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Biomedical subjects

W D Edwards

Publications and source records attributed to W D Edwards.

At least 271 records · Page 15Linked to original sources
PubMed1983

Accuracy of 2-dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: echocardiographic-anatomic correlation in 115 patients.

The preoperative 2-dimensional (2-D) echocardiograms of all patients less than 50 years of age in whom the aortic valve had been directly inspected by the surgeon or the pathologist or both were reviewed. From June 1977 to June 1981, 283 patients aged less than or equal to 50 years had aortic valve surgery at the Mayo Clinic: 115 (aged 1 to 50 years [mean 32]) had 2-D examinations preoperatively. The echocardiograms were reviewed blindly, and the aortic valve structure was categorized as bicuspid, tricuspid, or indeterminate. On the basis of combined surgical and pathologic inspection, 50 aortic valves were congenitally bicuspid, 60 were tricuspid, 4 were unicommissural, and 1 was quadricuspid. By 2-D echocardiography, the number of cusps was indeterminate in 29 patients (25%). When these patients were excluded, the sensitivity, specificity, and diagnostic accuracy of 2-D echocardiography for bicuspid aortic valve were 78,96, and 93%, respectively. Thus, with adequate 2-D images, echocardiography is a sensitive and highly specific technique for the diagnosis of bicuspid aortic valve.

Adolescent↗
PubMed1983

Impact of 2-Dimensional echocardiography on the management of distressed newborns in whom cardiac disease is suspected.

The course and management of 40 consecutive newborns (aged less than 2 weeks) who presented with signs and symptoms of congenital heart disease were reviewed to determine the impact of 2-dimensional (2-D) echocardiography on their subsequent management. Of the 40 patients with congenital heart disease, 60% did not undergo cardiac catheterization. Forty-two percent of the patients who were treated surgically went directly to operation without preoperative cardiac catheterization. Only 40% of the patients with congenital heart disease required cardiac catheterization in the newborn period, and 43% of these procedures were primarily therapeutic (that is, balloon atrial septostomy). In each patient 2-D echocardiography correctly identified the major cardiac malformation and there was good agreement with angiographic, surgical, and autopsy findings. The most commonly overlooked defect was a patent ductus arteriosus. Thus, 2-D echocardiography not only allows diagnosis of congenital heart disease in the newborn but can expedite clinical management. No longer is cardiac catheterization necessarily the primary means for an anatomic diagnosis of congenital cardiac malformations in the newborn.

Angiography↗
PubMed1983

Papillary muscle rupture complicating acute myocardial infarction: analysis of 17 patients.

The records of 17 patients (10 men and 7 women) with the diagnosis of acute papillary muscle rupture secondary to acute myocardial infarction (AMI) were reviewed to determine the clinical course and pathologic features of this entity. Eight patients underwent operation after papillary muscle rupture had been diagnosed, and 9 had the diagnosis confirmed at autopsy without a prior surgical procedure. The ages were 44 to 80 years (mean 64). The site of AMI was inferolateral in 15 and anterior in 2. The recorded onset of mitral regurgitation ranged from less than 24 hours to 28 days after AMI (mean 6 days). Of the 11 patients presenting with pulmonary congestion alone, 6 remained stable and had subsequent mitral valve replacement and coronary artery bypass graft operation; however, 5 patients' condition initially stabilized with medical therapy and then suddenly deteriorated after a variable period (1 to 60 days), followed by death. Of the 6 patients who presented with systemic hypotension and pulmonary congestion, 4 were treated medically and died; 1 of the 2 who had surgical treatment survived. The extent of the AMI at autopsy was small and was limited to the subendocardium in half of the patients. Significant coronary artery disease was limited to a single vessel in 7 of 14 patients. The unpredictable and rapid clinical deterioration and the limited extent of coronary atherosclerotic disease and infarct size suggest that early surgical repair should be undertaken in patients with papillary muscle rupture after AMI.

Adult↗
PubMed1983

Left juxtaposed atrial appendages: diagnostic two-dimensional echocardiographic features.

Left juxtaposition of the atrial appendages is usually associated with cyanotic congenital heart disease. Recognition of this rare anomaly is important before therapeutic or surgical procedures that involve the atrial septum can be undertaken (for example, septostomy, the Mustard or Senning operation and the Fontan anastomosis). The diagnosis of left juxtaposition of the atrial appendages is most commonly an incidental finding at the time of surgery or autopsy. This report describes the two-dimensional echocardiographic visualization of left juxtaposed atrial appendages. The diagnostic echocardiographic features are based on characteristic alterations of the plane of the atrial septum and visualization of the malpositioned right atrial appendage. On the basis of these observations, a noninvasive diagnosis of left juxtaposed atrial appendages is now possible by means of two-dimensional echocardiography.

Adolescent↗
PubMed1983

Diagnosis of lipomatous hypertrophy of the atrial septum by two-dimensional echocardiography.

Originally described in 1964, lipomatous hypertrophy of the atrial septum currently remains a diagnosis established primarily at autopsy. Clinical interest in this disorder has centered on the reported association with supraventricular arrhythmias and sudden death. Because two-dimensional echocardiography allows detailed assessment of atrial septal configuration, we reviewed two-dimensional echocardiographic reports obtained over a 1 year period and identified 17 patients who had features consistent with lipomatous hypertrophy of the atrial septum. Nine were men and the average age was 70 years. Autopsy confirmation of the echographic findings was possible in one patient. In nine patients, ideal body weight was exceeded by 10% or more. The atrial septum viewed from the subcostal transducer position showed a distinctive echo-dense globular thickening sparing the valve of the fossa ovalis. The resultant tomographic image of the atrial septum had a characteristic dumbbell appearance. The mean thickness of the atrial septum was 21 mm (range 15 to 29). Seven patients had supraventricular arrhythmias, and eight had P wave abnormalities. The two-dimensional echocardiographic features described are distinctive and suggest that this technique is the procedure of choice not only for establishing the diagnosis of lipomatous hypertrophy of the atrial septum but also for providing a means for prospective follow-up of patients with this little known entity.

Aged↗
PubMed1983

Correlation of two-dimensional echocardiographic and autopsy findings in complete transposition of the great arteries.

Autopsy and antemortem two-dimensional echocardiographic findings were compared in 30 cases to assess the predictive accuracy of two-dimensional echocardiography in complete transposition of the great arteries, and thus its potential for replacing or altering an invasive examination. These cases represent consecutive autopsy cases of transposition between January 1978 and December 1982. Ages at echocardiographic study ranged from 1 day to 15.5 years (median 8.5 months). Transposition of the great arteries had been diagnosed correctly in every case, and all associated anomalies identified by two-dimensional echocardiography were confirmed at autopsy. Several additional anomalies not found by two-dimensional echocardiography were apparent at autopsy; however, most were minor and insignificant. The only potentially significant false negative findings were one ventricular septal defect, two small atrial septal defects, one mitral valve anomaly, one tricuspid valve anomaly, three instances of patent ductus arteriosus and four instances of persistent left superior vena cava. Although significant pulmonary stenosis was predicted correctly, the site of stenosis was not accurately defined in four cases. Two-dimensional echocardiography is a reliable means of diagnosing transposition of the great arteries. It can limit the need for angiocardiography in the neonate; and in older infants and children, it should be used to complement cardiac catheterization and angiocardiography. The latter may be indicated, especially before surgical repair, to better define small ventricular septal defects, site of pulmonary stenosis, atrioventricular valve insufficiency and patent ductus arteriosus.

Adolescent↗
PubMed1983

Pulmonary vascular disease in 57 necropsy cases of total anomalous pulmonary venous connection.

In a semi-quantitative necropsy study, total anomalous pulmonary venous connection (TAPVC) was an isolated anomaly in 35 cases and was associated with asplenia and either pulmonary stenosis or pulmonary atresia in 22 cases. A comparison of the two groups showed pulmonary venous obstruction (26% vs. 4%), a small interatrial communication (51% vs. 4%), a patent ductus arteriosus or operative shunt (40% vs. 64%), medial hypertrophy of muscular pulmonary arteries (80 vs. 23%), muscularization of arterioles (80% vs. 23%), capillary engorgement (60% vs. 27%) alveolar wall thickening (29% vs. 0%), interlobular septal oedema (34% vs. 14%), dilated lymphatics (80% vs. 45%), arterialization of pulmonary veins (86% vs. 68%), medial hypertrophy of veins (26% vs. 0%), and venous dilatation (74% vs. 50%). Only one patient, a 5-year-old girl with isolated TAPVC, had severe plexogenic pulmonary arteriopathy. In the remainder, the pulmonary lesions were those generally associated with reversible pulmonary venous hypertension; they were most striking in patients with pulmonary venous obstruction, and were least prominent in patients with pulmonary stenosis or pulmonary atresia.

Adolescent↗
PubMed1983

Anomalies of the left atrium and mitral valve: cords, flaps, and duplication of valve.

We studied seven hearts with abnormalities of the atrial septum of the mitral valve. Three had abnormalities of the atrial septum, characterized by a flap or a diaphragm within the left atrium. Another three cases had abnormal cords extending from the atrial septum to the anterior or the posterior mitral leaflets. A seventh case had a duplicated mitral valve. Grossly, the specific conditions among these seven hearts appeared very different: however, we believe that the origin of each anomaly can be explained by one of three developmental aberrations or a combination thereof. Although only one case was associated with severe cardiac disease, such structures may be seen during cardiac imaging or operation.

Adult↗
PubMed1983

Surgical pathology of obstructed, right-sided, porcine-valved extracardiac conduits.

Thirty-seven specimens were available from 39 children and adolescents with congenital heart disease who have had operations at the Mayo Clinic (Rochester, Minn) to replace obstructed Hancock conduits that had been implanted 17 to 93 months (mean, 62 months). Stenosis affected the porcine valve alone in 17 (46%), the synthetic graft alone in 11 (30%), both the valve and the graft in six (16%), and other sites in three (8%). Valvular stenosis resulted from degenerative changes with secondary thrombosis and calcification, whereas insufficiency resulted from cuspid tears, thrombotic adhesions, and endocarditis. Nonvalvular obstruction resulted from progressive thickening of fenestrated neointimae, owing to organization of thrombotic debris lining the interface between the conduit and this tissue. Late postoperative conduit stenosis may develop asymptomatically and unpredictably by several different mechanisms.

Adolescent↗
PubMed1983

Coronary artery compression with fatal myocardial ischemia. A rare complication of valved extracardiac conduits in children with congenital heart disease.

Three children with congenital heart disease died after surgical procedures involving the placement of valved extracardiac conduits; their deaths were caused by myocardial ischemia following coronary artery compression by the metallic stent of the conduit valve. The first and second patients died of acute myocardial ischemia or infarction during the immediate postoperative period, whereas the third patient died of chronic myocardial ischemia and progressive heart failure several months after the operation. In a fourth patient the problem of possible coronary artery compression was suspected on completion of the surgical procedure, and the valve stent was then repositioned away from the coronary artery; this resulted in marked hemodynamic improvement. Fatal myocardial ischemia from coronary artery compression is a rare but potential complication of valved extracardiac conduit placement in children with congenital heart disease. Preoperative assessment of coronary artery distribution is indicated in those patients with prior intrapericardial operations and subsequent pericardial adhesions. Such assessment in previously unoperated patients may be undertaken at the time of conduit operation. Proper conduit placement and intraoperative recognition of possible coronary artery compression by the conduit are important in preventing significant ischemic complications.

Child↗
PubMed1983

Enlargement of the aortic root or anulus with autogenous pericardial patch during aortic valve replacement. Long-term follow-up.

Patch enlargement of the aortic root or anulus is a widely accepted technique when restrictive anatomy is encountered during aortic valve replacement. Patches made of prosthetic material have been used almost exclusively, and patches of autogenous pericardium have not received wide acceptance. Although pericardium is advantageous because of its low cost, ready availability, and ease of handling, its long-term durability has not been fully established. From 1965 to 1981, 96 patients had autogenous pericardial patches placed during aortic valve replacement at the Mayo Clinic. In 81 patients, the patches were placed solely in a supravalvular position to facilitate aortic closure, while in 15 patients, the patches were placed in both subvalvular and supravalvular positions, allowing for annular expansion and insertion of a larger prosthesis. In a mean follow-up of 5.4 years, none of the 92 operative survivors has had clinical evidence of sudden patch failure and none has had patch aneurysms detected by routine chest roentgenography. One patient required reoperation for a perivalvular leak at the point where the prosthesis had been sutured to the patch. Objective data concerning the late postoperative status of the patch were available on 48 patients: 24 underwent reoperation, 16 underwent two-dimensional echocardiography, two underwent aortic root angiography, and six underwent postmortem examination. Patch aneurysms were universally absent, and in every patient the patches were well incorporated into the adjacent tissues. This proven durability suggests that autogenous pericardium is a satisfactory patch material when required during aortic valve replacement.

Adolescent↗
PubMed1982

Echocardiographic features of carcinoid heart disease.

We reviewed the records of the Mayo Clinic patients with known carcinoid syndrome in whom echocardiographic studies had been done. Nineteen patients had M-mode and 2-dimensional echocardiographic examinations, and 1 patient had an M-mode examination only. Of the 20 patients, 8 had no evidence by echocardiogram of carcinoid heart disease; 2 had changes in the tricuspid valve echogram suggestive of early carcinoid heart disease, and the other 10 patients had the following distinctive echocardiographic findings: (1) the pattern of right ventricular volume overload (enlarged right ventricle with abnormal septal motion); (2) abnormal right-sided valves, including (a) a striking appearance of the tricuspid valve, the leaflets appearing thickened, retracted, and fixed in a semiopen position throughout the cardiac cycle, and (b) thickened, retracted pulmonic valve cusps, when visualized; and (3) the left-sided valves and chambers rarely involved. These echocardiographic features are distinctive of advanced carcinoid heart disease and correlate closely with pathologic findings.

Adult↗
PubMed1982

Right Ventricular endomyocardial biopsy: clinicopathologic correlates in 100 consecutive patients.

The first 100 consecutive patients to undergo right ventricular endomyocardial biopsy at the Mayo Clinic were divided retrospectively into five groups, depending on the prebiopsy clinical diagnosis, and the biopsies were review histologically in a single-blind format. Group 1 consisted of 34 patients with a diagnosis of unexplained congestive heart failure and a dilated heart; of these, 4 (12%) had active myocarditis by biopsy. Of the six patients in group 2 with a clinical diagnosis of myocarditis, only one (17%) had biopsy evidence of inflammation, but two (33%) had changes that, in the clinical setting, were suggestive of cardiomyopathy. Group 3 consisted of 27 patients with dysrhythmia, syncope, or cardiac arrest but without congestive heart failure; of these, 4 (15%) had active myocarditis by biopsy, and 8 (30%) had changes that, with the clinical history, were consistent with cardiomyopathy. Group 4 included 19 patients with unexplained congestive heart failure and a nondilated heart; 4 (21%) had cardiac amyloid on biopsy. Group 5 was a diverse group of 14 patients with possible cardiac involvement by a known systemic disease; myocardial disease was documented by biopsy in 7 (50%). On the basis of these findings, we recommend endomyocardial biopsy (1) in patients with dilated cardiomyopathy in whom myocarditis is suspected, (2) in patients with the clinical diagnosis of active myocarditis in whom tissue documentation is indicated before treatment with anti-inflammatory or immunosuppressive drugs, (3) in patients with clinically unexplained life-threatening dysrhythmias in whom myocarditis or cardiomyopathy may be present, and (4) in patients with apparent hypertrophic or restrictive cardiomyopathy in whom cardiac amyloid may be present.

Adolescent↗
PubMed1982

Pathogenesis of nonobstructive fibrous peels in right-sided porcine-valved extracardiac conduits.

An autopsy study was conducted of 14 cardiopulmonary specimens in which porcine-valved extracardiac conduits had been placed from the right ventricle to the pulmonary artery. The gross and light microscopic appearance of the tissue lining in such conduits was evaluated. In no instance was the lining considered obstructive. The conduits had been in place for varying lengths of time ranging from 1 day to 5 years. The neointima appeared to begin developing as early as the first postoperative day as a thin layer of platelet-fibrin thrombus, followed by incorporation of red blood cells and a few leukocytes. Between 2 to 3 weeks postoperatively, such shallow thrombotic linings had become organized by fibroblastic migration and proliferation from both the proximal and distal anastomosis sites. However, incomplete development of the neointima frequently led to fenestrations. Peels, or neointimae, older than 1 month did not change, having densely fibrous luminal surfaces and having thrombus or necrotic thrombotic debris along the interface between the conduit and peel. These findings support the concept that progressive thickening of the lining peel takes place primarily along the interface between the peel and the conduit rather than the interface between the peel and the lumen.

Adolescent↗
PubMed1982

Abnormalities of the tricuspid valve in complete transposition of the great arteries with ventricular septal defect.

Structural abnormalities of the tricuspid valve were encountered in 38 of 121 autopsy specimens of complete transposition of the great arteries (TGA) with ventricular septal defect (VSD) (31%). Forty abnormalities were identified, including severe straddling of the tricuspid valve tensor apparatus in two, valvular dysplasia in two, left ventricular outflow tract obstruction caused by accessory tricuspid valvular tissue in two, double orifice in one, and abnormal chordal insertions in 33. Seventeen (14%) had abnormalities which were judged to have importance in the surgical management: in two cases, a straddling tricuspid valve would have prevented VSD closure; both cases with valve dysplasia would have required anuloplasty or valve replacement; one with left ventricular outflow obstruction from accessory tricuspid tissue would have required closure of a small VSD; and 12 had abnormal chordal insertions which were surgically significant. Of these 12 who were otherwise candidates for a Rastelli repair, this approach would have been possible in two only by enlargement of the VSD and deviation of the patch. In the 10 others abnormal chordal insertions to the superior aspect of the VSD would have prohibited a Rastelli operation. Abnormal tricuspid valve chordae of this type were present in 9 of 25 (36%) cases with overriding of the pulmonary trunk. Tricuspid valvular abnormalities may significantly alter the surgical approach to patients with complete transposition of the great arteries with VSD.

Heart Septal Defects, Ventricular↗
PubMed1982

Acute postoperative obstruction of extracardiac conduit due to separation of thin fibrous peel.

Late postoperative obstruction of extracardiac conduits may occur in some patients and may result from one of several mechanisms. Severe intraoperative or early postoperative obstruction of such conduits is very rare. Herein we describe a case of acute, severe, early postoperative obstruction of an extracardiac conduit; this followed partial excision and replacement of a Hancock conduit in which late postoperative calcific valvular stenosis had occurred. Unexpectedly elevated right ventricular pressure should suggest the possibility of acute conduit obstruction. In cases with partial conduit replacement, the remaining segment should be carefully inspected for the presence of a peel; if a peel is present, it should be removed from the conduit even if it is considered thin and nonobstructive.

Adolescent↗