Gastroesophageal Reflux in Association with Congenital Heart Disease

The clinical course of 19 infants with severe respiratory symptoms associated with the pres ence of both congenital heart disease and gastroesophageal reflux is described. Down Syndrome or central nervous system disease was present in 12 of the 19 infants. The identification of reflux as a major or additional cause of the respiratory complications was often overlooked. Medical therapy alone was successful in only one of the 19 patients. Early repair or palliation of the cardiac malformation with or without subsequent antireflux surgical procedure was as sociated with relief of the symptoms in 13 patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67259/2/10.1177_000992288302200606.pd

Transcatheter Atrial Septal Defect Closure: Preliminary Experience with the Rashkind Occluder Device

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72836/1/j.1540-8183.1989.tb00751.x.pd

Use of Balloon-Tipped Catheters in the Critically Ill Child

A retrospective study of our experience in the placement of 19 consecutive balloon-tipped catheters in the pulmonary artery of 18 children disclosed that the procedure can be performed with relative ease in the intensive care unit without the aid of fluoroscopy. Insertion of the catheters was not associated with any serious complications. Catheter malfunction, however, occurred in 9 of 18 patients: balloon rupture in 6 and clot formation in 3. Comparison of pulmonary capillary pressure through a balloon-tipped catheter and venous pressure through a central venous line indicates that, in the absence of significant pulmonary disease requiring high positive end expiratory pressure, or significant left heart dysfunction, a central venous pressure line is frequently adequate for monitoring right heart pressures and as a guidance to fluid therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67256/2/10.1177_000992288202100302.pd

Left ventricular aneurysms associated with intraoperative venting of the cardiac apex in children

Left ventricular (LV) apical aneurysms were observed in 16 of 50 (32%) children (average age 8 years) consecutively catheterized after surgical repair of congenital heart disease. The LV apex was vented by a sump during cardiopulmonary bypass in each. The aneurysms varied in size, but were generally small. Average dimensions were 7.5 x 6.8 mm in the anteroposterior projection and 8.9 x 5.7 mm in the left anterior oblique projection. The LV apex wall was thinner in patients with aneurysms than in age- and lesion-matched controls. All of the LV aneurysm patients were asymptomatic during average follow-up of 4 years. Nevertheless, such aneurysms are anticipated to represent a potential source of cardiovascular complications and, when possible, alternate methods for venting the left ventricle are recommended.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24571/1/0000853.pd

R-wave amplitude changes during exercise in adolescents with left ventricular pressure and volume overload

To determine the diagnostic value of exerciseinduced R-wave changes in adolescents with congenital heart disease, the responses of 50 adolescents without significant heart disease were compared with those of 72 patients with either a left ventricular (LV) pressure or volume overload lesion. Among the pressure overload group, 24 patients had valvular aortic stenosis (AS) and 27 had coarctation of the aorta. The volume overload group included 12 patients with mitral regurgitation (MR) and 9 with aortic regurgitation (AR). Severity of the cardiac lesion was assessed using cardiac catheterization in patients with AS, physical examination in patients with coarctation of the aorta and clinical or angiographiec criteria, or both, in patients with valvular regurgitation. The R wave was measured in 10 consecutive QRS complexes in leads II, aVF and V5 at rest, maximal exercise and 1-minute recovery. At maximal exercise, control subjects had a mean decrease in amplitude ([Delta]R) of -3.6 mm (p > 12 mm Hg (n = 7), the decrease in [Delta]R was also greater than that in patients with LV end-diastolic pressure <= 12 mm Hg (n = 14) (p < 0.006). Among patients with volume overload, more severe valvular regurgitation was associated with a smaller [Delta]R (p < 0.03). In patients with AS an increased [Delta]R reflects ischemia or diminished LV compliance, or both, whereas in patients with volume overload a decrease in [Delta]R is an indicator of the severity of regurgitation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25108/1/0000540.pd

Cardiovascular effects of breathing 95 percent oxygen in children with congenital heart disease

The hemodynamic effects of breathing 95% oxygen were evaluated in 26 children with congenital heart disease. Aortic, pulmonary arterial, right atrial, and pulmonary arterial wedge pressure, aortic and pulmonary artery oxygen saturation, and blood gas, cardiac index, and heart rate were measured in room air and after each patient had breathed 95 % oxygen for 10 (n = 26) and 20 (n = 5) minutes. Measurements were repeated with the patient again breathing room air for 10 (n = 11) and 20 (n = 6) minutes. After 10 minutes of 95% oxygen, arterial partial pressure of oxygen increased from 85 +/- 13 to 420 +/- 89 torr (p 2 (p 2/min/m2 (p < 0.001). Cardiac index, stroke index, and systemic vascular resistance did not return to normal until 20 minutes after cessation of oxygen breathing. To determine whether reflex bradycardia is responsible for these oxygen-induced hemodynamic changes, heart rate was kept constant by atrial pacing in a second group of 5 patients. In these children, significant decreases in cardiac index, stroke index, and oxygen consumption, and increases in systemic vascular resistance also occurred with 95% oxygen. Thus, in children with acyanotic congenital heart disease, hyperoxia increases aortic pressure and systemic vascular resistance and decreases cardiac index, stroke index, oxygen consumption, and oxygen transport.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25170/1/0000608.pd

Measurement of left ventricular ejection fraction in pediatric patients using the nuclear stethoscope

Left ventricular (LV) ejection fraction (EF) was measured in 25 patients, aged 2 weeks to 20 years (mean 8.6 years), using a portable nonimaging scintillation stethoscope. Technically satisfactory studies were obtained in 23 patients. LVEF was validated by cineangiography in 19 patients and by standard gated blood pool scintigraphy in 4. EF measured by the nuclear stethoscope correlated well with values obtained by cineangiography or scintigraphy (r = 0.869, p < 0.001) over a wide range of EF values (18 to 79%). In children younger than 5 years (n = 11), the correlation (r = 0.728, p < 0.02) was less satisfactory than in those older than 5 years (r = 0.926; p < 0.001). Although modifications in the instrument and further clinical trials with the stethoscope are needed before the device becomes clinically useful to pediatric cardiologists, our data indicate that the nuclear stethoscope can provide reliable assessment of LVEF in pediatric patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24989/1/0000416.pd

Aortic aneurysm after patch aortoplasty repair of coarctation: A prospective analysis of prevalence, screening tests and risks

AbstractTwenty-nine children were evaluated prospectively for the presence of an aortic aneurysm at the repair site 1 to 19 years after patch aortoplasty repair of coarctation of the aorta. In each child, noninvasive evaluation included a chest X-ray film, computed tomography of the chest and two-dimensional echocardiography. The presence and size of an aortic aneurysm were determined quantitatively by measuring the ratio of the diameter of the thoracic aorta at the repair site to the diameter of the aorta at the diaphragm (aortic ratio). An aortic ratio of ≥1.5 was judged abnormal and was shown to be significantly greater than the aortic ratio of a normal control group. An aortogram was obtained in each child if any noninvasive screening test was found to be abnormal.As assessed by the aortogram, the prevalence of aortic aneurysm was 24% in this patient group. The sensitivity of echocardiography and chest computed tomography for detecting an aneurysm was 71% and 66%, and the specificity 76% and 85%, respectively. The chest X-ray film was 100% sensitive and 68% specific in determining the presence of an aneurysm. Although the data are not statistically significant, they suggest that children undergoing patch aortoplasty as the primary procedure (rather than a reoperation after earlier resection), and children in whom a Dacron patch is utilized may be at increased risk for aneurysm formation.Thus, in a prospective manner, this study has documented that aortic aneurysm occurs commonly after patch aortoplasty for coarctation in childhood, that the chest X-ray film provides a sensitive screening test and that the aneurysm may be evaluated quantitatively (by measuring the aortic ratio) with echocardiography or chest computed tomography

Long-term studies of hemoglobin-oxygen affinity in hypoxemic dogs with a right-to-left cardiac shunt

Long-standing hypoxemia was surgically created in dogs by inserting an aortic homograft between the inferior vena cava and right atrium. Ligation of the caval--atrial junction resulted in a right-to-left cardiac shunt. Arterial p O2 fell immediately and P50 increased within 20 min. The 2,3-diphosphoglycerate concentration rose in 4 hr following surgery, while hemoglobin concentration increased within 7 days. Alterations in hemoglobin--oxygen affinity can occur rapidly and may be beneficial compensatory responses to acute and chronic hypoxemia caused by a right-to-left cardiac shunt.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23370/1/0000314.pd