Search PubMed⌕ Search

Biomedical subjects

R J Hall

Publications and source records attributed to R J Hall.

At least 55 records · Page 3Linked to original sources
PubMed1994

Abnormalities of left ventricular flow following mitral valve replacement: a colour flow Doppler study.

Left ventricular flow patterns were studied at rest by colour flow Doppler echocardiography in 33 patients with mitral tilting-disc prostheses (group 1), in 38 patients with mitral tissue prostheses (group 2) and in 18 healthy volunteers (controls). A 'crossed' flow pattern was seen in 14 patients with mechanical (42%) and in 15 patients with tissue prostheses (39%). The remaining patients and all controls had either 'parallel' or 'intermediate' flow patterns which were classified as 'normal'. There was a significant correlation between the type of flow pattern and the position of the mitral prosthesis in both study groups. The presence of a crossed flow pattern, however, was not related to functional status (assessed clinically by NYHA class) or to abnormalities on the electrocardiogram. Left atrial size was greater in patients with crossed flow than in those without, but all other echocardiographic parameters were similar. Eight patients with crossed and eight with normal flow patterns underwent treadmill exercise testing; there was no difference between the two groups with regard to exercise performance as determined by exercise duration, maximum oxygen consumption and the ventilatory response to exercise. The results of this study indicate that the pattern of blood flow within the left ventricle may be fundamentally altered by the orientation of both mechanical and tissue prostheses. The presence of a crossed flow pattern is not, however, accompanied by significant deleterious haemodynamic or functional consequences.

Adult↗
PubMed1994

Transoesophageal echocardiography as the sole diagnostic investigation in patients with suspected thoracic aortic dissection.

OBJECTIVES: To assess the value and limitations of using transoesophageal echocardiography as the sole diagnostic test in patients with suspected thoracic aortic dissection. DESIGN: Retrospective data review over a two year period. SETTING: A regional cardiothoracic centre. PATIENTS: Data were compiled from admission records, surgical records, and lists of patients undergoing diagnostic investigations in the hospital. Patient's notes were used to identify presentation, management, and outcome. INTERVENTIONS: Patients were managed according to the policy of our unit, which is to treat patients with dissection affecting the ascending aorta by an operation. Patients with uncomplicated dissection sparing the ascending aorta are initially managed medically. MAIN OUTCOME MEASURES: In hospital and two year follow-up of patients who were investigated by transoesophageal echocardiography alone. RESULTS: Of 48 patients referred, 45 underwent transoesophageal echocardiography. Dissection was confirmed in 22 patients. Transoesophageal echocardiography showed the proximal extent of the dissection in 21/22 (96%) and only one patient required a further diagnostic investigation. Ten patients with dissection of the ascending aorta underwent graft replacement of the ascending aorta; operative mortality was 10% and their two year survival was 80%. Of the eight patients with dissection of the descending aorta, six were discharged home, and five were alive at two years. No patient without evidence of dissection on their initial transoesophageal echocardiographic examination required re-investigation into possible dissection in the two years after discharge. CONCLUSIONS: In patients with suspected thoracic dissection transoesophageal echocardiography rapidly and safely gives all the necessary diagnostic information. Further investigations, including coronary angiography, before surgery are unnecessary.

Adult↗
PubMed1994

An unusual cause of dysphagia: a vascular ring.

A 40 year old woman presented with dysphagia which was due to one of the forms of vascular ring. Her symptoms were relieved by relatively conservative surgery. The means of diagnosis and the surgical approach are discussed.

Abnormalities, Multiple↗
PubMed1994

Echocardiographic evaluation of anuloplasty rings. Comparison of continuity equation and pressure half-time methods.

This study was undertaken to compare pressure half-time and continuity equation methods in the postoperative evaluation of anuloplasty rings. We performed 2-dimensional echocardiography and Doppler studies in 39 patients who had undergone valve repair for mitral regurgitation. In patients with a pressure half-time of 110 msec or more (9/39), there was no significant difference in calculated valve area between the 2 methods (p = 0.696). A significant difference was shown between the 2 methods (p < 0.001) in patients with a half-time less than 110 msec (30/39). When patients were classified according to the type of ring they had received, no significant difference was noted between the 2 groups with regard to peak and mean mitral gradients. In patients placed in subgroups according to half-times of less than 110 msec and half-times of 110 msec or more, no difference was noted between groups in terms of mean mitral gradient, presence of mitral regurgitation, left atrial size, left ventricular function, or heart rate. The continuity equation appears to provide much more homogeneous results in the calculation of valve area in patients who have undergone valvular repair for mitral valve regurgitation.

Adolescent↗
PubMed1994

The pediatric diaphragm in acute gastric volvulus.

Acute gastric volvulus occurred in nine infants and one older child during the past 19 years; all patients had an associated left diaphragmatic anomaly. There were seven examples of eventration of the diaphragm, two of giant hiatal hernia and one Bochdalek hernia. Nine of the ten patients presented with vomiting and one with acute respiratory distress. The gastric volvulus was mesenteroaxial in eight patients and organoaxial in two. Operative treatment consisted of repair of the diaphragmatic anomaly and gastric fixation in eight patients. Gastric fixation alone was performed in one patient. A single patient died preoperatively and had gastric necrosis at postmortem examination. Of the nine patients treated operatively, all remain alive and well without recurrence. Acute gastric volvulus should be considered in any infant presenting with unexplained vomiting in association with a left diaphragm anomaly, and once diagnosed, immediate operation is mandatory.

Acute Disease↗
PubMed1993

Role of balloon dilatation of the aortic valve in pregnant patients with severe aortic stenosis.

The outcome of unrelieved severe symptomatic aortic stenosis in pregnancy is poor. Though the valve lesion can be corrected surgically before delivery at a low risk to the mother, cardiopulmonary bypass during pregnancy carries a high risk to the fetus. Two patients in the second trimester of pregnancy were successfully managed with balloon dilatation of the aortic valve. Both delivered healthy infants and were well a year later. Balloon dilatation of the aortic valve is a useful palliative procedure in the management of pregnant women with severe aortic stenosis.

Adult↗
PubMed1993

Amyloid, thrombosis, and acute myocardial infarction in association with a bicuspid aortic valve.

A 34 year old man presented with an inferior non-Q-wave myocardial infarction. Echocardiography showed a bicuspid aortic valve with aortic outflow obstruction. Left coronary cusp morphology was normal but the right coronary cusp was grossly distorted and replaced by a mobile echodense mass encroaching upon the aortic valve orifice. The aortic valve was replaced and pathological analysis of the excised valve showed primary amyloid infiltration of the right coronary cusp but a normal left coronary cusp. The mass adherent to the right coronary leaflet had the histological appearances of organised thrombus and this was assumed to be the source of coronary embolism. This is the first reported case of primary valvar amyloid presenting with clinical sequelae and it illustrates the need for careful clinical assessment in young patients presenting with acute ischaemic syndromes.

Adult↗
PubMed1993

Aortic valve replacement in patients 80 years and older. Operative risks and long-term results.

BACKGROUND: Forty percent of 7.4 million Americans aged 80 years and older have symptomatic heart disease. Controversy exists as to whether the health care resources allotted to this patient subset represent a cost-effective approach to attaining a meaningful quality of life. Although aortic valve surgery carries greater risks in older than in younger patients, published studies reveal that the elderly should not be denied this procedure. METHODS AND RESULTS: To determine the results of aortic valve replacement (AVR) in an elderly population, we retrospectively analyzed 171 consecutive patients aged 80 to 91 years (mean, 82.6 years; 86 men and 85 women) who underwent AVR at the Texas Heart Institute between 1975 and 1991. Seventy-seven patients had AVR only, and 94 patients had concomitant surgical procedures (coronary artery bypass graft surgery, 75 patients; mitral valve replacement, mitral valve repair, aneurysm repair, 19 patients). The overall 30-day early mortality was 17.5%. The early mortality was 5.2% for patients with AVR only and 27.7% for those with concomitant surgical procedures. Statistical analysis of 17 perioperative variables revealed that left ventricular ejection fraction of less than 45%, hypertension, congestive heart failure, angina, and concomitant surgical procedures were significant univariate predictors of early mortality. Multivariate analysis revealed that left ventricular ejection fraction of less than 45%, hypertension, and concomitant surgical procedures were independent predictors of operative mortality. Mean follow-up of survivors was 39 months. The overall actuarial survival at 1, 3, and 5 years was 90.8%, 84.2%, and 76.0%, respectively. CONCLUSIONS: These results show that AVR can be performed with acceptable operative risks in the elderly. This study further shows that isolated AVR can be done with low operative mortality and that the performance of concomitant surgical procedures exposes elderly patients to higher operative risks.

Actuarial Analysis↗
PubMed1993

Tricuspid regurgitation following mitral valve replacement: an echocardiographic study.

The development of late tricuspid regurgitation following mitral valve replacement is accompanied by a severe reduction in exercise capacity and a poor functional outcome. In this study, we compared the clinical and echocardiographic characteristics of two matched groups with (n = 13) and without (n = 13) clinically significant tricuspid regurgitation. The preoperative pulmonary artery pressures and symptom durations were similar, but tricuspid regurgitation at palpation was detected only in patients who later developed severe tricuspid regurgitation (5/13 vs. 0/13; p < 0.02). None of the patients had echocardiographic evidence of rheumatic tricuspid valve disease at the time of the study, but the tricuspid annular diameter (3.7 +/- 0.5 cm vs. 3.2 +/- 0.4 cm; p < 0.05) and right ventricular diameter (4.9 +/- 0.4 cm vs. 4.0 +/- 0.8 cm; p < 0.01) were greater in patients who had developed severe late tricuspid regurgitation. Echocardiographic parameters of left ventricular function and Doppler estimated pulmonary artery systolic pressures were similar in the two groups, and no evidence of prosthetic dysfunction or aortic valve disease was found. These results imply that late tricuspid regurgitation following mitral valve replacement develops as a result of dilation of the tricuspid annulus associated with right ventricular decompensation. The persistence of uncorrected tricuspid incompetence would seem to be an important contributory factor, and its accurate detection and correction at the time of initial surgery may prove to be the most effective means of preventing the development of this important complication of mitral valve replacement.

Aged↗
PubMed1992

Exercise testing at 3 weeks, 6 weeks and 18 months after infarction and the outcome at 3 years in young patients (under 55 years).

To examine the prognostic value of routine postinfarction exercise tests in young patients, exercise tests were carried out at 3 and 6 weeks and 18 months after infarction in 149 patients aged under 55 years at the time of the index infarction. The patients also had coronary angiography and left ventriculography a mean of 3 months after infarction. Three years after infarction, only two of the 149 patients have died, reinfarction occurred in only seven (4.7%) patients; unstable angina in four (3%) patients and coronary artery surgery was needed in 31 (20.8%) patients; 16 in the first, 10 in the second, and 5 in the third year of follow-up. Angina on exercise testing at 6 weeks was the only variable with any predictive value. Eighteen (38%) of the 47 patients with, compared to 12 (11.8%) of the 102 patients without, angina on exercise testing at 6 weeks had coronary surgery (less than 0.001). None of the other exercise variables reliably predicted death, or other complications, including coronary surgery. Ten (13.8%) of the 75 patients excluded from the study died during follow-up; six of them within 6 weeks of infarction. Four (67%) of these patients were excluded from the study because of heart failure. Therefore, the 3-year outcome in young survivors of a myocardial infarction is good and is not reliably predicted by exercise testing at 3 and 6 weeks or 18 months.

Adult↗
PubMed1992

Late tricuspid regurgitation following mitral valve surgery.

The development of late tricuspid regurgitation is an important complication of mitral valve surgery, as it is associated with a severe impairment of exercise capacity and a poor symptomatic outcome. The pathogenesis of this condition remains poorly defined, but it is usually attributable to a functional abnormality of the tricuspid valve. Whilst its development may indicate an increased afterload on the right heart as a consequence of persistent pulmonary hypertension, mitral prosthetic dysfunction, progressive aortic valve disease or left ventricular failure, late tricuspid regurgitation may also develop in the absence of these factors and then may reflect right ventricular dysfunction and/or a localized abnormality of the tricuspid anulus. Failure to recognize and correct tricuspid regurgitation at the time of initial surgery may also account for many cases of tricuspid regurgitation but its re-appearance following tricuspid annuloplasty is uncommon and usually reflects a failure of the mitral prosthesis. A reduction in the prevalence of late tricuspid regurgitation is an important objective in view of the high operative mortality and disappointing long term results associated with reoperation for tricuspid regurgitation. This may be best achieved through combining earlier mitral valve surgery with the accurate detection and liberal correction of accompanying tricuspid incompetence at the time of initial surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography, Doppler↗
PubMed1991

Denton A. Cooley.

Explore the source record for details and available documents.

Cardiac Surgical Procedures↗