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Biomedical subjects

C E Mullins

Publications and source records attributed to C E Mullins.

151 records · Page 9Linked to original sources
PubMedDate not supplied

Patent foramen ovale morphology and impact on percutaneous device closure.

We sought to evaluate the effects of atrial septal and patent foramen ovale (PFO) morphology on the efficacy of transcatheter closure. We performed a retrospective analysis of all patients who underwent PFO device closure from January 1997 to January 2002. Forty-seven patients underwent percutaneous closure of a PFO with a median age of 45 years (range, 8-75) and weight of 76 kg (range 28-115). The septal morphology was flat in 33 and aneurysmal in 14 patients. The PFO morphology was a simple flap in 20 and complex in 27 patients. Complex morphologies included long-tunnel PFO (n = 15), coexistent small atrial septal defect (ASD) (n = 5), and aneurysmal septum without a tunnel or ASD (n = 7). Nonstretched PFO diameters were significantly smaller than stretched (4.8 +/- 1.1 mm vs 11.6 +/- 3.8 mm, p < 0.01). Median device size: stretched diameter ratio (DS:SD) was 3.7:1 (range, 2.2-9.1). The DS:SD ratio was significantly higher in patients with complex PFO (mean, 3.9:1 vs 2.6:1; p < 0.05). Device placement was successful in all patients. Five patients required transeptal puncture of the foraminal flap in long-tunnel PFOs. Effective closure on follow-up was achieved in 45 patients (95%). Of the 2 patients with residual shunts, 1 had a complex PFO and the other a simple PFO. Two patients (5%) experienced recurrent neurologic symptoms after device closure despite having no residual shunt by echocardiography. Complex PFO did not increase risk of residual shunt or recurrent neurologic symptoms after device closure.

Adolescent↗
PubMedDate not supplied

Novel approach to transvenous pacemaker implantation in a post-fontan adolescent.

Postoperative bradycardia is not uncommon following the Fontan procedure in patients with a functional single ventricle. The surgical connections created with various Fontan modifications may complicate access to the atria for transvenous implantation of a permanent pacemaker. We describe approaches to overcoming problems with atrial access in an adolescent with complex congenital heart disease who required permanent transvenous atrial pacing for tachycardia-bradycardia after Fontan surgery.

Adolescent↗
PubMedDate not supplied

Rashkind dedication.

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Cardiac Surgical Procedures↗
PubMedDate not supplied

Congenital fistulae of the coronary arteries. Clinical considerations and surgical management in 23 patients.

Experience gained during the past 18 years at the Texas Heart Institute in the surgical treatment of 23 patients with coronary artery fistulae is reported. Patients ranged in age from three to 63 years; 18 were women. The right coronary artery was most frequently involved (14 patients) and in 18 patients the fistulous communication was terminal. Cardiac catheterization and angiography were aids in determining the exact diagnosis in all but two patients. During the last three years cardiopulmonary bypass was used in five of eight patients, and it is believed that extracorporeal circulation should be employed routinely. Terminal fistulae were ligated with sutures distally, close to the cardiac chamber. Lateral fistulae, when single, can be closed if feasible by tangential arteriorrhaphy. However, in most of these patients multiple communications and aneurysmal dilatation are encountered which would be treated more successfully by proximal and distal ligation of the fistula and distal coronary bypass revascularization. There were no operative deaths in our series. It is believed that with the help of today's advanced methods in anesthesia, extracorporeal circulation and coronary artery bypass surgery, all patients with coronary artery fistulae, once diagnosis has been made, should undergo surgical treatment.

Adolescent↗