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Biomedical subjects

J Stark

Publications and source records attributed to J Stark.

At least 217 records · Page 12Linked to original sources
PubMed1977

Intraoperative mapping of atrial activation before, during, and after the Mustard operation.

Thirty-eight patients with transposition of the great arteries underwent intraoperative mapping of atrial epicardium and endocardium during various stages of the operative procedure. The purpose was to determine the electrophysiological basis of the postoperative supraventricular arrhythmias associated with this operation. Comparisons were made between atrial activation patterns and times before and after each of the following stages: (1) cannulation, (2) atriotomy, (3) excision of atrial septum and coronary sinus, and (4) placement of intra-atrial baffle. The first stage produced no significant changes in atrial activation times or patterns but did demonstrate a shift of the functional pacemaker to the sulcus terminalis in 8 of 14 patients studied. Longitudinal atriotomy did not significantly lengthen atrial activation. Transverse atriotomy did not alter activation times of the His bundle but did significantly change patterns of epicardial and endocardial activation. Excision of the septum and coronary sinus always produced block in the posterior crista terminalis, and placement of a baffle worsened this block. Four patients developed nodal rhythm on the operating table and had both a posterior crista terminalis block and anterior septal block. Suggestions for modification in the surgical techniques were advanced to help prevent rhythm disturbances in paitients undergoing transvenous correction of transposition of the great arteries.

Arrhythmias, Cardiac↗
PubMed1977

Surgical treatment of patients with transposition of the great arteries.

The prognosis of infants born with transposition of the great arteries has greatly improved in the last ten years. Some principles of diagnosis and treatment are generally accepted. However, considerable uncertainty still exists about the optimal age for elective Mustard operation, and about the details of surgical technique that would minimize the incidence of obstructive complications and post-operative dysrhythmias. These problems are discussed in the light of the surgical technique used in our unit since 1973 (143 Mustard operations) and our recent electrophysiological studies performed during the various phases of the Mustard operation.

Age Factors↗
PubMed1976

Mustard operation and creation of ventricular septal defect in two patients with transposition of the great arteries, intact ventricular septum and pulmonary vascular disease.

The condition of patients with transposition of the great arteries, intact ventricular septum and severe pulmonary vascular disease is inoperable with present techniques. In a series of 260 surgically treated patients with transposition of the great arteries and intact ventricular spetum, 5 had severely increased pulmonary vascular resistance, and all 5 died; postmortem examination confirmed the presence of severe pulmonary vascular disease. The concept of the "palliative Mustard" procedure was applied in two children with transposition of the great arteries, intact ventricular spetum and pulmonary vascular disease who underwent the Mustard operation with creation of a ventricular septal defect. The postoperative course was uneventful in both patients. Thirteen and 5 months, respectively, after operation, both are physically active and have respective arterial oxygen saturation levels of 94 and 92 percent.

Aneurysm↗
PubMed1976

Mustard's operation for transposition of the great arteries complicated by juxtaposition of the atrial appendages.

Six patients were seen with complete left-sided juxtaposition of the atrial appendages (LJAA) in a series of 366 consecutive Mustard operations for transposition of the great arteries. All 6 patients had situs solitus of the viscera and atria with concordant atrioventricular relationship. D-transposition was present in 3 patients and L-transposition in the other 3; all 6 had associated cardiac anomalies. The diagnosis of LJAA was first made at operation, although angiocardiographic recognition is possible. The size of the right atrium is small in the presence of this anomaly, and direct cannulation of the venae cavae and enlargement of the pulmonary venous atrium are therefore recommended.

Angiocardiography↗
PubMed1976

Left ventricle to pulmonary artery conduit in treatment of transposition of great arteries, restrictive ventricular septal defect, and acquired pulmonary atresia.

Progressive cyanosis after banding of the pulmonary artery in infancy occurred in a child with transposition of the great arteries and a ventricular septal defect, and a Blalock-Taussig shunt operation had to be performed. At the time of correction a segment of pulmonary artery between the left ventricle and the band was found to be completely occluded so that continuity between the left ventricle and the pulmonary artery could not be restored. A Rastelli type of operation was not feasible as the ventricular septal defect was sited low in the muscular septum. Therefore, in addition to Mustard's operation, a Dacron conduit was inserted from the left ventricle to the main pulmonary artery to relieve the obstruction. Postoperative cardiac catheterization with angiocardiography indicated a satisfactory haemodynamic result. The patient remains well 11 months after the operation. This operation, a left ventricle to pulmonary artery conduit, may be used as an alternative procedure in patients with transposition of the great arteries, intact interventricular septum, and obstruction to the left ventricular outflow, if the obstruction cannot be adequately relieved.

Arterial Occlusive Diseases↗
PubMed1976

Hemolysis following correction of double-outlet right ventricle.

A 41/2-year-old child developed a severe degree of intravascular hemolysis within 24 hours after intraventricular correction of double-outlet right ventricle with a Dacron patch. The child developed jaundice, with a serum bilirubin of 4.3 mg. per cent. The hematocrit value fell from 47 to 25 per cent and the reticulocyte count rose to 22 per cent. The hemolysis diminished after 3 weeks and completely disappeared after 6 weeks. We presume that the hemolysis was due to turbulence caused by a long, curved patch and that its disappearance coincided with the endothelialization of the patch. The child is well 3 years after the operation.

Anemia, Hemolytic↗
PubMed1976

Pulmonary artery banding for truncus arteriosus in the first year of life.

Results of pulmonary artery banding (PAB) for truncus arteriosus (TA) in infancy are reviewed in 15 children between 1957 and 1974. There were ten hospital and one late deaths (73%). A policy of early correction of severely symptomatic infants with TA was adopted in 1974. Since October, 1974, four infants with TA and one with hemitruncus had a complete correction. Three of these are surviving 22, 17, and 9 months after the operation. Their weight at operation was 4.7, 6.0, and 3.5 kg.

Autopsy↗
PubMed1975

[Successful surgical correction of total anomalous pulmonary venous drainage into the portal vein in a ten days old infant (author's transl)].

An infant, nine days old, with total anomalous pulmonary venous drainage into the portal vein was examined. The exact anatomy was clarified by means of cardiac catheterization and angiocardiography. One day later the operation was performed utilizing circulatory arrest in deep hypothermia. The procedure was successful, and the child, two years old now, is doing well. The problems of examination, treatment and surgery are discussed. There are only a few cases with successful correction in the literature.

Angiocardiography↗
PubMed1975

Congenital lobar emphysema.

43 patients with congenital lobar emphysema were treated surgically at the Thoracic Unit, Hospital for Sick Children, Great Ormond Street, London, between 1954 and 1974. Nearly half of the infants had additional congenital anomalies. 7 children died after operation.

Ductus Arteriosus, Patent↗