Ventricular septal defect with pulmonary stenosis

The role of diagnostic cardiac catheterization for children with congenital heart diseases: local experience

INTRODUCTION

Despite the development of non-invasive tools of investigations for congenital heart diseases (CHDs), still the role of diagnostic cardiac catheterization (DCC) cannot be undermined. The study aimed to analyze the clinical profile of indicated CHDs cases at our center for DCC to evaluate the contribution of DCC in patients' management plans.

MATERIAL AND METHODS

The study checked files of cases performed DCC between 2011 and 2012 at the pediatric catheterization unit of Alexandria University Children's Hospital by the same operator. Demographic, laboratory and hemodynamic data were collected and analyzed.

RESULTS

Files of 61 children were included in the study. They were grouped into: group I (GI) (n = 25) with pulmonary hypertension (PH), and group II (GII) (n = 36) cases with obstructive pulmonary artery diseases. For the PH group, ventricular septal defect (VSD) was the most common (55%), and patients' outcome plans were based on angiography - operable subgroup GI-A: (84%) (n = 21) and non-operable (16%) GI-B: (4% inoperable, 12% recommended for sildenafil). GI-B cases were significantly older, with higher PVRI and PVRI/SVRI (3.62, 0.68, p = 0.002) compared to GI-A (0.89, 0.23, p = 0.002, respectively). For group II, tetralogy of Fallot (TOF) was predominant (60%) among the disease spectrum, and the McGoon ratio ranged from 0.7 to 3.2 (median: 1.8). Outcome for GII: 63% operable, 25% shunt, 12% stent. Only pulmonary atresia cases showed a significant difference in the unmatched plans between echocardiography and catheterization reports (χ2 = 7.438, p = 0.023).

CONCLUSIONS

Diagnostic cardiac catheterization had a positive contribution for determination of the management plans for more than 84% of cases. The utility of pediatric cardiac catheterization in diagnosis should be adjusted according to the local needs of every cardiac center.

Retrospective review of congenital heart disease in 976 dogs

BACKGROUND

Knowledge of epidemiology is important for recognition of cardiovascular malformations.

OBJECTIVE

Review the incidence of congenital heart defects in dogs in Italy and assess breed and sex predispositions.

ANIMALS

Nine hundred and seventy-six dogs diagnosed with congenital heart disease (CHD) of 4,480 dogs presented to Clinica Veterinaria Gran Sasso for cardiovascular examination from 1997 to 2010.

METHODS

A retrospective analysis of medical records regarding signalment, history, clinical examination, radiography, electrocardiography, echocardiography, angiography, and postmortem examination was performed. Breed and sex predisposition were assessed with the odds ratio test.

RESULTS

CHD was observed in 21.7% of cases. A total of 1,132 defects were observed with single defects in 832 cases (85%), 2 concurrent defects in 132 cases (14%), and 3 concurrent defects in 12 cases (1%). The most common defects were pulmonic stenosis (PS; 32.1%), subaortic stenosis (SAS; 21.3%), and patent ductus arteriosus (20.9%), followed by ventricular septal defect (VSD; 7.5%), valvular aortic stenosis (AS; 5.7%), and tricuspid dysplasia (3.1%). SAS, PS, and VSD frequently were associated with other defects. Several breed and sex predispositions were identified.

CONCLUSIONS AND CLINICAL RELEVANCE

The results of this study are in accordance with previous studies, with slight differences. The breed and sex predilections identified may be of value for the diagnosis and screening of CHD in dogs. Additionally, the relatively high percentage of concurrent heart defects emphasizes the importance of accurate and complete examinations for identification. Because these data are from a cardiology referral center, a bias may exist.

Pulmonary Stenosis

The electrocardiographic, vectorcardiographic, and right heart catheterization data of 100 patients with isolated or complicated pulmonary stenosis were analyzed.

All but two patients had normal sinus rhythm. One patient, age 62, had atrial fibrillation; the other, age 8, had the Wolff-Parkin-son-White syndrome.

In isolated pulmonary stenosis, P-wave enlargement was far more frequently seen in those patients with right ventricular systolic pressures above 100 mm. Hg as compared to those with pressures less than 100 mm. Hg. This relationship was not observed in patients with complicated pulmonary stenosis.

The incidence of rsR' in V 1 , QRS widening, and the vectorcardiographic evidence of conduction delay was significantly lower in pulmonary stenosis, isolated or complicated, when compared to atrial septal defects alone. There was one instance of terminal conduction delay of the right bundle-branch block type and one diffuse slowing of the QRS sÊ loop in the present series.

The correlation between the amplitude of the R wave in V 1 and right ventricular systolic pressure was better in the group of isolated pulmonary stenosis as compared to the groups complicated by interatrial communications or ventricular septal defects.

The average right ventricular systolic pressures in patients with type 3 right ventricular hypertrophy was significantly higher than those with either type 1 or type 2 right ventricular hypertrophy on the basis of vectorcardiographic criteria discussed. In the presence of pulmonary stenosis, the electrocardiographic and vectorcardiographic evidence of left ventricular hypertrophy or combined ventricular hypertrophy suggests coexisting lesions such as ventricular septal defect with left-to-right shunts. However, it was not possible to differentiate between isolated pulmonary stenosis and pulmonary stenosis complicated by interatrial communication by either electrocardiograms or vectorcardiograms.

The vectorcardiographic features of combined ventricular hypertrophy are discussed.

The Electrocardiogram, Vectorcardiogram, and Ventricular Gradient in the Tetralogy of Fallot

The electrocardiogram, ventricular gradient, and spatial vectorcardiogram were studied in 140 patients with proved tetralogy of Fallot. The patients were separated into three groups according to hemodynamic data.

The salient features of the electrocardiogram in patients of group I consisted of diminutive R waves in leads I and V 6 , a deep Q wave and high R wave in lead III, a prominent R wave in lead V 1 , which was not wide, and the absence of Q waves in leads I, V 1 , and V 6 .

The electrocardiogram in patients of group II was similar to that of the patients of group I except for the appearance of more signs of left ventricular electric activity and less clock-wise rotation of the heart.

The electrocardiogram of the patients of group III was similar to that previously described for ventricular septal defect.

 QRS ,  T , Ĝ, and sVCG reflected the same general trend as the electrocardiograms.

The electrophysiologic data presented support clinical observations indicating that the tetralogy of Fallot includes patients with a wide range of hemodynamic differences.