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Biomedical subjects

M Ebaid

Publications and source records attributed to M Ebaid.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Transposition of the great arteries with posterior aorta].

Two cases of transposition of the great arteries (TGA) with posterior aorta are reported. The first was submitted to the Senning procedure with good outcome; the other had the diagnosis of double outlet right ventricle with severe pulmonary stenosis, and a Blalock-Taussig shunt was accomplished for hypoxic crisis. The patient died 11 days after surgery and the necropsy demonstrated TGA with posterior aorta. In both cases there was a sub-pulmonary infundibulum. The presence of ventricular septal defects allowed aortic-mitral fibrous continuity, a finding previously described in anatomical reports. Clinical and angiographic aspects are discussed.

Aorta↗
PubMed1992

Persistence of hypoplastic and recoarcted fifth aortic arch associated with type A aortic arch interruption: surgical and balloon angioplasty results in an infant.

A rare aortic malformation, the persistence of the fifth aortic arch (PFAA) associated with coarctation of the aorta, is reported in a 3-month-old male infant who underwent an emergency surgical intervention at 10 days of life, to relieve a severe aortic coarctation by pericardial patch technique. A successful balloon angioplasty was performed 2 months later eliminating a recoarctation. The gradient fell from 77 mmHg to 0, but a definitive surgical intervention for recoarctation was necessary 14 months after angioplasty.

Angioplasty, Balloon↗
PubMed1992

[Functional atresia of the pulmonary valve].

Three newborn children with cyanosis due to Ebstein's anomaly of tricuspid valve with an important hemodynamic repercussion presented features of imperforation of pulmonary valve. On the follow-up, clinical and laboratory findings verified that pulmonary atresia was functional resulting from a combination of low right ventricular pressure and high pulmonary vascular resistance.

Ebstein Anomaly↗
PubMed1992

[Dissection in an adult with dilatation of the ascendent aorta diagnosed in childhood].

Dilatation of the ascending aorta is relatively infrequent during childhood. Besides the Marfan syndrome, the congenital origin should be considered. We report a patient with dilatation of the ascending aorta diagnosed at the age of 10 who presented acute aortic dissection and rupture after a 13-year period of follow-up. Several aspects of the proper diagnosis are discussed.

Adult↗
PubMed1992

Post-ischemic rupture of the anterior papillary muscle of the right ventricle associated with persistent pulmonary hypertension of the newborn: a case report.

We report the case of a six-day-old male infant exposed in utero to a prostaglandin synthetase inhibitor, who presented pulmonary arterial hypertension, tricuspid insufficiency, and electrocardiographic signs of diffuse myocardial ischemia. The necropsy showed organizing infarction of the anterior and posterior right papillary muscles (probably occurred in utero) with complete rupture of the former, besides abnormal muscularization of the intraacinar pulmonary arterioles (persistent fetal circulation of the newborn). The authors suggest a possible relation between the myocardial ischemic and pulmonary hypertensive lesions since the prostaglandin synthetase inhibitor can induce precocious pulmonary arteriolar muscularization and constriction of the arterial duct, leading to right ventricular overload, thus facilitating the occurrence of papillary and subendocardial ischemia.

Coronary Disease↗
PubMed1991

Coexistence of divided left atrium (cor triatriatum) and tetralogy of Fallot.

The association of a partitioned left atrium (cor triatriatum) and tetralogy of Fallot has been reported a few times in the literature. In all of these cases, there was no clinical evidence of an obstructive lesion in the left heart, raising difficulties in establishing the proper diagnosis. We call attention to this rare combination of anomalies and to the particular morphological presentation of the dividing atrial shelf, which was partially formed by the wall of the left superior caval vein.

Adolescent↗
PubMed1991

Atresia of the left atrioventricular valve with patency of the aorta: anatomico-functional analysis of 23 patients.

We analyzed the findings in 23 patients with atresia of the left atrioventricular valve and a patent aorta seen in the period from January 1980 to July 1989. Having divided the cases according to the anatomical findings, we made a subsequent analysis of the clinical and surgical results with the aim of establishing the management most likely to diminish risks, still high, in treatment of this complex anomaly. From the anatomical viewpoint, three variants were observed. In the first, made up of 15 cases, there was absence of the left atrioventricular connexion. The characteristic finding in the second group, with five cases, was an imperforate left atrioventricular valve in the setting of concordant atrioventricular connexions. The third group, of these cases, was dominated by the presence of isomerism of the atrial appendages, both appendages being of left morphology in one case, and of right morphology in the other two. Further anatomical variation was then found in each group. Nine of the 15 with absence of the left atrioventricular connexion had the right atrium connected to a dominant left ventricle in presence of a rudimentary and incomplete right ventricle associated with discordant ventriculo-arterial connexions, all of them being in usual atrial arrangement and three with pulmonary stenosis. The remaining six in this first variant had the right atrium connected to a dominant right ventricle. In the five patients with imperforate left atrioventricular valves, two had discordant and three had concordant ventriculo-arterial connexions. In the three cases with isomerism, two had absence of the left atrioventricular connexion, with a dominant right ventricle. The last patient had an imperforate left atrioventricular valve and a discordant ventriculo-arterial connexion. From the functional viewpoint, there were 14 patients (10 with absence of an atrioventricular connexion, four with imperforate atrioventricular valve) with congestive heart failure and nine patients (five from the first, one from second, and three from the third variant) with hypoxia. Long-term follow-up (median 16.4 months--varying from 1 to 41 months--in the group with congestion and 27.7 months--varying from 12 to 57 months--in those with hypoxia) showed favorable clinical evolution in 11 (91%). We conclude that an anatomico-functional division can point towards the most appropriate management in this complex anomaly.

Aorta↗
PubMed1991

Lung beta-adrenoceptors in pulmonary hypertension. A study of biopsy specimens in children with congenital heart disease.

Characteristics of beta-adrenoceptors were analyzed using radioligand-binding techniques with 3H-dihydroalprenolol in lung specimens from 11 children with pulmonary hypertension (median age, three years) undergoing surgical repair of congenital heart defects and four pediatric control subjects (median age, five years) undergoing thoracotomy for removal of neoplasms or cysts. Scatchard analysis of 3H-DHA binding to lung membranes showed similar values of the dissociation constant in both groups (Kd = 0.72 +/- 0.22 nM in patients vs 1.22 +/- 0.22 nM in controls; p = NS). The receptor density was significantly increased in patients in comparison with controls, with respective values of 164 +/- 19 and 95 +/- 13 fmol/mg of protein (p less than 0.025), and correlated directly with mean pulmonary arterial pressure (r = 0.82; p less than 0.0005). No significant relationship was observed between receptor number and pulmonary arterial medial thickness. Thus, the increase in receptor density in these patients may be related to adaptative changes in cells other than vascular smooth muscle.

Adolescent↗
PubMed1991

[Origin of left coronary artery from right and left pulmonary arteries--clinical, anatomico surgical and follow-up evaluation of 3 cases].

Three infants with anomalous origin of left coronary artery, being two from the right pulmonary artery and one from the left, without other congenital defects, ages of 5, 15 and 3 months old, presented with early congestive heart failure due to anterolateral myocardial infarction. Anatomical characteristic was peculiar in two cases since the left coronary artery, before the anastomosis with the right pulmonary artery, presented a wy, 15 mm extension path within the aortic wall which has facilitated the surgical correction by the proximity of these structures. In the third case, the left coronary artery was anastomosed with the left pulmonary artery, 2 cm from its origin and anterior to the left atrium being the surgical correction by direct implant at the ascending aorta. Post-operative follow-up, 36, 30 and 33 months respectively, showed clinical and laboratorial normalization except for the second case in which ST segment remained upward due to ventricular aneurysm. Myocardial recovery, even after extensive infarction, in this anomaly, emphasizes the need for earlier diagnosis and management.

Coronary Vessel Anomalies↗
PubMed1991

[Mitral valve dysfunction caused by papillary muscle necrosis in patients with anomalous origin of the left coronary artery from the pulmonary trunk].

The clinical evolution of mitral valve disfunction caused by papillary muscle necrosis in patients with anomalous origin of the left coronary artery from the pulmonary trunk was analysed in three children (one 42-day-old male, one five-month-old female and one seven-year-old female). Two patients had been submitted to surgical repair of the anomalous origin of the coronary artery; one of them without mitral repair had a bad evolution in the postoperative period, was reoperated for mitral valve replacement and died two days after surgery. The other patient with plastic of mitral valve had a good outcome. The data indicated that the surgical repair of mitral valve should be provided in cases of mitral valve incompetence secondary to anomalous origin of the left coronary artery from the pulmonary trunk.

Child↗
PubMed1990

Aggregation of platelets in whole blood from children with pulmonary hypertension.

The response of aggregation of platelets to adenosine diphosphate (7.5-120 microM) and collagen (1.25 micrograms/ml) was assessed in whole blood (impedance method) in 10 children with pulmonary hypertension (hematocrit range, 42 to 71%). The response to collagen was normal (9.08 +/- 3.47 vs. 10.36 +/- 1.86 ohms in controls, P = NS) while there was a decreased response to adenosine diphosphate (6.98 +/- 3.83 vs. 11.21 +/- 2.02 ohms, P less than 0.01), in spite of high concentrations of the inducer. Lowering the hematocrit in vitro to 40% with autologous platelet-rich plasma resulted in a rise in the platelet count from 171 +/- 63 to 225 +/- 84 x 10(9) platelets/1 (P less than 0.001) and a significant increase in the response to adenosine diphosphate from 6.98 +/- 3.83 to 9.89 +/- 3.66 ohms (P less than 0.02). As in the baseline condition, high concentrations of adenosine diphosphate were required. The response to collagen did not change significantly. The results indicate that aggregatory response of platelets is relatively preserved in these children. The decreased response to adenosine diphosphate may be a result of a low count and interference of red cells on the accretion of platelets on the electrodes. Because high concentrations of adenosine diphosphate were still required after hemodilution to achieve an aggregatory response close to normal, we speculate that leakage of endogenous adenosine diphosphate from red cells may have accounted for partial activation of the platelets, resulting in a relative refractory state to in vitro stimulation.

Adenosine Diphosphate↗
PubMed1990

Correlation between gallium-67 imaging and endomyocardial biopsy in children with severe dilated cardiomyopathy.

Fourty-four patients (aged 10 months to 15 years) were assessed in a double-blind study to observe the correlation between myocardial uptake of 67-gallium and endomyocardial biopsy in the detection of moderate to severe myocardial inflammation. The sensitivity and specificity of gallium-67 imaging were 87 and 81%, respectively. Based on these findings, immunosuppressive therapy can be assigned to children with dilated cardiomyopathy and positive myocardial uptake, since moderate and severe myocardial inflammation may be detected by this non-invasive method.

Adolescent↗
PubMed1990

[Hypoplastic left heart syndrome. Clinical evaluation of 40 patients].

PURPOSE: To study the hypoplastic left heart syndrome (HLHS) emphasizing clinical aspects and therapeutic measures. PATIENTS AND METHODS: Forty patients, 24 male, ages ranging between one to 120 days (mean six days). Diagnosis was established by clinical elements, eletrocardiogram, chest X-ray and Doppler echocardiogram. Eight patients underwent cardiac catheterization. In 21 patients anatomical diagnosis was confirmed by necropsy. RESULTS: Twenty-two patients (55%) died, in spite of all possible clinical measures. In 16 (40%) palliative surgery was performed, Norwood technique in 14 and pulmonary artery banding with Dacron graft interposition between pulmonary trunk and brachiocephalic trunk in two. Immediate postoperative results were favorable in three patients (Norwood technique). Both patients underwent the other described technique died at 12th and 30th postoperative day due to infection. CONCLUSION: HLHS is a severe cardiac anomaly with a fast downhill evolution mostly at first week of life. The good results depend basically of early diagnosis as well as of an adequate clinical management for an appropriate time in indication of the palliative surgical technique.

Aorta↗
PubMed1990

[Immunosuppressive drugs for the treatment of active myocarditis in children. Hemodynamic evaluation].

PURPOSE: To analyse hemodynamic parameters (left ventricles ejection fraction, cardiac index, mean pulmonary wedge pressure and left ventricle diastolic diameter, in a group of children with active myocarditis (diagnosed by endomyocardial biopsy) pre and post treatment with conventional therapy and immunosuppressive drugs (isolated prednisone or prednisone associated with azathioprine or cyclosporine). PATIENTS AND METHODS: Forty-four pediatric patients with active myocarditis were studied. Twenty males and 24 females from 10 months to 15 years old (median = 1.3 years). All patients were submitted to hemodynamic study and endomyocardial biopsy. The hemodynamic parameters mentioned above were analysed before and after the proposed therapy. The patients were distributed in group according to the admission in the protocol, group I (9 pts)--conventional therapy (CT); group II (12 pts)--CT plus prednisone; group III (16 pts)--CT plus prednisone plus azathioprine; group IV (13 pts)--CT plus prednisone plus cyclosporine. RESULTS: Forty-four patients were submitted to four different groups of therapeutic protocol. The hemodynamic parameters were analysed in each of them. Left ventricle ejection fraction were no significantly different in the pre and post therapeutic scheme in group I and II, they were significantly higher (p less than 0.05) in group III and IV. The same happened with cardiac index. The mean pulmonary wedge pressure no presented statistical differences in group I and II before and after treatment but significantly lower lends were observed in group III and IV. The same behavior were noted in the left ventricle end diastolic diameter. CONCLUSION: The association of azathioprine or cyclosporine to prednisone presented better results in the left ventricle function, when compared with conventional drugs or isolated use of prednisone, based in the analysis of same hemodynamic parameters.

Adolescent↗
PubMed1990

[Endomyocardial biopsy and myocardial imaging with 67-gallium in the diagnosis of active myocarditis in children with dilated myocardiopathy].

PURPOSE: This study was designed to compare 67Ga imaging and endomyocardial biopsy (EB) in children with severe dilated cardiomyopathy (DC), as well as to evaluate the results in a group of patients with active myocarditis submitted to immunosuppressive therapy. PATIENTS AND METHODS: Forty-four pediatric patients with severe DC were studied. Twenty males and 24 females from 10 months to 15 year old (median = 2.6 years). All patients were submitted to a protocol including 67Ga uptake and EB. In patients submitted to immunosuppressive therapy these procedures were repeated after six months. RESULTS: In 32 patients (72.7%) the EB revealed presence of inflammatory process; 21 (65.6%) of these had a positive 67Ga uptake and 11 (34.4%) negative. Twelve patients with no evidence of inflammatory process in the EB, nine (75%) presented negative 67Ga uptake. However, when the intensity of myocardial inflammatory was analysed (mild, moderate and severe) and correlated with 67Ga imaging, was observed that the majority of patients with negative 67Ga uptake (11 patients) had mild inflammatory infiltration (nine patients). In this way the 67Ga uptake demonstrated a good correlation in the diagnosis of moderate and severe inflammatory process in children with DC. This is important because the use of immunosuppressive drugs is indicated only in these group. CONCLUSION: The 67Ga imaging is a noninvasive diagnostic method with a good sensitivity to the diagnostic method with a good sensitivity to the diagnosis of AM in children with severe DC, demonstrating to be very useful in the therapeutic approach.

Adolescent↗
PubMed1990

[Primary rhabdomyosarcoma of the heart in children. A case report].

The authors report a case of a child, 10 years old with a primary rhabdomyosarcoma of the heart that obstructed both caval veins. The clinical picture that lasted just three months before the admission was characterized by persistent fever, accentuated loss of weight and a very deteriorated general aspect. We emphasize the clinical aspects and other subsidiary elements that easily allowed to make the precise diagnosis in life as well as the therapeutic measures and follow up, besides a review of the literature, where it was confirmed the rarity of this pathological entity.

Angiocardiography↗
PubMed1990

[Transluminal angioplasty of aortopulmonary anastomosis by the Jatene surgical technique. Report of 2 cases].

Two patients with transposition of the great arteries submitted to Jatene surgery at ages of 6 days and 6 months respectively, presented in the postoperative period stenosis of the aorto-pulmonary anastomosis. The diagnosis was made three and six years after the surgery. In both patients successful percutaneous transluminal angioplasty (PTA) was performed, respectively six months and immediately after the diagnosis. Pressure gradients decreased from 83 mmHg to 24 mmHg in the first case, and from 76 mmHg to 13 mmHg in the other case, with clear improvement of the angiographic image. Complications of the procedure did not occur in any case. This application for PTA was not previously reported and should be considered as an alternative to the surgical correction of the "new" pulmonary trunk stenosis in the Jatene surgery.

Angioplasty, Balloon, Coronary↗