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Biomedical subjects

J C Huhta

Publications and source records attributed to J C Huhta.

At least 91 records · Page 5Linked to original sources
PubMed1986

Restrictive interatrial communication in total anomalous pulmonary venous connection.

Restriction to systemic blood flow at the atrial level in total anomalous pulmonary venous connection (TAPVC) may play a role in the early development of congestive heart failure in some patients. Over a 4-year period, 21 patients with TAPVC without extracardiac obstruction presented from 1 day to 10 months of age (mean 2.6 months). Of 21 patients, 17 (81%) presented after 1 month of age with moderate to severe congestive heart failure. In the first week after birth 4 patients presented with minimal symptoms of congestive heart failure. A small patent foramen ovale (3 mm or less in diameter) was found in 19 of 21 patients (90%) by 2-dimensional echocardiography or angiography. Balloon or blade and balloon atrial septostomy was performed in these 19 patients and resulted in significant decreases in mean right to left atrial pressure gradient (from 2.8 to 0.25 mm Hg, p less than 0.001), systolic pulmonary to femoral artery pressure ratio (from 0.80 to 0.60, p less than 0.001), and systemic arterial oxygen saturation (from 84% to 79%, p less than 0.01). One patient had nonfatal complications. Surgery was performed in 19 patients from 2 weeks to 29 months (mean 12 months) after catheterization, with 1 operative death (5% mortality). Four patients required early total correction because of persistent heart failure; 15 had elective surgical repair. One of 2 unoperated patients died of pneumonia at 2.5 years of age. A restrictive interatrial communication develops after the first month of extrauterine life in most patients with TAPVC. Atrial septostomy results in improved hemodynamic conditions and clinical palliation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1986

Continuous-wave Doppler in children with ventricular septal defect: noninvasive estimation of interventricular pressure gradient.

Continuous-wave Doppler was used to estimate the pressure gradient between the right and left ventricles in 28 children with ventricular septal defect (VSD). Doppler measurement of maximal velocity was performed during cardiac catheterization and the Doppler-predicted gradient was compared with the peak-to-peak gradient measured simultaneously by catheter. Doppler gradients ranged from 10 to 71 mm Hg and correlated well with measured gradient (r = 0.97, p greater than or equal to 0.001). Fourteen patients had isolated VSD, and in these patients Doppler measurements of gradient allowed accurate estimation of right ventricular pressure (r = 0.93). There was an inverse correlation between the ratio of pulmonary to systemic resistance and maximal velocity (r = -0.77). Thus, continuous-wave Doppler is an accurate means of measuring instantaneous VSD pressure gradient in children with congenital heart disease and can be used to estimate the right ventricular and pulmonary artery pressure in children with isolated VSD. This noninvasive method can be used to distinguish restrictive from nonrestrictive VSD.

Adolescent↗
PubMed1986

Recurrent Kawasaki disease.

This case report describes a boy who had Kawasaki disease (KD) at age 12 months and had a recurrence one year later. The coronary arteries were normal following the initial episode; however, during the second episode he developed coronary aneurysms. Gallium-67 radionuclide imaging, echocardiography, and angiography were used to diagnose the coronary abnormalities.

Aneurysm↗
PubMed1986

Doppler echocardiography in the diagnosis and management of persistent fetal arrhythmias.

Thirteen fetuses with persistent arrhythmias underwent combined noninvasive echocardiographic evaluation utilizing M-mode, two-dimensional and pulsed Doppler echocardiography. This group (Group A) was compared with 14 fetuses in which only two-dimensional and M-mode echocardiographic evaluations were performed (Group B). In both groups correct prenatal interpretation of the arrhythmia was confirmed by postnatal electrocardiograms in all surviving fetuses. Although Doppler echocardiography was not more sensitive than M-mode echocardiography in the interpretations of the arrhythmia, Doppler tracings of sufficient quality to analyze rate and rhythm were easier to obtain in all cases and provided additional information about valvular incompetence and the functional state of the fetal heart. Cardiac malformations and hydrops fetalis were commonly associated with persistent arrhythmias. Congenital heart disease occurred frequently (6 of 11) with complete atrioventricular (AV) block. Pulsed Doppler echocardiography defined the AV contraction sequence, atrial and ventricular rates and AV valve insufficiency, allowing rapid interpretation of fetal arrhythmias.

Arrhythmias, Cardiac↗
PubMed1986

Quantitative morphology of the aortic arch in neonatal coarctation.

It has been speculated that neonatal coarctation results from postnatal constriction of the aortic isthmus and ductus arteriosus. However, aortic arch hypoplasia is present in some neonates with coarctation and is presumed to be due to decreased aortic arch blood flow in utero. To measure the degree of aortic arch hypoplasia and to analyze the distribution of blood flow in neonatal coarctation, quantitative morphometric analysis of the great vessels from two-dimensional echocardiograms was performed in 14 neonates with isolated coarctation and 14 normal control neonates, all less than 1 month old. Measurements of the aortic valve, pulmonary valve, ascending aorta, transverse aortic arch between the carotid and subclavian arteries, aortic isthmus, descending aorta, main pulmonary artery and brachiocephalic vessels were obtained to the nearest 0.5 mm. In coarctation patients the transverse arch and isthmus were significantly smaller than in control subjects (p less than 0.001). In addition, pulmonary valve and main pulmonary artery diameters were significantly greater in neonates with coarctation than in normal neonates. Transverse arch hypoplasia and increased pulmonary valve and pulmonary artery diameters are present in neonates with coarctation. This suggests decreased aortic arch flow and increased pulmonary and ductus arteriosus flow in utero, which produce a characteristic echocardiographic appearance of transverse arch hypoplasia with a large main pulmonary artery.

Aorta, Thoracic↗
PubMed1986

Cardiac septation in atrioventricular canal defect.

To determine the relative contributions of the atrial and ventricular septa to total cardiac septation in patients with atrioventricular (AV) canal defect, two-dimensional echocardiography was used to measure the length of each portion of the septum in 14 patients with partial AV canal and 13 patients with the complete form of this lesion. Results were compared with similar data from 30 normal children, 10 patients with dilated cardiomyopathy and 11 patients with ostium secundum atrial septal defect. In patients with partial AV canal, the portion of total cardiac length occupied by the atrial septum did not differ from normal (24.8 +/- 9.9% versus 28.7 +/- 7.9%, p greater than 0.05), but there was a deficiency of both AV and ventricular septal tissue, the latter occupying only 48.2 +/- 7.0% of total cardiac length (versus 57.9 +/- 4.1% in normal subjects, p less than 0.05). Similarly, patients with complete AV canal had a normal amount of atrial septal tissue, a deficiency of AV septal tissue and a deficiency of ventricular septal tissue which was even greater than that of patients with a partial defect (39.4 +/- 5.0% versus 48.2 +/- 7.0%, p less than 0.05). Thus, although partial AV canal defect is often called ostium primum atrial septal defect, the amount of atrial tissue is usually normal, the defect being formed by a deficiency of AV and ventricular septal tissue. In the complete form of the lesion, the deficiency of ventricular septal tissue is greater.

Adolescent↗
PubMed1986

Hypoplastic left heart syndrome: is echocardiography accurate enough to guide surgical palliation?

Two-dimensional echocardiography can diagnose hypoplastic left heart syndrome. However, with the advent of the possibility of palliative open heart surgery, complete anatomic diagnosis is necessary. The anatomic findings of 15 neonates with hypoplastic left heart syndrome (age 1 to 10 days, mean 4.1) who had two-dimensional Doppler echocardiographic studies were compared with the results obtained by angiography (6 cases), surgery (11 cases) and autopsy (8 cases). Complete two-dimensional echocardiographic examination of the aortic arch, pulmonary and systemic venous return, atrial septum, ductus arteriosus and proximal coronary arteries was possible in all 15 neonates and correctly diagnosed hypoplastic left heart syndrome in each. Anatomic two-dimensional echocardiographic assessment was accurate in 13 (86%) of the 15 neonates and there were no false positive results. Undiagnosed associated abnormalities were hypoplasia of a left pulmonary artery in one patient and left superior vena cava in another. Accurate quantitation of the size of the tricuspid valve anulus, ascending aorta, pulmonary anulus and right and left pulmonary arteries was possible. Doppler examination was performed in seven patients and confirmed retrograde aortic arch flow and right to left systolic shunting in the patent ductus arteriosus. In selected neonates, surgical palliation can be attempted without angiography.

Aorta↗
PubMed1986

Color Doppler detection of multiple ventricular septal defects.

Combined two-dimensional and Doppler echocardiography has a high sensitivity and specificity for detection of isolated perimembranous ventricular septal defects. However, muscular or multiple ventricular septal defects may be difficult to diagnose with noninvasive methods, particularly in older children, necessitating angiography for accurate diagnosis. Detection of single and multiple ventricular septal defects with two-dimensional color flow mapping was compared with detection by standard two-dimensional imaging and Doppler. Both techniques were compared with four-chamber left ventricular angiography. Fifty-one patients (age 3 months to 25 years, mean 5.6 years) were studied. Eighteen had solitary ventricular septal defects, 18 had multiple ventricular septal defects, and 15 patients with intact ventricular septum served as a control group. At least one ventricular septal defect was detected by color Doppler and two-dimensional/Doppler methods in all patients with ventricular septal defect proved by angiography with no false positives. In the detection of multiple ventricular septal defects, the sensitivity of color Doppler was 72% and that of two-dimensional/Doppler was 38% (100% specificity in both). Color Doppler failed to identify multiple ventricular septal defects in five patients (two weighing less than 4 kg and three with reduced pulmonary blood flow). However, no large additional muscular defects were missed by imaging and color Doppler. Color Doppler is useful for the detection of ventricular septal defects and has higher sensitivity than two-dimensional/Doppler for multiple ventricular septal defects. The contribution of color Doppler appears to be in the detection of additional small muscular ventricular septal defects.

Adolescent↗
PubMed1985

Mitral and tricuspid valve anular diameter in normal children determined by two-dimensional echocardiography.

To establish normal values for atrioventricular valve anular diameter in children, we measured the diameter of the mitral and tricuspid valve anuli from 2-dimensional echocardiograms in 103 children aged 1 day to 15 years. Measurements of the mitral valve anulus were made from the parasternal long axis and the apical or subcostal 4-chamber views. The tricuspid valve was measured from the subcostal or apical 4-chamber view. Multiple regression analyses were performed comparing valve anular diameter to weight and body surface area and their respective square root, cube root and logarithmic functions. Mitral and tricuspid anular diameter increased in proportion to the logarithm of weight and body surface area. The best predictor of valve anular diameter was a logarithmic function of body surface area with a calculated correlation coefficient ranging from 0.90 to 0.93 for the 3 anular dimensions. Knowledge of the normal atrioventricular valve anular diameter should be useful in planning palliative or corrective surgery in children with congenital heart disease.

Adolescent↗
PubMed1985

Accuracy of two-dimensional echocardiography in the diagnosis of congenital heart disease.

To assess the accuracy of 2-dimensional (2-D) echocardiography in the evaluation of cardiac anatomy in patients with congenital heart disease, 2-D echocardiograms were performed in 126 infants and children before cardiac catheterization and angiocardiography. The segmental echocardiographic analysis included determination of intracardiac, great artery, systemic venous and pulmonary venous anatomy. The 126 patients had 259 separate cardiovascular abnormalities, of which 226 (87%) were prospectively identified by 2-D echocardiography. There were 8 false-positive diagnoses. The most common lesions and the sensitivity and specificity of echocardiography were: patent ductus arteriosus, 41 patients (83% and 100%, respectively), ventricular septal defect, 35 patients (86% and 100%); atrial septal defect, 26 patients (85% and 99%); pulmonary valve stenosis, 25 patients (77% and 97%), transposition of the great arteries, 16 patients (100% and 100%); and total anomalous pulmonary venous connection, 14 patients (85% and 100%). Less common defects and their rate of detection included coarctation of the aorta, 10 of 12 patients; atrioventricular canal, 10 of 10 patients; tetralogy of Fallot, 10 of 10 patients; aortic valve stenosis 8 of 8 patients; right aortic arch, 8 of 8 patients; interrupted aortic arch, 4 of 4 patients; and unilateral pulmonary vein atresia, 0 of 1 patient. In 33 patients (26%), the errors in echocardiographic analysis were judged to have surgical importance. Most errors were the result of overlooking or misinterpreting data that had been appropriately recorded on videotape. Pulmonary valve stenosis and patent ductus arteriosus are the lesions most likely to be misdiagnosed by ultrasound studies relying on imaging alone.

Cardiac Catheterization↗
PubMed1985

Pulsed Doppler fetal echocardiography.

Pulsed Doppler echocardiography (PDE) has proven value in the examination of the infant or child with known or suspected congenital heart disease. In order to assess how PDE might be useful in the evaluation of the infant in utero, we reviewed our experience with this technique used in combination with both cross-sectional and M-mode echocardiography. Where previous examinations had suggested some abnormality or where there was a risk factor for congenital heart disease, we performed PDE examinations on the cardiovascular system of 36 infants in utero ranging in gestational age from 20-39 weeks (mean 32 weeks). PDE of the fetal heart was found to be valuable in three areas: (1) quantitation of hemodynamics, (2) characterization of cardiac rhythm, and (3) identification of certain congenital cardiovascular structural anomalies.

Echocardiography↗
PubMed1985

Survival in atrioventricular discordance.

Limited information is available concerning the long-term survival of patients with atrioventricular discordance, ventriculoarterial discordance, and two ventricles (corrected transposition). The long-term follow-up of 107 patients examined at the Mayo Clinic over a 30-year period between 1951 and 1981 was reviewed. Overall survival from the date of Mayo Clinic diagnosis was 70% at five years and 64% at ten years. Associated variables were analyzed for their effect on survival including sex, age at diagnosis, presence of ventricular septal defect, pulmonary stenosis, dextrocardia, left atrioventricular valve insufficiency, and complete heart block. There was no significant difference between those with and without a ventricular septal defect (VSD). Pulmonary stenosis was protective when a VSD was present but was not a significant predictor of long-term survival. The only variable that consistently correlated with decreased survival was left atrioventricular valve insufficiency (p less than 0.04 for univariate and stepwise Cox, and p = 0.08 for multivariate analysis). A logistic model for survival after open-heart surgery failed to identify any significant variable. We conclude that the presence of left atrioventricular valve insufficiency in association with atrioventricular discordance significantly alters the long-term outcome. Atrioventricular valve replacement should be considered in such patients when insufficiency becomes hemodynamically significant.

Adolescent↗
PubMed1985

Surgical treatment for the type II and III truncus: complete division of the truncal root with primary repair using absorbable suture.

A simplified technique for repair of type II and III truncus arteriosus applicable in neonates is described. The method is particularly useful in those patients in whom the pulmonary artery orifices arise from the posterior wall of the truncal root. Advances in two-dimensional echocardiography have provided an accurate means of determining the exact anatomy preoperatively. At operation, isolation of the pulmonary orifices on a button of posterior truncal wall is accomplished by complete division of the main truncal root. Primary closure of the new ascending aorta is made possible by extensive mobilization of the aorta and pulmonary orifices. Early postoperative follow-up indicates that the use of a new absorbable suture for primary repair of the aortic root allows for normal growth.

Echocardiography↗
PubMed1985

Two-dimensional echocardiographic spectrum of univentricular atrioventricular connection.

The spectrum of anomalies in hearts having a univentricular atrioventricular (AV) connection was examined by two-dimensional echocardiography in 183 patients and the anatomic findings were compared with angiography. The mode of AV connection was found to be of three types: double inlet via two AV valves; single inlet via one AV valve with absence of the other (left or right AV valve atresia); and common inlet via a common AV valve. Identification of an accessory chamber by two-dimensional echocardiography was possible with 90% sensitivity, but it was limited compared with angiography in patients with severely hypoplastic anterior chambers and pulmonary valve atresia. All patients with subaortic outlet foramen obstruction were detected. Great artery position and the presence of obstruction to pulmonary flow were correctly predicted in all but one patient. Two-dimensional echocardiography was superior to angiography for the detection of AV valve abnormalities which were present in 27% and included abnormal chordae, hypoplasia or dysplasia of either valve. Two-dimensional echocardiography should play an essential role in the complete preoperative assessment of patients with univentricular AV connection.

Adolescent↗