No abstract

Slight to moderate post-convulsive prolongation of the QT interval is not rare but transient in paediatric patients.

According to this validation the prototype simulator could make a significant contribution to training in the use of echocardiography in congenital heart disease.

SummaryTransoesophageal echocardiography (TOE) requires extensive hands-on training, and it is for this purpose we have designed EchoComTEE, a simulator for TOE. It consists of a manikin and dummy probe; according to the position of the dummy probe (tracked by an electromagnetic sensor), two-dimensional (2D) images are calculated from three-dimensional (3D) data sets. Echocardiographic images are presented side-by-side with a virtual scene consisting of a 3D heart, probe tip and image plane. In this way the trainee is provided with visual feed-back of the relationship between echocardiogram and image plane position. We evaluated the simulator using a standardised questionnaire. Twenty-five experts and 31 novice users participated in the study. Most experts graded the simulator as realistic and all recommended its use for training. Most novice users felt the simulator supported spatial orientation during TOE and, as anaesthetists often do not have training in transthoracic echocardiography, in this group the TOE simulator might be particularly useful.

In this study we review our experience with total cavopulmonary anastomosis (modified Fontan procedure) which was performed in 31 patients. One patient died from postoperative cardiac low-output syndrome, the other died from a neurological complication (early mortality 6.5%). During a mean follow-up period of 15 months there was no late mortality. Preoperative assessment showed that one, two, or three of the Choussat criteria (defining the ideal Fontan candidate) were not fulfilled by 39%, 16% and 6% of our patients. In the 2 patients who died 2 and 3 of those criteria were not fulfilled. Poor outcome could not be predicted based on assessment of the pulmonary artery size (expressed as the McGoon-ratio or the Nakata-index) alone. In order to assess the relationship of pulmonary artery size and pulmonary arteriolar resistance (PVR) as a predictor of outcome, we introduced two new indices (McGoon-ratio/PVR and Nakata-index/PVR). The patient who died from poor postoperative hemodynamics had the lowest values of all patients. Among the 29 survivors we did not observe significant acquired postoperative arrhythmias. In our experience the total cavopulmonary anastomosis can be performed with a low mortality and good postoperative results. Patients who do not fulfill at least 8 of the Choussat criteria and children with a low ratio of pulmonary artery size to PVR are high-risk patients. In these children we recommend either a bidirectional Glenn anastomosis as a first-step procedure or a total cavopulmonary anastomosis with a fenestration of the intraatrial tunnel.