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PubMed1983

[Myocardium-cardiac jelly dissociation and conal torsion. A study on the chick embryo heart].

Conal twisting seems to result from dissociation between the cardiac jelly and the deep myocardial interface like the lining in the sleeve of a jacket. The conal ridges are the natural markers of the jelly and endocardium. They are responsible for septation of the conus and enable the twisting to be observed and measured. The myocardium is marked artificially by cauterisation. This marks the armature of the wall and leaves behind a zone of reduced resistance in the form of a hernia or false diverticulum. The conal ridges and marked myocardium dissociate. In the mid segment the myocardium does not play any role in twisting. In the proximal and distal segments it is only partially involved. This dissociation is observed even in the structure of the conal wall; the jelly, which is dense near the endocardium, is loose near the myocardium and adheres to the deep surface by dispersed fibres. Perfusion under pressure of the investigated specimens induces a detachment between the jelly and the myocardium and there only. This fragility only lasts during the twisting period. It is not found at the end of cardiac embryogenesis. This zone would allow not only a sliding--due to its fragility--but also a controlled sliding--by its fibres. In addition to twisting there is also conal migration. This takes place in the same direction as proximal twisting and determines myocardial rotation, which is less marked however, than that of the corresponding ridges. Experimentation may exaggerate this dissociation by preventing migration. It may also reduce or even suppress it by the formation of adhesions between the two layers. Although this mechanism is not univocal, a myocardial-jelly adhesion could stop distal twisting for example and explain malposition or transposition of the great vessels. This dissociation is no unique to superior vertebrates as it has also been found in the first living animals in whom conal twisting occurs, the dipneustes.

Animals↗
PubMed1984

Hemoptysis following Mustard repair: a late complication.

Hemoptysis was the presenting symptom in a 4-year, 11-month-old male who had had a Mustard operation for hemodynamic correction of transposition of the great vessels at the age of five months. Chest roentgenography demonstrated hyperlucency of the left lung and tomography showed compression and narrowing of left main stem bronchus. Angiography documented the absence of antegrade flow in the left pulmonary artery and no pulmonary venous drainage on the left. The left lung was supplied by bronchial collateral arteries which drained by retrograde filling of the left pulmonary artery. It is surmised that pulmonary venous drainage on the left was compromised at surgery and that the dilated main pulmonary artery compressed the left main stem bronchus. This combination promoted bronchial collateral ingrowth. Hemoptysis is a complication of enlargement of bronchial collateral vessels.

Child, Preschool↗
PubMed1978

Vulnerability of coronary arteries in surgery for transposition of the great arteries.

A detailed anatomic study of 82 hearts from patients operated upon for complete or congenitally corrected transposition of the great arteries revealed 12 instances of intraoperative injury to a major coronary artery. Because the coronary arterial anatomy is so variable in transposition of the great arteries, there is a significant risk of injury to them during operation. This is especially so if epicardial adhesions and scarring from previous operations obscure the surface anatomy of the heart. The most common site of injury was adjacent to incisions in the anterior surface of the right-sided ventricle, particularly in congenitally corrected transposition. Without a meticulous examination, these complications of cardiac surgery may be easily overlooked even when the hearts are examined at autopsy.

Blood Vessel Prosthesis↗
PubMed1976

[D-transposition in situs inversus, atrial septal defect, open foramen ovale and tricuspid valve insufficiency].

This paper reports on a rare case of a so-called corrected d-transposition of the great vessels of a 62-year old woman with situs inversus. In addition the patient had a VSD, a patent foramen ovale, and a tricuspid-valve insufficiency. The topography of the ventricular cavities, the great vessels and the coronary arteries is described in detail. There is pointed to the surgical treatment of additional abnormalities to improve the prognosis.

Electrocardiography↗
PubMed1983

Early cardiac evaluation of thoracically conjoined twins.

Thoracopagus conjoined twins were delivered at 31 weeks gestation by cesarean section. Although there was a single heart, the possibility of salvaging one twin only was contemplated. Echocardiography revealed an A-V canal and suspected transposition of the great vessels. To determine the possibility of surgery, cardiac catheterization was performed to rule out other congenital cardiac malformations incompatible with life, and also to delineate the exact anatomy of the great vessels of the heart. Unfortunately, complex congenital abnormalities were found, thus excluding the possibility of surgery. Newly delivered conjoined twins should be regarded as potentially correctable and should be promptly investigated while they are yet in good clinical condition.

Female↗
PubMed1999

Technique for repair of single-ventricle hearts with transposition of the great arteries and aortic arch hypoplasia.

We describe a modified technique of aortopulmonary anastomosis for palliative repair of hearts with a single left ventricle, a rudimentary right ventricle, transposition of the great vessels, and a hypoplastic aortic arch. This procedure creates an unobstructed left ventricular outflow tract and avoids the problems of spiral patch grafting and multiple patch enlargements of the ascending aorta and arch.

Aorta, Thoracic↗
PubMed1993

Permanent pacemaker positioning via the inferior vena cava in a case of single ventricle with loss of right atrial-vena cava continuity.

Successful dual chamber pacing was achieved by implanting permanent pacemaker leads using an extra-peritoneal approach to the inferior vena cava in a 48-year-old patient with a single ventricle, transposition of the great vessels, and a right atrial pulmonary artery shunt (Glenn's procedure). The pacemaker generator was implanted into a subcutaneous pocket in the anterior abdominal wall.

Cardiac Pacing, Artificial↗
PubMed1966

Intra-uterine closure of the atrial septum.

Two newborn babies with an intact atrial septum are described. In one, the two components of the atrial septum appeared to have become fused after relatively normal initial development; the left side of this heart was hypoplastic. In the other baby the formation of the atrial septum appeared to have been completely anomalous; this heart showed mitral atresia, absence of the left ventricle, and transposition of the great vessels. There was also pulmonary lymphangiectasis in the second case, and it is suggested that this was due to the cardiac malformation obstructing pulmonary venous drainage.

Female↗
PubMed1989

Permanent transvenous pacing after a Mustard procedure.

We report the case of a 20-year-old man born with transposition of the great vessels who underwent emergency balloon septostomy and subsequently a Mustard procedure. When aged 20 years, he had several syncopal attacks due to sinoatrial disease for which he was simply and successfully paced transvenously in VVI mode.

Adult↗
PubMed1988

Renal failure following cardiac surgery in a 2.8-kg infant managed with continuous arteriovenous hemofiltration.

Renal failure occurred after repair of transposition of the great vessels with ventricular septal defect in a 2.8-kg infant and was managed successfully with continuous arteriovenous hemofiltration. The infant lost the weight that had been gained as extravascular water, thereby simplifying her fluid, electrolyte, and nutritional management. She ultimately died of cardiac failure.

Acute Kidney Injury↗