Beta blockade with Bisoprolol seems to have no beneficial effect on asymptomatic or mildly symptomatic patients with right ventricular dysfunction secondary to repaired tetralogy of Fallot with residual pulmonary regurgitation and/or stenosis.

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ongenital heart disease (CHD), with its worldwide incidence of 0.8%, is the most common inborn heart defect. Advances in pediatric cardiology and cardiac surgery over the past 2 decades resulted in the success that more than 85% of these patients survive to adulthood. 1 As shown recently in a 5-year follow-up survey, the spectrum of young adults with operated CHD (ACHD) consists predominantly of a young population with substantial morbidity but relatively low mortality. 2 As a result of the progress discussed above, patients and clinicians are increasingly confronted with congestive heart failure (CHF) as a Circulation Journal Vol.72, May 2008 late complication of CHD. 3 Medical management of heart failure in these patients represents a challenge because of their complex hemodynamics and the lack of evidencebased guidelines derived from large randomized controlled trials. 4 In adult patients with left ventricular heart failure, a reduction of morbidity and mortality was achieved under neurohormonal blockade. 5,6 An important question remaining to be solved is, whether or not a similar beneficial effect of -blockade could be observed in ACHD patients, who predominantly have right ventricular heart failure. Thus, we carried out, to the best of our knowledge, the first clinical trial focusing on the use of -blockade during heart failure therapy in ACHD patients. 4,7 It has been proposed that cytokines are involved in various cardiovascular diseases. [8][9][10][11] Previous results obtained by us and other researchers showed that soluble tumor necrosis factor receptors (sTNF-R) and other cytokines are reduced in adult CHF patients treated with -blockers. [12][13][14][15][16][17][18] From these data it was concluded that cytokines might be involved in, or accompany, the beneficial effects of -blocker therapy. In pre-operated infants with heart failure resulting from left-toright shunts, we showed enhanced sTNF-R concentrations, which were reduced after propranolol treatment. 19 Qing et al showed that in right ventricular tissues of infants with CHD interleukin (IL)-1 , TNF-, IL-6 and IL-10 were detectable. 20 There are also studies reporting that IL-6 and TNF-are enhanced in CHD. [21][22][23] However, no studies have shown the influence of -block- Background Right heart failure is a major problem of young adults with congenital heart disease (ACHD) that has been corrected by cardiac surgery. In left ventricular dysfunction (LVD), -blocker therapy improved cytokine concentrations and clinical status. Thus, the effect of bisoprolol on clinical status and plasma cytokine concentrations in ACHD patients with right heart failure after surgical correction for Tetralogy of Fallot was investigated. Methods and ResultsA prospective, randomized, double-blind, placebo controlled study for a duration of 6 months was carried out. A total of 34 patients (30.9±9.5 years; New York Heart Association I or II) with brain natriuretic peptide plasma concentrations >100 pg/ml and peak oxygen uptake <25 ml·kg -1 ·min -1 were recruited. ...

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ObjectiveHypertrophic obstructive cardiomyopathy (HOCM) is treated by surgical myectomy or transcoronary ablation of septal hypertrophy (TASH). The aim of this study was to visualize the feasibility, success and short-term results of TASH on the basis of cardiac MRI (CMR) in comparison with cardiac catheterization and echocardiography.MethodsIn this in vivo study, nine patients with HOCM were treated with TASH. Patients were evaluated by transthoracic echocardiography, invasive cardiac angiography and CMR. Follow-up examinations were carried out after 1, 3 and 12 months. MR imaging was performed on a 1.5-T scanner. All images were processed using the semiautomatic Argus software and were evaluated by an attending thoracic radiologist and cardiologist.ResultsThe echocardiographic pressure gradient (at rest) was 69.3 ± 15.3 mmHg before and 22.1 ± 5.7 mmHg after TASH (P < 0.01, n = 9). The flux acceleration over the aortic valve examined (Vmax) was 5.1 ± 0.6 m/s before and 3.4 ± 0.3 m/s after the TASH procedure (P < 0.05). Also, there was a decrease of septum thickness from 22.0 ± 1.2 to 20.2 ± 1.0 mm (P < 0.05) after 6 ± 3 weeks. The invasively assessed pressure gradient at rest was reduced from 63.7 ± 15.2 to 21.2 ± 11.1 mmHg (P < 0.01) and the post-extrasystolic gradient was reduced from 138.9 ± 12.7 to 45.6 ± 16.5 mmHg (P < 0.01). All differences as well as the quantity of injected ethanol were plotted against the size or amount of scar tissue as assessed in the MRI. There was a statistically significant correlation between the post-extrasystolic gradient decrease and the amount of scar tissue (P = 0.03, r2 = 0.5). In addition, the correlation between the quantity of ethanol and scar tissue area was highly significant (P < 0.01, r2 = 0.6), whereas the values for the gradient deviation (P = 0.10, r2 = 0.34), ΔVmax (P = 0.12, r2 = 0.31), as well as the gradient at rest (P = 0.27, r2 = 0.17) were not significant.ConclusionTASH was consistently effective in reducing the gradient in all patients with HOCM. In contrast to the variables investigated by echocardiography, the invasively measured post-extrasystolic gradient correlated much better with the amount of scar tissue as assessed by CMR. We conclude that the optimal modality to visualize the TASH effect seems to be a combination of CMR and the invasive identification of the post-extrasystolic gradient.