No abstract

The effects of nasal continuous positive airway pressure (CPAP) were examined during cardiac catheterization in 22 patients with congestive heart failure (CHF). CPAP was applied at a level of 5 cm H2O pressure. Hemodynamic measurements were made at baseline and while on CPAP. We hypothesized that patients with high left ventricular (LV) diastolic pressures would experience an increase in cardiac index (CI). To test this hypothesis, patients were divided into two groups based on their baseline pulmonary capillary wedge pressure (PCWP): one group of 11 whose PCWP was greater than or equal to 12 mm Hg (high-PCWP group) and a second group of 11 whose PCWP was less than 12 mm Hg (low-PCWP group). Among the high-PCWP group (mean PCWP +/- SEM = 19.0 +/- 2.7 mm Hg), CI rose significantly while on CPAP (from 2.48 +/- 0.26 to 2.82 +/- 0.26 L/min/m2, p less than 0.01). Stroke volume index (SVI) also rose significantly (from 52.6 +/- 7.0 to 64.1 +/- 8.0 ml/m2, p less than 0.001). In contrast, among the low-PCWP group (PCWP = 8.3 +/- 0.6 mm Hg), CI decreased significantly while on CPAP (from 3.14 +/- 0.44 to 2.89 +/- 0.62 ml/m2, p less than 0.025). SVI fell but not significantly while on CPAP (from 75.5 +/- 8.4 to 74.2 +/- 8.5 ml/m2). Multiple stepwise linear regression analysis revealed that the only significant correlate of the magnitude of change in CI in response to CPAP was baseline PCWP (r = 0.50, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Right ventricular recovery following PVR for chronic significant pulmonary regurgitation after repair of TOF may be compromised in the adult population. In order to maintain adequate RV contractility, pulmonary valve implant in these patients should be considered before RV function deteriorates.

Objectives-To test the hypothesis that endovascular stents used with dilation of coarctation of the aorta (CoA) improve late outcomes. Balloon dilation for CoA has been limited by concerns over the risk for acute dissection, late restenosis, or aneurysm formation. Design-All patients seen with CoA between November 1994 and September 1997 underwent attempted stent implantation. Follow up was obtained for all patients and a subgroup (n = 18) had repeat catheterisation at a mean (SD) of 1.3 (0.5) years to assess residual gradient and stentCoA morphology. Results-Stents were placed in 27 patients (15 male and 12 female patients, mean age 30.1 (13.1) years), of whom seven had prior surgical coarctectomy and one had a prior balloon dilation. Hypertension was present in 26 patients (mean pressure 164 (26)/86 (13) mm Hg), of whom 16 were on antihypertension drugs. CoA gradients were 46 (20) mm Hg (range 18-106 mm Hg) at baseline and 3 (5) mm Hg after the procedure. One patient had a stroke following the procedure; another patient had incomplete dilation and underwent a second procedure. At 1.8 (1) years after the procedure the mean pressure was 130 (14)/74 (11) mm Hg with seven patients on antihypertension treatment. The clinical gradient was 4 (8) mm Hg (range 0-32 mm Hg). At follow up angiography, the mean gradient was 4(6) mm Hg, and two patients had a gradient over 10 mm Hg. Aneurysms formed in three patients at the dilation site; one patient was referred for surgery. Conclusion-In this age group stent management for CoA appears to be an eVective technique and results in sustained reduction in CoA gradients at early term follow up, but aortic aneurysm was detected in 17% of patients who had repeat angiography. (Heart 2001;85:561-566)

Congenitally corrected transposition in the adult patient is not a benign condition. Late complications are common and warrant careful, long-term follow-up.

Right heart morphology undergoes rapid improvement within one month of defect closure, with associated mechanoelectrical benefit. A small number of patients had persistent RV enlargement or pulmonary hypertension, or both, at one year. Our data support the application of transcatheter methods in achieving excellent hemodynamic and anatomic outcomes.

Device closure of ASDs leads to improvement of both RV and LV function as well as reduction in LA volume. These hemodynamic improvements provide insights into the symptomatic benefits gained in closure of ASDs using the transcatheter approach.

No abstract