Heart failure

ESC CardioMed ◽  
2018 ◽  
pp. 784-788
Author(s):  
Pieter De Meester ◽  
Werner Budts ◽  
Marc Gewillig
Keyword(s):  
Heart Failure ◽  
Patient Outcome ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Heart Transplantation ◽  
Congenital Heart ◽  
Common Presentation ◽  
Improve Patient ◽  
Residual Lesions

Heart failure is a common presentation of neonates and children with congenital heart disease and is the most important long-term complication in adults. It may be due to residual lesions and/or the complex circulation which are present even after repair. The mechanisms of heart failure are often different from normally built hearts and this will influence optimal treatment approaches. Several interventions (surgical, transcatheter, or pharmacological) can improve patient outcome and assist devices and heart transplantation are options in severe refractory cases.

scholarly journals Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease—a nationwide study

2020 ◽  
Author(s):  
Maria Fedchenko ◽  
Zacharias Mandalenakis ◽  
Kok Wai Giang ◽  
Annika Rosengren ◽  
Peter Eriksson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Older Patients ◽  
Congenital Heart ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
New Onset

Abstract Aims  We aimed to describe the risk of myocardial infarction (MI) in middle-aged and older patients with congenital heart disease (ACHD) and to evaluate the long-term outcomes after index MI in patients with ACHD compared with controls. Methods and results  A search of the Swedish National Patient Register identified 17 189 patients with ACHD (52.2% male) and 180 131 age- and sex-matched controls randomly selected from the general population who were born from 1930 to 1970 and were alive at 40 years of age; all followed up until December 2017 (mean follow-up 23.2 ± 11.0 years). Patients with ACHD had a 1.6-fold higher risk of MI compared with controls [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.5–1.7, P < 0.001] and the cumulative incidence of MI by 65 years of age was 7.4% in patients with ACHD vs. 4.4% in controls. Patients with ACHD had a 1.4-fold increased risk of experiencing a composite event after the index MI compared with controls (HR 1.4, 95% CI 1.3–1.6, P < 0.001), driven largely by the occurrence of new-onset heart failure in 42.2% (n = 537) of patients with ACHD vs. 29.5% (n = 2526) of controls. Conclusion  Patients with ACHD had an increased risk of developing MI and of recurrent MI, new-onset heart failure, or death after the index MI, compared with controls, mainly because of a higher incidence of newly diagnosed heart failure in patients with ACHD. Recognizing and managing the modifiable cardiovascular risk factors should be of importance to reduce morbidity and mortality in patients with ACHD.

scholarly journals Heart Transplantation in Congenital Heart Disease: In Whom to Consider and When?

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Christine H. Attenhofer Jost ◽  
Dörthe Schmidt ◽  
Michael Huebler ◽  
Christian Balmer ◽  
Georg Noll ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Heart Transplantation ◽  
Lung Transplantation ◽  
Congenital Heart ◽  
Complex Congenital Heart Disease ◽  
Eisenmenger’S Syndrome ◽  
Number Of Patients ◽  
Increased Risk

Due to impressive improvements in surgical repair options, even patients with complex congenital heart disease (CHD) may survive into adulthood and have a high risk of end-stage heart failure. Thus, the number of patients with CHD needing heart transplantation (HTx) has been increasing in the last decades. This paper summarizes the changing etiology of causes of death in heart failure in CHD. The main reasons, contraindications, and risks of heart transplantation in CHD are discussed and underlined with three case vignettes. Compared to HTx in acquired heart disease, HTx in CHD has an increased risk of perioperative death and rejection. However, outcome of HTx for complex CHD has improved over the past 20 years. Additionally, mechanical support options might decrease the waiting list mortality in the future. The number of patients needing heart-lung transplantation (especially for Eisenmenger’s syndrome) has decreased in the last years. Lung transplantation with intracardiac repair of a cardiac defect is another possibility especially for patients with interatrial shunts. Overall, HTx will remain an important treatment option for CHD in the near future.

scholarly journals Pacing-associated cardiomyopathy in adult congenital heart disease

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001374
Author(s):  
Benjamin M Moore ◽  
Caroline Medi ◽  
Mark A McGuire ◽  
David S Celermajer ◽  
Rachael L Cordina
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ventricular Function ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Pacemaker Implantation ◽  
Ventricular Pacing ◽  
Adult Congenital

ObjectivesLong-term single-site ventricular pacing may adversely affect ventricular function, due to dyssynchronous systemic ventricular contraction. We sought to determine the incidence, predictors and outcomes of pacing-associated cardiomyopathy (PACM) in an adult congenital heart disease (ACHD) cohort.MethodsWe retrospectively identified all patients in our database with a permanent pacemaker from 2000 to 2019. Patients were followed for the primary endpoint of unexplained decline in systemic ventricular function (PACM) and the secondary endpoint of heart failure admission.ResultsOf 2073 patients in our database, 106 had undergone pacemaker implantation. Over a median follow-up of 9.4 years, 25 patients (24%) developed PACM, but only in those with ventricular pacing percentage (VP%) ≥70%; PACM occurred in 0% of those with VP <70% and 47% of those with VP ≥70% (p<0.001). High-burden ventricular pacing (≥70%) remained predictive of PACM in transposition of the great arteries, tetralogy of Fallot and complex biventricular repair subgroups, but not in Fontan patients. Those with PACM were more likely to be admitted with heart failure (44% vs 15%, p=0.002). Cardiac resynchronisation therapy (CRT) upgrade was performed in 11 patients, with 9 responders (82%).ConclusionsIn a cohort of patients with ACHD followed long-term post-pacing, 24% developed cardiomyopathy that was significantly associated with a higher burden of ventricular pacing (VP ≥70%). Given promising response rates to CRT, patients with ACHD expected to pace in the ventricle should be closely monitored for systemic ventricular decline.

scholarly journals 0531: Long-term experience with heart transplantation in children and patients with congenital heart disease

2015 ◽  
Vol 7 (1) ◽  
pp. 21-22
Author(s):  
Sylvie Di Filippo ◽  
Magali Veyrier ◽  
Roland Henaine ◽  
Corinne Ducreux ◽  
Jean Ninet ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Heart Transplantation ◽  
Congenital Heart ◽  
Long Term Experience

Support/Transplantation

ESC CardioMed ◽  
2018 ◽  
pp. 788-790
Author(s):  
Michael Burch ◽  
Dilveer Panesar
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Heart Transplantation ◽  
Congenital Heart ◽  
Therapeutic Option ◽  
Blood Transfusions ◽  
End Stage

Heart transplantation is the only realistic therapeutic option for children with end-stage heart disease. Unlike in adults, ischaemic heart failure is rare and most paediatric transplant referrals are for cardiomyopathy and the rest for congenital heart disease. Patients with congenital heart disease pose difficulties in terms of their anatomy and the chronicity of the illness, often having had multiple surgeries and blood transfusions prior to transplantation.

Abstract 17289: A Baffling Heart: a 30 Year-old Man with Biventricular Heart Failure and Severe Pulmonary Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Lucas S Zier ◽  
Christopher Barnett ◽  
Elyse Foster
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Left Ventricular ◽  
Lv Dysfunction ◽  
Pulmonary Arterial

A thirty year-old man with an unknown surgery for congenital heart disease presented with intermittent chest pain and progressive decline in his exercise tolerance. Cardiovascular examination revealed a soft S1, loud S2 without splitting, right ventricular heave, a sustained and laterally displaced apical impulse and clubbing of his fingers. An echocardiogram showed d-transposition of the great arteries (d-TGA), a dilated, sub-pulmonic left ventricle (LV) with reduced function, smaller than expected sub-aortic right ventricle with reduced function, and elevated sub-pulmonic left ventricular systolic pressure without LV outflow tract obstruction. Cardiac MRI revealed d-TGA status post Senning repair, biventricular dysfunction without baffle obstruction, no evidence of repaired atrial or ventricular septal defect or delayed gadolinium enhancement. Cardiac catheterization showed a suprasystemic pulmonary artery pressure, a pulmonary vascular resistance of 18.4 Wood units and a small right to left shunt due to a baffle leak. No coronary disease was found on angiography. The patient was diagnosed with severe pulmonary arterial hypertension and biventricular dysfunction. This pattern of heart failure was discordant from the expected sequelae of palliated congenital heart defects as pulmonary arterial hypertension and LV dysfunction are both uncommon long-term complications after atrial switch. Systematic evaluation for a unifying cause of the patient’s pattern of heart failure was unrevealing until the patient presented with decompensated heart failure and evidence of stimulant withdrawal. Urine toxicology was positive for methamphetamine and the patient was diagnosed with methamphetamine induced pulmonary arterial hypertension and subpulmonic LV dysfunction. This case demonstrates the importance of understanding the common, long-term patterns of heart failure in repaired congenital heart disease and the need to search for alternative etiologies when the pattern is inconsistent. This case further shows the toxic effects of methamphetamine on the pulmonary vasculature and myocardium, which in our patient resulted in a highly unique pattern of sub-pulmonic LV dysfunction and pulmonary arterial hypertension.

scholarly journals Long-term experience with heart transplantation in children and patients with congenital heart disease

2014 ◽  
Vol 107 (8-9) ◽  
pp. 488
Author(s):  
S. Di Filippo ◽  
R. Henaine ◽  
M. Veyrier ◽  
C. Ducreux ◽  
J. Ninet ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Heart Transplantation ◽  
Congenital Heart ◽  
Long Term Experience
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