Quality of life in adults with repaired tetralogy of Fallot.

INTRODUCTION: Observations of patients after repair of tetralogy of Fallot (ToF) indicate good correction results and long-term survival. Few papers have been published in which the quality of life (QoL) of this population has been assessed. AIM: To evaluate QoL in adults with repaired ToF.. MATERIAL AND METHODS: We included 39 patients with repaired ToF and 40 age- and sex-matched healthy volunteers. Information recorded included echocardiography, cardiac magnetic resonance, cardiopulmonary exercise test, and self-reported health-related QoL questionnaire (SF-36).. RESULTS: The perceived physical and mental domains of health were signi cantly poorer in ToF patients than in controls. A positive correlation between VO2 peak and physical domains was observed: (VO2 peak vs. physical domains (r = 0.6, p ≤ 0.001), general health (r = 0.36, p = 0.03), and physical complex status (r = 0.51, p = 0.001). VO2 peak % correlated with physical functioning (r = 0.43, p = 0.007), general health (r = 0.39, p = 0.015) and physical complex status (r = 0.49, p = 0.002). Right ventricle ejection fraction, determined with cardiac magnetic resonance, positively correlated with role physical (r = 0.38, p = 0.04). In echocardiography, pressure half time was posi- tively correlated with physical functioning (r = 0.48, p = 0.004) and role physical (r = 0.4, p = 0.02).. CONCLUSIONS: The QoL in adults after repair of ToF and healthy control subjects was compared directly. The self-perceived physical and mental domains of health were significantly poorer in ToF patients than in controls. Strong associations were found between objective exercise capacity and physical aspects of quality of life. Complex assessment and quality of life instruments should be used together to obtain an accurate view of health status of patients with repaired ToF.

Effect of ventricular function and volumes on exercise capacity in adults with repaired Tetralogy of Fallot.

OBJECTIVES: Investigate the effects of left and right ventricular function and severity of pulmonary valve regurgitation, quantified by cardiac magnetic resonance (CMR), on exercise tolerance in adult patients who underwent ToF repair at a young age. METHODS: This is a retrospective cohort study of 52 patients after ToF surgery and 33 age- and sex-matched healthy volunteers. CMR and cardiopulmonary exercise testing (CPET) were performed on all patients; CPET was performed on control subjects. RESULTS: The main finding of CPET was a severe decrease in oxygen uptake at peak exercise VO2peak in TOF patients. The patients were characterized also by lower pulse O2peak and heart rate at peak exercise. Ejection fraction of the right and left ventricles was correlated (r=0,32; p=0,03). Left ventricle ejection fraction was negatively correlated with right ventricular volumes (r=-0,34; p=0,01) and right ventricular mass (r=-046; p<0,00). Right ventricular mass was positively correlated with left ventricular variables (left ventricle end diastolic volume, r=0,43; p=0,002; left ventricle end systolic volume, r=0,54; p<0,00) as was VO2peak: LVEDV (r=0,38; p=0,01); LVESV (r=0,33; p=0,03) and LV mass (r=0,42; p=0,006). CONCLUSION: Exercise intolerance in adults with repaired ToF is markedly depressed. The decreased exercise capacity is correlated with impaired RV function and may be associated also with LV dysfunction, which suggests right-to-left ventricular interaction.

Post-myocardial infarction ventricular septal defect. Is it better to operate on a fresh infarction or to wait? A case study.

The authors present case studies of two patients, aged 76 and 77, who were diagnosed with fresh post-myocardial infarction ventricular septal defects (VSD) and were admitted for urgent surgical intervention. The report is a comment in the discussion concerning the optimal time for surgical intervention.

Intramural hematoma or aortic dissection - a diagnostic and therapeutic problem. A case report.

The authors present a case report of a 60-year-old patient with an ascending aortic aneurysm along with the associated diagnostic and therapeutic problems. The choice of therapy in patients with aortic intramural hematoma is difficult and should be based on comprehensive evaluation of the patient's status as well as on the experience of the radiologist and surgeon.

CYP2C9 Polymorphism and Unstable Anticoagulation with Warfarin in Patients Within the First 3 Months Following Heart Valve Replacement.

BACKGROUND: Warfarin dose requirements are partly determined by common single nucleotide polymorphisms in VKORC1 and CYP2C9 genes. OBJECTIVES: The aim of this study was to investigate how the presence of allelic variants in CYP2C9 affects the stability of anticoagulation in patients within the first 3 months following elective heart valve replacement. MATERIAL AND METHODS: In a case-control study we compared 18 consecutive carriers of CYP2C9*2 and/or *3 and 25 well-matched patients with the wild type CYP2C9*1/*1 genotype. The former group was randomly assigned to use coagulometers or monitor international normalized ratio (INR) in local outpatient clinics. Subjects receiving drugs potently interfering with warfarin were ineligible. Anticoagulation with the baseline warfarin regimens based on pharmacogenetic algorithm was assessed by time in the therapeutic INR range (TTR) within the first 3 months following implantation. RESULTS: Carriers of the CYP2C9*2 and/or *3 genotypes were characterized by lower estimated warfarin dose (median, 21 [interquartile range, 21-35] vs. 35 [28-42] mg/week, p=0.02) and actual (27.8±13.2 vs. 46.3±13.9 mg/week, p<0.001), together with lower TTR values (56 [38.6-74.9] vs. 75.4 [58.1-83.6] %, p=0.03) and longer time above the therapeutic range (13.8 [4.9-34.5] vs. 4.5 [0-15.3]%, p=0.047) than patients with the CYP2C9*1/*1 genotype. There were no differences in the estimated and actual warfarin doses, TTR values and adverse events between the self-testing and standard-care subgroups. CONCLUSIONS: The presence of CYP2C9*2 and/or *3 genotypes is associated with unstable warfarin treatment in patients after heart valve replacement, regardless of the type of INR testing.

Conservative approach to mitral valve replacement in hypertrophic cardiomyopathy with systolic anterior motion - a case report.

The authors report the case of a 60-year-old patient with hypertrophic cardiomyopathy (HCM), systolic anterior motion (SAM), and high gradient in the left ventricular outflow tract (LVOT) who underwent surgical treatment. During the surgery, myomectomy of the septum was performed using the Morrow method: despite the persisting SAM and increased LVOT gradients, the mitral valve was not replaced. The case study presents a conservative approach to mitral valve replacement during HCM surgery.