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1/26. An unusual tethering of the bridging leaflets in atrioventricular septal defect producing a communication from left atrium to right ventricle.

    We describe a 39-year-old woman who was diagnosed as having an unusual atrioventricular septal defect with a communication from left atrium to right ventricle. A common atrioventricular junction, with partially separated right and left atrioventricular orifices, was found at transoesophageal ultrasonic examination. Both bridging leaflets were attached to the underside of the atrial septum, which was grossly malaligned relative to the ventricular septum. The shunt was exclusively from left atrium to right ventricle because of the overriding of the left atrioventricular valve, with the left component of the inferior bridging leaflet firmly fused to the ventricular septal crest.
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2/26. Iatrogenic main pulmonary artery-left atrial fistula in a child.

    A 14-month-old boy who underwent operation for ventricular septal defect patch closure and debanding of the pulmonary artery presented with arterial desaturation in the early postoperative period. Angiography confirmed the echocardiographic findings of hemodynamically significant main pulmonary artery-left atrial fistula. This communication was successfully closed surgically.
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3/26. A rare form of atrioventricular septal defect with severe subaortic stenosis.

    An unusual form of atrioventricular septal defect associated with severe subaortic obstruction is reported in a neonate who presented with intractable cardiac failure. The baby had a large defect in the atrioventricular septum allowing communication from the left ventricle to the right atrium, without interatrial or interventricular communication, and a cleft anterior mitral leaflet. The baby expired despite palliative surgery performed to bypass the subaortic stenosis.
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4/26. Acquired left ventricular-right atrial communication: Gerbode-type defect.

    Left ventricular-right atrial (LV-RA) communications are rare intracardiac defects, often congenital in nature and clinically apparent during childhood. Acquired LV-RA shunts are encountered occasionally in the adult population as a result of a defect in the upper portion of the membranous ventricular septum. We describe the clinical and echocardiographic features of an elderly patient with an acquired LV-RA communication in the setting of an aortic composite valve graft and endocarditis. We also review the anatomical features and hemodynamic consequences of such defects.
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5/26. Double-outlet right ventricle with tunnel from left ventricle to aorta.

    The successful surgical correction of an unusual form of double-outlet right ventricle (DORV) in a 4-year-old boy is described. A long tunnel-like structure was present between the left ventricle and the aorta and also communicated with the right ventricle. hemodynamic and angiographic evaluation demonstrated restrictive communications between the tunnel, the aorta, and each of the ventricles. A pathological concept explaining the anatomic abnormality seen in this patient is discussed.
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6/26. Intraventricular free wall dissection causing acute interventricular communication with intact septum in myocardial infarction.

    This report delineates a previously unrecognized complication of acute myocardial infarction, an intraventricular wall dissection producing interventricular communication without septal perforation. The clinical, hemodynamic, and pathologic features of this unique condition are documented, as well as the factors important in the mechanism of its production.
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7/26. Successful extensive enlargement of a non-committed ventricular septal defect in double outlet right ventricle.

    We performed an arterial switch operation in a patient with double outlet right ventricle with non-committed ventricular septal defect, and abnormal insertion of the tension apparatus of the tricuspid valve which produced moderate tricuspid regurgitation. This required extensive enlargement of the ventricular septal defect between the attachments of the cords of the tricuspid valve so as to create the interventricular rerouting that made possible the arterial switch operation. Postoperatively, we produced a straight, unobstructed, left ventricular outflow tract, improved the extent of tricuspid regurgitation, and achieved low right atrial pressures. Enlargement of the interventricular communication can set the scene for biventricular repair in this particular subset of patients with both arterial trunks arising from the morphologically right ventricle.
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8/26. Can atrioventricular septal defects exist with intact septal structures?

    The hallmark of an atrioventricular septal defect (AVSD) is a common atrioventricular junction, giving rise to a trileaflet left atrioventricular valve. AVSDs have the potential for interatrial shunting alone, interventricular shunting alone, or both. AVSDs without interatrial or interventricular communications have been identified at postmortem examination, but there are no reports of AVSDs with intact septal structures diagnosed in life. Six patients are described with AVSD and intact atrial and ventricular septa diagnosed echocardiographically. This report shows that AVSDs can exist without interatrial or interventricular communications and that the characteristic feature of this condition, the common atrioventricular junction with a trileaflet left atrioventricular valve, can be diagnosed in life by using cross sectional echocardiography. AVSDs with intact septal structures may be more common than previously described.
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9/26. Aortoesophageal fistula due to double aortic arch and prolonged nasogastric intubation: case report and review of the literature.

    BACKGROUND: The authors present a patient and describe other cases from the literature which demonstrate that prolonged use of nasogastric tubes can result in life-threatening aortoesophageal fistula formation in patients with a double aortic arch. CONCLUSION: Aortoesophageal fistula (AEF) is an abnormal communication between the esophagus and the aorta. It can cause massive gastrointestinal hemorrhage. We present an infant with an operatively corrected double aortic arch, who developed this complication after prolonged nasogastric intubation.
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10/26. cerebral infarction and ventricular septal defect.

    With the availability of contrast echocardiography, patent foramen ovale is frequently detected in patients with stroke, especially in those with no clear etiology and/or the young patient with stroke. Before this report, an association of stroke with ventricular septal defect had not been reported. In this communication, we describe a 38-year-old patient who developed an occipital lobe infarction and who, on investigation, was found to have a ventricular septal defect. Other investigations, which included four-vessel cerebral angiography, collagen disease workup, and coagulation profile, were all normal. We believe this case further extends the spectrum of cerebral ischemic events that may occur with intracardiac shunts.
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