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Adult Congenital Heart Disease: An Increasing and Ageing Population: Part II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 October 2024) | Viewed by 12847

Special Issue Editor


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Guest Editor
1. Adult Congenital Heart Disease, Technical University of Munich, Munich, Germany
2. Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Munich, Germany
Interests: adult congenital heart disease; pulmonary hypertension; heart failure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Due to the advances in the diagnosis and treatment of congenital heart disease in newborns and children that took place in recent decades, today, the majority of patients survive to adulthood. However, unfortunately, a cure for congenital heart disease is seldom achieved, and residua and sequela are common, leading to an ever-increasing group of adult patients with congenital heart disease (ACHD). However, the population is not only increasing but also ageing. Consequently, as ACHD patients are getting older, comorbidities are acquired similar to in the general population, and sometimes even with a higher prevalence. Several recent studies have emphasized the importance of these comorbidities for increasing the morbidity and mortality in this patient group in addition to the underlying congenital heart defects. Nonetheless, this ageing ACHD population is less well-studied than children or young adults with congenital heart disease. The present Special Issue aims to fill this gap by focusing on the ageing ACHD population and the impact of comorbidities on the outcome of these patients.

Prof. Dr. Oktay Tutarel
Guest Editor

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Keywords

  • adult congenital heart disease
  • comorbidities
  • acquired diseases
  • ageing

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Published Papers (8 papers)

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Research

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8 pages, 221 KiB  
Article
Left Atrial Structural and Functional Changes in Adults with Congenital Septal Defects and Paroxysmal Atrial Fibrillation
by Anton V. Minaev, Marina Yu. Mironenko, Vera I. Dontsova, Yulia D. Pirushkina, Bektur Sh. Berdibekov, Alexander S. Voynov, Julia A. Sarkisyan and Elena Z. Golukhova
J. Clin. Med. 2024, 13(19), 6023; https://doi.org/10.3390/jcm13196023 - 9 Oct 2024
Viewed by 852
Abstract
Aims. To identify the difference between adult patients with septal defects and paroxysmal atrial fibrillation (AF) and patients without a history of arrhythmia using the left atrial (LA) volume and function parameters, to reveal the parameters associated with AF development. Methods and [...] Read more.
Aims. To identify the difference between adult patients with septal defects and paroxysmal atrial fibrillation (AF) and patients without a history of arrhythmia using the left atrial (LA) volume and function parameters, to reveal the parameters associated with AF development. Methods and results. In this prospective study, 81 patients with septal defects and left-to-right shunts were enrolled between 2021 and 2023 and divided into two groups: with paroxysmal AF and without AF. Left atrial function was analyzed based on the indexed left atrial volumes (LAVI and preA-LAVI), ejection fraction (LAEF), expansion index (LAEI), reservoir (LAS-r), conduit (LAS-cd) and contractile (LAS-ct) strain, and stiffness index (LASI) using a Philips CVx3D ultrasound system (Philips, Amsterdam, The Netherlands) and corresponding software. In total, 26 patients with paroxysmal atrial fibrillation (mean age: 59.6 ± 11.7 years, female: 80.8%) and 55 patients with septal defects without any history of arrhythmias (mean age: 44.8 ± 11.6 years, female: 81.8%) were included. All patients were in the NYHA class I or II at baseline. Our findings demonstrated a significant difference between all LA function parameters in the two groups. Upon univariable analysis, the LAVI, preA-LAVI, LASI, LAEF, LAEI, LAS-r, LAS-c, LAS-ct, age, cardiac index, E/A, and RV pressure were found to be associated with AF. The multivariate analysis identified LAVI (OR 1.236, 95% CI 1.022–1.494, p = 0.03), LAS-r (OR 0.723, 95% CI 0.556–0.940, p = 0.02), and LAS-ct (OR 1.518, 95% CI 1.225–1.880, p < 0.001) as independent predictors of AF development. The proposed model demonstrated high sensitivity and specificity with an adjusted classification threshold of 0.38 (AUC: 0.97, 95% CI 0.93–1.00, sensitivity 92% and specificity 92%, p < 0.001). Conclusions. The assessment of LA function using speckle-tracking echocardiography demonstrated significantly different values in the AF group among patients with congenital septal defects. This technique can therefore be implemented in routine clinical management. The key message. Atrial fibrillation development in adult patients with congenital septal defects and a left-to-right shunt is associated with the changes in left atrial function under conditions of an increased preload. Full article
11 pages, 1337 KiB  
Article
Occurrence and Outcome of Infective Endocarditis after Surgical Compared to Transcatheter Pulmonary Valve Implantation in Congenital Heart Disease
by Alicia Jeanette Fischer, Dominic Enders, Helmut Baumgartner, Gerhard-Paul Diller and Gerrit Kaleschke
J. Clin. Med. 2024, 13(9), 2683; https://doi.org/10.3390/jcm13092683 - 2 May 2024
Viewed by 1002
Abstract
Background: Conflicting data exist on the occurrence and outcome of infective endocarditis (IE) after pulmonary valve implantation. Objectives: This study sought to assess the differences between transcatheter pulmonary valve implantation (TPVI) and surgical pulmonary valve replacement (SPVR). Methods: All patients ≥ [...] Read more.
Background: Conflicting data exist on the occurrence and outcome of infective endocarditis (IE) after pulmonary valve implantation. Objectives: This study sought to assess the differences between transcatheter pulmonary valve implantation (TPVI) and surgical pulmonary valve replacement (SPVR). Methods: All patients ≥ 4 years who underwent isolated pulmonary valve replacement between 2005 and 2018 were analyzed based on the data of a major German health insurer (≈9.2 million insured subjects representative of the German population). The primary endpoint was a composite of IE occurrence and all-cause death. Results: Of 461 interventions (cases) in 413 patients (58.4% male, median age 18.9 years [IQR 12.3–33.4]), 34.4% underwent TPVI and 65.5% SPVR. IE was diagnosed in 8.0% of cases during a median follow-up of 3.5 years. Risk for IE and all-cause death was increased in patients with prior IE (p < 0.001), but not associated with age (p = 0.50), sex (p = 0.67) or complexity of disease (p = 0.59). While there was no difference in events over the entire observational time period (p = 0.22), the time dynamics varied between TPVI and SPVR: Within the first year, the risk for IE and all-cause death was lower after TPVI (Hazard Ratio (HR) 95% CI 0.19 (0.06–0.63; p = 0.006) but increased over time and exceeded that of SPVR in the long term (HR 10.07 (95% CI 3.41–29.76; p < 0.001). Conclusions: Patients with TPVI appear to be at lower risk for early but higher risk for late IE, resulting in no significant difference in the overall event rate compared to SPVR. The results highlight the importance of long-term specialized care and preventive measures after both interventions. Full article
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<p>Number of pulmonary valve implantations during the study period stratified by calendar year and treatment modality (transcatheter pulmonary valve implantation = TPVI, surgical pulmonary valve replacement = SPVR).</p>
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<p>Distribution of surgical procedures for the initial and subsequent surgery (<span class="html-italic">n</span> = 42).</p>
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<p>Kaplan–Meier estimates for infective endocarditis and combined endpoint of infective endocarditis and death (red = transcatheter pulmonary valve implantation (TPVI), green = surgically implanted pulmonary valves (SPVR)).</p>
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<p>Kaplan–Meier estimates for infective endocarditis and combined endpoint of infective endocarditis and death (red = transcatheter pulmonary valve implantation (TPVI), green = surgically implanted pulmonary valves (SPVR)).</p>
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13 pages, 5760 KiB  
Article
Pulmonary Artery Dilatation Due to Pressure or Volume Overload in Congenital Heart Disease
by Monika Kaldararova, Katarina Bobocka, Andrea Kantorova, Erika Drangova, Jana Polakova Mistinova, Filip Klauco, Tereza Hlavata, Adriana Reptova, Tatiana Valkovicova and Iveta Simkova
J. Clin. Med. 2024, 13(6), 1567; https://doi.org/10.3390/jcm13061567 - 9 Mar 2024
Viewed by 2146
Abstract
Background: Pulmonary artery dilatation is described mostly in association with pulmonary hypertension. Patients/Methods: Study analysis: 60 patients with pulmonary arterial hypertension in congenital heart disease (PAH-CHD); 64 with repaired tetralogy of Fallot/pulmonary regurgitation (rTOF/PR); and 80 healthy (NORMAL). Measured were: main pulmonary artery [...] Read more.
Background: Pulmonary artery dilatation is described mostly in association with pulmonary hypertension. Patients/Methods: Study analysis: 60 patients with pulmonary arterial hypertension in congenital heart disease (PAH-CHD); 64 with repaired tetralogy of Fallot/pulmonary regurgitation (rTOF/PR); and 80 healthy (NORMAL). Measured were: main pulmonary artery (MPA) diameter and MPA/ascending aorta (Ao asc) ratio, by echocardiography (ECHO) and computer tomography or magnetic resonance imaging (CT/MRI). Results: In MPA diameter, significant differences between PAH-CHD, rTOF/PR, and NORMAL were found (median): 37 vs. 27 vs. 21 mm (p < 0.0001). In MPA/Ao asc ratio, there was a difference between PAH-CHD and NORMAL (median): 1.3 vs. 0.8 (p < 0.0001), but not between rTOF/PR and NORMAL: 0.74 vs. 0.8 (p = 0.3). Significant MPA dilatation (>40 mm) was present: in PAH-CHD, 35% (ECHO) and 76.9% (CT/MRI) of patients, while in rTOF/PR, 3.1% (ECHO) and 7.8% (CT/MRI). Severe MPA dilatation (>50 mm) occurred only in PAH-CHD: 16.7% (ECHO) and 31.4% (CT/MRI), while not in rTOF/PR. There was a significant correlation between ECHO and CT/MRI measurements, but ECHO was underestimated in all parameters. Conclusions: MPA dilatation due to pressure overload is more frequent and more severe; volume overload also leads to MPA dilatation but is less severe. The MPA/Ao asc ratio is not reliable for MPA dilatation estimation in rTOF/PR. Full article
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<p>Pulmonary artery measurement: (<b>A</b>) scheme; (<b>B</b>) by echocardiography; and (<b>C</b>) by computer tomography (MPA—main pulmonary artery; Ao—aorta).</p>
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<p>Parameters measured by ECHO, compared in groups (NORMAL, PAH-CHD, and rTOF/PR): (<b>A</b>). MPA diameter; (<b>B</b>). Ao asc diameter; and (<b>C</b>). MPA/Ao asc ratio. NORMAL—control healthy subjects; PAH-CHD—pulmonary artery hypertension associated with congenital heart defects; rTOF/PR—repaired Tetralogy of Fallot with severe pulmonary regurgitation; ECHO—echocardiography; MPA—main pulmonary artery; and Ao asc—ascending aorta.</p>
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<p>Correlation of parameters by age, measured by ECHO, compared in groups (NORMAL, PAH-CHD, and rTOF/PR): (<b>A</b>). MPA diameter; (<b>B</b>). Ao asc diameter; and (<b>C</b>). MPA/Ao asc ratio. NORMAL—control healthy subjects; PAH-CHD—pulmonary artery hypertension associated with congenital heart defects; rTOF/PR—repaired Tetralogy of Fallot with severe pulmonary regurgitation; ECHO—echocardiography; MPA—main pulmonary artery; and Ao asc—ascending aorta.</p>
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<p>ECHO and CT/MRI correlation: (<b>A</b>) in MPA diameter; (<b>B</b>) in Ao asc diameter; and (<b>C</b>) in MPA/Ao asc ratio. PAH-CHD—pulmonary artery hypertension associated with congenital heart defects; rTOF/PR—repaired Tetralogy of Fallot with severe pulmonary regurgitation; ECHO—echocardiography; CT/MRI—computer tomography/magnetic resonance imaging; MPA—main pulmonary artery; and Ao asc—ascending aorta.</p>
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<p>(<b>A</b>–<b>C</b>) MPA dilatation in PAH-CHD (CT); (<b>D</b>–<b>F</b>) MPA plus RVOT dilatation in rTOF/PR (CT). PAH-CHD—pulmonary arterial hypertension associated with congenital heart defects; rTOF/PR—repaired Tetralogy of Fallot with isolated severe pulmonary regurgitation; PA—pulmonary artery; MPA—main pulmonary artery; RVOT—right ventricular outflow tract; LPA—left pulmonary artery; RPA—right pulmonary artery; Ao—aorta; and CT—computer tomography.</p>
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16 pages, 573 KiB  
Article
Respiratory Muscle Function and Exercise Performance in Adult Patients with Fontan Circulation
by Raquel Ladrón-Abia, Pilar Cejudo Ramos, Israel Valverde Pérez, Rocío Camacho Fernández De Liger, Amadeo-José Wals-Rodríguez, María José Rodríguez Puras, Begoña Manso García and Pastora Gallego
J. Clin. Med. 2023, 12(14), 4593; https://doi.org/10.3390/jcm12144593 - 10 Jul 2023
Cited by 1 | Viewed by 1248
Abstract
At rest, a good Fontan circulation can provide a normal cardiac output (CO). However, as a consequence of its unique hemodynamic nature, the limitations of the Fontan circuit are exposed during exercise. We aimed to provide a comprehensive assessment of the pathophysiology of [...] Read more.
At rest, a good Fontan circulation can provide a normal cardiac output (CO). However, as a consequence of its unique hemodynamic nature, the limitations of the Fontan circuit are exposed during exercise. We aimed to provide a comprehensive assessment of the pathophysiology of exercise in adult Fontan patients (FPs) and identify factors limiting their functional capacity (FC). In a single-center study conducted in 37 FPs aged ≥16 years and 19 healthy-controls (HCs) who underwent CPET on a cycle ergometer in February and March 2022, the mean peakVO2 was 21 ± 5.4 mL/kg/min, which was 55% of the predicted value. Morphologically, the left single ventricle showed a higher peakVO2% predicted value (57.4 ± 14.4% vs. 43.4 ± 8.1%, p = 0.045). The factors associated with low peakVO2 values were an early flattened or descending O2 pulse at maximal exertion (52 ± 14% vs. 62 ± 12.5, p = 0.04 and 47.6 ± 9% vs. 60 ± 14, p = 0.018, respectively) and chronotropic insufficiency (53 ± 12% vs. 69.8 ± 20%, p = 0.008). The OUES was found to be a useful parameter to assess the FC in FPs in maximal and submaximal exercise testing. A strong positive correlation was observed between the %OUES and peakVO2%predicted (r = 0.726, p > 0.001). The lung function was impaired in the FPs, mostly with a mild restrictive pattern (56.8%). The FPs showed lower inspiratory muscle strength compared to the HCs but it was not statistically associated with either the peakVO2 or VE/VCO2 slope. Regular intense physical activity improves one’s FC. Although FPs have inspiratory muscle weakness, its impact on their FC is unclear. The peakVO2% predicted grew progressively higher as the level of physical activity increased (low level 49.5 ± 14%, moderate level 55 ± 12%, intense level 69 ± 20%). Full article
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<p>Impact of the level of physical activity on the exercise capacity in Fontan patients and healthy controls. The peakVO<sub>2</sub>% predicted was progressively higher as the level of physical activity increased in both groups. Differences were statistically significant only between low and intense physical activity levels.</p>
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10 pages, 1255 KiB  
Article
NT-proBNP Is a Predictor of Mortality in Adults with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease
by Susanne J. Maurer, Veronika Habdank, Jürgen Hörer, Peter Ewert and Oktay Tutarel
J. Clin. Med. 2023, 12(9), 3101; https://doi.org/10.3390/jcm12093101 - 24 Apr 2023
Cited by 3 | Viewed by 1516
Abstract
Background: About 5–10% of adults with congenital heart disease (ACHD) will develop pulmonary arterial hypertension (PAH), which is associated with significant mortality. Studies on risk factors for poor outcome in a contemporary cohort of these patients with PAH associated with CHD (PAH-CHD) are [...] Read more.
Background: About 5–10% of adults with congenital heart disease (ACHD) will develop pulmonary arterial hypertension (PAH), which is associated with significant mortality. Studies on risk factors for poor outcome in a contemporary cohort of these patients with PAH associated with CHD (PAH-CHD) are rare. Methods: In this retrospective, single-center study, adult patients with the diagnosis PAH-CHD who had at least one contact as an outpatient or inpatient at the German Heart Centre Munich during the period January 2010–September 2019 were included. Patients with PAH without a CHD were excluded. The primary endpoint was all-cause mortality. Results: Altogether, 158 patients (mean age 39.9 ± 15.4 years, female 64.6%) were included in the study. A pre-tricuspid shunt was present in 17.7%, other shunts in 51.3%, PAH associated with complex CHD in 22.8%, and segmental PAH in 8.2%. An NT-proBNP measurement at baseline was available in 95 patients (60.1%). During a median follow-up of 5.37 years [IQR 1.76–8.63], the primary endpoint occurred in 10 patients (6.7%). On univariate analysis, CRP (log) (HR 3.35, 95% CI (1.07–10.48), p = 0.037), NT-proBNP (log) (HR: 7.10, 95% CI: 1.57–32.23, p = 0.011), and uric acid (HR: 1.37, 95% CI: 1.05–1.79, p = 0.020) were predictors of the primary endpoint. On multivariate analysis, only NT-proBNP (log) (HR: 6.91, 95% CI: 1.36–35.02, p = 0.0196) remained as an independent predictor. Conclusion: NT-proBNP is an independent predictor of all-cause mortality in a contemporary cohort of PAH-CHD patients. The role of CRP and uric acid should be further assessed in future studies. Full article
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<p>Receiver operating characteristics (ROC) curve for NT-proBNP as predictor of mortality.</p>
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<p>Kaplan–Meier curves stratifying patients according to an NT-proBNP value above or below the cut-off value.</p>
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14 pages, 735 KiB  
Article
Elective Ascending Aortic Aneurysm Surgery in the Elderly
by Feyza Memis, Carlijn G. E. Thijssen, Arjen L. Gökalp, Maximiliaan L. Notenboom, Frederike Meccanici, Mohammad Mostafa Mokhles, Roland R. J. van Kimmenade, Kevin M. Veen, Guillaume S. C. Geuzebroek, Jelena Sjatskig, Franciscus J. ter Woorst, Jos A. Bekkers, Johanna J. M. Takkenberg and Jolien W. Roos-Hesselink
J. Clin. Med. 2023, 12(5), 2015; https://doi.org/10.3390/jcm12052015 - 3 Mar 2023
Viewed by 2365
Abstract
Background. No clear guidelines exist for performing preventive surgery for ascending aortic (AA) aneurysm in elderly patients. This study aims to provide insights by: (1) evaluating patient and procedural characteristics and (2) comparing early outcomes and long-term mortality after surgery between elderly and [...] Read more.
Background. No clear guidelines exist for performing preventive surgery for ascending aortic (AA) aneurysm in elderly patients. This study aims to provide insights by: (1) evaluating patient and procedural characteristics and (2) comparing early outcomes and long-term mortality after surgery between elderly and non-elderly patients. Methods. A multicenter retrospective observational cohort-study was performed. Data was collected on patients who underwent elective AA surgery in three institutions (2006–2017). Clinical presentation, outcomes, and mortality were compared between elderly (≥70 years) and non-elderly patients. Results. In total, 724 non-elderly and 231 elderly patients were operated upon. Elderly patients had larger aortic diameters (57.0 mm (IQR 53–63) vs. 53.0 mm (IQR 49–58), p < 0.001) and more cardiovascular risk factors at the time of surgery than non-elderly patients. Elderly females had significantly larger aortic diameters than elderly males (59.5 mm (55–65) vs. 56.0 mm (51–60), p < 0.001). Short-term mortality was comparable between elderly and non-elderly patients (3.0% vs. 1.5%, p = 0.16). Five-year survival was 93.9% in non-elderly patients and 81.4% in elderly patients (p < 0.001), which are both lower than that of the age-matched general Dutch population. Conclusion. This study showed that in elderly patients, a higher threshold exists to undergo surgery, especially in elderly females. Despite these differences, short-term outcomes were comparable between ‘relatively healthy’ elderly and non-elderly patients. Full article
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<p>The Course of eGFR Level from Admission to Discharge. ** Significant at the <span class="html-italic">p</span> &lt; 0.001 level.</p>
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<p>Kaplan–Meier Survival Analysis. Kaplan–Meier survival analysis for the elderly (blue) versus the non-elderly (yellow).</p>
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<p>Forrest Plot of the Multivariable Analysis. Data are presented as Hazard Ratios (HR) with 95% Confidence Intervals (CI). VSARR: Valve Sparing Aortic Root Replacement (including partial Yacoub technique in this analysis); BSA: Body Surface Area. * Significant at the 0.05 level. ** Significant at the 0.01 level.</p>
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10 pages, 717 KiB  
Article
Transcatheter Interventions for Atrioventricular Dysfunction in Patients with Adult Congenital Heart Disease: An International Case Series
by Nili Schamroth Pravda, Hana Vaknin Assa, Lars Sondergaard, Vilhelmas Bajoras, Horst Sievert, Kerstin Piayda, Amos Levi, Guy Witberg, Yaron Shapira, Ashraf Hamdan, Leor Perl, Shahar Vig, Leonard Blieden, Ran Kornowski, Rafael Hirsch and Pablo Codner
J. Clin. Med. 2023, 12(2), 521; https://doi.org/10.3390/jcm12020521 - 9 Jan 2023
Cited by 1 | Viewed by 2023
Abstract
Introduction: A substantial proportion of patients with adult congenital heart disease (ACHD) suffer from worsening valvular dysfunction in adulthood. Transcatheter valve interventions can offer a therapeutic alternative to surgery for those at high surgical risk. There is emerging but limited data on transcatheter [...] Read more.
Introduction: A substantial proportion of patients with adult congenital heart disease (ACHD) suffer from worsening valvular dysfunction in adulthood. Transcatheter valve interventions can offer a therapeutic alternative to surgery for those at high surgical risk. There is emerging but limited data on transcatheter interventions for atrioventricular (AV) valve dysfunction in patients with ACHD. Methods: We compiled an international collaborative multi-center registry focusing on adult patients with congenital heart disease undergoing transcatheter AV valve interventions (repair or replacement). Included were patients from three international centers who underwent procedures between 2016 and 2022. Demographic, clinical, and procedural data were compiled. Results: Nine patients with ACHD underwent AV valve interventions. The median age was 48 years (IQR (37; 56), 55% women). At baseline, seven patients (78%) were in NYHA functional class III and two (22%) were in NYHA functional class II. The diagnosis of ACHD varied. Three valve interventions were performed on the subpulmonary AV valve and six on the systemic AV valve. The primary valvular pathology was regurgitation (six patients, 78%). Five procedures were valve-in-valve interventions, and four procedures were transcatheter edge-to-edge repair procedures. There were no major complications or peri-procedural complications or peri-procedural mortality. One patient developed a suspected non-obstructive thrombus on the valve that was medically treated. One patient did not improve clinically following the procedure and underwent a heart transplant, one patient died 6 months following the procedure due to a cardiovascular implantable electronic device infection. At one year, six patients were in NYHA functional class I, and one patient was in NYHA functional class III. In conclusion, transcatheter AV heart valve interventions are feasible and safe procedures in carefully selected ACHD patients. These procedures can offer an effective treatment option in these younger patients with high surgical risk. Full article
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<p>Sapien 3 valve-in-valve within bioprosthetic Valve in the systemic atrioventricular position with Occlutech<sup>®</sup> septal occluder device as shown in the RAO view.</p>
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<p>Sapien 3 valve-in-valve within bioprosthetic valve in the tricuspid position with pacemaker leads in situ in the RAO38 Caudal 10 view.</p>
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<p>Sapien 3 valve-in-valve within bioprosthetic valve in the tricuspid position with cardiac resynchronization therapy defibrillator device in-situ in the RAO 50 Caudal 10 view.</p>
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Review

Jump to: Research

13 pages, 15111 KiB  
Review
Highlights of Transesophageal Echocardiography During Interventions for Adult Congenital Heart Disease
by Eihab Ghantous and Gentian Lluri
J. Clin. Med. 2024, 13(22), 6995; https://doi.org/10.3390/jcm13226995 - 20 Nov 2024
Viewed by 912
Abstract
Significant advances in the diagnosis and treatment of congenital heart disease have transformed patient outcomes, leading to an expanding adult congenital heart disease population. Many of these adults require lifelong procedural interventions, frequently performed in catheterization labs under the guidance of echocardiography. This [...] Read more.
Significant advances in the diagnosis and treatment of congenital heart disease have transformed patient outcomes, leading to an expanding adult congenital heart disease population. Many of these adults require lifelong procedural interventions, frequently performed in catheterization labs under the guidance of echocardiography. This review explores the transesophageal echocardiographic aspect in key catheterization-based procedures. Full article
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Figure 1
<p>Baseline TEE images of a 43-year-old female with ostium secundum ASD closure during the percutaneous ostium secundum ASD closure procedure. Looking at the defect with the deficient rims at different angles, all with left-to-right shunt shown by color Doppler imaging: (<b>1</b>) At 0 degrees—atrioventricular valve rim with posterior rim. (<b>2</b>) At 40–60 degrees—retro-aortic rim with posterior rim. (<b>3</b>) At 70–90 degrees—superior rim and posterior/inferior vena cava rim. (<b>4</b>) At 90–130 degrees—superior vena cava rim and posterior/inferior vena cava rim.</p>
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<p>The same patient from <a href="#jcm-13-06995-f001" class="html-fig">Figure 1</a> during the same procedure, after deployment of the ASD closure device, confirming the position of the device in the different positions and its interaction with nearby structures and confirming no residual leak by color Doppler. (<b>1</b>) At 0 degrees—interaction with the aortic valve and mitral valve (not seen in the image). (<b>2</b>) At 40–60 degrees—interaction with the tricuspid valve and the aortic valve. (<b>3</b>) At 70–90 degrees—interaction with the superior vena cava and inferior vena cava. (<b>4</b>) At 90–130 degrees—again, looking at the interaction with the SVC and IVC from different angles.</p>
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<p>Baseline and interventional imaging during PFO closure of a 62-year-old male with a history of embolic stroke. (<b>1</b>) Looking at the interatrial septum with color Doppler and showing the PFO (arrow). (<b>2</b>) Looking at the pulmonary veins ensuring no anomalous pulmonary veinous return. In the image, the left lower pulmonary vein is seen at 136 degrees with flow towards the left atrium (arrow) with no anomalous connection. (<b>3</b>) Guiding the procedure—showing the wire crossing through the PFO (arrow). (<b>4</b>) Balloon inflation in the PFO and color Doppler confirming no other defects in the septum. (<b>5</b>) Deployment of the left atrial disc, confirming stable position and no interaction with the left atrial appendage and the aortic/mitral valve. (<b>6</b>) Deployment of the right atrial disc, confirming its stability, and using color Doppler to confirm no other shunts or defects in the interatrial septum.</p>
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<p>Guiding the percutaneous closure of the SSVD of a 70-year-old female. (<b>1</b>) The SVC right atrium (RA) and the sinus venosus defect seen with and without color Doppler with right upper anomalous pulmonary vein (RUPV) return in red at 120 degrees. (<b>2</b>) The same defect at 0 degrees with the wire (arrow) in the SVC and confirming its position in the RA and not through the defect. (<b>3</b>) Confirming the position of the wire (arrow) from the interatrial septum and in the right upper pulmonary vein (the anomalous vein) to check pressures during the intervention. (<b>4</b>) Post implantation of the covered stent in the SVC showing closure of the SSVD with no obstruction to pulmonary vein flow (in red).</p>
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<p>TEE of a percutaneous muscular VSD closure in a 54-year-old male with symptomatic significant left-to-right shunt. (<b>1</b>) Transgastric view of the muscular VSD with and without color Doppler showing left-to-right shunt. (<b>2</b>) X-plane on the defect with color Doppler at different angles to decide on the best angle for guiding the intervention. (<b>3</b>) X-plane of a transgastric view with color Doppler showing the wire (red arrow) across the VSD at 75 and 165 degrees. (<b>4</b>) X-plane of a transgastric view showing the VSD closure device (red arrow) in position and still attached to the wire at 80 and 170 degrees. (<b>5</b>) The same view from (<b>4</b>), now with color Doppler showing no residual left-to-right shunt. (<b>6</b>) Transgastric view at 55 degrees with color Doppler showing the VSD closure device (red arrow) after release in a stable position.</p>
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<p>A 69-year-old male patient with a congenitally corrected transposition of the great arteries with severe tricuspid valve (systemic atrioventricular valve) regurgitation (TR). (<b>1</b>) Confirming the severity of the TR with and without color Doppler at 0 degrees and with X-plane color Doppler at 35 and 125 degrees in (<b>2</b>). (<b>3</b>) Measuring the size of the left atrium to confirm the feasibility of the clip procedure. (<b>4</b>) Guiding the crossing of the interatrial septum with X-plane color Doppler and confirming the position of the wire in the left atrium. (<b>5</b>) Three-dimensional view of the clipping device (red arrow) crossing the tricuspid valve from the left atrial view. (<b>6</b>) Looking at the tricuspid valve at 0 degrees after releasing the clip (red arrow), with and without color Doppler, and confirming the reduction in TR severity.</p>
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<p>Paravalve leak plugging in a 51-year-old male with symptomatic paravalve leak. (<b>1</b>–<b>3</b>) Looking at the posterior paravalve area and the leak at different angles, with and without color Doppler—0 degrees in (<b>1</b>), 42 degrees in (<b>2</b>), and 79 degrees in (<b>3</b>). The intervention. (<b>4</b>) Guiding the wire across the paravalve leak and confirming its position with and without color Doppler. (<b>5</b>) Seeing the catheter inside the paravalve leak area with color Doppler. (<b>6</b>) The catheter (red arrow) in the paravalve leak area in 3D.</p>
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<p>Baffle leak occlusion in a 46-year-old male patient with D-transposition of the great arteries post Mustard atrial switch operation and with a significant inferior systemic baffle leak. (<b>1</b>) Mid esophageal view at 90 degrees showing the systemic baffle leak with and without color Doppler, with flow crossing from the pulmonary venous baffle towards the IVC baffle. (<b>2</b>) Mid esophageal view at 0 degrees showing widely patent pulmonary venous baffle—easily recognized from the tricuspid valve (systemic AV-valve) with and without color Doppler. (<b>3</b>) Showing wire (arrow) across the systemic baffle leak. (<b>4</b>) Balloon sizing (1.13 cm) and occlusion of the defect with and without color Doppler. (<b>5</b>) Deploying the pulmonary venous baffle disc (arrow). (<b>6</b>) Deployment of the systemic venous baffle disc. (<b>7</b>) Final result with the device in a stable position and no more leaks visible by color Doppler.</p>
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<p>Fontan fenestration device closure in a 37-year-old male with lateral tunnel Fontan. (<b>1</b>) Mid esophageal view at 90 degrees with X-plane showing the fenestration closure device (red arrow) in stable position. (<b>2</b>) Showing the same device from (<b>1</b>) with and without color Doppler.</p>
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