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Biomedical subjects

R M Sade

Publications and source records attributed to R M Sade.

At least 127 records · Page 7Linked to original sources
PubMed1980

Orthoterminally corrective operation in the presence of severe hypoplasia of a pulmonary artery.

Hypoplasia of the pulmonary arteries has been cited as a contraindication to right vertricular bypass operations. We have successfully corrected a lesion in which the left pulmonary artery was severely hypoplastic and have documented a good hemodynamic result postoperatively. Size of pulmonary arteries is less important than pulmonary vascular resistance as a criterion for orthoterminal correction.

Aorta↗
PubMed1979

Structural changes in a porcine xenograft after implantation for 105 months.

Morphologic studies including light microscopy and transmission and scanning electron microscopy were performed on a formaldehyde-fixed porcine xenograft prosthesis that functioned well for 8 years and had been implanted for 105 months in the tricuspid valve position. It is the oldest implanted valve studied in this manner. Although all leaflets had some gross deterioration, only one had adherent thrombus. The degenerative changes in the connective tissue from all leaflets were similar to those recently reported in glutaraldehyde-fixed porcine valves implanted for shorter periods. The surfaces of the two nonthrombosed leaflets and small portions of the surface of the thrombosed leaflet were endothelized, and the endothelium appeared to have little or no effect on the degenerative changes in the subjacent connective tissue. Further, the endothelium did not extend over the examined portion of the synthetic anulus of the prosthesis, suggesting that its origin was possibly from cells circulating in the blood.

Adolescent↗
PubMed1979

Aortoplasty compared with resection for coarctation of the aorta in young children.

We repaired coarctation of the aorta in a group of 18 children less than 3 years old, using either resection with end-to-end anastomosis (8 patients, Group 1) or patch graft aortoplasty (10 patients, Group 2). The two groups were similar preoperatively in age, pressure difference between proximal and distal aorta (delta PA0), and severity of aortic arch hypoplasia. Three patients, all less than 2 months old, died early postoperatively. Among the survivors, the right brachial artery systolic pressure was significantly higher in Group 1 (133.1 +/- 7.0 mm Hg) (mean +/- standard error of the mean) than in Group 2 (102.5 +/- 7.2 mm Hg) (p less than 0.05). The delta PA0 was significantly higher in Group 1 (33.0 +/- 7.5 mm Hg) than in Group 2 (5.1 +/- 2.3 mm Hg) (p less than 0.01). Three patients in Group 1 required reoperation and were treated with patch graft aortoplasty; relief of delta PO0 was complete in 2. Patch graft aortoplasty is more effective than resection in reducing proximal aortic systolic pressure and in relieving delta PA0 in infants and small children with coarctation of the aorta.

Aorta, Thoracic↗
PubMed1979

Coronary sinus septal defect. Surgical considerations.

The coronary sinus septal defect is an uncommon anomaly. If it is not suspected, found, and repaired at operation, a residual intracardiac shunt will result. The defect usually is associated with a left superior vena cava (LSVC), which necessitates special consideration in the conduct of cardiopulmonary bypass. Our recent treatment of three cases of coronary sinus septal defect stimulated us to review the embryology, anatomy, diagnosis, and surgical treatment of this malformation.

Child, Preschool↗
PubMed1979

Calculation of systemic blood flow with pulmonary artery thermistor probe.

A simple thermodilution technique is described for determining systemic blood flow with right atrial and left atrial catheters and a pulmonary arterial thermistor probe. Injections of cold water into the atrial catheters provide computer display readings that permit direct calculation of systemic blood flow. The method is convenient for determining systemic blood flow in postoperative patients with a residual left-to-right shunt.

Blood Circulation↗
PubMed1979

Cardiac valve replacement in children: comparison of tissue with mechanical prostheses.

Replacement of cardiac valves in children has been associated with high rates of mortality and morbidity in the past. We have compared 24 children from 2 to 18 years of age who have received mechanical valves with 24 children who have received porcine valves. The groups were similar except that (1) there were more mitral operations in the mechanical valve group and more aortic operations in the porcine valve group; (2) more porcine than mechanical valves were implanted in recent years; and (3) the porcine valve group comprised more young patients under 8 years and required more complex operations. Early and late mortality rates were higher in the mechanical than in the porcine valve group. Major late complications were seen in 50 percent of the mechanical valve group and 13 percent of the porcine group. Implantation of an adult-sized aortic valve was made possible in all patients by the use of aortic augmentation annuloplasty. Higher operative mortality rates in the mechanical valve group may have been related more to technique of myocardial preservation during operation than to type of valve. Although differing rates of late morbidity and mortality may also have been related to myocardial preservation and other technical factors, the type of valve used seemed to be an important determinant of the better results in the porcine group. Despite unknown durability of the porcine valve, our data suggest that the safest prosthetic valve to use in children at this time is the glutaraldehyde-fixed porcine prosthesis.

Adolescent↗
PubMed1977

Repair of tetralogy of Fallot after aortopulmonary anastomosis.

Thirty-eight corrective operations have been performed in patients with tetralogy of Fallot and a functioning aortopulmonary shunt. There were 3 operative deaths (7.9%) and 1 late death (2.6%), and 3 patients have required reoperation for significant residual defects. Only 1 of 10 patients studied postoperatively by radionuclide scanning has a significant reduction in blood flow to the lung on the side of the closed shunt. We conclude that the presence of an aortopulmonary shunt does not add to the risk of repair in patients with tetralogy of Fallot and that mortality after such operations is related to the complex anatomy often present in patients of this group.

Adolescent↗
PubMed1977

Regional lung function studies and radionuclide angiography in D-transposition of the great arteries.

Thirty-nine ventilation and perfusion lung studies with xenon 313 were perfomed in 29 patients with D-transposition of the great arteries (DTGA). Fifteen patients had simple DTGA and 14 more complex anatomic features. Inequalitiies of ventilation (V) were present in 23% (9/39) and perfusion (Q) in 44% (17/39) of studies. Six patients with simple DTGA showed abnormal distribution of perfusion, all with increased flow to the right lung. Among the 14 patients with complex DTGA, eight (57%) had abnormal distribution of perfusion. In patients with pulmonary artery band, increased flow was directed toward the left lung, and in those with an aorticopulmonary anastomosis, increased flow was to the side of the shunt. Radionuclide angiograms were performed in 17 patients with DTGA, both before and after surgical repair. In all, an abnormal circulatory pattern was noted. Complete superior vena cava obstruction present in four patients and residual left to right shunt (Qp/qs greater than 1.7/liter) in three was confirmed at cardiac catheterization. Ventilation perfusion studies with xenon-313 and technetium-99m radionuclide angiogram were effective noninvasive techniques in assessing pulmonary function and hemodynamics in patients with DTGA.

Adolescent↗
PubMed1976

The management of Hemophilus influenzae, Type B, pericarditis.

The incidence of Hemophilus influenzae, type B, infections in children has been increasing recently, so the number of cases of pericarditis is likely to rise also. We describe the clinical manifestations and treatment of H. influenzae, type B, pericarditis based on 4 patients and a review of the literature. The most common complication is cardiac tamponade, which requires drainage. All patients should be treated with antibiotics (chloramphenicol, ampicillin) and a drainage procedure. Because of several recently reported cases of subsequent constrictive pericarditis, we recomment anterior interphrenic pericardiectomy both for drainage and to prevent constrictive pericarditis. With appropriate therapy the survival rate should be very high.

Ampicillin↗