Heart Failure in Adult Congenital Heart Disease
As the population of adult congenital heart disease patients ages and grows, so too does the burden of heart failure in this population. Despite the advances in medical and surgical therapies over the last decades, heart failure in adult congenital heart disease remains a formidable complication with high morbidity and mortality. This review focuses on the challenges in determining the true burden and management of heart failure in adult congenital heart disease. There is a particular focus on the need for developing a common language for classifying and reporting heart failure in adult congenital heart disease, the clinic...
Source: Cardiology Clinics - July 2, 2020 Category: Cardiology Authors: Luke J. Burchill, Melissa G.Y. Lee, Vidang P. Nguyen, Karen K. Stout Source Type: research

The Adult Patient with a Fontan
The authors summarize the most important anatomic and physiologic substrates of Fontan circulation. Common anatomic substrates include hypoplastic left heart syndrome, tricuspid atresia, double inlet left ventricle, and unbalanced atrioventricular septal defects. After the Fontan operation exercise capacity is limited and the key hemodynamic drivers is limited preload due to a relatively fixed pulmonary vascular resistance. The authors provide contemporary data on survival, morbidity, and need for reintervention. Operative morality is now expected to be less than 1% and 30 year survival approximately 89%. The authors delin...
Source: Cardiology Clinics - July 2, 2020 Category: Cardiology Authors: Ahmed AlZahrani, Rahul Rathod, Ahmed Krimly, Yezan Salam, AlJuhara Thaar AlMarzoog, Gruschen R. Veldtman Source Type: research

Title Page
(Source: Cardiology Clinics)
Source: Cardiology Clinics - July 2, 2020 Category: Cardiology Source Type: research

Copyright
ELSEVIER (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 2, 2020 Category: Cardiology Source Type: research

Contributors
JAMIL A. ABOULHOSN, MD, FACC, FSCAI (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 2, 2020 Category: Cardiology Source Type: research

Contents
Curt J. Daniels (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 2, 2020 Category: Cardiology Source Type: research

Cardiology Clinics
Coronary Artery Disease (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 2, 2020 Category: Cardiology Source Type: research

Psychological Needs, Assessment, and Treatment in the Care of Adults with Congenital Heart Disease
Although the majority of congenital heart disease survivors are thriving, many are at risk for declining emotional well-being as they age. Emotional distress is a risk factor for poorer health outcomes and must be addressed. Primary care and cardiology teams may be the first line of defense in identifying and providing referral resources for symptoms of depression, anxiety, and medical trauma. The current review provides information about commonly used self-report measures of emotional distress to identify symptoms that warrant referral and describes multiple options for addressing these symptoms. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 9, 2020 Category: Cardiology Authors: Jamie L. Jackson, Kristen R. Fox, Adrienne H. Kovacs Source Type: research

Tetralogy of Fallot
Repaired tetralogy of Fallot is one of the most common conditions managed by adult congenital heart disease providers. Recent comprehensive review articles and book chapters are devoted to this topic. The purpose of this article is to address several common clinical questions encountered in the management of patients with repaired tetralogy of Fallot. These answers are not intended to supplant Practice Guidelines. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 9, 2020 Category: Cardiology Authors: Eric V. Krieger, Anne Marie Valente Source Type: research

Adult Congenital Heart Disease —Preparing for the Changing Work Force Demand
This volume is dedicated to advances in the care of adults with congenital heart disease (CHD). In this chapter the authors review the data cornerstone to the growing workforce needs.This first chapter serves as a backdrop to the second chapter that applies these observations to the planning of health care services delivery in the United States accounting for the definition and organization of multisystem expertise and centers for adults with CHD at a health systems level. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 9, 2020 Category: Cardiology Authors: Michelle Gurvitz, George K. Lui, Ariane Marelli Source Type: research

Surgery for Adult Congenital Heart Disease
Technical and medical improvements for congenital cardiac disease in children have contributed to an increasing population of patients who survive into adulthood. These patients may be prone to progression of their native palliated disease or suffer from sequelae of their childhood repair that requires repeat surgical intervention. Surgery for adult congenital cardiac disease poses unique challenges and risks. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 9, 2020 Category: Cardiology Authors: Tracy Geoffrion, Stephanie Fuller Source Type: research

Congenital Heart Disease and Pulmonary Hypertension
This article provides a guide on how to approach the adult with congenital heart disease and suspected PH of different types, including current management. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 8, 2020 Category: Cardiology Authors: Andrew Constantine, Konstantinos Dimopoulos, Alexander R. Opotowsky Source Type: research

Adults with Congenital Heart Disease and Arrhythmia Management
This article attempts to define these problems and review contemporary management for the patient with ACHD presenting with cardiac arrhythmia. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 7, 2020 Category: Cardiology Authors: Jeremy P. Moore, Paul Khairy Source Type: research

Access and Delivery of Adult Congenital Heart Disease Care in the United States
The landscape of congenital heart disease has changed rapidly over the past few decades. The shift from pediatric to adult congenital heart disease care has stretched resources and the ability to provide high-quality access and delivery of care for the more than 1.5 million adults with congenital heart disease in the United States. Meeting the demand for delivering high-quality care requires a team-based approach, with each member highly specialized. This review describes the deficits and deficiencies in providing care for adults with congenital heart disease in the United States and a team-based approach to improving acce...
Source: Cardiology Clinics - June 7, 2020 Category: Cardiology Authors: Susan M. Fernandes, Ariane Marelli, Danielle M. Hile, Curt J. Daniels Source Type: research

Atrial Septal Defect
Atrial septal defects are common congenital heart defects, characterized by insufficient/absent tissue at the interatrial septum. An unrepaired defect may be associated with right heart volume overload, atrial arrhythmia or pulmonary arterial hypertension. The 3 major types of atrial septal defect are: ostium secundum defect, ostium primum defect, and sinus venosus. Characteristic physical findings include a midsystolic pulmonary flow or ejection murmur, accompanied by a fixed split-second heart sound. Small defects may spontaneously close; larger defects may persist and result in hemodynamic and clinical sequelae requirin...
Source: Cardiology Clinics - June 5, 2020 Category: Cardiology Authors: Elisa A. Bradley, Ali N. Zaidi Source Type: research

Ebstein Anomaly in the Adult Patient
Ebstein anomaly is a congenital malformation involving primarily the tricuspid valve, with failure of delamination from the underlying myocardium and right ventricular myopathy. Echocardiography is diagnostic in most patients and demonstrates apical displacement of the septal leaflet and variable tethering of leaflet tissue to the right ventricular myocardium. Operative intervention is considered for exertional symptoms, progressive right ventricular enlargement, or right ventricular dysfunction. Tricuspid valve cone repair is the preferred surgical approach. Tricuspid valve replacement and bidirectional cavopulmonary shun...
Source: Cardiology Clinics - June 5, 2020 Category: Cardiology Authors: Margaret M. Fuchs, Heidi M. Connolly Source Type: research

Transcatheter Interventions in Adult Congenital Heart Disease
This article provides a detailed review of the current practices and future directions of transcatheter interventions in adults with congenital heart disease. This includes indications for intervention, risks, and potential complications, as well as a review of available devices and their performance. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 5, 2020 Category: Cardiology Authors: Jamil Aboulhosn, Ziyad M. Hijazi Source Type: research

Adult Congenital Heart Disease: A Population that Has Come of Age
Over the last several decades, we have witnessed a dramatic shift in the congenital heart disease population from mostly children to now adults by a two-thirds margin. The diverse anatomies and physiologies, surgical procedures, and adult co-morbidities, has created the most unique population in cardiovascular medicine - adults with congenital heart disease (ACHD). Patients with ACHD may develop complex arrhythmias, valvular heart disease, heart failure, pulmonary hypertension and require complex advanced imaging, electrophysiologic, transcatheter, and/or surgical interventions to improve their quality of life. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 5, 2020 Category: Cardiology Authors: Curt J. Daniels Tags: Preface Source Type: research

Aortopathy in Congenital Heart Disease
Aortic dilatation is common in patients with congenital heart disease and is seen in patients with bicuspid aortic valve and those with conotruncal congenital heart defects. It is important to identify patients with bicuspid aortic valve at high risk for aortic dissection. High-risk patients include those with the aortic root phenotype and those with syndromic or familial aortopathies including Marfan syndrome, Loeys-Dietz syndrome, and Turner syndrome. Aortic dilatation is common in patients with conotruncal congenital heart defects and rarely results in aortic dissection. (Source: Cardiology Clinics)
Source: Cardiology Clinics - June 3, 2020 Category: Cardiology Authors: Timothy B. Cotts, Katherine B. Salciccioli, Sara K. Swanson, Anji T. Yetman Source Type: research

Aortic Coarctation
Aortic coarctation is a discrete narrowing of the thoracic aorta. In addition to anatomic obstruction, it can be considered an aortopathy with abnormal vascular properties characterized by stiffness and impaired relaxation. There are surgical and transcatheter techniques to address the obstruction but, despite relief, patients with aortic coarctation are at risk for hypertension, aortic complications, and abnormalities with left ventricular performance. This review covers the etiology, pathophysiology, diagnosis, and management of adults with aortic coarctation, with emphasis on multimodality imaging characteristics and li...
Source: Cardiology Clinics - May 31, 2020 Category: Cardiology Authors: Yuli Y. Kim, Lauren Andrade, Stephen C. Cook Source Type: research

Right Ventricular Failure After Left Ventricular Assist Device
Right ventricular failure after left ventricular assist device (LVAD) implantation remains common in the contemporary, continuous-flow era. Clinically meaningful, reproducible, and consensus definitions of both early and late right ventricular failure after LVAD are needed for progress in advanced heart failure. Right ventricular failure after LVAD implantation and post-LVAD vasoplegia share similar risk factors and physiology. The relative right ventricular failure that accompanies right ventricular vasoplegia can be treated with temporary right ventricular assist device support. (Source: Cardiology Clinics)
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Authors: Rebecca Cogswell, Ranjit John, Andrew Shaffer Source Type: research

Right Heart Failure
This article describes the various causes of right heart disease and its epidemiology. (Source: Cardiology Clinics)
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Authors: Hasan Ashraf, Julie L. Rosenthal Source Type: research

Right Heart Failure in Pulmonary Hypertension
Right heart failure is a major cause of morbidity and mortality in pulmonary hypertension. Its pathophysiology is complex and involves both adaptive and maladaptive patterns of right ventricular change. In addition to the gold standard of right heart catheterization, noninvasive imaging such as echocardiography is useful in diagnosis and risk assessment. Management focuses on optimizing preload, reducing afterload, and supporting the function of the right ventricle with vasopressors and inotropes, if necessary. If required, mechanical support is increasingly used to facilitate recovery or as a bridge to transplant. (Source...
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Authors: Steven Cassady, Gautam V. Ramani Source Type: research

Right Ventricular Failure and Congenital Heart Disease
Survivorship into adulthood of patients with congenital heart disease is due to improvements in prenatal detection, novel surgeries, and specialized adult congenital heart disease care. As patients survive further into adulthood, long-term complications of congenital and repaired physiology have been more clearly elucidated. The overall mortality of patients with adult congenital heart disease with heart failure is around 4%. Congenital malformations, palliations, residual defects, and resultant physiology impact the right ventricle. This relationship influences morbidity and mortality. For this discussion, focus on atrial...
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Authors: Payton Kendsersky, Cary Ward Source Type: research

Right Heart Failure: Underlying Pathophysiology, Causes, Diagnostic, and Treatment Considerations
Right heart failure accounts for significant morbidity and mortality in the world. The list of conditions that cause right ventricular (RV) dysfunction that can progress to significant right heart failure are many, and these causes are often different from the conditions that cause classic, predominantly left-sided heart failure. Solid-organ replacement by heart or heart-lung transplantation and assistance with mechanical devices for those with significant right heart failure are, for many patients, the only options to treat this devastating syndrome. (Source: Cardiology Clinics)
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Authors: Jerry D. Estep, Miriam S. Jacob Tags: Preface Source Type: research

Right Ventricular Function and Failure
CARDIOLOGY CLINICS (Source: Cardiology Clinics)
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Authors: Jerry D. Estep, Miriam S. Jacob Source Type: research

Copyright
ELSEVIER (Source: Cardiology Clinics)
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Source Type: research

Contributors
JAMIL A. ABOULHOSN, MD, FACC, FSCAI (Source: Cardiology Clinics)
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Source Type: research

Contents
Jerry D. Estep and Miriam S. Jacob (Source: Cardiology Clinics)
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Source Type: research

Forthcoming Issues
Adult Congenital Heart Disease (Source: Cardiology Clinics)
Source: Cardiology Clinics - April 11, 2020 Category: Cardiology Source Type: research

Surgical and Percutaneous Interventions for Chronic Thromboembolic Pulmonary Hypertension
The treatment of chronic thromboembolic pulmonary hypertension has expanded considerably. The ability to endarterectomize chronic thromboembolic material, the availability of pulmonary hypertension medical therapy to treat inoperable chronic thromboembolic pulmonary hypertension and/or residual pulmonary hypertension, and the rebirth of pulmonary balloon angioplasty have changed the management landscape. Patient selection requires a multidisciplinary evaluation at an experienced center. What is inoperable chronic thromboembolic pulmonary hypertension to one group may be operable chronic thromboembolic pulmonary hypertensio...
Source: Cardiology Clinics - March 5, 2020 Category: Cardiology Authors: William R. Auger Source Type: research

Pathophysiology of Acute and Chronic Right Heart Failure
This article focuses on the distinct changes in RV structure, mechanics, and function, as well as molecular and inflammatory mediators involved in the pathophysiology of acute and chronic RHF. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 5, 2020 Category: Cardiology Authors: Rajarajan A. Thandavarayan, Kalyan R. Chitturi, Ashrith Guha Source Type: research

The Role of Multimodality Imaging in Right Ventricular Failure
This article outlines the clinically useful applications of multimodality imaging for comprehensive assessment of the right heart and associated structures in the setting of right ventricular failure. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 3, 2020 Category: Cardiology Authors: Tom Kai Ming Wang, Christine Jellis Source Type: research

Right Heart Failure and Cardiorenal Syndrome
Cardiorenal syndrome is a complex interplay of dysregulated heart and kidney interaction that leads to multiorgan system dysfunction, which is not an uncommon occurrence in the setting of right heart failure. The traditional concept of impaired perfusion and forward flow recently has been modified to include the recognition of systemic venous congestion as a contributor, with direct and indirect mechanisms, including elevated renal venous pressure, reduced renal perfusion pressure, increased renal interstitial pressure, tubular dysfunction, splanchnic congestion, and neurohormonal and inflammatory activation. Treatment opt...
Source: Cardiology Clinics - March 2, 2020 Category: Cardiology Authors: Thida Tabucanon, Wai Hong Wilson Tang Source Type: research

Pulmonary Hypertension and Right Ventricular Failure
Pulmonary arterial hypertension is a highly morbid disease with limited treatment options that improve survival and currently the only curative treatment is transplantation. There is a small body of literature comparing the efficacy of lung and heart-lung transplantation in this population. The bulk of evidence suggests that most patients with severe right ventricular failure undergoing transplant will have recovery of right ventricular function after lung transplantation. Existing data suggest that, in the absence of complex congenital heart disease or significant left ventricular dysfunction, double-lung transplant is th...
Source: Cardiology Clinics - February 28, 2020 Category: Cardiology Authors: Jessica H. Huston, Evan L. Brittain, Ivan M. Robbins Source Type: research

Right Heart Failure After Left Ventricular Assist Device Placement
Durable left ventricular assist device therapy is an increasingly accepted surgical therapy for advanced heart failure refractory to guideline-directed medical therapy. Right heart failure is a known and frequent complication after durable left ventricular assist device implantation and remains an important clinical challenge. Medical management of right heart failure after left ventricular assist device therapy focuses on improving right ventricular contractility and optimizing right ventricular preload and afterload. Mechanical circulatory support options include surgical and percutaneous devices options as well as the t...
Source: Cardiology Clinics - February 28, 2020 Category: Cardiology Authors: Francis D. Pagani Source Type: research

Right Heart Failure
This article reviews traditional and gold-standard hemodynamic assessments of the right ventricle in health and disease. (Source: Cardiology Clinics)
Source: Cardiology Clinics - February 19, 2020 Category: Cardiology Authors: Milad C. El Hajj, Michael C. Viray, Ryan J. Tedford Source Type: research

Assessment of Cardiac Damage in Aortic Stenosis
Severe aortic stenosis (AS) causes chronic pressure overload of the left ventricle (LV), resulting in the progressive cardiac damage, which extends beyond the LV. Several previous studies have shown a relationship of the cardiac damage to AS, rather than the stenosis severity, with adverse events after aortic valve replacement (AVR) in patients with severe AS. A new staging system for AS patients has important prognostic implications for clinical outcomes after AVR. This review summarizes the importance of assessment of cardiac damage in patients with AS. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Miho Fukui, Philippe G énéreux, João L. Cavalcante Source Type: research

Assessment of Aortic Stenosis Severity
Severe aortic stenosis (AS) is associated with a progressive cardiac remodeling that ultimately leads to heart failure and death if the valve is not replaced. The confirmation of AS severity is therefore crucial to adequately manage patients with AS. Transthoracic echocardiography is the first-line examination to confirm AS severity, but it may be inconclusive in discordant cases. In this setting, AS severity should be confirmed using a multimodality imaging approach. This review gives an overview of how to assess and/or confirm AS severity, especially in case of discordance. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Julien Ternacle, Marie-Annick Clavel Source Type: research

Biomarkers Associated with Aortic Stenosis and Structural Bioprosthesis Dysfunction
This article reviews current blood biomarkers associated with aortic valve stenosis/calcification and bioprosthesis dysfunction. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: C écile Oury, Nancy Côté, Marie-Annick Clavel Source Type: research

Transcatheter Aortic Valve Replacement
This article presents the evolution and current status of TAVR, with respect to the different types of devices and procedures as well as its outcomes. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Erwan Salaun, Philippe Pibarot, Josep Rod és-Cabau Source Type: research

Aortic Stenosis
This article reviews current literature regarding impact of aortic stenosis on pregnancy and anesthesia during noncardiac surgery. There are shortcomings in the scientific evidence. Most of the available studies are observational and often retrospective and therefore there is a great deal of bias. This leads to difficulty in drawing conclusions in terms of how to apply the published information to clinical management. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Jordi S. Dahl, Lucia Baris, Rasmus Carter-Storch, Roger Hall Source Type: research

Prevalence and Prognostic Implications of Frailty in Transcatheter Aortic Valve Replacement
Assessment of frailty has become engrained in the preprocedural evaluation of older adults referred for transcatheter aortic valve replacement. Addition of frailty and disability to clinical risk scores results in improved discrimination for short- and midterm mortality and identifies patients less likely to be discharged home and more likely to report worsening quality of life over the ensuing 6 to 12  months. In clinical practice, frailty can be evaluated by a tiered approach starting with a brief screening tool such as the Essential Frailty Toolset. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Palina Piankova, Jonathan Afilalo Source Type: research

Procedures and Outcomes of Surgical Aortic Valve Replacement in Adults
The ideal aortic valve substitute remains elusive. Bioprosthetic valves are the replacement option of choice in elderly patients undergoing aortic valve replacement (AVR). When implanted in young and middle-aged adults, both bioprosthetic and mechanical valves are associated with excess mortality compared with the age- and sex-matched general population. The Ross procedure is the only operation that can restore normal life expectancy in young and middle-aged adults undergoing AVR. In this article, the authors review the various options for surgical AVR and examine their contemporary applications and outcomes. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Amine Mazine, Ismail El-Hamamsy Source Type: research

Planning for Success
Since its inception in 2002, the use of transcatheter aortic valve replacement (TAVR) has rapidly increased over the last 17  years.1,2 Many of the challenges encountered in the early phases of TAVR adoption have been overcome with technological improvements in both the transcatheter valves and delivery systems.3,4 Nonetheless, as TAVR indications broaden to include lower-risk populations,5,6 detailed pre-procedural plan ning is crucial to maintain the safety and efficacy of this therapy. The 2017 American College of Cardiology (ACC) Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement suggeste...
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Vivian G. Ng, Rebecca T. Hahn, Tamim M. Nazif Source Type: research

A Decade of Revolutions in Calcific Aortic Stenosis
Calcific aortic stenosis (AS) is the most frequent valvular heart disease in high-income countries and the third most frequent cardiovascular disease after hypertension and coronary artery disease. The prevalence of aortic sclerosis (ie, the preclinical stage of AS) is estimated at 25% in the general population older than 65 years and close to 50% in those older than 80 years.1 The prevalence of AS is less than 1% in the population less than 60 years old,2 but increases exponentially to more than 10% in elderly people older than 75 years. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Marie-Annick Clavel, Philippe Pibarot Tags: Preface Source Type: research

Aortic Valve Disease
CARDIOLOGY CLINICS (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Marie-Annick Clavel, Philippe Pibarot Source Type: research

Copyright
ELSEVIER (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Source Type: research

Contributors
JAMIL A. ABOULHOSN, MD, FACC, FSCAI (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Source Type: research

Contents
Marie-Annick Clavel and Philippe Pibarot (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Source Type: research