Acute Heart Failure in Adult Patients with Congenital Heart Disease

We report a case of 46 year-old man, admitted to our Department for a possible massive pulmonary embolism. Instead, diagnosis of Tetralogy of Fallot was established by echocardiography and cardiac catetherization.

Download Full-text

Acute heart failure in congenital heart disease in adults: a single-institution study in Latin-America

European Heart Journal ◽

10.1093/eurheartj/ehab724.1886 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D B Ortega Zhindon ◽

H Gonzalez-Pacheco ◽

J L Cervantes-Salazar ◽

J Calderon-Colmenero ◽

D Manzur-Sandoval ◽

...

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Congenital Heart ◽

Group Iv ◽

Group V ◽

Group Iii ◽

Group I

Abstract Background Heart failure in the adult with adult congenital heart disease (ACHD) is a current topic due to its association with high morbidity and mortality and has been implicated as the leading cause of death in these kinds of patients. Purpose This study reports experience of patients with ACHD and Acute Heart Failure (AHF) hospitalized at a teaching center specialized in cardiovascular disease in Latin America. Methods A retrospective cohort study of patients with AHF who were hospitalized in the coronary care unit of a Latin-American teaching hospital from January 2006 to December 2018. Patients with ACHD were identified and their clinical characteristics and in-hospital evolution were analyzed. Results During the study period, of 7,759 patients admitted with AHF, 181 (2.3%) had ACHD. Their median age was 34 years and 53.6% were men. Patients were grouped as follows: (Group I) left to right shunt 51.4%, (Group II) left ventricular outflow tract obstruction 17.7%, (Group III) outflow tract obstruction of the right ventricle 7.2%, (Group IV) conotronchal anomalies 3.9% and (Group V) miscellaneous group 19.9%. In general, history of previous surgery was in 28.2%, the frequency was higher in Group I and Group III (38.5% and 31.3%, respectively). Overall, all-cause in-hospital mortality was higher among patients with AHF- ACHD compared with patients without ACHD with AHF (23.2% vs. 17.8%; p=0.05). Unadjusted in-hospital mortality was not significant different across the five groups (21.5%, 28.1%, 7.7%, 42.9% and 25.0% for Group I, Group II, Group III, Group IV and Group V, respectively; p=0.41) (Figure 1). Conclusions Adult patients with congenital heart disease and acute heart failure are a challenge in clinical and surgical management that entails a high in-hospital mortality. A high percentage of these patients are candidates for surgical treatment. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Download Full-text

Prevalence and risk factors of sleep apnea in adult patients with congenital heart disease

Cardiology in the Young ◽

10.1017/s1047951119000179 ◽

2019 ◽

Vol 29 (5) ◽

pp. 576-582 ◽

Cited By ~ 2

Author(s):

Gen Harada ◽

Daiji Takeuchi ◽

Kei Inai ◽

Tokuko Shinohara ◽

Toshio Nakanishi

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Sleep Apnea ◽

Congenital Heart ◽

Adult Patients ◽

Respiratory Disturbance Index ◽

Disturbance Index ◽

Respiratory Disturbance

AbstractBackground:Although sleep apnea is an important disorder associated with cardiac events, data regarding its prevalence and risk factors in adult patients with congenital heart disease are limited.Methods:In this study, patients underwent a sleep study in the hospital. Indications for admission were classified as heart failure, diagnostic catheterisation, interventional catheterisation, or arrhythmia. The prevalence, characteristics, and risk factors of sleep apnea using a type-3 portable overnight polygraph in adult patients with congenital heart disease were evaluated.Results:There were 104 patients [median age: 36 (interquartile range: 28–48) years] who were admitted for heart failure 34% (n = 36), diagnostic catheterisation 26% (n = 27), interventional catheterisation 18% (n = 19), or arrhythmia 22% (n = 23). The prevalence of sleep apnea, defined as a respiratory disturbance index ≥5, was 63% (n = 63), with a distribution of 37%, 16%, and 10% for mild (5≤ respiratory disturbance index <15), moderate (15≤ respiratory disturbance index <30), and severe (respiratory disturbance index ≥30) sleep apnea, respectively. A large majority of the sleep apnea cases were categorised as obstructive sleep apnea (92%, n = 58). The respiratory disturbance index ≥15 group had a significantly higher proportion of male patients and higher body mass index, noradrenaline level, and aortic blood pressure than the group without sleep apnea (respiratory disturbance index <5). Multivariable analysis showed that New York Heart Association class ≥II (OR, 4.36; 95% CI, 1.09–20.87) and body mass index ≥25 (OR, 4.29; 95% CI, 1.32–15.23) were independent risk factors for a respiratory disturbance index ≥15.Conclusion:Our results showed a high prevalence of sleep apnea in adult patients with congenital heart disease. Its unique haemodynamics may be associated with a high prevalence of sleep apnea. Congestive heart failure and being overweight are important risk factors for sleep apnea. Management of heart failure and general lifestyle improvements will be important for controlling sleep apnea symptoms in these patients.

Download Full-text

Causes of death in a contemporary adult congenital heart disease cohort

Heart ◽

10.1136/heartjnl-2017-312777 ◽

2018 ◽

Vol 104 (20) ◽

pp. 1678-1682 ◽

Cited By ~ 25

Author(s):

Christopher Yu ◽

Benjamin M Moore ◽

Irina Kotchetkova ◽

Rachael L Cordina ◽

David S Celermajer

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Cause Of Death ◽

Congenital Heart ◽

Causes Of Death ◽

Adult Congenital Heart Disease ◽

Premature Death ◽

Adult Patients ◽

Age Of Death

ObjectiveThe life expectancy of patients with congenital heart disease (CHD) has significantly improved with advances in their paediatric medical care. Mortality patterns are changing as a result. Our study aims to describe survival and causes of death in a contemporary cohort of adult patients with CHD.MethodsWe reviewed 3068 patients in our adult CHD database (age ≥16 years, seen at least once in our centre between 2000 and 2015), and documented the number and causes of death, via Australia’s National Death Index. Survival and mortality patterns were analysed by complexity of CHD and by underlying congenital diagnosis.ResultsOur cohort comprised 3068 adult patients (53% male). The distribution of patients (per the Bethesda classification) was 47% simple, 34% moderate and 18% complex (1% not classifiable). Over a median follow-up of 6.2 years (IQR 3.5–10.4), 341 patients (11%) died with an incidence of 0.4 deaths/100 patient years (py). Survival was significantly worse with increasing complexity of CHD (p<0.001); mortality rate in the simple group was 0.3 deaths/100 py with a median age of death 70 years, and in the complex group was 1.0 death/100 py with a median age of death 34 years. Overall, non-cardiac causes of death outnumbered cardiac causes, at 54% and 46%, respectively. The leading single cause of death was heart failure (17%), followed by malignancy (13%). Simple adult CHD patients mostly died due to non-cardiac causes such as malignancy. Perioperative mortality only accounted for 5% of deaths.ConclusionsPremature death is common in adults with CHD. Although heart failure remains the most common cause of death, in the contemporary era in a specialist CHD centre, non-cardiac related deaths outnumber cardiac deaths, particularly in those with simple CHD lesions.

Download Full-text