Webinar: Congenital Heart Disease – What Patients Need to Know

Fri, Feb 13, 2015
12:00pm to 1:00pm ET

Description

During this one-hour interactive Q&A, Dr. Joseph Dearani and Dr. Carole Warnes provide an overview of congenital heart disease, including transition of care into adulthood, pregnancy, surgical risks, valve repair or replacement, innovation, and lifelong follow-up. A question and answer period followed the presentation.

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Online

@bezel

You said a few words about Ebstein’s anomaly and it was quite helpful. My friends will be soon having a child with TGA – could focus at this condition for a moment? How do you manage these patients – do you perform Rashkind operation often and when is it performed – do you wait until jaundice passes? And regarding child with TGA and his development, is there part something in particular we should remember? What is your follow-up of adult patients with TGA correctec after birth, most common limitations? Thank you in advance nad greetings from Poland.

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Hi Alex,

We separated your post into three questions for Dr. Dearani to answer. His responses are below:

Q: How do you manage these patients – do you perform Rashkind operation often and when is it performed – do you wait until jaundice passes?
A: These patients undergo the arterial switch procedure in the first two weeks of life. Risk of surgery is low in experienced hands. A balloon septostomy is performed if the atrial septal defect is small right after birth to stabilize the situation until the switch can be performed.

Q: And regarding child with TGA and his development, is there part something in particular we should remember?
A: Results with surgery are generally excellent when this is straightforward transposition. Development should be normal.

Q: What is your follow-up of adult patients with TGA corrected after birth, most common limitations?
A: Late results are generally excellent. There can be coronary problems but these are usually identified before adulthood. Some can develop an aneurysm by early adulthood – surgery is usually effective if it occurs. Finally, they can develop pulmonary valve problems that may need intervention in childhood or adulthood.

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@khenry55904

9 month old diagnosed with TAPVR, surgery done but now has artery narrowing, will be having surgery at the end of the month in Boston to open the narrowed artery. What is the probability of an occlusion or re-narrowing after a TAPVR reversion?

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From Dr. Joseph Dearani: It sounds like the problem is pulmonary vein stenosis. This can be a difficult problem. There are some surgical procedures that can be very effective in relieving the problem. However, there can also be recurrences. Boston is quite experienced and will be able to comment on these questions more specifically around the time of surgery.

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@kwittich

Do you have an opinion about whether the Fontan should be delayed as long as tolerated post Glenn to delay the “clock” on the inevitable end-organ complications or done as early as possible to improve oxygen saturation as soon as possible? In particular, what differences are seen if Fontan is done at 2 vs. 4 or 5?

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From Dr. Joseph Dearani: I think anytime between 2 and 4 years of age is ideal. The oxygen saturation is usually the driver in terms of timing. Most like the extra-cardiac conduit technique so doing it closer to 3-4 usually allows an adult size tube graft to be utilized.

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@judytru

My daughter was born with coarctation of the aorta and aortic stenosis. She is now 26 years old. At 3 months, correction of the coarc as well as an aortic valve repair was done by Dr. Perryman at Jackson Memorial Hosp. in Miami, FL. At age 10, a Ross Procedure was performed by Dr. Redmond Burke at Miami Children’s Hosp. One year ago, another valve repair was done by Dr. Bleiweiss at Shands, University of Florida at Gainesville. She is now experiencing moderate to severe leakage and is quite possibly looking at either another valve repair or possible replacement. My question is, is there anywhere in the country where it is possible to have either a valve repair or replacement done arthroscopically, without having to open the chest cavity? Is anyone doing this practice yet?

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From Dr. Joseph Dearani: It is not clear to me what valves are dysfunctional right now. In general, this is a complex situation and probably an open procedure will be necessary. With that said, there are some problems that can be managed with a catheter valve. The data would need to be reviewed to know for sure. If you are interested in further discussing, please call 507-255-2034.

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@eileenfrances

Is there a limit to the amount of homografts you can receive in a lifetime, or is it more dangerous the more you have? My 29yo son (DORV, Taussig Bing anomaly) is due for 3rd pulmonary homograft. Has had 6 OHS so far. Thank you for the nice comment about families!

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From Dr. Joseph Dearani: While there is no limit per se, the risk generally goes up quite a bit when you are at the 5th sternotomy and beyond. It depends what valve(s) need attention and what the function of the heart is.

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@jbell22

I am a 54 year old female who has just been diagnosed with a right-sided aorta and Kommerelis Diverticulum. I have been a very high functioning athletic woman but now cannot do very much. My symptoms are breathlessness, body tingling, serious voice issues, hot flashes(could be my age) and chest pain (among a few other symptoms). I live on Vancouver Island, BC. What options do you see for me?

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From Dr. Joseph Dearani: Surgery is usually recommended for this, particularly if there is an aneurysm at the base of the duct of K. Imaging needs to be reviewed to know what would be best. Risk of surgery is low and results are very good.

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@jbell22

I am a 54 year old female who has just been diagnosed with a right-sided aorta and Kommerelis Diverticulum. I have been a very high functioning athletic woman but now cannot do very much. My symptoms are breathlessness, body tingling, serious voice issues, hot flashes(could be my age) and chest pain (among a few other symptoms). I live on Vancouver Island, BC. What options do you see for me?

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Thank you very much for your response.  I have been referred to the Pacific Adult Congenitive Heart Disorder Clinic at St. Paul’s Hospital and I appreciate your heads up about the possibility of surgery.  As per your webinar, I have learned the difficulty of dealing with cardiologists/surgeons that are not familiar with congenital issues. Thank you again,
Jackie

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