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Cilj rada bio je utvrditi razlike u zadovoljstvu i uključenosti u školske aktivnosti roditelja učenika osnovne škole tipičnog razvoja i s teškoćama u razvoju. Uzorak u radu čine 896 roditelja učenika drugih i šestih razreda trinaest osnovnih škola sjeverozapadne Hrvatske, od kojih je 57 roditelja učenika s teškoćama u razvoju koji se školuju u redovitome razrednom odjelu u skladu s primjerenim programima odgoja i obrazovanja ovisno o vrsti i stupnju teškoće. Usporedbom ekvivalentnih parova roditelja iz obje skupine utvrđeno je da ne postoji statistička razlika u procjeni zadovoljstva te da je ono za obje skupine iznadprosječno, a za roditelje učenika s teškoćama u razvoju čak i više. Opća uključenost roditelja u školi je gotovo ista za promatrane skupine roditelja, dok roditelji učenika s teškoćama statistički značajno više pomažu svojoj djeci kod kuće, češće potiču čitanje, učenje matematike i prirodoslovnih predmeta te su općenito više uključeni u učenju kod kuće. Rezultati analize pokazuju da zadovoljstvo školom roditelja učenika s teškoćama u razvoju pridonosi općoj roditeljskoj uključenosti kod kuće i učenju matematike sa svojom djecom. Provedeno istraživanje ukazuje na potrebu daljnje analize zadovoljstva roditelja i utjecaja na njihovu uključenost u aktivnosti u domu i školi.

Copyright of Croatian Journal of Education / Hrvatski Časopis za Odgoj i Obrazovanje is the property of Uciteljski Fakultet u Zagrebu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Croatian Journal of Education / Hrvatski Časopis za Odgoj i Obrazovanje is the property of Uciteljski Fakultet u Zagrebu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The paper investigates the sources of stress at work for kindergarten teachers. Its aim is to explore various sources of stress in kindergartens in the City of Zagreb, as well as stress intensity regarding years of work experience and education group in which they have been working. The study involved 257 kindergarten teachers from Zagreb, aged 22 to 65. For research purposes, the Scale of Assessment of Stress at Work for the Kindergarten Teachers was used. The scale describes situations the kindergarten teachers encounter on a daily basis and asks them to estimate to what extent particular situation is stressful. The research has shown that the greatest intensity of stress in kindergarten teachers is caused by parent behaviour. Additionally, prolonged work experience reduces stress in certain situations. The research results contribute to a better understanding of the work of kindergarten teachers and specific sources of stress in their work environment. They should help in further development of recognition, prevention and solution measures. [ABSTRACT FROM AUTHOR]

Copyright of Croatian Journal of Education / Hrvatski Časopis za Odgoj i Obrazovanje is the property of Uciteljski Fakultet u Zagrebu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Croatian Journal of Education / Hrvatski Časopis za Odgoj i Obrazovanje is the property of Uciteljski Fakultet u Zagrebu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Croatian Journal of Education / Hrvatski Časopis za Odgoj i Obrazovanje is the property of Uciteljski Fakultet u Zagrebu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Croatian Journal of Education / Hrvatski Časopis za Odgoj i Obrazovanje is the property of Uciteljski Fakultet u Zagrebu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background There are physiological reasons for the effects of positioning on hemodynamic variables and cardiac dimensions related to altered intra-abdominal and intra-thoracic pressures. This problem is especially evident in pregnant women due to the additional aorto-caval compression by the enlarged uterus. The purpose of this study was to investigate the effect of postural changes on cardiac dimensions and function during mid and late pregnancy using cardiovascular magnetic resonance (CMR). Methods Healthy non-pregnant women, pregnant women at 20th week of gestation and at 32nd week of gestation without history of cardiac disease were recruited to the study and underwent CMR in supine and left lateral positions. Cardiac hemodynamic parameters and dimensions were measured and compared between both positions. Results Five non-pregnant women, 6 healthy pregnant women at mid pregnancy and 8 healthy pregnant women at late pregnancy were enrolled in the study. In the group of non-pregnant women left ventricular (LV) cardiac output (CO) significantly decreased by 9% (p = 0.043) and right ventricular (RV) end-diastolic volume (EDV) significantly increased by 5% (p = 0.043) from the supine to the left lateral position. During mid pregnancy LV ejection fraction (EF), stroke volume (SV), left atrium lateral diameter and left atrial supero-inferior diameter increased significantly from the supine position to the left lateral position: 8%, 27%, 5% and 11%, respectively (p < 0.05). RV EDV, SV and right atrium supero-inferior diameter significantly increased from the supine to the left lateral position: 25%, 31% and 13% (p < 0.05), respectively. During late pregnancy a significant increment of LV EF, EDV, SV and CO was observed in the left lateral position: 11%, 21%, 35% and 24% (p < 0.05), respectively. Left atrial diameters were significantly larger in the left lateral position compared to the supine position (p < 0.05). RV CO was significantly increased in the left lateral position compared to the supine position (p < 0.05). Conclusions During pregnancy positional changes affect significantly cardiac hemodynamic parameters and dimensions. Pregnant women who need serial studies by CMR should be imaged in a consistent position. From as early as 20 weeks the left lateral position should be preferred on the supine position because it positively affects venous return, SV and CO.

The aim of this work is to point out the importance of the professionalization of the principal’s role in education institutions, with an accent on preschool institutions. The sample included principals (N=57) of preschool institutions in Central Croatia. The goal was to test the mediation relationship through SEM and examine the direct influence of interpersonal relationships within the preschool institution on the development of its work quality; furthermore, to test the indirect influence of these relationships by introducing the mediation variable of professional competence. The structured modelling in the AMOS was applied for testing the direct and indirect influence. The contribution of interpersonal relationships on the work quality is high and statistically significant (β=0,920), which confirms the direct influence. For testing the mediation effects, a bootstrapping method was designed that confirmed the indirect influence of interpersonal relationships on the work quality with the statistically significant serial mediator of professional competence (p= 0,016), thereby confirming partial mediation. This research determined that positive interpersonal relations, mediated by the principal’s professional competence, have a positive effect on the work quality of a preschool institution. In order for preschool institutions to reach the desired quality, it is necessary for them to be managed by professionally empowered and expert principals who promote prime cooperative relationships as the starting point in developing a high-quality institution. The results of this research contribute to a clearer perception and understanding of the professionalization of the principal’s role through key areas of his/her work and activity, and the possibility of their practical implementation into education institutions.

This is the first major research targeting a specific group of teachers, shaped with the idea of gathering empirical indicators of piano teachers’ job satisfaction. More than half of music schools’ piano teachers participated (N=253) from all the counties of the Republic of Croatia. The results have shown that piano teachers are moderately satisfied, that there are no differences when it comes to gender, nor with the type of school where they teach. Teachers with more years of experience are more satisfied with their work, similar to teachers who have advanced in their professional area. The results can contribute to improving teaching practice and effectiveness, with the further outcome being pupils achieving higher educational attainments.

The aim of research was to examine how students in higher secondary education estimate the importance of visual arts subjects for the acquisition of general knowledge and the importance of visual arts for their future profession. The participants (N=605) were students in the third year of higher secondary education. Although the participants in the sample did not attach importance to visual arts for their future professions, they assessed that during their education, activities that necessitated working with their hands helped them in developing their memorization skills and the ability to learn other subjects.

The purpose of the research was to explore the development of social skills among elementary school children and identify similarities and differences based on socio-demographic characteristics. The research was conducted in 2017. This study used a sample of 1639 fifth and eighth-grade students from 17 primary schools in the area of the Central Bosnia Canton. The obtained findings provided significant results. The high level of self-assessment of social competence was determined. The results also showed that there is a statistically significant difference between the respondents in the assessment of social competence with regard to the gender and grade of the students. The correlation between social competence and students’ school performance was determined. These findings will have their practical application in teaching process, and help teachers and students in the development of social competence through teaching process.

As part of the scientific project titled “The Curriculum of Social Competences and Relations in School”, the aim of this paper is to examine the quality of interpersonal relations between teachers and pupils. On a sample of 432 teachers from 20 towns, 35 primary schools in the Republic of Croatia, and 432 pupils, it was confirmed that there is a difference in the appraisal of the quality of their interpersonal relations. Although the overall quality of interpersonal relations between pupils and teachers is at a moderately satisfactory level, pupils still appraise the quality of interpersonal relations lower than their teachers. In view of latent dimensionality, a factor questionnaire structure was used (14 variables; ordinal type) and two main components (subscales) determined: didactic support and interaction, and rough verbal and physical treatment. As part of the differential draft of our research, no gender differences were established (between female and male teachers) in the appraisal of the quality of interpersonal relations with pupils (on two subscales). The correlation analysis confirmed a low negative statistically significant correlation between the years of service and the subscale rough verbal and physical treatment (Rho=-0.101). In view of the subscale of rough verbal and physical treatment between pupils and teachers, such results on a negative correlation imply that older teachers, as opposed to their younger colleagues, use more corporal punishment in schools, treat pupils rudely, use nasty and impolite words, and call pupils insulting names.

The objective of this study is to examine the prevalence of violence against teachers by students. The study included 175 teachers, five primary and five secondary schools. The age of respondents (teachers) ranges from 20 to 65, with average age being 44,33 years. The used instrument has assessed violence against teachers and has consisted of data about the characteristics of respondents, frequency and type of violence experienced from students.The results suggest that violence against teachers in primary and secondary schools in Zagreb taken in to sample is very much present. Since 74,3% teachers has experienced violence from their students during the year that kind of behavior is more of a rule than an exception. Students in primary and secondary schools show violent behavior against their teachers at an equal level. Male teachers, as opposed to female teachers, are more frequently victims of violent behavior (posting inappropriate content online) from their students. Also, there is a statistically significant correlation (negative) between age (years of service in school) and frequency of experienced violence from students.

BackgroundWomen are overrepresented among individuals with post-acute sequelae of SARS-CoV-2 infection (PASC). Biological (sex) as well as sociocultural (gender) differences between women and men might account for this imbalance, yet their impact on PASC is unknown.AimWe assessed the impact of sex and gender on PASC in a Swiss population.MethodOur multicentre prospective cohort study included 2,856 (46% women, mean age 44.2 ± 16.8 years) outpatients and hospitalised patients with PCR-confirmed SARS-CoV-2 infection.ResultsAmong those who remained outpatients during their first infection, women reported persisting symptoms more often than men (40.5% vs 25.5% of men; p < 0.001). This sex difference was absent in hospitalised patients. In a crude analysis, both female biological sex (RR = 1.59; 95% CI: 1.41-1.79; p < 0.001) and a score summarising gendered sociocultural variables (RR = 1.05; 95% CI: 1.03-1.07; p < 0.001) were significantly associated with PASC. Following multivariable adjustment, biological female sex (RR = 0.96; 95% CI: 0.74-1.25; p = 0.763) was outperformed by feminine gender-related factors such as a higher stress level (RR = 1.04; 95% CI: 1.01-1.06; p = 0.003), lower education (RR = 1.16; 95% CI: 1.03-1.30; p = 0.011), being female and living alone (RR = 1.91; 95% CI: 1.29-2.83; p = 0.001) or being male and earning the highest income in the household (RR = 0.76; 95% CI: 0.60-0.97; p = 0.030).ConclusionSpecific sociocultural parameters that differ in prevalence between women and men, or imply a unique risk for women, are predictors of PASC and may explain, at least in part, the higher incidence of PASC in women. Once patients are hospitalised during acute infection, sex differences in PASC are no longer evident.

Status epilepticus (SE), treatment-refractory status epilepticus (RSE), and super-treatment-refractory status epilepticus (SRSE) are associated with increased morbidity, mortality, and high socioeconomic burden and pose significant treatment challenges for intensivists and neurologists. To optimize and streamline emergency treatment, current practice guidelines recommend the use of continuously delivered intravenous anesthetic drugs such as midazolam, propofol, or barbiturates as the third-line therapy after first-line and second-line treatments have failed. Although the rationale for these third-line drugs seems intuitive at first glance, there is a clear paucity of evidence-based data on risks, benefits, and even on the choice of a third-line agent. Recent studies into safety and efficacy reveal disturbing results, such as a poor outcome and higher mortality associated with the use of intravenous anesthetic drugs, especially in patients with nonconvulsive SE without coma and in patients with out-of-hospital SE onset. Clinicians should deliberately weigh the advantages and disadvantages of intravenous anesthetic drug therapy in patients with different types of SE usually linked to a favorable outcome (i.e., simple partial, complex partial, or absence seizures). The lack of data to support evidence-based medicine prompts a careful balance of individual risks and benefits of intravenous anesthetic drug therapy in patients with SE, treatment-refractory SE, and super-RSE.

Objectives: Early identification of patients who are at risk of prolonged status epilepticus (SE) and patients with high chances of full recovery despite prolonged SE may urge clinicians to intensify treatment rather than to withdraw care. We aimed to develop prediction models based on readily available clinical parameters to predict prolonged SE at seizure onset and to identify patients with high chances for full recovery., Methods: From 2005 to 2016, all adult SE patients treated at the University Hospital Basel, a Swiss medical care center, were included. Multivariable Poisson regression was performed to identify predictors of prolonged SE (defined as SE for >12, >24, and >48 hours) and return to baseline from prolonged SE. The area under the receiver-operating characteristic curves (AUROC) for prediction models was calculated., Results: Of 467 patients, the median age was 66.7 years and mortality was 12%. Relative risk (RR) for death was 1.06 (P < 0.0001) with every SE day. In multivariable analysis, nonconvulsive SE with coma, SE severity score ≥3, and acute brain lesions at SE onset independently predicted prolonged SE with an AUROC of 0.68 for >12, 0.67 for >24, and 0.72 for >48 hours of SE. Absence of nonconvulsive SE with coma and a decreasing Charlson comorbidity index were independent predictors for return to baseline in prolonged SE with an AUROC of 0.82 and 0.76 following cross-validation. Both associations remained significant despite adjustments for determinants of adverse outcome, such as anesthetics and vasopressors (nonconvulsive SE with coma RR = 0.24, 95% confidence interval [CI] 0.07-0.86; comorbidity index RR = 0.87, 95% CI 0.76-0.99)., Significance: Although our data indicate that identification of prolonged SE at seizure onset is unreliable, timely recognition of patients with high chances of good outcome despite prolonged SE is promising on the basis of comorbidities, type of SE, and level of consciousness. Further external validation of this prediction model is needed., (Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.)

In Western countries heart disease is the leading cause of maternal death during pregnancy. The effect of pregnancy on the heart is difficult to study in patients with preexisting heart disease. Since experimental studies are scarce, we investigated the effect of pressure overload, produced by transverse aortic constriction (TAC) in mice, on the ability to conceive, pregnancy outcome, and maternal cardiac structure and function. Four weeks of TAC produced left ventricular (LV) hypertrophy and dysfunction with marked interstitial fibrosis, decreased capillary density, and induced pathological cardiac gene expression. Pregnancy increased relative LV and right ventricular weight without affecting the deterioration of LV function following TAC. Surprisingly, the TAC-induced increase in relative heart and lung weight was mitigated by pregnancy, which was accompanied by a trend towards normalization of capillary density and natriuretic peptide type A expression. Additionally, the combination of pregnancy and TAC increased the cardiac phosphorylation of c-Jun, and STAT1, but reduced phosphoinositide 3-kinase phosphorylation. Finally, TAC did not significantly affect conception rate, pregnancy duration, uterus size, litter size, and pup weight. In conclusion, we found that, rather than exacerbating the changes associated with cardiac pressure overload, pregnancy actually attenuated pathological LV remodeling and mitigated pulmonary congestion, and pathological gene expression produced by TAC, suggesting a positive effect of pregnancy on the pressure-overloaded heart., (Copyright © 2016 the American Physiological Society.)

Background: Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD)., Objectives: The objective of this study was to investigate clinical outcomes>30 years after surgical VSD closure., Methods: Patients who underwent surgical VSD closure during childhood between 1968 and 1980 were reexamined every 10 years. In 2012, we invited eligible patients to undergo another examination, which included electrocardiography, Holter monitoring, echocardiography, bicycle ergometry, measurement of N-terminal pro-B-type natriuretic peptide, and subjective health assessment., Results: Cumulative survival was 86% at 40 years. Causes of mortality were arrhythmia, heart failure, endocarditis, during valvular surgery, pulmonary hypertension, noncardiac causes, and unknown causes. Cumulative event-free survival after surgery was 72% at 40 years. Symptomatic arrhythmias occurred in 13% of patients and surgical or catheter-based reinterventions in 12%. Prevalence of impaired right ventricular systolic function increased from 1% in 2001 to 17% in 2012 (p=0.001). Left ventricular systolic function was impaired but stable in 21% of patients. Aortic regurgitation occurred more often in the last 20 years (p=0.039), and mean exercise capacity decreased (p=0.003). N-terminal pro-B-type natriuretic peptide (median: 11.6 pmol/l [interquartile range: 7.0 to 19.8 pmol/l]) was elevated (>14 pmol/l) in 38% of patients. A concomitant cardiac lesion, for example, patent ductus arteriosus, and aortic cross-clamp time were determinants of late events (hazard ratio: 2.84 [95% confidence interval: 1.23 to 6.53] and hazard ratio: 1.47 per 10 min [95% confidence interval: 1.22 to 1.99], respectively). Patients rated their subjective health status significantly better than a reference population., Conclusions: Survival up to 40 years after successful surgical VSD closure is slightly lower than in the general Dutch population. Morbidity is not negligible, especially in patients with a concomitant cardiac lesion., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: It is unclear whether sports participation in adults with repaired congenital heart disease is safe and has benefits., Methods: Congenital heart disease (ConHD) patients who underwent corrective surgery for Atrial Septal Defect, Ventricular Septal Defect, Pulmonary Stenosis, Tetralogy of Fallot or Transposition of the Great Arteries in our center between 1968 and 1980 were included, and participated in our longitudinal follow-up study with serial evaluations in 2001 and 2011. At both time points patients filled in questionnaires on sports participation, subjective physical functioning and quality of life. Exercise testing, echocardiogram and 24-hour continuous ambulatory ECG-monitoring were performed in both 2001 and 2011. All clinical events (re-intervention, arrhythmia, heart failure) were prospectively recorded., Results: No relationship was found between practicing sports and the occurrence of sudden death, PVCs or SVTs. Patients with moderate/complex forms of ConHD practiced fewer hours of sports compared with the general Dutch normative population. Patients with both simple and moderate/complex ConHD who practiced sports showed a higher exercise capacity. More favorable subjective physical functioning was found for moderate/complex patients who practiced sports., Conclusions: Adults with repaired ConHD are less often involved in sports than the Dutch general population. The patients that were engaged in sports show a higher exercise capacity than those who did not. Sports participation in patients with ConHD was not associated with an increased incidence of adverse cardiac events., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Aims: To describe long-term survival, clinical outcome and ventricular systolic function in a longitudinally followed cohort of patients after Mustard repair for transposition of the great arteries (TGA). There is serious concern about the long-term outcome after Mustard repair., Methods and Results: This longitudinal single-centre study consisted of 91 consecutive patients, who underwent Mustard repair before 1980, at age <15 years, and were evaluated in-hospital every 10 years. Survival status was obtained of 86 patients. Median follow-up was 35 (IQR 34-38) years. Cumulative survival was 84% after 10 years, 80% after 20 years, 77% after 30 years, and 68% after 39 years. Cumulative survival free of events (i.e. heart transplantation, arrhythmias, reintervention, and heart failure) was 19% after 39 years. Reinterventions were mainly required for baffle-related problems. Supraventricular and ventricular arrhythmias occurred in 28 and 6% of the patients, respectively. Pacemaker and/or ICD implantation was performed in 39%. Fifty survivors participated in the current in-hospital investigation including electrocardiography, 2D-echocardiography, cardiopulmonary-exercise testing, NT-proBNP measurement, Holter monitoring, and cardiac magnetic resonance. Right ventricular systolic function was impaired in all but one patient at last follow-up, and 14% developed heart failure in the last decade. NT-proBNP levels [median 31.6 (IQR 22.3-53.2) pmol/L] were elevated in 92% of the patients. Early postoperative arrhythmias were a predictor for late arrhythmias [HR 3.8 (95% CI 1.5-9.5)], and development of heart failure [HR 8.1 (95% CI 2.2-30.7)]. Also older age at operation was a predictor for heart failure [HR 1.26 (95% CI 1.0-1.6)]., Conclusion: Long-term survival after Mustard repair is clearly diminished and morbidity is substantial. Early postoperative arrhythmias are a predictor for heart failure and late arrhythmias., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

Background: To investigate the overall sexual functioning and disease specific sexual problems in congenital heart disease (ConHD) patients, for both genders and different cardiac diagnostic groups, and compare these with Dutch normative data. Also disease specific sexual problems were investigated., Methods: From a longitudinal cohort of patients, operated for ConHD between 1968 and 1980, 254 patients (median age: 40, 53.4% male) were included in this study: atrial septal defect (n = 72), ventricular septal defect (n = 71), pulmonary stenosis (n = 30), tetralogy of Fallot (n = 53) and transposition of the great arteries (n = 28). Patients completed internationally validated, generic questionnaires and also disease specific instruments on sexual functioning., Results: Patients showed a delay in starting sexual activities compared with peers. Females with ConHD scored significantly worse compared with normative data on all scales of sexual functioning, indicating a broad range of sexual problems and 15% showed clinical levels of sexual dysfunction. Of the males, 14% suffered from erectile dysfunction. Males with ConHD scored worse on erectile function, orgasmic function and satisfaction regarding their sexual life compared with normative data. No differences were found between the different cardiac diagnoses. The majority of patients reported disease specific worries and fears about the use of contraceptives, heredity, pregnancy and delivery. Patients indicated to have been suboptimally informed about sexuality in early adolescence., Conclusions: This study shows that sexual functioning is impaired in adults with ConHD. Providing information to patients about sexuality, pregnancy, delivery and heredity should be improved, and given at young age., (© 2013.)

Background: This study aims to investigate indications and complications of permanent cardiac pacing in adults with congenital heart disease (CHD)., Methods and Results: Two-hundred and seventy-four CHD patients were identified who underwent permanent pacemaker implantation between 1972 and 2009. The indication for pacing was acquired sinus node or AV node conduction disease (63%), sinus node or AV node conduction disease after cardiac surgery (28%), and drug/arrhythmia-related indications (9%). Patients with complex CHD received a pacemaker at younger age (23 versus 31 years, p<0.0001) and more often received an epicardial pacing system (51% versus 23%, p<0.0001) compared to those with simple or moderate CHD. Twenty-nine patients (10.6%) had a periprocedural complication during the primary pacemaker implantation (general population: 5.2%). The most common acute complications were lead dysfunction (4.0%), bleeding (2.6%), pocket infection (1.5%) and pneumothorax (1.5%). During a median follow-up of 12 years, pacemaker-related complications requiring intervention occurred in 95 patients (34.6%). The most common late pacemaker-related complications included lead failure (24.8%), pacemaker dysfunction/early battery depletion (5.1%), pacemaker migration (4.7%) and erosion (4.7%). Pacemaker implantation at younger age (<18 years) was an independent predictor of late pacemaker-related complication (adjusted hazard ratio 1.68, 95% confidence interval 1.07 to 2.63, p=0.023)., Conclusions: The risk of periprocedural complications seems higher in the CHD population compared to the general population and more than one-third of CHD patients encountered a pacemaker-related complication during long-term follow-up. This risk increases for those who receive a pacemaker at younger age., (Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.)

Objectives: The aim of this study was to determine the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in adults with congenital heart disease (CHD) and investigate its relationship with ventricular function and exercise capacity., Background: NT-proBNP may detect early deterioration in cardiac function., Methods: In this cross-sectional study, extensive echocardiography, exercise testing, and NT-proBNP measurements were performed on the same day in consecutive adult patients with CHD., Results: In total, 475 patients were included in this study (mean age of 34 ± 12 years, 57% male, 90% New York Heart Association class I). The median NT-proBNP level was 15.1 pmol/l (interquartile range [IQR]: 7.1 to 31.3 pmol/l), and the NT-proBNP level was >14 pmol/l in 53% of patients. The highest NT-proBNP levels were observed in patients with Fontan circulation (36.1 pmol/l [IQR: 14.4 to 103.8 pmol/l]) and a systemic right ventricle (RV) (31.1 pmol/l [IQR: 21.8 to 56.0 pmol/l]), and the lowest values were seen in patients with aortic coarctation (7.3 pmol/l [IQR: 2.8 to 19.5 pmol/l]). NT-proBNP levels correlated with age (r = 0.39, p < 0.001) and were higher in women (median of 21.7 vs. 10.4 pmol/l; p < 0.001). In patients with aortic stenosis or aortic coarctation, NT-proBNP levels correlated with diastolic function parameters of E/E' ratio (r = 0.40, p < 0.001) and left atrial dimension (r = 0.36, p < 0.001). In patients with a systemic RV, NT-proBNP levels correlated with RV annulus diameter (r = 0.31, p = 0.024). In patients with tetralogy of Fallot, the strongest correlations were observed with left atrial dimension (r = 0.46, p < 0.001) and left ventricular ejection fraction (r = 0.37, p < 0.001). NT-proBNP levels were associated with exercise capacity (n = 198) (maximum workload: β = -0.08, p = 0.021) and peak oxygen uptake (β = -0.012, p = 0.011) in a multivariable regression model adjusted for age and sex., Conclusions: NT-proBNP levels in adults with CHD clearly differ by diagnosis and are related to echocardiographic parameters and exercise capacity. Disease-specific correlations contribute to the understanding of the main hemodynamic problems per diagnosis. Follow-up data are needed to elucidate the additional prognostic value., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the very long-term outcome after surgical closure of an atrial septal defect (ASD)., Design: Longitudinal cohort study of 135 consecutive patients who underwent surgical ASD repair at age <15 years between 1968 and 1980. The study protocol included ECG, echocardiography, exercise testing, N-terminal prohormone of brain natriuretic hormone, Holter monitoring and cardiac MRI., Main Outcome Measures: Survival, major events (cardiac reinterventions, stroke, symptomatic arrhythmia or heart failure) and ventricular function., Results: After 35 years (range 30-41), survival status was obtained in 131 of 135 patients (97%): five died (4%), including two sudden deaths in the last decade. Fourteen patients (16%) had symptomatic supraventricular tachyarrhythmias and six (6%) had a pacemaker implanted which was predicted by early postoperative arrhythmias. Two reoperations were performed. One ischaemic stroke occurred. Left ventricular (LV) and right ventricular (RV) ejection fractions (EF) were 58 ± 7% and 51 ± 6%, respectively. RVEF was diminished in 17 patients (31%) and in 11 (20%) the RV was dilated. Exercise capacity and quality of life were comparable to the normal population. No clear differences were found between ASD-II or sinus venosus type ASD., Conclusions: Very long-term outcome after surgical ASD closure in childhood shows good survival and low morbidity. Early surgical closure prevents pulmonary hypertension and reduces the occurrence of supraventricular arrhythmias. Early postoperative arrhythmias are predictive for the need for pacemaker implantation during early follow-up, but the rate of late pacemaker implantation remains low. Although RVEF was unexpectedly found to be decreased in one-third of patients, the functional status remains excellent.