Stephan Schoof

Takotsubo Cardiomyopathy in a 2-Year-Old Girl: 3-Dimensional Visualization of Reversible Left Ventricular Dysfunction

![Figure][1] ![Figure][1] [Video 1][2] Video 1 Transthoracic 2-dimensional electrocardiography of the patient in apical 4-chamber view by admission to the intensive care unit after surgery during circulatory depression with left ventricular dysfunction. Study is consistent with

Transsplenic Endovascular Therapy of Portal Vein Stenosis and Subsequent Complete Portal Vein Thrombosis in a 2-year-old Child

A complex catheter intervention for portal vein stenosis and subsequent complete thrombosis after split-liver transplantation was performed using transsplenic access to the portal vein circulation. The combination of intrahepatic, local thrombolysis and extrahepatic portal vein angioplasty performed twice on 2 consecutive days followed by anticoagulation with a high dose of heparin and clopidogrel completely resolved portal vein stenosis and thrombosis. Postinterventional angiographic and serial ultrasound examinations confirmed that the endovascular therapy was successful. In selected patients, percutaneous transsplenic access to the portal vein circulation may be used for diagnostic and therapeutic interventions even in early childhood.

QRS duration in Fontan circulation in adults: A predictor of aerobic capacity

BACKGROUND The univentricular circulation after a Fontan procedure is characterized by an abnormal cardiorespiratory response being attributable to an inability to increase stroke volume during exercise. In congenital heart disease a broad QRS complex has been related to increased intracardiac volume and mass being associated with poor ventricular function and prognosis. OBJECTIVES This study investigated the relation between the width of the QRS complex and parameters of cardiorespiratory response in adult patients after a Fontan procedure. METHODS Clinical data and parameters of cardiorespiratory function of 56 patients (15 women, 41 men, mean age 23.7+/-6.4 years, mean age at operation 10.0+/-7.5 years) were related to the width of the QRS complex. RESULTS In the whole group the mean QRS duration was 115+/-23 ms. A QRS complex >or= 120 ms was present in 23 patients. These patients were characterized by significantly older age at operation (13.0+/-9.3 versus 7.9+/-5.1; p<0.05). Compared to individuals with smaller QRS complexes they showed a decreased oxygen uptake (PeakVO(2): 21.6+/-5.2 versus 27.7+/-6.6 ml/kg/min; p<0.001), work rate (1.6+/-0.5 versus 2.0+/-0.5 W/kg, p<0.05), maximum blood pressure (p<0.001) and increase in blood pressure (p<0.05). Univariate analysis showed a significant correlation between PeakVO(2) and several other parameters of cardiorespiratory exercise testing (work rate,O(2)-pulse, increase in heart rate and blood pressure, maximum heart rate and blood pressure), maximum enddiastolic diameter of the systemic ventricle, age at operation. Multivariate regression analysis identified QRS duration as the only independent predictor of PeakVO(2) (p=0.05). CONCLUSION In a Fontan circulation a broad QRS complex is a negative predictor of cardiorespiratory function. Early Fontan operation may be beneficial in terms of exercise capacity.

Alterations of acid–base balance, electrolyte concentrations, and osmolality caused by nonionic hyperosmolar contrast medium during pediatric cardiac catheterization

Objective:  This prospective clinical observational study was conducted to investigate the effects of contrast medium on acid–base balance, electrolyte concentrations, and osmolality in children.

Removal of temporary pacemaker after cardiac surgery in infants: A harmless procedure?

External pacemakers (PM) via temporary epicardial leads are routinely applied to infants and children during heart surgery, which usually, after an uneventful post surgical course, can be removed without complications. We report about two infants with complex congenital heart defects after cardiac surgery (arterial switch and Mustard operation for Transposition of the great arteries). Intraoperative these patients received temporary epicardial PM wires. Thirteen and 18 days post surgery, respectively, the PM wires were removed under electrocardiogram (ECG) monitoring. The patients showed acute ECG changes in terms of significant ST elevation during and after removing their pacing wires. Clinically, patients were stable and subsequent echocardiographic examination showed no evidence of myocardial dysfunction or pericardial effusion. In the course of time, patients showed no signs of arrhythmia or abnormal ECG changes. The decision to place temporary pacing wires during the cardiac surgery in patients with congenital heart defects should be considered carefully and their removal should occur under ECG monitoring as soon as the situation of the patient allows. It should be taken into consideration that a complication like this case may be related to delayed removal of temporary PMs leads.

Fulminant arterial thrombosis leading to amputation of forearm in a 16-year-old girl – Disastrous combination of diabetes mellitus, factor V Leiden mutation and oral contraception

Fulminant arterial thrombosis leading to amputation of forearm in a 16-year-old girl – Disastrous combination of diabetes mellitus, factor V Leiden mutation and oral contraception -

Cough: a potentially life-threatening condition after interventional closure of atrial septal defect.

A 3.5-year-old girl (weight, 19 kg; height, 103 cm) was hospitalized for interventional closure of secundum atrial septal defect (ASD II). In transthoracic and transesophageal echocardiography (TEE), we found a hemodynamically relevant left-to-right shunt caused by isolated ASD II without any systemic or pulmonary venous anomaly. All heart valves were patent and showed no regurgitation. The size of the ASD II was 9.5×7 mm, with enough rims to the aorta, the superior wall of the atrium, and the systemic and pulmonary veins (Figure 1A). No balloon sizing was performed. Figure 1. TEE shows ASD with left-to-right shunt (A). TEE of Amplatzer septal occluder shows its accurate position without any shunt (B). Fluoroscopy (C: frontal; D: lateral) …