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PubMed1983

Echocardiography in congenital heart disease.

The combination of M-mode and two-dimensional echocardiography provides precise anatomic and helpful functional information for most types of congenital heart defects. Great strides have been made in the past ten years in ultrasound technology and its applications. The examination of the congenitally deformed heart by echo methods is now an intrinsic component of patient evaluation; a remarkable array of important clinical decisions concerning such patients depends, at least in part, on the results of echocardiographic study.

Aortic Valve Stenosis↗
PubMed1981

Biologic reconstruction of the right ventricular outflow tract. Preliminary experimental analysis and clinical application in a neonate with type I truncus arteriosus.

A unique concept of right ventricular outflow tract reconstruction is presented. Applications of this concept, employing a glutaraldehyde-preserved heterograft mitral valve leaflet mounted directly to the right ventricle, was studied in six immature goat models. Interval evaluation of these models demonstrated no significant outflow tract obstruction or aneurysm. Only one animal had significant pulmonary outflow regurgitation angiographically at the time of sacrifice. All heterograft valve leaflets showed a degree of calcification and/or retraction directly related to the time interval between implant and sacrifice. Encouraging early results were obtained with this method of pulmonary outflow tract reconstruction in a 2,400 gram neonate with type I truncus arteriosus.

Animals↗
PubMed1984

[Diffuse pulmonary lymphangiectasia of late disclosure associated with cardiopathy].

Congenital pulmonary lymphangiectasia is a rare abnormality with dilatation of pulmonary lymphatics and the radiological pattern of a pulmonary interstitial syndrome. It is usually symptomatic at birth and is almost always lethal. The authors report the case of an infant with congenital pulmonary lymphangiectasis and congenital heart disease who is still alive. This case report is interesting from the pathogenic, nosologic and prognostic point of view.

Humans↗
PubMed1984

Modification of the precise relationship of the atrioventricular conduction bundle to the margins of the ventricular septal defects by the trabecula septomarginalis.

There is a widely recognized relationship between the atrioventricular conduction bundle and the margins of the ventricular septal defects according to whether the defect is perimembranous or muscular. We have shown that this relationship may in turn be markedly influenced by the precise topography of the trabecula septomarginalis. Fifteen hearts, each with a ventricular septal defect, were studied by serial sectioning. Four hearts had an isolated ventricular septal defect in the setting of normal chamber connections and relations. One heart had a truncus arteriosus, seven hearts had Fallot's tetralogy, and three hearts exhibited complete transposition. In those hearts with outlet defects in which a bar of muscle separated the rim of the defect from the position of the conduction bundle, deficiency of the posterior limb of the trabecula septomarginalis permitted the right-sided margin of the conduction axis to "surface" in directly subendocardial position. Moreover, in some of these outlet defects, the conduction axis in the region of the branching bundle was exposed directly upon the crest of the muscular septum. The position of the medial papillary muscle complex was the best landmark to this potential danger area. In some of the examples of Fallot's tetralogy, we observed a firm muscle bar overlying the posteroinferior margin of the defect, which nonetheless was perimembranous. This protected the nonbranching component of the conduction axis in the anticipated danger area. Paradoxically, a deficiency in the trabecula septomarginatis then permitted the branching bundle to sit directly astride the septum along the inferior rim of the defect. We noted particularly marked variability of the atrioventricular conduction axis among the hearts with tetralogy. Our results suggest that close inspection during the operation may reveal whether or not a well-developed trabecula septomarginalis is present and permit conclusions to be drawn concerning the precise position of the atrioventricular conduction axis.

Adult↗
PubMed1984

Repair of truncus arteriosus in neonates with the use of a valveless conduit.

Each of seven infants 1 to 9 days old and weighing 2.1 to 3.3 kg with truncus arteriosus underwent repair of their defects with a right ventricular-to-pulmonary artery valveless conduit. Congestive heart failure and cyanosis were present before surgery in each. Five patients survived surgery and one of these subsequently died. Comparison between preoperative hemodynamics of the survivors and nonsurvivors disclosed similar peak systolic pulmonary arterial and aortic pressures, and pulmonary (Rp) or systemic resistance (Rs) in the groups. However, the mean Rp/Rs ratio in survivors (0.15) was significantly less than in nonsurvivors (0.63) (p = .001). The four remaining survivors are asymptomatic 7 months to 5.5 years after operation. Postoperative cardiac catheterization in three patients disclosed proximal conduit obstruction of 10 to 20 mm Hg in each, distal conduit obstruction of 35 mm Hg in two, and mild truncal valve stenosis and moderate truncal regurgitation in one each. We recommend the use of a valveless conduit for the symptomatic neonate with truncus arteriosus and a low Rp/Rs ratio (less than or equal to 0.03).

Blood Vessel Prosthesis↗