Pulmonary Regurgitation after Tetralogy of Fallot Repair: Clinical Features,Sequelae, and Timing of Pulmonary Valve Replacement

Pulmonary regurgitation following repair of tetralogy of Fallot is a common postoperative sequela associated with progressive right ventricular enlargement, dysfunction, and is an important determinant of late morbidity and mortality. Although pulmonary regurgitation may be well tolerated for many years following surgery, it can be associated with progressive exercise intolerance, heart failure, tachyarrhythmia, and late sudden death. It also often necessitates re‐intervention. Identifying the appropriate timing of such intervention could be very challenging given the risk of prosthetic valve degeneration and the increased risk of reoperation. Comprehensive informed and regular assessment of the postoperative patient with tetralogy of Fallot, including evaluation of pulmonary regurgitation, right heart structure and function, is crucial to the optimal care of these patients. Pulmonary valve replacement performed in an experienced tertiary referral center is associated with low operative morbidity and mortality and very good long‐term results. Early results of percutaneous pulmonary valve replacement are also promising.     

Valve disease in pregnancy

Maternal cardiac disease is a major cause of non-obstetric morbidity and accounts for 10–25% of maternal mortality. Valvular heart disease may result from congenital abnormalities or acquired lesions, some of which may involve more than one valve. Maternal and fetal risks in pregnant patients with valve disease vary according to the type and severity of the valve lesion along with resulting abnormalities of functional capacity, left ventricular function, and pulmonary artery pressure. Certain high-risk conditions are considered contraindications to pregnancy, while others may be successfully managed with observation, medications, and, in refractory cases, surgical intervention. Communication between the patient?s obstetrician, maternal–fetal medicine specialist, obstetrical anesthesiologist, and cardiologist is critical in managing a pregnancy with underlying maternal cardiac disease. The management of the various types of valve diseases in pregnancy will be reviewed here, along with a discussion of related complications including mechanical prosthetic valves and infective endocarditis.     

Gastrointestinal manifestations of cow’s milk protein allergy and gastrointestinal motility

Cow’s milk protein allergy (CMPA) may cause gastrointestinal motility disorders. Symptoms of both conditions overlap and diagnostic tests do not reliably differentiate between both. A decrease of symptoms with an extensive hydrolysate and relapse during challenge is not a proof of allergy, because hydrolysates enhance gastric emptying, a pathophysiologic mechanism of gastro‐oesophageal reflux (GER). Thickened formula reduces regurgitation, and failure to do so suggests CMPA. A thickened extensive hydrolysate may induce more rapid improvement, but does not always differentiate between CMPA and GER. Different hypotheses are discussed: is the overlap between CMPA and functional disorders coincidence, or do both entities present with identical symptoms, or does the fact that symptoms are identical indicates that there is only one entity involved? Studies on the prevention of CMPA focused on ‘at‐risk families’, and resulted in a decrease of CMPA and atopic dermatitis, but did not provide data on the incidence of GER. Conclusion: As long as there are no objective diagnostic tools to separate GER from CMPA, the physician has two options: first treat the most likely diagnosis, and switch if after 2–4 weeks there is no improvement, or treat both conditions with one intervention, what will not result in a diagnosis.     

Perioperative management of a patient with Chagas disease having mitral valve surgery

A patient with advanced Chagas disease presented with symptoms attributable to dilated cardiomyopathy and mitral regurgitation. Although esophageal involvement is part of the constellation of findings in Chagas, transesophageal echocardiography was safely used to guide the mitral valve surgery.     

全身成像三维量化评估二尖瓣反流体积与多普勒法的对比研究

目的探讨全身成像三维量化（GI3DQ）法直接测量二尖瓣反流束体积用以评估二尖瓣反流（MR）体积的可行性和准确性。方法：93例MR患者,分两组：偏心性MR：52例;中心性MR：41例。GI3DQ法葭接测量MR体积;Doppler法计算的MR体积作为参考标准。结果：偏心性与中心性MR组：Doppler计算MR体积与GI3DQ测量MR体积相关性分别为：r=0．77,r=0．81;一致性分析：偏心性MR组,GI3DQ法较Doppler法平均低估12．19ml,P〈0．05;中心MR组,GI3DQ法较Doppler法平均低估1．34ml．P〉0．05,结论：与Doppler法相比,偏心件MR组,GI3DQ法低估MR体积;中心性MR组,两种方法未见明显差异。     

Isolated quadricuspid aortic valve referred with diagnosis of rheumatic carditis

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. It appears often isolated or sometimes associated with other truncal anomalies, and approximately 50% of patients have aortic regurgitation. In this article we reported an eight-years-old boy referred with diagnose of rheumatic carditis from the outer medical center.