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J H Moller

Publications and source records attributed to J H Moller.

At least 19 recordsLinked to original sources
PubMed2001

Long-term survival after mitral valve replacement in children aged <5 years: a multi-institutional study.

BACKGROUND: Short- and long-term outcomes after prosthetic mitral valve replacement (MVR) in children aged <5 years are ill-defined and generally perceived as poor. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1982 to 1999) was reviewed. METHODS AND RESULTS: MVR was performed 176 times on 139 patients. Median follow-up was 6.2 years (range 0 to 20 years, 96% complete). Age at initial MVR was 1.9+/-1.4 years. Complications after initial MVR included heart block requiring pacemaker (16%), endocarditis (6%), thrombosis (3%), and stroke (2%). Patient survival was as follows: 1 year, 79%; 5 years, 75%; and 10 years, 74%. The majority of deaths occurred early after initial MVR, with little late attrition despite repeat MVR and chronic anticoagulation. Among survivors, the 5-year freedom from reoperation was 81%. Age-adjusted multivariable predictors of death include the presence of complete atrioventricular canal (hazard ratio 4.76, 95% CI 1.59 to 14.30), Shone's syndrome (hazard ratio 3.68, 95% CI 1.14 to 11.89), and increased ratio of prosthetic valve size to patient weight (relative risk 1.77 per mm/kg increment, 95% CI 1.06 to 2.97). Age- and diagnosis-adjusted prosthetic size/weight ratios predicted a 1-year survival of 91% for size/weight ratio 2, 79% for size/weight ratio 3, 61% for size/weight ratio 4, and 37% for size/weight ratio 5. CONCLUSIONS: Early mortality after MVR can be predicted on the basis of diagnosis and the size/weight ratio. Late mortality is low. These data can assist in choosing between MVR and alternative palliative strategies.

Adolescent↗
PubMed2001

Significance of early transient complete heart block as a predictor of sudden death late after operative correction of tetralogy of Fallot.

We evaluated the long-term outcome and incidence of sudden death in the 288 patients discharged after corrective operation for tetralogy of Fallot at the University of Minnesota between 1954 and 1974. The perioperative characteristics of these patients were evaluated with respect to their long-term outcome. A health status survey was sent to each survivor and their functional status was evaluated with respect to the perioperative variables. Current follow-up was available in 279 of 288 of the postoperative survivors (97%); the mean duration of follow-up was 28 years. The 40-year survival rate was 76% and 154 of 163 of survey responders (95%) were in New York Heart Association class I or II. Twenty-six of the 288 died suddenly (9%). Those with transient complete heart block that persisted beyond the third postoperative day had a lower long-term survival rate (p <0.001) and a higher incidence of late sudden death (p <0.001). Patients aged >12 years at operation had a lower long-term survival rate (p <0.001) and less favorable long-term functional status. The use of a transannular patch was associated with increased late morbidity but not mortality. Thus, the very long-term outcome after operative correction of tetralogy of Fallot is excellent. Late sudden death remains a concern for operative survivors, occurring in 9% of these patients. Late sudden death is strongly associated with transient complete heart block that persisted beyond the third postoperative day.

Adolescent↗
PubMed2000

Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study.

BACKGROUND: Ventricular arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot are devastating complications in adult survivors of early surgery, but their prediction remains difficult. METHODS: We examined surgical, electrocardiographic, and late haemodynamic data, and their relation to clinical arrhythmia and sudden death occurring over 10 years, in a multicentre cohort of patients with repaired tetralogy, who were alive in 1985. RESULTS: Of 793 patients (mean age at repair 8.2 years [SD 8], mean time from repair 21.1 years [8.7]) who entered the study, 33 patients developed sustained monomorphic ventricular tachycardia, 16 died suddenly, and 29 had new-onset sustained atrial flutter or fibrillation. Electrocardiographic markers (QRS duration, QRS rate of change between 1985 and 1995) were significantly greater in the ventricular tachycardia and sudden-death groups. Older age at repair was associated with a higher risk of sudden death and atrial tachyarrhythmia. Pulmonary regurgitation was the main underlying haemodynamic lesion for patients with ventricular tachycardia and sudden death, whereas tricuspid regurgitation was for those with atrial flutter/fibrillation. Despite adverse haemodynamics, no patient who died suddenly had undergone late reoperation. CONCLUSION: Arrhythmia and sudden death are important late sequelae for patients after repair of tetralogy of Fallot. The electrophysiological and haemodynamic substrate of sudden death resembled that of sustained ventricular tachycardia, with pulmonary regurgitation being the predominant haemodynamic lesion. Preservation or restoration of pulmonary valve function may thus reduce the risk of sudden death. Furthermore, electrocardiographic markers can help to identify patients at risk.

Adult↗
PubMed2000

Echocardiographic diagnosis of heart disease in apparently healthy adolescents.

OBJECTIVE: Comprehensive data are currently unavailable on the prevalence of cardiac abnormalities in children after the newborn/infant period. The present report describes the prevalence of echocardiographically detected cardiac disease in a cohort of randomly selected healthy junior high school children. METHODS: The cohort for this report consists of 357 children (mean age: 13 years) randomly selected after blood pressure screening of 12 043 fifth through eighth grade students and having an echocardiographic examination as part of a study of insulin resistance in childhood. RESULTS: A physical examination performed by a board-certified pediatrician reported no cardiac abnormalities. However, echocardiography and Doppler studies identified 13 (3.6%) children (7 males and 6 females), with previously unknown cardiac abnormalities, as follows: abnormal mitral valve with mitral regurgitation (4), bicuspid aortic valve (2), atrial septal defect (2), coronary artery to pulmonary artery fistula (1), patent ductus arteriosus (1), pulmonary hypertension (1), cardiomyopathy (1), and pulmonary artery stenosis (1). Physical examination performed by a pediatric cardiologist detected abnormal cardiac findings in 7 (54%) of the children. Cardiac catheterization was required in 3 for additional diagnostic evaluation and in 2 for therapeutic intervention; 1 patient underwent open-heart surgery. Bacterial endocarditis prophylaxis was recommended in 8 (62%) of the 13 children. CONCLUSIONS: The results suggest that: 1) clinically significant cardiac disease in childhood is more prevalent than previously reported; and 2) improved screening methods should be considered to detect asymptomatic but significant cardiac abnormalities that may result in long-term complications. echocardiography, prevalence, incidence, heart disease, children.

Adolescent↗
PubMed1997

Hemodynamic data and survival in children with pulmonary hypertension.

OBJECTIVES: Using data from a multi-institutional data base, we sought to determine whether hemodynamic data predict duration of survival in children with primary or secondary pulmonary hypertension. BACKGROUND: Lung transplantation is a therapeutic option for children with pulmonary hypertension. Appropriate timing of lung transplantation requires reliable methods of predicting duration of survival in potential candidates. METHODS: A regional data base was used to obtain cardiac catheterization data on 50 children with mean pulmonary artery pressure (mPAP) > 25 mm Hg and indexed pulmonary resistance (Rp) > 4.5 Wood units. Data on survival were obtained from the participating centers. RESULTS: There were 15 patients without congenital heart disease (group 1) and 35 patients with congenital heart disease (group 2) for analysis. Actuarial survival at 1, 2 and 5 years was 86%, 69% and 69% in group 1 and 88% and 77% in group 2, respectively (p = NS). Hemodynamic variables that predicted survival on univariate analysis were mean right atrial pressure (mRAP) (p < 0.0001), mPAP (p = 0.034), Rp (p < 0.0001) and pulmonary flow (p = 0.003), as well as a variable that we generated-mRAP x Rp (p < 0.0001). On multivariate stepwise logistic regression analysis, mRAP x Rp was independently related to survival. A model using mRAP x Rp allows for the estimation of probability of death at 1 and 2 years after catheterization. CONCLUSIONS: Hemodynamic variables can predict survival in children with pulmonary hypertension in the presence or absence of congenital heart defects. This information can be used to determine the optimal timing of listing for lung transplantation.

Blood Pressure↗
PubMed1997

Diagnosing congenital heart defects using the Fallot computational model.

This paper describes a computational model developed for the diagnosis of multiple defects. If multiple defects interact, meaning that the cues observable for multiple defects are not a sum of the cues observable for the component defects, diagnosis is particularly difficult. We developed a description and classification of the ways cues change when defects interact. A computational model (named Fallot) was implemented and a knowledge-base was constructed for the diagnosis of congenital heart defects. On each case, Fallot performs recognition-based reasoning followed by solution construction and evaluation with the cue combination methods. Fallot was tested on cases from hospital files and correctly diagnoses cases with multiple interacting defects for which conventional methods are not applicable or fail.

Abnormalities, Multiple↗
PubMed1996

Occurrence of cardiac malformations in relatives of children with transposition of the great arteries.

Transposition of the great arteries (TGA) is the most common cyanotic cardiac malformation, representing 5-7% of all cardiac malformations. Previous estimates of the frequency of cardiac malformations in sibs of probands range from 0-1.7%. This study ascertained the frequency of congenital cardiac malformations in relatives of 271 probands with TGA, who were grouped according to the type of TGA present. These include dextro (d-TGA), levo (l-TGA), complex TGA, and asplenia with TGA. In the d-TGA cases there were 369 sibs, one of whom had a cardiac malformation (0.27%). There were 50 sibs in the l-TGA group, with one sib having a cardiac malformation (2.00%). Cardiac malformations were found in 2 of 143 (1.40%) sibs of the complex TGA index cases, and 1 of 50 (2.00%) sibs in the asplenia with TGA group. The overall recurrence risk of cardiac malformations in sibs of TGA probands was 0.82%. Cardiac malformations in parents of probands were found in 0.29% of d-TGA, 0% of l-TGA, 1.54% of complex TGA, and 0% of asplenia with TGA, giving an overall parental occurrence of 0.55%. This is the first study to provide information on the different types of TGA in evaluating sib occurrence. It provides necessary genetic counseling information for families of probands with TGA.

Adult↗
PubMed1994

Pediatric cardiology in the 1990s.

OBJECTIVES: In 1991, all active board-certified pediatric cardiologists were polled by questionnaire to examine the relation of subspecialty training and motivational and satisfaction issues to practice characteristics. BACKGROUND: Previous questionnaires with regard to manpower status and practice characteristics were published in 1967 and 1980. These indicated a field predominantly centered in academic medicine with growth in manpower close to predicted need. METHODS: The questionnaire was mailed to 844 of 884 active board-certified pediatric cardiologists and was returned anonymously by 570, a 68% response rate. RESULTS: Among respondents, the mean year in which fellowship training was completed was 1974. The average length of subspecialty training was 31 months for all respondents and 34 months among those completing training since 1981. Seventy-seven percent of subspecialty training centered on clinical training. Although there has been a slight increase in research training in recent years, only 18 respondents completed > or = 22 months of research training. Respondents devote a mean of 89% of professional hours to subspecialty activities and spend 63% of total hours in clinical care. Total hours, income and procedures were related to site of professional activity. Professional satisfaction was high in the factors considered more important: professional challenge and interaction, clinical resources, career security and clinical autonomy. CONCLUSIONS: The field of pediatric cardiology is a subspecialty centered on patient care and performance of diagnostic and interventional techniques. Professional activities varied according to practice site. Pediatric cardiologists with basic research training and professional activity remain a minority. Satisfaction is high, with greatest satisfaction in professional interactions and least satisfaction with income and free time.

Cardiology↗
PubMed1994

The pediatric cardiac care consortium--revisited.

BACKGROUND: The Pediatric Cardiac Care Consortium (PCCC) is a collaborative, voluntary effort of pediatric cardiologists to gather and analyze data regarding operative results. METHODS: PCCC collects information on each child who undergoes cardiac catheterization, electrophysiologic study, or a cardiac operation, or dies with a cardiac malformation. The data are analyzed annually and individual reports are created for each center. Also, representatives from the centers meet annually, and data-on the major operative procedures, including risk factors, patient profiles, and variations in adjusted mortality-are presented. RESULTS: Since PCCC's founding in 1982, overall operative mortality has decreased from 14% to 4.1% in 1991 (22% to 8.2% for infants). In one center, for example, in which overall and infant operative mortality dropped in seven years from 15% and 28% to 8% and 15%, respectively, the cardiologists and surgeon used the PCCC data to identify areas of weakness and adopt new diagnostic and treatment methods for particular cardiac conditions. They now opt for safer initial operative approaches. Another center reduced its operative mortality for coarctation of the aorta in infants after data review led to a decision to be more aggressive in early referral of infants for operations and for changes in perioperative management. DISCUSSION: Use of the study group model, in which key members work with their institution to use and interpret the data, has been an effective strategy for data dissemination. The PCCC is exploring the concept of "model centers," which would probably be procedure specific. With additional funding, the database could be expanded to include morbidity measures, functional outcome, and long-term follow-up.

Cardiac Care Facilities↗
PubMed1994

Cardiovascular health and disease in children: current status. A Special Writing Group from the Task Force on Children and Youth, American Heart Association.

More than 600,000 children in the United States have a congenital or acquired cardiac abnormality, and millions more are at risk of developing atherosclerotic disease in adulthood, a risk made particularly evident by the prevalence of cardiovascular risk factors in the young. There are barriers to optimum prevention and treatment of these conditions in children and youth. The AHA's Task Force on Children and Youth has described these barriers and outlined a series of recommendations and strategies to meet the challenges they impose. More research is needed, and research initiatives will be developed at scientific conferences designed to review critical areas of cardiac development and etiology of disease in children. Financial support for such research initiatives must be increased. Educational programs on cardiovascular risk factors will be extended to children and their families. When these programs are coordinated with efforts in the community and in schools, they will reduce the prevalence of cardiovascular risk factors. The task force recommends that various departments and committees of the AHA use their resources for the benefit of children: for example, by developing more research initiatives for funding by the AHA or NHLBI and increasing legislative and regulatory efforts in the areas such as mandatory school health programs and tobacco advertising. It is hoped that in the next decade, through research and educational efforts, many advances in the prevention and treatment of cardiovascular diseases in the young will be realized.

Cardiovascular Diseases↗
PubMed1993

Familial interruption of the aortic arch.

Interruption of the aortic arch (IAA) is an important congenital cardiac malformation occurring in 1.4% of cases with a congenital cardiac malformation. Only two reports have described IAA in siblings, each with type B and an anomalous right subclavian artery. We report the occurrence of IAA type B with an anomalous right subclavian artery in two siblings and their half-sibling, each of whom had additional conotruncal cardiac malformations. Recent evidence suggests that conotruncal cardiac malformations, including IAA type B, are related to abnormalities of neural crest cell migration. Thus, the family reported herein may manifest a syndrome related to alterations in mesenchymal tissue/neural crest cell migration.

Aorta, Thoracic↗
PubMed1993

Ebstein's anomaly: a long-term study of survival.

This study examines data regarding the survival of patients with Ebstein's malformation. Of 61 patients studied at the University of Minnesota, 31 are currently alive, with the average survival being 15 years. Several factors adversely affected survival: NYHA functional classification, hemoglobin level, right atrial pressure, symptoms during the neonatal period, and cardiac surgery. Data from a multi-institutional study collected during the past decade adds information regarding survival. Of 18,281 patients in the study, 71 (0.4%) had Ebstein's malformation. Sixteen of these were among 7235 infants, and of these seven died during the first year of life. In contrast, among 55 patients over the age of 1 year, four died, each after cardiac surgery. The data help our understanding of the course of patients with Ebstein's malformation and decisions regarding surgical treatment.

Adolescent↗