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Biomedical subjects

J Somerville

Publications and source records attributed to J Somerville.

At least 127 records · Page 7Linked to original sources
PubMed1987

Tricuspid atresia with transposition of the great arteries in adolescents and adults: current state and late complications.

The outcome was reviewed in 17 patients aged 15-40 years with tricuspid atresia and transposed great arteries selected by survival beyond age 14 years. Only five lead normal lives (ability index 1 or 2); the rest are dead or disabled. Arrhythmias occurred in seven. Maintenance of sinus rhythm is important because incessant atrial arrhythmias cause serious symptomatic deterioration. Pulmonary vascular disease and subaortic stenosis were important determinants of late mortality and morbidity. Because the mortality associated with the Fontan operation was high in these patients it should be performed with impeccable surgical technique and only in those who fulfil all the selection criteria for the operation. A shunt is the preferred option when any of the criteria are not met.

Abnormalities, Multiple↗
PubMed1987

Transposition of the great arteries: late results in adolescents and adults after the Mustard procedure.

A selected group of 18 patients aged 15-27 years with transposition of the great arteries and a previous Mustard procedure were evaluated to determine their functional ability and clinical state. Arrhythmias were common, occurring at some time in 16/18 (89%). Arrhythmia was serious in four; two of them required pacing and two had cardiac arrests, one resulting in death. Seven (41%) had right ventricular dysfunction; this was progressive in three. Tricuspid regurgitation was present in seven (41%); it occurred in patients with normal and reduced right ventricular ejection fractions. Regurgitation became progressively worse as the right ventricle dilated. Left ventricular function was well preserved in most patients. Fourteen (82%) of this pioneer group were leading normal lives (ability index 1 or 2). Although these results are acceptable concern remains about the probability of deteriorating right ventricular function.

Arrhythmias, Cardiac↗
PubMed1987

Magnetic resonance imaging of the pulmonary arteries and their systemic connections in pulmonary atresia: comparison with angiographic and surgical findings.

Patients with pulmonary atresia require several investigations and operations. The role of magnetic resonance imaging in assessing the anatomy of the central pulmonary arteries, the origin and course of systemic collateral arteries, and the patency of surgical shunts has been studied with the aim of reducing the need for invasive angiography. Transverse, coronal, and sagittal images were obtained in ten adult patients and assessed without knowledge of surgical and angiographic data. Central pulmonary artery anatomy varied from full development to complete absence. Transverse slices showed hypoplastic arteries particularly well and the findings accorded with surgical and angiographic data in all patients. The origin and proximal course of 15 large collaterals were identified on the magnetic resonance images and 18 were identified by surgical and angiographic data. Magnetic resonance imaging did not show their distal connections; if such information is required angiography will be needed. Five surgical shunts were shown to be patent and two occluded at surgery and angiography, and this was confirmed on the magnetic resonance images. The patency of a further four shunts was uncertain, but they were not seen by magnetic resonance and were presumed to be occluded.

Adult↗
PubMed1986

Ductus arteriosus associated with an anomalous left coronary artery arising from the pulmonary artery: catastrophe after duct ligation.

Chronic left ventricular failure developed two months after ligation of an apparently uncomplicated large ductus arteriosus in a one year old girl. Two years later deterioration had progressed to a terminal stage. An anomalous left coronary artery arising from the pulmonary artery had not been recognised before duct ligation. This anomaly was diagnosed two years after ligation and was then treated by surgical redirection, but the patient died of severe left ventricular dysfunction.

Coronary Vessel Anomalies↗
PubMed1986

Assessment by cross sectional echocardiography of surgical "mitral valve" disease in children and adolescents.

The anatomy of the left atrioventricular valve, a mitral valve unless there is atrioventricular discordance, was determined by cross sectional echocardiography in 15 young patients with congenital lesions and seven with rheumatic lesions. These results were compared with findings at operation. The preoperative diagnosis was accurate in 18 (80%). In the remaining four patients inaccurate echocardiographic diagnosis was due to the mistaken identification of clefts in redundant and multicuspid valves and of absent chordae that were thought to be ruptured chordae. In four patients a subvalvar abnormality was identified by echocardiography. With care, cross sectional echocardiography was a reliable method of defining abnormal anatomy in serious mitral disease and it predicted the need for replacement or the possibility of repair. In the absence of additional lesions invasive investigation was unnecessary.

Adolescent↗
PubMed1986

Tricuspid atresia in adolescents and adults: current state and late complications.

Twenty nine patients aged 15-35 years (mean 23) with tricuspid atresia and normally related great arteries were studied; 20 are alive. Ten patients who had had a Fontan operation (group 1) were compared with 10 patients with palliative shunts (9) or no surgery (1) (group 2). Patients were graded according to their ability to lead a normal life (ability index). Patients in group 1 tended to have a better ability index, a greater exercise capacity, and fewer social and extracardiac problems than those in group 2. The mean left ventricular ejection fraction measured by radionuclide angiography was the same in both groups. Arrhythmias were equally common in both groups; they appear to be age related and they occur independently of left ventricular function.

Adolescent↗
PubMed1986

Echocardiographic routine analysis of the coronary sinus by an apical view: normal and abnormal features.

The echocardiographic aspects of the coronary sinus have not received much attention in the literature. In the few published articles about anomalous venous connection to the coronary sinus, the parasternal long axis view has been suggested as ideal for its visualization. More recently, it has been suggested that the coronary sinus in normal hearts is best visualized from the apical transducer position. The purpose of this study was to assess the appearance of the coronary sinus from an apical view in a group of 400 consecutive patients with ages varying from 5 days to 80 years. In ten patients with persistent left superior vena cava, the coronary sinus was markedly dilated throughout its extension. All cases were confirmed either by angiography or surgery. In another three patients with Ebstein's anomaly studied postoperatively, it was observed that the coronary sinus was abnormally draining into the right ventricle below the prosthesis plane. These findings were confirmed by the surgical reports. The routine evaluation of the coronary sinus was better performed by an apical view, which provided detailed information not only of normal, but also abnormal anatomy of this segment of the heart. We speculate that it could be especially useful in diagnosing coronary sinus atresia and thrombosis, and coronary ostium atresia, as well as total anomalous intracardiac pulmonary venous drainage.

Journal Article↗
PubMed1985

Anatomically corrected malposition of the great arteries: diagnostic difficulties and surgical repair of associated lesions.

Four patients, aged 5 to 14 years, had repair of abnormalities associated with anatomically "corrected malposition," a condition associated with mitral/aortic discontinuity with atrioventricular and ventriculoarterial concordance, and with the aorta lying anterior and to the left of the pulmonary artery. All 4 patients had ventricular septal defect; in addition, 1 patient had coarctation, 2 patients had pulmonary infundibular stenosis, 1 patient had acquired pulmonary valve atresia, 1 patient had acquired fixed subaortic stenosis and 2 patients had left juxtaposition of the atrial appendages. The position of the great arteries suggest corrected transposition, but the true diagnosis is made from finding atrioventricular and ventriculoarterial concordance with wide mitral/aortic separation on the cross-sectional echocardiogram. The electrocardiogram shows normal ventricular activation. Three of the 4 patients had anticlockwise rotation of the heart, which displaced the apex. This made echocardiography difficult and caused a problem in visualizing the right-sided valved conduit and closing the VSD in conventional ways. One patient died at reoperation for an obstructed conduit. Mitral regurgitation developed after resection of subaortic stenosis in 1 patient. No arrhythmias occurred in the 3 surviving patients, followed for 1 to 5 years, but the risk of subaortic stenosis remains.

Adolescent↗
PubMed1985

Aneurysmal dilatation of left atrial appendage diagnosed by cross sectional echocardiography and surgically removed.

An isolated aneurysmal dilatation of the left atrial appendage was found in an 18 year old girl who presented with atrial fibrillation and an unusual cardiac shadow on routine chest radiographs. The diagnosis was made by cross sectional echocardiography. The giant appendage was excised to remove the risk of systemic embolism and the need for life long anticoagulation.

Adolescent↗