Early re-replacement after mitral valve replacement using the chimney technique in a child: a case report.

Mitral valve replacement for small pediatric patients is technically difficult because of the small annulus and requires some technical ideas. The chimney technique is useful for supra-annular mitral valve replacement. We describe a paediatric case of early re-replacement owing to pannus formation after mitral valve replacement using the chimney technique.

Posterior mitral leaflet extension using autologous pericardium to repair a hammock mitral valve associated with severe mitral valve regurgitation in a 4-month-old boy.

We successfully repaired a hammock mitral valve associated with severe mitral valve regurgitation in a 4-month-old boy using posterior leaflet extension along with glutaraldehyde-treated autologous pericardium and the splitting of bilateral papillary muscles. Surgical reinterventions were performed for the bilateral papillary muscles at 14 and 24 months postoperatively. The extended autologous pericardium was still pliable with mild mitral valve regurgitation at 26 months postoperatively.

Corynebacterium propinquum as the first cause of infective endocarditis in childhood.

We here present a 7-year-old girl with ventricular septum defect and ventriculoatrial communication, who developed infective endocarditis (IE) due to Corynebacterium propinquum in the tricuspid valve. The patient was admitted because of an 8-day history of fever. Transthoracic echocardiogram showed non-pedunculated vegetation on the septal leaflet of the tricuspid valve. Gram-positive coryneform bacteria grew from three consecutive sets of blood cultures taken on admission. C. propinquum was confirmed by 3 microbiological approaches; (i) biochemical testing using API Coryne panels, (ii) a sequence-based method using the 16S rRNA gene and partial rpoB sequencing, and (iii) matrix-assisted laser desorption ionization-time of flight mass spectrometry. The isolates were susceptible to a wide variety of ß-lactams and vancomycin. The patient was successfully treated with antimicrobial agents without surgical intervention. There have only been available of clinical details of two adult cases of invasive C. propinquum infections; one of which was presented as IE, and the other was pleuritis in a patient with lung cancer. To the best of our knowledge, this is the first report to describe C. propinquum as a cause of IE as well as that of invasive infections in a pediatric population. Multiple methods that reliably differentiated related species helped us to establish this rare organism. Our report expanded the clinical spectrum of C. propinquum infections.

High prevalence of abnormal glucose metabolism in young adult patients with complex congenital heart disease.

BACKGROUND: Abnormal glucose metabolism (AGM) adversely impacts morbidity and mortality in patients with chronic heart failure. No data on AGM in adult patients with congenital heart disease (ACHD) are available. METHODS: To assess the AGM in ACHD and compare the results with their clinical characteristics, we performed a 75-g oral glucose tolerance test to detect AGM, that is, insulin resistance, impaired glucose tolerance, and diabetes mellitus, in 205 consecutive ACHD (24 +/- 8 years), including 16 unrepaired patients, 67 Fontan patients, 122 postbiventricular (BV) patients, and 27 healthy controls (27 +/- 5 years). RESULTS: All ACHD groups had a high prevalence of AGM (unrepaired, 43.8%; Fontan, 43.3%; BV, 46.7%; control, 3.7%; P < .001). In the 2 postoperative groups, the Matsuda index was decreased (P < .0001), and greater waist circumference, liver dysfunction, higher plasma renin activity, and diuretic use were associated with AGM. Although male gender was associated with AGM (P < .01), baseline glucose and lipid metabolic variables did not correlate with the 75-g oral glucose tolerance test-induced hyperglycemia (area under the plasma glucose curve [AUC-PG]) in the Fontan patients but did correlate in the BV patients. The AUC-PG correlated inversely with exercise capacity (P < .05) in the 2 postoperative ACHD groups, and the AGM ACHD had a high incidence of future cardiac events (P < .05), especially the Fontan patients with diabetes mellitus (P < .01). CONCLUSIONS: Complex ACHD have a high prevalence of AGM, and this newly recognized pathophysiology should be considered in managing long-term survivors of complex ACHD.