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Biomedical subjects

I C Huggon

Publications and source records attributed to I C Huggon.

28 records · Page 2Linked to original sources
PubMed1994

Perioperative haemodynamic effects of an intravenous infusion of calcium chloride in children following cardiac surgery.

Twelve children received an infusion of 10% calcium chloride 0.1 ml/kg to a maximum dose of 5 ml, infused over 5 min, following open heart surgery. Blood ionized calcium, systemic arterial pH, cardiac index, mean systemic arterial blood pressure and systemic vascular resistance index were measured at baseline and repeated 20 and 40 min following completion of the infusion. There was considerable overlap, with no significant differences in the response to the calcium chloride infusion between children with ionized hypocalcaemia (< 1.1 mmol/l) and those with ionized normocalcaemia when its effect on percentage change in either the haemodynamic or biochemical measurements was assessed (p > 0.2 for all measurements; Mann-Whitney). For this reason they were treated as a single group. Significant changes from baseline were noted in mean systemic arterial pressure (p < 0.02), cardiac index (p < 0.01) and systemic vascular resistance index (p < 0.01) after completion of the calcium chloride infusion when analysed using Friedman's two-way analysis of variance. A significant increase in mean systemic arterial blood pressure occurs after an infusion of 10% calcium chloride as a direct result of an increase in the systemic vascular resistance index with a concomitant decrease in cardiac index.

Blood Pressure↗
PubMed1994

Percutaneous transcatheter retrieval of misplaced therapeutic embolisation devices.

OBJECTIVE: To assess the incidence and subsequent management of misplaced devices as a complication of therapeutic embolisation procedures. DESIGN: Retrospective review of case notes, cardiac catheterisation reports, and angiograms. SETTING: Tertiary referral centre for congenital heart disease. PATIENTS: 205 consecutive children and adults undergoing therapeutic embolisation for congenital heart disease in the 10 years up to 1 April 1993. This group had 231 therapeutic embolisation procedures at 241 sites using coils, umbrella devices, or detachable balloons. MAIN OUTCOME MEASURES: Incidences of misplacement and retrieval of the device; morbidity and mortality. RESULTS: The incidence of misplacement was 3% (10/332) of devices deployed and 4.3% (10/231) of procedures performed. Retrieval from distal pulmonary arteries was not attempted in two patients, but transcatheter retrieval of coils and umbrellas from systemic and pulmonary vessels, using snares or retrieval baskets, was successful in the remaining eight. There were no deaths or serious sequelae related to the procedure, but one patient required femoral arteriotomy for removal of an umbrella device retrieved only as far as the groin. In four of the five most recent cases, the misplaced device was retrieved and the therapeutic embolisation was completed at the same procedure. CONCLUSIONS: Misplacement of a device during therapeutic embolisation is a recognised complication that can be satisfactorily dealt with by transcatheter retrieval without recourse to surgery. For retrieval to be successful it is important to have a wide selection of retrieval equipment available and to be conversant with its use.

Adolescent↗
PubMed1993

Rapid diagnosis of the cause of pneumoperitoneum in ventilated asthmatic children.

Two asthmatic children developed a pneumoperitoneum whilst being mechanically ventilated. A quick and accurate diagnosis as to the cause of the pneumoperitoneum was made by analysing the partial pressure of oxygen in the intraperitoneal free gas. This analysis helped to diagnose an intestinal perforation in one child and an air leak from lung barotrauma in the other. There was minimal delay in the surgical treatment of the child with intestinal perforation and in the other, an unnecessary laparotomy was avoided.

Asthma↗
PubMed1993

Core-peripheral temperature gradient in children: does it reflect clinically important changes in circulatory haemodynamics?

Following open heart surgery, changes in core and peripheral skin temperature and changes in the core-peripheral temperature gradient were measured in 10 children. These were correlated with changes in cardiac index, systemic vascular resistance index, mean arterial pressure and urinary output. During the study intervals, which lasted 1 h each, no changes in medical management were made. Using Spearman's rank correlation, only a change in central venous pressure was found to correlate with a change in the core-peripheral temperature gradient. We conclude that a change in the core-peripheral temperature will give valuable information about the patient's intravascular volume.

Blood Pressure↗
PubMed1993

Use of a second transcatheter Rashkind arterial duct occluder for persistent flow after implantation of the first device: indications and results.

OBJECTIVE: To assess the efficacy, feasibility, and most appropriate timing of the implantation of a second Rashkind arterial duct occluder because of persistent flow after the first device. DESIGN: A prospective serial Doppler study of patients after the insertion of a Rashkind arterial duct occluder including a subgroup in whom a second device was implanted. SETTING: A tertiary referral centre for congenital heart disease. PATIENTS: 144 patients aged 7 months to 67 years (median 3.38 years) who underwent transcatheter occlusion of patent arterial duct, 20 of whom had attempted implantation of a second device. INTERVENTIONS: Implantation of a second device alongside the first was attempted in 20 of the patients with persistent residual flow. MAIN OUTCOME MEASURES: Successful implantation of a second device, the incidence of complications, and the achievement of complete occlusion on follow up Doppler echocardiography. The time to complete occlusion in the whole group and factors predictive of persistent leak were also analysed. RESULTS: Second devices were successfully implanted in 19 of 20 first attempts and in the remaining patient at the second attempt. Complete occlusion was found in 19 patients at a mean follow up of eight months. The complications included fracture of a guidewire requiring femoral arteriotomy for its removal in one patient and embolisation of a device in another. With a single device, persistence of residual flow six months after implantation and malposition of the device on the aortogram after implantation were predictive of continuing residual patency. CONCLUSIONS: Implantation of a second device is safe, feasible, and effective and should be considered when residual flow persists beyond six months, or if malposition of the first device causes complications such as haemolysis.

Adolescent↗
PubMed1992

Magnetic resonance imaging of hearts with atrioventricular valve atresia or double inlet ventricle.

OBJECTIVE: To investigate the effectiveness and limitations of magnetic resonance imaging in defining cardiac anatomy in patients with double inlet ventricle or atrioventricular valve atresia. DESIGN: Magnetic resonance images were reviewed retrospectively without reference to other morphological data. SETTING: A tertiary referral centre for paediatric cardiology. PATIENTS: 18 patients (aged 8 days to 27 years) with a suspected univentricular atrioventricular connection. METHODS: Imaging by a 1.5 T whole body magnetic resonance system with imaging planes adjusted to individual patient anatomy to best define the cardiac morphology. A complete sequential diagnosis obtained from an independent interpretation of the images was compared with the diagnosis obtained from cross sectional echocardiography and angiocardiography. RESULTS: There was substantial accord between the diagnosis from magnetic resonance alone and that from other methods. In the six instances where there was not accord the magnetic resonance diagnosis was considered to be correct in two cases and incorrect in three cases. In the remaining case no consensus could be reached. In eight patients magnetic resonance imaging provided anatomical information additional to that from other methods. The strengths of magnetic resonance were in imaging the pulmonary arteries and their abnormalities and identifying juxtaposed atrial appendanges but there were some deficiencies in identifying Blalock-Taussig shunts. CONCLUSION: Magnetic resonance imaging provided detailed information about all aspects of cardiac morphology in patients with a suspected diagnosis of univentricular atrioventricular connection. Often it provided additional information to echocardiography. Its use in selected patients should give valuable complementary information.

Adolescent↗
PubMed1990

Contractural arachnodactyly with mitral regurgitation and iridodonesis.

An infant girl with arachnodactyly, spontaneously resolving contractures, dolichostenomelia, iridodonesis, and mitral and tricuspid incompetence died in cardiac failure. We confirm that congenital contractural arachnodactyly may exhibit serious cardiovascular and ophthalmic complications like Marfan's syndrome. The presence of iridodonesis further obscures the differentiation between classical Marfan's syndrome and congenital contractural arachnodactyly.

Contracture↗
PubMedDate not supplied

Acute pseudoaneurysm formation complicating balloon dilation of native coarctation: treatment by delayed surgical repair.

An 11-year-old boy developed an acute aortic pseudoaneurysm during balloon dilation of unoperated coarctation of the aorta. The pseudoaneurysm occurred despite the fact that the balloon catheter size did not exceed the diameter of the aorta at the diaphragm. Elective delayed surgical repair was successfully performed after 3 weeks of antihypertensive treatment when serial magnetic resonance imaging had demonstrated a reduction in the local tissue swelling.

Acute Disease↗