Publications by authors named "Benjamin Asschenfeldt"

8 Publications

  • Page 1 of 1

Long-term neurodevelopmental effects of intraoperative blood pressure during surgical closure of a septal defect in infancy or early childhood.

Cardiol Young 2021 Apr 12:1-7. Epub 2021 Apr 12.

Department of Anesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark.

Background: Many children born with congenital heart defects are faced with cognitive deficits and psychological challenges later in life. The mechanisms behind are suggested to be multifactorial and are explained as an interplay between innate and modifiable risk factors. The aim was to assess whether there is a relationship between mean arterial pressure during surgery of a septal defect in infancy or early childhood and intelligence quotient scores in adulthood.

Methods: In a retrospective study, patients were included if they underwent surgical closure of a ventricular septal defect or an atrial septal defect in childhood between 1988 and 2002. Every patient completed an intelligence assessment upon inclusion, 14-27 years after surgery, using the Wechsler Adult Intelligence Scale Version IV.

Results: A total of 58 patients met the eligibility criteria and were included in the analyses. No statistically significant correlation was found between blood pressure during cardiopulmonary bypass and intelligence quotient scores in adulthood (r = 0.138; 95% CI-0.133-0.389). Although amongst patients with mean arterial pressure < 40 mmHg during cardiopulmonary bypass, intelligence quotient scores were significantly lower (91.4; 95% CI 86.9-95.9) compared to those with mean arterial pressure > 40 mmHg (99.8; 95% CI 94.7-104.9).

Conclusions: Mean arterial pressure during surgery of ventricular septal defects or atrial septal defects in childhood does not correlate linearly with intelligence quotient scores in adulthood. Although there may exist a specific cut-off value at which low blood pressure becomes harmful. Larger studies are warranted in order to confirm this, as it holds the potential of partly relieving CHD patients of their cognitive deficits.
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http://dx.doi.org/10.1017/S1047951121001414DOI Listing
April 2021

Abnormal Left-Hemispheric Sulcal Patterns in Adults With Simple Congenital Heart Defects Repaired in Childhood.

J Am Heart Assoc 2021 Apr 22;10(7):e018580. Epub 2021 Mar 22.

Department of Clinical Medicine Aarhus University Aarhus N Denmark.

Background Children operated on for a simple congenital heart defect (CHD) are at risk of neurodevelopmental abnormalities. Abnormal cortical development and folding have been observed in fetuses with CHD. We examined whether sulcal folding patterns in adults operated on for simple CHD in childhood differ from those of healthy controls, and whether such differences are associated with neuropsychological outcomes. Methods and Results Patients (mean age, 24.5 years) who underwent childhood surgery for isolated atrial septal defect (ASD; n=33) or ventricular septal defect (VSD; n=30) and healthy controls (n=37) were enrolled. Sulcal pattern similarity to healthy controls was determined using magnetic resonance imaging and looking at features of sulcal folds, their intersulcal relationships, and sulcal graph topology. The sulcal pattern similarity values were tested for associations with comprehensive neuropsychological scores. Patients with both ASD and VSD had decreased sulcal pattern similarity in the left hemisphere compared with controls. The differences were found in the left temporal lobe in the ASD group and in the whole left hemisphere in the VSD group (=0.033 and =0.039, respectively). The extent of abnormal left hemispheric sulcal pattern similarity was associated with worse neuropsychological scores (intelligence, executive function, and visuospatial abilities) in the VSD group, and special educational support in the ASD group. Conclusions Adults who underwent surgery for simple CHD in childhood display altered left hemisphere sulcal folding patterns, commensurate with neuropsychological scores for patients with VSD and special educational support for ASD. This may indicate that simple CHD affects early brain development. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03871881.
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http://dx.doi.org/10.1161/JAHA.120.018580DOI Listing
April 2021

Neuropsychological Status and Structural Brain Imaging in Adults With Simple Congenital Heart Defects Closed in Childhood.

J Am Heart Assoc 2020 06 19;9(11):e015843. Epub 2020 May 19.

Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Aarhus N Denmark.

Background Neurodevelopmental impairments are common in survivors of complex congenital heart defects (CHD). We report neuropsychological and brain imaging assessments in adults operated for isolated septal defects. Methods and Results Patients (mean age 25.6 yrs) who underwent childhood surgery for isolated atrial septal defect (n=34) or ventricular septal defect (n=32), and healthy matched peers (n=40), underwent a standard battery of neuropsychological tests and a 3.0T brain magnetic resonance imaging scan. Patient intelligence was affected with lower scores on Full-Scale intelligence quotient (<0.001), Verbal Comprehension (<0.001), Perceptual Reasoning (=0.007), and Working Memory (<0.001) compared with controls. Also, the CHD group had poorer visuospatial abilities (Immediate Recall, =0.033; Delayed Recall, =0.018), verbal memory (Trial 1, =0.015; Total Learning, <0.001; Delayed Recall, =0.007), executive function (Executive Composite Score, <0.001), and social recognition (Reading the Mind in the Eyes Test, =0.002) compared with controls. Self-reported levels of executive dysfunction, attention deficits and hyperactivity behavior, and social cognition dysfunction were higher in the CHD group compared with population means and controls. We found similar global and regional morphometric brain volumes and a similar frequency of brain magnetic resonance imaging abnormalities in the 2 groups. The CHD group had a high occurrence of psychiatric disease and a larger need for special teaching during school age. Conclusions Children operated for simple CHD demonstrate poorer neurodevelopmental outcomes in adulthood when compared with healthy controls and expected population means. REGISTRATION URL: https://www.clini​caltr​ials.gov. Unique identifier: NCT03871881.
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http://dx.doi.org/10.1161/JAHA.120.015843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428999PMC
June 2020

Disappearance of the shunt and lower cardiac index during exercise in small, unrepaired ventricular septal defects.

Cardiol Young 2020 Apr 25;30(4):526-532. Epub 2020 Mar 25.

Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark.

Objectives: Clinical studies have revealed decreased exercise capacity in adults with small, unrepaired ventricular septal defects. Increasing shunt ratio and growing incompetence of the aortic and pulmonary valve with retrograde flow during exercise have been proposed as reasons for the previously found reduced exercise parameters. With MRI, haemodynamic shunt properties were measured during exercise in ventricular septal defects.

Methods: Patients with small, unrepaired ventricular septal defects and healthy peers were examined with MRI during exercise. Quantitative flow scans measured blood flow through ascending aorta and pulmonary artery. Scans were analysed post hoc where cardiac index, retrograde flows, and shunt ratio were determined.

Results: In total, 32 patients (26 ± 6 years) and 28 controls (27 ± 5 years) were included. The shunt ratio was 1.2 ± 0.2 at rest and decreased to 1.0 ± 0.2 at peak exercise, p < 0.01. Aortic cardiac index was lower at peak exercise in patients (7.5 ± 2 L/minute/m2) compared with controls (9.0±2L l/minute/m2), p<0.01. Aortic and pulmonary retrograde flow was larger in patients during exercise, p < 0.01. Positive correlation was demonstrated between aortic cardiac index at peak exercise and previously established exercise capacity for all patients (r = 0.5, p < 0.01).

Conclusions: Small, unrepaired ventricular septal defects revealed declining shunt ratio with increasing exercise and lower aortic cardiac index. Patients demonstrated larger retrograde flow both through the pulmonary artery and the aorta during exercise compared with controls. In conclusion, adults with unrepaired ventricular septal defects redistribute blood flow during exercise probably secondary to a more fixed pulmonary vascular resistance compared with age-matched peers.
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http://dx.doi.org/10.1017/S1047951120000505DOI Listing
April 2020

Biventricular morphology in adults born with a ventricular septal defect.

Cardiol Young 2018 Dec 30;28(12):1379-1385. Epub 2018 Aug 30.

1Department of Cardiothoracic and Vascular Surgery,Aarhus University Hospital,Aarhus,Denmark.

Ventricular septal defects - large, surgically closed or small, untreated - have demonstrated lower peak exercise capacity compared with healthy controls. The mechanisms behind these findings are not yet fully understood. Therefore, we evaluated biventricular morphology in adults with a ventricular septal defect using MRI. Adults with either childhood surgically closed or small, untreated ventricular septal defects and healthy controls underwent cine MRI for the evaluation of biventricular volumes and quantitative flow scans for measurement of stroke index. Scans were analysed post hoc in a blinded manner. In total, 20 operated patients (22±2 years) and 20 healthy controls (23±2 years) were included, along with 32 patients with small, unrepaired ventricular septal defects (26±6 years) and 28 controls (27±5 years). Operated patients demonstrated larger right ventricular end-diastolic volume index (103±20 ml/m2) compared with their controls (88±16 ml/m2), p=0.01. Heart rate and right ventricular stroke index did not differ between operated patients and controls. Patients with unrepaired ventricular septal defects revealed larger right ventricular end-diastolic volume index (105±17 ml/m2) compared with their controls (88±13 ml/m2), p<0.01. Furthermore, right ventricular stroke index was higher in unrepaired ventricular septal defects (53±12 ml/minute/m2) compared with controls (46±8 ml/minute/m2), p=0.02, with similar heart rates. Both patient groups' right ventricles were visually characterised by abundant coarse trabeculation. Positive correlations were demonstrated between right ventricular end-diastolic volume indices and peak exercise capacity in patients. Left ventricle measurements displayed no differences between groups. In conclusion, altered right ventricular morphology was demonstrated in adults 20 years after surgical ventricular septal defect repair and in adults with small, untreated ventricular septal defects.
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http://dx.doi.org/10.1017/S1047951118001361DOI Listing
December 2018

Dynamic bicycle exercise to assess cardiac output at multiple exercise levels during magnetic resonance imaging.

Clin Imaging 2017 Nov - Dec;46:102-107. Epub 2017 Jul 27.

MR Research Center, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Aarhus University Hospital, Denmark.

Purpose: The aim was to establish a method for performing dynamic exercise during magnetic resonance imaging (MRI) using a slowly increasing workload protocol.

Methods: An ergometer bicycle with a step-wise, exercise protocol was used. Real-time phase-contrast MRI images of the aorta were obtained at each exercise step.

Results: In total, 40 participants completed the exercise protocol to reach a mean maximum cardiac output of 13.7±3.7l/min and a heart rate of 150±16beats/min at the highest exercise level. Less than 1% of scans were discarded due to poor quality.

Conclusions: Dynamic, high intensity exercise is feasible during MRI.
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http://dx.doi.org/10.1016/j.clinimag.2017.07.010DOI Listing
May 2018

Impaired cardiac output during exercise in adults operated for ventricular septal defect in childhood: a hitherto unrecognised pathophysiological response.

Cardiol Young 2017 Oct 25;27(8):1591-1598. Epub 2017 May 25.

1Department of Cardiothoracic & Vascular Surgery,Aarhus University Hospital,Aarhus,Denmark.

Background: Recent studies have demonstrated that surgical ventricular septal defect closure in childhood is associated with reduced functional capacity and disruption of the right ventricular force-frequency relationship during exercise. To further describe long-term cardiac function, we performed a non-invasive assessment of cardiac index during exercise in adults having undergone surgery for ventricular septal defect in early childhood.

Methods: A total of 20 patients (surgical age 2.1±1.4 years, age at examination 22.1±2.2 years) and 20 healthy, matched controls (23.4±2.1 years at examination) underwent continuous supine bicycle ergometry during MRI. Their blood flow was recorded in the ascending aorta and the pulmonary trunk at increasing exercise levels. Cardiac index, retrograde flow, and vessel diameters were determined by blinded, post hoc analyses.

Results: The patient group had normal cardiac index at rest (2.9±0.7 L/minute/m2), which was comparable with that of the controls (3.0±0.6 L/minute/m2); however, they had a lower increase in cardiac index during exercise (reaching 7.3±1.3 L/minute/m2 at submaximal exercise) compared with controls (8.2±1.2 L/minute/m2), p<0.05. Patients had a significantly higher ascending aorta retrograde flow than controls at rest and throughout exercise. In the pulmonary artery, the retrograde flow was minimal at rest in both groups, but increased significantly in patients during exercise compared with controls.

Conclusions: Young adults with a surgically closed ventricular septal defect have a reduced cardiac index during exercise compared with healthy, young adults. The impaired cardiac index appears to be related to an increasing retrograde flow in the pulmonary artery with progressive exertion.
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http://dx.doi.org/10.1017/S1047951117000877DOI Listing
October 2017

Does functional capacity depend on the size of the shunt? A prospective, cohort study of adults with small, unrepaired ventricular septal defects.

Eur J Cardiothorac Surg 2017 04;51(4):722-727

Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.

Objectives: Small ventricular septal defects (VSDs) are considered to have great prognoses and most remain unrepaired. However, we have recently demonstrated lower functional capacity in patients with small VSDs compared with healthy peers. Using magnetic resonance imaging scans, we determined whether the functional capacity was correlated to the size of the shunt.

Methods: We included patients with unrepaired VSDs and healthy adults between 18 and 40 years of age in a prospective, cohort study. Functional capacity was previously determined using an incremental bicycle test, establishing peak oxygen uptake. Magnetic resonance imaging scans were performed using a 1.5-tesla Philips scanner. With electrocardiographically triggered flow measurements, we calculated mean cardiac output from the pulmonary trunk and ascending aorta as well as vessel diameters.

Results: In total, 29 patients with unrepaired VSDs (26.5 ± 6 years) and 25 controls (26.9 ± 5 years) completed both studies. Previously measured peak oxygen uptake was nearly 20% lower in patients compared with controls (P = 0.002). All patients had shunt ratios below 1.5, with mean QpQs of 1.2 ± 0.1. When correlating shunt size to functional capacity, a negative correlation was found between the shunt ratio and peak oxygen uptake (r  = −0.44, P = 0.020). Compared with controls, patients had increased forward and retrograde flow in the pulmonary trunk but comparable flows in the ascending aorta. Pulmonary diameter was also increased in patients (30.3 ± 4 mm) compared with controls (28.2 ± 3 mm; P = 0.041), whereas aortic dimensions were comparable.

Conclusions: Our results demonstrate that, although small, unrepaired VSDs revealed reduced functional capacity that can be negatively correlated to the size of the shunt.
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http://dx.doi.org/10.1093/ejcts/ezw420DOI Listing
April 2017