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Timing of aortic valve intervention in pediatric chronic aortic insufficiency

Tretter, Justin T; Langsner, Alan
The timing of aortic valve intervention (AVI) in pediatric patients with chronic aortic insufficiency (AI) is largely based on adult experience, which is fraught with uncertainty and controversy. Current adult guidelines in the absence of symptoms use left ventricular (LV) systolic function and LV dimensions to guide AVI timing, with few studies translating these recommendations to pediatric patients. This article reviews the current guidelines for AVI timing in chronic AI along with the emerging data for pediatric patients.
PMID: 25179463
ISSN: 0172-0643
CID: 1360232

EARLY CORRECTION OF COMPLETE ENDOCARDIAL CUSHION DEFECTS UTILIZING THE 2-PATCH TECHNIQUE - A 10-YEAR RETROSPECTIVE EXPERIENCE

GLICKSTEIN, JS; GROSSI, EA; PARISH, M; RUTKOWSKI, M; LANGSNER, A; DANILOWICZ, D; FRIEDMAN, DM; DOYLE, EF; BAUMANN, FG; GALLOWAY, AC; COLVIN, SB
The goal of this study was to review the short-term and long- term results of aggressive corrective intervention in a consecutive series of patients with atrioventricular canal defects, especially with respect to minimizing progressive valvular insufficiency or pulmonary hypertension. A total of 46 consecutive patients with atrioventricular canal defects had operative repair between 1981 and 1991, using a two-patch technique in all but 4 patients. The median age was 8.5 months, with 29 patients (63%) < 1 year old. Left-to-right shunting was severe in all cases (mean Qp/Qs = 2.9:1), with a mean systolic pulmonary artery pressure of 63.6 mm Hg and a mean pulmonary vascular resistance of 4.03 Wood units. Preoperatively, 35 patients (76.1%) had moderate to severe congestive heart failure. Hospital mortality was 6.5% (3 patients), and the systolic pulmonary artery pressure dropped significantly in all cases, with a postrepair mean of 25.7 mm Hg. The 5 year actuarial survival rate was 70.3%. Late echocardiographic studies graded mitral insufficiency as 0-2+ in 41 patients (95.2%) and 3-4+ in 2 patients (4.6%); 2 patients required reoperation, and 41 (95.2%) were New York heart Association functional class I at follow-up. These data demonstrate excellent lat survival and functional results when complete atrioventricular canal correction is performed in infancy, despite significant preoperative pulmonary hypertension, valvular insufficiency, or symptoms. Prompt operative repair should be done for symptomatic patients and those with valvular incompetence; electrive repair is recommended before 1 year of age for most others
ISI:A1994PN07000006
ISSN: 1073-7774
CID: 33450

Doppler ultrasound and the silent ductus arteriosus [Letter]

Glickstein, J; Friedman, D; Langsner, A; Rutkowski, M
PMID: 8435249
ISSN: 0007-0769
CID: 1395172

Results of urgent or emergency repair for symptomatic infants under one year of age with single or multiple ventricular septal defect

Danilowicz D; Presti S; Colvin S; Galloway A; Langsner A; Doyle EF
PMID: 1536125
ISSN: 0002-9149
CID: 13683

Successful modified Fontan procedure in an adolescent after left pneumonectomy [Case Report]

Danilowicz D; Langsner A; Colvin SB
We performed a Waterston's anastomosis on a patient with complicated tricuspid atresia when she was two months of age. At age 14 years she required left pneumonectomy for massive, idiopathic hemoptysis. Four months after the pneumonectomy we substituted a modified Fontan anastomosis for the Waterston anastomosis. Restudy when she was 17 years of age showed continued satisfactory function
PMID: 1876520
ISSN: 0172-0643
CID: 13981

Simplified method for determining left to right shunts using pulsed doppler echo cardiography

Langsner, AM; Griepp, EB; Kiely, B; Rutkowski, MM
ORIGINAL:0009572
ISSN: 0031-3998
CID: 1494082