Congenital intrapericardial aneurysms of the left atrium.
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A patient with congenital intrapericardial aneurysm/diverticulum of the left atrium diagnosed preoperatively is described. A review of the 16 previously reported cases revealed that the majority of the patients present with palpitation and are found to have an abnormal cardiac shadow on chest radiography, as did this patient. The aneurysm appears to cause systemic emboli and paroxysmal or persistent atrial tachyarrhythmias which are often resistant to medical therapy. The presence of the aneurysm is suggested by an abnormal contour of the left cardiac border in the postero-anterior chest radiograph and this can be confirmed by angiocardiography. Surgical excision of the aneurysm is indicated in all patients to prevent the occurrence or recurrence of systemic emboli and atrial arrhythmias. Our patient has remained free of symptoms since her operation 14 months ago. (+info)
Validity of echocardiographic estimates of left ventricular size and performance in infants and children.
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Echocardiography has been shown to be a reliable method for estimating left ventricular size and function in adults, but little attention has been paid to its application to infants and children. This paper describes a validatory study in 40 children aged between 4 days and 16 years. There was a significant correlation between angiocardiographic and echocardiographic estimates of left ventricular end-diastolic volume (r=0.76), left ventricular end-systolic volume (r=0.68), and ejection fraction (r=0.73). Left ventricular mean circumferential shortening rate (mean Vcf), however, gave the mostsignificant correlation (r=0.91). These findings indicate that while care must be exercised in interpreting indices of left ventricular size and performance derived from echocardiography, these measurements, and in particular mean Vcf, do offer a useful and reliable means of assessing left ventricular function in infants and children. (+info)
Mitral stenosis with posterior diastolic movement of posterior leaflet.
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The echocardiographic diagnosis of mitral stenosis depends in part on the demonstration of abnormal posterior leaflet movement to distinguish it from other conditions that similarly affect anterior leaflet motion. In mitral stenosis the posterior leaflet has been shown to move anteriorly in diastole rather than in the normal posterior direction. A patient presented with clinical evidence of moderate mitral stenosis. The anterior leaflet echo was typical but the posterior leaflet showed posterior diastolic movement. At catheterization moderate mitral stenosis was confirmed. To our knowledge this is the first report of the echocardiographic demonstration of posterior diastolic movement of the posterior mitral leaflet in documented mitral stenosis. (+info)
Double outlet right ventricle with 1-malposition of the aorta.
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Four patients are described with a recently recognized variant of double outlet right ventricle. Clinical examination favoured tetralogy of Fallot, but the chest X-ray suggested corrected transposition. Catheterization and angiocardiography showed that the aorta was to the left of the main pulmonary artery, and both arose from a normally positioned morphological right ventricle. Egress of blood from the left ventricle was through a subaortic ventricular septal defect. In all patients severe pulmonary stenosis was present and the right coronary artery ran an anomalous course anterior to the pulmonary valve ring. Two children had successful total correction, and one a palliative Blalock-Taussing shunt. Necropsy material from the fourth patient allowed confirmation of the ventricular morphology and the conducting tissued was examined. In corrective surgery, blood from the left ventricle was rerouted into the aorta by an intraventricular baffle. Pulmonary stenosis was relived by infundibulectomy and outflow tract patch. (+info)
New performed catheter for entry into pulmonary artery in complete transposition of great arteries.
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A new performed, semi-rigid, polyethylene catheter, with built-in torque control, has been devised for entry to the pulmonary artery in complete transposition of the great arteries. It has been used 19 times in 17 patients: 18 times the pulmonary artery was entered from the right atrium (via the left atrium and ventricle) in a time between 40 s and 15 min (median 5 min); the patients' ages were 2 days to 6 years (median 8 months) and their weights were 3.1 to 13.3 kg (median 6.9 (kg: in the remaining 1 day-old patient, the procedures was terminated because of atrial flutter. The catheter was introduced into the axillary vein in 3 patients and thesaphenous or femoral vein in the remainder. It is suitable for angiocardiography, and the other heart chambers and vessels were easily entered. Thus the catheter has certain advantages over previously described methods for entry to the pulmonary artery, particularly when there is inferior vena caval thrombosis, or when angiocardiography is necessary. Its use does depend on the presence of an interatrial communication, so a method for entry to the pulmonary artery by retrograde catheterization from the axillary artery using a different catheter is also presented; this was successful in 2 patients with ventriculal sepatal defect. (+info)
Isolated ventricular inversion with situs solitus.
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The clinical and anatomical findings in two patients with isolated ventricular inversion and situs solitus are described. The other 4 previously published cases are reviewed. The 6 patients with this malformation, all without pulmonary stenosis, presented a clinical picture of cyanotic congenital heart disease, associated with increased pulmonary blood flow (hypoxaemia and cardiac failure). The importance of different diagnostic tests is discussed and it is concluded that angiocardiography is the only definitive means of establishing the dianosis. Because the physiopathological disturbance is the same as in transposition of the great arteries, both malformations should be similarly considered with respect to diagnosis and treatment. Nevertheless, the high incidence of certain associated malformations in cases of isolated ventricular inversion adds to difficulty in diagnosis, and makes a good result from the Mustard procedure less likely than in transposition of the great arteries. (+info)
Studies in a newborn infant with supraventricular tachycardia and Wolff-Parkinson-White syndrome.
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A neonatal patient with Wolff-Parkinson-White type A and supraventricular tachycardia is described. Demonstration of the mechanism of the tachycardia and its termination were achieved using intracardiac electrography and cardiac pacing. Quantitative left ventricular angiography and echocardiography showed impaired left ventricular function following the arrhythmia. Serial echocardiograms demonstrated the subsequent return to normal left ventricular performance. (+info)
Aortic stenosis, angina, and coronary artery disease. Interrelations.
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Sixty-nine patients over age 35 with severe valvular aortic stenosis were investigated for concomitant coronary artery disease. Forty (57.9%) had clinical angina pectoris. Sixteen (23.2%) had significant coronary occlusive disease by arteriography. Of those with angina, 13 patients (32.5) had significant coronary arterial obstruction, while in the pain-free group only (10.3%) had occlusive coronary disease. It is concluded that patients with severe aortic stenosis who are free of angina have only a small, but definite, chance of having significant coronary disease. (+info)