Obstruction develops commonly at the acute-angled portion of the vessels following palliative surgery, such as systemic–pulmonary shunt (SP shunt), right ventricle–to–pulmonary artery shunt (RV–PA shunt) in the Norwood–Sano procedure for hypoplastic left heart syndrome, and cavopulmonary (Glenn) anastomosis. Although balloon angioplasty is a treatment option, dilation with existing straight balloons is sometimes ineffective and technically complicated because of balloon slippage and target vessel distortion. In this study, we investigated the effectiveness of a curved GOKU balloon catheter for balloon angioplasty in postoperative acute-angled lesions associated with palliative surgery for congenital heart disease. We reviewed patients who underwent balloon angioplasty for angled lesions complicated by SP shunt, RV–PA shunt, or Glenn anastomosis, using the novel curved GOKU or a conventional balloon catheter, such as a Sterling balloon catheter. We evaluated patients’ backgrounds, balloon specifications, target lesion anatomical features and angles, and short-term outcomes. We evaluated 45 procedures in 18 patients. A curved GOKU was used in 20 procedures, and a Sterling balloon in 25 procedures. The angulation of the lesions at maximum balloon inflation was significantly smaller using a curved GOKU vs a Sterling balloon [70–120 (mean ± standard deviation, 97 ± 40) degrees vs 110–180 (149 ± 46) degrees, respectively; p < 0.001], while the original angle was similar between the groups. Patients’ short-term outcomes with the curved GOKU were excellent, with a significantly better percent increase in minimum lumen diameter of 0–220% (92% ± 66%) vs 0–46% (18% ± 15%) with the Sterling balloon (p < 00.1) and with less frequent balloon slippage. The curved GOKU was more effective in balloon angioplasty for acute-angled lesions compared with a conventional straight balloon, likely because of better conformability to the lesion angle and slip resistance.
Predicting normal values of cardiovascular structure size are essential in managing congenital and pediatric heart diseases. Conventionally, normal values of cardiovascular structure size are predicted based on body surface area (BSA) , which is calculated from the infantʼs weight and height. However, the predicted normal values may be more accurate if the actual body composition measurement is considered because there are large individual differences in lean body mass (LBM) and fat mass (FM) . The objective of this study was to evaluate the efficacy of measuring body fat percentage using the PEA POD Infant Body Composition System, a novel pediatric body composition measurement tool, in assessing cardiovascular structures focused on the diameters of the aortic valve (AVD) and mitral valve (MVD) and the left ventricular mass (LVM) in infants. We evaluated the associations between diameters of the AVD and MVD, LVM, and percent body fat (%BF) using the PEA POD system at term-equivalent age (37-42 weeks) . AVD and MVD were not significantly different between groups with high or low %BF, whereas the differences between the predicted normal values and AVD and between the predicted normal values and MVD were significantly larger in the high %BF group than those in the low %BF group (p<0.05 and p<0.01, respectively) . The high %BF group had significantly larger LVM/ height 2.16 than the low %BF group (p<0.05) , whereas no significant difference in LVM/BSA was found between the two groups. Body composition analysis is crucial for evaluating cardiovascular structure in infants because the existing methods for predicting normal values for valve diameter and LVM are significantly influenced by %BF.
Mitral valve aneurysm not associated with infective endocarditis is rarely reported in children. We report a case of perforated posterior mitral leaflet aneurysm in an infant with reference to surgical and histopathological findings. Although its aetiology remains unclear, we suggest to include mitral valve aneurysm in differential diagnosis as a cause of mitral regurgitation in children.
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