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J C Huhta

Publications and source records attributed to J C Huhta.

126 records · Page 7Linked to original sources
PubMed1982

Two-dimensional echocardiographic assessment of dextrocardia: a segmental approach.

Two-dimensional echocardiography was used in the prospective evaluation of 40 patients with the clinical diagnosis of dextrocardia. A segmental analysis of the situs, connections, ventricular anatomy, and chamber positions was utilized for a complete diagnostic assessment. An adequate examination was possible in 33 of these patients; the findings were confirmed by cardiac catheterization and angiography in 31 patients and at operation in 26. Use of the location of the liver and the drainage of the hepatic veins and inferior vena cava allowed atrial visceral situs to be defined in 33 patients (solitus 21, inversus 9, and ambiguous 3). Pulmonary venous connections were correctly identified in 27. In 33 patients, atrioventricular (AV) and ventriculoarterial connections and ventricular anatomy were correctly predicted. Twenty patients had 2 separate well-developed ventricles. Ventriculoarterial connections were determined correctly in all 20 patients: concordant in 5, discordant in 6, double-outlet right ventricle in 5, and single-outlet right ventricle (pulmonary atresia) in 4. In 16 patients a ventricular septal defect was correctly identified. In the remainder the ventricular septum was intact. Thirteen patients had univentricular heart: 8 had 2 AV valves (double-inlet ventricle) 3 had common AV inlet, and 2 had atresia of 1 AV connection. Two-dimensional echocardiography allowed the accurate assessment of complex congenital heart defects associated with dextrocardia. Utilizing a segmental approach, one can correctly predict atrial-visceral situs, ventricular morphology and situs, and AV and ventriculoarterial connections.

Adolescent↗
PubMed1982

Two dimensional echocardiographic diagnosis of situs.

At present there is no reliable method of recognising atrial isomerism by two dimensional echocardiography. We therefore used two dimensional echocardiography to examine 158 patients including 25 with atrial isomerism and four with situs inversus. Particular attention was paid to the short and long axis subcostal scans of the abdomen. Using the position of the inferior vena cava and the aorta with respect to the spine it was possible to separate those with situs solitus from the others. Two false positives for abnormal situs had exomphalos. In situs solitus the aorta lay to the left of the spine and the inferior vena cava lay to the right. One patient with situs solitus and azygos continuation of the inferior vena cava also had inferior vena cava to right atrial connection. In the four patients with situs inversus the mirror image of the normal pattern was present. In nine patients with right isomerism the inferior vena cava and aorta ran together on one or other side of the spine. The inferior vena cava, anterior to the aorta at the level of the diaphragm, received at least the right hepatic veins (normal or partial anomalous hepatic venous connection). Of the 16 patients with left isomerism, 14 had azygos continuation of the inferior vena cava which was visualised posterior to the aorta in all but two. All patients with left isomerism had total anomalous hepatic venous connection to one or both atria via one or two separate veins. Two dimensional echocardiography therefore provides the means of detecting abnormal atrial situs and of diagnosing right or left isomerism in the great majority of patients, if not all.

Adolescent↗
PubMed1982

Suprasternal cross-sectional echocardiography in assessment of patient ducts arteriosus.

Ninety-four patients with patent ductus arteriosus, whose ages ranged from 28 weeks gestation to 8 years, were assessed by suprasternal cross-sectional echocardiography. A further group of 37 cases without a patent ductus arteriosus were assessed by the same technique. The appearances of the ductus via this approach varied according to the ventriculoarterial connections. Reliable assessment of patency was possibly in 87 cases. In seven cases where the ductal lumen was less than 2 mm in size, a false negative diagnosis was made. In the 37 patients without a patent ductus arteriosus, no false positive diagnoses were made. Suprasternal cross-sectional echocardiography enables a reliable assessment of ductal patency, provided the lumen falls within the range of lateral resolution of the equipment being used.

Aorta, Thoracic↗
PubMed1982

Cross-sectional echocardiographic diagnosis of systemic venous return.

To determine the sensitivity and specificity of cross-sectional echocardiography in diagnosing anomalous systemic venous return we used the technique in 800 consecutive children with congenital heart disease and whom the diagnosis was ultimately confirmed by angiography. Cross-sectional echocardiography was performed without prior knowledge of the diagnosis in all but 11 patients, who were recalled because of a known abnormality of atrial situs. The sensitivity of cross-sectional echocardiographic detection of various structures was as follows: right superior vena cava 792/792 (100%); left superior vena cava 46/48 (96%); bilateral superior vena cava 38/40 (95%); bridging innominate vein with bilateral superior vena cava 13/18 (72%); connection of superior caval segment to heart (coronary sinus or either atrium) (100%); absence of suprarenal inferior vena cava 23/23 (100%); azygos continuation of the inferior vena cava 31/33 (91%); downstream connection of azygos continuation, once seen, 21/21 (100%); partial anomalous hepatic venous connection (one hepatic vein not connected to the inferior vena cava) 1/1 (100%); total anomalous hepatic venous connection (invariably associated with left isomerism) 23/23 (100%). The specificity of each above diagnoses was 100% except in one infant with exomphalos in whom absence of the suprarenal inferior vena cava was incorrectly diagnosed. Thus cross-sectional echocardiography is an extremely specific and highly sensitive method of recognizing anomalous systemic venous return. It is therefore of great value of planning both cardiac catheterisation and cannulation for open heart surgery.

Adolescent↗
PubMed1982

Abnormalities of the tricuspid valve in complete transposition of the great arteries with ventricular septal defect.

Structural abnormalities of the tricuspid valve were encountered in 38 of 121 autopsy specimens of complete transposition of the great arteries (TGA) with ventricular septal defect (VSD) (31%). Forty abnormalities were identified, including severe straddling of the tricuspid valve tensor apparatus in two, valvular dysplasia in two, left ventricular outflow tract obstruction caused by accessory tricuspid valvular tissue in two, double orifice in one, and abnormal chordal insertions in 33. Seventeen (14%) had abnormalities which were judged to have importance in the surgical management: in two cases, a straddling tricuspid valve would have prevented VSD closure; both cases with valve dysplasia would have required anuloplasty or valve replacement; one with left ventricular outflow obstruction from accessory tricuspid tissue would have required closure of a small VSD; and 12 had abnormal chordal insertions which were surgically significant. Of these 12 who were otherwise candidates for a Rastelli repair, this approach would have been possible in two only by enlargement of the VSD and deviation of the patch. In the 10 others abnormal chordal insertions to the superior aspect of the VSD would have prohibited a Rastelli operation. Abnormal tricuspid valve chordae of this type were present in 9 of 25 (36%) cases with overriding of the pulmonary trunk. Tricuspid valvular abnormalities may significantly alter the surgical approach to patients with complete transposition of the great arteries with VSD.

Heart Septal Defects, Ventricular↗
PubMed1982

Left ventricular wall thickness in complete transposition of the great arteries.

Age-related changes in left ventricular wall thickness were studied in 92 autopsy specimens of complete transposition of the great arteries (TGA) and in 189 normal hearts. By means of morphologic and clinical hemodynamic criteria, three groups were defined: Group II, TGA with intact ventricular septum (low left ventricular pressure): Group II, TGA with ventricular septal defect but without pulmonary stenosis (systemic left ventricular pressure combined with volume overload); and Group III, TGA with ventricular septal defect and pulmonary stenosis (systemic left ventricular pressure). At birth, the left ventricular thickness for the three groups did not significantly differ from normal. In group I, the left ventricular thickness remained constant with age up to 4 years and, accordingly, was significantly less after 4 months of age than that both in normals and in Groups II and III. In those Group II specimens from patients without irreversible pulmonary vascular disease, the left ventricular thickness was similar to that of normal hearts. The left ventricular thickness in Group III increased, with age in a manner similar to that of normal hearts. If left ventricular wall thickness correlates with potential ventricular function, then this measurement, combined with other clinical data, may help to predict the ability of the left ventricle to perform systemic work following one of the arterial switch operations. Sequential determinations of wall thickness may be attained noninvasively by echocardiography.

Age Factors↗
PubMedDate not supplied

Autoregulation of cerebral blood flow in fetuses with congenital heart disease: the brain sparing effect.

Fetuses with congenital heart disease (CHD) have circulatory abnormalities that may compromise cerebral oxygen delivery. We believe that some CHD fetuses with decreased cerebral oxygen supply have autoregulation of blood flow that enhances cerebral perfusion (brain sparing). We hypothesize that cerebral autoregulation occurs in CHD fetuses, and the degree of autoregulation is dependent on the specific CHD and correlates with intrauterine head circumferences. CHD fetuses were compared to normal fetuses. Data included cardiac diagnosis, cerebral and umbilical artery Doppler, head circumference, weight, and gestational age. The cerebral-to-placental resistance ratio (CPR) was assessed as a measure of cerebral autoregulation. CPR = cerebral/umbilical resistance index (RI) and RI = systolic-diastolic/systolic velocity (normal CPR > 1). CPR > 1 was found in 95% of normal vs 44% of CHD fetuses. The incidence of CPR < 1 was greatest in hypoplastic left or right heart fetuses. Compared to normal, cerebral RI was decreased in CHD fetuses. The CPR vs gestational age relationship, and the relationship among weight, head circumference, and CPR differed across normal and CHD fetuses. Fetuses > 2 kg with CHD and a CPR < 1 had smaller head circumferences than normal. Brain sparing occurs in CHD fetuses. Fetuses with single ventricular physiology are most affected. Inadequate cerebral flow in CHD fetuses, despite autoregulation, may alter brain growth.

Blood Flow Velocity↗
PubMedDate not supplied

Guidelines for the evaluation of heart failure in the fetus with or without hydrops.

Fetal echocardiography has progressed to be able to diagnose many forms of congenital heart disease and to assess the prognosis of cardiac lesions based on their anatomy and presentation in utero. However, the presence of signs of fetal heart failure, such as hydrops or valvular regurgitation, makes the assessment of prognosis difficult. This article outlines a straightforward method for the rapid evaluation of the fetus who may have congestive heart failure. The differentiation of the prehydropic state from normal is illustrated.

Cardiotonic Agents↗
PubMedDate not supplied

Premature constriction of the ductus arteriosus.

Prostaglandin synthetase inhibition in the fetus may induce constriction of the ductus arteriosus. Clinical experience is now accumulating that proves that this potential complication is reversible and that it is easily diagnosed by Doppler echocardiography.

Blood Flow Velocity↗
PubMedDate not supplied

Doppler echocardiography in the human fetus.

Fetal echocardiography has allowed prenatal diagnosis of heart disease to become a reality over the last decade. Recently, pulsed Doppler flow studies have been applied to the examination of the fetal cardiovascular system. In fetuses with dysrhythmias, complex structural heart malformations, nonimmune hydrops fetalis, or mothers receiving nonsteroidal prostaglandin synthetase inhibitors, pulsed Doppler echocardiographic studies are clinically indicated. These studies involve noninvestigational tests that provide information of critical clinical import. These studies may occasionally, require energy intensities that exceed the 510(k) limits. The physician should be held responsible for educating patients to the potential risks versus benefits of any imaging study they undergo, but appending potentially alarming labels to transducers, machines, or cathode-ray tube displays can only serve to undermine the fabric of the physician-patient relationship without achieving the desired goal of protection of the patient.

Echocardiography, Doppler↗
PubMedDate not supplied

[Fetal supraventricular extrasystole: indication for fetal echocardiography?].

The purpose of this study was to assess the incidence of congenital heart disease (CHD) in fetuses with premature atrial contractions (PAC) and to check whether these fetuses should be referred for a special fetal echocardiogram. Out of 120 fetuses with PACs and 75 fetuses with CHD both conditions were present in only 9 fetuses (= 7.5%). Two pregnancies were terminated because of associated severe fetal anomalies. After birth PACs disappeared in all other cases spontaneously. Despite higher numbers, the incidence of fetal CHD was not statistically significant higher in fetuses with PACs. Thus, recognition of fetal PACs should lead to a referral for a special fetal echocardiographic examination.

Cardiac Complexes, Premature↗
PubMedDate not supplied

Accuracy of prenatal diagnosis of congenital heart defects.

OBJECTIVES: (1) To evaluate the detection and accuracy of fetal echocardiography for congenital heart defects (CHD). (2) To compare the detection and accuracy of a team of maternal fetal medicine specialists and radiologists (MFM/R) with those of perinatal cardiologists (PC). METHODS: All fetal echocardiograms performed from 1/91 to 6/95 were reviewed retrospectively. CHD diagnoses made prenatally were compared with postnatally-confirmed diagnoses. RESULTS: 106 heat defects were correctly detected prenatally. There were 10 incorrect diagnoses, 6 false-negatives and 4 false-positives. Overall detection rate (sensitivity) was 95%, while overall accuracy was 87%. Detection rate for MFM/R and PC were 91 and 97%, respectively (p = 0.4). Accuracy was 74% for MFM/R and 92% for PC (p = 0.02). CONCLUSIONS: CHD can be identified reliably by prenatal echocardiography. The involvement of a PC in the prenatal diagnosis of these defects may improve diagnostic accuracy.

False Negative Reactions↗