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AbstractBackground:Anxiety before an invasive intervention is associated in children with persistent psychological disorders. We studied the effect of the transfer to the catheterisation room by an electric toy car on the anxiety of children and their parents before a cardiac catheterisation.Methods:Forty-eight children with a median age of 5.6 years [4.2–7.0] were randomised to either riding on an electric car to go to the catheterisation laboratory or being transported lying supine on a gurney. Anxiety assessments were performed by a physician blinded to group allocation on the day before the procedure (T0) and at anaesthesia induction (T1). The modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) and visual analogue scale for anxiety (VAS-A) were used in the children and the VAS-A in the parents.Results:The mYPAS-SF, VAS-A-child, and the VAS-A-parent scores were significantly higher at T1 than at T0 (p < 0.001, p < 0.001, and p = 0.005, respectively). The primary outcome (the median mYPAS-SF score at T1) was not significantly different in the two groups when males and females were combined. At T1, the VAS-A-child score, however, was significantly lower in the intervention than the control group (22 versus 55, p < 0.001). In the boys, the median mYPAS-SF score at T1 was significantly lower in the intervention group (25.0 versus 51.0, p = 0.024). No difference was observed in girls. The VAS-A parent score was lower at T1 in the intervention group (60 versus 87, p = 0.05).Conclusion:Riding to the catheterisation laboratory on an electric toy car decreased anxiety in boys and decreased parental anxiety.

Women with congenital heart disease at high risk for sudden cardiac death have been poorly studied thus far.

Heart failure is the main cause of death in patients with pulmonary arterial hypertension and congenital heart disease. We used an original approach in a 15-year-old girl with rapidly progressive right heart failure secondary to severe pulmonary arterial hypertension and partial anomalous pulmonary venous return. After surgical congenital heart defect repair on cardiopulmonary bypass, she was weaned off bypass using a central Novalung for 11 days, then started on triple specific pulmonary vasodilator therapy.

L’assistance circulatoire et la transplantation cardiaque et/ou pulmonaire pédiatrique sont les ultimes recours chez l’enfant ayant une défaillance cardiaque et/ou respiratoire terminale avec échec des traitements conventionnels et risque vital engagé à court terme. Actuellement, l’assistance circulatoire est utilisée en attente de récupération ou de transplantation mais pas en stratégie à long terme. Le Berlin Heart Excor est le système d’assistance ventriculaire pneumatique externe de longue durée actuellement disponible du nouveau-né jusqu’à l’âge adulte. Le pronostic à long terme après transplantation cardiaque et/ou pulmonaire pédiatrique est conditionné par la survenue d’une défaillance du greffon, par la maladie coronaire du greffon cardiaque, par les infections virales et la bronchiolite oblitérante du greffon pulmonaire, dont les incidences augmentent avec le temps. La pénurie de greffons et le risque de rejet aigu de greffon par défaut de compliance au traitement immunosuppresseur imposent un choix par les équipes spécialisées des candidats à la greffe en fonction de critères psychosociaux et biologiques. Les prochains développements attendus concernent surtout les assistances ventriculaires de longue durée avec des systèmes permettant d’envisager une plus grande autonomie et un retour à domicile de l’enfant.

Le cathétérisme cardiaque a grandement contribué aux progrès réalisés dans la gestion des maladies cardiaques congénitales (CHD). Initialement diagnostique, il a permis de progresser dans la compréhension de ces cardiopathies, de leur anatomie et de leur hémodynamique. Progressivement, le développement de la cardiologie interventionnelle en a fait un acteur majeur de la prise en charge de ces malformations (fermetures de canaux artériels persistants, des communications inter-auriculaires, dilatation des valves pulmonaires, revalvulation pulmonaire percutanée…). Le développement de ces techniques a été rendu possible grâce au développement concomitant des techniques d’imagerie : imagerie par rayonnement ionisant, échographie, IRM et scanner. L’imagerie doit fournir une vue précise des lésions, des structures cardiaques environnantes ainsi que des dispositifs médicaux et des outils utilisés. Nous abordons ici le domaine des images de fusion. Le principe de l’imagerie de fusion repose sur l’association en superposition de plusieurs techniques d’imagerie : fluoroscopie réalisée en direct et imagerie en coupe réalisée en différé ou imagerie échographique réalisée simultanément. Le but est d’améliorer la vue globale de l’organe, des structures avoisinantes et d’aider le cardiologue interventionnel à s’orienter dans son image de fluoroscopie.

ObjectiveThere is growing evidence that maternal mortality in pregnant women with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is lower than that in available data. In order to evaluate this hypothesis, we collected data of pregnancies in women with PAH-CHD.MethodsWomen with PAH-CHD followed in seven French referral centres were retrospectively included from 1997 to 2015. All pregnancies were recorded. We collected data on maternal, obstetrical and neonatal outcomes.Results28 pregnancies in 20 women (26±6 years old) with PAH-CHD were managed during this period. There were 18 complete pregnancies (≥20 weeks’ gestation (WG)), 8 abortions and 2 miscarriages. Six (33%, 95% CI (11.9 to 54.3)) patients experienced severe cardiac events. The concerned women had lower resting oxygen saturation (79.6±4.1% vs 89.3±3.8%, p<0.01). The most common cardiac complications during the complete pregnancies were heart failure (n=4) and severe hypoxaemia (n=5). Heart failure was overall severe, requiring inotropic treatment in three patients, mechanical circulatory support in one and led to one maternal death (mortality=5.0% 95% CI (0.1 to 24.9)). Obstetrical complications occurred in 25% of pregnancies. Small for gestational age was diagnosed in 39% (7/18) of fetuses. 12/18 (67%) pregnancies were delivered by caesarean section, of which 10 in emergency for obstetrical reason. Prematurity was frequent (78%), but no neonatal death occurred.ConclusionsOutcome of pregnancy in women with PAH-CHD is better than previously reported, with only 5% maternal mortality in our cohort. However, because of the severity of heart failure and the high rate of neonatal complications, patients should still be advised against pregnancy.

Morphologic description of ventricular septal defect (VSD) is mandatory before performing the newly developed transcatheter closure procedure. Inaccurate estimation of defect size has been reported using conventional two-dimensional (2D) transthoracic echocardiography (TTE). The aim of this study was to assess VSD morphology and size using three-dimensional (3D) TTE compared with 2D TTE and surgery.

Investigating accuracy of cardiac tomography (CT) derived post-processing3D reconstruction (CT-PPR) and 3D printing to predict percutaneous pulmonary valve implantation (PPVI) feasibility.

Right ventricle-dependent coronary circulation significantly alters the therapeutic options and prognosis in neonates with pulmonary atresia and intact ventricular septum. The contribution of cardiac computed tomography for the accurate assessment of multiple coronary arteries to right ventricle fistulas in a newborn infant with pulmonary atresia and intact ventricular septum is described.

Background A trans-catheter closure of an atrial septal defect (ASD) is efficient. Balloon sizing (BS) during the catheterization leads to an overestimation of ASD size. Three-dimensional transoesophageal echocardiography (3D-TEE) allows the ASD morphology to be assessed comprehensively. The aim of this study was to assess the relationships between the shape and the measurements of ASDs by 2D-, 3D-TEE, and BS in children. Methods and results Thirty children who underwent percutaneous closures of a single ASD were enrolled. ASD diameters were measured by 2D-transthoracic echocardiography (TTE), 2D-TEE, 3D-TEE and compared with BS. The ASD area was measured on 3D-TEE images after multi-planar reconstruction. ASD was estimated as round or oval on 3D-TEE ‘en-face’ view. 2D-TTE, 2D-TEE, and 3D-TEEmax ASD diameters were well correlated with BS (r = 0.75; 0.80, and 0.85, respectively). Mean diameters were all significantly smaller than the mean BS. The mean difference between the balloon area and 3D-TEE area was 1.6 ± 1.4 cm2 (P < 0.0001). The mean difference between BS and 3D-TEEmax diameters was higher in round ASDs than in oval ASDs (4.0 ± 3.3 vs. 1.1 ± 3.3, P = 0.02). With multivariate linear regression analysis, two formulas were built to predict BS. The first model was BS = 1.07 × 3D-TEEmax− 3.1 × ASDshape + 3. The ASD shape was 0 for round and 1 for oval ASDs. A second model was BS = 4.5 × ASDarea + 11.5. Conclusion The ASD shape is accurately estimated by 3D-TEE and influences the relationship between echocardiographic measurements and BS. The ASD shape, its maximal diameter and the area assessed by 3D-TEE may be sufficient to determine the device size without BS in children.