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PubMed1982

[Right and left ventricular systolic time intervals in patients with atrial septal defect measured by the ultrasonic Doppler method].

Noninvasive measurement of right and left ventricular systolic time intervals (STIs) was made utilizing ultrasonic Doppler method in 35 patients with secundum atrial septal defect (ASD) to evaluate their hemodynamic states. Using the Doppler signals relating to the opening and closure of the pulmonary and aortic valves, both right and left ventricular preejection periods (RPEP, LPEP) and ejection times (RVET, LVET) were measured. The same studies were carried out in 50 control healthy subjects. In patients of ASD without pulmonary hypertension (mean pulmonary arterial pressure less than 20 mmHg), RPEP did not differ significantly from that of healthy subjects, while RVET was significantly prolonged reflecting right ventricular volume overloading. In patients with pulmonary hypertension (mean pulmonary arterial pressure greater than or equal to 20 mmHg), RPEP was prolonged and RPEP/RVET was significantly higher than those in healthy subjects. These two parameters were correlated well with pulmonary arterial pressure. In both groups LVET was shorter and LPEP/LVET was larger than those of normal, suggesting low output state of the left ventricle. In 5 surgical cases, LVET was prolonged and LPEP/LVET decreased after operation, while the right ventricular STIs did not change significantly. With the pulmonary to systemic flow ratio (Qp/Qs), only RVET/LVET was correlated significantly, but with poor correlation coefficient (r = 0.47, p less than 0.01). These data may suggest that noninvasive measurement of combined right and left ventricular STIs is useful to assess the hemodynamic states of ASD, especially for evaluation of associated pulmonary hypertension.

Adolescent↗
PubMed1977

Monocytic differentiation of cluster cells in agar culture of normal human bone marrow. A cytochemical investigation.

A cytochemical investigation was carried out on the cells that make up the clusters forming in agar cultures of normal human bone marrow after 3, 4, and 5 days of incubation. All the clusters were found to comprise young monocytes that were PAS, peroxidase, Sudan Black, and alpha-naphthyl and naphthol-ASD-acetate esterase positive. Lysozyme activity, investigated by the cytobacterial test, was absent in all cases. After 3 days of incubation a large number of pairs of lymphomonocytes or monocytes with the same cytochemical characteristics were observed. When a method of double esterase incubation (alpha-naphthyl or naphthol-ASD-acetate and naphthol-ASD-chloroacetate) was performed on the same slide, no cells of the granulocytic line or intermediate cells between these and the monocytes were observed in any of the clusters. These results indicate that there is direct monocytic differentiation of the colony-forming cells cultured. The origins and stages observed in the maturation of the monocytes are discussed.

Agar↗
PubMed1980

[Reconstruction of underdeveloped right ventricle and tricuspid hypoplasia (author's transl)].

Total correction of underdeveloped right ventricle related to tricuspid hypoplasia has been performed in 6 patients at the department of thoracic and cardiovascular surgery University Göttingen. In 5 patients reconstruction of a four-chamber-four-valved heart could be accomplished. 1 patient with a poor result after Fontan's operation, performed one year previously, showed a significant growth in size of the hypoplastic right ventricle in the postoperative angiogram, but died 14 hours after reoperation. Prior to corrective surgery, 4 patients required 1 or 2 palliative procedures: 3 Glenn- and 2 Blalock-Taussig operations and a pulmonary valvulotomy in 1 patient. A Hancock-valved conduit was inserted between the right atrium and the hypoplastic right ventricle as an inlet of this chamber after closure of the ASD and VSD in 4 patients. The conduits are bypassing the hypoplastic tricuspid valve orifices closed during corrective surgery. In the remainder 2 patients with moderate tricuspid and right ventricle hypoplasia, closure of the ASD was performed only. Anomalous muscle bundles and fibrous tissue inside the right ventricular cavity were resected surgically, safely. 4 to 12 months after corrective surgery the 5 survivors were investigated by cardiac catheterization. In the 3 patients operated with a valved conduit there was a moderate growth in size of the hypoplastic right ventricle, the right atrial pressure was elevated and ranged from p = 14 to 16 mm Hg. There was a slight right atrial-right ventricular gradient of 4 mm Hg across the valved conduit. The 2 patients with closure of the ASD and VSD only had a nearly normal-sized right ventricle and a right atrial pressure of p = 10 mm Hg or less at the postoperative right ventricle and a right atrial pressure of p = 10 mm Hg or less at the postoperative investigation. All of them were acyanotic and had an improved or normal exercise tolerance. We concluded that reconstruction of an underdeveloped right ventricle in well-selected cases will yield more physiological benefits than do current surgical procedures, in which a conduit is interposed between the right atrium and the main pulmonary artery.

Adolescent↗
PubMed1981

[Ostium secundum atrial septal defect: report of a case with atypical auscultatory findings (author's transl)].

The wide and persistent splitting of S2 is commonly considered the auscultatory hallmark of uncomplicated ostium secundum atrial septal defect (ASD). We have recently observed a 31-year-old female with a variable splitting of S2 and a 2/6 systolic murmur at the second left intercostal space, who showed incomplete right bundle branch block on the ECG and normal heart shadow with increased pulmonary vascular markings on the chest film. Cardiac catheterization revealed an isolated ostium secundum atrial septal defect with significant left-to-right shunt, normal pulmonary pressures and normal ventricular function. Subsequently the patient underwent closure with patch of the ASD without complications. We feel our case is of interest since it demonstrates that the absence of a wide and persistent splitting of S2 in adults does not exclude the diagnosis of uncomplicated "ostium secundum" ASD, when ECG and x-ray findings suggest the disease.

Adult↗
PubMed1980

The role of reduced left ventricular enddiastolic volume in the apparently high prevalence of mitral valve prolapse in atrial septal defect.

Twenty-three patients with ostium-secundum atrial septal defect (ASD) were studied in order to investigate the etiology of angiographic mitral valve prolapse associated with ostium-secundum ASD. 12 patients (52%) had angiograhic MVP. Ventricular volumes, ejection fraction, segmentary contractility and oxygen step-up were analyzed in all patients. Patients with MVP had smaller enddiastolic and stroke volumes (73 +/- 21.8 ml/m2 and 46.6 +/- 18 ml/beat/m2) than patients without MVP (106.6 +/- 22 ml/m2 and 78 +/- 11.3 ml/beat/m2) (P less than 0.01). Oxygen step-up was greater in patients with MVP (P less than 0.05). No consistent differences in ejection fraction and segmentary contractility were found. Our findings suggest that angiographic MVP associated with ostium-secundum ASD is a functional disorder due to reduced left ventricular enddiastolic volume secondary to the atrial shunt.

Adolescent↗
PubMed1995

[A successful surgical case of bilateral partial anomalous pulmonary venous connection without atrial septal defect].

We performed the new operative method for bilateral partial anomalous pulmonary connections (PAPVC) without atrial septal defect (ASD). A 11-years-old boy was admitted for operation. The right upper pulmonary vein returned to the superior vena cave (SVC), and left upper pulmonary vein returned to the innominate vein. Atrial septum was intact. The Qp/Qs was 1.94. The right atrium (RA) was opened and ASD was created. Continuity between the distal end of the SVC and RA was re-established by end-to-end anastomosis to the right atrial appendage. The proximal end of the SVC was closed. The right anomalous pulmonary vein remained in situ on the lower segment of SVC, blood being directed to the left atrium (LA) through the created ASD by suturing the posterior flap of RA incision to the atrial septum well away from the sinoatrial node and artery, anomalous pulmonary vein and cavoatrial junction. The anomalous left vertical vein was dissected up to the innominate vein. The left pulmonary vein was mobilized as much as possible, and was anastomosed to the posterior wall of LA by end-to-side fashion. He has normal sinus rhythm and no evidence of pulmonary venous obstructions on both sides. We support the efficacy of this method as an alternative in the management of this disorder.

Brachiocephalic Veins↗
PubMed1994

[Cardiopulmonary capacity of patients with congenital heart defects in childhood, adolescence and adulthood].

Cardiopulmonary exercise capacity is a significant criterion of life quality. The evaluation of the exercise capacity is important to answer patient-questions concerning every day activity, choice of profession, sports-activity etc. We performed cardiopulmonary exercise testing in 38 patients (age 33.6 +/- 12.0 years, 18 women, 20 men) with different congenital heart disease (5 after surgical repair of tetralogy of fallot, 2 after Mustard-operation in transposition of the great arteries (TGA), 1 single ventricle, 14 atrial septal defect (ASD), 8 ventricular septal defect (VSD), 8 pulmonary valve stenosis (PS)) during outpatient routine control. All tests were performed on upright bicycle with continuous ramp program of 20 Watt increase/minute. Ventilatory values as O2-uptake, CO2-production, minute ventilation (VE) were measured breath-by-breath. Max. VO2 was reduced as average value for every patient group (tetralogy of fallot 60.2 +/- 20.3% pred., TGA 53.0 +/- 0.0% pred., single ventricle 35% pred., closed ASD 71.9 +/- 23.8% pred., ASD 62.7 +/- 30.0% pred., VSD 64.1 +/- 11.7% pred., PS 73.2 +/- 16.0% pred.). Anaerobic threshold was reduced in tetralogy of fallot (35.9 +/- 12.2% pred. max. VO2) and in single ventricle (28.3% pred. max. VO2). In comparison with clinical classification of exercise capacity we found for max. VO2 differences in 23/38 patients. 22/23 patients reported no exercise limitation but had reduced max. VO2. One patient had a normal max. VO 2 but complaints of exercise dyspnoea. For anaerobic threshold 18/38 patients had discrepancies in objective and subjective estimation of their exercise capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Still's disease in the adult].

The adult Still's disease (ASD) is an uncommon inflammatory systemic disorder which affects the young adult. It is characterized by high spiking fever, vanishing rash, oligopolyarthritis, neutrophilic leucocytosis, negative titers for rheumatoid factor and antinuclear antibodies. Polyserositis, sore throat, uveitis are sometimes present and in one third of the cases it is possible to find hepato-splenomegaly with lymph node enlargement. G. Still first described the disease in child, in 1897, and in the adult it was recognized as a nosologic entity more than 70 years later. The ASD diagnosis is difficult and it is possible after the exclusion of many other diseases. Clinical manifestation are all nonspecific. In particular the presence of adenopathy, hepato-splenomegaly may suggest the possibility of a malignant lymphoma. Important exclusions include many other diseases such as the rheumatic fever, periodic fever, Lyme disease. At the same time a probable diagnosis of ASD should be considered in all the cases of high fever with rash, arthritis, neutrophilic leucocytosis or in the cases of fever of unknown origin (FUO). The prognosis is considered overall benign. The disease is usually sensible to salicylate treatment, even but the association with corticosteroids or, sometimes, with cytotoxic therapy is often required.

Adult↗
PubMed1993

[Reoperations for recurrent atrial septal defect].

The authors discuss seven cases of recurrent atrial septal defect (ASD) without an inferior border which were treated by surgery. A typical clinical picture of the anomaly with arterial hypoxemia being the leading symptom was encountered in all cases. The main cause of the complications was overestimation of the indications for Lewis' operation, i.e. ASD suturation. A good clinical result was produced in all cases of a repeated intervention with ASD repair with a graft.

Adolescent↗
PubMed1993

Symptomatic atrial septal defect in infancy.

Isolated ostium secundum atrial septal defect (OS-ASD) may rarely lead to severe symptoms in infancy. Over a period of four years, 12 infants admitted to our hospital with severe congestive heart failure had an isolated OS-ASD. Their echocardiographic findings, clinical course, and outcome were outlined. All 12 infants had atypical findings including a holosystolic murmur parasternally and absence of wide fixed splitting of the second heart sound, and none were clinically suspected to have an ASD. M-mode echocardiography in all infants showed a greater than normal diastolic right ventricular internal diameter in the absence of pulmonary hypertension, indicating an increased right ventricular distensibility. Ten out of 12 infants responded well to medical decongestive treatment, and none developed pulmonary hypertension. Two infants who failed to improve with drugs, successfully underwent surgical closure, while two other infants revealed clinical and echocardiographic evidence of spontaneous closure.

Echocardiography↗
PubMed1994

[Changes in left ventricular pressure volume loop of Lutembacher syndrome].

A 49-year-old woman with Lutembacher syndrome, atrial septal defect (ASD), mitral stenosis (MS), tricuspid regurgitation and cardiac cachexia underwent a mitral valve replacement with a 27 mm CarboMedics valve, patch closure of ASD and tricuspid annuloplasty to 29 mm by DeVega's method. The pressure volume loop (PV loop) was measured, both preoperatively and postoperatively (immediately and two months after the operation) by a Miller catheter and echocardiogram. The left ventricular stroke work (LVSW), left ventricular end diastolic volume (LVEDV) and left ventricular end diastolic pressure (LVEDP) markedly increased immediately after the operation. LVSW and LVEDV further increased, whereas LVEDP decreased with improvements in diastolic compliance two months after the operation. It was likely that those change of LV function was a sum of simple ASD and MS both of which have similar but less significant characters than Lutembacher syndrome.

Cachexia↗
PubMed1993

[Pulmonary venous obstruction after repair of total anomalous pulmonary venous drainage: report of a case with reoperation].

A 8-month-old infant with Darling' type Ib of total anomalous pulmonary venous drainage underwent surgical correction. Common pulmonary vein drained into superior vena cava. Pulmonary venous channel was constructed between orifice of common pulmonary vein and atrial septal defect (ASD) with pericardial baffle drainage. Pulmonary venous obstruction occurred at the site of ASD and pericardial baffle was atrophic. ASD was enlarged and new pulmonary venous channel was reconstructed with EPTFE graft. Post-reoperative clinical course was uneventful.

Female↗
PubMed1993

[Re-operation for total anomalous pulmonary venous connection twelve years after radical operation].

Thirty five-year-old man required reoperation, twelve years after radical operation of total anomalous pulmonary venous connection (Darling IIb type), because of the clinically apparent pulmonary venous obstruction. The stenosis of ASD was revealed by cineangiocardiography and echocardiography. The fibrous thickening of atrial septal wall and stenosis of ASD were found at the operation. Operating procedure consisted of the enlargement of ASD and cut-back of the atrial septal wall. Postoperative study showed no evidence of stenosis of pulmonary venous return. The patient was discharged well and returned to his job. Late postoperative pulmonary venous obstruction is of particular concern. Usually it occurs within the first few postoperative months. We reported this case because it is rare that pulmonary venous obstruction occurred twelve years after radical operation.

Adult↗
PubMed1993

[Surgical repair of total anomalous pulmonary venous drainage--four adult cases of successful operation].

We have experienced four adult cases of total anomalous pulmonary venous drainage (TAPVD). They were three females and one male, age between 18-51 with a mean of 33.8. In Darling's classification, they constituted of three cases of type Ia and one type IV. Cardiac catheterization revealed 1.71-5.93 with a mean of 3.92 in Qp/Qs and 0.34-0.49 with a mean of 0.38 in Pp/Ps. The pulmonary to systemic resistance ratio (Rp/Rs) was then calculated as 0.02-0.15 with a mean of 0.09. All cases showed short route type of drainage vein in pulmonary arteriography. None of them had stenosis or obstruction in the drainage veins. The operation was composed of anastomosis between the left atrium and the common pulmonary vein, closure of the atrial septal defect (ASD), and ligation of the drainage vein. Gersony-Malm's method was adopted in two cases and the posterior approach in two cases in anastomoses between the left atrium and the common pulmonary vein. Intraatrial approach combined with posterior approach was tried in a case with small left atrium. The mean size of ASD was 43 mm (35-55 mm) in diameter. Patch closure was performed in three cases. Important factors in survival for adult TAPVD are large ASD and short route type drainage vein without stenosis. All of four cases had good results. The operation method is variable and an easier approach must be adopted.

Adolescent↗
PubMed1993

[Surgical treatment of total left anomalous pulmonary venous connection to the coronary sinus without atrial septal defect].

Surgical repair of total left anomalous pulmonary venous connection to coronary sinus without atrial septal defect (ASD), a very rare situation, was recently conducted. A 13-year-old girl was diagnosed as ASD. Two-dimensional echocardiography, however, indicated enlarged coronary sinus preoperatively. During operation the absence of ASD and drainage of total left pulmonary veins into the coronary sinus were observed. The operation was conducted by the method of Van-Praagh. The coronary sinus was closed to divert pulmonary venous blood to the left atrium, while maintaining coronary venous return to the right atrium. The postoperative course was uneventful and cardiac catheterization showed satisfactory results.

Adolescent↗
PubMed1996

[Surgical repair of atrial septal defect and tricuspid regurgitation in a 79-year-old man: a case report].

A 79-year-old man with atrial septal defect (ASD) and tricuspid regurgitation was successfully operated upon. Preoperative examinations showed atrial fibrillation, moderate pulmonary hypertension and lung dysfunction. Direct closure of the ASD accompanying with tricuspid annuloplasty was performed. Postoperative administration of catecholamines continued for twenty-six days to maintain hemodynamics. An intratracheal tube was extubated two days after the operation. However, an additional respiratory support using a nasal continuous positive airway pressure method was required for six days. His postoperative physical activity has been improved with class I of the New York Heart Association classification. Surgical intervention may be the treatment of choice for aged patients over 70 years with an ASD.

Aged↗
PubMed1996

[Surgical repair of atrial septal defect in patients over 70 years of age].

Three patients over 70 years of age underwent surgical repair of secundum atrial septal defect (ASD). All patients had preoperative symptoms such as heart failure, atrial fibrillation and cardiomegaly. According to the New York Heart Association (NYHA) functional classification, two patients belonged to class II and one class III. Cardiac catheterization data revealed mild pulmonary hypertension and mild to moderate tricuspid regurgitation in all the patients. An ASD was directly closed in all the patients, and two of them required tricuspid anuloplasty. The use of catecholamine continued for two or three weeks in two patients because of postoperative cardiac dysfunction. Postoperative physical activity has improved in all the patients. Surgical repair of an ASD is recommended even for patients over 70 years of age unless they have major risks and severe pulmonary hypertension.

Aged↗
PubMed1996

[Catheter closure in atrial septal defects and open foramen ovale using the Sideris buttoned device].

Percutaneous nonsurgical closure is an alternative to surgical repair of a significant atrial septal defect (ASD) or a patent foramen ovale (PFO) associated with systemic embolism without other cause. We report the results of the first 35 patients (19 ASDs, 16 PFOs) in whom transcatheter closure was attempted. Diagnosis and follow-up were based on transesophageal echocardiography in the majority of cases. In all patients the "Sideris buttoned device" was used. A total of 19 patients (13 women) were treated for symptomatic ASD of the secundum type. The mean defect size before the intervention was 17 mm by echocardiography and 24 mm measured by balloon in the catheterization laboratory (stretched diameter) with a reduction to 4 mm after treatment measured by echocardiography. A total of 16 patients (5 women) underwent transcatheter closure of a PFO; 14 patients had had cerebral embolic events and 2 peripheral. During follow-up of 104 patient months, only one patient had a recurrent embolic event. He had at that time no occluder protecting the PFO after early embolization and extraction of the device.

Adolescent↗