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J T Bricker

Publications and source records attributed to J T Bricker.

At least 55 records · Page 3Linked to original sources
PubMed1994

Guidelines for exercise testing in the pediatric age group. From the Committee on Atherosclerosis and Hypertension in Children, Council on Cardiovascular Disease in the Young, the American Heart Association.

Exercise testing of children differs from adult exercise testing in many ways beyond the technical issues related to test performance that are addressed in this report. Disease processes that produce myocardial ischemia are relatively rare in children compared with adults. Exercise testing may be useful in these cases, but the use of testing to assess functional capacity or cardiac rhythms will be encountered more often. Although the precise role of exercise testing in patient evaluation or long-term management of the cardiac patient will vary somewhat from center to center, exercise testing is often essential to diagnose and to direct treatment in a wide variety of clinical problems. An understanding of the role of exercise testing for children with known or suspected heart abnormalities is an essential part of the training of pediatric cardiologists. The staff of the pediatric exercise laboratory should be available to discuss with the clinician when a test might be of value in a specific case in addition to providing advice about the specifics of the performance of the test and offering age- and size-appropriate normal data from the laboratory with test interpretation.

Arteriosclerosis↗
PubMed1993

Transcatheter closure of residual atrial septal defect following cardiac transplantation.

An almost 3-year-old boy had a residual atrial septal defect after cardiac transplantation. The patient was symptomatic and had arrhythmia and cardiac enlargement. An atrial septal defect occlusion device was employed to close the communication with excellent results. Transcatheter occlusion enabled the patient to avoid further surgery and did not interfere with follow-up endomyocardial biopsies.

Child, Preschool↗
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↗
PubMed1992

Pulmonary artery banding and subaortic stenosis in patients with single ventricle: surgical alternatives and clinical outcome.

Subaortic obstruction is a potential problem in patients with single ventricle and a subaortic outflow chamber. Previous reports have indicated an association between pulmonary artery banding and the development of subaortic obstruction. The purpose of this study was to determine the incidence of subaortic obstruction in our patients with this cardiac anomaly who have undergone pulmonary artery banding, and to determine the eventual outcome in those who did develop obstruction. By reviewing cardiac catheterizations performed between 1977 and 1985, we found 36 patients with single ventricle and a subaortic outflow chamber. Ten patients had been lost to follow-up or had died within 3 months of banding. Twelve of the remaining 26 patients developed a pressure gradient between the left ventricle and ascending aorta, although 7 of these 12 had minimal gradients. Eight of the 12 have undergone further surgery, with the best results in patients who underwent a combined modified Fontan and Damus-Kaye-Stansel procedure. We believe that although subaortic obstruction may develop in patients with single ventricle after pulmonary artery banding, the degree of obstruction is often minimal, and in more severe cases the obstruction can be alleviated with a Damus-Kaye-Stansel procedure. (Texas Heart Institute Journal 1992; 19:15-20)

Journal Article↗
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↗