[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to describe gender differences in patients operated on for TOF and to define the impact of pregnancy in late post-surgical follow-up in women.
In this research, we studied 145 patients after correction of TOF: 66 male, 79 women, 41 of which reported history of 68 pregnancies, means age 37±10 years, age at operation 7±8 years, mean duration of post-surgical follow-up 30±7 years. Selected variables were compared according to sex and according to history of pregnancy with statistical tests.
Men had more severe hemodynamic impairment and a higher number of cardiac reoperations than females. 41% of patients had at least one complication during pregnancy; there were 16 (67%) abortions and 39 (74%) Caesarian delivers; the recurrence of congenital heart defect was 10%. After pregnancy, there was a shift from first to second functional class: unique pregnancy determined no differences in term of morpho-functional ventricular features compared to nulliparous, but they complained fatigue and palpitation and echocardiographyc dysfunction. Left ventricular dysfunction and QRS duration at ECG were independent predictors of ventricular arrhythmias in all patients.
There were no gender-specific differences in patients operated on for TOF using ventriculotomy. Pregnancy is an event in these patients at risk for the newborn, in terms of miscarriage, prematurity, and recurrence of birth defects, and for the mother in terms of ventricular dysfunction and electrical instability. At least a single pregnancy does not appear to significantly modify the natural history of post-surgical patients operated on for TOF.
PLoS ONE 12/2012; 7(12):e49729. DOI:10.1371/journal.pone.0049729 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this paper is to clarify two important aspects about patients affected by congenital heart disease. Their functional status plays a dominant role in the definition of quality of life related to health status, because of its implication in working and recreational activities. In the first part, we explain their cardiovascular adaptation on exercise, based on pathology (Tetralogy of Fallot, transposition of great arteries, univentricular heart). In the second part, we explain the risk of sudden death from congenital heart disease due to exercise, because of electrical cardiac instability and/or the structural abnormalities of the cardiovascular parietal walls.
[Show abstract][Hide abstract] ABSTRACT: The introduction and diffusion of cross-sectional echocardiography at the end of 1970s significantly improved case ascertainment and allowed the identification of congenital heart defects with a significant increase of mild forms. However, the prevalence of severe congenital heart disease (CHD), which represented 11.7% of overall cardiovascular malformations, remained quite stable (less than 1 per 1000 live births). In past decades, a new population of adults with CHD emerged who need specialized care in centres with trained and experienced professional staff with a different level of expertise. Clinical implications of this new scenario are discussed in this article.
Journal of Cardiovascular Medicine 07/2011; 12(7):487-92. DOI:10.2459/JCM.0b013e32834743cf · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Few cases of anomalous origin of the left coronary artery from the pulmonary artery remain asymptomatic until adolescence, and it is very rare to find a patient with this disease reaching the age of 70 without having undergone any surgery. Up to now, there have been only three other cases of patients, more than 70 years of age, with this congenital heart effect described in medical literature. We report the clinical history and the cardiac morphofunctional findings of 12 years of follow-up after a very late diagnosis of anomalous origin of the left coronary artery from the pulmonary artery.
Journal of Cardiovascular Medicine 03/2009; 10(2):174-7. DOI:10.2459/JCM.0b013e32831b6dfa · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The question on whether the electrocardiographic criteria are reliable for detection of left ventricular hypertrophy (LVH) and play a role in predicting outcome is open. Answer can only proceed from population-based studies over unselected people followed up for years. In this study, 1,699 subjects from general population underwent echocardiogram and standard electrocardiogram (ECG) codified for LVH with Minnesota code and with other five methods. Other items were also recorded and used as covariables. Left ventricular mass index (LVMI) was 127.6 +/- 44.9 g m(-2) in men and 120.8 +/- 41.2 g m(-2 )in women, and correlated directly with age in both genders. Prevalence of echocardiographic LVH was 36.6% in men and 53.4% in women. LVMI correlated directly with the Sokolow-Lyon score in both genders at any age, with the Romhilt-Estes, Cornell and R(aVL) scores in all subjects but elderly men, and with the Lewis score in men and women aged < or =69 years. Sensitivity and the predictive value of electrocardiographic tests, as well as the prevalence of LVH diagnosed with electrocardiographic criteria, were always low. Specificity was high for all the tests, and in particular for the Cornell index. Only when diagnosed with echocardiogram or with the Sokolow-Lyon criterion, LVH was an independent predictor of mortality. We conclude that electrocardiographic tests cannot be used as a surrogate of echocardiogram in detecting LVH in the general population because their positive predictive value (PPV) is unacceptably low. On the contrary, they could replace echocardiography in the follow up and for prediction of outcome, when LVH has previously been correctly diagnosed with other methods.
European Journal of Epidemiology 02/2008; 23(4):261-71. DOI:10.1007/s10654-008-9234-6 · 5.15 Impact Factor