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Venet M, Friedberg MK, Mertens L, Baranger J, Jalal Z, Tlili G, Villemain O. Nuclear Imaging in Pediatric Cardiology: Principles and Applications. Front Pediatr 2022; 10:909994. [PMID: 35874576 PMCID: PMC9301385 DOI: 10.3389/fped.2022.909994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Nuclear imaging plays a unique role within diagnostic imaging since it focuses on cellular and molecular processes. Using different radiotracers and detection techniques such as the single photon emission scintigraphy or the positron emission tomography, specific parameters can be assessed: myocardial perfusion and viability, pulmonary perfusion, ventricular function, flow and shunt quantification, and detection of inflammatory processes. In pediatric and congenital cardiology, nuclear imaging can add complementary information compared to other imaging modalities such as echocardiography or magnetic resonance imaging. In this state-of-the-art paper, we appraise the different techniques in pediatric nuclear imaging, evaluate their advantages and disadvantages, and discuss the current clinical applications.
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Affiliation(s)
- Maelys Venet
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark K. Friedberg
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jerome Baranger
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Zakaria Jalal
- Department of Congenital and Pediatric Cardiology, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghoufrane Tlili
- Department of Nuclear Medicine, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Olivier Villemain
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Muroke V, Jalanko M, Simonen P, Holmström M, Ventilä M, Sinisalo J. Non-invasive dye dilution method for measuring an atrial septal defect shunt size. Open Heart 2020; 7:e001313. [PMID: 33020256 PMCID: PMC7537437 DOI: 10.1136/openhrt-2020-001313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/26/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS Objective of this study was to evaluate the feasibility of the non-invasive dye dilution method to quantify shunt size related to atrial septal defects (ASD).The diagnostic accuracy of shunt size determination in ASD's has been suboptimal with common non-invasive methods. We have previously developed a cost-effective and time-effective non-invasive dye dilution method. In this method, the indocyanine green solution is injected into the antecubital vein and the appearance of the dye is detected with an earpiece densitometer. METHODS AND RESULTS We studied 192 patients with an ASD. Mean pulmonary blood flow/systemic blood flow (Qp/Qs) was measured with dye dilution technique and compared with following methods: Fick's invasive oximetry (n=49), transoesophageal echocardiography (TEE) measuring ASD size (n=143) and cardiac MR (CMR) (n=9).For the first 49 patients, Qp/Qs was 2.05±0.70 with the Fick's invasive oximetry and 2.12±0.68 with dye dilution method with an excellent correlation between the two methods (R=0.902, p<0.001). In the second study sample, the ASD size by TEE was 15±6 mm on average, and the mean Qp/Qs 2.16±0.65 measured with dye dilution method with a good correlation between the methods (R=0.674, p<0.001). Qp/Qs measured with CMR was 1.87±0.40 resulting in a good correlation with the dye dilution method (R=0.696, p=0.037). CONCLUSION The dye dilution method with earpiece densitometer recording is a clinically feasible and reliable method to assess shunt size in ASDs.
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Tracy E, Zhu M, Streiff C, Sahn DJ, Ashraf M. Quantification of the area and shunt volume of multiple, circular, and noncircular ventricular septal defects: A 2D/3D echocardiography comparison and real time 3D color Doppler feasibility determination study. Echocardiography 2017; 35:90-99. [PMID: 29082558 DOI: 10.1111/echo.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Quantification of defect size and shunt flow is an important aspect of ventricular septal defect (VSD) evaluation. This study compared three-dimensional echocardiography (3DE) with the current clinical standard two-dimensional echocardiography (2DE) for quantifying defect area and tested the feasibility of real time 3D color Doppler echocardiography (RT3D-CDE) for quantifying shunt volume of irregular shaped and multiple VSDs. METHODS Latex balloons were sutured into the ventricles of 32 freshly harvested porcine hearts and were connected with tubing placed in septal perforations. Tubing was varied in area (0.13-5.22 cm²), number (1-3), and shape (circle, oval, crescent, triangle). A pulsatile pump was used to pump "blood" through the VSD (LV to RV) at stroke volumes of 30-70 mL with a stroke rate of 60 bpm. Two-dimensional echocardiography (2DE), 3DE, and RT3D-CDE images were acquired from the right side of the phantom. RESULTS For circular VSDs, both 2DE and 3DE area measurements were consistent with the actual areas (R² = 0.98 vs 0.99). For noncircular/multiple VSDs, 3DE correlated with the actual area more closely than 2DE (R² = 0.99 vs 0.44). Shunt volumes obtained using RT3D-CDE positively correlated with pumped stroke volumes (R² = 0.96). CONCLUSIONS Three-dimensional echocardiography (3DE) is a feasible method for determining VSD area and is more accurate than 2DE for evaluating the area of multiple or noncircular VSDs. Real-time 3D color Doppler echocardiography (RT3D-CDE) is a feasible method for quantifying the shunt volume of multiple or noncircular VSDs.
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Affiliation(s)
- Evan Tracy
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
| | - Meihua Zhu
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
| | - Cole Streiff
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
| | - David J Sahn
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
| | - Muhammad Ashraf
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
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Zhu M, Ashraf M, Tam L, Streiff C, Kimura S, Shimada E, Sahn DJ. Quantification of Shunt Volume Through Ventricular Septal Defect by Real-Time 3-D Color Doppler Echocardiography: An in Vitro Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1193-1200. [PMID: 26850842 DOI: 10.1016/j.ultrasmedbio.2015.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 06/05/2023]
Abstract
Quantification of shunt volume is important for ventricular septal defects (VSDs). The aim of the in vitro study described here was to test the feasibility of using real-time 3-D color Doppler echocardiography (RT3-D-CDE) to quantify shunt volume through a modeled VSD. Eight porcine heart phantoms with VSDs ranging in diameter from 3 to 25 mm were studied. Each phantom was passively driven at five different stroke volumes from 30 to 70 mL and two stroke rates, 60 and 120 strokes/min. RT3-D-CDE full volumes were obtained at color Doppler volume rates of 15, 20 and 27 volumes/s. Shunt flow derived from RT3-D-CDE was linearly correlated with pump-driven stroke volume (R = 0.982). RT3-D-CDE-derived shunt volumes from three color Doppler flow rate settings and two stroke rate acquisitions did not differ (p > 0.05). The use of RT3-D-CDE to determine shunt volume though VSDs is feasible. Different color volume rates/heart rates under clinically/physiologically relevant range have no effect on VSD 3-D shunt volume determination.
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Affiliation(s)
- Meihua Zhu
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Muhammad Ashraf
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lydia Tam
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Cole Streiff
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sumito Kimura
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Eriko Shimada
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Sahn
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA.
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Stark RJ, Shekerdemian LS. Estimating intracardiac and extracardiac shunting in the setting of complex congenital heart disease. Ann Pediatr Cardiol 2014; 6:145-51. [PMID: 24688231 PMCID: PMC3957443 DOI: 10.4103/0974-2069.115259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Complex congenital heart disease (CHD) is associated with significant morbidity worldwide. Managing hypoxemia in these populations can be difficult, particularly in the setting of cyanotic CHD. However, the presence of additional extracardiac shunts secondary to acute respiratory disease can be very challenging to manage. Before understanding how to deal with hypoxemia in patients with dual shunts, one needs to understand the physiology and diagnosis related to the individual shunts and apply this knowledge to the patient as a whole.
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Affiliation(s)
- Ryan J Stark
- Department of Pediatric Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Lara S Shekerdemian
- Department of Pediatric Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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6
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New pulmonary vein Doppler echocardiographic index predicts significant interatrial shunting in secundum atrial septal defect. Int J Cardiol 2012; 160:59-65. [DOI: 10.1016/j.ijcard.2011.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/14/2011] [Accepted: 03/16/2011] [Indexed: 11/22/2022]
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Abstract
Echocardiography, magnetic resonance imaging and, more recently, multidetector computed tomography, have led to major advances in noninvasive image assessment of anatomy in pediatric cardiology. The radionuclide methods often lack sufficient resolution to precisely characterize complex morphology in congenital heart lesions. However, these methods provide an accurate and reproduceable quantitative assessment of the physiological consequences of structural heart disease. These unique capabilities will continue to assure ongoing clinical relevance of radionuclide methodology, as is the case in the assessment of heart disease in adult cardiology.
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Affiliation(s)
- Michael W Dae
- Department of Radiology and Medicine, Center for Functional Imaging, University of California at San Francisco, San Francisco, CA 94143, USA.
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8
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Abstract
Intracardiac shunts including atrial septal defect, ventricular septal defect, endocardial cushion defects, and surgical baffles may be identified, localized, and quantified using cardiac MRI methods. Both dark-blood and bright-blood techniques are helpful to identify anatomy. Contrast enhancement is especially useful for identifying associated vascular anomalies. Dynamic first-pass contrast agent signal-time studies may demonstrate rapid recirculation and shunting. Volumetric and phase contrast cine methods are useful to quantify flow. Pulmonary to systemic (Qp/Qs) flow ratios may be calculated noninvasively by comparing the pulmonary artery flow to the aortic flow measurement.
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Affiliation(s)
- Patrick M Colletti
- University of Southern California Keck School of Medicine, LAC+USC Imaging Science Center, 1744 Zonal Avenue, Los Angeles, CA 90033, USA.
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9
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Beerbaum P, Körperich H, Barth P, Esdorn H, Gieseke J, Meyer H. Noninvasive Quantification of Left-to-Right Shunt in Pediatric Patients. Circulation 2001; 103:2476-82. [PMID: 11369688 DOI: 10.1161/01.cir.103.20.2476] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
—Blood flow can be quantified noninvasively by phase-contrast cine MRI (PC-MRI) in adults. Little is known about the feasibility of the method in children with congenital heart disease.
Methods and Results
—In 50 children (mean age 6.2 years, range 1.1 to 17.7 years) with an atrial- or ventricular-level shunt, blood flow rate in the great vessels was determined by PC-MRI, and the ratio of pulmonary to aortic flow (Q̇p/Q̇s) was compared with Q̇p/Q̇s by oximetry. We found a difference of 2% and a range of −20% to +26% (limits of agreement, mean±2 SD). In another 7 children with congenital heart disease but no cardiac shunting (mean age 7.9 years, range 1.3 to 13.5 years), Q̇p/Q̇s by PC-MRI was 1.02 (SD ±0.06). No difference between systemic venous and aortic flow volumes was found (range −17% to +20%, n=37). Blood flow through a secundum atrial septal defect as assessed by PC-MRI (n=24) overestimated the shunt compared with the difference between pulmonary and aortic flows. The mean difference between 3 repeated PC-MRI measurements in each location was 5.3% (SD ±4.0%, n=522), demonstrating good precision. The interobserver variability was low. The accuracy of PC-MRI was confirmed by in vitro experiments.
Conclusions
—Determination of Q̇p/Q̇s by PC-MRI in children is quick, safe, and reliable compared with oximetry. Systemic venous flow can be quantified by PC-MRI, whereas through-plane shunt measurement within an atrial septal defect is inaccurate.
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Affiliation(s)
- P Beerbaum
- Clinic for Congenital Heart Disease, Heart and Diabetes Center, North Rhine-Westfalia, Ruhr-University Bochum, Germany.
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Candell Riera J, Castell Conesa J, Jurado López J, López De Sá E, Nuño de la Rosa JA, Ortigosa Aso FJ, Valle Tudela VV. [Nuclear cardiology: technical bases and clinical applications]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2000; 19:29-64. [PMID: 10758435 DOI: 10.1016/s0212-6982(00)71866-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although the role of nuclear cardiology is currently well consolidated, the addition of new radiotracers and modern techniques makes it necessary to continuously update the requirements, equipment and clinical applications of these isotopic tests. The characteristics of the radioisotopic drugs and examinations presently used are explained in the first part of this text. In the second, the indications of them in diagnostic and prognostic evaluation of the different coronary diseases are presented.
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Affiliation(s)
- J Candell Riera
- Servicio de Cardiología, Hospital General Universitari Vall d'Hebron, Barcelona, 08035, España.
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11
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Guías de actuación clínica de la Sociedad Española de Cardiología. Cardiología nuclear: bases técnicas y aplicaciones clínicas. Rev Esp Cardiol 1999. [DOI: 10.1016/s0300-8932(99)75025-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Mohaiddin RH. Assessment of intracardiac shunt by magnetic resonance imaging. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1996; 12:215-7. [PMID: 8915724 DOI: 10.1007/bf01806226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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13
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Mohiaddin RH, Underwood R, Romeira L, Anagnostopoulos C, Karwatowski SP, Laney R, Somerville J. Comparison between cine magnetic resonance velocity mapping and first-pass radionuclide angiocardiography for quantitating intracardiac shunts. Am J Cardiol 1995; 75:529-32. [PMID: 7864007 DOI: 10.1016/s0002-9149(99)80600-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R H Mohiaddin
- Royal Brompton Hospital, National Heart and Lung Institute, London, United Kingdom
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Teien D, Karp K, Wendel H, Human DG, Nanton MA. Quantification of left to right shunts by echo Doppler cardiography in patients with ventricular septal defects. ACTA PAEDIATRICA SCANDINAVICA 1991; 80:355-60. [PMID: 2035331 DOI: 10.1111/j.1651-2227.1991.tb11862.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Thirty-one patients with ventricular septal defect were evaluated with Echo Doppler cardiography and colour flow mapping. The ventricular septal defect area was estimated by measurement of the jet diameter by colour flow mapping. The ventricular septal defect flow was calculated as the product of the cross-sectional area of the ventricular septal defect and the velocity time integral of flow through the defect. In ten patients the diameter obtained by colour flow mapping was compared with the diameter obtained at angiography, r = 0.88 (SD = 0.14 cm). The aortic flow was calculated as the product of left ventricular outflow tract cross-sectional area and the corresponding velocity time integral. QP/QS ratio was estimated as (ventricular defect flow + aortic flow)/aortic flow and compared to estimates by a radionuclide or oximetric method. A correlation of r = 0.95 (SD = 0.23) was found.
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Affiliation(s)
- D Teien
- Department of Clinical Physiology, University of Umeå, Sweden
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Martin RP, Qureshi SA, Ettedgui JA, Baker EJ, O'Brien BJ, Deverall PB, Yates AK, Maisey MN, Radley-Smith R, Tynan M. An evaluation of right and left ventricular function after anatomical correction and intra-atrial repair operations for complete transposition of the great arteries. Circulation 1990; 82:808-16. [PMID: 2394003 DOI: 10.1161/01.cir.82.3.808] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Anatomical correction of complete transposition of the great arteries has the potential advantage over intra-atrial repair in that the left ventricle becomes the systemic pump. To investigate the importance of this, we evaluated right and left ventricular function in 21 patients after anatomical correction and in 21 patients after Mustard or Senning operations. First-pass and equilibrium-gated radionuclide angiography were used to measure right and left ventricular ejection fractions between 17 and 78 (mean, 47) months after anatomical correction and between 3 and 187 (mean, 67) months after intra-atrial repair. The mean age of the patient groups at the time of study was 52 and 84 months, respectively. The right ventricular ejection fraction ranged from 35% to 78% (mean, 58%) in patients after anatomical correction and from 27% to 68% (mean, 51%) after intra-atrial repair (p = 0.066). The left ventricular ejection fraction ranged from 39% to 74% (mean, 58%) after anatomical correction and from 35% to 74% (mean, 58%) after intra-atrial repair (p = 0.86). The mean right and left ventricular ejection fractions of both groups were significantly lower than those of normal children. Individuals with systemic ventricular dysfunction were identified after both types of operations; however, symptomatic dysfunction occurred only after intra-atrial repair (p = 0.24).
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Affiliation(s)
- R P Martin
- Department of Paediatric Cardiology, Guy's Hospital, United Kingdom
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Brand A, Keren A, Branski D, Abrahamov A, Stern S. Natural course of atrial septal aneurysm in children and the potential for spontaneous closure of associated septal defect. Am J Cardiol 1989; 64:996-1001. [PMID: 2816759 DOI: 10.1016/0002-9149(89)90797-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Atrial septum aneurysm (ASA), usually involving the region of the fossa ovalis, has rarely been described in children. In this study, the incidence and natural course of this anomaly were prospectively evaluated in 3,500 children referred for echocardiographic examination. ASA was found in 35 patients, 19 female and 16 male (1.0%). Patients were 6 years of age or younger at the time of diagnosis and 18 were neonates. None of the 750 children with normal echocardiograms had ASA. The most common associated lesion was atrial septal defect (ASD), which occurred in 24 of the 35 patients (69%). Other associated cardiac lesions were ventricular septal defect in 10, pulmonary stenosis in 5, patient ductus arteriosus in 4 and coarctation or interruption of the aorta with subaortic membrane in 2. No clinical complications were associated with ASA. Six patients with complex heart disease died. When associated with ASD, the direction of the ASA motion and that of the shunt found by Doppler echocardiography were similar. Fourteen patients with ASD were followed for 0.5 to 4 years. In 8 the ASD closed and in 6 the ASA disappeared. In 6 patients the ASD and ASA persisted until the end of the follow-up (p less than 0.01). Thus, the incidence of ASA in children in this series was higher than previously presumed and usually was associated with other cardiac anomalies, mainly ASD. In children, ASA tends to disappear with age and may have a role in spontaneous closure of associated ASD.
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Affiliation(s)
- A Brand
- Department of Pediatrics, Bikur Cholim Hospital, Jerusalem, Israel
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Martin RP, Ettedgui JA, Qureshi SA, Gibbs JL, Baker EJ, Radley-Smith R, Maisey MN, Tynan M, Yacoub MH. A quantitative evaluation of aortic regurgitation after anatomic correction of transposition of the great arteries. J Am Coll Cardiol 1988; 12:1281-4. [PMID: 3170972 DOI: 10.1016/0735-1097(88)92612-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Twenty patients who had undergone anatomic correction of transposition of the great arteries were assessed by Doppler echocardiography or cardiac catheterization, or both, to identify the presence of aortic regurgitation. The severity of aortic regurgitation was evaluated by radionuclide angiographic measurement of the stroke volume index a mean of 47.1 months postoperatively. The stroke volume index was defined as the ratio of the stroke counts between the left and right ventricles. A value greater than 1.8 was considered to indicate significant left ventricular volume overload. Eight patients (40%) were shown to have various degrees of aortic regurgitation by Doppler echocardiography or cardiac catheterization, or both. The mean (+/- SD) stroke volume index was 1.03 +/- 0.15 in these patients and 1.01 +/- 0.21 in the 12 patients without aortic regurgitation (p = NS). The stroke volume index was not above the normal range in any patient, indicating that the degree of aortic regurgitation present was trivial. This medium-term study indicates that trivial or mild aortic regurgitation is a frequent finding after anatomic correction of transposition of the great arteries. However, it rarely results in an audible cardiac murmur or significant left ventricular volume overload. Long-term evaluation is required to determine its importance.
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Affiliation(s)
- R P Martin
- Department of Pediatric Cardiology, Guy's, Hospital, London, England
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Gould BA, Turner J, Keeling DH, Ring NJ, Cox RR, Marshall AJ. Bedside nuclear probe for detection and quantification of left to right intracardiac shunts. Heart 1988; 59:463-7. [PMID: 2835974 PMCID: PMC1216492 DOI: 10.1136/hrt.59.4.463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A cadmium telluride nuclear probe with an Elscint gamma camera was used to detect and measure left to right intracardiac shunts at the bedside in 34 patients. Fifteen also had right heart catheterisation and oximetric measurement of the shunt. For the nuclear technique 740 MBq (20 mCi) of technetium-99m pertechnetate was injected into the right antecubital vein and the pulmonary to systemic flow ratio (QP:QS) was measured by the gamma variate technique. Data were not obtained in four patients because the nuclear probe failed in three patients and one storage disc was corrupted. Data from the gamma camera were lost in another patient. When the size of the shunt measured by the nuclear probe was compared with that measured by the oximetric technique the mean difference (SD of mean difference) was 0.36 (SD 0.78) and when it was compared with the gamma camera it was 0.08 (SD 0.67). Analysis of scatter plots showed that the larger the shunt, the larger the discrepancy. Twenty four of 29 data sets showed complete agreement between the nuclear probe and gamma camera on the size of the shunt. Any differences were small. These data indicate that left to right intracardiac shunts may be measured accurately by a nuclear probe at the bedside in either the coronary care unit or outpatient department.
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Affiliation(s)
- B A Gould
- Department of Cardiology, Plymouth Group of Hospitals
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Dittmann H, Jacksch R, Voelker W, Karsch KR, Seipel L. Accuracy of Doppler echocardiography in quantification of left to right shunts in adult patients with atrial septal defect. J Am Coll Cardiol 1988; 11:338-42. [PMID: 3339172 DOI: 10.1016/0735-1097(88)90099-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In previous experimental and pediatric studies, the ratio of pulmonary to systemic flow (Qp/Qs) was accurately estimated by Doppler echocardiography in various cardiac shunt lesions. The purpose of this study was to assess the accuracy of pulsed Doppler echocardiography in determining the magnitude of shunt flow in adult patients with an ostium secundum type atrial septal defect. In 32 patients with high quality echocardiograms and excellent Doppler signals, blood flow was measured in the right and left ventricular outflow tract by Doppler echocardiography. In 16 patients without heart disease, the correlation (r) between systemic (Qs) and pulmonary (Qp) blood flow was 0.96 (SEE = 0.417 liter/min, y = 1.05x - 0.21) and the mean Qp/Qs ratio was 1.01 +/- 0.09. In 16 patients with an atrial septal defect, the Qp/Qs ration measured by oximetry ranged from 1.34 to 4.61 and by pulsed Doppler echocardiography from 1.31 to 4.46 (p = NS). In these 16 patients, the correlation between the Qp/Qs ratio determined by oximetry and pulsed Doppler echocardiography was significant (r = 0.82, SEE = 0.54). In the total group of 32 patients, the correlation was stronger (r = 0.93, SEE = 0.37). Systematic differences between the invasive and noninvasive shunt calculations did not occur. Thus, in adult patients with an atrial septal defect of the secundum type and high quality echocardiograms, the magnitude of left to right shunt can be accurately assessed by pulsed Doppler echocardiography. In the absence of pulmonary hypertension, pulsed Doppler echocardiography provides precise information for the decision to undertake conservative or operative treatment.
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Affiliation(s)
- H Dittmann
- Medical Department III, University of Tuebingen, West Germany
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Brunotte F, Laurens MH, Cloez JL, Marcon F, Itty C, Robert J, Pernot C. Sensitivity and specificity of radionuclide equilibrium angiocardiography for detection of hemodynamically significant secundum atrial septal defect. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1986; 12:468-70. [PMID: 3816845 DOI: 10.1007/bf00254752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
To determine the value of gated equilibrium angiography in secundum atrial septal defect (ASD) in children, the first pass pulmonic/systemic flow ratio (Qp/Qs) was compared with diastolic count ratio (DCR) and stroke count ratio (SCR) of the two ventricles. In 50 children we have found a correlation between Qp/Qs and DCR (r = 0.71) and between Qp/Qs and SCR (r = 0.66). For detection of significant atrial shunt (QP/Qs greater than 1.5) the sensitivity of DCR greater than 2 was 0.81 and the specificity 0.75. For SCR greater than 1.5 we sensitivity and specificity values of 0.87 and 0.71 respectively. Left and right ventricular ejection fractions were normal (0.67 +/- 0.08 and 0.50 +/- 0.07).
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Baker EJ, Shubao C, Clarke SE, Fogelman I, Maisey MN, Tynan M. Radionuclide measurement of right ventricular function in atrial septal defect, ventricular septal defect and complete transposition of the great arteries. Am J Cardiol 1986; 57:1142-6. [PMID: 3706167 DOI: 10.1016/0002-9149(86)90689-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Right ventricular (RV) function was assessed in 80 patients with congenital heart disease by first-pass and gated equilibrium radionuclide angiography. In 30 patients with a ventricular septal defect (VSD) the mean RV ejection fraction (+/- standard deviation) was 64 +/- 7%. In 30 patients with a secundum atrial septal defect it was 61 +/- 9% and in 20 patients with surgically corrected complete transposition of the great arteries it was 49 +/- 13%. These values are in close agreement with values established with cineangiography for similar groups of patients. The mean ejection fraction in the group with transposition of the great arteries was significantly less than in the group with VSD (p less than 0.001). Phase analysis of the equilibrium studies showed that there was delayed RV contraction in many patients in the absence of conduction abnormalities. This delay was significantly greater in patients with atrial septal defect than in those with VSD (p less than 0.05). There was a strong correlation between size of left-to-right shunt and phase delay in patients with VSD (r = -0.72). Thus, first-pass gated radionuclide angiography provides a valid measurement of RV ejection fraction, and delayed RV contraction on phase analysis may be a sensitive index of early RV dysfunction.
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Stone DL, Barber RW, Ormerod OJ, Petch MC, Wraight EP. Quantification of intracardiac shunts by gold-195m, a new radionuclide with a short half life. BRITISH HEART JOURNAL 1985; 54:495-500. [PMID: 2996576 PMCID: PMC481936 DOI: 10.1136/hrt.54.5.495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Gold-195m, a radionuclide with a short half life (30.5 s) was used to quantify left to right intracardiac shunts. The results of this method were compared with those obtained with technetium-99m, a method that was validated against oximetry. In five patients the pulmonary to systemic flow ratio (greater than 3:1) obtained by both radionuclides indicated that the level of shunting was too high to be measured accurately. In one patient fragmentation of the bolus meant that no satisfactory gamma fit could be obtained. In the remaining 16 patients there was no significant difference between two successive 195mAu studies. The agreement between 99mTc results and 195mAu results was excellent. Oxygen administration, straight leg raising exercise, and the use of oblique projections did not affect the values of the pulmonary to systemic flow ratio. The technique of quantification of intracardiac shunts by 195mAu gives reproducible and accurate results and the low radiation dose means that it is suitable for use in children with suspected left to right shunts.
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