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Biomedical subjects

D F Dickinson

Publications and source records attributed to D F Dickinson.

At least 37 records · Page 2Linked to original sources
PubMed1988

Captopril in heart failure secondary to a left to right shunt.

Captopril was used in 20 infants aged less than 1 year with heart failure secondary to defects with predominantly a left to right shunt that was poorly controlled with digoxin and diuretics. Total daily dose of captopril ranged from 0.88 to 2.5 mg/kg (mean 1.3 mg/kg) in three divided doses. Improvement in the control of heart failure was seen mainly as an increase in the rate of weight gain from a mean of 48 g/week before treatment to 102 g/week on treatment and a decrease in the mean respiratory rate from 68 breaths/minute to 60 breaths/minute. Side effects were seen in four patients--two with asymptomatic mild hypotension, one with renal insufficiency which improved with a reduction in dose, and one with severe oliguria progressing to renal failure. Significant changes in plasma electrolyte concentration did not occur except in the infant who developed acute renal failure.

Captopril↗
PubMed1988

Protein-losing enteropathy caused by baffle obstruction after Mustard's operation.

Three patients developed protein-losing enteropathy caused by intra-atrial obstruction of the systemic venous return after Mustard's operation. The enteropathy resolved in one case after reoperation and in the others after balloon dilatation of the stenosed caval pathways. Protein-losing enteropathy may occur as a complication of Mustard's operation. Balloon dilatation of the obstructed baffle is an effective alternative to reoperation.

Humans↗
PubMed1986

Pulmonary balloon valvoplasty in late adult life.

A case of severe valvar pulmonary stenosis in a 60-year-old woman is described. Percutaneous balloon valvoplasty was performed without complication and reduced the right ventricular outflow pressure gradient from 95 mm Hg to 25 mm Hg. Balloon valvoplasty is an effective alternative to surgical valvotomy in adults as well as children.

Angioplasty, Balloon↗
PubMed1986

Abnormalities of the mitral valve in congenitally corrected transposition (discordant atrioventricular and ventriculoarterial connections).

Abnormalities of the mitral valve were found in 16 (55%) of 29 necropsy specimens of hearts with congenitally corrected transposition of the great arteries (discordant atrioventricular and ventriculoarterial connections). These abnormalities were most commonly of cusp number (21%) and tension apparatus (21%). Dysplasia of the valve was less common (10%), and other abnormalities identified included common valve, stenosis, and cleft valve. Some of the cases showed more than one morphological abnormality. The median age at death in those cases with mitral valve abnormalities was significantly higher than those without. More females than males had valves affected (ratio 2:1). Malformations such as ventricular septal defect and tricuspid or pulmonary valve anomalies were represented in similar proportions in cases with and without mitral anomalies.

Abnormalities, Multiple↗
PubMed1986

Architecture of the ventricular mass and atrioventricular valves in complete transposition with intact septum compared with the normal: I. The left ventricle, mitral valve, and interventricular septum.

Venous correction for complete transposition with intact ventricular septum remains the preferred surgical option in most centers (Mustard or Senning procedures). The long-term function of the morphologically right ventricle and tricuspid valve, which continue to sustain the systemic circulation thereafter, remains a matter of concern. Some centers have been performing arterial redirection ("arterial switch") as the surgical treatment of transposition. Consequently, the status of the left ventricle and mitral valve is of equal interest. Yet, detailed morphological studies of the ventricles, atrioventricular valves, and their tension apparatus in "simple" complete transposition are lacking. We have examined the morphology of the left ventricle and the spatial relationships of the component parts of the interventricular septum (part I) as well as the morphology of the right ventricle and the tricuspid valve (part II). A total of 77 specimens with complete transposition and intact ventricular septum were examined and compared with 50 normal hearts. Consistent deformities were noted in relation to the orientation of the ventricular septum. The ratios of ventricular outlet to the inlet lengths were increased in both ventricles and the posterior arterial valve was abnormally related to the atrioventricular valves. These anomalies are similar in some respects to those found in atrioventricular septal defects. Their significance in relation to long-term function remains unclear.

Child, Preschool↗
PubMed1986

Architecture of the ventricular mass and atrioventricular valves in complete transposition with intact septum compared with the normal: II. The right ventricle and tricuspid valve.

After the Mustard or Senning procedure for surgical correction of complete transposition of the great arteries, the right ventricle and tricuspid valve have to support the systemic circulation for life. Consequently their function is of prime importance. In this (second) part, the detailed anatomy of the right ventricles and tricuspid valves is described in the same series of 50 normal hearts and a series of 77 with complete transposition and intact septum. 21% of the transposition specimens showed significant abnormalities of the tricuspid valve. Consistent deformities were observed in the structure of the trabecula septomarginalis and the membranous septum. The ratios of ventricular outlet to inlet lengths were increased.

Aorta↗
PubMed1985

A comparison of information obtained by ultrasound examination and cardiac catheterisation in paediatric patients with congenital heart disease.

Fifty-eight paediatric patients were studied by cross-sectional echocardiography and pulsed Doppler ultrasound in a blind fashion. The information obtained was compared with data collected at cardiac catheterisation. The correct anatomical diagnosis was made by ultrasound in almost all cases but in 11 patients the diagnosis was incomplete or incorrect. Flow measurements made at the tricuspid valve, the pulmonary trunk and the ascending aorta using pulsed Doppler ultrasound correlated well with Fick measurements (r greater than 0.9 at all three sites). The correlation of pressure gradients by the two methods was 0.94. Measurement of the time to peak velocity in the pulmonary trunk provided a method for the identification of patients with elevated pulmonary pressure but the relationship with measured pressures was not sufficiently strong to provide a high degree of reliability.

Blood Flow Velocity↗
PubMed1985

An unusual type of anomalous pulmonary venous drainage associated with a complex left heart hypoplasia and a variety of divided left atrium ("cor triatriatum").

A previously unreported complex congenital cardiac malformation was noted in which a vestigial left atrium consisted of two completely separate portions, one of which was connected to the pulmonary veins but had no outlet orifice. The pulmonary venous drainage was through an anomalous intrapulmonary vein within the displaced right lung into the inferior caval vein above a deformed diaphragm. The left atrioventricular connexion was absent. Some points of terminology are considered.

Abnormalities, Multiple↗
PubMed1985

Normal intracardiac and great artery blood velocity measurements by pulsed Doppler echocardiography.

One hundred and 10 normal subjects were studied by pulsed Doppler velocimetry to determine the range of values of blood velocity across the cardiac valves and in the great vessels. Modal peak velocities of 1.55 m/s occurred in the left heart, but right heart peak velocities were lower. In most sites a statistically significant inverse relation between peak velocities and age or body surface area was found. Time to peak velcocity in the pulmonary artery and ascending aorta increased significantly with age and was shorter in the aorta than in the pulmonary artery. These data were developed to serve as standards for the assessment of values recorded in patients with congenital and acquired cardiac disease.

Adolescent↗
PubMed1985

Increased blood velocities in the heart and great vessels of patients with congenital heart disease. An assessment of their significance in the absence of valvar stenosis.

During a previous investigation and during routine clinical Doppler echocardiography velocities distal to normal valves were found to be increased in patients with congenital heart disease. To investigate this observation the velocity proximal and distal to cardiac valves was recorded in 56 patients with congenital heart disease. No detectable pressure gradient had been found across these valves at catheterisation and no velocity gradient greater than 20 cm/s was found across them by range gated Doppler echocardiography. In 82% of the patients, however, the blood velocity across one or more valves exceeded normal limits. Increased velocities were found at the tricuspid inflow (55%), pulmonary artery (38%), mitral inflow (34%), and ascending aorta (11%). Factors predisposing to the presence of increased velocities in these areas were increased flow through the valve and decreased compliance of the receiving chamber. This study shows the necessity for recording velocity both proximal and distal to a valve before a gradient is calculated according to the modified Bernouilli equation.

Adolescent↗
PubMed1985

Evaluation of an elliptical area technique for calculating mitral blood flow by Doppler echocardiography.

To evaluate a method for measuring blood flow through the mitral valve 18 normal subjects and 19 patients with cardiac disease in whom mitral and aortic blood flows were identical were studied. Initially the mitral ring area was planimetered from the echocardiographic image, but the results of area calculation using the mathematical formula for the area of an ellipse were found to approximate to within 8% of the planimetered result in most cases. The formula was therefore used if the ring appeared elliptical on the cross sectional echo image, and other shapes were planimetered. Mitral velocity, aligned with flow in three planes, was recorded just distal to the ring. Mitral flow calculated using the elliptical technique correlated closely with flow measured in the ascending aorta by the Doppler technique and also with systemic flow measured by the Fick method at cardiac catheterisation in 10 patients. The mitral flow technique that assumed a circular orifice correlated almost as well with Doppler aortic flow and with Fick flow but overestimated flow by a mean of 1446 ml, whereas the elliptical method had a mean error of only 138 ml. Both methods correlated well with standards, but the elliptical method was easy to apply and gave a better correlation with comparison reference values.

Adolescent↗
PubMed1984

Duplication of the left atrioventricular valve in double inlet left ventricle: a triple inlet ventricle?

A heart is described with double inlet left ventricle, rudimentary right ventricle and ventriculo-arterio discordance. The lesion was complicated by a malformation of the left atrioventricular valve. The valve was divided into two distinct orifices. The major orifice connected to the morphologically left ventricle along with the right atrioventricular valve. The minor orifice opened predominantly into the rudimentary right ventricle but in part to the dominant left ventricle. The problems such a lesion produces in terms of nomenclature are discussed with regard to sequential segmental analysis.

Aorta, Thoracic↗
PubMed1984

Digital subtraction imaging in cardiac investigations.

The role of digital subtraction imaging (DSI) in the investigation of heart disease in patients of all ages, including neonates, was evaluated by the addition of a continuous fluoroscopy system to an existing, single-plane catheterisation laboratory. In some situations, DSI provided diagnostic images where conventional radiography could not and, in general, provided images of comparable quality to cineangiography. The total dose of contrast medium was usually less than that which would have been required for biplane cineangiography and the dose of radiation was always less. Digital subtraction imaging can make a significant contribution to the investigation of congenital heart disease and has some useful features in the study of acquired heart disease.

Adult↗
PubMed1984

Ambulatory electrocardiographic monitoring in 100 healthy teenage boys.

Ambulatory monitoring of the electrocardiogram in 100 healthy 14 to 16 year old boys showed heart rates ranging from 45 to 200 beats/minute during the day and from 23 to 95 beats/minute during sleep. Sinus arrhythmia was present in all cases and was the only variation noted in 17%. Sudden variations in the PP interval occurred in 41%, but a precise diagnosis of the mechanism was usually impossible; 15% had changes compatible with sinus arrest or temporary complete sinoatrial block, and one boy had a pattern compatible with type II second degree sinoatrial block. Escape rhythms were noted in 26%, first degree atrioventricular block in 12%, and second degree atrioventricular block (Mobitz type I) in 11%. Mobitz type II second degree atrioventricular block was seen on one occasion in one boy. Ventricular extrasystoles seen in 41% were of uniform morphology in 75% and multiform in 25%. Short episodes of ventricular tachycardia were recorded in 3%.

Adolescent↗
PubMed1984

Digital subtraction angiography in infants and children with congenital heart disease.

Digital subtraction angiography was used as the sole imaging technique in 95 infants and children aged 13 hours to 16 years undergoing cardiac catheterisation for the investigation of congenital heart disease. Injections of diluted contrast medium were made selectively at central sites, and the images were obtained using continuous image intensification fluoroscopy at either 32.25 nC/kg/s (125 microR /s) or 129 nC/kg/s (500 microR /s). In all cases images adequate for diagnosis and management were obtained with appreciably less contrast medium and a lower radiation dose than in a comparable group of patients using conventional biplane cineangiography. Thus digital subtraction angiography is a viable alternative to biplane cineangiography for children with congenital heart disease.

Adolescent↗