disorders. Our objectives were to estimate the prevalence of these disorders among individuals with CHDs. METHODS Using IBM® MarketScan® Databases, we identified adults age 18-49 years with ≥2 outpatient anxiety/depressive disorder claims on separate dates or ≥1 inpatient anxiety/depressive disorder claim in 2017. CHDs were defined as ≥2 outpatient CHD claims ≥30 days apart or ≥1 inpatient CHD claim documented in 2007-2017. We used log-binomial regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between CHDs and anxiety/depressive disorders. RESULTS Of 13,807 adults with CHDs, 12.4% were diagnosed with an anxiety or depressive disorder. Adults with CHDs, compared to the 5,408,094 without CHDs, had higher prevalence of PTSD (0.8% vs. 0.5%; aPR: 1.5 [CI: 1.2-1.8]), anxiety disorders (9.9% vs. 7.5%; aPR: 1.3 [CI: 1.3-1.4]), and depressive disorders (6.3% vs. 4.9%; aPR: 1.3 [CI: 1.2-1.4]). Among individuals with CHDs, female sex (aPR range: 1.6-3.3) and inpatient admission (aPR range 1.1-1.9) were associated with anxiety/depressive disorders. CONCLUSION Over 1 in 8 adults with CHDs had diagnosed PTSD and/or other anxiety/depressive disorders, 30-50% higher than adults without CHDs. PTSD was rare, but three times more common in women with CHDs than men. Screening and referral for services for these conditions in people with CHDs may be beneficial.
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Affiliation(s)
- Regina M. Simeone
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amber D. Khanna
- Department of Internal Medicine, Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Department of Pediatrics, Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Hansen K, Edwards LA, Yohannes K, Luong R, Lin A, Long J, Halpern-Felsher B, Cohen H, Kaufman BD. Advance Care Planning Preferences for Adolescents With Cardiac Disease. Pediatrics 2022; 149:184391. [PMID: 34984466 DOI: 10.1542/peds.2020-049902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescents with cardiac disease are at risk for life-changing complications and premature death. The importance of advance care planning (ACP) in adults with congenital heart disease and in pediatric patients with HIV and cancer has been demonstrated. ACP preferences of adolescents with heart disease have not been evaluated. We describe ACP preferences of adolescents with heart disease and compare with those of their caregivers. METHODS Outpatient adolescents aged 12 to 18 years with heart failure, cardiomyopathy, heart transplantation, or who were at risk for cardiomyopathy, as well as their caregivers, completed self-administered questionnaires which evaluated participants' opinions regarding content and timing of ACP discussions, preferences for end-of-life communication, and emotional responses to ACP. RESULTS Seventy-eight adolescents and 69 caregivers participated, forming 62 adolescent-caregiver dyads. Adolescents and caregivers reported that adolescent ACP discussions should occur early in the disease course (75% and 61%, respectively). Adolescents (92%) wanted to be told about terminal prognosis, whereas only 43% of caregivers wanted the doctor to tell their child this information. Most adolescents (72%) and caregivers (67%) anticipated that discussing ACP would make the adolescent feel relieved the medical team knew their wishes. Most caregivers (61%) believed that adolescents would feel stress associated with ACP discussions, whereas only 31% of adolescents anticipated this. CONCLUSIONS Adolescents and their caregivers agree that ACP should occur early in disease course. There are discrepancies regarding communication of prognosis and perceived adolescent stress related to ACP discussions. Facilitated conversations between patient, caregiver, and providers may align goals of care and communication preferences.
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Affiliation(s)
| | - Lindsay A Edwards
- Divisions of Cardiology.,Division of Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | | | | | - Amy Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jin Long
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Bonnie Halpern-Felsher
- Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Harvey Cohen
- Division of Hematology/Oncology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
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Arora H, Vidya PL, Ghosh A, Mishra S, Shouche S, Sethi B, Mishra S, Nagi G. Midterm safety and outcome of balloon angioplasty of native aortic coarctation in neonates and young infants and initial experience of prepartial dilatation using high-pressure noncompliant balloon. Ann Pediatr Cardiol 2022; 15:121-127. [PMID: 36246746 PMCID: PMC9564400 DOI: 10.4103/apc.apc_197_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Balloon angioplasty (BA) for aortic coarctation in neonates and infants remains controversial due to high recurrence rate and vascular complications. Aim: This study aimed to determine the safety and outcome of percutaneous treatment of coarctation in neonates and infants and to share the initial experience of strategy of prepartial dilatation with high-pressure noncomplaint balloon before final targeted dilatation using low-pressure compliant balloon. Materials and Methods: Retrospective analysis of records of all neonates and infants aged <6 months who underwent BA either using only low-pressure balloon (Group A) or those with prepartial dilatation using high-pressure noncomplaint balloon followed by low-pressure compliant balloon (Group B) between July 2017 and February 2020 was performed. Demographic, clinical, echocardiographic, interventional, and follow-up data were collected for all. Results: A total of 51 patients (41.2% neonates) were included in the study. Median age was 1 month 14 days (60.8% girls) and mean weight was 3.6 ± 1.5 kg. The mean peak trans-coarctation gradient was 53 ± 12 (34–80) mmHg. The final pressure gradient dropped to <10 mmHg in all cases of Group B and only in 26.3% (5) patients of Group A (P < 0.001). Recoarctation rate was 25.5% (13) overall and was significantly higher in Group A patients (P < 0.001), in those with borderline/mildly hypoplastic arch (P = 0.04) and in those with postprocedure gradient between 10 and 20 mmHg (P = 0.02). Median time to re-coarctation was significantly delayed in Group B (P < 0.001). There were no major complications or mortality in either group. Conclusions: BA in neonates and young infants has an excellent short and mid-term safety and efficacy. The recoarctation rate is significantly reduced as well as delayed with prepartial dilatation using high-pressure noncompliant balloon.
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Choukair MO, Halawi A, Nehmeh A, Kazma H. Subaortic Membrane With Mitral Chordae Rupture Mimicking Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy. Cureus 2021; 13:e20372. [PMID: 35036205 PMCID: PMC8752994 DOI: 10.7759/cureus.20372] [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] [Accepted: 12/12/2021] [Indexed: 11/30/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal-dominant disorder that can lead to left ventricular outflow tract (LVOT) obstruction. Some patients present with syncope, dyspnea, chest pain, or sudden cardiac death. A subaortic membrane (SAM) is an unusual cause of ventricular outflow tract obstruction causing symptoms that can imitate HCM. It is essential to differentiate between these two entities, as it has important implications in guiding treatment and determining the type of intervention. Echocardiography is the gold standard modality for the diagnosis. In this report, we present a case of a 56-year-old man presenting with subaortic stenosis with ruptured mitral chordae misdiagnosed as HCM with SAM.
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Farr SL, Downing KF, Goudie A, Klewer SE, Andrews JG, Oster ME. Advance Care Directives Among a Population-Based Sample of Young Adults with Congenital Heart Defects, CH STRONG, 2016-2019. Pediatr Cardiol 2021; 42:1775-1784. [PMID: 34164699 PMCID: PMC9808577 DOI: 10.1007/s00246-021-02663-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/14/2021] [Indexed: 01/05/2023]
Abstract
Little is known about advance care planning among young adults with congenital heart defects (CHD). Congenital Heart Survey to Recognize Outcomes, Needs, and well-beinG (CH STRONG) participants were born with CHD between 1980 and 1997, identified using active, population-based birth defects surveillance systems in Arkansas, Arizona and Atlanta, and Georgia, and surveyed during 2016-2019. We estimated the percent having an advance care directive standardized to the site, year of birth, sex, maternal race, and CHD severity of the 9312 CH STRONG-eligible individuals. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for characteristics associated with having advance care directives. Of 1541 respondents, 34.1% had severe CHD, 54.1% were female, and 69.6% were non-Hispanic white. After standardization, 7.3% had an advance care directive (range: 2.5% among non-Hispanic blacks to 17.4% among individuals with "poor" perceived health). Individuals with severe CHD (10.5%, aOR = 1.6, 95% CI: 1.1-2.3), with public insurance (13.1%, aOR = 1.7, 95% CI: 1.1-2.7), with non-cardiac congenital anomalies (11.1%, aOR = 1.9, 95% CI: 1.3-2.7), and who were hospitalized in the past year (13.3%, aOR = 1.8, 95% CI: 1.1-2.8) were more likely than their counterparts to have advance care directives. Individuals aged 19-24 years (6.6%, aOR = 0.4, 95% CI: 0.3-0.7) and 25-30 years (7.6%, aOR = 0.5, 95% CI: 0.3-0.8), compared to 31-38 years (14.3%), and non-Hispanic blacks (2.5%), compared to non-Hispanic whites (9.5%, aOR = 0.2, 95% CI: 0.1-0.6), were less likely to have advance care directives. Few young adults with CHD had advance care directives. Disparities in advance care planning may exist.
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Affiliation(s)
- Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA.
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA
| | - Anthony Goudie
- Department of Pediatrics, Center for Applied Research and Evaluation, College of Medicine, Little Rock, AR, USA
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | | | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
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Clinical Characteristics and Long-Term Prognosis of Elderly Valvular Heart Disease Patients with Diabetes Mellitus: Five-Year Experience from a Single-Center Study of Southern China. Cardiol Res Pract 2021; 2021:2558639. [PMID: 34745659 PMCID: PMC8566085 DOI: 10.1155/2021/2558639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Diabetes mellitus (DM) is a prognostic marker in elderly patients with cardiovascular diseases, but its predictive value in elderly valvular heart disease (VHD) patients is unclear. This study aimed to investigate the effect of DM on the long-term outcome of elderly VHD patients. Methods This single-center, observational study enrolled patients aged 65 and older consecutively with confirmed VHD using echocardiography. Patients, divided into the DM group and non-DM group, were followed up for major adverse cardiac and cerebrovascular events (MACCEs), including all-cause death, ischemic stroke, and heart failure rehospitalization. Results Our study consisted of 532 patients over a median follow-up of 52.9 months. Compared with the non-DM group (n = 377), the DM group (n = 155) had higher incidences of ischemic stroke (25.2% vs. 13.5%, P=0.001), heart failure rehospitalization (37.4% vs. 20.7%, P < 0.001), and MACCEs (60.0% vs. 35.8%, P < 0.001). After adjustment of confounders by the multivariable cox regression, DM appeared as an independent predictor for MACCEs (adjusted hazard ratio, aHR: 1.88; 95% confidence interval 1.42–2.48; P < 0.001). In the subgroup analysis of VHD etiology and functional style, conversely, DM was a protective factor for MACCEs in the patients with rheumatic VHD compared with those without rheumatic VHD (aHR: 0.43 vs. 2.27, P=0.004). Conclusions DM was an independent predictor for ischemic stroke and heart failure rehospitalization in elderly VHD patients undergoing conservative treatment.
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Téllez L, Rodríguez de Santiago E, Albillos A. Fontan-Associated Liver Disease: Pathophysiology, Staging, and Management. Semin Liver Dis 2021; 41:538-550. [PMID: 34399435 DOI: 10.1055/s-0041-1732355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Fontan-associated liver disease is the term used to encompass the disorders arising from abnormal hemodynamic alterations and systemic venous congestion after the Fontan procedure. The histological changes produced in the liver are similar but not equivalent to those seen in other forms of cardiac liver disease. While the natural history of this form of liver disease is poorly established, many Fontan patients ultimately develop portal hypertension-related complications such as ascites, esophageal varices, malnutrition, and encephalopathy. Fontan survivors also show an elevated risk of hepatocellular carcinoma. Adequate staging of the liver damage is essential to anticipate screening strategies and improve global management.
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Affiliation(s)
- Luis Téllez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red (CIBEREHD), Universidad de Alcalá, Madrid, Spain
| | - Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red (CIBEREHD), Universidad de Alcalá, Madrid, Spain
| | - Agustín Albillos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red (CIBEREHD), Universidad de Alcalá, Madrid, Spain
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Nodari F, Verrengia A, Di Betta E, Bonera G, Bonardelli S. Combined endovascular and open treatment to prevent increase in afterload in anastomotic pseudoaneurysm and aortobronchial fistula after surgery for aortic coarctation. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:621-624. [PMID: 34693088 PMCID: PMC8515165 DOI: 10.1016/j.jvscit.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
We report the treatment of a patient who had presented with hemoptysis due to an aortobronchial fistula from an anastomotic pseudoaneurysm after extra-anatomic bypass for aortic coarctation. An aortobronchial fistula can often result from an aortic pseudoaneurysm and is associated with high mortality if not treated. We decided to use combined endovascular and open surgical treatment and obtained a satisfactory intraoperative result. The perioperative outcome and first follow-up visit were favorable. In recent years, endovascular repair of pathologic aortic conditions has increased; thus, we have placed the present case within the context of the relevant medical literature.
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Affiliation(s)
- Franco Nodari
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Apollonia Verrengia
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Ernesto Di Betta
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Giulia Bonera
- Division of Radiology, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Stefano Bonardelli
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia and Spedali Civili Hospital, Brescia, Italy
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Sheth K, Azad S, Dalvi B, Parekh M, Sagar P, Anantharaman R, Radhakrishnan S, Sivakumar K. Early multicenter experience of Melody valve implantation in India. Ann Pediatr Cardiol 2021; 14:302-309. [PMID: 34667400 PMCID: PMC8457271 DOI: 10.4103/apc.apc_73_21] [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] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background Transcatheter valves provide a safe and effective alternative to surgery for treating dysfunctional right ventricular outflow tracts (RVOTs). We present our early multicenter experience of percutaneous pulmonary valve implantation (PPVI) using Melody valve (Medtronic Inc., Minneapolis, MN). Methods Patients with stenosed conduits or degenerated bioprosthetic valves in RVOT with combined stenosis and regurgitation were evaluated for suitability of Melody valve implantation. After undergoing an initial structured training, PPVI using Melody transcatheter pulmonary valve (TPV) was guided by an approved proctor. Conduits were serially dilated and prestented with careful coronary interrogation, and bioprosthetic valves were dilated with high-pressure balloons. Clinical and echocardiographic follow-up was performed at 6 monthly intervals. Results Fifteen patients (three females) aged 23.1 ± 9.5 years in NYHA Class II-III underwent Melody TPV implantation in four Indian centers. The underlying anatomy comprised surgically implanted bioprosthetic valves for pulmonary regurgitation (n= 5), conduit repair for pulmonary atresia (n = 4), Rastelli repair (n = 3), truncus (n = 1), and Ross procedure (n = 2). Twelve patients had more than one previous surgery. Doppler gradient decreased from 74.2 ± 21.5 mmHg to 10.2 ± 4.5 mmHg after the PPVI. At a median follow-up of 14 months (1-39 months), all the patients were in NYHA Class I with echocardiographic gradients of 8 ± 5.7 mmHg with no evidence of pulmonary regurgitation. There were no major procedural adverse events or deaths. Conclusions Our early experience shows encouraging results of the PPVI program in India with proctored case selection and meticulous planning. It also confirms the safety and efficacy of Melody TPV for treating dysfunctional RVOT in postoperative patients.
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Affiliation(s)
- Kshitij Sheth
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Sushil Azad
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Bharat Dalvi
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Maulik Parekh
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Rajaram Anantharaman
- Department of Pediatric Cardiology, Frontier Lifeline Hospital, Chennai, Tamil Nadu, India
| | | | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
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Ectopic connection of left coronary artery from right coronary sinus, is the treatment always surgical? COR ET VASA 2021. [DOI: 10.33678/cor.2021.044] [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]
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Omori T, Maeda M, Kagawa S, Uno G, Rader F, Siegel RJ, Shiota T. Impact of Diastolic Interventricular Septal Flattening on Clinical Outcome in Patients With Severe Tricuspid Regurgitation. J Am Heart Assoc 2021; 10:e021363. [PMID: 34622664 PMCID: PMC8751866 DOI: 10.1161/jaha.121.021363] [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: 12/03/2022]
Abstract
Background Little is known about the impact of diastolic interventricular septal flattening on the clinical outcome in patients with severe tricuspid regurgitation. This study sought to evaluate the association of diastolic interventricular septal flattening with clinical outcome in patients with severe tricuspid regurgitation. Methods and Results We retrospectively studied 407 patients who underwent 2‐dimensional transthoracic echocardiography and were diagnosed with severe tricuspid regurgitation between January 2014 and December 2015. Cardiovascular events were defined as cardiovascular death or admission for heart failure. The magnitude of interventricular septal flattening was calculated by the eccentricity index (EI) of the left ventricle, and hemodynamic parameters were obtained from transthoracic echocardiography. During follow‐up (median, 200 days; interquartile range, 35–1059), 117 of the patients experienced cardiovascular events. By multivariate analysis including potential covariates, EI at end‐diastole and left ventricular ejection fraction were independent predictors of cardiovascular events (hazard ratio, 5.33 [1.63–17.41]; hazard ratio, 0.98 [0.97–0.99], respectively). An EI of 1.2 at end‐diastole was the optimal cutoff value for identifying poor hemodynamic status defined as cardiac index ≤2.2 L/min per m2 and right atrial pressure 15 mm Hg, both on transthoracic echocardiography. Patients with D‐shaped left ventricle defined as EI ≥1.2 at end‐diastole showed worse outcomes than those without (adjusted hazard ratio, 1.80 [1.18–2.74]). Conclusions Increasing EI at end‐diastole was strongly associated with worse outcomes in patients with severe tricuspid regurgitation. Furthermore, the presence of D‐shaped left ventricle defined as EI ≥1.2 at end‐diastole provides prognostic value for cardiovascular events.
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Affiliation(s)
- Taku Omori
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA
| | - Mika Maeda
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA
| | - Shunsuke Kagawa
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA
| | - Goki Uno
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA
| | - Florian Rader
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA.,Department of Medicine University of California Los Angeles CA
| | - Robert J Siegel
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA.,Department of Medicine University of California Los Angeles CA
| | - Takahiro Shiota
- Smidt Heart InstituteCedars-Sinai Medical Center Los Angeles CA.,Department of Medicine University of California Los Angeles CA
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Benetti F, Gonzalez J, Abuin G. Coronary artery fistula, where are we now? J Card Surg 2021; 36:4623-4624. [PMID: 34617328 DOI: 10.1111/jocs.16057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Gustavo Abuin
- Universidad de Buenos Aires, Buenos Aires, Argentina
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Long WJ, Huang X, Lu YH, Huang HM, Li GW, Wang X, He ZL. Intermittent appearance of right coronary fistula and collateral circulation: A case report. World J Clin Cases 2021; 9:8504-8508. [PMID: 34754860 PMCID: PMC8554440 DOI: 10.12998/wjcc.v9.i28.8504] [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: 03/29/2021] [Revised: 05/10/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital coronary artery fistula can lead to symptoms of chest tightness, chest pain, or exertional dyspnea, which is a congenital vascular malformation that should not be ignored. Patients who have such malformations are frequently observed with different concurrent abnormal anatomic structures. Collateral circulation may have a positive effect on improving the patients' symptoms.
CASE SUMMARY A 53-year-old female experienced episodic chest discomfort for the past month with symptoms manifesting when she was agitated or overexerted. After a positive treadmill test, the patient underwent coronary angiography. “Ghostlike” intermittent appearance of coronary ventricular fistula and collateral branching were observed. The patient was diagnosed with a right coronary ventricular fistula and collateral circulation.
CONCLUSION This case shows the likelihood of collateral circulation in patients with coronary artery fistula. This may provide medical staff with novel solutions to treat insufficiency of myocardial blood supply induced by cardiovascular malformations.
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Affiliation(s)
- Wen-Jie Long
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Xi Huang
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Yuan-Hong Lu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Hao-Ming Huang
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Guo-Wei Li
- Department of Emergency, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Xia Wang
- Department of Cardiovascular, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Zhi-Ling He
- Department of Cardiovascular, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
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Firouzi A, Alemzadeh-Ansari MJ, Mohebbi B, Khajali Z, Khalilipur E, Baay M, Bayatian A, Taherian M, Khosropour A, Hosseini Z. Diverse Transcatheter Closure Strategies in Coronary Artery Fistulas A State-of-the-Art Approach. Curr Probl Cardiol 2021; 47:101010. [PMID: 34599986 DOI: 10.1016/j.cpcardiol.2021.101010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/24/2022]
Abstract
Coronary artery fistulas (CAFs) are accounted as the most congenital coronary anomalies. As their natural course is progressive dilatation of the feeder arteries and the fistula tract, so, catastrophic complications are frequently illustrated by aging. Even in those with asymptomatic small fistulas, close follow-up is mandatory to prevent subsequent sequelas. In patients with medium or large-sized fistulas, irrespective of symptoms, closure (either by surgical ligation or transcatheter closure) is recommended. In the current era of advances in the equipment and devices and also innovations in percutaneous closure techniques and preprocedural imaging, TCC is now regarded as the preferred strategy for CAF closure except in some high-risk cases. So, by appropriate case selection modalities, pre-procedural planning, and determining the closure techniques, recent small case-series studies have been reported good final angiographic and clinical results by TCC. In this article, we have introduced several transcatheter closure techniques by details; also, we have recommended more multi-center trials with long-term clinical follow-up to address the best treatment options in these patients.
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Affiliation(s)
- Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Baay
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ayatollah Bayatian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maisam Taherian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Khosropour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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