Left Ventricular Outflow Tract Stenosis Research Articles

A Case of Forming Test for the Diagnosis of PFO Combined Dynamic Left Ventricular Outflow Tract Stenosis after Occlusion

This patient was diagnosed with Patent Foramen Ovale (PFO) due to recurrent headaches, and her headaches improved significantly after oval foramen occlusion, but a grade 3/6 coarse murmur was heard in the aortic valve auscultation area, and left ventricular outflow tract stenosis was suggested by cardiac ultrasound. This change may be related to a variety of factors, suggesting that we should do a good preoperative assessment of the patient; intraoperative operation as gentle as possible to reduce the damage to the surrounding tissues; postoperative operation should be strengthened to avoid the progression of the inflammatory process, and at the same time to pay attention to the patient's symptoms, signs and dynamics of the relevant examinations to reduce the incidence of complications.

A case of hypertrophic cardiomyopathy with previous aortic valve replacement

We describe a 45-year-old patient who was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) after the aortic valve replacement surgery. Enlarged left atria, thickened ventricular septum, left ventricular outflow tract stenosis, moderate mitral regurgitation and mild tricuspid regurgitation in the echocardiography were found. We offered the patient the new minimally invasive treatment modality: percutaneous intra-myocardial septal radiofrequency ablation (PIMSRA). We demonstrate the safety and efficacy with pictures. One month after surgery, the patient recovered well with improved symptoms of chest tightness, and no LVOT obstruction or arrhythmia.

Stenting for Left Ventricular Outflow Tract Stenosis after Double Outlet Right Ventricle Repair.

Stenting for Left Ventricular Outflow Tract Stenosis after Double Outlet Right Ventricle Repair.

ANALYSIS OF ECHOCARDIOGRAPHIC AND MRI ANATOMICAL CHARACTERISTICS AND HEMODYNAMIC CHARACTERISTICS OF LEFT VENTRICULAR OUTFLOW TRACT STENOSIS

Objective: To analyze the anatomical morphological and hemodynamic characteristics of left ventricular outflow tract stenosis (LVOTS) by echocardiography and MRI. Methods: The Echocardiography data of 112 patients with LVOTS were retrospectively analyzed by measuring the basal interventricular septal thickness (IVST-b), the left ventricle posterior wall thickness (LVPWT), and the peak pressure gradient of LVOTS, as well as by observing the characteristics of spectral pattern and the presence of systolic anterior motion of mitral valve leaflets. A Siemens 3.0T MRI scanner was used to scan the contrast-enhanced left ventricular (LV) volume of all cases. The obtained end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) of LV were compared with the Echocardiography results. Results: The 112 patients were divided into four groups: hypertrophic obstructive cardiomyopathy (Group I, 42 cases), hypertensive left ventricular hypertrophy (Group II, 40 cases), basal septal hypertrophy in the elderly (Group III, 21 cases), and the subaortic membrane (Group IV, 9 cases). The continuous wave (CW) Doppler characteristic of Groups I, II, and III was broadsword-shaped jet, and that of Group IV was equilateral triangle-like spectrum. The IVST-b, IVST-b/LVPWT ratio and peak pressure gradient of LVOTS of Group I was significantly higher than those in Groups II and III ([Formula: see text]). The LVPWT of the first three groups was slightly correlated with the LVOTS peak pressure gradient ([Formula: see text], respectively, [Formula: see text]). There were no statistically significant differences between Echocardiography and MRI results regarding the LV EDV, ESV, SV, and EF ([Formula: see text]), and no statistically significant differences were found between Echocardiography and MRI results regarding the myocardial thicknesses of septal, anterior, lateral, and inferior walls ([Formula: see text]). The Pearson’s correlation analysis demonstrated correlations between MRI and Echocardiography results for LV EDV, ESV, SV, and EF ([Formula: see text], 0.002, 0.009, and [Formula: see text], respectively). The MRI enhancement was shown as delayed enhancement in 52 cases, localized enhancement in 8 cases, diffuse enhancement in 6 cases, and transmural enhancement in 3 cases, with abnormal enhancement lesions distributed in the area of ventricular septum free wall junctions and ventricular septum. Conclusion: Using MRI to evaluate LV function of hypertrophic cardiomyopathy is reliable and accurate. MRI enhancement can be used for the quantitative measurement of myocardial fibrosis. Echocardiography can distinguish the stenosis types of LVOTS. The IVST-b and existence of SAM may be important anatomical characteristics determining the degree of dynamic stenosis, and MRI combined with Echocardiography can provide important detailed information.

Rapid right ventricular pacing for balloon aortic valvuloplasty: expanding its routine use in neonates and infants.

Rapid right ventricular pacing during balloon aortic valvuloplasty is commonly used to achieve balloon stability in children and adults. There is no consensus for the use of the technique in neonates and infants. We sought to review our institutional experience with rapid right ventricular pacing-assisted balloon aortic valvuloplasty across all age groups and evaluate the safety and effectiveness of the technique in the sub-group of neonates and infants <12months. Retrospective study between February, 2011 and February, 2020. A total of 37 patients (Group I: 21 neonates/infants <12months and Group II: 16 children 12 months-16 years) were analysed. Catheter-measured left ventricular to aortic gradient reduced from median of 66 mmHg (with a range from 30 to 125 mmHg) to 14 mmHg (with a range from 5 to 44 mmHg) in Group I and 44 mmHg (with a range from 28 to 93 mmHg) to 18 mmHg (with a range from 2 to 65 mmHg) in Group II (p < 0.001). Procedure and fluoroscopy times were identical in the two groups. Balloon:annulus ratio was 0.94 and 0.88 in Groups I and II, respectively. Freedom from reintervention was 100% for Group I at a median time of 3.2 years and 81% at 2.7 years for Group II. Reinterventions in Group II (3/16 pts) were performed predominantly for complex left ventricular outflow tract stenosis. At follow-up echocardiogram, 45% of patients in Group I had no aortic regurgitation, 30% trace-mild, 20% mild-moderate, and 5% moderate aortic regurgitation, whereas in Group II, 50% of patients had no aortic regurgitation, 32% had mild aortic regurgitation, and 18% mild-moderate aortic regurgitation. Unicuspid valves were only encountered in Group 1 (2/21 pts, 10%) and they were predictive of mild-aortic regurgitation during follow-up (p = 0.003). Ventricular fibrillation occurred in three neonates with suspicion of myocardial ischemia on the pre-procedure echocardiogram. All were successfully defibrillated. Rapid right ventricular pacing can be expanded in neonates and infants to potentially decrease the incidence of aortic regurgitation and reintervention rates, hence avoiding high-risk surgical bail-out procedures for severe aortic regurgitation in the first year of life. Myocardial ischemia may predispose to ventricular dysrhythmias during rapid right ventricular pacing.

Numerical Simulation of the Influence of Geometric Configurations on Pressure Difference in the Intraventricular Tunnel.

ObjectiveThe geometric configuration of the intraventricular tunnel is related to the re-intervention of left ventricular outflow tract stenosis after double outlet right ventricle (DORV) correction. Hemodynamic simulation was performed in order to study the influence of the geometric configuration of the IVT on the pressure difference.MethodsCT images of DORV were processed to reconstruct 3D models of left and right ventricular flow chambers and aortic valve orifice, and then the size and relative position of the aortic valve orifice and ventricular septal defect were determined. Twenty five groups of the idealized models were established according to orthogonal test design and computational fluid dynamics method was applied to simulate hemodynamics. Three factors of geometric configuration were considered for the study of their influences on the pressure difference. The first factor is the distance between the ventricular septal defect and the plane of the aortic valve (DSA), the second factor is the ejection angle of blood from left ventricle flowing into the IVT (ALT), and the third factor is the turning radius of the IVT (RTT). SPSS software was employed to perform the orthogonal analysis. Additionally, twelve models with different turning radii were established for hemodynamic analysis, with the turning radii increasing from 0 mm with an interval of 1 mm, so as to study the influence of turning radius on pressure difference of IVT.ResultsThe analysis of variance showed that only the change of RTT had a significant effect on the pressure difference (P = 0 < 0.05), while the change of DSA and ALT had no significant effect on the pressure difference (P = 0.459 > 0.05, P = 0.263 > 0.05). The pressure difference decreases with the increase of RTT. When RTT reaches 6 mm, the pressure difference gradually remains unchanged with the increase of RTT, and the rate of change is less than 5%.ConclusionRTT in the IVT is the main factor affecting the pressure difference. A small RTT will lead to a large pressure difference in the IVT. When RTT increases to 6 mm, the pressure difference in the IVT remains nearly unchanged. When performing the right ventricular double outlet correction; the turning radius of the IVT should be about 6 mm to ensure relatively small pressure difference.

Fixation of intracapsular fracture of the femoral neck using combined peripheral nerve blocks and transthoracic echocardiography in a patient with severe obstructive hypertrophic cardiomyopathy: a case report

BackgroundHypertrophic obstructive cardiomyopathy (HOCM) is a type of hypertrophic cardiomyopathy associated with left ventricular outflow tract stenosis. The increased pressure gradients across the left ventricular outflow tract in patients with HOCM could lead to circulatory collapse. We describe our experience with perioperative management under femoral nerve block (FNB), lateral femoral cutaneous nerve block (LFCNB), and transthoracic echocardiography (TTE) monitoring during open reduction and internal fixation of a femoral neck fracture in a patient with severe HOCM.Case presentationA 72-year-old man, who was indicated to undergo open reduction and internal fixation of an intracapsular femoral neck fracture, had a history of treatment for hypertension and HOCM. He had heart failure for 4 years and was hospitalized several times. He was resuscitated after ventricular fibrillation and received an implantable cardioverter-defibrillator at that time. He also had severe physical limitations (New York Heart Association class III). We selected FNB and LFCNB as the methods for anesthesia and injected 0.25% levobupivacaine (20 mL) around the femoral nerve and 0.25% levobupivacaine (10 mL) into the lateral femoral nerve region. He underwent TTE during the perioperative period, which enabled us to perform hemodynamic and morphological evaluations of the heart. The intraoperative TTE findings remained stable from before the induction of anesthesia to the patient’s exit from the operating room. Postoperatively, his hemodynamic parameters continued to remain stable.ConclusionsIn this case, FNB and LFCNB contributed to hemodynamic stability during non-cardiac surgery. Additionally, TTE was useful for the perioperative evaluation of cardiac hemodynamics and morphology in our patient with severe HOCM.

Results of Hemodynamic Correction in Patients with Double Outlet Right Ventricle

Aim. To analyze results of hemodynamic correction in surgical treatment of double outlet right ventricle (DORV).&#x0D; Маterials and methods. For the period from January 1996 to September 2017, 31 (6.03 % of total number of patients with DORV) patients underwent hemodynamic correction of DORV. The age of the patients ranged from 1 to 19 years (71.2 ± 50.5 months on the average). The weight of the patients ranged from 9 to 41 kg (19.6 ± 11.3 kg on the average). Of these, 19 (61.3 %) were male patients and 12 (38.7 %) were female patients. The overwhelming majority (25 (80.6 %)) of the patients were diagnosed with transposition-type DORV. The anatomy of DORV with non-committed ventricular septal defect was observed in 5 (16.1 %) patients. In one patient (3.1 %), the anatomy of DORV (in the form of tetralogy of Fallot) was combined with tricuspid valve atresia.&#x0D; Results. The main reasons of hemodynamic correction in 16 (51.6 %) cases was LV hypoplasia. In 2 cases it was combined with tricuspid valve (TV) straddling, and in 2 cases it was an integral part of the unbalanced form of complete atrio-ventricular communication (AVC). In one case (3.1 %), the unbalanced form of complete AVC was combined with a mixed form of the common ventricle. The mixed form of the common ventricle was the reason of hemodynamic correction in 9 (29 %) patients. In 2 (6.2 %) cases, hemodynamic correction was performed due to the anatomy of the RV hypoplasia. In the remaining 2 patients, anatomy of the common ventricle was not diagnosed, but a combination of other concomitant defects was a contraindication to biventricular correction. Palliative operations (Blalock-Taussig shunt, BTS) as the first stage of correction were performed in 16 (51.6 %) patients. In 2 patients with LV outflow tract obstruction, systemic-pulmonary anastomosis was applied in combination with plastic repair of the great vessel roots using the proprietary technique for elimination of the left ventricular outflow tract (LVOT) stenosis. Bidirectional cavopulmonary anastomosis (BCPA) was applied in 29 (93.5 %) cases. Of these, 4 (13.8 %) patients subsequently underwent total cavopulmonary anastomosis (TCPA) procedure. Two patients with good hemodynamic parameters underwent TCPA without prior palliative procedures.&#x0D; Conclusion. Palliative surgery as the first stage to hemodynamic correction is accompanied by significant improvement in hemodynamic parameters of patients. Application of BCPA as the second stage of hemodynamic correction provides good results and is required to prepare the patient for TCPA. The long-term period is characterized by improvement in the quality of life in patients with complex DORV. In the long-term period, 85.2 % of patients are classified as NYHA FC I.

Markers Of Arrhythmia In Patients With Left Ventricular Outflow Tract Stenosis And Coartation Of Aort

Objective: Arrhythmias due to congenital heart diseases are found to be the second most common cause of mortality after ischemic heart diseases in several studies . Coarctation of the aorta , hypertrophic cardiomyopathy and aort stenosis increase afterload of the left ventricle and as a result of this, they cause an increase in wall stress in the early and hypertophy of the wall in the late phase. This condition leads a corruption in ventricular and atrial conduction and predisposes to arrhythmias . In this study, we intended to examine the risks with indicators like P dis, QT dis, Tp-e for arrhythmias in diseases with left ventricular outflow tract stenosis in children. Method: 101 patients with with left ventricular outflow tract stenosis ( coarctation of the aorta, idiopathic hypertrophic subaortic stenosis , hypertrophic cardiomyopathy and aortic stenosis ) in pediatric age group who were diagnosed between 2008-2014 in Dr . Behçet Uz Children’s Training and Research Hospital were included in this study. 110 healthy children were included in this study as a control group. Pdis, corrected QT, QT dis ve Tp-e and Tp-e /QT indices in both groups were were calculated and compared using standard 12 -lead ECG. Results: P max, corrected QT, Pdis, QTdis, Tp-e and Tp-e/QT in patient group were found to be significantly higher than the control group . There was no difference between sub- groups of patient group according to Pmax, corrected QT, P dis, QT dis, Tp-e and Tp-e/QT. There was also no difference between beta blocker users and non-users according to P max, corrected QT, P dis, QT dis, Tp-e and Tp-e/QT. Conclusions: High P max, corrected QT, P dis, QT dis, Tp-e and Tp-e/QT in the patient group showed the risk for ventricular arrhythmias and atrial fibrillation in patients with left ventricular outflow tract stenosis .

Severe hemolysis associated with left ventricular outflow tract stenosis following aortic valve replacement

Severe hemolysis associated with left ventricular outflow tract stenosis following aortic valve replacement

Assessment of transposition of the great arteries associated with multiple malformations using dual-source computed tomography.

PurposeTo determine the value of dual-source computed tomography (DSCT) in depicting the morphological characteristics and diagnosing the associated malformations for patients with transposition of the great arteries (TGA) before surgery.Materials and methodsTwenty-five patients with TGA who underwent DSCT and transthoracic echocardiography (TTE) examination were retrospectively reviewed. The morphological types of TGA, the spatial relationship between the pulmonary artery and the aorta, as well as coronary artery-associated abnormalities were assessed by DSCT. In contrast to TTE, the diagnostic accuracy of associated malformations on DSCT were analyzed and calculated with reference to surgical or digital subtraction angiography (DSA) findings. Effective doses (EDs) were also calculated.ResultsAmong the 25 patients, 12 (48%) had ventricular septal defects and left ventricular outflow tract stenosis. Sixteen patients (16/25, 64%) had great arteries with an oblique spatial relationship on DSCT. In addition, we found seven patients (7/25, 28%) with coronary artery malformation, including five with an abnormal coronary origin and two with signs of a myocardial bridge. According to DSA or surgical findings, DSCT was superior to TTE in demonstrating extracardiac anomalies (sensitivity, anomalies of great vessels: 100% vs. 93.33%, other anomalies: 100% vs. 46.15%). The mean estimated ED for those aged <10 years was <2 mSv (1.59 ± 0.95 mSv).ConclusionsDSCT can achieve an overall assessment of patients with TGA, including any associated malformations as well as the identification of the spatial relationship of the great arteries. DSCT can therefore be considered as an alternative imaging modality for surgical decision making.

Anterior longitudinal aortotomy in aortic valve replacement

We adopted an anterior longitudinal aortotomy in some cases of aortic valve replacement (AVR), and report them here. The potential of this method is also discussed. We analyzed the data on 24 patients (75.5 ± 7.8 years of age) who had undergone AVR through anterior longitudinal aortotomy. The indications for surgery were prosthetic valve complication in 5 patients, aortic stenosis (AS) with left ventricular outflow tract stenosis (LVOTS) in 16 patients, and aortic regurgitation with moderately dilated ascending aorta in 3 patients. The Konno procedure was performed in 6 cases with small aortic annuli. A longitudinal aortotomy was made at the aortic root along the left side of the right coronary ostium, and extended beyond the right coronary annulus to the interventricular septum as needed. Bioprostheses (21.1 ± 1.7 mm) were used in 23 patients and a 21-mm mechanical valve for one (a 59-year-old man). One high-risk patient died of low output syndrome, leading to a mortality rate of 4.2 %. All other patients recovered well, though atrioventricular block occurred in 2 cases. Anterior longitudinal aortotomy provides a good field of vision at the aortic annulus and the flexibility to develop into anterior annular enlargement. Major indications for this approach are small sino-tubular junction and very small aortic annulus. This approach could be an attractive option in AVR for cases of AS with small aortic annuli and LVOTS. It could also be useful for AVR cases with moderately dilated ascending aorta requiring aortoplasty.

A case of hypertrophic cardiomyopathy suffering from heart failure due to mitral regurgitation caused by posterior chordal rupture and concomitant left ventricular outflow tract stenosis caused by systolic anterior motion of the mitral valve

A case of hypertrophic cardiomyopathy suffering from heart failure due to mitral regurgitation caused by posterior chordal rupture and concomitant left ventricular outflow tract stenosis caused by systolic anterior motion of the mitral valve

PRIMARY ROSS OPERATION MAY BE PREFERABLE TO ATTEMPTS AT AORTIC VALVE REPAIR IN OLDER CHILDREN WITH PRIMARY AORTIC INSUFFICIENCY

BACKGROUND: In older children with severe aortic insufficiency (AI), a strategy of aortic valve REPAIR is often pursued in order to delay ROSS procedure or aortic valve replacement with a mechanical/bioprosthetic device (AVR). We aimed to test this strategy of valve REPAIR by evaluating its durability. METHODS: From 2001-2012, 90 children with severe AI underwent: REPAIR (N1⁄446, 51%), ROSS (N1⁄421, 23%) or AVR (N1⁄423, 26%). Repeated measures (N1⁄41081 echos) mixed model analysis were used to evaluate haemodynamic outcomes. RESULTS: Mean age at operation was identical for REPAIR and ROSS (11 years), but slightly older for AVR (13 years). Annular dimensions were largest for REPAIR versus either AVR or ROSS (P1⁄4.01, figure). Cardiopulmonary bypass times were significantly shorter for REPAIRS versus either ROSS or AVR (figure, P<.01). REPAIRS were initially attempted in 52; 6 switched strategy during surgery to ROSS (5) or AVR (1). REPAIRS were associated with more multiple bypass runs than primary strategies of ROSS or AVR. Need for multiple runs did not influence survival or need for re-operation. After REPAIR, peak left ventricular outflow tract (LVOT) gradients were highly variable (figure). Some offered reasonable durability with peak LVOT w50 mmHg at 5-8 years, however recurrent stenosis was often evident within 2-3 years (figure). Overall, time-related LVOT gradients were significantly higher after REPAIR versus either AVR or ROSS (P1⁄4.04). ROSS offered the best long-term freedom from residual LVOT stenosis (figure). Long-term freedom from AI was comparable between REPAIR and ROSS: approximately 80% had mild+ or better AI at 8 years and 20% had moderate or worse. AVR offered the best freedom from AI. There have been no deaths. Estimated freedom from surgical re-operation is 74%, 100% and 63% at 5 years for REPAIRS, ROSS and AVR respectively (P1⁄4.05). 4 of 5 reoperations after AVR were for failed non-mechanical devices. CONCLUSION: Durability after aortic valve REPAIR for AI in children is unpredictable and this strategy may offer little benefit in off-setting need for ROSS or AVR. Small annular sizes as a driver for a REPAIR strategy (therefore allowing for continued annular-growth) seems incongruous, as mean annular dimensions were already favourable in the REPAIR group (mean 2.2 cm). Primary ROSS or AVR (in warfarintolerant teenagers) may be favourable over attempt at REPAIR. 233 CLINICAL OUTCOME SCORE PREDICTS ADVERSE NEURODEVELOPMENTAL OUTCOME AFTER INFANT HEART SURGERY

冠動脈バイパス術後にたこつぼ型心筋症を合併し治療に難渋した1例

冠動脈バイパス術後にたこつぼ型心筋症を合併し治療に難渋した1例

HEART's Original [症例] 一過性流出路狭窄を伴う冠攣縮誘発試験陽性たこつぼ心筋症にcarvedilolが有効であった1症例

HEART's Original [症例] 一過性流出路狭窄を伴う冠攣縮誘発試験陽性たこつぼ心筋症にcarvedilolが有効であった1症例

Modified Konno procedure: surgical management of tunnel-like left ventricular outflow tract stenosis

Left ventricular outflow tract stenosis represents 1-2 % of all congenital anomalies. In particular, tunnel-like left ventricular stenosis which is one type of fixed left ventricular outflow stenosis requires aggressive surgery to reduce the left ventricular outflow gradient. The purpose of the modified Konno procedure is to release fixed left ventricular outflow tract stenosis while preserving the native aortic valve and its function. Although the clinical results of the modified Konno procedure are acceptable, it is necessary to precisely understand this procedure and the anatomy of the left ventricular outflow tract in order to avoid complications.

Midterm Results of the Modified Ross/Konno Procedure in Neonates and Infants

The management of congenital aortic stenosis in neonates and infants continues to be a surgical challenge. We have performed the modified Ross-Konno procedure for patients who have severe aortic insufficiency or significant residual stenosis after balloon aortic dilation. The midterm results of this procedure were evaluated in this subset of patients. Between 1994 and 2010, a total of 24 patients younger than 1 year of age underwent the modified Ross-Konno procedure. The diagnoses were aortic stenosis with or without subaortic stenosis (n = 16), Shone's complex (n = 7), and interrupted aortic arch with subaortic stenosis (n = 1). The aortic root was replaced with a pulmonary autograft, and the left ventricular outflow tract (LVOT) was enlarged with a right ventricular infundibular free wall muscular extension harvested with the autograft. Age at operation ranged from 1 to 236 days (median 28 days). The median follow-up period was 81 months (range 1-173 months). There was 1 early death and no late mortality. Overall the 1-, 2-, and 5-year survival rate was 95% ± 4.5%. Freedom from aortic stenosis was 94.7% ± 5.1% at 1, 2, and 5 years. Less than mild aortic insufficiency was 93.3% ± 6.4% at 2 years, and 74.7% ± 12.9% at 5 years. In total, 23 reoperations and reinterventions were performed; 14 were allograft conduit replacements. Two patients required aortic valve plasty. None required valve replacement. The reintervention-free rate was 64.6% ± 10.8% at 2 years and 36.9% ± 11.3% at 5 years. Pulmonary autografts demonstrated good durability with low mortality and morbidity. This study shows that the modified Ross-Konno procedure can be a practical choice in selective cases for complex LVOT stenosis in neonates and infants.

A Model of Left Ventricular Dysfunction Complicated by CAWS Arteritis in DBA/2 Mice

It was reported previously that a Candida albicans water-soluble fraction (CAWS), including a mannoprotein and β-glucan complex, has strong potency in inducing fatal necrotizing arteritis in DBA/2 mice. In this study, histopathological changes and cardiac function were investigated in this system. One mg/day of CAWS was given to DBA/2 mice via peritoneal injection for five days. The CAWS-treated DBA/2 mice were induced aortitis and died at an incidence of 100% within several weeks. Histological findings included stenosis in the left ventricular outflow tract (LVOT) and severe inflammatory changes of the aortic valve with fibrinoid necrosis. Cardiomegaly was observed and heart weight increased 1.62 fold (P < 0.01). Echocardiography revealed a severe reduction in contractility and dilatation of the cavity in the left ventricle (LV): LV fractional shortening (LVFS) decreased from 71% to 38% (P < 0.01), and the LV end-diastolic diameter (LVDd) increased from 2.21 mm to 3.26 mm (P < 0.01). The titer of BNP mRNA increased in the CAWS-treated group. Severe inflammatory changes resulting from CAWS brought about lethal LV dysfunction by aortic valve deformation with LVOT stenosis. This system is proposed as an easy and useful experimental model of heart failure because CAWS arteritis can be induced by CAWS injection alone.

Long-term results of the REV (réparation à l’ètage ventriculaire) operation

Despite its innovative features, the réparation à l'ètage ventriculaire (REV) procedure has not gained large popularity in the treatment of transposition of the great arteries, ventricular septal defect, pulmonary stenosis, and related anomalies, and thus the Rastelli operation remains the preferred type of repair. We try to obviate the alleged lack of long-term results that has been suggested to explain this reluctance to change. We reviewed a series of 205 patients who underwent the REV procedure between 1980 and 2003. Hospital mortality was 12% (24 patients). Ten of 181 early survivors residing in distant countries could not be traced for follow-up. There were 13 late deaths (2 of noncardiac causes). Overall survival and freedom from any reoperation at 25 years were 85% and 45%, respectively, as determined by using the Kaplan-Meier method. Reoperation was commonly required because of recurrent right ventricular outflow tract obstruction (36patients) and rarely by left ventricular outflow tract stenosis (3 patients). By using cumulative method analysis, at the 25-year follow-up interval, the probability of being alive without reoperation was 45%, that of reoperation for right ventricular outflow tract obstruction was 33%, and that of reoperation for left ventricular outflow tract obstruction was 5%. Clinical status is excellent: 137 patients are in New York Heart Association class I (87%), and 131 patients are free of arrhythmias. These results represent a considerable improvement over those of the Rastelli operation in terms of survival and need for reoperation for right or left ventricular outflow tract obstruction.