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Biomedical subjects

D B Doty

Publications and source records attributed to D B Doty.

At least 91 records · Page 5Linked to original sources
PubMed1982

Bypass of superior vena cava: Six years' experience with spiral vein graft for obstruction of superior vena cava due to benign and malignant disease.

Ten patients had operations for obstruction of the superior vena cava (SVC) with SVC syndrome. Four patients had fibrosing mediastinitis and six and had bronchogenic carcinoma. A composite spiral vein graft was placed between the left jugular--subclavian vein and the right atrium to bypass the completely occluded SVC. The graft was constructed from the patient's own saphenous vein, which was split longitudinally and wrapped around a stent in spiral fashion. The edges of the vein were sutured together to form a large autogenous conduit. All patients were immediately relieved of SVC obstructive symptoms and signs. All grafts were patient at 7 days to 18 months, as determined by conventional or radionuclide venography or contrast-enhanced computerized axial tomography. The fact that SVC syndrome has not returned in any patient implies long-term patency. All patients with benign disease continue asymptomatic 3 months to 6 years after operation and have returned to gainful employment. All patients with SVC obstruction resulting from cancer died 1 to 21 months (mean 10.7 months) postoperatively. Spiral vein bypass graft provides effective treatment for SVC obstruction with immediate and long-term relief of SVC syndrome.

Adult↗
PubMed1982

Vasomotor dynamics associated with cardiac operations. II. Effect of cardiopulmonary bypass on venous tone.

The effect of cardiopulmonary bypass on venous tone was evaluated in 19 patients undergoing coronary artery bypass graft operations. The use of cardiopulmonary bypass with reduction of mean arterial pressure, nonpulsatile blood flow, and emptying of the heart maximally stimulates the sympathoadrenal system and would be expected to cause intense venous constriction. Venous capacitance, however, was reduced by the general effects of the operation, including anesthesia and surgical trauma, while cardiopulmonary bypass was a minor factor in the venous constriction response.

Adult↗
PubMed1982

Determination of coronary reserve in patients with supravalvular aortic stenosis.

Coronary reserve in patients with supravalvular aortic stenosis may be limited by coronary artery ostial obstruction or left ventricular hypertrophy. To assess the relative effect of these two factors on coronary reserve, seven patients with supravalvular aortic stenosis were studied intraoperatively before and after repair. Six patients who underwent elective cardiac surgery for conditions that did not involve the left ventricle or the left anterior ascending coronary artery served as controls (control group 1). Four patients were studied before and after cardiopulmonary bypass to determine if cardiopulmonary bypass altered coronary reserve in normal vessels perfusing normal ventricle (control group 2). Using a pulsed Doppler probe to determine coronary velocity, coronary reactive hyperemia was induced in the left anterior descending coronary artery (patients with supravalvular aortic stenosis and group 1 controls) or right ventricular branches of the right coronary artery (group 2 controls) during maximal coronary dilation produced by a 20-second coronary occlusion. All patients with supravalvular aortic stenosis underwent patch aortoplasty to relieve left coronary artery ostial obstruction and outflow tract obstruction; three patients also underwent aortic valvotomy and one patient also underwent valve replacement. Coronary reactive hyperemia was calculated as the ratio of peak to resting velocity. This ratio was 5.0 +/- 0.6 (mean +/- SEM) preoperatively and 3.6 +/- 0.3 postoperatively in control group 2. Thus, coronary reserve was only modestly reduced after cardiopulmonary bypass. Before repair, the ratio of peak to resting velocity was markedly reduced in patients with supravalvular aortic stenosis compared with control group 1 (1.8 +/- 0.3 vs 4.9 +/- 0.5, p less than 0.05) and did not change after repair (1.7 +/- 0.2), even though the aortic gradient was reduced (80 +/- 14 vs 38 +/- 6 mm Hg, p less than 0.05) and real or potential coronary ostial obstruction was eliminated by the operation. Because coronary reserve did not improve after surgery in patients with supravalvular aortic stenosis, we conclude that left ventricular hypertrophy is probably the primary determinant of decreased coronary reserve in these patients.

Adolescent↗
PubMed1982

Thrombosis of the Björk-Shiley prosthesis: illustrative cases and review of the literature.

Thrombosis of the Björk-Shiley prosthetic cardiac valve may occur in any valve position and regardless of anticoagulant status. Four illustrative cases are presented to demonstrate management problems. Review of cases reported in the literature suggests the minimal incidence of thrombosis of Björk-Shiley prostheses is about 2% in the aortic position and about 4% in the mitral position. Prevention of this complication appears to require continuous systemic anticoagulation with warfarin; even temporary interruption or alteration of anticoagulant regimen may be detrimental. Although changes in anticoagulation may rarely precipitate sudden thrombosis, in most cases a period averaging 10 months is required for pannus of organized thrombus to build up enough to cause acute thrombosis and malfunction of the valve. Operation to remove thrombus or replace the prosthesis is usually required for left-sided cardiac prostheses, but thrombosed valves in the tricuspid position may be successfully treated with fibrinolytic medical therapy.

Adult↗
PubMed1981

Operation for aortic arch anomalies.

Forty-two patients with aortic arch anomalies resulting in tracheoesophageal compression were treated during the period 1948 through 1978. These anomalies are important causes of upper respiratory and esophageal obstruction in babies and small children and can be corrected safely with excellent relief of symptoms. Nineteen patients (45%) had a right aortic arch with a ligamentum arteriosum, 17 patients (40%) had double aortic arches, and 6 patients (15%) had aberrant right subclavian arteries. Other associated congenital malformation and mental retardation were seen in 15 patients (36%). Diagnosis was accurately made in 38 patients (90%) by barium esophagogram. Basic surgical principles include exposure through a left thoracotomy, complete identification of the aortic arch anatomy, and division of the constricting ring. Surgical treatment resulted in 2 deaths (5%), and 1 patient died late. Early postoperative respiratory complications were common. All survivors were relieved of their symptoms late (median, 94 months) postoperatively.

Adolescent↗
PubMed1981

Ligation of patent ductus arteriosus in premature infants.

In the operating room, 66 preterm infants weighing between 710 and 2,700 gm (23 less than 1,000 gm) underwent ligation of a patent ductus arteriosus (PDA). Respiratory distress syndrome was present in 53 patients; the rest had apnea-bradycardia syndrome. PDA ligation was indicated for intractable congestive heart failure in 52 patients or progressive respiratory failure in 14. There were no intraoperative deaths. Fifteen infants died 1 to 120 days postoperatively. Seven deaths resulted from intracranial bleeding, 3 from diffuse coagulopathy, and 1 from respiratory failure. The condition of patients with heart failure improved postoperatively, with the mean left atrium to aorta ratio reduced from 1.56 to 1.02 (p = 0.05). Respiratory function improved in 25 patients extubated by the third postoperative day. Late follow-up (one to five years) of the 51 survivors showed 1 late death. Seventeen survivors had roentgenographic evidence of bronchopulmonary dysplasia. Infants with bronchopulmonary dysplasia required longer postoperative ventilation (mean, 21.5 days compared with 4.75 days). Twenty-four infants were normal. Ligation of PDA in preterm infants has low intraoperative risk and improves the condition of those with heart and respiratory failure. Late follow-up showed good recovery of nearly two-thirds of the patients.

Child, Preschool↗
PubMed1981

Aortopulmonary septal defect: hemodynamics, angiography, and operation.

Twenty-five patients with malseptation of the aortopulmonary trunk resulting in aortopulmonary septal defect (window) were evaluated in a unique combined surgical series assembled from two institutions participating in the USA-USSR Health Exchange Program. Typical aortopulmonary septal defect or window (type I) with the connection between the ascending aorta and main pulmonary artery was found in 21 patients. Four had a more cephalad defect (type II) between the ascending aorta and the origin of the right pulmonary artery. Hemodynamics were the consequence of a large left-to-right shunt (mean ratio of pulmonary to systemic flow, 3.0) with right ventricular hypertension (mean right ventricular pressure, 86 mm Hg) and increased pulmonary vascular resistance (mean, 7.4 U) (mean ratio of pulmonary to systemic vascular resistance, 0.33). Angiography may provide patterns that allow preoperative distinction between the two types of aortopulmonary septal defect and provide information important in planning the details of corrective operation. Operative techniques included ligation, direct suture, and patch closure of the aortopulmonary septal defect. The best method appeared to be patch closure by the transaortic approach; real and potential problems were associated with other techniques.

Aorta, Thoracic↗
PubMed1981

Single ventricle with aortic outflow obstruction: operative repair by creation of double outlet to the aorta and application of the Fontan principle.

A new operation is described which allows the Fontan procedure to be used in patients having single ventricle accompanied by aortic outflow obstruction. Connection of the proximal pulmonary artery and valve to the aorta via a tubular prosthesis provides a second outlet of the ventricle to the aorta in order to effectively bypass subaortic obstruction. Anastomosis of a distal pulmonary artery to the right atrium and closure of the atrial septum by patch (Fontan procedure) complete the establishment of unrestricted pulmonary and systemic circulations in series.

Adolescent↗
PubMed1981

Assisted circulation by phasic external lower body compression.

Assistance to the systemic venous circulation after experimental acute bypass of the right heart was provided by phasic external compression of the body. Pressure to 60 mm Hg administered to the body below the costal margin at 6--8 cycles/min augmented the circulation by translocation of blood volume from the peripheral to the central circulation, which increased right atrial pressure by 44%, mean cardiac index (61 to 74 m/kg/min) and mean arterial pressure (79 to 100 mm Hg) by 21%. The experimental study was followed by clinical trial of this method of circulatory support after anastomosis of the right atrium to the pulmonary artery (Fontan operations) in nine patients. One-minute cycles of phasic external compression of 45--50 mm Hg for 45 seconds followed by decompression for 15 seconds in patients increased right atrial pressure by 44% (mean increase 7 mm Hg) and systolic arterial pressure by 30% (average 20 mm Hg, range 13--28 mm Hg). Only two patients required inotropic medications; the others received either no medications or nitroprusside during the first 24 hours after surgery. Phasic external compression of the lower body is a simple and effective means of assisting the circulation after the Fontan operation.

Adolescent↗
PubMed1981

Cor triatriatum (subdivided left atrium).

Twenty-one patients (age 1 day to 156 months) with cor triatriatum sinister (subdivided left atrium) were treated over a 23 year period at two institutions. Anatomic classification of the hearts revealed 20 (95%) with classical cor triatriatum and normal pulmonary venous connections. One other patient had partial anomalous pulmonary venous connection. Three of these patients (14%) had other severe associated cardiac anomalies. Surgical correction of isolated cor triatriatum was performed in 13 patients of whom eight (62%) survived. Long-term results were excellent in seven (88%) patients; one late death occurred. A right atrial approach for infants and small children is recommended, while the left atrial approach appears satisfactory for larger children.

Adolescent↗
PubMed1981

Experimental cardiac trauma--ballistics of a captive bolt pistol.

Cardiac trauma can be experimentally produced by blunt impulsive impact over the cardiac apex in the anesthetized canine. A gradation of myocardial injury, including transient arrhythmia, contusion, and lethal ventricular fibrillation, can be produced by varying the power of the charge in a modified captive bolt pistol. Ballistics experiments were conducted to quantify the velocity, energy, and trajectory of impacts produced by the modified captive bolt pistol using various charges. Correlation of the impact data with the previously reported levels of trauma indicates that a 24 m/s impact with 178 joules of available energy results in lethal ventricular fibrillation with extensive myocardial contusion. Blunt impact at 17 m/s with 102 joules causes serious myocardial injury and at 13 m/s with 67 joules causes minor transient arrhythmia.

Animals↗
PubMed1981

Modified Fontan procedure. Methods to achieve direct anastomosis of right atrium to pulmonary artery.

Experience with Fontan operations suggests that techniques which utilize autogenous structures exclusively to achieve right atrium-pulmonary circuit connection may be preferred. Valves probably are not required in the circuit and in some cases have become obstructive with time. A large-diameter direct anastomosis of the right atrium to the pulmonary artery nearly always is possible and provides a modification of the Fontan procedure which combines favorable qualities of simplicity, all autogenous material, and posterior position which is free of the risks of compression. There also may be improved hemodynamics with this modification. Options to achieve this anastomosis depending on relations of the great arteries, previous operations, and other anatomic variations are described in eight patients.

Adolescent↗
PubMed1980

Esophageal atresia and tracheoesophageal fistula.

Fifty-seven babies were surgically treated for esophageal atresia and tracheoesophageal fistula between 1968 and 1978. Forty-eight (84%) had proximal esophageal atresia and a distal tracheoesophageal fistula, 2 (4%) had proximal and distal esophageal atresia and no tracheosophageal fistula, and 7 (12%) had a tracheosophageal fistula without esophageal atresia. Primary repair was accomplished in 43 patients (75%), colon interposition was required in 5 (9%), while the remainder had staged or palliative reapirs. Forty-six (81%) survived surgical treatment. All 21 babies in Waterston Category A, 90% of 20 in Category B, and 44% of 16 in Category C survived surgical treatment. Serious complications occurred in 17 (30%), and dilatable strictures and other minor problems developed in 27 (47%). Late follow-up (mean, 48 months) revealed 3 (7%) late deaths, 2 of which were due to congenital heart disease. Three patients required late colon interposition, and several require frequent dilatations of the esophagus. The Category A and B survivors are all functionally well, while the 5 surviving Category C patients are all significantly impaired by associated anomalies.

Child, Preschool↗
PubMed1980

Aortic atresia.

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Aorta, Thoracic↗