Pediatric case of the day. Aneurysm of the ductus arteriosus and vascular dysplasia.
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Aneurysm↗
Biomedical subjects
R Guérin
Publications and source records attributed to R Guérin.
Pulmonary banding complicated by low origin of right pulmonary artery.
In our attempt to band the main pulmonary artery above the valve in a 4-month-old prematurely born infant, we erroneously banded only the left pulmonary artery, owing to the unusually low origin of the right pulmonary artery (which arose partially in the sinus of Valsalva). When severe cardiac failure recurred, the anomaly was noted upon reoperation and the band was repositioned at the level of the pulmonary valve. Since this revision, the postoperative course has been good. Low origin of the right pulmonary artery is normal in premature infants. However, origin of the right pulmonary artery from the sinus of Valsalva is a sufficiently extreme variant to constitute a surgically important anomaly. Our postmortem studies of the pulmonary arteries of 25 premature infants born without cardiac malformation showed that while the right pulmonary artery was lower than the left, it never originated from the sinus of Valsalva. This anomalous configuration of the pulmonary arteries has, to our knowledge, never been found in an infant as old as 4 months; yet we believe it should be taken into account when banding pulmonary arteries in infants.
Cardiac Output, Low↗
[Percutaneous aortic valvuloplasty in children, non invasive evaluation and criteria of success].
The results of percutaneous aortic valvuloplasty in 15 children (average 8.4 years) were evaluated by echocardiography and non-invasive criteria of the indication of this procedure were defined. The aortic valve was unthickened in 7 patients (Group I) and dystrophic in the other 8 (Group II). Valvuloplasty decreased the transvalvular pressure gradient by 47 +/- 33%. Aortic regurgitation was aggravated in 4 patients. The reduction in pressure gradient was significantly greater in Group I than in Group II (64 +/- 19% vs 31 +/- 35%, p < 0.05). In Group I, in contrast to Group II, the results remained stable after an average follow-up of 14.5 months. When the maximal instantaneous pressure gradient on Doppler examination was < 80 mmHg, the peak-to-peak gradient at catheterisation was on average 21% less, whereas when the Doppler gradient was 80 mmHg or more, the percentage difference was only 8%. The myocardial mass index was over the 95th percentile in 7/8 patients with gradients > 80 mmHg whilst it was only increased in 1 patient with a gradient < 80 mmHg. Electrocardiographic LVH was observed in 6 of the 8 patients with a gradient > 80 mmHg but in none of the others. Although valvuloplasty reduced the transvalvular pressure gradient, the results were much less satisfactory in the dystrophic valves. The following indications were proposed for this techniques: a Doppler maximal pressure gradient > or = 80 mmHg, associated with at least one criterion of left ventricular hypertrophy.
Adolescent↗
Echocardiographic and angiographic findings in superior-inferior cardiac ventricles.
The anatomy of superior-inferior ventricles was studied in 17 patients, aged 1 day to 22 years, using echocardiography and angiography. In all patients, the right ventricle was located superiorly and the left ventricle inferiorly. The right ventricular sinus was underdeveloped in 14 of the 17 patients. Conversely, the right ventricular outflow tract was normally developed in all 17 patients. The visceroatrial situs was solitus in all patients, and it was associated with a concordant D-loop in 9 patients and with a discordant L-loop in 8. There was a high incidence of associated transposition of the great arteries (9 patients) or double-outlet right ventricle (5). Segmental combination was unpredictable, D-loop being associated with L-position of the great arteries in 4 of 8 patients and L-loop being associated with D-position of the great arteries in 4 of 9. There were only 3 concordant ventriculoarterial connections. Frequently associated anomalies included ventricular septal defect (17 patients), atrioventricular valve malformations (17) subaortic conus (14) and pulmonary outflow tract stenosis or atresia (11). Criss-cross hearts were present in only 7 patients.
Adult↗
[Congenital ventricular septal defect with late detection. Apropos of a case in an adult].
The authors report the case of a congenital interventricular communication discovered in a 75 year-old female patient. The shunt was identified on the cardiac Doppler and confirmed by catheterization. It was a type IIa interventricular communication which decompensated in the course of a pulmonary embolism. This case points out how rare is the diagnosis of congenital interventricular communication made during adulthood, and emphasizes the advantage of the Doppler in the diagnosis of ventricular shunts.
Age Factors↗
Value of respiratory variations of right ventricular dimension in the identification of small atrial septal defects (secundum type) not requiring surgery: an echocardiographic study.
In search of reliable criteria that could help differentiate insignificant atrial septal defects (ASDs) from those with a large shunt, M-mode echocardiograms of three groups of patients were studied retrospectively: group I = 10 normal children (mean age 5.7 years); group II = 10 patients (mean age 7 years) with small ASD in whom the decision was taken not to proceed to surgical closure, based on hemodynamic and angiographic criteria; and group III = 15 patients (mean age 7 years) with an "operable" shunt, who underwent corrective surgery. The results showed that right ventricular end-diastolic dimensions during expiration (RVDDE) were increased in all patients in group III but were normal in only 3 of the 10 patients in group II. A normal septal movement was found in all patients in groups I and II but also in five patients in group III. The variation in right ventricular diastolic dimension with respiration (RVDVR) was always normal in group II. However, in group III all patients but one had a small RVDVR (less than 6%). It was concluded that a normal RVDDE is very specific (100%) but not sensitive (30%), a normal septal movement is very sensitive (100%) and moderately specific (70.6%), and a normal RVDVR is both very sensitive (100%) and specific (94.4%) as a criterion for identification of small ASDs not requiring surgery.
Adolescent↗
[Radiologic and echographic aspect of the disease of Kawasaki: experience with 75 cases at the Hospital Sainte-Justine of Montreal].
Seventy-five patients with Kawasaki disease were studied in Hôpital Sainte-Justine between June 1979 and December 1984. Echography (abdominal and cardiac) proved to be a useful tool in the detection of the complications of this syndrome. Coronary aneurysms were present in 9% of our patients; two-dimensional echocardiography easily identified the proximal ones. In all patients, aortography allowed us to identify the extension of the lesions more distally. The left coronary artery was affected in all patients while in five both coronary arteries were involved. In all 75 patients chest radiographs were normal. Abdominal echography permitted diagnosis of a hydrocholecyst in three patients.
Adolescent↗
Surgical repair of superoinferior ventricles: experience with 3 patients.
Superoinferior ventricles are a rare anomaly characterized by a horizontal ventricular septum and a hypoplastic right ventricular sinus localized anterosuperiorly to the left ventricle. This anomaly frequently is accompanied by malformation of the atrioventricular valves. A large ventricular septal defect is always present, and anomalies of the ventriculoarterial relations are common. The results of surgical repair of this complex lesion have been poor. Our recent surgical experience with 3 patients, 2 of whom are well 36 and 38 months postoperatively, suggests a hopeful outcome for the repair of this complex anomaly. The surgical approach was different in each of the 3 patients, demonstrating the need for a precise echocardiographic and angiocardiographic preoperative description of the cardiac anatomy to appropriately repair the multiple variants of this complex anomaly.
Angiocardiography↗
[Respiratory variations in the right ventricular diameter: an echocardiographic element in the diagnosis of partial isolated pulmonary venous return anomaly].
Isolated partial anomalous pulmonary venous drainage (PAPVD), in contrast to atrial septal defect (ASD), does not cancel out the effects of respiration on blood flow in the right ventricle. The aim of this study was to see whether this difference could contribute to the diagnosis of PAPVD without ASD on M mode echocardiography. The diastolic dimensions of the right ventricle on expiration and inspiration were compared in 4 groups of patients aged 2 to 17 years. Group 1 comprised 6 children with PAPVD without ASD; Group 2: 10 children with PAPVD and ASD; Group 3: 11 children with isolated non-restrictive ASD, and Group 4: 10 normal children. Groups 1 and 4 were comparable with a respiratory variation of RV dimension of 10 to 29%. On the other hand, in Groups 2 and 3 the percentage variation was less than 6%. The finding of isolated RV dilatation with normal respiratory variation of its internal dimension should therefore alert the operator to the possible diagnosis of PAPVD without ASD.
Adolescent↗
[Kawasaki's disease. Epidemiological aspects and cardiovascular manifestations. Apropos of 106 cases].
One hundred and six patients fulfilling accepted diagnostic criteria for Kawasaki disease (90 p. 100 of French-Canadian origin) were evaluated with serial electrocardiograms and echocardiograms (M mode and two-dimensional). Half of the patients (53) had cardiovascular manifestations at one time during their illness. Thirty-one had abnormal electrocardiograms: non specific ST and T wave changes inferiorly (27), prolonged QT intervals (6), first degree AV block (3). M mode echo was abnormal in 31 cases showing: slight pericardial effusion (17), flat septal movement (11), left ventricular dilatation (4), decrease of shortening fraction (2). Seven patients (6.4 p. 100) presented fusiform coronary aneurysm detected in 6 by two-dimensional echography (with angiographic confirmation) and at autopsy in another. M mode echo and electrocardiogram abnormalities were transient in the great majority of patients disappearing during an average follow-up period of 10 months. Coronary aneurysm had disappeared at the end of follow-up in two patients, regressed in three and remained identical in another. There were no relations between severity of clinical symptoms, electrocardiographic or echocardiographic (M mode) abnormalities and the development of coronary aneurysm. Serial studies with two-dimensional echo should be done in every patient with this disease for early detection and follow-up of coronary aneurysm.
Adolescent↗
[Plain films in supero-inferior ventricles].
Chest radiographs of 11 patients with supero-inferior ventricles proven by echocardiography and angiocardiography are presented. The main feature is the modified configuration of the left heart contour. Even if not specific, this sign is encountered frequently (72%) and may suggest the diagnosis.
Abnormalities, Multiple↗
Use of the internal mammary artery for preservation of circulation to the left arm after subclavian flap aortoplasty in correction of coarctation in children.
In 14 children aged 4 to 12 years in whom the anatomy of the coarctation did not allow for an end-to-end anastomosis, we have performed a subclavian flap angioplasty. To correct the inconvenience of ligating the subclavian artery and to avoid the use of synthetic material, we used the internal mammary artery to reestablish circulation from the aorta to the subclavian artery. All patients are well. At postoperative catheterization (18 to 42 months, average 24) in the first eight, the mammary artery was patent and the flow to the subclavian was good.
Aortic Coarctation↗
Subxiphoid two-dimensional echocardiographic diagnosis of double-chambered right ventricle.
The echocardiographic features of 14 patients with double-chambered right ventricle are presented. Diagnosis was confirmed in 13 patients at cardiac catheterization and in one at necropsy. The ultrasonic diagnosis was based on the visualization in subxiphoid short-axis view of an anomalous muscle bundle at the lower margin of the right ventricular infundibulum; this structure was present in diastole and systole and the distal portion of infundibulum was wide and free of obstruction. Associated lesions were very frequent (especially ventricular septal defects, present in 13 patients). Subxiphoid two-dimensional echocardiography is an easy, reliable, noninvasive means of assessing this disease in infants and children.
Cardiac Catheterization↗
Echocardiographic manifestations of persistence of the right sinus venosus valve.
The echocardiographic features of a neonate born with a persistent right sinus venosus valve are presented. Because surgical correction of this serious anomaly may be possible, the diagnosis should be made soon after birth. An echocardiogram suggesting a right atrial myxoma, an unlikely finding in a neonate, should be an important clue to the diagnosis of this anomaly.
Echocardiography↗
[Scimitar syndrome. Report of 4 cases and review of the literature].
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Bronchography↗
[The parietal band. Normal angiographic appearance and its importance in the angiographic investigation of certain congenital cardiac malformations (author's transl)].
The angiographic study of the parietal band (distal conus) is an important part of the investigation of certain cardiac malformations. In this presentation we have tried to determine the angiographic appearance of the normal parietal band as well as the angiographic aspect of certain conal malformations. Different anomalies of the parietal band may be distinguished: --1) An abnormally developped parietal band may be hypertrophied. 2) The parietal band may be underdevelopped. 3) A well developped parietal band may be in an abnormal position in relation to the interventricular septum. In determining an angiographic relationship between the parietal band, be it normal or abnormal, and the ventricular septal defect, we have tried to establish an angiographic classification of ventricular septal defects.
Angiocardiography↗
[Neurofibromatosis: renovascular hypertension, stenosis of the abdominal aorta, the hepatic artery and the superior mesenteric artery].
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Aorta, Abdominal↗
[Left atrial myxoma in a 13-year-old child].
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Adolescent↗