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Biomedical subjects

J L Monro

Publications and source records attributed to J L Monro.

At least 127 records · Page 7Linked to original sources
PubMed1976

Surgical "correction" of solitus-concordant, double-outlet left ventricle with L-malposition and tricuspid stenosis with hypoplastic right ventricle.

This report concerns a 2-year-old boy who had situs solitus and atrioventricular concordance with double-outlet left ventricle, L-malposition of the aorta, pulmonary stenosis, tricuspid stenosis, hypoplastic right ventricle, ventricular septal defect, and secundum atrial septal defect. These lesions were correctly diagnosed preoperatively, and "correction" was achieved by closing the atrial septal defect and tricuspid valve and performing a Fontan procedure using an antibiotic-sterilized aortic homograft for the conduit. The patient initially did well postoperatively but, despite vigorous diuretic therapy, developed large bilateral pleural effusions necessitating frequent aspiration. He died unexpectedly one month after the operation. Postmortem examination showed the repair to be intact. Despite his death, we are encouraged to consider this operation in such cases in the future.

Angiocardiography↗
PubMed1975

Late complications of surgery for coarctation of the aorta.

The problem of the patient who has had one operation for coarctation of the aorta and who then requires another because of a late complication at or near the coarctation site is a demanding one. The safety of aortic cross-clamping at the second operation depends on the adequacy or otherwise of the collateral circulation, and this in turn depends on the presence or absence of residual or recurrent aortic obstruction. Three illustrative cases are described in which there was complete, incomplete, and no aortic obstruction respectively at the time of reoperation, two of the cases presenting the additional complication of local aneurysm formation. The various aspects of management of such individuals are discussed, and the relevant literature has been reviewed in an attempt to provide a systematic approach to these difficult patients. The methods for assessing collateral circulation are both clinical and radiological with trial clamping of the aorta and pressure measurement as the most reliable ultimate test. A pressure of 50 mmHg in the distal aorta is accepted as indicating an adequate peripheral circulation, but it is recommended that the trial clamping should always include both the left subclavian artery and any particularly large local collaterals. The use of a perfusion technique to sustain the distal tissues is also recommended, although local bypass shunts have a place when their use is dictated in the interests of safety for the patient.

Adolescent↗
PubMed1975

Simultaneous mitral valve replacement and ligation of persistent ductus arteriosus; a case report.

The successful simultaneous closure of a persistent ductus arteriosus and mitral valve replacement in a 65-year-old woman with pulmonary hypertension is reported. The approach through a left thoracotomy gave good exposure and momentary cessation of cardiopulmonary bypass made ligation of the calcified ductus possible. Although this seems to be a rare association, when mitral valve disease is significant the simultaneous closure of the duct and mitral valve surgery is the treatment of choice.

Aged↗
PubMed1972

Homograft valves.

Explore the source record for details and available documents.

Anti-Bacterial Agents↗
PubMedDate not supplied

Persistent hemolysis after transcatheter occlusion of a patent ductus arteriosus: surgical ligation of the duct over the occlusion device.

A 14-month-old child underwent routine transcatheter closure of her patent ductus arteriosus (PDA) using the Rashkind double-umbrella device. She developed severe persistent hemolysis in association with residual ductal flow. The problem was managed by the previously unreported approach of standard surgical ligation of the duct via a left thoracotomy, leaving the occlusion device in situ.

Cardiac Catheterization↗
PubMedDate not supplied

Persistent truncus arteriosus operated during infancy: long-term follow-up.

Between July 1974 and October 1988 19 consecutive infants (mean age 2.7 months, range 5 days to 11.7 months) underwent surgical correction for persistent truncus arteriosus by one surgeon (J.L.M.). Continuity between the right ventricle and pulmonary arteries was achieved with an antibiotic-sterilized aortic homograft (diameter 13-18 mm) together with patch closure of the ventricular septal defect. There were 3 early postoperative deaths (16%): 1 patient had severe aortic regurgitation, the other 2 had preoperative cardiac arrests. Of the latter, 1 had suffered severe cerebral damage, and the other developed recurrent pulmonary hypertensive crises and low cardiac output. The 16 survivors have been followed for 3.1-17.3 years (mean 7.8 years). Four patients required subsequent replacement of the homograft for stenosis, aortic valve replacement for regurgitation, or both (3.0, 4.0, 8.5, and 12.0 years postoperatively). Of the 16 survivors, 15 are in NYHA class I. Of the 13 patients who have not had aortic valve surgery, 9 have no evidence of stenosis or regurgitation. In the 14 children with the original homograft the median of the residual peak gradient across the right ventricular outflow tract is 15 mmHg (range 10-40 mmHg), and no patient has severe homograft regurgitation at follow-up. Repair of persistent truncus arteriosus has been achieved with low early mortality and no late mortality, which reflects excellent long-term function of the homograft. Furthermore, if truncal valve function is good at presentation, patients are unlikely to require aortic valve surgery.

Aortic Valve↗
PubMedDate not supplied

Twenty-year follow-up of acute type a dissection: the incidence and extent of distal aortic disease using magnetic resonance imaging.

A persistent distal false lumen (PDFL) after surgical repair of type A aortic dissection is the most important factor in determining long-term survival. It has been suggested that changes in surgical technique reduce the incidence of distal false lumen. We report the findings of a 20-year follow-up (mean 5.2 years) on 87 patients who have undergone surgical repair of type A aortic dissection with all survivors undergoing magnetic resonance (MR) scanning of the entire aorta. Early mortality was 27.5%, and actuarial 5-, 10-, and 15-year survival was 65%, 28% and 20% respectively. Early mortality had decreased to 18% in the last 5 years. The most common cause of late death was related to distal aortic disease, accounting for 47% of all late deaths with a peak incidence at 7-10 years after surgery. The incidence of PDFL in survivors was 72%, despite the fact that 82% of all intimal tears were resected at time of operation. Incidence was not affected by extension of the repair into the aortic arch nor by the use of the open technique or Gelatin-Resorcine-Formal tissue glue. In patients with a distal false lumen 6% had reached a maximum aortic diameter of 6 cm in at least one plane on MR scanning and 25% had reached 5 cm. We conclude that if dissection has extended beyond the arch at time of presentation then the choice of surgical technique does not prevent the persistance of a distal false lumen. MR scanning gives ideal anatomical and functional assessment of distal aortic disease and provides the surgeon with all the necessary information to plan the timing and indications for further surgery.

Actuarial Analysis↗