Asunto(s)
Calidad de la Atención de Salud , Estonia , Europa Oriental , Unión Europea , Femenino , Humanos , Letonia , Lituania , Masculino , Médicos Mujeres , Facultades de Medicina/normas , Distribución por SexoRESUMEN
Pregnancy in patients with Eisenmengers syndrome is associated with high maternal and fetal mortality rates and effective contraception or termination of pregnancy is strongly recommended. When these patients decide to begin or continue a pregnancy against advice a coordinated multi-specialist care at a center for congenital heart disease is mandatory. So far, experience with this demanding group of patients is limited. This report reviews the outcome of 30 pregnancies in 10 patients from a group of 35 women with Eisenmengers syndrome who have been treated at the University Hospital in Vilnius, Lithuania, between 1967 and 2003. The most frequent underlying lesion was a ventricular septal defect in 5 patients, their mean age was 26.2 +/- 5,4 years and they were in functional class II or III (9/1) at the beginning of the pregnancy. In this group 13 pregnancies were terminated (43 %), 4 spontaneous abortions (13 %) occurred at less than 21 weeks of pregnancy and one stillbirth at 23 weeks of gestation. Twelve children were born alive, 10 were premature and 2 term deliveries. One maternal death occurred on the third day following an emergency delivery in week 36 and another patient decompensated immediately following delivery, but could be stabilized with intensive care therapy. During long-term follow-up all of these 9 patients were alive at 10/2003 despite a significant deterioration in functional class. These data are comparable to previously published observations in pregnant women with Eisenmengers syndrome.
Asunto(s)
Complejo de Eisenmenger/complicaciones , Complicaciones Cardiovasculares del Embarazo/mortalidad , Resultado del Embarazo , Aborto Espontáneo/epidemiología , Aborto Espontáneo/etiología , Adulto , Complejo de Eisenmenger/mortalidad , Femenino , Muerte Fetal/epidemiología , Muerte Fetal/etiología , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Lituania/epidemiología , Mortalidad Materna , Embarazo , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The objective of this study was to assess the reliability of spiral CT angiography (CTA) and 3D reconstruction in patients with aortic coarctation (CoA). Eighteen patients with suspected or surgically proven coarctation were examined by spiral CT. In addition to the axial slices, 3D reconstructions, such as shaded surface display (SSD) and maximum intensity projection (MIP), were used to determine the diameters of the CoA and the pre- and poststenotic aorta and to visualise the collateral vessels. Diameters derived from cardiac catheterization were compared with those from CTA in 8 patients. The degree of aortic stenosis was correlated with blood pressure gradients (BPG) in 12 patients. The difference between the diameters of the CoA and the pre- and poststenotic aorta derived from MIP and angiography was not statistically significant (p = 0.69). With SSD the internal thoracic artery was detected in 16 and the posterior intercostal artery in 13 cases. The degree of aortic stenosis correlated poorly with the BPG (r = 0.51, r2 = 0.26). CTA with 3D reconstruction represents a reliable noninvasive technique for the assessment of the degree of CoA and the visualisation of collateral vessels. It may serve as a follow-up investigation after intervention or surgical treatment.
Asunto(s)
Coartación Aórtica/diagnóstico por imagen , Aortografía , Procesamiento de Imagen Asistido por Computador , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
Clinical symptoms and age at manifestation of a congenital coronary artery fistula may vary considerably. They depend on the underlying anatomy and also on the size of the fistulous connection to the left or right side of the heart. Using colour Doppler echocardiography for direct visualization of the entire course of the fistulous vessel, including the site of termination, succeeds only in a small number of cases. Furthermore, regular coronary vessels branching off proximally and distally of the coronary artery fistula usually are not recognizable by this method. Only selective angiography provides this information and is unchallenged the most important and indispensable diagnostic technique, especially with regard to surgical treatment. This publication presents physical, echocardiographic, and angiographic data of 15 patients, who were admitted to the German Heart Center Munich between 1970 and 1993. By an invasive diagnostic approach the following arteriovenous fistulous connections were found: from right coronary artery to right atrium (3 patients) or to right ventricle (3 patients), from left coronary artery to right atrium or coronary sinus (3 patients), from left coronary artery to right ventricle (4 patients) and from right and left coronary artery to right ventricle (2 patients). In 5 patients a "proximal" form of coronary artery fistula ("side-to-side pattern") was found, in 8 patients a "distal" form ("end-artery type"), and in 2 patients a combination of both forms. In 14 patients surgical closure was performed (6 symptomatic infants, mean age at surgery = 95 days, and 8 asymptomatic children, mean age at surgery = 7.1 years): 13 patients survived surgery. On an average of 5 years after surgery all of these 13 patients are in excellent condition (NYHA functional class I). The experiences in surgical treatment verify the importance of an exact angiographic visualization of the anatomy of a coronary artery fistula and the regular coronary vessels branching off proximally and distally of the fistula. Closure of coronary artery fistulas at the time of diagnosis is recommended also in asymptomatic patients, since perioperative morbidity and mortality increases in older patients.
Asunto(s)
Fístula Arteriovenosa/congénito , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/cirugía , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Preescolar , Angiografía Coronaria , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Resultado del TratamientoRESUMEN
To evaluate the use of three-dimensional (3D) echocardiography in the diagnosis of congenital heart defects, we studied 238 patients aged 3 days to 19 years (mean 4.3 years) with normal hearts (n=13) or a variety of congenital heart defects (n=225). Three different modalities of data acquisition suitable for 3D reconstruction were applied. For parallel scanning, the transducer is held in a 6-cm long scan frame and then moved over the thorax, or in the subcostal position, by a stepper motor using 0.5-mm steps with acquisition of perpendicular parallel images of the heart. For rotational scanning, the transducer is rotated at sectors of 2 degrees over a span of 180 degrees. For fan-like scanning, the transducer is moved in an arc 45 degrees each way from its vertical axis. Movement of the transducer is computer-controlled and performed with electrocardiographic and respiratory gating. Between 80 and 120 slices of the heart are thus obtained, which form the 3D dataset. This dataset can then be ¿sectioned¿ in any desired plane, thus permitting generation of views simulating intraoperative perspectives. Ventricular septal defects and atrioventricular valves can be displayed as viewed via the atrium. Muscular ventricular septal defects can be viewed as seen through a ventriculotomy. Obstruction in the left ventricular outflow tract can be viewed as via an aortotomy, and so on. We concluded that this new imaging modality has a vast potential and may facilitate planning of intracardiac surgery.
Asunto(s)
Ecocardiografía/métodos , Cardiopatías Congénitas/diagnóstico por imagen , Adolescente , Niño , Preescolar , Defectos del Tabique Interventricular/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Transductores , Válvula Tricúspide/anomalías , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagenRESUMEN
Twenty-three patients who underwent operation for anomalous origin of the left coronary artery from the pulmonary artery were reexamined with two-dimensional echocardiography and thallium 201 perfusion imaging. Follow-up studies were performed 0.6 to 16.2 years (median 2.9 years) after operation. In 22 of 23 patients, a two coronary artery system had been established by implantation of the left coronary artery into the aorta (n = 8) or by anastomosis of the left subclavian artery with the left coronary artery (n = 14). The left coronary artery had been ligated in only one patient. For stress testing, 0.8 mg dipyridamole per kilogram body weight was infused in a 10-minute period in 20 of the 23 patients. High-dose dipyridamole infusion increased mean heart rate (98.1 +/- 27.1 to 122.3 +/- 19.2 beats/min, p < 0.001) and mean left ventricular ejection fraction (54.8% +/- 11.8% to 61.3% +/- 12.5%, p < 0.05) and decreased left ventricular end-diastolic volume index (38.8 +/- 26.7 to 29.9 +/- 8.3 ml/m2, p < 0.005). At rest, left ventricular dimensions were abnormal in only one patient, in whom the anastomosis with the left coronary artery proved to be occluded, as seen with subsequent angiography. Left ventricular function seen with two-dimensional echocardiography was normal in 19 patients and was compromised in 3 (all of whom had major structural anomalies of the left ventricle, such as left ventricular aneurysm, occlusion of the anastomosis, or mitral valve prosthesis). Patients with R-wave loss as seen with preoperative electrocardiography tended to have larger left ventricular volumes at follow-up (69.2 +/- 56.5 ml/m2 versus 32.4 +/- 9.6 ml/m2, p < 0.07). Ten of 20 patients had normal thallium 201-perfusion scans. In 9 of 20 patients defects revealed by permanent thallium 201-perfusion were observed and determined to be myocardial scars. Transient perfusion defects under dipyridamole stress with redistribution at rest occurred in three children, two of whom also had permanent thallium 201 defects. None of the three patients had angina-like symptoms or S-T segment changes during dipyridamole stress. Left ventricular ejection fraction, however, decreased severely during dipyridamole infusion in the single patient with ligature of the left coronary artery. The two remaining patients had normal echocardiographic left ventricular function under stress, and the diagnosis of myocardial ischemia as seen with scintigraphy must be questioned.(ABSTRACT TRUNCATED AT 400 WORDS)
Asunto(s)
Anomalías de los Vasos Coronarios/fisiopatología , Anomalías de los Vasos Coronarios/cirugía , Arteria Pulmonar/anomalías , Función Ventricular Izquierda , Preescolar , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Dipiridamol/farmacología , Ecocardiografía , Prueba de Esfuerzo , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Lactante , Masculino , Válvula Mitral/fisiopatología , Pronóstico , Estenosis de la Válvula Pulmonar , Cintigrafía , Radioisótopos de TalioRESUMEN
The present study was conducted on 33 children (median age at initial cardiac catheterization 0.4 years [0.1 to 11.8]) with anomalous origin of the left coronary artery from the pulmonary artery, without associated hemodynamically significant cardiovascular anomalies, who were treated throughout a period of 18 years in our hospital. A two coronary artery circulation was reestablished in 31 of 33 children. One child died before the intended operation, and in one child the left coronary artery was ligated. There were six operative deaths, five intraoperative and one 12 hours after operation. The purpose of the study was to assess which preoperative clinical and angiographic features were associated with a higher perioperative mortality. The following preoperative factors were associated with a statistically significant higher perioperative mortality: young age at operation (p less than 0.03), left and balanced type of coronary circulation (p less than 0.01), and electrocardiographic signs of extensive acute myocardial infarction, namely, marked ST elevation (greater than or equal to 0.2 mV in at least two leads) (p less than 0.03). Left axis deviation on the electrocardiogram was associated with an extreme right dominant type of coronary circulation (p less than 0.005). The latter was also linked with adequate perfusion of the posterolateral left ventricular wall (p less than 0.005). At autopsy, severe increase of heart weight to two or three times the normal heart weight was established in six of seven children. Thus the perioperative mortality was determined primarily by the extent of myocardial ischemia. This in turn is decisively influenced by the dominant type of coronary circulation and the extent of inter-arterial collateralization. Young age, in addition, proved to be a risk factor for mortality at corrective surgery.
Asunto(s)
Anomalías de los Vasos Coronarios/cirugía , Arteria Pulmonar/anomalías , Aortografía , Niño , Preescolar , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/mortalidad , Electrocardiografía , Estudios de Seguimiento , Humanos , Lactante , Arteria Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
Thirty-eight patients were selected from a total of 120 patients who underwent the Fontan operation between 1974 and 1988. They were classified into two groups. Group 1 consisted of 18 patients with previous pulmonary artery banding at a mean age of 7 months (2 days to 59 months), and group 2 comprised 20 patients with native pulmonary stenosis. In group 1, 10 children had tricuspid atresia (seven with normally connected and three with transposed great arteries), six had double-inlet ventricle, and two had complex heart malformations. Group 2 consisted of 12 patients with tricuspid atresia and normally connected great arteries, six with double-inlet ventricle, and two with complex malformations. The following clinical and hemodynamic parameters at cardiac catheterization and cineangiocardiography were determined in both groups before the Fontan operation: age and body surface area, hemoglobin concentration and hematocrit value, atrial and pulmonary artery pressures, end-diastolic pressure of the systemic ventricle, arterial oxygen saturation, pulmonary/systemic flow ratio, end-diastolic volume, ejection fraction and mass of the systemic ventricle, cardiac index, and Nakata index. After the Fontan operation in all patients, the presence or absence of pericardial and pleural effusions, ascites, protein-losing enteropathy, and liver and kidney dysfunction was assessed and the clinical status was classified according to New York Heart Association criteria. All preoperative and postoperative parameters were tested for differences between the two groups, and they were compared with normal values. Hematocrit value was higher in group 2 than in group 1 (57.8% versus 53.1%; p less than 0.05). Ventricular mass index was increased in group 1 when compared with group 2 (125.8 gm/m2 versus 87 gm/m2; p less than 0.05). Severe pericardial effusions in the early postoperative period were significantly more frequent in group 1 and were particularly prevalent in the subgroup with long-standing pulmonary artery banding (p less than 0.01). Subaortic stenosis was observed more frequently in group 1. The remaining parameters were not statistically different between the two groups. We conclude that the significant increment in ventricular mass after pulmonary artery banding may represent a risk for unfavorable outcome after the Fontan operation, which increases with time. Therefore, long-standing pulmonary artery banding as a palliative procedure for candidates for the Fontan operation should be avoided.
Asunto(s)
Cardiopatías Congénitas/cirugía , Arteria Pulmonar , Adolescente , Adulto , Factores de Edad , Superficie Corporal , Niño , Preescolar , Ventrículos Cardíacos/anomalías , Hemodinámica , Humanos , Lactante , Recién Nacido , Métodos , Complicaciones Posoperatorias , Estenosis de la Válvula Pulmonar/cirugía , Transposición de los Grandes Vasos/cirugía , Válvula Tricúspide/anomalías , Válvula Tricúspide/cirugíaRESUMEN
Purpose of this study was to examine the influence of early (less than two and half years) versus later (greater than four years) age at time of Fontan type palliation in tricuspid atresia with native pulmonary stenosis on outcome with special reference to left ventricular mass and function. Among the 21 patients with tricuspid atresia, twelve (group A) underwent a Fontan type palliation at a median age of one (.6 to 2.5) years and nine (group B) at a median age of 7.5 (4.8 to 28) years. Left ventricular mass was assessed by cross-sectional echocardiography in the apical two and four chamber view. Mass was calculated as difference between epicardial and endocardial volume x 1.05 (specific gravity of heart muscle). Mass divided by volume at end-diastole yielded the mass/volume index. There was a weak correlation between age and left ventricular mass with an r-value of 0.74. Ejection fraction was calculated from the endocardial volume measurements at end-diastole and end-systole. Patient data were compared to normal values previously established in 95 controls, who were age-matched for the patients. Immediately before surgery left ventricular mass was significantly higher in the nine patients, who underwent surgery at a later age. While postoperative stay in hospital and duration of treatment in the intensive care unit did not differ significantly between both groups, the incidence of pleural and pericardial effusions and the duration of insertion of drainage tubes for these effusions differed significantly with the group A patients (under two and half years of age) doing better.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Volumen Cardíaco/fisiología , Cardiopatías Congénitas/cirugía , Hemodinámica/fisiología , Cuidados Paliativos , Estenosis de la Válvula Pulmonar/cirugía , Válvula Tricúspide/anomalías , Función Ventricular Izquierda/fisiología , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Ecocardiografía/instrumentación , Femenino , Estudios de Seguimiento , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/cirugía , Cardiopatías Congénitas/mortalidad , Cardiopatías Congénitas/fisiopatología , Humanos , Lactante , Masculino , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Arteria Pulmonar/fisiopatología , Arteria Pulmonar/cirugía , Estenosis de la Válvula Pulmonar/mortalidad , Estenosis de la Válvula Pulmonar/fisiopatología , Procesamiento de Señales Asistido por Computador/instrumentación , Tasa de Supervivencia , Función Ventricular Derecha/fisiologíaRESUMEN
The fate of the right ventricle as systemic ventricle after atrial repair of complete transposition of the great arteries has not been clearly elucidated. In order to assess the long-term results of the Mustard operation in patients with complete transposition of the great arteries we present the clinical data of 23 patients who had been operated in the years 1974 and 1975. Twenty of these patients had simple complete transposition of the great arteries with intact ventricular septum, two had an additional small ventricular septal defect and one an additional left ventricular outflow tract obstruction with a 40 mm Hg systolic pressure gradient. The Mustard operation had been performed at a mean age of 2.2 (1 to 3.7) years. Seventeen of the 23 patients underwent a postoperative hemodynamic study with angiocardiography 1.1 (1 to 1.8) years following surgery. At that time the right ventricular ejection fraction, which had been calculated from biplane angiographic right ventricular volume measurements in twelve patients was 62 (52 to 68) %. However the right ventricle was dilated and the mean enddiastolic volume was 132 (108 to 192) % of normal. In twelve of the 23 patients right ventricular function was reassessed 12.6 (11 to 15.3) years after surgery by Technetium-99m-scintigraphy at rest and in ten of those after exercise with a workload of 2 watt/kg. The mean ejection fraction was 51 (38 to 66) % at rest and 52 (40 to 80) % during exercise. Only three patients had a normal response to exercise, which was defined as an increase of ejection fraction with exercise of more than 5%.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Angiocardiografía , Hemodinámica/fisiología , Contracción Miocárdica/fisiología , Complicaciones Posoperatorias/fisiopatología , Ventriculografía con Radionúclidos , Transposición de los Grandes Vasos/cirugía , Gasto Cardíaco/fisiología , Preescolar , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Humanos , Lactante , Masculino , Transposición de los Grandes Vasos/fisiopatologíaRESUMEN
Most congenital heart diseases are detected in childhood, but some, such as atrial septal defect, can remain undiagnosed until adulthood. In the first part of this review, taking the auscultation findings and the clinical picture as a basis, the diagnosis of four common congenital heart diseases is discussed: ventricular septal defect, pulmonary stenosis, patient ductus arteriosus, and atrial septal defect. In addition, the latest developments in the field of therapy are briefly considered.
Asunto(s)
Cardiopatías Congénitas/diagnóstico , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/cirugía , Ecocardiografía Doppler , Electrocardiografía , Cardiopatías Congénitas/cirugía , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/diagnóstico , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Estenosis de la Válvula Pulmonar/diagnóstico , Estenosis de la Válvula Pulmonar/cirugíaRESUMEN
In this second part of our review, the diagnosis of the following congenital heart disease is discussed: aortic stenosis, aortic isthmus stenosis (coarctation of the aorta), Fallot's tetralogy and transposition of the great vessels. Aortic stenosis and coarctation of the aorta each represents a spectrum of cardiac diseases of varying severity. Cases that are clinical less severe may escape diagnosis until late childhood or adolescence. Fallot's tetralogy and transposition of the great vessels in contrast, lead to cyanosis, and are therefore usually diagnosed already in the young infant. In all four conditions, the suspected diagnosis can be established on the basis of clinical or auscultatory findings. Further diagnostic clarification is achieved with the aid of non-invasive procedures such as CT scan, chest X-ray, echocardiography and, where indicated, NMR imaging. Additional cardiac catheterization is required only in the case of the tetralogy of Fallot.
Asunto(s)
Cardiopatías Congénitas/diagnóstico , Coartación Aórtica/diagnóstico , Coartación Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Ecocardiografía Doppler , Electrocardiografía , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Tetralogía de Fallot/diagnóstico , Tetralogía de Fallot/cirugía , Transposición de los Grandes Vasos/diagnóstico , Transposición de los Grandes Vasos/cirugíaRESUMEN
Although left ventricular (LV) mass may be important to judge effects of left-sided cardiac obstruction or hypertension, reproducible noninvasively determined normal data in the pediatric age group are scarce. To validate cross-sectional echocardiographic LV mass determination, our data were compared with LV mass assessed by magnetic resonance imaging (MRI). MRI was considered to be a good reference method because there is usually no problem in defining endo- and epicardial borders with MRI. LV mass was assessed in 14 children aged 5.3 years (10 days to 14.7 years) with a mean body surface area of 0.78 m2 (range 0.25 to 1.61). With cross-sectional echocardiography the epicardial and endocardial volumes were calculated using a Simpsons rule algorithm in the apical 2- and 4-chamber view. The difference between epi- and endocardial volumes was multiplied by 1.05 to yield the mass. Mass was assessed with MRI using a multislice technique; the area of each myocardial slice was calculated and multiplied with the slice thickness, and the resultant slice volumes were added to obtain the myocardial volume. On cross-sectional echocardiography, the mass was 55 g (range 12 to 126) or 64 g/m2 (range 46 to 79); on MRI it was 60 g (range 33 to 87) or 69 g/m2 (range 46 to 89). Regression analysis yielded an r value of 0.98 with a standard error of the estimate of 5.7 g or a 10% difference. In older children, LV mass determined by MRI was bigger than the one derived by echocardiography. It is concluded that cross-sectional echocardiography can reliably assess LV myocardial mass in pediatric patients.
Asunto(s)
Coartación Aórtica/diagnóstico por imagen , Coartación Aórtica/patología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Imagen por Resonancia Magnética , Adolescente , Niño , Preescolar , Ecocardiografía , Femenino , Humanos , Lactante , Recién Nacido , Modelos Lineales , MasculinoRESUMEN
Eighteen of 25 survivors of aortic valvotomy in infancy were reinvestigated by cross-sectional echocardiography a mean of 7.5 (2.3-13.4) years after surgery. They had been operated at a median age of 38 (5-330) days. At the follow-up examination the gradient across the aortic valve was 41 +/- 19 (15-85) mmHg and the ejection fraction was 0.73 +/- 0.10 (0.48-0.84). Left ventricular (LV) end-diastolic volume was 66 +/- 17 (33-191) ml/m2. LV mass was 96 +/- 36 (44-204) g/m2 and the LV mass volume index (LVMVI) (mass divided by end-diastolic volume) was 1.43 +/- 0.4 (0.9-2.28). Eleven of 18 patients had an abnormally high mass volume index compared with 95 age-matched controls with structurally normal hearts. The correlation between the residual pressure gradient across the aortic valve and mass volume index yielded an r value of 0.75 (p less than 0.0004). One patient had been reoperated and underwent resection of a subaortic stenosis 4 years after the initial operation. Four patients with a resting gradient of more than 50 mmHg and one with grade 4 aortic regurgitation are scheduled for further surgical treatment. We conclude that, although LV function was normal in most patients who underwent aortic valvotomy in infancy, LV mass remains elevated in a significant number of patients, who may remain at risk of developing subendocardial ischemia.
Asunto(s)
Válvula Aórtica/fisiopatología , Miocardio/patología , Función Ventricular Izquierda/fisiología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Ecocardiografía , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Volumen Sistólico/fisiología , Factores de TiempoRESUMEN
OBJECTIVE: To assess whether changes in Doppler echocardiographic indices in the pulmonary artery correlated with changes in pulmonary vascular resistance. DESIGN: Acceleration time, ejection time, maximal flow velocity, and velocity time integrals were measured at the same time as pressure and oxygen saturation measurements in room air and during 10 minutes of oxygen breathing in the catheterisation laboratory. Pulmonary vascular resistance and pulmonary blood flow (Qp) were calculated from catheterisation data by use of the Fick principle. PATIENTS: 14 consecutive patients with a congenital heart defect and a left to right shunt associated with raised pulmonary artery pressure who underwent routine diagnostic cardiac catheterisation to assess their pulmonary vascular resistance. RESULTS: Though pulmonary vascular resistance and systolic pulmonary artery pressure fell significantly during oxygen administration, there was no significant change in the acceleration time or ejection time. Peak velocity increased significantly during oxygen administration. During oxygen breathing Doppler derived measurements of pulmonary flow showed a significant increase in Qp similar to the increase in Qp measured by the Fick principle. There was no significant correlation between the fall in pulmonary vascular resistance and the increase in acceleration time or ejection time, increase in peak velocity, increase in pulmonary artery diameter, or increase in Doppler derived pulmonary blood flow. CONCLUSIONS: Measurements of acceleration and ejection time by Doppler echocardiography did not predict the response of pulmonary artery pressure and resistance to oxygen. Though changes in maximal flow velocity across the pulmonary artery and in Doppler derived pulmonary blood flow measurements became significant during oxygen breathing, the correlation of these changes with fall in pulmonary vascular resistance was poor.
Asunto(s)
Cardiopatías Congénitas/fisiopatología , Arteria Pulmonar/fisiopatología , Resistencia Vascular/fisiología , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Niño , Preescolar , Ecocardiografía Doppler , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , Lactante , Oxígeno/administración & dosificación , Arteria Pulmonar/diagnóstico por imagenRESUMEN
Changes in left ventricular muscle mass may be an important diagnostic or prognostic finding in children with congenital heart defects, but there are no data on normal mass as determined by cross-sectional echocardiography (CSE) in children. Fourteen newborns, 12 infants, and 69 children (1.5-17 years old) with a structurally normal heart were studied. End-diastolic and end-systolic volume and mass were calculated from biplane-paired echocardiographic imaging planes-apical two-chamber and apical four-chamber views-using both an area/length and a Simpson's rule geometric method. Data were compared with M-mode measurements. There was a good correlation between area/length and Simpson's rule method [r = 0.94, standard error (SE) 4 g/m2]. To validate the measurements, interobserver data were gathered and end-diastolic and end-systolic mass measurements were compared. Interobserver variability for the measurements on the echocardiographic recordings was low at 4.8%; for end-diastolic mass the correlation between two observers was r = 0.99 (SE 3.3 g/m2) and for end-systolic mass r = 0.97 (SE 7.6 g/m2). Correlation between end-systolic and end-diastolic mass was acceptable (r = 0.88, SE 5.9 g/m2) for the CSE mass determination, but poor for the M-mode measurements (r = 0.51, SE 20.2 g/m2). Similarly, correlation between M-mode mass and mass estimated by CSE was poor, at r = 0.58 for end-diastolic and r = 0.094 for end-systolic mass.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Ecocardiografía/normas , Ventrículos Cardíacos/diagnóstico por imagen , Superficie Corporal , Ecocardiografía/métodos , Ventrículos Cardíacos/anatomía & histología , Humanos , Lactante , Recién Nacido , Masculino , Modelos Anatómicos , Variaciones Dependientes del Observador , Valores de Referencia , Reproducibilidad de los Resultados , InvestigaciónRESUMEN
Fifteen patients, aged between 9 and 21 years (mean, 15.1), with native coarctation of the aorta (CoA) or suspected recoarctation after surgical repair, underwent three different diagnostic procedures. Two-dimensional echocardiography (2D echo) and magnetic resonance imaging (MRI) of the thoracic aorta were performed in all patients; 14 patients underwent aortography, and digital subtraction angiography of the aorta was performed in one (after injection via a central venous catheter). Conventional electrocardiographic (ECG) gated MRI was performed, using the sagittal plane, a 256 x 256 acquisition matrix, multi-slice technique and a slice thickness of 10 mm. Diameters at the coarctation site were determined by all methods. Additional diameters of the descending aorta and the aortic arch were measured by MRI and echocardiography, respectively. All noninvasively obtained diameters were compared with angiographic data. Ultrasound imaging of the aortic isthmus was achieved in seven of 15 patients and of the aortic arch in nine of 15. The mean difference compared with angiographically determined diameters was 1.7 (0-7) mm, being greater for the coarctation site [mean, 2.2 (0-4)]. MRI images of the aortic isthmus were obtained in all patients, but the difference to angiographically determined diameters was slightly higher [mean, 3.2 mm (0-8)] than the ultrasound results. This deviation was presumably due to technical conditions, such as slice thickness and orthogonal imaging planes. Including all diameters, the correlation to invasive measurements was r = 0.82 (SEM = 3.1) for MRI and r = 0.89 (SEM = 2.3) for echo recordings.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Angiografía , Coartación Aórtica/diagnóstico por imagen , Ecocardiografía , Imagen por Resonancia Magnética , Adolescente , Adulto , Coartación Aórtica/diagnóstico , Niño , Femenino , Humanos , MasculinoRESUMEN
Chest-X-ray films of 61 children with isolated total anomalous pulmonary vein connection (TAPVC) were re-evaluated retrospectively. A small heart silhouette with normal pulmonary perfusion and signs of pulmonary oedema is typical of TAPVC with obstruction. There is no typical pattern in TAPVC without obstruction. The "snowman" or "figure of eight" does not develop within the first months of life.