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Biventricular repair approach in ducto-dependent neonates with hypoplastic but morphologically normal left ventricle

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期33卷 827-834页

作者： Serraf, A Piot, JD Bonnet, N Lacour-Gayet, F Touchot, A Bruniaux, J Belli, E Galletti, L Planché, C Hop Marie Lannelongue Dept Pediat Cardiac Surg F-92350 Le Plessis Robinson France

OBJECTIVES Increased afterload and multilevel LV obstruction is constant. We assumed that restoration of normal loading conditions by relief of LV obstructions promotes its growth, provided that part of the cardiac output was preoperatively supported by the LV, whatever the echocardiographic indexes. BACKGROUND Whether to perform uni- or biventricular repair in ducto dependent neonates with hypoplastic but morphologically normal LV (hypoplastic left heart syndrome classes II & III) remains unanswered. Echocardiographic criteria have been proposed for surgical decision. METHODS Twenty ducto dependent neonates presented with this anomaly. All had aortic coarctation associated to multilevel LV obstruction. Preoperative echocardiographic assessment showed: mean EDLVV of 12.4 +/- 3.03 ml/m(2) and mean Rhodes score of -1.73 +/- 0.8. Surgery consisted in relief of LV outflow tract obstruction by coarctation repair in all associated to aortic commissurotomy in one and ASD closure in 2. RESULTS There were 3 early and 2 late deaths. Failure of biventricular repair and LV growth was obvious in patients with severe anatomic mitral stenosis. The other demonstrated growth of the left heart. At hospital discharge the EDLVV was 19.4 +/- 3.12 ml/m(2) (p = 0.0001) and the Rhodes score was -0.38 +/-. 1.01 (p = 0.0003). Actuarial survival and freedom from reoperation rates at 5 years were 72.5% and 46%, respectively. CONCLUSIONS Biventricular repair can be proposed to ducto dependent neonates with hypoplastic but morphologically normal LV provided that all anatomical causes of LV obstruction can be relieved. Secondary growth of the left heart then occurs;however, the reoperation rate is high. (C) 1999 by the American College of Cardiology.

关键词：畸形多发性主动脉缩窄/并发症主动脉缩窄/诊断显像主动脉缩窄/外科学心脏外科手术心肺转流术动脉导管超声心动描记术随访研究房间隔缺损/并发症房间隔缺损/诊断显像房间隔缺损/外科学心室/诊断显像心室/生长和发育左心发育不全综合征/并发症左心发育不全综合征/诊断显像左心发育不全综合征/外科学二尖瓣狭窄/并发症二尖瓣狭窄/诊断显像二尖瓣狭窄/外科学手术后并发症/死亡率手术后并发症/外科学复发再手术回顾性研究存活率治疗结果室性流出道阻塞/诊断显像室性流出道阻塞/病因学室性流出道阻塞/外科学录像女(雌)性人类婴儿新生男(雄)性

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Left ventricular systolic dysfunction during exercise and dobutamine stress in patients with hypertrophic cardiomyopathy

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第3期36卷 856-863页

作者： Okeie, K Shimizu, M Yoshio, H Ino, H Yamaguchi, M Matsuyama, T Yasuda, T Taki, J Mabuchi, H Kanazawa Univ Sch Med Dept Internal Med 2 Kanazawa Ishikawa 9208641 Japan Kanazawa Univ Sch Med Dept Nucl Med Kanazawa Ishikawa 9208641 Japan

OBJECTIVES We sought to characterize stress-induced left ventricular systolic dysfunction in patients with hypertrophic cardiomyopathy (HCM). BACKGROUNDS Myocardial ischemia and diastolic dysfunction occur in patients with HCM. We hypothesized that, in the setting of transient myocardial ischemia, left ventricular systolic dysfunction occurs during exercise and dobutamine stress. METHODS We studied 39 patients with HCM but without obstructive symptoms at rest or coronary artery disease. A continuous ventricular function monitor equipped with cadmium telluride detectors (VEST) was used to evaluate left ventricular function during supine bicycle ergometer exercise. Dobutamine stress echocardiography (DSE) was also performed. The left ventricular ejection Fraction (LVEF) and regional wall motion were determined from echocardiographic images. RESULTS Changes in the LVEF correlated between exercise and dobutamine stress (r = 0.643, p < 0.0001). The LVEF decreased more than 5% at peak exercise in 17 of patients (group IT), while the other patients had normal responses (group I). New regional wall motion abnormalities during dobutamine infusion were detected in 18 of 110 (16.4%) segments in group I and 42 of 85 (49.4%) segments in group II. Decreased or unchanged regional wall motion occurred more frequently in hypertrophied segments than in nonhypertrophied segments (p < 0.0001). There were significant inverse correlations between the LVEF responses during both stresses and the number of abnormal segments noted during dobutamine stress in all patients (VEST: p < 0.005;DSE: p < 0.0005). Signs of left ventricular obstruction were observed in 11 of 39 patients during DSE. However, there was no significant correlation between the LVEF response and the dobutamine-induced left ventricular pressure gradient. CONCLUSIONS Exercise-induced systolic dysfunction occurred in 50% of patients with HCM. In these patients, regional wall motion abnormalities were present in hypertrophied s

关键词：血压心肌病肥厚性/诊断心肌病肥厚性/诊断显像强心药/治疗应用多巴酚丁胺超声心动描记术运动试验/副作用血流动力学每搏输出量心缩期心室功能障碍左/病因学心室功能左室性流出道阻塞/病因学室性流出道阻塞/病理生理学成年人女(雌)性人类男(雄)性中年人

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Systolic anterior motion begins at low left ventricular outflow tract velocity in obstructive hypertrophic cardiomyopathy

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第4期36卷 1344-1354页

作者： Sherrid, MV Gunsburg, DZ Moldenhauer, S Pearle, G Columbia Univ Coll Phys & Surg St Lukes Roosevelt Hosp Ctr Div Cardiol HCM Program New York NY 10032 USA

OBJECTIVES The purpose of this study was to determine whether the dynamic cause for mitral systolic anterior motion (SAM) is a Venturi or a flow drag (pushing) mechanism. BACKGROUND In obstructive hypertrophic cardiomyopathy (HCM), if SAM were caused by the Venturi mechanism, high flow velocity in the left ventricular outflow tract (LVOT) should be found at the time of SAM onset. However, if the velocity was found to be normal, this would support an alternative mechanism. METHODS We studied with echocardiography 25 patients with obstructive HCM who had a mean outflow tract gradient of 82 +/- 6 mm Hg. We compared mitral valve M-mode echocardiogram tracings with continuous wave (CW) and pulsed wave (PW) Doppler tracings recorded on the same study. A total of 98 M-mode, 159 CW, and 151 PW Doppler tracings were digitized and analyzed. For each patient we determined the LVOT CW velocity at the time of SAM onset. This was done by first determining the mean time interval from Q-wave to SAM onset from multiple M-mode tracings. Then, CW velocity in the outflow tract was measured at that same time interval following the Q wave. RESULTS Systolic anterior motion began mean 71 +/- 5 ms after Q-wave onset. Mean CW Doppler velocity in the LVOT at SAM onset was 89 +/- 8 cm/s. In 68% of cases SAM began before onset of CW and PW Doppler LV ejection. CONCLUSIONS Systolic anterior motion begins at normal LVOT velocity. At SAM onset, though Venturi forces are present in the outflow tract, their magnitude is much smaller than previously assumed;the Venturi mechanism cannot explain SAM. These velocity data, along with shape, orientation and temporal observations in patients, indicate that drag, the pushing force of flow, is the dominant hydrodynamic force that causes SAM. (J Am Coll Cardiol 2000;36: 1344-54) (C) 2000 by the American College of Cardiology.

关键词：血流速度心肌病肥厚性/并发症心肌病肥厚性/诊断显像心肌病肥厚性/病理生理学超声心动描记术多普勒脉冲心电描记术观察者偏差每搏输出量心缩期/生理学室性流出道阻塞/诊断显像室性流出道阻塞/病因学室性流出道阻塞/病理生理学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Clinical and echocardiographic features of hypereosinophilic Syndromes

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期86卷 110-+页

作者： Ommen, SR Seward, JB Tajik, AJ Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA

Idiopathic hypereosinophilic syndrome results in characteristic cardiac abnormalities and increased morbidity in 50% of patients. Other causes of prolonged eosinophilia can demonstrate similar findings in a smaller pr... 详细信息

关键词：诊断鉴别超声心动描记术心脏病/病因学心脏病/超声检查嗜酸细胞增多综合征/并发症嗜酸细胞增多综合征/超声检查心包积液/病因学心包积液/超声检查预后回顾性研究血栓形成/病因学血栓形成/超声检查室性流出道阻塞/病因学室性流出道阻塞/超声检查录像成年人女(雌)性人类男(雄)性中年人

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Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: One-year follow-up

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第3期36卷 852-855页

作者： Lakkis, NM Nagueh, SF Dunn, JK Killip, D Spencer, WH Baylor Coll Med Dept Med Cardiol Sect Houston TX 77030 USA

OBJECTIVE The objective of this study is to evaluate the one-year outcome of the first 50 patients who underwent nonsurgical septal reduction for symptomatic hypertrophic obstructive cardiomyopathy at our institution. BACKGROUND Left ventricular outflow tract obstruction is an important determinant of clinical symptoms in patients with hypertrophic obstructive cardiomyopathy. Nonsurgical septal reduction is a new therapy that has been shown to result in left ventricular outflow tract gradient reduction and resolution of symptoms immediately after the procedure and on midterm follow-up. METHODS Fifty patients with hypertrophic obstructive cardiomyopathy who underwent nonsurgical sep;al reduction at our institution and completed 1-year follow-up are described. Complete history, physical examination, two-dimensional echocardiography with Doppler and exercise treadmill. testing have been analyzed. RESULTS The mean age of the study group was 53 +/- 17 years. All patients had refractory symptoms before enrollment. Ninety-four percent had class III or IV New York Heart Association class symptoms at baseline compared to none at 1 year (p < 0.001). The exercise duration increased by 136 s at 1 year (p < 0.021). Only 20% of patients were either receiving beta-blockers or calcium-channel blockers on follow-up. The resting left ventricular outflow tract gradient decreased from 74 +/- 23 mm Hg to 6 +/- 18 mm Hg (p < 0.01) and from 84 +/- 28 mm Hg to 30 +/- 33 mm Hg (p < 0.01) in patients with dobutamine-provoked gradient at one year. These changes are associated with decreased septal thickness and preserved systolic function. CONCLUSION Nonsurgical septal reduction therapy is an effective therapy for symptomatic patients with hypertrophic obstructive cardiomyopathy with persistence of the favorable outcome up to one year after the procedure. (C) 2000 by the American College of Cardiology.

关键词：心肌病肥厚性/并发症心肌病肥厚性/诊断显像心肌病肥厚性/死亡率心肌病肥厚性/治疗补充疗法/方法超声心动描记术多普勒乙醇/治疗应用随访研究心间隔/药物作用注射室性流出道阻塞/病因学成年人老年人女(雌)性人类男(雄)性中年人

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Left ventricular outflow tract obstruction with mitral mechanical prosthesis

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ANNALS OF THORACIC SURGERY 1999年第1期68卷 255-257页

作者： Melero, JM Rodriguez, I Such, M Porras, C Olalla, E Virgen Victoria Univ Hosp Dept Cardiac Surg Malaga 29010 Spain Virgen Victoria Univ Hosp Dept Cardiol Malaga 29010 Spain

Left ventricular outflow tract obstruction after mitral valve replacement may occur when the native mitral apparatus is preserved intact. Although it has usually been reported using bioprostheses, we present one case using a low-profile mechanical prosthesis. The reduction of left ventricular dimensions and valvular redundancy contributed to this complication. We obtained definitive relief of left ventricular outflow tract obstruction by transaortic exposure and partial resection of the obstructing tissue with the help of video-assisted cardioscopy. (C) 1999 by The Society of Thoracic Surgeons.

关键词：心脏瓣膜假体植入/方法二尖瓣/外科学室性流出道阻塞/诊断室性流出道阻塞/病因学女(雌)性人类中年人

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Spontaneous resolution of obstructive valvular tumors in infants

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AMERICAN HEART JOURNAL 2002年第5期143卷 868-872页

作者： Guntheroth, WG Fujioka, MC Reichenbach, DD Univ Washington Sch Med Dept Pathol Seattle WA 98195 USA Univ Washington Sch Med Dept Pediat Cardiol Seattle WA 98195 USA Univ Washington Sch Med Cardiac Diagnost Labs Echocardiog Seattle WA 98195 USA

Background Myxomas, the most common cardiac tumor in adults, occur in the atria and are prone to embolization. Obstructive valvular tumors in infants occur in pulmonic and aortic valves and generally have a more benign course. Methods We conducted a review of our experience in infants with tumors obstructing the right or left ventricular outflow tract, originating from pulmonic or aortic valve tissue. Tissue diagnosis was available from only the index case;A additional infants survived with spontaneous regression, and only echocardiographic characterizations were available. Results Five cases were found with obstructing valvular tumors. In the index case, the obstruction resulted in heart failure, required surgical extirpation, and revealed histology diagnostic of a myxoma. In the subsequent 4 infants with conditions diagnosed with echocardiography, the appearance was suggestive of myxomas (small, compact, ovoid, with no fronds and no embolization). All 4 cases remained mildly to moderately obstructive and then showed spontaneous regression during a period of months to years. Conclusion None of our cases deteriorated clinically, except the first, and were therefore different from other tumors, such as adult atrial myxomas, papillary fibroelastomas, fibromas, and rhabdomyomas. Only the latter are known to spontaneously regress in infancy. The prevalence of valvular tumors in infants may have previously been underestimated, given the absence of symptoms in 4 of our cases and the spontaneous regression of the tumor. An alternate diagnosis for these 4 cases could be a tissue "myxomatous rest" as opposed to a neoplastic myxoma. In either case, surgical intervention may not be necessary.

关键词：主动脉瓣超声心动描记术心脏肿瘤/并发症心脏肿瘤/病理学心脏肿瘤/超声检查心脏瓣膜疾病/病因学婴儿早产黏液瘤/并发症黏液瘤/病理学黏液瘤/超声检查肿瘤消退自行性肺动脉瓣超声检查产前室性流出道阻塞/病因学室性流出道阻塞/超声检查人类婴儿婴儿新生

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An unusual cause of shock in a woman with chest pain

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HOSPITAL PRACTICE 1999年第4期34卷 155-+页

作者： Alberio, L Fiori, G Domenighetti, G Reg Hosp La Carita Multidisciplinary Intens Care Unit Locarno Switzerland

Click to increase image sizeClick to decrease image size

关键词：心绞痛不稳定型/并发症心绞痛不稳定型/药物疗法心绞痛不稳定型/病因学心血管药物/治疗应用心室/药物作用心室/病理生理学肥大左心室/并发症休克心原性/化学诱导休克心原性/药物疗法室性流出道阻塞/并发症室性流出道阻塞/病因学室性流出道阻塞/病理生理学女(雌)性人类中年人

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Rapid return of left ventricular outflow tract obstruction and symptoms following cessation of long-term atrioventricular synchronous pacing for obstructive hypertrophic cardiomyopathy

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第4期83卷 553-557页

作者： Gadler, F Linde, C Rydén, L Karolinska Hosp Dept Cardiol S-17176 Stockholm Sweden

Atrioventricular (AV) synchronous pacing reduces left ventricular (LV) outflow tract obstruction and symptoms in patients with obstructive hypertrophic cardiomyopathy (HC). The duration of gradient reduction, if pacing is discontinued for a prolonged period of time, is unknown. This question is addressed in the present randomized double-blind crossover study comparing continued with inactivated pacing. Ten patients, successfully paced for greater than or equal to 6 months, were randomized to continue pacing or to have their pacemakers inactivated after examinations, including echo-Doppler imaging, exercise testing, and a quality-of-life questionnaire. When entering the study, the patients were in New York Heart Asssosciation functional classes I to II. After pacemaker programming, examinations were repeated at 1, 4, and 12 weeks. At the 12-week follow-up the alternate pacing mode was programmed, and the patient entered the second study arm. Premature pacemaker pacing occurred if severe clinical deterioration or a significant increase of the LV outflow tract obstruction were evident. Three patients started in the inactive mode and 7 patients in the active mode. All patients who started with the pacemaker inactivated required early reprogramming due to return of symptoms after 7, 10, and 13 days, respectively. All 7 patients who started in the active pacing mode completed the first period;however, after reprogramming to the inactive mode they required early activation after 1 to 20 days due to reappearance of intolerable subjective symptoms. The LV outflow tract gradient increased significantly after inactivation of pacing in all patients (22 +/- 21 mm Hg to 47 +/- 21 mm Hg). Thus, AV synchronous pacing effectively relieves symptoms and reduces the LV outflow tract gradient in patients with obstructive HC. This improvement, which is rapidly established with the initiation of cardiac pacing, is not persistent after cessation of pacing. Reinitialization of pacing prompt

关键词：心脏起搏人工心肌病肥厚性/治疗心肌病肥厚性/超声检查交叉研究双盲法超声心动描记术多普勒生活质量复发时间因素治疗结果室性流出道阻塞/病因学室性流出道阻塞/超声检查老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Predictors of left ventricular outflow obstruction following single-stage repair of interrupted aortic arch and ventricular septal defect

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第9期86卷 1044-1047页

作者： Salem, MM Starnes, VA Wells, WJ Acherman, RJ Chang, RKR Luciani, GB Wong, PC Kaiser Permanente Med Ctr Dept Pediat Los Angeles CA 90027 USA Childrens Hosp Los Angeles Div Pediat Cardiol Los Angeles CA 90027 USA Childrens Hosp Los Angeles Div Cardiothorac Surg Los Angeles CA 90027 USA Univ Calif Los Angeles Harbor Med Ctr Torrance CA 90509 USA Univ Verona Div Cardiac Surg I-37100 Verona Italy

Since its first description by Steidele1 in 1778, interrupted aortic arch and ventricular septal defect (IAA/VSD) has gained notoriety as one of the most challenging anomalies to treat surgically. Management of IAA/VSD has advanced from palliative procedures—including the modified Van Praagh procedure using extracardiac conduits and pulmonary artery banding2—to staged repair algorithms. Although some centers have reported excellent results using the staged approach, most institutions continue to have significant morbidity and mortality rates, as well as a high reoperation rate.3 In 1996, Luciani et al4 reported a novel single-stage neonatal repair technique that involved VSD closure and arch repair without resection of the conal septum. Although several series have looked at preoperative echocardiographic predictors of left ventricular outflow tract (LVOT) obstruction,5–8 to the best of our knowledge, none has looked at predictors of obstruction following this surgical approach. The objectives of our study were twofold: (1) to determine if there are any significant echocardiographic predictors of obstruction following the approach of Luciani et al,4 and (2) to assess growth of the aortic valve (AoV) and subaortic region.

关键词：畸形多发性/诊断畸形多发性/外科学方差分析主动脉胸/畸形主动脉胸/外科学心脏外科手术/方法随访研究心脏缺损先天性/诊断心脏缺损先天性/外科学室间隔缺损/诊断室间隔缺损/外科学多元分析试验预期值概率回顾性研究危险性评估治疗结果室性流出道阻塞/流行病学室性流出道阻塞/病因学室性流出道阻塞/超声检查女(雌)性人类婴儿新生男(雄)性

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