1/137. Impact of rifampin on serum amiodarone concentrations in a patient with congenital heart disease.A 33-year-old woman with congenital heart disease and atrial and ventricular arrhythmias, managed over the long term with an implantable cardioverter defibrillator, epicardial pacing system, and amiodarone, experienced an increase in palpitations and a shock from her defibrillator. Evaluation revealed decreases in amiodarone and desethylamiodarone serum concentrations from previous levels. rifampin had been added to her therapy 5 weeks earlier. Increases in amiodarone and desethylamiodarone concentrations were observed after an increase in the amiodarone dosage and discontinuation of rifampin. The time course suggested that the addition of rifampin led to reductions in serum concentrations of both the drug and metabolite.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/137. Damus-Kaye-Stansel connections in children with previously transected pulmonary arteries.BACKGROUND: In patients with a univentricular arteriovenous connection, transection of the main pulmonary artery may be performed as part of a bidirectional cavopulmonary shunt or fontan procedure. The proximal stump of the pulmonary artery may remain in the systemic circulation. In cases with a discordant ventriculoarterial connection, subsequent restriction of the bulboventricular foramen may lead to subaortic stenosis. The subaortic stenosis can be corrected in some patients by directing the systemic flow through a combined nonobstructed aortopulmonary outlet, as in the Damus-Kaye-Stansel connection. Previous closure of the pulmonary artery has been considered by some investigators to be a relative contraindication to the Damus-Kaye-Stansel procedure, unless an allograft root can be added to the circuit after excision of the closed pulmonary stump. methods: Three patients with previously transected pulmonary arteries underwent a modified Damus-Kaye-Stansel connection using the native pulmonary valve and the proximal pulmonary artery stump. RESULTS: The native pulmonary valves have functioned well despite thrombus formation in the proximal stump in 2 patients before Damus conversion. All 3 patients are alive and well after 108, 19, and 3 months, with competent nonobstructed ventriculoarterial connections. CONCLUSIONS: If transection and closure of the pulmonary artery as part of a previous palliation has spared the pulmonary valve, then the native pulmonary outlet might be used for a safe Damus-Kaye-Stansel connection.- - - - - - - - - - ranking = 140.96262076919keywords = closure (Clic here for more details about this article) |
3/137. Left superior vena cava connection to unroofed coronary sinus associated with positional cyanosis: successful transcatheter treatment using Gianturco-Grifka vascular occlusion device.A persistent left superior vena cava connection to an unroofed coronary sinus is a rare cardiac anomaly that is associated with a variable degree of cyanosis. We report an infant with this condition and the unusual feature of cyanosis dependent on head position. When the patient's head was rotated to the left, he developed severe stenosis of the left internal jugular vein, enlarged cervical collateral veins that connected to the right superior vena cava and had an oxygen saturation 95%. When the patient's head was rotated to the right, the left internal jugular vein was widely patent and systemic oxygen saturation decreased to 87%. There was no right ventricular volume overload. Temporary occlusion of the left superior vena cava documented tolerable proximal venous pressure. cyanosis was relieved by transcatheter closure of the left superior vena cava with a Gianturco-Grifka vascular occlusion device. Cathet. Cardiovasc. Intervent. 48:369-373, 1999.- - - - - - - - - - ranking = 70.481310384596keywords = closure (Clic here for more details about this article) |
4/137. Aorticoright atrial tunnel.Two unusual cases of aorticoright atrial tunnel are described. Both patients were referred to our institution for evaluation of a continuous heart murmur best heard along the right upper sternal border. Ascending aortography showed the tunnel taking its origin from the aortic root and entering the right atrium through a tortuous link. Both patients underwent surgical closure. In addition, a review of similar cases in the literature is presented.- - - - - - - - - - ranking = 70.481310384596keywords = closure (Clic here for more details about this article) |
5/137. In utero development of hypertensive necrotizing pulmonary arterial lesions: report of a case associated with premature closure of the ductus arteriosus and pulmonary hypoplasia.Premature closure of the ductus arteriosus (PCDA) is an uncommon defect in which pulmonary hypertension (PH) has been documented by echocardiography in patients and by direct measurement after experimental PCDA in animals. The pulmonary vascular histology in human cases has received little attention but in the few recorded observations the vessels were either normal or showed increased muscularity. We report the case of a 31 week hydropic female stillborn monozygotic twin in whom postmortem examination disclosed PCDA and hypoplasia of the lungs. Atypical plexiform lesions with necrotizing pulmonary arteritis were present. These lesions represent vascular consequences of severe pulmonary hypertension produced by greatly enhanced blood flow through a restricted vascular bed resulting from the combined effects of these two abnormalities. The findings in this case of PCDA with presumed severe PH indicate that severe pulmonary vascular changes can develop in utero and that the interval of time needed for development of such chances in secondary PH is relatively short.- - - - - - - - - - ranking = 352.40655192298keywords = closure (Clic here for more details about this article) |
6/137. Use of a bow tie stent occluder for transcatheter closure of a large anomalous vein.Percutaneous occlusion of superfluous vascular connections, which are short and have large caliber, is technically difficult. We report use of a composite device (consisting of a Palmaz stent, a Gianturco Grifka vascular occlusion device, and multiple platinum detachable embolization coils) to close a large left superior vena cava draining to the pulmonary venous atrium.- - - - - - - - - - ranking = 281.92524153839keywords = closure (Clic here for more details about this article) |
7/137. Anatomic biventricular correction by taking down bicaval Glenn shunt.A 7-year-old boy underwent ventricular and atrial septal defect patch closures, pulmonary valvulotomy, left pulmonary artery dilatation, and bicaval Glenn shunt, which maintained good patency between the superior vena cava and right atrium, because of a reduced right ventricular end-diastolic volume (RVEDV). The RVEDV had increased at 15 years of age; therefore, we performed an anatomic biventricular correction by removing the bicaval Glenn shunt. We found that anatomic biventricular correction becomes possible if RVEDV increases postoperatively.- - - - - - - - - - ranking = 70.481310384596keywords = closure (Clic here for more details about this article) |
8/137. Transcatheter coil closure of a right pulmonary artery to left atrial fistula in an ill neonate.Although rare, a congenital direct fistula connection between the proximal right pulmonary artery and the left atrium can present as cyanosis in the newborn. We report the first case in which catheter-based coil closure of such a fistula in a neonate resulted in rapid clinical improvement, obviating the need for surgical repair.- - - - - - - - - - ranking = 352.40655192298keywords = closure (Clic here for more details about this article) |
9/137. Adverse reaction to amoxicillin: a case report.Penicillin is the drug that most often leads to allergic reactions and anaphylaxis. The incidence of adverse events triggered by penicillins is believed to be between 1% and 10%. Up to one-tenth of these episodes are life-threatening, with the most serious reactions occurring in patients with no history of allergy. The case of a 5 year, 3 month-old female who had a severe allergic reaction to amoxicillin prior to a dental appointment is described. The literature on penicillin hypersensitivity is reviewed and recommendations for management of an allergic reaction in the pediatric dental office are discussed.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
10/137. Repeated delayed sternal closure with stenting for right and left heart failure.Delayed sternal closure is an established method to overcome circulatory instability, especially in pediatric cardiac surgery. We describe the management of complications in a seven-year-old boy in whom staged chest closure augmented by sternal stenting was used twice within three weeks, once for right heart and once for left heart failure.- - - - - - - - - - ranking = 422.88786230758keywords = closure (Clic here for more details about this article) |
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