Transcatheter closure of VSD in both Pm VSD and DCSA can be achieved by using either of the device. The Amplatzer® VSD device had the advantage of closure of larger defects with immediate less residual shunt but appeared to have a significant number of 3° AVB, which required pacemaker implantation. The Nit Occlud® Lê VSD Coil had the advantage of closure of both types of defects, in particular DCSA VSD with only small residual shunt.

The high incidence of cardiotoxicity associated with higher administered anthracycline dose, young age, bolus infusion, and EF decline warrants evaluation in a larger cohort.

T ricuspid regurgitation (TR) is associated with morbidity and mortality in children with hypoplastic left heart syndrome (HLHS). [1][2][3] Cross-sectional studies using 2-dimensional echocardiography (2DE), 3-dimensional echocardiography (3DE), and intraoperative surgical inspection of the tricuspid valve (TV) after stage 1 palliation have suggested multiple causative factors for TR in HLHS. These include annular and ventricular dilation, leaflet prolapse and tethering, leaflet dysplasia, papillary muscle (PM) displacement, and right ventricular (RV) dyssynchrony. 4-6 Clinical Perspective on p 772Real-time 3DE has emerged as a clinically useful tool for anatomic and functional assessment of atrioventricular valves before and after surgical repair. 7,8 Several studies have shown the added value of 3DE over 2DE in the evaluation of mitral valve disease. 6,[9][10][11][12][13][14][15][16] In pediatric subjects, real-time transthoracic 3DE generates optimal images of the TV. [8][9][10] Quantitative 3DE permits evaluation of the spatial relationships between the TV annulus, leaflets, and the supporting apparatus by measurement of tethering and prolapse volumes, leaflet and annular areas, and PM angles. 4,11 We have reported the use of quantitative 3DE to assess mechanisms of TR and demonstrated that this technique is able to detect areas of TV tethering and prolapse in HLHS. 4 Previous studies have evaluated mechanisms for TR in HLHS at or beyond the time of the second-stage palliation; however, there is a paucity of literature on TV function before Background-Our purpose was to test the following hypotheses: (1) patients with hypoplastic left heart syndrome who develop significant tricuspid regurgitation (TR) or require tricuspid valve (TV) surgery in the medium term have detectable TV abnormalities by 3-dimensional echocardiography (3DE) prestage 1 palliation and (2) TR is associated with reduced survival and increased TV intervention. Methods and Results-Infants were prospectively studied with 3DE and 2DE prestage 1 and followed up for the end points of TR, TV surgery, transplantation, or death. From prestage 1 3DE, spatial coordinates of TV annulus and leaflets were extracted; annulus size, leaflet area, prolapse volume, tethering volume, bending angle, and papillary muscle angle were measured. TR was assessed prestage 1 and at latest follow-up.