scholarly journals Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC)

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318685
Author(s):  
Oktay Tutarel ◽  
Lucia Baris ◽  
Werner Budts ◽  
Mohamad Gamal Abd-El Aziz ◽  
Csilla Liptai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricle ◽  
Maternal Mortality ◽  
Cardiac Disease ◽  
Pregnancy Outcomes ◽  
Fetal Loss ◽  
Coronary Event ◽  
Fetal Outcome ◽  
Mortality Data ◽  
Systemic Right Ventricle

ObjectiveCardiac disease is a major cause of maternal mortality. Data regarding pregnancy outcomes in women with a systemic right ventricle (sRV) are scarce. We studied pregnancy outcomes in women with an sRV after the atrial switch procedure for transposition of the great arteries (TGA) or congenitally corrected TGA (CCTGA).MethodsThe ESC EORP Registry of Pregnancy and Cardiac Disease is an international prospective registry of pregnant women with cardiac disease. Pregnancy outcomes (maternal/fetal) in all women with an sRV are described. The primary end point was a major adverse cardiac event (MACE) defined as maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischaemic coronary event and other thromboembolic events.ResultsAltogether, 162 women with an sRV (TGA n=121, CCTGA n=41, mean age 28.8±4.6 years) were included. No maternal mortality occurred. In 26 women, at least one MACE occurred, heart failure in 16 (9.8%), arrhythmias (atrial 5, ventricular 6) in 11 (6.7%) and others in 4 (2.5%). Prepregnancy signs of heart failure as well as an sRV ejection fraction <40% were predictors of MACE. One woman experienced fetal loss, while no neonatal mortality was observed. No significant differences were found between women with CCTGA and TGA. In the subset of women who had an echocardiogram before and after pregnancy, no clear deterioration in sRV was observed.ConclusionThe majority of women with an sRV tolerated pregnancy well with a favourable maternal and fetal outcome. Heart failure and arrhythmias were the most common MACE.

scholarly journals Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries. Results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Tutarel ◽  
L Baris ◽  
M Johnson ◽  
R Hall ◽  
J.W Roos-Hesselink
Keyword(s):  
Heart Failure ◽  
Right Ventricle ◽  
Maternal Mortality ◽  
Cardiac Disease ◽  
Pregnancy Outcomes ◽  
Fetal Loss ◽  
Coronary Event ◽  
Fetal Outcome ◽  
Systemic Right Ventricle ◽  
Before And After

Abstract Background Cardiac disease is one of the major causes of maternal mortality. We studied pregnancy outcomes in women with a systemic right ventricle (sRV) after the atrial switch procedure for transposition of the great arteries (TGA) or congenitally corrected TGA (CCTGA). Methods The ESC-EORP Registry of Pregnancy and Cardiac Disease is an international prospective registry of pregnant women with cardiac disease. Pregnancy outcomes (maternal and fetal) in women with a sRV are described. The primary endpoint was a major cardiovascular event (MACE) defined as maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary event and other thromboembolic events. Results Altogether, 163 women with a sRV (TGA n=121, CCTGA n=42, mean age 28.8±4.6 years) were included. Maternal mortality did not occur. At least one MACE occurred in 26 women (heart failure in 16 (9.8%), arrhythmias (atrial 5, ventricular 6) in 11 (6.7%), and others in 4 (2.5%)). Predictors of MACE were pre-pregnancy signs of heart failure [Odds ratio (OR) 6.05, 95% CI: 1.41–25.97, p=0.02] as well as a sRV ejection fraction below 40% [OR 2.81, 95% CI: 1.18–6.69, p=0.02]. One woman experienced fetal loss, while no neonatal mortality was observed. No significant differences were found between women with CCTGA and TGA. In the subset of women who had an echocardiogram before and after pregnancy, no clear deterioration in sRV was observed. Conclusion The majority of women with a sRV tolerated pregnancy well with a favorable maternal and fetal outcome. Heart failure and arrhythmias were the most common MACE. Funding Acknowledgement Type of funding source: None

Effect of medical treatment on heart failure incidence in patients with a systemic right ventricle

2021 ◽  
Vol 13 (4) ◽  
pp. 288
Author(s):  
Magalie Ladouceur ◽  
Teresa Segura de la Cal ◽  
Bamba Gaye ◽  
Eugénie Valentin ◽  
Reamsmei Ly ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricle ◽  
Medical Treatment ◽  
Systemic Right Ventricle

scholarly journals MicroRNA-183-3p Is a Predictor of Worsening Heart Failure in Adult Patients With Transposition of the Great Arteries and a Systemic Right Ventricle

2021 ◽  
Vol 8 ◽  
Author(s):  
Masood Abu-Halima ◽  
Eckart Meese ◽  
Hashim Abdul-Khaliq ◽  
Tanja Raedle-Hurst
Keyword(s):  
Heart Failure ◽  
Right Ventricle ◽  
Cox Regression ◽  
Independent Predictor ◽  
Array Analysis ◽  
Cox Regression Analysis ◽  
Mirna Array ◽  
Systemic Right Ventricle ◽  
And Gender ◽  
Mirna Abundance

Aim: MicroRNAs (miRNAs) have been shown to play an important role in the progression of heart failure (HF). The aim of our study was to analyze miRNAs in the blood of patients with transposition of the great arteries and a systemic right ventricle (TGA-RV) in order to identify those that predict worsening HF.Materials and Methods: In 36 patients with TGA-RV, SurePrint™ 8 × 60K Human v21 miRNA microarrays were used to determine the miRNA abundance profiles and compared to 35 age- and gender-matched healthy volunteers (HVs). MiRNAs that were most significantly abundant or best related to worsening HF were further validated by RT-qPCR.Results: Using miRNA array analysis, a total of 50 down-regulated and 56 up-regulated miRNAs were found to be differentially abundant in TGA-RV patients compared to HVs. Six of these 106 miRNAs were significantly related to worsening HF. After validation by RT-qPCR, four miRNAs turned out to be significantly associated with worsening HF, namely miR-150-5p, miR-1255b-5p, miR-423-3p, and miR-183-3p. In the stepwise multivariable Cox regression analysis, ejection fraction of the systemic RV, high sensitive TNT and miR-183-3p were found to be independent predictors of worsening HF (P = 0.001, P = 0.002, and P = 0.001, respectively).Conclusions: In patients with TGA-RV, miR-183-3p is an independent predictor of worsening HF and thus may be used as additional biomarker in the risk assessment of these patients.

scholarly journals Adverse remodeling of the subpulmonary left ventricle in patient with systemic right ventricle is associated with clinical outcome

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
B Santens ◽  
F Helsen ◽  
A Van De Bruaene ◽  
P De Meester ◽  
A Budts ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Clinical Outcome ◽  
Right Ventricle ◽  
Prognostic Markers ◽  
Volume Index ◽  
Short Term ◽  
Systemic Right Ventricle ◽  
Adverse Remodeling

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This research received project funding by KU Leuven Background – Early recognition of adverse remodeling is important since outcome is unfavorable once patients with a systemic right ventricle (sRV) become symptomatic. We aimed assessing prognostic markers linked to short-term clinical evolution in this population.  Purpose - We aimed assessing short-term clinical evolution and early prognostic markers of cardiac complications in adults with sRV (atrial switch repair for D-transposition of the great arteries (D-TGA) and congenitally corrected transposition of the great arteries (ccTGA)) based on detailed phenotyping.  Methods– Thirty-three patients with sRV underwent detailed phenotyping including exercise CMR. Adverse outcome was a composite of heart failure episode and tachyarrhythmia. Descriptive statistics and univariate cox regression analyses were performed.  Results - Thirty-three patients (76% male) with sRV were followed over mean follow-up time of 3 years. Mean age was 40 ± 8 (range 26-57) years at latest follow-up. When compared to baseline, (I) most patients remained in NYHA functional class I (76%),  (II) the degree of severity of the SAVV regurgitation rose and (III) more electrical instability was documented at latest follow-up. Six (18%) of a total of nine events were counted as first cardiovascular events (9% heart failure, 9% arrhythmia). NTproBNP (HR 11.02 (95%CI 1.296-93.662), p= 0.028), oxygen pulse (HR 1.202 (95% CI 1.012-1.428), p = 0.037), left ventricle end diastolic volume index (LVEDVi) in rest (HR 1.046 (95% CI 1.002-1.092), p = 0.041) and during exercise (HR 1.035 (95% CI 1.002-1.069), p = 0.038), stroke volume index (SVi) of the subpulmonary left ventricle (LV) in rest (HR 1.154 (95% CI 1.005-1.322), p = 0.038) and at peak exercise (HR 1.065 (95% CI 1.007-1.125), p = 0.026) were significantly associated with the first cardiovascular event (Figure 1A and B).  Conclusion – NTproBNP was by far the best prognostic marker for clinical outcome. Adverse remodelling with increase of LVEDVi and SVi of the subpulmonary LV at rest and during exercise were associated with worse clinical outcome. We theorize that remodeling of the subpulmonary ventricle might be an early sign of a failing sRV circulation (Figure 2).

scholarly journals Improving the Metrics and Data Reporting for Maternal Mortality:A Challenge to Public Health Surveillance and Effective Prevention

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
James Studnicki ◽  
David Reardon ◽  
Donna Harrison ◽  
John Fisher ◽  
Ingrid Skop
Keyword(s):  
Maternal Mortality ◽  
Pregnancy Outcome ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Maternal Mortality Ratio ◽  
Mortality Data ◽  
Evidence Based ◽  
Maternal Deaths ◽  
Effective Prevention ◽  
Mortality Ratio

AbstractBackgroundThe current measuring metric and reporting methods for assessing maternal mortality are seriously flawed. Evidence-based prevention strategies require consistently reported surveillance data and validated measurement metrics.Main BodyThe denominator of live births used in the maternal mortality ratio reinforces the mistaken notion that all maternal deaths are consequent to a live birth and, at the same time, inappropriately inflates the value of the ratio for subpopulations of women with the highest percentage of pregnancies ending in outcomes other than a live birth. Inadequate methods for identifying induced or spontaneous abortion complications assure that most maternal deaths associated with those pregnancy outcomes are unlikely to be attributed. Absent the ability to identify all maternal deaths, and without the ability to differentiate those deaths by specific pregnancy outcomes, existing variations in pregnancy outcome-specific maternal deaths are masked by the use of an aggregated (all outcome) numerator. Under these circumstances, clear and accurate data is not available to inform evidence-based preventive strategies. As the result, algorithms applied for analyzing maternal mortality data may return distorted results.ConclusionImprovement in the effectiveness of maternal mortality surveillance will require: mandatory certification of all fetal losses; linkage of death, birth and all fetal loss (induced and natural) certificates; modification of the structure of the overall maternal mortality ratio to enable pregnancy outcome-specific ratio calculations; development of the appropriate ICD codes which are specific to induced and spontaneous abortions; education for providers on identifying and reporting early pregnancy losses; and, flexible information systems and methods which integrate these capabilities and inform users. 

The pregnancy outcomes for mother and baby of women with a systemic right ventricle

2011 ◽  
Vol 96 (Supplement 1) ◽  
pp. Fa104-Fa104
Author(s):  
T. Selman ◽  
S. Bowater ◽  
S. Thorne ◽  
P. Thompson
Keyword(s):  
Right Ventricle ◽  
Pregnancy Outcomes ◽  
Systemic Right Ventricle

Levosimendan as a bridge to heart transplant in a 16-year-old patient with univentricular heart

2020 ◽  
Vol 30 (10) ◽  
pp. 1504-1506
Author(s):  
Magdalena Mazurak ◽  
Paweł Cześniewicz ◽  
Jacek Kusa
Keyword(s):  
Heart Failure ◽  
Right Ventricle ◽  
Effective Treatment ◽  
Heart Transplant ◽  
Univentricular Heart ◽  
Systemic Right Ventricle

AbstractWe report the successful use of levosimendan in the treatment of heart failure in a patient with the univentricular heart. The presented case was atypical because our patient had systemic right ventricle. To our knowledge, it is the first reported such case with intermittent levosimendan administration as an effective treatment and bridge to successful heart transplant in a patient with functionally univentricular heart.

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