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Biomedical subjects

A M Worms

Publications and source records attributed to A M Worms.

At least 73 records · Page 4Linked to original sources
PubMed1984

[Evaluation of the pulmonary artery and its branches by two-dimensional echocardiography in the tetralogy of Fallot and pulmonary atresia in infants. Angiocardiographic correlation and therapeutic implications].

Twenty-two infants aged 5 days to one year (mean: 3.8 months), consisting of 17 with tetralogy of Fallot and 5 with pulmonary atresia-ventricular septal defect, were prospectively investigated by two dimensional echocardiography (2 D echo) in order to evaluate the severity of the impairment of the pulmonary outflow tract and value of 2 D echo in the preoperative evaluation. Right pulmonary artery (PA), observed by angiography in 20 patients, was correctly recorded and could be measured in all cases (20/20), whereas the left PA was seen in 19 patients (19/20). Pulmonary confluence was recognized in 20/20 cases and its absence in 2 cases. In one patient without pulmonary confluence, a large substituted systemic vessel was mistaken for right PA. Echo established in the 22 patients (100%) the presence (17 cases) or absence (5 cases) of continuity between the right ventricle and the PA. Echo demonstrated 2 out of the 3 stenoses of the branches found by angiography. The internal diameter of PA measured by echo, ranging from 3 to 9 mm, was compared with angiographic measurements. A significant linear correlation was observed for each diameter (ring, trunk and branches) between the two techniques. However, echo slightly under-estimated the angiographic diameters. These results show that 2 D echo is a reliable method to determine the severity of impairment of the pulmonary outflow tract in infants with tetralogy of Fallot. They suggest that is may be used to guide the choice of surgical procedure and is adequate, in selected patients, to carry out a palliative intervention without open surgical procedure.

Angiocardiography↗
PubMed1984

Radiologic and echocardiographic patterns of 98 cases of atrial septal defect without other defects (isolated atrial septal defect).

We collected 98 cases of single atrial septal defect. Analytical study of the pulmonary vasculature and the shape of the heart allowed us to differentiate 71 cases of pulmonary hypervascularity with increased cardiothoracic index and an appearance of right ventricular dilatation. The left inferior segment was usually straight, but sometimes convex, with a great curvature including the middle left segment. Apart from these 71 typical cases, there were 18 cases of incomplete patterns, 7 cases of atypical patterns with a convex left inferior segment with a small curvature and two normal cases (normal shape of the heart and normal vasculature). - Echocardiography was performed in 35 cases. It was valuable in 34 cases and established the diagnosis each time the X-ray picture was uncertain. Increase of the ratio of the telediastolic diameter of the right to left ventricle is almost constant and the septal motion is paradoxical in 79% of all cases. - Post-operative change was characterized from the radiological point of view by rapid return to normal of the pulmonary vascularity, followed by decrease of the cardiothoracic index, while the modifications of the shape of the left middle and inferior segment regress slowly and incompletely. As for echocardiography there is constant decrease of the ratio of the telediastolic diameter of the right to left ventricle, while the septal motion returns to normal in 79% of all cases.

Adolescent↗
PubMed1984

[Abnormal origin of the anterior interventricular artery from the pulmonary artery responsible for a postinfarction left ventricular aneurysm in a 6-year-old girl].

The isolated abnormal origin of the anterior interventricular artery from the pulmonary artery with the circumflex artery, arising normally from the right coronary artery and implanting in the aorta is much less common than the origin of a common left coronary trunk from the pulmonary artery. The first condition is also better tolerated than the second. In the present case, the clinical tolerance was excellent, but there was, nevertheless, a complicated antero-apical necrosis of a left ventricular aneurysm, which was successfully resected at the same time as the reimplantation of the anterior interventricular artery into the aorta. The patency of the anastomosis was subsequently confirmed.

Child↗
PubMed1983

[Central and peripheral coronary-pulmonary fistulae. Apropos of 4 case reports].

The authors report four cases of fistulae between coronary arteries and the main pulmonary artery or its branches. Proximal fistulae, often considered with coronary-cardiac fistulae (between coronary arteries and cardiac cavities, usually in the right heart) probably result from accessory coronary buds originating in the truncus arteriosus, on its pulmonary part, as in anomalous coronary arteries stemming from the pulmonary trunk. Two such cases are reported, including one in a girl with severe congenital mitral insufficiency. Peripheral fistulae probably do not result from a single mechanism, and their congenital or acquired origin is often difficult to determine, especially in adults. Nevertheless, in a 54-year-old female with angina by coronary steal, without any associated pulmonary disease, the fistula is probably congenital. On the other hand, in a boy who had a Blalock operation for Tetralogy of Fallot, the fistula is probably acquired, as part of the collateral circulation which developed after pleuro-pericardial symphysis. Such fistulae usually do not require surgery except in cases of coronary artery steal, which are exceptional in children but not infrequent in adults.

Adolescent↗
PubMed1983

[Use of emergency 2-dimensional echocardiography in the diagnosis and maintenance of newborn and nursing infants hospitalized because of poorly tolerated cardiopathy. A prospective study of 82 cases].

The value of 2D echocardiography was assessed prospectively in 82 patients (average age 2.6 months) including 41 newborn babies, in the emergency investigation of cardiac distress. The recording was made before any other investigations or treatment and associated subcostal and supra sternal views, and the results were compared with angiography (64 cases) or anatomical findings (44 cases). A cardiac abnormality was excluded in 5 cyanotic newborn children (persistent foetal circulation) and a precise diagnosis was made in 74 of the remaining 77 patients (94 p. 100). All cases of malposition of the great vessels were recognised (17 cases). The diagnosis was based on the simultaneous recording of the vessels, proximal branches and their ventricular connections. In conditions with severe obstruction of the pulmonary outflow tract (26 cases), 2D echo enabled an exact evaluation of ventriculo arterial concordance, pulmonary confluence and a quantitative assessment of the diameter of the pulmonary artery in 25 patients. Angiography provided little further information, mainly concerning associated lesions (anterior muscular VSDs, abnormalities of the supra aortic vessels). On the other hand, 2D echocardiography was superior to angiocardiography for the study of the atrioventricular values and intracavitary and subvalvular obstruction. 2D echo is a reliable method for emergency assessment of the indication for therapeutic catheterisation (atrioseptostomy). In other cases it allows it to be deferred and guided. The comparison of the results of 2D echo and angiocardiography in this series suggests the possibility of reducing the number of endocavitary investigations in the newborn and infant in the future, even in cases where surgery is being considered.

Angiocardiography↗
PubMed1983

[Cardiovascular malformations associated with tetralogy of Fallot. Apropos of a series of 250 cases of tetralogy of Fallot].

This study was undertaken in 39 patients with Fallot's tetralogy associated with one or more cardiovascular malformations. Some common anomalies, simple anatomical variations were excluded (right sided aortic arch, patent foramen ovale). Out of a total of 48 anomalies (6 children had 2, 3 or 4 associated malformations) there were 5 anomalous systemic venous drainages (including 4 supernumerary left superior vena cava), 8 secundum atrial septal defects (including one multiperforated defect), 2 muscular ventricular septal defects, 7 atrioventricular canals (5 in mongol children); 1 tricuspid hypoplasia, 1 absent left pulmonary artery, 1 mitral valve prolapse, 1 obstructive cardiomyopathy, 10 coronary anomalies (including 5 ectopic left anterior descending arteries arising from the right coronary artery), 8 patent ductus arteriosus (arising from the left subclavian in 4 cases of right aortic arch), 3 retro oesophageal subclavian arteries and one congenital subclavian steal syndrome. The incidence of associated malformations was 15 p. 100, but values of up to 30 p. 100 have been reported mainly in anatomical studies. The authors emphasise the diagnostic and therapeutic implications of these associated malformations. In most cases, especially Fallot's tetralogy with an endocardial cushion defect, 2D echocardiography proved to be an essential diagnostic tool. Catheter studies, however, remain necessary, especially for the detection of aortic and coronary anomalies: selective coronary angiography is sometimes required. Difficult surgical problems are mainly encountered when the associated anomaly has not been diagnosed preoperatively. Although the variations of systemic venous drainage are not of great importance, those of the aortic arch can influence the technique of palliative procedures. Muscular VSD must not be missed. Tricuspid hypoplasia may pose a complex surgical problem. Malformations of the left heart which are sometimes unrecognised, aggravate the situation considerably. The association of Fallot's tetralogy and atrioventricular canal can now be corrected under good conditions. Finally, variations in the coronary anatomy must be documented meticulously as they may contraindicate early complete repair.

Angiocardiography↗
PubMed1983

[Double isthmic coarctation of the aorta: "tandem" coarctation].

A second case of double coarctation of the thoracic aorta is reported, the first having been observed at the Marie-Lannelongue Surgical Center in an older child. This case was a 3 months infant in which the missed pre- and postoperative diagnosis led to reoperation after control catheter and angiographic studies. These investigations were carried out one month after the first operation because of persistent severe cardiac failure. Surgical cure in two stages consisted in a Waldhausen plastic enlargement procedure and a Crafoord-type resection anastomosis, ensuring the best chances for a good result.

Aortic Coarctation↗
PubMed1983

[Outcome of patients undergoing open-heart surgery for congenital heart disease in early childhood].

Corrective surgery for congenital heart disease is performed on progressively younger children in order to restore normal haemodynamics during infancy and to avoid the disadvantages of palliative operations. The authors consider the long-term outcome of children who have been operated for complete transposition of the great vessels--by physiological correction or by anatomical correction--for tetralogy of Fallot, interventricular communication, atrio-ventricular channel and aortic stenosis. The sequelae and complications of these various operations are reviewed and the authors stress, in particular, the risk of delayed arrhythmias and disturbances of ventricular function. The risk of delayed complications justifies long-term follow-up of all these patients, even those who are leading a normal life, i.e. the majority of them.

Cardiac Surgical Procedures↗
PubMed1982

[Detection and quantification of left-to-right intracardiac shunts by angiocardioscintigraphy].

The ratio of pulmonary/systemic output (QP/QS) was measured by angioscintigraphy in 70 patients from 1 to 22 years of age (average 10 years) admitted to the Department of pediatric cardiology for a left-to-right shunt. Fifty nine of these patients underwent cardiac cathetarisation and QP/QS determination by oxymetry. The correlation between the values of QP/QS calculated by the two techniques was R = 0,83 (p less than 0,001: n = 59); in 28 cases of atrial septal defect R = 0,85; in 20 cases of ventricular septal defect, R = 0,75; in 11 cases of other left-to-right shunts, R = 0,79. No significant shunt was detected in 16 patients by oxymetry and the QP/QS ratio on angioscintigraphy was less than or equal to 1,2 except in 3 cases. In 7 cases of isolated pulmonary stenosis and 4 cases of operated septal defects no shunt could be detected by isotopic investigation. We conclude that angioscintigraphy is a reliable non-invasive method of detection and assessment of left-to-right shunts. In some cases it may avoid the necessity of cardiac catheterisation. The advantages, limitations and applications of this method are discussed.

Adolescent↗
PubMed1982

[Radiological and echotomographic findings in 98 children with isolated atrial septal defects].

Chest roentgenograms were carried out in 98 children with atrial septal defects and showed in 71 of them an increase of the pulmonary vascular markings, an increased heart index and right ventricular enlargement. In other children, abnormalities were either incomplete (18 cases) misleading (7 cases) or normal (2 cases). Echocardiogram was characteristic in 34 of 35 children showing an increased telediastolic ratio in virtually all cases and paradoxical septal motion in 79%. Postoperatively, chest roentgenographic findings include a return to normal of pulmonary markings and heart index while right ventricular enlargement regresses only partially. Echocardiograms show a decrease of the telediastolic ratio in all patients and a normal septal motion in 78%.

Adolescent↗
PubMed1981

Radiological patterns of truncus arteriosus in plain roentgenography.

15 cases of persistent truncus arteriosus in infants and children were subjected to roentgenographic examination by the authors via plain frontal and profile roentgenography of the thorax. In infants (12 patients) the left midzone section is concave or straight, especially in the lower part. This aspect is typical of this congenital anomaly if it is associated with active pulmonary hypervascularisation. Cases without pulmonary hypervascularisation are very difficult to diagnose safely. In 7 profile roentgenographs 3 retrosternal enlarged areas were seen soon after birth. In children of 2 to 6 years of age, cardiac dilatation with a right-side aortic arch and pulmonary hypervascularisation are very typical. In children over 6 years of age we observed an Eisenmenger's syndrome with a retrosternal enlarged area. According to the authors' experience, a combination of a right-side aortic arch associated with pulmonary hypervascularisation must be considered highly typical.

Abnormalities, Multiple↗