Biomedical subjects
Publications and source records attributed to I Pohanka.
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 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.
A new morphological-clinical classification was suggested for this type of heart malformations based on confrontation of authors' results with literature. The classification took into consideration appearance of the top of ventricular septum, form of atrioventricular valves, topography of the defect and its relation to the location of conducting system.
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.
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.
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A description is presented of improved methods of examining the conductive system of the heart designed for special routine investigations. The methodology comprises: a) injection of coronary arteries with contrast medium and their X-ray visualization, b) special technique of heart postmortem, c) histological investigation with a view to the precise topography of the particular parts of the conductive system including detailed histological processing in series cestions by means of staining methods: haematoxylin-eosin, elastica-van Gieson, P. A. S., and Heidenhain.