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Biomedical subjects

W B Strong

Publications and source records attributed to W B Strong.

At least 109 records · Page 6Linked to original sources
PubMed1982

Evaluation of heart sounds and murmurs in children.

Auscultation is the core of pediatric cardiovascular evaluation and should be performed according to a routine. The four heart sounds should be sought in order at their usual locations, with particular attention to the second sound because of its important diagnostic role in congenital cyanotic heart disease. The next sounds to listen for are clicks, which can be systolic, pulmonary, aortic, or midsystolic. Finally, murmurs should be sought in systole and then diastole. Besides being identified as systolic, diastolic, or continuous, murmurs should be characterized according to their relationship with the first and second heart sounds, intensity, frequency, and maximum location and radiation.

Adolescent↗
PubMed1982

Differential diagnosis of heart murmurs in children.

When a heart murmur turns up on routine examination of an otherwise health child, a thorough cardiovascular evaluation should be carried out according to the guidelines presented in the first two articles in this series (June, page 235, and July, page 151). The information gained by inspection, palpation, and auscultation is then coordinated and analyzed to arrive at the most likely diagnosis, as described in this concluding presentation.

Aortic Coarctation↗
PubMed1981

Hemodynamic and ECG responses to exercise in children with sickle cell anemia.

To determine whether exercise responses are different from normal in children with sickle cell anemia (SCA), we performed dynamic cycle ergometer exercise testing in 47 patients with SCA, aged 5 to 18 years, and 170 healthy, black age-matched control subjects. Seven (15%) of the patients with SCA had definitely ischemic, 16 (34%) had equivocally ischemic, and 24 (51%) had nonischemic ECG responses. Resting heart rate in the three groups of patients with SCA was higher than control values. Maximum exercise heart rate attained was lowest in the definitely ischemic group. All patients with SCA had decreased blood pressure responses and maximum working capacity when compared with control subjects. Hemoglobin concentration was lowest in the definitely ischemic group and correlated with maximum workload. Long-term myocardial ischemia may lead to fibrosis and the decreased myocardial contractility seen in adult patients with SCA.

Adolescent↗
PubMed1981

Effect of intraarterial injection of heparin on the complications of percutaneous arterial catheterization in infants and children.

Thrombotic complications of percutaneous arterial catheterization still remain a significant and serious problem in infants and children. Systemic heparinization has been recommended for prevention of these complications. The purpose of this study was to evaluate the effect of intraarterial injection of heparin in reducing thrombotic complications following percutaneous femoral artery catheterization. One hundred sixteen consecutive patients (ages four months to 20 years) studied by the Desilets-Hoffman modification of Seldinger's technique of femoral artery catheterization were randomly allocated to the control or heparin groups using a double-blind technique. At the completion of the catheterization, 0.1 mg/kg of placebo or heparin (1,000 units/ml) was injected into the common iliac artery prior to removal of the catheter and sheath. Segmental plethysmography was performed in both lower extremities prior to and after the catheterization, and a plethysmography index (PI) was calculated. The age and sex distribution, diagnoses, number, type, and site of previous catheterization, hemoglobin, platelet count, the amount of flush solution and the heparin contained therein, size of the catheter and sheath used, number of arterial punctures, and the length of the time in the artery were similar in the two groups (P greater than 0.1). Thrombin time and activated partial thromboplastin time were measured prior to the use of flush solution and prior to angiography, and these remained essentially unchanged in the two groups. The PI in the control group (97.5 +/- 320 was not significantly different (P greater than 0.1) from that of the heparin group (97.7 +/- 32). Similarly, the six to 24 month of postcatheterization plethysmography data show no differences (P greater than 0.1). The number of patients with reduced ipsilateral posterior tibial and dorsalis pedis pulses was also similar (P greater than 0.1). None of the patients in either group required thrombectomy. The low low incidence of arterial complications in our patients when compared with other studies may be related in part to the use of a sheath, which is not called for in original Seldinger technique. The data suggest that full-dose heparin administration does not significantly alter arterial complications following percutaneous femoral artery catheterization, especially in children over five years of age.

Adolescent↗
PubMed1981

Blood pressure response to dynamic exercise in healthy children--black vs white.

In order to determine normal values for systolic blood pressure response to cycle ergometer stress testing in children, we performed 405 studies in subjects from 6 to 15 years of age, of whom 184 were black and 221 were white. We analyzed the data in relation to sex, color, age, and body surface area. Resting systolic blood pressure showed no differences between groups of black and white children, analyzed either by age or surface area. Peak exercise blood pressures were higher in the black females, in comparison to their white counterparts, only when separated into groups by body surface area. The black males had higher exercise blood pressure values than the whites, both by age and surface area evaluation. Our data suggest a difference in the blood pressure response to dynamic exercise within the black population. Further studies are needed to define the mechanism of this difference and whether this difference may provide a clue to the identification of children at increased risk for developing hypertension later in life.

Adolescent↗
PubMed1981

Syndrome of single ventricle without pulmonary stenosis but with left atrioventricular valve atresia and interatrial obstruction. Palliative management with simultaneous atrial septostomy and pulmonary artery banding.

Case histories of four infants with single ventricle and left atrioventricular (AV) valve atresia, with interatrial obstruction but without pulmonic stenosis, are presented. Relief of interatrial obstruction by surgical or balloon atrial septostomy resulted in a marked fall in the left atrial pressure and the pulmonary artery mean pressure and resistance as well as a marked increase in the left-to-right interatrial shunt, pulmonary blood flow, and systemic arterial oxygen saturation. Because of this predictable fall in pulmonary vascular resistance, concomitant pulmonary artery banding was performed in each case with good results. There are only a few previously reported cases of single ventricle with left AV valve atresia. Interatrial obstruction is quite common in this lesion. The concept that relief of interatrial obstruction produces a rapid and predictable fall in the pulmonary vascular resistance and that concomitant pulmonary artery banding is necessary in these infants with complex congenital heart disease is emphasized.

Blood Pressure↗
PubMed1979

False aneurysm of right pulmonary artery. New complication of aorta-right pulmonary artery anastomosis.

The case history of an infant with tetralogy of Fallot who had a Waterston anastomosis performed at the age of 1 year is presented. Subsequent chest roentgenograms revealed a ringlike calcification which was shown at angiography and operation to be due to a false aneurysm of the right pulmonary artery at the site of the Waterston anastomosis. The aneurysm also produced unidirectional obstruction of the right pulmonary artery. A review of the literature suggested that a false aneurysm of the right pulmonary artery after a Waterson anatomosis had not been reported previously.

Aneurysm↗