Longitudinal systolic strain of the bilayered ventricular septum during the first 72 hours of life in preterm infants.

BACKGROUND: Quantitative evaluation of right ventricular myocardial performance in preterm infants remains a challenge because of the limitations of conventional echocardiographic measurement and the complex geometry of the right ventricle (RV). Serial assessment of peak longitudinal systolic strain on the right and left sides of the ventricular septum (VS), RV, and left ventricle (LV) during the transitional period in preterm infants using two-dimensional speckle-tracking echocardiography is reported. METHODS: In 21 preterm infants (33 ± 2 gestational weeks, 1,913 ± 218 g birth weight) without mechanical ventilation, inotropic agents, or symptomatic patent ductus arteriosus (PDA), longitudinal strain (LS) was measured on both sides of the VS, RV free wall, and LV, along with conventional echocardiography at 1, 3, 6, 9, 12, 24, 48, and 72 h after birth. Correlations and factors associated with echocardiographic measurements were analyzed. RESULT: LS was maintained on the four analyzed regions during the first 72 h of life despite significant hemodynamic changes, including a decrease in pulmonary artery pressure and PDA closure. LS was significantly larger on the left side of the VS than on the right side of the VS at 1, 48, and 72 h after birth. CONCLUSIONS: Preterm infants showed stable LS on both sides of the VS, the RV free wall, and the LV despite significant hemodynamic changes during the first 72 h of life. These results suggest that the right and left sides of the VS respond differently to the complex cardiopulmonary transitions from fetal to neonatal life in preterm infants.

Increased serum high-sensitivity C-reactive protein is related to hypoxia and brain natriuretic peptide in congenital heart disease.

BACKGROUND: Studies of adults have shown a direct association between increased serum concentrations of high-sensitivity C-reactive protein (hs-CRP) and atherosclerotic cardiovascular disease, diabetes, and chronic heart failure. Some studies have documented elevated hs-CRP in obese children and adolescents, and in patients with a history of Kawasaki disease, but there are few data on its clinical significance in congenital heart disease. METHODS: Measurements of hs-CRP, brain natriuretic peptide (BNP), hemoglobin, and percutaneous oxygen saturation (SpO2) were done in the following 70 patients: 18 controls; 11 with hypoxia (SpO2 /= 40 pg/mL and SpO2 > 85%); and 10 patients with hypoxia-BNP (SpO2 /= 40 pg/mL). Correlations between hs-CRP, and age, body mass index (BMI), hemoglobin, SpO2, and BNP were analyzed using single and multiple regression analysis. RESULTS: Hs-CRP in the hypoxia-BNP group was higher than in the other three groups, while in the hypoxia and the BNP groups it tended to be higher than in the controls. Although single regression analysis showed significant correlations between hs-CRP and, age, BNP, hemoglobin, and SpO2, multiple regression analysis showed that only BNP and SpO2 had a significant correlation with hs-CRP. CONCLUSIONS: In preoperative or postoperative congenital heart disease, patients who had hypoxia or increased BNP had a higher hs-CRP level than controls. Serum concentration of hs-CRP significantly correlated with SpO2 and plasma BNP levels, but not with age or BMI.

Static balloon atrial septostomy with buddy wire technique: a case report.

The buddy wire technique, i.e. the use of a second 0.014" guidewire placed alongside the one employed to advance balloons, stents or other devices, improves the balloon or stent support and also provides guiding catheter stability. Furthermore, it concentrates forces transferred from the balloon along the line of the wire. We used a second 0.014" Platinum PLUS guidewire as a buddy wire during static balloon atrial septostomy in a 19-day-old baby with hypoplastic left heart syndrome, in whom standard balloon atrial septostomy was inadequate even with a fully dilated balloon. This procedure effectively dilated the atrial septal defect.

Efficacy of ticlopidine for preventing migraine after transcatheter closure of atrial septal defect with Amplatzer septal occluder: a case report.

Transcatheter closure of an atrial septal defect using the Amplatzer septal occluder is a current treatment option in Japan, but is occasionally associated with transient exacerbation or new onset migraine. Clopidogrel is effective in such a situation, but the efficacy of ticlopidine, an analog of clopidogrel, on migraine remains unclear. A 15-year-old girl presented with typical migraine attacks with aura 11 days after transcatheter closure of an atrial septal defect with an Amplatzer septal occluder. All examinations excluded thromboembolic origin of the migrain. Her symptoms disappeared completely after medication with ticlopidine.