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M Leijala

Publications and source records attributed to M Leijala.

62 records · Page 4Linked to original sources
PubMed1983

Diminutive pulmonary artery growth following right ventricular outflow tract enlargement.

We have assessed the clinical results and angiographic pulmonary artery growth following construction of the right ventricular outflow tract in 10 children with tetralogy of Fallot or pulmonary atresia. All cases were associated with diminutive pulmonary arteries and considered unsuitable for total corrective surgery. The mean age of the children was 34 months, mean weight 10 kg and mean body surface area 0.48 m2. The right ventricular outflow tract was constructed by insertion of a patch of dura mater (5 patients), pericardium (2 patients), homograft valved conduit (2 patients) and infundibulectomy (1 patient). The ventricular septal defect was not closed. Study of the patients between 13 and 37 months postoperatively revealed an increase in mean arterial oxygen saturation of 22% (P less than 0.01) and a fall in mean haemoglobin concentration of 1.6 g% (P less than 0.05). Overall change in pulmonary artery diameter compared to that of the trachea was insignificant although in individual cases a 50% increase in diameter was shown. Palliation of symptoms was equivalent to conventional shunting procedures. Closure of the ventricular septal defect was performed successfully in 2 patients at a later date.

Child↗
PubMed1982

Open lung biopsy in children with diffuse pulmonary lesions.

During the period 1973-81, open lung biopsy was performed in 33 consecutive children, aged 1 month to 13 years, to exclude or diagnose Pneumocystis carinii pneumonia and to differentiate other interstitial pulmonary lesions. Twenty-one of the patients were undergoing immunosuppressive treatment because of their malignant disease. The clinical diagnosis was correct only in 55% of the patients, but open lung biopsy and histological examination gave the final answer in every patient. Pneumocystis carinii was the causative organism in 67% of the immunosuppressed patients. Nine patients had postoperative complications, 5 of which were mild in nature and resolved spontaneously. Three patients had to be reoperated on for postoperative sequelae. There was one death possibly caused by surgical intervention--tension pneumothorax 10 days after surgery. It is concluded that open lung biopsy is the most reliable method in the diagnosis of diffuse interstitial pneumonitis in children. The need of anaesthesia is no contra-indication and the benefits of the biopsy far outweight the risks of its complications.

Adolescent↗
PubMed1981

Primary cardiac tumours in infancy and childhood. A review and six case reports.

Primary cardiac tumours are rarities in infants and children. We have had 6 patients, aged 17 days to 10 years, with primary cardiac tumours: 1 had a fibroma, 1 had a myxoma, 2 had an haemangioma and 2 had a rhabdomyoma. Correct diagnosis was missed pre-operatively in 3 cases and finally established at autopsy. Three of the patients underwent cardiac operation-one of them unsuccessfully. At surgery the main difficulties were with tumour infiltration and the multifocal nature of some tumours. We conclude that the echo- and angiocardiography are essential tools in the diagnosis of primary cardiac tumours. Large tumours or conduction tissue infiltration means an extremely poor prognosis. Multifocal cardiac tumours can be successfully removed, even in newborn babies, and the outcome for the patients is also affected by other important factors, e.g. tuberous sclerosis in rhabdomyomas.

Child↗
PubMed1981

The use of tolazoline hydrochloride as a pulmonary vasodilator in potentially fatal episodes of pulmonary vasoconstriction after cardiac surgery in children.

Infants and children with highly reactive pulmonary vasculature may die of an acutely increased pulmonary vascular resistance (PVR) during or after correction of congenital heart defects. Fifteen patients, 11 infants ages 2--12 months (mean 5.3 months) and 4 children ages 2--10 years (mean 5.8 years), were treated with tolazoline to reduce an acutely elevated PVR during or after operation. Five patients had total anomalous pulmonary venous drainage, six had ventricular septal defect and four had truncus arteriosus. Preoperatively, the ratio of systolic pulmonary artery pressure to systemic artery pressure (PAP/SAP) was 0.57--1.54 (mean 0.93), and PVR was 1.8--20 units/m2 (mean 6.2 units/m2). The pulmonary artery pressure was monitored postoperatively by pulmonary artery lines placed at surgery (12 patients) or by balloon flotation catheters (two patients). Acute elevations in PAP/SAP accompanied by clinical deterioration occurred during attempted withdrawal from cardiopulmonary bypass in three patients, during apparently optimal ventilation postoperatively in eight patients, and after withdrawal of ventilatory support in four patients. Administration of tolazoline as a bolus (1--2 mg/kg) followed by infusion of 1--2 mg/kg/hour resulted in a rapid and sustained decrease in PAP/SAP, from 1.00 +/- 0.18 (mean +/- SD) to 0.40 +/- 0.09 (p less than 0.001), and was effective management for all these clinical crises. The use of tolazoline may prevent a fatal outcome from acute elevation of PVR in the perioperative period.

Cardiac Surgical Procedures↗
PubMed1980

Effect of combined cold and pharmacological ischaemic cardioplegia on myocardial intrinsic sympatho-adrenergic system during coronary bypass surgery.

The effect of combined cold and pharmacological ischaemic cardioplegia on the structural integrity and the degree of the functional activity of the inbuilt intrinsic sympatho-adrenergic nervous system was studied by means of fluorescence microscopy of atrial myocardial biopsies obtained in the course of coronary bypass surgery on 8 consecutive patients. The specimens were taken 1) before starting extracorporeal circulation (controls), and 2) at decannulation (i.e. after cold cardioplegic ischaemic asystole and subsequent coronary reperfusion). The cardioplegia was induced by perfusing the coronary arteries via the aortic root with cold "cardioplegic solution" after starting extracorporeal circulation, venting the left ventricle and cross-clamping the ascending aorta. The specimens were processed for semi-quantitative fluorescence histochemical analysis. No changes were observed. Thus, it is concluded that the procedure of the combined cold and pharmacological ischaemic cardioplegia obviously preserves well the neural noradrenalin of the heart, a vital means of compensating for decreasing myocardial contractility. As the clinical parallelism, all patients made a smooth convalescence.

Adult↗