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Biomedical subjects

R Radley-Smith

Publications and source records attributed to R Radley-Smith.

At least 73 records · Page 4Linked to original sources
PubMed1981

The spectrum of pulmonary arterio-venous fistulae. Clinico-pathological correlations.

Four male patients with pulmonary arterio-venous fistulae are reported. Familiar occurrence was noticed in 2 brothers. Physiological effects, clinical pictures and treatment of these lesions depend on the size and number of the fistulae. A 4-day-old baby presented with severe cyanosis and cardiomegaly. Cardiac catheterization and angiography demonstrated a large arterio-venous fistula affecting the whole of the right upper lobe and a small ventricular septal defect resulting in a high output cardiac failure. The patient underwent emergency lobectomy with good early and long-term results. The other 3 patients (mean age of 7.6 years) developed progressive cyanosis and polycythemia. Cardiac catheterization showed normal intracardiac pressures and peripheral arterial desaturation. Pulmonary angiogram demonstrated multiple fistulae in both lungs. Surgery was not performed because of the diffuse nature of the lesions. The patients reported in this paper illustrate the wide spectrum of clinico-pathological conditions of this anomaly.

Adolescent↗
PubMed1981

Two-stage anatomic correction of complete transposition of the great arteries: ventricular volumes and muscle mass.

Between 1976 and 1981, 27 patients with complete transposition of the great arteries, ranging from one month to 2 1/2 years, underwent two-stage anatomic correction and 7 patients first-stage operation only. There were three early deaths after the first-stage and five after the second-stage operation and no late deaths. In seven patients the results of repeat cardiac catheterization including quantitative analysis of ventricular angiocardiograms at the different stages of the procedure were available. In these patients peak systolic pressure in the left ventricle rose to systemic levels after banding of the pulmonary artery. Left ventricular end-diastolic and stroke volumes decreased to normal levels without significant reduction of arterial oxygen saturation. One to 2 1/2 years after anatomic correction left and right ventricular function was normal, as judged by normal end-diastolic pressure, ejection fraction and ratio left ventricular muscle volume/end-diastolic volume. Minimal aortic regurgitation in five patients, mild mitral insufficiency in two and a small VSD in two contributed to elevated end-diastolic volumes of the left ventricle, observed in six patients, and of the right ventricle, found in two patients. The aortic and coronary anastomoses appeared to grow normally.

Angiocardiography↗
PubMed1981

Surgical treatment of mitral regurgitation caused by floppy valves: repair versus replacement.

Between October 1969 and April 1980, 132 patients underwent operation for floppy mitral valve. The 46 patients in group A underwent valve replacement using an inverted, fresh, unstented, antibiotic-sterilized aortic homograft and the 86 patients in group B underwent valve repair. The onset of symptoms was sudden. More than 80% of the patients in both groups were in New York Association functional class III or IV. The dominant lesion in both groups was ruptured chordae to the posterior cusp (72% in group A and 58% in group B). There were five early deaths (11%) and 15 late deaths (32%) in group A and four early deaths (5%) and five late deaths (7%) in group B. The actuarial survival rate at 5 years was 62% in group A and 90% in group B. In group A, five patients (11%) had valve failure, which led to late death in two. Four patients (8%) in group A required reoperation. Two patients in group B developed a loud mitral systolic murmur soon after operation and required reoperation. Two patients in group B had thromboembolism before routine anticoagulation. Sixteen patients (61%) in group A and 56 (76%) in group B were functional class I after operation.

Anticoagulants↗
PubMed1980

Anomalous origin of the right coronary artery with aortopulmonary window: functional and surgical considerations.

A rare case of anomalous origin of the right coronary artery from the pulmonary artery associated with a large aortopulmonary window in a 4-month-old boy is reported. The right coronary artery is exposed to systemic pressure and carries fairly well-oxygenated blood to the myocardium. Angiographic diagnosis could be difficult because of the simultaneous filling of both great arteries which obscures the origin of the anomalous vessel. Closure of the aortopulmonary window alone could result in acute myocardial ischaemia. A plastic procedure for correction of this association of defects, which should allow normal growth, is described.

Aorta↗
PubMed1980

Clinical and hemodynamic results of the two-stage anatomic correction of simple transposition of the great arteries.

Between 1976-1979, 14 patients with simple transposition of the great arteries (TGA), ranging in age from 1 month to 2 1/2 years, underwent two-stage anatomic correction. Twenty patients underwent a first-stage operation, with three early deaths (15%). After the first-stage operation the peak systolic left ventricular pressure rose from 38 +/- 6 mm Hg to 79.6 +/- 11 mm Hg, with no significant change in end-diastolic pressure or ejection fraction. This was associated with a decrease in the actual pulmonary flow but no change in effective pulmonary flow. Between the first and second stages we allowed a 5-week to 9-month interval. There were four early (29%) and no late deaths. Follow-up was 5-37 months. After an initial period of cardiac failure, all patients became asymptomatic and developed normally. Rapid changes in ECG, vectocardiogram and echocardiogram toward normal were observed. Repeat cardiac catheterization was performed in nine patients, 3 weeks to 2 1/2 years after operation. Left ventricular ejection fraction was normal in all. Two who were investigated early had mild mitral regurgitation, five had minimal aortic regurgitation and one had moderate supravalvar pulmonary stenosis. The aortic and coronary anastomoses appeared to grow normally.

Blood Pressure↗
PubMed1978

Anomalous origin of the right pulmonary artery from the ascending aorta associated with aortopulmonary window.

A rare case of anomalous origin of the right pulmonary artery from the ascending aorta associated with an aortopulmonary window and severe pulmonary hypertension in a 13-year-old girl is reported. The window was closed using a Dacron patch and the continuity between the anomalous vessel and the main pulmonary artery was restored with a tubular Dacron graft. After operation the pulmonary pressure dropped to about one-half of the systemic pressure, and equal perfusion and ventilation of both lungs was demonstrated. Although early recognition and surgical treatment of this condition are mandatory to prevent the onset of irreversible pulmonary vascular disease, the presence of severe pulmonary hypertension did not contraindicate surgical correction in our patient.

Adolescent↗
PubMed1978

Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction.

For the success of anatomical correction of transposition of the great arteries (TGA) it is essential to transfer the coronary ostia to the posterior vessel without undue tension, torsion, or kinking of the proximal coronary arteries or their early branches. This requires thorough understanding of the different modes of origin and early branching of the coronary arteries in TGA. Based on observations made during anatomical correction, a classification of the coronary arteries in TGA is suggested. In type A the right and left coronary ostia arise from the middle of the right and left posterior aortic sinuses and curve forwards to reach the right atrioventricular groove or anterior interventricular groove respectively. In type B both coronary arteries arise by a single ostium, while in type C the two coronary ostia are situated posteriorly, very close to each other, in a position similar to that in type B. The origin of the coronary arteries in type D is similar to that of type A. However, the right coronary artery gives origin to the circumflex coronary artery that curves round the posterior (pulmonary) vessel to reach the atrioventricular groove. In type E the right coronary artery arises in common with the left anterior descending artery from the left posterior sinus, while the circumflex artery arises separately from the right posterior sinus. Three techniques for the transfer of the different types of coronary arteries during anatomical correction are described.

Coronary Vessels↗
PubMed1978

[Primary repair of large ventricular septal defects in the first year of life (author's transl)].

It has been our policy at Harefield Hospital since 1971 to perform primary repair of large ventricular septal defects in the first year of life if there is severe intractable cardiac failure or persistent pulmonary hypertension in infants approaching the first year of age. Twenty-six infants underwent repair; their ages were between one and twelve months. One child died early. The remaining 25 have been followed up for between 6 and 78 months (mean 30.3 months). There have been no late deaths and all children are asymptomatic. Late, postoperative cardiac catheterization was performed in 17 patients. This showed that in all the patients the pulmonary artery pressure was normal and there were no residual shunts. It is concluded that primary repair of large ventricular septal defects in the first year of life gives good results and appears to prevent pulmonary hypertension.

Age Factors↗
PubMed1977

Two-stage operation for anatomical correction of transposition of the great arteries with intact interventricular septum.

To allow redevelopment of the posterior ventricle in an infant with transposition of the great arteries and intact interventricular septum, at the age of 4 weeks the pulmonary artery was banded, an aortopulmonary shunt was fashioned proximal to the band, and atrial septectomy was performed. Peak systolic posterior ventricular pressure immediately rose to systemic level (70 mm Hg.) During the next 4 months the pressure drifted back to 55 mm Hg but rose to 72 mm Hg after angiography without a rise in end-diastolic pressure. When the child was six months old anatomical correction of the transposition was successfully performed, the aorta, pulmonary, and coronary arteries being reattached to the appropriate ventricles. Debanding was performed at the same time. For the first 48 hours after operation phenoxybenzamine was given to reduce overload. At 6-month follow-up the child remained symptomless and was not on any cardiac drugs; left-ventricular function was good. This two-stage technique should widen the application of anatomical correction from a small selected group with additional defects to include most patients with transposition of the great arteries.

Aorta↗
PubMed1976

Anatomical correction of complete transposition of the great arteries and ventricular septal defect in infancy.

Two patients, aged 8 weeks and 5 years, with D transposition of great arteries and large ventricular septal defect were treated by transection of both aorta and pulmonary arteries and reattaching them to the appropriate ventricles. This included the origins of the coronary arteries. The ventricular septal defect was closed through a transverse ventriculotomy using a Dacron patch. The younger child was operated on as an emergency because of cyanosis and severe heart failure resistant to intensive medical treatment. The older child had had previous banding of the pulmonary artery at the age of 1 year. In both patients pulmonary artery pressure dropped to below half systemic pressure immediately after the operation. Postoperative progress was satisfactory with relief of cyanosis and heart failure. Early anatomical correction of transposition of the great arteries and ventricular septal defect is feasible and should play an important part in the management of these patients.

Aorta, Thoracic↗
PubMed1976

Use of a valved conduit from right atrium to pulmonary artery for "correction" of single ventricle.

Nine patients with single ventricle and pulmonary stenosis were treated by using a valved conduit from right atrium to the main pulmonary artery. The patient's own mobilized pulmonary valve was used in one patient and fresh, adult-sized aortic homograft in the remaining eight. Two additional unstented homografts were inserted at the entrance of both superior and inferior venae cavae in four patients. A pericardial baffle was used to direct pulmonary venous blood to both atrioventricular valves in three, and the tricuspid valve was oversewn in six. L-transposition of the great arteries was present in five patients and D-transposition in one. Tricuspid valve hypoplasia was present in one and mitral hypoplasia in one. The age at operation was 4 months to 36 years. All patients were severely incapacitated with arterial oxygen saturation varying from 28% to 76%. Four patients died within the first week after operation, the remaining five patients derived excellent symptomatic improvement. Repeat cardiac catheterization, performed in five patients, showed a mean right atrial pressure varying from 8 to 17 mm Hg and a prominent right atrial A wave, measuring 10 to 25 mm Hg, with evidence of good function of the homografts at the entrance of the venae cavae. The arterial oxygen saturation varied from 88% to 97%.

Adolescent↗
PubMed1975

Late results of aortic homograft reconstruction of the right ventricular outflow tract in infants and children.

33 infants and children between 4 months and 14 years have undergone successful reconstruction of the right ventricular outflow tract with adult sized fresh aortic homografts. The late results have been analysed and it is concluded that satisfactory results can be obtained even in infants and that the operation should be performed early to prevent secondary changes in the heart and lungs.

Age Factors↗