Selective angiocardiography in congenital heart disease

Angiocardiography has come to be a highly specialized procedure and there are definite indications for doing it. In specific cases it offers clear-cut advantages. Technical improvements permit a single injection of a small amount of contrast substance. Selective angiocardiography is advised where the particular detail of a certain region in the heart is desired.     

Diagnosis of Congenital Heart Disease in the First Two Weeks of Life

The differential diagnosis of congenital heart disease which presents cyanosis or respiratory distress, or both, in the first two weeks of life, is difficult. Close correlation of clinical features, electrocardiogram and chest roentgenogram is most helpful. The diagnosis of congenital heart disease should lead to immediate cardiac catheterization, angiocardiography and appropriate therapy.     

CARDIAC CATHETERIZATION IN ADULT CONGENITAL HEART DISEASE—A Preliminary Report

The diagnosis of uncomplicated ventricular septal defect and uncomplicated patent ductus arteriosus presents few hazards. Differential diagnosis of atrial septal defect and of transposed pulmonary veins is technically more difficult. The complex nature of most types of cyanotic congenital heart disease requires the combined use of catheterization, determination of circulation times, ventilation studies, and possibly angiocardiography.Reports of eight cases in which cardiac catheterization was carried out illustrate the common forms of acyanotic and cyanotic heart disease and the factors in diagnosis.     

Cardiac catheterization in adult congenital heart disease; a preliminary report

The diagnosis of uncomplicated ventricular septal defect and uncomplicated patent ductus arteriosus presents few hazards. Differential diagnosis of atrial septal defect and of transposed pulmonary veins is technically more difficult. The complex nature of most types of cyanotic congenital heart disease requires the combined use of catheterization, determination of circulation times, ventilation studies, and possibly angiocardiography. Reports of eight cases in which cardiac catheterization was carried out illustrate the common forms of acyanotic and cyanotic heart disease and the factors in diagnosis.     

产前超声诊断结果与胎儿先天性心脏病结局的相关性及危险因素分析

摘要 目的：对比先天性心脏病胎儿与正常胎儿的产前超声差异，分析产前超声诊断结果与胎儿先天性心脏病的相关性及危险因素。方法：选取我院2018年12月到2020年12月共收治的80例有先天性心脏病胎儿的孕妇作为研究对象，将其分为观察组，另选取健康胎儿的80例孕妇进行对比研究，将其分为对照组，对所有孕妇进行彩色多普勒超声进行诊断，分析观察组超声诊断与最终结果，对比两组胎儿的超声诊断情况，并对孕期胎儿先天性心脏病的风险因素进行单因素与多因素logistic回归分析。结果：通过尸检和出生后随访最终确定结果与超声诊断结果对比无显著差异（P＞0.05），超声诊断中有3例漏诊；由于卵圆孔直径大于6 mm、心内膜垫缺损（Endocardial cushion defect, ECD）和单心房胎儿没有正常的四腔心结构，因此无法进行腔室内径的测量，对其他观察组患儿进行测量之后发现，观察组患儿左心发育不全综合征（hypoplastic left heart syndrome, HLHS）的左心房与左心室、法洛氏四联症（Tetralogy of Fallot, TOF）右心室、室间隔缺损（Ventricular Septal Defect, VSD）右心室内径明显低于对照组（P＜0.05）；对可能造成胎儿先天性心脏病的高风险因素进行分析发现，两组孕妇的孕期早期服药、高龄产妇以及家族心脏病史情况对比差异显著，观察组明显更高（P＜0.05）；对所有因素进行赋值，其中"是"或"有"为1，"否"或"无"为0。通过logistic回归分析发现只有孕期早期服药和家族心脏病史为胎儿先天性心脏病的独立危险因素（P＜0.05）。结论：对孕妇进行综合产前超声诊断胎儿先天性心脏病的准确率较高，与最终结果无明显区别；虽然高龄孕妇与胎儿先天性心脏病具有一定关系，但是只有孕期早期服药和家族心脏病史是胎儿先天性心脏病的独立危险因素。     

MENTAL health services

In the diagnosis of congenital heart disease, the cardiologist was formerly concerned with distinguishing the operable from the inoperable cases. With the development of "open" heart operations under hypothermia and extracorporeal circulation, the majority of congenital heart lesions have become correctable. It is now necessary to make an exact anatomic diagnosis preoperatively. The present discussion reviews the diagnostic methods employed by the cardiac team in investigating a patient with congenital heart disease.     

Congenital heart disease cyanotic children

Cyanosis is often the only apparent symptom of congenital heart disease for which a child is brought to a physician. Some of the more common anomalies can be diagnosed from this and other symptoms by a general practitioner. Squatting after exertion is a sign of tetralogy of Fallot; severe disability with relatively mild cyanosis may indicate pure pulmonary stenosis. A brisk, short, rasping systolic murmur is characteristic of these conditions and of tricuspid atresia. Tetralogy of Fallot is further symptomatized by a boot-shaped heart, not greatly enlarged, and right axis deviation on electrocardiograms. Typically the lung fields are clear. The author's treatment of choice is aortic-pulmonary or subclavian-pulmonary anastomosis as indicated, preferably done after the child is three years old if the condition is not so severe as to require earlier operation. Pure pulmonary stenosis, which in some cases cannot be distinguished from tetralogy of Fallot except by cardiac catheterization and angiocardiography, may in more typical cases be diagnosed by convexity rather than concavity in the pulmonary segment and by differences in electrocardiograms. An expanding valvulotome is used to open the stenosed pulmonary valve, which is then dilated.A systolic murmur, a round heart and left axis deviation are usually found in tricuspid atresia. Shunt operations performed for relief of this condition may lead to later heart failure because of the devious rerouting of blood through the heart. The operations here outlined and others are statistically evaluated.     

CONGENITAL HEART DISEASE IN CYANOTIC CHILDREN

Cyanosis is often the only apparent symptom of congenital heart disease for which a child is brought to a physician. Some of the more common anomalies can be diagnosed from this and other symptoms by a general practitioner. Squatting after exertion is a sign of tetralogy of Fallot; severe disability with relatively mild cyanosis may indicate pure pulmonary stenosis. A brisk, short, rasping systolic murmur is characteristic of these conditions and of tricuspid atresia.Tetralogy of Fallot is further symptomatized by a boot-shaped heart, not greatly enlarged, and right axis deviation on electrocardiograms. Typically the lung fields are clear. The author''s treatment of choice is aortic-pulmonary or subclavian-pulmonary anastomosis as indicated, preferably done after the child is three years old if the condition is not so severe as to require earlier operation.Pure pulmonary stenosis, which in some cases cannot be distinguished from tetralogy of Fallot except by cardiac catheterization and angiocardiography, may in more typical cases be diagnosed by convexity rather than concavity in the pulmonary segment and by differences in electrocardiograms. An expanding valvulotome is used to open the stenosed pulmonary valve, which is then dilated.A systolic murmur, a round heart and left axis deviation are usually found in tricuspid atresia. Shunt operations performed for relief of this condition may lead to later heart failure because of the devious rerouting of blood through the heart.The operations here outlined and others are statistically evaluated.     

四维彩超技术在筛查胎儿先天性心脏病的应用价值分析

目的:探讨四维彩超技术在筛查胎儿先天性心脏病的应用价值。方法:择取我院2012年3月至2014年3月收治的行产前筛查的300例产妇为研究对象,采用四维彩色多普勒超声择取心脏三血管、四腔观、肺动脉分叉、上下腔静脉回流、动脉导管弓、主动脉弓等常规切面,予以胎心各腔血流及胎心率等多项检测,对胎儿是否存在先心病进行综合诊断,并综合胎儿大体解剖状况,与病理诊断及二维超声检查结果进行对比。结果:四维彩超检出率为6.67%,正确率为90.00%;二维超声检出率为6.00%,正确率为83.33%,两组比较差异具有统计学意义(P0.05)。结论:四维彩超技术在筛查胎儿先天性心脏病中具有至关重要的应用价值,有助于指导胎儿先天性心脏病早期治疗,保证患儿预后,值得临床借鉴。     

Comparison of echocardiography and 64-slice spiral computed tomography in the diagnosis of congenital heart disease in children

The diagnosis of congenital heart disease in children has been an issue in the medical community. Timely diagnosis and treatment can provide a greater guarantee for children's healthy growth. In recent years, there have been more and more studies on the diagnosis of congenital heart disease in children. This paper compares the advantages and disadvantages of echocardiography and 64-slice spiral computed tomography (CT) in the diagnosis of congenital heart disease in children. In clinical trials, we also tested 64 patients with spiral computed tomography (SCT) and transthoracic echocardiography (TTE) detection of patients and then confirmed the accuracy of the diagnosis by the surgical methods. The two methods of detection, the rate of missed diagnosis, and the rate of misdiagnosis were counted. Through the test results and pathological diagnosis results, the diagnostic accuracy of the two methods were all above 90%, each with its own advantages and disadvantages. The sensitivity of echocardiographic in detecting intracardiac structure abnormalities was relatively high, but when the diagnosis of extracardiac structural abnormalities less than 64-slice spiral CT method, misdiagnosis of TTE was mainly due to extracardiac vascular malformations. Therefore, it is recommended to combine the two methods to improve the diagnosis of congenital heart disease in children.     

The diagnosis and surgical treatment of tetralogies

Patients with congenital heart disease of the cyanotic type may be presumed to be candidates for surgical treatment if the examination of the heart reveals compatible findings, particularly murmurs characteristic of an interventricular septal defect, overriding aorta, and pulmonary stenosis; if the electrocardiogram shows right axis deviation; if the x-ray or fluoroscopic study demonstrates decreased pulmonary markings; if Diodrast injection shows right ventricular enlargement, a septal defect, overriding of the aorta, and small pulmonary arteries. In some cases some of these criteria may be missing. If there are not definite contraindications, exploratory thoracotomy is indicated for patients with congenital heart disease causing cyanosis.     

PRENATAL CARE

Patients with congenital heart disease of the cyanotic type may be presumed to be candidates for surgical treatment if the examination of the heart reveals compatible findings, particularly murmurs characteristic of an interventricular septal defect, overriding aorta, and pulmonary stenosis; if the electrocardiogram shows right axis deviation; if the x-ray or fluoroscopic study demonstrates decreased pulmonary markings; if Diodrast injection shows right ventricular enlargement, a septal defect, overriding of the aorta, and small pulmonary arteries.In some cases some of these criteria may be missing. If there are not definite contraindications, exploratory thoracotomy is indicated for patients with congenital heart disease causing cyanosis.     

成人弯刀综合症1例并相关文献复习

目的:探讨我院1例成人弯刀综合症患者的临床表现、诊断手段及治疗方法。方法:简要陈述我院1例成人弯刀综合症患者的入院基本情况及诊疗过程,调研并结合相关文献进行复习。结果:该患者结合临床表现,通过超声心动图、胸部后前位X片及右心导管造影等检查,结果证实该患者右下肺静脉畸形引流,诊断为弯刀综合症,并进行相关对症治疗及后续生活和治疗指导。结论:弯刀综合症为一种罕见而复杂的先天性心肺血管疾病,属于肺静脉畸形引流的一个类型(心下型),病因不明,此病在成人中更为少见,该病的诊断主要依赖于右心导管术和心血管造影以及一些影像学手段,成人型多以保守对症治疗为主,若出现严重症状者则选择外科手术纠正畸形引流治疗。     

产前超声在中孕期胎儿严重先天性心脏病筛查中的应用

目的:探究产前超声检查在中孕期胎儿严重先天性心脏病(CHD)筛查中的应用。方法:选择2012年1月至2014年1月在我院妇产科进行产前常规超声检查的孕妇12076例,年龄22-41岁,平均(28.6±8.3)岁,孕周20-36周,平均(25.2±6.7)周。将符合纳入排除标准的孕妇8953例作为研究对象,其中初产妇6023例,经产妇2930例。对纳入研究的孕妇行彩色多普勒超声检查,并对妊娠结局进行追踪,将确诊情况与筛查结果进行比较分析。结果:产前彩色多普勒超声诊断出胎儿CHD38例,经尸检或新生儿彩色多普勒超声检查均确诊为CHD,对胎儿期未筛查出CHD的孕妇进行新生儿彩色多普勒超声检查,确诊4例,产前超声检查胎儿CHD检出率为90.48%(38/42),检出准确率100%(38/38)。结论:彩色多普勒超声筛查孕中期胎儿CHD,灵敏度和特异性高,安全无创伤,操作简便快速,值得推广为产前筛查的首选方法。     

A rare case of congenital heart disease with ambiguous genitalia

Birth defects have become the important cause of mortality and morbidity in the perinatal period. Congenital heart disease (CHD) is the most common birth defect which includes the varying forms of cardiac abnormalities and occurs with an incidence of 1 per 100 live births. In most of the cases, CHD is an isolated malformation, but about 33% have associated anomalies. Ambiguous genitalia are one such rare anomaly that is associated with CHD among other genital abnormalities. The possible causes for this association could be pseudohermaphroditism, which in turn, may be due to congenital adrenal hyperplasia. The government of any country should consider providing for its people a free prenatal diagnosis for susceptible disorders.     

Medical Radiation to Children with Congenital Heart Disease

A retrospective analysis was made of the source of medical radiation received by 25 children who were investigated by cardiac catheterization techniques and followed in the Cardiac Outpatient Clinic of the Health Centre for Children, Vancouver General Hospital. The source of radiation was analyzed. The r dose per year received from plane films averaged 0.05 r, from cardiac fluoroscopy 6.7 r, and from catheterization and angiocardiography studies 1.58 r per year. In six of the 25 children, radiation doses to the thorax exceeded the LD₅₀ for adult humans. In these six patients 95.8% of the radiation received was during cardiac fluoroscopy. Routine fluoroscopy for the radiological re-evaluation of pediatric patients with congenital heart disease should be replaced by plain chest radiographs.     

Estimates of Incidence and Prevalence of Mongolism and of Congenital Heart Disease in British Columbia

There is a need for accurate ascertainment of incidence and prevalence rates of congenital anomalies. In British Columbia the Registry for Handicapped Children and Adults used in conjunction with vital records has proved a valuable source of information. Birth notifications alone cannot be relied upon for incidence data. It was found that seven times as many cases of congenital heart disease were registered subsequently as were reported at birth. The estimated minimal incidence rates of mongolism and congenital heart disease per 1000 live births were 1.46 and 4.75, respectively. The well-known association of maternal age with mongolism was confirmed. Twice as many babies with congenital heart disease (without mongolism) were born to mothers over 39 years of age as would be expected on the basis of the maternal age distribution for all live births in the population. Prevalence estimates of these two diseases compared favourably with other published estimates.     

49例先天性胎儿心脏疾病的静脉导管血流频谱分析

目的：不同的胎儿先天性心脏疾病通过不同的作用机制影响到胎儿心脏功能,会引起胎儿体内血循环的不同改变。静脉导管是胎儿血循环中重要的组成,也会随之出现相应的频谱改变。通过对49例合并先天性心脏疾病胎儿的静脉导管血流频谱及参数进行分析,研究胎儿不同类型心脏疾病对静脉导管（DV）血流频谱的影响。方法：选取2009年1月至2012年12月间我们在产前超声检查中发现的49例合并先天性心脏疾病的胎儿,分别测量DV血流频谱并进行参数分析,根据DV频谱是否正常分为两组。结果：DV频谱正常组有29例（59.18%）,表现为S波、a波的流速和方向正常,PVIV及DVRI指标位于正常范围。DV频谱异常组有20例,表现为S波流速降低、a波缺失或反向,PVIV及DVRI升高。结论：DV血流频谱和参数是评价胎儿心功能的良好指标。不同种类胎儿心脏发育异常对胎儿心功能影响的作用机制不同,其DV频谱也有着不同改变。通过对DV频谱的波形和参数分析,了解胎儿心脏异常的病生理机制,评价其严重程度和预后,这对于指导临床诊疗有着重要意义。