Background: One of the main goals of corrective surgery of congenital heart defects in children is the improvement of quality of life, which in young children is predominantly determined by exercise capacity. It is no...Background: One of the main goals of corrective surgery of congenital heart defects in children is the improvement of quality of life, which in young children is predominantly determined by exercise capacity. It is not known whether this goal can be achieved in school-aged children who have undergone cardiac surgery in infancy. Objectives: To determine if primary schoolaged children who underwent surgery to correct congenital heart defects in infancy are physically as fit as their peers. Methods: We examined 84 children with congenital heart defects, aged 4 to 11 years, after surgical repair. Fifty-two children had simple defects (ie, atrial or ventricular septal defect, coarctation of the aorta). Thirty two children had complex defects (ie, tetralogy of Fallot, pulmonary atresia with ventricular septal defect). All patients underwent exercise testing performed on a specially modified bicycle ergometer. Ninety-eight sex- and age-matched healthy children served as the control group. Results: There was no gender difference, either in healthy children or in the group with congenital heart defects, regarding exercise testing and that the healthy children reached a mean ± SD normalized maximal performance of 2.8 ± 0.3 W/kg. The same range was found for the children who had undergone surgery to correct simple heart defects. The children operated on to correct complex heart defects showed significantly impaired mean normalized maximal performance, although this tended to be lower in the group that had pulmonary atresia with a ventricular septal defect than in the group with tetralogy of Fallot (mean normalized maximal performance, 1.9 W/kg vs 2.3 W/kg). Conclusions: The goal of normal exercise capacity in childhood after heart surgery is achieved in those with simple heart defects only. In children with complex heart defects impaired exercise performance persists, depending on the severity of the heart defect and probably on chronotropic incompetence.展开更多
Aim: The objectives of this study were 1) to compare early mortality (first 30 d after surgery) and long-term survival between two cohorts of patients operated on for congenital cardiac defects, and 2) to evaluate the...Aim: The objectives of this study were 1) to compare early mortality (first 30 d after surgery) and long-term survival between two cohorts of patients operated on for congenital cardiac defects, and 2) to evaluate the impact of possible changes in early mortality on long-term survival. Methods: 945 patients with congenital cardiac defects, born in 1990-1999 and operated on in the same period were examined in a retrospective cohort study. The patients were divided into three groups: “ univentricular cardiac defects” , “ severe cardiac defects” and “ less severe cardiac defects” . The study population was divided into two cohorts: group 1 included patients born and operated on in 1990-1994; group 2 included patients born and operated on in 1995-1999. The survival patterns in the two groups were compared. Results: For all patients, except those with univentricular cardiac defects, early mortality (30 d after surgery) was reduced. Among patients with severe cardiac defects, early mortality was reduced from 18.6% in group 1 to 2.9% in group 2. Among patients with less severe cardiac defects, early mortality was reduced from 6.2% to 1.9% . The improved outcome was maintained during the following 5 y. Overall relative risk of death during follow-up was reduced to 0.31 (95% CI: 0.15-0.56) for patients with severe cardiac defects, and to 0.53 (95% CI: 0.31-0.93) for patients with less severe cardiac defects born and operated on in 1995-1999. Conclusion: Early mortality has been substantially reduced in congenital heart defect patients, and corresponds with significantly improved long-term survival.展开更多
Impaired neurodevelopmental outcome represents a major morbidity for survivors of infant heart surgery for congenital heart defects. Previous studies in these neonates have reported preoperative microcephaly, perivent...Impaired neurodevelopmental outcome represents a major morbidity for survivors of infant heart surgery for congenital heart defects. Previous studies in these neonates have reported preoperative microcephaly, periventricular leukomalacia, and other findings. The hypothesis of this study is that preoperative cerebral blood flow is substantially diminished and might relate to preoperative neurolog ic conditions. Preoperative brain magnetic resonance imaging was performed. Cere bral blood flow measurements in infants with congenital heart defects were obtai ned by using a novel noninvasive magnetic resonance imaging technique, pulsed ar terial spin-label perfusion magnetic resonance imaging. Cerebral blood flow was measured before the operation under standard ventilation and repeated after inc reased carbon dioxide. A total of 25 term infants were studied. The average age at the time of the operation was 4.4 ±.4.6 days. Congenital heart defects varie d widely. Microcephaly occurred in 24%(6/25). Baseline cerebral blood flow was 19.7±9.2 mL·100 g-1·min-1(8.0-42.2 mL·100 g -1·min-1). Five patients h ad cerebral blood flow measurements of less than 10 mL·100 g-1·min -1. Mean hypercarbic cerebral blood flow increased to 40.1±20.3 mL·100 g-1·min-1 (11 .4-94.0 mL·100 g-1·min-1,P < . 001). Pairwise analyses found that low hemog lobin levels were associated with higher baseline cerebral blood flow values (P= . 04). Periventricular leukomalacia occurred in 28%(7/25) and was associated wi th decreased baseline cerebral blood flow values (P=. 05) and a smaller change i n cerebral blood flow with hypercarbia (P=. 003). Structural brain abnormalities are common in these neonates before surgical intervention. Preoperative cerebra l blood flow for this cohort was low and drastically reduced in some patients. L ow cerebral blood flow values were associated with periventricular leukomalacia. Carbon dioxide reactivity was preserved but might be compromised by some aspect s of the cardiac anatomy. The full spectrum of cerebral blood flow measurements with this technique in congenital heart defects and their long-term significanc e require continued investigation. Copyright.展开更多
Background -Right ventricular outflow tract obstruction(RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation(PPVI) can treat this condition without consequent ...Background -Right ventricular outflow tract obstruction(RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation(PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical and physiological response to relieving RVOTO. Methods and Results -We studied 18 patients who underwent PPVI for RVOTO(72%male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract(RVOT)gradient >50 mm Hg on echocardiography without important pulmonary regurgitation(less than mild or regurgitant fraction< 10%on magnetic resonance imaging[MRI]). Cardiopulmonary exercise testing, tissue Doppler echocardiography, and MRI were performed before and within 50 days of PPVI. PPVI reduced RVOT gradient(51.4 to 21.7 mm Hg, P< 0.001)and right ventricular systolic pressure(72.8 to 47.3 mm Hg, P< 0.001) at catheterization. Symptoms and aerobic(25.7 to 28.9 mL·kg-1.min-1, P=0.002) and anaerobic(14.4 to 16.2 mL·kg-1.min-1, P=0.002) exercise capacity improved. Myocardial systolic velocity improved acutely(tricuspid 4.8 to 5.3 cm/s, P=0.05; mitral 4.7 to 5.5 cm/s, P=0.01), whereas isovolumic acceleration was unchanged. The tricuspid annular velocity was not maintained on intermediate follow-up. Right ventricular end-diastolic volume(99.9 to 89.7 mL/m2, P< 0.001) fell, whereas effective stroke volume(43.7 to 48.3mL/m2, P=0.06) and ejection fraction(48.0%to 56.8%, P=0.01) increased. Left ventricular end-diastolic volume(72.5 to 77.4 mL/m2, P=0.145), stroke volume(45.3 to 50.6 mL/m2, P=0.02), and ejection fraction(62.6%to 65.8%, P=0.03) increased. Conclusions -PPVI relieves RVOTO, which leads to an early improvement in biventricular performance. Furthermore, it reduces symptoms and improves exercise tolerance. These findings have important implications for the management of this increasingly common condition.展开更多
文摘Background: One of the main goals of corrective surgery of congenital heart defects in children is the improvement of quality of life, which in young children is predominantly determined by exercise capacity. It is not known whether this goal can be achieved in school-aged children who have undergone cardiac surgery in infancy. Objectives: To determine if primary schoolaged children who underwent surgery to correct congenital heart defects in infancy are physically as fit as their peers. Methods: We examined 84 children with congenital heart defects, aged 4 to 11 years, after surgical repair. Fifty-two children had simple defects (ie, atrial or ventricular septal defect, coarctation of the aorta). Thirty two children had complex defects (ie, tetralogy of Fallot, pulmonary atresia with ventricular septal defect). All patients underwent exercise testing performed on a specially modified bicycle ergometer. Ninety-eight sex- and age-matched healthy children served as the control group. Results: There was no gender difference, either in healthy children or in the group with congenital heart defects, regarding exercise testing and that the healthy children reached a mean ± SD normalized maximal performance of 2.8 ± 0.3 W/kg. The same range was found for the children who had undergone surgery to correct simple heart defects. The children operated on to correct complex heart defects showed significantly impaired mean normalized maximal performance, although this tended to be lower in the group that had pulmonary atresia with a ventricular septal defect than in the group with tetralogy of Fallot (mean normalized maximal performance, 1.9 W/kg vs 2.3 W/kg). Conclusions: The goal of normal exercise capacity in childhood after heart surgery is achieved in those with simple heart defects only. In children with complex heart defects impaired exercise performance persists, depending on the severity of the heart defect and probably on chronotropic incompetence.
文摘Aim: The objectives of this study were 1) to compare early mortality (first 30 d after surgery) and long-term survival between two cohorts of patients operated on for congenital cardiac defects, and 2) to evaluate the impact of possible changes in early mortality on long-term survival. Methods: 945 patients with congenital cardiac defects, born in 1990-1999 and operated on in the same period were examined in a retrospective cohort study. The patients were divided into three groups: “ univentricular cardiac defects” , “ severe cardiac defects” and “ less severe cardiac defects” . The study population was divided into two cohorts: group 1 included patients born and operated on in 1990-1994; group 2 included patients born and operated on in 1995-1999. The survival patterns in the two groups were compared. Results: For all patients, except those with univentricular cardiac defects, early mortality (30 d after surgery) was reduced. Among patients with severe cardiac defects, early mortality was reduced from 18.6% in group 1 to 2.9% in group 2. Among patients with less severe cardiac defects, early mortality was reduced from 6.2% to 1.9% . The improved outcome was maintained during the following 5 y. Overall relative risk of death during follow-up was reduced to 0.31 (95% CI: 0.15-0.56) for patients with severe cardiac defects, and to 0.53 (95% CI: 0.31-0.93) for patients with less severe cardiac defects born and operated on in 1995-1999. Conclusion: Early mortality has been substantially reduced in congenital heart defect patients, and corresponds with significantly improved long-term survival.
文摘Impaired neurodevelopmental outcome represents a major morbidity for survivors of infant heart surgery for congenital heart defects. Previous studies in these neonates have reported preoperative microcephaly, periventricular leukomalacia, and other findings. The hypothesis of this study is that preoperative cerebral blood flow is substantially diminished and might relate to preoperative neurolog ic conditions. Preoperative brain magnetic resonance imaging was performed. Cere bral blood flow measurements in infants with congenital heart defects were obtai ned by using a novel noninvasive magnetic resonance imaging technique, pulsed ar terial spin-label perfusion magnetic resonance imaging. Cerebral blood flow was measured before the operation under standard ventilation and repeated after inc reased carbon dioxide. A total of 25 term infants were studied. The average age at the time of the operation was 4.4 ±.4.6 days. Congenital heart defects varie d widely. Microcephaly occurred in 24%(6/25). Baseline cerebral blood flow was 19.7±9.2 mL·100 g-1·min-1(8.0-42.2 mL·100 g -1·min-1). Five patients h ad cerebral blood flow measurements of less than 10 mL·100 g-1·min -1. Mean hypercarbic cerebral blood flow increased to 40.1±20.3 mL·100 g-1·min-1 (11 .4-94.0 mL·100 g-1·min-1,P < . 001). Pairwise analyses found that low hemog lobin levels were associated with higher baseline cerebral blood flow values (P= . 04). Periventricular leukomalacia occurred in 28%(7/25) and was associated wi th decreased baseline cerebral blood flow values (P=. 05) and a smaller change i n cerebral blood flow with hypercarbia (P=. 003). Structural brain abnormalities are common in these neonates before surgical intervention. Preoperative cerebra l blood flow for this cohort was low and drastically reduced in some patients. L ow cerebral blood flow values were associated with periventricular leukomalacia. Carbon dioxide reactivity was preserved but might be compromised by some aspect s of the cardiac anatomy. The full spectrum of cerebral blood flow measurements with this technique in congenital heart defects and their long-term significanc e require continued investigation. Copyright.
文摘Background -Right ventricular outflow tract obstruction(RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation(PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical and physiological response to relieving RVOTO. Methods and Results -We studied 18 patients who underwent PPVI for RVOTO(72%male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract(RVOT)gradient >50 mm Hg on echocardiography without important pulmonary regurgitation(less than mild or regurgitant fraction< 10%on magnetic resonance imaging[MRI]). Cardiopulmonary exercise testing, tissue Doppler echocardiography, and MRI were performed before and within 50 days of PPVI. PPVI reduced RVOT gradient(51.4 to 21.7 mm Hg, P< 0.001)and right ventricular systolic pressure(72.8 to 47.3 mm Hg, P< 0.001) at catheterization. Symptoms and aerobic(25.7 to 28.9 mL·kg-1.min-1, P=0.002) and anaerobic(14.4 to 16.2 mL·kg-1.min-1, P=0.002) exercise capacity improved. Myocardial systolic velocity improved acutely(tricuspid 4.8 to 5.3 cm/s, P=0.05; mitral 4.7 to 5.5 cm/s, P=0.01), whereas isovolumic acceleration was unchanged. The tricuspid annular velocity was not maintained on intermediate follow-up. Right ventricular end-diastolic volume(99.9 to 89.7 mL/m2, P< 0.001) fell, whereas effective stroke volume(43.7 to 48.3mL/m2, P=0.06) and ejection fraction(48.0%to 56.8%, P=0.01) increased. Left ventricular end-diastolic volume(72.5 to 77.4 mL/m2, P=0.145), stroke volume(45.3 to 50.6 mL/m2, P=0.02), and ejection fraction(62.6%to 65.8%, P=0.03) increased. Conclusions -PPVI relieves RVOTO, which leads to an early improvement in biventricular performance. Furthermore, it reduces symptoms and improves exercise tolerance. These findings have important implications for the management of this increasingly common condition.
