1/10. Acquired left ventricular-right atrial communication: Gerbode-type defect.Left ventricular-right atrial (LV-RA) communications are rare intracardiac defects, often congenital in nature and clinically apparent during childhood. Acquired LV-RA shunts are encountered occasionally in the adult population as a result of a defect in the upper portion of the membranous ventricular septum. We describe the clinical and echocardiographic features of an elderly patient with an acquired LV-RA communication in the setting of an aortic composite valve graft and endocarditis. We also review the anatomical features and hemodynamic consequences of such defects.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Anaesthetic implications of leopard syndrome.leopard syndrome is a neuroectodermal disorder presumed to result from an abnormality in neural crest cells. The acronym 'LEOPARD' is derived from the clinical features which include multiple lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormal genitalia, retarded growth, and deafness. Given the multisystem nature of the disease process, several issues may affect the perioperative care of these patients. Of primary importance are associated conditions of the cardiovascular system including congenital heart disease, conduction disturbances, and progressive hypertrophic obstructive cardiomyopathy. The authors present a 4-year old boy who presented for anaesthetic care for repair of a ventricular septal defect and pulmonary valvotomy for congenital pulmonary stenosis. The potential perioperative implications of leopard syndrome are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. The harlequin color change and association with prostaglandin E1.The harlequin color change is an unusual cutaneous phenomenon observed in newborn infants as transient, benign episodes of a sharply demarcated erythema on half of the infant, with simultaneous contralateral blanching. In this report, two newborns with congenital heart anomalies demonstrated the harlequin color change, one whose skin findings showed a course related to the dose of systemic prostaglandin E1, suggesting a possible association. The benign, self-limited nature of the color change mandates that prostaglandin E1 not be discontinued for this reason. The entity is likely more common than the paucity of reports in the world literature suggests, and all physicians should recognize its graphic appearance to avoid unnecessary exposure to agents in an effort to treat it.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Continuous murmur caused by a ventricular septal defect post-myocardial infarction: visual display with a handheld computer.Ventricular septal defects do not typically result in a continuous murmur. The only previously reported case involved a congenital ventricular septal defect. We report a case of an acquired ventricular septal defect following a large anterior myocardial infarction resulting in a continuous murmur. The continUous nature was confirmed both with 2D echocardiography and a specially equipped stethoscope in conjunction with a handheld computer to provide a visual display of the murmur. A proposed mechanism for the continuous murmur was discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. Potential value of intraoperative Doppler colour flow mapping in operations for complex intracardiac shunting.An eight year old boy presented with multiple residual intracardiac shunts and considerable persisting haemolytic anaemia five years after the repair of a single perimembranous ventricular septal defect. Preoperative transthoracic colour flow mapping showed an "acquired" left ventricular right atrial shunt and three small residual ventricular septal defects around the patch. These had been poorly visualised by both angiography and conventional cross sectional echocardiography and pulsed and continuous wave Doppler. Clearly, to stop the haemolysis effectively, closure of all residual intracardiac shunts was required. Intraoperative pre-bypass colour flow mapping was successfully used to confirm the precise number and nature of the defects and more importantly studies after bypass were used to confirm immediate closure of all defects.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Pulmonary function testing in children with cardiac disease.These cases illustrate the clinical importance of pulmonary function testing in children. The first case demonstrated a significant restrictive defect in a child with pulmonic stenosis and scoliosis. Although this child had no respiratory symptoms, it was important to document the degree of functional impairment to plan for her postoperative course. The second case demonstrated the way in which pulmonary function tests can lead to a specific diagnosis and provide important information about response to therapy. This patient had distressing symptoms which limited her ability to participate in sports. Her chest x-ray revealed no significant abnormality and she had no auscultatory finding. Pulmonary function tests defined both the nature and severity of her problems and provided objective information about her response to therapy. In the third case, one might have anticipated decreases in flow rates and lung volumes because of neuromuscular weakness. That was not evident on testing and the patient had an uneventful postoperative recovery. Pulmonary function testing provides invaluable information about the nature and severity of functional impairment in children with known or suspected pulmonary disease. New equipment and individuals specifically trained to work with children now permit the evaluation of even young children. Pulmonary function testing can expand our knowledge of disease processes and improve our therapeutic strategies.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
7/10. Group C beta-hemolytic streptococcal endocarditis: report of a pediatric case.A 9-year-old boy with a ventricular septal defect and a bicuspid aortic valve developed bacterial endocarditis due to group C streptococci. He responded to an initial antibiotic regimen of nafcillin plus gentamicin and was cured by the use of penicillin g following the isolation of the organism. The unusual nature of this case is discussed and physicians are cautioned to recognize this organism as a potential cause of infectious endocarditis in the pediatric population.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. tetralogy of fallot. Occlusion of the ventricular septal defect due to accessory tricuspid valve leaflet and an associated membranous aneurysm.A unique case of tetralogy of fallot is presented in a 3 7/12-yr-old white female. At surgical repair, a ventricular septal defect smaller than usual was demonstrated in the usual infracristal position. The ventricular septal defect was partially obstructed from the right side of the ventricular septum by adherence of an accessory tricuspid leaflet. An associated membranous aneurysm, presumably acquired, was occluding the ventricular septal defect at its outlet almost completely. The literature has been reviewed and the pathophysiology of this lesion is discussed, underlining the nature and plausible development of the membranous aneurysm.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. endocarditis and ventricular septal defect: surgical vs. conservative treatment.Three patients with ventricular septal defect and bacterial endocarditis are reported. Because of the very frequent spontaneous closure of the defect, especially in children, and the rarity and benign nature of bacterial endocarditis superimposed on ventricular septal defect, it is suggested that the condition be treated conservatively. An exception to this is the rare case with recurrent endocarditis, mainly in older individuals, in whom surgery may be contemplated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Anatomic conundrum in a case of complete transposition of the aorta and pulmonary trunk.An unusual cord-like structure was found on postmortem examination of the heart of a 30-year-old woman who had complete transposition of the great arteries. This extended from the posterior aspect of the right side of the base of the aorta to the posterior wall of the distal part of the arch immediately proximal to the insertion of the arterial ligament. The nature and origin of this is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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