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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Patients with congenital heart disease often have complex surgery with multiple procedures and complex physiology and anatomy. Autopsy is valuable in clarifying the cause of death and major discrepancies found between the clinical and pathological cause of death in 15% of patients, and in 6% these affected survival or treatment.20 The AECVP has issued recent guidelines in the autopsy examination of complex congenital heart disease.21
Cardiac Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Preethi Pirlamarla, Gregary D. Marhefka
For years cardiac disease complicated only 1–4% of all pregnancies in the United States, yet cardiovascular diseases are responsible for the majority of maternal deaths. In an update from 2017, evaluating data from 2009 pregnancy-related deaths from 2010–2013 reported to the Centers for Disease Control, more than 25% were deemed cardiovascular in nature (cardiovascular conditions – not including cardiomyopathy – in 15.5%, and cardiomyopathy in another 11%) [1]. The four risk factors identified by the American College of Obstetrics and Gynecology for maternal cardiovascular mortality are non-Hispanic black race, age > 40 years old, hypertension, and obesity [2]. In the developed world, important acquired cardiac diseases are in large part caused by poor diet, inactivity, obesity, smoking, hyperlipidemia, diabetes, and hypertension. The incidence of pregnancies in heart disease is also increasing due to a higher number of survivors of congenital heart disease into adulthood and an increasing maternal age. In the Western world, congenital heart disease makes up 80% of pregnancies in patients with pre-existing cardiac disease, with a low risk of mortality (0.5%), but significant risk of morbidity (11%, mainly in the form of arrhythmias and heart failure) [4]. Cardiac diseases are a leading cause of admission of the peripartum patient to an intensive care unit [5].
Comparison of Two Means
Published in Marcello Pagano, Kimberlee Gauvreau, Heather Mattie, Principles of Biostatistics, 2022
Marcello Pagano, Kimberlee Gauvreau, Heather Mattie
Referring to Table A.4, we observe that for a t distribution with degrees of freedom, the area under the curve to the right of is less than 0.0005. Similarly, the area to the left of is also less than 0.0005, and . Rejecting the null hypothesis at the 0.05 level, we conclude that there is a significant difference between the mean peak work rate at baseline and the mean at the end of the cardiac rehabilitation program. Equivalently, the mean change in peak work rate is not equal to 0. Participation in the program increases the exercise capacity of children with serious congenital heart disease.
Reproductive health in adults with congenital heart disease: a review on fertility, sexual health, assisted reproductive technology and contraception
Published in Expert Review of Cardiovascular Therapy, 2023
J.A. van der Zande, G. Wander, K.P. Ramlakhan, J.W. Roos-Hesselink, M.R. Johnson
Congenital heart disease (CHD) affects around 1% of all live births worldwide and is the most frequently diagnosed congenital disorder [1,2]. Bicuspid aortic valve, ventricular septal defect, and atrial septal defect are the most common subtypes of CHD and are relatively mild compared with more complex abnormalities such as hypoplastic left heart syndrome and pulmonary atresia [3]. The survival rates vary between the different subtypes of CHD and substantially across the world [3,4]. Due to improvements in diagnosis, surgical and medical treatments, more people with CHD are reaching adulthood and considering pregnancy [5]. The European Society of Cardiology (ESC) guideline and the American Heart Association (AHA) guideline provide information on the management and organization of care for adults with CHD and give a clear overview of the risks and treatments of the different types of CHD [6,7]. However, due to the improved survival in individuals with CHD, considering their reproductive health has become more important, and this topic is still underexplored. In this review, we will discuss multiple aspects of reproductive health in both women and, when applicable, in men, including fertility, sexual health, assisted reproductive technology and contraception.
Robotic magnetic-guided catheter ablation in patients with congenital heart disease: a systematic review and pooled analysis
Published in Expert Review of Cardiovascular Therapy, 2023
Christophe Vô, Stefano Bartoletti, Karim Benali, Cecilia M Gonzalez, Blandine Mondésert, Marie-Hélène Gagnon, Katia Dyrda, Anne Fourier, Paul Khairy
Congenital heart disease was defined as a malformation of the heart or great vessels that was present at birth. This definition included the absence of an inferior vena cava (IVC) but not presence of a patent foramen ovale. If articles published by the same institutions contained overlapping patient populations, only the studies with the greatest number of patients, longest follow-up duration, most complete data reporting, and/or fewer translation impediments to English were retained. Studies were excluded if there were reasonable grounds to suspect patient double-counting. Articles were also excluded if patients with CHD who underwent catheter ablation by RMN could not be separated out from a larger mixed cohort that included non-CHD patients or CHD patients with mapping studies but no ablation.
Current evidence for pharmacologic therapy following stage 1 palliation for single ventricle congenital heart disease
Published in Expert Review of Cardiovascular Therapy, 2022
Meredith C. G. Broberg, Ira M Cheifetz, Sarah T Plummer
The survival of patients with congenital heart disease has significantly improved over the past several decades. Hypoplastic left heart syndrome (HLHS) and other single ventricle heart lesions were uniformly fatal 40 years ago. Now, many patients with HLHS undergo staged palliation with survival ranging from 70% to 90% [1, 2]. The palliative approach includes stage 1 surgical palliation in the neonatal period with either the Norwood procedure with a modified Blalock-Taussig shunt (mBTS) or a right ventricle to pulmonary artery conduit (RV-PA conduit); or a hybrid procedure with stenting of the patent ductus arteriosus and bilateral branch pulmonary artery band placement. At approximately 4–6 months of age patients undergo stage 2 palliation, most commonly, with a superior cavopulmonary anastomosis (bidirectional Glenn procedure). This is followed by stage 3 palliation with the Fontan operation at generally 2–4 years of age. The stage 2 superior cavopulmonary anastomosis and stage 3 Fontan procedures have excellent surgical outcomes [3]. Mortality, however, is greatest following stage 1 palliation and within the first interstage period – the time between stage 1 and stage 2 operations [4].