Incidence and outcomes of patients with functionally univentricular heart born in Latvia, 2007 to 2015

Funding Information: This study was approved by the Ethics Committee of the Children’s Clinical University Hospital (Decision No. 5-2016; 12 September 2016); given the retrospective nature and absence of any patient identification, the requirement for individual patient or parent consent was waived. Publisher Copyright: © 2018 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: A functionally univentricular heart is the term used to describe congenital heart defects where it is impossible to restore two pumping chambers. These lesions are associated with high mortality, morbidity, and medical resource utilization. The aim of this study was to review incidence and outcomes of patients with a functionally univentricular heart at the only pediatric cardiac surgery center in Latvia. Methods: We performed a retrospective review of medical records of (i) all children with a functionally univentricular heart treated at the Clinic of Pediatric Cardiology and Cardiac Surgery, and (ii) all prenatally diagnosed cases of univentricular heart at Children’s Clinical University Hospital in Latvia. We reviewed data regarding children born from January 1, 2007, to December 31, 2015. The children’s cardiac anatomy and interventions were categorized in accordance with the International Pediatric and Congenital Cardiac Code (v3.3). Results: During the study period, 49 patients with a functionally univentricular heart were admitted to Children’s Clinical University Hospital with a corrected incidence of 0.69 per 1000 live births per year. There were 26 patients that had a hypoplastic left ventricle, and 22 patients that had a hypoplastic right ventricle, while one patient had an indeterminate ventricle. Thirty (61.2%) patients had died by the end of data collection. Twenty-one of the 30 deaths occurred before or immediately after stage I surgical palliation. Cumulative neonatal and 5-year survival of patients with a hypoplastic right ventricle was 81.8% and 63.6%, respectively; for patients with hypoplastic left ventricle—46.2% and 17.3%, respectively. Discussion: This is the first mid-term outcome study of patients with a univentricular heart in Latvia. The high mortality reflects the challenges of a small-volume, developing congenital cardiac surgery center. Data from this study will be used as a baseline for quality improvement.publishersversionPeer reviewe

Echocardiographic follow up after surgical correction of aortic coarctation during the first year of life

Publisher Copyright: Copyright © 2011-2014 by Walter de Gruyter GmbH.Coarctation of the aorta (AoCo) accounts for 6-10% of congenital heart diseases in infants. We analysed echocardiographic findings of patients operated on for AoCo in the University Hospital for Children in Riga during the first year of life to evaluate the long-term findings. Fifty-nine children underwent surgical correction of AoCo at the age of 55 ± 61 days. The methods of surgical correction were anastomosis end-to-end (ETE) in 29% (n = 17), subclavian flap aortoplasty (SFA) in 64% (n = 38) and extended anastomosis end-to-end (EETE) in 7% (n = 4). Recoarctation developed in 15 patients (25%) with no difference between surgical techniques (P > 0.05). The recoarcation patients had left ventricle hypertrophy (left ventricle mass index (LVMi) 76 ± 19 g/m2.7) normalising after angioplasty (LVMi 42 ± 7 g/m2.7). Patients with recoarctation had a decreased pulsed wave (PW) Doppler systolic/diastolic ratio in abdominal aorta 2.3 ± 0.4 versus patients without recoarctation 5.3 ± 1.2 and the control group 6.3 ± 1.4 (P < 0.05). A high incidence of recoarctation exists in patients operated on for AoCo as small infants. Life-long surveillance is required to monitor and to intervene in a timely way. Supplementation of the echocardiographic protocol with an evaluation of PW Doppler flow pattern in abdominal aorta can provide additional information about the presence of obstruction.publishersversionPeer reviewe

ISOLATED COR TRIATRIATUM SINISTER : A CASE REPORT

Cor triatriatum sinister is a rare congenital cardiac anomaly that has been identified in 0.1% of children with congenital heart disease. It is defined as a fibromuscular membrane that divides the left atrium into two chambers: a superior (proximal) that in most cases receives drainage from the pulmonary veins and an inferior (distal) chamber that communicates with the mitral valve and the left atrium. Cor triatriatum sinister can be an isolated lesion (approximately 25% of cases), but in many cases it is associated with other congenital cardiovascular anomalies, the most common one being – atrial septal defect(3). Symptoms in patients with cor triatriatum sinister are related to obstruction of pulmonary venous drainage, pressure loading of the right side of the heart and congestive cardiac failure. Depending on the severity of the obstruction and presence of associated cardiac anomalies it can be diagnosed at any age. Diagnosis is usually achieved by echocardiography in early infancy. Elective treatment method is surgical excision of the membrane. Here we present a pediatric patient (4 months old) presenting in cardiogenic shock with a successful correction of isolated cor triatriatum sinister. To confirm diagnosis and success of surgical repair, transthoracic and transesophageal echocardiography were used.publishersversionPeer reviewe

Initial experience with Edwards SAPIEN valve transcatheter implantation in native RVOT in Latvia

© Lietuvos mokslų akademija, 2020.Transcatheter pulmonary valve implantation has been a well-known method for more than a decade, but there are still many challenging cases when a personalized solution is needed. We report a case of a 15-year-old female patient with tetralogy of Fallot, who underwent a surgical correction during infancy. Because of progressive pulmonary regurgitation, stenosis, and right ventricle dilatation, transcatheter pulmonary valve implantation in the native right ventricle outflow tract (RVOT) using Edwards SAPIEN valve was performed. A "landing zone" was created prior to the intervention of stenting the RVOT and the right pulmonary artery. The transcatheter approach for pulmonary valve replacement in a native RVOT is a reasonable alternative to the surgical approach.publishersversionPeer reviewe

Comparision of Biomechanical Properties of Two Synthetic Biomaterials for VSD Closure

Ventricular septal defect (VSD) is most common congenital heart disease (15-20%) [Hoffman, 2002] and about 70% of these are perimembranous (PmVSD). The traditional treatment, if necessary, is surgical repair - VSD closure using the autologous pericardium or synthetic material such as polytetrafluorethylene (PTFE). There are two types that are commonly in use - GORE TEX Cardiovascular patch (GRTX) and BARD Edwards Outflow Tract Fabric knitted PTFE (BARD). Polytetrafluorethylene (PTFE) polymers are successfully used to repair as large diameter VSD and small VSD as well. For surgical operation there are usually used synthetic patch, uninterrupted (continuous) and interrupted suture technique, and transatrial access with cardiopulmonary bypass, cardioplegia in aortic root and local myocardial hypothermia Most patients undergo the operation in the first year of life6, therefore the structure of the myocardial tissues is more soft in contrast with age two or more years old child tissues characteristics, concerning the used material for VSD closure. At the moment of exposure of VSD, considering localization, size and shape of the VSD, we make a decision, which material is more suitable in certain case. We suspect that knitted material (BARD) would be more appropriate to be with greater accordance to myocardial tissues and it has the advantage of making less myocardial and conduction tissue trauma and being more fitted for good shaping of VSD patch to avoid residual defects. [Stark, 1986]. The goal of this research was to investigate the biomechanical properties of two synthetic materials, such as the PTFE material patches - GRTX and BARD in vitro, and compare the main biomechanical parameter of these materials

Biomechanical Properties and Resistens to Proteolytic Degradation of Glutaraldehyde Treated Human Pericardium

Pericardium is commonly used for repair of congenital heart defects [Paez, 1999]. Autologous pericardium can be used in its fresh non-treated state, or after chemical fixation with glutaraldehyde solution as a biomaterial for surgical repair of congenital heart anomalies. However, there are not many studies about changes of biomechanical properties of human pericardium after treating with glutaraldehyde. Influence of different concentration and exposition time of glutaraldehyde on resistance of human pericardium to proteolytic degradation needs further investigations. [Vincentelli, 1998, Stacchino, 1998] The aim of this experimental study is to investigate changes of biomechanical properties and resistance to proteolytic degradation of human pericardium, which was used as patch material for congenital heart surgery, after harvesting and treatment with glutaraldehyde solution

Incidence and Outcomes of Patients with Functionally Univentricular Heart Born in Latvia, 2007 to 2015

Funding Information: This study was approved by the Ethics Committee of the Children’s Clinical University Hospital (Decision No. 5-2016; 12 September 2016); given the retrospective nature and absence of any patient identification, the requirement for individual patient or parent consent was waived. Publisher Copyright: © 2018 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: A functionally univentricular heart is the term used to describe congenital heart defects where it is impossible to restore two pumping chambers. These lesions are associated with high mortality, morbidity, and medical resource utilization. The aim of this study was to review incidence and outcomes of patients with a functionally univentricular heart at the only pediatric cardiac surgery center in Latvia. Methods: We performed a retrospective review of medical records of (i) all children with a functionally univentricular heart treated at the Clinic of Pediatric Cardiology and Cardiac Surgery, and (ii) all prenatally diagnosed cases of univentricular heart at Children’s Clinical University Hospital in Latvia. We reviewed data regarding children born from January 1, 2007, to December 31, 2015. The children’s cardiac anatomy and interventions were categorized in accordance with the International Pediatric and Congenital Cardiac Code (v3.3). Results: During the study period, 49 patients with a functionally univentricular heart were admitted to Children’s Clinical University Hospital with a corrected incidence of 0.69 per 1000 live births per year. There were 26 patients that had a hypoplastic left ventricle, and 22 patients that had a hypoplastic right ventricle, while one patient had an indeterminate ventricle. Thirty (61.2%) patients had died by the end of data collection. Twenty-one of the 30 deaths occurred before or immediately after stage I surgical palliation. Cumulative neonatal and 5-year survival of patients with a hypoplastic right ventricle was 81.8% and 63.6%, respectively; for patients with hypoplastic left ventricle—46.2% and 17.3%, respectively. Discussion: This is the first mid-term outcome study of patients with a univentricular heart in Latvia. The high mortality reflects the challenges of a small-volume, developing congenital cardiac surgery center. Data from this study will be used as a baseline for quality improvement.Peer reviewe

Prevalence of patent ductus arteriosus in children under 18 years in Latvia 2018‑2022

Introduction: Accounting for 5‑10% of all congenital heart defects, patent ductus arteriosus (PDA) is one of the most common congenital cardiovascular malformations. The condition is often diagnosed in the neonatal period. Howev‑ er, it can be delayed until childhood or even adulthood. A small PDA often doesn’t cause problems and may never need treatment, but a large, untreated PDA can reduce heart function or problems related to high pressure in the lungs. Aim: Analysis and summary of data from medical history of patients with PDA in the system of the Children’s Clinical University Hospital. Materials and Methods: The study included 70 patients diagnosed with PDA aged 0‑18 years from term infants. Data were analyzed using the diagnostic criteria for PDA. Results: A total of 70 patients were enrolled in the study, of whom 71% (n=50) were female and 29% (n=20) were male. Most patients (60%) were children aged 0 to 3 years (n=42). The small and moderate PDA type predominate, each type is 44% (n=31) by PDA criterion. When analyzing one of the most important echocardiographic criteria for PDA, the LA /AO ratio, pulmonary hyperperfusion was present in 53% (n=36) of patients. Angiography to close the PDA was performed in 94% (n=66) of cases, open surgery was performed in 3% (n=2) of cases, and surgery was discontinued in 3% (n=2) because of disease. Of the total number of patients, complications occurred in only 5,8 % (n=4), including migration of the occluding device 3% (n=2), residual PDA 1,4% (n=1), and a small piece of the encapsulating ligature 1,4% (n=1). Conclusions: By 2021, 359 000 children had been registered in Latvia, and ~ 0,018 % of children aged 0‑18 with PDA. For children born full‑term, early diagnosis and correction of PDA enables a good long‑term quality of life.Peer reviewe