To determine the presence of depressive symptoms in adolescent and adult patients with CHD and th... more To determine the presence of depressive symptoms in adolescent and adult patients with CHD and their impact on prognosis, using self-rating depression scales. Prospective study. Outpatient clinic of a tertiary center. Sixty ambulatory adolescent and adult patients admitted at the outpatient clinic for regular evaluation. Self-rating depression questionnaires (Beck Depression Inventory [BDI] and Zung Self-Rating Depression Scale [Zung SDS]) were administered on admission. Patients were characterized as having depressive symptoms when scores on both questionnaires were above cutoff levels and were subsequently followed for 5.1 ± 1.1 years for major adverse cardiovascular events (MACEs; death or hospitalization for cardiac reasons). Seventeen patients (mean age 28.9 ± 11.4 years) were characterized as having depressive symptoms. According to univariate Cox regression analysis, the presence of depressive symptoms was independently associated with adverse clinical outcome. During the fol...
Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular... more Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular, young male individuals have been identified to exhibit an increased risk of myocardial inflammation following the administration of mRNA-based vaccines. Even though the first epidemiological analyses and numerous case reports investigated potential relationships, endomyocardial biopsy (EMB)-proven cases are limited. Here, we present a comprehensive histopathological analysis of EMBs from 15 patients with reduced ejection fraction (LVEF = 30 (14–39)%) and the clinical suspicion of myocarditis following vaccination with Comirnaty® (Pfizer-BioNTech) (n = 11), Vaxzevria® (AstraZenica) (n = 2) and Janssen® (Johnson & Johnson) (n = 2). Immunohistochemical EMB analyses reveal myocardial inflammation in 14 of 15 patients, with the histopathological diagnosis of active myocarditis according the Dallas criteria (n = 2), severe giant cell myocarditis (n = 2) and inflammatory cardiomyopathy (n = 1...
AIM: The purpose of this study was to evaluate the safety and effectiveness of the multilayer flo... more AIM: The purpose of this study was to evaluate the safety and effectiveness of the multilayer flow modulator and its delivery system for totally endovascular repair of aortic aneurysms in high risk patients and to demonstrate deployment success and preservation of all side-branch vessels. METHODS AND RESULTS: We report on 22 cases (mean age 67 ± 5 years all males) with thoracic, thoracoabdominal and abdominal aneurysm considered high risk patients for surgical treatment. In all patients, treated with a multilayer stent, there were side branches arising from the aneurysm sac and maintained patency after the procedure. Two patients died after the procedure: 1 patient who developed a stroke two weeks post procedure and 1 patient who sustained a myocardial infarction two days post-procedurally. No vascular or systematic complications were observed in the other 20 patients in the short and long term follow-up. CONCLUSIONS: Our preliminary results indicate that the use of the multilayer s...
In this paper we present our experience with the Amplatzer septal occluder device, employed in 14... more In this paper we present our experience with the Amplatzer septal occluder device, employed in 140 patients for percutaneous closure of atrial secundum defect (ASD), from October 2002 to February 2006. The age of patients ranged between 5.3 and 70 years, median 21.9 years. Procedure time ranged between 25 and 240 minutes, median 60 minutes; fluoroscopy time ranged between 3.5 and 45 minutes, median 12 minutes. Transoesophageal echocardiography was used to monitor the implantation procedure. The size of the selected device was 1 to 2 mm larger than the stretched diameter of the defect and ranged between 6-40 mm. Two devices have been implanted in two patients. Serious procedure related complications (embolization and perforation of the left atrial wall) occurred in two cases. At follow up (10 days to 3.4 years, median 2.3 years) complete closure was documented in 97% of this patient group. Unrecognized during implantation, but detected after release, small additional defect with triv...
Objective: To evaluate the long-term clinical and exercise effect of chronic oral administration ... more Objective: To evaluate the long-term clinical and exercise effect of chronic oral administration of the nonselective endothelin receptor antagonist bosentan in patients with pulmonary arterial hypertension (PAH) related to congenital heart disease (CHD). Design: Extension of a preceding prospective non-randomised open clinical study on bosentan treatment in PAH related to CHD. Setting: A tertiary referral centre for cardiology. Patients: 19 of the original 21 patients of mean (standard deviation (SD)) age 22 (3) years (13 with Eisenmenger syndrome) in World Health Organization (WHO) class II-IV and having a mean (SD) oxygen saturation of 87 (2) %. Intervention: Patients received bosentan treatment for 2.4 (0.1) years and underwent clinical and exercise evaluation at baseline, 16 weeks and 2 years of treatment, with haemodynamic assessment at baseline and 16 weeks. Results: All patients remained stable with sustained subjective clinical and WHO class improvement (p,0.01) at 16 weeks and 2 years of treatment without significant side effects or changes in oxygen saturation. After the initial 16-week improvement (p,0.05) in peak oxygen consumption and exercise duration at treadmill test, and walking distance and Borg dyspnoea index at 6-min walk test, all exercise parameters appeared to return to their baseline values at 2 years of follow-up. Conclusions: Long-term bosentan treatment in patients with PAH related to CHD is safe and induces clinical stability and improvement, but the objective exercise values appear to slowly return to baseline. Larger studies on long-term endothelin receptor antagonism including quality of life assessment are needed to evaluate the therapeutic role of bosentan in this population.
To evaluate the clinical, exercise, and haemodynamic effects of chronic oral administration of th... more To evaluate the clinical, exercise, and haemodynamic effects of chronic oral administration of the non-selective endothelin receptor antagonist bosentan on patients with pulmonary arterial hypertension (PAH) related to congenital heart disease (CHD). Design: Prospective non-randomised open clinical study. Setting: Cardiology tertiary referral centre. Patients: 21 patients with a mean (SEM) age of 22 (3) years with chronic PAH related to CHD (15 with Eisenmenger's syndrome). Patients were in World Health Organization (WHO) class II to IV with oxygen saturation 87 (2)%. Intervention: Patients underwent clinical, exercise, and haemodynamic evaluations at baseline and after 16 weeks of treatment. Results: Bosentan improved (p , 0.01) WHO class, peak oxygen consumption from 16.8 (1.4) to 18.3 (1.4) ml/kg/min, exercise duration from 9.0 (0.8) to 10.7 (0.6) minutes during the treadmill test, walking distance from 416 (23) to 459 (22) m, and Borg dyspnoea index from 2.8 (0.2) to 2.0 (0.1) during the six minute walk test. Bosentan treatment improved (p , 0.05) mean pulmonary artery pressure from 87 (4) to 81 (4) mm Hg, pulmonary blood flow index from 3.2 (0.4) to 3.7 (0.5) l/min/m 2 , pulmonary to systemic blood flow ratio from 1.2 (0.2) to 1.4 (0.2), and pulmonary vascular resistance index from 2232 (283) to 1768 (248) dyn?s?cm 25. Two patients died, presumably of arrhythmic causes, who were in WHO class IV at baseline and who had improved during treatment. Conclusions: Bosentan induces short and mid term clinical, exercise, and haemodynamic improvements in patients with PAH related to CHD. Larger studies with long term endothelin receptor antagonism are needed to assess the safety and possible treatment role of bosentan in this population.
Transcatheter closure of ventricular septal defects with the Amplatzer® Membranous VSD Occluder h... more Transcatheter closure of ventricular septal defects with the Amplatzer® Membranous VSD Occluder has yielded promising initial results, but disturbances of conduction, including complete heart block, have been reported. We report our experience with the Amplatzer occluder in 35 patients with a median age 4.5 years, the defects being sized angiographically at 4.4 plus or minus 1.1 millimetres, with a range from 3 to 8 millimetres, and the size of the occluder varying from 4 to 12 millimetres. Over a median follow-up of 2.5 years, the rate of complete closure was 87% and 91%, at 1 and 2 years respectively, while 2 patients required surgical closure of the defect subsequent to the insertion of the device. Persistent regurgitation across the tricuspid valve related to the occluder was observed in 3 patients, and in 6 patients across the aortic valve. Abnormalities of conduction related to the procedure were noted in 7 patients, one-fifth of the cohort. The disturbances were transient in ...
We report our initial experience in using the Amplatzer® vascular plug for closure of coronary ar... more We report our initial experience in using the Amplatzer® vascular plug for closure of coronary arterial fistulas. The self-expanding, cylindrical, device is made from Nitinol wire mesh, and is available from 4 to 16 millimetres in diameter. We have now used the device to close fistulas in 3 patients, aged from 3 to 14 years, who presented with ratios of pulmonary-to-systemic flow from 1.5 to 3. In 2 patients, fistulas arising from the proximal right and left coronary arteries, with maximal diameters of 9 and 10 millimetres, respectively, had their narrowest diameter, of 6 millimetres, proximal to the entrance into the right atrium via a saccular aneurysm. The third fistula, with a maximal diameter of 16 millimetres, and with its origin from the circumflex coronary artery, entered the right atrium with nearly unrestricted flow, its narrowest diameter being 8 millimetres. For interventional closure, we chose plugs twice the diameter of the narrowest segment of the fistula, thus using ...
The purpose of this article is to present serial clinical and imaging findings for the &a... more The purpose of this article is to present serial clinical and imaging findings for the "absent" pulmonary artery. Data from six patients with this condition (five unilateral cases and one bilateral case) provide evidence concerning its embryology and illustrate the therapeutic implications of surgical intervention. In our series, we found the anatomy of the absent pulmonary artery to be consistent with a distal ductal origin and involution of the proximal sixth aortic arch. The absent pulmonary artery is a distinct embryologic entity that requires early detection and detailed investigation. Early surgical intervention may be justified in selected patients.
&... more <p>Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients.</p><p>We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.</p>
bAcKGrOUND: Transcatheter closure of secundum atrial septal defect (ASD) is nowadays widely pract... more bAcKGrOUND: Transcatheter closure of secundum atrial septal defect (ASD) is nowadays widely practiced and has replaced surgical ASD closure in many centers. Improvements in design have made the closure devices retrievable, and reduction in the size of the introduction systems allows interventional treatment even in young patients. In this paper we present our experience with the Amplatzer septal occluder device in patients with ASD.
Respiratory syncytial virus is the most common pathogen causing lower respiratory tract infection... more Respiratory syncytial virus is the most common pathogen causing lower respiratory tract infection in infants. In recent years, the importance of extrapulmonary complications and longterm sequelae including those involving the cardiovascular system has become apparent. We report on a 10 month old infant with respiratory syncytial virus bronchiolitis, the acute phase of which was complicated by irreversible complete heart block, which was managed conservatively.
World journal for pediatric & congenital heart surgery, Mar 23, 2016
Transposition of the great arteries occurs rarely in patients with mirror image dextrocardia and ... more Transposition of the great arteries occurs rarely in patients with mirror image dextrocardia and situs inversus, while the combination with severe coarctation of the descending aorta (CoA) makes the anatomy even more unusual. Therefore, it is not surprising that a case with such unusual and complicated anatomy presents unique problems when a primary definitive correction is attempted. We report a patient with situs inversus totalis and complex congenital heart disease including transposition of the great arteries and severe CoA who underwent successful complete, single-stage, anatomic correction.
The occurrence of aorto-right ventricular fistula after an aortic valve replacement is rare. If i... more The occurrence of aorto-right ventricular fistula after an aortic valve replacement is rare. If it remains untreated, this condition can result in heart failure and could thus significantly compromise patient survival. Surgical closure is the treatment of choice; however, transcatheter closure has been attempted with relatively acceptable results. Here, we report on a patient who presented with heart failure with an aorto-right ventricular fistula that was present for nine years following aortic valve replacement. Successful transcatheter closure of the fistula with the use of the Amplatzer duct occluder was performed, suggesting that the percutaneous approach is an efficient technique for the treatment of such fistulae.
We report our experience with the use of AMPLATZER® Vascular Plug for the closure of coronary art... more We report our experience with the use of AMPLATZER® Vascular Plug for the closure of coronary artery fistulas. Three patients (age: 3, 12, 14 years) were diagnosed with coronary fistulas (pulmonary-to-systemic blood flow ratio: 1.5 to 3). Two of the fistulas originated each, from the proximal right and left coronary artery and had maximal diameter and 10 mm respectively; their narrowest diameter (6 mm) was proximal to their entrance into the right atrium creating a form of a saccular aneurysm. The third fistula (maximal diameter: 16 mm) originated from the circumflex artery and entered the right atrium with unobstructed flow (narrowest diameter: 8 mm). Interventional closure was considered optimal and the decision was made to use devices sized twice the size of the narrowest diameter of the fistulas (12, 12 and 16 mm respectively). An arterio-venous loop was established through the fistula by snaring an exchange guide-wire. All plugs were implanted from the femoral vein with the use of a seven or eight French guide catheter, reaching the narrowest segment of the fistula and leading to complete closure of the two fistulas, immediately after the procedure. The fistula arising from the circumflex artery that received the largest plug continued to have residual flow up to 12 months after the procedure, when follow-up echocardiography revealed its complete occlusion. We present and consider the use of the AMPLATZER ® Vascular Plug as a safe and effective method for the transcatheter closure of large-sized coronary fistulas. The plug potentially offers an alternative method to coil occlusion techniques as well as open heart surgery. INtrODUctION Congenital coronary artery fistulas are rare malformations with an incidence rate of 0.002 percent and small fistulas up to 0.08 to 0.30% during coronary angiography [1]. Most of the patients are asymptomatic during childhood but in older patients, late symptoms and complications, like congestive heart failure, bacterial endocarditis, coronary ischemia or fistula rupture have been reported [2]. Surgical ligation of coronary artery fistulas, was reported for the first time in 147 by Bjorck [3] and was the treatment of choice for many years. Transcatheter closure as a less invasive alternative to surgery was undertaken in the 180's and early 10's using different devices [4,5]. Today, transcatheter closure using coils is the most commonly used technique and is performed in many cardiac centers [6,7]. Even though the results of transcatheter closure of coronary artery fistulas are comparable with surgery, the procedure may be difficult and time consuming in cArDIOLOGY UPDA tE 2008
The well-known flaws of existing valved conduits for reconstruction of the right ventricular outf... more The well-known flaws of existing valved conduits for reconstruction of the right ventricular outflow tract (RVOT) continue to stimulate research for the elusive "perfect" conduit. In this study, we describe our experience with a glutaraldehyde-treated bovine jugular vein valved conduit (Contegra). 55 years underwent implantation of a Contegra conduit. Diagnoses/procedures included repair of truncus arteriosus (2 patients), pulmonary atresia (3 patients), severe pulmonary insufficiency after prior repair of tetralogy of Fallot (9 patients), and replacement of degenerated valved conduit (1 patient). No operative deaths occurred. One patient required an early conduit replacement for unexplained valve thrombosis. The early postoperative mean transconduit pressure gradient was 7.7+/- 4.9 mm Hg. At a mean follow-up time of 18.5 +/- 6.9 months, all patients were asymptomatic with no discernible calcification in the valve or conduit or significant valve incompetence, while the mean transvalvular gradient remained low (11.1 +/- 4.5 mm Hg). The Contegra valved conduit is well suited for RVOT reconstruction, avoids the use of additional foreign material, and remains well functioning during early followup. Nonetheless, the long-term durability remains to be ascertained.
In two patients with obstruction of the upper respiratory airways, echocardiography, subsequent a... more In two patients with obstruction of the upper respiratory airways, echocardiography, subsequent angio-cardiography and bronchoscopy disclosed the presence of a pulmonary artery sling. The clinical course of the disease, the diagnostic approach and the procedures for surgical repair are described. Embryological as well as differential diagnostic aspects are discussed with regard to the literature.
To determine the presence of depressive symptoms in adolescent and adult patients with CHD and th... more To determine the presence of depressive symptoms in adolescent and adult patients with CHD and their impact on prognosis, using self-rating depression scales. Prospective study. Outpatient clinic of a tertiary center. Sixty ambulatory adolescent and adult patients admitted at the outpatient clinic for regular evaluation. Self-rating depression questionnaires (Beck Depression Inventory [BDI] and Zung Self-Rating Depression Scale [Zung SDS]) were administered on admission. Patients were characterized as having depressive symptoms when scores on both questionnaires were above cutoff levels and were subsequently followed for 5.1 ± 1.1 years for major adverse cardiovascular events (MACEs; death or hospitalization for cardiac reasons). Seventeen patients (mean age 28.9 ± 11.4 years) were characterized as having depressive symptoms. According to univariate Cox regression analysis, the presence of depressive symptoms was independently associated with adverse clinical outcome. During the fol...
Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular... more Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular, young male individuals have been identified to exhibit an increased risk of myocardial inflammation following the administration of mRNA-based vaccines. Even though the first epidemiological analyses and numerous case reports investigated potential relationships, endomyocardial biopsy (EMB)-proven cases are limited. Here, we present a comprehensive histopathological analysis of EMBs from 15 patients with reduced ejection fraction (LVEF = 30 (14–39)%) and the clinical suspicion of myocarditis following vaccination with Comirnaty® (Pfizer-BioNTech) (n = 11), Vaxzevria® (AstraZenica) (n = 2) and Janssen® (Johnson & Johnson) (n = 2). Immunohistochemical EMB analyses reveal myocardial inflammation in 14 of 15 patients, with the histopathological diagnosis of active myocarditis according the Dallas criteria (n = 2), severe giant cell myocarditis (n = 2) and inflammatory cardiomyopathy (n = 1...
AIM: The purpose of this study was to evaluate the safety and effectiveness of the multilayer flo... more AIM: The purpose of this study was to evaluate the safety and effectiveness of the multilayer flow modulator and its delivery system for totally endovascular repair of aortic aneurysms in high risk patients and to demonstrate deployment success and preservation of all side-branch vessels. METHODS AND RESULTS: We report on 22 cases (mean age 67 ± 5 years all males) with thoracic, thoracoabdominal and abdominal aneurysm considered high risk patients for surgical treatment. In all patients, treated with a multilayer stent, there were side branches arising from the aneurysm sac and maintained patency after the procedure. Two patients died after the procedure: 1 patient who developed a stroke two weeks post procedure and 1 patient who sustained a myocardial infarction two days post-procedurally. No vascular or systematic complications were observed in the other 20 patients in the short and long term follow-up. CONCLUSIONS: Our preliminary results indicate that the use of the multilayer s...
In this paper we present our experience with the Amplatzer septal occluder device, employed in 14... more In this paper we present our experience with the Amplatzer septal occluder device, employed in 140 patients for percutaneous closure of atrial secundum defect (ASD), from October 2002 to February 2006. The age of patients ranged between 5.3 and 70 years, median 21.9 years. Procedure time ranged between 25 and 240 minutes, median 60 minutes; fluoroscopy time ranged between 3.5 and 45 minutes, median 12 minutes. Transoesophageal echocardiography was used to monitor the implantation procedure. The size of the selected device was 1 to 2 mm larger than the stretched diameter of the defect and ranged between 6-40 mm. Two devices have been implanted in two patients. Serious procedure related complications (embolization and perforation of the left atrial wall) occurred in two cases. At follow up (10 days to 3.4 years, median 2.3 years) complete closure was documented in 97% of this patient group. Unrecognized during implantation, but detected after release, small additional defect with triv...
Objective: To evaluate the long-term clinical and exercise effect of chronic oral administration ... more Objective: To evaluate the long-term clinical and exercise effect of chronic oral administration of the nonselective endothelin receptor antagonist bosentan in patients with pulmonary arterial hypertension (PAH) related to congenital heart disease (CHD). Design: Extension of a preceding prospective non-randomised open clinical study on bosentan treatment in PAH related to CHD. Setting: A tertiary referral centre for cardiology. Patients: 19 of the original 21 patients of mean (standard deviation (SD)) age 22 (3) years (13 with Eisenmenger syndrome) in World Health Organization (WHO) class II-IV and having a mean (SD) oxygen saturation of 87 (2) %. Intervention: Patients received bosentan treatment for 2.4 (0.1) years and underwent clinical and exercise evaluation at baseline, 16 weeks and 2 years of treatment, with haemodynamic assessment at baseline and 16 weeks. Results: All patients remained stable with sustained subjective clinical and WHO class improvement (p,0.01) at 16 weeks and 2 years of treatment without significant side effects or changes in oxygen saturation. After the initial 16-week improvement (p,0.05) in peak oxygen consumption and exercise duration at treadmill test, and walking distance and Borg dyspnoea index at 6-min walk test, all exercise parameters appeared to return to their baseline values at 2 years of follow-up. Conclusions: Long-term bosentan treatment in patients with PAH related to CHD is safe and induces clinical stability and improvement, but the objective exercise values appear to slowly return to baseline. Larger studies on long-term endothelin receptor antagonism including quality of life assessment are needed to evaluate the therapeutic role of bosentan in this population.
To evaluate the clinical, exercise, and haemodynamic effects of chronic oral administration of th... more To evaluate the clinical, exercise, and haemodynamic effects of chronic oral administration of the non-selective endothelin receptor antagonist bosentan on patients with pulmonary arterial hypertension (PAH) related to congenital heart disease (CHD). Design: Prospective non-randomised open clinical study. Setting: Cardiology tertiary referral centre. Patients: 21 patients with a mean (SEM) age of 22 (3) years with chronic PAH related to CHD (15 with Eisenmenger's syndrome). Patients were in World Health Organization (WHO) class II to IV with oxygen saturation 87 (2)%. Intervention: Patients underwent clinical, exercise, and haemodynamic evaluations at baseline and after 16 weeks of treatment. Results: Bosentan improved (p , 0.01) WHO class, peak oxygen consumption from 16.8 (1.4) to 18.3 (1.4) ml/kg/min, exercise duration from 9.0 (0.8) to 10.7 (0.6) minutes during the treadmill test, walking distance from 416 (23) to 459 (22) m, and Borg dyspnoea index from 2.8 (0.2) to 2.0 (0.1) during the six minute walk test. Bosentan treatment improved (p , 0.05) mean pulmonary artery pressure from 87 (4) to 81 (4) mm Hg, pulmonary blood flow index from 3.2 (0.4) to 3.7 (0.5) l/min/m 2 , pulmonary to systemic blood flow ratio from 1.2 (0.2) to 1.4 (0.2), and pulmonary vascular resistance index from 2232 (283) to 1768 (248) dyn?s?cm 25. Two patients died, presumably of arrhythmic causes, who were in WHO class IV at baseline and who had improved during treatment. Conclusions: Bosentan induces short and mid term clinical, exercise, and haemodynamic improvements in patients with PAH related to CHD. Larger studies with long term endothelin receptor antagonism are needed to assess the safety and possible treatment role of bosentan in this population.
Transcatheter closure of ventricular septal defects with the Amplatzer® Membranous VSD Occluder h... more Transcatheter closure of ventricular septal defects with the Amplatzer® Membranous VSD Occluder has yielded promising initial results, but disturbances of conduction, including complete heart block, have been reported. We report our experience with the Amplatzer occluder in 35 patients with a median age 4.5 years, the defects being sized angiographically at 4.4 plus or minus 1.1 millimetres, with a range from 3 to 8 millimetres, and the size of the occluder varying from 4 to 12 millimetres. Over a median follow-up of 2.5 years, the rate of complete closure was 87% and 91%, at 1 and 2 years respectively, while 2 patients required surgical closure of the defect subsequent to the insertion of the device. Persistent regurgitation across the tricuspid valve related to the occluder was observed in 3 patients, and in 6 patients across the aortic valve. Abnormalities of conduction related to the procedure were noted in 7 patients, one-fifth of the cohort. The disturbances were transient in ...
We report our initial experience in using the Amplatzer® vascular plug for closure of coronary ar... more We report our initial experience in using the Amplatzer® vascular plug for closure of coronary arterial fistulas. The self-expanding, cylindrical, device is made from Nitinol wire mesh, and is available from 4 to 16 millimetres in diameter. We have now used the device to close fistulas in 3 patients, aged from 3 to 14 years, who presented with ratios of pulmonary-to-systemic flow from 1.5 to 3. In 2 patients, fistulas arising from the proximal right and left coronary arteries, with maximal diameters of 9 and 10 millimetres, respectively, had their narrowest diameter, of 6 millimetres, proximal to the entrance into the right atrium via a saccular aneurysm. The third fistula, with a maximal diameter of 16 millimetres, and with its origin from the circumflex coronary artery, entered the right atrium with nearly unrestricted flow, its narrowest diameter being 8 millimetres. For interventional closure, we chose plugs twice the diameter of the narrowest segment of the fistula, thus using ...
The purpose of this article is to present serial clinical and imaging findings for the &a... more The purpose of this article is to present serial clinical and imaging findings for the "absent" pulmonary artery. Data from six patients with this condition (five unilateral cases and one bilateral case) provide evidence concerning its embryology and illustrate the therapeutic implications of surgical intervention. In our series, we found the anatomy of the absent pulmonary artery to be consistent with a distal ductal origin and involution of the proximal sixth aortic arch. The absent pulmonary artery is a distinct embryologic entity that requires early detection and detailed investigation. Early surgical intervention may be justified in selected patients.
&... more <p>Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients.</p><p>We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.</p>
bAcKGrOUND: Transcatheter closure of secundum atrial septal defect (ASD) is nowadays widely pract... more bAcKGrOUND: Transcatheter closure of secundum atrial septal defect (ASD) is nowadays widely practiced and has replaced surgical ASD closure in many centers. Improvements in design have made the closure devices retrievable, and reduction in the size of the introduction systems allows interventional treatment even in young patients. In this paper we present our experience with the Amplatzer septal occluder device in patients with ASD.
Respiratory syncytial virus is the most common pathogen causing lower respiratory tract infection... more Respiratory syncytial virus is the most common pathogen causing lower respiratory tract infection in infants. In recent years, the importance of extrapulmonary complications and longterm sequelae including those involving the cardiovascular system has become apparent. We report on a 10 month old infant with respiratory syncytial virus bronchiolitis, the acute phase of which was complicated by irreversible complete heart block, which was managed conservatively.
World journal for pediatric & congenital heart surgery, Mar 23, 2016
Transposition of the great arteries occurs rarely in patients with mirror image dextrocardia and ... more Transposition of the great arteries occurs rarely in patients with mirror image dextrocardia and situs inversus, while the combination with severe coarctation of the descending aorta (CoA) makes the anatomy even more unusual. Therefore, it is not surprising that a case with such unusual and complicated anatomy presents unique problems when a primary definitive correction is attempted. We report a patient with situs inversus totalis and complex congenital heart disease including transposition of the great arteries and severe CoA who underwent successful complete, single-stage, anatomic correction.
The occurrence of aorto-right ventricular fistula after an aortic valve replacement is rare. If i... more The occurrence of aorto-right ventricular fistula after an aortic valve replacement is rare. If it remains untreated, this condition can result in heart failure and could thus significantly compromise patient survival. Surgical closure is the treatment of choice; however, transcatheter closure has been attempted with relatively acceptable results. Here, we report on a patient who presented with heart failure with an aorto-right ventricular fistula that was present for nine years following aortic valve replacement. Successful transcatheter closure of the fistula with the use of the Amplatzer duct occluder was performed, suggesting that the percutaneous approach is an efficient technique for the treatment of such fistulae.
We report our experience with the use of AMPLATZER® Vascular Plug for the closure of coronary art... more We report our experience with the use of AMPLATZER® Vascular Plug for the closure of coronary artery fistulas. Three patients (age: 3, 12, 14 years) were diagnosed with coronary fistulas (pulmonary-to-systemic blood flow ratio: 1.5 to 3). Two of the fistulas originated each, from the proximal right and left coronary artery and had maximal diameter and 10 mm respectively; their narrowest diameter (6 mm) was proximal to their entrance into the right atrium creating a form of a saccular aneurysm. The third fistula (maximal diameter: 16 mm) originated from the circumflex artery and entered the right atrium with unobstructed flow (narrowest diameter: 8 mm). Interventional closure was considered optimal and the decision was made to use devices sized twice the size of the narrowest diameter of the fistulas (12, 12 and 16 mm respectively). An arterio-venous loop was established through the fistula by snaring an exchange guide-wire. All plugs were implanted from the femoral vein with the use of a seven or eight French guide catheter, reaching the narrowest segment of the fistula and leading to complete closure of the two fistulas, immediately after the procedure. The fistula arising from the circumflex artery that received the largest plug continued to have residual flow up to 12 months after the procedure, when follow-up echocardiography revealed its complete occlusion. We present and consider the use of the AMPLATZER ® Vascular Plug as a safe and effective method for the transcatheter closure of large-sized coronary fistulas. The plug potentially offers an alternative method to coil occlusion techniques as well as open heart surgery. INtrODUctION Congenital coronary artery fistulas are rare malformations with an incidence rate of 0.002 percent and small fistulas up to 0.08 to 0.30% during coronary angiography [1]. Most of the patients are asymptomatic during childhood but in older patients, late symptoms and complications, like congestive heart failure, bacterial endocarditis, coronary ischemia or fistula rupture have been reported [2]. Surgical ligation of coronary artery fistulas, was reported for the first time in 147 by Bjorck [3] and was the treatment of choice for many years. Transcatheter closure as a less invasive alternative to surgery was undertaken in the 180's and early 10's using different devices [4,5]. Today, transcatheter closure using coils is the most commonly used technique and is performed in many cardiac centers [6,7]. Even though the results of transcatheter closure of coronary artery fistulas are comparable with surgery, the procedure may be difficult and time consuming in cArDIOLOGY UPDA tE 2008
The well-known flaws of existing valved conduits for reconstruction of the right ventricular outf... more The well-known flaws of existing valved conduits for reconstruction of the right ventricular outflow tract (RVOT) continue to stimulate research for the elusive "perfect" conduit. In this study, we describe our experience with a glutaraldehyde-treated bovine jugular vein valved conduit (Contegra). 55 years underwent implantation of a Contegra conduit. Diagnoses/procedures included repair of truncus arteriosus (2 patients), pulmonary atresia (3 patients), severe pulmonary insufficiency after prior repair of tetralogy of Fallot (9 patients), and replacement of degenerated valved conduit (1 patient). No operative deaths occurred. One patient required an early conduit replacement for unexplained valve thrombosis. The early postoperative mean transconduit pressure gradient was 7.7+/- 4.9 mm Hg. At a mean follow-up time of 18.5 +/- 6.9 months, all patients were asymptomatic with no discernible calcification in the valve or conduit or significant valve incompetence, while the mean transvalvular gradient remained low (11.1 +/- 4.5 mm Hg). The Contegra valved conduit is well suited for RVOT reconstruction, avoids the use of additional foreign material, and remains well functioning during early followup. Nonetheless, the long-term durability remains to be ascertained.
In two patients with obstruction of the upper respiratory airways, echocardiography, subsequent a... more In two patients with obstruction of the upper respiratory airways, echocardiography, subsequent angio-cardiography and bronchoscopy disclosed the presence of a pulmonary artery sling. The clinical course of the disease, the diagnostic approach and the procedures for surgical repair are described. Embryological as well as differential diagnostic aspects are discussed with regard to the literature.
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