Cardiopulmonary bypass in interrupted aortic arch.
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Aorta, Thoracic↗
Biomedical subjects
K Turley
Publications and source records attributed to K Turley.
Management of symptomatic tetralogy of Fallot in the first year of life.
The surgical management of symptomatic tetralogy of Fallot in infants is debatable. The question of total correction versus palliation and the type of palliative procedure remain controversial. During the past 4 years, 30 infants, aged 1 day to 12 months (mean 5.6 months) with symptomatic tetralogy of Fallot underwent either total correction (21 infants) or palliation by relieving the pulmonary stenosis with a right ventricular outflow tract patch (nine infants). The ratio of diameter of the right pulmonary artery to diameter of the ascending aorta (PA/Ao ratio) was calculated from the anteroposterior cineangiogram of all patients. There were three operative deaths in the total correction group; two of these occurred in infants with PA/Ao ratios less than 0.3. One death occurred in the 19 patients undergoing total correction with PA/Ao ratios greater than 0.3 (mortality rate 5.3%). All nine infants undergoing right ventricular outflow tract patching had PA/Ao ratios less than 0.3, and one operative death occurred in this group. Four patients who had right ventricular outflow tract patching have had repeat cardiac catheterization 2 to 15 months postoperatively. All four have shown symmetrical enlargement of the pulmonary arterial tree and significant increases in their PA/Ao ratios.
Abnormalities, Multiple↗
Total correction of transposition of the great arteries. Conduction disturbances in infants younger than three months of age.
Although total physiological correction of d-transposition of the great arteries (d-TGA) is technically feasible in infants, the optimal age for correction has remained controversial because of concern regarding major life-threatening arrhythmias and the long-term results of the intra-atrial baffle procedure. During a 3 year period, 54 children aged 4 days to 5 years, including 24 infants aged 3 months or younger, underwent the baffle procedure. Thirty-two children had simple transposition and underwent only placement of a pericardial baffle; no deaths occurred in this group. Twenty-two had complex transposition requiring in addition closure of a ventricular septal defect (VSD) and/or resection of outflow tract obstruction; there were four hospital and two late deaths in this group. A single operative approach was used in all patients. Sinus rhythm was present at discharge in 85 percent of the infants and 76 percent of the older children. Three factors--age, mode of cardiopulmonary support, and complexity of the lesion--influenced these results.
Age Factors↗
Aortic aneurysm with retroperitoneal fibrosis and ureteral obstruction.
Arteriosclerotic aneurysms of the abdominal aorta constitute a common clinical entity. Rarely are they associated with retroperitoneal fibrosis and ureteral obstruction requiring ureterolysis. Fifteen such cases have been reported, with resection successful in 5 of 7. A sixteenth case is presented complicated by the presence of a persistent left cardinal vein. It is the third aneurysm resected with such an anomaly, and to our knowledge the first to be associated with retroperitoneal fibrosis and ureteral obstruction. Ureterolysis with resection of the aneurysm was performed. The difficulties presented by these pathologic entities, as well as the anomalous venous pattern, are reviewed. Complete preoperative evaluation, including intravenous pyelogram, retrograde pyelography, aortography, and venacavography, for the definition of anatomic relationships and planning of the surgical approach is stressed.
Aorta, Abdominal↗
Biliary ascariasis.
Biliary ascariasis, rarely noted in the western literature, is a common condition in other climates. An increase in infestation may occur with travel to these countries. With the changes in biliary function which follow common duct exploration, invasion can occur in the affected individual. Treatment involves antispasmodics, antihelminthetics, and prevention of superinfection. Surgical intervention is reserved for specific indications of failure of medical therapy.
Ascariasis↗
Transposition of the great arteries in the neonate: failed balloon atrial septostomy.
The authors discuss the early management of patients with transposition of the great arteries in the neonate. The success of early operative procedures in the neonatal period has limited the usefulness of the Rashkind balloon septostomy. The authors propose that both the Senning and arterial switch procedure may be better accomplished if the septostomy is not performed. The Senning operation appears to be the current method of choice and early operative intervention is highly successful.
Catheterization↗
Surgical management of tetralogy of Fallot with absent pulmonary valve.
Tetralogy of Fallot and absent pulmonary valve (T-APV) is associated with massively dilated pulmonary arteries that cause tracheobronchial compression in the newborn and heart failure and cyanosis in older patients. Corrective operations have been attended by high mortality rates due to pulmonary insufficiency causing right heart failure (RHF) and pulmonary complications. Pulmonic valve insertion (PVI) with complete repair has resulted in improved survival. During the last 5 years, 152 patients with tetralogy were corrected. Of these, 10 patients (ages 51 days to 34 years) had absent pulmonary valve. One patient (age 51 days) presented with severe RHF and pulmonary insufficiency and 9 patients presented with mild RHF and cyanosis. Chest roentgenograms showed increased cardiothoracic ratio and pulmonary prominence in all. Arteriography revealed massively enlarged pulmonary arteries with a mean ratio of 2:1 for size of pulmonary artery to aorta. Associated pulmonic stenosis and insufficiency was present in all. Seven patients underwent closure of ventricular septal defect (VSD) and PVI. Of these, 3 had PVI (2 tissue and 1 prosthetic) with outflow patch and 4 had right ventricle to pulmonary artery (RV-PA) tissue valved conduits. Two patients had repair without PVI, and 1 had repair with a monocusp pericardial valve patch. Nine patients have done well with no episodes of thromboembolism or infection. Death occurred in a 51-day-old infant who had VSD closure and relief of pulmonic stenosis. Pulmonary valve insertion seems to be indicated in these patients because it lowers peak pulmonary artery pressure and, thus, reduces compression effects on the trachea and bronchi. When PVI was used, RHF did not occur post-operatively.
Adolescent↗