Biomedical subjects

Suchaya Silvilairat

Publications and source records attributed to Suchaya Silvilairat.

8 recordsLinked to original sources

PubMed2006

Right ventricular function in asymptomatic individuals with a systemic right ventricle.

BACKGROUND: In congenital heart defects where the morphologic right ventricle (RV) supports the systemic circulation, RV failure is common yet develops gradually. We hypothesized that patients who are asymptomatic may have unrecognized RV dysfunction. METHODS: Conventional and Doppler tissue/strain echocardiography were performed on consecutive patients with asymptomatic systemic RV caused by congenitally corrected transposition of the great arteries (ccTGA) and on age-matched control subjects. RV index of myocardial performance was measured using conventional echocardiography. Longitudinal tissue velocities, strain rate, and strain of the basal RV free wall were measured using Doppler tissue/strain echocardiography and compared with nonsystemic RV of the control subjects. RESULTS: Mean age was 39.5 +/- 14.6 (n = 13) and 36 +/- 24 (n = 10) years for ccTGA and control groups, respectively. Mean RV index of myocardial performance was higher in patients with ccTGA than in control subjects (0.66 +/- 0.25 vs 0.28 +/- 0.12, P < .001). Mean RV tissue displacement (10.8 +/- 4.5 vs 20.3 +/- 3.9 mm, P < .0001), peak systolic strain rate (-1.16 +/- 0.3 vs -2.23 +/- 0.9 s(-1), P = .005), and peak systolic strain (-17.3 +/- 8.0 vs -30.6 +/- 11.0%, P = .008) were significantly lower in patients with ccTGA compared with control subjects, respectively. CONCLUSION: Patients with asymptomatic ccTGA have quantifiable RV dysfunction by echocardiography.

Adult↗

PubMed2006

Factors determining immediate and medium-term results after pulmonary balloon valvuloplasty.

OBJECTIVE: To determine factors influencing immediate and medium-term results of Pulmonary Balloon Valvuloplasty (PBV) for pulmonary valve stenosis. MATERIAL AND METHOD: Between 1995 and 2001, the authors carried out PBV in 25 consecutive patients. Two treatment outcomes including immediate and medium-term results were analyzed. The immediate results were classified into two groups based on the pulmonary systolic pressure gradient (PG) immediately after dilation: group 1 with a PG < or = 35 mmHg and group II with a PG > 35 mmHg. At medium-term follow-up of 6 to 60 months, echocardiographic evaluations were analyzed and divided into two groups: group A with a PG < or = 25 mmHg and group B with a PG > 25 mmHg. Demographic characteristics and hemodynamic parameters of immediate and medium-term results were compared and analyzed. RESULTS: Immediately after PBV the right ventricular systolic pressure (RVSP) decreased from 115.3 +/- 37.6 mmHg to 67.0 +/- 28.5 mmHg (p < 0.001). The pulmonary systolic pressure gradient decreased from 90.4 +/- 37.9 mmHg to 39.3 +/- 25.6 mmHg (p < 0.001). Nine of the 25 patients (group 11; 36%), with incomplete immediate relief of the obstruction, had more symptoms, a higher baseline PG, higher right atrial pressure, higher RVSP, and a higher systolic pressure ratio. Six of the 25 patients (group B; 24%), with suboptimal medium-term results, had a higher right ventricular voltage on the electrocardiogram, higher pre-dilation PG, and higher RVSP. CONCLUSION: Successful medium-term outcomes following pulmonary balloon valvuloplasty were achieved in 76% of the patients, with a greater success rate (91%) in patients with a lower right ventricular voltage electrocardiogram (R wave amplitude in V1) < or = 21 mm, a prevalvuloplasty systolic gradient < or = 90 mmHg, and right ventricular systolic pressure < or = 125 mmHg.

Adolescent↗

PubMed2005

Echocardiographic assessment of isolated pulmonary valve stenosis: which outpatient Doppler gradient has the most clinical validity?

Maximum instantaneous Doppler gradient has been the primary variable used to assess severity of pulmonary valve stenosis. However, recent observations suggest that outpatient maximum Doppler gradient often overstates clinical severity, as measured by catheter peak-to-peak gradient (PPG). This study sought to determine which outpatient Doppler gradient was most predictive of subsequently measured PPG. Ninety patients were included. Outpatient mean Doppler gradient showed the best correlation and agreement with the catheter PPG (r = 0.82, bias = -5 mm Hg). Maximum Doppler gradients, even when corrected for proximal velocity, consistently overestimated the PPG (bias = +21-26 mm Hg). Outpatient mean gradient was most predictive of subsequent PPG and should be used to determine whether to intervene for patients with isolated pulmonary valve stenosis. Use of only the maximum Doppler gradient to assess pulmonary valve stenosis will lead to a systematic overstatement of the severity of the stenosis.

Adolescent↗

PubMed2005

Outpatient echocardiographic assessment of complex pulmonary outflow stenosis: Doppler mean gradient is superior to the maximum instantaneous gradient.

Evaluation of pulmonary outflow obstruction has focused on maximum instantaneous gradient (MIG). However, experience suggests that outpatient Doppler MIG often overstates the degree of stenosis. In this study of 132 patients with complex pulmonary stenosis, the mean Doppler gradient showed superior correlation and agreement with invasive peak-to-peak gradient (PPG) (r = 0.91, bias = -6 mm Hg). Agreement between mean gradient and PPG remained excellent for patients with prosthetic conduits (bias = -4 mm Hg). When PPG was 50 mm Hg more, both mean Doppler gradient and MIG corrected for prevalve velocity provided reasonable estimates of PPG (bias = -13 and +17 mm Hg, respectively). Uncorrected MIG remained significantly greater than PPG (bias = +27 mm Hg). Outpatient MIG consistently overstated subsequent PPG. In unselected patients with conduits or with PPG of 50 mm Hg or less, mean Doppler gradient provided the best prediction of PPG. These data provide a strong argument for the routine use of mean gradients in complex pulmonary stenosis.

Adolescent↗

PubMed2004

Kawasaki disease in Thai infants compared with older children.

Infants with Kawasaki disease (KD) are at increased risk of having coronary artery abnormalities (CAA). The purpose of this study was to evaluate the clinical features of KD in infants and compare these with findings in older children to determine the risk factors for CAA in infants. All children with KD admitted to a tertiary care hospital between January 1993 and April 2003 were studied retrospectively. Of a total of 51 patients included in the study, 22 (43%) were <1 year of age (mean 8 months, range 2-12 months). All had classical clinical manifestations such as fever, skin rash and mucositis; extremity change occurred in 95%, conjunctivitis in 81% and cervical lymphadenopathy in 27%. Infants had significantly more non-classical symptoms, e.g. diarrhoea (68%), than older children (38%) (p=0.04). The mean number of days before intravenous immunoglobulin (IVIG) treatment was given to infants was 2 days later than in older children. The predictors of CAA in infants were resistance to IVIG treatment (p=0.02) and long duration of fever (p=0.009). Compared with older children, the less typical presentations and delay in diagnosis and treatment in infants might be important factors in CAA in KD.

Age Distribution↗

PubMed2004

Cardiac manifestations in HIV-infected Thai children.

Cardiac complications contribute significantly to morbidity and mortality in HIV-infected children. There have been few reports of cardiac manifestations in HIV-infected children in developing countries. The aims of this study were to evaluate the clinical manifestations and echocardiographic findings in Thai children with HIV infection and determine the clinical predictors of left ventricular dysfunction and pulmonary hypertension. We retrospectively reviewed the medical records of 27 infants infected with HIV perinatally who presented with cardiovascular problems at a tertiary care hospital between 1995 and 2000. The mean age at initial cardiac evaluation was 36 months (range 8-65). Signs and symptoms included dyspnoea in all cases, oedema in 12 (44%), finger clubbing in 11 (41%), cyanosis in 6 (22%) and S(3) gallop in 8 (30%). Echocardiographic abnormalities included pericardial effusion in 12 (44 %), right ventricular dilatation in 12 (44%), pulmonary hypertension in 11 (41%), diminished left ventricular fractional shortening in 10 (37%), left ventricular dilatation in 9 (33%) and combined ventricular dilatation in 2 (7%). Left ventricular dysfunction did not correlate with HIV CDC classification, age, nutritional status or clinical signs and symptoms.

Child, Preschool↗

PubMed2003

Isolated primary chylopericardium: a case report.

Isolated primary chylopericardium is a rare entity with an obscure etiology. The authors report a 10-week-old male infant presenting with tachypnea and enlarged cardiac silhouette. Echocardiography revealed a large pericardial effusion. A specific diagnosis of chylopericardium was made by pericardiocentesis and analysis of the fluid. Despite the pericardial tube drainage and medium-chain triglyceride diet, pericardial effusion reaccumulated. Ligation of the thoracic duct with the establishment of a pleuropericardial window was performed through a left thoracotomy. Follow-up echocardiograms have shown no reaccumulation of the pericardial fluid.

Humans↗

PubMed2003

Pseudoaneurysm following modified Blalock-Taussig shunt: a rare complication mimicking pulmonary disease.

The authors report a pseudoaneurysm in a 2-year-old boy presenting with fever, increasing cyanosis and right upper lung shadowing on a chest radiograph at six weeks following modified Blalock-Taussig shunt surgery. Echocardiography and a CT scan of the chest revealed a large pseudoaneurysm originating from the right subclavian artery at the proximal insertion of modified Blalock-Taussig shunt. The patient underwent aneurysmal resection, Blalock-Taussig shunt removal, right subclavian artery ligation and the creation of a central shunt between the ascending aorta and main pulmonary artery. Unfortunately, the patient died 3 hours after the operation.

Aneurysm, False↗