Prediction of early pulmonary artery stenosis after arterial switch operation: the role of intraoperative transesophageal echocardiography.

OBJECTIVES: To investigate prospectively the prediction of the neopulmonary stenosis (neo-PS) after arterial switch operation (ASO) for transposition of the great artery (TGA) with intraoperative transesophageal echocardiography (TEE). METHODS: Infants with TGA undergoing the ASO were prospectively studied over 5 years. The neo-PS was defined when the peak flow velocity was over 3 m/s at the neo main pulmonary artery (neo-MPA) after ASO by TEE (TEEPS). Catheterization was performed if estimated peak neo-PS pressure gradient was over 40 mm Hg by transthoracic echocardiography. Balloon angioplasty was tried first and surgical reoperation was reserved for those with failed angioplasty. RESULTS: In total 49 consecutive patients were enrolled into the cohort study. TEEPS was identified in 21 patients. For patients with TEEPS, freedom from reintervention was 28% at 1 year and 23% at 2 years. For patients without TEEPS, freedom from reintervention for PS was 92% at 1 year and 78% at 2 years. The time interval from ASO to reintervention was significantly shorter in patients with TEEPS than without TEEPS. Existence of TEEPS and non-Lecompte method were main risk factor for reintervention. CONCLUSION: The present study demonstrated that the application of intraoperative TEE for infants undergoing ASO is very helpful in predicting the development of early postoperative neo-PS.

Surveillance of Kawasaki disease in Taiwan and review of the literature.

BACKGROUND: Kawasaki disease affects mainly children younger than five years, leading to coronary artery lesions, even to life-threatening myocardial infarctions. Since 1976, Kawasaki disease has occurred in thousands of children in Taiwan; some of them died. METHODS: Questionnaire forms for the survey of epidemiological features of Kawasaki disease were designed and sent to the hospitals of 100 or more beds in Taiwan, in 1987, 1992, 1994, and 2001, for retrospective reviews of their patients with Kawasaki disease encountered during 1976-2000. A school-based mass survey, on the prevalence of children with history of Kawasaki disease was conducted every year from 1990 to 2000. RESULTS: Since 1976, the number of Kawasaki disease patients increased, totaling to 8,267 patients in 2000. The ratio of the incidence increased by 1.15 times annually (Poisson regression), reaching the highest incidence of 54.9 per 100,000 children <5 years of age in 1998. Of them, 85.1% were under 5 years of age. The male-to-female ratio was 1.6. Coronary artery lesions were noted during acute, subacute and convalescent stages in 25.8% of the patients. The fatality rate decreased from 0.4% to 0.06%. There was no student with history of Kawasaki disease among students surveyed in 1990. Subsequent school surveys showed the prevalence was 24.6 in 1991, 74.6 in 1996, then reached to 103.9 per 100,000 school children in 2000, with an annual increase of 1.24 times (Poisson regression). CONCLUSIONS: In Taiwan, Kawasaki disease, first diagnosed in 1976, continued to occur with several outbreaks reaching to a peak incidence of 54.9 per 100,000 population less than 5 years of age in 1998. Epidemiological features of Kawasaki disease in Taiwan were similar to the Japanese experiences and the incidence was, next only to Japan, the second highest in the world.