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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

PURPOSE--To present initial experience on radiofrequency (RF) ablation of atrial flutter (AFL) guided by anatomic and electrophysiologic parameters. METHODS--Eight patients (six males), mean-age of 42 +/- 17.5 years with chronic type I AFL (mean cycle length of 251 +/- 14.3 msec, range 240 to 280 msec) were undergone to RF catheter ablation applied between inferior vena cava (IVC) and tricuspid annulus (TA). Two had persistent and two the paroxysmal form. Two had surgical corrected congenital heart disease (atrial septal defect in 2 and ventricular septal defect in 1). Four had systolic dysfunction and 2, an atrial tachycardia associated with the AFL. RESULTS--Areas of slow conduction represented by fractionated potentials were recorded between IVC and TA in all patients. RF ablation was successful in 8/8 patients (100%). The mean number of RF applications was 9.2 +/- 6.2 (4-24). The successful ablation site was located in the isthmus between IVC and TA in seven patients and in the lateral wall in the patient with ASD. Successful sites had an early atrial activation preceding the atrial electrogram (range from -65 to -82 ms). In one patient the RF energy was successfully delivered between the atriotomy scar (AS) and IVC. After three months follow-up six remained free of recurrent AFL. One pt had type 1 AFL recurrence and one with ASD had a type II AFL. The Type II AFL was successfully ablated between AS and IVC. CONCLUSION--Fractionated potentials were commonly observed between IVC and T; AFL ablation can be guided by anatomic landmarks or electrophysiologic parameters; electrograms recorded at successful sites were early and never fractionated; the long-term evaluation must be analyzed prospectively.
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PMID:[Ablation therapy of type I atrial flutter with radiofrequency]. 749 90

The treatment of congenital heart disease may be palliative because many residua and sequelae persist into adulthood. Except for trivial lesions and anomalies such as PDA or secundum ASD where surgical cure is possible, continued supervision is mandatory. These patients deserve expert medical assessment from adult cardiologists and from other specialists when appropriate. The prevalence of postoperative adult congenital heart disease is increasing: by the year 2000 it is estimated that over 2000 in each million of the adult population will have congenital heart disease, one third of these having undergone cardiac surgery. It is important that some adult cardiologists in each major centre develop skills in adult congenital heart disease for this new patient population.
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PMID:Adult congenital heart disease: principles and management guidelines: Part II. 751 73

Fifty children with established congenital heart disease (CHD) were surveyed for the immune profile. Ventricular septal defect (VSD) was the commonest lesion (56%) followed by Tetralogy of Fallot (ToF; 16%), atrial septal defect (ASD; 8%), patent ductus arteriosus (PDA; 4%), transposition of great arteries (TGA; 4%), aortic stenosis (AS; 4%), and pulmonic stenosis (PS), tricuspid atresia (TA), single ventricle with pulmonic stenosis (SV with PS) and dextrocardia with ToF (2% each). Immunoglobulins (IgG, IgA and IgM) were estimated. IgG and IgA levels were significantly reduced in all children with congenital heart disease, whereas IgM levels were increased in cyanotic but unaffected in the acyanotic group. Complement C3 and C4 levels were reduced in all, more so in cyanotics. T-helper cells were decreased and T-suppressor cells were increased in all groups with congenital heart disease as compared to controls. B-cell percentage was increased in cyanotics but not affected in the acyanotics.
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PMID:Immunological profile in congenital heart disease. 789 64

This study was undertaken to evaluate factors predictive of postoperative outcome after general surgical (GS) procedures in patients with congenital heart disease (CHD). All patients with a diagnosis of CHD who underwent a GS procedure under general anesthesia during a consecutive 10-year period were considered eligible for the study The congenital heart defect was classified as either simple (ASD, VSD, PDA) or complex (endocardial cushion defects, transposition of the great vessels, tetralogy of Fallot), and the GS procedure as either major (intraperitoneal, intrathoracic, or vascular reconstructive) or minor (inguinal herniorrhaphy, vascular access). The overall mortality rate for the patient population was 12% (27 deaths among 226 procedures), minor procedures being associated with a 3% mortality rate (2 of 70 procedures), and major procedures with a 16% mortality rate (25 of 156 procedures). Incremental risk factors for mortality included a preoperative American Society of Anesthesiologists' (ASA) physical status class of IV or higher (P = .0003), a preoperative in-hospital stay of 10 or more days (P = .004), birth at a tertiary care center (P = .04), and emergency operations (P = .05). In the subgroup of patients less than 6 months old, weight of less than 2.4 kg at the time of surgery and a 1-minute Apgar score of less than 4 were additional independent risk factors (P = .04 and .01, respectively). By logistic analysis, previous corrective cardiac procedures, whether complete or palliative, did not significantly alter the postoperative outcome. The authors conclude that physiologically well-compensated patients with CHD can undergo elective operations at a low operative risk; however, poorly compensated patients undergoing urgent or emergent operations are at high risk.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Predictors of postoperative outcome after general surgical procedures in patients with congenital heart disease. 793 59

Relation between pulmonary vascular resistance (PVR) and left-to-right (L-D) shunt has been statistically tested in 87 patients with congenital heart diseases. In all patients, PVR and L-D shunt were calculated from the catheterization test results. Among 87 patients, 45 (52%) were female and 42 (48%) male children. The average age at the catheterization was 4.63 (min 6 mo, max 15 yr). Patients were divided into two groups with regard to the level of PVR. The first group consisted of patients with PVR higher than 160 dyn sec cm-5, and the second group with PVR lower than 160 dyn sec cm-5. The whole group was also divided according to VSD, and separate correlation was done for ASD with PVR below 160 dyn sec cm-5. A negative statistically significant correlation was observed between the height of PVR and size of L-D shunt among the entire group with PVR higher than 160 dyn sec cm-5, regardless of congenital heart disease (N = 29, r = -0.4676, P < 0.05). Also, a negative statistically significant correlation was found between PVR and L-D shunt in VSD, with PVR higher than 160 dyn sec cm-5 (N = 17, r = -0.669, P < 0.05). Among patients with low PVR, there was no negative statistically significant correlation between PVR and L-D shunt, neither for the whole group (N = 58, r = 0.1174, P > 0.05), nor among the patients with VSD r = -0.0133, P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Relation between the size of the left-right shunt and pulmonary resistance in congenital heart defects]. 813 63

As the operation risk of ASD is little today, the unexpected postoperative complication such as embolism is a miserable concern. We experienced two cases of embolism, which were cerebral infarction, in old-aged patients after ASD correction. It has been reported that low cardiac function, atrial fibrillation and foreign body in the left atrium should be risk factors of the embolism after ASD correction. However, blood stasis in the left atrium due to its enlargement may be an essential risk factor of the embolism. Accordingly we evaluated the left atrial volume in 87 ASD patients without complicated cardiac disorder. There was a significant correlation between the age (X) and left atrial volume index (Y). (Y = 16.5 + 1.1X, r = 0.668, p < 0.001). Left atrial volume index in our two cases of cerebral infarction indicated 171.7, 190.8 ml/m2 respectively. The former case had sinus rhythm and its defect was directly closed, and the latter had atrial fibrillation and its defect was closed with teflon patch. In addition pulmonary artery pressure and cardiothoracic ratio correlated with left atrial volume index significantly. Although some investigators reported that pulmonary hypertension and cardiomegaly were the risk factors of embolism, the left atrial enlargement by aging was thought to be the main risk factor. Thus, we concluded that anticoagulant therapy was necessary for the ASD patients with marked left atrial enlargement.
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PMID:[Post operative embolism and left atrial enlargement in the old-aged ASD (atrial septal defect) patients]. 822 8

Two hundred adults who underwent surgery for congenital heart disease at our institution within a four year period were the basis for this report. Clinical data was obtained, i.e. demographic details, past medical history, physical findings, EKGs, echocardiograms, catheterization and angiography material as well as the New York Heart Association (NYHA) class. Intraoperative findings, perioperative management, complications and morbidity and mortality were assessed. After discharge the patients were followed on an outpatient basis. Again the clinical findings, laboratory results and NYHA class were recorded. Age ranged from 16 to 75 years (mean = 38). There were 114 females and 86 males. 178 patients had primary surgical correction, 18 were reoperated after prior correction and 4 underwent palliation. Eighty-three percent of the patients were symptomatic preoperatively. Seventeen percent were diagnosed per chance, for example by a preemployment physical examination, without a prior history of heart disease. The patients were grouped according to related diagnoses (Table 1). Among the 130 patients with left to right shunts, 112 had an atrial septal defect, 7 a ventricular septal defect, 5 a persistent ductus arteriosus, and 6 partial anomalous pulmonary venous return. Atrial flutter or fibrillation occurred in approximately 10% of all patients with atrial septal defects. It was terminated either by rapid overdrive pacing or DC cardioversion. Postoperatively the patients with pulmonary hypertension were monitored invasively with arterial lines and thermodilution catheters. Therapy consisted of alkalization, hyperventilation and sedation. There was only one postoperative death in this patient group due to marked pulmonary hypertension (1/130 = 0.8%). Nineteen adults had obstruction to right or left ventricular outflow. Surgery included valvotomy, infundibulectomy and valve replacement by homograft or mechanical valve. One patient with multiple previous surgeries expired due to bleeding (3%). Thirteen patients had coarctation. All of them were hypertensive, some on medication. Surgery consisted of aortic patchplasty or interposition of a graft. There was no mortality. Perioperative antihypertensive therapy was necessary in most patients and consisted of nifedipin, nitroprussid or propanolol intravenously. Upon follow up 11 patients became normotensive, 8 of these without the need for medication. Fifteen cyanotic patients underwent 11 corrective and 4 shunt procedures (3 with tricuspid atresia, 10 with Tetralogy of Fallot and 2 with complex cyanotic heart disease. Three died due to low cardiac output or dysrhythmias (20%). The survivors improved their clinical status markedly. Seven adults with Ebstein's disease had valve reconstruction and/or ASD closure. Five had recurrent supraventricular tachycardia, 2 paradoxical emboli with neurological symptoms and 4 out of 7 had decreased exercise tolerance. One patient died postoperatively because of dysrhythmias (14%). Sixteen patients had a variety of defects, i.e. status post Rastelli operation and conduit obstruction, status post Tetralogy of Fallot with pulmonary valvar disease, corrected transposition with left AV valve insufficiency, congenital mitral valve disease and double aortic arch, no deaths. The overall operative mortality was 6/200 = 3%. the late mortality was 4/200 = 2%. The morbidity included 7 reoperations due to bleeding. Five patients needed short-term hemodialysis. One patient developed hemiplegia and two patients had permanent decrease of their left ventricular function. The mean length of follow up was 21 months. The clinical status improved from a NYHA class mean of 2.1 +/- 0.9 to 1.2 +/- 0.45 (p < 0.001). In Germany significant numbers of adults with operated and unoperated congenital heart disease do exist. Detection of these patients can be difficult due to inconspicuous murmurs or stable clinical status.
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PMID:[Adults with congenital heart defects--clinical spectrum and surgical management]. 901 42

We report on some members of two unrelated families showing the characteristic features of Robinow syndrome. In a consanguineous Kuwaiti family, the index case with Robinow syndrome showed some unusual features including severe IUGR, laxity of ligaments, hyperextensible joints, redundant skin folds, severe normocytic anaemia, repeated infection, increased percentage of total T cells and CD4 positive population, reduced percentage of CD8 positive cells, and EMG abnormality. In a Pakistani family with a high degree of multigenerational consanguinity, a single case with the Robinow phenotype also had congenital heart disease, mainly involving the right side of the heart, with pulmonary stenosis, tricuspid atresia, ASD, VSD, double outlet right ventricle, and right atrial isomerism. This report suggests that the disease profile of Robinow syndrome may be extended to accommodate the unusual traits mentioned above. The association of the Robinow phenotype with congenital heart disease in case 2 of this report is consistent with the previously reported finding that congenital heart disease, particularly involving the right side of the heart, may be a prominent component of Robinow syndrome in a subset of patients.
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PMID:Unusual traits associated with Robinow syndrome. 959 42

In a past one decade from January 1981 to August 1991, 231 patients over 18 years old with congenital heart disease (CHD) including 65 patients with cyanotic (C) and 166 with acyanotic (AC) diseases, were surgically treated. There were one operative death (0.6 percent mortality) and three late deaths (1.9%) in 166 patients with AC diseases, whereas there were four operative (6.1%), and four late deaths (6.1%) in 65 patients with C. These patients were followed for 3 to 124 months (the mean of 46.4 +/- 11.9) after the operation. Compared with group AC, group C showed a high rate of early postoperative deaths or late deaths. Group AC comprised patients in their forties (95 patients with ASD and 15 with PDA) and those in their thirties (26 with VSD and 13 with ECD) at the operation. On the contrary, except 5 patients with Ebstein disease, a mean age of patients of group C at the operation lay in their twenties. Surgical outcomes for adult patients of group C still pose much problems compared with AC group in terms of decreased heart function, development of collateral circulatory pathway, and impaired hepatic and renal functions by long lasting hypoxemia. In group C decreased heart function or association of abscess of the brain might be the main cause of postoperative LOS. These findings indicate that early diagnosis, recent advanced operative procedure and appropriate postoperative care can provide symptomatic remission for even adult patients with severe CHD with a low mortality.
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PMID:[Surgical treatment and long-term results of congenital heart disease in adults: early and late follow-up studies in 231 cases]. 942 96

The authors performed 451 transesophageal echocardiographic (TEE) investigations over a period of three years and four months. Atrial septal aneurysm (ASA) was found in 40 cases. Of these, protrusion of the atrial septum towards the right atrium was observed in 17 cases, whilst oscillation of the atrial septum was noted in 23 cases. ASA was associated with patent foramen ovale (PFO) in ten patients, with type II. ASD in nine patients, with other congenital heart disease in six patients, and with other organic heart disease in eight patients. In three cases either an embolus or a tumor was detected in the left atrium, whilst in four cases with ASA there were no other organic cardiac disorders found. In ten patients there was a history of cerebral embolisation. Of these two had chronic atrial fibrillation, whilst the others had sinusrhythm. Of those who had cerebral embolisation, four patients had PFO, one patient had left atrial and auricular thrombi, whilst in four patients various organic heart problems (ischemic heart disease, left ventricular hypertrophy) were detected. In one patient with ASA there was no other cardiac abnormality detected. The authors conclude that ASA, which is often associated with PFO and ASD (in 25.0% and 22.5% of their cases, respectively) is detected in around eight percent of the patients who undergo TEE. ASA particularly when associated with PFO should be considered as a potential source of cerebral emboli. Indeed, cerebral embolisation occurred in 25% of their patients with ASA. It is recommended, that patients with ASA are treated with acetyl salicylic acid, whilst in patients with ASA and PFO anticoagulant therapy is the treatment of choice. In case of cerebral embolisation, or repeated cerebral ischemic attacks, operative interventions should be considered.
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PMID:[Incidence of septal aneurysm and its clinical significance]. 955 64


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