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[Prevalence and distribution of congenital heart diseases in Indre-et-Loire. Evaluation of prenatal diagnosis (1991-1994)].

UNLABELLED: Congenital heart diseases are the most frequent malformation at birth. New technologies have improved diagnosis procedures (echocardiography and Doppler). The aim of our study was to evaluate the prevalence of congenital heart diseases, their different types, and the detection rate of antenatal diagnosis. METHODS: A retrospective study was performed for all infants with congenital heart disease (CHD), born between January 1st 1991 and December 31st 1994, and for all fetuses which died after disruption of pregnancy, in Indre-et-Loire (a French country). In all cases, CHD diagnosis was confirmed with echocardiography and Doppler. RESULTS: CHD prevalence in newborns was 9.8% and 10.4% for the total population including dead fetal material. A high proportion of septal defects (64.8%) was observed with muscular, isolated and small forms (< 3 mm) in 70.2% of cases. The prevalence of great vessels transposition (0.15%), left ventricular hypoplasia (0.11%), and atrioventricular septal defect (0.11%), were lower than in previous studies. The performance of antenatal diagnosis was estimated at 40.5% for the four years; the prevalence of detectable CHD was only 1.4/1000. The atrioventricular septal defect was the most frequently detected. CONCLUSION: Relative high prevalence of congenital heart disease in this French county is due to the high level of small septal defects. Prevalence of detectable CHD remains low, which explains in part the difficulties of improving the antenatal diagnosis.

Abortion, Induced↗

Surgical correction of ascending type a thoracic aortic dissection: simultaneous endoluminal exclusion of the arch and distal aorta.

PURPOSE: To describe repair of an ascending type A dissection combining an open ascending tube graft with simultaneous great vessel transposition and antegrade deployment of an endoluminal graft across the arch and into the descending thoracic aorta. CASE REPORT: A 50-year-old man was evaluated at an outside hospital and transferred to our service for treatment of an ascending aortic dissection with associated lower extremity ischemia. Imaging identified an aortic dissection extending from the aortic root to the aortic bifurcation and into the right common iliac artery. A hybrid procedure incorporating both open and endovascular techniques successfully repaired the dissection and aneurysm and restored blood flow to the extremity. CONCLUSIONS: Although less invasive procedures are sometimes appropriate for repair in the descending thoracic aorta, surgical correction of an ascending dissection and endoluminal exclusion of the arch and distal aorta may form the basis of future treatment strategies for complex aortic pathologies, possibly eliminating the need for hypothermic cardiac arrest.

Aortic Dissection↗

[Arterial-switch operation for transposition of the great vessels; good results in the Wilhelmina Children's Hospital, Utrecht, 1977-2000].

OBJECTIVE: To examine the results of the arterial switch operation which is used to correct the transposition of the great arteries. DESIGN: Descriptive. METHOD: In the period May 1977-October 2000 195 patients at the Wilhelmina Children's Hospital in Utrecht, the Netherlands, underwent an arterial switch operation. The patient group consisted of 132 boys and 63 girls, with a median age at surgery of 8 days (range: 0-1976). In accordance with the protocol, the postoperative follow-up consisted of echocardiography and an ECG. Further investigations were performed on indication. Additional data were collected from the status reports. The mean follow-up was 8.0 years (range: 0.04-22.17). RESULTS: The overall peri-operative mortality was 15% (30/195). Initially this figure was about 50%, in the 1980s it was 15% and from 1996 onwards it was 4%. Of the 151 surviving and traceable patients, 2 patients died years later (1.3%). Of the remaining 149 patients, 145 were classified in New York Heart Association class I and 4 in class II. Due to pulmonary stenosis, 45 reinterventions were required in 26 patients (/149; 17%). Left ventricle dysfunction occurred in 5 patients (3%), arrhythmias in 5 patients and aorta abnormalities in 5 patients. Coronary artery abnormalities were found in 5 of the 61 patients who underwent angiography (8%). CONCLUSION: Peri-operative mortality decreased to 4% and late mortality was 1.3%. The long-term clinical outcome of the arterial switch operation was good. Morbidity was predominantly caused by pulmonary stenosis and late coronary obstruction.

Cause of Death↗

[Anesthesia for the surgery of delayed postoperative stenosis in the pulmonary suture in children with corrected transposition of the great vessels with Jatene's technique].

Any patient with congenital heart disease is at high risk for anesthesia no matter what surgical procedure is performed. Children undergoing D-transposition of the great arteries using Jatene's technique present stenosis of the pulmonary artery in 10-20% of cases and may require surgery to correct that or some other surgically caused anomally. In either case the children must be managed as patients with heart disease, with special attention to cardiovascular depression and rhythm abnormalities. We report the cases of two children who underwent D-transposition of the great arteries in the neonatal period using Jatene's anatomical technique. They were later anesthetized at ages 5 and 6 years to correct pulmonary suture stenosis. Recovery was good.

Child↗

[Pre- and postoperative study of neonatal transposition of the great vessels by magnetic resonance imaging].

The authors report the case of a 34 weeks premature infant presenting a transpositions of the large vessels, who underwent a Rashkind during the neonatal period, a Senning procedure at three months, and was explored and followed-up by magnetic resonance imaging (MRI). The images obtained are of good quality, permitting a precise diagnosis of transposition of the large vessels and visualization of an inter-ventricular communication (IVC) which were missed on ultrasonography. The MRI shows complete images of the Senning correction and permits a non-invasive post-operative monitoring of this correction. MIR is therefore an interesting second intention examination which may effectively complement ultrasonography and limit the indications of angiography.

Humans↗