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Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Pulmonary valve replacement (PVR) often is performed in adults with repaired tetralogy of Fallot (TOF). For patients who have tricuspid regurgitation (TR), tricuspid valve (TV) repair associated to PVR is still debated. Objective We sought to evaluate perioperative factors related to TV repair when performed at the time of PVR in patients with repaired TOF. Methods We retrospectively reviewed 104 patients with repaired TOF (or its equivalent) who underwent PVR (2002-2014). Results Mean age at initial complete correction and at PVR was 20.1 ± 17.2 months and 26.3 ± 9.5 years, respectively. Forty-one patients had significant preoperative TR: 24 were moderate (group M) and 17 were severe (group S). A total of 16 TV repair were performed (8 for each group). Moderate and severe tricuspid regurgitation observed in the first year following the initial complete repair were significantly associated with severe TR at PVR ( P < .001). In group M patients, TR was improved regardless of TV repair, whereas, in group S, residual significant TR was reported in 7 patients who did not have TV repair. No cases were observed for patients who underwent concomitant TV repair ( P = .002). Among these patients with residual significant TR, 2 needed a tricuspid valve replacement. The functional status (New York Heart Association classification) of group S patients was significantly improved by concomitant TV repair. Conclusions In adults with repaired TOF, TV repair is a safe procedure when performed at the time of PVR. If, at mid-term follow-up, there is probably no benefit of TV repair when preoperative TR is moderate, TV repair may improve both tricuspid valve function and functional status of the patients in case of severe preoperative TR. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Le levosimendan est un médicament inotrope positif de la famille des sensibilisateurs calciques. Appartenant au groupe des inodilatateurs, il a également une action vasodilatatrice. Alors que son efficacité a été prouvée chez l’adulte dans le cadre de la chirurgie cardiaque, son utilisation pédiatrique n’est encore que faiblement répandue. Pourtant, de nombreuses études ont montré sa sûreté d’emploi chez l’enfant, y compris chez le nouveau-né. Un nombre croissant d’équipes l’utilisent désormais pour le traitement de l’insuffisance cardiaque aiguë ou chronique. À travers une revue de la littérature, nous nous proposons de décrire ses effets pharmacodynamiques ainsi que ses applications actuelles et ses perspectives d’utilisation chez l’enfant. Summary Levosimendan is a calcium-sensitizing drug with positive inotropic properties. As an inodilator, this molecule also has a vasodilation effect. While its efficacy has been demonstrated in the adult in the context of cardiac surgery, its pediatric use is still not widespread. Many studies have shown its safety of use in children, including in the newborn. Across the world, a growing number of teams use levosimendan to treat both acute and chronic heart failure. Through a review of the literature, we describe its pharmacodynamic effects, its current applications, and its perspectives of use in children. [ABSTRACT FROM AUTHOR]

Summary In ductus-dependent congenital heart disease, preserving the blood flow through the ductus arteriosus (DA) is vital before surgery. We present the cases of three full-term neonates with ductus-dependent congenital heart disease for whom near-infrared spectroscopy (NIRS) monitoring was performed. We recorded cyclical drops in regional oxygen saturation, both cerebral and renal, that corresponded to constrictions of the DA. These findings appeared either simultaneously or previous to SpO 2 drops and were corrected by prostaglandin infusion. Through these cases, we assume that cyclical constrictions of ductal cells participate in the DA closure process in its early phase. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pratique Medicale et Chirurgicale de l'Animal de Compagnie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases Supplements is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Coarctation of the aorta is an obstructive aortic lesion that causes secondary hypertension. Diagnosis is sometimes difficult because patients could present no other symptom. An asymptomatic 20-month-old child was referred in the context of isolated high blood pressure. Echocardiography was not effective, but CT scan established the diagnosis of coarctation. This case report underlines the importance of blood pressure measurement in the detection of aortic obstructions in the pediatric population. [ABSTRACT FROM AUTHOR]

Background After congenital heart surgery, delayed sternal closure (DSC) can be used electively to aid in hemodynamic and respiratory stability in the initial postoperative period. Risk factors for DSC have been previously determined for neonates. The purpose of our study was to determine risk factors that may predict the need for DSC in children < 1 year. Patients and methods We retrospectively reviewed records of children < 1 year who underwent open-heart surgery in our institution over a period of 5 years. The criteria for DSC were hemodynamic instability, deterioration of the central venous saturation, metabolic status and/or high ventilatory pressures. In total, 283 patients underwent open-heart surgery during the period and 89 (31.4%) had DSC. Mean age was 3.8 months (± 3.3) and mean weight was 4.8 kg (± 1.8). The major congenital heart diseases encountered were ventricular septal defect ( n = 80), tetralogy of Fallot ( n = 41) and transposition of the great arteries ( n = 38). Ten patients (3.5%) needed sternal reopening during the first postoperative 24 h. Thirteen patients (4.6%) died after the surgery. Results Cardiopulmonary bypass (CPB) time was significantly longer in children who had DSC (189 min ± 68 versus 130 min ± 44, P < 0.001). Among the studied factors, use of hypothermia, preoperative use of prostaglandin, preexistent renal insufficiency, pulmonary hypertension and cyanosis were significantly associated with DSC ( r = 0.406, P < 0.001; r = 0.335, P < 0.001; r = 0.250, P < 0.001; r = 0.164, P = 0.006; respectively). Multivariate analysis determined an age < 7 days, long CPB time, preoperative mechanical ventilation and renal insufficiency as independent risk factors for DSC. The best cut-off value was 147 min (se = 75%, sp = 70%, AUC = 0.79) for CPB time. Conclusion Small age at surgery, long CPB time and altered preoperative condition are highly at risk for DSC in children < 1 year. Further studies are needed to develop a predictive model for the anticipation of sternal closure in this population. [ABSTRACT FROM AUTHOR]

Background Although ventricular septal defect (VSD) is one of the most common congenital heart disease, this defect is not so frequent in adults because of early surgery and spontaneous closure. Complications such as aortic insufficiency, infectious endocarditis or supraventricular arrhythmia are classically described. Purpose The main objective of this study was to determine the outcome of adult patients who were operated for VSD after childhood. Methods We conducted an observational, retrospective and multicenter study including patients operated for VSD from the age of 18 years, over a 15-year period (2000–2015). Overall survival and occurrence of adverse events were analyzed. Results Seventy-three patients were included. Mean age was 37.47 ± 2.1 years with a male predominance (62%). Type 2 VSDs were the most common type encountered. After surgery, overall survival was 92% with a mean follow-up of 6 years. Excluding events occurring during the early postoperative period, overall survival was significantly better in patients operated for isolated VSD than in patients operated for VSD associated with other cardiac injuries (95% versus 92%, P = 0.02). Early postoperative complications were found in 14% of patients (principally atrioventricular block requiring early postoperative permanent pacing). Aortic cross clamp and cardiopulmonary bypass time were significantly lower in patients operated for isolated VSD than in patients with associated lesion. Conclusion As morbi-mortality is low, surgical closure of VSD in adults is not a high-risk intervention. Survival of patients with isolated VSD is better than that of patients with associated cardiac lesions. This last finding advocates for early surgery before the apparition of complications. [ABSTRACT FROM AUTHOR]

Background Although coarctation of the aorta could be suspected prenatally, the diagnosis is not certain before birth and remains difficult in the neonatal period especially when ductus arteriosus is open. 2D strain, a recent echocardiographic tool to assess myocardial performance, allows the early detection of abnormal myocardial deformation. Objective The aim of this study was to assess the accuracy of left ventricular 2D strain to predict aortic coarctation in neonates with patent ductus arteriosus. Patients and Methods This was a single centre prospective study. Neonates with patent ductus arteriosus and prenatal/postnatal suspicion of isthmic coarctation were included. Left ventricular (LV) 2D strain was performed for each patient. Patients were divided into three groups: those who developed coarctation (group 1, n=9), those who had normal aorta after ductal closure (group 2, n=10), and a control group of healthy neonates with patent ductus arteriosus (group 3, n=20). Results The median age of gestation was 38+4 weeks of amenorrhea and the median birth weight was 3.088kg. The inter observer agreement was good for the assessment of LV 2D strain. Although radial strain was significantly decreased in group 1 (17.76 vs 40.19 in group 2, p<0.001), there was only a trend in the alteration of longitudinal and circumferential strain (-16.34 vs -16.84, p=0.059 & -10.41 vs – 13.88, p=0.053 respectively). Conclusion LV 2D strain seems to be effective for the early diagnosis of aortic coarctation before the ductus arteriosus closes. [ABSTRACT FROM AUTHOR]

Background Intra-aortic balloon pump (IABP) is a commonly used method of temporary circulatory support in adults. Despite the availability of paediatric size balloons, the use of IABP in children is currently not widespread. Aims To describe our practice of IABP in children and to review its indications. Methods Single-centre retrospective study. We reviewed the medical records of all paediatric patients (<18 years) who were supported with IABP from April 2010 to April 2015. We compare our practice with those reported in Pubmed (37 articles). Results During this period 7 patients (6 boys) had a circulatory support with IABP. Mean age was 12.1 years (10-14) and mean weight was 46.1kg (30-61). All were mechanically ventilated and received inotropic support at the time of IABP deployment. 2 IABP were started before surgery to treat acute heart failure (1 myocarditis and 1 ischemic condition). The major indication for IABP was postoperative hemodynamic deterioration (n=5). 4 of them were related to suboptimal cardioplegia in a context of left ventricular hypertrophy. Mean duration of IABP support was 7.1 days (2-13). All IABP catheters were inserted through the common femoral artery. No local complication was reported. All IABP were inserted by an intensivist without surgical help. Conclusion IABP is a feasible method in children with acute left ventricular failure. By improving diastolic perfusion of the coronary arteries, IABP is effective especially in case of myocardial ischemia. This life-saving technique has to be associated to conventional medical treatment of refractory low cardiac output. Sometimes, IABP may be an alternative for effective mechanical circulatory support. [ABSTRACT FROM AUTHOR]

Background Levosimendan is an inodilator agent belonging to the family of calcium sensitizer agents. Its positive inotropic and vasodilating properties make it interesting for the treatment of heart failure. Although this inotropic drug is increasingly used in children, a special license is still needed to obtain it in several countries. Aims To report our experience of levosimendan and to analyse its effects in children. Methods It was a single-centre retrospective study. From January 2010 to December 2014, all paediatric patients who received at least one perfusion of levosimendan were included. Levosimendan was administered as continuous infusions at a dose of 0.2 µg/kg/min for 24 hours without any loading dose. Medical records were analyzed for each patient. Results More than 200 patients received levosimendan during the period and more than 300 infusions were performed. No side effect was reported. Levosimendan significantly improved BNP level. Indications of levosimendan infusion were: 1) treatment of postoperative hemodynamic deterioration, 2) preoperative conditioning, 3) treatment of acute heart failure (myocardial ischemia, myocarditis, decompensated cardiomyopathies), 4) treatment of chronic heart failure (cardiomyopathies and failing Fontan). Conclusion Because of the long half-life of its active metabolite, levosimendan has a prolonged effect lasting for up to 7 to 9 days after discontinuation of a 24-hour infusion. Using this drug, the potential of arrhythmia is reduced as total intracellular calcium levels are not raised. This inodilator agent is safe and effective for the treatment of heart failure in children and must be part of the conventional therapeutic arsenal. [ABSTRACT FROM AUTHOR]

Background Animal studies showed that levosimendan protects cardiomyocytes against apoptotic cell death in acute viral myocarditis. In addition to its inotropic properties, levosimendan seems to prevent the detrimental effects of oxidative stress and to limit cardiomyocyte loss. Aim To analyze the outcome of children who received levosimendan for acute or fulminant viral myocarditis. Patients and methods Retrospective single center study covering the period 2007- 2013. All children (<18 years) with viral myocarditis were treated, in association with epinephrine and/or milrinone, with a 24-hours infusion of levosimendan. Clinical, biological and echocardiographic evolutions were analyzed. Results Between 2007 and 2013, 18 successive children were treated, 9 for acute myocarditis and 9 for fulminant myocarditis (according to the international clinicopathological classification). Median age was 4 years (1.1-11) and median weight was 15kg (10-40). BNP level significantly decreased 48 hours after the beginning of the infusion (4599ng/L [2698-9266] vs 1928ng/L [848-4557], p=0.05). No dialysis was necessary. Among the fulminant myocarditis group, 1 patient (11%) required early mechanical circulatory support with a limitation of care due to severe neurologic complications. 13 patients (72%) recovered a LVEF >55% (100% for the acute myocarditis group). 1 patient had heart transplantation 18 months later. Conlusion In our experience, levosimendan was efficient for the inotropic support of acute and fulminant viral myocarditis. We believe that its cardioprotective effect enabled us to limit the use of mechanical assistance (only 11% of the fulminant forms) and allowed a recovering of the cardiac function for the majority of the patients. Although further clinical studies are needed to confirm these data, levosimendan should be systematically considered for the treatment of these critical patients. [ABSTRACT FROM AUTHOR]

Introduction Cardiopulmonary bypass can be responsible for post-operative left ventricular dysfunction. As conventional echographic parameters are not reliable in the post-operative period, we assessed left ventricular function by 2D strain. The main objective of this study was to evaluate the peri-operative feasibility and reliability of 2D strain. The second objective was to assess the impact of aortic cross-clamp duration on echographic parameters. Methods 33 pediatric patients (<18 years) with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were included in this prospective single center study. Daily echocardiography was performed from the day before surgery to the sixth post-operative day. Left ventricular ejection fraction (Teichholz and Simpson) and 2D strain (longitudinal, circumferential and radial) were measured. The cohort was then divided into three groups according to aortic cross-clamp duration (<30 min for group 1, 30-80 min for group 2, >80 min for group 3). Results Mean age and weight were 4 years [2-6] and 15kg [10-20]. Mean duration of aortic cross-clamp was respectively 22 min, 56 min and 101 min in groups 1, 2 and 3. Longitudinal, circumferential and radial strains were feasible in 91%, 95% and 95% of the cases respectively, which was similar to conventional parameters (97%). The reliability of 2D strain measurements was better than the one of conventional parameters (intra and inter-observer correlation coefficients: 0.916, p<0.001 and 0.885 p<0.001 for longitudinal strain versus 0.156, p=0.538 and 0.064, p=0.800 for Simpson). The means of longitudinal and circumferential strains over time were significantly different between the three groups (p<0,001) whereas there was no difference for Simpson measurements (p=0,617). Conclusion 2D strain is feasible and more reproducible than echographic parameters in the post-operative period. Post-operative evolution of 2D strain is linked to aortic cross-clamp duration. [ABSTRACT FROM AUTHOR]

Introduction Conventional echographic parameters are neither accurate nor reproducible to assess left ventricular function after cardiac surgery with cardiopulmonary bypass. The main objective of this study was to evaluate the feasibility and reproducibility of 2D strain during the peri-operative period. The second objective was to assess the post-operative evolution of 2D strain, particularly after an atrial septal defect closure. Methods 33 pediatric patients (<18years) with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were included in this prospective single center study. Daily echocardiography was performed from the day before surgery to the sixth post-operative day. Left ventricular ejection fraction (Teichholz and Simpson) and 2D strain (longitudinal, circumferential and radial) were measured. Results Mean age and weight were 4years [2-6] and 15kg [10-20]. Mean durations of cardiopulmonary bypass and aortic cross-clamp were 117min [86-148] and 58min [44-72]. The global post-operative feasibility of longitudinal, circumferential and radial strain was respectively 91%, 95% and 95%, similar to the feasibility of conventional parameters (97%). The intra- and inter-observer correlation coefficients were good for longitudinal strain (0.916, P<0.001 and 0.885, P<0.001), circumferential strain (0.880, P<0.001 and 0.829, P<0.001) and radial strain (0.701, P=0.002 and 0.559, P=0.020). Early post-operative circumferential strain was correlated to the durations of aortic cross-clamp (r=0.603, P=0.001), inotropic support (r=0.558, P=0.004) and mechanical ventilation (r=0.580, P=0.002). Circumferential strain significantly improved after an atrial septal defect closure (−19.86 [−22.73; −17.00] versus −14.95 [−17.79; −12.11], P=0.028). Conclusion 2D strain is feasible and reproducible in the post-operative period. Further studies are needed to assess its interest in early diagnosis of post-operative myocardial dysfunction. [ABSTRACT FROM AUTHOR]

Summary: Bacterial endocarditis is rare in children. We report the case of streptococcal B endocarditis in a newborn whose mother had asymptomatic bacteriuria during pregnancy. This report emphasizes the importance of maternal intrapartum antibiotic therapy when there is a major risk of neonatal infection and underlines the diagnostic value of echocardiography in case of prolonged fever. [Copyright &y& Elsevier]