Mechanical valve replacement in congenital heart disease in children.

BACKGROUND AND AIM OF THE STUDY: The study aim was to analyze predictive factors of long-term results after mechanical heart valve replacement in children. METHODS: Forty-four patients (19 males, 25 females; mean age 8.9+/-3.9 years, median 7.0 years, range: 1.3 to 15 years) underwent heart valve replacement with mechanical prostheses. Of these patients, 25 had left atrioventricular valve replacement (LavVR) (18 mitral, six tricuspid in corrected transposition of the great arteries (TGA), one common in a univentricular heart), 13 had aortic valve replacement (AVR) and six had tricuspid valve replacement (TVR). The etiology of the valvular disease was congenital in all patients, and complicated by infective endocarditis in seven (16%). Fifteen patients had undergone previous procedures and 16 required simultaneous repair of associated lesions. The mean size of the implanted prosthesis was 26 mm (range: 19-29 mm) for LavVR, 29.7 mm (range: 23-33 mm) for TVR, and 21.9 mm (range: 19-25 mm) for AVR. Postoperatively, all patients received oral anticoagulation. The mean follow up was 6.8+/-3.5 years (total 290 patient-years). RESULTS: There was no early mortality, but three patients (7%) died later; all late deaths occurred in patients with LavVR. There were two sudden deaths, both in patients with complex congenital heart disease and heart failure (before the ACE inhibitor era), and one valve-related death from thrombotic occlusion of a mitral prosthesis. Five patients were reoperated on; three for patient-prosthesis mismatch, one for periprosthetic leak, and one for aortic dissection due to Marfan's syndrome. Thrombotic obstruction occurred in three patients; two in the tricuspid position were treated successfully with thrombolysis, but one in the left atrioventricular position proved fatal. After seven years, the survival rate was 93.4%. CONCLUSIONS: Mechanical heart valve replacement in children aged over one year with congenital heart disease can be performed with satisfactory early and late results. Mechanical valves of >23 mm diameter in the atrioventricular position in the systemic ventricle, and >21 mm in the aortic orifice, can offer excellent long-lasting hemodynamic performance. However, mechanical valves in the tricuspid position are prone to develop thrombotic occlusion.

Long-term follow-up results of balloon valvuloplasty for congenital aortic stenosis: predictors of late outcome.

AIMS: Long-term follow-up of patients with aortic valve stenosis undergoing balloon valvuloplasty was evaluated with respect to survival, the need for repeat intervention and factors predicting late outcome. METHODS AND RESULTS: Forty-five patients between 3.5 to 23 years old (mean 11.7 +/- 4.5) were followed for 62 +/- 30 months (range 11-122). The transvalvar aortic gradient decreased from 84 +/- 20 to 36 +/- 10 mmHg (p < 0.001) and remained significantly lower (50 +/- 26 mmHg; p < 0.001) at follow-up. At that time, 10 patients (including 4 with significant valve incompetence) had gradients >/= 60 mmHg. The procedure resulted in significant valve incompetence (grade >/= 3) in 8 patients (17.8%). There was a progression of incompetence and 13 patients (28.9%) had significant regurgitation at follow-up. All survived. Fifteen patients (33.3%) required re-intervention 51 +/- 24 months after valvuloplasty. The indications were: aortic stenosis in 5 patients; regurgitation in 6 patients; and stenosis with regurgitation in 4 patients. Actuarial freedom from re-intervention at 2, 4, 6 and 8 years was 96%, 88%, 61% and 56% of patients, respectively. The residual post-valvuloplasty gradient was the only predictor of re-intervention for valve stenosis (odds ratio = 3.2 for every 10 mmHg gradient increase; p = 0.017). A residual post-valvuloplasty gradient >/= 40 mmHg increased the relative risk of re-intervention sixfold. The immediate post-valvuloplasty aortic regurgitation grade was the only risk factor of re-intervention for regurgitation (odds ratio = 34 for every incompetence degree increase; p = 0.0019). Incompetence grade >/= 2 increased the risk of re-intervention tenfold. CONCLUSIONS: Valvuloplasty carries the risk of development of valve incompetence, which progresses with time. Some patients develop restenosis. The

Stepwise Inoue balloon catheter valvuloplasty for congenital aortic valve stenosis: comparison with standard balloon catheter technique.

Experience with stepwise balloon dilatation of congenital aortic valve stenosis using the new Inoue balloon catheter in 16 patients (aged 12 +/- 4.6 years; group II) is presented. Results are compared with those obtained in 15 patients (10 +/- 6 years; group I) in whom standard balloon catheters were used. The procedure resulted in a similar transvalvar gradient reduction in both groups (83 +/- 25 to 34 +/- 14 mmHg in group I versus 84 +/- 21 to 28 +/- 10 mmHg in group II). Significant aortic incompetence occurred in three patients from group I and in four from group II. There was no difference in the average increase in AR grade between the groups. At follow-up (group I, 24 +/- 13 months; group II, 7 +/- 3 months) there was no significant change in transaortic gradient or aortic incompetence. Balloon aortic valvuloplasty for congenital aortic stenosis carries a risk of aortic incompetence. Stepwise dilatation of the stenosis does not prevent this complication. The Inoue balloon catheter offers technical advantages.

[Left ventricular outflow obstruction as a result of external cardiac compression by a mediastinal tumor]. / Zwezenie drogi odplywu lewej komory wywolane uciskiem przez guz sródpiersia.

A case of left ventricular outflow tract stenosis resulted from compression of the heart is presented. This symptomatic cardiovascular lesion was produced by extensive growth of mediastinal tumour. Numerous noninvasive methods were necessary to establish this difficult diagnosis. The patient underwent surgery that disclosed a benign process (of neurofibroma). After tumour's resection marked hemodynamic signs subsided.

[Left ventricular hypertrophy and blood pressure values during 24-hour ambulatory monitoring and office measurements in essential hypertension]. / Przerost lewej komory serca a wartosci cisnienia tetnicznego podczas 24-godzinnej automatycznej rejestracji i pomiarów przygodnych w nadcisnieniu tetniczym pierwotnym.

119 hypertensive patients were examined by 24-hour ambulatory blood pressure monitoring (ABPM) and traditional (casual) blood pressure measurements. The echocardiographic examination was also performed. Mean and maximal systolic and diastolic blood pressure values, systolic and diastolic pressure amplitude as well as traditional blood pressure values were correlated with left ventricular walls thickness and left ventricular mass. Maximal values were obtained for left ventricular mass and mean systolic blood pressure (especially in the evening). No statistically significant correlation was stated for left ventricular mass and systolic pressure amplitude. The correlation coefficients of left ventricular mass and wall thickness with ABPM were significantly higher than those calculated from echocardiographic parameters and traditional blood pressure measurements.

[Percutaneous pulmonary valvuloplasty in 135 patients]. / Przezskórna walwuloplastyka plucna u 135 chorych.

We present our 7 years experience with 135 pts aged 1.4-44 years (mean 10-yrs) in whom percutaneous balloon valvuloplasty (BPV) for congenital pulmonary stenosis was attempted. In 4 pts we failed to place the balloon at valvar level, in another four BPV was repeated so, 135 procedures in 131 pts were performed. Balloon diameter/pulmonary anulus diameter ratio (BD/PD) ranged from 0.9 to 1.85 (mean 1.37). In 10 cases double balloon technique was used. Immediate results: in the whole group of 131 pts the right ventricular-pulmonary artery gradient (RV-PAG) was reduced from 74 +/- 42 to 34 +/- 34 mm Hg, and right ventricular systolic pressure (RVSP) decreased from 92 +/- 41 to 54 +/- 34 mm Hg just after BPV. 86 pts (65.6%)--group I, had good immediate result of BPV (RVSP less than 50 mm Hg). 4 of them had dysplastic pulmonary valves (DPVs). RV-PAG in 82 pts with normal valves decreased from 53 +/- 25 to 15 +/- 7 mm Hg right after BPV. In 45 pts (34.4%)--group II, immediate result of valvuloplasty was recognised as unsatisfactory (RVSP greater than or equal to 50 mm Hg): in 4 of them BD/PD was smaller or equal 1.2 (subgroup IIa); 34 others had significant subpulmonary obstruction (SPO) that appeared or increased after BPV (subgroup IIb); and in remaining 7, DPVs were noticed (subgroup II c).(ABSTRACT TRUNCATED AT 250 WORDS)

[Membranous subvalvular aortic stenosis--echocardiographic image]. / Membranowe zwezenie podzastawkowe aorty--obraz echokardiograficzny.

There were presented 19 cases of membrane subvalvular aortic stenosis. Echocardiographic diagnosis was proved by the cardiac catheterization and/or intraoperatively. It was discussed the usefulness of echocardiography (especially 2-DE and Doppler method) in diagnosis of this cardiac defect.

[Echocardiographic diagnosis of the aortic--left ventricular tunnel. A case report]. / Diagnostyka echokardiograficzna tunelu aorta-lewa komora--opis przypadku.

The aorta--left ventricle tunnel echocardiographic image was discussed basing on the own case. Most useful projections in cardiac defect assessment were presented as well as a value of Doppler examination in hemodynamic disorders estimation and differential diagnostics of this rare, congenital anomaly.

[Ultrasonic diagnosis of atrial septal defect with normal pressure of the right ventricle and left-to-right shunt]. / Ubytek przegrody miedzyprzedsionkowej z prawidlowym cisnieniem w prawej komorze i dwukierunkowym przeciekiem krwi--analiza ultradzwiekowa.

There was presented echocardiographic analysis of the atrial septal defect with normal right ventricular pressure and a bidirectional shunt. Authors emphasized special value of a contrast examination and Doppler method in hemodynamic disorders assessment.