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Antal A, Szegedi M, Takacs E, Szabo B, Solymosi B, Vincze V, Ablonczy L, Kornyei L, Temesvari A, Andreka P, Balint H. Outcome of patients with tetralogy of Fallot repair over 50 years of age. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2223] [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: 11/13/2022] Open
Abstract
Abstract
Purpose
To report the outcomes of patients with repaired tetralogy of Fallot (TOF) above 50 years of age.
Methods
We reviewed records of TOF patients who were followed in our institution since 2000. Demographic data, surgical reports and long-term outcomes were analyzed retrospectively.
Results
Thirty-five of 297 (12%) patients who underwent TOF repair were above 50 years of age (25 men [60%]) at the last follow-up. Eighteen patients (48%) had prior palliative surgery. The mean age at the first repair was 18±13 years (5 patients after 40 years of age). Reoperation with pulmonary valve replacement was performed in 10 (28%) patients, and a second redo surgery in 6 (17%) patients. During a mean 17± 2 years follow-up 7 (8.5%) patients died (n=6 end-stage heart failure, n=1 infective endocarditis). At the last follow-up 21/35 patients (60%) were treated with tachyarrhythmia, 19/35 (54%) with chronic heart failure and 17/35 (48%) with comorbidities (hypertension, coronary artery disease/peripherial artery disease, diabetes mellitus, renal failure). Using multivariate analysis the only predictor of death was heart failure (OR: 6.8). Furthermore atrial tachycardia (OR: 8.8) and at least grade II tricuspid regurgitation (OR: 5.0) were identified as predictors of heart failure.
Conclusion
This historical cohort of TOF patients with late repair has a high morbidity rate later in life. Approximately half of the patients require treatment for chronic heart failure, arrhythmias and cardiovascular related comorbidities. Atrial tachycardia and tricuspid regurgitation are strong predictors for heart failure. In this population the strongest predictor for death is heart failure.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Antal
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - M Szegedi
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - E Takacs
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - B Szabo
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - B Solymosi
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - V Vincze
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - L Ablonczy
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - L Kornyei
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - A Temesvari
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - P Andreka
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - H Balint
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
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Pataki S, Szegedi M, Temesvari A, Ablonczy L, Andreka P, Balint H. P5353Pregnancy in congenital heart disease - risk stratificaton. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0320] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Maternal congenital heart disease is a leading cause of peripartum maternal mortality, which is also associated with increased risk of fetal morbidity and mortality. We aimed to provide risk stratification for congenital heart disease patients using the recently introduced CARPREG (Cardiac Disease in Pregnancy) II score at our Institute.
Patients and methods
We enrolled 191 pregnant women with congenital heart disease (mean age at pregnancy 29.2±5,7 years). We recorded all foetal (premature birth, abortion, congenital heart abnormalities) and maternal (postpartum heart failure, stroke, hypertension) events in 276 pregnancies. High-risk pregnancy was defined as a CARPREG II score of 4≤.
Results
High-risk pregnancy was detected in 14.1%. We found fetal and maternal events in 13.8% and 14.5% of all pregnancies, respectively, which both were more prevalent in the high-risk group (p<0.001). No maternal death occurred, whereas premature birth and abortion was detected in 7.6 and 2.9%, respectively, both complications were more frequent in the high-risk patient population as compared to the lower risk patients (30.8 vs. 7.2%, p<0.001). In univariate analysis, CARPREG II of 4≤ was significantly associated with fetal (p<0.001, OR: 4.2) and maternal (p<0.001, OR: 5.3) events. Risk factors of the CARPREG II were further analyzed using multivariate logistic regression analysis: prior cardiac events or arrhythmias (p=0.027) and cyanosis (p=0.026) were independent predictors of fetal complications. Left ventricular outflow tract obstruction (p<0.001), cardiac interventions (p=0.024) and prior cardiac events or arrhythmias (p=0.001) demonstrated significant association with maternal events.
Conclusion
The CARPREG II could help in the identification of high-risk pregnancies and thus aids the selection of patients for strict monitoring and special therapies. In line with previous studies we detected higher rates of fetal and maternal events among patients with CARPREG II of 4≤ score.
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Affiliation(s)
- S Pataki
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - M Szegedi
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - A Temesvari
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - L Ablonczy
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - P Andreka
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - H Balint
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
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Mladoniczky S, Szegedi M, Piroth ZS, Nemeth J, Ablonczy L, Andreka P, Temesvari A, Balint OH. P2267CTEPH patients long term follow-up: results from a single center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0744] [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: 11/13/2022] Open
Abstract
Abstract
Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is a thrombotic pulmonary disease associated with pulmonary vasculopathy. Pulmonary endarterectomy (opus, PEA) is the first treatment choice in CTEPH, and specific PAH medication when there is a contraindication for surgery or residual pulmonary arterial hypertension (rPAH) occurs. In the presence of PAH balloon pulmonary angioplasty (BPA) might be also recommended if available.
Objective
We investigated the long term outcome of our CTEPH patients.
Methods
CTEPH from our institution retrospectively analyzed (data between 2003 and 2018). Baseline, treatment and outcome data were documented. We compared the outcome, together with mortality in those with and without surgery (PEA vs. non PEA group). NYHA class, 6 minutes walking distance (6MWD) and NT-proBNP were also reported during follow-up.
Results
Of 29 CTEPH patients (mean age was 62±19 years, 52% male) 16 (55%) were accepted for PEA, and further 12 of them had a long term follow-up post surgery (n=3 periop exit, n=1 waiting for surgery). Half of the PEA patients were cured (n=6) and the other half (n=6) required specific PAH treatment (n=1, in combination with BPA) for rPAH. All patients from the non-PEA group (n=13) were started on specific PAH treatment (n=1 in combination with BPA). Patients with or without PEA did not differ hemodynamically. At the late follow-up there was a significant improvement in PEA group for NYHA class and NT-proBNP (p<0,001, and p=0,046), and in non PEA group for NYHA class and the 6MWD (p=0,012, and 0,006). We found significant difference in mortality at 1,3,5 year (Kaplan-Meier survival analysis) follow-up, for PEA group 100%-100%-100% and non PEA group 100%-85%-78% (p=0,013), respectively.
Conclusions
55% of CTEPH patients were suitable for PEA, and those who survived the surgery 50% were cured. Non PEA patients improved functionally on the long term, but had worse survival.
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Affiliation(s)
| | - M Szegedi
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - Z S Piroth
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - J Nemeth
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - L Ablonczy
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - P Andreka
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - A Temesvari
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - O H Balint
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
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Szabó A, Ablonczy L, Vilmányi C, Szatmári A. Tacrolimus Monotherapy After Pediatric Heart Transplantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Pólos M, Hüttl T, Németh E, Balogh O, Ágg B, Benke K, Ablonczy L, Bartha E, Szabolcs Z. Successful heart transplantation as third cardiac operation in a 12 year-old Marfan patient. J Cardiothorac Surg 2013. [PMCID: PMC3844454 DOI: 10.1186/1749-8090-8-s1-o152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gergely M, Ablonczy L, Kramer S, Székely EA, Sápi E, Gál J, Szatmári A, Székely A. Comparison of transpulmonary thermodilution, transthoracic echocardiography and conventional hemodynamic monitoring in neonates and infants after open heart surgery: a preliminary study. Minerva Anestesiol 2012; 78:1101-1108. [PMID: 23059514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Transpulmonary thermodilution (TPTD) is an increasingly popular method used to monitor the complex hemodynamic changes in critically ill children. The purpose of our study was to examine the relationship between transthoracic echocardiographic (TTE) parameters and global hemodynamic variables derived from TPTD and those derived from conventional measurements in infants and neonates undergoing corrective cardiac surgery. METHODS After approval from the Ethics Committee of Gottsegen György Hungarian Institute of Cardiology and individual parental consent were obtained, patients were prospectively enrolled. In parallel with continuous postoperative conventional monitoring, TPTD was measured four times daily, and TTE was performed once per day. Conventional hemodynamic, TPTD and TTE parameters were compared with weighted linear regression statistics and a Pearson correlation. RESULTS One hundred forty-five TPTD measurements and 35 TTE examinations of thirteen enrolled patients were analyzed. Global end-diastolic volume index (GEDVI) was correlated with the fractional shortening (SF, r=0.67, P=0.001) measured by TTE. Among the preload parameters, the percentage change of GEDVI between two consecutive time points showed a pertinent correlation with changes of cardiac index (r=0.67, P=0.001) and changes of stroke volume index (r=0.57, P=0.008). Percentage changes in SF demonstrated a strong negative correlation with changes of left ventricular end-systolic diameter (r=-0.86, P<0.001). There was no significant relationship between alterations in arterial or central venous pressure values with TTE or TPTD parameters. CONCLUSION Both TPTD and TTE may be used in the estimating volumetric preload parameters. The time course of TPTD-derived parameters may have clinical relevance in pediatric critical care practice.
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Affiliation(s)
- M Gergely
- Department of Anesthesiology and Intensive Therapy, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
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Ablonczy L, Schubert S, Lehmkuhl H, Miera O, H[ue]bler M, Knosalla C, Grauhan O, Abdul-Khaliq H, Berger F, Hetzer R. 213: Pediatric heart transplantation: Implications for 2 hour cyclosporin a blood levels greater 600 ng/ml for graft protection monitoring. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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