11/224. An uncommon echocardiographic marker for anomalous origin of the left coronary artery from the pulmonary artery: visualization of intercoronary collaterals within the ventricular septum. A rare and striking echocardiographic finding with color-flow Doppler--visualization of intercoronary collaterals within the ventricular septum--in an asymptomatic 5-year-old girl is reported. It strongly suggests anomalous origin of the left coronary artery from the pulmonary artery. Several additional echocardiographic features can secure the diagnosis and allow one to proceed with surgical correction without confirmatory cardiac catheterization and angiocardiography. The ages of our patient and of the seven cases reported previously suggest that these collaterals will more likely be identified beyond infancy and in relatively asymptomatic patients with this congenital anomaly. ( info) |
12/224. Telangiectatic fistula between the conal branch of the left coronary artery and the pulmonary trunk. A rare case of telangiectatic communication between the conal branch of the left coronary artery and the pulmonary trunk in a 50-year-old woman is reported. Unusual features included the presence of clear-cut angina on effort, unstable auscultatory findings and a RSR' pattern in lead V1, probably related to concommitant diffuse coronary atherosclerosis. Ten previously reported cases of the condition are briefly reviewed. ( info) |
13/224. Congenital fistula between an aberrant systemic artery and a pulmonary vein without sequestration. A report of three cases. Three children had an arteriovenous fistula between an aberrant vessel from the descending aorta and a normal pulmonary vein in the posterior basal segment of a lung. The affected lung was otherwise normally developed. Only a few similar cases could be found in the literature. ( info) |
14/224. Flow murmur associated with partial occlusion of the right pulmonary artery. An 18-year-old male student presented with a brief history of syncope followed by shortness of breath with exertion, and the development of murmur over the right chest. The symptoms and murmurs were related to a pulmonary embolus which partially occluded the right pulmonary artery and its major branches. The murmur gradually diminished and disappeared when right pulmonary perfusion had almost returned to normal as determined by lung scan. The association of pulmonic flow murmurs and pulmonary emboli is reviewed. ( info) |
15/224. Aberrant course of the left anterior descending coronary artery assoicated with anomalous left circumflex origin from the pulmonary artery. We have presented a two year nonoperative follow-up of an asymptomatic 14-year-old girl with an unusual anomaly of the coronary arteries. Systolic and diastolic murmurs heard preoperatively did not change following severance of a patent ductus arteriosus. Postoperative selective coronary arteriography revealed (1) anomalous orgin of the left anterior descending artery from the right aortic sinus of valsalva crossing between the aorta and pulmonary artery, (2) aberrant circumflex artery orgin from the pulmonary artery and (3) collaterals from the left anterior descending and right coronary arteries to the circumflex artery. This combination of coronary anomalies has never been described previously. ( info) |
16/224. Echocardiographic manifestations of postinfarction ventricular septal rupture. The echocardiographic features of three patients with postinfarction ventricular spectal rupture are described. All patients showed a decreased or paradoxical motion on the ventricular septum, and two of the patients demonstrated an unusual motion of the tricuspid valve. There were no abnormalities in mitral valve motion. The echocardiogram can be helpful in the diagnosis of postinfarction ventricular septal rupture and can assist in distinguishing this condition from acute disruption of the mitral valve complex. ( info) |
17/224. Coronary artery fistula: report of three cases. Three children are described with a right coronary artery fistula communicating with a right heart chamber. Each had a continuous murmur like that of a patent ductus arteriosus but situated at a lower level. aortography established the diagnosis and excluded any accompanying malformation. It is concluded that to prevent complications surgical treatment should be recommended. ( info) |
18/224. The versatility of the Amplatzer Septal Occluder for the management of multiple atrial septal defects in a patient with dextrocardia and situs inversus. A 7-year-old male was referred for evaluation of a heart murmur heard on routine check-up. Transthoracic echocardiogram revealed the presence of a fenestrated atrial septal defect (ASD) in a dextrocardia with total situs inversus ( mirror image ). Two Amplatzer Septal Occluders (Cook Incorporated, Bloomington, indiana) were used to successfully occlude the ASDs with no residual shunt. ( info) |
19/224. Exceptional survival of a patient with large ventricular septal defect, bidirectional shunt, and severe pulmonary valve stenosis. A 74-year-old man has survived in good health for an exceptionally long time despite the presence of a moderate-to-large-sized membranous ventricular septal defect (VSD). He has remained acyanotic with new york heart association class I function. Transthoracic and transesophageal echocardiography with color flow Doppler demonstrated a membranous VSD with left-to-right and right-to-left bidirectional shunts during ventricular systole and diastole, respectively, with an right ventricular systolic pressure of 93 mm Hg, dilation of the atria and the right ventricle, and right ventricular hypertrophy. The pulmonary valve was severely stenotic with transpulmonary valve peak velocity of 6.1 m/s and a peak pressure gradient of 147 mm Hg. The pulmonary artery and inferior vena cava were mildly dilated, and the left ventricular dimension and systolic function were normal. Transesophageal echocardiography with saline solution microbubble injection demonstrated positive contrast effect in the left ventricle in diastole confirming a right-to-left shunt at the ventricular level. This man is currently the oldest survivor with a moderate-to-large-sized membranous VSD reported in the literature. ( info) |
20/224. Tricuspid whoop. The present report describes a patient with a whooping murmur secondary to tricuspid insufficiency. The main features of this tricuspid whoop were as follows: variable in time, moving from mid to late systole; unpredictably associated with normal respiratory phases; after deep inspiratory apnea was almost constantly present. ( info) |