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Biomedical subjects

W D Edwards

Publications and source records attributed to W D Edwards.

At least 289 records · Page 16Linked to original sources
PubMed1982

Left ventricular wall thickness in complete transposition of the great arteries.

Age-related changes in left ventricular wall thickness were studied in 92 autopsy specimens of complete transposition of the great arteries (TGA) and in 189 normal hearts. By means of morphologic and clinical hemodynamic criteria, three groups were defined: Group II, TGA with intact ventricular septum (low left ventricular pressure): Group II, TGA with ventricular septal defect but without pulmonary stenosis (systemic left ventricular pressure combined with volume overload); and Group III, TGA with ventricular septal defect and pulmonary stenosis (systemic left ventricular pressure). At birth, the left ventricular thickness for the three groups did not significantly differ from normal. In group I, the left ventricular thickness remained constant with age up to 4 years and, accordingly, was significantly less after 4 months of age than that both in normals and in Groups II and III. In those Group II specimens from patients without irreversible pulmonary vascular disease, the left ventricular thickness was similar to that of normal hearts. The left ventricular thickness in Group III increased, with age in a manner similar to that of normal hearts. If left ventricular wall thickness correlates with potential ventricular function, then this measurement, combined with other clinical data, may help to predict the ability of the left ventricle to perform systemic work following one of the arterial switch operations. Sequential determinations of wall thickness may be attained noninvasively by echocardiography.

Age Factors↗
PubMed1982

Diagnosis of active lymphocytic myocarditis by endomyocardial biopsy: quantitative criteria for light microscopy.

The clinical diagnosis of active lymphocytic myocarditis is often difficult, owing to the nonspecific nature of the clinical presentation. Although endomyocardial biopsy is potentially the best available tool for establishing this diagnosis, reliable and quantitative criteria for light microscopy are needed. In an attempt to define specific histologic criteria for the diagnosis of myocarditis, we counted the number of interstitial lymphocytes in 20 high-power (X400) microscopic fields in each of 170 endomyocardial biopsy specimens. The normal mean number of myocardial lymphocytes was determined to be fewer than 5.0 per high-power field, and mean values greater than this were considered to represent active lymphocytic myocarditis. With the use of these histologic criteria, the endomyocardial biopsy may be helpful in the detection of active myocarditis and in the evaluation of treatment.

Adult↗
PubMed1982

Cardiac fibroma: long-term survival after excision.

Four patients have had operation at the Mayo Clinic for a cardiac fibroma and all survived. Three patients have an excellent clinical result and are free of tumor 1 year, 13 years, and 17 years postoperatively. The fourth shows radiographic evidence of residual tumor near the mitral anulus, but is clinically well 15 years postoperatively. A fifth unoperated patient died suddenly 8 years after presumptive diagnosis of fibroma at the age of 83 years. This experience suggests that patients who have undergone successful excision of cardiac fibroma have an excellent probability of remaining free of disease.

Child↗
PubMed1982

Porcine heterograft valve replacement in children.

From 1973 to 1980, 49 patients under 18 years of age survived cardiac valve replacement with Hancock porcine heterografts. Complete follow-up has been obtained on 44 patients (90%) in whom 46 valves were placed. There were 30 boys and 14 girls with an age range of 2 to 18 years (mean 10.0 years). Severe prosthetic valvular dysfunction requiring valve replacement occurred in eight valves in seven patients at 15 to 60 months postoperatively (mean 34.1 months), yielding a calculated replacement rate of 7.1% per patient-year. All eight valves demonstrated severe calcification with stenosis, two valves had significant insufficiency secondary to leaflet disruption, and one valve had a large leaflet perforation. Thirty-one patients with valves in place at 7 to 90 months (mean 38.4 months) are alive, but six have clinical evidence of progressive valvular dysfunction. The mean age at the time of the original Hancock valve placement of the group of patients having undergone replacement of a failed prosthesis together with those with clinical evidence of prosthetic dysfunction was 8.0 years, which is significantly less than that of the remaining group of patients with normally functioning valves (mean 11.2 years, p = 0.043). Actuarial curves demonstrate a predicted replacement-free rate of 87.4% +/- 5.9% at 3 years. 82.3% +/- 7.5% at 4 years, and 58.5% +/- 15.7% at 5 years. On the basis of these data and other reports of early failure in the literature, we have discontinued the routine use of Hancock porcine heterografts for cardiac valve replacement in children in favor of mechanical prostheses.

Actuarial Analysis↗
PubMed1981

Evaluation of two methods for estimating theophylline clearance prior to achieving steady state.

The Koup et al. and Chiou et al. clearance estimation methods were evaluated n 19 chronic obstructive pulmonary disease (COPD)/asthmatic patients who were receiving aminophylline by continuous infusion. Estimated theophylline clearance (Clest) was determined using two serum concentrations obtained during the first few hours of therapy (1-16 hr) prior to achievement of steady state. Actual theophylline clearance (Clact) was determined after steady state conditions had been achieved (defined as 4-5 half-lives at the same infusion rate). The correlation between Clact and Clest was highly significant for both the Koup et al. and Chiou et al. methods, r = 0.865, p less than 0.001, and r = 0.858, p less than 0.001, respectively. The clearance estimation methods were compared with the Food and Drug Administration (FDA) dosage guidelines and shown to be clearly superior in predicting therapeutic steady state theophylline concentrations.

Aminophylline↗
PubMed1981

Coronary arterial anatomy in bicuspid aortic valve. Necropsy study of 100 hearts.

In a necropsy study, the conjoined cusps of 50 congenitally and 50 acquired bicuspid aortic valves most commonly involved the right and left aortic cusps. In hearts with congenitally bicuspid aortic valves, the left coronary ostium arose at or above the aortic sinotubular junction in 44 per cent, whereas the incidence for the left coronary ostium in the acquired group was 20 per cent and that for the right coronary ostium in both groups was less than 20 per cent. In hearts with congenitally bicuspid aortic valves, the incidence of left coronary dominance (26%) was higher than in normal hearts. In hearts with apparently acquired bicuspid aortic valves, this incidence was also higher than normal, possibly because of acquired fusion of atypical congenitally bicuspid valves in some cases. In both types of aortic valve disease, the length of the left main coronary artery was similar; this length, however, was significantly shorter in hearts with left coronary dominance than in those with right or shared dominance.

Adolescent↗
PubMed1981

Aortic origin of conus coronary artery. Evidence of postnatal coronary development.

The conus coronary artery has been reported to arise independently from the aorta in approximately 45 per cent of hearts. In this study, 305 necropsy specimens were examined to determine the origin of the conus coronary artery and variations in patterns of origin with respect to age. Three patterns were recognised: 1, in which the conus artery arose from the aorta independently of the right coronary artery; 2, in which the conus artery and the right coronary arose from a common ostium; and 3, in which only the right coronary artery took origin from the right aortic sinus. The relative incidence of the three patterns varied with age. Pattern 1 was recognised in 14 to 24 per cent of specimens from patients under the age of 2 years, whereas in older patients, it occurred in 41 to 63 per cent. These data suggest that aortic origin of the conus arterial ostium may appear in some individuals between 2 and 4 years of age, and they support the concept that some coronary arterial patterns are not fully established at the time of birth.

Adolescent↗
PubMed1981

Fabry cardiomyopathy in the female confirmed by endomyocardial biopsy.

A 58-year-old woman with cardiac enlargement and heart failure was a member of a family with Fabry disease. In this patient, endomyocardial biopsy permitted microscopic examination of the myocardium which revealed cellular abnormalities characteristic of Fabry cardiomyopathy. It is suggested that unfavorable lyonization of the mutant-bearing X chromosome accounted for the expression of this disorder in specific organs of a female patient.

Adolescent↗
PubMed1981

Effects of cyproterone acetate on growth and androgen metabolism of rat ventral prostate transplants.

Cyproterone acetate (CA0 (10 or 20 mg kg-1 daily for 5 days) injected into castrate rats supplemented with testosterone propionate (TP) caused a significant decrease in ventral prostate weights in situ; no inhibitory effects were noted in transplant weights. CA failed to significantly inhibit DNA in either the in situ prostate or transplant, but his anti-androgen caused a significant decrease in the formation of 3H-dihydrotestosterone and 3H-androstanediol from radioactive testosterone in the in situ organ. Histologically, CA caused a decrease in epithelial cell secretory activity.

Androgens↗
PubMed1981

Clinicopathological correlates of obstructed right-sided porcine-valved extracardiac conduits.

Thirteen of 308 patients (4.2%), who had received right-sided valved extracardiac conduits at the Mayo Clinic from November, 1972, to April, 1977, have required conduit replacement because of obstruction. Patients were 5 to 16 years old at initial operation and 8 to 20 years old at reoperation; the duration of conduit implantation was 27 to 79 months (mean 50). Four patients (31%) were asymptomatic; exertional dyspnea was present in eight (62%) and dizziness was reported in one (8%). Signs of conduit obstruction included increasing intensity of murmurs in 11 (85%), cyanosis in two (15%), and heart failure in one (8%). Peak pressure gradients from the right ventricle to the pulmonary arteries ranged from 50 to 140 mm Hg (mean 87) and correlated well with the degree of conduit obstruction. Catheter pullback allowed accurate localization of stenosis within the conduit, whereas angiography alone did not. The site of major obstruction was in the proximal conduit in five (38%), at the valve in nine (69%), and in the distal conduit or side branches in six (46%); stated differently, major stenosis affected the valve alone in five (38%), the graft alone in four (31%), and both the valve and the graft in four (31%). Valvular changes leading to stenosis included thrombosis, commissural fusion, and calcification, and changes consistent with insufficiency included tears, fusion of cusps to the conduit wall, and, in one case, infective endocarditis. Within the conduit, nonvalvular obstruction was due to formation of a thick fibrous peel (or neointima). Progressive thickening of the peel appeared to be due to organization of thrombus between the peel and conduit and not due to luminal mural thrombus. In one case, the peel formed a flap-valve, causing even further obstruction. Since many patients are asymptomatic, and since late conduit stenosis may develop unpredictably by several mechanisms, long-term follow-up is necessary.

Adolescent↗
PubMed1981

Standardized nomenclature and anatomic basis for regional tomographic analysis of the heart.

The noninvasive evaluation of cardiac diseases by two-dimensional imaging techniques is now a reality. Two-dimensional echocardiography is a well-established clinical tool, and both roentgenographic computed tomography and isotope positron reconstructions of the heart are being developed. The time has come for the pathologist to perform systematic and correlative cross-sectional analysis of cardiac diseases at autopsy. To attain this goal, the pathologist and clinician must work together. This paper describes various methods for examination of the heart at autopsy and emphasizes the value of tomographic sections. The concept of regional analysis of the heart is described, and a standardized system of nomenclature is offered for the pathologist and the clinician.

Autopsy↗
PubMed1981

Atrioventricular and ventriculoarterial discordance (corrected transposition of the great arteries). Wide-angle two-dimensional echocardiographic assessment of ventricular morphology.

Wide-angle two-dimensional echocardiography was used to establish criteria for recognition of ventricular situs and ventricular morphology in 27 patients (ages 2 month to 58 years) with atrioventricular amd ventriculoarterial discordance (corrected transposition of the great arteries). The morphologic left ventricle was recognized by the presence of an atrioventricular valve that was attached more superiorly along the ventricular septum than the other atrioventricular valve, that had a fish-mouth (bicommissural) appearance in diastole, and that had two discrete papillary muscles; by a ventricle with a finely trabecular pattern and ellipsoid shape; and by the presence of direct continuity between the atrioventricular and semilunar valves. The morphologic right ventricle was recognized by the presence of an atrioventricular valve that was attached more inferiorly along the ventricular septum, that had a triangular (tricommissural) appearance, and that had multiple irregular papillary muscles; by a ventricle with a coarsely trabecular pattern and a triangular or crescentic shape, and by the presence of muscular atrioventricular-semilunar valve discontinuity. Using these criteria, ventricular situs and morphology could be reliably determined by noninvasive two-dimensional echocardiography. In addition, two-dimensional echocardiography allowed the recognition of frequently associated anomalies. In this series, two-dimensional echocardiography demonstrated Ebsteins's malformation of the left atrioventricular valve in four patients and a straddling atrioventricular valve in eight (one right-sided, seven left-sided.

Adolescent↗