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Heart valve sizing in children

George M Alfieris, Michael F Swartz, Juan Lehoux, Edward L Bove
BACKGROUND: The optimal choice for pulmonary valve replacement (PVR) remains controversial. This study hypothesized that xenografts used for PVR would result in prolonged long-term survival and freedom from reoperation. METHODS: Children and adults with congenital heart disease requiring PVR using a xenograft from 1980 to 1985 were reviewed. In all cases, the xenograft valve was either sewn or manufactured into a Dacron conduit, and the conduit was sewn to the pulmonary artery bifurcation...
August 2016: Annals of Thoracic Surgery
H M Gardiner, A Kovacevic, G Tulzer, T Sarkola, U Herberg, J Dangel, A Öhman, J Bartrons, J S Carvalho, H Jicinska, V Fesslova, I Averiss, M Mellander
OBJECTIVES: Fetal aortic valvuloplasty (FV) aims to prevent fetal aortic valve stenosis progressing into hypoplastic left heart syndrome (HLHS), which results in postnatal univentricular (UV) circulation. Despite increasing numbers of FVs performed worldwide, the natural history of the disease in fetal life remains poorly defined. The primary aim of this study was to describe the natural history of fetal aortic stenosis, and a secondary aim was to test previously published criteria designed to identify cases of emerging HLHS with the potential for a biventricular (BV) outcome after FV...
September 2016: Ultrasound in Obstetrics & Gynecology
Julie Cleuziou, Keti Vitanova, Jelena Kasnar-Samprec, Jürgen Hörer, Rüdiger Lange, Christian Schreiber
OBJECTIVES: Small-sized homografts are rare but may be required for the reconstruction of the right ventricular outflow tract (RVOT). Down-sizing adult-sized homografts can be an option to overcome the shortage of availability. METHODS: Since 1994, we have been down-sizing adult-sized homografts by excising one cusp. The aim of the study was to analyse the durability of down-sized homografts and compare it with small-sized homografts in a paediatric population. All patients below a body weight of 14 kg were included in the study...
May 2016: European Journal of Cardio-thoracic Surgery
Massimiliano Cantinotti, Raffaele Giordano, Marco Scalese, Bruno Murzi, Nadia Assanta, Isabella Spadoni, Maura Crocetti, Marco Marotta, Sabrina Molinaro, Shelby Kutty, Giorgio Iervasi
BACKGROUND: Pediatric echocardiographic nomograms for systolic/diastolic functional indices are limited by small sample size and inconsistent methodologies. Our aim was to establish pediatric nomograms for mitral valve (MV) pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI) velocities. METHODS: We performed PWD/TDI measurements of MV velocities and generated models testing for linear/logarithmic/exponential/square root relationships. Heteroscedasticity was accounted for by White test or Breusch-Pagan test...
October 2016: Journal of Cardiology
Simon J Sonntag, Maximilan Kütting, Pejman Farhadi Ghalati, Tim Kaufmann, Jaime Vázquez-Jiménez, Ulrich Steinseifer, Janez Vodiskar
PURPOSE: Implanting the largest valved conduit possible - oversizing - to reconstruct an absent connection from the right ventricle to the pulmonary artery in certain types of congenital heart defects has been suggested as a compensating measure for somatic outgrowth of the patient. However, one effect that has not been investigated yet is the hemodynamic consequence. For this purpose, virtual implantation and flow simulations were conducted in this study. METHODS: To isolate the effects of conduit oversizing on the hemodynamics observed after conduit implantation and outgrowth, calculated wall shear stresses (WSS) of image-based computational fluid dynamic (CFD) simulations were used as indicators...
October 2015: International Journal of Artificial Organs
Luigi P Badano, Marcelo H Miglioranza, Thor Edvardsen, Alexandre Siciliano Colafranceschi, Denisa Muraru, Fernando Bacal, Koen Nieman, Giacomo Zoppellaro, Fabiana G Marcondes Braga, Thomas Binder, Gilbert Habib, Patrizio Lancellotti
The cohort of long-term survivors of heart transplant is expanding, and the assessment of these patients requires specific knowledge of the surgical techniques employed to implant the donor heart, the physiology of the transplanted heart, complications of invasive tests routinely performed to detect graft rejection (GR), and the specific pathologies that may affect the transplanted heart. A joint EACVI/Brazilian cardiovascular imaging writing group committee has prepared these recommendations to provide a practical guide to echocardiographers involved in the follow-up of heart transplant patients and a framework for standardized and efficient use of cardiovascular imaging after heart transplant...
September 2015: European Heart Journal Cardiovascular Imaging
Constance G Weismann, Kristin C Lombardi, Bernhard S Grell, Veronika Northrup, Lissa Sugeng
AIMS: Aortic stiffness and diastolic function are abnormal in adults with bicuspid aortic valves (BAVs). The goal of this study was to determine the relationship between aortic stiffness and left ventricular (LV) diastolic impairment in children with well-functioning BAV and no associated congenital heart disease. METHODS AND RESULTS: This is a retrospective review of echocardiograms in children with isolated BAV (group BAV; N = 50) and healthy frequency-matched controls (group Control; N = 50)...
February 2016: European Heart Journal Cardiovascular Imaging
Anita Saxena
Stenosis of the mitral valve most often occurs as a result of chronic rheumatic heart disease, causing thickening and fibrosis of the mitral valve apparatus. Rheumatic heart disease continues to be a major public health problem in several developing countries and mitral stenosis is also common in these regions. According to the reports from India and Africa, the disease tends to follow a rapidly progressive course in children. The treatment of choice is balloon dilatation of the mitral valve. Echocardiography is indispensable for this procedure...
April 2015: World Journal for Pediatric & Congenital Heart Surgery
Christopher K Davis, Dan A Dyar, Lisa A Vargas, Paul D Grossfeld
OBJECTIVE: The aim of this study was to characterize the cardiovascular and musculoskeletal systems of elite volleyball players, including aortic dimensions. Previous studies have shown that the upper limit of normal aortic sinus diameter for male and female athletes is 4 and 3.4 cm, respectively. DESIGN: Cross-sectional analysis. SETTING: United States Olympic Volleyball Training Facility and Rady Children's Hospital San Diego. PARTICIPANTS: Seventy (37 male) members of the US national volleyball team...
November 2015: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
Jenna M Murray, Amy Hellinger, Roger Dionne, Loren Brown, Rosemary Galvin, Suzanne Griggs, Karen Mittler, Kathy Harney, Shannon Manzi, Christina VanderPluym, Annette Baker, Patricia O'Brien, Cheryl O'Connell, Christopher S Almond
Congenital heart disease is the leading cause of stroke in children. Warfarin therapy can be difficult to manage safely in this population because of its narrow therapeutic index, multiple drug and dietary interactions, small patient size, high-risk cardiac indications, and lack of data to support anticoagulation recommendations. We sought to describe our institution's effort to develop a dedicated cardiac anticoagulation service to address the special needs of this population and to review the literature. In 2009, in response to Joint Commission National Patient Safety Goals for Anticoagulation, Boston Children's Hospital created a dedicated pediatric Cardiac Anticoagulation Monitoring Program (CAMP)...
April 2015: Pediatric Cardiology
Willem A Helbing, Mohamed Ouhlous
MRI is an important additional tool in the diagnostic work-up of children with congenital heart disease. This review aims to summarise the role MRI has in this patient population. Echocardiography remains the main diagnostic tool in congenital heart disease. In specific situations, MRI is used for anatomical imaging of congenital heart disease. This includes detailed assessment of intracardiac anatomy with 2-D and 3-D sequences. MRI is particularly useful for assessment of retrosternal structures in the heart and for imaging large vessel anatomy...
January 2015: Pediatric Radiology
Peter C Frommelt, Eric Gerstenberger, James F Cnota, Meryl S Cohen, Jessica Gorentz, Kevin D Hill, J Blaine John, Jami C Levine, Jimmy Lu, William T Mahle, Rachel T McCandless, Luc Mertens, Gail D Pearson, Carolyn Spencer, Deepika Thacker, Ismee A Williams, Pierre C Wong, Jane W Newburger
BACKGROUND: In children with single right ventricular (RV) anomalies, changes in RV size and function may be influenced by shunt type chosen at the time of the Norwood procedure. OBJECTIVES: The study sought to identify shunt-related differences in echocardiographic findings at 14 months and ≤6 months pre-Fontan in survivors of the Norwood procedure. METHODS: We compared 2-dimensional and Doppler echocardiographic indices of RV size and function, neo-aortic and tricuspid valve annulus dimensions and function, and aortic size and patency at 14...
November 11, 2014: Journal of the American College of Cardiology
Luke Eckersley, John Stirling, Christopher Occleshaw, Nigel Wilson
This study identified tracheobronchial cartilage calcification in children with congenital heart disease. Calcification of the tracheobronchial airways has been found previously in adults receiving warfarin and in children receiving warfarin after mitral valve replacement. A 9-year-old girl who had received a Fontan repair 6 years previously underwent a cardiac computed tomography (CT) scan to evaluate pulmonary artery size. The result was an incidental finding of extensive tracheobronchial cartilage calcification...
August 2014: Pediatric Cardiology
Ping Huang, Hongwei Wang, Yanping Li, Peixuan Cheng, Qingjun Liu, Zhenlu Zhang, Jianying Liu
The histopathological characteristics of congenital aortic valve malformations in children were investigated. All the native surgically excised aortic valves from 32 pediatric patients suffering from symptomatic aortic valve dysfunction due to congenital aortic valve malformations between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. The diagnosis was made by the clinical presentation, preoperative echocardiography, intraoperative examination, and postoperative histopathological study, excluding rheumatic or degenerative aortic valve diseases, infective endocarditis and primary connective tissue disorders, e...
February 2007: Frontiers of Medicine in China
Monesha Gupta-Malhotra, Richard B Devereux, Archana Dave, Cynthia Bell, Ronald Portman, Diana Milewicz
The aim of the study was to determine the presence of aortic dilatation in hypertensive children, the prevalence of which is 4% to 10% in hypertensive adults. Prospectively enrolled multiethnic children, untreated for their hypertension, underwent an echocardiogram to exclude congenital heart disease and evaluate for end-organ damage and aortic size. The aorta was measured in the parasternal long-axis view at three levels: the sinus of Valsalva, supra-tubular junction, and the ascending aorta. Aortic dilatation was determined by z-score >2 at any one of the levels measured...
April 2014: Journal of the American Society of Hypertension: JASH
Carolina E Lemmer Hunsinger, Mark E Engel, John C Stanfliet, Bongani M Mayosi
BACKGROUND: Transthoracic echocardiography is the primary imaging modality for the diagnosis of right ventricular (RV) involvement in congenital and acquired heart diseases. There is increasing recognition of the contribution of RV dysfunction in heart diseases affecting children and adolescents, but there is insufficient information on reference intervals for the echocardiographic measurements of the right heart in children and adolescents that represent all the continental populations of the world...
2014: Cardiovascular Ultrasound
Olivier Metton, Walid Ben Ali, Olivier Raisky, Pascal R Vouhé
The modified Konno operation is designed to provide relief of diffuse subaortic stenosis, while preserving the native aortic valve. The aorta and the right ventricular infundibulum are opened. The upper part of the subaortic stenosis is incised through the aortic orifice. The conal septum is incised and the septotomy is extended across the stenotic area. The obstructive tissue is removed (mainly from the left-handed rim of the septotomy) and the conal septum is enlarged with a prosthetic patch. The aorta is closed and the right ventricular infundibulum is enlarged...
January 1, 2008: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Jeffrey A Poynter, Pirooz Eghtesady, Brian W McCrindle, Henry L Walters, Paul M Kirshbom, Eugene H Blackstone, S Adil Husain, David M Overman, Erle H Austin, Tara Karamlou, Andrew J Lodge, James D St Louis, Peter J Gruber, Gerhard Ziemer, Ryan R Davies, Jeffrey P Jacobs, John W Brown, William G Williams, Christo I Tchervenkov, Marshall L Jacobs, Christopher A Caldarone
BACKGROUND: Treatment of congenital heart disease may include placement of a right ventricle to pulmonary artery conduit that requires future surgical replacement. We sought to identify surgeon-modifiable factors associated with durability (defined as freedom from surgical replacement or explantation) of the initial conduit in children less than 2 years of age at initial insertion. METHODS: Since 2002, 429 infants were discharged from 24 Congenital Heart Surgeons' Society member institutions after initial conduit insertion...
November 2013: Annals of Thoracic Surgery
Ajit P Yoganathan, Mark Fogel, Susan Gamble, Michael Morton, Paul Schmidt, Jeff Secunda, Sara Vidmar, Pedro Del Nido
OBJECTIVE: Congenital heart valve disease is one of the most common abnormalities in children. There are limited technological solutions available for treating children with congenital heart valve diseases. The aim of this study is to provide the details of the consensus reached in terms of pediatric definitions, design approach, in vitro testing, and clinical trials, which may be used as guidance for developing prosthetic heart valves for the pediatric indication. METHODS: In stark contrast to the various designs of adult-sized replacement valves available in the market, there are no Food and Drug Administration (FDA)-approved prosthetic heart valves available for use in the pediatric population...
October 2013: Journal of Thoracic and Cardiovascular Surgery
Yong Zhou, Zhifu Guo, Yuan Bai, Xianxian Zhao, Yongwen Qin, Shaoping Chen, Hong Wu, Xinmiao Huang, Songhua Li, Bo Liu
BACKGROUND: Structural heart interventions require the use of relatively large-diameter delivery sheaths or latex nylon net balloon catheters, which results in a relatively large-diameter venous puncture point. At present, femoral venous hemostasis is achieved by manual compression. A temporary figure-of-eight subcutaneous suture has been introduced to achieve immediate postprocedural femoral venous hemostasis after using a ≥24Fr sheath in an adult. This method is not well evaluated in children...
March 2014: Congenital Heart Disease
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