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At least 325 records · Page 18Linked to original sources
PubMed1975

[Transposition of great vessels with pulmonary stenosis and interventricular communication. Anatomic and surgical aspects. Apropos of 10 cases].

10 cases of anomalous position of the great vessels are reported. They include 8 cases of d-transpositions, 1 of 1-transposition and 1 anatomically corrected malposition. These cases have in common the combination of a ventricular septal defect with a pulmonary stenosis. The anatomical study (6 of 10 cases) made it possible to describe the type of the VSD (related to a defect of development and/or alinement of parietal on the septal band) and of the pulmonary pathway stenosis. Blalock's anastomosis has made it possible to obtain an improvement in 6 patients. 4 operations of complete cure were undertaken in d-transpositions: 2 Mustard's operations ending in death. 2 operations according to Rastelli's principles with one death and one good result. The case of anatomically corrected malposition died after an attempt at complete cure, in view of a left ventricular hypoplasia. The indication for the type of complete cure was discussed in relation with the anatomical data.

Blood Pressure↗
PubMed1976

Right and left ventricular volume characteristics in children with pulmonary stenosis and intact ventricular septum.

Right (RV) and left ventricular (LV) volume variables were calculated in 27 patients with pulmonary stenosis (PS) during routine cardiac catheterization. These included 21 patients with isolated PS (group I) and seven studies in six patients (group II) with PS and right-to-left atrial shunt. Right and left ventricular volumes were calculated according to Simpson's rule and the area length methods respectively. In group I, right ventricular end-diastolic volume (RVEDV) was not different from normal, RVEF (0.70 +/- 0.02) was significantly higher than normal, and right ventricular stroke index (RVSI) (4.36/L/min/M2 +/- 0.23) was normal. The RVEDV/LVEDV ratio was significantly less than normal (P=0.001). Multiple regression analysis indicated that RVEDV (% of normal) decreased with both age and severity of RV outflow obstruction (r=0.77). In group II, RVEDV and RVSI were both less than normal (P less than 0.001), while RVEF was normal. LVEDV in the group was slightly higher than normal (P=0.026) while LVEF was less than normal (P=0.027) and resulted in normal LVSI. The data suggest that RV and LV function in children with isolated PS are normal, and that knowledge of the RV volume variables is not essential for the management of these patients. In contrast, hearts of patients with PS and right-to-left interatrial shunt have evidence that suggest depressed ventricular function, and the quantitation of RV volume may be helpful in the management of these patients.

Adolescent↗
PubMed1986

Transcatheter treatment of pulmonary stenosis and coarctation of the aorta: experience with percutaneous balloon dilatation.

Twenty two children (age range 4 months-20 years) with pulmonary valve stenosis and ten children (age range 1 month-11 years) with coarctation of the aorta underwent balloon dilatation in the 29 month period between October 1983 and February 1986. Number 5-9 French catheters with 5-20 mm balloons were used according to the size of the angiographically measured pulmonary valve annulus or coarcted segment and the aorta proximal to coarctation. The peak inflation pressure used in the balloons varied from 2-5 atm (202-505 kN/m2) for pulmonary valve stenosis and 4-8 atm (404-808 kN/m2) for coarctation, and inflation lasted 8-15 s. At least four balloon dilatations were performed in every case. After balloon dilatation the mean (SD) peak systolic pressure gradient across the pulmonary valve fell from 98 (39) to 33 (13) mm Hg. The cardiac index did not change. After balloon dilatation of aortic coarctation the systolic pressure in the descending aorta rose from 86.4 (17.7) to 107.8 (20) mm Hg and the peak systolic pressure difference across the coarctation fell from 44.1 (19.1) to 8.5 (8.5) mm Hg. The diameter of the angiographically measured coarcted segment increased, the Doppler estimate of the pressure difference across the coarctation decreased, and the femoral pulses improved. There were no important complications. Long term follow up results for balloon dilatation of pulmonary valve stenosis were excellent. Similar follow up was not available for patients after dilatation of aortic coarctation. Percutaneous balloon dilatation for pulmonary stenosis and coarctation of the aorta is a safe and effective alternative to operation. It is the treatment of choice for pulmonary valve stenosis and it may become so for coarctation of the aorta in young children if long term results are favourable.

Adolescent↗
PubMed1981

[Pulmonary stenosis with intact interventricular septum: qualitative and quantitative analysis of the vectorcardiogram (author's transl)].

Eighty-one patients suffering from pulmonary stenosis with intact interventricular septum were divided into two groups according to their age: Group I (greater than 2 years), Group II (less than 2 years). In Group I, patients with RVSP up to 50 mmHg have been included in subgroup A; patients with RVSP from 50 to 90 mmHg in subgroup B, patients with RVSP greater than 90 mmHg in subgroup C. In Group II forms with RVSP less than or equal to 60 mmHg have been considered moderate and forms with RVSP greater than 60 mmHg severe. The rotation and duration of the QRS loop on the various planes, presence of a terminal slowing, the ratios 0,01"/LMSV and 0,02"/LMSV, the LMSV and the RMSV in order to assess the most significant vcgraphic parameters to predict severity of the stenosis have been analysed. A fair correlation has been found between RMSV and RVSP (r = 0,55 in Group I; r = 0,54 in Group II). The AA. conclude that a counterclockwiseloop on the H plane and the presence of a terminal slowing are the most reliable parameters for recognizing the light forms, while the clockwise loop on the H plane and a markedly increased voltage of RMSV indicate more severe stenosis.

Adolescent↗
PubMed1999

Pulmonary stenosis: defect-specific diagnostic accuracy of heart murmurs in children.

OBJECTIVE: To determine the accuracy of expert examination for pulmonary stenosis (PS) among children with murmur. STUDY DESIGN: Five hundred twenty-one consecutive, previously unevaluated, pediatric patients were enrolled. The investigators prospectively recorded their diagnosis and level of confidence, categorizing any PS suspected as mild or severe. After echocardiography, PS was categorized by severity with peak systolic flow velocity. Receiver operating characteristic curves described accuracy of clinical examination. RESULTS: Sixty-two patients had PS (mild, 29; moderate, 27; and severe, 6). Receiver operator characteristic curve areas were: total, 0.834 +/- 0.033; mild, 0.862 +/- 0.044; and moderate to severe, 0.809 +/- 0.046 (P =.20). Specific difficulties in discrimination of PS from small ventricular septal defect, aortic valve disease, atrial septal defect, and innocent murmur were identified. All cases of severe PS in which PS was suspected were thought possibly severe. CONCLUSIONS: Although expert clinical examination is highly accurate for distinguishing PS from non-PS cardiac murmurs in pediatric patients, it is imperfect.

Adolescent↗
PubMedDate not supplied

Right transatrial approach to relieve pulmonary stenosis in patients with corrected transposition of the great vessels: a new operation without use of an extracardiac conduit.

BACKGROUND: A new operation to relieve pulmonary obstruction is proposed for patients with corrected transposition of the great vessels and pulmonary stenosis (PS). A right transatrial approach involves excising or detaching the right-sided atrioventricular valve (AV). Next, the pulmonary outflow tract is opened wide with an incision extending from the right-sided ventricle upward across the AV valve annulus. This incision extends into the main trunk of the pulmonary artery located behind the right atrium. A patch, with or without implantation of a pulmonary valve prosthesis, widens the outflow tract, thus avoiding use of an extracardiac conduit. METHOD: We describe this operation performed in a 51-year-old man who had previously undergone correction with an extracardiac conduit that had become obstructed. The patient had severe right-sided AV valve insufficiency and complete heart block with a functioning transvenous pacemaker. We replaced the right-sided AV valve and positioned the permanent pacemaker lead outside of the prosthetic skirt. The PS was corrected as described above and a pulmonary prosthetic valve implanted. Use of an extracardiac conduit was avoided altogether. CONCLUSION: This technique may be applicable even without excising the right-sided AV valve. The clinical result for our patient is still optimal 4 years after surgery.

Cardiac Surgical Procedures↗
PubMed2003

Two-dimensional echocardiographic diagnosis of double outlet left ventricle with subaortic ventricular septal defect, pulmonary stenosis, and a hypoplastic left ventricle.

Double outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both the pulmonary artery and the aorta arise exclusively or predominantly from the morphologic left ventricle. We describe a case of DOLV with situs solitus, d-loop ventricles, d-malposition of the great arteries (S, D, D), severe pulmonary stenosis, and a subaortic ventricular septal defect in which the left ventricle was also severely hypoplastic. The anatomic features were shown with 2-dimensional echocardiography, and the diagnosis was later confirmed at cardiac catheterization. Many morphologic variations of this malformation have been described but to the our knowledge DOLV with a hypoplastic left ventricle has not been reported before.

Aortic Diseases↗