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Biomedical subjects

K Turley

Publications and source records attributed to K Turley.

At least 73 records · Page 4Linked to original sources
PubMed1982

Surgical management of complete atrioventricular canal.

Successful correction of complete atrioventricular (AV) canal depends on accurate assessment of surgical anatomy and preservation of valve tissue to avoid postoperative valvular insufficiency. From 1975 to 1980 there were 68 patients aged 2 months to 17 years (median age 12 months) who underwent correction for the complete form of AV canal. Forty-six percent had associated anomalies which included patent ductus arteriosus, right aortic arch, pulmonic stenosis, and ostium secundum defect. Two types of repairs were employed: group I-Teflon patch closure of the ventricular septal defect (VSD) by division of the common leaflets into mitral and tricuspid components: Group II-Teflon patch closure of the VSD without division of common leaflets by fashioning the patch between the chordae tendineae and under the common leaflets. The atrial septal defect component was closed separately with pericardium or Teflon. Overall mortality is related to presence of (1) elevated pulmonary vascular resistance (Wood units greater than 4), (2) prior palliative operations, or (3) associated cardiovascular anomalies. Repair of complete AV canal without splitting the common leaflets preserves valve tissue. The act of splitting the common leaflets and reattaching the mitral and tricuspid components to the VSD patch by necessity sacrifices valve tissue. Although this may not be significant in older children, it becomes important in infants, for the sacrificed valve tissue comprises a greater proportion of the whole. Moreover, patch disruption of the reattached mitral and tricuspid components can be avoided if the common leaflets are not split.

Adolescent↗
PubMed1982

Repair of congenital cardiac lesions during the first week of life.

Repair of congenital cardiac defects in the neonatal period has been associated with a high operative mortality thought to be due to the adverse effects of cardiopulmonary bypass. This has prompted the use of closed palliation in such patients. Between 1957 and 1981, 195 of 988 patients (20%) operated in the first year of life were critically ill neonates ages 1-7 days. Fifty-six underwent repair using cardiopulmonary bypass. These included l29 operations at the arterial level, five for aortic stenosis, 19 for pulmonary stenosis and five for transposition of the great arteries using the switch procedure; 25 at the atrial level, eight for transposition of the great arteries, 16 for total anomalous pulmonary venous connection, and one for combined total anomalous pulmonary venous connection and anomalous systemic venous connection; and two at the ventricular level, one for tetralogy of Fallot and one for double-outlet right ventricle. The hospital survival rate in this group was 91%. Palliations using cardiopulmonary bypass were performed in an additional 27 patients, including right ventricular outflow tract patches in 20. The survival rate in this group was 73%. The survival rate was 100% for closed repairs and 76% for palliations. These results demonstrate that cardiopulmonary bypass per se is not a determinant of survival in the neonate; an effective repair combined with proper diagnostic techniques and postoperative management are probably the critical factors.

Cardiopulmonary Bypass↗
PubMed1981

Repair of combined total anomalous pulmonary venous connection and anomalous systemic connection in early infancy.

A simple intraatrial reconstruction can be utilized in infants to simultaneously correct both the systemic and pulmonary venous returns. Two infants with polysplenia syndrome treated in the first months of life are presented. One had levocardia and combined total anomalous pulmonary venous connection (type II-Cardiac) and anomalous systemic venous connection. The other had dextrocardia L-loop, L-normal great arteries, and combined total anomalous pulmonary venous connection (type II-Cardiac) and anomalous systemic venous connection. The posterior position of the systemic atrioventricular valve and systemic ventricle in both patients allowed the use of this reconstructive technique. The extensive size and transverse position of this patch when used in the infant may require both continued postoperative controlled ventilation until it stiffens and prolonged attention to postoperative cardiac care until adaptation of the infant heart to the new atria can occur. Early restudy and reoperation should be performed if signs of stenosis develop.

Dextrocardia↗
PubMed1981

Computed tomography for follow-up of chronic aortic dissections.

Patients who have chronic dissections of the aorta are prone to re-dissection, extension of dissection, aortic aneurysm, and aortic rupture. Computed tomography (CT) with contrast enhancement provides a convenient, noninvasive method for follow-up of these patients. We used CT in a group of twelve patients who were treated for aortic dissection. CT demonstrated re-dissection, aneurysmal dilation of the aorta, and delayed filling of the false lumen. CT also showed persistent patency of the false lumen in almost all of the postoperative cases.

Aortic Dissection↗
PubMed1981

The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations.

Acute right ventricular (RV) hypertension and failure occur clinically. In this study we examined the mechanism of RV failure. Adult dogs were studied acutely under anesthesia; dogs were instrumented for measurement of pressures and right coronary artery blood flow. Myocardial blood flow and cardiac output were determined with radionuclide-labeled microspheres, and the presence of ischemia was determined by biochemical analysis of ventricular biopsies. RV hypertension was produced by constricting the pulmonary artery and was increased until RV failure occurred, as evidenced by decreased aortic pressure and cardiac output and increased RV end-diastolic pressure. With increasing RV systolic pressure, RV myocardial blood flow failed to increase in proportion to demand. At the onset of RV failure, there was no reactive hyperemia of right coronary flow compared with control, indicating the absence of further coronary vascular reserve; biochemical analysis demonstrated that the RV free wall was ischemic; the LV free wall was not. Infusion of phenylephrine raised aortic pressure and hence, myocardial perfusion pressure; RV failure reversed as shown by decreased RV end-diastolic pressure and increased cardiac output and RV systolic pressure; reactive hyperemia of right coronary flow was restored and the biochemical indexes of ischemia were reversed, demonstrating that ischemia is the cause of failure in acute RV hypertension.

Acute Disease↗
PubMed1981

Superior vena caval obstruction after Mustard's operation: detection by two-dimensional contrast echocardiography.

To assess superior vena caval (SVC) obstruction after the Mustard operation for transposition of the great arteries, we performed two-dimensional contrast echocardiography (2-D contrast echo) in 18 patients, ages 1-9 years. Sterile saline was injected into a peripheral scalp or arm vein while the junction of the inferior vena cava (IVC) and the systemic venous atrium (SVA) was imaged from the subcostal long-axis plane. The results of 2-D contrast echo were compared with those obtained at cardiac catheterization. In nine patients, contrast passed from the SVC to the SVA and the IVC remained free of contrast echoes. At catheterization, these patients had no SVC obstruction by angiography and minor SVC-SVA mean pressure differences (0-4 mm Hg). In five patients, contrast passed from the SVC into the SVA. Within a few cardiac cycles, contrast from azygos-IVC collateral vessels flowed in the IVC toward the SVA. At catheterization, these patients had partial SVC obstruction by angiography and SVC-SVA mean pressure differences of 9-13 mm Hg. In four patients, the SVA was filled only by contrast arriving from the IVC by way of azygos-IVC collateral vessels. At catheterization, these patients had complete SVC obstruction and SVC-SVA mean pressure differences of 14-20 mm Hg. Two-dimensional contrast echocardiography is a simple, accurate, noninvasive method for detecting SVC obstruction after Mustard's operation and allows differentiation of complete from partial SVC obstruction.

Cardiac Catheterization↗
PubMed1981

Persistent stenosis and deformity of the right pulmonary artery after correction of the Waterston anastomosis.

Between July, 1975, and July, 1979, 16 patients with cyanotic heart disease and previously constructed ascending aorta-right pulmonary artery (AA-RPA) shunts underwent subsequent operations. Fourteen of the 16 had significant physiological and anatomic problems associated with the shunts. Eight had kinking and preferential flow to the right pulmonary artery (RPA), four had preferential flow without kinking, and two had small pulmonary arteries bilaterally. Various techniques were used to close the RPA after Waterston takedown: direct suture in four, pericardial patch in five, prosthetic patch in four, and conduit in three. Five patients required reoperation 3 months to 3 years after Waterston dismantling because of persistent deformity of the RPA. Four patients had pericardial patch reconstruction of the RPA and one had direct closure of the opening in the RPA when the Waterston shunt was dismantled. All five patients received prosthetic patch enlargment of the RPA either alone or with a conduit. The four surviving patients are doing well 7 to 15 months following repair. Three have been studied angiographically and have been found to have no pulmonary artery deformity.

Angiography↗
PubMed1981

Repair of dissection of the thoracic aorta. Evaluation of false lumen utilizing computed tomography.

During the period 1975 to 1980, 21 patients with thoracic aortic dissections underwent surgical treatment. The operative technique was resection and tube graft replacement of the segment of the aorta containing the entry point into the false channel. Eleven Type A and 10 Type B dissections were resected. The hospital survival rate was 95%. The single operative death occurred in a patient with an acute Type A dissection. Three patients had total resection of the dissected segment; three had clotted false lumina; five had distal anastomosis to true and false lamina; and 10 had distal anastomosis to the true lumen only, with proximal entry into the false lumen obliterated by incorporating both intimal and adventitial walls in a single suture line. The late survival rate was 95% (mean 32 months, range 8 to 63 months). No late ruptures occurred. Computed tomography (CT) with contrast enhancement was used to evaluate the aorta and any residual false lumen at follow-up. Seven of eight patients in whom obliteration was attempted and CT scans performed demonstrated persistence of false lumen perfusion; in six of the eight, preoperative angiograms were adequate for evaluation of false lumen runoff. Major vessels arose from the false lumen in all cases, except in the one patient in whom obliteration was later successful. This report demonstrates that there is persistence of false lumen perfusion in patients in whom obliteration is attempted, and the mechanism of this persistence is the presence of major vessel runoff. It suggests that the mechanism by which long-term survival is achieved is by resection of the segment of aorta containing the entry site, which is frequently the site of subsequent enlargement and rupture, rather than obliteration of the false channel.

Adult↗
PubMed1980

Atrial repairs of infant complex congenital heart lesions. Emphasis on the first 3 months of life.

From 1975 to 1980, 106 infants in the first year of life with complex cardiac anomalies underwent isolated intra-atrial repair; 70 were in the first 3 months of life. Of these 70, 39 were 1 to 3 months old, 15 were 1 week to 1 month old, and 16 were less than 1 week old. The median age was 70 days, the range, 1 to 360 days. These infants included 74 with transposition of the great arteries, 28 with total anomalous pulmonary venous connection, and four with complex lesions (cor triatriatum and combined total anomalous pulmonary venous connection and anomalous systemic connection). Overall survival was 95%; for those in the first 3 months of life, 96%; for those in the first month, 94%; and for those in the first week, 100%. Age was not a determinant of survival. Attempts to delay surgical intervention once symptoms appear only results in clinical deterioration and interim mortality.

Age Factors↗
PubMed1979

Right paraduodenal hernia: a source of chronic abdominal pain in the adult.

Right paraduodenal hernias are a relatively rare congenital malformation with a total of 50 clinical cases having been reported. This anomaly can be seen as total encapsulation of the small bowel or a single loop within a hernia sac. Symptoms are often chronic vague abdominal pain and intermittent obstructive episodes. Barium studies in patients with moderate and large defects, and angiography in small hernias may provide the diagnosis. The method of repair is dependent on the size of the hernia encountered. The management of two patients with this problem is described.

Adult↗
PubMed1979

Operative correction of total left anomalous pulmonary venous return.

The evaluation, surgical repair, and follow-up are described in an asymptomatic 27-year-old man with unilateral total anomalous pulmonary venous return from the left lung through an innominate vein and a patent foramen ovale. The anomalous vein was divided and anastomosed directly to the left atrium using a vascular technique that produced an orifice larger than the vein diameter. Radionuclide scanning accurately identified the anomaly before operation and allows periodic noninvasive reevaluation after operation. Correction is recommended in all patients with unilateral anomalous pulmonary venous return because disease in the one normal lung could be fatal.

Adult↗