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  • Cambridge University Press (CUP)  (27)
  • Berger, Felix  (27)
  • 1
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    Quantification of morphologic and hemodynamic severity of coarctation of the aorta by magnetic resonance imaging
    Cambridge University Press (CUP) ; 2001
    In:  Cardiology in the Young Vol. 11, No. 5 ( 2001-09), p. 512-520
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 11, No. 5 ( 2001-09), p. 512-520
    Abstract: Objective: As the morpholgic severity of coarctation of the aorta is difficult to assess, especially after previous repair, the value of the technique of multiplanar reconstruction of magnetic resonance imaging data to achieve a 3-dimensional reconstruction of the aortic arch was evaluated and compared to hemodynamic measurements. Methods and Results: We performed 30 examinations in 27 patients aged from 6 to 54 years, with a mean of 21 years, by magnetic resonance imaging using a 1.5 Tesla scanner with a standard body coil. Measurements of flow across the coarctation were performed using phase! shift velocity mapping, and peak velocity was calculated at the site of stenosis. Aortic cross-sectional area before, at, and beyond the stenosis was reconstructed 3-dimensionally to calculate a percentage degree of stenosis. Morphologic severity of stenosis was correlated to invasively assessed hemodynamic gradients and morphologic data from biplane angiography in 23 patients. Among the 30 examinations, 24 patients had been previously treated by either surgery, in 17 patients, or balloon dilation, while 6 had native coarctation. 3-dimensional reconstruction was possible in all and better delineated the anatomy concerning the hemodynamic relevance of stenoses even as compared with biplane angiography. The correlation between severity of narrowing assessed by diameter measurements in the biplane angiography and 2-dimensional magnetic resonance imaging was r = 0.94, and multiplanar reformation with 2-dimensional magnetic resonance imaging was r = 0.87 with a tendency of higher grading with the 3-dimensional technique (p = 0.0001). The correlation of 2-dimensional magnetic resonance imaging with invasively measured hemodynamic gradients was r = 0.67 versus r = 0.74 for the areas assessed by multiplanar reformation, indicating that the hemodynamic relevance of a morphological approach to evaluate the degree of a stenosis should better be assessed 3-dimensionally. Conclusions: The 3-dimensional reconstruction of the morphologic severity of coarctation offers additonal information over conventional imaging especially in patients with kinking, complex geometry, or collaterals,in whom hemodynamic measurements can become unreliable.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951101000749
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2001
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  • 2
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    Cardiac MRI in patients with complex CHD following primary or secondary implantation of MRI-conditional pacemaker system
    Cambridge University Press (CUP) ; 2016
    In:  Cardiology in the Young Vol. 26, No. 2 ( 2016-02), p. 306-314
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    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 26, No. 2 ( 2016-02), p. 306-314
    Abstract: In patients with CHD, cardiac MRI is often indicated for functional and anatomical assessment. With the recent introduction of MRI-conditional pacemaker systems, cardiac MRI has become accessible for patients with pacemakers. The present clinical study aims to evaluate safety, susceptibility artefacts, and image reading of cardiac MRI in patients with CHD and MRI-conditional pacemaker systems. Material and methods CHD patients with MRI-conditional pacemaker systems and a clinical need for cardiac MRI were examined with a 1.5-T MRI system. Lead function was tested before and after MRI. Artefacts and image readings were evaluated using a four-point grading scale. Results A total of nine patients with CHD (mean age 34.0 years, range 19.5–53.6 years) received a total of 11 cardiac MRI examinations. Owing to clinical indications, seven patients had previously been converted from conventional to MRI-conditional pacemaker systems. All MRI examinations were completed without adverse effects. Device testing immediately after MRI and at follow-up showed no alteration of pacemaker device and lead function. Clinical questions could be addressed and answered in all patients. Conclusion Cardiac MRI can be performed safely with high certainty of diagnosis in CHD patients with MRI-conditional pacemaker systems. In case of clinically indicated lead and box changing, CHD patients with non-MRI-conditional pacemaker systems should be considered for complete conversion to MRI-conditional systems.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951115000190
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2016
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  • 3
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    ENNOBLE-ATE trial: an open-label, randomised, multi-centre, observational study of edoxaban for children with cardiac diseases at risk of thromboembolism
    Cambridge University Press (CUP) ; 2021
    In:  Cardiology in the Young Vol. 31, No. 8 ( 2021-08), p. 1213-1219
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    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 31, No. 8 ( 2021-08), p. 1213-1219
    Abstract: Children with cardiac diseases suffer from significant morbidity and mortality secondary to thromboembolic complications. Anticoagulant agents currently used for thromboprophylaxis have many limitations, including subcutaneous administration (low molecular weight heparins) and requirement for frequent monitoring via venipuncture (vitamin K antagonists). Edoxaban is an oral direct factor Xa inhibitor without need of monitoring. In the treatment of venous thromboembolism in adults, edoxaban has shown to be effective and safe. This manuscript summarises the rationale and design of a phase 3, open-label, randomised controlled trial to evaluate and compare the safety and efficacy of edoxaban against standard of care (namely, vitamin K antagonist and low molecular weight heparin) in children with cardiac diseases. A goal of 150 children with cardiac diseases at risk of thromboembolic complications who need primary or secondary anticoagulant prophylaxis will be recruited. Eligible children between 6 months and 〈 18 years of age will be randomised in a ratio of 2 to 1 for edoxaban versus standard of care. Randomisation will be stratified based on underlying cardiac disease and concomitant use of aspirin for patients other than Kawasaki disease. The primary outcome will be safety, comprised of major and clinically relevant non-major bleeding in first 3 months of treatment. Bleeding beyond 3 months, symptomatic and asymptomatic thromboembolic events, and pharmacokinetic and pharmacodynamic parameters will be evaluated as secondary outcomes. Randomised controlled anticoagulation trials are challenging in children. This study will evaluate a potentially valuable alternative of oral anticoagulant prophylactic use in children with cardiac diseases.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951121002523
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2021
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  • 4
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    Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer ™ Septal Occluder
    Cambridge University Press (CUP) ; 1999
    In:  Cardiology in the Young Vol. 9, No. 5 ( 1999-09), p. 468-473
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 9, No. 5 ( 1999-09), p. 468-473
    Abstract: To judge whether an Amplatzer™ Septal Occluder can be used as standard therapy instead of surgery for closure of atrial septal defects we report our experiences in 200 patients. Of these patients, 127 had an atrial septal defect with haemodynamically significant left-to-right shunt, 68 patients a persistent oval foramen after presumed paradoxical embolism, and 5 had a fenestration after Fontan-repair. Mean age was 29.8 years (0.8 to 77.7 years). Body weight ranged from 6.9 to 120.0 kg (mean 51.5 kg). After diagnostic cardiac catheterization, and balloon-sizing of the defect, we implanted Amplatzer™ Septal Occluders with stents of 4 to 28 mm diameter. Follow-up studies were obtained after 48hours, and one, six, and twelve months. Transcatheter closure of the atrial septal defect proved successful in all without any relevant residual shunts. In particular, complete closure was achieved in all patients after presumed paradoxical embolism. The mean period of follow-up is 9–5 months, with a range from 0.4 to 23.5 months, giving a total of 1898 patient months. The occlusion rate after three month was 98.1°. A trivial haemodynamically insignificant residual shunt remained in 1.9° of the patients. Fluoroscopy times ranged from 0 to 43.5 minutes, with a median of 8.7 minutes. The excellent results in the short and medium term in children and adults have resulted in using this device routinely at the present time for closure of central atrial septal defects up to a diameter of 28 mm. Final judgement, however, is only possible after long-term follow-up.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951100005369
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 1999
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  • 5
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    Vascular endothelial growth factor and its soluble receptor in infants with congenital cardiac disease
    Cambridge University Press (CUP) ; 2010
    In:  Cardiology in the Young Vol. 20, No. 05 ( 2010-10), p. 505-508
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 20, No. 05 ( 2010-10), p. 505-508
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951110000545
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2010
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  • 6
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    Feasibility of customised unipolar conversion using bipolar temporary pacing wires in patients after surgical repair of congenital heart disease
    Cambridge University Press (CUP) ; 2014
    In:  Cardiology in the Young Vol. 24, No. 4 ( 2014-08), p. 610-615
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 24, No. 4 ( 2014-08), p. 610-615
    Abstract: Objective: Temporary pacing wires play a crucial role in the diagnosis and therapy of post-operative arrhythmia after surgery for congenital heart disease. At present, bipolar pacing wires are used in most institutions. In case of functional failure of these wires, a unipolar mode of stimulation and sensing should be theoretically possible as a rescue procedure. Methods: We tested the feasibility of the customised unipolar mode in 18 post-operative patients with congenital heart disease (age 9.2 ± 13.9 months, weight 6.3 ± 3.8 kg, and cardiopulmonary bypass time 70 ± 29 minutes). As there are two possible unipolar configurations, there are twice the number of testing parameters; of those, we compared sensing (mV) and pacing thresholds (V at 0.5 ms). Results: Atrial sensing was significantly better in the unipolar modes (p 〈 0.001, p 〈 0.003). The ventricular unipolar sensing did not differ significantly in the “better” of the two possible configurations from the bipolar values (p = 0.363). For the unipolar pacing thresholds, only the “better” unipolar configuration did not differ significantly from the bipolar measurements (atrial: p = 0.058, ventricular: p = 0.138). There was no exit block or undersensing. Conclusion: The results demonstrate that unipolar stimulation and sensing using bipolar epicardial temporary pacing wires is feasible. In the case of failure of bipolar temporary pacing wires, this modality represents an easy rescue measure that in such cases should always be considered.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951113000802
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2014
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  • 7
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    Educational level and employment status in adults with congenital heart disease
    Cambridge University Press (CUP) ; 2018
    In:  Cardiology in the Young Vol. 28, No. 1 ( 2018-01), p. 32-38
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    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 28, No. 1 ( 2018-01), p. 32-38
    Abstract: Through this study we aimed to assess the educational level and employment status of adults with CHD in Germany. Methods Data were acquired from an online survey carried out in 2015 by the German National Register for Congenital Heart Defects. A total of 1458 adults with CHD participated in the survey (response rate: 37.6%). For 1198 participants, detailed medical information, such as main cardiac diagnosis and information from medical reports, was available. Results Of the participants surveyed (n=1198), 54.5% (n=653) were female, and the mean age was 30 years. The majority of respondents (59.4%) stated that they had high education levels and that they were currently employed (51.1%). Patients with simple CHD had significantly higher levels of education (p 〈 0.001) and were more likely to be employed (p=0.01) than were patients with complex CHD. Conclusions More than half of the participants had high education levels and the majority were employed. The association between CHD and its severity and individuals’ educational attainment should be investigated more closely in future studies.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S104795111700138X
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2018
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  • 8
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    Treatment of atrial septal defects in symptomatic children aged less than 2 years of age using the Amplatzer septal occluder
    Cambridge University Press (CUP) ; 2000
    In:  Cardiology in the Young Vol. 10, No. 5 ( 2000-09), p. 534-537
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    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 10, No. 5 ( 2000-09), p. 534-537
    Abstract: To assess results of closure of atrial septal defects within the oval fossa by devices delivered by catheterisation in symptomatic infants and children under 2 years of age. Methods and results The Amplatzer septal occluder was used. Results, and complications of transcatheter device treatment in patients aged below 2 years were compared to previous results from our institution. Patients We attempted closure in 12 consecutive patients below the age of 2 years who presented with an atrial septal defect between May 1997 and 1999. Symptoms were failure to thrive in 6, frequent chest infections in 5, and the need for treatment of heart failure in the other. All were thought to have a defect suitable for interventional closure. The atrial defects were seen in isolation in 10 children, but 2 had associated pulmonary stenosis which had been treated by balloon dilation prior to placement of the Amplatzer occluder. Results The Amplatzer septal occluder was implanted at a mean age of 1.4 ± 0.4, with a range from 0.8 to 1.8 years. Ratios of pulmonaryto-systemic flow had been 2.1 ± 0.5, with a range from 1.6 and 3.2, and the defect was measured at 12 ± 4 mms. Fluoroscopy time was 12.8 ± 10.2 minutes, with a range from 5 to 43 minutes, and the time of the overall procedure was 162 ± 70 minutes, with a range from 85 to 360 minutes. It proved necessary to remove the device in 2 patients (16%) because of a residual shunt and movement after release. One of these developed transient neurological complications. Both subsequently underwent surgical treatment. Conclusion Symptomatic patients less than 2 years of age can undergo successful closure of an atrial septal defect using the Amplatzer device, but the rates of success are less, and procedure time longer, than in older children or adults.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951100008234
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2000
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  • 9
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    Treatment strategies for protein-losing enteropathy in Fontan-palliated patients
    Cambridge University Press (CUP) ; 2020
    In:  Cardiology in the Young Vol. 30, No. 5 ( 2020-05), p. 698-709
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    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 30, No. 5 ( 2020-05), p. 698-709
    Abstract: Protein-losing enteropathy is an infrequent but severe condition occurring after Fontan procedure. The multifactorial pathogenesis remains unclear and no single proposed treatment strategy has proven universally successful. Therefore, we sought to describe different treatment strategies and their effect on clinical outcome and mortality. Material and Methods: We performed a retrospective observational study. From the total cohort of 439 Fontan patients treated in our institution during the study period 1986–2019, 30 patients (6.8%) with protein-losing enteropathy were identified. Perioperative, clinical, echocardiographic, laboratory, and invasive haemodynamic findings and treatment details were analysed. Results: Median follow-up after disease onset was 13.1 years [interquartile range 10.6]. Twenty-five patients received surgical or interventional treatment for haemodynamic restrictions. Medical treatment, predominantly pulmonary vasodilator and/or systemic anti-inflammatory therapy with budesonide, was initiated in 28 patients. In 15 patients, a stable remission could be achieved by medical or surgical procedures (n = 3 each), by combined multimodal therapy (n = 8), or ultimately by cardiac transplantation (n = 1). Phrenic palsy, bradyarrhythmia, Fontan pathway stenosis, and absence of a fenestration were significantly associated with development of protein-losing enteropathy (p = 0.001–0.48). Ten patients (33.3%) died during follow-up; 5-year survival estimate was 96.1%. In unadjusted analysis, medical therapy with budesonide and pulmonary vasodilator therapy in combination was associated with improved survival. Conclusions: Protein-losing enteropathy is a serious condition limiting survival after the Fontan procedure. Comprehensive assessment and individual treatment strategies are mandatory to achieve best possible outcome. Nevertheless, relapse is frequent and long-term mortality substantial. Cardiac transplantation should be considered early as treatment option.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951120000864
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2020
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  • 10
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    Mature and immature platelets during the first week after birth and incidence of patent ductus arteriosus
    Cambridge University Press (CUP) ; 2020
    In:  Cardiology in the Young Vol. 30, No. 6 ( 2020-06), p. 769-773
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    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 30, No. 6 ( 2020-06), p. 769-773
    Abstract: Thrombocytopenia is a risk factor for patent ductus arteriosus. Immature and mature platelets exhibit distinct haemostatic properties; however, whether platelet maturity plays a role in postnatal, ductus arteriosus closure is unknown. Methods: In this observational study, counts of immature and mature platelets (=total platelet count − immature platelet count) were assessed on days 1, 3, and 7 of life in very low birth weight infants ( 〈 1500 g birth weight). We performed echocardiographic screening for haemodynamically significant patent ductus arteriosus on day 7. Results: Counts of mature platelets did not differ on day 1 in infants with (n = 24) and without (n = 45) haemodynamically significant patent ductus arteriosus, while infants with significant patent ductus arteriosus exhibited lower counts of mature platelet on postnatal days 3 and 7. Relative counts of immature platelets (fraction, in %) were higher in infants with patent ductus arteriosus on day 7 but not on days 1 and 3. Receiver operating characteristic curve analysis unraveled associations between both lower mature platelet counts and higher immature platelet fraction (percentage) values on days 3 and 7, with haemodynamically significant ductus arteriosus. Logistic regression analysis revealed that mature platelet counts, but not immature platelet fraction values, were independent predictors of haemodynamically significant patent ductus arteriosus. Conclusion: During the first week of postnatal life, lower counts of mature platelets and higher immature platelet fraction values are associated with haemodynamically significant patent ductus arteriosus. Lower counts of mature platelet were found to be independent predictors of haemodynamically significant patent ductus arteriosus.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951120000943
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2020
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