RESUMEN
Isolation of the right subclavian artery (RSCA) from the pulmonary artery is a rare anomaly of the aortic arch. We report a case of an isolated RSCA from the right pulmonary artery that was discovered at the time of device occlusion of a patent arterial duct. We review the literature and discuss management options.
Asunto(s)
Aorta Torácica/anomalías , Cateterismo Cardíaco/instrumentación , Conducto Arterioso Permeable/terapia , Hallazgos Incidentales , Arteria Pulmonar/anomalías , Arteria Subclavia/anomalías , Aorta Torácica/diagnóstico por imagen , Aortografía/métodos , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/fisiopatología , Ecocardiografía Doppler en Color , Hemodinámica , Humanos , Lactante , Diseño de Prótesis , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: A shortcoming of the pediatric electrocardiogram (ECG) appears to be its inability to accurately detect left ventricular hypertrophy (LVH). This study prospectively assesses the usefulness of the pediatric ECG as a screening modality for LVH. METHODS: Concomitant echocardiograms and ECGs from a large cohort of children who were exposed to the human immunodeficiency virus (HIV; uninfected) and children who were infected with HIV were compared. By use of the values of Davignon et al, qualitative determination of LVH and quantitative criteria for LVH (RV6, SV1, RV6+SV1, QV6, and Q(III) >98% for age, R/SV1 <98% for age, and [-]TV6) were compared to body surface area adjusted for left ventricular (LV) mass z score. Results were then stratified according to weight and weight-for-height z scores. New age-adjusted predicted values were then constructed from children of a mixed race who were HIV-uninfected, < or =6 years old, and similarly assessed. RESULTS: The sensitivity rate was <20% for detecting increased LV mass, irrespective of HIV status; the specificity rate was 88% to 92%. The sensitivity rate of the individual criteria ranged from 0 to 35%; the specificity rate was 76% to 99%. Test sensitivities remained low when stratified by weight and weight-for-height z scores. Areas under the receiver operator characteristic curves were between 0.59 and 0.70, also suggesting poor accuracy of the ECG criteria. By use of new age-adjusted predicted values, the sensitivity rate decreased to <17%, and the specificity rate increased to 94% to 100%. CONCLUSION: The ECG is a poor screening tool for identifying LVH in children. Sensitivity is not improved with revision of current criteria.
Asunto(s)
Electrocardiografía , Infecciones por VIH/transmisión , Hipertrofia Ventricular Izquierda/diagnóstico , Transmisión Vertical de Enfermedad Infecciosa , Preescolar , Ecocardiografía , Femenino , Humanos , Hipertrofia Ventricular Izquierda/epidemiología , Incidencia , Lactante , Recién Nacido , Estudios Longitudinales , Embarazo , Estudios Prospectivos , Curva ROC , Sensibilidad y EspecificidadAsunto(s)
Quistes/diagnóstico por imagen , Aneurisma Cardíaco/diagnóstico por imagen , Defectos del Tabique Interventricular/diagnóstico por imagen , Tabiques Cardíacos/diagnóstico por imagen , Quistes/cirugía , Diagnóstico Diferencial , Aneurisma Cardíaco/cirugía , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Defectos del Tabique Interventricular/cirugía , Tabiques Cardíacos/cirugía , Humanos , Lactante , UltrasonografíaRESUMEN
UNLABELLED: The cardiovascular effects of volatile anesthetics in children with congenital heart disease have been studied, but there are limited data on the effects of anesthetics on pulmonary-to-systemic blood flow ratio (Qp:Qs) in patients with intracardiac shunting. In this study, we compared the effects of halothane, isoflurane, sevoflurane, and fentanyl/midazolam on Qp:Qs and myocardial contractility in patients with atrial (ASD) or ventricular (VSD) septal defects. Forty patients younger than 14 yr old scheduled to undergo repair of ASD or VSD were randomized to receive halothane, sevoflurane, isoflurane, or fentanyl/midazolam. Cardiovascular and echocardiographic data were recorded at baseline, randomly ordered 1 and 1.5 mean alveolar anesthetic concentration (MAC) levels, or predicted equivalent fentanyl/midazolam plasma levels. Ejection fraction (using the modified Simpson's rule) was calculated. Systemic (Qs) and pulmonary (Qp) blood flow was echocardiographically assessed by the velocity-time integral method. Qp:Qs was not significantly affected by any of the four regimens at either anesthetic level. Left ventricular systolic function was mildly depressed by isoflurane and sevoflurane at 1.5 MAC and depressed by halothane at 1 and 1.5 MAC. Sevoflurane, halothane, isoflurane, or fentanyl/midazolam in 1 or 1.5 MAC concentrations or their equivalent do not change Qp:Qs in patients with isolated ASD or VSD. IMPLICATIONS: Sevoflurane, halothane, isoflurane, and fentanyl/midazolam do not change pulmonary-to-systemic blood flow ratio in children with atrial and ventricular septal defects when administered at standard anesthetic doses with 100% oxygen.