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PubMed1975

Evaluation of intracardiac shunts.

This article will review the qualitative and quantitative methods of radionuclide evaluation of intracardiac shunts. Radionuclide angiocardiography of the cardiopulmonary system has proven adequate, with few exceptions, for qualitative detection of left-to-right and right-to-left intracardiac shunts. Numerous authors have reported on the detection of intracardiac shunts using qualitative methods such as rapid sequential visualization of nuclide angiocardiography using the scintillation camera with Polaroid, 35mm or 70mm film. Recent development of videotape storage systems and computers offers a quantitative technique of permanently recording the nuclide angiocardiogram and thus the capability for replay and analysis of the study. Quantitative analysis of the nuclide angiogram in the form of heart chamber dilution curves or pulmonary dilution curves permits 1) determination of the presence or absence of left-to-right, right-to-left, or bi-directional intracardiac shunts, including shunts which might go undetected using the qualitative techniques, 2) shunt location at the atrial or ventricular level, 3) determination of the functional status of a corrective left-to-right shunt, and 4) shunt quantitation. By quantitative analysis of the isotope dilution curves, it is possible to calculate the size of left-to-right or right-to-left intracardiac shunts (Qp/Qs ratio) to within 10% of the values obtained at cardiac catheterization.

Adolescent↗
PubMed2004

[Application of one-way valved patch in treatment of patients with congenital heart disease with severe pulmonary hypertension].

OBJECTIVE: To explore the effect of one-way valved patch used in congenital heart disease with severe pulmonary hypertension. METHODS: One-way valved patch was used in 30 patients of congenital heart disease with severe pulmonary hypertension (PP/PS > 0.75) in operation. Follow-up of 6 approximately 86 months was conducted to observe its effect. RESULTS: The pulmonary artery pressure was significantly decreased without trans-patch shunt in 11 cases postoperatively. Trans-patch shunt was determined in 27 cases within postperative 72 hours. There were 2 postoperative deaths out of these 27 patients: one died of low cardiac output syndrome 72 hours after operation, and the other died of right heart failure 4 weeks after operation. Thirty-six patients were restored to health and discharged. Three-month follow-up showed trans-patch shunt in 7 cases, including right-to left shunt in 4 cases and two-side shunt in other 3 cases. Color Doppler ultrasonography conducted 6 months after operation proved trans-patch shunt in 4 cases, right-to-left shunt in 1 case, two-side shunt in 2 cases, and left-to-right shunt in 1 case (PP/PS = 0.45). CONCLUSION: One-way valved patch is useful in selected patients in which postoperative right heart failure can be anticipated so as to shunt the blood in the right heart to the left heart and increase the blood volume in the left heart system to ensure the left heart output and minimize the risk of postoperative right heart failure, at the expense of systemic low oxygen saturation that is, however, well tolerated.

Adolescent↗