RESUMEN
Objectives.In cardiovascular magnetic resonance, the 3D time-resolved phase-contrast technique, also known as 4D flow, is gaining increasing attention due to applications that exploit three-directional velocity encoding throughout the cardiac cycle. Blood flow volume assessment usually requires an expert to draw regions of interest (ROI) around the vessel cross section, whereas the errors involved in this estimation have not been thoroughly investigated. Our objective is to quantify the influence of ROI sizing, angulation and spatial resolution of the reconstructed plane employed in blood flow measurements using 4D flow.Approach.Three circular ROIs were drawn around the ascending, arch and descending aorta of healthy volunteers (n= 27) and patients with a dilated ascending aorta or bicuspid valve (n= 37). We applied systematic changes of ROI diameter (up to ±10%), tilt angle (up to ±25°) and spatial resolution (from 0.25 to 2 mm) of the reconstructed oblique planes, calculating the effects on net, forward and backward blood flow volumes.Main results.Patients had a larger ascending aorta than healthy volunteers with similar ages and male sex proportion (60 ± 15 y.o. vs 58 ± 16 y.o. and 84% vs 70%, respectively). Higher forward and backward flow volumes were observed in the ascending aorta and the aortic arch of the patients with respect to controls (p< 0.001), whereas net volumes were similar: 74.0 ± 20.8 ml versus 75.7 ± 21.8 ml (p= 0.37), respectively. The ascending aorta was the most sensitive to ROI modifications. Changes of ±10% in the ROI diameter and ±25° in tilt angles produced flow volume differences of up to 9 ml (10%) and 18 ml (15%) in controls and patients, respectively. Modifying the reconstructed planes spatial resolution produced flow volume changes below 2 ml.Significance.Since the setting of the ROI size and plane angle could produce errors that represent up to 20% of the forward and/or backward aortic flow volume, a good standardization for vessel segmentation and plane positioning is desirable.
Asunto(s)
Aorta , Imagen por Resonancia Magnética , Aorta/diagnóstico por imagen , Aorta Torácica , Válvula Aórtica , Velocidad del Flujo Sanguíneo , Humanos , Imagenología Tridimensional , Masculino , Flujo Sanguíneo RegionalRESUMEN
Between 1983-1988 cross-sectional echocardiography was performed in 63 patients having an atrioventricular septal defect with common atrioventricular orifice. We excluded from this study all those patients with separate right and left orifices ("ostium primum" defects), those with isomerism of the right and left atrial appendages, those with univentricular atrioventricular connexions and those with discordant atrioventricular and ventriculo-arterial connexions. Parasternal long- and short-axis views, apical 4-chamber views and subcostal long-axis views were employed in all patients. In the last 26 cases, we also obtained the subcostal short-axis view. Nineteen patients showed ventricular dominance, with the right ventricle being dominant in 15. Ten patients had an associated defect in the oval fossa, while the atrial septum was partially or completely absent in the other 53. A ventricular septal defect was observed in all, but it was small in 10 and multiple in 2. Attachments of the superior and inferior bridging leaflets to the crest or the right side of the ventricular septum were seen in 32 cases. The inferior leaflet was hypoplastic in 19 patients. There was narrowing of the left ventricular outflow tract in 8 patients, and obstruction of the right ventricular outflow tract in 3. Abnormal attachment of the right portion of the common valvar orifice was present in 2 cases. A solitary papillary muscle supporting the left ventricular component of the common valve was seen in 6 cases producing a parachute-like arrangement. Our study shows that cross-sectional echocardiography is an excellent technique for the analysis of this anomaly.
Asunto(s)
Ecocardiografía , Defectos de la Almohadilla Endocárdica/diagnóstico , Defectos de los Tabiques Cardíacos/diagnóstico , Preescolar , Femenino , Defectos del Tabique Interventricular/diagnóstico , Humanos , Lactante , Recién Nacido , MasculinoRESUMEN
A 5.5-week-old infant with tricuspid atresia presented with severe hypoxemia not responding to the placement of a central shunt (4 mm polytetrafluorethylene). The infant was taken to the catheterization laboratory, where an AVE stent was successfully implanted in a severe postoperative stenosis, at the pulmonary end of the anastomosis. The oxygen saturation improved significantly, however, the infant died due to renal failure. The post-mortem anatomical findings are shown.
Asunto(s)
Aorta/cirugía , Derivación Arteriovenosa Quirúrgica , Arteria Pulmonar/cirugía , Stents , Atresia Tricúspide/terapia , Aortografía , Resultado Fatal , Humanos , Recién Nacido , Masculino , Politetrafluoroetileno , Retratamiento , Atresia Tricúspide/cirugíaRESUMEN
Heart involvement is usually the cause of death in patients with carcinoid syndrome, who may survive a long time even after the disease has entered an advanced stage. For this reason, carcinoid heart disease patients have undergone surgical replacement of affected valves. Two of our patients were not good candidates for surgery, due to the extent of hepatic metastasis. Alternatively, we performed percutaneous balloon valvuloplasty on both the tricuspid and pulmonary valves in both patients. To our knowledge, there has been only 1 previous report of successful tricuspid valvuloplasty in a case of carcinoid heart disease, and this did not involve concomitant pulmonary valvuloplasty. Before the procedure, both of our patients had low cardiac output with restriction in the right ventricle, pulmonary and tricuspid stenosis, and moderate tricuspid regurgitation. In the 1st patient, valvuloplasty reduced tricuspid and pulmonary gradients without change in cardiac output. This patient experienced initial clinical improvement but died 8 months after the procedure, of portal hypertension and extensive hepatic metastasis. The 2nd patient showed notably diminished gradients and a very significant increase in cardiac output. She advanced from New York Heart Association functional class IV to class I, and is now maintained with diuretic therapy. In our judgment, balloon valvuloplasty is a sound alternative to surgery for patients with carcinoid heart disease, especially when stenosis is the dominant symptom. Valvuloplasty is contraindicated in cases of severe tricuspid regurgitation.
Asunto(s)
Cardiopatía Carcinoide/terapia , Cateterismo , Estenosis de la Válvula Pulmonar/terapia , Estenosis de la Válvula Tricúspide/terapia , Adulto , Cardiopatía Carcinoide/fisiopatología , Femenino , Hemodinámica , Humanos , Persona de Mediana Edad , Estenosis de la Válvula Pulmonar/etiología , Estenosis de la Válvula Pulmonar/fisiopatología , Estenosis de la Válvula Tricúspide/etiología , Estenosis de la Válvula Tricúspide/fisiopatologíaRESUMEN
We report the case of a 56-year-old woman with congenital coarctation of the aorta, who presented in critical clinical condition with advanced secondary cardiomyopathy and heart failure. We successfully applied an unusual technique to pass the aortic obstruction, and then implanted a PALMAZ stent. The procedure resulted in prompt clinical improvement and completely resolved the coarctation. The patient's improved clinical condition was still evident 11 months after the procedure.
Asunto(s)
Coartación Aórtica/terapia , Insuficiencia Cardíaca/complicaciones , Stents , Coartación Aórtica/complicaciones , Coartación Aórtica/diagnóstico por imagen , Cateterismo Cardíaco , Cateterismo , Angiografía Coronaria , Femenino , Humanos , Persona de Mediana EdadRESUMEN
We report a 51-year-old patient, diagnosed with single left ventricle and anterior rudimentary chamber which was corrected by a Fontan procedure in 1997. The echocardiogram, Holter and pulmonary perfusion scintigraphy, isotopic ventriculography, magnetic resonance and blood tests performed during follow-up showed an uncomplicated postoperative course. The patient remains asymptomatic. We believe that this is the oldest case suffering from this anomaly who underwent surgical repair.
Asunto(s)
Cardiopatías Congénitas/cirugía , Femenino , Cardiopatías Congénitas/patología , Ventrículos Cardíacos/anomalías , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Persona de Mediana Edad , Función Ventricular Izquierda/fisiologíaRESUMEN
The coarctation of the aorta can be acquired or secondary to the surgical correction of congenital anomalies of the great vessels. We report the cases of two newborns operated for patency of the ductus arteriosus (normal aortic arch and a great left-to-right-shunt). During the postoperative period the patients were asymptomatic and the echocardiogram showed no abnormalities. Later, both patients developed coarctation of the aorta. This is the first report of this condition during the neonatal period.
Asunto(s)
Coartación Aórtica/etiología , Conducto Arterioso Permeable/cirugía , Recien Nacido Prematuro , Complicaciones Posoperatorias/etiología , Femenino , Humanos , Recién Nacido , MasculinoRESUMEN
A six-month-old female baby with a left coronary artery of anomalous origin in the right pulmonary artery, associated with a interventricular septal defect and a slight mitral pathology, was operated on direct implantation of the left coronary artery with a small segment of the pulmonary artery in the posterior wall of the ascending aorta and closure of the perimembranous defect was performed. The patient has been asymptomatic for one year since surgery.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico , Defectos del Tabique Interventricular/diagnóstico , Arteria Pulmonar/anomalías , Anomalías de los Vasos Coronarios/cirugía , Vasos Coronarios/cirugía , Femenino , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Estenosis de la Válvula Mitral/diagnóstico , Arteria Pulmonar/cirugíaRESUMEN
A 50 year old male with isolated left main coronary artery disease was surgically treated with saphenous vein patch angioplasty. Surgery results are reviewed by coronariography 2 months later and we comment its use as alternative technique in selected cases.
Asunto(s)
Prótesis Vascular , Enfermedad Coronaria/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A case of 20 year-old man with a left coronary artery fistula to right ventricle secondary to open heart surgery is reported; he was asymptomatic and a continuous precordial murmur was found on physical examination. Two dimensional echocardiography-Doppler color flow imaging visualized a dilated left coronary artery with flow into the right ventricle. The discovery was confirmed by coronary angiography. We conclude that two dimensional echocardiography Doppler color flow imaging may be a method included in evaluation of pediatric patients with coronary artery fistula suspicion.
Asunto(s)
Cardiomiopatías/diagnóstico por imagen , Enfermedad Coronaria/diagnóstico por imagen , Ecocardiografía Doppler , Fístula/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Adulto , Cardiomiopatías/etiología , Enfermedad Coronaria/etiología , Fístula/etiología , Cardiopatías Congénitas/cirugía , Humanos , Masculino , Complicaciones Posoperatorias/etiologíaRESUMEN
Fourteen cases (10 males, 4 females) of aortic atresia with hypoplastic left ventricle are reviewed. All were studied by two-dimensional echocardiography, treated by prostaglandin E1 and proved by necropsy. Surgery was also performed in 3 cases by Norwood technique. A good echo-anatomical correlation was found in the size of pulmonary artery (1.14 +/- 0.17 and 1.28 +/- 0.33 respectively), mitral valve (0.4 +/- 0.3 and 0.33 +/- 0.24) and aortic diameter ring with atresic valve (0.38 +/- 0.12 and 0.31 +/- 0.1). However, echocardiography overestimated the diameter of ascending aorta (p less than 0.001) and tricuspid valve (p less than 0.001) and the length of the left ventricle. These differences may be related to the greater distension of the aorta in vivo and to the difficulty of determining the exact direction of the ultrasounds. We conclude that two dimensional echocardiography is of great value not only for the diagnosis but also for the selection of patients for surgery.
Asunto(s)
Válvula Aórtica/anomalías , Enfermedades en Gemelos , Ecocardiografía , Válvula Aórtica/patología , Autopsia , Femenino , Ventrículos Cardíacos/anomalías , Ventrículos Cardíacos/patología , Humanos , Recién Nacido , Masculino , Valor Predictivo de las PruebasRESUMEN
A Blalock-Taussig shunt was performed in a child of 14 months diagnosed with tetralogy of Fallot associated with a complete atrioventricular defect. Seven months later, a balloon dilatation was performed because the shunt was stenosed in the site of the distal anastomosis. Repeat angiography we proved the patency of the shunt without restenosis 4 year later.
Asunto(s)
Angioplastia de Balón , Complicaciones Posoperatorias/terapia , Anastomosis Quirúrgica , Preescolar , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/terapia , Síndrome de Down/diagnóstico por imagen , Síndrome de Down/cirugía , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Radiografía , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Tetralogía de Fallot/diagnóstico por imagen , Tetralogía de Fallot/cirugíaRESUMEN
We report on a newborn infant with right ventricular diverticulum associated to dilated myocardiopathy, who was diagnosed by two-dimensional echocardiography within 24 hours after vaginal delivery. We believe this case represents the youngest one ever diagnosed with this disease.
Asunto(s)
Cardiomiopatía Dilatada/congénito , Divertículo/congénito , Cardiopatías Congénitas/diagnóstico , Cardiomiopatía Dilatada/diagnóstico , Divertículo/diagnóstico , Ventrículos Cardíacos/anomalías , Humanos , Recién Nacido , MasculinoRESUMEN
We report a 50 year old patient who was admitted because of congestive heart failure. Under hemodynamic and angiographic study she was diagnosed of anomalous origin of the left coronary artery from the pulmonary trunk. We examine the main aspects of the disease, physiopathology and treatment.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico por imagen , Arteria Pulmonar/anomalías , Femenino , Humanos , Persona de Mediana Edad , RadiografíaRESUMEN
We report a case of congenital bilateral pulmonary vein stenosis associated with a double-chambered right ventricle, ventricular septal defect and persistence of the ductus arteriosus in a 29 year-old female. The angiographic, echocardiographic and surgical findings are discussed. A precise diagnosis, the utility of the echocardiography and the surgical correction of this type of ostial stenosis is also reported.
Asunto(s)
Anomalías Múltiples , Cardiopatías Congénitas , Venas Pulmonares/anomalías , Anomalías Múltiples/diagnóstico , Adulto , Constricción Patológica/congénito , Constricción Patológica/diagnóstico , Femenino , Cardiopatías Congénitas/diagnóstico , HumanosRESUMEN
A case of superior vena cava obstruction secondary to surgical repair of partial anomalous pulmonary venous drainage was successfully treated with balloon angioplasty in a double procedure. Dilatation was effective with a significant clinical benefit and patient remains symptoms free at mid-term.
Asunto(s)
Angioplastia de Balón , Complicaciones Posoperatorias/terapia , Síndrome de la Vena Cava Superior/terapia , Niño , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Venas Pulmonares/anomalías , Venas Pulmonares/cirugía , Radiografía , Inducción de Remisión , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/diagnóstico por imagenRESUMEN
OBJECTIVES: We studied all patients operated for partial anomalous pulmonary venous drainage and half-time follow-up. MATERIALS AND METHODS: Twenty-eight patients with a mean age of 5 +/- 5 years (5 patients were less than 1 year old). There were sixteen male and twelve female patients. Thirteen patients were symptomatic (47%). The drainage was to the superior vena cava in thirteen cases, to the inferior vena cava in eight cases, to the right atrium in five cases, mixed (to the superior vena cava and to the inferior vena cava) in one case and to the innominate vein in one patient. The diagnosis was made through echocardiography and catheterization in 25 patients, whereas nuclear magnetic resonance was performed in the last five patients. All cases were corrected through medium thoracotomy, except for the single case in which the drainage was to the innominate vein). In 27 patients, the pulmonary veins were guided to the left atrium through an enlarged present atrial septal defect or through a created atrial septal defect. In one case a direct connection was performed from the veins to the left atrium. After the surgical correction, all patients underwent a color-coded Doppler echocardiography study and a nuclear magnetic resonance study was performed in five patients. RESULTS: Twenty-seven patients survived after surgical correction. The patient with a mixed drainage developed an obstruction of the superior vena cava, the pressure gradient was 9 mmHg. He required a second surgical procedure followed with angioplasty on two occasions during a six month period. Two patients showed an ectopic atrial rhythm at some late time. The patient who died was one month old and had an associated pulmonary parenchymal sequestration. CONCLUSION: Partial anomalous venous connection is a congenital heart disease which has an easy surgical correction. Complications may arise after the surgical correction, among them obstruction of the superior vena cava and arrythmias are most frequently found. Obstruction is present when 50% of the caval area is occupied by the patch. The arrythmias occur following all surgical techniques. In order to decrease the arrythmias it is necessary to perform a good hemosthasis at the site of the patch, to leave the sinus node free of compression and to perform the atrial incision at the posterior wall. The diagnosis and the follow-up can be performed with non-invasive procedures.
Asunto(s)
Venas Pulmonares/anomalías , Venas Pulmonares/cirugía , Adolescente , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
We describe the pioneer experience of balloon angioplasty and stent implantation in the central polytetrafluoroethylene aorto-pulmonary shunt. Two infants 1 and 13 month-old, with cyanotic complex congenital cardiopathy and pulmonary hypoperfusion, presented signs of prosthesis dysfunction with severe and critic hypoxemia. The angioplasty and stent implantation were performed through retrograde femoral arterial approach and "freely" (without a guide catheter) in the first case and venous via by using Judkins right coronary guiding catheter in the second one. Both cases experienced sustained O2 saturation improvement, although the neonate died on the fifth post-procedure day clue to acute renal failure. The postmortem anatomical findings are shown.
Asunto(s)
Aorta Torácica/cirugía , Derivación Arteriovenosa Quirúrgica/métodos , Cardiopatías Congénitas/cirugía , Arteria Pulmonar/cirugía , Stents , Atresia Tricúspide/cirugía , Resultado Fatal , Humanos , Lactante , MasculinoRESUMEN
We report the case of a 6-year-old girl with mitral atresia, hypoplastic left ventricle with a large right ventricle from which the main vases flow with a normal relationship and pulmonary obstruction, in which a modified fenestrated Fontan procedure with Gore-Tex baffle was performed. In the course of the treatment she developed cyanosis and a significant desaturation related to the presence and development of a levoatrial cardinal vein which was treated effectively using Gianturco coils with a good latter evolution. We discuss the possibilities of right-to-left shunting post Fontan procedure, percutaneous treatment as an alternative to surgery, the technique and angiographic characteristics of this case.
Asunto(s)
Embolización Terapéutica , Procedimiento de Fontan , Atrios Cardíacos/anomalías , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/anomalías , Venas/anomalías , Angiografía , Niño , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , PolitetrafluoroetilenoRESUMEN
This report describe a 69-year old woman with a congenital aneurysm of the non-coronary sinus of Valsalva ruptured in the right atrium, causing severe hemodynamic derangement of the right ventricle. The site of the communication between the aneurysm and the receiving chamber was accurately diagnosed by two-dimensional color flow Doppler imaging which provided more valuable preoperative information than conventional aortography.