Background: At present, the exclusion for percutaneous pulmonary valve implantation for free pulmonary regurgitation after tetralogy of Fallot repair includes an unfavourably large right ventricular outflow tract. Objective: To report feasibility and early experience with a recently developed transcatheter heart valve, Venus P-valve TM , implanted in six patients with severe pulmonary regurgitation with large right ventricular outflow tracts. Patients: There were two female patients and four male patients. The median age of the patients was 18.5 years, and the mean body weight was 53.8 kg. All the patients were in NYHA class II and had severe pulmonary regurgitation after previous transannular patch repair of tetralogy of Fallot. The median time after the last surgical operation was 13.5 years. Results: The Venus P-valve TM was successfully implanted in all the patients with implanted valve diameters ranging from 24 to 32 mm. The mean fluoroscopy time was 29.8 minutes. None of the patients had significant outflow tract gradient or pulmonary regurgitation immediately after valve implantation. Only one patient had unexpected mild proximal valve migration to the right ventricular body during withdrawal of the delivery system. It caused mild paravalvar leak and significant tricuspid regurgitation. At 6 months follow-up, the median of right ventricular end-diastolic volume indices decreased from 146 to 108 ml/m 2 (p-value = 0.046). The Doppler systolic peak gradient across the valve ranged from 4 to 40 mmHg, and there was no evidence of stent fracture on fluoroscopy or structural valve failure. Conclusion: The Venus P-valve TM can be implanted successfully and effectively in patients with severe pulmonary regurgitation and a large right ventricular outflow tract. The early results with this valve are encouraging.

No abstract

Primary malignant cardiac tumors have distinctive MR features that can be used to differentiate them from primary benign cardiac tumors.

Characteristic responses of different-size myocardial microvessels may be inferred with EBCT, which provides a unique opportunity to portray intramyocardial microcirculatory function noninvasively.

No abstract

Patients with tetralogy of Fallot (TOF) after total correction usually have residual pulmonary regurgitation resulting in right ventricular (RV) dilatation and dysfunction. This study was performed to evaluate N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting RV dilatation and RV dysfunction in TOF after total correction. Twenty-one patients with TOF after total correction (12 males and 9 females, 12.06 +/- 2.54 years old) underwent echocardiography, cardiac magnetic resonance imaging (MRI), and blood sampling for NT-proBNP. Mean time after total correction was 7.59 +/- 2.30 years. From cardiac MRI study, mean right ventricular end diastolic volume index (RVEDVi) was 148.36 +/- 64.50 ml/m2 and mean right ventricular ejection fraction (RVEF) was 35.50 +/- 10.50%. Right ventricular dilatation was considered if RVEDVi was >108 ml/m2 and RV dysfunction was considered if RVEF was <40%. A plasma NT-proBNP level of 115 pg/ml was identified by receiver operating characteristic analysis in predicting RV dilatation and/or dysfunction. At this value, the sensitivity and specificity for predicting RV dilatation, RV dysfunction, and both RV dilatation and dysfunction were 71 and 100%, 71 and 71%, and 83 and 78%, respectively. In conclusion, plasma NT-proBNP level may be helpful in follow-up patients. Plasma NT-proBNP levels >115 pg/ml can be used as a marker in the detection of RV dilatation and dysfunction.

Background: Recent advances in stem cell therapy to restore cardiac function have great promise for patients with congestive heart failure after myocardial infarction in an adult population. Objective: We examined the benefits of bone marrow-derived progenitor cells treatment modality for the pediatric patient. Methods and Results:We present our first case of transcoronary autologous stem cell transplantation in a 9-year-old girl with refractory congestive heart failure secondary to myocardial infarction 1 year after transcatheterrevascularization. The child received daily injections of granulocyte colony-stimulating factor for 3 days prior to the bone marrow aspiration.The bone marrow cells were isolated to constituteCD133+/CD34+ more than 90% of the total number. Subsequently, the progenitor cell suspension was injected via a transcoronary catheter without any complication. Three months after stem cell therapy, her cardiac function, assessed by both cardiac magnetic resonance and echocardiogram, has been improved with the left ventricular ejection fraction at 47% compared to the baseline of 30%. Conclusion: This is the first reported pediatric case of successful transcoronary injection of bone marrowderived progenitor cells for end-stage heart disease. The procedure is considered safe and feasible for the pediatric population. IntroductionMyocardial infarction (MI) occurs rarely in children. Given the infrequency of direct experience with MI in pediatric patients, the management of these children is an extrapolation of the experience in adult patients. Young patients are at a further disadvantage due to the lack of treatment options usually available to adult patients, particularly cardiac transplantation for end-stage heart disease due to the shortage of organ donors. With the recent advances in stem cell therapy, the use of this technique to restore cardiac function holds great promise for patients with postinfarction congestive heart failure (CHF) refractory to medical therapy. 1,2 To our knowledge, there have been no previously reported cases on the use of stem cell transplantation for the treatment of postinfarction heart failure in children. We present our first experience in transcoronary autologous stem cell transplantation for a 9-year-old girl with CHF secondary to MI.

We recommended the appropriate CVC length via RIJV approach should be between these two calculated lengths and the CVC length in each age according to the BSA.