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Biomedical subjects

H W Bender

Publications and source records attributed to H W Bender.

At least 73 records · Page 4Linked to original sources
PubMed1982

Repair of atrioventricular canal malformation in the first year of life.

Disappointing results with pulmonary artery banding and subsequent correction led to the decision in 1977 that all infants presenting to our hospital with atrioventricular (AV) canal and evidence of severe heart failure, lack of growth, or pulmonary hypertension should have early operative correction. Since that time 24 consecutive infants have undergone repair. All had refractory heart failure. Average age at operation was 18 weeks (3 to 38) and average weight was 4.3 kg (2.3 to 6.4). Only four patients were older than 6 months of age at operation. Preoperative peak pulmonary artery pressure was 81 +/- 3.3 mm Hg, which was equal to systemic arterial pressure in all cases. Mean pulmonary-to-systemic resistance ratio was 0.28 +/- 0.05. five patients had moderate mitral regurgitation and five had a ductus arteriosus. Three had significant associated malformations. Profound hypothermia and circulatory arrest were utilized in all patients. Common AV valve tissue was divided and valvular integrity was ensured by resuspension to a single Dacron patch which closed both the atrial and ventricular defects. Operative death occurred in two patients (8%) both with associated defects (one with total anomalous pulmonary venous connection and the other with coarctation). One late death occurred in a patient with associated partial anomalous pulmonary venous connection, and one patient has had a pacemaker implanted. Survivors have been followed for 7 to 60 months. All patients are growing at an increased rate postoperatively. All cardiac medications have been discontinued in 16 of 21 patients. Operative repair of complete atrioventricular canal can be performed in infancy with low operative and late death rates and will relieve signs and symptoms of heart failure and allow more normal growth and development. On the basis of this experience, it appears unnecessary to delay operative correction with the known increased risk of the development of pulmonary hypertension.

Blood Pressure↗
PubMed1981

Early operative intervention in aortic bacterial endocarditis.

Since 1974, 14 patients have required valve replacement for native aortic valve bacterial endocarditis at Vanderbilt University Medical Center. There were 7 male and 7 female patients ranging from 11 to 65 years old. Nine of the patients were less than 27 years old. All patients had congestive heart failure as a complication of the bacterial endocarditis and were in New York Heart Association (NYHA) Functional Class III or IV. Two patients were seen initially with arrhythmias, 3 had episodes of septic emboli, and 1 patient was operated on immediately after sustaining a cardiac arrest. Echocardiogram was utilized in 9 patients, and cardiac catheterization was performed in 6 patients who were suspected to have concomitant mitral valve or coronary artery disease. All patients were operated on within two weeks after the institution of antibiotic therapy, and there were no operative or early postoperatively deaths. Preoperative blood cultures were positive in 13 patients, with streptococcus cultured in 6 patients and staphylococcus in 4. Escherichia coli and enterococcus were the other pathogens cultured. All patients received antibiotics intravenously for a total of six weeks. There has been 1 late postoperative death, which occurred 2 months following operation in a patient with myocardial failure unresponsive to treatment. Two patients underwent reoperation, 1 because of a persistent aorto-right ventricular fistula and the second because of paraprosthetic aortic regurgitation. Nine patients are now in NYHA Functional Class I and 4 are in Class II.

Adolescent↗
PubMed1981

Comparison of the effects of saline and homologous plasma infusion on lung fluid balance during endotoxemia in the unanesthetized sheep.

The effects of saline infusion (20 ml/kg/30 minutes) and homologous plasma infusion (20 ml/kg/30 minutes) on the lung fluid balance during increased pulmonary capillary permeability secondary to Escherichia coli endotoxin infusion (1 microgram/kg/15 minutes) were studied in unanesthetized sheep. Saline and homologous plasma infusion increased lung lymph flow by 10.6% and 10.8%, respectively. The bloodless wet-to-dry ratio was 5.1 +/- 0.2 in the saline group and 5.2 +/- 0.2 in the homologous plasma group. The saline infusion decreased the plasma oncotic pressure while the plasma infusion increased plasma oncotic pressure. However, the increase in plasma oncotic pressure was negated by concomitant changes in the lymph oncotic pressure and greater increases in pulmonary microvascular pressure during the plasma infusion. Changes in pulmonary microvascular pressure predominated over changes in the oncotic pressure gradient. Both saline and homologous plasma infusion increase fluid filtration into the interstitial space by the same magnitude. Therefore neither has a clear advantage in the treatment of pulmonary edema during increased permeability.

Animals↗
PubMed1981

Blind nasotracheal intubation.

Nasotracheal intubation is a useful technique for intubating the conscious, active patient. This can be accomplished blindly without sedation or muscle relaxation and without the trauma of laryngoscopy. The method is not new but is not well known in proportion to its usefulness. Attention to detail renders the procedure safe, certain and atraumatic for patient and physician alike.

Humans↗
PubMed1980

Pulmonary, mediastinal, and cardiac presentations of histoplasmosis.

Sixty-one patients with histoplasmosis were identified. They ranged from 14 months to 67 years old. There were 56 male and 5 female patients. Disease presentations were categorized into pulmonary (47), mediastinal (11), pericardial (2), and cardiac (1). Twenty of the patients with pulmonary involvement had histoplasmomas treated by wedge resection (18) or lobectomy (2). Twenty-two of the 27 cavitary lesions were treated by lobectomy and 4 by segmental resection, and 1 required pneumonectomy. The patients with mediastinal granulomas or fibrosis underwent exploration for diagnosis and curative or palliative procedures. Two patients with pericardial histoplasmosis required pericardial windows to relieve acute tamponade. One patient with disseminated histoplasmosis required aortic valve replacement for histoplasmosis valvulitis with severe regurgitation. The 1 operative death was a patient requiring pneumonectomy for mediastinal histoplasmosis. Indications for operative intervention in pulmonary histoplasmosis included resection of a new or enlarging pulmonary nodule to provide a definite pathological diagnosis and resection of persistent thick-walled pulmonary cavities. Mediastinal granuloma with or without fibrosis required exploration for diagnosis, palliation, or cure. Fungal endocarditis necessitated treatment with amphotericin B and valve replacement to stabilize the patient's hemodynamic status and prevent embolization of large fungal vegetations. Pericardial effusion, a rare manifestation of histoplasmosis, was seen as acute tamponade requiring emergency intervention.

Adolescent↗
PubMed1980

Preoperative diagnosis and management of infants with critical congenital heart disease.

Operative repair with an associated low morbidity and mortality is available now for most infants with congenital cardiac defects. Precise preoperative diagnosis is an essential part of continuing attempts to lower the operative risk for these patients. In this review we cover major areas of concern in regard to preoperative diagnosis and management. Long-term follow-up studies with clinical, hemodynamic, electrophysiological, and exercise data are required to assess current diagnostic and therapeutic practices.

Aortic Coarctation↗
PubMed1980

Total anomalous pulmonary venous connection in infancy. Ten years' experience including studies of postoperative ventricular function.

The surgical experience with total anomalous pulmonary venous connection (TAPVC) at the Venderbilt Hospital between the years 1969 and 1979 was reviewed. Twenty-five patients with TAPVC were studied. All but one patient presented at less than 1 year of age, and 11 patients were operated upon in the first 2 weeks of life. Operative mortality rate was 20% (5/25). Four of the five deaths were in critically ill neonates requiring preoperative ventilatory support. All operative deaths were in patients with pulmonary venous obstruction. All operative survivors have been followed for a mean 4.5 years (6 months to 10 years). There have been no late deaths or cases of symptomatic pulmonary venous obstruction. All children have had normal growth patterns. Ten patients have been recatheterized. Pulmonary artery systolic pressure, which was markedly elevated prior to operation, fell to normal levels after operation. Ventricular function has been evaluated by quantitative angiocardiography in nine patients before and after operation. Left ventricular size and function were markedly depressed preoperatively and rose to normal levels in postoperative survivors. Left atrial maximal volume was found to be 94% of normal values. These data support the contention that preoperative pulmonary venous obstruction is the single risk factor predicting higher risk of operative death. The presence of severe depression of left ventricular size and function preoperatively does not predict a higher operative risk, and postoperative survivors can expect normal ventricular function.

Angiocardiography↗
PubMed1979

Reparative cardiac surgery in infants and small children: Five years experience with profound hypothermia and circulatory arrest.

A five year experience of profound hypothermia and circulatory arrest in the operative management of severe congenital heart disease in 128 infants and children weighing 10 kg or less is reviewed. Hospital mortality was 13% for the entire series--8% in the last two years. Mortality varied with the defect present rather than with the age at operation, and appeared to decline over the five years. There was no morbidity associated particularly with this technique, and no evidence of permanent neurologic nor intellectual impairment. Total arrest time averaged 55 minutes, was related significantly to the defect being repaired, but was not related to hospital mortality. The results support the idea of definitive early cardiac repair for severely symptomatic infants and young children, rather than surgical palliation. The hypothermic arrest technique is attractive since it allows optimal operating conditions, thus permitting an accurate repair and the consequent improvement in surgical results.

Child, Preschool↗
PubMed1979

Rheumatoid pericarditis. Clinical significance and operative management.

The incidence of subclinical pericarditis associated with rheumatoid pericarditis may be as high as 50 percent, but significant impairment of cardiac performance owing to this type of pericarditis rarely occurs. In the past 7 years, we have encountered eight men with congestive heart failure owing to rheumatoid pericarditis. Cardiac catheterization and echocardiography were useful in establishing the diagnosis of pericardial constriction. Pericardiocentesis was unsuccessful in relieving symptoms in the three patients in whom the procedure was performed. Seven patients underwent pericardiectomy; six had constrictive pericarditis and one patient had an acute pericarditis with the sudden onset of cardiac tamponade. The other patient died of cardiac tamponade prior to operation. All patients improved after operation and have remained free of cardiac symptoms 3 months to 4 1/2 years later. The frequent occurrence of adhesive and obliterative pericarditis with loculated effusions suggests the need for pericardiectomy rather than pericardiocentesis in the patient with rheumatoid arthritis and symptomatic pericardial involvement. Immediate and lasting relief of this unusual nonarticular manifestation of rheumatoid arthritis can be expected after pericardiectomy.

Adult↗
PubMed1978

Operative closure of isolated defects of the ventricular septum: planned delay.

Selection of patients and the timing of operation for closure of ventricular septal defect (VSD) can be difficult because the risk of operation must be balanced against the hemodynamic abnormality and the age and size of the infant. In the past 6 years we have individualized our approach to the timing and necessity of operation in the patient with an isolated VSD. During this period, 133 patients with VSD were evaluated, and 71 underwent operative closure of the VSD. Of the 133 patients, 90 were 2 years old or younger, and 40 of them required operation because of congestive failure and growth retardation. Of the 45 infants who did not undergo operation, 17 have small intracardiac shunts with normal pulmonary vascular resistance while the other 28 infants remain compensated and are growing despite moderate left-to-right shunts. A persistent, large intracardiac shunt was the indication for operation in 31 of the 48 older patients; the other 17 older patients remain well. Although 3 severely growth-retarded infants (2 to 4 kg) died soon after operation, all infants weighing 4 kg or more survive. No child has died during preoperative observation, and irreversible pulmonary vascular changes have not occurred. Most infants with VSD and large intracardiac shunts do require early VSD closure, but the risk of operation remains high in the tiny neonate with profound failure. With appropriate hemodynamic and clinical criteria, operation for selected infants can be delayed so that the risk of operation can be minimized.

Age Factors↗
PubMed1978

Hemoptysis and pulmonary aspergilloma: operative versus nonoperative treatment.

The clinical experience with 42 patients with pulmonary aspergilloma evaluated at the Vanderbilt University Affliated Hospitals in a 22-year period was reviewed to determine the necessity and advisability of pulmonary resection. Twenty-nine patients (69%) had sustained one or more episodes of gross hemoptysis. Eleven of the 42 patients were treated operatively with lobectomy, wedge resection, or cavernostomy. Five of them had had hemoptysis preoperatively, but in only 1 patient was massive hemoptysis the primary indication for operation. The single death among these 11 patients occurred in the patient undergoing operation for control of massive hemoptysis. Nonoperative treatment was selected in 31 patients because of advanced chronic lung disease. Twenty-four of these 31 patients experienced 41 episodes of gross hemoptysis during observation periods up to 8 years (average, 32 months). Superimposed bacterial infection usually accompanied the episodes of hemoptysis, and medical therapy with bedrest, antibiotics, and postural drainage was successful in controlling the hemorrhage in 40 of the 41 episodes. One patient died from massive hemoptysis. On the basis of this experience, pulmonary resection for aspergilloma in patients with hemoptysis seems rarely indicated.

Adult↗
PubMed1978

Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants.

As a result of randomized assignment, 15 preterm infants weighing 1,500 gm or less at birth and who had a symptomatic PDA were treated according to a medical management protocol, and ten according to an early surgical closure protocol. All infants required mechanical ventilation at the time of study entry, which was one week after birth. Birth weight, gestational age, age at onset of congestive failure, age at study entry, and the initial morbidity of members of the two groups were similar. The nine surviving infants managed according to the surgical closure protocol were weaned from mechanical ventilation sooner, had a decreased need for digoxin and furosemide, achieved gastrointestinal function sooner, and had a smaller hospital bill than the 12 survivors of the medical management group. These results indicate that infants with a symptomatic PDA still requiring mechanical ventilation at one week after birth will benefit from surgical closure of the ductus at that time.

Digoxin↗
PubMed1977

Contemporary management of myasthenia gravis: the clinical role of thymectomy.

Thirty-six patients with myasthenia gravis have been evaluated and treated over the past five years. Eleven patients had ocular myasthenia gravis and responded well to anticholinesterase medications. Twenty-five patients had generalized myasthenia gravis, and 22 of them were initially treated with anticholinesterase medications; 18(82%) failed to improve or to maintain an initial improvement on medication, and 14 of these 18 patients underwent thymectomy. In addition, 3 patients underwent thymectomy as part of their initial treatment during the later part of this study. All thymectomies were performed through a median sternotomy. All 17 patients manifested sustained improvement as judged by a gain in strength and decrease in medications. Thymectomy is beneficial in the treatment of myasthenia gravis, and it is most efficacious when performed early in the course of the disease.

Adolescent↗
PubMed1976

Preferential atherosclerosis at the aortic junction of the ligamentum arteriosum: clinical significance and pathological correlation.

Clinical experience with 5 patients who had complications of atherosclerosis within the aorta at the site of the obliterated ductus arteriosus suggested the occurrence of clinically significant preferential atherosclerosis at this location. To examine this hypothesis, the clinical findings in these patients (4 with saccular aneurysm and 1 with systemic emboli from an ulcerated plaque at this location) were correlated with postmortem examination of the aortic isthmus in 40 consecutive cadavers. The point of ductal closure was the area of most severe atheromatous involvement in 32 of the 40 cadavers, and 25 of the 40 specimens demonstrated ulcerated plaques at this location. Microscopical examination consistently demonstrated intimal irregularity or disruption and thinning of the aortic media in this area. These studies indicate that preferential atherosclerosis occurs at the aortic end of the obliterated ducts arteriosus and that these atherosclerotic changes can be a clinically significant development.

Adult↗
PubMed1976

Selective operative treatment for tetraology of Fallot: rationale and results.

Eighty-one patients with tetralogy of Fallot malformations evaluated between July 1, 1971 and November, 1975 are presented. Fifty-one patients underwent primary intracardiac repair; three died. Twenty-seven patients were corrected after a previous palliative shunt; there was one death. Three additional patients have been palliated and are awaiting repair. While the overall mortality in these patients was less than 5%, the infants undergoing total correction before the age of two years appeared to be at greater risk (25%). There were no deaths in the group of patients undergoing palliative procedures. Based on these data it appears that a safely performed palliative shunt in the symptomatic small infant is a reasonable first step, particularly if the outflow tract of the right ventricle is diffusely hypoplastic.

Adolescent↗
PubMed1976

Ostium primum atrial septal defect in the adult.

Seven adults with ostium primum atrial septal defect (ASD) are presented. All but one patient were symptomatic at the time of diagnosis with the average age being 41 years. At catheterization each had a large, low ASD, left-to-right shunt, and a cleft mitral valve leaflet with minimal regurgitation. Pulmonary hypertension occurred in one. Six patients are asymptomatic an average of 3.5 years after surgical correction. One patient died of other causes at 18 months. Rapid decompensation secondary to arrhythmias or atrioventricular block occurs much more frequently with primum than with secundum ASDs, approaching 80% by age 45. Follow-up in this series suggests that surgical correction may prevent these developments.

Adult↗