Growing potential of small aortic valve with aortic coarctation or interrupted aortic arch after bilateral pulmonary artery banding.

OBJECTIVES: Bilateral pulmonary artery banding (bPAB) is utilized for some patients with a ventricular septal defect (VSD) and aortic coarctation (CoA) or interrupted aortic arch (IAA). We evaluated aortic valve (AoV) diameter and patient outcomes following bPAB. METHODS: Between August 2010 and September 2015, 10 consecutive patients with VSD and patent ductus arteriosus-dependent CoA or IAA underwent bPAB because of an AoV diameter of approximately <50% of the normal value (n = 6), severe subaortic stenosis and poor patient condition (n = 1, respectively), or low birthweight (n = 2). RESULTS: Second-stage operations were conventional total repair in five and Damus-Kaye-Stansel anastomosis, aortic arch reconstruction and right ventricle-pulmonary artery shunt (modified Norwood) type repair in five. After modified Norwood-type repair, four patients were Yasui-type repair candidates and one was a Fontan candidate. For all patients, the mean AoV diameter increased from 3.7 ± 0.7 mm before bPAB to 4.6 ± 0.8 mm before the second-stage operation. In five patients with CoA or IAA type A, the AoV diameter significantly increased from 3.5 ± 0.3 mm to 4.5 ± 0.5 mm during the term between bPAB and the second-stage operation, with an AoV Z-score increase from -5.82 ± 0.92 to -4.28 ± 0.86. IAA type B showed a slight increase in the AoV diameter. CONCLUSIONS: Initial palliation with bPAB enables AoV diameter growth in some patients, improving the likelihood of conventional total repair adaptation rate, particularly for CoA or IAA type A.

Phrenic nerve protection via packing of gauze into the pericardial space during ablation of cristal atrial tachycardia in a child.

The success of catheter ablation of focal atrial tachycardia is limited by possible collateral damage to the phrenic nerve. Protection of the phrenic nerve is required. Here we present a case of a 9-year-old girl having a history of an unsuccessful catheter ablation of a focal atrial tachycardia near the crista terminalis (because of proximity of the phrenic nerve) who underwent a successful ablation by means of a novel technique for phrenic nerve protection: packing of gauze into the pericardial space. This method is a viable approach for patients with a failed endocardial ablation due to the proximity of the phrenic nerve.

QT dynamics evaluated on fully automated QT measurement in children.

BACKGROUND: The association between QT interval and heart rate (HR), QT dynamics, has been reported to vary greatly between individuals. We investigated QT dynamics using fully automated QT interval measurement with a commercially available multifunctional electrocardiogram (ECG) recorder. METHODS: The study group included 17 otherwise healthy subjects (mean age, 12.7 years; 11 girls, 6 boys), who were undergoing exercise test for arrhythmia evaluation. The subjects had single premature ventricular contraction. RESULTS: Mean corrected QT interval (Fridericia) at rest was 412 ± 19 ms (male, 408 ± 20 ms; female, 414 ± 19 ms), manually measured with a digitizer, using the tangent method. We assessed QT interval/HR slope during the whole exercise test, the exercise phase, and the recovery from exercise phase; the slopes were calculated offline after excluding wide QRS complex and were -1.15 ± 0.26 (r(2) = 0.65), -1.18 ± 0.30 (r(2) = 0.62), and -1.11 ± 0.25 (r(2) = 0.70), respectively. Estimated QT interval at HR 60 beats/min (QT60) was calculated using the regression line formula and was 383 ± 24 ms, 387 ± 28 ms, and 375 ± 21 ms, respectively. QT60 of the total exercise test correlated with the corrected QT interval at rest (P = 0.04, r(2) = 0.25). CONCLUSIONS: Assessment of QT dynamics is feasible on fully automated QT interval measurement with this ECG recorder. Further studies are required in larger populations to confirm the accuracy and precision of QT measurement and QT dynamics using this new multifunctional ECG.