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Biomedical subjects

A E Becker

Publications and source records attributed to A E Becker.

At least 163 records · Page 9Linked to original sources
PubMed1986

The surgical pathology of rheumatic and floppy mitral valves. Distinctive morphologic features upon gross examination.

A total of 30 surgically resected complete mitral valves were examined, without prior knowledge of the clinical history, to evaluate the reliability of gross inspection only for the correct morphological diagnosis. Twenty valves were rheumatic; 10 were obtained from patients with idiopathic mitral valve prolapse. Two groups were identified: group I correlated with a rheumatic history; group II showed floppy mitral valves, which correlated with mitral valve prolapse. Hence, it is considered that the diagnosis of rheumatic or floppy mitral valve can be established accurately upon gross examination only. The rheumatic valve is fibrotic and firm, leading to thickening and fusion of leaflets and commissures. Narrowing and lowering of the "principal" ostium occurs. This results in a funnel-shaped valve, which is further accentuated by interchordal fusion. Rigidity is its hallmark. Chordal rupture is unlikely. Calcification can be found anywhere in the valve. Hooding is extremely unusual. The floppy valve, by contrast, shows laxity of leaflets, which may lead to the formation of dome-like deformities reaching above the level of the annulus. The chordae are often thin, attenuated, and may have ruptured. The distribution of chordae and mode of anchoring is often chaotic. Fibrosis occurs mainly at the anchoring sites of the chordae underneath or at the margin of the leaflet, or where previously ruptured, intertwined chordae are plastered underneath the dome. Fibrosis is further aggravated at the margins and atrial surface of the leaflets because of regurgitant friction. In spite of fibrosis, the floppy valve remains soft and flexible. Commissural fusion is absent. Interchordal fusion is not a characteristic feature of the floppy mitral valve. Gross inspection will not only correctly discriminate between a rheumatic and floppy mitral valve, but may also contribute to an understanding of the pathogenesis of the valve deformity.

Humans↗
PubMed1986

The infundibular septum in normal hearts and in hearts with isolated ventricular septal defect. A comparison between Japanese and Dutch hearts.

The observation that subpulmonary or doubly committed subarterial ventricular septal defects occur with a high frequency among orientals as compared to westerners has led to the hypothesis that a racial difference exists with regard to normal and abnormal development of the embryonic conal septum. In an attempt to contribute to this concept we have studied 24 normal hearts and 70 hearts with a perimembranous ventricular septal defect from patients of Japanese and Dutch origin. The length of the infundibular septum and the length of the right ventricle were not statistically different between the 2 groups. These findings suggest that in normal hearts and in hearts with perimembranous ventricular septal defects no racial differences exist with respect to the role of the embryonic conal septum in contributing to the definitive infundibular septum. The results indicate that subpulmonary or doubly committed subarterial defects may have a different origin from that of the usual perimembranous defect.

Asian People↗
PubMed1986

Kawasaki disease: a pathology survey in western Europe.

There is an increasing awareness that Kawasaki disease does occur outside Japan, but reliable data regarding the incidence of the disease in western Europe are lacking. Such information may be important, not only providing insight into the incidence but also indicating whether or not the pathology is comparable to that reported from Japan. For these reasons a survey has been initiated among pediatric pathologists in western Europe with the use of a questionnaire. The results show that the experience with Kawasaki disease of pediatric pathologists in western Europe is extremely limited. Only 25 cases have been reported. One may infer from these data that the incidence of Kawasaki disease in western Europe is far below that in Japan. The pathology encountered appears to be the same as that reported from Japan and the United States. This finding in particular may be important for further epidemiological studies regarding etiology and pathogenesis of Kawasaki disease.

Child, Preschool↗
PubMed1985

Surgical anatomy of the atrioventricular conduction bundle in anomalous muscle bundle of the right ventricle with subarterial ventricular septal defect.

A stillborn baby girl was found to have an anomalous muscle bundle of the right ventricle, associated with a doubly committed subarterial ventricular septal defect. The latter was separated from the area of the atrioventricular conduction bundle by muscle. Serial histologic sectioning of the specialized atrioventricular junctional area revealed that the final bifurcation of the branching bundle came astride the septum in the inferior angle of the defect. The right bundle branch bifurcated and one of its branches continued along the anomalous muscle bundle in subendocardial position. This anatomy supports the concept that the bundle, in this heart, represented an early takeoff of the moderator band. The surgical anatomy suggests that resection of the anomalous muscle bundle and closure of the ventricular septal defect might well have produced heart block. The generally accepted rule that resection of anomalous muscle bundles in the right ventricle is surgically safe should be reconsidered.

Bundle of His↗
PubMed1985

Classification of hearts with overriding aortic and pulmonary valves.

Despite the clarity of the sequential segmential segmental approach to complex congenital heart malformations, the classification of hearts with overriding arterial valves remains contentious. A series of 67 hearts, all with overriding arterial valves, has therefore been studied in an attempt to provide clear and unambiguous criteria for their classification. There were 51 hearts with an overriding aortic valve, 13 hearts with an overriding pulmonary valve and 3 specimens with overriding of both valves. In each of these categories the degree of override and the underlying morphology varied considerably. The options to classify these hearts are limited. Using the "50 per cent rule" as a device to catalogue the type of connexion - irrespective of the morphology - all hearts were described in unambiguous fashion. A comparison with synonyms, as frequently used for purposes of classification, revealed that the latter are often insufficient properly to classify the basic abnormality. By classifying the type of connexion and describing the morphology separately, no basic problem remains in distinguishing between hearts with double outlet right ventricle and subpulmonary ventricular septal defect and hearts with the morphology of Fallot's tetralogy with an aorta almost exclusively arising from the right ventricle. Similarly, the classification of hearts with complete transposition and subpulmonary defect in the setting of the so-called Taussig-Bing heart is brought back to its proper perspective. Proper and consistent application of the sequential segmental approach leaves no room for ambiguity, even in complicated hearts with overriding arterial valves.

Aortic Valve↗
PubMed1985

Dead-end tract of the conduction axis.

In the definitive heart the anterior continuation of the main conduction axis is considered to be the right bundle branch. In this study three hearts from neonates and infants were examined in which this situation did not pertain. The conduction axis continued beyond the point of origin of the right bundle branch as a dead-end tract. In two normal hearts the tract then faded out in the central fibrous body. In one heart with Fallot's tetralogy it disappeared on the crest of the trabecular septum. Although we are unaware of any functional significance of these tracts, our findings are of considerable interest in understanding the development of the atrioventricular conduction system.

Bundle of His↗
PubMed1985

Morphological characteristics of perimembranous ventricular septal defects and their surgical significance.

The recognition of perimembranous ventricular septal defects and their subcategorization into inlet, outlet and trabecular types is important surgically because of the information it gives concerning the relationship with the atrioventricular conduction bundle. Inlet and outlet defects are well defined. The trabecular defect, in contrast, is less well defined. To obtain a better understanding of the perimembranous trabecular defect we studied 30 hearts, each having a ventricular septal defect known to be perimembranous. Of these 30 hearts, 16 were classified as inlet and 10 as outlet types. The "in between" trabecular defect in each of the remaining four hearts was slit-like, extending from the membranous septum into the area of the medial papillary muscle complex. Each was associated with a complex arrangement of the adjacent tricuspid valve leaflet tissues. In three hearts, leaflets and chords were attached to both the upper and lower rim of the defects. In the other specimen a shelf-like anomalous leaflet attachment was present along the lower rim. The atrioventricular conduction tissues were studied in two of the hearts, showing a close relation between the conduction bundle and the rim of the defect and the anomalous tricuspid valve leaflet attachments. In one case a most unusual disposition was encountered. A fan-like right bundle originated from the main axis at the same level as the origin of the left bundle branches. The anomalous fan penetrated into the connective tissue core of the valve leaflet. The bundle was then traced anteriorly to its usual intramyocardial position. The observed features of perimembranous trabecular ventricular septal defects warrant further caution should they require surgical repair.

Heart Conduction System↗
PubMed1985

Ventricular exclusion during Fontan operation: an evolving technique.

The modified Fontan operation, which consists of ventricular exclusion by obliteration of the right atrioventricular ostium, requires a technique that provides firm and permanent occlusion while preserving the atrioventricular node and bundle. Ten patients underwent such an operation. In 5 of them, closure of the right atrioventricular ostium was achieved by suturing a patch into the valve leaflets; in the other 5, the ventricle was excluded by a patch sutured into the right atrial wall above the annulus fibrosus. None of the patients who underwent this procedure experienced heart block postoperatively. However, three instances of late patch dehiscence occurred, each in the group of patients in whom the patch had been attached to the valve leaflets. We conclude that both patching techniques are safe as far as the atrioventricular node and bundle are concerned but that permanent occlusion is better obtained by implanting the patch into the atrial wall. Therefore, we prefer to use this technique.

Adolescent↗
PubMed1985

Isolated mitral valve prolapse: chordal architecture as an anatomic basis in older patients.

Ten patients with an average age of 58 years underwent valve replacement because of isolated mitral valve prolapse with severe regurgitation. None had clinical evidence of Marfan's syndrome or another systemic disease that would indicate that a primary connective tissue disorder was the cause of the prolapse. All 10 patients had a dome configuration of the posterior leaflet and one or more ruptured chordae related to it. The gross morphology of the resected specimens revealed marked deviations in chordal branching and the pattern of anchoring in each of the 10 cases, rendering the most severely affected parts of the leaflets less well supported. Similar changes occurred at sites remote from the principal abnormality. Microscopically, the dominant tissue change was myxomatous transformation within the affected leaflets and chordae with secondary changes at both atrial and ventricular surfaces. These findings could indicate that insufficient chordal support may have promoted the development of the floppy valve through a process of chronic undue and unbalanced stress on the valve tension and closure apparatus. The resultant degeneration of the connective tissues, histologically expressed as myxomatous transformation, may underlie stretching and thus redundance of the leaflets and eventually rupture of chordae. It is suggested that this sequence of events be considered as a possible pathogenetic mechanism of isolated mitral valve prolapse, particularly in the subset of aged patients.

Age Factors↗
PubMed1985

Early prenatal detection of double outlet right ventricle by echocardiography.

A double outlet right ventricle with subpulmonary ventricular septal defect and right sided hypoplastic aorta was diagnosed in a 22 week fetus of a mother with diabetes mellitus. Elective termination of pregnancy was carried out and the echocardiographic findings were confirmed. Early prenatal detection of congenital heart disease may allow elective termination of pregnancy when the fetus has severe defects.

Adult↗
PubMed1984

The univentricular atrioventricular connection: getting to the root of a thorny problem.

Most hearts described as "single ventricle" or "univentricular heart" possess 2 ventricular chambers, even though 1 is usually described as an "outlet chamber." This stems from the wide acceptance that the criterion of a single ventricle is the presence of a double-inlet atrioventricular (AV) connection. In recent years, using this criterion, an attempt was made to show how hearts with double-inlet right ventricle or "classic tricuspid atresia" were (in terms of ventricular morphology) just as univentricular as "single ventricle with outlet chamber." This attempt brought still further confusion to an already contentious topic. The root of the problem clearly is the injudicious use of the adjective "single" or "univentricular." Conventionally it is used to describe the ventricular mass. In most hearts with double-inlet connection it is not the ventricles that are univentricular; it is the AV connection. The concept of a univentricular AV connection, then, appropriately groups hearts with double-inlet along with those having absence of 1 AV connection. It distinguishes this entire group from those other hearts with biventricular AV connections (each atrium connected to its own ventricle). The term "univentricular AV connection" is thus a collective one for all those hearts in which the atria connect to only 1 ventricle. Confusion will be completely removed if individual hearts are described for what they are in terms of AV connection and ventricular morphology (for example, double-inlet left ventricle with rudimentary right ventricle rather than single ventricle with outlet chamber).

Heart Atria↗
PubMed1984

"Offsetting" of the septal tricuspid leaflet in normal hearts and in hearts with Ebstein's anomaly. Anatomic and echographic correlation.

Apical displacement of the septal tricuspid valve leaflet is considered the most reliable criterion to diagnose Ebstein's anomaly. This feature is best assessed using 2-dimensional echocardiography. However, the anatomy in Ebstein's anomaly is highly variable; therefore, the problem arises as to how to distinguish between the abnormal displacement in borderline cases of Ebstein's disease and the lowered septal offsetting of the tricuspid valve in normal persons. To solve this problem the minimal and maximal differences in offsetting of the tricuspid and mitral valves have been studied, both anatomically and echocardiographically, in fetuses, infants, children and adults. In fetuses in the first trimester of pregnancy it was impossible to measure a difference in offsetting of the 2 atrioventricular valves. Thereafter, a gradual increase occurred with age. In normal hearts the most significant separation was usually recorded in anteriorly angulated 4-chamber views, whereas in hearts with Ebstein's anomaly maximal separation appeared to posteriorly angulated views. The anatomic and echographic measurements showed a constant relation. When the minimal distances in offsetting were measured, an overlap was found between cases with and those without Ebstein's anomaly. The maximal values, however, clearly discriminated between the 2 conditions. The critical difference in children was 15 mm, and in adults the discriminating value was 20 mm.

Adolescent↗
PubMed1984

The pathology of the heart following long-term anticoagulant therapy in elderly patients after myocardial infarction. The Dutch sixty-plus reinfarction study.

A pathomorphologic study of 30 hearts of elderly patients, who died during a double-blind trial to assess the long-term effects of oral anticoagulants following myocardial infarction, showed that all patients had suffered of severe and extensive obstructive coronary atherosclerotic disease. Eight hearts were obtained from patients who had received anticoagulants, while 22 hearts were obtained from patients of the placebo group. Complicated coronary arterial lesions, such as cracked plaques and coronary thrombosis, occurred more frequently in hearts of patients of the placebo group. A recurrent recent infarction was found at autopsy in 13 of the 22 patients receiving a placebo, in contrast to 3 of the 8 hearts from the group of patients receiving anticoagulants. The findings point in the same direction as the clinical trial, which showed a statistically significant reduced risk of recurrent myocardial infarction and, hence, cardiac death, but in the autopsy study do not reach statistical significance. The occurrence of grossly recognizable intraventricular thrombosis in 5 of the 22 hearts from the placebo group contrasted to none in the 8 hearts of the anticoagulant group. Although none of these differences is statistically significant they all point in one and the same direction, viz. prevention of complicating thrombotic lesions following the long-term application of anticoagulants.

Aged↗