Search PubMed⌕ Search

Biomedical subjects

J Stark

Publications and source records attributed to J Stark.

At least 181 records · Page 10Linked to original sources
PubMed1981

Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts.

Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried out at The Hospital for Sick Children, Great Ormond Street. The operation consists of interposing between the subclavian artery and the pulmonary artery a prosthesis of greater diameter than that of the subclavian artery. The first 13 operations were performed with a prosthesis of woven Dacron. Conduits of expanded polytetrafluorethylene (PTFE) were used for 86 MBTSs, and these form the basis of this report. Forty-four (51.1%) shunts were performed in infancy, 25 in patients under the age of 1 month (29.0%). Prostheses of 4 mm were used in 34 cases, 5 mm in 14, and 6 mm in 38. There were five shunt failures (5.8%) documented at postmortem or angiocardiographic investigation. Including two late deaths for which postmortem examinations were not obtained, the overall failure rate was 8.1% (seven patients). All these patients were operated upon in infancy, four of them in the neonatal period. Although a longer follow-up is necessary to assess the validity of these shunts, the early results are encouraging. We believe we can now recommend MBTS as an alternative when the classical Blalock-Taussig shunt is considered unsuitable.

Blood Vessel Prosthesis↗
PubMed1981

[Indications to the surgical treatment of patients with "simple" transposition of the great arteries. Analysis of 302 cases surgically treated according to mustard's technique (author's transl)].

Between January 1965 and December 1979, 302 patients underwent Mustard's operation for "simple" transposition of the great arteries (TGA). 31 cases who underwent Senning operation for "simple" TGA and 7 patients with "simple" TGA and severe pulmonary vascular disease, in whom Mustard's operation was performed and a ventricular septal defect created, have not been included in the present series. The patients analysed ranged in age from 3 days to 17 years (mean = 27,6 months) and in weight from 2.7 to 40 Kg (mean = 9.9 Kg). The technique originally described by Mustard was used, with some technical modifications. There were 26 early deaths (early mortality rate = 9%). The hospital mortality was 16% during the period 1965-1969, 75% between 1970 and 1974, while during the last 5 years it was 6%. The hospital mortality was lower among the infants between 6 and 12 months of age (6%), compared with an early mortality rate of 11% among those younger than 6 months and 9% in the age group over 1 year. There were 34 late deaths (12% of the survivors). Reoperation was performed in 42 cases. Forty patients required revision of the inter-atrial baffle for pulmonary and/or caval venous obstruction and 10 of them subsequently died. Post-operative venous obstructions were observed more frequently in patients with dumb-bell shaped dacron patch, which has been since 6 years abandoned. Since the introduction of Brom's trouser shape pericardial patch, venous obstructions are extremely rare. Both patients who underwent reoperation respectively for severe tricuspid valve incompetence and for occlusion of the left pulmonary artery, died early after reoperation. In our Unit, the actual management program for patients with "simple" TGA is the following. We keep to a minimum the degree of invasive investigations, 2 D ECHO diagnoses TGA with great accuracy. At the initial cardiac catheterization, a balloon atrial septostomy (BAS) is performed. A good inter-atrial mixing is usually obtained with balloons sized more than 2.5 ml. Angiocardiography is undertaken only when associated lesions, such as patent ductus arteriosus or aortic coarctation are suspected. If the child improves, complete investigation is performed at 3-4 months of age and the inter-atrial redirection of the venous inflow is scheduled for the age of 8-12 months. If the child fails to improve after BAS or deteriorates during the waiting period, restudy is performed immediately to ensure that additional lesions are not present and that the inter-atrial shunt is adequate. Rather than a surgical atrial septectomy, in this group of cases we prefer an early intracardial total repair, irrespective of age and weight.

Adolescent↗
PubMed1980

Postoperative angiographic assessment of modified Blalock-Taussig shunts using expanded polytetrafluoroethylene (Gore-Tex).

Thirty-six of 87 modified Blalock-Taussig shunts done with expanded polytetrafluoroethylene (Gore-Tex) were restudied angiocardiographically. In 7 patients the study was carried out within 1 month of the shunt operation because the patients failed to make satisfactory clinical progress. Two shunts were occluded and 1 ws stenosed; all 3 were in neonates. The remaining 29 patients were reinvestigated electively between 5 and 29 months postoperatively and had a 97% shunt patency rate. Because of the rather high incidence of irregular or stenosed shunts among neonates with 4 mm conduits, we now prefer to use a larger conduit even in this age group.

Arteriovenous Shunt, Surgical↗
PubMed1980

Tricuspid endocarditis with ventricular septal defect. Case report with surgical management.

A 13-year-old girl presented with infective endocarditis of the tricuspid valve related to a residual ventricular septal defect. Antibiotic therapy produced a satisfactory initial improvement, however, subsequent deterioration with uncontrolled infection, in spite of alterations in the antibiotic regime, necessitated surgical intervention. Because the endocarditis was localized to the septal leaflet, management by excision of this leaflet and annuloplasty was possible and resulted in a rapid and sustained clinical improvement with no evidence of significant residual valvar incompetence. The medical management of infective endocarditis requires bacteriological assessment to ensure that the drugs and dosages selected are appropriate and adequate for the causative organism. Early operation may be required for uncontrolled infection or cardiac decompensation; in tricuspid endocarditis secondary to a ventricular septal defect, the operation described permits removal of infective tissue while retaining valvar competence.

Adolescent↗
PubMed1980

Late results of surgical treatment of transposition of the great arteries.

In summary, many of these patients have achieved a normal working capacity, but as a group there is a statistically significant reduction when compared to healthy children (p < 0.01). There was no significant difference between the group of patients who had their Mustard operation in infancy and later. As yet, there is no suggestion that the older patients, or those with the longest time interval between the operation and the exercise test, have a progressive reduction in working capacity. The decreased working capacity and moderate increase in ventilation suggests restricted cardiac output on exercise. This could be related to the abnormal heart rate response rather than indicating poor ventricular function. Equally, a restricted cardiac output on exercise may be due to inefficiency of atrial transport, tricuspid regurgitation or unmasked pulmonary vascular obstructive disease. Further studies may clarify these points. This study demonstrated that the exercise performance of asymptomatic patients 6-13 years after Mustard's operation was somewhat diminished, compared with a group of normal children. Nevertheless, these patients did lead and enjoy a normal life. Only longitudinal studies may bring the final answer to the important question: How many patients will be alive with normal or near normal exercise tolerance 40-50 years after Mustard's operation? Until such an answer is available, we believe that the Mustard operation should be used in the treatment of TGA, while the alternative techniques are carefully explored.

Arrhythmias, Cardiac↗
PubMed1980

[Surgical treatment of transposition of the great arteries in infancy (author's transl)].

Since 85 to 90% of children with d-TGA die in the first year of life, treatment of this malformation is mandatory before age one. Even after Rashkind septostomy, 50% of the patients die before 2,5 years of age. In Great Ormond Street Hospital for Sick Children all the patients with d-TGA have a balloon septostomy performed at birth. Then at 4-5 months of age all patients are evaluated with cardiac catheterisation and angiography. If the patient is doing well, surgery at atrial level (Mustard or Senning operation) is performed between 6 and 12 months of age. But, if despite Rashkind atrioseptostomy, the child remains cyanotic the authors do not perform Blalock Hanlon operation and prefer to do a repair at atrial level. If the child presents with d-TGA and PDA the ductus is ligated during the neonatal period and the repair at atrial level is performed before 6 months of age. In children with VSD associated with d-TGA, the authors prefer to do a Mustard or a Senning operation with closure of the VSD, and so before 6 months of age. In patients with left ventricular outflow tract obstruction, the authors do a Blalock Taussig shunt in the cases with VSD and try a repair at atrial level in the cases with intact septum. The authors discuss the results, not only in term of mortality but also in terms of post-operative complications.

Age Factors↗
PubMed1979

Early and late results of surgical correction of pulmonary artery sling.

Since 1976, we have operated on 4 children with pulmonary vascular sling. They were 5, 12, 19, and 54 months old. All patients were seen initially with severe stridor. Diagnosis was made by barium swallow in all 4. Each child was operated on through a left thoracotomy; the left pulmonary artery was dissected deep between the trachea and esophagus. Systemic heparinization and microsurgical techniques were used. All patients improved after operation. Radioisotope pulmonary ventilation/perfusion scans were performed 9, 9, 14, and 21 months after operation. Decreased ventilation was noted in the right upper lobe of one scan; the other three ventilation scans were normal. Perfusion scans showed good patency of both pulmonary arteries in all 4 patients. It is concluded that pulmonary vascular slings should be treated surgically as soon as diagnosed. Delayed operation can lead to severe tracheomalacia, as demonstrated in our 54-month-old patient.

Child, Preschool↗
PubMed1979

Surgical treatment of ventricular septal defect in infancy. Primary repair versus banding of pulmonary artery and later repair.

Results of primary closure of ventricular septal defects are compared with those of two-stage repair, with banding of the pulmonary artery followed by debanding and closure. Apart from the high incidence of unsatisfactory results after banding and a significant morbidity with the two-stage approach, the mortality for primary repair (2.4%) is considerably lower than that achieved with the staged repair (19.3%). Primary repair of ventricular septal defect is advocated for infants resistant to maximal medical treatment. A more flexible policy is adopted for patients with multiple ventricular septal defects and those with associated anomalies.

Child↗
PubMed1979

Angiocardiographic appearances of atrioventricular defects with particular reference to distinction of ostium primum atrial septal defect from common atrioventricular orifice.

Preoperative distinction between common atrioventricular orifice and ostium primum atrial septal defect may be difficult. To improve diagnostic accuracy, the right and left ventricle angiocardiograms were reviewed 'blind' in 92 patients with atrioventricular defects. The true diagnosis was known from necropsy or surgery in 60. Angiocardiograms had been obtained in various projections with or without craniocaudal tilt. Those features thought to distinguish between common orifice and ostium primum were coded, together with the ventricular systolic pressures. Computerised disciminant function analysis identified the following distinguishing features: (1) right ventricular systolic pressure; (2) immediate right ventricular outflow tract opacification from the left ventricle; (3) identification of the anterior attachment of the mitral component; (4) recognition of a single straddling atrioventricular orifice; (5) passage of contrast medium above or below the anterior or posterior bridging leaflets. Feature (3) indicates that in contrast to classic teaching the direct septal attachment of the mitral component does not contribute to the 'gooseneck' in complete atrioventricular defects. The significance of (4) and (5) is that they may be identified from right as well as left ventriculography, and are more likely to be identified in oblique than standard projections. Computerisation produced a correct diagnosis in 92 per cent of known cases, and determined precise probabilities of diagnosis in the remainder.

Angiocardiography↗
PubMed1979

Parachute deformity of the tricuspid valve.

A parachute deformity of the tricuspid valve occurred in a heart with atrioventricular concordance, double outlet right ventricle, and straddling mitral valve. Although to the best of our knowledge parachute deformity of the tricuspid valve has not previously been reported, in this case its presence was insignificant in relation to the other lesions.

Heart Septal Defects, Ventricular↗
PubMed1979

[Influence on the programmed labour of some perinatological parameter (author's transl)].

In a critical analysis the obstetric results of individual induced labour (socalled "programmed labour") are compared with a series of births with spontaneous start of labour and of indicated induced deliveries. The results shows a much superior outcome of programmed labour: a shorter period of labour, a much reduced number of cesarean sections, a lower frequency of hypoxia, fewer newborn with pronounced Clifford-signs. The technical, personal and organisational efforts in modern obstetric is enormous increased. The induced labour is a possibility, this efforts to put into practice.

Apgar Score↗