ADOLESCENTS WITH CONGENITAL HEART DISEASE: A HIGH RISK GROUP

Amiodarone therapy in adults with congenital heart disease (CHD) is associated with a significant risk of amiodarone-induced thyrotoxicosis (AIT). We developed a risk index to identify those patients being considered for amiodarone treatment who are at high risk for AIT. We reviewed the health records of adults with CHD and assessed the association between potential clinical predictors and AIT. Significant predictors were included in multivariate analyses. The parameter estimates from multivariate analysis were subsequently used to develop a risk index. 169 adults met eligibility criteria and 23 developed AIT. The final model included age, cyanotic heart disease and BMI. The risk index developed identified 3 categories of risk. Their AIT likelihood ratios were: 0.37 for low risk (95% CI 0.15–0.92); 1.12 for medium risk (95% CI 0.65–1.91); and 3.47 for high risk (95% CI 1.7–7.11). The AIT predicted risk in our population was 5% for the low risk group, 15% for the medium risk group and 47% for the high risk group.Conclusions. We derived the first model to quantify the risk for developing AIT among adults with CHD. Before using it clinically to help selecting among alternative antiarrhythmic options, it needs validation in an independent population.

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Cerebral Emboli during Cardiac Surgery in Children

Anesthesiology ◽

10.1097/00000542-199711000-00009 ◽

1997 ◽

Vol 87 (5) ◽

pp. 1063-1069 ◽

Cited By ~ 35

Author(s):

James J. O'Brien ◽

John Butterworth ◽

John W. Hammon ◽

Kristin J. Morris ◽

Julia M. Phipps ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

High Risk ◽

Congenital Heart ◽

Risk Group ◽

Heart Defects ◽

Low Risk ◽

Time Interval ◽

Significant Difference

Background Microemboli occur commonly during cardiac surgery in adults, and, when present, increase the risk of neuropsychological deficits. Their incidence and significance during correction of congenital heart disease is unknown. The authors hypothesized that microemboli would occur before bypass with right-to-left cardiac shunts and would also occur in large numbers when the aortic crossclamp was released in children during repair of congenital heart defects. Methods In 25 children studied with carotid artery Doppler, embolic signals were counted and timed in relation to 13 intraoperative events. Patients were classified as either at high risk (obligate right-to-left shunt or uncorrected transposition of the great arteries) or at low risk (net left-to-right shunt or simple obstructive lesions) for paradoxical (venous to arterial) emboli. Results The median number of emboli detected was 122 (range, 2-2,664). Forty-two percent of all emboli were detected within 3 min of release of the aortic crossclamp. The high-risk group had significantly more emboli (median, 66; range, 0-116) during the time interval before cardiopulmonary bypass than did the low-risk group (median, 8; range, 0-73), with P < 0.01. There was no significant difference between the high- and low-risk groups in the total number of emboli detected. There was no apparent association between number of emboli and gross neurologic deficits. Conclusions Microemboli can be detected in the carotid arteries of children undergoing repair of congenital heart disease and are especially prevalent immediately after release of the aortic crossclamp. The role of emboli in causing neurologic injury in children undergoing repair of congenital heart disease remains to be determined.

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Survival of Patients with High-Risk Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.06.12404 ◽

2021 ◽

Vol 104 (6) ◽

pp. 895-901

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

High Risk ◽

Congenital Heart ◽

First Year ◽

Pulmonary Arterial ◽

Group 3 ◽

Group 2 ◽

Group 1

Background: Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) with uncorrected left-to-right shunts. Currently, no consensus guideline exists on the management of PAH-CHD in children, especially those who do not meet operability criteria. Objective: To compare survival between three groups of high-risk PAH-CHD, group 1: total correction including both surgical and percutaneous intervention, group 2: palliative treatment, and group 3: conservative with medical treatment group. Materials and Methods: All pediatric patients with PAH-CHD that underwent cardiac catheterization between January 1, 2008 and December 31, 2017 were retrospectively reviewed. Inclusion criteria were high risk PAH-CHD patients who had pulmonary vascular resistance (PVR) greater than 6 Wood unit·m² and PVR-to-SVR ratio greater than 0.3 evaluated in room air. Exclusion criteria were younger than three months of age, severe left side heart disease with pulmonary capillary wedge pressure greater than 15 mmHg, obstructive total pulmonary venous return, and single ventricle physiology. The Kaplan-Meier analysis was performed from the date of PAH diagnosis to the date of all-cause mortality or to censored date at last follow-up. Results: Seventy-six patients with a median age at diagnosis of 27.5 months (IQR 14.5 to 69.0 months) were included in this study. The patients were divided into three subgroups and included 38 patients (50.0%) in group 1, six patients (7.9%) in group 2, and 32 patients (42.1%) in group 3. The median follow-up time was 554 days (IQR 103 to 2,133 days). The overall mortality was 21.7%. One-year survival in patients with simple lesion in group 1 and 3 were 79.5% and 87.5% and patients with complex lesions in group 1, 2, and 3 were 93.8%, 83.3%, and 73.1%, respectively. The results showed that most mortalities occurred in the first year. There were no statistically significant differences in survival among difference types of treatment (log rank test, p=0.522). Conclusion: The mortality of high-risk PAH-CHD patients were not different among those who underwent corrective surgery, palliative, or conservative treatment. The mortality was high in the first year after PAH diagnosis and remain stable afterward. Management decision for an individual with high-risk PAH-CHD patients requires comprehensive clinical assessment to balance the risks and benefits before making individualized clinical judgment. Keywords: Pulmonary hypertension; Congenital heart disease; High-risk patients

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Contraception and pregnancy

10.1093/med/9780199228188.003.0028 ◽

2011 ◽

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

High Risk ◽

General Population ◽

Congenital Heart ◽

Post Partum ◽

Maternal Risk ◽

Risk Of Death ◽

Pregnancy And Delivery

Introduction 208General principles 208Contraception 210Preconception 214Pregnancy and delivery 218Post-partum 220Heart disease is the largest single cause of maternal death in the UK4. The number and complexity of survivors of congenital heart disease well enough to consider pregnancy is growing. The maternal risk amongst this population varies from being no different to that of the general population, to carrying a high risk of long-term morbidity and >40% risk of death....

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The association between feeding protocol compliance and weight gain following high-risk neonatal cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951119000222 ◽

2019 ◽

Vol 29 (5) ◽

pp. 594-601 ◽

Cited By ~ 1

Author(s):

Jamie M. Furlong-Dillard ◽

Benjamin J. Miller ◽

Kathy A. Sward ◽

Alaina I. Neary ◽

Trudy L. Hardin-Reynolds ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Weight Gain ◽

High Risk ◽

Congenital Heart ◽

Clinical Severity ◽

Z Score ◽

Protocol Adherence ◽

Feeding Protocol ◽

Weight For Age

AbstractBackground:Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions’ feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols.Methods:Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals.Results:Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates.Conclusions:High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.

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High-Risk Reoperative Sternotomy—How We Do It, How We Teach It

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120922222 ◽

2020 ◽

Vol 11 (4) ◽

pp. 459-465

Author(s):

Siddharth Pahwa ◽

Elizabeth H. Stephens ◽

Joseph A. Dearani

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

High Risk ◽

Congenital Heart ◽

Preoperative Evaluation ◽

Cardiac Injury ◽

Insight Into ◽

Level Of Risk

With the increasing number of congenital heart disease patients living into adulthood and requiring reoperations, learning a safe and efficient reoperative sternotomy is essential. This article provides insight into the successful reoperative sternotomy, including preoperative evaluation, assessing risk for cardiac injury and preparations to take depending on the level of risk, safeguards taken before and during the sternotomy, and pearls and pitfalls in managing untoward events.

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