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Cardiac resynchronization therapy via transvenous approach in a 2-year-old boy with a complete atrioventricular block after a tetralogy of Fallot repair.

ABSTRACT: Cardiac resychronization therapy (CRT) was performed via transvenous approach in a 2-year-old boy with a tetralogy of Fallot and postoperative severe heart failure, and complete atrioventricular block treated with a dual-chamber pacemaker. Epicardial leads were unavailable because of mediastinitis and the presence of severe bilateral pleural effusions requiring continuous drainage. There were no procedural complications. Biventricular pacing was significantly effective and both mediastinitis and pleural effusions recurred. The transvenous CRT was exchanged for an epicardial CRT after 4 months because of the possibility of a venous obstruction.

SUBMITTER: Aoki H

PROVIDER: S-EPMC5728997 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Cardiac resynchronization therapy via transvenous approach in a 2-year-old boy with a complete atrioventricular block after a tetralogy of Fallot repair.

Aoki Hisaaki H Emi Misugi M Inamura Noboru N Iwai Shigemitsu S Kayatani Futoshi F

Journal of arrhythmia 20170909 6

Cardiac resychronization therapy (CRT) was performed via transvenous approach in a 2-year-old boy with a tetralogy of Fallot and postoperative severe heart failure, and complete atrioventricular block treated with a dual-chamber pacemaker. Epicardial leads were unavailable because of mediastinitis and the presence of severe bilateral pleural effusions requiring continuous drainage. There were no procedural complications. Biventricular pacing was significantly effective and both mediastinitis and ...[more]

PMID: 29255519

Similar Datasets

A case report of paroxysmal complete atrioventricular block in a patient with dextrocardia and repaired tetralogy of Fallot.

Project description:BackgroundSome adults suffer sudden cardiac death after previous surgical repair of tetralogy of Fallot (TOF), and in such cases, ventricular tachycardia is believed to be the most frequent cause of death. However, we report a case of cardiac arrest due to paroxysmal complete atrioventricular block in an adult with dextrocardia and repaired TOF.Case summaryA 49-year-old woman with dextrocardia and a history of surgical treatment for TOF lost consciousness three times. A previously implanted loop recorder showed a 60-second cardiac arrest, and complete atrioventricular block was diagnosed. An electrophysiological study showed prolongation of the His-ventricular interval but no ventricular tachycardia. A dual chamber pacemaker was implanted, and there has been no recurrence of syncope in the 23 months since implantation.DiscussionThere is little evidence for paroxysmal complete atrioventricular block in patients with repaired TOF. This case suggests that paroxysmal complete atrioventricular block can occur late after surgical repair of TOF, and research needs to elucidate whether it is the cause of sudden cardiac death in some patients with TOF.

| S-EPMC9671030 | biostudies-literature

Complete percutaneous repair of Tetralogy of Fallot in adult: a case report.

Project description:Tetralogy of Fallot (TOF) is the most common congenital cyanotic heart disease and is characterized by an antero-superior deviation of the infundibular septum with a consequent large malaligned ventricular septal defect (VSD) and a pulmonary and sub-pulmonary (infundibular) stenosis. Surgical repair has been the cornerstone of treatment that is electively performed early in their lives between 3 and 6 months of age. With advancements in transcatheter interventions, the complete percutaneous repair of TOF, a complex disease with multiple treatable lesions, is becoming a conceivable possibility. Here, we report the case of total transcatheter correction of an 18-year-old boy with TOF, performed in two stages. The first stage involved addressing the right ventricular outflow tract (RVOT) obstruction with balloon pulmonary valvuloplasty (BPV) and occluding the conal artery using absolute alcohol and a coil. In the second stage, the VSD was closed with a Multifunctional Occluder (MFO) Konar device 14 -12 mm (Lifetech, China). While surgical treatment remains the gold standard for total correction of TOF, the transcatheter approach can also be considered for selected group of patients who are surgically turned-down.

| S-EPMC11657948 | biostudies-literature

Staged Versus Complete Repair in the Symptomatic Neonate With Tetralogy of Fallot.

Project description:BackgroundThe optimal management of tetralogy of Fallot (TOF) in symptomatic neonates remains unknown. We compared outcomes for those undergoing palliation vs complete repair in the neonatal period.MethodsIn a retrospective cohort study of symptomatic neonates with TOF who had a neonatal complete repair (group 1, n = 112) or staged repair (group 2, n = 26) from 2000 to 2013, we compared outcomes at 4 time points: neonatal complete repair vs palliation (group 1 vs 2A), neonatal vs later complete repair (group 1 vs 2B), the single vs combined admissions to achieve a complete repair (group 1 vs group 2A + 2B), and cumulative events 2 years after complete repair for both groups.ResultsDemographics, anatomy, comorbidities, surgical approach, and mortality were similar between groups 1 and 2. Group 1 had a longer duration of cardiopulmonary bypass and deep hypothermic circulatory arrest and more postprocedure cardiac events compared with group 2A; a longer duration of intubation, intensive care, and postprocedure hospital stay compared with groups 2A and 2B; and a longer total hospital stay compared with group 2B. With combined admissions for group 2, there was no difference in the total duration of intensive care, total hospital stay, or reinterventions compared with group 1.ConclusionsBoth management options result in similar survival; however, early morbidity was greater with neonatal complete repair. The impact of increased neonatal exposures, such as cardiopulmonary bypass, deep hypothermic circulatory arrest, and intensive care, on neurocognitive development requires further study but should be considered when choosing an optimal strategy.

| S-EPMC7054157 | biostudies-literature

Surgical repair of tetralogy of Fallot in a 78-year-old woman: a case report

Project description: Not available

| S-EPMC10910697 | biostudies-literature

Ventricular Dysfunction in a 40-Year-Old With Coronary Compression From Aortic Aneurysm Following Waterston Shunt and Complete Repair of Tetralogy of Fallot.

Project description: Not available

| S-EPMC6479195 | biostudies-literature

Biomechanical Modeling to Inform Pulmonary Valve Replacement in Tetralogy of Fallot Patients After Complete Repair.

Project description:BackgroundA biomechanical model of the heart can be used to incorporate multiple data sources (electrocardiography, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of patients with tetralogy of Fallot after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health.MethodsTwenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance imaging were included in this retrospective study. Biomechanical models specific to individual patient and physiology (before and after PVR) were created and used to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values.ResultsRV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) after PVR than those with predominant pulmonary regurgitation (median decrease 11%). The model simulated post-PVR decreased EDV for the majority and suggested an increase of Qeff-both in line with published data.ConclusionsThis study used a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.

| S-EPMC9810481 | biostudies-literature

Tetralogy of Fallot: morphological variations and implications for surgical repair.

Project description:ObjectivesTetralogy of Fallot is characterized by anterocephalad deviation of the outlet septum, along with abnormal septoparietal trabeculations, which lead to subpulmonary infundibular stenosis. Archives of retained hearts are an important resource for improving our understanding of congenital heart defects and their morphological variability. This study aims to define variations in aortic override, coronary arterial patterns and ventricular septal defects in tetralogy of Fallot as observed in a morphological archive, highlighting implications for surgical management.MethodsThe Birmingham Children's Hospital archive contains 211 hearts with tetralogy of Fallot, of which 164 were analysed [69 (42.1%) unrepaired and 95 (57.9%) operated specimens]. A detailed morphological and geometric analysis was performed using a rigorous 5-layer review process.ResultsAnomalies were observed in the orifices, origins and course of the coronary arteries: 20 hearts (13.0%) had more than 2 orifices and 3 hearts (1.9%) had a single orifice. In 7 hearts (4.3%), a coronary artery crossed the right ventricular outflow tract. The extent of aortic override ranged from 31.0% to 100% (median of 59.5%). The ventricular septal defect was most often perimembranous (139, 84.8%), but we also found muscular (14, 8.5%), atrioventricular (7, 4.3%) and doubly committed juxta-arterial (2, 1.2%) variants.ConclusionsAnatomical variations are common and can impact surgical management. Anomalous coronary arteries may require a conduit rather than a transannular patch. Variability in aortic override determines the size of patch used to baffle blood to the aorta. The type of ventricular septal defect affects patch closure and the risk of postoperative conduction defects.

| S-EPMC6580293 | biostudies-literature

Intermittent complete atrioventricular block in a 20-year-old woman with cardiac sarcoidosis: a case report.

Project description:BackgroundAtrioventricular conduction disturbance may rarely be caused by cardiac involvement of sarcoidosis.Case summaryA 20-year-old Caucasian female with exertional dyspnoea was admitted to the hospital. Electrocardiogram revealed intermittent complete atrioventricular block with ventricular escape rhythm. Laboratory findings indicated no obvious cause for the complete heart block, and echocardiography showed no abnormalities with normal systolic left ventricular function. However, in gadolinium-enhanced cardiovascular magnetic resonance imaging, a mass at the basal septum with high intensity of T2-weighted signal was found, and 18-fluorodeoxyglucose positron emission tomography revealed severe enhancement in this area and in the mediastinal lymph nodes. The diagnosis of cardiac sarcoidosis was established by the detection of non-caseating epithelioid granulomas in the endobronchial lymph node biopsy. Corticosteroid therapy with oral administration of 30 mg prednisolone was initiated, and complete recovery of atrioventricular block was observed within several weeks, obviating the need for permanent pacemaker implantation.DiscussionCardiac sarcoidosis can cause complete atrioventricular block and should always be considered, especially in younger patients. Early diagnosis and initiation of corticosteroid therapy may lead to complete recovery of conduction system without the need for permanent pacemaker implantation.

| S-EPMC9753548 | biostudies-literature

Takotsubo Syndrome in a 47-Year-Old Woman With Repaired Tetralogy of Fallot.

Project description:Takotsubo syndrome or broken-heart syndrome is a rare form of nonischemic cardiomyopathy characterized by regional systolic dysfunction of the left ventricle without evidence of coronary artery disease or acute plaque rupture. This transient impairment in myocardial contractility leads to symptoms and signs that can mimic a myocardial infarction. We present a case of Takotsubo syndrome in a 47-year-old premenopausal woman with complex congenital heart disease who initially presented with acute onset of shortness of breath and chest tightness after a verbal altercation. Extremely rare cases of Takotsubo syndrome have been described in the congenital heart disease population in premenopausal women. This case emphasizes the need to highlight acquired cardiac disease in patients with adult congenital heart disease as this cohort continues to age.

| S-EPMC11775812 | biostudies-literature

Technical performance scores associate with early prognosis of tetralogy of Fallot repair.

Project description:ObjectiveThis study aimed to investigate the relationship between technical performance scores (TPS) and the early prognosis of tetralogy of Fallot repair (TOF).MethodsA retrospective study was conducted on TOF repair patients at our center from Oct 2017 to Oct 2022. Patients were classified into Class 1 (no residua), Class 2 (minor residua), or Class 3 (major residua) based on TPS derived from predischarge echocardiograms and need for reintervention. Statistical methods were used to assess the association between TPS and early prognosis.ResultsA total of 75 TOF repair patients (40% female, 60% male) were analyzed and categorized into TPS1 (24%), TPS2 (53.3%), and TPS3 (22.6%) based on pre-discharge echocardiographic findings. The median follow-up time was 7.0 months. The multivariable Cox regression analysis indicated that TPS3 scores are associated with a 12.68-fold increase in risk compared to TPS1 and TPS2 scores [95% CI = 12.68 (0.9∼179.28), P = 0.06]. The Spearman rank correlation analysis revealed a weak positive correlation between TPS classification and low cardiac output syndrome (r = 0.26, P = 0.03). However, there were no significant differences in ICU stay or duration of mechanical ventilation among the groups.ConclusionTPS3 after intracardiac TOF repair is associated with higher risk of early re-intervention, highlighting the importance of close follow-up and monitoring in this patient population. Patients who develop low cardiac output syndrome in the early postoperative period may have residual defects that require prompt identification.

| S-EPMC10864547 | biostudies-literature

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