1/6. double outlet right ventricle associated with persistent common atrioventricular canal and pulmonary stenosis.A case of a month-old baby admitted for dyspnea and cyanosis, is described. His past history consisted of only mild cyanosis during crying. On physical examination nail beds and lips were cyanotic; on heart auscultation the pulmonary second sound was single. The chest X-ray showed a decreased pulmonary vascularity; the ECG demonstrated extreme right axis deviation (-170 degrees). Capillary gas analysis revealed hypoxic metabolic acidosis. Ten hours after his admission the child suddenly died. The anatomicopathological examination stated the diagnosis of double outlet right ventricle (DORV), infundibular pulmonary stenosis and common atrioventricular canal (transitional type). When clinical findings are compatible with DORV the ECG could be of value in establishing the presence of common atrioventricular canal when extreme right axis deviation is found.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Primitive ventricle with normally related great vessels and stenotic subpulmonary outlet chamber. Angiographic differentiation from tetralogy of fallot.Four patients with primitive ventricle and normally related great vessels with stenotic subpulmonary outlet chamber (Holmes' heart with pulmonary stenosis) are reported. The history, physical examination, and chest x-ray film are not helpful in distinguishing Holmes' heart with pulmonary stenosis from tetralogy of fallot. Electrocardiogram often provides the first clue to the presence of Holmes' heart; left axis deviation with or without left ventricular hypertrophy is an unusual finding in tetralogy of fallot, but common in Holmes' heart. Selective ventriculography is diagnostic: the right ventricular outflow chamber overlies the aortic root and aortic valve in the frontal view in Holmes' heart with pulmonary stenosis, but is to the left of the aortic valve in tetralogy of fallot; no ventricular septum can be identified in Holmes' heart. The diagnosis can be suspected in a child with clinical features of tetralogy of fallot but atypical electrocardiogram, and can be established by angiography.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. Long-term prognosis (15 to 26 years) after repair of tetralogy of fallot: I. survival and symptomatic status.One hundred eighty-two patients with tetralogy of fallot repaired before or during 1967 were studied by interview, physical examination, and noninvasive testing. Twenty were excluded from the final analysis because review of cineangiograms and operative reports disclosed that they had had double-chambered right ventricle rather than tetralogy of fallot. On follow-up ranging from 15 to 26 years (mean, 20.2 years), there were 86 patients in new york Heart association Functional Class I, 53 in Class II, 5 in Class III, and none in Class IV. There were 9 late deaths. Functional classification was not ascertained in the remaining 9 patients. Cumulative survival at 25 years postoperatively was 94.4%. There was no significant relationship between survival and year of operation, age at operation, sex, or presence of a prior shunt. The 9 late deaths occurred between 6 and 23 years after operation and were due to late-onset complete heart block in 2 patients, congestive failure in 4, suicide in 1, accident in 1, and an unknown cause in 1. We conclude that long-term survival after repair of tetralogy of fallot is excellent and not influenced by prior shunt.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Acquired extrinsic pulmonic stenosis caused by mediastinal tumors.Clinically detectable pulmonic stenosis resulting from compression of the pulmonary artery or right ventricular outflow tract by mediastinal tumors is uncommon. This report describes the occurrence of pulmonic stenosis secondary to a mediastinal tumor in a patient with Hodgkin's disease and in two patients with non-Hodgkin's lymphomas. review of 35 published reports reveals that teratomas (ten cases) and Hodgkin's disease (eight cases) are the neoplasms most frequently reported to cause extrinsic pulmonic stenosis. chest pain and dyspnea were the symptoms most commonly reported and a pulmonic ejection murmur was the most common physical finding in patients with acquired pulmonic stenosis. The prognostic significance of acquired pulmonic stenosis. The prognostic significance of acquired pulmonic stenosis secondary to mediastinal tumors is unclear.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Successful pregnancy in a woman with cyanotic congenital heart disease after a palliative pulmonary-systemic shunt. A case report.A 20-year-old woman with cyanotic congenital heart disease composed of corrected transposition of the great vessels, severe pulmonic stenosis, atresia of the left pulmonary artery and a large ventricular septal defect, had a successful pregnancy following a pulmonary-systemic shunt (Blalock-Taussig). The hemoglobin decreased from 21 to 16 g/dL following the operation. The antepartum course was complicated by intrauterine growth retardation and pregnancy-induced hypertension. A normal fetal nonstress test and biophysical profile permitted continuation of the pregnancy until 38 weeks' gestation, with delivery of a healthy infant.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Severe calcific pulmonic valve stenosis and restrictive ventricular septal defect in a 64-year-old man. Results of percutaneous double balloon valvuloplasty.The clinical and hemodynamic features of a 64-year-old symptomatic man with severe calcific pulmonic valve stenosis and restrictive ventricular septal defect are reported. Successful double balloon percutaneous pulmonic valvuloplasty immediately produced excellent symptomatic benefit and introduced expected and well tolerated hemodynamic changes. The transpulmonic valve peak systolic pressure gradient was reduced from 130 to 30 mmHg and pulmonary artery pressure increased to top normal levels acquiring normal pulse wave configuration. A left-to-right shunt, negligible prior to valvuloplasty, increased appreciably producing a pulmonary to systemic flow ratio of 1.7. Reevaluation at 5 months revealed sustained hemodynamic profile. Symptomatic benefit and tolerance to ordinary physical activities have remained excellent at 1 year follow-up.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |