erikthau

• Christensen, Anders Haugom; Wyller, Vegard Bruun Bratholm; Nygaard, Sissel; Rolid, Katrine; Nytrøen, Kari & Gullestad, Lars [Vis alle 10 forfattere av denne artikkelen] (2023). Factors Associated with Sinoatrial Reinnervation after Heart Transplantation. Transplantation direct. 9(12). doi: 10.1097/TXD.0000000000001553. Fulltekst i vitenarkiv Vis sammendrag

  Background. Factors associated with sympathetic and parasympathetic sinoatrial reinnervation after heart transplantation (HTx) are inadequately studied. Methods. Fifty transplant recipients were examined at 7 to 12 wk (index visit), 6, 12, 24, and 36 mo after HTx. Supine rest heart rate variability in the low-frequency (LF) domain (sympathetic and parasympathetic sinoatrial reinnervation) and the high-frequency (HF) domain (parasympathetic sinoatrial reinnervation) were measured repeatedly and related to selected recipient, donor, and perisurgical characteristics. We primarily aimed to identify index visit factors that affect the sinoatrial reinnervation process. Secondarily, we examined overall associations between indices of reinnervation and repeatedly measured recipient characteristics to generate new hypotheses regarding the consequences of reinnervation. Results. LF and HF variability increased time dependently. In multivariate modeling, a pretransplant diagnosis of nonischemic cardiomyopathy (P = 0.038) and higher index visit handgrip strength (P = 0.028) predicted improved LF variability. Recipient age, early episodes of rejection, and duration of extracorporeal circulation were not associated with indices of reinnervation. Study average handgrip strength was positively associated with LF and HF variability (respectively, P = 0.005 and P = 0.029), whereas study average C-reactive protein was negatively associated (respectively, P = 0.015 and P = 0.008). Conclusions. Indices of both sympathetic and parasympathetic sinoatrial reinnervation increased with time after HTx. A pretransplant diagnosis of nonischemic cardiomyopathy and higher index visit handgrip strength predicted higher indices of mainly sympathetic reinnervation, whereas age, rejection episodes, and duration of extracorporeal circulation had no association. HTx recipients with higher indices of reinnervation had higher average handgrip strength, suggesting a link between reinnervation and improved frailty. The more reinnervated participants had lower average C-reactive protein, suggesting an inhibitory effect of reinnervation on inflammation, possibly through enhanced function of the inflammatory reflex. These potential effects of reinnervation may affect long-term morbidity in HTx patients and should be scrutinized in future research.

• Erikssen, Gunnar; Liestøl, Knut; Aboulhosn, Jamil; Holmstrøm, Henrik; Wik, Gunnar & Døhlen, Gaute [Vis alle 14 forfattere av denne artikkelen] (2023). Preoperative versus postoperative survival in patients with univentricular heart: A nationwide, retrospective study of patients born in 1990-2015. BMJ Open. 13(7). doi: 10.1136/bmjopen-2022-069531. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Few data exist on mortality among patients with univentricular heart (UVH) before surgery. Our aim was to explore the results of intention to perform surgery by estimating preoperative vs postoperative survival in different UVH subgroups. Design Retrospective. Setting Tertiary centre for congenital cardiology and congenital heart surgery. Participants All 595 Norwegian children with UVH born alive from 1990 to 2015, followed until 31 December 2020. Results One quarter (151/595; 25.4%) were not operated. Among these, only two survived, and 125/149 (83.9%) died within 1 month. Reasons for not operating were that surgery was not feasible in 31.1%, preoperative complications in 25.2%, general health issues in 23.2% and parental decision in 20.5%. In total, 327/595 (55.0%) died; 283/327 (86.5%) already died during the first 2 years of life. Preoperative survival varied widely among the UVH subgroups, ranging from 40/65 (61.5%) among patients with unbalanced atrioventricular septal defect to 39/42 (92.9%) among patients with double inlet left ventricle. Postoperative survival followed a similar pattern. Postoperative survival among patients with hypoplastic left heart syndrome (HLHS) improved significantly (5-year survival, 42.5% vs 75.3% among patients born in 1990–2002 vs 2003–2015; p<0.0001), but not among non-HLHS patients (65.7% vs 72.6%; p=0.22)—among whom several subgroups had a poor prognosis similar to HLHS. A total of 291/595 patients (48.9%) had Fontan surgery Conclusions Surgery was refrained in one quarter of the patients, among whom almost all died shortly after birth. Long-term prognosis was largely determined during the first 2 years. There was a strong concordance between preoperative and postoperative survival. HLHS survival was improved, but non-HLHS survival did not change significantly. This study demonstrates the complications and outcomes encountering newborns with UVH at all major stages of preoperative and operative treatment.

• Nygaard, Sissel; Christensen, Anders Haugom; Sletner, Line; Rolid, Katrine; Nytrøen, Kari & Gullestad, Lars [Vis alle 11 forfattere av denne artikkelen] (2022). Predictors of Hypertension Development 1 Year after Heart Transplantation. Transplantation. ISSN 0041-1337. 106(8), s. 1656–1665. doi: 10.1097/TP.0000000000004068. Fulltekst i vitenarkiv
• Möller, Thomas; Klungerbo, Vibeke; Diab, Simone; Holmstrøm, Henrik; Edvardsen, Elisabeth & Grindheim, Guro [Vis alle 11 forfattere av denne artikkelen] (2021). Circulatory Response to Rapid Volume Expansion and Cardiorespiratory Fitness in Fontan Circulation. Pediatric Cardiology. ISSN 0172-0643. doi: 10.1007/s00246-021-02802-y. Fulltekst i vitenarkiv Vis sammendrag

  The role of dysfunction of the single ventricle in Fontan failure is incompletely understood. We aimed to evaluate hemodynamic responses to preload increase in Fontan circulation, to determine whether circulatory limitations in different locations identified by experimental preload increase are associated with cardiorespiratory fitness (CRF), and to assess the impact of left versus right ventricular morphology. In 38 consecutive patients (median age = 16.6 years, 16 females), heart catheterization was supplemented with a rapid 5-mL/kg body weight volume expansion. Central venous pressure (CVP), ventricular end-diastolic pressure (VEDP), and peak systolic pressure were averaged for 15‒30 s, 45‒120 s, and 4‒6 min (steady state), respectively. CRF was assessed by peak oxygen consumption (VO2peak) and ventilatory threshold (VT). Median CVP increased from 13 mmHg at baseline to 14.5 mmHg (p < 0.001) at steady state. CVP increased by more than 20% in eight patients. Median VEDP increased from 10 mmHg at baseline to 11.5 mmHg (p < 0.001). Ten patients had elevated VEDP at steady state, and in 21, VEDP increased more than 20%. The transpulmonary pressure difference (CVP‒VEDP) and CVP were consistently higher in patients with right ventricular morphology across repeated measurements. CVP at any stage was associated with VO2peak and VT. VEDP after volume expansion was associated with VT. Preload challenge demonstrates the limitations beyond baseline measurements. Elevation of both CVP and VEDP are associated with impaired CRF. Transpulmonary flow limitation was more pronounced in right ventricular morphology. Ventricular dysfunction may contribute to functional impairment after Fontan operation in young adulthood.

• Christensen, Anders Haugom; Nygaard, Sissel; Rolid, Katrine; Nytrøen, Kari; Gullestad, Lars & Fiane, Arnt Eltvedt [Vis alle 10 forfattere av denne artikkelen] (2021). Strong evidence for parasympathetic sinoatrial reinnervation after heart transplantation. The Journal of Heart and Lung Transplantation. ISSN 1053-2498. s. 1–12. doi: 10.1016/j.healun.2021.11.005. Fulltekst i vitenarkiv Vis sammendrag

  Background Heart transplantation (HTx) surgically denervates the heart. We examined indices of sinoatrial reinnervation, with emphasis on (1) the occurrence and timing of parasympathetic reinnervation, and (2) the consequences of reinnervation for heart rate (HR) responsiveness and arterial baroreceptor sensitivity. Methods Fifty HTx recipients were prospectively followed for 36 months after surgery. Hemodynamic variables and heart rate variability were continuously recorded at supine rest, 60 degrees head-up-tilt, during the Valsalva maneuver and during handgrip isometric exercise. Results Suggesting parasympathetic reinnervation: at baseline rest, root of the mean squared differences of successive RR intervals increased from median 3.9(5.9) to 7.1(5.1) ms (p < 0.001); high-frequency power increased from 4.0(12) to 5.7(18.9) ms2 (p = 0.018); and baroreceptor sensitivity increased from 0.04(0.36) to 1.3(2.4) ms/mmHg (p < 0.001). Suggesting sympathetic reinnervation: at baseline rest low-frequency power increased from 0.49(2.5) to 7.5(18.1) ms2 (p < 0.001); and HR responses to sympathetic stimulation during (1) head-up tilt increased from 1.9(4.2) to 9.1(8.2) bpm (p < 0.001), (2) Valsalva increased from 1.6(1.4) to 8.3(10.8) bpm (p < 0.001) and (3) handgrip increased from 0.3(0.6) to 1.9(5.1) bpm (p < 0.001). Signs of sympathetic reinnervation emerged within 6 months, while signs of parasympathetic reinnervation emerged by 24 months. Conclusions Root of the mean squared differences of successive RR intervals, high-frequency and low-frequency variability, HR responsiveness and arterial baroreflex sensitivity all increased after HTx, suggesting functional parasympathetic and sympathetic sinoatrial reinnervation. Accordingly, the pathological regulatory state present in heart transplant recipients, which is responsible for a host of functional and clinical abnormalities, is being partially offset over time by restored autonomic control of the heart in many heart transplant recipients.

• Christensen, Anders Haugom; Nygaard, Sissel Irene; Rolid, Katrine; Nytrøen, Kari; Gullestad, Lars & Fiane, Arnt [Vis alle 10 forfattere av denne artikkelen] (2021). Early Signs of Sinoatrial Reinnervation in the Transplanted Heart. Transplantation. ISSN 0041-1337. 105(9), s. 2086–2096. doi: 10.1097/TP.0000000000003580. Fulltekst i vitenarkiv
• Thrane, Karl Julius; Müller, Lil-Sofie Ording; Suther, Lene Kathrine R; Thomassen, Kristian Stien; Holmstrøm, Henrik & Thaulow, Erik [Vis alle 9 forfattere av denne artikkelen] (2021). Spectrum of Fontan‑associated liver disease assessed by MRI and US in young adolescents. Abdominal Radiology. ISSN 2366-004X. 46, s. 3205–3216. doi: 10.1007/s00261-021-02994-0. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Purpose Patients with Fontan circulation are at risk of developing hepatic fibrosis/cirrhosis. The mechanisms and disease development are unclear and early secondary liver cancer is a concern. This study will describe hepatic imaging findings in a national cohort of adolescents with Fontan circulation. Methods The patients prospectively underwent abdominal contrast enhanced magnetic resonance imaging (MRI) including diffusion-weighted imaging. Images were assessed for criteria of fibrosis / cirrhosis including characterization of hepatic nodules. These nodules were in addition, assessed by ultrasonography (US). Nodules ≥ 1 cm were investigated and monitored to evaluate malignant transformation. Clinical and hepatic serological data were recorded. Results Forty-six patients, median age of 16.5 years (15.4–17.9 years) were enrolled. All patients underwent US examination and MRI was performed in 35/46 patients. On MRI, 60% had hepatomegaly and 37% had signs of fibrosis/cirrhosis. Seven patients had together 13 nodules ≥ 1 cm in diameter. Only 4/13 (17%) where seen on US. Nodules had variable MRI signal characteristics including hepatobiliary contrast enhancement and two nodules revealed portal venous phase ‘wash-out’ on the first examination. No further imaging signs of malignancy were revealed during the follow-up period of median 24.4 (7–42) months. Conclusion The majority of adolescents with Fontan circulation had imaging findings of fibrosis/cirrhosis of varying severity. US had low detection rate of hepatic nodules compared to MRI. The imaging work-up before transition to adult cardiology care did not reveal findings suggestive of malignancy. However, the high prevalence of Fontan-associated liver disease calls for surveillance strategies even in childhood.

• Wyller, Vegard Bruun Bratholm; Nygaard, Sissel; Christensen, Anders Haugom; Rolid, Katrine; Nytrøen, Kari & Gullestad, Lars [Vis alle 10 forfattere av denne artikkelen] (2021). Functional evidence of low-pressure cardiopulmonary baroreceptor reinnervation 1 year after heart transplantation. European Journal of Applied Physiology. ISSN 1439-6319. 121(3), s. 915–927. doi: 10.1007/s00421-020-04586-0. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Heart transplantation (HTx) implies denervation of afferent neural connections. Reinnervation of low-pressure cardiopulmonary baroreceptors might impact the development and treatment of hypertension, but little is known of its occurrence. The present prospective study investigated possible afferent reinnervation of low-pressure cardiopulmonary baroreceptors during the first year after heart transplantation. Methods A total of 50 heart transplant recipients (HTxRs) were included and were evaluated 7–12 weeks after transplant surgery, with follow-up 6 and 12 months later. In addition, a reference group of 50 healthy control subjects was examined once. Continuous, non-invasive recordings of cardiovascular variables were carried out at supine rest, during 15 min of 20° head-up tilt, during Valsalva maneuver and during 1 min of 30% maximal voluntary handgrip. In addition, routine clinical data including invasive measurements were used in the analyses. Results During the first year after HTx, the heart rate (HR) response to 20° head-up tilt partly normalized, a negative relationship between resting mean right atrial pressure and HR tilt response developed, low-frequency variability of the RR interval and systolic blood pressure at supine rest increased, and the total peripheral resistance response to Valsalva maneuver became stronger. Conclusion Functional assessments suggest that afferent reinnervation of low-pressure cardiopulmonary receptors occurs during the first year after heart transplantation, partially restoring reflex-mediated responses to altered cardiac filling.

• Falk, Ragnhild Sørum; Mariampillai, Julian Eek; Prestgaard, Erik Edvard; Heir, Trond; Bodegard, Johan & Robsahm, Trude Eid [Vis alle 18 forfattere av denne artikkelen] (2021). The Oslo Ischaemia Study: cohort profile. BMJ Open. 11(10). doi: 10.1136/bmjopen-2021-049111. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Purpose The Oslo Ischaemia Study was designed to investigate the prevalence and predictors of silent coronary disease in Norwegian middle-aged men, specifically validating exercise electrocardiography (ECG) findings compared with angiography. The study has been important in investigating long-term predictors of cardiovascular morbidity and mortality, as well as investigating a broad spectrum of epidemiological and public health perspectives. Participants In 1972–1975, 2014 healthy men, 40–59 years old, were enrolled in the study. Comprehensive clinical examination included an ECG-monitored exercise test at baseline and follow-ups. The cohort has been re-examined four times during 20 years. Linkage to health records and national health registries has ensured complete endpoint registration of morbidity until the end of 2006, and cancer and mortality until the end of 2017. Findings to date The early study results provided new evidence, as many participants with a positive exercise ECG, but no chest pain (‘silent ischaemia’), did not have significant coronary artery stenosis after all. Still, they were over-represented with coronary disease after years of follow-up. Furthermore, participants with the highest physical fitness had lower risk of cardiovascular disease, and the magnitude of blood pressure responses to moderate exercise was shown to influence the risk of cardiovascular disease and mortality. With time, follow-up data allowed the scope of research to expand into other fields of medicine, with the aim of investigating predictors and the importance of lifestyle and risk factors. Future plans Recently, the Oslo Ischaemia Study has been found worthy, as the first scientific study, to be preserved by The National Archives of Norway. All the study material will be digitised, free to use and accessible for all. In 2030, the Oslo Ischaemia Study will be linked to the Norwegian Cause of Death Registry to obtain complete follow-up to death. Thus, a broad spectrum of additional opportunities opens.

• Lange, Charlotte de; Thrane, Karl Julius; Thomassen, Kristian Stien; Geier, Oliver; Nguyen, Bac & Tomterstad, Anders [Vis alle 12 forfattere av denne artikkelen] (2020). Hepatic magnetic resonance T1-mapping and extracellular volume fraction compared to shear-wave elastography in pediatric Fontan-associated liver disease. Pediatric Radiology. ISSN 0301-0449. 51, s. 66–76. doi: 10.1007/s00247-020-04805-y. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Children with Fontan circulation are at risk of developing hepatic fibrosis/cirrhosis. Reliable noninvasive monitoring techniques are lacking or under development. Objective To investigate surrogate indicators of hepatic fibrosis in adolescents with Fontan circulation by evaluating hepatic magnetic resonance (MR) T1 mapping and extracellular volume fraction measurements compared to US shear-wave elastography. Materials and methods We analyzed hepatic native T1 times and extracellular volume fractions with modified Look-Locker inversion recovery. Liver stiffness was analyzed with shear-wave elastography. We compared results between 45 pediatric patients ages 16.7±0.6 years with Fontan circulation and 15 healthy controls ages 19.2±1.2 years. Measurements were correlated to clinical and hemodynamic data from cardiac catheterization. Results MR mapping was successful in 35/45 patients, revealing higher hepatic T1 times (774±44 ms) than in controls (632±52 ms; P &lt;0.001) and higher extracellular volume fractions (47.4±5.0%) than in controls (34.6±3.8%; P &lt;0.001). Liver stiffness was 1.91±0.13 m/s in patients vs. 1.20±0.10 m/s in controls ( P &lt;0.001). Native T1 times correlated with central venous pressures (r=0.5, P =0.007). Native T1 was not correlated with elastography in patients (r=0.2, P =0.1) or controls (r = −0.3, P =0.3). Extracellular volume fraction was correlated with elastography in patients (r=0.5, P =0.005) but not in controls (r=0.2, P =0.6). Conclusion Increased hepatic MR relaxometry and shear-wave elastography values in adolescents with Fontan circulation suggested the presence of hepatic fibrosis or congestion. Central venous pressure was related to T1 times. Changes were detected differently with MR relaxometry and elastography; thus, these techniques should not be used interchangeably in monitoring hepatic fibrosis.

• Nygaard, Sissel Irene; Christensen, Anders Haugom; Rolid, Katrine; Nytrøen, Kari; Gullestad, Lars & Fiane, Arnt E [Vis alle 11 forfattere av denne artikkelen] (2019). Autonomic cardiovascular control changes in recent heart transplant recipients lead to physiological limitations in response to orthostatic challenge and isometric exercise. European Journal of Applied Physiology. ISSN 1439-6319. 119(10), s. 2225–2236. doi: 10.1007/s00421-019-04207-5. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Heart transplantation causes denervation of the donor heart, but the consequences for cardiovascular homeostasis remain to be fully understood. The present study investigated cardiovascular autonomic control at supine rest, during orthostatic challenge and during isometric exercise in heart transplant recipients (HTxR). Methods A total of 50 HTxRs were investigated 7–12 weeks after transplant surgery and compared with 50 healthy control subjects. Continuous, noninvasive recordings of cardiovascular variables were carried out at supine rest, during 15 min of 60° head-up tilt and during 1 min of 30% of maximal voluntary handgrip. Plasma and urine catecholamines were assayed, and symptoms were charted. Results At supine rest, heart rate, blood pressures and total peripheral resistance were higher, and stroke volume and end diastolic volume were lower in the HTxR group. During tilt, heart rate, blood pressures and total peripheral resistance increased less, and stroke volume and end diastolic volume decreased less. During handgrip, heart rate and cardiac output increased less, and stroke volume and end diastolic volume decreased less. Orthostatic symptoms were similar across the groups, but the HTxRs complained more of pale and cold hands. Conclusion HTxRs are characterized by elevated blood pressures and total peripheral resistance at supine rest as well as attenuated blood pressures and total peripheral resistance responses during orthostatic challenge, possibly caused by low-pressure cardiopulmonary baroreceptor denervation. In addition, HTxRs show attenuated cardiac output response during isometric exercise due to efferent sympathetic denervation. These physiological limitations might have negative functional consequences.

• Diab, Simone; Godang, Kristin; Müller, Lil-Sofie Ording; Almaas, Runar; Lange, Charlotte de & Brunvand, Leif [Vis alle 12 forfattere av denne artikkelen] (2019). Progressive loss of bone mass in children with Fontan circulation. Congenital Heart Disease. ISSN 1747-079X. s. 1–9. doi: 10.1111/chd.12848. Fulltekst i vitenarkiv
• Möller, Thomas; Lindberg, Harald L; Samersaw-Lund, May Brit; Holmstrøm, Henrik; Døhlen, Gaute & Thaulow, Erik (2018). Right ventricular pressure response to exercise in adults with isolated ventricular septal defect closed in early childhood. Cardiology in the Young. ISSN 1047-9511. 28(6), s. 797–803. doi: 10.1017/S1047951117002979. Fulltekst i vitenarkiv Vis sammendrag

  We previously demonstrated an abnormally high right ventricular systolic pressure response to exercise in 50% of adolescents operated on for isolated ventricular septal defect. The present study investigated the prevalence of abnormal right ventricular systolic pressure response in 20 adult (age 30–45 years) patients who underwent surgery for early ventricular septal defect closure and its association with impaired ventricular function, pulmonary function, or exercise capacity. The patients underwent cardiopulmonary tests, including exercise stress echocardiography. Five of 19 patients (26%) presented an abnormal right ventricular systolic pressure response to exercise ⩾ 52 mmHg. Right ventricular systolic function was mixed, with normal tricuspid annular plane systolic excursion and fractional area change, but abnormal tricuspid annular systolic motion velocity (median 6.7 cm/second) and isovolumetric acceleration (median 0.8 m/second2). Left ventricular systolic and diastolic function was normal at rest as measured by the peak systolic velocity of the lateral wall and isovolumic acceleration, early diastolic velocity, and ratio of early diastolic flow to tissue velocity, except for ejection fraction (median 53%). The myocardial performance index was abnormal for both the left and right ventricle. Peak oxygen uptake was normal (mean z score −0.4, 95% CI −2.8–0.3). There was no association between an abnormal right ventricular systolic pressure response during exercise and right or left ventricular function, pulmonary function, or exercise capacity. Abnormal right ventricular pressure response is not more frequent in adult patients compared with adolescents. This does not support the theory of progressive pulmonary vascular disease following closure of left-to-right shunts.

• Erikssen, Gunnar; Liestøl, Knut; Seem, Egil; Birkelance, Sigurce; Saatvedt, Kjell & Nilsen-Hoel, Tom [Vis alle 11 forfattere av denne artikkelen] (2015). Achievements in congenital heart defect surgery: A prospective, 40-year study of 7038 patients. Circulation. ISSN 0009-7322. 131, s. 337–346. doi: 10.1161/CIRCULATIONAHA.114.012033. Fulltekst i vitenarkiv
• Khoury, Janette; Knutsen, Marie; Stray-Pedersen, Babill; Thaulow, Erik & Tonstad, Serena (2015). A lower reduction in umbilical artery pulsatility in mid-pregnancy predicts higher infant blood pressure six months after birth. Acta Paediatrica. ISSN 0803-5253. 104(8), s. 796–800. doi: 10.1111/apa.13020. Fulltekst i vitenarkiv
• Døhlen, Gaute; Antal, Ellen-Ann; Castellheim, Albert; Thaulow, Erik; Kielland, Anders & Saugstad, Ola Didrik (2013). Hyperoxic resuscitation after hypoxia-ischemia induces cerebral inflammation that is attenuated by tempol in a reporter mouse model with very young mice. Journal of Perinatal Medicine. ISSN 0300-5577. 41(3), s. 251–257. doi: 10.1515/jpm-2012-0135. Fulltekst i vitenarkiv
• Brun, Henrik; Moller, Thomas; Freriksen, Per Morten; Thaulow, Erik; Pripp, Are Hugo & Holmstrøm, Henrik Alf B (2012). Mechanisms of Exercise-Induced Pulmonary Hypertension in Patients With Cardiac Septal Defects. Pediatric Cardiology. ISSN 0172-0643. 33(5), s. 782–790. doi: 10.1007/s00246-012-0216-9. Fulltekst i vitenarkiv
• Wæhre, Anne; Vistnes, Maria; Sjaastad, Ivar; Nygård, Ståle; Husberg, Cathrine & Lunde, Ida Gjervold [Vis alle 14 forfattere av denne artikkelen] (2012). Chemokines regulate small leucine-rich proteoglycans in the extracellular matrix of the pressure-overloaded right ventricle. Journal of applied physiology. ISSN 8750-7587. 112(8), s. 1372–1382. doi: 10.1152/japplphysiol.01350.2011. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Brun, Henrik; Sejersted, Yngve; Dalen, Marit Lunde; Edvardsen, Thor & Saugstad, Ola Didrik [Vis alle 7 forfattere av denne artikkelen] (2012). Myocardial longitudinal peak systolic acceleration (pSac): relationship to ejection phase, pressure, and contractility. Echocardiography. ISSN 0742-2822. 29(5), s. 541–553. doi: 10.1111/j.1540-8175.2011.01628.x. Fulltekst i vitenarkiv Vis sammendrag

  Acceleration has been measured both noninvasively and invasively, during both isovolumic contraction and early ejection and has been shown to reflect contractility, especially through correlation with dP/dtmax. In this study timing and amplitude of mitral valve annulus acceleration assessed by tissue Doppler were measured and related to diastolic and systolic events. Invasive load independent measures of contractility, based on pressure–volume relationships, were derived, and pacing was done to modulate and control heart rate. Peak systolic acceleration (pSac) of the mitral valve annulus was shown to occur slightly later but timely related to dP/dtmax (P < 0.05), while peak preejection acceleration (pPac) was related to diastolic events. During inotropy and preload modulation dP/dtmax was found to be the strongest determinant of pSac (β = 0.9 ± 0.1; P < 0.001 and β = 1.3 ± 0.4; P < 0.001, respectively, log-transformed variables). PSac increased with pacing at a higher rate (β = 0.1 ± 0.0 cm/sec2, P = 0.03). Furthermore, pSac indexed to end-diastolic volume (EDV) was linearly correlated to load independent contractility parameters (Emax, R = 0.7; ESPVR, R = 0.7; and PRSW, R = 0.5), and proved stable toward changes in preload and afterload. The relation between dP/dtmax/EDV and pSac/EDV was stable throughout the study. In conclusion we found that peak systolic longitudinal acceleration (pSac) of the mitral valve annulus during aortic valve opening is strongly associated with dP/dtmax. Indexed to EDV, pSac may represent a load independent noninvasive contractility parameter. We consider pSac a candidate marker of long-axis contractility which should be viewed upon as the long-axis contribution to dP/dtmax

• Sulheim, Dag; Hurum, Harald; Helland, Ingrid B; Thaulow, Erik & Wyller, Vegard Bruun (2012). Adolescent chronic fatigue syndrome; a follow-up study displays concurrent improvement of circulatory abnormalities and clinical symptoms. BioPsychoSocial Medicine. 6. doi: 10.1186/1751-0759-6-10. Fulltekst i vitenarkiv Vis sammendrag

  Background The pathophysiology of chronic fatigue syndrome (CFS) in adolescents is unknown, and the clinical course and prognosis is still questioned. Recent research indicates that abnormalities of autonomic cardiovascular control may play an important role. The aim of this research project was to perform a follow-up study of adolescents with chronic fatigue syndrome, focusing on clinical symptoms and autonomic cardiovascular control. Methods 47 adolescents (12-18 years old) with CFS were recruited from the outpatient clinic at the Department of Pediatrics, Oslo University Hospital. In a primary visit and a follow-up visit (3-17 months later), we evaluated: a) a wide range of complaints and symptoms and b) cardiovascular variables at baseline and during a 20° head-up tilt-test (HUT). Results At the second visit, patients reported significant improvement regarding functional impairments, fatigue severity, muscular pain, concentration problems, post-exertional malaise and the problem of non-relieving rest. Also, at the second visit, baseline heart rate (HR), blood pressure, total peripheral resistance index (TPRI) and LF/HF (low-frequency:high-frequency heart rate variability ratio, an index of sinus node sympathovagal balance derived from spectral analyses of heart rate) were significant lower, and the increases in HR, mean blood pressure (MBP), diastolic blood pressure (DBP) and TPRI during tilt were significantly less pronounced as compared to the first visit. There was a significant correlation between changes in autonomic symptom score, fatigue severity score and functional impairment score from the first to the second visit. Conclusions The majority of adolescents with CFS experienced an improvement over time in functional impairment, self-reported fatigue and additional symptoms, and a concurrent improvement of autonomic cardiovascular control. A possible connection between clinical symptoms and abnormal autonomic control in CFS might represent a focus for further research.

• Odland, Hans Henrik; Kro, Grete A; Edvardsen, Thor; Thaulow, Erik & Saugstad, Ola Didrik (2012). Impaired diastolic function and disruption of the force-frequency relationship in the right ventricle of newborn pigs resuscitated with 100% oxygen. Neonatology. ISSN 1661-7800. 101(2), s. 147–153. doi: 10.1159/000330804. Fulltekst i vitenarkiv
• Fagermoen, Frode Even; Sulheim, Dag; Winger, Anette; Andersen, Anders Mikal; Vethe, Nils Tore & Saul, J P [Vis alle 8 forfattere av denne artikkelen] (2012). Clonidine in the treatment of adolescent chronic fatigue syndrome: a pilot study for the NorCAPITAL trial. BMC Research Notes. 5. doi: 10.1186/1756-0500-5-418. Fulltekst i vitenarkiv Vis sammendrag

  Background This pilot study (ClinicalTrials.gov ID: NCT01507701) assessed the feasibility and safety of clonidine in adolescent chronic fatigue syndrome (CFS). Specifically, we assessed clonidine dosage in relation to a) plasma concentration levels, b) orthostatic cardiovascular responses, and c) possible adverse effects. Findings Five adolescent CFS patients (14–19 years old) received 50 μg clonidine twice per day during 14 days in an open, uncontrolled design. Plasma concentration of clonidine was assayed by standard laboratory methods. Changes in orthostatic cardiovascular responses were assessed by a 20o head-up tilt-test (HUT). Adverse effects were mapped by a questionnaire. After 14 days, C0 median (range) of clonidine was 0.21 (0.18-0.36) μg/L, and Cmax median (range) of clonidine was 0.41 (0.38-0.56) μg/L. Also, supine blood pressures and heart rate were lower during clonidine treatment, and the HUT response was closer to the normal response. No serious adverse effects were registered. Conclusion Clonidine 50 μg BID seems to be safe enough to proceed from a pilot study to a controlled trial in a select group of adolescents with CFS (ClinicalTrials.gov ID: NCT01040429).

• Brun, Henrik; Ueland, Thor; Thaulow, Erik; Damås, Jan Kristian; Yndestad, Arne & Aukrust, Pål [Vis alle 7 forfattere av denne artikkelen] (2011). No Inflammatory Response Related to Pulmonary Hemodynamics in Children with Systemic to Pulmonary Shunts. Congenital Heart Disease. ISSN 1747-079X. 6(4), s. 338–346. doi: 10.1111/j.1747-0803.2011.00505.x. Fulltekst i vitenarkiv
• Hurum, Harald; Sulheim, Dag; Thaulow, Erik & Wyller, Vegard Bruun (2011). Elevated nocturnal blood pressure and heart rate in adolescent chronic fatigue syndrome. Acta Paediatrica. ISSN 0803-5253. 100(2), s. 289–292. doi: 10.1111/j.1651-2227.2010.02073.x. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Brun, Henrik; Sejersted, Yngve; Dalen, Marit Lunde; Edvardsen, Thor & Saugstad, Ola Didrik [Vis alle 7 forfattere av denne artikkelen] (2011). Longitudinal Myocardial Contribution to Peak Systolic Flow and Stroke Volume in the Neonatal Heart. Pediatric Research. ISSN 0031-3998. 70(4), s. 345–351. doi: 10.1203/PDR.0b013e318229032b. Fulltekst i vitenarkiv
• Wyller, Vegard Bruun; Aaberge, Lars; Thaulow, Erik & Døhlen, Gaute (2011). Perkutan kateterbasert innsetting av kunstig pulmonalklaff ved medfødt hjertefeil. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 13-14, s. 1289–1293. doi: 10.4045/tidsskr.10.0920. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn. Perkutan kateterbasert innsetting av kunstige hjerteklaffer er en ny teknikk som kan få økende utbredelse i fremtiden og supplere kirurgiske inngrep. Vi rapporterer her våre første erfaringer med innsetting av kunstig pulmonalklaff hos barn med medfødt hjertefeil. Materiale og metode. Teknikken vurderes hos pasienter med hjertesviktsymptomer og stenose og/eller insuffisiens i et kunstig utløp fra høyre ventrikkel. Klaffen føres gjennom et kateter fra lyskevene eller halsvene. Behandlingseffekt vurderes ved symptombeskrivelse, ekkokardiografi, invasive målinger og angiografi. Vi rapporterer her våre behandlingsresultater i perioden april 2007 til september 2009. Resultater. Materialet består av ti pasienter (sju menn og tre kvinner, median alder 17 år). Prosedyren reduserte trykket i høyre ventrikkel (p = 0,008) og opphevet pulmonalinsuffisiensen hos alle ti pasienter. Median liggetid var to dager. Det oppsto ingen komplikasjoner med direkte forbindelse til innsettelsesprosedyren, men én pasient utviklet et pseudoaneurisme i a. femoralis, og en annen pasient fikk kortvarig feber to dager etter prosedyren. Hos én pasient måtte klaffen fjernes kirurgisk etter ni måneder pga. stentbrudd. Etter seks måneder rapporterte samtlige pasienter en symptombedring, trykkgradienten i høyre ventrikkel-utløp var redusert (p = 0,008) og pulmonalinsuffisiensen var bedret (p = 0,006). Disse resultatene vedvarte hos de fire pasientene som er blitt undersøkt etter 24 måneder. Fortolkning. Perkutan kateterbasert innsetting av kunstig pulmonalklaff bedrer høyre ventrikkels hemodynamikk hos utvalgte pasienter med medfødt hjertefeil. For sikrere kunnskap bør det imidlertid gjennomføres en randomisert, kontrollert studie.

• Odland, Hans Henrik; Kro, Grete A; Munkeby, Berit Holthe; Edvardsen, Thor; Saugstad, Ola Didrik & Thaulow, Erik (2010). Ejection Time-Corrected Systolic Velocity Improves Accuracy in the Evaluation of Myocardial Dysfunction: A Study in Piglets. Pediatric Cardiology. ISSN 0172-0643. 31(7), s. 1070–1078. doi: 10.1007/s00246-010-9767-9. Fulltekst i vitenarkiv Vis sammendrag

  This study aimed to assess the effect of correcting for the impact of heart rate (HR) or ejection time (ET) on myocardial velocities in the long axis in piglets undergoing hypoxia. The ability to eject a higher volume at a fixed ET is a characteristic of contractility in the heart. Systolic velocity of the atrioventricular annulus displacement is directly related to volume changes of the ventricle. Both ET and systolic velocity may be measured in a single heartbeat. In 29 neonatal pigs, systolic velocity and ET were measured with tissue Doppler techniques in the mitral valve annulus, the tricuspid valve annulus, and the septum. All ejection time corrected velocities (S((ET)), mean +/- SEM, cm/s) decreased significantly during hypoxia (S(mva(ET)) 15.5 +/- 0.2 to 13.2 +/- 0.3 (p < 0.001), S(septal(ET)) 9.9 +/- 0.1 to 7.8 +/- 0.2 (p < 0.001), S(tva(ET)) 12.1 +/- 0.2 to 9.8 +/- 0.3 (p < 0.001)). The magnitude of change from baseline to hypoxia was greater for ejection time corrected systolic velocities than for RR-interval corrected velocities (mean +/- SEM, cm/s); DeltaS(mva(ET)) 2.3 +/- 2.0 vs. DeltaS(mva(RR)) 1.6 +/- 1.1 (p = 0.02), DeltaS(septal(ET)) 2.1 +/- 1.0 vs. DeltaS(septal(RR)) 1.6 +/- 1.0 (p < 0.01), DeltaS(tva(ET)) 2.3 +/- 1.1 vs. DeltaS(tva(RR)) 1.8 +/- 1.3 (p = 0.04). The receiver operator characteristic (ROC) showed superior performance of S((ET)) compared with uncorrected velocities. The decrease in S((ET)) during hypoxia was not influenced by important hemodynamic determinants. ET-corrected systolic velocity improves accuracy and decreases variability in the evaluation of systolic longitudinal function and contractility during global hypoxia in neonatal pigs compared with systolic velocity alone. It is robust toward hemodynamic changes. This novel method has the potential of becoming a useful tool in clinical practice

• Møller, Thomas Friedrich; Brun, Henrik; Fredriksen, Per-Morten; Holmstrøm, Henrik Alf B; Pettersen, Eirik & Thaulow, Erik (2010). Moderate Altitude Increases Right Ventricular Pressure and Oxygen Desaturation in Adolescents with Surgically Closed Septal Defect. Congenital Heart Disease. ISSN 1747-079X. 5(6), s. 556–564. doi: 10.1111/j.1747-0803.2010.00425.x. Fulltekst i vitenarkiv
• Deanfield, John E; Sellier, Phillipe; Thaulow, Erik; Bultas, Jan; Yunis, Carla & Shi, Harry [Vis alle 8 forfattere av denne artikkelen] (2010). Potent anti-ischaemic effects of statins in chronic stable angina: incremental benefit beyond lipid lowering? European Heart Journal. ISSN 0195-668X. 31(21), s. 2650–2659. doi: 10.1093/eurheartj/ehq133. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Kro, Grete A; Edvardsen, Thor; Thaulow, Erik & Saugstad, Ola Didrik (2010). Atrioventricular Valve Annulus Velocity and Acceleration during Global Hypoxia in Newborn Pigs - Assessment of Myocardial Function. Neonatology. ISSN 1661-7800. 97(2), s. 100–107. doi: 10.1159/000235806. Fulltekst i vitenarkiv
• Møller, Thomas; Brun, Henrik; Fredriksen, Per Morten; Holmstrøm, Henrik Alf B; Peersen, Kari & Pettersen, Eirik [Vis alle 9 forfattere av denne artikkelen] (2010). Right Ventricular Systolic Pressure Response During Exercise in Adolescents Born With Atrial or Ventricular Septal Defect. American Journal of Cardiology. ISSN 0002-9149. 105(11), s. 1610–1616. doi: 10.1016/j.amjcard.2010.01.024. Fulltekst i vitenarkiv
• Skretteberg, Torger; Bodegard, Johan; Kjeldsen, Sverre Erik; Erikssen, Gunnar; Thaulow, Erik & Sandvik, Leiv [Vis alle 7 forfattere av denne artikkelen] (2010). Interaction between inflammation and blood viscosity predicts cardiovascular mortality. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 44(2), s. 107–112. doi: 10.3109/14017430903171248. Fulltekst i vitenarkiv
• Møller, Thomas Friedrich; Leren, Trond P.; Eiklid, Kristin Louise; Holmstrøm, Henrik Alf B; Fredriksen, Per-Morten & Thaulow, Erik (2010). A novel BMPR2 gene mutation associated with exercise-induced pulmonary hypertension in septal defects. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 44(6), s. 331–336. doi: 10.3109/14017431.2010.525747. Fulltekst i vitenarkiv
• Brun, Henrik; Holmstrøm, Henrik Alf B; Thaulow, Erik; Damås, Jan Kristian; Yndestad, Arne & Aukrust, Pål [Vis alle 7 forfattere av denne artikkelen] (2009). Patients with Pulmonary Hypertension Related to Congenital Systemic-to-Pulmonary Shunts are Characterized by Inflammation Involving Endothelial Cell Activation and Platelet-mediated Inflammation. Congenital Heart Disease. ISSN 1747-079X. 4(1), s. 153–159. Fulltekst i vitenarkiv
• Fredriksen, Per Morten; Pettersen, Eirik & Thaulow, Erik (2009). Declining aerobic capacity of patients with arterial and atrial switch procedures. Pediatric Cardiology. ISSN 0172-0643. 30(2), s. 166–171. doi: 10.1007/s00246-008-9291-3. Fulltekst i vitenarkiv
• Møller, Thomas; Peersen, K; Pettersen, Eirik; Thaulow, Erik; Holmstrøm, Henrik Alf B & Fredriksen, PM (2009). Non-invasive measurement of the response of right ventricular pressure to exercise, and its relation to aerobic capacity. Cardiology in the Young. ISSN 1047-9511. 13, s. 1–9. Fulltekst i vitenarkiv
• Fredriksen, Per Morten; Diseth, Trond H & Thaulow, Erik (2009). Children and adolescents with congenital heart disease: assessment of behavioural and emotional problems. European Child and Adolescent Psychiatry. ISSN 1018-8827. 18(5), s. 292–300. doi: 10.1007/s00787-008-0730-8. Fulltekst i vitenarkiv
• Matthews, Iren; Bjørnstad, Per G; Kaldestad, Runa Helen; Heiberg, Lise; Thaulow, Erik & Grønn, Morten (2009). The impact of shunt size on lung function in infants with univentricular heart physiology. Pediatric Critical Care Medicine. ISSN 1529-7535. 10(1), s. 60–65. doi: 10.1097/PCC.0b013e3181936968. Fulltekst i vitenarkiv
• Pettersen, Eirik; Fredriksen, PM; Urheim, S; Thaulow, Erik; Smith, Hans-Jørgen & Smevik, B. [Vis alle 8 forfattere av denne artikkelen] (2009). Ventricular Function in Patients With Transposition of the Great Arteries Operated With Arterial Switch. American Journal of Cardiology. ISSN 0002-9149. 104(4), s. 583–589. doi: 10.1016/j.amjcard.2009.04.029. Fulltekst i vitenarkiv
• Eskedal, Leif Torvald; Hagemo, Petter; Seem, E; Eskild, Anne; Cvancarova, Milada & Seiler, Stephen [Vis alle 7 forfattere av denne artikkelen] (2008). Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Archives of Disease in Childhood. ISSN 0003-9888. 93(6), s. 495–501. Fulltekst i vitenarkiv Vis sammendrag

  Conclusions: A decrease in weight for age during the first months after surgery for congenital heart defects of more than 0.67 z scores, corresponding to a downward percentile crossing through at least one of the displayed percentile lines on standard growth charts, is strongly related to late mortality in children operated on for congenital heart defects.

• Døhlen, Gaute; Odland, Hans Henrik; Carlsen, Harald; Blomhoff, Rune; Thaulow, Erik & Saugstad, Ola Didrik (2008). Antioxidant Activity in the Newborn Brain: A Luciferase Mouse Model. Neonatology. ISSN 1661-7800. 93(2), s. 125–131. doi: 10.1159/000107777. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Oxidative stress in the newborn period may cause cell injury and inflammation if the antioxidant capacity is insufficient. To monitor antioxidant and inflammatory activity we examined by in vivo imaging various strains of luciferase reporter mice whose light-emitting properties were regulated by response elements or complete promoters related to oxidative stress and/or inflammation. The aim of this study is to present a model that can monitor genetic activity in vivo during pregnancy and the first 10 days of life. Methods: One mouse strain reports the activity of nuclear factor-kappaB (NF-kappaB) activity, a transcription factor essential for modulating inflammation, apoptosis, differentiation and cell growth. A second mouse strain reports on superoxide dismutase 1-promoter activity. A third strain reports the promoter activity of gamma-glutamylcysteine synthetase, the rate limiting enzyme in glutathione production, and the last strain reports on antioxidant responsive element (ARE)/electrophil responsive element. Wild-type female mice mated with NF-kappaB mice were imaged through pregnancy to monitor intrauterine NF-kappaB activation. Results: Intrauterine NF-kappaB activity increased dramatically from day 17 towards labor. During the first 4 days of life luminescence measured was intense in all mice with distinct strain differences. All strains had high luminescence levels at day 1 and a considerably lower level at day 10. Conclusion: This model allows investigation of the transcriptional regulation of key proteins related to oxidative stress and inflammation in pregnancy and the first days of life. With very little stress to the newborn animals genetic activity can be monitored day by day.

• Wyller, Vegard Bruun; Saul, J. Philip; Amlie, Jan Peder & Thaulow, Erik (2007). Sympathetic predominance of cardiovascular regulation during mild orthostatic stress in adolescents with chronic fatigue. Clinical Physiology and Functional Imaging. ISSN 1475-0961. 27(4), s. 231–238. doi: 10.1111/j.1475-097X.2007.00743.x. Fulltekst i vitenarkiv Vis sammendrag

  Haemodynamic abnormalities have been documented in the chronic fatigue syndrome (CFS), indicating functional disturbances of the autonomic nervous system responsible for cardiovascular control. This study was designed to explore the pathophysiology in adolescent CFS-patients by analysing RR-interval (RRI) variability and diastolic blood pressure (DBP) variability during mild orthostatic stress, using an algorithm which accounts for non-stationary biosignals. A total of 27 adolescents with CFS and 33 healthy control subjects having equal age- and sex distribution underwent 15 min of 20° head-up tilt (HUT). The spectral power densities of RRI and DBP were computed in the low-frequency (LF) band (0·04–0·15 Hz) and the high-frequency (HF) band (0·15–0·4 Hz) using an adaptive autoregressive algorithm to obtain a time-varying spectrum. RMSSD, a time domain index of RRI variability, was also computed. At rest, all indices of variability were similar in the two groups. During tilt, CFS patients had a larger increase in the LF/HF ratio (P≤0·001) and normalized LF power of RRI (P≤0·01), and a larger decrease in normalized HF power (P≤0·01) of RRI than controls. CFS patients also had trends towards a larger decrease in absolute HF power of RRI and a larger increase in normalized LF power of DBP. These findings suggest that adolescents with CFS have sympathetic predominance of cardiovascular regulation during very mild orthostatic stress. Possible underlying mechanisms are moderate hypovolemia, abnormalities of reflex control or physical de-conditioning.

• Brun, Henrik; Thaulow, Erik; Fredriksen, Per Morten & Holmstrøm, Henrik Alf B (2007). Treatment of patients with Eisenmenger's syndrome with Bosentan. Cardiology in the Young. ISSN 1047-9511. 17(3), s. 288–294. doi: 10.1017/S1047951107000522. Fulltekst i vitenarkiv Vis sammendrag

  We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.

• Eskedal, Leif Torvald; Hagemo, Petter; Eskild, Anne; Seiler, Stephen; Frøslie, KF & Thaulow, Erik (2007). A population-based study relevant to seasonal variations in causes of death in children undergoing surgery for congenital cardiac malformations. Cardiology in the Young. ISSN 1047-9511. 17(4), s. 423–431. Fulltekst i vitenarkiv Vis sammendrag

  AIMS: Our objectives were, first, to study seasonal distribution of perioperative deaths within 30 days after surgery, and late death, in children undergoing surgery for congenitally malformed hearts, and second, to study the causes of late death. METHODS: We analysed a retrospective cohort of 1,753 children with congenital cardiac malformations born and undergoing surgery in the period from 1990 through 2002 with a special focus on the causes of late death. The data was obtained from the registry of congenital cardiac malformations at Rikshospitalet, Oslo, and the Norwegian Medical Birth Registry. The mean follow-up from birth was 8.1 years, with a range from zero to 15.2 years. RESULTS: During the period of follow-up, 204 (11.6%) of the children died having undergone previous surgery. Of these 124 (7.1%) died in the perioperative period, and 80 (4.5%) were late deaths. There were 56 late deaths during the 6 coldest months, compared with 24 during the 6 warmest months (p < 0.01). There was no significant seasonal variation in perioperative deaths. Respiratory infection was the most common cause of late death, and occurred in 25 children, of whom 24 died during the 6 coldest months. Of the 8 sudden late deaths, 7 occurred during the 6 coldest months. There was no seasonal variation for the other causes of death. CONCLUSIONS: In children undergoing surgery for congenital cardiac malformations in Norway, there is a seasonal variation in late death, with a higher proportion occurring in the coldest months. Death related to respiratory infections predominantly occurs in the winter season, and is the overall most common cause of late death.

• Wyller, Vegard Bruun; Due, Reidar; Saul, J. Philip; Amlie, Jan Peder & Thaulow, Erik (2007). Usefulness of an Abnormal Cardiovascular Response During Low-Grade Head-Up Tilt-Test for Discriminating Adolescents With Chronic Fatigue from Healthy Controls. American Journal of Cardiology. ISSN 0002-9149. 99(7), s. 997–1001. doi: 10.1016/j.amjcard.2006.10.067. Fulltekst i vitenarkiv Vis sammendrag

  Hemodynamic dysfunction is documented in chronic fatigue syndrome (CFS). This study was conducted to investigate cardiovascular responses to orthostatic stress in adolescents with CFS, using a novel procedure for tilt-table testing. A total of 27 adolescents with CFS and 33 healthy control subjects with equal age and gender distribution underwent 15 minutes of 20° head-up tilt testing. Heart rate, systolic blood pressure (BP), mean BP, diastolic BP, stroke index, total peripheral resistance index, end-diastolic volume index, and acceleration index were continuously and noninvasively recorded. At rest, patients with CFS had higher total peripheral resistance index values (p <0.01) and lower stroke index and end-diastolic volume index values (p <0.05) than controls. During 20° head-up tilt testing, patients with CFS had greater increases in heart rate, diastolic BP (p <0.001), mean BP (p <0.01), and total peripheral resistance index (p <0.05) than controls and greater decreases in stroke index (p <0.05). Syncope or near syncope was not observed. In conclusion, this study found that adolescents with CFS have significant abnormalities of cardiovascular regulation in response to mild orthostatic stress, differentiating them from healthy controls

• Wyller, Vegard Bruun; Thaulow, Erik & Amlie, Jan Peder (2007). Treatment of chronic fatigue and orthostatic intolerance with propranolol. Journal of Pediatrics. ISSN 0022-3476. 150(6), s. 654–655. doi: 10.1016/j.jpeds.2007.03.012. Fulltekst i vitenarkiv Vis sammendrag

  We describe the effect of propranolol in an adolescent with chronic fatigue syndrome and orthostatic intolerance. Our observations suggest that the head-up tilt-test and beta-blocker treatment might be considered in patients with chronic fatigue syndrome and that enhanced sympathetic nervous activity might be part of the underlying pathophysiology.

• Wyller, Vegard Bruun; Godang, K; Mørkrid, Lars; Saul, J. Philip; Thaulow, Erik & Walløe, Lars (2007). Abnormal Thermoregulatory Responses in Adolescents With Chronic Fatigue Syndrome: Relation to Clinical Symptoms. Pediatrics. ISSN 0031-4005. 120(1), s. 129–137. doi: 10.1542/peds.2006-2759. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVES. Chronic fatigue syndrome is a common and disabling disease of unknown etiology. Accumulating evidence indicates dysfunction of the autonomic nervous system. To further explore the pathophysiology of chronic fatigue syndrome, we investigated thermoregulatory responses dependent on catecholaminergic effector systems in adolescent patients with chronic fatigue syndrome. PATIENTS AND METHODS. A consecutive sample of 15 patients with chronic fatigue syndrome aged 12 to 18 years and a volunteer sample of 57 healthy control subjects of equal gender and age distribution were included. Plasma catecholamines and metanephrines were measured before and after strong cooling of 1 hand. Acral skin blood flow, tympanic temperature, heart rate, and mean blood pressure were measured during moderate cooling of 1 hand. In addition, clinical symptoms indicative of thermoregulatory disturbances were recorded. RESULTS. Patients with chronic fatigue syndrome reported significantly more shivering, sweating, sudden change of skin color, and feeling unusually warm. At baseline, patients with chronic fatigue syndrome had higher levels of norepinephrine, heart rate, epinephrine, and tympanic temperature than control subjects. During cooling of 1 hand, acral skin blood flow was less reduced, vasoconstrictor events occurred at lower temperatures, and tympanic temperature decreased more in patients with chronic fatigue syndrome compared with control subjects. Catecholamines increased and metanephrines decreased similarly in the 2 groups. CONCLUSIONS. Adolescent patients with chronic fatigue syndrome have abnormal catecholaminergic-dependent thermoregulatory responses both at rest and during local skin cooling, supporting a hypothesis of sympathetic dysfunction and possibly explaining important clinical symptoms.

• Meberg, Alf; Hals, Jardar & Thaulow, Erik (2007). Congenital heart defects—chromosomal anomalies, syndromes and extracardiac malformations. Acta Paediatrica. ISSN 0803-5253. 96(8), s. 1142–1145. doi: 10.1111/j.1651-2227.2007.00381.x. Fulltekst i vitenarkiv Vis sammendrag

  Aim: To register chromosomal anomalies, syndromes and extracardiac malformations in patients with Congenital heart defects (CHDs). Method: Population-based prospective observational study. Results: Of 57 027 live births during 1982–2005, CHDs were detected in 662 (11.6 per 1000), of whom 146 (22%) had associated anomalies. Of these 52 (36%) had chromosomal anomalies (exclusive microdeletions), 26 (18%) genetic syndromes/microdeletions, 1 (0.7%) a teratogenous syndrome and 67 (46%) extracardiac malformations. In perimembraneous ventricular septal defects (VSDs), associated anomalies occurred in 22 of 70 (31%) compared to 27 of 298 (9%) in VSDs located in the muscular part of the septum (p < 0.0001). The prevalence of CHDs with associated disorders increased significantly from the cohort born during 1982–1993 to those born during 1994–2005 (2.0 vs. 3.1 per 1000, respectively; p < 0.0001), mainly caused by an increase of chromosomal trisomies (0.5 vs. 1.1 per 1000; p = 0.026). The percentage of women giving live birth at 35 years of age or more was 7.6% for the period 1982–1993 compared to 13.4% for 1994–2005 (p = 0.001). Conclusions: Chromosomal anomalies, syndromes and extracardiac malformations occurred in nearly one-fourth of CHD cases. Muscular VSDs had a low prevalence of such conditions. The prevalence of CHDs with chromosomal trisomies increased, and was probably related to an increasing age of women giving birth.

• Matthews, Iren; Kaldestad, Runa Helen; Bjørnstad, Per G; Thaulow, Erik & Grønn, Morten (2007). Preoperative lung function in newborn infants with univentricular hearts compared with healthy controls. Acta Paediatrica. ISSN 0803-5253. 96(1), s. 44–48. doi: 10.1111/j.1651-2227.2007.00036.x. Fulltekst i vitenarkiv Vis sammendrag

  Aim: To measure the difference in lung function between newborns with univentricular hearts and healthy controls and study associations between lung function and pulmonary blood flow and pulmonary vasculature markings. Method: Tidal flow-volume measurements and single occlusion tests were performed before surgery on 25 unsedated spontaneously breathing newborns with univentricular hearts recruited over a 3-year period. Seventy-five healthy control infants were measured. Pulmonary blood flow was graded according to the haemodynamic effect of the echocardiographically defined anatomy of the heart defect. Pulmonary vasculature was graded according to radiological markings. Results: The infants with univentricular hearts had a lower mean tidal volume of 4.7 ml (CI 2.3, 7.2, p < 0.001) (n = 24) and a lower mean compliance of the respiratory system of 12.7 ml/kPa (CI 4.6, 20.8, p = 0.004) (n = 14). Pulmonary blood flow grading was associated with respiratory rate (r = 0.53, p < 0.001), tidal volume (r = –0.48, p < 0.001), compliance (r = –0.55, p < 0.001) and resistance (r = –0.31, p = 0.043). Pulmonary vasculature grading was associated with compliance (r = –0.68, p = 0.006), resistance (r = –0.69, p = 0.007) and the time constant (r = –0.62, p = 0.042). Conclusion: Newborns with univentricular hearts have reduced tidal volumes and reduced compliance of the respiratory system. The lung function abnormalities are associated with the degree of pulmonary blood flow and pulmonary vasculature markings.

• Matthews, Iren; Fredriksen, Per Morten; Bjørnstad, Per G; Thaulow, Erik & Grønn, Morten (2006). Reduced pulmonary function in children with the Fontan circulation affects their exercise capacity. Cardiology in the Young. ISSN 1047-9511. 16(3), s. 261–267. doi: 10.1017/S1047951106000345. Fulltekst i vitenarkiv Vis sammendrag

  Most children with functionally univentricular hearts nowadays are treated surgically by creating a total cavopulmonary connection. In the resulting Fontan circulation, the venous return and the pulmonary arterial bed are coupled in series, bypassing the heart. This gives the potential for interaction between the abnormal circulation and function of the lungs. In this study, we investigated the pattern of impairment of pulmonary function, and its relation to decreased exercise capacity. We performed spirometry in 33 (85 percent) of 39 eligible Norwegian children, aged from 8 to 16, with a total cavopulmonary connection, along with whole body plethysmography, the carbon monoxide single breath test, and a peak treadmill exercise test. The single breath test showed a mean corrected diffusing capacity of 66.5 percent of predicted, giving a z score of minus 2.88. The mean residual volume measured by whole body plethysmography was 146.8 percent, equivalent to a z score of 2.46, whereas the mean residual volume measured by the single breath test was 102.4 percent of predicted, this being the same as a z score of 0.43. The mean peak treadmill exercise test was 70.0 percent of predicted, equivalent with a z score of minus 3.07. Mean forced vital capacity was 85.7 percent of predicted, the equivalent z score being minus 0.92. Lung function correlated with the peak treadmill exercise test. We have shown, therefore, that children with the Fontan circulation have reduced diffusing capacity, possibly caused by the abnormal circulation through the lungs. The difference between residual volume measured by plethysmography and the single breath test implies trapping of air. The correlation of parameters for lung function with peak consumption of oxygen during exercise indicates that the abnormalities of pulmonary function may affect physical capacity.

• Børke, Wenche Bakken; Edvardsen, Thor; Fugelseth, Drude Merete; Lenes, K; Ihlen, Halfdan & Saugstad, Ola Didrik [Vis alle 7 forfattere av denne artikkelen] (2006). Reduced left ventricular function in hypoxemic newborn pigs: a strain Doppler echocardiographic study. Pediatric Research. ISSN 0031-3998. 59(5), s. 630–635. Fulltekst i vitenarkiv
• Odland, Hans Henrik & Thaulow, Erik (2006). Heart failure therapy in children. Expert Review of Cardiovascular Therapy. ISSN 1477-9072. 4(1), s. 33–40. Fulltekst i vitenarkiv Vis sammendrag

  The most common reason for heart failure in children is volume overload secondary to a left-to-right shunt. Therefore, an accurate diagnosis with identification of possible surgical or interventional reactions should be the first priority. Medical therapy is mainly based on diuretics, angiotensin-converting enzyme inhibitors, cardiac glycosides and beta-blockers. There are few prospective trials in pediatric cardiology, but the available data reach a similar conclusion to that of adults with heart failure. Diuretics are an important tool in patients with fluid retention, and angiotensin-converting enzyme inhibitors are helpful in patients with volume overload of the ventricles. Cardiac glycosides are still in use, but there is a trend toward primary use of diuretics. Angiotensin-converting enzyme inhibitors and beta-blockers have been used successfully in the treatment of heart failure in children, but there are limited data on its efficacy.

• Lingaas, Per Snorre; Hol, Per Kristian; Lundblad, Runar; Rein, Kjell Arne; Mathisen, Lars & Smith, Hans-Jørgen [Vis alle 14 forfattere av denne artikkelen] (2006). Clinical and Radiological Outcome of Off-Pump Coronary Surgery at 12 Months Follow-Up: A Prospective Randomized Trial. Annals of Thoracic Surgery. ISSN 0003-4975. 81(6), s. 289–295. doi: 10.1016/j.athoracsur.2005.12.003. Fulltekst i vitenarkiv
• Engelfriet, P; Tijssen, J; Kaemmerer, H; Gatzoulis, Michael A; Boersma, E & Oechslin, E [Vis alle 7 forfattere av denne artikkelen] (2006). Adherence to guidelines in the clinical care for adults with congenital heart disease: The Euro Heart Survey on Adult Congenital Heart Disease. European Heart Journal. ISSN 0195-668X. 27(4). doi: 10.1093/eurheartj/ehi718. Fulltekst i vitenarkiv Vis sammendrag

  Aims To investigate the role of guidelines in structuring the clinical care for adult patients with congenital heart disease (CHD), and to assess adherence to the guidelines in Europe. Methods and results A selected number of current guidelines were chosen pertaining to operative procedures, investigations, and the use of medication (‘interventions’). The source for this analysis was the database of the Euro Heart Survey on adult CHD, which contains retrospectively collected data on 4110 patients followed-up for a median of 5.1 years. For each guideline investigated, patients were selected from the database for whom the particular guideline was relevant. The selected cases were classified according to two criteria: was there an indication for the particular intervention and did the intervention take place? In this manner, cases of ‘undue treatment’ and ‘insufficient treatment’ were identified. Adherence to guidelines was found to be good in the case of operative procedures and prophylactic drug treatment. However, regarding diagnostic procedures there had been adherence to guidelines in only slightly more than half of the cases. Conclusion Guidelines have an important role in the actual clinical care of adults with CHD. However, large outcome studies are needed to develop more precise guidelines.

• Lingaas, Per Snorre; Hol, Per Kristian; Lundblad, Runar; Rein, Kjell Arne; Mathisen, Lars & Smith, Hans Jørgen [Vis alle 14 forfattere av denne artikkelen] (2006). Clinical and radiologic outcome of off-pump coronary surgery at 12 months follow-up: prospective randomized trial. Annals of Thoracic Surgery. ISSN 0003-4975. Fulltekst i vitenarkiv
• Lingaas, Per Snorre; Hol, Per Kristian; Lundblad, Runar; Rein, Kjell Arne; Mathisen, Lars & Smith, Hans Jørgen [Vis alle 14 forfattere av denne artikkelen] (2006). Clinical and radiologic outcome of off-pump coronary surgery at 12 months follow-up: prospective randomized trial. Annals of Thoracic Surgery. ISSN 0003-4975. Fulltekst i vitenarkiv
• Stavem, Knut; Aaser, E.; Sandvik, L.; Bjørnholt, Jørgen Vildershøy; Erikssen, G & Thaulow, Erik [Vis alle 7 forfattere av denne artikkelen] (2005). Lung function, smoking and mortality in a 26-year follow-up of healthy middle-aged males. European Respiratory Journal. ISSN 0903-1936. 25. Fulltekst i vitenarkiv Vis sammendrag

  Lung function has been associated with mortality after adjusting for other risk factors; however, few studies have adjusted for physical fitness and reported separate analyses according to smoking status. In 1972�1975, spirometry, clinical and physiological parameters were recorded in 1,623 apparently healthy males aged 40�59 yrs. After 26 yrs of follow-up, the current authors investigated the association between baseline lung function and mortality, adjusting for smoking, physical fitness and other potential factors. By 2000, 615 individuals (38%) had died, with 308 (50%) of these deaths from cardiovascular (CV) causes. Forced expiratory volume in one second was a predictor of all-cause mortality (risk ratio (RR) 1.10 per reduction of 10%) after adjusting for smoking, physical fitness, age, systolic blood pressure, body mass index and serum cholesterol. The corresponding multivariate RR was 1.07 for CV causes and 1.34 for respiratory death. In conclusion, in stratified analyses among current and former smokers, forced expiratory volume in one second % predicted was a strong independent predictor of all-cause mortality and respiratory death among current smokers. Forced expiratory volume in one second % predicted was not associated with mortality among never-smokers. Prospective population studies have reported pulmonary function to be an independent predictor of all-cause and cardiovascular (CV) mortality when adjusting for a variety of confounders or known risk factors. Poor lung function, measured as forced expiratory volume in one second (FEV1), is also associated with increased mortality from respiratory diseases and malignancies. The mechanism for the relationship between lung function and CV mortality remains largely unexplained. Various mechanisms for the association between lung function and CV mortality have been suggested, such as through systemic inflammation, autonomic dysfunction, physical inactivity, socio-economic status, residual confounding, or that lung function is an indicator of general health status or unmeasurable environmental or lifestyle influences. The impact of lung function on mortality and coronary heart disease 24 after adjustment for self-reported physical activity has been reported, although no studies of mortality have adjusted for objective measures of physical fitness. Few studies also have reported the association between lung function and mortality separately for smoking groups. In this study, the current authors aimed to assess the predictive value of pulmonary function for all-cause, CV and respiratory mortality after adjusting for a number of risk factors, including smoking status and physical fitness. In addition, the present authors intended to assess the association separately in groups with different smoking habits. This study presents data from a population of healthy middle-aged males with follow-up over 26 yrs.

• Fugelseth, Drude Merete; Børke, Wenche Bakken; Lenes, K; Matthews, Iren; Saugstad, Ola Didrik & Thaulow, Erik (2005). Restoration of cardiopulmonary function with 21% versus 100% oxygen after hypoxaemia in newborn pigs. Archives of Disease in Childhood: Fetal and Neonatal Edition. ISSN 1359-2998. 90, s. 229–234. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To assess the consequences of hypoxaemia and resuscitation with room air versus 100% O2 on cardiac troponin I (cTnI), cardiac output (CO), and pulmonary artery pressure (PAP) in newborn pigs. Design: Twenty anaesthetised pigs (12�36 hours; 1.7�2.7 kg) were subjected to hypoxaemia by ventilation with 8% O2. When mean arterial blood pressure fell to 15 mm Hg, or arterial base excess was �20 mmol/l, resuscitation was performed with 21% (n = 10) or 100% (n = 10) O2 for 30 minutes, then ventilation with 21% O2 for 120 minutes. Blood was analysed for cTnI. Ultrasound examinations of CO and PAP (estimated from tricuspid regurgitation velocity (TR-Vmax)) were performed at baseline, during hypoxia, and at the start of and during reoxygenation. Results: cTnI increased from baseline to the end point (p<0.001), confirming a serious myocardial injury, with no differences between the 21% and 100% O2 group (p = 0.12). TR-Vmax increased during the insult and returned towards baseline values during reoxygenation, with no differences between the groups (p = 0.11) or between cTnI concentrations (p = 0.31). An inverse relation was found between increasing age and TR-Vmax during hypoxaemia (p = 0.034). CO per kg body weight increased during the early phase of hypoxaemia (p<0.001), then decreased. Changes in CO per kg were mainly due to changes in heart rate, with no differences between the groups during reoxygenation (p = 0.298). Conclusion: Hypoxaemia affects the myocardium and PAP. During this limited period of observation, reoxygenation with 100% O2 showed no benefits compared with 21% O2 in normalising myocardial function and PAP. The important issue may be resuscitation and reoxygenation without hyperoxygenation

• Meberg, Alf; Lindberg, Harald & Thaulow, Erik (2005). Congenital heart defects: The patients who die. Acta Paediatrica. ISSN 0803-5253. 94. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To register mortality and causes of death in patients with congenital heart defects (CHDs). Methods: Prospective population-based observational study. Results: 553 infants with CHD (1.1% of live born) were observed for 1-22 y (median 10 7/12 y). Sixty-four died (11.6%), of whom 32 (50%) died during the first 4 wk, and 51 (79.7%) during the first year of life. Of the total neonatal deaths in the population (3 per 1000), CHDs occurred in 21.5%. Mortality for children with CHDs was not significantly different between the cohorts born in 1982-1991 and 1992-2002, for either neonatal deaths or deaths later on (p>0.05). Out of 170 patients in whom therapeutic procedures (surgery, catheter interventions) were undertaken, 34 (20%) died. Nine cases (1.6%) died with unrecognized CHDs; seven of these on the first day of life with severe extracardiac malformations. In 50 (78.1%) cases, death was judged to be caused directly or indirectly from the CHD, and in 14 (21.9%) from extracardiac malformations or other conditions.Conclusion: CHDs occur in a substantial number of neonatal deaths. Most deaths are caused by cardiac insufficiency. The mortality rate remained unchanged.

• Døhlen, Gaute; Carlsen, Harald; Blomhoff, Rune; Thaulow, Erik & Saugstad, Ola Didrik (2005). Reoxygenation of Hypoxic Mice with 100% Oxygen Induces Brain Nuclear Factor-kappa B. Pediatric Research. ISSN 0031-3998. 58, s. 941–945. doi: 10.1203/01.PDR.0000182595.6254. Fulltekst i vitenarkiv Vis sammendrag

  Oxidative stress is closely related to inflammation, a pathologic process characterized by activation of the transcriptional factor nuclear factor-kappa B (NF-kappaB). We have used transgenic NF-kappaB luciferase reporter mice to assess brain NF-kappaB activity noninvasively in living mice. We have studied NF-kappaB activation in hypoxic mice reoxygenated with either 21% O2 (room air) or 100% O2. Forty-one mice exposed for 2 h to 4% oxygen and then randomized to reoxygenation with pure oxygen or room air were investigated. A control mouse was dedicated to every mouse exposed to hypoxia. In vivo luminescence originated from brain was measured from mice 2 d before hypoxia, and 3 h after reoxygenation. A change in luminescence between the mouse exposed to hypoxia and its control demonstrates an alteration in NF-kappaB activity. Because of high mortality among males, only females were included. Six female mice died. Nineteen female mice were reoxygenated with room air, 16 with pure oxygen. We observed a significantly higher luminescence in the brain of the 100% O2 group versus the 21% O2 group (p = 0.016). Our data indicate that brain NF-kappaB activity is increased in mice subjected to 4% oxygen followed by reoxygenation with 100% oxygen. However, when reoxygenation occurs with 21% O2 (room air), no elevation in NF-kappaB activity is observed. Thus, reoxygenation with room air may induce less brain inflammation than reoxygenation with pure oxygen.

• Eskedal, Leif Torvald; Hagemo, Petter Skjalg; Eskild, Anne; Aamodt, Geir; Seiler, Stephen & Thaulow, Erik (2005). Survival after surgery for congenital heart defects: Does reduced early mortality predict improved long-term survival? Acta Paediatrica. ISSN 0803-5253. 94, s. 438–443. Fulltekst i vitenarkiv
• Eskedal, Leif Torvald; Eskild, Anne; Hagemo, Petter; Seiler, Stephen & Thaulow, Erik (2005). Survival after surgery for congenital heart defects: Does reduced early mortality predict improved long-term survival? Acta Paediatrica. ISSN 0803-5253. 94, s. 438–443. Fulltekst i vitenarkiv Vis sammendrag

  Conclusion: Early mortality has been substantially reduced in congenital heart defect patients, and corresponds with significantly improved long-term survival.

• Brun, Henrik; Holmstrøm, Henrik Alf B & Thaulow, Erik (2005). Sudden death during a change in treatment for pulmonary hypertension. Cardiology in the Young. ISSN 1047-9511. 15(2), s. 223–225. Fulltekst i vitenarkiv Vis sammendrag

  We describe an infant with an atrioventricular septal defect and separate valvar orifices for the right and left ventricles, the so-called primum defect, who presented with serious pulmonary hypertension. Treatment with sildenafil was changed to intravenous epoprostenol due to lack of any measurable effects of the initial therapy as shown by echocardiography. The girl died three days after the change in treatment. We suggest that a mismatch between ventilation and perfusion contributed significantly to her death

• Eskedal, Leif Torvald; Hagemo, Petter S.; Eskild, Anne; Aamodt, Geir; Seiler, Karry Stephen & Thaulow, Erik (2005). Survival after surgery for congenital heart defects: does reduced early mortality predict improved long-term survival? Acta Paediatrica. ISSN 0803-5253. 94(4), s. 438–443. Fulltekst i vitenarkiv Vis sammendrag

  The objectives of this study were 1) to compare early mortality (first 30 d after surgery) and long-term survival between two cohorts of patients operated on for congenital cardiac defects, and 2) to evaluate the impact of possible changes in early mortality on long-term survival. METHODS: 945 patients with congenital cardiac defects, born in 1990-1999 and operated on in the same period were examined in a retrospective cohort study. The patients were divided into three groups: "univentricular cardiac defects", "severe cardiac defects" and "less severe cardiac defects". The study population was divided into two cohorts: group 1 included patients born and operated on in 1990-1994; group 2 included patients born and operated on in 1995-1999. The survival patterns in the two groups were compared. RESULTS: For all patients, except those with univentricular cardiac defects, early mortality (30 d after surgery) was reduced. Among patients with severe cardiac defects, early mortality was reduced from 18.6% in group 1 to 2.9% in group 2. Among patients with less severe cardiac defects, early mortality was reduced from 6.2% to 1.9%. The improved outcome was maintained during the following 5 y. Overall relative risk of death during follow-up was reduced to 0.31 (95% CI: 0.15-0.56) for patients with severe cardiac defects, and to 0.53 (95% CI: 0.31-0.93) for patients with less severe cardiac defects born and operated on in 1995-1999. CONCLUSION: Early mortality has been substantially reduced in congenital heart defect patients, and corresponds with significantly improved long-term survival

• Thaulow, Erik & Lenes, K (2005). Echocardiography in adults with congenital heart disease. Minerva Cardioangiologica : a Journal on Cardiovascular Pathophysiology, Clinical Medicine and Therapy. ISSN 0026-4725. 53(2), s. 117–127. Fulltekst i vitenarkiv Vis sammendrag

  Echocardiography is a valuable tool in the investigation and follow-up of adult patients with congenital heart disease. The majority of these patients have been recognised and treated in childhood, and effective investigations in adult life depend on exact knowledge of the patient history and previous treatments/operations. The major lesions are presented and important echocardiographic features briefly discussed

• Engelfriet, P; Boersma, E; Oechslin, E; Tijssen, J; Gatzoulis, Michael A & Thilen, U [Vis alle 15 forfattere av denne artikkelen] (2005). The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period. European Heart Journal. ISSN 0195-668X. s. 1–9. doi: 10.1093/eurheartj/ehi396. Fulltekst i vitenarkiv Vis sammendrag

  AIMS: To describe clinical and demographic characteristics at baseline of a European cohort of adults with congenital heart disease (CHD) and to assess mortality and morbidity in a 5 year follow-up period. METHODS AND RESULTS: Data collected as part of the Euro Heart Survey on adult CHD was analysed. This entailed information transcribed from the files of 4110 patients diagnosed with one of eight congenital heart conditions ('defects'), who consecutively visited the outpatient clinics of one of the participating centres in 1998. The patients were included retrospectively and followed until the end of 2003 for a median follow-up of 5.1 years. Notwithstanding their overall relatively good functional class and low mortality over the follow-up period, a considerable proportion of the patients had a history of endocarditis, arrhythmias, or vascular events. There were major differences between the eight defects, both in morbidity and regarding specific characteristics. Outcomes were worst in cyanotic defects and in the Fontan circulation, but a considerable proportion of the other patients also suffer from cardiac symptoms. In particular, arrhythmias are common. CONCLUSION: The spectrum of adult CHD in Europe emerging from this survey is one of a predominantly young population with substantial morbidity but relatively low mortality in a 5 year period

• Børke, Wenche Bakken; Munkeby, Berit Holthe; Mørkrid, Lars; Thaulow, Erik & Saugstad, Ola Didrik (2004). Resuscitation with 100% O-2 does not protect the myocardium in hypoxic newborn piglets. Archives of Disease in Childhood. ISSN 0003-9888. 89, s. 156–160. Fulltekst i vitenarkiv Vis sammendrag

  * Background: Perinatal asphyxia is associated with cardiac dysfunction secondary to myocardial ischaemia. Cardiac troponin I (cTnI) is a marker of myocardial necrosis. Raised concentrations in the blood are related to perinatal asphyxia and increased morbidity. * Objective: To assess porcine myocardial damage from enzyme release during hypoxaemia induced global ischaemia, and subsequent resuscitation with ambient air or 100% O2. To investigate whether CO2 level during resuscitation influences myocardial damage. * Design: Newborn piglets (12�36 hours) were exposed to hypoxaemia by ventilation with 8% O2 in nitrogen. When mean arterial blood pressure had fallen to 15 mm Hg, or base excess to < -20 mmol/l, the animals were randomly resuscitated by ventilation with either 21% O2 (group A, n = 29) or 100% O2 (group B, n = 29) for 30 minutes. Afterwards they were observed in ambient air for another 150 minutes. During resuscitation, the two groups were further divided into three subgroups with different CO2 levels. * Analysis: Blood samples were analysed for cTnI, myoglobin, and creatine kinase-myocardial band (CK-MB) at baseline and at the end of the study. * Results: cTnI increased more than 10-fold (p < 0.001) in all the groups. Myoglobin and CK-MB doubled in concentration. * Conclusion: The considerable increase in cTnI indicates seriously affected myocardium. Reoxygenation with 100% oxygen offered no biochemical benefit over ambient air. CK-MB and myoglobin were not reliable markers of myocardial damage. Normoventilation tended to produce better myocardial outcome than hyperventilation or hypoventilation.

• Eskedal, Leif Torvald; Hagemo, Petter S.; Eskild, Anne; Aamodt, Geir; Seiler, Karry Stephen & Thaulow, Erik (2004). A population-based study of extra-cardiac anomalies in children with congenital cardiac malformations. Cardiology in the Young. ISSN 1047-9511. 14(6), s. 600–608. Fulltekst i vitenarkiv Vis sammendrag

  We describe the prevalence of extra-cardiac anomalies in children with congenital cardiac malformations, and their impact on survival, compared to the outcome in children with the congenital cardiac lesions as the only recognised anomaly. Our population comprises the 3527 children born with congenital cardiac anomalies between 1990 and 1999, and registered at the largest tertiary centre for Paediatric Cardiology in Norway. Extra-cardiac anomalies were found in one-fifth of the population, with Down's syndrome accounting for nearly one-third. Survival improved for children born between 1995 and 1999 compared with those born in the period from 1990 to 1994 for all groups, except for children with additional extra-cardiac anomalies in the absence of Down's syndrome. The results were the same for children undergoing surgical treatment of their cardiac malformation. The survival in children with Down's syndrome improved in comparable fashion to those without extra-cardiac anomalies. Children with extra-cardiac anomalies in the absence of Down's syndrome represent a heterogeneous group, with varying patterns of survival. Survival did not improve in these latter patients during the period of our study

• Eskedal, Leif Torvald; Hagemo, Petter; Eskild, Anne; Aamodt, Geir; Seiler, Stephen & Thaulow, Erik (2004). A population-based study of extra-cardiac anomalies in children with congenital cardiac malformations. Cardiology in the Young. ISSN 1047-9511. 14, s. 600–607. Fulltekst i vitenarkiv
• Thaulow, Erik & Fredriksen, Per Morten (2004). Exercise and training in adults with congenital heart disease. International Journal of Cardiology. ISSN 0167-5273. 97(12), s. 35–38. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Patients with congenital heart disease run the risk of overweight and low physical activity. Lifestyle measures are as important in these patients as in the general population. Exercise testing is an effective tool to identify patients in whom exercise may induce arrhythmias or hemodynamic instability but more often to reveal the safety of exercise, which is the conclusion in the majority of these patients. Systematic training programs have only been introduced to small groups of patients with congenital heart disease, and there are only few data on the effects obtained. The studies concluded that the exercise training programs used were safe. http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T16-4DR1WDN-2-1&_cdi=4882&_user=674998&_orig=search&_coverDate=12%2F01%2F2004&_qd=1&_sk=999029999.8998&view=c&wchp=dGLbVlb-zSkWz&md5=cbd21a2e70044c07b41a217d330c2901&ie=/sdarticle.pdf

• Jørgensen, B & Thaulow, Erik (2004). The effects of amlodipine on ischemia after PTCA. Secondary results of the CAPARES study. Cardiovascular Research (CVR). ISSN 0008-6363. 1, s. 22–23. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Thaulow, Erik; Døhlen, Gaute & Erikssen, Gunnar (2019). Kapittel 17: Medfødte hjertefeil. I Dalen, Håvard; Forfang, Kolbjørn; Haugaa, Kristina; Istad, Helge & Wiseth, Rune (Red.), Kardiologi - Klinisk veileder, 3.utgave. Gyldendal Akademisk. ISSN 9788205523951. s. 263–273. Fulltekst i vitenarkiv
• Thrane, Karl Julius; Thomassen, Kristian Stien; Suther, Lene Kathrine R; Geier, Oliver; Nguyen, Bac & Tomterstad, Anders Høye [Vis alle 10 forfattere av denne artikkelen] (2017). MRI T1 mapping of the liver in adolescents with Fontan circulation. Fulltekst i vitenarkiv
• Møller, Thomas; Fredriksen, P M; Holmström, Henrik Alf B. & Thaulow, Erik (2012). Impaired right ventricular contractile reserve late after surgical closure of isolated ventricular septal defect. European Heart Journal. ISSN 0195-668X. 33, s. 260–261. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Brun, Henrik; Dalen, Marit Lunde; Sejersted, Yngve; Edvardsen, Thor & Saugstad, Ola Didrik [Vis alle 7 forfattere av denne artikkelen] (2010). Determinants of mitral annulus peak systolic velocity - a study in piglets. Fulltekst i vitenarkiv Vis sammendrag

  Background: Systolic long axis myocardial dysfunction is an important determinant for mortality in adults. This study aimed at defining hemodynamic determinants of tissue Doppler derived, long-axis function, parameters in the newborn. Methods: Ten newborn pigs were studied under general anesthesia. Modulation of inotropy (dobutamine, esmolol), preload and afterload was done. Heart rate was increased by atrial pacing at each stage of inotropy. Tissue Doppler velocities in the mitral valve annulus were measured at each stage. Invasive measurements included high fidelity pressures (Millar catheters) in the left ventricle (LV) and aorta, and volume (conductance) in the LV. Velocity was integrated into displacement, and stroke volume and pressure was derived into flow and dP/dt respectively. All data were integrated in a computer and analyzed on a beat to beat fashion. For statistical modelling we used linear mixed models. Statistical models included unique hemodynamic determinants (stroke volume, flow, heart rate, ejection time and maximum dP/dt, effective arterial elastance) to assess their effect on peak systolic velocity (S') and displacement (D). The parameter estimate (beta) indicates the magnitude and directional change in the tissue Doppler parameter for a 1-unit increase in the corresponding variable. Results: During inotropy modulation with dobutamine S' increased, while (D) did not change. There was no change in S' with pacing at a higher rate, while D decreased with pacing. The strongest determinants of S' included both peak systolic flow (PSF, beta= 0.09 cm/mL; P<0.001) and end-systolic pressure (ESP, beta= -0.07 cm/mL; P=0.003). At the same time a strong association was found between stroke volume (SV) and D (D, beta= 0.05cm/mL; P<0.001). Hemodynamic changes were evident during modulation of pre- and afterload. Ejection time, stroke volume, end-systolic pressure, maximum dP/dt and PSF were all found to influence S' and D during preload and afterload modulation. The ratio PSF/S' and SV/D were found to be stable under the different hemodynamic modulations. Conclusion: First, this study provides feasibility of tissue Doppler assessment of the lateral mitral valve annulus long axis velocity in the neonate, even at higher heart rates. Secondly it provides validity to the assumption that systolic mitral valve annulus displacement is the long axis contribution to stroke volume, and peak systolic mitral valve annulus velocity is the long axis contribution to peak systolic flow.

• Odland, Hans Henrik; Brun, Henrik; Dalen, Marit Lunde; Sejersted, Yngve; Edvardsen, Thor & Saugstad, Ola Didrik [Vis alle 7 forfattere av denne artikkelen] (2010). Peak systolic acceleration: a new marker of long axis contractility. Fulltekst i vitenarkiv Vis sammendrag

  Background: Myocardial and endomyocardial accelerations have been shown to relate to contractility in adults and children. This study was designed to assess and validate myocardial acceleration of the left ventricular lateral mitral valve annulus by tissue Doppler in neonatal pigs by comparison with invasive hemodynamic data. Methods: Ten newborn pigs were studied under general anesthesia. Modulation of inotropy (dobutamine,esmolol), preload and afterload was done. Heart rate was increased by atrial pacing at each stage of inotropy. Tissue Doppler velocities were measured at each stage of inotropy and again with increased heart rate. Invasive measurements consisted of high fidelity pressures (Millar catheters) in the left ventricle (LV) and aorta, and volume (conductance) in the LV. Velocity was derived into acceleration, and pressures and volume into dP/dt and Flow respectively. All data were integrated in a computer and analyzed on a beat to beat fashion. ESPVR, Emax, PRSW was extracted for each stage of inotropy. We used mixed linear models for statistical modelling. Statistical models included unique hemodynamic determinants and assessed their effect on systolic acceleration. Peak systolic acceleration (pSac) was measured after the onset of left ventricular pressure rise. The parameter estimate (beta) indicates the magnitude and directional change in the tissue Doppler parameter for a 1-unit increase in the corresponding variable. Results: Maximum dP/dt was found to be the strongest determinant of pSac (beta=0.9±0.1; P<0.001) during inotropy modulation. Log pSac was related to logarithmic transformed ESPVR, Emax and PRSW (beta= 0.35±0.11; P= 0.005, beta= 0.53±0.14; P= 0.001 and beta= 0.9±0.14; P< 0.001 respectively). During preload reduction pSac determined log dP/dtmax (beta= 1.33±0.37; P< 0.001), while during afterload increase log ET (beta= -0.76±0.33; P< 0.032) and log SW (beta= 0.26±0.10; P< 0.026) were the strongest determinants of pSac. Log pSac increased by 0.10±0.03 cm/s2 (P=0.03) with pacing at a higher rate. Accelerations occurring before and during the isovolumic period were not associated with inotropic parameters. Conclusion: A stable and constant relation towards maximum dP/dt and preload independent parameters could be established in this study. pSac is a marker of long axis contractility, and this study provides evidence that pSac should be viewed upon as the long axis contribution to maximum dP/dt.

• Nordhagen, Live Solveig; Matthews, Iren; Grønn, Morten & Thaulow, Erik (2010). Increased functional residual capacity in infants with Univentricular Heart Physiology. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Brun, Henrik; Dalen, Marit Lunde; Sejersted, Yngve; Edvardsen, Thor & Saugstad, Ola Didrik [Vis alle 7 forfattere av denne artikkelen] (2010). Peak systolic acceleration: a new marker of long axis contractility. European Heart Journal. ISSN 0195-668X. 31, s. 860–861. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Brun, Henrik; Dalen, M.; Sejersted, Yngve; Edvardsen, T & Saugstad, Ola Didrik [Vis alle 7 forfattere av denne artikkelen] (2010). Determinants of mitral annulus peak systolic velocity - a study in piglets. European Heart Journal. ISSN 0195-668X. 31(Supp. 1), s. 863–863. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Kro, Grete A B; Munkeby, Berit Holthe; Edvardsen, Thor; Saugstad, Ola Didrik & Thaulow, Erik (2009). STRAIN RATE BY SPECKLE TRACKING PERFORMS BETTER THAN TISSUE DOPPLER DERIVED STRAIN RATE IN A MODEL OF NEONATAL HYPOXIA. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Kro, Grete A B; Munkeby, Berit Holthe; Edvardsen, Thor; Saugstad, Ola Didrik & Thaulow, Erik (2008). Myocardial septal velocity is a more robust parameter than lateral wall velocity for evaluation of global myocardial hypoxia in the neonate. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Kro, Grete A B; Munkeby, Berit Holthe; Edvardsen, Thor; Saugstad, Ola Didrik & Thaulow, Erik (2008). Myocardial Tissue Velocities Are Dependent on Weight and LVEDV during Global Hypoxia in The Neonate. Fulltekst i vitenarkiv
• Moller, T; Peersen, K; Fredriksen, PM; Holmstrom, H & Thaulow, Erik (2008). Exercise-induced abnormal pulmonary arterial pressure response in young athletes - normal physiology or precursor of endothelial damage? Circulation. ISSN 0009-7322. 118, s. E290–E290. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Carlsen, Harald; NESSE, ANN LISBETH; Thaulow, Erik; Blomhoff, Rune & Saugstad, Ola Didrik (2007). Reoxygenation With 100% Oxygen In Hypoxic Neonatal Mice Increases NF- B Activity In The Brain. Fulltekst i vitenarkiv
• Odland, Hans Henrik; Edvardsen, Thor; Thaulow, Erik & Saugstad, Ola Didrik (2007). MYOCARDIAL FUNCTION IS IMPROVED IN HYPOGLYCEMIC COMPARED TO NORMOGLYCEMIC NEONATAL PIGS AFTER RESUSCITATION. Fulltekst i vitenarkiv
• Thaulow, Erik (2007). Ny klaff med fjernstyrt operasjon. [TV]. Nrk Schrödingers katt . Fulltekst i vitenarkiv Vis sammendrag

  Hvert år blir det født mellom 5 - og 600 barn med hjertefeil her til lands. Mange av dem har hjerteklaffer som fungerer dårlig, og de må derfor gjennomgå en serie åpne hjerteoperasjoner i oppveksten. Nå kan en ny operasjonsmetode spare dem den belastningen. Firmaet Medtronic produserer utstyret som trengs til denne operasjonen. Den er blitt brukt i andre land tidligere og det er canadiske kirurger som nå har vært i Norge for å lære opp sine norske kolleger. - De gjentatte hjerteoperasjonene er en stor belastning for både kroppen og psyken til disse pasientene. Åpen hjertekirurgi gir mange måneder lang rekonvalesens, mens de etter denne operasjonen kan forlate sykehuset etter bare ett døgn og gjenoppta livet etter få dager, sier overlege Erik Thaulow ved Rikshospitalet

• Thaulow, Erik (2006). Exercise and training in Grown-Ups with Congenital Heart Disease. Fulltekst i vitenarkiv
• Thaulow, Erik (2006). Pediatric cardiac surgery in Norway. Long term survival rates. Fulltekst i vitenarkiv
• Wyller, Vegard Bruun; Thaulow, Erik & Amlie, Jan Peder (2006). Synkope hos barn og unge voksne. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 126(21), s. 2831–2831. Fulltekst i vitenarkiv
• Thaulow, Erik (2006). Fysisk aktivitet bra for hjertesyke barn. [TV]. NRK 1 - Puls . Fulltekst i vitenarkiv Vis sammendrag

  Erik Thaulow, som er seksjonsoverlege på barnehjerteavdelingen ved Rikshospitalet og fysioterapeut Per Morten Fredriksen startet i 1994 opp en ny metode for å teste hjertesyke barns yteevne. I stedet for å la dem gå i trapper, slik man hadde gjort tidligere, tok de i bruk den samme tredemølletesten som Idrettshøgskolen bruker. Under konstant oppsyn av Fredriksen løper barna til de svettende og pesende ikke orker mer. Arbeidet gir nå resultater. Kunnskaper og holdninger om hva hjertesyk ungdom tåler har forandret seg radikalt siden Fredriksen og Thaulow startet testene sine. Nå tør også legene å gi helt andre råd enn de gjorde før. - Med utgangspunkt i hva slags type hjertefeil det er, så er budskapet at de kan trene og de kan være fysisk aktive, Fredriksen. - De skal få en trygghet på det å være fysisk aktiv og kunne trene. Det beroliger både foreldre leger, lærere, trenere og ikke minst dem selv, sier han.

• Thaulow, Erik (2006). Markus fikk livet to ganger. [Journal]. Asker og Bærum Budstikke. Fulltekst i vitenarkiv Vis sammendrag

  Vi kan ikke garantere at det går bra, sa legen før Markus Røang skulle opereres for en hjertefeil han ikke kunne leve med. Mange barn som vi opererer i dag, ville dødd bare for noen år siden, sier seksjonsoverlege på barnehjerteseksjonen på Rikshospitalet, Erik Thaulow fra Jar.

• Wyller, Vegard Bruun & Thaulow, Erik (2006). Barnehjerter ikke leget for alltid. [Journal]. A-Magasinet Aftenposten. Fulltekst i vitenarkiv Vis sammendrag

  Hjertebarna: 40 prosent av alle barn med hjertefeilen Fallots tetrade må opereres på nytt i tenårene.

• Odland, Hans Henrik; Fruh, Andreas; Seem, E. & Thaulow, Erik (2005). Results after mid-term implantation of Contegragraft. Fulltekst i vitenarkiv
• Holmstrøm, Henrik Alf B & Thaulow, Erik (2005). Ekko for alle barn med bilyd? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 125(8), s. 994–994. Fulltekst i vitenarkiv Vis sammendrag

  Klinisk undersøkelse av barn med hjertefeil har høy treffsikkerhet, men er den god nok?

• Brun, Henrik; Holmstrøm, Henrik Alf B; Fredriksen, Per Morten; Matthews, Iren; Lund, May Brit & Thaulow, Erik (2005). Behandlingsprogram ved Eisenmenger-syndrom- hvordan måle effekt? Paidos: Tidsskrift for Norsk barnelegeforening. ISSN 1503-5360. s. 10–10. Fulltekst i vitenarkiv Vis sammendrag

  Abstrakt fra Norsk Barnelegeforenings høstmøte 2004

• Thaulow, Erik & Seem, Egil (2005). Dødeligheten blant hjerteopererte barn halvert. [Journal]. Verdens Gang. Fulltekst i vitenarkiv Vis sammendrag

  Rekordmange hjerteopererte barn overlever. Risikoen for å dø er mer enn halvert på få år. Det viser en ny norsk forskningsrapport som legges frem denne måneden. Barnekardiolog og forsker Leif Eskedal ved Sørlandet sykehus har studert hvordan det har gått med 1415 norske hjerteopererte barn, både på kort og lang sikt. Andelen hjerteopererte barn som ikke overlevde de første 30 dagene, sank fra 11 prosent til under fem prosent fra første til andre halvdel av 90-tallet. Deretter har utviklingen fortsatt i positiv utvikling. Samtidig som flere hjerteopererte barn overlever, utfører hjertekirurgene stadig mer komplekse inngrep. All hjertekirurgi på barn i Norge utføres nå på Rikshospitalet. Der forklarer de kraftig økende overlevelsestallene med at kompetansen har økt på alle områder. - Vi skjønner tidligere enn før når noe kan gå galt, og er blitt flinkere til å stille diagnoser tidlig og følge opp etter operasjonen. I tillegg er det tekniske utstyret forbedret. Blant annet kan vi bruke hjerte-lungemaskiner og ultralyd på yngre barn enn vi kunne før, sier seksjonsleder Erik Thaulow og leder for barnehjertekirurgien, Egil Seem.

• Matthews, Iren; Fredriksen, Per Morten; Bjørnstad, Per G & Thaulow, Erik (2004). Abnormal lung function and exercise test in children with the Fontan circulation. Fulltekst i vitenarkiv
• Möller, Thomas & Thaulow, Erik (2010). Right ventricular pressure response to exercise in congenital heart septal defects. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Pulmonary arterial hypertension (PAH) is a serious long-term complication of congenital heart disease with systemic-to-pulmonary shunting of blood. The volume overload in the pulmonary circulation can result in chronic pulmonary vascular disease and PAH. A European multi-centre study reported a high prevalence of secondary PAH in adult patients with closed atrial septal defect (ASD) or closed ventricular septal defect (VSD). It is commonly assumed that secondary PAH could be prevented by surgical or interventional closure of septal defects early in childhood. Our study aimed to investigate early indications of pulmonary circulatory changes in a population-based group of young patients with ASD or VSD. Abnormal rise of right ventricular systolic pressure (RVSP) during exercise reflects high pulmonary arterial pressure and it is considered to be an early sign of pulmonary vascular disease. We studied 116 healthy volunteers and an unselected group of 50 patients, age 13 to 25, who were born with either isolated ASD or isolated VSD. All patients with ASD and the patients with large VSD had their defect closed by surgery or device implantation. The study investigation consisted of exercise testing on a treadmill (VO2peak), echocardiography at rest and during supine bicycling, biochemical and genetical analysis. A selected patient subgroup was also examined during simulated altitude conditions. All patient groups (closed ASD, closed VSD, small open VSD) had reduced exercise capacity as compared to controls. One out of three patients with VSD (50% of those with closed VSD) showed an RVSP above 50 mmHg during exercise, which had been previously demonstrated to be the upper normal pressure limit for healthy non-athletic individuals. Abnormal RVSP response could also be induced or worsened by moderate altitude. In two patients with abnormal RVSP response we found a previously undescribed mutation in the BPMR-2 gene which is the affected gene in hereditary forms of PAH.

• Eskedal, Leif Torvald & Thaulow, Erik (2008). Survival in surgical congenital heart defects. Universitetet i Oslo. ISSN 9788280729088. Fulltekst i vitenarkiv
• Børke, Wenche Bakken; Saugstad, Ola Didrik & Thaulow, Erik (2005). Myocardial injury and performance in hypoxaemic neonates: Effects of oxygen and carbon dioxide during reoxygenation : An experimental study in newborn pigs. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Definition of asphyxia. Asphyxia is a Greek term and means loss of pulse (1). There is no clear definition of the term, though perinatal asphyxia or birth asphyxia often is defined as impaired placental- or pulmonary oxygen delivery to the neonate. As a consequence the neonate is going through a period of hypoxaemia and hypercapnia with a subsequent respiratory and metabolic acidosis (1). In clinical work, the diagnosis of perinatal asphyxia predominantly is based on its consequences, and there is a general agreement that a combination of perinatal stress (i.e. fetal bradycardia, acidosis, low Apgar scores), multiple organ affection and neurological symptoms (i.e. hypoxic ischemic encephalopathy) are required for the diagnosis (2). Cardiac abnormalities in perinatal asphyxia. Myocardial performance may vary subsequent to asphyxia. The cardiac dysfunction is often underdiagnosed and requires a high index of suspicion to detect (3;4). The clinical picture varies from brady- or tachycardia to cardiogenic shock (1;5). Myocardial failure subsequent to asphyxia was first reported in 1961 (6). The authors described a group of asphyxiated neonates with left ventricular (LV) heart failure within the first 24 hours of life. A decade later three term infants were reported with a syndrome of acute LV failure accompanied by cyanosis and pulmonary and systemic venous congestion (7). Rowe et al. (8) classified the cardiac abnormalities following asphyxia in 1978, broadly as: 1) Transient myocardial ischaemia of the newborn 2) Transient mitral regurgitation of the newborn 3) Transient tricuspid regurgitation of the newborn 4) Persistent pulmonary hypertension of the newborn Increased pulmonary artery pressure (PAP) and tricuspid regurgitation is the most common, and although the cardiac abnormalities were described as separate clinical entities, it is important to understand that the distinction may not be clear, and there is much overlap in the pathogenesis. In severely asphyxiated neonates post-mortem autopsies have showed ischemic papillary muscle necrosis and diffuse subendocardial left ventricular (LV) necrosis secondary to perinatal asphyxia (9;10). Aetiology The aetiology of asphyxia in the newborn is multifactorial, including abruption or infarction of the placenta, excessive uterine contraction, fetal or maternal bleeding, and compression of the umbilical cord. Infection is contributing to its severity, and the clinical picture in severe asphyxia may present similar to what is seen in severe congenital heart disease, thus it is mandatory to evaluate these neonates by echocardiography to exclude congenital heart disease.

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