481/989. cerebral infarction and ventricular septal defect. With the availability of contrast echocardiography, patent foramen ovale is frequently detected in patients with stroke, especially in those with no clear etiology and/or the young patient with stroke. Before this report, an association of stroke with ventricular septal defect had not been reported. In this communication, we describe a 38-year-old patient who developed an occipital lobe infarction and who, on investigation, was found to have a ventricular septal defect. Other investigations, which included four-vessel cerebral angiography, collagen disease workup, and coagulation profile, were all normal. We believe this case further extends the spectrum of cerebral ischemic events that may occur with intracardiac shunts. ( info) |
482/989. Anatomically corrected malposition of the great arteries, inflow ventricular septal defect, and subaortic stenosis: diagnostic and operative implications. Intracardiac correction of the combination of rare congenital heart lesion of anatomically corrected malposition of the great arteries, severe muscular as well as fibrous subaortic stenosis, and ventricular septal defects in the inflow and the trabecular septum in a 2 1/2 years old boy is reported. There was an additional large secundum atrial septal defect. The operation consisted of resection of the subaortic stenosis by a combined transatrial and transaortic approach, thereby regaining a wide outflow tract of the systemic ventricle. Both the ventricular and atrial septal defects were closed with Dacron patches. Reinvestigation 10 days after the operation revealed a residual pressure gradient across the outflow of the systemic ventricle of less than 10 mmHg. A secondary ventricular septal defect was detected in the anterior muscular septum at the same time and closed with a patch in a reintervention. At discharge from the hospital two weeks later the child was in excellent condition and had a stable sinus rhythm. The preoperative differential diagnosis of a double outlet right ventricle with L-malposition of the aorta as well as possible surgical approaches are discussed. ( info) |
| A case of an infant with median sternotomy wound infection and sternal necrosis treated by debridement and muscle flap transposition is reported. As in adults, the procedure can be done safely and successfully. Rapid healing and chest wall stability were obtained. A later cardiac procedure was performed without technical difficulties and without untoward effects on chest wall stability. ( info) |
484/989. Tricuspid and pulmonary atresia with coarctation of the aorta: a rare combination possibly explained by persistence of the fifth aortic arch with a systemic-to-pulmonary arterial connection. A ten-day old baby was found to have tricuspid and pulmonary atresia, and a "ductal-dependent" pulmonary circulation that was prostaglandin-sensitive. An unusual coarctation of the aorta was not recognised until an autopsy was performed, some 11 days after construction of an aortopulmonary shunt. A previously undefined anomaly in this neonate was persistence of the fifth aortic arch with a systemic-to-pulmonary artery connection on the same side as the definitive aorta. The histology of the fifth aortic arch is consistent with the pattern of an arterial duct. ( info) |
485/989. Subaortic stenosis associated with anomalous right ventricular muscle bundle and ventricular septal defect. A rare case of biventricular outflow tract obstruction in the form of discrete subaortic membrane and hypertrophic anomalous right ventricular muscle bundle associated with ventricular septal defect is presented. ( info) |
486/989. Acquired obstruction of the ventricular septal defect in tetralogy of fallot. The interventricular septal defect in patients with tetralogy of fallot is, in most cases, a nonrestrictive malalignment type of defect. Rare examples of a restrictive defect have been described. We report a case of tetralogy of fallot with pulmonic atresia in which the interventricular septal defect was found to be nonrestrictive at birth. The obstruction of the defect developed gradually, until, at the age of 6 years, a gradient of 55 mm Hg across the defect was found at repeat cardiac catheterization. echocardiography proved that the acquired obstruction was due to excessive tricuspid valve tissue, while Doppler studies suggested a similar gradient between the right ventricle and the ascending aorta. This rare case should alert the clinician to the possibility of an acquired obstruction of the ventricular septal defect, with suprasystemic right ventricular pressure, in cases of tetralogy of fallot, even if an early study suggested a nonobstructive defect. The diagnosis of this situation is of importance because of the poor prognosis which it carries. ( info) |
487/989. Bilateral femoral dysgenesis syndrome: a case report. This paper reports a child with the Bilateral femoral dysgenesis--unusual facies syndrome (BFD-UF). The child has, in addition to previously reported findings, a ventricular septal defect with valvar and infundibular pulmonic stenosis, absence of the labia majora, bilateral syndactyly of the second and third toes, bifid great right toe and a pilonidal sinus. The similarity to cases of Caudal Regression syndrome (phocomelic diabetic embryopathy) is noted. ( info) |
| heparin-induced thrombocytopenia and thrombosis was diagnosed in a 50-year-old man undergoing a repeat heart operation after heparinization led to microemboli and an eventual left transmetatarsal amputation. A third heart operation was aborted when anticoagulation with low molecular weight heparin produced intraoperative thrombi. The patient was referred to Toronto where ancrod (Arvin) was used to lower plasma fibrinogen level, allowing successful repair of a ventricular septal defect using cardiopulmonary bypass support. The patient made an uneventful recovery. ( info) |
489/989. Use of a total wash-out method in an open heart operation. Pathological cold agglutinins may induce hemolysis in patients who need hypothermic cardiopulmonary bypass and blood transfusion. A simple technique, termed the total wash-out method, was used in a patient with high thermal amplitude, moderate-titer cold agglutinin before hypothermic cardiopulmonary bypass. The patient's cold agglutinin titer decreased abruptly after operation. None of the preoperative hemolysis phenomena were found during her 6 months of follow-up. ( info) |
490/989. Right-sided heart with mirror-image atrial arrangement, complete transposition, ventricular septal defect and subpulmonary stenosis. An infant is described with complete transposition in the setting of a right-sided heart, and mirror-image atrial arrangement. A ventricular septal defect and subpulmonary stenosis were also present. We discuss the anatomic features of this patient, undescribed prior to this case, and their implications for surgical repair. ( info) |