PET findings in a brain abscess associated with a silent atrial septal defect

Brain abscesses are classical complications of congenital heart disease (CHD) in children and adolescents. This association is rarely observed in adults. We report a 46-year-old man presenting a fronto-parietal abscess associated with an asymptomatic atrial septal defect. Positron emission tomography (PET) study revealed high uptake of L-[methyl-11C]methionine ([11C]methionine) and 2-[18F]fluoro-2-deoxy-D-glucose (FDG) around the brain abscess. We suggest (1) to exclude a silent cardiac malformation in the presence of a cerebral abscess of unknown source occurring in adults; (2) to consider the diagnosis of brain abscess in cases of high uptake of [11C]methionine and FDG in relation to a brain lesion.     

Transcatheter closure of atrial septal defect

Isolated secundum atrial septal defect is one of the most common congenital heart defects. Surgical closure is the treatment of choice but is associated with a chest scar, some morbidity and a relatively long recovery and the use of cardiopulmonary bypass. Transcatheter closure of secundum atrial septal defect is therefore an attractive approach. 3 children, aged 5-10 years, underwent successful transcatheter closure of moderate to large central atrial septal defects with the Cardioseal device. The procedures were performed under x-ray and transesophageal echocardiographic guidance. Our initial experience, and that of others, indicates that transcatheter occlusion of secundum atrial septal defects is safe and effective and can be an appropriate alternative in approximately 60% of patients.     

Balloon pulmonary valvuloplasty for pulmonary valve stenosis with atrial septal defect

We performed successful balloon pulmonary valvuloplasty (BPV) in 6 patients with pulmonary valve stenosis and atrial septal defect (ASD) accompanied by atrial left-to-right shunt without an increase of shunting immediately after BPV. It suggests that such patients should be treated by BPV initially and the need for ASD repair can be assessed during long-term follow-up.     

Mechanics of breathing in patients with atrial septal defect

Mechanics of breathing and pulmonary diffusing properties were investigated in 24 adult patients with atrial septal defect. The patients were divided into 3 groups according to mean pulmonary artery pressure: less than 19 mm Hg (group I), 20 to 24 mm Hg (group II), and greater than 25 mm Hg (group III). The only change observed in group I was a marked increase in diffusing capacity. Patients of group II showed not only an increase in diffusing capacity, but also an overt decrease in maximal expiratory flow at all lung volumes and at any given driving pressure. For these two groups, a highly significant inverse correlation was found between changes in diffusing and elastic lung properties (r = -0.71; P less than 0.001). In patients of group III, the expiratory flow remained clearly decreased; furthermore, lung compliance and lung volumes were sharply reduced, airway resistance was elevated, and diffusing capacity was normal. Finally, from group I to group III, the lung elastic recoil became progressively diminished at small lung volumes. These results suggest that an increased pulmonary blood volume induces an increase in diffusing capacity and a slight decrease in lung compliance. Simultaneous existance of high intravascular pressure strengthens the effects of increased pulmonary blood volume on lung mechanics and results in significant abnormalities in the lung mechanical behavior. It is postulated that these effects are due to a competition for space between vessels and airways within the bronchovascular sheaths, with a subsequent compression of small airways.     

Left atrial reduction for chronic atrial fibrillation associated with mitral valve disease

Currently available surgical procedures to control chronic atrial fibrillation associated with mitral valvar disease are not always successful. The size of the left atrium is a major factor in the initiation and maintenance of atrial fibrillation. Here we describe a case of ablation of atrial fibrillation with left atrial reduction and pulmonary vein isolation in a patient with mitral valve disease.     

Double ventricular parasystole associated with atrial fibrillation

The case of a 75-year-old man with acute myocardial infarction is presented. Two ventricular parasystolic foci, one in the right bundle branch, the other in the left bundle branch system were demonstrated with the aid of a His bundle recording, in the presence of atrial fibrillation.     

Right ventricular volume characteristics in ventricular septal defect

Right and left ventricular volume characteristics were determined from biplane cineangiocardiography in 37 patients with isolated ventricular septal defects. Patients were divided into three categories as determined by the degree of left-to-right shunt: small shunt-less than 35% of pulmonary blood flow (N=9); moderate shunt-35-49% (N=8), and large shunt-greater than 50% (N=20). Right ventricular (RV) end-diastolic volume was increased above normal in 15 of 20 studies performed in patients with large left-to-right shunts and averaged 159 +/- 10% of normal (P less than 0.001). In contrast, only one of the patients in the small shunt group and only half of the patients in the moderate shunt group showed increases in RV end-diastolic volume. The increase in RV volume was proportional to the corresponding increase in left ventricular end-diastolic volume, with the right ventricle ranging from 48 to 116% of LV end-diastolic volume (average 83%). Right ventricular ejection fraction was normal in all patient groups. Right ventricular outpur was increased commensurate with the increases in the RV end-diastolic volume. These data indicate that substantial augmentation in RV end-diastolic volume does occur in patients with isolated ventricular septal defects and large left-to-right shunts. These data can be explained by the significant diastolic and "isovolumic" shunting from left ventricle to right ventricle which occurs in these patients.     

Echocardiography determination of shunt volume in children with atrial septal defect

The accuracy of echocardiographic estimation of left-to-right shunts was studied prospectively in children with secundum ASD. Fifty-one consecutive patients were examined from March 1987 to August 1991. Mean age was 64/12 years with a minimum age of 12/12 and a maximum of 131/12 years. Twenty-five children were included in the first part of the study. The ratios of right and left atrial and ventricular areas and pulmonary and aortic diameters were correlated with the left-to-right shunts determined by oximetry (mean shunt 48.7%; min. 10.1%, max. 73.2%). The pulmonary/aortic diameter ratio provided the closest correlation (r = 0.95; p < 0.01). During the second part of the study the left-to-right shunt was estimated using the regression equations developed from part one. Thus, in 26 subsequent patients these values were compared with oximetric shunt values. Again, the pulmonary/aortic diameter ratio provided the closest correlation (r = 0.97). The pair comparison yielded a difference of 0.7 +/- 3.8%. Based on these results since 1991, surgery for ASD II has been performed without preoperative cardiac catheterization in 33 patients, provided echocardiographic shunt estimation was > or = 48%.     

Left atrial isolation for chronic atrial fibrillation caused by mitral valvular stenosis and regurgitation

Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to mitral valvular disease in a 65-year-old woman who underwent mitral valvular replacement. Left atrial isolation was simple procedure, prolonging the usual paraseptal atriotomy toward the both mitral valvular commissures anteriorly and posteriorly. The incision was conducted two centimeters apart from the mitral valve annulus, and cryoablation was added at the edges to ensure isolation of the residual left atrium. We suggest performing this simple procedure in patients with chronic atrial fibrillation undergoing mitral valvular replacement, in whom correction of irregular beat and compromised hemodynamics can be obtained.     

Comparison of three different atrial septal defect occlusion devices

Three different devices were used to close secundum-type atrial septal defects in 28 patients. The "Amplatzer" is associated with an easier and shorter procedure than are the "Sideris Buttoned Device" and the Microvena "Angel Wings" devices.     

Surgical management of aortic regurgitation associated with ventricular septal defect

The intracarotid amobarbital procedure was carried out in 8 male and 7 female candidates to temporal lobectomy, and a female candidate to frontal lesionectomy, aged 18-50 (mean 32.5) years. Language and memory were tested after injection in each hemisphere. Both were measured by the Montreal procedure. In 9 patients language and memory were evaluated with the Seattle procedure too. In 12 patients the left hemisphere was dominant for language; three had bilateral dominance. In 1 patient the Seattle procedure demonstrated the dominant hemisphere by relatively slowness of speech during the drug effect in the left hemisphere. Memory was defined to be in the left hemisphere in 12 patients, in the right in 2, bilateral in 1 and in another lateralization was not possible. In 1 patient memory dominance was determined by the Montreal protocol alone because of lack of cooperation. These early results indicate that the methods may be complementary for determination of language and memory dominance in epilepsy surgery candidates.     

Double-orifice right atrioventricular valve associated with partial atrioventricular septal defect

We describe the case of a double-orifice right atrioventricular valve that was discovered at operation for an associated atrioventricular septal defect. The diagnosis and operative management are discussed. Developmental concepts illustrate the mechanism by which this defect arises, and emphasize that its great rarity remains an enigma.