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

Transposition of the great arteries, right aortic arch, coarctation, and isolation of the left subclavian artery: Report of surgical therapy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24449/1/0000723.pd

Excitation of the double chamber right ventricle: Electrophysiologic and anatomic correlation

To examine the excitation of the double chamber right ventricle and the possibility that it results from a displaced, hypertrophied moderator band, seven patients with double chamber right ventricle were studied. All seven had pre- and postoperative electrocardiograms. Intraoperative right ventricular epicardial maps were obtained in three; right ventricular endocardial activation maps performed at postoperative catheterization were obtained in four. In the three patients studied at operation the breakthrough point of right ventricular epicardial activation was demonstrated in a normal inferior location well below the obstructing muscle band. Two patients with right bundle branch block after operation and two others with only right ventricular conduction delay on postoperative electrocardiogram demonstrated high normal right ventricular time with prolongation of activation in the right ventricular outflow or inflow region, or both, suggesting only peripheral injury. These data suggest that activation of the double chamber right ventricle is similar to that of the normal heart. In addition, the observed normal activation sequence militates against the hypothesis that the moderator band is the obstructing bundle.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24028/1/0000277.pd

Tricuspid atresia and the Wolff-Parkinson-White Syndrome: Evaluation methodology and successful surgical treatment of the combined disorders

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24417/1/0000688.pd

Ventricular tachycardia associated with a left ventricular apex sump aneurysm in an adolescent

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25313/1/0000758.pd

Modified technique for balloon valvuloplasty of critical pulmonary stenosis in the newborn

AbstractObjectives. We report our experience in eight consecutive neonates who underwent attempted balloon dilation as an initial therapy far critical valvular pulmonary stenosis, and we review in detail technical modifications that improved the success rate.Background. Balloon dilation of the pulmonary valve has become the treatment of choice for valvular pulmonary stenosis in children and adults. There are few reports of its effectiveness in critical pulmonary stenosis in the newborn. In this setting, application of the tecnique of baloon dilation has been limited by the ability to advance the necessary guide wires and catheters across the stenotic, often near-atretic, pulmonary valve.Methods. The pulmonary valve was crossed in all patients. When this could not be accomplished with an end-hole catheter, a soft guide wire was advanced directly across the pulmonary valve through the end-hole catheter positioned in the right ventricular outflow tract below the valve. Initial prediction was achieved in all patients by using a coronary dilation catheter in an effort to facilitate introduction of the definitive balloon dilation catheter. Definitive dilation with a balloon diameter of ≥110% of the diameter of the pulmonary valve annulus was possible in six patients.Results. Right ventricular pressure declined from a mean value of 108 ± 32 mm Hg to a mean value of 49 ± 11 mm Hg after balloon dilation, with no change in heart rate or aortic pressure in these six patients after definitive balloon dilation.Conclusions. The results of this small series suggest that critical valvular pulmonary stenosis in the newborn can be successfully treated by transluminal balloon valvuloplasty