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Biomedical subjects

J Stark

Publications and source records attributed to J Stark.

At least 199 records · Page 11Linked to original sources
PubMed1979

Surgical technique to reduce the risks of heart block following closure of ventricular septal defect in atrioventricular discordance.

Traumatic heart block remains a major concern after ventricular septal defect (VSD) closure in patients with atrioventricular discordance. A technique of closing the VSD, placing the suture line on the morphologically right side of the septum without opening the systemic ventricle, is described. This was used in 13 consecutive patients. The VSD was closed through the right atrium in eight patients, the left ventricle in three patients, the right atrium and the left ventricle in one patient, and through the right ventricle in one patient with atrioventricular disordance and ventriculo-arterial concordance. All patients were in sinus rhythm preoperatively, two exhibited atrioventricular dissociation before intracardiac manipulation began, and 11 patients were in sinus rhythm postoperatively. No major arrhythmia could be attributed to the closure of the VSD.

Adolescent↗
PubMed1979

Factors contributing to the mortality associated with open-heart surgery in infants.

About 40% of children born with congenital heart disease die within the first year of life unless treated surgically. The results of surgery have improved with increasing experience. Currently, the mortality rate of open-heart procedures performed during the first year of life have decreased to about 25%. The present study analyses the causes of death in 53 infants who underwent open heart surgery at the Hospital for Sick Children, Great Ormond Street, London between 1973--1977. Fifty-three deaths represented 25% of the total 212 operated infants. Causes of death and possible contributing factors are discussed under the following headings: Inoperable lesions (18), poor preoperative condition (8), mistake in pre-, intra- and postoperative management (15), infection (2) and unclear (10). It is suggested that earlier diagnosis and operation may improve the results. The purpose of this study was to identify problems in the management of critically ill infants with congenital heart disease and thus improve their prognosis in future.

Age Factors↗
PubMed1979

Analysis of factors which might improve the survival rate of infants with congenital heart disease.

During 1973--1977, 212 infants underwent open heart operations for congenital heart disease at the Thoracic Unit, The Hospital for Sick Children, Great Ormond Street. The current results (75% survival rate) are compared with the results from earlier years (1963--1967) which showed only a 35% survival rate. Two groups are discussed in detail: Infants with Total Anomalous Pulmonary Venous Drainage, and Persistent Truncus Arteriosus. Although the operative risk in both groups remains high, the analysis of the natural history, palliative and corrective surgery and causes of death suggests that early total repair of severely symptomatic infants achieves the optimal results. The importance of careful analysis is emphasised. Palliative surgery still plays an important role in the treatment of congenital heart defects in infancy. The optimal timing and time of operation can only be selected after careful analysis of various factors.

Heart Defects, Congenital↗
PubMed1978

Reoperation for complictions after inflow correction of transposition of the great arteries: technical considerations.

A right anterolateral thoracotomy through the fifth or sixth intercostal space is described as an easier approach for reoperations after the Mustard procedure for transportation of the great arteries. Advantages of this approach compared with repeated sternotomy include easier cannulation of the superior and inferior vena cava; less extensive dissection of adhesions, resulting in decreased postoperative bleeding; reduced risk of injury to the coronary asteries and the right phrenic nerve; and improved exposure of intracardiac pathways and the tricuspid valve.

Humans↗
PubMed1978

Tracheal compression by the aortic arch following right pneumonectomy in infancy.

Uneventful pneumonectomy was carrried out in a 10-month-old infant for hypoplastic right lung associated with esophageal origin of the right main bronchus. Eight months after operation, symptoms of tracheal compression began. This compression was due to the aortic arch, which was stretched across the lower trachea following the displacement of the heart to the posterior right chest after pneumonectomy. Successful relief of the airway obstruction was achieved by inserting a 20 mm woven Dacron graft between the ascending and the descending aorta, with division of the aortic arch between the left carotid and the left subclavian arteries. An aortogram performed two years after operation confirmed good patency of the graft and normal flow through the descending aorta. The child remains well two years after operation but continues to have mild residual tracheomalacia and limited exercise tolerance, compatible with the presence of only one lung.

Airway Obstruction↗
PubMed1978

Treatment of patients with transposition of great arteries and pulmonary vascular obstructive disease.

Twenty-two patients with transposition of the great arteries with or without ventricular septal defect and one with double outlet right ventricle, d-malposition, and severe pulmonary vascular obstructive disease were treated surgically. All were cyanosed and had very limited exercise tolerance. Preoperatively, systemic arterial oxygen saturation (SaO2) varied from 45 to 79% (mean 65), haemoglobin was 13 to 23 g/dl (mean 19). Pulmonary arteriolar resistance was 6.4 to 35 units m2 (mean 17). In the patients with a ventricular septal defect the Mustard operation was done without closure of the ventricular septal defect, and in the 3 patients with intact ventricular septum the Mustard operation was combined with creation of a ventricular septal defect. All patients survived the operation and improved. Postoperative SaO2 ranged from 75 to 96% (mean 89) and haemoglobin from 10.6 to 17.8 g/dl (mean 14.0). This improvement was significant (P less than 0.05). Five patients have had a postoperative cardiac catheterisation. The pulmonary arteriolar resistance remains high in all. Postoperative follow-up varies from 4 to 40 months (mean 14 months). So far there have been no late deaths and all patients remain improved.

Adolescent↗
PubMed1978

Correction of tye C atrioventricular canal associated with tetralogy of Fallot.

Type C complete atrioventricular canal associated with tetralogy of Fallot in a 5-year old child was successfully corrected. Repair of the atrioventricular canal was combined with infundibular resection and the insertion of an outflow tract patch across the pulmonary valve ring. The postoperative course was uneventful, and the child is well one year after operation.

Child, Preschool↗
PubMed1977

The villous stroma of the human placenta. I. The ultrastructure of fixed connective tissue cells.

In human placental villi the connective tissue is constructed by mesenchymal cells, small and large reticulum cells and fibroblasts. During early pregnancy mesenchymal cells dominate; starting with the third month of gestation the reticulum cells are in the majority within the terminal villi, the fibroblasts within the stem villi. Ultrastructurally intermediary types of cells can be differentiated. Together with reticular and collagenous fibres the reticulum cells form the basic architecture of the villous stroma during the first 2/3 of gestation: the "reticular type of stroma". This consists of a network of cells and fibres with fetal vessels fitted in between. The remaining interspaces form a fluid system of compartments in which Hofbauer cells are suspended. They are called stromal channels. During the last trimester these channels and the Hofbauer cells as well are progressively replaced either by voluminous masses of fibres ("fibrous type of stroma", mainly in the stem villi) or by sinusoidal enlargements of fetal capillaries ("sinusoidal type of stroma", mainly in the terminal villi).

Cell Differentiation↗
PubMed1977

Transposition of the great arteries, primum atrial septal defect, azygos continuation of the inferior vena cava, bilateral superior venae cavae and dextrocardia with centrally placed liver.

Successful surgical correction of transposition of the great arteries in a nine-year-old girl with dextrocardia, primum atrial septal defect, bilateral venae cavae, and azygos continuation of inferior vena cava is reported. The patient was cooled on cardiopulmonary bypass and the operation performed under circulatory arrest at 19 degrees C. nasopharyngeal temperature. The problems of diagnosis and management are discussed.

Abnormalities, Multiple↗
PubMed1977

Double outlet left ventricle associated with situs inversus and atrioventricular concordance.

A case is described in which the ventriculo-arterial connection of double-outlet left ventricle was associated with situs inversus and atrioventricular concordance. The case additionally exhibited l-malposition of the aorta, a subaortic ventricular septal defect, and valvar and subvalvar pulmonary stenosis. Originally diagnosed as transposition of the great arteries, a Rastelli type correction was attempted. This was not successful, owing to hypoplasia of the morphological tricuspid valve orifice.

Autopsy↗
PubMed1977

Left ventriculotomy for closure of muscular ventricular septal defects. Treatment of choice.

Closure of muscular ventricular septal defects (VSDs) through the right atriotomy or right ventriculotomy may be difficult. These VSDs are often located behind the hypertrophied trabeculae carnae or papillary muscle. Residual or recurrent VSD may result from the difficult approach. Between March 1971 and December 1975, we have used the left ventriculotomy near the apex for closure of muscular VSDs in ten children. The patients' ages ranged from five months to eight years and three months. The diagnosis was established by cardiac catheterisation and left ventricular angiocardiogram in all patients. Six patients had multiple VSDs; in four patients VSD in the muscular septum was present (three apical, one midseptal). Operations were performed on cardiopulmonary bypass with moderate hypothermia and intermittent anoxic arrest. VSDs in the membranous septum were closed through the right atrium. Muscular VSDs were approached through a small vertical incision in the left ventricle near the apex. The postoperative course was uneventful in eight patients. Two patients, aged 16 months and eight years, died; histology showed grade IV pulmonary vascular disease in both. All survivors are well four months to five years after the operation, without clinical evidence of residual or recurrent VSD.

Angiocardiography↗
PubMed1977

Total anomalous pulmonary venous drainage in infancy.

Between May 1971 and December 1975, 39 infants had operations for correction of total anomalous pulmonary venous drainage. Fourteen of the 39 patients were under 1 month of age at the time of operation. Twenty-four patients had supracardiac, 7 intracardiac, and 6 infracardiac total anomalous pulmonary venous drainage, and 2 had a mixed type. The overall hospital mortality was 36 per cent. There have been no late deaths. The improvement in survival rate in this series is attributed to: (1) earlier recognition and prompt referral, (2) an aggressive approach to diagnosis involving complete cardiac catheterisation and angiocardiography, (3) vigorous preoperative care, (4) early complete correction including construction of a large anastomosis and enlargement of the left atrium when indicated, and (5) intensive postoperative management paying particular attention to fluid balance and treatment of pulmonary complications. Operative mortality was highest in patients with total anomalous pulmonary venous drainage directly to the superior vena cava, and in those with infradiaphragmatic drainage of whom all had pulmonary venous obstruction. Mortality was not closely related to age, body weight, or severity of pulmonary hypertension.

Age Factors↗