RESUMEN
Patency of the ductus arteriosus (PDA) is a common finding in small premature infants. Recently pulsed-Doppler-cross sectional echocardiography (PD-CSE) has been successfully used in these patients. We report a case of a premature infant with an unusual PD-CSE pattern.
Asunto(s)
Conducto Arterioso Permeable/diagnóstico , Ecocardiografía , Enfermedades del Prematuro/diagnóstico , Conducto Arterioso Permeable/complicaciones , Humanos , Recién Nacido , Síndrome de Dificultad Respiratoria del Recién Nacido/complicacionesRESUMEN
In 1983, a US National Collaborative Study (NCS) proposed criteria for the diagnosis of hemodynamically significant patent ductus arteriosus (PDA) in premature infants with respiratory distress syndrome (RDS), but the widespread use of pulsed Doppler cross-sectional echocardiography (PD-CSE) in neonatal intensive care units has made direct assessment of the ductus possible thus providing more timely therapy. We have compared the results in 30 premature infants with severe RDS, assessed according to the guidelines of the US NCS, with those in 51 infants whose PDA was diagnosed by PD-CSE. Together with a significant reduction in the age at treatment (7.8 +/- 3.9 vs 2.4 +/- 1.1 days), there was a reduced dependence on artificial ventilation (14.8 +/- 11.0 vs 7.8 +/- 2.7 days), a reduction in the number requiring surgical ligation of PDA (9 vs 2), a decreased incidence of bronchopulmonary-dysplasia (BPD) (40% vs 16%), and a reduction of unfavorable outcome of treatment (death or BPD) (76% vs 49%).
Asunto(s)
Conducto Arterioso Permeable/patología , Ecocardiografía , Indometacina/administración & dosificación , Síndrome de Dificultad Respiratoria del Recién Nacido/patología , Displasia Broncopulmonar/patología , Conducto Arterial/patología , Conducto Arterioso Permeable/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Infusiones Intravenosas , Masculino , RecurrenciaRESUMEN
Congenital Heart Malformations (CHM) can be present together with Extracardiac Malformations (ECM) in a single individual, however the frequency and the patterns of associations are not well defined because the casistics of the literature are little comparable. The diagnosis of CHM has been demonstrated with cardiac catheterization in any case. Between January 1st, 1976 and December 31st, 1983 cardiac catheterization has been performed in 1012 children and 971 of them were affected by Congenital there was at least one ECM as well (group B); 311 ECM were present in group B. VSD (p less than 0.05) and Atrioventricular Septal Defects (AV.SD) (p less than 0.01) resulted associated with ECM while T.F. (p less than 0.05) and isolated TGA (p less than 0.01) showed the tendency to occur in isolation. VDS resulted associated with gastrointestinal anomalies (p less than 0.05), AV.SD with T21 (p less than 0.001), aortic valve (p less than 0.05) and supra-valve (p less than 0.001) stenosis with Nervous System abnormalities. Pulmonary stenosis showed little tendency to occur together with T21 (p less than 0.05).
Asunto(s)
Anomalías Múltiples , Cardiopatías Congénitas/complicaciones , Adolescente , Cateterismo Cardíaco , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , MasculinoRESUMEN
Fetal cardiac anatomy was studied by ultrasound in 96 pregnancies between 16 and 24 weeks' gestation. Sequential approach was used to identify all venous, atrioventricular and ventriculoarterial connections as well as intracardiac anatomy. A standard CSE was performed after birth in all patients to confirm the normal heart anatomy. Aortic arch, pulmonary veins and pulmonary artery branches resulted sometimes uncertainly identified but a nearly complete morphological heart study was performed in almost all cases.
Asunto(s)
Ecocardiografía , Corazón Fetal/anatomía & histología , Diagnóstico Prenatal/métodos , HumanosRESUMEN
Vascular thrombosis is a harmful and rather frequent event in sick premature infants. Only recently has intracardiac thrombosis been described in preterm babies and virtually all the surviving cases are those treated surgically. We report the cases of two premature infants with intra-atrial thrombosis detected by cross-sectional echocardiography and successfully treated with heparin and urokinase for 12 and 16 days, respectively. Our patients required larger doses of urokinase over a longer period of time than are required at older ages to obtain thrombolysis. Our data suggest that fibrinolytic therapy may be an alternative to surgery in premature babies with right atrial thrombosis and that cross-sectional echocardiography is very useful in the titration of the therapy in order to achieve consistent dissolution of the thrombus.
Asunto(s)
Cardiopatías/tratamiento farmacológico , Heparina/uso terapéutico , Enfermedades del Prematuro/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico , Quimioterapia Combinada , Ecocardiografía , Femenino , Estudios de Seguimiento , Atrios Cardíacos , Humanos , Recién Nacido , MasculinoRESUMEN
The usual non invasive diagnostic methods may not be able to estimate a mild residual gradient in infants treated for Coarctation of the Aorta (CA) so we tried to determine whether Pulsed Doppler (PD) may be useful in these cases. We studied 16 children (Group A) treated for CA, clinically considered as good operative results (arm to leg gradient less than or equal to 10 mmHg) and admitted for cardiac catheterization to study associated cardiac defects. Ten children with congenital heart disease different from CA were studied as a control (Group B). Percutaneous left cardiac catheterization was performed in all children with pull-back recording of the aortic pressure across aortoplasty before angiography. PD study was performed with an ATL Mark 600 and a 3 MHz transducer positioned in the suprasternal notch. The sample volume was moved into the descending aorta in order to obtain peak flow velocity (PFV) and estimate systolic gradient (DEG). Cardiac catheterization gradients (CCG) ranged from 0 to 20 mmHg (3.9 +/- 6.3 mmHg) in Group A while no gradient was recorded at the Isthmus in Group B. In Group A the frequency shift changed just below the aortoplasty; PFV and DEG ranged respectively from 1 to 2.3 m/s (1.6 +/- 0.3 m/s) and from 4 to 22 mmHg (10 +/- 4.8 mmHg). In Group B the descending aorta PFV ranged from 0.8 +/- 1.3 m/s (1 +/- 0.2 m/s). PFV in Group A was higher than in Group B (p less than 0.001). CCG were plotted against DEG; the linear regression gave a satisfactory coefficient of correlation (R = 0.93 and p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Coartación Aórtica/fisiopatología , Reología , Adolescente , Coartación Aórtica/cirugía , Velocidad del Flujo Sanguíneo , Cateterismo Cardíaco , Niño , Preescolar , Humanos , Lactante , Recién Nacido , RecurrenciaAsunto(s)
Aorta Torácica/anomalías , Coartación Aórtica/fisiopatología , Cardiomiopatía Hipertrófica/fisiopatología , Enfermedades de las Válvulas Cardíacas/fisiopatología , Ventrículos Cardíacos/fisiopatología , Aorta Torácica/fisiopatología , Estenosis de la Válvula Aórtica/fisiopatología , Niño , Preescolar , Hemodinámica , Humanos , Lactante , Recién Nacido , Estenosis de la Válvula Mitral/fisiopatología , Estenosis de la Válvula Tricúspide/fisiopatologíaRESUMEN
A case of aortic arch interruption detected in a 17-week-old fetus and confirmed after therapeutic abortion is reported. The potential usefulness of cross-sectional echocardiography in prenatal detection of aortic arch anomalies is discussed.
Asunto(s)
Aorta Torácica/anomalías , Ecocardiografía , Enfermedades Fetales/diagnóstico , Diagnóstico Prenatal , Adulto , Edema/complicaciones , Femenino , Humanos , Embarazo , Síndrome de Turner/complicacionesRESUMEN
The cerebral arteriovenous fistula is a rare cause of neonatal cardiac failure. We have recently observed three cases of severe cardiac failure associated with an arterio-venous malformation of the vein of Galen. At echocardiography and angiography the right cardiac chambers were seen to be more enlarged than the left ones. This may have resulted to some extent from an insufficient right-to-left shunt during foetal life due to a relatively small foramen ovale confronting an increased systemic venous return. Two of the neonates were operated upon and one survived. Based on our experience and on a review of the literature we feel that the diagnostic clues are: 1) severe cardiac enlargement; 2) a vascular bruit on the head; 3) hyperpulsatile neck vessels, sometimes with small peripheral pulses.