1
|
Gunasekaran T, Sanders RA. Double-outlet right ventricle in a Vietnamese potbellied pig. J Vet Cardiol 2020; 32:49-54. [PMID: 33137659 DOI: 10.1016/j.jvc.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 11/18/2022]
Abstract
A 6-month-old, neutered male, Vietnamese potbellied pig presented for evaluation of exercise intolerance and intermittent episodes of exertional cyanosis. Initial diagnostic evaluation revealed arterial hypoxemia. Transthoracic echocardiogram revealed double-outlet right ventricle (DORV) and a subaortic ventricular septal defect. Agitated saline contrast study confirmed the entry of saline contrast from the right ventricle into both pulmonary artery and aorta. Due to deterioration of clinical status, the patient was euthanized 3 months later. Gross necropsy examination was performed confirming the congenital cardiac defects noted on the echocardiogram. To the authors knowledge, this is the first case report of DORV in a Vietnamese potbellied pig.
Collapse
Affiliation(s)
- T Gunasekaran
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States
| | - R A Sanders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States.
| |
Collapse
|
2
|
Patel ND, Justino H, Ing FF. Hybrid approach to ventricular septal defect enlargement. Catheter Cardiovasc Interv 2019; 94:732-737. [PMID: 30983081 DOI: 10.1002/ccd.28227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/06/2019] [Accepted: 03/23/2019] [Indexed: 11/07/2022]
Abstract
The need for creation or enlargement of a ventricular septal defect (VSD) is a rare occurrence. It is most frequently required in patients with double-outlet right ventricle who develop restriction of a remote muscular VSD or obstruction of a perimembranous VSD secondary to atrioventricular (AV) valve attachments to the interventricular septum. Surgical and transcatheter options for VSD creation or enlargement are associated with several risks including heart block, AV valve injury, and perforation. We report the first description of a hybrid approach to VSD creation and enlargement in two patients.
Collapse
Affiliation(s)
- Neil D Patel
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Henri Justino
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Frank F Ing
- Division of Cardiology, Department of Pediatrics, UC Davis Children's Hospital, Sacramento, California
| |
Collapse
|
3
|
El-Asmar JM, Degheili JA, Al-Halabi E, Sklansky M. Prenatally Diagnosed Ventricular Inversion, Restrictive Ventricular Septal Defect, Pulmonary Stenosis, Hypertensive Left Ventricle and Double Outlet Right Ventricle: Case Report and Literature Review. Pediatr Cardiol 2019; 40:234-236. [PMID: 30569250 DOI: 10.1007/s00246-018-2048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022]
Abstract
We herein describe, for the first time, the fetal presentation of a case of ventricular inversion, restrictive ventricular septal defect, pulmonary stenosis, hypertensive left ventricle and double outlet right ventricle at 34 weeks of gestational age. Postnatal echocardiography confirmed the prenatal diagnosis. The patient was subsequently successfully palliated with a left ventricle to pulmonary artery conduit. This report illustrates the importance of detailed fetal echocardiography to ensure appropriate delivery and neonatal management, and to optimize outcome.
Collapse
Affiliation(s)
- J M El-Asmar
- Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - J A Degheili
- Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - E Al-Halabi
- Department of Anesthesiology, American University of Beirut-Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - M Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| |
Collapse
|
4
|
Hou C, Sihag V, Ling Y, An Q. Surgical management of double outlet right ventricle with aortopulmonary window. J Card Surg 2017; 32:203-205. [PMID: 28247470 DOI: 10.1111/jocs.13102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Chao Hou
- Departments of Cardiovascular Surgery, West China Hospital; Sichuan University; Sichuan People's Republic of China
| | - Vivendar Sihag
- Departments of Cardiovascular Surgery, West China Hospital; Sichuan University; Sichuan People's Republic of China
| | - Yunfei Ling
- Departments of Cardiovascular Surgery, West China Hospital; Sichuan University; Sichuan People's Republic of China
| | - Qi An
- Departments of Cardiovascular Surgery, West China Hospital; Sichuan University; Sichuan People's Republic of China
| |
Collapse
|
5
|
Newhard DK, Jung SW, Winter RL, Kuca T, Bayne J, Passler T. Double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle in a calf. J Vet Cardiol 2017; 19:205-210. [PMID: 28111139 DOI: 10.1016/j.jvc.2016.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 11/18/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
A 3-day-old Hereford heifer calf presented for evaluation of lethargy and dyspnea, with persistent hypoxia despite supplemental oxygen therapy. A grade III/VI right apical systolic murmur was noted during cardiac auscultation. Echocardiography revealed a double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle and tricuspid valve dysplasia. Post-mortem examination revealed additional congenital anomalies of ductus arteriosus, patent foramen ovale, and persistent left cranial vena cava. This report illustrates the use of echocardiographic images to diagnose a double-outlet right ventricle with an intact interventricular septum and a hypoplastic left ventricle in a calf.
Collapse
Affiliation(s)
- D K Newhard
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - S W Jung
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.
| | - R L Winter
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - T Kuca
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - J Bayne
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - T Passler
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| |
Collapse
|
6
|
Abstract
Although the spectrum of physiology seen in infants and children with double-outlet right ventricle is broad, this anatomy in combination with an aortopulmonary window is extremely rare. We present an interesting case of an infant prenatally diagnosed with this rare CHD. To our knowledge, this is the first report of complete repair in the neonatal period for such a combination of defects.
Collapse
|
7
|
Biventricular repair of double-outlet right ventricle and closing ventricular septal defect. Ann Thorac Surg 2015; 99:312-4. [PMID: 25555952 DOI: 10.1016/j.athoracsur.2014.02.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/05/2014] [Accepted: 02/17/2014] [Indexed: 11/20/2022]
Abstract
We report an infant with double-outlet right ventricle and progressive left ventricular failure caused by a closing apical muscular ventricular septal defect detected during follow-up, who achieved successful biventricular repair after surgical opening and enlargement of a closed perimembranous ventricular septal defect.
Collapse
|
8
|
Double-outlet right ventricle without interventricular communication: an unusual and challenging problem. Pediatr Cardiol 2014; 34:1941-4. [PMID: 22926400 DOI: 10.1007/s00246-012-0483-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 08/04/2012] [Indexed: 11/27/2022]
Abstract
A ventriculoseptal defect (VSD) usually is present in patients with a double-outlet right ventricle. This report describes a case of double-outlet right ventricle with a completely shrouded inlet VSD and no interventricular shunting. This was associated with a severely regurgitant dysplastic mitral valve. The anatomy and clinical management of the patient is discussed together with an overview of the existing literature.
Collapse
|
9
|
Lin CH, Huddleston C, Balzer DT. Transcatheter ventricular septal defect (VSD) creation for restrictive VSD in double-outlet right ventricle. Pediatr Cardiol 2013; 34:743-7. [PMID: 22580772 PMCID: PMC3586406 DOI: 10.1007/s00246-012-0337-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Double-outlet right ventricle (DORV) with a restrictive ventricular septum is a rare but highly morbid phenomenon that can be complicated by progressive left ventricular hypertrophy, arrhythmias, aneurysm formation, severe pulmonary hypertension, and death in the newborn. Surgical creation or enlargement of a ventricular septal defect (VSD) is palliative but may damage the conduction system or the atrioventricular valves in the newborn. This report presents a transcatheter approach to palliation for a newborn that had DORV with a restrictive ventricular septum. METHODS/RESULTS A full-term infant girl (2.9 kg) referred for hypoxia (80% with room air) and murmur was found to have DORV, interrupted inferior vena cava, and restrictive VSD (95-mmHg gradient). Transhepatic access was performed, and an internal mammary (IM) catheter was advanced through the atrial septal defect and into the left ventricle. By transesophageal echocardiographic guidance, a Baylis radiofrequency perforation wire was used to cross the ventricular septum, and the defect was enlarged using a 4-mm cutting balloon. A bare metal stent then was deployed to maintain the newly created VSD. The patient did well after the procedure but required pulmonary artery banding 4 days later. She returned 5 months later with cyanosis and the development of obstructing right ventricle muscle bundles, requiring further surgical palliation. CONCLUSIONS This report describes the first transcatheter creation of VSD in DORV with a restrictive ventricular septum in a newborn infant. Use of the radiofrequency catheter in combination with cutting balloon dilation and stent implantation is an efficient method for creating a VSD in such a patient.
Collapse
Affiliation(s)
- C. Huie Lin
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, 8th Floor NWT, 1 Children’s Place, St. Louis, MO 63110 USA
| | - Charles Huddleston
- Department of Surgery, SSM Cardinal Glennon Children’s Medical Center, St. Louis, MO USA
| | - David T. Balzer
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, 8th Floor NWT, 1 Children’s Place, St. Louis, MO 63110 USA
| |
Collapse
|
10
|
Meadows J, Pigula F, Lock J, Marshall A. Transcatheter creation and enlargement of ventricular septal defects for relief of ventricular hypertension. J Thorac Cardiovasc Surg 2007; 133:912-8. [PMID: 17382625 DOI: 10.1016/j.jtcvs.2006.09.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 09/15/2006] [Accepted: 09/28/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Creation or enlargement of a ventricular septal defect is indicated in rare clinical situations. In the setting of double-outlet right ventricle requiring single-ventricle palliation, left ventricular outflow tract obstruction caused by progressive restriction at the ventricular septal defect poses an uncommon but recognized dilemma. In this situation surgical ventricular septal defect enlargement may be desirable but risks damage to the atrioventricular valve or conduction system. We report the results of a novel technique for transcatheter creation or enlargement of ventricular septal defects as an alternative to reoperation when decompression of an isolated ventricle is indicated. METHODS Eight patients had undergone transcatheter ventricular septal defect enlargement or creation, and 3 of these patients had undergone 4 prior surgical attempts at left ventricular decompression. Ventricular aneurysms had developed in 3 patients before intervention. RESULTS Five patients underwent ventricular septal defect creation, and 3 patients underwent enlargement of existing ventricular septal defects. Initial intervention resulted in a decreased ventricular septal defect pressure gradient from 76.9 mm Hg to 20.3 mm Hg (P = .004). There was no procedural mortality or sustained heart block. Two patients had moderate-to-severe atrioventricular valve regurgitation, and 1 required surgical repair. At last follow-up, all ventricular septal defects remained patent, with recurrent obstruction in the majority of cases caused by muscular hypertrophy beyond the stent margins. In 1 patient a ventricular aneurysm has regressed in size. Repeat intervention reduced recurrent obstruction, but recurrence was the rule. CONCLUSIONS When reoperation is considered high risk, transcatheter creation and enlargement of ventricular septal defects is possible with excellent short-term results. Recurrent obstruction is common but responds to repeated intervention. Further studies are required to establish clinical benefit.
Collapse
Affiliation(s)
- Jeffery Meadows
- Department of Cardiology, Children's Hospital-Boston, Boston, Mass 02115, USA.
| | | | | | | |
Collapse
|
11
|
Veldtman GR, Norgard G, Wåhlander H, Garty Y, Thabit O, McCrindle BW, Lee KJ, Benson LN. Creation and enlargement of atrial defects in congenital heart disease. Pediatr Cardiol 2005; 26:162-8. [PMID: 15868326 DOI: 10.1007/s00246-004-0953-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transcatheter creation and enlargement of interatrial defects (IAD) may improve hemodynamics; however, procedural outcomes have not been well defined. Hospital records were reviewed for children who underwent percutaneous procedures to create and enlarge an IAD and were grouped as follows: (1) right and (2) left heart obstructive lesions, (3) left atrial (LA) decompression during left heart assist, (4) failing Fontan circulation, and (5) miscellaneous. Forty-five children (mean age, 3.4 +/- 4.7 years; 30 (67%) male) were identified. In group 1 (n = 6), all achieved endpoints of right atrial (RA) decompression (n = 2), improved left ventricular filling (n = 3), or improved arterial saturations (n = 1). In group 2 (n = 18), mean LA pressure decreased (21 +/- 6 to 13 +/- 5 mmHg, p < 0.001) and arterial saturations increased (61 +/- 13% to 78 +/- 11%, p < 0.001). All except 2 patients achieved definitive repair, further palliation (n = 9), or heart transplantation (HTX) (n = 7). In group 3 (n = 5), the LA was decompressed (21 to 13 mmHg, p = 0.03) in all, and all except 1 patient survived to HTX (n = 2) or full recovery (n = 2). In group 4 (n = 11), of 7 patients with a low cardiac output syndrome after surgery, despite improved atrial shunting, 3 died and 1 required a HTX. In group 5 (n = 5), RA decompression (n = 1) or improved arterial saturation (n = 4) was achieved in all. Overall, 5-year HTX free survival was 75%. Mechanical ventilation before the procedure (p < 0.001), the need for a blade septostomy (p = 0.002), and higher LA pressures after the procedure (p = 0.04) independently predicted mortality or the requirement for HTX. Transcatheter optimization of an atrial communication can help optimize treatment strategies and has a low procedural risk.
Collapse
Affiliation(s)
- G R Veldtman
- Department of Pediatrics, Division of Cardiology, Hospital for Sick Children, The University of Toronto School of Medicine, 555 University Avenue, M5G 1X8, Toronto, Canada
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Chen MR, Yu CH. Subclavian and pulmonary steal phenomenon in isolated left subclavian artery with left lung agenesis. JAPANESE HEART JOURNAL 2002; 43:429-32. [PMID: 12227719 DOI: 10.1536/jhj.43.429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Isolated left subclavian artery has been documented to be associated with several congenital cardiac defects, including tetralogy of Fallot and transposition of the great arteries. In some cases subclavian or pulmonary artery steal phenomenon may occur when the isolated left subclavian artery connects to the main pulmonary artery via a ductus arteriosus. The isolated left subclavian artery may be part of the cardiac manifestations in multiple congenital anomalies, such as VACTERL association. We describe subclavian and pulmonary steal phenomenon in a neonate with complex congenital heart disease, including an isolated left subclavian artery, and left lung agenesis. An isolated left subclavian artery is rare and its association with agenesis of the left lung has not been reported previously.
Collapse
Affiliation(s)
- Ming-Ren Chen
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | | |
Collapse
|