Doppler detection of valvular regurgitation after radiofrequency ablation of accessory connections

Radiofrequency current was used recently to ablate accessory connections in patients with supraventricular tachycardia.1-5 After locating the accessory connection by electrophysiologic mapping, ablation is achieved by positioning a 7Fr catheter (with 4 mm electrode at distal tip) within the ipsilateral cardiac chamber and adjacent to the accessory connection. Radiofrequency current is then delivered at the point of earliest electrical activation along the atrioventricular valve annulus. For a left-sided accessory connection, the catheter is usually passed retrograde across the aortic valve into the left ventricle and under the posterior mitral valve leaflet. For a right-sided accessory connection, the catheter is passed anterograde into the right atrium or ventricle.1-5 Systematic evaluation of the effects of this technique on the function of all cardiac valves has not been reported. This study evaluates the effects of catheter manipulation and radiofrequency current delivery on valve competence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29958/1/0000320.pd

Echocardiographic predictors of the need for infundibular wedge resection in infants with aortic arch obstruction, ventricular septal defect and subaortic stenosis

Infants with aortic arch obstruction and outlet ventricular septal defect can have posterior displacement of the infundibular septum into the left ventricular outflow tract causing varying degrees of subaortic stenosis.1-3 Because of the large ventricular septal defect, left ventricular outflow tract velocities are frequently normal. For this reason, Doppler peak gradients are often not helpful for assessing the severity of the outflow tract narrowing preoperatively. Preoperative evaluation of the degree of subaortic obstruction and, thus, the need for surgical intervention is usually based on qualitative assessment of the anatomic 2-dimensional echocardiographic image.2-6 This study defines 2-dimensional echocardiographic predictors of the need for subaortic resection in infants with aortic arch obstruction, outlet ventricular septal defect and posterior deviation of the infundibular septum.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29683/1/0000010.pd

Noncoronary Cardiac Abnormalities Are Associated With Coronary Artery Dilation and With Laboratory Inflammatory Markers in Acute Kawasaki Disease

ObjectivesWe explored the association of noncoronary cardiac abnormalities with coronary artery dilation and with laboratory inflammatory markers early after Kawasaki disease (KD) diagnosis.BackgroundLeft ventricular (LV) dysfunction, mitral regurgitation (MR), and aortic root dilation occur early after diagnosis; their associations with coronary artery dilation and inflammatory markers have not been well-described.MethodsCentrally interpreted echocardiograms were obtained at KD diagnosis and 1 and 5 weeks after diagnosis on 198 subjects in the National Institutes of Health-sponsored Pediatric Heart Network KD pulsed steroid trial. Regression models were constructed to investigate the relationships among early LV dysfunction, MR, and aortic root dilation with coronary artery dilation and laboratory inflammatory markers.ResultsAt diagnosis, LV systolic dysfunction was present in 20% of subjects and was associated with coronary artery dilation, seen in 29% (p = 0.004). Although LV dysfunction improved rapidly, LV dysfunction at diagnosis predicted greater odds of coronary artery dilation at 1 and 5 weeks after diagnosis (5-week odds ratio: 2.7, 95% confidence interval: 1.2 to 6.3). At diagnosis, MR was present in 27% of subjects and aortic root dilation was present in 8%; each was associated with larger coronary artery size at diagnosis. Left ventricular dysfunction was associated with higher erythrocyte sedimentation rate and, at diagnosis only, lower serum albumin; MR was associated with higher erythrocyte sedimentation rate and lower albumin at all times. Aortic root size had little association with inflammatory markers.ConclusionsNoncoronary cardiac abnormalities are associated with coronary artery dilation and laboratory evidence of inflammation in the first 5 weeks after KD, suggesting a shared inflammatory mechanism. (Trial of Pulse Steroid Therapy in Kawasaki Disease [A Trial Conducted by the Pediatric Heart Network]; NCT00132080

Longitudinal Assessment of Growth in Hypoplastic Left Heart Syndrome: Results From the Single Ventricle Reconstruction Trial

Background: We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. Methods and Results: We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients 2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient‐ and stage‐specific targets. Clinical Trial Registration URL: http://clinicaltrials.gov/. Unique identifier: NCT00115934