[Obstructions of the left ventricular outflow track. Clinical experience with the use of composite tubular prostheses].
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Biomedical subjects
Publications and source records attributed to P Angelini.
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After formulating the definition of double outlet right ventricle (DORV) as the persistence origin of the trunco-conal structures from the right ventricle, 64 autopsy cases meeting this definition were reviewed. A wide spectrum of anatomic variations of DORV were found. A classification is proposed based upon the type of relationship between the great vessels and upon the presence and type of ventricular septal defect. Twenty-five cases had normally crossed great arteries (13 of which had pulmonic stenosis), nine cases had transposed vessels and 23 cases had a double muscular conus and a side-by-side arrangement of the great vessels in the frontal view, a relationship called "partial distortion" or atypical transposition. Seven cases had absent trunco-conal septum (common truncus). Only one case had intact ventricular septum. Anterior ventricular septal defect was found only in cases with partial distortion or common truncus. Angiographic and surgical correlations are presented. Because of their great heterogeneity, the need for detailed description of the anatomy of the individual case of DORV is emphasized.
Two cases of horseshoe lung are described; one was suspected and the other was diagnosed preoperatively. Both underwent successful surgical treatment. The embryology of this anomaly is briefly reviewed with reference to the closely related scimitar syndrome (anomalous venous return of right lung to inferior atriocaval junction). Diagnostic studies are discussed with stress on the need for a thorough functional evaluation of both the heart and lungs before the surgical indication is made.
A child with truncus arteriosus communis, characterized by the posterior origin of an individualized pulmonary trunk is presented. This relationship between the great arteries is unusual in truncus arteriosus communis and the spatial orientation resembles that seen in transposition of the great vessels. A brief discussion is proposed about a proper terminology in this type of complex anomaly.
Anomalous origin of the left coronary artery from the pulmonary artery is a rare and usually fatal congenital malformation. Most surgical attempts to correct this anomaly have been unsuccessful, particularly those in infants. Recently, four patients underwent reimplantation of an anomalous left coronary artery into the aorta; all four survived the operation and are asymptomatic. This technique of reimplantation of the aberrant vessel into the aorta appears to be prefereble to other methods of repair, especially since it can be applied in any patient with the anomaly regardless of age or size. Because of the poor prognosis for patients with anomalous left coronary artery, surgical intervention should be made as soon as the diagnosis is made.
Volatile components present at spoilage of refrigerated chicken breasts were identified using high-vacuum-low-temperature distillation techniques followed by analysis with combined temperature-programmed gas chromatography and mass spectrometry. A comparison was made of the compounds detected from both irradiated and non-irradiated muscle stored at 2 and 10 degrees C under both aerobic and anaerobic conditions. Isolates were randomly selected from the spoiled poultry, identified, and evaluated for their ability to produce volatile spoilage noted when grown on radiation-sterilized chicken. Several isolates that produced off-odors on sterile chicken breasts were examined. Twenty-two compounds were associated with spoilage. Some of the compounds found on both irradiated and unirradiated samples were considered to play only a minor role in the spoilage aroma or were present in low concentrations, since the aroma of spoiled irradiated chicken lacked the harsh odor notes typical of spoiled unirradiated chicken. Fifteen of the 22 compounds were considered to be unique to unirradiated, aerobically spoiled samples. Nine of these compounds, hydrogen sulfide, methyl mercaptan, dimethyl sulfide, dimethyl disulfide, methyl acetate, ethyl acetate, heptadiene, methanol, and ethanol, were found on chicken spoiled at both 2 and 10 degrees C. xylene, benzaldehyde, and 2,3-dithiahexane were detected only in samples stored at 2 degrees C and methyl thiolacetate, 2-butanone, and ethyl propionate were associated with 10 degrees C spoilage. Fifty-eight isolates randomly selected from fresh, radiation-pasteurized, and unirradiated spoiled poultry were classified taxonomically, and 10 of them, which produced spoilage odors on sterilized chicken breasts, were selected for subsequent analysis of their volatiles. Isolates identified as Pseudomonas putrefaciens and Pseudomonas species that were members of groups I and II of Shewan's classification, as well as Flavobacterium and oxidative Moraxella, produced a number of the compounds found in the aroma of spoiled chicken. A total of 17 compounds were identified. Whereas no isolate produced all of the aroma compounds found in the aroma of spoiled chicken, together they did produce the nine found in unirradiated samples spoiled at either 2 or 10 degrees C, as well as methyl thiolacetate and xylene. Six compounds were present in the volatiles produced by the isolates but were absent in the volatiles identified from spoiled chicken. These were hydrogen cyanide, methyl isopropyl sulfide, 2-propane thiol, methyl propionate, ethyl benzene, and an unidentified compound.
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Repair of transposition of the great arteries by the technique developed by Mustard is the method routinely used for correction of such anomalies. Intraventricular repair of transposition complexes associated with a large ventricular septal defect can prevent some of the limitations and late complications of the intra-atrial operation. A technique is described of intraventricular repair of an unusual Taussig-Bing type of anomaly with a pericardial patch as a baffle to channel left ventricular outflow to the aorta and right ventricular outflow to the pulmonary artery.
The case of a three year-old child with anomalous origin of the left coronary artery from the pulmonary artery is presented. He had a clinical picture and an electrocardiographic pattern of antero-lateral myocardial infarction that suggested a cardiac malformation. Once the diagnosis was established by cardiac catheterization and coronary arteriography, the defect was successfully correted by transplanting the anomalous coronary vessel to the aorta. The clinical, electrocardiographic and angiographic features of the anomaly are given.
Two Pseudomonas fluorescens isolates were found to produce hydrogen cyanide when cultured on either Trypticase soy agar supplemented with 0.5% yeast extract or on irradiation-sterilized chicken.
Two maternal cousins affected by the X-linked form of Ehlers-Danlos syndrome have been observed. Both had congenital heart disease, "floppy valve syndrome", hernias, short stature, stretchable skin and moderate joint hypermobility. Both excreted normal amounts of urinary glycosaminoglycans, almost entirely represented by dermatan sulfate, whose degradation appeared to be inadequate. They also excreted large amounts of hydroxylysine glycosides and L-valyl-proline, considered to be products of degradation of collagen and elastin, respectively. Cultured skin fibroblasts of the propositus synthesized excessively soluble collagen and had a low lysyl oxidase activity. These findings suggest that the increased degradation of structural proteins may be secondary to the defective cross-linking processes caused by the enzymic defect. Addition of (+) catechin, a flavonoid, to the propositus's cultured fibroblasts decreased the abnormal solubility of their collagen.
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