Jun Yanai

Coronary arterial involvement and QT dispersion in Kawasaki disease

For the early detection of myocardial ischemia in patients with severe involvement of the coronary arteries after Kawasaki disease, a method with high sensitivity and low cost is desirable because these patients require frequent follow-up and diagnostic tests. For this purpose, electrocardiographic, echocardiographic, Holter, and stress testing or angiography are repeated. However, these tests have some limitations due to cost, convenience, or sensitivity. It is uncertain that increased QT dispersion would exactly indicate progression of myocardial ischemia after Kawasaki disease, but this is the first study to present that QT dispersion of > or = 60 ms had higher sensitivity for detection of severe involvement of coronary artery after Kawasaki disease. This study is limited due to the small number of patients; larger prospective studies are required to clarify the usefulness of QT dispersion analysis in detecting the progression of myocardial ischemia after Kawasaki disease.

Partial left ventriculectomy in an infant with dilated cardiomyopathy

being living autogenous tissue. Hence the potential for growth exists when the pulmonary autograft is used in the aortic position, and that is the reason the Ross operation is considered ideal for aortic valve replacements in infants and children. However, the potential for growth is lost when the pulmonary autograft is used in the mitral position because it has to be housed within the Dacron tube. On the other hand, inasmuch as the autograft is lying in the left atrium as a top hat, a partial or total preservation of the mitral valve apparatus is feasible, as was done in our patient. The autograft is a living autogenous tissue, fully flexible, and it cannot obstruct the left ventricular outflow tract because of its position inside the left atrium (Figs I and 2). The improved clinical condition of our patient, freedom from anticoagulation, absence of thromboembolism, and the maintained excellent performance of the pulmonary autograft in the mitral position 6 years later cautiously support this procedure as a viable alternative in specific clinical situations requiring replacement of the mitral valve. However, a larger The Journal of Thoracic and Cardiovascular Surgery March 1999

Thoracoabdominal Aortic Aneurysm in an Infant Treated by Thromboexclusion with Thoracoabdominal Aortic Bypass A Case Report

A case of a huge thoracoabdominal aortic aneurysm in an eighteen-month-old boy is reported. Surgical treatment was successfully performed by thromboexclusion of the aneurysm with thoracoabdominal aortic bypass using a low-porosity woven Dacron graft 10 mm in diameter and of sufficient surplus length. During the early postoperative period, he developed moderate hydronephrosis, owing to compression of the left ureter by the graft, but no further deterioration was seen. Follow-up angiographies performed four and six years after surgery revealed straightening of the graft and slight stretching of the aorta at the distal anastomosis, but no stenosis was found. Now, seven and a half years after surgery, he has no pressure gradient between upper and lower extremities.

Recovery from congenital complete atrioventricular block

SummaryCongenital complete atrioventricular block without any other intracardiac anomaly reverted to sinus rhythm at the age of 7 years. The girl had had heart failure and Adams-Stokes attacks when aged 1 year, requiring pacemaker implantation. Electrocardiography confirmed sinus rhythm for the first time at the age of 7 years. At the same time, a treadmill test yielded a normal tracing without any arrhythmias.

Gigantic aneurysm in the thoraco-abdominal aorta of an infant.

We report the case of a boy with a gigantic aneurysm in the thoraco‐abdominal region which was detected by a chest X‐ray taken prior to surgical correction of ptosis of the eyelids at 11 months of age. At 18 months, he successfully underwent aneurysm exclusion and bypass grafting. A biopsy from the thoracic aorta revealed medial degeneration with conspicuous smooth muscle cell involvement. Laboratory examination showed altered elastase activity in the granulocytes and whole blood. The present case may represent a unique form of aneurysm in infancy.

Diagnosis and Morphological Classification of Pulmonary Arteriovenous Fistula by 99mTc MAA

Pulmonary A‐V fistula was diagnosed and classified morphologically based on the pattern of time‐activity curves by 99m Tc MAA. If the diameter of the fistula is large, macro‐albumin easily reveals a shunt. If the iistula has the form of an “aneurysm,” the degree of shunt is generally slight.

Development of Adipose Tissue with Special Reference to Recovery from Adipose Hypocellularity in Congential Heart Disease.

Thirty two children with normal growth and development for age, and 57 children with serious congenital heart disease were investigated for height, weight, total body fat, fat cell size, total fat cell number, and lean body mass as a function of age. Examination of fat samples was carried out by a modification of the method of Hirsch and Gallian. In children with normal growth (ages 1–14 years) fat cell number continues to increase, but fat cell size does not change with increasing age. Reduced fat in congenital heart disease is primarily due to decreased fat cell number. If cardiac defects are repaired between 1 and 5 years of age recovery of flat cell number can be achieved.