Spontaneous echocardiographic contrast with the carbomedics mitral valve prosthesis.
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Biomedical subjects
Publications and source records attributed to S Milo.
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The use of transvaginal ultrasound scanning has substantially improved early pregnancy imaging of fetal anatomy. We detected cardiac abnormalities in ten fetuses at 12-16 weeks' gestation using transvaginal ultrasound.
A female infant, who died 17 hours after spontaneous birth, was found to have three distinct coronary arterial anomalies in association with pulmonary atresia with intact ventricular septum. These anomalies were first, an aneurysmal left coronary artery with a fistulous communication into the right ventricle; second, an anomalous origin of the right coronary artery from the pulmonary artery; and third, a supernumerary coronary artery arising from the right ventricle. Although the coronary arterial system was entirely connected to the right ventricle, the perfusing blood originated from the left ventricle and there was no clinical or histological evidence of significant myocardial ischaemia.
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Two of the 26 cases of left atrial isomerism in our clinical material had an unusual drainage of the inferior caval vein. In one, the inferior caval vein crossed from left to right infradiophragmatically and then drained into the right-sided morphologically left atrium. In the second case, there was azygos continuation to both right and left superior caval veins. These variations have major surgical significance.
Right ventricular pressure dynamics were monitored during the first 24 hours after operation for relief of pulmonary stenosis in 9 patients with dysplastic pulmonary valves who underwent total valvectomy. Rather than the expected immediate drop in pressure after total removal of the obstruction, right ventricular pressures required 18 to 24 hours to decrease to physiological values. In 7 patients, the pressures decreased steadily, but in 2, there was an increase in pressure immediately postoperatively, followed by a gradual decrease.
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In the 12 years from 1975 to 1987, 55 patients had open pulmonary valve surgery for isolated congenital stenosis of the pulmonary valve. Three types of pulmonary stenosis were seen: (a) dome-shaped pulmonary stenosis (34 patients); (b) dysplastic pulmonary valves with thick cauliflower-like cusps (12 patients), and (c) hour-glass deformity of the pulmonary valve, with "bottle-shaped" sinuses (nine patients). This third type has not been described before. Preoperative identification of the valve structure is important because the choice of treatment (balloon dilatation for some dome-shaped valves and excision for dysplastic and hour-glass valves) depends on the type of stenosis.
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A two-year-old patient had an atrial septal defect associated with a remnant of the valve of the sinus venosus which produced an unusual drainage of the inferior caval vein. The preoperative knowledge of the unusual anatomy allowed the surgeon to repair the anomaly without difficulties.
Early repair of acute rupture of the ventricular septum after myocardial infarction is now the procedure of choice accepted by most centers. Rupture of the right ventricular free wall is rare and usually is accompanied by tamponade. The finding of coincidental right ventricular free wall rupture and acute ventricular septal defect following myocardial infarction and their successful repair are discussed in the following report.
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In 4 critically ill patients with acute rheumatic carditis, valve incompetence, and severe life-threatening cardiac failure, medical treatment consisting of bedrest, oxygen, digitalis, diuretics, and steroids produced little or no clinical improvement. Echocardiography showed that in each patient myocardial function was relatively well preserved despite active rheumatic carditis and the critical clinical state. Emergency valve replacement was performed, and a good clinical result was achieved in all 4 patients.
Injudicious selection of a saphenous vein graft can adversely affect the the late postoperative patency of the proximal coronary artery which it bypasses. The purpose of this investigation was to deduce an upper bound for graft diameter, at small angle of distal anastomosis, below which the stenosed artery will remain patent, from a mathematical model of aortocoronary bypass haemodynamics.
A parachute deformity of the tricuspid valve occurred in a heart with atrioventricular concordance, double outlet right ventricle, and straddling mitral valve. Although to the best of our knowledge parachute deformity of the tricuspid valve has not previously been reported, in this case its presence was insignificant in relation to the other lesions.