Heidi M Connolly

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (223)1716.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: Patients with unoperated single ventricle (SV) rarely survive into adulthood with good functional status and may develop Eisenmenger's syndrome (ES). We report outcomes of a 30-year cohort of such patients. METHODS: Adult patients with unoperated SV were identified by searching the Mayo Clinic medical record from 1984 to 2014. Clinical data were collected and compared between patients with pulmonary stenosis (PS) and ES. RESULTS: 24 patients were identified (median peak-age 56 (31-77) years (11 ES, 13 PS); 22 had left ventricular morphology. 50-year transplant-free survival was 65% (95% CI 43 to 81). Median age at death was 55 years (31-77 years); 15 deaths (62%) occurred before oral pulmonary vasodilators were commercially available. Two-thirds of the cohort demonstrated preserved New York Heart Association functional class and median EF was 60% (49% to 62%). The majority of patients to survive into the fifth decade exhibited anatomy of double-inlet LV (DILV) with PS. CONCLUSION: Selected patients with unoperated SV with PS and ES can survive with good functional class up to the eighth decade with good medical management. DILV/PS appears to be the ideal phenotype for advanced survival. Our outcomes may be considered when such patients with SV having 'balanced' physiology are evaluated for Fontan palliation. However, additional prospective study will be necessary to verify this assertion.
    No preview · Article · Feb 2016 · Heart
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    ABSTRACT: Background: Limited data are available about direct current cardioversion (DCCV) in Fontan patients. Methods: Retrospective review of adult Fontan patients that underwent DCCV for atrial arrhythmias at Mayo Clinic, 1994-2014. Study endpoints were to determine procedural success, safety, and the freedom from arrhythmia recurrence after DCCV. Procedural success was defined as termination of the presenting atrial arrhythmia prior to leaving the cardioversion suite. Results: 86 patients underwent 152 DCCV; age 27±8years; male 49 (57%); atriopulmonary Fontan, 64 (74%); atrial flutter/interatrial reentry tachycardia 125 (82%). Freedom from recurrence was 84% and 47% at 12 and 36months; freedom from repeat DCCV was 91% and 64% at 12 and 36months. Procedural failure occurred in 41 (27%); predictors of procedural failure were older age (HR 1.91, CI 1.16-2.73 per decade) and prior DCCV (HR 2.71, CI 1.22-3.21). Concomitant oral class I or III antiarrhythmic medication was associated with an increased likelihood of success (HR 0.64, CI 0.41-0.87). Predictors of recurrence were older age (HR 3.26, CI 1.19-6.55 per decade); duration of arrhythmia (HR 1.87, CI 1.14-2.56 per decade); and presence of atriopulmonary Fontan (HR 1.54, CI 1.27-1.85). Procedural complications were symptomatic bradycardia in 2 cases (1%). No thromboembolic complications or deaths occurred. Conclusion: DCCV in Fontan patients is safe but is associated with significant procedural failure and recurrence rates. Ideally, antiarrhythmic medication should be instituted prior to DCCV in stable patients and DCCV alone should be considered as a temporizing measure to maintain sinus rhythm.
    No preview · Article · Jan 2016 · International journal of cardiology
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    ABSTRACT: Carcinoid syndrome causes a rare form of acquired valvular heart disease which typically occurs in the setting of liver metastases. In carcinoid-induced valvular heart disease, the tricuspid valve is almost universally affected; left-sided valve disease occurs infrequently in affected patients. Herein, we report 2 cases of carcinoid-induced valvular heart disease; one case had no evidence of tricuspid valve involvement despite severe involvement of all other valves, while the other case was without severe tricuspid valve involvement.
    No preview · Article · Dec 2015 · Cardiology
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    ABSTRACT: BACKGROUND Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Recent data suggest that BPVT responds to vitamin K antagonists, emphasizing the need for reliable diagnosis. OBJECTIVES This study sought to determine the diagnostic features of BPVT and to formulate a diagnostic model for BPVT. METHODS Cases of BPVT occurring between 1997 and 2013 were identified from the Mayo Clinic pathology database. Patients with BPVT were matched 1: 2 for age, sex, and prosthesis position with patients whose valves were explanted for structural failure. We formulated a diagnostic model for BPVT using multivariate linear logistic regression and receiver operating characteristic. RESULTS Among 397 consecutive cases of explanted bioprostheses, there were 46 cases of BPVT (11.6%; aortic 29, mitral 9, tricuspid 7, pulmonary 1), mean age was 63 years, and 68% were male. Thirty (65%) cases occurred >12 months post-implantation; median bioprosthetic valve longevity was 24 months (cases) versus 108 months (controls) (p < 0.001). Independent predictors of BPVT were >50% increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR]: 12.7), paroxysmal atrial fibrillation (OR: 5.19), subtherapeutic international normalized ratio (OR: 7.37), increased cusp thickness (OR: 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76% sensitivity, 93% specificity, 85% positive predictive value, and 89% negative predictive value (p < 0.001). CONCLUSIONS BPVT is not uncommon and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT. (C) 2015 by the American College of Cardiology Foundation.
    No preview · Article · Dec 2015 · Journal of the American College of Cardiology
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    ABSTRACT: Background Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival. Objectives This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care. Methods We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012. Results The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit. Conclusions Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team.
    No preview · Article · Nov 2015 · Journal of the American College of Cardiology
  • Yogesh N. V. Reddy · Heidi M. Connolly · Naser M. Ammash
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    ABSTRACT: The percutaneous Melody valve is occasionally used for the treatment of bioprosthetic valve dysfunction and is an attractive option for patients at high risk for repeat operation. Anticoagulation is not routinely recommended following Melody valve placement. We present the case of a young woman who developed subacute spontaneous thrombosis of her Melody valve 15 months after placement. Her clinical status was compromised by severe tricuspid prosthesis stenosis and right-to-left shunting across a small residual atrial septal defect. Surgical replacement was required. To our knowledge, this is the first reported case of spontaneous thrombosis of a Melody valve in the tricuspid position.
    No preview · Article · Oct 2015 · World Journal for Pediatric and Congenital Hearth Surgery

  • No preview · Article · Oct 2015
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    ABSTRACT: Approximately 20% to 30% of patients with Noonan syndrome (NS) have asymmetric left ventricular hypertrophy (LVH) and LV outflow tract obstruction (LVOTO). The role of surgical myectomy in such patients is unknown. We sought to compare clinical features and outcomes of patients with NS and LVOTO with age- and gender-matched patients with nonsyndromic, obstructive hypertrophic cardiomyopathy (HC) after myectomy. Two cohorts were selected and retrospectively analyzed using Mayo Clinic databases from 1996 to 2014. Subjects included patients with NS with LVH and LVOTO and nonsyndromic controls with obstructive HC. Twenty-three patients with NS and LVH were identified, of whom 12 (8 males) underwent myectomy (10 septal and 2 combined septal/apical) for severe LVOTO (10 pediatric and 2 adults; 13 ± 10 year old [range 1 to 39]). Similar echocardiographic improvements were noted in both groups. There were no perioperative deaths. Residual gradients were slightly higher in patients with NS. No improvement was noted in left atrial volume after myectomy in patients with NS. At early follow-up, the majority showed improvement in the New York Heart Association class (88% in NS vs 82% in HC, median of 6 and 2 months, respectively). At late follow-up (median of 7 years), the survival rate was 92% in NS and 100% in HC. In patients with NS with LVH and symptomatic LVOTO, myectomy reduces both gradient and the New York Heart Association class, similar to patients with nonsyndromic obstructive HC. Residual gradients were slightly higher, and left atrial dilation persisted in patients with NS. In conclusion, myectomy should be considered in patients older than 1 year with NS and symptomatic LVOTO. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · The American journal of cardiology
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    ABSTRACT: Women with Marfan syndrome are at increased risk of aortic events during pregnancy. We present the case of a ruptured descending thoracic aortic aneurysm in a woman with Marfan syndrome who was 25 weeks pregnant. Emergent intervention was performed using an endovascular repair as a bridge to allow continuation of pregnancy, decreasing fetal morbidity, and allow subsequent later definitive open aortic repair. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · The Annals of thoracic surgery
  • M. Lyle · E. Fenstad · K. Arendt · R. Frantz · H. Connolly · C. Warnes · G. Kane

    No preview · Article · Apr 2015 · The Journal of Heart and Lung Transplantation
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    ABSTRACT: Among patients with severe aortic stenosis (sAS) and preserved LVEF, those with low-flow, low-gradient sAS (LFLG-sAS) have an adverse prognosis. It has been proposed that LFLG-sAS represents an end-stage point of sAS, but longitudinal information has not been described. The aim was to determine whether LFLG-sAS represents an end-stage consequence of normal-flow, high-gradient sAS (NFHG-sAS) or a different entity. From our transthoracic echocardiogram (TTE) database, we identified patients with sAS (aortic valve area <1 cm(2)) and preserved LVEF (≥50%), and from these, patients with LFLG-sAS (stroke volume index <35 mL/m(2) and mean transvalvular gradient <40 mm Hg) who had ≥1 additional TTE within five years prior to the index TTE. Patients were age/sex/date matched 2:1 with patients with NFHG-sAS and normal-flow, low-gradient (NFLG)-sAS who also had ≥1 TTE. Included were 1203 TTEs (383 index studies and 820 preceding studies). In 78 patients with LFLG-sAS, an HG stage preceded the index TTE in only 4 (5%). During the five years preceding the index TTE, patients with LFLG-sAS developed increasing relative wall thickness (0.42 to 0.49; p<0.001) without change in LV mass index. Patients with NFHG-sAS had a marked increase in LV mass index (87 to 115 g/m(2); p<0.001). Patients with LFLG-sAS demonstrated the greatest reduction in LV end-diastolic diameters (-3 vs -1 for NFLG-sAS vs +2 mm for NFHG-sAS; p=0.001), deceleration time (-55 vs -3 vs +3 ms, respectively; p<0.01) and LVEF (-4 vs 0 vs 0%, respectively; p=0.01). LFLG-sAS is a distinct presentation of sAS preceded by a unique remodelling pathway and is uncommonly preceded by an HG stage. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    No preview · Article · Mar 2015 · Heart (British Cardiac Society)

  • No preview · Article · Mar 2015 · Journal of Thoracic and Cardiovascular Surgery
  • Yogesh N V Reddy · Naser Ammash · Heidi Connolly

    No preview · Article · Mar 2015 · Journal of the American College of Cardiology
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    Full-text · Article · Mar 2015 · Journal of the American College of Cardiology
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    Full-text · Article · Mar 2015 · Journal of the American College of Cardiology
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    Full-text · Article · Mar 2015 · Journal of the American College of Cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Patients with unoperated single ventricle (SV) rarely survive into adulthood with good functional status and may develop Eisenmenger's syndrome (ES). We report outcomes of a 30-year cohort of such patients. Methods: Adult patients with unoperated SV were identified by searching the Mayo Clinic medical record from 1984 to 2014. Clinical data were collected and compared between patients with pulmonary stenosis (PS) and ES. Results: 24 patients were identified (median peak-age 56 (31-77) years (11 ES, 13 PS); 22 had left ventricular morphology. 50-year transplant-free survival was 65% (95% CI 43 to 81). Median age at death was 55 years (31-77 years); 15 deaths (62%) occurred before oral pulmonary vasodilators were commercially available. Two-thirds of the cohort demonstrated preserved New York Heart Association functional class and median EF was 60% (49% to 62%). The majority of patients to survive into the fifth decade exhibited anatomy of double-inlet LV (DILV) with PS. Conclusion: Selected patients with unoperated SV with PS and ES can survive with good functional class up to the eighth decade with good medical management. DILV/PS appears to be the ideal phenotype for advanced survival. Our outcomes may be considered when such patients with SV having 'balanced' physiology are evaluated for Fontan palliation. However, additional prospective study will be necessary to verify this assertion.
    No preview · Article · Mar 2015 · Journal of the American College of Cardiology
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    Full-text · Article · Feb 2015 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: -Most patients with repaired tetralogy of Fallot (TOF) require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remains unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. -A retrospective analysis was performed on 205 patients with repaired TOF undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range 25.6 years). Previous ventricular tachycardia (VT) occurred in 16 patients (8%) and 37 (16%) had left ventricular (LV) dysfunction, defined as LV ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including VT, out-of-hospital cardiac arrest, appropriate implantable cardioverter-defibrillator therapy and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95, 90, and 79%, respectively. In the first year following PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of VT and LV dysfunction were associated with higher risk for the combined event (HR 4.7, p=0.004 and HR 0.8, p=0.02 respectively). -Patients with repaired TOF undergoing PVR with history of VT and/or LV dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high risk patients, surgical cryoablation does not appear to increase arrhythmic events and may be protective.
    Preview · Article · Nov 2014 · Circulation Arrhythmia and Electrophysiology
  • Juan M Bowen · Heidi M Connolly
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    ABSTRACT: Marfan's syndrome was once a disease of unknown cause, and those affected often died young from aortic dissection. Today, most patients with Marfan's syndrome who receive comprehensive care have a near-normal life expectancy. Initial therapeutic strategies evolved from clinical research done before the disease pathogenesis was understood. They include prophylactic composite aortic repair, which reduces the threat of aortic dissection, and beta-blockade, which provides medical aortic protection. An understanding of the disease pathogenesis from basic research has resulted in new treatment strategies.(1) Mutations in the gene encoding fibrillin-1 were shown in 1991 to be the cause of Marfan's syndrome.(2) Fibrillin-1 . . .
    No preview · Article · Nov 2014 · New England Journal of Medicine

Publication Stats

8k Citations
1,716.63 Total Impact Points

Institutions

  • 1995-2015
    • Mayo Clinic - Rochester
      • • Department of Cardiovascular Diseases
      • • Department of Cardiovascular Surgery
      Рочестер, Minnesota, United States
  • 2014
    • Autonomous University of Barcelona
      Cerdanyola del Vallès, Catalonia, Spain
  • 2012
    • Children's National Medical Center
      • Division of Cardiology
      Washington, Washington, D.C., United States
  • 2011
    • George Washington University
      • Division of Cardiology
      Washington, Washington, D.C., United States
  • 2008
    • Mayo Foundation for Medical Education and Research
      • Division of Vascular Surgery
      Рочестер, Michigan, United States
  • 2005
    • Klinik Im Park
      Zürich, Zurich, Switzerland
  • 2000
    • Hannover Medical School
      Hanover, Lower Saxony, Germany