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Biomedical subjects

N Roguin

Publications and source records attributed to N Roguin.

At least 55 records · Page 3Linked to original sources

The use of calcium gluconate prior to verapamil in infants with paroxysmal supraventricular tachycardia.

Verapamil is a useful drug for treating supraventricular tachycardia; however, severe side effects occasionally have been reported in infants. We describe here our experience with the use of a 10 percent solution of intravenous calcium gluconate prior to the use of verapamil in infants with paroxysmal supraventricular tachycardia. In all the attacks verapamil converted the supraventricular tachycardia to sinus rhythm. We feel that calcium gluconate injected previous to verapamil can avoid the negative inotropic effects without interfering with the antiarrhythmic properties of verapamil.

Bradycardia↗

Angiography of azygos continuation of inferior vena cava in situs ambiguus with left isomerism (polysplenia syndrome).

We have in our records 11 patients with situs ambiguus and left isomerism (polysplenia). Ten had an interruption of the inferior vena cava (IVC) with azygos continuation; in eight cases the continuation was to the left superior vena cava (LSVC), in one case to the right superior vena cava (RSVC) and in one case to both the LSVC and RSVC. Two patients underwent surgical correction by a baffle procedure of the functioning single atrium. The angiographic confirmation of the azygos system anatomy is important in planning the surgical correction of patients with left isomerism. Clinically, given the same heart defects with normal pressures, the right-sided drainage is probably more favorable, producing less peripheral desaturation.

Azygos Vein↗

Atrioventricular block in situs ambiguus and left isomerism (polysplenia syndrome).

Three patients are described who had situs ambiguus and left isomerism (polysplenia syndrome) and advanced atrioventricular block. One presented with a complex bradyarrhythmia with Wenckebach block. The other two had congenital atrioventricular block with a narrow QRS at a ventricular rate of 80 per minute, an atrial rate of 150' per minute, and both had a P wave axis directed superiorly and to the right in one, and superiorly to the left in the other. This ECG pattern was not observed in more than 400 adult patients with complete A-V block treated in our service. It is our opinion that in infants and children with heart disease the presence of complete A-V block with narrow QRS and an unusual P waves axis directed superiorly is strongly suggestive of left isomerism. The incidence rate of complete A-V block in left isomerism is nearly twenty percent of the cases described.

Abnormalities, Multiple↗

Mitral valve replacement in active rheumatic heart disease in a five years old child.

A case of a five-year-old patient with severe rheumatic mitral regurgitation is reported. Intensive anticongestive and corticosteroid therapy were ineffective. Despite the diagnosis of chronic carditis she underwent successful mitral valve replacement with significant improvement of her cardiac status. Valve replacement is indicated in a certain group of patients with rheumatic heart disease which have a poor prognosis on medical therapy alone.

Child, Preschool↗

Right aortic arch with isolation of the left subclavian artery.

A 5-year-old boy with cyanotic heart disease and weak pulses in the left arm is described. Cardiac catheterization and cineangiography confirmed the diagnosis of tetralogy of Fallot and right aortic arch with isolation of the left subclavian artery. In addition to the aortogram and right ventricular cineangiography, pulmonary angiography was performed, demonstrating that blood did not reach the left subclavian artery through a left ductus arteriosus.

Aortic Arch Syndromes↗

The value of cardiac catheterization and cineangiography in infantile lobar emphysema.

Lobar emphysema is an uncommon cause of respiratory distress in infancy. Congenital heart disease is seen in about 20% of the patients with infantile (congenital) lobar emphysema. We described six infants with lobar emphysema. In three of them a congenital heart disease was demonstrated by cardiac catheterization and cineangiography; two had a tetralogy of Fallot with right aortic arch and the third infant a ventricular septal defect. The pulmonary angiography showed stretching of the arteries with very poor filling of the peripheral arteries and a characteristic smaller pulmonary vein in the affected lobe. In all the six patients the pulmonary artery pressure was normal. All the patients underwent lobectomy with good results. We feel that a preoperative cardiac catheterization and cineangiography is of value in this very sick group of infants.

Cardiac Catheterization↗

Congenital hepatic fibrosis with congenital heart disease. A family study with ultrastructural features of the liver.

A family with congenital hepatic fibrosis (CHF) and congenital heart disease (CHD) is presented. The consanguineous healthy parents gave birth to 12 children of whom 10 survived. One son had CHF and CHD, one daughter had CHF and a second daughter had CHD. Three other siblings probably had small a ventricular septal defect and another one probably had mild pulmonary valve stenosis. Development of portal hypertension and hypersplenism necessitated performing shunt operation on both siblings suffering from congenital hepatic fibrosis. Ultrastructural findings were giant mitochondria with large laminar inclusions in hepatocytes, and excess of villi and whorls of membranes and collagen fibrils between hepatocytes.

Adolescent↗

Asplenia syndrome. Report of two cases.

Two babies with asplenia syndrome are described. Both presented with the severe cardiovascular anomalies found in this syndrome and had Howell-Jolly bodies in peripheral blood smears. The chest X-rays showed dextrocardia, decreased pulmonary circulation and a horizontal symmetrical liver, and were helpful in the clinical diagnosis. Additional findings at autopsy included a mobile cecum and bilateral trilobed lungs with bilateral eparterial bronchi.

Abnormalities, Multiple↗

Cardiac involvement and superior vena caval obstruction in Behçet's disease.

A patient with Behçet's disease developed the rare complications of pericarditis and, two months later, superior vena caval obstruction. The latter complication was investigated by angiography to exclude other causes. As a result of this investigation the caval obstruction was managed conservatively, the symptoms and signs improving spontaneously.

Adult↗

Polysplenia syndrome. A study of five new cases.

Five children with polysplenia syndrome are described. Cardiac catheterization or postmortem examination revealed the following cardiac anomalies: interruption of the inferior vena cava with azygos (or hemiazygos) continuation to the left superior vena cava and a single atrium or a large atrial septal defect in all five children; a ventricular septal defect in three; and a primitive ventricle in one case. Other anomalies found were: central liver in all five; a right-sided stomach in three; and multiple small spleens and bilateral left, bilobed lungs--found on autopsy--in two of the children. In four of the five patients, whose ECG was available, a negative P wave was present in leads II, III and AVF. This leftward and superiorly directed P wave axis should suggest a diagnosis of polysplenia syndrome in an infant with congenital heart disease. The cardiac anomalies are surgically correctable; therefore, early recognition of this syndrome is of practical importance.

Abnormalities, Multiple↗

Primary ST changes. Diagnostic aid in paced patients with acute myocardial infarction.

In 34 out of 36 patients with apical right ventricular endocardial pacing, primary ischaemic ST alterations were observed during the early stage of acute myocardial infarction. These ST changes, indicating acute injury, were detected in the paced beats in inferior and in anterior infarct. The primary ST changes were consistent only during the early stages of acute myocardial infarction and were not detected when the electrode tip was not in the apex of the right ventricle. It is suggested that the primary ST changes should be used to diagnose acute myocardial infarction in paced patients.

Acute Disease↗

Prolapsing right atrial myxoma: clinical and heamodynamic considerations.

A 22-year-old woman with a right atrial myxoma prolapsing to the right ventricle is described. The haemodynamic findings were similar to those of cases of prolapsing myxoma of the left atrium; a notching on the ascending limb of the right ventricular pressure curve, and an initial negative, irregular deflection on the pulmonary artery pressure curve with a pronounced rise in the mean right atrial pressure (18 mmHg) were found. On deep inspiration there was a significant deepening of the y descent from 12 mmHg to 2 mmHg, indicating a changing, dynamic obstruction of the right ventricle inflow tract. These haemodynamic features can be helpful in the diagnosis of prolapsing right atrial myxoma.

Adult↗