61 results on '"Thorne SA"'
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2. 30 Managing delivery in women with congenital heart disease: results from the cuban national programme for pregnancy and heart disease
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Kinsella, C, primary, Thorne, SA, additional, Clift, PF, additional, Hudsmith, LE, additional, Bowater, S, additional, Peraza, R Vasallo, additional, Torga, JE Perez, additional, and Rubio, PA Roman, additional more...
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- 2018
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Catalog
3. 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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van Hagen, Iris, Boersma, Eric, Johnson, MR, Thorne, SA, Parsonage, W A, Subias, P E, Lesniak-Sobelga, A, Irtyuga, O, Sorour, KA, Taha, N (Nasser), Maggioni, AP, Hall, R, Roos - Hesselink, Jolien, Cardiology, and Epidemiology more...
- Published
- 2016
4. Acute heart failure in pregnancy: importance of a timely multidisciplinary approach to recognition and management
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Chacko Sanoj, De Bono Joseph, Marshall Howard, Haseeb Yumna B., Haseeb Sohaib, Morris Katie, and Thorne Sara
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acute disease ,heart failure ,female ,emergency care ,pregnancy ,Internal medicine ,RC31-1245 - Abstract
Increased cardiovascular demands of pregnancy may unmask occult diseases, such as dilated cardiomyopathy or valvular stenosis, or precipitate peripartum cardiomyopathy. We report a case of the emergency management and delivery of a young pregnant woman who presented with acute decompensated heart failure that was not immediately recognized. An emergency transfer to a tertiary care institution was arranged. Once diagnosed, the patient received multidisciplinary care shared between cardiologists, obstetricians, cardiac anesthetists, a neonatologist, and a midwife, resulting in good maternal and fetal outcomes. more...
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- 2021
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5. Management of polycythaemia in adults with cyanotic congenital heart disease
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Thorne Sa
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Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Polycythaemia ,Blood viscosity ,Hyperviscosity ,Polycythemia ,Hematocrit ,Phlebotomy ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Letters to the Editor ,Cyanosis ,medicine.diagnostic_test ,business.industry ,Contraindications ,Hypoxia (medical) ,Blood Viscosity ,medicine.disease ,Surgery ,Cerebrovascular Disorders ,Red blood cell ,medicine.anatomical_structure ,Editorial ,Cardiology ,Bone marrow ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Adults with polycythaemia secondary to cyanotic congenital heart disease may be at greater risk from injudicious venesection than from their polycythaemia.1 Despite an established literature on the subject, patients are frequently put at risk from acute volume depletion and chronic iron deficiency. This article aims to clarify some of the issues surrounding venesection and to set out guidelines for when and how to venesect these patients. The polycythaemia of chronic hypoxaemia may be more precisely termed erythrocytosis as, in contrast to polycythaemia rubra vera,2 it is the red blood cell mass alone that is increased. This secondary polycythaemia, or erythrocytosis, is a physiological response to tissue hypoxia. Hypoxia increases erythropoetin, which in turn stimulates the bone marrow to produce increased numbers of circulating red cells, enhancing oxygen carrying capacity as well as producing an increase in the erythrocyte mass, haematocrit, and whole blood viscosity. The improved tissue oxygenation that results from this adaptation may be sufficient to reach a new equilibrium at a higher haematocrit.3 However, adaptive failure can occur if the increased whole blood viscosity impairs oxygen delivery and negates the beneficial effects of erythrocytosis.1 4 Polycythaemic cyanotic patients experience symptoms caused by the detrimental effects of hyperviscosity on tissue oxygen delivery rather than by a high haematocrit itself (table … more...
- Published
- 1998
6. Restenosis and myointimal hyperplasia
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Thorne, SA
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Abstracts in Cardiology - Published
- 1993
7. Law and psychiatry. Personality disorders and violence potential.
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Reid WH and Thorne SA
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- 2007
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8. Analytical identification of ideal pulmonary-systemic flow balance in patients with bidirectional cavopulmonary shunt and univentricular circulation: oxygen delivery or tissue oxygenation?
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Diller GP, Uebing A, Willson K, Davies LC, Dimopoulos K, Thorne SA, Gatzoulis MA, and Francis DP
- Published
- 2006
9. 30 Managing delivery in women with congenital heart disease: results from the cuban national programme for pregnancy and heart disease
- Author
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Kinsella, C, Thorne, SA, Clift, PF, Hudsmith, LE, Bowater, S, Peraza, R Vasallo, Torga, JE Perez, and Rubio, PA Roman
- Abstract
PurposeTo provide an update on the delivery outcomes achieved in congenital heart disease (CHD) patients by the Cuban National Programme for Pregnancy and Heart Disease.MethodsThis was a single-centre retrospective study on a prospectively collected database from 1 st January 2000 to 15th May 2017. Baseline data: demographics (age, province of origin), diagnosis, co-morbidities and functional status. Primary outcomes: duration of pregnancy, pregnancy outcome, any maternal or fetal complications.ResultsOverall 467 pregnancies in 462 women reached the third trimester. Median age was 25 (21–29) years, with 71% of cases originating from Havana. Patients presented in NYHA class I (97%, n=453) or II (3%, n=14), 6% (n=27) of patients had arrhythmias, 1% (n=4) had significant co-morbidities, and 1% (n=4) had impaired left ventricular function. One pregnancy resulted in stillbirth, with the rest (n=466) resulting in live births (n=469) of median birth weight 3200 (2880–3420) grams. Median duration of gestation was 39 (38.6–40) weeks. Sixty-six percent (n=307) of patients had a vaginal delivery; caesarean section rates were 34% (n=161). Maternal cardiovascular complications (<0.5%, n=2), and obstetric complications (14%, n=67) did not result in mortality. Being small-for-gestational-age was the commonest complication (10%, n=48) in neonates, with zero mortality. Three neonates (1%) inherited congenital cardiac defects. Post-delivery NYHA functional status was class I in 84% (n=393) patients, class II in 16% (n=73) of patients and class III in one patient (<0.5%).ConclusionDespite considerable resource constraints, in middle-income countries management of CHD pregnancies according to existing guidelines can achieve excellent outcomes. more...
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- 2018
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10. Infected thrombus compression of the right ventricular outflow tract in transposition of the great arteries.
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Chue CD, Hudsmith LE, Thorne SA, and Clift P
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- 2009
11. Functional and imaging outcomes of the Fontan circulation following pregnancy.
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Thompson SE, Yuan M, Lodge F, Arif S, Castleman J, Clift P, Morris RK, Fox C, Thorne SA, and Hudsmith LE
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- Humans, Female, Pregnancy, Retrospective Studies, Adult, Young Adult, Fontan Procedure adverse effects, Fontan Procedure trends, Pregnancy Complications, Cardiovascular diagnostic imaging, Pregnancy Complications, Cardiovascular physiopathology, Heart Defects, Congenital surgery, Heart Defects, Congenital physiopathology, Heart Defects, Congenital diagnostic imaging, Pregnancy Outcome epidemiology
- Abstract
Introduction: The Fontan circulation palliates single-ventricle congenital heart disease by separating the systemic and pulmonary circulations. An increasing number of women with a Fontan circulation are wishing to become pregnant, however the ability to increase cardiac output during pregnancy is limited in many due to the chronic low output state. We describe pregnancy outcomes in these women at a large tertiary centre, including functional and imaging outcomes., Methods: We retrospectively investigated women with a Fontan circulation giving birth after 24 weeks' gestation between 1995 and 2023. Data collected included obstetric and neonatal complications, changes in cardiac volumes and ejection fraction (EF), and functional outcomes including change in NYHA class and exercise capacity pre- and post-pregnancy, compared to matched male controls., Results: Twenty-six pregnancies occurred among 23 women. Almost half experienced obstetric complications, primarily bleeding, which was the commonest indication for emergency C-section. Worsening cardiac symptoms complicated 50 % of pregnancies, with 4 requiring hospital admission for decompensation. Arrhythmias were not uncommon. Mean VO
2max declined post-pregnancy (p = 0.03), though not significantly compared to controls. Worsening of NYHA class was uncommon (15.4 %), suggesting that cardiovascular complications during pregnancy do not correlate with longer-term functional limitation. EF worsened post-pregnancy, declining significantly more so than in matched controls (p = 0.03), however there were no changes in cardiac volumes., Conclusions: Pregnancy in women with a Fontan circulation is associated with high rates of obstetric complications and worsening cardiac symptoms. However, successful pregnancies are possible, with little evidence of medium-term functional impairment. This data informs pre-pregnancy counselling of Fontan women of child-bearing age., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.) more...- Published
- 2025
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12. Pregnancy Considerations in Tetralogy of Fallot.
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Garagiola ML and Thorne SA
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The majority of women with repaired tetralogy of Fallot are able to tolerate pregnancy with a low risk of cardiovascular events. However, proactive contraceptive advice, prepregnancy counselling, and care by a pregnancy heart team with expertise in congenital heart disease are key to ensuring a good outcome for mother and baby. Maternal and fetal risks are increased in the presence of severe valvular stenosis, poorly tolerated arrhythmia, significant ventricular dysfunction, and cyanosis. It is unusual to see cyanotic adults with tetralogy of Fallot, whether unoperated or shunt palliated; pregnancy risks are greatly reduced by completing their repair before pregnancy is undertaken. The multidisciplinary pregnancy heart team should make a risk-stratified pregnancy care plan using a combination of published scoring systems and an individualized assessment of the patient's comorbidities. Low-risk patients may have the majority of their care and give birth in local units, whereas those at high risk should be managed and give birth in a tertiary centre with high-level expertise and intensive care facilities. Age-appropriate conversations about future childbearing and safe and reliable contraception should be part of routine follow-up from teenage years, so that women with tetralogy of Fallot can control their own fertility and make informed decisions about having children., (© 2023 The Author(s).) more...
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- 2023
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13. Intracranial Aneurysms in Patients With Coarctation of the Aorta: To Screen or Not to Screen?
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Thorne SA and Fernández-Campos B
- Abstract
Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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- 2023
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14. Transthoracic Echocardiographic Assessment of the Heart in Pregnancy-a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society.
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Curtis SL, Belham M, Bennett S, James R, Harkness A, Gamlin W, Thilaganathan B, Giorgione V, Douglas H, Carroll A, Kitt J, Colebourn C, Ribeiro I, Fairbairn S, Augustine DX, Robinson S, and Thorne SA
- Abstract
Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes which result in structural and functional adaptations in the cardiovascular system. An understanding of the myocardial adaptations is important for echocardiographers and clinicians undertaking or interpreting echocardiograms on pregnant and post-partum women. This guideline, on behalf of the British Society of Echocardiography and United Kingdom Maternal Cardiology Society, reviews the expected echocardiographic findings in normal pregnancy and in different cardiac disease states, as well as echocardiographic signs of decompensation. It aims to lay out a structure for echocardiographic scanning and surveillance during and after pregnancy as well as suggesting practical advice on scanning pregnant women., (© 2023. The Author(s).) more...
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- 2023
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15. Assessment and Prediction of Cardiovascular Contributions to Severe Maternal Morbidity.
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Thakkar A, Hameed AB, Makshood M, Gudenkauf B, Creanga AA, Malhamé I, Grandi SM, Thorne SA, D'Souza R, and Sharma G
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Severe maternal morbidity (SMM) refers to any unexpected outcome directly related to pregnancy and childbirth that results in both short-term delivery complications and long-term consequences to a women's health. This affects about 60,000 women annually in the United States. Cardiovascular contributions to SMM including cardiac arrest, arrhythmia, and acute myocardial infarction are on the rise, probably driven by changing demographics of the pregnant population including more women of extreme maternal age and an increased prevalence of cardiometabolic and structural heart disease. The utilization of SMM prediction tools and risk scores specific to cardiovascular disease in pregnancy has helped with risk stratification. Furthermore, health system data monitoring and reporting to identify and assess etiologies of cardiovascular complications has led to improvement in outcomes and greater standardization of care for mothers with cardiovascular disease. Improving cardiovascular disease-related SMM relies on a multipronged approach comprised of patient-level identification of risk factors, individualized review of SMM cases, and validation of risk stratification tools and system-wide improvements in quality of care. In this article, we review the epidemiology and cardiac causes of SMM, we provide a framework of risk prediction clinical tools, and we highlight need for organization of care to improve outcomes. more...
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- 2023
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16. Pregnancy outcomes in women following the Ross procedure.
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Thompson SE, Prabhakar CRK, Creasey T, Stoll VM, Gurney L, Green J, Fox C, Morris RK, Thompson PJ, Thorne SA, Clift P, and Hudsmith LE
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- Humans, Female, Pregnancy, Retrospective Studies, Pregnancy Outcome epidemiology, Autografts, Cesarean Section, Transplantation, Autologous adverse effects, Aortic Valve diagnostic imaging, Aortic Valve surgery, Dilatation, Pathologic, Follow-Up Studies, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency surgery, Aortic Valve Insufficiency etiology, Aortic Valve Stenosis surgery, Pulmonary Valve diagnostic imaging, Pulmonary Valve surgery
- Abstract
Introduction: 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., Methods: 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., Results: 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., Conclusions: 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., Competing Interests: Declaration of Competing Interest All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation., (Copyright © 2022 Elsevier B.V. All rights reserved.) more...
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- 2023
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17. Outcome and right ventricle remodelling after valve replacement for pulmonic stenosis.
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Laflamme E, Wald RM, Roche SL, Silversides CK, Thorne SA, Colman JM, Benson L, Osten M, Horlick E, Oechslin E, and Alonso-Gonzalez R
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- Humans, Retrospective Studies, Treatment Outcome, Ventricular Function, Right, Ventricular Remodeling, Heart Valve Prosthesis Implantation adverse effects, Pulmonary Valve diagnostic imaging, Pulmonary Valve surgery, Pulmonary Valve Insufficiency diagnostic imaging, Pulmonary Valve Insufficiency etiology, Pulmonary Valve Insufficiency surgery, Pulmonary Valve Stenosis complications, Pulmonary Valve Stenosis diagnostic imaging, Pulmonary Valve Stenosis surgery, Tetralogy of Fallot surgery
- Abstract
Background: Complications 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)., Methods: We 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., Results: After 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/m
2 for RV end-diastolic volume indexed(sensitivity 80%, specificity 64%) and 100 mL/m2 for RV end-systolic volume indexed(sensitivity 80%, specificity 56%)., Conclusions: Previous 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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.) more...- Published
- 2022
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18. Coagulation and Anticoagulation in Fontan Patients.
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Heidendael JF, Engele LJ, Bouma BJ, Dipchand AI, Thorne SA, McCrindle BW, and Mulder BJM
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- Adult, Anticoagulants therapeutic use, Child, Humans, Warfarin therapeutic use, Fontan Procedure adverse effects, Fontan Procedure methods, Heart Defects, Congenital epidemiology, Heart Defects, Congenital surgery, Stroke etiology, Venous Thromboembolism drug therapy
- 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., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2022
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19. Prevalence and Predictors of Young-Onset Colorectal Neoplasia: Insights From a Nationally Representative Colonoscopy Registry.
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Trivedi PD, Mohapatra A, Morris MK, Thorne SA, Smith SC, Ward AM, Schroy P, Hampel H, Jandorf L, Popp JW Jr, and Itzkowitz SH
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- Early Detection of Cancer, Humans, Male, Middle Aged, Prevalence, Registries, Risk Factors, United States epidemiology, Colonoscopy, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology
- Abstract
Background & Aims: A disturbing increase in early-onset colorectal cancer (EOCRC) has prompted recent guidelines to recommend lowering the colorectal cancer (CRC) screening starting age from 50 to 45 years old for average-risk individuals. Little is known about the prevalence of colorectal neoplasia in individuals between 45 and 49 years old, or even younger, in the United States. We analyzed a large, nationally representative data set of almost 3 million outpatient colonoscopies to determine the prevalence of, and risk factors for, colorectal neoplasia among patients aged 18 to 54., Methods: Findings from high-quality colonoscopies were analyzed from AMSURG ambulatory endoscopy centers (ASCs) that report their results in the GI Quality Improvement Consortium (GIQuIC) Registry. Logistic regression was used to identify risk factors for EOCRC., Results: Increasing age, male sex, White race, family history of CRC, and examinations for bleeding or screening were all associated with higher odds of advanced premalignant lesions (APLs) and CRC. Among patients aged 45 to 49, 32% had any neoplasia, 7.5% had APLs, and 0.58% had CRC. Rates were almost as high in those aged 40 to 44. Family history of CRC portended neoplasia rates 5 years earlier. Rates of APLs were higher in American Indian/Alaskan Natives, but lower among Blacks, Asians, and Hispanics, compared with White counterparts. The prevalence of any neoplasia and APL gradually increased between 2014 and 2019, in all age groups., Conclusions: These data provide support for lowering the screening age to 45 for all average-risk individuals. Early messaging to patients and providers in the years leading up to age 45 is warranted, especially in those with a family history of CRC., (Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.) more...
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- 2022
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20. Pre-conceptual counselling in cardiology patients: still work to do and still missed opportunities. A comparison between 2015 and 2019 in women with cardiac disease attending combined obstetric cardiology clinics. Should the European Guidelines change anything?
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Kasargod Prabhakar CR, Pamment D, Thompson PJ, Chong H, Thorne SA, Fox C, Morris K, and Hudsmith LH
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- Counseling, Female, Humans, Pregnancy, Pregnancy Outcome, Retrospective Studies, Cardiology, Heart Diseases complications, Heart Diseases epidemiology, Heart Diseases prevention & control
- Abstract
Women with underlying cardiac conditions have an increased risk of adverse pregnancy outcomes. Counselling reproductive age women with heart disease is important to assist them in deciding whether to pursue pregnancy, to ensure their best cardiovascular status prior to pregnancy, and that they understand the risks of pregnancy for them and baby. This also provides an opportunity to explore management strategies to reduce risks. For this growing cohort of women, there is a great need for pre-conceptual counselling.This retrospective comparative audit assessed new referrals and pre-conceptual counselling of women attending a joint obstetric-cardiology clinic at a tertiary maternity centre in a 12-month period of 2015-2016 compared with 2018-2019. This reflected the timing of the introduction of a multidisciplinary meeting prior to clinics and assessed the impact on referrals with the introduction of the European Society of Cardiology guidelines.Data were reviewed from 56 and 67 patients in respective audit periods. Patient's risk was stratified using modified World Health Organization classification.Less than 50% of women with pre-existing cardiac conditions had received pre-conceptual counselling, although half of them had risks clearly documented. The majority of patients had a recent electrocardiograph and echocardiogram performed prior to counselling, and there was a modest improvement in the number of appropriate functional tests performed between time points. One-third of patients in both cohorts were taking cardiac medications during pregnancy.There was a significant increase in the number of pregnant women with cardiac disease and in complexity according to modified World Health Organization risk classification. While there have been improvements, it is clear that further work to improve availability and documentation of pre-pregnancy counselling is needed. more...
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- 2022
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21. The Role of National Pregnancy Surveillance Systems in Improving Maternal Mortality and Morbidity: The Next Steps for Canada.
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Thorne SA, Cook JL, and D'Souza R
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- Canada epidemiology, Female, Humans, Maternal Mortality trends, Morbidity trends, Pregnancy, Population Surveillance methods, Pregnancy Complications epidemiology
- Published
- 2021
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22. Neural Activation During Visual Attention Differs in Individuals with High versus Low Macular Pigment Density.
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Oliver W, Renzi-Hammond LM, Thorne SA, Clementz B, Miller LS, and Hammond BR Jr
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- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Electroencephalography, Evoked Potentials, Visual, Female, Humans, Male, Photic Stimulation, Young Adult, Attention physiology, Brain physiology, Macular Pigment physiology, Vision, Ocular physiology
- Abstract
Scope: The neural efficiency hypothesis for lutein (L) and zeaxanthin (Z) suggests that higher levels of L+Z in the central nervous system (CNS) are predictive of stronger stimulus-specific brain responses. Past research suggests that supplementing L+Z can improve neural processing speed and cognitive function across multiple domains, which supports this hypothesis. The purpose of this study is to determine the extent to which CNS L+Z levels predict brain responses using an attentionally taxing task., Methods and Results: Macular pigment optical density (MPOD) is measured at baseline in 85 participants ranging in age from 18-92 years. Brain activation is measured using dense array electroencephalography. Stimuli evoking the signal include a grating array of vertical bars, oscillating at four driving frequencies. Significant stimulus-specific interactions are detected between attend condition, location, and age (p < .002) for unattended image locations, and between age and location (p < .008) for attended locations. Although no differences are found across age by MPOD, this measure is found to be predictive of neural power at parafoveal bar locations (R
2 .080)., Conclusion: CNS L+Z status is related to differences in brain activation in conditions designed to stress visual attention. These differences are strongest for older subjects., (© 2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.) more...- Published
- 2019
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23. Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease: Results From the Registry of Pregnancy and Cardiac Disease.
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van Hagen IM, Thorne SA, Taha N, Youssef G, Elnagar A, Gabriel H, ElRakshy Y, Iung B, Johnson MR, Hall R, and Roos-Hesselink JW
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- Adult, Female, Humans, Pregnancy, Prospective Studies, Mitral Valve Insufficiency mortality, Mitral Valve Insufficiency therapy, Models, Cardiovascular, Pregnancy Complications, Cardiovascular mortality, Pregnancy Complications, Cardiovascular therapy, Pregnancy Outcome, Registries, Rheumatic Heart Disease mortality, Rheumatic Heart Disease therapy
- Abstract
Background: Cardiac disease is 1 of the major causes of maternal mortality. We studied pregnancy outcomes in women with rheumatic mitral valve disease., Methods: The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease and no prepregnancy valve replacement is described in the present study (n=390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention. Associations between patient characteristics and cardiac outcomes were checked in a 3-level model (patient-center-country)., Results: Most patients came from emerging countries (75%). Mitral stenosis (MS) with or without mitral regurgitation (MR) was present in 273 women, isolated MR in 117. The degree of MS was mild in 20.9%, moderate in 39.2%, severe in 19.8%, and severity not classified in the remainder. Maternal death during pregnancy occurred in 1 patient with severe MS. Hospital admission occurred in 23.1% of the women with MS, and the main reason was heart failure (mild MS 15.8%, moderate 23.4%, severe 48.1%; P <0.001). Heart failure occurred in 23.1% of patients with moderate or severe MR. An intervention during pregnancy was performed in 16 patients, 14 had percutaneous balloon mitral commissurotomy, and 2 had surgical valve replacement (1 for MS, 1 for MR). In multivariable modeling, prepregnancy New York Heart Association class >1 was an independent predictor of maternal cardiac events. Follow-up at 6 months postpartum was available for 53%, and 3 more patients died (1 with severe MS, 1 with moderate MS, 1 with moderate to severe MR)., Conclusions: Although mortality was only 1.9% during pregnancy, ≈50% of the patients with severe rheumatic MS and 23% of those with significant MR developed heart failure during pregnancy. Prepregnancy counseling and considering mitral valve interventions in selected patients are important to prevent these complications., (© 2018 American Heart Association, Inc.) more...
- Published
- 2018
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24. 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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Taylor C, McCance DR, Chappell L, Nelson-Piercy C, Thorne SA, Ismail KMK, Green JSA, and Bick D
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- Adult, Cardiovascular Diseases therapy, Diabetes Mellitus therapy, Female, Health Care Surveys, Humans, Pregnancy, Pregnancy Complications etiology, Prenatal Care organization & administration, United Kingdom, Young Adult, Health Plan Implementation statistics & numerical data, Patient Care Team standards, Practice Guidelines as Topic, Pregnancy Complications therapy, Prenatal Care standards
- 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. more...
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- 2017
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25. 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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van Hagen IM, Boersma E, Johnson MR, Thorne SA, Parsonage WA, Escribano Subías P, Leśniak-Sobelga A, Irtyuga O, Sorour KA, Taha N, Maggioni AP, Hall R, and Roos-Hesselink JW
- Subjects
- Acute Coronary Syndrome epidemiology, Adult, Aortic Dissection epidemiology, Aortic Aneurysm epidemiology, Arrhythmias, Cardiac epidemiology, Atrial Fibrillation epidemiology, Cardiology, Developed Countries, Developing Countries, Europe, Female, Humans, Pregnancy, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Societies, Medical, World Health Organization, Young Adult, Heart Defects, Congenital epidemiology, Heart Failure epidemiology, Heart Valve Diseases epidemiology, Maternal Mortality, Pregnancy Complications, Cardiovascular epidemiology, Registries
- Abstract
Aims: 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., Methods and Results: 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., Conclusion: 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., (© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.) more...
- Published
- 2016
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26. Heart disease in pregnancy.
- Author
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Emmanuel Y and Thorne SA
- Subjects
- Anticoagulants adverse effects, Arrhythmias, Cardiac therapy, Directive Counseling, Early Diagnosis, Female, Heart Defects, Congenital therapy, Heart Diseases diagnosis, Heart Diseases physiopathology, Heart Valve Diseases therapy, Hemodynamics, Humans, Hypertension, Pulmonary therapy, Preconception Care methods, Pregnancy, Pregnancy Complications, Cardiovascular diagnosis, Pregnancy Complications, Cardiovascular physiopathology, Risk Assessment, Ventricular Dysfunction therapy, Aortic Diseases therapy, Heart Diseases therapy, Pregnancy Complications, Cardiovascular therapy
- Abstract
Cardiac disease is the leading cause of maternal mortality in the developed world. The majority of women with heart disease are able to successfully undergo pregnancy. However, in women with severely impaired ventricular function, severe left heart obstruction, pulmonary hypertension and aortopathy, such as Marfan syndrome, with significant aortic dilatation, pregnancy is associated with a significant risk, and these women should be counselled against pregnancy if there is no option for treatment that reduces risk. Although there are increasing numbers of women with congenital heart disease who are considering pregnancy, as a result of joint expert specialist cardiac and obstetric care, maternal mortality is low. Most of the observed mortality occurs in women with structurally normal hearts who were not known to have heart disease before their pregnancy. It is therefore important that those caring for pregnant women are aware of the risk factors for and presentation of cardiac conditions in pregnancy. We review the presentation and management of both congenital and acquired heart diseases in pregnancy., (Copyright © 2015 Elsevier Ltd. All rights reserved.) more...
- Published
- 2015
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27. Long-term outcome following pregnancy in women with a systemic right ventricle: is the deterioration due to pregnancy or a consequence of time?
- Author
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Bowater SE, Selman TJ, Hudsmith LE, Clift PF, Thompson PJ, and Thorne SA
- Subjects
- Adolescent, Adult, Chi-Square Distribution, Congenitally Corrected Transposition of the Great Arteries, Disease Progression, England, Female, Heart Ventricles abnormalities, Heart Ventricles surgery, Humans, Pregnancy, Pregnancy Complications, Cardiovascular physiopathology, Pregnancy Outcome, Retrospective Studies, Risk Factors, Time Factors, Transposition of Great Vessels physiopathology, Transposition of Great Vessels surgery, Ventricular Dysfunction, Right physiopathology, Young Adult, Heart Ventricles physiopathology, Parity, Pregnancy Complications, Cardiovascular etiology, Transposition of Great Vessels complications, Ventricular Dysfunction, Right etiology, Ventricular Function, Right
- Abstract
Introduction: 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., Methods: 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., Results: 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., Conclusion: 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., (© 2012 Wiley Periodicals, Inc.) more...
- Published
- 2013
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28. End-of-life care in adults with congenital heart disease: now is the time to act.
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Bowater SE, Speakman JK, and Thorne SA
- Subjects
- Adult, Advance Care Planning trends, Comorbidity, Disease Progression, Heart Defects, Congenital complications, Heart Defects, Congenital epidemiology, Heart Defects, Congenital surgery, Humans, Life Expectancy trends, Middle Aged, Palliative Care methods, Palliative Care standards, Patient-Centered Care trends, Prevalence, Transition to Adult Care standards, Advance Care Planning standards, Heart Defects, Congenital psychology, Palliative Care psychology, Patient-Centered Care standards
- Abstract
Purpose of Review: There are increasing numbers of adults with congenital heart disease (CHD) and these patients remain at long-term risk of complications and premature death. This review focuses on the changing picture of adult CHD with more complex patients surviving, the challenges of balancing life-prolonging intervention, the barriers to discussing the end-of-life (EOL) issues and draws on the experience of other specialities in managing young patients., Recent Findings: The prevalence of adults with the most severe forms of CHD has increased, especially those with a Fontan circulation. The eventual decline is inevitable with limited treatment options. There should be a parallel palliative care approach in patients who are being considered for high-risk, life-prolonging interventions. Oncologists caring for the young patients with cancer and cystic fibrosis specialists have demonstrated the unique needs of young patients with chronic diseases that may be applicable to adult CHD patients and help with their EOL planning., Summary: These patients require an early and proactive approach to EOL discussions, and the unique needs of young patients should be recognized. Further research is needed to develop local and national guidelines for the palliative care approach in these patients. more...
- Published
- 2013
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29. The safety and effects of bosentan in patients with a Fontan circulation.
- Author
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Bowater SE, Weaver RA, Thorne SA, and Clift PF
- Subjects
- Adult, Bosentan, Cardiovascular Agents adverse effects, Echocardiography, Doppler, Endothelin Receptor Antagonists, England, Exercise Test, Exercise Tolerance drug effects, Female, Humans, Male, Pilot Projects, Postoperative Complications diagnostic imaging, Postoperative Complications etiology, Postoperative Complications metabolism, Postoperative Complications physiopathology, Predictive Value of Tests, Prospective Studies, Pulmonary Artery metabolism, Pulmonary Artery physiopathology, Receptors, Endothelin metabolism, Recovery of Function, Sulfonamides adverse effects, Time Factors, Treatment Outcome, Vascular Resistance drug effects, Ventricular Function drug effects, Cardiovascular Agents therapeutic use, Fontan Procedure adverse effects, Heart Defects, Congenital surgery, Postoperative Complications drug therapy, Pulmonary Artery drug effects, Sulfonamides therapeutic use
- Abstract
Objective: 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., Design: A 6-month prospective, single-center, pilot, safety study of bosentan in Fontan patients. Setting. Adult Congenital Heart Disease referral center., Patients: 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., Outcome Measures: 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., Results: 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., Conclusions: 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., (© 2012 Wiley Periodicals, Inc.) more...
- Published
- 2012
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30. An unusual treatment for protein losing enteropathy.
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Windram JD, Clift PF, Speakman J, and Thorne SA
- Subjects
- Biomarkers blood, Diarrhea etiology, Humans, Male, Protein-Losing Enteropathies blood, Protein-Losing Enteropathies etiology, Treatment Outcome, Young Adult, Antidiarrheals therapeutic use, Diarrhea drug therapy, Fontan Procedure adverse effects, Loperamide therapeutic use, Protein-Losing Enteropathies drug therapy, Serum Albumin metabolism
- 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., (© 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.) more...
- Published
- 2011
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31. Management of pregnancy in women with acquired and congenital heart disease.
- Author
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Bowater SE and Thorne SA
- Subjects
- Anticoagulants, Arrhythmias, Cardiac therapy, Contraindications, Early Diagnosis, Female, Heart Defects, Congenital physiopathology, Heart Defects, Congenital therapy, Heart Diseases diagnosis, Heart Diseases physiopathology, Heart Valve Prosthesis, Hemodynamics, Heparin, Humans, Myocardial Ischemia diagnosis, Myocardial Ischemia therapy, Postnatal Care methods, Preconception Care methods, Pregnancy, Pregnancy Complications, Cardiovascular diagnosis, Pregnancy Complications, Cardiovascular physiopathology, Rheumatic Heart Disease therapy, Risk Factors, Heart Diseases therapy, Pregnancy Complications, Cardiovascular therapy, Prenatal Care methods
- Abstract
Heart disease is the leading cause of maternal mortality in the UK. Deaths from acquired conditions such as ischaemic heart disease are increasing and often occur in patients with no history of heart disease, thus emphasising the need for vigilance for risk factors in women of childbearing age. All women with known heart disease should have pre-pregnancy counselling to assess for maternal and fetal risk. Women deemed to be at moderate or high risk should be under the care of a specialist antenatal team with experience of managing women with heart disease in pregnancy. Conditions that are considered particularly high risk (mortality >10%) include Marfan syndrome with dilated aortic root, severe left heart obstructive lesions, pulmonary hypertension, and severe left ventricular dysfunction. This article reviews the management of women with heart disease during pregnancy, labour and in the puerperium. more...
- Published
- 2010
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32. Treatment of dynamic subvalvar muscular obstruction in the native right ventricular outflow tract by percutaneous stenting in adults.
- Author
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Steadman CD, Clift PF, Thorne SA, Hudsmith L, and De Giovanni JV
- Subjects
- Adult, Aged, Down Syndrome, Fluoroscopy, Heart Defects, Congenital diagnostic imaging, Humans, Male, Pulmonary Valve Stenosis congenital, Pulmonary Valve Stenosis diagnostic imaging, Ventricular Outflow Obstruction diagnostic imaging, Heart Defects, Congenital therapy, Pulmonary Valve Stenosis therapy, Stents, Ventricular Outflow Obstruction therapy
- Abstract
Percutaneous techniques are being increasingly used in adult congenital heart disease but there is limited experience in the treatment of native nonvalvar right ventricular outflow tract obstruction. We describe two cases of percutaneous stenting of the subpulmonary region where surgery was not an option. more...
- Published
- 2009
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33. Pregnancy in high risk cardiac conditions.
- Author
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Roos-Hesselink JW, Duvekot JJ, and Thorne SA
- Subjects
- Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome therapy, Adult, Aortic Dissection diagnosis, Aortic Dissection therapy, Aortic Aneurysm diagnosis, Aortic Aneurysm therapy, Cardiomyopathy, Dilated diagnosis, Cardiomyopathy, Dilated therapy, Female, Humans, Myocardial Ischemia diagnosis, Myocardial Ischemia therapy, Pregnancy, Pregnancy Complications, Cardiovascular diagnosis, Prognosis, Puerperal Disorders diagnosis, Puerperal Disorders therapy, Pregnancy Complications, Cardiovascular therapy, Pregnancy, High-Risk
- Published
- 2009
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34. Maternal mortality due to cardiac disease in Sri Lanka.
- Author
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Haththotuwa HR, Attygalle D, Jayatilleka AC, Karunaratna V, and Thorne SA
- Subjects
- Cause of Death, Female, Heart Diseases complications, Humans, Maternal Health Services, Pregnancy, Quality of Health Care, Retrospective Studies, Sri Lanka epidemiology, Heart Diseases mortality, Maternal Mortality, Obstetric Labor Complications mortality, Pregnancy Complications, Cardiovascular mortality
- Abstract
Objective: To investigate Sri Lankan maternal deaths due to heart disease and to consider low-cost interventions to reduce these deaths., Methods: A qualitative study based on retrospective audit of all maternal deaths and late maternal deaths in Sri Lanka caused by cardiac disease in 2004., Results: A total of 145 maternal deaths were recorded in 2004, for a maternal mortality rate of 38 per 100,000. There were 42 indirect deaths, 25 of which were due to cardiac disease; 23 deaths had a specific cardiac cause listed. Standard care was identified in prepregnancy counseling, contraception, and prenatal community and specialist care., Conclusion: Cardiac disease is a major cause of maternal mortality in Sri Lanka, second only to postpartum hemorrhage. Rheumatic mitral valve disease is responsible for more than a third of maternal deaths from cardiac disease. Substandard care was identified in all cases; strategies to improve care could allow a reduction in maternal cardiac deaths. more...
- Published
- 2009
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35. Acquired thoracic aortic interruption: percutaneous repair using graft stents.
- Author
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Hudsmith LE, Thorne SA, Clift PF, and de Giovanni J
- Subjects
- Aortic Dissection diagnostic imaging, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic diagnostic imaging, Aortography, Cardiac Catheterization methods, Female, Follow-Up Studies, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures methods, Risk Assessment, Treatment Outcome, Aortic Dissection surgery, Angioplasty methods, Aortic Aneurysm, Thoracic surgery, Stents
- Abstract
Two adult patients with isolated, aortic interruption were successfully treated by percutaneous insertion of graft stents. Prior to the intervention, both patients were hypertensive and on medication. In both cases, an ascending aortogram demonstrated a blind ending of the thoracic aorta distal to the left subclavian artery with a large gradient across the interruption and with multiple collaterals. A graft stent was successfully deployed across the interrupted segment in both cases. We believe that this is one of the first reported cases of percutaneous stenting of aortic interruption and represents a promising new therapeutic option for these adult patients. more...
- Published
- 2009
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36. Transvenous pacing via a disconnected superior vena cava in a patient with transposition of the great arteries.
- Author
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Steadman CD, Clift P, Thorne SA, and De Giovanni JV
- Subjects
- Humans, Infant, Newborn, Male, Transposition of Great Vessels, Arrhythmias, Cardiac prevention & control, Cardiac Pacing, Artificial methods, Pacemaker, Artificial, Prosthesis Implantation methods, Vena Cava, Superior abnormalities, Vena Cava, Superior surgery
- Abstract
We describe successful implantation of a permanent pacemaker via the right subclavian vein in a 28-year-old man with operated transposition of the great arteries where the superior vena cava is completely disconnected from the systemic venous atrium following a previous Glenn procedure. more...
- Published
- 2008
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37. Femoral vascular access complications in adult congenital heart disease patients: audit from a single tertiary center.
- Author
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Chue CD, Hudsmith LE, Stumper O, De Giovanni J, Thorne SA, and Clift P
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Aneurysm, False epidemiology, Aneurysm, False etiology, Arteriovenous Fistula epidemiology, Arteriovenous Fistula etiology, Cardiac Catheterization statistics & numerical data, Coronary Angiography statistics & numerical data, Female, Heart Defects, Congenital epidemiology, Hematoma epidemiology, Hemorrhage epidemiology, Hemorrhage etiology, Humans, Incidence, Male, Medical Audit, Middle Aged, Retrospective Studies, Risk Factors, Young Adult, Cardiac Catheterization adverse effects, Coronary Angiography adverse effects, Femoral Artery, Heart Defects, Congenital diagnostic imaging, Hematoma etiology
- 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 2(2/3) 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. more...
- Published
- 2008
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38. Echocardiography in cryptogenic cerebrospinal abscess.
- Author
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Mahadevan G, Thorne SA, and Steeds RP
- Subjects
- Adult, Aged, Case-Control Studies, Contrast Media, Female, Humans, Male, Middle Aged, Brain Abscess diagnostic imaging, Echocardiography methods, Endocarditis, Bacterial diagnostic imaging, Sodium Chloride
- Published
- 2008
- Full Text
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39. Transition of care from paediatric to adult services in cardiology.
- Author
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Hudsmith LE and Thorne SA
- Subjects
- Adolescent, Adult, Cardiology organization & administration, Child, Delivery of Health Care ethics, Female, Heart Defects, Congenital psychology, Humans, Male, Continuity of Patient Care standards, Delivery of Health Care standards, Heart Defects, Congenital therapy, Pediatrics
- Published
- 2007
- Full Text
- View/download PDF
40. Personality disorders and violence potential.
- Author
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Reid WH and Thorne SA
- Subjects
- Comorbidity, Forensic Psychiatry, Humans, Personality Disorders psychology, Personality Disorders therapy, Risk Assessment, Violence classification, Violence legislation & jurisprudence, Violence prevention & control, Personality Disorders diagnosis, Violence psychology
- Abstract
Violence associated with personality disorders is usually best viewed separately from psychiatric diagnosis, as a syndrome of violence rather than a syndrome of diagnosis. The authors describe eight categories of violence associated with personality disorders that may help clinicians choose treatment or management techniques: purposeful, instrumental violence; purposeful, non-instrumental violence; purposeful, targeted, defensive violence; targeted, impulsive violence; nontargeted, impulsive violence incidental to emotional escape; random but purposeful violence; violence related to perceived or feared loss or abandonment; and violence related to chronic paranoia or related misconceptions. The categories are not completely mutually exclusive, nor do they represent a "decision tree." We also point out three important principles about the relationship between personality disorders and violence: 1) Personality disorders are rarely ego dystonic; 2) Most patients and violent situations that come to clinical attention involve comorbid conditions. 3) Violence and violence risk are often associated with intoxication. more...
- Published
- 2007
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- View/download PDF
41. Management of re-coarctation due to prosthetic graft pseudo-intimal dissection.
- Author
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Kalkat MS, Thorne SA, Guest P, and Bonser RS
- Subjects
- Acrylic Resins, Female, Humans, Magnetic Resonance Angiography, Middle Aged, Recurrence, Aortic Coarctation etiology, Aortic Coarctation surgery, Blood Vessel Prosthesis, Graft Occlusion, Vascular complications, Graft Occlusion, Vascular surgery, Prosthesis Failure
- 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. more...
- Published
- 2007
- Full Text
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42. Treating antisocial syndromes.
- Author
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Reid WH and Thorne SA
- Subjects
- Antisocial Personality Disorder psychology, Community Mental Health Services organization & administration, Crime psychology, Humans, Antisocial Personality Disorder therapy, Psychotherapy methods
- Published
- 2006
- Full Text
- View/download PDF
43. Congenital heart disease in pregnancy.
- Author
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Head CE and Thorne SA
- Subjects
- Bioprosthesis, Delivery, Obstetric, Female, Fetal Diseases etiology, Heart Defects, Congenital therapy, Heart Valve Diseases etiology, Heart Valve Diseases therapy, Heart Valve Prosthesis, Humans, Obstetric Labor Complications prevention & control, Pregnancy Complications, Cardiovascular therapy, Pregnancy Outcome, Prenatal Care methods, Risk Assessment, Risk Factors, Heart Defects, Congenital physiopathology, Hemodynamics physiology, Pregnancy, Pregnancy Complications, Cardiovascular physiopathology
- Abstract
Congenital heart disease is now more prevalent than acquired in pregnancy in the developed world. In pregnancy the fall in systemic vascular resistance and increase in blood volume and cardiac output can cause functional deterioration in certain conditions. A minimally symptomatic woman with good ventricular function, normal oxygen saturation, and no left heart obstruction should tolerate pregnancy well. Women with pulmonary hypertension or dilated aortic root (pre-replacement) should be counselled against pregnancy and given appropriate contraceptive advice. The optimum management of a pregnant woman with a metallic prosthetic valve remains to be determined. more...
- Published
- 2005
- Full Text
- View/download PDF
44. Changing practice of cardiac surgery in adult patients with congenital heart disease.
- Author
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Srinathan SK, Bonser RS, Sethia B, Thorne SA, Brawn WJ, and Barron DJ
- Subjects
- Adolescent, Adult, Aged, Blood Vessel Prosthesis Implantation economics, Blood Vessel Prosthesis Implantation statistics & numerical data, Blood Vessel Prosthesis Implantation trends, Costs and Cost Analysis, England, Heart Defects, Congenital economics, Humans, Length of Stay economics, Middle Aged, Professional Practice economics, Reoperation economics, Reoperation statistics & numerical data, Reoperation trends, Workload statistics & numerical data, Heart Defects, Congenital surgery, Professional Practice trends
- Abstract
Objectives: To review 13 years' data from a unit for grown ups with congenital heart disease (GUCH) to understand the change in surgical practice., Methods: Records were reviewed of patients over 16 years of age undergoing surgery between 1 January 1990 and 31 December 2002 in a dedicated GUCH unit. Patients with atrial septal defects were included but not those with Marfan's syndrome or undergoing a first procedure for bicuspid aortic valves. Three equal time periods of 52 months were analysed., Results: Of 474 operations performed, 162 (34.2%) were repeat operations. The percentage of repeat operations increased from 24.8% (41 of 165) in January 1990-April 1994 to 49.7% (74 of 149) in September 1998-December 2002. Mortality was 6.3% (n = 30). The median age decreased from 25.4 years (interquartile range 18.7) in January 1990-April 1994 to 23.9 (interquartile range 17.3) in September 1998-December 2002 (p = 0.04). The proportion of patients with a "simple" diagnosis decreased from 45.4% (74 or 165) in January 1990-April 1994 to 27.5% (41 of 149) in September 1998-December 2002 (p = 0.013). Pulmonary valve replacements in operated tetralogy of Fallot increased from one case in January 1990-April 1994 to 23 cases in September 1998-December 2002 and conduit replacement increased from five cases to 17. However, secundum atrial septal defect closures decreased from 35 cases to 14 (p < 0.0001). The estimated cost (not including salaries and prosthetics) incurred by an adult patient with congenital heart disease was pound2290 compared with pound2641 for a patient undergoing coronary artery bypass grafting., Conclusion: Despite the impact of interventional cardiology, the total number of surgical procedures remained unchanged. The complexity of the cases increased particularly with repeat surgery. Nevertheless, the patients do well with low mortality and the inpatient costs remain comparable with costs of surgery for acquired disease. more...
- Published
- 2005
- Full Text
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45. Pregnancy in heart disease.
- Author
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Thorne SA
- Subjects
- Counseling, Female, Heart Defects, Congenital therapy, Heart Diseases etiology, Humans, Preconception Care, Pregnancy, Pregnancy Complications, Cardiovascular etiology, Prenatal Care, Risk Assessment, Heart Diseases therapy, Pregnancy Complications, Cardiovascular therapy
- Published
- 2004
- Full Text
- View/download PDF
46. The effect of amlodipine on endothelial function in young adults with a strong family history of premature coronary artery disease: a randomised double blind study.
- Author
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Clarkson P, Mullen MJ, Donald AE, Powe AJ, Thomson H, Thorne SA, Bull T, and Deanfield JE
- Subjects
- Adult, Brachial Artery diagnostic imaging, Brachial Artery drug effects, Brachial Artery physiopathology, Double-Blind Method, Female, Humans, Male, Nitroglycerin, Regional Blood Flow drug effects, Ultrasonography, Vasodilator Agents, Amlodipine therapeutic use, Calcium Channel Blockers therapeutic use, Coronary Disease genetics, Endothelium, Vascular drug effects, Endothelium, Vascular physiopathology
- Abstract
Endothelial dysfunction, an early event in atherogenesis, has been demonstrated in young asymptomatic subjects with a strong family history of premature coronary artery disease (CAD). In these subjects, preventive measures involving risk factor modification are not appropriate, and strategies employing novel antiatherogenic agents, such as the dihydropyridine calcium channel blocker, amlodipine, may be useful. Ninety-one subjects (mean age, 28.6 years; range, 18-40) with a strong family history of premature CAD and no other identified vascular risk factors were randomised to either 5 mg amlodipine (49 subjects) or placebo (42 subjects). Brachial artery flow mediated dilatation (FMD) (endothelium-dependent response) and response to glyceryltrinitrate (GTN) (direct smooth muscle dilator) were assessed non-invasively at baseline, and after 12 and 24 weeks using high-resolution vascular ultrasound. In those treated with amlodipine, mean FMD increased from 2.32+/-2.23% at baseline to 3.52+/-3.1% at 24 weeks (P<0.005). However, FMD also increased in the placebo group from 1.64+/-2.12 to 3.37+/-2.68% (P<0.002), and the difference between the FMD response in the amlodipine and placebo groups was not significant. Dilatation to GTN did not change in either group. Therefore, impaired endothelial function improved in family history subjects taking both amlodipine and placebo, but there is no difference between the groups. more...
- Published
- 2001
- Full Text
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47. Coronary artery imaging in grown up congenital heart disease: complementary role of magnetic resonance and x-ray coronary angiography.
- Author
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Taylor AM, Thorne SA, Rubens MB, Jhooti P, Keegan J, Gatehouse PD, Wiesmann F, Grothues F, Somerville J, and Pennell DJ
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Respiration, Single-Blind Method, Coronary Angiography, Coronary Vessels pathology, Heart Defects, Congenital diagnosis, Magnetic Resonance Angiography methods
- Abstract
Background: There is a high incidence of anomalous coronary arteries in subjects with congenital heart disease. These abnormalities can be responsible for myocardial ischemia and sudden death or be damaged during surgical intervention. It can be difficult to define the proximal course of anomalous coronary arteries with the use of conventional x-ray coronary angiography. Magnetic resonance coronary angiography (MRCA) has been shown to be useful in the assessment of the 3-dimensional relationship between the coronary arteries and the great vessels in subjects with normal cardiac morphology but has not been used in patients with congenital heart disease., Methods and Results: Twenty-five adults with various congenital heart abnormalities were studied. X-ray coronary angiography and respiratory-gated MRCA were performed in all subjects. Coronary artery origin and proximal course were assessed for each imaging modality by separate, blinded investigators. Images were then compared, and a consensus diagnosis was reached. With the consensus readings for both magnetic resonance and x-ray coronary angiography, it was possible to identify the origin and course of the proximal coronary arteries in all 25 subjects: 16 with coronary anomalies and 9 with normal coronary arteries. Respiratory-gated MRCA had an accuracy of 92%, a sensitivity of 88%, and a specificity of 100% for the detection of abnormal coronary arteries. The MRCA results were more likely to agree with the consensus for definition of the proximal course of the coronary arteries (P<0.02)., Conclusions: For the assessment of anomalous coronary artery anatomy in patients with congenital heart disease, the use of the combination of MRCA with x-ray coronary angiography improves the definition of the proximal coronary artery course. MRCA provides correct spatial relationships, whereas x-ray angiography provides a view of the entire coronary length and its peripheral run-off. Furthermore, respiratory-gated MRCA can be performed without breath holding and with only limited subject cooperation. more...
- Published
- 2000
- Full Text
- View/download PDF
48. Repaired coarctation: a "cost-effective" approach to identify complications in adults.
- Author
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Therrien J, Thorne SA, Wright A, Kilner PJ, and Somerville J
- Subjects
- Adolescent, Adult, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic economics, Aortic Aneurysm, Thoracic surgery, Aortic Coarctation diagnosis, Aortic Coarctation economics, Cost-Benefit Analysis, Echocardiography economics, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging economics, Male, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications surgery, Predictive Value of Tests, Recurrence, Reoperation, Aortic Coarctation surgery, Postoperative Complications economics
- Abstract
Objectives: The study was done to determine the most "cost-effective" approach to follow adults after repair of coarctation of the aorta., Background: Recoarctation and/or aneurysm formation following surgical repair or angioplasty for coarctation of the aorta carry a significant morbidity and mortality. Various screening tests to detect such complications are used, but little is known of their sensitivities and specificities; as a consequence, the most "cost-effective" approach to follow such patients is undefined., Methods: Retrospective analysis was done on the sensitivity and specificity of symptomatology, physical examination, electrocardiogram, chest radiograph, exercise testing and transthoracic echocardiography to detect recoarctation and/or aneurysm formation in 84 adult patients following surgical repair or angioplasty of coarctation of the aorta, using magnetic resonance imaging (MRI) as the gold standard test., Results: Echocardiography had the highest sensitivity in detecting recoarctation (87%) and chest radiograph the highest sensitivity in detecting aneurysm formation (67%). Combined clinical visit and echocardiography had a high sensitivity for diagnosing recoarctation and/or aneurysm formation (97%), but performing a clinical visit and an MRI on every patient without any prior screening test emerged as the most "cost-effective" strategy., Conclusions: The most "cost-effective" approach to diagnose complications at the site of repair in patients after surgical repair or balloon angioplasty of coarctation of the aorta appears to be the combination of clinical assessment and MRI scan on every patient. If MRI resources are scant, performing a clinical assessment plus a transthoracic echocardiography and an MRI on patients with positive results is an acceptable alternative. more...
- Published
- 2000
- Full Text
- View/download PDF
49. Oxygenation in patients with a functionally univentricular circulation and complete mixing of blood: are saturation and flow interchangeable?
- Author
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Francis DP, Willson K, Thorne SA, Davies LC, and Coats AJ
- Subjects
- Computer Simulation, Humans, Oxygen Consumption, Coronary Circulation, Oxygen blood, Pulmonary Circulation
- Abstract
Background: Perioperative management of patients with complete mixing of pulmonary and systemic blood centers on approximately equating pulmonary (Qp) and systemic (Qs) blood flow (Qp/Qs approximately 1). This empirically derived target is opposed by theoretical studies advocating a target Qp/Qs well below 1. We studied the cause of this persistent discrepancy., Methods and Results: Classic theoretical studies have concentrated on maximizing 1 of many potential combination parameters of arterial oxygen content (CaO(2)) and systemic blood flow: total oxygen delivery (DO(2))=CaO(2)xQs. We defined "useful" oxygen delivery as the amount of oxygen above a notional saturation threshold (Sat(Thresh)): D(u)O(2)=carrying capacityx(SaO(2)-Sat(Thresh))xQs. Whereas DO(2) peaks at Qp/Qs ratios <1, D(u)O(2) peaks at higher Qp/Qs ratios, nearer to (or exceeding) 1. Systemic venous saturation (which mirrors tissue oxygen tension) peaks at Qp/Qs=1., Conclusions: First, the standard model of single-ventricle physiology can be reexpressed in a form allowing analysis by differential calculus, which allows broader conclusions to be drawn than does computer modeling alone. Second, the classic measure DO(2) fails to reflect the fact that proportional changes in saturation and flow are not clinically equivalent. Recognizing this asymmetry by using D(u)O(2) can give a target Qp:Qs balance that better represents clinical experience. Finally, to avoid an arbitrary choice of Sat(Thresh), systemic venous oxygen saturation (SsvO(2)) may be a useful parameter to maximize: this occurs at a Qp/Qs ratio of 1. Attempts to increase DO(2) by altering Qp/Qs away from this value will inevitably reduce SsvO(2) and therefore tissue oxygenation. Oxygen delivery is far from synonymous with tissue oxygen status. more...
- Published
- 1999
- Full Text
- View/download PDF
50. Amiodarone-associated thyroid dysfunction: risk factors in adults with congenital heart disease.
- Author
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Thorne SA, Barnes I, Cullinan P, and Somerville J
- Subjects
- Adolescent, Adult, Amiodarone therapeutic use, Anti-Arrhythmia Agents therapeutic use, Case-Control Studies, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Amiodarone adverse effects, Anti-Arrhythmia Agents adverse effects, Heart Defects, Congenital drug therapy, Thyroid Diseases chemically induced
- Abstract
Background: Amiodarone is widely used in adults with congenital heart disease, but no systematic study has been published on its effects on thyroid function in these patients. A retrospective study was performed to examine the frequency of amiodarone-associated thyroid dysfunction in adults with congenital heart disease and to identify any contributing factors., Methods and Results: All adults (16 to 60 years old) with congenital heart disease were identified from a database if they had no preexisting thyroid disease, had taken amiodarone for >/=6 months, and were currently followed up by 1 consultant (J.S.). Ninety-two patients were found and evaluated for thyroid status and cardiac complications. A case-control analysis was performed, with patients matched for duration of amiodarone therapy. Of the 92 patients (age, 34.9+/-10.2 years; range, 18 to 60 years), 36% developed thyroid dysfunction: 19 became hyperthyroid and 14 hypothyroid. Female sex and complex cyanotic heart disease were significant risk factors for developing thyroid dysfunction (odds ratios, 3.0 and 7.00; P=0.04 and 0.01, respectively). Previous Fontan-type surgery also appeared to be a risk factor for developing thyrotoxicosis (odds ratio, 4.0; P=0.17), and amiodarone >200 mg/d a risk factor for thyroid dysfunction (odds ratio, 4.0; P=0.60)., Conclusions: Amiodarone-associated thyroid dysfunction is common in adults with congenital heart disease. Women and those with complex cyanotic lesions are at particular risk, as patients may be who have had Fontan-type surgery or are taking >200 mg/d of amiodarone. Amiodarone should be used only when other antiarrhythmics are ineffective or contraindicated. Vigilance is required to detect and treat thyroid dysfunction. more...
- Published
- 1999
- Full Text
- View/download PDF
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