No abstract available.
Child* ; Humans ; Infant* ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Estrogens, Conjugated (USP)* ; Heart Failure*

PURPOSE: One of the major complication of arterial catheterization is the thrombosis of the iliac or femoral arteries. Tissue loss following femoral artery catheterization is rare. However long- term sequelae such as impaired limb growth and future impairment of vascular access, are also important in pediatric cardiac patients. But standard methods to treat thrombotic complication of arterial catheterization in infants and children is not established. The present study was performed to assess the efficacy of intraarterial catheter-directed urokinase infusion in infants and children with limb ischemia due to arterial thrombosis after cardiac catheterization. METHODS: From January 1994 to August 2002, 12 patients with thrombotic femoral artery occlusion after arterial catheterization were treated with catheter-directed urokinase infusion in Dong-A University Hospital. Retrospective analysis of the medical records and angiograms was conducted. RESULTS: The incidence of femoral artery thrombosis after retrograde arterial catheterization, which had not responded to systemic infusion of heparin and/or urokinase, was 2.8 percent. The doses of urokinase were 1,000-4,400 unit/kg/hr and duration of infusion was 50.6+/-29.2 hours(18-110 hours). Clot resolution was complete in all patients who started to receive the intraarterial urokinase infusion within four days after catheterization. Only partial thrombolysis was seen in two patients who were treated with intraarterial urokinase on the 12th and 19th days after thrombus formation. Balloon angioplasty was done for these two patients with partial success. Bleeding complications were seen in two cases. CONCLUSION: Early use of catheter-directed intraarterial infusion of urokinase is safe and effective in thrombolysis of femoral artery occlusion after cardiac catheterization in infants and children.
Angioplasty, Balloon ; Cardiac Catheterization* ; Cardiac Catheters* ; Catheterization ; Catheters ; Child* ; Extremities ; Femoral Artery* ; Hemorrhage ; Heparin ; Humans ; Incidence ; Infant* ; Infusions, Intra-Arterial ; Ischemia ; Medical Records ; Retrospective Studies ; Thrombosis* ; Urokinase-Type Plasminogen Activator*

No abstract available.
Pulmonary Valve* ; Tetralogy of Fallot*

No abstract available.
Aorta, Thoracic*

PURPOSE: This study was perfomed to evaluate the success rate and complications of transcatheter closure of patent ductus arteriosus with the Rashkind PDA Occluder System (USCI). METHODS: Between February 1993 and January 1996, 24 patients (6 men and 18 women, median age 4 years, range 10 months to 51 years) were treated with the Rashkind PDA Occluder System for occlusion of patent ductus arteriosus at Dong-A University Hospital. The rate of presence of residual shunt and complications associated with the ductus occlusions in these patients were investigated. RESULTS: At pre-occlusion cardiac catheterization, mean Qp/Qs was 1.49+/-0.48 and mean pulmonary artery pressure was 18.1+/-4.93mmHg. The narrowest diameters of ductus ranged from 1.2mm to 6mm (mean 2.8+/-1.3mm). The most frequently encountered ductal shape was Krichenko type A (16 patients, 66.6%). Three patients required dilatation of ductus with 3mm balloon catheter to cross with 8Fr long sheath. Seventeen 12mm and seven 17mm devices were successfully placed in twenty-four patients. Mean pulse pressure was decreased from 45.5+/-7.11mmHg to 38.8+/-8.98mmHg (p<0.05). After occlusion, the continuous murmurs were disappeared from all but one. From the immediate (20 minute) postocclusion aortogram, 12 of 24 patients (50%) had evidence of residual left to right shunt through the ductus. Four of these 24 patients (17%) demonstrated residual shunt by echocardiogram which performed within 2 weeks after the procedure. Of 20 patients with 3 patients who had residual shunt at previous study, having returned for follow up echocardiogram at 6 months after occlusion, only one (5%) had residual shunt. There were no significant differences in incidence of residual shunt according to size of devices or ductal shape. In 2 patients, Doppler study revealed mild pressure gradient at origin of left pulmonary artery. CONCLUSIONS: In selective candidates, transcatheter closure of the patent ductus arteriosus using the Rashkind PDA Occluder System is a safe and effective method in the nonsurgical management of patent ductus arteriosus.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Dilatation ; Ductus Arteriosus, Patent* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Pulmonary Artery

PURPOSE: This study was perfomed to evaluate the success rate and complications of transcatheter closure of patent ductus arteriosus with the Rashkind PDA Occluder System (USCI). METHODS: Between February 1993 and January 1996, 24 patients (6 men and 18 women, median age 4 years, range 10 months to 51 years) were treated with the Rashkind PDA Occluder System for occlusion of patent ductus arteriosus at Dong-A University Hospital. The rate of presence of residual shunt and complications associated with the ductus occlusions in these patients were investigated. RESULTS: At pre-occlusion cardiac catheterization, mean Qp/Qs was 1.49+/-0.48 and mean pulmonary artery pressure was 18.1+/-4.93mmHg. The narrowest diameters of ductus ranged from 1.2mm to 6mm (mean 2.8+/-1.3mm). The most frequently encountered ductal shape was Krichenko type A (16 patients, 66.6%). Three patients required dilatation of ductus with 3mm balloon catheter to cross with 8Fr long sheath. Seventeen 12mm and seven 17mm devices were successfully placed in twenty-four patients. Mean pulse pressure was decreased from 45.5+/-7.11mmHg to 38.8+/-8.98mmHg (p<0.05). After occlusion, the continuous murmurs were disappeared from all but one. From the immediate (20 minute) postocclusion aortogram, 12 of 24 patients (50%) had evidence of residual left to right shunt through the ductus. Four of these 24 patients (17%) demonstrated residual shunt by echocardiogram which performed within 2 weeks after the procedure. Of 20 patients with 3 patients who had residual shunt at previous study, having returned for follow up echocardiogram at 6 months after occlusion, only one (5%) had residual shunt. There were no significant differences in incidence of residual shunt according to size of devices or ductal shape. In 2 patients, Doppler study revealed mild pressure gradient at origin of left pulmonary artery. CONCLUSIONS: In selective candidates, transcatheter closure of the patent ductus arteriosus using the Rashkind PDA Occluder System is a safe and effective method in the nonsurgical management of patent ductus arteriosus.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Dilatation ; Ductus Arteriosus, Patent* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Pulmonary Artery

For some cyanotic children with deficient pulmonary blood flow, the Blalock-Taussig shunt is a life-saving or temporizing form of palhation. Extensive experience has been gathered, and mortality and morbidity as well as the incidence of shunt stenosis and thrombosis have significantly decreased. However, even nowadays, the most frequently encountered complication excluding mortality in early postoperative course is occlusion of the shunt. We experienced a case of Blalock-Taussig shunt occlusion with thrombus. We diagnosed him as ventricular septal defect with pulmonary atresia by echocardiography and performed a right classic Blalock-Taussig shunt at 7th day of age, Oxygen saturation was gradually decreased since the 6th day postoperative. He was diagnosed as thrombosis of shunt at 12th day postoperative by cardiac angiography, and then was treated with a local low-dose urokinase infusion(1,000U/kg/hr) through Cobra catheter(Cook. In. Co.). After 21 hours, thrombolysis of shunts was comfirmed. We stopped the urokinase and medicated low-dose aspirin(5mg/kg/day). After the eighth day, shunt flow by echocardiography was patent.
Angiography ; Child ; Constriction, Pathologic ; Echocardiography ; Elapidae ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Infant, Newborn* ; Mortality ; Oxygen ; Pulmonary Atresia ; Thrombosis* ; Urokinase-Type Plasminogen Activator*

For some cyanotic children with deficient pulmonary blood flow, the Blalock-Taussig shunt is a life-saving or temporizing form of palhation. Extensive experience has been gathered, and mortality and morbidity as well as the incidence of shunt stenosis and thrombosis have significantly decreased. However, even nowadays, the most frequently encountered complication excluding mortality in early postoperative course is occlusion of the shunt. We experienced a case of Blalock-Taussig shunt occlusion with thrombus. We diagnosed him as ventricular septal defect with pulmonary atresia by echocardiography and performed a right classic Blalock-Taussig shunt at 7th day of age, Oxygen saturation was gradually decreased since the 6th day postoperative. He was diagnosed as thrombosis of shunt at 12th day postoperative by cardiac angiography, and then was treated with a local low-dose urokinase infusion(1,000U/kg/hr) through Cobra catheter(Cook. In. Co.). After 21 hours, thrombolysis of shunts was comfirmed. We stopped the urokinase and medicated low-dose aspirin(5mg/kg/day). After the eighth day, shunt flow by echocardiography was patent.
Angiography ; Child ; Constriction, Pathologic ; Echocardiography ; Elapidae ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Infant, Newborn* ; Mortality ; Oxygen ; Pulmonary Atresia ; Thrombosis* ; Urokinase-Type Plasminogen Activator*

PURPOSE: We conducted this study to evaluate the efficacy of Doppler study by examining obstruction at the site of anastomosis in patients with total anomalous pulmonary venous return(TAPVR). METHODS: Retrograde analysis of the postoperative echocardiography results was done in 14 patients with simple TAPVR, who were operated at Dong-A University Hospital from January 1993 to July 1998. The peak systolic velocities, peak diastolic velocities and flow patterns of the 14 patients were compared with those of 9 control cases. Among the 14 patients, 2 cases showed evidence of obstruction at the anastomosis site. RESULTS: Pulmonary venous flow patterns of normal infants were biphasic, varying with the cardiac cycle. The peak velocities during systole and diastole were 40 to 60cm/sec(mean 51+/-9cm/sec) and 45 to 78cm/sec(mean 59+/-9cm/sec), respectively. The flow patterns of patients without postoperative stenosis were also biphasic. The peak velocities during systole and diastole was 38 to 115cm/sec(mean 71+/-27cm/sec) and 55 to 140cm/sec(mean 111+/-28cm/sec), respectively. The diastole peak velocity was significantly higher than normal(P=0.0002). The flow patterns of patients with postoperative stenosis was continuous, non-phasic or increased peak velocity even though it was phasic. CONCLUSION: Postoperative Doppler echocardiographic evaluation of pulmonary venous return in patients with TAPVR is useful in examining obstruction at the site of anastomosis. But a study on the Doppler echocardiographic normal range of postoperative patients will be needed.
Constriction, Pathologic ; Diastole ; Echocardiography* ; Echocardiography, Doppler ; Humans ; Infant ; Reference Values ; Scimitar Syndrome* ; Systole