Fungal Ball in Ascending Aorta: Disseminated Histoplasmosis 20 Years After Aneurysm Repair.

, an Ascomycetes fungus, is the responsible pathogen for histoplasmosis. Although often asymptomatic, around 1% of cases progress to disseminated infection. Endovascular graft infections with this fungus have been reported, particularly on abdominal aortic or aortofemoral bypass grafts.

Outcomes of Surgical Repair of Aberrant Subclavian Arteries in Adults.

Background: Symptoms, imaging characteristics, and early and midterm surgical outcomes for aberrant subclavian arteries (ASCA) are not well defined in the adult population.

Methods: A single-institution retrospective review was conducted of adults undergoing surgical repair of ASCA and descending aorta origin/Kommerell diverticulum (KD) from January 1, 2002, to December 31, 2021. Symptom improvement and differences in imaging characteristics between anatomic groups and the number of symptoms were assessed.

Incidence and Outcomes of Advanced Heart Failure in Adults With Congenital Heart Disease.

Background: There are limited data about the stage D heart failure (advanced HF) in adults with congenital heart disease. Our study objectives were (1) to determine the incidence of new-onset advanced HF in patients and the relationship between advanced HF and all-cause mortality and (2) to determine the relationship between therapies for advanced HF and all-cause mortality.

Methods: Retrospective cohort study of adults with congenital heart disease at Mayo Clinic (2003-2019).

Prevalence and risk of progressive aortic aneurysm and dissection in adults with conotruncal anomalies.

Aims: Conotruncal anomalies share common embryogenic defects of the outflow tracts and great arteries, which result in a predisposition to aortic aneurysms. The purpose of this study was to describe the prevalence and risk of progressive aortic aneurysms in adults with conotruncal anomalies.

Methods And Results: Retrospective study of adults with conotruncal anomalies that underwent cross-sectional imaging 2003-20.

Early and Late Outcomes of Cardiovascular Surgery in Patients With Ehlers-Danlos Syndrome.

Background: Cardiovascular surgical outcomes reports are few for vascular type IV of Ehlers- Danlos Syndrome (vEDS) compared to non-vascular types I-III (nEDS).

Methods: To define cardiovascular surgical outcomes among adult patients (≥18 years) with EDS types, a review of our institution's in-house STS Adult Cardiac Surgery Database-compliant software and electronic medical records from Mayo Clinic (1993-2019) was performed. Outcomes were compared for vEDS patients and nEDS patients.

Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications.

Objective: To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications.

Patients And Methods: We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008, through June 21, 2018. Patients' characteristics, preoperative imaging, surgical interventions, outcomes, and complications were analyzed.

Persistent Hypertension and Left Ventricular Hypertrophy After Repair of Native Coarctation of Aorta in Adults.

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Heightened Dependence of Left-Heart Filling Pressures on Right-Heart Failure in Congenital Heart Disease.

Background: Pulmonary artery wedge pressure (PAWP) is often elevated in patients with right-sided congenital heart disease (CHD), raising the possibility of coexisting left-heart disease, but pressure-volume relationships in the left and right sides of the heart influence one another through interdependence, which may be amplified in patients with CHD.

Methods: We hypothesized that increases in PAWP in patients with CHD would be more strongly related to ventricular interdependence compared with patients who have isolated left-heart disease such as heart failure with preserved ejection fraction (HFpEF). Ventricular interdependence was assessed by the relationship between PAWP and right-atrial pressure (RAP), RAP/PAWP ratio, and the left-ventricular (LV) eccentricity index.

Impact of Inferior Venae Cava Assessment in Tetralogy of Fallot.

Background: Inferior vena cava (IVC) size and collapsibility provide a noninvasive estimate of right heart filling pressures, an important determinant of right heart hemodynamic performance that is not measured by cardiac magnetic resonance imaging (CMRI). We hypothesized that compared with CMRI risk model alone, a combined CMRI-IVC risk model will have better correlation with disease severity and peak oxygen consumption in patients with tetralogy of Fallot (TOF).

Methods: We performed a retrospective review of patients with TOF with moderate/severe pulmonary regurgitation who underwent CMRI and echocardiography.

Echocardiographic predictors of severe right ventricular diastolic dysfunction in tetralogy of Fallot: Relations to patient outcomes.

Background: Previous studies have described echocardiographic indices of right ventricular (RV) diastolic function in patients with tetralogy of Fallot (TOF) but these indices have not been validated against invasive hemodynamic data. The purpose of this study was to determine echocardiographic predictors of severe RV diastolic dysfunction, and the impact of severe RV diastolic dysfunction on transplant-free survival.

Methods: Cohort study of TOF patients that underwent non-simultaneous cardiac catheterization and echocardiogram at Mayo Clinic.

Pathophysiologic and Prognostic Implications of Right Atrial Hypertension in Adults With Tetralogy of Fallot.

Background Right atrial pressure (RAP), a composite metric of right ventricular diastolic function, volume status, and right heart compliance, is a predictor of mortality in patients with heart failure due to acquired heart disease. Because patients with tetralogy of Fallot (TOF) might have abnormal right atrial and ventricular mechanics caused by myocardial injury and remodeling, we hypothesized that RAP would be associated with disease severity and cardiovascular adverse events in this population. Methods and Results We performed a cohort study of adults with TOF who underwent right heart catheterization at the Mayo Clinic Rochester between 1990 and 2017.

Impact of atrial arrhythmia on survival in adults with tetralogy of Fallot.

Background: Atrial arrhythmia is a late complication after tetralogy of Fallot (TOF) repair, but arrhythmia outcomes data are limited.

Objectives: The purpose of the study was to describe atrial arrhythmia presentations, outcomes of antiarrhythmic therapy, and impact of arrhythmia on transplant-free survival.

Methods: We reviewed the MACHD (Mayo Adult Congenital Heart Disease) Registry and identified 113 patients (age 49 ± 13 years) with documented arrhythmia, and 302 patients without history of arrhythmia, 1990-2017.

The placenta: A site of end-organ damage after Fontan operation. A case series.

Background: Placental insufficiency may be the cause of the high preterm birth rate in women after Fontan operation. In this study we reviewed the clinical course and pregnancy outcome of women with Fontan physiology with a focus on placental pathology.

Methods: We reviewed clinical charts and placental pathology from 7 women with Fontan physiology who had pregnancies at Mayo Clinic, Rochester, Minnesota.

Exercise Capacity After Repair of Ebstein Anomaly in Adults.

Repair of Ebstein anomaly has evolved over the last decade, and timing of repair remains variable. There have been no studies of exercise or functional capacity in patients who have had tricuspid valve surgery for Ebstein anomaly in adulthood. We aimed to compare exercise capacity before and after tricuspid valve repair or replacement for Ebstein anomaly in adults at Mayo Clinic.

Transthoracic Echocardiography versus Computed Tomography for Ascending Aortic Measurements in Patients with Bicuspid Aortic Valve.

Background: Ascending aorta dilatation is common in bicuspid aortic valve (BAV). The aim of this study was to investigate agreement of transthoracic echocardiographic (TTE) measurement of the sinuses of Valsalva and the tubular mid-ascending aorta (Asc-Ao) compared with electrocardiographically gated computed tomographic angiographic (CTA) assessment in patients with BAV.

Methods: Fifty-three patients with BAV (mean age, 54 ± 14 years; 74% men) who underwent both TTE and CTA imaging for ascending aortic assessment were retrospectively identified.

When is the right time for Fontan conversion? The role of cardiopulmonary exercise test.

Background: To determine if Fontan conversion (FC) resulted in improvement in exercise capacity (EC), and to determine the role of cardiopulmonary exercise test (CPET) in risk stratification of patients undergoing FC.

Methods: A retrospective review of patients who underwent CPET prior to FC at Mayo Clinic from 1994 to 2014. The patients who also underwent post-operative CPET were selected for the analysis of improvement in EC defined as 10% increase in baseline peak oxygen consumption (VO2).

Prosthetic pulmonary valve and pulmonary conduit endocarditis: clinical, microbiological and echocardiographic features in adults.

Aims: To review clinical and microbiological findings in adults with prosthetic pulmonary valve (PPV) or right ventricle to pulmonary artery conduit (RVPAC) infective endocarditis (IE) and to assess the yield of transthoracic (TTE) and transesophageal echocardiography (TEE) as diagnostic tools.

Methods And Results: Seventeen adults (age ≥18 years) with PPV/RVPAC who met diagnostic criteria for definite IE between 2000 and 2015 were included. Median age was 34 years and 29% were females; four patients (24%) had a previous episode of IE.

Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease.

Background: The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate.

Methods and results: We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position.