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Gottschalk I, Walter A, Menzel T, Weber EC, Wendt S, Sreeram N, Gembruch U, Berg C, Abel JS. D-Transposition of the great arteries with restrictive foramen ovale in the fetus: the dilemma of predicting the need for postnatal urgent balloon atrial septostomy. Arch Gynecol Obstet 2024; 309:1353-1367. [PMID: 36971845 PMCID: PMC10894161 DOI: 10.1007/s00404-023-06997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Restrictive foramen ovale (FO) in dextro-transposition of the great arteries (d-TGA) with intact ventricular septum may lead to severe life-threatening hypoxia within the first hours of life, making urgent balloon atrial septostomy (BAS) inevitable. Reliable prenatal prediction of restrictive FO is crucial in these cases. However, current prenatal echocardiographic markers show low predictive value, and prenatal prediction often fails with fatal consequences for a subset of newborns. In this study, we described our experience and aimed to identify reliable predictive markers for BAS. METHODS We included 45 fetuses with isolated d-TGA that were diagnosed and delivered between 2010 and 2022 in two large German tertiary referral centers. Inclusion criteria were the availability of former prenatal ultrasound reports, of stored echocardiographic videos and still images, which had to be obtained within the last 14 days prior to delivery and that were of sufficient quality for retrospective re-analysis. Cardiac parameters were retrospectively assessed and their predictive value was evaluated. RESULTS Among the 45 included fetuses with d-TGA, 22 neonates had restrictive FO postnatally and required urgent BAS within the first 24 h of life. In contrast, 23 neonates had normal FO anatomy, but 4 of them unexpectedly showed inadequate interatrial mixing despite their normal FO anatomy, rapidly developed hypoxia and also required urgent BAS ('bad mixer'). Overall, 26 (58%) neonates required urgent BAS, whereas 19 (42%) achieved good O2 saturation and did not undergo urgent BAS. In the former prenatal ultrasound reports, restrictive FO with subsequent urgent BAS was correctly predicted in 11 of 22 cases (50% sensitivity), whereas a normal FO anatomy was correctly predicted in 19 of 23 cases (83% specificity). After current re-analysis of the stored videos and images, we identified three highly significant markers for restrictive FO: a FO diameter < 7 mm (p < 0.01), a fixed (p = 0.035) and a hypermobile (p = 0.014) FO flap. The maximum systolic flow velocities in the pulmonary veins were also significantly increased in restrictive FO (p = 0.021), but no cut-off value to reliably predict restrictive FO could be identified. If the above markers are applied, all 22 cases with restrictive FO and all 23 cases with normal FO anatomy could correctly be predicted (100% positive predictive value). Correct prediction of urgent BAS also succeeded in all 22 cases with restrictive FO (100% PPV), but naturally failed in 4 of the 23 cases with correctly predicted normal FO ('bad mixer') (82.6% negative predictive value). CONCLUSION Precise assessment of FO size and FO flap motility allows a reliable prenatal prediction of both restrictive and normal FO anatomy postnatally. Prediction of likelihood of urgent BAS also succeeds reliably in all fetuses with restrictive FO, but identification of the small subset of fetuses that also requires urgent BAS despite their normal FO anatomy fails, because the ability of sufficient postnatal interatrial mixing cannot be predicted prenatally. Therefore, all fetuses with prenatally diagnosed d-TGA should always be delivered in a tertiary center with cardiac catheter stand-by, allowing BAS within the first 24 h after birth, regardless of their predicted FO anatomy.
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Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - A Walter
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - T Menzel
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - E C Weber
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - S Wendt
- Heartcenter, Department of Cardiac Surgery, Cardiothoracic Intensive Care and Thoracic Surgery, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - N Sreeram
- Department of Pediatric Cardiology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - J S Abel
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
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Sreeram N, Aruna V, Koutavarapu R, Lee DY, Rao MC, Shim J. Fabrication of InVO 4/SnWO 4 heterostructured photocatalyst for efficient photocatalytic degradation of tetracycline under visible light. Environ Res 2023; 220:115191. [PMID: 36587724 DOI: 10.1016/j.envres.2022.115191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
In the present study, novel InVO4/SnWO4 nanocomposites with different concentrations of SnWO4 were successfully prepared using a facile hydrothermal technique and investigated employing a wide range of analytical methods for efficient photocatalytic degradation of tetracycline (TC). X-ray diffraction analysis showed the presence of the orthorhombic phases of both InVO4 and SnWO4 in the composite catalyst. Dispersion of SnWO4 nanoplates over the InVO4 nanosheets enhanced the synergistic interactions, improving the separation of charge carriers and their transfer. Furthermore, the formation of heterostructure expanded the absorption range and promoted visible light harvesting. The TC degradation efficiency of InVO4/SnWO4 nanocomposite (5 mg loading of SnWO4) reached 97.13% in 80 min under visible light, with the kinetic rate constants 5.51 and 7.63 times greater than those of pure InVO4 and SnWO4, respectively. Additionally, the scavenger results proved that hydroxyl radicals and holes played a significant role in the photodegradation of TC. Furthermore, the electrochemical impedance spectroscopy (EIS) and transient photocurrent response analysis showed enhanced e-/h+ partition efficiency. Thus, the formation of heterostructure with strong synergistic interactions can effectively transfer the excited charge carriers and shorten the reunion rate. Accordingly, the InVO4/SnWO4 nanocomposites exhibited remarkable photocatalytic performance due to the increased number of charge carriers on the surface.
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Affiliation(s)
- N Sreeram
- Department of Physics, Acharya Nagarjuna University, Nagarjuna Nagar, Guntur 522 510, Andhra Pradesh, India
| | - V Aruna
- Department of Physics, Acharya Nagarjuna University, Nagarjuna Nagar, Guntur 522 510, Andhra Pradesh, India; Department of Physics, Bapatla Engineering College, Bapatla 522 102, Andhra Pradesh, India.
| | - Ravindranadh Koutavarapu
- Department of Robotics Engineering, College of Mechanical and IT Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea.
| | - Dong-Yeon Lee
- Department of Robotics Engineering, College of Mechanical and IT Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea.
| | - M C Rao
- Department of Physics, Andhra Loyola College, Vijayawada 520008, Andhra Pradesh, India.
| | - Jaesool Shim
- School of Mechanical Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea.
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Sreeram N, Aruna V, Koutavarapu R, Lee DY, Shim J. Visible-light-driven indium vanadium oxide nanosheets supported bismuth tungsten oxide nanoflakes heterostructure as an efficient photocatalyst for the tetracycline degradation. Chemosphere 2022; 299:134477. [PMID: 35367491 DOI: 10.1016/j.chemosphere.2022.134477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
The development of excellent photocatalysts is of great significance for the efficient photocatalytic degradation process, however, the low carrier separation efficiency and poor light absorption ability typically limit the performance of photocatalysts. Herein, a visible light responsive heterostructure composed with indium vanadium oxide nanosheets supported bismuth tungsten oxide nanoflakes (InVO4/Bi2WO6) was synthetized through in-situ hydrothermal method. Further, the photocatalytic activity was performed for tetracycline (TC) under visible light illumination. The InVO4/Bi2WO6 heterostructure builds a strong interface between InVO4 and Bi2WO6 to hinder reunion of photoinduced charge carriers, and provides the sensitive agents for the removal of TC. In particular, the InVO4/Bi2WO6 photocatalyst prepared by taking 5.0 mg of Bi2WO6 shows the highest degradation of TC about 97.42% in 72 min. The quenching experiments identified that hydroxyl radicals, and holes dominated in the photocatalytic process. Furthermore, the optimized nanocomposite is stable even after four cycles, which exposes the excellent photostability and reusability of the photocatalyst. In addition, a plausible degradation pathway and mechanism of TC over InVO4/Bi2WO6 nanocomposite is also projected.
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Affiliation(s)
- N Sreeram
- Department of Physics, Acharya Nagarjuna University, Nagarjuna Nagar, Guntur, 522 510, Andhra Pradesh, India
| | - V Aruna
- Department of Physics, Acharya Nagarjuna University, Nagarjuna Nagar, Guntur, 522 510, Andhra Pradesh, India; Department of Physics, Bapatla Engineering College, Bapatla, 522 102, Andhra Pradesh, India.
| | - Ravindranadh Koutavarapu
- Department of Robotics Engineering, College of Mechanical and IT Engineering, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
| | - Dong-Yeon Lee
- Department of Robotics Engineering, College of Mechanical and IT Engineering, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
| | - Jaesool Shim
- School of Mechanical Engineering, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
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Udink ten Cate F, Hannes T, Broekaert I, Hünseler C, Brockmeier K, Sreeram N. Small Intestinal Bacterial Overgrowth in Fontan Patients with Protein-Losing Enteropathy: Preliminary Results. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Udink ten Cate F, Lagies R, Herberg U, Schmidt B, Hannes T, Nazzal R, Sreeram N. Rigid Body Rotation Is a Robust and Highly Reproducible Marker of Cardiac Dysfunction in Children and Young Adults with Heart Disease. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Udink ten Cate F, Hannes T, Germund I, Khalil M, Huntgeburth M, Brockmeier K, Sreeram N. Towards a Proposal for a Universal Diagnostic Definition of Protein-Losing Enteropathy in Fontan Patients. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1556036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Udink ten Cate F, Holler F, Hannes T, Germund I, Emmel M, Hoyer-Kuhn H, Khalil M, Sreeram N. High Prevalence of Low Serum 25-Hydroxyvitamin D Levels and Hyperparathyroidism in Fontan. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1556035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Emmel M, Khalil M, Udink ten Cate F, Brockmeier K, Sreeram N. Comparison of Cryo- vs. Radio-Frequency-Current-Ablation in Patients with AV-Nodal-Reentry-Tachycardia. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kroener A, Trieschmann U, Emmel M, Brockmeier K, Sreeram N, Bennink G. The temporary stent as a bridge to congenital cardiac repair. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kroener A, Trieschmann U, Sreeram N, Brockmeier K, Bennink G. Is the re-coarctation rate in neonatal arch enlargement related to the material used? Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Junghaenel S, Sreeram N, Demant A, Vierzig A, Kribs A, Roth B. Pneumopericardium as a rare complication of continuous positive airway pressure in spontaneously breathing neonates. Klin Padiatr 2011; 224:34-5. [PMID: 22161563 DOI: 10.1055/s-0031-1298025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- S Junghaenel
- Department of Neonatology and Paediatric Intensive Care, University Hospital of Cologne, Germany.
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Emmel M, Sreeram N, Khalil M, Brockmeier K. [Cryoenergy for the ablation of arrhythmogenic paraseptal substrates in children and adolescents with heart rhythm disorders]. Dtsch Med Wochenschr 2011; 136:2187-91. [PMID: 22009170 DOI: 10.1055/s-0031-1292030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Cryoablation is safe for the ablation of substrates in proximity to the AV node, because the initial lesion is reversible. We report our results of cryoablation in a transregional center for ablation in children and adolescents. PATIENTS AND METHODS Data on 39 children and adolescents (4 - 18 years of age) who had been treated with cryo energy were analyzed retrospectively. The diagnosis was AV nodal reentry tachycardia (AVNRT; n = 30), para-Hisian accessory pathway (AP; n = 6) and congenital junctional ectopic tachycardia (JET; n = 4). In addition to non-inducibility, the targeted endpoint for AP-ablation was a missing or decremental concentric retrograde conduction, for ablation of AVNRT the endpoint was no slow pathway, no AH jumps and no echo-beats. The median follow-up was 3 years (270 - 1919 days). RESULTS The targeted endpoint was reached in 35/39 patients (90 %), in four patients (10 %) RF energy had to be applied. A recurrence occurred in 7/35 (20 %) successfully treated patients. Two patients had a pre-excitation again after AP ablation, but no symptoms. Thus, 28/35 patients (80 %) remained asymptomatic after cryoablation, and 26/35 (74 %) are definitively cured, regarding all follow-up data. The subgroup of AVNRT patients does not differ from the entire group. There was no AV block in the cryoablation group. CONCLUSIONS Cryoablation is very safe and effective for the definitive treatment of arrhythmias in children and adolescents. The price for the high safety is a reduced efficacy and a higher recurrence rate.
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Affiliation(s)
- M Emmel
- Kinderkardiologie, Herzzentrum, Uniklinik Köln.
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Ben Mime L, Sreeram N, Rosser B, Kretschmar O, Prêtre R, Bennink G. Hybrid intraoperative pulmonary artery stent placement for congenital heart disease. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sreeram N, Trieschmann U, Khalil M, Emmel M. Risk stratification in young patients with channelopathies. Indian Pacing Electrophysiol J 2010; 10:257-73. [PMID: 20552061 PMCID: PMC2880872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Identifying the young patient at risk of malignant arrhythmias and sudden cardiac death remains a challenge. It is increasingly recognised that sudden death, syncope and aborted cardiac arrest at a young age in patients with a structurally normal heart may be the result of various ion channel disorders - the channelopathies. The approach to risk stratification involves a combination of the clinical presentation, taken in conjunction with the family history, genetic testing, invasive electrophysiological studies or other provocative tests where appropriate and feasible. A logical approach to risk stratification in some of the commoner channelopathies seen in paediatric practice is presented.
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Affiliation(s)
- N Sreeram
- Department of Paediatric Cardiology. University Hospital of Cologne, Germany
| | - U Trieschmann
- Paediatric Cardiac Anaesthesia and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - M Khalil
- Department of Paediatric Cardiology. University Hospital of Cologne, Germany
| | - M Emmel
- Department of Paediatric Cardiology. University Hospital of Cologne, Germany
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Ben Mime L, Elhamine F, Iorga B, Emmel M, Sreeram N, Brockmeier K, Stehle R, Pfitzer G, Bennink G, Wahlers T. Myofibrillar protein expression and contractility in congenital heart diseases associated with right ventricular hypertrophy. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sarkis V, Sreeram N, Trieschmann U, Emmel M, Brockmeier K, Bennink G. Arrhythmia incidence after the intracardiac lateral tunnel Fontan completion versus the extracardiac conduit. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Valeske K, Akintuerk H, Schranz D, Sreeram N, Brockmeier K, Bennink G. Surgical challenges and tricks after hybrid approaches in congenital cardiac surgery. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ben Mime L, Emmel M, Sreeram N, Brockmeier K, Bennink G, Wahlers T. Results of aortic arch reconstruction in neonates and infants. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sreeram N, Emmel M, Trieschmann U, de Haan E. Paediatric electrophysiologic studies: how and what with? Indian Pacing Electrophysiol J 2008; 8:S36-54. [PMID: 18478065 PMCID: PMC2363726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Catheter ablation of arrhythmias in children has become standard practice virtually worldwide. Successful and safe ablation has been made possible by a combination of factors. These include increased operator experience, a better understanding of the natural history of a wide variety of arrhythmias, advances in technology such as smaller catheters, the routine use of various three-dimensional mapping systems, and the development of alternative energy sources. It is also not uncommon to perform multiple catheter intervention procedures (ablation +/- intravascular stent implantation +/- device closure of residual shunts +/- elective pacemaker or device implantation) during a single session. It is important to bear in mind that arrhythmia recurrence is commoner in children in general, and that this is particularly the case with postoperative (scar-related arrhythmias). Despite acute success, long-term follow-up is mandated for this subgroup of patients.
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Sreeram N, Trieschmann U, de Haan E. Device therapy in children: current indications. Indian Pacing Electrophysiol J 2008; 8:S92-S104. [PMID: 18478061 PMCID: PMC2363722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The implantable cardioverter defibrillator has achieved increasing acceptance in paediatric cardiologic practice. Concurrent with technological advances which have made the devices more versatile, easier to implant and to program, there has been a fundamental breakthrough in our understanding of genetic and inherited arrhythmia syndromes in the last decade. This in turn has led to investigations into risk stratification, with the aim of choosing high risk candidates for timely device therapy. The second group of young patients with a risk of sudden death are those who have had a previous repair of a structural heart defect. Given that sudden arrhythmic death is the commonest cause of mortality in this population, it behoves the practising paediatric cardiologist to be aware of the current recommendations for device implantation in this population. In this manuscript, we summarise the current state of our understanding of the risk factors for sudden death, and identify possible candidates for ICD implantation.
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Affiliation(s)
- N Sreeram
- Department of paediatric cardiology, University Hospital of Cologne, Germany.
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Sreeram N, Emmel M, Trieschmann U, Brockmeier K, Bennink G. Pulmonary vein stents in infants and children: is there lasting benefit? Clin Res Cardiol 2008; 97:463-6. [PMID: 18347768 DOI: 10.1007/s00392-008-0653-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 02/08/2008] [Indexed: 11/24/2022]
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Eifinger F, Sreeram N, Mehler K, Huenseler C, Kribs A, Roth B. Aerosolized Iloprost in the Treatment of Pulmonary Hypertension in Extremely Preterm Infants: A Pilot Study. Klin Padiatr 2008; 220:66-9. [PMID: 17710738 DOI: 10.1055/s-2007-984370] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In premature infants with preterm prolonged rupture of membranes, death after birth is often due to persistent pulmonary hyper-tension. PATIENTS Aerosolized iloprost was used to treat pulmonary hypertension due to prolonged preterm rupture of fetal membranes (7-56 days) in four extremely low-birthweight neonates (23-25 weeks' gestation, weight 448-645 g) under spontaneous breathing supported by nasal continuous positive airway pressure. METHOD Inhalation dose was 2 microg/kg b.w. and between 44 and 65 inhalations were performed in each patient starting within the first hour of life over a total of several days. Single inhalations lasted 5 min and were not repeated until 60 min had elapsed. RESULTS After the first inhalation, the PaO2/FiO2 mean ratio increased from 65 (range 35-114) to 194 (148-250) mmHg and oxygenation requirements decreased within the next 7 days. Echocardiography similarly showed reduction in pulmonary resistance. We observed no severe side effects on blood pressure or prolonged bleeding time during inhalation. CONCLUSIONS Iloprost inhalation might therefore be an additional treatment for improving oxygenation in cases of persistent pulmonary hypertension in extremely low-birthweight infants under spontaneous breathing. Further randomized clinical studies are required to establish the role of iloprost in this setting.
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Affiliation(s)
- F Eifinger
- Klinik und Poliklinik für Kinderheilkunde, Abteilung für Neonatologie, Klinikum der Universität zu Köln.
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Ben Mime L, Sreeram N, Emmel M, Trieschmann U, Brockmeier K, Wahlers T, Bennink G. Close interdisciplinary surveillance and earlier age at PCPC prevent interstage mortality after the Norwood procedure. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Trieschmann U, Kruessell M, Cate UTF, Sreeram N. Central venous catheters in children and neonates (Part 2) - Access via the internal jugular vein. Images Paediatr Cardiol 2008; 10:1-7. [PMID: 22368541 PMCID: PMC3232585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Central venous access via the internal jugular vein (IJV) is safe, relatively easy and very commonly used in infants and children undergoing cardiac surgery for congenital heart disease. Because of the wide range of anatomical variations an ultrasound-guided technique is advantageous in many cases, in particular in patients who have had previous punctures or those in whom difficulties are anticipated for various reasons. The right internal jugular vein is the preferred vein for central venous access as it offers straight access to the superior vena cava. The rate of complications - insertion-related as well as long term - are lower compared to the femoral and the subclavian access.
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Affiliation(s)
- U Trieschmann
- Department of Intensive and Emergency Care, University Hospital of Cologne, Germany
| | - M Kruessell
- Department of Intensive and Emergency Care, University Hospital of Cologne, Germany
| | - Udink ten F Cate
- Department of Paediatric Cardiology, University Hospital of Cologne, Germany
| | - N Sreeram
- Department of Paediatric Cardiology, University Hospital of Cologne, Germany,Contact information: N. Sreeram, Paediatric cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany. Phone: +49 221 478 32517
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Sreeram N, Pretel E, Pillekamp F, Bennink G. Scimitar syndrome in infancy. Images Paediatr Cardiol 2008; 10:1-4. [PMID: 22368549 PMCID: PMC3232593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- N Sreeram
- University Hospital of Cologne, Germany.,Contact information: N. Sreeram, Department of Paediatric Cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany. Phone: +49 221 478 32517 Fax: +49 221 478 32515
| | - E Pretel
- University Hospital of Cologne, Germany
| | | | - G Bennink
- University Hospital of Cologne, Germany
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Pillekamp F, Hannes T, Koch D, Brockmeier K, Sreeram N. Transcatheter closure of symptomatic aortopulmonary window in an infant. Images Paediatr Cardiol 2008; 10:11-7. [PMID: 22368546 PMCID: PMC3232589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
An aortopulmonary window is a rare congenital cardiac defect. In the majority of symptomatic neonates and infants, primary surgical repair is the treatment of choice. In selected infants, catheter closure of the defect with a device may be feasible. We report on the successful closure of an AP window in a 12 month old infant, using a 6mm Amplatzer septal occluder. The procedure and follow-up were uneventful.
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Affiliation(s)
- F Pillekamp
- Pediatric Cardiology, University of Cologne, 50931 Cologne, Germany
| | - T Hannes
- Pediatric Cardiology, University of Cologne, 50931 Cologne, Germany
| | - D Koch
- Pediatric Cardiologist, 51607 Cologne, Germany
| | - K Brockmeier
- Pediatric Cardiology, University of Cologne, 50931 Cologne, Germany
| | - N Sreeram
- Pediatric Cardiology, University of Cologne, 50931 Cologne, Germany,Contact information: N. Sreeram, Pediatric Cardiology, University Hospital of Cologne, Kerpenerstraße 62, 50937 Cologne, Germany Tel.: ++49-(0)-221-47886301 Fax: ++49-(0)-221-47886302
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Sreeram N, Gass M, Apitz C, Ziemer G, Hofbeck M, Emmel M, Brockmeier K, Hitchcock F, Bennink G. The diagnostic yield from implantable loop recorders in children and young adults. Clin Res Cardiol 2007; 97:327-33. [PMID: 18158580 DOI: 10.1007/s00392-007-0635-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 11/26/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syncope and palpitations occur frequently in young patients. Noninvasive diagnostic testing may be inconclusive. AIM To assess the diagnostic yield of implantable loop recorders in young patients. PATIENTS AND METHODS Thirty-three young patients underwent implantation of a loop recorder for long-term monitoring of cardiac rhythm, to establish symptom-rhythm correlation. They belonged to one of three subgroups: those with structurally normal heart, normal electrocardiogram at rest, and negative family history (n = 16); patients with structural heart disease and previous surgical repair (n = 11), and patients with proven or suspected primary electrical disease (n = 6). A combination of automatic and patient-activated recordings was used to monitor cardiac rhythm during symptomatic episodes. RESULTS There were no procedural complications. Diagnostic electrograms could be obtained in all patients. A high degree of symptom-rhythm correlation was established. In 8/33 patients, no recurrence of symptoms was observed either until end of battery life of the device (n = 4) or until last follow-up (n = 2). Specific cardiac therapy was required, based on rhythms recorded by the device in 15 patients (until last follow-up). This consisted of catheter ablation of a tachyarrhythmia (n = 7), pacemaker implantation or upgrade (n = 5) or ICD implantation (n = 5). In the remaining patients (n = 10), recurrence of symptoms was associated with a normal electrocardiogram, and in two of these patients a non-cardiac diagnosis was made. CONCLUSIONS In selected patients, the implantable loop recorder provides valuable diagnostic information to guide further therapy.
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Affiliation(s)
- N Sreeram
- Department of paediatric cardiology, University Hospitals of Tuebingen and Cologne, Germany.
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Sreeram N, Emmel M, Ben-Mime L, Brockmeier K, Bennink G. Transcatheter recanalization of acutely occluded modified systemic to pulmonary artery shunts in infancy. Clin Res Cardiol 2007; 97:181-6. [DOI: 10.1007/s00392-007-0614-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 10/17/2007] [Indexed: 11/29/2022]
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Dodge-Khatami A, Sreeram N, de Mol BAJM, Bennink GBWE. Systemic plasma vascular endothelial growth factor levels as a marker for increased angiogenesis during the single ventricle surgical pathway. Interact Cardiovasc Thorac Surg 2007; 2:458-61. [PMID: 17670095 DOI: 10.1016/s1569-9293(03)00113-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cyanosis and the cavopulmonary anastomosis (CPA) are associated with pulmonary arterio-venous malformations (PAVMs) in single ventricle physiology. Vascular endothelial growth factor (VEGF) may be a marker of abnormal angiogenesis in this setting. Plasma VEGF levels were measured in 14 patients undergoing the surgical pathway leading to total cavopulmonary connection (TCPC). Venous blood samples were taken before and then months after CPA (n=6), and immediately before TCPC and 1 month thereafter (n=9). Corresponding arterial saturations were correlated with VEGF levels at each time frame. In six patients, pre-CPA plasma VEGF levels rose from a mean of 24.4-112.4 pg/ml (p<0.03) just prior to completion of TCPC. In nine patients, VEGF levels diminished from 115.7 to 48.9 pg/ml (p<0.05) after TCPC. VEGF levels were disproportionately elevated to arterial saturations most notably after CPA (r2=0.002), suggesting an additional angiogenic stimulus besides cyanosis. Plasma VEGF levels fluctuate during the single ventricle surgical pathway, with maximal levels after CPA, and regression after completion of TCPC. High VEGF levels are disproportionate to hypoxia after CPA, potentially incriminating the absence of hepatic flow to the lungs as an abnormal angiogenic stimulus. Measuring VEGF in venous blood may serve as a biochemical marker of angiogenesis after CPA.
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Affiliation(s)
- A Dodge-Khatami
- Division of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Mehler K, Sreeram N, Vierzig A, Boehm WE, Kribs A, Bennink G, Brockmeier K, Roth B. Verschluss eines Vorhofseptumdefekts als therapeutische Option bei Extreme Low Birthweight Frühgeborenen mit Bronchopulmonaler Dysplasie. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ben Mime L, Sreeram N, Christov G, Lazarov S, Bennink G. Long-term results of corrected aortoventricular tunnel. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ben Mime L, Sreeram N, Wahlers T, Brockmeier K, Bennink G. Aortic valve reconstruction in the pediatric age group: Surgical management and long-term results. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Emmel M, Brockmeier K, Sreeram N. Intracardiac rhabdomyomas producing symptoms in infancy: the role of radiofrequency catheter ablation. Neth Heart J 2006; 14:215-218. [PMID: 25696636 PMCID: PMC2557260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Cardiac rhabdomyomas, although benign, may produce symptoms related to arrhythmia or mechanical obstruction. Surgical excision is the therapy of choice for symptomatic rhabdomyomas in infancy. PATIENTS AND METHODS Two infants with intracardiac rhabdomyomas producing symptoms underwent radiofrequency catheter ablation of the tumour. In patient 1 the diagnosis of multiple rhabdomyomas associated with recurrent supraventricular tachyarrhythmias and foetal hydrops was made in utero. After birth, several antiarrhythmic agents were administered, without successful suppression of the tachyarrhythmia. At seven months of age, the infant had one large residual tumour on the left atrial aspect of the anterior mitral valve leaflet with associated pre-excitation and re-entrant supraventricular tachyarrhythmia suggestive of a left-sided pathway. Catheter ablation of the accessory pathway was performed via a retrograde femoral arterial approach, targeting the earliest site of ventricular activation. Patient 2 presented as a neonate with multiple rhabdomyomas, one of which, measuring 15 mm × 15 mm, was producing severe mitral valve inflow obstruction resulting in symptoms of heart failure due to a large left-to-right shunt at atrial level and persistent pulmonary hypertension. Via the femoral vein, a 5F ablation catheter was advanced across the atrial septum, and the tumour directly ablated. RESULTS Echocardiography performed 24 hours later demonstrated alteration in tumour morphology, with the development of a large central echolucent area, followed by progressive tumour shrinkage in both infants. Patient 1 was discharged at 24 hours, and patient 2 at seven days post-ablation, without symptoms. Follow-up at four weeks confirmed further tumour shrinkage. CONCLUSION Transcatheter tumour ablation may be beneficial in selected infants and children.
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Emmel M, Sreeram N, Pillekamp F, Boehm W, Brockmeier K. Transhepatic approach for catheter interventions in infants and children with congenital heart disease. Clin Res Cardiol 2006; 95:329-33. [PMID: 16598389 DOI: 10.1007/s00392-006-0382-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 02/21/2006] [Indexed: 11/27/2022]
Abstract
UNLABELLED We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months-9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore-Tex tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the transseptal needle to the atrial baffle, allowing puncture of the Gore-Tex membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression. RESULTS Transhepatic access could be established in all six patients (using a mirror image approach in children with left atrial isomerism) and the interventional procedures could be performed as planned. In one patient with implantation of a permanent pacemaker, a subcutaneous hematoma occurred, requiring blood transfusion. CONCLUSION In selected pediatric patients, transhepatic access for catheter intervention can easily be achieved.
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Affiliation(s)
- M Emmel
- Klinik und Poliklinik für Kinderkardiologie, Kerpener Str. 62, 50937, Köln, Germany
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Emmel M, Sreeram N, Schickendantz S, Brockmeier K. Experience with an ambulatory 12-lead Holter recording system for evaluation of pediatric dysrhythmias. J Electrocardiol 2006; 39:188-93. [PMID: 16580418 DOI: 10.1016/j.jelectrocard.2005.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 07/10/2005] [Accepted: 09/13/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND The 12-lead electrocardiogram demonstrates noninvasively many details concerning cardiac arrhythmias and their mechanism, but only for a limited period. A Holter system can record heart rhythm for a longer period, but shows 2 or 3 leads only. An ambulatory 12-lead Holter recording system combines the advantages of both. We report on our experience with the 12-lead Holter system in children. STUDY POPULATION Twenty-four patients (age range, 3-22 years) underwent one or more 12-lead Holter recordings. Twelve patients had suspected or documented tachyarrhythmia, and 12 patients had suspected or proven long QT syndrome (LQTS). RESULTS In the tachyarrhythmia group, 4 patients had supraventricular tachycardia and 7 ventricular tachycardia (VT). In the supraventricular tachycardia, group 1 patient had intra-atrial reentrant tachycardia with a single reentrant circuit, whereas another had multiple P-wave morphologies, suggesting multiple circuits. Two others had evidence for concealed atrioventricular accessory pathways. One patient had isolated supraventricular ectopy. In the VT group, 4 patients had uniform VT, and 3 patients had polymorphic VT. One patient with LQTS had macroscopic T-wave alternans. Two others showed intermittent extreme QT prolongation and T-wave notching during 12-lead Holter recording. THERAPEUTIC IMPLICATIONS Patients with uniform VT underwent catheter ablation, guided in 2 instances by intracardiac pace mapping and comparison with the 12-lead Holter QRS morphology. All reentrant supraventricular arrhythmias with single P-wave morphology were ablated. One patient with intra-atrial reentrant tachycardia and multiple circuits received an antitachycardia pacemaker. In the LQTS group, the neonate with T-wave alternans received mexiletine in addition to beta-blocker therapy. CONCLUSION In individual patients, the 12-lead Holter system provides important additional information about the arrhythmia and helps to plan appropriate therapy. Intermittent T-wave morphology changes can be diagnosed using 12-lead Holter recordings in patients with LQTS, allowing dynamic T-wave changes to be monitored. In specific cases, this may help identify patients with LQTS and also influence pharmacological therapy.
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Affiliation(s)
- M Emmel
- Department of Pediatric Cardiology, University of Cologne, 50937 Cologne, Germany
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Ben Mime L, Raji R, Hekmat K, Sreeram N, Brockmeier K, Bennink G. Biological implants as therapeutic option for mid and distal arch stenosis in children. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Boehm W, Emmel M, Sreeram N. Balloon atrial septostomy: history and technique. Images Paediatr Cardiol 2006; 8:8-14. [PMID: 22368660 PMCID: PMC3232558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- W Boehm
- University Hospital of Cologne, Germany
| | - M Emmel
- University Hospital of Cologne, Germany
| | - N Sreeram
- University Hospital of Cologne, Germany.,Contact information: N. Sreeram, Department of Paediatric Cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany Phone: +49 221 47886301 Fax: +49 221 47886302
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Brockmeier K, Emmel M, Pillekamp F, Sreeram N. [Electrical heart diseases--therapy during childhood and adolescence]. Herzschrittmacherther Elektrophysiol 2005; 16:239-49. [PMID: 16362730 DOI: 10.1007/s00399-005-0491-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 11/08/2005] [Indexed: 10/25/2022]
Abstract
With increasing experience, radiofrequency catheter ablation of tachyarrhythmia substrates has become first choice therapy for children >4 years of age with recurrent tachyarrhythmia. In younger patients, the risks associated with the procedure (typically procedure-related AV block or possible coronary artery damage) have to be weighed against the natural history of the tachyarrhythmia substrate, and the degree of control achieved with pharmacologic agents. Ablation for postoperative arrhythmias is more complicated, and associated with lower success rates and a higher rate of recurrence (of the same or a new tachyarrhythmia) despite acute procedural success. In this setting, catheter ablation has to be considered in conjunction with further surgery or the use of a defibrillator as a backup device to prevent arrhythmia-related sudden death. Also in inherited arrhythmias as in long QT syndrome and Brugada syndrome, implantable defibrillators have to be considered as a possible therapeutic option for patients with a higher risk for sudden cardiac death, irrespective of age.
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Affiliation(s)
- K Brockmeier
- Klinik und Poliklinik für Kinderkardiologie, Universitätsklinikum Köln, Kerpener Strasse 62, 50937 Köln.
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Emmel M, Brockmeier K, Sreeram N. Slow pathway ablation in children with documented reentrant supraventricular tachycardia not inducible during invasive electrophysiologic study. ACTA ACUST UNITED AC 2005; 94:808-12. [PMID: 16382381 DOI: 10.1007/s00392-005-0305-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 07/22/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Radiofrequency catheter ablation (RFA) has become the procedure of choice for permanent therapy of atrioventricular nodal reentrant tachycardia (AVNRT). This report presents our experience with atrio-ventricular node (AVN) modification in patients with documented narrow complex reentrant SVT, but no evidence for an accessory pathway, and no inducible tachyarrhythmia during invasive electrophysiology (EP) study. METHODS The study population consists of nine children, age range 6-13 years (median 9) with previously documented SVT who had no tachyarrhythmia inducible during EP study (at baseline and following isoprenaline infusion). Eight of the 9 EP studies were performed under general anesthesia, and one under conscious sedation. An accessory pathway was excluded in all patients by appropriate atrial and ventricular extrastimulus pacing techniques. Eight of the nine patients had dual AV nodal physiology, and one had single AV nodal echo beats. The slow AV nodal pathway was empirically ablated, by applying RF lesions in the right inferoseptal AV groove, achieving catheter tip temperature of 50 degrees C. The appearance of an accelerated junctional rhythm during RF application was deemed to denote a successful application site. AV conduction during RF application was confirmed by incremental atrial pacing. The catheter position, and its relation to the compact AV node was constantly monitored using the LocaLisa navigation system. The end-point was absence of dual AVN physiology, and/or AV nodal echo beats. RESULTS Successful slow pathway ablation was achieved in all patients. One patient appeared to have two separate slow pathways with different locations and two AH-jumps, which were both successfully ablated. None of the patients had evidence of temporary or permanent AV block at follow-up (median duration 9 months, range 4 to 36 months); none has had recurrence of symptoms or documented tachyarrhythmia. CONCLUSIONS In children with structurally normal hearts, a previously documented SVT, absence of an accessory pathway and noninducibility of SVT during EP study, empirical slow pathway ablation appears to be justified.
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Affiliation(s)
- M Emmel
- Department Paediatric Cardiology, University Hospital of Cologne, Kerpener Str. 62, 50924 Köln, Germany
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Emmel M, Sreeram N. Radiofrequency catheter septal ablation for hypertrophic obstructive cardiomyopathy in children. Neth Heart J 2005; 13:448-451. [PMID: 25696442 PMCID: PMC2497374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The definitive therapeutic options for symptomatic obstructive cardiomyopathy in childhood are restricted. At present, extensive surgical myectomy is the only procedure that is of proven benefit. PATIENTS AND METHODS Three patients, aged 5, 11 and 17 years, respectively, with progressive hypertrophic obstructive cardiomyopathy and increasing symptoms were considered for radiofrequency catheter septal ablation. The peak Doppler gradient recorded on several occasions ranged between 50 to 90mmHg. Via a femoral arterial approach, the His bundle was initially plotted and marked using the LocaLisa navigation system. Subsequently, using a cooled tip catheter a series of lesions were placed in the hypertrophied septum, taking care to stay away from the His bundle. A total of 17, 50 and 45 lesions were applied in the three patients. In one case, the procedure was complicated by two episodes of ventricular fibrillation requiring DC cardioversion but without any neurological sequelae. RESULTS The preablation peak-to-peak gradient between left ventricle and aorta was 50 mmHg, 60 mmHg and 60 mmHg, respectively, and remained unchanged immediately after the procedure. All patients were discharged from hospital 48 hours later. Serial measurement of serum troponin T and CK-MB isoenzyme confirmed significant myocardial necrosis. Follow-up echocardiography both at seven days and at six weeks postablation confirmed a beneficial haemodynamic result, with reduction of left ventricular outflow obstruction and relief of symptoms. CONCLUSION In young children, in whom alcohol-induced septal ablation is not an option, radiofrequency catheter ablation offers an alternative to surgery, with the benefits of repeatability and a lower risk of procedure-related permanent AV block.
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Ben Mime L, Raji R, Sreeram N, Brockmeier K, Bennink G. Efficacy of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bennink G, Hekmat K, Hitchcock F, Sreeram N, Brockmeier K. RV-PA shunt in the norwood procedure: Advantages and disadvantages between the newer approach and the modified blalock taussig shunt. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Emmel M, Sreeram N, deGiovanni JV, Brockmeier K. Radiofrequency catheter septal ablation for hypertrophic obstructive cardiomyopathy in childhood. ACTA ACUST UNITED AC 2005; 94:699-703. [PMID: 16200487 DOI: 10.1007/s00392-005-0282-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 05/24/2005] [Indexed: 10/25/2022]
Abstract
Two patients, a 5 year old boy with progressive hypertrophic obstructive cardiomyopathy and increasing symptoms despite appropriate pharmacologic therapy and an 11 year old girl with symptoms of tiredness and peak instantaneous LVOT gradient of 80 and 90 mmHg respectively were considered for radiofrequency catheter septal ablation, to relieve the left ventricular outflow tract obstruction. Via a femoral arterial approach, the His bundle was initially plotted and marked using the LocaLisa navigation system. Subsequently, using a cooled tip catheter a series of lesions was placed in the hypertrophied septum, commencing distally in the ventricle and proceeding towards the aortic valve, taking care to stay away from the His bundle. The procedure was deemed to be completed when the entire extent of the hypertrophied septum had been treated. In the boy the procedure was complicated by two episodes of ventricular fibrillation, requiring DC cardioversion, but without any neurologic sequelae. The peak to peak gradient between left ventricle and aorta was 50 mmHg and 60 mmHg respectively pre-ablation, and remained unchanged immediately after. Both patients were discharged from the hospital 48 hours later. Serial measurement of serum Troponin T and CK-MB isoenzyme confirmed significant myocardial necrosis. Follow-up echocardiography at 7 days and at 6 weeks post-ablation respectively confirmed a beneficial hemodynamic result, with reduction of left ventricular outflow obstruction and relief of symptoms. In young children, in whom alcohol induced septal ablation is not an option, radiofrequency catheter ablation offers an alternative to surgery, with the benefits of repeatability and a lower risk of procedure-related permanent AV block.
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Affiliation(s)
- M Emmel
- University Hospital of Cologne
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Emmel M, Brockmeier K, Sreeram N. Ambulatory 12-lead Holter recordings in children with arrhythmias: initial clinical application? J Electrocardiol 2005. [DOI: 10.1016/j.jelectrocard.2005.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Emmel M, Sreeram N, Brockmeier K. Catheter ablation of junctional ectopic tachycardia in children, with preservation of atrioventricular conduction. ACTA ACUST UNITED AC 2005; 94:280-6. [PMID: 15803265 DOI: 10.1007/s00392-005-0215-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 12/08/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Idiopathic junctional ectopic tachycardia is a rare arrhythmia in children. Several studies have demonstrated that drug therapy is often ineffective and sometimes the only achieved effect is rate control. Early presentation and frequent recurrence are associated with adverse outcome. PATIENTS AND METHODS Three consecutive children, aged 9, 7 and 12 years respectively, underwent radiofrequency catheter ablation for junctional ectopic tachycardia, after having failed antiarrhythmic drug therapy. The entire His bundle was plotted out and marked, using the Localisa navigation system. The arrhythmia was readily and repeatedly inducible using intravenous isoprenaline infusion and the site of earliest retrograde conduction during tachycardia could be assessed. Ablations were performed in sinus rhythm, empirically targeting the site of earliest retrograde conduction during tachycardia. RESULTS This approach was successful in abolishing tachyarrhythmia in the first two patients, in whom the successful ablation site was located superoparaseptally. In the third patient, junctional ectopic tachycardia was inducible, despite abolishing retrograde atrial activation, in a septal location on the tricuspid valve annulus. Further ablations in the superoparaseptal region, closer to the His bundle, were successful in rendering tachyarrhythmia noninducible. Over a median follow-up of 10 months, none of the patients has had recurrence of arrhythmia, despite discontinuing all antiarrhythmic medications. CONCLUSIONS Radio frequency catheter ablation of junctional ectopic tachycardia is feasible with preservation of atrioventricular conduction.
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Affiliation(s)
- M Emmel
- Department of Paediatric Cardiology, University Hospital of Cologne, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany
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Fischer U, Sreeram N, Brockmeier K, Hekmat K, Bennink G. The choice of pericardium type used for reconstruction is crucial for morbidity following the Norwood I procedure. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-862144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Emmel M, Sreeram N, Brockmeier K. Stenting of the aortic arch as an emergency palliation of aortic dissection after cardiac surgery in an infant. Images Paediatr Cardiol 2005; 7:8-11. [PMID: 22368646 PMCID: PMC3232567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - N Sreeram
- ,Contact information: Dr. N. Sreeram, Department Pediatric Cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany Phone: 0049 221 478 86301 Fax: 0049 221 478 86302
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Sreeram N, DeGiovanni J. Stent implantation for coarctation facilitated by the anterograde trans-septal approach. Images Paediatr Cardiol 2005; 7:12-7. [PMID: 22368647 PMCID: PMC3232568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N Sreeram
- ,Contact information: Dr. N. Sreeram, Department Pediatric Cardiology, University Hospital of Cologne, Kerpenerstrasse 62 50937 Cologne, Germany Phone: 0049 221 478 86301 Fax: 0049 221 478 86302
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Sreeram N, de Giovanni JV, Boehm W. Palliative balloon dilation of native coarctation of the aorta in a preterm infant. Images Paediatr Cardiol 2005; 7:1-4. [PMID: 22368655 PMCID: PMC3232556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The role of balloon dilation for native coarctation in neonates is controversial, due to the relatively high recurrence rate. Balloon dilation may however provide adequate palliation in preterm infants, by relieving symptoms and allowing somatic growth until definitive surgical repair can be performed. We report successful balloon angioplasty, on 2 occasions, in a preterm neonate with coarctation of the aorta and associated left ventricular cardiomyopathy.
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Affiliation(s)
- N Sreeram
- University Hospital of Cologne, Germany,Contact information: N. Sreeram, Pediatric cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany. Phone: +49 221 478 86301. Fax: +49 221 478 86302.
| | | | - W Boehm
- University Hospital of Cologne, Germany
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Schmidt B, Emmel M, Sreeram N. Pulmonary atresia with ventricular septal defect and an atypical duct. Neth Heart J 2004; 12:547. [PMID: 25696288 PMCID: PMC2497212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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