Denis J. Levy

Upper Extremity Peripheral Venous Pressure Measurements Accurately Reflect Pulmonary Artery Pressures in Patients with Cavopulmonary or Fontan Connections

After the bidirectional cavopulmonary or Fontan operation, the physiologic consequence is passive flow of the systemic venous return to the pulmonary arteries. Knowledge of pulmonary artery pressure (PA) is valuable in the management of these patients, and obtaining this information without the need for a central line or cardiac catheterization would be advantageous. The aim of this study was to evaluate the correlation between upper extremity peripheral venous (PV) pressures and PA or superior vena cava (SVC) pressures in patients who have undergone cavopulmonary or Fontan connections. During cardiac catheterization, 19 patients with complex cyanotic heart disease who had undergone a cavopulmonary shunt or Fontan procedure were studied. Simultaneous pressure measurements were obtained from the peripheral intravenous line placed prior to the procedure and the SVC or PA. The mean pressures were compared. The mean PV pressure was 17.5 ± 5.6 mmHg. The mean SVC or PA pressure was 16.1 ± 5.4 mmHg. The mean difference was 1.5 ± 1.5 mmHg (p < 0.001). The correlation coefficient PV to SVC or PA pressure was 0.97 (p < 0.001). PV pressure measurements taken from an upper extremity accurately reflect PA pressures in patients who have undergone a cavopulmonary shunt or Fontan procedure.

Congenital Cardiac Anomalies Prenatal Readings Versus Neonatal Outcomes

The purpose of this study was to determine the variation between prenatal and postnatal diagnosis of congenital cardiac lesions diagnosed by both fetal center primary physicians and fetal pediatric cardiologists at a single tertiary referral center in the United States and evaluate why cases were misdiagnosed.

Reptilian Echocardiography: Insights into Ontogeny and Phylogeny?

We describe the echocardiographic findings in a large reptile‐the carpet python. If ontogeny recapitulates phylogeny, the study of reptilian hearts may provide insights into human cardiac development. In addition, the reptilian heart has unique structural and physiological adaptations that may broaden our perspective on evolutionary cardiac adaptation.

Balloon angioplasty and stenting of multiple intralobar pulmonary arterial stenoses in adult patients

Balloon angioplasty and stent placement for pulmonary arterial stenoses in children are well‐established therapies. In contrast, management of isolated peripheral pulmonary arterial stenoses in adults remains relatively unexplored. Four women (ages 18–63 years) with multiple discrete intralobar pulmonary arterial stenoses were treated with balloon angioplasty. Initially, 4–5 stenoses were dilated in each patient. The mean minimum diameter of the stenoses increased from 1.3 to 3.1 mm (P < 0.001), and the mean ratio of right ventricular to aortic systolic pressure decreased from 0.92 to 0.62 (P < 0.05). Each patient had marked symptomatic improvement. However, three patients developed recurrence of symptoms 4–24 months after angioplasty, and two had angiographic evidence of restenosis at previously dilated sites. These restenoses were treated with repeat angioplasty or stent implantation (three stents in each patient). One of these two patients developed near‐occlusive restenosis of the stents and had successful bilateral lung transplantation. The other patient had a third catheterization with successful implantation of three additional stents. The third patient with recurrent symptoms died 2 years later, without further intervention. Transcutaneous catheter therapy for multiple intralobar pulmonary arterial stenoses in adults is highly successful acutely, but restenosis is common within several months. For some patients, balloon angioplasty and stent implantation may provide definitive management, while for others these procedures may serve as a bridge to lung transplantation. Cathet Cardiovasc Intervent 2003;58:252–260.

Anomalous Pulmonary Venous Return Insights Into Prenatal Detection

To review all cases of total anomalous pulmonary venous return (TAPVR) or partial anomalous pulmonary venous return (PAPVR) identified prenatally or postnatally at a single institution and to identify factors that may lead to a correct or missed diagnosis in both high‐ and low‐risk fetuses on screening examinations.

P26.07: Success of prenatal diagnosis of TAPVR/PAPVR in high and low risk patients

Methods: This was a retrospective review over a 2 year period (1st June 2008 to 31st May 2010). Cases were identified from local registration, referrals to a tertiary centre, admission to the neonatal unit and the local paediatric cardiology outpatient. 4 chamber view and outflow tracts were evaluated at anomaly scan. Results: There were 17 cases of congenital heart disease out of 7690 deliveries (0.2%). Eleven of the cases were detected antenatally giving a detection rate of 65% (11/16). Six cases went undetected out of which two were transpositions of the great arteries, one pulmonary atresia, one pulmonary stenosis with an atrial-septal defect, one tetraology of fallot and two atrio-ventricular septal defects. One neonate died due to an inoperable defect and the others are all alive and well till date. Five out of the six undetected cases had more than one anomaly scan by sonographers due to ‘inadequate’ cardiac views Conclusions: The overall detection rate in our Hospital NHS Trust meets the required standard of 50% set by the National Screening Committee, UK. There is current inadequate capture of data on a regional level making underreporting likely. In those cases that were missed, repeated anomaly scans by sonographers should prompt specialist review. This is likely to improve the detection rate even further.

OP03.08: Congenital cardiac lesions: prenatal readings vs. outcomes

S. Jaudi1, N. Fries2, S. Tézenas du Montcel3, J. Nizard1, V. Halley Desfontaines4, M. Dommergues1 1Obstetrics and Gynecology, Groupe Hospitalier Pitié Salpêtrière, APHP and Université Paris 6 UPMC, Paris, France; 2Collège Français d’Echographie Fœtale, Paris, France; 3Department of Medical Statistics, ER4 Modeling in Clinical Research UPMC, APHP and Université Paris 6 UPMC, Paris, France; 4Paris 6 UPMC, Paris, France

P22.02: Recognition of fetal cardiac abnormalities by sonographers: still frames vs. fast cine vs. slow cine

Objectives: To identify the different sonographic findings on gray scale and color doppler in tuboavarian abscess (TOA) which conformed by surgery. Methods: Eighty women with surgically documented TOA were enroleed into this study. A retrospective review of their USG records was performed. Results: The mass was documented at the position of the ovary in 65 cases and at the cul-de sac in 15 cases. Th maximum diameter was 10 cm. The mass was a simple cyst in 10 cases, in 10 cases it was cyst with septation, in 15 cases it was a thickend tube-shaped structure with multiple internal echoes and in 39 cases it was a mixture of cystic and solid elements. Color doppler sonography demonstrated low impedance blood flow in the borders. Conclusions: The USG findings of TOA are not specific. However the presence of a mass at the ovary or cul-de-sac in combination with clinical findings is helpful for a correct diagnosis. Also the color doppler flow can further characterize the nature of pelvic mass by detecting a significant rich blood flow.

Spontaneous echocardiographic contrast (SpE) associated with mechanical valve (MHV) closure: Evaluation by TEE and an in-vitro comparison between two different mechanical bileaflet and a bioprosthetic valves

SpE is a poorly understood phenomenon with recent reports of a variety of bright echoes seen in patients with MHV. The present study was undertaken to review the TEE images of patients with prosthetic mitral valves and to compare and validate the clinical observations with in-vitro investigations. Our goals were to gain a better understanding of whether microbubbles are associated with a specific type of mitral valve prosthesis and to correlate this association with left ventricular function (LVF) and with the dynamics of the transvalvular flow.