Recanalisation of the left superior caval vein after Fontan procedure: not so rare complication: possibilities of percutaneous closure using various devices.

AIM: Evaluation of possibilities of percutaneous closure of recanalised left superior caval vein after total cavopulmonary connection. METHODS AND RESULTS: We analysed 19 patients after total cavopulmonary connection catheterised because of a sudden increase of desaturation. In four of them, the recanalisation of the left superior caval vein was identified. For this reason, the balloon occlusion tests of the veins were made temporarily. In all cases, the haemodynamic status of patients did not change, and arterial oxygen saturation increased significantly. Thus, using different types of implants, these veins were closed effectively in all patients. During the short-term follow-up, the effectiveness of treatments and constantly maintaining a high level of saturation were confirmed. CONCLUSIONS: Meticulous investigation of unclear causes of desaturation in cyanotic patients after Fontan completion is necessary. Almost all causes of desaturation, including recanalised additional left superior caval vein, can be effectively treated percutaneously.

The Differences in the Diagnostic Profile in Children with Vasovagal Syncope between the Result of Head-Up Tilt Table Test.

(1) Background: The features characterizing vasovagal syncope (VVS) are an important factor in the correct evaluation of diagnostic risk stratification in children and adolescents. The aim of the study was to determine the value of identifying the clinical characteristics in children with VVS. (2) Methods: We made a retrospective analysis of the medical records of 109 children with diagnosed VVS. We investigated the specific characteristics of syncope in children with VVS including the positive VVS (+) and negative VVS (-) result of the Head-Up Tilt Table Test (HUTT). (3) Results: We did not observe significant differences in the prodromal symptoms of VVS with HUTT response. In addition to typical prodromal symptoms, no difference in statistically reported palpitations (35/109 or 32.1%) and chest discomfort (27/109 or 27.7%) were recorded. Fear-pain-stress emotions as circumstances of syncope were more often reported by children with a negative HUTT (p = 0.02). Cramps-contractures (p = 0.016) and speech disorders (p = 0.038) were significantly higher in the group with negative HUTT. (4) Conclusions: There is a close relationship in the diagnostic profile between the negative and positive results of head-up tilt table test in children with vasovagal syncope.

Usefulness of cutting balloon angioplasty for the treatment of congenital heart defects.

BACKGROUND: Patients with complex congenital heart defects may have different hemodynamic prob-lems which require a variety of interventional procedures including angioplasty which involves using high-pressure balloons. After failure of conventional balloon angioplasty, cutting balloon angioplasty is the next treatment option available. The purpose of this study was to evaluate the safety and efficacy of cutting balloon angioplasty in children with different types of congenital heart defects. METHODS: Cutting balloon angioplasty was performed in 28 children with different congenital heart defects. The indication for cutting balloon angioplasty was: pulmonary artery stenosis in 17 patients, creating or dilatation of interatrial communication in 10 patients, and stenosis of left subclavian artery in 1 patient. RESULTS: In the pulmonary arteries group there was a significant decrease in systolic blood pressure (SBP) in the proximal part of the artery from the average 74.33 ± 20.4 mm Hg to 55 ± 16.7 mm Hg (p < 0.001). Distal to the stenosis there was an increase in SBP from 19.8 ± 3.82 mm Hg to 30.3 ± ± 13.3 mm Hg (p = 0.04). This result remained constant in the follow-up. In atrial septal defect/fenestra-tion group, cutting balloon angioplasty was performed after an unsuccessful classic Rashkind procedure. After cutting balloon angioplasty there was a significant widening of the interatrial communication. CONCLUSIONS: Cutting balloon angioplasty is a feasible and effective treatment option in different con-genital heart defects.

Electrocardiographic T-wave parameters in families with long QT syndrome.

BACKGROUND: T-wave parameters, especially the Tpeak-Tend interval (TpTe), reflect the total dispersion of repolarization, whose amplification may lead to the development of life-threatening ventricular arrhythmias observed in the long QT syndrome (LQTS). OBJECTIVES: The study attempted to evaluate QT, QTp (Q-Tpeak) and TpTe (Tpeak-Tend) intervals in unaffected and affected blood relatives of children with clinically confirmed LQTS as well as to determine whether the values of these repolarization parameters may be used in clinical practice. MATERIAL AND METHODS: The study group included 47 affected blood relatives (27 LQTS1 and 20 LQTS2) and 68 unaffected family members without clinically confirmed LQTS symptoms. The TpTe, QT and QTp intervals were measured manually in the lead V5 of standard ECGs and corrected using Bazett's and Fridericia's formulas. RESULTS: The RR, QT, QTp and TpTe intervals with their corrected values were significantly longer (p < 0.0001) in the affected subjects than in the unaffected subjects and, similarly, in LQTS1 and LQTS2 patients compared with the unaffected family members. The TpTe interval in LQTS2 showed only a tendency to be longer compared to LQTS1, but did not reach statistical significance (p = 0.0933). For affected blood relatives, only the TpTe interval (p < 0.0409) and QT interval, corrected with Bazett's (p < 0.0393) and Fridericia's (p < 0.0495) formulas, enabled differentiation between LQTS1 (mean TpTe = 103 ±15) and LQTS2 women (mean TpTe = 106 ±17). Moreover, there were statistically significant differences (p < 0.05) in the TpTe interval between the 6 sex subgroups: unaffected women and men as well as women and men with LQTS1 and LQTS2. CONCLUSIONS: The electrocardiographic Tpeak-Tend parameter, in addition to the QT interval, is helpful in identifying affected blood relatives of children with LQTS, particularly for the group of LQTS1 and LQTS2 women. Further studies are required to assess the clinical importance of the TpTe interval in families with long QT syndrome.

[Arterial hypertension among children and teenagers in the Upper Silesia]. / Nadcisnienie tetnicze u dzieci i mlodziezy w populacji slaskiej.

Nowadays arterial hypertension is more frequently observed among children and teenagers then it used to be earlier. Arterial hypertension and obesity are more and more often the main sources of atherosclerosis. The purpose of this work was to assess the patients with the arterial hypertension treated in the Department of Pediatric Cardiology in Katowice in 2003. Patients' age, family history of hypertension, family background and parents' education were taken into consideration. Birth weight, BMI factor, all the sufferings reported by patients, blood pressure measurements results, ABPM, EKG parameters, ECHO+ Doppler parameters, exercise test results, fundus of the eye examination, laboratory investigation results, were also analyzed. Our results show that a positive family history is a very important factor in the development of arterial hypertension among children (44.7%). In our patients' cases the most frequent clinical symptoms are tachycardia (68%) and obesity (59.2%). In conclusion, children and teenagers with hypertension should be successfully treated and those with positive family history of hypertension should be taken under primary prevention in order to decrease the risk of cardiovascular complications.

[Vasovagal syncope--diagnostic difficulties in adolescents]. / Omdlenia wazowagalne--trudnosci diagnostyczne u mlodziezy.

Consciousness disturbances in adolescents may be caused by different reasons. Among them, cardiologic and neurological backgrounds should be considered. The most important diagnostic tests the vasovagal syncopes are: tilt-table test, brain oxygenation measurement, routine and extended elektroencephalography. Performing of these examinations simultaneously may help in determining cause of symptoms. Our patient serves us as an example.

[Characteristics of psychological factors participating in the etiopathogenesis of primary arterial hypertension of children and adolescents]. / Rola czynników psychologicznych w etiopatogenezie pierwotnego nadcisnienia tetniczego u dzieci i mlodziezy.

The article presents summary of psychological examination of patients with the primary arterial hypertension disease who where hospitalized in the Department of Pediatric Cardiology of Silesian Medical University in Katowice. All results were analyzed in comparison with actual literature related to discussed problem--participation of psychosocial factors in the development of arterial hypertension. Psychological tests were performed for 60 patients between 9 and 18 years old. Selected group was analyzed on the following agents: sociodemographic data, intra-familial relations, level ofneuroticism, alexithymia, external and internal irritation, Behavioral pattern "A", learning achievements and data related to selected elements of lifestyle. The choice of above variables comes from their importance of illness' etiopathogenesis in literature. Achieved results proved theoretical expectations about selected group specification. They also showed the necessity of taking primary arterial hypertension referring to children and adolescents in psychosocial context of diagnostic and therapeutic assumptions.

[Psychological characteristics of children suffering from Duchenne muscular dystrophy]. / Psychologiczna charakterystyka dzieci z dystrofia miesniowa typu Duchenne'a.

The authors examined intellectual and socio-emotional functioning of 39 subjects suffering from Duchenne muscular dystrophy. Their school situation, access to rehabilitation and a quality of familial upbringing attitude were characterized, as well. No significant differences concerning I.Q. between sick children and healthy population were found.

Arterial hypertension in children treated at the Katowice Department of Pediatric Cardiology between 1993-2000.

In the literature, one can find a common opinion that 1-3% of the children population suffers from arterial hypertension. This rate depends on the diagnostic criterion and the studied population (age, sex, race etc.). The aim of this work was to present a rather large group (271 patients) treated for hypertension in our centre between 1993-2000. The ranged children from newborns to 18 year olds (mean = 13.75 +/- 4.5 years). In the study period, there is approximately a four fold annual increase in the number of hypertensive patients among all patients of the pediatric cardiology units. On the basis of our material, the rate of arterial hypertension depends on the age of the pediatric patients with as many as 3/4 of the children being teenagers > or = 14 years old. In the teenager group, all cases of essential hypertension were observed. Almost 70% of the studied children were boys. In about half the studied group, hypertensive changes on the eye fundus were found. One can suspect that automatic 24-hour measurement of arterial hypertension (so called "tension Holter") is of great value in children. A number of individual measurements exceeding the norm during "tension Holter" correlated with eye fundus vessel changes. In conclusion more attention should be paid to arterial hypertension in children. For example, in our previous paper published in 2000 it was stated that among 2.3% of "healthy" school children who suffered from arterial hypertension, non of these children were suspected of suffering from arterial hypertension.