Biomedical subjects

G L Hallman

Publications and source records attributed to G L Hallman.

At least 73 records · Page 4Linked to original sources

PubMed1975

[Surgical treatment of acute dissection of the ascending aorta (author's transl)].

Since 1959, 51 patients underwent open heart surgery for correction of acute dissection of the ascending aorta. Upon admission 33 patients were severely hypotensive or in porgressive heart failure. Acute aortic insufficiency was found in 24 patients, and hemiplegia or hemiparesis in 4. In 45 patients the ascending aorta was reconstructed with a woven graft. After excision of the dissected part of the aorta primary anastomosis or patch aortoplasty was performed in 6 patients. The aortic valve remained intact in 26 cases, and resuspension of the commissures restored competence of the aortic valve in another 9 patients. Sixteen patients required aortic valve replacement because of disrupture of the commissures. Dissection extended into the coronary ostia in 5 cases. Reconstruction of the coronary system was accomplished by reimplantation of the ostia, interposition of a vein graft or aorto-coronary bypass. Nine patients died within the early postoperative course from uncontrollable hemorrhage (4), further dissection (3) and myocardial infarction (2). Within the first year after surgery another 5 patients died from acute aortic dissection (2), pseudomonas-infection causing rupture of the proximal graft anastomosis (1), and myocardial infarction (2). The contraindications of antihypertensive treatment of actue dissection of the ascending aorta are discussed. We recommend prompt surgical intervention in acute dissecting aneurysm of the ascending aorta.

Aortic Aneurysm↗

PubMed1975

Surgical palliation of tricuspid atresia.

In the 20-year period ending December 31, 1973 we operated on 105 patients for palliation of tricuspid atresia (TA) with reduced pulmonary blood flow. Pott's anastomosis (85), Blalock-Taussig anastomosis (19), intrapericardial aorta (Ao)-to-right pulmonary artery (RPA) (18), Glenn procedure (3) and miscellaneous shunts (2) have been used. Of patients undergoing operation more than 15 years ago, 45% (9/20) are still alive. The over-all operative mortality was 9%. It was highest in patients less than one month of age (7/23, 30%). There were no operative deaths in patients older than 12 months. The median age at first operation for the entire series was five months. Our results indicate the Pott's anastomosis and Ao-to-RPA anastomosis are superior to the Blalock-Taussig anastomosis (BT) for palliation of TA. Of patients surviving BT, 69% (11/16) required reoperation, compared to 22% (17/78) surviving Pott's anastomosis and 13% (2/16) surviving Ao-to-RPA shunts. All three patients undergoing Glenn procedures (superior vena cava-to-RPA anastomosis) required reoperation or died without significant benefit. Ballon atrial septosomy and Pott's anastomosis appear to be indicated for infants less than six months of age, and Ao-to-RPA shunt with simultaneous atrial septectomy (if indicated) for older children.

Adolescent↗

PubMed1975

Complications of cloth-covered prosthetic valves: results with a new mitral prosthesis.

During a 12 year period 5,103 cardiac prosthetic valves in 4,193 patients have been evaluated for performance and incidence of complications. As a result of our experience, the advantages of fewer embolic phenomena, associated with epithelialization in completely cloth-covered valves and those with cloth-covered seating rings, are outweighed by the problems of cloth wear, hemolysis, and hemodynamic obstruction from tissue overgrowth. A valve has been designed which incorporates the desirable features of full-flow orifice, low-profile, self-washing principle, polished contact surfaces, durable materials, and a large eccentric sewing ring into a new mitral prosthesis. Clinical evaluation in 394 patients from Aug. 1, 1971, through Dec. 31, 1973, has demonstrated excellent hemodynamic function and a low incidence of thromboembolic phenomenon.

Heart Valve Prosthesis↗

PubMed1975

Runaway pacemaker in seven patients: a persisting problem.

Runaway pacemaker has been encountered in 7 patients during the past 7 years at the Texas Heart Institute. In this series, 4 patients with fixed-rate pacemakers experienced pacemaker arrhythmias because of battery depletion, and 3 had arrhythmias because of component failure. Battery deterioration was heralded by an increase in cardiac rate. Ventricular tachycardia, rapidly followed by ventricular fibrillation, occurred in 2 patients. Prompt surgical exteriorization of the failing pulse generator and connection to an external pacemaker resulted in prompt recovery in all patients. Elective generator change should be performed routinely after 24 to 30 months unless reliable serial observations of ventricular rates can be attained. This at least will reduce the lethal complications attributed to battery exhaustion. Increasing developments in the design of generators and sources of power, as well as data from pacemaker clinic follow-up and telephone pulse transmittal, are expected to decrease the frequency of this complication.

Adult↗

PubMed1975

Coronary artery anomalies in patients with tetralogy of Fallot.

A left anterior descending coronary artery arising from the right coronary artery can be easily injured during performance of a right ventriculotomy for correction of tetralogy of Fallot. This occurred in 2 of the 23 patients in this series, and both patients died from myocardial failure in the early period after operation. Of 19 patients who presented a combination of tetralogy of Fallot and unusual coronary artery distribution, injury to the abnormal coronary artery was avoided by a transverse right ventriculotomy either alone or combined with an upper vertical incision in 17 patients. In 2 patients a Dacron tube graft was inserted between the right ventricular outflow tract and the pulmonary artery. In 2 patients a right ventriculotomy was avoided by closing the ventricular septal defect through a transaortic approach. All 21 patients survived. Before a vertical or longitudinal incision in the right ventricular outflow tract is performed, the coronary artery distribution should always be checked and confirmation made of the normal origin of the left anterior descending branch from the left coronary artery to the left of the pulmonary artery.

Adolescent↗

PubMed1975

Intracardiac repair of tetralogy of Fallot. Five-year review of 403 patients.

During the 5 year period 1969 to 1973, 403 patients underwent intracardiac repair of tetralogy of Fallot. The patients ranged in age from 3 months to 41 years. Before operation, 86 per cent were cyanotic and 14 per cent were acyanotic. Forty-nine per cent had had at least one palliative procedure before total correction. Mahor associated anomalies included atrial septal defect in 24 per cent, patent ductus arteriosus in 2.5 per cent, coronary anomalies in 4 per cent, and left superior vena cava in 4.5 per cent. Seven per cent of the patients had pulmonary atresia. Pulmonary valvotomy was performed in 111 patients and complete excision of the pulmonary valve in 151. Patch graft reconstruction of the right ventricular outflow tract was performed in 57 per cent of the patients. In 11 patients a conduit was used to connect the right ventricle to the pulmonary artery. The over-all hospital mortality rate was 9.5 per cent, with the lowest rate (3.5 per cent) in the age group 6 to 10 years and the highest in the infant and adult groups (16.5 and 14.5 per cent, respectively). Three known late deaths occurred. A residual ventricular septal defect (VSD) was found in 3 per cent of the patients and an aneurysm of the pericardial patch in the right ventricular outflow tract developed in 7 patients. Intracardiac repair of the tetralogy of Fallot can be performed with reasonable risk and low morbidity. In our experience the optimal age for elective surgery is between 6 and 10 years.

Adolescent↗

PubMed1975

[Clinical experinece using tubular grafts in the reconstruction of the right ventricular outflow tract (author's transl)].

Conduit reconstruction of the right ventricular outflow tract is useful in treatment of a variety of congenital cardiac malformations. Seventeen patients underwent conduit reconstruction at the Texas Heart Institute between December 1965 and June 1974. Fifteen patients survived the operation and have significantly improved. Several different conduits were used: allograft aorta with the aortic valve and mitral leaflet attached, a woven Dacron prosthesis containing a prosthetic valve, a prosthesis containing a xenograft (porcine) valve and a valveless Dacron tube graft. Allograft conduits present difficulties with procurement and inventory and tend to calcify with time. Woven Dacron prostheses are favored because of ready availability in a wide range of sizes. In the case of pulmonary hypertension, we use a conduit containing a xenograft (porcine) value. The largest conduit possible must be used. Indications for conduit reconstruction include anomalous coronary arteries, discontinuity between the pulmonary arteries and pulmonary atresia with a VSD. Our current method of management of pulmonary atresia with VSD includes palliative shunt during infancy to permit full development of the pulmonary arteries for total correction at a more optimal age when a larger conduit may be used.

Adolescent↗

PubMed1974