Pulmonary arterial hypertension PAH is a progressive disease characterized by an increase in pulmonary arterial pressure and resistance. It often complicates congenital heart disease with a left-to-right shunt. The ob...Pulmonary arterial hypertension PAH is a progressive disease characterized by an increase in pulmonary arterial pressure and resistance. It often complicates congenital heart disease with a left-to-right shunt. The objective of this study is to evaluate the evolutionary profile of the pulmonary pressures of children with congenital heart disease with left-to-right shunt and to identify the factors favoring an evolution towards PAH. This is a retrospective, descriptive and analytical study over a period of four years and six months (from January 1, 2016 to June 30, 2020) at the Center National d’Enfant Albert Royer in Dakar on a series of 87 cases. The hospital frequency was 3.98 per thousand, and the incidence of PAH was 9.44%. The sex ratio of 0.74. The average age was 44.76 months. The average time between the onset of symptoms and the diagnosis of heart disease is 78.81 days. Dyspnea was found in 70.11% of cases, the burst of pulmonary B2 was found in 55%. Global heart failure was noted in 39.08% of cases. Cardiomegaly was found in 89.66% and pulmonary hypervascularization was found in 57.72% of cases. CIV was present in 54.02% of cases, followed by PCA in 21.14% and CAVc in 18.39% of cases. furosemide was used in 97.70% of cases and Captopril in 74.71% of cases. Sildenafil was used in 10.34% of patients, and 12.64% of patients benefited from surgical management. Eisenmenger syndrome was found in 12.64% of patients. PAH in these heart diseases is a formidable and frequent complication, due to an increase in precapillary flow. The major improvement in mortality and morbidity is early surgical management, in the first months of life, to prevent pulmonary vascular disease.展开更多
Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enc...Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.展开更多
In this study, we investigated the changes in the right-to-left shunt (RLS) of the patent foramen ovale (PFO) at different phases of the Valsalva maneuver and analyzed the possible mechanisms. The study population con...In this study, we investigated the changes in the right-to-left shunt (RLS) of the patent foramen ovale (PFO) at different phases of the Valsalva maneuver and analyzed the possible mechanisms. The study population consisted of 57 patients with symptoms highly suggestive of a PFO. These patients had been diagnosed with apsychia, migraine with aura, cerebral infarction, transient ischemic attack (TIA), and cerebral ischemia with unknown cause. Routine echocardiography was performed in all patients to rule out a cardiac malformation. Contrast-transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) were used to visualize and quantify the RLS. The standard apical four chamber view was used to observe the changes of E peak, A peak, and velocity-time integral (VTI) ratio of tricuspid blood flow during the strain phase and release phase of the Valsalva maneuver. Paired t-test was used to compare E peak, A peak, and VTI ratio of tricuspid blood flow during the different phases. The right-to-left shunt across the PFO (PFO-RLS) was graded in the two phases and compared by Kruskal-Wallis test. Compared with the strain phase of the Valsalva maneuver, the parameters of E, A, and VTI in diastolic period in patients with PFO-RLS at the release phase were significantly increased [54.30 ± 13.65 cm/s vs 100.35 ± 21.11 cm/s, 42.21 ± 12.32 cm/s vs 57.30 ± 18.88 cm/s, 10.34 ± 3.27 cm/s vs 19.58 ± 4.56 cm/s, respectively], and the difference was statistically significant. The positive consequence of PFO-RLS, as diagnosed by c-TTE with the Valsalva maneuver at the release phase of the Valsalva maneuver, was significantly higher than that at the strain phase of the Valsalva maneuver. At the beginning of release phase of the Valsalva maneuver, decreased intrathoracic pressure led to increased venous backflow into the right atrium. Thus, high-velocity blood flow rapidly pushed the PFO open, which resulted in a significant increase in the PFO-RLS. Therefore, the increase of the PFO-RLS during the Valsalva maneuver is caused by the impact of high-velocity blood flow the PFO.展开更多
Patent foramen ovale (PFO) closure for systemic hypoxemia is controversial. The first systematic, albeit retrospective, study was recently presented which showed good procedural and clinical success for PFO closure fo...Patent foramen ovale (PFO) closure for systemic hypoxemia is controversial. The first systematic, albeit retrospective, study was recently presented which showed good procedural and clinical success for PFO closure for this indication. We present a case of acute right to left intra-cardiac shunt across PFO where the shunting is not persistent. Hence making a decision on PFO closure based on the aforementioned promising trial may not have been the right decision for the patient. This case highlights that the decision on PFO closure for such indication needs to be individualized. We also review the sparse literature on PFO closure for this indication and discuss how the decision making for such indication needs to be individualized.展开更多
文摘Pulmonary arterial hypertension PAH is a progressive disease characterized by an increase in pulmonary arterial pressure and resistance. It often complicates congenital heart disease with a left-to-right shunt. The objective of this study is to evaluate the evolutionary profile of the pulmonary pressures of children with congenital heart disease with left-to-right shunt and to identify the factors favoring an evolution towards PAH. This is a retrospective, descriptive and analytical study over a period of four years and six months (from January 1, 2016 to June 30, 2020) at the Center National d’Enfant Albert Royer in Dakar on a series of 87 cases. The hospital frequency was 3.98 per thousand, and the incidence of PAH was 9.44%. The sex ratio of 0.74. The average age was 44.76 months. The average time between the onset of symptoms and the diagnosis of heart disease is 78.81 days. Dyspnea was found in 70.11% of cases, the burst of pulmonary B2 was found in 55%. Global heart failure was noted in 39.08% of cases. Cardiomegaly was found in 89.66% and pulmonary hypervascularization was found in 57.72% of cases. CIV was present in 54.02% of cases, followed by PCA in 21.14% and CAVc in 18.39% of cases. furosemide was used in 97.70% of cases and Captopril in 74.71% of cases. Sildenafil was used in 10.34% of patients, and 12.64% of patients benefited from surgical management. Eisenmenger syndrome was found in 12.64% of patients. PAH in these heart diseases is a formidable and frequent complication, due to an increase in precapillary flow. The major improvement in mortality and morbidity is early surgical management, in the first months of life, to prevent pulmonary vascular disease.
文摘Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.
文摘In this study, we investigated the changes in the right-to-left shunt (RLS) of the patent foramen ovale (PFO) at different phases of the Valsalva maneuver and analyzed the possible mechanisms. The study population consisted of 57 patients with symptoms highly suggestive of a PFO. These patients had been diagnosed with apsychia, migraine with aura, cerebral infarction, transient ischemic attack (TIA), and cerebral ischemia with unknown cause. Routine echocardiography was performed in all patients to rule out a cardiac malformation. Contrast-transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) were used to visualize and quantify the RLS. The standard apical four chamber view was used to observe the changes of E peak, A peak, and velocity-time integral (VTI) ratio of tricuspid blood flow during the strain phase and release phase of the Valsalva maneuver. Paired t-test was used to compare E peak, A peak, and VTI ratio of tricuspid blood flow during the different phases. The right-to-left shunt across the PFO (PFO-RLS) was graded in the two phases and compared by Kruskal-Wallis test. Compared with the strain phase of the Valsalva maneuver, the parameters of E, A, and VTI in diastolic period in patients with PFO-RLS at the release phase were significantly increased [54.30 ± 13.65 cm/s vs 100.35 ± 21.11 cm/s, 42.21 ± 12.32 cm/s vs 57.30 ± 18.88 cm/s, 10.34 ± 3.27 cm/s vs 19.58 ± 4.56 cm/s, respectively], and the difference was statistically significant. The positive consequence of PFO-RLS, as diagnosed by c-TTE with the Valsalva maneuver at the release phase of the Valsalva maneuver, was significantly higher than that at the strain phase of the Valsalva maneuver. At the beginning of release phase of the Valsalva maneuver, decreased intrathoracic pressure led to increased venous backflow into the right atrium. Thus, high-velocity blood flow rapidly pushed the PFO open, which resulted in a significant increase in the PFO-RLS. Therefore, the increase of the PFO-RLS during the Valsalva maneuver is caused by the impact of high-velocity blood flow the PFO.
文摘Patent foramen ovale (PFO) closure for systemic hypoxemia is controversial. The first systematic, albeit retrospective, study was recently presented which showed good procedural and clinical success for PFO closure for this indication. We present a case of acute right to left intra-cardiac shunt across PFO where the shunting is not persistent. Hence making a decision on PFO closure based on the aforementioned promising trial may not have been the right decision for the patient. This case highlights that the decision on PFO closure for such indication needs to be individualized. We also review the sparse literature on PFO closure for this indication and discuss how the decision making for such indication needs to be individualized.
