Concomitant Right Ventricular Outflow Tract Cryoablation during Pulmonary Valve Replacement in a Patient with Tetralogy of Fallot

A 38-year-old female patient with a history of tetralogy of Fallot repair at 10 years of age underwent pulmonary valve replacement with a mechanical prosthesis, tricuspid annuloplasty, and right ventricular outflow tract cryoablation due to pulmonary regurgitation, tricuspid regurgitation, and multiple premature ventricular contractions with sustained ventricular tachycardia. After surgery, she had an uneventful postoperative course with arrhythmia monitoring. She was discharged without incident, and a follow-up Holter examination showed a decrease in the number of ventricular ectopic beats from 702 to 41.ope

Increasing demand for hospitalization in adults with congenital heart disease

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QTc Prolongation after Ventricular Septal Defect Repair in Infants

BACKGROUND AND OBJECTIVES: Prolonging of the corrected QT interval (QTc) has been reported after cardiac surgery in some studies. However, there have not been many studies on infant open cardiac surgery for ventricular septal defect (VSD) repair. This study was performed to define the changes in QTc and to find related post-surgery factors in this patient group. SUBJECTS AND METHODS: From 2008 to 2012, 154 infants underwent VSD repair at the Severance Cardiovascular Hospital. This study includes 105 of these cases. QTc was measured in these patients retrospectively. Demographic data and peri-procedural data, such as Aristotle score, cross-clamp time and bypass time, were analyzed. The exclusion criteria included multiple and small VSDs that underwent direct closure. RESULTS: Mean post-operative QTc was increased compared to the pre-operative measurements (from 413.6±2.3 to 444.9±2.5, p<0.001). In multiple linear regression, the comprehensive Aristotle score was associated with increasing QTc (p=0.047). The incidence of transient arrhythmia, such as atrial tachycardia, junctional ectopic tachycardia, premature atrial contraction, or premature ventricular contraction, was associated with QTc prolongation (p=0.005). Prolonged QTc was also associated with cross-clamp time (p=0.008) and low weight (p=0.042). Total length of stay at the intensive care unit and intubation time after surgery were not associated with QTc prolongation. CONCLUSION: Prolonged QTc could be seen after VSD repair in infants. This phenomenon was associated with peri-procedural factors such as the Aristotle score and cross-clamp time. Patients with QTc prolongation after cardiac surgery had an increased tendency towards arrhythmogenicity in the post-operative period.ope

Relationship between bicuspid aortic valve phenotype, valvular function, and ascending aortic dimensions.

Background and aim of the study: Bicuspid aortic valve (BAV) is known to be associated with aortic valve dysfunction and ascending aorta (AA) dilatation. However, the relationship between BAV morphology and AA dimensions remains unclear. Thus, the study aim was to characterize the aortic valve function and AA dimensions according to the presence of raphe and BAV phenotype. Methods: A total of 164 patients with BAV who underwent aortic valve surgery between October 2007 and November 2012 was investigated. BAV was classified as either type I (anterior-posterior orientation) or type II (right-left orientation), and subdivided as raphe+ (presence of raphe) and raphe- (no raphe). Results: Type I BAV was present in 103 patients (62.8%), and raphe+ in 100 (61.0%). Patients with raphe+ were typically younger than those with raphe-, and male gender was more predominant (88.0% and 53.1%, respectively, p <0.05). Aortic regurgitation was more common in patients with type I and raphe+ BAV, and aortic stenosis in patients with type II and raphe- BAV. In patients with raphe+, the diameters of aortic annulus related to the body surface area (BSA) were larger, and the diameters of the tubular portion of AA indexed to BSA were smaller than in patients with raphe- (p <0.05). Conclusion: BAV morphology is helpful for predicting the type of aortic valve dysfunction and the location of AA dilatation.ope

Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology

OBJECTIVE: To characterize aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve (BAV) morphology using computed tomography (CT) and surgical findings. METHODS: We retrospectively enrolled 209 patients with BAVs who underwent transthoracic echocardiography (TTE) and CT. BAVs were classified as anterior-posterior (BAV-AP) or lateral (BAV-LA) orientation of the cusps and divided according to the presence (raphe+) or absence (raphe-) of a raphe. Ascending aortic dimensions were measured by CT at four levels. RESULTS: BAV-AP was present in 129 patients (61.7%) and raphe+ in 120 (57.4%). Sixty-nine patients (33.0%) had aortic regurgitation (AR), 70 (33.5%) had aortic stenosis (AS), and 58 (27.8%) had combined AS and AR. AR was more common in patients with BAV-AP and raphe+; AS was more common with BAV-LA and raphe-.Annulus/body surface area and tubular portion/body surface area diameters in patients with BAV-AP (17.1 ± 2.3 mm/m(2) and 24.2 ± 5.3 mm/m(2), respectively) and raphe+ (17.3 ± 2.2 mm/m(2) and 24.2 ± 5.5 mm/m(2), respectively) were significantly different from those with BAV-LA (15.8 ± 1.9 mm/m(2) and 26.4 ± 5.5 mm/m(2), respectively) and raphe- (15.7 ± 1.9 mm/m(2) and 26.2 ± 5.4 mm/m(2), respectively). CONCLUSION: The morphological characteristics of BAV might be associated with the type of valvular dysfunction, and degree and location of an ascending aorta dilatation. KEY POINTS: • The BAV-AP type had more frequent aortic regurgitation, raphe, and a larger aortic annulus. • BAV without raphe had more frequent aortic stenosis and mid-ascending aorta dilatation. • CT allows assessment of the morphological characteristics of BAV and associated aortopathy.ope

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Dept. of Medicine/박사There are some evidences that angiotensin II type I receptor blocker (ARB) could reduce the structural valve deterioration. However, the anticalcification effect on the bioprosthetic heart valve is not yet investigated. Thus, we investigated the effects of the ARB on calcification of implanted bovine pericardial tissue in a rabbit intravascular implant model. A total of 16 male New Zealand White rabbits (20 weeks old, body weight: 2.98~3.34 kg) were used in this study. Commercially available bioprosthetic heart valve leaflet of bovine pericardium was trimmed to a 3-mm triangle shape and implanted to both external jugular veins of the rabbit. The ARB group (n=8) was given 25 mg/kg of powdered losartan daily until 6 weeks after surgery by directly administration in buccal pouch of the animals. The control group (n=8) was given 5 ml of normal saline with the same method. After 6 weeks, quantitative calcium determination, histological evaluation, and western blot analysis about interleukin-6, osteopontin, and BMP-2 were performed to identify the anti-calcification effect and its mechanisms of losartan. No deaths or complications such as infection or hematoma were recorded during the experiment. All animals were euthanized on the planned date. Calcium measurements level in the ARB group (2.28 ± 0.65 mg/g) was significantly lower than that in the control group (3.68 ± 1.00 mg/g) (p = 0.0281). Immunohistochemistry analyses revealed that bone morphogenetic protein 2 (BMP-2)-positive reactions were significantly attenuated in the ARB group. Western blot analysis showed that losartan suppressed the expression of interleukin-6, osteopontin, and BMP-2. Our results indicate that losartan significantly attenuates post-implant degenerative calcification of bovine pericardial bioprosthesis in a rabbit intravascular implant model. Further studies are required to assess the effects of ARBs on bioprosthetic heart valve tissue in orthotopic implantations using a large animal model.ope

Abnormal fibrous band from the left atrium to the left ventricle causing mitral regurgitation

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Neo-ostium creation for anomalous aortic origin of the coronary artery

For the anomalous aortic origin of the coronary artery with interarterial course, surgical repair is recommended. We describe a technique of neo-ostium creation at the correct anatomic position for the right coronary artery arising from a single left coronary ostium without an intramural course and coursing between the ascending aorta and the main pulmonary artery.ope

Pulmonary valve cusp augmentation for pulmonary regurgitation after repair of valvular pulmonary stenosis

A 23-year-old female patient with a history of pulmonary valvectomy for pulmonary stenosis at 2 years of age underwent pulmonary valve repair, which consisted of remnant cusp extension using a fresh pericardium and commissural resuspension. An immediate postoperative computed tomographic scan showed full movement of the extended anterior cusp during systole, yet flail motion during diastole. However, follow-up magnetic resonance imaging at 10 months postoperatively revealed a small amount of pulmonary flow regurgitation (2.0%).ope