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Celermajer DS, Baker DW, Cordina RL, Gatzoulis M, Broberg CS. Common diagnostic errors in adults with congenital heart disease. Eur Heart J 2023; 44:3217-3227. [PMID: 36527303 DOI: 10.1093/eurheartj/ehac717] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 08/23/2022] [Revised: 10/07/2022] [Accepted: 11/20/2022] [Indexed: 09/08/2023] Open
Abstract
Owing to the great advances in the care for children with congenital heart disease by paediatric cardiac surgeons and cardiologists, there are ever increasing numbers of patients with congenital heart disease who reach adult life. At some stage during the late teenage years or soon after, these patients 'transition' from paediatric cardiac care to surveillance by cardiologists who look after adults. Many such specialists, however, are more familiar with commoner acquired heart problems such as coronary disease, heart failure, and arrhythmia in structurally normal hearts and less familiar with congenital heart disease. For this reason, international guidelines have suggested that the care of young adults with congenital heart disease take place in designated specialist adult congenital heart disease centres. It remains very important, however, for general cardiologists to have a good understanding of many aspects of adult congenital heart disease, including common pitfalls to avoid and, importantly, when to refer on, to a specialist centre. To help healthcare providers across the spectrum of cardiology practice to address common themes in adult congenital heart disease, this state-of-the-art review provides a series of case vignettes to illustrate frequent diagnostic problems that we have seen in our tertiary-level adult congenital heart disease centres, which are sometimes encountered in general cardiology settings. These include commonly 'missed' diagnoses, or errors with diagnosis or management, in these often very complex patients.
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Affiliation(s)
- David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - David W Baker
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Rachael L Cordina
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Michael Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
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2
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Samaranayake CB, Kempny A, Naeije R, Gatzoulis M, Price LC, Dimopoulos K, Zhao L, Wort SJ, McCabe C. Beta-blockade improves right ventricular diastolic function in exercising pulmonary arterial hypertension. Eur Respir J 2023; 61:13993003.00144-2023. [PMID: 36990471 DOI: 10.1183/13993003.00144-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/01/2023] [Indexed: 03/31/2023]
Affiliation(s)
| | - Aleksander Kempny
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Michael Gatzoulis
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Lan Zhao
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Stephen J Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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Ricci P, Bouchard M, Chong Zhiya C, Constantine A, Castro Meira V, Gatzoulis M, Haidu L, Dimopoulos K. Efficacy of congenital heart disease transition clinics in improving patient education. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1853] [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
Less than one third of adolescents with congenital heart disease (CHD) successfully complete a structured transition to adult care. Patient education is at the centre of the transition process, however, data on the impact of transition visits are limited.
Purpose
To assess the efficacy of our transition clinic in educating adolescents with CHD about their cardiac condition in preparation for adult CHD care.
Methods
All patients seen in our transition clinic between April 2015 and January 2022 were included. Integrated care pathways designed by the Pan London Transition Consortium guided us in the assessment and education during each of the 3 pre-planned transition visits (“ready, steady and go” model). Data collected included demographic and clinical characteristics, and qualitative assessment of the following categories: understanding, naming and describing their cardiac condition, adherence to and involvement in medication management, self-reported anxiety and awareness of the importance of dental hygiene.
Results
A total of 611 patients were included in the study (age 15.1±2.3 years at the first visit, 48.1% female). 51.1% of patients attended 2 and 19.3% 3 transition consultations.
Most adolescents (52.5%) had CHD of moderate complexity, whereas 28.5% had simple defects and 19% severe complexity. Learning disability (LD) was present in 19% of cases, of which 35.3% were genetic syndromes (21.6% Down Syndrome, 8.6% DiGeorge Syndrome, 2.6% Noonan Syndrome, 1.9% Sotos Syndrome, 0.9% Asperger Syndrome, 0.9% Cornelia De Lange Syndrome).
The overall comprehension of their condition increased significantly in patients without LD at the second (good or excellent understanding: from 20.9% to 60.2%, p<0.0001; naming: from 19.8% to 50.2%, p<0.0001; describing: from 13.9% to 40.2%, p<0.0001) and third visit (understanding: 66.7%, p=0.043; naming: 60.4%, p=0.004, describing: 56.3%, p=0.002; Table 1). Patients with LD did not improve their knowledge over time in understanding, naming, and describing their condition between the first and second and second and third visits (all p>0.05). Adherence to and the involvement in medication management, the self-reported anxiety and awareness of the importance of dental care did not change over time (Figure 1).
Conclusions
A structured transition program is an important tool in educating and supporting the delivery of care for CHD adolescents and their families prior their transition into the adult care. Our transition programme had a positive impact on comprehension in the majority of children. Adolescents with learning difficulties are a group who may benefit from more intensive or individually tailored education during transition to ensure that they are supported to understand their health needs and empowered to make their own choices where possible.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Ricci
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension , London , United Kingdom
| | - M Bouchard
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension , London , United Kingdom
| | - C Chong Zhiya
- National University of Singapore , Singapore , Singapore
| | - A Constantine
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension , London , United Kingdom
| | - V Castro Meira
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension , London , United Kingdom
| | - M Gatzoulis
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension , London , United Kingdom
| | - L Haidu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension , London , United Kingdom
| | - K Dimopoulos
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension , London , United Kingdom
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Masding A, Hoschtitzky A, Gatzoulis M. A case report of atrial fibrillation in early adulthood: dig deeper. Eur Heart J Case Rep 2022; 6:ytac323. [PMID: 35965606 PMCID: PMC9366865 DOI: 10.1093/ehjcr/ytac323] [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: 01/27/2022] [Revised: 03/21/2022] [Accepted: 07/29/2022] [Indexed: 11/21/2022]
Abstract
Background Atrial fibrillation (AF) is a common cardiac arrhythmia, which is often associated with underlying risk factors and undiagnosed conditions, including congenital heart disease. Atrial septal defects (ASDs) come to mind, albeit arrhythmias usually present later in life. We present herewith a young patient with cor triatriatum sinister (CTS), with some delay in establishing the diagnosis, following new onset AF in early adulthood. Case summary A 31-year-old man presented with pre-syncope and coryzal symptoms and was newly diagnosed with AF in the context of an intercurrent viral illness. After treatment with oral anticoagulation and successful outpatient cardioversion, he was discharged from cardiology review. Two years later he re-presented with exercise intolerance and a 12-lead electrocardiogram revealing recurrence of AF. Subsequent investigation with transthoracic echocardiography revealed the underlying congenital cardiac defect of CTS, together with an ASD and patent foramen ovale. After corrective surgery, which involved membrane resection, a Cox-maze procedure and ASD closure, sinus rhythm was restored and at follow-up the patient had returned to baseline function. Discussion Young patients presenting with new onset AF should undergo thorough cardiovascular assessment to identify treatable causes and reversible risk factors. Cor triatriatum sinister is a rare congenital anomaly that may present in adulthood and give rise to symptomatic AF. Surgical correction including a Cox-maze procedure in our patient resulted in restoration of sinus rhythm and a return of the patient’s baseline functional status and improved quality of life.
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McGlothlin D, Granton J, Klepetko W, Beghetti M, Rosenzweig EB, Corris P, Horn E, Kanwar M, McRae K, Roman A, Tedford R, Badagliacca R, Bartolome S, Benza R, Caccamo M, Cogswell R, Dewachter C, Donahoe L, Fadel E, Farber HW, Feinstein J, Franco V, Frantz R, Gatzoulis M, Hwa (Anne) Goh C, Guazzi M, Hansmann G, Hastings S, Heerdt P, Hemnes A, Herpain A, Hsu CH, Kerr K, Kolaitis N, Kukreja J, Madani M, McCluskey S, McCulloch M, Moser B, Navaratnam M, Radegran G, Reimer C, Savale L, Shlobin O, Svetlichnaya J, Swetz K, Tashjian J, Thenappan T, Vizza CD, West S, Zuckerman W, Zuckermann A, De Marco T. ISHLT CONSENSUS STATEMENT: Peri-operative Management of Patients with Pulmonary Hypertension and Right Heart Failure Undergoing Surgery. J Heart Lung Transplant 2022; 41:1135-1194. [DOI: 10.1016/j.healun.2022.06.013] [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] [Received: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
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Riad O, Hunnybun D, O’connor M, Shi R, Cantor E, Jarman J, Foran J, Markides V, Gatzoulis M, Wong T. Conduction system pacing in the adult congenital population; feasibility and outcomes. Europace 2022. [DOI: 10.1093/europace/euac053.552] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left bundle pacing (LBP) is an evolving pacing method designed to capture the intrinsic conduction and minimise ventricular dys- synchrony. Anatomical complexity, scars of previous corrective surgeries and haemodynamic properties of adult congenital heart disease (ACHD) population could increase challenges of LBP. We describe our experience in LBP in ACHD patients and different patient groups.
Purpose
To compare the feasibility of LBP in ACHD patient population and non-ACHD patients.
Methods
We included all patients who had LBP at our institution in 2020 and 2021. Demographic data, imaging data, procedural parameters and follow up data were collected and analysed.
Results
A total of 36 patients were included and divided into two groups: ACHD (n=8, mean age, 54 years, 38% females) and non-ACHD (n=28, mean age, 74 years, 43% females). ACHD anatomy included simple lesions (4) as atrial and ventricular septal defects, partial anomalous pulmonary venous drainage, bicuspid aortic valve and Shone’s syndrome, moderate (3), as Tetralogy of Fallot with surgical repair, and complex (1), as transposition of great arteries with Mustard repair. Non-ACHD included patients with structurally normal heart, dilated cardiomyopathy, and those who underwent mitral and aortic valve interventions. Mean left ventricular ejection fraction in ACHD group was 59.5%, and 57.5% in non-ACHD. Late gadolinium enhancement in basal septal area was present in 5 patients in ACHD group. Acute success rate, defined as capture of left bundle branch, was 100% in ACHD group, and 88% in non-ACHD. No acute complications were recorded in both groups. Mean pre-procedural QRS duration was longer in ACHD group (170 ms, vs, 120, p=<0.001). Mean reduction in QRS duration in ACHD group was 27 ms, vs, 15, p= 0.856. Mean procedural and fluoroscopy times were similar in both groups (ACHD, 75.5 minutes, vs, 70, p= 0.26, and ACHD, 9 minutes, vs 7.13, respectively, p= 0.46). Pacing parameters at implantation and after 2 months were satisfactory in both groups (Fig 1).
Conclusion
Left bundle pacing is feasible in ACHD population as compared to non-ACHD patients, with low incidence of complications. Procedural and fluoroscopic times were similar in both groups. Pacing parameters were satisfactory and stable over 2 month-follow up.
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Affiliation(s)
- O Riad
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Hunnybun
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M O’connor
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Shi
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - E Cantor
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Jarman
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Foran
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - V Markides
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - T Wong
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Arvanitaki A, Ibrahim W, Shore D, Diller GP, Li W, Rafiq I, Gatzoulis M, Montanaro C. Epidemiology and management of Staphylococcus Aureus infective endocarditis in adult patients with congenital heart disease: A single tertiary center experience. Int J Cardiol 2022; 360:23-28. [DOI: 10.1016/j.ijcard.2022.04.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/10/2022] [Accepted: 04/27/2022] [Indexed: 12/27/2022]
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8
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O’Connor M, Ho SY, McCarthy KP, Gatzoulis M, Wong T. Left bundle pacing in transposition of the great arteries with previous atrial redirection operation. HeartRhythm Case Rep 2022; 8:176-179. [PMID: 35492840 PMCID: PMC9039560 DOI: 10.1016/j.hrcr.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Matthew O’Connor
- Department of Electrophysiology, Royal Brompton Hospital, London, United Kingdom
- Adult Congenital Heart Centre, Royal Brompton Hospital, London, United Kingdom
| | - S. Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
| | - Karen P. McCarthy
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
| | - Michael Gatzoulis
- Adult Congenital Heart Centre, Royal Brompton Hospital, London, United Kingdom
| | - Tom Wong
- Department of Electrophysiology, Royal Brompton Hospital, London, United Kingdom
- Adult Congenital Heart Centre, Royal Brompton Hospital, London, United Kingdom
- Address reprint requests and correspondence: Dr Tom Wong, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney St, London, SW3 6NP UK.
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9
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Egidy Assenza G, Dimopoulos K, Budts W, Donti A, Economy KE, Gargiulo GD, Gatzoulis M, Landzberg MJ, Valente AM, Roos-Hesselink J. Management of acute cardiovascular complications in pregnancy. Eur Heart J 2021; 42:4224-4240. [PMID: 34405872 DOI: 10.1093/eurheartj/ehab546] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/30/2021] [Accepted: 07/27/2021] [Indexed: 11/14/2022] Open
Abstract
The growing population of women with heart disease of reproductive age has been associated with an increasing number of high-risk pregnancies. Pregnant women with heart disease are a very heterogeneous population, with different risks for maternal cardiovascular, obstetric, and foetal complications. Adverse cardiovascular events during pregnancy pose significant clinical challenges, with uncertainties regarding diagnostic and therapeutic approaches potentially compromising maternal and foetal health. This review summarizes best practice for the treatment of common cardiovascular complications during pregnancy, based on expert opinion, current guidelines, and available evidence. Topics covered include heart failure (HF), arrhythmias, coronary artery disease, aortic and thromboembolic events, and the management of mechanical heart valves during pregnancy. Cardiovascular pathology is the leading cause of non-obstetric morbidity and mortality during pregnancy in developed countries. For women with pre-existing cardiac conditions, preconception counselling and structured follow-up during pregnancy are important measures for reducing the risk of acute cardiovascular complications during gestation and at the time of delivery. However, many women do not receive pre-pregnancy counselling often due to gaps in what should be lifelong care, and physicians are increasingly encountering pregnant women who present acutely with cardiac complications, including HF, arrhythmias, aortic events, coronary syndromes, and bleeding or thrombotic events. This review provides a summary of recommendations on the management of acute cardiovascular complication during pregnancy, based on available literature and expert opinion. This article covers the diagnosis, risk stratification, and therapy and is organized according to the clinical presentation and the type of complication, providing a reference for the practicing cardiologist, obstetrician, and acute medicine specialist, while highlighting areas of need and potential future research.
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Affiliation(s)
- Gabriele Egidy Assenza
- Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, 40138 Bologna, Italy
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Werner Budts
- Congenital and Structural Cardiology University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Andrea Donti
- Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, 40138 Bologna, Italy
| | - Katherine E Economy
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gaetano Domenico Gargiulo
- Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, 40138 Bologna, Italy
| | - Michael Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Michael Job Landzberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Samaranayake CB, Warren C, Siewers K, Craig S, Price LC, Kempny A, Dimopoulos K, Gatzoulis M, Hopkinson NS, Wort SJ, Hull JH, McCabe C. Impact of cyanosis on ventilatory responses during stair climb exercise in Eisenmenger syndrome and idiopathic pulmonary arterial hypertension. Int J Cardiol 2021; 341:84-87. [PMID: 34416318 DOI: 10.1016/j.ijcard.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/25/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
Studies assessing exercise ventilatory responses during real-life exercise in pulmonary arterial hypertension (PAH) which include patients with cyanotic congenital heart disease are scarce. We assessed the ventilatory response to stairclimbing in patients with idiopathic PAH (IPAH) and congenital heart disease-associated PAH with Eisenmenger (EIS) physiology compared to healthy controls. Fifteen adults with IPAH, six EIS and 15 age and body mass index (BMI) matched controls were prospectively recruited. Participants completed spirometry and a self-paced stair-climb (48 steps) with portable cardiopulmonary exercise testing (CPET) equipment in-situ. Borg dyspnoea scores were measured at rest and on stair-climb cessation. Both IPAH and EIS groups had amplified ventilatory responses compared to Controls. The rate of increase in minute ventilation (VE) was exaggerated in EIS driven by an early increase in tidal volume (Tv) and more gradual increase in respiratory rate (RR). Peak Tv, RR, Tv: forced vital capacity (FVC) ratio, VE/VCO2 slope and stairclimb duration were significantly higher in EIS and IPAH compared to controls despite similar baseline spirometry and change in oxygen uptake on exercise. A decline in end-tidal carbon dioxide (CO2) and arterial oxygen saturations in early exercise distinguished EIS and IPAH patients. Significant correlations were observed between peak exercise Borg score and stair-climb time (r = 0.73, p = 0.002), peak end-tidal CO2 (r = -0.73, p = 0.001), peak VE (r = 0.53, p = 0.008), peak RR (r = 0.42, p = 0.011) and VE/VCO2 slope (r = 0.54, p = 0.001). Patients with IPAH and EIS have exaggerated ventilatory responses to stair-climbing compared to the controls with more severe levels of dyspnoea perception in Eisenmenger syndrome for equivalent oxygen uptake and work.
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Affiliation(s)
| | - Christopher Warren
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Karina Siewers
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Stuart Craig
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Laura C Price
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London
| | - Aleksander Kempny
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London
| | - Konstantinos Dimopoulos
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London
| | - Michael Gatzoulis
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London
| | - Nicholas S Hopkinson
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London
| | - Stephen J Wort
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London
| | - Colm McCabe
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London.
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11
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Budts W, Miller O, Babu-Narayan SV, Li W, Valsangiacomo Buechel E, Frigiola A, van den Bosch A, Bonello B, Mertens L, Hussain T, Parish V, Habib G, Edvardsen T, Geva T, Roos-Hesselink JW, Hanseus K, Dos Subira L, Baumgartner H, Gatzoulis M, Di Salvo G. Imaging the adult with simple shunt lesions: position paper from the EACVI and the ESC WG on ACHD. Endorsed by AEPC (Association for European Paediatric and Congenital Cardiology). Eur Heart J Cardiovasc Imaging 2021; 22:e58-e70. [PMID: 33338215 DOI: 10.1093/ehjci/jeaa314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
In 2018, the position paper 'Imaging the adult with congenital heart disease: a multimodality imaging approach' was published. The paper highlights, in the first part, the different imaging modalities applied in adult congenital heart disease patients. In the second part, these modalities are discussed more detailed for moderate to complex anatomical defects. Because of the length of the paper, simple lesions were not touched on. However, imaging modalities to use for simple shunt lesions are still poorly known. One is looking for structured recommendations on which they can rely when dealing with an (undiscovered) shunt lesion. This information is lacking for the initial diagnostic process, during repair and at follow-up. Therefore, this paper will focus on atrial septal defect, ventricular septal defect, and persistent arterial duct. Pre-, intra-, and post-procedural imaging techniques will be systematically discussed. This position paper will offer algorithms that might help at a glance. The document is prepared for general cardiologists, trainees, medical students, imagers/technicians to select the most appropriate imaging modality and to detect the requested information for each specific lesion. It might serve as reference to which researchers could refer when setting up a (imaging) study.
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Affiliation(s)
- Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Herestraat 49, B-3000 Leuven, Belgium
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Wei Li
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Alessandra Frigiola
- Department of Adult Congenital Heart Disease, Guy's and St Thomas' Hospital and School of Biomedical Engineering and Imaging Sciences, Kings College, London, UK
| | | | - Beatrice Bonello
- Department of Pediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, SickKids, Ontario, Canada
| | - Tarique Hussain
- Department of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Victoria Parish
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille, France
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Laura Dos Subira
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Michael Gatzoulis
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Giovanni Di Salvo
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
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12
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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13
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Kadiwar S, Smith JJ, Ledot S, Johnson M, Bianchi P, Singh N, Montanaro C, Gatzoulis M, Shah N, Ukor EF. Were pregnant women more affected by COVID-19 in the second wave of the pandemic? Lancet 2021; 397:1539-1540. [PMID: 33864751 PMCID: PMC8046416 DOI: 10.1016/s0140-6736(21)00716-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Nishel Shah
- Chelsea and Westminster Hospital, London, UK
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14
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Sliwa K, van der Meer P, Petrie MC, Frogoudaki A, Johnson MR, Hilfiker-Kleiner D, Hamdan R, Jackson AM, Ibrahim B, Mbakwem A, Tschöpe C, Regitz-Zagrosek V, Omerovic E, Roos-Hesselink J, Gatzoulis M, Tutarel O, Price S, Heymans S, Coats AJS, Müller C, Chioncel O, Thum T, de Boer RA, Jankowska E, Ponikowski P, Lyon AR, Rosano G, Seferovic PM, Bauersachs J. Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy. Eur J Heart Fail 2021; 23:527-540. [PMID: 33609068 DOI: 10.1002/ejhf.2133] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/22/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non-classified cardiomyopathies, left ventricular non-compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo-/radiotherapy for cancer or haematological malignancies need specific pre-, during and post-pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects.
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Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Cardiology and Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Mark C Petrie
- Department of Cardiology, Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, UK
| | - Alexandra Frogoudaki
- Adult Congenital Heart Disease Clinic, Second Cardiology Department ATTIKON University Hospital, Athens, Greece
| | - Mark R Johnson
- Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
| | | | - Righab Hamdan
- Department of Cardiology, Beirut Cardiac Institute, Beirut, Lebanon
| | - Alice M Jackson
- Department of Cardiology, Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, UK
| | - Bassem Ibrahim
- Consultant Cardiologist & Heart Failure Lead. North Cumbria University Hospitals, Cumbria, UK
| | - Amam Mbakwem
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Carsten Tschöpe
- Berlin- Institute of Health (BIH), Berlin-Brandenburger Center for Regenerative Therapies (BCRT), Department of Cardiology (CVK), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité University, Berlin, Germany
| | | | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital University of Gothenburg, Gothenburg, Sweden
| | - Jolien Roos-Hesselink
- Department of Adult Congenital Heart Disease, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michael Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College, London, UK
| | - Oktay Tutarel
- Adult Congenital Heart Disease, TUM School of Medicine, Munich, Germany
| | - Susanna Price
- Division of Cardiology and Metabolism, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Stephane Heymans
- Department of Cardiology, Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.,Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Christian Müller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu' and University of Medicine Carol Davila, Bucuresti, Romania
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewa Jankowska
- Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Piotr Ponikowski
- Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Giuseppe Rosano
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Cardiology Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK
| | - Petar M Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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15
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Price LC, Martinez G, Brame A, Pickworth T, Samaranayake C, Alexander D, Garfield B, Aw TC, McCabe C, Mukherjee B, Harries C, Kempny A, Gatzoulis M, Marino P, Kiely DG, Condliffe R, Howard L, Davies R, Coghlan G, Schreiber BE, Lordan J, Taboada D, Gaine S, Johnson M, Church C, Kemp SV, Wong D, Curry A, Levett D, Price S, Ledot S, Reed A, Dimopoulos K, Wort SJ. Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement. Br J Anaesth 2021; 126:774-790. [PMID: 33612249 DOI: 10.1016/j.bja.2021.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death. METHODS A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research. RESULTS Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15-50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning. CONCLUSIONS With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount.
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Affiliation(s)
- Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Guillermo Martinez
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - Aimee Brame
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | | | | | - David Alexander
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Benjamin Garfield
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Tuan-Chen Aw
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Bhashkar Mukherjee
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - Carl Harries
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Aleksander Kempny
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael Gatzoulis
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Philip Marino
- Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - David G Kiely
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Luke Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Rachel Davies
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free Hospital, London, UK
| | | | - James Lordan
- National Pulmonary Hypertension Service, Freeman Hospital, Newcastle upon Tyne, UK
| | - Dolores Taboada
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK
| | - Colin Church
- Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK
| | - Samuel V Kemp
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Davina Wong
- Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - Andrew Curry
- Cardiothoracic Anaesthesia, University Hospital Southampton, Southampton, Hampshire, UK
| | - Denny Levett
- Anaesthesia and Critical Care Research Area, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Anna Reed
- National Heart and Lung Institute, Imperial College London, London, UK; Respiratory and Lung Transplantation, Harefield Hospital, Uxbridge, UK
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephen John Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
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16
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Surkova E, Kovacs A, Bispo D, Flick C, Lakatos BK, Tokodi M, Liptai C, Fabian A, Merkely B, Senior R, Gatzoulis M, Li W. Mechanical contraction patterns of the systemic right ventricle: a 3D echocardiography study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.412] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. In patients with transposition of great arteries (TGA) post atrial switch operation or with congenitally corrected TGA (ccTGA), the morphologically right ventricle (RV) has to adapt to the chronically increased systemic pressure.
Purpose. To investigate the functional adaptation of the systemic RV in patients with TGA post Mustard repair or ccTGA.
Methods. RV volumes and EF were measured by 3D echocardiography in 33 patients with the systemic RV (21 TGA and 12 ccTGA; 45 ± 13y, 61% male), and in 33 healthy volunteers (44 ± 13y, 61% male).
The 3D RV model was postprocessed by the ReVISION software and its contraction was decomposed along the longitudinal, radial and anteroposterior directions (Fig.A, Systemic RV in TGA) providing longitudinal, radial and anteroposterior EF (LEF, REF and AEF). Relative contribution of each component was measured as the ratio between LEF, REF and AEF to the global RVEF (LEFi, REFi and AEFi).
Results. Systemic RV was significantly larger with reduced function compared to controls (Tab). 3D RVEF demonstrated stronger correlation with BNP (Rho -0.76, p < 0.0001) compared to other parameters of RV function (free wall strain 0.55, p = 0.0083; FAC -0.47, p = 0.024; S’ -0.39 and TAPSE 0.06, p > 0.05).
While in healthy volunteers, all 3 components of RV systolic function contributed equally to the global RV EF, in patients with TGA the relative contribution of the anteroposterior component was dominant and differed significantly from longitudinal and radial components (AEFi 0.48 ± 0.06 vs LEFi 0.31 ± 0.07 vs REFi 0.36 ± 0.09, p < 0.0001)(Fig. B,C). In patients with ccTGA the longitudinal component was dominant and provided a relative compensation for the reduced anteroposterior and radial components (LEFi 0.47 ± 0.07 vs AEFi 0.34 ± 0.07, p = 0.0002 and vs REFi 0.36 ± 0.09, p = 0.0023)(Fig. B,C). Relative contribution of the radial contraction was significantly reduced in all systemic RV patients.
Conclusions. Systemic RV contraction patterns change significantly with anteroposterior contraction being dominant in patients with TGA post Mustard repair and longitudinal component being dominant in ccTGA.
3DE should be a part of routine assessment of the systemic RV, especially in TGA since no conventional echo parameters take into account anteroposterior RV contraction.
Parameters of RV systolic function Parameter Control group (N = 33) All SRV patients (N = 33) TGA (N = 21) ccTGA (N = 12) 3D EF, % 60 ± 3.8 36 ± 8.6* 34 ± 7.3* 38 ± 10* FAC, % 41.4 ± 3.7 25.9 ± 9.3* 25.1 ± 9.2* 27.1 ± 9.9* TAPSE, mm 24.6 ± 4.2 11.9 ± 3.9* 11.1 ± 2.9* 13.2 ± 5.1* RV free wall strain, % -32.5 ± 4.2 -14.5 ± 3.5* -14.5 ± 2.9* -15.5 ± 3.5* * p < 0.0001 Abstract Figure.
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Affiliation(s)
- E Surkova
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Kovacs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - D Bispo
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Flick
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - BK Lakatos
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - M Tokodi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - C Liptai
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Fabian
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - R Senior
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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17
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Thoreau J, Gatzoulis M, Semple T, Wechalekar K. 5. Clinical experience of 18F-FDG-PET/CT in cases of suspected infective endocarditis in an adult congenital heart disease unit. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2020.100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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O'Neill L, Floyd CN, Sim I, Whitaker J, Mukherjee R, O'Hare D, Gatzoulis M, Frigiola A, O'Neill MD, Williams SE. Percutaneous secundum atrial septal defect closure for the treatment of atrial arrhythmia in the adult: A meta-analysis. Int J Cardiol 2020; 321:104-112. [PMID: 32679141 DOI: 10.1016/j.ijcard.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/01/2020] [Revised: 04/24/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atrial arrhythmias are common in patients with atrial septal defects (ASD) but the effects of percutaneous closure on atrial arrhythmia prevalence is unclear. We investigated the effects of ASD device closure and the impact of age at time of closure on prevalent atrial arrythmia. METHODS Meta-analysis of studies reporting atrial arrhythmia prevalence in adult patients before and after percutaneous closure was performed. Primary outcomes were prevalence of 'all atrial arrhythmia' and atrial fibrillation alone post closure. Sub-group analysis examined the effects of closure according to age in patients; <40 years, ≥40 and ≥ 60 years. 25 studies were included. RESULTS Meta-analysis of all studies demonstrated no reduction in all atrial arrhythmia or atrial fibrillation prevalence post-closure (OR 0.855, 95% CI 0.672 to 1.087, P = .201 and OR 0.818, 95% CI 0.645 to 1.038, P = .099, respectively). A weak reduction in all atrial arrhythmia and atrial fibrillation was seen in patients ≥40 years (OR 0.77, 95% CI 0.616 to 0.979, P = .032 and OR 0.760, 95% CI 0.6 to 0.964, P = .024, respectively) but not ≥60 years (OR 0.822, 95% CI 0.593 to 1.141, P = .242 and OR 0.83, 95% CI 0.598 to 1.152, P = .266, respectively). No data were available in patients <40 years. This, and other limitations, prevents conclusive assessment of the effect of age on arrhythmia prevalence. CONCLUSIONS Overall, percutaneous ASD closure is not associated with a reduction in atrial arrhythmia prevalence in this meta-analysis. A weak benefit is seen in patients ≥40 years of age, not present in patients ≥60 years.
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Affiliation(s)
| | - Christopher N Floyd
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Iain Sim
- King's College London, London, United Kingdom
| | | | | | | | - Michael Gatzoulis
- Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | - Steven E Williams
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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19
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Gribaudo E, Constantine A, Costola G, Kempny A, Gatzoulis M, Rafiq I, Dimopoulos K. Patients with Fontan circulation beyond the fourth decade of life. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2221] [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: 11/14/2022] Open
Abstract
Abstract
Background
The survival rate after Fontan procedure is improving and many of these patients now survive well into adulthood. Data on the late morbidity and mortality of Fontan patients in their fourth decade of life are lacking.
Purpose
To evaluate the late outcome of adult patients with Fontan circulation who have survived beyond 35 years.
Methods
Data were collected retrospectively on consecutive patients with a Fontan circulation ≥35 years between 2005 and 2019. Baseline (at 35th birthday) and follow-up data includes functional class, blood tests, history of arrhythmia, heart failure (HF), thromboembolism, Fontan related liver disease (FLD), protein losing enteropathy (PLE) and plastic bronchitis. Echocardiographic data on systemic atrioventricular valve (SAVV) regurgitation and ventricular function were also analysed.
Results
61 patients were included (29, 47.5% female). Tricuspid atresia was the most common underline anatomy (29,47.5%) and the median age at Fontan procedure was 12 [8.0–19.0] years. 34 (56%) patients had an atrio-pulmonary connection Fontan and 15 (24.5%) total cavo-pulmonary connection (86.7% lateral tunnel and 13.3% extra-cardiac conduit), 10 (16%) a Bjork Fontan and 2 (3%) a Kawashima procedure. At baseline 40 (66%) patients were in NYHA class II or III, 7 (11%) had a moderate or severely impaired ventricular function and 12 (20%) had at least moderate SSAV regurgitation. At baseline, 35 (57.4%) patients had experienced at least one arrhythmia, 7 (11.4%) patients had a history of atrial thrombosis or thromboembolic events and 2 (3.3%) of PLE. At a median follow-up of 6.4 [2.9–11.3] years, 11 (18%) patients died, 7 of chronic HF, 1 hepatic carcinoma, 1 sepsis, 1 pulmonary embolism, 1 malignancy (1 cause unknown). During follow-up, 28 (46%) patients had a new episode of atrial arrhythmia, 23 (38%) developed FLD and 2 (3.3%) PLE. 9 (15%) required at least one admission for HF. 2 (3.3%) patients experienced worsening of their ventricular function and 7 (11.4%) of their SAVV regurgitation. On univariable analysis, a baseline diagnosis of PLE (HR 15.23, 95% CI:2.77–83.86, p=0.002), HF (HR 6.18, 95% CI:1.74–21.99, p=0.005), atrial arrhythmia (HR 4.99, 95% CI:1.07–23.21, p=0.04), lower serum albumin (HR 1.14, 95% CI:1.06–1.23, p=0.0006), lower iron levels (HR 1.31, 95% CI:1.02–1.68, p=0.04) and a higher urea (HR 1.18, 95% CI:1.04–1.34, p=0.01) were associated with death or heart transplantation. On bivariable analysis, lower serum albumin was stronger than all other univariable predictors.
Conclusions
Adult Fontan survivors are a high risk population with significant morbidity and mortality driven primarily by HF and other long-term complications of the Fontan operation. The predictors of outcome in this cohort reflects the chronic low cardiac output state and systemic venous hypertension. Vigilance is required to identify patients who may benefit of haemodynamic optimization and close monitoring for Fontan-related complications.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Gribaudo
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - A Constantine
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - G Costola
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - A Kempny
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - M Gatzoulis
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - I Rafiq
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton and Harefield Hospital, London, United Kingdom
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20
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Dos Santos F, Baris L, Varley A, Cornette J, Allam J, Steer P, Swan L, Gatzoulis M, Roos-Hesselink J, Johnson MR. Mechanical heart valves and pregnancy: Issues surrounding anticoagulation. Experience from two obstetric cardiac centres. Obstet Med 2020; 14:95-101. [PMID: 34394718 DOI: 10.1177/1753495x20924937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Pregnant women with mechanical heart valves are at significant risk of obstetric/cardiac complications. This study compares the anticoagulation management in two obstetric cardiac centres. Methods Retrospective case-note review from Chelsea and Westminster/Royal Brompton Hospitals (CR) and Erasmus Medical Centre (EMC). Main outcome measure was mechanical heart valve thrombosis. Results Nineteen pregnancies from CR and 25 pregnancies from EMC were included. Most women were on low-molecular-weight heparin (LMWH) throughout pregnancy at CR, whereas at EMC most had LMWH in the first trimester and vitamin K antagonists in subsequent trimesters. Peak anti-factor Xa were performed monthly at CR, levels 0.39-1.51 IU/mL (mean 0.82 IU/mL). Anticoagulation management peri-partum was inconsistent. Delivery was mainly by caesarean section at CR (74%) and vaginal delivery at EMC (64%). No maternal deaths and only one mechanical heart valve thrombosis at CR. Two mechanical heart valve thromboses and one maternal death at EMC. Conclusion Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.
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Affiliation(s)
- Francois Dos Santos
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Lucia Baris
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alice Varley
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Jerome Cornette
- Department of Obstetric Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joanna Allam
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
| | - Philip Steer
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Lorna Swan
- Department of Cardiology, Toronto General Hospital, Toronto, Canada
| | | | | | - Mark R Johnson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Bouchard M, Hoschtitzky A, Gatzoulis M. Diagnosis and management of congenital absence of pericardium: a case report. Eur Heart J Case Rep 2020; 3:1-5. [PMID: 31911998 PMCID: PMC6939816 DOI: 10.1093/ehjcr/ytz223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
Abstract
Background Absence of the pericardium is a rare congenital defect with an approximate incidence of <1/10 000. We review a case of complete pericardial agenesis in a symptomatic patient with gross cardiac mobility, for which pericardial reconstruction was undertaken successfully. Case summary A 24-year-old otherwise fit and well patient, with debilitating exertional chest pain was found to have complete pericardial agenesis on the left side and on the diaphragmatic surface. There was gross cardiac mobility demonstrated on cardiac magnetic resonance imaging. His pericardium was reconstructed surgically using Gore-tex® patches. There were no complications, and the patient was discharged 8 days later. Three months later at follow-up, the patient required no analgesia and has had complete resolution of his chest pains. Discussion Congenital hemi-pericardial agenesis is a very rare condition which often remains undetected due to its asymptomatic nature. It is important to consider this as a differential diagnosis of exertional chest pains. Cardiac magnetic resonance imaging remains the investigation of gold standard. There is no consensus on whether surgical intervention in symptomatic or asymptomatic patients has any prognostic value. However, we have demonstrated that by reconstructing the pericardium in a highly symptomatic patient, there has been a resolution in size of a previously dilated right ventricle and most importantly an improvement in quality of life.
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Affiliation(s)
- Melissa Bouchard
- Department of Adult Congenital Heart Disease and Surgery, The Royal Brompton Hospital, Sydney Street, Chelsea, London SW3 6NP, UK
| | - A Hoschtitzky
- Department of Adult Congenital Heart Disease and Surgery, The Royal Brompton Hospital, Sydney Street, Chelsea, London SW3 6NP, UK
| | - M Gatzoulis
- Department of Adult Congenital Heart Disease and Surgery, The Royal Brompton Hospital, Sydney Street, Chelsea, London SW3 6NP, UK
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22
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Surkova E, Segura T, Dimopoulos K, Flick C, West C, Senior R, Gatzoulis M, Li W. P1292 Prevalence and mechanisms of mitral regurgitation and its association with advanced heart failure in patients with a systemic right ventricle. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.737] [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: 11/14/2022] Open
Abstract
Abstract
Background
Although tricuspid regurgitation in patients with cardiac diseases is an established predictor of adverse outcomes, prevalence, mechanisms and clinical/prognostic value of non-systemic mitral regurgitation (MR) in patients with congenitally corrected transposition of great arteries (ccTGA) or simple transposition after Mustard or Senning procedures (TGA) are still poorly understood.
Purpose
To assess prevalence, mechanisms of MR and its association with severity of heart failure in patients with a systemic right ventricle (SRV).
Methods
From our digital echocardiographic database, we have identified all patients with a SRV who underwent echocardiography between 2014 and 2018. Severity of MR, size and function of SRV and subpulmonary LV were assessed from the latest echocardiographic studies.
Results
157 patients fulfilled inclusion criteria (89 post-Mustard/Senning, 68 ccTGA), median age 40.6 (33.1; 46.8) years, 57% male, median BNP 79.5 [38.3; 173.3] ng/l.
More than trivial MR was present in 44 (28.0%), further classified as mild, moderate and severe in 26 (16.6%), 15 (9.6%) and 3 (1.9%), respectively.
Principal mechanisms of MR included (i) device lead interference with the leaflet(s) in 26, (ii) organic pathology of mitral valve in 5 (2 prolapse, 2 cleft and 1 parachute mitral valve) and (iii) systolic leaflet(s) tethering ± annular dilatation in 4; no obvious cause of MR was identified in 10 patients.
Presence of more than trivial MR was significantly associated with NYHA class 3-4 (Chi-square 25.74, p < 0.0001). Patients with MR also had higher BNP levels, larger LV with poorer systolic function and were more likely to have pulmonary stenosis (Table).
MR was less common in patients post-Mustard/Senning procedures compared to ccTGA (p < 0.0001, Table); however, patients from the former group were more likely to have severe heart failure (Figure).
Conclusions
Non-systemic MR in patients with a SRV is relatively uncommon, but when present is associated with LV dilatation and systolic dysfunction, raised BNP levels, and heart failure symptoms. Predominant underlying mechanisms were device leads, organic pathology, and valve tethering. MR should be routinely assessed in SRV patients, particularly those with previous Mustard/Senning procedures, and be taken into account in decision making and timing interventions.
Characteristics of 157 patients with SRV Parameter No/trivial MR (N = 113) Mild-severe MR (N = 44) P value Age, years Mustard/Senning ccTGA Pulmonary stenosis NYHA class 3-4 ICD/Pacemaker lead 39.5 (33.1; 45.7) 75 (66%) 38 (34%) 13 (12%) 7 (6%) 31 (27%) 44.4 (32.7; 52) 14 (32%) 30 (68%) 12 (27%) 17 (39%) 32 (73%) 0.105 <0.0001 <0.0001 0.022 <0.0001 <0.0001 LV EDDi, cm/m2 LV FAC, % MAPSE, mm SRV EDAi, cm2/m² TAPSE, mm 2.11 (1.9; 2.45) 48 (42; 52.5) 18 (14; 22) 17.6 (15.0; 20.2) 12 (9; 15) 2.5 (2.0; 2.9) 40 (34; 48.8) 14.6 (11.5; 16.5) 17.5 (14.4; 22.2) 10.5 (9; 13) 0.0007 0.0011 0.0005 0.754 0.435 BNP 68 (35.3; 104.3) 177 (62.5; 345.3) <0.0001 Values are reported as median (25th; 75th percentile) or n(%)
Abstract P1292 Figure. SRV patients with more than trivial MR
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Affiliation(s)
- E Surkova
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - T Segura
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - K Dimopoulos
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Flick
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C West
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Senior
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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23
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Surkova E, Segura T, Dimopoulos K, Flick C, West C, Senior R, Gatzoulis M, Li W. P679 Subpulmonary left ventricular dysfunction is associated with severity of heart failure in patients with systemic right ventricle. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.357] [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: 11/14/2022] Open
Abstract
Abstract
Background
Dysfunction of systemic right ventricle (SRV) in patients with congenitally corrected transposition of great arteries (ccTGA) or simple transposition (TGA) is commonly associated with exercise intolerance, heart failure and death. However, the relevance of subpulmonary left ventricular (LV) function in these settings is unknown.
Purpose
To examine the relation between severity of heart failure and echocardiographic parameters of subpulmonary LV size and function in patients with SRV.
Methods
We identified all patients with SRV from our digital echocardiographic database between 2014 and 2018. The size and function of SRV and subpulmonary LV were assessed in the most recent examination. Clinical data were collected from electronic patient records.
Results
We included 157 patients with SRV, median age 40.6 [33.1; 46.8] years, 57% male. 133 (85%) patients had NYHA functional class 1-2 and 24 (15%) NYHA class 3-4.
Patients with NYHA class 3-4 were older, had larger SRV and subpulmonary LV with poorer function and higher BNP level (Table, Figure A).
LV fractional area change (FAC) had higher sensitivity and specificity in differentiation of patients with severe heart failure than SRV FAC (Figurel B) with LV FAC cut-off value <39.2% showing the highest accuracy in prediction of NYHA class 3-4 (Se 83% and Sp 88%) and 86% Sp in predicting BNP > 100 ng/l.
LV end-diastolic diameter and area, MAPSE and FAC significantly correlated with BNP level (p < 0.0001; p = 0.001; p = 0.007; and p = 0.0002, respectively).
In Multivariate Cox regression analysis LV FAC and RV FAC were the only independent associates of NYHA class 3-4 (HR 0.69 [95%CI 0.55-0.86], p = 0.001 and HR 0.71 [95%CI 0.55-0.93], p = 0.012, respectively), while age, degree of tricuspid regurgitation and BNP were not.
Conclusions
Subpulmonary LV dysfunction is strongly associated with NYHA class 3-4 heart failure in patients with SRV. LV FAC is more accurate than SRV FAC in predicting heart failure symptoms. Subpulmonary LV should be accurately assessed in all SRV patients and be taken into account in clinical decision making and timing for interventions.
Characteristics of 157 patients with SRV Parameter NYHA Class 1-2 (N = 133) NYHA Class 3-4 (N = 24) P value Age, years 39.1 (31.9; 45.7) 46.5 (43.9; 58.1) <0.0001 RV EDAi, cm2/m2 17.4 (15.2; 20.1) 21.8 (17.5; 25.6) 0.0002 RV FAC, % 29.5 (23; 35) 22 (20; 27) <0.0001 LV EDAi, cm2/m2 12.0 (10.1; 14.1) 16.4 (11.6; 19.1) 0.0008 Reduced LV function by eyeballing 3 (2%) 18 (75%) <0.0001 BNP, ng/l 66 (35; 109) 356 (196; 512) <0.0001 Data presented as median (25th; 75th percentiles)
Abstract P679 Figure.
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Affiliation(s)
- E Surkova
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - T Segura
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - K Dimopoulos
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Flick
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C West
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Senior
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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24
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Fusco F, Castro M, Rigby M, Shore D, Scognamiglio G, Gatzoulis M, Li W. P1598 Ruptured Sinus of Valsalva: clinical and echocardiographic features at presentation and long-term results after surgical and percutaneous repair. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1016] [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
Rupture of Sinus of Valsalva (rSOV) is a rare and potentially life-threatening condition often misdiagnosed. Percutaneous device closure has been replacing surgical repair as a treatment of choice. However, long-term outcome is poorly documented.
Methods
Echo database (2001-2019) was searched for patients >16y with rSOV. Clinical data were collected from ACHD database. Marfan Syndrome patients were excluded.
Results
Fifteen patients (42.2y, 10M) were diagnosed with rSOVbetween 1979 and 2019. HF symptoms at initial presentation were reported in 50%. All cases were diagnosed by TTE with finding of high velocity continuous flow from SOV to right heart. Two were initially misdiagnosed as VSD. Digital imaging recordings of 10/15 were available. The aortic root was dilated in 8/10. Four had asymmetrical SOV dilatation. LV and LA were dilated in 7/10 and 9/10. Significant aortic regurgitation was in 4. Two had RVOTO. RVSP was always raised. Echo findings are summarised in the Table.
Mean FU after repair was 10,7y (0,9-39). Ten patients had surgical repair and 5 device closure. Seven had repair of concomitant lesions (4 VSD closure and 3 AVR) at the time of the procedure. One redo device closure was performed. During FU 1 died from Cardiomyopathy. At the latest FU significant improvement in functional class, LV and LA size and RVSP was found.
Conclusion
Patients with rSOV may present with acute HF. High velocity continuous flow from SOV to right heart on TTE is characteristic feature for diagnosis. Percutaneous closure is an attractive alternative to surgery in patients with isolated lesion. Significant haemodynamic improvement can be achieved with good long-term haemodynamic results
Tot = 15 Initial findings Latest FU NYHA class 4 class I 2 class II 2 class III 4 class IV 3 unknown 11 class I 2 class II 1 class III 0 class IV* SOV (mm) 38.2 (33-44) STJ (mm) 36.2 (26-42 Asc Ao (mm) 30.3 (25-34) rupture site 8 RC sinus, 2 NC sinus Shunt to 8 RVOT, 1 RA, 1 RVOT + RA LVEDV (ml) 169.7 (114-330) 120 (67-230)* LVESV (ml) 66(42-130) 46 (28-80)* LAVi (ml/m2) 53.1 (30-129) 35 (24-53)* LV EF% 61.2 (57-65) 60.4 (50-70) RVSP (mmHg) 53.2 (37-130) 24.06 (15-32)** Pre VS post procedure p-value: * P < 0,05 **P < 0,01
Abstract P1598 Figure. PLAX in patient with ruptured RC sinus
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Affiliation(s)
- F Fusco
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Castro
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Rigby
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Shore
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | | | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Kavouras C, Dimopoulos K, La Leggia A, Barracano R, Brida M, Cazzoli I, Gatzoulis M, Li W. P1446 Correlation of B-Type natriuretic peptide with LV and RV function assessed by echocardiography in adults congenital heart diseases patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.874] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Brain natriuretic peptide (BNP) is a well-established marker for heart failure in the general population however limited data are available on the value of BNP as a diagnostic and prognostic marker in adults with congenital heart disease (ACHD). The purpose of our study is to evaluate the relation between BNP levels and biventricular systolic and diastolic function in patients with ACHD.
Methods
We evaluated clinically stable ACHD patients who underwent echocardiography from May 2015 until January 2018. We studied the correlation of BNP with the degree of systolic and diastolic dysfunction of the left ventricle. Moreover we also investigate the relation of BNP with the right tricuspid annular plane systolic excursion (TAPSE), the fractional area change (FAC) and the pulmonary arterial systolic pressure (PASP).
Results
In total, 385 patients were included in our study (median age, 43 ±12 years; 61% male). Of the 385 patients, 193 (50%) had tetralogy of Fallot, 94 (24%) had systemic RV, including patients with transposition of the great arteries (TGA) after atrial switch operation (Mustard or Senning) and congenitally corrected TGA -ccTGA , 43 (11%) had univentricular hearts and Fontan physiology, 55 (14%) had other lesions. BNP levels were 66 ± 26 pg/mL and 93, ±31pg/mL, for patients with EF > 50% and 50%> EF >35% respectively (p = 0.003). BNP levels correlate with parameters reflecting LV filling pressure, including transmitral early diastolic velocity (E) 81 ± 29pg/mL and its ratio to early diastolic annular myocardial tissue velocity (E/Ea) 77 ± 17pg/mL. (r=-0.607, p = 0.003 r=-0.598, p = 0.005, respectively) BNP levels were also significantly higher in patients with impaired tricuspid annular plane systolic excursion 87 ± 21 pg/mL (TAPSE < 14mm; p = 0.002) and decreased RV FAC 81 ± 18 pg/mL (FAC <35% P= 0.004) and in patients with PASP≥35 mmHg (p = 0.003). The ROC curve and logistic regression analysis spotted the role of BNP in identifying systolic and diastolic dysfunction patterns in ACHD patients. Conclusion: In clinical stable ACHD patiens BNP levels correlate well with LV systolic dysfunction as well as with impaired diastolic function. Furthermore patients with impaired RV function and increased PASP have raised BNP levels. Therefore monitoring BNP levels plays an important role in management of clinical stable ACHD patients
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Affiliation(s)
- C Kavouras
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - K Dimopoulos
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A La Leggia
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Barracano
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Brida
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - I Cazzoli
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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26
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Ghonim S, Gatehouse PD, Giblin G, Keegan J, Smith GC, Mathews GC, Jenkins S, Alpendurada F, Dimopoulos K, Pennell DJ, Li W, Moon JC, Gatzoulis M, Babu-Narayan S. 277Can RV optimised native T1 mapping and ECV add clinical value in repaired tetralogy of Fallot? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez121.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Ghonim
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - P D Gatehouse
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - G Giblin
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J Keegan
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - G C Smith
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - G C Mathews
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Jenkins
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - F Alpendurada
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - K Dimopoulos
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - D J Pennell
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - S Babu-Narayan
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
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27
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Meras P, Barradas-Pires A, Gatzoulis M. Psychosocial sphere of congenital heart disease patients and the costs of forgetting about it. Int J Cardiol 2019; 276:112-113. [DOI: 10.1016/j.ijcard.2018.10.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022]
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28
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Ahmed R, Dimopoulos K, Alonso R, Swan L, Li W, Gatzoulis M, Kempny A. 2380Survival prospects and surgical outcomes in 1792 patients with Ebstein's anomaly. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Ahmed
- Royal Brompton Hospital, Adult Congenital Heart Disease, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton Hospital, Adult Congenital Heart Disease, London, United Kingdom
| | - R Alonso
- Royal Brompton Hospital, Adult Congenital Heart Disease, London, United Kingdom
| | - L Swan
- Royal Brompton Hospital, Adult Congenital Heart Disease, London, United Kingdom
| | - W Li
- Royal Brompton Hospital, Adult Congenital Heart Disease, London, United Kingdom
| | - M Gatzoulis
- Royal Brompton Hospital, Adult Congenital Heart Disease, London, United Kingdom
| | - A Kempny
- Royal Brompton Hospital, Adult Congenital Heart Disease, London, United Kingdom
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Kavouras C, Khokhar A, Dimopoulos K, La Leggia A, Barracano R, Ilagan L, Gatzoulis M, Li M. P1618Usefulness of exercise stress echocardiography in adults with congenital heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Kavouras
- Hippokration General Hospital, Athens, Greece
| | - A Khokhar
- Royal Brompton Hospital, London, United Kingdom
| | | | - A La Leggia
- Royal Brompton Hospital, London, United Kingdom
| | - R Barracano
- Royal Brompton Hospital, London, United Kingdom
| | - L Ilagan
- Royal Brompton Hospital, London, United Kingdom
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom
| | - M Li
- Royal Brompton Hospital, London, United Kingdom
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30
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Kavouras C, Li W, Dimopoulos K, Efstathiou M, Giannakoulias G, Brida M, Barracano R, Ntiloudi D, Lallegia A, Gatzoulis M. P1235Non compaction cardiomyopathy. Prevalence and relation to outcome among patients with congenital heart diseases. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Kavouras
- Hippokration General Hospital, Athens, Greece
| | - W Li
- Royal Brompton Hospital, London, United Kingdom
| | | | | | | | - M Brida
- Royal Brompton Hospital, London, United Kingdom
| | - R Barracano
- Royal Brompton Hospital, London, United Kingdom
| | - D Ntiloudi
- Ahepa University Hospital, Thessaloniki, Greece
| | - A Lallegia
- Royal Brompton Hospital, London, United Kingdom
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom
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31
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Heiberg J, Eckerström F, Rex CE, Maagaard M, Mølgaard H, Redington A, Gatzoulis M, Hjortdal VE. Heart rate variability is impaired in adults after closure of ventricular septal defect in childhood: A novel finding associated with right bundle branch block. Int J Cardiol 2018; 274:88-92. [PMID: 30454724 DOI: 10.1016/j.ijcard.2018.06.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ventricular septal defects (VSDs) generally have benign long-term prognoses, but recent studies have indicated increased pulmonary vascular resistance. A potential tool for monitoring pulmonary artery pressure is heart rate variability, and therefore, the aim of this study was to assess heart rate variability in adults with a surgically repaired or unrepaired VSD. METHODS In a long-term, follow-up study, three groups were included; VSD-patients operated in early childhood, patients with an open VSD, and controls. For each patient, 24-hour Holter monitoring was performed and heart rate variability was assessed. RESULTS In total, 30 participants with a surgically closed VSD, 30 participants with an unrepaired VSD, and 36 controls were included. In the closed VSD group, there was a higher proportion of participants, who had low sNN50 (p = 0.005) and low sNN6% (p = 0.017) than in the other two groups. Similar differences were found when sNN50 was divided into increases and decreases (p = 0.007 and p = 0.005, respectively) as well as sNN6% (p = 0.014 and p = 0.014, respectively). Lastly, there was a higher proportion of patients in the closed VSD group with low rMSSD than in the other two groups (p = 0.005). For the closed VSD group, the proportion of participants with low total sNN50 (p = 0.046) and low total sNN6% (p = 0.046) were higher among participants with a complete right bundle branch block (RBBB) than among participants with no or an incomplete RBBB. CONCLUSIONS Adults who had surgical VSD closure in early childhood had impaired heart rate variability and, particularly, participants with complete RBBB had lower heart rate variability.
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Affiliation(s)
- Johan Heiberg
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Filip Eckerström
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian E Rex
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marie Maagaard
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henning Mølgaard
- Dept. of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Vibeke E Hjortdal
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Affiliation(s)
- Matthew Cauldwell
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - Francois Dos Santos
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, London, UK
| | - Philip J Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - Lorna Swan
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, London, UK
| | - Michael Gatzoulis
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, London, UK
| | - Mark R Johnson
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
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Cauldwell M, Patel RR, Steer PJ, Swan L, Norman-Taylor J, Gatzoulis M, Johnson MR. Managing subfertility in patients with heart disease: What are the choices? Am Heart J 2017; 187:29-36. [PMID: 28454805 DOI: 10.1016/j.ahj.2017.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 08/19/2016] [Accepted: 02/08/2017] [Indexed: 11/19/2022]
Abstract
More women with heart disease are reaching reproductive age and will want to embark upon pregnancy. Furthermore, many of these women are delaying pregnancy until later in life when they may be exposed to a greater number of complications from their heart disease. A relatively high proportion of these women will pursue fertility treatment to achieve a pregnancy; consequently, the management of subfertile couples where the woman (or man) has heart disease is of growing importance. In this review, we discuss how fertility investigations and treatment can impact a women with heart disease and how some of the potential complications can be minimized or avoided. We also consider surrogacy, which is an important option when pregnancy is contraindicated.
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Affiliation(s)
- Matthew Cauldwell
- Academic Department of Obstetrics and Gynaecology, Imperial College London Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom.
| | - Roshni R Patel
- Academic Department of Obstetrics and Gynaecology, Imperial College London Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom
| | - Philip J Steer
- Academic Department of Obstetrics and Gynaecology, Imperial College London Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom
| | - Lorna Swan
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney St, London, United Kingdom
| | - Julian Norman-Taylor
- Chelsea and Westminster Assisted Conception Unit, Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom
| | - Michael Gatzoulis
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney St, London, United Kingdom
| | - Mark R Johnson
- Academic Department of Obstetrics and Gynaecology, Imperial College London Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom
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Cauldwell M, Cox M, Gatzoulis M, Nelson-Piercy C, O'Brien P, Roos-Hesselink JW, Thorne S, Walker F, Johnson MR. The management of labour in women with cardiac disease: need for more evidence? BJOG 2017; 124:1307-1309. [PMID: 28218452 DOI: 10.1111/1471-0528.14547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- M Cauldwell
- Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - M Cox
- Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - M Gatzoulis
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - P O'Brien
- University College London Hospital, London, UK
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - S Thorne
- Queen Elizabeth Hospital, Edbaston, Birmingham, UK
| | - F Walker
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - M R Johnson
- Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK
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Cauldwell M, Gatzoulis M, Steer P. Congenital heart disease and pregnancy: A contemporary approach to counselling, pre-pregnancy investigations and the impact of pregnancy on heart function. Obstet Med 2017; 10:53-57. [PMID: 28680462 DOI: 10.1177/1753495x16687905] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 10/05/2016] [Accepted: 12/04/2016] [Indexed: 12/17/2022] Open
Abstract
Cardiac disease in pregnancy is a challenging clinical problem. The number of women pursuing pregnancy and the underlying complexity of their cardiac disease is increasing, such that heart disease is now the leading cause of maternal mortality in developed countries. Women with congenital heart disease make up the majority of these cases and although maternal mortality is infrequent, a good outcome is only achieved though meticulous multidisciplinary care, beginning with pre-pregnancy counselling. All women with congenital heart disease should be assessed and be referred for pre-conception counselling prior to pregnancy and should receive thorough clinical assessment prior to pregnancy. In some conditions, such as pulmonary hypertension or severe/progressive aortic dilatation, pregnancy is of very high risk and women should be made aware of such risks. In such circumstances, if women choose to proceed with pregnancy, it is paramount that they are cared for by multidisciplinary teams who have experience and expertise of managing such conditions to minimise risks and optimise outcome.
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Affiliation(s)
- Matthew Cauldwell
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Michael Gatzoulis
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Philip Steer
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK
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Cauldwell M, Ghonim S, Uebing A, Swan L, Steer PJ, Gatzoulis M, Johnson MR. Preconception counseling, predicting risk and outcomes in women with mWHO 3 and 4 heart disease. Int J Cardiol 2017; 234:76-80. [PMID: 28238509 DOI: 10.1016/j.ijcard.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/21/2016] [Revised: 11/22/2016] [Accepted: 02/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE All women with CHD, especially those with more severe disease, should be offered preconception counseling (PCC), to discuss the risk of complications and to plan a future pregnancy. Several scoring system have been devised to estimate the risk of adverse events in pregnancies complicated by maternal heart disease (HD) and while comparisons have been made across the whole population, none have focused on the high-risk population. METHODS Retrospective cohort study that included women classed as modified WHO (mWHO) 3 and 4 who had a pregnancy from at least 20weeks gestation between 1994 and 2015 managed within our institution. We assessed how well the quoted risk (at PCC) of an adverse event (maternal or fetal) related to the actual rate of occurrence. We calculated NYHA and CARPREG scores for all patients, and the clinician assessment of percentage risk, to predict the occurrence of an adverse outcome. RESULTS We identified 76 mWHO 3 and 4 women who had a total of 102 pregnancies. However, only in 63 pregnancies had the woman attended PCC. Both maternal and fetal adverse events were common. NYHA did not significantly predict any adverse events, whilst a CARPREG score of >3 score predicted heart failure and mWHO4 score predicted maternal death. However, the best prediction of adverse outcomes was a composite quoted risk (percent) given at PCC. CONCLUSIONS Women must have access to PCC as those with worse CARPREG and mWHO scores encounter greater adverse events.
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Affiliation(s)
- Matthew Cauldwell
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
| | - Sarah Ghonim
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Anselm Uebing
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Lorna Swan
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Philip J Steer
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - Michael Gatzoulis
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Mark R Johnson
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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Lech P, Vatan A, Modas Daniel P, Tsai HR, Vidal Perez RC, Anwer S, Gorriz Magana J, Giavarini A, Katbeh A, Lo Iudice F, Hayashida A, Lembo M, Jamiel AM, Peacock K, Wong CY, Ministeri M, Woolf A, Carbone A, Ma G, Lee AF, Ripley DP, Karabag T, Arslan C, Yakisan T, Sak D, Galrinho A, Ramos R, Aguiar Rosa S, Viveiros Monteiro A, Branco LM, Morais L, Rodrigues I, Figueiredo L, Ferreira RC, Lin CC, Wu HY, Chen TY, Tsai WC, Castineiras Busto M, Pena Gil C, Trillo Nouche R, Lopez Otero D, Bandin Dieguez MA, Martinez Monzonis A, Gonzalez-Juanatey JR, Atef M, Hassan N, Aboulfotouh Y, Moharem-Elgamal S, Katta A, Seleem M, Meshaal M, Lopez Pais J, Monjas Garcia S, Mata Caballero R, Molina Blazquez L, Alcon Duran B, Alcocer Ayuga M, Fraile Sanz A, Saavedra Falero J, Alonso Martin JJ, Barosi A, Vanelli P, Cerchiello M, Islas Ramirez F, De Agustin A, Marcos Alberca P, Nombela L, Jimenez P, Fernandez Ortiz A, Luis Rodrigo J, Perez De Isla L, Macaya C, Petitto M, Schiano Lomoriello V, Imbriaco M, Trimarco B, Galderisi M, Kagiyama N, Hirohata AH, Yamamoto K, Yoshida K, Santoro C, Esposito R, Gerardi D, Sellitto V, Trimarco B, Galderisi M, Ahmed AM, Alharbi AS, Savis A, Bellsham-Revell H, Salih C, Simpson JM, Uebing U, Gatzoulis M, Li WL, Jaber W, Salerno G, Rea G, D'andrea A, Di Maio M, Limongelli G, Muto M, Pacileo G. Clinical Case Poster session 1P501The incremental value of advanced cardiovascular multi-modality imaging in the investigation of a cardiac massP502Metastatic adenocarsinoma involving the right ventricle and pulmonary artery leading right heart failureP503A malignant cause of angina in hypertrophic cardiomyopathyP504Dyspnea in a severe mitral stenotic gentleman with hypereosinophiliaP505After transcatheter aortic valve implantation be aware of infections, a case of fistulization from left ventricular outflow track to left atriumP506Myocardial infarction masking infective endocarditisP507Subendocardial abscess by contiguity of a valvular vegetationP508Real-time three-dimensional transesophageal echocardiography as compared to in vivo anatomy in a case of Candida parapsilosis native mitral valve endocarditisP509TAVI in prosthetic heart valve failure : echocardiography guided transcatether percuntaneous valve in valve implantation (VIV) for failed TAVI corevalve bioprosthesisP510Functional-anatomic matching between longitudinal strain pattern and late gadolinium enhancement of cardiac amyloidosis at presentationP511Heart failure due to masked systolic atrial contraction detected by pulmonary venous flow in a patient with ventricular pacingP512The detection of early left ventricular dysfunction by global longitudinal strain is helpful to keep in adjuvant therapy breast cancer patients till completionP513Forgotten cause of known disease: pulmonary hypertension caused by schistosomiasisP515Single coronary origin delineation by echocardiography alone in a patient with tetralogy of fallot changing the surgical planP516A rare complication after multiple valve repairP517Unusual cause of cyanosis in a young adult with cavopulmonary connectionsP518Abnormal flow in the main pulmonary artery in adult patients: a tale of 2 shuntsP519Unexpected TEE finding: mediastinal lipomatosis can fake an aortic intramural haematoma. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew247] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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Cauldwell M, Von Klemperer K, Uebing A, Swan L, Steer PJ, Gatzoulis M, Johnson MR. Why is post-partum haemorrhage more common in women with congenital heart disease? Int J Cardiol 2016; 218:285-290. [DOI: 10.1016/j.ijcard.2016.05.068] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/12/2016] [Indexed: 11/26/2022]
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Affiliation(s)
- Matthew Cauldwell
- Academic Department of Obstetrics and Gynaecology, Imperial College London, London SW10 9NH, UK
| | - Philip J Steer
- Academic Department of Obstetrics and Gynaecology, Imperial College London, London SW10 9NH, UK
| | - Mark Johnson
- Academic Department of Obstetrics and Gynaecology, Imperial College London, London SW10 9NH, UK
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Ross HJ, Law Y, Book WM, Broberg CS, Burchill L, Cecchin F, Chen JM, Delgado D, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Martin CM, Murphy AM, Singh G, Spray TL, Stout KK. Transplantation and Mechanical Circulatory Support in Congenital Heart Disease. Circulation 2016; 133:802-20. [DOI: 10.1161/cir.0000000000000353] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Stout KK, Broberg CS, Book WM, Cecchin F, Chen JM, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Law Y, Martin CM, Murphy AM, Ross HJ, Singh G, Spray TL. Chronic Heart Failure in Congenital Heart Disease. Circulation 2016; 133:770-801. [DOI: 10.1161/cir.0000000000000352] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Cordina R, Bellsham-Revell H, Melero Ferrer J, Perez V, Pietrzak R, Cruz C, Cruz C, Ladouceur M, Von Klemperer K, Kempny A, Senior R, Celermajer DS, Babu-Narayan S, Gatzoulis M, Li W, Peacock K, Pushparajah K, Miller OI, Simpson JM, Rueda Soriano J, Osa Saez A, Calvillo Batlles P, Buendia Fuentes F, Flors L, Rodriguez Serrano M, Andres Lahuerta A, Marti Bonmati L, Martinez Dolz L, Paolino A, Pavon A, Hussain T, Velasco MN, Werner B, Pinho T, Madureira AJ, Lebreiro A, Dias CC, Ramos I, Silva Cardoso J, Julia Maciel M, Pinho T, Madureira AJ, Lebreiro A, Dias CC, Ramos I, Silva Cardoso J, Julia Maciel M, Kachenoura N, Soulat G, Baron S, Nivet V, Maruani G, Paul JL, Blanchard A, Iserin L, Mousseaux E. Rapid Fire Abstract session: assessing the single ventricule and new techniques for assessing tetralogy477Echocardiographic assessment of ventricular function and predictors of mortality in adults with a Fontan circulation478The left pulmonary artery doppler in the assessment of atrial restriction after the hybrid procedure for hypoplastic left heart syndrome479Magnetic resonance imaging in patients with Fontan physiology detects a high prevalence of liver lesions480NT-proBNP as marker of right ventricular dilatation and pulmonary regurgitation after surgical correction of tetralogy of fallot481Right ventricular postsystolic shortening is associated with diastolic dysfunction in children after tetralogy of fallot repair.482Multimodality assessment of the ascending aorta after tetralogy of Fallot repair483Is there an arterial-ventricular coupling in tetralogy of Fallot?484Diastolic dysfunction is related to myocardial remodeling of the systemic right ventricle and neurohormonal activation in adults with transposition of the great arteries palliated by atrial switch. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev255] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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Müller J, Hager A, Diller GP, Derrick G, Buys R, Dubowy KO, Takken T, Orwat S, Inuzuka R, Vanhees L, Gatzoulis M, Giardini A. Peak oxygen uptake, ventilatory efficiency and QRS-duration predict event free survival in patients late after surgical repair of tetralogy of Fallot. Int J Cardiol 2015; 196:158-64. [DOI: 10.1016/j.ijcard.2015.05.174] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 12/16/2022]
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Toumpourleka M, Belitsis G, Alonso R, Rubens M, Moat N, Gatzoulis M. Late presentation and surgical repair of ALCAPA. Int J Cardiol 2015; 186:207-9. [DOI: 10.1016/j.ijcard.2015.03.202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/17/2015] [Indexed: 11/26/2022]
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Mills R, Alam MH, Alonso-Gonzalez R, Rubens MB, Gatzoulis M. A case of malignant aortic calcification in congenital heart disease and rheumatoid arthritis. Int J Cardiol 2015; 186:152-3. [PMID: 25828107 DOI: 10.1016/j.ijcard.2015.03.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/16/2015] [Indexed: 12/01/2022]
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Garfield B, Parfitt L, Harries C, Dimopoulos K, Gatzoulis M, Kemp P, Polkey M, Wort S. S144 Quality Of Life In Idiopathic Pulmonary Arterial Hypertension Is Associated With Quadriceps Function And Size. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Orton CM, Norrington K, Alam H, Alonso-Gonzalez R, Gatzoulis M. The danger of wearing your heart on your sleeve. Int J Cardiol 2014; 175:e6-7. [DOI: 10.1016/j.ijcard.2014.04.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
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Affiliation(s)
- Olivier Ghez
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Sonya V Babu-Narayan
- Royal Brompton and Harefield NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College London, London, UK NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London
| | - Michael Gatzoulis
- Royal Brompton and Harefield NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College London, London, UK NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London
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Shiina Y, Babu-Narayan S, Niwa K, Rydman R, Li W, Karonis T, Papaioannou V, Tutarel O, Kempny A, Diller GP, Kilner P, Uemura H, Gatzoulis M. LEFT VENTRICULAR DYSFUNCTION HAS AN ADDITIONAL NEGATIVE IMPACT ON CARDIAC OUTCOMES IN ADULTS WITH EBSTEIN'S ANOMALY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bartczak A, Plaskota K, Trojnarska O, Szczepaniak-Chichel L, Popiel M, Grajek S, Eindhoven JA, Van Den Bosch A, Ruys T, Opic P, Cuypers J, Mc Ghie - Vletter J, Witsenburg M, Boersma H, Roos-Hesselink J, Carro A, Sanz M, Galuppo V, Maldonado G, Santos A, Miranda B, Huguet F, Gonzalez N, Abad C, Evangelista A, Eindhoven JA, Van Den Bosch A, Menting M, Cuypers J, Witsenburg M, Vletter- Mcghie J, Ruys P, Boermsa H, Roos-Hesselink J, Dragulescu A, Mroczek D, Chaturvedi R, Benson L, Friedberg M, Mertens L, Nastase O, Enache R, Popescu B, Botezatu D, Aschie D, State S, Rosca M, Calin A, Beladan C, Ginghina C, Huang F, Zhong L, Tan J, Le T, Tan R, Pietrzak R, Werner B, Scognamiglio G, Karonis T, Gatzoulis M, Babu-Narayan S, Li W, Gonzalez-Gonzalez A, Alonso-Gonzalez R, West C, Senior R, Li W. Moderated Posters session * Congenital heart disease: 12/12/2013, 14:00-18:00 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet209] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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