Adult congenital heart disease training in Europe:current status, disparities and potential solutions

Objectives:This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe.Methods:A questionnaire was sent to ACHD cardiologists from 34 European countries.Results:Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001).Conclusion: Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care

Lead Extraction in Children and Young Adults Using Different Techniques

Objective: To describe our experience with removal of pacing lead in children using different techniques. Patients and Methods: Between 1999 and 2006, removal of 39 leads was attempted in 30 patients: 21 males and 9 females aged 4-21 years (mean 12 +/- 5 years). Sixteen patients had previous corrective cardiac surgery. The leads had been implanted for 46 +/- 31 months (range 1-120 months). The reasons for removal included lead fracture in 14, upgrading in 8, infection in 7, dislodgment in 5, pacing system not needed in 2, and other reasons in 3. Results: Of the 39 leads, 29 (74.3%) were completely removed. Twelve leads were removed with simple traction and rotation and 9 were removed using a locking stylet combined with simple traction and rotation; a laser extraction system was used in 10 cases in which 8 leads were successfully removed. Duration of implantation was the only important predictor for successful removal. Three patients necessitated surgical lead removal and had epicardial pacemaker implantation. Conclusion: Using currently available techniques, percutaneous pacemaker lead removal was possible in the majority of cases, although a significant number of cases were not successful. Attempted lead removal with simple traction and rotation resulted in the need for surgical removal in a significant number of patients. Newer techniques should be developed to increase the success rate. Copyright (C) 2009 S. Karger AG, BaselWoSScopu

Transcatheter Closure Of Coronary Artery Fistula With An Amplatzer Duct Occluder Ii In A Symptomatic Infant

WoSScopu

Nrg (Tm) Rf Powered Transseptal Needle: A Useful Technique For Transcatheter Atrial Septostomy And Fontan Fenestration: Report Of Three Cases

Transseptal puncture (TSP) is a frequently performed procedure for gaining access to the left atrium for catheter ablation, hemodynamic assessment of the left heart, left ventricular assist device implantation, percutaneous left atrial appendage closure or mitral valvuloplasty during childhood and adulthood. The standard technique for tsansseptal puncture applies mechanical pressure on the fossa ovalis with a Brockenbrough needle. However, this method is not feasible when the fossa ovalis is thick and aneurysmatic. In such patients, the radiofrequency ablation energy systems can be offered as a better alternative for TSP. Here, we aimed to demonstrate the outcome of transseptal puncture performed with an NRG (TM) RF powered transseptal needle in three patients.WoSScopu

Fallot Tetralojisi Nedeniyle Tüm Düzeltme Ameliyatı Uygulanmış Hastalarda Pulmoner Yetmezliğin Miktarını Belirlemek için Anjiyokardiyografi ve Manyetik Rezonans Görüntüleme

Objective: This study aimed to compare the results of angiocardiography and cardiovascular magnetic resonance imaging in the assessment of pulmonary regurgitation following repair of tetralogy of Fallot. Methods: We prospectively studied 37 patients with repaired tetralogy of Fallot. After routine examination cardiovascular magnetic resonance imaging (CMR) and cardiac catheterization and angiography were performed. Pulmonary regurgitation (PR) was classified according to the following criteria, using a left lateral angiogram of the main pulmonary artery; insufficiency jet is limited to right ventricular outflow tract (mild); jet reaches the body of right ventricle (moderate); jet fills the apex of the right ventricle (severe). Results: Pulmonary regurgitation determined by angiocardiography and CMR was severe in 51.4% and 32.4%, moderate in 27% and 40.5%, and none or mild in 21.6% and 27% of patients respectively. The ability of semi-quantitative estimation of PR determined by cardiac catheterization to distinguish between mild, moderate and severe pulmonary regurgitation was shown to have significant correlation with pulmonary regurgitant fraction obtained by CMR. Conclusions: Angiography obtained during invasive study can be used for the diagnosis and follow-up of pulmonary regurgitation confidently in patients with repaired tetralogy of Fallot and residual pulmonary regurgitation. (Anadolu Kardiyol Derg 2010; 10: 353-7)WoSScopu

Pulmonary Thromboendarterectomy in Pediatric Patients: Report of Three Cases

Chronic thromboembolic pulmonary hypertension (CTEPH), which occurs due to impartial resolution of the pulmonary thrombus, is a rare type of pulmonary hypertension. However, most patients have an excellent long-term survival following pulmonary thromboendarterectomy (PTE). Pulmonary emboli and associated CTEPH is unusual in the pediatric population and is mostly reveals an underlying thrombophilic state. PTE is also recognized as the best therapeutic option in this subgroup of patients. In this case series, we report three young patients who had successfully undergone PTE due to pulmonary emboli and associated CTEPH.WoSScopu

Evaluation Of Tissue Doppler Echocardiographic Imaging Findings In Children With Pulmonary Hypertension

Tissue Doppler Imaging has become an important prognostic marker that can be used in follow-up and determination of the prognosis in pulmonary hypertension patients. We compared the Tissue Doppler imaging parameters of 34 patients with pulmonary hypertension and 43 healthy controls. In addition, Brain-Natriuretic Peptide levels, pulmonary artery systolic pressures measured with echocardiography, 6-minute walking tests and New York Heart Association functional classification were compared. Among patients with Eisenmenger syndrome and idiopathic pulmonary hypertension, Tissue Doppler imaging parameters were mostly similar. In patients with New York Heart Association functional class 3, mitral septal annulus E/Ea (p=0.050) and mitral lateral annulus myocardial performance index (p=0.009) were higher than class 2 patients. In patients with higher Brain Natriuretic Peptide level, mitral lateral annulus and tricuspid septal annulus Ea/Aa values were lower (p=0.046 and <0.001 respectively); tricuspid septal annulus E/Ea and interventricular septum myocardial performance index values were higher than in patients with normal Brain-Natriuretic Peptide level (p=0.006). In conclusion tissue Doppler imaging findings were significantly impaired in children with pulmonary hypertension compared to the control group. Findings were similar in patients with idiopathic pulmonary hypertension and Eisenmenger syndrome. Mitral lateral annulus myocardial performance index value may have a prognostic importance due its significant association with poor functional class. Due to the significant associations between mitral lateral annulus, tricuspid septal annulus Ea/Aa, tricuspid septal annulus Ea and E/Aa, interventricular septum-myocardial performance index values and brain natriuretic peptide levels, these parameters may be used in evaluating response to therapy.WoSScopu

Evaluation Of Diagnostic Accuracy Of Portable Echocardiography In Newborns

Objective: Congenital heart disease is the most common life-threatening anomaly in the neonatal period. Screening for this disease with portable echocardiography is crucial to diagnose in the early period, and it has benefits in saving time and decreasing the cost. Portable echocardiography has advantages of rapid access and lower costs and also has advantage that in intensive care units there is no necessity to move patients. With these advantages, it is aimed to compare the sensitivity of portable echocardiography comparing to standard echocardiography. Methods: In this study, the portable echocardiography results of the sequentially enrolled newborns hospitalized in the neonatal departments are revised. Portable echocardiography results were verified with standard echocardiography in 83(43%) female and 111 (57%) male patients. This study was planned as a study on diagnostic accuracy. Results: The gestational periods were between 24 weeks, 3 days and 42 weeks (average 35 weeks 4 weeks 3 days). Birth weights were between 500 and 4850 grams (average 2370 936 grams). The reason that portable echocardiography had been studied was murmur in 113(58.2%) patients, cyanosis in 47(24.2%) patients, prenatal anomaly in 12(6.2%) patients, bradycardia in 12 (6.2%) patients, maternal diabetes in 6(3.1%) patients and respiratory distress in 4(2.1%) patients. Out of 194 patients 8(4.1%) had differences between standard and portable echocardiography. Compared to standard echocardiography, portable echocardiography has the sensitivity values ranged between 99.3-100% and the specificity values ranged between 90.9-100% in diagnosis of specific CHD anomalies. Positive predictive value was between 50-100% whereas negative predictive value was between 97.9-100%. The agreement between results of two tests was determined as very good - kappa 0.886, 95%Cl -0.821-0.951, p<0.0001. Conclusion: It is demonstrated that portable echocardiography has a high sensitivity especially diagnosing major heart defects, and with advantages of rapid access and lower costs it is estimated that increasing usage of portable echocardiography could be beneficial. (Anadolu Kardiyol Derg 2011; 11: 627-32)WoSScopusTr-Dizi

Endovascular stents for treatment of coarctation of the aorta

International audienc

The Effect of Biologics in the Treatment of Multisystem Inflammatory Syndrome in Children (Mis-C): A Single-Center Propensity-Score-Matched Study

Multisystem inflammatory syndrome in children (MIS-C) is a serious condition characterized by excessive inflammation that can arise as a complication of SARS-CoV-2 infection in children. While our understanding of COVID-19 and MIS-C has been advancing, there is still uncertainty regarding the optimal treatment for MIS-C. In this study, we aimed to compare the clinical and laboratory outcomes of MIS-C patients treated with IVIG plus corticosteroids (CS) to those treated with IVIG plus CS and an additional biologic drug. We used the propensity score (PS)-matching method to assess the relationships between initial treatment and outcomes. The primary outcome was a left ventricular ejection fraction of less than 55% on day 2 or beyond and/or the requirement of inotrope support on day 2 or beyond. We included 79 MIS-C patients (median age 8.51 years, 33 boys) followed in our center. Among them, 50 children (25 in each group) were allocated to the PS-matched cohort sample. The primary outcome was observed in none of the patients in the IVIG and CS group, while it occurred in eight patients in the IVIG plus CS and biologic group (p = 0.04). MIS-C is a disorder that may progress rapidly and calls for extensive care. For definitive recommendations, further studies, including randomized control trials, are required