Percutaneous pulmonary valve implantation as an alternative to repeat open-heart surgery for patients with pulmonary outflow obstruction: a reality in Singapore.

Right ventricle to pulmonary artery (RV-PA) conduits have been used for the surgical repair of congenital heart defects. These conduits frequently become stenosed or develop insufficiency with time, necessitating reoperations. Percutanous pulmonary valve implantation (PPVI) can delay the need for repeated surgeries in patients with congenital heart defects and degenerated RV-PA conduits. We presented our first experience with PPVI and described in detail the procedural methods and the considerations that are needed for this intervention to be successful. Immediate and short-term clinical outcomes of our patients were reported. Good haemodynamic results were obtained, both angiographically and on echocardiography. PPVI provides an excellent alternative to repeat open-heart surgery for patients with congenital heart defects and degenerated RV-PA conduits. This represents a paradigm shift in the management of congenital heart disease, which is traditionally managed by open-heart surgery.

Comparison of cardiac function in children after surgical and Amplatzer occluder closure of secundum atrial septal defects.

OBJECTIVE: The aim of the retrospective study was to examine the changes in the left and right ventricular size as well as the systolic and diastolic function of the left ventricle after surgical and transcatheter treatment of atrial septal defects with Amplatzer atrial septal defect occluder (ASDO). METHODS: Two groups of patients were examined using transthoracic cross-sectional echocardiography before and after the treatment of atrial septal defect: Group A--Amplatzer ASD occluder--38 children and Group S treated surgically--20 children. The following parameters were assessed: left and right ventricular end-diastolic diameter indexes, ejection fraction, mitral E wave to A wave velocity ratio, deceleration time (DCT), isovolumetric relaxation time (IVRT) and heart rate. RESULTS: There was a significant decrease in right ventricular and an increase in left ventricular size in both groups during the follow-up observation. The long-term ECHO examination revealed smaller right ventricle (RV) (Group A: RVEDI=1.00+/-0.20 vs Group S RVEDI: 1.18+/-0.20 (p=0.001)) and bigger left ventricle (Group A: LVEDI=1.04+/-0.08 vs Group S: LVEDI=0.99+/-0.07 (p=0.022)) in Group A in comparison to Group S. Children undergoing operation had significantly shorter IVRT (Group A: IVRT=50.00+/- 9.65 vs Group S: IVRT=42.5+/- 8.95 (p=0.02)) than patients after ASDO device application. CONCLUSIONS: (1) During the follow-up period, the diastolic function of the left ventricle is better in children with device closure of ASD compared with those patients treated surgically. (2) Postoperative changes of the left and right ventricular size indexes are more favourable in patients after the device closure of ASD compared with children undergoing the surgical procedure.