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Biomedical subjects

L L Bailey

Publications and source records attributed to L L Bailey.

At least 109 records · Page 6Linked to original sources
PubMed1989

Heart transplantation during the first 12 years of life. Loma Linda University Pediatric Heart Transplant Group.

Since November 1985, forty-four heart transplants have been accomplished in 43 infants and children younger than 12 years of age. Indications for transplantation included structural heart disease (31 patients), idiopathic or viral cardiomyopathy (10 patients), and combined structural and myopathic disease (2 patients). Postoperative recipient surveillance was achieved noninvasively during the first year of life; endomyocardial biopsy was employed in children. Maintenance immunosuppression included cyclosporine and azathioprine therapy during the first year after transplantation in young infants, graduating to cyclosporine therapy alone beyond the first year. Azathioprine therapy was continued indefinitely in children. There have been 5 perioperative deaths and 1 late death in this series of recipients. Overall survival was 86%. Growth, development, and psychosocial adjustments generally have been excellent. Donor heart growth has been normal. Coronary artery disease has not yet been observed. Our findings indicate that heart transplantation seems to be effective therapy for selected incurable pediatric cardiac diseases.

Child↗
PubMed1989

Late hemodynamic results after orthotopic heart transplantation in early infancy.

To study the late hemodynamic results after infant orthotopic heart transplantation, five late survivors, as of October 1988, underwent right and left cardiac catheterization and endomyocardial biopsy. Mean age at transplantation was 1.4 +/- 1.5 months. Mean post-transplantation period was 17 +/- 5.6 months. All patients were on maintenance immunotherapy. The systemic and mixed venous saturations were normal, with no intracardiac shunt. The atrial and pulmonary artery anastomoses were widely patent. Three patients had coarctation of the aorta with a respective gradient of 24, 26, and 30 mm Hg; two were successfully treated by balloon angioplasty. The right-side hemodynamics were normal in all patients. Left ventricular pressures were elevated only in the patients with coarctation. The ventricular ejection fraction was normal. The right ventricular endomyocardial biopsy revealed no evidence of rejection. The mean cardiac index was 4.7 liter/min/m2 (range, 3.68-5.9). These data indicate excellent hemodynamic results and support orthotopic heart transplantation as therapy for selected neonates and infants with incurable heart disease.

Angiocardiography↗
PubMed1988

Orthotopic transplantation during early infancy as therapy for incurable congenital heart disease.

Since November 1985, 14 neonates and young infants have undergone orthotopic heart transplantation at Loma Linda University Medical Center (LLUMC) as therapy for hypoplastic aortic tract complex. Eleven (78%) survived surgery and are living and well today. Three perioperative deaths resulted: one due to perforated peptic ulcer, one due to necrotizing pneumonitis, and one due to graft failure unrelated to rejection. No late deaths occurred in the 1-29 months of follow-up, during which time noninvasive surveillance techniques were used. Immunosuppression was accomplished using cyclosporine and azathioprine. Steroids and antithymocyte globulin were used for identified rejection episodes only. Ordinary childhood infections were tolerated well. All survivors were normotensive. There was no late renal dysfunction. Although inadequate donor resources remain a significant limiting factor for transplantation therapy during early life, these results suggest that cardiac transplantation is effective therapy for selected neonates and young infants with incurable congenital heart disease.

Heart Defects, Congenital↗
PubMed1988

Chest radiography in infant cardiac allotransplantation.

Heart transplants were performed in seven infants at Loma Linda University Medical Center from 1985 to 1987. Five of these seven patients survived. In this report, the radiographic appearance of the chest is presented before surgery, immediately after surgery, and during a documented episode of rejection. The most current available chest radiograph is also presented. Acute rejection was confirmed by clinical, echocardiographic, and ECG findings. The only pulmonary infection encountered was mycoplasma pneumonitis. Four patients developed gastrointestinal rotavirus infections and were shown to have dilated proximal small-bowel folds on upper gastrointestinal studies. At the time of this writing, the prognosis for the five surviving infants is good. We conclude that the radiographs of infants who have received heart transplants show an unusual cardiac contour and slight cardiomegaly. Increasing cardiomegaly can alert one to early rejection. Prominent folds in the small bowel are of uncertain origin and significance, but they may be related to infection resulting from immunosuppression.

Female↗
PubMed1985

Baboon-to-human cardiac xenotransplantation in a neonate.

This report details the first case of cardiac xenotransplantation in a neonate. The recipient, a victim of hypoplastic left heart syndrome (HLHS), survived 20 days. Autopsy findings are documented. The cardiac graft showed only traces of cell-mediated rejection. Graft failure appears to have resulted from a progressive, potentially avoidable humoral response, unmodified by immunosuppression. Cardiac allotransplantation and selective baboon-to-human xenotransplantation deserve further exploration as investigational therapy for neonatal HLHS.

Animals↗
PubMed1985

Orthotopic cardiac xenografting in the newborn goat.

Fourteen newborn (less than 7 days) goats were subjected to orthotopic cardiac transplantation with donor xenografts from size-matched lambs. Ten goats survived the operation (greater than 24 hours). Recipient animals received cyclosporine 48 and 24 hours before the operation and daily after the operation on a gradually reducing daily protocol. Recipients were also given pulse doses of methylprednisolone (100 mg/kg) and azathioprine (3 mg/kg) once a week, the dosage schedule being gradually reduced and azathioprine discontinued as recipients became long-term survivors (greater than 60 days). Seven recipients had radionuclide left ventriculography for measurement of left ventricular ejection fraction from 1 to 4 months postoperatively. Ejection fractions at 1 month in two recipients were 35% and 57%, and at 2 months the ejection fraction in one recipient was 58%. Serial ejection fractions from 1 to 4 months postoperatively in four recipients averaged 50%, 58%, 45%, and 45%. Survival in days among the 10 recipients was 24, 32, 44, 47, 60, 60, 78, 90, 120, and 165. Average survival was 72 days. There were no significant infections. Most animals showed mild-to-moderate subacute and chronic graft rejection at autopsy. One host showed no gross or microscopic graft rejection at autopsy on postoperative day 47. Tumor was not observed. These data suggest that long-term survival may be feasible for newborn recipients of cardiac xenografts with cyclosporine therapy and limited supplemental immunosuppression.

Animals↗
PubMed1984

A cause of right ventricular dysfunction after cardiac operations.

We examined the impact of mediastinal healing on right ventricular performance in three groups of five piglets by performing gated blood pool scans in two planes to determine right ventricular ejection fraction. Animals in Group I then had sternotomy and excision of anterior pericardium. Group II animals had a similar operation plus insertion of a silicone rubber sheet as a pericardial substitute. Group III animals (controls) had no operation. Each group was followed up for 60 days, after which gated blood pool scans were repeated in a manner identical to the initial study. Experimental animals in Groups I and II were then put to death and autopsied. Adhesion formation between the right ventricle and sternum was graded on a 0 to 3 scale. Group I animals showed a significant average decline in right ventricular ejection fraction of 19.2% (p less than 0.02). Group II animals demonstrated an average decrease in ejection fraction, although not significant, of 12.2%. Groups I and II combined showed a significant average loss in ejection fraction of 15.7% (p less than 0.01). Severity of adhesions between the right ventricle and sternum correlated well with loss of right ventricular ejection fraction (p less than 0.01). Group III controls demonstrated no significant change in ejection fraction. Mediastinal healing and fibrous attachment of the right ventricle to the sternum may play a significant role in loss of right ventricular ejection fraction after cardiac operations. Variability in loss of right ventricular ejection fraction is related to intensity of the mediastinal healing process.

Animals↗
PubMed1982

Mustard operation in the 1st month of life.

Since April 1976, nine infants less than 1 month of age underwent a Mustard intraatrial baffle procedure. All had transposition of the great arteries and were persistently symptomatic or hypoxic after the Rashkind balloon atrioseptostomy. Two had an associated large ventricular septal defect patched at the time of physiologic correction. The average age of the infants was 11.6 days (range 36 hours to 28 days). Weight averaged 3.4 kg (range 2.5 to 4.2). In all the Mustard procedure was performed using deep hypothermic circulatory arrest, averaging 71 minutes (range 48 to 88) at a mean core temperature of 13 degrees C. An average of 2.8 days of postoperative ventilatory assistance was required. One death occurred in a 28 day old male infant with an associated ventricular septal defect who, the morning after operation, had a sudden unresponsive cardiac standstill. The postoperative hospitalization period averaged 15 days (range 10 to 23). Follow-up evaluation has extended from 4 to 63 months (average 31). Six patients were restudied 2 to 21 months postoperatively. One had obstruction of the superior limb of the baffle, which had separated from the right atrial wall permitting a modest right to left shunt. She has had uneventful repair employing a unique modification of Senning's operation. Another child has asymptomatic partial obstruction of the superior limb of the baffle demonstrated angiographically. None has pulmonary venous obstruction and all have prevailing normal sinus rhythm. Significant right ventricular dysfunction has been demonstrated in one. Early correction in these persistently symptomatic or hypoxic neonates with transposition of the great arteries with or without a ventricular septal defect has obviated the need for palliative operations and produced gratifying early and late results.

Child, Preschool↗
PubMed1982

Embolotherapy of a ruptured internal mammary artery secondary to blunt chest trauma.

A unique case of traumatic rupture of the internal mammary artery secondary to blunt deceleration injury of the chest is reported. The injury, which produced changes consistent with great vessel disruption on the plain chest radiograph, was treated by percutaneous transcatheter embolization of Gianturco steel coils. The importance of surveying all arteries visualized during thoracic aortography in patients with widened mediastinum following deceleration injury to the chest is reinforced. Embolotherapy of this noncritical chest wall vessel is demonstrated.

Accidents↗
PubMed1981

Biologic reconstruction of the right ventricular outflow tract. Preliminary experimental analysis and clinical application in a neonate with type I truncus arteriosus.

A unique concept of right ventricular outflow tract reconstruction is presented. Applications of this concept, employing a glutaraldehyde-preserved heterograft mitral valve leaflet mounted directly to the right ventricle, was studied in six immature goat models. Interval evaluation of these models demonstrated no significant outflow tract obstruction or aneurysm. Only one animal had significant pulmonary outflow regurgitation angiographically at the time of sacrifice. All heterograft valve leaflets showed a degree of calcification and/or retraction directly related to the time interval between implant and sacrifice. Encouraging early results were obtained with this method of pulmonary outflow tract reconstruction in a 2,400 gram neonate with type I truncus arteriosus.

Animals↗
PubMed1981

Anatomic correction of interrupted aortic arch complex in neonates.

Anatomic correction of interrupted aortic arch complex by direct aortic anastomosis was accomplished in five neonates ranging in age from 2 to 19 days. Three had type B and two had type A interruption of the aortic arch. All operations were performed through a transverse bilateral thoracotomy by use of hypothermic circulatory arrest. The descending thoracic aorta is widely mobilized to the level of the diaphragm. The ductus arteriosus is completely excised and the descending aortic segment is anastomosed end to side to the ascending aorta. The large ventricular septal defect is patched with Dacron velour, and atrial communications are closed with running suture. Three of the babies survived surgery and are making satisfactory clinical progress. All three have been restudied on a routine basis. They were found to have excellent anatomic repairs with no residual intracardiac shunts. There was a peak systolic gradient of 8 mm Hg at the aortic anastomosis in the second survivor; however, she does not have ascending aortic hypertension. The first and last survivors have no aortic gradients. It is recommended that a newborn with interrupted aortic arch complex be subjected to corrective surgery as the procedure of choice. Excellent results may be expected when surgery is done prior to irreversible metabolic decompensation of the patient.

Aorta, Thoracic↗