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Biomedical subjects

R M Sade

Publications and source records attributed to R M Sade.

At least 73 records · Page 4Linked to original sources
PubMed1990

Subvalvar aortic stenosis: timing of operation.

Subvalvar aortic stenosis can be associated with progressive left ventricular outflow tract obstruction, aortic insufficiency, and infective endocarditis. We reviewed the records of 36 surgical patients who underwent 39 operations for subaortic stenosis. Seventeen patients had associated congenital cardiac anomalies. One perioperative death occurred in a patient with tetralogy of Fallot. The mean preoperative left ventricular outflow tract systolic pressure gradient was 64 +/- 5 mm Hg (+/- standard error of the mean) and decreased to 9 +/- 2 mm Hg postoperatively (p less than 0.001). Reliable preoperative and postoperative information regarding aortic valve function was available for 27 patients. Aortic insufficiency was found in 17 (63%) of those patients preoperatively. Postoperatively, insufficiency increased in 3 patients and decreased in 4; none of these changes was major. Severity of preoperative aortic insufficiency increased significantly with age (p less than 0.05), but did not correlate with left ventricular outflow tract gradient. The information from this study and previous studies suggests that resection of subaortic stenosis is safe and effective, and operation at the time of diagnosis, regardless of left ventricular outflow tract gradient or symptomatic status, is a reasonable therapeutic alternative.

Adolescent↗
PubMed1990

Repair of supravalvar aortic stenosis: cardiovascular morphometric and hemodynamic results.

Supravalvar aortic stenosis is associated with normal systolic pressure in the aorta and its branches with the singular exception of the coronary arteries, which are hypertensive. This uncommon lesion has been treated by patch aortoplasty of several types. We examined hemodynamics and morphometrics in 13 patients who underwent operation for supravalvar aortic stenosis from 1979 through 1988. They ranged in age from 2 to 43 years (mean age, 14.5 +/- 3.8 years [+/- standard error of the mean]). There were no operative deaths. Preoperative and postoperative (1 to 5 years) catheterization or echocardiography or a combination of these was done in all but 3 patients (1 died late suddenly without a postmortem examination; 1 was lost to follow-up; and 1 has not yet been restudied). Pressure gradients across the stenosis in patients treated with a single-sinus patch (n = 4) were 65 +/- 18 mm Hg preoperatively and 5 +/- 3 mm Hg postoperatively (p less than 0.05) and in patients with a bisinus patch (n = 6), 83 +/- 15 mm Hg preoperatively and 6 +/- 2 mm Hg postoperatively (p less than 0.05); the two groups were not significantly different. Measurements of the diameters of the coronary arteries, aortic annulus, and descending aorta were made, and calculation of the ratio of the coronary artery and annulus diameters to the descending aortic diameters both preoperatively and postoperatively was possible in 5 patients. The left coronary artery was larger than normal before and after operation. Preoperatively there was a disproportionate increase in left coronary artery and annulus size during systole. Left ventricular wall thickness decreased significantly postoperatively (p less than 0.05). Repair of supravalvar aortic stenosis (localized and diffuse) by both single sinus and bisinus patch repair is safe and hemodynamic results are good.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Tricuspid atresia: current concepts in diagnosis and treatment.

Tricuspid atresia is the third most common cyanotic cardiac malformation, seen in 1 per cent of children with congenital heart disease. Anatomic details in each patient can be elucidated by echocardiography. Surgical treatment initially is palliation, usually with aortopulmonary shunt. Definitive treatment is with a Fontan operation, in which the systemic venous return is connected directly to the pulmonary arterial tree. Long-term results of the corrective procedure have been very good.

Cardiac Catheterization↗
PubMed1989

Problems with permanent atrial pacing in the Fontan patient.

Transvenous atrial pacing is the preferred method for control of both brady and tachyarrhythmias in the postoperative pediatric patient with normal atrioventricular conduction. We reviewed our experience with the use of permanent atrial pacing for the control of bradycardia and tachycardia in the Fontan patient. We then compared this pacing experience to atrial pacing data compiled for postop Transposition of the Great Arteries (TGA) patients. Out of twenty-five Fontan patients followed at the Medical University of South Carolina, six patients have had atrial arrhythmias necessitating pacing (24%). Underlying congenital heart disease included tricuspid atresia physiology in three and single ventricle in three. The indications for atrial pacing was brady-tachy syndrome in four patients and sick sinus syndrome in two. Pacers were inserted immediately post-op in three patients and 1.5 years, 2 years, and 8 years post Fontan in the other three. These six patients have required a total of nine pulse generator implantations. Five of the nine pacers were inserted transvenously and four via thoracotomy. In contrast to our experience with permanent atrial pacing in post TGA patients, dysrhythmia control with atrial pacing in the Fontan patient has been more difficult to achieve. The Fontan patients have a higher incidence of symptomatic dysrhythmias, hospitalizations, and antidysrhythmic medication requirements after pacer insertion. Implantation thresholds of the Fontan patients are higher than those of the transposition group. While successful atrial demand pacing is attainable in both groups, antitachycardia pacing is more reliable in the post-op TGA patient. The Fontan procedure seems to present a new set of obstacles for successful atrial pacing in the pediatric post-op patient.

Arrhythmias, Cardiac↗
PubMed1988

Valve prostheses in children: a reassessment of anticoagulation.

We have previously published evidence that children with St. Jude Medical prostheses on the left side of the heart may not require anticoagulation. Between March 1979 and September 1986, we followed up 48 patients who had no anticoagulant therapy for up to 7 years after valve replacement, an aggregate of 122 patient-years. The 25 male and 23 female patients ranged in age at implantation from 5 months to 21 years (12 +/- 6 years, mean +/- standard deviation). Five patients (all with complex associated malformation) died in the hospital (10%), and nine died late (22%). None of the early and one of the late deaths was associated with a thrombosed prosthesis. During follow-up, seven thrombotic (one mitral, one aortic) or thromboembolic (two mitral, three aortic) events occurred (5.7 +/- 2.1 per 100 patient-years). Of these seven events, five occurred within the last 14 months of the study. There was no relation of these events to age of patient at implantation, age at the time of even, gender, or site of implantation. Concurrently, we have followed up 340 adult patients with St. Jude Medical prostheses who had warfarin sodium (Coumadin) anticoagulation for 875 patient-years. By the end of this study, the children who did not receive anticoagulants were significantly less free of thrombotic and thromboembolic events than the adults who did receive anticoagulants (p less than 0.01).

Anticoagulants↗
PubMed1987

The Blalock-Taussig shunt in infants: standard versus modified.

In recent years, the modified Blalock-Taussig shunt--a polytetrafluoroethylene graft from the subclavian artery to the pulmonary artery--has been preferred over the standard shunt by some surgeons because (1) it requires less dissection and (2) length of native vessels is not critical. From January, 1979, to June, 1985, we operated on 51 infants less than 1 year of age, including 26 less than 1 week of age, to palliate severe complex cyanotic congenital cardiac malformations. Twenty-four modified Blalock-Taussig shunts and 29 standard Blalock-Taussig shunts were created. The groups were concurrent. We reviewed all available cineangiograms and measured branch pulmonary and subclavian arteries. Pulmonary artery index was not different preoperatively in patients given a modified versus a standard Blalock-Taussig shunt (144 +/- 118 and 118 +/- 59 mm2/m2, respectively), but it was greater postoperatively in patients with a modified shunt (431 +/- 188 and 189 +/- 106 mm2/m2) (p = 0.07). Distortion of the pulmonary artery occurred less often after a modified Blalock-Taussig shunt (4/11) than a standard Blalock-Taussig shunt (6/8) (p = 0.06), though none of the distortions was severe. Early and late shunt failure occurred less often with a modified shunt (5/24) than with a standard shunt (15/29) (p less than 0.05). The modified Blalock-Taussig shunt had advantages over the standard Blalock-Taussig shunt in our series: pulmonary artery growth was greater, distortion of pulmonary arteries was less commonly seen, and shunt failure occurred less often. Thus, in infants, we believe the modified Blalock-Taussig shunt should be considered a reasonable alternative to the standard Blalock-Taussig shunt.

Blood Vessel Prosthesis↗
PubMed1987

Double-chambered right ventricle.

Thirty (10.8%) of 279 patients undergoing correction of a ventricular septal defect (VSD) from January, 1972, to September, 1986, also had a double-chambered right ventricle (DCRV). Age at operation ranged from 1.3 to 18.8 years (mean, 6.7 +/- 4.5 years [+/- standard deviation]). Seventeen patients were male, and 13 were female. Two-dimensional echocardiography was used after 1978 in the initial evaluation of 20 patients; however, the diagnosis of DCRV was made with the use of subcostal views only since 1984 in 4 of 5 patients. Surgical correction consisted of closure of the VSD and resection of anomalous muscle bundles through a right ventriculotomy (28 patients), and right atriotomy (2 patients). All patients survived and are asymptomatic 4.2 +/- 3.4 years following operation. Six patients have undergone catheterization postoperatively and 8 patients had intraoperative pressure recordings. The mean preoperative ratio of right ventricular to left ventricular pressures was 0.67 +/- 0.22 compared with 0.34 +/- 0.15 postoperatively (p less than .001). In 2 patients, DCRV was not recognized preoperatively or at VSD closure through a right atriotomy, and reoperation was necessary after DCRV was demonstrated at postoperative catheterization. DCRV may occur in approximately 10% of patients undergoing correction of VSD. Careful evaluation of echocardiographic and catheterization data preoperatively and careful evaluation of the anatomy intraoperatively are necessary so that DCRV not be overlooked, especially because most VSDs are now closed through the right atrium. Successful correction of VSD and DCRV is associated with excellent long-term results.

Adolescent↗
PubMed1986

Bovine pericardium for correction of congenital heart defects.

From July, 1980, until January, 1985, preserved bovine pericardium was utilized in the repair of a wide variety of congenital heart defects in 105 patients. Ages ranged from newborn to 56 years (mean, 9.6 years). Eighty-three of the 87 long-term survivors are in New York Heart Association Functional Class I or II. Bovine pericardium was not a contributing factor in the 12 hospital and 6 late deaths. The material was found to be flexible and easy to suture. No patient has demonstrated calcification of the patch in follow-up ranging from 6 to 60 months (mean, 30.2 months). Preserved bovine pericardium offers several potential advantages in the correction of congenital intracardiac defects.

Adolescent↗
PubMed1986

Diaphragmatic paralysis and eventration in infants.

Twenty-six children with eventration (congenital in 10, resulting from birth trauma in four, and resulting from operative phrenic nerve injury in 12) under 15 months of age were evaluated at a single institution in a 5 year period. There was a high incidence of significant associated anomalies and prematurity. All operative phrenic nerve injuries occurred in patients under 3 months of age, and they were most common in patients undergoing Blalock-Taussig shunt. Plication (12 thoracic, nine abdominal) was performed in 21 patients, 19 of whom had respiratory distress or were ventilator dependent. Repeat plication was required in four patients. All long-term survivors were extubated within 1 week of plication. Of 21 patients undergoing plication, 14 (67%) died. Death was attributed directly to complications of eventration in three patients and was a contributing factor in nine patients. We reached the following conclusions: The incidence of operative phrenic nerve injury in infants undergoing lateral thoracotomy, particularly for Blalock-Taussig shunt, is higher than generally appreciated; plication is a safe procedure as performed by either an abdominal or thoracic approach; failure to achieve extubation within a week of plication is an ominous prognostic sign; mortality in patients with eventration in the presence of major associated conditions may be high despite plication.

Diaphragmatic Eventration↗
PubMed1985

Criteria for selection of future physicians.

Academic achievement correlates poorly with clinical performance of physicians, so it is probably more important to select college students for medical school admission who will be superior physicians than to select those who will be excellent medical students. Before such selection criteria can be developed, a valid description of a superior physician must be determined. The relative importance of 87 characteristics of a superior physician, based on a previously published list, was determined by asking medical school faculty members to rate them. The resulting description of a superior physician is valid, because it correlated very highly (r = 0.87, p less than 0.001) with the published ratings of the same characteristics from decades earlier in another part of the country, and because it was constant across many subgroups. The faculty was also asked to rate how easily each characteristic could be taught, and those ratings were validated by high correlations across several subgroups. The importance and the teachability ratings were combined into a nonteachable-important index (NTII) that provides a rank order of traits that are important but cannot be taught easily. These are the characteristics that should be used in selecting future physicians.

Character↗