scholarly journals Role of Balloon Pulmonary Valvuloplasty in the Management of Pulmonary Stenosis

2021 ◽  
Vol 04 (15) ◽  
pp. 01-41
Author(s):  
P. Syamasundar Rao
Keyword(s):  
Congenital Heart ◽  
Surgical Intervention ◽  
Pulmonary Stenosis ◽  
Cyanotic Congenital Heart Disease ◽  
Pulmonary Insufficiency ◽  
Therapeutic Procedure ◽  
Definitive Evidence ◽  
Adolescents And Adults

Although there is definitive evidence for pressure gradient relief both immediately after and at follow-up after balloon pulmonary valvuloplasty (BPV) for pulmonary stenosis (PS), the progression of pulmonary insufficiency (PI) at late follow up emerged as a concern. To address the concern for development of PI during late follow-up, balloon/annuls ratio used for BPV was reduced to 1.2 to 1.25. Recurrence of stenosis was seen in nearly 10% of patients. The causes of recurrence were identified to be balloon/annulus ratio less than 1.2 and immediate post-BPV gradients in excess of 30 mmHg. Recurrent obstructions can be effectively relieved by repeat BPV. The BPV procedure is safe and effective in fetal, neonatal and adult subjects as well. The BPV is also effective in palliating cyanotic congenital heart disease patients with valvar PS. Despite the limitations, BPV is currently considered as therapeutic procedure of choice in the management of congenital PS in both the pediatric and adult populations. BPV provides an excellent alternative to surgical intervention and has become the preferred intervention for initial treatment for PS in neonates, infants, children, adolescents, and adults. Careful follow-up to detect development of significant PI and investigate methods to prevent PI are recommended.

Extracorporeal membrane oxygenation and cyanotic congenital heart disease

1992 ◽  
Vol 2 (4) ◽  
pp. 359-360 ◽  
Author(s):  
Gale A. Pearson ◽  
Richard K. Firmin ◽  
Ranjit Leanage
Keyword(s):  
Congenital Heart Disease ◽  
United Kingdom ◽  
Heart Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Congenital Heart ◽  
Cyanotic Congenital Heart Disease ◽  
Membrane Oxygenation ◽  
The United Kingdom

AbstractWorldwide figures suggest that two percent of appropriate referrals for neonatal extracorporeal membrane oxygenation turn out to have previously covert congenital heart disease. This is despite the fact that expert cardiological evaluation is routine prior to cannulation. The experience in the United Kingdom includes such a case which is reported here. The implications for the role of pediatric cardiologists in such a service are considered.

scholarly journals Efficacy and safety of balloon valvuloplasty as a treatment of choice for pulmonary stenosis in children and adolescents

2014 ◽  
Vol 142 (9-10) ◽  
pp. 542-546
Author(s):  
Vojislav Parezanovic ◽  
Milan Djukic ◽  
Sanja Dzelebdzic ◽  
Tamara Ilisic ◽  
Igor Stefanovic ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Pulmonary Stenosis ◽  
Age Groups ◽  
Balloon Valvuloplasty ◽  
Pulmonary Artery Stenosis ◽  
Pulmonary Valve Insufficiency ◽  
Valve Insufficiency

Introduction. Pulmonary artery stenosis (PS) is a congenital heart defect which occurs in 10% of all congenital heart defects. Pulmonary balloon valvuloplasty (BVP) has been the treatment of choice of PS over the last 30 years. Objective. The purpose of this study was to evaluate the efficacy of this method based on middle-term hospital follow-up, and safety of BVP based on our experience. Methods. The study included 88 patients diagnosed with PS. The patients were divided into three groups based on the severity of the disease. Also, they were divided into two age groups in order to analyze the frequency of complications. Hemodynamic measurements and echocardiography results were recorded before, 24-36 hours after BVP and at the end of follow-up. Results. The studied group involved patients of average age 3.75?4.3 years (20 days to 17 years). Immediately after BVP a significant decrease of pressure gradient across the pulmonary valve (PV) was recorded in all patients; this result was similar in all 3 groups of patients regardless of the severity of stenosis (p<0.001). Complications of BVP occurred most commonly in children up to 12 months of age (ventricular tachycardia 4.5% and supraventricular tachycardia 6.8%). Pulmonary valve insufficiency after dilatation occurred in 6.6% of cases, and was most common in children aged up to 12 months. In 87 (98.9%) patients BVP was a definitive solution, and a significant residual stenosis was not recorded during follow-up. Conclusion. BVP is a safe and effective procedure in the treatment of isolated PS in children, regardless of the severity of stenosis but also regardless of patients? age.

scholarly journals Double Inlet Left Ventricle with Eisenmenger Syndrome in an Adult – A Case Report

2017 ◽  
Vol 5 (1) ◽  
pp. 53-56
Author(s):  
Rahul Regi Abraham ◽  
Rahul Regi Abraham
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Left Ventricle ◽  
Congenital Heart ◽  
Pulmonary Stenosis ◽  
Eisenmenger Syndrome ◽  
Tertiary Center ◽  
History Of ◽  
Double Inlet Left Ventricle

Background: Patient diagnosed with double inlet left ventricle (prevalent in 5 – 10 in 100,000 newborns) complicated with Eisenmenger syndrome had a median survival age of 14 years without corrective surgery. Congenital heart disease such as this is usually treated by multiple surgeries during early childhood. A surgically uncorrected case in adults is not of common occurrence. Further, generalized itching after coming in contact with water (aquagenic pruritis) presented an interesting conundrum to treat. Case: A 29-year-old patient in India presented at a primary health care center with a history of difficulty breathing and discoloration of extremities since birth. He also gave a history of itching which commonly occurred after taking bath, hemoptysis and history of turning blue in color after birth. Patient had received no treatment besides regular phlebotomies. On examination, there was grade IV clubbing and conjunctival congestion. Cardiovascular examination revealed an enlarged heart, heaving apex beat and a pan-systolic murmur. A provisional diagnosis of a congenital cyanotic heart disease was made. Investigations revealed hemoglobin of 16.8g/dl. X–ray and electrocardiogram showed hypertrophy of the ventricles. An echocardiogram showed double inlet left ventricle with L-malposed vessels but without pulmonary stenosis. A final diagnosis of congenital heart disease; double inlet left ventricle, L-malposed vessels without pulmonary stenosis, Eisenmenger Syndrome and absolute erythrocytosis was made. Patient was advised for further management with a cardiologist in a tertiary center but the patient did not follow up. Conclusion: Unlike in high-income countries where most congenital heart diseases are detected and dealt with at birth whereas low-and middle-income nations often have to deal with cases that present much later and should often be included in the differential diagnosis. Inability to follow up cases, centers that are poorly equipped and lack of facilities for investigations, patient’s lack of medical awareness, and financial restrictions are major barriers to providing optimal treatment.

scholarly journals Cyanotic congenital heart disease: Impact on growth and endocrine functions.

2021 ◽  
Vol 28 (10) ◽  
pp. 1477-1483
Author(s):  
Muhammad Sohail Arshad ◽  
Waqas Imran Khan ◽  
Arif Zulqarnain ◽  
Hafiz Muhammad Anwar-ul-Haq ◽  
Mudasser Adnan
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Pulmonary Stenosis ◽  
Tertiary Care ◽  
Cyanotic Congenital Heart Disease ◽  
P Value ◽  
Common Diagnosis ◽  
Significant Difference ◽  
The Impact

Objective: To find out the impact of Cyanotic Congenital Heart Disease (CCHD) on growth and endocrine functions at a tertiary care child healthcare facility of South Punjab. Study Design: Case Control study. Setting: Department of Pediatric Cardiology and Department of Pediatric Endocrinology, Institute of Child’s Health (ICH), Multan, Pakistan. Period: December 2018 to March 2020. Material & Methods: During the study period, a total of 53 cases of Echocardiography confirmed CCHD were registered. Along with 53 cases, 50 controls during the study period were also enrolled. Height, weight, body mass index (BMI) along with hormonal and biochemical laboratory investigations were done. Results: There was no significant difference between gender and age among cases and controls (p value>0.05). Most common diagnosis of CCHD among cases, 24 (45.3%) were Tetralogy of Fallot (TOF) followed by 9 (17.0%) transposition of the great arteries (TGA) with Ventricular Septal Defect (VSD) with Pulmonary Stenosis (PS). Mean weight of CCHD cases was significantly lower in comparison to controls (21.19+6.24 kg vs. 26.48+8.1 kg, p value=0.0003). Blood glucose was significantly lower among cases in comparison to controls (77.58+14.58 mg/dl vs. 87.25+11.82 mg/dl, p value=0.0004). No significant difference was found in between cases and controls in terms of various hormone levels studied (p value>0.05) except Insulin-like Growth Factor-1 (IGF-1) levels (p value<0.0001). Conclusion: Children with cyanotic congenital heart disease seem to have negative effects on nutrition and growth. Change in pituitary-adrenal axis is suspected while pituitary-thyroid axis seemed to be working fine among CCHD cases. Serum glucose and IGF-1 levels were significantly decreased among CCHD cases.

scholarly journals Developmental approaches to substance use and abuse

1999 ◽  
Vol 11 (4) ◽  
pp. 655-656 ◽  
Author(s):  
DANTE CICCHETTI ◽  
SUNIYA S. LUTHAR
Keyword(s):  
Drug Use ◽  
Protective Factors ◽  
Developmental Psychopathology ◽  
Developmental Stages ◽  
Risk And Protective Factors ◽  
Institute Of Medicine ◽  
Drug Use Disorders ◽  
Adolescents And Adults

In 1996 the Institute of Medicine (IOM, 1996) issued a report on pathways to addiction. Although focused on the use of illegal drugs, the recommendations of the committee are equally applicable to more socially condoned, but still addictive, substances such as alcohol. The IOM (1996) report articulated the types of research that would be needed to expand the understanding of the etiology of drug use disorders, including the following: (a) multidisciplinary research to investigate the combined effects of biological, psychosocial, and contextual factors as they relate to the development of drug use, abuse, and dependence; (b) studies of sufficient duration to enable follow-up of participants in determining the role of risk and protective factors related to the transition from drug use to abuse to dependence; (c) research investigating the role of family factors in the etiology of drug use and abuse; (d) examination of psychopathology as a precursor to drug use and abuse in adolescents and adults; (e) studies of risk and protective factors related to drug use and abuse, especially during discrete developmental stages; and (f) investigation of childhood risk and protective factors that are associated with drug abuse and dependence. In reflecting on these comprehensive goals, striking similarities emerge with respect to these research foci and the field of developmental psychopathology (Cicchetti & Cohen, 1995; Cicchetti & Toth, 1991). Specifically, the principles that guide inquiries conceptualized within a developmental psychopathology framework can be applied toward the conduct of studies designed to address the agenda generated by the IOM (1996) report on substance abuse.

Combined pulmonary stenosis and insufficiency preserves myocardial contractility in the developing heart of growing swine at midterm follow-up

2005 ◽  
Vol 99 (4) ◽  
pp. 1422-1427 ◽  
Author(s):  
Titus Kuehne ◽  
B. Kelly Gleason ◽  
Maythem Saeed ◽  
Daniel Turner ◽  
Jochen Weil ◽  
...  
Keyword(s):  
Myocardial Contractility ◽  
Pulmonary Stenosis ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Insufficiency ◽  
Published Data ◽  
Functional Reserve ◽  
Developing Heart ◽  
Diastolic Compliance

This study was conducted to determine the effects of chronic combined pulmonary stenosis and pulmonary insufficiency (PSPI) on right (RV) and left ventricular (LV) function in young, growing swine. Six pigs with combined PSPI were studied, and data were compared with previously published data of animals with isolated pulmonary insufficiency and controls. Indexes of systolic function (stroke volume, ejection fraction, and cardiac functional reserve), myocardial contractility (slope of the end-systolic pressure-volume and change in pressure over time-end-diastolic volume relationship), and diastolic compliance were assessed within 2 days of intervention and 3 mo later. Magnetic resonance imaging was used to quantify pulmonary insufficiency and ventricular volumes. The conductance catheter was used to obtain indexes of the cardiac functional reserve, diastolic compliance, and myocardial contractility from pressure-volume relations acquired at rest and under dobutamine infusion. In the PSPI group, the pulmonary regurgitant fraction was 34.3 ± 5.8%, the pressure gradient across the site of pulmonary stenosis was 20.9 ± 20 mmHg, and the average RV peak systolic pressure was 70% systemic at 12 wk follow-up. Biventricular resting cardiac outputs and cardiac functional reserves were significantly limited ( P < 0.05), LV diastolic compliance significantly decreased ( P < 0.05), but RV myocardial contractility significantly enhanced ( P < 0.05) compared with control animals at 3-mo follow-up. In the young, developing heart, chronic combined PSPI impairs biventricular systolic pump function and diastolic compliance but preserves RV myocardial contractility.

Outcome of the construction of a Blalock–Taussig shunt in adolescents and adults

2005 ◽  
Vol 15 (4) ◽  
pp. 368-372 ◽  
Author(s):  
Aubrey Peries ◽  
Amira A. A. Al-Hay ◽  
Elliot A. Shinebourne
Keyword(s):  
Pulmonary Stenosis ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Symptomatic Improvement ◽  
Cardiac Events ◽  
Volume Load ◽  
Adverse Cardiac Events ◽  
Adolescents And Adults ◽  
Blalock Taussig Shunt

Aims:The purpose of our study was to ascertain the outcome of the construction of a Blalock–Taussig shunt in patients aged 12 years and over.Patients and methods:We identified 21 patients in whom a Blalock–Taussig shunt had been constructed subsequent to the age of 12 years. Of the patients, 9 were female, and their median age was 18.5 years, with a range from 12 to 46 years. All had usual atrial arrangement, and the atrioventricular connections were concordant in 11, with univentricular atrioventricular connection in 10. Pulmonary atresia was present in 8 (38 per cent), and pulmonary stenosis, either valvar or subvalvar, in 13. An interposition graft had been placed between the subclavian and pulmonary arteries in 16 patients, and an end-to-side anastomosis between the arteries in 5.Results:One patient had died in hospital, while 4 patients had died during the period of follow-up after initial construction of the shunt. Long-term follow-up was available in 86 per cent of patients. In the 3 patients lost to follow-up, the shunt had been known to be functioning at periods of 4, 8, and 10 years, respectively. Actuarial freedom from death after a period of 17 years was 76 per cent. In 8 patients, a period of 10 years had elapsed with the shunt patent, and a further 10 had a patent shunt after 5 years follow-up. Symptomatic improvement was reported in 16 (76 per cent) patients, although adverse cardiac events had occurred during follow-up in 17, including congestive heart failure in 3, atrial fibrillation in 3, and endocarditis in 2. In 2 patients, it had been possible to proceed to biventricular repair, one with tetralogy of Fallot, and the other having a Rastelli procedure. Further in 3 patients, it had been possible to construct the Fontan circulation, or one of its variants. One patient has undergone cardiac transplantation, while 2 are awaiting transplantation.Conclusions:Symptomatic improvement can be achieved by construction of a Blalock–Taussig shunt in older subjects, and the risks of surgery are low. Later repair may be feasible in some patients, but adverse cardiac events may follow the increased volume load on the systemic ventricle.

scholarly journals The radiologic roadmap for treatment of an acute appendicitis patient who tested positive for coronavirus disease 19

2021 ◽  
Author(s):  
Şeref Barbaros Arik ◽  
Elif Gunaydin ◽  
Celal İsmail Bİlgiç ◽  
İnanç Güvenç
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Standard Treatment ◽  
Surgical Intervention ◽  
Ultrasound Examination ◽  
Bridging Therapy ◽  
Emergency Surgical Intervention ◽  
Pelvic Ct Scan

Objective: In this study, we aimed to emphasize the role of radiological imaging in determining the treatment of a patient, who tested positive for COVID-19 and diagnosed with acute appendicitis during the pandemic. Methods: A 31-year-old patient presented to the emergency department due to abdominal pain. Ultrasound examination, thoracic and pelvic CT scan were performed. Results: Non-complicated appendicitis can be treated conservatively with antibiotics. Treatment can be maintained by starting with IV antibiotics and bridging therapy with oral antibiotics. Conclusion: This study aims to summarize how radiological follow-up can be used to decide on the suitability of the patient for appropriate medical treatment as an alternative to surgery in a patient, whose gold standard treatment is emergency surgical intervention, which is frequently encountered in the emergency department during the COVID-19 pandemic.

scholarly journals Feasibility of surgical management in patients with mammary tuberculosis-study of 100 cases.

2018 ◽  
Vol 27 (1) ◽  
pp. 44-49
Author(s):  
RN Laila ◽  
B Islam ◽  
S Banu ◽  
J Raihan
Keyword(s):  
Surgical Intervention ◽  
Treatment Strategies ◽  
Diagnosis And Treatment ◽  
Idiopathic Granulomatous Mastitis ◽  
Breast Tuberculosis ◽  
Chest Disease ◽  
Disease Hospital ◽  
Anti Tubercular Therapy

Tuberculous mastitis is a rare entity in patients with mammary disease even in countries where incidence of tuberculosis is high. In Bangladesh, TB is an endemic disease but breast tuberculosis is rarely reported. Its clinical patterns and treatment strategies are changing day by day. With this study, we aimed to analyze the role of surgery in diagnosis and treatment of hundred (100) cases received care for tuberculous mastitis at the Chest Disease Hospital, Rajshahi, from July’ 2012 to July’ 2016. This is a prospective nonrandomized descriptive study. Diagnosis was made in all patients initially by cytological examination from suspected lesions, which revealed typical tuberculous lesions. In all the patients the diagnosis was confirmed by biopsy of the lesion (open biopsy or core cut biopsy) with histological examination and detection of acid fast bacilli in discharge by Gene x-pert test and Z-N staining to exclude idiopathic granulomatous mastitis, malignancy and very rare concomitant malignancy. Medical therapy with anti-tubercular drugs (ATT) ranging from 9 to 12 months with follow up monthly was the mainstay of treatment. Surgical intervention reserved for selected refractory cases (36%). Extension of anti-tubercular therapy from 9 to 12 or 18 months required in fifty-eight(58) patients on the basis of slow clinical response. Complete resolution obtained in 92 patients but residual tiny mass in eight patients confirmed by repeated FNAC or biopsy to be fibrotic. Surgery play an essential role both in diagnosis and treatment of tubercular mastitis in addition with ATT but beware about unnecessary surgical intervention as majority of patients cured with only ATT.TAJ 2014; 27(1): 44-49

scholarly journals Traumatic Orbital Subperiosteal Hematoma With Acute Visual Compromise: Role of the Head and Neck Surgeon

2019 ◽  
Vol 98 (10) ◽  
pp. 617-620
Author(s):  
Tom Shokri ◽  
Vijay A. Patel ◽  
Neerav Goyal
Keyword(s):  
Surgical Intervention ◽  
Ocular Injury ◽  
Optimal Method ◽  
Craniomaxillofacial Trauma ◽  
Institutional Experience ◽  
Sudden Blindness ◽  
Age Range

The primary goal was to report our institutional experience of a rare, vision-threatening complication following craniomaxillofacial trauma. A retrospective review was performed between January 2016 and January 2018 to identify 3 patients with traumatic orbital subperiosteal hematoma (OSPH). Visual acuity, intraocular pressures (IOPs), and the need for surgical intervention were abstracted. The age range was 36 to 88 years. Indications for surgical intervention include relative afferent pupillary defect, gaze restriction, visual impairment, and elevated IOP. Preoperatively, IOP range was 15.0 to 25.0. Two patients required OSPH evacuation via a medial brow approach. Follow-up after ocular injury ranged from 25 to 41 days, with IOP range of 13.0 to 16.0. Traumatic OSPH is an uncommon clinical finding; prompt assessment with consideration of surgical intervention may mitigate deleterious long-term morbidity, chiefly sudden blindness. Further research efforts may elucidate the optimal method in the management of this complex clinical entity.

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