Right ventricular outflow tract obstruction after sinus of valsalva aneurysm repair.

Sinus of Valsalva aneurysm (SVA) is a rare cardiac lesion especially in the western countries and older population. We report an unusual case of a 60-year-old Caucasian male with SVA, acute decompensation, and a pressurized prolapsed aortic leaflet cystic remnant via a small supracristal VSD causing recurrent right ventricular outflow tract obstruction following a Bentall procedure

Influence of Echocardiographic Guidance on Positioning of the Buttoned Occluder for Transcatheter Closure of Atrial Septal Defects.

Ideal position of the buttoned device for occlusion of atrial septal defects was achieved more often with transesophageal than with transthoracic echocardiographic guidance (10/11 vs 7/23; P = 0.001). Patients with ideal device position were less likely to have residual shunts, device unbuttoning, or atrioventricular valve regurgitation (2/17 vs 11/17; P = 0.002). We therefore recommend the use of transesophageal echocardiography to guide implantation of the buttoned device. (ECHOCARDIOGRAPHY, Volume 13, March 1996)

Aortopulmonary Window with Interrupted Aortic Arch and Pulmonary Artery Sling: Diagnosis by Echocardiography and Magnetic Resonance Imaging: Case Report and Literature Review.

We present the pediatric case of a patient who had aortopulmonary window with interrupted aortic arch, intact ventricular septum, and pulmonary artery sling that was imaged with echocardiography and magnetic resonance imaging. This case is unique because this combination of findings has not been previously reported. The diagnosis was made without the need for angiography, and the findings were confirmed at surgery. This case shows that complex congenital heart defects can be accurately imaged by noninvasive methods.

A simple method of measuring thoracic aortic pulse wave velocity in children: methods and normal values.

BACKGROUND: The objective of this study was to define a simple method of measuring thoracic aortic pulse-wave velocity (PWV) using only an aortic length regression equation based on the subject's height and two pulsed Doppler recordings of the aorta. METHODS: The thoracic aortas of 80 subjects (age range, 0-20 years) were measured retrospectively by direct echocardiographic visualization. A simple linear regression equation for thoracic aortic length on the basis of height was derived. PWV was defined as the thoracic aortic length, derived from the subject's height, divided by pulse transit time. Pulse transit time was defined as the difference in the time of onset of two pulsed Doppler recordings placed at the level of the aortic valve leaflet tips and the diaphragm. Normative data were retrospectively defined in 206 children. RESULTS: Thoracic aortic length was linearly related to subject height by the equation thoracic aortic length (cm)=1.7 cm+0.1 (height [cm]) (R2=0.98, P<.0001). Thoracic aortic PWV was independent of age (median, 3.04 m/s). CONCLUSION: Thoracic aortic PWV can be simply calculated from a routine echocardiogram, it is constant throughout childhood, and it may improve the assessment of left ventricular load.

Elevated blood pressure, race/ethnicity, and C-reactive protein levels in children and adolescents.

OBJECTIVE: Adult hypertension is independently associated with elevated C-reactive protein levels, after controlling for obesity and other cardiovascular risk factors. The objective of this study was to determine, with a nationally representative sample of children, whether the relationship between elevated blood pressure and C-reactive protein levels may be evident before adulthood. METHODS: Cross-sectional data for children 8 to 17 years of age who participated in the National Health and Nutrition Examination Survey between 1999 and 2004 were analyzed. Bivariate analyses compared children with C-reactive protein levels of >3 mg/L versus or=95th percentile and 1.3% had diastolic blood pressure of >or=95th percentile. Children with C-reactive protein levels of >3 mg/L had higher systolic blood pressure, compared with children with C-reactive protein levels of or=95th percentile was independently associated with C-reactive protein levels in boys but not girls. Subset analyses according to race/ethnicity demonstrated that the independent association of elevated systolic blood pressure with C-reactive protein levels was largely limited to black boys. CONCLUSIONS: These data indicate that there is interplay between race/ethnicity, elevated systolic blood pressure, obesity, and inflammation in children, a finding that has potential implications for disparities in cardiovascular disease later in life.