- Email: [email protected]
Infective endocarditis in children: morbi-mortality and impact of congenital heart disease
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Archives of Cardiovascular Diseases Supplements (2017) 9, 113-117
Methods Hospital records and catheterization reports of all premature neonates (<32 weeks’ gestation) who underwent transcatheter PDA closure between March 2015 and March 2016 were reviewed. After only venous femoral punction, the PDA was closed using a 4Fr delivery system from the pulmonary side. Echocardiography and fluoroscopy were performed for the guidance of ductal closure. Contrast angiography was not used in any patient.
Topic 10 – Pediatric and congenital cardiopathies January 12th, Thursday 2017
651 Long-term functional and myocardial assessment in patients with critical aortic valve stenosis B. Bonello* (1), M. Carr (1), X. Iriart (2), G. Derrick (1), G. Christov (1), M. Kostolny (1), J. Marek (1) (1) GOSH, London, United Kingdom – (2) CHU Bordeaux, Bordeaux, France *Corresponding author: [email protected] Background Short-term outcome of neonateswith critical aortic valve stenosis (CAS) is good, even in borderline left ventricle. Purpose To study long-term morbidity/mortality of patients with CAS who underwent biventricular repair. Methods Between 1970-2010, 96 patients were identified. Twenty-seven patients died, 22 were lost to follow-up. Twenty-five of the remaining 47 patients had late follow up at our institution, including cardiopulmonary exercise testing, echocardiography and cardiac magnetic resonance imaging. Results Median follow up age was 15.7±6.4 years. Fourteen had initial surgical valvuloplasty. The majority (84%) had atleast one reintervention. Aortic valve replacement (AVR) performed in 19 patients: 16 patients had a Ross procedureand 3 patients had alternative AVR. Additionally, intervention for other small left heart structures was undertaken in 6 patients. At follow up, peak VO2 was normal in 1, depressedin 3, severely depressed in 15 patients. Left ventricular (LV) ejection fraction was normal in all but one patient. Tenpatients had LVOT obstruction >2,5m/s and 4 patients had moderate AR. Five patients had restrictive LV physiology, of which, 3 have pulmonary hypertension. LV longitudinal strainwas depressed (17±3). Notably endocardial fibroelastosis (EFE) was present in 18 patients (papillary muscles alone (n=8); extension to lateral wall (n=2), inter ventricular septum (n=1), and circumferential (n=2)). EFE correlated with early Ross intervention (r =-0.52, p=0.0324), diastolic LV dysfunction (r =-0.48, p=0.0164) and with pulmonary hypertension (r=0.65, p=0.0004), but not with exercise capacity. Conclusions Long-term follow-up of patients with CAS is characterised by a high rate of reinterventions. Exercise capacity is decreased in most cases despite normal LV systolic function. EFE is associated with poor outcome. The authors hereby declare no conflict of interest
Results 7 premature infants born at gestational ages ranging between 25 and 30 weeks (median 27 weeks) underwent PDA closure. Median age was 18 days [10 - 32 days], and median weight was 1203 g [860 g – 1400g] ADOIIAS devices were successfully deployed in all cases. Complete closure was achieved in all patients. Median fluoroscopy time was 5,79 mn (4,1 – 8,31). Median total dose-area product was 16.78 µGy/m² (4.7-39). We don’t have major procedural complications. There were no instances of device migration, residual PDA, left pulmonary artery coarctation or aortic coarctation at mid term outcomes. All patients were alive at the time of this report. Conclusion We demonstrates that transcatheter PDA closure can be successfully performed in extremely preterm neonates using the new ADOIIAS device with a high success rate and low incidence of complications. This report also describes a novel transvenous approach using a combination of echocardiography and judicious use of fluoroscopy to avoid arterial access in this fragile patient. The authors hereby declare no conflict of interest
758 Infective endocarditis in children: morbi-mortality and impact of congenital heart disease P. Aldebert (*)(1), M. Orabonna (2), G. Habib (3), JP. Casalta (3), JP. Pinto (2), C. Ovaert (1), L. Mace (1) (1) APHM-Hôpital la Timone, Cardiologie congénitale et pédiatrique, Marseille, France – (2) APHM-Hôpital Nord, Cardiologie, Marseilles, France – (3) APHM-Hôpital la Timone, Insuffisance cardiaque et valvulopathies, Marseille, France *Corresponding author: philippe. [email protected] Background Infective endocarditis (IE) is a rare and severe illness. Incidence is increasing in children but mortality remains stable in spite of diagnostic and therapeutic progress. The lack of data in pediatric population supports our study. Purpose Main purpose was to assess morbidity and mortality of children hospitalized with IE, over 15 past years. The second purposes were to describe characteristics of IE, and compare the management of IE in congenital heart disease (CHD) versus non-CHD. Methods It was a retrospective study including children hospitalized for IE in Timone hospital, Marseille (France), from 2000 to 2015. Clinical, para-clinical and therapeutic data were identified. Diagnosis was bases on the modified Duke criteria
692 The Amplatzer Duct Occluder II additional sizes device for transcatheter PDA closure in preterms infants: monocentric experience A. Chalard* (1), M. Lang (2), B. Cosserant (3), F. Rusé (3), JR. Lusson (1), B. Boeuf (2), C. Dauphin (1) (1) CHU Clermont-Ferrand, Cardiologie, Clermont-Ferrand, France – (2) CHU Clermont-Ferrand, Réanimation pédiatrique et néonatale, Clermont-Ferrand, France – (3) CHU Clermont-Ferrand, Réanimation chirurgie cardiovasculaire, Clermont-Ferrand, France *Corresponding author: [email protected] Introduction Patent ductus arteriosus (PDA) in preterm infants continues to be a significant clinical problem contributing importantly to both morbidity and mortality. We report a new technique for transcatheter PDA closure in extremely preterm infants using new commercially available technology. Purpose To present our initial experience with the Amplatzer Duct Occluder II Additional Sizes (ADOIIAS) device.
Results 37 patients were included with median age of 7 years. 59.5% of our population had CHD. The most frequent CHD was ventricular septal defect (28%). 18 patients (48,6%) had previous cardiac surgery with prosthetic material. Patients with CHD were hospitalized more quickly (p=0,037). Left heart IE was diagnosed in 56.8% of the cases. Aortic localization was the most frequent lesion (27%) but pulmonary IE was significantly more present in CHD population (p=0,017). Non-invasive exams were not systematic but permit to discover silent embolization in 27%. PET-CT was realized in 18.9% of patients, all with CHD. It helped to diagnosis of IE in half of cases. The principal bacteria found were streptococci and staphylococci in the 2 groups. A surgery was necessary in 56.8%. Mortality was 2.7% without difference between CHD and non-CHD populations. The complication rate (hemodynamic, infectious and embolic) remains high (46,8%) without difference between CHD and non-CHD populations. Conclusion Mortality of IE is low in contrast to complications, but without difference between CHD and non-CHD. Systematic non-invasive exams could help to diagnosis of IE and improve the management of IE. The author declares a conflict of interest: Saint Jude Medical consultant
© Elsevier Masson SAS. All rights reserved.
Archives of Cardiovascular Diseases Supplements (2017) 9, 113-117
Methods Hospital records and catheterization reports of all premature neonates (<32 weeks’ gestation) who underwent transcatheter PDA closure between March 2015 and March 2016 were reviewed. After only venous femoral punction, the PDA was closed using a 4Fr delivery system from the pulmonary side. Echocardiography and fluoroscopy were performed for the guidance of ductal closure. Contrast angiography was not used in any patient.
Topic 10 – Pediatric and congenital cardiopathies January 12th, Thursday 2017
651 Long-term functional and myocardial assessment in patients with critical aortic valve stenosis B. Bonello* (1), M. Carr (1), X. Iriart (2), G. Derrick (1), G. Christov (1), M. Kostolny (1), J. Marek (1) (1) GOSH, London, United Kingdom – (2) CHU Bordeaux, Bordeaux, France *Corresponding author: [email protected] Background Short-term outcome of neonateswith critical aortic valve stenosis (CAS) is good, even in borderline left ventricle. Purpose To study long-term morbidity/mortality of patients with CAS who underwent biventricular repair. Methods Between 1970-2010, 96 patients were identified. Twenty-seven patients died, 22 were lost to follow-up. Twenty-five of the remaining 47 patients had late follow up at our institution, including cardiopulmonary exercise testing, echocardiography and cardiac magnetic resonance imaging. Results Median follow up age was 15.7±6.4 years. Fourteen had initial surgical valvuloplasty. The majority (84%) had atleast one reintervention. Aortic valve replacement (AVR) performed in 19 patients: 16 patients had a Ross procedureand 3 patients had alternative AVR. Additionally, intervention for other small left heart structures was undertaken in 6 patients. At follow up, peak VO2 was normal in 1, depressedin 3, severely depressed in 15 patients. Left ventricular (LV) ejection fraction was normal in all but one patient. Tenpatients had LVOT obstruction >2,5m/s and 4 patients had moderate AR. Five patients had restrictive LV physiology, of which, 3 have pulmonary hypertension. LV longitudinal strainwas depressed (17±3). Notably endocardial fibroelastosis (EFE) was present in 18 patients (papillary muscles alone (n=8); extension to lateral wall (n=2), inter ventricular septum (n=1), and circumferential (n=2)). EFE correlated with early Ross intervention (r =-0.52, p=0.0324), diastolic LV dysfunction (r =-0.48, p=0.0164) and with pulmonary hypertension (r=0.65, p=0.0004), but not with exercise capacity. Conclusions Long-term follow-up of patients with CAS is characterised by a high rate of reinterventions. Exercise capacity is decreased in most cases despite normal LV systolic function. EFE is associated with poor outcome. The authors hereby declare no conflict of interest
Results 7 premature infants born at gestational ages ranging between 25 and 30 weeks (median 27 weeks) underwent PDA closure. Median age was 18 days [10 - 32 days], and median weight was 1203 g [860 g – 1400g] ADOIIAS devices were successfully deployed in all cases. Complete closure was achieved in all patients. Median fluoroscopy time was 5,79 mn (4,1 – 8,31). Median total dose-area product was 16.78 µGy/m² (4.7-39). We don’t have major procedural complications. There were no instances of device migration, residual PDA, left pulmonary artery coarctation or aortic coarctation at mid term outcomes. All patients were alive at the time of this report. Conclusion We demonstrates that transcatheter PDA closure can be successfully performed in extremely preterm neonates using the new ADOIIAS device with a high success rate and low incidence of complications. This report also describes a novel transvenous approach using a combination of echocardiography and judicious use of fluoroscopy to avoid arterial access in this fragile patient. The authors hereby declare no conflict of interest
758 Infective endocarditis in children: morbi-mortality and impact of congenital heart disease P. Aldebert (*)(1), M. Orabonna (2), G. Habib (3), JP. Casalta (3), JP. Pinto (2), C. Ovaert (1), L. Mace (1) (1) APHM-Hôpital la Timone, Cardiologie congénitale et pédiatrique, Marseille, France – (2) APHM-Hôpital Nord, Cardiologie, Marseilles, France – (3) APHM-Hôpital la Timone, Insuffisance cardiaque et valvulopathies, Marseille, France *Corresponding author: philippe. [email protected] Background Infective endocarditis (IE) is a rare and severe illness. Incidence is increasing in children but mortality remains stable in spite of diagnostic and therapeutic progress. The lack of data in pediatric population supports our study. Purpose Main purpose was to assess morbidity and mortality of children hospitalized with IE, over 15 past years. The second purposes were to describe characteristics of IE, and compare the management of IE in congenital heart disease (CHD) versus non-CHD. Methods It was a retrospective study including children hospitalized for IE in Timone hospital, Marseille (France), from 2000 to 2015. Clinical, para-clinical and therapeutic data were identified. Diagnosis was bases on the modified Duke criteria
692 The Amplatzer Duct Occluder II additional sizes device for transcatheter PDA closure in preterms infants: monocentric experience A. Chalard* (1), M. Lang (2), B. Cosserant (3), F. Rusé (3), JR. Lusson (1), B. Boeuf (2), C. Dauphin (1) (1) CHU Clermont-Ferrand, Cardiologie, Clermont-Ferrand, France – (2) CHU Clermont-Ferrand, Réanimation pédiatrique et néonatale, Clermont-Ferrand, France – (3) CHU Clermont-Ferrand, Réanimation chirurgie cardiovasculaire, Clermont-Ferrand, France *Corresponding author: [email protected] Introduction Patent ductus arteriosus (PDA) in preterm infants continues to be a significant clinical problem contributing importantly to both morbidity and mortality. We report a new technique for transcatheter PDA closure in extremely preterm infants using new commercially available technology. Purpose To present our initial experience with the Amplatzer Duct Occluder II Additional Sizes (ADOIIAS) device.
Results 37 patients were included with median age of 7 years. 59.5% of our population had CHD. The most frequent CHD was ventricular septal defect (28%). 18 patients (48,6%) had previous cardiac surgery with prosthetic material. Patients with CHD were hospitalized more quickly (p=0,037). Left heart IE was diagnosed in 56.8% of the cases. Aortic localization was the most frequent lesion (27%) but pulmonary IE was significantly more present in CHD population (p=0,017). Non-invasive exams were not systematic but permit to discover silent embolization in 27%. PET-CT was realized in 18.9% of patients, all with CHD. It helped to diagnosis of IE in half of cases. The principal bacteria found were streptococci and staphylococci in the 2 groups. A surgery was necessary in 56.8%. Mortality was 2.7% without difference between CHD and non-CHD populations. The complication rate (hemodynamic, infectious and embolic) remains high (46,8%) without difference between CHD and non-CHD populations. Conclusion Mortality of IE is low in contrast to complications, but without difference between CHD and non-CHD. Systematic non-invasive exams could help to diagnosis of IE and improve the management of IE. The author declares a conflict of interest: Saint Jude Medical consultant
© Elsevier Masson SAS. All rights reserved.