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Biomedical subjects

M J Godman

Publications and source records attributed to M J Godman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Superior QRS axis in ventricular septal defect.

The relation between the superior orientation of the QRS axis and the anatomical site of the defect in the ventricular septum in patients with a ventricular septal defect was studied. Of 1031 patients with a ventricular septal defect, 64 (6.2%) had a superior axis on their electrocardiogram. In 59% of these patients the defect was in the inlet portion of the ventricular septum or affected this area. None of the cases was classified as an isolated ventricular septal defect of the persistent atrioventricular canal type. While there is an association between a superior axis and perimembranous inlet ventricular septal defect, a superior QRS axis does not characterise a ventricular septal defect as being of the atrioventricular canal type.

Echocardiography↗
PubMed1986

Truncus arteriosus: successful surgical correction without the use of a valved conduit.

A new operation for the restoration of continuity between the right ventricle and pulmonary circulation in truncus arteriosus in infancy without the use of a tube graft is described. This was achieved by anastomosing the inferior margin of the detached confluent branch pulmonary arteries to the apex of a vertical infundibular ventriculotomy to form the posterior wall of the reconstructed right ventricular outflow tract. A patch of pericardium was used to form the anterior wall and complete the primary cardiac repair.

Female↗
PubMed1985

Functional and anatomical correlates in atrial septal defect. An echocardiographic analysis.

The results of cross sectional echocardiography, intracardiac contrast echocardiography, and balloon sizing techniques and conventional haemodynamic assessment were correlated in 40 consecutive patients evaluated for an isolated left to right shunt at atrial level. Echo free areas along the septum were identified in 23 of 25 patients with a secundum defect, but not in two with a fenestrated defect, and in the upper atrial septum in three of four patients with a sinus venosus defect. No false positive results occurred in 11 patients with a probe patent foramen ovale. Saline contrast injection into the left atrium showed significant left to right shunting in all patients with atrial septal defect; inferior vena caval injection produced right to left shunting in 15 of 29 patients and a negative contrast effect in eight of 29 patients with an atrial septal defect, although neither correlated quantitatively with defect diameter or magnitude of the left to right shunt. Echocardiographic assessment of defect size as small, moderate, or large showed a highly significant correlation with balloon measurement of defect diameter, although some overlap between the groups was evident. In contrast, the correlation between defect diameter and pulmonary to systemic blood flow ratio was poor, mainly because of highly variable shunting in patients with an anatomically large defect. Cross sectional echocardiography has high sensitivity and specificity in the diagnosis of the non-fenestrated atrial septal defect and provides quantitative information about defect diameter. Contrast studies do not add to the diagnostic value of imaging from the subcostal position. The poor correlation between defect size and the measured shunt suggests that the latter may not be the best criterion for surgical management and that size could be an important factor likely to influence both the long term prognosis and the decision for closure.

Adolescent↗
PubMed1984

The silent ductus arteriosus in idiopathic respiratory distress syndrome.

Among 425 pre-term low birthweight babies who survived more than 48 hours there were 130 with idiopathic respiratory distress syndrome, 73 of whom received ventilation for their disease. The ductus arteriosus was considered patent by clinical criteria in 41 of these babies, all but 1 of whom had a murmur. Of the remaining 32 infants there were 2 babies only who died and both were found to have a patent ductus arteriosus which had not been detected clinically. Another baby died whilst being ventilated for idiopathic respiratory distress syndrome and although autopsy information is not available it seems likely that factors other than a patent ductus arteriosus caused death. The mean age of murmur detection in those ventilated infants considered to have a patent ductus arteriosus was 6 days (range 2-19). Infants without a murmur or other features of a ductus arteriosus did not require to be ventilated beyond day 7 with the exception of the 2 fatalities already mentioned. Thus, relying on clinical criteria and particularly on the presence of a murmur, if sought often, rarely results in missing or seriously delaying the diagnosis of patent ductus arteriosus in babies with severe idiopathic respiratory distress syndrome.

Ductus Arteriosus, Patent↗
PubMed1982

Ventricular septal defects. Two dimensional echocardiographic and morphological correlations.

To evaluate the ability of two dimensional echocardiography to identify and classify ventricular septal defects, 280 infants and children with clinically significant ventricular septal defects were studied. Multiple precordial and subcostal echocardiographic planes were scanned in each patient in an attempt to identify the defects. Defects visualised were classified on the basis of the structures which formed their margins. Subsequent correlation of this information with angiographic (280 patients), surgical (130 patients), and pathological (31 patients) data confirmed that defects in the following sites produced a specific two dimensional echocardiographic pattern. (a) Perimembranous inlet, (b) perimembranous outlet, (c) muscular inlet, (d) single trabecular, (e) muscular outlet, and (f) doubly committed subarterial. A defect was identified and correctly classified in 252 patients. Individual defects were identified with varying degrees of accuracy. All subarterial (24 patients) defects were correctly identified and classified, as were muscular defects of the inlet (18 patients) and outlet (six patients) septa. Of the 185 perimembranous defects, 182 were identified. Only 23 of the 43 single trabecular defects were identified. Small multiple ("Swiss cheese") defects (four patients) were not identified. We conclude that two dimensional echocardiography provides a reliable non-invasive method of identifying and classifying the following ventricular septal defects: (a) perimembranous defects, (b) doubly committed subarterial defects, and (c) muscular defects of the inlet and outlet septa. In our experience it fails consistently to visualise defects in the trabecular septum.

Adolescent↗
PubMed1981

Rigid spine syndrome and fatal cardiomyopathy.

A 7 1/2-year-old girl had the clinical features of the rigid spine syndrome of Dubowitz. Muscle biopsy showed a predominance of type 2 fibres with neither myopathic features nor an increase in connective tissue. In addition, she had a hypertrophic cardiomyopathy with which she presented in heart failure and from which she died suddenly one month later. The association of rigid spine syndrome with cardiomyopathy has not been reported previously.

Cardiomyopathy, Hypertrophic↗
PubMed1977

Varicella myocarditis presenting with unusual ventricular arrhythmias.

A 10-year-old boy with varicella developed syncopal episodes caused by runs of self-terminating ventricular tachycardia and ventricular fibrillation. These arrhythmias were thought to be caused by varicella myocarditis and were resistant to most common antiarrhythmic agents. Continuous electrocardiographic recording and analysis proved extremely useful in the management of this case. Mexiletine, a new antiarrhythmic drug, was finally effective in controlling recurrent attacks of ventricular tachycardia.

Arrhythmias, Cardiac↗
PubMed1976

Hemodynamic studies in children four to ten years after the Mustard operation for transposition of the great arteries.

Fourteen patients have been studied hemodynamically 4-10 years (mean 5.5 years) after the Mustard operation for transposition of the great arteries. Investigation was directed principally at 1) the detection of baffle obstruction by catheterization of the pulmonary veins (PV) and venae cavae and recording of simultaneous right ventricular (RV) and pulmonary capillary wedge pressures (PCW); 2) the detection of intra-atrial baffle leaks by dye curves and selective angiography; 3) the assessment of RV and LV function by calculating peak VCE (dp/dt/28p) from high fidelity recordings in 11 patients. Severe baffle obstruction to the PV return was found in only one patient. The others had no or minimal gradients between RV end-diastolic and PCW pressures (mean 1.3 +/- 0.69 mm Hg). Cardiac output was normal at rest (4.1 +/- .22) and increased to 7.1 +/- .62 L/min/m2 (+73%) but the gradient between the RV end-diastolic and PCW pressures remained insignificant (2.2 +/- 1.13 mm Hg). No evidence of caval obstruction was found in any patient. Baffle leaks were found in five patients with mild bidirectional shunting. All arterial oxygen saturations were above 90%. Mild tricuspid regurgitation was demonstrated in two patients by RV angiography and was absent in 12 others. The contractility index peak VCE averaged 1.87 +/- .122 sec-1 for the RV and was significantly lower in the LV (1.53 +/- 1.35 SEC-1, P less than 0.01). Only one patient presented significantly decreased RV contractility with a peak VCE of 1.07 sec-1 and poor contraction on the RV angiogram. These data indicate that the long-term prognosis after the Mustard operation should be good in most patients and that the right ventricle is capable of functioning at the level of contractility of a normal left ventricle.

Angiocardiography↗