Robert Lichtenberg

Piercing and tattooing in patients with congenital heart disease: patient and physician perspectives

PURPOSE The frequency and safety of ear piercing and tattooing were assessed in a group of children, adolescents, and adults with congenital heart disease (CHD). Also, a group of physicians who care for adolescents and adults with CHD were surveyed for opinions and experiences regarding piercing and tattooing. METHODS An eight-question survey was mailed to 445 patients (181 adults and 264 children) from one center. A different five-question survey was mailed to 176 physician members of the International Society of Adult Congenital Cardiac Disease. RESULTS The patient survey was completed by 152 of 445 (34%) patients (mean age +/- standard deviation 19.8 +/- 16.2 years; range 0.25-67 years). Eighty-eight of 152 (58%) patients were female. Ear piercing occurred in 65 of 152 (43%) patients (mean age 12.4 +/- 8.7 years; range 0.25-45 years). Prior to piercing, only 4 of 65 (6%) patients took antibiotics, but 15 of 65 (23%) had piercing-related infections. No patient had endocarditis. Infections occurred 1 week to 3 years after piercing. All were local skin infections. Tattoos were placed in 8 of 152 (5%) patients (median age 17.5 years; range 13-56 years). No antibiotic use or infections were reported in patients with tattoos. The physician survey was completed by 118 of 176 (67%) physicians. The majority of physicians did not approve of patients having piercing or tattooing performed. However, 60% of physicians believed that antibiotic prophylaxis is indicated for these procedures. CONCLUSIONS Despite the opinion of many physicians, most patients do not take antibiotic prophylaxis for piercing and tattooing. Patients apparently do not suffer serious sequelae. The efficacy of standard antibiotic regimes as applied to ear piercing and tattooing requires further study, since these procedures are increasingly popular in modern society.

Effect of an inelastic aortic synthetic vascular graft on exercise hemodynamics

This study compared aortic input impedance characteristics between patients with aortic interposition Dacron grafts placed for traumatic aortic injury and normal age-matched control subjects. All subjects were examined at rest and after treadmill exercise. Magnetic resonance imaging was conducted to rule out anatomic (stenosis) effects. Exercise increased characteristic impedance (ie, reduced aortic distensibility) by 29% and decreased total systemic arterial compliance by 21% in the patient group, whereas the normal control group showed insignificant change in these variables after exercise. Peripheral pressure wave reflection was reduced substantially with exercise (27%) in the control group, with much less reduction observed in the patient group. These abnormal vascular hemodynamics were associated with significantly high cardiac energetic costs in the patient group. A plausible explanation for the observed differences lies in the exaggerated vascular impedance mismatch between compliant aorta and inelastic graft, when cardiac output increases dramatically.

Heart transplantation in a patient with chloroquine-induced cardiomyopathy☆

We present the first report of a patient who underwent heart transplantation (HT) after endomyocardial biopsy (EMB) and revealed chloroquine-induced cardiomyopathy (CIC). This patient, who was treated with chloroquine for 6 years, developed a restrictive cardiomyopathy that progressed to congestive heart failure (CHF) resistant to medical management.

Ejection fraction: subjective visual echocardiographic estimation versus radionuclide angiography.

Objectives: The aim of this study was to validate the correlation of left ventricular ejection fraction (LVEF) between two‐dimensional (2D) echocardiography with harmonic imaging modality and radionuclide angiography (RNA) in a large number of patients. Background: Subjective visual estimation of LVEF is the most prevalent method in evaluating left ventricular systolic function. Previous published reports demonstrated that visual estimation from 2D was superior to other mathematical calculations, however the studies contained less than 50 patients. Methods: Retrospective review of 377 consecutive medical records containing LVEF from both 2D echocardiography and RNA obtained from the same patient within 15 days from January 1998 to September 1999. Results: Correlation coefficient value (r) between 2D echocardiography subjective visual estimation and RNA was 0.84. The r value was further increased to 0.87 when heart transplant recipients excluded. The agreement of LVEF between 2D echocardiography and RNA are higher in normal or severely depressed LV. Conclusion: Excellent correlation of LVEF exists between 2D echocardiography subjective visual estimation and RNA, especially in normal or severely depressed LV. (ECHOCARDIOGRAPHY, Volume 20, April 2003)

Anatomic Correction of Dextrotransposition of the Great Arteries in a 36-Year-Old Patient

During the 1960s, the Mustard or Senning operation was the conventional palliative therapy for patients with transposition of the great arteries. Many of these patients are now adults, and the durability of the morphologic right ventricle to function as the systemic ventricle is being questioned. Surgical options for such adult patients have traditionally been limited to cardiac transplantation. More recently, an arterial switch operation with take-down of the Mustard or Senning baffles has been reported. Herein we describe the clinical course of a 36-year-old woman who underwent a successful single-stage Mustard take-down, atrial reconstruction, and arterial switch operation.

Cost-Effectiveness of Transaxillary Muscle-Sparing Same-Day Operative Closure of Patent Ductus Arteriosus

Transaxillary muscle-sparing patent ductus arteriosus closure performed as same-day surgery is described in 10 patients. This approach provides a superb cosmetic result while obviating the need for thoracostomy tube placement.

Diagnosis and management of right atrial thrombus in heparin-induced thrombocytopenia and thrombosis syndrome with transesophageal echocardiography and thrombolytic therapy

2. Berdusis K, Fisher JB, Webb CL, Gidding SS, Alboliras ET. Successful preparation of community hospital sonogTaphers for transtelephonic transmission of infant echocardiographic studies. J Am Soc Echocardiography 1995;8:16E. 3. Fisher JB, Alboliras ET, Berdusis K, Gidding SS, Webb CL. Feasibility of transtelephonic echocardiology for evaluation of neonates in a community hospital setting. Ped Res 1995;37:205A. 4. Sobczyk, WL, Solinger RE, Rees AH, Elbl F. Transtelephonic echocardiography: successful use in a tertiary pediatric referral center. J Pediatr 1993;122:

Diagnostic value and safety of endomyocardial biopsy in selected patients with heart failure

84-8. 5. Finley JP, Human DG, Nanton MA, Roy DL, MacDonald RG, Marr DR, Chiasson H. Echocardiography by telephone evaluation of pediatric heart disease at a distance. Am J Cardiol 1989;63:1475-7. 6. Sahn DJ, Williams J, Rice MJ, MacDonald RW, Gross B. A real-time satellite-based telecommunications system providing live video conferencing and instantaneous transmission of echo Doppler images. J Am Coll Cardiol Feb 1994;Feb:409A.

DIASTOLIC FUNCTION IN CHILDREN WITH SICKLE CELL ANEMIA (SCA). 131

Abstract Background: The routine use of endomyocardial biopsy (EMB) as a diagnostic test in the evaluation of heart failure patients (HFP) is controversial and generally unadvisable because of low diagnostic yield and potential for significant procedural morbidity and mortality. Purpose: Therefore we reviewed our experience with EMB in a large and mostly referral HFP at our tertiary care center. Methods: We retrospectively reviewed 3419 EMB records from 3/1/97 to 2/28/02 and identified 78 (2.3%) HFP, who were screened and referred for EMB by the heart failure specialists. Pre-EMB clinical diagnosis included 55% dilated cardiomyopathy, 14% prior condition (amyloid, sarcoid, lupus), 7% probable myocarditis, 11% ischemia, 6% drug toxicity, 3% hypertrophic cardiomyopathy, 3% constrictive pericarditis, 1% restrictive cardiomyopathy. EMB samples were routinely submitted for light and electron microscopy, immunofluoresence, Congo red and iron staining. Results: There were 44 (56%) men and 34 (44%) women with mean age of 50.5±18.5 (13–81) years. EMB results were non-diagnostic in 57 (73.1%) and diagnostic in 21(26.9%). Diagnostic finding consisted of 8 (10.2%) amyloid, 5 (6.4%) drug toxicity, 4 (5.1%) myocarditis, 2 (2.6%) iron overload and 2 (2.6%) immunologic/lupus. In HFP undergoing EMB there were 2 (2.6%) of right ventricular perforations as the major procedural complication. In comparison in 3341 EMB performed routinely in heart transplant recipients there were 4 (0.12%) bleedings/hematoma, 3 (0.09%) life threatening arrhythmia, 3 (0.09%) carotid puncture and 1 (0.03%) right ventricular perforation. Conclusions: In HFP without established etiology for heart failure, EMB is of diagnostic value in 26.9% of cases. Contrary to prior concerns regarding the safety of the EMB in HFP this diagnostic test can be completed with low procedural morbidity and no mortality.

A new angle on the Angle of Louis.

Left ventricular (LV) dilation and systolic dysfunction are recognized causes of mortality in patients with SCA. But, data evaluating diastolic function in children with SCA are limited. We used Doppler echocardiography(echo) to assess diastolic function in children with SCA.