Use of the new IntraStent for treatment of transverse arch hypoplasia/coarctation of the aorta.

We report the use of a new biliary stent (IntraStent Double Strut LD) adapted for use in a 16-year-old young man with moderate-severe transverse arch hypoplasia/coarctation of the aorta following two surgical attempts at correction/relief of the coarctation. The stent implantation procedure resulted in complete relief of the coarctation.

Transcatheter closure of large persistent left superior vena cava causing cyanosis in two patients post-Fontan operation utilizing the Gianturco Grifka vascular occlusion device.

We report the successful transcatheter closure of a large persistent left superior vena cava draining into the pulmonary venous circulation causing cyanosis in two patients who had previously undergone the Fontan operation utilizing the Gianturco Grifka vascular occlusion device. Cathet Cardiovasc Intervent 2001;53:398-404.

Transcatheter coil occlusion of a thoracic arteriovenous fistula in an infant with congestive heart failure.

An 8-week-old baby boy presented at our institution with a continuous murmur and congestive heart failure. Echocardiography showed normal cardiac anatomy. Catheterization revealed the presence of a large thoracic arteriovenous fistula between the descending thoracic aorta and the hemiazygous system, with eventual drainage into the azygous vein and the innominate vein.

Successful double bypass grafting in a child with coronary artery obstruction due to Kawasaki disease.

We describe the clinical evaluation and surgical treatment of a 7-year-old child who had severe coronary artery obstructions that occurred as a sequela of previously diagnosed Kawasaki disease.

Transtelephonic echocardiography: successful use in a tertiary pediatric referral center.

Recent advances in computers and telecommunications have made transtelephonic echocardiography practical. Our institution is developing a network of transmissional echocardiographic sites at several hospitals in our referral region. We reviewed our initial experience to determine whether transmissional echocardiographic studies (1) gave an appropriate diagnostic impression compared with subsequent videotape review and (2) led to appropriate clinical management (i.

Echocardiography for evaluating anatomic repair of transposition of the great arteries.

Fifteen survivors of a single-stage anatomic correction of complete transposition of the great arteries performed at a mean age of 1 month were studied by cross-sectional echocardiography, conventional Doppler echocardiography, Doppler color flow mapping, and catheterization at mean of 10 months after surgery. Small aortic regurgitant jets were documented by angiography and Doppler color flow mapping in seven patients. A trivial supravalvular pulmonary gradient was present in seven patients and a mild to moderate gradient in three.

Two-dimensional echocardiographic assessment of intracardiac masses in infants and children.

We studied six infants and children with intracardiac masses of different causes. The diagnosis was made noninvasively using two-dimensional echocardiography in all six patients. In five patients, surgical excision of the mass was undertaken with good results.

An electrocardiographic midterm follow-up study after anatomic repair of transposition of the great arteries.

Prospective studies of rhythm and conduction, before and after 1-stage anatomic repair of simple transposition of the great arteries, were performed on 24 survivors. Pre- and postsurgical serial standard electrocardiograms were obtained on each patient. Fourteen patients underwent perioperative 24-hour electrocardiograms; all had follow-up 24-hour electrocardiograms.

Factor VIII related antigen (von Willebrand's factor) in Kawasaki disease.

Kawasaki disease is a systemic vasculitis in which secondary development of coronary artery aneurysms can occur. Because Factor VIII related antigen has been found increased in other vasculiditides, VIII R:Ag was measured serially in patients with Kawasaki disease. Factor VIII related antigen was prospectively evaluated in the acute phase of ten patients with Kawasaki disease, all of whom showed increased values at this stage (p greater than 0001).

Surgical repair of atypical coarctation of the abdominal aorta in an infant.

A seven-week-old infant with multiple areas of coarctation of the abdominal aorta and renal artery pathology underwent staged surgical repair of his malformations in our medical center. The clinical and routine echocardiographic evaluations suggested the diagnosis of atypical coarctation of the aorta. The exact anatomical characteristics of his vascular malformations were established by repeated angiocardiographic studies, which should be performed in any patient in which the diagnosis of atypical coarctation of the aorta is suspected.

Infant orthotopic cardiac transplantation.

Infant orthotopic cardiac transplantation has been recently applied to various forms of congenital heart disease with encouraging short-term results. Between June 1986 and September 1987 we evaluated 16 infants for orthotopic cardiac transplantation. Fourteen had hypoplastic left heart syndrome, one had endocardial fibroelastosis with aortic atresia, and one had anomalous pulmonary arterial origin of the left main coronary.

Neonatal refractory supraventricular tachycardia: successful treatment with amiodarone.

A 3-week-old neonate with supraventricular tachycardia unresponsive to traditional therapy was treated successfully with amiodarone. An electrophysiologic study suggested the presence of a concealed left-sided accessory atrioventricular pathway. Because of its significant side effects, amiodarone should be used only as a last resort in the treatment of neonatal supraventricular tachycardia.

The prognostic value of intraoperative pressure gradients with congenital aortic stenosis.

Patients with congenital aortic stenosis are subject to sudden death without prior symptoms. Indications for operation are based on pressure gradients, but intraoperative evaluation of results after relief of obstruction can be subjective and arbitrary. Between September, 1981, and October, 1983, 21 patients underwent operation for relief of congenital aortic stenosis.

Modified aortoseptoplasty for anular abscess and erosion of the membranous septum.

Surgery for bacterial endocarditis may require extensive debridement and appropriate reconstruction for optimal results. Excision of the aortic valve and eroded membranous septum due to pneumococcal endocarditis with modified aortoseptoplasty was successfully accomplished in a six-year-old child.

Left atrial-left ventricular bypass for congenital mitral stenosis.

The case of a patient with congenital mitral stenosis successfully treated by insertion of a left atrial-left ventricular valved conduit is presented. After insertion of the conduit, pulmonary artery pressure was normal, persistent pulmonary edema and ascites disappeared, and the child's rate of growth and level of activities returned to normal.

Detecting ductal shunting in premature infants by range-gated Doppler echocardiography.

Range-gated pulsed Doppler echocardiography has been reported to be a useful noninvasive bedside technic for detecting ductal left-to-right shunting in premature infants. We studied 30 premature infants with a birth weight of less than 1,500 gm, using a 5 MHz system developed by Advanced Technology Laboratories. An umbilical artery catheter was used to obtain a contrast aortogram.

Echocardiographic evidence of left ventricular tumor in a neonate.

We present the case of a ten-hour-old infant with clinical findings suggestive of hypoplastic left-heart syndrome. A diagnosis of left ventricular tumor was made by echocardiographic examination. This diagnosis was confirmed at autopsy, when a large rhabdomyoma was found in the interventricular septum, obliterating the major portion of the left ventricular cavity.

Echocardiographic evidence of outflow tract obstruction in Pompe's disease (glycogen storage disease of the heart).

A 7 month old black female infant with the clinical findings of Pompe's disease is presented. The diagnosis of an infiltrative myocardiopathy with left ventricular outflow tract obstruction presenting with a pronounced systolic anterior motion of the anterior mitral valve leaflet was made by echocardiography. This diagnosis was confirmed by cardiac catheterization and angiocardiography.

Echocardiography: its role in the severely ill infant.

Echocardiography is a noninvasive diagnostic tool which has the capacity to provide reliable information on cardiac anatomy and function without risk or discomfort to the patient. The quality and quantity of information obtained in any given study is highly dependent upon the skill of the examiner. The anatomic and physiologic data obtained through its use in the severely ill infant allows immediate separation of infants with serious anatomic cardiovascular defects from those with conditions simulating heart disease.