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Anesthetic Management for Surgical Myectomy in Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Heather K. Hayanga, Jeremiah W. Hayanga, Joseph McGuire, Vinay Badhwar
Transesophageal echocardiography allows evaluation of the adequacy of myectomy and any post-operative complications immediately following cardiopulmonary bypass. The LVOT postoperatively should appear widened with improvements in SAM of the mitral valve, MR, and LVOT gradient. Color-flow Doppler should show laminar systolic LVOT flow. Where there is a persistent elevated outflow gradient, one should look for persistent mitral valve or papillary muscle abnormalities. Mitral or aortic regurgitant jets should be measured and evaluated for size, duration, location, and mechanism. The zone of coaptation is best evaluated in the deep transgastric view. A coaptation zone of greater than 5 mm is required for adequate valve closure [8]. Postoperative complications associated with surgical myectomy include atrial arrhythmias, ventricular arrhythmias, heart block, left ventricular rupture, and ventricular septal defect [9]. Excessive resection of the septum may result in a ventricular septal defect (VSD) and this is a consideration that must be borne in mind for a few days postoperatively. As such the septum should be carefully evaluated in the ME views. Flow across the interventricular septum should be differentiated from flow related to unroofed septal perforators, the latter of which will be seen only in diastole. A small amount of residual SAM is permissible and typically resolves within two weeks [28, 31–37].
Cardiovascular system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
8.26. Prophylaxis with penicillin against subacute bacterial endocarditis in a patient with congenital heart disease isinadequate treatment for a child requiring abdominal surgery.not necessary in a patient with a very small ventricular septal defect.adequate treatment in a patient requiring dental treatment.not indicated in a patient who has had his ductus arteriosus ligated and who has no other cardiac lesions.indicated if the patient has an upper respiratory tract infection.
Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Ventricular septal defects are usually repaired in childhood. Maternal morbidity is related to the size of the lesion, and whether it has caused pulmonary hypertension. Even some asymptomatic women with a repaired VSD may have unrecognised pulmonary hypertension6, so assessment, ideally before pregnancy, should be made. Any sequelae from the surgery has the potential to complicate pregnancy, and unrecognised pulmonary hypertension may become clinically obvious only when the woman is pregnant; therefore, surveillance in pregnancy is necessary2.
Update on percutaneous and perventricular device closure of congenital ventricular septal defect
Published in Expert Review of Cardiovascular Therapy, 2023
John S Lozier, Maram Sati, Ira M Cheifetz, Martin L Bocks
When isolated ventricular septal defects are large, infants typically become symptomatic with feeding difficulties and poor somatic growth. In these cases, closure is usually performed in infancy. Moderate-sized VSDs result in more subtle clinical symptoms in early infancy but lead to chronic pulmonary overcirculation and left heart volume overload, necessitating closure at a later time. Indications for closure of VSD include uncontrolled overcirculation despite maximal medical therapy, typically associated with poor somatic growth in infants; pulmonary hypertension secondary to large VSD; left ventricular dilation or a pulmonary-to-systemic flow ratio (Qp:Qs) greater than 2:1; aortic valve prolapse and regurgitation secondary to subpulmonary or perimembranous VSD; and double-chamber right ventricle, leading to subpulmonary obstruction and right ventricular hypertension [3].
Prenatal Diagnosis of Fetal Trisomy 5 Mosaicism with Congenital Pulmonary Airway Malformation Type 3: A Case Report
Published in Fetal and Pediatric Pathology, 2022
Maria Paola Bonasoni, Giuseppina Comitini, Gabriele Tonni, Silvia Asioli, Veronica Barbieri, Monia Rinaldini, Maria Marinelli
At postmortem, growth parameters were mainly consistent with 17 weeks of gestational age: fetus weighed 345 g and crown-heel length measured 19 cm. Face was slightly dysmorphic with broad forehead, hypertelorism, flattened nose, long phyltrum, faded chin and low-set ears (Fig. 1A). Both feet presented brachydactyly of the 1st, 4th and 5th toes (Fig. 1B). Heart examination revealed a wide ventricular septal defect (VSD), but no other cardiac anomalies. Inferior lobe of left lung was pinkish with a spongy-like appearance. Histological examination showed a CPAM type 3 reminiscent of fetal lung in canalicular stage of development with terminal bronchioles and alveolar ducts (Figs. 2 and 3). Remaining pulmonary parenchyma in other lobes was in pseudoglandular/early canalicular stage of development compatible with 17th week maturation (Fig. 4). Placenta weighed 60 g and histologically villi were edematous with an irregular contour. At postmortem, fetal tissues were sampled and cultured to evaluate distribution of mosaic cells (Table 1). These were predominant in skin, thymus, lungs, and kidneys. Tissue sampling by CPAM also showed a trisomic cell line (Fig. 5). A normal karyotype of 46, XX was obtained from placenta and fetal blood. Samples from heart and liver failed to grow.
Peripheral Blood Mononuclear Cells Expression Levels of miR-196a and miR-100 in Coronary Artery Disease Patients
Published in Immunological Investigations, 2021
Zahra Saadatian, Ziba Nariman-Saleh-Fam, Isa Khaheshi, Yaser Mansoori, Abdolreza Daraei, Sayyed Mohammad Hossein Ghaderian, Mir Davood Omrani
Clinical and paraclinical characteristics of the study population are presented in Table 2. All three groups didn’t exhibit significant differences in terms of gender, mean age, the proportion of smoking individuals, or the proportion of participants suffering from diabetes, dyslipidemia, obesity, or hypertension (Table 2). Seventy-two CAD patients including, 25, 15, and 32 subjects with one, two, and three Ventricular Septal Defects (VSD) in the order given comprised our patient population in this research. Also, the CAD group was divided into three groups including 32 UAP, 20 NSTEMI, and 20 SAP. The mean age of CADs, ICADs, and controls was 60.97, 60.16, and 59.87, respectively. The median of Gensini scores in CAD and ICAD patients was 40 and one, respectively. About 88.8% of CAD cases owned zero or one Rentrop grade and their coronary collateral circulation was weak.