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Biomedical subjects

J H Moller

Publications and source records attributed to J H Moller.

At least 109 records · Page 6Linked to original sources

Single ventricle: a new angiographic classification.

The authors recommend that the "single ventricle" be differentiated into two types. There are single ventricles of the left ventricular type, and others of the primitive type; in other words, the chamber is typically left ventricular or cannot be differentiated into left or right. In the latter case we are dealing with a primitive chamber. In addition there may be variations of the large vessels. Of 40 patients with a single ventricle of the left ventricular type, ten showed normal topography of the major vessels, 13 had a d-transposition and 17 an 1-transposition. In the d-transposition, the outflow track of the ventricle was anterior and to the right and the aorta arises in front of the pulmonary artery; in the 1-transposition and sub-aortic portion is anterior and to the left, the aorta is ventral and to the left of the pulmonary artery. In the discussion it is pointed out that the "single ventricle" must be included in the differential diagnosis of cyanotic, congenital heart disease. Angiographic confirmation of the "single ventricle" depends on the demonstration of an absent ventricular septum and of two separate atrio-ventricular valves.

Angiocardiography↗

Analysis of expert diagnosis of a computer simulation of congenital heart disease.

Analysis of data from five expert cardiologists indicates substantial agreement on the first step to be taken in response to an emergency case of computer-simulated congenital heart disease. There was little or no agreement among these same subjects on the specific steps undertaken following their initial response. The problem was solved in 11, 10, 8, and 6 steps by four of the cardiologists. The problem-solving sequence employed by one expert resulted in the patient's death. It is concluded that while the behavior of experts in the hospital and clinic is the primary means of evaluating successful student performance, computer simulations of patient cases offer the opportunity to use expert data in the calibration of student error.

Computers↗

Alternate pathways to pulmonary venous flow in left-sided obstructive anomalies.

In cardiac anomalies causing severe obstruction in the left side of the heart, such as aortic atresia, mitral atresia, or occasionally severe aortic stenosis, maintenance of circulation depends upon shunting of pulmonary venous blood into the right atrium. The usual pathway by which the shunt is achieved is across the atrial septum through the foramen ovale. When this route is closed or severely narrowed, alternate but less common pathways may exist. These involve either anomalous connections of pulmonary veins to systemic veins or communications with the coronary venous system. In the latter, as commonly occurs in aortic atresia, left ventricular myocardial sinusoids carry pulmonary venous blood from the left ventricular cavity and into the cardiac veins. In other instances of severe left-sided obstruction, a direct communication may exist between the left atrium and the coronary sinus.

Aortic Valve↗

Coarctation of the aorta associated with aortic valvular atresia.

The aortas in 41 specimeans of aortic atresia (ten with associated mitral atresia) were studied for the presence of coarctation of the aorta. The basic lesion, causing varying degrees of obstruction, was observed in 31 instances (75%), 24 minor, seven with major degrees of obstruction. In half, the aortic lesion lay proximal to the ductus, and in the majority of the remainder, opposite the ductus arteriosus. The location of lesion and degree of obstruction was essentially the same whether aortic atresia occurred alone or in association with mitral atresia. Angiography is a fairly reliable method of identifying coarctation associated with aortic atresia. An additional point of interest was that in aortic atresia alone there was strong dominance of the male sex, while this tendency was not observed when mitral atresia was associated with aortic atresia.

Aorta↗

Ventricular inversion associated with normally related great vessels.

A patient with ventricular inversion with normally related great vessels and double inlet left ventricle is presented. the patient also showed features of Down's syndrome. Association of ventricular inversion with normally related great vessels is rare and leads to a basic functional state like that of complete transposition of great vessels derived from the connections between the ventricles and great vessels. The association of ventricular inversion with Down's syndrome observed in the case reported represents a rarity.

Aorta↗

Recurrent myxosarcoma of left atrium.

The surgical treatment of cardiac myxosarcoma is reviewed with emphasis placed on palliative response to radiation therapy. A case of primary myxosarcoma of the left atrium in a 16-year-old girl is presented. The tumor was surgically removed in October, 1967. Recurrently myxosarcoma was removed in August, 1968, at which time involvement of the pulmonary veins and the pericardium was noted. Subsequent to postoperative radiation therapy, the patient remained symptom-free for more than three years. Death occurred 4 1/2 years after the original operation from local and systemic recurrence of the tumor.

Adolescent↗

Polyvinyl alcohol (Ivalon)--a new embolic material.

Successful nonsurgical treatment of gastrointestinal bleeding and arteriovenous malformations by embolization techniques has been previously documented. 1) Compressed Ivalon sponge was found to be a suitable embolic material in animals and in four patients. 2) The material has been extensively used in surgery, and its biocompatibility has been proved. 3) Expansion of the compressed sponge to its original size after embolization makes this material extremely effective. Recanalization did not occur in animals and humans. 4) For the occlusion of larger arteries, Ivalon can be wrapped around the guidewire. Ivalon sponge absorbs blood and serum, unwraps itself allowing withdrawal of the guidewire. 5) Embolization procedures are not without risk since reflux of embolic material may occur. Therefore, these procedures have to be carried out under fluoroscopic control.

Animals↗