Biomedical subjects

W J Brawn

Publications and source records attributed to W J Brawn.

42 records · Page 3Linked to original sources

PubMed1988

Early results for anatomic correction of transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect.

Fifty patients, 21 with transposition of the great arteries plus ventricular septal defect, four with double-outlet right ventricle plus ventricular septal defect, and 25 with transposition of the great arteries plus intact ventricular septum, have undergone anatomic correction. There were four hospital deaths, all in the patients with ventricular septal defects (overall mortality rate 8%). The Lecompte maneuver was used in all patients, and in the last 25 patients the coronary arteries were transposed to medially hinged trapdoor flaps created in the neoaorta. In 10 patients (20%) intraoperative adjustments were necessary to the great vessels and coronary arteries to achieve unobstructed coronary artery flow. There have been no late deaths. Postoperative cardiac catheterization in 19 patients has revealed stenosis on the new main pulmonary artery suture line to be the main early problem. Anatomic correction of transposition (with or without ventricular septal defect) and double-outlet right ventricle septal defect would seem to be a good operative alternative to the Mustard or Senning operation, with the advantage of incorporating the left ventricle into the systemic circulation.

Aorta↗

PubMed1987

Cerebellar infarction secondary to subclavian aortoplasty repair for coarctation of the aorta.

A five-year-old boy developed a left cerebellar infarction following repair of coarctation of the aorta by subclavian aortoplasty. At operation a large left vertebral artery had been ligated. If a large vertebral artery is encountered at repair of coarctation of the aorta then consideration should be given to a method of repair which does not sacrifice this vessel.

Aortic Coarctation↗

PubMed1987

Surgical excision of primary cardiac tumours in infancy.

Six cases of primary cardiac tumour have been operated upon in a 7 year period from 1 June 1979 until 1 June 1986. All patients were under 6 months of age at the time of operation and two of the patients were in their first week of life. The principal indication for surgery was obstruction mainly at the right or left ventricular outflow tract level. More recently echo evaluation alone has been adequate to define the problem prior to surgery. Surgical excision has been performed without mortality or significant complications. In most cases resection has been complete, although in one case residual tumour has been left because of attachment of the tumour to vital structures. Follow-up of this case has not resulted in further surgery being required because of regrowth of the tumour. In one case, with co-existent congenital heart disease, the tumour was brought to notice after palliative systemic to pulmonary artery shunt had been performed. From the cardiac view point gratifying results have been obtained both in the short and long term following surgical resection. However, for patients with rhabdomyoma, later development of symptomatic tuberosclerosis should be anticipated in 50% of cases.

Dysgerminoma↗

PubMed1986

Pulmonary atresia with intact ventricular septum.

Neonates with pulmonary atresia with intact ventricular septum are ductus dependent from birth. The initial approach in these patients is to ensure continued adequate pulmonary blood flow in anticipation of imminent spontaneous closure of the ductus. Our experience and evolving approach in the management of 16 consecutive neonates with pulmonary atresia with intact ventricular septum from 1978 to 1984 is presented. On the basis of the revised classification by Bull and associates, we divided the patients into four different groups according to right ventricular morphology. Basically, three types of palliative surgical procedures were performed: systemic-pulmonary artery shunt; systemic-pulmonary artery shunt with pulmonary valvotomy; and pulmonary valvotomy alone. Systemic-pulmonary artery shunt is the most important part of neonatal palliation. Our present routine is to perform left subclavian-main pulmonary artery shunt with a polytetrafluoroethylene tube in all patients and, in addition, to perform an open transpulmonary valvotomy without cardiopulmonary bypass in patients with a patent infundibular portion of the right ventricle. Our technique and the advantages of this type of shunt procedure are discussed. Patients with right ventricular sinusoidal-coronary artery communications are a subgroup with an additional problem. In our series, patients with this anomaly are categorized into groups with major and minor connections and their surgical significance is discussed. Overall, there was one death among 16 patients after neonatal palliative procedures and one death among five patients after hemodynamic repair.

Echocardiography↗

PubMed1985

Truncus arteriosus. Surgical approach.

Between mid-1979 and December, 1983, 23 patients with various types of truncus arteriosus underwent total surgical correction at Royal Children's Hospital, Melbourne, Australia. Nineteen patients had primary total repair and four had secondary repair, three having survived banding done prior to 1978. Sixteen patients were less than 1 year of age. Repair was performed with circulatory arrest in infants and cardiopulmonary bypass with core cooling in older patients. Patients were electively ventilated preoperatively. In the postoperative period, pulmonary artery pressure was monitored very closely and any rise was treated with hyperventilation and vasodilators. Two patients under 1 month of age, who were severely acidotic and anuric preoperatively, died of low output syndrome. Among the rest of the infants there was only one death, probably because of pulmonary hypertensive crisis that might have been prevented. From our experience, we think that patients with truncus arteriosus should have total correction during infancy, preferably at 2 to 3 months of age, as it can be performed with a very low risk and also avoids the development of pulmonary vascular disease, which occurs very rapidly in these infants.

Blood Pressure↗

PubMed1983

Surgical treatment of absent pulmonary valve syndrome in infants: relief of bronchial obstruction.

Congenital absence of the pulmonary valve is usually associated with a malalignment type of ventricular septal defect as well as right ventricular outflow obstruction and aneurysmal dilatation of the pulmonary arteries. Symptomatic infants primarily have severe tracheobronchial obstruction caused by aneurysmal dilatation of the proximal pulmonary arteries; pulmonic and systemic blood flow are usually balanced. Surgical intervention to relieve the obstruction by plicating the pulmonary artery and its branches under deep hypothermia and circulatory arrest, together with patch closure of the ventricular septal defect, is advocated.

Airway Obstruction↗