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Biomedical subjects

D B Nudel

Publications and source records attributed to D B Nudel.

32 records · Page 2Linked to original sources
PubMed1982

Pulmonary sequestration causing congestive heart failure in infancy: a report of two cases and review of the literature.

Congestive heart failure as a presenting symptom in infants with pulmonary sequestration is rare, and the cases of only 3 such patients have been reported. The clinical features, hemodynamics, and management of two additional patients are described. Both were seen in severe congestive heart failure in the absence of any associated cardiac anomalies. The physical findings, plain roentgenograms, electrocardiograms, and echocardiograms may provide some diagnostic clues, but cardiac catheterization is the essential diagnostic investigation. In 1 patient, pneumonectomy was performed because of extensive changes throughout the affected lung. In the other, ligation of the anomalous systemic artery to the sequestered lobe was the only surgical procedure. Both patients are doing well 15 months and 18 months after operation. Success with the latter surgical approach has not been reported previously.

Bronchopulmonary Sequestration↗
PubMed1978

Adrenal contribution to coronary regulation in the newborn.

Evidence for adrenergic regulation of the coronary vessels was sought in 27 newborn lambs. Sympathetic activity was altered by temporarily lowering cephalic perfusion pressure (CPP) from 90 to 20 mmHg while aortic pressure was held constant. Heart rate (HR) and left ventricular dP/dt max increased markedly, while end-diastolic pressure and stroke volume fell. These changes were accompanied by an increase in coronary blood flow (CBF), myocardial O2 consumption (MVO2), and reduced coronary resistance (CF) (P less than 0.005). After beta blockade, which prevented an augmentation of metabolic demand, the same maneuver resulted in coronary vasoconstriction, reflected by reduced CBF and increased CR (P less than 0.02). This response was eliminated by alpha blockade with phentolamine (2 mg/kg). In 13 lambs subjected to bilateral adrenalectomy or sham operation, lowering CPP elicited similar positive chronotropic and inotropic changes, increases of MVO2 and CBF, and reduced CR. Following beta blockade, lowering CPP in the sham group caused coronary constriction. However, no changes in CBF or CR were elicited in the adrenalectomized lambs. These observations indicate that integrity of the adrenal glands is required for adrenergic control of the coronary vessels in the newborn. Chronotropic and inotropic regulation is mediated by direct neural action and is not dependent on adrenal function.

Adrenal Glands↗
PubMed1976

Effects of acutely increasing systemic vascular resistance on oxygen tension in tetralogy of Fallot.

Effects of phenylephrine hydrochloride on the degree of hypoxia were studied in six cyanotic patients with tetralogy of Fallot. Baseline aortic and right atrial oxygen saturations, blood gas tensions, pH, and indicator-dilution curves were obtained under stable conditions. Phenylephrine was infused while systemic arterial pressure was monitored continuously. Aortic and right atrial blood samples were measured at each 10 mm Hg systolic pressure increment and decrement and analyzed for pH, PO2, PCO2, and oxygen saturation. A 40 mm Hg peak systolic aortic pressure rise was the arbitrary end point for phenylephrine infusion and the indicator-dilution curve repeated. Aortic oxygen tensions rose in all from 4 to 28 mm Hg (mean, 14 mm Hg). The net right-to-left shunt decreased from 10% to 40% (mean, 25%) with phenylephrine infusion as compared to the shunt under basal conditions. The presumed mechanism related to the increase in systemic vascular resistance relative to right ventricular outflow obstruction with resultant augmentation of pulmonary blood flow. It is concluded that acutely raising systemic vascular resistance in patients with tetralogy of Fallot using phenylephrine infusion has a beneficial effect on systemic arterial oxygen level and might be the medical treatment of choice for protracted hypoxic spells.

Child↗
PubMed1976

Cor triatriatum: masked by complex congenital cardiac anomalies.

The radiographic, angiographic, hemodynamic, and surgical features of 2 cases of cor triatriatum complicated by other cardiac anomalies are presented. In the first case, the patient had tetralogy of Fallot, the scimitar syndrome, and left ventricular obstruction. In the second case the patient had truncus arteriosus. The first case was revealed only after augmentation of pulmonary flow by an aorta-pulmonary artery anastomosis. In the second case, the diagnosis was retrospectively suggested by certain angiographic and hemodynamic clues. The prospective diagnosis was made only after a modified Rastelli procedure for truncus arteriosus. The difficulties encountered in making the diagnosis in both cases are discussed. It is stressed that a high index of suspicion, thorough accumulation and examination of hemodynamic data, and excellent angiograms and plain film radiography are all necessary to an early diagnosis of cor triatriatum when the latter is complicated by other congenital heart anomalies.

Abnormalities, Multiple↗
PubMed1975

Prosthetic valve replacement in children.

Reported clinical experience with prosthetic valve replacement in children have suggested a high operative mortality. We placed 25 valves in 24 children with one operative death. There has been one late death related to pacemaker malfunction, but the remainder of the patients have generally done extremely well. The children have not undergone elective anticoagulation, and the long-term embolism rate has not exceeded the incidence of systemic embolization in adults who have been controlled on warfarin sodium (Coumadin) therapy. The objective of prosthetic valve replacement is myocardial preservation. We believe that valve replacement with currently available prostheses should be undertaken in any child with valvular malfunction who is not well controlled with good medical management.

Adolescent↗
PubMedDate not supplied

Pleural drainage after repair of tetralogy of Fallot.

Prolonged pleural effusion after congenital heart surgery results in extended hospitalization. Pleural drainage was evaluated in 39 consecutive patients undergoing repair of tetralogy of Fallot, to identify risk factors for persistent pleural effusion. Duration and amount of drainage was examined by the Kaplan-Meier method and risk factors were evaluated by univariable and multivariable analyses. Median time of pleural drainage was 6.1 days, range 3 to 42 days. Duration of pleural drainage correlated with length of hospital stay (p < 0.0001). Postrepair right atrial pressure (p = 0.018) and preoperative hemoglobin (p = 0.035) were risk factors for persistent drainage. The presence of a previous right thoracotomy reduced drainage duration (p = 0.034). Prolonged mechanical ventilation increased the average daily volume of effusion (p < 0.0001). In conclusion, prolonged pleural effusion is an important morbidity factor after repair of tetralogy of Fallot. Bilateral chest tube insertion is indicated in patients with high preoperative hemoglobin and elevated postrepair right atrial pressure. Right thoracotomy is the preferred surgical approach when a preliminary palliative shunt is required.

Adolescent↗