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[Pulmonary insufficiency in childhood. Contribution to diastolic murmurs (author's transl)]
Insights
Diastolic murmurs in children often indicate pulmonary insufficiency, particularly after heart surgery for congenital defects. Postoperative pulmonary insufficiency does not hinder surgical success but requires regular pediatric cardiology follow-up.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Context:
- Diastolic murmurs in children are frequently linked to pulmonary insufficiency.
- This insufficiency can be functional or, increasingly, a consequence of surgical interventions for congenital heart defects.
- Common conditions include pulmonary stenosis and tetralogy of Fallot.
Purpose:
- To investigate the incidence and implications of diastolic murmurs related to pulmonary insufficiency in pediatric patients undergoing cardiac surgery.
- To assess the diagnostic utility of phonocardiography, heart catheterization, and angiocardiography in evaluating postoperative pulmonary insufficiency.
- To determine the impact of postoperative pulmonary insufficiency on surgical outcomes in children.
Summary:
- Diastolic murmurs indicating pulmonary insufficiency were detected in 92.5% of children after surgery for valvular/infundibular pulmonary stenosis and 89% after tetralogy of Fallot correction.
- Phonocardiography, postoperative heart catheterization, and angiocardiography are effective tools for assessing the severity of pulmonary insufficiency.
- While postoperative pulmonary insufficiency is common, it does not negate the benefits of surgical correction for congenital heart defects.
Impact:
- Surgical correction of congenital heart defects leads to significant improvement in affected children.
- Postoperative pulmonary insufficiency, though prevalent, does not compromise the overall positive impact of these cardiac surgeries.
- Long-term follow-up with regular pediatric cardiology examinations is essential for managing these patients into adulthood.
Abstract:
Diastolic murmurs in childhood are in most cases due to pulmonary insufficiency. They may be functional (Graham-Steel-murmurs, for instance with idiopathic pulmonary ectasis or pulmonary hypertension), but are more and more the symptom of postoperative pulmonary insufficiency. Diastolic murmurs of pulmonary insufficiency were found after operations of valvular and infundibular pulmonary stenosis in 92,5% of the cases (40 children) and after total correction of tetralogy of Fallot in 89% of 27 children. The diastolic murmur of pulmonary insufficiency is very good recorded in phonocardiography; with postoperative heart catheterisations and angiocardiography there is good estimation of the degree of the pulmonary insufficiency. There is no doubt about the curative effort of operations in these congenital heart defects, and postoperative pulmonary insufficiency does not impair the operative improvement in childhood. Till now long term observations of these cases up to late adulthood cannot be possible; regular pediatric cardiologic examinations of these operated children are mandatory.