Alexander Kadner

Assessment of myocardial function in pediatric patients with operated tetralogy of Fallot: preliminary results with 2D strain echocardiography.

The global myocardial function in patients after repair of tetralogy of Fallot (TOF) can be assessed by cardiovascular magnetic resonance (CMR) and measurement of B-type natriuretic peptides. Two-dimensional echocardiography-derived strain and strain rate (2D strain) facilitate the assessment of regional myocardial function. We evaluated myocardial function in 16 children with residual severe pulmonary valve regurgitation and right ventricular (RV) volume overload after TOF repair before, 1xa0month after, and 6xa0months after pulmonary valve replacement (PVR). In 2D strain echocardiography preoperatively, the longitudinal systolic RV strain was reduced (pxa0<xa00.05). One month after PVR, longitudinal systolic RV strain decreased further (pxa0<xa00.05), while systolic and early diastolic radial left ventricular strain and strain rate increased (each pxa0<xa00.05), followed by a return toward preoperative values after 6xa0months. Six months after PVR, preoperatively elevated RV end-diastolic volume (pxa0<xa00.01) assessed by CMR and N-terminal pro-B-type natriuretic peptide (pxa0<xa00.05) decreased. In conclusion, the impairment of the regional myocardial after TOF repair and transient changes after PVR can be subtly analyzed by 2D strain echocardiography in addition to the established assessment of myocardial function with CMR and measurement of B-type natriuretic peptides.

Aortic sinus‐left atrial fistula after interventional closure of atrial septal defect

A 3‐year‐old boy underwent interventional closure of an atrial septal defect using an Amplatzer septal occluder. After 4 weeks, an aortic sinus‐to‐left atrial fistula was detected by echocardiography in an asymptomatic child. The device was surgically explanted with fistula and atrial septal defect closure. Follow‐up was uneventful.

Dimensions of the Ascending Aorta in Conotruncal Heart Defects

Dilatation of the ascending aorta is an important sequel in conotruncal anomalies, such as tetralogy of Fallot (TOF) or d-transposition of the great arteries (TGA). We measured dimensions and their progression at different levels of the ascending aorta in 80 patients. In TOF patients, mean z-score for aortic annulus was 1.65 (range −3.16–6.47), for sinus 1.93 (range −2.28–5.39), for st-junction 4.15 (range 0.0–8.18), and for ascending aorta 3.51 (range −1.23–6.36). Over time, annulus z-scores increased in the univariate analysis [0.07/year, 95xa0% confidence interval (CI) 0.01–0.14; pxa0=xa00.02], and this was unique to male patients (0.08/year, 95xa0% CI 0.00–0.15; pxa0=xa00.05). z-scores of the ascending aorta decreased (−0.1/year, 95xa0% CI −0.18 to −0.02; pxa0=xa00.02), and this was confined to patients without aortic regurgitation (AR; −0.09/year, 95xa0% CI −0.18 to −0.01; pxa0=xa00.04). In TGA, mean z-score for the aortic annulus was 2.13 (range −3.71–8.39), for sinus 1.77 (range −3.04–6.69), for st-junction 1.01 (range −5.44–6.71), and for ascending aorta 0.82 (range −4.91–6.46). In bivariate analysis, annulus z-scores decreased in females (−0.14/year, 95xa0% CI −0.25 to −0.03; pxa0=xa00.01) and in patients without AR (−0.07/year, 95xa0% CI −0.14–0.0; pxa0=xa00.03). z-scores of the ascending aorta increased significantly in males (0.08/year, 95xa0% CI 0.0 to 0.16; pxa0=xa00.05) and in patients with AR (0.12/year, 95xa0% CI 0.03–0.21; pxa0=xa00.01). In conclusion, TOF and TGA z-scores of the ascending aorta differ significantly from those of the normal population. Progression of z-scores over time is influenced by diagnosis, sex, and presence of AR.

Transcranial Doppler-guided deairing of a pediatric ventricular assist device: experience with twins.

We report the intraoperative courses of 2 consecutive Berlin Heart Excor® Pediatric Ventricular Assist Device implantations, in which transcranial Doppler ultrasonography helped to detect macroscopically undetected residual air bubbles captured in the pump after air removal had been correctly performed according to manufacturers specifications. Our experience with these cases suggests that a beat-to beat deairing maneuver guided by transcranial Doppler is a useful strategy for reducing cerebral exposure to perioperative gaseous microembolism.