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Biomedical subjects

H C Stansel

Publications and source records attributed to H C Stansel.

At least 37 records · Page 2Linked to original sources
PubMed1979

Late failure of porcine valve heterografts in children.

Heterograft porcine valves have gained wide acceptance in replacement of diseased cardiac valves, and their clinical performance in adults has been very satisfactory over follow-up periods of up to 8 years. Valve replacement in children is relatively infrequent and experience with porcine xenografts is necessarily small. Our combined experience at three university hospitals has been with 25 children, 17 months to 16 years of age, who have been followed for 10 to 54 months (mean follow-up 33 months). Porcine valves were used to replace the aortic valve in nine, the mitral valve in seven, both valves in two, the tricuspid valve in two, and the pulmonary valve in five patients. Severe bioprosthetic valve dysfunction has occurred in five (20%) of these patients so far and necessitated replacement because of severe stenosis in mitral (two) or aortic (three) valve prostheses at 18 to 45 months after implantation; one postoperative death occurred among the five reoperations. Pathological examination showed extensive fragmentation of collagen with focal heavy calcification and degeneration. In addition we have encountered deterioration and calcification of two porcine valves in 23 valved conduits followed for 12 to 70 months (mean 43 months), requiring removal and replacement of the valves 65 and 67 months after implantation. This experience indicates a disquietingly high incidence of relatively early failure of porcine xenograft valves in children. This is significantly higher than the failure rate observed in adult patients. The failure rate is not consistently related to the small size of an implanted valve which becomes relatively narrow with the growth of the patient, leading to excessive turbulence and trauma to the prosthesis. Other factors, including increased turnover of calcium and accelerated rejection in growing children, may contribute to these failures and should be examined in order to improve long-term results. A satisfactory performance would make heterografts the ideal valvular prosthesis in children, since anticoagulation is avoided.

Adolescent↗
PubMed1979

Retroperitoneal cross pelvic bypass grafts.

An extraperitoneal retropubic cross iliac artery bypass graft is a safe alternative to an intra-abdominal aortoiliac bypass, axillofemoral bypass or subcutaneous femorofemoral bypass in the patient considered to be at high risk. This procedure may prove to be superior to subcutaneously placed grafts because the graft is less prone to trauma and infection. The circulation of the donor limb must be adequate to produce a significant increase in the rate of flow through the recipient limb. There was an early patency of the graft in 58 of 61 patients. There was patency of the graft at three years in 40 of 61 patients.

Blood Vessel Prosthesis↗
PubMed1978

Apical-aortic shunts in children.

Experience with four children undergoing apicalaortic shunts for relief of aortic valvular disease is reported. All children tolerated the procedure uneventfully, and postoperative cardiac catheterization in three revealed restoration of normal hemodynamics. In one unique case severe aortic regurgitation in a two year old boy was managed by suture closure of the aortic valve producing total left ventricular output through the apical-aortic conduit.

Adult↗
PubMed1978

Cervical aortic arch with retroesophageal aortic obstruction: report of a case with successful surgical intervention.

The clinical, roentgenographic, hemodynamic, and angiographic features of a patient with a right cervical aortic arch and retroesophageal aortic obstruction associated with a ventricular septal defect are presented. Surgical relief of the aortic obstruction was successfully achieved by placement of a bypass graft between the left common carotid artery and the descending thoracic aorta.

Aorta, Thoracic↗
PubMed1978

Incidence of emboli with cloth-covered Starr-Edwards valve without anticoagulation and with varying forms of anticoagulation. Analysis of 183 patients followed for 3 1/2 years.

One hundred eighty-three patients with cloth-covered valves were studied from 1 1/2 to 8 years after operation, with an average follow-up time of 3 1/2 years. Over the total period, patients taking Coumadin sustained a 4 percent embolic incidence (1.2 per 100 patient-years); those taking aspirin had a 7 percent incidence (2.6 per 100 patient-years); and those taking Persantine had a 43 percent incidence (10 per 100 patient-years). Patients on no regimen of anticoagulation had a 16 percent embolic rate (four per 100 patient-years), whereas another group of patients who stopped anticoagulants after a year incurred a 13 percent embolic incidence in the subsequent 2 years (6.4 per 100 patient-years). These data showed a significantly lowered embolic rate with anticoagulation and suggest that all patients with cloth-covered valves should be taking anticoagulants. That these valves become epithelialized and do not form thrombus after a year was not borne out by this study. Persantine alone is not a satisfactory anticoagulant. Coumadin appears to be the superior anticoagulant, but if careful monitoring of its use is in question or if serious bleeding complications ensue, aspirin may provide satisfactory protection.

Anticoagulants↗
PubMed1978

Abdominal angina.

Explore the source record for details and available documents.

Aorta, Abdominal↗
PubMed1977

One hundred consecutive coarctation resections followed from one to thirteen years.

The technique of operative repair for coarctation of the aorta is now well standardized and the immediate surgical mortality has been lowered to less than 5% in most large series. Long term follow up, however, is only recently being reported. This paper describes the current status of 100 consecutive patients who underwent elective resection from 1--13 yr ago. There was only one operative death. In contrast with other reports, residual systemic hypertension is rare in the 97 survivors. These observations confirm that coarctation of the aorta can be repaired surgically with an acceptable operative mortality; the outlook of the survivors appears excellent.

Adolescent↗
PubMed1977

Late development of severe pulmonary venous obstruction following the Mustard operation.

While four patients with d-transposition of the great arteries who had a Mustard operation before 2 years of age developed severe pulmonary venous obstruction 2, 3 1/2, 3 9/12, and 5 years following their operation, initial postoperative catheterization (less than 1 year) revealed only minimal pulmonary artery wedge and right ventricular end-diastolic pressure differences, with normal peak systolic pulmonary artery pressures. Serial clinical examination, including height and weight percentiles, chest X-rays, electrocardiograms, and the presence of a continuous murmur in one patient suggested development of pulmonary venous obstruction. Repeat catheterizations demonstrated pulmonary artery pressures greater than or equal to systemic and pulmonary artery wedge minus right ventricular end-diastolic differences greater than 13. Successful relief of the pulmonary venous obstruction included insertion of a Dacron patch to enlarge the pulmonary venous atrium, incision of the obstructing orifice, and repair of associated intra-atrial defects. Operation and postoperative course have been unremarkable. It is concluded that pulmonary venous obstruction can be both an early and progressively late sequela of the Mustard operation. Serial examinations with a high index of suspicion should allow repeated catheterizations to document the occurrence. Operative revision of the obstruction appears to be effective with minimal risk.

Body Height↗
PubMed1977

Mesenteric and peripheral vascular ischemia secondary to ergotism.

At the present time ergotism is due primarily to excessive use or abuse of ergot preparations for migraine headaches. The diagnosis may be made with the evidence of vascular ischemia in the presence of a history of migraines and its treatment with this drug. The therapy for the vasospasm is directed chiefly at the discontinuation of the ergot preparation, with further treatment aimed at the relief of symptoms or prevention of complications. A case is presented of lower extremity ischemia with impending gangrene of both feet in a patient with a history of chronic schizophrenia. Arteriograms revealed symmetrical vasospasm in the lower extremities as well as spasm of the superior mesenteric artery and its intestinal branches. This is believed to be the first documented case of mesenteric vasospasm due to ergotism. Treatment was instituted with low molecular weight dextran, tolazoline, and reserpine with rapid and complete resolution. Caution is advised in the use of ergot preparations in neuropsychiatric disorders.

Adult↗
PubMed1976

Further hazards of heparin therapy in vascular surgery.

Three consecutive patients were treated with heparin sodium administered intravenously for phlebitis and pulmonary embolism following abdominal aortic surgery. After the institution of heparin, hemorrhage in these patients occurred from the suture line 14 days, 18 days, and 31 days after surgery, respectively. the diagnosis was correctly made and control of the bleeding was achieved in each case. The first two patients required exploratory surgery and the third patient was treated successfully without surgical intervention. We propose that the integrity of the clot at the suture line is in dynamic balance. There is a continuous lysis and resorption of old thrombus and replacement with new clot formation until the suture line is sealed by regeneration of the new "intima". If the blood is anticoagulated by heparin, this balance is disrupted and hemorrhage may result.

Aged↗
PubMed1976

Abdominal angina. Intestinal absorption eight years after successful mesenteric revascularization.

A woman with panmalabsorption and symptoms characteristic of abdominal angina underwent successful revascularization of the superior mesenteric artery. Laboratory studies obtained eight years postoperatively were compared with preoperative data. Her stool fat was reduced to 29 per cent of the preoperative quantity, although her dietary intake of fat was increased fivefold. The d-xylose tolerance test was increased to 346 per cent of the preoperative value, serum carotenes to 817 per cent, serum albumin to 172 per cent, hematocrit to 148 per cent, and cholesterol to 296 per cent. Her weight had risen from 69 to 122 pounds. We conclude that the panmalabsorptive defect associated with mesenteric vascular insufficiency is reversible and that the intestine may function normally for a prolonged period of time after revascularization.

Abdomen, Acute↗
PubMed1976

Markedly improved pulmonary function after open heart surgery in infancy utilizing surface cooling, profound hypothermia, and circulatory arrest.

The use of surface-induced profound hypothermia with limited cardiopulmonary bypass and circulatory arrest markedly diminished the need for mechanical ventilation for patients undergoing cardiac surgery. Eleven of twenty-two patients were extubated in the operating room and five more patients within 70 minutes postoperatively. Five patients required mechanical ventilation. Four of the five were extubated within 24 hours (mean, 19.05 hours); only one patient required mechanical ventilation greater than 24 hours. This experience would indicate that as the age of surgery is decreased, in conjunction with improved technics of cardiac surgery and anesthesia, the need for mechanical ventilation should be diminished.

Anesthesia, Inhalation↗
PubMed1976

Cor triatriatum: masked by complex congenital cardiac anomalies.

The radiographic, angiographic, hemodynamic, and surgical features of 2 cases of cor triatriatum complicated by other cardiac anomalies are presented. In the first case, the patient had tetralogy of Fallot, the scimitar syndrome, and left ventricular obstruction. In the second case the patient had truncus arteriosus. The first case was revealed only after augmentation of pulmonary flow by an aorta-pulmonary artery anastomosis. In the second case, the diagnosis was retrospectively suggested by certain angiographic and hemodynamic clues. The prospective diagnosis was made only after a modified Rastelli procedure for truncus arteriosus. The difficulties encountered in making the diagnosis in both cases are discussed. It is stressed that a high index of suspicion, thorough accumulation and examination of hemodynamic data, and excellent angiograms and plain film radiography are all necessary to an early diagnosis of cor triatriatum when the latter is complicated by other congenital heart anomalies.

Abnormalities, Multiple↗
PubMed1975

Prosthetic valve replacement in children.

Reported clinical experience with prosthetic valve replacement in children have suggested a high operative mortality. We placed 25 valves in 24 children with one operative death. There has been one late death related to pacemaker malfunction, but the remainder of the patients have generally done extremely well. The children have not undergone elective anticoagulation, and the long-term embolism rate has not exceeded the incidence of systemic embolization in adults who have been controlled on warfarin sodium (Coumadin) therapy. The objective of prosthetic valve replacement is myocardial preservation. We believe that valve replacement with currently available prostheses should be undertaken in any child with valvular malfunction who is not well controlled with good medical management.

Adolescent↗
PubMed1975

A new operation for d-loop transposition of the great vessels.

Transposition of the great vessels remains a major problem for the cardiac surgeons. Although the Mustard (intraatrial baffle) procedure has provided the means for physiological correction of this anomaly, there are many complications that plague the lives of the survivors. This report describes an operation that is essentially extracardiac and achieves the desired goal of simple switching of the great vessels. Future revisions of the outflow tract prosthesis may become a major problem, but probably less of one than the complications that have been and will be associated with the intraatrial baffle procedure.

Heart Ventricles↗