Adult survivors of congenital heart disease form a continuously growing population, as each succe... more Adult survivors of congenital heart disease form a continuously growing population, as each successive cohort graduating from pediatric care expands the total number of patients worldwide. Consequently, there is an increasing interest and study of their late pathophysiology, the understanding of which can only truly be understood during very long-term follow-up. Indeed, we have already learned that, for some patient groups, hitherto unexpected problems may only develop decades after surgery. Consequently, many patients require careful follow-up in ACHD clinics throughout life. However, in the most frequent congenital heart disease, ventricular septal defect (VSD), most guidelines recommend that specialized follow-up in ACHD clinics may only be indicated for those patients with significant residual anatomic problems, or overt pulmonary hypertension. Indeed, the late outcome for patients undergoing 'uncomplicated' repair in childhood has been described as benign. However, rece...
Severe pulmonary valve regurgitation caused by a pulmonary valve tear is a rare complication to a... more Severe pulmonary valve regurgitation caused by a pulmonary valve tear is a rare complication to a blunt chest trauma. In this case report, we present a patient with pulmonary regurgitation originating from a chest trauma 40 years ago. Possible mechanisms are osseous pinch of the pulmonary valve between the anterior chest wall and the vertebral column, and retrograde blowout from severe compression of the lungs.
Ventricular septal defects (VSDs) are normally closed in early childhood, and postsurgical physic... more Ventricular septal defects (VSDs) are normally closed in early childhood, and postsurgical physical capacity is generally considered normal. Despite an increasing understanding of late cardiac morbidity among these patients, long-term pulmonary function remains to be investigated. Therefore, the aim of this prospective follow-up study was to describe ventilatory function during exercise in VSD-repaired adults operated in early life. We tested cardiopulmonary exercise capacity in 27 patients and 30 healthy control subjects on an ergometer cycle. Each test was preceded by a standard spirometry, and the exercise test was performed as a maximal incremental test. Pulmonary ventilation and gas exchange were simultaneously measured breath-by-breath with minute ventilation at peak exercise as our main endpoint. In the VSD-group the median surgical age was 1.9 (95% CI 1.1-2.8years) and the mean age at time of examination was 21.1±3.1years in the VSD-group vs. 21.2±2.5years in the control gro...
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2014
To investigate the effect of right ventricular stunning on interventricular relationships in newb... more To investigate the effect of right ventricular stunning on interventricular relationships in newborn piglets and to determine the effect of three commonly used inotropic treatment strategies. Randomized, placebo-controlled animal study. Aarhus University Hospital, animal laboratory. Twenty-eight newborn (4-d old) farm-bred piglets. Acute right ventricular failure was induced by 10 cycles of alternating 3 minutes of ischemia and reperfusion of the right coronary artery. After right ventricular failure was induced, treatment with epinephrine + milrinone, dopamine + milrinone, dobutamine, or control (saline) was initiated, and the animals were observed for 180 minutes. Right and left ventricular systolic and diastolic variables were measured using pressure-volume loops recorded by conductance catheters. Arterial and central venous pressures were recorded, and cardiac index was determined by placing a flow probe around the pulmonary artery. Whole-body perfusion was evaluated by measurin...
Recent studies have shown markedly reduced functional capacity in long-term survivors of ventricu... more Recent studies have shown markedly reduced functional capacity in long-term survivors of ventricular septal defect (VSD), and in order to explore possible mechanisms, we performed non-invasive assessment of ventricular force-frequency relationships during exercise in adults operated for VSD in early childhood. We conducted a prospective study at a tertiary referral center. Patients (n=23) and healthy controls (n=20) underwent continuous Doppler-echocardiographic imaging during supine bicycle ergometry. The cycling workload was individually and manually incremented during the test session in response to heart rate. The heart was imaged in an apical 4-chamber view, and color-coded myocardial velocities were recorded. Post hoc, peak systolic velocity and isovolumetric acceleration (IVA) were blindly determined in the basal ventricular segments. VSD-operated patients differed markedly in all right ventricular endpoints compared with controls. IVA was lower prior to the test, 70±30cm/s(2...
European heart journal cardiovascular Imaging, Jan 31, 2014
Patients with a surgically closed ventricular septal defect (VSD) contribute significantly to the... more Patients with a surgically closed ventricular septal defect (VSD) contribute significantly to the increasing number of adults with congenital heart disease. The chronic effects of prior adverse haemodynamics in this population are incompletely understood. Our objective was to assess postoperative cardiac function and morphology in adult survivors of surgery in childhood. Patients (n = 27), median surgical age of 1.9 (95% CI 1.1-2.8 years) and 20.5 (95% CI 19.6-22.1 years) at the time of examination, and age-matched controls (n = 28) underwent cardiac magnetic resonance imaging. We performed offline analyses of biventricular cardiac deformations, myocardial mass indices, flow patterns, and chamber areas and dimensions. In comparison with controls, VSD-operated patients had higher right ventricular (RV) areas; 36.8 ± 9.0 vs. 30.4 ± 6.4 cm(2) in end-diastole, P < 0.01, and 21.3 ± 5.9 vs. 16.0 ± 3.9 cm(2) in end-systole, P < 0.01. Furthermore, we found that fractional area change ...
Adult survivors of congenital heart disease form a continuously growing population, as each succe... more Adult survivors of congenital heart disease form a continuously growing population, as each successive cohort graduating from pediatric care expands the total number of patients worldwide. Consequently, there is an increasing interest and study of their late pathophysiology, the understanding of which can only truly be understood during very long-term follow-up. Indeed, we have already learned that, for some patient groups, hitherto unexpected problems may only develop decades after surgery. Consequently, many patients require careful follow-up in ACHD clinics throughout life. However, in the most frequent congenital heart disease, ventricular septal defect (VSD), most guidelines recommend that specialized follow-up in ACHD clinics may only be indicated for those patients with significant residual anatomic problems, or overt pulmonary hypertension. Indeed, the late outcome for patients undergoing 'uncomplicated' repair in childhood has been described as benign. However, rece...
Severe pulmonary valve regurgitation caused by a pulmonary valve tear is a rare complication to a... more Severe pulmonary valve regurgitation caused by a pulmonary valve tear is a rare complication to a blunt chest trauma. In this case report, we present a patient with pulmonary regurgitation originating from a chest trauma 40 years ago. Possible mechanisms are osseous pinch of the pulmonary valve between the anterior chest wall and the vertebral column, and retrograde blowout from severe compression of the lungs.
Ventricular septal defects (VSDs) are normally closed in early childhood, and postsurgical physic... more Ventricular septal defects (VSDs) are normally closed in early childhood, and postsurgical physical capacity is generally considered normal. Despite an increasing understanding of late cardiac morbidity among these patients, long-term pulmonary function remains to be investigated. Therefore, the aim of this prospective follow-up study was to describe ventilatory function during exercise in VSD-repaired adults operated in early life. We tested cardiopulmonary exercise capacity in 27 patients and 30 healthy control subjects on an ergometer cycle. Each test was preceded by a standard spirometry, and the exercise test was performed as a maximal incremental test. Pulmonary ventilation and gas exchange were simultaneously measured breath-by-breath with minute ventilation at peak exercise as our main endpoint. In the VSD-group the median surgical age was 1.9 (95% CI 1.1-2.8years) and the mean age at time of examination was 21.1±3.1years in the VSD-group vs. 21.2±2.5years in the control gro...
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2014
To investigate the effect of right ventricular stunning on interventricular relationships in newb... more To investigate the effect of right ventricular stunning on interventricular relationships in newborn piglets and to determine the effect of three commonly used inotropic treatment strategies. Randomized, placebo-controlled animal study. Aarhus University Hospital, animal laboratory. Twenty-eight newborn (4-d old) farm-bred piglets. Acute right ventricular failure was induced by 10 cycles of alternating 3 minutes of ischemia and reperfusion of the right coronary artery. After right ventricular failure was induced, treatment with epinephrine + milrinone, dopamine + milrinone, dobutamine, or control (saline) was initiated, and the animals were observed for 180 minutes. Right and left ventricular systolic and diastolic variables were measured using pressure-volume loops recorded by conductance catheters. Arterial and central venous pressures were recorded, and cardiac index was determined by placing a flow probe around the pulmonary artery. Whole-body perfusion was evaluated by measurin...
Recent studies have shown markedly reduced functional capacity in long-term survivors of ventricu... more Recent studies have shown markedly reduced functional capacity in long-term survivors of ventricular septal defect (VSD), and in order to explore possible mechanisms, we performed non-invasive assessment of ventricular force-frequency relationships during exercise in adults operated for VSD in early childhood. We conducted a prospective study at a tertiary referral center. Patients (n=23) and healthy controls (n=20) underwent continuous Doppler-echocardiographic imaging during supine bicycle ergometry. The cycling workload was individually and manually incremented during the test session in response to heart rate. The heart was imaged in an apical 4-chamber view, and color-coded myocardial velocities were recorded. Post hoc, peak systolic velocity and isovolumetric acceleration (IVA) were blindly determined in the basal ventricular segments. VSD-operated patients differed markedly in all right ventricular endpoints compared with controls. IVA was lower prior to the test, 70±30cm/s(2...
European heart journal cardiovascular Imaging, Jan 31, 2014
Patients with a surgically closed ventricular septal defect (VSD) contribute significantly to the... more Patients with a surgically closed ventricular septal defect (VSD) contribute significantly to the increasing number of adults with congenital heart disease. The chronic effects of prior adverse haemodynamics in this population are incompletely understood. Our objective was to assess postoperative cardiac function and morphology in adult survivors of surgery in childhood. Patients (n = 27), median surgical age of 1.9 (95% CI 1.1-2.8 years) and 20.5 (95% CI 19.6-22.1 years) at the time of examination, and age-matched controls (n = 28) underwent cardiac magnetic resonance imaging. We performed offline analyses of biventricular cardiac deformations, myocardial mass indices, flow patterns, and chamber areas and dimensions. In comparison with controls, VSD-operated patients had higher right ventricular (RV) areas; 36.8 ± 9.0 vs. 30.4 ± 6.4 cm(2) in end-diastole, P < 0.01, and 21.3 ± 5.9 vs. 16.0 ± 3.9 cm(2) in end-systole, P < 0.01. Furthermore, we found that fractional area change ...
Uploads
Papers by Johan Heiberg