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Clinical data of 23 children with atrial septal defect and pulmonary valvular stenosis admitted in Dalian Children′s Hospital during March 2015 to March 2018 were retrospectively analyzed. Twenty patients were treated with percutaneous closure of atrial septal defect through femoral vein first, then transthoracic echocardiography-guided balloon pulmonary valvuloplasty was performed; while 3 patients had no balloon pulmonary valvuloplasty after percutaneous closure of atrial septal defect. Patients were followed up by transthoracic echocardiography and all were doing well. The transvalvular pressure fell under 35 mmHg (1 mmHg=0.133 kPa) [(19.5±1.9)mmHg] in all patients, which was significantly lower than that before treatment [(62.0±7.8 mmHg)] (t=28.92, P<0.01). During follow-up, no residual shunt of atrial septal defect was found; and mild pulmonary regurgitation occurred in 3 cases. The study indicates that combined percutaneous treatment with transthoracic echocardiography guidance is effective and safe for children with atrial septal defect and pulmonary valvular stenosis. The pulmonary artery stenosis of some patients can be alleviated, after closuring of the atrial septal defect.
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Abstract Objective: To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. Methods: We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). Results: VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). Conclusion: Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.
Subject(s)
Humans , Male , Female , Pregnancy , Infant , Postoperative Complications/etiology , Wound Closure Techniques/adverse effects , Heart Septal Defects, Ventricular/surgery , Time Factors , Body Weight , Cardiopulmonary Bypass/methods , Retrospective Studies , Risk Factors , Age Factors , Statistics, Nonparametric , Intensive Care Units , Length of StayABSTRACT
Objective@#To explore the relationship between the expression of serum B-type natriuretic peptide(BNP) levels and cardiac function, heart failure(HF) in children with ventricular septal defect of congenital heart disease(CHD).@*Methods@#From October 2013 to July 2017, 150 children with ventricular septal defect of CHD who were treated in Yuncheng Central Hospital were selected, and they were divided into no HF group(n=40), mild HF group(n=46) and moderately severe HF group(n=64) according to the New York university pediatric heart failure index(NYU PHFI) evaluation standard.Meanwhile, 148 healthy children were selected as control group.The serum BNP levels, left ventricular ejection fraction(LVEF), left ventricular ejection fraction shortening rate(LVFS), left ventricular end diastolic diameter index(LVEDDI) and cardiac output index(CI) were measured in all subjects.The levels of BNP, LVFS, LVEF, LVEDDI and CI in the study group were compared with those in the control group.The levels of BNP, LVEF, LVFS, LVEDDI and CI in children with CHD ventricular septal defect were compared.The relationship between the level of BNP and LVEF, LVFS, LVEDDI and CI in patients with ventricular septal defect of CHD was analyzed.@*Results@#The serum level of BNP in the study group was (268.47±25.48)ng/L, the levels of LVEF, LVFS, LVEDDI and CI in the study group were (55.56±4.23)%, (27.96±2.74)%, (77.56±6.54)mm/m2, (3.35±0.41)L·min-1·(m2)-1, respectively.The serum level of BNP in the control group was (33.41±6.21)ng/L, and the levels of LVEF, LVFS, LVEDDI and CI in the control group were (65.43±5.12)%, (36.24±3.23)%, (57.32±5.31)mm/m2, (4.27±0.46)L·min-1·(m2)-1, respectively.The serum levels of BNP and LVEDDI in the study group were significantly higher than those in the control group(t=109.077, 29.306, all P<0.05), while the levels of LVEF, LVFS and CI in the study group were significantly lower than those in the control group(t=18.152, 23.875, 18.231, all P<0.05). With the increased severity of HF, the levels of BNP and LVEDDI were increased, while the levels of LVEF, LVFS and CI were gradually decreased(F=332.232, 245.400, all P<0.05). The level of serum BNP was negatively correlated with LVEF, LVFS, CI(r=-0.705, -0.692, -0.718, all P<0.05), but it was positively correlated with LVEDDI and HF(r=0.721, 0.735, all P<0.05).@*Conclusion@#The level of serum BNP in patients with ventricular septal defect of CHD is correlated with cardiac function indicators, and serum BNP is positively correlated with HF in children with ventricular septal defect of CHD, which plays an important role for the diagnosis, treatment and prognosis of HF.
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Objective To explore the relationship between the expression of serum B －type natriuretic peptide(BNP) levels and cardiac function,heart failure(HF) in children with ventricular septal defect of congenital heart disease(CHD).Methods From October 2013 to July 2017,150 children with ventricular septal defect of CHD who were treated in Yuncheng Central Hospital were selected ,and they were divided into no HF group (n＝40),mild HF group(n＝46) and moderately severe HF group ( n＝64) according to the New York university pediatric heart failure index(NYU PHFI) evaluation standard.Meanwhile,148 healthy children were selected as control group.The serum BNP levels,left ventricular ejection fraction (LVEF),left ventricular ejection fraction shortening rate (LVFS), left ventricular end diastolic diameter index (LVEDDI) and cardiac output index (CI) were measured in all subjects. The levels of BNP,LVFS,LVEF,LVEDDI and CI in the study group were compared with those in the control group. The levels of BNP,LVEF,LVFS,LVEDDI and CI in children with CHD ventricular septal defect were compared.The relationship between the level of BNP and LVEF ,LVFS,LVEDDI and CI in patients with ventricular septal defect of CHD was analyzed.Results The serum level of BNP in the study group was (268.47 ±25.48) ng／L,the levels of LVEF,LVFS,LVEDDI and CI in the study group were (55.56 ±4.23)%,(27.96 ±2.74)%,(77.56 ±6.54)mm／m2, (3.35 ±0.41) L· min－1·( m2 )－1 ,respectively.The serum level of BNP in the control group was (33.41 ± 6.21)ng／L,and the levels of LVEF,LVFS,LVEDDI and CI in the control group were (65.43 ±5.12)%,(36.24 ± 3.23)%,(57.32 ±5.31) mm／m2 ,(4.27 ±0.46)L· min－1·(m2 )－1 ,respectively.The serum levels of BNP and LVEDDI in the study group were significantly higher than those in the control group (t＝109.077,29.306,all P＜0.05),while the levels of LVEF,LVFS and CI in the study group were significantly lower than those in the control group(t＝18.152,23.875,18.231,all P＜0.05).With the increased severity of HF ,the levels of BNP and LVEDDI were increased,while the levels of LVEF,LVFS and CI were gradually decreased ( F＝332.232,245.400,all P＜0.05).The level of serum BNP was negatively correlated with LVEF ,LVFS,CI(r＝－0.705,－0.692,－0.718,all P＜0.05),but it was positively correlated with LVEDDI and HF (r＝0.721,0.735,all P＜0.05).Conclusion The level of serum BNP in patients with ventricular septal defect of CHD is correlated with cardiac function indicators ,and serum BNP is positively correlated with HF in children with ventricular septal defect of CHD ,which plays an important role for the diagnosis,treatment and prognosis of HF.
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Objective To analyze the echocardiographic findings , associated anomalies and chromosomal characteristics in fetuses with pulmonary atresia with ventricular septal defect ( PA/VSD ) . Methods T he echocardiographic data and follow‐up materials were retrospectively reviewed in 30 256 fetuses from December 2012 to M arch 2018 in the consultation center of fetal heart disease in maternal‐fetal medicine in Anzhen hospital . Of all the fetuses ,59 cases ( 0 .19% ) had PA/VSD . T he echocardiographic findings ,associated anomalies and chromosomal characteristics were retrospectively analyzed in all the 59 fetuses with PA/VSD . Based on w hether the presence of the native pulmonary arteries and the major aortopulmonary collateral arteries ( M APCAs) or not ,the PA‐VSD was classified into type A ,type B ,and type C . Results A large ventricular defect was demonstrated in five‐chamber view with 61 .7% of the mean ratio of the aortic overriding . O ther fetal echocardiographic features of all the 59 fetuses with PA/VSD included :the right aortic arch ( n ＝19 ) ,reversal flow in the ductus arteriosus ( n ＝40 ) ,M APCAs ( n ＝24) . T he classification of the PA/VSD included :type A ( n ＝35) ,type B ( n ＝5) and type C ( n ＝19) . Associated anomalies :persistent left superior vena cava ( n ＝ 13 ) ,anomalous pulmonary vein connection ( n＝5 ) ,complete atrioventricular septal defect ( n ＝ 5 ) ; single umbilical artery ( n ＝ 3 ) ,right atrial isomerism ( n ＝3) . Of all the 30 cases performed chromosomal test ,3 cases had aneuploidy and 7 cases had microdeletion of chromosome . Conclusions The fetal echocardiographic findings of the PA/VSD are characteristic . For prenatal diagnosis of PA/VSD ,the type of PA/VSD should be defined and chromosomal test should be performed ,w hich can be helpful for prenatal consulting .
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Objective To investigate the value of three-dimensional speckle tracking imaging (3D-STI) in quantitative evaluation of left ventricular global strain in patients with atrial septal defect (ASD) before and after transcatheter closure.Methods Totally 35 patients with secondary ASD who received successful transcatheter occlusion were selected.Routine echocardiography and 3D-STI examination were performed before the operation,2 days,1 month,3 months and 6 months after the operation.Routine echocardiography was used to obtain the parameters of left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVEDS),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),stroke volume (SV) and other parameters.The left ventricular global peak longitudinal strain (GPLS),left ventricular global peak circumferential strain (GPCS),left ventricular global peak radial strain (GPRS) and left ventricular global peak area strain (GPAS) were examined with 3D-STI.The preoperative and postoperative parameters at each time point were analyzed statistically.Results Routine echocardiography showed that LVEDD,LVEDS,LVEDV,LVESV and SV increased significantly after operation,but no significant difference was found to compare each other 2 days,1 month,3 months and 6 months after operation (all P＞0.05).3D-STI examination showed that left ventricular GPLS,GPCS,GPRS and GPAS increased after operation,and the most increase was noticed at the second day after transcatheter occlusion.GPLS,GPCS and GPAS 6 months after operation were larger than those 3 months after operation (all P＞0.05).Conclusion 3D-STI technique can evaluate the left ventricular global strain in patients with ASD before and after occlusion.Compared with conventional echocardiography,3D-STI technique can objectively and effectively evaluate the changes of left ventricular systolic function.
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Objective To assess the brain development of newborns with cardiac septal defects by MRI.Methods The brain MR images of 150 newborns with cardiac septal defects and 50 normal newborns were analyzed retrospectively.We evaluated the brain development by measuring the four indices of lateral ventricle:anterior horn index (F/F'),body index (D/D'),caudate nucleus index (C/C')and Evans index.Independent samples t test was used to compare the differences between the two groups,and the possible positive diagnostic cut-off points were calculated by using the nonparametric ROC analysis.Results There were no significant differences between the congenital heart disease group and the control group in the two indices:F/F'[(0.301±0.035)vs (0.296±0.031);t=1.035,P>0.05]and Evans index [(0.239±0.052)vs (0.233±0.025);t=0.778,P>0.05].The values of D/D'[(0.261±0.039)vs (0.234±0.032);t=3.873,P<0.05)] and C/C'[(0.138±0.018)vs (0.124±0.015);t=4.479,P<0.05]were significantly higher in the congenital heart disease group than in the control group.In the congenial heart disease group,the area under the ROC curve obtained by D/D'and C/C'were 0.698 and 0.750,respectively.The maximum Yuedeng index corresponding to the D/D'value and the C/C'value were 0.28 and 0.12,respectively. Conclusion The body index(D/D')and the caudate nucleus index(C/C')are sensitive to evaluate the differences of the brain volume between the newborns with cardiac septal defects and the normal newborns.It is helpful to find the abnormal brain volume when the value of D/D'is greater than 0.28 and the value of C/C'is greater than 0.12.
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Resumen La ruptura del septum ventricular (RSV) es una complicación mecánica infrecuente del infarto agudo de miocardio (IAM). Los principales factores de riesgo descritos son la edad avanzada, el género femenino, un primer episodio de IAM y la presencia de enfermedad coronaria. Se sospecha de esta patología cuando clínicamente se evidencia un deterioro inexplicable del estado hemodinámico posterior al infarto. Los estudios imagenológicos (ecocardiograma y Doppler color) ayudan a confirmar el diagnóstico de RSV. Respecto al manejo, la corrección quirúrgica continúa siendo el pilar del tratamiento, ya que posee menor mortalidad en comparación con el abordaje médico no quirúrgico. Se presentan dos casos de ruptura del septum ventricular; el primero corresponde a una paciente femenina adulta mayor, con múltiples comorbilidades, quien desarrolló un síndrome coronario agudo tipo infarto agudo de miocardio con elevación del segmento ST a nivel anteroseptal. Se le realizó angioplastia primaria con evidencia de ruptura del septum ventricular, que fue corregida mediante cirugía de forma temprana. Pasadas veinticuatro horas, presentó ruptura de la pared libre del ventrículo izquierdo, hecho que precipitó su deceso. El segundo caso es una paciente femenina adulta mayor, quien presentó síndrome coronario agudo tipo infarto agudo de miocardio sin elevación del ST en cara lateral. Siete días después se documentó la existencia de la ruptura del septum ventricular, la cual fue corregida de manera tardía, en el día octavo, sin complicaciones asociadas.
Abstract Ventricular septal rupture (VSR) is a rare mechanical complication of acute myocardial infarction (AMI). The main risk factors described are advanced age, female gender, a first episode of AMI and presence of coronary disease. There is suspicion for this condition when clinical evidence shows unexplained deterioration of hemodynamic status following infarction. Imaging studies (echocardiogram and colour Doppler) help confirm the diagnosis of ventricular septal rupture. Regarding management, surgical correction continues to be the mainstay of treatment, as it poses lower mortality in comparison to nonsurgical medical approach. Two cases of VSR are presented, the first one is a female adult patient with multiple comorbidities who developed an acute coronary syndrome of a acute myocardial infarction with an anteroseptal ST segment elevation. Primary angioplasty was performed that evidenced ventricular septal rupture, which was surgically corrected at an early stage. After 24 hours, patient showed left ventricular free wall rupture, which precipitated her death. Second case is a female old patient who presented acute acute coronary syndrome of a acute myocardial infarction without lateral ST segment elevation. Seven days later a ventricular septal rupture was documented, which was corrected at a later stage on the eighth day without associated complications.
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Humans , Female , Middle Aged , Aged , Heart Septal Defects, Ventricular , Myocardial Infarction , Risk Factors , DiagnosisABSTRACT
Objective To evaluate the accuracy of three-dimensional printing atrial septal defect (ASD)models from three dimensional transesophageal echocardiography(3D-TEE)images and to lay the foundation for the application of 3D printing technology in the diagnosis and treatment of ASD.Methods Twenty patients with ASD were analyzed retrospectively.2D-TEE and 3D-TEE were performed before ASD occlusion.The 3D-TEE data were post-processed by Mimics software and the volume images of ASD in STL format were developed.Then the STL file was output and the ASD 3D models were printed.The ASD size parameters included the maximal diameter(Dmax),the minimal diameter(Dmin),circumference(C)and area(A),which were measured from 2D-TEE images,3D-TEE images and 3D printing models,respectively. The absolute difference value of ASD size parameters between 3D printing models and 2D-TEE images,or 3D-TEE images were calculated.The sizes of occluder were recorded during the operation and the preoperative exercises on 3D printing models were performed.Results There were no significant difference in ASD size parameters among 3D printing models,2D-TEE and 3D-TEE images(all P > 0.05),the ASD size parameters were concordant well between 3D printing models and 2D-TEE or 3D-TEE images. Moreover,the absolute difference value of ASD size parameters between 3D printing models and 2D-TEE or 3D-TEE images were little.In addition,linear regression analysis revealed a significant correlation in the Dmaxmeasured from 3D printing models and the sizes of occulder used in the operation(r =0.94,P <0.05).In the ASD 3D printing models the preoperative exercise had an impressive effect.Conclusions It is quite feasible to use 3D-TEE images as the data source of ASD 3D printing models.Ultrasound-derived ASD 3D printing models are of highly accuracy,which have the potential to provide evidence for the clinical application of 3D printing technology.
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Objective To investigate the differences between prenatal and postnatal ultrasound findings in isolated ventricular septal defects.Methods Totally 244 cases of isolated ventricular septal defect were retrospectively analyzed and followed in one year after birth.All fetus were divided into the correct group and the error group according to the postnatal results.The size and type of ventricular septal defect and ventricular shunt were assessed and analyzed statistically.Results In all of the 244 cases,correct group included 181 cases and error group included 63 cases.There was no significant difference in the type of defects between two groups (P=0.061);there were significant differences in the size of postpartum defect and the velocity of ventricular shunt between the two groups (both P＜0.05),and no significant difference of the direction of shunt between two groups (P=0.408);there were significant differences in the size of defects between the prenatal and postnatal in correct groups (P＜0.05),but the direction of shunt had no significant difference (P=0.087).Conclusion There is certain detection rate in prenatal diagnosis of isolated ventricular septal defect;anatomical characteristics of defect may affect antenatal examination results.There was significant difference between prenatal and postnatal ultrasound in the same lesion.
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Objective To compare the clinical effects of totally thoracoscopic surgery and conventional median thoracoto my surgery in the repair of atrial septal defect(ASD),so as to provide reference for the clinical choice of atrial septal defect repair.Methods 131 patients with ASD from January 2015 to November 2016 in the First Affiliated Hospital of Xinjiang Medical University were divided into two groups according to operation type:totally thoracoscopic group(58 cases),median thoracotomy group.The differences in operative time,cardiopulmonary bypass time(CPB),ventilator assist time,ICU stay time,postoperative hospital stay and other aspects were compared.Results There was no death and no serious complication in the two groups.There was no statistical difference between the two groups (P ＞ 0.05) in sex,weight,age,right atrial size and cardiac function.The time of thoracoscopic surgery [(3.6 ± 1.0) h vs.(2.6 ± 0.6) h] and the duration of CPB [(98.3 ± 35.8)min vs.(32.3 ± 16.1) min] were longer than those of median thoracotomy group (P ＜ 0.05).There was no statistical difference between two groups in the time of mechanical ventilation,ICU stay,postoperative drainage and postoperative hospital stay (P ＞ 0.05).Conclusion Although ASD repair of thoracoscopic surgery is difficult and the learning curve is long,but it can be said that the totally thoracoscopic ASD repair can achieve the same results as conventional median thoracotomy does,and it is effective and safe,and thoracoscopic surgery also has less trauma and cosmetic appearance,no bone structure damage,worthy of clinical promotion.
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Percutaneous closure of atrial septal defect (ASD) has become an increasingly common procedure. Serious complications of the procedure, such as cardiac migration, are rare, and usually occur <72 hours after device placement. In this report, we present the case of a patient who underwent successful surgical treatment for the migration of an ASD occluder device to the thoracic aorta 12 months after ASD closure.
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Humans , Aorta, Thoracic , Foreign-Body Migration , Heart Septal Defects, Atrial , Septal Occluder DeviceABSTRACT
We report the case of a rare association of a congenital Gerbode defect with severe mitral regurgitation due to abnormal linear structure of mitral valve, diagnosed in an adult patient. The case highlights the importance of a thorough examination interpreting the echocardiographic findings on a pathophysiological basis. It also underlines the complementary role of different imaging techniques with transesophageal echocardiography, allowing the precise assessment of both structural and functional abnormalities in such a complex case. The patient underwent mitral valve replacement with a bileaflet mechanical prosthesis and repair of the Gerbode defect. The imaging findings were confirmed during the surgical procedure, leading to a good outcome.
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Adult , Humans , Echocardiography , Echocardiography, Transesophageal , Heart Septal Defects , Mitral Valve Insufficiency , Mitral Valve , Prostheses and ImplantsABSTRACT
Objective: To explore the effect of three-dimensional echocardiography (RT-3DE) for evaluating right atrial function in patients after atrial septal defect (ASD) closure. Methods: Our research included 2 group: ASD group,n=50 patients with successful ASD closure and Control group, n=30 normal subjects from physical examination. RT-3DE was conducted at pre-operation and at 3 days, 1 month, 3 months post-operation; the volume of right atrium before contraction (Vpre), minimum volume of the right atrium (Vmin), maximum volume of the right atrium (Vmax), total emptying volume of right atrium (Vt), total emptying volume fraction of right atrium (Ft), active emptying volume fraction (Fa) and passive emptying volume fraction (Fp) were measured and compared between 2 groups at pre- and post-operation respectively. Results: At pre-operation, compared with Control group, ASD group had increased Vmax, Vmin, Vpre, Vt, and Fa, while decreased Ft and Fp, allP0.05. Conclusion: ADS patients had abnormal volume and function in right atrium, the abnormalities could be improved at 3 days after ASD closure and could be recovered to normal level at 3 months after operation. RT-3DE has the important role for evaluating right atrial volume and function in patients after ASD closure.
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PURPOSE: A recent study analyzing several cytokines reported that long cardiopulmonary bypass (CPB) time and long aortic cross clamp (ACC) time were accompanied by enhanced postoperative inflammation, which contrasted with the modest influence of the degree of hypothermia. In this present study, we aimed to examine the effect of CPB temperature on the clinical outcome in infants undergoing repair of isolated ventricular septal defect (VSD). METHODS: Of the 212 infants with isolated VSD who underwent open heart surgery (OHS) between January 2001 and December 2010, 43 infants were enrolled. They were classified into 2 groups: group 1, infants undergoing hypothermic CPB (26degrees C-28degrees C; n=19) and group 2, infants undergoing near-normothermic CPB (34degrees C-36degrees C; n=24). RESULTS: The age at the time of the OHS, and number of infants aged<3 months showed no significant differences between the groups. The CPB time and ACC time in group 1 were longer than those in group 2 (88 minutes vs. 59 minutes, P=0.002, and 54 minutes vs. 37 minutes, P=0.006 respectively). The duration of postoperative mechanical ventilation was 1.6 days in group 1 and 1.8 days in group 2. None of the infants showed postoperative neurological and developmental abnormalities. Moreover, no postoperative differences in the white blood cell count and C-reactive protein levels were noted between two groups. CONCLUSION: This study revealed that hypothermic and near-normothermic CPB were associated with similar clinical outcomes and inflammatory reactions in neonates and infants treated for simple congenital heart disease.
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Humans , Infant , Infant, Newborn , C-Reactive Protein , Cardiopulmonary Bypass , Cytokines , Heart Defects, Congenital , Heart Septal Defects, Ventricular , Hypothermia , Inflammation , Leukocyte Count , Respiration, Artificial , Thoracic SurgeryABSTRACT
Congenital extrahepatic portocaval shunt (CEPS) is a rare anomaly of the mesenteric vasculature in which the intestinal and splenic venous drainage bypasses the liver and drains directly into the inferior vena cava, the left hepatic vein or the left renal vein. This uncommon disease is frequently associated with other malformations and mainly affects females. Here we report a case of pulmonary arterial hypertension associated with CEPS (Abernethy type 1b shunt) in a 20-yr-old man who was incidentally diagnosed during evaluation of multiple nodules of the liver. The patient was treated by inhalation of iloprost (40 microg/day) with improved condition and walking test. Physicians should note that congenital portocaval shunt may cause pulmonary hypertension.
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Humans , Male , Young Adult , Echocardiography, Doppler , Hypertension, Pulmonary/diagnosis , Iloprost/therapeutic use , Liver/blood supply , Magnetic Resonance Imaging , Thoracic Arteries/diagnostic imaging , Tomography, X-Ray Computed , Vasodilator Agents/therapeutic use , Vena Cava, Inferior/abnormalitiesABSTRACT
Objective To evaluate right ventricular (RV) global and regional volume and systolic function in patients with secondum atrial septal defect (ASD) using real-time three-dimensional echocardiography (RT3DE),and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.Methods RT3DE images were acquired from 22 patients with secundum ASD and 22 normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV),end systolic volume (ESV),systolic volume (SV) and ejection fraction (EF) in three compartments (inflow,body and outflow).RV dyssynehrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv％) in three RV compartments.Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP),pulmonary vascular resistance (PVRe) and maximum diameter of ASD (ASD-D) were calculated and recorded.Results RV global and regional EDV,ESV and SV were larger (all P ＜0.001) and EF was lower (all P ＜0.05) in the ASD group than in the controls.RV regional volume and systolic function were changed to various degrees in different compartment in the patients group.There were no significant differences in Tmsv,Tmsv％ and RV dyssynchrony parameters between the two groups.In patients with ASD,RV global and regional EDV,ESV and SV in the inflow compartment were positively correlated with ASD-D and PASP (r =0.463-0.704,all P ＜ 0.05) ; RV global EF was negatively correlated with PVRe (r =-0.477,P ＜ 0.05).Conclusions In patients with ASD,RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global volume and regional volume in the inflow compartment were positively correlated with RV pre-load while RV global EF was negatively correlated with RV afterload.
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The Gerbode shunt, known as the left ventricle to the right atrial communication, is a rather rare finding, following surgical closure of septal defects. Even though the surgical closure is accepted as a treatment of choice, we report a successful percutaneous transcatheter closure of the Gerbode shunt in a 3-months old baby who weighed 3 kilograms.
Subject(s)
Humans , Heart Septal Defects , Heart Ventricles , Septal Occluder DeviceABSTRACT
Cardiac surgery in neonates with congenital heart disease has progressed dramatically in the past three decades. However, low-birth-weight neonates with congenital heart disease continue to challenge the intellectual and technical skills of healthcare professionals. We present a case of a low-birth-weight neonate with pulmonary atresia and a ventricular septal defect, in whom palliation was achieved with a right ventricular outflow tract stent using a hybrid procedure.
Subject(s)
Humans , Infant, Newborn , Chimera , Delivery of Health Care , Heart Diseases , Heart Septal Defects , Heart Septal Defects, Ventricular , Infant, Low Birth Weight , Pulmonary Atresia , Stents , Thoracic SurgeryABSTRACT
Objective To study the relationship of the antepartum foramen ovale (FO),the ratios of foramen ovale and aorta (FO/AO) and postpartum ostium secundum atrial septal defect (ASD).Methods Nine hundred fifty-eight fetuses were divided into 5 groups by gestational age,18-22 weeks,23-26 weeks,27-30 weeks,31-34 weeks,35-40 weeks.The diameter of FO and aortic (AO) and FO/AO were measured by fetal echocardiography,the postpartum echocardiography were followed up more than 12 months after birth.ANOVA was used to compare FO,AO,FO/AO with different gestational age.Regression equation estimate was used to compare the relationship of FO and AO with gestational age.Independent sample T test was used to compare FO and FO/AO with postpartum ostium secundum ASD and postpartum normal heart.Results There was significant difference in FO and AO among 5 groups(P =0.000),FO and AO increased with increasing gestational age.There was significant difference in antepartum FO,FO/AO between postpartum ostium secundum ASD and postpartum normal heart (P =0.000).Conclusions Antepartum FO and FO/AO provide clinical value in observing postpartum ostium secundum ASD.