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Biomedical subjects

F J Macartney

Publications and source records attributed to F J Macartney.

At least 127 records · Page 7Linked to original sources
PubMed1979

Anatomy of aortic atresia. Cases presenting with a ventricular septal defect.

The anatomy of 58 specimens of aortic outflow tract atresia was studied. All cases had situs solitus and levocardia, 37 had atrioventricular (AV) concordance, two had common inlet to a right ventricle and 19 had mitral atresia. The great arteries were normally interrelated in all cases. Fifty-one cases had an intact ventricular septum, while seven presented with a ventricular septal defect (VSD). Of the seven with VSD, in two it was associated with a common AV orifice draining exclusively into the right ventricle in the presence of a rudimentary left ventricular chamber. In one case a small VSD accompanied combined mitral and aortic atresia. In the other four cases the left ventricles and mitral valves were fairly normal in size; the VSD was subpulmonary in three cases, due to infundibuloventricular malalignment, and perimembranous in one. These last four cases are of particular interest since they could be amenable to surgical correction. Possible approaches to surgical treatment and morphologic features pertinent to them are described and discussed.

Aortic Valve↗
PubMed1979

Univentricular heart of right ventricular type with double or common inlet.

Seventeen cases are described in which both atria connect directly to a chamber with right ventricular characteristics. The atria connected through separate atrioventricular valves in six hearts and a common valve in 11. All hearts had a posterior rudimentary chamber. The septum which separated it from the main chamber was directed to the crux of the heart. Ten hearts were from patients with atrial situs solitus and seven from patients with atrial situs ambigous. Arterial connections were concordant in three cases, had a double outlet from the main ventricular chamber in nine and single outlet of the heart in five. The patent artery always arose from the main chamber, with pulmonary atresia in three and aortic atresia in two. This and other studies indicate that double inlet atrioventricular connection does not predict the morphology of the main chamber. Although usually associated with a main chamber of left ventricular type, it may also be associated with a main chamber having right ventricular characteristics. Both types should be considered as univentricular hearts; the posterior chamber in hearts of right ventricular type are analogous to the anterior chamber in univentricular hearts of left ventricular type and are a rudimentary chamber rather than a hypoplastic ventricle. In the right ventricular form of univentricular heart, the trabecular zone of the rudimentary chamber is of left ventricular type.

Abnormalities, Multiple↗
PubMed1979

Surgical technique to reduce the risks of heart block following closure of ventricular septal defect in atrioventricular discordance.

Traumatic heart block remains a major concern after ventricular septal defect (VSD) closure in patients with atrioventricular discordance. A technique of closing the VSD, placing the suture line on the morphologically right side of the septum without opening the systemic ventricle, is described. This was used in 13 consecutive patients. The VSD was closed through the right atrium in eight patients, the left ventricle in three patients, the right atrium and the left ventricle in one patient, and through the right ventricle in one patient with atrioventricular disordance and ventriculo-arterial concordance. All patients were in sinus rhythm preoperatively, two exhibited atrioventricular dissociation before intracardiac manipulation began, and 11 patients were in sinus rhythm postoperatively. No major arrhythmia could be attributed to the closure of the VSD.

Adolescent↗
PubMed1979

Nomenclature of the univentricular heart.

A simple system for the analysis and classification of the univentricular heart is described. The basis of this approach is the use of a step by step sequential nomenclature with attention paid to the morphology, connexions and relationships of each cardiac segment in turn. Three major morphological types of univentricular heart are identified and these may be distinguished, by their characteristic trabecular patterns, into hearts of left ventricular type, right ventricular type and indeterminate type. With the exception of the last it is usual for a rudimentary second chamber to be present upon the use of a clear definition of "ventricle", depending on readily ascertainable anatomical characteristics. Each morphological type of univentricular heart may be associated with a wide variety of different connexions and intracardiac relationships and it is neither possible nor desirable to describe these in terms of a rigidly structured classification. Adherence to the simple semantic framework outlined would resolve much of the confusion and controversy which exists in relation to the univentricular heart.

Heart Septal Defects, Ventricular↗
PubMed1979

Morphology and conducting tissue in univentricular hearts of right ventricular type.

22 specimens of univentricular hearts of right ventricular type were examined morphologically. 6 hearts were sectioned for study of the conducting tissue. All the specimens had rudimentary second chambers, which were frequently so small as to have been overlooked, both angiographically and at initial morphological study. The segmental connexions and intracardiac relationships varied widely. Examples were found with 2 atrioventricular valves, a common valve and with absence of either the right or the left atrio-ventricular connexion. In some cases straddling of an atrioventricular valve was observed. The rudimentary chambers always lay posteriorly but varied between a position to the left of the ventricle and one to the right. The septum between ventricle and rudimentary chamber ran to the crux of the heart in all but 2 instances. In most specimens both great arteries arose from the ventricle (double outlet ventricle), so that the rudimentary chamber was solely a trabecular pouch. 4 hearts had concordant arterial connections with the aorta arising from a posterior "outlet" chamber. Pulmonary atresia was found in 5 cases and aortic atresia in 2. The conduction system originated from a normally placed atrioventricular node in 4 out of 6 cases and was related to the trabecular septum in 5. The penetrating bundle usually descended onto the crest of the septum at the "crux" of the heart and bifurcated astride it. In 2 cases with an absent atrioventricular connexion the penetrating bundle originated from an abnormally placed node and in one of these specimens a sling of conducting tissue was identified with dual pathways.

Atrioventricular Node↗
PubMed1979

Ventricular morphology in the univentricular heart.

The ventricle morphology is described in hearts in which the entire atrial inputs are committed to a single chamber in the ventricular mass, this being considered the criterion for definition of the univentricular heart. Such a definition does not exclude from the univentricular category hearts with two chambers in their ventricular mass providing that the second chamber does not receive a direct atrial input. Three types of ventricular morphology were identified: hearts with a main chamber of left ventricular pattern and a rudimentary chamber of right ventricular pattern; hearts with a main chamber of right ventricular pattern and a rudimentary chamber of left ventricular pattern and hearts with a sole chamber in their ventricular mass of indeterminate pattern. Hearts may also exist of right or left ventricular type without rudimentary chambers. Variation was noted in type and position of the rudimentary chambers. Chambers of either right or left ventricular type were found supporting either or both great arteries (outlet chambers), and also without a direct outlet (trabecular pouches). Right ventricular rudimentary chambers were usually anterior but could be right or left sided; left ventricular chambers were posterior but again could be right or left sided. Hearts with these ventricular morphologies possessed either double inlet atrioventricular connexions, or absence of the right or left atrioventriuclar connexion. In double inlet ventricles, cases were observed with two valves, a common valve, one imperforate valve, and with straddling atrioventricular valves. A straddling valve was also found in hearts with absence of one atrioventricular connexion. Further variation was found in the pattern of arterial connexions. It is concluded that ventricular morphology is an important feature of the iniventricular heart but must be considered in the context of other important and variable features.

Heart Septal Defects, Ventricular↗
PubMed1979

Angiocardiography in the pre-operative evaluation of patients with univentricular hearts.

Diagnosis of the univentricular heart and recognition of its most important variations depends on the establishment of atrial situs, the demonstration of the type and mode of the atrio-ventricular connexion, the identification of the presence or absence of a rudimentary chamber, the establishment of its morphology, together with that of the main chamber, and classification of the arterial connexion. A logical means of demonstrating these features is presented, depending on bronchial visualization, one or possible two injections of contrast medium into the main chamber, followed if necessary by selective injection into the rudimentary chamber, and in exceptional cases, demonstration of the atrial septum by atrial injection. The advantagess of cranio-caudal tilt and oblique projections are discussed in detail.

Angiocardiography↗
PubMed1979

Problems in the nomenclature of the univentricular heart.

There are three main reasons why there are problems concerning the nomenclature of the univentricular heart. The first is that different authorities have used the same term to describe different varieties of the univentricular heart. The second is that many of the terms used in categorisation of these anomalies are derived from embryological concepts which are more or less speculative. The final reason, perhaps the major one, is that there is a lack of definition of a ventricle. Consequently there is no consensus as to precisely what constitutes a "univentricular" heart. Many of the heart described as "single" or "common" ventricle possess two chambers within their ventricular mass. For such hearts to be univentricular it is evident that one of these chambers cannot be a ventricle. Yet definitions have yet to be provided to distinguish ventricles from rudimentary chambers. The solutions to these problems can be produced firstly by using descriptive terms for categorisation of univentricular hearts which do not have multiple meanings. Secondly, the problems concerning usage of embryologic terms can be easily circumvented by eschewing all embryologic considerations in naming these malformations. The problem of definition of a ventricle is best solved by considering normal ventricles as possessing three portions -- an inlet portion, a trabecular portion and an outlet portion. It may then be proposed that the minimal requirements for a ventricle are that it possesses at least an inlet and a trabecular portion. Chambers without inlet portions are rudimentary chambers. Either ventricles or rudimentary chambers may possess a trabecular pattern of right or left ventricular type. Tue univentricular heart may then be categorised as composing all anomalies which have a sole chamber in their ventricular mass together with all anomalies which possess a rudimentary chamber.

Heart Septal Defects, Ventricular↗
PubMed1977

Retrograde left atrial catheterization in children with congenital heart disease.

Entry into the left atrium during cardiac catheterization may be essential for full assessment of the hemodynamic situation, particularly for the accurate calculation of pulmonary blood flow and pulmonary arteriolar resistance. The retrograde transaortic transmitral technique of left atrial catheterization has been described in adults but no detailed reports are available for the pediatric age group. Experience of this technique in 43 children with congenital heart disease is now presented, with a success rate of 67 per cent and a low incidence of complications. This method compares favorably with other methods of left atrial catheterization when the interatrial septum is intact.

Adolescent↗
PubMed1976

Sick sinus syndrome in children.

The ages of 6 male patients with the sick sinus syndrome ranged from 10-15 years when their symptoms began. At rest all had a heart rate of 60/min or less. Two had syncopal attacks which threatened life; 1 had only attacks of dizziness; the other 3 had no syncopal attacks but had recurrent attacks of supraventricular tachycardia ('brady-tachycardia syndrome') which were more resistant to drug therapy than is usual in childhood. They were not controlled or suppressed by digoxin when it was given. Substernal pain occurred in 2 patients who had syncope. In all patients the heart rate remained inappropriately slow after exercise and atropine. Cardiac pacemakers were used in the 2 patients with life-threatening syncope. Any patient who has dizziness or syncopal attacks and an inappropriately slow heart rate should have electrocardiograms recorded at rest and after exercise to record the heart rate and to look for abnormal P-waves.

Adolescent↗
PubMed1976

Effect of environmental temperatures on oxygen consumption in infants with congenital disease of the heart.

The effect of changes in environmental temperature on the oxygen consumption in babies with congenital disease of the heart has been studied and it has been shown that an inverse relation exists between those two variables. The significance of these findings on the practice of calculating systemic and pulmonary blood flow from predicted values of oxygen consumption is discussed.

Female↗
PubMed1976

Sequential chamber localization--logical approach to diagnosis in congenital heart disease.

A nomenclature is described for congenital heart disease employing sequential chamber localization. It is an eclectic system based in part upon the previous classifications of Van Praagh and Kirklin. It links together the atrial, ventricular, and arterial segments of the heart and then permits tabulation of associated anomalies. The atrial segment of the heart can exist as situs solitus, situs inversus, or situs ambiguus. Atrioventricular connexions can be concordant or discordant. In certain circumstances the terms concordant and discordant cannot be used. These are in the presence of primitive ventricle and in the presence of situs ambiguus. Alternative terms are described for these contingencies. Ventriculo-arterial connexions can be (a) normal; (b) transposition; (c) double outlet ventricle; or (d) single arterial trunk. These are defined as connexions; relations are relegated to secondary position. Associated anomalies are categorized in terms of venous return, atria, atrioventricular junction, ventricles, and great arteries. Controversial topics are discussed with regard to previous definitions.

Angiocardiography↗
PubMed1976

Common or single ventricle. An angiocardiographic and hemodynamic study of 42 patients.

To correlate anatomy with hemodynamics, the angiocardiographic findings were reviewed in 42 patients with common ventricle (CV). Nine had normally related great arteries (NRGA), 12 d-malposition, 21 l-malposition and 5 a common atrioventricular valve. Selective outlet chamber (OLC) angiocardiograms were available in 14 out of 29 patients with OLCs. OLC position varied from anterior and to the right of the CV to posterior and to the left of it; two categories (anterior and lateral OLC) were delineated by a line 45 degrees to theleft of anterior in the horizontal plane. The OLC was anterior in all patients with NRGA, lateral in most l-malpositions, and almost equally divided between anterior and lateral in d-malposition (P less than 0.05). Complete hemodynamic data were obtained in 29 patients. Complete mixing of venous return occurred in four patients with atresia of one valve. In the remainder complete mixing occurred in 36%, unfavorable streaming in 12% and favorable streaming in 52%. Semilunar valve position and pulmonary stenosis did not affect the nature of mixing. Systemic arterial (SA) minus pulmonary arterial O2 saturation was positive and significantly higher in patients with malposition with lateral OLCs than anterior OLCs (P less than 0.001). However 79% of SA O2 saturation variation could be predicted from pulmonary and systemic blood flow alone.

Adolescent↗
PubMed1976

Angiocardiographic/pathologic correlations in congenital mitral valve anomalies.

The angiocardiographic findings were reviewed in 21 patients with congenital mitral valve disease in whom the exact anotomic diagnosis was known independently. Patients with discordant (1)transposition and simple atrioventricular canal defects were excluded. No precise diagnosis was made in five patients (24%), all of whom had a cleft anterior leaflet or congenital short chordae. In the remainder, the specific diagnosis could have been made by injection of constrast medium downstream to the mitral valve alone in 15 (71%). Upstream injection was performed in 13 of these but would have made the precise diagnosis in only three (23%). In one patient both upstream and downstream injections were necessary. Anomalies giving characteristic angiocardiographic appearances were parachute valve, atresia, annular hypoplasia, dysplasia, anomalous arcade and anomalies associated with subaortic stenosis. Thus injection downstream to the valve is preferable to upstream injection, because it gives information about its patency, competence, tensor apparatus, and annular dimensions.

Adolescent↗
PubMed1975

Late hemodynamic results of fascia lata reconstruction of the right ventricular outlet.

Eight patients were catheterized between 1.2 and 2.4 years after reconstruction of the right ventricular outflow tract with autologous fascia lata. Whereas the immediate post-bypass pressures had demonstrated a maximum gradient of 15 mm. Hg across the fascial valve at the time of recatheterization, this varied from 55 to 142 mm. Hg (mean 83 mm. Hg). Right ventricular systolic pressure varied between 80 and 160mm. Hg (mean 106 mm. Hg). All but one patient had clinical evidence of pulmonary incompetence. Selective angiography with injection into the right ventricle and pulmonary artery demonstrated shrunken, thickened, immobile valve cusps with an abrupt stenosis of the fascial tube or a diaphragm across it. Re-operation has been done in five patients. In each, the graft tube functioned satisfactorily, but at the site of the "valve," no leaflets were visible, and the orifice of the conduit narrowed abruptly to 6 to 10 mm. in diameter. It is concluded that autologous fascia lata is unsuitable for reconstruction of the right ventricular outflow tract.

Adolescent↗