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Biomedical subjects

A R Castaneda

Publications and source records attributed to A R Castaneda.

At least 181 records · Page 10Linked to original sources
PubMed1976

The palliative Mustard operation for double outlet right ventricle or transposition of the great arteries associated with ventricular septal defect, pulmonary arterial hypertension, and pulmonary vascular obstructive disease. A report of eight patients.

Five patients with double outlet right ventricle, ventricular septal defect, pulmonary arterial hypertension and pulmonary vascular obstructive disease and three patients with complete d-transposition of the great arteries, ventricular septal defect, pulonary arterial hypertension and pulmonary vascular obstructive disease underwent an elective Mustard baffle operation. The ventricular septal defect was not closed. A large patent ductus arteriosus was divided in three patients. Seven of the eight patients are alive five to 32 months after surgery; one patient died 11 months after surgery. Cyanosis, dyspnea on exertion, and exercise limitation improved initially in all and has persisted in the survivors. In pre and postoperative hemodynamic studies in four patients, systemic arterial oxygen saturation and effective pulmonary blood flow increased from mean values of 70% to 90% and 1.7/min/m2 to 3.3 L/mon/m2, respectively. Absolute systemic and pulmonary flows, and pressures and resistances, were not significantly altered. Criteria for selection of patients with transposition of the great arteries of double outlet right ventricle who would benefit from a palliative Mustard procedure (Mustard atrial baffle without closure of the ventricular spetal defect) are: 1) severe symptoms; 2) pulmonary arteiral hypertension (75% systemic) with pulmonary vascular obstructive disease; and 3) pulmonary artieral oxygen saturation greater than systemic (ascending aorta) arterial oxygen saturation by approximately 10%.

Adolescent↗
PubMed1976

Hemodynamics after surgical repair with right ventricle to pulmonary artery conduit.

To assess the results of cardiac repair utilizing a right ventricular to pulmonary artery conduit, we reviewed postoperative hemodynamic data in 16 patients catheterized 0.5 to 5 years after repair. In 12 patients, a Hancock conduit (dacron conduit with porcine valve) was used; the conduit in the remaining four patients was made with an aortic homograft. All patients in whom an aortic homograft was utilized developed severe obstruction and calcification of their graft. The majority of patients, 9/12, with a Hancock conduit, had only mild to moderate conduit obstruction; the remaining three had severe obstruction (gradients greater than 70 mm Hg). The sites of Hancock conduit obstruction were at the distal end of the conduit in 8/12, proximal end of conduit in 6/12, and at the porcine valve in 4/12 patients. The data suggest that repair with a Hancock conduit is hemodynamically more satisfactory than with aortic homograft.

Adolescent↗
PubMed1976

Subaortic obstruction after the use of an intracardiac baffle to tunnel the left ventricle to the aorta.

Postoperative hemodynamic studies in five patients document subaortic obstruction after surgical repair utilizing an intracardiac baffle to establish continuity between the left ventricle and the aorta. Four of the patients had a Rastelli procedure for D-transposition of the great arteries with a ventricular septal defect and pulmonary stenosis; one patient had repair of double outlet right ventricle with a ventricular septal defect and pulmonary stenosis. The left ventricular outflow was shown to be a long narrow tunnel by angiography in four of five patients and by echocardiography in one patient. Resting aortic peak systolic pressure gradient ranged from 10 to 42 mm Hg (mean 24). The obstruction was localized to the proximal end of the left ventricule to aorta tunnel (i.e., at the site of ventricular septal defect) in five patients. One patient with a gradient of 42 mm Hg has angina and decreased exercise tolerance. Subaortic obstruction is a newly described sequelae after the Rastelli procedure for transposition or repair of double outlet right ventricle. The obstruction may be hemodynamically significant and should be searched for at postoperative cardiac catheterization.

Adolescent↗
PubMed1976

Abnormalities of regional lung function associated with ventricular septal defect and pulmonary artery band.

Xenon-133 ventilation-perfusion scans and technetium-99m angiocardiograms were performed 47 times in 34 patients. All patients had ventricular septal defect (VSD), 17 with pulmonary artery band (PAB), 6 with isolated VSD, 4 with pulmonary valvar stenosis (PS), and 7 with transposition of the great arteries (d-TGA), VSD, and PAB. Patients with VSD had slightly depressed ventilation fraction of the left lung and slightly elevated perfusion fraction of the left lung, both before and after closure of the VSD. Patients with VSD and PAB had slightly depressed ventilation fraction of the left lung but perfusion fraction of the left lung that was either markedly elevated or markedly depressed. After closure of VSD and removal of PAB the perfusion abnormality returned toward normal in some patients but remained abnormal in most. The findings were similar in most patients with d-TGA. Ventilation-perfusion ratio was nearly normal in patients with VSD alone, both before and after closure of VSD. In patients with VSD with PAB the severe abnormality of ventilation-perfusion ratio returned toward normal after corrective operation but did not reach normal. There was no abnormality of distribution of perfusion along the cephalocaudal axis of the lung with the patient supine.

Adolescent↗
PubMed1976

Tetralogy of Fallot with acquired pulmonary atresia and hypoplasia of pulmonary arteries. Report of surgical management in infancy.

A perforated intracardiac prosthesis, and patch infundibuloplasty and annuloplasty were employed for the surgical management of an infant with tetralogy of Fallot, pulmonary atresia, and severe hypoplasia of the pulmonary arteries. This approach provides a means of decompression of the right ventricle in the immediate postoperative period. It allows sufficient systemic cardiac output while increasing pulmonary blood flow to relieve severe hypoxemia and cyanosis. In addition, the high risk of further compromise to the diminutive pulmonary arteries by a palliative shunt is avoided. A physiological basis for the use of this technique is discussed.

Blood Gas Analysis↗
PubMed1975

Local cardiac hypothermia for myocardial protection during correction of congenital heart disease.

Eighty-eight operations for correction of intracardiac congenital heart defects were performed using local cardiac hypothermia for protection of the ischemic myocardium. Twenty-six patients underwent repair of tetralogy of Fallot, 23 had patch closure of ventricular septal defect, 24 had correction of various types of congenital aortic stenosis, and 15 were operated upon for other complex lesions. The overall operative mortality was 5.6%. Ischemia times ranged from 9 to 119 minutes (mean, 48 minutes). Ischemic arrest protected by local cardiac hypothermia provides an optimal operative field, permitting repair of uncomplicated intracardiac defects in a precise, unhurried manner. No hemodynamic abnormalities attributable to the technique were encountered.

Adolescent↗
PubMed1975

Recurrent myxosarcoma of left atrium.

The surgical treatment of cardiac myxosarcoma is reviewed with emphasis placed on palliative response to radiation therapy. A case of primary myxosarcoma of the left atrium in a 16-year-old girl is presented. The tumor was surgically removed in October, 1967. Recurrently myxosarcoma was removed in August, 1968, at which time involvement of the pulmonary veins and the pericardium was noted. Subsequent to postoperative radiation therapy, the patient remained symptom-free for more than three years. Death occurred 4 1/2 years after the original operation from local and systemic recurrence of the tumor.

Adolescent↗
PubMed1975

Cardiac valve replacement with the stabilized glutaraldehyde porcine aortic valve: indications, operative results, and followup.

Porcine aortic valve xenografts stabilized with glutaraldehyde have been implanted in 91 patients with acquired and congenital valvular heart disease. The indications for use of this valve have included age, previous sensitivity to anticoagulants, or a concomitant condition contraindicating anticoagulant therapy. There were two operative deaths and three late deaths in 44 mitral, 25 aortic, 16 aortic-mitral, 5 mitral-tricuspid, and one aortic-mitral-tricuspid replacements. There were no valve failures from cusp rupture, although one valve was replaced because of annular disproportion. There was one inhospital stroke but no late emboli in a 3 to 33 month followup period, 16.5; 72 patients are functional class 1, 10 class 2, and one patient is class 3. In appropriate patients this biologic tissue valve relieves the hemodynamic abnormalities of valvular heart disease, is associated with a low embolization rate without anticoagulant therapy and, to date, has been durable.

Adolescent↗
PubMed1975

Pulmonary artery sling.

Pulmonary artery sling is an uncommon and potentially lethal vascular anomaly that can produce airway obstruction. Despite the availability of a corrective operation, the mortality rate remains very high (50 per cent of surgically treated children) due to the high incidence of associated obstructive anormaliies of the tracheobronchial tree. The survivors of corrective operation have done well symptomatically. However, when restudied, most have been found to have no pulmonary blood flow to the left lung. Successful treatment requires early recognition of the anomaly, adequate preoperative investigation for associated anormalies (especially those of the tracheobronchial tree), a technically perfect vascular reconstruction, and meticulous postoperative respiratory therapy.

Airway Obstruction↗
PubMed1975

The dispensable right ventricle.

The historical development of the concept that an anatomic ventricle is not needed for the pulmonary circulation is reviewed. The application of this idea to surgical treatment of congenital heart disease has culminated in atriopulmonary bypass for tricuspid atresia, an operation that relieves cyanosis and creates a functionally normal circulation, but which may have late risk due to arrhythmias or valve failure.

Animals↗
PubMed1975

Post-traumatic aneurysms of the thoracic aorta.

Nineteen patients with histologically proved post-traumatic aneurysm of the thoracic aorta were reviewed. Only seven aneurysms were detected at the time of hospitalization for trauma. Eight of 12 patients with chronic aneurysms either became symptomatic or showed enlargment during a period of observation. Surgical excision was the recommended method of therapy.

Accidents, Traffic↗