Journal Watch

What are the mechanisms for FALD and how can we prevent the progression?

Int J Cardiol. 2018 Sep 22;:

Authors: Ohuchi H

PMID: 30268385 [PubMed - as supplied by publisher]

Hospitalisations for heart failure predict mortality in pulmonary hypertension related to congenital heart disease.

Heart. 2018 Sep 29;:

Authors: Ntiloudi D, Apostolopoulou S, Vasiliadis K, Frogoudaki A, Tzifa A, Ntellos C, Brili S, Manginas A, Pitsis A, Kolios M, Karvounis H, Tsioufis C, Goudevenos J, Rammos S, Giannakoulas G, CHALLENGE investigators

OBJECTIVE: Despite the progress in the management of patients with adult congenital heart disease (ACHD), a significant proportion of patients still develop pulmonary hypertension (PH). We aimed to highlight the rate of the complications in PH-ACHD and the predicting factors of cumulative mortality risk in this population.
METHODS: Data were obtained from the cohort of the national registry of ACHD in Greece from February 2012 until January 2018.
RESULTS: Overall, 65 patients receiving PH-specific therapy were included (mean age 46.1±14.4 years, 64.6% females). Heavily symptomatic (New York Heart Association (NYHA) class III/IV) were 53.8% of patients. The majority received monotherapy, while combination therapy was administered in 41.5% of patients. Cardiac arrhythmia was reported in 30.8%, endocarditis in 1.5%, stroke in 4.6%, pulmonary arterial thrombosis in 6.2%, haemoptysis in 3.1% and hospitalisation due to heart failure (HF) in 23.1%. Over a median follow-up of 3 years (range 1-6), 12 (18.5%) patients died. On univariate Cox regression analysis history of HF hospitalisation emerged as a strong predictor of mortality (HR 8.91, 95% CI 2.64 to 30.02, p<0.001), which remained significant after adjustment for age and for NYHA functional class.
CONCLUSIONS: Long-term complications are common among patients with PH-ACHD. Hospitalisations for HF predict mortality and should be considered in the risk stratification of this population.

PMID: 30269081 [PubMed - as supplied by publisher]

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Late presentation of ALCAPA syndrome in an elderly Asian lady.

Med J Malaysia. 2016 08;71(4):217-219

Authors: Yew KL, Kang Z, Anum A

Coronary artery anomalies are often discovered incidentally during cardiac catheterization or computed tomography coronary angiography and may involve the affected coronary artery origin and its course. Coronary artery anomalies are associated with congenital heart disease. The affected coronary arteries may have an unusual high take off origin, origin from contralateral or non-coronary sinus, origin from the pulmonary artery, single coronary system or coronary artery fistula.

PMID: 27770127 [PubMed - indexed for MEDLINE]

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Electronic spatiotemporal image correlation improves four-dimensional fetal echocardiography.

Ultrasound Obstet Gynecol. 2018 Mar;51(3):357-360

Authors: Guasina F, Bellussi F, Morganelli G, Salsi G, Pilu G, Simonazzi G

OBJECTIVES: To compare the efficiency of electronic spatiotemporal image correlation (eSTIC) with that of conventional STIC to acquire four-dimensional (4D) fetal cardiac volumes of diagnostic quality.
METHODS: This was a randomized controlled trial of 100 patients in mid-gestation with normal sonograms. In half of the cases, STIC volumes of the fetal heart were obtained with a conventional mechanical 4D probe and in the remaining cases eSTIC volumes were obtained with an electronic 4D probe. Examinations were kept within the timeframe allotted for a standard examination of fetal anatomy, and a maximum of two attempts were made at obtaining a 4D cardiac volume. Datasets were stored on a computer and subsequently analyzed and categorized as being of optimal, satisfactory or inadequate quality, depending on whether or not it was possible to perform an extended basic cardiac examination, including obtaining a three vessels and trachea view, as well as a clear reconstruction of both the aortic and ductal arches in the sagittal plane.
RESULTS: The eSTIC volume datasets were more frequently of optimal or satisfactory diagnostic quality compared with conventional STIC (94% vs 76%, P < 0.0001). Failure to obtain an eSTIC volume of adequate quality was in all cases the consequence of an unfavorable position of the fetus.
CONCLUSIONS: Compared with a standard mechanical probe, the electronic 4D probe facilitates acquisition of sonographic cardiac volumes in mid-trimester fetuses. In our hands, eSTIC volumes of optimal or satisfactory diagnostic quality, allowing a detailed offline evaluation of the fetal heart, were obtained in more than 90% of cases within the time frame of a standard examination of fetal anatomy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

PMID: 28337810 [PubMed - indexed for MEDLINE]

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Prenatal diagnosis of coronary artery fistula using 2D and 3D/4D ultrasound.

Ultrasound Obstet Gynecol. 2018 02;51(2):274-275

Authors: Tekesin I, Uhlemann F

PMID: 28436615 [PubMed - indexed for MEDLINE]

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Effect of known history of heart disease on survival outcomes after out-of-hospital cardiac arrests.

Emerg Med Australas. 2018 Feb;30(1):67-76

Authors: Lee MH, Fook-Chong S, Wah W, Shin SD, Nishiuchi T, Ko PC, Naroo GY, Wong KD, Tiah L, Monsomboon A, Siddiqui FJ, Ong ME, PAROS Clinical Research Network

OBJECTIVE: We aimed to investigate the effect of known heart disease on post-out-of-hospital cardiac arrest (OHCA) survival outcomes, and its association with factors influencing survival.
METHODS: This was an observational, retrospective study involving an OHCA database from seven Asian countries in 2009-2012. Heart disease was defined as a documented diagnosis of coronary artery disease or congenital heart disease. Patients with non-traumatic arrests for whom resuscitation was attempted and with known medical histories were included. Differences in demographics, arrest characteristics and survival between patients with and without known heart disease were analysed. Multivariate logistic regression was performed to identify factors influencing survival to discharge.
RESULTS: Of 19 044 eligible patients, 5687 had known heart disease. They were older (77 vs 72 years) and had more comorbidities like diabetes (40.9 vs 21.8%), hypertension (60.6 vs 36.0%) and previous stroke (15.2 vs 10.1%). However, they were not more likely to receive bystander cardiopulmonary resuscitation (P = 0.205) or automated external defibrillation (P = 0.980). On univariate analysis, known heart disease was associated with increased survival (unadjusted odds ratio 1.16, 95% confidence interval 1.03-1.30). However, on multivariate analysis, heart disease predicted poorer survival (adjusted odds ratio 0.76, 95% confidence interval 0.58-1.00). Other factors influencing survival corresponded with previous reports.
CONCLUSIONS: Known heart disease independently predicted poorer post-OHCA survival. This study may provide information to guide future prospective studies specifically looking at family education for patients with heart disease and the effect on OHCA outcomes.

PMID: 28568968 [PubMed - indexed for MEDLINE]

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Care of Preschoolers with Congenital Heart Disease by Kindergarten and Nursery Teachers in Japan.

Compr Child Adolesc Nurs. 2017 Sep;40(3):144-156

Authors: Tabata H

The purpose of this study was to elucidate the involvement of kindergarten and nursery school teachers with young children with congenital heart disease. The study was designed as a qualitative descriptive study. Interviews of kindergarten and nursery school teachers with experience in the care and education of young children with congenital heart disease were conducted, during which they described their experience. Verbatim transcripts of the interviews were prepared, and the content was categorized. The study participants were 11 kindergarten and nursery school teachers. Extracted from the content of the interviews of the study participants were 282 codes, 33 subcategories, 6 categories, and 2 major categories. In their responses, the teachers indicated that they had been "Providing care for the children while seeking ways to avoid special treatment in a group setting." In addition, they established a "Framework for school-parent cooperation in order to promptly accommodate the wishes of parents" of these children. The study showed that the kindergarten and nursery school teachers involved other pupils and monitored the condition of children with congenital heart disease to avoid special treatment of the children in the group setting. In addition, the teachers established a framework for cooperation between the school and parents. In the future, these findings will be used to create a nursing support model for the group life of young children with congenital heart disease.

PMID: 28749226 [PubMed - indexed for MEDLINE]

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Prognostic risk factors for conversion in laparoscopic cholecystectomy.

Updates Surg. 2018 Mar;70(1):67-72

Authors: Chávez KV, Márquez-González H, Aguirre I, Orellana JC

Laparoscopic cholecystectomy (LC) is the gold standard technique for the treatment of gallbladder disease. However, in some cases, conversion to open surgery is still necessary. Identification of patients with high risk of conversion is of great importance to prepare the surgical scenario and to anticipate the convalescence. The objective of this study is to identify the factors that may predict a conversion to an open procedure. A total of 1386 LC were performed in Dr. Manuel Gea González General Hospital, from January 2009 to May 2013. A retrospective analysis of 41 parameters in these patients was performed, including demographic variables, clinical history, laboratory studies, ultrasound results and intraoperative findings. Subsequently, a multivariate logistic regression analysis was used to determine the predictive variables for conversion. Fourteen patients required conversion (1%). The multivariate analysis revealed that the factor that was most associated with conversion was emergency surgery (OR 4.9, CI 95% 2.3-2.4), as well as dilatation > 6 mm of the common bile duct in ultrasound (OR 1.8, CI 95% 1.1-1.7), hepatomegaly (OR 1.3, CI 95% 0.3-4.9), diagnosis of chronic cholecystitis associated to previous biliary colics (OR 2.8, CI 95% 1.0-21) and elevated alanine aminotransaminase (OR 1.2, CI 95% 1.0-2.1). Patients with acute symptoms, with dilatation of the bile duct, cholestasis history and hepatomegaly have a higher risk of a conversion surgery. These factors may warn both the patient and the surgeon for a complex surgery and possible complications.

PMID: 28980164 [PubMed - indexed for MEDLINE]

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Constrictive Pericarditis as a Long-term Undetermined Etiology of Ascites and Edema.

Intern Med. 2018 May 15;57(10):1487-1491

Authors: Kamio T, Hiraoka E, Obunai K, Watanabe H

Constrictive pericarditis (CP) is defined as impedance to diastolic filling caused by a fibrotic pericardium. The diagnosis of CP is a clinical challenge and requires a high index of clinical suspicion. The signs and symptoms of CP include fatigue, edema, ascites, and liver dysfunction. These can be mistakenly diagnosed as primary liver disease. We present the case of a 69-year-old woman with a 7-year history of leg edema and a 2-year history of ascites who was initially diagnosed with cryptogenic liver cirrhosis and was finally diagnosed with CP.

PMID: 29321423 [PubMed - indexed for MEDLINE]

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Congenital aortic stenosis due to unicuspid unicommissural aortic valve: a case report.

J Cardiothorac Surg. 2018 Jun 07;13(1):61

Authors: Ingason AB, Sigfusson G, Torfason B

BACKGROUND: Unicuspid unicommissural aortic valve is an extremely rare congenital anomaly that usually presents in adulthood but can rarely present in infancy. We report a 17-year-old patient with congenital aortic stenosis secondary to unicuspid unicommissural aortic valve that was successfully treated with aortic valve replacement.
CASE PRESENTATION: The patient was diagnosed with aortic stenosis after a murmur was heard in the newborn nursery and subsequently underwent aortic balloon valvuloplasty 6 weeks after birth. He had been regularly followed up since and underwent numerous cardiac catheterizations, including another aortic balloon valvuloplasty at age 13. During follow-up at age 17, the patient presented with symptomatic severe aortic stenosis and mild left ventricular hypertrophy. Aortic valve replacement was planned since the patient was nearly adult-sized and to reduce the risk of cardiac decompensation. During the operation an unicuspid unicommissural aortic valve was revealed. The patient recovered well post-operatively. He was discharged 5 days after the surgery in good condition and was completely symptom-free at follow-up 6 weeks later.
CONCLUSIONS: Unicuspid aortic valve is a rare congenital anomaly that can cause congenital aortic stenosis. It is seldom diagnosed pre-operatively but should be suspected in infants presenting with aortic stenosis.

PMID: 29880056 [PubMed - indexed for MEDLINE]