The Pulse – September 2019

The Pulse is a summary of relevant news and articles for Congenital Heart Professionals and highlights:

What’s Been Happening?

Featured Science

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What's Been Happening?

Featured Science

Pediatric Cardiology Featured Science

Long-Term Survival of Patients With Coarctation Repaired During Infancy (from the Pediatric Cardiac Care Consortium).
Oster ME, McCracken C, Kiener A, Aylward B, Cory M, Hunting J, Kochilas LK.
Am J Cardiol. 2019 Jun 6. pii: S0002-9149(19)30626-5. doi: 10.1016/j.amjcard.2019.05.047. [Epub ahead of print]
PMID: 31272703
Similar articles
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Take Home Points by Dr. Inga Voges (Kiel, Germany):

• The long-term survival in patients with aortic coarctation who underwent surgery before the age of 12 months is excellent.
• Weight <2.5 kg at the time of CoA repair, presence of a genetic syndrome and surgery before 1990 seems to be associated with increased late mortality.

Cardiomegaly on chest radiographs as a predictor of heart disease in the pediatric population.
Dasgupta S, Kelleman M, Slesnick T, Oster ME.
Am J Emerg Med. 2019 Jun 25. pii: S0735-6757(19)30426-7. doi: 10.1016/j.ajem.2019.06.045. [Epub ahead of print]
PMID: 31272753
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Take Home Points by Dr. Jared Hershenson (Greater Washington DC):

• Cardiomegaly on chest x-ray (CXR) has a relatively poor positive predictive value (PPV) for subsequent diagnosis of true heart disease.
• The addition of an EKG and BNP > 100 pg/ml improves the PPV, especially in patients < 1 year of age but does not negate the need for a subsequent echocardiogram.

Congenital and Pediatric Cardiac EP Featured Science

Different characteristics of postoperative atrial tachyarrhythmias between congenital and non-congenital heart disease.
Kondo M, Fukuda K, Wakayama Y, Nakano M, Hasebe Y, Satake H, Segawa M, Hirano M, Shimokawa H.
J Interv Card Electrophysiol. 2019 Jun 13. doi: 10.1007/s10840-019-00575-2. [Epub ahead of print]
PMID: 31197584

Take Home Points by Dr. Philip Chang (Gainesville, FL):

• Atrial tachyarrhythmias in ACHD vs. non-ACHD differ with regards to arrhythmia mechanism and substrate.
• Atrial tachyarrhythmias develop at earlier age and following longer duration after cardiac surgery in ACHD patients.

ACHD Featured Science (sponsored by ISACHD)

Mechanism and Risk Factors for Death in Adults With Tetralogy of Fallot.
Egbe AC, Kothapalli S, Borlaug BA, Ammash NM, Najam M, Bajwa N, Tarek K, Matthew J, Connolly HM.
Am J Cardiol. 2019 Jun 7. pii: S0002-9149(19)30627-7. doi: 10.1016/j.amjcard.2019.05.048. [Epub ahead of print]
PMID: 31272701
Similar articles

Take Home Points by Dr. Timothy Roberts (Melbourne, Australia):

• Annual event rate of death or cardiac transplant was 0.9 % in a Mayo Clinic cohort of 465 TOF patients.
• Six independent risk factors associated with death/transplant were age > 42 years, atrial fibrillation, ³ moderate QRS fragmentation, LVEF < 50 %, RVEDP > 16 mmHg, and LVEDP > 16 mmHg.
• Nearly two-fold increased risk of death or transplant per unit increase in number of risk factors.

Non-vitamin K antagonist oral anticoagulants in adults with a Fontan circulation: are they safe?
Yang H, Veldtman GR, Bouma BJ, Budts W, Niwa K, Meijboom F, Scognamiglio G, Egbe AC, Schwerzmann M, Broberg C, Morissens M, Buber J, Tsai S, Polyzois I, Post MC, Greutmann M, Van Dijk A, Mulder BJ, Aboulhosn J.
Open Heart. 2019 Jun 3;6(1):e000985. doi: 10.1136/openhrt-2018-000985. eCollection 2019.
PMID: 31245011 Free PMC Article
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Take Home Points by Dr. Blanche Cupido (Cape Town, South Africa):

• The 2014 PACES/HRS gave NOACS a class III recommendation for use in Fontan patients with atrial arrhythmias – this was based on a lack of data rather than reported adverse events.
• This is the first study providing prospective safety data for the use of NOACS in Fontan patients.
• They showed comparable safety and efficacy to VKA’s with an annual rate of 2.9% respectively for thromboembolism and major bleeding.
• Since the mean follow-up in this study was only 1.4 years, longer follow-up data is needed.

Interventional Cardiology Featured Science

A Low Residual Pressure Gradient Yields Excellent Long-Term Outcome After Percutaneous Pulmonary Valve Implantation.
Georgiev S, Ewert P, Tanase D, Hess J, Hager A, Cleuziou J, Meierhofer C, Eicken A.
JACC Cardiovasc Interv. 2019 Jun 10. pii: S1936-8798(19)30846-5. doi: 10.1016/j.jcin.2019.03.037. [Epub ahead of print]
PMID: 31202951
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Take Home Points by Dr. Wendy Whiteside (Ann Arbor MI):

• Transcatheter pulmonary valve implantation has excellent long-term outcomes with surgery-free survival 92% at 5 years and 83% at 10 years.
• Significant risk factor for death and valve failure include an RV-PA gradient >15 mmHg. All efforts to adequate prepare the RVOT and minimize residual gradient leads to significant improvement in survival free of repeat interventions.

Congenital Cardiology Today

Congenital Cardiology Today publishes the one-of-a-kind Hospital Directory annually. It is a comprehensive list of Congenital Cardiac Care Providers in North America at Hospitals That Offer Open Heart Surgery for Children throughout the US and Canada.

See Featured Hospital Directory 2019


ACHA Webinars for Patients and Families

Managing Common Illnesses and Vaccine Update for Patients with Congenital Heart Disease        

Tuesday, October 29, 2019, 7 p.m. – 8 p.m. EDT

Presented by Rachel Steury, NP, and Nancy Klein, RN

As someone with congenital heart disease (CHD), do you worry about getting sick with common illnesses like upper respiratory infections, the flu and GI bugs? Do you want to learn some tricks for staying healthy during the cold and flu season? Do you know what to do if you do get sick? And what about vaccines? Should you take them? Do they make you sick? Watch this webinar for an update on all of this and more. You’ll also get an update on the vaccines you should receive. Hint—it may be more than you think! You don’t want to miss this webinar.

Click here to register

This webinar is made possible in part by sponsorship support provided by Actelion Pharmaceuticals US and Gilead Sciences, Inc.

To view previous webinars and see full schedule click here.

More information / registration

To view previous webinars and see full schedule click here.

Stanford Survey Request

Stanford Medicine is conducting a research study to examine physicians’ understanding of leadership and barriers to their participation in such roles.

The survey is a short ( about 2 minutes), anonymous, online survey, and is designed to gather information on how to improve physicians’ training and interest in assuming leadership roles.

Your input will be greatly appreciated.

Take the survey

CHIP Network Partner Organizations

On behalf of the CHiP Network, thank you for reading!

Gary Webb, MD
CHiP Network