Ascending Aorta and Myocardial Mechanics in Patients with "Clinically Normal" Bicuspid Aortic Valve.

Aortic valve dysfunction and aortic wall changes are well-known complications of bicuspid aortic valve (BAV) disease. The aim of the present study was to investigate whether a remodeling process of the left ventricle (LV) is present in patients with isolated BAV. Twenty-two consecutive patients (39 ± 15 years, 9 males) with clinically normal BAV and 18 age- and gender-matched control subjects (37 ± 10 years, 9 males) were included. Cardiovascular magnetic resonance (CMR) imaging was performed to evaluate LV function, aortic valve morphology, aortic orifice area, and ascending aorta (AA) dimensions. Tissue-tracking analysis was applied to assess LV systolic and diastolic myocardial mechanics in the longitudinal, circumferential, and radial direction and AA circumferential strain (CS). No significant difference was observed between BAV and controls regarding LV ejection fraction and LV mass index. Tissue-tracking analysis demonstrated that BAV patients had significantly impaired LV systolic and diastolic myocardial mechanics. BAV patients had also significantly lower AA CS compared with controls. At multivariate analysis, the presence of BAV was the only variable significantly and independently related to the impaired AA and LV systolic myocardial mechanics. In conclusion, LV myocardial deformation properties are impaired among BAV patients. The impairment of LV systolic mechanics observed in BAV patients appears to be related only to the congenital abnormality of the aortic valve itself.

How to choose between a pacemaker or defibrillator for resynchronization therapy?

OBJECTIVE: The choice between a resynchronization pacemaker (CRT-P) or defibrillator (CRT-D) is still a matter of debate. We hypothesised that when selecting patients based on co-morbidities and age as proposed by the ESC-guidelines, there would be no long-term survival benefit of CRT-D compared to CRT-P. METHODS: We performed a retrospective analysis of patients who received a CRT device at the University Hospitals Leuven between 2001 and 2007. For the analysis of the association between predictors and outcome, uni- and multivariate Cox regression analyses were performed. We present data from three multivariate models. RESULTS: A total of 144 CRT devices were implanted (CRT-D n=98, CRT-P n=46). Patients who received a CRT-P were older and had a higher prevalence of co-morbidities. Patients who received a CRT-D had a significant lower mortality. When applying incremental multivariate analysis using 1st variables with a P < 0.05 in univariate analysis, 2nd variables with a P < 0.10 and 3rd adding on top all the baseline variables that were significantly different between the two groups, the significance of a possible survival benefit for CRT-D over CRT-P disappeared: risk model 1, hazard ratio 2.21 (P = 0.008), risk model 2, HR 1.81 (P = 0.069), and risk model 3, HR 1.85 (P = 0.091). The use of amiodarone and the presence of COPD or renal insufficiency remained associated with a significant, higher mortality risk, while the use of beta blockers was protective in all three models. CONCLUSION: The choice of a CRT-D seemed a predictor of improved survival in simple but not in more complex multivariable analyses. The fact that the survival benefit strongly depended on the number of co-variables suggests that it is at most marginal.

Hypoperfusion, shock states, and abdominal compartment syndrome (ACS).

Cardiovascular dysfunction and failure are commonly encountered in patients with intra-abdominal hypertension or abdominal compartment syndrome. Accurate assessment and optimization of preload, afterload, and contractility are essential to restoring end-organ perfusion and maximizing patient survival. Application of a goal-directed resuscitation strategy, including abdominal decompression, when indicated, improves cardiac function, reverses end-organ failure, and minimizes intra-abdominal hypertension-related patient morbidity and mortality.

Cardiopulmonary monitoring in intra-abdominal hypertension.

Cardiopulmonary dysfunction and failure are commonly encountered in the patient with intra-abdominal hypertension (IAH) or abdominal compartment syndrome. Accurate assessment and optimization of preload, contractility, and afterload in conjunction with appropriate goal-directed resuscitation and assessment of fluid responsiveness are essential to restore end-organ perfusion. In patients with IAH, the traditional "barometric" preload indicators such as pulmonary artery occlusion pressure and central venous pressure are erroneously increased. Volumetric monitoring techniques have been proven to be superior in directing the appropriate resuscitation together with targeted abdominal perfusion pressure. If such limitations are not recognized, misinterpretation of the patient's cardiac status is likely, resulting in inappropriate and potentially detrimental therapy. IAH also markedly affects the mechanical properties of the chest wall and consequently also the respiratory function. Altered mechanical properties of the chest wall may limit ventilation, influence the work of breathing, affect the interaction between the respiratory muscles, hasten the development of respiratory failure, and interfere with gas exchange. Pulmonary monitoring is important to understand the relationships between intra-abdominal pressure and chest wall mechanics and the impact of IAH on ventilator-induced lung injury, lung distention, recruitment, and lung edema.

Mid-term outcome of patients with Kawasaki disease, single-centre experience.

BACKGROUND: More and more children, who suffered from Kawasaki disease in childhood, reach today adulthood. The future perspectives of these patients are not yet well defined, therefore, we wanted to determine mid-term outcome of our Kawasaki patients. METHODOLOGY: All patients with the diagnosis of Kawasaki disease were selected from the database of paediatric and congenital cardiology of our hospital. The records were reviewed for disease characteristics and follow-up data. Descriptive statistics were performed. RESULTS: Thirty-five patients were included (18 boys, median age at diagnosis 1.9 years, range from 0.4 to 12.2 years). In 94% of the cases, the left coronary artery was affected, whereas in 58% the right coronary artery was involved in the disease process. In three patients the left ventricular ejection fraction worsened below 50%. One patient underwent a balloon dilatation and stenting of a coronary artery, and in another patient inotropic support was needed. Aspirin was given in all, sandoglobulin in thirty patients; in 10% of the cases corticosteroids were administered. The active disease process terminated after a median of 0.5 months, ranging from 0.1 to 2.0 months. The patient cohort was followed for a median of 4 years (range from 0.1 to 17.7 years). During this follow-up time, no reoccurrences, no significant arrhythmias, and no deaths occurred. In all patients, the left ventricular ejection fraction remained normal or normalized. However, at the latest follow-up, 43% was still treated with a low dose of aspirin. CONCLUSIONS: The mid-term outcome of patients who suffered from Kawasaki disease during childhood is excellent. However, almost half of them were treated with oral aspirin during follow-up.