Browsing by Autor "Inge von Alvensleben"

Now showing 1 - 9 of 9

Chronic hypobaric hypoxia, patent arterial duct and a new interventional technique to close it
(Cambridge University Press, 2011) Franz Freudenthal; Alexandra Heath; Jorge Villanueva; Janne Mendes; Ximena Vicente; Inge von Alvensleben; Gabriel Echazú; Joaquin Navarro; Nora Lang; Rainer Kozlik‐Feldmann
We conclude that the "Nit-Occlud® PDA-R" device is safe and effective in closing patent arterial duct up to a diameter of 8 millimetres.
Developing High Medical Technology, a Challenge for Developing Countries: The Percutaneous Closure of Atrial Septal Defects Using Nit-Occlud ASD-R: Early and Mid-term Results
(SAGE Publishing, 2019) Alexandra Heath; Inge von Alvensleben; Joaquin Navarro; Gabriel Echazú; Rainer Kozlik‐Feldmann; Franz Freudenthal
The Nit-Occlud ASD-R device is safe and effective with very good closure rates.
Ebstein Repair in a High-Altitude Setting ≥2,500 m: First Experience from Bolivia
(Georg Thieme Verlag, 2025) Sven C. Weber; Inge von Alvensleben; Valentin Vadiunec; Andre Iben; Felix Berger; Hannes Sallmon; Joachim Photiadis
Contemporary surgical approaches for Ebstein anomaly are based on a paradigm shift towards earlier surgery in order to avoid the deleterious effects of chronic right ventricular (RV) volume overload. In addition, RV dysfunction may worsen in the setting of high altitude, and to date, no results on Ebstein anomaly surgery have been reported from a high-altitude setting.We herein present first postoperative results from Ebstein anomaly patients who underwent cone reconstruction (with or without bidirectional Glenn anastomosis) in Cochabamba, Bolivia (>2,500 m above sea level) using a specific high-altitude protocol for prophylactic medical treatment of presumed pulmonary hypertension (PH), including sildenafil, iloprost, and higher FiO2.Four patients underwent surgical correction of Ebstein anomaly (median age 9 years, range 4-12 years, all female). Ebstein anomaly was classified as Carpentier type C in three and as Carpentier Type B in one patient. All patients showed some degree of atrial shunting while one patient exhibited an additional perimembranous ventricular septal defect. All underwent cone reconstruction of the tricuspid valve. Due to massive intraoperative bleeding, which required rethoracotomy, subsequently causing impaired RV function, one patient underwent concomitant "one and a half ventricle" repair. All other patients showed an uncomplicated postoperative course and all were alive with a good and/or improved RV function and only minimal-to-mild tricuspid regurgitation after 1 year.Cone reconstruction in children with Ebstein anomaly is feasible in a high-altitude setting when using a dedicated protocol to prophylactically manage PH.
High Altitude May Protect Against the Early Development of Irreversible Pulmonary Hypertension in Patients With Congenital Heart Disease
(SAGE Publishing, 2025) Inge von Alvensleben; Brian B. Graham; Gustavo Balanza; Carlos Brockmann; Ermindo Barrientos Pérez; Ximena Vicente; C. A. Rosal Arteaga; Claudia Scherer; Franz Freudenthal; Rubin M. Tuder
Congenital heart disease (CHD) occurs at increased prevalence at high altitude, but there may be a paradoxical later onset of the development of Eisenmenger syndrome. We hypothesized that congenital heart disease patients at high altitude are protected from an early onset of irreversible pulmonary hypertension. We present a ospective observational case series study, supported by a PVRI grant, of patients in La Paz, Bolivia, located at 3600 m, who underwent surgery for CHD. 10 consecutive patients aged 5 to 29 years (mean 12) with left-to-right shunts and pulmonary hypertension underwent diagnostic catheterization to assess pulmonary pressure pre-operatively and six to 9 months postoperatively, and had a lung biopsy performed at the time of the surgery. Control lung tissue was obtained from patients living at the same altitude who underwent pulmonary hydatid cyst resection. 10 CHD patients and 4 control patients were analyzed. Pre-operatively, the patients had a significant response to hyperoxia with a fall in mean pulmonary pressure (mPAP) from 59.6 mmHg (SD 7.74) to 46.3 mmHg (SD 11.1); (p < 0.05). Postoperatively, the patients had an excellent response to surgery, with a mPAP of 26.4 mmHg (SD 6.42) (p < 0.05 vs. preoperative pressures). Analysis of the lung histology did not show evidence of pulmonary vascular remodeling in the CHD patients compared to the control patients. During the follow-up in up to 11 years, pulmonary pressure assessed by echocardiography remained normal. In conclusion, chronic hypobaric hypoxemia at high altitude may delay the development of pulmonary vascular disease in CHD patients.
Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia
(Wiley, 2025) Alexandra Heath; Inge von Alvensleben; Jesús Ardiles Spielvogel; Pablo Freudenthal; J. Douglas Trapp; Ivanna Noya; Miguel Gálvez; Fanny Mendizábal; Marcelino Gonzales; Ceylan Apaza
Highland populations suffer from significant infant mortality due to chronic ambient hypoxia, which increases the risk of congenital heart disease (CHD) and neonatal pulmonary hypertension. Neither the prevalence of these conditions nor the effectiveness of neonatal cardiac screening to identify CHD or pulmonary hypertension among neonates born at altitudes >4000 m in Bolivia has been reported. In a study of 1033 newborns in El Alto, Bolivia (4150 m), we determined the prevalence of CHD and prolonged postnatal adaptation. We also tested the accuracy of a neonatal cardiac screening tool in identifying infants with/without these conditions. Finally, diagnoses were contrasted between offspring born to parents of lowland versus highland origin. CHD was found in 54 neonates (5.2%), with the most common diagnoses being patent ductus arteriosus and atrial septal defect. Pulmonary hypertension without CHD was observed in 64 neonates (6.8%), with seven cases of persistent pulmonary hypertension of the newborn (PPHN). The neonatal cardiac screening tool showed a sensitivity of 45% and specificity of 99% for CHD, and 35% sensitivity and 92% specificity for prolonged pulmonary adaptation. Offspring of highland-origin women tended to have increased CHD risk, while those from lower altitudes were predisposed to prolonged postnatal adaptation and PPHN; paternal altitude of origin had no statistic significance but showed same tendency. The high prevalence of relevant CHD and prolonged pulmonary adaptation in neonates born >4000 m in Bolivia likely contributes to the high infant mortality rates observed. The poor sensitivity of the pilot neonatal cardiac screening instrument underscores the need to develop evidence-based tools optimized for use in low-resource, high-altitude settings.
Surviving birth at high altitude
(Wiley, 2024) Alexandra Heath‐Freudenthal; Alejandra Estrada; Inge von Alvensleben; Colleen G. Julian
This Symposium Review examines challenges to surviving birth and infancy at high altitudes. Chronic exposure to the environmental hypoxia of high altitudes increases the incidence of maternal vascular disorders of pregnancy characterized by placental insufficiency, restricted fetal growth and preterm delivery, and impairs pulmonary vascular health during infancy. While each condition independently contributes to excess morbidity and mortality in early life, evidence indicates vascular disorders of pregnancy and infantile pulmonary vascular dysfunction are intertwined. By integrating our recent scientific and clinical observations in Bolivia with existing literature, we propose potential avenues to reduce the infant mortality burden at high altitudes and reduce pulmonary vascular disease in highland neonates, and emphasize the need for further research to address unresolved questions.
Use of a ductal occluder device as a test and then permanent closure of a large ductus arteriosus with increased pulmonary vascular resistance: a case report
(Cambridge University Press, 2025) Nelly Rocío Fabiani Hurtado; Alexandra Heath‐Freudenthal; Inge von Alvensleben; Gabriel Echazú; Franz Freudenthal; Abraham Rothman
A 3-year-old girl with a large ductus arteriosus had increased pulmonary vascular resistance at cardiac catheterisation. Test occlusion of the ductus arteriosus with a Nit-Occlud PDA-R device and hyperoxia decreased the pulmonary arterial pressure to < 50% of systemic level. The ductus was closed with the same device. Two years later, an echocardiogram showed normal pulmonary arterial pressure.
Vascular Disorders of Pregnancy Increase Susceptibility to Neonatal Pulmonary Hypertension in High-Altitude Populations
(Lippincott Williams & Wilkins, 2022) Alexandra Heath-Freudenthal; Lilian Toledo-Jaldin; Inge von Alvensleben; Litzi Lazo-Vega; Rodrigo Mizutani; Margaret Stalker; Hussna Yasini; Fanny Mendizabal; Jesus Dorado Madera; William Mundo
The effect of preeclampsia with fetal growth restriction to increase fetal hypoxia and sFlt1 levels may impede normal development of the pulmonary circulation at high altitude, leading to adverse neonatal pulmonary vascular outcomes. Our observations highlight important temporal windows for the prevention of pulmonary vascular disease among babies born to highland residents or those with exaggerated hypoxia in utero or newborn life.
Vascular Disorders of Pregnancy Increase Susceptibility to Neonatal Pulmonary Hypertension in High-Altitude Populations.
(University of Cambridge, 2022) Alexandra Heath‐Freudenthal; Lilian Toledo‐Jaldin; Inge von Alvensleben; Litzi Lazo‐Vega; Rodrigo Mizutani; Margaret Stalker; Hussna Yasini; Fanny Mendizábal; Jesus Dorado Madera; William Mundo
BACKGROUND: Preeclampsia and fetal growth restriction increase cardiopulmonary disease risk for affected offspring and occur more frequently at high-altitude (≥2500 m). Retrospective studies indicate that birth to a preeclampsia woman at high altitude increases the risk of pulmonary hypertension (PH) in later life. This prospective study asked whether preeclampsia with or without fetal growth restriction exaggerated fetal hypoxia and impaired angiogenesis in the fetal lung, leading to neonatal cardiopulmonary circulation abnormalities and neonatal or infantile PH. METHODS AND RESULTS: We studied 79 maternal-infant pairs (39 preeclampsia, 40 controls) in Bolivia (3600-4100 m). Cord blood erythropoietin, hemoglobin, and umbilical artery and venous blood gases were measured as indices of fetal hypoxia. Maternal and cord plasma levels of angiogenic (VEGF [vascular endothelial growth factor]) and antiangiogenic (sFlt1 [soluble fms-like tyrosine kinase]) factors were determined. Postnatal echocardiography (1 week and 6-9 months) assessed pulmonary hemodynamics and PH. Preeclampsia augmented fetal hypoxia and increased the risk of PH in the neonate but not later in infancy. Pulmonary abnormalities were confined to preeclampsia cases with fetal growth restriction. Maternal and fetal plasma sFlt1 levels were higher in preeclampsia than controls and positively associated with PH. CONCLUSIONS: The effect of preeclampsia with fetal growth restriction to increase fetal hypoxia and sFlt1 levels may impede normal development of the pulmonary circulation at high altitude, leading to adverse neonatal pulmonary vascular outcomes. Our observations highlight important temporal windows for the prevention of pulmonary vascular disease among babies born to highland residents or those with exaggerated hypoxia in utero or newborn life.