RESUMO
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.
Assuntos
Aorta Torácica/anormalidades , Cateterismo Cardíaco/instrumentação , Permeabilidade do Canal Arterial/terapia , Achados Incidentais , Artéria Pulmonar/anormalidades , Artéria Subclávia/anormalidades , Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia Doppler em Cores , Hemodinâmica , Humanos , Lactente , Desenho de Prótese , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Eletrocardiografia , Infecções por HIV/transmissão , Hipertrofia Ventricular Esquerda/diagnóstico , Transmissão Vertical de Doenças Infecciosas , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Incidência , Lactente , Recém-Nascido , Estudos Longitudinais , Gravidez , Estudos Prospectivos , Curva ROC , Sensibilidade e EspecificidadeAssuntos
Cistos/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Cistos/cirurgia , Diagnóstico Diferencial , Aneurisma Cardíaco/cirurgia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Comunicação Interventricular/cirurgia , Septos Cardíacos/cirurgia , Humanos , Lactente , UltrassonografiaRESUMO
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.