Michael A. Berman

Echocardiographic assessment of the severity of aortic stenosis in children and adolescents.

The magnitude of ventricular hypertrophy in response to afterloading is determined by wall stress, with wall thickness increasing in proportion to ventricular load until systolic wall stress is normalized. With use of echocardiographic measurements of left ventricular end-systolic wall thickness (Ws) and cavity transverse dimension (Ds), the pressure constant k was calculated in 16 patients without left heart obstruction according to the formula k = P-Ds/Ws. The mean value for k was 225 +/- 6.7 (standard deviation) mm Hg. From this value, left ventricular pressure was estimated in 13 patients with aortic stenosis aged 4 to 17 years using the formula P = k-Ws/Ds. No subject had evidence of cardiac failure. Peak systolic aortic pressure difference (delta P) was calculated by subtracting cuff-measured brachial arterial peak systolic pressure from the estimated left ventricular pressure. Excellent correlation was obtained between the estimated delta P and that found at cardiac catheterization (r = 0.89). In two patients, echocardiographic data predicted significant obstruction in the presence of normal electrocardiographic, vectorcardiographic and vector lead tracings. Echocardiography offers a noninvasive method for estimating the severity of aortic stenosis, in the absence of myocardial failure; it appears to be more sensitive than other currently employed techniques.

Postoperative Studies in Patients with Tetralogy of Fallot

Abstract The present series demonstrates that hemodynamic abnormalities persist following intracardiac repair of tetralogy of Fallot despite clinical improvement. The incidence of residual ventricular communication and residual outflow obstruction is consistent with previous reports. The pulmonary incompetence is well tolerated when it exists as an isolated residual abnormality. The use of Teflon cloth to relieve the outflow obstruction has not led to aneurysm formation. This report calls attention to the occurrence of tricuspid insufficiency in patients with tetralogy of Fallot and the increased postoperative morbidity with this combination. Finally, aortic regurgitation is part of the pathophysiology of tetralogy of Fallot and may well affect the results of the intracardiac repair. The long-term consequences of these abnormalities are left to future consideration.

One hundred consecutive coarctation resections followed from one to thirteen years

The technique of operative repair for coarctation of the aorta is now well standardized and the immediate surgical mortality has been lowered to less than 5% in most large series. Long term follow up, however, is only recently being reported. This paper describes the current status of 100 consecutive patients who underwent elective resection from 1--13 yr ago. There was only one operative death. In contrast with other reports, residual systemic hypertension is rare in the 97 survivors. These observations confirm that coarctation of the aorta can be repaired surgically with an acceptable operative mortality; the outlook of the survivors appears excellent.

Cervical Aortic Arch with Retroesophageal Aortic Obstruction: Report of a Case with Successful Surgical Intervention

The clinical, roentgenographic, hemodynamic, and angiographic features of a patient with a right cervical aortic arch and retroesophageal aortic obstruction associated with a ventricular septal defect are presented. Surgical relief of the aortic obstruction was successfully achieved by placement of a bypass graft between the left common carotid artery and the descending thoracic aorta.

Double aortic arch system producing obstruction to left ventricular outflow

Abstract The occurrence of a double aortic arch system with intracardiac defects is unusual. Clinical recognition may be difficult in the absence of upper airway obstruction. This report describes the diagnosis and surgical management of an infant with Interruption of the ventral left arch and hypoplasia of the dorsal right arch who presented with evidence of pulmonary and systemic venous congestion caused by obstruction to left ventricular outflow and a large left to right ventricular shunt.