Frequency of restenosis after balloon pulmonary arterioplasty and its causes.

Restenosis has been described after balloon pulmonary arterioplasty (BPA), but litte is known about its frequency, settings, and time course. We undertook this study to (1) determine the incidence of restenosis after BPA, and (2) identify its potential determinants. We reviewed clinical data and measured pulmonary artery diameters from angiograms of 134 dilations on 75 patients (median 2.1 years, range 0.3 to 32) who had BPA from January 1990 to June 1998. Successful BPA was defined as a > or = 50% increase in predilation diameter, whereas restenosis was said to occur if there was a > or = 50% loss in initial diameter gain. The success rate after BPA by angiographic criteria was 64% (95% confidence interval 56% to 73%). Seventy-four percent of BPAs were successful by published standard criteria (angiographic criteria or > or = 20% change in right ventricular/aortic pressure). Baseline demographic variables and predilation parameters were not predictive of initial dilation success. Restenosis occurred in 35% (95% confidence interval 22% to 49%) of successfully dilated vessels. Only weight at follow-up (p = 0.02) was associated with an increased likelihood of restenosis. Predilation parameters, technical aspects of dilation, or immediate results of BPA were not predictive of restenosis. We therefore conclude that restenosis is unpredictable and more common after BPA than previously recognized.

[Allergy and asthma in Icelandic children - an epidemiological study.].

OBJECTIVE: The prevalence of allergy and asthma is increasing in Western industrialized countries. The etiology of allergy is multifactorial and only partly understood. In an effort to gather information about asthma and allergy in the pediatric population in Iceland, we have evaluated on a regular basis a cohort of randomly selected children born in 1987. MATERIAL AND METHODS: The first part of the study included 179 children at the age of 18-23 months (mean age 20 months). Of these, 161 children were re-evaluated at four years of age and 134 at eight years. The evaluation included a standardized questionnaire, clinical examination and skin-prick tests. Asthma, eczema, allergic rhinoconjunctivitis and food allergy were diagnosed according to established criteria. RESULTS: At 20 months of age 42% of the children were diagnosed with asthma or allergic disorders, 45% at four years and 34% at the age of eight years. Initially asthma and eczema were most common, but the prevalence and severity of eczema had decreased at four years of age and the prevalence of asthma decreased between four and eight years. No child was diagnosed with allergic rhinoconjunctivitis before two years of age but 7% of four year olds and 10% at the age of eight years. A quarter of the children had at some stage symptoms compatible with more than one allergic disorder. Two-thirds of the children who were diagnosed with eczema and/or asthma before two years of age, were symptom free at eight years. Thirty-eight percent of eight year old children with allergic symptoms had positive skin-prick tests to the allergens used, most commonly to cats. Seventy three percent of eight year old children with allergy and/or asthma, had a first degree relative with a history of allergies. CONCLUSIONS: As in other Western industrialized societies asthma and allergic disorders are common health problems amongst children in Iceland. However, the majority of children with allergic manifestations during the first two years of life, became symptom free before the age of eight years. Conversely, 50% of eight year olds with asthma or allergies were symptom free during the first two years of their life. This suggests that the mechanisms causing allergic symptoms may not be uniform in different age groups.

[Transposition of the great arteries in Iceland over a 26 year period from 1971 to 1996.].

OBJECTIVE: We reviewed our experience regarding D- and L-transposition of the great arteries (D- and L-TGA) in Iceland over a 26 year period, from 1971 to 1996. We looked at incidence, diagnosis, treatment and outcome and any changes in these parameters during the study period were noted. MATERIAL AND METHODS: Data were obtained from hospital records which contained echocardiographic, cardiac catheterization- and autopsy reports. RESULTS: There were 31 children diagnosed as having transposition of the great arteries during the study period, 29 had D-TGA. Follow-up period was from 11 months to 21 years (median 13 years). The incidence was 1:3681 births and male to female ratio 2.4:1. Cardiac catheterization was used as a diagnostic tool in 11 cases, but as of 1984 all diagnoses were made by echocardiography. Of the patients with D-TGA, 21 (72%) had no additional cardiac defects, however when these were present, a ventricular septal defect was most common. Twenty-six patients (84%) underwent a balloon atrial septostomy and it was successful in 24 (92%). Twenty-three of 31 patients (74%) have had cardiac surgery, all fully corrective. Of the 23 surgeries, 21 were done in London, England. Fifteen children had atrial switch repair, a Mustard operation was done twice and Senning in 13 patients. In five cases an arterial switch operation was performed and three patients had other surgeries. Half of the patients had a difficult post operative course, however there was only one death within the first month following surgery. Of the 31 children born with TGA from 1971 to 1996, eight (26%) have died and two are lost to follow-up. All the patients that died were born during the first half of the study period. Of these eight children, four died within the first four days of life. Corrective cardiac surgery had been done on two patients before death. There are 21 patients alive which updated information is available on. All are in good condition leading full active lives. Five patients are needing prescription medications, thereof two antiarrhythmics. Of the most recent echocardiograms, 16 are without hemo-dynamically significant sequela. In five cases however, echocardiography shows significant abnormalities, probably warranting intervention within the next few years. CONCLUSIONS: The diagnosis, treatment and outcome of patients with transposition of the great arteries has improved dramatically over the years. Close follow-up of these patients with regards to sequela of cardiac surgery is mandatory, especially since the majority of this patient population has had atrial switch repair.

Role of echocardiography in the diagnosis and surgical management of accessory mitral valve tissue causing left ventricular outflow tract obstruction.

We report an unusual case of left ventricular outflow tract obstruction caused by accessory mitral valve tissue. This case illustrates the importance of transthoracic echocardiography in preoperative evaluation and the usefulness of transesophageal echocardiography for intraoperative assessment. If the accessory mitral valve has no functional significance it may be surgically excised, thereby relieving the outflow tract obstruction.