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SummaryA total of 80 patients, diagnosed by echocardiography as having ventricular septal defect with aortic valvar prolapse, underwent cardiac catheterization and surgery. Echocardiographic and angiographic results were compared with surgical findings. The ventricular septal defects as observed during surgery were found to be doubly committed and subarterial in 49 (61%), muscular outlet in 10 (13%), and perimembranous in 21(26%). The location had been erroneously categorized by echocardiography and angiography in 12 (15%) and in 15 (19%) patients, respectively. Prolapse of the right coronary leaflet of the aortic valve, as documented by echocardiography, was confirmed by angiography in all but two cases. Prolapse of the noncoronary leaflet was detected by both imaging modalities in three patients. Prolapse of the right coronary and noncoronary leaflets was observed at surgery in 49 and three patients, respectively. The mean size of the ventricular septal defect, when measured by echocardiography, was significantly smaller than that found following surgical measurements (3.3±1.3 vs 8.4±3.8 mm, p

A case of fetal tuberous sclerosis with multiple intracardiac rhabdomyomas exhibited persistent supraventricular tachycardia. The tachycardia was terminated by the use of cardiac version. The largest tumor almost occluded the right ventricular inlet portion. The obstruction was relieved after surgical removal of the largest tumor. No arrhythmia was noted after 3 months of follow-up.

To determine the mechanism of cardiac output and hemodynamic changes during cardiopulmonary resuscitation (CPR), we performed 60 min of CPR using a mechanical resuscitator ("Thumper", MII, USA) in 20 piglets (13.7 +/- 1.2 kg) following cardiac arrest induced by intravenous injection of KCl. Conventional CPR (C-CPR), i.e., 60 external chest compressions (60 psi force, 3 cm deep, and 50% duration) and 12 ventilations (following every 5th compression, with peak airway pressure of 30 cmH2O) per minute, was performed in 10 piglets; and simultaneous compression and ventilation CPR (SCV-CPR), i.e., 60 external chest compressions of the same magnitude, simultaneously with 60 ventilations (with peak airway pressure of 60 cmH2O) per minute, was performed in the 10 other piglets. Cardiac output in C-CPR and SCV-CPR was maintained near 70% or more of baseline throughout the CPR. Systemic vascular resistance dropped to below 50% of baseline. Systolic, mean and diastolic arterial pressures were maintained above 70, 40, and around 20 mmHg, respectively, during the first 30 min of CPR. Central venous pressure rose after arrest and subsequent CPR to above 25 mmHg, and remained high in SCV-CPR, but declined thereafter in C-CPR. Aortic diastolic minus right atrial diastolic pressure was around 15 mmHg early in CPR and dropped to almost zero thereafter. Serial arterial blood gas analyses showed a significant deterioration after 20 min of SCV-CPR. All but one piglet in the SCV-CPR group died after 60 min of CPR. Postmortem examination revealed that pulmonary barotrauma was more extensive and severe in SCV-CPR than in C-CPR.(ABSTRACT TRUNCATED AT 250 WORDS)

Objectives: We investigated the influence of cardiopulmonary bypass on cardiomyocyte gap junctions and connexins. Methods: Samples were collected at intervals during operation from the right atrial appendage in 21 patients (mean [± SD] age 55 ± 21 years). Immunodetection of connexins was conducted by Western blotting and confocal microscopy with parallel electron microscopic examination of gap junctions. Results: Downregulation of connexin 43 during the course of operation occurred in more than half of the patients. The mean densitometric value of connexin 43 decreased by 23%, with samples from patients with coronary artery disease showing a greater reduction than seen in those from patients with other diseases (31% ± 22% vs 10% ± 24%, P =.04). Such alterations were confirmed by confocal microscopy, which also demonstrated reduced connexin 45 immunolabeling in most patients. Electron microscopy revealed a reduction in the dimensions of cell membrane-located gap junctions and more frequent intracytoplasmic gap junctional membrane in samples from later time points ( P =.04). Conclusions: Downregulation of connexins accompanied by a reduction in gap junctions is common in the cardiomyocytes of the right atrial appendage during cardiopulmonary bypass. The association of a marked reduction in connexin 43 with coronary artery disease may imply inadequate intraoperative cardiac protection in patients with this disease. J Thorac Cardiovasc Surg 2002;124:1106-12

A rare case of combined aortic and mitral regurgitation resulting from downward displacement of the aortic anulus is reported. The patient was treated successfully with an aortic valve replacement with a Bjork-Shiley valve prosthesis, which was anchored at the normal site of the aortic anulus. No procedures were performed on the mitral valve, but mitral regurgitation was not evident postoperatively.

The incidence of aortic valve prolapse and aortic regurgitation (AR) among Chinese with ventricular septal defect (VSD) has not been studied, and controversies still exist regarding optimal surgical treatment and timing of operation for this condition. A prospective study of 332 consecutive patients with VSD showed that aortic valve prolapse and AR occurred in 43 (11.9%) patients. Valve lesions occurred more commonly among patients with subpulmonic VSD (28.0%) than with subaortic VSD (8.8%) (P less than 0.005). A retrospective study of another 306 patients revealed that 37 (12.1%) had valve complications. Of the 80 patients with valve lesions, 60 were males and 20 were females. The youngest ages of prolapse and AR in subpulmonic VSD were 7 months and 3 years 8 months, respectively; those in subaortic VSD were 2 years and 3 years 6 months, respectively. Valve prolapse occurred mostly before the age of 6-10 years, leading progressively to AR. The coronary cusps prolapsed in subpulmonic VSD were limited to the right cusp; and those in subaortic VSD were the right cusp, noncoronary cusp, or both. The magnitude of left-to-right shunts was small and the pulmonary artery pressure was normal in the majority of patients. Seventy-two patients underwent open-heart closure of the VSD, with additional valvuloplasty in 15 and valve replacement in three patients. It is concluded that Chinese with VSD are prone to develop aortic valve complications. Surgical closure of the subpulmonic VSD may restore the prolapsed valve to normal. Closure of the subaortic VSD has little effect. Valvuloplasty in subaortic VSD may palliate AR, but in all probability cannot restore valve competency.