Biomedical subjects
D Danilowicz
Publications and source records attributed to D Danilowicz.
Results of urgent or emergency repair for symptomatic infants under one year of age with single or multiple ventricular septal defect.
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Transient third-degree atrioventricular block in a 4-year-old child with familial dysautonomia.
The case of a transient third degree atrioventricular block in a 4-year-old patient with familial dysautonomia is reported. A review of the literature follows with analysis of the significance of arrhythmias in the natural history of the patient with familial dysautonomia.
Recovery from pulmonary hypertension in an adolescent with mixed connective tissue disease.
This paper describes the case of an 11 year old girl who presented with mixed connective tissue disease which was complicated by the development of pulmonary hypertension. This case is unique with respect to the young age of onset, the serial non-invasive method used to follow the disease process, and the favourable response to treatment with vasodilator and anti-inflammatory drugs.
Successful modified Fontan procedure in an adolescent after left pneumonectomy.
We performed a Waterston's anastomosis on a patient with complicated tricuspid atresia when she was two months of age. At age 14 years she required left pneumonectomy for massive, idiopathic hemoptysis. Four months after the pneumonectomy we substituted a modified Fontan anastomosis for the Waterston anastomosis. Restudy when she was 17 years of age showed continued satisfactory function.
The disappearing pulmonary artery band.
A child is presented who had pulmonary artery bands that eroded or cut-through to the point where congestive heart failure and pulmonary arterial hypertension recurred. A summary of previously reported cases of band erosion or cut-through is presented, noting that many of these children died. Pulmonary artery banding is now mainly used in infants with complex defects where mortality of early repair is prohibitive or where the Fontan procedure is the only "repair" possible. To obtain good results, a normal pulmonary vascular resistance is preferred; therefore, it is important that the pulmonary artery band is truly protective over the period of time needed. The occurrence of pulmonary vascular disease can cause a decrease in left-to-right shunting and allow a child to clinically improve, thus duplicating the response to a successful banding. If noninvasive evaluation cannot provide clear-cut proof that the band is protective, then measurement of pulmonary artery pressure and flow must be done.
Congenital fistulous tract between aorta and right atrium presenting as heart failure in a newborn.
A newborn with a fistulous communication between the right coronary sinus and right atrium had congestive heart failure on the first day of life. Medical management was unsuccessful and operative repair was performed using bypass surgery at 5 days of age. Echocardiographic evaluation preoperatively diagnosed the defect correctly and postoperatively confirmed a complete repair. Since aneurysms and/or fistulae can occur in other sinuses after an initial repair of the presenting lesion, the infant will continue to be followed with periodic echocardiographic and clinical evaluations.
Mirror-image dextrocardia with failure of apical pivoting ("levocardia") and situs inversus.
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Massive aneurysmal dilatation of saphenous vein grafts used for systemic-pulmonary artery shunts: a role for magnetic resonance imaging in diagnosis.
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Recanalization of a Blalock-Taussig anastomosis eight years after repair of tetralogy of Fallot.
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Successful excision of an atrial fibroma in a four-month-old male infant.
This report presents an infant who was initially admitted with a pericardial effusion. Subsequent evaluation led to the diagnosis of a primary cardiac tumor. Excision of the tumor which arose from the atrial septum was possible only by removing most of the free right atrial wall and a portion of the septal leaflet of the tricuspid valve. Reconstruction of the tricuspid valve leaflet by reattachment of chordae and a partial annuloplasty was done with the right atrial wall being replaced using pericardial tissue. The histology of the tumor was compatible with a fibroma, a type not previously reported in this location in the pediatric age group. Twenty-one months following operation, the child was restudied and the catheterization revealed mild to moderate tricuspid regurgitation and no recurrence of the tumor. The child is now 4 years of age and remains asymptomatic with normal growth and development and no evidence of fibromatosis.
Cardiac tamponade secondary to chylopericardium following cardiac surgery: case report and review of the literature.
Only four instances of isolated chylopericardium following cardiac operation have been reported previously. We encountered this complication in a young patient who was operated on for infundibular pulmonary stenosis. The etiology appears to be related to a combination of intraoperative lymphatic injury and catheter-related subclavian vein thrombosis, the latter potentially elevating pressure within the thoracic duct and thereby resulting in an accumulation of chyle within the pericardial space. Therapy for this problem usually includes partial pericardiectomy with or without ligation of the thoracic duct.
Anomalous right ventricular muscle bundle: clinical pitfalls and extracardiac anomalies.
Seven patients with anomalous right ventricular muscle bundle are presented to emphasize possible pitfalls in the clinical diagnosis as based on physical examination, chest x ray, and electrocardiogram. Echocardiography, on the other hand, revealed abnormalities in all four of the patients on whom the study was done. The echocardiogram was directly responsible for a change in diagnosis and referral for a cardiac catheterization in one patient who had been followed for 19 years with the clinical diagnosis of a small ventricular septal defect. Four of the seven patients with anomalous right ventricular muscle bundle had extracardiac anomalies, one girl with an absent left thumb, and three patients, one girl and two boys, with left-sided renal anomalies. This high incidence of renal anomalies has not been previously reported in clinical or postmortem series.
Superior vena caval syndrome ater Mustard repair: surgical decompression using a saphenous vein homograft.
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Echocardiographic patterns after mitral annuloplasty.
18 adolescents and children who underwent mitral annuloplasty for severe mitral regurgitation were evaluated by echocardiography. In 7 patients studied preoperatively, mitral valve excursion ranged from 25 to 56 mm with E-F slopes from 92 to 160 mm/sec. 5 of the 7 patients showed mitral valve prolapse. The left ventricle was dilated in 6 and the left atrium was dilated in 4 patients. Postoperatively, the mitral valve excursion decreased ( range 15-26 mm; p less than 0.01) as did the E-F slope (range 44-100 mm/sec; 0.10 greater than p greater than 0.05). The prolapse pattern disappeared and the left heart chambers decreased in size. In these 7 patients and in 11 others studied postoperatively only, a common echocardiographic pattern was that of early anterior motion of the posterior mitral valve leaflet, which was not present preoperatively and was, therefore, tentatively ascribed to the technique of annuloplasty repair. No calciferation and no definite mitral steosis has occurred in the follow-up of these patients to date. Persistent left atrial/left ventricular dilatation appeared related to residual mitral regurgitation with or without atrial fibrillation.
Use of contrast echocardiography in the diagnosis of partial anomalous pulmonary venous connection.
Contrast echocardiography is useful in diagnosing the presence of partial anomalous pulmonary venous connection, particularly when it occurs in association with an atrial septal defect. Injections of saline solution, Cardiogreen or the patient's own blood were made in the inferior vena cava, left atrium and pulmonary veins of 27 patients. In all patients, the inferior vena caval injections showed only right heart clouding with no evidence of a right to left shunt. In 21 patients, the left atrial and pulmonary venous injections showed clouding of both the right and left heart structures, indicating a left to right atrial shunt and normal pulmonary venous connection. In six patients, the left artrial injections showed right and left heart clouding, but the right pulmonary venous injections showed only right heart structures, indicating a left to right atrial shunt with partial anomalous pulmonary venous connection. Contrast echocardiography proved to be a sensitive method of diagnosing the anomalous venous connection without the use of dye curves. The method is not useful when a right to left atrial shunt is present and may show false positive results for partial anomalous pulmonary venous connection it left atrial visualization is not adequate during injection into the pulmonary vein.
Postoperative responses in 'prepared' child after cardiac surgery.
Postoperative reactions of children and adolescents realistically prepared for cardiac surgery were analysed for acute and long-term responses. No cases of delirium or psychoses occurred in the 60 children while they were in hospital. Fifty sets of parents and children answered questionnaires 6 months to 4 years after operation (36 under 1 year, 8 from 1 to 3 years, and 6 over 3 years) and assessment of these showed only long-term reaction. Evaluation of reactions is presented by age and in detail. The children aged 2 to 7 years had the greatest number of negative reactions and the only long-term reaction also came from this group. Children 8 to 11 years of age had the least number of negative reactions and the highest number of positive gains. Adolescents, 12 to 19 years of age, were often concerned with their body image (wanted to be considered 'well', resented the scar, etc). From the standpoint of emotional stability and after effects, the 8 to 11-year-old group seemed to do best.
Why does a child with a normal heart undergo cardiac catheterization?
Children who have no heart disease at cardiac catheterization have usually been referred because of signs or symptoms on the background of a basal flow murmur. The ECG and chest x-ray are sometimes spurious and may lead to catheterization. Advances in noninvasive testing are helping to screen this population. Only in rare instances should the risks involved with catheterization be taken in a child with a basal flow murmur and no other evidence of heart disease.