C. Ward

Factors influencing the prenatal detection of structural congenital heart diseases

To assess the factors influencing the prenatal detection rate of structural congenital heart diseases (CHDs).

Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists

Objective: To assess the diagnostic error rate among echocardiograms undertaken by individuals other than paediatric cardiologists in our referral area.

Pulmonary artery/aorta ratio in simple screening for fetal outflow tract abnormalities during the second trimester.

Congenital heart disease is associated with high mortality and morbidity rates, being the most life‐threatening defect in the first month of postnatal life and accounting for approximately half of all childhood mortality from birth defects. Despite this, the prenatal detection rate for congenital outflow tract anomalies by ultrasound imaging is relatively low. The aim of this study was to establish a nomogram for the pulmonary artery/aorta (PA/AO) ratio measured in the three‐vessel view plane. This ratio was investigated as a simple screening tool for congenital cardiac outflow tract abnormalities.

Echocardiographic load-independent indices of contractility in children and adolescents with type I diabetes: Effect of metabolic control and insulin on left ventricular performance

A case-control study was carried out in a tertiary referral teaching hospital to evaluate left ventricular contractility in children and adolescents with type 1 diabetes and to study factors influencing left ventricular contractility. Thirty-four children and young adults with type 1 diabetes (age 10.8–21.8 years) were randomly selected from approximately 400 patients of the same age range in the outpatient department and compared with 16 nondiabetic controls (age 7.3–21.2 years). The relation of end-systolic wall stress to velocity of circumferential fiber shortening as a standard deviation score (SDS) from the normal range described by Colan et al. was used to assess left ventricular contractility. In the diabetic group the effect of age, duration of diabetes, metabolic control, insulin dose, and autonomic function on left ventricular contractility were studied. It was found that the end-systolic wall stress-velocity of circumferential fiber shortening relation was not different between diabetic subjects and controls [+0.52 (SEM 0.21) vs +0.90 (SEM 0.26) SDS,p=0.3]. In the diabetic subjects, the end-systolic wall stress-velocity of circumferential fiber shortening relation was positively correlated with glycated hemoglobin (r=0.37,p=0.03) and insulin dose per kilogram of body weight (r=0.36,p=0.04). Those two variables together explained 24% of the variability in the end-systolic wall stress-velocity of circumferential fiber shortening relation. Twenty-eight of the diabetic subjects were also assessed for cardiac autonomic function. Disturbances of cardiac autonomic function were not associated with increased contractility. It is concluded that left ventricular contractility assessed by load-independent echocardiographic indices was not different between children and adolescents with type 1 diabetes and controls. However, increased contractility was positively related to unfavorable metabolic control and higher insulin dose.

The use of recombinant tissue plasminogen activator in the management of infective intracardiac thrombi in pre-term infants with thrombocytopaenia

Bacterial endocarditis complicated by the development of intra‐cardiac thrombus presents a difficult management dilemma in the pre‐term infant. Here we present our experience with three infants who had this condition, all of whom were successfully managed using therapy with recombinant tissue plasminogen activator (r‐TPA). Therapy in one of the infants was particularly instructive, as the condition was further complicated by severe thrombocytopaenia, making the decision to treat using r‐TPA difficult.

Cardiac outcomes of hydrops as a result of twin–twin transfusion syndrome treated with laser surgery

Aim:  To determine cardiac outcomes of foetal hydrops as a result of twin–twin transfusion syndrome treated with laser surgery.

Transcatheter Closure of the Patent Ductus Arteriosus: An Intention to Treat Analysis

BACKGROUND In patients with patent ductus arteriosus (PDA), transcatheter closure is the current procedure of choice. There are multiple devices available with limited current comparative data and varied recommendations for device selection. OBJECTIVE To assess the efficacy and safety of the Flipper coil (FC) and the Amplatzer Duct Occluder (ADO). METHODS An intention to treat analysis of all children admitted to the catheter laboratory at a single institution for occlusion of PDA from 2003 to 2011 was performed. Patient and device selection were determined by the treating physician. Standard techniques for FC and ADO implantation were used. RESULTS Two hundred and twenty eight children with median weight of 14.2 kg (range; 5.5-68 kg) underwent cardiac catheterisation, with successful occlusion in 96.2% of patients when attempted. In 16 patients, median angiographic PDA diameter of 0.8 mm (range; 0.4-1.2 mm), was considered too small to warrant closure. Eight patients with large PDAs underwent surgical ligation. FC was successfully used in 70 (34.3%) and ADO in 134 (66.7%) patients. ADO patients were smaller (P=0.004) with larger PDAs (P<0.0001) than the FC group. Median fluoroscopy time was longer for ADO patients (10.1 min vs 8.0 min; P<0.0001). ADO had a lower embolisation rate (0% vs 6.6%; P=0.005) and a higher complete occlusion rate at follow-up (100% vs 73.4%; P<0.0001). Length of hospital admission decreased with time in both groups. CONCLUSION Transcatheter closure of the PDA has a high degree of safety and efficacy. This study suggests that the ADO may be the device of first choice in the current era.

Isolated Innominate Artery as a Cause of Subclavian Steal and Cerebral Hemisphere Atrophy

A rare case of isolated innominate artery arising from a left persistent arterial duct with a right aortic arch is presented. Of interest in this case is the retrograde flow in the left carotid system, the history of developmental delay, and the magnetic resonance image (MRI) brain findings suggestive of asymmetric volume loss affecting the left cerebral hemisphere. The authors postulate a possible mechanism of subclavian steal.

A Simplified Technique for Interventional Extracardiac Fontan

Purpose: We report a simple technique for an interventional extracardiac Fontan (ECF) procedure. Description: At the preparatory stage along with a bidirectional cavopulmonary connection (BCPC; cardiopulmonary bypass), a short piece of polytetrafluoroethylene (PTFE) tube graft is anastomosed to the inferior surface of the right pulmonary artery. Another longer PTFE graft is anastomosed to the transected inferior vena cava (IVC). A large medial opening in the lower PTFE graft is anastomosed to an atriotomy. These two PTFE tubes are anastomosed with a pericardial patch interposed between them. During the later interventional Fontan procedure, this pericardial patch is perforated using radiofrequency, and a covered stent is positioned entirely within the PTFE tubes, eliminating the window into the common atrium and leaving no intrapulmonary prosthetic material. Evaluation: The hemodynamics after the preparatory stage is similar to those following a BCPC, with uninterrupted flow from the IVC to the right atrium. On completion, there is a nonfenestrated Fontan circuit. Conclusion: Our technique of interventional Fontan, anatomically and hemodynamically, mimics a standard ECF procedure.

Reconfiguration of the Amplatzer Vascular Plug II 5 months after occlusion of venovenous collateral in a bidirectional cavopulmonary circulation.

Venovenous anomalous vessels are a common complication seen in the bidirectional cavopulmonary circulation. In this report, we describe the use of the Amplatzer Vascular Plug II and subsequent demonstration of nitinol device memory with significant device reconfiguration at 5 months follow‐up.