*****AJR. AMERICAN JOURNAL OF ROENTGENOLOGY*****
(REFERENCE 1 OF 30) 82110637
Tamaki N Itoh H Ishii Y Yonekura Y Yamamoto K Torizuka K Konishi Y Hikasa Y Kambara H Kawai C Hemodynamic significance of increased lung uptake of thallium-201.
In: AJR Am J Roentgenol (1982 Feb) 138(2):223-8
ISSN: 0361-803X
To determine the hemodynamic significance of increased lung thallium- 201 uptake, resting thallium images in 23 normal subjects and 90 patients with various cardiac diseases were reviewed. Significant thallium uptake in the lung was observed in 60 cases and was especially frequently in mitral valvular disease (19 of 19 cases) and in myocardial infarction (25 of 37 cases). Chest radiographs of most of these patients showed pulmonary congestion or edema (50 or 69 cases). Pulmonary wedge pressure was measured in 25 of these patients and was significantly higher than in those of normal thallium uptake in the lung. Assessment of lung thallium uptake at the time of myocardial imaging can be used as a noninvasive means for evaluation of pulmonary venous hypertension.
Registry Numbers: 7440-28-0 (Thallium)
*****AMERICAN HEART JOURNAL*****
(REFERENCE 2 OF 30) 84124911
Grenadier E Sahn DJ Valdes-Cruz LM Allen HD Oliveira Lima C Goldberg SJ Two-dimensional echo Doppler study of congenital disorders of the mitral valve.
In: Am Heart J (1984 Feb) 107(2):319-25
ISSN: 0002-8703
To define the use of two-dimensional echocardiography (2DE) and Doppler methods for diagnosis of forms of congenital mitral stenosis, we studied 16 children, age range 2 months to 13 years, with congenital deformities of the mitral valve documented at cardiac catheterization. Thirteen had additional congenital heart defects, most commonly aortic stenosis or aortic coarctation. In eight patients features of mitral valve anatomy were observed and described during cardiac surgery and in one child the anatomy was verified by postmortem examination. 2DE studies allowed anatomic subclassification of 10 valves which had asymmetric or single dominant papillary muscles (parachute) and six which had arcade mitral valve attached by short chords to multiple diminutive papillary muscle heads. All patients' echoes exhibited shortened and thickened mitral chordae and doming of the mitral leaflets during diastole, and seven children had restricted mitral orifices imaged on the short-axis imaging plane. All seven of the patients studied by Doppler echocardiography had increased maximal transmitral inflow velocity (range 111 to 260 cm/sec) greater than the 95% confidence limits for mitral flow velocities in 34 normal children who served as the control group. Our study suggests that 2DE studies, especially when combined with Doppler interrogation, are sensitive for defining forms of congenital mitral stenosis.
(REFERENCE 3 OF 30) 75125693
Murphy KF Kotler MN Reichek N Perloff JK Ultrasound in the diagnosis of congenital heart disease.
In: Am Heart J (1975 May) 89(5):638-56
ISSN: 0002-8703
In addition to recording the motion of the mitral, tricuspid, aortic, and pulmonic valves, echocardiography can identify right and left ventricular cavities and the interventricular septum. Disorders such as atrial-septal defect, valvular and subvalvular aortic stenosis, pulmonic stenosis, Ebstein's anomaly of the tricuspid valve, and the hypoplastic left-heart syndrome can readily be evaluated by echocardiography. In tetralogy of Fallot and truncus arteriosus, discontinuity between the anterior aortic wall and septum with overriding aorta has been demonstrated. Doubleoutlet right ventricle is associated with posterior aortic wall and mitral valve discontinuity. In disorders such as single ventricle, tricuspid atresia, and endocardial cushion defect with common A-V canal, echocardiographic demonstration of the absence of the interventricular septum has provided the clinician with valuable information. Newer techniques such as compound-B ultrasonography, which produces a two-dimensional cross-sectional image of intracardiac structures, and multiscan echocardiography will enhance the use of conventional echocardiography by providing a more accurate anatomic display of cardiac chambers and outflow vessels.
*****AMERICAN JOURNAL OF CARDIOLOGY*****
(REFERENCE 4 OF 30) 85019962
Miyatake K Okamoto M Kinoshita N Izumi S Owa M Takao S Sakakibara H Nimura Y Clinical applications of a new type of real-time two-dimensional Doppler flow imaging system.
In: Am J Cardiol (1984 Oct 1) 54(7):857-68
ISSN: 0002-9149
The clinical significance of a newly developed real-time 2- dimensional (2-D) Doppler flow imaging technique was assessed. In the instrumentation of the echocardiograph, the pulsed Doppler mechanism was incorporated in a wide-angle, phased-array system. The Doppler flow signals obtained from the cardiac chamber were processed on the basis of the autocorrelation principle. The direction, velocity and variance of the intracardiac blood flow were calculated in real time and displayed in the color-coded mode on the television screen, and were superimposed on the 2-D echocardiographic image of the heart. The technique was used in 20 healthy subjects and 100 cardiac patients. The new technique clearly visualized the whole aspect of intracardiac blood flow by the cine mode in real time; thus, the technique may be called Doppler cineangiocardiography. The mitral inflow and the aortic ejection flow were clearly demonstrated. A regurgitant jet from the valve orifices was dynamically visualized as seen in the cineangiogram. The spatial orientation and extent of the regurgitant jet were easily assessed. The jet stream through the stenotic mitral orifice was well imaged in the left ventricular cavity, showing a variety of stream directions. Intracardiac shunts in ventricular septal defect and atrial septal defect were clearly visualized. The defect could be localized on the interventricular septum on the basis of the site where the shunt flow spurted, although the echocardiographic interruption was not demonstrated in the 2-D echocardiographic image of the cardiac structure. Although some technical problems remain, our new technique greatly improves the diagnostic efficacy of ultrasound.
(REFERENCE 5 OF 30) 82132509
Elliott LP Green CE Rogers WJ Hood WP Mantle JA Papapietro SE Advantages of the caudocranial left anterior oblique left ventriculogram in adult heart disease.
In: Am J Cardiol (1982 Feb 1) 49(2):369-80
ISSN: 0002-9149
Biplane axial left cineventriculography represents the most accurate diagnostic technique for evaluating acquired and congenital heart disease. However, data have accumulated to indicate that without angled views of the left ventricle, the diagnosis will be incomplete and inaccurate in a significant number of patients. Left ventriculography is the acknowledged standard for left ventricular performance. However, comparison of the conventional or nonangled left anterior oblique left ventriculogram with the angled views of the left ventricle obtained with either two dimensional ultrasound or radionuclide left ventriculography may in many cases be invalid because dissimilar views are compared. The cranial-left anterior oblique view allows more accurate assessment of the precise degree and extent of asynergy, left ventricular aneurysms and ventricular septal defects. Left ventricular outflow tract abnormalities such as discrete subaortic stenosis and the obstructive form of hypertrophic cardiomyopathy can easily be distinguished. Lesions involving the mitral valve, especially mitral valve prolapse, are readily evaluated. Lastly, comparison with noninvasive tests of left ventricular performance can be more accurately performed.
(REFERENCE 6 OF 30) 78017299
Canedo MI Stefadouros MA Frank MJ Moore HV Cundey DW Echocardiographic features of cor triatriatum.
In: Am J Cardiol (1977 Oct) 40(4):615-9
ISSN: 0002-9149
A patient is presented who had cor triatriatum documented with angiography and surgery. On echocardiographic study, an abnormal, dense linear echo on "sector scan" was consistently seen to traverse the left atrial cavity obliquely; the ends of the echo were attached to the posterior aortic and lateral walls of the left atrium. In addition, high frequency oscillatory movements were evident in the echo of the posterior mitral cusp. Both echocardiographic features disappeared promptly after successful resection of the intraatrial fibrinous membrane. This experience indicates that in the presence of strong evidence of mitral stenosis, an unexpectedly normal mitral valve echogram should initiate a thorough echographic search for cor triatriatum, a treatable cardiac malformation whose diagnosis can easily be missed on "routine" echocardiographic studies.
(REFERENCE 7 OF 30) 77062972
Parisi AF Tow DE Sasahara AA Clinical appraisal of current nuclear and other noninvasive cardiac diagnostic techniques.
In: Am J Cardiol (1976 Nov 23) 38(6):722-30
ISSN: 0002-9149
At a time of rapid increases in the cost of medical care and the application of complex invasive procedures to cardiovascular diagnosis, the use of noninvasive methods has aroused interest. This report discusses the usefulness and limitations of various noninvasive diagnostic methods including nuclear medicine techniques, echocardiography, exercise electrocardiography and determination of systolic time intervals. Emphasis is placed on the applicability of these methods to specific disease processes (such as ischemic heart disease, cardiac valve disease, pulmonary embolic disease), their relative merits, future potential and present shortcomings.
*****ANNALS OF THORACIC SURGERY*****
(REFERENCE 8 OF 30) 77110914
Tarhan S White RD Moffitt EA Anesthesia and postoperative care for cardiac operations.
In: Ann Thorac Surg (1977 Feb) 23(2):173-93
ISSN: 0003-4975
Almost three decades have passed since the establishment of open- heart surgery, and in such a short life span the specialty has established itself scientifically and reached a certain maturity. New techniques, better understanding of the pathophysiology of cardiac problems, and the effective use of new drugs constantly improve the results of operation. Greater experience in anesthetic management and improved postoperative care will contribute much to the success of this youngest surgical specialty. This review outlines the current principles of anesthesia and postoperative care of patients undergoing cardiac operations. Preanesthetic evaluation provides guidance for anesthetic management, supportive techniques, and postoperative care. During operations, light anesthesia is usually sufficient for patients with cardiac disease and minimizes myocardial depression. Monitoring must provide data on the physiological changes that are taking place from moment to moment during and after operations. Perfusion produces a highly abnormal state, and the severity of complications varies with its duration. Introduction of new drugs has also facilitated hemodynamic management during and after operations. Postoperative care is based on careful observation of the patient and early detection of trends, both of which lead to preventive rather than curative treatment wheneven possible.
(REFERENCE 9 OF 30) 76183446
Oglietti J Reul GJ Jr Leachman RD Cooley DA Supravalvular stenosing ring of the left atrium.
In: Ann Thorac Surg (1976 May) 21(5):421-4
ISSN: 0003-4975
Two patients with supravalvular stenosing ring of the left atrium are described. In 1 patient with an associated ventricular septal defect and Wolff-Parkinson-White syndrome, the diagnosis of supravalvular stenosing ring was only suspected. This patient underwent correction but died 34 days after the operation because of pulmonary embolism. In the second patient a preoperative diagnosis was not made, and this contributed to his death following correction of tetralogy of Fallot. The association of these two anomalies is very rare. Differential diagnosis from other congenital anomalies producing obstruction of left atrial flow is discussed. The divergent microscopical features of the membrane in supravalvular stenosing ring of the left atrium and in cor triatriatum are described. The value of cardiac catheterization, angiography, and echocardiography as diagnostic aids is emphasized. The hazards of not recognizing and diagnosing this anomaly when associated with other cardiac malformations are pointed out.
(REFERENCE 10 OF 30) 97452673
Brauner RA Laks H Drinkwater DC Jr Scholl F McCaffery S Multiple left heart obstructions (Shone's anomaly) with mitral valve involvement: long-term surgical outcome.
In: Ann Thorac Surg (1997 Sep) 64(3):721-9
ISSN: 0003-4975
BACKGROUND: The outcome of children with multilevel left heart obstructions (Shone's anomaly) is generally poor. Literature is scarce, consisting mainly of case reports. The mitral disease may be the predominant factor affecting outcome. METHODS: Surgical results in 19 consecutive patients are presented, with a median follow-up of 8 years. Mitral stenosis was present in all, with parachute deformity in 12 patients. Supramitral rings were found in 9 patients. Other features included subaortic stenosis (15 patients), valvar aortic stenosis (9), bicuspid aortic valve (16), and coarctation (13 patients). The patients underwent 46 surgical procedures, including 18 mitral operations (9 replacements, 9 repairs). RESULTS: There were three in-hospital (16%) and two late (10.5%) deaths. Of the 5 nonsurvivors, 4 patients (80%) had predominant mitral disease and moderate to severe pulmonary hypertension, versus 4 (28.5%) and 5 (36%) survivors, respectively (p = not significant). Valve repair was the final procedure in 9 survivors. The other 5 patients had repeated valve replacements (1), aortoventriculoplasty with valve replacements (2), or no mitral operation (2). Freedom from mitral reoperation was 78% (7 of 9 patients) after repair procedures and 43% (3 of 7 patients) after replacement. At follow-up, 10 patients (71.4%) are in New York Heart Association functional class I and the other 4 in class II and III. Six (43%) await reoperation due to recurrent aortic (4) or subaortic (1) stenosis and recoarctation (2). Echocardiography reveals mild mitral stenosis or regurgitation in 3 patients after repair (33%). Four are considered free of residual disease (21% of all). CONCLUSIONS: Late outcome in Shone's anomaly seems to correlate with the predominance of mitral valve involvement and the degree of pulmonary hypertension. Valve repair is indicated whenever feasible and should be considered before the occurrence of pulmonary hypertension.
Institutional address: Division of Cardiothoracic Surgery UCLA School of Medicine 90095 USA.
*****BRITISH HEART JOURNAL*****
(REFERENCE 11 OF 30) 75090814
Lowe KG Emslie-Smith D Ward C Watson H Classification of ventricular pre-excitation. Vectorcardiographic study.
In: Br Heart J (1975 Jan) 37(1):9-19
ISSN: 0007-0769
In a study of 45 cases of ventricular pre-excitation, 19 were classified as type A and 20 as type B according to Rosenbaum's criteria, which depend on the polarity of the major deflections in the right praecordial leads and not, as is commonly thought, on the direction of the delta vector. Six cases that could not be classified as type A or type B were termed intermediate. Vectorcardiograms were recorded from 29, and these showed a wide but continuous range of values for both the delta and the main QRS vectors in all three planes. Any classification based on these features must, therefore, depend on arbitrary quantitative data. Three patients in this series had associated right bundle-branch block. A review of the published reports on the association of pre-excitation and bundle-branch block failed to provide a rational basis for the classification of pre- excitation. It is emphasized that Rosenbaum's classification is empirical and its validity is questioned.
*****CHEST*****
(REFERENCE 12 OF 30) 82185687
Wagenvoort CA Wagenvoort N Smooth muscle content of pulmonary arterial media in pulmonary venous hypertension compared with other forms of pulmonary hypertension.
In: Chest (1982 May) 81(5):581-5
ISSN: 0012-3692
The number of smooth muscle cells per unit of surface area of the media of muscular pulmonary arteries was assessed and expressed as an index of medial smooth muscle density. The relative medial thickness of these arteries was also established. Subjects were ten children and ten adults in each of the following conditions: normal, congenital cardial defects with a left-to-right shunt (CCD), primary pulmonary hypertension (PPH), and mitral stenosis (MS); ie, 80 persons in all. The density of medial smooth muscle is generally the same in normal control subjects and in patients with CCD or PPH and is independent of the medial thickness. The index is also the same in children with MS, but significantly reduced in adult patients with MS, apparently by a prominent contribution of collagen and edematous ground substance to the structure of the media. This may explain, at least to some extent, the discrepancy often observed in adult patients with MS, of a very thick media associated with mild elevation of pulmonary arterial pressure. The present study leaves open the possibility that other factors, decisive for this elevation of pressure, are involved. The differences in medial structure may also account for some hemodynamic differences between adults and children with MS.
(REFERENCE 13 OF 30) 81187525
Hatem J Sade RM Taylor A Usher BW Upshur JK Supernumerary mitral valve producing subaortic stenosis.
In: Chest (1981 Apr) 79(4):483-6
ISSN: 0012-3692
A ten-year-old girl with severe subaortic stenosis was found to have relatively mature valvular endocardial cushion tissue (fibromyxomatous sheets with a chorda tendinea attached to a left ventricular papillary muscle) immediately beneath the aortic valve. This structure behaved like a valve mechanism, obstructing the left ventricular outflow tract during ventricular systole. This anomaly is an extreme on the spectrum of obstructive endocardial cushion malformations.
*****CIRCULATION*****
(REFERENCE 14 OF 30) 80132875
Snider AR Roge CL Schiller NB Silverman NH Congenital left ventricular inflow obstruction evaluated by two- dimensional echocardiography.
In: Circulation (1980 Apr) 61(4):848-55
Several forms of congenital heart disease that cause left ventricular inflow obstruction have similar M-mode findings, and frequently the exact anatomic diagnosis cannot be made by M-mode echocardiography alone. We examined five children with various forms of left ventricular inflow obstruction using two-dimensional echocardiography. The diagnosis was confirmed by cardiac catheterization and surgery in all five patients. In one patient with congenital mitral valve stenosis, a thick mitral valve with two papillary muscles was imaged. This patient was easily distinguished from a second child with parachute deformity of the mitral valve in whom a single papillary muscle arising from the left ventricular apex was seen. These two patients with mitral valve stenosis were easily differentiated from the three patients in whom the left ventricular inflow obstruction was caused by a membrane within the left atrium. The membrane could be seen in several spatial planes; however, we could not distinguish by two-dimensional echocardiography one child who had cor triatriatum from the other two patients who had a supravalvar mitral ring. Because of its spatial anatomic display, the two-dimensional echocardiogram provides information for a more detailed anatomic diagnosis in children with congenital left ventricular inflow obstruction.
(REFERENCE 15 OF 30) 79190126
Kutsche LM Oyer P Shumway N Baum D An important complication of Hancock mitral valve replacement in
children.
In: Circulation (1979 Aug) 60(2 Pt 2):98-103
Nine children ages 2--15 years have undergone mitral valve replacement (MVR) with Hancock porcine heterograft valves for severe mitral insufficiency. The etiology of the mitral valve disease was rheumatic in two patients, and congenital in seven. Porcine valve sizes ranged from 19--31 mm. Follow-up has been from 1.6 to 6.1 years (mean, 4.3 years). All nine children have had marked postoperative improvement, no thromboembolic complications despite no long-term anticoagulations, and no episodes of endocarditis. There have been no early or late deaths. Although six of the nine patients remain asymptomatic, three others developed severe fibrocalcific obstruction of the heterograft, requiring valve re-replacement at 3.5, 3.6, and 4.8 years following the initial valve replacement. This complication has not been previously reported in children. It is a factor that must be considered when deciding on MVR for children and their postoperative management.
(REFERENCE 16 OF 30) 77001920
LaCorte M Harada K Williams RG Echocardiographic features of congenital left ventricular inflow obstruction.
In: Circulation (1976 Oct) 54(4):562-6
ISSN: 0009-7322
The echocardiographic features of congenital left ventricular inflow obstruction are described in six patients. The echocardiograms in two patients with cor triatriatum were distinguished by normal mitral valve motion and an abnormal echo within the left atrium. In two patients with supravalvar mitral ring, in addition to abnormal mitral valve motion, an abnormal echo, presumably originating from the obstructive membrane, was located between the anterior and posterior mitral leaflets. In two cases of parachute mitral valve, mitral valve motion was abnormal. In one of these cases there were multiple mitral valve echoes similar to those found in supravalvar mitral ring. The echocardiographic identification of an obstructive membrane within the left atrium is difficult because of the occurrence of artifacts. However, membranes may be identified if careful scanning techniques are employed in patients in whom left ventricular inflow obstruction is suspected. The echocardiogram is useful in detecting mitral valve abnormalities in these patients and is valuable in cases where mitral valve replacement is contemplated.
(REFERENCE 17 OF 30) 76064660
Mathewson JW Riemenschneider TA McGough EC Condon VR Left ventricular outflow tract obstruction produced by redundant mitral valve tissue in a neonate. Clinical, angiographic, and operative findings.
In: Circulation (1976 Jan) 53(1):196-9
ISSN: 0009-7322
An unusual case of left ventricular outflow tract obstruction associated with severe left ventricular failure in a neonate is reported. The physical and laboratory data were consistent with the diagnosis of infantile valvular aortic stenosis. At operation, however, redundant gelatinous pedunculated tissue attached to the mitral valve annulus appeared to move through and obstruct the aortic valve during systole. The aortic valve showed only minimal thickening of the right and left coronary cusps. A distinct angiographic pattern was demonstrated during left ventricular cineangiography. In the frontal projection a large ovoid filling defect appeared to protrude through the aortic valve during systole and return to a subvalvular location during diastole. Recognition of this angiographic pattern should facilitate diagnosis and subsequent repair. Complete correction is possible by operative excision of the obstructing tissue without damaging the mitral valve. In contrast to isolated congenital infantile valvular aortic stenosis, a condition in which the valve leaflets are often primitive and deformed, aortic valvotomy and/or subsequent valve replacement are not necessary, resulting in a better long-term prognosis.
(REFERENCE 18 OF 30) 89355380
Sauer U Gittenberger-de Groot AC Geishauser M Babic R Buhlmeyer K Coronary arteries in the hypoplastic left heart syndrome. Histopathologic and histometrical studies and implications for surgery.
In: Circulation (1989 Sep) 80(3 Pt 1):I168-76
ISSN: 0009-7322
The subepicardial coronary arteries (CAs) in the hypoplastic left heart syndrome (HLHS) were studied for pathology dependent on the patency of the mitral valve and the presence of endocardial fibroelastosis (EFE) of the left ventricle (LV). Nine heart specimens with aortic and mitral atresia (group 1) were studied and compared with 19 hearts with aortic atresia and mitral stenosis (group 2) (EFE of the LV was present in all cases) and 10 normal hearts. The median age at death was 3 days. For the histological and histometrical studies, 5-mm blocks from six comparable sites of the left (L) and right (R) CAs were serially sectioned and routinely processed. The arterial size and wall thickness were measured. Macroscopically, the CAs in group 1 were normal except for the prevalence of left dominance (56%). In contrast in group 2, the CAs were thicker and tortuous. Histopathology was restricted almost exclusively to group 2 specimens (11 of 19), with the proximal LCAs being the most affected. However, eight hearts with EFE in group 2 had no structural wall changes of the CAs. Histometrically, the sizes (external diameters) of the LCAs and RCAs were similar (0.5-1.0 mm) in groups 1 and 2 and in the normal group; however, we noted an increase in percent medial thickness in group 2 specimens, especially of the LCAs. Furthermore, in some group 2 hearts, the wall thickness (intima and media) relative to the luminal size (internal radius) of proximal and middle LCAs was significantly increased, suggesting the presence of ventricle-CA communications.(ABSTRACT TRUNCATED AT 250 WORDS)
Institutional address: Kinderkardiologie Deutsches Herzzentrum FRG.
(REFERENCE 19 OF 30) 75166982
Alderson PO Jost RG Strauss AW Boonvisut S Markham J Radionuclide angiocardiography. Improved diagnosis and quantitation of left-to-right shunts using area ratio techniques in children.
In: Circulation (1975 Jun) 51(6):1136-43
ISSN: 0009-7322
A comparison of several reported methods for detection and quantitation of left-to-right shunts by radionuclides was performed in 50 children. Count ratio (C2/C1) techniques were compared with the exponential extrapolation and gamma function area ratio techniques. C2/C1 ratios accurately detected shunts and could reliably separate shunts from normals, but there was a high rate of false positives in children with valvular heart disease. The area ratio methods provided more accurate shunt quantitation and a better separation of patietns with valvular heart disease than did the C2/C1 ratio. The gamma function method showed a higher correlation with oximetry than the exponential method, but the difference was not statistically significant. For accurate shunt quantitation and a reliable separation of patients with valvular heart disease from those with shunts, area ratio calculations are preferable to the C2/C1 ratio.
*****JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY*****
(REFERENCE 20 OF 30) 87138858
Vick GW 3d Murphy DJ Jr Ludomirsky A Morrow WR Morriss MJ Danford DA Huhta JC Pulmonary venous and systemic ventricular inflow obstruction in patients with congenital heart disease: detection by combined two- dimensional and Doppler echocardiography.
In: J Am Coll Cardiol (1987 Mar) 9(3):580-7
ISSN: 0735-1097
Obstruction to pulmonary venous return may be associated with a number of congenital cardiovascular abnormalities occurring both before and after surgery. Hemodynamic assessment by cardiac catheterization is often difficult. A noninvasive method for detection and quantitation of obstruction to systemic ventricular inflow would be clinically useful. Two-dimensionally directed pulsed and continuous wave Doppler echocardiography was performed before cardiac catheterization in 31 patients thought clinically to have possible obstruction to left ventricular inflow or pulmonary venous return. Primary diagnoses included transposition of the great arteries after the Mustard or Senning procedure in nine patients, total anomalous pulmonary venous connection in nine (in two after surgical repair), cor triatriatum in eight (in four after surgical repair), congenital mitral stenosis in four (in one after surgical repair) and mitral atresia in one. Severe obstruction was defined as a mean pressure gradient at catheterization of greater than or equal to 16 mm Hg at any level of the pulmonary venous return or of the systemic ventricular inflow. Severe obstruction was predicted if Doppler examination measured a flow velocity of greater than or equal to 2 m/s across any area of inflow obstruction. At catheterization, 12 patients (39%) had severe obstruction to left ventricular inflow or pulmonary venous return and all obstructions were correctly detected by Doppler echocardiography. The site of pulmonary venous obstruction was localized by two-dimensionally directed pulsed Doppler study. Patients with a lesser degree of obstruction had a lower Doppler velocity, but none had a maximal Doppler velocity of greater than or equal to 2 ms/s.(ABSTRACT TRUNCATED AT 250 WORDS)
(REFERENCE 21 OF 30) 86225071
Sullivan ID Robinson PJ de Leval M Graham TP Jr Membranous supravalvular mitral stenosis: a treatable form of congenital heart disease.
In: J Am Coll Cardiol (1986 Jul) 8(1):159-64
ISSN: 0735-1097
The clinical data, echocardiographic findings, operative anatomy and postoperative follow-up were assessed in 14 patients who had surgery for membranous supravalvular mitral stenosis between 1978 and 1985. The patients ranged in age from 6 weeks to 13 years at the time of operation, and 8 of the 14 had associated mitral valve abnormalities. Other associated lesions included ventricular septal defect (n = 7), coarctation of the aorta (n = 5), left superior vena cava (n = 6), subaortic stenosis (n = 3) and atrial septal defect (n = 1). Twelve of the 14 patients had successful removal of the supravalvular membrane, which was usually adherent to the valve, and 2 patients with associated mitral valve abnormalities underwent mitral valve replacement. There were no operative deaths. Review of preoperative two-dimensional echocardiograms, which were available in 11 patients, revealed two types of membranous supravalvular mitral stenosis in 10 patients. In four of these patients, the membrane was only evident after repeated stop action viewing from a single subcostal or parasternal location. The membrane was never seen in one patient. Eleven patients had follow-up in excess of 1 year, and there was one late death. Eight of the remaining 10 patients are asymptomatic, and 7 have no clinical evidence of residual mitral obstruction. Failure to recognize membranous supravalvular mitral stenosis can result in undue delay of cardiac surgery with resultant cardiopulmonary deterioration. Patients with evidence of left ventricular inflow obstruction should have extensive echocardiographic evaluation in an effort to detect membranous supravalvular mitral stenosis, which may be amenable to surgical repair.
*****JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY*****
(REFERENCE 22 OF 30) 81147031
Utley JR Noonan J Cardiopulmonary bypass in the presence of uncorrected coarctation.
In: J Thorac Cardiovasc Surg (1981 Apr) 81(4):588-90
ISSN: 0022-5223
We performed correction of intracardiac lesions in 10 patients with coarctation. All cardiovascular lesions were corrected except coarctation. Six patients had a large left-to-right shunt though a ventricular septal defect (VSD), two patients had left ventricular outflow obstruction, two patients had mitral insufficiency, and one patient had mitral stenosis. Arterial perfusion was through the ascending aorta. Urine output was 6.0 +/- 1.5 cc/kg/hr during cardiopulmonary bypass. There was no morbidity related to cardiopulmonary bypass or inadequate perfusion of the lower body, and left ventricular failure did not occur. One patient with Taussig-Bing abnormality and pulmonary vascular disease died postoperatively of right ventricular failure. Intracardiac repair with aortic perfusion in the presence of coarctation is a safe alternative to coarctation repair or combined procedures.
(REFERENCE 23 OF 30) 81147029
Huhta JC Edwards WD Danielson GK Supravalvular mitral ridge containing the dominant left circumflex coronary artery.
In: J Thorac Cardiovasc Surg (1981 Apr) 81(4):577-9
ISSN: 0022-5223
A supravalvular mitral ridge containing the dominant left circumflex coronary artery was found at autopsy in a 2-month-old girl with atrial and ventricular septal defects. This ridge is compared to the classical supravalvular mitral ring, and surgical implications are discussed.
(REFERENCE 24 OF 30) 75215398
Khalil KG Shapiro I Kilman JW Congenital mitral stenosis.
In: J Thorac Cardiovasc Surg (1975 Jul) 70(1):40-5
ISSN: 0022-5223
This report presents a 15 year review of the surgical treatment of 9 patients with congenital mitral stenosis seen at the Columbus Children's Hospital. The over-all mortality rate was 45 per cent. Seven patients had associated lesions, mostly coarctation of the aorta and patent ductus arteriosus. In the planning of the operative procedure, distal obstructive lesions of the left heart should generally be relieved first. The mitral valve should be explored with the use of cardiopulmonary bypass and the anatomic type of the valve determined. Type I valves will often respond to open valvulotomy, whereas Type II and III valves must be replaced.
(REFERENCE 25 OF 30) 87285566
Westerman GR VanDevanter SH Norton JB Jr Readinger RI Congenital mitral valve stenosis in infancy: a different approach to a difficult problem.
In: J Thorac Cardiovasc Surg (1987 Aug) 94(2):305-7
ISSN: 0022-5223
Mitral valve replacement and bypass are high-risk operations in the infant with severe mitral stenosis. A palliative approach is presented that obviates the need for valve replacement in infancy.
(REFERENCE 26 OF 30) 94231828
Aharon AS Laks H Drinkwater DC Chugh R Gates RN Grant PW Permut LC Ardehali A Rudis E Early and late results of mitral valve repair in children.
In: J Thorac Cardiovasc Surg (1994 May) 107(5):1262-70; discussion 1270-1
ISSN: 0022-5223
Mitral valve repair in children has the advantage of avoiding mitral valve replacement with its attendant need for anticoagulation and reoperation. Seventy-nine children between the ages of 2 months and 17 years (mean 4.9 years) underwent mitral valve repair between May 1982 and April 1993. There were five patients with mitral stenosis and 74 patients with mitral regurgitation, and 19 children were less than 2 years of age. Patients were divided into anatomic subgroups on the basis of the primary cardiac pathologic condition. Forty-three had severe mitral regurgitation, 21 had moderate mitral regurgitation, and 12 patients with primum atrial-septal defect and 2 patients with univentricular hearts had minimal to moderate mitral regurgitation. Associated cardiac anomalies were present in 68 patients and 85% of the patients required concomitant intracardiac procedures. The methods of mitral valve repair included annuloplasty in 68 (86%), repair of cleft leaflet in 41 (52%), chordal shortening in 9 (11%), triangular leaflet resection in 8 (10%), splitting of papillary muscles with resection of subvalvular apparatus in 7 (9%), and chordal substitution in 1 (1%). The technique of annuloplasty was modified to allow for annular growth. Follow-up was available from 1 to 10 years (mean 4 +/- 2.5 years). There were three early deaths (4%), all occurring as a result of low output cardiac failure in patients with minimal postoperative mitral regurgitation. Three late deaths (4%) occurred in patients with persistent moderate to severe mitral regurgitation and progressive cardiac failure and eight patients (10%) required either rerepair or replacement of the mitral valve. Actuarial survival was 94% at 1 year, 84% at 2 years, and 82% at 5 years, and actuarial freedom from reoperation was 89% at 8 years. All patients received postoperative echocardiography with 82% having minimal to no mitral regurgitation and 98% of long-term surviving patients being free of symptoms. We conclude that mitral valve repair can be done with low early and late mortality. The need for reoperation is relatively low and valve growth has occurred with the use of a modified annuloplasty.
Institutional address: Division of Cardiothoracic Surgery University of California Los Angeles School of Medicine.
*****MAYO CLINIC PROCEEDINGS*****
(REFERENCE 27 OF 30) 76173053
Moodie DS Hagler DJ Ritter DG Cor triatriatum: echocardiograhic findings.
In: Mayo Clin Proc (1976 May) 51(5):289-95
ISSN: 0025-6196
The echocardiographic findings in a patient with cor triatriatum are presented. The preoperative echocardiogram demonstrated an unusual structure behind the mitral valve that moved anteriorly during atrial systole. There was also echocardiographic evidence of abnormalities of mitral valve motion, right ventricular and left atrial enlargement, and pulmonary hypertension. Postoperatively, the unusual echo behind the mitral valve had disappeared and the mitral valve appeared more normal. Left atrial and right ventricular dimension had decreased and the pulmonary valve appeared more normal. Fine diastolic mitral valve fluttering, an abnormal echo behind the anterior mitral valve leaflet moving anteriorly with atrial systole, an abnormal pulmonary valve echogram suggesting pulmonary hypertension, and marked right ventricular and left atrial enlargement were the main echocardiographic findings in our patient.
(REFERENCE 28 OF 30) 86309654
Reeder GS Currie PJ Hagler DJ Tajik AJ Seward JB Use of Doppler techniques (continuous-wave, pulsed-wave, and color flow imaging) in the noninvasive hemodynamic assessment of congenital heart disease.
In: Mayo Clin Proc (1986 Sep) 61(9):725-44
ISSN: 0025-6196
Doppler echocardiography is a relatively new technique that has become an integral part of the cardiovascular ultrasound examination. The hemodynamic information provided by the Doppler technique is complementary to the tomographic anatomy depicted by the two- dimensional examination and, in some patients, may obviate the need for cardiac catheterization. In this article, we focus on the role of Doppler echocardiography in the noninvasive diagnosis of congenital cardiac abnormalities.
*****POSTGRADUATE MEDICINE*****
(REFERENCE 29 OF 30) 84144558
Naggar CZ Two-dimensional echocardiography. Viewing the heart in motion.
In: Postgrad Med (1984 Feb 15) 75(3):68-70, 75-82
ISSN: 0032-5481
The accuracy and safety of two-dimensional echocardiography and the reproducibility of findings have led to its current prominence in the physician's diagnostic armamentarium. It has wide clinical applications, excelling in assessment of valvular heart disease, pericardial effusion, and intracavitary masses, such as vegetations and left ventricular clots. In addition, it is useful in differentiating types of cardiomyopathy and in evaluating global left ventricular systolic function. This article highlights the clinical applications of two-dimensional echocardiography, which is easily the most complete anatomic study of the beating heart.
*****PROGRESS IN CARDIOVASCULAR DISEASES*****
(REFERENCE 30 OF 30) 78158908
Williams RG LaCorte MA Echocardiographic evaluation of valvar and shunt lesions in children.
In: Prog Cardiovasc Dis (1978 May-Jun) 20(6):423-40
ISSN: 0033-0620
An evaluation of valvar and shunt lesions in children is directed toward appraising the need for, and timing of, surgical repair or palliation as well as demonstrating the cardiac anatomy which will, in turn, direct the type of surgery to be chosen. Static dimension measurements as well as dynamic measurements of wall velocity and time intervals are atraumatic and easily obtained values that increase our sensitivity to early cardiac decompensation. Contrast studies add both functional and anatomic information. Although one- dimensional time-motion scanning remains an invaluable source of anatomic detail, two-dimensional imaging has made positional information clearer and more reliable. The combined use of these three techniques offers the most complete evaluation of children with volume and pressure overload lesions.