bluuebunny/crossref_metadata_2025_split huggingface dataset:
Closure of the ventricular component of an atrioventricular septal defect during fetal life
Authors: Sharland Gurleen Kaur , Qureshi Shakeel Ahmed 
Published: August 2008

SummaryA case of a complete atrioventricular septal defect was detected in a 20-week gestation fetus, in whom the ventricular component of the defect was subsequently noted to close spontaneously with advancing gestational age. The antenatal and postnatal findings are discussed.
Congenital anomaly of the right coronary leaflet complicated by infective endocarditis
Authors: Benatar Avram , Bennink Ger , van de Wal Henry 
Published: August 2008

AbstractA congenital defect of the right coronary leaflet (fenestration) is an unusually rare cause for aortic incompetence in childhood. We report an eight-year-old child with such an anomaly who presented with infective endocarditis of the left ventricle. The importance of excision of the vegetation prior to the occurrence of life-threatening embolic complications is discussed.
Development of right ventricular outflow tract obstruction after double-lung transplantation for primary pulmonary hypertension
Authors: Saylam Gül Sagin , Somerville Jane 
Published: August 2008

SummaryWe present a patient with primary pulmonary hypertension who had unusually high pulmonary arterial pressure prior to double-lung transplantation. Obstruction of the right ventricular outflow tract developed after transplantation and progressed over the subsequent two years.
Aortic atresia with normal left ventricle and intact ventricular septum—a major form of subaortic stenosis complicating an atrioventricular septal defect with intact septal structures
Authors: Houyel Lucile , Zupana Véronique , Roset Françoise 
Published: August 2008

SummaryWe report an unusual form of aortic atresia with a normal sized left ventricle, intact ventricular septum and isolated cleft of the left atrioventricular valve, with abnormal attachments creating both subaortic atresia and massive regurgitation across the left atrioventricular valve. This combination, never described before as far as we are aware, can be considered as an extreme form of subaortic stenosis complicating a very particular type of atrioventricular septal defect.
Tetralogy of Fallot with pulmonary atresia associated with aortopulmonary window and major aortopulmonary collaterals
Authors: Bhagwat A. R. , Pinto R. J. , Sharma Satyavan 
Published: August 2008

SummaryWe report a patient with tetralogy of Fallot and pulmonary atresia in whom the predominant extracardiac supply of arterial blood was via an aortopulmonary window. Major aortopulmonary collateral arteries originating from the descending thoracic aorta provided an additional source of pulmonary blood flow. The patient underwent successful correction and the postoperative recovery was uneventful.
Surgical treatment of Ebstein's malformation—the ‘Hôpital Broussais’ experience
Authors: Chauvaud Sylvain M. , Mihaileanu Serban A. , Gaer Julian A.R. , Carpentier Alain C. 
Published: August 2008

AbstractEbstein's malformation is usually treated by replacing the tricuspid valve, albeit with controversial results. The “Carpentier technique,” introduced in 1980, offers both a new classification and new surgical methods for treatment of this lesion. The classification is based on the severity of the displacement of the septal and posteroinferior leaflets, with four grades of increasing severity. The surgical techniques involve mobilization of the anterosuperior leaflet, reduction of the diameter of the annulus, and longitudinal plication of the atrialized part of the right ventricle. Following this approach, 64 patients underwent consecutive surgical evaluation, with only one valvar replacement. The mean age was 26±15 years. The hospital mortality was nine percent. The mean follow-up is now 5.18±3.25 years. The actuarial survival rate was 87% at one year and 82% at five and 10 years. Of the patients, 90% were in postoperative functional class I or II. Control echocardiography revealed either no insufficiency, or minimal regurgitation in 80%. A second operation was needed in six patients because of right ventricular failure (two patients) or recurrence of valvar insufficiency (four patients). Sinus rhythm was present in 44 (88%) of the surviving patients. We conclude that repair of the malformed tricuspid valve, associated with longitudinal plication of the right ventricle, is safe and efficient. The prognosis depends on right ventricular contractility, which should be evaluated carefully before and after the operative procedure.
Evidence for time-dependent autonomic cardiac reinnervation in children subsequent to transplantation of the heart
Authors: Kreuder Joachim , Netz Heinrich , Paul Thomas , Müller Andreas , Bauer Jürgen , Repp Reinald 
Published: August 2008

AbstractAutonomic denervation has been assumed to persist after orthotopic heart transplantation. Analyzing spontaneous and induced variations of heart rate, the status of autonomic cardiac innervation was investigated in six children 19–37 months after cardiac transplantation. The age at the time of transplantation varied from three weeks to 15.4 years. Heart rate variability was assessed on 24-hour Holter recordings by calculating time-domain indices (standard deviation of all RR intervals; standard deviation of the mean RR intervals from successive five-minute periods; mean of the standard deviations of RR intervals from successive five-minute periods; proportion of adjacent RR intervals > 50 msec different; square root of mean square successive differences in RR intervals) and frequency-domain variables (low frequency power, high frequency power and total spectrum power). Sinus node recovery time, sinoatrial conduction time and post-pacing cycle lengths were examined at different rates of endocardial atrial pacing. After the first year subsequent to transplantation, standard deviation of the mean RR intervals reached the normal range in four patients, whereas the other time-domain variables became normal in two patients. Both patients displayed normal or near-normal power spectrums of heart rate with normal day-to-night variations. For the remaining patients, spectrums of heart rate failed to show the main frequency peaks. Only the patient with normal variability in heart rate exhibited a decrease in corrected sinus node recovery time at higher stimulation rates, shortening of the first recovery cycle below the pre-pacing level, and a rapid decline of the accelerated post-pacing heart rate as described in innervated hearts. These results suggest the evolution of time-dependent efferent autonomic reinnervation after cardiac transplantation in children.
Repaired aortic coarctation in adults—magnetic resonance imaging with velocity mapping shows distortions of anatomy and flow
Authors: Kilner Philip J. , Shinohara Tokuko , Sampson Cynthia , Mohiaddin Raad H. , Firmin David N. , Somerville Jane 
Published: August 2008

AbstractMagnetic resonance velocity mapping of intraaortic flow was performed prospectively in adolescents and adults after coarctation repair. The aims were to assess the feasibility and clinical usefulness of the technique in this patient group, and to study flow velocity distributions in repaired regions. Twenty consecutive patients attending for follow-up after repair of aortic coarctation, aged 15–39, mean 25 years, were studied using a 0.5 tesla Picker magnetic resonance machine. Spin echo and cine imaging with phase velocity mapping, echo time 3.6 ms, were used to study anatomy and flow in the repaired region. Transcutaneous ultrasonic examination, with continuous wave Doppler velocity measurement was performed independently on the same day. Velocity maps, acquired successfully in all patients, showed asymmetry and nonhomogeneity of flow in relation to anatomical distortions of repaired regions. Magnetic resonance and Doppler measurements of peak velocity compared as follows: n=20, range 1.2–3.9 m/sec, mean 2.33 m/sec, mean of differences (Doppler-MR) 0.22 m/sec, standard deviation of differences ±0.27 m/sec. Localized velocity peaks adjacent to wall deformations were identified by magnetic resonance in five patients without significant restenosis. Magnetic resonance imaging with velocity mapping proved reliable and informative in follow-up assessment in adolescents and adults after surgical repair of aortic coarctation. There was satisfactory agreement between magnetic resonance and Doppler measurements of peak velocity. Velocity maps showed that localized velocity peaks may occur in limited parts of the stream adjacent to distorted aortic boundaries without stenosis. This could be a cause of overestimation of pressure gradients from peak velocity data, a possibility which requires further investigation.
Irregular heart rate in the fetus—not always benign
Authors: Simpson John M. , Yates Robert W. , Sharland Gurleen K. 
Published: August 2008

SummaryOne hundred-ninety-four fetuses with irregular heart rates were seen over a five-year period at a tertiary center for fetal cardiology. The median gestation at referral was 31 weeks, with a range from 19 to 41 weeks. Of these fetuses, 157 had extrasystoles of either atrial or ventricular origin. Blocked atrial ectopic beats had led to slow ventricular rates (80–110 beats per minute) in 37 fetuses. The structure of the heart was normal in all except two fetuses. Postnatal outcome was known for 165 of the fetuses. Of these, 157 (95%) had an uneventful antenatal and postnatal course. Tachyarrhythmias developed in eight fetuses (5%) in either the prenatal (n=4) or postnatal (n=4) period. Five of 37 fetuses with blocked atrial ectopic beats (13%) developed a tachyarrhythmia. No fetus developed hydrops, and all infants survived. All cases had required treatment with antiarrhythmic drugs. The occurrence of an irregular heart rhythm in the fetus, therefore, is not always benign. Fetuses with blocked atrial ectopic beats require particularly close monitoring.
Serial echocardiographic Doppler evaluation of diastolic function in the normal human fetus
Authors: Weber Howard S. 
Published: August 2008

AbstractThe assessment of diastolic function in the developing fetus is difficult because of constantly changing conditions of loading. Previous reports suggesting improved ventricular compliance with fetal development are limited by the Doppler indices utilized. Using load-dependent and independent variables, we examined and compared serially right and left ventricular diastolic function in 11 normal fetuses (44 echocardiographic studies) at 22±1.0 weeks; 30±1.0 weeks; 36±1.0 weeks of gestation and 64±25 hours postnatally. Load-dependent indices included early to late time velocity integral ratios and percentage of early filling to total diastolic filling. The load-independent index was the peak filling rate normalized to the total time velocity integral. Both right and left ventricular time velocity integral ratios were similar initially, and shifted from late to early diastole with increasing gestational age (greater ratios). The shift in left ventricular ratios was greater, and increased earlier in fetal development. The right ventricular normalized peak filling rate decreased with increasing gestational age, while the left ventricular normalized peak filling rate remained constant, but was greater than the right ventricular rate postnatally. Both right and left ventricular filling shifts from late “active” to early “passive” diastole during fetal development. Left ventricular ratios are greater and increase earlier in fetal development, likely influenced by changes in preload. The right and left ventricular normalized peak filling rates were similar prenatally, indicating similar diastolic filling properties, but disparate postnatally, consistent with improved left ventricular relaxation immediately preceding or at the time of onset of transitional circulation.
Relationship between scooping of the ventricular septum, morphology of the inferior bridging leaflet and electrocardiographic findings in atrioventricular septal defect with common valvar orifice
Authors: Suzuki Kiyoshi , Tatsuno Katsuhiko , Mimori Shigekazu , Murakami Yasuo , Mori Katsuhiko , Takahashi Yukihiro , Kikuchi Toshio 
Published: August 2008

AbstractWe described previously that the degree of deficiency of the ventricular septum (scooping) affects electrocardiographic findings in atrioventricular septal defect with separate right and left atrioventricular orifices. The aim of this study was to clarify the clinicomorphological relationships of the degree of scooping, the precise morphology of the atrioventricular valve, and electrocardiographic findings in hearts having a common atrioventricular orifice. In 63 patients with usual atrial arrangement, the outlet, scoop and inlet dimensions of the ventricular septum were measured by biplanar cineangiography and were compared with the body surface area. The scoop/outlet ratio and inlet/outlet ratio were also compared with the body surface area, atrioventricular valvar morphology, electrocardiographic findings, and severity of regurgitation of the atrioventricular valve. The results showed that the three individual dimensions of the septum correlated significantly with the body surface area, even though the scoop/outlet ratio and inlet/outlet ratio did not. A correlation was found between the scoop/outlet ratio and the degree of left axis deviation on the electrocardiogram (r=0.74, p<0.001). In 16 patients with division of the inferior bridging leaflet, there was a lower scoop/outlet ratio than in the remaining 37 with an undivided bridging leaflet (p<0.01). Of 24 patients with counterclockwise rotation in the horizontal loop of the vectorcardiogram, 22 had an undivided inferior bridging leaflet (p<0.01). The morphology of the superior bridging leaflet, in contrast, was not associated with the scoop/outlet ratio, and neither was the severity of valvar regurgitation. We conclude that the degree of scooping of the ventricular septum is related not only to electrocardiographic findings, but also to the morphology of the inferior bridging leaflet in atrioventricular septal defect with common atrioventricular orifice.
Diagnostic findings and outcome in children with primary restrictive cardiomyopathy
Authors: Neudorf Ulrich , Bolte Angelika , Lang Dieter , Hentrich Frank , Schmaltz Achim A. 
Published: August 2008

SummaryRestrictive cardiomyopathy is a rare disease in children and adolescents. We have now encountered eight such cases in infants and children aged between nine months and 14 years. The reasons for admission to hospital were not very specific and included recurrent bronchitis, thoracic deformity, pathologic findings on routine electro-cardiography, or signs of cardiac failure. Despite two cases with atrial flutter, the characteristic electrocardiographic sign was a P-wave in lead II of about 0.6 to 1.5 m V. Echocardiographically, the leading feature was enlargement of the atriums, seen in cross-sectional and M-mode tracings. Diameters and functional parameters for the left ventricle, and the EF-slope of the mitral valve were normal. In four patients examined specifically for diis aspect, a typical E/A-ratio was found. Cardiac catheterization was performed in all patients. Left atrial or pulmonary capillary wedge pressures were all abnormal, and pulmonary arterial pressures ranged from 30 to 60 mm Hg. Calculated pulmonary resistances were 3 to 12 units per meter squared. End-diastolic left ventricular pressures were elevated, while comparable right-sided pressures were normal. Percutaneous endomyocardial biopsy was done in six patients and performed as an open biopsy in two. Only unspecified signs, such as myocytic hypertrophy or interstitial fibrosis, were found. At present, five of the children have died within two years of diagnosis. One boy has undergone cardiac transplantation success-fully. The two youngest children are still alive. As there is such a poor prognosis, and no alternative specific therapy is known, cardiac transplantation must be discussed with the family at an early stage, emphasizing its consequences.
The clinical impact of percutaneous balloon expandable endovascular stents in the management of early postoperative vascular obstruction
Authors: Hatai Yoshiho , Nykanen David G. , Williams William G. , Freedom Robert M. , Benson Lee N. 
Published: August 2008

AbstractTo assess the clinical impact of percutaneously implanted balloon expandable endovascular stents on patient management, we reviewed 20 children aged 14 days to 4.8 years (median 1.3 years) with residual vascular obstructions in the immediate postoperative period. Patients included 11 with pulmonary arterial stenosis, five with stenosis of venous pathways after a modified Fontan procedure or bidirectional cavopulmonary anastomosis, and four with a restrictive modified Blalock-Taussig shunt. Placement of the stent was optimal in 18 of 20 patients (24 of 26 Palmaz or Palmaz-Schatz implants). In two patients, rupture of the balloon resulted in malposition of the stent. Reoperation was avoided and symptomatic improvement was noted in 11 of 20 patients (55%), while procedural complications occurred in eight patients. Seven of 10 patients presenting with a low cardiac output syndrome died despite relief of the obstructions. This early experience supports consideration of the application of these devices in the management of significant vascular obstructive lesions in the immediate postoperative period, thus avoiding early reoperation in this profoundly compromised population.
Arterial morbidity following interventional balloon dilation procedures
Authors: Barlow Amanda , Menahem Samuel , Wilkinson James L. 
Published: August 2008

SummaryInterventional catheterization procedures performed via the arterial route are well recognized therapies which are being employed with increasing frequency. This review summarizes our experience with local arterial complications of such procedures performed on 44 patients in our institution since 1985. A total of 51 balloon dilations were performed. All patients were heparinized during the procedure. Twenty-one procedures (41%) were followed by clinical evidence of reduced arterial circulation to the affected leg more than four hours after the procedure. Continuing infusion of heparin was used in 17 patients, with return of the pulse concerned in six, while two further patients developed evidence of arterial obstruction after an interval (having initially been found to have ‘satisfactory’ pulses at the end of the procedure). The final infant, whose femoral artery had been torn and could not be repaired, was observed without continuing heparinization. Streptokinase and/or tissue plasminogen activator was employed in eight patients, with resultant success in four. The remaining three, and three who failed thrombolytic therapy, underwent embolectomy. The incidence of arterial damage was related to the size of the catheter (assessed by the size of sheath required to introduce the collapsed balloon, indexed to body surface area) and to low weight or young age at the time of the procedure. No relationship could be established with other variables, including operator, type of catheter, or year or duration of procedure. At long-term follow-up, 11 (22%) patients still have absent or reduced pulses in the leg concerned. Arterial damage following interventional catheterization procedures remains a frequent occurrence despite increasing experience and technical improvements.
Cardiac catheterization in children on extracorporeal membrane oxygenation
Authors: Ettedgui José A. , Fricker F. Jay , Park Sang C. , Fischer Donald R. , Siewers Ralph D. , del Nido Pedro J. 
Published: August 2008

SummaryThere are limited reports in the literature that address the unique issues related to cardiac catheterization on extracorporeal membrane oxygenation. Since 1990, cardiac catheterization has been performed on nine patients on extracorporeal membrane oxygenation. The median age was 10 months (range four days to 18 years) and the median weight was 4 kg (range 2.3–73.8 kg). The indications for catheterization were to relieve pulmonary edema in five patients with severe left ventricular dysfunction, and in one instance each, evaluation of probable anomalous left coronary artery, tetralogy of Fallot associated with a diaphragmatic hernia, possible pulmonary venous abnormalities, and postoperative evaluation after an arterial switch. Venous access was obtained through a preexisting femoral venous line in six patients, and through a cutdown of the saphenous or femoral vein in the other three. Interventional catheterization procedures were performed in six of the nine patients in this group. These consisted of blade atrial septostomy followed by balloon septostomy or dilation of the atrial septum in four patients, balloon septostomy alone in one, and placement of a catheter from the left atrium to the circuit used for extracorporeal oxygenation in another. A transseptal puncture was performed in five of them. Adequate decompression of the left atrium with relief of pulmonary edema was achieved in five patients. Six of the nine children in this group died, although there were no complications or deaths related to the catheterization. Children in cardiopulmonary failure on extracorporeal support represent a population at high risk. Diagnostic cardiac catheterization and atrial septostomy to decompress the left heart, when indicated, can be performed safely in such patients.
Postoperative complications after the Mustard operation for complete transposition—a qualitative evaluation with magnetic resonance imaging
Authors: Kaemmerer Harald , Theissen Peter , Schirg Eckart , Kaulitz Renate , Schicha Harald , Kallfelz Hans-Carlo 
Published: August 2008

AbstractLong-term follow-up studies after intraatrial repair for complete transposition have shown postoperative morphologic and hemodynamic abnormalities in many patients which often require reevaluation and therapeutic intervention. The purpose of this study was to assess, using magnetic resonance imaging, the presence and extent of late postoperative complications in a large cohort of 44 patients undergoing repair with the Mustard procedure. Of these 34 had an intact ventricular septum with or without obstruction of the left ventricular outflow tract, while 10 had an associated ventricular septal defect. Transverse spin-echo and gradient-echo images were acquired of the entire heart from the diaphragm to the bifurcation of the pulmonary trunk. Additional oblique images were acquired for better visualization of venous connections. Abnormal findings were diagnosed by visual inspection of spin-echo and gradient-echo images, and diagnoses were compared to previous findings at cardiac catheterization. On magnetic resonance imaging, a baffle leak was seen in eight patients, two had pulmonary venous obstruction, four had obstruction at the caval veins, 23 had obstruction of the left ventricular outflow tract and 18 had tricuspid regurgitation. Cardiac catheterization showed a leak across the baffle in 16, pulmonary venous obstruction in two, obstruction at the caval veins in four, obstruction of the left ventricular outflow tract in nine, and tricuspid regurgitation in nine. We conclude that combined spin-echo and gradient-echo magnetic resonance imaging provides extensive noninvasive assessment of postoperative sequels and residuals in patients after the Mustard procedure for complete transposition.