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PubMed1988

[Function of the right ventricle in interauricular communication in adults].

This study was designed prospectively to analyze the influence of age and operation on right ventricular function in atrial septal defect; 17 patients were studied by means of radionuclide studies performed immediately before and approximately 6 months (5,8 +/- 2,3) after surgery. The pulmonary/systemic flow ratio (Qp/Qs) was determined by first pass technique, and right ventricular ejection fraction and peak filling rate were determined by equilibrium ventriculography. In addition, all patients had preoperative catheterization. According to age, patients were divided in group I (less than 35 years) and group II (greater than or equal to 35 years). Preoperatively, patients in group I, in comparison to group II, had better ejection fraction (48 +/- 8 vs 36 +/- 7; p less than 0.01), and better peak filling rate (3.7 +/- 0.9 vs 2.6 +/- 0.7; p less than 0.01), while Qp/Qs were not significantly different (2.5 +/- 0.8 vs 3.0 +/- 1.6) and pulmonary vascular resistances were less elevated (69 +/- 32 vs157 +/- 95 dynes/sec/cm-5; p less than 0.01). After surgery, right ventricular function did not significatively change in relation to preoperative data in both groups (ejection fraction: 44 +/- 13 and 34 +/- 5, respectively; peak filling rate: 3.3 +/- 1.4 and 2.1 +/- 0.6). We conclude that in atrial septal defect indexes of systolic and diastolic right ventricular function deteriorate with age, these changes being associated with a slight increase in pulmonary vascular resistance without changes of Qp/Qs; right ventricular dysfunction does not tend to improve postoperatively.

Adolescent↗
PubMed1987

Ventricular function after atrial cardioplegia.

Continuous retrograde coronary sinus cardioplegia (CSCP) has previously been carefully evaluated experimentally and shown to be efficacious during ischemia, even in the presence of coronary lesions and in the hypertrophied state. A new technique of retrograde cardioplegia delivery through the right atrium, using right ventricular distension and pressures of 60 mm Hg, has recently been described with excellent clinical results. This study was designed to specifically examine right ventricular function after atrial cardioplegia and acute passive right ventricular distension. CSCP (n = 10) was compared with cardioplegia delivered through the right atrium both continuously (n = 10) and intermittently (n = 8). When ventricular function was examined with the use of the load-independent relationship of stroke work vs end-diastolic length, there was a profound deterioration of right ventricular function in both atrial cardioplegia groups (44% and 37% of control values, respectively) after 1 hr of reperfusion. In contrast, biventricular function was fully preserved in the CSCP group 1 hr after reperfusion. Left ventricular function measured at the end of reperfusion was preserved in all three groups. Right ventricular ATP levels were slightly but significantly depressed in all groups and in the atrial cardioplegia groups, this metabolic change was also seen in the left ventricle. These metabolic and hemodynamic data may reflect the inability of atrial cardioplegia to cool the myocardium below 16 degrees C. Postoperative right ventricular dysfunction may be more common than has been previously thought when atrial cardioplegia is used, particularly in the absence of topical cooling.

Adenine Nucleotides↗
PubMed1985

Cardiac involvement in cystic fibrosis: early noninvasive detection and vasodilator therapy.

Cardiac involvement in cystic fibrosis (CF) occurs commonly but may remain undetected by usual evaluation in its early stages when right ventricular dysfunction (RVD) may be treatable. To assess the role of vasodilator therapy for early RVD in CF, we performed a prospective study in 23 ambulatory CF patients with mild CF (clinical score m = 79 +/- 8, range 61 to 90). Echocardiography (echo) and radionuclide angiography (RA) were performed at rest and with exercise stress testing (EST) in all 23 to select patients with early RVD. Thirteen of twenty-three had RVD on echo or RA evidenced by increased RV dimensions (P less than 0.001) on echo and decreased RV ejection fraction (EF) on RA (P less than 0.01) but 30% of these patients were abnormal only with EST. All 13 with RVD underwent inpatient double-blinded randomization to receive placebo or hydralazine orally without changing other standard therapy. Nine of thirteen received hydralazine (2 mg/kg/day) for 3 days. With hydralazine no change from placebo was seen on any echo or RA measurement at rest or with EST other than left ventricular STI which fell (P less than 0.05). These data indicate: 1) EST with echo and RA detects RVD in CF earlier than resting studies, 2) patients with mild CF (clinical score less than 85) frequently have RVD on EST, and 3) hydralazine does not improve RVD in CF even very early in its development.

Adolescent↗
PubMed1985

[Measurement of right systolic time intervals in complete transposition of the great vessels. Value in the surveillance of ventricular function].

Right ventricular function was regularly assessed pre- and postoperatively by measuring right systolic time intervals at the aortic valve in 21 children with complete transposition of the great arteries. Twenty children underwent "physiological" surgical correction (Senning procedure) and one child with right ventricular hypokinesia underwent detransposition of the arteries. The mean value of the right ventricular pre ejection/ejection period ratio was 0.40 +/- 0.05; this was independent of age and no significant difference was observed between the pre- and postoperative periods (0.41 +/- 0.06 vs 0.39 +/- 0.04) at least with a maximum follow-up of 5 years. This index allows early diagnosis of right ventricular dysfunction and therefore helps to orientate the choice between "physiological" or "anatomical" surgical correction.

Child, Preschool↗
PubMed1985

[Ergospirometry after repair of Fallot's tetralogy].

Ergospirometry was performed in 19 children and adolescents operated for tetralogy of Fallot (TOF) to assess their exercise capacity compared to an active non sportive control group. The test was carried out on a treadmill with measurement of oxygen consumption cycle by cycle throughout exercise. In comparison with the control group, the patients had: a working capacity which was normal or reduced by 30 to 40 p. 100; a decrease d'oxygen consumption (-30 to 40 p. 100) throughout exercise and at maximal effort: this corresponds to a lower stroke volume secondary to the absence of physical activity during childhood and/or residual cardiac lesions; abnormal chronotropism: the test was stopped at a lower heart rate corresponding to a fall in oxygen uptake during exercise, or to an increase in the systolic ejection period probably due to right ventricular dysfunction or to the patient reaching maximal ventilation; decreased maximal ventilation capacity due to a lower tidal volume and a higher respiratory rate. This type of ventilation increases to role of the dead space and may be related to progressive "pulmonary dysfunction" or secondary to residual cardiac lesions. These different parameters cannot be assessed by simple ergospirometry: the test must be coupled with an evaluation of ventilatory function on effort in order to control and evaluate the long term functional results and the aptitude of these patients to regular physical activity.

Adolescent↗
PubMed1985

Replacement of obstructed right ventricular-pulmonary arterial valved conduits with nonvalved conduits in children.

Six to thirty percent of right ventricular-to-pulmonary arterial (RV-PA) valved conduits in children fail within 5 years. Experience with correction of tetralogy of Fallot has shown that a competent pulmonary valve is not essential for excellent late results in most patients. Between March 1980 and November 1984, 26 patients who were 12.5 +/- 3.3 years old underwent conduit replacement 6.7 +/- 2.4 years after definitive repair of congenital heart defects in which a xenograft RV-PA valved conduit had been used. A new Dacron tube graft (n = 15) or pericardial (n = 8), dura mater (n = 2), or Dacron patch (n = 1) over the previous conduit bed was used as replacement. Preoperative mean right ventricular systolic pressure was 90.5 +/- 20 mm Hg and mean gradient across the conduit was 67.9 +/- 24.5 mm Hg. After replacement with a nonvalved conduit, right ventricular systolic pressure was reduced to 45.2 +/- 10.8 mm Hg (p less than .001), with a gradient of 8.9 +/- 7.6 mm Hg (p less than .001). There were no operative deaths. Follow-up at 19.5 +/- 14.9 months (range = 0 to 53) showed that all patients were in New York Heart Association class I (n = 21) or class II (n = 5). In the absence of pulmonary hypertension, hypoplastic pulmonary arteries, significant right ventricular dysfunction, or unrepaired tricuspid regurgitation, replacement of an obstructed conduit with a nonvalved conduit gives excellent early results and may diminish the need for late reoperation.

Adolescent↗
PubMed1979

Comparison of intraoperative nitroprusside unloading in mitral and aortic regurgitation.

To compare the hemodynamic effect of vasodilator therapy on different regurgitant lesions, we infused sodium nitroprusside intraooperatively in 12 patients with mitral regurgitation and 15 with aortic regurgitation. During the critical period preceding establishment of cardiopulmonary bypass, both groups had developed intense vasoconstriction and cardiac decompensation. All demonstrated improved cardiac function with vasodilator therapy; however, the degree of improvement with nitroprusside differed in the two groups. Stroke volume increased 10 ml. per beat per meter squared in those patients with aortic regurgitation and only 6 ml. per beat per meter squared in those with mitral regurgitation (p less than 0.05). The percent increase in stoke volume induced by nitroprusside was inversely correlated to the preoperative left ventricular ejection fraction (r = 0.44, p less than 0.02). Patients with aortic regurgitation had lower preoperative left ventricular ejection fractions than those with mitral regurgitation (0.53 versus 0.63, p less than 0.02). Therefore, we conclude that patients with aortic regurgitation derived greater intraoperative hemodynamic benefit from unloading with nitroprusside, because they came to surgery with greater impairment of left ventricular contractility. Although nitroprusside improved cardiac function in both groups, only the patients with aortic regurgitation achieved normal pulmonary artery pressure (17 torr) and pulmonary vascular resistance (2.1 units) as a result of unloading. Those with mitral regurgitation continued to have pulmonary hypertension (28 torr) and increased pulmonary vascular resistance (3.9 units) despite vasodilator therapy. Thus the data suggest that patients with mitral regurgitation derived less hemodynamic benefit from intraoperative nitroprusside therapy because they were also limited by right ventricular dysfunction and a less responsive pulmonary vasculature.

Adult↗
PubMed1984

Infarct size as a determinant of acute and long-term prognosis.

Enzymatic estimates of infarct size based on the analysis of either plasma total or CK-MB activity are substantially larger in patients who succumb to myocardial infarction compared with survivors. Similarly, if patients are stratified according to infarct size calculations, mortality increases as infarct size increases. Enzymatic markers of infarction are closely related to other indicators of prognosis, including infarct type (transmural versus nontransmural), infarct location (anterior versus inferior), the degree of left and right ventricular dysfunction, and the frequency of ventricular dysrhythmia. Hence, at least some of the prognostic impact of these variables may be due to the initial extent of infarction sustained. Multivariate analysis has been employed by several groups to analyze the independent contribution of these clinical descriptors to prognosis after infarction. These analyses have consistently indicated a substantial independent impact of enzymatic estimates of infarct size on prognosis. In studies of patients with initial myocardial infarction, infarct size index calculated from total plasma CK time activity curves had the greatest independent influence on survival. Unfortunately, the utility of enzymatic estimates of infarction as prognostic indicators in individual patients is attenuated by alterations in the strength of the apparent association between CK infarct size and prognosis in specific clinical situations. Thrombolytic therapy is now employed with increasing frequency during acute myocardial infarction. It has become abundantly clear that plasma CK release kinetics are profoundly modified by this procedure. Peak plasma total and CK-MB activity is markedly increased compared with that of patients undergoing routine therapy for infarction, with a profoundly altered CK time activity curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Creatine Kinase↗
PubMed1983

[Long-term evolution of children operated on for tetralogy of Fallot].

While open heart surgery has much improved the prognosis of tetralogy of Fallot, surgical repair does not usually restore completely normal anatomy. Residual defects include some degree of pulmonary stenosis, pulmonary regurgitation (unavoidable if the pulmonic valve and valve ring need to be widened by patch), and, sometimes, residual ventricular septal defect. In addition, left and right ventricular dysfunction of mild to moderate degree, unrelated to residual lesions, may be observed. Other late complications may arise from conduction disturbances and ventricular arrhythmias. The occurrence of late sudden death is related to such rhythm disturbances, it occurs particularly in patients with ventricular premature beats on routine ECGs and is probably due to ventricular fibrillation. Patients with such premature beats must therefore be treated with antiarrhythmic drugs. In spite of these late complications, the majority of patients lead a normal life and professional integration is usually excellent. Many patients practise sports. Exercise tests late after surgery show mild or moderate decrease in maximal exercise performance if there are residual lesions of significance, and especially when there is more than one such residua (e.g. pulmonic stenosis and regurgitation). Life expectancy should be normal, at least for postoperative patients with minimal residual lesions.

Age Factors↗
PubMed1983

[Clinical and pathophysiological study of myocardial contusion].

Myocardial contusion was observed in 25 patients (7.5%) out of 333 blunt chest trauma victims. As the cause of injury, 19 patients (76%) were due to traffic accident and 12 out of 19 patients had steering wheel injuries. There were a total of 72 associated thoracic injuries, and this means 2.9 injuries for each patient. As ECG abnormalities, sinus tachycardia on admission and ST, T change in time course were mostly found in this series. Chest X-ray findings revealed the maximum value (55.2 +/- 1.3%) of CTR (cardio-thoracic ratio) on the 2nd-4th hospital days, followed the decreasing tendency. CPK-MB showed its peak on the 1st-3rd hospital days, and was nearly normalized on the 5th hospital day. There were 10 expired cases, and the mortality was 40%. Cardiac death due to cardiac tamponade or cardiogenic shock was observed in 4 cases. Ventricular function study showed 2 right ventricular dysfunction. 1 left ventricular dysfunction, and 4 biventricular dysfunction, and showed extremely poor prognosis in the biventricular dysfunction group. The cases of myocardial contusion were classified into the following 3 types by the clinical findings. Type I: ECG abnormality type 13 cases; Type II: Cardiac tamponade type 7 cases; Type III: Cardiogenic shock type 6 cases. I conclude that measuring the ventricular function is useful for the evaluation of the severity and prognosis of myocardial contusion if the blunt chest trauma victim is in shock state.

Adolescent↗
PubMed1984

Results of the Senning operation for transposition of the great arteries with intact ventricular septum in neonates.

In spite of an adequate balloon atrial septostomy, some neonates (less than 28 days of age) with transposition of the great arteries and intact ventricular septum (TGA, IVS) remain hypoxemic and acidotic and require operative treatment. Our entire experience with the Senning operation in neonates with TGA, IVS is reviewed. From March 1978 to March 1983 there were 104 infants who underwent the Senning operation for TGA, IVS. Of these, 19 were neonates (18%). The mean age at operation was 12 days (2 to 24) and mean weight was 3.52 kg (3 to 4.38). Two died early (10%) and one died late (5%). The last 16 are alive and well. Causes of early mortality were sepsis and severe obstruction of the superior vena cava. The cause of late mortality was severe pulmonary venous obstruction. Among the 16 survivors, postoperative courses, both early and late, have been remarkably benign. Ten patients have undergone postoperative cardiac catheterization (mean follow up 17 months). Two (12%) had severe pulmonary venous obstruction (one diagnosed by two-dimensional echocardiography), but both were successfully repaired. Atrial shunt was noted in two patients (12%), one of which underwent elective repair. Five infants have dynamic subvalvular pulmonary stenosis of various gradients (9 to 93 mm Hg). One infant has mild tricuspid regurgitation. There are no cases of superior vena caval obstruction or right ventricular dysfunction. Twenty-four hour electrocardiographic monitoring (mean follow-up 25 months) showed predominant normal sinus rhythm in 15 infants and predominant junctional rhythm in one.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1983

The influence of pulmonary insufficiency on ventricular function following repair of tetralogy of Fallot. Evaluation using radionuclide ventriculography.

Long-standing pulmonary insufficiency after repair of tetralogy of Fallot may adversely affect ventricular function. We evaluated 20 patients at a mean of 9 years after repair by radionuclide ventriculography, 24 hour Holter monitoring, and M-mode echocardiography. The mean age at complete repair was 7.1 +/- 2.6 years. Patients were divided into groups as follows: Group I (eight patients), no clinical pulmonary insufficiency; Group II (12 patients), moderate to severe pulmonary insufficiency. Group II was further divided: Group IIa, transannular patch (six patients); Group IIb, no transannular patch (six patients). There was no difference between groups for age at operation, duration of follow-up, right ventricular pressure, or right ventricular-pulmonary arterial gradient. No patient had a residual shunt and all were in New York Heart Association Class I. Serious ventricular dysrhythmias occurred in 38% of Group I patients and 50% of Group II (p = NS). The echocardiographic ratio of right to left ventricular end-diastolic dimension was greater in patients with pulmonary insufficiency than in those without pulmonary insufficiency: 0.83 +/- 0.17 versus 0.55 +/- 0.15, p less than 0.01. Right ventricular ejection fraction was 0.39 +/- 0.08 in Group I and 0.27 +/- 0.07 in Group II, p less than 0.01. Left ventricular ejection fraction was 0.64 +/- 0.12 in Group I and 0.53 +/- 0.07 in Group II, p less than 0.02. Radionuclide angiography is a useful means of identifying right ventricular dysfunction following repair of tetralogy of Fallot. The dysfunction appears significantly worse in patients with pulmonary insufficiency.

Adolescent↗
PubMed1981

[Acute myocardial infarction of the right ventricle: hemodynamic and electrocardiographic correlation (author's transl)].

The electrocardiogram as a diagnostic aid in acute myocardial infarction of the right ventricle (AMI-RV) was studied prospectively in a group of 66 patients in our coronary unit. Diagnosis was AMI in all cases, divided into 29 (44%) with posterior-descending and 35 (53%) with anterior location. Electrocardiography was practiced with standard and special modes: CRnR, CR and VR. Thirty-nine patients were hemodynamically monitored. In 13 patients with posterior-descending location (19.6%) the hemodynamic pattern disclosed AMI. Right ventricular dysfunction was found in 17%, left ventricular dysfunction in 9% and biventricular dysfunction in 20%. In 30 patients (45.5%) ST increased to greater than 1 mm CR3R-CR6R of which 77% were false positive and 46% false negative. No improvement in these proportions was observed with the use of special mode, special in infarctions with anterior location. The correlation between hemodynamics-site of necrosis was better than that between hemodynamics-increase in ST in CRnR. The authors draw the conclusion that special modes as an aid to diagnosis are of limited value, sensitivity is 54% and specificity is 23%, which rises to 50% in posterior-descending infarctions. At present hemodynamics are the choice diagnostic procedure for AMI-RV which must be suspected if serial studies disclose PVC of more than 9 mm Hg.

Electrocardiography↗
PubMed1995

Intravascular bronchioloalveolar tumor of the lung presenting as pulmonary thromboembolic disease and pulmonary hypertension.

Intravascular bronchioloalveolar tumor, the pulmonary counterpart of epithelioid hemangioendothelioma, typically presents as bilateral pulmonary nodules in young women. We report a case of intravascular bronchioloalveolar tumor that clinically mimicked acute pulmonary thromboembolic disease initially and was subsequently proven to have pulmonary hypertension with right ventricular dysfunction by angiography. The diagnosis of intravascular bronchioloalveolar tumor was confirmed by immunohistochemical and ultrastructural studies after it was suspected on routine histologic examination. In addition, the tumor cells expressed glycoprotein cell adhesion molecule CD44, which has been implicated in increased tumor invasiveness and metastasis in various carcinomas and several aggressive non-Hodgkin's lymphomas.

Carrier Proteins↗
PubMedDate not supplied

Thrombolysis in pulmonary embolism: an adolescent with protein S deficiency.

Because of the low incidence of pulmonary embolism in children, the therapeutic approach is extrapolated from guidelines for adults. An adolescent boy with a massive pulmonary embolism associated with protein S deficiency was cared for successfully with intravenous thrombolytic therapy using 1.3 mg/kg of rt-PA with a 2-hour infusion time. In the absence of contraindications, most physicians consider using thrombolytic drugs in hemodynamically unstable patients who have a pulmonary embolism. A recent study described a subset of hemodynamically stable patients with right-ventricular dysfunction who also might benefit from thrombolytic therapy.

Adolescent↗
PubMed1993

[Diuretics in the treatment of heart failure].

Diuretics, together with other drugs and general measures, are of prime importance in the medical treatment of most heart failure patients, namely those with acute pulmonary oedema and overt congestive heart failure. Their beneficial effects result not only from preload and afterload reduction, but also because diuretics are able to improve responses to nitrates and ACE-inhibitors. The appropriate utilisation of diuretics in heart failure therapy frequently involves the use of efficient small doses and drug associations, namely between loop diuretics, thiazides, potassium sparing agents and spirolactone. Physicians must choose the drug carefully, its dosage, time and route of administration, according to the patient's characteristics: heart failure clinical syndrome, age, activity level, systolic or diastolic, left or right ventricular dysfunction, and associated diseases. The role of diuretics in the treatment asymptomatic systolic left ventricular dysfunction and oligosymptomatic diastolic ventricular dysfunction is unclear and should remain under investigation; diuretics may be of benefit in treating those patients with associated diseases, for example arterial hypertension and mild chronic renal failure.

Diuretics↗
PubMed1993

[Surgery for Wolff-Parkinson-White syndrome in the first year of life].

A case of surgical treatment for reentrant atrioventricular tachycardia in a 7 months old child is reported. Episodes of tachycardia were repetitive and long-lasting, often leading to signs of hemodynamic impairement, and were not controlled by antiarrhythmic drugs. The electrophysiologic study showed a circus-movement tachycardia utilizing a concealed accessory pathway located at the anterior septal aspect of tricuspid anulus. The child underwent successful surgical treatment by the endocardial technique. Few minutes after weaning from extracorporeal circulation, developed T wave inversion followed by acute right ventricular dysfunction and ventricular fibrillation. Others ischemic like episodes, maybe as a result of coronary artery spasm, occurring in the next 6 hours were successfully treated with isosorbide dinitrate. At 18 months follow-up, the child is free of tachycardia and has normal atrioventricular conduction.

Electrocardiography↗