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1. Significance of additional pulmonary blood flow between second and third stage in Fontan pathway

Author

Katarzyna Januszewska, Pawel Nawrocki, Andreas Bruenen, Alexander Schnabel, and Edward Malec

Subjects
Additional pulmonary blood flow, Fontan operation, Single ventricle, Pediatrics, RJ1-570
Abstract

Abstract Background The benefit of additional pulmonary blood flow (APBF) in Fontan pathway remains controversial. The aim of the study was to analyze the systemic arterial saturation, ventricular and atrioventricular (AV) valve function, development of pulmonary arteries and postoperative course after Fontan operation in children with preserved or eliminated APBF between stages 2 and 3 of the Fontan pathway. Methods A group of 180 consecutive children (median age: 2.92(1.83–16.83) years) with single ventricle underwent extracardiac conduit Fontan operation. The patients were retrospectively analyzed with respect to the presence of APBF between stages 2 and 3. Results Preoperative echocardiography showed no differences in ventricular function (good – 105[95%] vs. 65[98.5%]; reduced – 9[5%] vs 1[1.5%]; p = 0.07) or AV valve function (p = 0.78). There was no difference in oxygen saturation at admission (p = 0.48), in preoperative blood gas analysis (p = 0.62), or at the discharge (p = 0.73). There was no difference in size of the left pulmonary artery (9.5(0–16.2) vs 10.6 (4.9–21.7) mm; p = 0.13), however the right pulmonary artery was significantly larger (11.2(6.5–19.6) vs. 12.8(7.8–2.5) mm; p = 0.048) in APBF group. In this group the mean pressure in the pulmonary artery was significantly higher as well (8[4–17.5] vs 9.5[4–17.3] mmHg; p = 0.03). Conclusions APBF does not result in higher oxygen saturation, both before and after Fontan completion. APBF can stimulate the growth of the pulmonary arteries and increase the pulmonary artery pressure. The presence of APBF does not affect the post-operative course after Fontan operation, however it can increase the need of AV valve reconstruction.

Published
2024
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2. Wady serca płodu. Diagnostyka i postępowanie

Author

Maria Respondek-Liberska, Katarzyna Januszewska, Paulina Kordjalik, Edward Malec, Tomasz Moszura, Michał Krekora, Julia Murlewska, Iwona Maroszyńska, Maciej Słodki, Łukasz Sokołowski, Iwona Strzelecka, Oskar Sylwestrzak, and Agnieszka Żalińska

Published
2022

3. Impact of Right Ventricular Pressure Load After Repair of Tetralogy of Fallot

Author

Heiner Latus, Jana Stammermann, Inga Voges, Birgit Waschulzik, Matthias Gutberlet, Gerhard‐Paul Diller, Dietmar Schranz, Peter Ewert, Philipp Beerbaum, Titus Kühne, Samir Sarikouch, Gunter Kerst, Majed Kanaan, Corinna Lebherz, André Rüffer, Dimitrios Gkalpakiotis, Andrea Schedifka, Gernot Buheitel, Joachim Streble, Rainer Willing, Stephan Schubert, Kai Thorsten Laser, Eugen Sandica, Burkhard Trusen, Felix Berger, Oliver Miera, Stanislav Ovroutski, Katharina Schmitt, Joachim Photiadis, Bernd Opgen‐Rhein, Katja Weiss, Sabine Klaassen, Christoph Berns, Thomas Boeckel, Guido Haverkämper, Andreas Kästner, Heike Koch, Björn Peters, Florian Schmidt, Jens Timme, Konstanze Engel, Birgit Franzbach, Gabriela Senft, Frank Beyer, Klaus Winter, Johannes Breuer, Martin Schneider, Jens Bahlmann, Eberhard Griese, Trong Phi Lê, Joachim Hebe, Jan‐Hendrik Nürnberg, Annette Magsaam, Ronald Müller, Ludger Potthoff, Renate Voigt, Tim Krüger, Hubert Gerleve, Ulrich Kleideiter, Dirk Schneider‐Kulla, Jürgen Krülls‐Münch, Thomas Menke, Martin Lehn, Antje Heilmann, Helge Tomczak, Gleb Tarusinov, Michael Scheid, Ertan Mayatepek, Frank Pillekamp, Artur Lichtenberg, Christiane Terpeluk, Bruno Kolterer, Sven Dittrich, Ulrike Gundlach, Robert Cesnjevar, Carsten Müntjes, Geert Morf, Anoosh Esmaeili, Stephan Backhoff, Brigitte Stiller, Friedhelm Beyersdorf, Johannes Kroll, Nicole Häffner, Jannos Siaplaouras, Antje Masri‐Zada, Christian Jux, Andreas Böning, Hakan Akintürk, Thomas Paul, Matthias Sigler, Theodor Tirilomis, Gabriele Schürer, Johannes Hartmann, Ralph Grabitz, Uta Liebaug, Claudius Rotzsch, Rainer Kozlik‐Feldmann, Carsten Rickers, Thomas Mir, Michael Hübler, Jörg Sachweh, Stefan Renz, Andreas Schemm, Bernd Friedrich, Otmar Schlobohm, Dietmar Böthig, Burkhard Wermter, Andrea Kelter‐Klöpping, Alexander Horke, Johann Bauersachs, Mechthild Westhoff‐Bleck, Matthias Gorenflo, Matthias Karck, Tsvetomir Loukanov, Hermann Schrüfer, Martin Wilken, Hashim Abdul‐Khaliq, Tanja Rädle‐Hurst, Axel Rentzsch, Hans‐Joachim Schäfers, Hagen Reichert, Daniel Vilser, Thomas Kriebel, Arnulf Boysen, Anselm Uebing, Tim Attmann, Joachim Thomas Cremer, Jens Scheewe, Regina Buchholz‐Berdau, Peter Möller, Thorsten Horter, Konrad Brockmeier, Gerardus B. W. E Bennink, Stephan Baldus, Alex Gillor, Tim Niehues, Wolfgang Lawrenz, Steffen Leidig, Ingo Dähnert, Frank‐Thomas Riede, Martin Kostelka, Liane Kändler, Martin Bethge, Stefan Köster, Christoph Schröder, Jens Karstedt, Uwe Seitz, Christoph Kampmann, Daniel‐Sebastian Dohle, Frank Stahl, Mojtaba Abedini, Joachim Müller‐Scholden, Alfred Hager, Michael Huntgeburth, Harald Kaemmerer, Nicole Nagdyman, Jörg Schoetzau, Oktay Tutarel, Rüdiger Lange, Jürgen Hörer, Nikolaus A Haas, Michael Hauser, Alexander Roithmaier, Hans‐Gerd Kehl, Astrid Lammers, Edward Malec, Helmut Baumgartner, Gerhard Diller, Roswitha Bahle, Gerald Hofner, Stefan Zink, Roland Reif, Helmut Singer, Christoph Parlasca, Matthias W Freund, Michael Schumacher, Oliver Dewald, Christine Darrelmann, Olaf Willmann, Norbert Schmiedl, Peter Quick, Dirk Hillebrand, Stephan Michele Eiselt, Torsten Nekarda, Michael Eberhard, Georg Baier, Frank Uhlemann, Ioannis Tzanavaros, Alexander Beyer, Gudrun Binz, Steffen Hess, Thomas Teufel, Ronald‐Peter Handke, Michael Hofbeck, Renate Kaulitz, Ludger Sieverding, Christian Schlensak, Christian Apitz, Michael Kaestner, Jürgen Holtvogt, Carl‐Friedrich Wippermann, Sönke Hinz, Andreas Heusch, Johannes Wirbelauer, and Wolfgang Brosi

Subjects
Adult, Pulmonary Valve, Adolescent, Pulmonary Valve Insufficiency, Young Adult, Treatment Outcome, Tetralogy of Fallot, Ventricular Pressure, cardiovascular system, Humans, Prospective Studies, Cardiac Surgical Procedures, Child, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract

Background Right ventricular outflow tract (RVOT) stenosis after repair of tetralogy of Fallot has been linked with favorable right ventricular remodeling but adverse outcomes. The aim of our study was to assess the hemodynamic impact and prognostic relevance of right ventricular pressure load in this population. Methods and Results A total of 296 patients with repaired tetralogy of Fallot (mean age, 17.8±7.9 years) were included in a prospective cardiovascular magnetic resonance multicenter study. Myocardial strain was quantified by feature tracking technique at study entry. Follow‐up, including the need for pulmonary valve replacement, was assessed. The combined end point consisted of ventricular tachycardia and cardiac death. A higher echocardiographic RVOT peak gradient was significantly associated with smaller right ventricular volumes and less pulmonary regurgitation, but lower biventricular longitudinal strain. During a follow‐up of 10.1 (0.1–12.9) years, the primary end point was reached in 19 of 296 patients (cardiac death, n=6; sustained ventricular tachycardia, n=2; and nonsustained ventricular tachycardia, n=11). A higher RVOT gradient was associated with the combined outcome (hazard ratio [HR], 1.03; 95% CI, 1.00–1.06; P =0.026), and a cutoff gradient of ≥25 mm Hg was predictive for cardiovascular events (HR, 3.69; 95% CI, 1.47–9.27; P =0.005). In patients with pulmonary regurgitation ≥25%, a mild residual RVOT gradient (15–30 mm Hg) was not associated with a lower risk for pulmonary valve replacement. Conclusions Higher RVOT gradients were associated with less pulmonary regurgitation and smaller right ventricular dimensions but were related to reduced biventricular strain and emerged as univariate predictors of adverse events. Mild residual pressure gradients did not protect from pulmonary valve replacement. These results may have implications for the indication for RVOT reintervention in this population.

Published
2022

4. Steady critical accretion onto black holes: selfgravity and sonic point characteristics

Author

Patryk Mach and Edward Malec

Subjects
General Relativity and Quantum Cosmology, Astrophysics::High Energy Astrophysical Phenomena, FOS: Physical sciences, General Relativity and Quantum Cosmology (gr-qc)
Abstract

The spherically symmetric steady accretion of polytropic perfect fluids onto a black hole is the simplest flow model that can demonstrate effects of backreaction (selfgravity). It has been discovered 16 years ago that backreaction does not influence some ("intensive") characteristics of sonic points, under suitable conditions. Herein we consider a wider class of equations of state, with polytropic indices in the range (1,2], and establish detailed boundary conditions that allow one to prove this fact. We find also numerical examples showing limits of our analytic criteria - if suitable analytic conditions are not satisfied, then selfgravity influences all characteristics of sonic points. That fact constrains the applicability of the recent proposal of Baumgarte and Shapiro to estimate the lifetime of black holes within compact stellar objects., 19 pages, 17 figures

Published
2022

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