RESUMO
The presence of a single coronary artery arising in the anterior cusp and terminating in a large fistula to the main pulmonary artery was noted during the preoperative evaluation of a patient with tetralogy of Fallot. Recognition of this rare association dictated the use of a valved conduit to avoid injury to the left anterior descending coronary as it crossed the right ventricular outflow tract and permitted abolition of intracardiac shunting by ligation of the fistula. It is postulated that the increasing arterial saturation noted in this patient prior to intracardiac repair may have been related in part to progressive augmentation in flow through the coronary fistula to the main pulmonary artery.
Assuntos
Anomalias dos Vasos Coronários/complicações , Fístula/etiologia , Artéria Pulmonar/anormalidades , Tetralogia de Fallot/complicações , Adulto , Criança , Cineangiografia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Fístula/diagnóstico por imagem , Fístula/cirurgia , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgiaRESUMO
In this retrospective study, we reviewed the records of patients who had coarctectomies at the University of Virginia Hospital after 1 year of age. Follow-up data for 5 years or more after surgery were available for 52 patients. Data from 23 similar patients from the Medical College of Virginia brought the total postoperative sample size to 75. The blood pressure of this group of patients did not differ significantly from that of the population at large. We conclude that successful repair of coarctation of the aorta in childhood or early adolescence does not lead to a higher-than-expected incidence of resting hypertension in childhood.
Assuntos
Coartação Aórtica/cirurgia , Pressão Sanguínea , Hipertensão/etiologia , Adolescente , Adulto , Fatores Etários , Coartação Aórtica/mortalidade , Coartação Aórtica/fisiopatologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Congenital absence of the pulmonary valve (CAPV) is a rare anomaly usually associated with ventricular septal defect or Fallot's tetralogy. CAPV may be rapidly fatal in infancy because of severe disturbance of pulmonary ventilation resulting from bronchial compression by massively dilated pulmonary arteries. Other cases may be relatively benign. Our group of five cases with CAPV ranged from the severe to one case in which there was documented closure of a patent ductus arteriosus and a ventricular septal defect, leaving the CAPV as an apparently isolated, well-tolerated lesion. Plain chest radiographs play a major part in the diagnosis of CAPV since they almost invariably give some indication od the aneurysmal dilatation of the pulmonary arteries. On angiography, dilated main pulmonary arteries are shown giving rise to branches of normal or even diminished caliber.