Intracoronary ultrasound assessment late after the arterial switch operation for transposition of the great arteries

This research was undertaken to assess the status of the coronary wall morphology late after the arterial swith operation (ASO) for transposition of the great arteries employing intravascular ultrasound(IVUS).Long-term patency of the reimplanted coronary arteries is a key issue after ASO. Follow-up studies have demonstrated coronary obstruction in up to 8% o9f patients that may be related to progressive fibrocellular intimal thickening.Twenty-two asymptomatic chidren were enrolled at a median age of 9.5 years (range 5 to 22 years); IVUS images were obtained in 20 children at cardiac catheterization 5.0 to 21.6 years after the operation (in two cases IVUS study was not feasible duo to technical constraints)...

Intracoronary ultrasound assessment late after the arterial witch operation for transposition of the great arteries

This research was undertaken to assess the status of the coronary wall morphology late after the arterial switch operation (ASO) for transposition of the great arteries employing intravascular ultrasound (IVUS). BACKGROUND Long-term patency of the reimplanted coronary arteries is a key issue after ASO. Follow-up studies have demonstrated coronary obstruction in up to 8% of patients that may be related to progressive fibrocellular intimal thickening. METHODS Twenty-two asymptomatic children were

enrolled at a median age of 9.5 years (range 5 to 22 years); IVUS images were obtained in 20 children at cardiac catheterization 5.0 to 21.6 years after the operation (in two cases IVUS study was not feasible due to technical constraints). Quantitative analysis was performed in 37 coronary arteries involving segments with a mean

length of 28.4 1.8 mm. RESULTS Thirty-three arteries (89%) displayed variable degrees of proximal eccentric intimal proliferation, with the maximal intimal thickening being 0.26 0.14 mm (range 0.06 to 0.71 mm) at the most thickened site. According to the Stanford classification, all children had coronary

artery involvement with 50% having moderate-to-severe lesions ( 0.3 mm). No risk factors for such abnormalities were encountered, including age, origin of the coronary arteries, hemodynamics, and follow-up duration after surgery. CONCLUSIONS Intravascular ultrasound assessment late after the ASO revealed proximal eccentric intimal thickening in most of the studied vessels. This observation suggests the development of early atherosclerosis in the reimplanted coronary arteries, which may have a role in the genesis of

Fetal cardiomyopathies pathogenic mechanisms, hemodynamic findings, and clinical outcome

Background—Although the prenatal diagnosis of most fetal structural heart defects and dysrhythmias has been described,there is a paucity of information about cardiomyopathies (CMs) in prenatal life.Methods and Results—-To determine the pathogenic mechanisms, hemodynamic findings, and outcome of fetal CM, wereviewed the fetal echocardiograms and perinatal histories of 55 affected fetuses. Dilated CM was diagnosed in 22 cases,including 2 with congenital infections, 5 familial cases, 6 with endocardial fibroelastosis related to maternal anti-Ro/Laantibodies, and 9 idiopathic cases. Thirty-three had hypertrophic CM, 7 associated with maternal diabetes, 2 withNoonan’s syndrome, 2 with -thalassemia, 18 with twin-twin transfusion syndrome, 1 with familial hypertrophy, and3 with idiopathic hypertrophy. Systolic dysfunction was present in all cases of dilated CM and 15 cases of hypertrophicCM. Diastolic dysfunction was present in 19 of 30 fetuses with assessment of diastolic function parameters. Significantmitral or tricuspid valve regurgitation was seen in 32 cases. Eight fetuses were hydropic and 23 had signs of earlyhydrops. Seven pregnancies were terminated. Of 46 continued pregnancies with follow-up, 29 (63%) died perinatally.The presence of systolic dysfunction, diastolic dysfunction, and significant atrioventricular valve regurgitation wereidentified as risk factors for mortality. By multiple logistic regression, diastolic dysfunction was associated with an8-fold increased risk relative to the other parameters.Conclusions—Fetal CM has a broad spectrum of intrinsic and extrinsic causes. A poor outcome is observed in manyaffected fetuses. Diastolic dysfunction in fetal CM is associated with the highest risk of mortality.