University of Groningen. Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria
|
|
- Roland Porter
- 5 years ago
- Views:
Transcription
1 University of Groningen Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2016 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Kampman, M. A. M. (2016). Pregnancy in women with congenital heart disease: Complications and mechanisms [Groningen]: Rijksuniversiteit Groningen Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date:
2 Chapter 1 Introduction A
3
4 Introduction 11 Epidemiology Congenital heart defects (CHD) are the most common congenital defects in newborns, with a birth prevalence of 9/1000 live births worldwide 1,2. Due to improved surgical and medical treatment, the majority of these children survive until adulthood. This resulted in a large cohort of adult survivors, mostly still young and of child bearing age 3. It is important to realize that these women are not cured and that pregnancy can have deleterious effects on cardiac function and patient wellbeing since pregnancy requires major hemodynamic changes. 1 Physiological changes during normal pregnancy Pregnancy induces profound changes in the cardiovascular system, in order to meet the increased maternal and fetal metabolic demands. During normal pregnancy, cardiac output increases 30-50% above baseline, starting in early pregnancy and continues to rise until 24 weeks gestation. This augmented cardiac output is maintained until term (figure 1) 4. The increase in cardiac output results from an increase in preload (circulating volume), a decrease in afterload (peripheral vascular resistance) and an increase in heart rate. During labor, delivery and the post-partum period again profound changes in cardiac output occur, because of pain, anxiety, uterine contraction and uterine involution 4-6. The hemodynamic changes described result in progressive left ventricular remodeling. Left ventricular end-diastolic and end-systolic dimensions increase during pregnancy, where ejection fraction remains unchanged 7,8. The myocardium becomes hypertrophic as gestation advances and as a result of that, left ventricular mass increases. Despite the morphological changes, diastolic function is not impaired during pregnancy and left ventricular diastolic filling pressures remain unchanged 7,9. Studies describing right ventricular remodeling during pregnancy are extremely scarce. The available data suggests that right ventricular systolic function remains stable during pregnancy 10,11. Right ventricular diameter appears to increase towards the third trimester of pregnancy 10. Figure 1: Hemodynamic changes during pregnancy according to gestational week (modified from Robson et al. 4 ).
5 12 Chapter 1 Pregnancy in women with congenital heart disease Thirteen years of ZAHARA (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease) research provided valuable insights to the knowledge of pregnancy in women with CHD and the research line evolved from epidemiology focused to more fundamental research focusing on the underlying pathophysiological mechanism of complications. The first ZAHARA study was conducted between 2002 and 2007 aiming to investigate pregnancy outcome in women with CHD and to identify predictors of cardiac complications during pregnancy retrospectively. Pregnancy in women with congenital heart disease appeared to be associated with increased incidence of cardiovascular, obstetric and neonatal complications In approximately 7-13% (depending on the underlying heart disease) of the pregnancies in women with CHD, cardiovascular complications occur, with heart failure and arrhythmia being most frequently observed 14, Siu et al. developed the CARPREG (Cardiac disease in pregnancy) risk score, in order to estimate the risk of cardiac complications during pregnancy in women with cardiac disease 24. The CARPREG risk score underestimated the risk of cardiac events in a cohort of women with solely CHD, which suggested that modifications in the risk score were needed 26. The ZAHARA study resulted in the development of a new risk estimation model for the occurrence of cardiovascular complications during pregnancy in women with CHD, and also identified new predictors of adverse neonatal outcome 23. The study resulted in the thesis that was defended by Wim Drenthen ( ). The first ZAHARA study, as well as other reports, revealed that especially placenta-related complications are more frequently observed in women with CHD (ie. hypertensive disorders of pregnancy and fetal growth restriction) 12-14,27. The ZAHARA II study was primarily designed to shed light on a possible underlying mechanism for the increased incidence. In patients with chronic heart failure, worsening cardiac function is associated with dysfunction of other organs 28,29 and a similar mechanism might be present during pregnancy, during which cardiac dysfunction hampers placental development and function leading to adverse pregnancy outcome. We postulated that maternal cardiac dysfunction is responsible for abnormal placental development and placental dysfunction. In pregnant women without underlying heart disease, inadequate adaption of the uteroplacental circulation is responsible for several obstetric and offspring complications. The pathophysiological mechanism is poor trophoblast invasion of the spiral arteries during the placentation process 30, causing failure of the placental-bed arteries to transform from high to low-resistance vessels. Uteroplacental flow investigations (resistance and pulsatility indices of the uterine artery and umbilical artery) provide insight in the placentation process and are commonly used as screening tool to predict the future development of pre-eclampsia, fetal growth restriction, still birth and placental abruption 31,32. In ZAHARA II we investigated the effect of impaired cardiac function
6 Introduction 13 on the uteroplacental circulation and its relationship with the occurrence of adverse obstetric and offspring outcome 33. The ZAHARA II study was conducted between March 2008 and August This study also provided the opportunity to validate the ZAHARA prediction model and to compare it with the other risk prediction models used. It turned out to perform better in a population with CHD compared to the CARPREG risk score 34. These findings, as well as the study design of ZAHARA II were described in the thesis of Ali Balci, defended at The increased volume load is thought to play an important role in the pathogenesis of the cardiovascular complications and therefore natriuretic peptides (B-type natriuretic peptide (BNP) and amino terminal probnp (Nt-proBNP)) may be an important predictor of cardiovascular events. Natriuretic peptides are well established predictors of adverse outcome in various cardiac diseases and predict outcome independent of ejection fraction Data on the predictive role for cardiac event during pregnancy in women with CHD are scarce. Tanous et al. reported a clear association between high BNP values and cardiovascular events during pregnancy, but could not determine the role of BNP in predicting adverse cardiovascular events 40. Natriuretic peptides can provide a valuable tool for the clinicians caring for these patients in order to identify high risk patients, needing close follow up. The prospective nature of ZAHARA II allowed a comparison of Nt-proBNP between women with CHD and healthy controls. In addition, the role of Nt-proBNP in predicting cardiovascular events during pregnancy could be assessed. In women with congenital heart disease the progressive cardiac remodeling during pregnancy might have serious repercussions for cardiac function after pregnancy, and therefore might influence their prognosis. Longitudinal data on cardiac remodeling during and after pregnancy in women with CHD is scarce and most of the available research focuses on left ventricular parameters. Data examining longitudinal changes in right ventricular parameters have never been reported in pregnant women with CHD. Several studies indicate that pregnancy can be associated with permanent deterioration in cardiac function and impaired event-free survival The secondary objective of ZAHARA II was to investigate the incidence of permanent post-partum cardiovascular deterioration in women with CHD, since data is scarce and existing reports mainly describe small retrospective study populations.
7 14 Chapter 1 Aims of the thesis In this thesis we describe the incidence of cardiovascular complications and we report new predictors for cardiovascular complications during and after pregnancy, furthermore we assess the impact of pregnancy on cardiac function and remodeling. Finally, we investigate whether cardiac dysfunction plays a role in the pathogenesis of obstetric and neonatal complications. In part I of this thesis, we focus on the cardiovascular complications during and after pregnancy and we assess the impact of pregnancy on cardiac function and remodeling. In chapter 2 the independent role of Nt-proBNP levels during pregnancy in women with CHD in predicting the occurrence of cardiovascular events will be assessed. Chapter 3 will focus on cardiac adaption during pregnancy in women with CHD compared to healthy pregnant women. The incidence of cardiovascular complications one year post-partum will be described and cardiac function parameters pre-pregnancy and one year post-partum will be compared in chapter 4. In part II of this thesis we investigate the role of cardiac dysfunction in the pathogenesis of obstetric and neonatal complications. Chapter 5 describes the main outcomes of the ZA- HARA II study, which assesses the differences in uteroplacental Doppler flow (UDF) patterns as well as the differences in outcome in pregnant women with CHD and healthy pregnant women. The relationship between cardiac dysfunction and uteroplacental Doppler flow patterns will be investigated. Chapter 6 will focus on pregnancy outcome and complications in women with Tetralogy of Fallot. The outcome of the ZAHARA II study will be verified in a homogeneous population. The final chapter of this thesis, chapter 7, reviews the literature systematically in order to investigate all existing evidence for a link between maternal cardiac function, abnormal uteroplacental flow and poor perinatal outcome in women with and without known cardiac disease.
8 Introduction 15 References 1 1. European Surveillance of Congenital Anomalies (EUROCAT) Working Group. 2011; Available at: Accessed 03/14, van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011 Nov 15; 58(21): Marelli AJ, Mackie AS, Ionescu-Ittu R, Rahme E, Pilote L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 2007 Jan 16; 115(2): Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol 1989 Apr; 256(4 Pt 2): H Robson SC, Dunlop W, Boys RJ, Hunter S. Cardiac output during labour. Br Med J (Clin Res Ed) 1987 Nov 7; 295(6607): Robson SC, Dunlop W, Hunter S. Haemodynamic changes during the early puerperium. Br Med J (Clin Res Ed) 1987 Apr 25; 294(6579): Estensen ME, Beitnes JO, Grindheim G, Aaberge L, Smiseth OA, Henriksen T, et al. Altered maternal left ventricular contractility and function during normal pregnancy. Ultrasound Obstet Gynecol 2013 Jun; 41(6): Savu O, Jurcut R, Giusca S, van Mieghem T, Gussi I, Popescu BA, et al. Morphological and functional adaptation of the maternal heart during pregnancy. Circ Cardiovasc Imaging 2012 May 1; 5(3): Fok WY, Chan LY, Wong JT, Yu CM, Lau TK. Left ventricular diastolic function during normal pregnancy: assessment by spectral tissue Doppler imaging. Ultrasound Obstet Gynecol 2006 Nov; 28(6): Ducas RA, Elliott JE, Melnyk SF, Premecz S, dasilva M, Cleverley K, et al. Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study. J Cardiovasc Magn Reson 2014 Jan 3; 16(1): 1-429X Vogt M, Muller J, Kuhn A, Elmenhorst J, Muhlbauer F, Oberhoffer A. Cardiac Adaptation of the Maternal Heart During Pregnancy: A Color-Coded Tissue Doppler Imaging Study - Feasibility, Reproducibility and Course during Pregnancy. Ultraschall Med 2014 Apr Drenthen W, Pieper PG, Ploeg M, Voors AA, Roos-Hesselink JW, Mulder BJ, et al. Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries. Eur Heart J 2005 Dec; 26(23): Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. Pregnancy and delivery in women after Fontan palliation. Heart 2006 Sep; 92(9): Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007 Jun 19; 49(24): Drenthen W, Pieper PG, Roos-Hesselink JW, Schmidt AC, Mulder BJ, van Dijk AP, et al. Noncardiac complications during pregnancy in women with isolated congenital pulmonary valvar stenosis. Heart 2006 Dec; 92(12): Drenthen W, Pieper PG, Roos-Hesselink JW, Zoon N, Voors AA, Mulder BJ, et al. Fertility, pregnancy, and delivery after biventricular repair for pulmonary atresia with an intact ventricular septum. Am J Cardiol 2006 Jul 15; 98(2):
9 16 Chapter Drenthen W, Pieper PG, Zoon N, Roos-Hesselink JW, Voors AA, Mulder BJ, et al. Pregnancy after biventricular repair for pulmonary atresia with ventricular septal defect. Am J Cardiol 2006 Jul 15; 98(2): Yap SC, Drenthen W, Meijboom FJ, Moons P, Mulder BJ, Vliegen HW, et al. Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect. BJOG 2009 Nov; 116(12): Yap SC, Drenthen W, Pieper PG, Moons P, Mulder BJ, Klieverik LM, et al. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease. J Heart Valve Dis 2007 Jul; 16(4): Yap SC, Drenthen W, Pieper PG, Moons P, Mulder BJ, Vliegen HW, et al. Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect. BJOG 2010 May; 117(6): Yap SC, Drenthen W, Pieper PG, Moons P, Mulder BJ, Mostert B, et al. Risk of complications during pregnancy in women with congenital aortic stenosis. Int J Cardiol 2008 May 23; 126(2): Balci A, Drenthen W, Mulder BJ, Roos-Hesselink JW, Voors AA, Vliegen HW, et al. Pregnancy in women with corrected tetralogy of Fallot: Occurrence and predictors of adverse events. Am Heart J 2011 Feb; 161(2): Drenthen W, Boersma E, Balci A, Moons P, Roos-Hesselink JW, Mulder BJ, et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010 Sep; 31(17): Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001 Jul 31; 104(5): Roos-Hesselink JW, Ruys TP, Stein JI, Thilen U, Webb GD, Niwa K, et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J 2013 Mar; 34(9): Khairy P, Ouyang DW, Fernandes SM, Lee-Parritz A, Economy KE, Landzberg MJ. Pregnancy outcomes in women with congenital heart disease. Circulation 2006 Jan 31; 113(4): Siu SC, Colman JM, Sorensen S, Smallhorn JF, Farine D, Amankwah KS, et al. Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. Circulation 2002 May 7; 105(18): Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 2009 Feb 17; 53(7): van Deursen VM, Damman K, Hillege HL, van Beek AP, van Veldhuisen DJ, Voors AA. Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail 2010 Jan; 16(1): Prefumo F, Sebire NJ, Thilaganathan B. Decreased endovascular trophoblast invasion in first trimester pregnancies with high-resistance uterine artery Doppler indices. Hum Reprod 2004 Jan; 19(1): Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Post JA, Coomarasamy A, et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ 2008 Mar 11; 178(6): Harrington K, Cooper D, Lees C, Hecher K, Campbell S. Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of pre-eclampsia, placental abrup-
10 Introduction 17 tion or delivery of a small-for-gestational-age baby. Ultrasound Obstet Gynecol 1996 Mar; 7(3): Balci A, Sollie KM, Mulder BJ, de Laat MW, Roos-Hesselink JW, van Dijk AP, et al. Associations between cardiovascular parameters and uteroplacental Doppler (blood) flow patterns during pregnancy in women with congenital heart disease: Rationale and design of the Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II study. Am Heart J 2011 Feb; 161(2): e Balci A, Sollie-Szarynska KM, van der Bijl AG, Ruys TP, Mulder BJ, Roos-Hesselink JW, et al. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease. Heart 2014 Sep; 100(17): van Veldhuisen DJ, Linssen GC, Jaarsma T, van Gilst WH, Hoes AW, Tijssen JG, et al. B-type natriuretic Peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol 2013 Apr 9; 61(14): Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, et al. N-terminal probnp and mortality in hospitalised patients with heart failure and preserved vs. reduced systolic function: data from the prospective Copenhagen Hospital Heart Failure Study (CHHF). Eur J Heart Fail 2004 Mar 15; 6(3): Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-terminal pro-b-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 2005 Feb 17; 352(7): Linssen GC, Bakker SJ, Voors AA, Gansevoort RT, Hillege HL, de Jong PE, et al. N-terminal pro-btype natriuretic peptide is an independent predictor of cardiovascular morbidity and mortality in the general population. Eur Heart J 2010 Jan; 31(1): Omland T, Persson A, Ng L, O Brien R, Karlsson T, Herlitz J, et al. N-terminal pro-b-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation 2002 Dec 3; 106(23): Tanous D, Siu SC, Mason J, Greutmann M, Wald RM, Parker JD, et al. B-type natriuretic peptide in pregnant women with heart disease. J Am Coll Cardiol 2010 Oct 5; 56(15): Uebing A, Arvanitis P, Li W, Diller GP, Babu-Narayan SV, Okonko D, et al. Effect of pregnancy on clinical status and ventricular function in women with heart disease. Int J Cardiol 2010 Feb 18; 139(1): Guedes A, Mercier LA, Leduc L, Berube L, Marcotte F, Dore A. Impact of pregnancy on the systemic right ventricle after a Mustard operation for transposition of the great arteries. J Am Coll Cardiol 2004 Jul 21; 44(2): Balint OH, Siu SC, Mason J, Grewal J, Wald R, Oechslin EN, et al. Cardiac outcomes after pregnancy in women with congenital heart disease. Heart 2010 Oct; 96(20): Silversides CK, Colman JM, Sermer M, Farine D, Siu SC. Early and intermediate-term outcomes of pregnancy with congenital aortic stenosis. Am J Cardiol 2003 Jun 1; 91(11): Tzemos N, Silversides CK, Colman JM, Therrien J, Webb GD, Mason J, et al. Late cardiac outcomes after pregnancy in women with congenital aortic stenosis. Am Heart J 2009 Mar; 157(3): Zentner D, Wheeler M, Grigg L. Does pregnancy contribute to systemic right ventricular dysfunction in adults with an atrial switch operation? Heart Lung Circ 2012 Aug; 21(8): Kamiya CA, Iwamiya T, Neki R, Katsuragi S, Kawasaki K, Miyoshi T, et al. Outcome of pregnancy and effects on the right heart in women with repaired tetralogy of fallot. Circ J 2012; 76(4):
11
12 Part I 8 Complications A
13
University of Groningen. Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria
University of Groningen Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to
More informationUniversity of Groningen. Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria
University of Groningen Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to
More informationUniversity of Groningen. Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria
University of Groningen Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to
More informationHeart failure in pregnancy
Heart failure in pregnancy PD Dr. med Daniel Tobler Leiter angeborene Herzfehler (GUCH) Universitätsspital Basel! www.heartdiseaseandpregnancy.com Heart failure in pregnancy Agenda! - general considerations
More informationUniversity of Groningen. BNP and NT-proBNP in heart failure Hogenhuis, Jochem
University of Groningen BNP and NT-proBNP in heart failure Hogenhuis, Jochem IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check
More informationMaternal And Fetal Outcome In Pregnancies Complicated With Maternal Cardiac Diseases: Experience At A Tertiary Care Hospital
ISPUB.COM The Internet Journal of Gynecology and Obstetrics Volume 19 Number 1 Maternal And Fetal Outcome In Pregnancies Complicated With Maternal Cardiac Diseases: Experience At A Tertiary Care Hospital
More informationUteroplacental Doppler flow and pregnancy outcome in women with tetralogy of Fallot
Ultrasound Obstet Gynecol 2017; 49: 231 239 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.15938 Uteroplacental Doppler flow and pregnancy outcome in women with tetralogy
More informationResearch Presentation June 23, Nimish Muni Resident Internal Medicine
Research Presentation June 23, 2009 Nimish Muni Resident Internal Medicine Research Question In adult patients with repaired Tetralogy of Fallot, how does Echocardiography compare to MRI in evaluating
More informationUniversity of Groningen. Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria
University of Groningen Pregnancy in women with congenital heart disease Kampman, Marlies Aleida Maria IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to
More informationTetralogy of Fallot Latest data in risk stratification and replacement of pulmonic valve
Tetralogy of Fallot Latest data in risk stratification and replacement of pulmonic valve Alexandra A Frogoudaki Adult Congenital Heart Clinic Second Cardiology Department ATTIKON University Hospital No
More informationEVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE. Karen Stout, MD University of Washington Seattle Children s Seattle, WA
EVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE Karen Stout, MD University of Washington Seattle Children s Seattle, WA CASE PRESENTATION 24 year old woman with aortic regurgitation referred for evaluation
More informationThe Effect of Valvular Heart Diseases on Maternal and Fetal Outcome of Pregnancy Nada Salih Ameen*,Nawfal Fawzi Anwer**
THE VALVULAR IRAQI POSTGRADUATE HEART DISEASES MEDICAL AND JOURNAL PREGNANCY The Effect of Valvular Heart Diseases on Maternal and Fetal Outcome of Pregnancy Nada Salih Ameen*,Nawfal Fawzi Anwer** ABSTRACT:
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 informationCritical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials
Critical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials Pregnancy and Congenital Heart Disease Heidi M. Connolly, M.D. Professor of Medicine Chair for Education Division
More informationCardiac outcomes after pregnancy in women with congenital heart disease
1 University of Toronto Pregnancy and Heart Disease Research Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada 2 Division of Cardiology, Department of Medicine, University of
More informationCitation for published version (APA): Sinkeler, S. J. (2016). A tubulo-centric view on cardiorenal disease [Groningen]
University of Groningen A tubulo-centric view on cardiorenal disease Sinkeler, Steef Jasper IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from
More informationCitation for published version (APA): Wolff, D. (2016). The Enigma of the Fontan circulation [Groningen]: Rijksuniversiteit Groningen
University of Groningen The Enigma of the Fontan circulation Wolff, Djoeke IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check
More informationValve Disease in the Pregnant Patient
Valve Disease in the Pregnant Patient Julie B. Damp, MD December 6, 2012 VanderbiltHeart.com If single, do not allow marriage. If fertile, do not allow pregnancy. If pregnant, do not allow delivery. If
More informationCitation for published version (APA): Balci, A. (2012). Pregnancy and outcome in women with congenital heart disease Groningen: s.n.
University of Groningen Pregnancy and outcome in women with congenital heart disease Balci, Ali IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite
More informationPregnancy and Heart Disease Sharon L. Roble, MD Echo Hawaii 2016
1 Pregnancy and Heart Disease Sharon L. Roble, MD Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Cardiovascular Effects of Pregnancy Anatomic Ventricular muscle mass increases
More informationPREGNANCY IN PATIENTS WITH A SYSTEMIC RV
PREGNANCY IN PATIENTS WITH A SYSTEMIC RV Carole A. Warnes MD, FRCP Professor of Medicine, Mayo Clinic No disclosures 2013 MFMER slide-1 PREGNANCY : SYSTEMIC RV D - transposition after atrial switch procedure
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 informationPregnancy in Non-Peripartum Cardiomyopathy
Pregnancy in Non-Peripartum Cardiomyopathy Avraham Shotan, Lubov Vasilenco, Michael Shochat, Mark Kazatsker, David Blondheim, Yaniv Levi, Simcha Meisel, Alicia Vazan Heart Institute, Hillel Yaffe Medical
More informationUniversity of Groningen. Diuretic response and renal function in heart failure ter Maaten, Jozine Magdalena
University of Groningen Diuretic response and renal function in heart failure ter Maaten, Jozine Magdalena IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish
More informationHeart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output
Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover
More informationDiagnosis of Congenital Cardiac Defects Between 11 and 14 Weeks Gestation in High-Risk Patients
Article Diagnosis of Congenital Cardiac Defects Between 11 and 14 Weeks Gestation in High-Risk Patients Zeev Weiner, MD, Abraham Lorber, MD, Eliezer Shalev, MD Objective. To examine the feasibility of
More informationTHE SPECTRUM OF PAEDIATRIC CARDIAC DISEASE IN VANUATU. Dr Annette Garae (PGDCH)
THE SPECTRUM OF PAEDIATRIC CARDIAC DISEASE IN VANUATU Dr Annette Garae (PGDCH) Introduction Heart disease in children can be either congenital or acquired. Congenital heart disease (CHD) accounts for nearly
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 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 informationPregnancy outcomes in women after an arterial switch operation for transposition of the great arteries
Pregnancy outcomes in women after an arterial switch operation for transposition of the great arteries Department of Obstetrics and Gynecology 1) Department of Pediatrics 2) National Cerebral and Cardiovascular
More informationcctga patients need lifelong follow-up in an age-appropriate facility with expertise in
ONLINE SUPPLEMENT ONLY: ISSUES IN THE ADULT WITH CCTGA General cctga patients need lifelong follow-up in an age-appropriate facility with expertise in congenital heart disease care at annual intervals.
More informationCongenital Heart Disease
Screening Programmes Fetal Anomaly Congenital Heart Disease Information for health professionals Publication date: April 2012 Review date: April 2013 Version 2 67 Congenital Heart Disease Information for
More informationΈγκυος και συγγενής καρδιοπάθεια: Τι πρέπει να γνωρίζει ο Καρδιολόγος Ενηλίκων
Έγκυος και συγγενής καρδιοπάθεια: Τι πρέπει να γνωρίζει ο Καρδιολόγος Ενηλίκων Αντώνιος Π. Βλάχος Αναπληρωτής Καθηγητής Παιδοκαρδιολογίας Πανεπιστήμιο Ιωαννίνων No conflict of interest Pregnancy and CHD
More informationPregnancy and Heart Disease. Alexandra A Frogoudaki Adult Congenital Heart Clinic ATTIKON University Hospital
Pregnancy and Heart Disease Alexandra A Frogoudaki Adult Congenital Heart Clinic ATTIKON University Hospital Pregnancy is not a state Hemodynamic changes During pregnancy Estrogens 1. Renin 2.
More informationFetal Tetralogy of Fallot
36 Fetal Tetralogy of Fallot E.D. Bespalova, R.M. Gasanova, O.A.Pitirimova National Scientific and Practical Center of Cardiovascular Surgery, Moscow Elena D. Bespalova, MD Professor, Director Rena M,
More informationT etralogy of Fallot is characterised by a ventricular septal
801 CONGENITAL HEART DISEASE Pregnancy, fertility, and recurrence risk in corrected tetralogy of Fallot J M Meijer, P G Pieper, W Drenthen, A A Voors, J W Roos-Hesselink, A P J van Dijk, B J M Mulder,
More informationSummary. HVRA s Cardio Vascular Genetic Detailed L2 Obstetrical Ultrasound. CPT 76811, 76825, _ 90% CHD detection. _ 90% DS detection.
What is the role of fetal echocardiography (2D 76825, cardiovascular color flow mapping 93325) as performed in conjunction with detailed fetal anatomy scan (CPT 76811) now that AIUM requires limited outflow
More informationClinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!!
Clinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!! Abha'Khandelwal,'MD,'MS' 'Stanford'University'School'of'Medicine'
More informationCardiovascular Events in Pregnancy With Hypertrophic Cardiomyopathy
Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp ORIGINAL ARTICLE Myocardial Disease Cardiovascular Events in Pregnancy With Hypertrophic Cardiomyopathy
More informationUniversity of Groningen. Gestational diabetes mellitus: diagnosis and outcome Koning, Saakje Hillie
University of Groningen Gestational diabetes mellitus: diagnosis and outcome Koning, Saakje Hillie IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite
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 informationPrenatal and early postnatal long-chain polyunsaturated fatty acid status Bouwstra, Hylco
University of Groningen Prenatal and early postnatal long-chain polyunsaturated fatty acid status Bouwstra, Hylco IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if
More informationFETAL ECHO IN TWIN PREGNACY: MONOCHORIONIC TWINS DELHI CHILD HEART CENTER & INDRAPRASTHA APOLLO HOSPITAL NEW DELHI
FETAL ECHO IN TWIN PREGNACY: MONOCHORIONIC TWINS DELHI CHILD HEART CENTER & INDRAPRASTHA APOLLO HOSPITAL NEW DELHI Scope of this talk Twin to Twin Transfusion TRAP Sequence Congenital Heart Defects in
More informationValue of echocardiography in chronic dyspnea
Value of echocardiography in chronic dyspnea Jahrestagung Schweizerische Gesellschaft für /Schweizerische Gesellschaft für Pneumologie B. Kaufmann 16.06.2016 Chronic dyspnea Shortness of breath lasting
More informationLeft atrial function. Aliakbar Arvandi MD
In the clinic Left atrial function Abstract The left atrium (LA) is a left posterior cardiac chamber which is located adjacent to the esophagus. It is separated from the right atrium by the inter-atrial
More informationScreening for Critical Congenital Heart Disease
Screening for Critical Congenital Heart Disease Caroline K. Lee, MD Pediatric Cardiology Disclosures I have no relevant financial relationships or conflicts of interest 1 Most Common Birth Defect Most
More informationUniversity of Groningen. Paediatric pulmonary hypertension Loon, Rosa Laura Elisabeth van
University of Groningen Paediatric pulmonary hypertension Loon, Rosa Laura Elisabeth van IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it.
More informationPregnancy in women with pulmonary hypertension
Neth Heart J (2011) 19:504 508 DOI 10.1007/s12471-011-0219-9 SPECIAL ARTICLE Pregnancy in women with pulmonary hypertension P. G. Pieper & E. S. Hoendermis Published online: 9 November 2011 # The Author(s)
More informationVentricular tachyarrhythmia during pregnancy in women with heart disease: data from the ROPAC
Ventricular tachyarrhythmia during pregnancy in women with heart disease: data from the ROPAC Ebru Ertekin MD, Iris M. Van Hagen MD, Amar M. Salam MD, Titia P.E. Ruys MD PhD, Jolien W. Roos-Hesselink MD
More informationS. 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 informationCardiac Disease in Pregnancy
Cardiac Disease in Pregnancy DATE: SEPTEMBER 11, 2016 PRESENTED BY: ABIGAIL KHAN, MD Outline Scope of the problem Physiology of pregnancy Cardiac risk in pregnancy Pregnancy management Contraception 1
More informationBACKGROUND: Identifying women at high risk is an important aspect of care for women with heart disease.
ΕΝΔΙΑΦΕΡΟΝΤΑ ΑΡΘΡΑ 1) Long-Term Risk of Cardiovascular Disease in Women Who Have Had Infants With Heart Defects Nathalie Auger Brian J. Potter Marianne Bilodeau-Bertrand Gilles Paradis Circulation. 2018;137:2321
More information(restrictive physiology)
52 2 10 (2016 ) (restrictive physiology) 1) 2) 1) 1) 1) 1) 1) 1) 1) 2) 2) 1) 2) 40-50% A A A 47 47 11 A (23.4%) 4 ( )30-32 A 3 ( ( ) 2 septation1 )1-2 A 4 ( 21 1 ) () (4 8.5% 2 4.2%) (p=0.053) A NYHA functional
More informationUniversity of Groningen. Ablation of atrial fibrillation de Maat, Gijs Eduard
University of Groningen Ablation of atrial fibrillation de Maat, Gijs Eduard IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check
More informationOutline. Maternal Congenital Heart Disease in Pregnancy. Maternal congenital heart disease. Cardiovascular disease in pregnancy 10/18/2017
I have no disclosures or conflicts of interest to report. Maternal Congenital Heart Disease in Pregnancy Jennifer A. Jolley, MD Associate Clinical Professor University of California, Irvine Department
More informationAdults with Congenital Heart Disease. Michael E. McConnell MD, Wendy Book MD Teresa Lyle RN NNP
Adults with Congenital Heart Disease Michael E. McConnell MD, Wendy Book MD Teresa Lyle RN NNP Outline History of CHD Statistics Specific lesions (TOF, TGA, Single ventricle) Erythrocytosis Pregnancy History
More informationB-Type Natriuretic Peptide in Pregnant Women With Heart Disease
Journal of the American College of Cardiology Vol. 56, No. 15, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.02.076
More informationUniversity of Groningen. Pulmonary arterial hypertension van Albada, Mirjam Ellen
University of Groningen Pulmonary arterial hypertension van Albada, Mirjam Ellen IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please
More informationImages in Cardiovascular Medicine
Images in Cardiovascular Medicine Management of Severe Mitral Stenosis During Pregnancy Rebecca S. Norrad, MBBS; Omid Salehian, MSc, MD, FRCPC, FACC, FAHA A 37-year-old woman originally from Iraq was referred
More informationUniversity of Groningen. Acute kidney injury after cardiac surgery Loef, Berthus Gerard
University of Groningen Acute kidney injury after cardiac surgery Loef, Berthus Gerard IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it.
More informationMajor Forms of Congenital Heart Disease: Consultant Pediatric and Fetal Cardiology King Abdulaziz Cardiac Center, National Guard Hospital Riyadh
Major Forms of Congenital Heart Disease: Impact of Prenatal Detection and Diagnosis Dr Merna Atiyah Consultant Pediatric and Fetal Cardiology King Abdulaziz Cardiac Center, National Guard Hospital Riyadh
More informationIncreasing numbers of women with heart disease are
Maternal Cardiac Output and Fetal Doppler Predict Adverse Neonatal Outcomes in Pregnant Women With Heart Disease Rachel M. Wald, MD; Candice K. Silversides, MD, SM; John Kingdom, MD; Ants Toi, MD; Cathy
More informationCONGENITAL HEART DISEASE (CHD)
CONGENITAL HEART DISEASE (CHD) DEFINITION It is the result of a structural or functional abnormality of the cardiovascular system at birth GENERAL FEATURES OF CHD Structural defects due to specific disturbance
More informationUniversity of Groningen. Left ventricular diastolic function and cardiac disease Muntinga, Harm Jans
University of Groningen Left ventricular diastolic function and cardiac disease Muntinga, Harm Jans IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite
More informationFirst Trimester Fetal Echocardiography: Insight Into the Fetal Circulation
First Trimester Fetal Echocardiography: Insight Into the Fetal Circulation Lisa K. Hornberger, MD Fetal & Neonatal Cardiology Program Department of Pediatrics, Division of Cardiology Department of Obstetrics
More informationPregnancy and cyanotic congenital heart disease. A. Pijuan Domènech (U. de C. Congènites de l Adult) Hospital Vall d Hebron Barcelona, Spain
Pregnancy and cyanotic congenital heart disease A. Pijuan Domènech (U. de C. Congènites de l Adult) Hospital Vall d Hebron Barcelona, Spain I have nothing to disclose. Pregnancy and cyanotic congenital
More informationΠνευμονική υπέρταση και περικαρδιακή συλλογή. Τρόποι αντιμετώπισης
Πνευμονική υπέρταση και περικαρδιακή συλλογή. Τρόποι αντιμετώπισης Γεώργιος Λάζαρος Καρδιολόγος, Διευθυντής ΕΣΥ Α Πανεπιστημιακή Καρδιολογική Κλινική Ιπποκράτειο Γ.Ν. Αθηνών Pericardial syndromes o Acute
More informationUniversity of Groningen. Ablation of atrial fibrillation de Maat, Gijs
University of Groningen Ablation of atrial fibrillation de Maat, Gijs IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the
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 informationThe Fetus: Five Top Do Not Miss Diagnoses. Doppler Ultrasound
The Fetus: Five Top Do Not Miss Diagnoses Doppler Ultrasound Giancarlo Mari, MD, MBA Professor and Chair Department of Obstetrics and Gynecology University of Tennessee Health Science Center Memphis, TN
More informationUnexpected resolution of first trimester fetal valve stenosis: consequence
Unexpected resolution of first trimester fetal valve stenosis: consequence of developmental remodeling? Gardiner, Helena M. The Fetal Center, Children s Memorial Hermann Hospital, McGovern Medical School,
More informationPIAF study: Placental insufficiency and aortic isthmus flow Jean-Claude Fouron, MD
Dear colleagues, I would like to thank you very sincerely for agreeing to participate in our multicentre study on the clinical significance of recording fetal aortic isthmus flow during placental circulatory
More informationOutcome of Pregnancy and Effects on the Right Heart in Women With Repaired Tetralogy of Fallot
Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp Advance Publication by J-STAGE Outcome of Pregnancy and Effects on the Right Heart in Women With Repaired
More informationUniversity of Groningen. Cost and outcome of liver transplantation van der Hilst, Christian
University of Groningen Cost and outcome of liver transplantation van der Hilst, Christian IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from
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 informationUniversity of Groningen. Stormy clouds in seventh heaven Meijer, Judith
University of Groningen Stormy clouds in seventh heaven Meijer, Judith IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the
More informationPeripartum management of Rheumatic Heart Disease
Peripartum management of Rheumatic Heart Disease Dr James Sartain Director of Anaesthesia & Perioperative Medicine Cairns & Hinterland Hospital & Health Service Talk outline Why (still) talk about RHD
More informationUniversity of Groningen. Diabetes mellitus and rhegmatogenous retinal detachment Fokkens, Bernardina Teunisje
University of Groningen Diabetes mellitus and rhegmatogenous retinal detachment Fokkens, Bernardina Teunisje IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you
More informationClinical applications of positron emission tomography in coronary atherosclerosis Siebelink, Hans-Marc José
University of Groningen Clinical applications of positron emission tomography in coronary atherosclerosis Siebelink, Hans-Marc José IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's
More informationMitral Valve Disease, When to Intervene
Mitral Valve Disease, When to Intervene Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Current ACC/AHA guideline Stages
More informationΜαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό
Μαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό Diastolic HF DD: Diastolic Dysfunction DHF: Diastolic HF HFpEF: HF with preserved EF DD Pathophysiologic condition: impaired relaxation, LV compliance, LV filling
More informationThe Use of 3D Printing in the Teaching of Congenital Heart Disease
The Use of 3D Printing in the Teaching of Congenital Heart Disease Introduction Congenital heart disease (CHD), one of the most common congenital anomalies, is a leading cause of infant morbidity and mortality,
More informationPreconception Counseling for Women with Congenital Heart Disease
Mini Forum for Pediatric ardiac Disease in Young Adulthood Acta ardiol Sin 2015;31:500 506 doi: 10.6515/AS20150319B Preconception ounseling for Women with ongenital Heart Disease hun-wei Lu, Mei-Hwan Wu,
More informationUniversity of Groningen. Cardiotoxicity after anticancer treatment Perik, Patrick Jozef
University of Groningen Cardiotoxicity after anticancer treatment Perik, Patrick Jozef IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it.
More informationDevelopment of patient centered management of asthma and COPD in primary care Metting, Esther
University of Groningen Development of patient centered management of asthma and COPD in primary care Metting, Esther IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF)
More informationAlcohol septal ablation for obstructive hypertrophic cardiomyopathy Steggerda, Robbert
University of Groningen Alcohol septal ablation for obstructive hypertrophic cardiomyopathy Steggerda, Robbert IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you
More informationThe role of the general practitioner in the care for patients with colorectal cancer Brandenbarg, Daan
University of Groningen The role of the general practitioner in the care for patients with colorectal cancer Brandenbarg, Daan IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's
More informationFrequency of detection of congenital heart diseases in different regions of Kyrgyz Republic
Brief Report Frequency of detection of congenital heart diseases in different regions of Kyrgyz Republic Taalaibek Z. Kudaiberdiev, Irina A. Akhmedova, Gulzada A. Imanalieva, Gulnaz T. Tursunbekova, Kayirnisa
More informationUniversity of Groningen. Adaptation after mild traumatic brain injury van der Horn, Harm J.
University of Groningen Adaptation after mild traumatic brain injury van der Horn, Harm J. IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from
More informationUvA-DARE (Digital Academic Repository) The systemic right ventricle van der Bom, T. Link to publication
UvA-DARE (Digital Academic Repository) The systemic right ventricle van der Bom, T. Link to publication Citation for published version (APA): van der Bom, T. (2014). The systemic right ventricle. General
More informationAnatomy & Physiology
1 Anatomy & Physiology Heart is divided into four chambers, two atrias & two ventricles. Atrioventricular valves (tricuspid & mitral) separate the atria from ventricles. they open & close to control flow
More informationUniversity of Groningen. Understanding negative symptoms Klaasen, Nicky Gabriëlle
University of Groningen Understanding negative symptoms Klaasen, Nicky Gabriëlle IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please
More informationPattern of Congenital Heart Disease A Hospital-Based Study *Sadiq Mohammed Al-Hamash MBChB, FICMS
Pattern of Congenital Heart Disease A Hospital-Based Study *Sadiq Mohammed Al-Hamash MBChB, FICMS ABSTRACT Background: The congenital heart disease occurs in 0,8% of live births and they have a wide spectrum
More informationClinical implications of deficiencies of protein S, protein C or antithrombin Brouwer, Jan Leendert Pouwel
University of Groningen Clinical implications of deficiencies of protein S, protein C or antithrombin Brouwer, Jan Leendert Pouwel IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's
More informationA Growing Problem: Maternal Death and Peripartum Complications Are Higher in Women With Grown-Up Congenital Heart Disease
ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS
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 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 informationUniversity of Groningen. Diagnosis and imaging of essential and other tremors van der Stouwe, Anna
University of Groningen Diagnosis and imaging of essential and other tremors van der Stouwe, Anna IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite
More informationPreconceptional evaluation of women with heart disease
3 Preconceptional evaluation of women with heart disease Marla A. Mendelson INTRODUCTION Women reaching childbearing age may present with congenital or acquired cardiac disease. Cardiac complications arising
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 information