Echocardiographic Screening for Pulmonary Hypertension in Congenital Heart Disease: JACC Review Topic of the Week.

Echocardiography is the mainstay in screening for pulmonary hypertension (PH). International guidelines suggest echocardiographic parameters for suspecting PH, but these may not apply to many adults with congenital heart disease (ACHD). PH is relatively common in ACHD patients and can significantly affect their exercise capacity, quality of life, and prognosis. Identification of patients who have developed PH and who may benefit from further investigations (including cardiac catheterization) and treatment is thus extremely important. A systematic review and survey of experts from the United Kingdom and Ireland were performed to assess current knowledge and practice on echocardiographic screening for PH in ACHD. This paper presents the findings of the review and expert statements on the optimal approaches when using echocardiography to assess ACHD patients for PH, with particular focus on major subgroups: patients with right ventricular outflow tract obstruction, patients with systemic right ventricles, patients with unrepaired univentricular circulation, and patients with tetralogy of Fallot with pulmonary atresia.

An audit of persistent foramen ovale closure in 105 divers.

INTRODUCTION: Right-to-left shunt across a persistent foramen ovale (PFO) has been associated with cutaneous, neurological and vestibular decompression illness (DCI). Percutaneous closure of a PFO has been used to reduce the risk of DCI. There are no randomised controlled trial data to support PFO closure for the prevention of decompression illness (DCI), so the need for audit data on the safety and efficacy of this technique has been recognised by the National Institute of Health and Clinical Excellence in the UK. METHOD: Retrospective audit of all transcatheter PFO closures to reduce the risk of DCI performed by a single cardiologist with an interest in diving medicine. RESULTS: A total of 105 eligible divers undergoing 107 procedures was identified. There was a low rate of procedural complications; a rate lower than a recent randomised trial of PFO closure for stroke. Atrial fibrillation required treatment in two patients. One patient with a previously repaired mitral valve had a stroke that was thought to be unrelated to the PFO closure. Sixteen divers had minor post-procedure symptoms not requiring any treatment. Two divers required a second procedure because of residual shunt; both subsequently returned to unrestricted diving. Eighty-one of 95 divers in whom follow-up bubble contrast echocardiography was available returned to unrestricted diving. CONCLUSIONS: The PFO closure procedure appeared to be safe and was associated with the majority of divers being able to successfully return to unrestricted diving.