Search

The application of a catheter tip oximeter incorporating a lumen, which allows simultaneous recordings of intracardiac oxygen saturation and pressure, to the diagnosis of patients with congenital heart disease is described. When combined with the cinetrace system, intracardiac oxygen saturation and pressure could be correlated precisely with the anatomic position of the catheter tip. Fifty patients with congenital heart disease and intracardiac and great vessel shunts were studied. The detection, localization and quantification of left to right shunts required no withdrawal of blood, and the findings were in close agreement with the results of the 85 krypton inhalation test. The fiberoptic catheter incorporating a lumen for pressure recording allows beat to beat display of the relations among intracardiac and intravascular oxygen saturation, shunt flow, pressure and the electrocardiogram. The simultaneous visual display of catheter position, hemodynamic data, blood oxygen saturation, and electrocardiogram on cine film permits rapid, complete and accurate assessment of the condition of children and adults with congenital cardiac defects.

There is a paucity of information on the natural history of congenital aortic stenosis. This report analyzes serial clinical and hemodynamic data obtained prospectively from 15 initially asymptomatic children with congenital aortic stenosis. The first hemodynamic study was performed at an average age of 8.5, and the follow-up study at an average age of 15.1 years. The cardiac index was consistently normal in all patients. The peak pressure difference across the left ventricular outflow tract increased between initial and final studies in 12 of the 15 patients. The gradient ranged from 5 to 45 mm Hg (mean 26) during the first study, and from 15 to 81 mm Hg (mean 44) at follow-up examination. Severe obstruction (gradient > 50 mm Hg, normal cardiac output; or calculated aortic valve orifice

A patient with double-outlet right ventricle is reported with the heretofore unreported association of a right pulmonary artery arising from a persistent right ductus arteriosus. The patient also had an infracrista ventricular septal defect, a secundum atrial septal defect, severe bicuspid valvular pulmonary stenosis, and a right-sided aortic arch.

The recent development of the instantaneously sensing Anger scintillation camera, capable of recording wide-field radioisotope images from the precordium, and a system for video storage and analysis has provided a means of visualizing the anatomic and hemodynamic features of the heart and great vessels without the hazards involved in introducing a radiopaque agent. Sodium pertechnetate ( 99m TcO 4 - ) produces no cardiocirculatory effects or untoward actions and delivers only 0.13 rads of total body radiation. Following injection, the rapidly changing distribution of radioactivity within the heart is recorded by the scintillation camera-television system which includes no inherent dead time or overlap of the scanned field from frame to frame. Video tape replay is available immediately and sequential integrated pictures are possible at any rate up to 60 sec. Radioisotope images of longer intervals are easily obtained by the integration of successive stop-action fields reproduced on a high resolution television monitor and photographed on rapidly developed film. In addition, the replay may be gated and tracked, allowing selected phases to be integrated and time-concentration curves of blood flow. Five to 10 millicuries of 99m TcO 4 - in 2 to 8 cc were rapidly injected into selected cardiac chambers at the time of diagnostic catheterization in 50 patients with a variety of congenital and acquired forms of heart disease. Movement of radioisotope closely reflected the hemodynamic alterations caused by these conditions, as determined by standard contrast angiocardiography. The radioisotope-angiocardiogram provides a new approach for visualization of the cardiovascular system, does not require the use of radiopaque medium, is safer than angiography, and does not disturb circulatory function.

Experience with 200 consecutive patients who received temporary pacemaker treatment during a 14-month period demonstrated that aside from complete heart block, this mode of therapy can be effective in sinus bradycardia, in S-A arrest, block or standstill, in A-V conduction defects, in ventricular tachycardia, and in the treatment of supraventricular tachycardia. Forty-two percent (83 of 200) ultimately required permanent units. There was no mortality associated with this mode of temporary pacemaker therapy and the only morbidity encountered was catheter malposition in 5 percent of the cases which merely required repositioning.

His bundle electrograms were recorded in 20 patients. Conduction times from atrium to His bundle (A-H time) and His bundle to ventricle (H-V time) were measured and the sites of delay or block were localized to the proximal or distal A-V junction. On progressively increasing the atrial rate by atrial pacing, the A-H time lengthened, while the H-V time remained constant. Premature atrial beats usually resulted in prolongation of the A-H time only. In some instances, premature atrial beats also resulted in prolongation of the H-V time and aberrant ventricular conduction (change in configuration of the QRS complex). In patients with first degree heart block during sinus rhythm the A-H time was prolonged and the H-V time was either normal or prolonged. In higher degrees of heart block, the block was localized either in the proximal or distal A-V junction.