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Biomedical subjects

D C McGoon

Publications and source records attributed to D C McGoon.

At least 73 records · Page 4Linked to original sources
PubMed1982

Reoperation after correction of tetralogy of Fallot.

Forty-one patients underwent reoperation after total correction of tetralogy of Fallot from 1962 through 1979. The indications for surgical repair were recurrent or residual lesions alone or in combination with other lesions. The reoperation consisted of closure of a residual ventricular septal defect (VSD) in 28 patients, relief of residual right ventricular outflow tract (RVOT) gradient in 11, tricuspid value replacement, repair or annuloplasty in six, aneurysmorrhaphy or excision of an RVOT aneurysm in five, insertion of a right ventricular-pulmonary artery valved conduit in five, insertion of an RVOT valve in three, closure of a patent foramen ovale or atrial septal defect in three, repair of a residual surgical shunt in three, mitral valve replacement in one patient, and aortic valve repair in one. Thirty-eight patients (93%) survived the operation. The surgical mortality decreased from 25% during 1962 through 1970 to 0% during 1971 through 1979 (p = 0.02). There was one late death. Five patients (12%) required a second-reoperation for recurrent VSD. Even a small residual shunt, especially when associated with other defects such as pulmonary insufficiency or tricuspid insufficiency, may cause clinical deterioration that can be improved by reoperation. This study tends to support the policy of recommending reoperation when either RVOT obstruction (gradient greater than or equal to 50 mm Hg) or isolated VSD (Qp/Qs greater than 1.5) is present. Reoperation is associated with a low mortality and good long-term results.

Adolescent↗
PubMed1982

Cardiac fibroma: long-term survival after excision.

Four patients have had operation at the Mayo Clinic for a cardiac fibroma and all survived. Three patients have an excellent clinical result and are free of tumor 1 year, 13 years, and 17 years postoperatively. The fourth shows radiographic evidence of residual tumor near the mitral anulus, but is clinically well 15 years postoperatively. A fifth unoperated patient died suddenly 8 years after presumptive diagnosis of fibroma at the age of 83 years. This experience suggests that patients who have undergone successful excision of cardiac fibroma have an excellent probability of remaining free of disease.

Child↗
PubMed1982

Porcine heterograft valve replacement in children.

From 1973 to 1980, 49 patients under 18 years of age survived cardiac valve replacement with Hancock porcine heterografts. Complete follow-up has been obtained on 44 patients (90%) in whom 46 valves were placed. There were 30 boys and 14 girls with an age range of 2 to 18 years (mean 10.0 years). Severe prosthetic valvular dysfunction requiring valve replacement occurred in eight valves in seven patients at 15 to 60 months postoperatively (mean 34.1 months), yielding a calculated replacement rate of 7.1% per patient-year. All eight valves demonstrated severe calcification with stenosis, two valves had significant insufficiency secondary to leaflet disruption, and one valve had a large leaflet perforation. Thirty-one patients with valves in place at 7 to 90 months (mean 38.4 months) are alive, but six have clinical evidence of progressive valvular dysfunction. The mean age at the time of the original Hancock valve placement of the group of patients having undergone replacement of a failed prosthesis together with those with clinical evidence of prosthetic dysfunction was 8.0 years, which is significantly less than that of the remaining group of patients with normally functioning valves (mean 11.2 years, p = 0.043). Actuarial curves demonstrate a predicted replacement-free rate of 87.4% +/- 5.9% at 3 years. 82.3% +/- 7.5% at 4 years, and 58.5% +/- 15.7% at 5 years. On the basis of these data and other reports of early failure in the literature, we have discontinued the routine use of Hancock porcine heterografts for cardiac valve replacement in children in favor of mechanical prostheses.

Actuarial Analysis↗
PubMed1981

Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up.

Between 1955 and 1977, 66 patients ages 60 years or older underwent operative closure of secundum atrial septal defect. Of these, 56 (85%) were catheterized preoperatively. The 56 patients were divided into three groups to assess the effects of pulmonary hypertension on operative mortality, symptoms and longevity. The 17 group 1 patients had peak systolic pulmonary artery pressures (PAPs) of less than 40 mm Hg; the 21 group 2 patients had PAPs of 40-60 mm Hg; and the 18 group 3 patients had PAPs of more than 60 mm Hg. Among the three groups, there was no significant difference in Qp/Qs, right or left atrial pressures, right or left ventricular end-diastolic pressures and Qs, although pulmonary vascular resistance was significantly higher (p less than 0.01) in group 3 than in group 1. Four patients died, yielding an operative mortality of 6%. All four patients had undergone additional operative procedures. Operative mortality was unrelated to preoperative symptom class, PAP or pulmonary vascular resistance. Forty-seven patients were followed up for 2-20 years (mean 6.6 years), and of these, 41 (87%) improved by at least one functional class. Symptomatic benefit occurred in all groups, regardless of preoperative PAP, pulmonary vascular resistance or functional class. Actuarial survival curves showed that longevity at 5 and 10 years postoperatively was significantly increased (p less than 0.01) for patient with atrial septal defect treated surgically compared with that predicted for age-matched patients treated medically.

Actuarial Analysis↗
PubMed1981

Clinicopathological correlates of obstructed right-sided porcine-valved extracardiac conduits.

Thirteen of 308 patients (4.2%), who had received right-sided valved extracardiac conduits at the Mayo Clinic from November, 1972, to April, 1977, have required conduit replacement because of obstruction. Patients were 5 to 16 years old at initial operation and 8 to 20 years old at reoperation; the duration of conduit implantation was 27 to 79 months (mean 50). Four patients (31%) were asymptomatic; exertional dyspnea was present in eight (62%) and dizziness was reported in one (8%). Signs of conduit obstruction included increasing intensity of murmurs in 11 (85%), cyanosis in two (15%), and heart failure in one (8%). Peak pressure gradients from the right ventricle to the pulmonary arteries ranged from 50 to 140 mm Hg (mean 87) and correlated well with the degree of conduit obstruction. Catheter pullback allowed accurate localization of stenosis within the conduit, whereas angiography alone did not. The site of major obstruction was in the proximal conduit in five (38%), at the valve in nine (69%), and in the distal conduit or side branches in six (46%); stated differently, major stenosis affected the valve alone in five (38%), the graft alone in four (31%), and both the valve and the graft in four (31%). Valvular changes leading to stenosis included thrombosis, commissural fusion, and calcification, and changes consistent with insufficiency included tears, fusion of cusps to the conduit wall, and, in one case, infective endocarditis. Within the conduit, nonvalvular obstruction was due to formation of a thick fibrous peel (or neointima). Progressive thickening of the peel appeared to be due to organization of thrombus between the peel and conduit and not due to luminal mural thrombus. In one case, the peel formed a flap-valve, causing even further obstruction. Since many patients are asymptomatic, and since late conduit stenosis may develop unpredictably by several mechanisms, long-term follow-up is necessary.

Adolescent↗
PubMed1981

Current status of the septation procedure for univentricular heart.

The current status of the septation procedure for univentricular heart was assessed by analyzing the outcomes of 45 procedures done from 1973 through June of 1978. The hospital mortality was 21 (47%) of 45 patients, and eight (18%) patients died during follow-up. Of the 16 survivors, 12 have a fair-to-good surgical result and four are doing poorly. Only two factors were significantly related to increased survival: no history of congestive failure and no previous palliative procedure. Multivariate analysis revealed a small subgroup of 11 patients with a survival rate of 82%. These patients had a subaortic chamber to the left, no previous congestive failure, no previous palliation, and no profound polycythemia, and they were between 5 and 15 years of age at operation. Current practice now employs the Fontan procedure for patients with univentricular heart and low pulmonary artery pressure and resistance. However, nearly half of the patients with univentricular heart will not qualify for a Fontan procedure. For a selected group of these patients, septation must be considered because of the poor long-term outlook for patients with univentricular heart who do not undergo operation.

Adolescent↗
PubMed1981

Population-based requirements for thoracic surgery.

In order to determine the population-based requirement for thoracic surgery, we identified of the thoracotomies undertaken upon Olmsted county, Minnesota, residents in a 10 year period. There were 674 initial operations and 78 reoperations among 689 residents. The age-adjusted incidence rate for all thoracotomies in the community was 99.6 per 100,000 person-years. Rates generally increased with age and were greater for men, with an age-adjusted male: female ratio of incidence rates of 2.1 : 1. Age-adjusted rates for urban residents were nearly twice as great as those for rural residents of the county. Sixty percent of the operations were performed for cardiovascular disease, 30% for pulmonary disease, and 10% for all other chest conditions. The incidence of operations for all three of these subgroups increased substantially during the 10 year study period. If the Olmsted County experience for 1976-1979 is applied to the 1980 United States population, an estimated 300,000 thoracic operations would be required. The operations could entail the use of nearly 6 million hospital bed-days and over 1 million operating room hours.

Adolescent↗
PubMed1980

Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of Fallot.

Four hundred seventy-five patients underwent repair of tetralogy of Fallot from 1955 to 1964; 396 of these were hospital survivors and were followed up for 12 to 22 years. An excellent late clinical result was maintained by 87 percent of the 396 hospital survivors. A less than excellent result in the remaining 13 percent of hospital survivors was caused by late mortality in 7 percent (sudden death in 3 percent, death due to cardiac causes in 2 percnt and death due to noncardiac causes in 2 percent), required reoperation in 4 percent (mainly because of residual ventricular septal defect) and development of symptoms in 2 percent. Postoperative cardiomegaly (cardiothoracic ratio greater than 0.55) was observed in 60 (25 percent) of 246 patients who had a follow-up chest roentgenogram, and was more common among those who died late or remained symptomatic. Among the few patients with inadequate surgical relief of right ventricular hypertension who did not have transanular patch repair, the hypertension did not tend to decrease progressively, whereas it did decrease in patients who had patch repair. No late sudden deaths were encountered in 20 patients shown to have postoperative right bundle branch block plus left axis deviation (bifascicular block pattern). Pulmonary valve incompetence appeared to have relatively little harmful influence on the late result, causng cardiac disability in 1 percent of the patients and appeared to be the main contributing factor of postoperative cardiomegaly in 13 (5 percent) of the 246 patients who had a follow-up chest roentgenogram. Most late deaths and complicatins appeared within 2 years of operation, and accelerating deterioration in late results did not occur as the follow-up extended beyond 2 decades.

Cardiomegaly↗
PubMed1980

Corrected transposition and ventricular septal defect. Surgical experience.

The entire 21-year experience at our institution with intracardiac repair of corrected transposition of the great arteries (CTGA) associated with ventricular septal defect (VSD) is reviewed. There were 53 such operations. The hospital mortality rate fell from 50% before 1972 to 18% since then (p < 0.02), and was 19% when a systemic ventriculotomy was not used compared to 60% when it was used (p < 0.01). A technique is described for correction of CTGA with VSD and pulmonary outflow tract obstruction (POTO) designed to minimize risk of heart block and to increase the degree of relief of POTO: the VSD patch is placed to the right side of the conduction tissue and the pulmonary outflow tract, and POTO is bypassed with an extracardiac conduit. This technique reduced the incidence of complete heart block from 67% by direct relief of POTO to 28% (p < 0.05) and decreased the frequency of inadequate relief of POTO from 50% to 8% (p < 0.01). However, experience with these two approaches was not concurrent. Successful intraoperative mapping of the conduction bundle was associated with operatively induced heart block in 37%, whereas prior to the availability of mapping the incidence of heart block was 57% (difference not significant). Twelve patients required atrioventricular (AV) valve repair or replacement, and in them the operative mortality was 50%, compared to 20% in the remainder (p < 0.05). For the 21 patients with VSD and POTO who achieved good relief of POTO, the operative mortality was only 5%. These findings suggest that good progress has been made in the surgical repair of CTGA with VSD, though further improvement in results is required.

Adolescent↗
PubMed1980

Fontan procedure for tricuspid atresia.

A Fontan procedure has been performed on 29 patients for tricuspid valvular atresia. The age range was 8 months to 33 years (median 10 years), the pulmonary vascular resistance ranged from 1.8-6.1 units . m2 (mean 3.3 units . m2), and the mean pulmonary arterial pressure ranged from 13-45 mm Hg (mean 21 mm Hg). Twenty-nine previous operations had been performed in 23 patients. Fourteen other associated cardiopulmonary anomalies were present in 12 patients. There were four hospital deaths (13.8%), all in patients with complicating features. Among the last 22 consecutive patients who have undergone operation, one died (4.5%). Complete atrioventricular block necessitated pacemaker implantation in one patient. No late deaths occurred. Of the 19 patients followed 3 months or more from the time of operation, eight have no restriction of exercise capacity, nine have only mild restriction, and two have a poor result. The Fontan approach to tricuspid atresia has several theoretical advantages over previously used shunts or pulmonary artery banding, the operative mortality in patients who have suitable anatomy and hemodynamics is low, and the results have been good.

Adolescent↗
PubMed1980

Trends in cardiac surgery. Five-year study of a defined population.

The total number and types of cardiac operations performed on residents of Olmsted County, Minnesota, from 1973 through 1977 were studied through the use of the medical-records linkage system at the Mayo Clinic. During this time, 213 patients underwent 216 operations. The rates of cardiac operations per 10,000 population increased from 4.1 in 1973 to 5.9 in 1977. Operations other than for coronary artery bypass showed no significant trends over time, and the average rate was 2.5 per year. The incidence of coronary artery bypass operations increased from 1.5 in 1973 to 4.0 in 1977. On the basis of the rates for open-heart operations and under conditions similar to those in this community, a population of approximately 380,000 persons less than 15 years of age would be required to ensure 75 cases requiring open-heart operations per year, and a population of approximately 230,000 persons more than 14 years of age would provide 200 adult open-heart cases per year. Thus total populations of approximately 1,380,000 and 310,000 of all ages would be required to meet these minimum standards for pediatric and adult open-heart operations.

Adolescent↗