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Michael A Gatzoulis - One of the best experts on this subject based on the ideXlab platform.

  • cerebrovascular accidents in adult patients with Congenital Heart Disease
    Heart, 2010
    Co-Authors: A Hoffmann, Priya Chockalingam, Olga Hajnalka Balint, A Dadashev, Konstantinos Dimopoulos, R Engel, M Schmid, Markus Schwerzmann, Michael A Gatzoulis
    Abstract:

    To investigate the prevalence and characteristics of cerebrovascular accidents (CVA) in a large population of adults with Congenital Heart Disease (CHD).

  • pulmonary vascular Disease in adults with Congenital Heart Disease
    Circulation, 2007
    Co-Authors: Gerhardpaul Diller, Michael A Gatzoulis
    Abstract:

    Pulmonary arterial hypertension of variable degree is commonly associated with adult Congenital Heart Disease. Depending on size and location of the underlying cardiac defect as well as on repair status, pulmonary arterial hypertension may present with or without reversed shunting and associated cyanosis (ie, Eisenmenger syndrome). We review available data on etiology, clinical presentation, prognosis, and management strategies of pulmonary arterial hypertension in adult patients with Congenital Heart Disease. In addition, we discuss the numerous complications associated with Eisenmenger syndrome, representing a multisystem disorder. Finally, we present general management strategies and emerging Disease-targeting therapies.

  • the right ventricle in Congenital Heart Disease
    Heart, 2006
    Co-Authors: Periklis Davlouros, Koichiro Niwa, Gary D Webb, Michael A Gatzoulis
    Abstract:

    In patients with Congenital Heart Disease the right ventricle (RV) may support the pulmonary (subpulmonary RV) or the systemic circulation (systemic RV). During the last 50 years evidence is accumulating that RV dysfunction develops in many of these patients and leads to considerable morbidity and mortality. Therefore RV function in certain groups of Congenital Heart Disease patients needs close surveillance and timely and appropriate intervention to optimise outcomes. Despite major progress being made, assessing the RV either in the subpulmonary or the systemic circulation remains challenging, often requiring a multi-imaging approach and expertise (echocardiography, magnetic resonance imaging, nuclear and occasionally invasive assessment with angiography). This review discusses the implications of volume and pressure loading of the RV in the context of Congenital Heart Disease and describes the most relevant imaging modalities for monitoring RV function.

  • adult Congenital Heart Disease education education education
    Nature Reviews Cardiology, 2006
    Co-Authors: Michael A Gatzoulis
    Abstract:

    The complexity of the anatomy and physiology with which patients with Congenital Heart Disease present in adulthood often exceed the expertise of physicians not trained specifically in Congenital Heart Disease. In this viewpoint, Michael A Gatzoulis argues that education is the key to improving care of the growing population of adults with Congenital Heart Disease.

Jeffrey A Feinstein - One of the best experts on this subject based on the ideXlab platform.

  • pulmonary hypertension associated with Congenital Heart Disease pulmonary vascular Disease the global perspective
    Chest, 2010
    Co-Authors: Ian Adatia, Shyam S Kothari, Jeffrey A Feinstein
    Abstract:

    The incidence of Congenital Heart Disease is approximately 8/1,000 live births and appears to be constant around the world. The currently accepted paradigm for the development of pulmonary vascular Disease associated with Congenital Heart Disease maintains that increased pulmonary blood flow and pressure trigger unfavorable vascular remodeling. Endothelial cell dysfunction, abnormal shear stress, circumferential wall stretch, and an imbalance in vasoactive mediators conspire to promote vasoconstriction, inflammation, thrombosis, cell proliferation, impaired apoptosis, and fibrosis. We estimate that worldwide 3 million children are at risk for the development of pulmonary vascular Disease due to Congenital Heart Disease. The majority of children at risk globally will have a reparable Heart defect, such as an isolated atrial septal or ventricular septal defect or patent ductus arteriosus. Cardiac repair in the first 2 years of life would prevent the development of Eisenmenger syndrome, the most advanced form of pulmonary vascular Disease secondary to Congenital Heart Disease. Worldwide, only a small fraction of those at risk are offered surgical repair. Thus, access to timely medical care would eliminate the vast majority of suffering, disability, and death from Eisenmenger syndrome. Globally, pulmonary vascular Disease associated with Congenital Heart Disease may be the most preventable cause of pulmonary artery hypertension and related mortality and morbidity.

Paul Khairy - One of the best experts on this subject based on the ideXlab platform.

  • thromboprophylaxis for atrial arrhythmias in Congenital Heart Disease a multicenter study
    International Journal of Cardiology, 2016
    Co-Authors: Paul Khairy, Jamil Aboulhosn, Craig S Broberg, Scott Cohen, Stephen C Cook, Annie Dore, Susan M Fernandes, Anne Fournier, Joseph Kay, Sylvie Levesque
    Abstract:

    Abstract Background There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias in Congenital Heart Disease. Methods A retrospective multicenter cohort study enrolled patients with documented sustained atrial arrhythmias and Congenital Heart Disease from 12 North American centers to quantify thromboembolic and bleeding rates associated with antiplatelet and anticoagulation therapy, and explore associated factors. A blinded committee adjudicated all qualifying arrhythmias and outcomes. Results A total of 482 patients, 45.2% female, age 32.0±18.0years, were followed for 11.3±9.4years since the qualifying arrhythmia. Antiplatelet therapy was administered to 37.8%, anticoagulation to 54.4%, and neither to 7.9%. Congenital Heart Disease complexity was simple, moderate, and severe in 18.5%, 34.4%, and 47.1%, respectively. Freedom from thromboembolic events was 84.7±2.7% at 15years, with no difference between anticoagulation versus antiplatelet therapy (P=0.97). Congenital Heart Disease complexity was independently associated with thromboembolic events, with rates of 0.00%, 0.93%, and 1.95%/year in those with simple, moderate, and severe forms (P 2 and CHA 2 DS 2 -VASc scores were not predictive of thromboembolic risk. Annualized bleeding rates with antiplatelet and anticoagulation therapy were 0.66% and 1.82% (P=0.039). In multivariable analyses, anticoagulation [hazard ratio (HR) 4.76, 95% CI (1.05–21.58), P=0.043] and HAS-BLED score [HR 3.15, 95% CI (1.02, 9.78), P=0.047] were independently associated with major bleeds. Conclusion Current management of atrial arrhythmias in Congenital Heart Disease is associated with a modest rate of thromboembolic events, which is predicted by Disease complexity but not CHADS 2 /CHA 2 DS 2 -VASc scores. HAS-BLED score is applicable to the Congenital population in predicting major bleeds.

  • diagnostic tools for arrhythmia detection in adults with Congenital Heart Disease and Heart failure
    Heart Failure Clinics, 2014
    Co-Authors: Blandine Mondesert, Anne M Dubin, Paul Khairy
    Abstract:

    Abstract As patients with Congenital Heart Disease age with increasingly complex lesions, Heart failure and arrhythmias have emerged as leading sources of morbidity and mortality. The two are intertwined, as one may herald, beget, or aggravate the other. Moreover, arrhythmias in adults with Congenital Heart Disease and Heart failure can be poorly tolerated or life threatening. There is, therefore, much interest in promptly and accurately diagnosing arrhythmias and identifying risk factors for sudden death. This article appraises current knowledge regarding diagnostic tools for arrhythmias in adults with Congenital Heart Disease and Heart failure and comments on their prognostic value where relevant.

  • electrophysiology and adult Congenital Heart Disease advances and options
    Progress in Cardiovascular Diseases, 2011
    Co-Authors: Sylvia Abadir, Paul Khairy
    Abstract:

    Although "Congenital Heart Disease" incorporates a broad and diverse spectrum of inborn cardiac disorders, one shared feature is the propensity for cardiac arrhythmias, albeit to varying degrees. The magnitude of this issue is underscored by its high prevalence, major impact on morbidity and disability, considerable consummation of healthcare resources, and loss of life at ages well below normative population values. Moreover, with changing demographics, arrhythmias increasingly afflict the aging and growing population of survivors with Congenital Heart Disease. Nevertheless, the field of cardiac electrophysiology has, auspiciously, greatly matured over the past 2 decades. The fruits of this progress are largely applicable to adults with Congenital Heart Disease. This review focuses on recent advances and emerging therapeutic options that are providing safer solutions and increasing the effectiveness with which arrhythmias may be managed in adults with Congenital Heart Disease, spanning pharmacotherapy to innovative interventions.

Christopher M Rausch - One of the best experts on this subject based on the ideXlab platform.

  • restrictive lung function in pediatric patients with structural Congenital Heart Disease
    The Journal of Thoracic and Cardiovascular Surgery, 2014
    Co-Authors: Stephen M M Hawkins, Amy L Taylor, Stefan Sillau, Max B Mitchell, Christopher M Rausch
    Abstract:

    Objectives We sought to describe the prevalence of restrictive lung function in structural Congenital Heart Disease and to determine the effect of cardiothoracic surgical intervention. Methods The data from a retrospective review of the spirometry findings from pediatric patients with structural Congenital Heart Disease were compared with the data from 220 matched controls. Restrictive lung function was defined as a forced vital capacity of 80%. Results Of the children with Congenital Heart Disease, 20% met the criteria for restrictive lung function compared with 13.2% of the controls ( P  = .03). The prevalence in those with Congenital Heart Disease without a surgical history was similar to that of the controls (odds ratio, 0.62; 95% confidence interval, 0.34-1.13). Restrictive lung function was more likely if surgical intervention had occurred within the first year of life (odds ratio, 1.96; 95% confidence interval, 1.08-3.55; P P P Conclusions Restrictive lung function was more prevalent in those with Congenital Heart Disease after cardiothoracic surgical intervention than in the controls or patients without surgical intervention. The prevalence was also greater with surgical intervention at an earlier age. The risk was equivalent when sternotomy alone was compared with thoracotomy alone but was significantly greater when both sternotomy and thoracotomy were performed. The risk increased with each additional surgery performed.

Michael J Landzberg - One of the best experts on this subject based on the ideXlab platform.

  • interventional catheterization in adult Congenital Heart Disease
    Circulation, 2007
    Co-Authors: Ignacio Inglessis, Michael J Landzberg
    Abstract:

    Improved medical and surgical therapies for children with Congenital Heart Disease have resulted in a growing population of patients reaching adulthood.1,2 Over this same time, the field of interventional cardiology has experienced significant growth, driven by technological improvements and better understanding of the mechanisms and intermediate-term results of individual procedures. Consequently, for adults with uncorrected or previously palliated Congenital Heart Disease, percutaneous therapies have increasing acceptance as reasonable additions, alternatives, and treatments of choice when further surgical or medical intervention is contemplated (Table 1). Currently, interventional cardiology of adult Congenital Heart Disease (ACHD) is a well-established field on its own and, programmatically, is a fundamental component of any center providing care for these patients.3 Although limited safety of interventional procedures for the ACHD population has been suggested in centers without ACHD global care programs,4 the wide variation in clinical presentation, novelty of cardiovascular pathologies (with similarity to as well as marked differences from both Congenital and acquired conditions), and potential for concomitant multiple organ system pathology all contribute to situations atypical for standard adult or pediatric laboratories. These concerns, combined with a desire to centralize data collection to establish outcomes assessments for ACHD patients considered for interventional catheterization, lead to the recommendation that such procedures be performed in centers with ACHD expertise and established care programs.3 View this table: TABLE 1. Commonly Practiced Catheter-Based Interventions in ACHD: Indications and Level of Evidence In this article, we review the most commonly performed percutaneous procedures in ACHD, including valvuloplasty, angioplasty, and device closures. We also include discussions concerning complex ACHD patients (Table 2) as well as future directions. View this table: TABLE 2. Potential Interventions in Complex ACHD Patients ### Pulmonary Valve Stenosis Pulmonary valve stenosis (PS) is almost always Congenital in origin and usually results from commissural fusion of thin and pliable leaflets. Less frequently, the pulmonary …

  • pediatric cardiology and adult Congenital Heart Disease
    Journal of the American College of Cardiology, 2006
    Co-Authors: Michael J Landzberg, Ross M Ungerleider
    Abstract:

    In the new Congenital Heart Disease and Pediatric Cardiology subsection, 186 abstracts were submitted to the Program Committee of the 55th Annual Scientific Session, with 60 accepted and presented during 8 abstract sessions. In addition, there were 17 structured sessions at ACC.06. Altogether, 50