International journal of cardiology. Congenital heart disease最新文献

Objectives

To investigate the incidence, types and pathophysiology of criss-cross pattern of the proximal pulmonary arteries in common arterial trunk and its influence on management and outcomes.

Methods

Retrospective review of all patients with common arterial trunk who underwent Aswan Truncus Operation with regard to the origin and course of the proximal pulmonary artery branches as defined by 3D segmented models pre, immediately and 1 and 2 years after operation.

Results

Between January 2019 and September 2022, 39 patients (19 males, aged 1–12 months) underwent the Aswan Truncus Operation. 18 patients (46%) had criss-cross arrangement of the proximal pulmonary artery. The mortality, ICU and hospital stay were not affected by the presence or absence of the criss-cross pattern. However, following operation in the criss-cross group, there was evidence of different degrees of kinking and twisting of the right pulmonary artery. This resulted in severe narrowing which required stenting or reoperation at different stages (1 during ICU stay and another after 1 year). Separate origin of the left pulmonary artery (Criss-cross Type 2) from a long stenotic ductus arteriosus required resection of the stenotic segment followed by anastomosis to the right pulmonary artery recreating a 60° angle of bifurcation.

Conclusion

Criss-cross pattern of proximal pulmonary arteries is common in patients with common arterial trunk. Pre-operative diagnosis and tailored approaches of repair are required to prevent late complications.

The number of adult patients with congenital heart disease (CHD) is steadily increasing and exceeds nowadays the number of children with CHD. This is due to significant advances in therapeutic possibilities that became available over the last four decades. As such, this aging population survives the CHD complications and is exposed to the traditional cardiovascular risk factors for atherosclerotic disease such as high blood pressure, elevated cholesterol levels, long-standing exposure to smoking, overweight and obesity, and a sedentary lifestyle. Consequently, it becomes important to put more emphasis on all these risk factors. A preventive strategy is central, and early encouragement of physical activity is part of this approach. A minimum of physical activity has a beneficial effect both physically and mentally. With this overview, we mainly want to emphasize the importance of preventive measures. We would like to emphasize that all individuals should receive an exercise prescription which adheres to the minimum recommendations by WHO/NICE and this advice should form the baseline. Moreover, we intend to show that physical activity can be done safely in patients with CHD and that recreational and competitive sports are feasible in many circumstances.

In 2020, there was an estimated prevalence of more than 1.8 million adults with congenital heart disease (ACHDs) living in South America, and 677,000 in Central America and the Caribbean. The ACHD mortality is higher in developing countries, compared with developed countries, and it has been shown that concentrating this population in specialized ACHD units improves their survival and prognosis. Currently, Latin American (LATAM) and Caribbean countries have an insufficient number of specialists and specialized ACHD units. Analyzing this situation, the Inter-American Society of Cardiology's (IASC) ACHD chapter and Pediatric Cardiology Council have prepared the first recommendations for developing ACHD units in LATAM and Caribbean countries. This article is the first collaborative work between South American, Central American and Caribbean countries. It describes the main points for organizing and developing ACHD units adapted to our own reality. Each point has been discussed in terms of barriers and challenges, followed by specific recommendations for improving and developing ACHD care. They have been reviewed and endorsed by the International Society for Adult Congenital Heart Disease (ISACHD), and the goal of their implementation is for each ACHD unit in the region to have the standards of quality and efficiency to improve the prognosis and survival of ACHDs in the region.

Aims

To define the cohort of adult congenital heart disease (ACHD) patients undergoing catheter ablation for supraventricular arrhythmia in a large tertiary centre, characterise outcomes, and determine factors associated with arrhythmia recurrence.

Methods

Single centre retrospective study of all catheter ablations for atrial arrhythmias in ACHD patients between September 2014 and October 2021. Patients were identified using a field search through a centralised database. Pre-specified clinical and procedural data of interest, and time from ablation to recurrence, were determined. Cox regression analyses were used to determine potential predictors of acute procedural success and arrhythmia recurrence.

Results

Cardiac ablation for supraventricular arrhythmia was undertaken in 142 cases across 100 unique patients (median age 41, interquartile range 31–52), with 70 (49%) cases treated for macro-reentrant atrial tachycardia, 16 (11%) for focal atrial tachycardia, 19 (13%) for multifocal atrial tachycardia, 17 (12%) for atrial fibrillation, 7 (5%) for atrioventricular nodal reentrant tachycardia, and 8 (6%) for atrioventricular reentrant tachycardia; and 68 cases (48%) had recurrent arrhythmia with a median time to recurrence of 800 days. Multivariable analysis identified acute procedural success as an independent predictor of freedom from arrhythmia, and ablation for persistent atrial fibrillation as an independent predictor for recurrence of arrhythmia.

Conclusion

Catheter ablation for supraventricular arrhythmia in ACHD patients is safe and effective, with most patients achieving multiple arrhythmia-free months. Procedural success and arrhythmia mechanism are important predictors of recurrence.

Thanks to advances in both medical care and surgical techniques, over recent years, survival for patients with congenital heart disease (CHD) has increased significantly, with about 90% of patients now reaching adulthood. However, as CHD patients grow older, their relative risk of developing coronary artery disease (CAD) increases. Moreover, it has been demonstrated that the majority of adult congenital heart disease (ACHD) patients has at least one cardiovascular risk factor. On the other hand, common complications, such as atrial fibrillation (AF) may evolve into a major clinical concern and can be difficult to manage medically.

This review aimed at examining the current pharmacological treatment strategies for primary and secondary prevention of CAD, medical and interventional treatment for supraventricular arrhythmias, as well as optimal medical strategies for ACHD patients with CAD and AF.

Nutrition is the cornerstone of a healthy life and is crucial for the prevention of cardiovascular disease. Patients with congenital heart disease (CHD) are prone to nutrition disorders, including abnormalities in body composition such as overweight or obesity which, along with other classic cardiovascular risk factors, places our increasing and aging adult CHD (ACHD) population at a higher risk for acquired cardiovascular disease. These patients are also at risk of cachexia or sarcopenia as well as macronutrient and micronutrient deficiencies derived from the development of heart failure as a complication of their underlying cardiac disease. In this paper, we review different dietary recommendations and supplementation with specific macronutrients and micronutrients. We also discuss some special scenarios in ACHD patients and the importance of the microbiota, a new therapeutical target as yet underexplored in this patient population.