This study was performed to assess the accuracy of pulsed Doppler echocardiographic(PDE) diagnosis of ventricular septal defect(VSD). 119 children with congenital heart disease, aged 9 months to 17 years, admitted to our hospital for cardiac surgery, were studied. These children had VSD(56), ASD(18), PDA(43), PS(1) and Cortriatrium(1). A specific PDE diagnosis of VSD can be made by following the turbulent VSD jet(TVJ) through the septum, and a PDE diagnosis of VSD was made in 53 out of 56 patients(95%) proven by catheterization and operation. There were two false positive PDE diagnosis of VSD by PDE, were proven to be perimembranous VSD at operation, and 3 children who were classified into subarterial infundibular VSD by PDE, were proven to be perimembranous VSD at operation. PDE seems to be a very useful tool in preoperative evaluation of VSD.
Catheterization ; Catheters ; Child ; Diagnosis* ; Echocardiography, Doppler, Pulsed* ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Humans ; Thoracic Surgery

Angiography ; Cardiac Catheterization ; Child ; Child, Preschool ; Female ; Heart Septal Defects, Ventricular ; diagnosis ; surgery ; Humans ; Male ; Septal Occluder Device ; Treatment Outcome

BACKGROUND: We performed a prospective clinical study to evaluate the ultrastructural integrity of the myocardium after using Histidine-Tryptophan-Ketoglutarate (HTK) solution in comparison with blood cardioplegic solution during congenital heart surgery. MATERIAL AND METHOD: Twenty two patients with acyanotic heart disease, who were scheduled for elective open heart surgery, were randomized into two groups. The HTK Group (n=11) received HTK cardioplegic solution; the blood group (n=11) received conventional blood cardioplegic solution during surgery. The preoperative diagnoses included ventricular septal defect (n=9) and atrial septal defect (n=2) in each group. A small biopsy specimen was taken from the right ventricle's myocardium, and this was processed for ultrastructural examination at the end of 30 minutes of reperfusion. Semiquantitative electron microscopy was carried out "blindly" in 4 areas per specimen and in 5 test fields per area by 'random systematic sampling' and 'point and intersection counting'. The morphology of the mitochondrial membrane and cristae were then scored. The interstitial edema of the myocardium was also graded. RESULT: The semiquantitative score of the mitochondrial morphology was 19.65+/-4.75 in the blood group and 25.25+/-5.85 in the HTK group (p=0.03). 6 patients (54.5%) in the blood group and 3 patients (27.3%) in the HTK group were grade 3 or more for the interstitial edema of the myocardium. CONCLUSION: The ultrastructural integrity was preserved even better with HTK solution than with conventional blood cardioplegic solution.
Biopsy ; Cardioplegic Solutions* ; Diagnosis ; Edema ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Microscopy, Electron ; Mitochondrial Membranes ; Myocardial Reperfusion ; Myocardium ; Prospective Studies* ; Reperfusion ; Thoracic Surgery

OBJECTIVETo review the experiences in surgical management and diagnosis for the children with multiple ventricular septal defects (VSDs).

METHODSThe clinical data of 21 children with multiple VSDs (8 males, 13 females) were analysed retrospectively. Multiple muscle defects in all patients were repaired by left ventricle incision and their near future clinical outcome was investigated.

RESULTSThe accuracy of diagnosis was 95.2% and the mortality was 9.5%. No residual shunts were found. Complete atrioventricular block was found early in 2 patients postoperation.

CONCLUSIONSThe operative outcome of children with multiple VSDs is satisfied. For these patients detailed preoperative color flow mapping and careful observation during operation are essential to increase the accuracy of diagnosis and prevention of residual shunts.

Cardiac Surgical Procedures ; Child, Preschool ; Female ; Heart Septal Defects, Ventricular ; diagnosis ; surgery ; Humans ; Infant ; Male ; Retrospective Studies ; Treatment Outcome

BACKGROUND/AIMS: This study evaluated the clinical features of double-chambered right ventricle (DCRV) in adults. Most cases of DCRV are diagnosed and treated during childhood. Consequently, very few reports include cases in which its clinical characteristics are evident in adults. METHODS: We reviewed the clinical data for 10 adult patients (age > or = 18 years) with DCRV. RESULTS: Electrocardiogram showed right ventricular hypertrophy in 3 DCRV patients. All cases were associated with ventricular septal defect (VSD; 7 for perimembranous, 2 for muscular outlet, and 1 for the subarterial type). Surgical correction was done for 7 DCRV patients all of whom survived operations. Their follow-up echocardiogram showed the pressure gradient in their right ventricle was significantly decreased from 69.4 +/- 17.2 mmHg preoperatively to 10.2 +/- 5.0 mmHg postoperatively (p < 0.05). In the short-term follow-up, there was no significant increase in the pressure gradient in the right ventricle. CONCLUSIONS: There are lots of cases of DCRV that are not diagnosed accurately in adults. In our experience, all DCRV cases had VSD and surgical correction of these cases showed excellent results. Therefore, accurate diagnosis of DCRV is necessary so that DCRV is not overlooked and operations are enabled within an appropriate time.
Adolescent ; Adult ; Age Factors ; Echocardiography, Doppler ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Catheterization ; Heart Septal Defects, Ventricular/*diagnosis/*surgery ; Heart Ventricles ; Humans ; Hypertrophy, Right Ventricular/*diagnosis/*surgery ; Male ; Middle Aged ; Ventricular Dysfunction, Right/*diagnosis/*surgery ; Young Adult

BACKGROUND: There are still debates in the literature on the relative benefits of blood cardioplegia and crystalloid cardioplegia in pediatric cardiac surgery. We performed a clinical trial to compare the myocardial protective effect between HTK solution and blood cardioplegic solution in congenital heart surgery. MATERIAL AND METHOD: 15 patients who underwent HTK solution cardioplegia (group 1) and 15 patients who underwent blood cardioplegia (group 2) were included in this study. Preoperative and postoperative serial serum cardiac enzyme levels (troponin I, CK-MB, LDH) were measured in all patients. Clinical data were analyzed and compared between the two groups. RESULT: There were no differences in age and body weight between the two groups. Operative diagnosis included ventricular septal defect (VSD, n=4), atrial septal defect (ASD, n=1), tetralogy of Fallot (TOF, n=4), and other complex heart diseases (n=6) in group 1, VSD (n=7), ASD (n=5), and TOF (n=3) in group 2. Cardiopulmonary bypass times were 99.1+/-48.1 minutes in group 1, and 69.3+/-27.3 minutes in group 2 (p=0.02). Aortic clamping times were 52.1+/-23.6 minutes in group 1, and 37.9+/-20.5 minutes in group 2 (p=0.07). There was no mortality and spontaneous defibrillation was possible in all patients. No differences were observed in the serial enzyme levels between the two groups. There were no differences in the duration of inotropic support and ventilator time between the two groups. CONCLUSION: HTK solution provided comparable myocardial protection compared with blood cardioplegic solution. A single high dose of HTK solution may be safely and conveniently used for an extended periods as well in congenital heart surgery.
Body Weight ; Cardioplegic Solutions ; Cardiopulmonary Bypass ; Constriction ; Diagnosis ; Heart Arrest, Induced ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Mortality ; Prospective Studies* ; Tetralogy of Fallot ; Thoracic Surgery* ; Ventilators, Mechanical

A congenital portosystemic shunt is a very rare portosystemic vascular anomaly which leads to jaundice, hypoglycemia, hyperammonemia, liver cirrhosis, hepatic coma, and pulmonary hypertension. Anatomically, portosystemic shunts are divided into intra- and extra- hepatic shunts. Congenital intrahepatic portosystemic shunts are rare anomalies, and the early diagnosis is important to prevent hepatic encephalopathy and hypoglycemia. We report a case of an infant with symptoms of heart failure due to a congenital intrahepatic portosystemic shunt and a ventricular septal defect (VSD), which were treated successfully with four coil embolizations and open heart surgery for the VSD.
Early Diagnosis ; Heart ; Heart Failure ; Heart Septal Defects, Ventricular ; Hepatic Encephalopathy ; Humans ; Hyperammonemia ; Hypertension, Pulmonary ; Hypoglycemia ; Infant ; Jaundice ; Liver Cirrhosis ; Parturition ; Portasystemic Shunt, Surgical ; Thoracic Surgery

Cardiac Surgical Procedures ; adverse effects ; methods ; Female ; Heart Septal Defects, Ventricular ; diagnosis ; surgery ; Humans ; Infant, Newborn ; Male ; Transposition of Great Vessels ; diagnosis ; surgery ; Treatment Outcome

BACKGROUNDCongenital heart disease with severe pulmonary arterial hypertension (SPAH), previously thought to have irreversible pulmonary vascular disease (PVD), has been recently successfully corrected using diagnostic treatment and repair strategy by our surgery team. This study aimed to evaluate the midterm results of a selected cohort of older patients with nonrestrictive ventricular septal defect (VSD) and SPAH using diagnostic treatment and repair strategy.

METHODSThe records of 56 patients older than six years with nonrestrictive VSD and SPAH undergoing diagnostic treatment and repair strategy from 2006 to 2012 were retrospectively reviewed. All patients received advanced pulmonary arterial hypertension (PAH) therapy and radical repairs were performed when transcutaneous oxygen saturation (SPO2) increased up to 93%.

RESULTSThere were no operative deaths. SPO2 and baseline six-minute walk test (SMWT) distance of all selected patients increased significantly and mean pulmonary artery pressure (MPAP) regressed significantly after diagnostic treatment and at late follow-up (P < 0.01). The incidence of late postoperative PAH was seen in six (10.7%) patients and by Logistic regression analysis, early postoperative PAH was an independent risk factor related to late postoperative PAH CONCLUSIONS: Diagnostic treatment and repair strategy was effective and safe for treatment of nonrestrictive VSD and SPAH and the midterm results were excellent. Diagnostic treatment strategy was effective in assessing the reversibility of SPAH in older patients associated with nonrestrictive VSD and the PVD in these selective patients is generally reversible.

Adolescent ; Adult ; Child ; Female ; Heart Defects, Congenital ; diagnosis ; surgery ; Heart Septal Defects, Ventricular ; diagnosis ; surgery ; Humans ; Hypertension, Pulmonary ; diagnosis ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Effusive constrictive pericarditis after open heart surgery is a rare complication occuring in 0.2% to 0.3%. Presenting symptoms after surgery are associated with right heart failure and an elevated jugular venous pressure is most common abnormal physical sign. Predisposing factors include hemorrhage, perioperative pericardial injury or inflammation, presence of postpericardiotomy syndrome and open pericardium. Early diagnosis is important because(1) if it is unrecognized, the patient may deteriorate clinically, and(2) if surgery is delayed, the patient may have an increased risk of operative death. Hereby we report a case of effusive constrictive pericarditis after ventricular septal defect repair, in which constriction physiology was suggested by Doppler echocardiography after pericardiostomy.
Causality ; Constriction ; Early Diagnosis ; Echocardiography, Doppler ; Heart Failure ; Heart Septal Defects, Ventricular* ; Hemorrhage ; Humans ; Inflammation ; Pericardial Window Techniques ; Pericarditis, Constrictive* ; Pericardium ; Physiology ; Postpericardiotomy Syndrome ; Thoracic Surgery ; Venous Pressure