novel method for quantification of left ventricular noncompaction using two-dimensional echocardiography in children

Although there are several echocardiographic criteria, there is not yet a general consensus about the diagnosis of left ventricular noncompaction. The current criteria are mostly based on the areas with maximal noncompaction in the heart The echocardiographer may miss this maximal point leading to a misdiagnosis. Accordingly, we suggested a new method to measure the percentage of myocardial noncompaction using two-dimensional echocardiography. In this study, the new method was examined on 4 noncompaction and 26 dilated cardiomyopathies, and 25 normal subjects. The percentage of noncompaction was measured at 3 levels [apical, papillary muscle and mitral valve] and averaged. The mean percentages of myocardial noncompaction were 3.59 +/- 2.27, 8.86 +/- 5.52 and 34.7 +/- 26.1 in the control, dilated cardiomyopathy and noncompaction groups, respectively. A value of 17% or greater could distinguish left ventricular noncompaction from dilated cardiomyopathy with 92% specificity and 100% sensitivity and from normal subjects with 100% specificity and sensitivity. This percentage had a statistically significant association with noncompacted to compacted myocardial thickness ratio [P<0.001]. This method showed good correlations with the existing echocardiographic and magnetic resonance criteria. However, it is not dependent on finding the area of maximal involvement Being comparable to magnetic resonance imaging in accuracy, it is easier to perform and more available

Correlation between qrs duration, pulmonary insufficiency and right ventricle performance in totally corrected tetralogy of fallot

Despite progresses in surgical correction of Tetralogy of Fallot, pulmonary insufficiency and progressive dysfunction of the right ventricle impress its long-term prognosis. In this study we examined the correlations between QRS duration, pulmonary insufficiency and right ventricular performance index. We enrolled 57 repaired Tetralogy of Fallot patients. QRS duration on electrocardiogram, pulmonary regurgitation index [regurgitation time to diastolic time ratio], and right ventricular myocardial performance index were measured. There was a strong inverse correlation between QRS duration and pulmonary regurgitation index. However, significant correlation did not exist between QRS duration and right ventricular myocardial performance index. QRS duration >160 ms predicted severe pulmonary regurgitation with 100% sensitivity and 87% specificity. Increased QRS duration can predict severity of pulmonary regurgitation

Transcatheter atrial septal defect closure using occlutech figulla device: a two-center experience

Despite several reports regarding the use of the Occlutech Figulla[R] Flex septal occluder [OFFSO] in adults, there are few reports on its use in children. We sought to study the result of the transcatheter closure of atrial septal defect [ASD] using the OFFSO in children

Platelets in pulmonary hypertension: a causative role or a simple association?

Pathophysiology of pulmonary arterial hypertension is based on three basic mechanisms: thrombotic pulmonary vascular lesions, vasoconstriction and vascular remodeling. Platelets are related to all of these mechanisms by their aggregation, production, storage and release of several mediators. The role of platelets is more prominent in some types of pulmonary arterial hypertension, including those which are secondary to inflammatory and infectious diseases, hemoglobinopathies, essential thrombocythemia, drugs, thrombo-embolism, and cardiac surgery. Most pulmonary antihypertensive drugs have a negative effect on platelets. In this review, the mechanisms of platelets association with pulmonary arterial hypertension, those types of pulmonary arterial hypertension with greatest platelet contribution to their pathophysiology, and the effects of pulmonary antihypertensive drugs on platelets are summarized

Right ventricular myocardial tissue velocities, myocardial performance index, and tricuspid annular plane systolic excursion in totally corrected tetralogy of Fallot patients

Longer survival after the total repair of the Tetralogy of Fallot increases the importance of late complications such as right ventricular dysfunction. This is a prospective study of the right ventricular function in totally corrected Tetralogy of Fallot patients versus healthy children. Thirty-two healthy children were prospectively compared with 30 totally corrected Tetralogy of Fallot patients. Right ventricular myocardial tissue velocities, right ventricular myocardial performance index, and tricuspid annular plane systolic excursion were investigated as well as the presence and severity of pulmonary regurgitation. The two groups were age-and sex-matched. Mean systolic peak velocity [Sa] and tricuspid annular plane systolic excursion were significantly decreased, while myocardial performance index and early to late diastolic velocity [Ea/Aa] were significantly increased in the Tetralogy of Fallot patients. Early diastolic velocity [Ea] showed no significant difference between the two groups. Sa correlated significantly with tricuspid annular plane systolic excursion in both the normal children and totally corrected Tetralogy of Fallot patients. Myocardial performance index was significantly higher in the patients with moderate to severe pulmonary regurgitation than in those with mild regurgitation. However, there was no significant correlation between this index and right ventricular myocardial tissue velocities. In this study, systolic right ventricular function indices [Sa and tricuspid annular plane systolic excursion] were impaired in the totally corrected Tetralogy of Fallot patients. Myocardial performance index was affected by the severity of pulmonary regurgitation

Transcatheter atrial septal defect closure under transthorasic echocardiography in children

Atrial septal defect [ASD] device closure is routinely done under the guide of transesophageal or intracardiac echocardiography which are expensive techniques and not easily affordable in developing countries. Using metallic devices, we attempted 32 ASD device closures under transthoracic echocardiography. Of those, 30 procedures were successful [94%]. In two patients with relatively large ASD we encountered difficulty in positioning the device. These patients were referred for surgical closure. ASD device closure can be carried out successfully in most patients under transthoracic echocardiography in situations where transesophageal or intravenous echocardiographies are not available or affordable

Device occlusion versus surgery for closure of congenital heart defects: cost issues in Iran

Closure of patent ductus arteriosus [PDA], ventricular septal defect [VSD] and atrial septal defect [ASD] can be done surgically or by device. This study was designed to compare the total cost of surgical or device closures of PDA, ASD or VSD for Iranian patients. This is a cross-sectional study, conducted from January 1, 2005 until January 1, 2006 in two large heart centers of Tehran. The study population consisted of 91 patients with isolated PDA, ASD or VSD who underwent either surgical or device closure. PDA device closure either with the Amplatzer device or coil was less costly than that via surgery. VSD closure with the Amplatzer device was more costly [17.6%]. Although ASD closure was also more expensive [15.4%], the difference was not statistically significant. It can be concluded that PDA closure is cheaper than surgery in Iran. ASD and VSD device closures are more expensive, but the added cost can be affordable in view of the advantages of device closure