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Biomedical subjects

I S Chiu

Publications and source records attributed to I S Chiu.

88 records · Page 5Linked to original sources
PubMedDate not supplied

Echocardiographic features of left juxtaposed atrial appendages associated with dextro-transposition of the great arteries.

We found that echocardiography in cases of left juxtaposed atrial appendage (JAA) consistently featured a malpositioned right atrial appendage, abnormal spatial orientation of the atrial septum, and posterior deviation of the septum secundum toward the left atrium. The qualitative displacement of the septum secundum together with the posterior and leftward displacement of the right atrial appendage (with respect to the great arteries) prompted us to pose questions concerning the morphogenesis of left JAA and the implications for surgery. The importance of precatheterization and preoperative recognition of left JAA in dextrotransposition of the great arteries by echocardiography cannot be overemphasized when planning a balloon atrial septostomy or a biventricular repair.

Child, Preschool↗
PubMedDate not supplied

CT and MRI findings in a child with constrictive pericarditis.

Constrictive pericarditis is rare in children. We report computed tomography (CT) and magnetic resonance imaging (MRI) findings in a 3-year-old girl. She had a swollen abdomen that increased in two months. CT and MRI showed a thickened pericardium (5.2 mm) without calcification. Both atria were enlarged and ventricles were relatively small. The engorged inferior vena cava had 2.8x the diameter of the descending aorta at the same level. Symptoms were dramatically improved after pericardiectomy. The histopathological features confirmed chronic pericarditis.

Child, Preschool↗
PubMedDate not supplied

Three-dimensional reconstruction of abnormal ventriculoarterial relationship by electron beam CT.

PURPOSE: Assessment of the relationships of the ventricles and great vessels is critical in evaluating cardiac anomalies before surgery. We investigated the usefulness of 3D CT in their demonstration. METHOD: From July 1995 through June 1996, 20 patients with abnormal ventriculoarterial relationships were analyzed by electron beam CT. A 3D gradient shading surface rendering was done on a workstation. We focused on the morphologies of the atria, ventricles, and great vessels and particularly their spatial relationships on the 3D images. RESULTS: There were two cases of isolated ventricular inversion, three of anatomically corrected malposition, seven of congenitally corrected transposition, and eight of complete transposition. Anatomic presentations of 3D surface images in all were superior to cineangiography and echocardiography presentations and were consistent with intraoperative findings. CONCLUSION: 3D CT images provide useful information that is not available by sectional or projective imaging. Independent segmental analysis of the anomalies by this method provides a complement for surgeons to understand the spatial relationships of the vessels and chambers of the heart, which may be of value in preoperative planning.

Adolescent↗
PubMedDate not supplied

Utilization of the aortic flap above the facing commissure in arterial switch operations.

BACKGROUND: The aortic flap above the facing commissure after removal of the coronary button from the aortic sinus can be utilized for reconstruction in an arterial switch operation. METHODS: The free flap was used to reconstruct the coronary artery in two cases, as a medially based trapdoor. A rotational flap was inserted into the cut-open right pulmonary artery to augment the neopulmonary arterial anastomotic site in another case. RESULTS: All patients are doing well at mid term follow-up. CONCLUSIONS: The indications of each method and reported tricks to avoid coronary artery kinking during an arterial switch operation are discussed.

Aorta↗
PubMedDate not supplied

Creation of a one-way interatrial communication in the treatment of critical pulmonary stenosis with intact ventricular septum: a case report.

BACKGROUND: In biventricular repair of pulmonary outflow tract obstruction with intact ventricular septum, the right ventricle is loaded with total pulmonary blood flow acutely as the right-to-left shunt is abolished by closure of the atrial septal defect (ASD). METHODS: We designed a one-way interatrial communication by creation of an atrial septal flap to reduce the excessive volume load of the right ventricle. RESULTS: This procedure was successfully performed in a 3-year-old girl undergoing definitive biventricular repair for critical pulmonary stenosis associated with tricuspid stenosis and a small right ventricle. CONCLUSIONS: We believe that creation of a one-way interatrial communication might be a good alternative to adjustable ASD and/or bidirectional Glenn shunt in biventricular repair of critical pulmonary stenosis or pulmonary atresia with intact ventricular septum.

Child, Preschool↗
PubMedDate not supplied

Clinical implications of short-axis aortopulmonary rotation on juxtacommissural origin of the coronary artery in transposition of the great arteries and surgical strategy.

BACKGROUND: The relationship of short-axis aortopulmonary rotation (APR) with juxtacommissural origin of the coronary arteries (JOCA) in transposition of the great arteries (TGA) has never been elucidated. The surgical outcome of arterial switch operation (ASO) is influenced by the presence of JOCA. METHODS: Fifteen patients with TGA who presented to our institution between 1988 and 1995, and 23 cases from the literature, all with documented JOCA and APR, were analyzed. Each coronary arterial type was assigned to one of five patterns, according to similarities of epicardial configuration. All our patients underwent an ASO with various techniques to deal with JOCA. RESULTS: JOCA near the facing commissure (FC, 35 cases), were more frequent with anterior TGA (29/31, 94%) except types 5cj and 9j that were seen with posterior and right lateral TGA (4/4, 100%); whereas JOCA near the right-hand nonfacing commissure (RNC, 3 cases) were related with posterior TGA. Eta-square analysis showed significant correlation between various JOCA and short axis APR. Thirteen of our cases had JOCA near FC, two near RNC. Five of the former in whom the coronary artery was excised as a single button had a superior trapdoor; using a two-button technique three of the former had a lateral funnel and one of the latter had a medial trapdoor for the JOCA; all survived although on late noncoronary death was noted. In the remaining six cases without augmentation, only one survived (8/1 vs 1/5, p < 0.02). CONCLUSION: JOCA in TGA was related to short axis APR, generally near FC in anterior TGA (except types 5cj and 9j), and near the RNC in posterior TGA. A superior (lateral) or medial flap, to augment the coronary button for JOCA near FC or RNC is helpful for a successful ASO.

Aorta↗
PubMedDate not supplied

One-stage repair of interrupted aortic arch and aortopulmonary window with an autologous arterial flap.

Interrupted aortic arch associated with an aortopulmonary window is a rare congenital malformation that requires an early diagnosis and surgical treatment to avoid irreversible pulmonary vascular changes. We describe herein successful one-stage repair in a neonate without the use of pericardium or other prosthetic material. Use of a transaortic approach permitted both accurate planning of the appropriate size of pulmonary trunk flap and also facilitated easy repair of the aortopulmonary septal defect. The growth potential of both great arteries was optimized.

Anastomosis, Surgical↗
PubMedDate not supplied

Midterm outcome of mitral valve regurgitation after repair of atrioventricular septal defect.

The purpose of this retrospective study was to evaluate the outcome of mitral regurgitation (MR) following repair of atrioventricular septal defects (AVSDs). Echocardiograms of all survivors after AVSD surgery between 1991 and 1996 were reviewed. This study enrolled 16 patients who had had more than two postoperative color Doppler studies. On each echocardiogram, MR severity was graded on a 1+ to 4+ scale, based on the size of the MR jet. Mean age at surgery was 31.1 months (range 2.5 to 83) and mean postoperative follow-up duration was 23.6 months (range 1 to 59). Mild deterioration of mitral valve function was common. MR severity increased by one or more grades in 5 patients (31%) between the initial and final examinations. However, the deterioration in mitral valve function occurred primarily on the immediate postoperative stage. On mid-term follow-up, the MR improved, or at least became stationary, in all patients. Mitral valvuloplasty was not necessary in surviving patients. We conclude that postoperative MR remains fairly stable following AVSD repair. Serious deterioration is rare.

Child↗
PubMedDate not supplied

Midterm results of aortic valve reconstruction for congenital aortic stenosis with or without regurgitation.

Aortic valve is often replaced if valvular stenosis fails to be balloon dilated. Aortic valve reconstruction was performed on 4 patients from August 1993 to 1999. Their ages ranged from 1 month to 15 years (mean 8.3 years). Unicuspid aortic valve was present in three of them and bicuspid in the other one. Two patients were associated with a patent arterial duct, one aortic regurgitation, and one pulmonary stenosis. Commissurotomy was done in three of them to transform the aortic valve into tricuspid except one, in whom bicuspid valve was preserved. In one case with unicuspid aortic valve, a piece of tanned autologous pericardium was used to augment one myxomatous and retracted leaflet. The sinus of Valsalva was molded together with a bulging shape of its aortic leaflet. All four were weaned from cardiopulmonary bypass smoothly. Transesophageal echocardiography in one case prompted rebypass to decrease the degree of regurgitation from moderate to mild by further shaping of the leaflet and sinus of Valsalva. In one patient chylopericardium was complicated and subsided in 5 days after conservative treatment. All patients were doing well on follow up at 56.8 +/- 34.4 months after surgery, with trivial to mild systolic pressure gradient (20 +/- 26 mmHg; preoperatively: 88 +/- 36 mmHg) and mild regurgitation. Aortic valve reconstruction is feasible in the setting of congenital aortic stenosis in our limited experience; repair instead of replacement is recommended even when regurgitation is present.

Adolescent↗
PubMedDate not supplied

Pulsatile flow during routine cardiopulmonary bypass.

The effect of pulsatile flow during cardiopulmonary bypass (CPB) was studied on two groups of 11 patients each (aged between 18 and 48 years) undergoing open valvular and congenital heart surgery. In the nonpulsatile group, mean blood pressure (BP) and systemic vascular resistance index (SVRI) increased steadily during CPB; while in the pulsatile group, both BP and SVRI remained stationary. The difference of SVRI between the two groups was not significant within 30 minutes after initiation of CPB (3136 +/- 882 to 2536 +/- 530 dynes X sec X cm-5 X m2). Contrarily, it was significantly higher in the nonpulsatile group after 40 minutes of CPB (3748 +/- 562 to 2612 +/- 609 dynes X sec X cm-5 X m2, p less than 0.02) and thereafter. Oxygen consumption index (59.6 +/- 12.9 to 77.8 +/- 32.6 ml X min-1 X m-2) and carbon dioxide production index (41.1 +/- 16.0 to 59.3 +/- 28.1 ml X min-1 X m-2) measured 20 minutes after institution of CPB seemed lower in the nonpulsatile group than in the pulsatile group, but the differences were not statistically significant. Increased urine flow during CPB (1.8 +/- 1.1 to 6.3 +/- 3.8 ml X min-1 X m-2, p less than 0.001) with less variability indicated better reserve of renal function in the pulsatile group; and less percent change of postoperative sGOT from preoperative level (529.8 +/- 129.8 to 310.0 +/- 175.2%, p less than 0.005) also showed better hepatic function in the pulsatile group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Kabuki make-up syndrome associated with congenital heart disease.

The Kabuki make-up syndrome, reported in 1981 by Niikawa et al. and Kuroki et al. independently, is also known as "Niikawa-Kuroki syndrome". Here we report two cases of this syndrome, both of them were boys, showing facial dysmorphism, hand abnormalities and congenital heart disease. The first case had developmental retardation noticed since 3 months old and frequent upper respiratory tract infections in the following years, and the cardiac echo revealed mitral regurgitation and tricuspid regurgitation. The second case had patent ductus arteriosus and ventricular septal defect diagnosed at 17 days old. He underwent corrective surgery for his heart problems, he also couldn't complete a sentence at two and half years old. It was estimated that the incidence of this syndrome was 1/32,000 in Japanese Children, and Chinese are similar to Japanese as yellow-skinned oriental, there should be more cases in our country, and a detailed cardiac study may be necessary for them.

Abnormalities, Multiple↗
PubMedDate not supplied

Long-term survival after neonatal arterial switch operation.

An arterial switch operation was used only for a hyperdynamic transposition of the great arteries beyond the neonatal period at this hospital until the end of 1989. A 20-day-old baby girl underwent an arterial switch operation on March 3 1992 under the impression of simple transposition of the great arteries. The coronary artery pattern was Shaher's type 4. An autologous aortic flap just above the facing commissure was used to augment the medially based trapdoor for the left circumflex scallop. The baby survived the operation and has been faring well for the past three years. This case is the longest survival after a neonatal arterial switch operation in our hospital.

Aorta↗