Functional outcome and quality of life in adult congenital heart disease patients with prosthetic valves*

In patients with congenital heart disease (CHD), often mechanical or biological
prosthetic valves are
implanted. These patients differ from adults who have prosthetic valves
implanted for acquired valve disease (e.g.
differences in age, lifestyle, variety of valve location). The prevalence of
pulmonary and tricuspid prosthetic valves
is high. The prevalence of prosthesis-patient-mismatch (PPM) is probably high
because often valves were
implanted during childhood. In patients with acquired valve disease PPM is
associated with decreased survival and
increased incidence of heart failure. Data about the prevalence of PPM in
adults with CHD are lacking. The
probable high prevalence of PPM and the complicated history of many CHD
patients may predestinate them for
complications such as heart failure and arrhythmias. The influence of
prosthetic valve characteristics (type,
location, size/PPM) in adults with CHD on functional outcome and quality of
life has however not been
investigated. Moreover, data about the long-term complications of prosthetic
valves in adults with CHD are scarce.
For example, in the pulmonary position usually biological valves are implanted
because of a presumed high
incidence of thrombo-embolism associated with mechanical valves, but scientific
evidence confirming this
presumption is lacking.

To investigate the relation between characteristics of valve prosthesis on
functional outcome and
quality of life in adult patients with CHD.
To investigate the prevalence and predictors of PPM in a population with
CHD.
To investigate the incidence of valve prosthesis-related complications in a
population with CHD
(re-operation, valve thrombosis, bleeding complications, hemolysis,
paravalvular regurgitation, endocarditis,
arrhythmias, pregnancy-related complications, heart failure).
To investigate the relation between prosthesis related complications and valve
type.

Patient files of CHD patients with prosthetic valves identified from the CONCOR
database will be studied for past
medical history including surgical procedures and for the occurrence of
valve-related complications. The
cross-sectional evaluation comprises history, physical examination, VO2max,
quality of life questionnaires,
echocardiogram including prosthetic valve area, MRI (ventricular volumes and
mass), laboratory evaluation
(including NT-pro-BNP).

As all investigations are routine investigations in this population, no risk is
involved. Investigations will be scheduled as much as possible combine with an
already scheduled visit. maximum extra time for each patients is one day.
Patients may indirectly benefit from the study resulsts, because our results
may influence the choice of valve prosthesis, the indication for more extensive
surgery (e.g. annulus enlargement) and the indication for re-operation in
patients with prosthesis-patient-mismatch.