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ABSTRACT: This paper describes a case of congenital aortic stenosis with eccentric left ventricular hypertrophy associated with hypothyroidism in a 1-year-old Bourdeaux Mastiff dog. The dog had ascites, apathy, alopecic and erythematous skin lesions in different parts of the body. A two-dimensional echocardiogram revealed aortic valve stenosis, with poststenotic dilation in the ascending aorta. The same exam showed eccentric hypertrophy and dilation of the left ventricle during systole and diastole. Aortic stenosis usually results in concentric left ventricular hypertrophy instead of eccentric hypertrophy; and therefore, this finding was very unusual. Hypothyroidism, which is uncommon in young dogs, may be incriminated as the cause of ventricular dilation, making this report even more interesting. Because hypothyroidism would only result in dilatation, the eccentric hypertrophy was attributed to pressure overload caused by aortic stenosis. Thus, cardiac alterations of this case represent a paradoxical association of both diseases.
RESUMO: Este trabalho descreve um caso de estenose aórtica congênita com hipertrofia excêntrica do ventrículo esquerdo associado ao hipotireoidismo em um cão Dogue de Bordeaux. O cão, de um ano de idade, apresentava ascite, apatia, lesões cutâneas alopécicas e eritematosas generalizadas. Na ecocardiografia bidimensional foi observada estenose da valva aórtica, com dilatação pós-estenótica em aorta ascendente. Foi detectado, no mesmo exame, hipertrofia excêntrica e dilatação do ventrículo esquerdo em sístole e diástole. Usualmente, como consequência, a estenose aórtica causa hipertrofia concêntrica do ventrículo esquerdo e não hipertrofia excêntrica, sendo este achado infrequente em tal cardiopatia. O hipotireoidismo, incomum em cães jovens, pode representar a causa da dilatação ventricular observada, o que torna mais relevante esse relato. Como no hipotireoidismo é esperado apenas dilatação, a hipertrofia excêntrica supostamente é atribuída à sobrecarga de pressão causada pela estenose aórtica. Dessa forma, as alterações cardíacas deste caso representam uma associação paradoxal das duas afecções.
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Objective Functional mitral regurgitation (FMR) refers to the systolic regurgitation of mitral valve secondary to compromised cardiac function or geometry abnormity with non-organic change of leaflets and ancillary parts of the valve.Severe aortic insufficiency (AI) with left ventricular dilation and dysfunction is clinically a complex heart disease and its postoperative complications and mortality are higher than usual valvular surgery.And such patients are often accompanied by FMR.It is generally acknowledged that FMR may improve after aortic valve replacement(AVR).This study follow up AI patients with left ventricular dilation and dysfunction and preoperative 2 + ＜ FMR≤3 + to evaluate the outcome of FMR after AVR.Preoperative clinical data is assessed by regression analysis.Methods From January 2000 to April 2011 our hospital treated 74 cases of patients with severe aortic regurgitation combined with left ventricular dilation (LVEDds ≥70 mm) and dysfunction (left ventricle ejection fraction,LVEF≤0.35) accompanied by 2 + ＜ FMR≤3 +.Postoperative follow-up was performed.Results The perioperative mortality rate was 8.1％.Average follow-up time was (14.9 ± 7.7) months and follow-up rate of 83.6％.5 patients died during follow-up.6 months after surgery,the average of FMR was (2.64 ± 1.17) (+),compared with preoperative data.LVEDd,LAD,CPMA,all P ＞ 0.05 compared with the preoperative data.LVEF,PAH,both P ＜ 0.05 compared with preoperative data.3.Multiple regression analysis:FMR pre/FMR post ratio is not correlated with age,gender,weight,LVEDd ≥ 75 mm,LVEF≤0.30,hypertension,ventricular arrhythmia and FMR postoperative improvement.However,PAH ≥ 50 mm Hg(1 mm Hg =0.133 kPa),LAD ≥ 50 mm,PAH≥50 mm Hg,CPMA ≥ 15mm,preoperative atrial fibrillation was negatively correlated with FMR postoperative improvement.Conclusion Severe AI with left ventricular dilation and dysfunction is a critical clinical heart disease and its postoperative complications and mortality are high.PAH ≥ 50 mm Hg,LAD ≥ 50 mm,PAH ≥ 50 nun Hg,CPMA ≥ 15mm,preoperative atrial fibrillation was negatively correlated with FMR postoperative improvement.Since patients with 2 + ＜ FMR ≤3 + usually do not improve or even worsen after AVR,those who have these above conditions preoperatively,should be treated on FMR during AVR.
ABSTRACT
Objective Functional mitral regurgitation (FMR) refers to the systolic regurgitation of mitral valve secondary to compromised cardiac function or geometry abnormity with non-organic change of leaflets and ancillary parts of the valve.Severe aortic insufficiency (AI) with left ventricular dilation and dysfunction is clinically a complex heart disease and its postoperative complications and mortality are higher than usual valvular surgery.And such patients are often accompanied by FMR.It is generally acknowledged that FMR may improve after aortic valve replacement (AVR).This study follow up AI patients with left ventricular dilation and dysfunction and preoperative 2 + ＜ FMR ≤3 + to evaluate the outcome of FMR after AVR.Preoperative clinical data is assessed by regression analysis.Methods From January 2000 to April 2011,74 cases of patients were treated,who with severe aortic regurgitation combined with left ventricular dilation (left ventricle,LVEDD ≥ 70 mm) and dysfunction (left ventricle ejection fraction,LVEF ≤ 0.35) accompanied by 2 + ＜ FMR ≤3 +.Postoperative follow-up was performed.Calculation FMR preoperative/FMR postoperative ratio,the age,sex,weight,high blood pressure,ventricular arrhythmia,atrium fibrillation,LVEDD,LVEF,left atrium diameter(LAD),pulmonary artery pressure (PAH),mitral leaflet coaptation point and the mitral annular(CPMA).All factors for logistic multiple faotors regression analysis.Results The perioperative mortality rate was 8.1％.Average follow-up time was (14.9 ± 7.7) months and follow-up rate of 83.6％.5 patients died during follow-up.6 months after surgery,the average of FMR was 2.64 ± 1.17 (+),P ＞0.05 compared with preoperative data.LVEDD,LAD,CPMA,P ＞0.05 compared with the preoperative data.LVEF,PAH,both P ＜0.05 compared with preoperative data.3.Multiple regression analysis:FMR preoperative/FMR postoperative ratio is not correlated with age,gender,weight,LVEDD ≥75 mm,LVEF≤0.30,hypertension,ventricular arrhythmia and FMR postoperative improvement.However,PAH ≥50 mm Hg,LAD ≥50 mm,PAH ≥50 mm Hg,CPMA ≥ 15 mm,preoperative atrial fibrillation was negatively correlated with FMR postoperative improvement.Conclusion Severe AI with left ventricular dilation and dysfunction is a critical clinical heart disease and its postoperative complications and mortality were high.PAH ≥50 mm Hg,LAD ≥50 mm,PAH ≥50 mm Hg,CPMA ≥15 mm,preoperative atrial fibrillation was negatively correlated with FMR postoperative improvement.Since patients with 2 + ＜ FMR≤3 + usually do not improve or even worsen after AVR,those who have these above conditions preoperatively,should be treated on FMR during AVR.
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Lissencephaly is a rare disorder that is characterized by the disorganized and unlayered cortex. The cause of this disorder is related to chromosomal abnormalities or infection. The pathogenesis of lissencephaly is faulty migration of neuroblast. Lissencephaly is associated with Dandy-Walker syndrome and Miller-Dieker syndrome. A woman at 35 weeks of gestaion was transferred to our hospital due to abnormal antenatal sonographic findings (ventricular dilation and decreased sulci in cerebral cortex after 31 weeks of gestation). The antenatal studies showed none-specific findings. The infant was diagnosed lissencephaly by postnatal MRI evaluation and showed normal karyotype. We report the prenatal diagnosis of lissencephaly case with a literature.
Subject(s)
Female , Humans , Infant , Cerebral Cortex , Chromosome Aberrations , Classical Lissencephalies and Subcortical Band Heterotopias , Dandy-Walker Syndrome , Karyotype , Lissencephaly , Magnetic Resonance Imaging , Prenatal Diagnosis , UltrasonographyABSTRACT
The authors reviewed medical records of 219 patients who were admitted due to the hypertensive intracerebral hemorrhage(HICH) between January 1993 and December 1994. The relationship between the patient's age and sex, Glasgow Coma Scale(GCS) on the admission, location and volume of intracerebral hematoma, Graeb score, ventriculocranial ratio(VCR) and the maximum transverse diameter of fourth ventricle were analyzed. The neurological outcome for survivors was determined two years after admission. Forty normal brain scans were obtained to determine the normal range of VCR and the maximum transverse diameter of fourth ventricle. From reviewing the cases, the authors found; the most common age group of HICH was 7th and 8th decades with slight male preponderance(1:0.75); VCR of the lateral ventricle and maximum transverse diameter of the 4th ventricle were 0.16 and 1.14 cm in 40 normal brain scans, respectively; basal ganglia(42%) and thalamus(29.2%) were the most common sites of HICH hemorrhage in 219 patients followed by subcortex(13.7%), pons(7.3%) and cerebellum(4.6%); the fourth ventricular dilation(>1.35cm in diameter) and increased VCR(>0.24) were the most significant predictors for poor outcome.