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Biomedical subjects

E Oknińska

Publications and source records attributed to E Oknińska.

3 recordsLinked to original sources
PubMed1979

[Early detection and observation of the evolution of congenital malformations of the aorta in newborn infants, infants and young children].

UNLABELLED: 57 infants and small children (42 boys and 15 girls) with congenital aortic malformations were investigated. Clinical, ecg and X-ray follow-up was carried out. Following 4 groups of patients were separated: 1) neonates and infants with supraductal (preductal) aortic hypoplasia or atresia, with hypoplastic left ventricle of the heart (5 boys and 2 girls), 2) infants with supraductal coarctation of the aorta, without underdevelopment of the left heart cavities (2 boys and 2 girls), 3) infants and children with postductal coarctation of the aorta (17 boys and 3 girls) and 4) infants and children with valvular or/and subvalvular, or supravalvular aortic stenosis (18 boys and 8 girls). CONCLUSIONS: Congenital malformations of the aorta and of the left side of the heart should be suspected in all neonates and infants displaying early symptoms of cardiorespiratory failure, resembling frequently the symptoms of severe "pneumonia". Proper measurement and thorough analysis of arterial pulses and pressures in upper and lower extremities is of great importance in detection and differential diagnosis of congenital aortic malformations in infants, even when features of other cardiovascular lesions (e.g. ventricular septal defect, endocardial cushion defect, transposition of the great arteries) dominated in the clinical picture of complex malformations. Small amplitudes of peripheral arterial pulses, with considerably--prolonged upstroke time, small amplitude of arterial pressure measured in upper and lower extremities, co-existing with electrocardiographic patterns of the right ventricular hypertrophy--suggested an aortic malformation complicated by hypoplasia of the left ventricle. Distinctly lower systolic and mean arterial pressure in legs, than in arms was typical for coarctation of the aorta. Significant differences in diastolic pressure values in arms and legs with coexisting ecg patterns of dominating right ventricular hypertrophy should rise a suspicion of abnormal, separate communication of the ascending aorta, and the descending aorta, separately from the left and from the right ventricles of the heart. The electrocardiogram seems to be of great help in differentiation between aortic lesions with or without hypoplastic left ventricle, those with or without systemic right and left ventricle, and those with systemic left ventricle only. Early detection, diagnosis, prompt and proper medical and surgical treatment may be lifesaving for the majority of infants with congenital malformations of the aorta not complicated by left ventricular hypoplasia.

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PubMed1975

[Monitoring of cardiac rhythm changes during surgical operations with total cardiopulmonary bypass with haemodilution and hypothermia in infants and small children (author's transl)].

Surgical corrections of some serious cardiovascular anomalies in infants and small children were attempted within the last 2 years; 12 severely ill infants and children below the age of 3 years were operated. All, but one, were below 10 kg of body weight, and in all of them there was a considerable weight deficit, more than 30%. The risk of operation was undertaken because of the ineffectiveness of medical treatment and very bad prognosis. The following cardiovascular lesions were operated: large aortopulmonary septal defects, localized just above the valvular rings in 2 patients with severe pulmonary hypertension, with very good effect in both; tetralogy of Fallot - in 2 babies, in one with good effect; congenital mitral obstruction with pulmonary hypertension in one case, with good effect; total anomalous pulmonary venous return of supracardiac type in one child, decreased 1 week following operation; type 1 complete transposition of great arteries in one baby, deceased one day following operation; large ventricular septal defects, with systemic or nearly systemic pulmonary hypertension in 5 children, in one with long-term good effect. A modification of the Barrat-Boyes, Neutze and Simpson method, based upon a combination of surface and core cooling was applied. Thoracotomy was performed after surface cooling to 34-32 centigrades, and then a single venous cannula was inserted into the right atrium and an arterial cannula -- into the aorta. Deep cooling was obtained during perfusion, using a heat exchanger. The duration of cooling perfusion was, on an average, 20 min., and the patients were cooled to a temperature of 23-21 centigrades. The corrections were performed on relaxed and bloodless heart, during the circulatory arrest lasting for 20-65 min. (40 min. on an average). Following repair the patients were rewarmed to temperatures of 36-37 centigrades by warming perfusion lasting on the average 40 min., including assisted circulation, until a haemodynamically sufficient cardiac output was present. Silicated ACD-blood, diluted to a hematocrit value of 28-30 Vol. % by a polyelectrolyte buffered solution was used for priming and perfusion. During all the procedures any pH and HCO3 deviations were balanced currently. At the time of cooling perfusion, when the patient's rectal temperature fell down to 30-25 centigrades, the heart started to fibrillate. At temperatures above 26 degrees C ventricular fibrillation was sometimes preceded by sinus bradycardia, or sinoatrial block/arrest, with an AV nodal rhythm and gradually increasing intraventricular conduction slowing. In some cases high degree AV block appeared. At temperatures of 25-23 centigrades - slow fibrillation appeared, followed usually by a complete cardiac arrest.

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