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[Acquired infundibular pulmonary stenosis. Possible late complication following radiotherapy of Hodgkin disease].

A case of infundibular pulmonary stenosis occurring years after a mediastinal radiation for Hodgkin's disease is reported. As far as the literature is known to us, a similar case has not yet been described. It is most likely that the development of the stenosis is due to the radiation therapy, since a murmur was not heard before radiation and a mild stenosis was proved several years after radiation. Now, a high gradient with the typical signs of an infundibular pulmonary stenosis was present. Unfortunately the patient refused the operation. Further possibilities for acquired pulmonary stenosis and cardial complications after mediastinal radiation for Hodgkin's disease will be discussed.

Adult↗

Diastolic murmurs.

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Aortic Valve Insufficiency↗

[Interventional catheter therapy in childhood].

The paediatric therapeutic heart catheterization becomes more and more important in the treatment of congenital heart disease. Depending on the situation, interventional therapy can become an alternative or a replacement or supplement to surgical intervention. The methods of interventional therapy include the balloon valvuloplasty of stenotic valves or vessels, the implantation of stents and the occlusion of defects as well as of unwanted vascular structures with coil embolisation or umbrella devices. The balloon valvuloplasty of pulmonary valve stenosis or the embolisation of small vessels have become the treatment of choice. Valvuloplasty of aortic stenosis, angioplasty of residual coarctation, balloon dilatation of peripheral pulmonic stenosis and occlusion of a patent ductus arteriosus with a Rashkind PDA-occluder are now a valuable alternative to surgical procedure although studies of long-term results are not yet available. Occlusions of atrial or ventricular septal defects as well as the implantation of stents are still investigational tools, but give enormous hope for the future.

Angioplasty, Balloon↗

Carcinoid heart disease with severe hypoxia due to interatrial shunt through patent foramen ovale.

Carcinoid heart disease occurs in approximately half of patients who have carcinoid syndrome and is the leading cause of death among these patients. It is typically manifest as right-sided valvular lesions, usually tricuspid insufficiency and pulmonary valve stenosis. This case report describes the unusual presentation of a patient with carcinoid heart disease and a large right-to-left shunt through a patent foramen ovale.

Adult↗

[Therapeutic exhaustion in patients with an implantable cardioverter-defibrillator. Are there predisposing factors?].

UNLABELLED: In patients (pts) with implantable cardioverter-defibrillators (ICD), antitachycardia pacing (ATP) schemes may be used followed by a limited number of endocavitary shocks in the same episode of ventricular tachycardia (VT) with the potential risk of therapeutic exhaustion. OBJECTIVE: To assess the incidence of episodes of therapeutic exhaustion in a population of ICD carriers with ATP programmes and to attempt to determine their correlation with clinical variables. METHODS: Study of the episodes of VT treated by ICD in 8 patients (6 male; 2 female) with an average age of 56 +/- 17 years with a follow-up > 6 months. The underlying pathology was: ischemic heart disease-5 patients; arrhythmogenic dysplasia of the right ventricle-1 patient; hypertrophic cardiomyopathy-1 patient; and operated pulmonary valve stenosis-1 patient. The authors considered therapeutic exhaustion to be the occurrence of episodes in which VT persisted after the application of ATP and the maximum number of shocks. The patients with episodes of therapeutic exhaustion (group A-3 patients) were compared with the remaining patients (group B-5 patients) with regard to the following parameters: age; ejection fraction; previous myocardial infarction (pMI; cardiac frequency during VT (cfVT); number of episodes of non-maintained VT (NMVT) without therapeutic intervention; > 20% reduction of the VT cycle after ATP (VTATP); intensity of programmable shocks (Icho); and medication with anti-arrhythmia drugs (AA). RESULTS: In a total of 262 VT records (duration > 2.5 sec. after detection) with treatment by ICD during an average follow-up of 11 months, 6 episodes (2.3%) of therapeutic exhaustion were detected in 3 patients. Four of the episodes occurred in the same patient in a period of 4 hours, hospitalisation being necessary following syncope. In the other two cases, there were complaints of dizziness which subsided spontaneously a short time after the application of the last shock by the ICD. [table: see text] CONCLUSION: Therapeutic exhaustion occurred in about 2% of the VT treated with this population. The possibility of a high number of non maintained VT episodes being associated to a greater possibility of therapeutic exhaustion may have implications on ICD programming.

Adult↗