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Paediatric and adult congenital cardiology education and training in Europe
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- Colin J. McMahon, Ruth Heying, Werner Budts, Anna Cavigelli-Brunner, Maria Shkolnikova, Ina Michel-Behnke, Rainer Kozlik-Feldmann, Håkan Wåhlander, Daniel DeWolf, Sylvie Difilippo, Laslo Kornyei, Maria Giovanna Russo, Anna Kaneva-Nencheva, Senka Mesihovic-Dinarevic, Samo Vesel, Gylfi Oskarsson, George Papadopoulos, Andreas C. Petropoulos, Berna Saylan Cevik, Antonis Jossif, Gabriela Doros, Thomas Krusensjerna-Hafstrom, Joanna Dangel, Otto Rahkonen, Dimpna C. Albert-Brotons, Silvia Alvares, Henrik Brun, Jan Janousek, Olli Pitkänen-Argillander, Inga Voges, Inguna Lubaua, Skaiste Sendzikaite, Alan G. Magee, Mark J. Rhodes, Nico A. Blom, Frances Bu’Lock, Katarina Hanseus, Ornella Milanesi
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 12 / December 2022
- Published online by Cambridge University Press:
- 01 March 2022, pp. 1966-1983
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Background:
Limited data exist on training of European paediatric and adult congenital cardiologists.
Methods:A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries.
Results:Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87–9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63–10.72 million), and one training centre per 4.29 million population (range 1.63–10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1–17), and duration of training was 3 years (range 2–5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R2 = 0.41).
Conclusion:Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists.
Aortic elasticity and carotid intima-media thickness in children with mitral valve prolapse
- Elif Erolu, Figen Akalın, Nilüfer Çetiner, Berna Şaylan Çevik
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- Journal:
- Cardiology in the Young / Volume 28 / Issue 2 / February 2018
- Published online by Cambridge University Press:
- 07 November 2017, pp. 292-301
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Aim
We aimed to study the dimensions, systolic and diastolic functions of the left ventricle; dimensions and elasticity of the aorta; and carotid intima-media thickness and flow-mediated dilatation of the brachial artery in mitral valve prolapse.
MethodsThe study group consisted of 43 patients (mean age=13.3±3.9) and 42 healthy children (mean age=12.9±3.4). Left ventricular end-diastolic, end-systolic, left atrial diameters, interventricular septum, and left ventricular posterior wall thickness were measured. Ejection and shortening fractions were calculated by M-mode. Measurements were adjusted to the body surface area. Mitral annulus, and systolic and diastolic diameters of the aortic annulus and aorta at each level were obtained; z-scores, aortic strain, distensibility, stiffness index were calculated. Carotid intima-media thickness and flow-mediated dilatation were studied. Patients were classified as classical/non-classical mitral valve prolapse and younger/older patients.
ResultsLeft ventricular end-systolic, end-diastolic, and left atrial diameters (p=0.009, p=0.024, p=0.001) and aortic z-scores at annulus, sinus valsalva, and sinotubuler junction were larger (p=0.008, p=0.003, p=0.002, respectively) in the mitral valve prolapse group. Aortic strain and distensibility increased and stiffness decreased at the ascending aorta in the patient group (p=0.012, 0.020, p=0.019, respectively). Classical mitral valve prolapse had lower strain and distensibility and higher stiffness of the aorta at sinus valsalva level (p=0.010, 0.027, 0.004, respectively). Carotid intima-media thickness was thinner in the patient group, especially in the non-classical mitral valve prolapse group (p=0.037). Flow-mediated dilatation did not differ among the groups.
ConclusionMitral valve prolapse is a systemic disease of the connective tissue causing enlarged cardiac chambers and increased elasticity of the aorta. Decreased carotid intima-media thickness in this group may indicate low atherosclerosis risk.
Myocardial performance after successful intervention for native aortic coarctation
- Vedide Tavli, Turkay Saritas, Baris Guven, Faik Okur, Berna Cevik Saylan, Talat Tavli, Bekir Sami Uyanik, Zeki Ari, Banu İsbilen
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- Journal:
- Cardiology in the Young / Volume 20 / Issue 1 / February 2010
- Published online by Cambridge University Press:
- 13 January 2010, pp. 33-38
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Coarctation of the aorta is associated with increased risk for hypertension in adulthood, despite successful repair. The intrinsic mechanisms underscoring hypertension and left ventricular performance in these patients, however, remains to be determined. Our objective was to evaluate left ventricular performance by means of echocardiographic and biochemical parameters at midterm follow-up in normotensive children who have had undergone successful surgical or catheter interventional treatment of coarctation with a residual gradient of less than 20 mmHg at rest. We studied prospectively 14 patients with native aortic coarctation who underwent surgery or balloon angioplasty, the cohort made up of equal numbers of boys and girls, and having a mean age of 8.5 plus or minus 4 years. We also studied 30 age-matched healthy subjects, measuring mitral inflow pulsed wave signals, isovolumic relaxation and contraction times, myocardial performance index parameters, and levels of B-type natriuretic peptide and endothelin-1 in both groups. We found no differences in systolic blood pressure at rest between the patients and their controls. The ventricular septal diastolic dimensions, left ventricular posterior wall dimensions, mitral valve E wave, deceleration time, isovolumic relaxation time, isovolumic contraction time and myocardial performance index were all significantly increased in the patients. Levels of plasma B-type natriuretic peptide and endothelin-1 were also significantly higher in the patients when compared to the control group. We conclude that aortic coarctation is a chronic disease characterized by persistency of myocardial and vascular alterations. The elevated levels of plasma b-type natriuretic peptide and endothelin-1 may be indicative of late onset hypertension after successful treatment of native coarctation in early childhood.