39 research outputs found
Nawracające infekcje dróg oddechowych : maska czy objaw slingu naczyniowego?
Pulmonary artery sling is a rare congenital vascular anomaly in which the left pulmonary artery originates from the right
pulmonary artery. The report presents a boy with recurrent respiratory tract infections who was continuously followed-up at
a pulmonology centre since he was 2 years old. When he was 7 years old, echocardiography examination finally showed left
pulmonary artery sling. Next, chest computed tomography confirmed the diagnosis and also detected bronchomalacia. Left
pulmonary artery sling is a rare genetic defect that is diagnosed by echocardiography. Surgical treatment of left pulmonary artery
sling at an early age prevents the development of lesions of the bronchial tree that later require long-term pulmonology treatment
and rehabilitation. In case of a late diagnosis and intensified sling consequences manifest as bronchomalacia and bronchiectasis
these factors will play a decisive role in the future clinical picture and the patient may need tracheoplasty treatment
Unresectable cardiac paraganglioma - a rare case of clinically malignant tumor in an 8-year-old girl
Hypoplastic left heart syndrome with anomalous circumflex artery arising from left pulmonary artery : a description of combined surgical and interventional cardiac treatment
Comparison of the degree of exercise tolerance in children after surgical treatment of complex cardiac defects, assessed using ergospirometry and the level of brain natriuretic peptide
Children who underwent surgery for complex congenital heart defects present worse exercise capacity than their healthy peers. In adults and adolescents, heart failure is assessed on the basis of clinical symptoms using the New York Heart Association (NYHA) score, while in an infant Ross scale; heart failure can also be evaluated by other parameters. The purpose of this study was to compare the degree of exercise tolerance in children after surgery for complex heart defects, assessed by the ratio of maximum oxygen uptake (VO2max) and the brain natriuretic peptide (N-terminal fragment of the prohormone brain-type natriuretic peptide [NT-proBNP]) concentration. The study group consisted of 42 children, ages 9 to 17 years (mean 14.00 ± 2.72). Among them there were 22 children with tetralogy of Fallot (ToF) after total correction, 18 children with transposition of the great arteries (d-TGA) after the arterial switch operation, and 2 children with single ventricle (SV) after the Fontan operation. All but 1 child were in NYHA class I. The control group consisted of 20 healthy children. Outcomes of interest were the ratio of VO2max, determined during ergospirometry, and the level of NT-proBNP. The statistical analysis was performed and the groups were considered significantly different for P < 0.05. There was no statistically significant correlation between NT-proBNP and maximum oxygen uptake (VO2) kg(−1) min(−1) in the study group compared with the control group. The VO2max in the test group had a mean value less (34.6 ± 8.0) than controls (38.4 ± 7.7), and the differences were statistically significant (P = 0.041). In contrast, the average concentration of NT-proBNP in the study group was higher than controls (117.9 ± 74.3 vs 18.0 ± 24.5), and these differences were statistically significant (P < 0.001). After operations for complex heart defects (ToF, TGA, and SV), children have worse heart function parameters and exercise capacity than the healthy population. To control this, we recommend postoperative ergospirometry and determination of NT-proBNP concentrations
The increase of the pulmonary blood flow in high-risk hypoxic patients with a bidirectional Glenn anastomosis
Background: An additional shunt in single ventricle patients with Glenn anastomosis may increase pulmonary flow at the expense of ventricle volume overloading. The performance of the modification depends on pulmonary resistance, indicating better results in favorable hemodynamic conditions. Aims: The study aims at analyzing the influence of precisely adjusted pulsatile shunt in borderline high-risk Glenn patients on early and late results. Methods: The study involved 99 patients (including 21 children) with the bidirectional Glenn and accessory pulsatile shunt (BDGS group), and 78 patients with the classic bidirectional Glenn anastomosis (BDG group). Results: There was 1 death in the BDGS group and 4 deaths in the BDG group. No difference in mortality (P = 0.71) was found. The Fontan completion was achieved in 69 (88.5%) children in the BDG group and 18 (85.7%) patients in the BDGS group, without fatalities. No intergroup differences in postoperative pulmonary artery pressure (P = 0.10), ventilation time (P = 0.12), the McGoon ratio (P = 0.9), or chylothorax frequency (P = 0.14) were observed. Intensive care unit (P = 0.28) and hospitalization (P = 0.05) times were comparable. Echocardiography revealed no significant differences in the ventricle and atrioventricular valve function between groups. In the BDGS group, higher blood oxygen saturation (P = 0.03) and increase of the McGoon index (P = 0.002) were noted. Conclusions: Bidirectional Glenn anastomosis with precisely adjusted accessory pulmonary blood flow provides stable hemodynamics and adequate oxygen saturation in borderline, profoundly hypoxic patients. An advantageous pulmonary artery development before Fontan completion was observed
Feasibility and performance of catheter ablation with zero-fluoroscopy approach for regular supraventricular tachycardia in patients with structural and/or congenital heart disease
Risk factors for recoarctation of aorta after Norwood procedure in patients with hypoplastic left heart syndrome
Echocardiography and newer imaging techniques in diagnosis and long-term follow-up of primary heart tumors in children
Electrocardiographic algorithms to guide a management strategy of idiopathic outflow tract ventricular arrhythmias
The current guidelines of the European Society of Cardiology outlined electrocardiographic
(ECG) differentiation of the site of origin (SoO) in patients with idiopathic ventricular arrhythmias (IVAs). The aim of this study was to compare 3 ECG algorithms for differentiating the SoO and to
determine their diagnostic value for the management of outflow tract IVA. We analyzed 202 patients (mean age [SD]: 45 [16.7] years; 133 women [66%])
with IVAs with the inferior axis (130 premature ventricular contractions or ventricular tachycardias from
the right ventricular outflow tract [RVOT]; 72, from the left ventricular outflow tract [LVOT]), who underwent
successful radiofrequency catheter ablation (RFCA) using the 3‑dimensional
electroanatomical system.
The ECGs before ablation were analyzed using custom‑developed
software. Automated measurements
were performed for the 3 algorithms: 1) novel transitional zone (TZ) index, 2) , and 3) transition
ratio. The results were compared with the SoO of acutely successful RFCA. The algorithm predicted the left‑sided
SoO with a sensitivity and specificity close
to 90%. The TZ index showed higher sensitivity (93%) with lower specificity (85%). In the subgroup
with the transition zone in lead V3 (n = 44, 15 from the LVOT) the sensitivity and specificity of the V2–
transition‑ratio
algorithm were 100% and 45%, respectively. The combined TZ index+ algorithm
(LVOT was considered only when both algorithms suggested the LVOT SoO) can increase the specificity
of the LVOT SoO prediction to 98% with a sensitivity of 88%. The combined TZ‑index
and algorithm allowed an accurate and simple identification
of the SoO of IVA. A prospective study is needed to determine the strategy for skipping the RVOT
mapping in patients with LVOT arrhythmias indicated by the 2 combined algorithms
Long-term follow-up and comparison of techniques in radiofrequency ablation of ventricular arrhythmias originating from the aortic cusps (AVATAR Registry)
Introduction: Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long-term efficacy and safety as well as optimal technique after aortic cusp ablation have not previously been reported. Objectives: This aim of the study was to determine the short- and long-term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening. Patients and methods: This was a prospective multicenter registry (AVATAR, Aortic Cusp Ventricular Arrhythmias: Long Term Safety and Outcome from a Multicenter Prospective Ablation Registry) study. A total of 103 patients at a mean age of 56 years (34–64) from the “Electra” Registry (2005–2017) undergoing RFA of aortic cusps VA were enrolled. The following 3 ablation techniques were used: zero-fluoroscopy (ZF; electroanatomical mapping [EAM] without fluoroscopy), EAM with fluoroscopy, and conventional fluoroscopy-based RFA. Data on clinical history, complications after RFA, echocardiography, and 24-hour Holter monitoring were collected. The follow-up was 12 months or longer. Results: There were no major acute cardiac complications after RFA. In one case, a vascular access complication required surgery. The median (interquartile range [IQR]) procedure time was 75 minutes (IQR, 58–95), median follow-up, 32 months (IQR, 12–70). Acute and long-term procedural success rates were 93% and 86%, respectively. The long-term RFA outcomes were observed in ZF technique (88%), EAM with fluoroscopy (86%), and conventional RFA (82%), without differences. During long-term follow-up, no abnormalities were found within the aortic root. Conclusions: Ablation of VA within the aortic cusps is safe and effective in long-term follow-up. The ZF approach is feasible, although it requires greater expertise and more imaging modalities