Elastic properties of the abdominal aorta in the children with bicuspid aortic valve: an observational study

Objective: Abnormalities of the aortic root and ascending aorta are common in patients with a bicuspid aortic valve (BAV). the aim of this study was to evaluate the stiffness of the abdominal aorta in children with BAV. Methods: in this cross-sectional observational study, we evaluated 35 children with normally functioning or mildly regurgitant BAV and 35 healthy children as controls. All children were noninvasively evaluated with transthoracic echocardiography. Annulus of aorta and abdominal aorta diameters were measured. Aortic strain (S), pressure strain elastic modulus (Ep), pressure strain normalized by diastolic pressure (Ep*), aortic stiffness ? index (?SI) and, aortic distensibility (DIS) were calculated using the measured data. in evaluation of the data Student’s t-test, Chi-square test, Pearson’s correlation and multivariate linear regression analysis were used. Results: Diameter of the aortic annulus was found significantly larger in the children with BAV than the control group (p;lt;0.05). the abdominal aorta systolic and diastolic diameters were similar in the two groups (p>0.05). the children with BAV exhibited significantly lower S (0.210±0.04/0.267±0.07, p;lt;0.001) and DIS (1.04±0.2/1.4±0.4 $10^{-6}$ $cm^{2}$ $dyne^{-1}$, p;lt;0.001); and higher Ep (200±39/153±47 N/$m^{-2}$, p;lt;0.001), Ep* (3.42±0.9/2.5±0.9, p;lt;0.001) and ?SI (1.1±0.3/0.84±0.3, p;lt;0.001) than the control group. There was no correlation between the systolic and diastolic diameters of abdominal aorta and aortic elasticity parameters (p>0.05). Conclusion: Bicuspid aortic valve is associated with an increased abdominal aortic stiffness in children. However, impaired abdominal aortic elasticity is not due to abdominal aortic dilatation. These findings require validation by further studies. (Anadolu Kardiyol Derg 2012; 12: 413-9)Amaç: Biküspit aortik kapaklı hastalarda aort anülüsü ve asendan aort anomalileri oldukça yaygın görülmektedir. Bu çalışmanın amacı biküspit aortik kapaklı çocuklarda abdominal aort sertliğini değerlendirmektir. Yöntemler: Enine kesitli gözlemsel olan bu çalışmada, kapak fonksiyonu normal veya hafif derecede yetmezliği olan 35 biküspit aortik kapaklı çocuk ile kontrol grubu olarak alınan sağlıklı 35 çocuk değerlendirildi. Tüm çocuklar transtorasik ekokardiyografi ile noninvaziv olarak değerlendirildi. Aort anülüsü ve abdominal aorta çapları ölçüldü. Bu ölçümlerde alınan veriler ile aortik gerilme (G), gerilme elastik modülü (Ep), diyastolik basınç ile normalleştirilmiş gerilme elastik modülü (Ep*), aortik sertlik indeksi (?SI) ve aortik esneklik (ES) hesaplandı. Verilerin istatistiksel değerlendirmesinde Student’s t-testi, Ki-kare testi, Pearson’s korelasyon analizi ve çoklu lineer regresyon analizi kullanıldı. Bulgular: Aort anülüs çapı kontrol grubuna göre anlamlı olarak geniş bulundu (p0.05). Abdominal aortun sistolik ve diyastolik çapları açısından farklılık saptanmadı (p>0.05). Biküspit aortik kapaklı çocuklarda G (0.210±0.04/0.267±0.07, p0.001) ve ES (1.04±0.2/1.4±0.4 $10^{-6}$ $cm^{2}$ $dyne^{-1}$, p0.001) kontrol grubuna göre belirgin düşük; Ep (200±39/153±47 N/$m^{-2}$, p0.001), Ep* (3.42±0.9/2.5±0.9, p0.001) ve ?SI (1.1±0.3/0.84±0.3, p0.001) ise belirgin olarak yüksek bulundu. Abdominal aort sistolik ve diyastolik çapları ile aortik elastisite parametreleri arasında ilişki saptanmadı (p>0.05). Sonuç: Biküspit aortik kapak, çocuklarda artmış aort sertliği ile ilişkilidir. Bununla birlikte abdominal aort elastisitesindeki bu bozulma aortik dilatasyondan kaynaklanmamaktadır. (Anadolu Kardiyol Derg 2012; 12: 413-9

A Retrospective Survey Comparing Suture Techniques Regarding the Risk of Permanent Epicardial Pacemaker Implantation After Ventricular Septal Defect Closure

Abstract Objective: The aim of this study is to compare the continuous and combined suturing techniques in regards to the needing epicardial pacing at the time of weaning from cardiopulmonary bypass (EP-CPB) and to evaluate permanent epicardial pacemaker (PEP) implantation in patients who had undergone surgical ventricular septal defect (VSD) closure. Methods: This single-centre retrospective survey includes 365 patients who had consecutively undergone VSD closure between January 2006 and October 2015. Results: The median age and weight of the patients were 15 months (range 27 days - 56.9 years) and 10 kg (range 3.5 - 100 kg), respectively. Continuous and combined suturing techniques were utilised in 302 (82.7%) and 63 (17.3%) patients, respectively. While 25 (6.8%) patients required EP-CPB, PEP was implanted in eight (2.2%) patients. Comparison of the continuous and combined suturing techniques regarding the need for EP-CPB (72% vs. 28%, P=0.231) and PEP implantation (87.5% vs. 12.5%, P=1.0) were not statistically significant. The rate of PEP implantation in patients with perimembraneous VSD without extension and perimembraneous VSD with inlet extension did not reveal significant difference between the suture techniques (P=1.0 and P=0.16, respectively). In both univariate and multivariate analyses, large VSD (P=0.001; OR 8.63; P=0.011) and perimembraneous VSD with inlet extension (P<0.001; OR 9.02; P=0.005) had a significant influence on PEP implantation. Conclusion: Both suturing techniques were comparable regarding the need for EP-CPB or PEP implantation. Caution should be exercised when closing a large perimembraneous VSD with inlet extension