RESUMO
The authors describe an acquired atrioventricular septal defect that has resulted from a blunt chest trauma. Besides being an uncommon traumatic heart injury, this case has the particularities of the non-involvement of other adjacent anatomical structures and the long delay between the accident and the occurrence of the myocardial rupture.
Assuntos
Traumatismos Cardíacos/complicações , Comunicação Interatrial/etiologia , Comunicação Interventricular/etiologia , Septos Cardíacos/lesões , Ferimentos não Penetrantes/complicações , Adolescente , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia Transesofagiana , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/cirurgia , Septos Cardíacos/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgiaRESUMO
In this study the authors make a critical appraisal of transesophageal echocardiography. A retrospective analysis was made of the transesophageal echocardiographic performed in the Thoracic Surgery Center of S. João Hospital, Oporto, over a period of approximately five years. The authors report the limitations and complications of this diagnostic tool with particular emphasis on the leading causes of pitfalls. Between October 1990 and December 1995, 1282 examinations were performed in our echocardiographic laboratory, mean age 49.6 +/- 14 years (5-86), 57% of the patients were female and 43% male. A biplane transducer was used in these examinations. Patient absenteeism was 2% and only one major complication occurred in a patient with an aortic dissection. Pitfalls are of special concern with this technology. The new esophagic window over the heart and the high quality of the cardiac images, depicting structures and anatomic details inaccessible, or difficult to be observed by transthoracic echocardiographic, led to the major causes of transesophageal echocardiographic pitfalls. Once recognized, most of the pitfalls can be avoided. In what concerns our experience, examples of the most common pitfalls are illustrated.
Assuntos
Ecocardiografia Transesofagiana/métodos , Cardiopatias/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Criança , Pré-Escolar , Reações Falso-Positivas , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: To assess the accuracy of Doppler-echocardiography in the diagnosis and management of the child with heart disease. MATERIAL AND METHODS: Prospective echocardiographic study of 132 consecutive patients aged 1 day to 16 years old with heart disease confirmed by cardiac catheterization (n = 109) or anatomic examination (surgical = 21, necropsy = 2). RESULTS: Of the 258 cardiovascular anomalies diagnosed by cardiac catheterization and anatomical examination, 247 were correctly identified by echocardiography (sensitivity = 96%). There were 11 missed and 4 false positive diagnosis (specificity = 98%), all of them were vascular anomalies. Intracardiac anatomy and segmentary alignment were always correctly identified. The 21 cardiovascular anomalies operated without cardiac catheterization were correctly diagnosed. In 16 patients (12%) a management plan could not be established only on clinical echocardiographic grounds and, in another patient, the plan was incomplete. In the remaining 115 patients (87%) the management plan was correct and complete. CONCLUSIONS: The clinical-echocardiographic study allows: 1) an excellent anatomo-functional evaluation of the heart and great vessels, 2) surgical repair of some selected cardiovascular anomalies without previous cardiac catheterization.
Assuntos
Ecocardiografia Doppler , Cardiopatias/diagnóstico , Adolescente , Criança , Pré-Escolar , Erros de Diagnóstico , Reações Falso-Positivas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
The aim of the present study was to evaluate the cardiovascular morphology after Senning's operation for transposition of the great vessels (TGV) using Döppler-echocardiography. The study included 25 patients (pts) aged 17 to 127 months (mean = 60 +/- 27) who were evaluated 6 to 112 months (mean = 42 +/- 27) after surgery. The following parameters were analysed: right (RV) and left ventricular (LV) morphology and function; tricuspid regurgitation and its severity; caval and pulmonary venous pathways and the presence of pulmonary stenosis, its type and severity. All the 25 pts had an abnormal end-systolic interventricular septal (IVS) configuration, with left convexity in 22 (88%) and a flat septum present in 3 (12%). The LV fractional shortening (FS) ranged from 25 to 60% (mean = 41 +/- 10) and the preejection/ejection time ratio (PET/ET) from 0.18 to 0.33 (mean = 0.24 +/- 0.04). The RV mean FS ranged from 23.0 to 32.5% (mean = 26.9 +/- 3.0) and PET/ET from 0.27 to 0.46 (mean = 0.38). The RV wall motion study revealed that the IVS was hypokinetic in 3 pts (12%), akinetic in 19 (76%) and dyskinetic in 3 (12%). Three pts also had an hypokinetic antero-apical segment. TR was detected in 22 (88%) pts being trivial in 16 (64%), mild in 4 (16%) and moderate in 2 (8%). It was always possible to visualise the neo left and right atria as well as the caval-right atrial junctions. No systemic or pulmonary venous obstruction was detected. In 3 pts there was a mild subpulmonic dynamic stenosis related with septal buldging and mitral valve apposition. In conclusion, Döppler-echocardiography can provide accurate information for the follow-up of patients with TGV submitted to physiological correction and it can reduce the number and frequency of late postoperative cardiac catheterization.