Aberrant right coronary artery occlusion during the percutaneous pulmonary trunk stenting in a patient with tetralogy of Fallot

Aberrant coronary arteries are frequently observed in patients presenting with Fallot's tetralogy (TOF). Before the complete surgical repair of the TOF, the percutaneously performed pulmonary trunk (PT) angioplasty is often performed in order to temporarily increase the pulmonary circulation, thus increasing the pulmonary vessel size, finally improving surgical outcome. This case reports a 12-year-old boy with a TOF insufficiently improved by surgical correction, in whom a PT angioplasty with stent implantation was complicated by an extrinsic compression of an aberrant right coronary artery (RCA) causing a myocardial ischemia with severe hypotension. The RCA, originating from the left anterior descending coronary artery, passed through the aortic root and the PT and was thus compressed by the PT-stent. Finally the RCA was successfully treated with standard coronary balloon angioplasty and stenting, improving myocardial perfusion and the hemodynamics of the patient, who finally died several days thereafter due to septic shock and massive pulmonary embolis

Value of brain natriuretic peptide in the perioperative follow-up of children with valvular disease

Objective: To characterize N-terminal pro-brain natriuretic peptide (N-proBNP) and troponin I (TnI) profile following mitral and/or aortic valve surgery and to evaluate correlations with echocardiography measures and outcome criteria. Design and setting: Prospective cross-controlled study in auniversity children's hospital. Patients: Twenty children with acquired valvular disease requiring valvular surgery. Interventions: We prospectively studied clinical, biochemical, and echocardiographic characteristics at baseline and 6, 12, 24 h and 3-4 weeks postoperatively. Results: TnI peaked 6 h after surgery and remained elevated during the first 24 h. N-proBNP was significantly lower 3-4 weeks after surgery than during the perioperative period. Overall, N-proBNP was correlated with the Pediatric Heart Failure Index, left ventricle shortening fraction, left atrium to aorta ratio, left ventricle mass index, end-systolic wall stress, and with outcome measures such as inotropic score, duration of inotropic support, and ICU length of stay. Preoperative N-proBNP was significantly more elevated in patients with complicated outcome than in patients with uneventful postoperative course. Conclusions: In pediatric valvular patients, perioperative N-proBNP is apromising risk stratification predicting factor. It is correlated with evolutive echocardiographic measures, need for inotropic support, and ICU length of sta

Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure

Aims To determine whether impaired brachial endothelial (flow-mediated dilation, FMD) and smooth muscle function (nitroglycerin-mediated dilation, NTGMD), and remodelling of the common carotid artery (CCA) develop before puberty in obese children. Methods and results Arterial intima-media thickness (IMT), FMD and NTGMD were measured by high-resolution ultrasound in 48 obese and 23 lean pre-pubertal children (8.8 ± 1.5 years old). We assessed central pulse pressure, incremental elastic modulus (Einc), casual and ambulatory systolic (SBP) and diastolic blood pressure (DBP), and body fatness by DXA. Obese children had significantly lower FMD (4.5 ± 4.0 vs. 8.3 ± 1.7%), NTGMD (19.0 ± 9.0 vs. 25.8 ± 6.1%), and increased Einc (13.9 ± 5.2 vs. 10.4 ± 5.2 mmHg/102), ambulatory SBP (121.3 ± 12.6 vs. 106.6 ± 7.1, mmHg), and DBP (69.1 ± 5.7 vs. 63.7 ± 4.5) than lean subjects, whereas IMT was not augmented. Ambulatory systolic hypertension was present in 47% of obese subjects. FMD, NTGMD, and Einc were correlated with body fatness, body mass index, and blood pressure (BP). Conclusion Impaired endothelial and smooth muscle functions and altered wall material develop before puberty in obese children, however remodelling of the CCA is not yet present. Arterial dysfunction may be considered as the first marker of atherosclerosis and is associated with elevated BP. Ambulatory blood pressure monitoring may be a potential tool to improve risk stratification in obese childre

Effectiveness of individual and group programmes to treat obesity and reduce cardiovascular disease risk factors in pre‐pubertal children

Childhood obesity results in premature atherosclerosis and requires early intervention. Compare the effectiveness of 6‐month lifestyle interventions (with choice of either individual or group therapy) with standard care on body mass index (BMI) z‐score and cardiovascular disease (CVD) risks factors in children with obesity. This 6‐month randomized controlled trial with a 6‐month follow‐up included 74 pre‐pubertal children with obesity (7.5‐11.9 years) assigned randomly (2:1) to intervention or control. Families in the intervention arm choose between an individually delivered treatment (3 hours paediatrician + 4 hours dietician) or group treatment (35 hours with a multidisciplinary team). Children participated also to a weekly physical activity programme. We measured BMI, BMI z‐score; waist circumference (WC); total and abdominal fat; blood pressure; common carotid artery intima‐media thickness and incremental elastic modulus (Einc); endothelium‐dependent and independent dilation (nitroglycerin‐mediated dilation [NTGMD]) of the brachial artery; fasting plasma glucose, insulin, lipids; and high‐sensitivity C‐reactive protein (hs‐CRP). Compared to controls, at 6 months, abdominal fat and hs‐CRP were reduced in both interventions. The group intervention was also effective in reducing BMI (−0.55 kg/m2; 95% confidence interval −1.16 to 0.06) and BMI z‐score (−0.08; −0.15 to 0.00) at 6 months and BMI, BMI z‐score, WC, NTGMD, total and abdominal fat at 12 months. Abdominal fat and low‐grade inflammation were significantly decreased in both interventions. High‐intensity group treatment improved early signs of atherosclerosis in children with obesity. These findings are important for the promotion of cardiometabolic health in this population

Transpulmonary stenting of both pulmonary arteries with a surgical access through redo sternotomy

We report the case of a four-year-old boy with pulmonary atresia (PA) and ventricular septal defect (VSD) associated with MAPCAs who had a complete repair two times. He developed 21 months later stenosis at the origin of both pulmonary arteries. The conventional interventional catheterization approaches were not available due to femoral vein thrombosis and severe transient complete atrioventricular block due to the manipulations to catheterize the left pulmonary artery. The stenoses were treated by implant of stents using a surgical access to the proximal portion of a Contegra valved conduit (Medtronic, Inc., Minneapolis, MN, USA) by sternotomy