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Left atrial dysfunction in elderly patients with patent foramen ovale and atrial septal aneurysm

Journal of Geriatric Cardiology 2009年第4期6卷 195-198页

作者： Gianluca Rigatelli Fabio Dell＇Avvocata Federico Ronco Massimo Giordan Paolo Cardaioli Section of adult congenital and adult heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo GeneralHospital Rovigo 45100 Italy

Objective Recently it has been suggested that, in patients with large patent foramen ovale （PFO） and atrial septal aneurysms （ASA）, a certain amount of left atrial （LA） dysfunction may be active as an alternate mechanism promoting arterial embolism. Following this hypothesis, elderly patients, being more susceptible to atrial chambers stiffness, should present a more severe LA dysfunction profile. We sought to evaluate the grade of LA dysfunction in elderly patients submitted to transcatheter PFO closure. Methods We retrospectively enrolled 28 consecutive patients with previous stroke （mean age 674-12.5 years, 18 females） referred to our centre for catheter-based PFO closure after recurrent stroke. Baseline values of LA passive and active emptying, LA conduit function, LA ejection fraction, and spontaneous echocontrast （SEC） in the LA and LA appendage were compared with those of 50 atrial fibrillation patients, as well as a sex/age/cardiac risk matched population of 70 healthy controls. Results Pre-closure elderly subjects demonstrated significantly greater reservoir function as well as passive and active emptying, with reduced conduit function and LA ejection fraction, when compared to healthy and younger patients. After closure in elderly patients, LAparameters did not return completely to the levels of healthy patients, whereas LA dysfunction in younger subjects returned normal. Conclusions This study suggests that elderly patients have more severe LA dysfunction than younger patients, which affects the LA remodelling after closure.

关键词： patent foramen ovale stroke embolism cardiac anatomy echocardiography

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Patent foramen ovale closure in over-60-years old patients with diastolic dysfunction

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Journal of Geriatric Cardiology 2008年第1期5卷 3-6页

作者： Gianluca Rigatelli Fabio Dell'Avvocata Paolo Cardaioli Massimo Giordan Gabriele Braggion Loris Roncon Section of adult congenital and Structural heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Rovigo Italy

Background Patent foramen ovale (PFO)-related stroke is a possible and not easily manageable occurrence in ≤60-years-old patients due to the presence of different comorbidities and in particular of diastolic dysfunction which is considered as a contraindication to PFO *** grade of diastolic dysfunction for which PFO closure is contraindicated and whether there are changes in diastolic dysfunction class after closure have not been investigated in deep *** We prospectively enrolled patients who were referred to our centre over a 12 months period for PFO transcatheter closure having echocardiographic demonstration of diastolic dysfunction (≤Ⅲ class diastolic dysfunction).Echocardiography was scheduled at 1,6 and 12 months in order to assess changes in haemodynamic parameters of left ventricle *** Thirteen out of 80 patients referred to our centre (16.2%,mean age 65 + 6.4 years) over a 24-month period were enrolled in the study (Table 1).Eighteen Amplatzer PFO Occluder 25 mm and one 35 mm,two Amplatzer 25/25 mm Cribriform Occluder and two 25 nun Premere Occlusion System were successfully implanted with no intraoperative *** collateral findings on ICE 8/12 patients (66.7 %) had hypertrophy of the interatrial septum (thickness of the rims ＞ 1.2 mm) probably imputable to hypertensive *** patients developed atrial fibrillation during the first month post-implantation,all successfully treated with antiarrhythmic *** a mean follow-up of 40±4.3 months left ventricle performance indices (ejection fraction and end-diastolic volume) and diastolic dysfunction parameters (E/A,deceleration time,diastolic dysfunction class) did not change *** The present study suggests that PFO transcatheter closure may be safely performed in aged patients with diastolic dysfunction class 1-2.(J Geriatr Cardio12008;5:3-6.)

关键词： patent foramen ovale elderly diastolic dysfunction transcatheter closure

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Patent foramen ovale in the elderly:what to do?

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Journal of Geriatric Cardiology 2007年第4期4卷 254-256页

作者： Gianluca Rigatelli Fabio Dell’Avvocata Section of adult congenital and Structural heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Rovigo Italy

The increase in life expectance makes the diagnosis of PFO a possible and not easily manageable event in patients > 60-years-old due to the presence of different comorbidities and in particular of diastolic dysfunction which is considered as a contraindication to PFO closure. The literature review suggests that aged patients with PFO cannot be excluded"a priori"from PFO closure that should evaluated as therapeutic options in presence of anatomical and functional indications. Moreover in the elderly many other syndromes than paradoxical stroke mediated by PFO required full assessment and, if needed, transcather PFO closure:deoxygenating in obstructive sleeping apnoea, unexplained increased dyspnoea associated with hypoxemia after lung surgery, paralysis of the hemidiaphragm, and platypnea orthodeoxia. Differently from in the young and middle age, the management of PFO in aged patients should obligatory include the careful evaluation of potential comorbidities and eventual contraindications, such as severe diastolic dysfunction due to for example to hypertensive cardiomyopathy and coronary heart disease, the main causes of diastolic dysfunction.(J Geriatr Cardiol 2007;4:254-256.)

关键词： stroke patent foramen ovale elderly transcatheter closure

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Simultaneous interventional therapy for coarctation of the aorta combined with intracristal ventricular septal defect in older age adult

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Journal of Geriatric Cardiology 2022年第6期19卷 481-484页

作者： Jian-Ming WANG Xian-Yang ZHU Jia-Wang XIAO Qi-Guang WANG Department of congenital heart disease General Hospital of Northern Theater CommandShenyangChina

Coarctation of the aorta(CoA)is an uncommon congenital cardiovascular malformation,which is rare associated with several other cardiac and vascular anomalies,such as bicuspid aortic valve,ventricular septal defect(VSD),patent ductus arteriosus and aortic arch hypoplasia.[1,2]Open surgical repair is the usual treatment for neonatal CoA,whereas balloon angioplasty and stent placement are the treatment of choice for older children and adults.[3]

关键词： ventricular septal balloon

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Past and present of cardiocirculatory assist devices: a comprehensive critical review

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Journal of Geriatric Cardiology 2012年第4期9卷 389-400页

作者： Gianluca Rigatelli Francesco Santini Giuseppe Faggian Section of adult congenital heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Viale Tre Martiri 45100 Rovigo Italy Division of Cardiac Surgery University of Verona Medical School Verona Italy

During the last 20 years, the management of heart failure has significantly improved by means of new pharmacotherapies, more timely invasive treatments and device assisted therapies. Indeed, advances in mechanical support, namely with the development of more efficient left ventricular assist devices (LVADs), and the total artificial heart have reduced mortality and morbidity in patients awaiting transplantation, so much so, that LVADs are now approved of as a strategy for destination therapy. In this review, the authors describe in detail the current basic indications, functioning modalities, main limitations of surgical LAVDs, total artificial heart development, and percutaneous assist devices, trying to clarify this complex, but fascinating topic.

关键词： Cardiac surgery Cardiocirculatory support Devices heart failure heart transplant

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Should we consider patent foramen ovale and secundum atrial septal defect as different steps of a single anatomo-clinical continuum？

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Journal of Geriatric Cardiology 2014年第3期11卷 177-179页

作者： Gianluca Rigatelli Section of adult congenital and adult heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Rovigo 45100

1 Introduction Isolated atrial septal defects （ASD） represent 7% of all cardiac anomalies and can present at any age. Adolescents and adults with simple congenital heart disease such as isolated atrial septal defects are more likely to reach adult age without being diagnosed. Secundum ASD （sASD） is by far the most common type, occurring in 1/1500 live births, with 65% to 75% involving females, On the other hand, patent foramen ovale （PFO） represents an endemic variant in the normal population with a prevalence of 25%-27%. These two entities appear so different that is difficult to fred a conjunction ring： nevertheless we use the same philosophy for the treatment, Indeed, device-based closure has been proved to be effective in both settings.

关键词： Anatomy Atrial septal defect Echocardiography Patent foramen ovale

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Multimodal Imaging with 3D-Holograms for Preoperative Planning in Pediatric Cardiac Surgery:A Unique Case Report

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congenital heart disease 2022年第4期17卷 491-494页

作者： Federica Caldaroni Massimo Chessa Alessandro Varrica Alessandro Giamberti Department of congenital Cardiac Surgery IRCCS Policlinico San DonatoSan Donato MilaneseMilanItaly ACHD Unit–Pediatric and adult congenital heart centre IRCCS Policlinico San DonatoSan Donato MilaneseMilanItaly

Multimodal imaging,including augmented or mixed reality,transforms the physicians’interaction with clinical imaging,allowing more accurate data interpretation,better spatial resolution,and depth perception of the patient’s *** successfully overlay 3D holographic visualization to magnetic resonance imaging images for preoperative decision making of a complex case of cardiac tumour in a 7-year-old girl.

关键词： Hologram augmented reality multimodal imaging 3D CHD cardiac tumour arrhythmia anatomy

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congenital Absence of Pericardium:The Largest Systematic Review in the Field on 247 Worldwide Cases(1977-Now)

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congenital heart disease 2023年第6期18卷 595-610页

作者： Pier Paolo Bassareo Aurelio Secinaro Paolo Ciliberti Massimo Chessa Marco Alfonso Perrone Kevin Patrick Walsh Colin Joseph Mcmahon Mater Misericordiae University Hospital National Adult Congenital Heart Disease ServiceDublinD07 R2WYIreland Children’s Health Ireland Crumlin DublinIreland School of Medicine University College of DublinDublinIreland Advanced Cardiovascular Imaging Unit Bambino GesùChildren’s HospitalIRCCSRomeItaly Department of Cardiac Surgery CardiologyHeart and Lung Transplantation Bambino Gesu’Children’s HospitalIRCCSRomeItaly adult congenital heart disease UNIT Paediatric and Adult Congenital Heart CentreIRCCS-Policlinico San DonatoSan Donato MilaneseMilanItaly School of Medicine Vita Salute San Raffaele UniversityMilanItaly Division of Cardiology and CardioLab Department of Clinical Sciences and Translational MedicineUniversity of Rome Tor VergataRomeItaly

Background:congenital absence of pericardium(CAP),also known as pericardial agenesis,represents an uncommon cardiac abnormality and mostly incidental *** can be subdivided into complete and partial(left or right-sided)*** of its infrequency,just case reports and a few case series have been released so *** paper represents the largest systematic review in the *** features(age at diagnosis,type,gender,clinical presentation,electrocardiography,imaging(ultrasounds,CT/MRI),concomitant cardiac defects,and outcome)were ***:The electronic database PubMed was investigated from its establishment up to July 15th,*** case reports and case series were *** studies,papers that were not in English,Spanish,and Italian,and those manuscripts not reporting at least seven of the nine analysed *** ruled *** analysed data were reported mostly in terms of ***:One hundred eighty studies were included encompassing 247 *** than half of reviewed CAP cases were in males(63.2%).The mean age at diagnosis was 31.8±19.3 years;a range of 32 weeks of gestation-81 years).23.5%of the patients did not report any *** most common clinical presentations were chest pain(35.2%)and dyspnoea(29.2%).The most commonly seen ECG changes were right axis deviation(28.7%)and right bundle branch block(23.9%).CAP was suspected or diagnosed by echocardiography in 20.1%of *** diagnosis was made by CT and/or MRI in 61.9%of *** was left-sided in 71.2%,complete in 23.1%,and right-sided in 5.7%.A concomitant congenital heart defect was found in 22.7%,especially in the form of atrial septal defect(6.5%)and patency of ductus arteriosus(2.8%).The pericardial repair was required in 12.9% of the incomplete forms of the *** did the complete form require surgical *** outcome appeared favourable in the vast majority of cases,with just 18 deaths(7.3%).Discussion:The main limitation of this syste

关键词： congenital absence pericardium pericardial agenesis electrocardiography echocardiography computed tomography cardiac magnetic resonance imaging

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Evaluation of Post-Operative Atrial Fibrillation after Cardiac Surgery for adult congenital heart disease

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congenital heart disease 2024年第5期19卷 457-472页

作者： Jonathan S.Taylor-Fishwick Nicholas Holzemer Brandon Middlemist Vivian Duarte Kaitlin E.Olson Johannes Cvon Alvensleben Megan SooHoo Amber Khanna Internal Medicine-Pediatrics Residency University of ColoradoAuroraCO 80045USA adult congenital heart disease Fellowship University of ColoradoAuroraCO 80045USA School of Medicine University of ColoradoAuroraCO 80045USA Department of Pediatrics University of ColoradoAuroraCO 80045USA Division of Pediatric Cardiology ElectrophysiologyUniversity of ColoradoAuroraCO 80045USA Division of Pediatric Cardiology University of ColoradoAuroraCO 80045USA Division of Cardiology University of ColoradoAuroraCO 80045USA

Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac *** adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is scant literature on POAF in ACHD ***:Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short-and mid-term significance of developing ***:A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of *** institutional Society of Thoracic Surgeons(STS)surgical registry was used to identify patients≥18-year-old with congenital heart disease who underwent cardiac surgery during the study ***:A total of 168 patients(48%female)were *** median age was 36 years(IQR 28–48).Onehundred and fifty patients(90%)had moderate ACHD anatomical complexity,and 10 patients(6%)had severe ACHD anatomical complexity based on initial ACHD *** occurred in 40(24%)*** age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted *** was associated with an increased length of stay(8 vs.5 days,p<0.001)and recurrence of atrial fibrillation(46%vs.21%,OR 3.35,p=0.002)but did not predict mortality,stroke,or bleeding ***:Atrial fibrillation is a common complication after cardiac surgery in the ACHD *** age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted *** investigation is needed to understand the long-term impacts of POAF.

关键词： Atrial fibrillation adult congenital heart disease cardiac surgery post-operative complications

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Selexipag as Add-on Therapy for Patients with Pulmonary Arterial Hypertension Associated with congenital heart disease:A Single-Center Retrospective Study

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congenital heart disease 2021年第3期16卷 233-244页

作者： Se Yong Jung Doyoung Jung Ah Young Kim Jae Hee Seol Jung Min Park Jo Won Jung Jae Young Choi Division of Pediatric Cardiology Congenital Heart Disease CenterSeverance Cardiovascular HospitalDepartment of PediatricsYonsei University College of MedicineSeoulKorea

Purpose:This study examined the efficacy and safety of selexipag in treating pulmonary arterial hypertension(PAH)associated with congenital heart disease(CHD).Materials and Methods:We conducted a retrospective study of patients with CHD-associated PAH,treated with selexipag since December *** adult patients(mean age,45.4 years;women,77%)were treated with selexipag as add-on *** characteristics,World Health Organization functional class,6-minute walking distance(6MWD)test results,N-terminal pro-B-type natriuretic peptide levels,echocardiographic data,and incidence of side effects were ***:The majority of patients(12/13,92.3%)experienced more than one treatment-associated complication;one patient dropped out of the study due to intolerable *** results of 6MWD test(from 299.2±56.2 m to 363.8±86.5 m,p=0.039)and tricuspid regurgitation(TR)pressure gradient(from 84.7±20.5 mmHg to 61.6±24.0 mmHg,p=0.018)improved and remained improved after selexipag treatment in 12 *** on the results of a non-invasive risk assessment,8(66.7%)patients showed improvement,3(25.0%)showed no interval change,and the status of one patient(8.3%)***,compared to patients treated with a low dosage,patients treated with a medium-to-high dosage showed a greater increase in 6MWD results(88.3±26.4 m vs.55.3±27.6 m,p=0.043)and a greater reduction in the TR pressure gradient(-33.7±10.9 mmHg vs.-12.5±12.0 mmHg,p=0.015).Conclusion:Selexipag is an efficient pulmonary vasodilator as add-on therapy in treating CHD-associated PAH.

关键词： Selexipag congenital heart disease pulmonary arterial hypertension

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