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Biomedical subjects

M Witsenburg

Publications and source records attributed to M Witsenburg.

At least 19 recordsLinked to original sources
PubMed2004

[Closure of a ventricular septum defect in a 4-year-old boy during percutaneous heart catheterisation].

A 4-year-old boy in whom a muscular ventricular septal defect (VSD) had been diagnosed at birth presented with limited exercise tolerance and mild cardiomegaly. The moderately large defect was closed with an umbrella device via percutaneous heart catheterisation. Thereafter, his symptoms disappeared and the dimensions of the left heart returned to normal. A VSD occurs in 1.5-3.5 per 1,000 live births. In symptomatic patients with a medium or large-sized VSD, surgical closure is indicated to prevent the development of a fixed pulmonary resistance hypertension, ventricular dysfunction and the risk of endocarditis. Depending on the size and localisation of the defect, closure with an umbrella device may be chosen. The initial results have been promising in children. The safety and efficacy in the long term are still unknown.

Cardiac Catheterization↗
PubMed2004

Slide tracheoplasty for congenital tracheal stenosis.

BACKGROUND/PURPOSE: The aim of this study was to add to the experience of slide tracheoplasty in infants with congenital tracheal stenosis (CTS), to review the recent literature on this subject, and to evaluate the diagnostic workup in infants with CTS. METHODS: A retrospective review of 3 infants with CTS treated with slide tracheoplasty was conducted at our institution. They all underwent bronchoscopy, tracheobronchography, and echocardiography. Therapy consisted of slide tracheoplasty and simultaneous correction of associated vascular malformations. RESULTS: A pulmonary artery sling was missed initially on esophagography in 2 patients. Stridor became worse in 2 patients after tracheobronchography. After surgical therapy, 2 patients survived and were discharged 12 days after surgery. Both are without symptoms at follow-up of 12 and 20 months. One patient had inoperable restenosis and died 27 days after the operation. CONCLUSIONS: Esophagography is not a reliable tool to depict associated vascular anomalies for patients with CTS. According to the literature, computer tomography has become more reliable to depict the tracheobronchial tree and is useful to elucidate associated vascular anomalies as well. Compared with other surgical techniques for infants with CTS reported in the literature, slide tracheoplasty has fewer postoperative complications and comparable survival rates.

Esophagoscopy↗
PubMed2003

Follow-up after surgical closure of congenital ventricular septal defect.

OBJECTIVES: The purpose of this retrospective study was to assess long-term outcome of children after surgical closure of a ventricular septal defect (VSD). MATERIAL AND METHODS: Between January 1992 and December 2001 a consecutive series of 188 patients (100 females) were operated for closure of a VSD. Temporary tricuspid valve detachment (TVD) was applied in 46 patients (24%) to enhance exposure of the defect using transatrial approach. Pre-operative baseline characteristics showed that the detached group was younger (0.79+/-1.8 vs 2.1+/-3.5 years, p=0.002) and had a lower weight (6.5+/-6.4 vs 10.0+/-11.0 kg, p=0.009). RESULTS: There was no difference in cross-clamp time (temporary TVD 36.2+/-11.3 vs non-temporary TVD 33.6+/-13.1 min, p=0.228). Postoperative echocardiography showed that 67 patients (36%) had trivial/minimal regurgitation, 10 patients (22%) from the temporary TVD group vs 57 patients (40%) from the non-detached group (p=0.02). There was no tricuspid stenosis. Hospital mortality comprised two patients (1%). One patient died due to a pulmonary hypertensive crisis and one in relation to an acute patch dehiscence for which an emergency reoperation was necessary. At first postoperative echocardiography no shunting was detected in 113 patients, trivial shunting in 73 and significant shunting in none. Multivariate logistic regression analysis revealed that weight at operation was a predictive factor for the occurrence of residual shunting (OR 0.95, C.I. 0.91-0.99). One patient with conduction disturbances needed a permanent DDD-pacemaker. Three patients were lost to follow-up. Mean follow-up time was 2.6 years (range 0.1-9.4). During follow-up no reoperations were necessary for closing a residual VSD. One patient died 7 months postoperative due to a bronchopneumonia. During follow-up in 37 (51%) of the 73 patients the trivial shunting disappeared spontaneously at a median time of 3.9 years. According to actuarial analysis all trivial shunting had disappeared at 8.4 years. CONCLUSION: Trivial residual shunting disappeared spontaneously at a median follow-up time of 3.9 years. During follow-up no patient needed to be reoperated for residual VSD. TVD proved to be a safe method to enhance the exposure of a VSD.

Adolescent↗
PubMed2002

Pacemaker dislocation--truly ectopic activation necessitating surgical treatment.

Intra-abdominal migration of a generator from an epicardial pacemaker system is a rare but potentially life-threatening complication. We report on a case of a 2-year-old child in whom the generator silently migrated from the sheath of the rectus abdominis muscle in the upper abdominal wall down into the peritoneal cavity. We advise that if there is any evidence of intra-abdominal migration, the generator should be properly repositioned without delay.

Child, Preschool↗
PubMed2001

Minimum bandwidth requirements for recording of pediatric electrocardiograms.

BACKGROUND: Previous studies that determined the frequency content of the pediatric ECG had their limitations: the study population was small or the sampling frequency used by the recording system was low. Therefore, current bandwidth recommendations for recording pediatric ECGs are not well founded. We wanted to establish minimum bandwidth requirements using a large set of pediatric ECGs recorded at a high sampling rate. METHODS AND RESULTS: For 2169 children aged 1 day to 16 years, a 12-lead ECG was recorded at a sampling rate of 1200 Hz. The averaged beats of each ECG were passed through digital filters with different cut off points (50 to 300 Hz in 25-Hz steps). We measured the absolute errors in maximum QRS amplitude for each simulated bandwidth and determined the percentage of records with an error >25 microV. We found that in any lead, a bandwidth of 250 Hz yields amplitude errors <25 microV in >95% of the children <1 year. For older children, a gradual decrease in ECG frequency content was demonstrated. CONCLUSIONS: We recommend a minimum bandwidth of 250 Hz to record pediatric ECGs. This bandwidth is considerably higher than the previous recommendation of 150 Hz from the American Heart Association.

Adolescent↗
PubMed2001

Is there a place for pediatric valvotomy in the autograft era?

OBJECTIVE: Valvotomy and the autograft procedure are the most common surgical treatment options for children with valvular aortic stenosis. We evaluated the results of these surgical procedures in our institution. METHODS: Retrospective analysis was done of all patients presenting with aortic stenosis and operated upon before the age of 18. In 11 patients a valvotomy was performed and in 36 an autograft procedure. RESULTS: There was no hospital mortality. Mean follow-up in the valvotomy group was 4.8 years (SD 3.3), in the autograft group 4.5 years (SD 3.3). During follow-up one patient died suddenly 2 months after valvotomy. Two patients in the autograft group died (not valve-related). After valvotomy three patients underwent a balloon valvotomy, in one followed by an autograft procedure and one patient had a repeat valvotomy. In the autograft group one patient was reoperated for severe aortic regurgitation and moderate pulmonary stenosis. At last echocardiography after valvotomy (eight remaining patients) in only two patients (25%) no aortic stenosis or regurgitation was present. In the remaining six patients aortic stenosis is mild in two and moderate in three, including one with moderate aortic regurgitation. In one patient without stenosis, moderate aortic regurgitation was seen. No pulmonary stenosis or regurgitation is present. Echocardiography after autografting (33 remaining patients) showed no aortic stenosis. Aortic regurgitation was mild in seven patients, moderate in two, severe in one. Pulmonary stenosis was present in two patients (16%). Pulmonary regurgitation was mild in three patients and moderate in one. CONCLUSIONS: In selected patients with valvular aortic stenosis who are beyond infancy, valvotomy may be adequate and may postpone further surgery for a significant length of time. After valvotomy the main problem is residual aortic stenosis while after autografting a shift occurs to aortic regurgitation and problems related to the pulmonary valve. Careful clinical and echocardiographic follow-up is therefore warranted in young patients after the autograft procedure.

Adolescent↗
PubMed2001

Cognitive, and behavioural and emotional functioning of young children awaiting elective cardiac surgery or catheter intervention.

AIMS: To assess the cognitive, and behavioural and emotional functioning of children aged 3 months to 7 years shortly before elective cardiac surgery or elective interventional catheterisation. METHODS: We used the Bayley Scales of Infant Development, and the McCarthy Scales of Children's Abilities, to measure cognitive functioning. The Child Behavior Checklist was used to assess behavioural and emotional problems. RESULTS: We found no significant differences in mean cognitive scores for children scheduled for cardiac surgery or interventional catheterisation when compared with reference groups. This was also the case for children awaiting cardiac surgery as opposed to those awaiting interventional catheterisation, and for those below as compared to those above the age of 2.5 years. Overall, our results regarding behavioural and emotional functioning were comparable to those of normative reference groups. The only difference found was that the children scheduled for cardiac surgery and aged from 2 to 3 years had significantly higher scores on the Child Behavior Checklist than did peers from normative groups. CONCLUSION: Cognitive, and behavioural and emotional functioning, both for young children awaiting elective cardiac surgery and interventional catheterisation, can be considered as quite favourable.

Age Factors↗
PubMed2001

New normal limits for the paediatric electrocardiogram.

AIMS: Previous studies that determined the normal limits for the paediatric ECG had their imperfections: ECGs were recorded at a relatively low sampling rate, ECG measurements were conducted manually, or normal limits were presented for only a limited set of parameters. The aim of this study was to establish an up-to-date and complete set of clinically relevant normal limits for the paediatric ECG. METHODS AND RESULTS: ECGs from 1912 healthy Dutch children (age 11 days to 16 years) were recorded at a sampling rate of 1200 Hz. The digitally stored ECGs were analysed using a well-validated ECG computer program. The normal limits of all clinically relevant ECG measurements were determined for nine age groups. Clinically significant differences were shown to exist, compared with previously established normal limits. Sex differences could be demonstrated for QRS duration and several amplitude measurements. CONCLUSIONS: These new normal limits differ substantially from those commonly used and suggest that diagnostic criteria for the paediatric ECG should be adjusted.

Adolescent↗
PubMed2001

PEDMEANS: a computer program for the interpretation of pediatric electrocardiograms.

The interpretation pediatric electrocardiograms (ECGs) is complicated because of the strong age-dependency of the diagnostic criteria. We wanted to develop and evaluate a computer program for the interpretation of pediatric 12-lead ECGs. Continuous age-dependent normal limits were established based on ECGs from 1,912 healthy Dutch children. Additionally, a reference interpretation was obtained for 1,718 ECGs recorded at the Sophia Children's Hospital. The total set of ECGs was divided in a training set of 1076 ECGs and a test set of 642 ECGs. All ECGs were recorded at a sampling rate of 1,200 Hz. Based on the normal limits and the training set, diagnostic rules were formalized in an iterative process by using expert interviews and automatic rule induction. The resultant rules were evaluated on the test set. The performance of the program, on our study population, appears to justify its use in a clinical setting. Preferably, the program should also be evaluated in other clinical centers.

Algorithms↗
PubMed2000

Results of primary two-patch repair of complete atrioventricular septal defect.

OBJECTIVE: The policy of primary repair of complete atrioventricular septal defect (CAVSD), using a two-patch technique, was evaluated with special attention to the risk of implantation of a prosthetic atrioventricular (AV) valve. METHODS: From 1986 to 1999, all 97 patients who underwent primary repair for CAVSD were included in a retrospective analysis. Seventy-five patients (75%) had Down's syndrome. Preoperative echocardiographic AV valve regurgitation was absent or limited in 85 (88%), moderate in seven (7%) and severe in five (5%). Fifty-six patients (58%) were on diuretics, six (6%) on artificial ventilation and four (4%) were on inotropic support. The mean age at operation was 10.2 months (SD, 16.4), with a mean weight of 5.9 kg (SD, 3.7). RESULTS: Early mortality comprised three patients (4%), and late mortality two patients. Follow up was complete and comprised 402 patient-years (mean, 4.5 years; SD, 3.2). The cumulative survival at 10 years was 93% (95% CI, 89-97%). Multivariate analysis with regard to mortality revealed no associations with any of the analyzed factors. Eight patients were reoperated, all for regurgitant left AV valve. The reoperation-free survival at 10 years was 83% (95% CI, 75-91%). Multivariate analysis with regard to reoperation showed being on preoperative diuretics to be a decreasing risk factor (Odd's Ratio (OR), 0.13; 95% CI, 0.00-0. 99; P=0.005) and significant postoperative left AV valve regurgitation to be an increasing risk factor (OR, 9.90; 95% CI, 1. 90-53.0; P=0.001). Only one prosthetic valve was implanted (annual linearized risk of 0.002/patient-year). At the latest follow up of the surviving patients, left AV valve regurgitation was absent or limited in 83 (90%) and moderate in nine (10%). Right AV valve regurgitation was absent or limited in all 92 (100%) patients. All surviving patients are thriving well, seven (8%) of whom are on diuretics. CONCLUSIONS: Primary repair of CAVSD with a two-patch technique, including cleft closure of the left AV valve, has good clinical and functional results without problems for the right-sided AV valve. The need for prosthetic valve implantation for the left AV valve is minimal.

Cardiac Surgical Procedures↗
PubMed2000

A European multicentric experience using the CardioSEal and Starflex double umbrella devices to close interatrial communications holes within the oval fossa.

In this review, we describe the experience from 13 European centres using the CardioSEAL and Starflex double umbrella devices to close interatrial communications within the oval fossa (so-called 'secundum' defects). Between October 1996 and April 1999, the procedure was attempted in 334 patients with a mean age of 12 years and a mean weight of 44kg. The mean measured stretched diameter of the defect was 15 mm. In the overall group, the defect was solitary in 245 patients (73%), multiple in 21 (6%), associated with an aneurysm of the flap valve in 15 (5 %), was represented by patency of the oval foramen in 44 (13%), and was a fenestration in a Fontan repair in 9 (3%). In all patients, the devices were inserted under general anesthesia, using fluoroscopic and transesophageal echocardiographic control. Implantation was achieved in 325 (97,3%). The device embolized within either a few minutes or a few hours in 13 patients (4%). Of these, uncomplicated surgical repair was undertaken in 10, while the device was retrieved in 3 using catheters and a second device was successfully implanted. Residual shunting was detected immediately after the procedure in 41% of the patients, with the incidence decreasing to 31% at discharge, 24% at 1 month, 21% at 6 months, and 20.5% at one year. During the period of follow-up, elective surgical repair became necessary in two patients, due to malposition of the device in one, and late embolization in the other. Fractures of arms were seen in 6.1 %, most commonly with the largest devices. All those with fractured arms of the device were asymptomatic, and no clinical complications related to the fractures were observed. There were no arrhythmias, endocarditis, valvar distortion, thromboembolic events, or other complications. After one year of follow-up, clinical success, defined as complete closure of the defect or presence of only a trivial leak, had been obtained in 92.5% of the patients. We conclude, therefore, that these devices produce excellent results when used to close defects of small to moderate size. Results are less than optimal, or else complications ensure, when attempts are made to close very large defects.

Adolescent↗
PubMed2000

Psychological distress and styles of coping in parents of children awaiting elective cardiac surgery.

AIMS: We sought to assess the level of psychological distress, and the styles of coping of, parents of children with congenital heart disease. The study was based on questionnaires, which were completed, on average, four weeks, with a range from 0.1 to 22.1 weeks, prior to elective cardiac surgery or elective catheter intervention. METHODS: We used the General Health Questionnaire, and the Utrecht Coping List, to compare scores from parents of those undergoing surgery, with scores of reference groups, and with scores of the parents of those undergoing intervention. RESULTS: Overall, in comparison with our reference groups, the parents of the 75 children undergoing surgery showed elevated levels of psychological distress, manifested as anxiety, sleeplessness, and social dysfunctioning. They also demonstrated less adequate styles of coping, being, for example, less active in solving problems. With only one exception, no differences were demonstrated in parental reactions to whether cardiac surgery or catheter intervention had been planned. The mothers of the 68 patients who were to undergo cardiac surgery, however, reported greater psychological distress and manifested greater problems with coping than did the fathers. CONCLUSION: Elevated levels of psychological distress, and less adequate styles of coping, were found in the parents of patients about to undergo cardiac surgery, especially the mothers, when compared to reference groups. Future research should investigate whether these difficulties persist, and whether this will influence the emotional development of their children with congenital cardiac malformations.

Adaptation, Psychological↗
PubMed1999

[Interventional catheter occlusion of the atrial septal defect of the secundum type--experiences with "CardioSeal" and "Angel Wings"].

Between July 1996 and July 1998, 34 patients (female n = 16, male n = 18) were scheduled for catheter--interventional occlusion (ASDO) of an atrium septum defect of secundum type (ASD II). Median age was 7.9 years (2.5-54.6), weight 23.1 kg (9-97). 9 defects were closed with "Angel Wings" (AW) and 25 ASD occlusions were attempted with "CardioSeal" (CS). 30 patients had simple ASD II, 3 persisting foramen ovale with suspected paradoxal cerebral embolization and 1 significant residual shunt at atrial level after corrective heart surgery for interrupted aortic arch type B. ASDO was successful in 31/34 cases (91%). One CS was removed surgically due to significant left to right shunt after release and two CS devices were withdrawn back into the sheath. Median ASD diameter was 11.9 mm (6-16), balloon occlusive diameter was 15 mm (6-20) and median left to right shunt was 40% (6-64%). On follow up minimal left to right shunt was seen in 5/31 patients (16%). In selected patients catheter--interventional ASDO may be a good alternative to surgical ASD closure.

Adolescent↗
PubMed1999

Brom's three-patch technique for repair of supravalvular aortic stenosis.

OBJECTIVE: Case histories of all patients (n = 29) operated on for supravalvular aortic stenosis from 1962 to the present were reviewed to study different techniques and outcomes. The technique of symmetric aortoplasty with 3 patches (1 in each sinus) is described and compared with other methods. METHODS: Case reports were reviewed and follow-up was completed by contacting the patient's (pediatric) cardiologist. We aimed for a last follow-up visit, including Doppler echocardiographic studies, in a period no more than 12 months earlier than December 1997. Supravalvular aortic stenosis was discrete in 25 and diffuse with involvement of the aortic arch and arch vessels in 4 patients. Additional anomalies were bicuspid aortic valve (n = 5), coarctation (n = 3), ascending aortic aneurysm (n = 1), mitral valve insufficiency (n = 2), pulmonary valvular stenosis (n = 1), and peripheral pulmonary artery stenosis (n = 2). Eleven patients had Williams syndrome and 1 patient had Noonan syndrome. Symmetric aortoplasty with 3 patches (1 in each sinus) was used in 13 patients, whereas other nonsymmetric methods (1, 2, or Y-shaped patches) were used in 16 patients. Mean follow-up was 10.5 years (range: 4 months-36 years). RESULTS: All techniques adequately decreased the pressure gradient. Progression of preoperative aortic valve insufficiency or de novo regurgitation was not observed except in 1 patient in whom the patches inserted were too large. CONCLUSIONS: No difference could be demonstrated in outcome for any surgical technique; however, reconstruction of the aortic root with autologous pericardial patches in each sinus after transection of the aorta has the advantage of symmetry while restoring the normal aortic root anatomy.

Adolescent↗
PubMed1999

Early results and long-term follow-up after corrective surgery for total anomalous pulmonary venous return.

OBJECTIVE: An ever increasing number of patients with an operated congenital cardiac anomaly is reaching adulthood. Insight in the long-term characteristics of these patients is steadily growing for the more common anomalies, but is still scarce for the less frequent entities. In this regard we report our results and long-term follow-up of surgically treated total anomalous pulmonary venous return (TAPVR). METHODS: Since 1973 44 patients with TAPVR were treated with surgery. There were 23 girls and 21 boys. Hospital mortality concerned six patients and additionally one patient died 2.5 months after surgery. Follow-up data could be collected from all the surviving patients at last outpatient visit or by phone contact. The mean duration of the follow-up was 12 years (range 1 month to 24 years). RESULTS: The Kaplan-Meier estimate of survival at 15 years was 84% (95% CI 73-95%). Reoperations were performed for five patients at 7 days to 4.5 years after surgery. In one patient this involved obstruction of pulmonary venous return, in four complications of the primary repair. The reoperation-free survival at 15 years was 74% (95% CI 61-87%). At the end of follow-up all survivors were in NYHA functional class I and, at appropriate age, normally attended school or were employed. None of the patients was using cardiac medication. CONCLUSIONS: We conclude that, despite a possible hectic initial postoperative course of surgery for TAPVR, only a limited number of reoperations is necessary relatively short after initial surgery. The long-term perspective for those surviving surgical treatment is good.

Cardiopulmonary Bypass↗
PubMed1999

Vascular rings: a rare cause of common respiratory symptoms.

Upper airway symptoms or dysphagia may be caused by vascular anomalies, forming a ring around the trachea, oesophagus or both. To analyse the clinical presentation, use of various diagnostic techniques, treatment and follow-up we carried out a retrospective study of 38 children who had been diagnosed with a vascular ring between 1981 and 1996. We found 74% of the vascular rings to be symptomatic, with inspiratory stridor and wheezing as the main complaints. The delay between the onset of symptoms and diagnosis of a vascular ring in patients without associated anomalies ranged from 1 to 84 mo. Associated anomalies were found in 53% of cases and 80% of these anomalies consisted of associated cardiovascular malformations. Oesophagography proved to be a valuable diagnostic technique when a vascular ring was suspected. Echocardiography appeared to be of little value for the diagnosis of a vascular ring, but was essential to exclude associated cardiovascular malformations. Although angiography has always been considered to be the gold standard in the determination of the exact anatomy of vascular rings, increasing evidence is available that CT scan or MRI may replace this role. Mortality was related to co-existent tracheal deformities in 5/6 cases. Of the remaining, preoperatively symptomatic patients, relief of symptoms was achieved immediately after surgery in 43% and within 4 y after surgery in 57%. Prolonged and recurrent respiratory complaints or dysphagia in infancy or childhood should alert the paediatrician to the possibility of a vascular ring.

Aorta, Thoracic↗