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Biomedical subjects

M D Freed

Publications and source records attributed to M D Freed.

At least 37 records · Page 2Linked to original sources
PubMed1985

Complications and mortality associated with cardiac catheterization in infants under one year: a prospective study.

To evaluate complications and mortality following cardiac catheterization (CC) in patients under one year of age, we prospectively examined 312 CC on 273 patients from the centers in the New England Regional Infant Cardiac Program during a one-year period. Among CC performed on patients less than four months old, the incidence of complications requiring treatment was 12%; for patients 4-12 months, it was 1.5% (p less than 0.02). By pre-CC risk assessment, 13% of CC were high risk, 21% medium risk, and 66% low risk. The incidence of major complications was much greater among the High Risk (30%) compared with Medium Risk (14%) (p less than 0.05) and with Low Risk (4%) (p less than 0.001). The overall mortality rates 24 h, 48 h, and one week after CC were 3.8%, 8.3%, and 13.5%, including patients with inoperable lesions and those having cardiac surgery, while deaths directly attributable to a CC complication were 0, 0.3%, and 0.3%, respectively. We can predict, prior to CC, the high-risk cases where major complications and death are likeliest to occur. The incidence of death from CC-related complications is extremely low in patients under one year of age, compared with death from the underlying lesion or following cardiac surgery.

Age Factors↗
PubMed1985

Pulmonary valvotomy under normothermic caval inflow occlusion.

Pulmonary valve stenosis may require urgent surgical relief in infancy or elective valvotomy in childhood. A retrospective study has been made of 94 children who underwent pulmonary valvotomy for pulmonary valve stenosis between 1972 and 1983 using the technique of normothermic caval inflow occlusion. There were no early deaths nor late deaths. The group included 13 neonates less than 1 week old and 14 other infants under 1 year of age. The mean follow-up is 45 months. No child has had a second valvotomy for recurrent valvar stenosis. Two children have required re-operation for placement of a transannular right ventricular outflow patch for hypoplastic pulmonary annulus. Neonates who present early with critical pulmonary valve stenosis may remain moderately to severely cyanosed for several days after a satisfactory valvotomy but this is almost invariably followed by a progressive increase in oxygen saturation to an acceptable level. One neonate, who had a Blalock-Taussig shunt at 2 weeks of age for persistent postvalvotomy cyanosis, had the shunt ligated at 2 years. Pulmonary valvotomy under normothermic caval inflow occlusion is a safe, cost-effective technique which provides excellent early and late haemodynamic results. This operation sets a standard against which the newly introduced technique of percutaneous balloon pulmonary valvotomy should be assessed.

Adolescent↗
PubMed1985

Long-term follow-up of patients with synthetic right heart conduits.

Between 1971 and 1983, 201 patients received synthetic right heart conduits, predominantly porcine-valved Dacron conduits, at The Children's Hospital, Boston. There were 45 hospital deaths (22%). Follow-up has been achieved in 148 of 156 survivors (95%). Thirty-four conduits have been replaced, all because of conduit obstruction. The actuarial freedom from conduit replacement was 81% at 5 years, 61% at 7 years, and 0% at 10 years for valved conduits. There was no significant difference to 5 years in reoperation rate between patients with Carpentier-Edwards and those with Hancock conduits. Patients older than 18 years at the time of conduit insertion were 92% free of conduit replacement at 5 years. Those with nonvalved conduits were 100% reoperation free at 4 years. The actuarial survival of patients with valved conduits was 91% at 5 years and 83% at 10 years. The poor performance of porcine-valved tightly woven Dacron conduits warrants a change to use of an alternative conduit, particularly in smaller children. Possible alternatives include antibiotic-sterilized homografts and valved or nonvalved high-porosity knitted Dacron conduits appropriately pretreated with collagen impregnation or fibrin glue.

Actuarial Analysis↗
PubMed1985

Normothermic caval inflow occlusion. Application to operations for congenital heart disease.

The technique of normothermic caval inflow occlusion was introduced primarily for relief of pulmonary valve stenosis and continues to be used for this purpose with excellent results. However, the technique may also be applied to a number of other lesions such as aortic valve stenosis in neonates and infants, for placement of outflow patches or valve excision for pulmonary atresia with intact ventricular septum, for atrial septectomy in children with restrictive atrial septum, and for other conditions wherein a period of up to 2 minutes of intracardiac exposure is sufficient. This report examines the early and long-term results in 140 children who underwent normothermic caval inflow occlusion at The Children's Hospital, Boston, Massachusetts, over the past 11 years. Ninety-four children underwent pulmonary valvotomy (early mortality 0%), 21 had aortic valvotomy (19%), 10 with pulmonary atresia and intact ventricular septum underwent various procedures (50%), 11 had atrial septectomy (9%), and there were four miscellaneous procedures (50%). Apart from avoiding many of the potential complications of cardiopulmonary bypass, inflow occlusion has provided as good or better short-term and long-term results as those obtained with cardiopulmonary bypass, particularly in infants and neonates, and also has proved more cost effective.

Adolescent↗
PubMed1984

Recreational and sports recommendations for the child with heart disease.

Although there is widespread acceptance that some children with congenital or acquired heart disease need exercise proscription, there is little data on which to base recommendations. In this article, the author, after reviewing the hemodynamic burdens of the common cardiac anomalies in children, gives his personal recommendations for recreational and sports activities.

Adaptation, Physiological↗
PubMed1984

Primary surgical closure of ventricular septal defect in the first year of life: results in 128 infants.

Between January 1973 and July 1981, 128 patients less than 1 year of age with failure to thrive, congestive heart failure or pulmonary artery hypertension underwent primary repair of a ventricular septal defect. The hospital mortality rate was 7.8% (10 of 128), and the late mortality rate was 2.3% (3 of 128). Mortality was highest among younger infants with preexisting respiratory problems or a hemodynamically significant residual lesion postoperatively. Complications included a large residual shunt in eight (6.2%), transient neurologic problems in five (3.9%) and persistent complete heart block in three (2.3%). Lung biopsy specimens obtained from 49 patients showed pulmonary vascular abnormalities in all. Complete right bundle branch block developed in 74 (64%) and bifascicular block appeared in 11 (9%). Recatheterization in 70 patients (55%) showed normal pulmonary artery pressures in all but 2 patients with a large residual shunt. Complete closure of the defect had been achieved in 49 (70%), and a hemodynamically insignificant shunt remained in 19 (27%). Patients without significant hemodynamic residua were asymptomatic and tended to accelerate in growth after surgery.

Age Factors↗
PubMed1984

Is routine preoperative cardiac catheterization necessary before repair of secundum and sinus venosus atrial septal defects?

Between January 1976 and July 1983, 217 patients with atrial septal defect underwent surgical repair at Children's Hospital. Thirty with a primum atrial septal defect and 26 who underwent cardiac catheterization elsewhere before being seen were excluded from analysis. Of the 161 remaining patients, 52 (31%) underwent preoperative cardiac catheterization, 38 because the physical examination was considered atypical for a secundum atrial septal defect and 14 because of a preexisting routine indication. One hundred nine (69%) underwent surgery without catheterization, with the attending cardiologist relying on clinical examination alone in 5, additional technetium radionuclide angiocardiography in 5, M-mode echocardiography in 13 and two-dimensional echocardiography in 43; both M-mode echocardiography and radionuclide angiography were performed in 24 and two-dimensional echocardiography and radionuclide angiography in 19. Since 1976, there has been a trend toward a reduction in the use of catheterization and use of one rather than two noninvasive or semiinvasive techniques for the detection of atrial defects. Of the 52 patients who underwent catheterization, the correct anatomic diagnosis was made before catheterization in 47 (90%). Two patients with a sinus venosus defect and one each with a sinus venosus defect plus partial anomalous pulmonary venous connection, partial anomalous pulmonary venous connection without an atrial septal defect and a sinoseptal defect were missed. Of 109 patients without catheterization, a correct morphologic diagnosis was made before surgery in 92 (84%). Nine patients with a sinus venosus defect, three with sinus venous defect and partial anomolous pulmonary venous connection, four with partial anomalous pulmonary venous return without an atrial septal defect and one with a secundum defect were incorrectly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Reoperation for isthmic coarctation of the aorta: follow-up of 26 patients.

Twenty-six patients underwent reoperation for coarctation of the aorta (C of A) between 1972 and 1980. Most patients (73%) had undergone primary repair in infancy. The interval to reoperation was 5 months to 18 years (mean 8.2 years). Indications for reoperation included symptoms in 4, exercise systemic hypertension in 1, electrocardiographic changes of left ventricular strain in 1, arm hypertension in 21, and a C of A gradient at rest greater than 30 mm Hg in all. Surgical procedures included patch aortoplasty (16 patients), bypass graft (6 patients), left subclavian angioplasty (3 patients), and end-to-end anastomosis (1 patient). There were no operative complications or mortality. There was 1 late death from aortic valve disease. Duration of follow-up in the remaining 25 patients was 2 weeks to 7 years (mean 2.5 years). All patients are asymptomatic. C of A gradients were significantly reduced from 30 to 132 mm Hg (mean 56) preoperatively to 0 to 48 mm Hg (mean 15) postoperatively. Right arm systolic blood pressure also was significantly improved from 120 to 237 mm Hg (mean 153) preoperatively to 100 to 160 mm Hg (mean 124) postoperatively. Systemic systolic hypertension persisted in 5 of 25 (20%). It is concluded that C of A reoperation is a low risk procedure that improves symptoms and reduces C of A gradient and arm blood pressure. However, systolic hypertension does not always resolve postoperatively. Patch aortoplasty appears to be a safe and effective surgical approach.

Adolescent↗
PubMed1983

Transposition of the great arteries and ventricular septal defect: results with the Senning operation and closure of the ventricular septal defect in infants.

From May, 1978, to July, 1982, 46 infants ranging in age from 12 days to 12 months and in weight from 2.1 to 8.4 kg underwent repair of dextrotransposition of the great arteries (D-TGA) and ventricular septal defect (VSD) using a Senning repair and closure of the VSD. Ventricular septal defects were classified as membranous (47.8%), malaligned (28.3%), atrioventricular (AV) canal type (13.0%), subarterial (2.2%), muscular (2.2%), and multiple (6.5%). Hospital mortality was 15.2% and late mortality, 5.1%. Postoperative complications included tricuspid regurgitation (mild in 3 and severe, requiring tricuspid valve replacement, in 3), residual VSD (pulmonary/systemic flow ratio of greater than 2:1) in 3 patients (2, AV canal type and 1, multiple VSDs), pulmonary venous obstruction in 3 patients, and permanent complete heart block in 4 patients (2, AV canal type of VSD also requiring tricuspid valve replacement). Lung biopsy studies showed reversible Heath-Edwards and morphometric changes. No patient was seen with Heath-Edwards III or greater changes. In 10 patients, right ventricular end-diastolic pressures and pulmonary artery pressures at rest were within normal limits one year after operation. As the operative mortality of atrial inversion and arterial switch operations for D-TGA with VSD tends to become comparable, more extensive follow-up data, including cardiac catheterization and coronary arteriography in a large number of patients, will be necessary to establish the superiority of one approach over the other.

Abnormalities, Multiple↗
PubMed1981

Side effects of therapy with prostaglandin E1 in infants with critical congenital heart disease.

The case reports of 492 infants with critical congenital cardiac disease treated with prostaglandin E1 (PGE1) were reviewed to determine the nature and incidence of intercurrent medical events. Forty-three percent of the infants had at least one such event, but only half of these were related to PGE1 and the majority required only minor changes in management. Cardiovascular events were the most common (18% incidence), with cutaneous vasodilation and edema occurring more frequently during intraaortic infusion than during i.v. infusion. Central nervous system events were reported in 16% of the patients. Respiratory depression was reported in 12%, and was particularly common in infants weighing less than 2.0 kg at birth (42%). Hematologic, infectious and renal events appeared for the most part to be unrelated to PGE1. The overall mortality (excluding 19 patients with hypoplastic left-heart syndrome) was 31%; the mortality for the patients with critical coarctation or interruption of the aortic arch was nearly twice that for the cyanotic infants (50% vs 27%). No death was attributed to PGE1 administration. During infusion of PGE1, arterial blood pressure and respiratory activity should be monitored carefully and appropriate supportive steps taken if hypotension or respiratory depression occurs. The development of fever or jitteriness may require reduction of the infusion rate and, in view of the possible increased incidence of infections, the prophylactic use of antibiotics is recommended.

Bacterial Infections↗
PubMed1980

Exercise-induced ventricular ectopy in children and young adults with complete heart block.

Twenty-five children and young adults with complete heart block and 50 normal control subjects were maximally exercised on a treadmill and their electrocardiograms were analyzed for the presence and degree of ventricular ectopy activity. Sixty-eight % (17 of 25) of the heart block patients and significant ventricular ectopy (frequent unifocal ectopy or worse) on exercise compared to 2% (one of 50) of the controls (p = less than 0.01). In the patients with block there was a significant trend toward more frequent and more severe ectopy with increasing age (p = less than 0.05) independent of heart rate. More severe ventricular ectopy was also seen in those patients with QRS prolongation (p = less than 0.05). No significant differences were found between the 14 patients with isolated "congenital" heart block, the seven with associated defects, and the four with surgically acquired block. We believe that severe ventricular ectopy is common at exercise in patients with complete heart block and they may have an increased risk for sudden death.

Adolescent↗