Search PubMed⌕ Search

Biomedical subjects

J T Bricker

Publications and source records attributed to J T Bricker.

84 records · Page 5Linked to original sources
PubMed1985

Echocardiographic evaluation of infective endocarditis in children.

To determine the incidence and prognostic importance of the echocardiographic abnormalities associated with infective endocarditis, we reviewed these findings in 45 episodes occurring in 41 children and young adults. Thirty-three patients had congenital cardiac abnormalities, and eight patients had no previously known heart disease. Echocardiographic abnormalities were detected in 16 of the 45 episodes of endocarditis (36%). M-mode echocardiography revealed abnormalities in seven of the 35 episodes (20%) in which it was performed, and two-dimensional echocardiography revealed abnormalities in 16 of the 28 episodes (59%) in which it was used. The presence of echocardiographic abnormalities was unrelated to the causative organism and to the need for early operation.

Adolescent↗
PubMed1984

Atrioventricular valve anular diameter: two-dimensional echocardiographic-autopsy correlation.

To study the accuracy of 2-dimensional echocardiography (2-D echo) in estimating mitral and tricuspid anular diameter, 2-D echo estimates were compared with autopsy measurements of anular diameter in 21 children studied by echo within 30 days of death. The mitral anulus was measured from the left parasternal long axis view and the apical or subcostal 4-chamber image and the tricuspid anulus from the 4-chamber view. Comparable measurements were made from the autopsy specimen with calipers. The correlation coefficient for echocardiographic vs autopsy measurements was 0.79 (standard error of the estimate 2.8 mm) (mitral long axis r = 0.76, mitral 4-chamber r = 0.85, tricuspid 4-chamber r = 0.76). Echo measurements exceeded the corresponding autopsy measurements by an average of 17%; this was at least partially attributed to shrinkage of the specimen during fixation. Thus, 2-D echo may be used to provide a reasonable estimate of mitral and tricuspid anular diameter.

Adolescent↗
PubMed1984

A family history of seizures associated with sudden cardiac deaths.

Hereditary prolongation of the Q-T interval is associated with ventricular dysrhythmias. Children with hereditary prolongation of the Q-T interval may have symptoms that seem related to a neurologic abnormality. Two families had members who had been treated with phenytoin sodium for seizures and had died suddenly when the medication was discontinued. Children in both families were found to have prolongation of the Q-T interval. A history of seizures or of seizures in the family may be an indication of hereditary prolongation of the Q-T interval.

Adolescent↗
PubMed1984

Tetralogy of fallot and congenital connection between the left subclavian artery and the pulmonary artery: possible relationship to a congenital left-hand deformity.

A patient with tetralogy of Fallot was found to have pulmonary sling and an anomalous connection of the left subclavian artery with the pulmonary artery. At birth, she had a left split-hand deformity with preaxial (radial) syndactyly. Anomalous connection of a systemic vessel with the pulmonary artery is an uncommon cardiovascular defect. It is suggested that this cardiac defect may have caused intrauterine limb ischemia and the hand defect.

Journal Article↗
PubMedDate not supplied

Growth of an atrial septal defect: missing the window for transcatheter closure.

We describe a patient diagnosed with a small atrial septal defect (3-4 mm) that had grown to 24 mm in diameter over a six-year period. Timing of transcatheter intervention may be affected by growth of the atrial septal defect and this reports the first case of an atrial septal defect outgrowing the possibility of transcatheter closure.

Cardiac Catheterization↗
PubMedDate not supplied

Can pediatric residents interpret electrocardiograms?

The purpose of this study was to assess the electrocardiogram (ECG) interpretation skills of pediatric residents in a controlled environment and determine if the level of residency training (intern vs senior) improves accuracy. A list of ECG diagnoses was provided to four pediatric residency educators with instructions to categorize each diagnosis as follows: I, all residents; II, the majority of residents, including all senior residents; III, less than the majority of residents; and IV, few residents should be able to interpret correctly. Only those categories that the entire panel believed all residents (category I) or all senior residents (category II) should be able to interpret correctly were included. The test included 17 ECGs: 14 category I and 3 category II. A total of 132 residents participated: 78 interns and 54 seniors. Both groups scored below expected levels. Mean correct score among seniors was 10.9 out of the expected 17 (p < 0.001). Mean correct score for interns was 7.7 out of the expected 14 (p < 0.00l). No difference in ECG interpretation accuracy was found between residency programs. In general, pediatric residents' ECG interpretation skills are less accurate than expected. Although there is a trend toward improvement during training, senior residents fell short of the expectations of the panel. We speculate that focused education in this area will improve resident ECG interpretation and benefit patient care by (1) facilitating referral and treatment of patients with cardiovascular disease and (2) decreasing referrals for erroneous interpretations.

Clinical Competence↗
PubMedDate not supplied

Electrocardiography and 24-hour electrocardiographic ambulatory recording (Holter monitor) studies in children infected with human immunodeficiency virus type 1. The Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV-1 Infection Study Group.

Limited data are available on the electrocardiogram and ambulatory electrocardiogram recording (Holter) in children infected with the human immunodeficiency virus type 1 (HIV-1). The purpose of this study was to estimate the prevalence and cumulative incidence of rhythm and conduction abnormalities in HIV-1-infected children. Electrocardiograms and Holter monitoring studies were performed annually on 205 HIV-1-infected children enrolled after 28 days of life (group I), 93 HIV-1-infected infants enrolled during pregnancy or during the first 28 days of life (group IIa), and 463 HIV-1-uninfected infants enrolled during pregnancy or during the first 28 days of life (group IIb). The 5-year cumulative incidence in the group I children of second-degree atrioventricular block or supraventricular or ventricular tachycardia was 13.4%, and the 5-year incidence was higher for the older infected group I children (16.8% for children > or =4 years old at first study and 11.4% for children <4 years, p = 0.04). The mean corrected QT interval was also longer for the older infected group I children (p = 0.002) and prolonged in the HIV-1-infected compared to the HIV-1-uninfected group II children (p = 0.02). None of the children had atrial fibrillation or flutter. Arrhythmias are uncommon in children infected with HIV-1 and in children of HIV-1-infected mothers and the arrhythmias identified tend to be benign. Therefore, routine Holter monitoring does not appear to be indicated in asymptomatic children.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Cardiac, aortic, and pulmonary arteriopathy in HIV-infected children: the Prospective P2C2 HIV Multicenter Study.

Arteriopathy in human immunodeficiency virus (HIV)-infected patients is being increasingly recognized, especially in children. However, few studies have histologically evaluated the coronary arteries in HIV-infected children, and none have systematically assessed the aorta and pulmonary arteries. The coronary arteries, thoracic aorta, and the main and branch pulmonary arteries from the postmortem hearts of 14 HIV-infected children were systematically reviewed for vasculopathic lesions and compared with 14 age-matched controls. Findings from the HIV-infected children were compared with clinical, laboratory, and other postmortem findings. Coronary arteriopathy, seen in seven (50%) of the HIV-infected children, was primarily calcific, and it was associated with decreased CD3 and CD4 peripheral blood counts. Large vessel arteriopathy, seen in 9 (64%) of the 14 HIV-infected children, was primarily centered on the vasa vasorum and consisted mainly of medial hypertrophy and chronic inflammation. Large vessel lesions were associated with increased left ventricular mass z-scores (P = 0.02), and 78% of patients with large vessel arteriopathy had postmortem cardiomegaly. Coronary and large vessel arteriopathies are common in pediatric HIV-infection and have different clinicopathologic features suggesting different pathogenesis.

Aorta↗
PubMedDate not supplied

Exercise-induced gastroesophageal reflux in an athletic child.

Exercise-induced gastroesophageal reflux (GER) is described in an athletic child with chronic abdominal pain and vomiting in conjunction with strenuous exercise. Although continuous 24-h pH probe monitoring was negative for GER, simultaneous pH probe and exercise stress testing (treadmill) showed a prolonged, continuous episode of acid reflux throughout exercise and the 30-min recovery phase. The authors are unaware of other cases of exercise-induced GER in children and suggest that simultaneous pH probe and exercise stress testing may be a useful technique to evaluate exercise-induced symptoms in children. Moreover, the presence of acid reflux during stress may warrant exercise restriction during the early management of reflux esophagitis.

Abdomen↗
PubMedDate not supplied

Neurologic complications of heart transplantation in children.

Neurologic complications can add significant morbidity to otherwise successful orthotopic heart transplantations in children. Complications have been reported to occur in up to 50% of children undergoing heart transplantation. The purpose of this study was to identify the prevalence and outcome of neurologic complications of heart transplantation in children. We reviewed all children who received orthotopic heart transplantation at Texas Children's Hospital from November 1984 to November 1990. Twenty-two patients (ages, 3 weeks to 17 years; mean, 8.5 years) underwent heart transplantation using cardiopulmonary bypass with moderate hypothermia. For analysis, we compared results during the first 3 years of our experience, 1984 through 1987 (group 1), to 1987 through 1990 (group 2). Survival was 45% (5 of 11 patients) for group 1 and 73% (8 of 11 patients) for group 2. A neurologic complication was defined as a change in the neurologic examination and/or status. Neurologic complications included seizures (6 of 22 patients), strokes (3 of 22 patients), unresponsiveness (3 of 22 patients), and change in mental status (2 of 22 patients). Early (within 2 weeks after operation) neurologic complications occurred in 45% (10 of 22 patients), were persistent (sequelae lasting more than 4 months) in 27% (6 of 22 patients), and resulted in death in 9% (2 of 22 patients). Late (after 2 weeks after operation) neurologic complications occurred in 23% (5 of 22 patients), were persistent in 9% (2 of 22 patients), and have occurred in only two survivors. Neurologic factors were not responsible for the cause of death in group 2. No neurologic complications (early or late) were seen in 1 of 11 patients in group 1 as compared with 7 of 11 patients in group 2 (p < 0.015). Serious neurologic morbidity decreased between the two groups after preoperative cyclosporine was avoided and postoperative hypertension was controlled. All survivors are functioning at age-appropriate levels. Although neurologic complications may be frequent, long-term neurologic disability in survivors is rare.

Adolescent↗
PubMedDate not supplied

Pseudoconduction of atrial flutter of a recipient atrium.

A nine-year-old girl had an episode of atrial flutter and a nonsustained wide QRS tachycardia during her initial hospitalization after orthotopic heart transplantation. Evaluation of her ECG and telemetric tracing revealed atrial flutter of the recipient atrium and sinus rhythm of the donor atrium. The wide QRS tachycardia was an accelerated ventricular rhythm that was also found on subsequent 24-hour ambulatory ECG monitoring. Timely recognition of recipient atrial arrhythmias prevents inappropriate clinical intervention.

Atrial Flutter↗