The significance of the pulmonary vascular bed in congenital heart disease

Dammann, Jr Jf; Ferencz, Charlotte

doi:10.1016/0002-8703(56)90260-5

Cited by 95 publications

(18 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A split second sound was found in all but 12 individuals; one half of these had pulmonary vascular obstruction. The second heart sound was obscured ill 4 Normal axis deviation (0 to +900) was present in well over one half the total series and bore no specific relationship to the various ventricular hypertrophy patterns. Indeterminate axis was uncommon and likewise bore no relationship to the patterns of ventricular hypertrophy.…”

Section: Physical Examinationmentioning

confidence: 94%

“…We have classified the entire group physiolgically into 4 subdivisions on the basis of (a) size of uncomplicated left-to-right shunt (small or large), or (b) presence of complications (pulmonary vascular obstruction or pulmonary stenosis) ( In addition to the 98 patients with complete clinical and physiologic studies, we also included in this report 5 patients with uncomplicated ventricular septal defect in whom complete autopsy data are available. These children will only be discussed in terms of course and prognosis since the clinical data available on them are incomplete.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Ventricular Septal Defect in Infants and Children

et al. 1958

View full text Add to dashboard Cite

Now that ventricular septal defect is amenable to surgical repair it is most important to define the indications for surgical intervention. In this paper the natural history of the disease and its clinical and physiologic characteristics are carefully detailed. These observations permit better recognition and understanding of the condition and offer a basis for comparison with results after surgery.IT HAS BEEN demonstrated recently that ventricular septal defects in children can be repaired surgically with an acceptable mortality rate under appropriate circumstances.1-3 For infants who at present are not considered suitable candidates for direct surgical repair, an ingenious palliative operation offers considerable theoretical promise. To achieve a better understanding of the nature of the anomaly and to arrive at some working hypothesis ill regard to operative indications, we reviewed the clinical picture, the physiologic data, and the natural history of our patients with proven ventricular septal defect. MATERIALS AND METHODSThe physiological data were surveyed on all patients admitted to the Children's Medical Center, Boston, between 1950 and and diagnosed at cardiac catheterization as having a ventricular septal defect. All these subjects had an increase in oxygen content of at least a 1.0 volume per cent at the right ventricular level as compared to the right atrial sample. The catheterized patients were considered to have severe disease on clinical grounds; thus they represent a select group from the total number of children with ventricular septal defect attending our clinic.The catheterization data were reviewed for completeness and all patients with associated cardiac anomalies other than pulmonary stenosis or aortic regurgitation were arbitrarily excluded. Cases of ventricular septal defect and pulmonary stenosis with a resting arterial saturation of less than 94 per cent were also eliminated as examples Fromt the ShliArol Caar(liovalscular

show abstract

Section: Physical Examinationmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Ventricular Septal Defect in Infants and Children

et al. 1958

View full text Add to dashboard Cite

show abstract

“…The protective effect of stenosis is the basis of modern surgical therapy in the Eisenmenger group (Civin and Edwards, 1950;Dammann and Ferencz, 1956 Small venesections, repeated from time to time, may be helpful in cases with gross polycythaemia, but should be undertaken very slowly and with the utmost vigilance. Heart failure requires the usual remedies.…”

Section: Elastlc Arteriesmentioning

confidence: 99%

“…As suggested by and as practised by Dammann and Ferencz (1956), artificial stenosis of the pulmonary artery may be created surgically in cases of Eisenmenger's syndrome in order to lower the pulmonary artery pressure and so initiate the involutionary cycle. Just how long it may be wise to maintain the stenosis before repairing the defect remains to be seen, but the post-operative course of cases of mitral stenosis with extreme reactive pulmonary hypertension suggests that a year or two should be sufficient.…”

Section: Protective Effect Of Pulmonary Stenosismentioning

confidence: 99%

“…11). Selective angiocardiograms, however, give no information about pressure, and reversed shunts are encouraged by transient overfilling of the chamber into which the contrast medium is injected; moreover, the danger of an overdose of x rays may limit the number of angiocardiograms to which a patient should be exposed, Dammann and Ferencz (1956) and Edwards (1957), could not be excluded. In a case described by Selzer and Lewis (1949) at atrial and ventricular levels in the other; the pathological reports from the hospitals where they died concluded that the first had nothing more than a simple atrial septal defect of the secundum type, and that the second had a single ventricle with intact atrial septum.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The Eisenmenger Syndrome: II

Wood¹

1958

BMJ

267

View full text Add to dashboard Cite

Distinctive Characteristics of Individual Members of the Eisenmenger GroupPatent Ductus.- (1) The catheter passed through the duct more easily than through any other central communication between the two circulations. It did so in 90% of cases, and usually took an anticlockwise course to enter the descending aorta. (2) The shunt was wholly reversed far more frequently (50%) than with other defects. (3) Patent ductus was the only lesion which was occasionally associated with no shunt in either direction. (4 Differential oxygen desaturation between right brachial and femoral samples was pathognomonic of patent ductus, and occurred in all but two cases in which there was no shunt in either direction. The oxygen saturation of samples from the right brachial artery averaged 89.6% (range 81 to 96%), and from the descending aorta or femoral artery 77.1 % (range 65 to 88%/). Aorto-pulmonary Septal Defect.-(l) When the catheter passed through the defect it entered the ascending aorta from the pulmonary artery. (2) In other respects the findings were similar to those of patent ductus with bidirectional shunt but no differential desaturation.Eisenmenger's Complex.-(1) Passage of the catheter via the defect (28%) into the ascending aorta followed a characteristic medial course as in Fallot's tetralogy. (2) An appreciable left-to-right shunt at ventricular level, as described by Bing et al. (1947), could be detected in all but two cases, in both of which the diagnosis was subsequently proved at necropsy. (3 (1) The physiological situation was similar to that in aorto-pulmonary septal defect with the addition of a second left-to-right shunt at ventricular level. As the catheter passed from the right atrium, through the right ventricle, into the truncus, the oxygen saturation of respective samples rose first by 10 and 12.5%, and then by a further 10 and 14%. (2) The catheter entered the pulmonary arteries from the " aorta," instead of vice versa as in aorto-pulmonary septal defect. (3) Samples from the " aorta" and pulmonary arteries were identical.Atrial Septal Defect.-(I) The catheter passed through the defect in two-thirds of 18 proved cases. (2) The pulmonary artery pressure was less than the systemic pressure by an average of 27/34 mm. Hg in 70% of the cases; in 10% it ,was higher; and in the remalnder about the same. When mean pressures were similar the pulse pressure was usually greater in the pulmonary artery, the systolic pressure being higher and the diastolic lower than in the systemic arteries. Agents affecting pulmonary or systemic flow or resistance selectively usually altered the pressure relationship between the two circulations. (3) A direct shunt at atrial level was demonstrated in 84% of the cases, right atrial samples being on the average 13 % more saurated than samples from the superior vena cava (range 6 to 21%). (4) The oxygen saturation of left atrial samples averaged 81 % in the eight cases in which they were obtained (range 72 to 88). Left ventricular samples were similar when secured, and arterial s...

show abstract

Pulmonary Hypertension and Vascular Change in Patients with Congenital Heart Disease

Crittenden¹,

Linde²

1959

AMA Am J Dis Child

View full text Add to dashboard Cite

The significance of the pulmonary vascular bed in congenital heart disease

Cited by 95 publications

References 24 publications

Ventricular Septal Defect in Infants and Children

Ventricular Septal Defect in Infants and Children

The Eisenmenger Syndrome: II

Pulmonary Hypertension and Vascular Change in Patients with Congenital Heart Disease

Contact Info

Product

Resources

About