Complete Atrioventricular Septal Defect Research Articles

The particular anatomy of ventricular septal defect in patients with Down syndrome and complete atrioventricular septal defect: An echocardiographic study

Complete atrioventricular septal defect (CAVSD) is associated with Down syndrome (DS) in almost half of cases, and is due in this setting to an abnormal development of the vestibular spine, derived from the posterior second heart field (SHF). Clinical studies have shown that Tetralogy of Fallot (TF), an outflow tract defect involving the anterior SHF, is more frequent in CAVSD patients with DS. We therefore decided to look for an outlet extension of the VSD in DS and non-DS. We reviewed retrospectively all 208 consecutive patients hospitalized in our unit with the diagnosis of CAVSD between 01/01/2017 and 09/12/2019. All echocardiographic examinations were screened by 2 pediatric cardiologists (ZB/LH). We excluded 46 patients whose VSD anatomical type could not be determined. We used the classification as agreed upon by ICD-11 to determine the VSD anatomical type in the 162 patients included. Among the cohort, 101/162 had DS (62.7%). An outlet extension of the VSD, with anterior malalignment of the outlet septum, was found in 88/101 (87.1%) DS vs. 4/61 (6.5%) non-DS ( P < 0.0001). Associated TF was found in 12 DS vs. 1 in non-DS ( P = ns). Ventricles were balanced in 126 patients, 23 had a hypoplastic left ventricle (LV), 13 had a hypoplastic right ventricle (RV). There was no significant difference regarding balanced or not ventricles between DS and non-DS. However, the hypoplastic ventricle was always the LV in non-DS, and was the RV in 62% of DS ( P = 0.006). This echocardiographic study describes for the first time that outlet extension of the VSD is the rule in CAVSD with DS and that hypoplastic RV occurs only in DS. This seems to confirm the involvement of the two parts of the second heart field in the morphogenesis of CAVSD in DS patients. The presence of a malaligned outlet septum in a fetus with CAVSD should raise awareness of the high risk of associated DS.

Intra-Atrial Rerouting of Anomalous Systemic Venous Connection and Septation of Common Atrium in Intracardiac Repair of Complete Atrioventricular Septal Defect with Left Isomerism and Dextrocardia: A Case Report

Intra-Atrial Rerouting of Anomalous Systemic Venous Connection and Septation of Common Atrium in Intracardiac Repair of Complete Atrioventricular Septal Defect with Left Isomerism and Dextrocardia: A Case Report

Early outcome of surgical repair of complete atrioventricular canal defects (comparative study between children before and after 6 months of age)

Background: Complete atrioventricular septal defect (CAVSD) is composed of a primum atrial septal defect, nonrestrictive inlet ventricular septal defect and common atrioventricular (AV) valve. The aim of this study was to compare the result of surgical repair of complete atrioventricular (CAVC) before and after six months of age. Methods: Between January 2018 and December 2019 at Al-Azhar University and Atfal Misr hospital, 80 patients underwent CAVC repair. These patients were divided into 2 groups according to the age and each group is of 40 patients. These patients were managed by modified patch and double patch techniques. Results: In-group A, the mortality was four operative deaths, four patients with severs mitral reguigitation and mean pulmonary artery pressure 30 – 55 mmHg. While in the group B, there were seven operative deaths, two patients with severs mitral reguigitation and mean pulmonary artery pressure 50 – 65 mmHg. Conclusion: Early repair improve the pulmonary artery pressure with high incidence of surgical reintervention for Lt AV valve, while late repair improve the results for Lt AV valve but has a lower effect on the pulmonary artery pressure.

Three-dimensional transesophageal echocardiography in diagnosis of intermediate atrioventricular septal defect in the adult: case report and literature review

BackgroundIntermediate type atrioventricular septal defect is less frequent than complete or partial atrioventricular septal defect, and is rarely encountered in the elderly and the utility of three dimensional transesophageal echocardiography in the diagnosis has not been reported to date.Case presentationIn this case report, we described a rare case of an intermediate atrioventricular septal defect in an adult patient and we showed the valuable utility of real time 3D transesophageal echocardiography in the diagnosis and future surgical planning. The patient was referred to a tertiary center for an elective surgical repair. Finally, we provided a detailed review of the literature concerning the intermediate type of atrioventricular septal defect.ConclusionAlthough 2D transthoracic and transesophageal echocardiography enables diagnosis of the intermediate type atrioventricular septal defect, precise assessment of anatomy of atrioventricular septal defects and common atrioventricular valve was enabled only by real time 3D echocardiography.

Mitral valve replacement in infants and younger children

Data on mitral valve replacement (MVR) in young children is still limited. Our objective was to evaluate MVR in children below 5 years and identify factors affecting the outcomes. This retrospective study included 29 patients who had MVR from 2002 to 2020. We grouped the patients into two groups according to their age: age ≤ 24 months (n = 18) and > 24 months (n = 11). Primary cardiac diagnoses were Shone complex (n = 7; 24%), isolated congenital mitral valve abnormality (n = 11; 38%), and complete atrioventricular septal defect (n = 3; 10%). The median age was 19 month (25th–75th percentile: 11–32) and 59% were females (n = 17). The hemodynamic lesions were mitral regurgitation in 66%, mitral stenosis in 10%, and combined mitral stenosis and regurgitation in 24% of the patients. St. Jude mitral valve was the most common valve implanted (n = 19, 66%), followed by CarboMedics in 21% of the patients (n = 6). The mitral valve was implanted in the supra-annular position in 6 cases (21%). Preoperative and operative data were comparable between both groups. There was no association between valve size and position with postoperative heart block (P > 0.99, for both). The median follow-up duration was 19.4 months (8.6–102.5). Nine patients had mitral valve reoperation, six had MVR, and three had clot removal from the mitral valve. There was no effect for age group on reoperation (SHR 0.89 (95% CI 0.27–2.87), P = 0.84). Valve size significantly affected reoperation (SHR 0.39 (95% CI 0.18–0.87), P = 0.02). The supra-annular position was associated with an increased risk of reoperation (SHR 3.1 (95% CI 1.003–9.4), P = 0.049). There was no difference in survival according to the age (Log-rank P = 0.57) or valve size (Log-rank P = 0.66). Mitral valve replacement in children is associated with low morbidity and mortality. The risk of reoperation could be affected by the valve size and position rather than the age.

Rare atrioventricular septal defects in veterinary species: Complete atrioventricular septal defect in a dog and double‐outlet right atrium in a cat

AbstractCase 1: A 9‐year‐old Yorkshire terrier mix was referred for evaluation of heart failure presumed to be secondary to myxomatous mitral valve disease. Case 2: A 6‐year‐old Domestic Longhair cat was referred for evaluation of heart failure presumed to be secondary to hypertrophic cardiomyopathy. Thoracic radiographs revealed pulmonary overcirculation suggestive of a cardiac shunt in both cases. Echocardiographic findings confirmed the diagnosis of rare atrioventricular septal defects (AVSDs): complete AVSD (case 1) and double‐outlet right atrium (case 2). Complete AVSDs are rare congenital cardiac defects in veterinary species that result from inappropriate embryogenesis of the atrioventricular septum. Sequelae include congestive heart failure and possibly shunt reversal due to concomitant pulmonary hypertension. Few veterinary reports describe the natural timeline of this condition and outcomes. This report describes both a dog and cat that presented symptomatic in adulthood, were diagnosed via echocardiography and medically managed long‐term.

Challenges in the Surgical Treatment of Atrioventricular Septal Defect in Children With and Without Down Syndrome in Romania-A Developing Country.

Background: Atrioventricular septal defect (AVSD) is a cardiac malformation that accounts for up to 5% of total congenital heart disease, occurring with high frequency in people with Down Syndrome (DS). We aimed to establish the surgical challenges and outcome of medical care in different types of AVSD in children with DS compared to those without DS (WDS).Methods: The study included 62 children (31 with DS) with AVSD, evaluated over a 5 year period.Results: Complete AVSD was observed in 49 (79%) children (27 with DS). Six children had partial AVSD (all WDS) and seven had intermediate types of AVSD (4 with DS). Eight children had unbalanced complete AVSD (1 DS). Median age at diagnosis and age at surgical intervention in complete AVSD was not significantly different in children with DS compared to those WDS (7.5 months vs. 8.6). Median age at surgical intervention for partial and transitional AVSDs was 10.5 months for DS and 17.8 months in those without DS. A large number of patients were not operated: 13/31 with DS and 8/31 WDS.Conclusion: The complete form of AVSD was more frequent in DS group, having worse prognosis, while unbalanced AVSD was observed predominantly in the group without DS. Children with DS required special attention due to increased risk of pulmonary hypertension. Late diagnosis was an important risk factor for poor prognosis, in the setting of suboptimal access to cardiac surgery for patients in Romania. Although post-surgery mortality was low, infant mortality before surgery remains high. Increased awareness is needed in order to provide early diagnosis of AVSD and enable optimal surgical treatment.

Outcomes of Complete Atrioventricular Septal Defect Surgical Repair in Down Patients

Background: Atrioventricular septal defect (AVSD) is commonly associated with chromosomal abnormalities, especially trisomy 21 or Down syndrome (DS). Surgical repair of complete AVSD (CAVSD) is a complex procedure that carries risks of postoperative morbidity and mortality. Objective: To evaluate the surgical outcomes and to identify the risk factors for hospital mortality and reoperation after repair of CAVSD in DS patients. Patients and Methods: This retrospective cohort study included 65 consecutive DS patients who underwent surgical correction for the complete form of AVSD with or without associated congenital heart diseases during the period from 1st January 2014 to the end of June 2020. Patients with associated other major cardiac anomalies were excluded. Results: In-hospital mortality was documented in 3 (4.6%) patients, whereas 4 (6.2%) patients needed second unplanned operation for valve/shunt correction. Heart block that needed permanent pacemaker insertion was recorded in 3 (4.6%) patients. In-hospital mortality was significantly associated with prolonged cardiopulmonary bypass (CPB) time (p = 0.008) and the development of renal dysfunction that required dialysis or sepsis (p = 0.004). We found a significant association between the need for second unplanned operation and type A CAVSD (p = 0.041) and the presence of preoperative moderate/severe atrioventricular (AV) valve regurgitation as detected in the transesophageal echocardiography (TEE) (p=0.035). Conclusions: In view of the incidence of the hospital mortality, reoperation, and other postoperative morbidities, we suggest that our outcomes are accepted for surgical repair of CAVSD in DS patients. The CPB time and the development of renal dysfunction that required dialysis and sepsis during the ICU care significantly contributed to the hospital mortality.

Complete atrioventricular septal defect with absent or diminutive primum component: Incidence, anatomic characteristics, and outcomes

BackgroundRepair of complete atrioventricular septal defect with absent or diminutive primum defect is challenging because of atrial septal malposition and abnormal anatomy of the left atrioventricular valve. We sought to define the incidence, anatomy, and surgical outcomes of this entity. MethodsWe identified all patients in our institutional database presenting for complete atrioventricular septal defect repair from 2006 to 2018. Operative reports and echocardiograms were reviewed to determine the presence and size of the primum defect, atrioventricular valve anatomy, degree of atrioventricular valve regurgitation, repair method, and complications, including reoperation for atrioventricular valve regurgitation. Functionally univentricular patients and those receiving repair at an outside institution were excluded. ResultsOf 183 patients with complete atrioventricular septal defect, absent/diminutive primum defect occurred in 16 patients (8.7%; 10 absent, 6 diminutive). Six patients (38%) had leftward malposition of the atrium septum on the common atrioventricular valve. The rate of reoperation for left atrioventricular valve regurgitation was 31% (3 early, 2 late), for which preoperative predictors included leftward malposition of the atrial septum onto the common atrioventricular valve (4/6 patients with malposition required reoperation, P = .036, Fisher exact test). One patient exhibiting this risk factor died. The overall rate of moderate or greater left atrioventricular valve regurgitation on the most recent postoperative echocardiogram was 13% (2/16 patients; median follow-up, 141 days; range, 3-2236 days). ConclusionsComplete atrioventricular septal defect with absent or diminutive primum defect is a unique variant of complete atrioventricular septal defect for which the risk of reoperation for left atrioventricular valve regurgitation after complete repair is high and risk factors include leftward malposition of the atrial septum on the common atrioventricular valve.

"Prenatal Detection of Complete Atrioventricular Septal Defect: A Down - Klinefelter Syndrome Case Report from Vietnam"

Down syndrome (DS) and Klinefelter syndrome (KS) are both serious congenital birth defects. DS is estimated to affect 1 in 700 births...

Incidence, risk factors and outcomes of atrial arrhythmias in adult patients with atrioventricular septal defect

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): French Federation of Cardiology Background The number of adults with atrioventricular septal defects (AVSD) is growing, with however, very few data regarding the natural history of atrial arrhythmias in this specific population. We aimed to assess the incidence, associated factors and outcomes of atrial arrhythmias among adult patients with AVSD. Methods Multicentric retrospective cohort of patients with AVSD from 3 referral centers specialized in adult congenital heart disease. Unbalanced AVSD, univentricular hearts, and Eisenmenger syndromes were excluded. Lifetime cumulative incidences of different types of atrial arrhythmia (&amp;gt;30 seconds) were analyzed (atrial fibrillation [AF] and intra atrial reentrant tachycardia/focal atrial tachycardia [IART/FAT]). Multiple logistic regression models were used to identify risk factors for atrial arrhythmias. Results The cohort comprised of 391 patients (61.6% of women) with a mean age of 36.3 ± 16.3 years and 17.3 ± 14.2 years of follow-up after surgical repair in operated patients, including 333 (85.1%) partial/intermediate and 58 (1.0%) complete AVSD. Overall, atrial arrhythmias were documented in 98 patients (25.1%). The lifetime risks for developing atrial arrhythmia to ages 20, 40, and 60 were 3.7%, 17.6%, and 54.8%. IART/FAT was the leading arrhythmia until the age of 45 then AF surpassed IART/FAT. Age (OR = 1.4, 95%CI = 1.2-1.6 by 5 years increment), the number of cardiac surgeries (OR = 4.1, 95%CI = 2.5-6.9), left atrial dilatation (OR = 3.1, 95%CI = 1.4-6.8), right atrial dilatation (OR = 4.1, 95%CI = 1.7-10.3), and moderate or severe left AV valve regurgitation (OR = 3.7, 95%CI = 1.2-11.7) were independently associated with a higher risk of atrial arrhythmias. Patients with atrial arrhythmias more frequently had pacemaker implantation (41.8% vs. 8.5%, p &amp;lt; 0.001), heart failure (24.5% vs 1.0%, p &amp;lt; 0.001) and cerebrovascular accidents (11.2% vs 3.4%, p = 0.007). Conclusions The lifetime risk of atrial arrhythmias in patients with AVSD is considerable with more than half of patients who will develop an atrial arrhythmia by the age of 60. Atrial arrhythmias are associated with a significant morbidity in this population. Abstract Figure. Central Illustration AVSD

Predictors of reoperation and mortality after complete atrioventricular septal defect repair.

Previous studies investigating risk factors associated with reoperation or mortality after repair of complete atrioventricular septal defect (CAVSD) often have not included sizeable cohorts undergoing modified single-patch repair. Both double patch and modified single-patch techniques have been widely used in Australia since the 1990s. Using a large multi-institutional cohort, we aimed to identify risk factors associated with reoperation or mortality following CAVSD repair. Between January 1990 and December 2015, a total of 829 patients underwent biventricular surgical repair of CAVSD in Australia at 4 centres. Patients with associated tetralogy of Fallot and other conotruncal abnormalities were excluded. Demographic details, postoperative outcomes including reoperation and survival, and associated risk factors were analysed. Fifty-six patients (6.8%) required early reoperation (≤30 days) for significant left atrioventricular valve regurgitation or residual septal defects. Freedom from reoperation at 10, 15 and 20 years was 82.7%, 81.1% and 77%, respectively. Patients without Down syndrome and moderate left atrioventricular valve regurgitation on postoperative echocardiogram were found to be independent risk factors for reoperation. Operative mortality was 3.3%. Overall survival at 10, 15 and 20 years was 91.7%, 90.7% and 88.7%, respectively. Prior pulmonary artery banding was a predictor for mortality, while later surgical era (2010-2015) was associated with a reduction in mortality risk. Improved survival in the contemporary era is in keeping with improvements in surgical management and higher rates of primary CAVSD repair over time. The presence of residual moderate left atrioventricular valve regurgitation on postoperative echocardiography is an important factor associated with reoperation and close surveillance is essential to allow timely reintervention. Primary CAVSD repair at age <3 months should be preferenced to palliation with pulmonary artery banding due to the association of pulmonary artery banding with mortality in the long-term.

Surgery for severe congenital heart diseases in children from developing nations

BackgroundChildren with severe congenital heart disease (CHD) are rarely treated in developing countries and have very little to no chance to survive in their local environment. Mécénat Chirurgie Cardiaque (MCC) flies to France children with CHD from developing countries. This report focuses on the early, mid, and late outcomes of 531 children with severe CHD sent to MCC for surgery from 1996 to 2019. MethodsThe inclusion criteria were based on diagnosis and not on procedure. MCC is present in 66 countries and has developed a robust staff, including 12 permanent employees and 700 volunteers, with 350 host families based in France, 120 local correspondents, and 100 local physicians. Since 1996, MCC has organized a basic training of local pediatric cardiologists yearly, offering a free 1-month training course. Over time, MCC could count on a pool of doctors trained in basic pediatric cardiology. Flights were secured by the Aviation Sans Frontieres Foundation. Nine French centers performed the surgeries. A robust follow-up was conducted in all the nations where MCC operates. ResultsThe most frequent pathologies were single ventricle (n = 126), double-outlet right ventricle (n = 116), pulmonary atresia with ventricular septal defect (n = 68), transposition of the great arteries with ventricular septal defect and transposition of the great arteries with intact ventricular septum (n = 61), arterial trunk (n = 39), transposition of the great arteries with ventricular septal defect and left ventricle outflow tract obstruction (n = 35), complete atrioventricular septal defect (n = 18), congenitally corrected transposition of the great arteries (n = 16), and so on. The median age was 5.4 years (range, 1 month-26 years). The mean perioperative mortality was 5.5% (29 out of 531) (95% confidence limit, 3.5%-7.4%). The follow-up was 91.3%, with a mean follow-up of 5.1 years. The global actuarial survival at 5, 10, and 15 years was, respectively, 85%, 83%, and 74%. There was a significant higher late mortality for patients surviving only with a Blalock-Taussig shunt (P = .001). ConclusionsOperating on 531 children with severe CHD from developing nations was achieved with satisfactory early and long-term results. Children with severe CHD are rarely operated on in developing nations. Programs like MCC's offer a viable option to save these children born with severe CHD.

Repair of complete atrioventricular canal defects: Early and midterm results and comparison of the left anterior leaflet augmentation technique with traditional technics.

Complete atrioventricular septal defects (CAVSD) include a variable spectrum of congenital malformations with different forms of clinical findings. We examined early and midterm outcomes, the need for reoperation, postoperative residual AV valve regurgitation, and other risk factors after various CAVSD repairs. Between 2014 and 2018, we have performed 89 isolated CAVSD repairs. We retrospectively reviewed the patients' medical records. Patients were divided into three groups according to their repair techniques modified one patch repair (MP) (n = 16); two patch repair (TP) (n = 49); and left anterior leaflet augmentation (ALA) technique (n = 24). Eighty patients (89.8%) survived hospital discharge. Early mortality rates were three (18.8%) in the group MP, five (10.2%) in the group TP, and one (4.2%) in the group ALA. Thirteen patients died during the follow-up period. Late mortality rates were three (18.8%) in the group MP, four (16.6%) in the group ALA, and six (12.2%) in the group TP. The mean follow-up time was 35.9 ± 22.97 months (range: 0.3-77 months). The morbidity and mortality results were similar between-group TP and ALA but worse in the MP group. Low body weight (<4 kg) and younger age at surgery (<4 months) were found to be risk factors on mortality by univariate and multivariate analysis. Surgical technic was not found to be an independent risk factor. In our series, TP and ALA techniques had satisfactory results in early and midterm periods. Younger age and small bodyweight might increase early mortality and the need for reoperation.

Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease

BackgroundMany factors affect outcomes after congenital cardiac surgery. ObjectivesThe RLS (Residual Lesion Score) study explored the impact of severity of residual lesions on post-operative outcomes across operations of varying complexity. MethodsIn a prospective, multicenter, observational study, 17 sites enrolled 1,149 infants undergoing 5 common operations: tetralogy of Fallot repair (n = 250), complete atrioventricular septal defect repair (n = 249), arterial switch operation (n = 251), coarctation or interrupted arch with ventricular septal defect (VSD) repair (n = 150), and Norwood operation (n = 249). The RLS was assigned based on post-operative echocardiography and clinical events: RLS 1 (trivial or no residual lesions), RLS 2 (minor residual lesions), or RLS 3 (reintervention for or major residual lesions before discharge). The primary outcome was days alive and out of hospital within 30 post-operative days (60 for Norwood). Secondary outcomes assessed post-operative course, including major medical events and days in hospital. ResultsRLS 3 (vs. RLS 1) was an independent risk factor for fewer days alive and out of hospital (p ≤ 0.008) and longer post-operative hospital stay (p ≤ 0.02) for all 5 operations, and for all secondary outcomes after coarctation or interrupted arch with VSD repair and Norwood (p ≤ 0.03). Outcomes for RLS 1 versus 2 did not differ consistently. RLS alone explained 5% (tetralogy of Fallot repair) to 20% (Norwood) of variation in the primary outcome. ConclusionsAdjusting for pre-operative factors, residual lesions after congenital cardiac surgery impacted in-hospital outcomes across operative complexity with greatest impact following complex operations. Minor residual lesions had minimal impact. These findings may provide guidance for surgeons when considering short-term risks and benefits of returning to bypass to repair residual lesions.

Upper mini sternotomy approach for pulmonary artery banding: A single centre experience.

Pulmonary artery banding (PAB) remains a crucial technique in modern cardiac surgery. Left lateral thoracotomy, median sternotomy, and left anterior thoracotomy are well-known approaches. With significant scarce reports addressing the application of the upper mini sternotomy approach for PAB, this study aims to share experience and report outcomes of patients operated upon using this approach and its impact on facilitating the redo surgery. Since 2015, we practiced the use upper mini sternotomy approach for PAB in the study center where we conducted this retrospective study of 22 patients who underwent banding through the upper mini sternotomy approach. Indications varied between complete atrioventricular septal defect, multiple muscular ventricular septal defects, and univentricular heart with increased pulmonary blood flow. At the time of PAB, the medians of age 2.0 (1-4.5) months and bodyweight of 3.1 (1.9-4.2) kg were reported against a surgery time range of 75- 135 min and peak gradient across the band of 54-78 mmHg. There was one unrelated mortality case (4.5%) due to a severe attack of pulmonary hypertensive crisis. Fifteen patients underwent the redo surgery. No mortality or sternotomy-related complications were reported following the second stage surgery while the reopening time ranged between 17 and 32 min. The upper mini sternotomy approach for PAB is safe and facilitates the subsequent redo surgery and could be a valuable alternative to other surgical approaches.

Levosimendan Versus Milrinone and Release of Myocardial Biomarkers After Pediatric Cardiac Surgery: Post Hoc Analysis of Clinical Trial Data.

We compared the effect of two inodilators, levosimendan and milrinone, on the plasma levels of myocardial injury biomarkers, that is, high-sensitivity troponin T and heart-type fatty acid binding protein, and on N-terminal prohormone of brain natriuretic peptide as a biomarker of ventricular function. We hypothesized that levosimendan could attenuate the degree of myocardial injury when compared with milrinone. A post hoc, nonprespecified exploratory secondary analysis of the Milrinone versus Levosimendan-1 trial (ClinicalTrials.gov Identifier: NCT02232399). Two pediatric tertiary university hospitals. Infants 1-12 months old, diagnosed with ventricular septal defect, complete atrioventricular septal defect, or Tetralogy of Fallot undergoing corrective surgery with cardiopulmonary bypass. Seventy patients received a loading dose of either levosimendan or milrinone at the start of cardiopulmonary bypass followed by an infusion of the respective drug, which continued for 26 hours. Plasma levels of the three cardiac biomarkers were measured prior to the initiation of cardiopulmonary bypass and 2, 6, and 24 hours after weaning from cardiopulmonary bypass. In both groups, the levels of high-sensitivity troponin T and heart-type fatty acid binding protein were highest at 2 hours post cardiopulmonary bypass, whereas the highest level of N-terminal prohormone of brain natriuretic peptide occurred at 24 hours post cardiopulmonary bypass. There was no significant difference in the biomarkers' plasma levels between the study groups over time. Neither was there a significant difference in the postoperative peak plasma levels of the cardiac biomarkers. In this post hoc analysis of the MiLe-1 trial, there was no demonstrable difference in the postoperative cardiac biomarker profile of myocardial injury and ventricular function when comparing infants managed in the perioperative period with levosimendan versus milrinone.

Early postoperative arrhythmias in patients undergoing congenital heart surgery.

Background This study aims to evaluate early postoperative arrhythmias in children undergoing congenital cardiac surgery. Methods A total of 670 pediatric patients (355 males, 315 females; median age: 4 months; range, 1 day to 18 years) who underwent cardiac surgery due to congenital heart defects between December 2018 and November 2019 were included. The rate of postoperative arrhythmias, diagnosis, potential risk factors, and management strategies were evaluated. Multivariate regression analysis was used to identify significant factors of development of postoperative arrhythmias. Results Tachyarrhythmia was detected in 54 patients (8.1%), and the most common tachyarrhythmia was junctional ectopic tachycardia. Medical treatment was required in 25/38 (66%) of junctional ectopic tachycardia patients. Amiodarone was initiated in 18, dexmedetomidine in five, and flecainide + amiodarone in two of the patients. Different degrees of atrioventricular block were observed in 30 patients (4.5%). In 12 patients, permanent pacemakers were implanted during hospitalization. Age at the time of surgery under one-year-old, high inotropic scores, prolonged operation time, and high Aristotele"s scores were independent risk factors associated with early postoperative arrhythmia (p<0.05). The most common operations associated with early postoperative arrhythmia were left ventricular outflow tract, (6/20, 30%), complete atrioventricular septal defect (13/53, 24%), and tetralogy of Fallot (20/134, 14%) surgeries. Conclusion Cardiac arrhythmias are common in the early period after congenital heart surgery in children. The diagnosis and frequency of arrhythmias may vary according to different surgical procedures.

Blood speckle imaging: A new echocardiographic approach to study fluid dynamics in congenital heart disease

IntroductionBlood speckle imaging (BSI) is a new speckle-tracking-based technique for blood flow study. Flows assessment is particularly challenging in Congenital heart diseases (CHDs), where a profound distortion in cardiac anatomy gives reason of alteration in fluid mechanics. Up until now doppler methods were the only ones used for the analysis of fluid. Overcoming standard Doppler limits, BSI is becoming a promising new approach for the study of fluid dynamics.The aim of the study was to assess fluid-dynamics of different CHDs by using BSI. Methods and resultsTen children (7 with suspected CHDs and 3 controls) were enrolled for the purpose between January and June 2019. All of them underwent a complete 2D and Doppler echocardiographic assessment plus a further BSI study. We studied: one complex transposition of great arteries, one coarctation of aorta, one tetralogy of Fallot, one complete atrio-ventricular septal defect, one suspicious flow in pulmonary artery, one aortic stenosis, one hypertrophic cardiomyopathy and three normal controls. ConclusionCompared to conventional Doppler methods, BSI was able to better describe fluid dynamics and hemodynamics of these CHDs by showing laminar and turbulent flows and vortices. In our experience, it helped to define the diagnosis and, in some cases, drove the management.

Complete atrioventricular septal defect: Impact of Down syndrome on atrioventricular valve morphology and haemodynamics and clinical outcomes

Complete atrioventricular septal defect (CAVSD) is a common congenital heart disease among children with Donw syndrome Investigate the impact of Down syndrome on atrioventricular valve morphology and haemodynamics as well as on outcomes in children with CAVSD. We performed a single-centre, retrospective, analytic study with a prospective follow-up in the Congenital Heart Disease Unit of cardiology department over a 9-year period (from December 2008 to September 2017).We compared 2 groups of patients with CAVSD: Down syndrome patients (group 1) and non-Down syndrome patients (group 2). Among the 2778 patients registered in our CHD Unit during the study period, 225 (8%) were diagnosed with CAVSD, 121 (54%) in group 1 and 104 (46%) in group 2. Median age at diagnosis was 5 months [0–17 years] in group 1 versus 5 months [1month–10 years] in group 2. The situs was solitus in all group 1 patients. However, in group 2, the situs was inversus in 4 patients (3.8%) and ambiguous in 17 (16.3%) (P < 0.001). Ventricles were unbalanced in 4 patients (3.3%) in group 1 versus 30patients (28.8%)in group 2 (P < 0.001). Atrioventricular valve annulus was hypoplastic in 6 patients (5.8%) of group 2 whereas all patients in group 1 had a normally developed atrioventricular valve annulus (P = 0.024). Papillary muscles were abnormal in 8 patients (6.6%) in group 1 versus 15 patients (14.4%) of group 2 (P = 0.048). Significant preoperative left atrioventricular valve regurgitation was lower in group 1 patients: 11 (9.1%) versus 23 (22.1%) (P = 0.02). Median age at surgery was 6 months [1month–7 years] in group 1 versus 7 months [1month–11 years] in group 2 (P = 0.023). Mortality rate was lower in group 1; 14 (11.5%) versus 23 (22.1%) (P = 0.03). Down syndrome patients have a better atrioventricular valve anatomy, fewer preoperative left atrioventricular valve regurgitation and a lower long-term mortality rate after surgery.