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Biomedical subjects

Michele A Frommelt

Publications and source records attributed to Michele A Frommelt.

7 recordsLinked to original sources
PubMed2005

Does fetal diagnosis make a difference?

Fetal echocardiography has clearly made a difference in the world of pediatric cardiology today. It has taught us much about the natural history of fetal cardiac disease, and with ongoing collaborative studies, it should continue to enhance our knowledge base. Fetal echocardiography has enabled us to identify potential candidates for fetal cardiac intervention and has promoted the development of an exciting new discipline within pediatric cardiology. We hope that the recognition of critical congenital heart disease in utero improves the long-term outcome of our patients, including neurodevelopmental outcome and quality of life.

Echocardiography↗
PubMed2004

Differential diagnosis and approach to a heart murmur in term infants.

This article reviews the differential diagnosis of and approach to a heart murmur in the term infant. After addressing important aspects of the history, physical examination, and cardiac examination,the most common structural cardiac lesions generating a heart murmur in the term infant are discussed.

Diagnosis, Differential↗
PubMed2004

Congenital coronary artery anomalies.

Congenital coronary artery anomalies are rare but can carry a significant risk of myocardial ischemia, myocardial dysfunction, congestive heart failure, and sudden death. This risk seems to be highest during childhood and adolescence; therefore, an understanding of these anomalies is important for the pediatrician and pediatric cardiologist. This article focuses on the anatomic features, mode of presentation, diagnostic findings, and surgical treatments that are available for the two most common types of isolated congenital coronary anomalies that are associated with myocardial ischemia during childhood: (1) anomalous origin of a coronary artery from the opposite sinus of Valsalva with an interarterial course between the great arteries and (2) anomalous origin of a coronary artery from the pulmonary artery. A brief discussion of coronary artery fistulous connections completes the article.

Coronary Circulation↗
PubMed2003

Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course.

OBJECTIVES: In this study, we sought to describe the mode of presentation, anatomic features, diagnostic techniques, and surgical outcome in a group of patients with anomalous origin of a coronary artery from the opposite sinus with an interarterial course between the great arteries (AOCA). BACKGROUND: Anomalous origin of a coronary artery from the opposite sinus with an interarterial course is associated with myocardial ischemia and sudden cardiac death, particularly in adolescents and young adults. METHODS: The cardiology database at Children's Hospital of Wisconsin was reviewed to identify all patients diagnosed with AOCA. RESULTS: From September 1997 to August 2002, 10 patients were identified with AOCA; all were children/adolescents (age range, 3 months to 20 years; weight range, 4.7 to 72 kg), and nine were diagnosed prospectively by transthoracic echocardiography (TTE). Symptoms of cardiac ischemia initiated investigation in 4/10 patients at a mean age of 16 +/- 2.8 years; the other six had TTE for suspected congenital heart disease/musculoskeletal chest pain. The left coronary artery originated from the right sinus in six patients, and the right coronary artery originated from the left sinus in four patients. An intramural course of the AOCA within the anterior aortic wall was found in 9/10 patients and was reliably identified by TTE; the other patient had an intramyocardial course of the anomalous coronary. Surgical repair was performed in 8/10 patients at a mean age of 13 +/- 4.7 years. Unroofing of the intramural portion of the AOCA to relocate the ostia in the appropriate sinus was successfully performed in seven patients. All patients status post unroofing were asymptomatic with patent coronary flow by Doppler and normal exercise treadmill testing at a median follow-up interval of 1.5 years. CONCLUSIONS: Anomalous origin of a coronary artery from the opposite sinus with an interarterial course is frequently characterized by an intramural course, which can be prospectively identified by TTE. Unroofing the intramural segment without bypass grafting can reliably repair the intramural form of AOCA.

Adolescent↗
PubMed2003

Diastolic dysfunction in an unusual case of cardiomyopathy in a child: insights from Doppler and Doppler tissue imaging analysis.

OBJECTIVES: This case report describes an unusual form of cardiomyopathy in a child with abnormalities in both ventricular relaxation and compliance. The diastolic abnormalities are well-defined using Doppler inflow velocities and Doppler tissue imaging, and the Doppler findings are correlated with intracardiac pressure measurements. This case illustrates the use of noninvasive Doppler techniques in identifying diastolic dysfunction, and it sheds additional light on the interplay of relaxation, compliance, and heart rate in creating the variable inflow Doppler patterns encountered clinically.

Cardiomyopathy, Hypertrophic↗
PubMed2002

Detection of septal coronary collaterals by color flow Doppler mapping is a marker for anomalous origin of a coronary artery from the pulmonary artery.

Between August 1991 and September 2000, 15 patients received a diagnosis of the anomalous origin of the coronary artery from the pulmonary artery, at the Children's Hospital of Wisconsin. All were evaluated initially by transthoracic echocardiography, with subsequent diagnosis confirmation at cardiac catheterization and/or surgery. Seven of the 15 patients were referred in infancy (mean age 4.3 months) with symptoms of congestive heart failure. The remaining 8 patients were older (mean age 7.0 years) at the time of diagnosis, and 7 of those 8 patients were clinically asymptomatic and were referred for evaluation of a heart murmur and/or cardiomegaly on chest radiograph. One older patient, previously healthy, was referred at age 18 for an episode of sudden death while playing basketball. All the older asymptomatic patients had echocardiographic detection of multiple unusual color flow Doppler signals within the ventricular septum, believed to represent septal coronary collaterals, which raised suspicion of a coronary artery abnormality and led to more detailed imaging of the coronary artery anatomy. In the younger infants with congestive heart failure, septal coronary collaterals were less frequent, but did aid in the diagnosis of an anomalous coronary artery when present.

Adolescent↗