Biomedical subjects
Publications and source records attributed to B Vítek.
Morphology of common (single) ventricle, primitive ventricle, huge defect of ventricular septum and residual apical septum were described according to a group of 27 autopsies studied between 1972 and 1987 and comparative information from the literature. Nomenclature and differential diagnostics were discussed.
Conductive system in selected cases of common ventricle was studied by serial histological sections and compared with information from the literature. Results of the study showed that morphology and topography of conductive system suited to principles of concordance and discordance of atriums and ventricles. presence or lack of inflow ventricular septum were crucial for discrimination of ventral or dorsal conductive system. They both can be present in atrioventricular discordance.
The authors treated in the Centre for cardiovascular and transplantation surgery in Brno between January 1986 and September 1990 84 children with the tetralogy of Fallot. In 77 children a radical correction was made, in 7 children a modified B-T anastomosis was established. Soon after the radical operation four children died (5.1%), soon after the palliative operation 2 children (28%). When selecting the type of surgery the authors take into account the clinical status of the child, the frequency of hypoxic episodes and anatomical conditions of the heart. In the authors opinion the optimal time for operation is toddler and preschool age. For diagnosis of the defect and postoperative evaluation in the majority of patients echocardiographic examination suffices, in extreme forms of the defect with associated defects and in patients where examination is difficult catheterization of the heart is necessary. In children before radical surgery selective coronagraphy is performed. In 87% of radically operated children the haemodynamic results are very good, 5% of the children have a medium severe residual defect and 3% of the children must undergo another operation.
The authors describe the in Czechoslovakia so far not used therapeutic catheterization ablation method of the accessory atrioventricular pathway in patients with tachycardia with the Wolff-Parkinson-White syndrome. They performed successful ablation of the accessory bundle of Kent located by electrophysiological examination behind the left atrium and left ventricle in a 17-year-old boy with WPW Syndrome type A. They severed the accessory pathway by radiofrequency current using a catheter inserted from a retrograde approach into the left ventricle beneath the mitral valve. After ablation the boy suffers no longer from tachycardia, the ECG tracing in devoid of preventricular preexcitation, although he has no medicamentous treatment.
Congenital coronary fistulas diagnosed from systolic-diastolic murmurs were detected in 10 patients. They were verified and located by coronarography in six patients between the right coronary artery and right atrium, right ventricle and pulmonary artery; in four patients between the left coronary artery and pulmonary artery and sinus coronarius cordis. In five patients followed marked left-right shunt the fistula was surgically eliminated by a very favourable postoperative course.
In a group of 47 patients with Ebstein's anomaly followed up on a long-term basis the authors describe the natural course of the disease as well as contemporary diagnostic and therapeutic possibilities. The authors draw attention to typical symptoms of Ebstein's anomaly and emphasize the importance of early diagnosis by two-dimensional echocardiographic and Doppler examination and the introduction of individual conservative or surgical treatment.
Postoperative atrioventricular block may be the cause of early or late death unless diagnosed and treated in time. The authors describe the development of late intermittent complete intraventricular block in an 11-year-old girl with syncope nine years after radical correction of the tetralogy of Fallot. Incomplete trifascicular block was diagnosed by electrophysiological examination of the conduction system four years before the development of complete trifascicular block. With regard to the serious character of an intermittent block cardiac pacing therapy was used.
The authors present their diagnostic and therapeutic experience with aortopulmonary window in 10 children. As it threatens, in particular if combined with other heart diseases, the majority of children with development of early irreparable changes in the pulmonary circulation it is important to diagnose the defect, preferably by echocardiography and treat it already in childhood.
Authors collected 110 cases of transposition of great arteries between 1972 and 1989. Nine transpositions were corrected and the conduction system was studied on histological serial sections in 6 of them. Two cases of corrected transposition without septal or any other defect were described in detail, one in situs solitus, another in situs inversus. According to the literature, an anterior conduction system often tends to develop in situs solitus, and posterior conduction system in situs inversus. Two presented cases as well as other cases in situs ambiguous quoted in authors' and other papers showed that an arrangement of conduction system in corrected transposition does not depend on general visceral situs but on mutual position of atrial and ventricular septa instead.
The prequisite of better therapeutic results in patients with Ebstein's anomaly of the tricuspid valve is more perfect diagnosis not only of the severity of the malformed valve but also of other associated defects incl. the anomalous accessory bundle of Kent which causes the development of dangerous tachydysrhythmias. The authors present their own experience with the localization of the bundle of Kent by mapping the endocardium of the atria in seven children before a cardiac operation. In all ventricular preexcitation type B with the bundle of Kent in the posterior lower portion of the atrial septum was found. In two non-operated patients who died with tachydysrhythmia which could not be controlled, the bundle of Kent was confirmed by histological examination, in three it was severed by operation, two patients are waiting to be operated. The authors recommend interruption of the bundle of Kent always concurrently with operation of the malformed tricuspid valve and other associated cardiac defects.
Case-history of an eight-year-old boy with subvalvular membranous aortal stenosis where the authors used for treatment percutaneous dilatation by means of a balloon catheter without using surgery. The authors recommend to eliminate the stenosis as soon as possible before serious aortal insufficiency develops.
In patients with Ebstein's anomaly of the tricuspid valve combined with WPW syndrome, possibly other cardiac disease, in particular with the repeated occurrence of severe tachydysrhythmias we can foresee cure or at least elimination of complaints by simultaneous surgical treatment of all defects. The author presents experience with the surgical treatment, the first of its kind in this country, in a boy aged 13 years. By better diagnosis it proved possible to locate correctly and to severe by surgery the abnormal accessory bundle between the right atrium and right ventricle, simultaneously with a plastic operation of the insufficient tricuspid valve with closure of the atrial septal defect. Since the operation the patient has no signs of ventricular preexcitation and has no tachydysrhythmias.
One of the causes of the late deaths after operations of the tetralogy of Fallot are dysrhythmias caused by impaired conduction and automatism. To assess the severity and site of the atrioventricular and intraventricular block the authors used in 19 patients after operation of the tetralogy of Fallot an invasive electrophysiological examination. The authors recommend, based on their own experience, to follow-up on a long-term basis all patients with temporary postoperative complete a-v block. The presence of bifascicular or temporary postoperative a-v block alone does not yet imply the need of a permanent pacemaker. If a serious a-v block persists after the third week or if a syncope or cardiac weakness develops, the authors indicate a permanent pacemaker. Also the development of trifascicular block, even in patients with a normal P-Q interval, detected during fever, physical work or during electrostimulation of the atria is an indication for the introduction of a permanent pacemaker.
From a total group of 189 children with a ventricular septal defect operated in 1978-1985 at the Cardiosurgical and Transplantation Department in Brno the authors followed up 60 patients with pulmonary hypertension. In addition to catheterization and echocardiographic examination, they made in 28 patients (46%) a preoperative pulmonary biopsy. In the majority of children before and after operation by catheterization the pulmonary tension Rp/Rs was measured and in some also pulmonary vascular resistance. During the echocardiographic examination attention was focused on the possibility to as the pulmonary tension by pulsed Doppler and continuous technique, on the detection of left-to-right shunt, pulmonary or tricuspid insufficiency. Of 60 patients 5 children (8.3%) died soon after operation, one patient died six years after operation. Long-term postoperative follow up made is possible to define more accurate indication criteria for operation as well as for pulmonary biopsy.
Case-history of a four-year-old boy with Ebstein's anomaly of the tricuspid valve with WPW syndrome. Severe tricuspid insufficiency and repeatedly occurring tachydysrhythmias soon led to cardiac decompensation and death before the intended cardiac operation. Non-invasive clinical, ECG, X-ray and ECHO examinations correlated with catheterization, electrophysiological and pathological findings. In addition to the dislocated, malformed tricuspid valve the septal cusp of which was fused with the ventricular septum the authors found another additional atrioventricular muscular connection between the lower part of the septum of the right atrium and right ventricle.
After reconstruction of the right ventricular outflow tract in the tetralogy of Fallot by means of a pericardial patch or patch from synthetic material in rare instances an aneurysm of the right ventricle may develop. The authors diagnosed seven postoperative aneurysms of the right ventricle in a group of 220 children operated on account of the tetralogy of Fallot (3.18%), incl. four where an urgent surgical operation was necessary. The aneurysm developed once after suture of the transmural pericardial patch and six times after an enlarging plastic operation of the outflow tract of the right ventricle by means of a synthetic patch. Of the four operated patients three times a pseudoaneurysm was involved and once a true aneurysm.
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