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Biomedical subjects

M D Freed

Publications and source records attributed to M D Freed.

At least 55 records · Page 3Linked to original sources
PubMed1979

Use of prostaglandin E1 in infants with d-transposition of the great arteries and intact ventricular septum.

Prostaglandin E1 was used to treat five infants with d-transposition of the great arteries and intact ventricular septum who had persistent severe hypoxemia after the creation of an interatrial communication. Three infants had a dramatic improvement in systemic arterial oxygen saturation associated with dilation of the ductus arteriosus; in two of the three cases urgent surgery was avoided. Two infants had no clinical evidence of increased ductal shunting and no improvement in oxygen saturation. A trial of prostaglandin E1 is recommended for treatment of severe hypoxemia in infants with d-transposition of the great arteries with intact ventricular septum if the presence of a large atrial septal defect is established.

Cardiac Catheterization↗
PubMed1978

His bundle electrogram after intracardiac repair of tetralogy of Fallot. Analysis of data in 59 patients.

His bundle electrograms were recorded in 59 patients after intracardiac repair of tetralogy of Fallot and were correlated with the postoperative electrocardiogram. Except for five patients with first degree atrioventricular block postoperatively all patients in Group A (those with either a normal electrocardiogram or solitary right bundle branch block) had a normal A-H interval (77.7 +/- 21.6 msec) (mean +/- standard deviation); all had a normal H-V interval (39.5 +/- 7.2 msec). Patients in Group B (bifascicular block) tended to have a normal A-H interval (97.2 +/- 26.2 msec) with a prolonged H-V interval (48.8 +/- 10.7 msec). Patients in Group C (trifascicular block) had prolongation of both the A-H (160.0 +/- 32.4 msec) and the H-V interval (58.8 +/- 10.6 msec) by comparison with control values. Patients in Group D (transient complete heart block) had a normal A-H interval (79.5 +/- 28.2 msec) but a prolonged H-V interval (57.8 +/- 16.4 msec), similar to that in Group C. A good hemodynamic result was associated with a normal H-V interval; a prolonged interval accompanied a poor result.

Adolescent↗
PubMed1978

Early and late results with the Mustard operation in infancy.

Eighty-one patients, ranging in age from 36 hours to 24 months and in weight from 2.5 to 12 kg had a Mustard operation for D-transposition of the great arteries (D-TGA) (20 with complex D-TGA) using either deep hypothermic circulatory arrest (68 patients) or conventional cardiopulmonary bypass (13 patients). A Dacron patch was used for the intraatrial baffle and pericardium for augmentation of the pulmonary atrium. Ten patients died following operation. Thirty-two patients had cardiac catheterization 1 year after operation. Of 24 patients with D-TGA and intact ventricular septum, 23 had normal pulmonary artery pressures. In 20 patients left ventricular outflow tract gradients decreased from a mean of 32 mm Hg to a mean of 18 mm Hg after operation. Five patients who had D-TGA and ventricular septal defect and systemic pressures in the left ventricle before operation, had a notable decrease in left ventricular pressures after the procedure. Seven patients required reoperation for baffle obstruction. Mortality following Mustard repair was primarily related to the complexity of the lesion, maturity of the infant, and degree of pulmonary vascular changes. Caval obstruction was related to the configuration of the baffle used in the early part of this series.

Blood Pressure↗
PubMed1978

Cardiac output measured by thermodilution in infants and children.

To determine the accuracy and reproducibility of cardiac output determination by thermodilution (COT) in children, simultaneous outputs were measured by the Fick technique (COF) (using measured oxygen consumption) and thermodilution in 26 children, ranging in age from 8 to 86 months, who were undergoing cardiac catheterization. There was excellent correlation between mean output by thermodilution and by the Fick technique: COT = 1.10 COF -- 0.2 l/minute, R = 0.91. In three-quarters of the patients with COT differed by 15% or less and in none differed by more than 25%. Serial values of thermodilution outputs were reproducible in each patient with a SD of 5.5%. Our observations indicate that COT is accurate, reproducible, and valuable in the care of critically ill infants and children.

Cardiac Catheterization↗
PubMed1978

Left ventricular function following attempted surgical repair of tetralogy of Fallot.

Left ventricular function was assessed by angiographic methods in 40 patients (ages 3-27), 1-12 years following repair of tetralogy of Fallot. Twenty of the 40 patients (group A) had a satisfactory repair with a pulmonary-systemic flow ratio (Qp/Qs) less then or equal to 1.5 and a right ventricular systolic pressure of less than or equal to 60% of the left ventricular value. The other 20 patients (group B) had a Qp/Qs greater than 1.5 and/or a right ventricular systolic pressure greater than 60% of the left ventricular value. Group A patients had a normal left ventricular end-diastolic volume (LVEDV), end-diastolic pressure (LVEDP), ejection fraction (LVEF), and mass (LVM), while the group B patients had significantly elevated LVEDV, LVEDP, LVM, and a significantly depressed LVEF. These findings indicate that patients with a satisfactory hemodynamic repair of tetralogy of Fallot have normal left ventricular function while patients with postoperative unsatisfactory hemodynamics have significantly impaired left ventricular function.

Adolescent↗
PubMed1977

Pediatric cardiac angiography using a 4 French catheter.

Thirty specially designed 4 French pigtail white Teflon catheters 50 cm in length were utilized for angiography using the retrograde arterial approach in 26 infants and children. Angiographic opacification was considered very satisfactory. Apart from one episode of temporary occlusion of the right coronary artery ostium, there were no other significant complications. The catheters were introduced percutaneously in 21 instances and distal pulses were palpable in 18 patients by the second day after catheterization. At postcatheterization testing with increasing volumes and flow rates, the first rupture occurred, delivering 13 ml at 13 ml/second. On testing an additional 15 catheters using fixed volumes of 5, 10, and 15 ml at increasing flow rates, rupture first occurred at 34, 22, and 18 ml/second, respectively. We conclude that this small catheter is relatively safe and satisfactory for the retrograde arterial approach in the study of infants and children.

Angiography↗
PubMed1977

Ascending aorta-pulmonary artery anastomosis for cyanotic congenital heart disease.

The course and prognosis of 208 patients with an ascending aorta to pulmonary artery anastomosis is reviewed. Mortality rate during, or within one month, of surgery was 24 per cent (50/208) and late mortality rate, prior to repair, was 10 per cent (21/208). An additional 5 per cent (10/208) died during subsequent intracardiac repair. Congestive heart failure developed in 25 per cent (53/208), pulmonary artery hypertension in 17 per cent (12/72), and pulmonary vascular obstruction in 6 per cent (4/72). An increase in orifice size of the stoma with time was documented in eight patients. Additional subsequent palliative surgery was required in 22 per cent (45/208). Mortality rate was directly related to age at operation and was highest in neonates less than one week of age. In infants with tetralogy of Fallot, a preliminary comparison of mortality rate between palliative surgery and primary repair clearly suggests that the latter is the preferred method of treatment.

Aorta↗
PubMed1977

Experience with valved conduits for repair of congenital cardiac lesions.

Dacron valved conduits or aortic allografts were placed between the right heart and the pulmonary artery for repair of various complex congenital cardiac anomalies in 56 patients (aged 15 days to 33 years; median, 11 years). Forty-four patients had a total of 56 previous palliative procedures, which contributed to postoperative morbidity and mortality. Six patients had a total of seven episodes of early or late sepsis involving the conduit. One patient, treated for early sepsis, again developed infection in the Hancock graft 1 year postoperatively and died. Three other patients, 2 with calcified allografts, developed infections 4 months to 7 years following repair and required graft replacement. Hemodynamic data 1 month to 5 years (mean, 1.6 years) following repair revealed mild to moderate obstruction (less than 45 mm Hg gradient) at the Hancock conduit valve ring in 13 of 19 patients, while 5 had large pressure gradients (greater than 75 mm Hg). All aortic allografts had severe obstruction and calcification necessitating graft replacement. It is anticipated that improved technique and appropriate timing of palliative and corrective operations will substantially reduce or eliminate these problems.

Adolescent↗
PubMed1977

Early and late results of closure of ventricular septal defect in infancy.

Fifty infants ranging in age from 13 days to 18 months (mean age 6 months) and weighing from 1.7 to 8.2 kg (mean weight 4.5 kg) underwent patch closure of a ventricular septal defect (VSD) with use of deep hypothermic circulatory arrest. Seventeen infants were under 3 months of age. The principal indication for operation was intractable chronic congestive heart failure; All infants were below the third percentile for weight preoperatively; Three patients (6%) died postoperatively within the second month of life. There was no late mortality. Seven infants (14%) had seizures; these were associated with a low output state in 2 infants, with hypoxic episodes in 4 infants, and occurred postoperatively in 1 infant. Postoperatively, 8 (17%) of the surviving infants developed right bundle-branch block and left anterior hemiblock, and 16 (32%) developed right bundle-branch block alone. One year postoperatively, catheterization studies in 24 children revealed normal pulmonary artery pressure and pulmonary vascular resistance in all; there were no significant residual ventricular septal defects. Because of these results we continue to be enthusiastic about primary closure of VSD irrespective of age or weightk0

Blood Pressure↗
PubMed1977

The use of prostaglandin E1 in an infant with interruption of the aortic arch.

Infusion of prostaglandin E1 into the main pulmonary artery of an infant with interruption of the aortic arch and a closing ductus arteriosus resulted in dilation of the ductus arteriosus and improved systemic perfusion. Treatment with prostaglandin E1 is recommended for infants with interruption of the aortic arch, critical coarctation of the aorta, and other lesions in which systemic perfusion is limited by a restrictive ductus arteriosus.

Aorta, Thoracic↗
PubMed1977

Angled views in cineangiocardiography of congenital heart disease.

Simple and compound sagittally angled views of the heart obtained cineangiocardiographically with a parallelographic U-arm device were evaluated clinically in 132 patients with congenital heart disease. The principle advantage of the apparatus was the case with which axial and oblique projections were obtained without repositioning of the patient, although rotation and angulation of the image intensifier-X-ray tube unit resulted in some increase in scattered radiation. Certain angled views, particularly the 40 degree cranial and the compound 25 degrees cranial/70 degrees left oblique projections, were better than standard frontal and lateral views for visualization of pulmonary arteries in the mediastinum, in ventricular septal defects and anomalies of the left ventricular outflow tract.

Angiocardiography↗
PubMed1975

Results of routine preoperative coronary angiography in tetralogy of Fallot.

In the surgical repair of tetralogy of Fallot, morvidity and mortality are increased by certain coronary anomalies, in particular, an anterior descending branch originating from the right coronary artery or a single coronary artery in which a large coronary branch runs across the pulmonary outflow tract. In series of 94 patients with tetralogy of Fallot who underwent cardiac catheterization, coronary artery visualization was attempted routinely, most often by flush aortography using a venous catheter. Diagnostic coronary visualization was obtained in 84 patients (89%). In these, the incidence of recognized coronary anomalies was 5%; anterior decending from the right coronary artery in four patients (4%), and singly left coronary in one patient (1%). In 195 autopsied cases of tetralogy, the incidence of coronary anomalies was also 5%. Routine preoperative demonstration of the coronary artery anatomy in tetralogy patients usually can be accomplished satisfactorily and conveniently by transvenous flush aortography.

Adolescent↗