Simple Congenital Heart Disease Research Articles

Changes of serum TSH, FT3, and FT4 levels in infants received surgical correction of congenital heart disease under cardiopulmonary bypass

ObjectiveThis study aimed to explore the fluctuations and clinical relevance of serum thyrotropin (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels in infants undergoing surgical correction for congenital heart disease (CHD) using cardiopulmonary bypass (CPB).MethodsIn a retrospective design, 58 infants who underwent CHD surgical correction under CPB between January 2021 and January 2022 at our institution were incorporated. These infants were categorized into two groups: simple CHD (n = 34) and complex CHD (n = 24). TSH, FT3, and FT4 serum concentrations were assessed at four intervals: 24 h pre-surgery (T0) and 24 h (T1), 48 h (T2), and 72 h (T3) post-surgery.ResultsThe simple CHD group displayed a significantly reduced CPB duration compared to the complex CHD group (P < 0.001). Both groups exhibited a notable decline in serum thyroid hormone concentrations at T1 compared to T0. However, from T1 to T3, an upward trend in hormone levels was observed. By T3, though the levels in both groups had risen notably from T1, they remained significantly diminished from T0 (P < 0.01). In both the simple and complex CHD cohorts, significant fluctuations in thyroid hormone levels (TSH, FT3, FT4) were noted across the different timepoints (T0, T1, T3) (P < 0.01). While no significant disparities were found between the two groups’ hormone concentrations at T0 and T1 (P > 0.05), at T2 and T3, the simple CHD group manifested higher TSH, FT3, and FT4 levels compared to the complex CHD group (P < 0.05).ConclusionsInfants undergoing CHD surgical correction under CPB experience significant declines in TSH, FT3, and FT4 serum levels. The post-surgery thyroid hormone recovery was more pronounced in infants with simple CHD compared to those with complex CHD. As such, vigilant monitoring of thyroid hormone levels during the perioperative phase is imperative, and timely intervention measures should be employed when necessary.

Abstract 19033: Increased Prevalence of Gaps in Care for Patients With Congenital Heart Disease Are Associated With Social Determinants of Health Including Childhood Opportunity Index

Background: Lifelong continuity of care is imperative for patients with congenital heart disease (CHD). Unfortunately, gaps in care (GIC) are common. Hypothesis: Social determinants of health are associated with GIC in patients with CHD. Methods and Results: A total of 2511 patients followed at Nemours Cardiac Center (NCC) with CHD were seen in the clinic between January 2005 and December 2022. Patients were divided into 3 cohorts based on anatomic complexity described in 2018 AHA/ACC adult congenital guidelines as simple, moderate, and complex CHD. Patient characteristics were analyzed, including race, ethnicity, gender, language, insurance status, and Childhood Opportunity Index (COI) based on home address zip code. GIC of &gt; 3 years were identified in 56% (n=1168) of patients. Linear regression model showed that the proportion of GIC stayed consistent for complex CHD with an increase of 0.1% per year and had a significant increase for those with simple and moderate CHD (Figure 1) with a yearly increase of 1.1% and 0.6% respectively. On the multivariable model GIC were associated with a non-Delaware residence (P&lt;0.001), simple to moderate CHD (P&lt;0.001), having less than two caregivers listed (P&lt;0.001), not having public insurance (P&lt;0.001), being none-white (P&lt;0.007), age (P&lt;0.001) Overall COI (P&lt;0.007) with a c-Statistic of 0.692. Conclusions: Over half of the patients with CHD experienced a substantial GIC. GIC were consistent for those with complex CHD but increased significantly for those with simple to moderate CHD over almost two decades and were associated with various SDOH factors including COI. Providing consistency in practice, minimizing practice variation especially for those with mild and moderate CHD and understanding the role of SDOH factors can help decrease GIC and improve patient care for this vulnerable population.

Echocardiography in Simple Congenital Heart Diseases: Guiding Adult Patient Management

Abstract This article provides comprehensive insights into the evaluation of simple congenital heart diseases (CHDs) in adults, emphasizing the pivotal role of echocardiography. By focusing on conditions such as congenital aortic stenosis, aortic coarctation, patent ductus arteriosus, atrial septal defects (ASDs), and ventricular septal defects (VSDs), the review underscores echocardiography’s intricate contributions to precise clinical decision-making. Echocardiography serves as the primary imaging modality, offering high-resolution visualization of anatomical anomalies and quantification of hemodynamic parameters. It enables tailored therapeutic strategies through its capacity to discern the dimensions, spatial orientation, and dynamic shunt dynamics of defects such as ASDs and VSDs. Moreover, echocardiography’s advanced techniques, such as tissue Doppler imaging and speckle tracking, provide detailed insights into atrial mechanics, diastolic function, and ventricular filling kinetics. Integration of echocardiographic findings into clinical practice empowers clinicians to create personalized interventions based on quantified ventricular function, which spans systolic and diastolic aspects. This approach facilitates risk stratification and therapeutic planning, particularly pertinent in heart failure management within the CHD patient population. In summary, echocardiography transcends its role as an imaging tool, emerging as a precision-guided instrument adept at navigating the complexities of simple CHD in adults. Its ability to expedite diagnosis, quantify hemodynamic impacts, and unravel multifaceted functional dynamics culminates in a comprehensive depiction of these conditions. The fusion of these insights with clinical expertise empowers clinicians to navigate the intricate pathways of CHD, crafting tailored therapeutic strategies characterized by precision and efficacy.

Microvascular Endothelial Function Assessed Using Peripheral Arterial Tonometry in Adolescents with Repaired Congenital Heart Disease.

Atherosclerosis can develop in adult patients with congenital heart disease (CHD) and should be given attention. Endothelial function is well known as a predictor of the development of atherosclerosis but has not been well investigated in patients with repaired CHD. This study aimed to clarify the endothelial function and its relationship with clinical backgrounds and parameters in adolescents with various types of repaired CHDs. Endothelial function was evaluated using peripheral arterial tonometry (PAT). The reactive hyperemia index (RHI) was evaluated and compared between adolescents with repaired CHD and those in the control group. The relationship between the clinical background and parameters was also investigated in patients with repaired CHD. Forty-eight patients with repaired CHD (age 14.0 ± 3.3 years) and 114 healthy volunteers were included in this study. Patients with repaired CHD comprised 16 with repaired non-cyanotic CHD, 14 with repaired tetralogy of Fallot, and 18 who underwent the Fontan procedure. RHI in the repaired CHD group was significantly lower than in the control group. There was no significant correlation between the RHI and blood biochemical markers, such as uric acid, creatine, and brain natriuretic peptide levels. The RHI was significantly higher in patients taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) than in those not taking them. Endothelial function was impaired in adolescents with repaired CHD compared to that in the control group. Microvascular endothelial dysfunction developed even in adolescents with simple non-cyanotic CHD.

An 18-year evolution of congenital heart disease in China: An echocardiographic database-based study

ObjectiveData on the evolution of congenital heart disease (CHD) in China remain scarce. Based on a Chinese echocardiography database, we analyzed the observed rate (OR) and spectrum changes of CHD over the past 18 years with a focus on the congenital aortic valve malformation (CAVM) and Adult CHD (ACHD). Methods and resultsThe transthoracic echocardiographic data of 682,565 records from 2003 to 2020 were retrospectively reviewed at Fujian Medical University Union Hospital, China. A total of 37,200 CHD cases were recruited in this study. Over the three periods (from 2003 to 2008, 2009–2014, to 2015–2020), the OR of Total CHD decreased (106.72, 90.64, and 67.43 per 1000 cases, respectively); the proportion of Simple CHD to Total CHD increased (80.96%, 83.41%, and 87.97%, respectively), with a decrease in the proportion of Complex CHD (18.11%, 15.51%, and 10.42%, respectively) (p < 0.05 for all). The proportion of ACHD increased in most types of CHD [Total CHD: 25.79%, 27.84%, and 31.43%; CAVM: 69.02%, 73.42%, and 78.16%; CAVM with aortic stenosis (AS): 67.42%, 70.73%, and 79.25%; respectively, p < 0.05 for all], with a much higher proportion in both CAVM and CAVM with AS than in the other CHD types. The proportion of CHD patients receiving intervention increased over the designated periods. ConclusionsThis study depicts the longitudinal changes of CHD in the Chinese population with a single-center echocardiographic data, revealing an increased proportion of Simple CHD, ACHD (including CAVM and CAVM with AS), and a decreased OR of Total CHD and proportion of Complex CHD.

Catheter Ablation of Atrial Fibrillation in Adult Congenital Heart Disease: Procedural Characteristics and Outcomes.

The outcomes of catheter ablation for atrial fibrillation in adults with congenital heart disease are not well described. In a retrospective study of adult patients with congenital heart disease who underwent catheter ablation for atrial fibrillation between 2000 and 2020 at Mayo Clinic, procedural characteristics and outcomes were collected. The primary outcomes were atrial arrhythmia (AA) recurrence following a 3-month blanking period and repeat ablation. An arrhythmia clinical severity score was assessed pre- and post-ablation based on the duration of arrhythmia episodes, symptoms, cardioversion frequency, and antiarrhythmic drug use. One hundred forty-five patients (age, 57±12 years; 28% female; 63% paroxysmal atrial fibrillation) underwent 198 ablations with a median follow-up of 26 months (interquartile range, 14-69). One hundred ten, 26, and 9 patients had simple, moderate, and complex congenital heart disease, respectively. All patients underwent pulmonary vein isolation, and non-pulmonary vein targets were ablated in 79 (54%). AA recurrence at 12 months was 37% (95% CI, 29%-45%). On univariate analysis, increasing left atrial volume index was associated with higher odds of AA recurrence (odds ratio, 1.03 [1.00-1.06] per 1 mL/m2 increment; P=0.05). Noninducibility of atrial flutter was predictive of decreased odds of AA recurrence (odds ratio, 0.43 [0.21-0.90]; P=0.03). A second ablation was performed in 43 patients after a median of 20 (interquartile range, 8-37) months. Arrhythmia clinical severity scores improved following ablation, reflecting a decrease in symptoms, cardioversions, and antiarrhythmic drugs. Catheter ablation of atrial fibrillation is feasible and effective in patients with adult congenital heart disease and reduces symptoms. Recurrence of AA frequently requires repeat ablation.

Outcomes of out-of-hospital cardiac arrest in adult congenital heart disease: a Danish nationwide study.

The risk, characteristics, and outcome of out-of-hospital cardiac arrest (OHCA) in patients with congenital heart disease (CHD) remain scarcely investigated. An epidemiological registry-based study was conducted. Using time-dependent Cox regression models fitted with a nested case-control design, hazard ratios (HRs) with 95% confidence intervals of OHCA of presumed cardiac cause (2001-19) associated with simple, moderate, and severe CHD were calculated. Moreover, using multiple logistic regression, we investigated the association between pre-hospital OHCA characteristics and 30-day survival and compared 30-day survival in OHCA patients with and without CHD. Overall, 43 967 cases (105 with simple, 144 with moderate, and 53 with severe CHD) and 219 772 controls (median age 72 years, 68.2% male) were identified. Any type of CHD was found to be associated with higher rates of OHCA compared with the background population [simple CHD: HR 1.37 (1.08-1.70); moderate CHD: HR 1.64 (1.36-1.99); and severe CHD: HR 4.36 (3.01-6.30)]. Pre-hospital cardiopulmonary resuscitation and defibrillation were both associated with improved 30-day survival in patients with CHD, regardless of CHD severity. Among patients with OHCA, simple, moderate, and severe CHD had a similar likelihood of 30-day survival compared with no CHD [odds ratio 0.95 (0.53-1.69), 0.70 (0.43-1.14), and 0.68 (0.33-1.57), respectively]. A higher risk of OHCA was found throughout the spectrum of CHD. Patients with and without CHD showed the same 30-day survival, which relies on the pre-hospital chain of survival, namely cardiopulmonary resuscitation and defibrillation.

Temporal Changes in Clinical Characteristics and Outcomes of Adults With Congenital Heart Disease

The purpose of this study was to assess differences in the clinical characteristics (defined by congenital heart disease [CHD] anatomic and physiologic classification scheme) of adults with CHD across different eras, and how these differences influence outcomes (heart failure hospitalization and all-cause mortality). Patients were divided into depending on year of baseline encounter: cohort #1 (1991-2000, n=1,984 [27%]), cohort #2 (2001-2010, n=2,448 [34%]), and cohort #3 (2011-2020, n=2,847 [39%]). Patients were classified into 3 anatomic groups (simple, moderate, and complex CHD) and 4 physiologic stages (stage A-D). There was a temporal increase in the proportion of patients in physiologic stage C (17% vs 21% vs 24%, P < .001), and stage D (7% vs 8% vs 10%, P=.09), with a corresponding decrease in physiologic stage A (39% vs 35% vs 28%, P < .001). No temporal change in anatomic groups. There was a temporal decrease in the incidence of all-cause mortality (12.7 vs 10.6 vs 9.5 per 1,000 patient-years, P < .001). However, there was a temporal increase in the incidence of heart failure hospitalization (6.8 vs 8.4 vs 11.2 per 1,000 patient-years, P < .001). CHD physiologic stage (but not anatomic groups) was associated with heart failure hospitalization and all-cause mortality. There is a need for better strategies to identify and treat heart failure, and to modify the risk factors associated with heart failure and all-cause mortality.

Positive mindset and exercise capacity in school-aged children and adolescents with congenital heart disease.

Patients with congenital heart disease (CHD) have variable degrees of peak oxygen consumption (VO2) that can be improved with supervised fitness training. The ability to exercise is affected by anatomy, hemodynamics, and motivation. Motivation is in part related to mindset, or personal attitudes and beliefs, and a more positive mindset around exercise has been associated with better outcomes. It is unknown whether variations in measured peak VO2 in patients with CHD are related to having a positive mindset. Patient's ages 8-17 years with CHD were administered quality of life and physical activity questionnaires at the time of their routine cardiopulmonary exercise test. Those with severe hemodynamic burden were excluded. Patients were grouped based on disease classification. Mindset was evaluated via validated questionnaires including a PROMIS Meaning and Purpose (MaP) survey and an Anxiety survey. Pearson correlation coefficients were calculated to estimate the magnitude of the association between percent predicted peak oxygen consumption (pppVO2) and questionnaire scores overall and within CHD subgroups. Eighty-five patients participated; median age was 14.7 years, 53% were female, 66% had complex CHD, 20% had simple CHD, and 14% had single ventricle heart disease. Mean MaP scores were significantly lower in all CHD groups compared to population norms (p < 0.001). As a group, MaP scores were positively associated with the amount of reported physical activity (p = 0.017). In patients with simple CHD, MaP scores were positively associated with pppVO2 (p = 0.015). The association was even stronger for MaP:Anxiety, with worse ratios associated with lower pppVO2 (p = 0.005). Patients with complex and single ventricle CHD did not show a similar association. Patients with CHD, regardless of severity, had lower meaning and purpose scores than the general population, and these scores were associated with amount of reported physical activity. In the simple CHD subset, having a more positive mindset was associated with higher peak VO2 and a more negative mindset with lower peak VO2. This relationship was not seen with more significant CHD. While underlying CHD diagnoses are not modifiable, mindset and peak VO2 are, and consideration should be given to measuring both as each may be a target for intervention.

PO-04-145 ATRIAL FIBRILLATION AND PULMONARY HYPERTENSION IN ADULT CONGENITAL HEART DISEASE

ith the improvement of surgery and perioperative care, the survival of congenital heart disease (CHD) has improved much in recent decades. The long-term complication especially atrial fibrillation (Af) has gained attention. With a large ACHD cohort, we tried to find out the epidemiology data and risk factors of Af in adult CHD patients and see the impact of Af on the late outcome. From 2007 to 2018, all patients older than 18 years of age and diagnosed as CHD in National Taiwan University Hospital were enrolled in our study. The basic clinical characteristics, ECG and Holter result, and follow-up data were collected through the National Taiwan University Hospital-Integrated Medical Database. Atrial fibrillation status was categorized as persistent Af, paroxysmal Af, and atrial flutter (AFL). CHD was categorized as simple, severe, or complex CHD (according to the World Symposia on Pulmonary Hypertension classification). There were 4403 patients (women, 55.9%), 15.4% with severe and 3.9% with complex CHD. The cumulative incidence of Af was 6.9% (54.7% as paroxysmal Af, 26.9% as persistent Af, and 18.4% as AFL). Mean onset age of AFL, paroxysmal Af, and persistent Af was 35.7±15.8, 48.4±19.3, and 57.2±14.3 years-old. The 70-years old cardiovascular accident (CVA) free survival rate was 67.1% in those with Af (vs. 80.7% in those without, p<0.001). The 5 years CVA free survival rate since the onset of Af was low in paroxysmal and persistent Af (71.2% and 72.1%) compared to those of AFL (91.5%, p=0.004). Patients with pulmonary hypertension has significantly higher risk of Af. The multivariable regression model indicated that Af and PAH were most significant risk factors of mortality (odds ratio 2.8 (95% CI 2.0-4.0) and 9.4 (95% CI 6.6-13.2) respectively, both p<0.001). In this large ACHD cohort, the cumulative incidence of Af was high, increasing with age and presence of PH. CVA and Mortality increased with presence of Af.

Congenital heart disease and the risk of impaired fertility: A Danish nationwide cohort study using time to pregnancy

BackgroundThe number of women with congenital heart disease (CHD) becoming pregnant are increasing. Although menstrual irregularities appear to occur more often in these patients, knowledge on their fertility is limited. In this nationwide cohort study, we evaluated the risk of impaired fertility in women with CHD compared with unaffected women using time to pregnancy (TTP). MethodsThe Danish National Birth Cohort (DNBC) of pregnant women constituted the study population. Information on TTP and use of medically assisted reproduction (MAR) treatment was reported at a first trimester interview. Women with CHD were identified by linkage to the Danish National Patient Registry. TTP was divided into three categories; 0–5 months, 6–12 months (i.e. subfertile), and > 12 months or use of MAR treatment (i.e. infertile). Relative risk ratios (RRR) for subfertility and infertility with 95% confidence intervals were estimated using multinomial logistic regression. ResultsAmong 93,832 pregnancies in 84,922 women, CHD was diagnosed in 333 women (0.4%), contributing with 360 pregnancies. The CHD was of simple complexity in 291 women (87.4%). No association was found between CHD and longer TTP (RRR of 1.02 (95% CI: 0.75–1.40) for subfertility, and RRR of 0.86 (95% CI: 0.61–1.20) for infertility). Similar was observed when comparing women with simple CHD and unaffected women. The number of women with complex CHD was too low for evaluation. ConclusionsWomen with CHD had no increased risk of impaired fertility, assessed by TTP, when compared with unaffected women. Separate analysis of women with complex CHD was hampered by low numbers.

Obesity in Pediatric Congenital Heart Disease: The Role of Age, Complexity, and Sociodemographics.

The prevalence of obesity in children with congenital heart disease (CHD) is greater than 25%, putting these patients at-risk for increased surgical morbidity and mortality. Our goal was to determine the association between CHD complexity, sociodemographic factors, and obesity. Our hypothesis was that among CHD patients, the odds of obesity would be highest in older children with simple CHD, and in all children with a lower socioeconomic status. We conducted a retrospective cohort study, reviewing electronic medical records of children aged 2-17years from over 50 outpatient pediatric clinics in Houston, TX. Children were classified as simple or moderate/complex CHD, and obesity was defined by BMI ≥ 95th percentile for age and sex. Logistic regression was used to determine the association between sociodemographic factors and CHD complexity with obesity. We identified 648 CHD and 369,776 non-CHD patients. Children with simple CHD had a similar odds of obesity as non-CHD children. Children with CHD had a higher prevalence of obesity if they were older, male, Black, Hispanic, and publicly insured. Children with moderate/complex CHD had lower odds of obesity [OR 0.24 (95% CI 0.07-0.73)], however their predicted probability of obesity approached that of the general population as they aged. Additionally, there was an incremental relationship with poverty and obesity [1.01 (1.01-1.01)]. Awareness of which patients with CHD are at highest risk of obesity may help in targeting interventions to assist at-risk patients maintain a healthy lifestyle.

POST HOC ANALYSIS ON THE INCIDENCE OF CONGENITAL HEART DISEASE IN BAKU-AZERBAIJAN CALCULATED BY A PROSPECTIVE EPIDEMIOLOGY STUDY

Background: The incidence of Congenital Heart Disease (CHD)in Azerbaijan was firstly published following a prospective study, using Echo-2D as a study method, in 2019.&#x0D; Aim: Of this post hoc analysis of the first ever prospective epidemiology study that calculated incidence and types of CHD in Baku, Azerbaijan, is to verify the forms of diseases that will have and early clinical impact on the patients and the health system of the country.&#x0D; Population-method: From June 2016 to August 2018, 2570, term neonates were screened in 2 major state maternity hospitals in Baku. Their screening was randomized to equal females/males with not known previous obstetric alert regarding CHD. Scanning was done by two teams of pediatric cardiologists by using echo-2D. Each team was ‘blinded’ to the findings of each other. All scans were recorded, and a third senior physician reevaluated them.&#x0D; Results: From 2570 term neonates of the general population, they detected 47 CHD’s. From them, 17 were critical and severe-CHD and 7/47(14.9%) were of moderate complex. 17/47 (36.2%) were cyanotic and 30/47(63.8%) were non-cyanotic. The incidence of simple CHD was 25/47(53.2%). Analysis of the specific anatomy is presented in table1. The estimated incidence was 1.83%. As this incidence has been among the highest reported a post hoc analysis has clarified and presented an important clinical rate of 1.48% after redacting minimal defects without any clinical significance, as minor PDA’s, ASD II, VSD’s. A post hoc calculation of BAov, revealed an anatomical BAov incidence of 1.65% and a functional BAov incidence of 1.4%.&#x0D; Conclusions: This first-ever prospective epidemiology study in Azerbaijan involving a cohort equal to 1.65% of the annual living births of the country, estimated a high incidence of CHD. This is among the highest reported globally. The amount of critical and severe CHD after the post hoc analysis increased from 46.8% to 55.3%. The incidence of cyanotic CHD after the post hoc analysis increased from 36.2% to 42.1%. These high numbers are possibly related to an isolated population and conjugated marriage customs of the country. As this represented a state population health burden a post hoc analysis based on clinical important CHD minimized the calculated index nearby 20%.

School performance is impaired in children with both simple and complex congenital heart disease.

We do not know if children born with a simple or uncorrected congenital heart disease (CHD) have school performance issues and an increased need for special education compared to healthy peers. With this study we examine the school performance and the need for special education in children with both simple and complex CHD. Further, we evaluate if exposure to preeclampsia or smoking affects the need for special education. In this nation-wide population based registry study, we included all Danish children with CHD born 1994-2012. In addition ten age and gender matched control per CHD child were included. Non-singletons and children born with a syndrome were excluded. Exposure was defined as having a CHD and the outcome was defined as needing special education service in the Danish primary and lower secondary school. The population consisted of 7,559 CHD children and 77,046 non-CHD children (controls). CHD children had a higher need for special education compared to non-CHD children, OR: 2.14 (95% CI: 2.00; 2.28), p < 0.001. The odds ratio was also increased when comparing children with a minor CHD to non-CHD children, OR: 1.99 (95% CI: 1.86; 2.14), p < 0.001. CHD children exposed to preeclampsia or smoking had a higher risk of receiving special education compared to unexposed CHD children. We find that school performance is impaired in children born with CHD. This applies to both simple and complex CHD. If a child with CHD was exposed to preeclampsia or maternal smoking this further increased the need for special education.

Strategies to Aid Successful Transition of Adolescents with Congenital Heart Disease: A Systematic Review

The majority of patients born with congenital heart disease (CHD) need lifelong surveillance with serial clinical attendance and examinations. However, loss of follow-up (namely no documented follow-up for 3 years or more) is a recognised common problem since it is often related to remarkable worsening in the health of CHD patients with increased morbidity and mortality. Transitioning from paediatric to adult care has proven to be the most vulnerable point in the care of these subjects. As such, a systematic review was carried out to ask the following questions: What is the percentage of loss of follow-up worldwide? Are there regional fluctuations in the percentage? Is there a link between loss of follow-up and the complexity of CHD? What strategies should be employed to lower the risk of discontinuity in care? The most recent worldwide averaged loss of follow-up is 26.1%, with significant fluctuations across continents and countries. This percentage is even higher (31.9%) when one includes all untraceable patients, presuming that they are not having any cardiac follow-up. The highest discontinuity of care was reported in the USA and in patients with simple CHD. Planning the rules of transition seems to be one of the most reliable tools to minimise the number of CHD patients who are lost in transition. Recalling patients, with general practitioners who are crucial in readdressing half of the lost to follow-up CHD patients to adult CHD specialists, and a good relationship between paediatric cardiologists and the adult CHD team are two other valuable strategies in aiding successful transition.

Transition to adult care of young people with congenital heart disease: impact of a service on knowledge and self-care skills and correlates of a successful transition.

Less than one-third of adolescents with congenital heart disease (CHD) successfully transition to adult care, missing out on education of their cardiac condition, and risking loss to follow-up. We assessed the efficacy of our transition clinic on patient education and empowerment and identified correlates of successful transition. Overall, 592 patients were seen at least once in our transition service between 2015 and 2022 (age 15.2±1.8 years, 47.5% female). Most adolescents (53%) had moderate CHD, followed by simple (27.9%) and severe (19.1%) CHD. Learning disability (LD) was present in 18.9% and physical disability (PD) in 4.7%. In patients without LD, knowledge of their cardiac condition improved significantly from the first to the second visit (naming their condition: from 20 to 52.3%, P<0.0001; describing: 14.4-42.7%, P<0.0001; understanding: 26.1-60.7%, P<0.0001), and from the second to the third (naming: 67.4%, P=0.004, describing: 61.4%, P<0.001, understanding: 71.1%, P=0.02;). Patients with LD did not improve their disease knowledge over time (all P>0.05). Treatment adherence and management involvement, self-reported anxiety, and dental care awareness did not change over time. Successful transition (attendance of≥2 clinics) was achieved in 49.3%. Younger age at the first visit, simpler CHD, and absence of PD were associated with successful transition. A transition service positively impacts on patient education and empowerment in most CHD adolescents transitioning to adult care. Strategies to promote a tailored support for patients with LD should be sought, and earlier engagement should be encouraged to minimize follow-up losses.

Congenital Heart Disease and Fertility: A Danish Nationwide Cohort Study Including Both Men and Women.

Background Despite an increasing number of patients with congenital heart disease (CHD) reaching reproductive age, the fertility of these patients remains undescribed. Therefore, the aim of the study was to evaluate the fertility in men and women with CHD by estimating the risk of infertility and comparing the birth rates, proportions of individuals becoming parents or remaining childless, and the number of children per parent with unaffected individuals. Methods and Results The study population consisted of individuals born between 1977 and 2000. Information on CHD, infertility, and live born children were obtained from the Danish health registries. Hazard ratios for infertility were analyzed using a Cox regression model. Differences of proportions and birth rates were calculated and compared between groups. Among 1 385 895 individuals, a total of 8679 (0.6%) were diagnosed with CHD. Men and women with simple or moderate CHD had no increased risk of infertility when compared with the reference population. Estimates for complex CHD groups were too imprecise for evaluation. Individuals with CHD were more often childless with consequently lower birth rates compared with unaffected individuals. However, those becoming parents had the same number of children as the reference population. Conclusions Men and women with simple or moderate CHD had the same risk of infertility as the reference population. Despite patients with CHD more often being childless, those becoming parents had the same number of children as parents without CHD. The current findings increase the knowledge regarding fertility in the CHD population.

Adults with CHD balancing motivations and concerns in pregnancy decision-making.

While the incidence of pregnancy has increased among individuals with adult CHD, little has been described about considerations and experiences of patients with adult CHD regarding pregnancy. We aimed to explore patients' motivations, concerns, and decision-making processes regarding pregnancy. In April 2019-January 2020, we conducted in-depth telephone interviews with patients (n = 25) with simple, moderate, or complex adult CHD, who received prenatal care at the University of Washington during 2010-2019 and experienced a live birth. Transcripts were analysed using thematic analysis. Participants described motivations for pregnancy as both internal desires (motherhood, marriage fulfillment, biological connection, fetal personhood, self-efficacy) and external drivers (family or community), as well as concerns for the health and survival of themselves and the fetus. Factors that enabled their decision to maintain a pregnancy included having a desire that outweighed their perceived risk, using available data to guide their decision, planning for contingencies and knowing their beliefs about termination, plus having a trusted healthcare team, social support, and resources. Factors that led to insurmountable risk in subsequent pregnancies included desire having been fulfilled by the first pregnancy, compounding risk with age and additional pregnancies, new responsibility to an existing child, and reduced healthcare team and social support. Understanding individuals' motivations and concerns, and how they weigh their decisions to become or remain pregnant, can help clinicians better support patients with adult CHD considering pregnancy. Clinician education on patient experiences is warranted.

Neonatal Outcomes in Pregnant Women With Repaired and Unrepaired Congenital Heart Disease in Zhejiang, China

To compare the neonatal outcomes in pregnant women with repaired vs unrepaired congenital heart disease (CHD). Data on pregnant women with CHD was retrieved from our hospital records for the duration April, 2014 to December, 2021. Pregnant women with CHD were divided into two groups: simple CHD and moderate-to-complex CHD. In simple CHD group, neonatal outcomes were similar in pregnant women with repaired and unrepaired CHD. By contrast, in moderate-to-complex CHD group, the offspring of women with unrepaired CHD had lower gestational age [mean (SD) 34.3 (2.7) vs 36.8 (2.1) week; P=0.016] and lower birth weight [mean (SD) 2126.8 (711.9) vs 2720 (645.7); P=0.037] than those with repaired CHD. Infants of women with unrepaired moderate-to-complex CHD had a higher risk of premature delivery (87.5% vs 45.5%, P=0.013), low birth weight (81.3% vs 36.4%, P=0.04) and neonatal intensive care unit (NICU) admission (68.8% vs 27.3%, P=0.034). Surgical repair before pregnancy in women with moderate-to-complex CHD significantly minimized the risks of neonatal complications.

Multicentre experience with Optimus balloon-expandable cobalt–chromium stents in congenital heart disease interventions

ObjectivesTo evaluate bare-metal Optimus and polytetrafluoroethylene (PTFE)-covered Optimus-CVS balloon-expandable, cobalt–chromium, hybrid cell–designed stents in congenital heart disease (CHD) interventions.MethodsRetrospective multicentre review of patients with CHD receiving Optimus stents. Stent mechanical...