1/18. Right transatrial approach to relieve pulmonary stenosis in patients with corrected transposition of the great vessels: a new operation without use of an extracardiac conduit.BACKGROUND: A new operation to relieve pulmonary obstruction is proposed for patients with corrected transposition of the great vessels and pulmonary stenosis (PS). A right transatrial approach involves excising or detaching the right-sided atrioventricular valve (AV). Next, the pulmonary outflow tract is opened wide with an incision extending from the right-sided ventricle upward across the AV valve annulus. This incision extends into the main trunk of the pulmonary artery located behind the right atrium. A patch, with or without implantation of a pulmonary valve prosthesis, widens the outflow tract, thus avoiding use of an extracardiac conduit. METHOD: We describe this operation performed in a 51-year-old man who had previously undergone correction with an extracardiac conduit that had become obstructed. The patient had severe right-sided AV valve insufficiency and complete heart block with a functioning transvenous pacemaker. We replaced the right-sided AV valve and positioned the permanent pacemaker lead outside of the prosthetic skirt. The PS was corrected as described above and a pulmonary prosthetic valve implanted. Use of an extracardiac conduit was avoided altogether. CONCLUSION: This technique may be applicable even without excising the right-sided AV valve. The clinical result for our patient is still optimal 4 years after surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/18. Atypical Bland-White-Garland syndrome: a 58-year-old woman with stenosis of the pulmonary origin of the left coronary artery.The anomalous origin of the left coronary artery from the main pulmonary trunk (also known as Bland-White-Garland syndrome) is a rare congenital malformation that occurs in 0.4% of patients with cardiac anomalies. We present an adult case (a 58-year-old woman) of atypical Bland-White-Garland syndrome. The patient displayed a stenosis at the ostium of the anomalous origin of the left coronary artery and an aortopulmonary fistula. Using conventional angiography, it was not possible to differentiate between an anomalous origin of the pulmonary coronary artery and total stenosis of the left main coronary artery in combination with a pulmonary fistula. However, transesophageal echocardiography (TEE) succeeded in making this differential diagnosis. CONCLUSION: If there is subtotal or total occlusion, TEE can be used for detection of coronary vessel morphology, particularly in cases of coronary anomalies.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
3/18. Double outlet left ventricle, transposition of great vessels and pulmonary stenosis.A 4 year-old boy with double outlet left ventricle, transposition of the great vessels, severe pulmonary and subpulmonary stenosis, and subaortic ventricular septal defect underwent successful surgical intervention. The surgical techniques and management plan for double-outlet left ventricle are reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/18. Pulmonary venous thrombosis and infarction complicating pulmonary venous stenosis following radiofrequency ablation.Pulmonary vein stenosis is a recently described complication of radiofrequency ablation. We report a patient who experienced thrombosis of the lingular vein and pulmonary infarction resulting from mild single-vessel pulmonary vein stenosis. This report extends available experience with complications of radiofrequency ablation, by demonstrating pulmonary venous thrombosis as a complication of relatively minor (approximately 50% luminal narrowing) stenosis of a single pulmonary vein, despite the fact that the patient was taking an anticoagulant. .- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
5/18. pulmonary artery stenting without angiographic imaging.pulmonary artery stenosis is a frequent complication seen after surgical repair of tetralogy of fallot. In this setting, endovascular stent implantation is now accepted as the first-choice therapeutic option. However, angiographic imaging still being held as mandatory to check the stent position before final deployment, this procedure is not considered suitable for patients who cannot be submitted to angiography. In this paper, we report a novel method for the correct implantation of an endovascular stent without angiographic imaging. A 9-year-old boy underwent cardiac catheterization to relieve a severe left pulmonary artery stenosis. A previous attempt had been aborted due to a life-threatening anaphylactic reaction to the contrast medium. To avoid angiography, a contrast medium-filled compliant atrial septal defect sizing balloon (Amplatzer Sizing Balloon, AGA Medical Corporation) was used to image the vessel stenosis and successfully guide stent deployment. After the procedure, the transstenotic pressure gradient disappeared and the left-to-right pulmonary perfusion imbalance almost completely reverted.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
6/18. Bronchial compression due to stent placement in pulmonary artery in a child with congenital heart disease.Congenital heart disease, such as transposition of the great vessels (TGV), requires surgical procedures which can lead to important complications. We report on a case of bronchial obstruction following placement of a pulmonary artery stent in a 4-year-old boy who had undergone a Rastelli procedure to correct TGV, ventricular septal defect and pulmonary stenosis. There are many complications that can arise as a consequence of intravascular stents in heart surgery, as well as many causes of bronchial compression. However we have not found any report which describes bronchial compression as a direct consequence of endovascular stent.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
7/18. Isolated supravalvular pulmonary artery ridge in a 70-year-old man.Transthoracic echocardiography allows noninvasive assessment of the structure and function of the great vessels of the heart. We report a case of a 70-year-old man who had an isolated, mildly obstructive, supravalvular pulmonary artery ridge that was detected incidentally with transthoracic echocardiography. This report confirms the utility of transthoracic echocardiography in the detection of this condition and discusses quantification of this rare anomaly.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
8/18. Thickening of the pulmonary artery wall in acute intramural hematoma of the ascending aorta.BACKGROUND: The occurrence of pulmonary artery obstruction in the course of acute aortic dissection is an unusual complication. The mechanism implicated is the rupture of the outer layer of the aorta and the subsequent hemorrhage into the adventitia of the pulmonary artery that causes its wall thickening and, at times, produces extrinsic obstruction of the vessel. There are no reports of this complication in acute intramural hematoma. CASE PRESENTATION: An 87-year-old woman was admitted to the hospital in shock after having had severe chest pain followed by syncope. An urgent transesophageal echocardiogram revealed the presence of acute intramural hematoma, no evidence of aortic dissection, severe pericardial effusion with cardiac tamponade, and periaortic hematoma that involved the pulmonary artery generating circumferential wall thickening of its trunk and right branch with no evidence of flow obstruction. Urgent surgery was performed but the patient died in the operating room. The post mortem examination, in the operating room, confirmed that there was an extensive hematoma around the aorta and beneath the adventitial layer of the pulmonary artery, with no evidence of flow obstruction. CONCLUSION: This is the first time that this rare complication is reported in the scenario of acute intramural hematoma and with the transesophageal echocardiogram as the diagnostic tool.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
9/18. Alagille's syndrome. A case with a hamartomatous nodule of the liver.A male case of Alagille's syndrome associated with a hamartomatous nodule of the liver is described. The patient developed jaundice soon after birth, and was diagnosed as the syndrome with signs such as paucity of the intrahepatic bile ducts, pulmonary stenosis and embryotoxon in the cornea at 15 years of age. The liver was examined in recurrent biopsies and other tests. However, no evidence of liver cirrhosis was confirmed until his 15th year. The patient died of hepatic dysfunction when he was 17 years old. At autopsy, a large hamartomatous nodule was found in the liver showing biliary cirrhosis. Morphology of the nodule resembled that of focal nodular hyperplasia. Abnormalities of the large vessels were noted around the liver. Vascular abnormalities were also seen in the mass. The relation of these vascular abnormalities to etiological background of the syndrome and occurrence of the nodular lesion is discussed.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
10/18. 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 = vessel (Clic here for more details about this article) |
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