Experimental Evaluation of Venous Autografts as Aorta to Left Ventricular Myocardial Shunts in Revascularization of the Heart: A Preliminary Report
Cardiovascular Research Center bulletin
... EXPERIMENTAL EVALUATION OF VENOUS AUTOGRAFTS AS AORTA TO LEFT VENTRICULAR MYOCARDIAL SHUNTS I... more ... EXPERIMENTAL EVALUATION OF VENOUS AUTOGRAFTS AS AORTA TO LEFT VENTRICULAR MYOCARDIAL SHUNTS IN REVASCULARIZATION OF THE HEART: A PRELIMINARY REPORT.GARRETT HE, CARTMILL TB, THIELE JP, HOWELL JF, DEBAKEY ME. ...
Congenital central hypoventilation syndrome and Hirschsprung's disease
Archives of disease in childhood, 1998
Five cases of the Hirschsprung's disease-congenital central hypoventilation syndrome (CCHS) a... more Five cases of the Hirschsprung's disease-congenital central hypoventilation syndrome (CCHS) association are presented and 41 other published cases reviewed. These children have a distinct pattern of associated features, an equal sex incidence, and a characteristic spectrum of disease severity which suggests that the condition is genetically distinct from other cases of Hirschsprung's disease. While approximately 1.5% of Hirschsprung's disease patients, and 10% of those with total colonic aganglionosis, will have CCHS, up to 50% of CCHS patients will have Hirschsprung's disease. Approximately 20% of CCHS/Hirschsprung patients will also have neuroblastoma or ganglioneuroma, usually multiple. Abnormalities of the eye and autonomic nervous system are also common. The ventilatory abnormality is usually evident on the first day of life. The aganglionosis is also severe, with more than half (59%) of the patients having aganglionosis extending into the small bowel.
Managing and understanding variances in clinical path methodology: a case study
Journal of quality in clinical practice, 1996
Clinical path is a tool to improve efficiency. The increasing use of this methodology is evidence... more Clinical path is a tool to improve efficiency. The increasing use of this methodology is evidenced by the proliferation of literature documenting its usage. A search of Cumulative Index to Nursing & Allied Health Literature (CINAHL) alone yielded over 38 articles related to clinical path. This trend of using clinical path to manage patient care is also evident from the recent literature in Australia. However, the literature has been silent on the documentation, interpretation and management of the variances. The purpose of this paper is to describe our three years' experience with clinical path management. Some examples of the variances we have experienced in the cardiac unit will be discussed.
The Journal of Thoracic and Cardiovascular Surgery, 2000
Surgical correction of the sinus venosus syndrome has been associated with sinus node dysfunction... more Surgical correction of the sinus venosus syndrome has been associated with sinus node dysfunction and venous obstruction postoperatively. We present the long-term follow-up of a lateral transcaval approach, which closes the atrial communication and corrects the partial anomalous pulmonary venous connection to the superior vena cava with the use of a simple pericardial patch. The records of 66 patients undergoing repair between April 1981 and April 1997 were examined. Mean age at repair was 10.2 years (range, 1.5-65 years; median, 5 years). Six patients had a left superior vena cava, 4 had an additional atrial septal defect, and 2 had coronary artery bypass grafts. Immediate and long-term follow-up included physical examination, electrocardiography, transthoracic echocardiography, and use of a 24-hour ambulatory Holter monitor. Sinus node function, incidence of significant arrhythmia, and evidence of mechanical venous obstruction were assessed. Follow-up data were available for 64 (97%) patients for a mean follow-up of 4.1 years (range, 1-9 years). There were no deaths. No evidence of residual atrial septal defect, superior vena cava, or venous obstruction were found by echocardiography. On electrocardiography all patients were in sinus rhythm, with no arrhythmia seen. Holter monitoring was performed at a mean of 7.3 years postoperatively. All patients had normal sinus node function, and no sustained atrial arrhythmia was seen. Transcaval repair is a simple technique that does not interfere with sinus node function. There is no evidence to suggest that this approach leads to venous obstruction.
A structured questionnaire was sent to the parents of 120 children from a cohort 192, who had und... more A structured questionnaire was sent to the parents of 120 children from a cohort 192, who had undergone a pyloromyotomy for pyloric stenosis at Westmead Hospital during the years 1984-91. Information was gained from 85 children in 82 families regarding gastrointestinal complaints and family history of pyloric stenosis. There were few gastrointestinal problems, no reports of recurrent abdominal pain, but two reports of clinically significant vomiting (2.3%) and one of infantile colic. Of the 85 individuals studied, 21 (24.7%) had a positive family history of pyloric stenosis, a higher frequency than previously reported.
A review of 212 cases of infantile hypertrophic pyloric stenosis (IHPS) in a general hospital dur... more A review of 212 cases of infantile hypertrophic pyloric stenosis (IHPS) in a general hospital during an 8.5 year period documents clinical features and suggests refinement of treatment. Features such as sex, age at onset and presentation were similar to other studies. There was a preponderance of infants born in the summer. Premature infants represented 10% of the series, and the most premature (<33 weeks gestation) presented later after birth (40 vs25 days). Diagnosis was clinical in 65% of cases, but 4% presented before physical examination and diagnostic tests were positive. At the time of admission only 15% had significant abnormalities of serum electrolytes (chloride <85 mmol/L). The periumbilical incision resulted in a hidden scar. Duodenal perforation (3.3%) and wound dehiscence (1.4%) are related to technical factors and can be avoided. The timing of commencement of postoperative feeds did not influence the rate of vomiting. The average length of stay was 3.5 days. These results are discussed with suggestions about how to minimize diagnostic tests and length of hospital stay.
Myosin Light Chain Gene Expression Associated with Disease States of the Human Heart
Journal of Molecular and Cellular Cardiology, 1993
During development of the human heart, the atrial isoform of alkali myosin light chain (MLC1A) is... more During development of the human heart, the atrial isoform of alkali myosin light chain (MLC1A) is expressed in the ventricle. With maturation of the heart, MLC1A expression is completely replaced by that of the adult ventricular myosin light chain, MLC1V. We have evaluated the re-expression of MLC1A as a marker of different disease states of the human ventricle. RNA was isolated from the ventricles of patients with idiopathic dilated cardiomyopathy (CM) and severe congenital cardiac defects (CCD). Northern blot analysis was used to measure the mRNA levels of MLC1A and MLC1V in these samples. As a control, the level of regulatory MLC2V mRNA was also measured. We find that the level of MLC2V mRNA per microgram total ventricular RNA is very similar in CM, CCD and normal human samples. In contrast, we find that MLC1V mRNA levels tend to be reduced in both CM and CCD samples. In the case of the CCD samples, this apparent drop in MLC1V is compensated by expression of the developmental MLC1A isoform. However, in CM patients in end-stage failure, expression of MLC1A is barely detectable. The expression of MLC1A in CCD samples may reflect an adaptive mechanism in response to cardiac overload. The failure to detect substantial MLC1A expression in the CM samples may reflect the failure of such an adaptive mechanism.
Late results of right ventricular outflow tract reconstruction with Bjork-Shiley valved conduits
Heart, 1986
Between 1971 and December 1976, 27 children with congenital heart disease underwent right ventric... more Between 1971 and December 1976, 27 children with congenital heart disease underwent right ventricular outflow tract reconstruction with conduits incorporating a Björk-Shiley valve. The conditions corrected were pulmonary atresia with ventricular septal defect (14 patients), truncus arteriosus (6 patients), and complex disease (7 patients). At operation the children were aged from 12 days to 16 years (five patients were less than one year old). Overall mortality for the group was high (52%). There were nine early deaths and five late ones. Actuarial survival till death or reoperation was 55% at four years, 35% at eight years, and 28% at 12 years. Ten children subsequently underwent reoperation for conduit stenosis caused by neointimal proliferation and valve obstruction. The new conduits incorporated a biological valve. Mortality was highest in patients aged less than one year, and in those with truncus arteriosus, severe pulmonary hypertension, or complex heart disease. Mechanical valves should be avoided in conduit reconstruction of the right ventricular outflow tract for congenital heart disease.
Accessory mitral valve tissue causing left ventricular outflow tract obstruction
Heart, 1986
Among the various causes of left ventricular outflow tract obstruction accessory mitral valve tis... more Among the various causes of left ventricular outflow tract obstruction accessory mitral valve tissue is the least common. To the best of our knowledge there have been only five such cases reported to date. The aim of presenting two more cases and reviewing the literature is to bring attention to this rare anomaly as it is easy to treat provided it has been diagnosed preoperatively or recognised at surgery.
Management of Ascending Aortic Dissection: Experience with the Usci Intraluminal Prosthesis and a Method of Aortic Valve Repair
ANZ Journal of Surgery, 1987
Ten consecutive cases of acute ascending aortic dissection operated on using the USCI intralumina... more Ten consecutive cases of acute ascending aortic dissection operated on using the USCI intraluminal prosthesis from 1983 to 1986 were reviewed. Diagnosis was achieved by conventional angiography in six cases, by intraarterial digital subtraction angiography in one case, by computerized tomography (CT) scan in two cases and by echocardiography and abdominal ultrasound in one case. An entry site was seen in only five out of six conventional angiograms. At operation six of the 10 had a degree of tamponade. Aortic regurgitation was seen five times, due to dissection in four cases and to Marfan&#39;s disease in one. The entry site was controlled in eight cases. Repair using intraluminal prosthesis only was achieved in five cases. Aortic valve repair was added in four out of 10 cases, and in one of these an aorta-to-right coronary graft was also added. One case required aortic valve replacement. A method of aortic valve repair is presented. There were nine survivors, 1-36 months postoperatively. Of these, eight were asymptomatic on no medication. One had severe aortic regurgitation noted 2 months postoperatively and has mildly reduced exercise tolerance. Surgical treatment can be planned if the presence of dissection is proven and involvement of the ascending aorta is demonstrated. Early surgery is important, since six of the 10 cases in this series had tamponade. The intraluminal graft will reliably redirect flow to the true lumen and exclude the dissection from the pericardium. Aortic valve repair can be successful though late replacement may be necessary in some cases. Control of the entry site is not essential to achieve a good clinical result.
Patch aonoplastry. used almost routinely in the period 1972-86, except in infants in the operativ... more Patch aonoplastry. used almost routinely in the period 1972-86, except in infants in the operative treatment of coarctation ol'aona. is sometimes complicated by late formation of true or false aneurysms. This complication. which seems likely to increase with longer follow-up. calls into question the advisability of patch aonoplasty except when i t has specific advantages. Other surgical techniques such as subclavian flap angioplasty in infants and young children or radical excision with end-to-end anastomosis may be preferable where there is no anatomical contraindication.
HISTORICAL DEVELOPMENT OF CARDIAC SERVICES AND TERTIARY PAEDIATRIC SERVICES IN QUEENSLAND .......... more HISTORICAL DEVELOPMENT OF CARDIAC SERVICES AND TERTIARY PAEDIATRIC SERVICES IN QUEENSLAND ..................................................7 ... DECISION NOT TO IDENTIFY THE CONTRIBUTING PARTIES .................18 ... PROBLEMS WITH CARE OF CARDIAC INFANTS AND ...
The Journal of thoracic and cardiovascular surgery, 1980
Five patients aged 2 months to 2 years with isolated large supracristal ventricular septal defect... more Five patients aged 2 months to 2 years with isolated large supracristal ventricular septal defect (VDS) and severe pulmonary hypertension had corrective operation between April, 1978, and November, 1979, performed via a trans--pulmonary arterial approach. This technique provided excellent exposure for accurate placement of sutures, especially between the two semilunar valves. All patients are well, with no residual defects, and their postoperative electrocardiograms (ECGs) do not show any intraventricular conduction abnormality. The technique is especially useful in the presence of severe pulmonary hypertension, wherein ventriculotomy is best avoided and the dilated main pulmonary artery offers excellent access.
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