1/18. cyanosis due to diastolic right-to-left shunting across a ventricular septal defect in a patient with repaired tetralogy of fallot and pulmonary atresia.cyanosis as a result of right-to-left shunting across a ventricular septal defect is commonly encountered in patients with congenital heart disease when systolic pressure in the right ventricle exceeds that in the left ventricle. Reported is the case of a child who remained cyanosed after surgical correction of pulmonary atresia despite right ventricular systolic pressure being lower than left ventricular pressure. Colour-flow Doppler showed a residual ventricular septal defect, with right-to-left shunting in diastole alone.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/18. Permissive hypoxemia permitted postoperative weaning from artificial ventilation after repair of pulmonary atresia.survival after corrective surgery of pulmonary atresia was associated with low right ventricular pressure, indicating normal pulmonary vascular resistance. Therefore increased fractional inspiratory oxygen concentration, inhaled nitric oxide and intravenous prostacyclin were considered to be effective measures during postoperative intensive care. In a 20-year-old female, conduit repair and unifocalisation of pulmonary atresia with ventricular septal defect and systemic to pulmonary arterial collaterals were performed despite preexisting one-sided pulmonary hypertension. During the following postoperative period, normal arterial oxygen saturation aimed at by means of a high fractional inspiratory oxygen concentration, resulted in persistent pulmonary oedema despite fluid restriction. After several trials of weaning from artificial ventilation, permissive hypoxemia was eventually successful.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
3/18. association of pulmonary atresia with intact ventricular septum and aortic valve stenosis. prenatal diagnosis.A rare association of pulmonary atresia with an intact septum was diagnosed through echocardiography in a fetus 32 weeks of gestational age. The diagnosis was later confirmed by echocardiography of the newborn infant and further on autopsy. The aortic valve was bicuspid with a pressure gradient of 81 mmHg, and the right ventricle was hypoplastic, as were the pulmonary trunk and arteries, and the blood flow was totally dependent on the ductus arteriosus.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
4/18. Functional pulmonary atresia in neonatal Marfan's syndrome: successful treatment with inhaled nitric oxide.Functional pulmonary atresia is characterized by a structurally normal pulmonary valve not opening during right ventricular ejection. We report this rare condition in a premature newborn of a twin pregnancy, in which fetal echocardiography findings were consistent with critical pulmonary stenosis. After birth, features of neonatal Marfan's syndrome were noted. echocardiography showed a morphologically normal but immobile pulmonary valve with continuous regurgitation. Right ventricular pressure was subsystemic. In this case, initial treatment with nitric oxide, followed by pharmacological duct closure, was successful. Differentiating between anatomic and functional pulmonary valve atresia may be difficult. The echocardiographic criteria are discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
5/18. Regression of cardiac enzyme and ventriculocoronary communication in an infant with pulmonary atresia and intact ventricular septum after radiofrequency valvulotomy and valvuloplasty.I report on a 3-month-old infant with pulmonary atresia-intact ventricular septum and ventriculocoronary communication (VCC) who underwent percutaneous radiofrequency valvulotomy and valvuloplasty (RFVV). The patient's cardiac troponin-I, creatine kinase (CK), and myocardial fraction of (CK-MB) were elevated before RFVV and were gradually regressed to normal levels 12 days after RFVV. The VCC disappeared after RFVV. The transvalvular pressure gradients across the pulmonary valve were less than 30 mmHg in the follow-up echocardiography at 4-12 months of age. oxygen saturation was approximately 90% in room air. dipyridamole-thallium myocardial scintigraphy showed positive reperfusion over the apex and interventricular septum.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
6/18. Percutaneous balloon valvuloplasty of both pulmonary and aortic valves in a neonate with pulmonary atresia and critical aortic stenosis.We report a case of hydrops fetalis originating from critical aortic stenosis and pulmonary atresia with intact ventricular septum that was diagnosed in utero by echocardiography. We performed a percutaneous balloon valvuloplasty of the bilateral semilunar valves on the 2nd day after birth. We used a stiff-ended guidewire to perforate the pulmonary valve. After valvuloplasty, the aortic valve pressure gradient decreased from 55 to 25 mmHg. The procedure was successful, and the patient's heart condition improved.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
7/18. A Gore-Tex 'new-innominate' vein: a surgical option for complicated bilateral cavopulmonary shunts.A bilateral bidirectional cavopulmonary shunt was performed in a cyanotic 14-month-old girl who had tricuspid and pulmonary valve atresia, with right pulmonary artery (RPA) hypoplasia (3 mm), bilateral superior vena cavae and a ductus arteriosus-dependent pulmonary blood flow. Because of 62% postoperative arterial oxygen saturation and a right superior vena cava (RSVC) pressure of 30 mmHg, a 5 mm Gore-Tex tube was interposed to connect the two superior venae cavae. The creation of a 'new-innominate' vein allowed decompression of the right superior vena cava and an increase in arterial oxygen saturation to 86%.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
8/18. Anesthetic management of bidirectional cavopulmonary shunt in a patient with pulmonary atresia with intact ventricular septum associated with sinusoidal communications.pulmonary atresia with intact ventricular septum (PAIVS) is sometimes associated with coronary artery anomalies, including right ventricle (RV)-to-coronary artery fistulas (sinusoidal communications), coronary artery stenoses, and coronary artery occlusions. In some cases, the coronary circulation depends entirely or partly on the desaturated systemic venous blood supply from the RV. Under these circumstances, decompression of the RV can result in fatal myocardial ischemia. A 6-month-old boy, diagnosed with PAIVS associated with sinusoidal communications, underwent a bidirectional cavopulmonary shunt procedure under venoarterial cardiopulmonary bypass (CPB). During CPB, to prevent RV decompression, we maintained right atrial pressure above 5 mmHg and used a pump perfusion rate of 30%-40% of the calculated value based on body surface area. Although electrocardiography showed slight ST depression and bradycardia, myocardial contractility after weaning from CPB was adequate to maintain the circulation with the administration of dobutamine and atrial pacing. In patients with PAIVS and RV-dependent coronary circulation, it is important to maintain coronary artery perfusion throughout the period of anesthesia.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
9/18. Doppler echocardiography for detection of ventriculo-coronary communication: report of a case.Ventriculo-coronary communication is frequently encountered in pulmonary atresia patients who have an intact ventricular septum. Preoperative documentation is important to decide the feasibility of right ventricular decompression procedure. Experience of Doppler echocardiographic visualization of this anomaly in a case of critical pulmonary stenosis with intact ventricular septum is reported. Doppler echocardiography is a promising method of detection and should be used in every patient with a high-pressured hypoplastic ventricle before intervention.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
10/18. Size-reduced cryopreserved pulmonary valve allograft for an RV-PA conduit: technical modification and functional evaluation.Cryopreserved pulmonary allografts harvested from adults at the time of kidney donation were size reduced and used in two children with pulmonary atresia and ventricular septal defect. A technical modification for the creation of size-reduced pulmonary allograft conduits is described. Postoperative ultrasonic and cineangiographic assessments revealed excellent function of the pulmonary bicuspid valved conduit with a minimal pressure gradient and essentially no regurgitation. Although the long-term fate of cryopreserved bicuspid pulmonary valve and conduit is unknown, this conduit provides excellent handling characteristics that render allograft conduits preferable to synthetic conduits. In addition, the remodeled bicuspid pulmonary allograft conduits have exhibited excellent hemodynamic characteristics and are a reasonable alternative to other types of conduits when an appropriate size allograft is not available.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
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