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Nicolarsen J, Mudd J, Coletti A. Medical Therapy and Monitoring in Adult Congenital Heart Disease Heart Failure. Heart Fail Clin 2024; 20:137-146. [PMID: 38462318 DOI: 10.1016/j.hfc.2023.12.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heart failure (HF) in adult congenital heart disease (ACHD) is an increasingly common problem facing ACHD and advanced heart disease and transplant providers. Patients are highly nuanced, and therapies are poorly studied. Standard HF medications are often used in patients who are not targets of large clinical trials. HF management in this data-free zone requires focused, comprehensive team-based care and close follow-up and communication with patients.
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Affiliation(s)
- Jeremy Nicolarsen
- Providence Adult and Teen Congenital Heart Program (PATCH), Providence Sacred Heart Medical Center and Children's Hospital, 101 West 8th Avenue, Suite 4300, Spokane, WA 99204, USA.
| | - James Mudd
- Center for Advanced Heart Disease and Transplantation, Providence Spokane Heart Institute, 62 West 7th Avenue, Suite 232, Spokane, WA 99204, USA
| | - Andrew Coletti
- Center for Advanced Heart Disease and Transplantation, Providence Spokane Heart Institute, 62 West 7th Avenue, Suite 232, Spokane, WA 99204, USA
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van Dissel AC, Opotowsky AR, Burchill LJ, Aboulhosn J, Grewal J, Lubert AM, Antonova P, Shah S, Cotts T, John AS, Kay WA, DeZorzi C, Magalski A, Han F, Baker D, Kay J, Yeung E, Vonder Muhll I, Pylypchuk S, Kuo MC, Nicolarsen J, Sarubbi B, Fusco F, Jameson SM, Cramer J, Gupta T, Gallego P, O’Donnell C, Hannah J, Dellborg M, Kauling RM, Ginde S, Krieger EV, Rodriguez F, Dehghani P, Kutty S, Wong J, Wilson WM, Rodriguez-Monserrate CP, Roos-Hesselink J, Celermajer DS, Khairy P, Broberg CS. End-stage heart failure in congenitally corrected transposition of the great arteries: a multicentre study. Eur Heart J 2023; 44:3278-3291. [PMID: 37592821 PMCID: PMC10482567 DOI: 10.1093/eurheartj/ehad511] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/19/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND AIMS For patients with congenitally corrected transposition of the great arteries (ccTGA), factors associated with progression to end-stage congestive heart failure (CHF) remain largely unclear. METHODS This multicentre, retrospective cohort study included adults with ccTGA seen at a congenital heart disease centre. Clinical data from initial and most recent visits were obtained. The composite primary outcome was mechanical circulatory support, heart transplantation, or death. RESULTS From 558 patients (48% female, age at first visit 36 ± 14.2 years, median follow-up 8.7 years), the event rate of the primary outcome was 15.4 per 1000 person-years (11 mechanical circulatory support implantations, 12 transplantations, and 52 deaths). Patients experiencing the primary outcome were older and more likely to have a history of atrial arrhythmia. The primary outcome was highest in those with both moderate/severe right ventricular (RV) dysfunction and tricuspid regurgitation (n = 110, 31 events) and uncommon in those with mild/less RV dysfunction and tricuspid regurgitation (n = 181, 13 events, P < .001). Outcomes were not different based on anatomic complexity and history of tricuspid valve surgery or of subpulmonic obstruction. New CHF admission or ventricular arrhythmia was associated with the primary outcome. Individuals who underwent childhood surgery had more adverse outcomes than age- and sex-matched controls. Multivariable Cox regression analysis identified older age, prior CHF admission, and severe RV dysfunction as independent predictors for the primary outcome. CONCLUSIONS Patients with ccTGA have variable deterioration to end-stage heart failure or death over time, commonly between their fifth and sixth decades. Predictors include arrhythmic and CHF events and severe RV dysfunction but not anatomy or need for tricuspid valve surgery.
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Affiliation(s)
- Alexandra C van Dissel
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Knight Cardiovascular Institute, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, Portland, OR 97221, USA
| | - Alexander R Opotowsky
- Department of Paediatrics, Cincinnati Children’s Hospital Medical Centre, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Luke J Burchill
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Jasmine Grewal
- Division of Cardiology, St Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Adam M Lubert
- Department of Paediatrics, Cincinnati Children’s Hospital Medical Centre, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Timothy Cotts
- University of Michigan Medical Centre, Ann Arbor, MI, USA
| | | | | | - Christopher DeZorzi
- University of Missouri–Kansas City and Saint Luke’s Hospital, Kansas City, MO, USA
| | - Anthony Magalski
- University of Missouri–Kansas City and Saint Luke’s Hospital, Kansas City, MO, USA
| | - Frank Han
- University of Illinois, Chicago, IL, USA
| | - David Baker
- The University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Joseph Kay
- Colorado University School of Medicine, Denver, CO, USA
| | | | | | | | - Marissa C Kuo
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Susan M Jameson
- Departments of Paediatrics and Cardiovascular Medicine, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jonathan Cramer
- Children’s Hospital, University of Nebraska Medical Centre, Omaha, NE, USA
| | | | - Pastora Gallego
- Hospital Universitario Virgen Del Rocio, Sevilla, Spain
- European Reference Network for Rare, Low Prevalence and Complex Disease of the Heart—ERN GUARD Heart
| | - Clare O’Donnell
- Green Lane Paediatric and Congenital Cardiac Service, Auckland City Hospital, Auckland, New Zealand
| | - Jane Hannah
- Green Lane Paediatric and Congenital Cardiac Service, Auckland City Hospital, Auckland, New Zealand
| | - Mikael Dellborg
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Salil Ginde
- Children’s Hospital of Wisconsin, Milwaukee, WI, USA
| | - Eric V Krieger
- University of Washington Medical Centre and Seattle Children’s Hospital, Seattle, WA, USA
| | | | | | | | - Joshua Wong
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - William M Wilson
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Jolien Roos-Hesselink
- European Reference Network for Rare, Low Prevalence and Complex Disease of the Heart—ERN GUARD Heart
- Erasmus Medical Centre, Rotterdam, The Netherlands
| | - David S Celermajer
- The University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, Portland, OR 97221, USA
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Clift P, Berger F, Sondergaard L, Antonova P, Disney P, Nicolarsen J, Thambo JB, Tomkiewicz Pajak L, Wang JK, Schophuus Jensen A, Burgess G, Efficace M, Friberg M, Lassen C, d'Udekem Y. The efficacy and safety of macitentan in Fontan-palliated patients: results of the 52-week randomised, placebo-controlled RUBATO trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The clinical utility and long-term effects of endothelin receptor antagonists (ERAs) in Fontan-palliated patients remain unclear and there are currently no approved therapies. A decline in peak VO2 between consecutive cardiopulmonary exercise tests (CPETs) is highly prognostic for death or transplant in adult Fontan patients, hence its use as a primary endpoint in clinical trials of ERAs in patients with Fontan circulation.
Purpose
The RUBATO trial aimed to assess the efficacy and safety of macitentan, an endothelin receptor antagonist, in Fontan-palliated patients over 52 weeks.
Methods
In the multicentre, double-blind, randomised, placebo-controlled, phase 3 RUBATO trial, Fontan-palliated patients were randomised 1:1 to macitentan 10 mg once-daily or placebo for 52 weeks. Eligible patients were aged ≥12 years, in New York Heart Association functional class II or III, had no limitations for CPET (including no pacemakers), had undergone lateral tunnel or extracardiac conduit Fontan (total cavopulmonary connection) >1 year before screening and showed no signs of Fontan failure or clinical deterioration within 3 months before screening. Primary efficacy endpoint was change in peak VO2 from baseline to week 16. Secondary endpoints were change in peak VO2 from baseline over 52 weeks and change in mean count per minute of daily physical activity from baseline to week 16 as measured by an accelerometer. Adverse events were also assessed.
Results
137 patients were randomised to macitentan (n=68) or placebo (n=69). 92.7% of patients completed 52 weeks of double-blind treatment: 7 and 3 patients prematurely discontinued study treatment in macitentan and placebo arms, respectively. Patient baseline characteristics are shown in Table 1. At week 16, the mean (SD) change from baseline in peak VO2 was –0.16 (2.86) with macitentan vs –0.67 (2.66) mL/kg/min with placebo (median unbiased estimate of the difference between macitentan and placebo: 0.62 mL/kg/min [99% repeated confidence interval –0.62; 1.85], p=0.1930). No treatment effect was observed in the two secondary endpoints (Table 2): mean (SD) count per minute of daily physical activity decreased from baseline to week 16 by 3.02 (92.44) with macitentan and by 14.34 (117.56) with placebo (p=0.4512). The most common AEs were headache (10.3% vs 8.7% on placebo), nasopharyngitis (5.9% vs 4.3%), and pyrexia (5.9% vs 4.3%). AEs leading to treatment discontinuation were reported in 3 (4.4%) and 1 (1.4%) of macitentan and placebo patients.
Conclusion
The 52-week RUBATO trial provides an important addition to data on the clinical utility of ERAs in Fontan-palliated patients. The primary efficacy endpoint was not met and no treatment effect was observed for the two secondary endpoints. Macitentan was well tolerated; safety findings were consistent with the known safety profile of macitentan 10 mg.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Actelion Pharmaceuticals Ltd., a Janssen pharmaceutical company of Johnson & Johnson.
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Affiliation(s)
- P Clift
- Queen Elizabeth Hospital Birmingham, Adult Congenital Heart Disease Unit , Birmingham , United Kingdom
| | - F Berger
- German Heart Center Berlin, Department of Congenital Heart Disease/Pediatric Cardiology , Berlin , Germany
| | - L Sondergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - P Antonova
- Charles University in Prague, Motol University Hospital, Department of Cardiovascular Surgery, 2nd Faculty of Medicine , Motol , Czechia
| | - P Disney
- Royal Adelaide Hospital, Department of Cardiology , Adelaide , Australia
| | - J Nicolarsen
- Providence Sacred Heart Medical Center and Children's Hospital, Providence Adult and Teen Congenital Heart Program (PATCH) , Spokane , United States of America
| | - J B Thambo
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology , Pessac , France
| | - L Tomkiewicz Pajak
- Jagiellonian University Medical College, John Paul II Hospital, Department of Cardiac and Vascular Diseases, Institute of Cardiology , Krakow , Poland
| | - J K Wang
- National Taiwan University Hospital, Department of Pediatrics , Taipei , Taiwan
| | - A Schophuus Jensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G Burgess
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | | | - M Friberg
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | - C Lassen
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | - Y d'Udekem
- Children's National Hospital, Washington , D.C. , United States of America
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Broberg CS, van Dissel A, Minnier J, Aboulhosn J, Kauling RM, Ginde S, Krieger EV, Rodriguez F, Gupta T, Shah S, John AS, Cotts T, Kay WA, Kuo M, Dwight C, Woods P, Nicolarsen J, Sarubbi B, Fusco F, Antonova P, Fernandes S, Grewal J, Cramer J, Khairy P, Gallego P, O'Donnell C, Hannah J, Dellborg M, Rodriguez-Monserrate CP, Muhll IV, Pylypchuk S, Magalski A, Han F, Lubert AM, Kay J, Yeung E, Roos-Hesselink J, Baker D, Celermajer DS, Burchill LJ, Wilson WM, Wong J, Kutty S, Opotowsky AR. Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries. J Am Coll Cardiol 2022; 80:951-963. [PMID: 36049802 DOI: 10.1016/j.jacc.2022.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/02/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND For patients with d-loop transposition of the great arteries (d-TGA) with a systemic right ventricle after an atrial switch operation, there is a need to identify risks for end-stage heart failure outcomes. OBJECTIVES The authors aimed to determine factors associated with survival in a large cohort of such individuals. METHODS This multicenter, retrospective cohort study included adults with d-TGA and prior atrial switch surgery seen at a congenital heart center. Clinical data from initial and most recent visits were obtained. The composite primary outcome was death, transplantation, or mechanical circulatory support (MCS). RESULTS From 1,168 patients (38% female, age at first visit 29 ± 7.2 years) during a median 9.2 years of follow-up, 91 (8.8% per 10 person-years) met the outcome (66 deaths, 19 transplantations, 6 MCS). Patients experiencing sudden/arrhythmic death were younger than those dying of other causes (32.6 ± 6.4 years vs 42.4 ± 6.8 years; P < 0.001). There was a long duration between sentinel clinical events and end-stage heart failure. Age, atrial arrhythmia, pacemaker, biventricular enlargement, systolic dysfunction, and tricuspid regurgitation were all associated with the primary outcome. Independent 5-year predictors of primary outcome were prior ventricular arrhythmia, heart failure admission, complex anatomy, QRS duration >120 ms, and severe right ventricle dysfunction based on echocardiography. CONCLUSIONS For most adults with d-TGA after atrial switch, progress to end-stage heart failure or death is slow. A simplified prediction score for 5-year adverse outcome is derived to help identify those at greatest risk.
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Affiliation(s)
- Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
| | - Alexandra van Dissel
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA; Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jessica Minnier
- School of Public Health, Oregon Health and Science University, Portland, Oregon, USA
| | | | | | - Salil Ginde
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Eric V Krieger
- University of Washington Medical Center and Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Tripti Gupta
- Ochsner Medical Center, New Orleans, Louisiana, USA
| | | | | | - Timothy Cotts
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - W Aaron Kay
- Krannert Institute of Cardiology, Indianapolis, Indiana, USA
| | - Marissa Kuo
- Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Cindy Dwight
- Krannert Institute of Cardiology, Indianapolis, Indiana, USA
| | - Patricia Woods
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | - Susan Fernandes
- Stanford University, School of Medicine, Departments of Pediatrics and Medicine, Palo Alto, California, USA
| | - Jasmine Grewal
- St. Paul's Hospital, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Cramer
- Children's Hospital, Omaha & University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paul Khairy
- Montreal Heart Institute, Montreal, Quebec, Canada
| | | | - Clare O'Donnell
- Green Lane Paediatric and Congenital Cardiac Service, Auckland City Hospital, Auckland, New Zealand
| | - Jane Hannah
- Green Lane Paediatric and Congenital Cardiac Service, Auckland City Hospital, Auckland, New Zealand
| | - Mikael Dellborg
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carla P Rodriguez-Monserrate
- Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Frank Han
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adam M Lubert
- Cincinnati Children's Hospital Medical Center, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph Kay
- Colorado University School of Medicine, Denver, Colorado, USA
| | - Elizabeth Yeung
- Colorado University School of Medicine, Denver, Colorado, USA
| | | | - David Baker
- University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David S Celermajer
- University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Luke J Burchill
- Royal Melbourne Hospital, Department of Medicine, Melbourne, Victoria, Australia
| | - William M Wilson
- Royal Melbourne Hospital, Department of Medicine, Melbourne, Victoria, Australia
| | - Joshua Wong
- Royal Melbourne Hospital, Department of Medicine, Melbourne, Victoria, Australia
| | - Shelby Kutty
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexander R Opotowsky
- Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cincinnati Children's Hospital Medical Center, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Broberg CS, Kovacs AH, Sadeghi S, Rosenbaum MS, Lewis MJ, Carazo MR, Rodriguez FH, Halpern DG, Feinberg J, Galilea FA, Baraona F, Cedars AM, Ko JM, Porayette P, Maldonado J, Sarubbi B, Fusco F, Frogoudaki AA, Nir A, Chaudhry A, John AS, Karbassi A, Hoskoppal AK, Frischhertz BP, Hendrickson B, Bouma BJ, Rodriguez-Monserrate CP, Broda CR, Tobler D, Gregg D, Martinez-Quintana E, Yeung E, Krieger EV, Ruperti-Repilado FJ, Giannakoulas G, Lui GK, Ephrem G, Singh HS, Almeneisi HM, Bartlett HL, Lindsay I, Grewal J, Nicolarsen J, Araujo JJ, Cramer JW, Bouchardy J, Al Najashi K, Ryan K, Alshawabkeh L, Andrade L, Ladouceur M, Schwerzmann M, Greutmann M, Meras P, Ferrero P, Dehghani P, Tung PP, Garcia-Orta R, Tompkins RO, Gendi SM, Cohen S, Klewer S, Hascoet S, Mohammadzadeh S, Upadhyay S, Fisher SD, Cook S, Cotts TB, Aboulhosn JA. COVID-19 in Adults With Congenital Heart Disease. J Am Coll Cardiol 2021; 77:1644-1655. [PMID: 33795039 PMCID: PMC8006800 DOI: 10.1016/j.jacc.2021.02.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.
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Affiliation(s)
- Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Soraya Sadeghi
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA
| | - Marlon S Rosenbaum
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew J Lewis
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew R Carazo
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dan G Halpern
- Division of Cardiology, York University Langone Health, New York, New York, USA
| | - Jodi Feinberg
- Division of Cardiology, York University Langone Health, New York, New York, USA
| | | | - Fernando Baraona
- Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ari M Cedars
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jong M Ko
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prashob Porayette
- Division of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jennifer Maldonado
- Division of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Berardo Sarubbi
- Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - Flavia Fusco
- Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | | | - Amiram Nir
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anisa Chaudhry
- Penn State Hershey Heart and Vascular Institute, State College, Pennsylvania, USA
| | - Anitha S John
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | - Arvind K Hoskoppal
- UPMC Adult Congenital Heart Disease Program, Pittsburgh, Pennsylvania, USA
| | - Benjamin P Frischhertz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Hendrickson
- University of Tennessee Health Science Center, Le Bonheur Heart Institute, Memphis, Tennessee, USA
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | - Daniel Tobler
- Division of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - David Gregg
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Efren Martinez-Quintana
- Cardiology Service, Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Elizabeth Yeung
- Anschutz Medical Campus, Colorado's Adult and Teen Congenital Heart Program, Aurora, Colorado, USA
| | - Eric V Krieger
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - George K Lui
- Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Georges Ephrem
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA
| | - Harsimran S Singh
- Weill Cornell Medicine, New York Presbyterian Hospital, Department of Medicine and Pediatrics, New York, New York, USA
| | - Hassan Mk Almeneisi
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - Heather L Bartlett
- Department of Pediatrics and Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Ian Lindsay
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, USA
| | - Jasmine Grewal
- University of British Columbia, St. Paul's Hospital, Vancouver, British Colombia, Canada
| | - Jeremy Nicolarsen
- Providence Adult and Teen Congenital Heart Program, Pediatric and Adult Cardiology, Spokane, Washington, USA
| | - John J Araujo
- Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Rionegro, Colombia
| | - Jonathan W Cramer
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Khalid Al Najashi
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Kristi Ryan
- OSF Healthcare Children's Hospital of Illinois, Adult Congenital Heart Program, Peoria, Illinois, USA
| | - Laith Alshawabkeh
- Department of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Lauren Andrade
- Division of Cardiology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Magalie Ladouceur
- Hôpital Européen Georges Pompidou, Adult Congenital Heart Disease Unit, Paris, France
| | - Markus Schwerzmann
- University Hospital Inselspital, Center for Congenital Heart Disease, Bern, Switzerland
| | | | | | - Paolo Ferrero
- ASST Papa Giovanni XXIII, Cardiovascular Department, University of Milano, Bergamo, Italy
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Poyee P Tung
- University of Texas at Houston, Adult Congenital Heart Disease, Houston, Texas, USA
| | - Rocio Garcia-Orta
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rose O Tompkins
- Cedars-Sinai Medical Center, The Geurin Family Congenital Heart Program, Los Angeles, California, USA
| | - Salwa M Gendi
- West Virginia University, Adult Congenital Heart Disease Program, Morgantown, West Virginia, USA
| | - Scott Cohen
- Medical College of Wisconsin, Adult Congenital Heart Disease Program, Milwaukee, Wisconsin, USA
| | - Scott Klewer
- Division of Cardiology, University of Arizona, Tucson, Arizona, USA
| | | | | | - Shailendra Upadhyay
- Connecticut Children's Medical Center, Pediatric Cardiology Hartford, Connecticut, USA
| | - Stacy D Fisher
- Department of Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephen Cook
- Helen DeVos Children's Hospital, Adult Congenital Heart Center, Grand Rapids, Michigan, USA
| | - Timothy B Cotts
- Department of Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA.
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Abstract
Congenital heart disease (CHD) is the most common and perhaps most widely variable birth defect. Decades of improved CHD care has resulted in a steady growth in the number and complexity of adults with CHD, and many of these patients require lifelong, specialized follow-up care. This begins with successful transition from pediatric-based to adult-based care. Despite the remarkable advances in this field, many adults with CHD still experience lapses in care that have significant health consequences. This review outlines some of the challenges, progress, and areas for improvement in CHD transition medicine. [Pediatr Ann. 2017;46(6):e224-e228.].
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Ruckdeschel E, Nicolarsen J, Yeung E, Khanna A, Kay J. Echocardiographic parameters of systemic right ventricular size and function compared to cardiac MRI. J Cardiovasc Magn Reson 2014. [PMCID: PMC4044782 DOI: 10.1186/1532-429x-16-s1-p130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Singhal NR, Da Cruz EM, Nicolarsen J, Schwartz LI, Merritt GR, Barrett C, Twite MD, Ing RJ. Perioperative management of shock in two fontan patients with plastic bronchitis. Semin Cardiothorac Vasc Anesth 2013; 17:55-60. [PMID: 23381614 DOI: 10.1177/1089253213475879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Plastic bronchitis is potentially a life-threatening complication of long-standing surgically palliated single ventricle congenital heart disease. Patients can present with hypoxia requiring urgent bronchoscopy for removal of bronchial casts. Perioperative care for these patients is challenging and anesthesia is associated with significant cardiac risk. As more surgically corrected single ventricle patients survive to adulthood, these patients are expected to present more frequently. This report details the perioperative management of 2 Fontan patients with hypoxia and significant plastic bronchitis disease burden.
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Affiliation(s)
- Niel Raj Singhal
- Children's Hospital Colorado and University of Colorado, Denver, Aurora, CO, USA
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Abstract
Cardiac sarcoidosis is most often clinically silent. When symptomatic, it commonly involves the conduction system. This inflammatory and infiltrative process may be manifest as conduction delays and/or important ventricular ectopy. More diffuse myocardial infiltration may result in congestive heart failure (CHF). This case report illustrates how a more focal infiltrative process in sarcoidosis may cause severe CHF with involvement of the papillary muscle, resulting in worsening of mitral regurgitation. After a cardiac workup that revealed evidence of sarcoidosis, a gadolinium-enhanced magnetic resonance imaging series showed focal infiltration of the left ventricular wall over the region of the posterior papillary muscle, giving a pathophysiologic explanation for the patient's severe mitral regurgitation. This case report depicts sarcoidosis-associated CHF arising in an unusual fashion, resulting not from widespread myocardial infiltration, but rather from focal papillary muscle involvement and, consequently, mitral valve dysfunction. This example suggests that cardiac sarcoidosis should be considered in the differential diagnosis of mitral regurgitation leading to progressive CHF. We briefly review the diagnostic approach to cardiac sarcoidosis, with representative images from this case.
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Affiliation(s)
- Brian Cross
- Cardiac Imaging Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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