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The Journal of Veterinary Medical... Jun 2020A seven-month-old cat was referred for evaluation of exercise intolerance and open-mouth breathing. Based on ultrasonographic examination, caudal vena cava (CVC)...
A seven-month-old cat was referred for evaluation of exercise intolerance and open-mouth breathing. Based on ultrasonographic examination, caudal vena cava (CVC) aneurysm associated with right congestive heart failure resulting from congenital heart disease was diagnosed. Conservative treatment for alleviating pulmonary hypertension mildly improved the clinical signs and decreased the heart size and CVC aneurysm diameter. However, the improvements were transient and four months after initiating therapy, the cat developed dyspnea and uncontrollable seizures and was euthanized.
Topics: Aneurysm; Animals; Cat Diseases; Cats; Echocardiography; Eisenmenger Complex; Heart Defects, Congenital; Heart Failure; Hypertension, Pulmonary; Male; Ultrasonography; Vena Cava, Inferior
PubMed: 32418943
DOI: 10.1292/jvms.19-0518 -
Journal of Clinical Medicine May 2020Pulmonary hypertension (PH) is a common complication in patients with congenital heart disease (CHD), aggravating the natural, post-operative, or post-interventional...
INTRODUCTION
Pulmonary hypertension (PH) is a common complication in patients with congenital heart disease (CHD), aggravating the natural, post-operative, or post-interventional course of the underlying anomaly. The various CHDs differ substantially in characteristics, functionality, and clinical outcomes among each other and compared with other diseases with pulmonary hypertension.
OBJECTIVE
To describe current management strategies and outcomes for adults with PH in relation to different types of CHD based on real-world data.
METHODS AND RESULTS
COMPERA (Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension) is a prospective, international PH registry comprising, at the time of data analysis, >8200 patients with various forms of PH. Here, we analyzed a subgroup of 680 patients with PH due to CHD, who were included between 2007 and 2018 in 49 specialized centers for PH and/or CHD located in 11 European countries. At enrollment, the patients´ median age was 44 years (67% female), and patients had either pre-tricuspid shunts, post-tricuspid shunts, complex CHD, congenital left heart or aortic disease, or miscellaneous other types of CHD. Upon inclusion, targeted therapies for pulmonary arterial hypertension (PAH) included endothelin receptor antagonists, PDE-5 inhibitors, prostacyclin analogues, and soluble guanylate cyclase stimulators. Eighty patients with Eisenmenger syndrome were treatment-naïve. While at inclusion the primary PAH treatment for the cohort was monotherapy (70% of patients), with 30% of the patients on combination therapy, after a median observation time of 45.3 months, the number of patients on combination therapy had increased significantly, to 50%. The use of oral anticoagulants or antiplatelets was dependent on the underlying diagnosis or comorbidities. In the entire COMPERA-CHD cohort, after follow-up and receiving targeted PAH therapy ( = 511), 91 patients died over the course of a 5-year follow up. The 5-year Kaplan-Meier survival estimate for CHD associated PH was significantly better than that for idiopathic PAH (76% vs. 54%; < 0.001). Within the CHD associated PH group, survival estimates differed particularly depending on the underlying diagnosis and treatment status.
CONCLUSIONS
In COMPERA-CHD, the overall survival of patients with CHD associated PH was dependent on the underlying diagnosis and treatment status, but was significantly better as than that for idiopathic PAH. Nevertheless, overall survival of patients with PAH due to CHD was still markedly reduced compared with survival of patients with other types of CHD, despite an increasing number of patients on PAH-targeted combination therapy.
PubMed: 32414075
DOI: 10.3390/jcm9051456 -
BMC Cardiovascular Disorders Apr 2020Early identification of congenital heart disease (CHD) allows detection of the pulmonary arteriopathy in an early stage, and timely shunt closure can permanently reverse...
BACKGROUND
Early identification of congenital heart disease (CHD) allows detection of the pulmonary arteriopathy in an early stage, and timely shunt closure can permanently reverse pulmonary arterial hypertension (PAH). However, surgical correction is not recommended in patients with irreversible PAH. Herein we report our experience about Eisenmenger's syndrome in simple CHD.
CASE PRESENTATION
From January 2017 to November 2018, a total of 8 CHD patients (3 ventricular septal defects (VSD), 2 atrial septal defects (ASD), and 3 patent ductus arteriosus (PDA), median age, 15.5 years [range, 3-18 years]) with PAH were detected by chest X-ray, electrocardiogram, transthoracic echocardiography (TTE), computed tomographic angiography (CTA) and cardiac catheterization. The median defect diameter, pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) were 16.5 mm (range, 3-30 mm), 75 mmHg (range, 60-86 mmHg), and 16 Woods units (range, 12-19 Woods units), respectively. Here, we report the representative cases of three types of simple CHD with irreversible PAH. The surgical correction was not performed in all patients who had fixed PAH and were referred to medical treatment.
CONCLUSIONS
PAH in CHD can be reversed by early shunt closure, but this potential is lost beyond a certain point of no return. This article highlights the essence of enhancing the level of healthcare and services in Chinese rural areas. Failure to accurately and timely assess PAH will delay effective treatment past optimal treatment time, and even lead to death.
Topics: Adolescent; Arterial Pressure; Child; Computed Tomography Angiography; Early Diagnosis; Echocardiography; Eisenmenger Complex; Female; Humans; Male; Predictive Value of Tests; Prognosis; Pulmonary Arterial Hypertension; Pulmonary Artery
PubMed: 32326907
DOI: 10.1186/s12872-020-01489-y -
Journal of the American Heart... Mar 2020Background Patients with Eisenmenger syndrome are known to have a high incidence of sudden cardiac death (SCD), yet the underlying causes are not well understood. We...
Background Patients with Eisenmenger syndrome are known to have a high incidence of sudden cardiac death (SCD), yet the underlying causes are not well understood. We sought to define the predictors of SCD in this population. Methods and Results A retrospective analysis of all patients with Eisenmenger syndrome from 2 large tertiary referral centers was performed. ECGs, prolonged ambulatory recordings, echocardiograms, and clinical histories were reviewed; and the cause of death was identified. A total of 246 patients (85 [34.6%] men) with a mean age of 37.3 (±14.2) years were followed up for a median of 7 years. Over the study period, 136 patients died, with 40 experiencing SCD and 74 experiencing cardiac death (sudden and nonsudden). Age, atrial fibrillation, prolonged QRS duration, complete heart block, right atrial enlargement, right bundle branch block, increased right atrial pressure, impaired biventricular function, and the presence of a pacemaker were associated with increased risk of SCD, whereas advanced pulmonary hypertension therapies were protective. Atrial fibrillation (11.45-fold increased risk; <0.001) and QRS duration ≥120 ms (2.06-fold increased risk; =0.034) remained significant predictors of SCD in the multivariate analysis, whereas advanced pulmonary hypertension therapies were strongly protective against SCD (<0.001). Conclusions Atrial arrhythmias, impaired ventricular function, and conduction system disease were associated with increased risk of SCD in this cohort of patients with Eisenmenger syndrome, providing an opportunity for early risk stratification and potential intervention. Clinical heart failure symptoms (New York Heart Association class ≥II) were predictive of increased mortality but not of SCD, suggesting a potential arrhythmic cause behind SCD.
Topics: Adult; Arrhythmias, Cardiac; Cause of Death; Death, Sudden, Cardiac; Eisenmenger Complex; Female; Florida; Humans; Los Angeles; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Young Adult
PubMed: 32174228
DOI: 10.1161/JAHA.119.014554 -
Dental and Medical Problems 2020The various abnormalities of occlusion cause significant discomfort to the patient suffering from them. Currently, the surgical treatment of malocclusion in healthy...
The various abnormalities of occlusion cause significant discomfort to the patient suffering from them. Currently, the surgical treatment of malocclusion in healthy patients is a routine process. The situation is completely different when the patient has a serious disease of the respiratory or cardiovascular system - a condition which may contraindicate such treatment. A 30-year-old female patient, with a class III skeletal defect (open bite and progeny) and Eisenmenger's syndrome was chosen as a clinical case. The DDS-Pro software was selected to plan the operation. The bilateral sagittal split osteotomy of the mandible was selected as the method of surgery. At the time of the initial examination, the patient had been denied surgical treatment several times in several other clinics. Before the treatment began, the patient underwent intensive preparation in the cardiac surgery unit for 2.5 months. Using the software, a surgical intervention was planned with the production of a surgical template. The operation was then performed; the treatment period was unremarkable. The resulting occlusion and changes in the shape of the face fully met the patient's psychological and esthetic expectations. In conclusion, a complicated cardiovascular pathology does not always deprive patients with malocclusion of the possibility to undergo surgical treatment.
Topics: Adult; Eisenmenger Complex; Esthetics, Dental; Female; Humans; Malocclusion; Mandible; Mandibular Osteotomy
PubMed: 32083816
DOI: 10.17219/dmp/113206 -
Archives de Pediatrie : Organe Officiel... Feb 2020In patients with congenital heart diseases, new procedures, such as transcatheter valve replacement, have been associated with a non-negligible incidence of infective...
In patients with congenital heart diseases, new procedures, such as transcatheter valve replacement, have been associated with a non-negligible incidence of infective endocarditis (IE): up to 4% patient-year IE incidence. Prosthetic IE after percutaneous tricuspid valve replacement (PTVR) has been scarcely reported. We report the first pediatric case of IE after percutaneous tricuspid Melody™ valve-in-valve implantation in a boy who was diagnosed with Eisenmenger syndrome, related to patent ductus arteriosus. This first pediatric case of late IE (4 years) after PTVR is added to eight previously reported cases of IE from the valve-in-valve international database registry (VIVID registry).
Topics: Adolescent; Ductus Arteriosus, Patent; Eisenmenger Complex; Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Prosthesis-Related Infections; Staphylococcal Infections; Staphylococcus epidermidis; Time Factors; Tricuspid Valve
PubMed: 31955957
DOI: 10.1016/j.arcped.2019.12.002 -
Annals of Cardiac Anaesthesia 2020Successful management of a pregnant patient with complex congenital heart disease is a challenge for anesthesiologists, requiring thorough knowledge of the impact of...
Successful management of a pregnant patient with complex congenital heart disease is a challenge for anesthesiologists, requiring thorough knowledge of the impact of pregnancy on the cardiac lesion. Hearing and speech impaired patients pose a barrier to effective communication between the patient and the doctors, thus increasing the anxiety and risk of complications. Here, we present a case of a hearing and speech impaired woman with the rare and dangerous Eisenmenger's syndrome, presenting for an emergency cesarean section (CS).
Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Cesarean Section; Dyspnea; Eisenmenger Complex; Female; Heart Murmurs; Humans; Pregnancy; Pregnancy Complications, Cardiovascular
PubMed: 31929258
DOI: 10.4103/aca.ACA_175_18 -
Anatolian Journal of Cardiology Jan 2020
Topics: Adult; Coronary Angiography; Coronary Stenosis; Diagnosis, Differential; Dyspnea; Eisenmenger Complex; Electrocardiography; Female; Humans; Pulmonary Artery; Video Recording
PubMed: 31911563
DOI: 10.14744/AnatolJCardiol.2019.38845 -
Kardiologia Polska Feb 2020
Topics: Death, Sudden, Cardiac; Defibrillators, Implantable; Eisenmenger Complex; Humans
PubMed: 31821312
DOI: 10.33963/KP.15098 -
Acute and Critical Care Feb 2020The presentation of coronary artery disease in a patient with Eisenmenger syndrome (ES) is relatively rare. Cardiogenic shock due to coronary artery dissection during...
The presentation of coronary artery disease in a patient with Eisenmenger syndrome (ES) is relatively rare. Cardiogenic shock due to coronary artery dissection during percutaneous coronary intervention (PCI) can be more critical in these patients. Here, we report a case of successful PCI under mechanical circulation support in a patient with ES who experienced potentially fatal right coronary artery dissection. This case emphasizes that use of extracorporeal membrane oxygenation (ECMO) can lead to successful management of critical complication during PCI, and that the immediate decision to apply of ECMO is important in ES patients who face impending cardiogenic shock with acute heart failure.
PubMed: 31743640
DOI: 10.4266/acc.2017.00024