PubMed Health⌕ Search

Biomedical subjects

A R Castaneda

Publications and source records attributed to A R Castaneda.

At least 127 records · Page 7Linked to original sources
PubMed1983

Aneurysm of the pulmonary artery as a cause of severe chest pain.

A 35-year-old man came to the emergency room with severe prolonged precordial chest pain. Serial chest roentgenograms obtained over a ten-year period revealed gradual development of marked aneurysmal dilatation of the pulmonary artery. Impending rupture of the artery was feared in spite of the presence of normal pulmonary artery pressure. At surgery, a markedly dilated pulmonary artery without evidence of rupture was found and the size was reduced by aneurysmorrhaphy. Prompt and continued relief of symptoms was achieved thereafter. Severe chest pain can be an initial symptom of pulmonary artery aneurysm in the absence of rupture, such pain arising either from pain receptors in the wall of the pulmonary artery or possibly from pressure on contiguous mediastinal structures.

Adult↗
PubMed1983

Repair of double-outlet right ventricle: early and late results.

Fifty-seven patients underwent reparative surgery between 1973 and 1981 for various forms of double-outlet right ventricle. Pulmonic stenosis was present in 35 (61%), 15 (43%) of whom required a valved conduit for repair. Subaortic stenosis was present in six patients (11%). Hospital mortality was 12% (7/57), with three of the deaths among five patients with associated defects of the atrioventricular valves. During a mean follow-up of 3.6 years (range 2 months to 9 years), there have been no late deaths. Repeat cardiac catheterization in 28 of 50 survivors (56%) showed a residual ventricular septal defect (Qp/Qs greater than 1.5) in six patients, residual pulmonic stenosis (gradient greater than 35 mm Hg) in six patients, and subaortic obstruction (gradient greater than 50 mm Hg) in two patients: The indications for reoperation in 12 of 50 survivors was a residual ventricular septal defect in five patients, atrioventricular valve regurgitation in three patients, subaortic or subpulmonic obstruction in three patients, and aortic valve regurgitation in one patient. None of the patients died after repeat surgery. Our results indicate that surgical risk is related to the anatomic complexity of the malformation. Although a good hemodynamic outcome was achieved at initial surgery in the majority of patients, a residual abnormality was present in 24% needing surgery. When present, significant defects can be repaired with low mortality and morbidity.

Adolescent↗
PubMed1982

Early assessment of hemodynamic status after repair of tetralogy of Fallot: a comparison of 24 hour (intensive care unit) and 1 year postoperative data in 98 patients.

Hemodynamic data obtained in the intensive care unit, immediately after repair of tetralogy of Fallot, were compared with measurements obtained at 1 year postoperative catheterization in 98 infants and children. Eight of 12 patients who had pulmonary artery oxygen saturation of 80% or greater in the intensive care unit had a pulmonary to systemic flow ratio greater than 1.5 at catheterization; all 79 patients who had a pulmonary artery oxygen saturation of ess than 80% in the intensive care unit had a pulmonary to systemic flow ratio of 1.5 or less at catheterization. Five of six patients who had a right ventricular outflow tract pressure gradient greater than 40 mm Hg in the intensive care unit had a gradient greater than 40 mm Hg at catheterization; 7 of 61 patients who had a right ventricular outflow tract gradient of 40 mm Hg or less in the intensive care unit had a gradient greater than 40 mm Hg at catheterization. The addition of measurements of right ventricular pressure and the right ventricular to systemic arterial pressure ratio in the intensive care unit did not improve sensitivity in identifying patients with a right ventricular outflow tract gradient greater than 40 mm Hg at catheterization. Intensive care unit measurement of pulmonary artery oxygen saturation is valuable for determining the presence or absence of a significant left to right shunt after repair of tetralogy of Fallot and should be considered an adjunct to patient management. Intensive care unit measurement of the right ventricular outflow tract gradient identifies patients with a significant right ventricular outflow tract gradient at catheterization but is not highly sensitive.

Blood Pressure↗
PubMed1982

Compression of intrapulmonary bronchi by abnormally branching pulmonary arteries associated with absent pulmonary valves.

In 3 patients with absent pulmonary valve syndrome and absent ductus arteriosus, the lungs were injected and analyzed postmortem using morphometric techniques. Two patients had tetralogy of Fallot and 1 had D-transposition of the great arteries, the latter being the first autopsy-proved case of absent pulmonary valve with transposition. In addition to the expected dilatation of the central pulmonary arteries and compression of the mainstem bronchi, postmortem pulmonary arteriography revealed a bizarre pattern of hilar branching. Instead of single segmental arteries, tufts of arteries arose which entwined and compressed the intrapulmonary bronchi. In all 3 patients the histologic structure of the pulmonary arteries was abnormal. The elastic lamina of the media of the right and left pulmonary arteries were increased in number outside the lung, but were decreased within the lung. At both sites, the elastic laminae were thickened and fragmented. In the 2 ventilator-dependent patients, there was slight medial hypertrophy and extension of muscle into normally nonmuscular arteries. In 1 of the 2 cases in which the number of bronchial generations was counted, they were decreased, and in the 1 case in which bronchial count was unknown, alveolar multiplication was severely impaired. Therefore, our data may explain why, in some patients with absent pulmonary valve syndrome, relief of compression of the mainstem bronchi alone does not appreciably alleviate or reverse severe respiratory disease.

Bronchi↗
PubMed1982

Corrected transposition and repair of associated intracardiac defects.

From August 1974 through April 1981, 23 patients, ages 5 months to 40 years (median 11 years) with corrected transposition of the great arteries (C-TGA), underwent repair of associated intracardiac defects: 20 for ventricular septal defect (VSD), 19 for pulmonary outflow tract obstruction, and five for anatomic tricuspid valve regurgitation. Segmental anatomy was [S,L,L] in 18 or [I,D,D] in 5. Pulmonary outflow tract obstruction was resected in 10 and bypassed with a left ventricle-to-main pulmonary artery conduit in nine patients. Hospital mortality was 9% (two of 23). One patient died from arrhythmia and one from sepsis and arrhythmia. The late mortality rate was 14% (three patients). Two patients died from severe pulmonary vascular obstructive disease (5 months and 2 years postoperatively) and one from arrhythmia (2 months postoperatively). Fourteen have undergone cardiac catheterization 3 days to 4 years (mean 12 months) postoperatively. Three had a small residual VDS (Qp/Qs less than 1.5). Five had residual pulmonary outflow tract obstruction (peak systolic ejection gradient 30-130 mm Hg) after resection or pulmonary valvotomy. One patient had reresection and four had placement of a secondary left ventricular-pulmonary artery conduit. Anatomic tricuspid valve regurgitation became severe in three patients after VSD closure, two of whom required valve replacement; the other died of coexisting pulmonary vascular obstructive disease. Five with [S,L,L] segmental anatomy had complete atrioventricular block preoperatively and six developed complete atrioventricular block at surgery. Eleven of 18 patients with [S,L,L] anatomy had atrioventricular spontaneous or iatrogenic complete block; none of the five patients with [I,D,D] anatomy had atrioventricular block. Pulmonary outflow tract obstruction in [S,L,L] segmental anatomy required conduit interposition in 12 of 14 of our patients to significantly decompress the ventricle. Postoperative development or exacerbation of anatomic tricuspid valve regurgitation occurs in TGA [S,L,L] and may be causally related to surgical complete atrioventricular block.

Adolescent↗
PubMed1982

Potentially parachute mitral valve in common atrioventricular canal: pathological anatomy and surgical importance.

An essentially single focus of left ventricular chordal insertion was found in 23 of 164 autopsied cases of common atrioventricular canal (CAVC) with a normally formed spleen (14%). Suture closure of the cleft of the mitral valve in such cases results in the surgical creation of parachute mitral valve, often with fatal iatrogenic mitral stenosis. In such patients, the cleft of the mitral valve is its main orifice and must not be sutured closed. There are four anatomic types of potentially parachute mitral valve in CAVC: (1) with one papillary muscle group and one mitral orifice (type 1A), in 10 cases (43%); (2) with one papillary muscle group and two mitral orifices (type 1B), in one case (4%); (3) with two papillary muscle groups and one mitral orifice (type 2A), in five cases (22%); and (4) with two papillary muscle groups and two mitral orifices (type 2B), in seven cases (30%). Parachute mitral valve exists only when the AVC is divided, either naturally or surgically. The essence of parachute mitral valve is an essentially single focus of chordal insertion. One or both left ventricular papillary muscle groups may be present. The presence of only one focus of left ventricular chordal insertion contraindicates cleft closure.

Adolescent↗
PubMed1982

Repair of complete common atrioventricular canal in infancy.

Forty-three infants with common atrioventricular canal (CAVC) underwent repair before 24 months of age at Children's Hospital Medical Center, Boston, between Jan. 1, 1975, and June 30, 1980. From 1975 to 1977, the operative mortality was 62% (8/13); the late mortality was 7% (1/13). From 1978 to 1980, the operative mortality was 17% (5/30) and the late mortality, was 6% (2/30). Seventeen (63%) unselected patients of the 27 long-term survivors have undergone cardiac catheterization 10 to 19 months following the operation. Five (29%) had mitral regurgitation of either moderate (four) or severe (one) degree. One had a significant residual shunt. The pulmonary/systemic resistance ratio (Rp/Rs) remained the same or decreased after repair except in the patient with severe mitral regurgitation. Anatomic features which determine outcome of reparative procedures are (1) deficiency of atrioventricular valve tissue, (2) the presence of ventricular hypoplasia, (3) malalignment of the common atrioventricular valve (CAVV) with respect to the ventricles, (4) the presence of double-orifice mitral valve, (5) the presence of solitary left ventricular papillary muscle group, and, in our experience, (6) the presence of additional muscular ventricular septal defects (VSDs). Four of these six anatomic variables can now be evaluated preoperatively by axial angiography and subxiphoid two-dimensional echocardiography. However, the architecture of the CAVV is extremely variable, so that the development of a "uniform approach" to valve reconstruction is impossible; mitral dysfunction is likely to remain the major cause of operative mortality and long-term morbidity.

Cardiac Catheterization↗
PubMed1981

Lung biopsy with frozen section as a diagnostic aid in patients with congenital heart defects.

In eight patients with congenital heart defects and equivocal preoperative hemodynamic data, lung biopsy with frozen section was performed and quantitative morphometric analysis carried out to help select a palliative or corrective surgical procedure. During catheterization it had been possible in only six of the eight patients to enter the pulmonary artery and obtain pressure measurements; four patients had moderate to severe elevation of pulmonary vascular resistance whereas the other two had only mild elevation of pulmonary arterial pressure, but they were being considered for a Fontan procedure. The lung biopsy tissue was taken inflated and fixed inflated in hot glutaraldehyde. From cryostat sections arterial concentration was assessed relative to alveolar concentration, and the degree of arterial muscularity was assessed by wall thickness and extension of muscle; the more advanced Health-Edwards arterial changes were also evaluated. On the basis of the morphologic assessment, six of the eight patients underwent corrective surgery and two underwent a palliative procedure. Postoperative hemodynamic data available in four of the patients who underwent corrective surgery revealed either a significant reduction in pulmonary vascular resistance or return to a normal level of pulmonary arterial pressure, whereas no change has occurred in the one patient studied who underwent a palliative procedure. Assessment of pulmonary arterial development and structure on lung biopsy with frozen section proved helpful in deciding between a palliative and corrective surgical procedure.

Adolescent↗
PubMed1981

Electrophysiologic delineation of the intraventricular His bundle in two patients with endocardial cushion type of ventricular septal defect.

Two patients who had an endocardial cushion type of ventricular septal defect underwent electrophysiologic studies for detection of specialized conduction tissue during operative repair. In one patient, with an inferior leftward frontal plane QRS axis on the ECG, we recorded an intraventricular His bundle electrograms from both the anterosuperior and posteroinferior margins of the defect, suggesting dual atrioventricular conduction tracts (branching intraventricular His bundle). These anatomic and electrophysiologic findings may account for the more normally oriented QRS frontal plane axis on the surface ECG of both of these patients and support the hypothesis that the changes observed on the ECGs of patients with the various forms of endocardial cushion defect can be explained by alterations in the anatomic configuration of the specialized atrioventricular conduction tissue.

Bundle of His↗
PubMed1981

Aortic thrombosis in the neonate.

The case histories of two infants with aortic thrombosis are presented. Clinically, an obstructive aortic arch lesion was suspected because of a systolic pressure gradient between the upper and lower extremities in one infant and unequal peripheral pulses with lower limb cyanosis in the other. Noninvasive studies were inconclusive, the only abnormality noted echocardiographically being severe left ventricular dysfunction. Cardiac catheterization including angiography defined the severity of the obstruction and location of the thrombus in both babies. The thrombus originated within a ductus arteriosus aneurysm in one infant and was located in the ascending aorta and transverse arch in the other. Although successful surgical removal was accomplished, both babies died unexpectedly in the early postoperative period.

Aneurysm↗
PubMed1980

The hemodynamic effects of dopamine in infants after corrective cardiac surgery.

The hemodynamic effects of dopamine were measured during the immediate postoperative period in five infants with low cardiac output following repair of congenital cardiac defects. Dopamine was administered at doses of 5, 10, 15, 20 and 25 micrograms/kg/minute. Heart rate, systemic arterial pressure, and cardiac index increased significantly at a dose of 15 micrograms/kg/minute or greater. There were no significant changes in right atrial pressure, left atrial pressure, pulmonary artery pressure, pulmonary vascular resistance, systemic vascular resistance, or stroke volume. These data support the hypothesis that inants respond to dopamine in a fashion qualitatively and quantitatively different from that in adults.

Blood Pressure↗