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Results for “TRANSPOSITION OF GREAT VESSELS”

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Arterial switch procedure for D-transposition of the great arteries: quantitative midterm evaluation of hemodynamic changes with cine MR imaging and phase-shift velocity mapping-initial experience.

PURPOSE: To evaluate cine magnetic resonance (MR) imaging and phase-shift velocity mapping for assessment of the hemodynamic relevance of stenotic segments or specific hemodynamic changes in the great vessels after an arterial switch procedure for correction of D-transposition of the great arteries. MATERIALS AND METHODS: Twenty consecutive patients (age range, 2-17 years) with an acoustic window that was insufficient for Doppler transthoracic echocardiography were included in the study. Flow and diameter measurements of the pulmonary arterial trunk and its primary branches were performed with phase-shift velocity mapping and cine MR imaging. RESULTS: There were good correlations between pressure gradients in the pulmonary arteries estimated with MR imaging and those measured with Doppler echocardiography (r = 0.83, n = 15) and cardiac catheterization (r = 0.90, n = 13). Cine MR imaging revealed that the diameters of the right and left pulmonary arteries decreased with the expansion of the aorta during systole, which increased the peak velocity. This temporary stenosis was more severe in the right than in the left pulmonary artery and was accompanied by a significantly (P <.05) lower volume flow in the right artery. CONCLUSION: The anatomic situation after arterial switch repair tended to produce temporary stenoses in the primary pulmonary arterial branches, with significant changes in hemodynamics. These changes may affect the long-term outcome and go undetected with other imaging modalities.

Adolescent↗

Tricuspid atresia. A review of 68 cases.

Sixty-eight patients with tricuspid atresia were seen at Indiana University during the past 30 years. Long term survivors treated without operation emerged from our review. In these, there was a combination of tricuspid atresia and transposition of the great vessels.

Adolescent↗

Use of polytetrafluoroethylene (Gore-Tex) grafts for the construction of right ventricle-pulmonary artery conduits.

Placement of a right ventricle-pulmonary artery conduit (18- or 20-mm grafts) made of Gore-Tex without a prosthetic valve was undertaken in 6 patients ranging in age from 8 1/2 to 32 years. Three patients had tetralogy of Fallot with pulmonary atresia, and the other 3 had transposition of the great vessels, ventricular septal defect, and pulmonary obstruction. Pulmonary pressure was low in all patients. The technique for implantation of this valveless, noncrimped type of prosthesis is described.

Adult↗

[The autologous pericardial tube-flap. A new technic for restoring the continuity between the right ventricle and the pulmonary artery].

Re-establishing continuity between the right ventricle and the division of the pulmonary trunk may prove difficult in surgical correction of transposition of the great vessels. Although prosthetic tubes, which had many drawbacks, have been replaced by direct anastomoses, partial reconstruction of the pulmonary arterial wall is still often necessary. The materials commonly used are segments of gore-tex, stored pericardium and fresh or glutaraldehyde-treated pericardium. However, retractions may develop in these reconstructions resulting in pulmonary stenosis. These complications have revived the debate on the best technique for re-establishing continuity, and it is mandatory to use a growing tissue to keep pace with the child's development. We report here an original technique used in an infant. Previous studies have shown that the autologous pericardial flap, transformed here into a tube, retains its potential for growth.

Blood Vessel Prosthesis↗

Heparinless, oxygenatorless perfusion rewarming following surface-induced deep hypothermia for open-heart surgery.

To facilitate perfusion rewarming without the use of total body heparinization or an oxygenator following open-heart correction with surface hypothermia, we divised a pump circuit. The circuit, totally primed with 100 c.c. of saline, consists of polyurethane-polyvinyl-graphite (PPG) coated Tygon tubes (with one end tapered by heat treatment) and a copper-coil heat exchanger. A roller pump was used to achieve partial bypass from the left atrium to the ascending aorta with flow rates up to 70 c.c. per kilogram per minute. Experiments in dogs resulted in rapid rewarming, immediate return of cardiac function, and hematologic alterations similar to those noted during surface rewarming. The safety of the method was also demonstrated. Prothrombin time, partial thromboplastin time, and platelet values returned to control levels upon rewarming, and no thromboemboli or bleeding problems were noted. Six clinical experiences were accumulated. Details of the method, hematologic and blood chemical analyses in dogs, and the first clinical trial in a 3-month-old infant with transposition of the great vessels are reported.

Animals↗

Paradoxical embolisation of a catheter fragment to a coronary artery in an infant with congenital heart disease.

Six weeks after cardiac catheterisation via the right femoral vein an infant underwent an anatomical correction for transposition of the great vessels and closure of a large ventricular septal defect. The patient died intraoperatively as a result of severe left ventricular dysfunction. Necropsy showed an old myocardial infarction associated with thrombosis of the circumflex coronary artery. Electron probe x ray analysis showed that foreign refractile material within the thrombus contained bismuth, an element used in the construction of some cardiac catheters. This is believed to be the first report of "paradoxical" coronary embolisation of catheter-derived material and highlights the usefulness of electron probe x ray analysis.

Cardiac Catheterization↗

Tricuspid atresia with dextrotransposition, dextrocardia, and mitral insufficiency: successful circulatory correction.

A 13-year-old patient with visceral and atrial situs solitus, dextrocardia, dextro (D) transposition of the great vessels with subaortic conus, tricuspid atresia, massive mitral valve insufficiency, and previously performed pulmonary artery banding was seen at our hospital. A right atrial to pulmonary artery conduit procedure and mitral valve replacement successfully repaired this child's circulation.

Adolescent↗

Double-outlet right ventricle. A clinical-roentgenologic-pathologic study of 28 consecutive patients.

Twenty-eight cases of double-outlet right ventricle (DORV) were found from 1975 to 1980 in the Shanghai Chest Hospital. On plain films, four types of abnormal heart configuration were found: mitral, boot-shaped, atypical, and bizarre. The main angiocardiographic findings were: (1) simultaneous visualization of aorta and pulmonary artery on right ventriculography, both arising from the right ventricle; (2) D- or L-type of aortic transposition in most; (3) the two semilunar valves at approximately the same horizontal level; (4) an infundibulum present below the semilunar valve; (5) ventricular septal defect; and (6) associated pulmonary stenosis and/or other anomalies. An anatomic-radiologic classification was suggested and based chiefly on symbolic representation of segmental combinations including visceral trial situs, type of cardiac loop, relation between the semilunar valves, presence or absence of pulmonary stenosis and whether the ventricular septal defect was subpulmonary or not. The findings substantiated the viewpoint that in DORV there exists on embryologic and pathologic ground transitional changes ranging from those closely resembling tetralogy of Fallot to complete transposition of the great vessels.

Adolescent↗

Truncus arteriosus communis. Unusual case associated with transposition.

A child with truncus arteriosus communis, characterized by the posterior origin of an individualized pulmonary trunk is presented. This relationship between the great arteries is unusual in truncus arteriosus communis and the spatial orientation resembles that seen in transposition of the great vessels. A brief discussion is proposed about a proper terminology in this type of complex anomaly.

Child, Preschool↗

[Bypass of the outlet of the left ventricle with a Hancock valve tube: report of two cases surgically treated (author's transl)].

The Authors describe two cases in which the outlet of the left ventricle was recreated by means of a bypass with a valve tube. The first is a case of correct levo-transposition of the great vessels with atresia of the pulmonary, in which a valve tube was applied between the inverted left ventricle and the right branch and trunk of the pulmonary. The second is a case of "long" fibrous subvalvular aortic stenosis, a relapse from former correction of membranous subaortic stenosis, in which bypass was applied between the left ventricle and the ascending aorta. This latter method, adopted by McGoon, is held by the Authors to be easier to apply and more physiological in its hemodynamic effects. The clinical and instrumental results were good in both cases. The hemodynamic and cardioangiographic controls carried out in the second case, 4 months after the surgical operation, showed the normal functioning of the prosthesis, an outflow equal to 60.3% of the total capacity through the bypass, and the ample neostomy of the left ventricle in systolic phase.

Adolescent↗

[Follow-up of surgically treated congenital heart disease using Doppler echocardiography].

Surgery can restore normal cardiac anatomy in some forms of congenital heart disease but in others this is not possible even after a "complete correction". In yet other forms, surgery is only palliative. Echocardiography coupled with pulsed, continuous wave and color coded Doppler should be carried out after clinical, electrocardiographic and radiological examination to assess the surgical results and detect possible complications in the short or long-term. It is therefore important to be familiar with the "normal" appearances of operated congenital heart disease in order to be able to detect postoperative abnormalities. The authors describe the normal postoperative findings for each form of congenital abnormality and the changes which may be observed during Doppler echocardiographic examination. This paper only deals with the more simple malformations: ventricular septal defect, atrial septal defect, atrioventricular canal, patent ductus arteriosus, coarctation of the aorta, aortic stenosis, tetralogy of Fallot and simple transposition of the great vessels.

Aortic Coarctation↗

Restrictive dermopathy associated with transposition of the great arteries and microcolon: a rare neonatal entity with new symptoms.

BACKGROUND: Restrictive dermopathy is a very rare autosomal recessive skin disorder. The typical pathologic findings are striking: microstomia, micrognathia, thin but very tight translucent skin that tears spontaneously, and arthrogryposis multiplex. The mechanisms behind this disease are unknown. OBSERVATIONS: We describe for the first time a newborn girl with restrictive dermopathy, transposition of the great vessels, and microcolon. She had thin shiny skin with nearly no compliance indicating restrictive dermopathy. Additional dysmorphic findings included enlarged fontanelle, hypertelorism, absent eyelashes, small pinched nose, microstomia, micrognathia, dysplastic ears, pterygium colli, dyplastic fingers and toes with upper- and partial lower-limb flexion contractures, dysplastic genitalia, and muscular hypotonia. She also had left transposition of the great artery with small atrial septal defect, bilateral hypoplasia of the first rib, and congenital stenosis of the small bowel with microcolon. CONCLUSIONS: The pathogonomic diagnostic features remain reduced dermal thickness and nearly complete absence of elastic fibers in the dermis. In mice, a defective fatty acid transport protein 4 gene (Fatp4) leads to clear signs of restrictive dermopathy by influencing the arrangement of the lipids in the epidermis. Whether the left transposition of the great artery is associated with restrictive dermopathy or represents an additional malformation of multifactorial, polygenetic, or monogenetic cause remains open.

Abnormalities, Multiple↗