Echocardiographic diagnosis of right aortic arch with a retroesophageal segment and left descending aorta

Two-dimensional echocardiography has been used extensively to assess aortic arch anatomy in infants and children. Echocardiographic techniques for examination of left and right aortic arch, coarctation and interruption of the aorta, aortic aneurysm and double aortic arch have been well described.1,2 Right aortic arch with retroesophageal segment and left descending aorta, an unusual form of vascular ring, has been described using angiography, barium swallow and computed axial tomography.3-5 In this report, we describe 2-dimensional (2-D) echocardiographic findings in an infant with this unusual form of vascular ring.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26188/1/0000267.pd

Hemodynamic determinants of exercise-induced ST-Segment depression in children with valvar aortic stenosis

To evaluate the hemodynamic factors associated with treadmill-induced ST-segment depression in children with valvar aortic stenosis, 12 patients (mean age 13 years) with ST-segment depression during treadmill exercise and 5 patients (mean age 13 years) without ST-segment depression during treadmill exercise underwent exercise testing during cardiac catheterization. The left ventricular (LV) systolic pressure and LV outflow tract gradient at rest (177 +/- 25 vs 138 +/- 8 mm Hg and 59 +/- 18 vs 23 +/- 7 mm Hg, respectively) and corresponding pressures during maximal supine exercise (248 +/-37 vs 189 +/- 17 mm Hg and 112 +/- 34 vs 52 +/- 14 mm Hg) were significantly greater (p 2 supply-demand ratio during maximal supine exercise was significantly less (6.4 +/- 2.7 vs 11.8 +/- 0.7; p 2 supply-demand ratio less than 11.0 was 100% sensitive and specific in predicting treadmill-induced ST-segment depression. These results suggest that although the development of ST-segment depression during treadmill exercise is related to LV systolic pressure and LV outflow gradient, its major hemodynamic determinant is the LV-02 supply-demand ratio.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25706/1/0000260.pd

Balloon angioplasty for congenital and rheumatic mitral stenosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26283/1/0000368.pd

Results of balloon valvuloplasty in the treatment of congenital valvar pulmonary stenosis in children

Transluminal balloon valvuloplasty was used in the treatment of congenital valvar pulmonary stenosis in 19 children, aged 5 months to 18 years. The right ventricular (RV) systolic pressure and RV outflow tract gradient decreased significantly immediately after the procedure (95 +/- 29 vs 59 +/- 14 mm Hg, p < 0.01, and 78 +/- 27 vs 38 +/- 13 mm Hg, p < 0.01). Seven of these patients were evaluated at cardiac catheterization 1 year after balloon valvuloplasty. No significant change occurred in RV systolic pressure or RV outflow tract gradient at follow-up evaluation compared with measurements immediately after balloon valvuloplasty (60 +/- 5 mm Hg vs 56 +/- 12 mm Hg and 39 +/- 5 vs 38 +/- 10 mm Hg). In addition, follow-up evaluation was performed using noninvasive methods and included electrocardiography (n = 13), vectorcardiography (n = 11) and Doppler echocardiography (n = 11) Doppler echocardiography in 11 patients 15 +/- 9 months after balloon valvuloplasty showed a continued beneficial effect with a mild further decrease in RV outflow tract gradient. Thus, balloon valvuloplasty is effective in the relief of pulmonary stenosis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25572/1/0000114.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