Patent ductus venosus associated with a hyperintense globus pallidum on T1-weighted magnetic resonance imaging and pulmonary hypertension

Abstract We report the case of a 13-year-old Japanese boy with a patent ductus venosus. He experienced mild disorientation and hallucination at age 8 years. Hyperammonaemia was discovered at age 12 years. Brain MRI demonstrated multiple intracranial hyperintense lesions, mainly in the globus pallidum, which suggested portosystemic encephalopathy. Patent ductus venosus was demonstrated by abdominal ultrasonography and angiography. Cardiopulmonary investigation revealed pulmonary hypertension. An intracranial hyperintense lesion observed on T1-weighted MRI may be an initial clue for discovering a patent ductus venosus in asymptomatic patients.Conclusion When patent ductus venosus is disclosed, pulmonary hypertension should be sought, as in cases with other portosystemic shunts.     

Re-occlusion of residual leaks after transcatheter occlusion of patent ductus arteriosus

Abstract Between March 1990 and November 1993 175 patients underwent successful closure of patent ductus arteriosus using the Rashkind double umbrella device. Of those patients seen on follow up, 13 (9 female, 4 male) had a residual leak and were admitted for implantation of a second device alongside the first device. The interval between the procedures ranged from 6 to 22 months. The mean age at the first procedure was 73.9 months (range 24–204 months) and the mean weight was 18.9 kg (range 8.4–64). The mean age at the second procedure was 86.9 months (30–213) and the mean weight was 21.4 kg (8.6–64). The first device was 17 mm in 11 patients and 12 mm in two. The second device was 17 mm in four patients and 12 mm in nine. Four patients required two 17 mm devices in total. There was no difference in the two procedures regarding the fluoroscopy time, procedure time, complications and length of hospital stay. The second procedure was uneventful; however, in one patient the residual ductus had to be dilated before successfully deploying a 12 mm device. Ten patients had immediate total occlusion and three had a trivial leak on echocardiography 24 h later. One of the three patients was found to have total occlusion on Doppler echocardiography 1 year later. The other patients are yet to be seen for follow up. Hence a total occlusion rate was in 11/13 patients (85%). In nine patients pulmonary artery angiography was performed immediately after the implantation of the second device to rule out left pulmonary artery stenosis; three of those developed mild indentation at the origin of the left pulmonary artery but there was no evidence of stenosis on withdrawal pressure recordings Doppler echocardiography in any of the 13 patients.Conclusion The re-occlusion of a patent ductus arteriosus using a second Rashkind umbrella device is feasible and has a low risk.     

Patency of foramen ovale — does it influence haemodynamics in newborn infants?

Colour-coded Doppler ultrasound examination was carried out in 37 healthy newborns at 24 h of age to determine the patency of the foramen ovale. In addition, Doppler-derived cardiac output was measured 5 times during the first 2 days of life in the same infants. Our aim was to examine the influence of foramen ovale on Doppler-derived cardiac output and its association with left-to-right shunting through the ductus arteriosus. In 22 infants the foramen ovale was patent at 24 h of age and in 15 it was closed. Haemodynamic variables measured using non-imaging Doppler-ultrasonic methods did not differ between these two groups. The closure of left-to-right shunt at the ductus was similar in both groups. In a follow-up examination at the age of 1 year, one child had an open foramen ovale without haemodynamic consequences. This study provides evidence that patency of foramen ovale does not influence hemodynamics in early infancy.     

Subcostal cross-sectional echocardiographic imaging of patent ductus arteriosus

Summary A modified subcostal short-axis cross-sectional echocardiographic view for imaging the patent ductus arteriosus (PDA) was studied. A total of 22 newborns with PDA and various associated cardiac anomalies and 16 newborns without PDA were examined. The PDA was imaged in the subcostal view in 19 newborns. In the control group, the absence of the PDA was established in 13 newborns and considered probable in three. The PDA was optimally imaged in the subcostal view in patients with normal or enlarged pulmonary artery, mainly those with the hypoplastic left heart. Among the eight patients with small pulmonary artery (pulmonary atresia or severe tetralogy of Fallot), the PDA was imaged in the subcostal view in three and in the suprasternal view in eight. By combining the suprasternal and the subcostal views, the PDA was imaged in each instance.     

指,趾骨滋养孔的观察

对不分性别的指骨和趾骨共２４９１根的滋养孔的数目、位置和方向进行了研究。滋养孔几乎全部位于远侧２／３。近节指、趾骨有时存在滋养孔，其中大多位于或邻近两侧缘的掌／跖侧。滋养管几乎全部背离生长端。长骨异向滋养管是胚胎期近侧滋养动脉残留所形成。     

枕下远外侧经枕髁入路的应用解剖

目的：为枕下远外侧经枕髁入路提供应用解剖学基础。方法：在５例共１０侧正常人头颅标本上模拟枕下远外侧经枕髁入路逐层解剖和观测到达枕骨大孔区腹外侧。结果：应用此入路切除部分枕髁后可满意暴露枕骨大孔区腹外侧而对重要的神经血管的损伤最小。结论：正确的头位和切口设计、向外侧充分切除骨质、椎动脉内移、乙状窦外牵、上二条齿状韧带的切断及妥善保护重要的神经血管等是应用此入路成功的关键。     

桡尺骨滋养孔和滋养动脉的研究

对234侧挠骨、235侧尺骨滋养孔及56侧滋养动脉进行了观察,绝大多数为单孔,缺少滋养孔者仅占:挠骨为1. 71±0. 85%,尺骨为0. 43±0. 42%。较有规律性的是滋养动脉“向肘而来”极为恒定。由孔至骨髓腔毫无例外的都要斜穿一段变异较大的8～33mm 的骨管。滋养动脉在骨管中虽能得到较好的保护,但骨折时也易受到损伤,并可能是延缓骨折愈合的因素之一。     

Variations in shape and dimensions of sigmoid groove, venous portion of jugular foramen, jugular fossa, condylar and mastoid foramina classified by age, sex and body side

Summary The authors have examined variations in shape and dimensions in the region of the terminal part of the sigmoid groove, venous portion of jugular foramen and jugular fossa with reference to age, sex, and body side. Examinations were carried out on 300 macerated skulls of both sexes within age limits of 11 up to 88 years. The specimens were divided into three age groups.The jugular fossa becomes deeper with age, whereas there is no substantial variation in the dimensions of the terminal part of the sigmoid groove or the venous portion of the jugular foramen. All the dimensions are larger on the right hand-side but do not differ significantly with sex.It was noted that the venous portion of the jugular foramen appears to be positioned in the transversal direction more frequently in the older age group and on the right-hand side. With the transversal position of the jugular foramen a more pronounced and medially sited lower knee of the sigmoid groove and a reduced lateral edge of the venous portion of jugular foramen were found.Dehiscences in the region of the medial wall of the venous portion of the jugular foramen and the dome of the jugular fossa were examined and found in 14.3 percent of skulls. The importance of dehiscences through which the jugular fossa communicates with the cavum tympani are emphasized. The number of dehiscences increases with age, and they are twice as frequent on the right side as on the left.Frequency and dimensions of condylar and mastoid foramina were examined and the sum of the areas of these foramina was found to be in inverse proportion to the sum of the areas of the venous portion of the jugular foramina on both sides of the skull.     

颅骨颈静脉孔及周围结构显微解剖

目的 :研究颅骨颈静脉孔及周围结构的显微解剖。方法 :镜下 (× 3 )观测 40例颅骨的颈静脉孔及周围结构。结果 :颈静脉孔分为岩部和乙状部。 5 3 8%的颈静脉孔基本呈三角形 ;67 5 %的内口、72 5 %的外口右侧大于左侧。内口上方有内耳门和前庭水管外口 ;外口外侧有茎乳孔和茎突 ,后方有枕骨颈突。鼓乳切迹位于茎乳孔外侧。结论 :多数标本的颈静脉孔右侧大于左侧。半数以上颈静脉孔呈三角形。茎突和枕骨颈突可作为颈静脉孔的定位标志 ,鼓乳切迹可作为茎乳孔定位的标志     

Transcatheter Closure of Patent Ductus Arteriosus and Atrial Septal Defects Using the Amplatzer Occluder

ＩＮＴＲＯＵＵＣＴＩＯＮＳｉｎｃｅｔｈｅｆｉｒｓｔｄｅｓｃｒｉｐｔｉｏｎｏｆｔｈｅｉｎｔｅｒｖｅｎｔｉｏｎａｌｏ ｃｌｌｕｓｉｏｎｏｆｔｈｅ ｐａｔｅｎｔｄｕｃｔｕｓａｒｔｅｒｉｏｕｓｕｓ(ＰＤＡ )ｉｎ1967[1] ,ｖａｒｉｏｕｓｄｅｖｉｃｅｓｈａｖｅｂｅｅｎｄｅｖｅｌｏｐｅｄａｎｄｔｅｓｔ ｅｄｂｕｎｏｎｅｏｆｔｈｅｍｉｓｆｕｌｌｙｓａｔｉｆａｃｔｏｒｙ .ＴｈｅＡｍ ｐａｌａｔｚｅｒｏｃｃｌｕｄｅｒｉｓａｎｅｗｄｅｖｉｃｅｗｉｔｈｅａｓｙｐｌａｃｅｍｅｎｔ.Ｉｔｉｓｒｅｐｏｒｔｅｄｔｏｈａｖｅｈｉｇｈｅ…