ABSTRACT
INTRODUCTION: The anatomic diversity of the coronary artery and the alignment of the aortic and pulmonary valves have special importance on the surgical anatomic correction of the transposition of the great arteries and double outlet of the right ventricle, because of their repercussions on surgical technique and the effect on the operative results. OBJECTIVE: To determine the coronary artery pattern; the aortic and pulmonary valve alignment, and their effects on the surgical results in 57 patients submitted to anatomic correction in our hospital. METHOD: We used the Yacoub and Radley-Smith patterns in order to classify the different coronary distributions. The relation between the coronary pattern and degree of alignment with surgical difficulty and the mortality rate was examined. The coronary pattern established by echocardiography was compared with the surgical findings in the last 16 patients. RESULTS: 31 patients belonged to group A, 3 to B, 2 to C, 19 to D and 2 to E. There was no difference in the extracorporeal circulation time among the groups, although the difficulty in the coronary transfer was not the same among them. Type E mortality rate was 50%, type B 33%, and type D 5.2%. There were no deaths in the other groups. Malalignment was found in the three patients who died. The coronary pattern found by echocardiography was confirmed in 13 patients whose images were quite clear. CONCLUSIONS: Coronary pattern and the malignment affect both surgical difficulty and mortality rate of patients undergoing anatomic correction. Bidimensional-echocardiography is useful to demonstrate the different coronary patterns in most cases.
Subject(s)
Abnormalities, Multiple , Coronary Vessel Anomalies , Coronary Vessels/anatomy & histology , Transposition of Great Vessels/surgery , Humans , Infant , Infant, NewbornABSTRACT
Ebstein's anomaly of the tricuspid valve is a relatively uncommon congenital heart defect which consists of an apical displacement of the valvar annulus with a deformity of the septal and posterior leaflets. We report 35 cases studied from 1969 to 1993 (45% males and 55% females). One patient presented a polymalformation syndrome and another had a case of Ebstein's anomaly amongst his siblings. We performed an echocardiography in 31 patients and a catheterization in 15. The mean follow-up was 7.6 years (range: 1 day to 16.1 years). The diagnosis was established during the neonatal period in 66.7%. We found other associated cardiac anomalies in 57.1%, with radiologic cardiomegaly in 80.7%. Upon analysis of the EKGs, the P wave was higher than 0.3 mV in 48.4% and 16.1% showed Wolff-Parkinson-White syndrome. Paroxysmal supraventricular tachycardia developed in 12.9%. Long term cardiotonic treatment was needed in 27.3%. In 24.2% cardiac surgery was performed, including one heart transplantation. The mortality rate was 27.3%. The severity of Ebstein's anomaly is extremely variable, not only in its anatomy, but also in the clinical presentation. The severe neonatal form, the associated cardiac defects and heart failure worsen the prognosis.
Subject(s)
Ebstein Anomaly/diagnosis , Adolescent , Cardiac Catheterization , Child , Child, Preschool , Ebstein Anomaly/mortality , Ebstein Anomaly/surgery , Echocardiography , Electrocardiography , Female , Humans , Infant , Infant, Newborn , Male , Radiography, Thoracic , Retrospective Studies , Spain/epidemiologySubject(s)
Heart Aneurysm/diagnosis , Heart Septal Defects, Atrial/diagnosis , Ventricular Premature Complexes/diagnosis , Echocardiography , Electrocardiography , Female , Heart Aneurysm/complications , Heart Septal Defects, Atrial/complications , Humans , Infant, Newborn , Ventricular Premature Complexes/etiologyABSTRACT
OBJECTIVE: To assess nuclear magnetic resonance (NMR) usefulness in aortic coarctation and recoarctation diagnosis. MATERIAL: 46 NMR performed on 43 patients: aortic coarctation was suspected in 30 patients and recoarctation in 13 by means of clinical, echocardiographic and Doppler examination. METHOD: Comparison of the NMR observations with the previous diagnosis and the surgical and therapeutic catheterism findings. RESULTS: 41 patients were diagnosed of aortic coarctation or recoarctation by NMR, although a second examination was needed in 3 cases. This diagnosis was confirmed in the 26 treated children (surgical treatment or by angioplasty). CONCLUSIONS: NMR offers excellent aortic images; positive diagnoses have a high safety level, but patients with negative diagnoses must be clinically followed; children suffering from native coarctation can be operated without previous angiographic examination.
