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Candice Silversides

Publications and source records attributed to Candice Silversides.

12 recordsLinked to original sources
PubMed2006

The role of the psychologist in adult congenital heart disease.

In addition to monitoring and treating the cardiac disease, patients benefit from health professionals recognizing and managing the potential psychosocial consequences of growing up with congenital heart disease. Working groups from Europe and North America have emphasized the benefit of inclusion of specialized mental health care for adult congenital heart disease (ACHD) patients. This article reviews the evidence that ACHD patients have special and unique psychosocial needs and outlines ways in which psychologists can be integrated into multidisciplinary ACHD care teams. There are three professional domains in which clinical health psychologists can contribute to an ACHD team: provision of clinical services, multidisciplinary research, and professional education. Considerations for incorporating psychology into ACHD teams are presented.

Adolescent↗
PubMed2004

Outcomes and alternative techniques for device closure of the large secundum atrial septal defect.

Outcomes of device closure of large and small secundum atrial septal defects (ASDs) as related to rim anatomy with the Amplatzer atrial septal occluder were compared. Rim adequacy (> or = 5mm) of the anterior, inferior, posterior, and superior rims was determined using transesophageal echocardiography. Balloon-stretched defect size defined patients into two groups: group 1, < or = 25 mm (n = 138); group 2, > 25 mm (n = 34). Rim deficiency (n = 62) was more frequent in group 2 compared to group 1 (50% vs. 33%; P = 0.07), especially inferior rim deficiency (35% vs. 2%; P = 0.005). Device deployment was successful in group 1 and group 2 (100% vs. 91%; P = 0.007). Unsuccessful deployment was associated with an ASD of > 25 mm (P = 0.007) and inferior rim deficiency (P = 0.001). At first follow-up (54 +/- 16 days), right ventricular systolic pressure had improved in both groups (P < 0.001). Closure of a large ASD associated with a lack of support in the inferior rim may warrant alternative strategies to position the device successfully.

Adult↗
PubMed2003

Can structured clinical assessment using modified Duke's criteria improve appropriate use of echocardiography in patients with suspected infective endocarditis?

BACKGROUND: Although echocardiography has been incorporated into the diagnostic algorithm of patients with suspected infective endocarditis, systematic usage in clinical practice remains ill defined. OBJECTIVE: To test whether the rigid application of a predefined standardized clinical assessment using the Duke criteria by the research team would provide improved diagnostic accuracy of endocarditis when compared with usual clinical care provided by the attending team. METHODS: Between April 1, 2000 and March 31, 2001, 101 consecutive inpatients with suspected endocarditis were examined prospectively and independently by both teams. The clinical likelihood of endocarditis was graded as low, moderate or high. All patients underwent transthoracic echocardiography and appropriate transesophageal echocardiography if deemed necessary. All diagnostic and therapeutic outcomes were evaluated prospectively. RESULTS: Of 101 consecutive inpatients (age 50+/-16 years; 62 males) enrolled, 22% subsequently were found to have endocarditis. The pre-echocardiographic likelihood categories as graded by the clinical and research teams were low in nine and 37 patients, respectively, moderate in 83 and 40 patients, respectively, and high in nine and 24 patients, respectively, with only a marginal agreement in classification (kappa=0.33). Of the 37 patients in the low likelihood group and 40 in the intermediate group, no endocarditis was diagnosed. In 22 of 24 patients classified in the high likelihood group, there was echocardiographic evidence of vegetations suggestive of endocarditis. Discriminating factors that increased the likelihood of endocarditis were a prior history of valvular disease, the presence of an indwelling catheter, positive blood cultures, and the presence of a new murmur and a vascular event. General internists, rheumatologists and intensive care physicians were more likely to order echocardiography in patients with low clinical probability of endocarditis, of which pneumonia was the most common alternative diagnosis. CONCLUSION: Although prediction of clinical likelihood varies between observers, endocarditis is generally found only in those individuals with a moderate to high pre-echocardiographic clinical likelihood. Strict adherence to indications for transthoracic echocardiography and transesophageal echocardiography may help to facilitate more accurate diagnosis within the moderate likelihood category. Patients with low likelihood do not derive additional diagnostic benefit with echocardiography although other factors such as physician reassurance may continue to drive diagnostic demand.

Adult↗
PubMed2003

Subaortic stenosis: recurrence of a fibrous ring after 28 years.

Aortic stenosis is a common cardiac problem. Morphological aortic stenosis can be due to valvular, subvalvular and supravalvular causes. Subvalvular causes include subaortic rings and membranes, which usually manifest at a young age, depending on the size of the ring and the degree of obstruction. Recurrent (post-operative) stenosis is a rare potential problem. A case of recurrent subaortic stenosis due to a subaortic ring, 28 years after the initial surgical excision of the ring is presented.

Adult↗
PubMed2003

An incidental calcified right atrial mass.

A 58-year-old man presented to his family physician with a mild cough. A routine chest x-ray revealed a 4 cm 'ring opacity' in the right atrium. A transthoracic echocardiogram revealed a 41 mm x 33 mm mass in the right atrium. The patient underwent urgent cardiac surgery, where a firm to hard 4 cm x 3 cm mass was excised. Pathology revealed an old, largely infarcted and calcified right atrial myxoma. A review of the published literature shows that this case is the first to demonstrate an almost completely infarcted atrial myxoma with only a few clusters of viable cells identified histologically.

Calcinosis↗
PubMed2002

Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot.

OBJECTIVES: The purpose of this study was to determine if left ventricular (LV) systolic dysfunction was also a predictor of sudden cardiac death (SCD) in adults late after repair of tetralogy of Fallot (TOF). BACKGROUND: Previous studies looking at risk factors for SCD in adults with repair of TOF have focused on the right ventricle (RV). METHODS: A retrospective chart review of patients assessed at the Toronto Congenital Cardiac Centre for Adults was performed. Twelve adult patients with repaired TOF and SCD were identified (SCD group). A total of 125 living adult patients with repaired TOF were randomly selected for comparison (control group). RESULTS: Patients with SCD were more likely to exhibit moderate or severe pulmonary regurgitation (92% vs. 51%, p = 0.02), have a history of sustained ventricular tachycardia (42% vs. 6%, p < 0.01), and have a QRS > or =180 ms (56% vs. 13%, p = 0.02). Moderate or severe LV systolic dysfunction was also significantly more common in patients with SCD than in the control group (42% vs. 9%, p < 0.01) with a positive predictive value of 29%. The combination of moderate or severe LV systolic dysfunction and QRS > or =180 ms had a positive and negative predictive value for SCD of 66% and 93%, respectively. CONCLUSIONS: Moderate or severe LV systolic dysfunction is significantly more common in adult patients with repaired TOF and SCD. The combination of QRS > or =180 ms and significant LV systolic dysfunction has high positive and negative predictive value for SCD. The implication of the role of prophylactic antiarrhythmic implantable cardiac defibrillator insertion in these patients needs further elucidating.

Adult↗
PubMed2002

Apolipoprotein(a) phenotypes predict the severity of coronary artery stenosis.

BACKGROUND: Studies on the impact of elevated levels of lipoprotein(a) (Lp[a]) or apolipoprotein(a) (apo[a]) on the development of coronary artery disease have given controversial results. The relationship between apo(a) phenotypes and coronary artery stenosis remains unclear. METHODS: Lipid profiles, and apo(a) levels and phenotypes were analyzed in 225 patients who underwent elective coronary angiography. Coronary artery stenosis, as indicated by angiography, was estimated by a newly devised minimal lesion (ML) grading system. Relationships between lipoprotein variables and coronary artery stenosis were examined by linear and logistic regression models. RESULTS: On the basis of ML score, patients with larger apo(a) phenotypes (S3, S3a or S4) had a lower rate of coronary artery stenosis (68%-76%) than those with smaller phenotypes (S1, S1a, S2 or S2a - 79%-95%). The odds of coronary artery stenosis in patients with smaller apo(a) phenotypes were significantly different from those of patients with larger phenotypes (p < 0.001). Also, patients with a history of myocardial infarction, angina, hypertension, diabetes or hypercholesterolemia were more likely to show coronary artery stenosis on angiography. With respect to lipid levels, 20.2% of patients had an elevated serum total cholesterol (TC) level and 16.1% an elevated low-density lipoprotein cholesterol (LDL-c) level. In 21.3%, the high-density lipoprotein cholesterol (HDL-c) level was decreased. There were significant positive correlations of serum TC with those of the TC/HDL-c ratio, LDL-c, triglycerides and HDL-c (p < 0.05 and 0.001), of LDL-c with TC and apo(a) (p < 0.001) and of ML scores with the TC/HDL-c ratio and patient age (p < 0.01 and 0.001). There were significant negative correlations of TC and apo(a) levels with apo(a) phenotypes (p < 0.05 and 0.001) and of ML scores with HDL-c (p < 0.001). The odds of coronary artery stenosis in patients with abnormally high apo(a) levels (44.6%) were not significantly different from those of patients with apo(a) levels in the normal range. INTERPRETATION: Smaller apo(a) phenotypes, but not elevated levels of apo(a), may help to predict the rate and severity of coronary artery stenosis. HDL-c independently and negatively correlated with the extent of the stenosis.

Adult↗
PubMedDate not supplied

Artificial chordae tendinae: long-term changes.

BACKGROUND AND AIM: We present the clinical and pathological findings of a patient who underwent mitral valve repair, with synthetic chordae, for rheumatic disease 13 years earlier. METHODS: Echocardiographic, pathologic, and histologic examination of a previously repaired mitral valve using artificial chordae tendinae. RESULTS AND CONCLUSIONS: Extensive fibrosis and thickening, consisting of fibroblasts and mature collagen, in time surrounds the artificial chorda rendering it indistinguishable from its native counterparts on gross examination and even during echocardiography.

Chordae Tendineae↗
PubMedDate not supplied

Pathologic analysis of 19 heart valves with silver-coated sewing rings.

OBJECTIVE: The St. Jude Medical Silzone (Silzone) mechanical heart valve was voluntarily recalled (January 2000) due to an unusually high incidence of paravalvular leaks. We present the first series of human morphological data on the failure of these valves. METHODS: Nineteen Silzone valves were evaluated from the 176 Silzone valves implanted in 147 patients at our institution between 1997 and 1999. Explanted prostheses were fixed in 10% formalin, photographed, and X-rayed. Histological sections were collected from the sewing cuff, accompanying tissues, and thrombus. For comparison, six age-matched SJM-standard valves were similarly analyzed. RESULTS: Nineteen Silzone valves from 16 patients (10 male, six female, 52.0 +/- 15.2 years) were examined. Significantly more mitral (15/95) prostheses were removed than aortic (4/81) despite the nearly equal number implanted (p = 0.027). Fifteen of the Silzone valves (13/16 patients) were explanted in the early postoperative period (within six months of implantation), although collection continued for eight years after our institution stopped implanting them. The common indications for surgical explantation were paravalvular leak (8/12) and clinically suspected infective endocarditis (IE) (four patients, five valves). IE was not confirmed by histology or culture in any valve. The sewing cuffs of many Silzone valves showed large regions of pannus, granulation tissue, and purulent exudate. Polymorphonuclear leukocytes were more common in the sewing cuff of Silzone valves; however, the cellular infiltrate was superficial when compared to SJM-standard valves. CONCLUSION: This is the largest morphologically analyzed series of Silzone explants. It demonstrates a consistent pattern of atypical tissue incorporation into the silver-coated sewing ring particularly in the mitral position. Clinical and morphologic features of IE (sterile) are seen in the early postimplant period. Prosthesis-related problems were almost wholly seen at the mitral site, in our group. Our current data indicate that although early failure due to dehiscence and paravalvular leak is a problem, Silzone valves that "survive" past six months will likely function as well as the SJM-standard prosthesis.

Adult↗