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Biomedical subjects

G L Hallman

Publications and source records attributed to G L Hallman.

At least 55 records · Page 3Linked to original sources
PubMed1977

Left ventricular apical-abdominal aortic conduits for left ventricular outflow tract obstructions. Clinical results in eleven patients with a special composite prosthesis.

Cardiologists and surgeons are occasionally faced with therapeutic dilemmas regarding the management of recurrent left ventricular outflow tract obstructions, such as supravalvular, valvular, subvalvular or "tunnel" stenoses and obstructive myopathies. Following an extended series of biomaterial, hemodynamic, reliability and configuration studies in calves, we have created double-outlet left ventricles in 11 patients. All gradients were markedly reduced. All patients were discharged without anticoagulants, and the longest follow-up period is in excess of 1 year. In eight cases, the percent of cardiac output flowing antegrade and retrograde was quantitated with velocity-tipped catheters. An average ratio of 2:1 (antegrade [ascending aorta]: retrograde [composite conduit]) was found. The procedure is simple and effective in relieving primary or recurrent left ventricular outflow tract obstructions.

Adolescent↗
PubMed1976

Aortocoronary artery bypass: present indications and risk factors.

From 1969 through 1974, a total of 4,522 patients were operated on for coronary artery occlusive disease. This article is an in-depth analysis of a consecutive series of 275 of these patients, operated on during 1974. The mortality was 1.8% and perioperative myocardial infarction occurred in 3.6%. On analysis of risk factors, it was found that 24% of the patients were over the age of 60; 57% had some degree of left ventricular dysfunction; 9% had generalized hypokinesis; 24% were New York Heart Association functional class IV; 13% had left main coronary artery stenosis; and 11% had preinfarction angina. On analysis of the early mortality, the limiting factor was diffuse coronary arteriosclerosis combined with poor ventricular function. This resulted in inadequate or incomplete myocardial revascularization. Since these two risk factors are usually predictable, coronary artery bypass can be recommended not only for patients with intractable angina, but also for patients with impaired left ventricular function associated with angina, and in patients without angina who have a positive stress electrocardiogram.

Coronary Artery Bypass↗
PubMed1976

Early and late results after surgical treatment of preinfarction angina.

Among 3,707 patients who underwent aortocoronary bypass, 302 had preinfarction angina. Coronary angiography revealed single-vessel disease in 43 patients, double-vessel disease in 81, and triple in 178 patients. Plane ventriculography showed contractility to be normal in 178 patients, fair in 88, and poor in 36 patients. Left ventricular end-diastolic pressure was normal in 203 patients, 13 to 23 mm Hg in 73, and larger than or equal to 24 mm Hg in 26 patients. Using cardiopulmonary bypass and moderate hypothermia, single coronary bypass was performed in 45 patients, double bypass in 120 patients, triple in 118 patients, quadruple in 15, and quintuple in 4 patients. Right coronary artery endarterectomy was necessary in 22 patients. The early mortality was 6.6% (20 patients) and was strongly related to poor contractility and congestive heart failure. One- to four-year follow-up data were obtained in 126 patients. Late myocardial infarction occurred in 11 patients and caused 4 late deaths; 3 unrelated deaths occurred. Ten patients experienced no benefit from their operations, 56 are completely asymptomatic, and 53 are significantly improved. Our results show that surgical intervention can improve the poor prognosis of preinfarction angina and appears to be superior to medical treatment.

Adult↗
PubMed1976

A new approach to repair of pulmonary branch stenosis following ascending aorta-right pulmonary artery anastomosis.

Ascending aorta-right pulmonary artery anastomosis may result in branch stenosis or occlusion of the right pulmonary artery from growth or from failure to place the anastomosis on the posterior surface of the aorta at the time of construction. Closure of the anastomosis is usually easily accomplished by simple suture through the ascending aorta. When branch stenosis is present at the site of anastomosis, reconstruction of the pulmonary artery is necessary. A new approach that facilitates repair of pulmonary branch stenosis by transecting the ascending aorta over the obstructed area has been utilized in 2 patients who required reoperation for branch stenosis following repair for tetralogy of Fallot. The method is an alternative approach to gain exposure for reconstruction of the pulmonary artery.

Aorta↗
PubMed1976

[Aneurysm of pericardial right ventricular outflow tract patches (author's transl)].

Among 1022 patients who underwent total repair of tetralogy of Fallot, 252 patients received a pericardial patch of the right ventricular outflow tract (RVOT); and of these 10 subsequently developed an aneurysm of the RVOT. Cardiac catheterization and angiography revealed moderate pulmonary unsufficiency in all patients, a residual pressure gradient in the RVOT in seven and a residual ventricular septal defect in two patients. Surgery was indicated in eight patients because of progressive distension of the aneurysm. Reconstruction of the RVOT was accomplished by resection of the aneurysm and insertion of a woven Dacron patch in five patients, primary suture of the pulmonary artery in two and implantation of a woven Dacron conduit containing a Björk-Shiley valve in one patient. No early or late death occured. Although aneurysms of the RVOT with pericardial patches represent a rare complication after total correction of tetralogy of Fallot, we recommend primary reconstruction of the RVOT with a woven Dacron patch.

Child↗
PubMed1976

Permanent pacemaker implantation in infants, children, and adolescents. Long-term follow-up.

Twenty-four patients in the pediatric age range who underwent implantation of a cardiac pacemaker for treatment of complete atrioventricular (A-V) block were followed for an average of five years (range 1-12 years). The etiology of the A-V block was surgical in 13 cases, congenital in nine, and acquired in two. Twenty patients had symptoms of cerebrovascular insufficiency and four had congestive heart failure. To date, 18 of the 24 patients studied are alive and well. Death occurred in six patients, five of whom had complex congenital heart defects, and one of whom had Refsum's disease. Death probably was caused by complete heart block despite pacemaker treatment in four patients, and congestive heart failure in two. In 18 of the 24 children with disabling complete A-V block, pacemaker therapy provided relief of symptoms and prolonged life.

Adolescent↗
PubMed1976

Treatment of severe coronary artery disease with quadruple and quintuple saphenous vein grafts. Review of 100 consecutive patients.

In order to establish the anatomic criteria, the functional results, and the safety of complete myocardial revascularization for severe coronary artery disease, 100 consecutive patients who received four or five saphenous-vein grafts were analyzed. Ages ranged from 37 to 75 years (mean, 56 years). Men predominated by a ratio of 12:1. As an indication of the severity of multiple-vessel disease, 28 percent were in functional class 4, and left ventricular function was classified as good in 47 percent, as fair in 44 percent, and as poor in 8 percent. Coronary arterial scores ranged from 9 to 15 (average, 12.2). Fourteen patients had significant left main coronary arterial obstruction. All 100 patients had grafts to the left anterior descending coronary artery; 96 to the right coronary artery; 94 to the obtuse marginal branch of the circumflex; 78 to a diagonal branch of the left anterior descending; and 27 to the distal circumflex. Operative mortality was 5 percent. Nonfatal perioperative myocardial infarction occurred in 10 percent, and only one of these had low cardiac output. Follow-up from 5 to 23 months showed 95 percent of the patients to be improved, with 70 percent free of angina. Two late deaths occurred, for an overall mortality of 7 percent.

Adult↗
PubMed1976

Repair of ventricular septal defect after pulmonary artery banding.

Since 1964, 90 patients have undergone two-stage surgical repair of ventricular septal defect (VSD) with pulmonary artery banding (PAB) in early infancy and total repair at an average age of 4 years. Reconstruction of the pulmonary artery was accomplished with a pericardial patch, woven Dacron patch, or transverse angioplasty. The VSD was closed with a knitted Dacron patch in 75 patients and by primary suture technique in 13 patients. The VSD closed spontaneously in 2 patients. The mortality rate for patients who had repair and debanding was 9 per cent (8 patients), including 4 deaths due to severe pulmonary hypertensive disease, 3 from congestive heart failure, and one from atrioventricular block. Twenty patients underwent repeat cardiac catheterization several months to 7 years after total repair. This study revealed no shunt in 16 patients and a minimal shunt not requiring operation in the other 4 children. Slight residual stenosis of the pulmonary artery was found in 2 patients and a residual infundibular stenosis in another 2 patients. We believe two-stage surgical treatment of VSD in severely ill infants under one year of age is safe and reliable.

Blood Vessel Prosthesis↗
PubMed1976

Interruption of the aortic arch. Surgical considerations.

During a 10 year period, January, 1965, through January, 1975, 5 patients with interruption of the aortic arch (IAA) underwent operation at the Texas Heart Institute. The mortality rate was 60 per cent; 2 patients survived the operation. One 11-day-old infant with IAA, type A, a ventricular septal defect (VSD), and a patent ductus arteriosus (PDA) underwent successful two-stage treatment. A left subclavian-ductus anastomosis, closure of the PDA, and banding of the pulmonary artery were done initially. The VSD was closed later. The second survivor, a 3-year-old girl, had IAA, type B, with a PDA and VSD. Total correction was done with the aid of cardiopulmonary bypass and hypothermia. Considerations include palliative and staged procedures versus total correction with either conventional cardiopulmonary bypass or deep hypothermia and circulatory arrest. Survival rate is improved if associated lesions are totally repaired or palliated at the time of reconstruction of IAA.

Aorta↗
PubMed1975

Dissecting aneurysm of the descending aorta. Improved surgical results in 91 patients.

Dissecting aneurysm of the descending thoraic aorta (type iii) is a specific disease process whose pathogenesis, pathologic description, surgical treatment, and prognosis is different from dissections of the ascending arota (types l and ll). From 1964 through 1974, 91 patients underwent surgical correction of type iii dissection. The operative mortality was 21% and late mortality, up to ten years follow-up, was 13%. During the past four years, operative mortality has dropped to 6.5%. Mortality was determined by extent of the aneurysm and underlying cardiac disease. Antihypertensive and negative ionotropic drugs have not been used as definitive treatment but as adjuncts in perioperative support. Based on our present mortality of 6.5%, with no late mortality, we urge early surgical treatment of acute and chronic dissecting aneurysms of the descending thoracic aorta before extension, rupture, or massive enlargement of the aneurysm occurs.

Adult↗
PubMed1975

Long-term survival following coronary artery bypass. Analysis of 4,522 consecutive patients.

A consecutive series of 4,522 patients who received aortocoronary bypass (ACB) from October 1969 through December 1974 has been analyzed with respect to cumulative (actuarial) survival, cause of late death, and late postoperative complications. Through December 1973, 2,676 patients received ACB alone. Cumulative survival was 85.9% for five years. Late cumulative mortality averaged 2.7% per year. Causes of death were myocardial in origin in only 60.4% of the patients. Late complications of nonfatal myocardial infarction occurred in 4.1% of the patients, and congestive heart failure occurred in 10.2%. However, preoperative congestive heart failure was present in 25% of these subjects. Mortality in 1974 was 3.4% in patients who underwent ACB only, and 4.2% for all patients who received ACB procedures (1,478 patients). Comparison to previous medical data makes it appear that this surgery increased the actuarial survival over long-term follow-up.

Adult↗
PubMed1975

Surgical experience in patients with Marfan's syndrome, ascending aortic aneurysm and aortic regurgitation.

Surgical treatment of cardiovascular complications in patients with Marfan's syndrome is usually recommended with apprehension since the systemic nature of the disease predisposes to early and late complications. To define the incidence of these complications, 30 patients were evaluated after surgical treatment of aortic insufficiency and ascending aortic aneurysm at the Texas Heart Institute. To provide a minimal follow-up period of 5 years, only patients operated upon during of before 1968 were included in this series. There were 9 female and 21 male patients aged 4 to 80 years (mean 44 years). Aortic insufficiency was treated by valvuloplasty in 3 patients and by aortic valve replacement in 27. Graft replacement of the ascending aorta was required in 23 patients, and the aneurysm was excised and the aorta repaired by direct anastomosis in 7. Two patients were lost to follow-up study; 12 of the remaining 28 (42.8 percent) lived 5 years or more. The hospital mortality rate was 20 percent (6 of 30); the causes of death included dissection or rupture of the aorta in three patients, congestive heart failure in two and pulmonary embolism in one. The 24 survivors lived from 5 weeks to 9 years. Follow-up data were available on 22 of these patients. Ten of these (45.4 percent) died of late complications. Seven died suddenly, four of these had redissection, one patient had occlusion of the right coronary artery, and two had ventricular fibrillation of no apparent cause. The remaining three died of noncardiac causes. Although the risk of ascending aortic and aortic valve surgery in patients with Marfan's syndrome is high, 42.8 percent of the patients in our series survived 5 years or more. We believe that surgery should be recommended for patients with Marfan's disease who have dissection of the aorta or severe aortic regurgitation, or both.

Adolescent↗
PubMed1975

Coronary artery bypass in patients over 70 years of age: indications and results.

With recent advances in all phases of coronary care and the increasing success of coronary arterial surgery, operative treatment of coronary artery disease is more readily recommended, even for patients over 70 years of age. In a series of 3,730 patients who underwent aortocoronary bypass from November 1969 through June 1974, there were 95 patients who were 70 years of age or older. The primary indication for surgery was severe angina, which was present in 88 patients. The mean coronary arterial score was 9.51. Associated valvular lesions were treated surgically in 21 patients, and a left ventricular aneurysm was resected in 7. Improvements in surgical technique and postoperative care are responsible for the hospital mortality rate of only 4.8 percent in the 21 patients operated upon during the first 6 months of 1974 compared with the overall mortality rate of 22.1 percent in all 95 patients. Long-term follow-up among the 95 patients includes data from 33 patients: 9 patients whose condition improved, 21 who were asymptomatic and 1 "coronary death".

Age Factors↗
PubMed1975

Total anomalous pulmonary venous return. Review of 125 patients treated surgically.

One hundred twenty-five patients undergoing surgical correction of total anomalous pulmonary venous return were studied. The overall mortality was 37% and was related to age at the time operation was required. Mortality was 57% during the first year of life, 29% in patients between 13 and 24 months, and 15% in those between 2 and 10 years; no deaths occurred in those over 10 years. Mortality was highest in patients with infracardiac lesions (62%), and lowest in those with cardiac defects (30%). The major cause of death was pulmonary edema, and survival was closely related to the degree of increased pulmonary vascular resistance. Surgical treatment should be delayed until at least 6 months of age, but the development of congestive heart failure may necessitate earlier operation.

Adolescent↗
PubMed1975

Aneurysm and fistula of the sinus of Valsalva. Clinical considerations and surgical treatment in 45 patients.

Aneurysms and fistulas of the sinus of Valsalva, although rare, present a challenging surgical problem. Forty-five patients with this lesion have undergone operative treatment during the last 17 years. The series includes 32 male and 13 female patients ranging in age from 2 to 68 years with a mean age of 35.3 years. Only 1 early death occurred in the series, a hospital mortality of 2.2%. Diagnosis of the aneurysm was made preoperatively in 30 patients and discovered at operation 15. The lesion involved the right coronary sinus in 28 patients, the noncoronary sinus in 19, and the left coronary sinus in 5. The aneurysm had not ruptured in 22 patients and had formed a fistulous communication between the right coronary sinus and the right ventricle in 13. Acute rupture occurred in 10 patients (22.2%). Long-term follow-up data were obtained in 38 patients after 1 to 15 years. Late mortality is low. A nonruptured aneurysm of the sinus of Valsalva should be managed conservatively when it occurs as an isolated lesion. Our experience supports the concept that perforated aneurysms and fistulas of the sinus of Valsalva, even if asymptomatic, should be treated operatively.

Adolescent↗
PubMed1975

Conduit reconstruction of right ventricular outflow tract. Experience with 17 patients.

Evaluation was made of 17 patients who underwent conduit reconstruction of the right ventricular outflow tract (for anomalies other than truncus arteriosus) at the Texas Heart Institute between December, 1965, and June, 1974. Fifteen patients survived the operation and have shown substantial clinical improvement. Several different conduits were used, principally an allograft aorta with the aortic valve and mitral leaflet attached, a woven Dacron prosthesis containing a xenograft (porcine) valve, and a valveless Dacron tube graft. Allograft conduits are sometimes difficult to procure and keep and tend to calcify with passage of time. Woven Dacron prostheses are favored because they are readily available in a wide range of sizes. We believe it is not necessary for the conduit to contain a valve unless the patient has pulmonary hypertension, in which case we use a xenograft (porcine) valve because this valve does not require the long-term use of anticoagulants, a difficult regimen to manage in children. The largest possible prosthesis must be used; otherwise right ventricular hypertension will persist. Indications for conduit reconstruction include anomalous coronary arteries crossing the right ventricular outflow tract, discontinuity of the pulmonary arteries, and pulmonary atresia with a ventricular septal defect. Our current method of managing pulmonary atresia with ventricular septal defect (pseudotruncus arteriosus) includes palliative shunting to relieve hypoxemia during infancy and to permit full development of the pulmonary arteries for eventual total correction at a more optimal age when a larger conduit may be used.

Adolescent↗
PubMed1975

Surgical treatment for anomalous origin of left coronary artery from pulmonary artery.

Anomalous origin of the left coronary artery from the pulmonary artery carries a poor prognosis; most patients die early in life from myocardial infarction and congestive heart failure. During a 12-year period at the Texas Heart Institute, 13 patients with this congenital malformation ranging in age from 1 to 24 years underwent operation. The anomalous coronary artery was sutured or ligated, or both, close to the pulmonary artery in 3 patients, 2 before 1965. Aortocoronary bypass was performed in the remaining 10 patients, using an autogenous saphenous vein graft in 9 and a Dacron tube in 1. More recently a distal end-to-side anastomosis has been employed and is not the preferred method. If necessary, a pump oxygenator may be used to complete the procedure. The only death was that of the first patient in the series who underwent ligation of the left coronary artery and mitral annuloplasty for severe mitral insufficiency; Of the 12 patients available for long-term follow-up study, all but 1 were asymptomatic. Follow-up angiographic studies showed the graft to be patent in 7 patients; the longest period of graft patency was 8 years. Definitive operative therapy is preferable to simple ligation because it eliminates the left-to-right shunt from the right coronary artery to the pulmonary artery and establishes a double coronary artery system.

Adolescent↗