Heart failure in adult congenital heart disease: Emerging concepts with a focus on tetralogy of Fallot

Wald, Rachel M.; Valente, Anne Marie; Marelli, Ariane J.

doi:10.1016/j.tcm.2014.11.011

Cited by 61 publications

(34 citation statements)

References 83 publications

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“…These commercial ventricle assist devices have made great contributions to heart failure treatment with massive clinical cases (Sabashnikov et al, 2014;Anderson et al, 2015). RV heart failure has become a major clinical problem for TOF patients as the surgeries greatly extended their life expectancy (Wald et al, 2015). However, ventricle assist devices have not gained widespread use in adult patients with RV heart failure caused by a congenital heart disease due to many potential barriers (Everitt et al, 2015;Wald et al, 2015).…”

Section: Discussion Pvr Surgical Options and Challenge For Band Insermentioning

confidence: 99%

“…RV heart failure has become a major clinical problem for TOF patients as the surgeries greatly extended their life expectancy (Wald et al, 2015). However, ventricle assist devices have not gained widespread use in adult patients with RV heart failure caused by a congenital heart disease due to many potential barriers (Everitt et al, 2015;Wald et al, 2015). Instead of using a pump draining blood from the ventricle and delivering it to the pulmonary artery or the artery directly, active contractional band insertion surgery presents an innovative method by helping the ventricle in squeezing more blood into the pulmonary artery.…”

Section: Discussion Pvr Surgical Options and Challenge For Band Insermentioning

confidence: 99%

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Multi-Band Surgery for Repaired Tetralogy of Fallot Patients With Reduced Right Ventricle Ejection Fraction: A Pilot Study

et al. 2020

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Introduction: Right ventricle (RV) failure is one of the most common symptoms among patients with repaired tetralogy of Fallot (TOF). The current surgery treatment approach including pulmonary valve replacement (PVR) showed mixed post-surgery outcomes. A novel PVR surgical strategy using active contracting bands is proposed to improve the post-PVR outcome. In lieu of testing the risky surgical procedures on real patients, computational simulations (virtual surgery) using biomechanical ventricle models based on patient-specific cardiac magnetic resonance (CMR) data were performed to test the feasibility of the PVR procedures with active contracting bands. Different band combination and insertion options were tested to identify optimal surgery designs. Method: Cardiac magnetic resonance data were obtained from one TOF patient (male, age 23) whose informed consent was obtained. A total of 21 finite element models were constructed and solved following our established procedures to investigate the outcomes of the band insertion surgery. The non-linear anisotropic Mooney-Rivlin model was used as the material model. Five different band insertion plans were simulated (three single band models with different band locations, one model with two bands, and one model with three bands). Three band contraction ratios (10, 15, and 20%) and passive bands (0% contraction ratio) were tested. RV ejection fraction was used as the measure for cardiac function. Results: The RV ejection fraction from the three-band model with 20% contraction increased to 41.58% from the baseline of 37.38%, a 4.20% absolute improvement. The RV ejection fractions from the other four band models with 20% contraction rate were 39.70, 39.45, and 40.70% (two-band) and 39.17%, respectively. The mean RV stress and strain values from all of the 21 models showed only modest differences (5-11%).

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Section: Discussion Pvr Surgical Options and Challenge For Band Insermentioning

confidence: 99%

Section: Discussion Pvr Surgical Options and Challenge For Band Insermentioning

confidence: 99%

Multi-Band Surgery for Repaired Tetralogy of Fallot Patients With Reduced Right Ventricle Ejection Fraction: A Pilot Study

et al. 2020

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“…[8][9][10][11] Single ventricle patients palliated to Fontan circulation can develop end-stage multi-organ dysfunction including hepatopathy, cyanosis, or hyperammonemia resulting from the development of veno-venous collaterals, circulatory inefficiency from a heavy aortopulmonary collateral burden, poorly understood chronic renal disease, development of micro-arteriovenous malformations in the pulmonary circulation from inadequate delivery of hepatic factor, protein losing enteropathy, plastic bronchitis, incessant arrhythmias, and systolic and/or diastolic heart failure. Symptomatology differs by disease processes including pulmonary hypertension/Eisenmenger's syndrome and chronic cyanosis; systemic right ventricular failure after an atrial switch operation or physiologically palliated congenitally corrected transposition of the great arteries; and left, right, or biventricular failure from unusual mechanisms in the tetralogy of Fallot population.…”

Section: The Need For Adult Cong Enital Advan Ced Circul Atory Failmentioning

confidence: 99%

“…Symptomatology differs by disease processes including pulmonary hypertension/Eisenmenger's syndrome and chronic cyanosis; systemic right ventricular failure after an atrial switch operation or physiologically palliated congenitally corrected transposition of the great arteries; and left, right, or biventricular failure from unusual mechanisms in the tetralogy of Fallot population. [8][9][10][11] Single ventricle patients palliated to Fontan circulation can develop end-stage multi-organ dysfunction including hepatopathy, cyanosis, or hyperammonemia resulting from the development of veno-venous collaterals, circulatory inefficiency from a heavy aortopulmonary collateral burden, poorly understood chronic renal disease, development of micro-arteriovenous malformations in the pulmonary circulation from inadequate delivery of hepatic factor, protein losing enteropathy, plastic bronchitis, incessant arrhythmias, and systolic and/or diastolic heart failure. [12][13][14][15] Traditional means of treating heart failure may not be applicable in these populations.…”

Section: The Need For Adult Cong Enital Advan Ced Circul Atory Failmentioning

confidence: 99%

Opportunities for training to advance the care for adults with congenital heart disease with advanced circulatory failure

Broda

2019

Congenital Heart Disease

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Much effort and consideration has been given to designing and implementing appropriate physician training to engender germane skills to care for patients with adult congenital heart disease (ACHD), a population which is growing in both size and complexity. 1 In the United States, the current training pathway allows for physicians who have completed either a pediatric or adult cardiology fellowship to pursue a two-year fellowship which allows one to become eligible to take the Adult Congenital Heart Disease Certification Exam offered by the American Board of Internal Medicine (ABIM). With an estimated population of well over one million individuals and only ~300 board-certified ACHD specialists, 2,3 the need for "generalists" in ACHD is paramount. However, it is very likely that subspecialization within the ACHD specialty is additionally necessary to optimize care for patients. ACHD-specific expertise is needed in focused areas including surgery, cardiac catheterization, electrophysiology, critical care, and advanced heart failure. 4 Despite the present and future needs in these disciplines, there are no clear pathways for trainees to gain a specific knowledge and skill set for ACHD subspecialty training. While all the aforementioned experts are necessary to improve the care and outlook for ACHD patients, perhaps one of the most pressing issues is the need to address the significant problem of heart failure in the ACHD population. AbstractHeart failure is an emerging issue with important implications in adult patients with congenital heart disease. Practitioners with expertise in both adult congenital heart disease and heart failure are needed to manage this growing and often complex population. In the United States, the optimal training pathway to enable practitioners to best care for these patients is ill-defined. This article explores possibilities and issues that interested trainees may encounter during their training experience.

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“…Cardiovascular magnetic resonance (CMR) is increasingly being heralded [5] as the imaging modality of choice for the evaluation of the right ventricular anatomy in ToF patients. It allows enhanced visualization of cardiac structures without exposing the body to ionizing radiation.…”

Section: Introductionmentioning

confidence: 99%

Fast Fully Automatic Segmentation of the Severely Abnormal Human Right Ventricle from Cardiovascular Magnetic Resonance Images Using a Multi-Scale 3D Convolutional Neural Network

Giannakidis

Kamnitsas

Spadotto

et al. 2016

2016 12th International Conference on Signal-Image Technology &Amp; Internet-Based Systems (SITIS)

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Abstract-Cardiac magnetic resonance (CMR) is regarded as the reference examination for cardiac morphology in tetralogy of Fallot (ToF) patients allowing images of high spatial resolution and high contrast. The detailed knowledge of the right ventricular anatomy is critical in ToF management. The segmentation of the right ventricle (RV) in CMR images from ToF patients is a challenging task due to the high shape and image quality variability. In this paper we propose a fully automatic deep learning-based framework to segment the RV from CMR anatomical images of the whole heart. We adopt a 3D multi-scale deep convolutional neural network to identify pixels that belong to the RV. Our robust segmentation framework was tested on 26 ToF patients achieving a Dice similarity coefficient of 0.8281±0.1010 with reference to manual annotations performed by expert cardiologists. The proposed technique is also computationally efficient, which may further facilitate its adoption in the clinical routine.

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Heart failure in adult congenital heart disease: Emerging concepts with a focus on tetralogy of Fallot

Cited by 61 publications

References 83 publications

Multi-Band Surgery for Repaired Tetralogy of Fallot Patients With Reduced Right Ventricle Ejection Fraction: A Pilot Study

Multi-Band Surgery for Repaired Tetralogy of Fallot Patients With Reduced Right Ventricle Ejection Fraction: A Pilot Study

Opportunities for training to advance the care for adults with congenital heart disease with advanced circulatory failure

Fast Fully Automatic Segmentation of the Severely Abnormal Human Right Ventricle from Cardiovascular Magnetic Resonance Images Using a Multi-Scale 3D Convolutional Neural Network

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