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Article ; Online: The Acute Impact of Endurance Exercise on Right Ventricular Structure and Function: A Systematic Review and Meta-analysis.

Ramcharan, Tristan / Edwards, Jamie / O'Driscoll, Jamie / Papadakis, Michael

Cardiac electrophysiology clinics

2023 Volume 16, Issue 1, Page(s) 25–34

Abstract: There have been many studies since the late 1980s investigating the effect of endurance exercise on the left ventricle. More recently, attention has shifted to the right heart, with suggestions that endurance exercise may have a detrimental effect on the ...

Abstract	There have been many studies since the late 1980s investigating the effect of endurance exercise on the left ventricle. More recently, attention has shifted to the right heart, with suggestions that endurance exercise may have a detrimental effect on the right ventricle. This systematic review and meta-analysis summarizes and critiques 26 studies, including 649 athletes, examining the acute impact of endurance exercise on the right ventricle. We also present a subanalysis contrasting ultraendurance with endurance exercise. Finally, we identify areas for future research, such as the influence of sex, ethnicity, and age.
MeSH term(s)	Humans ; Heart Ventricles ; Physical Endurance ; Ventricular Function, Right ; Heart
Language	English
Publishing date	2023-12-14
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ISSN	1877-9190
ISSN (online)	1877-9190
DOI	10.1016/j.ccep.2023.09.005
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Article ; Online: The Acute Impact of Endurance Exercise on Right Ventricular Structure and Function: A Systematic Review and Meta-analysis.

Ramcharan, Tristan / Edwards, Jamie / O'Driscoll, Jamie / Papadakis, Michael

Cardiology clinics

2022 Volume 41, Issue 1, Page(s) 25–34

Abstract	There have been many studies since the late 1980s investigating the effect of endurance exercise on the left ventricle. More recently, attention has shifted to the right heart, with suggestions that endurance exercise may have a detrimental effect on the right ventricle. This systematic review and meta-analysis summarizes and critiques 26 studies, including 649 athletes, examining the acute impact of endurance exercise on the right ventricle. We also present a subanalysis contrasting ultraendurance with endurance exercise. Finally, we identify areas for future research, such as the influence of sex, ethnicity, and age.
MeSH term(s)	Humans ; Heart Ventricles ; Ventricular Function, Right ; Physical Endurance ; Athletes ; Heart ; Ventricular Function, Left
Language	English
Publishing date	2022-10-19
Publishing country	Netherlands
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	1196385-2
ISSN	1558-2264 ; 0733-8651
ISSN (online)	1558-2264
ISSN	0733-8651
DOI	10.1016/j.ccl.2022.08.004
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Article ; Online: Ebstein's Anomaly: From Fetus to Adult-Literature Review and Pathway for Patient Care.

Ramcharan, Tristan K W / Goff, Donna A / Greenleaf, Christopher E / Shebani, Suhair O / Salazar, Jorge D / Corno, Antonio F

Pediatric cardiology

2022 Volume 43, Issue 7, Page(s) 1409–1428

Abstract: Ebstein's anomaly, first described in 1866 by Dr William Ebstein, accounts for 0.3-0.5% of congenital heart defects and represents 40% of congenital tricuspid valve abnormalities. Ebstein's anomaly affects the development of the tricuspid valve with ... ...

Abstract	Ebstein's anomaly, first described in 1866 by Dr William Ebstein, accounts for 0.3-0.5% of congenital heart defects and represents 40% of congenital tricuspid valve abnormalities. Ebstein's anomaly affects the development of the tricuspid valve with widely varying morphology and, therefore, clinical presentation. Associated congenital cardiac lesions tend to be found more often in younger patients and may even be the reason for presentation. Presentation can vary from the most extreme form in fetal life, to asymptomatic diagnosis late in adult life. The most symptomatic patients need intensive care support in the neonatal period. This article summarizes and analyzes the literature on Ebstein's anomaly and provides a framework for the investigation, management, and follow-up of these patients, whether they present via fetal detection or late in adult life. For each age group, the clinical presentation, required diagnostic investigations, natural history, and management are described. The surgical options available for patients with Ebstein's anomaly are detailed and analyzed, starting from the initial mono-leaflet repairs to the most recent cone repair and its modifications. The review also assesses the effects of pregnancy on the Ebstein's circulation, and vice versa, the effects of Ebstein's on pregnancy outcomes. Finally, two attached appendices are provided for a structured echocardiogram protocol and key information useful for comprehensive Multi-Disciplinary Team discussion.
MeSH term(s)	Adult ; Ebstein Anomaly/diagnostic imaging ; Ebstein Anomaly/surgery ; Echocardiography ; Fetus ; Heart Defects, Congenital/diagnostic imaging ; Heart Defects, Congenital/therapy ; Humans ; Infant, Newborn ; Patient Care ; Tricuspid Valve/diagnostic imaging
Language	English
Publishing date	2022-04-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-022-02908-x
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Article ; Online: Medium-term Outcome of Prenatally Diagnosed Hypoplastic Left-Heart Syndrome and Impact of a Restrictive Atrial Septum Diagnosed in-utero.

Ramcharan, Tristan / Quintero, Diana B / Stickley, John / Poole, Esther / Miller, Paul / Desai, Tarak / Harris, Michael / Kilby, Mark D / Stumper, Oliver / Khan, Natasha / Barron, David J / Seale, Anna N

Pediatric cardiology

2023 Volume 44, Issue 6, Page(s) 1217–1225

Abstract: Objective: Surgical outcome data differs from overall outcomes of prenatally diagnosed fetuses with hypoplastic left heart syndrome (HLHS). Our aim was to describe outcome of prenatally diagnosed fetuses with this anomaly.: Methods: Retrospective ... ...

Abstract	Objective: Surgical outcome data differs from overall outcomes of prenatally diagnosed fetuses with hypoplastic left heart syndrome (HLHS). Our aim was to describe outcome of prenatally diagnosed fetuses with this anomaly. Methods: Retrospective review of prenatally diagnosed classical HLHS at a tertiary hospital over a 13-year period, estimated due dates 01/08/2006 to 31/12/2019. HLHS-variants and ventricular disproportion were excluded. Results: 203 fetuses were identified with outcome information available for 201. There were extra-cardiac abnormalities in 8% (16/203), with genetic variants in 14% of those tested (17/122). There were 55 (27%) terminations of pregnancy, 5 (2%) intrauterine deaths and 10 (5%) babies had prenatally planned compassionate care. There was intention to treat (ITT) in the remaining 131/201(65%). Of these, there were 8 neonatal deaths before intervention, two patients had surgery in other centers. Of the other 121 patients, Norwood procedure performed in 113 (93%), initial hybrid in 7 (6%), and 1 had palliative coarctation stenting. Survival for the ITT group from birth at 6-months, 1-year and 5-years was 70%, 65%, 62% respectively. Altogether of the initial 201 prenatally diagnosed fetuses, 80 patients (40%) are currently alive. A restrictive atrial septum (RAS) is an important sub-category associated with death, HR 2.61, 95%CI 1.34-5.05, p = 0.005, with only 5/29 patients still alive. Conclusion: Medium-term outcomes of prenatally diagnosed HLHS have improved however it should be noted that almost 40% do not get to surgical palliation, which is vital to those doing fetal counselling. There remains significant mortality particularly in fetuses with in-utero diagnosed RAS.
MeSH term(s)	Pregnancy ; Infant ; Infant, Newborn ; Female ; Humans ; Hypoplastic Left Heart Syndrome/diagnostic imaging ; Hypoplastic Left Heart Syndrome/surgery ; Atrial Septum ; Ultrasonography, Prenatal ; Retrospective Studies ; Norwood Procedures ; Treatment Outcome
Language	English
Publishing date	2023-05-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-023-03184-z
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Article ; Online: Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group - CORRIGENDUM.

Cantinotti, Massimiliano / Voges, Inga / Miller, Owen / Raimondi, Francesca / Grotenhuis, Heynric / Bharucha, Tara / Garrido, Almudena Ortiz / Valsangiacomo, Emanuela / Roest, Arno / Sunnegårdh, Jan / Salaets, Thomas / Brun, Henrik / Khraiche, Diala / Jossif, Antonis / Schokking, Michiel / Sabate-Rotes, Anna / Meyer-Szary, Jaroslaw / Deri, Antigoni / Koopman, Laurens /

Herberg, Ulrike / du Marchie Sarvaas, Gideon / Leskinen, Markku / Tchana, Bertrand / Ten Harkel, Arend D J / Ödemis, Ender / Morrison, Louise / Steimetz, Micheal / Laser, Kai Thorsten / Doros, Gabriela / Bellshan-Revell, Hannah / Muntean, Iolanda / Anagostopoulou, Andriana / Alpman, Maria Sjoborg / Hunter, Lindsey / Ojala, Tiina / Bhat, Misha / Olejnik, Peter / Wacker, Julie / Bonello, Beatrice / Ramcharan, Tristan / Greil, Gerald / Marek, Jan / DiSalvo, Giovanni / McMahon, Colin J

Cardiology in the young

2024 , Page(s) 1

Language	English
Publishing date	2024-04-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1078466-4
ISSN	1467-1107 ; 1047-9511
ISSN (online)	1467-1107
ISSN	1047-9511
DOI	10.1017/S1047951124000519
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Article ; Online: Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities, and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group.

Cantinotti, Massimiliano / Voges, Inga / Miller, Owen / Raimondi, Francesca / Grotenhuis, Heynric / Bharucha, Tara / Garrido, Almudena Ortiz / Valsangiacomo, Emanuela / Roest, Arno / Sunnegårdh, Jan / Salaets, Thomas / Brun, Henrik / Khraiche, Diala / Jossif, Antonis / Schokking, Michiel / Sebate-Rotes, Anna / Meyer-Szary, Jaroslaw / Deri, Antigoni / Koopman, Laurens /

Cardiology in the young

2024 , Page(s) 1–9

Abstract: Background: There is limited data on the organisation of paediatric echocardiography laboratories in Europe.: Methods: A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology ... ...

Abstract	Background: There is limited data on the organisation of paediatric echocardiography laboratories in Europe. Methods: A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs. Results: Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1-12), and echocardiography machines was four (range 1-12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20-60) minutes, and for repeat examination was 20 (5-30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%). Conclusion: Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.
Language	English
Publishing date	2024-03-05
Publishing country	England
Document type	Journal Article
ZDB-ID	1078466-4
ISSN	1467-1107 ; 1047-9511
ISSN (online)	1467-1107
ISSN	1047-9511
DOI	10.1017/S1047951124000131
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Article: COVID-19 in congenital heart disease (COaCHeD) study.

Chivers, Sian / Cleary, Aoife / Knowles, Rachel / Babu-Narayan, Sonya V / Simpson, John M / Nashat, Heba / Dimopoulos, Konstantinos / Gatzoulis, Michael A / Wilson, Dirk / Prica, Milos / Anthony, James / Clift, Paul F / Jowett, Victoria / Jenkins, Petra / Khodaghalian, Bernadette / Jones, Caroline B / Hardiman, Antonia / Head, Catherine / Miller, Owen /

Chung, Natali Ay / Mahmood, Umar / Bu'Lock, Frances A / Ramcharan, Tristan Kw / Chikermane, Ashish / Shortland, Jennifer / Tometzki, Andrew / Crossland, David S / Reinhardt, Zdenka / Lewis, Clive / Rittey, Leila / Hares, Dominic / Panagiotopoulou, Olga / Smith, Benjamin / Najih L, Muhammad / Bharucha, Tara / Daubeney, Piers Ef

Open heart

2023 Volume 10, Issue 2

Abstract: Background: COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care.: Objective: Ascertain ... ...

Abstract	Background: COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care. Objective: Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes. Methods: Multicentre UK study undertaken 1 March 2020-30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation. Results: There were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)). Conclusions: Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD.
MeSH term(s)	Adult ; Humans ; Child ; Adolescent ; COVID-19/therapy ; COVID-19/complications ; Pandemics ; Hospitalization ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/epidemiology ; Heart Defects, Congenital/therapy ; Pulmonary Arterial Hypertension ; Familial Primary Pulmonary Hypertension
Language	English
Publishing date	2023-07-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2053-3624
ISSN	2053-3624
DOI	10.1136/openhrt-2023-002356
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Article ; Online: Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital.

Ramcharan, Tristan / Nolan, Oscar / Lai, Chui Yi / Prabhu, Nanda / Krishnamurthy, Raghu / Richter, Alex G / Jyothish, Deepthi / Kanthimathinathan, Hari Krishnan / Welch, Steven B / Hackett, Scott / Al-Abadi, Eslam / Scholefield, Barnaby R / Chikermane, Ashish

Pediatric cardiology

2020 Volume 41, Issue 7, Page(s) 1391–1401

Abstract: Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome-"Paediatric Inflammatory Multisystem Syndrome-temporally associated ...

Abstract	Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome-"Paediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2" (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children's hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4-11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Child ; Coronavirus Infections/complications ; Coronavirus Infections/therapy ; Echocardiography ; Female ; Heart Diseases/complications ; Heart Diseases/diagnostic imaging ; Heart Diseases/therapy ; Hospitals, Pediatric ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Male ; Mucocutaneous Lymph Node Syndrome/complications ; Pandemics ; Patient Discharge ; Pneumonia, Viral/complications ; Pneumonia, Viral/therapy ; Retrospective Studies ; SARS-CoV-2 ; Stroke Volume ; Systemic Inflammatory Response Syndrome/complications ; Systemic Inflammatory Response Syndrome/therapy ; Treatment Outcome ; United Kingdom ; Vasoconstrictor Agents/therapeutic use ; Ventricular Function, Left
Chemical Substances	Immunoglobulins, Intravenous ; Vasoconstrictor Agents
Keywords	covid19
Language	English
Publishing date	2020-06-12
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-020-02391-2
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Article ; Online: Paediatric Inflammatory Multisystem Syndrome

Ramcharan, Tristan / Nolan, Oscar / Lai, Chui Yi / Prabhu, Nanda / Krishnamurthy, Raghu / Richter, Alex G. / Jyothish, Deepthi / Kanthimathinathan, Hari Krishnan / Welch, Steven B. / Hackett, Scott / Al-Abadi, Eslam / Scholefield, Barnaby R. / Chikermane, Ashish

Pediatric Cardiology ; ISSN 0172-0643 1432-1971

Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital

2020

Keywords	Pediatrics, Perinatology, and Child Health ; Cardiology and Cardiovascular Medicine ; covid19
Language	English
Publisher	Springer Science and Business Media LLC
Publishing country	us
Document type	Article ; Online
DOI	10.1007/s00246-020-02391-2
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Article ; Online: Ventricular fibromas in children, arrhythmia risk, and outcomes: A multicenter study.

Jones, John P / Ramcharan, Tristan / Chaudhari, Milind / Bhole, Vinay / Mcleod, Karen / Sadagopan, Shankar / Uzun, Orhan / Parry, Andrew / Till, Jan / McMahon, Colin J / Stuart, Alan G / Walsh, Mark A

Heart rhythm

2018 Volume 15, Issue 10, Page(s) 1507–1512

Abstract: Background: Although ventricular fibromas are rare, they are the second most common type of cardiac tumor in children. While histologically benign, they have a propensity to cause malignant arrhythmias, with cardiac arrest often being the first ... ...

Abstract	Background: Although ventricular fibromas are rare, they are the second most common type of cardiac tumor in children. While histologically benign, they have a propensity to cause malignant arrhythmias, with cardiac arrest often being the first presentation. Objective: The purpose of this study was to evaluate the arrhythmia risk and management strategies for pediatric ventricular fibromas. Methods: Fifteen centers in the British Paediatric Arrhythmia Group network were contacted to partake in the study to contribute cases. A detailed database search was performed at 2 hospitals for cases of ventricular fibromas. Results: A total of 19 patients were included in the study. Arrhythmias were common, with 5 patients presenting with cardiac arrest and 5 others having documented ventricular tachycardia. Nine patients have undergone surgical resection at various hospitals, and all these patients have survived with good long-term outcomes. One patient who did not have any treatment died, presumably of a ventricular arrhythmia; another died of metastatic disease. There were no recurrences of arrhythmia after surgery, and the need for a defibrillator was alleviated in all cases. Conclusion: Ventricular fibromas have a high propensity to cause malignant arrhythmias, and if they are not managed appropriately, mortality is high. The outcomes of surgical resection are good, regardless of size, and this represents the best therapeutic option, with most patients being symptom free in the longer term.
MeSH term(s)	Arrhythmias, Cardiac/epidemiology ; Arrhythmias, Cardiac/etiology ; Child ; Child, Preschool ; Female ; Fibroma/complications ; Fibroma/diagnosis ; Fibroma/mortality ; Follow-Up Studies ; Forecasting ; Heart Neoplasms/complications ; Heart Neoplasms/diagnosis ; Heart Neoplasms/mortality ; Heart Ventricles ; Humans ; Incidence ; Infant ; Infant, Newborn ; Ireland/epidemiology ; Magnetic Resonance Imaging, Cine ; Male ; Survival Rate/trends ; United Kingdom/epidemiology
Language	English
Publishing date	2018-06-12
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2018.06.018
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