ABSTRACT
OBJECTIVES: The goal of this research was to identify predictors for sudden death (SD) in patients with transposition of the great arteries (TGA) who have undergone atrial inflow repair. BACKGROUND: Sudden death is the most common cause of late death after atrial inflow repair of TGA. Little is known about the predictors of SD. METHODS: This was a retrospective, multicenter, case-controlled study. We identified 47 patients after Mustard's or Senning's operation who experienced an SD event (34 SD, 13 near-miss SD). Each patient was matched with two controls with the same operation, but without an SD event. Information on numerous variables before the event was obtained and compared with controls at the same time frame. RESULTS: Presence of symptoms of arrhythmia or heart failure at most recent follow-up and history of documented arrhythmia (atrial flutter [AFL]/atrial fibrillation [AF]) were found to increase the risk of SD. Electrocardiogram (ECG), chest X-ray, and Holter ECG findings were not predictive of SD. Neither medication nor pacing was found to be protective. Most SD events (81%) occurred during exercise. Ventricular tachycardia/ventricular fibrillation were the recorded rhythm during SD in 21 of 47 patients. CONCLUSIONS: Presence of symptoms and documented AFL/AF are the best predictors of SD in TGA patients. Patients with these findings should be further evaluated for risk of SD.
Subject(s)
Death, Sudden, Cardiac/epidemiology , Postoperative Complications/mortality , Transposition of Great Vessels/surgery , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/mortality , Child , Death, Sudden, Cardiac/prevention & control , Electrocardiography , Electrocardiography, Ambulatory , Female , Humans , Logistic Models , Male , Prognosis , Retrospective Studies , Risk Assessment , Transposition of Great Vessels/mortalityABSTRACT
To determine the value of noninvasive assessment of right ventricular preload in neonates, a prospective unblinded study was performed. Thirty-seven neonates without heart disease (median birth weight 1390 g, range 900 to 4400) were studied at the neonatal intensive care unit, comparing directly measured central venous pressure (CVP) and two-dimensional echocardiographic measurement of the maximum and minimum diameter of the inferior vena cava and calculated vena cava index (VCI). CVP was higher in conventionally ventilated and high-frequency oscillatory ventilated neonates than in those breathing spontaneously ( p < 0.0001). VCI in high-frequency oscillatory ventilated patients was lower (5 +/- 4) than in spontaneously breathing (56 +/- 19) and conventionally ventilated (49 +/- 19) (p = 0.002) neonates. CVP and VCI were inversely correlated in spontaneously breathing (r = -0.631), but not in conventionally and high-frequency oscillatory ventilated patients. VCI does not predict CVP in ventilated premature neonates, the correlation is limited only to spontaneously breathing infants.
