Pulmonary balloon valvuloplasty in the palliation of complex cyanotic congenital heart disease.

OBJECTIVE: To assess the value of pulmonary balloon valvuloplasty in the interim palliation of complex congenital heart disease and pulmonary stenosis in children, who often require numerous palliative operations before definitive surgical repair. METHODS: Evaluation of pulmonary balloon valvuloplasty procedures performed over a five year period in 18 patients (age 8 days--29 years; mean 5.5 years) with complex cyanotic congenital heart disease. RESULTS: After pulmonary balloon valvuloplasty oxygen saturation increased from a mean (SD) of 69 (7.5)% to 83 (7.0)% (P < 0.001). Mean pulmonary artery pressure increased from a mean (SD) of 11.3 (3.8) mm Hg to 15.7 (3.9) mm Hg (P < 0.001). Transient complete atrioventricular block occurred in one patient. No other complications were encountered. In 5 patients (28%) there was an inadequate improvement in cyanosis compared with pre-procedure values (72 (4.7)% v 66 (8.1)%). Reasons for failure were increasing infundibular stenosis in three and inadequate mixing in one child. In 13 patients (72%) pulmonary balloon valvuloplasty gave adequate interim palliation over a mean follow up of 1.1 (1.3) years. Oxygen saturation was 81 (5.6)% at last follow up compared with 70 (7.3)% before pulmonary balloon valvuloplasty (P < 0.001). CONCLUSION: Pulmonary balloon valvuloplasty is a safe and effective technique in the palliation of patients with complex cyanotic congenital heart disease associated with pulmonary valve stenosis.     

Cured brain abscess in a boy with congenital cyanotic cardiopathy

We present a patient with severe tricuspid stenosis whom at the age of 13 developed a brain abscess successfully treated by surgical means.     

Balloon pulmonary valvuloplasty for congenital cyanotic heart defects

Eight infants with congenital cyanotic heart defects, aged 7 days to 10 months, weighing 2.9 to 10.0 kg, underwent percutaneous balloon pulmonary valvuloplasty as a palliative procedure to improve pulmonary oligemia. The indication for valvuloplasty was cyanotic heart defect not amenable to total surgical correction at the age and size at presentation but at the same time requiring palliation of pulmonary oligemia. After balloon valvuloplasty, there was an increase in the pulmonary blood flow index (1.83 +/- 0.55 to 3.14 +/- 1.38 L/min/m2; p less than 0.05), pulmonary-to-systemic flow ratio (0.55 +/- 0.35 to 1.19 +/- 0.63; p less than 0.05), and pulmonary artery pressure (15.5 +/- 6.6 to 29.1 +/- 12.1 mm Hg; p less than 0.02). Arterial oxygen saturation, although increased from 69.6 +/- 11.5% to 81.4 +/- 12.3%, did not attain statistical significance (p greater than 0.05). Immediate surgical intervention was avoided in all eight patients. At follow-up, 4 to 12 months after balloon valvuloplasty, all infants were thriving with decreased hypoxemia and polycythemia. Follow-up catheterization data were available from six patients, 3 to 10 months after valvuloplasty, and in all of them the immediate postballoon valvuloplasty improvement persisted or further improvement noted. These data suggest that pulmonary valvuloplasty offers excellent palliation of pulmonary oligemia in cyanotic heart defects, thus avoiding the risks of immediate surgical palliation and paving the way for a better result of eventual total surgical correction.     

Balloon pulmonary valvuloplasty in the management of cyanotic congenital heart defects

Twenty-three children with cyanotic congenital heart defects, aged 3 days to 11.5 years, weighing 2.9 to 30 kg, underwent percutaneous balloon pulmonary valvuloplasty to improve pulmonary oligemia. The patients were divided into two groups: group I with intact ventricular septum and group II with ventricular septal defect. In 12 group I patients, there was an increase of systemic arterial oxygen saturation [83 ± 8% (mean ± SD) vs. 94 ± 5%, P < 0.001] and pulmonary-to-systemic flow ratio (0.7 ± 0.1 vs. 1.0 ± 0.2, P < 0.001). Peak systolic pressure gradient across the pulmonary valve decreased (P > 0.001) from 105 ± 48 to 25 ± 18 mm Hg. In 11 group II patients, arterial oxygen saturation (67 ± 13 vs. 83 ± 13%, P < 0.01) and pulmonary-to-systemic flow ratio (0.7 ± 0.4 vs. 1.2 ± 0.5, P < 0.02) increased following valvuloplasty. Peak systolic pressure gradient across the pul-monic valve (52 ± 16 vs. 32 ± 22 mm Hg, P < 0.05) decreased while infundibular and total pulmonary outflow tract gradients were unchanged (P > 0.1). Immediate surgical intervention was avoided in all cases in both groups. On follow-up, 1 to 36 months after valvuloplasty, arterial oxygen saturation, pulmonary-to-systemic flow ratio, and pulmonary valve gradients remain improved in both groups. However, in group I, repeat balloon valvuloplasty was required in two children. In group II, six children with tetralogy of Fallot (TOF) underwent successful total surgical correction 4 months to 2 years after valvuloplasty. Two children with transposition of the great arteries required Blalock-Taussig shunts 6 and 18 months after valvuloplasty for further improvement of hypoxemia. Demonstrable increase in pulmonary artery diameter occurred in several children. These data suggest that pulmonary valvuloplasty offers an excellent relief of pulmonary valve obstruction in the intact ventricular septum group and palliation of pulmonary oligemia in the ventricular septal defect group. In the latter group, avoiding immediate surgical shunts in all patients and achieving growth in pulmonary arterial size in many patients, thus making them suitable for further surgical palliation or correction, are additional advantages.     

Balloon pulmonary valvuloplasty in the management of cyanotic congenital heart defects.

Twenty-three children with cyanotic congenital heart defects, aged 3 days to 11.5 years, weighing 2.9 to 30 kg, underwent percutaneous balloon pulmonary valvuloplasty to improve pulmonary oligemia. The patients were divided into two groups: group I with intact ventricular septum and group II with ventricular septal defect. In 12 group I patients, there was an increase of systemic arterial oxygen saturation [83 +/- 8% (mean +/- SD) vs. 94 +/- 5%, P less than 0.001] and pulmonary-to-systemic flow ratio (0.7 +/- 0.1 vs. 1.0 +/- 0.2, P less than 0.001). Peak systolic pressure gradient across the pulmonary valve decreased (P less than 0.001) from 105 +/- 48 to 25 +/- 18 mm Hg. In 11 group II patients, arterial oxygen saturation (67 +/- 13 vs. 83 +/- 13%, P less than 0.01) and pulmonary-to-systemic flow ratio (0.7 +/- 0.4 vs. 1.2 +/- 0.5, P less than 0.02) increased following valvuloplasty. Peak systolic pressure gradient across the pulmonic valve (52 +/- 16 vs. 32 +/- 22 mm Hg, P less than 0.05) decreased while infundibular and total pulmonary outflow tract gradients were unchanged (P greater than 0.1). Immediate surgical intervention was avoided in all cases in both groups. On follow-up, 1 to 36 months after valvuloplasty, arterial oxygen saturation, pulmonary-to-systemic flow ratio, and pulmonary valve gradients remain improved in both groups. However, in group I, repeat balloon valvuloplasty was required in two children. In group II, six children with tetralogy of Fallot (TOF) underwent successful total surgical correction 4 months to 2 years after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)     

采用不同球囊行肺动脉瓣成形术

对２５例肺动脉瓣狭窄患者行经皮球囊扩张术，探讨（Ｍａｎｓｆｉｅｌｄ球囊和Ｉｎｏｕｅ球囊对手术效果的影响及其优缺点。结果表明：Ｉｎｏｕｅ球囊导管进行经皮肺动脉瓣扩张术可取得与Ｍａｎｓｆｉｅｌｄ球囊导管法相似的疗效，但比Ｍａｎｓｆｉｅｌｄ球囊导管法具有更多的优点，如操作简便、可顺序扩张，并发症少等。     

Blood coagulation tests in children with cyanotic heart defects]

In 57 children with congenital cyanotic heart disease coagulation analyses were performed before operation. The patients with low haematocrit only sometimes exhibited defects of low degree. In patients with haematocrit values of more than 60% were increasingly found complex coagulation disturbances. Many correlations could be proved between the coagulation parameters. Thrombocytopenia, plasmatic defects and hyperfibrinolysis were parallel. The cause of the changes is to be seen in chronic disseminated intravasal coagulation processes. The results of investigations presented confirm the necessity of preoperative coagulation analyses especially in patients with high haematocrit values. Larger disturbances of coagulation may influence the decision between a palliative intervention or immediate causal operation.     

Pulmonary and tricuspid valvuloplasty in carcinoid heart disease

A 26‐year‐old female with carcinoid heart disease consisting of severe pulmonary and tricuspid valve stenosis was admitted with line associated sepsis. She recovered from sepsis with antibiotics and aggressive fluid resuscitation but became grossly volume overloaded with evidence of tense ascites and lower extremity edema. She developed worsening renal and hepatic function due to congestive nephropathy and hepatopathy, which did not respond to intravenous diuretics, and she was deemed too sick for surgical pulmonary and tricuspid valve replacement. Pulmonary and tricuspid valvuloplasty was performed as a rescue measure to alleviate her congestive symptoms and improve her candidacy for valve replacement. © 2016 Wiley Periodicals, Inc.     

Haemostatic changes in children with cyanotic and acyanotic congenital heart disease

This study was undertaken to screen children with congenital heart disease for coagulation abnormalities and to compare the groups of cyanotic and acyanotic children with congenital heart disease with respect to abnormalities of the coagulation system. Following investigations were done in all the patients: complete blood count, erythrocyte sedimentation rate, peripheral smear examination, bleeding time, prothrombin time, activated partial thromboplastin time, assay of fibrinogen, D-dimer, factors VII and VIII and antithrombin III. Red cell indices were determined in 12 control, 12 acyanotic and 20 cyanotic children. Twenty-five patients each, with echocardiographically proven cyanotic and acyanotic congenital heart disease under 12 years of age constituted the study group; as many children of the same age group were included as the control group. The results showed isolated abnormalities of laboratory tests with equal frequency (28%) in acyanotic and cyanotic groups but coexisting abnormalities of more than one test were seen in significantly larger number of cyanotic children (5/25 and 16/25, respectively). A significant association was noted between thrombocytopenia and a high haematocrit in cyanotic patients. It is concluded that laboratory abnormalities of tests of haemostasis are more common in cyanotic congenital heart disease patients. The patterns of laboratory abnormalities suggest a chronic compensated disseminated intravascular coagulation at a subclinical level, reduced synthesis of clotting factors and/or deranged platelet aggregation in different subgroups of patients.     

Frustration and body image in children with and without congenital cardiopathy]

The aim of the present study was to determine the existence of differences on the type of response to frustration and disintegration of body image among children with congenital heart diseases (hospitalized and out patients) with or without symptomatology and children without heart disease. The study was performed in the outpatient clinic and the pediatric cardiology ward of the Instituto Nacional de Cardiología "Ignacio Chávez". Two tests were used: The Rosenzweig picture frustration test for children (PFT) and the human figure drawing (HFD) of Elizabeth Koppitz. No differences were found regarding the type of response to frustration, differences between groups were present in only two emotional items of the HFD. We conclude that children with congenital heart disease have special capabilities that enable them to respond to illness in adaptative ways.