bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perfusion defects in patients with complete transposition after the Mustard or Senning operation
Authors: Lubiszewska Barbara , Gosiewska-Marcinkowska Elzbieta , Teresinska Anna , Rozanski Jacek , Rydlewska-Sadowska Wanda , Ruzyllo Witold 
Published: August 2008

AbstractAtrial correction for complete transposition involves a potential risk of later development of right ventricular dysfunction. To determine the reasons contributing to such systemic ventricular failure, radioisotope first-pass and SPECT perfusion studies at rest after one dose of Technetium-99m MIBI were performed in 26 asymptomatic patients, 5.9±2.7 years after a Mustard or Senning repair. Mean age at operation was 4.3±4.3 years. All patients were followed with 24-hour Holter monitoring and echocardiography. Normal perfusion was observed in 11 patients with a mean age at operation of 2.25±1.8 years and mean right ventricular ejection fraction of 49.0±8.7%. Perfusion defects were found in 15 patients with a mean age at operation 5.8±4.8 years (p<0.05) and mean right ventricular ejection fraction of 43.2±9.3% (NS). In the group of older patients, 10 had extensive perfusion defects with significantly lower right ventricular ejection fraction (39.7±9.3%, p<0.05) and even older mean age at the surgery (7.1±5.6 years p<0.02). Mild or moderate tricuspid regurgitation was found significantly more frequently in those patients with perfusion defects (73%) than in the group of younger patients (36.3%), p<0.05. There was no difference in the frequency and type of arrhythmias, nor in the extent of follow-up, between the two groups. We conclude that, in patients undergoing surgery at an older age, it is more common to find perfusion defects and, often, lower right ventricular ejection fraction. Perfusion abnormalities found in such asymptomatic patients may be a result of several factors: impaired right ventricular function as a consequence of pressure and volume overload, enhanced myocardial fibrosis, or long-lasting preoperative hypoxemia and tricuspid valvar dysfunction secondary to ventricular dilation. We suggest that the perfusion defects observed in this study may be a better indicator of systemic ventricular impairment.
Lower mid-line skin incision and minimal sternotomy—a more cosmetic challenge for pediatric cardiac surgery
Authors: Komai Hiroyoshi , Naito Yasuaki , Fujiwara Keiichi , Takagaki Yusaku , Nishimura Yoshiharu , Kawasaki Sadao , Nakamura Takako 
Published: August 2008

AbstractWe performed ten operations in children using a lower mid-line incision and limited minimal sternotomy. The skin incision is made from the level of nipples to the lower end of the xiphoid process, and only the body of the sternum is cut vertically. There was neither operative mortality nor complications. The upper limit of the scar was, at the most, 1 cm beyond the level of the nipples, and was difficult to observe in typical open-necked shirts. We believe our method is suitable in fulfilling the cosmetic needs for eligible children.
Divided right atrium (‘cor triatriatum dexter’) with azygous drainage of the superior caval vein
Authors: Mühler Eberhard G. , Franke Andreas , Messmer Bruno J. 
Published: August 2008

SummaryWe describe the symptoms, the techniques for imaging and the surgical therapy in a patient with divided right atrium (‘cor triatriatum dexter’) combined with atresia of the superior caval vein. In addition to peripheral venous congestion and cyanosis, macrocephaly was the most prominent sign, the high pressure in the superior caval vein disturbing the circulation of cerebrospinal fluid. Transesophageal echocardiography was the optimal technique for imaging the dividing shelf in the right atrium. Cardiac catheterization after surgical excision of the shelf and reconstruction of the junction between the superior caval vein and the right atrium excluded any residual gradient or shunt.
Benign congenital cardiac tumor associated with a ‘malignant’ cardiac malformation
Authors: Davis Andrew M. , Silver Meredith M. , Freedom Robert M. 
Published: August 2008

SummaryWe describe a multicystic tumor of the atrial septum associated with a fatal cardiac malformation. The tumor contained bronchogenic cysts and two types of vascular hamartomas. A complex form of double outlet right ventricle was present. We speculate that this tumor formed at a critical time in cardiac embryogenesis and contributed to the abnormal formation of the heart.
Endovascular stenting of the left pulmonary artery using the Strecker stent
Authors: van Oort Anton , Tanke Ronald , van de Kaa Christine 
Published: August 2008

AbstractAn intravascular stent was successfully implanted in a 15-year-old gid with stenosis of the left pulmonary artery subsequent to a modified Fontan correction. Complaints of tiredness, edema, ascites and enlargement of the left breast disappeared. Unfortunately, she died of a rhythm disturbance unrelated to the stent. Autopsy revealed excellent endothelialization of the stent without any thrombosis and with patency of the orifice of the branch to the upper lobe of the lung.
Combined construction of bidirectional cavopulmonary and aortopulmonary shunts as an intermediate stage in the repair of an 18-year-old high-risk Fontan candidate
Authors: Yamagishi Masaaki , Kurosawa Hiromi , Hashimoto Kazuhiro 
Published: August 2008

AbstractA combined procedure of a bilateral bidirectional cavopulmonary shunt and a central aortopulmonaiy shunt was performed on an 18-year-old boy with pulmonary atresia. Arterial oxygen saturation was elevated after the combined shunt, whereas the ventricular stroke work was reduced. Such a combined shunt is a useful alternative prior procedure which does not produce ventricular overload in older or higher-risk candidates for the Fontan procedure.
Inflammatory lung disease in a patient with tricuspid atresia palliated by a Glenn anastomosis
Authors: Thorne Sara , Somerville Jane 
Published: August 2008

SummaryA 37-year-old man with tricuspid atresia, in whom a chronic right apical aspergilloma had stimulated formation of extensive aortopulmonary collateral circulation, suffered reversal of flow within his long-standing fistulous Glenn anastomosis. By reversing the flow through the pulmonary arteriovenous fistula and raising oxygen saturation in the right atrium, the acquired aortopulmonary collateral circulation prevented the increase in cyanosis which usually occurs when fistulous changes develop late after the Glenn operation.
Percutaneous retrieval of a broken pacemaker fragment from the superior caval vein in a child
Authors: Karaaslan Sevim , Çeliker Alpay , Günal Nazlihan 
Published: August 2008

SummaryThe increase in use of endovascular devices in the treatment and diagnosis of malformations of the cardiovascular system has created a need for another device suitable for retrieval of dislodged catheters or fragments in children. We describe the use of a snare made of nickel-titanium (nitinol) cable for retrieval of a broken pacemaker electrode lodged in the superior caval vein.
Anomalous muscle bundle in the left ventricle causing subaortic obstruction
Authors: Kothari Shyam S. , Iyer Krishna S. 
Published: August 2008

AbstractWe report a 14-year-old boy in whom an anomalous muscle bundle in the left ventricle caused subaortic obstruction. It was diagnosed by echocardiography and resected at operation. The anomalous muscle most likely represents the hypertrophied anterolateral muscle bundle.
Cardiopulmonary reponse to exercise after the Fontan Operation—a cross-sectional and longitudinal evaluation
Authors: Mertens Luc , Rogers Ralph , Reybrouck Tony , Dumoulin Monique , Vanhees Luc , Gewillig Marc 
Published: August 2008

AbstractThe purpose of this study was to assess cardiorespiratory responses to submaximal exercise in patients with univentricular atrioventricular connection after the Fontan operation, and to evaluate whether changes occur during medium-term follow-up. Eighteen patients (age 12.1±5.5 years) underwent graded exercise test on a treadmill 2.3±1.4 year after the Fontan repair. Ventilatory gases were measured using breath-by-breath analysis. Results were compared to gender/age-matched controls. Twelve patients (age 14.2±5.4 years) were reevaluated 2.4±2.1 years after the first test. Aerobic exercise performance was subnormal in all patients during the first test. At the lowest level of exercise, the ventilatory threshold was already surpassed in 6/18 patients, while it was reduced in all other patients (p<0.001). All patients were in stable sinus rhythm throughout the test. Heart rate at all exercise levels was ±10% below normal (p<0.05). The respiratory frequency was increased at all exercise levels (p<0.001). The ventilatory equivalent for oxygen was increased (p<0.001), and the end-tidal tension of carbon dioxide was decreased (p<0.001). The ratio of physiological dead space/tidal volume was increased in all patients (p<0.001), while the normal decrease of this ratio during exercise was not observed. Upon reevaluation heart rate, respiratory rate, oxygen uptake, venti latory equivalent for oxygen, end-tidal carbon dioxide tension and physiological dead space did not change signifi cantly. Only a slight further decrease in ventilatory threshold was observed. Aerobic performance after the Fontan procedure ranges widely from just above resting metabolic rate to the lower limit of normal. Dyspnea during exercise is exacerbated by a decreased ventilatory threshold, increased physiological dead space, and decreased respir-atory efficiency. Cardiorespiratory response to exercise, nonetheless, remains relatively stable during medium-term follow-up.
Evaluation of coronary arterial patterns in complete transposition by laid-back aortography
Authors: Yoo Shi-Joon , Burrows Patricia E. , Moes C. A. Frederic , MacDonald Cathy , Williams William G. , Houde Christine , McCrindle Brian W. , Freedom Robert M. , Benson Lee 
Published: August 2008

AbstractFor the visualization of the coronary arterial patterns in complete transposition (concordant atrioventricular and discordant ventriculoarterial connections), balloon occlusion aortography has been performed in right and left anterior oblique or in frontal and lateral views. These views, however, are often unsatisfactory because of super-imposition of the aortic sinuses. The so-called “laid-back” view is a newly developed angiographic projection in which the aortic sinuses and the intervening commissures are imaged as if they were seen from below and the front. We performed such laid-back aortography in 36 consecutive patients with an echocardiographic diagnosis of complete transposition. In 23 of 36 patients, we obtained additional aortograms in right and left anterior oblique views. For the evaluation of the diagnostic value of the laid-back view, as compared with that of the combined right and left anterior oblique views, both sets of aortograms were reviewed independently by the five reviewers who were asked to make a diagnosis and to specify their levels of confidence (“definite,” “probable,” and “possible”) for their diagnosis. Error rates were significantly lower for the laid-back aortograms than for the combined right and left aortograms (4 and 11%, respectively). An increased level of confidence was significantly associated with the laid-back aortograms. We illustrate the anatomy of various coronary arterial patterns seen by laid-back aortography.
Arrhythmias after surgical correction of complete transposition—follow-up into adolescence
Authors: Hutter Paul A. , Baars Menno W. , den Boer Karin T. , van den Haak Ronald F. F. , Harinck Eric , Kingma J. Herre , Benatar Avram A. , Meijboom Erik Jan 
Published: August 2008

SummaryThe long-term natural progression of cardiac rhythm and the incidence of serious arrhythmias in relation to previous procedures and associated heart defects were studied in a group of 76 patients after an arterial switch operation for complete transposition and compared to a group of 24 patients who had undergone intraatrial corrections (Mustard or Senning operation). Standard and 24-hour ambulatory electrocardiograms were reviewed. Mean follow-up was 7.9 years (range 2-16) after an arterial switch and 15.2 years (range 6-26) following the Mustard or Senning procedures. One patient died after an arterial switch from pulmonary hypertension (age 9.9 years), and three patients died suddenly, presumably from arrhythmias, following atrial redirection procedures (ages 13, 18 and 20 years). Symptomatic arrhythmias were not seen after the arterial switch operation. Three patients required pacemaker implantation after atrial redirection, and a further two required medication to control tachyarrhythmias. Survival analysis of sequential electrocardiograms showed a mean maintenance of sinus rhythm during 12.9 years (95% confidence interval 11.4-14.5) after the arterial switch and 9.0 years (7.3-10.7) after atrial procedures (p=0.003). Development of heart rate was significantly different (p=0.001), with higher rates in adolescents after an arterial switch. Twenty-four-hour recordings were abnormal in five of 72 patients following arterial correction, disclosing excessive ventricular extrasystoles in four (three monomorphic, one polymorphic) and a wandering pacemaker in one. After atrial procedures, 11 of 19 were abnormal (p<0.001), with sinus or atrial bradycardia in eight, atrial flutter in two, and monomorphic ventricular tachycardias in one. Abnormal findings on either 12-lead or 24-hour electrocardiograms were seen in 22% of patients following an arterial switch procedure and 83% of patients undergoing atrial redirection (p<0.001). Sinus rhythm, therefore, is preserved longer and arrhythmias are less frequent and less severe after the arterial switch operation than after the Mustard or Senning operations.
Etiology and danger of pericardial effusion in infants and children
Authors: Zreik Hani , Li Jennifer , Garson Arthur T. 
Published: August 2008

SummaryPericardial effusion requires attention because of its underlying pathology and its potential for producing hemodynamic compromise. It was our hypothesis that the etiology of and danger from large pericardial effusions are different at different ages. We reviewed the clinical data on 44 consecutive patients seen between 1986 and 1993. All (age range 0-19 years) had a large pericardial effusion identified by echocardiography, and 38 had fluid available for analysis, pericardiocentesis in these cases being undertaken on the basis of the clinical decision of the attending physician. History, physical examination, chest x-ray, electrocardiogram, and echocardiographic Doppler findings were evaluated retrospectively. Of the patients, 17 presented with tamponade. Of the 14 patients aged less than one year, 12 had tamponade (85%), whereas in the 30 patients older than one year, only five (16%) had tamponade. Surgical drainage was needed in seven patients. Typical physical and electrocardiographic findings (distant heart sounds, pericardial friction rub, decreased QRS voltage, and ST-T wave abnormalities) were present in less than half the patients. Etiologies of the effusion included infection in 10 (four less than one year old, and six greater than one year of age). Among these, two unusual pathogens were detected: Mycobacterium avium-intracellulaire and Candida tropicalis. In eight patients, the effusion was due to trauma (six less than one year old, and two older than one year), and in 11 it was due to post-pericardiotomy syndrome (two less than one year of age and nine older than one year). Malignancy was the cause in six (all older than one year of age), radiation in two, and collagen vascular disease, drug induced, and uremia in one each, all older than one year. Only three patients had idiopathic effusions (6%). These data suggest that, unlike adults, an etiologycan be found in most children with large pericardial effusions. Those less than one year of age are much more likely to present in cardiac tamponade.
False aneurysm of the pulmonary trunk complicating complete transposition and presenting as pyrexia of unknown origin
Authors: Gerlis Leon M. , Hirsch Rafael , Somerville Jane 
Published: August 2008

SummaryA patient with complete transposition and a ventricular septal defect was clinically improved by an atrial septectomy at nine years but continued sepsis in the thoracotomy scar resulted in blood-stream infection with Staphylococcus aureus at the age of 24 years. A deep nylon suture was found and removed at surgical exploration. Five months later she again became febrile and had a vasculitic skin rash which responded to antibiotic therapy. At that time she was cyanosed and had a restricted exercise tolerance and was found to have aneurysmal dilatation of the pulmonary trunk. A year later she had acute chest pain with increased breathlessness, fever, hepatomegaly and pulmonary regurgitation. The fever did not respond to antibiotic therapy and she died suddenly following removal of a Hickman line. At postmortem examination, there was found to be a false aneurysm in the mediastinum due to rupture of the aneurysmal pulmonary trunk. No evidence of infection was found and it was considered that the low grade pyrexia had been due to the large hematoma within the false aneurysm.
Large blood cyst causing severe left ventricular obstruction in a fetus
Authors: Cook Andrew C. , Fagg Nuala L. K. , Sharland Gurleen K. 
Published: August 2008

SummaryA case of left ventricular obstruction is reported in a fetus of 21 weeks gestation. Obstruction to the left ventricular inflow and outflow tracts was documented by prenatal echocardiography and, at autopsy, the cause was found to be a large blood cyst. It is likely that the associated hypoplasia of the left heart was a result of reduced blood flow beyond this obstructive lesion.
Supravalvar stenosing tricuspid ring in congenitally corrected transposition
Authors: Gladman Gordon , Casey Frank , Adatia Ian 
Published: August 2008

SummaryWe report an unusual case with discordant atrioventricular and ventriculoarterial connections. In addition to the commonly associated intracardiac anomalies ofventricular septal defect and subpulmonary tissue tags, a supravalvar ring was present above the left-sided, morphologically tricuspid valve. This case highlights the value of color flow Doppler echocardiography in making the diagnosis, particularly as the supravalvar ring was seen poorly angiographically.
Basilar arterial migraine—a substrate for non-hypotensive syncope
Authors: Moran Adrian M. , Arnold Lucy W. , Saul J. Philip 
Published: August 2008

AbstractSyncope occurring simultaneously with documented normal blood pressures has been termed “psychogenic” in some patients. Two cases of basilar arterial migraine are presented, both with a diagnosis of syncope and documented normal blood pressures during the syncopal episodes. These findings highlight that syncope seen in the setting of basilar migraine is a variant from the typical form of neurally mediated syncope or cardiac arrhythmia. There is a need to consider the diagnosis of migraine when normal blood pressures and heart rates are recorded during such syncopal episodes.
Cervical aortic arch with anomalous origin of the left subclavian artery from Kommerell's diverticulum
Authors: Norgård Gunnar , Gerlis Leon , Tulloh Robert 
Published: August 2008

SummaryWe report here a patient with right cervical arch and anomalous origin of the left subclavian artery from the diverticulum of Kommerell. This uncommon abnormality can give rise to symptoms due to compression of the trachea and esophagus. Unlike right aortic arch with mirror image pattern of branching, however, this abnormality is seldom associated with intracardiac defects. Most patients are asymptomatic, and surgery is indicated only if severe symptoms are present.
Left-sided hepatic vein connected to the coronary sinus
Authors: Király László , Deanfield John E. , de Leval Marc R. 
Published: August 2008

AbstractA left-sided hepatic vein connected to the coronary sinus is reported in a case of a 22-month-old boy with isomerism of the left atrial appendages, complete atrioventricular septal defect and azygous continuation of the inferior caval vein. The diagnosis of the anomalous hepatic vein was made intraoperatively and successful biventricular repair has been accomplished. To the best of our knowledge, this is the first communication on this peculiar entity diagnosed during life, notwithstanding Nabarro's description of a similar autopsy finding in 1903. Aspects of the development of this rare entity are discussed.
The bidirectional Glenn and Fontan procedures—integrated management of the patient with a functionally single ventricle
Authors: Mainwaring Richard D. , Lamberti John J. , Moore John W. 
Published: August 2008

AbstractThe Fontan procedure provides a means of separating the systemic and pulmonary circulations in patients with congenital heart defects characterized by a functionally single ventricle. The procedure has undergone numerous changes since its introduction 25 years ago. Technical modifications have now increased its applicability to virtually all forms of univentricular atrioventricular connection, as well as many hearts with biventricular connections. More recently, philosophical changes have been introduced to address increased rates of morbidity and mortality observed in certain subsets of patients. These changes appear to have improved short- and midterm results. The purpose of this review is to offer our strategy for management of such patients. We will discuss the interrelationship between the bidirectional Glenn and Fontan procedures. We will also focus on a number of observations concerning the possible role of accessory pulmonary blood flow, aortopulmonary collateral arteries, and endocrinologic changes.
Maximal exercise test in long-term follow-up after atrial redirection for complete transposition in a population-based cohort
Authors: Gilljam Thomas , Eriksson Bengt O. 
Published: August 2008

AbstractIn western Sweden, less than one-third of children born with complete transposition between 1964 and 1983 are long-time survivors. During bicycle ergometry, using a steady-state protocol with analyses of the expiratory gases and lactate, we investigated the exercise capacity in survivors of atrial redirection. There were 16 patients who had a Mustard procedure, now aged 16.9±3.6 years (12.0–22.0) and 15 patients who underwent a Senning correction aged 9.4±1.6 years (7.2–12.1). Nineteen percent of Mustard cases and 53% of Senning cases had minor or no sequels. Moderate sequels were found in 44% of post-Mustard cases, and 40% of post-Senning cases, including baffle complications, moderate systemic ventricular dysfunction, sinus node dysfunction and tracheal stenosis. Severe problems were encountered in 37% of post-Mustard cases and 7% of post-Senning cases, including pulmonary hypertension, pulmonary venous obstruction, atrioventricular block and hemiparesis. The maximal exercise capacity was low (p<0.0001); 71% had an oxygen uptake below −2 SD of predicted values, with severely impaired oxygen uptake in all except one of the cases with severe sequels, but no significant difference was found between patients having mild and moderate sequels. The maximally achieved heart rate was low (p<0.0001); 71% had values below −2 SD of predicted, including all cases with sinus nodal dysfunction, as well as 40% of cases without it. The maximal oxygen pulse was low (p<0.01), below −2 SD in 36%, but it was less affected than other exercise variables in 68% of the patients. Our study, therefore, presents exercise data in an epidemiologically-based population, relates the data to postoperative sequels and discusses some possible adaptive mechanisms.