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Biomedical subjects

J T Bricker

Publications and source records attributed to J T Bricker.

At least 19 recordsLinked to original sources
PubMed1992

Electrocardiographic criteria for diagnosis of acute myocardial infarction in childhood.

Myocardial infarction (MI), a common occurrence in adults, is generally considered to be rare in children. Electrocardiographic criteria for diagnosis of MI in adults are well known and accepted, but no general criteria exist for children. We report 37 autopsy-proved cases of transmural MI and electrocardiographic evidence of MI in 30 of these cases. A variety of conditions previously reported to produce "pseudo-infarction" are included in these cases of MI, including myocarditis, hypertrophic cardiomyopathy, and the cardiomyopathy of Duchenne's muscular dystrophy. Compilation of the electrocardiographic data in all patients allowed for the development of criteria for this diagnosis of MI in childhood, and include wide Q waves (greater than 35 ms) with or without Q-wave notching, ST-segment elevation (greater than 2 mm), and prolonged QT interval corrected for heart rate (QTc greater than 440 ms) with accompanying Q-wave abnormalities. With use of these electrocardiographic criteria, an additional 3 patients were subsequently diagnosed prospectively with MI and confirmed on autopsy. Pathologic evaluation confirmed the location of infarction predicted by the electrocardiograms in all 3 cases.

Adolescent↗
PubMed1991

Blade atrial septostomy: experience with the first 50 procedures.

We have performed 50 blade and balloon atrial septostomies in 46 patients with diagnoses of transposition of the great arteries--32 patients; mitral atresia or stenosis--10 patients; total anomalous pulmonary venous drainage--2 patients; tricuspid atresia--1 patient; and pulmonary valve atresia with hypoplastic right ventricle--1 patient. The patients' age ranged from 1 day to 72 months (median = 8 months) and weights ranged from 2.7 to 14.5 kg. In patients with transposition the systemic saturation increased from an average of 62% to 74.6% (p less than 0.001) and the inter-atrial mean pressure gradient was reduced from 7.74 +/- 5.3 to 1.4 +/- 2.04 mm Hg. Patients with mitral atresia had no significant increase in systemic arterial saturation but a significant decrease in the mean inter-atrial gradient from 19.6 +/- 12.4 to 3.8 +/- 5.3 mm Hg. In three patients the blade septostomy was unsuccessful for technical reasons and the condition of the patient. Complications included one death due to atrial laceration, blood loss requiring transfusion in 5 patients, transient CVA in one patient, and failure of the blade to close in one patient. We have found the palliative use of the blade catheter in conjunction with balloon atrial septostomy to be an effective and safe procedure.

Cardiac Catheterization↗
PubMed1990

Intracardiac fibroma in an asymptomatic infant.

Primary tumors of the heart are rare in infancy and childhood. A one-year-old, asymptomatic, male infant with unimpressive physical findings in whom an echocardiogram demonstrated a large, encapsulated, solid fibroma filling the right ventricle without obstruction of either the inflow or outflow tract is presented. Successful complete surgical excision of the tumor was accomplished. The histological examination was compatible with a benign fibroma. The infant has remained asymptomatic postoperatively with subsidence of the heart murmur. He has not shown any evidence of recurrence of the tumor during a follow-up period of 29 months. This represents an unusual case of a huge right ventricular fibroma and only the fifth youngest patient, to our knowledge, to undergo successful surgical removal.

Echocardiography↗
PubMed1990

Preseason cardiovascular examination: a review.

The responsibility of the physician performing a preseason sports physical examination includes identifying cardiac disease and giving appropriate guidance about participation in competitive sports. This article reviews the leading causes of sudden cardiac death in young athletes, discusses other common cardiac conditions, assesses recommendations for competitive sports, and discusses the preseason examination as a mechanism for detecting a cardiac problem that should exclude an athlete from competition.

Adolescent↗
PubMed1990

Atrial alternans.

Explore the source record for details and available documents.

Echocardiography↗
PubMed1990

Back pain with cardiovascular collapse in a pediatric emergency department patient.

Severe back pain in the pediatric patient is an infrequent complaint. The following case report illustrates the disastrous outcome for this patient with back pain secondary to aortic dissection. The most common predisposing disease process is hypertension, which exposes the aortic wall to high pressures and flows. Just as in the adult patient, the possibility of aortic dissection should be included in the differential diagnosis of acute onset of severe back pain with preexisting hypertension in the pediatric patient. A high index of suspicion is warranted.

Adolescent↗
PubMed1990

Quantitative QRS changes with exercise in children and adolescents.

Exercise-induced changes in QRS voltage have been used to evaluate left ventricular function in adults, children, and adolescents. The purpose of this study was to investigate changes in QRS voltage with exercise in a population of healthy children and adolescents. Eighty-two normal subjects (61 boys and 21 girls) ages 4-18 yr (mean = 12 yr) had maximal exercise testing performed according to Bruce treadmill protocol. Subjects were exercised to exhaustion with continuous monitoring of a VF, V2, and V5. Twelve lead electrocardiograms were recorded at each stage of exercise. Maximum heart rate obtained was 180-212 (mean = 197). Resting and exercise QRS voltages were measured in a VF and V5 averaged over five consecutive QRS complexes. From 12 lead electrocardiographic recordings, frontal and horizontal QRS vectors were calculated. There was no change in the frontal plane QRS vector with exercise (P = 0.4). There was a posterior change in horizontal vector at peak exercise (P less than 0.001) with a mean shift of 14.5 degrees. The R wave voltage diminished in V5 (P less than 0.001, mean decrease of 0.39 mV). However, V5 R wave voltage was increased or unchanged in 23 of the 61 boys and in three of the 21 girls. In males 10 yr of age or younger, 72% had no change or increased R wave voltage compared with 21% for males older than 10 yr (P less than 0.05). These findings are clearly different from the QRS changes with exercise in healthy adults.

Adolescent↗
PubMed1990

Teaching preventive cardiology in the pediatric setting.

This article presents both the rationale behind and a framework for incorporating pediatric preventive cardiology into undergraduate medical education and pediatric residency training. Such education of physicians in the practice of preventive cardiology requires provision of not only didactic information but also training and practice in clinical skills. A combination of didactic lectures, small group discussions, interactive programs utilizing video tapes and computer programs, family and patient simulation, preventive cardiology clinics, and community cardiovascular health promotion activities all help to provide the optimal framework for an effective medical student and pediatric resident training program in pediatric preventive cardiology. Since pediatricians are in the best position to practice true primary prevention of cardiovascular disease beginning in childhood, it is essential that physicians in training understand the concepts and learn the skills needed to practice this critical component of pediatric medicine.

Adolescent↗
PubMed1989

Critical pulmonary valve stenosis in patients less than 1 year of age: treatment with percutaneous gradational balloon pulmonary valvuloplasty.

A new technique of percutaneous gradational balloon pulmonary valvuloplasty was used successfully in 17 infants less than 1 year of age, including four neonates, with critical congenital pulmonary valve stenosis, who would otherwise have required surgical intervention. This technique uses a sequential series of balloon catheters of gradually increasing size as a means of eventually crossing the very small valve orifice with a balloon catheter of adequate size to achieve successful pulmonary valvuloplasty. The initial dilatations were achieved with balloon catheters 2, 3, or 4 mm in diameter. Immediately after successful balloon valvuloplasty, the mean pulmonary systolic pressure gradient was reduced from 105 +/- 11 to 20 +/- 5 mm Hg. Percutaneous balloon pulmonary valvuloplasty can be performed safely with good results despite critical congenital pulmonary valve obstruction in severely ill infants.

Catheterization↗
PubMed1989

The effects of hypoxemia on myocardial blood flow during exercise.

We evaluated the adequacy of regional and transmural blood flow during exercise and rapid pacing after 1 wk of hypoxemia. Seven mature mongrel dogs were made hypoxemic (mean O2 saturation = 72.4%) by anastomosis of left pulmonary artery to left atrial appendage. Catheters were placed in the left atrium, right atrium, pulmonary artery, and aorta. Atrial and ventricular pacing wires were placed. An aortic flow probe was placed to measure cardiac output. Ten nonshunted dogs, similarly instrumented, served as controls. Recovery time was approximately 1 wk. Cardiac output, mean aortic pressure, and oxygen saturation were measured at rest, with ventricular pacing, atrial pacing, and with treadmill exercise. Ventricular and atrial pace and exercise were at a heart rate of 200. Right ventricular free wall, left ventricular free wall, and septal blood flow were measured with radionuclide-labeled microspheres. Cardiac output, left atrial blood pressure, and aortic blood pressure were similar between the two groups of dogs in all testing states. Myocardial blood flow was significantly higher in the right and left ventricular free wall in the hypoxemic animals during resting and exercise testing states. Myocardial oxygen delivery was similar between the two groups of animals. Pacing resulted in an increase in myocardial blood flow in the control animals but not the hypoxemic animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Decrease in canine endocardial and epicardial electrogram voltages with exercise: implications for pacemaker sensing.

Individuals with permanently implanted pacemakers who have normal sensing and pacing at rest may demonstrate abnormalities, particularly of atrial sensing, with exercise. Exercise is known to cause changes in the surface electrocardiographic voltages. The purpose of this study was to evaluate changes in endocardial and epicardial voltages during exercise in canines with permanently implanted pacing leads similar to those permanently implanted in humans with pacemakers. Six adult mongrel dogs were equipped with transvenous atrial and ventricular endocardial bipolar screw-in leads from a jugular venosection, and with atrial and ventricular bipolar stab-on leads from a left thoracotomy. Exercise was performed at one week following implantation and at weekly intervals for a total of 4 weeks. The animals were studied at rest and at a single workload of 3 miles per hour at a 30% elevation. Unfiltered electrograms were recorded with a VR-12 Electronics-for-Medicine photographic recorder. The mean decreases of electrograms with exercise from resting voltage were: 15% for atrial endocardial unipolar leads; 11% for atrial endocardial bipolar leads; 4% for atrial epicardial unipolar leads; 15% for atrial epicardial bipolar leads; 8% for ventricular endocardial unipolar leads; 18% for ventricular endocardial bipolar leads; 0.1% for ventricular epicardial unipolar leads and 5% for ventricular epicardial bipolar leads.

Animals↗
PubMed1987

Emergency gastrotomy: treatment of choice for iron bezoar.

The authors believe that gastrotomy and surgical removal of tablets is the treatment of choice in massive iron ingestion with development of an "iron bezoar" unresponsive to gastric lavage. Prompt surgical treatment in such cases may be lifesaving.

Acute Disease↗
PubMed1987

Severe cardiopathy in branching enzyme deficiency.

A 7 1/2-year-old girl had exercise intolerance and exertional dyspnea. Four months later, congestive heart failure developed, with recurrent chylous pleural effusions, and she died at age 8 1/2 years. Endomyocardial biopsy tissue showed abundant PAS-positive, diastase-resistant cytoplasmic deposits. Similar inclusions were seen in muscle, skin, and liver specimens. Postmortem studies showed that the abnormal polysaccharide was especially abundant in heart and muscle, but was also present in all other tissues, including the central nervous system. Glycogen isolated from heart, muscle, and spinal cord showed a shift of the iodine spectrum toward higher than normal wavelengths. Branching enzyme activity was lacking in the muscle biopsy specimen and in all postmortem tissues; glycogenolytic enzymes had normal activities. These studies show that cardiomyopathy can be the first symptom of generalized branching enzyme deficiency and that the degree of accumulation of the abnormal polysaccharide may vary in different tissues.

Biopsy↗
PubMed1987

Double balloon technique for dilation of valvular or vessel stenosis in congenital and acquired heart disease.

Despite the generally excellent success with balloon dilation for the stenotic lesions of congenital and acquired heart disease, technical difficulties sometimes prevent satisfactory results. Such technical difficulties include: a large diameter of the anulus of the stenotic lesion relative to available balloon diameter, difficulty in the insertion or removal of the larger balloon catheters, and permanent damage to or obstruction of the femoral vessels by the redundant deflated balloon material of the large balloons. A double balloon technique was initiated to resolve these difficulties. With this method, percutaneous balloon angioplasty catheters were inserted in right and left femoral vessels, placed side by side across the stenotic lesion and inflated simultaneously. Dilation procedures using the two balloon technique were performed in 41 patients: 18 with pulmonary valve stenosis, 14 with aortic valve stenosis, 5 with mitral valve stenosis, 3 with vena caval obstruction following the Mustard or Senning procedure and 1 with tricuspid valve stenosis. Patient ages ranged from 1 to 75 years (mean 17.8) and patient weights ranged from 8.9 to 89 kg (mean 42.3). Balloon catheter sizes ranged from 10 to 20 mm in diameter. Average maximal pressure gradient in mm Hg before dilation was 61 in pulmonary stenosis, 68 in aortic stenosis, 21 in mitral stenosis, 12 in tricuspid stenosis and 25 in vena caval stenosis. Average maximal valvular pressure gradient after dilation was 13 in pulmonary stenosis, 24 in aortic stenosis, 4 in mitral stenosis, 0 in tricuspid stenosis, and 1 in vena caval stenosis. No major complications were encountered with the procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Cardiac transplantation in an 8-month-old female infant with subendocardial fibroelastosis.

On Nov 1, 1984, an orthotopic cardiac transplantation was performed in an 8-month-old female infant with subendocardial fibroelastosis. Because of the advanced state of cardiac failure, the operation was done despite a positive tissue crossmatch for antitoxic donor-specific antibodies. Immunosuppression consisted of high doses of cyclosporine (up to 550 mg/m2 or 30 mg/kg) and steroids. Hypertension and tremor of the extremities, which were attributed to cyclosporine, occurred during the first week but resolved after seven days. No signs of nephrotoxic effects have been noted; however, a severe episode of allograft rejection was detected by endomyocardial biopsy on the seventh postoperative day, and a moderate rejection episode was noted on the 22nd postoperative day. Histologic improvement was seen after treatment with conventional steroid pulses. The patient was discharged on Nov 29, 1984. Complications consisted of four episodes of otitis media caused by Staphylococcus aureus and one rejection episode that was treated on an outpatient basis with an intravenous methylprednisolone sodium succinate pulse. Our experience emphasizes both the feasibility and importance of performing endomyocardial biopsies in infant recipients. Through biopsy, episodes of rejection can be discovered when clinical signs are not yet apparent. Eighteen months after transplantation, the child was developing and growing normally.

Cyclosporins↗