William Pearl

Rupture of the outer partition of aortic dissection during transesophageal echocardiography

Abstract Transesophageal echocardiography (TEE) has gained widespread clinical acceptance as a cardiovascular imaging technique.1 Its reported accuracy and ease of performance may make TEE the procedure of choice for the evaluation of thoracic aortic aneurysms.2 The safety of this procedure has been well demonstrated, and serious complications have rarely been noted.3,4 We report an unusual case in which an aortic root aneurysm with a DeBakey type I dissection ruptured during a TEE procedure, resulting in cardiac tamponade and death.

Cardiovascular effects of adolescent drug abuse

Adolescent drug abuse has been shown to be highly prevalent. Similarly, chest pain is a frequent complaint among adolescents. The cardiovascular effects of adolescent drug abuse, however, are infrequently considered. We present a case report of a 17-year-old drug abuser who presented with a myocardial infarction. The potential cardiovascular complications of the commonly abused drugs are discussed. When dealing with an adolescent with potential cardiovascular symptoms, we stress an awareness of the potential cardiovascular effects of drug abuse and that such cardiovascular effects are not unique to the habitual or intravenous drug abuser.

The relationship between sexual maturity rating, age, and increased blood pressure in adolescents

Blood pressure values are known to vary with age and body size. The effect of sexual maturity was explored in 746 patients in an adolescent clinic. Systolic blood pressure for boys and girls showed an increase with a change from Tanner stage 2 to 3. Diastolic blood pressure did not increase. Both systolic and diastolic blood pressures showed a weight effect that was generally maintained within the Tanner stages. The gradual increase in blood pressure for large groups of adolescents would appear to be the result of the aggregate increase in size (weight) resulting from the asynchronous growth spurts of individuals studied. Consequently, those individuals with a strikingly early or late onset of maturation may have erroneous interpretations of their blood pressure. As biologic outliers, the borderline hypertensive who matures early may be overidentified, while the late maturer might go unrecognized.

Breakage of an Embolized Intravascular Catheter Fragment: A Complication of Nonsurgical Transvenous Retrieval

The use of permanently implantable central venous catheters may be complicated by catheter fracture and embolism. Nonsurgical retrieval of embolized catheter fragments is well established, and complications are rarely noted. We report a case in which the retrieval technique led to further fracture of a silicone rubber (Silastic) catheter and embolization to the lung. Silastic catheters may be prone to this complication, and appropriate caution during recovery of such catheter fragments is recommended.

Congenital heart disease in the Pierre Robin syndrome

SummaryCongenital heart disease occurs in about 20 percent of patients with Pierre Robin syndrome. Ventricular septal defect, patent ductus arteriosus, and atrial septal defect are the most common congenital cardiac lesions in this syndrome. The associated upper airway obstruction can produce cor pulmonale, cardiomegaly, pulmonary edema, and cyanosis.

Heart disease associated with deletion of the short arm of chromosome 18

SummaryDeletion of the short arm of chromosome 18 produces a highly variable phenotype. Mental retardation, short stature, and an abnormal facies are invariably present. About 9% of patients with this syndrome have cardiac pathology.

EXPERIENCE WITH THE GIANTURCO-ROEHM BIRD'S NEST VENA CAVA FILTER

Abstract Mechanical interruption of the inferior vena cava protects patients with lower extremity deep venous thrombosis from pulmonary embolism. It is the procedure of choice for patients who either cannot be anticoagulated, or have had recurrent pulmonary embolism despite anticoagulation. Extensive experience with the Greenfield vena cava filter (Medi-tech Inc., Watertown, Massachusetts) has shown long-term caval patency rates of >95%, and rates of recurrent pulmonary embolism of 1 However, a malposition rate as high as 14%, 2,3 premature filter release, 4 perforation of the inferior vena cava and associated structures, 5 and femoral vein thrombosis at the site of insertion 6 remain potential problems. The Gianturco-Roehm Birds Nest Filter (Cook Inc., Bloomington, Indiana), approved for clinical use by the Food and Drug Administration in 1989, was designed to overcome some of the disadvantages of the Greenfield filter. Designed for percutaneous introduction through the jugular, subclavian and femoral approaches, it consists of 2 rigid, V-shaped struts, between which are attached four 25-cm-long, 0.18-mm diameter stainless steel wires (Figure 1). Properly positioned, the fine wire mesh filter occupies a 6- to 7-cm length of inferior vena cava (Figure 2).

Junctional ectopic tachycardia in infants.

and a right pleural effusion. He was successfully reoperated on in February 1979, with decortication of very adherent, densely fibrous tissue encompassing the heart and adjacent great vessels. It is not known whether he had had intraoperative pericardial irrigation with povidone-iodine solution at the time of his original operation. There was no evidence of tuberculosis. Case 2: In a 9 year old Korean girl with tetralogy of Fallot, bilateral pleural effusions developed 10 days after corrective surgery performed at this institution in January 1980. She was afebrile. Increasing evidence of right heart failure led to cardiac catheterization (intracardiac diastolic pressures were approximately 20 mm Hg) and to surgical exploration 4 weeks postoperatively. Surgery revealed loculated pericardial fluid with a severely adherent pericardium, which was removed anteriorly. Recurrent right heart failure and pleural effusions led to reexploration 5 da;ys later, with discovery of a newly formed, dense epicardial peel. Decortication was followed by immediate improvement in the patient’s hemodynamics and a subsequently uncomplicated course. Histologically the surgical speciman showed dense fibrosis and areas with possible talc crystals and foreign body giant cells. The pericardium had not been irrigat.ed with povidone-iodine. The addition of these two cases to previously reported cases of constrictive pericarditis after cardiac surgery gives a total of 19. It is possible that as awareness of this entity increases it may prove to be more flrequent than previously thought. Robert J. Ma&a, MD Division of Cardiology Loma Linda University Medical Center Loma Linda, California

ECG in sickle cell trait at rest and during exercise and hypoxia

The electrocardiograms of 28 volunteers with sickle cell trait were compared to those of 28 control subjects. Tracings were recorded at rest, at peak exercise, at simulated sea level, and at a simulated altitude of 4,000 m. No differences between the subjects with sickle cell trait and control subjects were observed for the majority of electrocardiographic measurements. Several measurements had statistically significant differences that persisted after correcting for body surface area and physical fitness. The magnitude of the differences does not appear to have physiologic or clinical significance. The observation that the differences were greatest for resting and sea level recordings indicates that sickling is probably not responsible. Further investigation will be needed to substantiate these differences and determine whether these electrical observations have any physiologic implication.

Stokes-Adams attacks in congenital complete heart block.

SummaryStokes-Adams attacks are a well-known complication of congenital complete heart block. Although they are generally felt to be precipitated by either bradycardia or tachycardia, this is poorly documented. A case is presented in which a 23 month old with congenital complete heart block and an intermittently prolonged QT interval had a Stokes-Adams attack during a spontaneous episode of ventricular tachycardia. The combination of congenital complete heart block and a prolonged QT interval carries a significant risk of ventricular tachycardia.