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Biomedical subjects

F Z Bierman

Publications and source records attributed to F Z Bierman.

48 records · Page 3Linked to original sources
PubMed1982

Conotruncal malformations: diagnosis in infancy using subxiphoid 2-dimensional echocardiography.

Subxiphoid 2-dimensional echocardiography was performed and interpreted before the first cardiac catheterization of 109 of 113 infants less than 1 year of age with conotruncal malformations, situs solitus of the atria, and d-ventricular loop. The 4 remaining infants could not be examined using this technique for technical reasons. In 104 of 109 patients successfully examined a correct diagnosis was obtained with the use of subxiphoid 2-dimensional echocardiography. All patients with d-transposition of the great arteries had a correct diagnosis, and in 10 of 11 patients various types of double-outlet right ventricle were recognized by direct visualization of ventriculoarterial connection. Tetralogy of Fallot was correctly diagnosed in 34 of 36 patients and tetralogy of Fallot and pulmonary atresia were correctly diagnosed in 8 of 9 patients, on the basis of the position of the infundibular septum and presence or absence of continuity between the main pulmonary artery and the right ventricular. Five of 6 patients with truncus arteriosus communis were correctly diagnosed by demonstrating a connection between the pulmonary arteries and the ascending portion of the single large semilunar root. Subxiphoid 2-dimensional echocardiography proved to be a sensitive and specific technique for diagnosing conotruncal malformations in infancy.

Cardiac Catheterization↗
PubMed1980

Prospective identification of ventricular septal defects in infancy using subxiphoid two-dimensional echocardiography.

The objective of this study was to establish a dependable technique for imaging the interventricular septum and ventricular septal defects in infants. Subxiphoid two-dimensional echocardiograms were performed on 81 infants who were 1 day to 12 months (median 43 days) old and weighed 1.6-8.6 kg (median 3.4 kg). A short-focus, 5-MHz crystal with a 13-mm active element diameter was used in all studies. The interventricular septum was visualized in 80 of 81 infants. Defects in the membranous, atrioventricular canal, conoventricular and muscular segments of the sentum were identified using three standard transverse subxiphoid projections. All defects in the membranous and atrioventricular canal segments, as well as malalignment type conoventricular communications, were correctly identified when compared with selective angled cineangiocardiography. Only two of the three subpulmonic and four of 11 muscular defects were identified successfully. Limitations in imaging defects in the muscular septum reflected the varied morphology of these interventricular communications and the tangential orientation of the echo beam to the extreme apical and anterior segments of the muscular septum.

Airway Obstruction↗
PubMed1979

Use of prostaglandin E1 in infants with d-transposition of the great arteries and intact ventricular septum.

Prostaglandin E1 was used to treat five infants with d-transposition of the great arteries and intact ventricular septum who had persistent severe hypoxemia after the creation of an interatrial communication. Three infants had a dramatic improvement in systemic arterial oxygen saturation associated with dilation of the ductus arteriosus; in two of the three cases urgent surgery was avoided. Two infants had no clinical evidence of increased ductal shunting and no improvement in oxygen saturation. A trial of prostaglandin E1 is recommended for treatment of severe hypoxemia in infants with d-transposition of the great arteries with intact ventricular septum if the presence of a large atrial septal defect is established.

Cardiac Catheterization↗
PubMed1979

Subxiphoid two-dimensional imaging of the interatrial septum in infants and neonates with congenital heart disease.

The interatrial septum (IAS) was studied by subxiphoid two-dimensional echocardiography (S2DE) in 88 infants under 12 months of age who weighed 1.2-9.1 kg. The IAS was adequately displayed in 87 of 88 patients. The morphology, presence and localization of defects in the IAS were evaluated by S2DE and retrospectively related to the findings at cardiac catheterization. In seven patients with no interatrial communication at cardiac catheterization, the IAS was straight, with an area of central thinning corresponding to the veil-like cover of the septum primum over the foramen ovale. The morphology of the IAS with a stretched, patent foramen ovale (56 patients) indicated the coexistence of a right or left ventricular volume or pressure overload, and was readily distinguishable from the IAS with a secundum type communication (13 patients). In patients with a stretched, patent foramen ovale and left ventricular overload lesions, the IAS was a nearly homogenous, curvilinear structure bowing into the right atrium, with a small area of septal dropout at the superior rim of the septum primum. In the presence of right ventricular overload lesions, the central defect of the foramen ovale was associated with a redundant flap valve of the septum primum billowing into the left atrium. In secundum type communications, the centrally located defect represented a deficiency rather than a redundancy of the septum primum. Balloon atrial septostomy (BAS) in 17 patients produced a secundum-type defect bordered by the flail remnants of the torn septum primum. Blalock-Hanlon septectomy (two patients) resulted in a large, posterior, sinus venosus-type communication which incorporated the preexisting BAS. Ostium primum defects (seven patients) were distinguished from the secundum lesions by their eccentric position in the IAS adjacent to the atrioventricular ring.

Cardiac Catheterization↗
PubMed1979

Prospective diagnosis of d-transposition of the great arteries in neonates by subxiphoid, two-dimensional echocardiography.

Subxiphoid, two-dimensional echocardiograms (S2DE) were performed and interpreted before diagnostic cardiac catheterization on 59 neonates who weighed 1.3--6.0 kg (median 3.3 kg) and were 1--35 days old (median 4.5 days). The echocardiographic studies were successfully performed on 58 of 59 infants. Using appropriate longitudinal and transverse projections, S2DE permitted simultaneous visualization of the branch pulmonary arteries, proximal thoracic aorta and ventriculoarterial attachments. D-transposition of the great arteries was correctly predicted in all 16 infants with levocardia, situs solitus and atrioventricular concordance. In these patients, the standard left ventricular longitudinal projection demonstrated the bifurcating main pulmonary artery attached to the posterior ventricle; the transverse projection displayed the relationship of the proximal thoracic aorta to the anterior ventricle. The broad acoustical window using the subxiphoid approach in conjunction with a high-frequency focused transducer and a large active-element diameter permitted detailed imaging of intra- and supracardiac structures.

Aorta, Thoracic↗
PubMedDate not supplied

Percutaneous transcatheter coil occlusion of the patent ductus arteriosus aided by the nitinol snare: further observations.

PURPOSE: To assess the safety and efficacy of the nitinol snare to aid in the delivery of a Gianturco coil in percutaneous occlusion of a patent ductus arteriosus (PDA). METHODS: Seventeen patients (mean age 8.2 years) underwent catheterization and coil occlusion of a PDA (mean minimum diameter 1.9 mm). A nitinol snare was used to deliver and position the coil in the ductus. RESULTS: A single Gianturco coil was placed successfully in all patients, resulting in complete ductal occlusion documented by aortic angiography. Color echocardiography documented a trivial residual shunt in one patient who had no audible cardiac murmurs following the procedure. There was no hemodynamic or echocardiographic evidence of left pulmonary artery obstruction. There were no complications and all patients were discharged within 24 hr following the procedure. CONCLUSIONS: Percutaneous coil occlusion of the PDA is safe and effective. Snare-controlled coil delivery eliminates the risk of coil dislodgement and optimizes coil position.

Adult↗
PubMedDate not supplied

Arterial stents in the management of neurofibromatosis and renovascular hypertension in a pediatric patient: case report of a new treatment modality.

A 17-year-old male with neurofibromatosis presented with severe hypertension secondary to an abdominal aortic coarctation and bilateral renal artery stenoses. Despite previous surgical bypass grafts and aggressive medical management, including treatment with diuretics, beta-blocker, calcium channel blocker, angiotensin converting enzyme (ACE) inhibitors, and direct vasodilator agents, severe hypertension persisted. Following intravascular stent placement in the aorta and both renal arteries, blood pressures normalized.

Adolescent↗
PubMedDate not supplied

Effect of blood pressure cuffs on neonatal circulation: their potential application to newborns with persistent pulmonary hypertension.

The contribution of vasoactive pharmacologic agents to the care of the infant with primary pulmonary hypertension of the newborn (PPHN) is hampered by their limited ability to act selectively on different vascular beds. In contrast, blood pressure (BP) cuffs decrease flow and increase resistance only in the extremities around which they are applied. They therefore offer a means of increasing systemic vascular resistance without affecting pulmonary vascular resistance, a hemodynamic effect that may be particularly desirable among PPHN patients receiving vasodilators. We studied the effect of BP cuffs on the circulation of nine healthy neonates and three infants with severe PPHN. Among the healthy neonates, inflation of the cuffs to 20 mmHg had no discernible hemodynamic effect. Inflation to systolic pressures, however, caused the left ventricular preejection period to increase from 36 +/- 9 ms to 45 +/- 10 ms, the end-diastolic dimension to increase from 1.80 +/- 0.16 cm to 1.92 +/- 0.16 cm, and the cardiac output to fall to 87 +/- 12% of baseline (all p < 0.05)--changes indicative of an increase in systemic vascular resistance. Application of BP cuffs to the patients with PPHN was associated with 10-25 mmHg increases in transcutaneous arterial oxygen tensions. Administration of tolazoline to these patients while the cuffs were inflated resulted in additional 10-20 mmHg increases and did not precipitate hypotension. These observations suggest that BP cuffs can play a useful role in the management of patients with PPHN.

Blood Circulation↗
PubMedDate not supplied

Unique association of a rapidly growing right atrial myxoma in a child with double-outlet right ventricle.

We describe a patient with double-outlet right ventricle in whom a large right atrial myxoma developed over approximately 6 months. This patient represents the first case described of a right atrial myxoma occurring in an unoperated patient with congenital heart disease other than an isolated atrial septal defect. Because the child was followed with serial echocardiograms, we can document the rapid growth of the tumor.

Double Outlet Right Ventricle↗
PubMedDate not supplied

M-mode and two-dimensional echocardiography--contributions and limitations in management of interatrial and interventricular septal defects and conotruncal anomalies.

The relative contributions of M-mode and two-dimensional echocardiography to the management of a congenital cardiac anomaly reflects their individual sensitivity to the physiologic and anatomic alterations of the lesions. The integration of these imaging techniques should not be based on their historical relationship. Two-dimensional imaging has, in most cardiac laboratories, become the cardiac ultrasound technique of choice for patients suspected of having defects in the atrial and ventricular septum or anomalies of the conotruncus. Two-dimensional examination of intra- and extracardiovascular anatomy displays defects in both the interatrial and interventricular septae and permits their segmental localization. Anomalies of great vessel relationships are detailed by two-dimensional presentation of the ventriculo-arterial attachments. M-mode echocardiography's strength remains its presentation of temporal/spatial data. Combined M-mode/two-dimensional imaging facilitates quantitation of chamber dimensions as well as vessel and semilunar root diameters.

Aortopulmonary Septal Defect↗