ABSTRACT
Ten patients with coronary artery fistulae were identified from records at Columbus Children's Hospital between 1974 and 1993. Clinical presentations of patients were quite variable, from 1 day to 20 years of age. Symptoms ranged from none to severe cardiorespiratory failure requiring extracorporeal membrane oxygenation. Long term follow-up revealed one sudden death and one spontaneous closure of the fistula. This lesion should be ruled out in patients who present as extracorporeal membrane oxygenation candidates. Patients with mild forms of this lesion may be followed up medically if the left to right shunt is inconsequential, because spontaneous closure is a possibility. Because of the risk of sudden death, close long-term follow-up is mandatory even for operated patients, and antiplatelet therapy should be considered for these patients.
Subject(s)
Coronary Vessel Anomalies/therapy , Fistula/therapy , Heart Atria , Heart Ventricles , Pulmonary Artery , Adult , Arterio-Arterial Fistula/diagnosis , Arterio-Arterial Fistula/therapy , Cardiopulmonary Bypass , Catheter Ablation , Child, Preschool , Combined Modality Therapy , Constriction , Coronary Vessel Anomalies/diagnosis , Extracorporeal Membrane Oxygenation , Female , Fistula/diagnosis , Follow-Up Studies , Heart Diseases/diagnosis , Heart Diseases/therapy , Humans , Infant , Infant, Newborn , Ligation , Male , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Risk Factors , Severity of Illness Index , Suture Techniques , Time FactorsABSTRACT
Current practice patterns relating to pediatric cardiac catheterization (Cath) have considerable economic implications. The decreased cost and risk of noninvasive methods such as echocardiography (ECHO) and magnetic resonance imaging (MRI) make them attractive alternative diagnostic methods if they can sufficiently define cardiac anatomy and the need for surgical intervention. We reviewed a recent cardiac surgical series of 465 cases in 1.5 years to determine how often a Cath was performed prior to surgery. Overall, 59.4% of the procedures were preceded by a Cath (76% of open heart operations, and 26.7% of closed heart operations). We specify the situations where we feel enough information is available for preoperative decision making from non-invasive testing, and we present some diagnostic pitfalls that have been encountered.
Subject(s)
Cardiac Catheterization/statistics & numerical data , Cardiac Surgical Procedures/statistics & numerical data , Heart Defects, Congenital/surgery , Child , Echocardiography, Doppler/statistics & numerical data , Heart Defects, Congenital/diagnosis , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging/statistics & numerical data , Retrospective StudiesABSTRACT
Surgical procedures for aortic valve stenosis may be considered either corrective or palliative. During a 22-year period from 1962 to 1984, 120 patients required operation for aortic valve stenosis. The operations done included 117 valvotomies and three initial valve replacements. Six patients, five infants and a 7-year-old girl, died at operation. The remaining 114 patients were followed up for 1 to 23 years (mean 8.7 years). Twenty-six patients (23%) required a second operation 1 to 15 years (mean 6.8 years) after initial valvotomy. Six patients (5%) required a third operation 3 months to 8 years (mean 4.4 years) after the second operation. Eighteen of the 26 patients (69%) having second operations required valve replacement. All third operations were valve replacements. No perioperative deaths occurred at the second and third operations. There were four sudden late deaths (3.5%). Eighty-four of the 114 patients (74%) followed up for 1 to 23 years (mean 7.7 years) have had a satisfactory result from initial valvotomy, being free of symptoms and major events (stroke, endocarditis, sudden death), and have not required reoperation. Fifty-nine percent of a subgroup of 22 patients followed up for a mean of 17.7 years have had a satisfactory result from initial valvotomy.
Subject(s)
Aortic Valve Stenosis/surgery , Adolescent , Adult , Aortic Valve Stenosis/mortality , Child , Child, Preschool , Death, Sudden/etiology , Female , Humans , Infant , Male , ReoperationABSTRACT
Rheumatic fever has been disappearing in the United States, especially during the past two decades. In the past two years, however, there have been 40 patients seen at the Columbus (Ohio) Children's Hospital diagnosed as having acute rheumatic fever. In marked contrast to the infrequency during the preceding ten years. Twenty of the 40 patients had carditis. Five of these patients were suffering from heart failure, and there was one death. The cause for this outbreak has not yet been found, but some possible causes are discussed. A possible nationwide resurgence of this disease may be heralded by our experience and that of others.
Subject(s)
Disease Outbreaks , Rheumatic Fever/epidemiology , Acute Disease , Adolescent , Child , Child, Preschool , Female , Humans , Male , Myocarditis/epidemiology , Ohio , Pharyngitis/complications , Rheumatic Fever/etiology , Rheumatic Heart Disease/epidemiology , Streptococcal InfectionsABSTRACT
An air gun pellet cardiac injury, in which there was penetration through the right ventricle, interventricular septum, and anterior papillary muscle and ejection from the left ventricle, is described. The pellet embolus was removed from the left popliteal artery with restoration of flow. The particular implications of pellet embolization are discussed and contrasted with those of bullet embolism.
Subject(s)
Foreign Bodies/diagnostic imaging , Heart Injuries/etiology , Popliteal Artery , Wounds, Gunshot/etiology , Child , Heart Ventricles/injuries , Humans , Male , Papillary Muscles/injuries , RadiographyABSTRACT
A simplified method for managing chylothorax in neonates and infants is presented. Use of an elemental diet markedly reduces the volume of the chyle leak while supporting total caloric intake. Either prolonged drainage or reexploration often can be avoided by the use of the described regimen.
