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Biomedical subjects

V Schmer

Publications and source records attributed to V Schmer.

5 recordsLinked to original sources

Neonatal echocardiograms of macrosomic neonates.

OBJECTIVE: To compare echocardiograms of macrosomic and healthy full term neonates whose weight was appropriate for gestational age (AGA). METHODS: Echocardiography was performed on 9 healthy full term AGA neonates and 15 macrosomic neonates. A data base was generated from valid echocardiographic measurements on each infant. RESULTS: Macrosomic infants were heavier than control infants and had a greater body surface area, but their mean cardiac dimensions were similar. The mean LVES volume was smaller than that of the control group when expressed as a fraction of individual LVED values (0.61 +/- 0.04 vs 0.64 +/- 0.02; p = 0.02). When comparing IVS/PW, it was observed that the ratio was up to and including 1.33 in the control group, while the upper limit of the ratio of the nondiabetic macrosomic infants was 1.6. The shortening fraction (SF%) was increased in comparison to infants of normal weight (40.67% +/- 3.34 vs 36.00% +/- 1.89; p = 0.0009). The thickened IVS did not elevate SF% by decreasing LVES; the macrosomic infants had a smaller LVES mean volume. CONCLUSION: IVS/PW ratio of macrosomic infants fell outside of the normal range. Macrosomic neonates were found to have an increased SF% secondary to a proportionally smaller LVES volume, regardless of IVS thickness.

Aorta↗

Ventricular dominance patterns in preterm infants.

OBJECTIVE: The purpose of the study was to determine EKG and 2-D echocardiographic criteria of ventricular dominance in preterm infants and select those by which ventricular dominance could be established by EKG alone. METHODS: A database was constructed from EKG and 2-D echocardiographic measurements on preterm infants ranging in gestational ages from 23 to 34 weeks and birth weights from 555-2490 g, and fullterm controls. Twelve-lead EKGs were obtained in the first 4 days of life in 12 preterm infants and in the first 24 hours of 4 controls. 2-D echocardiograms were performed with sweeps from the subcostal, parasternal, apical and suprasternal views and M-mode measurements in the short axis parasternal view on 11 of the preterm infants and 9 fullterm controls. RESULTS: A definite leftward QRS axis for the preterm infants (+90 degrees, preterm; +133.75 degrees, term; t = -5.63; p < 0.001) indicated a left ventricular (LV) dominance. But R/S in favor of LV dominance for preterm infants was apparent in V6 only. A pooled amplitude index for each ventricle based on R and S wave from V1, V2, V5, and V6 leads, showed LV dominance for the preterm infants with a trend toward RV dominance with increasing gestational age (F = 20.82; p < 0.001). RVD/LVED M-mode echo ratios confirmed the LV dominance in preterm infants. CONCLUSION: A healthy full term infant is born with RV dominance. LV dominance with a trend toward RV dominance with increasing gestational age was found in preterm infants by EKG and echo criteria.

Child↗

One day old infant with acyanotic congenital heart disease: critical aortic stenosis.

Congenital aortic stenosis accounts for about 5% of cardiac malformations recognized in childhood. It belongs to the category of acyanotic congenital heart disease. These lesions produce a load on the heart because of left ventricular outflow tract obstruction. Severe aortic stenosis in the newborn period (critical aortic stenosis) presents with signs of left sided heart failure (pulmonary edema, poor perfusion), right sided heart failure (hepatomegaly, peripheral edema) and may progress rapidly to total circulatory collapse. We present a case of an infant with critical aortic stenosis presenting with cyanosis, who was entirely dependent on ductal patency for systemic output. When oxygen was given, the ductus started to close, with a worsening of the left sided output and subsequent acidosis. With the right to left shunt across the ductus, the baby was cyanotic and dependent on prostaglandin to keep the ductus open. There was minimal flow across the aortic valve because of the stenosis and extremely poor left ventricular function prior to surgery. After relief of the aortic valvular obstruction, there was finally good antegrade flow across the aortic valve, terminating cyanosis.

Adult↗

Cardiovascular anomalies associated with prenatal exposure to theophylline.

Theophylline has been shown to be a potent cardiovascular teratogen in animals, but there has been no evidence linking theophylline with congenital anomalies in infants. The cardiovascular anomalies in our three patients were aortic anomalies, double-outlet right ventricle, transposition of the great arteries, total anomalous pulmonary venous connection, and hypoplasia of the left ventricle. Some of these rare defects were also induced frequently in animal experiments with theophylline, which suggests that this drug can be a cardiovascular teratogen in a susceptible human fetus.

Adult↗