Pub Date : 2025-01-07DOI: 10.1016/j.ijcchd.2025.100566
Gurleen Wander , Claudia Montanaro , Prithvi Dixit , Daryl Dob , Mark R. Johnson , Roshni R. Patel
Pulmonary hypertension (PH) is a term used to describe a complex heterogenous group of conditions defined by a mean pulmonary arterial pressure of more than 20 mmHg at rest on right-heart catheterization. PH in pregnancy is associated with high rates of maternal morbidity and mortality and poor fetal outcomes. Currently, pregnancy in these women is classified as modified WHO class IV (pregnancy contraindicated). More recent data suggest that the prognosis varies with the underlying aetiology as well as with PH severity. Consequently, management during pregnancy must be individualised, with patients cared for in a tertiary unit as part of an experienced multidisciplinary team. In this article, we will discuss the importance of preconception counselling, the impact of the haemodynamic changes induced by pregnancy, the maternal and fetal risks of pregnancy in women with PH, and how these can be minimised by close antenatal, intrapartum and post-partum care and the development of individualised pregnancy plans.
{"title":"Pregnancy and pulmonary artery hypertension: Management challenges","authors":"Gurleen Wander , Claudia Montanaro , Prithvi Dixit , Daryl Dob , Mark R. Johnson , Roshni R. Patel","doi":"10.1016/j.ijcchd.2025.100566","DOIUrl":"10.1016/j.ijcchd.2025.100566","url":null,"abstract":"<div><div>Pulmonary hypertension (PH) is a term used to describe a complex heterogenous group of conditions defined by a mean pulmonary arterial pressure of more than 20 mmHg at rest on right-heart catheterization. PH in pregnancy is associated with high rates of maternal morbidity and mortality and poor fetal outcomes. Currently, pregnancy in these women is classified as modified WHO class IV (pregnancy contraindicated). More recent data suggest that the prognosis varies with the underlying aetiology as well as with PH severity. Consequently, management during pregnancy must be individualised, with patients cared for in a tertiary unit as part of an experienced multidisciplinary team. In this article, we will discuss the importance of preconception counselling, the impact of the haemodynamic changes induced by pregnancy, the maternal and fetal risks of pregnancy in women with PH, and how these can be minimised by close antenatal, intrapartum and post-partum care and the development of individualised pregnancy plans.</div></div>","PeriodicalId":73429,"journal":{"name":"International journal of cardiology. Congenital heart disease","volume":"19 ","pages":"Article 100566"},"PeriodicalIF":0.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31DOI: 10.1016/j.ijcchd.2024.100564
Ioannis Kasouridis , Heather Probert , Michael A. Gatzoulis
{"title":"Cardiac rehabilitation in ACHD: Further investment is now due","authors":"Ioannis Kasouridis , Heather Probert , Michael A. Gatzoulis","doi":"10.1016/j.ijcchd.2024.100564","DOIUrl":"10.1016/j.ijcchd.2024.100564","url":null,"abstract":"","PeriodicalId":73429,"journal":{"name":"International journal of cardiology. Congenital heart disease","volume":"19 ","pages":"Article 100564"},"PeriodicalIF":0.8,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-30DOI: 10.1016/j.ijcchd.2024.100563
J.M. Colman , W.G. Williams , C.K. Silversides , L. Harris , L. Benson , J. Heggie , R. Alonso-Gonzalez , E. Oechslin
The Toronto Adult Congenital Heart Disease (ACHD) Program at the University Health Network, University of Toronto, began in 1959. It traces its origins to a Paul Wood protégé, Dr. John Evans, and to a long-standing and supportive relationship with Hospital for Sick Children (SickKids), located just across the street. Over the decades, the program has grown to become a major center for training and research in ACHD and one of the largest clinical programs for ACHD care globally. This paper recounts the 65-year history of the program, including some of its key individuals, challenges, milestones, innovations, discoveries, and future aspirations.
{"title":"Toronto ACHD program: A 65 year legacy","authors":"J.M. Colman , W.G. Williams , C.K. Silversides , L. Harris , L. Benson , J. Heggie , R. Alonso-Gonzalez , E. Oechslin","doi":"10.1016/j.ijcchd.2024.100563","DOIUrl":"10.1016/j.ijcchd.2024.100563","url":null,"abstract":"<div><div>The Toronto Adult Congenital Heart Disease (ACHD) Program at the University Health Network, University of Toronto, began in 1959. It traces its origins to a Paul Wood protégé, Dr. John Evans, and to a long-standing and supportive relationship with Hospital for Sick Children (SickKids), located just across the street. Over the decades, the program has grown to become a major center for training and research in ACHD and one of the largest clinical programs for ACHD care globally. This paper recounts the 65-year history of the program, including some of its key individuals, challenges, milestones, innovations, discoveries, and future aspirations.</div></div>","PeriodicalId":73429,"journal":{"name":"International journal of cardiology. Congenital heart disease","volume":"19 ","pages":"Article 100563"},"PeriodicalIF":0.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-28DOI: 10.1016/j.ijcchd.2024.100562
Verena Kantenwein , Herribert Pavaci , Bernhard Haller , Marta Telishevska , Lena Friedrich , Maximilian Walgenbach , Carsten Lennerz , Christof Kolb
Background
Whether it is reasonable to program ATP in patients with electrical heart disease (EHD) or hypertrophic cardiomyopathy (HCM) is not thoroughly clarified. Aim of the study was to define the types of ventricular arrhythmias and evaluate the safety and efficacy of ATP activation in these patients.
Methods and results
A total of 154 patients (53.9 % male, 64.9 % secondary prevention) with EHD or HCM, who had an implanted cardioverter defibrillator (ICD) with ATP activated, were included in this retrospective analysis; comprising a median of 65.0 months of follow-up. In 39/154 (25.3 %) patients appropriate ICD therapy was delivered during the follow-up. Patients with HCM had a significantly higher incidence rate of monomorphic VTs than patients with EHD (0.21 versus 0.01 per month, 0 < 0.001). ATP terminated monomorphic VT with an efficacy of 88,2 % in 94.9 % of the occurring episodes. The incidence rate per month of torsade de pointes (TdP) tachycardia and VF was significantly higher in patients with EHD versus HCM (0.04 vs. 0.001, p=<0.001; 0.06 vs. 0.007, p=<0.001). The termination of TdP tachycardia and VF was associated with ATP in 14.0 % and 0 % (ATP efficacy of 28.3 % and 0 % respectively). The implantation for secondary prevention was associated with the occurrence of appropriate ICD therapy during the follow-up period (OR 3.94 [95%CI 1.53–10.14], p = 0.005).
Conclusion
Ventricular tachycardias in patients with HCM are primarily monomorphic and can be effectively terminated with ATP. In patients with EHD, TdP tachycardias and VF occur more frequently and are preferentially terminated by ICD shock.
背景：对于电性心脏病（EHD）或肥厚性心肌病（HCM）患者，对ATP进行编程是否合理尚不完全清楚。本研究的目的是确定室性心律失常的类型，并评估ATP激活在这些患者中的安全性和有效性。方法和结果回顾性分析154例EHD或HCM患者（53.9%为男性，64.9%为二级预防），植入ATP激活的心律转复除颤器（ICD）；中位随访时间为65.0个月。39/154（25.3%）患者在随访期间给予适当的ICD治疗。HCM患者单型型室性血栓的发生率明显高于EHD患者(0.21 vs 0.01 /月，0 <；0.001)。在94.9%的发作中，ATP终止单型室速的有效率为88.2%。EHD患者每月TdP心动过速和VF的发生率明显高于HCM患者(0.04 vs. 0.001, p=<0.001；0.06 vs. 0.007, p=<0.001)。TdP心动过速和VF的终止与ATP的相关性分别为14.0%和0% （ATP的有效性分别为28.3%和0%）。二级预防植入与随访期间适当的ICD治疗发生率相关（OR 3.94 [95%CI 1.53-10.14], p = 0.005）。结论HCM患者室性心动过速以单形态性心动过速为主，ATP可有效终止。在EHD患者中，TdP心动过速和室颤更频繁发生，并优先通过ICD休克终止。
{"title":"Ventricular arrhythmias and the role of antitachycardia pacing in patients with electrical heart disease and hypertrophic cardiomyopathy","authors":"Verena Kantenwein , Herribert Pavaci , Bernhard Haller , Marta Telishevska , Lena Friedrich , Maximilian Walgenbach , Carsten Lennerz , Christof Kolb","doi":"10.1016/j.ijcchd.2024.100562","DOIUrl":"10.1016/j.ijcchd.2024.100562","url":null,"abstract":"<div><h3>Background</h3><div>Whether it is reasonable to program ATP in patients with electrical heart disease (EHD) or hypertrophic cardiomyopathy (HCM) is not thoroughly clarified. Aim of the study was to define the types of ventricular arrhythmias and evaluate the safety and efficacy of ATP activation in these patients.</div></div><div><h3>Methods and results</h3><div>A total of 154 patients (53.9 % male, 64.9 % secondary prevention) with EHD or HCM, who had an implanted cardioverter defibrillator (ICD) with ATP activated, were included in this retrospective analysis; comprising a median of 65.0 months of follow-up. In 39/154 (25.3 %) patients appropriate ICD therapy was delivered during the follow-up. Patients with HCM had a significantly higher incidence rate of monomorphic VTs than patients with EHD (0.21 versus 0.01 per month, 0 < 0.001). ATP terminated monomorphic VT with an efficacy of 88,2 % in 94.9 % of the occurring episodes. The incidence rate per month of torsade de pointes (TdP) tachycardia and VF was significantly higher in patients with EHD versus HCM (0.04 vs. 0.001, p=<0.001; 0.06 vs. 0.007, p=<0.001). The termination of TdP tachycardia and VF was associated with ATP in 14.0 % and 0 % (ATP efficacy of 28.3 % and 0 % respectively). The implantation for secondary prevention was associated with the occurrence of appropriate ICD therapy during the follow-up period (OR 3.94 [95%CI 1.53–10.14], p = 0.005).</div></div><div><h3>Conclusion</h3><div>Ventricular tachycardias in patients with HCM are primarily monomorphic and can be effectively terminated with ATP. In patients with EHD, TdP tachycardias and VF occur more frequently and are preferentially terminated by ICD shock.</div></div>","PeriodicalId":73429,"journal":{"name":"International journal of cardiology. Congenital heart disease","volume":"19 ","pages":"Article 100562"},"PeriodicalIF":0.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-25DOI: 10.1016/j.ijcchd.2024.100561
Melissa G.Y. Lee , Phillip S. Naimo , Anoop N. Koshy , Edward Buratto , William M. Wilson , Leeanne E. Grigg , Subodh B. Joshi , Katherine M. English
Coarctation of the aorta (CoA) is one of the most common types of congenital heart disease. Unfortunately, there is a high prevalence of hypertension and late cardiovascular mortality in patients with CoA despite successful repair. The growing impact of acquired cardiovascular disease remains a significant concern as the adult congenital heart disease population continues to rapidly expand and age. This review aims to explore (1) the determinants of vascular health and atherosclerosis including endothelial dysfunction and vascular wall abnormalities, (2) the prevalence of atherosclerosis and associated sequelae in repaired CoA including coronary artery disease, coronary artery calcium, aortic calcium, stroke, and peripheral artery disease, and (3) the contributing factors specific to CoA. This review aims to guide optimization of long-term cardiovascular health to ultimately reduce mortality and morbidity in this young high-risk population.
{"title":"Coarctation of the aorta and accelerated atherosclerosis: A contemporary review on the burden of atherosclerotic cardiovascular disease","authors":"Melissa G.Y. Lee , Phillip S. Naimo , Anoop N. Koshy , Edward Buratto , William M. Wilson , Leeanne E. Grigg , Subodh B. Joshi , Katherine M. English","doi":"10.1016/j.ijcchd.2024.100561","DOIUrl":"10.1016/j.ijcchd.2024.100561","url":null,"abstract":"<div><div>Coarctation of the aorta (CoA) is one of the most common types of congenital heart disease. Unfortunately, there is a high prevalence of hypertension and late cardiovascular mortality in patients with CoA despite successful repair. The growing impact of acquired cardiovascular disease remains a significant concern as the adult congenital heart disease population continues to rapidly expand and age. This review aims to explore (1) the determinants of vascular health and atherosclerosis including endothelial dysfunction and vascular wall abnormalities, (2) the prevalence of atherosclerosis and associated sequelae in repaired CoA including coronary artery disease, coronary artery calcium, aortic calcium, stroke, and peripheral artery disease, and (3) the contributing factors specific to CoA. This review aims to guide optimization of long-term cardiovascular health to ultimately reduce mortality and morbidity in this young high-risk population.</div></div>","PeriodicalId":73429,"journal":{"name":"International journal of cardiology. Congenital heart disease","volume":"19 ","pages":"Article 100561"},"PeriodicalIF":0.8,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-20DOI: 10.1016/j.ijcchd.2024.100560
Covadonga Terol Espinosa de los Monteros , Roel L.F. van der Palen , Jef Van den Eynde , Lukas Rammeloo , Mark G. Hazekamp , Nico A. Blom , Irene M. Kuipers , Arend D.J. ten Harkel
Background
Advanced echocardiographic techniques such as Tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) can detect more subtle changes in ventricular performance. We aimed to study the ventricular performance in patients with transposition of the great arteries (TGA) at mid-term follow-up after the arterial switch operation (ASO) with advanced echocardiographic techniques. In addition, we sought to discover new clinical phenotypes using unsupervised machine learning.
Methods
Conventional, TDI and STE echocardiographic parameters were prospectively obtained from 124 TGA patients (66.1 % male, age 10.8 ± 5.1 years, 24.2 % with ventricular septal defect) in this observational study. The data was analyzed with conventional statistics and new machine learning techniques.
Results
TGA patients had reduced biventricular systolic (septal s’ Z-score −2.28 ± 1.26; RV s’ Z-score −2.16 ± 0.71; mean left ventricular longitudinal strain Z-score of the LV -2.49 ± 1.68) and RV diastolic performance (RV E/e’ Z-score 2.35 ± 1.70) mid-term after ASO. Unsupervised clustering within the TGA population revealed 3 clusters. Interestingly, cluster 3 defined a group of patients with older age at ASO, the most reduced ventricular performance as well as the highest rates of reoperations and interventions.
Conclusions
Assessment of ventricular performance with TDI and STE 10 years after ASO showed that TGA patients have decreased biventricular systolic and diastolic function, especially at the septal regions. Novel analytical methods such as unsupervised clustering may help identify new clinical phenotypes from multiple variables and may contribute to improved risk stratification.
先进的超声心动图技术，如组织多普勒成像（TDI）和斑点跟踪超声心动图（STE）可以检测到心室功能更细微的变化。我们的目的是利用先进的超声心动图技术研究大动脉转位（TGA）患者在动脉转换手术（ASO）后中期随访时的心室功能。此外，我们试图使用无监督机器学习来发现新的临床表型。方法对124例TGA患者（男性66.1%，年龄10.8±5.1岁，室间隔缺损24.2%）的常规、TDI和STE超声心动图参数进行前瞻性分析。使用传统统计学和新的机器学习技术对数据进行分析。结果stga患者双室收缩（间隔）Z-score（- 2.28±1.26）降低；RV s ' Z-score−2.16±0.71；ASO中期平均左室纵向应变Z-score（-2.49±1.68）和左室舒张性能（RV E/ E ' Z-score 2.35±1.70）。TGA人口中的无监督聚类显示出3个聚类。有趣的是，第3组定义了一组年龄较大的ASO患者，心室功能下降最多，再手术和干预率最高。结论在ASO术后10年用TDI和STE评估心室功能显示TGA患者双心室收缩和舒张功能下降，特别是在间隔区。新的分析方法，如无监督聚类可能有助于从多个变量中识别新的临床表型，并可能有助于改善风险分层。
{"title":"Using machine learning analysis to describe patterns in tissue Doppler and speckle tracking echocardiography in patients with transposition of the great arteries after arterial switch operation","authors":"Covadonga Terol Espinosa de los Monteros , Roel L.F. van der Palen , Jef Van den Eynde , Lukas Rammeloo , Mark G. Hazekamp , Nico A. Blom , Irene M. Kuipers , Arend D.J. ten Harkel","doi":"10.1016/j.ijcchd.2024.100560","DOIUrl":"10.1016/j.ijcchd.2024.100560","url":null,"abstract":"<div><h3>Background</h3><div>Advanced echocardiographic techniques such as Tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) can detect more subtle changes in ventricular performance. We aimed to study the ventricular performance in patients with transposition of the great arteries (TGA) at mid-term follow-up after the arterial switch operation (ASO) with advanced echocardiographic techniques. In addition, we sought to discover new clinical phenotypes using unsupervised machine learning.</div></div><div><h3>Methods</h3><div>Conventional, TDI and STE echocardiographic parameters were prospectively obtained from 124 TGA patients (66.1 % male, age 10.8 ± 5.1 years, 24.2 % with ventricular septal defect) in this observational study. The data was analyzed with conventional statistics and new machine learning techniques.</div></div><div><h3>Results</h3><div>TGA patients had reduced biventricular systolic (septal s’ Z-score −2.28 ± 1.26; RV s’ Z-score −2.16 ± 0.71; mean left ventricular longitudinal strain Z-score of the LV -2.49 ± 1.68) and RV diastolic performance (RV E/e’ Z-score 2.35 ± 1.70) mid-term after ASO. Unsupervised clustering within the TGA population revealed 3 clusters. Interestingly, cluster 3 defined a group of patients with older age at ASO, the most reduced ventricular performance as well as the highest rates of reoperations and interventions.</div></div><div><h3>Conclusions</h3><div>Assessment of ventricular performance with TDI and STE 10 years after ASO showed that TGA patients have decreased biventricular systolic and diastolic function, especially at the septal regions. Novel analytical methods such as unsupervised clustering may help identify new clinical phenotypes from multiple variables and may contribute to improved risk stratification.</div></div>","PeriodicalId":73429,"journal":{"name":"International journal of cardiology. Congenital heart disease","volume":"19 ","pages":"Article 100560"},"PeriodicalIF":0.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-20DOI: 10.1016/j.ijcchd.2024.100559
Joshua J. Price , Kalani Ruiz , Jaewon Lim , Yuli Kim , Jonathan Buber
Background
Despite increasing frequency of pregnancies among patients with cardiac conditions, including the presence of prosthetic heart valves, data on the effects of physiological changes during pregnancy on the function of bioprosthetic valves remains scarce and shows conflicting results.
Objectives
This study was aimed to determine the effect of pregnancy on the rate of bioprosthetic structural valve degeneration.
Methods
We designed a retrospective matched cohort study of patients seen between June 2018 and February 2023. All pregnant patients with bioprosthetic valves were matched to non-pregnant controls with prior valve replacement based on bioprosthetic valve location, time since valve implantation, age of the patient at valve implantation and time between baseline and follow up echocardiograms. Echocardiograms of pregnant patients were evaluated for bioprosthetic structural valve degeneration grade based on a dedicated scale before and after pregnancy. Non-pregnant controls had echocardiogram scoring of structural valve degeneration over a similar time period.
Results
Thirty four pregnant patients with bioprosthetic valves in the pulmonary, aortic and mitral positions were matched with 71 non-pregnant controls with identical bioprosthetic valves locations. Over a median follow up period of 13.5 months that included the gestational period, 18 (53 %) pregnant patients had an increase in structural valve degeneration score as compared to 17 (26 %) of the non-pregnant patients in median follow up of 13.7 months (OR 3.87, p = 0.004). On multivariable analysis, pregnancy was the only variable associated with increased structural valve degeneration score.
Conclusions
Our results suggest that pregnancy is associated with increased bioprosthetic structural valve degeneration.
尽管有心脏疾病的患者怀孕的频率越来越高，包括人工心脏瓣膜的存在，但关于怀孕期间生理变化对生物人工心脏瓣膜功能影响的数据仍然很少，并且结果相互矛盾。目的探讨妊娠对人工瓣膜退行性变发生率的影响。方法我们设计了一项回顾性匹配队列研究，纳入了2018年6月至2023年2月期间就诊的患者。根据生物瓣膜置换术的位置、瓣膜置换术的时间、瓣膜置换术患者的年龄以及基线和随访超声心动图之间的时间，将所有接受生物瓣膜置换术的孕妇与未接受过瓣膜置换术的未怀孕对照组进行匹配。采用超声心动图对妊娠患者在妊娠前后的生物假体结构瓣膜退行性变分级进行评价。未怀孕的对照组在相似的时间内有结构性瓣膜变性的超声心动图评分。结果34例在肺动脉、主动脉和二尖瓣位置放置生物瓣膜的孕妇与71例具有相同生物瓣膜位置的非妊娠对照组匹配。在包括妊娠期在内的中位随访13.5个月期间，18例（53%）妊娠患者的结构性瓣膜退变评分增加，而在中位随访13.7个月期间，17例（26%）非妊娠患者的结构性瓣膜退变评分增加（OR 3.87, p = 0.004）。在多变量分析中，妊娠是唯一与结构性瓣膜变性评分增加相关的变量。结论妊娠与生物假体结构瓣膜变性增加有关。
{"title":"Effect of pregnancy on bioprosthetic structural valve degeneration","authors":"Joshua J. Price , Kalani Ruiz , Jaewon Lim , Yuli Kim , Jonathan Buber","doi":"10.1016/j.ijcchd.2024.100559","DOIUrl":"10.1016/j.ijcchd.2024.100559","url":null,"abstract":"<div><h3>Background</h3><div>Despite increasing frequency of pregnancies among patients with cardiac conditions, including the presence of prosthetic heart valves, data on the effects of physiological changes during pregnancy on the function of bioprosthetic valves remains scarce and shows conflicting results.</div></div><div><h3>Objectives</h3><div>This study was aimed to determine the effect of pregnancy on the rate of bioprosthetic structural valve degeneration.</div></div><div><h3>Methods</h3><div>We designed a retrospective matched cohort study of patients seen between June 2018 and February 2023. All pregnant patients with bioprosthetic valves were matched to non-pregnant controls with prior valve replacement based on bioprosthetic valve location, time since valve implantation, age of the patient at valve implantation and time between baseline and follow up echocardiograms. Echocardiograms of pregnant patients were evaluated for bioprosthetic structural valve degeneration grade based on a dedicated scale before and after pregnancy. Non-pregnant controls had echocardiogram scoring of structural valve degeneration over a similar time period.</div></div><div><h3>Results</h3><div>Thirty four pregnant patients with bioprosthetic valves in the pulmonary, aortic and mitral positions were matched with 71 non-pregnant controls with identical bioprosthetic valves locations. Over a median follow up period of 13.5 months that included the gestational period, 18 (53 %) pregnant patients had an increase in structural valve degeneration score as compared to 17 (26 %) of the non-pregnant patients in median follow up of 13.7 months (OR 3.87, p = 0.004). On multivariable analysis, pregnancy was the only variable associated with increased structural valve degeneration score.</div></div><div><h3>Conclusions</h3><div>Our results suggest that pregnancy is associated with increased bioprosthetic structural valve degeneration.</div></div>","PeriodicalId":73429,"journal":{"name":"International journal of cardiology. Congenital heart disease","volume":"19 ","pages":"Article 100559"},"PeriodicalIF":0.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-11DOI: 10.1016/j.ijcchd.2024.100556
Jamil Aboulhosn
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Pub Date : 2024-12-10DOI: 10.1016/j.ijcchd.2024.100557
Jose Arriola-Montenegro , Joel Coronado-Quispe , Juan Carlos Mego , Odalis Luis-Ybáñez , Astrid Tauma-Arrué , Samantha Chavez-Saldivar , Javier E. Sierra-Pagan , Miguel Pinto-Salinas , Rafael Marquez , Miguel Arboleda , Ivan Niño de Guzman , Luis Vera , Carlos Alvarez , Katia Bravo-Jaimes
Introduction
Congenital heart disease (CHD) affects 1 % of all live births globally, with critical CHD (CCHD) requiring early intervention to avoid neonatal mortality. To date, CHD-related mortality within the first year of life and its associated factors have not been studied in Peru.
Methods
This is an observational secondary analysis using the Peruvian National Computerized System of Deaths, data from 2017 to 2021. CHD-related mortality was assessed by sex, age, altitude level, region, insurance type, healthcare institution, contributing factors, and CHD complexity. Geographic patterns were visualized using heatmaps, trends were analyzed through linear regression and survival analyses were performed using Kaplan Meier curves and log-rank tests.
Results
Peru experienced 70.6 CHD-related deaths per 100,000 live births. Mortality was significantly higher in males, most CHD-related deaths took place at a median age of 1 month. Regions like Huancavelica and Junín, located in the Andes, exhibited the highest mortality rates. Others significant related factors were receiving care at healthcare institution operated by Ministry of Health (MINSA) and complex CHDs. A non-significant increase in CHD-related deaths and mortality rates was noted, particularly affecting regions such as La Libertad and Lima.
Conclusion
Peru faces a critical public health crisis concerning CHD-related mortality among infants, especially those living in the Andes and receiving care at healthcare institutions operated by MINSA. A National Congenital Heart Disease Program is essential to ensure equitable access to specialized care, potentially saving numerous young lives.
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