Before the 1950s,D-transposition of the great arteries was associated with nearly 90% mortality within the first year of life.The Mustard and Senning procedures resulted in a signifi cant increase in the lifespan of t...Before the 1950s,D-transposition of the great arteries was associated with nearly 90% mortality within the first year of life.The Mustard and Senning procedures resulted in a signifi cant increase in the lifespan of these patients but with notable long-term complications,including arrhythmias,sinus node dysfunction,chronotropic incompetence,and right ventricular systolic dysfunction.The arterial switch operation(first described by Adib Jatene)initially resulted in nearly universal death.However,the use of coronary buttons for coronary artery translocation has improved operative survival dramatically.It is now considered the treatment of choice in patients amendable to the arterial switch operation.Considered an anatomic repair,resulting in concordant ventriculoarterial connections and a systemic left ventricle,the arterial switch operation reduces the incidence of ventricular dysfunction.However,it is also associated with long-term complications,including aortic root dilatation,aortic valve regurgitation,right ventricular outfl ow tract obstructions,coronary artery stenosis/compression,and branch pulmonary artery stenosis.展开更多
Following reparative surgery for tetralogy of Fallot or critical pulmonary stenosis(PS),patients frequently present with severe right ventricular(RV)volume overload due to pulmonary regurgitation,resulting in decrease...Following reparative surgery for tetralogy of Fallot or critical pulmonary stenosis(PS),patients frequently present with severe right ventricular(RV)volume overload due to pulmonary regurgitation,resulting in decreased RV function.Surgical pulmonary valve replacement(PVR)is known to improve RV function,but changes in left ventricular(LV)function after PVR have rarely been described.We sought to determine the midterm results regarding LV systolic function after PVR using cardiac MRI in 40 consecutive patients with repaired TOF(31 patients)or PS(9 patients)with an age of 29±9 years who underwent PVR from 2006 to 2011 at a single center.Cardiac MRI RV and LV volumes before and after PVR were analyzed.Demographics,clinical variables,cardiopulmonary bypass duration,and medications were reviewed.LV ejection fraction(LVEF)increased from(54±8)to(57±6)%(P=0.02).Before PVR,26 patients had depressed LVEF of(49±5)%(range 36– 54%).In this group,LVEF increased by(7±7)%(P<0.0001)after PVR.Low LVEF before PVR was correlated with increased LVEF after PVR(regression coefficient-0.7,R 2=0.59,P<0.0001).Demographics,medications,prior pregnancies,and cardiopulmonary bypass duration had no effect on LVEF after PVR.The increase in LVEF was most significant in patients with low pre-PVR LVEF.展开更多
Congenital heart disease(CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertia...Congenital heart disease(CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertiary care expertise and facilities for this growing cardiovascular field in the UK and around the world. We aimed to report our experience with a joint adult CHD clinic run in a district general hospital with regular input from the local cardiology team and a visiting adult CHD specialist. In total, 148 patients aged 33.6+/-14.1 years were seen once or more in 12 clinics over the study period(September 1999 to January 2003). Diagnostic case mix consisted of 2.9%complex, 67.9%moderate and 29.2%minor cases of CHD. Twenty percent of patients visited the counterpart tertiary center for additional investigations(mostly MRI) and 8%for intervention(with no operative mortality). There was one death during the study period giving an overall mortality of 0.2%/year. Patients were referred to the clinic from tertiary centres, the local cardiology and paediatric clinics and with time from obstetric and community sources. Nonattendance rates were relatively low, comparing favourably with tertiary care. This model of joint care for the adult CHD patient at a general district hospital with regular onsite specialized input appears to be effective and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for CHD services.展开更多
文摘Before the 1950s,D-transposition of the great arteries was associated with nearly 90% mortality within the first year of life.The Mustard and Senning procedures resulted in a signifi cant increase in the lifespan of these patients but with notable long-term complications,including arrhythmias,sinus node dysfunction,chronotropic incompetence,and right ventricular systolic dysfunction.The arterial switch operation(first described by Adib Jatene)initially resulted in nearly universal death.However,the use of coronary buttons for coronary artery translocation has improved operative survival dramatically.It is now considered the treatment of choice in patients amendable to the arterial switch operation.Considered an anatomic repair,resulting in concordant ventriculoarterial connections and a systemic left ventricle,the arterial switch operation reduces the incidence of ventricular dysfunction.However,it is also associated with long-term complications,including aortic root dilatation,aortic valve regurgitation,right ventricular outfl ow tract obstructions,coronary artery stenosis/compression,and branch pulmonary artery stenosis.
文摘Following reparative surgery for tetralogy of Fallot or critical pulmonary stenosis(PS),patients frequently present with severe right ventricular(RV)volume overload due to pulmonary regurgitation,resulting in decreased RV function.Surgical pulmonary valve replacement(PVR)is known to improve RV function,but changes in left ventricular(LV)function after PVR have rarely been described.We sought to determine the midterm results regarding LV systolic function after PVR using cardiac MRI in 40 consecutive patients with repaired TOF(31 patients)or PS(9 patients)with an age of 29±9 years who underwent PVR from 2006 to 2011 at a single center.Cardiac MRI RV and LV volumes before and after PVR were analyzed.Demographics,clinical variables,cardiopulmonary bypass duration,and medications were reviewed.LV ejection fraction(LVEF)increased from(54±8)to(57±6)%(P=0.02).Before PVR,26 patients had depressed LVEF of(49±5)%(range 36– 54%).In this group,LVEF increased by(7±7)%(P<0.0001)after PVR.Low LVEF before PVR was correlated with increased LVEF after PVR(regression coefficient-0.7,R 2=0.59,P<0.0001).Demographics,medications,prior pregnancies,and cardiopulmonary bypass duration had no effect on LVEF after PVR.The increase in LVEF was most significant in patients with low pre-PVR LVEF.
文摘Congenital heart disease(CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertiary care expertise and facilities for this growing cardiovascular field in the UK and around the world. We aimed to report our experience with a joint adult CHD clinic run in a district general hospital with regular input from the local cardiology team and a visiting adult CHD specialist. In total, 148 patients aged 33.6+/-14.1 years were seen once or more in 12 clinics over the study period(September 1999 to January 2003). Diagnostic case mix consisted of 2.9%complex, 67.9%moderate and 29.2%minor cases of CHD. Twenty percent of patients visited the counterpart tertiary center for additional investigations(mostly MRI) and 8%for intervention(with no operative mortality). There was one death during the study period giving an overall mortality of 0.2%/year. Patients were referred to the clinic from tertiary centres, the local cardiology and paediatric clinics and with time from obstetric and community sources. Nonattendance rates were relatively low, comparing favourably with tertiary care. This model of joint care for the adult CHD patient at a general district hospital with regular onsite specialized input appears to be effective and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for CHD services.
