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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Left atrial enlargement can usually be detected accurately using M mode echocardiography. However, in the presence of heart disease, asymmetric enlargement may lead to inaccurate assessment of left atrial size and shape. Pericardial effusion can usually be diagnosed on the basis of characteristic M mode echocardiographic findings. However, false positive patterns sometimes occur with the use of this single dimensional technique. Three patients with a greatly enlarged left atrium are described whose M mode echocardiogram suggested significant posterior pericardial fluid accumulation. In each patient, two dimensional echocardiography detected portions of a huge left atrium that prolapsed behind the left ventricular posterior wall and mimicked an isolated posterior pericardial effusion. In one case a right anterior oblique left ventricular cineangiogram suggested the presence of a ventricular septal defect or a false aneurysm of the left ventricle due to the prolapsed left atrium. Because two dimensional echocardiography can provide accurate spatial orientation with visualization of intracardiac structures in relation to one another in real time, it can identify the presence of left atrial prolapse and play an important role in the differential diagnosis of isolated echo-free spaces behind the left ventricle detected with M mode echocardiography.
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PMID:Prolapsed left atrium behind the left ventricular posterior wall: two dimensional echocardiographic and angiographic features. 746 4

We performed an open heart surgery for ventricular septal defect and right coronary cusp prolapse in a 5-year-old boy with hemophilia A. He has only 3.5% of factor VIII activity. This paper describes a successful perioperative management of hemophilia A. Previous infusion study of factor VIII concentrate showed an administration of 500 units of factor VIII increased its level from 3.5 to 25% two hours after the infusion. With this result we administered 1,500 units of concentrate 14 and 2 hours before the operation, factor VIII level was 201% after the induction of anesthesia. Sternotomy was uneventfully performed. Subarterial VSD was patch closed and right coronary cusp hung down into the defect was plicated. After intra cardiac repair, we administered 2,000 units of VIII factor concentrate, followed by an injection of protamin and its level was 240% at CCU. During the initial 3 postoperative day, patient was maintained with 1,500 units of factor VIII every 12 hours. Chest drains were removed on 2 postoperative day with no evidence of bleeding. Additional infusion of 1,000 units per a day was continued on postoperative days 4 through 17th. Subsequently factor VIII level was maintained more than 60%, so that we achieved successful perioperative course in a patient with hemophilia A.
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PMID:[Perioperative management of ventricular septal defect and right coronary cusp prolapse in a patient with hemophilia A]. 783 Mar 56

Pulmonary autograft replacement (PAG) of the aortic valve in children has been shown to be safe and effective with a low incidence of late valve dysfunction. Relief of all types of left ventricular outflow tract obstruction using the pulmonary root has been possible. Concern about the durability of the pulmonary root in the aortic position, and the potential for growth of the pulmonary autograft used either as a root replacement or intraaortic implant, has been questioned. Sixty-five consecutive patients, aged 1.8 to 21 years (mean 12 years) operated on between September 1986 and January 1993, 35 with an intra-aortic implant (IA) and 30 with root replacement (RR), were evaluated by clinical and serial echocardiographic studies (ECHO) up to 6.5 years post-operatively. The hospital mortality rate was 3.0% (70% CL 2.1-5.1%). Two patients required reoperation for PAG insufficiency (AI), one for technical malalignment necessitating replacement at 6 months, and one with progressive leaflet prolapse due to adherence of the valve leaflet to a ventricular septal defect (VSD) patch. Freedom from significant aortic regurgitation at 6-year follow-up was 100% for RR and 91 +/- 6% for IA, and freedom from all valve-related complications including reoperation was 92 +/- 5% at 6 years. Significant enlargement of the aortic annulus which parallels somatic growth has been measured by ECHO in 17 IA implants (P < 0.001) and 17 RR patients (P < 0.01) by 1 year, and in 10 IA (P = 0.007) and 6 RR (P < 0.05) by 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Medium-term follow-up of pulmonary autograft replacement of aortic valves in children. 794 16

Between September 1980 and August 1988, 21 patients, of mean age 7.3 (range 1-19) years, with ventricular septal defect and aortic valve prolapse, underwent surgery. Aortic insufficiency was mild in three patients, moderate in 13 and severe in five. Surgical repair was performed using a combined transaortic and transpulmonary approach. The prolapsed leaflets were evaluated through the ventricular septal defect before and after valvuloplasty. Using the Trusler technique, the prolapsed cusps were plicated at the level of the commissures; only one patient required aortic valve replacement. After functional assessment of the valve repair, through the ventricular septal defect, during infusion of cardioplegia in the aortic root, the defects were closed through the pulmonary artery, or through a right atriotomy. Mean follow-up was 51.5 (range 3-108) months. One patient developed bacterial endocarditis and died 3 months after surgery. The other 20 patients remained symptom-free. There are no residual ventricular septal defects, and mild residual aortic insufficiency is present in six patients. The mean(s.d.) cardiothoracic ratio decreased from 0.61(0.07) before to 0.49(0.05) after surgery. In summary, preservation and repair of the prolapsed aortic valve is possible even in the presence of severe aortic insufficiency. The combined approach through both great arteries enables good visualization with minimal traction, and accurate assessment of the aortic valvuloplasty through the ventricular septal defect. In addition, problems associated with a right ventriculotomy are avoided.
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PMID:Combined transaortic-transpulmonary approach for surgical repair of aortic insufficiency associated with ventricular septal defect. 807 11

The miniaturization of transesophageal echocardiography (TEE) probes, together with the development of the capability for biplane imaging from the esophagus, have increased the use of TEE in pediatric cardiology. The aim of this study was to evaluate the TEE findings in patients with ventricular septal defect (VSD) before and after closure primarily by means of pediatric biplane probes. This study group included 69 patients who underwent VSD closure as an isolated repair or as a part of a definitive repair of a more complicated lesion. Ages ranged from 6 days to 15.6 years (median 1 year, 4 months), with operative weights ranging from 2.9 kg to 68 kg (median 10 kg). Preoperative and follow-up transthoracic echocardiograms (TTE) were also performed. Intraoperative TEE was performed without complication in all 69 patients. Preoperative results: (1) anatomic findings: Two muscular VSDs were detected by matrix TEE but could not be observed by TTE. A patient with preoperative TTE diagnosis of an ostium primum ASD was found to have atrioventricular (AV) canal by TEE. In three of six AV canal type VSDs, both TTE and TEE demonstrated left ventricular-right atrial shunting (2) aortic regurgitation associated with VSD: Aortic regurgitation as a result of right coronary cusp prolapse was detected in one of five supracristal VSDs in which the biplane or matrix TEE was used.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of ventricular septal defect by transesophageal echocardiography: intraoperative assessment. 812 6

Frequency and surgical results of aortic cusp prolapse and aortic regurgitation (AR) associated with ventricular septal defect (VSD) were studied. One hundred thirty-six consecutive patients with type I and II VSD according to Kirklin and associates' classification were divided into two groups; group A included 50 patients with type Ia VSD without the conal muscular rim, and group B included 86 patients with type Ib VSD with the conal muscular rim, or with type II VSD. Aortic cusp prolapse was detected in 74% of group A patients and 29% of group B patients. The aortic cusp prolapse correlated negatively with preoperative left-to-right shunt ratio, mean pulmonary artery pressure, and pulmonary-to-systemic pressure ratio in both groups. In group B patients, the smaller the VSD, the higher the frequency of aortic cusp prolapse, especially when less than 4 mm. Aortic regurgitation was observed in 44% of group A patients and 24% of group B patients. All 20 patients with first grade AR underwent VSD closure, 11 with second or third grade AR underwent VSD closure plus valvuloplasty, and 1 with third grade AR underwent aortic valve replacement. Postoperative persistent AR occurred in 8 out of 32 patients, and correlated positively (p < 0.01) with the preoperative grade of AR and the number of plication stitches in both groups.
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PMID:Frequency and operative correction of aortic insufficiency associated with ventricular septal defect. 816 56

Aortic valve replacement in the child and young adult is often delayed, and multiple operations or invasive procedures are performed to avoid valve replacements. Prosthetic valves, bioprosthetic valves, or allograft valves have been associated with significant complications or early failure and have been a disappointing solution for the patient requiring aortic valve replacement. The pulmonary autograft replacement (PAR) of the aortic valve in children has been shown to be safe and effective with a low incidence of late valve dysfunction. The absence of thromboembolism, the avoidance of anticoagulants, and its viability with the potential for growth and repair strongly support its use for the potential parent, patients of age 35 or less. The experience with 112 patients, 32 females and 80 males, ages 1.5 to 35 years (average 16.1) are reviewed. Twenty-four had aortic insufficiency, 34 had aortic stenosis, and 54 had both aortic stenosis and insufficiency. Actuarial survival was 95.4% +/- 2.0% at 7 years and freedom from reoperation or significant aortic insufficiency of the autograft valve was 92.7% +/- 3.7%. Freedom from all valve related complications of the autograft valve and the homograft replacement of the pulmonary valve was 90.0% +/- 4.0%. Reoperation for the autograft valve was related to limited experience in one, leaflet prolapse and adherence to a VSD patch in one, associated lupus erythematosus in one, and annular and sinotubular dilatation in one. Reoperation of the homograft valve in two patients was secondary to early homograft stenosis, probably due to rejection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pulmonary autograft replacement of the aortic valve in the potential parent. 818 67

Twenty-two patients (mean age of 12.9 years) with ventricular septal defect (VSD) associated with aortic regurgitation (AR) were treated surgically. Sixteen patients had subpulmonic VSD and six had infracristal VSD. Fourteen patients with subpulmonic VSD underwent VSD closure alone. VSD was closed by pulling up the inferior rim to the pulmonary valve thus support the prolapse aortic cusp. AR improved in two and has remained stable in eleven for 0.5 to 12.7 years (mean 4.4 years). Aortic valve replacement (AVR) was necessary in an adult patient later. Plication of the aortic valve was effective in a young patient but ineffective in an adult patient. In infracristal VSD, AVR was necessary in two adult patients. In a young patient, AR improved by plication. Direct VSD closure ceased progression of AR in three patients. The long-term follow-up shows that VSD closure with our technique has been sufficient to arrest progression of AR in subpulmonic VSD. Early closure of VSD should be emphasized to prevent aortic valve prolapse and regurgitation.
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PMID:[Surgery for ventricular septal defect with aortic regurgitation]. 823 Sep 24

Historically, indications for ventricular septal defect closure have included congestive heart failure, pulmonary hypertension, aortic insufficiency with or without aortic valve prolapse, and prior bacterial endocarditis. However, controversy exists as to how the lifetime risk of an isolated, nonoperated restrictive ventricular septal defect compares with the risk of surgical closure in an asymptomatic child. Between 1980 and 1991, cardiac catheterization and elective ventricular septal defect closure (age > 1 year, pulmonary to systemic flow ratio < 2.0) were performed in 141 patients aged 1 to 23 years (mean age, 6.1 +/- 4.7 years). Mean systolic pulmonary artery pressure was 26.9 +/- 13.0 mm Hg, and mean pulmonary to systemic flow ratio was 1.6 +/- 0.3. Aortic valve prolapse was present in 63 patients (45%), aortic insufficiency was present in 25 (18%), and 5 (3.5%) had prior bacterial endocarditis. There were no early or late deaths or major morbidity. No patient required a ventriculotomy to accomplish ventricular septal defect closure. Mean postoperative intensive care unit stay was 1.3 +/- 0.9 days, and mean hospital stay was 5.5 +/- 1.9 days. There were no instances of permanent complete atrioventricular dissociation, reoperations for bleeding, postoperative wound infections, or reoperations for residual or recurrent ventricular septal defect. These improved results justify a reevaluation of historic indications for ventricular septal defect closure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Restrictive ventricular septal defect: how small is too small to close? 823 92

Luxation of the epiglottic cartilage is a very uncommon complication of endotracheal intubation in paediatric anaesthesia. We report on a case of prolapse of the epiglottic cartilage into the trachea in a 4-month-old child who had been anaesthetized for palliative banding of the pulmonary artery and correction of a coarctation of the aorta. Further malformations included a single ventricle combined with an ASD II and VSD. The first intubation (ID 3.5 mm) via the nasopharyngeal route seemed not to involve any problems; breathing pressure, however, increased to 25 cm H2O. Direct laryngoscopy after extubation of the smaller tube and insertion of another one (ID 4.0 mm) demonstrated a completely blocked trachea. The epiglottidean cartilage had prolapsed into the tracheal lumen and excluded any possibility of ventilating the patient. After seizing the epiglottic cartilage with a Magill forceps it was possible to pull the cartilage out of the trachea and to intubate again with the 4.0 mm tube. There were no complications in the postoperative period.
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PMID:[A difficult intubation: prolapse of the epiglottis into the trachea in an infant]. 834 49


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