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Christensen AH, Wyller VB, Nygaard S, Rolid K, Nytrøen K, Gullestad L, Fiane A, Thaulow E, Saul JP, Døhlen G. Factors Associated With Sinoatrial Reinnervation After Heart Transplantation. Transplant Direct 2023; 9:e1553. [PMID: 37928482 PMCID: PMC10624457 DOI: 10.1097/txd.0000000000001553] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 11/07/2023] Open
Abstract
Background Factors associated with sympathetic and parasympathetic sinoatrial reinnervation after heart transplantation (HTx) are inadequately studied. Methods Fifty transplant recipients were examined at 7 to 12 wk (index visit), 6, 12, 24, and 36 mo after HTx. Supine rest heart rate variability in the low-frequency (LF) domain (sympathetic and parasympathetic sinoatrial reinnervation) and the high-frequency (HF) domain (parasympathetic sinoatrial reinnervation) were measured repeatedly and related to selected recipient, donor, and perisurgical characteristics. We primarily aimed to identify index visit factors that affect the sinoatrial reinnervation process. Secondarily, we examined overall associations between indices of reinnervation and repeatedly measured recipient characteristics to generate new hypotheses regarding the consequences of reinnervation. Results LF and HF variability increased time dependently. In multivariate modeling, a pretransplant diagnosis of nonischemic cardiomyopathy (P = 0.038) and higher index visit handgrip strength (P = 0.028) predicted improved LF variability. Recipient age, early episodes of rejection, and duration of extracorporeal circulation were not associated with indices of reinnervation. Study average handgrip strength was positively associated with LF and HF variability (respectively, P = 0.005 and P = 0.029), whereas study average C-reactive protein was negatively associated (respectively, P = 0.015 and P = 0.008). Conclusions Indices of both sympathetic and parasympathetic sinoatrial reinnervation increased with time after HTx. A pretransplant diagnosis of nonischemic cardiomyopathy and higher index visit handgrip strength predicted higher indices of mainly sympathetic reinnervation, whereas age, rejection episodes, and duration of extracorporeal circulation had no association. HTx recipients with higher indices of reinnervation had higher average handgrip strength, suggesting a link between reinnervation and improved frailty. The more reinnervated participants had lower average C-reactive protein, suggesting an inhibitory effect of reinnervation on inflammation, possibly through enhanced function of the inflammatory reflex. These potential effects of reinnervation may affect long-term morbidity in HTx patients and should be scrutinized in future research.
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Affiliation(s)
- Anders H. Christensen
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Vegard B.B. Wyller
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics, Akershus University Hospital, Norway
| | - Sissel Nygaard
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Katrine Rolid
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Norway
- Center for Heart Failure Research, Oslo University Hospital, Norway
| | - Kari Nytrøen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Norway
- Center for Heart Failure Research, Oslo University Hospital, Norway
| | - Arnt Fiane
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Thaulow
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J. Philip Saul
- Department of Pediatrics, West Virginia University, Morgantown, VA
| | - Gaute Døhlen
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Erikssen G, Liestøl K, Aboulhosn J, Wik G, Holmstrøm H, Døhlen G, Gjesdal O, Birkeland S, Hoel TN, Saatvedt KJ, Seem E, Thaulow E, Estensen ME, Lindberg HL. Preoperative versus postoperative survival in patients with univentricular heart: a nationwide, retrospective study of patients born in 1990-2015. BMJ Open 2023; 13:e069531. [PMID: 37491095 PMCID: PMC10373731 DOI: 10.1136/bmjopen-2022-069531] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES Few data exist on mortality among patients with univentricular heart (UVH) before surgery. Our aim was to explore the results of intention to perform surgery by estimating preoperative vs postoperative survival in different UVH subgroups. DESIGN Retrospective. SETTING Tertiary centre for congenital cardiology and congenital heart surgery. PARTICIPANTS All 595 Norwegian children with UVH born alive from 1990 to 2015, followed until 31 December 2020. RESULTS One quarter (151/595; 25.4%) were not operated. Among these, only two survived, and 125/149 (83.9%) died within 1 month. Reasons for not operating were that surgery was not feasible in 31.1%, preoperative complications in 25.2%, general health issues in 23.2% and parental decision in 20.5%. In total, 327/595 (55.0%) died; 283/327 (86.5%) already died during the first 2 years of life. Preoperative survival varied widely among the UVH subgroups, ranging from 40/65 (61.5%) among patients with unbalanced atrioventricular septal defect to 39/42 (92.9%) among patients with double inlet left ventricle. Postoperative survival followed a similar pattern. Postoperative survival among patients with hypoplastic left heart syndrome (HLHS) improved significantly (5-year survival, 42.5% vs 75.3% among patients born in 1990-2002 vs 2003-2015; p<0.0001), but not among non-HLHS patients (65.7% vs 72.6%; p=0.22)-among whom several subgroups had a poor prognosis similar to HLHS. A total of 291/595 patients (48.9%) had Fontan surgery CONCLUSIONS: Surgery was refrained in one quarter of the patients, among whom almost all died shortly after birth. Long-term prognosis was largely determined during the first 2 years. There was a strong concordance between preoperative and postoperative survival. HLHS survival was improved, but non-HLHS survival did not change significantly. This study demonstrates the complications and outcomes encountering newborns with UVH at all major stages of preoperative and operative treatment.
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Affiliation(s)
- Gunnar Erikssen
- Department of Cardiology, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Jamil Aboulhosn
- Ahmanson Adult Congenital Heart Disease Center, UCLA, Los Angeles, California, USA
| | - Gunnar Wik
- Department of Pediatrics, Sørlandet Hospital, Kristiansand, Norway
| | - Henrik Holmstrøm
- Department of Women's and Children's, Oslo University Hospital, Oslo, Norway
- Department of Women's and Children's, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gaute Døhlen
- Department of Women's and Children's, Oslo University Hospital, Oslo, Norway
| | - Ola Gjesdal
- Department of Cardiology, Oslo University Hospital rikshospitalet, Oslo, Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Tom Nilsen Hoel
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kjell Johan Saatvedt
- Department of Coardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Egil Seem
- Department of Coardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Erik Thaulow
- Department of Pediatric Cardiology, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Mette E Estensen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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Möller T, Klungerbo V, Diab S, Holmstrøm H, Edvardsen E, Grindheim G, Brun H, Thaulow E, Köhn-Luque A, Rösner A, Døhlen G. Circulatory Response to Rapid Volume Expansion and Cardiorespiratory Fitness in Fontan Circulation. Pediatr Cardiol 2022; 43:903-913. [PMID: 34921324 PMCID: PMC9005395 DOI: 10.1007/s00246-021-02802-y] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
The role of dysfunction of the single ventricle in Fontan failure is incompletely understood. We aimed to evaluate hemodynamic responses to preload increase in Fontan circulation, to determine whether circulatory limitations in different locations identified by experimental preload increase are associated with cardiorespiratory fitness (CRF), and to assess the impact of left versus right ventricular morphology. In 38 consecutive patients (median age = 16.6 years, 16 females), heart catheterization was supplemented with a rapid 5-mL/kg body weight volume expansion. Central venous pressure (CVP), ventricular end-diastolic pressure (VEDP), and peak systolic pressure were averaged for 15‒30 s, 45‒120 s, and 4‒6 min (steady state), respectively. CRF was assessed by peak oxygen consumption (VO2peak) and ventilatory threshold (VT). Median CVP increased from 13 mmHg at baseline to 14.5 mmHg (p < 0.001) at steady state. CVP increased by more than 20% in eight patients. Median VEDP increased from 10 mmHg at baseline to 11.5 mmHg (p < 0.001). Ten patients had elevated VEDP at steady state, and in 21, VEDP increased more than 20%. The transpulmonary pressure difference (CVP‒VEDP) and CVP were consistently higher in patients with right ventricular morphology across repeated measurements. CVP at any stage was associated with VO2peak and VT. VEDP after volume expansion was associated with VT. Preload challenge demonstrates the limitations beyond baseline measurements. Elevation of both CVP and VEDP are associated with impaired CRF. Transpulmonary flow limitation was more pronounced in right ventricular morphology. Ventricular dysfunction may contribute to functional impairment after Fontan operation in young adulthood.ClinicalTrials.gov identifier NCT02378857.
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Affiliation(s)
- Thomas Möller
- Department of Paediatric Cardiology, Oslo University Hospital Rikshospitalet, Nydalen, P.O. Box 4950, 0424, Oslo, Norway.
| | - Vibeke Klungerbo
- Department of Paediatric Cardiology, Oslo University Hospital Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway ,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Simone Diab
- Department of Paediatric Cardiology, Oslo University Hospital Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway ,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Paediatric Cardiology, Oslo University Hospital Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway ,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Edvardsen
- Institute of Physical Performance, Norwegian School of Sport and Sciences, Oslo, Norway ,Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Guro Grindheim
- Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Henrik Brun
- Department of Paediatric Cardiology, Oslo University Hospital Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway
| | - Erik Thaulow
- Department of Paediatric Cardiology, Oslo University Hospital Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway
| | - Alvaro Köhn-Luque
- Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Assami Rösner
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Gaute Døhlen
- Department of Paediatric Cardiology, Oslo University Hospital Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway
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Falk RS, Mariampillai JE, Prestgaard EE, Heir T, Bodegård J, Robsahm TE, Grundvold I, Skretteberg PT, Engeseth K, Bjornholt JV, Stavem K, Liestøl K, Sandvik L, Thaulow E, Erikssen G, Kjeldsen SE, Gjesdal K, Erikssen JE. The Oslo Ischaemia Study: cohort profile. BMJ Open 2021; 11:e049111. [PMID: 34645662 PMCID: PMC8515426 DOI: 10.1136/bmjopen-2021-049111] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The Oslo Ischaemia Study was designed to investigate the prevalence and predictors of silent coronary disease in Norwegian middle-aged men, specifically validating exercise electrocardiography (ECG) findings compared with angiography. The study has been important in investigating long-term predictors of cardiovascular morbidity and mortality, as well as investigating a broad spectrum of epidemiological and public health perspectives. PARTICIPANTS In 1972-1975, 2014 healthy men, 40-59 years old, were enrolled in the study. Comprehensive clinical examination included an ECG-monitored exercise test at baseline and follow-ups. The cohort has been re-examined four times during 20 years. Linkage to health records and national health registries has ensured complete endpoint registration of morbidity until the end of 2006, and cancer and mortality until the end of 2017. FINDINGS TO DATE The early study results provided new evidence, as many participants with a positive exercise ECG, but no chest pain ('silent ischaemia'), did not have significant coronary artery stenosis after all. Still, they were over-represented with coronary disease after years of follow-up. Furthermore, participants with the highest physical fitness had lower risk of cardiovascular disease, and the magnitude of blood pressure responses to moderate exercise was shown to influence the risk of cardiovascular disease and mortality. With time, follow-up data allowed the scope of research to expand into other fields of medicine, with the aim of investigating predictors and the importance of lifestyle and risk factors. FUTURE PLANS Recently, the Oslo Ischaemia Study has been found worthy, as the first scientific study, to be preserved by The National Archives of Norway. All the study material will be digitised, free to use and accessible for all. In 2030, the Oslo Ischaemia Study will be linked to the Norwegian Cause of Death Registry to obtain complete follow-up to death. Thus, a broad spectrum of additional opportunities opens.
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Affiliation(s)
- Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | | | - Trond Heir
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johan Bodegård
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Irene Grundvold
- Department of Cardiology, Akershus University Hospital, Lorenskog, Lørenskog, Norway
| | | | - Kristian Engeseth
- Department of Cardiology, Akershus University Hospital, Lorenskog, Lørenskog, Norway
| | - Jorgen Vildershoj Bjornholt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Knut Stavem
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway
| | - Knut Liestøl
- Institute of Informatics, University of Oslo, Oslo, Norway
| | - Leiv Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Erik Thaulow
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Gunnar Erikssen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Knut Gjesdal
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jan E Erikssen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wyller VBB, Nygaard S, Christensen AH, Rolid K, Nytrøen K, Gullestad L, Fiane A, Thaulow E, Døhlen G, Saul JP. Functional evidence of low-pressure cardiopulmonary baroreceptor reinnervation 1 year after heart transplantation. Eur J Appl Physiol 2021; 121:915-927. [PMID: 33389144 DOI: 10.1007/s00421-020-04586-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Heart transplantation (HTx) implies denervation of afferent neural connections. Reinnervation of low-pressure cardiopulmonary baroreceptors might impact the development and treatment of hypertension, but little is known of its occurrence. The present prospective study investigated possible afferent reinnervation of low-pressure cardiopulmonary baroreceptors during the first year after heart transplantation. METHODS A total of 50 heart transplant recipients (HTxRs) were included and were evaluated 7-12 weeks after transplant surgery, with follow-up 6 and 12 months later. In addition, a reference group of 50 healthy control subjects was examined once. Continuous, non-invasive recordings of cardiovascular variables were carried out at supine rest, during 15 min of 20° head-up tilt, during Valsalva maneuver and during 1 min of 30% maximal voluntary handgrip. In addition, routine clinical data including invasive measurements were used in the analyses. RESULTS During the first year after HTx, the heart rate (HR) response to 20° head-up tilt partly normalized, a negative relationship between resting mean right atrial pressure and HR tilt response developed, low-frequency variability of the RR interval and systolic blood pressure at supine rest increased, and the total peripheral resistance response to Valsalva maneuver became stronger. CONCLUSION Functional assessments suggest that afferent reinnervation of low-pressure cardiopulmonary receptors occurs during the first year after heart transplantation, partially restoring reflex-mediated responses to altered cardiac filling.
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Affiliation(s)
- Vegard Bruun Bratholm Wyller
- Department of Pediatrics, Akershus University Hospital, 1478, Lørenskog, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Sissel Nygaard
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Pediatric Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Anders Haugom Christensen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Pediatric Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Katrine Rolid
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Kari Nytrøen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Arnt Fiane
- Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Erik Thaulow
- Department of Pediatric Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Gaute Døhlen
- Department of Pediatric Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - J Philip Saul
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
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de Lange C, Thrane KJ, Thomassen KS, Geier O, Nguyen B, Tomterstad A, Ording Müller LS, Thaulow E, Almaas R, Døhlen G, Suther KR, Möller T. Hepatic magnetic resonance T1-mapping and extracellular volume fraction compared to shear-wave elastography in pediatric Fontan-associated liver disease. Pediatr Radiol 2021; 51:66-76. [PMID: 33033916 PMCID: PMC7796890 DOI: 10.1007/s00247-020-04805-y] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/10/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Children with Fontan circulation are at risk of developing hepatic fibrosis/cirrhosis. Reliable noninvasive monitoring techniques are lacking or under development. OBJECTIVE To investigate surrogate indicators of hepatic fibrosis in adolescents with Fontan circulation by evaluating hepatic magnetic resonance (MR) T1 mapping and extracellular volume fraction measurements compared to US shear-wave elastography. MATERIALS AND METHODS We analyzed hepatic native T1 times and extracellular volume fractions with modified Look-Locker inversion recovery. Liver stiffness was analyzed with shear-wave elastography. We compared results between 45 pediatric patients ages 16.7±0.6 years with Fontan circulation and 15 healthy controls ages 19.2±1.2 years. Measurements were correlated to clinical and hemodynamic data from cardiac catheterization. RESULTS MR mapping was successful in 35/45 patients, revealing higher hepatic T1 times (774±44 ms) than in controls (632±52 ms; P<0.001) and higher extracellular volume fractions (47.4±5.0%) than in controls (34.6±3.8%; P<0.001). Liver stiffness was 1.91±0.13 m/s in patients vs. 1.20±0.10 m/s in controls (P<0.001). Native T1 times correlated with central venous pressures (r=0.5, P=0.007). Native T1 was not correlated with elastography in patients (r=0.2, P=0.1) or controls (r = -0.3, P=0.3). Extracellular volume fraction was correlated with elastography in patients (r=0.5, P=0.005) but not in controls (r=0.2, P=0.6). CONCLUSION Increased hepatic MR relaxometry and shear-wave elastography values in adolescents with Fontan circulation suggested the presence of hepatic fibrosis or congestion. Central venous pressure was related to T1 times. Changes were detected differently with MR relaxometry and elastography; thus, these techniques should not be used interchangeably in monitoring hepatic fibrosis.
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Affiliation(s)
- Charlotte de Lange
- Division of Radiology and Nuclear Medicine, Section of Paediatric Radiology, Oslo University Hospital, Oslo, Norway. .,Department of Radiology and Clinical Physiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Rondv 10, S-41615, Göteborg, Sweden.
| | - Karl Julius Thrane
- Division of Radiology and Nuclear Medicine, Section of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Kristian S. Thomassen
- Division of Radiology and Nuclear Medicine, Section of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Oliver Geier
- Department of Physics, Oslo University Hospital, Oslo, Norway
| | - Bac Nguyen
- Division of Radiology and Nuclear Medicine, Section of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Anders Tomterstad
- Division of Radiology and Nuclear Medicine, Section of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Lil-Sofie Ording Müller
- Division of Radiology and Nuclear Medicine, Section of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Erik Thaulow
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Runar Almaas
- Department of Paediatric Research and Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Gaute Døhlen
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kathrine Rydén Suther
- Division of Radiology and Nuclear Medicine, Section of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Thomas Möller
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
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Smiseth OA, Edvardsen T, Thaulow E, Fiane A. Sigurd Nitter-Hauge. Tidsskriftet 2020. [DOI: 10.4045/tidsskr.19.0774] [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: 11/02/2022] Open
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Diab SG, Godang K, Müller LO, Almaas R, Lange C, Brunvand L, Hansen KM, Myhre AG, Døhlen G, Thaulow E, Bollerslev J, Möller T. Progressive loss of bone mass in children with Fontan circulation. CONGENIT HEART DIS 2019; 14:996-1004. [DOI: 10.1111/chd.12848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Simone Goa Diab
- Department of Pediatric Cardiology Oslo University Hospital Oslo Norway
| | - Kristin Godang
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway
| | - Lil‐Sofie Ording Müller
- Division of Radiology and Nuclear Medicine Section of Pediatric Radiology Oslo University Hospital Oslo Norway
| | - Runar Almaas
- Division of Pediatric and Adolescent Medicine Department of Pediatric Research Oslo University Hospital Oslo Norway
| | - Charlotte Lange
- Division of Radiology and Nuclear Medicine Section of Pediatric Radiology Oslo University Hospital Oslo Norway
| | - Leif Brunvand
- Department of Pediatric Cardiology Oslo University Hospital Oslo Norway
| | | | | | - Gaute Døhlen
- Department of Pediatric Cardiology Oslo University Hospital Oslo Norway
| | - Erik Thaulow
- Department of Pediatric Cardiology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Jens Bollerslev
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Thomas Möller
- Department of Pediatric Cardiology Oslo University Hospital Oslo Norway
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Nygaard S, Christensen AH, Rolid K, Nytrøen K, Gullestad L, Fiane A, Thaulow E, Døhlen G, Godang K, Saul JP, Wyller VBB. Autonomic cardiovascular control changes in recent heart transplant recipients lead to physiological limitations in response to orthostatic challenge and isometric exercise. Eur J Appl Physiol 2019; 119:2225-2236. [PMID: 31407088 PMCID: PMC6763412 DOI: 10.1007/s00421-019-04207-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Heart transplantation causes denervation of the donor heart, but the consequences for cardiovascular homeostasis remain to be fully understood. The present study investigated cardiovascular autonomic control at supine rest, during orthostatic challenge and during isometric exercise in heart transplant recipients (HTxR). METHODS A total of 50 HTxRs were investigated 7-12 weeks after transplant surgery and compared with 50 healthy control subjects. Continuous, noninvasive recordings of cardiovascular variables were carried out at supine rest, during 15 min of 60° head-up tilt and during 1 min of 30% of maximal voluntary handgrip. Plasma and urine catecholamines were assayed, and symptoms were charted. RESULTS At supine rest, heart rate, blood pressures and total peripheral resistance were higher, and stroke volume and end diastolic volume were lower in the HTxR group. During tilt, heart rate, blood pressures and total peripheral resistance increased less, and stroke volume and end diastolic volume decreased less. During handgrip, heart rate and cardiac output increased less, and stroke volume and end diastolic volume decreased less. Orthostatic symptoms were similar across the groups, but the HTxRs complained more of pale and cold hands. CONCLUSION HTxRs are characterized by elevated blood pressures and total peripheral resistance at supine rest as well as attenuated blood pressures and total peripheral resistance responses during orthostatic challenge, possibly caused by low-pressure cardiopulmonary baroreceptor denervation. In addition, HTxRs show attenuated cardiac output response during isometric exercise due to efferent sympathetic denervation. These physiological limitations might have negative functional consequences.
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Affiliation(s)
- Sissel Nygaard
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anders Haugom Christensen
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Katrine Rolid
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kari Nytrøen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Arnt Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Thaulow
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Gaute Døhlen
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - J Philip Saul
- Department of Pediatrics, West Virginia University, Morgantown, USA
| | - Vegard Bruun Bratholm Wyller
- Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Paediatrics, Akershus University Hospital, 1478, Lørenskog, Norway.
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10
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Dale J, Thaulow E, Myhre E, Parry J. The Effect of a Thromboxane Synthetase Inhibitor, Dazoxiben, and Acetylsalicylic Acid on Platelet Function and Prostaglandin Metabolism. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1665291] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryTwenty-four men received either placebo, 0.1 g of the thromboxane synthetase inhibitor dazoxiben, 0.25 or 1.0 g of acetylsalicylic acid (ASA). Dazoxiben reduced the maximal rate of collagen-induced platelet aggregation, but less than did ASA. ASA abolished secondary, ADP-induced aggregation, dazoxiben not. Both drugs prolonged the bleeding-time.Plasma thromboxane B2 (TxB2) levels did not change significantly after dazoxiben, whereas the prostacyclin metabolite 6-keto-PGF1α rose. The larger dose of ASA reduced both TxB2 and 6-keto-PGF1α in plasma. Whole blood was allowed to clot in order to estimate prostaglandin metabolism. Both drugs prevented thromboxane production effectively. Formation of 6-keto-PGF1α decreased by 95 per cent after ASA but was more than doubled after dazoxiben.Dazoxiben is a selective and effective thromboxane synthetase inhibitor, but has a weaker effect on platelet reactivity than ASA, possibly because endoperoxide formation is not prevented.
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Affiliation(s)
- Jon Dale
- The Medical Department B, Research Institute for Internal Medicine, Rikshospitalet, Oslo, Norway, and Pfizer Central Research, Pfizer Ltd., Sandwich, Kent, England
| | - Erik Thaulow
- The Medical Department B, Research Institute for Internal Medicine, Rikshospitalet, Oslo, Norway, and Pfizer Central Research, Pfizer Ltd., Sandwich, Kent, England
| | - Erik Myhre
- The Medical Department B, Research Institute for Internal Medicine, Rikshospitalet, Oslo, Norway, and Pfizer Central Research, Pfizer Ltd., Sandwich, Kent, England
| | - John Parry
- The Medical Department B, Research Institute for Internal Medicine, Rikshospitalet, Oslo, Norway, and Pfizer Central Research, Pfizer Ltd., Sandwich, Kent, England
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11
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Abstract
SummaryThe view based on epidemiological and laboratory data that blood group A subjects (=A) have clinically significant higher thrombotic potential than blood group 0 subjects (= O), is supported by the present finding of a significantly higher platelet retention in A than 0.The completely normal ABO distribution found among 71 cases of proven latent CHD, and the disproportionate excess of 0 vs. A in a consecutive series of 191 coronary artery bypass candidates apparently conflict with epidemiological data indicating a higher risk of achieving CHD in A than 0. The conflict may be solved by suggestinga) that the »thrombotic proneness« in A compared with 0 causes a poorer prognosis in CHD among the former, leaving a disproportionate excess of 0 among longterm CHD survivors, and b) that AB0-related factors have had an insignificant, independent impact on the evolution of preclinical coronary artery disease in our 71 men with latent CHD.
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Affiliation(s)
- Jan Erikssen
- The Cardiological Section, Medical Dept. B, Rikshospitalet, Oslo, Norway
| | - Erik Thaulow
- The Cardiological Section, Medical Dept. B, Rikshospitalet, Oslo, Norway
| | - Helge Stormorken
- The Institute for Thrombosis Research, Rikshospitalet, Oslo, Norway
| | - Ole Brendemoen
- The Institute of Blood Group and Tissue Typing, Rikshospitalet, Oslo, Norway
| | - Arvid Hellem
- The Institute for Thrombosis Research, Rikshospitalet, Oslo, Norway
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12
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Nygaard S, Christensen A, Rolid K, Nytroen K, Gullestad L, Fiane A, Thaulow E, Dohlen G, Wyller V. Discrepancy Between Heart Rate Response and Indices of Autonomic Cardiovascular Control One Year After Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1093] [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] Open
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13
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Christensen A, Nygaard S, Rolid K, Nytrøen K, Gullestad L, Fiane A, Thaulow E, Døhlen G, Wyller V. Factors Influencing Heart Rate Control After Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.903] [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: 10/17/2022] Open
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14
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Khoury J, Knutsen M, Stray-Pedersen B, Thaulow E, Tonstad S. A lower reduction in umbilical artery pulsatility in mid-pregnancy predicts higher infant blood pressure six months after birth. Acta Paediatr 2015; 104:796-800. [PMID: 25865616 DOI: 10.1111/apa.13020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/01/2014] [Revised: 03/04/2015] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
AIM The Norwegian-based Cardiovascular Risk Reduction Diet in Pregnancy study found that a cholesterol-lowering diet during pregnancy was associated with an accentuated reduction in the umbilical artery pulsatility index. This follow-up study assessed the possible association between the index and the infants' blood pressure at six months of age. METHODS In the original study, pregnant women consumed an anti-atherogenic or usual diet from gestational weeks 17-20 to birth and underwent Doppler velocimetry at 24, 30 and 36 gestational weeks. In this follow-up study, blood pressure was measured in 105 mother-infant pairs in the intervention group and 106 mother-infant pairs in the control group six months after birth. RESULTS Mean systolic and diastolic blood pressures were not significantly different between both groups. When the groups were combined, multivariate linear analyses showed that a lower versus higher reduction (≥-0.17 versus <-0.17) in the umbilical artery pulsatility index between gestational weeks 24 and 30 and maternal diastolic blood pressure at six months postpartum were significant predictors of higher infant systolic blood pressure (p = 0.03, 0.01, respectively). CONCLUSION A lower reduction in umbilical pulsatility index in mid-pregnancy was associated with higher infant blood pressure at six months of age. This suggests that fetoplacental intrauterine factors may influence future cardiovascular risk.
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Affiliation(s)
- J Khoury
- Division of Women and Children; Oslo University Hospital; Oslo Norway
- Bryn Medical Center; Oslo Norway
| | - M Knutsen
- Department of Pediatric Cardiology; Oslo University Hospital; Oslo Norway
| | - B Stray-Pedersen
- Division of Women and Children; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - E Thaulow
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Section of Congenital Heart Disease; Division of Women and Children; Oslo University Hospital; Oslo Norway
| | - S Tonstad
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Section for Preventive Cardiology; Department of Endocrinology, Morbid Obesity and Preventive Medicine; Oslo University Hospital; Oslo Norway
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15
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Valsangiacomo Buechel ER, Grosse-Wortmann L, Fratz S, Eichhorn J, Sarikouch S, Greil GF, Beerbaum P, Bucciarelli-Ducci C, Bonello B, Sieverding L, Schwitter J, Helbing WA, Galderisi M, Miller O, Sicari R, Rosa J, Thaulow E, Edvardsen T, Brockmeier K, Qureshi S, Stein J. Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Eur Heart J Cardiovasc Imaging 2015; 16:281-97. [PMID: 25712078 DOI: 10.1093/ehjci/jeu129] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
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16
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Erikssen G, Liestøl K, Seem E, Birkeland S, Saatvedt KJ, Hoel TN, Døhlen G, Skulstad H, Svennevig JL, Thaulow E, Lindberg HL. Achievements in Congenital Heart Defect Surgery. Circulation 2015; 131:337-46; discussion 346. [DOI: 10.1161/circulationaha.114.012033] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Gunnar Erikssen
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Knut Liestøl
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Egil Seem
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Sigurd Birkeland
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Kjell Johan Saatvedt
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Tom Nilsen Hoel
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Gaute Døhlen
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Helge Skulstad
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Jan Ludvig Svennevig
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Erik Thaulow
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
| | - Harald Lauritz Lindberg
- From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.)
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17
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Døhlen G, Antal EA, Castellheim A, Thaulow E, Kielland A, Saugstad OD. Hyperoxic resuscitation after hypoxia-ischemia induces cerebral inflammation that is attenuated by tempol in a reporter mouse model with very young mice. J Perinat Med 2013; 41:251-7. [PMID: 23241583 DOI: 10.1515/jpm-2012-0135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 06/08/2012] [Accepted: 10/16/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oxygen supplementation is still part of international resuscitation protocols for premature children. Mechanisms for tissue damage by hypoxia/ischemia in the extreme premature involve inflammation. AIM AND METHOD To study cerebral inflammation after hypoxia/ischemia and oxygen treatment in the premature, we measured NF-κB activity in 5-day-old transgenic reporter mice in response to experimental hypoxia/ischemia. results were correlated to cerebral histological evaluation and plasma cytokine levels. A treatment strategy with the antioxidant tempol was tested. RESULTS One day after hypoxia/ischemia NF-κB activation was increased compared to controls [mean difference: 10.6±4.6% (P=0.03)]. Exposure to 100% oxygen after hypoxia/ischemia further increased NF-κB activation compared to hypoxia/ischemia alone [mean difference: 15.0±5.5% (P=0.01)]. Histological changes in the brain were positively correlated with NF-κB activity (P<0.001), but we found no significant difference in tissue damage between resuscitation with air and resuscitation with pure oxygen. Administration of tempol reduced NF-κB activation [mean difference: 14.6±5.0% (P=0.01)] and the plasma level of cytokines; however, the histological damage score was not affected. CONCLUSION Cerebral inflammatory response after hypoxia/ischemia in a mouse model with immature brain development corresponding to human prematurity prior to 32 weeks' gestation was influenced by administration of oxygen. Tempol treatment attenuated inflammation but did not reduce the extent of histological cerebral damage.
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Affiliation(s)
- Gaute Døhlen
- Department of Paediatric Research, University of Oslo and Oslo University Hospital, Oslo, Norway.
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18
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Fagermoen E, Sulheim D, Winger A, Andersen AM, Vethe NT, Saul JP, Thaulow E, Wyller VB. Clonidine in the treatment of adolescent chronic fatigue syndrome: a pilot study for the NorCAPITAL trial. BMC Res Notes 2012; 5:418. [PMID: 22871021 PMCID: PMC3461473 DOI: 10.1186/1756-0500-5-418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 07/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This pilot study (ClinicalTrials.gov ID: NCT01507701) assessed the feasibility and safety of clonidine in adolescent chronic fatigue syndrome (CFS). Specifically, we assessed clonidine dosage in relation to a) plasma concentration levels, b) orthostatic cardiovascular responses, and c) possible adverse effects. FINDINGS Five adolescent CFS patients (14-19 years old) received 50 μg clonidine twice per day during 14 days in an open, uncontrolled design. Plasma concentration of clonidine was assayed by standard laboratory methods. Changes in orthostatic cardiovascular responses were assessed by a 20o head-up tilt-test (HUT). Adverse effects were mapped by a questionnaire.After 14 days, C0 median (range) of clonidine was 0.21 (0.18-0.36) μg/L, and Cmax median (range) of clonidine was 0.41 (0.38-0.56) μg/L. Also, supine blood pressures and heart rate were lower during clonidine treatment, and the HUT response was closer to the normal response. No serious adverse effects were registered. CONCLUSION Clonidine 50 μg BID seems to be safe enough to proceed from a pilot study to a controlled trial in a select group of adolescents with CFS (ClinicalTrials.gov ID: NCT01040429).
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Affiliation(s)
- Even Fagermoen
- Department of Pediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
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19
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Baumgartner H, Bonhoeffer P, de Groo NM, de Haan F, Erik Deanfield J, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJ, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Revista Portuguesa de Cardiologia (English Edition) 2012. [DOI: 10.1016/j.repce.2012.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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20
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Brun H, Moller T, Fredriksen PM, Thaulow E, Pripp AH, Holmstrom H. Mechanisms of exercise-induced pulmonary hypertension in patients with cardiac septal defects. Pediatr Cardiol 2012; 33:782-90. [PMID: 22383098 DOI: 10.1007/s00246-012-0216-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 09/23/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022]
Abstract
The objective of this study was to investigate mechanisms of exercise-induced pulmonary hypertension in patients with congenital cardiac septal defects. This was a randomized, placebo controlled, crossover drug trial in a single national pediatric cardiology centre that performs congenital cardiac defect surgery. There were 14 patients with cardiac septal defects and known exercise-induced pulmonary hypertension. The intervention consisted of 50 mg oral sildenafil versus placebo. Measurements included supine bicycle exercise echocardiography and oxygen uptake. The outcome measure was right-ventricular systolic pressure as estimated by Doppler tracings of tricuspid regurgitant jet as well as systolic and diastolic longitudinal myocardial velocities by color tissue Doppler echocardiography. Sildenafil did not change exercise right-ventricular systolic pressure during exercise; however, decreased systemic systolic pressure was seen. Enhanced biventricular longitudinal function with sildenafil compared with placebo was indicated by greater tissue Doppler velocities and displacement measurements during exercise. Finally, a less steep increase of right-ventricular pressure during exercise was associated with greater left-ventricular diastolic myocardial tissue Doppler velocity. Exercise-induced pulmonary hypertension in cardiac septal defects does not seem to have a pulmonary vasoconstrictive component, but it may be related to left-ventricular filling pressure. Furthermore, sildenafil improved biventricular systolic performance in this patient group, possibly related to decreased systemic afterload.
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Affiliation(s)
- Henrik Brun
- Department of Pediatric Cardiology, Oslo University Hospital, 0027 Oslo, Norway.
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21
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Odland HH, Brun H, Sejersted Y, Dalen M, Edvardsen T, Saugstad OD, Thaulow E. Myocardial Longitudinal Peak Systolic Acceleration (pSac): Relationship to Ejection Phase, Pressure, and Contractility. Echocardiography 2012; 29:541-53. [DOI: 10.1111/j.1540-8175.2011.01628.x] [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] Open
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22
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Waehre A, Vistnes M, Sjaastad I, Nygård S, Husberg C, Lunde IG, Aukrust P, Yndestad A, Vinge LE, Behmen D, Neukamm C, Brun H, Thaulow E, Christensen G. Chemokines regulate small leucine-rich proteoglycans in the extracellular matrix of the pressure-overloaded right ventricle. J Appl Physiol (1985) 2012; 112:1372-82. [DOI: 10.1152/japplphysiol.01350.2011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Chemokines have been suggested to play a role during development of left ventricular failure, but little is known about their role during right ventricular (RV) remodeling and dysfunction. We have previously shown that the chemokine (C-X-C motif) ligand 13 (CXCL13) regulates small leucine-rich proteoglycans (SLRPs). We hypothesized that chemokines are upregulated in the pressure-overloaded RV, and that they regulate SLRPs. Mice with RV pressure overload following pulmonary banding (PB) had a significant increase in RV weight and an increase in liver weight after 1 wk. Microarray analysis (Affymetrix) of RV tissue from mice with PB revealed that CXCL10, CXCL6, chemokine (C-X3-C motif) ligand 1 (CX3CL1), chemokine (C-C motif) ligand 5 (CCL5), CXCL16, and CCL2 were the most upregulated chemokines. Stimulation of cardiac fibroblasts with these same chemokines showed that CXCL16 increased the expression of the four SLRPs: decorin, lumican, biglycan, and fibromodulin. CCL5 increased the same SLRPs, except decorin, whereas CX3CL1 increased the expression of decorin and lumican. CXCL16, CX3CL1, and CCL5 were also shown to increase the levels of glycosylated decorin and lumican in the medium after stimulation of fibroblasts. In the pressure-overloaded RV tissue, Western blotting revealed an increase in the total protein level of lumican and a glycosylated form of decorin with a higher molecular weight compared with control mice. Both mice with PB and patients with pulmonary stenosis had significantly increased circulating levels of CXCL16 compared with healthy controls measured by enzyme immunoassay. In conclusion, we have found that chemokines are upregulated in the pressure-overloaded RV and that CXCL16, CX3CL1, and CCL5 regulate expression and posttranslational modifications of SLRPs in cardiac fibroblasts. In the pressure-overloaded RV, protein levels of lumican were increased, and a glycosylated form of decorin with a high molecular weight appeared.
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Affiliation(s)
- Anne Waehre
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo,
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
| | - Maria Vistnes
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo,
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo,
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
- Department of Cardiology, Oslo University Hospital Ullevål,
| | - Ståle Nygård
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo,
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
- Bioinformatics Core Facility, Institute for Medical Informatics,
| | - Cathrine Husberg
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo,
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
| | - Ida Gjervold Lunde
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo,
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
| | - Pål Aukrust
- Research Institute for Internal Medicine,
- Section of Clinical Immunology and Infectious Diseases, and
| | - Arne Yndestad
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
- Research Institute for Internal Medicine,
| | - Leif E. Vinge
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
- Research Institute for Internal Medicine,
- Departments of 7Cardiology and
| | - Dina Behmen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo,
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
| | - Christian Neukamm
- Pediatric Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Henrik Brun
- Pediatric Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Erik Thaulow
- Pediatric Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Geir Christensen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo,
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo,
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23
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Sulheim D, Hurum H, Helland IB, Thaulow E, Wyller VB. Adolescent chronic fatigue syndrome; a follow-up study displays concurrent improvement of circulatory abnormalities and clinical symptoms. Biopsychosoc Med 2012; 6:10. [PMID: 22436201 PMCID: PMC3337799 DOI: 10.1186/1751-0759-6-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 03/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pathophysiology of chronic fatigue syndrome (CFS) in adolescents is unknown, and the clinical course and prognosis is still questioned. Recent research indicates that abnormalities of autonomic cardiovascular control may play an important role. The aim of this research project was to perform a follow-up study of adolescents with chronic fatigue syndrome, focusing on clinical symptoms and autonomic cardiovascular control. METHODS 47 adolescents (12-18 years old) with CFS were recruited from the outpatient clinic at the Department of Pediatrics, Oslo University Hospital. In a primary visit and a follow-up visit (3-17 months later), we evaluated: a) a wide range of complaints and symptoms and b) cardiovascular variables at baseline and during a 20° head-up tilt-test (HUT). RESULTS At the second visit, patients reported significant improvement regarding functional impairments, fatigue severity, muscular pain, concentration problems, post-exertional malaise and the problem of non-relieving rest. Also, at the second visit, baseline heart rate (HR), blood pressure, total peripheral resistance index (TPRI) and LF/HF (low-frequency:high-frequency heart rate variability ratio, an index of sinus node sympathovagal balance derived from spectral analyses of heart rate) were significant lower, and the increases in HR, mean blood pressure (MBP), diastolic blood pressure (DBP) and TPRI during tilt were significantly less pronounced as compared to the first visit. There was a significant correlation between changes in autonomic symptom score, fatigue severity score and functional impairment score from the first to the second visit. CONCLUSIONS The majority of adolescents with CFS experienced an improvement over time in functional impairment, self-reported fatigue and additional symptoms, and a concurrent improvement of autonomic cardiovascular control. A possible connection between clinical symptoms and abnormal autonomic control in CFS might represent a focus for further research.
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Affiliation(s)
- Dag Sulheim
- Department of Paediatric Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Odland HH, Kro GAB, Edvardsen T, Thaulow E, Saugstad OD. Impaired diastolic function and disruption of the force-frequency relationship in the right ventricle of newborn pigs resuscitated with 100% oxygen. Neonatology 2012; 101:147-53. [PMID: 21952615 DOI: 10.1159/000330804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/12/2011] [Accepted: 07/08/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Resuscitation with 100% oxygen increases oxidative stress and is detrimental for organ function. OBJECTIVE To study the effects of resuscitation with 100% oxygen compared to room-air on myocardial function. METHODS Twenty-eight newborn pigs underwent global hypoxia (8% oxygen/N2) until base excess reached -20 mmol/l. The animals were randomized into two groups and resuscitated with either 100% or room air for 30 min. Myocardial tissue Doppler velocities and acceleration of the mitral and tricuspid valve annuli during systole and diastole were assessed before global hypoxia and after resuscitation together with troponin I. RESULTS Peak early diastolic velocity (E') and acceleration (pEac) in the septum and pEac in the lateral tricuspid valve annulus were lower after resuscitation with 100% oxygen, suggesting impaired diastolic relaxation in the right ventricle. Lower systolic velocities and acceleration in the right ventricle relative to heart rate indicate disruption of the right ventricular force-frequency relationship after resuscitation with 100% oxygen. Troponins were higher in the 100% oxygen group, suggesting increased myocardial damage in this group. CONCLUSION Resuscitation with 100% oxygen compared to room air induces diastolic dysfunction, disrupts the systolic force-frequency relationship and increases myocardial damage in the newborn pig.
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Affiliation(s)
- Hans Henrik Odland
- Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Odland HH, Brun H, Sejersted Y, Dalen M, Edvardsen T, Saugstad OD, Thaulow E. Longitudinal myocardial contribution to peak systolic flow and stroke volume in the neonatal heart. Pediatr Res 2011; 70:345-51. [PMID: 21691252 DOI: 10.1203/pdr.0b013e318229032b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/06/2022]
Abstract
Systolic longitudinal myocardial function is important for cardiac ejection. Data describing hemodynamic determinants and the time course of myocardial longitudinal contraction as measured by tissue Doppler are lacking. Ten newborn pigs were used for invasive hemodynamic investigation. Tissue Doppler assessment of the lateral part of the mitral valve annulus during systole was performed during pharmacological modulation of inotropy, cardiac pacing, and modulations of loading conditions. The strongest association was found between peak systolic velocity (S') and peak systolic flow (PSF) and end-systolic pressure (ESP), respectively (β = 0.09 cm/mL, p < 0.001 and β = -0.07 cm/mL, p = 0.003). Displacement (D) was mostly influenced by stroke volume (SV) (β = 0.05 cm/mL, p < 0.001). Ejection time, SV, ESP, maximum first derivative of pressure (dP/dtmax), and PSF were all associated with S' and D under different states of hemodynamic modulation; however, the ratio between PSF and S', SV, and D were stable during hemodynamic modulations. Normalized cross correlations indicate that S' and D follow the same trajectory as flow and SV, respectively. In conclusion, this study provides validity of accounting systolic D in the long axis as the longitudinal contribution to SV and peak systolic tissue velocity as the longitudinal contribution to PSF.
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Affiliation(s)
- Hans H Odland
- Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, University of Oslo, N-0027 Oslo, Norway.
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Wyller VB, Aaberge L, Thaulow E, Døhlen G. [Percutaneous catheter-based implantation of artificial pulmonary valves in patients with congenital heart defects]. Tidsskr Nor Laegeforen 2011; 131:1289-93. [PMID: 21725388 DOI: 10.4045/tidsskr.10.0920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Percutaneous catheter-based implantation of artificial heart valves is a new technique that may supplement surgery and which may be used more in the future. We here report our first experience with implantation of artificial pulmonary valves in children with congenital heart defects. MATERIAL AND METHODS Eligible patients were those with symptoms of heart failure combined with stenosis and/or insufficiency in an established artificial right ventricular outflow tract. The valve was inserted through a catheter from a vein in the groin or neck. Symptoms, echocardiography, invasive measurements and angiography were assessed for evaluation of treatment effect. Our treatment results are reported for the period April 2007-September 2009. RESULTS Ten patients (seven men and three women, median age 17 years) were assessed. The procedure reduced pressure in the right ventricle (p = 0.008) and resolved the pulmonary insufficiency in all patients. The median time in hospital was two days. No patients had complications that were directly associated with the implantation procedure. One patient developed a pseudoaneurysm in the femoral artery, another had a short-lasting fever two days after the procedure and one patient experienced a stent fracture that required surgery 9 months after the implantation. After 6 months all patients had a reduced pressure gradient in the right ventricular outflow tract (p = 0.008), the pulmonary insufficiency had improved (p = 0.006) and they all reported improval of symptoms. These results persisted for at least 24 months for the four patients who were monitored until then. INTERPRETATION Percutaneous catheter-based implantation of artificial pulmonary valves improves hemodynamics in the right ventricle of selected patients with congenital heart defects. A randomized controlled study should be undertaken to provide a stronger evidence-base for usefulness of this procedure.
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Affiliation(s)
- Vegard Bruun Wyller
- Hjerte-, lunge- og allergiseksjonen, Oslo universitetssykehus, Rikshospitalet, Norway
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Brun H, Ueland T, Thaulow E, Damas JK, Yndestad A, Aukrust P, Holmstrøm H. No inflammatory response related to pulmonary hemodynamics in children with systemic to pulmonary shunts. CONGENIT HEART DIS 2011; 6:338-46. [PMID: 21450032 DOI: 10.1111/j.1747-0803.2011.00505.x] [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: 11/28/2022]
Abstract
OBJECTIVE The hypothesis was that the levels of circulating inflammatory mediators are related to the degree of volume and pressure stress on the pulmonary vasculature in children with congenital systemic to pulmonary shunts. DESIGN Prospective, cross-sectional study. SETTING Tertiary center covering all pediatric heart surgery and interventions in Norway. PATIENTS Seventy-four children, aged 0-12 years, admitted for surgical or interventional treatment of congenital systemic to pulmonary shunts. OUTCOME MEASURES Plasma levels of eight mediators of vascular inflammation and endothelial activation, sampled from different vascular compartments. RESULTS Patients with the most pronounced pulmonary flow and pressure stress demonstrated no elevation of inflammatory mediator levels when compared with healthy controls. No pulmonary production or uptake of the measured markers was found. Hemodynamic explanatory factors showed weak correlations to the inflammatory marker levels by univariate analysis. Age was the only factor that significantly explained inflammatory response in the multivariate model. The presence of Down syndrome, irrespective of hemodynamic category, was associated with elevated plasma levels of soluble tumor necrosis factor receptor I, when controlling for age. CONCLUSIONS Inflammatory mediators show no significant relationship to pulmonary hemodynamics in children with systemic to pulmonary shunts. Children with Down syndrome may have an increased inflammatory response.
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Affiliation(s)
- Henrik Brun
- Unit for Pediatric Heart, Lung and Allergic Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Abstract
AIM To compare ambulatory recordings of heart rate (HR) and blood pressure in adolescents with chronic fatigue syndrome (CFS) and healthy controls. We hypothesized both HR and blood pressure to be elevated among CFS patients. METHODS Forty-four CFS patients aged 12-18 years were recruited from our paediatric outpatient clinic. The controls were 52 healthy adolescents having similar distribution of age and gender. 24-h ambulatory blood pressure and HR were recorded using a validated, portable oscillometric device. RESULTS At night (sleep), HR, mean arterial blood pressure and diastolic blood pressure were significantly higher in CFS patients as compared with controls (p < 0.01). During daytime, HR was significantly higher among CFS patients (p < 0.05), whereas blood pressures were equal among the two groups. CONCLUSIONS The findings support previous experimental evidence of sympathetic predominance of cardiovascular control in adolescent CFS patients. Also, the findings prompt increased focus on cardiovascular risk assessment and suggest a possible target for therapeutic intervention.
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Wyller V, Thaulow E, Aaberge L, Døhlen G. Erfaringsbaserte materialer og selvstendige leger. Tidsskriftet 2011; 131:1637. [DOI: 10.4045/tidsskr.11.0846] [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: 11/02/2022] Open
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Wyller V, Thaulow E, Aaberge L, Døhlen G. Erfaringsbaserte materialer og selvstendige leger. Tidsskriftet 2011. [DOI: 10.4045/tidsskr.11.1051] [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: 11/02/2022] Open
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Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Erik Deanfield J, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJ, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E. Guía de práctica clínica de la ESC para el manejo de cardiopatías congénitas en el adulto (nueva versión 2010). Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70276-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Möller T, Brun H, Fredriksen PM, Holmstrøm H, Pettersen E, Thaulow E. Moderate Altitude Increases Right Ventricular Pressure and Oxygen Desaturation in Adolescents with Surgically Closed Septal Defect. CONGENIT HEART DIS 2010; 5:556-64. [DOI: 10.1111/j.1747-0803.2010.00425.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Möller T, Leren TP, Eiklid KL, Holmstrøm H, Fredriksen PM, Thaulow E. A novel BMPR2 gene mutation associated with exercise-induced pulmonary hypertension in septal defects. SCAND CARDIOVASC J 2010; 44:331-6. [PMID: 21070126 DOI: 10.3109/14017431.2010.525747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 11/13/2022]
Abstract
OBJECTIVE Our study aimed to investigate the relationship between exercise-induced pulmonary arterial hypertension and genetic changes related to the transforming growth factor-β (TGF-β) signalling pathway in patients with cardiac septal defects. DESIGN In a population-based group of 44 patients (age 13-25 years) with either isolated ventricular septal defect (n=27) or isolated atrial septal defect (n=17), right ventricular systolic pressure response to submaximal exercise was studied by echocardiography and classified as normal (≤45 mmHg), borderline (45-50 mmHg) or abnormal (>50 mmHg). Three genes related to TGF-β, bone morphogenetic protein receptor type 2 (BMPR2), activin receptor-like kinase 1 (ALK1) and endoglin (ENG), were analyzed by DNA sequencing (only BMPR2) and multiplex ligand-dependent probe amplification (BMPR2, ALK1 and ENG). RESULTS Pressure response was borderline in five and abnormal in nine patients. Five patients showed mutations in exon 12 of the bone morphogenetic protein receptor type 2 gene. The previously described polymorphism S775N (c. 2324, G > A) was found in three patients with normal pressure response. The mutation Y589C (c. 1766, A > G), which has not been described previously, was found in two of 14 patients with borderline/abnormal pressure response. CONCLUSION Genetic changes in the BMPR2 gene may be overrepresented in patients with cardiac septal defects and exercise-induced pulmonary hypertension.
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Affiliation(s)
- Thomas Möller
- Pediatric Department, Vestfold Hospital Trust, Tønsberg, Norway.
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Baumgartner H, Bonhoeffer P, De Groot NMS, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJM, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, McDonagh T, Swan L, Andreotti F, Beghetti M, Borggrefe M, Bozio A, Brecker S, Budts W, Hess J, Hirsch R, Jondeau G, Kokkonen J, Kozelj M, Kucukoglu S, Laan M, Lionis C, Metreveli I, Moons P, Pieper PG, Pilossoff V, Popelova J, Price S, Roos-Hesselink J, Uva MS, Tornos P, Trindade PT, Ukkonen H, Walker H, Webb GD, Westby J. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31:2915-57. [PMID: 20801927 DOI: 10.1093/eurheartj/ehq249] [Citation(s) in RCA: 1511] [Impact Index Per Article: 107.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Helmut Baumgartner
- Adult Congenital and Valvular Heart Disease Center (EMAH-Zentrum) Muenster, Department of Cardiology and Angiology, University Hospital Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany.
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Skretteberg PT, Bodegård J, Kjeldsen SE, Erikssen G, Thaulow E, Sandvik L, Erikssen JE. Interaction between inflammation and blood viscosity predicts cardiovascular mortality. SCAND CARDIOVASC J 2010; 44:107-12. [PMID: 19670036 DOI: 10.1080/14017430903171248] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 10/20/2022]
Abstract
OBJECTIVES Inflammation and increased blood viscosity are associated with increased risk of cardiovascular mortality. Erythrocyte sedimentation rate (ESR) and hematocrit both influence blood viscosity whereas the first also is a marker of inflammation. We aimed to investigate ESR, hematocrit and the interaction between them as predictors of cardiovascular mortality during 26 years follow-up among healthy middle aged men. DESIGN Four hundred and eighty eight men aged 40-59 were extensively examined in 1972-1975 and followed over a period of 26 years. Risk estimation was made in Cox proportional hazards and adjusted for age, smoking, systolic blood pressure, total serum cholesterol, and physical fitness. RESULTS A 2.44-fold (95% CI 1.37-4.35) adjusted risk of cardiovascular mortality was found in the highest quartile of hematocrit compared to the lowest. Among the 265 men who had an ESR <6 mm/h (median), the adjusted risk of cardiovascular mortality was 3.05-fold (95% CI 1.49-6.23) in the highest quartile of hematocrit compared to the lowest. This association was not observed among the 223 men with ESR <6 mm/h. CONCLUSION Elevated hematocrit is independently associated with increased long-term risk of cardiovascular mortality in men with high ESR. Our data suggest that the combination of inflammation and blood viscosity may improve the prediction of cardiovascular risk.
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Möller T, Brun H, Fredriksen PM, Holmstrøm H, Peersen K, Pettersen E, Grünig E, Mereles D, Thaulow E. Right ventricular systolic pressure response during exercise in adolescents born with atrial or ventricular septal defect. Am J Cardiol 2010; 105:1610-6. [PMID: 20494671 DOI: 10.1016/j.amjcard.2010.01.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 01/10/2010] [Accepted: 01/10/2010] [Indexed: 11/17/2022]
Abstract
Our study investigated the abnormal right ventricular systolic pressure response (RVPR) in young patients with isolated atrial septal defect (ASD) or ventricular septal defect (VSD). An abnormal RVPR >50 mm Hg during exercise has been identified as a precursor of pulmonary artery hypertension. The present study included a population-based selection of 44 patients (age 13 to 25 years) with either isolated VSD (n = 27) or ASD (n = 17) and without right ventricular outflow tract obstruction. Of the 44 defects, 28 had been surgically closed (17 ASDs and 11 VSDs); 16 minor VSDs were untreated. Cardiovascular exercise testing and echocardiography at rest and during exercise were performed for all patients and 88 healthy controls. The aerobic capacity was significantly reduced in all patient groups (open VSD, closed VSD, closed ASD). The measurements of right ventricular performance were significantly lower in patients with closed ASD or closed VSD compared to those of the controls and patients with open VSD. Finally, 5% of the controls, no patient with ASD, and 9 patients with VSD (33%), regardless of defect closure, had an abnormal RVPR during exercise. In conclusion, 1/3 of young patients with isolated VSD had an abnormal RVPR during exercise.
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Affiliation(s)
- Thomas Möller
- Department of Pediatrics, Vestfold Hospital Trust, Tønsberg, Norway.
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Deanfield JE, Sellier P, Thaulow E, Bultas J, Yunis C, Shi H, Buch J, Beckerman B. Potent anti-ischaemic effects of statins in chronic stable angina: incremental benefit beyond lipid lowering? Eur Heart J 2010; 31:2650-9. [PMID: 20494902 PMCID: PMC2966969 DOI: 10.1093/eurheartj/ehq133] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims The DoUble-blind Atorvastatin AmLodipine (DUAAL) trial investigated whether atorvastatin decreases ischaemia by a vascular benefit, independent of low-density lipoprotein cholesterol lowering, in patients with coronary artery disease (CAD), both alone and in combination with the traditional anti-anginal therapy, amlodipine. Methods and results Randomized, double-blind, parallel-group, multicountry trial (2 weeks run-in and 24 weeks active therapy) comparing three treatments: amlodipine, atorvastatin, and amlodipine + atorvastatin; in 311 patients (78% male; mean age 62 years) with stable angina (≥2 attacks/week), CAD history, ≥3 transient myocardial ischaemia (TMI) episodes, and/or ≥15 min ischaemia on 48 h ambulatory electrocardiographic (AECG) monitoring. Efficacy variables were change in TMI by AECG, exercise ischaemia, angina diary data, and inflammatory biomarkers at Week 26. There was a comparable, highly significant decrease in TMI with amlodipine and atorvastatin, but no additional benefit for the combination. More than 50% of patients became TMI-free in all three groups and this was accompanied by a comparable, marked reduction in angina and nitroglycerin consumption. High-sensitivity C-reactive protein fell by 40% in patients receiving atorvastatin but there was no change with amlodipine. Adverse events were comparable among groups. Conclusion Atorvastatin was as potent an anti-ischaemic agent as amlodipine. Future studies of combination therapies will be instructive. Clinical trial registration information: National clinical trial number: NCT00159718, protocol number A0531031 listed on http://clinicaltrials.gov/.
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Affiliation(s)
- John E Deanfield
- Great Ormond Street Hospital, University College London, London, UK.
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Skretteberg PT, Bodegård J, Kjeldsen SE, Erikssen G, Thaulow E, Sandvik L, Erikssen JE. Interaction between inflammation and blood viscosity predicts cardiovascular mortality. SCAND CARDIOVASC J 2010. [DOI: 10.3109/14017430903171248] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Odland HH, Kro GAB, Edvardsen T, Thaulow E, Saugstad OD. Atrioventricular valve annulus velocity and acceleration during global hypoxia in newborn pigs - assessment of myocardial function. Neonatology 2010; 97:100-7. [PMID: 19713716 DOI: 10.1159/000235806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 04/08/2008] [Accepted: 01/27/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Global hypoxia may affect regions of the neonatal heart during systole and diastole differently. OBJECTIVE In the first study, the aim was to assess longitudinal myocardial function in newborn pigs during global hypoxia and recovery. In the second study, invasive hemodynamic data were evaluated and compared with tissue velocities and acceleration. METHODS Myocardial Doppler measurements of velocity and acceleration in the atrioventricular valve annuli during global hypoxia were made. RESULTS In the first experiment, systolic velocity (S), early diastolic velocity (E') and peak systolic acceleration (pSac) decreased during hypoxia. S, pSac and E'(mva) (mitral valve annulus) recovered after reoxygenation, while E'(septal) and E'(tva) (tricuspid valve annulus) did not. Isovolumic acceleration (IVA) did not reflect systolic dysfunction. In the second experiment, S(mva) and pSac(mva) declined during hypoxia similarly to maximum dP/dT. E'(mva) and E'(tva) were correlated with tau and both changed parallel to minimum dP/dT. In the TVA maximum dP/dT and pSac(tva) did not change, while S(tva) declined. By correcting for heart rate the pattern of alteration in S and pSac became comparable to the changes in E'. CONCLUSION Tissue Doppler velocity in systole, diastole and acceleration during rapid ejection reflect hemodynamic changes in the neonatal myocardium during global hypoxia and recovery. S and pSac reflect systolic function, while E' correlates with tau and mirrors diastolic function.
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Affiliation(s)
- Hans Henrik Odland
- Department of Pediatric Research, Rikshospitalet University Hospital, Oslo, Norway.
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Pettersen E, Fredriksen PM, Urheim S, Thaulow E, Smith HJ, Smevik B, Smiseth O, Andersen K. Ventricular function in patients with transposition of the great arteries operated with arterial switch. Am J Cardiol 2009; 104:583-9. [PMID: 19660616 DOI: 10.1016/j.amjcard.2009.04.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 04/08/2009] [Accepted: 04/08/2009] [Indexed: 11/28/2022]
Abstract
The study aim was to investigate ventricular function at long-term follow-up in patients operated with arterial switch for transposition of the great arteries (TGAs). Although midterm results for anatomic correction of TGA are promising, there are reported minor alterations in left ventricular (LV) function possibly indicating myocardial dysfunction. Twenty-two patients with TGAs 12.4 +/- 2.3 years old operated with arterial switch were studied by magnetic resonance imaging and echocardiography. Twenty-two age-matched healthy subjects served as controls. Myocardial deformation was described by longitudinal and circumferential shortening (measured as strain and strain rate) and ventricular torsion, measured by speckle-tracking echocardiography. Although standard measurements of global systolic LV function were normal in patients with TGAs, longitudinal shortening was decreased compared with controls. Longitudinal strain was decreased in all ventricular regions except the posterior wall and most pronounced in the apical segments. LV circumferential shortening was similar in the 2 groups. Also, in the right ventricular free wall patients displayed decreased longitudinal shortening in the mid and apical segment. Moreover, LV torsion was decreased in the TGA group. Although rotation was relatively homogenous at the apical and basal levels in controls, there was greater dispersion in rotation in the patient group, with basal rotation being greatest in the inferior wall and apical rotation being greatest in the anterior wall. In conclusion, there was slightly decreased longitudinal shortening in the 2 ventricles and decreased LV torsion in patients with TGAs, although standard measurements of global ventricular function were normal.
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Affiliation(s)
- Eirik Pettersen
- Department of Cardiology, Rikshospitalet University Hospital, Oslo, Norway.
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Brun H, Holmstrøm H, Thaulow E, Damås JK, Yndestad A, Aukrust P, Ueland T. Patients with Pulmonary Hypertension Related to Congenital Systemic-to-Pulmonary Shunts are Characterized by Inflammation Involving Endothelial Cell Activation and Platelet-mediated Inflammation. CONGENIT HEART DIS 2009; 4:153-9. [DOI: 10.1111/j.1747-0803.2009.00297.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fredriksen PM, Diseth TH, Thaulow E. Children and adolescents with congenital heart disease: assessment of behavioural and emotional problems. Eur Child Adolesc Psychiatry 2009; 18:292-300. [PMID: 19156353 DOI: 10.1007/s00787-008-0730-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [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: 03/17/2008] [Accepted: 09/22/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to assess behavioural and emotional problems in children and adolescents with congenital cardiac disease. DESIGN From the database of Paediatric Heart Section, Rikshospitalet University Hospital, Norway, 430 patients and their parents were included and received questionnaires of youth self-report and child behavior checklist. The response rate was 71.4%. RESULTS Compared to their parents children with congenital heart disease reported more behavioural and emotional problems. Boys scored significantly higher than girls in total problem score and externalising scores with more social problems, attention problems, delinquent behaviour and aggressive behaviour. No gender difference was found regarding internalising problem score. Compared to healthy boys, no differences were found in total problem, externalising or internalising score. In girls lower values were found in patients than healthy children for total problem, externalising and internalising scores. CONCLUSIONS In the present study boys scored themselves higher with regard to total problem score than girls. No effect was found of due to different diagnoses. The data indicate that the children experience more problems than the parents are aware of. However, the behaviour problem scores in children with cardiac disease are significantly lower than in healthy children. A close parental follow-up and an experience of being exposed to life-threatening situation may play a role for the latter results.
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Abstract
The immediate effect of beta-blockers versus placebo in platelet function was studied in ten healthy men one hour after either 40 mg propranolol, 5 mg timolol or placebo was given. Both beta-blockers had similar platelet effects. They increased the ADP-threshold in a platelet aggregation test and reduced the plasma level of beta-thromboglobulin whereas the primary aggregation remained unchanged. Forty-four patients were given timolol 10 mg twice daily or corresponding placebo medication in a secondary prevention trial after a myocardial infarction. At rest and also immediately after a near maximal exercise test the platelet function was similar on timolol and placebo. During exercise a lower ADP-threshold and a higher plasma level of beta-thromboglobulin was observed irrespective of whether the patients received placebo or timolol. Thus, the acute platelet inhibiting effect of timolol observed after a single dose disappeared during chronic timolol treatment. During 24 hours continuous ambulatory ECG monitoring patients on timolol treatment had significantly less arrhythmias than patients on placebo. A general effect on platelets cannot explain this antiarrhythmic effect of timolol during chronic therapy.
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Abstract
Platelet function was studied in blood sampled from the caval vein of 56 patients through various heart catheters. Reduced platelet retention was the most consistent finding while aggregation was not influenced by the sampling procedure. Polyurethane (Cordis and Positrol) catheters affected platelets less than catheters of woven dacron (Sones and Zucker). Sones catheters increased plasma beta-thromboglobulin levels slightly, and some platelets were trapped in the Zucker catheters. Much the same reduction in retention was induced by heparinized as by other catheters. Platelet retention values had a poorer reproducibility than the other platelet function parameters in samples collected at intervals of 45 min, while an acceptable correlation existed between parallel samples. The influence on platelets of blood sampled via polyurethane catheters was very moderate, and should allow the detection of alterations in platelet functions that occur in the circulation.
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Thaulow E, Dale J. Effects of timolol on platelets in coronary sinus blood and on myocardial ischemia during pacing-induced angina. Acta Med Scand 2009; 216:193-8. [PMID: 6496177 DOI: 10.1111/j.0954-6820.1984.tb03792.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The effect of timolol on blood platelet function was studied in coronary sinus and caval vein blood at rest and during pacing-induced angina in 20 patients with coronary heart disease. During pacing-induced angina, lactate measurements confirmed that coronary sinus blood was sampled from ischemic regions in 13 men. The ischemia did not influence platelet function. In blood from non-ischemic myocardium, platelet activation was found during pacing: the ADP-induced aggregation, platelet retention and plasma beta-thromboglobulin levels increased moderately but significantly. Timolol administration prevented this platelet activation, possibly by inhibiting catecholamine release from the myocardium, and reduced the ischemic response during pacing as judged from lactate measurements and ST depressions. It is concluded that timolol reduced platelet activation induced in non-ischemic regions of the heart during tachycardia stress as well as myocardial ischemia.
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Ihlen H, Thaulow E, Kjekshus J, Forfang K. Loss of prazosin effect in severe chronic CHF. Acta Med Scand Suppl 2009; 652:149-54. [PMID: 6949461 DOI: 10.1111/j.0954-6820.1981.tb06805.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Twelve patients with congestive heart failure were monitored with invasive and noninvasive techniques to evaluate the effect of vasodilator treatment. During the 18 hours of strict bed rest before administration of prazosin, the hemodynamics improved substantially while only small and transient heModynamic changes were observed after introduction of prazosin. At 6 weeks' control the effect of vasodilator treatment with prazosin, 3 mg x 4, was lost. The beneficial results often credited to vasodilators in studies on congestive heart failure might in part be due to the concomitant bed rest introduced during the monitoring of the patients.
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Abstract
Coronary heart disease (CHD), previously neither diagnosed nor suspected, was strongly suspected in 115 of 2014 men aged 40-59 years during a cardiovascular survey examination. Sixty-nine of 105 men who underwent diagnostic coronary angiography had pathologic angiograms. Twenty-six of these 69 had angina pectoris (AP) with and without pathologic exercise ECGs and 43 had pathologic exercise ECG as the only indicator of CHD. The extent of coronary artery changes was similar in the two groups. The men without AP were in almost all respects similar to 1832 men labelled as normals. The men with AP differed in several respects from their non-AP angiographic counterparts and from their non-AP angiographic counterparts and from the normals: they had more dyspepsia, a higher stress score, higher serum cholesterol and triglycerides, lower antithrombin III levels in the blood and lower blood platelet retention values. These results indicate that coronary artery disease with and without AP may represent somewhat different pathogenetic entities.
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Pape J, Jervell J, Anker E, Bergrem H, Dahle K, Leivestad T, vd Lippe A, Myrseth L, Thaulow E, Urving H. Blood pressure and pulse response to insulin-induced hypoglycemia during non-selective and selective beta-blockade. Acta Med Scand Suppl 2009; 645:105-8. [PMID: 6112844 DOI: 10.1111/j.0954-6820.1981.tb02608.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Hypoglycemia was induced in ten healthy male volunteers during medication with atenolol, metoprolol and propranolol. The beta-blockers abolished the tachycardia during hypoglycemia. In some subjects bradycardia, and in two nodal bradycardia was observed on propranol. The physiologic blood pressure responses were dampend during the beta1-selective blockade. With propranolol a rise in blood pressure was recorded, in two subjects up to 160/105. The blockers had no effect on degree of hypoglycemia or glucose recovery.
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