Cardiovascular morbidity and mortality in adult patients with repaired aortic coarctation

BACKGROUND: The long‐term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been elucidated. We aimed to determine the incidence of and risk factors for cardiovascular events in adult patients with repaired CoA. Additionally, mortality rates were compared between adults with repaired CoA and the general population. METHODS AND RESULTS: Using the Dutch Congenital Corvitia (CONCOR) registry, patients aged ≥16 years with previous surgical or transcatheter CoA repair from 5 tertiary referral centers were included. Cardiovascular events were recorded, comprising coronary artery disease, stroke/transient ischemic attack, aortic complications, arrhythmias, heart failure hospitalizations, endocarditis, and cardiovascular death. In total, 920 patients (median age, 24 years [range 16–74 years]) were included. After a mean follow‐up of 9.3±5.1 years, 191 patients (21%) experienced at least 1 cardiovascular event. A total of 270 cardiovascular events occurred, of which aortic complications and arrhythmias were most frequent. Older age at initial CoA repair (hazard ratio [HR], 1.017; 95% CI, 1.000–1.033 [P=0.048]) and elevated left ventricular mass index (HR, 1.009; 95% CI, 1.005–1.013 [P<0.001]) were independently associated with an increased risk of cardiovascular events. The mortality rate was 3.3 times higher than expected based on an age‐ and sex‐matched cohort from the Dutch general population (standardized mortality ratio, 3.3; 95% CI, 2.3–4.4 [P<0.001]). CONCLUSIONS: This large, prospective cohort of adults with repaired CoA showed a high burden of cardiovascular events, particularly aortic complications and arrhythmias, during long‐term follow‐up. Older age at initial CoA repair and elevated left ventricular mass index were independent risk factors for the occurrence of cardiovascular events. Mortality was 3.3‐fold higher compared with the general population. These results advocate stringent follow‐up after CoA repair and emphasize the need for improved preventive strategies

Residual signs in severe Guillain-Barré syndrome:analysis of 57 patients

The residual signs in a group of seriously paralyzed Guillain-Barre patients are reported (follow-up 2-24 years) and the social effects of the illness are discussed. Thirty-five percent of the patients had recovered completely at the time of the follow-up examination, 35% had minimal residual motor signs and 30% had a moderate or severe residual paresis. The most serious residua were found distally in the legs. Muscles innervated by nerves running along an entrapment site had the most severe deficits. Sensory signs were present in 49% of the patients. More than half of the patients considered themselves to be cured. The others were more or less handicapped by their sequelae. Of the adults, 60% resumed work, 25% found a less demanding job and 15% did not return to work. Statistically significant correlations were found between the degree of residual motor deficit and the severity of the weakness in the acute phase, the duration of the plateau phase or the duration of the artificial ventilation

Oordelen en argumenteren

Bij het doen van beoordelingen in het kader van de WAO moest onder meer worden aangegeven wat een cliënt in theorie nog kan verdienen in gangbare arbeid. Daartoe wordt gebruik gemaakt van een systeem van matching van mogelijkheden en beperkingen van cliënt met vereisten van arbeidssituaties. Dat systeem was jarenlang het zogeheten FIS (Functie Informatiesysteem) en per 1-1-2002 moest dat vervangen zijn door het CBBS (Claimbeoordelings- en Borgingssysteem). De vraag daarbij was hoe je bereikt dat gelijke gevallen gelijk beoordeeld worden. Het moet leiden tot een serie voorbeelden van voorkomende situaties en voorschriften van hoe in die situaties het oordeel zou moeten zijn. TNO Arbeid heeft met een aantal experts gewerkt aan het opstellen van genormeerde beoordelingen van casuïstiek. Dit rapport is een weerslag van het tot standkomen hiervan en de resultaten