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1.
Eroglu AG Babaoglu K Saltik L Oztunç F Demir T Ahunbay G Guzeltas A Cetin G 《Pediatric cardiology》2006,27(6):713-719
We investigated the morphology of the stenotic aortic valve, the progression of the stenosis, and the onset and progression
of aortic regurgitation (AR) in patients with congenital aortic valvular stenosis (AVS). The medical records of 278 patients
with AVS were reviewed, with the patients with concomitant lesions besides AR excluded. Very mild aortic stenosis was defined
as a transvalvular Doppler peak systolic instantaneous gradient (PSIG) less than 25 mmHg, mild stenosis as 25–49 mmHg, moderate stenosis as 50–75 mmHg, and severe stenosis as more than 75 mmHg. The mean age of the patients was 4.9 ±
4.3 years (range, 3 days to 15 years), and 203 (73%) were male. The number of the cusps was determined with two-dimensional
echocardiography in 266 patients (95%): unicuspid in 3 patients (1%), bicuspid in 127 patients (48%), and tricuspid in 136
patients (51%). A total of 192 of all patients were followed for 2 months to 14.6 years (mean 4.2 ± 3.3 years) with medical
treatment alone. Among 72 patients with very mild stenosis at initial echocardiographic examination, 20% had mild, 3% moderate,
and 1% severe stenosis after a mean period of 3.7 years. In 70 patients with mild stenosis at initial echocardiographic examination,
28% had moderate and 9% severe stenosis after a mean period of 5 years. Among 44 patients with moderate stenosis at initial
echocardiographic examination, 36% had severe stenosis after a mean period of 3.7 years. Among 192 patients, 40% had AR (3%
trivial, 28% mild, and 9% moderate) at initial echocardiographic examination. After a mean period of 4.2 years, 58% of the
patients had AR (13 % trivial, 25% mild, 16% moderate, and 4% severe). There was not statistically significant difference
between catheterization peak systolic gradients (47 ± 16 mmHg) and Doppler estimated mean gradients (45 ± 9 mmHg) (p = 0.53), whereas Doppler PSIGs (74.9 ± 15.7 mmHg) were higher than catheterization peak systolic gradients (p < 0.0001) in 25 patients who were studied in the catheterization lab. Patients with very mild stenosis may be followed with
a noninvasive approach every 1 or 2 years, and an annual follow-up is suggested for patients with mild stenosis. Nearly one-third
of patients with moderate stenosis at initial echocardiographic examination had severe stenosis after a mean period of 3.7
years. Therefore, we recommend, that patients with moderate stenosis undergo noninvasive evaluation every 6 months. Doppler
estimated mean gradient is very useful in predicting the need for intervention in children with AVS. 相似文献
2.
Exercise Testing in Children with Pulmonary Valvar Stenosis 总被引:4,自引:0,他引:4
Pulmonary valvar stenosis with intact ventricular septum is a common anomaly. This lesion poses a fixed obstruction to the
right ventricular outflow. The right ventricle ejects the entire cardiac output across the stenotic valve. Right ventricular
systolic pressure and oxygen demand are increased at rest and more so with exercise. Exercise tolerance in children and adults
with mild valvar pulmonary stenosis is nearly normal, but is diminished in those with moderate and severe stenosis, indicating
impaired ability to sustain adequate cardiac output. Following relief of stenosis, cardiac performance improves in children,
but remains abnormal in adults. This appears to be related to postoperative resolution of right ventricular hypertrophy in
children, whereas myocardial fibrosis may explain the lack of improvement in adults. 相似文献
3.
We evaluated the aortic outflow tract (AOT) and coronary artery dimensions in pediatric patients with unicommissural aortic
valves. A retrospective review of an echocardiographic database identified 37 patients with unicommissural aortic valves.
A total of 115 echocardiograms were reviewed, and the right coronary artery (RCA), left main coronary artery (LM), left anterior
descending coronary artery aortic valve annulus, aortic root, sinotubular junction (STJ), and ascending aorta were measured
and z scores determined. The aortic stenosis peak gradient and the amount of aortic regurgitation (AR) were also measured. The
RCA diameter (z score, 1.85 ± 1.8, p = 0.03) and LM diameter (z score, 1.74 ± 1.47, p = 0.04) are significantly dilated, as are all the AOT measurements: aortic annulus (2.02 ± 1.9, p = 0.02), aortic root (2.25 ± 1.9, p = 0.02), STJ (2.22 ± 1.74, p = 0.01), and ascending aorta (4.38 ± 2.03, p < 0.001). Longitudinal follow-up showed that there was no significant variation over time in any variable. The AOT measurements
were significantly correlated with each other. A trend was found in which an increasing amount of AR gave an increase in AOT
measurements. The aortic gradient was not significantly associated with any measurement. Our study population demonstrated
significant dilatation of the RCA and LM as well as the AOT. The dilatation of the AOT structures is likely caused by the
same mechanism that accounts for the AOT dilatation in patients with bicommissural aortic valves. Dilatation of the coronary
arteries may represent an intrinsic abnormality in the vessel wall. Further studies are needed to define possible changes.
Work was performed at Johns Hopkins Hospital, Baltimore, MD 21287, USA. 相似文献
4.
Congenital aortic stenosis is a relatively common cardiac anomaly encountered in approximately 5% of all children with heart
disease. The Ross procedure is increasingly used for replacement of the aortic valve in children. We report a 12-year-old
boy who was born with congenital aortic stenosis secondary to a bicommissural aortic valve. The patient underwent open valvotomy
in infancy and aortic valvuloplasty 2 years later. Residual/recurrent stenosis prompted referral for aortic valve replacement,
and he underwent an autologous Ross procedure, in which the aortic root was replaced with a pulmonary autograft and the repaired
aortic valve was used to restore right ventricular-to-pulmonary artery continuity. The postoperative course was unremarkable.
Nitroprusside, esmolol, and labetolol were used to control postoperative hypertension. He was discharged 4 days after surgery
on oral furosemide and aspirin, and he has had no cardiovascular symptoms during follow-up. Recent echocardiography demonstrated
mild right ventricular outflow tract obstruction with a peak velocity of 3.6 m/sec, with a gradient of 42 mmHg and moderate
pulmonary insufficiency. There was no left ventricular outlet tract obstruction or aortic insufficiency. 相似文献
5.
Eroglu AG Babaoglu K Oztunc F Saltik L Demir T Ahunbay G Guzeltas A Cetin G 《Pediatric cardiology》2006,27(6):707-712
This study evaluates the course of supravalvular aortic stenosis (SVAS)-associated right ventricular outflow tract (RVOT)
obstruction and the results of surgery in children. We reviewed the medical records of 24 patients diagnosed with SVAS at
initial echocardiographic examination or during the following period of RVOT obstruction. Very mild SVAS was defined as a
transvalvular Doppler peak systolic instantanous gradient (PSIG) less than 25 mmHg, mild stenosis as 25–49 mmHg, moderate
stenosis as 50–75 mmHg, and severe stenosis as more than 75 mmHg. The mean age of the patients was 3.1 ± 2.9 years (range,
7 days to 12.7 years), and 18 of the patients (72%) were male. Fifteen patients had Williams’ syndrome. Seventeen patients
(71%) were followed for a mean of 5.2 ± 3.8 years (range, 7 months to 13.5 years). Among 17 patients with complete follow-up
records, 1 (6%) had very mild, 5 (29%) mild, 3 (18%) moderate, and 3 (18%) severe aortic stenosis at initial echocardiographic
examination. In a newborn patient with mild pulmonary valvular stenosis. SVAS became evident after 2 months and progressed
rapidly. Supravalvular aortic stenosis was very mild in 4 patients (23%), mild in 3 (18%), moderate in 3 (18%), and severe
in 7 (41%) at last echocardiographic examination. Of 17 patients who were followed, 11 (65%) had RVOT obstruction at initial
echocardiographic examination. RVOT obstruction disappeared in 5 patients, regressed in 1 patient, and appeared in 1 patient
over the follow-up period. Four patients underwent operation. It appears reasonable that patients with very mild and mild
stenosis should be followed medically every 1 or 2 years and patients with moderate stenosis once a year. Newborns with SVAS
should be followed for rapid progression of SVAS. In some patients, RVOT obstruction may disappear, and SVAS may develop in
others with RVOT obstruction. Patients with RVOT obstruction (at the valvular, supravalvular, or peripheral pulmonary arterial
level) should be evaluated carefully for development of SVAS at follow-up. 相似文献
6.
Kuninobu Saiki M.D. Hirohisa Kato M.D. Kazushige Suzuki M.D. Osamu Inoue M.D. On Toyoda M.D. Junichi Takagi M.D. Noboru Sato M.D. Nobutoshi Ohara M.D. Teiji Akagi M.D. Masahiro Ishii M.D. Takumi Miyake M.D. Tetsu Sugimura M.D. Yasuki Maeno M.D. Kanoko Hashino M.D. Tsuyoshi Fukuda M.D. 《Pediatrics international》1992,34(4):433-440
Percutaneous balloon aortic valvuloplasty (BAV) was performed in 14 patients, including one critically ill infant with congenital valvular aortic stenosis (AS). BAV was effective in 13 patients (except the infant). The peak systolic pressure gradient between the left ventricle (LV) and the ascending aorta decreased from 76.6 ± 21.6 to 29.5 ± 15.3 mmHg ( P < 0.001). Follow-up cardiac catheterization was performed for eight patients between 1 and 3 years (1.6 ± 1.1 years) after BAV. Restenosis was found in only one patient, and the efficacy of BAV continued significantly. Aortic regurgitation developed or increased in severity in 5 of 13 children immediately after BAV. Any other severe complication was not observed.
Dilatation by BAV was not sufficient for the infant with critical AS, and acute myocardial infarction (AMI) in the lateral wall of the LV occurred during the BAV procedure. The infant died 3 days after the procedure due to AMI.
It was concluded that the retrograde double balloon technique was superior to the retrograde single balloon technique. In two cases, the single balloon technique was ineffective because it was impossible to fix the balloon at the aortic annulus. However, the double balloon technique was effective in every patient.
BAV is effective for AS in children, and an optional repeat trial may enable BAV to be the first choice for AS. Although BAV may be effective for neonates and infants with critical AS as an emergency treatment, much attention must be paid during the procedure. 相似文献
Dilatation by BAV was not sufficient for the infant with critical AS, and acute myocardial infarction (AMI) in the lateral wall of the LV occurred during the BAV procedure. The infant died 3 days after the procedure due to AMI.
It was concluded that the retrograde double balloon technique was superior to the retrograde single balloon technique. In two cases, the single balloon technique was ineffective because it was impossible to fix the balloon at the aortic annulus. However, the double balloon technique was effective in every patient.
BAV is effective for AS in children, and an optional repeat trial may enable BAV to be the first choice for AS. Although BAV may be effective for neonates and infants with critical AS as an emergency treatment, much attention must be paid during the procedure. 相似文献
7.
8.
Maostafa Behjati-Ardakani Seyed-Hossien Moshtaghion Shahrokh Rajaei 《Iranian journal of pediatrics.》2013,23(1):32-36
Objective
Immediate, short and midterm outcome of balloon pulmonary valvuloplasty are well known, but there is limited information on long term results. We report long term results of 2–13. 5 years follow up of balloon pulmonary valvuloplasty in children.Methods
From June 1998 to January 2012 sixty consecutive patients (33 females, 27 males) with moderate to severe valvar pulmonary stenosis (right ventricular to pulmonary artery pressure gradient greater than 50 mmHg) were considered for balloon valvuloplasty. The gradient was measured pre and immediately post–valvuloplasty at catheterization, and then by echocardiography at follow up. Follow up studies were performed 2–13.5 years (mean±SD; 7.1±2.5 years, median: 5.5 years) after procedure, by Doppler echocardiography in all patients and catheterization and angiography in two patients.Findings
Balloon pulmonary valvuloplasty BPV was successful in 53 of 60 (88.3%) patients whereas surgical valvotomy was necessary in 6 to 60 (10%). There was one immediate death due to perforation of the right ventricular outflow tract. Pulmonary valve systolic pressure gradient decreased from 83.3±32.1 to 19.3±14.2 mmHg immediately after BPV and to 12.3±6.6 mmHg at late follow up (P<0.001). Pulmonary insufficiency was noted in 20 (38%) patient at short–term, but it was demonstrated in 17 (32%) at late follow up. A second valvuloplasty was performed in two (3.8%) patients presenting with re-stenosis.Conclusion
The short, intermediate and long-term outcomes of pulmonary balloon valvuloplasty in children are excellent. Therefore it can be considered as the treatment of choice for children with pulmonary valve stenosis. 相似文献9.
Familial homozygous hypercholesterolemia is a rare disease with diverse clinical presentations. Patients often present with
cutaneous xanthomas, particularly in the Achilles’ tendon. They may have significant cardiovascular involvement, including
premature atherosclerotic coronary artery disease and valvar and supravalvar aortic stenosis. Standard therapy includes diet
modulation, pharmacotherapy, and lipid apheresis. Rarely, patients require surgical intervention for coronary artery bypass
grafting and/or relief of the aortic stenosis. We present the case of a patient with severe progressive supravalvar aortic
stenosis that ultimately required surgical resection despite aggressive medical therapy. 相似文献
10.
Aortic Stenosis: The Spectrum of Practice 总被引:2,自引:0,他引:2
Khalid O Luxenberg DM Sable C Benavidez O Geva T Hanna B Abdulla R 《Pediatric cardiology》2006,27(6):661-669
There is significant variation in practice patterns in managing congenital aortic valve stenosis. Review of medical literature
reveals no significant information regarding the current practice methods in the treatment of a simple lesion such as aortic
stenosis (AS). Therefore, this survey-based study was conducted in an attempt to better understand the uniformity or heterogeneity
of practice in treating AS. A questionnaire was prepared to evaluate the style of management of AS. This survey was designed
to assess the practice of follow-up visitations, type and frequency of investigative studies, pharmacological therapy, and
exercise recommendations. Questions about therapeutic intervention included those of timing and type of intervention. Questionnaires
were sent to all academic pediatric cardiology programs in the United States (48 program) and selected international programs
from Europe, Asia, and Australasia (19 program). The total number of surveys sent out was 67, and the total number of respondents
was 25 (37%), 15 (31%) from the United States and 9 (53%) from outside the United States. The definition of moderate AS varied
among respondents. The range provided for mild AS was identified as that with a peak-to-peak pressure gradient of < 25–30
mmHg, peak instantaneous Doppler gradient of < 36–50 mmHg, or mean Doppler gradient of < 25–40 mmHg. On the other hand, severe
AS was defined as that with a peak-to-peak gradient of > 50–60 mmHg, peak instantaneous Doppler gradient of > 64–80 mmHg,
or mean Doppler gradient of > 45–64 mmHg. In assessing follow-up patterns, 84% of respondents recommended seeing patients
with mild AS annually, the longest time of follow-up listed in the questionnaire, whereas 20% suggested follow-up every 6
months. There was no consensus among survey centers regarding follow-up of patients with moderate AS. For severe AS, 16% recommend
immediate intervention, 16% arrange follow-up every 6 months, and 56 and 28% recommend follow-up in 3 and 1 month(s), respectively.
In making the decision to proceed with biventricular versus univentricular repair in patients with AS in the neonatal period,
many factors were considered. Ninety-two percent of respondents rely on mitral valve z score, 84% on aortic valve z score, 52% on left ventricle length, 48% on the presence of antegrade ascending aorta flow, and only 32% considered significant
endocardial fibroelastosis as a factor. Rhodes score was used by 20% of respondents in decision making regarding the approach
to management of this subset of AS. This study shows that there is consensus in the management of mild and severe forms of
AS. As expected, disagreement is present in the definition, evaluation, and therapy of moderate aortic valve stenosis. There
is a tendency for catheter intervention except in the presence of dysplastic aortic valve or moderate to severe aortic regurgitation.
There is also disagreement regarding methods used to determine biventricular versus univentricular repair of a borderline
hypoplastic left heart. 相似文献
11.
We report a case of a 12-year-old boy with severe congenital aortic stenosis in whom magnetic resonance imaging (MRI) with
delayed contrast enhancement demonstrated extensive subendocardial hyperenhancement within the left ventricle. The hyperenlaancement
was confirmed to be subendocardial infarct and fibrosis by histopathology. This case supports the utility of MRI with delayed
contrast enhancement in evaluating myocardial viability in patients with congenital heart disease. 相似文献
12.
We report our experience with asymptomatic valvar aortic stenosis diagnosed during infancy. During the period between November
1, 1986 and October 31, 1992 a total of 13 infants were diagnosed with asymptomatic aortic stenosis, 5 of whom showed rapid
progression over the first 2 years of life. Two of these asymptomatic infants had severe aortic stenosis by 2 months of age,
requiring intervention. We agree that aortic stenosis is a progressive lesion even in mild cases, but we emphasize the need
for close clinical and echocardiographic follow-up of these asymptomatic children during infancy to prevent congestive heart
failure and sudden death. 相似文献
13.
We assessed heart rate (HR) recovery following peak exercise before and after a 12-week cardiac rehabilitation program in
14 children, 12.1 ± 1.8 years of age, with repaired complex congenital heart disease (CHD; 11 with Fontan surgery) and impaired
exercise performance. Exercise testing using bicycle ergometry was performed at baseline, after completion of the rehab program
and 1.0 ± 0.2 years after the baseline test. These data were compared to HR recovery in 15 controls (age, 12.7 ± 2.4 years)
with CHD (13 with Fontan surgery) with two serial exercise tests at an interval of 1.1± 0.3 years. There was no change in
peak HR between the two serial tests in either group. Peak VO2 improved in the rehab group (26.3 ± 9.6 ml/kg/min at baseline vs 30.9 ± 9.6 ml/kg/min after rehab, p = 0.01) but remained unchanged in controls on serial testing. One-minute HR recovery (in beats per minute) improved significantly
following completion of the rehab program (27 ± 15 at baseline vs 40 ± 23 after rehab, p = 0.01). Partial improvement in 1-minute HR recovery in the rehab group persisted 1 year later (1-minute HR recovery, 35
± 19; p = 0.1 compared to baseline). There was no change in 1-minute HR recovery over time in the control group (37 ± 16 vs 40 ±
13, p = not significant). In conclusion, HR recovery following peak exercise improves in children with CHD after participation
in a cardiac rehab program. 相似文献
14.
Percutaneous Transluminal Angioplasty for Stenosis of the Aorta Due to Aortic Arteritis in Children 总被引:3,自引:0,他引:3
Percutaneous transluminal balloon angioplasty for stenosis of the aorta due to aortic arteritis was attempted on 45 lesions
in 41 children (age range, 4–14 years; mean, 9.9±4.2 years) presenting with symptoms of hypertension, severe congestive heart
failure, and lower limb claudication. Balloon dilatation was technically successful in 38 (92.7%) patients for 41 stenotic
lesions (91.1%). The mean peak systolic pressure gradient (PSG) decreased from 71.7 ± 23.9 mmHg to 23.2 ± 17.5 mmHg (p < 0.001) and the diameter of the stenosed segment increased from 3.3 ± 1.1 mm to 7.5 ± 2.2 mm (p < 0.001) immediately after angioplasty. Patients with short-segment (<3 cm) stenosis had a lower residual gradient (17.9
± 11.1 mmHg vs 30.5 ± 22.6 mmHg; p < 0.05) and a wider diameter of the aorta (8.8 ± 1.1 mm vs 7.5 ± 2.2 mm; p < 0.02) compared to patients with long-segment (≥3 cm) stenosis. Four patients required stent implantation; 2 for flow-limiting
dissection, 1 for failure to reduce PSG by >50%, and 1 for recurrent restenosis. There was marked hemodynamic and angiographic
improvement in these 4 patients. Hemodynamic and angiographic restudy in 21 of the 41 patients at mean follow-up period of
6.2 ± 4.2 months (range, 3–24 months) showed restenosis in 4 (19%) patients. Restenosis was more common in patients with long-segment
stenosis than those with short-segment stenosis (30% vs 9.1%). Late restudy in 8 patients, done at 3–7 years after first restudy,
showed no recurrence of aortic narrowing. On clinical follow-up of 38 patients for a mean of 58.8 ± 36.0 months (range, 8–146
months) there was marked improvement in symptoms. Hypertension was cured in 11 (29%), improved in 24 (63%), and persisted
in 3 (8%). Six patients with associated severe renal artery stenosis showed further improvement in hypertension after successful
renal angioplasty. Severe congestive heart failure improved in 21 (95.4%) of 22 patients. Mean left ventricular ejection fraction
improved from 0.32 ± 0.08 to 0.48 ± 0.10 (p < 0.001) at a mean follow-up of 28.7 ± 8.4 months in these patients. Hemodynamic restudy in 10 of these patients showed improvements
in left ventricular end-diastolic pressure from a mean 37 ± 9 mmHg (range, 25–55 mmHg) to 16.4 ± 6.2 mmHg (range, 6–25 mmHg)
(p < 0.001). Lower limb claudication improved in all 4 patients. Our results suggest that percutaneous transluminal balloon
angioplasty in children is safe and highly effective in relieving stenosis of the aorta due to aortic arteritis, with marked
clinical improvement, and should be the treatment of choice particularly for discrete stenosis. 相似文献
15.
This study was designed to evaluate the phenomenon of pressure recovery in pediatric patients with aortic stenosis and also to evaluate how observed differences between catheter and Doppler gradients can be predicted by Doppler echocardiography. Doppler measurements of aortic valve stenosis gradients are known to overestimate observed gradients in the catheterization laboratory. Pressure recovery has been shown to be a contributing factor to this discrepancy. However, the clinical relevance of correcting Doppler gradients using the pressure recovery equation has not been evaluated in the pediatric population. Simultaneously obtained catheter and Doppler gradients were studied in 14 patients (range, 0.03–18 years; mean, 4.1 years) with aortic valve stenosis. A total of 23 data points were measured because 9 patients underwent balloon valvuloplasty and had both a pre- and a post-balloon valvuloplasty data point in the study. The catheter gradients were then compared to peak, mean, and pressure recovery corrected Doppler gradients. Pressure recovery was calculated using a previously validated equation. As expected, measured echocardiographic continuous-wave peak Doppler gradients overestimated the observed catheter gradients (range, 16–93 mmHg; mean, 43 mmHg). The continuous-wave peak Doppler gradients, mean, and pressure recovery adjusted gradients were equally as good in correlating the observed catheter gradients to those obtained by Doppler echocardiography (r = 0.92). However, pressure recovery corrected Doppler gradients were in better agreement with catheter gradients than echocardiographic mean or peak Doppler gradients (95% limit of agreement: –9 to 19 mmHg for pressure recovery corrected gradients, –30 to 11 mmHg for mean Doppler gradients, and 2–83 mmHg for peak Doppler gradients). Measured continuous-wave peak Doppler gradients consistently overestimated catheter gradients. The noted differences may be predicted using the pressure recovery equation. Pressure recovery is a significant factor in children with aortic valve stenosis. 相似文献
16.
Vehbi Dogan Burhan Öcal Utku Arman Orun Senem Ozgur Osman Yılmaz Mahmut Keskin Özben Ceylan Selmin Karademir Filiz Şenocak 《Pediatric cardiology》2013,34(5):1152-1158
The aim of our study was to evaluate myocardial functions with strain/strain rate echocardiography in asymptomatic patients having congenital aortic stenosis (CAS) with normal cardiac functions as determined by conventional echocardiographic techniques and comparing them with those of healthy controls. A total of 58 patients with various degrees of isolated CAS and 52 healthy controls were enrolled in this study. Conventional and two-dimensional speckle tracking (2DSTE) echocardiography were performed. Global longitudinal strain (LS) (?23.1 ± 3.6 and ?23.8 ± 4.7), and longitudinal strain rate (LSR) (?1.49 ± 0.32 and ?1.76 ± 0.39) values were lower, whereas circumferential strain (CS) (?25.9 ± 4.7 and ?22.8 ± 6.4) and circumferential strain rate (CSR) (?1.82 ± 0.46 and ?1.69 ± 0.49) values were greater in the patient group than in the control subjects. The difference was significant for global LSR and CS (p < 0.05) values. Regional analysis showed lower LS values in the basal part of the left-ventricular (LV) free wall and lower LSR values in the basal parts of both of the septum and free wall in the patient group (p < 0.05). CS values in the anteroseptal, posterior, and inferior walls were significantly greater in the patients (p < 0.05). 2DSTE detects subtle alterations in myocardial function in asymptomatic children with CAS. Impairment of LV long-axis function occurred earlier and was more prominent in basal parts of the interventricular septum and the free wall of the left ventricle. 相似文献
17.
Aortic valve replacement has been recommended in patients who have severe symptoms, in patients with extreme left ventricle
(LV) dilatation (end diastolic dimension >4 SD above normal) or LV ejection fraction <50%. However, the occurrence of advanced
symptoms or severe LV dilatation raises concern about irreversible LV dysfunction. This study sought to determine the influence
of preoperative symptoms, LV size and function on mortality, and postoperative LV performance in children and adolescence
after valve replacement for aortic regurgitation (AR). A total of 49 patients 18 years old or younger (mean, 13.9 ± 3) who
underwent valve replacement for chronic AR between 1991 and 2001 were followed up for 1–10 years (mean, 3.3 ± 2.1). Baseline
and postoperative characteristics were compared between 13 patients (group 1) with extreme LV dilatation and 34 patients (group
2) with a lesser degree of LV enlargement. Preoperative low ejection fraction (p < 0.008), extreme LV dilatation (p < 0.05), and LV end systolic dimension >4 SD above normal (p < 0.05) were predictors of persistent LV dysfunction. Extreme LV dilatation (p < 0.0003), LV end systolic dimension (p < 0.0007), and reduced LV ejection fraction (p < 0.01) predicted persistent LV dilatation. In the setting of chronic AR, preoperative symptoms, LV systolic function, and
LV internal dimensions are the main predictors for persistent LV dysfunction and dilatation. Surgical correction should be
performed before LV systolic dysfunction and/or extreme LV enlargement occurs. 相似文献
18.
H. WENDEL D. TEIEN D. G. HUMAN M. A. NANTON 《Acta paediatrica (Oslo, Norway : 1992)》1990,79(11):1112-1115
ABSTRACT. Fifteen children with aortic stenosis were examined with Echo-Doppler cardiography in order to evaluate the use of the continuity equation to calculate the aortic valve area. The results were compared to invasive estimates of valve area calculated with the Gorlin's equation. A close correlation between the two methods, r=0.94, was found and it is concluded that even in children an accurate estimate of valve area can be expected with the use of the continuity equation. 相似文献
19.
Babaoglu K Eroglu AG Oztunç F Saltik L Demir T Ahunbay G Guzeltas A Cetin G 《Pediatric cardiology》2006,27(6):699-706
This study evaluates the progression of stenosis, onset and progression of aortic regurgitation (AR), and the results of surgical
outcomes in children with isolated discrete subaortic stenosis (SAS). The medical records of 108 patients (mean age, 5.5 ±
3.8 years; range, 3 days to 18 years) with isolated discrete SAS were reviewed. Patients with lesions other than AR were excluded.
Very mild stenosis was defined as Doppler peak systolic instantaneous gradient (PSIG) less than 25 mmHg, mild stenosis as
25–49 mmHg, moderate stenosis as 50–75 mmHg, and severe stenosis as more than 75 mmHg. Seventy-eight of 108 patients were
followed for 2 months to 14 years (mean, 4.8 ± 3.7 years; median, 5 years) with medical treatment alone. In these patients,
the mean PSIG at last echocardiogram was higher than the mean PSIG at initial echocardiogram (39 ± 19 vs 31 ± 12 mmHg, respectively;
p < 0.001). Among 24 patients with very mild stenosis at initial echocardiogram, 10 had mild and 2 had moderate stenosis after
a mean period of 5.6 years. Among 46 patients with mild stenosis at initial echocardiogram, 11 had moderate and 5 had severe
stenosis after a mean period of 4.1 years. Only 1 patient among the 8 patients with moderate stenosis at initial echocardiogram
had severe stenosis after a mean period of 2.7 years. Thirty-nine patients (50%) had AR (13% trivial, 33% mild, and 4% moderate)
at initial echocardiogram. After a mean period of 4.8 years, 77% of the patients had AR (10% trivial, 53% mild, 9% mild–moderate,
and 5% moderate). Twenty-four patients underwent surgery. Preoperatively, mean Doppler PSIG and AR incidence were 64 ± 17
mmHg and 91% (22/24), respectively. The mean Doppler PSIG was 30 ± 19 mmHg and AR was present in all of the patients a mean
period of 4.1 years after surgery. Two patients underwent reoperation for recurrent SAS and AR. Patients with very mild or
mild stenosis may be followed noninvasively every year. One patient of the 8 patients with moderate stenosis progressed to
severe stenosis, and moderate AR developed in 2 patients after a mean of 2.7 years. We recommend that patients with moderate
stenosis undergo careful evaluation to determine whether surgery is necessary due to the severity of stenosis and AR. 相似文献
20.
In this report, we describe a case of coarctation of the aorta, congenital aortic stenosis with bicuspid valve, and supravalvar
aortic stenosis with left coronary artery ostial stenosis. The child underwent staged treatment using a hybrid approach employing
both surgical and interventional cardiology methods. A single pericardial patch repair technique for supravalvar aortic stenosis
associated with left coronary ostial stenosis is also described. 相似文献