12 results on '"Sara A. Thorne"'
Search Results
2. The Role of Ablation in Prevention of Recurrent Implantable Cardioverter Defibrillator Shocks in Patients With Tetralogy of Fallot
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Andreu Porta Sanchez, Edward J. Hickey, Paul Khairy, Blandine Mondésert, Lorna Swan, Candice K. Silversides, Louise Harris, Rachel M. Wald, Susan Lucy Roche, Priyanka Kugamoorthy, Krishnakumar Nair, Rafael Alonso-Gonzalez, Eugene Downar, Praloy Chakraborty, Abhishek Bhaskaran, Satoshi Kawada, Lisa Albertini, Erwin Oechslin, Sara A Thorne, Gnalini Sathananthan, and Kumaraswamy Nanthakumar
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medicine.medical_specialty ,Ischemic cardiomyopathy ,business.industry ,medicine.medical_treatment ,Odds ratio ,medicine.disease ,Implantable cardioverter-defibrillator ,Confidence interval ,Sudden cardiac death ,Transplantation ,Interquartile range ,Internal medicine ,RC666-701 ,medicine ,Cardiology ,Diseases of the circulatory (Cardiovascular) system ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,Tetralogy of Fallot - Abstract
Background: Implantable cardioverter defibrillators (ICDs) are effective in preventing arrhythmic sudden cardiac death in patients with tetralogy of Fallot (TOF). Although ICD therapies for malignant ventricular arrhythmias can be life-saving, shocks could have deleterious consequences. Substrate-based ablation therapy has become the standard of care to prevent recurrent ICD shocks in patients with ischemic cardiomyopathy. However, the efficacy and safety of this invasive therapy in the prevention of recurrent ICD shocks in patients with TOF has not been well evaluated. Methods: Records of a total of 47 consecutive TOF patients (mean age: 43.1 ± 13.2 years, male sex: n = 34 [72.3%]) who underwent ICD implantation for secondary prevention between 2000 and 2018 were reviewed. Results: Twenty (42.6%) patients underwent invasive therapy (radiofrequency catheter ablation, n = 8; surgical ablation with pulmonary valve replacement, n = 12) before ICD implantation. Twenty-seven patients (57.4%) were managed noninvasively. During follow-up (median 80.5 [interquartile range, 28.5-131.0] months), 2 (10.0%) patients in the invasive group and 10 (37.0%) patients in the noninvasive group received appropriate ICD shocks (P = 0.036). Logistic regression analysis showed that invasive therapy was associated with a decreased risk of ICD shocks by 81.1% (odds ratio, 0.189; 95% confidence interval, 0.036-0.990; P = 0.049). Furthermore, invasive therapy was associated with decreased risk of the composite outcomes of ICD shock, death, cardiac transplantation, and hospital admission (odds ratio, 0.090; 95% confidence interval, 0.025-0.365; P = 0.013) compared with noninvasive therapy. Conclusions: Invasive substrate modification therapy was associated with a lower likelihood of ICD shocks and improvement of long-term outcomes in TOF patients. Résumé: Contexte: Les défibrillateurs cardioverteurs implantables (DCI) sont efficaces pour prévenir la mort cardiaque subite provoquée par une arythmie chez les patients présentant une tétralogie de Fallot (TF). Bien que le traitement des arythmies ventriculaires malignes par DCI puisse sauver des vies, les chocs administrés peuvent avoir des conséquences délétères. L’ablation du substrat est devenue le traitement de référence pour prévenir l’administration à répétition de chocs par DCI chez les patients atteints d’une cardiomyopathie ischémique. L’efficacité et l’innocuité de ce traitement invasif pour prévenir l’administration de chocs répétés chez les patients présentant une TF n’ont toutefois pas été bien évaluées. Méthodologie: Nous avons examiné les cas consécutifs de 47 patients présentant une TF (âge moyen : 43,1 ± 13,2 ans; hommes : n = 34 [72,3 %]) ayant reçu un DCI en prévention secondaire entre 2000 et 2018. Résultats: Au total, 20 (42,6 %) patients ont subi un traitement invasif (ablation par cathéter par radiofréquence, n = 8; ablation chirurgicale et remplacement de la valve pulmonaire, n = 12) avant l’implantation d’un DCI. Vingt-sept patients (57,4 %) ont été pris en charge de façon non invasive. Au cours de la période de suivi (durée médiane de 80,5 [intervalle interquartile : 28,5 à 131,0] mois), 2 (10,0 %) patients du groupe ayant subi une intervention invasive et 10 (37,0 %) patients du groupe ayant subi une intervention non invasive ont reçu un choc approprié par DCI (p = 0,036). Les résultats de l’analyse par régression logistique montrent que le traitement invasif est associé à une réduction du risque de choc par DCI de 81,1 % (rapport des cotes : 0,189; intervalle de confiance à 95 % : de 0,036 à 0,990; p = 0,049). En outre, le traitement invasif est associé à une réduction du risque de survenue d’un des événements du paramètre d’évaluation composé, soit un choc administré par DCI, le décès, une transplantation cardiaque ou une hospitalisation (rapport des cotes : 0,090; intervalle de confiance à 95 % : de 0,025 à 0,365; p = 0,013) par rapport au traitement non invasif. Conclusions: La modification invasive du substrat a été associée à une probabilité plus faible de choc administré par DCI et à une amélioration des résultats à long terme chez les patients présentant une TF.
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- 2021
3. Outcome and right ventricle remodelling after valve replacement for pulmonic stenosis
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Erwin Oechslin, Sara A Thorne, Emilie Laflamme, Candice K. Silversides, Rachel M. Wald, Lee N. Benson, Rafael Alonso-Gonzalez, Eric Horlick, S. Lucy Roche, Mark Osten, and Jack M. Colman
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medicine.medical_specialty ,Pulmonic stenosis ,medicine.medical_treatment ,Population ,Valve replacement ,Internal medicine ,Pulmonary Valve Replacement ,medicine ,Ventricular outflow tract ,Humans ,education ,Tetralogy of Fallot ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,education.field_of_study ,Pulmonary Valve ,Ventricular Remodeling ,business.industry ,medicine.disease ,Pulmonary Valve Insufficiency ,Pulmonary Valve Stenosis ,Treatment Outcome ,Pulmonary valve stenosis ,Cardiology ,Ventricular Function, Right ,Cardiology and Cardiovascular Medicine ,business - Abstract
BackgroundComplications and need for reinterventions are frequent in patients with pulmonary valve stenosis (PVS). Pulmonary regurgitation is common, but no data are available on outcome after pulmonary valve replacement (PVR).MethodsWe performed a retrospective analysis of 215 patients with PVS who underwent surgical valvotomy or balloon valvuloplasty. Incidence and predictors of reinterventions and complications were identified. Right ventricle (RV) remodelling after PVR was also assessed.ResultsAfter a median follow-up of 38.6 (30.9–49.4) years, 93% of the patients were asymptomatic. Thirty-nine patients (18%) had at least one PVR. Associated right ventricular outflow tract (RVOT) intervention and the presence of an associated defect were independent predictors of reintervention (OR: 4.1 (95% CI 1.5 to 10.8) and OR: 3.6 (95% CI 1.9 to 6.9), respectively). Cardiovascular death occurred in 2 patients, and 29 patients (14%) had supraventricular arrhythmia. Older age at the time of first intervention and the presence of an associated defect were independent predictors of complications (OR: 1.0 (95% CI 1.0 to 1.1) and OR: 2.1 (95% CI 1.1 to 4.2), respectively). In 16 patients, cardiac magnetic resonance before and after PVR was available. The optimal cut-off values for RV volume normalisation were 193 mL/m2 for RV end-diastolic volume indexed(sensitivity 80%, specificity 64%) and 100 mL/m2 for RV end-systolic volume indexed(sensitivity 80%, specificity 56%).ConclusionsPrevious RVOT intervention, presence of an associated defect and older age at the time of first repair were predictors of outcome. More data are needed to guide timing of PVR, and extrapolation of tetralogy of Fallot guidelines to this population is unlikely to be appropriate.
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- 2021
4. Impact of Catheter Ablation for Atrial Arrhythmias on Repeat Cardioversion in Adults With Congenital Heart Disease
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Louise Harris, Erwin Oechslin, Sara A Thorne, Lorna Swan, Candice K. Silversides, Susan Lucy Roche, Rachel M. Wald, Krishnakumar Nair, Christian Joens, Blandine Mondésert, Kumaraswamy Nanthakumar, Satoshi Kawada, Eugene Downar, Paul Khairy, Rafael Alonso-Gonzalez, and Praloy Chakraborty
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Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Electric Countershock ,Catheter ablation ,030204 cardiovascular system & hematology ,Cardioversion ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Recurrence ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,medicine.disease ,Ablation ,Confidence interval ,Retreatment ,Cardiology ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Atrial tachyarrhythmias (AAs) are the main source of morbidity and mortality in adult congenital heart disease (ACHD). Direct-current cardioversion (DCCV) is an effective method to acutely terminate AAs, but many patients require repeated DCCV. Little is known about the impact of radiofrequency catheter ablation (RFCA) of AAs on the incidence of repeated DCCV in patients with ACHD. The purpose of this study was to evaluate the impact of RFCA on the incidence of DCCV in patients with ACHD. Methods A total of 157 patients with ACHD undergoing DCCV in our hospital from 2011 to 2018 (female n = 76 [48.4%], mean age 37.8 ± 12.5 y), were reviewed. The median follow-up period was 31.8 months (interquartile range 16.3-55.1 mo). Results Out of the total of 157 patients, 102 (65.0%) underwent RFCA for AAs, and 55 (35.0%) were treated without RFCA. Successful RFCA with termination of AAs during ablation was 62.7%. More than one-half of the patients had complex forms of CHD (62.4%). During follow-up, 57 patients (55.9%) who had RFCA developed recurrence of AAs, and 36 patients (35.2%) underwent repeated DCCV. Thirty-three (60.0%) out of 55 patients without RFCA required repeated cardioversion. Compared with patients without RFCA, RFCA significantly reduced the need for repeated DCCV by 40% (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.23-0.80; P = 0.009). In multivariate analysis, successful RFCA was associated with reduced risk of DCCV (HR 0.41, 95% CI 0.19-0.92; P = 0.031). Conclusions AAs remain common despite RFCA in patients with ACHD. Nevertheless, RFCA is associated with a marked reduction in the need for repeated DCCV.
- Published
- 2020
5. Safety and Long-term Outcomes of Defibrillator Therapy in Patients With Right-Sided Implantable Cardiac Devices in Adults With Congenital Heart Disease
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Erwin Oechslin, Sara A Thorne, Rafael Alonso-Gonzalez, Praloy Chakraborty, Paul Khairy, Louise Harris, S. Lucy Roche, Abhishek Bhaskaran, Candice Sliversides, Rachel M. Wald, Krishnakumar Nair, Blandine Mondésert, Lorna Swan, Eugene Downar, Kumaraswamy Nanthakumar, Satoshi Kawada, and Lisa Albertini
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Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Canada ,Heart disease ,Heart Ventricles ,030204 cardiovascular system & hematology ,Sudden cardiac death ,Defibrillation threshold ,Cardiac Resynchronization Therapy ,Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Long term outcomes ,Humans ,In patient ,030212 general & internal medicine ,Persistent left superior vena cava ,Cardiac Resynchronization Therapy Devices ,Retrospective Studies ,business.industry ,Retrospective cohort study ,medicine.disease ,Vein occlusion ,Defibrillators, Implantable ,Death, Sudden, Cardiac ,Outcome and Process Assessment, Health Care ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Implantable cardioverter-defibrillators (ICDs) have been proven to prevent sudden cardiac death in adult congenital heart disease (ACHD) patients. Although the left side is chosen by default, implantation from the right side is often required. However, little is known about the efficacy and safety of right-sided ICDs in ACHD patients. Methods In this study we reviewed a total of 191 ACHD patients undergoing ICD/cardioverter resynchronisation therapy-defibrillator (CRT-D) implantation at our hospital between 2001 and 2019 (134 men and 57 women; age [mean ± standard deviation], 41.5 ± 14.8 years). Results Twenty-seven patients (14.1%) had right-sided devices. The most common causes of right-sided implantation were persistent left superior vena cava and vein occlusion (37.0%). Although procedure time (202.8 ± 60.5 minutes vs 143.8 ± 69.1 minutes, P = 0.008) was longer and the procedural success was lower (92.6% vs 99.4%, P = 0.008) for right-sided devices, no difference in R-wave and pacing threshold were noted. Among the 47 patients (24.6%) who underwent defibrillation threshold testing (DFT), no difference in DFT was observed (25.2 ± 5.3 J vs 23.8 ± 4.1 J, P = 0.460). During the median follow-up of 42.4 months, appropriate ICD therapy was observed in 5 (18.5%) and 30 (18.3%) patients for right- and left-sided ICDs/CRTDs, respectively (P = 0.978). No significant difference was seen in complications between them. Conclusions Implantation of an ICD on the right side is technically challenging, but it is feasible as an alternative approach for ACHD patients with contraindications to left-sided device implantation.
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- 2020
6. Anomalous origin of a coronary artery from the pulmonary artery presenting in adulthood: Experience from a tertiary center
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Candice K. Silversides, Emilie Laflamme, David J. Barron, Lee N. Benson, Lorna Swan, Erwin Oechslin, Sara A Thorne, Jack M. Colman, Mark Osten, Rachel M. Wald, Andrew M. Crean, Eric Horlick, S. Lucy Roche, Rafael Alonso-Gonzalez, and Edward Hickey
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Mitral regurgitation ,medicine.medical_specialty ,Ejection fraction ,business.industry ,Retrospective cohort study ,General Medicine ,Coronary artery ,medicine.disease ,Pulmonary hypertension ,Sudden cardiac death ,medicine.anatomical_structure ,Ischemia ,RC666-701 ,medicine.artery ,Internal medicine ,Pulmonary artery ,Cohort ,medicine ,Cardiology ,Diseases of the circulatory (Cardiovascular) system ,business ,Congenital heart disease ,Artery - Abstract
Background Anomalous origin of a coronary artery from the pulmonary artery (PA) is a rare condition that usually presents in childhood. The aim of this study is to describe its characteristics in unrepaired adults. Methods We conducted a retrospective study of 18 patients with left and right anomalous coronary artery from the PA (ALCAPA and ARCAPA) diagnosed in adulthood. Patients ≥18 years old at diagnosis and assessed at least once in our institution were included. Results Median age at diagnosis was 29.5 years [IQR 24.0–48.8]. Presentation mode varied, with two patients (11%) diagnosed following aborted sudden cardiac death. Diagnosis was most frequently made by coronary angiography (44%) and cardiac computed tomography (28%). The mean left ventricle ejection fraction (LVEF) at presentation was 56 ±10% and moderate or severe mitral regurgitation was present in 5 patients. Surgical or interventional repair was performed in 14 patients (78%), 9 of whom (50%) underwent reimplantation. Median follow-up was 8.5 years [IQR 0.98–13.8]. One patient with severe pulmonary hypertension died during the follow-up. Most patients (79%) were in NYHA functional class 1 at last follow-up with a mean LVEF of 53±12%. Conclusions Anomalous origin of a coronary artery from the PA can present in adulthood in various ways. Multimodality imaging allows the diagnosis and assessment of functional impact. Surgical correction of ALCAPA with establishment of a dual coronary pathway was the most frequent management strategy in our cohort. The majority of patients experienced favorable long-term outcomes.
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- 2021
7. Patient with Complex Congenital Heart Disease (Fontan Circulation)
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Yaso Emmanuel and Sara A. Thorne
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medicine.medical_specialty ,business.industry ,Right-to-left shunt ,medicine.artery ,Medicine ,Complex congenital heart disease ,business ,Oral anticoagulation ,Surgery ,Fontan circulation - Published
- 2016
8. Atrioventricular Valve Atresia
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Sara A. Thorne
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03 medical and health sciences ,medicine.medical_specialty ,Atrioventricular valve ,0302 clinical medicine ,business.industry ,Internal medicine ,Atresia ,Cardiology ,Medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,business ,medicine.disease - Published
- 2011
9. Congenitally Corrected Transposition of the Great Arteries
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Sara A. Thorne
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medicine.medical_specialty ,Congenitally corrected transposition ,Great arteries ,business.industry ,Internal medicine ,medicine ,Cardiology ,business ,Surgery - Published
- 2009
10. Femoral vascular access complications in adult congenital heart disease patients: audit from a single tertiary center
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Lucy Hudsmith, Colin D. Chue, Sara A. Thorne, Joseph V. De Giovanni, Oliver Stumper, and Paul Clift
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Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Heart disease ,Adolescent ,medicine.medical_treatment ,Population ,Arteriovenous fistula ,Hemorrhage ,Femoral artery ,Coronary Angiography ,Pseudoaneurysm ,Young Adult ,Hematoma ,Risk Factors ,Internal medicine ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Cardiac catheterization ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,Medical Audit ,business.industry ,Incidence ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Femoral Artery ,Pediatrics, Perinatology and Child Health ,Arteriovenous Fistula ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Aneurysm, False - Abstract
Objective. To determine the rate of vascular access complications in patients with adult congenital heart disease (ACHD). Background. Complications of femoral access following coronary angiography or percutaneous coronary intervention have been studied extensively, but the complication rate following catheterization and intervention in ACHD patients is poorly documented. Design, Setting, and Outcome Measures. We present a retrospective audit of vascular access complications in a large tertiary ACHD center over a 12-month period. Complications were defined as any clinically significant hematoma, pseudoaneurysm, arteriovenous fistula, or bleeding resulting in the need for imaging, transfusion, vascular or radiological intervention, or delayed discharge. Results. Of 197 procedures (102 interventions and 95 cardiac catheterizations), a complication rate of 3.6% was identified, comparable to that of coronary angiography and percutaneous coronary intervention. The main complications were femoral artery pseudoaneurysm and hematoma resulting in delayed discharge by a mean of 2⅔ days (range 1–4 days). Predictors of risk for vascular complications include female sex, history of diabetes, and anticoagulation; larger sheath sizes and obesity were not associated with higher complication rate. Conclusions. Adult congenital heart disease patients represent a unique and ever-growing population with a higher incidence of catheterization as children, surgical cut-down scars and anatomical variants. We present a low incidence of femoral access complications in interventional and diagnostic procedures in a large series of ACHD patients over a 12-month period. Patients with risk factors for vascular complications may be considered for device closure of the venous access site.
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- 2008
11. Management of re-coarctation due to prosthetic graft pseudo-intimal dissection
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Peter Guest, Sara A. Thorne, Robert S. Bonser, and Maninder S Kalkat
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Acrylic Resins ,Balloon ,Magnetic resonance angiography ,Aortic Coarctation ,Blood vessel prosthesis ,Recurrence ,medicine.artery ,Angioplasty ,medicine ,Humans ,Interposition graft ,Aorta ,medicine.diagnostic_test ,business.industry ,Graft Occlusion, Vascular ,Stent ,Middle Aged ,Surgery ,Blood Vessel Prosthesis ,Prosthesis Failure ,surgical procedures, operative ,Descending aorta ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography - Abstract
Re-coarctation is a recognised late complication of surgical coarctation repair. Re-operation in these patients is difficult and the role of surgery has been partly subsumed by balloon angioplasty and endovascular stenting. We describe a patient who twice developed re-coarctation, the second time because of a raised pseudo-intimal flap within an interposition graft. It was managed successfully with an ascending-descending aorta extra-anatomic graft.
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- 2007
12. Infected thrombus compression of the right ventricular outflow tract in transposition of the great arteries
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Paul Clift, Colin D. Chue, Sara A. Thorne, and Lucy Hudsmith
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Adult ,Heart Defects, Congenital ,Heart Septal Defects, Ventricular ,medicine.medical_specialty ,Heart disease ,Pregnancy, High-Risk ,Transposition of Great Vessels ,Pregnancy Complications, Cardiovascular ,Echocardiography, Three-Dimensional ,Ventricular Outflow Obstruction ,Risk Assessment ,Pregnancy ,Cardiac magnetic resonance imaging ,Prenatal Diagnosis ,Internal medicine ,medicine ,Humans ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,Pregnancy Complications, Infectious ,Thrombus ,medicine.diagnostic_test ,business.industry ,Thrombosis ,Magnetic resonance imaging ,General Medicine ,Staphylococcal Infections ,medicine.disease ,Magnetic Resonance Imaging ,Abortion, Spontaneous ,Pulmonary Valve Stenosis ,Pregnancy Trimester, First ,Great arteries ,Pulmonary valve stenosis ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
We describe the first reported case of infected thrombus compression of the right ventricular outflow tract in a Rastelli patient as a complication of pregnancy. This case emphasizes the importance of cardiac magnetic resonance imaging and echocardiography in the assessment of patients with adult congenital heart disease prior to and during pregnancy.
- Published
- 2008
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