Determination of anomalous pulmonary venous return with high-pitch low-dose computed tomography in paediatric patients

Background: In this study, we aimed to image pulmonary venous return anomalies and associated cardiovascular and pulmonary abnormalities by high-pitch low-dose computed tomography (CT) in children. Materials and methods: Forty-one patients with total or partial anomalous pulmonary venous return anomalous between May 2012 and June 2019 were retrospectively reviewed. The anomalies were determined using high-pitch low-dose CT. The patients’ mean age was 3 years (6 months to 15 years), and 24 of them were female. Results: There were 10 patients with total pulmonary venous return anomalies (TPVRA) and 31 patients with partial pulmonary venous return anomalies (PPVRA). Six (60%) patients with TPVRA had the supracardiac type, 2 (20%) had the cardiac type, and 2 (20%) had the mixed type. All patients with TPVRA had a large atrial septal defect (ASD), 1 patient also had patent ductus arteriosus, and 1 patient had right cardiac hypertrophy. Forty cases of PPVRA were found in 31 patients. Twenty-seven (67%) of them were right-sided, and 13 were left-sided (33%). Twenty (65%) patients also had an additional cardiovascular anomaly (ASD in 12 patients, persistent superior vena cava in 4 patients, patent ductus arteriosus in 3 patients, and aortic coarctation in 2 patients). Of the 27 patients with right-sided PPVRA, it drained into the superior vena cava in 19 patients, the right atrium in 5 patients, and the inferior vena cava in 3 patients. In left-sided cases, the anomalous pulmonary vein drained into the left innominate vein in 9 patients, and in 4 patients, there were accessory pulmonary veins that drained into the left innominate vein. Many of the patients had additional lung anomalies, including pneumonic infiltration (n = 12), atelectasis (n = 8), and lobar emphysema (n = 5), and some of these findings coexisted. Conclusions: Anomalous pulmonary venous drains and associated cardiac and extra-cardiac anomalies can be detected reliably and quickly with high-pitch low-dose CT without sedation in paediatric patients

The utility of multidetector computed tomography for evaluation of congenital heart disease

Background: Congenital heart diseases (CHD) are the leading cause of birthdefect-related deaths. Multidedector computed tomography (MDCT) plays animportant role for imaging CHD in addition to echocardiography and providesa comprehensive evaluation of complex heart malformations for the referringcardiologist. The aim of the study was to evaluate the utility of MDCT in theassessment of CHD.Materials and methods: A 102 patients with CHD were investigated after initialassessment by echocardiography. The information obtained by MDCT and findingsof echocardiography were reviewed together by paediatric cardiologistsand cardiac radiologists. Perioperative anatomic descriptions, wherever available(n = 34) formed the gold standard for the comparison.Results: The clinical consensus diagnosis defined 154 cardiovascular lesions inthe patients. The results were classified in groups. We present the appearanceof various congenital cardiac lesions seen in clinical practice.Conclusions: MDCT provides important information about anatomic details ofCHD for the referring cardiologist. The evaluation of different anatomic structuressuch as heart, great vessels, lungs and abdomen is possible in one acquisitionwith this technique

Improved model for the analysis of the Heat Release Rate (HRR) in Compression Ignition (CI) engines

The accuracy of the Heat Release Rate (HRR) model of Internal Combustion Engines (ICEs) is highly depended on the ratio of specific heats, gamma (γ). Previous γ models were largely expressed as functions of temperature only. The effects of the excess air ratio (λ) and the Exhaust Gas Recirculation (EGR) rate on γ were neglected in most of the existing γ functions. Furthermore, previous HRR models were developed for stoichiometric or near – stoichiometric air - fuel mixtures in an engine condition. However, Compression Ignition (CI) engines operate over a wide range of λ. No work has been done to model the HRR of CI engines under non – stoichiometric conditions. Also, no work has been done to investigate the accuracy of existing γ functions specifically with respect to the modelling of the HRR of CI engines for non – stoichiometric conditions. The aim of this work was to develop an improved HRR model for the analysis of the HRR of CI engines for non – stoichiometric conditions (λ>1). In this work, a modified γ(T,λ), was used to model the HRR of a 96 kW, multiple fuel injection, Euro V, Direct Injection (DI) engine. The modified HRR model (Leeds HRR model) predicted the fuel consumption of the engine with an average error of 1.41% confirming that the accuracy of the HRR model of CI engines is improved by using γ(T,λ). The typical average error in the prediction of the other models was 16%. The much improved HRR model leads to more accurate prediction of fuel consumption, which enables the development of and enhances better fuel consumption management strategies for engines and fuels. It was also ascertained in this work that EGR has insignificant effect on the HRR of CI engines at low and medium loads

Infected cardiac hydatid cyst

A 24 year old woman presented with chest pain and palpitation. The presence of a semisolid mass—an echinococcal cyst or tumour—in the left ventricular apex was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. The infected cyst was seen at surgery. The cyst was removed successfully by using cardiopulmonary bypass with cross clamp.


Keywords: cardiac hydatid cyst; infected cardiac hydatid cys

Mitral valve replacement and tricuspid annuloplasty via right mini-thoracotomy in a patient with tracheostomy

This report describes our experience in performing mitral valve replacement and tricuspid annuloplasty via a right mini-thoracotomy in a patient with tracheostomy. A 24-year-old woman was admitted with shortness of breath and palpitations. She had subglottic tracheal stenosis and tracheostomy due to tracheal intubation of long duration. Echocardiography revealed chronic severe mitral and tricuspid valve regurgitation. We planned to perform at first the cardiac, and then the tracheal operation, because her left ventricular function was worsening. To eliminate the potential complications of sternotomy in patients with tracheostomy, we used right mini-thoracotomy. We performed mechanical mitral valve replacement for the mitral valve and De Vega annuloplasty for the tricuspid valve. The patient was transferred to the tracheal surgery clinic after the 20th day. Tracheal resection and anastomosis were performed in this department. Three months later, the patient was asymptomatic. We believe that the right mini-thoracotomy approach is a good technique for mitral valve replacement in patients with tracheostomy

Paroxysmal Complete Atrioventricular Block: A Rare Cause of Syncope in Children

Paroxysmal atrioventricular block (PAVB) is a rare cause of syncope, mostly reported in adults. In the present study, a child with recurrent syncope due to PAVB is reported. A 12-year old boy was admitted due to syncope. Some syncopal episodes were consistent with vasovagal syncope, while others had atypical features. Electrocardiography, echocardiography, and 24-hour electrocardiography monitoring were normal. Head-up tilt table test revealed mixed type vasovagal syncope. With beta-blocker treatment, the frequency of syncopal episodes decreased; however, the episodes with atypical features continued. Intracardiac electrophysiological study was normal, but repeated external loop recorder monitoring revealed transient AVB during a syncopal episode. In children with syncope with atypical features, PAVB should be kept in mind. Repeated external loop recorder monitoring may be useful in the diagnosis of such seldom seen arrhythmic causes.Wo

Long-term results of endocardial pacing with Autocapture™ threshold tracking pacemakers in children

PubMedID: 16216759Aim: We aimed to evaluate the long-term results of endocardial pacing with Autocapture™ threshold tracking pacemakers in children. Methods and results: Implantation and follow-up data of 20 children with these pacemakers were retrospectively evaluated. The pacemakers were implanted subpectorally in five and subcutaneously in 15 patients. The indication for pacing was high-grade atrioventricular block in 18 cases. The mean age at implantation was 7 ± 4.8 years. Four patients were pacemaker dependant (heart rate < 30 bpm). At implantation, the mean pacing threshold was 0.5 V at 0.5 ms. The mean evoked response (ER) signal was 8.5 ± 3.6 mV, and the polarisation signal (PS) was <1 mV in 15 patients and 1-2 mV in five patients. During the mean follow-up period of 60 months, mean ER signal decreased significantly to 7.7 ± 6.3 mV at 24 months and 6.5 ± 2.5 mV at 60 months (P < 0.05). In four of 15 patients (26.6%), with a predischarge PS value of <1 mV, it increased between 1 and 2 mV over time. During follow-up, autocapture function was deactivated in six (30%) patients; due to inappropriate ER/PS values in four and due to severe muscle twitching in two with subpectoral implants. These problems occurred during a median period of 21 months after implantation. Generators were replaced in three patients with Microny pacemakers because of battery depletion at 54, 66 and 78 months. In two of them autocapture function had been working since implantation. In seven of 10 patients, who completed ?60 months of follow-up, battery impedances were still at the predischarge level. Conclusions: Autocapture function works well in most children at implantation. Mean ER signal significantly decreases over time despite stable pacing parameters. Autocapture function may become nonoperational due to decreased ER signal in some patients. Muscle twitching may be an important problem that may result in discontinuation of autocapture function in children with subpectoral implants. © 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved

Long-term results of endocardial pacing with Autocapture (TM) threshold tracking pacemakers in children

WOS: 000233324000010PubMed ID: 16216759Aim We aimed to evaluate the Long-term results of endocardial pacing with Autocapture (TM) threshold tracking pacemakers in children. Methods and results Implantation and follow-up data of 20 children with these pacemakers were retrospectively evaluated. The pacemakers were implanted subpectorally in five and subcutaneously in 15 patients. The indication for pacing was high-grade atrioventricutar block in 18 cases. The mean age at implantation was 7 +/- 4.8 years. Four patients were pacemaker dependant (heart rate = 60 months of follow-up, battery impedances were still at the predischarge level. Conclusions Autocapture function works well in most children at implantation. Mean ER signal significantly decreases over time despite stable pacing parameters. Autocapture function may become nonoperational due to decreased ER signal in some patients. Muscle twitching may be an important problem that may result in discontinuation of autocapture function in children with subpectoral implants. (c) 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved