Significant Ventricular Septal Defect Research Articles

The Correlation between Serum Level of NT-Pro Brain Natriuretic Peptide and Hemodynamically Significant Ventricular Septal Defects

Abstract Background Ventricular septal defect (VSD) is the most common congenital heart disease accounting for 40% of all congenital heart diseases. An isolated VSD accounts for more than 20% of all congenital heart diseases. Aim of the Work We aimed in this study to correlate the serum level of NT Pro-BNP with different 2D and 3D variables and the hemodynamic significance of ventricular septal defects including LV volumes, dimensions, functions and left to right shunt quantification (Qp/Qs) measured by 2D echocardiogram. Patients and Methods Our study included 60 patients in the pediatric age group (up to18 years old) who were referred for elective echocardiogram in the congenital and structural heart disease unit cardiology department in Ain Shams University hospital. Patients with VSD were divided into three equal subgroups according to shunt quantification (Qp/Qs): group (1) included patients with (Qp/Qs <1.5), group (2) included patients with (Qp/Qs>1.5-2) and group (3) included patients with (Qp/Qs >2). Results There was a highly significant positive correlation between Pro-BNP level and echocardiographic shunt quantification by QP_QS (p < 0.001). And there was a highly significant positive correlation between Pro-BNP and echocardiographic VSD Size (r = 0.8) & Mean. PAP (0.8). A highly significant positive correlation between Pro-BNP and indexed LVEDV and indexed LVESV by 2D and 3D echocardiography was also noticed. Also there was a highly significant negative correlation between Pro- BNP and EF by m mode and a significant negative correlation with LV EF by Simpsons method and LV EF by 3D echocardiography. In our study with ROC curve analysis a cut-off point of discriminating patients with QP/QS <1.5 from those >1.5 was 98 pg/ml that had the highest balanced sensitivity and specificity to predict significant shunt with sensitivity = 97.5 % and specificity = 90 %. Conclusion Pro-BNP level correlates with the amount of left to right shunt (Qp/Qs ratio) in children with VSD. Therefore, pro-BNP can be used as a screening tool for evaluating hemodynamic load in these patients.

Incidence and Antenatal Detection of Congenital Heart Malformations-Data from a Tertiary Obstetric Romanian Center.

Congenital heart defects (CHDs) are among the most frequent congenital defects, and they significantly burden the healthcare system due to their high mortality rate and high cost of care for survivors. We aimed to highlight the incidence of CHDs in a tertiary center in Western Romania. A retrospective study was carried out between 2018 and 2022 at the "Pius Brinzeu" Emergency County Hospital Timisoara. Relevant information about the mothers and the newborns were collected and statistically analyzed. The incidence of CHDs from 2018 to 2022 in our center was 5.3%. Eleven types of malformations were diagnosed postnatally in 541 newborns, with 28.8% of cases having more than one type of CHD. The antenatal detection rate was 28%, with the highest rates for tetralogy of Fallot, hypoplastic left heart syndrome, or significant ventricular septal defects and the lowest for pulmonary stenosis. The lower antenatal detection rate was influenced mainly by incomplete or absent prenatal care. The incidence of CHDs is clearly dependent of a multifactorial approach, and the results highlight this. With an incidence almost 50% lower than reported within the literature and a low rate of prenatal detections, CHDs could be a more of a burden to endure regarding medical treatment. Improvements in patients' education, prenatal care, and screening programs could improve diagnosis, decrease mortality, and optimize postnatal care.

Percutaneous Closure of Hemodynamically Significant Postoperative Residual Ventricular Septal Defects.

The experience with percutaneous closure of postoperative residual ventricular septal defects (VSDs) is expanding with improved device technology and techniques. To report our experience with percutaneous closure of residual VSDs after cardiac surgeries. Retrospective clinical data review of patients who had percutaneous closure of postoperative residual VSDs at our institution between 2010 and 2022. Patients' demographics, procedural, and follow-up data were looked at. Twelve patients (50% males) with a median age of 9.2years (range 0.9-22) were identified. Baseline surgeries were 8 tetralogy of Fallot corrections, 2 pulmonary bandings for large muscular VSD (mVSD) including 1 coarctation repair, 1 atrioventricular septal defect repair, 1 sub-aortic membrane resection-induced iatrogenic VSD, 1 isolated VSD closure, and 1 additional mVSD. Median duration between baseline surgery and percutaneous VSD closure was 2.2years (range 0.2-8.3). Residual VSD shunting was secondary to surgical patch leakage in 8/12 patients. The median angiographic defect diameter was 6.8mm (range 4.8-14). The defect was balloon-calibrated in 3/12 patients. Defects were tackled retrogradely in 3/9 patients. Amplatzer Membranous VSD occluder (n = 1), Lifetech Multifunctional (n = 5), Membranous (n = 1) and muscular VSD occluders (n = 2) and Occlutech Membranous (n = 1) and Muscular (n = 2) VSD occluders were used. The procedure was successful in 10/12 patients. Two devices embolized to the pulmonary artery and were snare-retrieved. Both patients were referred for surgery. The median follow-up was 1.3years (range 0.1-12). Six-month ultrasound showed one trivial residual shunt and one mild right ventricular outflow obstruction. One patient is receiving targeted therapy for pulmonary hypertension at 2years of follow-up. Transcatheter closure of postoperative residual VSDs is a feasible yet challenging intervention. Procedural complications can be encountered.

Long-Term Results Following Combined Repair of Atrioventricular Septal Defect with Tetralogy of Fallot.

Atrioventricular septal defect (AVSD) in association with tetralogy of Fallot (TOF) is a rare and complex congenital cardiac malformation. We report our institutional experience and outcomes following surgical correction over a 20-year period. Patients who underwent combined surgical AVSD and TOF correction between October 2001 and February 2020 were included for analysis. All patients underwent primary repair. The study data were prospectively collected and retrospectively analyzed. Primary outcomes were in-hospital mortality and long-term freedom from reoperation. During the study period, a total of 10 consecutive patients underwent combined surgical AVSD and TOF correction. Median age at operation was 307days (IQR 228-457) and median weight was 7.7kg (IQR 6.7-9.5). Down Syndrome was present in six of the patients. In-hospital mortality was 0%. One patient required re-exploration due to bleeding. Median follow-up was 11years (IQR 11months -16years). There was one case of reoperation due to significant residual ventricular septal defect after 2 months. None of the patients died during follow-up. Combined primary AVSD and TOF repair can be performed with low early mortality and morbidity, as well as a high long-term freedom from reoperation.

The V-shaped double-layer patch technique for complete atrioventricular septal defect: A novel surgical technique.

Several surgical techniques for repair of a complete atrioventricular septal defect have been developed. However, the postoperative complications with these methods may lead to reoperation during follow-up. The aim of this report is to share our experience with a modified surgical technique for complete atrioventricular septal defect that has anatomic advantages postoperatively and could reduce the reoperation rate. Twenty-nine patients who underwent repair of complete atrioventricular septal defect using a V-shaped double-layer patch between April 2011 and September 2019 were retrospectively investigated. There were no deaths (0%) and only 1 reoperation (3.4%) in the series. The aortic crossclamp and cardiopulmonary bypass times were 62.7±16.0minutes and 113.9±25.9minutes, respectively. The median follow-up duration was 5.1years. To date, no significant residual ventricular septal defects have been detected and no left ventricular outflow tract obstruction has been seen on echocardiography in any patient. During follow-up, the left atrioventricular valve status was assessed as no incompetence in 9 patients (31.0%), trivial in 18 patients (62.1%), and mild in 2 patients (6.9%). The V-shaped double-layer patch technique is a valuable surgical option for patients with complete atrioventricular septal defects. The midterm results in our series document excellent performance of this technique, which augments the area of the anterior valve of the left atrioventricular valve to make it closer to a normal mitral valve and may also reduce the need for reoperation.

Situación Fallot reparada en la edad adulta: resultados de 3 décadas de experiencia

IntroductionWe define “Fallot situation” as the existence of significant ventricular septal defect and right ventricular outflow obstruction. Survival into adulthood is extremely rare without complete surgical repair. We present our experience operating these adults. MethodsWe consider complete surgical repair in Fallot adult patients if they have pulmonary arteries with adequate size. Retrospective study: 45 Fallot patients operated from 1993 to 2022 in our adult congenital heart unit. Statistical analysis: SPSS® 20.0. ResultsMean age: 37±13 years, 53% male, 18% prior palliation. Principal diagnosis: double chamber right ventricle+ventricular septal defect (60%), tetralogy of Fallot (27%). NYHA functional class: i 31%, ii 38%, iii 31%. Arrhythmia 20%. Mean hematocrit: 48±10%. Associated left pulmonary artery agenesis 7%, severe aortic regurgitation 7%. Main surgical indication was pulmonary stenosis 98%. Additional tests showed high gradients between the right ventricle and pulmonary artery, and good biventricular function. Surgeries were performed by median sternotomy with cardiopulmonary bypass, moderate hypothermia and aortic clamp. Ventricular septal defect was closed through the right atrium (71%). Reconstruction of the right ventricle outflow tract was done by preserving the pulmonary valve (80%), interposing bioprosthesis (16%), and using transannular patch (4%). Associated surgery (18%): tricuspid (one), aortic (6), anomalous pulmonary venous drainage (one). Inhospital mortality: one patient (2,2%). Mean follow-up: 8.9±7.6 years. Late mortality: 2 patients (4.5%). Reintervention: 7 patients (15%) because of residual lesions (3 percutaneous, 5 surgical). Nowadays, functional class: i 68%, ii 28%, iii 4%; sinus rhythm 83%. ConclusionsComplete surgical repair in adulthood of Fallot patients achieves clinical improvement by eliminating the cyanosis, closing intracardiac shunts, and decreasing right ventricular pressure overload. Our results are excellent with good rates of pulmonary annulus preservation, low mortality and acceptable reintervention rate in the follow up.

Experiences of Two Centers in Percutaneous Ventricular Septal Defect Closure Using Konar Multifunctional Occluder.

BackgroundTranscatheter closure of perimembraneous ventricular septal defect still poses a challenge due to the adjacent structures of the tricuspid and aortic valves and the risk of atrioventricular block. We report our experience at 2 centers using the KONAR-MF (multifunctional occluder) ventricular septal defect device, which gained its CE mark in May 2018.Methods A retrospective study was carried out on all patients who underwent transcatheter ventricular septal defect closure with the KONAR-MF (multifunctional occluder) ventricular septal defect device at 2 centers.Results A total of 47 patients were identified. The median age and weight of the patients were 25.8 months and 11 kg. The ventricular septal defects that were closed in 5 cases were post-operative hemodynamically significant residual ventricular septal defects. Forty-eight devices were used in the 47 cases. As for the location of the ventricular septal defect, 40/48 (83.33%) ventricular septal defects were perimembranous and 8/48 (16.66%) were muscular. The percutaneous device closure was successful in 46 procedures (95.8%). Device embolization was observed in 2 patients, and a significant residual shunt was observed in 2 cases. In the follow-up, there was no enhancement in the residual shunt in the remaining cases. Temporary atrioventricular block occurred in 2 cases during the procedure and improved after long sheath withdrawal.Conclusion Soft, flexible, and low-profile KONAR-MF (multifunctional occluder) occluders ensure easy and safe implantation, and small sheath sizes allow for their use in small infants. Although near and mid-term follow-ups did not indicate any permanent atrioventricular block, a larger sample of patients and a longer follow-up period is necessary to understand long-term outcomes.

Analysis of six cancer patients with persistent left superior vena cava identified during central venous access device placement via an intracavitary electrocardiogram.

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.

Dilatable pulmonary artery banding for ventricular septal defect: surgical technique and case report of three cats

Pulmonary artery banding (PAB) is a viable but underreported palliative option for hemodynamically significant ventricular septal defect in small animals. A significant challenge associated with PAB is judging the degree of band tightening, which can be further complicated when animals are immature and still growing at the time of PAB. If a pulmonary artery band is overtightened or becomes progressively too tight after surgery, the result can be reversal of shunt flow with potentially devastating consequences. Placement of a band that could be percutaneously dilated using a balloon catheter affords a minimally invasive option for partially or completely relieving the band should it become too tight after PAB. This report describes a surgical technique for placement of a dilatable pulmonary artery band, reviews guidelines for tightening the band, and reports the outcome of three cats undergoing the procedure. All three cats showed evidence of reduced hemodynamic load after PAB for a period of up to three years after PAB.

Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo-aortic root dilatation.

AbstractObjectivesDocumentation of semilunar valve growth in fetal transposition of the great arteries (TGA) and the relationship between neo‐aortic root (NAoR) dilatation, a cause for postoperative reinterventions after the arterial switch operation (ASO), and pulmonary valve (PV) annulus dimensions prenatally.MethodsThis retrospective multicenter observational study included TGA fetuses suitable for ASO. Semilunar valve annuli pre‐ASO and NAoR diameters (post‐ASO) were measured. Trends in annulus diameters were analyzed using a linear mixed‐effects model and compared with normal values. Prenatal semilunar valve Z‐scores were correlated with NAoR diameters post‐ASO.ResultsWe included 137 TGA fetuses (35.8% with significant ventricular septal defects [VSDs]). One hundred twenty‐one underwent ASO. Fetal TGA‐PV diameters were significantly larger than control aortic valve (AoV) and PV annuli from 23 and 27 weeks, respectively, especially when a VSD was present. Fetal TGA‐AoV annuli were significantly larger than control AoV and PV annuli from 26 and 30 weeks, respectively.Z‐scores of fetal TGA‐PV and NAoR diameter at last follow‐up correlated significantly (P < .001 at 26‐30 wk).ConclusionFetal TGA semilunar valve annuli are larger than control annuli, especially when there is a significant VSD. Factors besides postoperative hemodynamics, including fetal anatomy, PV Z‐score, prenatal flow, connective tissue properties, and genetics, may influence the risk for late reintervention in these fetuses.

Surgical treatment of anomalous left main coronary artery with an intraconal course.

Anomalous left main coronary artery (LMCA) with an intraconal course is a relatively rare form of anomalous aortic origin of a coronary artery (AAOCA) from the wrong sinus of Valsalva. There is currently a paucity of information regarding this entity. The purpose of this article is to review our surgical experience with repair of anomalous LMCA with an intraconal course. This was a retrospective review of 12 patients with an anomalous LMCA and an intraconal course who underwent surgical repair. The median age at surgery was 15years (range 2-47). The seven oldest patients all had preoperative symptoms of exertional chest pain and one also had exertional syncope. The five youngest patients had no preoperative symptoms. One of these patients had a hemodynamically significant ventricular septal defect and one patient was the sibling of a patient who had undergone repair of AAOCA. The 12 patients underwent surgical repair including unroofing of the myocardial bridge overlying the intraconal LMCA and a LeCompte procedure. There was no early or late mortality and there were no significant complications. All 12 patients have resumed normal, unrestricted activities. Twelve patients with an anomalous LMCA and intraconal course presented to our institution for treatment. Surgical repair was performed successfully in all 12, with resolution of symptoms in the 7 patients who were symptomatic preoperatively. These results suggest that the surgical treatment is safe and efficacious in patients with an anomalous LMCA and intraconal course.

Off-label use of duct occluder devices to close hemodynamically significant perimembranous ventricular septal defects: A multicenter experience.

We sought to evaluate the feasibility, technical aspects, and outcome of transcatheter perimembranous ventricular septal defect (pmVSD) closure using duct occluder devices with a single retention disc. Use of duct occluder devices to close pmVSD seems a promising alternative therapy. However, limited data exist on this technique. From 2010 to 2016, 222 patients (female 47.7%) were identified from databases of five participating institutions in whom pmVSD closure was attempted using an Amplatzer Duct Occluder I or Lifetech duct occluder device. Patients ranged in age from 0.7 to 52 years (median, 7.0 years) and in weight from 4.0 to 70 kg (median, 18.0 kg). The mean size of the VSD was 6.8 ± 2.2 mm. A large defect (> 6 mm) was present in 137 patients (61.7%). Device closure was successful in 218 patients (98.2%). The 10/8 mm device was used in most patients (n = 85, 38.3%), and the vascular approach was from the femoral vein in 169 patients (76.1%). There were 18 early complications in 17/218 patients (7.8%). Three patients (1.4%) developed complete heart block (transient n = 2; requiring permanent pacing n = 1). Median follow-up was 6 months (6 months-6 years). A mild residual shunt was seen in 10 patients at 6 months follow-up. The immediate results of transcatheter pmVSD closure using a duct occluder device with a single retention disc are promising. It is an effective technique with a lower rate of complications than for other currently available devices.

Longitudinal Strain and Strain Rate in Patients With Hemodynamically Significant Ventricular Septal Defects

Patients with significant overcirculation from large ventricular septal defects (VSDs) may have altered contractility compared to normal patients. Patients were enrolled prospectively. Patients were excluded if they were acutely ill or over age five. Left ventricular longitudinal strain and strain rate were measured in patients with VSDs referred for surgical correction and control participants with structurally normal hearts. There was no difference in the average longitudinal strain or strain rate of six segments in the left ventricle. The mean for both the groups was 19.9% (P = .95). Strain rate was 1.5 s(-1) in the patients with a VSD and 1.42 s(-1) in the control group (P = .30). The left ventricular end diastolic dimension was significantly larger in the group with ventricular defects (z score 1.38 vs -0.37) than the control group (P = .000). The left ventricle end-diastolic dimension in patients with ventricular defects was significantly larger, but there was no difference in longitudinal strain or strain rate.

When Side Matters

An 8-year-old boy underwent surgical ventricular septal defect closure and tricuspid valvuloplasty. At 25 years of age, he underwent percutaneous closure of a hemodynamically significant residual ventricular septal defect with a 16-mm muscular ventricular septal defect Amplatzer occluder. Three years later, he experienced an ischemic stroke in the right sylvian area. He underwent complete investigation to look for ischemic causes and transesophageal echocardiography to rule out a cardioembolic source. No thrombus was seen either on the ventricular septal defect device …

Does the technique of interventional closure of perimembranous ventricular septal defect reduce the incidence of heart block?

To describe the difficulties and differing techniques in the transcatheter placement of amplatz ventricular septal defect devices to close perimembranous ventricular septal defects and place these in the context of the expanding literature on ventricular septal defect catheter closure. Surgery remains the established first-line therapy for closure of haemodynamically significant perimembranous ventricular septal defects. Transcatheter techniques appeared to promise a possible alternative, obviating the need for cardiac surgery. However, significant technical and anatomical constraints coupled with ongoing reports of a high incidence of heart block have prevented these hopes from being realised to any significant extent. It is likely that there are important methodological reasons for the high complication rates observed. The potential advantages of transcatheter perimembranous ventricular septal defect closure over surgery warrant further exploration of differing transcatheter techniques. Between August, 2004 and November, 2009, 21 patients had a perimembranous ventricular septal defect closed with transcatheter techniques. Of these, 14 were closed with a muscular amplatz ventricular septal defect device. The median age and weight at device placement were 8 years, ranging from 2 to 19 years, and 18.6 kilograms, ranging from 10 to 21 kilograms, respectively. There were 25 procedures performed on 23 patients using 21 amplatz ventricular septal defect devices. Median defect size on angiography was 7.8 millimetres, ranging from 4 to 14.3 millimetres, with a median device size of 8 millimetres, ranging from 4 to 18 millimetres, and a defect/device ratio of 1.1, with a range from 0.85 to 1.33. Median procedure time was 100 minutes, with a range from 38 to 235 minutes. Adverse events included device embolisation following haemolysis in one, and new aortic incompetence in another, but there were no cases of heart block. Median follow-up was 41.7 months, with a range from 2 to 71 months. Evaluating transcatheter closure of perimembranous ventricular septal defect using amplatz ventricular septal defect devices remains important, if a technically feasible method with low and acceptable complication rates is to be identified. Incidence of heart block may be minimised by avoiding oversized devices, using muscular devices, and accepting defeat if an appropriately selected device pulls through. Given the current transcatheter technologies, the closure of perimembranous ventricular septal defects should generally be performed in children when they weigh at least 10 kilograms.

Treatment of Isolated Ventricular Septal Defects in Children: Amplatzer Versus Surgical Closure

Isolated hemodynamically significant ventricular septal defects (VSD) were previously treated surgically. Since the introduction of percutaneous (PC) devices, the management of isolated VSD has evolved. In our center, Amplatzer devices have been implanted for selected isolated perimembranous VSD since 2002. The charts of all isolated PC perimembranous VSD closures and all surgical closures performed since 2002 were reviewed retrospectively. Clinical, electrocardiographic, and echocardiographic data were analyzed. The preclosure, immediate postclosure, and 1-month, 6-month, and 12-month postclosure results were assessed. Thirty-seven patients underwent PC closure, and 34 had surgical treatment. Mean follow-up was 42.1 ± 26.0 months. The PC group was significantly older (p < 0.01) and larger in size (p < 0.001). Surgical patients had more severe congestive heart failure and a significantly lower VSD gradient (p < 0.004). At follow-up, there were no differences in the incidence of residual shunting between the two groups (p = 0.92). All valvular regurgitations improved over time, except for 3 aortic regurgitations (5.4%) in the PC group that got worse. Two permanent pacemakers were implanted for early complete heart block in the PC group, and one was implanted in the surgical group (p = 0.94). The surgical results in our population were excellent. The selection of patients with perimembranous VSD remains a challenge to avoid post-PC intervention complications such as heart block and aortic insufficiency. For isolated VSD, PC closure, which avoids the morbidity of open heart surgery, should be considered as part of the therapeutic armamentarium.

307 Contemporary treatment of isolated vsd in children: amplatzer vs surgical closure

Isolated hemodynamically significant Ventricular septal defects (VSD) were once solely surgical lesions. Since the introduction of percutaneous devices, the management of isolated VSD has evolved. In our center, Amplatzer devices have been implanted since 1998 and for selected isolated perimembranous and muscular VSD since 2002. We therefore reviewed our institutional practice selectively using percutaneous and surgical approaches. We retrospectively reviewed clinical, electrocardiographic and echocardiographic data of all isolated percutaneous and surgical VSD closures since 2002. Pre-operative (preop), immediate post-operative (postop) in addition to 1 month, 6 month and annual postop results were studied. The following table summarizes demographic data: 37 patients who underwent percutaneous closures and 34 who treated surgically, mean follow-up 42 months. Percutanous group were older ( p < 0.01 ) and bigger ( p<0.001 ). The VSD gradient preop was lower in the surgical group ( p < 0.004 ), thus patients were in greater clinical heart failure. There was no mortality in either group. At follow-up there were no differences in the incidence of residual VSD ( p = 0.34 ). 2 patients with perimembranous VSD and pre-existing aortic valve deformity increased its level to moderate post-Amplatzer implantation versus none in the surgical group ( p = 0.45 ). A permanent pacemaker was implanted for complete heart block following post device closure of a perimembranous VSD in one patient and none in the surgical group. The surgical results are excellent in this sicker patient population, as reported in the literature. Patient selection remains a challenge to avoid post-percutaneous intervention complications such as heart block and aortic insufficiency in the perimembranous VSD patients. Percutaneous closure of isolated VSD, which avoids some morbidity of open heart surgery should however remain part of the therapeutic armamentarium. Results table Amplatzer group median (min-max) Surgical group median (min-max) P value Age (year) 12,83 (0,67-21,33) 1,41 (0,16-5,66) p<0,001 Weight (Kg) 24,6 (5,35-77,9) 5,00 (4,1-18,5) p<0,001 VSD size (mm) 5,7 (2,1-19) 11,00 (9,00-12,00) p<0,02 VSD Gradient (mmHg) 87 (54-138) 33 (25-66) p<0,004 LVEF (%) 59 (52,21-68,87) 60 (56,42-72,52) NS CPB duration (min.) N.A. 78,5 (70-150) - Aortic cross-clamp (min.) N.A. 55,5 (36-125) - Device size (mm) 8 (6-14) N.A. -

Spontaneous improvement of a haemodynamically significant ventricular septal defect produced by blunt chest trauma in a child

We describe the progress of a girl aged 5 years, who suffered blunt trauma to the chest producing a ventricular septal defect of 1 centimetre in diameter. The shunt generated a mild dilation of the left-sided chambers, and exertional dyspnoea. Three months later, therapeutic catheterisation revealed important diminution in the extent of shunting. We decided, therefore, not to close the defect, and she has since remained asymptomatic.

Signal-Averaged Electrocardiogram May Be a Beneficial Prognostic Procedure in the Postoperative Follow-Up Tetralogy of Fallot Patients to Determine the Risk of Ventricular Arrhythmias

Early detection of arrhythmias after congenital heart disease surgery is important because it can help decrease morbidity and mortality. Standard electrocardiograms (ECGs) contain frequencies between 0.05 and 100 Hz, but higher frequencies are also present. Using high-resolution technology, the highest amplitudes of these high-frequency components within the QRS complex can be recorded and analyzed. We studied the relationship between ventricular late potentials, ventricular arrhythmias and right ventricular systolic pressure in 22 patients who underwent tetralogy of Fallot repair (mean follow-up, 40.1 +/- 33.5 months). Holter ECG monitoring and signal-averaged electrocardiograms (SAECGs) were performed. SAECG parameters studied included the duration of the filtered QRS, the duration of terminal QRS below 40 muV, and the root mean square amplitude of the terminal 40 msec. Cardiac catheterization was performed on 19 patients. Eighteen healthy volunteers were studied as a control. Ventricular arrhythmias were found in 13 patients; right ventricular systolic hypertension was found in 1 patient. No significant residual ventricular septal defects were detected. Eight patients had ventricular late potentials. Right ventricular systolic pressure did not differ significantly between patients with or without late potentials. There were significant differences between patients with ventricular arrhythmias and healthy volunteers; filtered QRS duration was significantly longer in patients with ventricular arrhythmias. SAECG may be beneficial in determining ventricular arrhythmia risk in tetralogy of Fallot patients postoperatively.

Atrioventricular Canal: Modified Single Patch Technique

A single surgeon experience using a modified single patch technique for the repair of 128 patients with complete atrioventricular canal is presented. Thirty-day mortality was 1.6%. Follow-up of these patients has shown no incidence of significant residual ventricular septal defect, a 2.3% incidence of reoperation on the mitral valve, and no instances of left ventricular outlet obstruction requiring resection in the follow-up period. Comparisons are drawn between these results and the author's own experience with repair of complete atrioventricular canal using a two-patch technique (46 cases) and repair of partial atrioventricular canal (126 cases) to shed light on late valve function and left ventricular outlet obstruction in all groups.