LONG TERM OUTCOMES OF PALLIATIVE CONGENITAL HEART DISEASE
|
|
- Alannah Norman
- 6 years ago
- Views:
Transcription
1 LONG TERM OUTCOMES OF PALLIATIVE CONGENITAL HEART DISEASE S Bruce Greenberg, MD, FACR, FNASCI Professor of Radiology and Pediatrics Arkansas Children's Hospital University of Arkansas for Medical Sciences
2 Disclosures: None
3 Outline Incidence of complex congenital heart disease in adults Evolution of palliative procedures and physiology Long term outcomes and future concerns
4 Incidence of congenital heart disease Hoffman JIE and Kaplan S. The incidence of congenital heart disease. JACC2002; 39:
5 Worldwide increasing prevalence ACHD Marelli et al. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation Shiina et al. Prevalence of adult patients with congenital heart disease in Japan. International Journal of Cardiology
6 Adult CHD beyond age 60 Number of patients 60 years of age under follow-up. (A) Overview over the whole cohort. (B) Relative number of patients stratified by the complexity of congenital heart defect (year 2000 is indexed as 100%). There was a 12-fold increase of patients with simple defects, and a six- to seven-fold increase in patients with moderate severe complexity. Tutarel O, et al. Congenital heart disease beyond the age of 60: emergence of anew population with high resource utilization, high morbidity, and high mortality. European Heart Journal 2014: 35:
7 CHD prevalence in USA 2010 Total 2.4 million Adults 1.4 million Adults between 2000 and % increase 85% increase with severe congenital heart disease Gilboa SM, Devine OJ, Kucik JE, et al. Congenital heart defects in the United States. Estimating the magnitude of the affected population in Circulation 2016; 134:
8 Palliation for single ventricle physiology Fontan Tricuspid atresia Norwood Hypoplastic left heart syndrome
9 Anomalies palliated by Fontan Morphology Range Percent Tricuspid atresia , 22, 31, 16 Hypoplastic left heart syndrome , 21, 5, 40 Double inlet left ventricle , 15, 22, 19 Double outlet right ventricle 8 8, 8, X, X Heterotaxy/discordant AV connections 6-8 6, 8, X, 7 Unbalanced AVC 4-6 6, 4, X, 6 Other , 23, 42, 11 Dabal RJ, Kirklin JK, Kukreja M, et al. The modern Fontan operation show no increase in mortality out to 20 years: a new paradigm. J Thorac Cardiovasc Surg 2014; 148: Anderson PAW, Sleeper LA, Mahony L, et al. Comtemporary outcomes after the Fontan procedure. JACC 2008; 52: Khairy P, Fernandes SM, Mayer JE, et al. Long-term survival, modes of death, and predictors of mortality inpatients with Fontan Surgery. Circulation 2008; 117: Tweddell JS, Neresian M, Mussatto KA, Nugent M, et al. Fontan palliation in the modern era: factors Impacting mortality and morbidity. Ann Thorac Surg 2009; 88:
10 Fontan growth in the next decade 2.3: 10,000 live births evaluated for Fontan Adults 60% increase in Fontan patients NYHA functional class III expected to double Van Melle JP, Wolff D, Horer J, et al. Surgical options after Fontan failure. Heart 2016; 102:
11 Fontan mortality accelerates in 3 rd decade of life
12 Evolution of the Fontan Atrio-pulmonary connection Total cavo-pulmonary connection
13 Fontan mortality (operations ) Boston: 262 patient with follow up mean 12.2 years Mortality 29% Transplant, take down or revision 12% Late attrition in early survivors Sudden death (probable arrhythmia origin) Thromboembolic Heart failure Khairy P, Fernandes SM, Mayer JE, et al. Long-term survival, modes of death, and predictors of mortality inpatients with Fontan Surgery. Circulation 2008; 117:
14 Fontan survival (operations ) Milwaukee: 256 Survival at 10 year follow up 94% Event free survival at 10 years 64% Events include Death, heart transplant, Fontan take down Heart failure (NYHA class III-IV) Pacemaker, antiarrhythmic medication Protein-losing enteropathy, stroke, thrombus Tweddell JS, Neresian M, Mussatto KA, Nugent M, et al. Fontan palliation in the modern era: factors Impacting mortality and morbidity. Ann Thorac Surg 2009; 88:
15 Fontan survival (operations ) Birmingham: 207 Survival at 10 year follow up 88% % % Survival at 20 year follow up 76% Dabal RJ, Kirklin JK, Kukreja M, et al. The modern Fontan operation show no increase in mortality out to 20 years: a new paradigm. J Thorac Cardiovasc Surg 2014; 148:
16 Fontan survival (operations ) Dabal RJ, Kirklin JK, Kukreja M, et al. The modern Fontan operation show no increase in mortality out to 20 years: a new paradigm. J Thorac Cardiovasc Surg 2014; 148:
17 Fontan mortality accelerates in 3 rd decade of life
18 40 th Anniversary of Fontan palliation
19 Suboptimal physiology Elevated central venous pressure Hepatic congestion Splanchnic congestion Reduced cardiac output Increased pulmonary resistance from absent pulsatile flow Reduced pre-load Abnormal ventricle anatomy
20 Increased pulmonary vascular resistance Non-pulsatile pulmonary flow Remodeling of intra-acinar vessels Intima: acellular thickening Media: apoptosis of smooth muscle Lumen narrowing Inability to vasodilate Ridderbos F-JS, Wolff D, Timmer A, et al. Adverse pulmonary vascular remodeling in the Fontan circulation. J Heart Lung Transplant 2015; 34:
21 Systemic to pulmonary vein collaterals Adults with Fontan palliations and angiograms 58% systemic to pulmonary vein collaterals Source of collateral blood flow Right brachiocephalic vein 35% Azygous vein 20% Superior vena cava 13% Inferior vena cava 10% Other 22% 19 y.o.with atrio-pulmonary Fontan & systemic vein to pulmonary vein collateral Lluri G, Levi DS, Aboulhosn J. Systemic to pulmonary venous collaterals in adults with single ventricle physiology after cavopulmonary palliation. Intern J Cardiology 2015; 189:
22 Fontan and gastrointestinal vulnerability Elevated systemic venous pressure Low pressure gradient from portal vein to hepatic veins Chronic venous congestion Sinusoidal dilation, atrophy and necrosis Cirrhosis, regenerating nodules, hepatocellular carcinoma 19 year old with heterotaxy & cirrhosis Yoo SJ, Prsa M, Schantz D, et al. MR assessment of abdominal circulation in Fontan physiology. Int J Cardiovasc Imaging 2014; 30:
23 Protein losing enteropathy Loss of protein at the intestinal mucosa Mechanism hypothesis Chronic low cardiac output vascular redistribution away from gut Systemic venous hypertension vascular congestion Release of inflammatory mediators Breakdown of bowel mucosa Similar mechanism may be responsible for plastic bronchitis Rychik J. Forty years of the Fontan operation: a failed strategy. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2010; 13:
24 Late attrition after Fontan Decline in exercise tolerance Heart failure Arrhythmias Thromboembolic complications All are worse with atrio-pulmonary Fontan palliations Atrio-pulmonary Fontan with dilated right atrium
25 Treatment failing Fontan Fontan take down Fontan revision Heart transplant
26 Fontan take down Usually a bail out in early Fontan failure Reduced due to better patient selection Mortality 30 days post take down 26% Mean follow-up 5.9 yrs 40% Mortality + heart tx 45% Van Melle JP, Wolff D, Horer J, et al. Surgical options after Fontan failure. Heart 2016; 102:
27 Fontan revision & Heart transplant Late Fontan failure No difference in mortality Mortality Fontan Conversion 30 days post conversion 11% Mean follow-up 7.7 yrs 22% Mortality + heart tx 26% Van Melle JP, Wolff D, Horer J, et al. Surgical options after Fontan failure. Heart 2016; 102:
28 Hypoplastic left heart syndrome Norwood procedure: conversion of right ventricle to systemic ventricle by connecting pulmonary artery root and native aorta Bi-direction Glenn palliation Fontan palliation HLHS: Norwood (left) and extracardiac Fontan (right)
29 Long term outcome of HLHS palliation 70% survive to adulthood No long term data on adult mortality Fontan mortality Adults 8.2% over 5 years Univentricular heart patient mean age of death < 30 years Feinstein JA, Benson W, Dubin AM, et al. Hypoplastic left heart syndrome. Current considerations and expectations. JACC 2012; 59: S1-S42.
30 Hypoplastic left heart syndrome morbidity Known risk of Fontan Additional concerns Heart failure from absent left ventricle Neoaortic root abnormalities Aortic arch repair abnormalities Feinstein JA, Benson W, Dubin AM, et al. Hypoplastic left heart syndrome. Current considerations and expectations. JACC 2012; 59: S1-S42.
31 Conclusion adults with complex congenital heart disease Palliation results of Fontan and Norwood procedures Short and intermediate results are good Long term results are indeterminate Multiple organ systems require life-long follow up
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationOutline. Congenital Heart Disease. Special Considerations for Special Populations: Congenital Heart Disease
Special Considerations for Special Populations: Congenital Heart Disease Valerie Bosco, FNP, EdD Alison Knauth Meadows, MD, PhD University of California San Francisco Adult Congenital Heart Program Outline
More informationManagement of Heart Failure in Adult with Congenital Heart Disease
Management of Heart Failure in Adult with Congenital Heart Disease Ahmed Krimly Interventional and ACHD consultant King Faisal Cardiac Center National Guard Jeddah Background 0.4% of adults have some form
More information9/8/2009 < 1 1,2 3,4 5,6 7,8 9,10 11,12 13,14 15,16 17,18 > 18. Tetralogy of Fallot. Complex Congenital Heart Disease.
Current Indications for Pediatric CTA S Bruce Greenberg Professor of Radiology Arkansas Children s Hospital University of Arkansas for Medical Sciences greenbergsbruce@uams.edu 45 40 35 30 25 20 15 10
More informationGlenn Shunts Revisited
Glenn Shunts Revisited What is a Super Glenn Patricia O Brien, MSN, CPNP-AC Nurse Practitioner, Pediatric Cardiology No Disclosures Single Ventricle Anatomy Glenn Shunt Cavopulmonary Anastomosis Anastomosis
More informationSurvival Rates of Children with Congenital Heart Disease continue to improve.
DOROTHY RADFORD Survival Rates of Children with Congenital Heart Disease continue to improve. 1940-20% 1960-40% 1980-70% 2010->90% Percentage of children with CHD reaching age of 18 years 1938 First Patent
More informationChildren with Single Ventricle Physiology: The Possibilities
Children with Single Ventricle Physiology: The Possibilities William I. Douglas, M.D. Pediatric Cardiovascular Surgery Children s Memorial Hermann Hospital The University of Texas Health Science Center
More informationThe modified natural history of congenital heart disease
The modified natural history of congenital heart disease Matthias Greutmann, MD Adult Congenital Heart Disease Program University Hospital Zurich, Switzerland matthias.greutmann@usz.ch Are we ready for
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACHD. See Adult congenital heart disease (ACHD) Adult congenital heart disease (ACHD), 503 512 across life span prevalence of, 504 506
More informationWhat is the Definition of Small Systemic Ventricle. Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University
What is the Definition of Small Systemic Ventricle Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University Contents Introduction Aortic valve stenosis Aortic coarctation
More informationPediatric Echocardiography Examination Content Outline
Pediatric Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 Anatomy and Physiology Normal Anatomy and Physiology 10% 2 Abnormal Pathology and Pathophysiology
More informationAppendix A.1: Tier 1 Surgical Procedure Terms and Definitions
Appendix A.1: Tier 1 Surgical Procedure Terms and Definitions Tier 1 surgeries AV Canal Atrioventricular Septal Repair, Complete Repair of complete AV canal (AVSD) using one- or two-patch or other technique,
More informationSurgical Management of Failing Fontan Operation
Surgical Management of Failing Fontan Operation Jeong-Jun Park Dept. of Thoracic & cardiovascular Surgery Asan Medical Center, Ulsan University Fontan operation 1995-2001, 123 procedures in 71 pts EJCTS
More informationThe Challenging Pediatric Cardiac Patient. Edmund Jooste
The Challenging Pediatric Cardiac Patient Edmund Jooste A 5 -year old female with hypoplastic left heart syndrome s/p the Fontan procedure presents for laparoscopic appendectomy for acute appendicitis.
More informationSingle Ventricle with Mitral and Aortic Atresia
1 Bahrain Medical Bulletin, Vol. 26, No. 2, June 2004 Single Ventricle with Mitral and Aortic Atresia Vijaya V Mysorekar, MBBS, MD* Chitralekha P Dandekar, MBBS, MD** Saraswati G Rao, MBBS, MD*** We report
More informationPREGNANCY AND CONGENITAL HEART DISEASE
PREGNANCY AND CONGENITAL HEART DISEASE SIDDHARTH JADHAV M.D. Assistant Professor of Radiology E.B. Singleton Department of Pediatric Radiology Texas Children's Hospital COMMERCIAL DISCLOSURE - None Objectives
More informationChapter 14. The Cardiovascular System
Chapter 14 The Cardiovascular System Introduction Cardiovascular system - heart, blood and blood vessels Cardiac muscle makes up bulk of heart provides force to pump blood Function - transports blood 2
More information가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY
가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY PA c IVS (not only pulmonary valve disease) Edwards JE. Pathologic Alteration of the right heart. In: Konstam MA, Isner M, eds.
More informationChanging Profile of Adult Congenital Heart Disease
Congenital Heart Disease New Developments for the General Cardiologist Changing Profile of Adult Congenital Heart Disease European Society of Cardiology August 27, 2012 Ariane Marelli MD, FRCP, FACC, MPH
More informationHeart and Soul Evaluation of the Fetal Heart
Heart and Soul Evaluation of the Fetal Heart Ivana M. Vettraino, M.D., M.B.A. Clinical Associate Professor, Michigan State University College of Human Medicine Objectives Review the embryology of the formation
More informationThe Journal of Thoracic and Cardiovascular Surgery
Accepted Manuscript Dream Big in Every Small Step Lok Sinha, MD, Can Yerebakan, MD PII: S0022-5223(19)30013-3 DOI: https://doi.org/10.1016/j.jtcvs.2018.12.086 Reference: YMTC 13988 To appear in: The Journal
More informationIntroduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationCommon Defects With Expected Adult Survival:
Common Defects With Expected Adult Survival: Bicuspid aortic valve :Acyanotic Mitral valve prolapse Coarctation of aorta Pulmonary valve stenosis Atrial septal defect Patent ductus arteriosus (V.S.D.)
More informationBlood flows away from the heart in arteries, to the capillaries and back to the heart in the veins
Cardiovascular System Summary Notes The cardiovascular system includes: The heart, a muscular pump The blood, a fluid connective tissue The blood vessels, arteries, veins and capillaries Blood flows away
More informationFundamentals of Congenital heart surgery in the adult
Fundamentals of Congenital heart surgery in the adult Hospital Nacional A Posadas Hospital Universitario Austral Christian Kreutzer, MD AATS Cardiovscular Symposium, Sao Paulo December, 2017 STS CHSD Procedures
More informationMid-term Result of One and One Half Ventricular Repair in a Patient with Pulmonary Atresia and Intact Ventricular Septum
Mid-term Result of One and One Half Ventricular Repair in a Patient with Pulmonary Atresia and Intact Ventricular Septum Kagami MIYAJI, MD, Akira FURUSE, MD, Toshiya OHTSUKA, MD, and Motoaki KAWAUCHI,
More informationPulmonary vasodilators in Fontan Patients
Pulmonary vasodilators in Fontan Patients Maurice Beghetti Pediatric Cardiology University Children s Hospital HUG and CHUV Pulmonary Hypertension Program HUG Centre Universitaire Romand de Cardiologie
More informationCoarctation of the aorta
T H E P E D I A T R I C C A R D I A C S U R G E R Y I N Q U E S T R E P O R T Coarctation of the aorta In the normal heart, blood flows to the body through the aorta, which connects to the left ventricle
More informationManagement of a Patient after the Bidirectional Glenn
Management of a Patient after the Bidirectional Glenn Melissa B. Jones MSN, APRN, CPNP-AC CICU Nurse Practitioner Children s National Health System Washington, DC No Disclosures Objectives qbriefly describe
More informationAntithrombotic therapy for patients with congenital heart disease. George Giannakoulas, MD, PhD AHEPA University Hospital Thessaloniki
Antithrombotic therapy for patients with congenital heart disease George Giannakoulas, MD, PhD AHEPA University Hospital Thessaloniki Disclosures Educational fees from Astra Zeneca, GSK Research fees from
More informationPulmonary arterio-venous fistulas. Pulmonary arterio-venous fistulas. Pulmonary angiogram. Typical patient presentation
Pulmonary arterio-venous fistulas Pulmonary arterio-venous fistulas No conflicts of interest to declare Julien I.E.Hoffman Department of Pediatrics UCSF Typical patient presentation KB was cyanotic at
More informationIncidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institutional database. Carlos M.
Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institutional database Carlos M. Mery, MD, MPH Assistant Professor, and Pediatrics Congenital Heart Texas
More informationIntracardiac Lateral Tunnel Fontan by using Right Atrial Wall
Intracardiac Lateral Tunnel Fontan by using Right Atrial Wall Md Zahidul Islam¹, AM Asif Rahim², Kazi Abul Hasan¹, Syed Imtiaz Ahsan¹ 1 Department of Paediatric Cardiac Surgery, National Institute of Cardiovascular
More informationRegional Prenatal Congenital Heart Disease Detection and Practices Jenny Ecord, APRN Ward Family Heart Center Wichita
Regional Prenatal Congenital Heart Disease Detection and Practices Jenny Ecord, APRN Ward Family Heart Center Wichita The Children's Mercy Hospital, 2014. 05/14 Objectives Review current local and regional
More informationHypoplastic Left Heart Syndrome: Echocardiographic Assessment
Hypoplastic Left Heart Syndrome: Echocardiographic Assessment Craig E Fleishman, MD, FACC, FASE Director, Non-invasive Cardiac Imaging The Hear Center at Arnold Palmer Hospital for Children, Orlando SCAI
More informationCardiac Catheterization Cases Primary Cardiac Diagnoses Facility 12 month period from to PRIMARY DIAGNOSES (one per patient)
PRIMARY DIAGNOSES (one per patient) Septal Defects ASD (Atrial Septal Defect) PFO (Patent Foramen Ovale) ASD, Secundum ASD, Sinus venosus ASD, Coronary sinus ASD, Common atrium (single atrium) VSD (Ventricular
More informationCMS Limitations Guide - Radiology Services
CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations
More informationManagement of complex CHD in adults
Management of complex CHD in adults Victor Tsang Society of Thoracic Surgeons of Thailand 2016 The impact of infant cardiac surgery Over 90 % of infants born with CHD will reach adulthood By 2010, adults
More informationAdult Congenital Heart Disease T S U N ` A M I!
Adult Congenital Heart Disease T S U N ` A M I! Erwin Oechslin, MD, FRCPC, FESC Director, Congenital Cardiac Centre for Adults University Health Network Peter Munk Cardiac Centre / Toronto General Hospital
More informationT who has survived first-stage palliative surgical management
Intermediate Procedures After First-Stage Norwood Operation Facilitate Subsequent Repair Richard A. Jonas, MD Department of Cardiac Surgery, Children s Hospital, Boston, Massachusetts Actuarial analysis
More informationWhen to implant an ICD in systemic right ventricle?
When to implant an ICD in systemic right ventricle? Département de rythmologie et de stimulation cardiaque Nicolas Combes n.combes@clinique-pasteur.com Pôle de cardiologie pédiatrique et congénitale Risk
More informationCongenital Heart Disease in the Adult Presenting for Non-Cardiac Surgery
Page 1 Congenital Heart Disease in the Adult Presenting for Non-Cardiac Surgery Susan S. Eagle, M.D. Nashville, Tennessee Introduction: Advancement of surgical techniques and medical management patients
More informationM/3, cc-tga, PS, BCPC(+) Double Switch Operation
2005 < Pros & Cons > M/3, cc-tga, PS, BCPC(+) Double Switch Operation Congenitally corrected TGA Atrio-Ventricular & Ventriculo-Arterial discordance Physiologically corrected circulation with the morphologic
More informationSite of Interstage Care, Resource Utilization, and Interstage Mortality: A Report from the NPC-QIC Registry
Schidlow et al 1 Site of Interstage Care, Resource Utilization, and Interstage Mortality: A Report from the NPC-QIC Registry David Schidlow Kimberlee Gauvreau Mehul Patel Karen Uzark David W. Brown For
More informationTRACE A DROP OF BLOOD FROM RIGHT EAR TO LEFT OCULOMOTOR NERVE
TRACE A DROP OF BLOOD FROM RIGHT EAR TO LEFT OCULOMOTOR NERVE KEY: TRACE A DROP OF BLOOD FROM RIGHT EAR TO LEFT OCULOMOTOR NERVE RIGHT EAR RIGHT ATRIUM LEFT SUBCLAVIAN ARTERY RIGHT EXTERNAL JUGULAR VEIN
More informationAll You Need to Know About Situs and Looping Disorders: Embryology, Anatomy, and Echocardiography
All You Need to Know About Situs and Looping Disorders: Embryology, Anatomy, and Echocardiography Helena Gardiner Co-Director of Fetal Cardiology, The Fetal Center, University of Texas at Houston Situs
More informationTennessee Chapter of ACC Adult Congenital Heart Disease: Complex Thoughts on Simple Lesions & Simple Thoughts on Complex Lesions
Tennessee Chapter of ACC Adult Congenital Heart Disease: Complex Thoughts on Simple Lesions & Simple Thoughts on Complex Lesions Benjamin Frischhertz, M.D. Assistant Professor of Medicine and Pediatrics
More informationRegional Prenatal Congenital Heart Disease Detection and Practices Lori Erickson MSN, RN, CPNP-PC Ward Family Heart Center
Regional Prenatal Congenital Heart Disease Detection and Practices Lori Erickson MSN, RN, CPNP-PC Ward Family Heart Center The Children's Mercy Hospital, 2014. 05/14 Objectives Evaluate our regional prenatal
More informationThe Fontan circulation. Folkert Meijboom
The Fontan circulation Folkert Meijboom What to expect? Why a Fontan-circulation Indications How does it work Types of Fontan circulation Historical overview Role of echocardiography What to expect? Why
More informationFontan Deterioration in Pediatric Cardiologist s s View. Pusan National University Hospital Hyoung Doo Lee M.D.
Fontan Deterioration in Pediatric Cardiologist s s View Pusan National University Hospital Hyoung Doo Lee M.D. Outcomes of Fontan operation JTCS 2006:131;172-80 Mitchell ME et al Jan. 1992~Dec. 1999, 332
More informationCardiac MRI in ACHD What We. ACHD Patients
Cardiac MRI in ACHD What We Have Learned to Apply to ACHD Patients Faris Al Mousily, MBChB, FAAC, FACC Consultant, Pediatric Cardiology, KFSH&RC/Jeddah Adjunct Faculty, Division of Pediatric Cardiology
More informationI worldwide [ 11. The overall number of transplantations
Expanding Applicability of Transplantation After Multiple Prior Palliative Procedures Alan H. Menkis, MD, F. Neil McKenzie, MD, Richard J. Novick, MD, William J. Kostuk, MD, Peter W. Pflugfelder, MD, Martin
More informationHeart Transplantation for Patients with a Fontan Procedure
Heart Transplantation for Patients with a Fontan Procedure Kirk R. Kanter MD Professor of Surgery Pediatric Cardiac Surgery Emory University School of Medicine Children s Healthcare of Atlanta Atlanta,
More informationFUNCTIONALLY SINGLE VENTRICLE
MORPHOLOGICAL DETERMINANTS VI TRAN EuroEcho, Budapest, 7 th December 2011 DECLARATION OF CONFLICT OF INTEREST: I have nothing to declare What is the functionally single ventricle? The heart that is incapable
More informationAlthough the surgical management of hypoplastic left
Hypoplastic Left Heart Syndrome With Intact or Highly Restrictive Atrial Septum Outcome After Neonatal Transcatheter Atrial Septostomy Antonios P. Vlahos, MD; James E. Lock, MD; Doff B. McElhinney, MD;
More informationMajor Function of the Cardiovascular System. Transportation. Structures of the Cardiovascular System. Heart - muscular pump
Structures of the Cardiovascular System Heart - muscular pump Blood vessels - network of tubes Blood - liquid transport vehicle brachiocephalic trunk superior vena cava right pulmonary arteries right pulmonary
More informationDown Syndrome Medical Interest Group Friday, 12 June Cardiac Surgery in patients with Down Syndrome
Down Syndrome Medical Interest Group Friday, 12 June 2015 Cardiac Surgery in patients with Down Syndrome Mr. Attilio Lotto, FRCS CTh Congenital Cardiac Surgeon Cardiac surgery in patients with Down syndrome
More informationTom Gentles Paediatric Cardiologist Green Lane Paediatric and Congenital Cardiac Service Starship Children s Hospital
Tom Gentles Paediatric Cardiologist Green Lane Paediatric and Congenital Cardiac Service Starship Children s Hospital Systemic venous return bypasses the heart and goes direct to the lungs There is no
More informationCardiovascular System and Health. Chapter 15
Cardiovascular System and Health Chapter 15 Cardiovascular Disease Leading cause of death in U.S. Claims 1 life every 43 seconds Often, the first sign is a fatal heart attack Death Rates #1 CVD #2 Cancer
More informationDEVELOPMENT OF THE CIRCULATORY SYSTEM L E C T U R E 5
DEVELOPMENT OF THE CIRCULATORY SYSTEM L E C T U R E 5 REVIEW OF CARDIAC ANATOMY Heart 4 chambers Base and apex Valves Pericardial sac 3 layers: epi, myo, endo cardium Major blood vessels Aorta and its
More informationThe Heart. Made up of 3 different tissue: cardiac muscle tissue, nerve tissue, and connective tissue.
The Heart The Heart Made up of 3 different tissue: cardiac muscle tissue, nerve tissue, and connective tissue. Your heart pumps with a regular beat (Heart Rate) Your heart rate can change depending on
More informationWhat Can the Database Tell Us About Reoperation?
AATS/STS Congenital Heart Disease Postgraduate Symposium May 5, 2013 What Can the Database Tell Us About Reoperation? Jeffrey P. Jacobs, M.D. All Children s Hospital Johns Hopkins Medicine The Congenital
More informationCardiac CT in Infants with Congenital heart disease Sunrise Session. LaDonna Malone, MD May 17, 2018
Cardiac CT in Infants with Congenital heart disease Sunrise Session LaDonna Malone, MD May 17, 2018 None Disclosures Objectives Describe cardiac CT techniques used in infants with congenital heart disease.
More informationPreoperative Echocardiographic Assessment of Uni-ventricular Repair
Preoperative Echocardiographic Assessment of Uni-ventricular Repair Salem Deraz, MD Pediatric Cardiologist, Aswan Heart Centre Magdi Yacoub Heart Foundation Uni-ventricular repair A single or series of
More informationThe sinus venosus represent the venous end of the heart It receives 3 veins: 1- Common cardinal vein body wall 2- Umbilical vein from placenta 3-
1 2 The sinus venosus represent the venous end of the heart It receives 3 veins: 1- Common cardinal vein body wall 2- Umbilical vein from placenta 3- Vitelline vein from yolk sac 3 However!!!!! The left
More informationTranscoronary Infusion of Cardiac Progenitor Cells in Hypoplastic Left Heart Syndrome: 3-year Follow-up of the TICAP Trial
Transcoronary Infusion of Cardiac Progenitor Cells in Hypoplastic Left Heart Syndrome: 3-year Follow-up of the TICAP Trial Shunji Sano, Shuta Ishigami, Takuya Goto, Daiki Ousaka, Suguru Tarui, Michihiro
More informationThe Circulatory System (p )
The Circulatory System (p. 268-281) How Does Gravity Affect Blood Circulation? As with all land animals, the giraffe and the corn snake are constantly subject to the force of gravity The circulatory system
More information10. Thick deposits of lipids on the walls of blood vessels, called, can lead to serious circulatory issues. A. aneurysm B. atherosclerosis C.
Heart Student: 1. carry blood away from the heart. A. Arteries B. Veins C. Capillaries 2. What is the leading cause of heart attack and stroke in North America? A. alcohol B. smoking C. arteriosclerosis
More informationHeart Transplantation in Patients with Superior Vena Cava to Pulmonary Artery Anastomosis: A Single-Institution Experience
Korean J Thorac Cardiovasc Surg 2018;51:167-171 ISSN: 2233-601X (Print) ISSN: 2093-6516 (Online) CLINICAL RESEARCH https://doi.org/10.5090/kjtcs.2018.51.3.167 Heart Transplantation in Patients with Superior
More informationNDV OUTCOMES AND FOLLOW-UP IN CHILDREN WITH. Lisa Herzig 11/16/2015 COMPLEX CONGENITAL HEART DISEASE
NDV OUTCOMES AND FOLLOW-UP IN CHILDREN WITH Lisa Herzig 11/16/2015 COMPLEX CONGENITAL HEART DISEASE ROADMAP Congenital Heart Disease Terms and Lingo Prevalence and Patterns Specific Outcome Studies & Risk
More informationJ Somerville and V Grech. The chest x-ray in congenital heart disease 2. Images Paediatr Cardiol Jan-Mar; 12(1): 1 8.
IMAGES in PAEDIATRIC CARDIOLOGY Images Paediatr Cardiol. 2010 PMCID: PMC3228330 The chest x-ray in congenital heart disease 2 J Somerville and V Grech Paediatric Department, Mater Dei Hospital, Malta Corresponding
More informationAnatomy of Atrioventricular Septal Defect (AVSD)
Surgical challenges in atrio-ventricular septal defect in grown-up congenital heart disease Anatomy of Atrioventricular Septal Defect (AVSD) S. Yen Ho Professor of Cardiac Morphology Royal Brompton and
More informationNeurodevelopmental and Oral-feeding Outcomes for Infants
Neurodevelopmental and Oral-feeding Outcomes for Infants Sharon Sables-Baus, PhD, RN, MPA, PCNS-BC Associate Professor, University of Colorado College of Nursing/ School of Medicine, Department of Pediatrics
More informationLarge veins of the thorax Brachiocephalic veins
Large veins of the thorax Brachiocephalic veins Right brachiocephalic vein: formed at the root of the neck by the union of the right subclavian & the right internal jugular veins. Left brachiocephalic
More informationChapter 05 Cardiovascular System
Chapter 05 Cardiovascular System 1 Cardiovascular System: Heart and Blood Vessels 2 Points to ponder What are the functions of the cardiovascular system? What is the anatomy of the heart? Of blood vessels,
More informationThe Fetal Cardiology Program
The Fetal Cardiology Program at Texas Children s Fetal Center About the program Since the 1980s, Texas Children s Fetal Cardiology Program has provided comprehensive fetal cardiac care to expecting families
More informationReview Article An Adult Patient with Fontan Physiology: A TEE Perspective
Anesthesiology Research and Practice Volume 2012, Article ID 475015, 5 pages doi:10.1155/2012/475015 Review Article An Adult Patient with Fontan Physiology: A TEE Perspective Edward Gologorsky, 1 Angela
More informationAn Analysis of Results for the Norwood. Operation at Evelina London Children s Hospital (ELCH)
An Analysis of Results for the Norwood Operation at Evelina London Children s Hospital (ELCH) 2012-2015 1 Introduction This report addresses the concerns raised by the 2012-2015 National Congenital Heart
More informationAnesthetic Considerations in Adults with Congenital Heart Disease
CRASH Vail, Colorado 2018 Colorado Review of Anesthesia for SurgiCenters and Hospitals and Ski Holiday! CRASH Vail, Colorado 2018 Colorado Review of Anesthesia for SurgiCenters and Hospitals Anesthetic
More informationin PAEDIATRIC CARDIOLOGY
IMAGES in PAEDIATRIC CARDIOLOGY Morrison ML, 1 Sands AJ, 1 Paterson A. 2 Primitive hepatic venous plexus in a child with scimitar syndrome and pulmonary 1 Department of Paediatric Cardiology, Royal Belfast
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,
More informationGlenn and Fontan Caths:
Glenn and Fontan Caths: Pre-operative evaluation and Trouble-shooting Cavo-Pulmonary Shunts Daniel H. Gruenstein, M.D. Director, Pediatric Interventional Cardiology University of Minnesota Children s Hospital,
More informationCARDIOVASCULAR SURGERY
Volume 107, Number 4 April 1994 The Journal of THORACIC AND CARDIOVASCULAR SURGERY Cardiac and Pulmonary Transplantation Risk factors for graft failure associated with pulmonary hypertension after pediatric
More information1. Distinguish among the types of blood vessels on the basis of their structure and function.
Blood Vessels and Circulation Objectives This chapter describes the structure and functions of the blood vessels Additional subjects contained in Chapter 13 include cardiovascular physiology, regulation,
More informationSystematic approach to Fetal Echocardiography. Objectives. Introduction 11/2/2015
Systematic approach to Fetal Echocardiography. Pediatric Echocardiography Conference, JCMCH November 7, 2015 Rajani Anand Objectives Fetal cardiology pre-test Introduction Embryology and Physiology of
More information2010 년순환기관련학회춘계통합학술대회. Kim, Soo-Jin. Sejong General Hospital, Sejong Cardiovascular center
2010 년순환기관련학회춘계통합학술대회 세종병원 Sejong General Hospital Debate in Congenital Heart Disease : Pulmonary Vasodilator in Fontan Kim, Soo-Jin Sejong General Hospital, Sejong Cardiovascular center 12 yrs, s/p Fontan
More informationSURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE
SURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE Mr. W. Brawn Birmingham Children s Hospital. Aims of surgery The aim of surgery in congenital heart disease is to correct or palliate the heart
More informationSeptember 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical)
September 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical) Advances in cardiac surgery have created a new population of adult patients with repaired congenital heart
More informationInterstage attrition between bidirectional Glenn and Fontan palliation in children with hypoplastic left heart syndrome
Carlo et al Congenital Heart Disease Interstage attrition between bidirectional Glenn and Fontan palliation in children with hypoplastic left heart syndrome Waldemar F. Carlo, MD, a Kathleen E. Carberry,
More informationMRI and ce-mra in patients who have undergone a Fontan operation or a Bidirectional Cavo-Pulmonary Connection for Single Ventricle physiology
MRI and ce-mra in patients who have undergone a Fontan operation or a Bidirectional Cavo-Pulmonary Connection for Single Ventricle physiology R.Crepaz, J.Stuefer*, C.Romeo, C.Pedron **, O.Milanesi ^, G.
More informationUnderstanding your child s heart. Hypoplastic left heart syndrome
Understanding your child s heart Hypoplastic left heart syndrome 8 bout this book Contents If you re reading this book, you ve probably just had some very upsetting news and have lots of questions running
More informationCOMPREHENSIVE EVALUATION OF FETAL HEART R. GOWDAMARAJAN MD
COMPREHENSIVE EVALUATION OF FETAL HEART R. GOWDAMARAJAN MD Disclosure No Relevant Financial Relationships with Commercial Interests Fetal Echo: How to do it? Timing of Study -optimally between 22-24 weeks
More informationCardiovascular. Function of the cardiovascular system is to transport blood containing: Nutrients Waste Hormones Immune cells Oxygen
Cardiovascular The Cardiovascular System - Arteries Arteries Cardiovascular System Function of the cardiovascular system is to transport blood containing: Carry blood away from heart Carotid arteries Deliver
More informationObjective 2/9/2012. Blood Gas Analysis In The Univentricular Patient: The Need For A Different Perspective. VENOARTERIAL CO2 GRADIENT
Blood Gas Analysis In The Univentricular Patient: The Need For A Different Perspective. Gary Grist RN CCP Chief Perfusionist The Children s Mercy Hospitals and Clinics Kansas City, Mo. Objective The participant
More informationCardiac Radiology In-Training Test Questions for Diagnostic Radiology Residents
Cardiac Radiology In-Training Test Questions for Diagnostic Radiology Residents March, 2013 Sponsored by: Commission on Education Committee on Residency Training in Diagnostic Radiology 2013 by American
More informationSegmental approach to normal and abnormal situs arrangement - Echocardiography -
Segmental approach to normal and abnormal situs arrangement - Echocardiography - Jan Marek Great Ormond Street Hospital & Institute of Cardiovascular Sciences, University College London No disclosures
More informationChapter 27 The Heart and Blood Vessels
Chapter 27 The Heart and Blood Vessels Most animals have a closed blood system. The blood flows continuously in vessels back to the heart. In an open system the blood is pumped into open ended tubes and
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationSurgery For Ebstein Anomaly
Surgery For Ebstein Anomaly Christian Pizarro, MD Chief, Pediatric Cardiothoracic Surgery Director, Nemours Cardiac Center Alfred I. dupont Hospital for Children Professor of Surgery and Pediatrics Sidney
More informationDiseases of the Conduction System
4 CHAPTER 4 Diseases of the Conduction System Diseases of the conduction system are numerous and varied. The authors have selected a few representative entities for this section: complete heart block as
More information