ABSTRACT
BACKGROUND: Syncope and palpitations occur frequently in young patients. Noninvasive diagnostic testing may be inconclusive. AIM: To assess the diagnostic yield of implantable loop recorders in young patients. PATIENTS AND METHODS: Thirty-three young patients underwent implantation of a loop recorder for long-term monitoring of cardiac rhythm, to establish symptom-rhythm correlation. They belonged to one of three subgroups: those with structurally normal heart, normal electrocardiogram at rest, and negative family history (n = 16); patients with structural heart disease and previous surgical repair (n = 11), and patients with proven or suspected primary electrical disease (n = 6). A combination of automatic and patient-activated recordings was used to monitor cardiac rhythm during symptomatic episodes. RESULTS: There were no procedural complications. Diagnostic electrograms could be obtained in all patients. A high degree of symptom-rhythm correlation was established. In 8/33 patients, no recurrence of symptoms was observed either until end of battery life of the device (n = 4) or until last follow-up (n = 2). Specific cardiac therapy was required, based on rhythms recorded by the device in 15 patients (until last follow-up). This consisted of catheter ablation of a tachyarrhythmia (n = 7), pacemaker implantation or upgrade (n = 5) or ICD implantation (n = 5). In the remaining patients (n = 10), recurrence of symptoms was associated with a normal electrocardiogram, and in two of these patients a non-cardiac diagnosis was made. CONCLUSIONS: In selected patients, the implantable loop recorder provides valuable diagnostic information to guide further therapy.
Subject(s)
Arrhythmias, Cardiac/diagnosis , Electrocardiography, Ambulatory/methods , Electrodes, Implanted , Heart Rate/physiology , Monitoring, Physiologic/methods , Adolescent , Adult , Arrhythmias, Cardiac/physiopathology , Child , Child, Preschool , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Infant , Male , Prognosis , Reproducibility of Results , Time FactorsABSTRACT
BACKGROUND: Late ventricular failure remains a major concern in patients with congenitally corrected transposition of the great arteries (ccTGA). A new treatment for this condition is the double-switch procedure. METHODS: Three consecutive children with atrioventricular and ventriculoarterial discordance (congenitally corrected transposition of the great arteries) and associated ventricular septal defect underwent pulmonary artery banding in infancy, followed by a double-switch procedure and closure of the ventricular septal defect at a median age of 5.8 years (range 4.5 to 6 years). RESULTS: There were no major procedure-related complications and the median duration of hospital stay was 13 days. One patient required stent implantation in the superior vena cava five months after surgery to relieve a persistent caval stenosis associated with recurrent pleural and pericardial effusions. Apart from this, no other complications have occurred over a median follow-up of five months. CONCLUSION: The double-switch procedure offers the potential advantage of restoring the morphological left ventricle to systemic ventricle. Longer-term follow-up of this procedure is warranted.
ABSTRACT
A 2-month-old infant presented with acute onset of heart failure, having previously undergone anatomical repair of transposition of the great arteries and ventricular septal defect (VSD). Echocardiography demonstrated aneurysmal dilation of the native pericardial patch used for VSD closure, resulting in right ventricular inflow obstruction. The pericardial patch was excised, and the VSD closed using a GoreTex patch.
Subject(s)
Pericardium/transplantation , Surgical Flaps/adverse effects , Transposition of Great Vessels/surgery , Ventricular Outflow Obstruction/surgery , Aneurysm, False/diagnostic imaging , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Echocardiography, Doppler , Follow-Up Studies , Heart Septal Defects, Ventricular/diagnostic imaging , Heart Septal Defects, Ventricular/surgery , Humans , Infant , Male , Pulmonary Valve Stenosis/complications , Reoperation , Transposition of Great Vessels/complications , Transposition of Great Vessels/diagnostic imaging , Treatment Outcome , Ventricular Outflow Obstruction/diagnostic imaging , Ventricular Outflow Obstruction/etiologyABSTRACT
Transcatheter fenestration and balloon dilation of an atrial baffle created from native atrial tissue was attempted in a 15-year-old girl with failing Fontan physiology and protein-losing enteropathy. After transseptal puncture, initial dilations with a 10-mm and 12-mm diameter balloon resulted in an inadequate fenestration, with no significant decrease of right atrial pressure or systemic arterial saturation. Dilation of the fenestration with a 16-mm-diameter balloon produced a tear of the atrial septum and subsequent death. Balloon dilation of native atrial tissue may result in uncontrolled tears of the atrial septum.
