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Biomedical subjects

C Lincoln

Publications and source records attributed to C Lincoln.

At least 109 records · Page 6Linked to original sources
PubMed1984

Cor triatriatum sinistrum. Diagnostic features on cross sectional echocardiography.

M mode and cross sectional echocardiography was carried out in three cases of cor triatriatum sinistrum (two infants and one adult). In two cases a peculiar double arch appearance, not previously reported, was found. All three cases were referred for surgery without cardiac catheterisation, and the diagnosis proved to be correct. The characteristic echocardiographic feature of cor triatriatum is an intra-atrial membrane detected in multiple planes of examination, curving anteroinferiorly and inserting some distance away from the mitral valve ring, proximal to the left atrial appendage. Superiorly the membrane runs parallel to, and a short distance behind, the aortic root creating a superior recess of the distal left atrial chamber. These features differentiate cor triatriatum from a supravalvar mitral ring. During diastole the membrane moves forward towards the mitral valve funnel. This, together with the arching appearance of the membrane on four chamber views and the more superior position of the membrane, makes it possible to distinguish cor triatriatum from total anomalous pulmonary venous drainage to the coronary sinus. From a review of past experience at the Brompton Hospital of the diagnostic accuracy of cardiac catheterisation in this condition, it is concluded that cross sectional echocardiography is superior to angiography as a technique for diagnosing cor triatriatum.

Adult↗
PubMed1984

The spectrum of atrioventricular discordance. A clinical study.

The clinical, investigative, and surgical findings were reviewed in 47 patients with atrioventricular discordance who presented to the Brompton Hospital between January 1962 and June 1981. Although the unifying feature was the atria connecting to morphologically inappropriate ventricles, the hearts differed widely in other respects. In most cases there was the usual visceral and atrial arrangement, but six had a mirror image arrangement of the atria and viscera. Among those patients with usual atrial arrangement (solitus) the aorta was not always anterior and left sided, and ventricular "inversion" was not invariable. Only 35 of the 47 patients also had a discordant ventriculoarterial connexion, the majority of the remainder having a double outlet right ventricle. The specific diagnosis of atrioventricular discordance depended on echocardiographic and angiographic examination. The other investigations did not distinguish between different ventriculoarterial connexions and were not specific even for the presence of atrioventricular discordance. For those patients with the usual atrial arrangement the anticipated right heart border was present in only just over one third, and the reversal of Q wave progression in the precordial leads of the standard electrocardiogram was found in under a half. Many patients with atrioventricular discordance progressed normally to adult life. In 20 cases no surgery was performed. The results of total correction showed a mortality of 25% (three cases), including two deaths after a modified Fontan procedure for exceedingly complex associated lesions. The results of surgery in the survivors were excellent, and awareness of the disposition of the atrioventricular conduction tissue made it possible to avoid atrioventricular dissociation.

Adolescent↗
PubMed1983

Diminutive pulmonary artery growth following right ventricular outflow tract enlargement.

We have assessed the clinical results and angiographic pulmonary artery growth following construction of the right ventricular outflow tract in 10 children with tetralogy of Fallot or pulmonary atresia. All cases were associated with diminutive pulmonary arteries and considered unsuitable for total corrective surgery. The mean age of the children was 34 months, mean weight 10 kg and mean body surface area 0.48 m2. The right ventricular outflow tract was constructed by insertion of a patch of dura mater (5 patients), pericardium (2 patients), homograft valved conduit (2 patients) and infundibulectomy (1 patient). The ventricular septal defect was not closed. Study of the patients between 13 and 37 months postoperatively revealed an increase in mean arterial oxygen saturation of 22% (P less than 0.01) and a fall in mean haemoglobin concentration of 1.6 g% (P less than 0.05). Overall change in pulmonary artery diameter compared to that of the trachea was insignificant although in individual cases a 50% increase in diameter was shown. Palliation of symptoms was equivalent to conventional shunting procedures. Closure of the ventricular septal defect was performed successfully in 2 patients at a later date.

Child↗
PubMed1983

Aortopulmonary septal defect coexisting with ventricular septal defect and pulmonary atresia.

Three patients are described in whom an aortopulmonary septal defect (aortopulmonary window) coexisted with a ventricular septal defect and pulmonary atresia. One patient had mild and another, moderate aortic regurgitation. In addition, one patient had a sinus of Valsalva aortic aneurysm, while another had a single coronary artery arising from the pulmonary trunk. One patient underwent surgical correction in infancy; the other two, in early adult life. In all three patients, surgical correction involved closure of the aortopulmonary window, closure of the ventricular septal defect, and placement of a valved conduit between the right ventricle and the distal pulmonary trunk. One patient died 3 weeks postoperatively due to secondary hemorrhage where the conduit had been sutured to the right ventricle. The other two patients are alive and well 3 1/2 years and 6 months after surgery, respectively. The presence of aortopulmonary window permits normal development of the pulmonary arteries in the presence of the coexisting pulmonary atresia; in the three patients described, the absence of pulmonary vascular disease made total surgical repair feasible for this combination of defects.

Adult↗
PubMed1983

Bacteraemia with upper gastrointestinal endoscopy--a reappraisal.

To assess the risk of infective endocarditis for susceptible patients having upper gastrointestinal (GI) endoscopy, we have prospectively studied the incidence, level, duration and source of endoscopy-related bacteraemia and the microorganisms involved. Blood was drawn for aerobic and anaerobic culture and pour plate estimation from 50 patients undergoing upper GI endoscopy. Blood cultures were positive in two patients with the isolation of Streptococci and other oropharyngeal organisms during and 5 min after endoscopy. Pre-endoscopy salivary cultures in both patients grew Streptococci identical to those isolated from the blood; pour plates were negative. We conclude that though the risk of infective endocarditis after upper GI endoscopy is probably very low, the finding of a 4% incidence of transient low-level bacteraemia of oropharyngeal origin argues for antibiotic prophylaxis for susceptible patients.

Adolescent↗
PubMed1983

Disinfection of gastrointestinal fibrescopes--evaluation of the disinfectants Dettox and Gigasept.

The disinfectant solutions Dettox (based on a quaternary ammonium compound) and Gigasept (based on succine dialdehyde) were evaluated during disinfection procedures with a new disinfecting apparatus for gastrointestinal fibrescopes. Thorough disinfection was achieved after 2 minutes using Dettox 8% or Gigasept 10%; persistent fibrescope contamination with Gram-negative organisms was found after disinfection with Dettox 4% or Gigasep 5%. No adverse effects in endoscopy staff or damage to fibrescopes were seen. Adequate disinfection of endoscopic equipment prevents endoscopy-related infection and can be readily achieved by trained endoscopy staff using rapidly bactericidal disinfectants.

Aldehydes↗
PubMed1983

Anatomic problems associated with arterial switch procedures for double outlet right ventricle with subpulmonary ventricular septal defect.

Two cases of double outlet right ventricle with subpulmonary ventricular septal defect treated by arterial switch operations are reported. The anatomical problems of coronary artery transfer, occult outflow tract obstruction and position of the pulmonary bifurcation are discussed. Cases of double outlet right ventricle and subpulmonary ventricular septal defect with anterior-to-posterior relation of the great arteries are suited to the repair techniques pioneered by Jatene for complete transposition and ventricular septal defect. Cases in which the great arteries are side-by-side pose more difficult problems, partly because of the more complex and varied anatomy of the coronary arteries, and because of the spatial relation of the roots of the great arteries. Although it may be possible to overcome these technical problems, we have reservations about the reproducibility of such a procedure. We believe, however, that cases of this type are best treated without recourse to "inflow" correction. The options are either the arterial switch procedure or a modified Rastelli operation.

Child, Preschool↗
PubMed1983

Experience with the modified Blalock-Taussig operation using polytetrafluoroethylene (Impra) grafts.

Between June 1978 and January 1982, 115 patients underwent 122 subclavian artery-pulmonary artery shunts using polytetrafluoroethylene (PTFE Impra) grafts. Forty-six of the patients had a ductus dependent pulmonary circulation, the patency of which was maintained by an infusion of prostaglandin E2 in 29 cases. There were nine hospital deaths, four of which were related to shunt failure. Five patients underwent a second shunt procedure within one week of the first. There were two cases of late graft occlusion. Twelve shunts were considered to have failed. The actuarial estimate of shunt patency was 90% (+/- 3%) at two years for all patients and 74% (+/- 10%) for neonates. There was no statistically significant difference in two year shunt patency between 4 mm grafts (88 +/- 5%) and 6 mm grafts (96 +/- 3%). The modified Blalock shunt using a PTFE graft is an effective pulmonary-systemic shunt with a good short term patency.

Adolescent↗
PubMed1983

Duration of circulatory arrest does influence the psychological development of children after cardiac operation in early life.

Published works on intelligence quotient (IQ) and development following the use of profound hypothermia and circulatory arrest (TCA) to repair congenital heart defects in infants and young children suggest that little or no psychomotor impairment results. IQ scores derived from cognitive, memory, perceptual, quantitative, and verbal tests (McCarthy scale of the children's abilities, mean score 100, SD 16) were measured in 31 patients 5 years following operations performed with TCA between 1972 and 1976. These patients were compared with three control groups: (1) 19 patients with similar defects but operated upon using moderate hypothermia and continuous cardiopulmonary bypass (CPB); (2) 16 children who were the siblings of the TCA patients; and (3) 14 children who were the siblings of the CPB patients. The hypothermic temperatures reached were closely clustered around 15 degrees C in the TCA group and 28 degrees C in the CPB group. TCA time ranged from 22 to 71 minutes. Statistical analysis, which included, t test, chi square test of association, and Wilcoxon test, showed that the only baseline characteristic which differed between the two patient groups in respect to age at operation, age at testing, and preoperative physiological variables (level of cyanosis, weight, oxygen saturation, and hemoglobin concentration) was weight (p = 0.03). The mean score of the TCA group (91 +/- 4.0, SE) was significantly lower (p = 0.002) than that of their siblings (106 +/- 4.1, SE). The score for the CPB patients (102 +/- 5.2, SE) was not demonstrably different from that of their siblings (96 +/- 5.9, SE). The sibling and patient (TCA) IQ differences were associated with duration of arrest in verbal (p = 0.06), quantitative (p = 0.07), and general cognitive (p = 0.003) scores. A decrease of 0.53 point per minute of arrest time was estimated for the entire group of 31 patients; that is, in the 19 patients with siblings, for each minute increase in circulatory arrest time, the patients dropped 0.69 IQ point below their siblings. These results and analysis of other published data do not support the generally accepted view that TCA can be used entirely without penalty. We question the accepted "safe" limit of circulatory arrest of 60 minutes.

Cardiopulmonary Bypass↗
PubMed1983

Surgical correction in mirror-image atrial arrangement or left atrial isomerism with systemic venous return to the left-sided atrium.

We have recently encountered three patients with the hemodynamics of complete transposition accompanied by unusual atrial arrangements. The flow patterns produced all required correction by means of a "mirror-image" Mustard operation. Two of the patients had left atrial isomerism as evidenced by the finding of bilateral atrial appendages of morphologically left type. In both patients the systemic venous return was to the left-sided atrium and the pulmonary venous return to the right-sided atrium. The major effect of the isomerism was to reduce the volume of the left-sided chamber. This initially produced concern, since we now try to avoid enlargement of the pulmonary venous atrium when performing Mustard's operation. However, despite the small volume, it was possible to place the baffle without producing postoperative pulmonary or systemic venous obstruction. The other significant effect of left atrial isomerism is to deviate the position of the sinus node, but thus far we have not encountered any postoperative rhythm problems. The third patient had a mirror-image arrangement of the atrial chambers and the venous connections (situs inversus), and the anatomy was corrected by straightforward mirror-image reversal of our current technique for Mustard's procedure.

Child↗
PubMed1982

New disinfecting apparatus for gastrointestinal fibre-endoscopes.

Bacterial contamination of gastrointestinal fibre-endoscopes is a potential source of clinically significant infection. Aqueous 2% alkaline glutaraldehyde adequately disinfects fibre-endoscopes but may cause serious sensitivity reactions among endoscopy staff. A new 'closed-system' disinfecting apparatus is described that disinfects with glutaraldehyde for 30 minutes before an endoscopy session, for two minutes between patient procedures, and for 10 minutes before storage. Bacteriological cultures of the endoscope after disinfection were virtually sterile. Extremely low glutaraldehyde vapour levels were detected by gas chromatography in endoscopy room air during disinfection procedures. This relatively simple apparatus offers rapid, effective, and safe disinfection of fibre-endoscopes.

Disinfection↗
PubMed1982

Severe tricuspid stenosis presenting as tricuspid atresia. Echocargraphic diagnosis and surgical management.

Two cases of pulmonary atresia with intact ventricular septum and severe tricuspid stenosis are described in which the initial angiographic diagnosis was tricuspid atresia and pulmonary atresia. Two dimensional echocardiography showed the features of an imperforate tricuspid valve because in each case contrast echocardiography failed to show anterograde flow from the right atrium to right ventricle. Successful radical surgical repair was achieved in one patient with performing a tricuspid valvotomy and inserting an external valved conduit between the hypoplastic right ventricle and the main pulmonary artery. In the second case, an infant died four weeks after tricuspid valvotomy and right ventricular outflow tract reconstruction.

Child, Preschool↗
PubMed1982

Atypical tamponade after cardiac operation in infants and children.

A state clinically indistinguishable from cardiac tamponade can occur after operation for congenital heart disease in the absence of intrapericardial blood or clot. We have employed a method of splinting the sides of the sternum apart in nine patterns in whom low-output states developed postoperatively, unresponsive to either inotropic drugs or vasodilator therapy. Blood pressure, heart rate, central venous pressure, urine output, toe temperature, and arterial PO2 immediately before and 90 minutes after the procedure were compared. Significant increases in blood pressure (p less than 0.02), urine output (p less than 0.001), and toe temperature (p less than 0.001) and a significant fall in central venous pressure (p less than 0.001) resulted. The figures indicate a marked improvement in cardiac output which occurred without alteration in inotropic support or after load reduction. We conclude that mechanical restriction of ventricular relaxation can occur in the absence of intrapericardial blood or clot, may contribute to low-output states, and can be successfully managed by sternal splintage.

Cardiac Output, Low↗