Characterizing the Acute Changes in Pulmonary Capillary Wedge Pressure Associated With Transcatheter Pulmonary Valve Replacement.

Background: After transcatheter pulmonary valve replacement (TPVR), changes in left ventricular loading conditions can result in increased pulmonary capillary wedge pressure (PCWP). Recognizing this effect may allow better understanding of the physiologic response of the left ventricle (LV) as well as early identification and treatment of procedural complications.

Aims: Our aim was to describe the hemodynamic changes in LV filling pressures after TPVR measured by a PCWP before and after valve deployment.

Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease: ACEs in ACHD.

Background: Adverse childhood experiences (ACEs) are linked with poor physical and psychosocial health outcomes in adulthood, including cardiovascular disease.

Objectives: The purpose of this study was to evaluate associations between ACEs and cardiovascular outcomes in adult congenital heart disease (ACHD).

Methods: Outpatients with ACHD completed surveys including medical/psychosocial history, ACEs (range, 0-10), linear quality of life score (QoL, range, 0-100), and NYHA functional class (NYHA FC).

Validation of the Perioperative Mortality Risk in Adults with Congenital Heart Disease (PEACH) Score in a US Cohort.

The PErioperative ACHd (PEACH) score is a mortality risk assessment tool for adult congenital heart disease (ACHD) patients created to address the unique surgical risks in this population. Evaluation of the PEACH score's validity in a US cohort is needed. This paper sought to assess the PEACH score's performance in ACHD patients undergoing cardiac surgery.

A national megastudy shows that email nudges to elementary school teachers boost student math achievement, particularly when personalized.

In response to the alarming recent decline in US math achievement, we conducted a national megastudy in which 140,461 elementary school teachers who collectively taught 2,992,027 students were randomly assigned to receive a variety of behaviorally informed email nudges aimed at improving students' progress in math. Specifically, we partnered with the nonprofit educational platform Zearn Math to compare the impact of 15 different interventions with a reminder-only megastudy control condition. All 16 conditions entailed weekly emails delivered to teachers over 4-wk in the fall of 2021.

Determinants of cardiac output in health and heart failure.

Sustained physical exercise depends on delivery of oxygenated blood to exercising muscle. At least among healthy individuals, bulk transport of blood is tightly matched to metabolic demand, such that cardiac output increases by ∼6 L/min for every 1 L/min increase in oxygen uptake. Multiple factors contribute to the regulation of cardiac output, including central command, the exercise pressor reflex (EPR) and arterial baroreceptors.

Propensity Score Analysis of Possible Medication Effects on Outcomes in Patients With Systemic Right Ventricles.

Background: Patients with systemic right ventricle (SRV), either d-transposition of the great arteries following an atrial switch procedure or congenitally corrected transposition of the great arteries, develop severe right ventricular dysfunction, prompting appropriate medical therapy. However, the efficacy of beta-blockers and angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI) in SRV patients is unproven.

Objectives: The objective of this study was to determine the effects of ACEI/ARB and beta-blockers on outcomes in SRV patients after accounting for likely cofounders affecting their use.

Cardiovascular Outcomes in Fontan Patients With Right vs Left Univentricular Morphology: A Multicenter Study.

Background: There is a paucity of data on long-term outcomes after Fontan palliation in patients with a dominant morphological univentricular right (uRV) vs left (uLV) ventricle.

Objectives: The purpose of this study was to compare the incidence of atrial arrhythmias, thromboembolic events, cardiac transplantation, and death following Fontan palliation in patients with uRV vs uLV.

Methods: The Alliance for Adult Research in Congenital Cardiology conducted a multicenter retrospective cohort study on patients with total cavopulmonary connection Fontan palliation across 12 centers in North America.

Transcatheter closure of a large coronary cameral fistula presenting as a calcified cystic right atrial mass.

A 51-year-old patient with progressive right heart dysfunction was found to have a large calcified right atrial mass on echocardiography. As part of the work up for an intracardiac mass he had a cardiac computed tomogram which detailed a large coronary cameral fistula from the circumflex coronary artery to the right atrium associated with a spherical calcific pseudo-aneurysmal sac. Transcatheter occlusion of the exit point into the atrium with a vascular plug was performed directly from a right atrial approach without the need for an arteriovenous wire loop.

Impact of Fontan Fenestration on Adverse Cardiovascular Outcomes: A Multicentre Study.

Background: Fenestrating a Fontan baffle has been associated with improved perioperative outcomes in patients with univentricular hearts. However, longer-term potential adverse effects remain debated. We sought to assess the impact of a fenestrated Fontan baffle on adverse cardiovascular events including all-cause mortality, cardiac transplantation, atrial arrhythmias, and thromboemboli.

End-stage heart failure in congenitally corrected transposition of the great arteries: a multicentre study.

Background And Aims: For patients with congenitally corrected transposition of the great arteries (ccTGA), factors associated with progression to end-stage congestive heart failure (CHF) remain largely unclear.

Methods: This multicentre, retrospective cohort study included adults with ccTGA seen at a congenital heart disease centre. Clinical data from initial and most recent visits were obtained.

Submaximal Exercise Response is Associated with Future Hypertension in Patients with Coarctation of the Aorta.

Hypertension (HTN) is common in patients with a history of coarctation of the aorta (CoA) and remains underrecognized and undertreated. Studies in the non-coarctation otherwise healthy adult population have correlated an exaggerated blood pressure response during mild to moderate exercise with subsequent diagnosis of HTN. The goal of this study was to determine if blood pressure response to submaximal exercise in normotensive CoA patients correlated with development of HTN.

A systematic review of risk factors for mortality among tuberculosis patients in South Africa.

Background: Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients.

Methods: We conducted a systematic review of TB research articles published between 2010 and 2018.

A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit.

Purpose: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.

Design: Randomized, controlled trial.

Setting: Two health systems in the Northeastern US between September 2020 and March 2021.

Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries.

Background: For patients with d-loop transposition of the great arteries (d-TGA) with a systemic right ventricle after an atrial switch operation, there is a need to identify risks for end-stage heart failure outcomes.

Objectives: The authors aimed to determine factors associated with survival in a large cohort of such individuals.

Methods: This multicenter, retrospective cohort study included adults with d-TGA and prior atrial switch surgery seen at a congenital heart center.

Time in Therapeutic Range With Vitamin K Antagonists in Congenital Heart Disease: A Multicentre Study.

Background: Vitamin K antagonists (VKAs) are frequently prescribed to patients with congenital heart disease (CHD) for atrial arrhythmias or Fontan palliation, but there is a paucity of data regarding time spent in the therapeutic range (TTR). We sought to determine the TTR in patients with CHD and atrial arrhythmias or Fontan palliation prescribed VKAs and explore associations with thromboembolic and bleeding events.

Methods: A multicentre North American cohort study was conducted on patients with CHD who received VKAs for sustained atrial arrhythmia or Fontan palliation.

Surgical management and outcomes of endocarditis in adolescents and adults with congenital heart disease.

Background: Adolescents and adults with CHD have increased risk for IE because of anatomic anomalies and burden of intracardiac prosthetic material. There are significant challenges in determining primary surgical or medical management along with limited guidelines to determine management.

Methods: A retrospective review was performed at both the University of Colorado Hospital and Children's Hospital Colorado of patients 12 years of age and older with CHD who were treated for IE between 2009 and 2019.

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages.

Megastudies improve the impact of applied behavioural science.

Policy-makers are increasingly turning to behavioural science for insights about how to improve citizens' decisions and outcomes. Typically, different scientists test different intervention ideas in different samples using different outcomes over different time intervals. The lack of comparability of such individual investigations limits their potential to inform policy.

Contrast-free percutaneous pulmonary valve replacement: a safe approach for valve-in-valve procedures.

Introduction: Percutaneous pulmonary valve replacement (PPVI) continues to gather pace in pediatric and adult congenital practice. This is fueled by an expanding repertoire of devices, techniques and equipment to suit the heterogenous anatomical landscape of patients with lesions of the right ventricular outflow tract (RVOT). Contrast-induced nephropathy is a real risk for teenagers and adults with congenital heart disease (CHD).

A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment.

Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment ( = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%.

Patients with bicuspid aortic valves may be associated with infra-hisian conduction disease requiring pacemakers.

Background: Bicuspid aortic valves (BAVs) are associated with accelerated valvular dysfunction. Increasing rates of conduction system disease are seen in patients with calcific tricuspid aortic valves (TAVs). However, little is known regarding the extent of conduction disorders in BAV patients.