Ernerio T. Alboliras

Left ventricular growth in selected hypoplastic left ventricles: outcome after repair of coarctation of aorta.

BACKGROUND Models that predict survival in neonates with left ventricular hypoplasia and critical aortic stenosis may not be applicable to neonates with left ventricular hypoplasia and coarctation. METHODS AND RESULTS We report 8 infants with severe aortic coarctation and left ventricular hypoplasia. Mean age was 18 days (range 1-48 days), and mean weight was 3.5 kg (range 2.7-4.3 kg). Associated diagnoses included mild aortic stenosis (4), ventricular septal defect (2), and venous anomalies (2). All had coarctation repair as a primary procedure (3 of these had concomitant intracardiac procedures); 7 had subsequent operations. All are alive and well 1.1-6.7 years (mean 3.1 years) after the first surgery. Progressive increases were observed in aortic and mitral diameters, and in left ventricular dimensions, areas, and volumes when the preoperative, earliest postoperative, and most recent echocardiograms were compared. CONCLUSIONS Despite severe left ventricular hypoplasia, a two-ventricle repair is possible in selected cases. The prognostic criteria for left ventricular hypoplasia in critical aortic stenosis may not be applicable to infant coarctation. Relief of coarctation may result in the growth of the very small left ventricle, especially when the aortic root and mitral diameters are satisfactory.

Rapid identification of congenital heart disease by transmission of echocardiograms

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Transesophageal Echocardiographic Imaging for Congenital Lesions of the Left Ventricular Outflow Tract and the Aorta.

A comprehensive transthoracic echocardiographic imaging is possible for most pediatric patients. However, for patients in whom accurate anatomical and physiological assessment is not possible, transesophageal echocardiography (TEE) provides a supplemental diagnostic modality. Imaging the left ventricular outflow tract and the aorta involves a complicated technique of rotation, flexion, and changes in the depth of the transesophageal probe because the areas of interrogation involve multiple planes within the thoracic cavity. Furthermore, the relationship between the esophagus and the cardiovascular structures changes at various levels of the thorax. Transesophageal probes having characteristics of frequency agility, all forms of Doppler capability, and a higher number of crystal elements are now available. Abnormalities of the subaortic area, the aortic valve, coronary arteries, and the entire thoracic aorta can be clearly demonstrated. TEE also has played a complementary role in diagnostic and interventional catheterization. It has become vital in the operating room for the preoperative definition of certain aspects of the anatomy and for immediate postoperative evaluation of the result of surgery.

Double-horned or caplike right ventricle: Diagnosis and operative treatment

BACKGROUND Three patients reported here and 4 from the literature serve as background for the state-of-art diagnostic and operative considerations for an unusual congenital cardiac malformation: double-horned or caplike right ventricle. METHODS This is a retrospective analysis of cardiac catheterization, cineangiography, and two-dimensional echocardiography findings, as well as palliative and corrective operations in 3 previously unreported patients. Four patients from the literature are reviewed. RESULTS Characteristic morphologic features recognizable by invasive and noninvasive imaging distinguish double-horned right ventricle from complex malformations such as criss-cross hearts, superior-inferior ventricles, and univentricular hearts with a small outflow chamber. CONCLUSION Double-horned or caplike right ventricle is a congenital malformation characterized by an unusual ventricular morphology, which may be the result of incomplete development of the right ventricle. The two-horned appearance may be secondary to an absence of the apical trabeculated compartment, with the left ventricle wedged between the two horns. It is invariably associated with double right ventricular outlet. Surgical experience so far suggest that most patients with typical double-horned right ventricle should be considered for anatomic surgical correction.

Results of Physiologic Correction of Previously Palliated Pulmonary Atresia with Intact Ventricular Septum

The Fontan procedure is an alternative to conventional surgical technique (right ventricular outflow tract reconstruction) for physiologic correction of pulmonary atresia with intact ventricular septum; particularly for patients with an incompletely developed right ventricle or a severely diminutive tricuspid valve apparatus. This study compares the results of the Fontan procedure with right ventricular outflow tract reconstruction for previously palliated patients with pulmonary atresia with intact ventricular septum.