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Biomedical subjects

A Nana

Publications and source records attributed to A Nana.

At least 19 recordsLinked to original sources
PubMed2002

Immunoglobulin failure and retreatment in Kawasaki disease.

Several cases of Kawasaki disease (KD) were unresponsive to the initial treatment with intravenous immunoglobulin (IVIG). We retrospectively analyzed all children admitted with KD to determine the occurrence and variables associated with the initial IVIG treatment failure. All patients who fulfilled the criteria for KD and were treated with a single dose (2 g/kg) of IVIG between January 1995 and August 2001 were enrolled. An analysis of the patients who had initially failed to respond to IVIG was performed. A total of 120 patients were enrolled during the study period. There were 68 boys (56.7%). Fourteen patients (11.6%) were found to be unresponsive to initial IVIG treatment. Patients who were anemic (Hb<10 G/DL), had a high neutrophil count (> 75%), a high band count, and low albumin were at risk of failure to respond to a single dose of IVIG. We found no correlation among age, gender, days since starting IVIG treatment, and erythrocyte sedimentation rate (ESR) with failure of the initial IVIG treatment. There were 12 patients (10%) who developed coronary artery aneurysms. The failure of a single dose of IVIG treatment occured in up to 11.6% of our Kawasaki patients. We found that low hemoglobin (<10 G/DL), high neutrophil count (> 75%), high band count, and a low albumin were associated with the requirement for retreatment with a second dose of IVIG.

Chi-Square Distribution↗
PubMed2002

Comparison of atrial septal defect closure using amplatzer septal occluder with surgery.

Our study reports the results of a comparison of closure of atrial septal defect (ASD) surgically with transcatheter closure using the Amplatzer septal occluder. Patients having an ASD and a surgical closure or transcatheter closure between January 1999 and July 2000 were selected. There were 103 patients who had ASD. All 64 patients in group 1 (surgery) had a successful operation, with only 2 patients with a mild residual shunt. There were 39 patients enrolled for transcatheter closure of the ASD (group 2). Four patients were excluded initially. The median age for group 1 was 25 years (range 2.3-64 years) compared to 11.7 years (range 2-69 years) in group 2 (p = 0.035). In group 1, the mean ASD diameter measured was 28.4 +/- 10.2 mm compared to 23.4 +/- 5.7 mm in group 2 (p = 0.003). In 29 patients, devices were deployed with sizes from 10 mm to 30 mm (median 24 mm). Three patients were excluded because a larger device (>30 mm) was not available and devices were not successfully deployed in another 3 patients. One patient had a device embolized into the right ventricle (surgical removal and closure of the ASD). Complications occurred in 13 patients in group 1 and 4 patients in group 2. Complete occlusion occurred in 27 of 28 group 2 patients (96.4%) during the follow-up period (10.2 +/- 5.4 months). The Amplatzer septal occluder is a new device for closure of different-sized ASDs. The intermediate-term follow-up demonstrated excellent closure results. The benefit for each patient was demonstrated in less morbidity and less time spent in the hospital.

Adolescent↗
PubMed2001

Tibial intramedullary nail distal interlocking screw placement: comparison of the free-hand versus distally-based targeting device techniques.

Intramedullary nailing is the standard treatment for closed and some open unstable diaphyseal tibia fractures. Fluoroscopy, while essential for proper nail placement can subject the surgical team and patient to substantial radiation. A new targeting system for tibia nail distal interlocking was developed by Orthofix to limit fluoroscopy. This prospective clinical study compares the Orthofix targeting system versus a free-hand technique for the tibial nail distal interlocking. Fifty eight consecutive patients with sixty tibial fractures amenable for nail fixation were randomly assigned into two equal groups: Group 1: Orthofix distally based distal targeting device and Group 2: a free-hand technique. In all the cases stabilization was achieved with a reamed statically locked tibial nail. Recorded data included accuracy of screw placement, duration of surgery prior to and during distal interlocking, and the fluoroscopy time prior to and during distal interlocking. Both groups revealed comparable fracture patterns. In all fractures the technical aspects of the surgical treatment were performed without complications. There was no statistically significant difference between the groups in the mean time of surgery prior to (62.02 vs. 61.01 min, P=0.92) and during distal interlocking (17.06 vs. 19.08 min, P=0.55), or in the total surgical time (81 vs. 85 min), respectively. Neither was there a statistically significant difference in the mean fluoroscopy time prior to distal interlocking (69 vs. 81 s, p=0.22) nor in the total fluoroscopy time (84 vs. 117 s). There was however, a statistically significant difference between the Orthofix and free-hand groups with regards to the mean fluoroscopy time during distal interlocking (15 vs. 36 s, P=0.01, respectively). This study demonstrates that the distally based distal targeting device by Orthofix for tibial nailing can significantly decrease the mean fluoroscopy time necessary to complete distal interlocking versus free-hand technique.

Adolescent↗
PubMed2000

Bending of the Cotrel-Dubousset instrumentation after direct trauma: a case report.

STUDY DESIGN: Case report. OBJECTIVES: To describe a fracture through the fusion mass of a spine that had been corrected previously with Cotrel-Dubousset rods. These rods had failed in bending after direct trauma. SUMMARY OF BACKGROUND DATA: Nine years after successful treatment of scoliosis with Cotrel-Dubousset instrumentation, the patient was in a motor vehicle accident and sustained a hyperextension spine injury with complete L1-L2 paraplegia and disruption of the fusion mass. The Cotrel-Dubousset instrumentation rods, which failed in bending, could not be corrected in situ, and the angulated segments had to be resected. The spine then became extremely unstable, and the patient consulted the authors for definitive stabilization. RESULTS: The spine was stabilized by attaching the proximal and distal retained Cotrel-Dubousset instrumentation to supplemental rods in a "domino" fashion. Crosslinks were added to improve the torsional stability. Intraoperatively, the fracture was well reduced, and the fixation was stable. A posterolateral fusion was performed with allogenic bone graft. CONCLUSION: Bent Cotrel-Dubousset instrumentation rods are still very strong and may not correct in situ.- If resection is required, the retained portions of Cotrel-Dubousset instrumentation can serve as attachments to restore stable fixation a "domino"technique.

Accidents, Traffic↗
PubMed2000

Reference spirometric values for healthy lifetime nonsmokers in Thailand.

The normal spirometric reference values for Thai people are still not yet available. The aim of this study was to establish standard spirometric equations for Thai people. Subjects 10 years of age and over were selected and their demographic distributions represented that of the population of the whole country. Inclusion criteria were strictly lifetime nonsmokers, no history of chronic cardiopulmonary disease (using a modified ATS--DLD 78 respiratory adult questionnaire), normal standard chest radiograph and unremarkable physical examination. They had to be without respiratory symptoms at the time of the study. Spirometric values were obtained by 5 turbine system 'Pony graphic' (Cosmed, Italy) spirometers which met ATS recommendations. A normal group of 2299 women and 1655 men were selected. Regression analyses using sex, height and age as independent variables were used to provide equations for predicted values. The results were: [table: see text] FVC and FEV1 from this study are close to the Chinese but are 8-20 per cent lower than the Caucasians. These predicted equations are recommended to be used for future reference values in the Thai population.

Adolescent↗
PubMed2000

Intermediate term follow-up on transcatheter closure of atrial septal defects by Amplatzer septal occluder.

BACKGROUND: Surgical repair of secundum atrial septal defect (ASD) is a safe, widely accepted procedure with negligible mortality. However, it is associated with morbidity, discomfort and a thoracotomy scar. As an alternative to surgery, a variety of devices for transcatheter closure of ASD have been developed. OBJECTIVES: We report our clinical experience with transcatheter closure of ASD using the Amplatzer Septal Occluder, a new occlusion device with intermediate term follow-up. PATIENTS & METHOD: Patients having ASD met established two-dimensional echocardiographic criteria for transcatheter closure were selected. ASD size was measured by transesophageal echocardiogram (TEE) and balloon occlusion catheter (stretched diameter). The Amplatzer's size was chosen to be equal to or 1 mm less than the stretched diameter. The device was advanced transvenously into a guiding sheath and deployed under fluoroscopic and TEE guidance. Once its position was optimal, it was released. TEE was undertaken to demonstrate the residual shunt. RESULTS: There were 26 patients with a mean age of 17.2 +/- 15.9 years old (2 to 60) and a mean weight of 22 +/- 37.5 kg. (10.7 to 62.5). The mean ASD diameter measured by TEE was 18.3 +/- 5.2 mm. and by stretched diameter was 22 +/- 7.5 mm. Four patients who had ASD stretched diameter over 32 mm were excluded because a larger device was not available. Devices were deployed in 22 patients with sizes from 9 to 30 mm (median = 22mm). Immediately after closure a tiny residual shunt was observed at the core of the device in each case. At 24 hours only two patients had a small (< 2 mm) shunt. One patient with fenestrated ASD had a device embolized into the right ventricle with successful removal and surgical closure. Patients were followed-up for a mean duration of 8 +/- 3.5 months (from 3 to 12 months). Complete occlusion was found in 20 out of 21 patients (95%). CONCLUSION: The Amplatzer Septal Occluder is a new device designed for closure of different sizes of ASD and can be easily and safely deployed. Our experience showed that this device could be used to close an ASD as large as 30 mm. The intermediate term follow-up also demonstrated an excellent closure result. Caution should be undertaken with patients who have a fenestrated atrial septal defect particularly at the septal rim.

Adolescent↗
PubMed2000

The Fontan operation: experience at Siriraj Hospital.

Seventy five patients underwent modified Fontan operation at Siriraj Hospital from October 1987 to December 1998. Cardiology data was analyzed retrospectively. Four patients' data was unavailable. Median age at operation was 9.7 (1.8-34) years old. Tricuspid atresia accounted for 38 per cent of the patients. Ten patients (14.1%) died in the acute post operative period due to consequence of low cardiac output. Another 3 patients (4.2%) expired in the intermediate and late post operative period. Age at operation, pulmonary artery size, pre-operative oxygen saturation, and mean pre-operative pulmonary artery pressure were not different between those who survived and those who died. Abnormal pulmonary vein, atrioventricular valve regurgitation, and underlying ventricular morphology statistically affected the acute survival of modified Fontan operation. Intraoperative aortic cross clamp time, and post operative mean pulmonary artery pressure on day 0, 1 and 2 post operation were found statistically shorter and lower in the survival group. Survival rate at 5 years was 83 per cent. Modified Fontan operation is the final palliative operation of choice for low risk single ventricle physiology in our institution with acceptable outcome. Thorough pre-operative hemodynamic and anatomic studies and staging modified Fontan procedure may include a higher number of candidates and improve the outcome of the operation.

Adolescent↗
PubMed2000

Limitation of transthoracic echocardiography in the diagnosis of congenital heart diseases.

Nowadays, it has been widely accepted that echocardiography is the most efficient, non invasive diagnostic tool to diagnose congenital heart diseases. However, cardiac catheterization remains the gold standard to diagnose and obtain hemodynamic data prior to cardiovascular surgery. In order to find out the accuracy of transthoracic echocardiography in relation to the anatomical diagnosis of congenital heart diseases, 175 consecutive patients who underwent diagnostic cardiac catheterization during January 1999 to December 1999 were reviewed. All of them had complete echocardiographic studies prior to the procedure. The male to female ratio was 1.06:1. The median age at the time of echocardiography was 3.36 (0.01-28.8) years old. The indications of the cardiac catheterization were to demonstrate cardiovascular anatomy 64 per cent, to obtain pulmonary artery pressure and pulmonary vascular resistance 13.7 per cent, and to get both information 22.3 per cent. Tetralogy of Fallot (23.4%) was the most frequent cardiac malformation, followed by complex congenital heart diseases (22.3%), simple left to right shunt (12%), pulmonary atresia with ventricular septal defect (8.6%), tricuspid atresia (5.7%), simple d-transposition of great arteries (4%), etc. From cardiac catheterization; 49 cases (28%) revealed additional data which were surgically important, 3 cases (1.7%) resulted in different diagnoses, and 3 cases (1.7%) revealed additional information which was not surgically important. Inadequate imaging technique (36 cases, 65.5%) and limitation of technique (19 cases, 34.5%) were the reasons for missing anatomical findings of transthoracic echocardiography. Age at the time of echocardiography was not a significant factor affecting the accuracy. Persistent left superior vena cava, multiple aorto-pulmonary collateral arteries, pulmonary artery anatomy, and coronary artery anatomy were the most frequent cardiac lesions misdiagnosed by transthoracic echocardiography that were somewhat surgically important. The incorrect echocardiographic diagnoses were aorto-pulmonary window, patent ductus arteriosus, and vascular ring. Thorough and extensive echocardiographic scanning coupled with cooperative or adequately sedated patients by an experienced operator using an efficient echocardiographic machine might improve the accuracy of transthoracic echocardiography in the diagnosis of congenital heart diseases.

Adolescent↗
PubMed2000

Coarctation of the aorta in children at Siriraj Hospital.

A retrospective analysis of 33 children who were diagnosed to have coarctation of aorta at Siriraj Hospital between January 1989 and December 1998 was undertaken. There were 21 males (64%) and 12 females (36%). Their ages ranged from one day to 11 years (median 2 months). The majority of the patients (78.8%) were presented early within the first year of life. The predominant clinical manifestations were congestive heart failure (69.6%), systemic hypertension of the upper extremities (36.3%) and decreased femoral pulses. Chest roentgenogram revealed cardiomegaly (70%) and increased pulmonary blood flow (84%), reflecting congestive heart failure and associated left-to-right shunting. Electrocardiogram showed normal pattern (33.3%), right ventricular hypertrophy (33.3%), left ventricular hypertrophy (22.2%) and biventricular hypertrophy (11.2%). The younger the patient is, the more right ventricular predominance is demonstrated. According to the echocardiogram and/or aortogram, juxtaductal type was found in 51.5 per cent, postductal type in 27.3 per cent and preductal type in 21.2 per cent. Medical management included prostaglandin E1 infusion in a newborn baby presented with low-cardiac output state, anticongestion and antihypertension, if indicated, followed by surgical correction. The result of coarctectomy with end-to-end anastomosis with or without arch augmentation was good. The operative mortality rate was 5 per cent. The overall mortality in the present study was 9 per cent. The most common causes of death were multiorgan failure and pulmonary infection. Residual coarctation was found in 5 per cent.

Aortic Coarctation↗
PubMed1999

Respiratory symptoms and pulmonary function of traffic policemen in Thonburi.

A cross-sectional study was conducted to assess whether traffic policemen working in Thonburi district of Bangkok had poorer respiratory health than the normal Thai population. The benefits of wearing masks as a preventative measure against the respiratory hazards of air pollution were assessed. Traffic policemen (n = 629) who had worked in Thonburi and male subjects (n = 303, the control group) were evaluated for respiratory symptoms using the British Medical Research Council questionnaire. Their pulmonary function was measured by spirometry. Only non-smokers were included in the final analysis and it was found that traffic policemen (n = 242) suffered significantly more cough or phlegm (18.6% vs 7.8%, P = 0.005) and more rhinitis symptoms (17.8% vs 7.8%, P = 0.009) than the control subjects (n = 129). The traffic policemen also had a significantly higher prevalence of abnormal air flow (FEV1 < 80% predicted) than the control group (21.1% vs 12.4%, P = 0.04). The mean values of FEV1 and FVC of the traffic policemen were significantly lower than the control group (3.29 +/- 0.5 L vs 3.43 +/- 0.5 L, P = 0.01 for FEV1 and 3.86 +/- 0.5 L vs 3.98 +/- 0.6 L, P = 0.047 for FVC). Traffic policemen who did not use protective masks had not only a significantly higher prevalence of abnormal FEV1 but also a significantly higher prevalence of abnormal FVC than the control group (35% vs 14%, P = 0.046). They also had higher relative risks of abnormal FEV1 (2.76 vs 1.63) and FVC (2.51 vs 1.23) than those who used protective masks. Multivariate analyses with controlling for age, height, and pack-years of cigarette smoking, revealed that the traffic policemen were significantly and independently associated with lower FEV1 and FVC. In conclusion, the traffic policemen who work in Thonburi have more cough and rhinitis symptoms and lower FEV1 and FVC than the normal Thai population. Traffic policemen who do not use protective masks have higher relative risks of abnormal FEV1 and FVC than those who use them.

Adult↗
PubMed1998

Beta 2-agonists administered by a dry powder inhaler can be used in acute asthma.

Patients with acute asthma attending the emergency room were included in a double-blind, double-dummy and parallel group study to investigate whether a dry powder inhaler (Turbuhaler) can be used in acute asthma. If so, the aim was to establish the potency relationship between a beta 2-agonist (salbutamol) administered by the dry powder inhaler and the pressurized metered-dose inhaler (pMDI). Eighty-six patients with a mean age of 38 years and forced expiratory volume in 1 s (FEV1) of 37% of predicted normal value were randomized at Siriraj Hospital in Bangkok to either Turbuhaler (50 micrograms dose -1) or pMDI (100 micrograms dose -1) with spacer (Volumatic). Doses of 100 + 300 + 300 + 300 micrograms salbutamol were given at 0, 15, 30 and 45 min via Turbuhaler and repeated at 90, 105, 120 and 135 min (total dose 2000 micrograms). The same inhalation schedule with identical number of doses was used for the pMDI with spacer but in double doses (total 4000 micrograms), assuming a dose-potency ratio of salbutamol administered via Turbuhaler compared with the pMDI of 2:1. At 85 min after the first dose, 60 mg prednisolone was given orally. FEV1 was measured 10 min after each dosing. Peak inspiratory flow (PIF) through Turbuhaler was measured on each dosing occasion. Plasma (P)-salbutamol, serum (S)-potassium concentrations, pulse rate, blood pressure and adverse events were recorded. No statistically significant differences were observed in the increase in FEV1 between the groups: 55 min (165 min) after the first dose, the increase was 0.47 l and 47% (0.64 l and 63%) in the Turbuhaler group, and 0.46 l and 42% (0.68 l and 65%) in the pMDI group. Mean PIF though Turbuhaler was 49 l min -1 (range 26-68) at first inhalation and increased to 60 l min -1 (range 38-86). There was no correlation between the initial PIF through Turbuhaler and the initial FEV1 response. P-salbutamol and S-potassium values correlated well. A larger decrease in S-potassium was noticed after 75 min in the pMDI group (0.38 mmol l -1) compared with the Turbuhaler group (0.23 mmol l -1) (P = 0.02). In conclusion, the use of a dry powder inhaler, Turbuhaler, was investigated in the emergency room treatment of acute asthma, and was as effective as a pMDI with spacer. Half the dose of salbutamol administered via Turbuhaler was as effective as the full dose given via a pMDI with spacer.

Acute Disease↗
PubMed1998

Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer.

The objective of this study was to evaluate the value of bronchoalveolar lavage (BAL) and postbronchoscopic sputum cytology in diagnosing peripheral lung cancer. We performed a prospective study in 55 patients with lesions on chest radiographs who were suspected of having lung cancer and had non-endoscopically visible lesions on fiberoptic bronchoscopy. The sequence of procedures in all cases was BAL and transbronchial forceps biopsy. The final diagnosis of these patients were primary lung cancer in 30 patients, metatastic lung cancer in five and benign diseases in 20. In the primary lung cancer group, BAL was positive for malignant cells in 14 of the 30 patients (46.7%). In seven (50%) of these patients, the cell type diagnosed by BAL agreed with the final diagnosis. The diagnostic yield of BAL was influenced by the size and segmental location of the lesion. Bronchoalveolar lavage provided a higher diagnostic yield (46.7%) than transbronchial biopsy (16.7%). In five patients with metastatic lung cancer and 20 patients with benign disease, BAL gave negative results in all. Postbronchoscopic sputum cytology was positive in only two of the 26 patients (7.7%) from whom samples could be obtained. Bronchoalveolar lavage cytology proved to be a valuable diagnostic tool in detecting peripheral, primary lung cancer. Postbronchoscopic sputum cytology provided no significant additional information.

Biopsy↗
PubMed1998

High-dose inhaled budesonide may substitute for oral therapy after an acute asthma attack.

Patients attending the emergency room with acute asthma, participating in a study comparing salbutamol (albuterol in the United States) via a dry powder inhaler (Turbuhaler) with pressurized metered-dose inhaler (pMDI), were included in this 1-week follow-up study with the aim of assessing whether inhaled budesonide via Turbuhaler may be an alternative to prednisolone tablets after an acute asthma attack. Eighty-one patients with a mean age of 38 years and forced expiratory volume in 1 sec (FEV1) of 64% predicted normal value after treatment with salbutamol were randomized in this double-blind, double-dummy, parallel-group study. The doses given were budesonide 1600 microg b.i.d. or prednisolone in daily doses from 40 mg (day 1) decreased to 5 mg (day 7). FEV1 was recorded before and after the 7-day treatments and peak expiratory flow (PEF) morning and evening, clinical symptoms (visual analogue scale 0-100), and doses of rescue medication (terbutaline Turbuhaler 0.25 mg/dose) were recorded daily. The mean increase in FEV1 from baseline to day 7 was 17.3% in the budesonide Turbuhaler group and 17.6% in the prednisolone group. Mean values of morning PEF increased from day 1 to day 7 by 67 L/min in the budesonide Turbuhaler group and by 57 L/min in the prednisolone group (not significant). There were no statistically significant differences between the groups in clinical symptoms and in the number of doses of rescue medication. Because of disease deterioration, five patients in the Turbuhaler group and three in the prednisolone group needed additional symptomatic as well as corticosteroid treatment. Inhaled budesonide in high doses may be a substitute for oral therapy as follow-up treatment after an acute asthma attack.

Acute Disease↗
PubMed1998

Clonidine for smoking cessation.

Clonidine was used to reduce withdrawal symptoms of nicotine and increase the success rate of smoking cessation in the smoking cessation clinic of Siriraj Hospital. One hundred and fourteen subjects enrolled in a double-blind, randomised, placebo-controlled trial. Subjects were divided as clonidine group (n = 58) with the mean age of 38 years and placebo group (n = 56) with the mean age of 33 years. Both groups received information about harmful effects of smoking as well as behavioral modification protocol. The dose of clonidine used in this study was 300 micrograms and the duration of the trial was 5 weeks. Both subject groups attended the clinic weekly and received identical counselling. Clonidine did not reduce withdrawal symptoms of nicotine when compared to the placebo and the success rate of smoking cessation at the end of the 5 weeks' period was identical between the two groups (clonidine 50%; placebo 48%, p > 0.05). No significant side effects of clonidine were found. There was no correlation between background educational level, income, amount of cigarettes smoked per day and the success rate in both groups. In conclusion, clonidine did not show any beneficial effect on smoking cessation.

Adolescent↗
PubMed1998

Results of rapid two-stage arterial switch operation in patients with transposition of the great arteries: one-year postoperation.

The rapid two-stage arterial switch operation is an alternative therapy for patients with simple transposition of the great arteries who present beyond the neonatal period and have low left ventricular pressure. It provides normal ventricular function compared to the atrial switch operation. Between July 1994 and February 1997, there were 13 such infants who had rapid two-stage arterial switch operation performed at Siriraj Hospital. There was 1 late death (11 months after the operation). All 12 survivors (mean age 22.4 +/- 5.7 months) were clinically evaluated and had echocardiography performed at 14.8 +/- 4.9 months after the operation. All were asymptomatic. Echocardiogram revealed a residual small atrial septal defect (1 case), small ventricular septal defect (1 case), mild supravalvar neopulmonary stenosis (2 cases), bicuspid neoaortic valve without stenosis (2 cases), dilated neoaortic sinus of Valsalva (6 cases, 50%) and mild neoaortic insufficiency (11 cases, 91.7%). The left ventricular function was hyperdynamic after pulmonary artery banding and significantly decreased to normal level at the time of study (shortening fraction of 43.8 +/- 10.7 vs 29.2 +/- 3.8%, respectively, p = 0.0005). The wall thickness was significantly increased after pulmonary artery banding and decreased overtime (0.48 +/- 0.08 vs 0.32 +/- 0.05 cm, respectively, p < 0.0005). The left ventricular dimension was significantly increased both after pulmonary artery banding and at the time of study (2.06 +/- 0.42 vs 3.32 +/- 0.30 cm, respectively, p < 0.0005). The left ventricular mass was significantly increased after pulmonary artery banding and at the time of study (21.79 +/- 7.79 vs 33.08 +/- 7.40 g/m2, respectively, p = 0.0005). The mortality and morbidity of rapid two-stage arterial switch operation are low. However, long-term follow-up should be monitored.

Cardiac Surgical Procedures↗
PubMed1998

Transcatheter laser-assisted balloon valvulotomy as primary treatment in newborn with pulmonary atresia and intact ventricular septum.

We report our initial experience and the first case in Thailand in successfully performing transcatheter laser perforation of membranous pulmonary valve and subsequent balloon dilations of the valve in a 14-day-old baby with pulmonary atresia and intact ventricular septum. After the procedure, right ventricular angiograms revealed anterograde flow across the pulmonary valve. There was no major complication. Doppler echocardiography one week later demonstrated a pressure gradient across the pulmonary valve of 30 mmHg and right ventricular systolic pressure of 60 mmHg. Her peripheral oxygen saturation improved from 70's immediately after the procedure to 92-97 per cent at one-month after the procedure.

Cardiac Catheterization↗
PubMed1997

Percutaneous balloon pulmonary valvuloplasty in children: experience at Siriraj Hospital.

Twenty-seven children with pulmonary valvar stenosis with pressure gradient (PG) > or = 40 mmHg underwent percutaneous balloon pulmonary valvuloplasty (PBPV) at Siriraj Hospital between February 1993 and August 1996. There were 13 males and 14 females, with an age range from 2 months to 14 years, and body weight from 4.7 to 42.1 kg. The majority (92.6%) were asymptomatic. Before the PBPV, the pulmonary valve annulus (PVA) measured by echocardiography was significantly greater than that measured by cardiac catheterization (15.2 +/- 3.7 vs 14.5 +/- 3.9 mm, P = 0.006). However, there was linear association (r = 0.972) between the two methods. The PG obtained by the two methods showed no significant difference (90.8 +/- 35.3 by echocardiography vs 97.3 +/- 47.2 mmHg by catheterization, P = 0.266). Immediately after PBPV, the right ventricular systolic pressure (113.7 +/- 41.1 pre vs 62.3 +/- 28.1 mmHg post) and the PG 103.4 +/- 43.4 pre vs 49.0 +/- 31.1 mmHg post) were significantly reduced (p < or = 0.0005). At 6-mo follow-up echocardiography, the PG was 28.6 +/- 17.6 mmHg and was significantly reduced (P = 0.0005). The PVA significantly increased at the 12 mo follow-up (15.2 +/- 3.6 pre vs 17.6 +/- 3.8 mm post, P = 0.001). Only minor complications were reported in the present study; bleeding (3.7%), transient bradycardia (7.4%) and pulmonary regurgitation not more than moderate severity (79%). The immediate and intermediate results of PBPV are excellent with a success rate of 85 per cent.

Adolescent↗