Impact of percutaneous pulmonary valve implantation for right ventricular outflow tract dysfunction on exercise recovery kinetics.

The recovery of cardiopulmonary variables from peak exercise in patients with pulmonary stenosis (PS) or regurgitation (PR) is delayed, but the impact of treating PS or PR on exercise recovery kinetics is unknown. 43 patients (median age 14 years) with PS (n = 23) or PR (n = 20) after repair of congenital heart disease underwent successful percutaneous pulmonary valve implantation (PPVI). Cardiopulmonary exercise tests (CPET) were performed both before and within 1 month after PPVI. Apart from peak oxygen uptake (VO2), the constant decay of VO2, CO2 output (VCO2), minute ventilation (VE), and heart rate (HR) and oxygen pulse were calculated for the first minute of recovery as the first-degree slope of a single linear relation. PPVI led to a significant improvement in NYHA functional class in the PS and PR groups (p<0.001 and p=0.0015, respectively). On CPET, peak VO2 improved post-PPVI only in the PS (25.6 ± 6.2 vs. 27.8 ± 7.9 ml/kg/min; p = 0.01) but not PR group (29.0 ± 9.8 vs. 28.6 ± 8.9 ml/kg/min; p = 0.6). However, VO2 slope improved in the PS (0.40 ± 0.23 vs. 0.65 ± 0.27, p < 0.001) as well as in the PR group (0.56 ± 0.37 vs. 0.67 ± 0.37, p = 0.003) as did VCO2 slope (0.39 ± 0.2 vs. 0.55 ± 0.24, p = 0.002 and 0.42 ± 0.33 vs. 0.53 ± 0.35, p = 0.02: for the PS and PR groups, respectively). The VE and HR slopes did not change after PPVI. Despite the lack of improvement in exercise capacity in the PR group, treatment of PS and PR by PPVI induces significant and similar improvements in the ability of recovering from maximal exercise in the 2 groups.

Wire fractures in Solysafe septal occluders: a single center experience.

OBJECTIVES: To determine the incidence of device fractures (DF) after implantation of a Solysafe Septal Occluder (iSSO) and to assess the spectrum of associated problems. BACKGROUND: In August 2010, after initial unpublished reports on DF, the manufacturer issued an "urgent field safety notice," prompting all medical care providers to re-examine all patients after iSSO. METHODS: Prospective single center study. Extended follow-up examination, including standardized fluoroscopy (sF), was performed in all patients after iSSO. RESULTS: A total of 111 patients had undergone iSSO at our institution between June 2005 and July 2010. Median age and body weight were 50 years (9.3-79.6) and 75 kg (29-122), respectively. Indications for iSSO were (1) patent foramen ovale in patients with a history of cryptogenic stroke (n = 84; 76%) and (2) hemodynamically significant atrial septal defect of the secundum type (n = 27; 24%). A total of 113 devices were implanted. Complete follow-up was available in 103 patients (92.8%). Median follow-up was 1.9 years (0-5.2). There were no postimplantation neurological events or symptoms. The closure rate was 97.1%. DF was suspected on a chest X-ray in one patient and documented in 10 patients by sF. The overall probability of freedom from DF was 82.3% after 5 years. One patient had embolization of a device fragment to the right pulmonary artery. So far, all patients with DF have been managed conservatively. CONCLUSIONS: The incidence of DF after iSSO is unacceptably high. sF is imperative for accurate diagnosis of DF. Further, follow-up is needed to determine the risk of clinical complications and to optimize management.

Emergency covered stent implantation for rupture of the ascending aorta after balloon angioplasty.

An acute rupture of the ascending aorta occurred in a 12-year-old boy after balloon angioplasty and was successfully treated by emergency covered stent implantation during resuscitation and preparation for support with extracorporeal membrane oxygenation. Neuroprotection with sedation, core temperature cooling and mild hyperventilation were undertaken. The boy recovered quickly. There were no neurological sequalae with a good interventional result at discharge and at follow-up after 9 months.