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Rastelli operation for transposition of the great arteries with ventricular septal defect and pulmonary stenosis cheap generic super avana uk bisoprolol causes erectile dysfunction. Pregnancy outcomes in women who have undergone an atrial switch repair for congenital d-transposition of the great arteries discount 160mg super avana with amex diabetes-induced erectile dysfunction epidemiology pathophysiology and management. Pregnancy outcomes in women with transposition of the great arteries and arterial switch operation purchase 160mg super avana free shipping erectile dysfunction treatment fruits. Outcomes of biventricular repair for congenitally corrected transposition of the great arteries. Anatomic repair for congenitally corrected transposition of the great arteries: a single-institution 19-year experience. Usefulness of cardiovascular magnetic resonance imaging to predict the need for intervention in patients with coarctation of the aorta. Usefulness of screening cardiovascular magnetic resonance imaging to detect aortic abnormalities after repair of coarctation of the aorta. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood. Initial and Six-Year Results of Stent Implantation for Aortic Coarctation in Children. Usefulness of exercise-induced hypertension as predictor of chronic hypertension in adults after operative therapy for aortic isthmic coarctation in childhood. Comparison of risk of hypertensive complications of pregnancy among women with versus without coarctation of the aorta. Assessment of vascular phenotype using a novel very- high-resolution ultrasound technique in adolescents after aortic coarctation repair and/or stent implantation: relationship to central haemodynamics and left ventricular mass. Twenty-three years of single-stage end-to-side anastomosis repair of interrupted aortic arches. Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Outcomes of the infant Ross procedure for congenital aortic stenosis followed into adolescence. Long-term outcome of patients with isolated thin discrete subaortic stenosis treated by balloon dilation: a 25-year study. Valvular aortic stenosis as a major sequelae in patients with pre-existing subaortic stenosis changing spectrum of outcomes. Surgical reconstruction techniques for mitral valve insufficiency from lesions with restricted leaflet motion in infants and children. Surgical repair of congenital mitral valve malformations in infancy and childhood: a single-center 36-year experience. Outcome of cardiac surgery in patients 50 years of age or older with Ebstein anomaly: survival and functional improvement. One and a half ventricle repair in adults: postoperative hemodynamic assessment using phase-contrast magnetic resonance imaging. Surgery for ruptured sinus of Valsalva aneurysm: 25- year experience with 55 patients. Clinical outcomes of adult survivors of pulmonary atresia with intact ventricular septum. As this population continues to grow, the number of adults requiring intervention for the disease increases. Congenital heart disease is extremely variable and involves all aspects of cardiovascular physiology such that specialized training has become a necessity for anyone caring for these patients. Pediatric interventional cardiologists are also key persons on the team, and partnerships between adult congenital interventionalists and pediatric interventional cardiologists are mandatory. As the capabilities of the congenital catheterization laboratory continue to evolve, the line between surgical and catheter-based interventions will become more and more blurred. Many interventions already take place in highly specialized hybrid operating suites in which interventional cardiologists work alongside their cardiothoracic surgery colleagues. This combined model of intervention will continue to be adapted for adult congenital interventions, and it is this ongoing evolution that makes the field so exciting. Furthermore, as interventional approaches change, the indications for intervention become a “moving target. In this chapter we review major areas in which catheter-based interventions have become well established for adults with congenital heart disease. Valvular Interventions The first static pulmonary balloon valvuloplasty was performed in 1982; successful catheter-based 2 interventions have since been performed on all types of cardiac valves. Although valvuloplasty defined the early era of congenital interventional catheterization, valve replacement is defining the current era. Pulmonary Valvuloplasty In “typical” pulmonary valve stenosis, there are normal valve leaflets with limited valve excursion resulting from partial fusion. Static pulmonary valvuloplasty, which aims to separate the fused leaflets, was first performed in the early 1980s and has since replaced surgical valvotomy as the initial 3 intervention in cases of typical isolated valvar pulmonary stenosis. Valvuloplasty for thick and/or dysplastic valves is less successful; moreover, balloon dilation will be unsuccessful in relieving any muscular subvalvar stenosis. Indications for pulmonary valvuloplasty in adults with congenital heart 1 disease has been outlined elsewhere (see Chapter 75). Angiographic measurements of the pulmonary annulus allow for selection of the appropriately sized balloon, which is approximately 120% of the measured pulmonary annulus. Successful balloon valvuloplasty can usually be achieved with hand inflation of the selected balloon. After dilation of the pulmonary valve, repeat angiography should be performed to rule out vascular injury and assess the degree of pulmonary regurgitation. Patients with typical pulmonary valve stenosis will 4 have relatively thin leaflets with partial fusion and will respond well to balloon valvuloplasty. The most common complication for pulmonary valvuloplasty is pulmonary regurgitation (<10% with 2+ or greater pulmonary regurgitation), which is usually well tolerated. Pulmonary Valve Replacement The pulmonary valve is a semilunar valve separating the right ventricle from the main pulmonary artery. It allows for unobstructed right ventricular ejection while maintaining pulmonary arterial diastolic pressure via competent leaflet coaptation. Unfortunately, many patients with congenital heart disease have pulmonary valve disease involving stenosis or regurgitation, or a combination of both. Furthermore, bioprosthetic valves that are implanted in infants to reconstruct the right ventricular outflow tract will invariably fail. In an effort to avoid such dysfunction, relief of stenosis and placement of a competent valve are warranted. Determining the optimal timing for pulmonary valve replacement continues to be an issue; 1 6 there are currently several indications in symptomatic and asymptomatic patients with pulmonary valve disease (see Chapter 75). In addition, because the valve is harvested and not manufactured, there are natural limitations to its supply. Since its introduction in the early 2000s, the valve has undergone 11 modifications to improve its safety profile and procedural outcomes. In contrast to the Melody system, the Edwards family of valves have demonstrated superior radial strength and a wider range of sizes (approved for use in conduits with a diameter of 18 to 28 mm), but their delivery systems are more difficult to maneuver.
Larger paravalvular leaks may result in significant volume overload and heart failure buy super avana 160mg lowest price erectile dysfunction drugs forum, to an extent that reoperation might be indicated purchase super avana 160mg mastercard erectile dysfunction medications cost. Management can prove challenging buy discount super avana line erectile dysfunction treatment with viagra, and a conservative approach with medical therapy is often chosen, in part related to the risks associated with reoperation in some patients. Thromboembolism and Bleeding Thromboemboli are a major source of morbidity in patients with prosthetic heart valves. Thromboembolic incidence rates are similar for non-anticoagulated patients with bioprostheses and appropriately anticoagulated patients with mechanical valves. The risk of bleeding, estimated at 1% per patient-year, increases with age and the intensity of anticoagulation. In patients with uncontrollable bleeding who require reversal of anticoagulation, administration of fresh-frozen plasma or prothrombin-complex concentrate is reasonable. Reoperation to implant a less thrombogenic valve is rarely undertaken for patients with recurrent thromboemboli despite aggressive antithrombotic therapy. Prosthetic Valve Thrombosis The incidence of mechanical valve thrombosis is estimated at 0. Thrombosis of a mechanical heart valve can have devastating consequences (see Figs. Bioprosthetic (surgical or transcatheter) valve thrombosis is less common, with a reported incidence of 0. Clinical suspicion of prosthetic valve thrombosis should be raised by symptoms of heart failure, thromboembolism, or low cardiac output, coupled with a decrease in the intensity of the valve closure sounds (mechanical valves), new and pathologic murmurs, or documentation of inadequate anticoagulation. Thrombosis is more common in the mitral and tricuspid positions than in the aortic position. Although differentiation from pannus formation can be difficult, the clinical context usually 4,5 allows accurate diagnosis. In patients with mechanical valves, confirmation of abnormal leaflet or disc excursion in the 5 presence of an occluding thrombus can also be obtained with cinefluoroscopy. Fibrinolytic therapy is generally 2 recommended for patients with right-sided prosthetic valve thrombosis. An encouraging report of the efficacy of low-dose, slow- infusion tissue plasminogen activator in pregnant women with prosthetic valve thrombosis should prompt 39 investigation of this approach in other patient subsets. Reoperative surgery or catheter closure of the defect is indicated when heart failure, a persistent transfusion requirement, or poor quality of life intervenes. Empiric medical measures include iron and folic acid replacement therapy and beta-adrenoreceptor blockers. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. Utilization and mortality trends in transcatheter and surgical aortic valve replacement: the New York State experience—2011 to 2012. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging, endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography and the Brazilian Department of Cardiovascular Imaging. Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless versus stented aortic valves. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Aortic valve replacement: a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: results from the Society of Thoracic Surgeons Adult Cardiac Surgery National Database. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Valve prosthesis-patient mismatch, 1978 to 2011: from original concept to compelling evidence. Prosthesis-patient mismatch in high-risk patients with severe aortic stenosis: a randomized trial of a self-expanding prosthesis. Cerebral microembolization after bioprosthetic aortic valve replacement: comparison of warfarin plus aspirin versus aspirin only. Incidence, timing and predictors of valve hemodynamic deterioration after transcatheter aortic valve replacement: multicenter registry. Impact of aortic valve replacement on outcome of symptomatic patients with severe aortic stenosis with low gradient and preserved left ventricular ejection fraction. Positron emission tomography/computed tomography for 18 diagnosis of prosthetic valve endocarditis: increased valvular F-fluorodeoxyglucose uptake as a novel major criterion. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death. First, a transcatheter therapy can avoid the risks associated with more invasive surgical approaches, particularly those associated with cardiopulmonary bypass and median sternotomy, while preserving or enhancing outcomes. Second, the patient wants to avoid the invasiveness and prolonged recovery associated with major surgery. However, these factors must always be balanced with the efficacy of the transcatheter approach. In this regard, the patient will always prefer a transcatheter approach that is less invasive, provides a faster patient recovery, and has similar efficacy to a more invasive surgical approach. Aortic Stenosis (See Chapter 68) Paul Dudley White stated in 1931 that “there is no treatment for aortic valve disease. Early feasibility and safety were accomplished with a modicum of success and modest improvement in valve area and clinical symptomatic relief. Transcatheter Aortic Valve Replacement The idea of implanting a prosthetic valve to prevent restenosis after balloon valvuloplasty is credited to Henning Andersen, a Danish cardiologist who fashioned a stent from stainless steel surgical wires and mounted a bioprosthetic valve inside the stent. His initial animal experiments demonstrating feasibility were presented at the European Society of Cardiology in 1992 (see Classic References, Andersen).
