PubMed Health⌕ Search

Biomedical subjects

J C Huhta

Publications and source records attributed to J C Huhta.

At least 109 records · Page 6Linked to original sources
PubMed1985

Aortico-left ventricular tunnel with ventricular septal defect: two-dimensional/Doppler echocardiographic diagnosis.

Aortico-left ventricular tunnel is a rare congenital anomaly that presents as aortic regurgitation and congestive heart failure in childhood. Its association with a ventricular septal defect is even more rare. Because of the distortion of the normal anatomy around the aortic valve and the rarity of this combination of defects, the diagnosis of aortico-left ventricular tunnel with ventricular septal defect may be difficult. The two-dimensional and Doppler echocardiographic findings of aortico-left ventricular tunnel are described.

Angiocardiography↗
PubMed1985

Assessment of the ductus arteriosus in preterm infants utilizing suprasternal two-dimensional/Doppler echocardiography.

Evaluation for patent ductus arteriosus by both Doppler examination and direct two-dimensional echocardiographic visualization has been reported in infants and children. However, visualization of a patent ductus arteriosus in preterm infants with lung disease has been difficult. Using a recently developed 7.5 MHz mechanical scanner with interfaced two-dimensional directed pulsed Doppler ultrasonography, 36 examinations were performed from a suprasternal approach in 27 patients (age range 1 day to 3 months, mean 18 days; weight range 490 to 2,500 g, mean 1,260). Complete imaging for evaluation of patency of the ductus arteriosus was successful in 33 (92%) of 36 examinations, and imaging of the pulmonary end of the ductus arteriosus was successful in all. In 18 examinations, the ductus arteriosus was closed by both two-dimensional echocardiography and Doppler examination. In four cases the ductus arteriosus was widely patent by both two-dimensional echocardiography and Doppler examination. Eleven echocardiographic examinations revealed a narrowed ductus arteriosus, and of these, 10 (91%) showed Doppler findings of patent ductus arteriosus. It is concluded that combined two-dimensional/Doppler echocardiographic assessment allows confident detection of both a large unrestrictive and a small, stenotic patent ductus arteriosus in preterm infants with lung disease.

Aortography↗
PubMed1985

Cross sectional echocardiographic diagnosis of total anomalous pulmonary venous connection.

Total anomalous pulmonary venous connection can be diagnosed by cross sectional echocardiography. Information is, however, lacking concerning the diagnostic accuracy of this imaging method and any factors which may influence it. To predict the pulmonary venous connection 463 patients with congenital heart disease who had angiographic confirmation were prospectively examined. Total anomalous pulmonary venous connection was present in 34 (7%) patients and correctly detected in 33 (97% sensitivity). There were two false positive results (99% specificity). All 23 patients with atrial situs solitus with or without associated congenital heart defects were correctly detected. One false negative result occurred in a patient with right atrial isomerism and complex congenital heart disease with decreased pulmonary blood flow. Diagnosis of the type of total anomalous pulmonary venous connection, including the site and other anatomical details, was analysed and was correct in 24 of 34 (71%) patients. Errors included incorrect prediction of the site of total anomalous pulmonary venous connection in five patients with right atrial isomerism, atrioventricular canal defect, and pulmonary atresia, details of confluence interconnection in three of four patients with the mixed type of connection, undiagnosed pulmonary venous obstruction in three of the patients with right atrial isomerism, and failure to predict common pulmonary vein atresia in one patient. Factors which were related to incorrect echocardiographic diagnosis were abnormal atrial situs, mixed total anomalous pulmonary venous connection, and associated congenital cardiac defects, whereas age, weight, sex, clinical condition, and time during the study were not related. It is concluded that cross sectional echocardiography can be used to diagnose accurately total anomalous pulmonary venous connection. This method can be the definitive imaging and diagnostic method in symptomatic infants with total anomalous pulmonary venous connection who have atrial situs solitus, unifocal pulmonary venous connection, and no evidence of other major congenital cardiac defect.

Adolescent↗
PubMed1985

Echocardiographic evaluation of infective endocarditis in children.

To determine the incidence and prognostic importance of the echocardiographic abnormalities associated with infective endocarditis, we reviewed these findings in 45 episodes occurring in 41 children and young adults. Thirty-three patients had congenital cardiac abnormalities, and eight patients had no previously known heart disease. Echocardiographic abnormalities were detected in 16 of the 45 episodes of endocarditis (36%). M-mode echocardiography revealed abnormalities in seven of the 35 episodes (20%) in which it was performed, and two-dimensional echocardiography revealed abnormalities in 16 of the 28 episodes (59%) in which it was used. The presence of echocardiographic abnormalities was unrelated to the causative organism and to the need for early operation.

Adolescent↗
PubMed1985

Left ventricular wall stress and thickness in complete transposition of the great arteries. Implications for surgical intervention.

The effects of volume and pressure loading of the left ventricle on posterior wall thickness and left ventricular wall stress in transposition of the great arteries were studied by combining echocardiographic and cardiac catheterization data. Pure volume loading with low left ventricular pressure resulted in little or no thickening of the left ventricular posterior wall (0.52 mm/log month). Pressure loading to levels above half of the right ventricular pressure was associated with thickening (2.80 to 3.89 mm/log month); however, further increase in pressure or volume load did not significantly alter the rate of thickening. Estimates of ventricular wall stress using a simple radius/wall thickness ratio may be misleading. However, if allowance is made for variable ventricular geometry and pressure, estimated wall stress is constant in transposition and is approximately equal to that reported previously in patients with normally related great arteries. The walls of low-pressure left ventricles in patients with transposition are demonstrably thinner than those of high-pressure left ventricles by age 1 to 3 months (2.67 versus 3.52 mm). Surgical procedures to use the left ventricle for systemic work, such as the arterial switch operation, should be performed in the first month of extrauterine life. Preparatory operations, if necessary prior to arterial switch, should load the left ventricle to greater than half systemic pressure.

Adolescent↗
PubMed1984

Cross-sectional echocardiographic diagnosis of azygos continuation of the inferior vena cava.

Azygos continuation of the inferior vena cava has importance for both the invasive diagnosis of congenital heart disease by catheterization and for surgical treatment. Cross-sectional echocardiography was used to examine 1,000 patients (1 day to 16 years, mean 3.3 years) who also had angiographic or surgical confirmation. Twenty-eight patients (3%) had azygos continuation (left 13, right 14, bilateral 1) and, in 26 patients, the hepatic portion of the inferior vena cava was absent. Azygos continuation was prospectively detected in all and was directly visualized in subcostal scans as a venous structure posterior to the aorta coursing behind the heart and not entering the inferior aspect of either atrium in 26/28 (93%). Azygos connection to the ipsilateral superior vena cava or atrium was correctly predicted in all. The inferior vena cava was visualized in all patients without azygos continuation, except one neonate with omphalocele. We conclude that cross-sectional echocardiography can accurately detect azygos continuation of the inferior vena cava and predict its side and connection.

Adolescent↗
PubMed1984

Patency of the ductus arteriosus in normal neonates: two-dimensional echocardiography versus Doppler assessment.

Two-dimensional echocardiography using a high resolution, 7.5 ,Jsz transduce was compared with Doppler echocardiography for the assessment of patency of the ductus arteriosus in normal newborn infants. Twenty-eight neonates were studied between 1 and 10 hours (mean 5.5) after birth and both examinations were possible in 27 (96%). Doppler echocardiography under two-dimensional direction indicated ductal patency in all 27 neonates. Doppler sampling in the pulmonary end of the ductus rather than the main pulmonary artery was more sensitive for detecting patency. When two-dimensional echocardiography only was used to predict patency, there was 85% sensitivity. Two-dimensional echocardiography showed no evidence of ductus arteriosus narrowing ion four neonates studied shortly after birth. In 18, the pulmonary portion of the ductus arteriosus appeared narrowed and in 8 of these, the narrowing extended toward the mid-portion of the ductus. In five others, there was only mid-ductus arteriosus narrowing. It is concluded that high resolution two-dimensional echocardiography can be used to assess ductus arteriosus morphology, but is limited in predicting ductal patency near the time of normal physiologic closure. Combined two-dimensional and Doppler echocardiography is a highly sensitive technique for detection of ductal patency when sampling is performed in the pulmonary end of the ductus arteriosus.

Ductus Arteriosus↗
PubMed1984

Two-dimensional echocardiographic assessment of pulmonary artery and aortic arch anatomy in cyanotic infants.

To determine the feasibility and accuracy of noninvasive assessment of pulmonary artery and aortic arch anatomy, a prospective two-dimensional echocardiographic evaluation was performed in 20 consecutive cyanotic infants before cardiac catheterization and angiography. The echocardiographic assessment was correct with the following frequency: detection of left aortic arch in 13 of 13 infants, detection of right aortic arch in 7 of 7, identification of patent ductus arteriosus in 13 of 13 (one false positive finding), identification of a right pulmonary artery in 20 of 20, identification of a left pulmonary artery in 19 of 20, identification of the confluence of the right and left pulmonary arteries in 19 of 20 and identification of a main pulmonary artery in 14 of 16 (two false positive diagnoses by echocardiography). Echocardiographic estimates of arterial diameters were slightly smaller than those obtained by angiography. Mean vessel size (echocardiographic/angiographic diameter) was as follows: transverse aortic arch 8.6/10.6 mm, main pulmonary artery 5.7/6.3 mm, right pulmonary artery 4.1/4.2 mm and left pulmonary artery 4.2/3.9 mm. It is concluded that although two-dimensional echocardiography tends to underestimate vessel size, the qualitative assessment is adequate for planning a systemic to pulmonary artery anastomosis in selected infants with cyanotic forms of congenital heart disease.

Aorta, Thoracic↗
PubMed1984

Two-dimensional echocardiographic diagnosis of anomalous origin of the right pulmonary artery from the aorta: differentiation from aortopulmonary window.

Utilizing two-dimensional echocardiography, the diagnosis of anomalous origin of the right pulmonary artery from the aorta was made prospectively in a neonate who presented with signs of congestive heart failure. A complete echocardiographic evaluation, including both right parasternal short-axis and suprasternal long-axis scans, permitted differentiation from other defects in aortopulmonary septation.

Aorta↗
PubMed1984

Effect of prostaglandin on early surgical mortality in obstructive lesions of the systemic circulation.

To examine the effect of preoperative prostaglandin infusion on surgical mortality the records of all patients aged less than or equal to 28 days operated between January 1979 and December 1981 for obstructive lesions of the systemic circulation were reviewed. Forty patients had coarctation of the aorta, five interrupted aortic arch, and seven critical aortic stenosis. Fourteen patients received intravenous prostaglandin before operation. Among preoperative variables low cardiac output was identified as a possible risk factor for hospital death, whereas the presence of a raised blood urea concentration was possibly significantly associated with hospital mortality only in patients not treated with prostaglandin. The preoperative administration of prostaglandin had a strongly favourable influence: 11 out of 38 (29.0%) patients who did not receive prostaglandin died compared with none of 14 treated with prostaglandin. The two groups were otherwise comparable with respect to the incidence of coagulopathy, urgency of operation, associated anomalies, and other medical treatment. Mean age at operation was younger and mean admission blood urea concentration higher in the group treated with prostaglandin, whereas the incidence of preoperative low cardiac output was probably higher. It is concluded that short term preoperative infusion of prostaglandin in associated with a significant reduction in early surgical mortality in this high risk group of infants.

Alprostadil↗
PubMed1984

Two-dimensional echocardiographic assessment of the aorta in infants and children with congenital heart disease.

To determine the accuracy of two-dimensional echocardiography in the identification of congenital anomalies of the aorta, we compared two-dimensional echocardiographic with angiographic results in 261 consecutive infants and children with congenital heart disease (age 1 day to 20 years, mean 3.3 years). Two-dimensional echocardiography was performed and interpreted without knowledge of angiographic results. Complete visualization of the ascending and descending aorta and aortic arch branches was possible by two-dimensional echocardiographic examination in suprasternal, parasternal, and subcostal views of 255 patients (98%). Identification of the esophagus during swallowing aided the diagnosis of anatomic characteristics of aortic arch. One or more significant aortic arch anomalies were present on angiograms of 116 of 255 patients (46%) and were detected by two-dimensional echocardiography in 110 (sensitivity 95%, 99% specificity). Anomalies detected by two-dimensional echocardiography/angiography were ascending aorta hypoplasia in four/four, truncus arteriosus three/three, right aortic arch 31/31, anomalous subclavian artery 11/16, coarctation 27/29, and patent ductus arteriosus 53/57. We conclude that two-dimensional echocardiography can be used to determine the anatomy of the aorta in most infants and children. In selected patients, two-dimensional echocardiography may eliminate the need for angiographic examination before surgery for congenital heart disease.

Adolescent↗
PubMed1984

Echocardiography in the diagnosis and management of symptomatic aortic valve stenosis in infants.

Infants with severe aortic valve stenosis often are critically ill and require urgent surgical treatment. Currently, angiography is used at the time of cardiac catheterization to diagnose aortic valve stenosis. However, the use of this test may be hazardous in an unstable infant and may precipitate hemodynamic and clinical deterioration before surgery. Therefore, a noninvasive method of accurately making this diagnosis would be useful in that it would allow the risks of cardiac catheterization to be avoided. Between January 1982 and September 1983, 10 infants with critically severe aortic valve stenosis and intact ventricular septum were examined by echocardiography. There were no false-positive or negative results in this time period and several criteria for the noninvasive diagnosis of critical aortic valve stenosis were recognized. These included immobile aortic valve cusps and left ventricular hypertrophy with increased echo density of the left ventricular papillary muscles and mitral valve support apparatus. Patients without other aortic obstruction had poststenotic dilation of the ascending aorta, as evidenced by a ratio of the diameter of the ascending aorta to that of aortic valve anulus greater than 1.7. A disturbed Doppler velocity signal in the ascending aorta supported the presence of valvar stenosis. Nine patients underwent cardiac surgery and five survived. In five patients surgery was performed without angiographic examination. The correct diagnosis was made noninvasively in each, and four of the five patients survived surgery. Echocardiography was comparable to angiography in making the diagnosis and assessing the cardiovascular anatomic characteristics. Echocardiography could therefore replace angiography in selected infants with symptomatic aortic valve stenosis and should be routinely used in the evaluation of these patients.

Aortic Valve Stenosis↗
PubMed1984

Two-dimensional echocardiographic assessment of normal fetal cardiac anatomy.

The fetal heart is visualized routinely during the antepartum ultrasound examination. Because of the advent of high-resolution, real-time ultrasound instruments, details of fetal cardiac anatomy can now be defined. Fifty consecutive fetuses were examined in utero to assess the ability of two-dimensional echocardiography to define intracardiac anatomy at various gestational ages. A complete examination required at least three standard echocardiographic views of the heart: four-chamber, short-axis and long-axis views. In 30 of the 50 fetuses studied (60%) only one examination was necessary to obtain this information. Ten patients had a second examination later in gestation that complemented the findings of their first study. In all but two fetuses, detection of all four cardiac chambers and at least one semilunar valve was possible. Mitral-semilunar valve continuity was detected in all. The quality of echocardiographic imaging was enhanced by the fetal occiput posterior position (three views obtained in 83% of the fetuses studied). Breech position did not affect imaging quality. Prior to 30 weeks of gestation, fetal movement hampered analysis of fetal cardiac anatomy in some patients.

Echocardiography↗
PubMed1983

Cross-sectional echocardiographic assessment of coarctation in the sick neonate and infant.

To establish an integrated non-invasive method for diagnosing coarctation, cross-sectional echocardiographic appearances of 48 neonates and infants with coarctation were combined with clinical information on the peripheral pulses. Measurements of the ascending aorta, aortic arch, and isthmus were made and compared with those from controls matched for weight and age. Confirmation of the coarctation was available in all cases. Angiocardiographic measurements were performed in 15 patients from either the group with coarctation or the controls. After the aortic arch had been analysed segment by segment 40 patients were found to have preductal coarctation, five juxtaductal coarctation, and three postductal coarctation. In one of the patients in the latter group the obstruction was situated in the abdominal aorta. Specific echocardiographic features were present in each subgroup. Echocardiographic measurements were about two thirds of those obtained by angiocardiography. By combining information on the peripheral pulses, isthmic size, and the presence of a discrete shelf in the aorta it was retrospectively possible to predict correctly the presence of coarctation in 45 out of 48 cases. Since the beginning of this study 29 patients have undergone surgery without prior invasive investigation. A combination of clinical assessment and cross-sectional echocardiographic features allows a reliable diagnosis of coarctation to be made in most cases.

Angiocardiography↗
PubMed1983

Complete atrioventricular block in patients with atrioventricular discordance.

Although patients with atrioventricular (AV) discordance (corrected transposition) have abnormal conduction pathways and may spontaneously develop high-grade AV block, no quantitative assessment of the risk of this happening is available. We reviewed the data on 107 patients with AV discordance ages 2-76 years (mean 22 years) at follow-up. Eighty-two patients (77%) had a ventricular septal defect, 57 (53%) had pulmonary stenosis, 35 (34%) had tricuspid insufficiency and 24 (23%) had dextrocardia. Twenty-three patients (22%) had complete AV block. This condition was present in four patients at birth and developed in 19 patients at ages 4 months to 53 years (mean 18.1 years). Nine of these patients had permanent pacemaker implantation, four at the onset of complete block and five an average of 11 years later. Nine patients have AV block but no pacemaker. One patient died suddenly. Detailed data analysis showed that with increasing follow-up the risk of natural onset AV block continued at a rate of approximately 2% per year after diagnosis. The presence of an intact ventricular septum made AV block more likely. We conclude that patients with AV discordance are at risk of developing complete AV block throughout their lives. With increasing age, this risk is approximately constant and is probably not significantly increased by corrective or palliative surgery if acute surgical AV block does not occur. Pacemaker implantation is not necessary in some children with spontaneous AV block.

Actuarial Analysis↗
PubMed1982

Two dimensional echocardiographic detection and measurement of the right pulmonary artery in pulmonary atresia-ventricular septal defect: angiographic and surgical correlation.

This study assessed the value of two dimensional echocardiography in patients with pulmonary atresia-ventricular septal defect in order to detect the presence of true pulmonary arteries, measure the dimension of the visible proximal right pulmonary artery and correlate these echocardiographic observations with angiographic and surgical findings. The data from 65 patients (age range 16 months to 54 years) with pulmonary atresia-ventricular septal defect who had both two dimensional echocardiographic and angiographic evaluation to determine the presence of pulmonary arteries were reviewed. Echocardiography allowed visualization of a right pulmonary artery in 55 (85 percent) of the 65 patients. Echocardiography detected a measurable proximal right pulmonary artery in 52 (98 percent) of 53 patients who had confluent pulmonary arteries confirmed with angiography. In three patients without confluence, a large systemic to pulmonary collateral artery was misinterpreted as the right pulmonary artery on two dimensional echocardiography. Right pulmonary arterial measurements on echocardiography (range 3 to 21 mm) showed excellent correlation with angiographic (r = 0.95) and surgical (r = 0.84) measurements. These data indicate that two dimensional echocardiography can be used to visualize proximal true pulmonary arteries (specifically, a right pulmonary artery) in a large proportion of patients with pulmonary atresia-ventricular septal defect; this finding usually denotes the presence of confluent pulmonary arteries. The data also suggest that this method can be reliably used for serial follow-up studies with noninvasive measurement of proximal right pulmonary arterial growth.

Adolescent↗