Search PubMed⌕ Search

Biomedical subjects

R H Anderson

Publications and source records attributed to R H Anderson.

At least 307 records · Page 17Linked to original sources
PubMed1989

Cardiovascular cavities cast in silicone rubber as an adjunct to post-mortem examination of the heart.

We used silicone rubber as a material for making post-mortem casts of cavities in 21 human hearts, 16 of them congenitally malformed, 13 after surgical reconstruction (Fontan and Norwood procedures) and 4 after reconstruction had been performed posts mortem for study purposes. The organs were either fresh, or had been perfusion fixed with formalin prior to casting. When suitable silicone rubber and catalyst were used, we found that casts allowed a very clear view of chamber morphology, and, where surgery had been performed, of any vascular constriction or distortion. We made casts of the aortic sinus and coronary arteries in 3 adult hearts, demonstrating the location and extent of indentation due to atheromatous deposits. The resilience and non-adhesiveness of the silicone rubber allowed casts to be extracted without recourse to corrosion. The surrounding tissues, with the exception of trapped trabeculations and valve structures, were then available for conventional pathological examination. We propose that the relatively simple technique has important applications, not practicable using earlier casting materials, for the study of cardiovascular morphology, and for post-mortem evaluation of stenosed or surgically reconstructed vessels.

Adult↗
PubMed1989

The accuracy of fetal echocardiography in the diagnosis of congenital heart disease.

The accuracy of the echocardiographic diagnosis of fetal heart disease in an experienced centre was evaluated by analysing the results achieved during 1987 at the Perinatal Cardiology Unit, Guy's Hospital. In this one year, 978 high-risk patients were referred for fetal echocardiography. Of these, 74 cases were found to have cardiac malformation, 69 of which were predicted from the prenatal study. Of the 69, the autopsy specimen was available for correlative purposes in 41 cases. A postnatal echocardiogram was performed by us in a further 15 cases. The result of autopsy or of a postnatal echocardiogram was obtained from another hospital in 7 cases. Postmortem was refused in 5 cases, while one further case remains alive but has not had a postnatal echocardiogram. Close correlation was achieved between the predicted echocardiographic diagnosis and the anatomical results. Some minor errors in the complete interpretation of a defect were found, particularly in those fetuses in whom image quality was poor, due to early (less than 20 weeks) or late (greater than 34 weeks) gestation or to maternal obesity. Difficulty in echocardiographic interpretation was also experienced in unusual defects. There was one false positive prediction of coarctation of the aorta. One major (total anomalous pulmonary venous drainage) and 5 minor abnormalities (two atrial and three ventricular septal defects) detected after birth were overlooked on the fetal study. Although the echocardiogram in prenatal life is not as accurate as it can be postnatally, with suitable experience a high degree of precision can now be achieved.

Autopsy↗
PubMed1989

Persistent 5th aortic arch--a great pretender: three new covert cases.

Although persistence of the embryonic fifth aortic arch is considered a rare congenital malformation, analysis of the records of the cardiopathological collections of the Brompton and Killingbeck Hospitals reveals 6 examples in approximately 2000 specimens, an incidence amongst our material of 1 in 330. Since our review of the literature reveals only a further 13 described cases, we wonder if the condition may go unrecognized rather than being exceedingly rare. This possibility is further supported by the fact that 3 of our cases were incorrectly interpreted when initially described. In this report, we describe the details of 2 of these specimens and one other case that was not included in our earlier descriptions of this malformation. The first case had the persistent fifth arch as a conduit between the pulmonary and systemic circulations in the setting of aortic atresia with interruption of the aortic arch. The second case demonstrated a double lumen aortic arch, the fifth arch in this instance being an accessory systemic-to-systemic conduit. In the final case, the persistent arch was initially considered to represent an aorto-pulmonary window but review revealed an aortic to pulmonary conduit more in keeping with the presence of a fifth arch. We conclude that the powers of mimicry of this enigmatic structure may account for its apparent rarity.

Aorta, Thoracic↗
PubMed1989

Congenital atresia of the orifice of the left coronary artery and its main stem.

A 13-year-old black male who died suddenly as a result of atresia of the left coronary ostium and left main coronary artery is presented. An association between this anomaly and supravalvar aortic stenosis is observed. The literature is reviewed and 14 similar cases are compared. Presentation of this anomaly is variable, as is survival and may be attributed to the development of an adequate collateral circulation.

Adolescent↗
PubMed1989

Cross sectional echocardiography for recognition of ventricular topology in atrioventricular septal defect.

The cross sectional echocardiograms of 150 children with atrioventricular septal defects were reviewed to determine the spatial orientation of the ventricles. In 125 cases with usual atrial arrangement (situs solitus), ventricular topology showed the right hand pattern. Of the 25 patients with atrial isomerism, 13 had similar right hand topology but 12 (48%) had the left hand pattern. This finding was more common in hearts in the right side of the chest (dextrocardia), but there was no significant correlation between ventricular topology and number of atrioventricular valves or the ventriculoarterial connection. In part because of inferences for disposition of the conducting tissue, knowledge of ventricular topology is important when operation for atrioventricular septal defects is considered. Ventricular topology can be promptly recognised by cross sectional echocardiography.

Echocardiography↗
PubMed1989

Magnetic resonance imaging of coarctation of the aorta in infants: use of a high field strength.

Nineteen infants with suspected coarctation of the aorta were studied with electrocardiographically gated magnetic resonance imaging on a 1.5 T whole body imaging system. In all cases imaging was successful and produced diagnostic images of high resolution. Coarctation was shown in 12 cases. The position and shape of the coarctation were well displayed by the magnetic resonance images. In addition, they clearly showed the relation of the coarctation to arteries arising from the aortic arch and to the length and diameter of the aortic isthmus and the distal aortic arch. The anatomy was confirmed at operation in all 12 patients, except for two with a small ductus arteriosus (arterial duct), which was not seen in the magnetic resonance images. In the seven remaining patients, coarctation was excluded. Magnetic resonance imaging produced high quality images that showed the anatomy better than other non-invasive methods. It provided all the anatomical information required for surgical correction.

Aorta, Thoracic↗
PubMed1989

Magnetic resonance imaging at a high field strength of ventricular septal defects in infants.

Magnetic resonance imaging at a high field strength has potential benefits for the study of the heart in infants, which is when most congenital heart disease presents. Seventeen infants with various anatomical types of ventricular septal defect were studied by this technique. Good quality, high resolution, images were obtained in every case. There were no major practical problems. The morphology of the defects in all 17 hearts was displayed in great detail. In some instances, the interpretation of the images resembled that of equivalent images from cross sectional echocardiography. But this new technique allowed imaging in planes that cannot be obtained by echocardiography. One particularly valuable plane gave a face on view of the inlet and trabecular components of the septum. This allowed very precise localisation of defects in these areas. The relation between the defects and the atrioventricular and arterial valves was exceptionally well shown in various different imaging planes. One patient in the series had multiple trabecular defects that were clearly shown. Magnetic resonance imaging gives detailed morphological information about ventricular septal defects.

Heart Septal Defects, Ventricular↗
PubMed1989

Anomalous origin of one pulmonary artery from the ascending aorta: a review of echocardiographic, catheter, and morphological features.

Six patients with anomalous origin of one pulmonary artery from the ascending aorta were reviewed. Four had anomalous origin of the right pulmonary artery and two had anomalous origin of the left pulmonary artery from the ascending aorta. Two of these six patients had tetralogy of Fallot. Two patients died in the first month of life. No changes in the pulmonary vasculature were seen at necropsy. Corrective surgery was attempted in two patients with associated tetralogy of Fallot when they were two years old but both died. At necropsy there was severe pulmonary vascular disease in the lung supplied by the anomalous pulmonary artery but no pulmonary vascular hypertensive changes in the lung supplied by the pulmonary artery from the right ventricle. Two recent patients underwent successful anastomosis of the anomalous pulmonary artery to the main pulmonary artery at three months and one month and three weeks of age respectively. Intraoperative lung biopsy in the latter patient showed early changes in both lungs. Both echocardiography and cardiac catheterisation were used in the diagnoses. Systemic or suprasystemic pressures were found in the pulmonary artery arising from the right ventricle as well as the anomalous pulmonary artery in the three patients without tetralogy of Fallot. Anomalous origin of a pulmonary artery from the ascending aorta is a distinct entity and differs from other aorto-pulmonary arterial connections. Early surgical intervention is recommended in all patients (including those patients with associated tetralogy of Fallot) because of the risk of rapid development of irreversible pulmonary vascular disease.

Adult↗
PubMed1989

Morphological nature of the atrioventricular valves in hearts with double inlet left ventricle.

The rudimentary right ventricle in hearts with double inlet to a dominant left ventricle can exist either to the right or the left side of the ventricular mass. These variants have been interpreted to imply differences in ventricular topology. If correct, they also imply that differences should exist in the morphology of the atrioventricular valves, previously thought to be indistinguishable one from the other. To test this possibility, we examined 15 hearts with double inlet to a morphologically left ventricle and 10 normal hearts. The distinguishing features of normal valves were evaluated for their consistency, and the most reliable were employed for interpreting the valves in the abnormal hearts. As shown by previous echocardiographic studies, insertion of valvar tension apparatus to the interventricular septum was unique to the morphologically tricuspid valve. Ten of the abnormal hearts had one valve showing this feature, it being absent in the other valve. The attachment, consistently on the same side as the rudimentary right ventricle, could be of diagnostic value in determining ventricular topology. In our small study, nonetheless, this approach still leaves one third of the hearts in which topology cannot be ascertained with certainty and in which it is not possible to distinguish the morphological nature of the atrioventricular valves.

Echocardiography↗
PubMed1989

Superior caval to pulmonary venous fistula--the progenitor of the sinus venosus defect?

An infant with surgically corrected complete transposition of the arteries with intact ventricular septum, a superior caval (sinus venosus) defect, and partially anomalous pulmonary venous connection is described. The morphology of the sinus venosus defect is unusual because the pulmonary to systemic communication is a well-formed extracardiac vein that probably represents a persistence of one of the venous connections normally found in the fetus. This case complements the existing beliefs to how sinus venosus defects are formed and endorses why describing them as atrial septal defects is incorrect.

Fistula↗
PubMed1989

Anomalous origin of the left coronary artery from the pulmonary trunk. Anatomic findings in relation to pathophysiology and surgical repair.

Anomalous origin of the left coronary artery from the pulmonary trunk, though a discrete anatomic malformation, manifests a spectrum of clinical and pathologic consequences. The objectives of this study were to characterize the primary anatomic findings in a group of specimens with anomalous left coronary artery and the extent of secondary morphologic and pathologic changes. Although the cases studied probably represent the least favorable end of the spectrum, the observed pathogenesis and evolution of secondary changes suggest that reconstruction of a two-coronary arterial system supplied through two coronary arteries would be advantageous to most patients. A high origin of the right coronary artery or location of the left coronary artery adjacent to a pulmonary cusp or branch may complicate the tunnel-type repair. In these cases, transfer of the left coronary artery to the aorta may be preferable.

Abnormalities, Multiple↗
PubMed1989

The medial papillary muscle complex and its related septomarginal trabeculation. A normal anatomical study on human hearts.

The morphology of the medial papillary muscle complex of the right ventricle was studied in 81 normal hearts from subjects ranging in age from 20 weeks of gestation to 13 months. The position of the main medial papillary muscle (of Lancisi) was differentiated in terms of a root and a belly. The anterior aspect of the root was found in a constant position at the basal bifurcation of the septomarginal trabeculation, whereas its belly showed considerable positional variation. Three groups of minor papillary muscles were identified and localised in specific areas in the base of the right ventricle. Taken overall, they formed part of the medial papillary complex. The complex itself was found to be constantly related to the antero-septal commissure of the tricuspid valve. A separate group of septal papillary muscles could be differentiated from the medial papillary complex. The anchorage of the septal leaflet of the tricuspid valve to the ventricular septum was also studied. The antero-superior and postero-inferior portions of this leaflet were found to be supported by the medial and posterior papillary complexes, respectively. Its midportion was connected to the septal group of papillary muscles but much variability was evident. The portion of the septomarginal trabeculation supporting the medial papillary complex, namely the postero-basal division, was studied further. This showed considerable variability and did not form a continuous anatomical spectrum.

Fetus↗
PubMed1989

Atrial isomerism.

Explore the source record for details and available documents.

Heart Atria↗
PubMed1989

The morphology of the normal aortic valve as compared with the aortic valve having two leaflets.

We studied 30 normal aortic valves and 64 aortic valves with only two leaflets to examine their morphologic components. The components of the aortic valve are the leaflets, the sinuses, and the interleaflet triangles. The first part of our study shows the relationship of these component parts of the normal aortic valve to the other cardiac structures. The second part shows a wide variation in the architecture of valves having two leaflets. Having produced criteria for the number of sinuses and the number of leaflets, we discovered that previous criteria used in the definition of valves with two leaflets are inadequate when the whole valvular complex is considered. Only seven valves in the study have two leaflets supported by two sinuses. The evidence points to the other valves having started with three leaflets but becoming bicuspid during either intrauterine or postnatal life.

Adult↗