Heart failure in grown-up congenital heart disease.

The increasing survival to adulthood of patients with congenital heart disease (CHD) has changed the epidemiology of adult CHD (ACHD) patients and has led to an increment in hospitalization rates due to heart failure (HF). ACHD patients hospitalized for HF have a five-fold higher risk of death than those compensated. HF occurs predominantly in patients with tetralogy of Fallot, single ventricles, and after the Mustard operation for transposition of the great arteries. Diagnostic strategies applied in acquired HF patients are usually used to evaluate ACHD patients, but sometimes this can postpone the identification of HF that can become manifest with unusual and peculiar signs or symptoms. In the same way, therapeutic management resembles the acquired HF one, even if no large randomized clinical trials have been conducted in ACHD patients. Therefore, a close monitoring in dedicated units is mandatory in order to identify in time HF manifestations and manage them adequately.

Percutaneous pulmonary valve implantation in a single artery branch: A preliminary experience.

To describe preliminary experience of percutaneous pulmonary valve implantation, in a single pulmonary branch position. Two procedures in 2 patients from a single center are described, where implantation of percutaneous valves within a single pulmonary artery branch was technically successful. The procedural indication was pulmonary valve regurgitation and/or residual stenosis. The 2 patients were symptomatic. An Edwards Sapien™ valve (Patient 1), and a Medtronic Melody™ valve (Patient 2) were implanted. Both pts were discharged with an excellent valve function. In this report it is underlined that this modality is technically feasible and may be considered an option in patients with congenital heart defect under special circumstances.

Role of imaging in interventions on structural heart disease.

Recent technological progresses have led to the development of new devices and procedures which have greatly improved the chance to effectively treat structural heart diseases in both children and adults. Interventional cardiology has been receiving fast and wide implementation as an effective alternative treatment to surgery for several congenital and acquired diseases. The advent of transcatheter valve implantation/repair techniques constitutes one of the main breakthroughs of the last decades. Such development and implementation is strictly related to a continuous progress in cardiac imaging as well. Indeed, multimodality cardiac imaging (such as X-ray, echocardiography, MRI, multidetector computed tomography) has become essential in providing accurate patient selection and in monitoring the interventional procedures in order to optimize the success rate and minimize the frequency of complications. The current article aims at reviewing the role of multimodality imaging for planning and guiding interventions in several structural heart diseases.

What do parents know about the malformations afflicting the hearts of their children?

Traditionally, medical professionals have entrusted the parents of children with chronic illness with the task of imparting knowledge about the illness to the children. This practice assumes that parents understand the illness, and that they pass on their knowledge in a manner appropriate for the individual child. The aim of our study was to assess the knowledge that parents of children with a cardiac defect have about the malformation in the heart of their child. We sent a modified version of the Leuven questionnaire to 350 families. The questionnaire was filled in and sent back to our centre by 148 families. Parents showed a good knowledge of the name and anatomical characteristics of the cardiac disease suffered by their child. Parents with a child taking drugs were not very knowledgeable about the regime, side effects, and interaction with other drugs or food. Only one-quarter of the parents knew the definition of endocarditis, although almost two-fifths were aware that unexplained fever for more than 5 days was the most typical symptom. Less than half of the parents knew that endocarditis could recur. About two-fifths of parents knew the real possibility of their child being involved in competitive sports; but almost half of parents were unable to answer this question. The poor knowledge about particular aspects of the disease, treatment, and preventive measures revealed by our parents may have major consequences. The results of our study are relevant to general daily clinical practice.