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J Swiderski

Publications and source records attributed to J Swiderski.

8 recordsLinked to original sources
PubMed1979

[Early detection and observation of the evolution of congenital malformations of the aorta in newborn infants, infants and young children].

UNLABELLED: 57 infants and small children (42 boys and 15 girls) with congenital aortic malformations were investigated. Clinical, ecg and X-ray follow-up was carried out. Following 4 groups of patients were separated: 1) neonates and infants with supraductal (preductal) aortic hypoplasia or atresia, with hypoplastic left ventricle of the heart (5 boys and 2 girls), 2) infants with supraductal coarctation of the aorta, without underdevelopment of the left heart cavities (2 boys and 2 girls), 3) infants and children with postductal coarctation of the aorta (17 boys and 3 girls) and 4) infants and children with valvular or/and subvalvular, or supravalvular aortic stenosis (18 boys and 8 girls). CONCLUSIONS: Congenital malformations of the aorta and of the left side of the heart should be suspected in all neonates and infants displaying early symptoms of cardiorespiratory failure, resembling frequently the symptoms of severe "pneumonia". Proper measurement and thorough analysis of arterial pulses and pressures in upper and lower extremities is of great importance in detection and differential diagnosis of congenital aortic malformations in infants, even when features of other cardiovascular lesions (e.g. ventricular septal defect, endocardial cushion defect, transposition of the great arteries) dominated in the clinical picture of complex malformations. Small amplitudes of peripheral arterial pulses, with considerably--prolonged upstroke time, small amplitude of arterial pressure measured in upper and lower extremities, co-existing with electrocardiographic patterns of the right ventricular hypertrophy--suggested an aortic malformation complicated by hypoplasia of the left ventricle. Distinctly lower systolic and mean arterial pressure in legs, than in arms was typical for coarctation of the aorta. Significant differences in diastolic pressure values in arms and legs with coexisting ecg patterns of dominating right ventricular hypertrophy should rise a suspicion of abnormal, separate communication of the ascending aorta, and the descending aorta, separately from the left and from the right ventricles of the heart. The electrocardiogram seems to be of great help in differentiation between aortic lesions with or without hypoplastic left ventricle, those with or without systemic right and left ventricle, and those with systemic left ventricle only. Early detection, diagnosis, prompt and proper medical and surgical treatment may be lifesaving for the majority of infants with congenital malformations of the aorta not complicated by left ventricular hypoplasia.

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PubMed1975

[Congenital heart diseases in newborns and infants; early detection, differentiation and accuracy of clinical diagnoses (author's transl)].

In order to facilitate for the general physicians the making of a suitable selection of babies who are in the most urgent need of specialized treatment at cardiac centres, simple methods for diagnosing and qualifying congenital cardiovascular diseases were elaborated. The following "minor" criteria were taken for suspecting a CHD: 1) cardiorespiratory distress following birth, 2) sequentially repeated Apgar score below normal, 3) "pneumonia" symptoms with respiratory distress, dyspnoea and cyanosis, attacks of unconsciousness, 4) feeding difficulties, failure to thrive, inexplicable irritability, 5) presence of other congenital anomalies. The almost certain presence of serious heart disease should be recognized in children, showing the following "major" symptoms: 1) permanent cyanosis, pallor or greyish colour, 2) cardiorespiratory failure (resembling usually symptoms of pneumonia), 3) ECG patterns indicating ventricular hypertrophy signs, 4) other significantly abnormal ECG patterns (e.g. AV and intraventricular conduction disturbances), 5) cardiac enlargement and lung vascularity abnormalities in chest X-rays, 6) weak, or impalpable arterial, particularly femoral pulses, femoral arterial pressures significantly lower, than at upper extremities, bounding pulses and high-pressure amplitude in arms and legs, 7) abnormal heart sounds and pathologic heart and vascular murmurs. A diagnostic "key", based upon evaluation of the "major criteria" facilitates the diagnosis and differentiation of the most important CHD's at neonatal and infantile age. When using this "key" one should keep in mind the relative frequency of incidence of particular lesions. The initial diagnoses by the above "key" were verified in 354 patients by cardiovascular catherisation, angiocardiography, surgical exploration, and for by autopsy. The diagnoses were perfectly accurate in 83.6% cases, in further 11.3% cases being also accurate but were supplemented by some details, and had to be corrected in only 5.1% cases.

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PubMed1975

[Monitoring of cardiac rhythm changes during surgical operations with total cardiopulmonary bypass with haemodilution and hypothermia in infants and small children (author's transl)].

Surgical corrections of some serious cardiovascular anomalies in infants and small children were attempted within the last 2 years; 12 severely ill infants and children below the age of 3 years were operated. All, but one, were below 10 kg of body weight, and in all of them there was a considerable weight deficit, more than 30%. The risk of operation was undertaken because of the ineffectiveness of medical treatment and very bad prognosis. The following cardiovascular lesions were operated: large aortopulmonary septal defects, localized just above the valvular rings in 2 patients with severe pulmonary hypertension, with very good effect in both; tetralogy of Fallot - in 2 babies, in one with good effect; congenital mitral obstruction with pulmonary hypertension in one case, with good effect; total anomalous pulmonary venous return of supracardiac type in one child, decreased 1 week following operation; type 1 complete transposition of great arteries in one baby, deceased one day following operation; large ventricular septal defects, with systemic or nearly systemic pulmonary hypertension in 5 children, in one with long-term good effect. A modification of the Barrat-Boyes, Neutze and Simpson method, based upon a combination of surface and core cooling was applied. Thoracotomy was performed after surface cooling to 34-32 centigrades, and then a single venous cannula was inserted into the right atrium and an arterial cannula -- into the aorta. Deep cooling was obtained during perfusion, using a heat exchanger. The duration of cooling perfusion was, on an average, 20 min., and the patients were cooled to a temperature of 23-21 centigrades. The corrections were performed on relaxed and bloodless heart, during the circulatory arrest lasting for 20-65 min. (40 min. on an average). Following repair the patients were rewarmed to temperatures of 36-37 centigrades by warming perfusion lasting on the average 40 min., including assisted circulation, until a haemodynamically sufficient cardiac output was present. Silicated ACD-blood, diluted to a hematocrit value of 28-30 Vol. % by a polyelectrolyte buffered solution was used for priming and perfusion. During all the procedures any pH and HCO3 deviations were balanced currently. At the time of cooling perfusion, when the patient's rectal temperature fell down to 30-25 centigrades, the heart started to fibrillate. At temperatures above 26 degrees C ventricular fibrillation was sometimes preceded by sinus bradycardia, or sinoatrial block/arrest, with an AV nodal rhythm and gradually increasing intraventricular conduction slowing. In some cases high degree AV block appeared. At temperatures of 25-23 centigrades - slow fibrillation appeared, followed usually by a complete cardiac arrest.

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PubMed1975

[Congenital heart malformations in neonates, infants and young children (author's transl)].

Congenital heart malformations in neonates, infants and young children represent the main problem of paediatric cardiology in Poland. Congenital cardiovascular diseases (incidence also approximately 8 per 1000 in liveborn infants) cause very high mortality, particularly in the neonatal and infantile period. Approximately 5000 live-born children are affected every year by serious heart malformations. For at least two thirds of these previously hopelessly ill infants there are real possibilities of effective medical and surgical treatment. Not only a considerable drop in mortality in the earliest infancy would be achieved, but: a further normal physical and psychical growth and development of these children would be possible. At present, however, the available possibilities are by far not sufficient, as in all hitherto functioning centres we were able to manage 200-300 children yearly, whereas the real needs are at leasttenfold greater. Therefore it is necessary to: Increase the number and capacity of hospital wards capable enough to provide the intensive cardiopulmonary care; to execute appropriate reorganization aimed to concentrating the appropriate specialists (pediatric cardiologists, radiologists, surgeons, anesthesiologists, nurses) and equipment (cardiological and cardiosurgical appliances, X-ray equipment, intensive care units etc.) in centres designated for the above tasks. At least 7 paediatric intensive care and cardiosurgical centres should be instituted in Poland for a satisfactory management of congenital heart diseases.

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