No abstract

SUMMARY Although patients with atrioventricular (AV) discordance (corrected transposition) have abnormal conduction pathways and may spontaneously develop high-grade AV block, no quantitative assessment of the risk of this happening is available. We reviewed the data on 107 patients with AV discordance ages 2-76 years (mean 22 years) at follow-up. Eighty-two patients (77%) had a ventricular septal defect, 57 (53%) had pulmonary stenosis, 35 (34%) had tricuspid insufficiency and 24 (23%) had dextrocardia.Twenty-three patients (22%) had complete AV block. This condition was present in four patients at birth and developed in 19 patients at ages 4 months to 53 years (mean 18.1 years). Nine of these patients had permanent pacemaker implantation, four at the onset of complete block and five an average of 11 years later. Nine patients have AV block but no pacemaker. One patient died suddenly.Detailed data analysis showed that with increasing follow-up the risk of natural onset AV block continued at a rate of approximately 2 % per year after diagnosis. THE COURSE of the conduction system in congenital heart disease associated with corrected transposition or levotransposition is abnormal.' Impulses arise from the sinus node and pass to the atrioventricular (AV) node, located near the junction of the mitral and pulmonary valves. The infranodal common conduction tissues then pass anterior to the pulmonary valve annulus in the subendocardium and course inferiorly over the anterosuperior aspect of the membranous septum. Several studies have mentioned the increased likelihood of the spontaneous onset of complete AV block with this type of defect, but these have included patients with other lesions, such as univentricular heart.There is no information available specifically concerned with the expected rate of development of spontaneous complete AV block in patients with AV discordance and two ventricles. The clinical significance of complete AV block in AV discordance is variable and is related to the site of block and the resulting heart rate.4 5 However, it is not clear whether natural-onset (nonsurgical) complete AV block significantly affects survival in these patients and whether associated anatomic lesions increase the risk of this complication.We therefore reviewed the clinical course of 107 patients with this diagnosis. The goal of the study was to provide quantitative information concerning the risk of complete AV block in AV discordance using life-

Organized left atrial appendage function returns in most patients immediately after cardioversion of atrial fibrillation. However, its function is impaired compared with that before cardioversion. Furthermore, spontaneous echo contrast increased in 7 (35%) of 20 patients after cardioversion. These observations suggest that stunned left atrial appendage function after cardioversion may predispose the chamber to thrombus formation, which may play a role in the mechanism involved in the occurrence of embolization after cardioversion.

Our data show that the long-term patient and graft survival rates after donation after cardiac death lung transplantation were equivalent to those after brain-dead donor lung transplantation. Our findings suggest that the use of donation after cardiac death donors can safely and substantially expand the donor pool for lung transplantation.