Search

Background: The management of mitral valve disease in young children is challenging. Mechanical mitral valves could provide long-term durability; however, the need for anticoagulation increases the risk profile of mechanical valves. We report our experience in mechanical mitral valve replacement (MVR) in children under 2 years of age and evaluate factors affecting the outcomes. The study included all patients younger than 2 years who underwent mechanical MVR between 2000 and 2023. The study outcomes were mitral valve reoperation, bleeding, valve-related thrombosis, and survival. Results: Twenty-three patients were included, with a mean age of 10.2 ± 5.9 months. The mitral valve sizes ranged from 16 to 25 mm, and 6 (26%) were placed in the supra-annular position. Complete heart block occurred in seven patients (30%), and operative mortality occurred in three patients (13%). Postoperative warfarin was used in 17 patients (74%). After discharge, bleeding occurred in five patients (22%), four were managed conservatively, and one had intracranial hemorrhage treated with craniotomy. Nine patients (39%) had valve-related thrombosis; two underwent reoperation, while seven were treated with alteplase in 26 patients. Valve-related thrombosis was more common in patients with supra-annular valves (p < 0.001) and in those who were not on warfarin (p < 0.001). A total of seven patients (30%) underwent redo MVR, and redo was more common in young patients (p = 0.029) and in patients with supra-annular valves (p < 0.001). Survival of the whole cohort was 73% at 5 years. Among the annular position group, 5-year survival was 88%, while among the supra-annular position group, survival was 50% after 3 months and 25% after 14 months (p = 0.009). Conclusions: Mechanical MVR in children younger than 2 years is associated with high complication rates, including thrombosis and bleeding. The supra-annular valve position appears to be a risk factor for thrombosis and reoperation. Anticoagulation with warfarin remains challenging. However, further studies evaluating alternative options are needed. [ABSTRACT FROM AUTHOR]

A correction notice is presented related to the article "Mechanical mitral valve endurance in children under 2 years" which was published online on September 6, 2024.

Background: Assessment of the shape and dimensions of PDA is usually done angiographically and in the majority of cases need arterial access. Our aim was to evaluate the value of routine 2 D echocardiography (ECHO) in predicting type, dimensions of PDA and to anticipate device size to be used during the intervention. Material and methods: The charts of all patients who underwent transcatheter closure of PDA between January 2015 and December 2020 were reviewed. Their pre-procedure ECHO and catheterization details at the time of device closure were analyzed. Results: Total of 139 patients were reviewed and 8 were excluded because of lack of adequate echocardiographic or angiographic images. The mean age and weight of the study population were 2.6 ± 2.5 years (range 0.2-14 years) and 11.2 ± 7.8 kg (range: 1.5-57 kg), respectively. There was no statistically significant difference in PDA narrowest diameter (p ¼ 0.99) and predicted device type (p = 0.54) between Echo and angiography. Echo slightly overestimated PDA length (p = 0.01) and aortic ampulla dimension (p = 0.047), while morphology of PDA was correctly identified in the majority of cases (82%). Conclusions: Pre-procedure echocardiography correlates well with angiographically obtained measurements and hence can be used to estimate PDA diameter, shape and guide device decide selection. Routine echocardiography can be used successfully to plan the intervention and in some cases to guide transcatheter closure. [ABSTRACT FROM AUTHOR]

The role of the MAP kinase, extracellular signal-regulated kinase 5 (ERK5) remains unknown, however it is involved in cell differentiation and survival as highlighted by the embryonic lethality of the ERK5 knockout. ERK5 can be activated by growth factors and other extracellular signals. TGF-beta, a powerful controller of epithelial cell phenotype, is known to activate the MAP kinase, ERK1/2 however its effect on ERK5 remains unknown. This study demonstrates, fort the first time, ERK5 activation by TGF-beta, observed in both transformed and primary adult human PTEC; activation required ALK-5 receptor activity. In addition this work demonstrates expression of myocyte enhancer factor-2 (MEF2C) by PTEC and that TGF-beta increased the association of MEK5 with phospho-ERK5 and MEF2C. ERK5 activation by either TGF-beta or epidermal growth factor (EGF) was also inhibited by the p38 MAP kinase inhibitor, SB-202190.