Benjamin Zeevi

Self-efficacy and physical activity in adolescents with trivial, mild, or moderate congenital cardiac malformations.

Our purpose was to examine the cognitive processes that influence involvement in physical activity among 100 adolescents, 55 boys and 45 girls, ranging in age from 12 to 18 years, with trivial, mild, or moderate forms of congenital cardiac disease. We hypothesized, first, that the severity of the congenital cardiac malformation itself has an indirect effect on self-efficacy regarding physical activity, and that the relationship between the two is mediated by the recommendations of the cardiologist and the attitude of the mother. Second, we argued that self-efficacy serves as a mediating variable between the recommendations of the cardiologist and the attitude of the mother, on the one hand, and involvement in physical activity, on the other. The results confirmed both hypotheses. In a population of adolescents with trivial to moderate congenital cardiac malformations, beliefs in self-efficacy, rather than severity of the disease, were the most influential factors in determining whether or not adolescents will engage in sports or other physical activities. We also demonstrated the importance of the role played by the recommendations of the cardiologist in determining both the attitudes of the mother and the belief in self-efficacy of the adolescents.

Lung perfusion scans in patients with congenital heart defects

In 63 patients with various congenital heart defects, lung perfusion was evaluated with technetium-99mm macroaggregated albumin. Right lung perfusion abnormalities were documented in 34 patients (54%). A particularly high incidence occurred in patients who had undergone a systemic to pulmonary artery shunt operation as an initial palliative procedure or who had had right ventricular outflow reconstruction and in those with bilateral pulmonary artery stenosis. Serial studies were helpful in evaluating the functional results of different transcatheter interventions for optimizing pulmonary blood flow. The quantitative relative perfusion radionuclide method was a more sensitive means of detecting cases of abnormal lung perfusion than was chest radiology.

Percutaneous closure of small patent ductus arteriosus: Comparison of Rashkind double‐umbrella device and occluding spring coils

We compared our current practice of closing small patent ductus arteriosus (PDA) with coils with our previous experience of using double-umbrellas. Twelve patients underwent percutaneous closure of a small PDA with a coil. Selection criteria were a minimal diameter of < or = 2.5 mm and angiographic type A or E. The 12 most recent, non-consecutive patients who had undergone double-umbrella device closure of a PDA and would presently be considered suitable candidates for spring coil occlusion were retrospectively reviewed. The two groups were compared with regard to complications and immediate and midterm results. Eleven of the 12 attempted PDA occlusions using spring coils were successful. The mean follow-up period was 5.8 +/- 4.6 months. Color-Doppler echocardiograms have shown no residual leaks, no turbulence in the descending aorta, and no left pulmonary artery stenosis. All 12 attempted double-umbrella device placements were successful. The mean follow-up period was 16.2 +/- 5.8 months. Color-Doppler echocardiograms have shown trivial residual leaks in four patients and mild turbulent flow in the left pulmonary artery in one patient. There was no significant difference between the two groups in demographic and hemodynamic data. Although the mean follow-up time was significantly longer in the patients who underwent double-umbrella closure, there was significantly more color-Doppler echocardiographic evidence of residual flow (P < 0.03). Small PDA closure with coils is effective, resulting in less residual leaks compared with the double-umbrella device.

Acute hepatic failure after open-heart surgery in children

SummaryAcute hepatic failure (AHF) combined with acute renal failure (ARF) is a well-known complication of open-heart surgery in adults. The occurrence of this complication in two children after open-heart surgery for correction of congenital heart disease is reported. Hypotension occurred during the operation and was treated by catecholamine vasopressors. AHF set in during the postoperative course; it was manifested by impaired consciousness, hypoglycemia, hyperbilirubinemia, hyperammonemia, elevated liver enzymes and prolongation of the prothrombin time with failure of hemostasis. ARF also developed in both children. One of the patients survived the acute episode of hepatic failure. The importance of early diagnosis, routine close monitoring, and appropriate selection of vasopressors is emphasized.

Late death from aneurysm rupture following balloon angioplasty for branch pulmonary artery stenosis

We report on a child with Williams syndrome who died from aneurysm rupture 2 weeks following balloon angioplasty for branch pulmonary artery stenosis.

Use of the heart rate monitor to modulate physical activity in adolescents with congenital aortic stenosis: An innovative approach

The task of setting exercise limitations on children with aortic stenosis is fraught with difficulties. In particular, teenagers are difficult to manage because of the increasingly professional demands of adolescents sports; the rapid changes in somatic growth, which are often accompanied by an increase in the severity of aortic valve disease; and the natural tendency of teenagers to disregard advice from authoritarian sources like a medical team. This article describes our innovative approach of using a heart-rate monitor as a means of modulating physical activity in adolescents with mild to moderate aortic stenosis. This approach enabled the setting of clear, precise, observable, measureable limits on physical activity, and self-controling of an acceptable level of physical activity. This created a different negotiation between the patient, his parents, and the medical team, and eased the concern and anxiety of the mothers.

Interventional catheterization decreases plasma levels of atrial natriuretic peptide (ANP) in children with congenital heart defects

Atrial natriuretic peptide (ANP) is one of the cardiac peptides implicated in volume and sodium homeostasis. We investigated the effect of interventional catheterization on plasma levels of ANP, aldosterone, and cortisol in 28 children with various congenital heart defects (CHD). Patients were divided by age into two groups: group A--infants and children over 3 months of age (n = 22), and group B--newborns (n = 6). These were compared to age-matched control groups. In group A, interventions included pulmonic valvotomy (n = 8), aortic valvotomy (n = 4), balloon angioplasty of native coarctation of the aorta (n = 3), balloon dilatation of the mitral valve (n = 1), and Rashkind double umbrella closure of patent ductus arteriosus (n = 6). Group B interventions included pulmonic valvotomy (n = 3), aortic valvotomy (n = 1), and balloon atrial septosomy (n = 2). In group A, mean ANP levels were markedly higher than in age-matched controls (125.2+/-15.8 vs. 24.6+/-4.6 pg/ml) (P <0.0001), and decreased immediately after intervention (75.6+/-11.4 pg/ml, P <0.02), and more markedly on follow-up (42.9+/-5.0 pg/ml, P < 0.0001). In group B (newborns), mean basal plasma levels were high before and after intervention and were not different from age-matched controls (243+/-42.1 vs. 220.8+/-16.2 pg/ml). There was a significant decrease on follow-up measurement (62.1+/-12.7 pg/ml, P < 0.005). In both groups, plasma cortisol levels increased significantly immediately following catheterization (P < 0.02), and normalized on follow-up. Basal aldosterone levels were normal in group A and high in Group B (9.9+/-3.8 vs. 167.6+/-16.9 ng/dl) (P < 0.001). It is suggested that plasma ANP levels are increased in children with CHD, without overt heart failure, and decrease significantly following successful intervention. In newborns with CHD, the physiological high ANP levels obscure the effect of the CHD.

A comparison of arterial versus venous‐activated clotting time in patients with congenital heart disease undergoing cardiac catheterization

Studies in adult patients undergoing percutaneous coronary angioplasty have demonstrated differences in measured activated clotting time (ACT) in venous vs. arterial blood samples. Ninety‐two patients with congenital heart disease undergoing cardiac catheterization were prospectively evaluated to compare venous vs. arterial ACT values in monitoring heparin effect in this population. Simultaneous venous and arterial ACT samples were drawn at baseline, 10 min, 60 min, and every 30 min thereafter until each case was finished. ACT values were determined simultaneously with a dual‐chambered Hemochron 801 instrument. At baseline and throughout the study up to 90 min, venous and arterial ACT values were not significantly different. They were also no different in the subgroup of cyanotic patients. Therefore, venous and arterial ACT values can be safely used alternatively to guide heparin dosing during cardiac catheterization in patients with congenital heart disease without the risk of undercoagulation. Cathet. Cardiovasc. Intervent. 46:194–196, 1999.

Percutaneous closure of small patent arterial ducts using occluding spring coils and a snare

In recent years, the percutaneous closure of small and medium-sized patent arterial ducts has been achieved using occluding spring coils. We describe our experience in 33 patients with this technique using a snare to facilitate the procedure. All patients had a clinically apparent patent arterial duct and underwent an attempt at transcatheter closure at a mean age of 5.6 years. In one patient, the duct was a residual lesion following surgical ligation, and in three was residual following attempted closure with a Rashkind double-umbrella. The mean narrowest diameter of the ducts was 1.9 mm. The coil embolized in two of the first four patients, and subsequent to that experience we used a snare to improve delivery. Of the 33 patients, implantation was successful in 32 (97%) using one [29 patients] or two [two patients] coils and in one by a combination of a double-umbrella device and an occluding spring coil. The mean fluoroscopic screening time for the whole group was 26.5 minutes, this time decreasing to 18.5 minutes in the last 26 patients [p

Carbon dioxide fiberoptic laser for treatment of coarctation of the aorta

Much research is currently being undertaken to develop laser techniques for the treatment of acquired cardiovascular diseases.l There is only one preliminary report of the potential application of argon laser for congenital heart disease, including treatment of coarctation of the aorta in the newborn.2 In the present report, the use of a flexible CO, laser catheter for the potential treatment of coarctation of the aorta in children is described. Segments of the descending aorta including a severely coarcted area were removed during repair of coarctation of the aorta by end-to-end anastomosis in two boys (1 ‘/z and 3-years old, respectively). The segments were immersed in 0.9% saline solution at a temperature of 4” C. The laser irradiation was performed 24 hours later in room air. The CO, laser source was an Apollo model 580. An optical fiber of 0.9 mm in diameter that was produced by extrusion of silver chloride-silver bromide crystals through suitable dyes at an elevated temperature was inserted into a regular No. 6 French cardiovascular catheter. The distal tip of the catheter with the optical fiber was positioned perpendicularly and in contact with the coarctation membranes, which were approximately 1 to 2 mm in thickness. No manual pressure was applied to the catheter. Pulsed laser irradiation was performed with a mean power output of 2.3 W at the tip of the catheter for periods of 0.6 second, until dissolution of the membranes was achieved, as judged by the formation of new lumens about 4 x 5 mm and 3 x 4 mm in diameter (Fig. 1). In the first case we used 12 pulses and in the second 15 pulses. In some instances a single pulse perforated the membrane. In other instances, several pulses were necessary to create a perforation. The whole procedure took us less than 2 minutes. The histopathologic examination of the aortic segments revealed a thick muscular septum crossed by a central irregular lumen, lined by a thin layer (30 to 40 mm in width) of carbonized material (Fig. 2). The subjacent area showed a delicate cribriform pattern surrounded by relatively few necrotic cells and eosinophilic threads. The remaining myocytes in the coarctation membrane as well as the aortic wall were almost unaffected, and beyond 0.3