28 results on '"Sara A. Thorne"'
Search Results
2. Anomalous origin of a coronary artery from the pulmonary artery presenting in adulthood: Experience from a tertiary center
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Emilie Laflamme, Rafael Alonso-Gonzalez, S. Lucy Roche, Rachel M. Wald, Lorna Swan, Candice K. Silversides, Sara A. Thorne, Eric M. Horlick, Lee N. Benson, Mark Osten, Edward Hickey, David J. Barron, Jack M. Colman, Erwin Oechslin, and Andrew M. Crean
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Congenital heart disease ,Coronary artery ,Ischemia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - 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
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3. Implementation of guidelines for multidisciplinary team management of pregnancy in women with pre-existing diabetes or cardiac conditions: results from a UK national survey
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Cath Taylor, David R. McCance, Lucy Chappell, Catherine Nelson-Piercy, Sara A. Thorne, Khaled M. K. Ismail, James S. A. Green, and Debra Bick
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Diabetes ,Cardiac conditions ,Multidisciplinary care ,Pregnancy ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Despite numerous publications stating the importance of multidisciplinary care for women with pre-existing medical conditions, there is a lack of evidence regarding structure or processes of multidisciplinary working, nor impact on maternal or infant outcomes. This study aimed to evaluate the implementation of guidelines for multidisciplinary team (MDT) management in pregnant women with pre-existing diabetes or cardiac conditions. These conditions were selected as exemplars of increasingly common medical conditions in pregnancy for which MDT management is recommended to prevent or reduce adverse maternal and fetal outcomes. Methods National on-line survey sent to clinicians responsible for management or referral of women with pre-existing diabetes or cardiac conditions in UK National Health Service (NHS) maternity units. The survey comprised questions regarding the organisation of MDT management for women with pre-existing diabetes or cardiac conditions. Content was informed by national guidance. Results One hundred seventy-nine responses were received, covering all health regions in England (162 responses) and 17 responses from Scotland, Wales and Northern Ireland. 132 (74%) related to women with diabetes and 123 (69%) to women with cardiac conditions. MDT referral was reportedly standard practice in most hospitals, particularly for women with pre-existing diabetes (88% of responses vs. 63% for cardiac) but there was wide variation in relation to MDT membership, timing of referral and working practices. These inconsistencies were evident within and between maternity units across the UK. Reported membership was medically dominated and often in the absence of midwifery/nursing and other allied health professionals. Less than half of MDTs for women with diabetes met the recommendations for membership in national guidance, and although two thirds of MDTs for women with cardiac disease met the core recommendations for membership, most did not report having the extended members: midwives, neonatologists or intensivists. Conclusions The wide diversity of organisational management for women with pre-existing diabetes or cardiac conditions is of concern and merits more detailed inquiry. Evidence is also required to support and better define the recommendations for MDT care.
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- 2017
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4. Pregnancy outcomes in women following the Ross procedure
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Sophie E. Thompson, Chethan Ram Kasargod Prabhakar, Tristan Creasey, Victoria M. Stoll, Leo Gurney, Jennifer Green, Caroline Fox, R. Katie Morris, Peter J. Thompson, Sara A. Thorne, Paul Clift, and Lucy E. Hudsmith
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Cardiology and Cardiovascular Medicine - Abstract
The Ross procedure, where a pulmonary autograft (neoaorta) replaces the aortic valve, has excellent long-term outcomes in patients with congenital aortic valve disease. However, there are reports of neoaortic dilatation and dissection. An increasing number of women are wishing to become pregnant following the Ross procedure, but little is known about the occurrence and risks of neoaortic dilatation and complications in pregnancy. We investigated neoaorta function and outcomes in pregnancy following the Ross procedure.This retrospective study investigated women post-Ross procedure at a tertiary ACHD unit between 1997 and 2021. Imaging evaluated neoaortic root dimensions and regurgitation pre-, and post- pregnancy, compared with matched non-pregnant controls. Primary endpoints were change in neoaortic dimensions, degree of regurgitation and adverse maternal outcomes.Nineteen pregnancies in 12 women were included. The mean change in neoaortic root diameter post-pregnancy was 1.8 mm (SD 3.4) (p = 0.017). There was no significant change in neoaortic dimensions in matched controls during follow-up. There were no cases of dissection, arrhythmia, acute coronary syndrome, or maternal mortality. Three deliveries were pre-term, including one emergency Caesarean section due to maternal cardiac decompensation, requiring aortic root replacement post-partum but there were no neonatal deaths.Pregnancy following the Ross procedure is associated with neoaortic dilatation, and pregnancy is generally well tolerated. Although adverse maternal outcomes are uncommon, there are still rare cases of cardiac complications in and around the time of pregnancy. These findings emphasise the need for accessible pre-pregnancy counselling, risk stratification and careful surveillance through pregnancy by specialist cardio-obstetric multi-disciplinary teams.
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- 2023
5. The Role of National Pregnancy Surveillance Systems in Improving Maternal Mortality and Morbidity: The Next Steps for Canada
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Rohan D'Souza, Jocelynn L. Cook, and Sara A Thorne
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Canada ,Pregnancy ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,MEDLINE ,030204 cardiovascular system & hematology ,medicine.disease ,Pregnancy Complications ,03 medical and health sciences ,Maternal Mortality ,0302 clinical medicine ,Population Surveillance ,medicine ,Humans ,Female ,Morbidity ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2021
6. 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
7. Coagulation and Anticoagulation in Fontan Patients
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Josephine F, Heidendael, Leo J, Engele, Berto J, Bouma, Anne I, Dipchand, Sara A, Thorne, Brian W, McCrindle, and Barbara J M, Mulder
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Adult ,Heart Defects, Congenital ,congenital, hereditary, and neonatal diseases and abnormalities ,Anticoagulants ,Venous Thromboembolism ,Fontan Procedure ,Stroke ,surgical procedures, operative ,cardiovascular system ,Humans ,Warfarin ,cardiovascular diseases ,Child ,Cardiology and Cardiovascular Medicine - Abstract
Patients with a Fontan circulation for single-ventricle physiology are at increased risk of developing thromboembolic events. Thromboembolic events can lead to failure of the Fontan circulation, chronic sequelae in case of stroke, and early mortality. Controversies exist regarding the substrates, risk factors, and optimal detection methods for thromboembolic events. Despite the major clinical implications, there is currently no consensus regarding the optimal antithrombotic therapy to prevent or treat thromboembolic events after the Fontan procedure. In this review we aimed to untangle the available literature regarding antithrombotic prophylaxis and treatment for pediatric and adult Fontan patients. A decision-tree algorithm for thromboprophylaxis in Fontan patients is proposed. Additionally, the current state of knowledge is reviewed with respect to the epidemiology, pathophysiology, and detection of thromboembolic events in Fontan patients, and important evidence gaps are highlighted.
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- 2022
8. Assessment and Prediction of Cardiovascular Contributions to Severe Maternal Morbidity
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Aarti Thakkar, Afshan B. Hameed, Minhal Makshood, Brent Gudenkauf, Andreea A. Creanga, Isabelle Malhamé, Sonia M. Grandi, Sara A. Thorne, Rohan D'Souza, and Garima Sharma
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- 2023
9. 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
10. Delivery outcomes in women with congenital heart disease: results from the Cuban National Programme for pregnancy and heart disease
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Cristina Munte Kinsella, Sara A. Thorne, Hsu Chong, Paul F. Clift, Roman Vasallo Peraza, Jesus E. Perez Torga, and Pedro A. Roman Rubio
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lcsh:Diseases of the circulatory (Cardiovascular) system ,Pregnancy ,lcsh:RC666-701 ,Cuba ,Delivery outcomes ,Congenital heart disease - Abstract
Objective To inform on delivery outcomes achieved in congenital heart disease (CHD) patients by the Cuban National Programme for pregnancy and heart disease. Methods Single-centre retrospective study on a prospectively collected cardiac pregnancy database at a tertiary referral hospital (January 2000–May 2017). Primary outcomes: pregnancy duration, outcome, maternal/fetal complications. Results Four hundred sixty-seven pregnancies in 462 recorded cases reached third trimester. Median age: 25 (21–29) years. Patients presented in NYHA class I (97%, n = 453) or II (3%, n = 14), 6% (n = 27) had arrhythmias, 1% (n = 4) had co-morbidities, 1% (n = 4) had impaired left ventricular function. There were 464 singleton pregnancies and 3 twin pregnancies. Of the singleton pregnancies, one resulted in stillbirth (0.2%). The rest were live births (n = 463), median weight 3200 (2900–3421) grams. Median pregnancy duration: 39.1 (38.6–40) weeks. Caesarean rate: 34% (n = 156). All twin pregnancies (n = 3) resulted in live births (n = 6) via caesarean section, of median weight 2710 (2458–2850) grams and median pregnancy duration 37 (36–38) weeks. Maternal cardiovascular complications (
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- 2019
11. Heart disease in pregnancy
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Sara A. Thorne
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03 medical and health sciences ,0302 clinical medicine ,030212 general & internal medicine ,General Medicine ,030204 cardiovascular system & hematology - Published
- 2018
12. 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.
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- 2020
13. 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
14. 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
15. Contributors
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David Alexander, Abdullah A. Alghamdi, Rafael Alonso-Gonzalez, Naser M. Ammash, Annalisa Angelini, Iain Armstrong, Sonya V. Babu-Narayan, Vivan J.M. Baggen, Cristina Basso, Elisabeth Bédard, Lee N. Benson, Maria Boutsikou, Craig S. Broberg, Albert V.G. Bruschke, Werner Budts, Alida L.P. Caforio, Marie Chaix, Anisa Chaudhry, Stavros Chryssanthopoulos, Preeti Choudhary, Dennis V. Cokkinos, Jack M. Colman, Michael S. Connelly, Domenico Corrado, Mark Cox, Gordon Cumming, Marianne Cumming, Michele D’Alto, Piers E.F. Daubeney, Mark J. Dayer, Barbara J. Deal, Joseph A. Dearani, Gerhard-Paul Diller, Konstantinos Dimopoulos, Annie Dore, Jacqueline Durbridge, Alexander R. Ellis, Sabine Ernst, Peter Ewert, Marny Fedrigo, Simon J. Finney, Romy Franken, Michael A. Gatzoulis, Marc Gewillig, George Giannakoulas, Matthias Greutmann, Hong Gu, Ankur Gulati B.A. Hons (Cantab), Carl Harries, Jane Heggie, Paul Herijgers, Siew Yen Ho, Kimberly Holst, Eric Horlick, Tim Hornung, Jan Janousek, Harald Kaemmerer, Juan Pablo Kaski, W. Aaron Kay, Paul Khairy, Abigail Khan, Philip J. Kilner, Adrienne H. Kovacs, Michael J. Landzberg, Olga Lazoura, Wei Li, Eric Lim, Emmanouil Liodakis, Carmen J. Lopez-Guarch, Koen Luyckx, Ariane Marelli, Elisabeth Martin, Constantine Mavroudis, Bryan Maxwell, Brian W. McCrindle, Doff B. McElhinney, Folkert J. Meijboom, François-Pierre Mongeon, Claudia Montanaro, Roisin Monteiro, Philip Moons, Barbara J.M. Mulder, Edward Nicol, Koichiro Niwa, Gabrielle Norrish, Clare O’Donnell, Erwin Notker Oechslin, Alexander R. Opotowsky, Mark Osten, Mehul B. Patel, Joseph K. Perloff, Frank A. Pigula, Kalliopi Pilichou, Nancy Poirier, Sanjay Kumar Prasad, Michael A. Quail, Jelena Radojevic Liegeois, Andrew N. Redington, Michael L. Rigby, Josep Rodés-Cabau, Anitra W. Romfh, Jolien W. Roos-Hesselink, Suzanne Rowsell, Michael B. Rubens, Fadi Sawaya, Markus Schwerzmann, Mary N. Sheppard, Darryl F. Shore, Harsimran S. Singh, Jane Somerville, Lars Søndergaard, Mark S. Spence, Philip J. Steer, Lorna Swan, András Szatmári, Shigeru Tateno, Upasana Tayal, Basil D. Thanopoulos, Judith Therrien, Gaetano Thiene, Sara A. Thorne, Daniel Tobler, John K. Triedman, Pedro T. Trindade, Oktay Tutarel, Judith J Tweedie, Anselm Uebing, Hideki Uemura, Lindsay Urbinelli, Glen S. Van Arsdell, Gruschen R. Veldtman, Hubert W. Vliegen, Inga Voges, Fiona Walker, Edward P. Walsh, Stephanie M. Ware, Gary D. Webb, Steven A. Webber, Tom Wong, and Steve Yentis
- Published
- 2018
16. 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
17. Global cardiac risk assessment in the Registry Of Pregnancy And Cardiac disease: results of a registry from the European Society of Cardiology
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Iris M, van Hagen, Eric, Boersma, Mark R, Johnson, Sara A, Thorne, William A, Parsonage, Pilar, Escribano Subías, Agata, Leśniak-Sobelga, Olga, Irtyuga, Khaled A, Sorour, Nasser, Taha, Aldo P, Maggioni, Roger, Hall, and Jolien W, Roos-Hesselink
- Subjects
Adult ,Heart Defects, Congenital ,Pregnancy Complications, Cardiovascular ,Cardiology ,Heart Valve Diseases ,World Health Organization ,Risk Assessment ,Young Adult ,Pregnancy ,Atrial Fibrillation ,Humans ,Prospective Studies ,Registries ,Acute Coronary Syndrome ,Developing Countries ,Societies, Medical ,Heart Failure ,Developed Countries ,Arrhythmias, Cardiac ,Prognosis ,Aortic Aneurysm ,Europe ,Aortic Dissection ,Maternal Mortality ,ROC Curve ,Female - Abstract
To validate the modified World Health Organization (mWHO) risk classification in advanced and emerging countries, and to identify additional risk factors for cardiac events during pregnancy.The ongoing prospective worldwide Registry Of Pregnancy And Cardiac disease (ROPAC) included 2742 pregnant women (mean age ± standard deviation, 29.2 ± 5.5 years) with established cardiac disease: 1827 from advanced countries and 915 from emerging countries. In patients from advanced countries, congenital heart disease was the most prevalent diagnosis (70%) while in emerging countries valvular heart disease was more common (55%). A cardiac event occurred in 566 patients (20.6%) during pregnancy: 234 (12.8%) in advanced countries and 332 (36.3%) in emerging countries. The mWHO classification had a moderate performance to discriminate between women with and without cardiac events (c-statistic 0.711 and 95% confidence interval (CI) 0.686-0.735). However, its performance in advanced countries (0.726) was better than in emerging countries (0.633). The best performance was found in patients with acquired heart disease from developed countries (0.712). Pre-pregnancy signs of heart failure and, in advanced countries, atrial fibrillation and no previous cardiac intervention added prognostic value to the mWHO classification, with a c-statistic of 0.751 (95% CI 0.715-0.786) in advanced countries and of 0.724 (95% CI 0.691-0.758) in emerging countries.The mWHO risk classification is a useful tool for predicting cardiac events during pregnancy in women with established cardiac disease in advanced countries, but seems less effective in emerging countries. Data on pre-pregnancy cardiac condition including signs of heart failure and atrial fibrillation, may help to improve preconception counselling in advanced and emerging countries.
- Published
- 2015
18. Heart disease in pregnancy
- Author
-
Aisling J. Carroll and Sara A. Thorne
- Subjects
General Medicine - Published
- 2006
19. Long-term outcome following pregnancy in women with a systemic right ventricle: is the deterioration due to pregnancy or a consequence of time?
- Author
-
Sarah E, Bowater, Tara J, Selman, Lucy E, Hudsmith, Paul F, Clift, Peter J, Thompson, and Sara A, Thorne
- Subjects
Adult ,Chi-Square Distribution ,Time Factors ,Adolescent ,Heart Ventricles ,Transposition of Great Vessels ,Ventricular Dysfunction, Right ,Pregnancy Complications, Cardiovascular ,Pregnancy Outcome ,Congenitally Corrected Transposition of the Great Arteries ,Parity ,Young Adult ,England ,Pregnancy ,Risk Factors ,Disease Progression ,Ventricular Function, Right ,Humans ,Female ,Retrospective Studies - Abstract
The right ventricle (RV) supports the systemic circulation in patients who have had an intraatrial repair of transposition of the great arteries or have congenitally corrected transposition. There is concern about the ability of a systemic RV to support the additional volume load of pregnancy, and previous studies have reported deterioration in RV function following pregnancy. However, conditions with a systemic RV are also associated with progressive RV dysfunction over time. To date, no study has examined whether the deterioration associated with pregnancy is due to the physiological changes of pregnancy itself, or is part of the known deterioration that occurs with time in these patients.Women who had undergone pregnancy under the care of the Adult Congenital Heart Disease Unit at the Queen Elizabeth Hospital were retrospectively identified and matched to separate male and nulliparous female controls. Functional status (New York Health Association [NYHA]), RV function, and systemic atrioventricular valve regurgitation were recorded for each group at baseline, postpregnancy (or at 1 year for control groups) and at latest follow-up.Eighteen women had 31 pregnancies (range 1-4) resulting in 32 live births. There were no maternal but one neonatal death. At baseline, there was no significant difference in NYHA class or RV function between pregnancy and control groups. In postpregnancy, there was a significant deterioration in the pregnant group alone for both NYHA class (P = 0.004) and RV function (P = 0.02). At latest follow-up, there was a significant deterioration in RV function in all three groups. There was still a reduction from baseline in NYHA of women who had undergone pregnancy (P = 0.014), which again was not seen in the controls groups.This study suggests that pregnancy is associated with a premature deterioration in RV function in women with a systemic RV. These women are also more symptomatic, with a greater reduction in functional class compared with patients with a systemic RV who do not undergo pregnancy. This study will allow this cohort of women to be more accurately counseled as to the potential long-term risks of pregnancy.
- Published
- 2012
20. The safety and effects of bosentan in patients with a Fontan circulation
- Author
-
Sarah E, Bowater, Rebekah A, Weaver, Sara A, Thorne, and Paul F, Clift
- Subjects
Adult ,Endothelin Receptor Antagonists ,Heart Defects, Congenital ,Male ,Sulfonamides ,Exercise Tolerance ,Time Factors ,Receptors, Endothelin ,Bosentan ,Cardiovascular Agents ,Pilot Projects ,Recovery of Function ,Pulmonary Artery ,Fontan Procedure ,Echocardiography, Doppler ,Postoperative Complications ,Treatment Outcome ,England ,Predictive Value of Tests ,Exercise Test ,Humans ,Ventricular Function ,Female ,Vascular Resistance ,Prospective Studies - Abstract
Adult patients with a Fontan circulation tend to have diminished exercise capacity. The principal objective of this study was to investigate the safety of the endothelin receptor antagonist bosentan in Fontan patients, and, secondarily, to assess effects on cardiovascular performance, New York Heart Association functional classification (NYHA FC), and ventricular function. A 6-month prospective, single-center, pilot, safety study of bosentan in Fontan patients. Setting. Adult Congenital Heart Disease referral center. All patients ≥18 years old with a Fontan circulation and in NYHA FC ≥II were invited to enroll. Interventions. Patients started on 62.5 mg bid of bosentan, uptitrating to 125 mg bid after 2 weeks. Safety was assessed by the incidence of anticipated and unanticipated adverse events during the 6-month study period; specifically those relating to hepatic, renal, or hematological dysfunction as measured by monthly blood tests. Other outcome measures included cardiopulmonary exercise test, 6-minute walk distance test, Borg dyspnea index, NYHA FC, and ventricular function parameters using transthoracic echocardiography. Of the eight patients enrolled, six completed the study. Two patients withdrew from the study (one for non-trial related reasons, one due to adverse events). No clinically significant adverse events relating to bosentan therapy occurred during this study and, in particular, no significant abnormalities in hepatic function tests were observed. Three patients reported transient adverse events. Improvements in NYHA FC and systolic ventricular function were observed after 6 months of bosentan treatment. The small number of patients with a Fontan circulation in our study was able to tolerate bosentan for 6 months. The safety and tolerability of bosentan in a larger patient population remains unknown. The results presented here justify further investigation in larger studies.
- Published
- 2012
21. An unusual treatment for protein losing enteropathy
- Author
-
Jonathan D, Windram, Paul F J, Clift, John, Speakman, and Sara A, Thorne
- Subjects
Diarrhea ,Male ,Young Adult ,Treatment Outcome ,Protein-Losing Enteropathies ,Humans ,Antidiarrheals ,Fontan Procedure ,Loperamide ,Biomarkers ,Serum Albumin - Abstract
We present the case of a 22-year-old man with a Fontan circulation who suffered from intractable protein losing enteropathy for an 8-year period necessitating several hospital admissions for recurrent pleural effusions and edema. Despite trying several recognized medical therapies to alleviate his protein losing enteropathy, his condition did not improve until the introduction of loperamide for troublesome diarrhea. Following this, his symptoms and serum albumin improved dramatically and he has not required any further hospital admissions at 22 months follow up.
- Published
- 2011
22. Contributors
- Author
-
David Alexander, Abdullah A. Alghamdi, Rafael Alonso-gonzalez, Naser M. Ammash, Annalisa Angelini, Ravi Assomull, Sonya V. Babu-Narayan, Carl L. Backer, Cristina Basso, Elisabeth Bédard, D. Woodrow Benson, Lee Benson, Stella D. Brili, Craig S. Broberg, Morgan L. Brown, Albert V.G. Bruschke, Werner Budts, Alida L.P. Caforio, Dennis V. Cokkinos, Jack M. Colman, Michael S. Connelly, Heidi M. Connolly, Domenico Corrado, Gordon Cumming, Michael Cumper, Piers E.F. Daubeney, Barbara J. Deal, Joseph A. Dearani, Gerhard-Paul Diller, Konstantinos Dimopoulos, Annie Dore, Jacqueline Durbridge, Alexander R. Ellis, Sabine Ernst, Simon J. Finney, Michael A. Gatzoulis, Smitha H. Gawde, Marc Gewillig, Georgios Giannakoulas, Thomas P. Graham, Ankur Gulati, Asif Hasan, Siew Yen Ho, Eric Horlick, Tim Hornung, Harald Kaemmerer, Juan Pablo Kaski, Paul Khairy, Philip J. Kilner, Michael J. Landzberg, Wei Li, Emmanouil Liodakis, Simon T. Macdonald, Shreesha Maiya, Larry W. Markham, Constantine Mavroudis, Doff B. Mcelhinney, Peter Mclaughlin, Folkert J. Meijboom, Lise-Andrée Mercier, Barbara J.M. Mulder, Michael J. Mullen, Daniel Murphy, Nitha Naqvi, Edward D. Nicol, Koichiro Niwa, Mark D. Norris, Erwin Oechslin, George A. Pantely, Joseph K. Perloff, James C. Perry, Frank A. Pigula, Kalliopi Pilichou, Nancy C. Poirier, Matina Prapa, Sanjay K. Prasad, Jelena Radojevic, Andrew N. Redington, Michael L. Rigby, Josep Rodés-Cabau, Michael B. Rubens, Markus Schwerzmann, Elliot A. Shinebourne, Darryl F. Shore, Michael N. Singh, Mark Spence, Christodoulos Stefanadis, James Stirrup, Kristen Lipscomb Sund, Lorna Swan, Shigeru Tateno, Dylan A. Taylor, Basil D. Thanopoulos, Erik Thaulow, Gaetano Thiene, Sara A. Thorne, Jan Till, Pavlos K. Toutouzas, John K. Triedman, Pedro T. Trindade, Anselm Uebing, Hideki Uemura, Glen S. Van Arsdell, Hubert W. Vliegen, Fiona Walker, Nicola L. Walker, Edward P. Walsh, Carole A. Warnes, Gary D. Webb, Steven A. Webber, Tom Wong, Edgar Tay Lik Wui, Steven Yentis, and James W.L. Yip
- Published
- 2011
23. Atrioventricular Valve Atresia
- Author
-
Sara A. Thorne
- Subjects
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
24. Congenitally Corrected Transposition of the Great Arteries
- Author
-
Sara A. Thorne
- Subjects
medicine.medical_specialty ,Congenitally corrected transposition ,Great arteries ,business.industry ,Internal medicine ,medicine ,Cardiology ,business ,Surgery - Published
- 2009
25. Femoral vascular access complications in adult congenital heart disease patients: audit from a single tertiary center
- Author
-
Lucy Hudsmith, Colin D. Chue, Sara A. Thorne, Joseph V. De Giovanni, Oliver Stumper, and Paul Clift
- Subjects
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.
- Published
- 2008
26. Management of re-coarctation due to prosthetic graft pseudo-intimal dissection
- Author
-
Peter Guest, Sara A. Thorne, Robert S. Bonser, and Maninder S Kalkat
- Subjects
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.
- Published
- 2007
27. Infected thrombus compression of the right ventricular outflow tract in transposition of the great arteries
- Author
-
Paul Clift, Colin D. Chue, Sara A. Thorne, and Lucy Hudsmith
- Subjects
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
28. Infected thrombus compression of the right ventricular outflow tract in transposition of the great arteries.
- Author
-
Colin D. Chue, Lucy E. Hudsmith, Sara A. Thorne, and Paul Clift
- 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. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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