Aortic origin of right pulmonary artery: early detection by cross-sectional and color-Doppler-echocardiography in two infants submitted to successful surgical repair

The aortic origin of the right pulmonary artery was recognized in two infants by cross-sectional echocardiography. The sub-costal short axis view was sufficient to make the diagnosis. The Doppler and color-Doppler techniques were useful in adding the hemodynamic information to the anatomical diagnosis. Early surgical correction was performed in the infants with success without needing to resort to cardiac catheterization.

[Infusion of prostaglandin E1 in ductus-dependent congenital heart diseases. Analysis of 47 cases]

Prostaglandin E1, used since 1975, has changed favorably the clinical and surgical prognosis of neonates with congenital heart defects, mainly those with a variety of ductus-dependent defects. Due to recent modifications that have been observed with this drug as far as dosage, side effects, duration of venous infusion and the response of the different cardiac anomalies, this study was undertaken on 47 neonates evaluated with drug infusion between December 1985 and April 1988. The ages of the patients varied from 12 hours to 70 days (median age of 10.3 days), body weight ranged from 1990 to 4430 g (median of 3005 g). The average dose corresponded to 0.021 mcg/kg/min, varying between 0.013 to 0.0089 mcg/kg/min. The therapy was considered effective in 36 (76.5%) patients, evaluated by clinical improvement, increase of arterial oxygen saturation greater than 15 vol. O2% and increased ductus diameter measured by echocardiographic study. In the correlation between the therapeutic result and the patient age, the greatest elevation of arterial oxygen saturation occurred until 21 days of age, especially up to 7 days of age where the elevation in this period was of 24.5 vol. O2%. The cardiac defects that best responded to PGE1 were pulmonary atresia with or without ventricular septal defect, Ebstein's anomaly, tricuspid atresia, pulmonic stenosis, double outlet right ventricle, and those that the arterial oxygen saturation increase was less than 10 vol. O2% such as the hypoplastic left heart syndrome, tetralogy of Fallot and transposition of the great arteries. (ABSTRACT TRUNCATED AT 250 WORDS)

Effect of intentional hemodilution on platelet survival in secondary pulmonary hypertension

Platelet regeneration time was assessed in 13 young adults with pulmonary hypertension and polycythemia secondary to congenital heart defects who underwent isovolemic hemodilution to improve clinical status and coagulation defects. The estimated platelet half-life in patients with Eisenmenger's complex was significantly shortened in comparison with normal subjects (3.8 +/- 1.9 vs 4.8 +/- 1.0 days, p less than 0.05). Hemodilution was carried out with no adverse effects, using low molecular weight dextran solutions. Lowering hematocrit from 61 to 50 percent resulted in a significant increase in platelet half-life from 3.8 +/- 1.9 to 5.7 +/- 1.8 days (p less than 0.02), which was followed by a marked rise in platelet count from 149 +/- 31 to 209 +/- 47 x 10(9) platelets/L (p less than 0.003). Arterial oxygen tension did not change significantly. These observations indicate that high hematocrit levels may have accounted for the shortened platelet survival and thrombocytopenia in these patients. Significant hemodilution may lead to a marked improvement in platelet abnormalities in patients with Eisenmenger's complex.

An infant with two "half-hearts" who survived for five days: a clinical and pathological report

The case of a five-day-old boy with two "half-hearts," diagnosed at necropsy but not clinically, is presented. Each "half-heart" was totally separated from the other and each had a single atrium and ventricle. The two "half-hearts" were enveloped in a common pericardium. The left-sided atrium and the right-sided atrium had the morphologic characteristics of left and right atrium, respectively, but the morphology of the two ventricles was less characteristic. There were double truncuses and double superior and inferior venae cavae, too. Pulmonary venous drainage was totally anomalous; splenic abnormalities were not found. An embryologic lack of fusion of the primitive cardiac tubes is a possible starting point for these malformations.

Cross-sectional echocardiographic features of "absent" pulmonary valve. Report of two cases

"Absence" of the pulmonary valve was recognized by cross-sectional echocardiography in two infants having relatively atypical clinical manifestations for this cardiac malformation. Both had associated lesions: tetralogy of Fallot and ventricular septal defect, respectively, which were also detected by this non-invasive technique. The findings which strongly suggested the diagnosis were the presence of a ridge of rudimentary pulmonary valvular tissue at the level of the pulmonary annulus and the aneurysmal dilation of the pulmonary arteries. The short axis view at the level of the great arteries was the best approach for visualization of these anatomical abnormalities. The parasternal long axis and sub-costal four-chamber views were also helpful in detecting the associated lesions. In both cases the diagnoses were confirmed at autopsy.

Surgical treatment of coarctation of the aorta in the first year of life. Immediate and late results in 35 patients

Between February 1974 and September 1981, 35 consecutive infants younger than 12 months underwent repair of coarctation of the aorta. The mean age was 57 days and 24 were younger than 60 days. The indications for operation were congestive heart failure, metabolic acidosis and severe systemic hypertension. Only 3 cases had isolated coarctation, whereas the remaining 32 had associated anomalies. The first 4 patients were submitted to primary repair; after this, patch aortoplasty was utilized in 14 infants and in the remaining 17 patients the aortoplasty using the left subclavian artery was performed. The hospital mortality rate was 11.4% (4 cases) and there were 2 late deaths (5.7%). Follow-up over a 7-year period shows no clinical or hemodynamic evidence of recoarctation in any of the survivors.