ABSTRACT
The presence of cyanosis following repair of congenital cardiac defects may result from several different mechanisms. We report two patients in whom early postoperative arterial hypoxemia manifested by cyanosis was caused by right-to-left interatrial shunting. Two-dimensional contrast echocardiography correctly identified the site and direction of shunting, leading to surgical correction of the complication.
ABSTRACT
We studied 20 children with congenital heart disease using Echo-Phonocardiographic techniques to determine the presence and magnitude of pulmonary arterial hypertension. The results were compared with those obtained by catheterization. There was a significant correlation between the pulmonary arterial systolic pressure (PSP) estimated from the right ventricular isovolumetric relaxation period and the PSP from the catheterization (r = 0.92). The ratio preejection period /right ventricular ejection time (PEP/RVET) identified the patients (PEP/RVET greater than or equal to 0.30) with a PSP mean value = 64.5 mmHg (p less than 0.01). The presence of a systolic notch on the pulmonary valve echogram distinguished the group with a PSP mean value = 60 mmHg (p less than 0.005). There was a poor correlation between the depth of the "a" wave and the E-F slope of the pulmonary valve echogram and the catheterization PSP (r = -0.50 and r = -0.40, respectively). The interval PR from the electrocardiogram minus the distance AC from the tricuspid valve echogram had a poor correlation with the right ventricular end diastolic pressure (r = 0.57). We conclude that there are some Echo-Phonocardiographic signs which are very useful in the diagnosis and measurement of pulmonary arterial hypertension in children with congenital heart disease.
Subject(s)
Echocardiography , Heart Defects, Congenital/complications , Hypertension, Pulmonary/diagnosis , Phonocardiography , Adolescent , Cardiac Catheterization , Child , Child, Preschool , Female , Hemodynamics , Humans , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Infant , Infant, Newborn , MaleABSTRACT
Fourteen cases of coronary arteriovenous fistulae observed at the Instituto Nacional de Cardiología Ignacio Chávez were analyzed. The fistula originated from the right coronary artery in 57.1% of the cases, from the left coronary artery in 35.7% and from both coronary arteries in 7.2%. Drainage occurred into the right ventricle in 71.4% of the cases, into the right atrium in 7.2% and into the main pulmonary artery in 21.4%. The physical, roentgenological and electrocardiographic findings are undistinguishable from those usually obtained in malformations with a shunt between the aorta and the right heart or the pulmonary artery. Definite diagnosis is made at angiography. 2D and Doppler echocardiography may also be very useful. Natural history depends on the age of the patient, the size of the arteriovenous shunt, the presence of pulmonary hypertension and the development of complications. Even though malformations with small shunts may be well tolerated, serious complications are frequent and, thus, 14.3% of the patients developed infective endocarditis, 42.9% were in heart failure, 14.3% complained of angina pectoris and 54.5% had pulmonary hypertension. Mortality in this series was 28.6%. Early elective ligation seems to be the optimal treatment of coronary arteriovenous fistulae. The surgical procedure, however, is not devoid of risk. Thus, two of the three patients in this series who were operated upon after 1967 developed perioperative myocardial infarctions. Improvement in surgical technique should prevent this complication.
