Patent ductus arteriosus stenting for palliation of severe pulmonary arterial hypertension in childhood.

A 4.5-year-old child with severe idiopathic pulmonary arterial hypertension underwent right-heart catheterisation, showing suprasystemic pulmonary pressure and a tiny patent ductus arteriosus with trivial right-to-left shunting. The ductus arteriosus was successfully stented with a bare metal stent. At 1-year follow-up, a remarkable improvement was observed in clinical status, functional capacity, and serology. Echocardiography confirmed a favourable cardiac remodelling.

Cardioembolic stroke: who is the guilty?

A young woman was referred following a transient ischemic attack due to suspect patent foramen ovale. At the diagnostic workup a spontaneous mild right-to-left atrial shunt owing to fenestrated aneurysmal septum was found. However, also a large arteriovenous malformation of the left lung was also imaged. At interventional cardiac catheterization, both malformations were closed using an Amplatzer Cribriform occluding device and a Amplatzer Vascular Plug II, respectively. In conclusion, patent foramen ovale is just one of the potential causes of cardioembolic stroke and a thorough diagnostic workup is mandatory after a cryptogenic stroke to rule out any additional source of paradoxical embolism.

Changing spectrum and outcome of 705 fetal congenital heart disease cases: 12 years, experience in a third-level center.

INTRODUCTION: Congenital heart diseases are the most common prenatal and postnatal malformations. Nowadays, fetal echocardiography is a widely practiced technique; however, the impact of prenatal diagnosis on prognosis of the newborns affected by congenital heart disease remains uncertain. OBJECTIVE: To assess the outcome and the changes in the spectrum of prenatally detected congenital heart disease in our tertiary care centre in 12 years of activity (1995-2006). METHODS AND RESULTS: We detected 705 congenital heart diseases: 32% (223) were associated with extracardiac or chromosomal anomalies or both, and 68% (482) were isolated. Termination of pregnancy was chosen in 81% for associated anomalies and 37% for isolated anomalies (P<0.001). Of these, more than one-third occurred in hypoplasic left heart cases. The general survival rate was 72%; it was significantly lower in the group with associated heart diseases (46 vs. 80%, P<0.001). Over 12 years we noticed a reduction in the number of multimalformed fetuses and of the hypoplasic left heart cases, and a higher number of aortic arch anomalies detected. During the past 6 years of activity the survival rate obtained has significantly increased (55 to 84%, P<0.05), the termination rate has significantly decreased (35 to 14%, P<0.001) and the number of neonatal deaths has significantly decreased (39 to 10%, P<0.001). CONCLUSION: The survival and the voluntary termination of fetuses with prenatally detected congenital heart diseases are strongly influenced by disease severity and by associated extracardiac or chromosomal anomalies, or both. Over 12 years, the spectrum of fetal congenital heart disease has changed and their outcome has significantly improved.