ORCID Profile
0000-0002-4325-3521
Current Organisations
Hôpital universitaire Necker-Enfants malades
,
PARCC
,
Université Paris Descartes
,
Hôpital Europeen Georges-Pompidou Pôle Cardio-vasculaire Rénal Métabolique
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Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.IJCARD.2011.08.847
Abstract: In transposition of the great arteries (TGA), the right ventricle (RV) is subaortic and abnormal aortic structure or function could adversely affect the capacity of the RV to supply the systemic circulation. Our aim was to assess aortic dimensions and distensibility and RV function in patients with palliated TGA using cardiovascular magnetic resonance imaging (CMR). We studied 29 patients (22 males age 29±4 years) with simple TGA, who underwent an atrial switch procedure, and 29 age and sex matched controls. All subjects had cine and phase contrast CMR to evaluate aortic function and global RV function. TGA patients had significant dilatation of the aortic annulus (21.0±3.6 mm vs. 17.6±4.1 mm, p=0.002) and the sinus of Valsalva (30.0±4 mm vs. 26.8±4.2 mm, p=0.005), compared to controls. These findings were associated with reduced distensibility of the ascending aorta in patients with TGA (3.5±1.6 vs. 5.3±2.4 mmHg(-1) x 10(-3), p=0.0009). We could not show a significant correlation between aortic stiffness indices and RV size, function, mass or presence of fibrosis. The aortic root dilates and the ascending aorta stiffens in TGA, during young adult life. Although these proximal aortic changes did not show adverse effects on the RV in our young TGA s le, they might have important long-term physiopathological consequences in these patients.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.IJCARD.2014.09.015
Abstract: The experience with the implantable cardiac defibrillator (ICD) in patients with transposition of the great arteries (TGA) and history of atrial switch surgery remains limited. Retrospective evaluation aiming to assess characteristics and outcomes of consecutive TGA patients with history of atrial switch surgery implanted with an ICD between January 2005 and June 2012 in four French centers. Of the 12 patients (median 34 years [28, 40] 67% male), 4 patients (33%) were implanted for secondary prevention after symptomatic documented sustained ventricular tachycardia or sudden cardiac arrest. ICDs were implanted for primary prevention in 8 patients (67%), including cardiac resynchronization in 3 patients severe systemic ventricle dysfunction was present in all cases (median ejection fraction 27% [20, 40]). Overall, one patient died during the ICD implantation secondary to refractory cardiac arrest after defibrillation testing. Over a median follow-up of 19 months [10, 106], 6 patients out of 11 (54%) experienced worsening of congestive heart failure, including 5 who were eventually transplanted. Overall, 3 patients (27%) experienced significant ICD-related complications, whereas only one patient (primary prevention indication) developed appropriate ICD therapy (successful anti-tachycardia pacing without shock). Half of the patients presented with at least one episode of sustained (≥ 5 min) atrial arrhythmia during follow-up. Our findings underline the key role of progressive heart failure in dictating outcomes among TGA patients with prior atrial switch repair. Our results also underline the need of better risk-stratification for sudden cardiac death in those patients.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.IJCARD.2018.02.045
Abstract: Echocardiographic assessment of diastolic function in the setting of Fontan physiology is not well validated. We recently demonstrated that atrioventricular systolic to diastolic duration ratio (AVV S/D ratio) independently predicts mortality in Fontan-adults and that a value >1.1 was associated with poor prognosis. To correlate echocardiographic measures of diastolic function with direct measurement of ventricular end-diastolic pressure (VEDP). A retrospective analysis was undertaken of Fontan-adults who had transthoracic echocardiography (TTE) within 12 months of direct measurement of VEDP during cardiac catheterisation. Fifteen Fontan adults (3 males, mean age 29 ± 9 years) were evaluated. Thirteen patients had dominant morphologic left ventricle and 2 had morphologic right ventricle. Four had atriopulmonary connection and 11 had total cavopulmonary connection. Twelve patients were NYHA Class I/II and 3 were Class III. Time between TTE and cardiac catheter was 46 ± 113 days VEDP was 8 ± 5 mmHg. Ten patients had preserved ventricular function, 3 had mild and 2 had moderate systolic impairment by subjective TTE assessment. AVV S/D ratio had the strongest correlation with VEDP (r = 0.8, p = 0.001). AVV S/D ratio ≥ 1.1 had 100% positive predictive value and 92% negative predictive value for detecting VEDP >10 mmHg. The only conventional echocardiographic measure of diastolic function that correlated with VEDP was pulmonary vein A wave - atrioventricular A wave duration difference (r = 0.8, p = 0.02). TTE measures reflect VEDP in adults with a Fontan circulation. AVV S/D ratio is a simple parameter yet to enter standard practice that can be used to identify elevated VEDP.
Location: France
No related grants have been discovered for Magalie LADOUCEUR.