PubMed Health⌕ Search

Biomedical subjects

R Mocellin

Publications and source records attributed to R Mocellin.

At least 37 records · Page 2Linked to original sources
PubMed1983

[Anomalous coronary drainage from the pulmonary artery with associated heart and vascular abnormalities. Report on 3 patients and review of the literature].

The clinical and cineangiocardiographic findings of three children with anomalous coronary artery origin were analyzed: in the first case, associated with Scimitar syndrome, the left coronary artery arose from the left posterior pulmonary sinus; in the second case, in addition to Fallot's tetralogy, the left coronary artery had its origin from the right pulmonary artery; and in the third case, the left circumflex artery arose anomalously from the right pulmonary artery in association with coarctation of the aorta, aortic valve stenosis and diverticulum of the left ventricle. The findings of 46 cases reported in the literature to have anomalous origin of one or both coronary arteries, a single coronary artery, or of the left anterior descending coronary artery reveal that additional cardiovascular anomalies can also be found in 4 to 17% of the cases described in collectives of more than ten patients. Almost any type of cardiovascular malformation can coexist with anomalous origin of a coronary artery from the pulmonary artery. There seems to be a preponderance of conotruncal malformations accounting for 33%, whereas their incidence among all congenital heart defects is 15%. The effect of the hemodynamics of the associated malformation can exert can influence on the natural history of the disease and, experience indicates that the coronary anomaly may be masked by the signs and symptoms of the associated cardiovascular malformation. Accordingly, to exclude such anomalies, preoperative studies should include assessment of the coronary arteries. To establish the diagnosis of anomalous origin of a coronary artery from the pulmonary artery, in addition to an injection of contrast medium into the main pulmonary artery, an aortic root injection is adequate in the majority of patients and, in general, selective coronary arteriography is not required.

Abnormalities, Multiple↗
PubMed1982

[Ergometry in childhood. Normal values and use in paediatric cardiology (author's transl)].

In children with congenital heart disease ergometry may be used to measure cardiovascular performance capacity as well as to obtain detailed studies of the functional capacity of different aspects of the cardiovascular system by measuring various parameters during exercise and, thus, rendering a more complete preoperative or postoperative evaluation and possibly contributing to establishment of an indication for surgery. The direct method for measuring cardiovascular performance capacity is the determination of aerobic capacity. All indirect methods such as the W170 (the physical working capacity at a heart rate of 170 beats/min) permit only a rough estimation of working capacity. Since reliable normal values for aerobic capacity of representative samples of boys and girls in different age groups have not been rigidly established, plausible standard values have been estimated in relation to sex, age and body height from previously published data. Subsequently, maximal values for cardiac output have been calculated for all age groups based on a maximal arteriovenous oxygen difference of 13.5 ml/100 ml and, based on a mean maximal heart rate of 200 beats/min, the respective values for stroke volume during exercise have been calculated. In consideration of the fact that equal percentages of aerobic capacity correspond to equal values of arteriovenous oxygen difference, relationships between oxygen uptake and cardiac output were derived for boys and girls of different age groups. The respective regression lines run parallel to a regression valid for male adults which was derived from the values of Ekblom et al. [7] and is based on the formula Q[l/min] = 5.1 + 5.8 VO2[l/min]. In order to permit comparison independent of sex and age, the cardiac output values at rest and during exercise were corrected by subtracting the respective age-related intercepts. The resulting regression line representing normal values independent of sex and age has the formula: Qcorr[l/min] = 5.8 VO2[l/min]. Of particular clinical relevance in these young patients is that the question of feasibility of participation in school physical education classes can generally be answered. Children with congenital heart disease incurring severe hemodynamic compromise have frequently undergone corrective surgery in the pre-school age and the functional results can be assessed accordingly; in children with cyanotic heart disease in whom either no surgery or only a palliative procedure has been performed, ergometry may document severe hemodynamic derangement in spite of a seemingly bland history.

Adolescent↗
PubMed1982

[Complications of retrograde arterial catheterizations in infants and children (author's transl)].

550 retrograde arterial catheterizations, performed between 1974 and 1980, including 50 infants below the age of one year, 120 children between one and 5 years of age and 380 schoolchildren, were reviewed with respect to the rate of complications. Within this period the portion of open arteriotomies decreased from 41% during 1974-1977 to 7% during 1978-1980. Only 130 patients had systemic heparinization during the catheterization procedure, without preponderance of any age group. Complications occurred in 10% of the patients, 4% being major complications necessitating mostly thrombectomia or thrombolysis. The rate of major complications decreased from 6% during the first period (1974-77) to 3% during the second period (1979-80), which can partly be attributed to the decrease of open arteriotomies within the entire period. According to our results the open arteriotomy of the A. femoralis should be avoided as far as possible. The rate of arterial obstructions was highest in infancy, where it amounted to 14%, and did not change considerably between the first and second period of time in this age group. In schoolchildren, however, the rate of arterial obstruction diminished from 7% during the first period to 0.5% during the second period. Considering the entire period, systemic heparinization did not appear to influence significant the rate of complications. During the last 3 years, however, arterial obstruction was observed in none of 74 patients having undergone systemic heparinization, but in 8 of 228 patients without this measure, 7 of them being infants and children below the age of 6 years. We therefore conclude that systemic heparinization should be performed in infants and small children during retrograde catheterization.

Cardiac Catheterization↗
PubMed1979

Haemodynamics studies in patients with univentricular hearts.

The catheterization data including angiocardiography of 30 infants and children with different types of univentricular heart were used to study the influence of pulmonary and systemic flow as well as the position of the outlet chamber on systemic arterial saturation. All patients with normally connected great arteries displayed favourable streaming and differed significantly from those with 1-TGA as well as d-TGA, who showed varying streaming characteristics. Taking into account, however, the position of the outlet chamber, favourable streaming could be demonstrated to occur in most patients with TGA and lateral outlet chamber, and significantly less in patients with TGA and anterior outlet chamber. The influence of pulmonary and systemic flow on systemic arterial oxygen saturation was obvious only in the group with complete mixing and not in those patients, where arterial saturation was affected favourably or unfavourably by interindividual streaming differences. As expected, in patients with pulmonary stenosis the pulmonary flow was determined primarily by the degree of obstruction between ventricle and pulmonary artery. Reduced perfusion of the lungs in pulmonary stenosis does not result in increased perfusion of the systemic circulation. These results indicate that in patients with univentricular heart and ventriculo-arterial discordance, a pulmonary stenosis combined with lateral outlet chamber offers the most favourable outlook with regard to natural history.

Adolescent↗
PubMed1979

Angiocardiographic left ventricular volume determination in tricuspid atresia. Comparison of patients with and without palliative surgery.

Group A (n = 10) had reduced pulmonary blood flow and no previous surgery, group B (n = 9) had decreased pulmonary blood flow despite a systemic-to-pulmonary artery shunt and those in group C (n = 10) had increased pulmonary blood flow 9 of whom had no previous surgery and 1 a large Waterston anastomosis. Left ventricular end-diastolic volume (LVEDV) and left ventricular systolic output (LVSO) were higher than normal in all 3 groups with an order of descending magnitude of group C (278 +/- 20% and 264 +/- 32%), group B (264 +/- 19% and 243 +/- 37%) and group A (189 +/- 14% and 190 +/- 13%). For the entire group A, left ventricular ejection fraction (LVEF) was normal (0.66 +/- 0.06 or 97 +/- 8%) with low systemic arterial oxygen saturation (SAO2) averaging 58%, but the LVEF of those infants less than 6 months with a mean SAO2 of 49% was lowered to 0.58 +/- 0.08 or 87 +/- 13% of normal. The ejection fraction was reduced to the greatest extent (0.50 +/- 0.04 or 81 +/- 6%) in group B patients who averaged 12.8 years of age and had undergone shunt procedures 10 months to 13.6 years, median 7.8 years previously. These findings indicate that a moderate degree of arterial desaturation appears to be better tolerated than a chronic volume overload in patients with tricuspid atresia.

Adolescent↗
PubMed1978

[Prostaglandin E1 therapy in infants with cyanotic congenital heart malformations: hemodynamic and angiographic findings (author's transl)].

During emergency cardiac catheterization, the mechanism of action of prostaglandin E1 (PG-E1) was studied in 7 newborn infants with cyanotic congenital heart malformations and decreased pulmonary blood flow. The main effects upon hemodynamics were an increase of pulmonary blood flow and a decrease of systemic blood flow. At the same time systemic blood pressure decreased slightly and a rise in systemic vascular resistance was calculated. An aortogram before and 15--20 minutes after the infusion of Pg-E1 was started, demonstrated a marked increase of the pulmonary blood flow and a dilation of the ductus arteriosus. Together with these hemodynamic effects the arterial and central venous oxygen saturation rose. In one infant with severe Tetralogy of Fallot, the ductus had already closed and could not be reopened by PgE1. In this infant PG-E1-Infusion had no effect upon arterial oxygen saturation. From these observations it can be concluded that dilation of the ductus is responsible for the rise in arterial oxygen saturation. 3the different indications for therapy with PG-E1 in the neonate are discussed.

Cardiac Catheterization↗
PubMed1978

[Effect of prostaglandin E1 on the hemodynamics in newborn infants with pulmonary atresia (author's transl)].

The effect of prostaglandin E1 (PGE1) on the haemodynamics during cardiac catheterisation was studied in 6 newborn infants with pulmonary atresia and ductus-dependent pulmonary perfusion. In 4 patients with initial arterial O2-saturations between 24% and 45% pulmonary blood flow increased from a mean value of 1.0 to 4.5 1/min/m2, 15--20 minutes after the infusion of PGE1 was started. At the same time the systemic blood flow decreased markedly, the systemic blood pressure varied only slightly, and a marked increase in systemic vascular resistance was calculated. In one further patient with a relatively high initial arterial O2 saturation the pulmonary blood flow increased only minimally, whereas in the remainder patient with low initial arterial oxygen saturation there was no change after PGE1 during the investigation.

Blood Pressure↗
PubMed1978

Special problems in pulmonary atresia with ventricular septal defect: extreme hypoplasia of intrapericardial pulmonary arteries and autofocal collateral vessels.

4 patients with pulmonary atresia and ventricular septal defect are presented, who were selected from a group of 50 patients in whom intrapericardial pulmonary arteries were present. In 2 patients the pulmonary arteries were not only extremely hypoplastic but also displayed only minimal anastomoses with the arterial hilar vessels. They were considered not to be accessible for corrective surgery. In another patient about 50% of the pulmonary perfusion were supplied by collateral vessels not connected to the intrapericardial pulmonary arteries. The question is discussed, to what extent the systemic vessels are necessary for pulmonary perfusion and whether they may be all ligated at the time of corrective surgery. In the last patient anastomoses between 2 systemic vessels and the pulmonary arteries could be demonstrated, the right one of which was very hypoplastic. In this case a right-sided shunt operation combined with ligation of the collateral vessels seemed to be advisable to promote adaption of the pulmonary artery and to simplify the subsequent corrective procedure.

Adolescent↗
PubMed1978

[Entry into pulmonary artery in complete transposition of the great arteries (author's transl)].

In 91 children with complete transposition of the great arteries investigated by heart catheterization since 1974 the pulmonary artery was probed at the first investigation in 46% and at the second preoperative investigation in 85%. Considering only the last 2 years the pulmonary artery was entered in 93% during the second catheterization. When an additional catheterization was necessary the pulmonary artery was always entered. This was mostly achieved by a flow-directed balloon-catheter preformed before introduction into the vein by alternating application of hot and cold water or in the left atrium by use of a guide wire.

Cardiac Catheterization↗
PubMed1978

[Pulmonary hypertension after spontaneous closure of an atrial septal defect in infancy (author's transl)].

Clinical findings and haemodynamic data of an infant with atrial septal defect and hypoplasia of the left ventricle are reported. At the first cardiac catheterization at the age of 3 weeks an interatrial left to right shunt of 55% and a moderately elevated pulmonary artery pressure, but normal pulmonary vascular resistance were found. At repeat cardiac catheterization at the age of 6 month the atrial septal defect had closed spontaneously, however, the pressure in the pulmonary artery had risen to 90/55 mm Hg and pulmonary vascular resistance was elevated with 9.6 Um2. 3 months later pulmonary artery pressure had normalized to 35/15 mm Hg, but pulmonary vascular resistance was still elevated at 7.8 Um2.

Electrocardiography↗
PubMed1977

[Transposition of the great arteries: natural history and indications for surgery after balloon-atrioseptostomy (author's transl)].

The natural history of 162 children with transposition of the great arteries is referred, whose first heart catheterization fell between 1967 and June 1975. In 149 of them balloon atrial septostomy (BAS) was performed, with a mean increase in arterial oxygen saturation of 21 %. In 11 cases BAS was repeated after inadequate first BAS, but again without success. In 19 patients an atrial septectomy (Blalock-Hanlon) was performed later on, with 20% mortality. 3 children died during or immediately after BAS. The early mortality after BAS was 13% and the late mortality 17%. These values include the mortality of palliative operations which were necessary to bridge over the time until "corrective" operations could be performed. The operative mortality of Mustard operations was 10% for the simple TGA and 16% for all TGA cases operated on. On the basis of the mortality values of the BAS, of atrioseptectomy (Blalock-Hanlon) and of the Mustard procedure the proceeding after BAS and the indication for operations is thoroughly discussed.

Heart Atria↗