Intraoperative balloon valvuloplasty for critical aortic valvular stenosis in neonates.
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Aortic Valve Stenosis↗
Biomedical subjects
D A Ott
Publications and source records attributed to D A Ott.
Arterial switch procedure in an adult.
The arterial switch procedure has been shown to offer both anatomic and physiologic correction in infants and children with transposition of the great arteries and ventricular septal defect. We believe that adults may also benefit in some circumstances, as evidenced by the case of a 22-year-old man who underwent successful operation after having initially undergone pulmonary artery banding for transposition with ventricular septal defect in 1967 when he was 5 months of age.
Abnormalities, Multiple↗
Supravalvar aortic stenosis: a 29-year review of surgical experience.
Between February 1960 and August 1989, 73 consecutive patients underwent surgical correction for supravalvar aortic stenosis (SVAS) at the Texas Heart Institute. There were 43 male (59%) and 30 female patients (41%) ranging in age from 5 days to 27 years (mean age, 12 years). Preoperatively, 8 patients were in New York Heart Association functional class I, 43 in class II, 18 in class III, and 4 in class IV. Of the 73 patients, 62 had localized SVAS and 11 (15%), diffuse SVAS. For all procedures, patients were placed on cardiopulmonary bypass. Those with localized SVAS were successfully treated with patch aortoplasty, whereas those with diffuse SVAS required either an apicoaortic conduit or extensive end-arterectomy with extended patch aortoplasty. There were eight early deaths (less than or equal to 30 days postoperatively) (11%) and four late deaths (greater than 30 days postoperatively) (6%) in a follow-up period ranging from 2 months to 28 years. Sixteen patients (25%) underwent one or more additional operations in the follow-up period. Postoperatively, there were 44 patients in New York Heart Association functional class I and 17 in class II. Preoperative functional class III and class IV (p less than 0.0005), diffuse SVAS (p = 0.05), and the presence of associated congenital defects (p less than 0.01) were important determinants of death.
Adolescent↗
Innominate artery occlusive disease: surgical approach and long-term results.
We reviewed our experience with 54 patients who underwent innominate artery revascularization during a 10-year period. Their age range was from 16 to 75 years (mean, 49.8 years). The innominate artery alone was involved in 21 patients (39%); the remaining patients had additional arch vessel obstructions. Before operation, neurologic symptoms occurred in 25 patients (46%), arm ischemia related to claudication and microembolization occurred in 8 patients (14%), a combination of symptoms occurred in 17 patients (32%), and no symptoms were noted in 4 patients (8%). The extrathoracic approach to surgery was used in 16 patients (30%). Eleven of the 38 patients in whom the intrathoracic approach was used had endarterectomy of the innominate artery; in three of those, the procedure was combined with left common carotid endarterectomy. Bypass grafts were used in the other 27 patients undergoing procedures with an intrathoracic approach; in six of those, bypass was combined with carotid endarterectomy. No operative deaths occurred. Perioperative revascularization failure occurred in four cases; all of those patients underwent a second revascularization procedure, with a secondary patency rate of 100%. In four patients, late occlusion was noted at 6 months and at 1, 1.5, and 10 years. One patient had a permanent perioperative neurologic deficit in the distribution of the left carotid artery after a combined common carotid endarterectomy/innominate endarterectomy procedure. No neurologic deficits were directly related to the innominate artery territory. Long-term actuarial survival was 83% at 10 years. Early and late graft failures were related to inadequate inflow in bypass grafts, progression of distal disease in arteritis, and primary closure in endarterectomy.
Adolescent↗
The pulmonary artery lasso: epicardial pacing lead causing right ventricular outflow obstruction.
Permanent pacing in small children may require placement of an epicardial pacing system. This report describes a young child who underwent pacemaker implantation with epicardial ventricular lead placement in infancy as an adjunct to antiarrhythmic therapy for congenital junctional ectopic tachycardia. At 5 years of age, a harsh systolic murmur was detected for the first time. Evaluation by catheterization and transluminal echocardiography showed right ventricular outflow obstruction (pressure gradient 40 mmHg) secondary to extrinsic compression by the epicardial lead. Surgical removal of the lead relieved the obstruction.
Cardiac Pacing, Artificial↗
Surgical and catheter ablative techniques for treating supraventricular tachycardia.
Although antiarrhythmic drugs are commonly used in patients with supraventricular tachycardia, their use is limited due to inefficacy, side effects and patient compliance problems. Nonpharmacologic therapies used in the treatment of supraventricular tachycardia include: antitachycardia pacing, DC and radiofrequency catheter ablation and surgical therapy. Although certain pacing techniques can prevent the initiation of tachycardia, antitachycardia pacing is primarily used to terminate the supraventricular tachycardia once it has occurred. In patients with primary atrial tachycardias that are refractory to treatment, DC or radiofrequency catheter ablation can be used to modify or completely ablate the AV junction with resultant complete heart block. With DC AV junction ablation, 65% of patients will have resultant third degree AV block and 20% of patients will have modification of AV condition. Results with radiofrequency ablation have shown efficacy rates ranging from 56-9470 and can be used without the need for general anesthesia. Both forms of catheter ablation can be used to selectively alter the retrograde limb of an AV node reentrant circuit. Catheter ablation has been successful in ablating accessory pathways. DC catheter ablation has been predominantly used in posterior paraseptal pathways. More recently, radiofrequency catheter ablation of the ventricular insertion site of accessory pathways has demonstrated usefulness in selective laboratories. Surgical therapy for supraventricular tachycardia has been used for excision and/or ablation of an atrial ectopic focus, surgical ablation of the AV node in patients with refractory atrial tachyarrhythmias and microsurgery of the AV node in patients with AV node reentrant tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
Atrioventricular Node↗
Surgical treatment of postinfarction rupture of the interventricular septum.
Between 1975 and 1990, 28 patients at our institution underwent surgical repair for rupture of the interventricular septum after acute myocardial infarction. Of the infarctions, 16 (57%) were in the inferior wall, and 12 (43%) were in the anterior wall. The most consistent clinical indication of septal rupture after acute infarction was a systolic murmur heard over the left sternal border. This finding was followed by hemodynamic deterioration in all patients. At the time of admission, 18 (64%) of the patients were in cardiogenic shock or multiple organ failure. Twenty-one patients (75%) underwent left heart catheterization; multivessel coronary artery disease was present in 4 (19%) of these patients. In 26 (93%) of the patients, the septum ruptured within the 1st 10 days after the infarction. Emergency surgery for septal rupture was performed using standard techniques in 25 (89%) of the patients. The transatrial transtricuspid approach for septal repair, although used in only 3 (11%) of our patients, provided a good surgical alternative to standard techniques and warrants further research. Excluding 1 late death, the overall operative mortality was 57% (16 patients); the hospital survival rate was 43% (12 patients). Cardiogenic shock was the most common predictor of a poor prognosis. Therefore, in order to avoid this complication, we recommend immediate surgical repair of postinfarction interventricular septal rupture.
Journal Article↗
Left ventricular papillary fibroelastoma. An unusual cause of cerebral emboli.
We describe the case of a 63-year-old woman with a cardioembolic neurologic deficit secondary to papillary fibroelastoma, a rare intracardiac tumor. Diagnosis was made by use of 2-dimensional and transesophageal echocardiography. The tumor was surgically resected, and the patient had an uneventful recovery. In this report, we discuss the embolic potential of papillary fibroelastoma and the appropriate diagnostic and surgical approaches for patients with this rare disorder.
Journal Article↗
Cryosurgical modification of the atrioventricular node for treatment of atrioventricular junctional reentrant tachycardia.
Surgical correction of atrioventricular nodal reentrant tachycardia with preservation of atrioventricular nodal conduction in a 28-year-old woman is reported. At surgery, electrophysiologic mapping techniques were used during tachycardia to reveal and enable ablation of the appropriate site of atrial activation. Postoperative electrophysiologic studies indicated successful atrioventricular nodal modification.
Journal Article↗
Intracardiac fibroma in an asymptomatic infant.
Primary tumors of the heart are rare in infancy and childhood. A one-year-old, asymptomatic, male infant with unimpressive physical findings in whom an echocardiogram demonstrated a large, encapsulated, solid fibroma filling the right ventricle without obstruction of either the inflow or outflow tract is presented. Successful complete surgical excision of the tumor was accomplished. The histological examination was compatible with a benign fibroma. The infant has remained asymptomatic postoperatively with subsidence of the heart murmur. He has not shown any evidence of recurrence of the tumor during a follow-up period of 29 months. This represents an unusual case of a huge right ventricular fibroma and only the fifth youngest patient, to our knowledge, to undergo successful surgical removal.
Echocardiography↗
Surgical treatment of cardiac tumors: a 25-year experience.
From 1964 to 1989, we performed operations on 133 patients with cardiac tumors. There were 58 male and 75 female patients ranging in age from three days to 81 years; 101 were adults, and 32 were children (less than 12 years of age). Primary tumors (102 benign and 12 malignant) were found in 114 patients and metastatic tumors in 19. Symptoms included congestive heart failure, arrhythmias, emboli, and chest pain. Diagnosis was accomplished through angiography, echocardiography, computed tomography, and magnetic resonance imaging. Operative treatment encompassed techniques ranging from biopsy to complete excision (including hypothermic circulatory arrest and cardiac autotransplantation) depending on the site of disease and the extent of involvement. Overall operative survival was 91%. Twelve patients died early (within 30 days of operation), and follow-up was obtained for 110 (90.9%) of the remaining 121 survivors (total patient-years of follow-up, 572.8; mean follow-up, 5.2 years). Of the 20 patients who died late, 15 had malignant disease. Operative survival for patients with primary cardiac malignancies and for those with metastatic disease was 83% and 68.4%, respectively, with 3 and 5 patients, respectively, still living. We advocate an aggressive surgical approach, especially in patients with benign tumors, who can expect an excellent outcome. For patients with malignant or metastatic disease, palliation and cure are also possible if aggressive surgical actions are taken.
Adenocarcinoma↗
Surgical repair of type II truncus arteriosus without a conduit.
A technique for reconstructing the right ventricular outflow tract in an infant with type II truncus arteriosus without using a prosthetic conduit is described. The truncal root is transected, and the confluence of branch pulmonary arteries is brought anterior to the aorta by using Lecompte's maneuver. The aorta is then reconstructed directly with an end-to-end anastomosis. The right ventricular outflow tract is reconstructed by anastomosing the posterior wall of the confluence directly to the apex of the vertical right ventriculotomy. A glutaraldehyde-preserved pericardial patch is then placed anteriorly to complete reconstruction of the right ventricular outflow tract.
Anastomosis, Surgical↗
Management of postoperative chylopericardium in childhood.
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Cardiac Surgical Procedures↗
Surgical treatment of arrhythmias in children.
Primary surgical treatment of many tachyarrhythmias in children is now possible. In those with life-threatening arrhythmias not responsive to any form of medical treatment, the choice for surgery is clear. These arrhythmias include atrial fibrillation with the Wolff-Parkinson-White syndrome, PJRT, or atrial ectopic tachycardia with severe congestive cardiomyopathy, incessant ventricular tachycardia in infancy, and recurrent sustained ventricular tachycardia in postoperative congenital heart disease. In the majority of patients, however, surgical treatment remains an option to be weighed carefully against chronic medical treatment. Surgery is now possible with very low mortality for infants and children with Kent bundles, atrial ectopic tachycardia, and the permanent form of junctional reciprocating tachycardia. The mortality, morbidity, and likelihood of eventual resolution of the arrhythmia with each type of management plan should be considered. With possible direct surgical ablation of atrial flutter and newer forms of catheter treatment of arrhythmias, the future looks promising.
Arrhythmias, Cardiac↗
Surgery without angiography for neonates with aortic arch obstruction.
Traditional diagnostic assessment of the neonate and infant with congenital abnormalities of the aorta causing left ventricular outflow tract obstruction has required catheterization and angiography. However, these patients frequently present critically ill and invasive diagnostic procedures may be associated with significant risks. Two-dimensional echocardiography has been used for aiding diagnosis of aortic arch abnormalities, but there has been little information concerning its use as the definitive imaging technique for preoperative assessment. We reviewed neonates who required urgent surgery for congenital obstruction of the aorta. The diagnosis was made using two-dimensional echocardiographic imaging and Doppler techniques for hemodynamic assessment in lieu of catheterization and angiography in all. Anatomic detail provided by the noninvasive approach was both sensitive and specific in guiding surgery in all but one case. We conclude that echocardiography eliminates the need for invasive preoperative diagnostic procedures in selected neonates with congenital aortic arch obstruction.
Aorta, Thoracic↗
Early and late results of coronary endarterectomy in 3,369 patients.
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Aged↗
An unusual complication of left ventricular pseudoaneurysm: hemoptysis.
Left ventricular aneurysm is a common sequela of anterior myocardial infarction. At the time of coronary artery bypass grafting, resection of this aneurysm is frequently undertaken to alleviate symptoms of heart failure and/or refractory ventricular tachycardia. Complications related to aneurysmectomy are uncommon. We describe an unusual patient who presented with hemoptysis related to the formation of a pseudoaneurysm which communicated with the lung parenchyma. The etiology of the pseudoaneurysm formation was an indolent, slow-growing infection.
Aged↗
Surgical management of extracranial carotid artery aneurysms: report of 17 cases.
This article reviews the operative techniques, results, and complications associated with the treatment of 17 extracranial carotid artery aneurysms encountered in an overall experience of 6,096 carotid endarterectomies during a 24-year period. All 17 patients were operated upon because of severe symptoms and the potential for stroke. Eight patients underwent an aneurysmorrhaphy with Dacron-patch angioplasty; 7 had resection of the aneurysm, with end-to-end anastomosis and Dacron-patch angioplasty; and 2 underwent clipping of the aneurysm. There was 1 hospital death, in the case of a patient who sustained a postoperative myocardial infarction. Three patients had a postoperative neurologic deficit; this complication was permanent in 1 case and transient in 2. During long-term follow-up, no late stroke occurred; nevertheless, 3 patients died of a myocardial infarction, for an overall 5-year survival rate of 77%. On the basis of this study, we conclude that accessible aneurysms of the extracranial carotid artery can be excised with an acceptable morbidity and mortality.
Journal Article↗