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  1. Article: A case report of primary meningococcal pericarditis secondary to

    Green, Matthew / Harrison, Peter / Sengupta, Anshuman / Schlosshan, Dominik

    IDCases

    2022  Volume 30, Page(s) e01634

    Abstract: Pericarditis is responsible for approximately 5 % of emergency admissions due to chest pain. Pericarditis secondary to Neisseria meningitidis (meningococci) was originally reported in 1918, and remains a rare diagnosis. We report a case of primary ... ...

    Abstract Pericarditis is responsible for approximately 5 % of emergency admissions due to chest pain. Pericarditis secondary to Neisseria meningitidis (meningococci) was originally reported in 1918, and remains a rare diagnosis. We report a case of primary meningococcal pericarditis presenting with non-specific symptoms, illustrating the importance of considering rarer causes of pericardial effusion. A previously fit and well 23-year-old female presented to her local hospital with a 2-day history of feeling generally unwell with myalgia and fevers and was initially discharged. Four days following discharge the patient re-presented with worsening symptoms. A Computed Tomography Pulmonary Angiogram (CTPA) demonstrated a large pericardial effusion with subsequent bedside echocardiogram confirming a global pericardial effusion of up to 3 cm. This required drainage, with blood cultures and pericardial fluid showing polymerase chain reaction positivity for Neisseria meningitidis, serogroup B. Our report describes a rare case of Primary Meningococcal Pericarditis secondary to serotype B meningococcal infection. The European Society of Cardiology propose criteria that warrant hospital admission and an aetiology search for certain patients with pericardial disease. These criteria provide a useful framework to help select those minority of patients in whom a more serious underlying cause is present. Blood cultures provide vital information to allow us to complete a thorough aetiological search and empirical antibiotics can cloud the clinical picture, making it harder to identify causative organisms. To aid the early administration of appropriate therapy, it may be pertinent to recommend a low threshold for taking blood cultures in patients with pyrexia and pericarditis or pericardial effusion.
    Language English
    Publishing date 2022-11-01
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2745454-X
    ISSN 2214-2509
    ISSN 2214-2509
    DOI 10.1016/j.idcr.2022.e01634
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: An enormous right atrial myxoma highlights the role of echocardiography in heart failure pathways: a case report.

    Straw, Sam / Sengupta, Anshuman / Gantenby, V Kate / Schlosshan, Dominik / Ferrara, Antonella / Witte, Klaus K

    European heart journal. Case reports

    2022  Volume 6, Issue 2, Page(s) ytac042

    Abstract: Background: Myxomata are rare, benign, primary tumours of the heart which can present with a variety of symptoms depending on size, location, and mobility. Here, we report a case of enormous right atrial myxoma, obliterating the right atrial and right ... ...

    Abstract Background: Myxomata are rare, benign, primary tumours of the heart which can present with a variety of symptoms depending on size, location, and mobility. Here, we report a case of enormous right atrial myxoma, obliterating the right atrial and right ventricular cavities presenting with symptoms of heart failure.
    Case summary: A 66-year-old Caucasian female presented to primary care with symptoms of right heart failure and was found to have elevated N-terminal pro B-type natriuretic peptide of 2829 ng/L (normal value <125 ng/L). The patient was referred for urgent evaluation to the integrated heart failure service at our institution. Echocardiography revealed an enormous mobile mass attached to the right atrial septum, extending into the right ventricle and inferior vena cava measuring 90 × 42 mm. The patient underwent urgent surgical resection. Perioperative transoesophageal echocardiography demonstrated severe tricuspid regurgitation, which was treated with tricuspid annuloplasty ring. The patient made an uneventful recovery and was discharged. Subsequent imaging showed a reduction in right ventricular dimensions and improved systolic function.
    Discussion: This case serves to remind us of the critical role of echocardiography in the diagnosis and management of people with breathlessness and raised natriuretic peptides. Therapies for heart failure are guided by ejection fraction, therefore timely and accurate diagnosis is critical. Moreover, as in this case, echocardiography can also identify other features of critical relevance to patient care.
    Language English
    Publishing date 2022-01-28
    Publishing country England
    Document type Case Reports
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytac042
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: A case report of acute myopericarditis associated with Graves' thyrotoxicosis.

    Anderton, Thomas S / Saunderson, Christopher E D / Jain, Manali / Sengupta, Anshuman

    European heart journal. Case reports

    2020  Volume 4, Issue 6, Page(s) 1–5

    Abstract: Background: The effects of hyperthyroidism on the heart are well documented, primarily consisting of supraventricular tachycardias, congestive heart failure, and dilated cardiomyopathy. Acute myopericarditis resulting from a hyperthyroid state is an ... ...

    Abstract Background: The effects of hyperthyroidism on the heart are well documented, primarily consisting of supraventricular tachycardias, congestive heart failure, and dilated cardiomyopathy. Acute myopericarditis resulting from a hyperthyroid state is an uncommon but recognized association.
    Case summary: A 29-year-old man with a history of Graves' disease presented with chest pain and electrocardiogram changes suggestive of an infero-lateral ST-elevation myocardial infarction. However, emergent coronary angiography and bedside echocardiography were normal. Troponin-I was found to be >25 000 ng/L (normal value <57). Thyroid function tests showed a significantly raised free T4 and undetectable thyroid-stimulating hormone. Cardiovascular magnetic resonance (CMR) showed extensive myocardial oedema and late gadolinium enhancement (LGE) in keeping with acute myopericarditis, alongside an enlarged thyroid gland consistent with goitre. Propylthiouracil in combination with an angiotensin-converting enzyme inhibitor and beta-blocker were commenced and eventually definitive treatment with thyroidectomy was performed. Follow-up CMR at 6 months showed complete resolution of the prior noted oedema and a reduction in the location and extent of LGE with significant residual fibrosis.
    Discussion: Acute myopericarditis is a common diagnosis in young patients presenting with symptoms of chest pain with elevated troponin and is frequently related to a viral illness. Hyperthyroid states are also associated with acute myopericarditis and should be particularly considered in patients with a pre-existing thyroid condition or in those with symptoms suggestive of hyperthyroidism. Given the specific treatments required in a case of myopericarditis associated with hyperthyroidism, it is important to be aware of this association and consider screening where appropriate.
    Language English
    Publishing date 2020-12-12
    Publishing country England
    Document type Journal Article
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytaa465
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: A 30-Year-Old Man With Primary Cardiac Angiosarcoma.

    Jex, Nicholas / Farley, Jonathan / Thirunavukarasu, Sharmaine / Chowdhary, Amrit / Sengupta, Anshuman / Greenwood, John / Schlosshan, Dominik / Plein, Sven / Levelt, Eylem

    JACC. Case reports

    2021  Volume 3, Issue 6, Page(s) 944–949

    Abstract: A previously fit and well 30-year-old man presented with palpitations, fever, and pleuritic chest pain. Multimodality imaging and histopathology confirmed the diagnosis of primary cardiac angiosarcoma. We present the details of the presentation, ... ...

    Abstract A previously fit and well 30-year-old man presented with palpitations, fever, and pleuritic chest pain. Multimodality imaging and histopathology confirmed the diagnosis of primary cardiac angiosarcoma. We present the details of the presentation, diagnostic process using multimodality imaging, and clinical management. (
    Language English
    Publishing date 2021-05-12
    Publishing country Netherlands
    Document type Case Reports
    ISSN 2666-0849
    ISSN (online) 2666-0849
    DOI 10.1016/j.jaccas.2021.03.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Reduction of heart failure guideline-directed medication during hospitalization: prevalence, risk factors, and outcomes.

    Palin, Victoria / Drozd, Michael / Garland, Ellis / Malik, Anam / Straw, Sam / McGinlay, Melanie / Simms, Alexander / Gatenby, V Kate / Sengupta, Anshuman / Levelt, Eylem / Witte, Klaus K / Kearney, Mark T / Cubbon, Richard M

    ESC heart failure

    2022  Volume 9, Issue 5, Page(s) 3298–3307

    Abstract: Aims: Optimal management of heart failure with reduced ejection fraction (HFrEF) includes titration of guideline-directed medical therapy (GDMT) to the highest tolerated dose within the licensed range. During hospitalization, GDMT doses are often ... ...

    Abstract Aims: Optimal management of heart failure with reduced ejection fraction (HFrEF) includes titration of guideline-directed medical therapy (GDMT) to the highest tolerated dose within the licensed range. During hospitalization, GDMT doses are often significantly altered, although it is unknown whether the cause of hospitalization influences this.
    Methods and results: We recruited 711 people with stable HFrEF from specialist heart failure clinics and prospectively assessed events occurring during first unplanned hospitalization. Dose changes of ACE inhibitors or angiotensin receptor blockers (ACEi/ARB), beta-blockers, mineralocorticoid receptor antagonists, and loop diuretics were recorded during 414 hospitalizations, categorized as due to decompensated heart failure, other cardiovascular causes, infection, or other non-cardiovascular causes. Most hospitalizations resulted in no change to GDMT. ACEi/ARB dose was reduced in 21% of hospitalizations and was more common during non-cardiovascular hospitalization (25.4% vs. 13.9%; P = 0.005). ACEi/ARB dose reduction was associated with older age and lower left ventricular ejection fraction at study recruitment, and poorer renal function, lower systolic blood pressure, higher serum potassium, and less frequent care from a cardiologist during admission. People experiencing ACEi/ARB reduction had worse age-adjusted survival after discharge, without differences in heart failure re-hospitalization. De-escalation of beta-blockers occurred in 8% of hospitalizations, most often due to other non-cardiovascular causes; this was not associated with post-discharge survival or re-hospitalization with heart failure.
    Conclusions: De-escalation of HFrEF GDMT is more common during non-cardiovascular hospitalization and for ACEi/ARB is associated with reduced survival. Post-discharge care plans should include robust plans to consider re-escalation of GDMT in these cases.
    MeSH term(s) Humans ; Heart Failure/drug therapy ; Heart Failure/epidemiology ; Angiotensin Receptor Antagonists/therapeutic use ; Stroke Volume/physiology ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Aftercare ; Prevalence ; Ventricular Function, Left ; Patient Discharge ; Hospitalization ; Adrenergic beta-Antagonists/therapeutic use ; Risk Factors
    Chemical Substances Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Adrenergic beta-Antagonists
    Language English
    Publishing date 2022-07-07
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2814355-3
    ISSN 2055-5822 ; 2055-5822
    ISSN (online) 2055-5822
    ISSN 2055-5822
    DOI 10.1002/ehf2.14051
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Coronary microvascular function and visceral adiposity in patients with normal body weight and type 2 diabetes.

    Chowdhary, Amrit / Thirunavukarasu, Sharmaine / Jex, Nicholas / Coles, Lauren / Bowers, Charles / Sengupta, Anshuman / Swoboda, Peter / Witte, Klaus / Cubbon, Richard / Xue, Hui / Kellman, Peter / Greenwood, John / Plein, Sven / Levelt, Eylem

    Obesity (Silver Spring, Md.)

    2022  Volume 30, Issue 5, Page(s) 1079–1090

    Abstract: Objective: This study sought to assess whether diabetes affects coronary microvascular function in individuals with normal body weight.: Methods: Seventy-five participants (30 patients with type 2 diabetes [T2D] who were overweight [O-T2D], 15 ... ...

    Abstract Objective: This study sought to assess whether diabetes affects coronary microvascular function in individuals with normal body weight.
    Methods: Seventy-five participants (30 patients with type 2 diabetes [T2D] who were overweight [O-T2D], 15 patients with T2D who were lean [LnT2D], 15 healthy volunteers who were lean [LnHV], and 15 healthy volunteers who were overweight [O-HV]) without established cardiovascular disease were recruited. Participants underwent magnetic resonance imaging for assessment of subcutaneous, epicardial, and visceral adipose tissue areas, adenosine stress myocardial blood flow (MBF), and cardiac structure and function.
    Results: Stress MBF was reduced only in the O-T2D group (mean [SD], LnHV = 2.07 [0.47] mL/g/min, O-HV = 2.08 [0.42] mL/g/min, LnT2D = 2.16 [0.36] mL/g/min, O-T2D = 1.60 [0.28] mL/g/min; p ≤ 0.0001). Accumulation of visceral fat was evident in the LnT2D group at similar levels to the O-HV group (LnHV = 127 [53] cm
    Conclusions: Patients with T2D and normal body weight do not show alterations in global stress MBF, but they do show significant increases in visceral adiposity. Patients with T2D who were overweight and had no prior cardiovascular disease showed an increase in visceral adiposity and significant reductions in stress MBF.
    MeSH term(s) Adiposity ; Cardiovascular Diseases ; Diabetes Mellitus, Type 2/complications ; Humans ; Ideal Body Weight ; Obesity, Abdominal/complications ; Obesity, Abdominal/diagnostic imaging ; Overweight/complications ; Stroke Volume ; Ventricular Function, Left
    Language English
    Publishing date 2022-03-31
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2230457-5
    ISSN 1930-739X ; 1071-7323 ; 1930-7381
    ISSN (online) 1930-739X
    ISSN 1071-7323 ; 1930-7381
    DOI 10.1002/oby.23413
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  7. Article: The investigation and management of broad complex tachycardia and ventricular standstill presenting in pregnancy: A case report.

    Sengupta, Anshuman / Slater, Tom A / Sainsbury, Paul A

    Obstetric medicine

    2014  Volume 7, Issue 3, Page(s) 131–134

    Abstract: A 23 year old pregnant lady at 35 weeks gestation presented to accident and emergency with worsening dyspnoea, palpitations and dizziness. Twelve lead electrocardiogram, routine bloods and echocardiography were normal. Ambulatory monitoring previously ... ...

    Abstract A 23 year old pregnant lady at 35 weeks gestation presented to accident and emergency with worsening dyspnoea, palpitations and dizziness. Twelve lead electrocardiogram, routine bloods and echocardiography were normal. Ambulatory monitoring previously had shown an episode of monomorphic broad complex tachycardia (BCT) and a short episode of ventricular standstill. She was admitted for cardiac monitoring until delivery. Several episodes of ventricular standstill and self-terminating BCT were recorded, which were not associated with symptoms. The patient's symptoms either corresponded with sinus rhythm or supraventricular tachycardia. She underwent elective caesarean section at 37 weeks with no complications. The patient's symptoms reduced considerably post delivery, and she was discharged three days later. Unfortunately she then had a presyncopal episode whilst holding her baby. Due to concern regarding the safety of her baby she had a permanent pacemaker implanted to allow safe beta-blockade. She remains asymptomatic six months later.
    Language English
    Publishing date 2014-06-13
    Publishing country England
    Document type Case Reports
    ZDB-ID 2612229-7
    ISSN 1753-4968 ; 1753-495X
    ISSN (online) 1753-4968
    ISSN 1753-495X
    DOI 10.1177/1753495X14539679
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  8. Article ; Online: Coexistent Diabetes Is Associated With the Presence of Adverse Phenotypic Features in Patients With Hypertrophic Cardiomyopathy.

    Jex, Nicholas / Chowdhary, Amrit / Thirunavukarasu, Sharmaine / Procter, Henry / Sengupta, Anshuman / Natarajan, Pavithra / Kotha, Sindhoora / Poenar, Ana-Maria / Swoboda, Peter / Xue, Hui / Cubbon, Richard M / Kellman, Peter / Greenwood, John P / Plein, Sven / Page, Stephen / Levelt, Eylem

    Diabetes care

    2022  Volume 45, Issue 8, Page(s) 1852–1862

    Abstract: Objective: Type 2 diabetes mellitus (T2DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. We sought to investigate whether HCM patients with T2DM comorbidity exhibit adverse cardiac alterations in myocardial ...

    Abstract Objective: Type 2 diabetes mellitus (T2DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. We sought to investigate whether HCM patients with T2DM comorbidity exhibit adverse cardiac alterations in myocardial energetics, function, perfusion, or tissue characteristics.
    Research design and methods: A total of 55 participants with concomitant HCM and T2DM (HCM-DM) (n = 20) or isolated HCM (n = 20) and healthy volunteers (HV) (n = 15) underwent 31P-MRS and cardiovascular MRI. The HCM groups were matched for HCM phenotype.
    Results: Mean ± SD European Society of Cardiology sudden cardiac death risk scores were comparable between the HCM groups (HCM 2.2 ± 1.5%, HCM-DM 1.9 ± 1.2%; P = not significant), and sarcomeric mutations were equally common. HCM-DM patients had the highest median NT-proBNP levels (HV 42 ng/L [interquartile range 35-66], HCM 298 ng/L [157-837], HCM-DM 726 ng/L [213-8,695]; P < 0.0001). Left ventricular (LV) ejection fraction, mass, and wall thickness were similar between the HCM groups. HCM-DM patients displayed a greater degree of fibrosis burden with higher scar percentage and lower global longitudinal strain compared with HCM patients. PCr/ATP (the relative concentrations of phosphocreatine and ATP) was significantly lower in the HCM-DM group than in both HCM and HV (HV 2.17 ± 0.49, HCM 1.93 ± 0.38, HCM-DM 1.54 ± 0.27; P = 0.002). In a similar pattern, stress myocardial blood flow was significantly lower in the HCM-DM group than in both HCM and HV (HV 2.06 ± 0.42 mL/min/g, HCM 1.74 ± 0.44 mL/min/g, HCM-DM 1.39 ± 0.42 mL/min/g; P = 0.002).
    Conclusions: We show for the first time that HCM-DM patients display greater reductions in myocardial energetics, perfusion, and contractile function and higher myocardial scar burden and serum NT-proBNP levels compared with patients with isolated HCM despite similar LV mass and wall thickness and presence of sarcomeric mutations. These adverse phenotypic features may be important components of the adverse clinical manifestation attributable to a combined presence of HCM and T2DM.
    MeSH term(s) Adenosine Triphosphate ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/genetics ; Cicatrix ; Diabetes Mellitus, Type 2/complications ; Humans ; Phenotype
    Chemical Substances Adenosine Triphosphate (8L70Q75FXE)
    Language English
    Publishing date 2022-07-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 441231-x
    ISSN 1935-5548 ; 0149-5992
    ISSN (online) 1935-5548
    ISSN 0149-5992
    DOI 10.2337/dc22-0083
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  9. Article: Window manipulation in diagnosis of body packing using computed tomography.

    Sengupta, Anshuman / Page, Patrick

    Emergency radiology

    2008  Volume 15, Issue 3, Page(s) 203–205

    Abstract: Body packing refers to the internal concealment of narcotics, usually within the gastrointestinal tract. This is important to recognise for clinical and forensic reasons. Imaging is often helpful, particularly because an accurate history is unusual. ... ...

    Abstract Body packing refers to the internal concealment of narcotics, usually within the gastrointestinal tract. This is important to recognise for clinical and forensic reasons. Imaging is often helpful, particularly because an accurate history is unusual. Furthermore, clinical examination and urine screens are often unreliable. Plain abdominal radiography and ultrasonography have been used with limited success. Thus, the use of alternative modalities, such as computed tomography (CT), is becoming more widespread. Although there have been no large trials, one false-negative has been reported. We report the case of a body packer whose CT appeared normal with standard abdominal windowing (level 40/width 400). However, on manipulation of the windowing (level -175/width 600), paraffin and heroin packages became conspicuous within the colon. We suggest that the simple step of reviewing images on wider than standard abdominal windows may be helpful in the detection of ingested illicit packages of fatty density within the bowel.
    MeSH term(s) Adult ; Colon/diagnostic imaging ; Drug Packaging ; Foreign Bodies/diagnostic imaging ; Humans ; Male ; Narcotics ; Radiography, Abdominal ; Tomography, X-Ray Computed/methods
    Chemical Substances Narcotics
    Language English
    Publishing date 2008-05
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1425144-9
    ISSN 1438-1435 ; 1070-3004
    ISSN (online) 1438-1435
    ISSN 1070-3004
    DOI 10.1007/s10140-007-0652-7
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  10. Article ; Online: Implantable cardioverter-defibrillator therapy to reduce sudden cardiac death in adults with congenital heart disease: A registry study.

    Slater, Thomas A / Cupido, Blanche / Parry, Helen / Drozd, Michael / Blackburn, Michael E / Hares, Dominic / Pepper, Christopher B / Birkitt, Linda / Cullington, Damien / Witte, Klaus K / Oliver, James / English, Kate M / Sengupta, Anshuman

    Journal of cardiovascular electrophysiology

    2020  Volume 31, Issue 8, Page(s) 2086–2092

    Abstract: Introduction: The adult congenital heart disease (ACHD) population is rapidly expanding. However, a significant proportion of these patients suffer sudden cardiac death. Recommending implantable cardioverter-defibrillator (ICD) insertion requires ... ...

    Abstract Introduction: The adult congenital heart disease (ACHD) population is rapidly expanding. However, a significant proportion of these patients suffer sudden cardiac death. Recommending implantable cardioverter-defibrillator (ICD) insertion requires balancing the need for appropriate therapy in malignant arrhythmia against the consequences of inappropriate therapy and procedural complications. Here we present long-term follow-up data for ICD insertion in patients with ACHD from a large Level 1 congenital cardiac center.
    Methods and results: All patients with ACHD undergoing ICD insertion over an 18-year period were identified. Data were extracted for baseline characteristics including demographics, initial diagnosis, ventricular function, relevant medication, and indication for ICD insertion. Details regarding device insertion were gathered along with follow-up data including appropriate and inappropriate therapy and complications. A total of 136 ICDs were implanted during this period: 79 for primary and 57 for secondary prevention. The most common congenital cardiac conditions in both groups were tetralogy of Fallot and transposition of the great arteries. Twenty-two individuals in the primary prevention group received appropriate antitachycardia pacing (ATP), 14 underwent appropriate cardioversion, 17 received inappropriate ATP, and 15 received inappropriate cardioversion. In the secondary prevention group, 18 individuals received appropriate ATP, 8 underwent appropriate cardioversion, 8 received inappropriate ATP, and 7 were inappropriately cardioverted. Our data demonstrate low complication rates, particularly with leads without advisories.
    Conclusion: ICD insertion in the ACHD population involves a careful balance of the risks and benefits. Our data show a significant proportion of patients receiving appropriate therapy indicating that ICDs were inserted appropriately.
    MeSH term(s) Adult ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/prevention & control ; Defibrillators, Implantable ; Heart Defects, Congenital/complications ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/therapy ; Humans ; Registries ; Transposition of Great Vessels
    Language English
    Publishing date 2020-07-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1025989-2
    ISSN 1540-8167 ; 1045-3873
    ISSN (online) 1540-8167
    ISSN 1045-3873
    DOI 10.1111/jce.14633
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