10 results on '"Oosterhof, Thomas"'
Search Results
2. Individualised prediction of pulmonary homograft durability in tetralogy of Fallot.
- Author
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Bokma JP, Winter MM, Oosterhof T, Vliegen HW, van Dijk AP, Hazekamp MG, Koolbergen DR, Groenink M, Mulder BJ, and Bouma BJ
- Subjects
- Adult, Age Factors, Allografts physiopathology, Echocardiography methods, Female, Humans, Male, Netherlands epidemiology, Outcome Assessment, Health Care, Proportional Hazards Models, Prosthesis Failure, Reoperation methods, Reoperation statistics & numerical data, Retrospective Studies, Risk Assessment, Tetralogy of Fallot epidemiology, Tetralogy of Fallot physiopathology, Transplantation, Homologous methods, Cardiovascular Surgical Procedures adverse effects, Cardiovascular Surgical Procedures methods, Postoperative Complications diagnosis, Postoperative Complications physiopathology, Postoperative Complications surgery, Pulmonary Artery surgery, Pulmonary Valve surgery, Tetralogy of Fallot surgery, Ventricular Dysfunction, Right diagnosis, Ventricular Dysfunction, Right etiology, Ventricular Dysfunction, Right physiopathology, Ventricular Dysfunction, Right surgery
- Abstract
Background: In patients with repaired tetralogy of Fallot (rTOF), multiple reoperations or percutaneous interventions after pulmonary valve replacement (PVR) may be necessary due to limited homograft durability. However, data to guide individualised prediction of homograft durability remain scarce. The aim of this study was to provide risk models for RV to pulmonary artery homograft durability., Methods: This retrospective multicentre study included consecutive patients with rTOF who had undergone PVR at an age of >12 years. Homograft dysfunction was defined as at least moderate pulmonary regurgitation (PR) or pulmonary stenosis (PS) (pressure gradient ≥36 mm Hg) as assessed by echocardiography. Reintervention was defined as percutaneous intervention or redo-PVR., Results: A total of 153 patients with rTOF were included (62% male, mean age at PVR 31±11 years, pulmonary homograft 96%, follow-up 9.6 years (IQR 5.9, 13.3)). Average freedom from homograft dysfunction and reintervention after 10 years was 74% and 89%, respectively. In multivariable Cox proportional hazards analysis, postoperative PS ≥20 mm Hg (HR 6.52, 95% CI 3.09 to 13.7), postoperative PR ≥ grade 1 (HR 3.13, 95% CI 1.45 to 6.74) and age at PVR <18 years (HR 3.52, 95% CI 1.64 to 7.53) were independently predictive for homograft dysfunction. In patients without any risk factor, 10-year freedom from homograft dysfunction and reintervention was excellent (91% and 96%, respectively) in contrast to patients with ≥2 risk factors (25% and 73%, respectively)., Conclusions: Individualised prediction of homograft durability in patients with rTOF can be guided by early postoperative echocardiography. In adult patients without early postoperative PS or PR, homograft dysfunction and reintervention are unlikely to occur within 10 years, and follow-up may be less stringent., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2015
- Full Text
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3. Pulmonary valve replacement in tetralogy of Fallot improves the repolarization.
- Author
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Hooft van Huysduynen B, Henkens IR, Swenne CA, Oosterhof T, Draisma HH, Maan AC, Hazekamp MG, de Roos A, Schalij MJ, van der Wall EE, and Vliegen HW
- Subjects
- Adult, Electrocardiography, Female, Humans, Magnetic Resonance Imaging, Male, Pulmonary Valve Insufficiency diagnosis, Pulmonary Valve Insufficiency physiopathology, Pulmonary Valve Insufficiency surgery, Tachycardia, Ventricular prevention & control, Tetralogy of Fallot diagnosis, Tetralogy of Fallot physiopathology, Treatment Outcome, Heart Conduction System physiopathology, Heart Valve Prosthesis Implantation methods, Pulmonary Valve surgery, Tetralogy of Fallot surgery
- Abstract
Objective: To assess the effect of pulmonary valve replacement (PVR) on the repolarization of patients with tetralogy of Fallot., Background: Pulmonary valve regurgitation may cause right ventricular failure in adult patients with Fallot's tetralogy. In these patients, prolonged depolarization and disturbed repolarization are associated with ventricular arrhythmias and sudden cardiac death., Methods: Thirty Fallot patients (age 32+/-9 years, 19 male) eligible for PVR were studied with cardiac magnetic resonance imaging (CMR) before and 6 months after PVR. Electrocardiograms obtained during initial and follow-up CMR were analyzed and occurrence of ventricular arrhythmias was studied., Results: Right ventricular end-diastolic volume (RV EDV) decreased from 322+/-87 to 215+/-57 ml after PVR (P<0.0001). The spatial QRS-T angle normalized from 117+/-34 to 100+/-35 degrees , P=0.0004 (normal angle <105 degrees). QT dispersion and T-wave complexity did not change significantly. T-wave amplitude decreased from 376+/-121 to 329+/-100 microV (P=0.01). T-wave area decreased from 43+/-15 to 38+/-13 microV s (P=0.02). Decreases in T-wave amplitude and area were most prominent in the right precordial leads overlying the RV. Three patients had sustained ventricular arrhythmias and one patient died suddenly. These patients had a QRS duration >160 ms. No severe ventricular arrhythmias were found in patients with a RV EDV <220 ml, QRS-T angle <100 degrees , QT dispersion <60 ms or T-wave complexity <0.30., Conclusion: Normal repolarization indices may be associated with the absence of severe ventricular arrhythmias. PVR in Fallot patients with dilated right ventricles has a beneficial effect on electrocardiographic indices of repolarization heterogeneity.
- Published
- 2008
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4. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance.
- Author
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Oosterhof T, van Straten A, Vliegen HW, Meijboom FJ, van Dijk AP, Spijkerboer AM, Bouma BJ, Zwinderman AH, Hazekamp MG, de Roos A, and Mulder BJ
- Subjects
- Adult, Blood Flow Velocity, Female, Humans, Magnetic Resonance Imaging, Cine, Male, Organ Size, Postoperative Complications etiology, Postoperative Complications pathology, Prospective Studies, Pulmonary Valve Insufficiency etiology, Pulmonary Valve Insufficiency pathology, ROC Curve, Recurrence, Reoperation, Stroke Volume, Time Factors, Ventricular Outflow Obstruction etiology, Ventricular Outflow Obstruction surgery, Ventricular Remodeling, Heart Valve Prosthesis Implantation methods, Heart Ventricles pathology, Magnetic Resonance Imaging, Preoperative Care methods, Pulmonary Valve surgery, Pulmonary Valve Insufficiency surgery, Tetralogy of Fallot surgery, Ventricular Outflow Obstruction pathology
- Abstract
Background: To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery., Methods and Results: Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42+/-10% to 43+/-10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m2) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: beta=0.41; P<0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m2 for normalization of RV end-diastolic volume or 82 mL/m2 for RV end-systolic volume., Conclusions: Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was <160 mL/m2 or RV end-systolic volume was <82 mL/m2.
- Published
- 2007
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5. Cardiovascular magnetic resonance in a pregnant patient with absent pulmonary valve syndrome.
- Author
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Oosterhof T, Vriend JW, Spijkerboer AM, and Mulder BJ
- Subjects
- Adult, Chronic Disease, Female, Humans, Pregnancy, Pregnancy Complications, Cardiovascular surgery, Pulmonary Artery surgery, Pulmonary Valve pathology, Pulmonary Valve surgery, Pulmonary Valve Insufficiency surgery, Severity of Illness Index, Syndrome, Treatment Outcome, Magnetic Resonance Angiography, Magnetic Resonance Imaging, Cine, Pregnancy Complications, Cardiovascular pathology, Pulmonary Artery pathology, Pulmonary Valve abnormalities, Pulmonary Valve Insufficiency pathology
- Abstract
We present a 22 year old Moroccan woman with chronic severe pulmonary regurgitation, who becomes symptomatic in her fourth month of pregnancy. Cardiovascular magnetic resonance, during pregnancy, revealed a large pulmonary aneurysm and turbulent blood flow in the pulmonary trunk with severe pulmonary regurgitation. After gestation, the branch pulmonary arteries were assessed with magnetic resonance angiography and the severely dilated pulmonary arterial trunk and valve were replaced by a pulmonary homograft. We briefly review this rare syndrome, the management of pulmonary regurgitation during pregnancy and the role of CMR during pregnancy.
- Published
- 2007
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6. Long-term follow-up of homograft function after pulmonary valve replacement in patients with tetralogy of Fallot.
- Author
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Oosterhof T, Meijboom FJ, Vliegen HW, Hazekamp MG, Zwinderman AH, Bouma BJ, van Dijk AP, and Mulder BJ
- Subjects
- Adult, Blood Pressure physiology, Disease-Free Survival, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Pregnancy, Pregnancy Complications, Cardiovascular etiology, Pulmonary Valve Insufficiency complications, Pulmonary Valve Stenosis complications, Reoperation, Retrospective Studies, Transplantation, Homologous, Graft Survival physiology, Heart Valve Prosthesis, Pulmonary Valve, Pulmonary Valve Insufficiency surgery, Pulmonary Valve Stenosis surgery, Tetralogy of Fallot complications
- Abstract
Aims: To analyse the long-term outcomes after pulmonary valve replacement (PVR) in patients with a previous correction for tetralogy of Fallot., Methods and Results: In a retrospective study, 158 adult patients with a diagnosis of tetralogy of Fallot, who had undergone a PVR after initial total correction in childhood, were identified from the CONCOR (CONgenital CORvitia) registry. All patients underwent 175 PVRs between June 1986 and June 2005. To analyse the predictors for homograft dysfunction and adverse events (death, reoperations, balloon angioplasty), Cox-regression analysis was performed. Overall freedom from significant homograft dysfunction was 66% after 5 years and 47% after 10 years. We could not identify predictors for combined homograft dysfunction. Event-free survival was 78% at 10 years and 68% at 15 years after PVR. Both early significant pulmonary regurgitation (PR) (HR 6.8, P = 0.017) and pulmonary stenosis (PS) (HR 4.0, P = 0.037) after surgery were associated with adverse events. When analysing direct post-operative PR or PS, we observed that in patients with severe, pre-operative PR, right ventricular aneurysm/patch resection resulted in a lower post-operative PR (mean difference grade 0.38 +/- 0.14, P = 0.01). Less significant post-operative PS was associated with a higher diameter of the homograft (HR 0.37, P = 0.006)., Conclusion: While 47% of the patients in our study were free from homograft dysfunction at 10 years after PVR, event-free survival after PVR remained fairly good (78%). Significant residual lesions directly after surgery influenced event-free survival. A smaller diameter of the pulmonary homograft and severe pre-surgical PR were related to early homograft dysfunction after surgery.
- Published
- 2006
- Full Text
- View/download PDF
7. Opportunities in pulmonary valve replacement.
- Author
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Oosterhof, Thomas, Hazekamp, Mark G., and Mulder, Barbara J. M.
- Subjects
PULMONARY stenosis ,PULMONARY valve ,TETRALOGY of Fallot ,AORTIC valve insufficiency ,ANTICOAGULANTS ,THROMBOEMBOLISM ,HOMOGRAFTS ,PROSTHETIC heart valves ,SURGERY ,THERAPEUTICS - Abstract
Pulmonary regurgitation is the most important residual lesion after initial surgical correction for pulmonary (sub)valvular stenosis in the early life of patients with tetralogy of Fallot or isolated pulmonary stenosis. Symptomatic or asymptomatic patients with severe right ventricular dilatation due to pulmonary regurgitation may benefit from pulmonary valve replacement. Surgery is ideally performed before the right ventricle becomes irreversibly damaged as a result of longstanding volume overload. However, the beneficial effects must be weighed up against the problems associated with degradation of the allograft, which often result in (numerous) reoperations. Owing to the higher risk of thromboembolic events in mechanical prosthesis and the lifetime need for anticoagulation, allografts are the most widely used prosthesis. Degradation of the allograft often leads to reoperation, mostly 10-20 years after initial implantation. For a patient receiving his first allograft at 20 years of age, several reoperations will have to be performed later in life. Percutaneous pulmonary valve implantation has the potential to decrease the number of surgical reoperations. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
8. Long-term effect of pulmonary valve replacement on QRS duration in patients with corrected tetralogy of Fallot.
- Author
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Oosterhof, Thomas, Vliegen, Hubert W., Meijboom, Folkert J., Zwinderman, Aeilko H., Bouma, Berto, and Mulder, Barbara J. M.
- Subjects
- *
PULMONARY valve , *PATIENTS , *TETRALOGY of Fallot , *HEART valve surgery , *POSTOPERATIVE care , *HEALTH outcome assessment - Abstract
Objective: To analyse the long-term course of QRS duration after pulmonary valve replacement in patients with a previous correction for tetralogy of Fallot. Setting: Tertiary referral centres. Methods: In a retrospective study, 99 adult patients with tetralogy of Fallot, who had undergone a first pulmonary valve replacement late after initial total correction, were identified from the CONCOR (CONgenital CORvitia) registry. Computer-generated QRS durations were obtained from 12-lead electrocardiogram ECG reports in the medical records. A mixed linear regression model was used to analyse the course of QRS duration over time and to identify risk factors for increase in QRS duration over time. Composite end point was created from sudden cardiac death, ventricular tachycardia or implantable cardioverter-defibrillator discharge. Results: In total, 99 patients (57% men, mean (SD) age at pulmonary valve replacement 29 (11) years) with a median follow-up of 4.9 (0.1-16) years were analysed. In patients with preoperative QRS <120 ms, surgery caused no significant change in QRS duration (increase 1.3 (7.9) ms; p=0.65), and after surgery, QRS duration remained stable overtime (increase 0.0064(0.059) ms/year; p=0.98). By contrast, in patients with a preoperative ORS of 150-180 ms or QRS ⩾ 180 ms, surgery resulted in QRS shortening (mean decrease 9.9 (SE 4.3) ms, p=0.021, and 12.2 (SE 2) ms; p<0.001, respectively). During follow-up, a QRS widening 1.1(1.3) ms/year (p<0.001) in both groups was observed. In patients with a preoperative QRS ⩾ 180 ms, no significant difference was observed in the number of patients reaching the composite end point compared with patients with a preoperative QRS of 150-180 ms (25% vs 7%; p = 0.08). However, the former more often reached QRS ⩾180 ms again after surgery compared with the latter (53% vs 13%; p=0.02, respectively). None of the patients with a preoperative QRS ⩾ 180 ms died during follow-up. Conclusion: In our study, we observed a decrease in QRS duration directly after surgery, followed by a steady increase, in patients with a preoperative QRS >150 ms. The beneficial effect of pulmonary valve replacement on QRS duration was transient. The risk of developing ventricular arrhythmias after surgery was substantial when preoperative QRS was ⩾180 ms, but mortality remained low. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
- View/download PDF
9. Individualised prediction of pulmonary homograft durability in tetralogy of Fallot.
- Author
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Ee Ling Heng, Gatzoulis, Michael A., Babu-Narayan, Sonya V., Bokma, Jouke P, Winter, Michiel M, Oosterhof, Thomas, Vliegen, Hubert W, van Dijk, Arie P, Hazekamp, Mark G, Koolbergen, Dave R, Groenink, Maarten, Mulder, Barbara Jm, Bouma, Berto J, and Mulder, Barbara J M
- Subjects
PULMONARY artery ,PULMONARY valve ,AGE distribution ,HEART ventricle diseases ,CARDIOVASCULAR surgery ,ECHOCARDIOGRAPHY ,HOMOGRAFTS ,RIGHT heart ventricle ,HEALTH outcome assessment ,COMPLICATIONS of prosthesis ,REOPERATION ,RISK assessment ,SURGICAL complications ,TETRALOGY of Fallot ,PROPORTIONAL hazards models ,RETROSPECTIVE studies ,DIAGNOSIS ,SURGERY - Abstract
Background: In patients with repaired tetralogy of Fallot (rTOF), multiple reoperations or percutaneous interventions after pulmonary valve replacement (PVR) may be necessary due to limited homograft durability. However, data to guide individualised prediction of homograft durability remain scarce. The aim of this study was to provide risk models for RV to pulmonary artery homograft durability.Methods: This retrospective multicentre study included consecutive patients with rTOF who had undergone PVR at an age of >12 years. Homograft dysfunction was defined as at least moderate pulmonary regurgitation (PR) or pulmonary stenosis (PS) (pressure gradient ≥36 mm Hg) as assessed by echocardiography. Reintervention was defined as percutaneous intervention or redo-PVR.Results: A total of 153 patients with rTOF were included (62% male, mean age at PVR 31±11 years, pulmonary homograft 96%, follow-up 9.6 years (IQR 5.9, 13.3)). Average freedom from homograft dysfunction and reintervention after 10 years was 74% and 89%, respectively. In multivariable Cox proportional hazards analysis, postoperative PS ≥20 mm Hg (HR 6.52, 95% CI 3.09 to 13.7), postoperative PR ≥ grade 1 (HR 3.13, 95% CI 1.45 to 6.74) and age at PVR <18 years (HR 3.52, 95% CI 1.64 to 7.53) were independently predictive for homograft dysfunction. In patients without any risk factor, 10-year freedom from homograft dysfunction and reintervention was excellent (91% and 96%, respectively) in contrast to patients with ≥2 risk factors (25% and 73%, respectively).Conclusions: Individualised prediction of homograft durability in patients with rTOF can be guided by early postoperative echocardiography. In adult patients without early postoperative PS or PR, homograft dysfunction and reintervention are unlikely to occur within 10 years, and follow-up may be less stringent. [ABSTRACT FROM AUTHOR]- Published
- 2015
- Full Text
- View/download PDF
10. HEMODYNAMIC EFFECTS OF PULMONARY VALVE REPLACEMENT FOR PULMONARY REGURGITATION AFTER REPAIR OF ISOLATED PULMONARY STENOSIS: A MATCHED COMPARISON WITH TETRALOGY OF FALLOT.
- Author
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Bokma, Jouke Pieter, Winter, Michiel, Oosterhof, Thomas, Vliegen, Hubert, Van Dijk, Arie, Hazekamp, Mark, Koolbergen, David, Groenink, Maarten, Mulder, Barbara, and Bouma, Berto
- Subjects
- *
HEMODYNAMICS , *AORTIC valve insufficiency , *PULMONARY stenosis , *TETRALOGY of Fallot , *PULMONARY valve - Published
- 2015
- Full Text
- View/download PDF
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