Longitudinal sequential biventricular assessment in adults with transposition of the great arteries and relationship with adverse outcomes.

BACKGROUND: In a cohort of congenitally corrected transposition of the great arteries (cc-TGA) and transposition of the great arteries after atrial switch procedure (d-TGA) the study objectives were: 1) to assess the change of quantitative systemic right ventricle (sRV) parameters over time and; 2) to examine the relationship of quantitative sRV parameters with adverse clinical outcomes. METHODS AND RESULTS: Single-center cohort study that included 49 (39%) cc-TGA and 76 (61%) d-TGA patients >18years who had at least one MUGA sRV assessment, 18/39 had more than one respectively. The primary clinical endpoint was all-cause mortality, heart transplantation and/or heart failure hospitalization. At a median clinical follow-up of 7years following the first MUGA, the primary endpoint occurred more often in cc-TGA versus d-TGA patients (18 (36.7%) vs. 9 (11.8%), p=0.03). Median time between the MUGA assessments was 5.8 (cc-TGA) and 4.9years (d-TGA). At last MUGA follow-up: 6 (33%) cc-TGA/14 (36%) d-TGA patients showed a significant decline in sRVEF (>5%); 6 (33%) cc-TGA/17 (44%) d-TGA patients had a significant increase in sRVEDVi; and 7 (39%) cc-TGA/19 (49%) PA-TGA patients had a significant increase in sRVESVi. Baseline sRV parameters were not associated with the primary end point or sRV changes over time. CONCLUSIONS: An important proportion of both patient cohorts demonstrated a significant change in sRV parameters over time and these are likely related to multiple factors that vary between individuals given population heterogeneity. The TGA patients have distinct clinical trajectories with increased adverse heart failure outcomes in the cc-TGA population and sRV parameters were not related to adverse heart failure events in either group.

Technology assessment of nonsurgical closure of patent ductus arteriosus: an evaluation of the clinical effectiveness and costs of a new medical device.

OBJECTIVE: To assess the clinical efficacy and cost impact of a new medical device for the nonsurgical closure of patent ductus arteriosus (PDA). METHODS: This was a before-after study comparing the most recent 20 surgical procedures with the first 20 nonsurgical procedures for PDA using a new medical device. Clinical outcome, hospital stay, device cost, and physician fees were compared. RESULTS: Surgical closure was effective in all 20 patients, with an average cost of $4667. In a similar patient group, nonsurgical closure was achieved in 18 of 20 patients (90%), with an estimated average cost per successful procedure of $4690. A clinically insignificant PDA leak persisted beyond 12 months in four nonsurgically managed patients. CONCLUSION: Nonsurgical closure of PDA can be recommended as an effective new medical technique that is not associated with a measurable increase in direct costs and that provides significant indirect and intangible cost advantages.

Assessment of blood pressures and gradients by automated blood pressure device compared to invasive measurements in patients previously operated on for coarctation of the aorta.

The aim of the study was to compare invasive and non-invasive blood pressure measurements and gradients. Twenty-two children and 16 adults previously operated for coarctation of the aorta were included. Invasive blood pressures were recorded proximally and distally close to the former operation site and non-invasive systolic blood pressures were recorded by an automated sphygmomanometer on right arm and leg. The adults were investigated at rest and during supine exercise. The correlation between invasive and non-invasive measurements of proximal blood pressures in adults at rest and children were the following, r = 0.92, SD 7.6 mmHg (n = 16) and r = 0.85, SD 11 mmHg (n = 22) respectively. The corresponding correlation for the distal blood pressures were the following for adults at rest 0.64, SD 11.9 mmHg and in children r = 0.82, SD 9.2 mmHg. During exercise in adults we found a low correlation when comparing invasive and non-invasive proximal and distal blood pressures and a poor correlation regarding the gradients, r = 0.50, SD 16 mmHg, r = 0.45, SD 15.9 mmHg and r = 0.30, SD 22.9 mmHg respectively (n = 16). We also measured the time interval between cessation of exercise and completion of the blood pressure recordings, which gave a mean interval of 73 sec (range 45-115 sec). During that interval the mean fall in the proximal blood pressure was 37 mmHg (range 20-80 mmHg), and the mean fall of the gradient was from 41 mmHg (range 20-76 mmHg) to 23 mmHg (range 6-56 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography by telephone--evaluation of pediatric heart disease at a distance.

A 24-hour telephone transmission service was established for pediatric echocardiography between a general hospital and a children's hospital 500 km distant. Studies were transmitted in real time for interpretation and diagnosis by a pediatric cardiologist. In the first 9 months of operation, studies were transmitted for 18 children with a median age of 5 months. Image and sound quality was excellent. Complete segmental diagnosis was made in 16 patients, and further study was needed in 2 others. In 8 of the 18 patients a new diagnosis was provided, and in 10 patients diagnosis was confirmed. Congenital heart disease was found in 12 patients, other heart disease in 2 and a normal heart in 4. The population included 2 fetuses whose echocardiograms showed hypoplastic left heart and intracardiac tumor. In 4 patients transport was avoided. This is the first report of echocardiographic transmission by telephone, which was shown to be clearly feasible, cost-effective and diagnostic. It provides emergency access to specialist expertise, and may avoid hazardous and expensive transport of ill children.