213 research outputs found
Transition from adolescence to adulthood in congenital heart disease - Many roads lead to Rome
No full textMore than 90% of children born with heart defects reach adulthood. They continue to require specialized medical care. In most countries, their care has to be transferred from the pediatric care environment to specialized adult clinics. This transfer of care usually occurs at a time when adolescents become young adults. Supporting adolescents and emerging adults with congenital heart disease through transition has been recognized as an important task of their treating teams in recent years. An environment where adolescents feel welcome and where education and patient participation are fostered is crucial. For an optimal transition process, patients, their families and all health care providers need to be involved. Different models for transition programs have emerged, depending on local policies and resources. The authors offer insight into established transition programs in Bern and Zurich, Switzerland. Advantages and challenges of different models of care and transition programs are presented
Percutaneous PFO closure with Amplatzer PFO occluder: predictors of residual shunts at 6 months follow-up
No full textOBJECTIVE: The objective of this study was to assess predictors of residual shunts after percutaneous patent foramen ovale (PFO) closure with Amplatzer PFO occluder (AGA Medical Corporation, Golden Valley, MN, USA). METHODS: All percutaneous PFO closures, using Amplatzer PFO occluder performed at a tertiary center between May 2002 and August 2006, were reviewed. Follow-up, including saline contrast transesophageal echocardiography, was performed in all patients 6 months after the intervention. PATIENTS: A total of 135 procedures were performed. Mean age of the patients was 51 years. The indication for PFO closure was an ischemic cerebrovascular event in 92%, paradoxical systemic embolism in 4%, and a diving accident in 4%. Recurrent events prior to PFO closure were noted in 34%. A concomitant atrial septal aneurysm was present in 61%. RESULTS: At 6 months follow-up, a residual shunt was detected in 26 patients (19%). Residual shunts were more common in patients with an atrial septal aneurysm (27 vs. 8%, P= .01) and in patients treated with a 35-mm compared with a 25-mm device (39 vs. 15%, P= .01). A concomitant atrial septal aneurysm remained independently associated with residual shunts when controlled for body mass index, gender, age, atrial dimensions, and presence of a Chiari network (odds ratio 4.1, 95% confidence intervals 1.1-15.0). CONCLUSION: The presence of atrial septal aneurysms in patients undergoing percutaneous PFO closure with an Amplatzer PFO occluder significantly increases the rate of residual shunts at 6 months follow-up, even if 35-mm devices are used
Exercise testing in adult congenital heart disease: At center stage for many reasons
No full textAdult survivors with congenital heart disease represent rapidly evolving cohorts of complex patients that pose unique challenges to our adult cardiology clinics. These patients are at high risk of cardiovascular complications and premature death as young adults. Regular assessment at specialist centers by multidisciplinary expert teams is key to optimal management. Serial exercise testing has proven to be a powerful tool for optimal management of these patients.
In this overview, the major tasks of exercise testing are reviewed. This includes prognostication and risk stratification as well, as the evaluation of specific causes of impaired exercise capacity based on analysis of the different components of cardio-pulmonary exercise testing. While peak oxygen consumption has proven to be a robust marker of outcome in adult cardiology, in patients with congenital heart disease, reference values may need to be adapted to specific congenital heart disease entities and the prognostic validity for specific patient cohorts requires further elucidation. Careful analysis of results from exercise testing often reveal important insights into the individual patient's cardiac physiology and may allow targeted interventions that improve exercise capacity and potentially outcome. This requires integration of clinical findings and findings from cardiac imaging. Occasionally, exercise testing during cardiac catheterization may reveal insights into exercise hemodynamics and may be important for decision-making, particularly for decision-making about occlusion of intra-cardiac shunts.
From a research perspective, the analysis of exercise capacity and its components will enable us to make more evidence-based decisions for cardiac interventions and will allow a better understanding of prognosis
Tetralogy of Fallot, pulmonary valve replacement, and right ventricular volumes: are we chasing the right target?
No full text
Effect of Exercise-Based Cardiac Rehabilitation on Cardiorespiratory Fitness in Adults with Congenital Heart Disease
No full textBackground: The purpose of this study was to investigate whether patients with adult congenital heart disease (ACHD) benefit from exercise-based cardiac rehabilitation (CR) short- and long-term with regard to improvement of cardiorespiratory fitness. Methods: Cardiopulmonary exercise tests (CPET) completed by ACHD patients between January 2000 and October 2019 were analysed retrospectively. Linear mixed models were performed for peak oxygen consumption (VO2) with patients as random effect and age, sex, disease classification, preceding surgery (≤3 months) and preceding CR (≤4 weeks for short term and >4 weeks for long term) as fixed effects.
Results: 1056 CPETs of 311 ACHD patients with simple (7), moderate (188) or great (116) complexity heart defects were analysed. The 59 patients who completed a CR (median age 27 yrs, 38% females) increased peak VO2 from before to after CR by a median of 2.7 (IQR –0.6 to 5.5) ml/kg/min. However, in the multivariate mixed model, peak VO2 was non-significantly increased short-term after CR (β 0.8, 95%CI –0.7 to 2.4), not maintained long-term after CR (β 0.0, 95%CI –1.7 to 1.6) but significantly reduced after surgery (β –5.1, 95%CI –7.1 to –3.1). The 20 CR patients after surgery increased their peak VO2 by 6.2 (IQR 3.6–9.5) ml/kg/min, while the 39 CR patients without preceding surgery increased it by 0.9 (IQR –1.5 to 3.1) ml/kg/min.
Conclusions: The increase in peak VO2 with CR was mainly due to recovery from surgical intervention. The small independent benefit from CR was not maintained long-term, highlighting the potential to improve current CR concepts in ACHD populations
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