Aortic Septal Defect Research Articles

A Novel GMM-Based Estimated Splitting Coefficient of Second Heart Sound for Diagnosing Aortic Septal Defect

A Novel GMM-Based Estimated Splitting Coefficient of Second Heart Sound for Diagnosing Aortic Septal Defect

The choice of tactic for surgical treatment of aortic arch hypoplasia with ventricular septal defect in infants

Aim: to determine the optimal tactic for surgical correction of aortic arch hypoplasia and ventricular septal defect (VSD) in infants based on the comparison of immediate and follow-up outcomes of one- and two-stage repair.Materials and methods. Between 2011 to 2019, 138 patients under the age of one year underwent surgical repair of aortic arch hypoplasia with VSD in the leading Ukrainina cardiosurgical institutions – National M. Amosov Institute of Cardiovascular Surgery Affilated to National Academy of Medical Sciences of Ukraine and Center for Pediatric Cardiology and Cardiac Surgery. Patients were divided into two groups: group I involved 66 (47.8 %) patients who underwent one-stage repai of aortic arch hypoplasia and VSD, group II included 72 (52.2 %) patients with two-stage repair, consisting of aortic arch reconstruction and pulmonary banding at the first stage, and correction of VSD at the second stage.Results. The total hospital mortality was 3.6 % (n = 5). In group I, hospital mortality was 3.0 % (n = 2), in group II – 4.2 % (n = 3), but this difference is not statistically significant (P > 0.05). Follow-up was from 1 month to 11 years. Mortality rate over follow-up period was 0 %. Aortic arch restenosis developed in 16 (11.6 %) patients: 6 (9.1 %) patients in group I and 10 (13.9 %) patients in group II. There was no statistically significant difference in restenosis development between two groups. Compression of the trachea and left main bronchus developed in two patients of group II (2.8 %). There were no residual VSDs which would need repeated repair.Conclusions. Both one-stage and two-stage tactic for surgical treatment of aortic arch hypoplasia with VSD in infants is effective and safe showing good immediate and long-term follow-up results. The study indicates that one- stage correction is more acceptable in infants with hypoplasia of segment C or all aortic arch segments. Stage tactic can be used in hypoplasia of segments B and A.

Correction of the aortic arch hypoplasia in newborn babies, suffering complete form of atrio-ventricular septal defect

Objective. Tactics of treatment and results of the hypoplasia of the aortic arch correction in newborn babies with complete form of atrio-ventricular septal defect were studied.
 Маterials and methods. During period from 2011 tо 2019 yrs in 21 patients correction of hypoplasia of aortic arch and atrio-ventricular septal defect were performed. The investigated group consisted of patients with a two-ventricular physiology. The patients, suffering imbalanced form of atrio-ventricular septal defect and with variants of hypoplasia in left parts of the heart, were excluded from the investigation. There were 9 (42.9%) boys and 12 (57.1%) girls. Average age of the patients have constituted (2.3 ± 1.1) mo (from 0.06 до 7.7 mo). Average body mass of the patients have constituted (3.8 ± 1.0) kg (from 2.0 до 5.9 kg). The aortic arch segment was considered a hypoplastic one if a Z-score (Standard Score - standard estimation) shift have constituted lesser than 2.0.
 Results. Hospital lethality have constituted 14.2%. Three newborn babies died: 2 - after first stage of correction, and 1 - after second stage of correction. All the patients, to whom a one-staged correction was done, have survived. The causes of lethality were not connected with method of the aortic arch reconstruction. While performance of echocardiography before discharge from the hospital the pressure gradient on place of the aortic arch plasty have constituted (13.6 ± 6.8) mm Hg at average. Average follow-up period have constituted (2.6 ± 2.1) yrs (from 2 mo tо 8.1 yr). In late follow-up period lethality was absent. In 2 (9.5%) patients in postoperative period reoperations on aortic arch and mitral valve were performed. Tracheal compression as well as the main bronchi compression, neurological complications in late follow-up period were absent.
 Conclusion. For the patients, suffering complete form of atrio-ventricular septal defect in conjunction with hypoplasia of aortic arch the staged correction constitutes a more favorable option, owing good immediate and late results. A staged approach in the treatment is indicated for newborn babies, suffering hypoplasia of distal aortic arch and competent atrio-venticular valves or with small regurgitation. Оne-stage correction is indicated in hypoplasia of aortic arch, pronounced regurgitation on common atrio-ventricular valve and pronounced heart failure.

INFECTIOUS ENDOCARDITITIC AORTAL VALVE AND THE ATRIAL SEPTAL DEFECT AT THE PATIENT WITH TOTAL INVERSION OF THE INTERNAL ORGANS

Situs viscerus inversus totalis – a complete reverse arrangement of the internal organs – is a rarely occurring congenital anomaly of development. Situs inversus with dextrocardia is more common. Congenital heart disease is observed with situs inversus with dextrocardia in 3–5% of cases, usually with transposition of large vessels. Сlinical сase of the patient P., 28 years old, with infective endocarditis of the aortic valve and atrial septal defect and situs viscerus inversus totalis also are presented. This case demonstrates the high importance of radiation methods in the diagnosis of complete transposition of organs as a congenital anomaly of development, as well as concomitant pathological conditions at the stages of surgical correction of these conditions.

Cardiac Surgical Repair Should Be Offered to Infants with Trisomy 18, Interrupted Aortic Arch and Ventricular Septal Defect.

The management of children born with trisomy 18 is controversial, and both providers and parents often have differing opinions. Many parents choose to terminate the pregnancy while others go forward, making decisions based on their beliefs, understanding, and physician recommendations. Physicians are similarly divided regarding treatment of these children, as some feel that aggressive treatments are futile while others defer to the parents' wishes.Interrupted aortic arch with ventricular septal defect in children with trisomy 18 presents an ethical dilemma that highlights the kinds of controversies in medical decision making facing physicians on a daily basis. Repair of interrupted aortic arch with ventricular septal defect poses a high risk to newborns with or without trisomy 18. Therefore, the option for surgery should be treated as with any routine informed consent process. Parents should be counseled about the risks, benefits, alternatives, and the likelihood of success both short and long term and be should offered a choice between surgery and palliative care.

Key-Lock Type Mini-Sternotomy: An Alternative Approach for Adult Cardiac Operations

An alternative technique for minimally invasive aortic valve replacement and atrial septal defect repair is described. After a 5-cm skin incision, a key-lock type sternotomy is made. Excellent exposure of the right atrium and aortic valve was achieved. The configuration of the mini-sternotomy (or the lock) limits the movement of the sternal surfaces (or the key) on the lateral and craniocaudal directions.

Automatic moment segmentation and peak detection analysis of heart sound pattern via short-time modified Hilbert transform

This paper proposes a novel automatic method for the moment segmentation and peak detection analysis of heart sound (HS) pattern, with special attention to the characteristics of the envelopes of HS and considering the properties of the Hilbert transform (HT). The moment segmentation and peak location are accomplished in two steps. First, by applying the Viola integral waveform method in the time domain, the envelope (ET) of the HS signal is obtained with an emphasis on the first heart sound (S1) and the second heart sound (S2). Then, based on the characteristics of the ET and the properties of the HT of the convex and concave functions, a novel method, the short-time modified Hilbert transform (STMHT), is proposed to automatically locate the moment segmentation and peak points for the HS by the zero crossing points of the STMHT. A fast algorithm for calculating the STMHT of ET can be expressed by multiplying the ET by an equivalent window (WE). According to the range of heart beats and based on the numerical experiments and the important parameters of the STMHT, a moving window width of N=1s is validated for locating the moment segmentation and peak points for HS. The proposed moment segmentation and peak location procedure method is validated by sounds from Michigan HS database and sounds from clinical heart diseases, such as a ventricular septal defect (VSD), an aortic septal defect (ASD), Tetralogy of Fallot (TOF), rheumatic heart disease (RHD), and so on. As a result, for the sounds where S2 can be separated from S1, the average accuracies achieved for the peak of S1 (AP1), the peak of S2 (AP2), the moment segmentation points from S1 to S2 (AT12) and the cardiac cycle (ACC) are 98.53%, 98.31% and 98.36% and 97.37%, respectively. For the sounds where S1 cannot be separated from S2, the average accuracies achieved for the peak of S1 and S2 (AP12) and the cardiac cycle ACC are 100% and 96.69%.

The Boy from Fez: A tale of five charities, and the global community, joining hands

A case study in global cooperation between multiple charities and cardiac centers helped to save a 8-year-old Moroccan boy suffering a case of Laubry-Pezzi syndrome with severe aortic regurgitation and ventricular septal defect. His recuperation was aided by the support of communities in both Morocco and Qatar.

Further insights into the syndrome of prolapsing non-coronary aortic cusp and ventricular septal defect

Ventricular septal defect (VSD) with prolapse of the right coronary cusp and aortic regurgitation can be managed surgically with the anatomical correction technique. However when the VSD is located underneath the non coronary cusp surgical management differs due to anatomical constraints and secondary pathological changes seen in the non coronary cusp. It is therefore important that the location of the VSD and the morphology of prolapsing cusp be characterised preoperatively in order to plan appropriate surgical repair. We present a case study in which we discuss the salient differences in the surgical management of the prolapsing right and the prolapsing non coronary cusps.

Aortic Valve Regurgitation and Ventricular Septal Defect Diagnosed 5 Years after Penetrating Cardiac İnjury

Despite high mortality rates for penetrating heart injuries, developments in transport, diagnosis, and surgical interventions have increased survival rates. In some cases, life-threatening complications may be misdiagnosed or remain asymptomatic and lead to loss of life. Herein, we report a patient with aortic valve regurgitation because of noncoronary cusp perforation and ventricular septal defect that remained asymptomatic and diagnosed 5 years after a penetrating heart injury.

Elusive Pulmonary Venous Confluence-to-Hepatic Vein Connection Leading to Heart Failure

A persistent omphalomesenteric vein (POMV) maintaining a link between the pulmonary venous system and the infracardiac hepatic venous system can lead to significant left-to-right shunting. To the best of the authors' knowledge, POMV causing significant left-to-right shunting has been unreported previously, especially in association with type B interrupted aortic arch. This report describes this association in a child who had chronic heart failure even after successful repair of interrupted aortic arch and ventricular septal defect. Subsequent percutaneous device closure of the POMV using an Amplatzer vascular plug II led to resolution of the child's heart failure.

The use of pulmonary autograft patch for type A aortic interruption and Swiss-cheese ventricular septal defect (VSD)

The surgical management of the aortic arch pathologies is controversial. Primary anastomosis and patch aortoplasties combined with end-to-end anastomosis have some complications like recurrence and aneurysm formation. Surgical repair of apical muscular (Swiss-cheese) defects is also still under debate. A 6-year-old patient with diagnosis of type A aortic arch interruption and Swiss-cheese ventricular septal defect (VSD) underwent successful intracardiac repair and aortic arch reconstruction. Aortic arch reconstruction was done by end-to-side anastomosis of distal aortic archus and thoracic aorta without cardiopulmonary bypass. The anterior side of the anastomosis was augmented by using pulmonary autograft patch and this patch was extended to the inferior surface of the archus aorta. Swiss-cheese VSD was repaired with a single patch using septal obliteration technique via transatrial approach. Pulmonary autograft patch aortoplasty and end-to-side anastomosis may be an alternative surgical management for surgical repair and it may be done without the need for cardiopulmonary bypass. In these patients associated multiple apical muscular VSDs can be repaired with a single patch, septal obliteration technique.

The Norwood procedure for hypoplastic left heart syndrome.

Evolution of staged surgical managementAmong the earliest reported attempts at palliation of hypoplastic left heart syndrome were those described by Cayler et al. in 1970,1and Freedom et al. in 1977.2Each case involved separate banding of the right and left pulmonary arteries, together with the construction of a direct aortopulmonary shunt. These two babies, one with critical aortic stenosis, and one with aortic atresia and ventricular septal defect, survived initial palliation but died without more definitive surgery. The separate banding of the pulmonary arteries had resulted in distortion of the distal pulmonary arterial branches and abnormal distribution of flow. Litwin et al.,3in 1972, performed an operation for interrupted aortic arch in which a non-valved conduit was placed from the pulmonary trunk proximally to the descending thoracic aorta, and the pulmonary trunk was banded distal to the conduit. The one survivor again manifested severe distortion of the pulmonary arteries, and developed pulmonary vascular obstructive disease. An operation fundamentally similar to this, nonetheless, was subsequently used by several surgeons in an attempt to treat neonates with hypoplastic left heart syndrome. These included Albert et al. in 1978, and Mohri in 1979.

Benzofuranyl ureas with potent cardiovascular teratogenicity in rats.

Studies of embryo-fetal development in rats were conducted with two 5-lipoxygenase inhibitors. SB-202235 (1,000 mg/kg/day) or SB-210661 (50, 100, or 500 mg/kg/day) was administered orally by gavage to female rats on days 6-17 postcoitus (pc) or days 7-16 pc. SB-202235 (1,000 mg/kg/day) and SB-210661 (100 mg/kg/day) reduced maternal body weight gain for the treatment period by 16% and 21%, respectively, relative to controls. SB-202235 (1,000 mg/kg/day) or SB-210661 (50 or 100 mg/kg/day), did not affect numbers of resorptions, dead or live fetuses/litter, but 500 mg/kg/day of SB-210661 caused 100% embryo lethality. SB-202235 (1,000 mg/kg/day) and SB-210661 (50 and 100 mg/kg/day) reduced fetal body weight by 15-30% and produced extensive cardiovascular malformations, as well as diaphragmatic hernias. SB-210661 also caused thymic abnormalities and cryptorchidism. Cardiovascular defects included abnormalities in aorticopulmonary septation, the aortic arch, pulmonary trunk, and ventricular septal defects are discussed relative to comparable human syndromes of cardiovascular malformation.

Total repair of interrupted aortic arch and ventricular septal defect on cardiopulmonary bypass in a neonate weighing 900 grams—a case report

Total repair of interrupted aortic arch and ventricular septal defect on cardiopulmonary bypass in a neonate weighing 900 grams—a case report

Primary reconstruction of interrupted aortic arch by total aortic outflow obstruction

Primary aortic arch reconstruction was undertaken in three neonates with interrupted aortic arch and ventricular septal defect. Total ascending aortic occlusion without cardiopulmonary bypass or profound hypothermia permitted, in each case, a rapid tension-free end-to-side descending-to-ascending aortic anastomosis without resulting neurologic or cardiac sequelae. This technique offers distinct advantages over previously described methods and should be considered whenever interrupted aortic arch is present with a ventricular septal defect.

Total one-stage repair of interrupted aortic arch associated with aortic septal defect and patent ductus arteriosus

Successful total repair in one stage was performed in a 3-year-old girl who had interrupted aortic arch associated with aortic septal defect and patent ductus arteriosus. Surface-induced deep hypothermia and interrupted perfusion were used. The results of postoperative catheterization and angiocardiographic studies are analyzed, and the literature and results of previous surgical attempts at correction are reviewed.

Congenital Malformations of the Heart: Vol. I: General Considerations

This new edition of the famous textbook first published in 1947 includes all the most important data that have accumulated in the rapidly advancing field of congenital heart disease since that time. Medical students and pediatricians as well as cardiologists will be grateful for the lucid, meticulous treatment of a difficult subject which Dr. Taussig has made readily understandable. Because of expansion of the chapters on the individual malformations and the addition of many new sections, such as those on pulmonary hypertension, aortic septal defect, Taussig-Bing anomaly and endocardial fibroelastosis, the text has doubled in length and is now divided into two volumes. Volume I covers embryology, methods of diagnosis, special diagnostic procedures, cyanosis and medical care.

Combination of Ventricular Septal Defect and Aortic Insufficiency

(1) Two cases of ventricular septal defect with aortic insufficiency were presented.(2) The diagnosis was confirmed at autopsy in both cases. In one case, an associated right aortic arch and anomalous left subclavian artery were also noticed.(3) Differentiation of this lesion from similar conditions, especially those of the patent ductus arteriosus, ruptured aneurysm of the sinus of Valsalva and aortic septal defect, was discussed.

Ventricular septal defect and aortic insufficiency: Report of three cases ∗

1. (1) Three case reports of probable ventricular septal defect with aortic insufficiency are reported. One was misdiagnosed clinically and discovered at autopsy. The second was diagnosed by clinical means with the aid of cardiac catheterization. The third was diagnosed in a like fashion, with the aid of an aortogram, and proved at surgery (at which time the septal defect was closed, with the production of a moderate infundibular pulmonary stenosis). 2. (2) A discussion of the various differential diagnostic possibilities includes: the lesion described in the case reports, aortic septal defect, patent ductus arteriosus (with or without pulmonary hypertension and pulmonary valvular insufficiency), atrial or ventricular septal-defect with pulmonary hypertension and pulmonary valvular insufficiency, sinus of Valsalva aneurysm with rupture into the right ventricle or pulmonary artery, coronary arteriovenous fistula, arteriovenous fistula of any thoracic systemic vessel near the heart, and anomalous coronary artery communicating with a ventricular chamber. 3. (3) The differential diagnosis can seldom be made on the basis of the physical findings or the history. The electrocardiogram offers some help in excluding the septal defects with pulmonary hypertension, because right ventricular hypertrophy will be present in these circumstances. The cardiac catheterization and the x-ray findings, particularly when proper use is made of injected diodrast, offer the greatest help in making the proper diagnosis.