Long-term results of balloon pulmonary valvuloplasty in children with congenital pulmonary valve stenosis

Immediate, short and midterm outcome of balloon pulmonary valvuloplasty are well known, but there is limited information on long term results. We report long term results of 2-13. 5 years follow up of balloon pulmonary valvuloplasty in children. From June 1998 to January 2012 sixty consecutive patients [33 females, 27 males] with moderate to severe valvar pulmonary stenosis [right ventricular to pulmonary artery pressure gradient greater than 50 mmHg] were considered for balloon valvuloplasty. The gradient was measured pre and immediately post-valvuloplasty at catheterization, and then by echocardiography at follow up. Follow up studies were performed 2-13.5 years [mean +/- SD; 7.1 +/- 2.5 years, median: 5.5 years] after procedure, by Doppler echocardiography in all patients and catheterization and angiography in two patients. Balloon pulmonary valvuloplasty BPV was successful in 53 of 60 [88.3%] patients whereas surgical valvotomy was necessary in 6 to 60 [10%]. There was one immediate death due to perforation of the right ventricular outflow tract. Pulmonary valve systolic pressure gradient decreased from 83.3 +/- 32.1 to 19.3 +/- 14.2 mmHg immediately after BPV and to 12.3 +/- 6.6 mmHg at late follow up [P<0.001]. Pulmonary insufficiency was noted in 20 [38%] patient at short-term, but it was demonstrated in 17 [32%] at late follow up. A second valvuloplasty was performed in two [3.8%] patients presenting with re-stenosis. The short, intermediate and long-term outcomes of pulmonary balloon valvuloplasty in children are excellent. Therefore it can be considered as the treatment of choice for children with pulmonary valve stenosis

Simultaneous transcatheter closure of ventricular septal defect and pulmonary valvuloplasty

Transcatheter balloon valvuloplasty has been the accepted first line treatment for congenital pulmonic stenosis [PS] in children. Transcatheter closure of perimembranous ventricular septal defect [VSD] with Amplatzer VSD occluder is an alternative to surgical repair. A 12 year old boy presented with history of exertional dyspnea and atypical chest pain. Physical findings were suggestive of severe pulmonic stenosis. Transthoracic echocardiography, right and left ventricular angiography showed medium to large sized perimembranous VSD and severe valvar pulmonary stenosis. Transcatheter closure of VSD was done first so as to avoid large left to right shunt across VSD after balloon pulmonary valvuplasty. We demonstrated the feasibility and success in treating combined ventricular septal defect and severe pulmonary valve stenosis with transcatheter interventional procedure in the same session

Transcatheter closure of atrial septal defect with amplatzer device in children and adolescents: short and midterm results; an Iranian experience

Transcatheter closure of secundum atrial septal defect [ASD] with Amplatzer device is an alternative procedure to surgical repair, with some limitations. The aim of this study was to assess the initial and mid-term results of the treatment of ASD with Amplatzer septal occluder in children and adolescents. From May 2003 to January 2008 sixty three consecutive children and adolescent patients underwent transcatheter closure of ASD at a mean +/- SD age of 8.5 +/- 4.8 years [range 2.2 to 18 years]. All procedures were performed under local anesthesia and moderate sedation or general anesthesia with transthoracic echocardiography and fluoroscopic guidance. Stretch diameter of ASD was determined by balloon sizing catheter. Device selection was based on and matched to the standard diameter of the septal defect. Follow up at 24 hours, 1 month, 6 months, 12 months and yearly thereafter included physical examination, electrocardiography and transthoracic echocardiography. The mean ASD diameter, measured with transthoracic echocardiography and balloon catheter were 19.5 +/- 5.5 mm and 20.9 +/- 6.2 mm, respectively. The mean follow up period was 32.4 +/- 18.8 months. Deployment of the device was successful in 57 [90.5%] and failed in 6 [9.5%] patients. The major complication included dislodgement of device in 1 patient and device embolization to right ventricular inlet [surgically removed] in 1 patient. The minor complication included transient atrial tachycardia in 10 patients, paroxysmal supraventricular tachycardia in 2 patients during procedure, successfully terminated with medication. At 24 hour, 1 month, 6 month and 1 year follow up, total occlusion rates were 73.6%, 91%, 94.7%, and 94.7%, respectively. Transcatheter occlusion of ASD with Amplatzer device is an effective and safe procedure with minimal complication rate and short hospital stay, as well as excellent short and intermediate outcome in children and adolescents

Serum uric acid correlation with echocardiographic indices in children with dilated cardiomyopathy

Dilated cardiomyopathy [DCMP] is a myocardial disease characterized by dilated left ventricle or both, ventricles and reduced contractility of the myocardium. In patients suffering from DCMP, the serum level of uric acid may increase. This research was designed to evaluate the effect of the serum level of uric acid on systolic and diastolic functions in patients with DCMP. This case-control study was performed on 30 patients with DCMP aged between 1 month and 12 years who were consistent with a control group in terms of age and gender. Patients suffering from congenital and acquired cardiac, renal, metabolic, endocrine, musculoskeletal, neurologic, vascular, and hematologic diseases were excluded. After physical examination, chest X-ray, and electrocardiography, systolic and diastolic parameters were measured via echocardiography, and fasting serum uric acid level was measured. The data were analyzed using the t-test and Pearson correlation coefficient. The average age of the patients in the case and control groups was 7.28 and 7.13 years, respectively. There were 15 boys, and the rest were girls. The serum uric acid level in the case and control groups was 6.22 and 3.31 mg/dl, respectively; the difference was statistically significant [P value < 0.01]. There was a significant correlation between serum uric acid level and left ventricular isovolumic contraction, interventricular septal diameter, left ventricular septal diameter in diastole, and fractional shortening [P value < 0.05]. In children with DCMP, the serum level of uric acid increases significantly and this increase is significantly correlated with some of left heart echocardiographic parameters. This test is of predictive value for disease progression