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Deaths: Leading Causes for 2017.

Natl Vital Stat Rep. 2019 Jun;68(6):1-77

Authors: Heron M

Objectives-This report presents final 2017 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2017," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2017. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Results-In 2017, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Accidents (unintentional injuries); Chronic lower respiratory diseases; Cerebrovascular diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2017 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Newborn affected by maternal complications of pregnancy; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Diseases of the circulatory system; Respiratory distress of newborn; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

PMID: 32501203 [PubMed - indexed for MEDLINE]

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Patterns of cardiovascular risk and disease in HIV-positive adults on anti-retroviral therapy in Mozambique.

Cardiovasc J Afr. 2020 Jun 19;31:1-5

Authors: Dobe I, Manafe N, Majid N, Zimba I, Manuel B, Mocumbi A

INTRODUCTION: With improved access to anti-retroviral therapy (ART) the focus of HIV treatment is changing to reducing chronic co-morbidities and their effects, but guidelines for HIV care in many African countries do not include screening for cardiac disease. Our study aimed to determine the pattern of cardiac abnormalities in HIV-positive patients on ART.
METHODS: We implemented a prospective, observational study for 24 months on a random sample of adult patients seen at a dedicated HIV clinic in Mozambique. Demographic, clinical and full cardiovascular evaluations were performed on all participants.
RESULTS: We enrolled 264 HIVvpositive patients (mean age 39.3 years; 186 female, 70.5%). The mean time on ART was 46 (SD 36) months and most had low viral load (174, 65%). Obesity (45, 17%), overweight (65, 24.6%), hypertension (54, 20.5%) and severe anaemia (21, 8.3%) were frequent. Diabetes was present in four patients (1.5%). The most important conditions in 252 patients submitted to echocardiography (88, 34.9% had cardiac abnormalities) were: severe rheumatic heart valve disease (six), severe dilated cardiomyopathy (five), aortic degenerative disease and congenital heart disease (in three patients each). At 24-month follow up, six of the 252 patients had died; of the 196 reviewed on echocardiography 29 had progressed and two had improved ventricular systolic function.
CONCLUSION: This young cohort of HIV-positive patients on ART showed lower occurrence of tuberculous pericarditis and dilated cardiomyopathy but high cardiovascular risk, as assessed by the presence of obesity, hypertension and anaemia. Cardiac abnormalities needing multidisciplinary care were also found. There is a need for tailored cardiovascular risk stratification and screening for cardiovascular disease in HIV-positive patients on ART in Africa.

PMID: 32634198 [PubMed - as supplied by publisher]

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Low bone mineral density in adults with complex congenital heart disease.

Int J Cardiol. 2020 Jul 04;:

Authors: Sandberg C, Johansson K, Christersson C, Hlebowicz J, Thilén U, Johansson B

AIMS: The majority of children with complex congenital heart disease (CHD) survive into adulthood due to advances in medical care. Adult patients with CHD have an increased incidence of diagnoses related to ageing such as heart failure, dementia, cancer and sarcopenia, despite a relatively low age. They also have a shorter life expectancy. It is unknown if their bone structures also show signs of premature ageing. We therefore investigated Bone Mineral Content (BMC) and bone mineral density (BMD) in an adult population with complex CHD.
METHODS: The total body BMC and BMD was examined using dual energy X-ray absorptiometry (DXA) in 73 adults with complex CHD (mean age 35.8 ± 14.3, women n = 22) and 73 age and sex matched controls.
RESULTS: The adults with complex CHD had lower total body BMC (2.6 ± 0.5 kg vs. 2.9 ± 0.5 kg, p < 0.001) and BMD (1.18 ± 0.12 g/cm2vs. 1.26 ± 0.11 g/cm2, p < 0.001) compared to controls. BMD was lower for patients with single ventricle physiology and for the other complex diagnoses, and it persisted after correction for most common risk factors for osteoporosis.
CONCLUSION: Adults with complex CHD have reduced total body BMC and BMD compared to healthy controls. These results are a sign of frailty that conforms with other previously reported signs of premature ageing. The risk of osteoporosis is low in our relatively young population, but it is assumed to increase with ageing. We recommend that clinicians pay close attention to risk factors for osteoporosis, and are generous in administering DXA-measurements in order to prevent future fractures among adults with complex CHD.

PMID: 32634489 [PubMed - as supplied by publisher]

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Inspiratory muscle dysfunction and restrictive lung function impairment in congenital heart disease: Association with immune inflammatory response and exercise intolerance.

Int J Cardiol. 2020 Jul 04;:

Authors: Spiesshoefer J, Orwat S, Henke C, Kabitz HJ, Katsianos S, Borrelli C, Baumgartner H, Nofer JR, Spieker M, Bengel P, Giannoni A, Dreher M, Boentert M, Diller GP

BACKGROUND: In adult patients with congenital heart disease (ACHD), both underlying disease and lung restriction contribute to exercise intolerance. In ACHD the yet incompletely understood mechanism underlying restricted ventilation may be inspiratory muscle weakness. Therefore, this study comprehensively evaluated inspiratory muscle function in ACHD and associations with systemic inflammation and the clinical severity of exercise intolerance.
METHODS: 30 ACHD patients (21 men, 35 ± 12 years) and 30 healthy controls matched for age, gender and body mass index underwent spirometry, measurement of mouth occlusion pressures, and diaphragm ultrasound. Six-minute walking distance (6MWD) and New York Heart Association functional class were used to quantify exercise intolerance. Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels were measured using enzyme-linked immunosorbent assays.
RESULTS: ACHD patients showed lower forced vital capacity (FVC), and maximum inspiratory (PImax) and expiratory (PEmax) pressures compared with controls (all p < 0.05). On ultrasound, ACHD patients showed a lower diaphragm thickening ratio (2.3 ± 0.5 vs. 2.8 ± 0.9, p < 0.01) and lower diaphragm excursion velocity during a voluntary sniff maneuver (5.7 ± 2.2 vs. 7.6 ± 2.0 cm/s, p < 0.01). Respiratory parameters, such as FVC (r = 0.53; p < 0.01) and PImax (r = 0.43; p = 0.02), correlated with 6MWD. Furthermore, amino terminal pro B-type natriuretic peptide levels were inversely correlated with FVC (r = -0.54; p < 0.01). Circulating pro-inflammatory cytokines were markedly increased, and IL-6 was correlated with 6MWD, dyspnea, and biomarkers of heart, lung and inspiratory muscle function (all p < 0.05).
CONCLUSIONS: Our findings show that diaphragm dysfunction is present in ACHD and relates to restrictive ventilation disorder and exercise intolerance, possibly mediated by increased IL-6 levels.

PMID: 32634497 [PubMed - as supplied by publisher]

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Fetal Cardiac Intervention for Pulmonary Atresia with Intact Ventricular Septum: International Fetal Cardiac Intervention Registry.

Fetal Diagn Ther. 2020 Jul 07;:1-9

Authors: Hogan WJ, Grinenco S, Armstrong A, Devlieger R, Dangel J, Ferrer Q, Frommelt M, Galindo A, Gardiner H, Gelehrter S, Herberg U, Howley L, Jaeggi E, Miranda J, Morris SA, Oepkes D, Pedra S, Peterson R, Sholler G, Simpson J, Strainic J, Vigneswarran TV, Wacker-Gussmann A, Moon-Grady AJ, for the IFCIR Participants

INTRODUCTION: Invasive fetal cardiac intervention (FCI) for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (PS) has been performed with small single-institution series reporting technical and physiological success. We present the first multicenter experience.
OBJECTIVES: Describe fetal and maternal characteristics of those being evaluated for FCI, including pregnancy/neonatal outcome data using the International Fetal Cardiac Intervention Registry (IFCIR).
METHODS: We queried the IFCIR for PAIVS/PS cases evaluated from January 2001 to April 2018 and reviewed maternal/fetal characteristics, procedural details, pregnancy and neonatal outcomes. Data were analyzed using standard descriptive statistics.
RESULTS: Of the 84 maternal/fetal dyads in the registry, 58 underwent pulmonary valvuloplasty at a median gestational age of 26.1 (21.9-31.0) weeks. Characteristics of fetuses undergoing FCI varied in terms of tricuspid valve (TV) size, TV regurgitation, and pulmonary valve patency. There were fetal complications in 55% of cases, including 7 deaths and 2 delayed fetal losses. Among those who underwent successful FCI, the absolute measurement of the TV increased by 0.32 (±0.17) mm/week from intervention to birth. Among 60 liveborn with known outcome, there was a higher percentage having a biventricular circulation following successful FCI (87 vs. 43%).
CONCLUSIONS: Our data suggest a possible benefit to fetal therapy for PAIVS/PS, though rates of technically unsuccessful procedures and procedure-related complications, including fetal loss were substantial. FCI criteria are extremely variable, making direct comparison to nonintervention patients challenging and potentially biased. More uniform FCI criteria for fetuses with PAIVS/PS are needed to avoid unnecessary procedures, expose only fetuses most likely to sustain a benefit, and to enable comparisons to be made with nonintervention patients.

PMID: 32634804 [PubMed - as supplied by publisher]

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Risk of cardiac arrhythmias in patients with chronic hepatitis B and C infections - A 13-year nationwide population-based study.

J Cardiol. 2019 Oct;74(4):333-338

Authors: Wu VC, Chen TH, Wu M, Huang CH, Chen SW, Cheng CW, Lin YS, Chang PC, Hsieh MJ, Wang CY, Chang SH, Wang CL, Chu PH, Wu CS

BACKGROUND: Chronic hepatitis C virus (HCV) infection is associated with higher risk of cardiovascular events than chronic hepatitis B virus (HBV). We aimed to investigate whether there is higher risk of arrhythmia in HCV infection.
METHODS: Electronic medical records from National Health Institute Research Database during 2000-2012 were retrieved for patients with HBV or HCV. Patients with missing information, aged <18 years, diagnosed with HBV or HCV before year 2000, concomitant HBV and HCV, coagulopathy or organ transplant, history of arrhythmia, device implantation, congenital heart disease, rheumatic heart disease, hypertrophic cardiomyopathy, thyroid disease, alcohol or drug abuse, valvular heart disease, or follow-up <6 months were excluded. Primary outcomes were cardiac arrhythmias and all-cause mortality.
RESULTS: After 1:1 propensity score matching, 5480 patients with HBV and 5480 patients with HCV were included for study. During a mean follow-up of 6.5 years, the risk of all-cause mortality was higher in the HCV patients than in HBV patients [hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.16-1.58]. There was also a trend toward higher incidence of atrial fibrillation (HR 1.25, 95% 0.98-1.59, p=0.070) and a significantly higher incidence of sick sinus syndrome (HR 1.77, 95% CI 1.07-2.91) in HCV patients. In addition, among patients with all-cause mortality, arrhythmia death was significantly higher with chronic HCV infection.
CONCLUSIONS: In patients with chronic viral hepatitis, patients with HCV were associated with significantly increased risks of sick sinus syndrome, and all-cause mortality compared to patients with HBV.

PMID: 30982681 [PubMed - indexed for MEDLINE]

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Medium- and long-term follow-up of transcatheter closure of ruptured sinus of Valsalva aneurysm in Central Europe population.

J Cardiol. 2019 Oct;74(4):381-387

Authors: Galeczka M, Glowacki J, Yashchuk N, Ditkivskyy I, Rojczyk D, Knop M, Smerdzinski S, Cherpak B, Szkutnik M, Bialkowski J, Fiszer R, Lazoryshynets V

BACKGROUND: We aimed to evaluate medium- and long-term outcomes of transcatheter closure (TC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease.
METHODS: Retrospective analysis included 23 patients (14 males) aged 15-79 years (y; 39.9±18.5) selected for TC of RSVA between 2007 and 2017 in two tertiary centers in Poland and Ukraine. Fifteen patients were in New York Heart Association (NYHA) class III or IV before TC; 5 patients had acquired RSVA after previous cardiac surgery. We applied 22 duct, 3 muscular, and 1 atrial septal Amplatzer or Amplatzer-like occluders by the anterograde venous approach after arterio-venous loop creation in all but 1 patient. Mean follow-up conducted in outpatient clinic was 5.5±3.5 (1-11)y.
RESULTS: The procedure was successful in 19/23 patients (82.6%). Four procedures were abandoned and the device percutaneously retrieved due to coronary artery compression (1 patient), transient increase of aortic regurgitation (AR; 1 patients) or embolization (2 patients). New onset of significant AR was noted in one of the latter patients after device removal. NYHA class improved in all treated patients but 2, in whom it remained stable (p<0.05), with 10 patients in class I. Three patients needed percutaneous re-intervention during follow-up because of significant residual shunt in 1 and late recurrent RSVA in 2 patients. The follow-up of the remaining patients was uneventful. Neither erosion, embolization, new AR, nor death were observed.
CONCLUSIONS: The percutaneous closure of RSVA is a safe and effective method of treatment with good clinical outcome. However, although not described previously, recurrent shunts after TC of RSVA are possible and can be treated successfully with another transcatheter intervention.

PMID: 31023567 [PubMed - indexed for MEDLINE]

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Successful angioplasties using high pressure large balloons in a patient with severe anastomotic pulmonary artery stenosis soon after single-lung transplantation.

J Cardiol Cases. 2020 Jul;22(1):22-25

Authors: Shiraga K, Hirata Y, Saito A, Ozcelik N, Asakai H, Inuzuka R, Soma K, Sato M, Hirata Y, Oka A

A 59-year-old man received a single-lung transplantation due to interstitial pneumonitis. Severe anastomotic pulmonary artery stenosis (PAS) resulting in hypoxia and respiratory symptoms was found in the immediate postoperative period. A scintigraphy showed severe hypoperfusion of the left transplanted lung with 7% of the total pulmonary blood flow. On postoperative days (POD) 29 and 64, the patient underwent serial balloon angioplasties without any complications. Based on the balloon selection criteria for PAS after heart surgery in children, a high-pressure large balloon was used with resultant improvement in respiratory signs and symptoms without any complications. The patient was discharged on POD 92. A follow-up scintigraphy on POD 169 revealed 58% of blood distribution to the left lung. The patient has been doing clinically well and remained asymptomatic one year after the transplantation. Balloon angioplasty with a high-pressure large balloon without stent implantation during an early postoperative period may be a safe and effective strategy. The balloon selecting criteria used in pediatric patients may be applied in the adult lung transplant recipients. <Learning objective: Anastomotic pulmonary artery stenosis (PAS) in a single-lung transplant recipient is a critical complication. A balloon angioplasty with a high-pressure large balloon should be a first choice for anastomotic PAS, because it is safer than stent implantation especially for transplant recipients. And the balloon selecting criteria used in children with congenital heart disease may be applied in the adult lung transplant recipients.>.

PMID: 32636964 [PubMed]

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Partial Anomalous Pulmonary Venous Return Presenting in Adults: A Case Series With Review of Literature.

Cureus. 2020 Jun 01;12(6):e8388

Authors: Pendela VS, Tan BE, Chowdhury M, Chow M

Partial anomalous pulmonary venous return (PAPVR) is a congenital anomaly in which some of the pulmonary veins drain erroneously into the superior vena cava (SVC) or directly into the right atrium (RA). We present four cases of PAPVR presenting in adults. We discussed various presentations, diagnostic approaches and challenges in the management of these patients. Our first case had anomalous drainage from the right upper lobe of lung to SVC and was managed medically with riociguat and ambrisentan. The second patient had an unsuccessful attempt at repair of the anomalous vein. Our other two patients had right upper lobe veins draining into SVC. One of them had a successful surgical repair whereas the other patient declined surgery and is being monitored. In PAPVR patients, the decision for surgical repair depends on symptoms, shunt fraction, recurrent pulmonary infections, and concurrent indication for cardiac surgery.

PMID: 32637270 [PubMed]

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Association between early prenatal exposure to ambient air pollution and birth defects: evidence from newborns in Xi'an, China.

J Public Health (Oxf). 2019 09 30;41(3):494-501

Authors: Wang L, Xiang X, Mi B, Song H, Dong M, Zhang S, Bi Y, Zhao Y, Li Q, Zhang Q, Zhang L, Yan H, Wang D, Dang S

BACKGROUND: The aim of this study was to investigate an association between birth defects and exposure to sulfur dioxide (SO2), nitrogen dioxide (NO2) and particles ≤10 μm in an aerodynamic diameter (PM10) during early pregnancy in Xi'an, China.
METHODS: Birth defect data were from the Birth Defects Monitoring System of Xi'an, and data on ambient air pollutants during 2010-15 were from the Xi'an Environmental Protection Bureau. A generalized additive model (GAM) was used to investigate the relationship between birth defects and ambient air pollutants.
RESULTS: Among the 8865 cases with birth defects analyzed, the overall incidence of birth defects was 117.33 per 10 000 infants. Ambient air pollutant exposure during the first trimester increased the risk of birth defects by 10.3% per 10 μg/m3 increment of NO2 and 3.4% per 10 μg/m3 increment of PM10. No significant association was found between birth defects and SO2. Moreover, NO2 increased risk of neural tube defects, congenital heart disease, congenital polydactyly, cleft palate, digestive system abnormalities and gastroschisis, and PM10 was associated with congenital heart disease and cleft lip with or without cleft palate.
CONCLUSIONS: Chinese women should avoid exposure to high levels of NO2 and PM10 during the first 3 months of pregnancy.

PMID: 30137461 [PubMed - indexed for MEDLINE]