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ABSTRACT: Anomalous origin of the left coronary artery from the pulmonary trunk is a rare congenital heart defect. Cardiac catheterization remains the standard means of diagnosis. Our purpose in this study is to emphasize the importance of assessing the electrocardiogram when making the diagnosis, in addition to taking note of transthoracic echocardiographic findings. We also analyzed the sensitivity of each parameter under investigation.
Between June, 1999, and March, 2007, we studied 9 patients, 6 males and 3 females, with a mean age of 3.02 years, in whom anomalous origin of the left coronary artery from the pulmonary trunk was suspected subsequent to transthoracic echocardiographic examination. We examined their electrocardiograms, and undertook cardiac catheterization. In all patients, the transthoracic echocardiogram had shown retrograde flow into the pulmonary trunk, with the left coronary artery arising from pulmonary trunk, along with a dilated right coronary artery, or intercoronary collateral vessels. In 8 patients, the electrocardiogram showed deep Q wave in leads I and aVL, with depression of the ST segments over lead V4 through 6, or inversion of the T waves in leads I, II, and aVL. In the remaining patient, the electrocardiogram showed incomplete right bundle branch block. Later, cardiac catheterization confirmed the diagnosis in 8 patients, but the other patient was shown to have the right coronary artery arising from the pulmonary trunk.
By combining transthoracic echocardiography with study of the electrocardiogram, it is possible to provide accurate evaluation of anomalous origin of the left coronary artery from the pulmonary trunk.
Cardiology in the Young 09/2009; 19(5):474-81. · 0.76 Impact Factor
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ABSTRACT: Pulmonary sequestration (PS) is characterized by non-functioning lung tissue fed from 1 or several aberrant systemic arteries. The classical therapeutic approach is surgical resection. Several case reports have shown that coil embolization is feasible, but this technique has not been evaluated in a larger series of consecutively treated patients. The purpose of our study was to assess the early and long-term outcomes of coil embolization of PS in children and to determine the risk factors of early and late major adverse cardiovascular and pulmonary events.
Between March 1999 and December 2004, 6 patients (2 boys, 4 girls, mean age 4.7 +/-3.8 years) with PS were treated by coil embolization of the feeding systemic artery. Four patients were considered to have been cured and 2 patients required a second coil embolization 6 months later because of residual systemic flow seen on computed tomography. Transient ischemic change of the lower limb occurred in the youngest patient. None of the other patients had any late complications or recurrent pneumonia.
Coil embolization of PS is safe and feasible, with a good late outcome.
Circulation Journal 04/2009; 73(5):938-42. · 3.77 Impact Factor
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ABSTRACT: Percutaneous device closure is now the widely accepted management technique for patent ductus arteriosus (PDA). In the present study, current practice of closing moderate to large PDA using the Amplatzer duct occluder (ADO) was compared with the previous experience using 0.052-inch coils.
From August 1997 to September 2006, 76 patients were selected for either 0.052-inch coils or ADO implantation. Selection criteria were a minimal diameter of > or =2.5 mm and angiographic type A, C, D or E. In group I, 21 patients received 0.052-inch coils in a multiple coil strategy for PDA closure. In group II, 55 patients underwent ADO device implantation. The age, weight, hemodynamics, minimal PDA diameter and shunt size were insignificantly different between groups. However, group I had a higher rate of failed implantation and device embolization, and the immediate and 24-h closure rates (38.9% vs 81.8%, P<0.05; 72.3% vs 96.4%, P<0.05) favored group II.
ADO implantation is safer and more effective than the 0.052-inch coil strategy for transcatheter closure of moderate to large PDA.
Circulation Journal 01/2009; 73(2):356-60. · 3.77 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the follow-up results of perimembranous ventricular septal defect (VSD) with left ventricular to right atrial (LV-RA) shunt since infancy and to analyze the morphologic variations of this shunt.
The study group comprised 232 consecutive pediatric patients with isolated perimembranous VSD and aneurysm, of whom 134 (58%) had LV-RA shunts. Follow-up echocardiography was performed to assess for the size of both the VSD and LV-RA shunt. There were no significant differences between groups in terms of sex, age at the initial echocardiography, follow-up period, number of patients with tricuspid regurgitation, and initial VSD size. There was a significant difference between groups in spontaneous closure (p=0.039). The event-free probability (no surgical repair of the defect) was not significantly different between the groups (p=0.129).
Perimembranous VSD with LV-RA shunt in infancy is common and associated with less chance of spontaneous closure. Color Doppler echocardiography can greatly improves the diagnostic efficacy and assist in understanding the mechanisms leading to this particular anomaly.
Circulation Journal 10/2008; 72(9):1487-91. · 3.77 Impact Factor
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ABSTRACT: To simplify the conventional procedure, we developed a technique for transcatheter closure of atrial septal defects (ASDs) under transthoracic echocardiographic (TTE) sizing without balloon sizing. At present, device closure of interatrial communication has become a well-established technique to adequately treat severe left-to-right shunt associated with ASDs. During the traditional procedure, fluoroscopy with the waist of a compliant balloon is used to determine the appropriate size of the closure device and defect sizing. Choice of adequate closure device using transthoracic echocardiography (TTE) has been hitherto unreported. Between December 2002 and August 2004, 40 patients (15 males, 25 females, mean age 11.7 +/- 7.8 years) with secundum ASDs underwent transcatheter closure at our institution. In group 1, 30 patients had the procedure by balloon sizing and TTE sizing. In 10 patients (group 2), TTE sizing was used as the sole tool for selecting device size and the device size was chosen to be based on the Amplatzer septal occluder (ASO) size and TTE size ratio in group 1. The procedure was performed under continuous transesophageal echocardiographic monitoring with general anesthesia. A correlation was found between TTE and stretched balloon sizing diameter SBD (y = 1.2645x - 1.4465; R2 = 0.9861), and between TTE size and ASO size (y = 1.3412x - 1.2864; R2 = 0.9929) in group 1. In group 2, a statistical correlation between TTE and ASO (y = 1.3419x - 0.1172; R2 = 0.9934) was also found. Good linear regression between TTE size and ASO chosen size was noted in group 1 and group 2 (R2 = 0.99). In group 2, successful device implantation was accomplished in all patients whose device size was chosen to be based on the ASO and TTE ratio in group 1. Transthoracic echocardiographic sizing is a safe and ideal method to measure interatrial defect and choose the occluding device, respectively. With our experience, the sizing based on TTE is generally easier than measurement from the balloon sizing.
Heart and Vessels 08/2007; 22(4):245-50. · 2.05 Impact Factor
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ABSTRACT: Childhood obesity has become a growing public health issue in Taiwan. Obese children have risk factors for type 2 diabetes and cardiovascular disease. In this prospective study, we investigated the effect of a twelve-week heart health education and physical activity program on body weight and risk factors for type 2 diabetes and cardiovascular disease.
Subjects were 120 obese fifth graders (65 boys and 55 girls, aged 10-13 years (mean 10.6 yrs), body mass index (BMI) at the 95th percentile or more) and were randomly assigned to an intervention group (n=60) or control group (n=60). The intervention group received a twelve-week heart health education and physical activity program, while the control group did not. In both groups, a series of examinations were done at baseline and post-test, including height, weight, BMI, body fat, blood pressure (BP), physical fitness (800-meter running test), heart health knowledge, and serum biochemistry. Differences for baseline and post-test data were compared between both groups.
Mean changes in the intervention group versus control group were significant for weight (P = 0.024), BMI (P = 0.047), percentage body fat (P = 0.008), physical fitness (800-meter running test) (P = 0.025), heart health knowledge (P = 0.006), total cholesterol (P = 0.027), triglycerides (P = 0.018), high-density lipoprotein cholesterol (HDL-C) (P = 0.009), low-density lipoprotein cholesterol (LDL-C) (P = 0.041), sugar (P = 0.035), insulin (P = 0.007), and insulin resistance (HOMA-IR) (P = 0.028). At post-test, weight, BMI, body fat, total cholesterol, triglycerides, LDL-C, sugar, insulin and HOMA-IR had decreased, but HDL-C had increased in the intervention group.
A classroom-based weight-control intervention provides educational programs to promote cardiovascular health in children. This intervention is simple, practical, and beneficial for elementary school children.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi 48(4):201-6.
