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Biomedical subjects

A E Becker

Publications and source records attributed to A E Becker.

At least 235 records · Page 13Linked to original sources
PubMed1979

Palliative Mustard or Rastelli operation in complete transposition of the great arteries. Option decided by lung biopsy.

A case history is reported of a patient with complete transposition of the great arteries and a ventricular septal defect in whom pulmonary hypertension developed, with a pulmonary resistence of 10 units M.2. Because of the possibility that the pulmonary vascular obstructive disease might have been of recent onset and that a high hematocrit value of 82 percent may have interfered with the precise determination of pulmonary resistance, an open lung biopsy was performed. The histologic findings suggested that the vascular disease was as yet reversible. Because of these findings and the aforementioned considerations, a Rastelli operation was performed instead of a palliative Mustard procedure. At present, 6 months postoperatively, the patient is asymptomatic.

Adolescent↗
PubMed1979

Morphologic spectrum of Ebstein's anomaly of the heart: a review.

The rare and curious congenital malformation of the tricuspid valve known as Ebstein's disease or Ebstein's anomaly has been a subject of considerable interest to the cardiologist and the morphologist since its first description by Wilhelm Ebstein in 1866. With the evolution of various surgical techniques for the correction of this anomaly, a thorough understanding of the pathologic anatomy of the malformation assumes greater practical importance. It is now clear that although all hearts with Ebstein's anomaly have in common displaced basal insertions of the septal and posterior leaflets of the tricuspid valve, each case may be pathologically and hemodynamically unique. The malformed tricuspid valve may be incompetent, stenotic, or rarely, imperforate. It may be found in a left-sided tricuspid valve with inversion of ventricles. It is important that these individual variations be recognized so that the operative approach can be tailored to the particular variant of the malformation at hand.

Coronary Vessels↗
PubMed1979

Nomenclature of the univentricular heart.

A simple system for the analysis and classification of the univentricular heart is described. The basis of this approach is the use of a step by step sequential nomenclature with attention paid to the morphology, connexions and relationships of each cardiac segment in turn. Three major morphological types of univentricular heart are identified and these may be distinguished, by their characteristic trabecular patterns, into hearts of left ventricular type, right ventricular type and indeterminate type. With the exception of the last it is usual for a rudimentary second chamber to be present upon the use of a clear definition of "ventricle", depending on readily ascertainable anatomical characteristics. Each morphological type of univentricular heart may be associated with a wide variety of different connexions and intracardiac relationships and it is neither possible nor desirable to describe these in terms of a rigidly structured classification. Adherence to the simple semantic framework outlined would resolve much of the confusion and controversy which exists in relation to the univentricular heart.

Heart Septal Defects, Ventricular↗
PubMed1979

Atrioventricular conduction tissues in univentricular hearts of left ventricular type.

Univentricular heart of left ventricular type is defined as the condition in which the entirety of atrial inputs is committed to a main chamber exhibiting trabecular pattern of left ventricular type, usually in the presence of another chamber in the ventricular mass which has a right ventricular trabecular pattern. This condition can occur with two atrioventricular valves, a common atrioventricular valve, a straddling atrioventricular valve or with absence of the right or left atrioventricular connexions. The hallmark of univentricular heart of left ventricular type is absence of the inlet septum, which normally separates the inlet portions of the two ventricles and which in the normal heart carries the atrioventricular conduction bundle. In univentricular heart of the left ventricular type, as a consequence of its absence, an abnormal disposition of the atrioventricular conduction tissues is found. An anterior or lateral atrioventricular node is present from which the prenetrating bundle descends onto the trabecular septum separating main chamber from rudimentray chamber. The topographical relationship of the bundle particularly with respect to the outflow tract of the posterior great artery from the main chamber, depends on the position of the rudimentary chamber. In atrial situs solitus, a left-sided rudimentary chamber will be associated with a long bundle in close proximity to the ostium of the posterior great artery from the main chamber. In contrast, in the heart with a right-sided rudimentary chamber the bundle will stay remote from the posterior outflow tract. The position of the rudimentary chamber will also alter the site of the ventriculotomy for any proposed corrective surgery and, hence,, alter the relationship of the bundle relative to the outlet foremen, as viewed by the surgeon. The general disposition of the atrioventricular conduction system in univentricular heart of left ventricular type is not altered by the type or mode of the atrioventricular connexion, nor by the type of the arterial connexion.

Atrioventricular Node↗
PubMed1979

Ventricular morphology in the univentricular heart.

The ventricle morphology is described in hearts in which the entire atrial inputs are committed to a single chamber in the ventricular mass, this being considered the criterion for definition of the univentricular heart. Such a definition does not exclude from the univentricular category hearts with two chambers in their ventricular mass providing that the second chamber does not receive a direct atrial input. Three types of ventricular morphology were identified: hearts with a main chamber of left ventricular pattern and a rudimentary chamber of right ventricular pattern; hearts with a main chamber of right ventricular pattern and a rudimentary chamber of left ventricular pattern and hearts with a sole chamber in their ventricular mass of indeterminate pattern. Hearts may also exist of right or left ventricular type without rudimentary chambers. Variation was noted in type and position of the rudimentary chambers. Chambers of either right or left ventricular type were found supporting either or both great arteries (outlet chambers), and also without a direct outlet (trabecular pouches). Right ventricular rudimentary chambers were usually anterior but could be right or left sided; left ventricular chambers were posterior but again could be right or left sided. Hearts with these ventricular morphologies possessed either double inlet atrioventricular connexions, or absence of the right or left atrioventriuclar connexion. In double inlet ventricles, cases were observed with two valves, a common valve, one imperforate valve, and with straddling atrioventricular valves. A straddling valve was also found in hearts with absence of one atrioventricular connexion. Further variation was found in the pattern of arterial connexions. It is concluded that ventricular morphology is an important feature of the iniventricular heart but must be considered in the context of other important and variable features.

Heart Septal Defects, Ventricular↗
PubMed1979

Problems in the nomenclature of the univentricular heart.

There are three main reasons why there are problems concerning the nomenclature of the univentricular heart. The first is that different authorities have used the same term to describe different varieties of the univentricular heart. The second is that many of the terms used in categorisation of these anomalies are derived from embryological concepts which are more or less speculative. The final reason, perhaps the major one, is that there is a lack of definition of a ventricle. Consequently there is no consensus as to precisely what constitutes a "univentricular" heart. Many of the heart described as "single" or "common" ventricle possess two chambers within their ventricular mass. For such hearts to be univentricular it is evident that one of these chambers cannot be a ventricle. Yet definitions have yet to be provided to distinguish ventricles from rudimentary chambers. The solutions to these problems can be produced firstly by using descriptive terms for categorisation of univentricular hearts which do not have multiple meanings. Secondly, the problems concerning usage of embryologic terms can be easily circumvented by eschewing all embryologic considerations in naming these malformations. The problem of definition of a ventricle is best solved by considering normal ventricles as possessing three portions -- an inlet portion, a trabecular portion and an outlet portion. It may then be proposed that the minimal requirements for a ventricle are that it possesses at least an inlet and a trabecular portion. Chambers without inlet portions are rudimentary chambers. Either ventricles or rudimentary chambers may possess a trabecular pattern of right or left ventricular type. Tue univentricular heart may then be categorised as composing all anomalies which have a sole chamber in their ventricular mass together with all anomalies which possess a rudimentary chamber.

Heart Septal Defects, Ventricular↗
PubMed1978

Plunging or cervical ranula. Review of the literature and report of 4 cases.

A review of the literature pertaining to plunging ranula is presented with special emphasis on the historical development of the various aetiological theories and treatment recommendations. Also 4 cases of plunging ranula are presented; three were treated by extirpation of the sublingual gland and one was treated by exteriorization of the ranula into the oral cavity. The treatment methods used here are discussed in relationship to the accepted aetiological theory.

Adult↗
PubMed1978

Ebstein's anomaly in persistent common atrioventricualr canal.

This report documents 2 patients who presented with cyanosis early in life. In both instances the necropsy showed the simultaneous occurrence of an imcomplete type of persistent atrioventricular canal and an Ebstein's malformation of the "tricuspid" valve component. In the first patient no clinical investigations were done. In the second patient the electrocardiogram was consistent with persistent atrioventricular canal and the angiocardiogram showed the characteristic goose-neck deformity. Moreover, an abnormality of the right cardiac contour was seen, which in retrospect was correlated with the right-sided Ebstein's malformation. Ebstein's anomaly may significantly alter the clinical and haemodynamic profile of atrioventricular canal and should be considered in atypical cases. The presence of Ebstein's anomaly will complicate surgical repair of the atrioventricular canal.

Angiocardiography↗
PubMed1978

Histopathology of the ductus arteriosus after prostaglandin E1 administration in ductus dependent cardiac anomalies.

The histology of the ductus arteriosus was studied after prostaglandin E1 (PGE1) administration in 4 infants with ductus dependent cardiac malformations. Pronounced pathological changes were found in each instance. The changes consisted of oedema of the media with separation of medial components by clear spaces, pathological interruptions of the internal elastic lamina, and intimal lacerations, some of which extended into the media. The findings suggest that PGE1 administration has a profound weakening effect on the structure of the wall of the ductus arteriosus, rendering the vessel prone to laceration.

Ductus Arteriosus↗
PubMed1978

The anatomical substrates of wolff-parkinson-white syndrome. A clinicopathologic correlation in seven patients.

Clinicopathological correlations were made on the hearts from seven patients known to have exhibited electrocardiographic evidence of the Wolff-Parkinson-White syndrome. In each case, clinical and pathological investigations were conducted independently, neither group of investigators having knowledge of the other's results. In all seven hearts, the entire atrioventricular junctions were serially sectioned. Accessory atrioventricular connections were predicted in all seven cases following electrocardiographic investigation. Connections were identified histopathologically in four hearts in the predicted site. In another case two connections were identified, one being considered responsible for the pre-excitation. In the sixth case a right lateral connection was anticipated, but only accessory nodo-ventricular fibers were identified following histopathologic studies. In the final case, a posterior septal connection was predicted but the entire septum had fibrosed following previous operation. These findings are discussed in the light of the investigative techniques used, the theories of pre-excitation and the embryogenetic mechanisms producing accessory atrioventricular connections.

Adult↗
PubMed1977

Premature contraction of the ductus arteriosus: a cause of foetal death.

Necropsy findings are presented of two cases of foetal heart failure secondary to premature, in-utero contraction should lead to a redirection of the right heart output either through the pulmonary vascular bed or to the systemic circulation via the foramen ovale. The muscular pulmonary arteries, however, were not dilated, indicating that no excessive pulmonary flow had occurred. The increased volume load on the right heart may have rendered the foramen ovale restrictive, with right-sided heart failures as a consequence. Premature closure of the ductus arteriosus should be considered a cause of foetal or early neonatal death.

Constriction, Pathologic↗