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"Cases of SCMR" is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation, and the use of cardiovascular magnetic resonance (CMR) in the diagnosis and management of cardiovascular disease. The 2022 digital collection of cases are presented in this manuscript.
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Enfermedades Cardiovasculares , Valor Predictivo de las Pruebas , Humanos , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/terapia , Persona de Mediana Edad , Femenino , Masculino , Anciano , Imagen por Resonancia Magnética , Adulto , Pronóstico , Adulto JovenRESUMEN
BACKGROUND: Assessment of the shape and dimensions of PDA is usually done angiographically and in the majority of cases need arterial access. Our aim was to evaluate the value of routine 2 D echocardiography (ECHO) in predicting type, dimensions of PDA and to anticipate device size to be used during the intervention. MATERIAL AND METHODS: The charts of all patients who underwent transcatheter closure of PDA between January 2015 and December 2020 were reviewed. Their pre-procedure ECHO and catheterization details at the time of device closure were analyzed. RESULTS: Total of 139 patients were reviewed and 8 were excluded because of lack of adequate echocardiographic or angiographic images. The mean age and weight of the study population were 2.6 ± 2.5 years (range 0.2-14 years) and 11.2 ± 7.8 kg (range: 1.5-57 kg), respectively. There was no statistically significant difference in PDA narrowest diameter (p = 0.99) and predicted device type (p = 0.54) between Echo and angiography. Echo slightly overestimated PDA length (p = 0.01) and aortic ampulla dimension (p = 0.047), while morphology of PDA was correctly identified in the majority of cases (82%). CONCLUSIONS: Pre-procedure echocardiography correlates well with angiographically obtained measurements and hence can be used to estimate PDA diameter, shape and guide device decide selection. Routine echocardiography can be used successfully to plan the intervention and in some cases to guide transcatheter closure.
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BACKGROUND: Dilated cardiomyopathy (DCM) is characterized by left ventricular dilation and dysfunction. The association with significant mitral regurgitation worsens the prognosis. CASE REPORT: A 2-year-old girl presented with DCM and severe mitral regurgitation. She had a history of viral myocarditis at the age of 4 months, necessitating recurrent hospital admissions for management of intractable heart failure, pneumonia, and failure to thrive. The decision was taken to proceed for mitral valve surgery, which ended with mitral valve replacement. Over 3 years of follow-up after surgery, there was significant improvement in her weight gain and she improved clinically. There were still recurrent admissions, but mostly for adjustment of her deranged anticoagulation medications. CONCLUSION: Mitral valve surgery might be indicated in selected patients with DCM.
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Percutaneous closure of patent ductus arteriosus (PDA) is done in the cardiac catheterization laboratory, usually under fluoroscopic and angiographic guidance. The aortogram is used for assessing PDAsize and shape the pre-device implantation. Additionally, post-device aortograms are applied for the assessment of device position, profile and residual shunt. Angiograms expose patient to radiation and possible untoward effects of contrast media. Recently, transthoracic echocardiography has been utilized to guide in PDAclosure to avoid radiation exposure as well as contrast material. On two occasions, we were obligated by special circumstances to close the PDAunder echocardiography guidance. First case was a 6-month baby girl with mild signs of heart failure having moderate size PDA. She underwent device closure under transthoracic echocardiogram as the angiographic system had stopped working during the procedure. Second case was a 6-year girl, weighting 16-kg with chronic renal failure. She had moderate size PDAclosed by device under transthoracic echocardiographic, guidance avoiding the use of contrast agent due to chronic renal failure.
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Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/cirugía , Ecocardiografía Doppler en Color/métodos , Prótesis e Implantes , Niño , Femenino , Humanos , Lactante , Periodo Posoperatorio , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
Infants with post-tricuspid valve shunts (PTS) may benefit from interatrial communication (IAC). The effect of IAC on left ventricular (LV) performance in these patients was studied. IAC was documented prospectively in 55 patients with PTS. Clinical status, echocardiographic dimensions of LV, mitral inflow Doppler, tissue Doppler velocities and time intervals were measured. Creatinine kinase (CK), CKMB, troponin-I and NT pro-brain natriuretic peptide (NT pro-BNP) were measured. Patients were divided into four groups: (A) PTS but no IAC (n = 32); (B) PTS and IAC (n = 23); (C) VSD but no IAC (n = 16); and (D) VSD and IAC (n = 19). Group A had more frequent mitral regurgitation (p = 0.041), larger mitral annulus (1.80 vs. 1.30 cm, p < 0.0001) and larger LV systolic and diastolic dimensions (2.01 vs. 1.40 and 3.28 vs. 2.35 cm, p < 0.001) than group B. The E-wave deceleration time tended to be longer in group A (121.0 vs. 106.8 ms, p = 0.06). By tissue Doppler, group A had E'- and S-waves significantly taller (15.51 vs. 13.14 and 7.69 vs. 6.72 cm, p = 0.04 and p = 0.005, respectively) than group B. Also, NT pro-BNP was significantly higher in group A (1116.15 vs. 458.73 pg/ml, p = 0.028). Group C had significant larger mitral z-score values (1.2 vs. 0.01, p < 0.001), larger LV diameter z-score (p = 0.001) and higher NT pro-BNP level (1477.37 vs. 451.66 pg/ml, p = 0.001) than group D. There was no significant difference in the clinical status between the groups. In children with PTS, the presence of IAC could be beneficial. Their echocardiographic parameters and biomarker show better systolic and diastolic LV performance.
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Conducto Arterioso Permeable/diagnóstico por imagen , Defectos del Tabique Interventricular/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Válvula Tricúspide/fisiopatología , Biomarcadores/sangre , Preescolar , Ecocardiografía Doppler , Femenino , Humanos , Lactante , Masculino , Contracción Miocárdica , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Curva ROCRESUMEN
Life-threatening intracardiac and great vessels thrombi are rare in neonates. Recombinant tissue plasminogen activator (rTPA) is used in adults to stimulate fibrinolysis and facilitate thrombus resolution. Its use in neonates, along with heparin, remains controversial because of potential risk of serious bleeding. We aim to present our experience with the use of thrombolytic agents in seven neonates and young infants. In a retrospective study, over a period of 6 years, the medical records of neonates and young infants, who were diagnosed with intracardiac and great vessels thrombi, were reviewed. The following factors were collected: demographic data, primary diagnosis, thrombus site, risk factors, method of diagnosis, thrombolytic and/or anticoagulation agent, route, dose and duration of treatment, complications, and outcome. Six neonates and one 45-day-old infant were analyzed. Age ranged from 5 to 45 days (median age 12 days), and median weight was 2.9 kg (range 0.9-3.8 kg). The thrombi were diagnosed by echocardiography in five and by angiography in two cases. All patients had life-threatening thrombi; four were treated with rTPA (0.5 mg kg(-1) h(-1)) and heparin infusions with complete dissolution of the thrombi, within a median time of 60 h (6-72 h), and without complications. The remaining three patients (two who were premature, at 28 and 34 weeks of gestation, and the third who had a deranged coagulation profile) were treated with unfractionated heparin due to fear of bleeding. The thrombi dissolved in the premature babies (within 2 weeks and 3 months, respectively) but embolized and resulted in the death of the third infant after 2 weeks of treatment. The current case series confirmed the effectiveness and safety of intravenous rTPA infusion, at the dosages used, in neonates and young infants with life-threatening thrombi.
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Fibrinolíticos/administración & dosificación , Cardiopatías/diagnóstico por imagen , Cardiopatías/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Activador de Tejido Plasminógeno/administración & dosificación , Ecocardiografía , Femenino , Fibrinolíticos/efectos adversos , Hemorragia/prevención & control , Heparina/uso terapéutico , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Estudios Retrospectivos , Trombosis/diagnóstico por imagen , Activador de Tejido Plasminógeno/efectos adversosRESUMEN
An 18-year-old pregnant woman with severe pulmonary valve stenosis and exertional dyspnea underwent balloon dilation during pregnancy using sole echocardiographic guidance to protect the baby from radiation. The main technical difficulty encountered was during advancement of the catheter across the right ventricular outflow tract into the pulmonary valve. This was overcome using a wedge balloon catheter over a percutaneous transluminal coronary angioplasty (PTCA) wire. Using echo guidance, the balloon was positioned across the pulmonary valve and inflated. Pulmonary balloon valvuloplasty can be performed safely using sole transthoracic echocardiography guidance without fluoroscopy.
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Valvuloplastia con Balón/métodos , Ecocardiografía/métodos , Complicaciones Cardiovasculares del Embarazo/cirugía , Estenosis de la Válvula Pulmonar/cirugía , Válvula Pulmonar/cirugía , Cirugía Asistida por Computador/métodos , Adolescente , Cateterismo Cardíaco , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico por imagen , Estenosis de la Válvula Pulmonar/diagnóstico por imagenRESUMEN
Percutaneous closure of secundum atrial septal defect associated with situs solitus and dextrocardia has not been reported previously. We describe the technical difficulties encountered during transcatheter closure of a secundum atrial septal defect in a 19-month-old girl with situs solitus and dextrocardia.
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Anomalías Múltiples , Cateterismo Cardíaco , Dextrocardia/diagnóstico , Enfermedades Genéticas Ligadas al Cromosoma X/diagnóstico , Defectos del Tabique Interatrial/terapia , Síndrome de Heterotaxia/diagnóstico , Cateterismo Cardíaco/instrumentación , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Femenino , Defectos del Tabique Interatrial/diagnóstico , Humanos , Lactante , Radiografía Intervencional , Dispositivo Oclusor Septal , Resultado del TratamientoRESUMEN
Combination of right and left ventricular outflow tracts obstruction is extremely rare. Neonates with combined aortic stenosis (AS) and pulmonary stenosis (PS) present in critical condition and required urgent treatment. The management approach is not well defined. We report five female neonates with combined AS and PS presented to our institute in the last 5 years, age (1-18 days), weight (2.2-3.4 kg). Two had associated muscular ventricular septal defects. The mean Doppler gradient across the aortic valve (AV) was 73 mmHg (53-105 mmHg) and across the pulmonary valve was 62 mmHg (44-76 mmHg). Three had balloon dilatation and one surgical repair. The fifth patient was managed conservatively, but had sudden cardiac death at age of 3 months. One patient arrived in shock and sepsis, underwent emergency balloon dilation of the AV in the ICU. Despite decreasing the gradient, she died next day after the procedure. The surviving children were well at median follow-up age of 3.4 years. This is an extremely rare combination which needs early intervention. The management approach is not well defined. Interventional catheterization is possibly the better option.
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Estenosis de la Válvula Aórtica/terapia , Ecocardiografía Doppler , Defectos del Tabique Interventricular/terapia , Estenosis de la Válvula Pulmonar/terapia , Angioplastia de Balón/métodos , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/epidemiología , Procedimientos Quirúrgicos Cardíacos/métodos , Comorbilidad , Femenino , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/epidemiología , Humanos , Recién Nacido , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Estenosis de la Válvula Pulmonar/epidemiología , Literatura de Revisión como Asunto , Resultado del TratamientoRESUMEN
Ventricular septal defect (VSD) is a life-threatening complication of transmural myocardial infarction. Urgent surgical repair and concomitant revascularization are the standard of care. Percutaneous catheter-based closure techniques have been reserved for patients with a high-risk surgery or a failed surgical procedure with residual shunting. This case report demonstrates the successful transcatheter closure of residual VSD using the Amplatzer muscular VSD device (Amplatzer, Minnesota, USA) after surgical patch dehiscence for postinfarction VSD and 3-and-a-half years' post-intervention follow-up.
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Cateterismo Cardíaco/métodos , Rotura Cardíaca Posinfarto/cirugía , Tabiques Cardíacos/lesiones , Infarto de la Pared Inferior del Miocardio/complicaciones , Infarto del Miocardio/complicaciones , Dehiscencia de la Herida Operatoria/cirugía , Femenino , Rotura Cardíaca Posinfarto/etiología , Humanos , Persona de Mediana Edad , Dispositivo Oclusor Septal , Resultado del TratamientoRESUMEN
BACKGROUND: Central line insertion is a routine procedure in medical practice. Dislodgement of lines into the vascular system is a rare complication. We noticed that paediatric health care providers (PHCP) contact the cardiac or general paediatric surgeon for extraction of dislodged lines more frequently than using the less invasive percutaneous approach. AIM: To study the referral preference of PHCP for patient with embolised intravascular foreign bodies. METHODS: A questionnaire with three questions was distributed to PHCP of all paediatric subspecialties, including surgery, in two tertiary care centres. The questions were about the total number of patients seen with central line, experience with complications, and preferred specialty for removal of dislodged central lines. RESULTS: The questionnaire was distributed to 128 professionals. The response rate was 79% (n=101). Incomplete answers (n=14) were excluded. The grades of responders were senior consultants 18%, junior consultants 38%, and residents 43%. Thirty nine percent of care providers experienced dislodgement or fragmentation of central lines. The majority (82%) prefer to refer the patients for surgical removal. CONCLUSIONS: Most PHCP in the selected hospitals prefer to refer patients with embolised foreign bodies in the vascular system for surgical removal. The local health policy should be updated for the use of the alternative percutaneous approach.
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Actitud del Personal de Salud , Cateterismo Periférico/efectos adversos , Remoción de Dispositivos/métodos , Cuerpos Extraños/terapia , Pediatría , Derivación y Consulta/estadística & datos numéricos , Niño , Humanos , Arabia Saudita , Encuestas y Cuestionarios , Centros de Atención TerciariaRESUMEN
A newborn is presented with an association of hypoplastic left heart syndrome, cor triatriatum and partial anomalous pulmonary venous connection. The diagnosis was established with echocardiography and further confirmed with computed tomography. To our knowledge the images of such an association have never been reported before.
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A neonate is presented with a very rare association consisting of pulmonary atresia with large ventricular septal defect but additionally, combined with a hypoplastic right ventricle and well developed pulmonary arteries. The management strategy is described.
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A 12-year-old boy reported in outpatient department with history of shortness of breath and dyspnoea on moderate exertion. Physical examination was significant for bounding pulses and for a continuous murmur III/VI, best heard at the left upper sternal border. Echocardiography confirmed a large patent arterial duct with shortening fraction of 33%. He underwent successful transcatheter closure of the patent arterial, using Amplatzer duct occluder 12/10. Few hours later echocardiography revealed an unexpected, yet important depression of left ventricular systolic function with shortening fraction decreasing to 24% and then two weeks later decreasing further to 20%. At a follow-up after four months, he had improved clinically but left ventricular dysfunction still persisted with shortening fraction of 24%.
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Cateterismo Cardíaco/efectos adversos , Conducto Arterioso Permeable/cirugía , Disfunción Ventricular Izquierda/etiología , Niño , Humanos , MasculinoAsunto(s)
Aorta Torácica/anomalías , Malformaciones Arteriovenosas/diagnóstico , Malformaciones Arteriovenosas/terapia , Venas Cerebrales/anomalías , Aorta Torácica/diagnóstico por imagen , Cateterismo Venoso Central/efectos adversos , Angiografía Cerebral , Venas Cerebrales/diagnóstico por imagen , Ecocardiografía , Resultado Fatal , Femenino , Humanos , Recién Nacido , Hemorragias Intracraneales/etiología , RoturaRESUMEN
We sought to determine if a higher dose of heparin would reduce arterial complications in patients weighing 10 kg or less undergoing cardiac catheterization to investigate congenital heart disease. Sixty patients were given either 100 (group A) or 150 (group B) IU x kg(-1) of heparin in a double-blinded randomized manner. Initial arterial access was established using a 4F cannula in all patients. Mean activated clotting time measured 20 minutes following heparin administration was significantly lower in group A than in group B (199 versus 251 seconds). Only 3 out of 60 patients (5%) required treatment for loss of femoral pulse. The age, weight, activated clotting time, length of catheterization procedure, time taken to establish arterial access, and the duration of arterial cannulation were comparable between the groups. Weight under 4 kg, age under 1 month, and cannula size larger than 4F were identified as independent risk factors for the development of arterial complications. Arterial access using a 4F cannula is a safe procedure in children weighing 10 kg or less. The incidence of significant arterial complications is low, and they do not appear to be preventable by a higher dose of heparin.