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Biomedical subjects

T P Graham

Publications and source records attributed to T P Graham.

At least 109 records · Page 6Linked to original sources
PubMed1980

Hypoplasia of the systemic ventricle in congenitally corrected transposition of the great arteries: preoperative documentation and possible implications of operation.

This article describes the determination of small systemic ventricular volume by quantitative cineangiocardiography in two patients with congenitally corrected transposition of great arteries, Ebstein's malformation of the systemic atrioventricular valve, and ventricular septal defect. A subjectively small systemic ventricle and an Ebstein-like abnormality of the systemic atrioventricular valve have been described previously in association with congenitally corrected transposition, but in vivo quantification of ventricular size and pump function has not been reported. An initial palliative rather than a totally corrective procedure is probably desirable in patients with this combination of findings. Ventricular volume calculations may prove useful as an aid in selection of operation in this setting.

Adolescent↗
PubMed1980

Total anomalous pulmonary venous connection in infancy. Ten years' experience including studies of postoperative ventricular function.

The surgical experience with total anomalous pulmonary venous connection (TAPVC) at the Venderbilt Hospital between the years 1969 and 1979 was reviewed. Twenty-five patients with TAPVC were studied. All but one patient presented at less than 1 year of age, and 11 patients were operated upon in the first 2 weeks of life. Operative mortality rate was 20% (5/25). Four of the five deaths were in critically ill neonates requiring preoperative ventilatory support. All operative deaths were in patients with pulmonary venous obstruction. All operative survivors have been followed for a mean 4.5 years (6 months to 10 years). There have been no late deaths or cases of symptomatic pulmonary venous obstruction. All children have had normal growth patterns. Ten patients have been recatheterized. Pulmonary artery systolic pressure, which was markedly elevated prior to operation, fell to normal levels after operation. Ventricular function has been evaluated by quantitative angiocardiography in nine patients before and after operation. Left ventricular size and function were markedly depressed preoperatively and rose to normal levels in postoperative survivors. Left atrial maximal volume was found to be 94% of normal values. These data support the contention that preoperative pulmonary venous obstruction is the single risk factor predicting higher risk of operative death. The presence of severe depression of left ventricular size and function preoperatively does not predict a higher operative risk, and postoperative survivors can expect normal ventricular function.

Angiocardiography↗
PubMed1979

Myocardial anaerobic metabolism during isoprenaline infusion in a cyanotic animal model: possible cause of myocardial dysfunction in cyanotic congential heart disease.

Mongrel dogs were made acutely cyanotic by anastomosis of the inferior vena cava to the left atrium and measurements of high fidelity left ventricular pressure, arterial pressure, blood gases, and myocardial lactate arteriovenous differences were determined before pacing, with atrial pacing at a rate of approximately 240 per minute, and during an infusion of isoprenaline to increase myocardial oxygen demands. The animals were divided into two groups on the basis of the arterial PO2 during isoprenaline: acyanotic or control dogs (n = 4, PO2 greater than or equal to 6.7 kPa [50 mmHg], mean = 52) and cyanotic dogs (n = 5, PO2 less than or equal to 4.7 kPa (35 mmHg), mean = 32). Myocardial lactate arterio-venous difference showed no significant changes in the control dogs with pacing or isoprenaline, but myocardial lactate production occurred in all five cyanotic dogs with isoprenaline infusion. These studies demonstrate that myocardial anaerobic metabolism can be produced during times of stress with isoprenaline infusion in a cyanotic animal model at systemic oxygen levels that can occur clinically.

Anaerobiosis↗
PubMed1979

Reparative cardiac surgery in infants and small children: Five years experience with profound hypothermia and circulatory arrest.

A five year experience of profound hypothermia and circulatory arrest in the operative management of severe congenital heart disease in 128 infants and children weighing 10 kg or less is reviewed. Hospital mortality was 13% for the entire series--8% in the last two years. Mortality varied with the defect present rather than with the age at operation, and appeared to decline over the five years. There was no morbidity associated particularly with this technique, and no evidence of permanent neurologic nor intellectual impairment. Total arrest time averaged 55 minutes, was related significantly to the defect being repaired, but was not related to hospital mortality. The results support the idea of definitive early cardiac repair for severely symptomatic infants and young children, rather than surgical palliation. The hypothermic arrest technique is attractive since it allows optimal operating conditions, thus permitting an accurate repair and the consequent improvement in surgical results.

Child, Preschool↗
PubMed1978

Use of prostaglandin E1 for emergency palliation of symptomatic coarctation of the Aorta.

Prostaglandin E1 (PGE1) was infused into the pulmonary artery in a 1-day-old infant with symptomatic coarctation. Umbilical artery pressure rose from 50/40 mm Hg before infusion to 83/48 mm Hg after infusion, indicating significant improvement in lower-body perfusion. Successful coarctation repair was performed during continued PGE1 infusion. To our knowledge, this is the first reported patient in whom PGE1 has been used for successful emergency palliation of symptomatic coarctation.

Aortic Coarctation↗
PubMed1978

Restrictive cardiomyopathy in an infant with massive biatrial enlargement and normal ventricular size and pump function.

Restrictive cardiomyopathy in an infant with massive biatrial enlargement and normal ventricular size has been reported only once previously [3]. We now present a 13-month-old patient with severe and progressive congestive heart failure who demonstrated normal ventricular cavity size with biatrial enlargement. Ejection fraction and echocardiographic ventricular function studies were normal.

Adolescent↗
PubMed1978

An inexpensive computer-aided system for quantitative echocardiography.

A comprehensive system has been developed to quantitatively analyze standard M-mode pediatric echocardiograms. It utilizes relatively inexpensive hardware together with a telephone coupling to a time-sharing computer. A complete patient report on the study is printed out upon completion, and all the data are digitally stored for future research computations. Initial and operating costs for this system are significantly less than for any comparable one available.

Diagnosis, Computer-Assisted↗
PubMed1978

Operative closure of isolated defects of the ventricular septum: planned delay.

Selection of patients and the timing of operation for closure of ventricular septal defect (VSD) can be difficult because the risk of operation must be balanced against the hemodynamic abnormality and the age and size of the infant. In the past 6 years we have individualized our approach to the timing and necessity of operation in the patient with an isolated VSD. During this period, 133 patients with VSD were evaluated, and 71 underwent operative closure of the VSD. Of the 133 patients, 90 were 2 years old or younger, and 40 of them required operation because of congestive failure and growth retardation. Of the 45 infants who did not undergo operation, 17 have small intracardiac shunts with normal pulmonary vascular resistance while the other 28 infants remain compensated and are growing despite moderate left-to-right shunts. A persistent, large intracardiac shunt was the indication for operation in 31 of the 48 older patients; the other 17 older patients remain well. Although 3 severely growth-retarded infants (2 to 4 kg) died soon after operation, all infants weighing 4 kg or more survive. No child has died during preoperative observation, and irreversible pulmonary vascular changes have not occurred. Most infants with VSD and large intracardiac shunts do require early VSD closure, but the risk of operation remains high in the tiny neonate with profound failure. With appropriate hemodynamic and clinical criteria, operation for selected infants can be delayed so that the risk of operation can be minimized.

Age Factors↗
PubMed1978

Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants.

As a result of randomized assignment, 15 preterm infants weighing 1,500 gm or less at birth and who had a symptomatic PDA were treated according to a medical management protocol, and ten according to an early surgical closure protocol. All infants required mechanical ventilation at the time of study entry, which was one week after birth. Birth weight, gestational age, age at onset of congestive failure, age at study entry, and the initial morbidity of members of the two groups were similar. The nine surviving infants managed according to the surgical closure protocol were weaned from mechanical ventilation sooner, had a decreased need for digoxin and furosemide, achieved gastrointestinal function sooner, and had a smaller hospital bill than the 12 survivors of the medical management group. These results indicate that infants with a symptomatic PDA still requiring mechanical ventilation at one week after birth will benefit from surgical closure of the ductus at that time.

Digoxin↗
PubMed1978

Advances in invasive cardiac diagnosis and management.

Cardiac catheterization is now a relatively safe procedure when performed by an experienced pediatric cardiology team in a medical center with full ancillary pediatric services as well as cardiac surgery available on a 24 hour basis. Advances in equipment and techniques such as improved radiological equipment, newer catheters, and angled angiocardiographic views have improved diagnostic studies such that intraoperative changes in the preoperative diagnoses fortunately are rare. The use of prostaglandin E1 in neonates with either pulmonary atresia or the coarctation syndrome to achieve ductal dilatation with resultant marked clinical improvement preoperatively is a major advance that should become a standard method of therapy over the next few years. Newer catheterization techniques include devices for enlarging atrial septal defects (balloons and blades), closing atrial septal defects, closing a patent ductus, and performing myocardial biopsies in infants. All of these latter techniques hold promise for extending the pediatric cardiologist's role in providing newer diagnostic as well as therapeutic techniques in the care of infants and children with heart disease.

Adolescent↗
PubMed1978

Pharmacologic dilatation of the ductus arteriosus with prostaglandin E1 in infants with congenital heart disease.

Prostaglandin E1 (PGE1) has been used for successful palliation in nine infants with congenital heart disease. Seven patients had pulmonary atresia with ductal-dependent pulmonary blood flow. In this group, systemic O2 saturation increased from a mean value of 45% to 79% after infusion of PGE1, and surgical palliation was successfully done with the infants in stable condition, without hypoxemia or acidemia. An additional patient with coarctation of the aorta had marked ductal dilatation after PGE1 infusion as indicated by umbilical artery pulse pressure. The coarctation was repaired, with the infant in stable condition. The final patient had neonatal tricuspid insufficiency with right to left atrial shunting. Systemic O2 saturation was improved after PGE1 infusion, though the ductus was closed. The improved oxygenation was believed to be due to a reduction in pulmonary vascular resistance by PGE1. Prostaglandin E1 provides a powerful new tool for palliation of critical congenital heart disease in infants whose ductal constriction can markedly influence their clinical status.

Ductus Arteriosus, Patent↗
PubMed1977

Aneurysmal dilatation of the right ventricular outflow tract in infancy: severe form of Uhl's anomaly?

A previously unreported cardiovascular malformation is presented consisting of aneurysmal dilatation of the right ventricular outflow tract associated with a cardiomyopathy, a possible variant of Uhl's anomaly. The patient presented at 8 days of age with mild cyanosis and congestive failure. Cardiac catheterization revealed severe cardiomegaly associated with very poor pump function of both right and left ventricles. The present case is unique in showing 1) severe aneurysmal dilatation of the right ventricular outflow tract. 2) only partially absent right ventricular musculature documented before death by the pressure tracing and cineangiocardiograms, and 3) the first quantitation of both right and left ventricular size and function in this syndrome. A review of previous cases of Uhl's anomaly indicates that this case may represent a variant of that condition and that intrauterine myocarditis or myocardial infarct should be considered in regard to etiology.

Dilatation, Pathologic↗
PubMed1977

Hypoplasia of the left ventricle: rare cause of postoperative mortality in tetralogy of Fallot.

Severe left ventricular hypoplasia in tetralogy of Fallot is a rare complication. A case history of a 3 year old child who died after attempted repair of tetralogy is presented. Left ventricular end-diastolic volume was 26 ml/m2 (only 45 percent of predicted normal) after repair with normal filling pressure and no evidence of tamponade. Clinical examination, chest X-ray film, electrocardiogram and qualitative assessment of a preoperative left ventriculogram were not useful in assessing this degree of left ventricular hypoplasia; quantitative determination of left ventricular volumes is required for this purpose. When left ventricular end-diastolic volume is less than 55 percent of predicted normal, a shunt procedure may be indicated as an initial procedure with subsequent repair 1 to 2 years later, after left ventricular enlargement.

Child, Preschool↗