Tetralogy of Fallot in men: quality of life, family, education, and employment.

INTRODUCTION: Little is known about the quality of life, health, family, education, and employment status among adult men with repaired tetralogy of Fallot. MATERIAL AND METHODS: A total of 68 men who underwent repair of tetralogy of Fallot between 1971 and 1991 were studied. Fifty-three patients answered the SF-36 health survey and additional questions regarding offspring, education, and employment status. The men with repaired tetralogy of Fallot were compared with 32 healthy men and 40 women who also underwent repair of tetralogy of Fallot in the same period. RESULTS: The patients scored lower than healthy men in the SF-36 categories physical functioning, general health, and physical component summary. There were no statistically significant differences in the scores from male and female patients except a lower score in bodily pain among women. Educational level for men operated for tetralogy of Fallot was similar to the general male population, whereas fewer were employed and more were retired, undergoing rehabilitation or receiving social benefits. The reproduction rate was lower compared with the general population (0.65 versus 1.02 children per man) but relatively higher than the rate among women with tetralogy of Fallot (0.88 versus 1.84 children per woman). The risk of having a child with congenital heart disease was 8.3%. CONCLUSION: Men operated for tetralogy of Fallot have good quality of life and educational status. They start a family, although their reproduction rate is two-thirds that of the general population. The risk of having a child with congenital heart disease is higher compared with the background population. The overall quality of life is similar for men and women operated for tetralogy of Fallot.

High long-term morbidity in repaired aortic coarctation: weak association with residual arch obstruction.

OBJECTIVE: The objective of this study was to assess late morbidity after repair of aortic coarctation and its association with residual aortic arch obstruction. DESIGN AND SETTING: This is an observational cohort study of 133 patients who underwent surgical repair during 1965-1985. Echocardiography, bicycle exercise testing, 24-hour ambulatory blood pressure monitoring, and magnetic resonance imaging/computerized tomography scan of the thoracic aorta were performed. The setting of this study was a tertiary referral center. PATIENTS: Among 156 survivors, 133 (84 men) accepted study participation. Median age (range) was 10 (0.1-40) years at repair and 44 (26-74) years at follow-up. OUTCOME MEASURES: Outcome measures used are prevalence of previous cardiovascular reinterventions, current cardiac and valvular function, exercise capacity, blood pressure levels at rest and during exercise, and presence of recurrent or residual aortic arch obstruction and/or aortic aneurysms. RESULTS: Thirty-five had undergone cardiovascular reinterventions. Sixteen had an aortic and three had a mitral valve prosthesis; 117 had a native aortic valve that was bicuspid in 63 and dysfunctional in 45. Ejection fraction was below 50% in 16. On exercise, performance was reduced in 37 and hypertension was induced in 47. Fifty-eight had elevated blood pressures and further 17 received antihypertensives. The ascending aorta was aneurysmal in 28 and the distal arch in five. The presence of a bicuspid aortic valve was significantly associated with valve regurgitation and ascending aortic ectasia. Fifty-eight of 121 patients had minimal aortic arch diameters between 46% and 79% of the diaphragmatic aortic diameter, indicating moderate/mild recoarctation. This was associated with elevated blood pressures and use of antihypertensive medication, but not with hypertension in unmedicated patients or with echocardiographic or exercise parameters. Only five patients had normal study findings, were normotensive, and without reinterventions after coarctation repair. CONCLUSIONS: Cure by repair of aortic coarctation is rare; heart diseases, aortopathy, and hypertension are common. Morbidity is only weakly associated with mild/moderate recoarctation.

[Tricuspid valve annuloplasty]. / Plastik på trikuspidalklappen.

INTRODUCTION: Tricuspid valve regurgitation (TVR) is often secondary to left-sided or congenital heart disease (CHD). Surgical correction of TVR is indicated when the primary abnormalities require operation. MATERIAL AND METHODS: Retrospective analysis of all 50 patients (mean age: 65 years (range: 24-83), 27 males, 23 females) operated with tricuspid valve annuloplasty (TVA) in our hospital from 2000 to 2007. TVA took place concomitantly with operation for left heart disease (n = 39, 78%) or CHD (n = 11, 22%). RESULTS: Preoperatively, TVR was severe in 40, moderate in six and mild in four cases. Thirty-four had annulus dilation > 2 cm/m(2) body surface area. Half of the patients were in New York Heart Association (NYHA) class III or IV. Postoperatively, TVR was severe in two cases, moderate in one, mild in 25 and absent in 18, and 95% of patients followed up were in NYHA I or II. There were five (10%) early and two (4%) late deaths. Temporary arrhythmias requiring medical treatment occurred in 35 cases, but eight required permanent pacemaker. No tricuspid valve reoperations were performed. CONCLUSIONS: The combination of correction of primary heart abnormalities and TVA is associated with high perioperative mortality. In survivors, postoperative clinical improvement is common, in all probability this is mainly due to the correction of the primary disease. TVA reduces TVR, but its precise contribution to clinical improvement and prognosis remains unknown.

[Coarctation of the aorta: 40-year follow-up after surgical repair--secondary publication]. / Coarctatio aortae: 40 års opfølgning efter kirurgisk korrektion - sekundaerpublikation.

Coarctation of the aorta (CoA) was previously considered cured after surgical repair. Among 229 patients operated for CoA in Aarhus between 1965 and 1985, 14 died at surgery and 35 died during 20-40 years of follow-up, mainly due to cardiovascular disease. The mortality among CoA patients was 4.3 times higher than in a control population. Among 178 survivors, 35 had been reoperated and another 11 had received medical treatment for heart disease. Antihypertensive drugs were used by 25% of the survivors. Thus, CoA is not cured by surgery and long term follow-up is necessary.

Reconstruction of the thorax with Ley prosthesis after resection of the sternum.

The Ley prosthesis is a titanium plate, which has been used in the past few years for sternum stabilization after postoperative mediastinitis and sternal dehiscence. There is no previous description of the use of this device in chest wall reconstruction after tumor resection. We describe the surgical technique for reconstruction of the skeletal defects with the Ley prosthesis in 3 patients operated on for a sternal chondrosarcoma. We propose the application of the Ley prosthesis for optimal reconstruction of skeletal tissue after sternal resection.

Are sounds from mechanical heart valves equal for different valve types?

BACKGROUND AND AIM OF THE STUDY: The closing 'click' sounds from mechanical heart valve prostheses are often clearly audible for patients and their relatives. These sounds have been recognized as a disturbing factor causing sleeping disturbances or social embarrassment, which patients must endure for the rest of their lives. The study aim was to determine whether the intensity of the transmitted sounds varies according to the type of valve implanted. METHODS: Closing sounds were measured from 15 patients with ATS valves, 29 with Medtronic-Hall valves, and 40 with St. Jude Medical (SJM) valve prostheses; all prostheses were implanted in the aortic position. The sounds were recorded by a microphone placed 5 cm above the chest of the patient when placed in a supine position in a bioacoustical laboratory. The mean sound pressure levels (SPLs) from the valves were measured in dB(A). RESULTS: The mean SPL values were 43 +/- 5 dB(A) for ATS valves, 41 +/- 4 dB(A) for Medtronic-Hall valves and 40 +/- 4 dB(A) for SJM valves (p < 0.05, ATS versus SJM). CONCLUSION: The study results showed a statistically significant difference in SPLs among the three investigated mechanical heart valve prostheses. The highest levels were in the ATS valves, and the lowest in the SJM valves. These objectively measured SPLs must be correlated with the sound as perceived by the patient in order to determine the annoyance that they cause.

[Multiple pregnancies in women with corrected tetralogy of Fallot]. / Multipel graviditet hos kvinder med korrigeret Steno-Fallots tetralogi.

Tetralogy of Fallot is the most common cyanotic heart disease accounting for 5 to 8% of all cases of congenital heart disease. In a cohort of women with corrected Tetralogy of Fallot, followed concerning fertility and pregnancy outcome, we observed two cases of uncomplicated multiple pregnancies. Such pregnancies have not previously been described. Despite the overload on the operated heart resulting from a multiple pregnancy, both women experienced uncomplicated pregnancies and deliveries of healthy children. This reflects the good hemodynamic results of complete repair and meticulous pregnancy follow-up.

Outcomes of pregnancy in women with tetralogy of Fallot.

BACKGROUND: Surgical results after repair of tetralogy of Fallot have remained excellent for the last decades, with current long-term rates of survival over 95%. Since functional capacity, quality of life, and social interactions are basically normal in this large group of patients, pregnancy obviously becomes a relevant issue for the female subgroup. In consequence, adequate obstetrical and cardiological management of pregnancy is particularly important. OBJECTIVE: To describe the outcomes of pregnancy, and fertility, in a series of women who underwent surgery for tetralogy of Fallot in a single centre. METHODS AND RESULTS: We obtained data from hospital records, national registries, and questionnaires on 78 women who underwent surgical correction of tetralogy of Fallot between 1972 and 1992. Of 58 women who reached an age of at least 18 years, with 45 of this cohort currently surviving, 13 having died as adults, there were 54 pregnancies in 25 women. The recorded rate of spontaneous abortion was 15%, and infertility rate was 3.4%. There have been 41 life births, with a median weight at birth of 3.2 kg. Only 1 newborn was small for gestational age, and no one was born before the 36th week. The recurrence rate of congenital heart disease was high, at 9.8%. Cardiac complications during or after pregnancy were not observed, and only one woman had pre-eclampsia. CONCLUSIONS: Pregnancy is well tolerated in women with tetralogy of Fallot, and an excellent neonatal outcome is expected. The recurrence risk of congenital cardiac disease, most often tetralogy of Fallot, is high.

The effects of surgically induced right bundle branch block on left ventricular function after closure of the ventricular septal defect.

OBJECTIVE: To determine the long-term significance of right bundle branch block on left ventricular systolic and diastolic function in children subsequent to surgical closure of ventricular septal defect. METHODS: We studied 26 children who underwent surgical closure of a ventricular septal defect 11 +/- 2 years postoperatively by use of conventional and tissue Doppler echocardiography, comparing the findings to those obtained from a control group. Of those having surgical correction 14 had postoperative right bundle branch block. RESULTS: Irrespective of the presence of right bundle branch block, the peak systolic velocity of the mitral ring was lower in those undergoing surgical correction, with values of 5.2 +/- 1.4 cm/s in those with right bundle branch block, 5.4 +/- 1.2 cm/s in those without right bundle branch block after surgical correction, and 6.6 +/- 1.0 cm/s in the control subjects (p < 0.01). In terms of diastolic function, the early septal velocity of transmitral inflow divided by the early diastolic mitral annular velocity was significantly higher in children with right bundle branch block, at 12 +/- 3.0 cm/s compared to 8.4 +/- 1.5 cm/s in the control subjects (p < 0.01), but not significantly higher in the children without right bundle branch block after correction compared to the control group. The fractional shortening percentage was similar in both patients and control subjects. The changes noted in left ventricular function were not significantly related to age at surgery, the period of follow-up, or the surgical method. CONCLUSIONS: Systolic long axis function is significantly reduced in children after surgical closure of ventricular septal defects, irrespective of the presence of right bundle branch block. Diastolic dysfunction, in contrast, was observed primarily in children with post-operative right bundle branch block.