Significant Outflow Tract Obstruction Research Articles

Cardiac Risk Score to Predict Small for Gestational Age Infants in Pregnant Women With Heart Disease

BackgroundOne of the most common fetal complications in pregnant women with cardiovascular disease is a small for gestational age (SGA) neonate, which is associated with a higher risk of perinatal morbidity/mortality and poor long-term health outcomes. The objective of this study was to identify cardiac determinants and derive a risk score for clinically relevant SGA < 5th percentile (SGA-5th). MethodsA prospective cohort of 1812 pregnancies in women with heart disease were studied. SGA-5th was the outcome of interest, defined as birth weight < 5th percentile for gestational age and sex. Multivariable logistic regression analysis was used to identify predictors for SGA-5th. Based on the regression coefficients, a weighted risk score was created. ResultsSGA-5th complicated 10% of pregnancies, 11 predictors of SGA-5th were identified, and each was assigned a weighted score: maternal cyanosis (8), Fontan palliation (7), smoking (3), moderate or severe valvular regurgitation (3), β-blocker use throughout pregnancy (4) or only in the 2nd and 3rd trimesters (2), high baseline β-blocker dose (4), body mass index < 18.5 kg/m2 (3) or 18.5-24.9 kg/m2 (1), Asian/other ethnicity (2), and significant outflow tract obstruction (1). In the absence of these identified risk factors, the risk of SGA-5th was approximately 4%. Pregnancies with risk scores of 1 had a rate of 5%; 2, 7%; 3, 9%; 4, 12%; 5, 14%; 6, 18%; 7, 23%; 8, 28%; and ≥ 9, 34%. ConclusionsThere are a number of cardiac predictors that are associated with increased risk of SGA-5th. This is a prognostically important outcome, and consideration should be given to routinely predicting and modifying the risk whenever possible.

Beta-Blockers in the Treatment of Cardiovascular Diseases

INTRODUCTION: The past several years have witnessed a increase throughout the world in the use of beta-blocking drugs for the management nf hypertension and angina.The role of the adrenergic nervous systeth in influencing the outflow tract obstruction from the left and right ventricles in obstructive cardio— myopathv is well established. In man, stimulat ion of the sympathetic nervous system produces significant outflow tract obstruction in obstructive cardiomyopathy, and leads to further ventricular hypertrOphy and then to more out flow tract ohstructian (Flamm et al., 1968)27. This vicious cycle may be interrupred by trearment with Beta-Blocking drugs: producing favourable alt eration in the racJjent between the left ventricle and aorta. CONCLUSION: In conclusion it may be said that many pharmacological aspects of Beta-B!ockers have been uncovered, hut its exact mode of action,, especially in hypertension, is not fully understoocL There are many advantages in the use of Beta Blockers in various fields of cardiovascular di!ieases, however, Beta-Blockers are active phar— macalogical agents and their use should he made judiciously and carefully. period of time. Needless to say that like all new drugs about which we start with a lot of enthusiasm, we should keep a watch as to the corn— p1ictions whtat may arise with these agents over prolonged period of treatment and this should be done by all doctors who are maintaining their patients on long—term therapy with Beta—Blockers.

Double-chambered right ventricle presenting significant outflow tract obstruction only in the right decubitus position.

A 75-year-old man was referred to our echocardiography laboratory for presurgical evaluation. His past history included ventricular septal defect closure. He reported chest discomfort in the right decubitus position. Two-dimensional and Doppler echocardiography revealed an anomalous muscle bundle with accelerated blood flow in the right ventricle. The peak flow velocity of the flow increased from 1.4m/s in the left decubitus position to 2.9m/s in the right decubitus position. Double-chamber right ventricle with intermittent mid-ventricular obstruction during the right decubitus position was confirmed by transesophageal echocardiography.

Cardiac magnetic resonance characteristics of pediatric Cardiac Teratoma

5 day old term female with prenatal history of an intracardiac tumor followed by a post-natal echocardiography indentifying a large cystic mass compressing both ventricles, but without significant outflow tract obstruction. Cardiac MRI imaging showed a very large ventricular septal cystic mass most consistent with a primary cardiac teratoma causing mild LVOT obstruction.

Langzeitverlauf nach perkutaner Septumablation bei hypertropher obstruktiver Kardiomyopathie

Persisting disabling symptoms despite optimal medical treatment in patients with hypertrophic cardiomyopathy and significant outflow tract obstruction prompt surgical or interventional therapy targeted at relief of obstruction. While surgical treatment was introduced more than 40 years ago, there are only a few data on the long-term results of percutaneous septal ablation. This study gives the results of a large number of patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal ablation in our institution. 347 patients (156 females, 191 males, 54 +/- 15 years) in NYHA functional class III or IV, or in class II but with evidence of more severe limitation on exercise testing, underwent percutaneous transluminal septal myocardial ablation (PTSMA). Mortality and morbidity, as well as clinical and echocardiographic parameters were assessed during follow-up, either at our institution, or by the referring cardiologist. During an average follow-up of 58 +/- 35 months the overall mortality was about 1,8 % per year, with a cardiovascular-related mortality of about 1 % per year. 8 % of patients needed a second procedure. A significant and sustained improvement of symptoms (89 % patients were in NYHA class I or II a follow-up) and obstruction were demonstrated (74 % of patients were free from obstruction at rest, 60 % did not exhibit provokable gradients). Supraventricular arrhythmias, especially atrial fibrillation, were observed in 12 % of patients. Percutaneous septal ablation provides significant and sustained beneficial effects on symptoms and echocardiographic variables, without evidence of an excess mortality. But independently of the clinical success of the procedure persistence of the underlying structural heart disease should be kept in mind. Periodic re-evaluation is mandatory to identify and treat high-risk patients.

Can septal myectomy prevent sudden cardiac death in hypertrophic obstructive cardiomyopathy?

We would like to thank Dr Efthimiadis, and his colleagues for their interest in our study1 and their critical reflection on the relationship between surgical myectomy and implantable-cardioverter defibrillator (ICD) discharge in hypertrophic cardiomyopathy (HCM). The surgical myectomy has been demonstrated to be the ‘gold-standard’ in therapy for those symptomatic patients with drug-refractory HCM with significant outflow tract obstruction. Although significant improvements in haemodynamics, symptoms, morbidity, and mortality have been …

Early results of single-stage biventricular repair of severe aortic hypoplasia or atresia with ventricular septal defect and normal left ventricle

Biventricular repair of aortic atresia (or severe aortic hypoplasia) is possible in the presence of a ventricular septal defect and normal left ventricle. We considered whether primary biventricular repair was a safe alternative in all cases, even in the presence of interrupted aortic arch. This was a retrospective analysis of patients who underwent primary biventricular repair consisting of a combination Norwood-type reconstruction of the aortic arch, baffle of the left ventricle to both semilunar roots, and conduit placement from the right ventricle to pulmonary arteries. Between January 1995 and January 2005, a total of 21 patients underwent primary biventricular repair at a median age of 5 days and a median weight of 3.0 kg. Aortic atresia was present in 7 and aortic stenosis in 14; 6 had interrupted aortic arch. All patients with aortic stenosis had annular diameters 3 mm or smaller. Median circulatory arrest time was 55 minutes, aortic crossclamp time was 56 minutes, and total support time was 99 minutes. In-hospital survival was 100%. Postoperative echocardiography in 19 patients demonstrated no significant outflow tract obstruction. Total stay was a median of 17 days. At midterm follow-up, there has been 1 late death, and reoperation has been necessary in 10 cases. Primary biventricular repair is a safe alternative to staged repair in all cases of aortic hypoplasia with ventricular septal defect and normal left ventricle.

Resection of an Obstructive Neonatal Cardiac Myxoma of the Infundibulum

Myxoma, the most common primary cardiac tumor in adults, is rare in neonates. We describe a myxoma arising from the infundibulum of the right ventricle causing significant outflow tract obstruction in an otherwise normal newborn. Serial echocardiograms revealed an increasing gradient across the right ventricular outflow tract prompting surgery. The patient underwent successful excision of the myxoma with an uneventful recovery.

Biologic reconstruction of the right ventricular outflow tract: Preliminary experimental analysis and clinical application in a neonate with type I truncus arteriosus

A unique concept of right ventricular outflow tract reconstruction is presented. Applications of this concept, employing a glutaraldehyde-preserved heterograft mitral valve leaflet mounted directly to the right ventricle, was studied in six immature goat models. Interval evaluation of these models demonstrated no significant outflow tract obstruction or aneurysm. Only one animal had significant pulmonary outflow regurgitation angiographically at the time of sacrifice. All heterograft valve leaflets showed a degree of calcification and/or retraction directly related to the time interval between implant and sacrifice. Encouraging early results were obtained with this method of pulmonary outflow tract reconstruction in a 2,400 gram neonate with type I truncus arteriosus.

Pressure gradients without obstruction. A new concept of "hypertrophic subaortic stenosis".

Summary and Conclusions Significant outflow tract obstruction was notseen byleft ventricular cineangiocardiography in seven patients with hypertrophic subaorticstenosis.Catheter withdrawals through the leftventricle, recorded cinefluorographically, lo-calized the high pressure areas to portions ofthe left ventricle which emptied completely in early systole. Sustained systolic contractionin empty portions of the left ventricle pro-vides an explanation for the pressure gradi-entsinthesepatients.Isoproterenol infusions increased the rate and degree of left ventricular emptying, ob-literating portions of the cavity earlier andincreasingthepressure gradient.Themechanismof gradient production with- out obstruction was similar to the phenome-non observed in dogs receiving isoproterenol infusions. The cardiac muscle in these patients is ab-normally thick and the left ventricle emptiesmorerapidly than normal; therefore a hyper- trophic hyperkinetic cardiomyopathy is present.The nonobstructive