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Biomedical subjects

R D Leachman

Publications and source records attributed to R D Leachman.

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

Successful surgical correction of symptomatic cor triatriatum dexter.

An unusual case of cor triatriatum dexter is presented. Abnormal embryologic development of the eustachian valve caused nearly complete septation of the right atrium in a 67-year-old woman. Multiple supraventricular arrhythmias prompted clinical evaluation and diagnosis. Surgical excision of the anomalous membrane resulted in complete relief from arrhythmias and a clinical cure. Cor triatriatum dexter is rare and is infrequently diagnosed before postmortem study; however, once the diagnosis is extablished, the condition is amenable to a relatively simple surgical correction. Supraventricular tachycardia has not previously been reported to be associated with cor triatriatum dexter. We believe this is the first case in which such arrhythmias led to early diagnosis and successful surgical correction.

Aged↗
PubMed1979

Increased mortality rate from coronary artery disease following operation for coarctation of the aorta at a late age.

Sixty-six patients past 35 years of age at operation for coarctation of the aorta had significantly higher hospital (five of 66, 7.5 percent) and late cardiovascular (10 of 61, 16.4 percent) mortality rates than 137 patients aged 15 to 34 years (mean, 21.9 years). Three of the five hospital deaths, as well as four of the 10 late deaths, in the group greater than 35 years of age were due to myocardial infarction. Thus the total coronary mortality rate was 10.6 percent (seven of 66 patients), with all deaths occurring in men. It appears that coronary artery disease (CAD) is a significant complication in male patients who undergo operation for coarctation of the aorta at a late age.

Adolescent↗
PubMed1978

Echocardiography in the diagnosis of Lutembacher syndrome.

In two patients with Lutembacher syndrome cardiac catheterization demonstrated a large atrial septal defect but no diastolic gradient across the mitral valve. Echocardiography was compatible with right ventricular volume overload and mitral stenosis. Surgical exploration of the mitral valve at the time of atrial septal defect correction is warranted when the echocardiogram is suggestive of mitral stenosis.

Cardiac Catheterization↗
PubMed1978

Anomalous left coronary artery from pulmonary artery. Unusual case complicated by coronary arterial disease and fistula from coronary artery to left ventricle.

A 42-year-old woman with an anomalous left coronary artery originating from the pulmonary artery and a fistula from the left coronary artery to the left ventricle was treated by aortocoronary bypass grafting of an autologous saphenous vein. The presence of an abundant collateral circulation and of fistulous communications between the left coronary artery and the left ventricle, in our opinion, was the reason that this patient remained asymptomatic until the age of 40 years. We believe that this is the first report of the findings in an adult patient who had these two rare congenital anomalies complicated occlusive coronary arterial disease.

Adult↗
PubMed1978

[Anatomy and embriology of double outlet right ventricle (author's transl)].

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.

Heart↗
PubMed1977

Ventricular septal defect following blunt trauma: spontaneous closure of residual defect after surgical repair.

As a result of blunt chest trauma a patient developed a large ventricular septal defect (VSD). After surgical closure of the defect a grade 2/6 systolic murmur persisted. One year later findings were the same and left ventriculogram revealed a small residual VSD. Two years after the operation the systolic murmur had disappeared. We postulate that gradual endothelialization and possibly small thrombi (formed around and over the Dacron patch graft) caused the defect to close. This case serves to illustrate some of the Dacron patch graft) caused the defect to close. This case serves to illustrate some of the complexities in the diagnosis and management of an acquired VSD. To our knowledge this is the first reported spontaneous closure of a VSD occurring after incomplete surgical repair.

Adult↗
PubMed1977

Horses lung: Report of two cases.

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.

Abnormalities, Multiple↗
PubMed1977

Truncus arteriosus communis. Unusual case associated with transposition.

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.

Child, Preschool↗
PubMed1976

Radiation-related myocardial injury. Management of two cases.

Pericardial effusion and trifascicular block developed 5 years following mediastinal irradiation for Hodgkin's disease in a 19-year-old patient. Another 24-year-old patients had an acute myocardial infarction followed by severe angina pectoris 5 years following mediastinal irradiation for the same disease. A pericardial window and a permanent demand pacemaker were used in the first case; an aorto-coronary vein grafting was utilized in the second patient. Both patients responded to treatment and are well. Five other previously reported cases of myocardial injury that occurred 2 months to 8 years following mediastinal irradiation in young patients were reviewed. To our knowledge, successful surgical treatment of this disease entity has not been reported before. Close, long-term follow-up of patients who have received mediastinal irradiation should be helpful in the early recognition and successful management of these serious cardiac complications. The systematic clinical and radiographic surveilance of these patients should be supplemented by a routine 12-lead electrocardiogram.

Adult↗
PubMed1976

Association of ostium secundum atrial septal defects with mitral valve prolapse.

Severe prolapse of the mitral valve leaflets was seen at left ventricular angiography in 16 of 92 patients with a secundum type atrial septal defect studied prospectively from 1970 to 1974. The patients were aged 15 to 69 years; angioplasty or mitral valve replacement was carried out in nine. In 9 of 122 patients aged 15 to 55 years who were operated on for closure of a secundum type atrial septal defect between 1956 and 1969, mitral regurgitation due to prolapse but with intact chordae tendineae was seen at operation. In three of these patients chordal rupture was seen at a second operation 2 to 6 years later. The outlook in the syndrome of mitral valve prolapse may be less benign than is usually believed.

Adolescent↗
PubMed1976

Supravalvular mitral stenosis associated with tetralogy of Fallot.

The association of tetralogy of Fallot with supravalvular mitral stenosis is a rare anomaly that has been reported only once previously. The difficulty of preoperative diagnosis is emphasized. Although left-sided obstructive lesions in association with tetralogy of Fallot are rare, their recognition is imperative since these are surgically correctable anomalies and potentially lethal, as proved in this case and the one previously reported.

Adult↗
PubMed1976

Supravalvular stenosing ring of the left atrium.

Two patients with supravalvular stenosing ring of the left atrium are described. In 1 patient with an associated ventricular septal defect and Wolff-Parkinson-White syndrome, the diagnosis of supravalvular stenosing ring was only suspected. This patient underwent correction but died 34 days after the operation because of pulmonary embolism. In the second patient a preoperative diagnosis was not made, and this contributed to his death following correction of tetralogy of Fallot. The association of these two anomalies is very rare. Differential diagnosis from other congenital anomalies producing obstruction of left atrial flow is discussed. The divergent microscopical features of the membrane in supravalvular stenosing ring of the left atrium and in cor triatriatum are described. The value of cardiac catheterization, angiography, and echocardiography as diagnostic aids is emphasized. The hazards of not recognizing and diagnosing this anomaly when associated with other cardiac malformations are pointed out.

Adult↗
PubMed1976

Surgical repair of atrial septal defect in patients over 60 years of age. Long-term results.

In order to evaluate results of surgical repair of secundum atrial septal defect (ASD) in patients 60 years of age or older, a review was made of 16 patients who had undergone such operation between January 1964 and December 1974. Before operation eight patients were in functional classification III (New York Heart Association), seven were in class II, and one was in class I. Twelve patients had a left-to-right shunt greater than 3:1. Pulmonary artery systolic pressure was greater than 40 mm Hg in 12 patients and greater than 60 mm Hg in five. Four patients had documented paradoxical emboli and were being treated with Coumadin. Before operation all patients but one were receiving digoxin. Repair was accomplished by direct suture in two patients and Dacron patch graft in 14. No deaths occurred during the postoperative period. Postoperatively, ten patients were in class I, five in class II, and one remained in class III. The hospital stay ranged from eight to 20 days (average 11 days). Two patients died one year and another (at the age of 77) five years after surgery. The remaining 13 patients are alive and well three months to 11 years after surgery. We conclude that repair of secundum ASD in patients over the age of 60 is safe, has low morbidity, and produces considerable clinical improvement.

Age Factors↗
PubMed1976

Occlusion of the left main coronary artery secondary to left ventricular angioma.

Our experience with a patient who had an angioma of the anterior wall of the left ventricle that produced complete occlusion of the left main coronary artery is presented. Diagnosis was made before surgery from findings on cineangiographic studies. Successful surgical treatment consisted of a double aortocoronary bypass to the left anterior descending and obtuse marginal coronary arteries. The angioma was left undisturbed.

Adult↗
PubMed1976

Intraventricular repair of transposition complexes with ventricular septal defect.

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.

Adolescent↗
PubMed1975

Surgical experience in patients with Marfan's syndrome, ascending aortic aneurysm and aortic regurgitation.

Surgical treatment of cardiovascular complications in patients with Marfan's syndrome is usually recommended with apprehension since the systemic nature of the disease predisposes to early and late complications. To define the incidence of these complications, 30 patients were evaluated after surgical treatment of aortic insufficiency and ascending aortic aneurysm at the Texas Heart Institute. To provide a minimal follow-up period of 5 years, only patients operated upon during of before 1968 were included in this series. There were 9 female and 21 male patients aged 4 to 80 years (mean 44 years). Aortic insufficiency was treated by valvuloplasty in 3 patients and by aortic valve replacement in 27. Graft replacement of the ascending aorta was required in 23 patients, and the aneurysm was excised and the aorta repaired by direct anastomosis in 7. Two patients were lost to follow-up study; 12 of the remaining 28 (42.8 percent) lived 5 years or more. The hospital mortality rate was 20 percent (6 of 30); the causes of death included dissection or rupture of the aorta in three patients, congestive heart failure in two and pulmonary embolism in one. The 24 survivors lived from 5 weeks to 9 years. Follow-up data were available on 22 of these patients. Ten of these (45.4 percent) died of late complications. Seven died suddenly, four of these had redissection, one patient had occlusion of the right coronary artery, and two had ventricular fibrillation of no apparent cause. The remaining three died of noncardiac causes. Although the risk of ascending aortic and aortic valve surgery in patients with Marfan's syndrome is high, 42.8 percent of the patients in our series survived 5 years or more. We believe that surgery should be recommended for patients with Marfan's disease who have dissection of the aorta or severe aortic regurgitation, or both.

Adolescent↗