Adequacy of Cancer Screening in Adult Women with Congenital Heart Disease

Adults with congenital heart disease (ACHD) face noncardiac healthcare challenges as the population ages. We assessed whether women with ACHD have comparable cancer screening rates to non-ACHD women in a cardiac practice and to the general population. We performed a retrospective review of 175 adult women seen in a cardiac care center in 2009–2011. Data on Pap tests, mammography, and colonoscopies, were collected through electronic medical records and primary care provider records. Adequate documentation was available for 100 individuals with ACHD and 40 comparator cardiac patients. The adequacy of screening was determined using guidelines set forth by the American Cancer Society in 2010. Compared with the national average, ACHD patients had significantly lower rates of Pap tests (60% versus 83%, P < 0.001) and mammography (48% versus 72%, P < 0.001). Compared with non-ACHD women in the same practice, ACHD patients had consistently lower rates of mammography (48% versus 81%, P = 0.02) and colonoscopies (54% versus 82%, P = 0.23). As the population of ACHD individuals ages, attention to cancer screening becomes increasingly important but may be overlooked in this population. Primary care physicians and cardiologists should collaborate to ensure appropriate cancer screening for this growing population

Remodeling and thrombosis following closure of coronary artery fistula with review of management

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98782/1/ccd24699.pd

Single stage repair of a complex pathology: end stage ischaemic cardiomyopathy, ascending aortic aneurysm and thoracic coarctation

The not uncommon combination of ascending aortic pathology with late presenting coarctation is a difficult surgical challenge. The two stage approach is usually adopted. The necessity for cardiac transplantation adds to the complexity: a trans-sternal approach and single stage repair become mandatory

Doppler findings in a rare Coronary Artery Fistula

One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF). It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD) artery to the left ventricular (LV) apex. Associated cardiac abnormalities were found: a ventricular septal defect (diameter 4 mm), a patent foramen ovale as well as trivial tricuspid and mitral regurgitation. Here we demonstrate the echocardiograms of an extremely rare form of CAF diagnosed within the first days of postnatal life

Severe Aortic Coarctation in a 75-Year-Old Woman: Total Simultaneous Repair of Aortic Coarctation and Severe Aortic Stenosis

Aortic coarctation is usually diagnosed and repaired in childhood and early adulthood. Survival of a patient with an uncorrected coarctation to more than 70 years of age is extremely unusual, and management strategies for these cases remain controversial. We present a case of a 75-year-old woman who was first diagnosed with aortic coarctation and severe aortic valve stenosis 5 years ago and who underwent a successful one-stage repair involving valve replacement and insertion of an extra-anatomical bypass graft from the ascending to the descending aorta

Two stage hybrid approach for complex aortic coarctation repair

<p>Abstract</p> <p>Background</p> <p>Management of an adult patient with aortic coarctation and an associated cardiac pathology poses a great surgical challenge since there are no standard guidelines for the therapy of such complex pathology. Debate exists not only on which lesion should be corrected first, but also upon the type and timing of the procedure. Surgery can be one- or two-staged. Both of these strategies are accomplice with elevate morbidity and mortality.</p> <p>Case report</p> <p>In the face of such an extended surgical approach, balloon dilatation seems preferable for treatment of severe aortic coarctation.</p> <p>We present an adult male patient with aortic coarctation combined with ascending aorta aneurysm and concomitant aortic valve regurgitation. The aortic coarctation was corrected first, using percutaneous balloon dilatation; and in a second stage the aortic regurgitation and ascending aorta aneurysm was treated by Bentall procedure. The patients' postoperative period was uneventful. Three years after the operation he continues to do well.</p

Anomalous Right Coronary Artery From the Left Coronary Sinus With an Interarterial Course: Is It Really Dangerous?

Anomalous origin of the right or left coronary artery from the contralateral sinus of Valsalva is often asymptomatic, but many patients, particularly young ones, present with sudden death or myocardial ischemia without symptoms. The mechanism of sudden death in this entity is unclear and has not been fully evaluated. These anomalies are rare, and many cardiologists and radiologists are unfamiliar with them. Surgical repair is recommended, especially with anomalous origin of the left coronary artery (LCA). However, there is controversy concerning the treatment of anomalous right coronary artery (RCA) with interarterial course due to its relatively high incidence and the fact that it leads to few, if any, clinical problems

Sudden Death in Pediatric Populations

Sudden death (SD) in children is rarer than in adults. In the pediatric population, SD accounts for less than one tenth of deaths from all causes. SD in infants is a separate entity commonly termed "sudden infant death syndrome (SIDS)". Previous studies on SD in pediatric patients primarily focused on infants and showed that the incidence of SIDS was much lower in Asian countries than in Western ones. However, these differences diminished after educational campaigns such as the back to sleep act in the late 1980s to early 1990s. The incidence of SIDS from Western reports has decreased from 2.69 to around 0.5-0.24 per 1,000 live births. Beyond infancy, the annual incidence of SD ranges from 1.3 to 7.5 per 100,000. In 2009, two population-based studies, one from Taiwan and the other from the US, explored the epidemiological profile of SD in children. The child health care indexes of these two countries are similar, but the annual incidence of pediatric SD was 7.5 and 2.7 per 100,000 in the USA and Taiwan, respectively. The implications of ethic-related differences requires further confirmation. Around 40% of pediatric SD could be from cardiac causes, either diagnosed or undiagnosed. Risk stratification for cardiac SD and patient selection for implantable cardioverter-defibrillator (ICD) therapy are recommended. However, the adoption of ICD as primary prevention for SD in children is still a challenging issue. Early detection of undiagnosed cardiac risk may be facilitated by cardiac screening either in newborns or the school-age population to better manage the risk of SD. However, the efficacy of such screening remains still controversial