Echocardiographic changes in patients with a cylinder mitral valve replacement: Preliminary analysis.

AIMS: Cylinder mitral valve construct (cMVC) is new technique for replacing the mitral valve compared to more traditional mitral valve replacement (MVR) procedures. Goal of this study was to describe echocardiographic changes over time in patients undergoing a cMVC. Secondary goal was to compare echocardiographic changes in patients that underwent a cMVC to a group of patients that underwent a MVR. METHODS: Retrospective analysis of patients undergoing a cMVC was performed. Demographics, discharge echocardiogram, and recent echocardiogram vales were evaluated. Age matched patients undergoing a MVR were assessed. Discharge and recent echocardiographic parameters were compared within the cMVC group. cMVC and MVR values were compared between groups. RESULTS: Five cMVC patients were studied. Age at surgery for the cMVC was 4.3 ± 4.2 years (median 2.2, .8-10.3 years). Time interval from hospital discharge echocardiogram to the most recent echocardiogram was 1.2 ± .7 years (median 1.0, .6-2.0 years). Mean mitral valve gradient significantly increased over time (3.6 ± 3.0 mm Hg vs 7.6 ± 2.9 mm Hg). There were significant improvements in left ventricular diameters, systolic sphericity index, shortening fraction, and ejection fraction over time. There were no significant differences in demographics, discharge echocardiogram values, and follow up echocardiogram values between the cMVC and MVR groups. CONCLUSION: In conclusion, echocardiographic indices of left ventricular function improved over time in patients undergoing cMVC. In addition, there were no significant differences between cMVC and MVR patients in echocardiographic values. Studies with a larger patient sample with longer follow up are needed to determine if cMVC continues to have comparable echocardiographic results to MVR.

Usefulness of Postnatal Echocardiography in Patients with Down Syndrome with Normal Fetal Echocardiograms.

The objective of this study is to evaluate if the diagnosis of a complex congenital heart disease (CHD) was missed in a patient with Down syndrome (DS) who had a fetal echocardiogram that was read as normal. Secondary goal of this study was to determine if any CHD was missed postnatally when a fetal echocardiogram was read as normal. A retrospective chart review of children with DS at Nationwide Children's Hospital whose birthdates were between 1/1/2010 and 12/31/2017 was performed. Patients were included if they had a fetal echocardiogram that was read as normal and also had a postnatal echocardiogram performed. One hundred twenty fetal echocardiograms on patients with DS were performed, of which 45 patients met the inclusion criteria. No patient was diagnosed with a complex CHD postnatally, with a negative predictive value = 100%. Thirteen patients were diagnosed with CHD postnatally, with a negative predictive value of 71.1%. All 13 patients had either a murmur (11) or an abnormal EKG (9). One patient died at 8 days of life due to pulmonary hypertension complications. Five patients had resolution of their CHD, 2 patients have near resolution, 2 patients are being followed for their atrial septal defects and 3 underwent intervention (septum primum surgical repair = 1, PDA catheter occlusion = 2). Complex CHD was not missed on any fetal echocardiograms performed on patients with DS. All the other patients who had CHD diagnosed postnatally had an abnormal finding on evaluation. Further studies evaluating echocardiographic imaging recommendations are needed to maximize care in this patient population.

Left Ventricular Dilation: When Pediatric Meet Adult Guidelines.

Measuring and grading left ventricular (LV) size is essential for diagnostic, treatment, and prognostic purposes. Guidelines for quantifying LV size exist for pediatric and adult patients via M-mode measurements, but no data exist determining how well they agree with one another. The goal of this study was to determine the agreement between pediatric echocardiographic readers (PER), pediatric guidelines, and adult guidelines in assessing LV dilation. A retrospective review of all noncongenital echocardiograms from 9/2002 to 11/2015 that had a left ventricular end-diastolic diameter (LVEDD) >5.8 cm for males and >5.2 cm for females was performed. LV size was graded as normal (Z-score ≤ 2), mild (2 < Z-score ≤ 3), moderate (3 < Z-score ≤ 4), or severe (4 < Z-score) based on pediatric and adult guidelines. PER interpretation was also recorded. Agreement between LV size assessments was determined for these three interpretations. A total of 1489 echocardiograms met the inclusion criteria (654 males:835 females). Males were 19.0 ± 6.9 years old and had a BSA of 1.9 ± 0.3 m2, and LVEDD was 6.3 ± 0.5 cm. Females were 18.7 ± 8.3 years old and had a BSA of 1.8 ± 0.3 m2, and LVEDD was 5.7 ± 0.5 cm. There was a 63.91% agreement for males and an 81.8% agreement for females between PER and pediatric guidelines in assessing LV size. There was a 39.14% agreement for males and a 14.13% agreement for females between PER and adult guidelines in assessing LV size. There was a 41.44% agreement for males and a 14.49% agreement for females between adult and pediatric guidelines in assessing LV size. These agreement percentages did not change significantly when separating the population into greater than or less than 18 years of age cohorts. Pediatric echocardiographic readers were more consistent in following pediatric guidelines than adult guidelines in assessing LV size. The agreement for PER and pediatric guidelines was poor, especially for females, in relation to adult guidelines when assessing LV size. Further standardization and guidelines are needed for pediatric patients that are adult size.