Kritvikrom Durongpisitkul

Predictors of Early- and Late-Onset Supraventricular Tachyarrhythmias After Fontan Operation

BACKGROUND The objectives of our study were to determine the frequency of supraventricular tachyarrhythmias (SVTAs) among modifications of the Fontan operation and identify risk factors for developing SVTA. METHODS AND RESULTS The population consisted of all patients who had any modification of the Fontan operation at the Mayo Clinic between 1985 and 1993. Clinically significant SVTAs were those requiring initiation or change of antiarrhythmic treatment, and they were divided into early SVTAs (<30 days after the operation) and late SVTAs (>/=30 days after the operation). Clinical histories were reviewed, and health status questionnaires were sent. Four hundred ninety-nine patients had various modifications of the Fontan operation. Frequency of early SVTA was 15%. Risk factors identified by multivariate analysis for early SVTA were AV valve regurgitation, abnormal AV valve, and preoperative SVTA. Frequency of late SVTA was 6% by 1 year, 12% by 3 years, and 17% by 5 years. Risk factors for late SVTA were age at operation (<3 or >/=10 years) and systemic AV valve replacement. By univariate and multivariate analysis, the type of Fontan operation was not a significant risk factor for late SVTA when all 6 modifications were considered. However, when we analyzed the frequency of late SVTA for the 2 recently used modifications, we found a lower frequency of late SVTA in patients with atriopulmonary connection with lateral tunnel compared with those with total cavopulmonary connection. CONCLUSIONS Postoperative SVTA continues to be a significant problem. Risk factors for SVTA are AV valve regurgitation, abnormal AV valve, preoperative SVTA, and age at operation. Frequency of SVTA does not appear to be related to type of Fontan procedure except for slightly lower frequency in patients with atriopulmonary connection with lateral tunnel compared with those with total cavopulmonary connection.

Surveillance of Pediatric Cardiac Surgical Outcome Using Risk Stratifications at a Tertiary Care Center in Thailand

Objectives. To determine in-hospital mortality and complications of cardiac surgery in pediatric patients and identify predictors of hospital mortality. Methods. Records of pediatric patients who had undergone cardiac surgery in 2005 were reviewed retrospectively. The risk adjustment for congenital heart surgery (RACHS-1) method, the Aristotle basic complexity score (ABC score), and the Society of Thoracic Surgeons and the European Association for Cardiothoracic Surgery Mortality score (STS-EACTS score) were used as measures. Potential predictors were analyzed by risk analysis. Results. 230 pediatric patients had undergone congenital cardiac surgery. Overall, the mortality discharge was 6.1%. From the ROC curve of the RACHS-1, the ABC level, and the STS-EACTS categories, the validities were determined to be 0.78, 0.74, and 0.67, respectively. Mortality risks were found at the high complexity levels of the three tools, bypass time >85 min, and cross clamp time >60 min. Common morbidities were postoperative pyrexia, bleeding, and pleural effusion. Conclusions. Overall mortality and morbidities were 6.1%. The RACHS-1 method, ABC score, and STS-EACTS score were helpful for risk stratification.

Outcome of Atrial Septal Defects versus Ventricular Septal Defects in Response to Bosentan Treatment: Proof of Concept Controlled Study in Pulmonary Arterial Hypertension Related to Eisenmenger Syndrome

Background: Bosentan was shown to have benefit for treatment of patients with Eisenmenger (ES) with some data showing hemodynamic deterioration in patients with Atrial Septal Defect (ASD) than in Ventricular Septal Defect (VSD). Method: A proof of concept study was designed to evaluate effect of bosentan treatment for 12 months using both clinical outcome and Cardiac Magnetic Resonance (CMR). Results: Ten patients were enrolled with average age of 39.7 ± 9.7 years. There were 5 ASD and 5 VSD in each group. There is no statistical significance in baseline data among both groups. During the follow up period there is an improvement of 6 Minute Walk Distance (6 MWD) at 4 months, but the effect levels off at 12 months. Patients with VSD group showed better improvement of 6 MWD more than in ASD group (p=0.52 at 4 months and p=0.009 at 12 months). All CMR findings were not statistically different at 12 months. However, patients who had VSD showed significant improvement in RV EF from baseline of 54.6 ± 14.5% to 56.27 ± 13.79% and 57.53 ± 7.66% when compared to ASD of 38.3 ± 11.5% to 38.72 ± 10.55% and 39.24 ± 10.80% at 4 months and 12 months respectively (p=0.025). Conclusion: We demonstrated improvement of 6 MWD in ES with bosentan treatment for 12 months. We were not able to show improvement in CMR parameter at 12 months, however, when compared, VSD group had significant improvement in RVEF to ASD group. *Corresponding author: Kritvikrom Durongpisitkul, MD, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand, Tel: (66-02) 4196824; Fax: (66-02) 419-7000; E-mail: sikdr@mahidol.ac.th, kritvikrom@gmail.com Received December 16, 2011; Accepted April 13, 2012; Published April 15, 2012 Citation: Durongpisitkul K, Chungsomprasong P, Krittayaphong R, Sompradeekul S (2012) Outcome of Atrial Septal Defects versus Ventricular Septal Defects in Response to Bosentan Treatment: Proof of Concept Controlled Study in Pulmonary Arterial Hypertension Related to Eisenmenger Syndrome. J Pulmon Resp Med 2:120. doi:10.4172/2161-105X.1000120 Copyright:

CARDIOPULMONARY RESPONSE TO EXERCISE AFTER THE MODIFIED FONTAN OPERATION: A MULTIVARIATE ANALYSIS OF THE DETERMINANTS OF PERFORMANCE IN 60 PATIENTS. † 149

We describe the pre- and postoperative determinants of cardiorespiratory function after the modified Fontan operation for 60 patients operated at Mayo Clinic between 1985 and 1993. The patients were 5 to 41 years of age(m=[horizontal bar over]14 yr.) at the time of exercise. Exercise was performed 0.8 to 15 years following operation (m=[horizontal bar over]6.4±2.9yr.). The dependent variables at peak exercise included: O2 consumption (˙VO2/kg2/3), systemic arterial O2 sat and HR. We analyzed 126 pre- and 61 postoperative independent variables. Multiple linear regression using a stepwise approach was used to identify predictive variables.