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1.
Coronary flow measurement has provided useful clinical and physiologic information. However, there is little information
about values for coronary flow in normal neonates, much less neonates with congenital heart disease. The aim of this study
was to assess coronary blood flow in normal neonates and to compare the results with those in infants with ventricular septal
defect. The study groups consisted of 12 normal neonates and 9 infants with simple ventricular septal defect associated with
pulmonary hypertension. Left ventricular dimension, left ventricular mass, and the diameter of the coronary vessel were measured
by standard M-mode and two-dimensional echocardiography. Peak flow velocities, flow velocity integrals, and flow volumes in
the left anterior descending and circumflex coronary arteries were measured. The flow signals from the left anterior descending
and circumflex coronary arteries were recorded in 84% (10/12) and 17% (2/12), respectively, in the normal neonates and 78%
(7/9) and 11% (1/9), respectively, in the patients. The left ventricular end diastolic diameter and mass were significantly
lower in normal infants than in the infants with ventricular septal defect (1.56 ± 0.11 vs 1.84 ± 0.09 cm and 5.4 ± 1.6 vs
8.8 ± 0.8 g, respectively, p < 0.01). The mean peak diastolic velocity and the flow velocity time integral in the left anterior descending coronary artery
were significantly lower in the normal neonates than in the patients (15 ± 4 vs 28 ± 6 cm/sec and 2.3 ± 0.6 vs 5.9 ± 1.5 cm,
respectively, p < 0.01). The coronary flow volume was significantly lower in the normal neonates than in the patients (3.1 ± 1.4 vs 7.9 ±
4.7 ml/min, p < 0.05). However, the flow volume of the left anterior descending coronary artery/left ventricular mass did not show any
significant difference between the two groups. Our study demonstrated in neonates that it is feasible to detect noninvasively
and to evaluate the flow of the left anterior descending coronary artery under physiologic conditions and abnormal hemodynamic
situations. Increased flow volume in the left anterior descending coronary artery in patients with ventricular septal defect
may be a compensated mechanism for the increase in oxygen demand of hypertrophic myocardium of the left ventricle. 相似文献
2.
M.C. Vaillant A. Chantepie A. Casasoprana C. Chamboux A.L. Suc F. Gold J. Laugier 《Pediatric cardiology》1997,18(1):52-56
We report three cases of transient myocardial hypertrophy, diagnosed by echocardiography, occurring between the second and
seventh days of life in neonates with initially normal ventricular myocardial wall thickness. The three term neonates had
perinatal injury with acute fetal distress. In all three cases electrocardiographic and biologic signs of myocardial ischemia
were present. The first echocardiographic results showed abnormalities in systolic or diastolic left ventricular function,
without hypertrophy of the walls. The hypertrophic cardiomyopathy (HCM) occurred between days 2 and 7 and affected first the
interventricular septum and the free wall of the right ventricle. The left ventricular posterior wall subsequently became
abnormal, resulting in severe overall myocardial hypertrophy, which finally disappeared in all three cases between 1 and 5
months of life. Such observations of early severe and transient HCM have not been previously reported. We believe it is a
consequence of myocardial ischemia due to acute fetal distress. The prognosis of this type of HCM is good, in contrast to
that of other primitive HCM occurring in neonates. 相似文献
3.
Course of Right and Left Ventricular Function in Patients with Pulmonary Insufficiency After Repair of Tetralogy of Fallot 总被引:7,自引:0,他引:7
Surgical repair of tetralogy of Fallot (TOF) frequently results in pulmonary valve insufficiency. Nevertheless, no serial
information is available on the long-term impact of the valvular insufficiency on right and left ventricular function. Right
and left ventricular ejection fraction was measured serially by radionuclide angiocardiography in 21 patients with at least
moderate pulmonary insufficiency after repair of TOF. A baseline study was obtained an average of 1.2 years after repair,
and a follow-up study was performed an average of 10.2 years after surgery. Changes in ventricular function over time and
deviations from the normal range were analyzed. At baseline evaluation the mean right ventricular ejection fraction (RVEF;
0.52 ± 0.10) and left ventricular ejection fraction (LVEF; 0.68 ± 0.10) were normal. At the time of follow-up the mean RVEF
had significantly decreased to 0.45 ± 0.09 (p < 0.01). The mean LVEF had decreased to 0.60 ± 0.11 (p < 0.02). This change was independent of the RVEF (r=−0.13). Eleven patients (52%) had an abnormal RVEF or LVEF at follow-up. Nineteen patients (90%) showed a decrease of 0.05
or more in RVEF, LVEF, or both between studies. These data suggest a negative impact of long-standing pulmonary insufficiency
on right and left ventricular systolic function after repair of TOF. Therefore, continued surveillance of biventricular function
in this patient population appears warranted. 相似文献
4.
At autopsy, two infants had unsuspected coarctation of the left pulmonary artery (CoLPA), which was produced by an extension
of ductal tissue into the wall of the left pulmonary artery. The first case, a 4-month-old girl, also had a ventricular septal
defect and an anomalous branching pattern of the innominate arterial trunk. Pulmonary arterial hypertensive changes were noted
in the right lung. In contrast, the left lung showed thin-walled pulmonary arteries. The second case, a term female newborn,
had exhibited severe unexplained respiratory distress since birth. Histologic sections of the right lung showed dilated pulmonary
arteries with thinned media, whereas the left lung showed a persistent fetal arterial pattern. It is believed that the peripheral
pulmonary arterial changes are age-dependent and associated with asymmetric blood flow between the right and left pulmonary
arteries. CoLPA is a rare pulmonary artery defect, and early diagnosis of this abnormality is important. 相似文献
5.
We performed a retrospective echocardiographic study in tetralogy of Fallot (TOF) or pulmonay atresia with ventricular septal
defect (PA&VSD) to evaluate the effects of Blalock–Taussig shunt on branch pulmonary artery growth. There were 35 patients
with TOF and 11 with PA&VSD. We measured the right and left pulmonary artery area index and also the combined pulmonary artery
area index, both before and after shunt operation. The mean ± SD of these three variables before the shunt operation in the
TOF group were 63.5 ± 22.5, 57.8 ± 24.9, and 121.4 ± 42.8 mm2/m2; after shunt operation they were 98.5 ± 33.6, 85.9 ± 31.9, and 184.0 ± 59.8 mm2/m2, respectively (p values <0.0001, <0.0002, and <0.0001, respectively). In the PA&VSD group the comparable values before shunt operation were
66.5 ± 16.0, 55.4 ± 10.6, and 120.9 ± 26.9 mm2/m2 and after shunt operation were 90.5 ± 22.9, 77.2 ± 24.1, and 166.6 ± 44.4 mm2/m2, respectively (p values <0.0006, <0.014, and <0.002, respectively). We also examined the effect of distensibility of pulmonary arteries by
comparing the percentage change in size of the combined pulmonary artery area index in the first 4 months after shunt with
those after this time (p < 0.023). There were no significant differences between left- and right-sided shunts, origin and distal pulmonary artery
growth, and the TOF and PA&VSD groups. 相似文献
6.
Hypertrophic cardiomyopathy (HCM) in infancy has been described in association with many medical disorders. The genetic location
and mode of transmission of HCM in families also has been reported extensively. We present an infant with nonobstructive hypertrophic
cardiomyopathy whose mother also had HCM. Regression of septal hypertrophy was documented in this patient by 1 year of age
despite a positive family history. 相似文献
7.
Utility of Intraoperative Transesophageal Echocardiography in the Assessment of Residual Cardiac Defects 总被引:3,自引:0,他引:3
H.M. Rosenfeld T.L. Gentles G. Wernovsky P.C. Laussen R.A. Jonas J.E. Mayer Jr. S.D. Colan S.P. Sanders M.E. van der Velde 《Pediatric cardiology》1998,19(4):346-351
To investigate the accuracy of immediate postbypass transesophageal echocardiography in the assessment of residual cardiac
defects, we compared intraoperative transesophageal echocardiograms with intra/postoperative data in 86 patients, aged 4 days
to 30.7 years (median = 1.4 years), at risk for a total of 174 postoperative lesions: right (n= 55) or left (n= 26) ventricular outflow tract obstruction, ventricular septal defect (n= 65), aortic (n= 12) or mitral regurgitation (n= 8), or mitral stenosis (n= 8). Accuracy of intraoperative transesophageal echocardiography was evaluated based on comparison with (1) immediate post-bypass
left (n= 4) or right (n= 9) ventricular outflow tract pressure gradients by pullback in the operating room, (2) direct surgical inspection of residual
ventricular septal defects (n= 3), (3) pulmonary artery oxygen saturation (n= 49), (4) right ventricular outflow tract pullback gradient (n= 24), and (5) transthoracic echocardiogram (n= 51) performed within 40 days of surgery. The results indicate that intraoperative transesophageal echocardiography agreed
with intra/postoperative data in 87% of patients at risk for right ventricular outflow tract obstruction, 96% at risk for
left ventricular outflow tract obstruction, 97% at risk for ventricular septal defect, and 100% at risk for aortic regurgitation,
mitral regurgitation, or mitral stenosis. Significant residual lesions led to immediate surgical revision in 11 cases: 3 ventricular
septal defects, 6 right and 2 left ventricular outflow tract obstructions. Of these, intraoperative transesophageal echocardiography
confirmed and quantified suspected residual lesions in 7 and identified unsuspected lesions in 4 cases. Immediate postbypass
transesophageal echocardiography proved reliable for assessing residual ventricular septal defect, mitral stenosis, and mitral
or aortic regurgitation. Although accurate for assessment of the left and right ventricular outflow tracts in most patients,
transesophageal echocardiography may not reliably reflect the severity of obstruction in all cases. 相似文献
8.
Percutaneous Transluminal Angioplasty for Stenosis of the Aorta Due to Aortic Arteritis in Children 总被引:3,自引:0,他引:3
Percutaneous transluminal balloon angioplasty for stenosis of the aorta due to aortic arteritis was attempted on 45 lesions
in 41 children (age range, 4–14 years; mean, 9.9±4.2 years) presenting with symptoms of hypertension, severe congestive heart
failure, and lower limb claudication. Balloon dilatation was technically successful in 38 (92.7%) patients for 41 stenotic
lesions (91.1%). The mean peak systolic pressure gradient (PSG) decreased from 71.7 ± 23.9 mmHg to 23.2 ± 17.5 mmHg (p < 0.001) and the diameter of the stenosed segment increased from 3.3 ± 1.1 mm to 7.5 ± 2.2 mm (p < 0.001) immediately after angioplasty. Patients with short-segment (<3 cm) stenosis had a lower residual gradient (17.9
± 11.1 mmHg vs 30.5 ± 22.6 mmHg; p < 0.05) and a wider diameter of the aorta (8.8 ± 1.1 mm vs 7.5 ± 2.2 mm; p < 0.02) compared to patients with long-segment (≥3 cm) stenosis. Four patients required stent implantation; 2 for flow-limiting
dissection, 1 for failure to reduce PSG by >50%, and 1 for recurrent restenosis. There was marked hemodynamic and angiographic
improvement in these 4 patients. Hemodynamic and angiographic restudy in 21 of the 41 patients at mean follow-up period of
6.2 ± 4.2 months (range, 3–24 months) showed restenosis in 4 (19%) patients. Restenosis was more common in patients with long-segment
stenosis than those with short-segment stenosis (30% vs 9.1%). Late restudy in 8 patients, done at 3–7 years after first restudy,
showed no recurrence of aortic narrowing. On clinical follow-up of 38 patients for a mean of 58.8 ± 36.0 months (range, 8–146
months) there was marked improvement in symptoms. Hypertension was cured in 11 (29%), improved in 24 (63%), and persisted
in 3 (8%). Six patients with associated severe renal artery stenosis showed further improvement in hypertension after successful
renal angioplasty. Severe congestive heart failure improved in 21 (95.4%) of 22 patients. Mean left ventricular ejection fraction
improved from 0.32 ± 0.08 to 0.48 ± 0.10 (p < 0.001) at a mean follow-up of 28.7 ± 8.4 months in these patients. Hemodynamic restudy in 10 of these patients showed improvements
in left ventricular end-diastolic pressure from a mean 37 ± 9 mmHg (range, 25–55 mmHg) to 16.4 ± 6.2 mmHg (range, 6–25 mmHg)
(p < 0.001). Lower limb claudication improved in all 4 patients. Our results suggest that percutaneous transluminal balloon
angioplasty in children is safe and highly effective in relieving stenosis of the aorta due to aortic arteritis, with marked
clinical improvement, and should be the treatment of choice particularly for discrete stenosis. 相似文献
9.
H. Sugiyama C. Yutani K. Iida Y. Arakaki O. Yamada T. Kamiya 《Pediatric cardiology》1999,20(6):422-427
Cases of hypoplastic left heart syndrome (HLHS) were studied angiographically in 18 patients and pathologically in 22 patients.
They were divided into three subgroups according to the morphological features of the left heart: mitral atresia with aortic
atresia (MA/AA), mitral stenosis with aortic atresia (MS/AA) and mitral stenosis with severe aortic stenosis (MS/AS). Patients
with MS/AA had a significantly lower right ventricular end-diastolic volume index and more hypokinesis of the right ventricular
posterior wall than those with MA/AA. MS/AA not only increased the thickness of the left ventricular posterior wall and interventricular
septum but also increased endocardial thickness compared with MA/AA. Myocardial histology revealed more frequent abnormal
findings such as myocardial necrosis, calcification and interstitial fibrosis in the mitral stenosis groups (i.e., MS/AA and
MS/AS) than in MA/AA. Right ventricular function appeared to be greatly influenced by left heart structure. The presence of
larger left ventricular muscle bulk and frequent myocardial damage seen in MS/AA seems disadvantageous to right ventricular
end-diastolic volume and right ventricular wall motion. 相似文献
10.
Fouron JC Chemtob S Chartrand C Russo P Haswani P Sonesson SE Skoll A Teyssier G Castor S 《Pediatric cardiology》2001,22(2):143-146
Fetuses with pulmonary stenosis and constriction of the ductus arteriosus or the recipient twin in the context of a twin-to-twin
transfusion syndrome may present with severe right ventricular myocardial dysfunction. Free O2 radicals are known to be increased in hypertrophied adult myocardium secondary to an increase in endocavitary pressure. This
study investigates whether products of reactive O2 species generation are abnormally elevated in the myocardium of fetuses with increased right ventricular pressure. Banding
of the main pulmonary artery was performed in five fetal lambs at 90 to 100 days of gestation. Three other animals had a sham
intervention and were used as controls. Postoperative observation lasted on average 42 days (range 33–49 days). The levels
of hydroperoxides were found to be significantly higher in the right ventricle of the stenosed lambs (6.6 ± 3.5 nmol/mg protein)
compared to the left ventricle of the same lambs (0.7 ± 0.7 nmol/mg protein), and compared to the right (0.12 ± 0.1 nmol/mg
protein) and the left (0.5 ± 0.8 nmol/mg protein) ventricles of the controls. It is concluded that during fetal life, an increase
in right ventricular pressure is associated with a marked accumulation of products of reactive O2 species generation in the right ventricular myocardium. 相似文献
11.
Quantitation of the Global Right Ventricular Function in Children with Normal Heart and Congenital Heart Disease: A Right Ventricular Myocardial Performance Index 总被引:16,自引:0,他引:16
Ishii M Eto G Tei C Tsutsumi T Hashino K Sugahara Y Himeno W Muta H Furui J Akagi T Fukiyama R Toyoda O Kato H 《Pediatric cardiology》2000,21(5):416-421
Although the assessment of right ventricular (RV) function is important in the clinical management of children with congenital
heart disease, available imaging techniques have been limited because of the complex geometry of the right ventricle. A new
Doppler index combining systolic and diastolic time intervals (the Tei index) has been reported to be useful for the assessment
of global RV function in adults. However, normal values in children, age-related changes, and the clinical utility of the
Tei index with regard to congenital heart disease have not been demonstrated. The purpose of this study was to prospectively
assess RV function in children with normal heart and congenital heart disease using the Tei index. The subjects included 150
healthy children and 43 patients with congenital heart disease (35 patients with atrial septal defects and 8 patients who
had had a Senning operation). The index was defined as the sum of isovolumetric contraction time and isovolumetric relaxation
time divided by ejection time and was measured from conventional RV outflow and inflow Doppler velocity profiles. The Tei
index was not affected by age in healthy children (0.24 ± 0.04). There was a significant difference in index rating between
patients who had had a Senning operation (0.58 ± 0.09) and healthy children (p < 0.01), but there was no significant difference between children with atrial septal defect (0.25 ± 0.13) and healthy children.
The Tei index is a feasible approach to use when assessing global RV function in children with congential heart disease. 相似文献
12.
Long-Term Outcome of Children with Complete Heart Block Diagnosed After the Newborn Period 总被引:2,自引:0,他引:2
Eronen M 《Pediatric cardiology》2001,22(2):133-137
The aims of this study were to assess morbidity, mortality, and long-term cardiac outcome of children with congenital complete
heart block (CHB) diagnosed between the ages of 3 months and 15 years. The study population consists of 61 children with CHB
diagnosed in five tertiary referral centers in Finland. There were two study groups: CHB diagnosed 3 months to 2 years of
age (group 1; n= 29) and CHB diagnosed between the age of 2 and 15 years (group 2; n= 32). Neonatal morbidity was significantly higher in group 1 than in group 2 (p= 0.047). In the whole study population, permanent pacemaker implantation with the main indications of low ventricular rate
and syncope (52%) was performed in 80% of cases, with a median age of 11.2 years. Structural heart defect not causally associated
with CHB was evident in 9 of 61 patients (15%). Of 8 patients with atrial septal defect (ASD) secundum, 6 (75%) were operated
on and 7 (88%) were paced. One patient had small ventricular septal defect. The incidence of dilated cardiomyopathy was 7%.
The mortality with cardiomyopathy was very high (75%). Of the 61 children, 3 (5%) died due to cardiomyopathy at the ages of
2, 26, and 31 years. In the long-term follow-up of 17 years (median, range 2.9–46 years) 17% of patients who survived had
cardiac problems: arrhythmias in 5, mitral valve insufficiency in 3, ASD secundum in 1, and cardiomyopathy in 1. The long-term
outcome did not depend on the age at which CHB was diagnosed. In conclusion, CHB diagnosed after the newborn period carries
relatively low mortality and morbidity. Pacemaker application was indicated in most children. The possibility of an associated
heart defect or dilated cardiomyopathy indicates regular echocardiographic monitoring in all children and young adults with
CHB. 相似文献
13.
Noninvasive Prediction of Pulmonary Artery Pressure in Patients with Isolated Ventricular Septal Defect 总被引:3,自引:0,他引:3
Management of patients with isolated ventricular septal defect (VSD) requires information regarding pulmonary artery pressure
(PAP). The purpose of this study was to evaluate the individual predictive value of noninvasive methods for assessment of
PAP and to determine if any combination of techniques significantly improved their predictive power. We reviewed the clinical
history, electrocardiogram, and echocardiogram of 31 patients (age 1.9 ± 1.73 years) who underwent catheterization for isolated
VSD. Noninvasive data were compared for patients with mean PAP <20 mmHg (group 1) and those with mean PAP ≥20 (group 2) at
catheterization. Fourteen (45%) patients were in group 1 and 17 (55%) in group 2. Doppler estimation of VSD gradient, right
ventricular hypertrophy by echocardiogram, interventricular septal orientation, and VSD size had predictive value for elevated
mean PAP (p < 0.01). All patients (n= 6) with normal findings in all four variables had normal PAP. All patients (n= 12) with at least three of four abnormal findings had elevated PAP. Six patients in group 1 had at least one variable that
incorrectly predicted high PAP, whereas 3 patients with normal findings on three of the four variables nevertheless had elevated
PAP. No single noninvasive variable accurately predicted PAP in all cases. However, normal findings for all four significant
variables did predict normal PAP and suggest that cardiac catheterization is unnecessary in that setting. However, any other
combination of normal and abnormal findings for the four significant variables did not reliably predict PAP and such patients
may require catheterization to directly measure PAP. 相似文献
14.
Congenital complete heart block in the fetus: hemodynamic features, antenatal treatment, and outcome in six cases 总被引:2,自引:0,他引:2
Congenital heart block (CHB) can result in intrauterine cardiac failure leading to fetal or neonatal loss. To establish perinatal
hemodynamic factors which might predict adverse outcome, six fetuses with CHB diagnosed between 20 and 30 gestational weeks
were examined by echocardiography at 2-week intervals. Neonatal morbidity and outcome in infancy are detailed. The fetuses
showed a significant decrease in ventricular rate (VR) with advancing gestation (60 ± 7 vs 51 ± 4 beats/min, p= 0.03). Cardiac decompensation defined as hydrops or pericardial effusion was associated with VR of lower than 55 beats/min
in two fetuses. Three mothers had a therapeutic trial with a sympathomimetic and digoxin. Salbutamol increased VR 10% in one
of three fetuses treated. Digoxin decreased pericardial effusion in one hydropic fetus with autoimmune myocarditis. In this
fetus, poor left ventricular fractional shortening (LVFS) was accompanied with high umbilical artery resistance index (RI).
High amniotic fluid erythropoietin indicated severe hypoxia preceding death. Pacemaker was indicated in all the newborns.
At the age of 2 weeks all the surviving infants had tricuspid regurgitation and a shunt through foramen ovale due to asynchronized
atrioventricular contraction. During the 12-month follow-up two of five surviving infants had no symptoms. One had symptomatic
neonatal lupus. Two infants had patent ductus arteriosus, one with dilated cardiomyopathy. In conclusion, poor fetal outcome
was associated with low VR, low LVFS, and high RI. Despite early pacing, morbidity was high in infancy due to cardiomyopathy
and associated heart defects. Regular echocardiographic monitoring during pregnancy and after delivery is required in order
to optimize care and timing of any interventions. 相似文献
15.
Three-Dimensional Echocardiographic Measurement of Left Ventricular Stroke Volume in Children: Comparison with Doppler Method 总被引:3,自引:0,他引:3
Three-dimensional echocardiography (3DE) allows calculation of ventricular volumes without geometric assumption on the ventricular
shape. Our aim was to apply 3DE in a normal pediatric population and to compare the left ventricular stroke volume measurements
to the Doppler method. Twenty-four normal patients (median age 7 years) underwent Doppler echocardiography and 3DE for left
ventricular stroke volume calculation. The left ventricular stroke volume by Doppler method was calculated as the product
of the aortic Doppler flow mean velocity and the area of the aortic annulus. The 3DE method was performed using a transthoracic
rotational probe (TomTec) and left ventricular volumes were calculated using the Simpson's rule. The mean time for 3DE acquisition
was 90 seconds without any sedation. 3DE correlated well with the Doppler method for left ventricular stroke volume measurements
(y= 0.8x− 0.2, r= 0.94). The mean difference between the average values of left ventricular stroke volume obtained by Doppler method and 3DE
was 5 ± 4 ml. Intraobserver and interobserver variabilities in the left ventricular stroke volume measurement by 3DE were
2.6% and 4.4%. In conclusion, 3DE compared to the Doppler method is an accurate, noninvasive, and reproducible method to measure
the left ventricular stroke volume in normal children. 相似文献
16.
To determine whether diastolic ventricular interdependence mechanisms would act in the presence of an open pericardial sac,
as during cardiac surgery, moderate acute right ventricle afterload increases were applied to eight dogs with the chest and
pericardium open while left ventricular filling dynamics were being assessed by Doppler echocardiography. Dogs were studied
under basal conditions and after acute banding of the main pulmonary artery tightened to produce a 100% increase in right
ventricular systolic pressure. With banding, the left ventricular filling velocity ratio (E/A), as assessed by Doppler echocardiography
of mitral inflow, changed from a baseline value of 1.32 ± 0.05 to 1.16 ± 0.03 (p < 0.02), suggesting a restrictive pattern to early left ventricular filling, which is differed to that during the second
half of diastole. Isovolumic relaxation time, measured as the time interval between aortic valve closure and mitral valve
opening, assessed by M-mode echocardiography of both valves, was prolonged, though not significantly, from 63.3 ± 2.5 ms to
69.4 ± 2.9 ms, by banding of the pulmonary artery. E wave deceleration time, a filling variable influenced by chamber pressure/volume
relations, was shortened by pulmonary artery banding, changing from 75.1 ± 1.7 ms to 68.0 ± 1.8 ms (p < 0.01). It was concluded that pressure loads applied to the right ventricle restricted early left ventricular filling. Prolonged
relaxation and altered pressure–volume chamber relations were the diastolic interdependence mechanisms involved that proved
to be acting even under open pericardium conditions. 相似文献
17.
Severe Left Ventricular Dysfunction and Arrhythmias as Complications of Gram-Positive Sepsis: Rapid Recovery in Children 总被引:1,自引:0,他引:1
Severe left ventricular dilatation and dysfunction in children may be associated with poor outcome in as many as 45% of cases.
The prognosis for children with poor left ventricular function or arrhythmias associated with septic shock may be better,
however, this has been inadequately studied. We report the favorable outcome of three children who presented with Gram-positive
sepsis and significant cardiovascular compromise—two with severely dilated, poorly contractile left ventricle, and one with
mild left ventricular dysfunction and incessant, malignant, and rapid atrial and ventricular arrhythmias. Our experience with
these patients shows that complete and rapid resolution of these complications may be achieved with aggressive therapy. 相似文献
18.
The assessment of ventricular function plays an important role in the pre- and postoperative management of many congenital
heart abnormalities. Normal ranges in left ventricular systolic function indices have been defined during childhood and age-related
alterations in left ventricular myocardial contractile state have recently been reported. This study was carried out to investigate
the developmental changes in left ventricular contractile state expressed by the endsystolic meridional stress (ESS)/rate-corrected
velocity of circumferential fiber shortening (VCFc) relation, calculated by echo in normal children and young adults. We examined
146 healthy subjects (80 males and 66 females), mean age 70.85 ± 63.89 months (range 0.5–228) and body surface area (BSA)
0.807 ± 0.47 (range 0.18–2.01) with no clinical and echocardiographic evidence of cardiac disease and with normal blood pressure.
The subjects were divided into three groups according to age: <6 months (group 1, n= 32), 6–36 months (group 2, n= 34), and >36 months (group 3, n= 80). Enddiastolic volume and mass (M) of the left ventricle were measured by M-mode Echo. ESS was considered as an index
of afterload and the VCFc as an index of systolic ventricular function. The left ventricular ejection time used for the calculation
of VCFc was measured from aortic flow obtained by PW–Doppler. The ESS/VCFc relation was used to assess left ventricular contractility.
Systolic blood pressure, volume, and mass of the left ventricle increase with age. The gradual increase in pressure despite
a stable mass/volume ratio [M/V = 0.900 + (0.0007 × age); r= 0.27, p < 0.005] resulted in a substantial increase of afterload [ESS = 29.78 + (0.116 × age); r= 0.58, p < 0.0001]. VCFc showed an inverse hyperbolic regression with afterload [VCFc = 1.01 + (7.598/ESS); r= 0.59, p < 0.0001]. The regression lines (best linear fit) between VCFc and ESS are significantly different in the three groups. The
Y intercept was higher and the slope steeper in group 1 [VCFc = 1.74 − (0.017 × ESS); r= 0.65, p < 0.0005] vs group 2 [VCFc = 1.54 − (0.008 × ESS); r= 0.58, p < 0.001] and group 3 [VCFc = 1.52 − (0.007 × ESS); r= 0.57, p < 0.0001]. These data indicate that, in children, the volume and mass of the left ventricle increase, whereas the M/V ratio
remains relatively constant; the progressive increase in arterial blood pressure explains the increase of afterload. The VCFc
is higher in the first few years of life compared to that seen in older children due to reduced afterload and increased contractile
state. Left ventricular contractility, expressed as ESS/VCFc relation, is thus inversely proportional to age. In the first
months of life the left ventricular myocardium exhibits a higher basal contractile state and a greater sensitivity to changes
in afterload. For obtaining an accurate assessment of left ventricular function, the ESS/VCFc relation in different age groups
should be measured. 相似文献
19.
Early Postoperative Results After Total Correction of Tetralogy of Fallot in Older Patients: Is Primary Repair Always Justified? 总被引:1,自引:0,他引:1
The objective of this study was to compare early postoperative results in primary vs 2-stage repair of tetralogy of Fallot
in patients operated on after 5 years of age. Eighty-four patients with tetralogy of Fallot were studied, who were more than
5 years of age and who were repaired in one center by one surgeon. Hospital death and ratio of right-to-left ventricle pressure
after correction were compared between the primary and the 2-stage groups as early outcome indices. Overall hospital mortality
was 11.9% (10/88). There were 9 (18.4%) hospital deaths in the primary and 1 (2.9%) in the 2-stage group. Mortality was significantly
higher in the primary group (p= 0.04 using the 2-tailed Fisher's exact test; relative risk = 6.43; 95% CI = 0.85–48.46). The mean ± standard deviation (SD)
for RV/LV ratio was 0.51 ± 0.13. It was 0.61 ± 0.11 in patients who died and 0.49 ± 0.12 in patients who lived (p= 0.01 using the 2-tailed t-test). RV/LV ratio was not significantly different between either group. In the 2-stage group, there was a small inverse
correlation between the time interval and the RV/LV ratio (correlation coefficient =−0.235). The TAP group had a statistically
significant lower time interval between shunt and total correction than the RVOT-P group (p= 0.02 using 2-tailed t-test). Older patients generally do better on 2-stage repair, because of their age. A long period of low pulmonary blood flow
has induced unbalanced ventricles and exaggerated RVOTO for these patients because of muscle hypertrophy. In such patients,
shunting will prepare the left ventricle for accepting the extra blood volume that will reach the left ventricle after total
correction. 相似文献
20.
Cost-Effectiveness Analysis of Stents,Balloon Angioplasty,and Surgery for the Treatment of Branch Pulmonary Artery Stenosis 总被引:4,自引:0,他引:4
C. A. Trant Jr. M. P. O’Laughlin R. M. Ungerleider A. Garson Jr. 《Pediatric cardiology》1997,18(5):339-344
Branch pulmonary artery stenosis is a common problem in pediatric cardiology. Treatment has included surgery, balloon angioplasty,
and balloon expandable stent placement. It was the purpose of this investigation to demonstrate the cost-effectiveness of
each of these modes of treatment. From 1983 to 1994 there were 30 patients admitted for treatment of branch pulmonary artery
stenosis only. Data included age at procedure, sex, primary diagnosis, acute and intermediate term success, and complications.
Acute success was defined by results at the end of the procedure where intermediate term (IT) success was defined by results
at follow-up. Success of a procedure was defined by at least one of the following: an increase in vessel diameter by ≥50%
of predilation diameter, a decrease in right ventricular to left ventricular or aortic systolic pressure ratio by ≥20%, or
a decrease in peak to peak pressure gradient by ≥50%. The procedure was considered a failure if the previously mentioned criteria
were not met or if the patient required a second procedure for the same stenosis. The expense of the procedure (estimated
by using the patient charges) were collected from the time of the procedure until December 1994. Because of differing lengths
of follow-up, the patients were analyzed separately for procedures and outpatient charges. The total charges were corrected
to 1994 dollars using the Medical Consumer Price Index. Thirty patients had 46 separate procedures (12 patients had >1 procedure
and 3 had >2 procedures). There were 13 surgeries, 13 balloon angioplasties, and 20 stents. Stents were the most successful
(90% acute and 85% IT), but were not statistically superior to surgery (62% acute and IT). Balloon angioplasty was significantly
less successful as compared with stents (31% acute and 23% IT), and was not statistically different from surgery over the
acute and intermediate term. The charge data showed balloon angioplasty was the least expensive followed by stents and then
by surgery. The average total charges per procedure, including outpatient charges, were: surgery $58,068 ± $4372 (standard
error), balloon $21,893 ± $5019, stents $33,809 ± $3533 (p < 0.001); excluding outpatient charges: surgery $52,989 ± $3649, balloon $15,653 ± $1691, and stents $29,531 ± $2241 (p < 0.001). Average total charges per patient, including all procedure types and grouped by initial procedure, were: surgery
$53,707 ± $6388, balloon $50,040 ± $8412, and stent $34,346 ± $3488 (p= 0.047). Stents were at least as effective as surgery and were more effective than balloon angioplasty in both acute and
intermediate term follow-up. Balloon angioplasty was least expensive per procedure but was also least effective. Therefore,
intravascular balloon expandable stents are the most cost-effective means available in the treatment of branch pulmonary artery
stenosis. 相似文献