Percutaneous closure of multiple ventricular septal defects: simultaneous use of muscular ventricular septal defect device and Multi-Fenestrated Septal Occluder - "Cribriform" to close residual ventricular septal defects after complex cardiac surgery in a child.

A male child, with d-transposition of great arteries, a large perimembranous ventricular septal defect, multiple additional ventricular septal defects, small muscle-bound right ventricle, and severe pulmonary stenosis with confluent, moderate-sized branch pulmonary arteries, underwent an emergency right modified Blalock-Taussig shunt on day 15 of life and réparation à l'étageventriculaire procedure with ventricular septal defect closure with takedown of the Blalock-Taussig shunt at 2.5 years of age. On follow-up, he showed a moderate residual upper ventricular septal defect and multiple apical ventricular septal defects, mild mid-right pulmonary artery stenosis, free pulmonary regurgitation, and right ventricular dysfunction. Surgical re-intervention was deemed extremely risky, the upper muscular ventricular septal defect was closed using an 8-mm Amplatzer Muscular Ventricular Septal Defect Occluder Device, and an 18 mm Amplatzer Multi-Fenestrated Septal Occluder - Cribriform was used for the multiple apical muscular ventricular septal defects. After 1 year, his right pulmonary artery stenosis worsened, for which right pulmonary artery angioplasty was carried out using an 8×20 mm cutting balloon followed by a 10×20 mm Tyshak II balloon. This is the only case reported for the paediatric age group using a cribriform septal occluder device for percutaneous closure of multiple apical ventricular septal defects.

Impact of left ventricular function on early outcomes after arterial switch for D-transposition of great arteries with intact ventricular septum.

OBJECTIVE: The aim of this study was to assess the utility of tissue Doppler echocardiography in evaluating the pre-operative left ventricular systolic function and in turn its impact on early post-operative outcomes following arterial switch operation for transposition of great arteries with intact ventricular septum. BACKGROUND: Pre-operative left ventricular function is an important determinant of outcomes following arterial switch. METHODS: We studied 19 patients with transposition and intact septum who had undergone one stage arterial switch operation. All had a pre-operative echocardiogram. RESULTS: The left ventricle was adequate in 15 infants as per the dimensions and shape for age. The early outcomes of surgery were assessed on the basis of their pre operative tissue Doppler. There were 7 (40%) patients with reduced S wave velocities (2.62 +/- 0.84 cm/sec) and lower isovolumetric myocardial acceleration (1.2 +/- 0.5 m/sec(2)) reflecting systolic dysfunction. Those patients with reduced S wave velocities and isovolumetric acceleration correlated with poor early surgical outcomes in terms of longer duration of ventilation ( p< 0.001), longer duration of inotropes ( p< 0.00001) and higher mortality ( p < 0.001). CONCLUSION: The tissue Doppler echocardiography is a more sensitive modality to evaluate ventricular performance than the 2D-echo. It can be used as a sensitive predictor of outcomes following arterial switch.

Echocardiographic evaluation of the morphology and function of the right ventricle in Eisenmenger's syndrome and idiopathic pulmonary hypertension.

AIM: The aim of this study was to investigate the reasons for better prognosis in adults with Eisenmenger's syndrome than those suffering from idiopathic pulmonary hypertension. Our hypothesis was that right ventricular function is better preserved in the former case than in the latter. METHODS: We used two-dimensional echocardiography and tissue Doppler imaging to compare right ventricular morphology and function in 24 subjects with Eisenmenger's syndrome and 23 age- and sex-matched subjects with idiopathic pulmonary hypertension. RESULTS: The mean age was 27.4+/-12.2 years for both groups. There were more patients from the idiopathic pulmonary hypertension group in the New York Heart Association Class III than those from the Eisenmenger's syndrome group (48.4% vs 36.3%; p<0.01). Measurements of the right and left ventricular free wall thickness, as well as the internal diameter of the right ventricle were taken, and tissue Doppler imaging was used to assess the function of both ventricles. In the Eisenmenger's group, the mean right ventricular and left ventricular free wall thickness was 10.4+/-2.78 mm and 9.7+/-1.98 mm, respectively. The mean right ventricular internal diameter in diastole and in systole were 20+/-8.64 mm and 18.1+/-9.24 mm, respectively. The mean right ventricular S1 was 10.4+/-3.4 cm/sec and S2, 10.3+/-2.6 cm/sec, while the left ventricular S1 was 7.4+/-1.87 cm/s and S2, 7.5+/-1.05 cm/sec, with a normal biventricular function. In the idiopathic pulmonary hypertension group, the mean right ventricular and left ventricular free wall thickness was 11.3+/-3.24 mm and 9.8+/-1.94 mm, respectively. The mean right ventricular internal diameter in diastole and systole was 36+/-8.9 mm and 30.1+/-9.8 mm, respectively. The mean right ventricular S1 was 6.9+/-3.4 cm/sec and S2, 6.8+/-2.8 cm/sec, while the left ventricular S1 was 7.4+/-1.8 cm/sec and S2, 7.5+/-1.05 cm/sec, reflecting right ventricular systolic dysfunction. CONCLUSIONS: Right ventricular function was better preserved among subjects with Eisenmenger's syndrome than those with idiopathic pulmonary hypertension in a study in which the two groups were matched for age and sex.