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Kearney K, Cordina R, Choudhary P, Tanous D, Celermajer D, Keogh A, Bart N, Jabbour A, Kotlyar E, Jansz P, Hayward C, Muthiah K, MacDonald P. Post-Transplantation Outcomes of Adult Congenital Heart Disease. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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2
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Offen S, Sy R, Chan KH, Medi C, Kilborn MJ, Plunkett B, Simmons L, McGuire M, Celermajer D. REDUCING TRICUSPID REGURGITATION BY TRANSESOPHAGEAL ECHO GUIDED LEAD POSITIONING: A PILOT STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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3
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Verrall CE, Tran DL, Yang JYM, Lubans DR, Winlaw DS, Ayer J, Celermajer D, Cordina R. Exercise as therapy for neurodevelopmental and cognitive dysfunction in people with a Fontan circulation: A narrative review. Front Pediatr 2023; 11:1111785. [PMID: 36861078 PMCID: PMC9969110 DOI: 10.3389/fped.2023.1111785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/25/2023] [Indexed: 02/15/2023] Open
Abstract
People with a Fontan circulation are at risk of neurodevelopmental delay and disability, and cognitive dysfunction, that has significant implications for academic and occupational attainment, psychosocial functioning, and overall quality of life. Interventions for improving these outcomes are lacking. This review article discusses current intervention practices and explores the evidence supporting exercise as a potential intervention for improving cognitive functioning in people living with a Fontan circulation. Proposed pathophysiological mechanisms underpinning these associations are discussed in the context of Fontan physiology and avenues for future research are recommended.
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Affiliation(s)
- Charlotte Elizabeth Verrall
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Derek Lee Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Service (NACIS), Royal Children's Hospital, Melbourne, VIC, Australia
| | - David Revalds Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - David Scott Winlaw
- Cardiothoracic Surgery, the Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Julian Ayer
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - David Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.,Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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4
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Othman F, Bailey B, Collins N, Lau E, Tanous D, Rao K, Celermajer D, Cordina R. Platypnea-Orthodeoxia Syndrome in the Setting of Patent Foramen Ovale Without Pulmonary Hypertension or Major Lung Disease. J Am Heart Assoc 2022; 11:e024609. [PMID: 35876406 PMCID: PMC9375500 DOI: 10.1161/jaha.121.024609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Patent foramen ovale (PFO)‐associated platypnea‐orthodeoxia syndrome is characterized by dyspnea and hypoxemia when upright. The pathogenesis is thought to involve an increase in right atrial pressure or change in degree of right to left shunting with upright posture. Methods and Results We sought to characterize patients with platypnea‐orthodeoxia syndrome related to PFO without pulmonary hypertension. We retrospectively reviewed databases at 3 tertiary referral hospitals in New South Wales, Australia from 2000 to 2019. Fourteen patients with a mean age of 69±14 years had a PFO with wide tunnel separation. Mean New York Heart Association Classification was II (±0.9) and 7 inpatients had been confined to bed (from postural symptoms). Baseline oxygen saturations supine were 93%±5% and 84%±6% upright. Two patients had a minor congenital heart defect and 4 had mild parenchymal lung disease with preserved lung function. The mean aortic root diameter was 37±6 mm and distance between aortic root and posterior atrial wall was 16±2 mm. Platypnea‐orthodeoxia syndrome was preceded by surgery in 5 patients and 1 patient had mild pneumonia. Successful closure of the PFO using an Amplatzer device was performed in 11 of 14 patients. Post‐closure, all patients had New York Heart Association Classification I (improvement 1.6±0.9, P<0.003) and semi‐recumbent oxygen saturations increased by 13%±8% (P<0.001, n=10). Conclusions Platypnea‐orthodeoxia syndrome is a debilitating condition, curable by PFO closure. Anatomical distortion of the atrial septum related to a dilated aortic root or shortening of the distance between the aortic root and posterior atrial wall may contribute to the syndrome.
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Affiliation(s)
| | - Brian Bailey
- Royal Prince Alfred Hospital Sydney NSW Australia
| | | | - Edmund Lau
- Royal Prince Alfred Hospital Sydney NSW Australia
| | - David Tanous
- Royal Prince Alfred Hospital Sydney NSW Australia.,Westmead Hospital Sydney NSW Australia
| | - Karan Rao
- Westmead Hospital Sydney NSW Australia
| | - David Celermajer
- Royal Prince Alfred Hospital Sydney NSW Australia.,Heart Research Institute Sydney NSW Australia.,Sydney Medical SchoolUniversity of Sydney NSW Australia
| | - Rachael Cordina
- Royal Prince Alfred Hospital Sydney NSW Australia.,Heart Research Institute Sydney NSW Australia.,Sydney Medical SchoolUniversity of Sydney NSW Australia
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5
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King G, Buratto E, Celermajer D, Grigg L, Alphonso N, Robertson T, Bullock A, Ayer J, Iyengar A, d'Udekem Y, Konstantinov I. Natural and Modified History of Atrioventricular Valve Regurgitation in Patients With Fontan Circulation: Impact of Right Ventricular Dominance. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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6
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Badal T, Ruban S, Nicholson C, Strange G, Celermajer D. Adult Congenital Heart Disease Patient-Reported Psychosocial Measures and COVID-19 Anxiety. Heart Lung Circ 2022. [PMCID: PMC9345558 DOI: 10.1016/j.hlc.2022.06.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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7
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Chami J, Nicholson C, Strange G, Baker D, Cordina R, Celermajer D. High Error Rates in Coding Causes of Death in Adults with Congenital Heart Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Kearney K, Adlard L, Vrklevski L, Osborn D, Cordina R, Celermajer D. Spectrum and Triggers for Psychological Problems in Adults With Congenital Heart Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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9
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Kearney K, Anderson J, Cordina R, Lavender M, Celermajer D, Collins N, Dwyer N, Keating D, Williams T, Whitford H, Whyte K, Weintraub R, Keogh A, Kotlyar E, Lau EMT. Impact of left heart disease risk factors on risk stratification and treatment response in pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Contemporary registries have documented a change in the epidemiology of PAH patients displaying increasing co-morbidities associated with left heart disease (LHD). These patients are often excluded from randomized clinical trials. It is unclear whether the presence of LHD comorbidities may adversely impact the accuracy of risk stratification and response to PAH therapy.
Method
Data was extracted from the Pulmonary Hypertension Society of Australia and New Zealand registry for incident patients with a diagnosis with idiopathic/heritable/toxin-induced (I/H/D)-PAH and connective tissue disease (CTD) associated PAH from 2011 - 2020. Patients without available medication and follow up data were excluded. We used the AMBITION trial exclusion criteria to define the subpopulation with LHD risk factors and haemodynamic phenotype (PAH-rLHD).
Results
489 patients (I/H/D-PAH=251, CTD-PAH=238) were included in our analysis, with 103 (21.0%) fulfilling the definition of PAH-rLHD (34 had ≥3 risk factors for left heart disease (rLHD-hypertension, diabetes, obesity or ischaemic heart disease) and 76 had borderline haemodynamics (mean capillary wedge pressure 13–15 with pulmonary vascular resistance <500 dynes sec/cm5) including 7 who met both criteria). Compared to classical PAH, patients with PAH-rLHD were older at diagnosis (66±13 vs 58±19, p<0.001), had lower pulmonary vascular resistance (PVR: 393±266 vs 708±391, p=0.031) but worse exercise capacity (6MWD: 286±130m vs 327±136m, p=0.005). PAH-rLHD were more likely to be started on initial monotherapy, compared with “classical” PAH (73% vs 56%, p=0.002). In the monotherapy groups, endothelin receptor antagonists (ERA) were used in 73% PAH-rLHD, compared with 66% in classical PAH group. Both groups exhibited similar response to both mono- and combination therapy with commensurate improvements in WHO functional class (mean change 0.3±0.6 vs 0.3±0.8, p=0.443) and 6-minute walk distance (mean change 44±82 vs 48±101, p=0.723). There was no difference in survival between classical PAH and PAH-rLHD (log rank, p=0.29). The REVEAL 2.0 risk score effectively discriminated risk in both populations at baseline and first follow up (classical PAH: baseline C statistic 0.750, follow up 0.774 and PAH-rLHD: baseline C statistic 0.756, follow up 0.791).
Conclusion
Despite lower PVR at diagnosis, PAH-rLHD patients and “classical” PAH demonstrate similar response to first-line therapy with similar long term survival. The REVEAL 2.0 risk score can be effectively applied to the subpopulation of PAH-rLHD in real life clinical practice.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Kearney
- St Vincents Hospital, Sydney, Australia
| | - J Anderson
- Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - R Cordina
- Royal Prince Alfred Hospital, Sydney, Australia
| | - M Lavender
- Fiona Stanley Hospital, Perth, Australia
| | | | - N Collins
- John Hunter Hospital, Newcastle, Australia
| | - N Dwyer
- Royal Hobart Hospital, Hobart, Australia
| | - D Keating
- The Alfred Hospital, Melbourne, Australia
| | - T Williams
- The Alfred Hospital, Melbourne, Australia
| | - H Whitford
- The Alfred Hospital, Melbourne, Australia
| | - K Whyte
- Auckland District Health Board, Auckland, New Zealand
| | - R Weintraub
- Royal Children's Hospital, Melbourne, Australia
| | - A Keogh
- St Vincents Hospital, Sydney, Australia
| | - E Kotlyar
- St Vincents Hospital, Sydney, Australia
| | - E M T Lau
- Royal Prince Alfred Hospital, Sydney, Australia
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10
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Brida M, Chessa M, Celermajer D, Li W, Geva T, Khairy P, Griselli M, Baumgartner H, Gatzoulis MA. Atrial septal defect in adulthood: a new paradigm for congenital heart disease. Eur Heart J 2021; 43:2660-2671. [PMID: 34535989 DOI: 10.1093/eurheartj/ehab646] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/09/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. surgical closure, consideration of pre-closure ablation for patients with atrial tachycardia and suitability for closure or/and targeted therapy for patients with PAH. This review serves to update the clinician on the latest evidence, the nuances of optimal diagnostics, treatment options, and long-term follow-up care for patients with an ASD.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Kispaticeva ul. 12, Zagreb 10000, Croatia.,Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Ul. Braće Branchetta 20/1, Rijeka 51000, Croatia
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Piazza Edmondo Malan, 2, Milan 20097, Italy.,UniSR - Vita Salute San Raffaele University, Via Olgettina, 58, Milan 20132, Italy
| | - David Celermajer
- Heart Research Institute, University of Sydney, Camperdown, NSW 2050, Australia
| | - Wei Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.,Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
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11
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Lapirow D, La Gerche A, Toro C, Masango E, Costello B, Porello E, Ludlow L, Marshall G, Trahair T, Mateos M, Lewin J, Byrne J, Boutros R, Manudhane R, Heath J, Ayer J, Gabriel M, Walwyn T, Saundankar J, Forsey J, Le H, Mason K, Celermajer D, Downie P, Walker R, Holland L, Martin M, McLeman L, Diamond Y, Marcocci M, Donath S, Cheung M, Elliott DA, Conyers R. The Australia and New Zealand Cardio-Oncology Registry: evaluation of chemotherapy-related cardiotoxicity in a national cohort of paediatric cancer patients. Intern Med J 2021; 51:229-234. [PMID: 31841257 DOI: 10.1111/imj.14719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
Cancer therapy related cardiac dysfunction (CTRCD) is an area of increasing focus, particularly during the survivorship period, for paediatric, adolescent and adult cancer survivors. With the advent of immunotherapy and targeted therapy, there is a new set of mechanisms from which paediatric and young adult patients with cancer may suffer cardiovascular injury. Furthermore, cardiovascular disease is the leading cause of morbidity and mortality in the survivorship period. The recently established Australian Cardio-Oncology Registry is the largest and only population-based cardiotoxicity database of paediatric and adolescent and young adult oncology patients in the world, and the first paediatric registry that will document cardiotoxicity caused by chemotherapy and novel targeted therapies using a prospective approach. The database is designed for comprehensive data collection and evaluation of the Australian practice in terms of diagnosis and management of CTRCD. Using the Australian Cardio-Oncology Registry critical clinical information will be collected regarding predisposing factors for the development of CTRCD, the rate of subclinical left ventricular dysfunction and transition to overt heart failure, further research into protectant molecules against cardiac dysfunction and aid in the discovery of which genetic variants predispose to CTRCD. A health economic arm of the study will assess the cost/benefit of both the registry and cardio-oncology clinical implementation. Finally, an imaging arm will establish if exercise cardiac magnetic resonance imaging and VO2 max testing is a more sensitive predictor of cardiac reserve in paediatric and adolescent and young adult oncology patients exposed to cardiac toxic therapies.
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Affiliation(s)
- Daniel Lapirow
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Cardiac Imaging Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Claudia Toro
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Emma Masango
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ben Costello
- Cardiac Imaging Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Enzo Porello
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Physiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Ludlow
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Glenn Marshall
- Department of Pathology, University of New South Wales, Sydney, New South Wales, Australia
| | - Toby Trahair
- Department of Pathology, University of New South Wales, Sydney, New South Wales, Australia
| | - Marion Mateos
- Department of Pathology, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jeremy Lewin
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jennifer Byrne
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rose Boutros
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rebecca Manudhane
- The Michael Rice Centre, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - John Heath
- Paediatric Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Julian Ayer
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Thomas Walwyn
- Oncology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jelena Saundankar
- Oncology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jonathon Forsey
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ha Le
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Kylie Mason
- OnTrac@Petermac, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Clinical Haematology and Bone Marrow Transplant Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Celermajer
- Cardiology Department, The Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Downie
- Children's Cancer Centre, Monash Health, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Roderick Walker
- Oncology Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Lucy Holland
- Oncology Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Michelle Martin
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lorna McLeman
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yonatan Diamond
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Maurizio Marcocci
- Chair, My Room Children's Cancer Charity, Melbourne, Victoria, Australia
| | - Susan Donath
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David A Elliott
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Conyers
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
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12
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Puranik R, Tann O, Occleshaw C, Celermajer D, Grigg L, Bullock A, Chen S, Ugander M, Cordina R, Ayer J. CMRI in Congenital Heart Disease Patients: Concerns Over Patient Safety Because of Inadequate Accreditation Procedures for MRI Scanning and Reporting. Heart Lung Circ 2021; 30:e86-e87. [PMID: 33637419 DOI: 10.1016/j.hlc.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 10/01/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Raj Puranik
- Royal Prince Alfred Hospital & Children's Hospital Westmead, Sydney, Australia.
| | | | | | | | | | | | - Sylvia Chen
- The Prince Charles Hospital, Queensland, Epworth Healthcare, Victoria, Australia
| | | | | | - Julian Ayer
- Children's Hospital Westmead, Sydney, Australia
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13
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Rehan R, Kotchetkova I, Cordina R, Celermajer D. Adult Congenital Heart Disease Survivors at Age 50 Years: Medical and Psychosocial Status. Heart Lung Circ 2021; 30:261-266. [DOI: 10.1016/j.hlc.2020.05.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/24/2020] [Indexed: 10/23/2022]
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14
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Offen S, Baker D, Puranik R, Celermajer D. Functional Tricuspid Regurgitation and its Relationship to Right Ventricular Volume. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Nicholson C, Hanly M, Celermajer D. Developing an Interactive Geographic Information System for Adult Congenital Heart Disease Service Planning in Rural New South Wales. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Offen S, Playford D, Strange G, Celermajer D. Prevalence and Outcomes of Tricuspid Regurgitation – From the National Echo Database of Australia. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Chami J, Nicholson C, Strange G, Cordina R, Celermajer D. National and Regional Registries for Congenital Heart Diseases: Strengths, Weaknesses and Opportunities. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Cherrett C, Baker D, Dennis M, Kotchetkova I, Celermajer D, Cordina R. Late Outcomes in Adults With Atrial Switch for Transposition of the Great Arteries Without High-risk Features at 30 Years of age. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Snir A, Wilson M, Ju A, Wong S, Khor K, Naoum C, Wong K, Keech A, Celermajer D, Ng M. Novel Pressure-Regulated Deployment Strategy for Improving the Safety and Efficacy of Balloon-Expandable Transcatheter Aortic Valves. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Wales K, Cao J, Zhao D, Seco M, Celermajer D, Bannon P. M05 Repair of Less Than Severe Tricuspid Regurgitation During Left Sided Valve Surgery: A Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Snir A, Ng M, Strange G, Playford D, Stewart S, Celermajer D. Cardiac Damage Staging Classification and Prognosis in Low Flow Low Gradient Severe Aortic Stenosis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Rubenis I, Tran D, Bullock A, Wijesekera V, Baker D, d'Udekem Y, du Plessis K, Katz D, Lowy M, Zentner D, Celermajer D, Cordina R. Sexual Function in Men Living With a Fontan Circulation. Front Pediatr 2021; 9:765380. [PMID: 34869122 PMCID: PMC8636090 DOI: 10.3389/fped.2021.765380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: It is unknown if the Fontan circulation has an impact on sexual health in men. This study assessed self-reported sexual health and fertility in men with a Fontan circulation. Aims: In this prospective, cross-sectional study, Australian men ≥18 years enrolled in the Fontan Registry of Australia and New Zealand were invited to complete the International Index of Erectile Function (IIEF), alongside questions assessing fertility. These data were compared to historical, age-matched controls. Results: Of 227 eligible men, 54 completed the survey; of those 37 were sexually active and included in the final analysis. Mean age was 28 ± 3 years, age at Fontan was 5 ± 3 years. Fontan type was extra-cardiac conduit in 15 (41%), lateral tunnel in 12 (32%), and atriopulmonary connection (APC) in 10 (27%). Ventricular function was normal in 24 (83%), and all were New York Heart Association Class I (23 patients, 79%) and II (six patients, 21%). Nine participants (24%) had erectile dysfunction (IIEF-EF score ≤25). The severity was mild (IIEF 22-24) in six (16%), mild-moderate (IIEF 17-21) in two (5%), and moderate (IIEF 11-16) in one (3%). Baseline characteristics and current medication usage were similar in those with and without erectile dysfunction. Compared with historical control values, erectile function was not significantly impaired in the Fontan population (p =0.76). Men with a Fontan circulation had decreased levels of sexual desire and overall satisfaction (p < 0.001). There was no correlation between the presence of erectile dysfunction and any assessed parameter. Eleven (30%) of the cohort reported a pregnancy with a prior partner. Conclusion: In our cohort, overall erectile function was comparable between men with a Fontan circulation and historical controls, however sexual desire and overall satisfaction were reduced. There was no correlation between study parameters and the presence of erectile dysfunction. The proportion of the cohort who had a prior pregnancy was congruent with population data.
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Affiliation(s)
- Imants Rubenis
- Concord Repatriation General Hospital, Concord, NSW, Australia.,School of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Derek Tran
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Heart Research Institute, Newtown, NSW, Australia
| | | | | | - David Baker
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Yves d'Udekem
- Children's National Hospital, Washington, DC, United States.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Darren Katz
- Men's Health Clinic Melbourne, Melbourne, VIC, Australia.,School of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | | | - Dominica Zentner
- School of Medicine, The University of Melbourne, Parkville, VIC, Australia.,Royal Melbourne Hospital, Parkville, VIC, Australia
| | - David Celermajer
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Heart Research Institute, Newtown, NSW, Australia.,Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Rachael Cordina
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Heart Research Institute, Newtown, NSW, Australia.,Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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23
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Lee T, D'Souza K, Hameed A, Yao J, Lam S, Chadban S, Ying T, Celermajer D, Sandroussi C, Pleass HCC, Laurence JM. Comparison of the effect of single vs dual antiplatelet agents on post-operative haemorrhage after renal transplantation: A systematic review and meta-analysis. Transplant Rev (Orlando) 2020; 35:100594. [PMID: 33482617 DOI: 10.1016/j.trre.2020.100594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A significant proportion of renal transplant patients have cardiovascular comorbidities for which they receive treatment with antiplatelet agents. The aim of this study was to systematically review the current literature reporting perioperative outcomes for patients receiving dual antiplatelet therapy compared to single antiplatelet therapy at the time of kidney transplantation with particular reference to the risks of postoperative haemorrhage. MATERIALS AND METHODS Embase, Medline and Cochrane databases were utilized to identify articles reporting outcomes of renal transplant recipients on single antiplatelet therapy and dual antiplatelet therapy. These outcomes were compared using a random effects model meta-analysis where appropriate. RESULTS Six articles were incorporated in the analysis, including 130 receiving dual antiplatelet therapy, and 781 in the single antiplatelet therapy group. There was a significantly higher risk of post-operative haemorrhagic events in the dual antiplatelet therapy group compared to the single antiplatelet therapy group (RR 1.58, 95% CI 1.19-2.09, p = 0.001). Post-operative cardiovascular event rates were similar between both groups in individual studies, although this could not be quantitatively analysed. CONCLUSIONS The use of dual antiplatelet therapy was associated with a higher risk of post-operative haemorrhage compared to the use of single antiplatelet therapy without increased rates of surgical intervention. However, the use of dual antiplatelet therapy may provide protection from cardiovascular events in an inherently higher risk patient group.
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Affiliation(s)
- Taina Lee
- Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | | | - Ahmer Hameed
- Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia
| | - Jinna Yao
- Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | - Susanna Lam
- Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | - Steven Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdwon, NSW 2050, Australia; University of Sydney Medical School, Australia
| | - Tracey Ying
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdwon, NSW 2050, Australia; University of Sydney Medical School, Australia
| | - David Celermajer
- University of Sydney Medical School, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdwon, NSW 2050, Australia
| | - Charbel Sandroussi
- RPA Institute of Academic Surgery, University of Sydney, RPA Institute of Academic Surgery, Level 9 E, Tranplantation Services, Missenden Road, Camperdwon, NSW 2050, Australia.; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | - Henry Claud Capron Pleass
- Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
| | - Jerome Martin Laurence
- RPA Institute of Academic Surgery, University of Sydney, RPA Institute of Academic Surgery, Level 9 E, Tranplantation Services, Missenden Road, Camperdwon, NSW 2050, Australia.; Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia.
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24
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Femia G, Semsarian C, Ross SB, Celermajer D, Puranik R. Left Ventricular Non-Compaction: Review of the Current Diagnostic Challenges and Consequences in Athletes. Medicina (Kaunas) 2020; 56:E697. [PMID: 33327510 PMCID: PMC7764920 DOI: 10.3390/medicina56120697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022]
Abstract
Left ventricular non-compaction (LVNC) is a complex clinical condition with no diagnostic gold standard. At present, there is trepidation about the accuracy of the diagnosis, the correlation to clinical outcomes and the long-term medical management. This article reviews the current imaging criteria, the limitations of echocardiography and cardiac magnetic resonance and the consequences of LV hypertrabeculation in athletes.
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Affiliation(s)
- Giuseppe Femia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
| | - Christopher Semsarian
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute, Camperdown 2050, Australia
| | - Samantha B. Ross
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - David Celermajer
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - Rajesh Puranik
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
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25
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Nanayakkara B, Lau E, Yee B, Gauthier G, Melehan K, Celermajer D, Cordina R. Sleep disordered breathing in adults living with a Fontan circulation and CPAP titration protocol. Int J Cardiol 2020; 317:70-74. [DOI: 10.1016/j.ijcard.2020.05.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 11/27/2022]
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26
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Tarp JB, Clausen P, Celermajer D, Christoffersen C, Jensen AS, Sørensen K, Sillesen H, Estensen ME, Nagy E, Holstein-Rathlou NH, Engstrøm T, Feldt-Rasmussen B, Søndergaard L. Vascular function in adults with cyanotic congenital heart disease. Int J Cardiol Heart Vasc 2020; 30:100632. [PMID: 32995473 PMCID: PMC7502339 DOI: 10.1016/j.ijcha.2020.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with cyanotic congenital heart disease (CCHD) may have a low burden of atherosclerosis. Endothelial dysfunction is an early stage of atherosclerosis and endothelial function is previously studied in smaller CCHD groups with different techniques and variable results. We aimed to examine endothelial function and carotid atherosclerosis in a larger group of CCHD patients. METHODS This multicentre study assessed endothelial function in adults with CCHD and controls by measuring the dilatory response of the brachial artery to post-ischemic hyperaemia (endothelium-dependent flow-mediated-vasodilatation (FMD)), and to nitroglycerin (endothelium-independent nitroglycerin-induced dilatation (NID)). Flow was measured at baseline and after ischaemia (reactive hyperaemia). Carotid-intima-media-thickness (CIMT), prevalence of carotid plaque and plaque thickness (cPT-max) were evaluated ultrasonographically. Lipoproteins, inflammatory and vascular markers, including sphingosine-1-phosphate (S1P) were measured. RESULTS Forty-five patients with CCHD (median age 50 years) and 45 matched controls (median age 52 years) were included. The patients presented with lower reactive hyperaemia (409 ± 114% vs. 611 ± 248%, p < 0.0001), however preserved FMD response compared to controls (106.5 ± 8.3% vs. 106.4 ± 6.1%, p = 0.95). In contrast, NID was lower in the patients (110.5 ± 6.1% vs. 115.1 ± 7.4%, p = 0.053). There was no difference in CIMT, carotid plaque or cPT-max. The patients presented with lower high-density-lipoprotein cholesterol, and higher level of inflammatory markers and S1P. CONCLUSION Adults with CCHD had preserved FMD in the brachial artery, but impaired NID response and lower reactive hyperaemia than controls. The preserved FMD and the comparable prevalence of carotid atherosclerosis indicate that CCHD patients have the same risk of atherosclerosis as controls.
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Affiliation(s)
- Julie Bjerre Tarp
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
- Department of Biomedical Science, University of Copenhagen, Denmark
| | - Peter Clausen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Denmark
| | - David Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christina Christoffersen
- Department of Biomedical Science, University of Copenhagen, Denmark
- Department of Biochemistry, Rigshospitalet and Bispebjerg Hospital, University Hospital of Copenhagen, Denmark
| | | | - Keld Sørensen
- Department of Medicine, Aalborg University Hospital (Farsoe), Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Edit Nagy
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
- Department of Cardiology, University of Lund, Sweden
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
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27
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Wang N, Fulcher J, Abeysuriya N, McGrady M, Wilcox I, Celermajer D, Lal S. Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis. Eur Heart J 2020; 40:476-484. [PMID: 30351406 DOI: 10.1093/eurheartj/ehy641] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Aims To undertake a systematic review and meta-analysis to determine the influence of tricuspid regurgitation (TR) severity on mortality. Methods and results We performed a systematic search for studies reporting clinical outcomes of patients with TR. The primary endpoint was all-cause mortality and secondary endpoints were cardiac mortality and hospitalization for heart failure (HF). Overall risk ratios (RR) and 95% confidence intervals (CIs) were derived for each endpoint according to the severity of TR by meta-analysing the effect estimates of eligible studies. Seventy studies totalling 32 601 patients were included in the analysis, with a mean (±SD) follow-up of 3.2 ± 2.1 years. Moderate/severe TR was associated with a two-fold increased mortality risk compared to no/mild TR (RR 1.95, 95% CI 1.75-2.17). Moderate/severe TR remained associated with higher all-cause mortality among 13 studies which adjusted for systolic pulmonary arterial pressures (RR 1.85, 95% CI 1.44-2.39), and 15 studies, which adjusted for right ventricular (RV) dysfunction (RR 1.78, 95% CI 1.49-2.13). Moderate/severe TR was also associated with increased cardiac mortality (RR 2.56, 95% CI 1.84-3.55) and HF hospitalization (RR 1.73, 95% CI 1.14-2.62). Compared to patients with no TR, patients with mild, moderate, and severe TR had a progressively increased risk of all-cause mortality (RR 1.25, 1.61, and 3.44, respectively; P < 0.001 for trend). Conclusions Moderate/severe TR is associated with an increased mortality risk, which appears to be independent of pulmonary pressures and RV dysfunction.
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Affiliation(s)
- Nelson Wang
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jordan Fulcher
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Michele McGrady
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ian Wilcox
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David Celermajer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sean Lal
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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28
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Gondoputro W, Rajendran S, Celermajer D, Qasabian R. An unusual case of upper limb ischemia in a marathon runner. J Vasc Surg Cases Innov Tech 2020; 6:160-164. [PMID: 32154474 PMCID: PMC7057154 DOI: 10.1016/j.jvscit.2020.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/30/2020] [Indexed: 11/23/2022]
Abstract
Acute limb ischemia in young adults warrants thorough investigation to determine the underlying cause. Here, we present a case of acute upper limb ischemia in a marathon runner secondary to paradoxical embolism. The patient had associated deep venous thrombosis of the lower limb with multiple pulmonary emboli and patent foramen ovale. This case report emphasizes the under-recognition of intense endurance exercise as a risk factor for venous thromboembolism and highlights the potentially debilitating embolic sequelae of venous thromboembolism in patients with patent foramen ovale.
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Affiliation(s)
- William Gondoputro
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Saissan Rajendran
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Correspondence: Saissan Rajendran, MBBS, MS, FRACS, Department of Vascular Surgery, Royal Prince Alfred Hospital, PO Box M157, Missenden Rd, NSW 2050, Australia
| | - David Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Heart Research Institute, Sydney, New South Wales, Australia
| | - Raffi Qasabian
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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29
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Anderson J, Lavender M, Lau E, Celermajer D, Collins N, Dwyer N, Feenstra J, Horrigan M, Keating D, Keogh A, Kotlyar E, Ng B, Proudman S, Steele P, Thakkar V, Weintraub R, Whitford H, Williams T, Wrobel J, Strange G. Pharmacological Treatment of Pulmonary Arterial Hypertension in Australia: Current Trends and Challenges. Heart Lung Circ 2020; 29:1459-1468. [PMID: 32280014 DOI: 10.1016/j.hlc.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/25/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Combination drug therapy for pulmonary arterial hypertension (PAH) is the international standard of care for most patients, however in Australia there are barriers to drug access. This study evaluates current treatment of PAH patients in Australia and the consistency of therapy with international guidelines. METHODS Cross-sectional analysis of patients with Group 1 PAH enrolled in the Pulmonary Hypertension Society of Australia and New Zealand Registry (PHSANZ) at 31 December 2017. Drug treatment was classified as monotherapy or combination therapy and adequacy of treatment was determined by risk status assessment using the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) 2.0 risk calculator. Predictors of monotherapy were assessed using a generalised linear model with Poisson distribution and logarithmic link function. RESULTS 1,046 patients met the criteria for analysis. Treatment was classified as monotherapy in 536 (51%) and combination therapy in 510 (49%) cases. Based on REVEAL 2.0, 184 (34%) patients on monotherapy failed to meet low-risk criteria and should be considered inadequately treated. Independent predictors of monotherapy included age greater than 60 years (risk ratio [RR] 1.23, 95% confidence interval [CI] 1.09-1.38; p=0.001), prevalent enrolment in the registry (RR 1.21 [95%CI 1.08-1.36]; p=0.001) and comorbid systemic hypertension (RR 1.17 [95%CI 1.03-1.32]; p=0.014), while idiopathic/heritable/drug-induced PAH subtype (RR 0.85 [95%CI 0.76-0.96]; p=0.006), functional class IV (RR 0.50 [95%CI 0.29-0.86]; p=0.012), increased right ventricular systolic pressure (RR 0.99 [95%CI 0.99-1.00]; p<0.001) and increased pulmonary vascular resistance (RR 0.96 [95%CI 0.95-0.98]; p<0.001) were less likely to be associated with monotherapy. CONCLUSIONS Most Australian PAH patients are treated with monotherapy and a significant proportion remain at risk of poor outcomes. This is below the standard of care recommended by international guidelines and at risk patients should be escalated to combination therapy.
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Affiliation(s)
- James Anderson
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; Respiratory Department, Sunshine Coast University Hospital, Birtinya, Qld, Australia.
| | - Melanie Lavender
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Edmund Lau
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - David Celermajer
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Nathan Dwyer
- Cardiology Department, Royal Hobart Hospital, Hobart, Tas, Australia
| | - John Feenstra
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Qld, Australia
| | | | - Dominic Keating
- Respiratory Department, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Anne Keogh
- Heart and Lung Transplant Unit and Cardiology Department, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Eugene Kotlyar
- Heart and Lung Transplant Unit and Cardiology Department, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | | | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter Steele
- Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Vivek Thakkar
- Macquarie University, Department of Clinical Medicine, Macquarie Park, NSW, Australia; Department of Rheumatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Robert Weintraub
- Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Helen Whitford
- Respiratory Department, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Trevor Williams
- Respiratory Department, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Jeremy Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; University of Notre Dame, Perth, WA, Australia
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30
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Othman F, Collins N, Bailey B, Rao K, Tanous D, Lau E, Celermajer D, Cordina R. PLATYPNEA-ORTHODEOXIA SYNDROME: KEY PATHOGENETIC ROLE OF PATENT FORAMEN OVALE (PFO) AND DRAMATIC RESPONSE TO PFO CLOSURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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31
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Tran D, Munoz P, Lau E, Alison J, Brown M, Zheng Y, Corkery P, Wong K, Lindstrom S, Celermajer D, Davis G, Cordina R. INSPIRATORY MUSCLE TRAINING IMPROVES SIX-MINUTE WALK DISTANCE IN ADULTS WITH PULMONARY ARTERIAL HYPERTENSION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32712-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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32
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Khuong JN, Wilson TG, Grigg LE, Bullock A, Celermajer D, Disney P, Wijesekera VA, Hornung T, Zannino D, Iyengar AJ, d'Udekem Y. Fontan-associated nephropathy: Predictors and outcomes. Int J Cardiol 2020; 306:73-77. [PMID: 31955974 DOI: 10.1016/j.ijcard.2020.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/08/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Nephropathy is a known complication of the Fontan circulation, but its determinants have not been identified and patient outcomes are also still unknown. METHODS The Australia and New Zealand Fontan Registry was used to identify those who underwent Fontan operation before and survived beyond 16-years-old with an intact Fontan circulation. Serum creatinine values were collected for each patient between 16 and 25 years and at recent follow-up. The Modification of Diet in Renal Disease (MDRD) equation was used to calculate eGFR. Patient outcomes were obtained from the Registry. Fontan failure was defined as death, transplantation, plastic bronchitis, protein losing enteropathy, Fontan takedown and NYHA class III-IV. RESULTS Serum creatinine measurements were available for 328 patients. Renal dysfunction was defined as eGFR <90 mL/min/1.72m2. Renal dysfunction was present in 67/328 (20%) and 3/328 (1%) patients had an eGFR <60 mL/min/1.72m2. The 10-year survival and 10-year freedom from death and transplantation were the same, 96% (95% CI: 0.9-1) for those with renal dysfunction, and 89% (0.83-0.95; p = 0.1) and 87% (95% CI: 0.81-0.94; p = 0.05) for patients without dysfunction. The 10-year freedom from failure were also similar, 83% (95% CI: 0.70-0.97) for those without renal dysfunction vs 80% (95% CI: 0.74-0.89; p = 0.84). There was no change in mean eGFR for the renal dysfunction group over a mean of 8 ± 5.5 years. CONCLUSION By the time they reach adulthood, 20% of patients with a Fontan circulation have renal dysfunction by eGFR calculation. Over the course of one decade, Fontan-associated nephropathy appears well tolerated.
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Affiliation(s)
- Jacqueline Nguyen Khuong
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
| | - Thomas G Wilson
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
| | - Leeanne E Grigg
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew Bullock
- Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, Australia
| | - David Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Patrick Disney
- Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia
| | | | - Tim Hornung
- Green Lane Paediatric and Congenital Cardiac Service, Auckland District Health Board, Auckland, New Zealand
| | - Diana Zannino
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ajay J Iyengar
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia; Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
| | - Yves d'Udekem
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia; Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.
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33
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Lim M, Strange G, Playford D, Celermajer D. 652 Bicuspid Aortic Valve – A Community-Based Study of 4,999 Adults From the National Echo Database of Australia (NEDA). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Cao J, Marathe S, Zannino D, Celermajer D, Justo R, Alphonso N, d'Udekem Y, Winlaw D. 042 Challenging the “Ten Commandments” – Early Age at Fontan is not a Risk Factor for Long-Term Failure. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Baker D, Osborn D, Fleischer R, Celermajer D, Collins F, Cordina R. 658 Early Experience of a Combined Adult Congenital Heart Disease and Genetic Clinic. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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36
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Offen S, Simmons L, Lal S, Celermajer D. 301 Characterising the Tricuspid Valve to Inform Interventional Strategies. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Lim M, Playford D, Strange G, Celermajer D. 655 Different Clinical Features of Bicuspid Versus Tricuspid Aortic Stenosis; a Study From the National Echo Database of Australia (NEDA). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Marshall K, D'Udekem Y, Sholler G, Costa D, Celermajer D, Winlaw D, Kasparian N. 656 Do You See What I See?: Comparing Child and Parent-Proxy Reported Health-Related Quality of Life and Wellbeing Among People With a Fontan Circulation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Holmes L, Black G, Jeremy R, Cordina R, Celermajer D, Karkenahalli S, Puranik R. 403 Simulation of Altered Blood Flow in Bicuspid Aortic Valve Disease: A Proof of Concept Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Rehan R, Kotchetkova I, Cordina R, Celermajer D. 041 Adult Congenital Heart Disease Survivors At Age 50; Medical and Psychosocial Status. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Othman F, Collins N, Bailey B, Lau E, Tanous D, Rao K, Celermajer D, Cordina R. 676 Platypnea-Orthodeoxia Syndrome: Key Pathogenetic Role of Patent Foramen Ovale (PFO) and Dramatic Response to PFO Closure. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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42
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Stanton K, Kienzle V, Dinnes D, Jessup W, Kritharides L, Rye K, Celermajer D. 739 Moderate and High Intensity Exercise Improve Cholesterol Efflux Capacity, Lipoprotein Profile and Increase HDL Particle Size in Healthy Young Men. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Cai T, Alice M, Qasem A, Butlin M, Ayer J, Celermajer D, Avolio A, Skilton M. P128 Accuracy of Age-appropriate Transfer Functions in Modelling Central Arterial Waveform Features. Artery Res 2020. [DOI: 10.2991/artres.k.191224.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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44
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Playford D, Stewart S, Celermajer D, Prior D, Scalia G, Marwick T, Ilton M, Codde J, Strange G. 619 Poor Survival With Impaired Valvular Haemodynamics After Aortic Valve Replacement: The National Echocardiography Database of Australia Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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45
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Wales K, Osborn D, Cordina R, Celermajer D. 670 Menorrhagia: A Serious and Under-Recognised Complication of Eisenmenger’s Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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46
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Femia G, Zhu D, Choudhary P, B. Ross S, Muthurangu V, Richmond D, Celermajer D, Semsarian C, Puranik R. 136 Long Term Clinical Outcomes in CMR Quantified Left Ventricular Noncompaction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Cai Y, Haghighi M, Roberts P, Mervis J, Qasem A, Butlin M, Celermajer D, Avolio A, Skilton M, Ayer J. 061 Validity of Carotid Artery Tonometry for Estimating Central Hemodynamic Indices in Children. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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Lim M, Celermajer D. 666 Implications of Concomitant Bicuspid Aortic Valve in Patients With Aortic Coarctation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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49
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Tait J, Chow C, Figtree G, Celermajer D, Patel S. 491 Fate of “Low Risk” Chest Pain Patients Discharged From the Emergency Department. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Cai T, Meroni A, Qasem A, Butlin M, Ayer J, Celermajer D, Avolio A, Skilton M. P136 Determinants of Arterial Stiffness in Children Using Population-indexed Anthropometric and Hemodynamic Parameters. Artery Res 2020. [DOI: 10.2991/artres.k.191224.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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