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Biomedical subjects

R H Anderson

Publications and source records attributed to R H Anderson.

At least 289 records · Page 16Linked to original sources
PubMed1990

Abnormalities of the spleen in relation to congenital malformations of the heart: a survey of necropsy findings in children.

A series of 1042 reports of necropsies on children dying at Children's Hospital of Pittsburgh was reviewed. In each case, note was taken of the status of the spleen, the lobation of the lungs, the arrangement of the bronchi, the morphology of the atrial appendages, and the presence of any congenital malformations of the heart and great vessels and of any malformations of the abdominal organs. There was isomerism of the left atrial appendages in eight (0.77%), 13 (1.25%) showed isomerism of the right appendages, and seven (0.67%) had multiple spleens without having isomerism of the atrial appendages. Unexpectedly, a normal spleen was found in one patient with isomerism of the right appendages and also in a patient with isomerism of the left appendages. In one patient with isomeric left atrial appendages there was no spleen. The review showed that the morphology of the atrial appendages, and hence the arrangement of the atria, is not accurately predicted by the type of spleen. The arrangement of the atrial appendages is the most reliable guide to the recognised combinations of congenital cardiac malformations previously described as "splenic syndromes". Because there is no certain way of predicting all the malformations in patients with complex congenital heart disease, it is advisable to record separately for each patient the details of lobation of the lungs, the bronchial and atrial arrangement, anomalies of the heart and great vessels, the type of spleen, and any abnormal arrangement of the abdominal organs.

Abnormalities, Multiple↗
PubMed1990

Morphological evaluation of atrioventricular septal defects by magnetic resonance imaging.

Twelve patients aged between 2 weeks and 22 months (median 6 weeks) with atrioventricular septal defects were examined with a 1.5 T, whole body, magnetic resonance imaging system. Ten patients had a common atrioventricular orifice (complete defect) while two patients had separate right and left valve orifices (partial defect). Associated cardiac malformations included the tetralogy of Fallot in two, isomerism of the right atrial appendages and pulmonary atresia in two, and right isomerism and double outlet right ventricle in one. All had previously been examined by cross sectional echocardiography. Eight subsequently had angiography and six underwent surgical correction. There was one operative death and three other deaths. Three of these patients underwent postmortem examinations. Small children and infants were scanned inside a 32 cm diameter head coil. Multiple electrocardiographically gated sections 5 mm thick, separated by 0.5 mm, were acquired using a spin echo sequence with echo time of 30 ms. A combination of standard and oblique imaging planes was used. Magnetic resonance imaging was more accurate than echocardiography in predicting the size of the ventricular component of the defect. It was also better than either echocardiography and angiography in identifying the presence of ventricular hypoplasia. All these findings were confirmed by surgical or postmortem examinations or both. Magnetic resonance imaging is capable of providing detailed morphological information in children with atrioventricular septal defects which is likely to be of value in their management.

Abnormalities, Multiple↗
PubMed1990

Transoesophageal echocardiography in the longitudinal axis: correlation between anatomy and images and its clinical implications.

Transoesophageal echocardiographic imaging in the longitudinal axis is a recent addition to the non-invasive evaluation of congenital and acquired heart disease. The technique provides unique images of intracardiac anatomy but their interpretation remains difficult. A heart specimen was therefore cut according to the echocardiographic imaging planes to elucidate the morphological details. The results suggested that longitudinal transoesophageal imaging complements the transverse axis approach. It gave new imaging information on the right ventricular outflow tract and the pulmonary trunk, the atrioventricular valves, the interventricular septum, the cardiac apex, and the thoracic aorta. In particular, it showed the entire length of the right ventricular outflow tract. When longitudinal imaging was used in combination with transverse imaging almost all the thoracic aorta could be examined. Imaging in the longitudinal axis may also allow better assessment of the mechanisms of atrioventricular valve regurgitation.

Aorta, Thoracic↗
PubMed1990

Diagnostic echocardiographic features of the sinus venosus defect.

To establish the diagnostic criteria for a sinus venosus atrial septal defect cross sectional echocardiograms, cineangiograms, and surgical notes of all patients with this diagnosis seen at the Children's Hospital of Pittsburgh between 1986 and 1988 were reviewed. Seven patients were identified. In each the extent of the atrial septum and the nature of the junction of the superior vena cava with the atria were evaluated echocardiographically from the subcostal position. All had overriding of the superior vena cava and abnormally connected right pulmonary veins. Six patients had undergone cardiac catheterisation and cineangiography. Five patients underwent surgical repair. The operative findings were consistent with the expected morphology in all five, and these features were additionally confirmed in a specimen from the cardiopathological museum. Therefore, the basic anatomical feature of a superior sinus venosus interatrial communication is a biatrial connection of the superior vena cava. This, together with anomalous drainage of the right sided pulmonary veins, results in an interatrial communication outside the confines of the true atrial septum. Overriding of the superior vena cava across the upper rim of the oval fossa is suggested as the pathognomonic diagnostic feature that can clearly be demonstrated echocardiographically from the subcostal position. In essence the lesion is an interatrial communication rather than an atrial septal defect.

Adolescent↗
PubMed1990

Morphologic features of the hypoplastic left heart syndrome--a reappraisal.

The report describes the morphologic features of 102 specimens with hypoplasia of the chambers of the left heart, all with either a concordant atrioventricular connection (66 cases) or absence of the left atrioventricular connection, the right atrium being connected to a dominant right ventricle (36 cases). Either the aorta was connected to the left ventricle, having a patent valve in 23 cases and an imperforate valve in 5, or else the aortic trunk was atretic (74 cases). It was not possible to determine with certainty the ventricular origin of the aorta when its trunk was atretic, but in all hearts but 1 it seemed to be connected to the left ventricle. The atrial septum was intact in 11 hearts and grossly restrictive in a further 8. Deviation of the atrial septum relative to the infolded atrial roof (septum secundum) was seen in 32 specimens. The ventricular septum was intact in 88 hearts. The length of the left ventricle compared to the right was greatest in the 14 hearts with a ventricular septal defect. The left ventricular length was also significantly greater in hearts with a patent aortic valve. The state of the atrial septum, in contrast, bore no relationship to the dimensions of the left ventricle. Aortic coarctation was found in 44 of the hearts, and in all but 2 the shelf lesion was preductal in location. Coarctation was significantly more frequent in those hearts in which the ascending aorta was less than 3 mm in diameter. The anatomic findings are discussed in relation to recent advances in the surgical palliation of these malformations.

Aortic Coarctation↗
PubMed1990

Options for surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis.

Thirteen patients have undergone surgical treatment because of subaortic obstruction in hearts with a univentricular atrioventricular connection. Nine patients underwent surgical enlargement of the ventricular septal defect and four patients had construction of an aortopulmonary anastomosis and closure of the pulmonary trunk (the Damus-Kaye-Stansel procedure). Two patients undergoing enlargement of the septal defect and two having the Damus-Kaye-Stansel procedure also had a modified Fontan procedure. One patient had complete atrioventricular dissociation after direct enlargement of the ventricular septal defect, which necessitated insertion of an epicardial pacemaker. One patient died within 30 days of the operation after enlargement of the defect and two patients after the Damus-Kaye-Stansel procedure. There was one late death, occurring in a patient who underwent enlargement of the ventricular septal defect. Ten patients have subsequently undergone conventional cardiac catheterization and angiography or transcutaneous Doppler flow studies to assess the relief of the subaortic obstruction. The result has been satisfactory in all. Because of this experience, we now recommend direct surgical enlargement of the restrictive ventricular septal defect for direct relief of subaortic stenosis occurring with a univentricular atrioventricular connection to a dominant left ventricle, inasmuch as it appears to be hemodynamically effective with a low operative mortality and morbidity. The Damus-Kaye-Stansel procedure can also have a role in relieving subaortic stenosis when the atria are connected to a dominant right ventricle.

Aortic Valve Stenosis↗
PubMed1990

Absence of one atrioventricular connection associated with straddling atrioventricular valve: distinction of a solitary from a common valve and further considerations on the diagnosis of ventricular topology.

Hearts with absence of the right atrioventricular connection (tricuspid atresia) are rarely associated with straddling of the left atrioventricular valve. We describe two hearts in which the left atrium is connected mostly to a dominant left ventricle but, in part, to a rudimentary right ventricle. In these particular hearts, this arrangement caused major problems in determining ventricular topology. This feature, the so-called handedness of the ventricular mass, is determined in hearts with two complete ventricles by attempting to place the palm of one's hand on the right ventricular septal surface with the thumb in the inlet and the fingers pointing to the outlet. The problems in these two cases were produced because the rudimentary right ventricle had only part of an inlet component. The discerned pattern of topology was different in the two cases, being left hand in one and right hand in the other. These cases emphasize, first, the need to distinguish between ventricular topology and the atrioventricular connection and, second, between a solitary and a common atrioventricular valve when the valvar tension apparatus is straddling.

Heart Atria↗
PubMed1990

The site of origin of nonconfluent pulmonary arteries from a common arterial trunk or from the ascending aorta: its morphological significance.

There are three possible embryological derivatives for nonconfluent pulmonary arteries which arise from a common arterial trunk or from the ascending aorta. We considered the feasibility of identifying these derivatives on the basis of the site of origin. We examined 15 specimens, in which both pulmonary arteries arose by separate orifices from a common arterial trunk (persistent truncus arteriosus), and 3 specimens, in which one pulmonary artery arose from the ascending aorta, the other being connected to the morphologically right ventricle (hemitruncus). Measurements were made for both the upper and lower margins of the orifices of the pulmonary arteries and then expressed as a percentage of the length of the ascending common trunk or aorta. The position of origin ranged from 39 to 100% for the upper margin and from 17 to 90% for the lower margin, without significant difference between left and right arteries. Since the range varied so widely, we contend that it is not possible to make a morphological identification of the pulmonary artery under consideration simply on the basis of the location of the site of origin.

Aorta↗
PubMed1990

Anomalies of the left atrioventricular valve and related ventricular septal morphology in atrioventricular septal defects.

A characteristic feature of atrioventricular septal defects is a deficiency of the inlet part of the ventricular septum that results in a "scooped out" appearance. The depth of the scoop in relation to the disposition of the atrioventricular valves has been debated. To clarify the relation between the morphology of the ventricular septum and the disposition of the atrioventricular valves, we quantified these anatomic features in 151 hearts at autopsy to determine whether those features identified particular groups within the overall lesion. We found that 137 hearts had left atrioventricular valves with three leaflets. The left valve in the other 14 hearts exhibited a dual orifice, a two-leaflet or one-leaflet arrangement, or was imperforate. These anomalies could be analyzed in terms of a sequence of diminishing formation of the commissures. Also, three-leaflet valves displayed a variability in which the angular size of the mural leaflet correlated negatively with that of the inferior leaflet. In some of the hearts with a common atrioventricular orifice, the bridging leaflets did not meet over the ventricular septum, thus creating a "gap." The mural leaflet's angular size corresponded to a deficiency of the combined inferior-mural leaflet complex. Hearts with an abnormal disposition of the left atrioventricular valve had the ventricular septum "scooped" to a greater extent than those with a common orifice, although most had separate right and left atrioventricular orifices.

Heart Septal Defects↗
PubMed1990

Further morphologic studies on tetralogy of Fallot, with particular emphasis on the prevalence and structure of the membranous flap.

We have investigated 158 hearts from patients with tetralogy Fallot so as to probe the precise anatomy of so-called membranous flaps and their relationship to the ventricular septal defect, the tricuspid valve, and the atrioventricular conduction axis. A membranous flap was detected in 61 hearts (38.6%) of the 158, all being found when the ventricular septal defect was perimembranous. Two types of flap were discovered. A remnant of the interventricular membranous septum (or a real flap) was seen in 32 and reduplication of the leaflets of the tricuspid valve (pseudoflap) was present in 32. The pseudoflaps either were connected to the anteroseptal commissure of the tricuspid valve or were attached to the medial papillary muscle complex. The medial papillary muscle was abnormally attached more frequently in those hearts with flaps (31%, 52%) than in the ones lacking a flap (5%) (p less than 0.01). An anomalous arrangement of the leaflet of the tricuspid valve was significantly more prevalent in those hearts with a pseudoflap (41%) than in those with a real flap (14%) and in those without a flap (9%). There was a tendency for real flaps to be smaller (p less than 0.05) and thinner than pseudoflaps. A few flaps were considered too tiny to warrant placement of sutures within their structure during surgical repair. During our investigation, we noted also the morphologic arrangement of the rest of the hearts.

Aortic Valve↗
PubMed1990

Surgical implications of juxtaposition of the atrial appendages. A review of forty-nine autopsied hearts.

We studied 49 hearts with juxtaposition of the atrial appendages, concentrating on the associated malformations and features of operative importance. Left juxtaposition was found in 42 cases (86%) and right juxtaposition in seven cases (14%). In the group of hearts with right juxtaposition, a normal segmental arrangement was present in three cases, double inlet in two cases, and double-outlet right ventricle in the remaining two cases. Hearts with left juxtaposition had usual atrial arrangement with concordant atrioventricular connection, together with anomalous ventriculoarterial connection in 22 cases and univentricular atrioventricular connection in 19 cases. Only one specimen had a normal segmental arrangement. A partial form of left juxtaposition was present in 60% of the specimens. Hearts with left juxtaposition had a transverse orientation of the atrial septum, which was displaced posteriorly and inferiorly in the medial atrial wall, separated from the orifice of the juxtaposed appendage by a muscular band. A small right atrial chamber was noted in hearts with anomalous ventriculoarterial connection, creating the potential for anatomic difficulties during operation conducted within the atria. In two thirds of the cases with classic tricuspid atresia, the size of the orifice of the juxtaposed appendage was larger than the atrial septal defect, and an anastomosis of the appendage with the pulmonary trunk was morphologically feasible.

Adolescent↗
PubMed1989

Coronary arterial and sinusal anatomy in hearts with a common arterial trunk.

Eighty-four specimens of common arterial trunk were studied with special reference to the arrangement of the leaflets in relation to the atrioventricular valves, the origin of the coronary arteries in relation to the arterial sinuses, and the epicardial course of the coronary arteries. Fourteen normal hearts were used for comparison. In the hearts with common arterial trunk, the location and level of the coronary artery orifices (as well as the relationship of the truncal root to the area of fibrous continuity with the mitral valve) are different from those in normal hearts. In none of the hearts with common arterial trunk (particularly the 53 hearts with three leaflets in the truncal valve) did the appearance of the truncal valve approximate that of a normal aortic valve. Among the 22 hearts with four leaflets, there was a high incidence of coronary artery orifices in opposite sinuses (17/22 or 77.3%) and a low incidence of coronary artery orifices in adjacent sinuses (2/22 or 9.1%). These results suggest that the formation of the truncal valve is independent of the formation of the coronary orifices. Its leaflets are not predestined to become part of either the aortic valve or the pulmonary valve.

Coronary Vessel Anomalies↗