Patent ductus arteriosus associated with pulmonary hypertension and desaturation

We present the cases of three children with patent ductus arteriosus (PDA), pulmonary arterial hypertension (PAH), and desaturation. One of them had desaturation associated with atrial septal defect (ASD). His ASD, PAH, and desaturation improved after successful device closure of the PDA. The other two had desaturation associated with Down syndrome. One had desaturation only at room air oxygen (21% oxygen) but well saturated with 100% oxygen, subsequently underwent successful device closure of the PDA. The other had experienced desaturation at a younger age but spontaneously recovered when he was older, following attempted device closure of the PDA, with late embolization of the device. (Cardiol J 2012; 19, 5: 543-546

Bacterial Endocarditis Caused by <i>Actinomyces oris</i>: First Reported Case and Literature Review

Actinomyces species are gram-positive, facultative anaerobic bacilli. Infection caused by Actinomyces species is usually limited to cervicofacial, thoracic, and abdominopelvic regions. Infective endocarditis due to Actinomyces species is extremely rare with only 30 reported cases since 1939. We report a case of Actinomyces oris endocarditis in a 14-year-old boy who had a 2-week history of dyspnea on exertion without other constitutional signs. Transthoracic echocardiography was suggestive of perforation of the right coronary cusp of aortic valve. No organisms were isolated from blood cultures. The patient underwent surgical valve repair due to deteriorated cardiac function. Valve tissue culture did not initially identify the organism. However, the terminal subculture in a thioglycolate broth grew gram-positive bacilli. The matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) was compatible with Actinomyces oris. After 6 weeks of intravenous ampicillin, the patient remained well with improved cardiac function. We reviewed all reported cases of infective endocarditis caused by Actinomyces species, commenting on clinical characteristics and factors associated with unfavorable outcomes in infective endocarditis due to Actinomyces species. Although infective endocarditis caused by Actinomyces spp is rare, it could be considered in a case of culture-negative endocarditis since the clinical features might be indistinguishable from other bacterial endocarditis. Additionally, MALDI-TOF MS is a useful diagnostic tool for the identification of Actinomyces spp to improve the accuracy of diagnosis. </jats:p

Branch Pulmonary Artery Regurgitation in Repaired Tetralogy of Fallot: Correlation with Pulmonary Artery Morphology, Distensibility, and Right Ventricular Function

Background: The aim was to determine the effect of pulmonary artery (PA) morphology on the branch pulmonary artery-regurgitation fraction (BPA-RF), the relationship of pulmonary insufficiency (PI) to BPA-RF and PA-distensibility, and factors (BPA-RF and PA-distensibility) associated with right ventricular function (RVF) in repaired tetralogy of Fallot (rTOF). Methods: A total of 182 rTOF patients (median age 17.1 years) were analyzed for length, angle of PA, BPA-RF, PI, and PA-distensibility, using magnetic resonance imaging. Results: The left PA had a significant greater RF than the right PA (median (interquartile range)): LPA 43.1% (32.6–51.5) and RPA 35.2% (24.7–44.7), p &lt; 0.001. The LPA was shorter with a narrower angle than the RPA (p &lt; 0.001). The anatomy of the branch-PA was not a factor for the greater LPA-RF (odds ratio, 95% confidence interval: CI, p-value): length 0.44 (0.95–2.00), p = 0.28; angle 0.63 (0.13–2.99), p = 0.56. There was a strong positive correlation between PI and BPA-RF-coefficients (95% CI), p-value: LPA 0.78% (0.70–0.86), p &lt; 0.001; RPA 0.78% (0.71–0.84), p &lt; 0.001 and between BPA-RF and distensibility-coefficients (95%CI), p-value: LPA 0.73% (0.37–1.09), p &lt; 0.001; RPA 1.63% (1.22–2.03), p &lt; 0.001, respectively. The adjusted BPA-RF did not predict RVF, RPA (p = 0.434), LPA (p = 0.268). Conclusions: PA morphology is not a significant factor for the differential BPA-RF. The vascular wall in rTOF patients responds to chronic increased intravascular volume by increasing distensibility. BPA-RF is not a determinant of RVF

Branch Pulmonary Artery Regurgitation in Repaired Tetralogy of Fallot: Correlation with Pulmonary Artery Morphology, Distensibility, and Right Ventricular Function

Background: The aim was to determine the effect of pulmonary artery (PA) morphology on the branch pulmonary artery-regurgitation fraction (BPA-RF), the relationship of pulmonary insufficiency (PI) to BPA-RF and PA-distensibility, and factors (BPA-RF and PA-distensibility) associated with right ventricular function (RVF) in repaired tetralogy of Fallot (rTOF). Methods: A total of 182 rTOF patients (median age 17.1 years) were analyzed for length, angle of PA, BPA-RF, PI, and PA-distensibility, using magnetic resonance imaging. Results: The left PA had a significant greater RF than the right PA (median (interquartile range)): LPA 43.1% (32.6–51.5) and RPA 35.2% (24.7–44.7), p &lt; 0.001. The LPA was shorter with a narrower angle than the RPA (p &lt; 0.001). The anatomy of the branch-PA was not a factor for the greater LPA-RF (odds ratio, 95% confidence interval: CI, p-value): length 0.44 (0.95–2.00), p = 0.28; angle 0.63 (0.13–2.99), p = 0.56. There was a strong positive correlation between PI and BPA-RF-coefficients (95% CI), p-value: LPA 0.78% (0.70–0.86), p &lt; 0.001; RPA 0.78% (0.71–0.84), p &lt; 0.001 and between BPA-RF and distensibility-coefficients (95%CI), p-value: LPA 0.73% (0.37–1.09), p &lt; 0.001; RPA 1.63% (1.22–2.03), p &lt; 0.001, respectively. The adjusted BPA-RF did not predict RVF, RPA (p = 0.434), LPA (p = 0.268). Conclusions: PA morphology is not a significant factor for the differential BPA-RF. The vascular wall in rTOF patients responds to chronic increased intravascular volume by increasing distensibility. BPA-RF is not a determinant of RVF.</jats:p

Evaluation of Descending Aortic Flow Volumes and Effective Orifice Area Through Aortic Coarctation by Spatiotemporal Integration of Color Doppler Data: An In Vitro Study

Flow volumes in an in vitro model of the aorta with 3 different degrees of stiffness (stiff, moderately stiff, and compliant) proximal to a coarctation were calculated by using a digital color Doppler echocardiography flow calculation method that semi-automatically integrates spatial and temporal color flow velocity data. These flow volumes were compared with those obtained by the conventional pulsed Doppler method with reference to ultrasonic flowmeter. Flow volumes determined by the automated method agreed well with those obtained by ultrasonic flowmeter, even in this compliant aorta model with vessel size changing with pulsation, whereas the pulsed Doppler method overestimated the reference data, especially for more compliant descending aortic segments. The combination of flow data with continuous wave Doppler allows definition of effective orifice area for coarctation