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Two case reports of right atrial aneurysm.

Medicine (Baltimore). 2020 Apr;99(16):e19748

Authors: Li HP, Ye XW, Wang HT

INTRODUCTION: Right atrial aneurysm (RAA) is a rare congenital heart disease (CHD) that usually shows no symptom and is discovered occasionally. This paper introduces the clinical and imaging data obtained in 2 RAA patients and presents a related literature review with the aim of increasing understanding of this disease.
PATIENT FOCUS: One case showed chest distress, while the other showed symptoms on physical examination and positive signs.
DIAGNOSIS: Both of these 2 cases were diagnosed with RAA based on ultrasonography, computed tomography angiography (CTA), and enhanced magnetic resonance imaging (MRI) examinations.
INTERVENTIONS: One patient was orally administered warfarin anticoagulant therapy, while the other was given amiodarone to control arrhythmia as well as warfarin anticoagulant therapy.
RESULTS: The clinical symptoms of both cases were not aggravated.
CONCLUSIONS: RAA is a rare cardiac anomaly that can induce severe complications, and it is mainly diagnosed based on imaging examinations. Conservative treatment and regular imaging monitoring are recommended for asymptomatic patients with no high-risk factors, while surgical treatment should be performed in symptomatic patients with high-risk factors.

PMID: 32311971 [PubMed - indexed for MEDLINE]

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Risk factors associated with the development of double-inlet ventricle congenital heart disease.

Birth Defects Res. 2019 07 01;111(11):640-648

Authors: Paige SL, Yang W, Priest JR, Botto LD, Shaw GM, Collins RT, National Birth Defects Prevention Study

BACKGROUND: Congenital heart disease (CHD) is the most common birth defect group and a significant contributor to neonatal and infant death. CHD with single ventricle anatomy, including hypoplastic left heart syndrome (HLHS), tricuspid atresia (TA), and various double-inlet ventricle (DIV) malformations, is the most complex with the highest mortality. Prenatal risk factors associated with HLHS have been studied, but such data for DIV are lacking.
METHODS: We analyzed DIV cases and nonmalformed controls in the National Birth Defects Prevention Study, a case-control, multicenter population-based study of birth defects. Random forest analysis identified potential predictor variables for DIV, which were included in multivariable models to estimate effect magnitude and directionality.
RESULTS: Random forest analysis identified pre-pregnancy diabetes, history of maternal insulin use, maternal total lipid intake, paternal race, and intake of several foods and nutrients as potential predictors of DIV. Logistic regression confirmed pre-pregnancy diabetes, maternal insulin use, and paternal race as risk factors for having a child with DIV. Additionally, higher maternal total fat intake was associated with a reduced risk.
CONCLUSIONS: Maternal pre-pregnancy diabetes and history of insulin use were associated with an increased risk of having an infant with DIV, while maternal lipid intake had an inverse association. These novel data provide multiple metabolic pathways for investigation to identify better the developmental etiologies of DIV and suggest that public health interventions targeting diabetes prevention and management in women of childbearing age could reduce CHD risk.

PMID: 30920163 [PubMed - indexed for MEDLINE]

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Trend and risk factors of recurrence and complications after arrhythmias radiofrequency catheter ablation: a nation-wide observational study in Taiwan.

BMJ Open. 2019 05 30;9(5):e023487

Authors: Lin Y, Wu HK, Wang TH, Chen TH, Lin YS

OBJECTIVES: This study determined the recurrence and complication rates after radiofrequency catheter ablation (RFCA) for those with paroxysmal supraventricular tachycardia (PSVT), Wolff-Parkinson-White syndrome (WPW), atrial flutter (AFL), atrial fibrillation (AF) and ventricular tachycardia (VT).
STUDY DESIGN AND SETTING: This retrospective study included RFCAs for 2001-2010 in the Taiwan National Health Insurance Research Database. Primary outcomes included perioperative complications (pericardial effusion and new-onset stroke), RFCA recurrence and long-term outcomes (high-grade atrioventricular block (AVB) and pacemaker implantation).
RESULTS: Of 19,475 patients who underwent RFCA, prevalence rates were 56.7% for PSVT, 13.5% for WPW, 9.5% for AFL, 5.1% for AF and 2.7% for VT. Prevalence rates increased in AF, AFL and VT over the study years. During an average follow-up period of 4.3 years (SD: 2.8 years), recurrence rates for PSVT, WPW, VT, AFL and AF were 2.0%, 4.9%, 5.7%, 5.8% and 16.1%, respectively. Compared with the PSVT group, the WPW and AF groups had significantly higher risk of pericardial effusion during admission (adjusted OR (aOR) 2.98, 95% CI (CI) 1.24 to 7.15; aOR 4.09, 95% CI 1.90 to 8.79, respectively); the AFL group had a higher risk of new-onset stroke during admission (aOR 4.07, 95% CI 1.39 to 11.91); the WPW group had a lower risk of high-grade AVB during follow-up (adjusted HR (aHR) 0.37, 95% CI 0.19 to 0.71) while the AFL group had a greater risk (aHR 1.74, 95% CI 1.17 to 2.60); and the AFL group had a higher risk of permanent pacemaker (aHR 2.14, 95% CI 1.27 to 3.62).
CONCLUSIONS: The RFCA rate increased rapidly during 2001-2010 for AF, AFL and VT. Recurrence was associated with congenital heart disease in PSVT and WPW, and with age in AF and AFL. AFL had a higher risk of permanent pacemaker implantation and new stroke. AF had a higher risk of life-threatening pericardial effusion.

PMID: 31152025 [PubMed - indexed for MEDLINE]

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Spontaneous Closure of Perimembranous Ventricular Septal Defects: A Janus-Faced Condition.

CASE (Phila). 2020 Apr;4(2):103-105

Authors: Bride P, Kaestner M, Radermacher M, Vitanova K, von Scheidt F, Scharnbeck D, Apitz C

PMID: 32337401 [PubMed]

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Permanent left bundle branch area pacing in a child with a third-degree atrioventricular block: A case report.

J Cardiovasc Electrophysiol. 2020 Apr 26;:

Authors: Huang J, Zhou R, Pan Y, Yang B

Permanent left bundle branch area pacing (LBBP) is a promising physiological pacing technique that has emerged in recent years. However, LBBP is almost exclusively clinically applied in adult patients. The feasibility and safety of the use of LBBP in children has not been well-assessed. Here, we report the case of a 6-year-old child with a third-degree atrioventricular block after surgical aortic valve replacement who successfully received a permanent LBBP. This article is protected by copyright. All rights reserved.

PMID: 32337777 [PubMed - as supplied by publisher]

A Case Series Describing Percutaneous Management of Aortic Isthmic Atresia.

Vasc Endovascular Surg. 2020 Apr 26;:1538574420921280

Authors: Menon PJ, Walsh K

Aortic isthmic atresia is a severe form of aortic coarctation where there is loss of luminal communication at the aortic isthmus. The primary approach for correcting aortic isthmic atresia has been surgical repair of the coarctation. A small number of case series have shown that percutaneous correction of aortic isthmic atresia is possible. We describe 3 cases of aortic isthmic atresia that was successfully treated using a percutaneous approach. Our cases ranged in age between 42 and 51 years, and they all had hypertension. In our case series, 2 patients were successfully treated with radiofrequency perforation and 1 patient had anterograde recanalization performed using a stiff wire. Our patients have been followed up for between 2 and 4 years post-procedure, and they continue to do well. The success of percutaneous management in this case series adds to the small but increasing amount of data available in support of endovascular management of aortic isthmic atresia in adult patients.

PMID: 32338186 [PubMed - as supplied by publisher]

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Rationale and design of CH STRONG: Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG.

Am Heart J. 2020 03;221:106-113

Authors: Farr SL, Klewer SE, Nembhard WN, Alter C, Downing KF, Andrews JG, Collins RT, Glidewell J, Benavides A, Goudie A, Riehle-Colarusso T, Overman L, Riser AP, Oster ME

Studies of outcomes among adults with congenital heart defects (CHDs) have focused on those receiving cardiac care, limiting generalizability. The Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) will assess comorbidities, health care utilization, quality of life, and social and educational outcomes from a US population-based sample of young adults living with CHD.
METHODS: Individuals with CHD born between 1980 and 1997 were identified using active, population-based birth defects surveillance systems from 3 US locations (Arkansas [AR]; Arizona [AZ]; and Atlanta, Georgia [GA]) linked to death records. Individuals with current contact information responded to mailed survey materials during 2016 to 2019. Respondents and nonrespondents were compared using χ2 tests.
RESULTS: Sites obtained contact information for 74.6% of the 9,312 eligible individuals alive at recruitment. Of those, 1,656 returned surveys, either online (18.1%) or via paper (81.9%), for a response rate of 23.9% (AR: 18.3%; AZ: 30.7%; Atlanta, GA: 28.0%; P value < .01). For 20.0% of respondents, a proxy completed the survey, with 63.9% reporting that the individual with CHD was mentally unable. Among respondents and nonrespondents, respectively, sex (female: 54.0% and 47.3%), maternal race/ethnicity (non-Hispanic white: 74.3% and 63.0%), CHD severity (severe: 33.8% and 27.9%), and noncardiac congenital anomalies (34.8% and 38.9%) differed significantly (P value < .01); birth year (1991-1997: 56.0% and 57.5%) and presence of Down syndrome (9.2% and 8.9%) did not differ.
CONCLUSIONS: CH STRONG will provide the first multisite, population-based findings on long-term outcomes among the growing population of US adults with CHD.

PMID: 31986287 [PubMed - indexed for MEDLINE]

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Deep learning in congenital heart disease imaging: hope but not haste.

Heart. 2020 Apr 27;:

Authors: Davies R, Babu-Narayan SV

PMID: 32341135 [PubMed - as supplied by publisher]

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Atrial Function and Its Role in the Non-invasive Evaluation of Diastolic Function in Congenital Heart Disease.

Pediatr Cardiol. 2020 Apr 27;:

Authors: Ta HT, Alsaied T, Steele JM, Truong VT, Mazur W, Nagueh SF, Kutty S, Tretter JT

Diastolic dysfunction has correlated with adverse outcomes in various forms of unrepaired and repaired or palliated congenital heart disease (CHD). The non-invasive assessment of diastolic function in pediatric and adult patients with CHD remains challenging. Atrial size has a pivotal role in the evaluation of diastolic function; however, a growing body of evidence supports the additional role of atrial function as a more sensitive parameter of ventricular diastolic dysfunction. While the importance of atrial function is becoming clearer in adult acquired heart disease, it remains ambiguous in those with CHD. In this review we set the stage with the current understanding of diastolic function assessment in CHD, followed by insight into atrial form and function including its non-invasive assessment, and conclude with the current knowledge of atrial function in CHD. A general pattern of decrease in reservoir and conduit function with compensatory increase followed by decompensatory decrease in contractile function seems to be the common pathway of atrial dysfunction in most forms of CHD.

PMID: 32342149 [PubMed - as supplied by publisher]

Prevalence and Prognostic Association of a Clinical Diagnosis of Depression in Adult Congenital Heart Disease: Results of the Boston Adult Congenital Heart Disease Biobank.

J Am Heart Assoc. 2020 Apr 28;:e014820

Authors: Carazo MR, Kolodziej MS, DeWitt ES, Kasparian NA, Newburger JW, Duarte VE, Singh MN, Opotowsky AR

Background In adults with acquired heart disease, depression is common and associated with adverse outcomes. Depression may also be important in adults with congenital heart disease (CHD). Methods and Results We conducted a cohort study of outpatients with CHD, aged ≥18 years, enrolled in a prospective biobank between 2012 and 2017. Clinical data were extracted from medical records. Survival analysis assessed the relationship between depression, defined by a history of clinical diagnosis of major depression, with all-cause mortality and a composite outcome of death or nonelective cardiovascular hospitalization. A total of 1146 patients were enrolled (age, 38.5±13.8 years; 49.6% women). Depression had been diagnosed in 219 (prevalence=19.1%), and these patients were more likely to have severely complex CHD (41.3% versus 33.7%; P=0.028), cyanosis (12.1% versus 5.7%; P=0.003), and worse functional class (≥II; 33.3% versus 20.4%; P<0.0001), and to be taking antidepressant medication at time of enrollment (68.5% versus 5.7%; P<0.0001). Depression was associated with biomarkers indicative of inflammation (hsCRP [high-sensitivity C-reactive protein], 1.71 [25th-75th percentile, 0.82-4.47] versus 1.10 [0.45-2.40]; P<0.0001) and heart failure (NT-proBNP [N-terminal pro-B-type natriuretic peptide], 190 [92-501] versus 111 [45-264]; P<0.0001). During follow-up of 605±547 days, 137 participants (12.0%) experienced the composite outcome, including 33 deaths (2.9%). Depression was associated with increased risk for both all-cause mortality (multivariable hazard ratio, 3.0; 95% CI, 1.4-6.4; P=0.005) and the composite outcome (multivariable hazard ratio, 1.6; 95% CI, 1.1-2.5; P=0.025), adjusting for age, sex, history of atrial arrhythmia, systolic ventricular function, CHD complexity, and corrected QT interval. Conclusions In adults with CHD, major depression is associated with impaired functional status, heart failure, systemic inflammation, and increased risk for adverse outcomes.

PMID: 32342722 [PubMed - as supplied by publisher]