Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Orphans --- Remarriage --- Widowhood --- Widows --- Social conditions. --- Veuves --- Orphelins --- History --- Histoire --- Economic conditions --- Social conditions --- Legal status, laws, etc. --- Droit --- Conditions sociales --- Remariage --- Rome --- Church work with widows --- Church work with orphans --- Church charities --- Church history --- Primitive and early church, ca. 30-600 A.D. --- History. --- Economic conditions. --- Theses --- -Remarriage --- -Widowhood --- -Widows --- -Life cycle, Human --- Marriage --- Orphans and orphan-asylums --- Children --- Marital status --- Women --- -Marital status --- Life cycle, Human --- Orphaned children --- -Social conditions

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Patients with 'transposition of the great arteries' (TGA) constitute about 5% of all patients born with a congenital heart defect. They have an anatomic right ventricle (RV) that has to support the high-pressure systemic circulation instead of the low-pressure pulmonary circulation. There are two types of TGA patients with a systemic RV (sRV) in a biventricular physiology: patients with complete TGA after atrial switch procedure (TGA-Mustard/Senning) and patients with congenitally corrected TGA (ccTGA). Besides important pathophysiological differences between TGA-Mustard/Senning and ccTGA patients, the presence of associated lesions and other factors may lead to a variation in time of onset of clinical symptoms and adverse events. These adverse events include sRV dysfunction and heart failure, conduction problems, supraventricular and ventricular arrhythmias, sudden death, and systemic atrioventricular valve (SAVV, morphological tricuspid valve) regurgitation. In this thesis we tried to better phenotype patients with a sRV by evaluating (1) the correlation of resting measure of sRV function with exercise capacity for both patient groups; (2) differences in myocardial deformation, myocardial extracellular volume and response to an exercise testing; (3) advanced analysis of pulmonary venous atrial (PVA) function; (4) SAVV morphology and dynamics; (5) the association between the appearance of fragmented QRS complexes -a presumed surrogate for fibrosis- and hard clinical endpoints related to the performance of the sRV in TGA-Mustard/Senning patients; and (6) the proposed protective effect of geometry alterations in the sRV of ccTGA patients by pulmonary outflow tract obstruction. We found that (1) there is norelation between standard parameters of systolic sRV function at rest and exercise performance; (2) caution should be exercised when evaluating pooled analyses of sRV patients given the differences in myocardial contraction pattern, septal interstitial expansion and the exercise response of TGA-Mustard/Senning versus ccTGA patients. Exercise impairment in TGA-Mustard/Senning patients seems not related to myocardial contractility but to a lower heart rate response.; (3) deformation imaging of the PVA is feasible and preliminary results seem promising indicating to worse PVA function in TGA-Mustard/Senning patients; (4) a 3D dynamical analysis of the SAVV is feasible; (5) appearance of fQRS complexes is associated with adverse outcome in TGA-Mustard/Senning patients making it a promising tool to implement in daily practice; and (6) pulmonary outflow tract obstruction is associated with an improved event-free survival and a slower deterioration of SAVV function in adults with ccTGA, questioning the validity and merits of physiologic repair in the situation of a balanced VSD/subPS.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Background Left bundle branch pacing (LBBP) has been proven to maintain electrical synchrony better than right ventricular pacing (RVP), but little is known about its impact on mechanical synchrony. This study investigates if LBBP preserves better left ventricular (LV) mechanical synchrony and function compared to conventional (CRVP) and leadless (LRVP) RVP. Methods Sixty-eight patients with pacing indication for bradycardia were prospectively enrolled: LBBP (n=25), CRVP (n=23) and LRVP (n=20). Echocardiography was performed before and after pacemaker implantation and at one-year follow-up. Regional septal (SW) and lateral wall work (LW) was calculated as the average from the respective basal and mid-ventricular segments in the apical four-chamber and three-chamber view. The lateral-septal (LW-S) work difference was used as a measure of mechanical dyssynchrony. Alternative parameters of mechanical dyssynchrony including septal flash, apical rocking and septal strain patterns were also assessed. Results At baseline, LW-S work difference was similar in all three groups. SW was markedly decreased in CRVP and LRVP while LW work remained unchanged, resulting in a larger LW-S work difference compared to LBBP (1444±695 mmHg*% and 1455±600 mmHg*% vs. 308±468 mmHg*%, both P<0.001) at last follow-up. LBBP also caused less septal flash or apical rocking, and less advanced strain patterns than both RVP groups. During one year follow-up, LV ejection fraction (EF) and global longitudinal strain (GLS) decreased more in RVP compared to LBBP (LVEF: P<0.05 vs CRVP; LVGLS: both P<0.01). In addition, ΔLW-S work difference inversely correlated with ΔLVEF and ΔLVGLS during follow-up (r = -0.37, -0.47, respectively, both P< 0.01). Conclusion LBBP causes less LV mechanical dyssynchrony than CRVP and LRVP as it preserves a more physiologic conduction pattern. With this, LBBP appears to preserve LV function better than RVP. CRVP and LRVP did not differ in mechanical dyssynchrony or LV remodelling.