Outcomes of Hospitalization in Adults in the United States With Atrial Septal Defect, Ventricular Septal Defect, and Atrioventricular Septal Defect
ABSTRACT Atrial septal defect, ventricular septal defect (VSD), and atrioventricular septal defect (AVSD) are among the most common congenital heart lesions, with most children surviving to adulthood. However, the clinical course of these patients is largely unknown, particularly pertaining to inpatient care. The purpose of this study was to assess hospitalizations for septal defects in adults with congenital heart disease (CHD) and risk factors associated with significant morbidity and mortality. The 2007 Nationwide Inpatient Sample was used to assess national prevalence of hospitalizations in adults with CHD with septal defects. Co-morbidities and risk factors for mortality were also determined. There were 84,308 adult CHD admissions in the United States in 2007. Fifty-four percent of adult CHD admissions had diagnoses of septal defects, with 48% having atrial septal defect, 7% having VSD, and 0.4% having AVSD. Overall in-hospital mortality was 2.1%. Common co-morbidities included arrhythmias (31%), heart failure (20%), and diabetes mellitus (18%). On multivariable analysis, independent risk factors for mortality included presence of VSD (odds ratio 3.1, 95% confidence interval [CI] 1.5 to 6.5), trisomy 21 (odds ratio 2.9, 95% CI 1.1 to 7.5), and pulmonary hypertension (odds ratio 1.5, 95% CI 1.0 to 2.4). In conclusion, this study of hospitalizations in adults with septal defects found that admissions are common and associated with significant co-morbidities. Overall mortality is low but is increased in patients with VSD. Cardiac and noncardiac co-morbidities are commonly encountered. Many noncardiac conditions, including trisomy 21 and the youngest and oldest groups, are associated with an increased risk of death.
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ABSTRACT: Background: Transthoracic echocardiography (TTE) is one of the most commonly performed cardiac investigations. It can provide comprehensive information about cardiac structure and function, helping to establish a diagnosis and guide therapy, and it is no longer the preserve of the specialist cardiology department. Previous studies on echocardiographic findings in our environment had documented valvular heart disease, hypertensive heart disease and congenital heart diseases as the commonest echocardiographic findings in Nigerians. Aims: The study aimed to provide an update on the common echocardiographic findings in different age groups in this part of the world, since some of the previous similar studies were done over a decade ago. Materials and Methods: We reviewed the echocardiogram reports of 608 consecutive patients done from July 2009 to October 2011 at a private echocardiographic laboratory in Enugu, South-East Nigeria. Data was analyzed for age, gender and echocardiographic findings. Results: The age range of the patients was from 3 days to 98 years with a mean age of 46.4 ± 21.4 years. The mean age of the males was 47.6 ± 21.3 years, while the mean age of the females was 45.2 ± 21.1 years. The commonest echocardiographic abnormality in children was atrial septal defect, while rheumatic heart disease was the commonest in adolescents and young adults. Left ventricular diastolic dysfunction and degenerative valvular diseases respectively were the commonest in the middle-aged and elderly populations in this study. Conclusion: This study has reaffirmed rheumatic heart disease (predominantly mitral valve regurgitation) as the commonest cardiac abnormality in adolescents and young adults. Degenerative valvular diseases, left ventricular diastolic dysfunction, and atrial septal defects were the commonest abnormalities in the elderly, middle-aged population and children, respectively.Nigerian journal of clinical practice 07/2013; 16(3):360-4. DOI:10.4103/1119-3077.113464 · 0.41 Impact Factor
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ABSTRACT: The genetic abnormalities associated with Down syndrome (DS) are still being identified. Few studies have examined the roles of CRELD1 and GATA4 in cardiac abnormalities or their association with pulmonary artery histopathology. Children with DS have an elevated risk of pulmonary arterial hypertension (PAH). This increased risk is likely mainly due to genetic background, the structural characteristics of the pulmonary vascular wall, and certain heart diseases and partly due to pulmonary hypoplasia, upper and lower airway obstructive diseases, chronic infection, and neuromuscular underdevelopment. Exposure to increased left-to-right shunt flow increases sheer stress on endothelium and may induce endothelial dysfunction followed by irreversible remodeling of pulmonary arteries. Pathologic changes include endothelial cell proliferation and thickening of the pulmonary arterial wall due to mechanical responses to the thinner medial smooth muscle cell layer, which includes underdevelopment of alveoli. Production of prostacyclin and nitric oxide is diminished in DS, but levels of endothelin-1 and thromboxane are elevated. Perioperatively, patients with DS may experience pulmonary hypertensive crisis after intracardiac repair and prolonged PAH and have a poorer response to nitric oxide inhalation. To better manage DS, it is crucial to systematically evaluate the systemic complications of DS. Cardiac catheterization data, particularly those regarding pulmonary arterial resistance, are essential in assessing severity and response to vasodilating agents, preventing postoperative crisis, and evaluating the possibility of intracardiac repair. Advanced therapy with pulmonary vasodilating agents appears effective. Operative risk is similar for individuals with and without DS, except among patients with a complete atrioventricular canal defect.Pediatrics International 04/2014; 56(3). DOI:10.1111/ped.12349 · 0.73 Impact Factor
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ABSTRACT: Since the advent of neonatal cardiac surgery in the 1970s, an increasing number of patients suffering from congenital heart disease (CHD) have survived into adulthood. In 2010, it is estimated that 1.2 million or 1 in 150 of young adults have some form of CHD in the United States. Current birth, incidence, and survival rate predict an increase in the CHD population between 10,000 and 300,000 patients per year. Data from large adult CHD (ACHD) centers (UCLA, Toronto, Mayo Clinic) show that as many as 50% of these patients with complex physiology are 40 years of age or older and that two-thirds of them can be categorized as medium or high risk to demonstrate signs and symptoms of low cardiac output. As this population ages, it is very likely for hospital-based physicians to encounter such patients in their procedural and/or surgical practice. Risk stratification and interdisciplinary approach in the care of these patients will assure a safe outcome. The assessment of the patient must consider the variable expression of CHD. Because most lesions are "fixed but not cured," the periprocedural practitioner must consider the altered physiology of the heart in context of the physiological challenges of percutaneous and open surgical interventions. The 2008 American Heart Association/American College of Cardiology guidelines for the Management of Adults with CHD establish for the first time a streamlined approach to the care of these patients. This review will apply these guidelines to the patients with ACHD undergoing noncardiac surgery and intervention.American journal of therapeutics 09/2012; DOI:10.1097/MJT.0b013e3182456db9 · 1.13 Impact Factor