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Biomedical subjects

F Attie

Publications and source records attributed to F Attie.

At least 37 records · Page 2Linked to original sources
PubMed1985

The clinical features and diagnosis of a discordant atrioventricular connexion.

Seventy-three patients were studied with a discordant atrioventricular connexion (ages 3 months to 46 years). In 58 the diagnosis was proved by angiography and in the other 15 at necropsy. Forty-eight had usual atrial arrangement and 25 mirror-image atria. Fifty-two patients had ventriculo-arterial discordance, 13 double outlet right ventricle, 4 ventriculoarterial concordance, 3 single outlet of the heart and 1 double outlet left ventricle. Nine with ventriculoarterial discordance had no other associated defects. The spatial relationship of the ventricles was variable, but in usual atrial arrangement the morphologically left ventricle tended to be on the right, and in mirror-image arrangement to the left of the morphologically right ventricle. The spatial relationship between the arterial valves was also variable, but in ventriculoarterial discordance and double outlet right ventricle the aortic valve was anterior and either to the right or left of the pulmonary valve in all but 3 cases. There is no typical clinical picture for these malformations. Symptoms depend upon the associated anomalies or the presence of atrioventricular dissociation. The diagnosis of a discordant atrioventricular connexion is best achieved by the echocardiographic and haemodynamic studies, but the electrocardiogram, chest radiograph and nuclear medicine studies may suggest its presence. Most patients are asymptomatic and progress normally to adult life. Only the symptomatic patients require surgical correction. Postoperative follow-up in the survivors is excellent, only 2 of 14 patients dying after surgery.

Adolescent↗
PubMed1983

Two-dimensional echocardiographic study of right ventricular outflow and great artery anatomy in pulmonary atresia with ventricular septal defects and in truncus arteriosus.

In this study, we reviewed M-mode and two-dimensional (2DE) echocardiographic observations in 13 patients with pulmonary atresia with ventricular septal defect and in six patients with truncus arteriosus in order to attempt to identify echocardiographic features distinguishing these two abnormalities in which no anatomic connection exists between the right ventricle and the pulmonary artery. M-Mode features compatible with the diagnosis of pulmonary atresia with a ventricular septal defect (VSD) were a small but identifiable space anterior to the aorta and/or immobile pulmonic valve echoes appearing to open during diastole rather than systole. By 2DE, the proximal and distal segments of the right ventricular outflow tract could be imaged and the length of the atretic segment estimated. In truncus arteriosus, no outflow tract of the right ventricle could be identified by 2DE or M-mode echocardiography, and the origin of the pulmonary artery from the truncus could be imaged directly in four patients with type I and in one patient with type II truncus. Abnormalities of the truncal valve were also present and were imaged by 2DE in three of our five patients. Our study identified specific echocardiographic criteria for diagnosing truncus arteriosus and pulmonary atresia with VSD and for differentiation between them.

Child↗
PubMed1983

Congenital absence of pulmonary valve leaflets.

Congenital absence of pulmonary valve leaflets is an uncommon condition usually associated with ventricular septal defect and an obstructive pulmonary valve ring. Twenty-one patients with these malformations are described. Twenty had an associated ventricular septal defect with ventriculoarterial concordance, and one also had transposition of the great arteries, ventricular septal defect, and obstructive pulmonary valve ring. The clinical features, cardiac catheterisation findings, and angiocardiographic results are presented. Twelve patients underwent cardiac surgery. Three patients died, one in the early, and the other two in the late postoperative period. The results, according to the surgical technique employed and postoperative cardiac catheterisation findings, showed that patients in whom the bioprostheses were implanted in the pulmonary position had a better late follow-up.

Adolescent↗
PubMed1982

Congenital absence of the pulmonary valve leaflets associated with complete transposition of the great arteries.

We describe the clinical and surgical findings of a patient with absence of the pulmonary valve leaflets and complete transposition of the great arteries. The main clinical features were a loud, single second heart sound, a loud pansystolic murmur over the entire precordial area, but no diastolic murmurs were heard. The electrocardiogram suggested right ventricular hypertrophy and right bundle branch block. The roentgenographic study showed cardiomegaly with dilatation of both branches of the pulmonary artery. Cardiac catheterization and angiocardiography showed systemic arterial desaturation, discordant ventriculo-arterial connections and absence of the pulmonary valve leaflets. The patient underwent surgical correction by the Rastelli technique with a favorable clinical course.

Blood Pressure↗
PubMed1982

The role of isoproterenol in the preoperative evaluation of high-pressure, high-resistance ventricular septal defect.

The experience we describe derives from the short-term administration of isoproterenol in 15 patients with ventricular septal defect (VSD) and severe pulmonary artery hypertension (PAH). For the whole study group, mean pulmonary artery pressure (PAP) was 68.5 +/- 2.6 mm Hg, pulmonary vascular resistance (Rp) was 11.6 +/- 0.9 U/m2, pulmonary vascular resistance/systemic vascular resistance ratio (Rp/Rs) was 0.9 +/- 0.03, and the pulmonary vascular gradient (PAd-PWP) was 45 +/- 3.5 mm Hg. Infusions of isoproterenol decreased PAP, Rp, Rp/Rs ratio, and PAd-PWP an average of 10.2 mm Hg, 2.88 U/m2, 0.13 and 6.6 mm Hg, respectively, for the whole group (P less than 0.001). On the basis of isoproterenol response, the patients could be divided into two groups: A (n = 4) and B (n = 11). In group A, the PAP decreased from 61.7 +/- 1 to 45 +/- 4 mm Hg, the Rp from 8.9 +/- 0.3 to 4.62 +/- 0.5 U/m2, the Rp/Rs from 0.84 +/- 0.02 to 0.55 +/- .05, and the PAd-PWP from 34.5 +/- 0.9 to 24 +/- 2 mm Hg (mean +/- 1 SE). In group B a less significant change in these measurements was observed. Group A patients underwent VSD repair, and the mean average postoperative decrease in PAP was 31 mm Hg (P less than 0.001). Our findings suggest that in patients with VSD and severe PAH, in whom surgical treatment is controversial, a trial with isoproterenol should be routinely attempted. If the preceding hemodynamic parameters improve significantly, the VSD repair should be performed.

Adolescent↗
PubMed1980

Crossed atrioventricular connections.

Four cases of crossed atrioventricular connections are described. All of them were diagnosed at cardiac catheterization by angiocardiography and one was examined pathologically. Two possessed situs solitus, one with concordant connections and the other with discordant connections; the other had two situs inversus, both of them with concordant connections. Two had double-outlet right ventricle, one had transposition of the great arteries, and the other had normally related and connected great arteries. These cases have been interpreted as representing abnormal rotation of the ventricles following sepatation. A review of 36 cases previously reported on and our own cases, suggests that most patients have concordant atrioventricular connections. There are many types of ventriculo-arterial connections, the most frequent being transposition of the great arteries. There has not been any case reported with persistent truncus arteriosus. On the basis of atrioventriculo-arterial connections, we propose a classification for this malformation. We discuss the importance of the bulboventricular loop in the type of atrioventricular connections, some clinical implications for the diagnosis, and analyze the value of the rules to localize the ventricles by means of the position of the great arteries.

Adolescent↗
PubMed1980

Angiographic studies of atrioventricular discordance.

The results and value of conventional and axial angiocardiography were studied in 26 cases of atrioventricular discordance (AVD). The angiographic anatomy of this malformation was analyzed to determine the precise characteristics of atrioventricular and ventriculoarterial connections. The left and right ventricles in atrial situs solitus and levocardia show angiographic features that differ from those seen in atrial situs solitus and dextrocardia. The same differences are found in atrial situs inversus. Regardless of the type of ventriculoarterial connections, the ventricles maintain the same angiographic characteristics. The ventricular septum in AVD in situs solitus and levocardia and situs inversus and dextrocardia has a peculiar orientation. The use of axial angiocardiography facilitates detection and localization of the ventricular septal defect. In cases of malposition of the heart, the conventional frontal view allows visualization of the ventricular septum in all of its length. The axial projection is useful in diagnosing left ventricular outflow tract obstruction.

Adolescent↗
PubMed1979

Qualitative radionuclide angiocardiography in the diagnosis of corrected transposition.

Seven patients with corrected transposition were studied by qualitative radionuclide angiocardiography. In four patients with situs solitus with apex on the left, the pulmonary artery was in a medial and posterior position, to the right of the aorta, with its root attached to the morphological left ventricle positioned on the right. The aorta arose from the ventricle placed on the left and had an anterior position. The ventricle located on the right has a triangular shape. In the case of situs solitus with dextroversion, the pulmonary artery was to the right of the aorta and had a right-to-left direction. The ventricle placed on the right was ovoid. In one single case of situs inversus with levoversion, the pulmonary artery was on the left, emerging from the morphological left ventricle placed on the left, and was ovoid in shape, while the aorta was on the right arising from the morphological right ventricle. In one case of situs inversus with dextrocardia, atrioventricular relationships were the same as in levoversion but the apex was on the right and the morphological left ventricle was triangular. Qualitative radionuclide angiocardiography is a simple and non-invasive method for obtaining morphological data for the precise diagnosis of corrected transposition.

Aorta↗
PubMed1979

[Critical study of the morphogenesis of trunco-conal malformations].

Anatomical and angiocardiographic studies have made possible discussion of hypotheses of the development and differentiation of the conus and of the trunco-conal orientation of the septum. Three autopsy specimens and two angiocardiogrammes of intertwined great vessels with transposition and partial distortion of the great vessels were studied. The specimen of intertwined great vessels comprised a muscular sub-aortic infundibulum posterior to and greater than the pulmonary infundibulum. In the case of transposition the opposite situation was encountered with a muscular pulmonary infundibulum posterior to and greater than the sub-aortic infundibulum; the plane of the aortic valves was higher than that of the pulmonary valves. The specimen of partial distortion of the great vessels comprised a muscular sub-aortic infundibulum posterior to and greater than the pulmonary infundibulum with the aortic valve set higher and in fibrous continuity with the mitral valve. It is concluded that the relations of the great vessels between each other and with the ventricles depend on the orientation of the trunco-conal septum and on the process of incorporation of the cone. The presence or absence of a posterior muscular infundibulum is not related to the growth or differential reabsorption of the cone but to a process of cellular differentiation. There was no relation between the level of the valves and their spatial orientation and the length of the infundibulum. The continuity or discontinuity between the aortic and atrio-ventricular valves is not determined by the level of the aortic valves.

Female↗
PubMed1976

Rules for diagnosis of arterioventricular discordances and spatial identification of ventricles. Crossed great arteries and transposition of the great arteries.

Rules are presented for the diagnosis of arterioventricular discordances and the spatial position of the ventricles in these cardiopathies by means of angiocardiography and the position of cardiac catheters. Because these rules are based on previous anatomo-embryological findings, the normal development of the conus and the truncus is briefly analysed. The probable morphogenesis of this group of truncoconal cardiopathies is discussed. The fundamental process required to establish the diagnosis of these cardiopathies is as follows: 1) The truncoconal morphology is identified in the lateral projection. a) The anterior position of the pulmonary artery and its infundibulum with respect to the aorta and its infundibulum is characteristic of crossed great arteries with arterioventricular concordance or discordance. b) The anterior position of the aorta and its infundibulum with respect to the pulmonary artery and its infundibulum is characteristic of transposition of the great arteries with arterioventricular concordance or discordance. 2) Once the truncoconal morphology is identified, the use of the anteroposterior projection allows the establishment of the differential diagnosis between arterioventricular concordances and discordances, and of the spatial location of the ventricles in these entities. a) An anterior pulmonary artery directed from right to left, emerging from an infundibulum placed on the left side (anatomically right ventricle on the left) or an anterior pulmonary artery directed from left to right, arising from an infundibulum located to the right (anatomically right ventricular placed on the right), is the specific image of discordant crossed great arteries. b) An anterior pulmonary artery directed from right to left emerging from an infundibulum placed on the right side (anatomically right ventricle on the right side) or the anterior pulmonary artery directed from left to right arising from a left-sided infundibulum (anatomically right ventricle placed on the left side) is characteristic of concordant crossed great arteries. c) An anterior aorta placed to the right of the pulmonary artery and emerging from a left-sided infundibulum (anatomically right ventricle placed on the left side) or an anterior aorta placed to the left of the pulmonary artery and arising from an infundibulum placed on the right side (anatomically right ventricle placed on the right) is characteristic of discordant transposition of the great arteries. d) An anterior aorta placed to the right of the pulmonary artery emerging from a right-sided infundibulum (anatomically right ventricle placed on the right) or an anterior aorta placed to the left of the pulmonary artery arising from an infundibulum placed on the left (anatomically right ventricle placed on the left) is the specific picture of concordant transposition of the great arteries...

Animals↗