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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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Implementation of a High-Risk Outpatient Clinic for Children with Complex congenital heart disease in a Reference service in Brazil

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congenital heart disease 2023年第6期18卷 649-656页

作者： Gustavo Foronda Vanessa Ferreira Amorim de Melo Claudia Regina Pinheiro de Castro Grau Ingrid Magatti Piva Glaucia Maria Penha Tavares Ana Cristina Sayuri Tanaka Nana Miura Department of Pediatric Cardiology and adult congenital heart diseases Heart Institute of the University of São PauloSão PauloBrazil Foronda Clinic São PauloBrazil Institute of Orthopedics and Traumatology University of São PauloSão PauloBrazil Department of Echocardiography Heart Institute of the University of São PauloSão PauloBrazil

Background:Children with congenital heart disease(CHD),even after surgical approaches,and especially those who undergo staged procedures in theﬁrst months of life,remain vulnerable to readmissions and complications,requiring very close monitoring and differentiated intervention ***:Descriptive and exploratory study,of the experience report type,which presents the process of building the high-risk outpatient clinic for complex congenital heart diseases(AAR)at the Instituto do Coração(InCor).Results:Report of the path taken to structure the AAR,demonstrating the organization,interface with the multidisciplinary team,admission and discharge criteria,training,and patient proﬁ*** theseﬁve years of care,275 patients were treated,59.65%with biventricular interstage physiology,followed by univentricular interstage physiology(34.55%),residual defects after surgical procedures(3.63%),tumors with risk of mechanical obstruction(1.45%)and patients with an intrauterine approach(0.72%).The signiﬁcant number of critical patients who were successfully discharged from hospital(44.72%),the low mortality rate due to sudden deaths at home and the high adherence to follow-up cor-roborate the impact of this specialized ***:Despite the limitations of the study,this experi-ence report showed that with few resources,there is the possibility of organizing an AAR with differentiated care,with the objective of early detection and treatment of residual injuries,identiﬁcation of early interventions,edu-cation of parents for follow-up of their children,resulting in individualized treatment,promoting a better quality of life for this population.

关键词： congenital heart defects ambulatory care heart defects

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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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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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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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Acceptability and Feasibility of YouthCHAT to Detect Psychosocial Problems in Young People with congenital heart disease

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International Journal of Mental Health Promotion 2021年第2期23卷 221-230页

作者： Hiran Thabrew Harshali Kumar Vanessa Garcia-Hoyos Felicity Goodyear-Smith Department of Psychological Medicine Faculty of Medical and Health SciencesUniversity of AucklandAuckland1023New Zealand adult congenital heart disease service Paediatric and Congenital CardiologyStarship HospitalAuckland1023New Zealand Department of General Practice and Primary Health Care University of AucklandAuckland1023New Zealand

Objective:Young people with congenital heart disease(CHD)are at increased risk of psychosocial issues,includ-ing anxiety and depression that can affect their medical care and quality of *** open trial investigated the acceptability,feasibility and preliminary effectiveness of YouthCHAT,a tablet-based screener,designed to identify similar issues to a face to face psychosocial assessment,with young people who have ***:Youth-CHAT was administered to 44 such young people aged 15–25 years attending a specialist outpatient clinic at a New Zealand tertiary *** outcomes were(i)acceptability and(ii)feasibility of YouthCHAT,assessed via feedback from young people and clinicians and(iii)detection rates for each domain of YouthCHAT,measured by mental health or lifestyle issue being‘present’or‘absent’.Results:YouthCHAT was quick to complete(mean 9 min and 7 s)and well-received by young people(overall rating 7 out of 10)and *** of anxiety,substance use and other issues were similar to those in a previous study of young people with mixed long-term physical ***,rates of depression(41%)and life stresses(98%)were notably ***:Although further research is required,our results provide initial evidence that YouthCHAT is a viable and accep-table psychosocial screener with which to improve the holistic care of young people with CHD.

关键词： Screening adolescent anxiety depression congenital heart disease

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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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Feasibility and safety of cryoballoon ablation for atrial fibrillation inpatients with congenital heart disease

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World Journal of Cardiology 2019年第5期11卷 149-158页

作者： Sylvia Abadir Victor Waldmann Katia Dyrda Mikael Laredo Blandine Mondésert Marc Dubuc Paul Khairy Electrophysiology service and adult congenital heart Center Montreal Heart Institute Université de Montréal

BACKGROUND The prevalence of atrial fibrillation (AF) is on the rise in the aging population with congenital heart disease (CHD). A few case series have described the feasibility and early outcomes associated with radiofrequency catheter ablation of AF centered on electrically isolating pulmonary veins (PV) in patients with CHD. In contrast, cryoballoon ablation has not previously been studied in this patient population despite its theoretical advantages, which include a favorable safety profile and shorter procedural time. AIM To assess the safety and feasibility of cryoballoon ablation for AF in an initial cohort of patients with CHD. METHODS The study population consisted of consecutive patients with CHD and cryoballoon ablation for AF at the Montreal heart Institute between December 2012 and June 2017. Procedural complications, acute success, and 1-year freedom from recurrent AF after a single procedure with or without antiarrhythmic drugs were assessed. Procedures were performed under conscious sedation. Left atrial access was obtained via a single transseptal puncture or through an existing atrial septal defect (ASD). Cryoballoon occlusion was assessed by distal injection of 50% diluted contrast into the pulmonary vein. At least one 240-second cryothermal application was performed upon obtaining complete pulmonary vein occlusion. Following ablation, patients were routinely followed at outpatient visits at 1, 3, 6, and 12 mo, and then annually. RESULTS Ten patients, median age 57.9 (interquartile range 48.2-61.7) years, 60% female, met inclusion criteria and were followed for 2.8 (interquartile range 1.4-4.5) *** had moderately complex CHD (sinus venosus ASD with partial anomalous pulmonary venous return;aortic coarctation with a persistent left superior vena cava), with the remainder having simple defects. AF was paroxysmal in 8 (80.0%) and persistent in 2 (20.0%) patients. The pulmonary vein anatomy was normal in 6 (60.0%) patients. Four had left common

关键词： congenital heart disease Atrial fibrillation Cryoballoon ablation Pulmonary vein isolation Catheter ablation

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