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Biomedical subjects

J F Keane

Publications and source records attributed to J F Keane.

142 records · Page 8Linked to original sources
PubMed1976

Hemodynamics after surgical repair with right ventricle to pulmonary artery conduit.

To assess the results of cardiac repair utilizing a right ventricular to pulmonary artery conduit, we reviewed postoperative hemodynamic data in 16 patients catheterized 0.5 to 5 years after repair. In 12 patients, a Hancock conduit (dacron conduit with porcine valve) was used; the conduit in the remaining four patients was made with an aortic homograft. All patients in whom an aortic homograft was utilized developed severe obstruction and calcification of their graft. The majority of patients, 9/12, with a Hancock conduit, had only mild to moderate conduit obstruction; the remaining three had severe obstruction (gradients greater than 70 mm Hg). The sites of Hancock conduit obstruction were at the distal end of the conduit in 8/12, proximal end of conduit in 6/12, and at the porcine valve in 4/12 patients. The data suggest that repair with a Hancock conduit is hemodynamically more satisfactory than with aortic homograft.

Adolescent↗
PubMed1976

Subaortic obstruction after the use of an intracardiac baffle to tunnel the left ventricle to the aorta.

Postoperative hemodynamic studies in five patients document subaortic obstruction after surgical repair utilizing an intracardiac baffle to establish continuity between the left ventricle and the aorta. Four of the patients had a Rastelli procedure for D-transposition of the great arteries with a ventricular septal defect and pulmonary stenosis; one patient had repair of double outlet right ventricle with a ventricular septal defect and pulmonary stenosis. The left ventricular outflow was shown to be a long narrow tunnel by angiography in four of five patients and by echocardiography in one patient. Resting aortic peak systolic pressure gradient ranged from 10 to 42 mm Hg (mean 24). The obstruction was localized to the proximal end of the left ventricule to aorta tunnel (i.e., at the site of ventricular septal defect) in five patients. One patient with a gradient of 42 mm Hg has angina and decreased exercise tolerance. Subaortic obstruction is a newly described sequelae after the Rastelli procedure for transposition or repair of double outlet right ventricle. The obstruction may be hemodynamically significant and should be searched for at postoperative cardiac catheterization.

Adolescent↗
PubMed1975

Results of routine preoperative coronary angiography in tetralogy of Fallot.

In the surgical repair of tetralogy of Fallot, morvidity and mortality are increased by certain coronary anomalies, in particular, an anterior descending branch originating from the right coronary artery or a single coronary artery in which a large coronary branch runs across the pulmonary outflow tract. In series of 94 patients with tetralogy of Fallot who underwent cardiac catheterization, coronary artery visualization was attempted routinely, most often by flush aortography using a venous catheter. Diagnostic coronary visualization was obtained in 84 patients (89%). In these, the incidence of recognized coronary anomalies was 5%; anterior decending from the right coronary artery in four patients (4%), and singly left coronary in one patient (1%). In 195 autopsied cases of tetralogy, the incidence of coronary anomalies was also 5%. Routine preoperative demonstration of the coronary artery anatomy in tetralogy patients usually can be accomplished satisfactorily and conveniently by transvenous flush aortography.

Adolescent↗
PubMed1975

Aortic stenosis surgery in infancy.

During the past 14 years, 28 infants (23 males) underwent valvotomy for severe aortic stenosis at the Children's Hospital Medical Center in Boston. The median age was two months and the oldest patient was six months old. Congestive heart failure was present in all but two babies. Preoperatively, the electrocardiogram was abnormal in all, with left ventricular hypertrophy and a strain pattern being present in 19. At cardiac catheterization, the peak systolic ejection gradient (PSEG) ranged from 35-130 mm Hg (median 90 mm Hg). Associated cardiac lesions were present in 39%. Twenty-four infants underwent valvotomy with inflow occlusion. Four patients were operated upon using cardiopulmonary bypass. There were eight early and two late deaths. The 18 survivors have been followed from six months to 11 years (median five years). Only four are symptomatic. Mild aortic regurgitation developed postoperatively in six patients, moderate in one and severe enough to require valve replacement in another one. The electrocardiogram improved postoperatively in 15 patients, but became entirely normal only in one. Five children required a repeat valvotomy for residual stenosis 1-10 years after the original procedure (median four years). At this second operation, the majority of the valves were flexible and noncalcified, and valvotomy was accomplished without difficulty. One child who underwent valve replacement for aortic regurgitation at age two years is well seven years later.

Angiocardiography↗
PubMedDate not supplied

Management strategy for very mild aortic valve stenosis.

It is unclear how often patients with very mild aortic stenosis (gradients < 25 mmHg) need interval follow-up. The purpose of this study was to define the determinants of disease severity progression and to propose appropriate management strategies. It is known that congenital aortic stenosis is a progressive disease that requires long-term follow-up at consistent intervals. We studied 89 patients with very mild aortic stenosis. Cox proportional hazard modeling was performed to ascertain predictors of morbidity and mortality. Events were defined as valve surgery or death. Of the original 89 patients, 7 died (92% survival); one death was sudden and unexplained and six were noncardiac. Eighteen individuals were lost to follow-up (10 not located and 8 refused participation). Twelve (17%) had valve surgery. The minimum time interval between initial diagnosis of very mild aortic stenosis and surgery was 4.6 years (mean, 14.0). Age at diagnosis, gender, initial gradient, initial gradient/age, and aortic regurgitation were found not to be predictive of outcome. However, the slope of the transaortic gradient [change of gradient/time (years)] was predictive of outcome (hazard ratio of 1.69; confidence interval, 1.4-2.2). At least 17% of these patients progress to require operation. For patients with a gradient slope < 1.1, evaluation every 4 or 5 years is recommended. For patients with a gradient slope > 1.2, evaluation every 1 or 2 years seems prudent.

Aortic Valve Stenosis↗
PubMedDate not supplied

Mitral and aortic atresia associated with hypoplastic right lung, crossover segment of right lower lobe, and anomalous scimitar-like right pulmonary venous connection with inferior vena cava: clinical, angiocardiographic, and autopsy findings in a rare case.

A newborn female infant was found to have a unique and previously unreported group of anomalies: (1) mitral and aortic atresia with a highly obstructive atrial septum; (2) hypoplasia of the right lung with a crossover segment involving the right lower lobe; (3) normally connected pulmonary veins, two from the left lung and one from the right; and (4) a large anomalous branch of the right pulmonary vein of scimitar configuration that anastomosed with the normally connected right pulmonary vein and with the inferior vena cava (IVC). The scimitar vein appeared obstructed at its junction with the right pulmonary vein and at its junction with the inferior vena cava within the hepatic parenchyma. To our knowledge, this is the first report of a scimitar-like vein coexisting with mitral and aortic atresia and connecting both with the right pulmonary vein and with the inferior vena cava. The highly obstructed left atrium was partially decompressed by retrograde blood flow via the normally connected right pulmonary vein to the anomalous scimitar venous pathway and thence to the inferior vena cava via a pulmonary-to-IVC collateral vein.

Abnormalities, Multiple↗
PubMedDate not supplied

Percutaneous therapy of structural heart disease: pediatric disease.

Interventional therapy of congenital heart lesions at cardiac catheterization has greatly increased during the past decade. At the authors' institution, the frequency of such procedures among catheterizations has increased from 5% to more than 60%. The variety of lesions so treated continues to expand and equipment continues to improve. These procedures may be divided into 2 groups, namely (1) those involving balloon dilation of stenotic valves and vessel obstructions with stent placement being increasingly used in the latter and (2) those involving occlusion of lesions with (a) coils, such as aortopulmonary collaterals, patent ductus arteriosi and coronary artery fistulae and (b) umbrella devices, such as atrial and ventricular septal defects. These have replaced surgery as the initial procedure of choice in many lesions including valvar pulmonary and aortic stenoses, and postoperative aortic coarctation in young patients. In addition, use of the double-umbrella device even in noncongenital lesions appears promising.

Adolescent↗