Biomedical subjects
Publications and source records attributed to S Tůma.
The authors describe a successful therapeutic occlusion of the left internal carotid artery in a five years old boy by the catheterization technique. The intervention treated a pseudoaneurysm originating after incision of a peritonsillar abscess.
Forty four children underwent surgery for congenital vascular anomalies causing tracheal compression in Kardiocentrum--Motol during last ten years. Double aortic arch was encountered 18 times, tracheal compression by the innominate artery in 12 instances, right aortic arch with left ligamentum arteriosum and possibly aberrant left subclavian artery 7 times, pulmonary artery sling in 5, finally aberrant right subclavian artery twice. The age of the children was 2 weeks to 11 years (median 6 months). Stridor was present in 38 infants under 3 months, 17 children with severe dyspnoea had artificial ventilation or were resuscitated or hospitalized at the intensive care department. In four an associated cardiac defects was present. The diagnosis was made by oesophagography, echography, laryngotracheoscopy, in the majority of children it was confirmed by angiography of the sometime with tracheobronchography. The operation was performed in 41 children from left-sided thoracotomy, the vascular ring was released by resection or retraction of the compromising vessel and connective tissue from the trachea. Serious stenosis of the distal trachea in one patient found before operation persists one year after operation, the patient breathes through an individual tracheostomic cannula. Four children could not be extubated for prolonged periods after operation, they were re-operated, the annulus was released. Three patients died, one from bronchopneumonia during the postoperative period, the second one from hypoxic brain damage and the third one after operation of a complex heart disease. In 40 children satisfactory long-term results were achieved, the operation resolved respiratory complaints. The prerequisite of satisfactory results in an accurate diagnosis, early indication of the operation and a perfect surgical operation and good postoperative care.
A group of post-mortem specimens of 82 hearts with a defect of the atrioventricular septum (atrioventricular canal) was retrospectively examined with special attention to the morphology of the defect in relation to the left atrioventricular anastomosis. In 42 preparations the finding was compared with previous angiocardiography and post-mortally with X-ray pictures of the specimens. Correlation of the findings revealed malformation of the left atrioventricular orifice as part of a complex malformation affecting the valvular apparatus in conjunction with the atrioventricular septal defect. In the very variable anatomical morphology a major part is played by the superior cusp of the left atrioventricular anastomosis. The relationship of the superior cusp to the outflow tract of the left ventricle and to the atrioventricular septal defect has an impact on the variability of the angiocardiographic picture, and last but not least, also on the results of surgical treatment. The anteroposterior, left oblique and hepatoclavicular projections are optimal for visualization of the anomaly.
Based on experience with the examination of 13 children with interruption of the aortal arch (IAA) the authors present an account of the basic echocardiographic (ECHO) diagnostic signs and procedures in IAA. Two-dimensional ECHO makes it possible, when a suprasternal approach is used, to assess the type of IAA. Examination from a subcostal and parasternal approach helps to detect associated heart diseases. ECHO findings correlated with angiocardiographic, surgical and necrotic findings. ECHO makes it possible to select further suitable examination methods and therapeutic procedures in this rare critical congenital heart disease.
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In a group of children with congenital heart disease in 10.7% concurrently skeletal anomalies were observed (1085 children) and in 10.5% anomalies of the upper urinary pathways (1807 children). The authors describe X-ray findings in syndromes of anomalies most frequently associated with congenital heart disease.
Based on experience with the examination of 33 children with total anomalous pulmonary venous return (TAPVD), the authors submit on account of basic echocardiographic (ECHO) findings and the examination procedure in TAPVD. The findings of two-dimensional ECHO reveal a typical enlargement of the right atrium and ventricle; in the four-chamber projection the pulmonary veins do not enter the left atrium but they join behind the left atrium. The site of the orifice of TAPVD in supracardial TAPVDS is found from a suprasternal approach, in intracardial TAPVD in the four-chamber projection, in infradiaphragmatic TAPVD from a subcostal approach. Doppler echocardiography reveals an impaired venous flow in the confluent on the pulmonary veins and in structures into which the pulmonary veins lead. ECHO makes it possible to assess the diagnosis of TAPVD by a non-invasive approach, to find the site of the orifice and indicate operation without the use of invasive examination methods.
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