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Biomedical subjects

J R Jacobsen

Publications and source records attributed to J R Jacobsen.

At least 55 records · Page 3Linked to original sources
PubMed1983

Assessment of rheumatic mitral valve disease. Value of echocardiography in patients clinically suspected of predominant stenosis.

The value of echocardiography as compared with cardiac catheterisation was evaluated prospectively in 33 consecutive patients clinically suspected of predominant mitral stenosis. Patients with clinical signs of accompanying mitral regurgitation, no matter how severe, and patients with clinical findings indicating insignificant aortic valve disease were included. Critical mitral stenosis was defined by a valve area of less than or equal to 1 cm2. Severe mitral regurgitation was diagnosed by echocardiography on the basis of left ventricular dilatation (more than 3.2 cm/m2 at end-diastole) if not explained otherwise. Significant aortic valve disease was suspected in cases with aortic valve deformity and left ventricular dilatation or hypertrophy as defined by echocardiography. Mitral valve area by echocardiography correlated well with mitral valve area calculated from catheterisation data and a good interobserver correlation was found for echocardiographic measurement. Mitral stenosis, critical or non-critical, may mask significant coexistent valve lesions; echocardiography failed to discover severe mitral regurgitation requiring valve replacement in two patients with non-critical stenosis, and significant aortic regurgitation needing valve replacement was underestimated in one patient with critical mitral stenosis. A correct echocardiographic classification with respect to surgery, however, was obtained in: (1) all patients with clinically pure mitral stenosis (nine patients), and (2) all patients with combined mitral stenosis and regurgitation when either critical stenosis or severe regurgitation was found at echocardiography (12 patients). It thus appears that two out of three patients with mitral valve disease in whom the clinical findings indicate predominant stenosis can be correctly evaluated with the echocardiogram.

Adult↗
PubMed1979

Dosage of digoxin in premature infants.

The pharmacokinetics and pharmacodynamics of digoxin in premature infants was studied. During maintenance therapy, after a total digitalizing dose of 30 microgram/kg, the measured digoxin level was related inversely to body weight at birth and to estimated gestational age. The serum digoxin levels found in the immature and smaller infants were two to three times the values usually reported to be toxic in older children. Based on these findings, a second group of premature infants was digitalized with 20 microgram/kg; in this group, the serum digoxin levels were below the toxic range, irrespective of gestational age or birth weight. The cardiac effects of digoxin, i.e., shortened left ventricular pre-ejection period and ejection time as determined by echocardiography, were similar in the two groups. For both groups, the half-life of digoxin in the serum was twice that reported for term infants and children. Since digitalis effect is obtained with lower dose and serum concentration, we recommend that this dose be used in premature infants.

Birth Weight↗
PubMed1979

Cervical aortic arch with ventricular septal defect. A differential diagnosis from interrupted aortic arch.

A case of right cervical aortic arch with a large ventricular septal defect and a bicuspid aortic valve is reported. The angiographic diagnosis was interruption of the aortic arch type II, with aberrant right subclavian artery, a closed ductus arteriosus and retrograde vertebral-subclavian flow to the descending aorta. The cervical arch, demonstrated post mortem, was located high and deep in the neck. This differential diagnosis may have potential importance, as reported experience shows that a surgical aortic anastomosis is not required in cervical aortic arch.

Aortic Arch Syndromes↗
PubMed1979

Coarctation of the aorta operated upon in infancy. Long-term follow-up.

A long-term follow-up study was performed in 14 patients, operated for coarctation of the aorta in infancy. The median age at operation was 4 mth. Mean and median age at follow-up were 16 yr, and the follow-up time varied between 7 and 22 yr (mean and median 15 yr). At follow-up recoarctation was or had been present in 6 patients; there was no relation between the development of recoarctation and the age at operation. Concomitant aortic valve anomaly had been overlooked at the initial investigation in 3 patients. The systolic and diastolic blood pressure at follow-up was significantly elevated above the mean of normals; 2 of 8 patients without recoarctation clearly had diastolic hypertension. It seems as if even operation in infancy does not prevent hypertension later in childhood or adolescence in some of the patients, and it hardly seems justified to perform elective operations for coarctation of the aorta in infancy with the appreciable risk of recoarctation, until more long-term follow-up results are known. The patients should not be lost to follow-up.

Adolescent↗
PubMed1978

Premature ventricular contractions in normal children.

To document the assumed benign prognosis of premature ventricular contractions in children, we followed 17 patients with PVCs and without other heart disease for a mean of seven years (range one to 19 years). Data were collected from the history, physical examination, 15-lead ECG, and treadmill exercise test. Eight of the 17 children still had PVCs at the most recent follow-up. Of these eight children, seven were asymptomatic. The physical examination remained normal in all except one, who developed signs of mitral prolapse. Light exercise abolished the PVCs in all children. We believe that if a careful clinical examination discloses no abnormalities, and if the PVCs are unifocal and disappear with exercise, this dysrhythmia is, in fact, benign in children, and requires no further cardiovascular examination.

Adolescent↗
PubMed1978

Intrauterine supraventricular tachycardia.

Four cases of intra-uterine ectopic supraventricular tachycardia are described. In three there were none or only minor symptoms immediately after delivery and subsequently. The fourth baby having a congenital W-P-W-syndrome was born with severe hydrops fetalis and was asphyxiated. From these cases and from data reported in the literature it is concluded that intra-uterine heart failure is a significant risk when the fetal heart rate persistently exceeds 230 per minute. It is suggested that digoxin administered to the mother may be beneficial to the fetus in cases of intra-uterine ectopic tachycardia.

Apgar Score↗
PubMed1978

Congenital apical aneurysm of the left ventricle: surgical removal in two infants.

The case histories are described of 2 infants, representing either type of congenital apical left ventricular aneurysm. Case 1 had a finger-like, pulsatile, actively contracting aneurysm which was associated with a split distal end of the sternum and a ventral hernia. In contrast to most of the 55--60 cases hitherto described, no other cardiovascular anomalies were detected at heart catheterization with angiocardiography. The aneurysm was resected at the age of 23 days. Postoperative angiocardiography demonstrated a normal-sized left ventricle with good contractions and no residual aneurysm. He was last seen at the age of 15 mth, doing well. Case 2 had a noncontractile aneurysm and congenital pyloric stenosis, which hitherto has not been found in association with this type of aneurysm in the about 20 reported cases. The aneurysm was resected at the age of 9 mth; the estimated reduction of the left ventricular cavity was 20%. 1 yr after operation the patient was doing well, but the chest roentgenogram was unchanged and at angiocardiography the left ventricular appearance was largely unchanged compared to the preoperative findings. He was last seen at the age of 2 yr, doing well. The long-term prognosis in the latter type of aneurysm has still to be elucidated.

Angiocardiography↗
PubMed1978

Natural history of valvular pulmonary stenosis in children below the age of two years. Long-term follow-up with serial heart catheterizations.

18 patients with mild and moderate valvular pulmonary stenosis diagnosed by heart catheterization before the age of 2 yr (mean 11.6 mth) were followed for 5 to 21 yr without operation. 15 cases had a repeat catheterization study after a mean interval of 10.7 yr. Of 7 cases with an initial right ventricular peak systolic pressure (RVSP) of 50 mm Hg or below, 6 had a decrease and 1 a moderate increase in RVSP. Of 8 cases with an initial RVSP of greater than 50 mm Hg 2 had a decrease, 2 had no change and 4 had a significant increase in RVSP; the latter subsequently underwent operation. Electrocardiography yielded some information, but neither roentgenography nor history was of any help in evaluating the severity of the stenosis at follow-up. As mild and moderate valvular pulmonary stenosis in infants and children below the age of 2 may progress and require operation a repeat heart catheterization is usually to be recommended later in childhood.

Adolescent↗
PubMed1976

Intracardiac electrography in endocardial cushion defects.

Conduction of the sino-atrial impulse from the high right atrium to the ventricles was studied by intracardiac electrography in 21 unoperated patients, age 3 months to 11 years, with endocardial cushion defects (ECD). The high right atrium-to-low right atrium conduction time was prolonged in 15 of 18 subjects (mean 57 +/- 20 msec). The low right atrium-to-His bundle conduction time (LRA-H) was normal in 16 of 17 subjects (mean 82 +/- 30 msec), prolonged in one. The His-to-ventricle conduction time (H-V) was normal in 16 of 17 subjects (mean 37 +/- 8 msec), equivocally short in one. Nine patients with ECD, age 3 to 21 years, were studied postoperatively. One had an acquired complete atrioventricular block in the His bundle. Two had prolonged LRA-H and two prolonged LRA-H and two prolonged H-V. The surface ECG failed to identify accurately either prolonged atrioventricular conduction or the site of prolongation.

Adolescent↗
PubMed1976

Acute aortic regurgitation and abscess of sinus of Valsalva due to fulminating ulcerative endocarditis. Report of three fatal cases in children.

Acute aortic regurgitation due to ulcerative endocarditis developed in 3 children aged 10, 6, and 7 years, respectively. All had congenital aortic valve lesions. Intractable congestive heart failure ensued about 2 weeks, 1 week, and a few days, respectively, after onset of infection. Two patients were operated on in the acute stage, and in both, perivalvular spread of the infection was found with abscess formation of the right sinus of Valsalva perforating through the interventricular septum to the right ventricle; valve replacement and repair were performed, but both patients died. The correct diagnosis was missed in the third patient, who was thought to have myocarditis and who died one week after onset of infection: at autopsy a perforation of a bicuspid aortic valve and an aneurysm of the sinus of Valsalva were found.

Abscess↗
PubMed1975

Exit block in sustained atrial tachycardia in two children.

The electrocardiographic findings in two children with sustained atrial tachycardia and exit block are reported. The exit block was dependent on the atrial pacemaker rate, being present only at rapid rates of discharge. In one case propranolol enhanced the exit block, and on an appropriate dose the heart rate was maintained within a well tolerated range.

Cardiac Complexes, Premature↗
PubMed1975

Chronic supraventricular tachycardia in infancy and childhood.

The results of a one to 19 year follow-up study of 9 children with supraventricular tachycardia of more than one month's duration are reported. The ECG diagnosis of tachycardia was made before birth in one patient and between the ages of 8 months and 12 years in 8. Four had sustained and 4 had repetitive tachycardia, while one patient had both patterns at different times. Reciprocal rhythm was diagnosed in 3 patients and exit block in 2. Severe symptoms had occurred in 2 patients, but as a rule symptoms were mild or absent. No treatment abolished the arrhythmias but digitalis reduced the overall ventricular rate in 6 patients. After a duration of 1-7 years, 3 patients still had tachycardia at the follow-up. In the remaining 6 patients the tachycardia had subsided 7 months to 10 years after the onset.

Adolescent↗