Increased risk of possible paradoxical embolic events in adults with ebstein anomaly and severe tricuspid regurgitation

Christine H. Attenhofer Jost, Heidi M. Connolly, Christopher G. Scott, Harold M. Burkhart, Naser M. Ammash, Joseph A. Dearani

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: Determine incidence and risk factors for possible paradoxical embolic events in patients who have Ebstein anomaly with severe tricuspid regurgitation. Design: Retrospective study of clinical and imaging data. Setting: Tertiary care center. Patients: Patients undergoing clinical evaluation and echocardiography prior to cardiac surgery for Ebstein anomaly (1975-2010) performed at age ≥ 40 years. Results: Mean age of 128 patients (81 female) was 53 ± 9 years. All had severe tricuspid regurgitation. Twenty-four (19%) had previous cardiac surgery (at <40 years), including 17 for interatrial shunt closure. Most (112 [88%]) had New York Heart Association functional class III/IV heart failure; 84 (66%) had interatrial shunting (58 had an atrial septal defect and 29 had a patent foramen ovale [3 had both]). During their lifetime, 29 patients (23%) had a history of ≥1 possible paradoxical embolic events (stroke or transient ischemic attack, brain abscess, or myocardial infarction). The best predictors of preoperative possible paradoxical embolic events were an atrial septal defect (P = .002) and older age at surgery (P = .007). There was no association of possible paradoxical embolic events with cardiovascular risk factors (hypertension, dyslipidemia, smoking, or family history of coronary artery disease) (all P ≥ .3) or atrial fibrillation (P = .69). Median age at occurrence of paradoxical embolism was 49 (range, 1.5-74 years). Conclusions: Possible paradoxical embolic events are common in adults with Ebstein anomaly and severe tricuspid regurgitation and are strongly associated with atrial septal defect. In patients with atrial septal defect or patent foramen ovale, shunt closure should be considered to reduce risk of possible paradoxical embolic events.

Original languageEnglish (US)
Pages (from-to)30-37
Number of pages8
JournalCongenital Heart Disease
Volume9
Issue number1
DOIs
StatePublished - Jan 2014

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Ebstein Anomaly
Tricuspid Valve Insufficiency
Atrial Heart Septal Defects
Patent Foramen Ovale
Thoracic Surgery
Paradoxical Embolism
Brain Infarction
Brain Abscess
Transient Ischemic Attack
Dyslipidemias
Tertiary Care Centers
Atrial Fibrillation
Echocardiography
Coronary Artery Disease
Heart Failure
Retrospective Studies
Smoking
Stroke
Myocardial Infarction
Hypertension

Keywords

  • Atrial Septal Defect
  • Ebstein Anomaly
  • Embolism
  • Heart Septal Defects
  • Paradoxical
  • Shunt

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging

Cite this

Attenhofer Jost, C. H., Connolly, H. M., Scott, C. G., Burkhart, H. M., Ammash, N. M., & Dearani, J. A. (2014). Increased risk of possible paradoxical embolic events in adults with ebstein anomaly and severe tricuspid regurgitation. Congenital Heart Disease, 9(1), 30-37. https://doi.org/10.1111/chd.12068

Increased risk of possible paradoxical embolic events in adults with ebstein anomaly and severe tricuspid regurgitation. / Attenhofer Jost, Christine H.; Connolly, Heidi M.; Scott, Christopher G.; Burkhart, Harold M.; Ammash, Naser M.; Dearani, Joseph A.

In: Congenital Heart Disease, Vol. 9, No. 1, 01.2014, p. 30-37.

Research output: Contribution to journalArticle

Attenhofer Jost, CH, Connolly, HM, Scott, CG, Burkhart, HM, Ammash, NM & Dearani, JA 2014, 'Increased risk of possible paradoxical embolic events in adults with ebstein anomaly and severe tricuspid regurgitation', Congenital Heart Disease, vol. 9, no. 1, pp. 30-37. https://doi.org/10.1111/chd.12068
Attenhofer Jost, Christine H. ; Connolly, Heidi M. ; Scott, Christopher G. ; Burkhart, Harold M. ; Ammash, Naser M. ; Dearani, Joseph A. / Increased risk of possible paradoxical embolic events in adults with ebstein anomaly and severe tricuspid regurgitation. In: Congenital Heart Disease. 2014 ; Vol. 9, No. 1. pp. 30-37.
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abstract = "Objective: Determine incidence and risk factors for possible paradoxical embolic events in patients who have Ebstein anomaly with severe tricuspid regurgitation. Design: Retrospective study of clinical and imaging data. Setting: Tertiary care center. Patients: Patients undergoing clinical evaluation and echocardiography prior to cardiac surgery for Ebstein anomaly (1975-2010) performed at age ≥ 40 years. Results: Mean age of 128 patients (81 female) was 53 ± 9 years. All had severe tricuspid regurgitation. Twenty-four (19{\%}) had previous cardiac surgery (at <40 years), including 17 for interatrial shunt closure. Most (112 [88{\%}]) had New York Heart Association functional class III/IV heart failure; 84 (66{\%}) had interatrial shunting (58 had an atrial septal defect and 29 had a patent foramen ovale [3 had both]). During their lifetime, 29 patients (23{\%}) had a history of ≥1 possible paradoxical embolic events (stroke or transient ischemic attack, brain abscess, or myocardial infarction). The best predictors of preoperative possible paradoxical embolic events were an atrial septal defect (P = .002) and older age at surgery (P = .007). There was no association of possible paradoxical embolic events with cardiovascular risk factors (hypertension, dyslipidemia, smoking, or family history of coronary artery disease) (all P ≥ .3) or atrial fibrillation (P = .69). Median age at occurrence of paradoxical embolism was 49 (range, 1.5-74 years). Conclusions: Possible paradoxical embolic events are common in adults with Ebstein anomaly and severe tricuspid regurgitation and are strongly associated with atrial septal defect. In patients with atrial septal defect or patent foramen ovale, shunt closure should be considered to reduce risk of possible paradoxical embolic events.",
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N2 - Objective: Determine incidence and risk factors for possible paradoxical embolic events in patients who have Ebstein anomaly with severe tricuspid regurgitation. Design: Retrospective study of clinical and imaging data. Setting: Tertiary care center. Patients: Patients undergoing clinical evaluation and echocardiography prior to cardiac surgery for Ebstein anomaly (1975-2010) performed at age ≥ 40 years. Results: Mean age of 128 patients (81 female) was 53 ± 9 years. All had severe tricuspid regurgitation. Twenty-four (19%) had previous cardiac surgery (at <40 years), including 17 for interatrial shunt closure. Most (112 [88%]) had New York Heart Association functional class III/IV heart failure; 84 (66%) had interatrial shunting (58 had an atrial septal defect and 29 had a patent foramen ovale [3 had both]). During their lifetime, 29 patients (23%) had a history of ≥1 possible paradoxical embolic events (stroke or transient ischemic attack, brain abscess, or myocardial infarction). The best predictors of preoperative possible paradoxical embolic events were an atrial septal defect (P = .002) and older age at surgery (P = .007). There was no association of possible paradoxical embolic events with cardiovascular risk factors (hypertension, dyslipidemia, smoking, or family history of coronary artery disease) (all P ≥ .3) or atrial fibrillation (P = .69). Median age at occurrence of paradoxical embolism was 49 (range, 1.5-74 years). Conclusions: Possible paradoxical embolic events are common in adults with Ebstein anomaly and severe tricuspid regurgitation and are strongly associated with atrial septal defect. In patients with atrial septal defect or patent foramen ovale, shunt closure should be considered to reduce risk of possible paradoxical embolic events.

AB - Objective: Determine incidence and risk factors for possible paradoxical embolic events in patients who have Ebstein anomaly with severe tricuspid regurgitation. Design: Retrospective study of clinical and imaging data. Setting: Tertiary care center. Patients: Patients undergoing clinical evaluation and echocardiography prior to cardiac surgery for Ebstein anomaly (1975-2010) performed at age ≥ 40 years. Results: Mean age of 128 patients (81 female) was 53 ± 9 years. All had severe tricuspid regurgitation. Twenty-four (19%) had previous cardiac surgery (at <40 years), including 17 for interatrial shunt closure. Most (112 [88%]) had New York Heart Association functional class III/IV heart failure; 84 (66%) had interatrial shunting (58 had an atrial septal defect and 29 had a patent foramen ovale [3 had both]). During their lifetime, 29 patients (23%) had a history of ≥1 possible paradoxical embolic events (stroke or transient ischemic attack, brain abscess, or myocardial infarction). The best predictors of preoperative possible paradoxical embolic events were an atrial septal defect (P = .002) and older age at surgery (P = .007). There was no association of possible paradoxical embolic events with cardiovascular risk factors (hypertension, dyslipidemia, smoking, or family history of coronary artery disease) (all P ≥ .3) or atrial fibrillation (P = .69). Median age at occurrence of paradoxical embolism was 49 (range, 1.5-74 years). Conclusions: Possible paradoxical embolic events are common in adults with Ebstein anomaly and severe tricuspid regurgitation and are strongly associated with atrial septal defect. In patients with atrial septal defect or patent foramen ovale, shunt closure should be considered to reduce risk of possible paradoxical embolic events.

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