PubMed · 13467356
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C A CESPEDES. 1957-05-23. [Dextrocardia].. https://pubmed.ncbi.nlm.nih.gov/13467356/
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OBJECTIVE: To assess neurodevelopmental outcome after endovascular treatment of vein of Galen malformations (VOGM). METHODS: Outcome of patients who underwent endovascular treatment for VOGM between 1983 and 2002 was assessed by chart review and parental questionnaires. Development was classified as normal, minor delay (slow initial acquisition of milestones but no permanent disability), or significant delay (slow or incomplete acquisition of milestones with some permanent disability) using an adaptation of the Denver Developmental Questionnaire. RESULTS: Twenty-seven patients were identified: five presented prenatally (by ultrasound), 16 as neonates, and 6 after the neonatal period. The most common presenting features were congestive heart failure (CHF; 16/27) and hydrocephalus (8/27). The 16 patients with CHF all presented either prenatally or neonatally; 4 died acutely, 6 had significant delay, and 6 had no or minor developmental delay. Of those presenting in the perinatal period without CHF, all survived, two of five were significantly delayed, and three of five had no delay. Of those presenting after the neonatal period, all survived and only one of six had delay. By angiographic classification, outcome was worse for those with choroidal VOGM (3/13 died; 5/13 had significant delay) than for those with mural VOGM (2/10 had significant delay; none died). For the entire series, 52% of all cases (61% of survivors) had no or minor delay. CONCLUSIONS: Fourteen of 27 children who received treatment for VOGM had a favorable outcome. Features associated with worse outcome were perinatal presentation, presence of CHF, and choroidal angioarchitecture.
OBJECTIVES: This study was designed to assess the feasibility and accuracy of positron emission tomography (PET) imaging in infants and children. BACKGROUND: Positron emission tomography is employed in adults for the evaluation of myocardial perfusion and the detection of myocardial viability. METHODS: Perfusion and metabolism findings on PET in infants and children with suspected coronary abnormalities (age 14 days to 12 years old, mean 3.3 +/- 4.0 years) were correlated with findings on coronary angiography, echocardiography, and myocardial histopathology. The segmental myocardial uptake of the flow tracer (13)N-ammonia and of the glucose tracer (18)F-deoxyglucose ((18)FDG) was graded on a five-point scale and compared with the angiographic perfusion score, with regional wall motion, and the presence of fibrosis. RESULTS: There was an agreement of r = 0.72 (p < 0.05) between regional myocardial perfusion and angiography. The correlation of histopathologic changes with normal, moderately, and severely reduced segmental (13)N-ammonia uptake was 87%, 60%, and 75%, respectively. Segmental myocardial (18)FDG uptake and histopathologic findings were concordant in 48 (79%) of 64 segments without fibrosis; absence of viability by perfusion and metabolism imaging correlated with the presence of fibrosis in 21 (84%) of 25 segments. CONCLUSIONS: The observed agreements between the findings on PET perfusion and metabolism imaging with those on coronary angiography, echocardiography, and histopathology support the utility and accuracy of PET for characterizing myocardial perfusion abnormalities and viability in pediatric patients.
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