Research in Cardiovascular Medicine

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Introduction: A Holter blood pressure monitoring is a basic method for the diagnosis and evaluation of hypertension therapy. Hypertension in children and adolescents is defined as an increase of systolic/diastolic pressure, which is equal, or above 95^th percentile blood pressure for sex, age, and height. Aim: The aim of this study is to analyze the etiology of arterial hypertension (AH) in the pediatric population. Methods: Research had descriptive and retrospective character. During the period from March 2006 to April 2020, 1527 registered continuous Holters of blood pressure were analyzed. Data were taken from the medical documentation of patients that were hospitalized on Pediatric Clinic (register of continuous Holter of blood pressure). Results: Out of the total number of registered and analyzed patients 833 were male (54.5%) with dominant age 15–19 years of life 774 (50.6%), school-age children 660 (43.2%), preschool children 93 (6.1%). We had 902 (59%) first registrations and 626 (41%) control registrations. AH was verified in 52 patients (387 records of continuous Holter of blood pressure were performed to them). Primary AH was verified in 27 patients and secondary AH in 25 patients. Forty patients (76.9%) were treated with monotherapy while combined therapy was used in 12 (23.1%) of cases. Renal cause was in 28% patients, endocrine in 24%, cardiovascular in 24%, neurological in 16%, and rheumatic in 8% of patients with secondary AH. Conclusion: Continuous Holter of blood pressure represents useful diagnostic method and method of control of high blood pressure in children and adolescents. It should be routine method in everyday pediatric clinical practice especially in pediatric cardiology.

Context: The optimal treatment strategy for in-stent restenosis (ISR) still remains under debate. Moreover, there have been scarce data on Indian patients relating to ISR treatment. Aim: The aim of this study was to determine the clinical profile and angiographic pattern of patients with ISR and to evaluate the outcome of these patients being treated for ISR. Settings and Design: This was a cross-sectional study which consisted of patients who had coronary angiographic characteristic of ISR. Materials and Methods: Patients were divided into subgroups as per presentation, acute coronary syndrome (ACS), and non-ACS. After the ISR event and treatment, the patients were followed up for a minimum period of 6 months for any adverse events. The primary outcome of the study was occurrence of a major adverse cardiac event. Statistical Analysis: Chi-square test, Fisher's exact test, Student's t-test, or Mann–Whitney test was applied according to type and distribution of variable (SPSS software). Results: One hundred patients with 109 culprit lesions of ISR were included in the study. The ACS was dominant clinical presentation mode, occurring in 62 patients. Fifty-four percent of the patients were treated with percutaneous coronary intervention, 26% were managed with coronary artery bypass grafting, and 19% were treated with optimized medical therapy. Majority of the adverse events (12 out of 15 patients) occurred in the ACS group, with a statistically significant difference at 6-month follow-up (P = 0.021). Conclusion: Patients with ISR have ACS as the most common mode of presentation. Patients with ISR presenting with ACS are at high risk and must be closely monitored. The treatment of ISR with drug-eluting stent or drug-coated balloon is most effective.

Long QT syndrome (LQTS) is a rare (1:2500–1:10,000) inherited disorder characterized by the onset of arrhythmogenic syncope, polymorphic ventricular tachycardia, and sudden cardiac death. The aim of this article was to describe an unexpected success with an unusual therapeutic modality of a patient diagnosed with LQTS syndrome (suspected Romano–Ward syndrome) during an 8-year period. A 59-year-old female patient was admitted to the hospital due to chest pain and nausea, and after diagnostic and therapeutical approach, a permanent dual-chamber rate-modulated (DDDR) pacemaker was implanted instead of the implantable cardioverter defibrillator (ICD). During the 8-year period, the patient remained stable, without rhythm disorder. Romano–Ward syndrome as a congenital LQTS carries a high risk of sudden cardiac death and presents an indication for ICD. In this patient, for objective reasons, this could not be performed. Implantation of a DDDR with an appropriate pharmacological therapy, including propranolol, in this case, proved to be a successful therapeutic modality.

A 28-year-old male patient was referred to our imaging center with the differential diagnosis of a right ventricular (RV) apical mass. He was a known case of the ventricular septal defect (VSD) with a history of spontaneous closure at the age of 2 years. His chief complaint was chest pain and palpitation. He was referred with a transthoracic echocardiography report of RV apical hypertrophy with almost apical obliteration or RV apical mass. Cardiovascular magnetic resonance imaging demonstrated few intramyocardial crypts of basal anteroseptal left ventricular (LV) segment. There was no evidence of concomitant LV apical hypertrophy. Indeed, there was a small conical- and tunnel-shaped serpiginous apical-infundibular muscular VSD (3.6 mm RV side's diameter and 7.6 mm LV side's diameter) resulted in a localized and severely hypertrophied RV apical segment and no significant shunt (QP/QS: 1.16). There was no evidence of other cardiac mass.

Background and Aim: “Idiopathic” ventricular arrhythmias most often arise from the right ventricular outflow tract (RVOT), although arrhythmias from the left ventricular outflow tract (LVOT) have also been observed. The aim of the study was to investigate the importance of signal of great cardiac vein (GCV) to distinguish premature ventricular contraction (PVC) originated from LVOT and PVC originated from RVOT. Materials and Methods: A coronary sinus catheter was placed in the GCV under fluoroscopy to measure the distance of GCV signal to the onset of QRS on surface electrocardiogram (ECG). Catheter ablation was performed utilizing radiofrequency energy in 31 patients. A 12-lead ECG was recorded during PVC. Successful ablation was defined as the complete disappearance of target PVC with no recurrence during the follow-up. Results: Thirty-one consecutive patients (16 male [51.6%]) were enrolled. Overall, 67.7% of the cases had PVC originated from the LVOT and 32.3% from the RVOT. Out of 48.4% of the females, 33.3% had PVC originated from the RVOT and 66.7% from the LVOT (P = 1). The mean ejection fraction regarding PVC originated from the LVOT and RVOT was 47.50 ± 8.95 and 45.50 ± 8.51, respectively (P = 0.7). The distance of GCV signal to the onset of QRS on surface ECG for LVOT- and RVOT-originated PVC was 15.38 ± 25.28 and −29.70 ± 25.66, respectively (P < 0.01). Conclusions: The differentiation between PVC originated from LVOT and RVOT is not entirely utilized through ECG criteria, thus the origin of PVC arising from RVOT/LVOT can be localized using the GCV signals.

Online since 6^the October 2017.