Recent technical advances and increasing experience
|
|
- Victoria Lewis
- 5 years ago
- Views:
Transcription
1 Pediatric Open Heart Operations Without Diagnostic Cardiac Catheterization Jean-Pierre Pfammatter, MD, Pascal A. Berdat, MD, Thierry P. Carrel, MD, and Franco P. Stocker, MD Division of Pediatric Cardiology, and Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland Background. Echocardiography allows for an adequate noninvasive preoperative evaluation in an increasing proportion of pediatric patients before open heart operations. The present study assessed the diagnostic accuracy of both invasive and noninvasive preoperative evaluation in children with congenital heart disease. Methods. We prospectively evaluated the accuracy of preoperative noninvasive or invasive diagnostic methods. Preoperatively established diagnosis was compared with the intraoperative diagnosis made by surgical inspection and routine perioperative transesophageal echocardiography. Results. During the study period of 30 months (ending in December 1997) 209 open-heart procedures were performed. Eighty-one patients (39%) were in the first year of life at the time of surgery, and 43% of all patients had symptoms. Noninvasive preoperative diagnosis using echocardiography was done exclusively in 142 patients (68%). Of the 67 children who had preoperative catheterization, 4 (6%) showed an additional intraoperative finding that modified the surgical approach in 2 of them. In the 142 patients who had echocardiographic preoperative assessment, the surgeons were confronted with a previously undiagnosed finding in 12 patients (8.5%). The finding was considered significant (prolongation of cardiopulmonary bypass time) in 2 patients and might have affected the outcome in 1 of them, a neonate with transposition of the great arteries and a preoperatively undiagnosed intramural coronary artery, who died postoperatively despite a technically adequate repair. Conclusions. In many infants and children, diagnostic work-up before open heart operations could be adequately based on an exclusively noninvasive basis by relying on echocardiography alone. (Ann Thorac Surg 1999;68:532 6) 1999 by The Society of Thoracic Surgeons Accepted for publication Feb 9, Address reprint requests to Dr Pfammatter, Division of Pediatric Cardiology, Children s Hospital, Freiburgstrasse, CH-3010 Berne, Switzerland. Recent technical advances and increasing experience in echocardiography allow for a detailed description of intracardiac anatomy. With Doppler analysis of blood flows, accurate estimation of hemodynamic characteristics has become possible in most patients, and especially in children. Early in the use of echocardiography, it was studied whether in certain circumstances echocardiography alone would enable adequate preoperative planning of cardiac corrective or palliative operations in children with congenital heart defects. Initially, echocardiography as the only preoperative diagnostic imaging modality had been proposed for more simple procedures, such as closure of atrial septal defects (ASD) [1]. More recently, exclusively noninvasive preoperative diagnostic work-up has been extended to more complex cardiac lesions, such as complete atrioventricular canal or selected patients with tetralogy of Fallot [2, 3]. The extent of preoperative diagnostic procedures must be based on a consensus between the pediatric cardiologist and the operating surgeon. At our institution, this consensus has led to a predominantly noninvasive preoperative evaluation for even complex cardiac defects in infants and children. In the present study, we prospectively assessed the accuracy of the preoperative diagnostic evaluation by echocardiography alone or by combined echocardiography and catheterization, in a population of unselected, consecutive pediatric patients who had open heart operations. Patients and Methods Between July 1995 and December 1997, all infants and children admitted at our institution for surgical palliation or correction of congenital heart disease using extracorporeal bypass were evaluated prospectively for the present study. Preoperative Diagnostic Procedures All patients had the standard preoperative evaluation according to the requirements of the surgical procedure and based on the institutional policy regarding preoperative diagnostic work-up requiring consensus between cardiovascular surgeons and pediatric cardiologists. The extent of preoperative evaluation was unaffected by the ongoing study and the diagnostic work-up was usually completed at the time of hospital admittance for the operation. Diagnostic evaluation consisted of complete two-dimensional and color Doppler echocardiography, This article has been selected for the open discussion forum on the STS Web site: by The Society of Thoracic Surgeons /99/$20.00 Published by Elsevier Science Inc PII S (99)
2 Ann Thorac Surg PFAMMATTER ET AL 1999;68:532 6 PEDIATRIC OPERATIONS WITHOUT CATHETERIZATION 533 Table 1. Patient Characteristics and Distribution of Cardiac Defects Diagnosis n Catheterization n (%) Mean Extracorporeal Bypass Time (min) Mean Aortic Cross-Clamp Time (min) Deaths Atrial septal defect 49 0 (0) Atrial septal defect and partial 8 5 (62) anomalous pulmonary vein connection Ventricular septal defect 33 4 (12) Complex ventricular septal 9 4 (44) defect Complete atrioventricular 26 3 (11) canal Partial atrioventricular canal 6 1 (17) Univentricular heart 10 9 (90) Tetralogy of Fallot (100) Double-outlet right ventricle 4 4 (100) Left outflow tract or aorta 13 2 (15) Right outflow tract or 6 5 (83) pulmonary artery Transposition of great arteries 14 3 (21) Complex transposition 3 3 (100) Total anomalous pulmonary 3 3 (100) vein connection Conduit replacement 4 4 (100) Other 5 1 (20) Total (32) 8 chest roentgenogram, and a 12-lead electrocardiogram in all cases. Based on these data, the team of surgeons and cardiologists decided individually for each case on the need for preoperative cardiac catheterization. The institutional consensus between cardiovascular surgeons and pediatric cardiologists during the study period defined was that cardiac catheterization was required before palliative procedures in children with univentricular hearts (except for newborns with hypoplastic left heart syndrome, where institutional policy discouraged operation), before repair of complex transposition, tetralogy of Fallot, and before replacement of conduits or operations on the pulmonary arteries. In all other cases, preoperative echocardiographic evaluation alone was considered adequate, but the decision was always made on an individual basis. All preoperative echocardiographic examinations were done by one of two pediatric cardiologists using an Acuson 128 XP/10 machine (Mountain View, CA) with a 7.5- or 5-MHz transducer according to age and weight of the patient. The detailed preoperative diagnosis was defined at the surgical briefing the day before the surgical intervention. The intraoperative diagnosis was obtained during surgical inspection and by routine perioperative transesophageal echocardiography (except in neonates because of the lack of an adequately sized echo-probe at the beginning of the study) using an Acuson 128 XP/10 machine with a 5-MHz biplane transesophageal transducer. Surgical Technique Throughout the study period, the same two surgeons did all cardiac procedures in the patients. All operations were performed using extracorporeal bypass, and myocardial protection was done using intermittent anterograde cold blood cardioplegia. Except for closure of ASD (normothermia) all other procedures were done with the child in hypothermia between 24 C and 28 C. Perioperative death was defined as death within 30 days postoperatively. Results Patient Characteristics During the study period, a total of 209 open heart procedures were done at our institution. The age of the patients was between 0.1 and 18 years (mean, 4.4 years); 23 patients were newborns and 81 were in their first year of life. Weight at operation was between 2 and 66 kg (mean, 17.6 kg). Of all the children operated on 91 (43%) were symptomatic at the time of surgical correction, including 80% (65 of 81) of the infants and 19% (26 of 128) of the older children. Preoperative Diagnostic Procedures Table 1 shows the distribution of cardiac defects in the study population, with the respective proportions of children who had preoperative invasive diagnosis. Of all
3 534 PFAMMATTER ET AL Ann Thorac Surg PEDIATRIC OPERATIONS WITHOUT CATHETERIZATION 1999;68:532 6 Table 2. Age Dependency of Preoperative Diagnostic Procedures Echocardiography Alone Preoperative Total Number Catheterization of Patients Infants 62 (77%) 19 (23%) 81 (39%) ( 1 year) Children 80 (63%) 48 (37%) 128 (61%) ( 1 year) Total 142 (68%) 67 (32%) 209 (100%) 209 patients, 67 (32%) had preoperative cardiac catheterization, whereas most patients (142 of 209 children, 68%) had echocardiography alone. In children with ASD, none of the 49 patients with isolated secundum ASD had catheterization, whereas 1 of 6 children with primum type ASD had catheterization (for suspected pulmonary hypertension), and 5 of 8 children with anomalous pulmonary veins were also studied invasively. Ventricular septal defect (VSD) was treated predominantly noninvasively (in 88% of the 33 children with isolated VSD and in 56% of the 9 children with complex forms of VSD). Eleven of 13 (85%) had operations in the left outflow tract or in the aorta also were diagnosed solely on a noninvasive basis. Of the children with more complex cardiac defects, newborns with transposition of the great arteries were operated on with echocardiographic diagnosis alone (11 of 14, 79%). In case of the need to proceed to a Rashkind atrioseptostomy, we preferred to do that procedure in the intensive care unit under echocardiographic control (n 6), and the children were taken to the catheterization laboratory only in case of failure to proceed by the umbilical route. Whereas none of the 22 infants with complete atrioventricular canal who were younger than 1 year old had catheterization before surgical correction, those older than 1 year at the time of diagnosis (n 3) had invasive hemodynamic testing for assessment of pulmonary vascular reactivity. Of the rare cardiac malformations, one newborn each with truncus arteriosus and aortopulmonary window were successfully operated on after only echocardiographic preoperative evaluation. In one infant with a univentricular heart, a Damus-Kaye- Stansel procedure was done without preoperative catheterization. For infants and children with double-outlet right ventricle or tetralogy of Fallot, catheterization before surgical correction was the rule (100% of patients). The proportion of children who had catheterization was dependent not only on the type of cardiac anomaly but also on the patient s age as shown in Table 2. Only 23% (19 of 81) of newborns and infants less than 1 year old had invasive diagnostic procedures, whereas catheterization was done in 37% (48 of 128) of older children ( p 0.01). Perioperative mortality for the whole series of pediatric patients was 3.8% (Table 1) or 8 of 209, of which 4 were infants and 4 older children. Table 1 also shows a comparison of procedural times. Incomplete Diagnosis After Invasive Preoperative Diagnostics Of 67 children who had preoperative catheterization, an additional undiagnosed finding was discovered intraoperatively in 4 (6%). In two cases the surgical plan had to be modified. In one child with a univentricular heart and heterotaxy syndrome, suspected but undiagnosed total anomalous pulmonary vein connection had to be repaired before the planned bidirectional shunt. In the other child who was preoperatively diagnosed as having tetralogy of Fallot, the VSD had to be enlarged for the presence of double-outlet right ventricle. Both patients had a good outcome. In the other 2 children, the additional finding was thought to be of minor importance (presence of a large ductus in a patient with VSD and pulmonary hypertension, and presence of double-outlet right ventricle instead of simple tetralogy but without the need for enlarging the VSD). Incomplete Diagnosis in Children Diagnosed by Echocardiography Alone Of 142 patients in whom echocardiography was the only preoperative imaging modality, 12 (8.5%) had an additional intraoperative finding. In children with secundum ASD, on two occasions, an additional small defect was seen, 2 more children had one pulmonary vein draining into the superior vena cava, and one patient had a persistent left superior vena cava. All these additional findings did not affect the surgical approach or the outcome. In 3 infants with complete atrioventricular canal, an additional intraoperative observation was made. One child had a large ductus, in 1 child only four instead of five leaflets of the common atrioventricular valve were found, and in 1 patient there was no ventricular component of the defect and the diagnosis in fact was partial atrioventricular canal. These additional findings did not affect the outcome and were not considered unexpected by the surgeons. The case of the child with absence of the VSD in presumed atrioventricular canal was the only instance in the series where the surgeon did not find a malformation diagnosed previously in the echocardiogram. In 3 newborns with transposition of the great arteries, the diagnosis had to be completed intraoperatively or postoperatively. In one patient an additional small muscular VSD, which closed spontaneously, was observed postoperatively. In 2 patients, a coronary anomaly was not observed on echocardiography. In the first patient the left anterior descending coronary artery originated from the right coronary artery and was treated surgically without technical difficulties. In the other newborn, the left anterior descending coronary artery was diagnosed intraoperatively as taking an intramural course; it was treated surgically with only short prolongation of the procedural time, but the child died postoperatively. At autopsy there was a large area of ischemia although the coronary artery was patent. For comparison, a coronary
4 Ann Thorac Surg PFAMMATTER ET AL 1999;68:532 6 PEDIATRIC OPERATIONS WITHOUT CATHETERIZATION 535 Fig 1. Evolution of the ratio between diagnostic catheterizations and open heart procedures during the past 18 years at our institution. anomaly was diagnosed correctly by echocardiography in 4 other newborns with transposition of the great arteries. In one older patient with valvular aortic stenosis, it was noticed only during an operation for valve replacement that the ascending aorta was dilated to such an extent that it had to be replaced at the same time. Figure 1 shows the evolution of noninvasive diagnostic procedures in our unit. In the era before echocardiography, the ratio between diagnostic catheterizations and open heart procedures was After introduction of echocardiography, that ratio decreased to 1. With the introduction of color Doppler technology that ratio further decreased to its recent level of 0.34 in Comment Open heart procedures in infants and children carry inherent risks, even in the best surgical hands. Because the length of open heart operations is an important determinant of successful outcome, unexpected intraoperative findings should be carefully avoided by a proper preoperative diagnostic evaluation. However, cardiac catheterization, especially in neonates and small infants, also carries a risk. Therefore many children with congenital heart disease would benefit if a preoperative evaluation by purely noninvasive methods could produce a diagnostic yield comparable to that of invasive diagnostic assessment and if the surgical outcomes of these patients with only echocardiography-based diagnostic work-up would not differ substantially from the outcomes of children who had preoperative catheterization. The main finding of this prospective evaluation of preoperative diagnostic procedures was that safety of pediatric open heart operations steadily improved despite the increasing use of only echocardiography as the primary preoperative imaging technique and the decreasing proportion of children who had preoperative catheterization. These results are highlighted by the fact that perioperative mortality rate decreased from 8% (in 1988) to its recent level of 4% during the study period, although the operative complexity increased. Soon after echocardiography had been established as a reliable diagnostic tool in pediatric cardiology, it was shown that in the simpler congenital cardiac malformations such as ASD it was possible to successfully correct them by relying mainly on echocardiography for the diagnostic evaluation rather than preoperative cardiac catheterization [1]. Concurrently it was shown that for ASD the diagnostic accuracy of echocardiography did not differ significantly from that of invasive diagnostic evaluation. Other authors showed that abandoning preoperative cardiac catheterization in children with a wider spectrum of congenital cardiac defects did not influence the surgical outcome negatively; however, these results were obtained in relatively small series of patients and included many children who had closed heart procedures [4, 5]. In one large study it was shown that, especially in infants, developments in echocardiography allowed for an increasing number of patients to be treated adequately without preoperative catheterization [6]. That study was undertaken shortly before the introduction of color Doppler technology. The proportion of children who had exclusively noninvasive diagnostic examination for an open heart procedure was 23% in that population. The present study assessed the contemporary diagnostic accuracy of color Doppler echocardiography in a population of consecutive pediatric patients who had open-heart procedures. During the study period, the proportion of patients who did not have catheterization before surgery was 68%, which again showed a significant evolution compared to the 23% of patients not catheterized in the late 1980s [6]. However, a direct comparison of these figures might not be accurate because institutional policies could differ significantly. Simple cardiac defects such as ASD or VSD, where pathologic-echocardiographic correlations have led to a thorough understanding of surgical anatomic significance of echocardiographic images [7], and more complex cardiac lesions, such as transposition of the great arteries or complete atrioventricular canal, were treated adequately during the study period by using predominantly echocardiography alone as the preoperative imaging mode. In complete atrioventricular canal, there is no advantage of angiography over echocardiography with regard to intracardiac anatomy. In infants younger than 1 year of age it was shown that successful surgical correction was possible in patients with severe elevation of pulmonary vascular resistance as calculated from catheterization data [2]. On the basis of our own results in children with that cardiac lesion we currently consider catheterization an unnecessary risk in infants. In newborns with transposition of the great arteries, the intracardiac anatomy was adequately shown by echocardiography. The anatomy of the coronary arteries could be shown with a very high accuracy by echocardiography, even in the presence of intramural coronary arteries [8, 9]. In the present study an anomaly of the coronary arteries was correctly predicted in most patients, although in one newborn, an intramural coronary artery
5 536 PFAMMATTER ET AL Ann Thorac Surg PEDIATRIC OPERATIONS WITHOUT CATHETERIZATION 1999;68:532 6 was not diagnosed preoperatively, which might have affected the patient s outcome. Now that the Rashkind procedure can be done safely in the pediatric intensive care unit by echocardiographic guidance [10], coronary angiography should not be considered a prerequisite to a successful arterial switch operation, except when institutional policy considers an intramural coronary artery a contraindication to the arterial switch operation. The present study was not undertaken to compare the diagnostic accuracy of either invasive or exclusively noninvasive preoperative diagnostic assessment, because of the spectrum of cardiac defects in the two groups. References 1. Freed MD, Nadas AS, Norwood WI, Castaneda AR. Is routine preoperative cardiac catheterization necessary before repair of secundum and sinus venosus atrial septal defects? J Am Coll Cardiol 1984;4: Zellers TM, Zehr R, Weinstein E, Leonard S, Ring WS, Nikaidoh H. Two-dimensional and doppler echocardiography alone can adequately define preoperative anatomy and hemodynamic status before repair of complete atrioventricular septal defect in infants 1 year old. J Am Coll Cardiol 1994;24: Santoro G, Marino B, Di Carlo D, et al. Echocardiographically guided repair of tetralogy of Fallot. Am J Cardiol 1994; 73: Huhta JC, Glasow P, Murphy DJ, et al. Surgery without catheterization for congenital heart defects: management of 100 patients. J Am Coll Cardiol 1987;9: Krabill KA, Ring S, Foker JE, et al. Echocardiographic versus cardiac catheterization diagnosis of infants with congenital heart disease requiring cardiac surgery. Am J Cardiol 1987; 60: Sreeram N, Colli AM, Monro JL, et al. Changing role of non-invasive investigation in the preoperative assessment of congenital heart disease: a nine year experience. Br Heart J 1990;63: Gatzoulis MA, Li J, Ho SY. The echocardiographic anatomy of ventricular septal defects. Cardiol Young 1997;7: Pasquini L, Sanders SP, Parness IA, et al. Coronary echocardiography in 406 patients with transposition of the great arteries. J Am Coll Cardiol 1994;24: Pasquini L, Parness IA, Colan SD, Wernovsky G, Mayer JE Jr, Sanders SP. Diagnosis of intramural coronary artery in transposition of the great arteries using two-dimensional echocardiography. Circulation 1993;88: Ward CJB, Hawker RE, Cooper SG, et al. Minimally invasive management of transposition of the great arteries in the newborn period. Am J Cardiol 1992;69: INVITED COMMENTARY Cardiovascular operations without preoperative cardiac catheterization began two generations ago, when physical findings, electrocardiogram, and chest roentgenogram were the sole preoperative evaluation methods in children with an atrial septal defect, patent ductus arteriosus, or coarctation of the aorta. In the next generation of pediatric cardiologists, this practice spread to more complicated lesions by combining anatomic data from two-dimensional echocardiographic imaging with flow and pressure dynamics from Doppler echocardiography. This technique required careful echocardiographic studies tracing every detail of cardiovascular anatomy. Cardiac catheterization was done in fewer patients until interventional procedures were developed. The present generation of pediatric cardiologists is trained in both technologies, and the two methods are used in combination. Noninvasive evaluation now determines when cardiac catheterization must be used. This reduces risk by shortening procedures and decreasing contrast load. A marriage of the two technologies, with cardiac catheterization for selected indications, provides the safest preoperative evaluation. The issue, then, is defining when cardiac catheterization is needed. Echocardiographic evaluation is only as good as the information available (garbage in, garbage out). Accuracy depends on high-quality images (top-ofthe-line equipment with high-frequency probes, good penetration which makes the newborn infant an ideal candidate, and a cooperative patient) and the experience of the pediatric sonographer and echocardiographer. When necessary information cannot be determined noninvasively, cardiac catheterization should be used to provide it. Each institution must have its own approach, as determined by physician experience and resources. It is important that the approach to each patient is controlled by medical indications determined by a team of cardiologists and surgeons. There is no place for pressure from competition or third-party payers in decisions on whether to perform an invasive evaluation. Studies defining the accuracy of noninvasive evaluation are important. Pfammatter and associates reported the accuracy of preoperative diagnosis in 142 patients who had clinical and echocardiographic assessment and 67 who also had diagnostic cardiac catheterization. An undiagnosed finding was discovered perioperatively in 8.5% of patients who had noninvasive procedures only and in 6% of patients who also had catheterization. An exact comparison between groups cannot be made, because patients were not randomly assigned to treatment, but accurate noninvasive preoperative evaluation is clearly possible in many patients. The surgeon and cardiologist must recognize the limitations of preoperative evaluation both of the techniques and quality of information and with consideration of the type of congenital heart disease. Some conditions might be difficult to detect using either approach, and an unrecognized patent ductus arteriosus with high pulmonary artery pressure or an intramural coronary artery might have to be dealt with perioperatively. John L. Bass, MD Division of Pediatric Cardiology University of Minnesota Box 94 Mayo, 420 Delaware St SE Minneapolis, MN by The Society of Thoracic Surgeons /99/$20.00 Published by Elsevier Science Inc PII S (99)
Pediatric Cardiac Surgery with Echocardiographic Diagnosis Alone
J Korean Med Sci 2002; 17: 463-7 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Pediatric Cardiac Surgery with Echocardiographic Diagnosis Alone The diagnostic accuracy of echocardiography
More informationPediatric Echocardiography Examination Content Outline
Pediatric Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 Anatomy and Physiology Normal Anatomy and Physiology 10% 2 Abnormal Pathology and Pathophysiology
More informationHeart and Lungs. LUNG Coronal section demonstrates relationship of pulmonary parenchyma to heart and chest wall.
Heart and Lungs Normal Sonographic Anatomy THORAX Axial and coronal sections demonstrate integrity of thorax, fetal breathing movements, and overall size and shape. LUNG Coronal section demonstrates relationship
More informationECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT
ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT Karen Stout, MD, FACC Divisions of Cardiology University of Washington Medical Center Seattle Children s Hospital NO DISCLOSURES
More informationAdult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016
1 Adult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Why should all echocardiographers
More information5.8 Congenital Heart Disease
5.8 Congenital Heart Disease Congenital heart diseases (CHD) refer to structural or functional heart diseases, which are present at birth. Some of these lesions may be discovered later. prevalence of Chd
More informationCardiology Fellowship Manual. Goals & Objectives -Cardiac Imaging- 1 P a g e
Cardiology Fellowship Manual Goals & Objectives -Cardiac Imaging- 1 P a g e UNIV. OF NEBRASKA CHILDREN S HOSPITAL & MEDICAL CENTER DIVISION OF CARDIOLOGY FELLOWSHIP PROGRAM CARDIAC IMAGING ROTATION GOALS
More informationCongenital Heart Defects
Normal Heart Congenital Heart Defects 1. Patent Ductus Arteriosus The ductus arteriosus connects the main pulmonary artery to the aorta. In utero, it allows the blood leaving the right ventricle to bypass
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationThe first report of the Society of Thoracic Surgeons
REPORT The Society of Thoracic Surgeons National Congenital Heart Surgery Database Report: Analysis of the First Harvest (1994 1997) Constantine Mavroudis, MD, Melanie Gevitz, BA, W. Steves Ring, MD, Charles
More informationAssessing Cardiac Anatomy With Digital Subtraction Angiography
485 JACC Vol. 5, No. I Assessing Cardiac Anatomy With Digital Subtraction Angiography DOUGLAS S., MD, FACC Cleveland, Ohio The use of intravenous digital subtraction angiography in the assessment of patients
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACHD. See Adult congenital heart disease (ACHD) Adult congenital heart disease (ACHD), 503 512 across life span prevalence of, 504 506
More informationEchocardiography in Congenital Heart Disease
Chapter 44 Echocardiography in Congenital Heart Disease John L. Cotton and G. William Henry Multiple-plane cardiac imaging by echocardiography can noninvasively define the anatomy of the heart and the
More informationThe role of intraoperative TOE in congenital cardiac surgery
The role of intraoperative TOE in congenital cardiac surgery Justiaan Swanevelder Dept of Anaesthesia Groote Schuur and Red Cross War Memorial Children s Hospitals University of Cape Town, South Africa
More information3/14/2011 MANAGEMENT OF NEWBORNS CARDIAC INTENSIVE CARE CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 WITH HEART DEFECTS
CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 MANAGEMENT OF NEWBORNS WITH HEART DEFECTS A NTHONY C. CHANG, MD, MBA, MPH M E D I C AL D I RE C T OR, HEART I N S T I T U T E C H I LDRE N
More informationSURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE
SURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE Mr. W. Brawn Birmingham Children s Hospital. Aims of surgery The aim of surgery in congenital heart disease is to correct or palliate the heart
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,
More informationAppendix A.1: Tier 1 Surgical Procedure Terms and Definitions
Appendix A.1: Tier 1 Surgical Procedure Terms and Definitions Tier 1 surgeries AV Canal Atrioventricular Septal Repair, Complete Repair of complete AV canal (AVSD) using one- or two-patch or other technique,
More informationCardiac Catheterization Cases Primary Cardiac Diagnoses Facility 12 month period from to PRIMARY DIAGNOSES (one per patient)
PRIMARY DIAGNOSES (one per patient) Septal Defects ASD (Atrial Septal Defect) PFO (Patent Foramen Ovale) ASD, Secundum ASD, Sinus venosus ASD, Coronary sinus ASD, Common atrium (single atrium) VSD (Ventricular
More informationDIAGNOSIS, MANAGEMENT AND OUTCOME OF HEART DISEASE IN SUDANESE PATIENTS
434 E AST AFRICAN MEDICAL JOURNAL September 2007 East African Medical Journal Vol. 84 No. 9 September 2007 DIAGNOSIS, MANAGEMENT AND OUTCOME OF CONGENITAL HEART DISEASE IN SUDANESE PATIENTS K.M.A. Sulafa,
More informationData Collected: June 17, Reported: June 30, Survey Dates 05/24/ /07/2010
Job Task Analysis for ARDMS Pediatric Echocardiography Data Collected: June 17, 2010 Reported: Analysis Summary For: Pediatric Echocardiography Exam Survey Dates 05/24/2010-06/07/2010 Invited Respondents
More informationIntraoperative transesophageal echocardiography (ITEE) has been used in
Intraoperative transesophageal echocardiography during surgery for congenital heart defects Guy R. Randolph, MD a Donald J. Hagler, MD a,b Heidi M. Connolly, MD a,b Joseph A. Dearani, MD c Francisco J.
More informationCommon Defects With Expected Adult Survival:
Common Defects With Expected Adult Survival: Bicuspid aortic valve :Acyanotic Mitral valve prolapse Coarctation of aorta Pulmonary valve stenosis Atrial septal defect Patent ductus arteriosus (V.S.D.)
More informationMEDICAL SCIENCES Vol.I -Adult Congenital Heart Disease: A Challenging Population - Khalid Aly Sorour
ADULT CONGENITAL HEART DISEASE: A CHALLENGING POPULATION Khalid Aly Sorour Cairo University, Kasr elaini Hospital, Egypt Keywords: Congenital heart disease, adult survival, specialized care centers. Contents
More informationTechniques for repair of complete atrioventricular septal
No Ventricular Septal Defect Patch Atrioventricular Septal Defect Repair Carl L. Backer, MD *, Osama Eltayeb, MD *, Michael C. Mongé, MD *, and John M. Costello, MD For the past 10 years, our center has
More informationCYANOTIC CONGENITAL HEART DISEASES. PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU
CYANOTIC CONGENITAL HEART DISEASES PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU DEFINITION Congenital heart diseases are defined as structural and functional problems of the heart that are
More informationScreening for Critical Congenital Heart Disease
Screening for Critical Congenital Heart Disease Caroline K. Lee, MD Pediatric Cardiology Disclosures I have no relevant financial relationships or conflicts of interest 1 Most Common Birth Defect Most
More informationSeptember 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical)
September 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical) Advances in cardiac surgery have created a new population of adult patients with repaired congenital heart
More informationDiagnosis of Congenital Cardiac Defects Between 11 and 14 Weeks Gestation in High-Risk Patients
Article Diagnosis of Congenital Cardiac Defects Between 11 and 14 Weeks Gestation in High-Risk Patients Zeev Weiner, MD, Abraham Lorber, MD, Eliezer Shalev, MD Objective. To examine the feasibility of
More informationDouble Outlet Right Ventricle with Anterior and Left-Sided Aorta and Subpulmonary Ventricular Septal Defect
Case Report Double Outlet Right Ventricle with Anterior and Left-Sided rta and Subpulmonary Ventricular Septal Defect Luciana Braz Peixoto, Samira Morhy Borges Leal, Carlos Eduardo Suaide Silva, Sandra
More informationPattern of Congenital Heart Disease A Hospital-Based Study *Sadiq Mohammed Al-Hamash MBChB, FICMS
Pattern of Congenital Heart Disease A Hospital-Based Study *Sadiq Mohammed Al-Hamash MBChB, FICMS ABSTRACT Background: The congenital heart disease occurs in 0,8% of live births and they have a wide spectrum
More informationAbsent Pulmonary Valve Syndrome
Absent Pulmonary Valve Syndrome Fact sheet on Absent Pulmonary Valve Syndrome In this condition, which has some similarities to Fallot's Tetralogy, there is a VSD with narrowing at the pulmonary valve.
More informationList of Videos. Video 1.1
Video 1.1 Video 1.2 Video 1.3 Video 1.4 Video 1.5 Video 1.6 Video 1.7 Video 1.8 The parasternal long-axis view of the left ventricle shows the left ventricular inflow and outflow tract. The left atrium
More informationAMERICAN ACADEMY OF PEDIATRICS 993 THE NATURAL HISTORY OF CERTAIN CONGENITAL CARDIOVASCULAR MALFORMATIONS. Alexander S. Nadas, M.D.
AMERICAN ACADEMY OF PEDIATRICS 993 tnicular overload is the major problem and left ventricular failure occurs. Since for many years the importance of hepatomegaly in the diagnosis of cardiac failure has
More informationMEDICAL MANAGEMENT WITH CAVEATS 1. In one study of 50 CHARGE patients with CHD, 75% required surgery. 2. Children with CHARGE may be resistant to chlo
CARDIOLOGY IN CHARGE SYNDROME: FOR THE PHYSICIAN Angela E. Lin, M.D. Teratology Program/Active Malformation Surveillance, Brigham and Women's Hospital, Old PBBH-B501, 75 Francis St., Boston, MA 02115 alin@partners.org
More information"Lecture Index. 1) Heart Progenitors. 2) Cardiac Tube Formation. 3) Valvulogenesis and Chamber Formation. 4) Epicardium Development.
"Lecture Index 1) Heart Progenitors. 2) Cardiac Tube Formation. 3) Valvulogenesis and Chamber Formation. 4) Epicardium Development. 5) Septation and Maturation. 6) Changes in Blood Flow during Development.
More informationEchocardiography of Congenital Heart Disease
Echocardiography of Congenital Heart Disease Sunday, April 15 Tuesday, April 17, 2018 Ruth and Tristram Colket, Jr. Translational Research Building on the Raymond G. Perelman Campus Learn more: chop.cloud-cme.com
More informationPerioperative Management of DORV Case
Perioperative Management of DORV Case James P. Spaeth, MD Department of Anesthesia Cincinnati Children s Hospital Medical Center University of Cincinnati Objectives: 1. Discuss considerations regarding
More informationCardiac MRI in ACHD What We. ACHD Patients
Cardiac MRI in ACHD What We Have Learned to Apply to ACHD Patients Faris Al Mousily, MBChB, FAAC, FACC Consultant, Pediatric Cardiology, KFSH&RC/Jeddah Adjunct Faculty, Division of Pediatric Cardiology
More informationChildren with Single Ventricle Physiology: The Possibilities
Children with Single Ventricle Physiology: The Possibilities William I. Douglas, M.D. Pediatric Cardiovascular Surgery Children s Memorial Hermann Hospital The University of Texas Health Science Center
More informationA Unique Milieu for Perioperative Care of Adult Congenital Heart Disease Patients at a Single Institution
Original Article A Unique Milieu for Perioperative Care of Adult Congenital Heart Disease Patients at a Single Institution Ghassan Baslaim, MD, and Jill Bashore, RN Purpose: Adult patients with congenital
More informationIn 1980, Bex and associates 1 first introduced the initial
Technique of Aortic Translocation for the Management of Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonary Stenosis Victor O. Morell, MD, and Peter D. Wearden, MD, PhD In
More informationMultimodality Imaging of Septal Defects
Multimodality Imaging of Septal Defects Ohio-ACC 2018 Annual Meeting October 27, 2018 Kan N. Hor, MD Director, Cardiac Magnetic Resonance Imaging Associate Professor of Pediatrics The Heart Center, Nationwide
More informationCongenital heart disease: When to act and what to do?
Leading Article Congenital heart disease: When to act and what to do? Duminda Samarasinghe 1 Sri Lanka Journal of Child Health, 2010; 39: 39-43 (Key words: Congenital heart disease) Congenital heart disease
More information9/8/2009 < 1 1,2 3,4 5,6 7,8 9,10 11,12 13,14 15,16 17,18 > 18. Tetralogy of Fallot. Complex Congenital Heart Disease.
Current Indications for Pediatric CTA S Bruce Greenberg Professor of Radiology Arkansas Children s Hospital University of Arkansas for Medical Sciences greenbergsbruce@uams.edu 45 40 35 30 25 20 15 10
More informationLow-dose prospective ECG-triggering dual-source CT angiography in infants and children with complex congenital heart disease: first experience
Low-dose prospective ECG-triggering dual-source CT angiography in infants and children with complex congenital heart disease: first experience Ximing Wang, M.D., Zhaoping Cheng, M.D., Dawei Wu, M.D., Lebin
More informationpulmonary valve on, 107 pulmonary valve vegetations on, 113
INDEX Adriamycin-induced cardiomyopathy, 176 Amyloidosis, 160-161 echocardiographic abnormalities in, 160 intra-mural tumors similar to, 294 myocardial involvement in, 160-161 two-dimensional echocardiography
More informationHeart and Soul Evaluation of the Fetal Heart
Heart and Soul Evaluation of the Fetal Heart Ivana M. Vettraino, M.D., M.B.A. Clinical Associate Professor, Michigan State University College of Human Medicine Objectives Review the embryology of the formation
More informationAnatomy & Physiology
1 Anatomy & Physiology Heart is divided into four chambers, two atrias & two ventricles. Atrioventricular valves (tricuspid & mitral) separate the atria from ventricles. they open & close to control flow
More informationCONGENITAL HEART DISEASE (CHD)
CONGENITAL HEART DISEASE (CHD) DEFINITION It is the result of a structural or functional abnormality of the cardiovascular system at birth GENERAL FEATURES OF CHD Structural defects due to specific disturbance
More informationRepair of Complete Atrioventricular Septal Defects Single Patch Technique
Repair of Complete Atrioventricular Septal Defects Single Patch Technique Fred A. Crawford, Jr., MD The first repair of a complete atrioventricular septal defect was performed in 1954 by Lillehei using
More informationAdult Congenital Heart Disease Certification Examination Blueprint
Adult Congenital Heart Disease Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the
More informationCoarctation of the aorta
T H E P E D I A T R I C C A R D I A C S U R G E R Y I N Q U E S T R E P O R T Coarctation of the aorta In the normal heart, blood flows to the body through the aorta, which connects to the left ventricle
More informationThe Fetal Cardiology Program
The Fetal Cardiology Program at Texas Children s Fetal Center About the program Since the 1980s, Texas Children s Fetal Cardiology Program has provided comprehensive fetal cardiac care to expecting families
More informationAccuracy of the Fetal Echocardiogram in Double-outlet Right Ventricle
Blackwell Publishing IncMalden, USACHDCongenital Heart Disease 2006 The Authors; Journal compilation 2006 Blackwell Publishing, Inc.? 200723237Original ArticleFetal Echocardiogram in Double-outlet Right
More informationThe incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients
The Turkish Journal of Pediatrics 2008; 50: 549-553 Original The incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients Selman Vefa Yıldırım 1, Kürşad
More informationCMS Limitations Guide - Radiology Services
CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations
More informationEchocardiography of Congenital Heart Disease
Echocardiography of Congenital Heart Disease Sunday, April 15 Tuesday, April 17, 2018 Ruth and Tristram Colket, Jr. Translational Research Building on the Raymond G. Perelman Campus Learn more: chop.cloud-cme.com
More informationAnomalous Systemic Venous Connection Systemic venous anomaly
World Database for Pediatric and Congenital Heart Surgery Appendix B: Diagnosis (International Paediatric and Congenital Cardiac Codes (IPCCC) and definitions) Anomalous Systemic Venous Connection Systemic
More informationJournal of the American College of Cardiology Vol. 33, No. 6, by the American College of Cardiology ISSN /99/$20.
Journal of the American College of Cardiology Vol. 33, No. 6, 1999 1999 by the American College of Cardiology ISSN 0735-1097/99/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00061-3 for Prediction
More informationCongenital pulmonary vein (PV) stenosis with anatomically
Pulmonary Vein Stenosis With Normal Connection: Associated Cardiac Abnormalities and Variable Outcome John P. Breinholt, BS, John A. Hawkins, MD, LuAnn Minich, MD, Lloyd Y. Tani, MD, Garth S. Orsmond,
More information4 th Echocardiography Course on Congenital Heart Disease
4 th Echocardiography Course on Congenital Heart Disease The Hospital for Sick Children s Daniels Hollywood Theatre April 4 6, 2019 Course Directors: Luc Mertens, Mark Friedberg, Andreea Dragulescu Co-directors:
More informationSummary. HVRA s Cardio Vascular Genetic Detailed L2 Obstetrical Ultrasound. CPT 76811, 76825, _ 90% CHD detection. _ 90% DS detection.
What is the role of fetal echocardiography (2D 76825, cardiovascular color flow mapping 93325) as performed in conjunction with detailed fetal anatomy scan (CPT 76811) now that AIUM requires limited outflow
More informationS. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationEchocardiography in Adult Congenital Heart Disease
Echocardiography in Adult Congenital Heart Disease Michael Vogel Kinderherz-Praxis München CHD missed in childhood Subsequent lesions after repaired CHD Follow-up of cyanotic heart disease CHD missed in
More informationThe Rastelli procedure has been traditionally used for repair
En-bloc Rotation of the Truncus Arteriosus A Technique for Complete Anatomic Repair of Transposition of the Great Arteries/Ventricular Septal Defect/Left Ventricular Outflow Tract Obstruction or Double
More informationSince first successfully performed by Jatene et al, the
Long-Term Predictors of Aortic Root Dilation and Aortic Regurgitation After Arterial Switch Operation Marcy L. Schwartz, MD; Kimberlee Gauvreau, ScD; Pedro del Nido, MD; John E. Mayer, MD; Steven D. Colan,
More informationCONGENITAL HEART LESIONS ((C.H.L
CONGENITAL HEART LESIONS ((C.H.L BY THE BOOKS: 0.8 IN FACT: 3-5% INCLUDING: - BICUSPID AORTIC VALVE MITRAL VALVE PROLAPSE LATE DIAGNOSIS - :INCREASED INCIDENCE IN ADULTS BETTER DIAGNOSIS IN INFANCY BETTER
More informationPediatric Cardiology. Diagnostic Errors in Pediatric Echocardiography Development of Taxonomy and Identification of Risk Factors
Pediatric Cardiology Diagnostic Errors in Pediatric Echocardiography Development of Taxonomy and Identification of Risk Factors Oscar J. Benavidez, MD, MPP; Kimberlee Gauvreau, ScD; Kathy J. Jenkins, MD,
More informationDiversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia
Marshall University Marshall Digital Scholar Internal Medicine Faculty Research Spring 5-2004 Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia Ellen A. Thompson
More informationPerimembranous VSD: When Do We Ask For A Surgical Closure? LI Xin. Department of Cardiothoracic Surgery Queen Mary Hospital Hong Kong
Perimembranous VSD: When Do We Ask For A Surgical Closure? LI Xin Department of Cardiothoracic Surgery Queen Mary Hospital Hong Kong Classification (by Kirklin) I. Subarterial (10%) Outlet, conal, supracristal,
More informationObstructed total anomalous pulmonary venous connection
Total Anomalous Pulmonary Venous Connection Richard A. Jonas, MD Children s National Medical Center, Department of Cardiovascular Surgery, Washington, DC. Address reprint requests to Richard A. Jonas,
More informationIndex. interventional.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Alagille syndrome, pulmonary artery stenosis in, 143 145, 148 149 Amplatz devices for atrial septal defect closure, 42 46 for coronary
More informationCongenital Heart Disease An Approach for Simple and Complex Anomalies
Congenital Heart Disease An Approach for Simple and Complex Anomalies Michael D. Pettersen, MD Director, Echocardiography Rocky Mountain Hospital for Children Denver, CO None Disclosures 1 ASCeXAM Contains
More informationAlthough most patients with Ebstein s anomaly live
Management of Neonatal Ebstein s Anomaly Christopher J. Knott-Craig, MD, FACS Although most patients with Ebstein s anomaly live through infancy, those who present clinically as neonates are a distinct
More informationSlide 1. Slide 2. Slide 3 CONGENITAL HEART DISEASE. Papworth Hospital NHS Trust INTRODUCTION. Jakub Kadlec/Catherine Sudarshan INTRODUCTION
Slide 1 CONGENITAL HEART DISEASE Jakub Kadlec/Catherine Sudarshan NHS Trust Slide 2 INTRODUCTION Most common congenital illness in the newborn Affects about 4 9 / 1000 full-term live births in the UK 1.5
More informationClinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!!
Clinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!! Abha'Khandelwal,'MD,'MS' 'Stanford'University'School'of'Medicine'
More informationLEFT VENTRICULAR OUTFLOW OBSTRUCTION WITH A VSD: OPTIONS FOR SURGICAL MANAGEMENT
LEFT VENTRICULAR OUTFLOW OBSTRUCTION WITH A VSD: OPTIONS FOR SURGICAL MANAGEMENT 10-13 March 2017 Ritz Carlton, Riyadh, Saudi Arabia Zohair AlHalees, MD Consultant, Cardiac Surgery Heart Centre LEFT VENTRICULAR
More informationResearch Presentation June 23, Nimish Muni Resident Internal Medicine
Research Presentation June 23, 2009 Nimish Muni Resident Internal Medicine Research Question In adult patients with repaired Tetralogy of Fallot, how does Echocardiography compare to MRI in evaluating
More informationUncommon Doppler Echocardiographic Findings of Severe Pulmonic Insufficiency
Uncommon Doppler Echocardiographic Findings of Severe Pulmonic Insufficiency Rahul R. Jhaveri, MD, Muhamed Saric, MD, PhD, FASE, and Itzhak Kronzon, MD, FASE, New York, New York Background: Two-dimensional
More information3 Aortopulmonary Window
0 0 0 0 0 Aortopulmonary Window Introduction Communications between the ascending aorta and pulmonary artery constitute a spectrum of malformations which is collectively designated aortopulmonary window,
More informationTransesophageal Echocardiography in Children: An Interactive Session on Common Congenital Cardiac Defects
Transesophageal Echocardiography in Children: An Interactive Session on Common Congenital Cardiac Defects Wanda C. Miller-Hance, M.D. Objective: At the conclusion of this workshop the participant should
More informationTwo Cases Report of Scimitar Syndrome: The Classical one with Subaortic Membrane and the Scimitar Variant
Bahrain Medical Bulletin, Vol.22, No.1, March 2000 Two Cases Report of Scimitar Syndrome: The Classical one with Subaortic Membrane and the Scimitar Variant F Hakim, MD* A Madani, MD* A Abu Haweleh, MD,MRCP*
More informationThe background of the Cardiac Sonographer Network News masthead is a diagnostic image:
Number 5 Welcome Number 5 Welcome to the newsletter created just for you: sonographers who perform pediatric echocardiograms in primarily adult echo labs. Each issue features tips on echocardiography of
More informationSurgical Management Of TAPVR. Daniel A. Velez, M.D. Congenital Cardiac Surgeon Phoenix Children s Hospital
Surgical Management Of TAPVR Daniel A. Velez, M.D. Congenital Cardiac Surgeon Phoenix Children s Hospital No Disclosures Goals Review the embryology and anatomy Review Surgical Strategies for repair Discuss
More informationDEVELOPMENT OF THE CIRCULATORY SYSTEM L E C T U R E 5
DEVELOPMENT OF THE CIRCULATORY SYSTEM L E C T U R E 5 REVIEW OF CARDIAC ANATOMY Heart 4 chambers Base and apex Valves Pericardial sac 3 layers: epi, myo, endo cardium Major blood vessels Aorta and its
More informationUPDATE FETAL ECHO REVIEW
UPDATE 1 FETAL ECHO REVIEW Study Alert for RDCS Candidates D A V I E S P U B L I S H I N G I N C. Fetal Echo Review Study Alert U P D A T E D A U G U S T 1, 2 0 1 2 Nikki Stahl, RT(R)(M)(CT), RDMS, RVT
More informationIntroduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationULTRASOUND OF THE FETAL HEART
ULTRASOUND OF THE FETAL HEART Cameron A. Manbeian, MD Disclosure Statement Today s faculty: Cameron Manbeian, MD does not have any relevant financial relationships with commercial interests or affiliations
More informationJournal of American Science 2014;10(9) Congenital Heart Disease in Pediatric with Down's Syndrome
Journal of American Science 2014;10(9) http://www.jofamericanscience.org Congenital Heart Disease in Pediatric with Down's Syndrome Jawaher Khalid Almaimani; Maryam Faisal Zafir; Hanan Yousif Abbas and
More informationSurgical Treatment for Double Outlet Right Ventricle. Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery
for Double Outlet Right Ventricle Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery 1 History Intraventricular tunnel (Kawashima) First repair of Taussig-Bing anomaly (Kirklin) Taussig-Bing
More informationINTEGRATING ECHOCARDIOGRAPHY WITH CATHETER INTERVENTIONS FOR CONGENITAL HEART DISEASE. Krishna Kumar SevenHills Hospital, Mumbai, India
INTEGRATING ECHOCARDIOGRAPHY WITH CATHETER INTERVENTIONS FOR CONGENITAL HEART DISEASE Krishna Kumar SevenHills Hospital, Mumbai, India Why talk about it? What is the big deal? Are we not stating the obvious?
More informationCommissural Malalignment of Aortic-Pulmonary Sinus in Complete Transposition of Great Arteries
Commissural Malalignment of Aortic-Pulmonary Sinus in Complete Transposition of Great Arteries Soo-Jin Kim, MD, Woong-Han Kim, MD, Cheong Lim, MD, Sam Se Oh, MD, and Yang-Min Kim, MD Departments of Pediatric
More informationCongenital Heart Disease: Physiology and Common Defects
Congenital Heart Disease: Physiology and Common Defects Jamie S. Sutherell, M.D, M.Ed. Associate Professor, Pediatrics Division of Cardiology Director, Medical Student Education in Pediatrics Director,
More informationCoronary Artery from the Wrong Sinus of Valsalva: A Physiologic Repair Strategy
Coronary Artery from the Wrong Sinus of Valsalva: A Physiologic Repair Strategy Tom R. Karl, MS, MD he most commonly reported coronary artery malformation leading to sudden death in children and young
More informationPamela Heggie, RN BN Clinic Coordinator Northern Alberta Adult Congenital Heart (NAACH) Clinic Mazankowski Heart Institute
Pamela Heggie, RN BN Clinic Coordinator Northern Alberta Adult Congenital Heart (NAACH) Clinic Mazankowski Heart Institute Brief Overview of Congenital Heart Disease Spectrum disorder Treatment & Impact
More informationIndications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014
Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such
More informationA SURGEONS' GUIDE TO CARDIAC DIAGNOSIS
A SURGEONS' GUIDE TO CARDIAC DIAGNOSIS PART II THE CLINICAL PICTURE DONALD N. ROSS B. Sc., M. B., CH. B., F. R. C. S. CONSULTANT THORACIC SURGEON GUY'S HOSPITAL, LONDON WITH 53 FIGURES Springer-Verlag
More informationAnatomy of Atrioventricular Septal Defect (AVSD)
Surgical challenges in atrio-ventricular septal defect in grown-up congenital heart disease Anatomy of Atrioventricular Septal Defect (AVSD) S. Yen Ho Professor of Cardiac Morphology Royal Brompton and
More informationfound that some patients without stenotic lesions had blood velocity or pressure measurement across the
Br Heart J 1985; 53: 640-4 Increased blood velocities in the heart and great vessels of patients with congenital heart disease An assessment of their significance in the absence of valvar stenosis STANLEY
More information