Pediatric cardiology
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Pediatric cardiology · Jan 1987
Case ReportsA rare case of double aortic arch: right thoracotomy and residual retroesophageal aortic arch.
The case of a 2-year-old boy with tetralogy of Fallot and a complete double aortic arch (both arches patent) is reported. The left dominant aortic arch ran retroesophageally to the right and joined with the right smaller arch to form the descending thoracic aorta on the right side. We employed a right thoracotomy and performed a division of the right nondominant arch at the connection with the descending aorta. The surgical implications of an unusual type of double aortic arch are discussed.
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Pediatric cardiology · Jan 1986
Pulmonary arterial changes in patients with ventricular septal defects and severe pulmonary hypertension.
In 25 patients, aged eight months to 31 years, with ventricular septal defect (VSD; isolated in 15, the others with atrial septal defect, PDA, coarctation or patent ductus arteriosus + coarctation), each with severe pulmonary artery hypertension (pulmonary artery systolic pressure [Ppa] at least 75% of systemic and an elevated pulmonary vascular resistance), we related morphologic and morphometric data from open-lung biopsy to hemodynamic measurements obtained at cardiac catheterization during the same hospital admission. Of the hemodynamic features measured, only the ratios of pulmonary-to-systemic flow and pulmonary-to-systemic resistance correlated significantly with structure. Neither pulmonary artery pressure (Ppa) nor pulmonary vascular resistance correlated significantly with any structural feature studied. ⋯ In the ten patients who underwent VSD closure, Ppa was measured postoperatively. The Heath-Edwards grade (no more than one grade-III lesion) and arterial density (at least one-half that normal for age) were the best correlates of the difference between preoperative Ppa and Ppa immediately after corrective surgery. The presurgical catheterization data, including pulmonary resistance and the resistance ratio, did not correlate significantly with change in Ppa following VSD closure.(ABSTRACT TRUNCATED AT 250 WORDS)
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The pulmonary-to-systemic blood flow ratio (Qp/Qs) is critical in the appraisal of the need for surgery in patients with left-to-right shunts. Because of the drawbacks present with conventional Fick, indicator dilution, and radionuclide techniques of Qp/Qs measurement, we sought to determine whether an extension of thermodilution technology could accurately predict Qp/Qs. We studied 30 children with clinically suspected or postoperative atrial or ventricular septal defects. ⋯ Gamma variate curve fitting and area analysis were used to determine Qp/Qs. The correlation between Fick and thermodilution Qp/Qs values was excellent (r = 0.95). The thermodilution technique was rapid, and did not require either arterial entry, radiation after venous catheter placement, or multiple sampling.
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Pediatric cardiology · Jan 1982
Comparative StudyQuantitative radionuclide angiocardiography for left-to-right cardiac shunts in children.
Pulmonary to systemic flow ratios (Qp/Qs) were estimated by quantitative radionuclide angiocardiography (QRAC) in 135 children. The Qp/Qs ratios were derived from pulmonary time/activity curves using a gamma variate model. Eighty-five of these children also had Qp/Qs ratios estimated by oximetry at cardiac catheterization. ⋯ The correlation between Qp/Qs, determined by QRAC and by oximetry was good (r = .93; SEE .31). This relatively noninvasive technique has now been used to estimate the Qp/Qs ratio in 34 children with a clinically suspected left-to-right shunt, and postoperatively in 16 cases with residual murmurs; it has obviated the need for catheterization in many of these patients. The technique may also be used serially to determine changes in the Qp/Qs ratio in patients with known left-to-right shunts.