ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

Warnes, Carole A.; Williams, Roberta G.; Bashore, Thomas M.; Child, John S.; Connolly, Heidi M.; Dearani, Joseph A.; Nido, Pedro J. del; Fasules, James W.; Graham, T.P.; Hijazi, Ziyad M.; Hunt, Sharon A.; King, Mary Etta; Landzberg, Michael J.; Miner, Pamela D.; Radford, Martha J.; Walsh, Edward P.; Webb, Gary D.

doi:10.1016/j.jacc.2008.10.001

Cited by 1,313 publications

(477 citation statements)

References 620 publications

(494 reference statements)

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“…Despite dramatic improvements in treatment, HLHS continues to be associated with significant mortality and morbidities (2-4), including short-and long-term central nervous system (CNS) abnormalities (5)(6)(7). In addition, there is a rapidly growing population of adult survivors with chronic morbidities that are only now beginning to be understood (8). Although some surgical risk factors have been identified, such as the presence of a genetic syndrome, low birth weight (LBW, <2.5 kg), or a prohibitively small ascending aorta, our ability to predict adverse clinical outcomes remains limited (4,9,10).…”

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confidence: 99%

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

et al. 2013

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Background: Hypoplastic left heart syndrome (HLHS) is associated with significant mortality and morbidity. Fetal head growth abnormalities have been identified in a subset of HLHS fetuses, but it is unclear whether specific patterns of maladaptive growth affect clinical outcomes. We hypothesized that poor fetal head growth is associated with an increased frequency of adverse clinical outcomes. Methods: We retrospectively examined a cohort of HLHS patients from midgestation to 1 y of age. Fetal and birth anthropometric measurements were analyzed using the Olsen standard, and clinical outcomes were obtained. results: A total of 104 HLHS patients were identified over a 12-y period; fetal data were available in 38 cases. HLHS neonates demonstrated a high incidence of microcephaly (12%), small head size (27%), and poor head growth (32%). Allcause mortality was 31% at 30 d and 43% at 1 y. Neurologic outcomes were observed in 12% of patients and were significantly increased with microcephaly (43 vs. 4%; P = 0.02). The average length of hospital stay following stage I palliation was 33.4 ± 33 d, correcting for early death. conclusion: In term nonsyndromic HLHS, fetal and neonatal microcephaly are associated with early adverse neurologic outcomes but not mortality.

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confidence: 99%

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

et al. 2013

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“…Class I evidence indication for PV implantation based on the current European [20] and North-American [21] guidelines is the presence of symptoms. These guidelines are in agreement with the clinical indications generally accepted in the literature for symptomatic patients, with the support of the clinical non-invasive and invasive investigations.…”

Section: Discussionmentioning

confidence: 99%

Trifecta St. Jude medical® aortic valve in pulmonary position

Corno

Dawson

Bolger

et al. 2017

Nano Reviews & Experiments

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Introduction: To evaluate an aortic pericardial valve for pulmonary valve (PV) regurgitation after repair of congenital heart defects. Methods: From July 2012 to June 2016 71 patients, mean age 24 ± 13 years (four to years) underwent PV implantation of aortic pericardial valve, mean interval after previous repair = 21 ± 10 years (two to 47 years). Previous surgery at mean age 3.2 ± 7.2 years (one day to 49 years): tetralogy of Fallot repair in 83% (59/71), pulmonary valvotomy in 11% (8/71), relief of right ventricular outflow tract (RVOT) obstruction in 6% (4/71). Pre-operative echocardiography and MRI showed severe PV regurgitation in 97% (69/71), moderate in 3% (2/71) with associated RVOT obstruction. MRI and knowledge-based reconstruction 3D volumetry (KBR-3D-volumetry) showed mean PV regurgitation = 42 ± 9% (20–58%), mean indexed RV end-diastolic volume = 169 ± 33 (130–265) ml m–2 BSA and mean ejection fraction (EF) = 46 ± 8% (33–61%). Cardio-pulmonary exercise showed mean peak O2/uptake = 24 ± 8 ml kg–1 min–1 (14–45 ml kg–1 min–1), predicted max O2/uptake 66 ± 17% (26–97%). Pre-operative NYHA class was I in 17% (12/71) patients, II in 70% (50/71) and III in 13% (9/71). Results: Mean cardio-pulmonary bypass duration was 95 ± 30ʹ (38–190ʹ), mean aortic cross-clamp in 23% (16/71) 46 ± 31ʹ (8–95ʹ), with 77% (55/71) implantations without aortic cross-clamp. Size of implanted PV: 21 mm in seven patients, 23 mm in 33, 25 mm in 23, and 27 mm in eight. The z-score of the implanted PV was −0.16 ± 0.80 (−1.6 to 2.5), effective orifice area indexed (for BSA) of native PV was 1.5 ± 0.2 (1.2 to –2.1) vs. implanted PV 1.2 ± 0.3 (0.76 to –2.5) (p = ns). In 76% (54/71) patients surgical RV modelling was associated. Mean duration of mechanical ventilation was 6 ± 5 h (0–26 h), mean ICU stay 21 ± 11 h (12–64 h), mean hospital stay 6 ± 3 days (three to 19 days). In mean follow-up = 25 ± 14 months (six to 53 months) there were no early/late deaths, no need for cardiac intervention/re-operation, no valve-related complications, thrombosis or endocarditis. Last echocardiography showed absent PV regurgitation in 87.3% (62/71) patients, trivial/mild degree in 11.3% (8/71), moderate degree in 1.45% (1/71), mean max peak velocity through RVOT 1.6 ± 0.4 (1.0–2.4) m s–1. Mean indexed RV end-diastolic volume at MRI/KBR-3D-volumetry was 96 ± 20 (63–151) ml m–2 BSA, lower than pre-operatively (p < 0.001), and mean EF = 55 ± 4% (49–61%), higher than pre-operatively (p < 0.05). Almost all patients (99% = 70/71) remain in NYHA class I, 1.45% = 1/71 in class II. Conclusion: (a) Aortic pericardial valve is implantable in PV position with an easy and reproducible surgical technique; (b) valve size adequate for patient BSA can be implanted with simultaneous RV remodelling; (c) medium-term outcomes are good with maintained PV function, RV dimensions significantly reduced and EF significantly improved; (d) adequate valve size will allow later percutaneous valve-in-valve implantation.

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“…The highest risk lesions of the left main or left anterior descending branch artery arising from the opposite sinus of Valsalva include the inter-arterial course between the aorta and the pulmonary artery [8]. In 80 % of autopsies in athletes with sudden cardiac death and anomalous coronary artery origins, the affected coronary artery coursed between the aorta and the pulmonary artery.…”

Section: Importance Of Awareness Of Congenital Coronary Anomalies Formentioning

confidence: 99%

“…The intramural left coronary artery ran inside the aortic wall anteriorly or posteriorly and takes off from the aorta at the left coronary sinus [11]. The ACC/AHA writing committee [8] recommended that surgical coronary revascularization should be performed in such a high-risk group of patients. Excellent outcomes have been reported with a unroofing technique for the intramural course of the coronary artery between the aorta and the pulmonary artery [9][10][11].…”

Section: Importance Of Awareness Of Congenital Coronary Anomalies Formentioning

confidence: 99%

Surgical treatment of a patient with heart disease and congenital coronary anomaly

Asou

2012

Gen Thorac Cardiovasc Surg

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ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

Cited by 1,313 publications

References 620 publications

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

Trifecta St. Jude medical® aortic valve in pulmonary position

Surgical treatment of a patient with heart disease and congenital coronary anomaly

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