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Biomedical subjects

J L Wilkinson

Publications and source records attributed to J L Wilkinson.

At least 91 records · Page 5Linked to original sources
PubMed1983

Cross-sectional echocardiographic assessment of coarctation in the sick neonate and infant.

To establish an integrated non-invasive method for diagnosing coarctation, cross-sectional echocardiographic appearances of 48 neonates and infants with coarctation were combined with clinical information on the peripheral pulses. Measurements of the ascending aorta, aortic arch, and isthmus were made and compared with those from controls matched for weight and age. Confirmation of the coarctation was available in all cases. Angiocardiographic measurements were performed in 15 patients from either the group with coarctation or the controls. After the aortic arch had been analysed segment by segment 40 patients were found to have preductal coarctation, five juxtaductal coarctation, and three postductal coarctation. In one of the patients in the latter group the obstruction was situated in the abdominal aorta. Specific echocardiographic features were present in each subgroup. Echocardiographic measurements were about two thirds of those obtained by angiocardiography. By combining information on the peripheral pulses, isthmic size, and the presence of a discrete shelf in the aorta it was retrospectively possible to predict correctly the presence of coarctation in 45 out of 48 cases. Since the beginning of this study 29 patients have undergone surgery without prior invasive investigation. A combination of clinical assessment and cross-sectional echocardiographic features allows a reliable diagnosis of coarctation to be made in most cases.

Angiocardiography↗
PubMed1983

Late effects on the left upper limb of subclavian flap aortoplasty.

The subclavian flap aortoplasty gives excellent short-term and medium-term results when performed on infants with coarctation of the aorta. This study was devised to determine whether there were any detrimental effects to the sacrifice of the left subclavian artery in infancy. Sixteen patients were studied 2 to 9 years post-operatively. Clinical evaluation revealed no major symptoms in the left upper limb. However, in seven children, minor symptoms had been noted by the parents. Anthropometric measurements revealed a shortening of the left upper limb in all patients; when these measurements were compared with those in normal subjects, the shortening was localized to the left upper arm. Four papers which mention the effect on the left arm of ligation of the subclavian artery in childhood during the Blalock-Taussig operation are discussed. It is concluded that the excellent results from the subclavian flap aortoplasty are not compromised by the minor effects of ligating the left subclavian artery in infancy.

Aortic Coarctation↗
PubMed1982

Variations in the morphology of the ventricular septal defect and disposition of the atrioventricular conduction tissues in tetralogy of Fallot.

Seventeen heart specimens with tetralogy of Fallot were studied to assess the anatomy of the ventricular septal defect and the disposition and potential vulnerability to surgical trauma of the atrioventricular conduction tissue. Eleven had defects of the perimembranous type. In the majority of these cases the non-branching and branching atrioventricular bundle lay posterior to the defect in a position unlikely to be damaged during closure of the defect. However, in one case, the non-branching bundle extended onto the rim of the defect and in a further 4 cases, other major components of the atrioventricular conduction tissue appeared vulnerable. Six ventricular septal defects were of the muscular outlet type and the atrioventricular conduction tissue did not appear vulnerable in any case of this type. Conclusive differentiation between perimembranous and muscular outlet defects was not always possible on gross morphological examination. It is suggested that the crest of the muscular septum and fibrous tissue in the posterior corner of the ventricular septal defect should be avoided during closure of the defect.

Atrioventricular Node↗
PubMed1982

Outcome of treatment for neonates referred to a supraregional cardiac centre 1976-78.

The clinical course and outcome of treatment for 322 consecutive neonates referred to a supraregional paediatric cardiac unit are reviewed. Two hundred and forty-eight (77%) had structural congenital cardiac defects. The remaining 74 (23%) presented with arrhythmia, nonstructural cardiorespiratory problems, or problems unrelated to the cardiovascular or respiratory system. Transposition of the great arteries and coarctation of the aorta were associated with a good prognosis. Infants with cyanotic cardiac defects associated with a low pulmonary blood flow who required early palliation were found to have a poorer outlook.

Actuarial Analysis↗
PubMed1982

Absent left atrioventricular connection with right atrium connected to morphologically left ventricular chamber, rudimentary right ventricular chamber, and ventriculoarterial discordance. Problem of mitral versus tricuspid atresia.

Four cases of absent left atrioventricular connection are reported. The observations from these cases have been used to emphasise problems concerning the use of the confusing terms "tricuspid" and "mitral" atresia to describe such hearts. One of the four cases represents a very uncommon condition since the rudimentary chamber was contralateral to the side of the absent emphasis given to the surgical implications of these anomalies.

Heart Atria↗
PubMed1982

Left-sided obstructive lesions in atrioventricular septal defects: an anatomic study.

Actual and potential factors that create an obstruction to the flow within the systemic side of the heart have been analyzed in 114 specimens with atrioventricular septal defects. Hearts with separate right and left atrioventricular orifices and with common atrioventricular orifice were included. Potential inlet obstruction was due to tethering of the "cleft" of the left atrioventricular valve to the septum in 17.5%, incomplete "cleft" in 8%, and deformed valve leaflets in 70% of cases. Potential factors predisposing to left ventricular outflow tract obstruction were seen in 70% of cases, 21% being due to abnormal position of the papillary muscle and the remainder due to intrinsic hypoplasia of the outflow tract. Anatomic factors producing unequivocal obstruction were seen in 29% of cases. Twenty-two percent had obstructions at the inlet level, of which 13% were due to malformations of the left atrioventricular valve or the left component of a common valve. The other 9% had overall inlet obstruction due to severe hypoplasia of the left ventricle itself. Unequivocal outlet obstruction was observed in 7% of cases, 5% due to abnormal disposition of papillary muscles in the outflow tract and 2% to aneurysm of the interventricular septal remnant. Although anatomic obstruction occurs in the minority of cases (29%), this report shows that potential obstruction must be taken into account when considering surgical repairs.

Heart Septal Defects↗
PubMed1981

Ventricular septal defect in children born in Liverpool 1960 to 1969. Evaluation of natural course and surgical implications in an unselected population.

We have reviewed data on all patients born between 1960 and 1969 and registered in the Liverpool Registry of Congenital Malformations as having congenital heart disease. There were 385 with a ventricular septal defect as their sole or main cardiac lesion. Analysis of the available follow-up data showed that 50 of these were subsequently assigned in other diagnostic categories and a further 41 failed to fulfil our diagnostic criteria for a ventricular septal defect, leaving 294 patients for study. In view of the high incidence of small defects in asymptomatic infants and children not subjected to cardiac catheterisation, clinical criteria for the acceptance of the diagnosis were defined and 190 patients were included on these grounds alone. The clinical course, associated cardiac and non-cardiac defects, and surgical implications were analysed. The majority of defects were small and 31% closed spontaneously. Fifty per cent of the deaths in infancy were unrelated to the ventricular septal defect. We estimate that by present criteria only 15% of an unselected population of patients with a ventricular septal defect are likely to require surgical treatment.

Child↗
PubMed1981

Congenital heart disease among 160 480 liveborn children in Liverpool 1960 to 1969. Implications for surgical treatment.

Among 160 480 children born alive between 1960 and 1969 in Liverpool, 884 patients with structural congenital heart disease were identified. Data on these patients have been reviewed in order to estimate the number likely to need cardiac surgery during childhood and adolescence. Though only 33.9% of patients had surgery, we estimate that if current policies for management were followed, 475 (53.7%) patients would not require surgery. Extrapolation of this data suggests that each year in England and Wales approximately 830 infants (1383 per million livebirths) will require cardiac surgery within the first year of life and a further 1424 operations (2374 per million livebirths) will be required in later childhood or adolescence. No attempt has been made to estimate the number of operations for congenital heart disease which may prove necessary in adult life.

Adolescent↗
PubMed1981

Appraisal of the Mustard procedure for the physiological correction of "simple" transposition of the great arteries. Eighty consecutive cases, 1970-1980.

Eighty successive patients underwent the Mustard operation for "simple" transposition of the great arteries (TGA) between January, 1970, and January, 1980. Ages ranged from 42 days to 12.4 years (mean 14.7 months). Balloon atrial septostomy (BAS) with balloon volumes of more than 2.5 ml produced significant increases of arterial oxygen saturation, although the initial benefit of BAS was greater than that found at follow-up catheterization. In these patients the left ventricular (LV) pressure tended to decrease during the first months of life, but this drop was less marked at the end of the first year. Deep hypothermia and cardiocirculatory arrest were employed in all cases. Several modifications were adapted to the original surgical technique in order to reduce last sequelae. There were two early and three late deaths. At follow-up (mean 4.5 years) 74% of patients were symptom free. Sinoatrial and atrioventricular (AV) conduction disturbances were present in five and six patients, respectively. Caval or pulmonary venous obstruction occurred in 13 patients, seven of whom required reoperation. Isolated tricuspid valve incompetence was present in one patient only, but in four it was associated with other defects. Primary right ventricular (RV) failure occurred in one patient. These findings, in relation to mortality, complications, and the excellent clinical results in the majority of survivors, compare favorably with results published for patients with "simple" TGA who have been subjected to other types of physiological or anatomic correction. At the present time, there seems to be no good reason to alter our surgical policy in this group of patients.

Blood Pressure↗
PubMed1980

Echocardiographic and anatomical correlates in the fetus.

Fetal cardiac anatomy was studied in 200 pregnancies between 14 weeks' gestation and term using real time two-dimensional echocardiography. Eight scan planes were chosen as contributing valuable and distinct information on the establishment of cardiac normality. To confirm the echocardiographic interpretation, 25 fetal specimens between 12 and 28 weeks' gestational age were sectioned to imitate echocardiographic scan planes and the echocardiographic and anatomical pictures obtained were correlated with each other. The number of patients in whom each plane was recognized was tabulated in the first and second hundred, the second hundred having been studied after the anatomical studies were made. One longitudinal and one transverse plane could be seen in nearly all patients and considerable improvement in the frequency of recognition of other planes was made in the second hundred patients with increasing experience and anatomical understanding. The tricuspid-pulmonary and four-chamber planes alone, however, showed four cardiac chambers, two atrioventricular valves, and two arterial valves within their respective outflow tracts.

Echocardiography↗