| Autor: |
Freedom, R M, Hawker, R E, Krovetz, L J |
| Zdroj: |
Pediatric Research; April 1974, Vol. 8 Issue: 4 p349-349, 1p |
| Abstrakt: |
Distinctive patterns of left-to-right shunting of pulmonary venous return (PVR) have previously been demonstrated by indicator dilution techniques in secundum (ASD 2), primum ASD, sinus venosus defects and in partial anomalous pulmonary venous connection. We intend to document a most unusual and paradoxical hemodynamic finding in ASD 2: Preferential shunting of venous return from normally connected left pulmonary veins. 80 patients with ASD 2 underwent cardiac catheterization from 1971 to 1973. In 32 of these, dye curves were recorded following injection of indocyanine green through an end-hole catheter into both distal right and left pulmonary arteries, with sampling in a peripheral artery. In 21 of these 32 (65%) there was the usual predominant shunting of the right PVR; in five (16%) shunting from both sides was equal; in six (19%) predominant shunting from the left PVR was shown. In these six, the pulmonary to systemic flow ratio was between 1.7 and 2.4 and the defects at surgery ranged from 1.5 to 2.5 cm in diameter. Pulmonary arteriograms and intra-operative visualization confirmed normal pulmonary venous connections in these six. Although this pattern of shunting is strongly suggestive of an associated anomalously connected left pulmonary vein, paradoxically this phenomenon is also consistent with an uncomplicated ASD 2. A precise hemodynamic explanation is not readily apparent. |
| Databáze: |
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