Torsion of young hearts: a speckle tracking study of normal infants, children, and adolescents.

AIM: Our aim was to study the rotational mechanics of the heart in a special population including neonates, young children, and adolescents. We showed the effect of age on torsion and the different rotational variables. This study is the first that focuses on neonatal heart mechanics. METHODS AND RESULTS: We recruited 70 normal children between few hours and 18 years old. We excluded abnormal rhythm and function. Short-axis parasternal views were taken at the base of the heart and the apex. Using the speckle tracking technique, we analysed the rotation curves at apex and base and calculated the net twist and torsion of the left ventricle (LV). We also calculated the twist and untwist rates to get the correlation with age and body surface area (BSA). Rotational patterns during diastole also were studied. Deformational time delay between the base and the apex was looked up. Apical rotation and net twist increased with age significantly (r = 0.41 and 0.38, respectively, P = 0.001) but when normalized by LV length there was fixed torsion among age groups. Rotation velocity declined with ageing during systole and diastole for both base and apex (r = -0.58 and -0.62 for twist rate, -0.69 and -0.6 for untwist rate, respectively, P < 0.001). Concordant results were reported for BSA. Deformational delay was decreasing with age (r = -0.74 for systolic and -0.53 for diastolic, P < 0.001). CONCLUSION: Infants hearts tend to deform more and faster than other groups. While apical twist and net twist increase with age, torsion is fixed among age groups. In young hearts, torsion is the result of differential twist.

Total anomalous pulmonary venous drainage to coronary sinus combined with left-sided obstructive lesions: a previously unreported association.

We present a very rare cardiac lesion where we found a combination of abnormal pulmonary venous drainage and left-sided obstructive lesions. This case gives new insight into the complex malformation of the heart, raising questions about cardiac embryology and timing of interfering events. Here we describe the lesion for the first time and review the related literature. To the best of our knowledge, this combination has never been reported.

Transposition of great arteries with constrictive ductus arteriosus revisited.

A case is presented of neonatal death despite prompt management of a baby diagnosed at 30 h of age with d-transposition of great arteries and intact ventricular septum, restrictive foramen ovale, and constrictive ductus arteriosus. The literature in this matter is reviewed and the poor prognosis of such cases despite rapid intervention is again emphasized.