1/128. Echocardiographic detection of bacterial vegetations in a child with a ventricular septal defect.A 13-year-old boy with a small ventricular septal defect was admitted with clinical manifestations of acute endocarditis. coagulase-positive staphylococci were isolated from the blood. Definitive diagnosis was made by detecting bacterial vegetations in the right ventricle on the echocardiogram. Repeated embolization of these vegetations to the pulmonary circulation led to the death of the patient.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/128. Anomalous origin of the right coronary artery from the left sinus of valsalva: transthoracic echocardiographic diagnosis.Anomalous origin of the right coronary artery from the left sinus of valsalva is a rare congenital defect that can be difficult to diagnose by echocardiography. We describe an infant with a ventricular septal defect that was diagnosed prospectively by transthoracic echocardiography as an anomalous origin of the right coronary artery from the left sinus of valsalva. Subcostal imaging and Doppler color flow mapping were instrumental in the echocardiographic diagnosis of this unusual coronary abnormality.- - - - - - - - - - ranking = 53.353183524078keywords = coronary (Clic here for more details about this article) |
3/128. High origin of the right coronary artery with congenital heart disease.We encountered a case of anomalous high origin of the right coronary artery associated with ventricular septal defect and patent ductus arteriosus. The right coronary artery originated from the distal part of the ascending aorta resulting in unsuccessful induction of cardiac arrest by cardioplegia. We describe this rare case with anomalous origin of the right coronary artery.- - - - - - - - - - ranking = 53.353183524078keywords = coronary (Clic here for more details about this article) |
4/128. Arterial switch with internal pulmonary artery banding. A new palliation for TGA and VSD in complex cases.In most cases, one stage repair by arterial switch operation (ASO) is the optimal treatment for neonates with transposition of the great arteries (TGA). Nevertheless, a ventricular septal defect (VSD) associated with TGA remains a major risk factor for early death and reoperation after complete repair in neonates with complex anatomy. A new palliative approach for such specific cases is proposed. An internal pulmonary artery banding (IPAB), as that already used to palliate other cardiac malformations, is performed in association with ASO instead of VSD closure. At the end of ASO, a circular polytetrafluorethylene (PTFE) patch with a 4-mm central hole is oversewn into the neo-pulmonary trunk. We adopted this method in a 17-day-old boy with TGA, VSD, hypoplastic tricuspid valve and diminutive right ventricle. After the operation the child thrived and was doing well without medication. Satisfactory growth of the right ventricle and tricuspid valve was observed by echocardiography during the following months. The patient successfully underwent VSD closure and IPAB removal 2 years after the first procedure. ASO with IPAB could be appropriate in all forms of TGA and VSD in which VSD closure appears too challenging in the neonatal period and in patients with uncertain suitability for biventricular repair. We preferred to use IPAB instead of classic PAB in order to reduce the risk of pulmonary valve damage, pulmonary artery distortion, and above all pulmonary artery dilatation and related coronary compression. In the presented case the strategy as well as IPAB worked according to our expectations.- - - - - - - - - - ranking = 7.6218833605826keywords = coronary (Clic here for more details about this article) |
5/128. thromboembolism originated from the pulmonary artery stump after Fontan operation.Cerebral thromboembolism is a rare but serious complication after Fontan operation. This is the report of a patient who underwent a successful intracardiac thrombectomy for cerebral thromboembolism after Fontan operation. A 2-year-old girl was referred to us with the diagnosis of tricuspid atresia without pulmonary stenosis, normally related great arteries, and a ventricular septal defect. Although she underwent a successful Fontan operation and division of the main pulmonary artery, she developed a cerebrovascular event at 3 weeks after the operation. echocardiography demonstrated a large thrombus within the residue of the main pulmonary artery, and suggested that the thrombus had migrated into the systemic circulation by way of the ventricular septal defect. At 2 weeks after the cerebrovascular event, she underwent thrombectomy and excision of the pulmonary valve. Although she has developed slight left-sided hemiparesis, she is leading a normal life at 1 year after the operation.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
6/128. Echocardiographic diagnosis of sinus Valsalva aneurysm rupture in two pediatric patients.Sinus Valsalva aneurysm rupture (SVAR) is a rare cardiac abnormality that requires surgical correction when diagnosed. Previously, cardiac catheterization and angiography were thought to be necessary for its diagnosis. We present two pediatric cases of SVAR with subarterial ventricular septal defect (VSD) diagnosed noninvasively by echocardiography; surgical findings confirmed the diagnosis. In both of our cases the origin of SVAR was the right coronary sinus. The first case was ruptured into the right ventricular cavity; the second was ruptured into the right ventricular outflow tract. Continuous murmurs heard during follow-up of children with VSD must alert the physician to this pathology. Combined two-dimensional, Doppler and color-Doppler echocardiography is an accurate, noninvasive method for diagnosis of SVAR.- - - - - - - - - - ranking = 7.6218833605826keywords = coronary (Clic here for more details about this article) |
7/128. Surgical management of ventricular septal defect complicating myocardial infarction.In an 18 month period six patients were treated by operation for ventricular septal defect occurring as a complication of acute myocardial infarction. Each septal defect occurred within one week of the myocardial infarct but the interval from infarction to operation ranged from 8 days to 7 months. All patients had intractable cardiac failure and two were in cardiogenic shock at the time of operation. Preoperatively right and left heart catheterisation with left ventriculography and biplane coronary arteriography was performed in every case. At operation the principle of "total correction" of all the cardiac defects was followed so that in addition to closure of the septal defect each patient required one or more additional operative procedures such as resection of left ventricular infarct or aneurysm, mitral valve replacement or coronary artery vein bypass grafts. All six patients survived operation but one died four weeks postoperatively from perforation of an acute peptic ulcer. In one patient the ventricular septal defect recurred and was successfully closed four months later. The surviving patients remain well at follow-up.- - - - - - - - - - ranking = 15.243766721165keywords = coronary (Clic here for more details about this article) |
8/128. Infective endocarditis affecting both systemic and pulmonary circulations predisposed by a ventricular septal defect.A 39-year-old woman was admitted to our hospital presenting persisting fever. An echocardiographic examination showed severe aortic and mitral valve regurgitation with moderate tricuspid regurgitation. Small left-to-right shunt through the ventricular septal defect was identified. Vegetation was also detected on the tricuspid, mitral, and aortic valves. At one month after admission, the patient showed sudden onset of headache and abdominal pain. A computed tomographic scan demonstrated cerebral and splenic infarction. A pulmonary perfusion scintigram demonstrated perfusion defects in left-S1 and right-S6 regions. At 4 months after admission, as operation was performed. The aortic valve was replaced with a #23 mm CarboMedics prosthesis and the mitral valve with a #29 mm Carbo Medics prosthesis. tricuspid valve plasty was performed, with closure of He laceration and perforation of the anterior leaflet combined with a commissuroplasty, according to Kay's method. Ventricular septal defect was closed with a bovine pericardial patch. She was discharged at 19 days after the operation, and is leading a good life. Pervasion of the organism seemed to be initiated from the mitral valve which was conveyed by the blood stream to the aortic valve, and to the tricuspid valve through the ventricula septal defect. Left heart evaluation may be important in cases with infective endocarditis and ventricula septal defect.- - - - - - - - - - ranking = 4keywords = circulation (Clic here for more details about this article) |
9/128. Considerations in biventricular repair after the Norwood procedure.OBJECTIVE: The Norwood procedure can be applicable as a first stage palliation in children who can eventually undergo a biventricular repair. Although usual management of these patients is a primary neonatal repair, in selected patients staged approach with a Norwood procedure in the neonatal period followed by a Rastelli procedure in the infancy for conversion to two-ventricle physiology has been used alternatively. methods: We report our experiences on two infants who underwent a previous palliation with the Norwood procedure for lesions other than hypoplastic left heart syndrome and converted to two-ventricle physiology by the use of a Rastelli-type procedure. This report examines considerations in biventricular repair after the Norwood procedure especially need for ventricular septal defect enlargement and approach to placement of the right ventricle to pulmonary artery conduit. RESULTS: Both of the infants who underwent staged approach with an initial Norwood procedure for lesions other than hypoplastic left heart syndrome survived the operations and were clinically well at mid-term follow-up. CONCLUSION: In selected patients, the staged approach is an alternative in management of malformations other than hypoplastic left heart syndrome which share the important physiologic features of aortic outlet obstruction and ductal dependency of systemic circulation. We recommend routine enlargement of ventricular septal defect and proper positioning of the conduit at the time of subsequent biventricular repair.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
10/128. hemoptysis following left ventricular aneurysm repair: a misleading clinical sign.We report on a 66-year-old man with severe hemoptysis following coronary artery bypass grafting and repair of a left ventricular septal defect after acute myocardial infarction. Initial diagnosis was delayed by misleading clinical symptoms and radiologic studies. Due to subfebrile temperature and sputum culture positive for pseudomonas aeruginosa, he had been treated with antibiotics before reoperation. At reoperation, replacement of all foreign material and reconstruction of the ventricular repair with bovine pericardium resulted in reinfection with the same organism despite prolonged antibiotic therapy after 6 months. Removal of the pericardial tissue with direct suture closure of the ventricles and interposition of omentum led to complete healing of the infection without reoccurrence after 2 years.- - - - - - - - - - ranking = 7.6218833605826keywords = coronary (Clic here for more details about this article) |
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