Pericarditis constrictiva in a 10-year-old boy after influenza A virus infection

Pericarditis constrictiva is caused by fibrotic degeneration of the pericardium and leads to impaired diastolic ventricular filling. The diagnosis of constrictive pericarditis in children remains challenging and often requires a multimodal approach. We present a case of a pericarditis constrictiva in a 10-year old boy after influenza A virus infection. Clinicians should be aware of this complication, especially in patients with symptoms of exertional dyspnea and congestive heart failure

Quantitative evaluation of aortic valve regurgitation in 4D flow cardiac magnetic resonance: at which level should we measure?

PURPOSE To find the best level to measure aortic flow for quantification of aortic regurgitation (AR) in 4D flow CMR. METHODS In 27 congenital heart disease patients with AR (67% male, 31 ± 16 years) two blinded observers measured antegrade, retrograde, net aortic flow volumes and regurgitant fractions at 6 levels in 4D flow: (1) below the aortic valve (AV), (2) at the AV, (3) at the aortic sinus, (4) at the sinotubular junction, (5) at the level of the pulmonary arteries (PA) and (6) below the brachiocephalic trunk. 2D phase contrast (2DPC) sequences were acquired at the level of PA. All patients received prior transthoracic echocardiography (TTE) with AR severity grading according to a recommended multiparametric approach. RESULTS After assigning 2DPC measurements into AR grading, agreement between TTE AR grading and 2DPC was good (κ = 0.88). In 4D flow, antegrade flow was similar between the six levels (p = 0.87). Net flow was higher at level 1-2 than at levels 3-6 (p < 0.05). Retrograde flow and regurgitant fraction at level 1-2 were lower compared to levels 3-6 (p < 0.05). Reproducibility (inter-reader agreement: ICC 0.993, 95% CI 0.986-0.99; intra-reader agreement: ICC 0.982, 95%CI 0.943-0.994) as well as measurement agreement between 4D flow and 2DPC (ICC 0.994; 95%CI 0.989 - 0.998) was best at the level of PA. CONCLUSION For estimating severity of AR in 4D flow, best reproducibility along with best agreement with 2DPC measurements can be expected at the level of PA. Measurements at AV or below AV might underestimate AR

Myocardial Deformation in Fontan Patients Assessed by Cardiac Magnetic Resonance Feature Tracking: Correlation with Function, Clinical Course, and Biomarkers

Cardiac MR (CMR) is a standard modality for assessing ventricular function of single ventricles. CMR feature-tracking (CMR-FT) is a novel application enabling strain measurement on cine MR images and is used in patients with congenital heart diseases. We sought to assess the feasibility of CMR-FT in Fontan patients and analyze the correlation between CMR-FT strain values and conventional CMR volumetric parameters, clinical findings, and biomarkers. Global circumferential (GCS) and longitudinal (GLS) strain were retrospectively measured by CMR-FT on Steady-State Free Precession cine images. Data regarding post-operative course at Fontan operation, and medication, exercise capacity, invasive hemodynamics, and blood biomarkers at a time interval ± 6 months from CMR were collected. Forty-seven patients underwent CMR 11 ± 6 years after the Fontan operation; age at CMR was 15 ± 7 years. End-diastolic volume (EDV) of the SV was 93 ± 37 ml/m2, end-systolic volume (ESV) was 46 ± 23 ml/m2, and ejection fraction (EF) was 51 ± 11%. Twenty (42%) patients had a single right ventricle (SRV). In single left ventricle (SLV), GCS was higher (p < 0.001), but GLS was lower (p = 0.04) than in SRV. GCS correlated positively with EDV (p = 0.005), ESV (p < 0.001), and EF (p ≤ 0.0001). GLS correlated positively with EF (p = 0.002), but not with ventricular volumes. Impaired GCS correlated with decreased ventricular function (p = 0.03) and atrioventricular valve regurgitation (p = 0.04) at echocardiography, direct atriopulmonary connection (p = 0.02), post-operative complications (p = 0.05), and presence of a rudimentary ventricle (p = 0.01). A reduced GCS was associated with increased NT-pro-BNP (p = 0.05). Myocardial deformation can be measured by CMR-FT in Fontan patients. SLVs have higher GCS, but lower GLS than SRVs. GCS correlates with ventricular volumes and EF, whereas GLS correlates with EF only. Myocardial deformation shows a relationship with several clinical parameters and NT-pro-BNP. Keywords: Biomarkers; CMR; CMR-FT; Fontan; Strai

Nicht invasive Bildgebung in der Kinderkardiologie

Nach einer sorgfältigen Anamnese und klinischen Untersuchung spielt die transthorakale Echokardiografie die grösste Rolle für die Diagnose angeborener Herzfehler. Invasive Abklärungen sind nur sehr selten indiziert

Congenital cardiac defects and MR-guided planning of surgery

In neonates and infants with congenital heart disease (CHD), cardiovascular magnetic resonance (CMR) is an established imaging modality in all patients in whom echocardiography does not provide sufficient information and definitive diagnosis. CMR is noninvasive, and does not involve vascular catheterization or ionizing radiation. Therefore the use of CMR obviates the potential risks of cardiac catheterization in critically ill infants. This article discusses the use of CMR in newborns with CHD before cardiac surgery, focusing on conotruncal anomalies, pulmonary venous anomalies, complex CHD in visceroatrial heterotaxy, borderline hypoplastic left heart syndrome, and the use of contrast medium in newborns

Predictors of parental quality of life after child open heart surgery: a 6-month prospective study

OBEJCTIVE: To prospectively assess parental health-related quality of life (HRQoL) and its predictors after child open heart surgery. STUDY DESIGN: Mothers (n = 135) and fathers (n = 97) of 138 children were assessed at discharge from hospital and 6 months after open heart surgery of their child. Parental HRQoL was compared with population norms. Medical, demographic, and psychosocial predictors of HRQoL were examined. RESULTS: In both parents, several domains of HRQoL were decreased at their child's hospital discharge with mothers showing lower HRQoL than fathers. Mental domains were more affected than physical domains. At 6 months, parental HRQoL was within or above population norms. At discharge, symptoms of post-traumatic stress and at 6 months a high impact of the child's disease on family life were associated with low mental HRQoL in both parents. In mothers, lower socioeconomic status and foreign nationality were also associated with a higher risk for low mental HRQoL at discharge. CONCLUSIONS: Parents' mental HRQoL is low in the immediate period after their child's open heart surgery but normalizes after 6 months. However, parents in whom the child's disease has a high impact on their family life are at increased risk for persistent low mental HRQoL