1/527. Pediatric transesophageal color flow imaging 1990: the long and short of it.Noninvasive cardiac imaging has dramatically altered the practice of cardiology, specifically, the pediatric patient with congenital heart disease over the past decade. Since the introduction of transesophageal echocardiography nearly 15 years ago, addition of high-resolution cross-sectional imaging combined with Doppler color flow mapping has provided a new window to examine the heart. Recently, miniaturization of the transesophageal probe to "pediatric-size" has enabled its use in the smallest of infants to add significantly to the assessment of congenital heart malformations. Most recently, addition of a longitudinal-plane probe to the already-existent, transverse-plane probe has made biplane transesophageal echocardiography a reality with significant additional information being provided by orthogonal images of the cardiac structures. We used these probes in complementary fashion in 30 studies performed in 23 patients ages 1 day to 12 years with a mean of 35 months, weighing 2.6-40 kg (mean 12.4 kg). These studies were performed in the operating room, intensive care unit, cardiac catheterization laboratory, and outpatient department. Limitations of single-plane, transverse transesophageal echocardiography were overcome using the longitudinal-axis pediatric probe: left and right ventricular outflow tracts, distal pulmonary arteries, and all of the interventricular and atrial septa were easily visualized. Its use in the operating room and postoperative cardiac intensive care unit for continuous ventricular monitoring in otherwise-inaccessible patients also provided critical information. Transesophageal echocardiography in infants and small children is a valuable "noninvasive" imaging technique which, with addition of complementary longitudinal-plane views, offers important additional information regarding congenital heart malformations and their repair.- - - - - - - - - - ranking = 1keywords = single (Clic here for more details about this article) |
2/527. Damus-Kaye-Stansel connections in children with previously transected pulmonary arteries.BACKGROUND: In patients with a univentricular arteriovenous connection, transection of the main pulmonary artery may be performed as part of a bidirectional cavopulmonary shunt or fontan procedure. The proximal stump of the pulmonary artery may remain in the systemic circulation. In cases with a discordant ventriculoarterial connection, subsequent restriction of the bulboventricular foramen may lead to subaortic stenosis. The subaortic stenosis can be corrected in some patients by directing the systemic flow through a combined nonobstructed aortopulmonary outlet, as in the Damus-Kaye-Stansel connection. Previous closure of the pulmonary artery has been considered by some investigators to be a relative contraindication to the Damus-Kaye-Stansel procedure, unless an allograft root can be added to the circuit after excision of the closed pulmonary stump. methods: Three patients with previously transected pulmonary arteries underwent a modified Damus-Kaye-Stansel connection using the native pulmonary valve and the proximal pulmonary artery stump. RESULTS: The native pulmonary valves have functioned well despite thrombus formation in the proximal stump in 2 patients before Damus conversion. All 3 patients are alive and well after 108, 19, and 3 months, with competent nonobstructed ventriculoarterial connections. CONCLUSIONS: If transection and closure of the pulmonary artery as part of a previous palliation has spared the pulmonary valve, then the native pulmonary outlet might be used for a safe Damus-Kaye-Stansel connection.- - - - - - - - - - ranking = 85.475394258274keywords = artery (Clic here for more details about this article) |
3/527. Heart/single-lung transplant for a "failed Fontan" with pulmonary A-V malformation.Pulmonary arteriovenous malformation can occur in patients with functional single ventricle after a cavopulmonary connection. There is no effective medical treatment for this complication. Pulmonary arteriovenous malformations may regress over time after heart transplantation, but may be a source of significant perioperative morbidity. We report the case of a woman with single ventricle, ventricular dysfunction, and bilateral pulmonary arteriovenous malformations who had successful treatment of both cardiac and pulmonary failure with en bloc heart and right lung transplantation.- - - - - - - - - - ranking = 6keywords = single (Clic here for more details about this article) |
4/527. Computational fluid dynamic and magnetic resonance analyses of flow distribution between the lungs after total cavopulmonary connection.Total cavopulmonary connection is a surgical procedure adopted to treat complex congenital malformations of the right heart. It consists basically in a connection of both venae cavae directly to the right pulmonary artery. In this paper a three-dimensional model of this connection is presented, which is based on in vivo measurements performed by means of magnetic resonance. The model was developed by means of computational fluid dynamics techniques, namely the finite element method. The aim of this study was to verify the capability of such a model to predict the distribution of the blood flow into the pulmonary arteries, by comparison with in vivo velocity measurements. Different simulations were performed on a single clinical case to test the sensitivity of the model to different boundary conditions, in terms of inlet velocity profiles as well as outlet pressure levels. Results showed that the flow distribution between the lungs is slightly affected by the shape of inlet velocity profiles, whereas it is influenced by different pressure levels to a greater extent.- - - - - - - - - - ranking = 18.095078851655keywords = artery, single (Clic here for more details about this article) |
5/527. Fibroelastosis of the posterior urethra associated with urinary, cardiac and digestive anomalies.A case of fibroelastosis of the posterior urethra associated with ectopic opening of the ureter of a solitary kidney in the urethra is described. Oesophageal atresia and anomalous origin of the left coronary artery were also observed. Management of fibroelastosis is pointed out.- - - - - - - - - - ranking = 17.095078851655keywords = artery (Clic here for more details about this article) |
6/527. Coarctation of the left pulmonary artery associated with congenitally corrected transposition.We describe an infant with congenitally corrected transposition, ventricular septal defect and severe pulmonary stenosis. The heart occupied a midline position. Extension of ductal tissue had resulted in occlusion of the left pulmonary artery. As far as we are aware, this is the first report of an association of coarctation of the left pulmonary artery with corrected transposition.- - - - - - - - - - ranking = 102.57047310993keywords = artery (Clic here for more details about this article) |
7/527. Percutaneous translumbar cardiac catheterization and central venous line insertion: an alternative approach in children with congenital heart disease.Children with congenital heart disease present major problems with venous access, eliminating conventional routes for cardiac catheterization. Although the transhepatic approach has recently gained popularity, we describe here an alternative approach using percutaneous translumbar approach for cardiac catheterization and/or in-dwelling central line insertion in three children with congenital heart disease. Diagnostic hemodynamic studies, transcatheter delivery of an intravascular stent for left pulmonary artery (LPA) stenosis, and chronic central venous line insertion were performed using this technique. Disadvantages include interventionalist's unfamiliarity with technique, awkward patient positioning, technically more difficult than transhepatic, and potential injury to kidney and bowel. Advantages include avoidance of vascular-rich hepatic parenchyma, thus reducing risk of hemorrhage; providing an alternative where transhepatic entry may be contraindicated; avoidance of bile duct, portal vein, and hepatic artery injury; and providing another alternative for not only transvenous, but also transarterial access that may be required for intravascular aortic stent delivery. The interventional radiologist should be utilized as a valuable resource to the cardiologist to help teach and supervise this technique in selected infants and children with limited vascular access.- - - - - - - - - - ranking = 34.19015770331keywords = artery (Clic here for more details about this article) |
8/527. First-trimester sonographic diagnosis of Cantrell's pentalogy with exencephaly.We report a case of Cantrell's pentalogy with exencephaly detected by sonography at 11 weeks 4 days' menstrual age and confirmed at autopsy. Cantrell's pentalogy consists of defects of the lower sternum, anterior diaphragm, midline supraumbilical abdominal wall, and diaphragmatic pericardium with ectopia cordis. Exencephaly involves acrania with a disorganized mass of brain tissue. Both conditions are rare; the combination of the 2 has been reported only twice before. To our knowledge, this is the earliest reported diagnosis of the 2 conditions by prenatal sonography.- - - - - - - - - - ranking = 8.1347992546348keywords = umbilical (Clic here for more details about this article) |
9/527. The vascular vise causing TAPVR type I to radiographically mimic TAPVR type III.A subtype of supracardiac total anomalous pulmonary venous return (TAPVR) consists of the vertical vein passing between the left pulmonary artery and the left mainstem bronchus resulting in relative obstruction to pulmonary venous return. This has been termed the vascular vise. In this situation, the supracardiac type of TAPVR (Type I) may mimic radiographically the infradiaphragmatic type (Type 3).- - - - - - - - - - ranking = 17.095078851655keywords = artery (Clic here for more details about this article) |
10/527. Lobar emphysema due to anomalous aortic origin of the left pulmonary artery.The unusual case of an infant with aortic origin of the left pulmonary artery is presented. The patient developed a rare complication of lobar emphysema due to bronchial compression from the enlarged right pulmonary artery. Operative anastomosis of the left pulmonary artery to the pulmonary trunk was successful, with subsequent resolution of the lobar emphysema.- - - - - - - - - - ranking = 119.66555196158keywords = artery (Clic here for more details about this article) |
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