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Biomedical subjects

A S Nadas

Publications and source records attributed to A S Nadas.

At least 19 recordsLinked to original sources
PubMed1979

Use of prostaglandin E1 in infants with d-transposition of the great arteries and intact ventricular septum.

Prostaglandin E1 was used to treat five infants with d-transposition of the great arteries and intact ventricular septum who had persistent severe hypoxemia after the creation of an interatrial communication. Three infants had a dramatic improvement in systemic arterial oxygen saturation associated with dilation of the ductus arteriosus; in two of the three cases urgent surgery was avoided. Two infants had no clinical evidence of increased ductal shunting and no improvement in oxygen saturation. A trial of prostaglandin E1 is recommended for treatment of severe hypoxemia in infants with d-transposition of the great arteries with intact ventricular septum if the presence of a large atrial septal defect is established.

Cardiac Catheterization↗
PubMed1979

Rat pulmonary circulation after chronic hypoxia: hemodynamic and structural features.

In 55 Sprague-Dawley rats (mean wt, 277 +/- 6.2 g) exposed to hypobaric hypoxia (air at 380 mmHg), and 23 weight-matched controls kept in room air, pulmonary and systemic artery pressures were measured daily for 2 wk via indwelling catheters. After each day of exposure, 1 or 2 hypoxic rats, to a total of 20, and 5 control rats were killed during the experiment. In these rats, the pulmonary arterial tree was injected post mortem with barium-gelatin and inflated with formaldehyde solution, and three structural features were quantified microscopically: 1) abnormal extension of muscle into peripheral arteries where it is not normally present (EMPA); 2) increased wall thickness of the normally muscular arteries, expressed as a percentage of external diameter (%WT); and 3) reduction in artery number expressed as an increase in the ratio of alveoli to arteries (A/a). Mean pulmonary artery pressure (Ppa) rose significantly after day 3 of hypoxic exposure (P less than 0.05) and had doubled by day 14; the mean systemic artery pressure (Psa) of hypoxic rats and Ppa and Psa of control rats were unchanged. The level of Ppa correlated with the degree of structural changes; for EMPA, r = 0.84; for %WT, r = 0.64; and for A/a, r = 0.73 (P less than 0.001 in all.

Animals↗
PubMed1978

Birthweight of infants with congenital heart disease.

A subnormal birth weight distribution was noted in a population of infants seen during the first year of life for major congenital heart disease (CHD). When arranged according to cardiac diagnostic categories, 17 of the 21 major cardiac lesions were associated with subnormal birth weight distribution. Major extracardiac anomalies present in 19.9% of all infants appeared not to influence the birth weight distributions of either the total population of 19 of 21 cardiac lesion categories. An increased incidence (6.1%) of small-for-dates infants was observed in the study population. Extra-cardiac anomalies occurred in 28% of the small-for-dates infants. Survival to 1 year of age was 42.8% for the total population with CHD and 49.2% in the small-for-dates group.

Abnormalities, Multiple↗
PubMed1978

Growth after surgical repair of simple D-transposition of the great arteries.

The effect of the Mustard procedure on growth was assesed in 45 patients with simple D-transposition of the great arteries (DTGA) surviving for at least one year after operation. Growth failure (below the third percentile for height, weight, or both) was found in 25 of the 45 patients preoperatively and in 8 patients postoperatively. The principal factors associated with poor growth before repair were advancing age, increased pulmonary and systemic flow, and subpulmonic stenosis. In those patients without postoperative growth failure, growth had returned to the normal range within two years. All patients wit retarded growth after the Mustard procedure had had preoperative growth failure as well. In addition, all 8 patients with postoperative growth failure had one or more amjor residual hemodynamic abnormalities, whereas residual lesions were present in only 10 of 37 patients with normal postoperative growth.

Age Factors↗
PubMed1978

Determinants of growth in patients with ventricular septal defect.

Growth status was studied in 1210 patients with ventricular septal defects (VSD) participating in the Joint Study on the Natural History of Congenital Heart Defects. A total of 793 patients were managed medically and 194 underwent successful surgical repair. Admission measurements revealed height and weight status to be subnormal and related to physiological severity and age. Successful repair resulted in significant increase in weight but not height. Medical therapy was associated with little change in the subnormal growth pattern. Multivariate analysis revealed determinants of admission height for all patients with VSD to be presence of extracardiac anomalies, birthweight below 2.5 kg, admission age greater than 2 years, history of heart failure and pulmonary/systemic pressure ratio. The same determinants were noted for admission weight with addition of pulmonary/systemic flow ratio. It is conluded that the severe growth disturbance in patients with VSD is only in part due to abnormal postnatal hemodynamics. Intrauterine and genetic factors and low birthweight also play a role and help explain the incomplete growth response after successful surgery.

Age Factors↗
PubMed1978

Left ventricular function following attempted surgical repair of tetralogy of Fallot.

Left ventricular function was assessed by angiographic methods in 40 patients (ages 3-27), 1-12 years following repair of tetralogy of Fallot. Twenty of the 40 patients (group A) had a satisfactory repair with a pulmonary-systemic flow ratio (Qp/Qs) less then or equal to 1.5 and a right ventricular systolic pressure of less than or equal to 60% of the left ventricular value. The other 20 patients (group B) had a Qp/Qs greater than 1.5 and/or a right ventricular systolic pressure greater than 60% of the left ventricular value. Group A patients had a normal left ventricular end-diastolic volume (LVEDV), end-diastolic pressure (LVEDP), ejection fraction (LVEF), and mass (LVM), while the group B patients had significantly elevated LVEDV, LVEDP, LVM, and a significantly depressed LVEF. These findings indicate that patients with a satisfactory hemodynamic repair of tetralogy of Fallot have normal left ventricular function while patients with postoperative unsatisfactory hemodynamics have significantly impaired left ventricular function.

Adolescent↗
PubMed1978

Lung biopsy in congenital heart disease: a morphometric approach to pulmonary vascular disease.

Fifty patients with congenital heart disease, ages 2 days-30 years (median 12 months) at cardiac surgery, underwent lung biopsy to assess pulmonary vascular disease (PVD). Twenty-six had ventricular septal defects (VSD), 17 d-transposition of the great arteries (D-TGA), and seven, defects of the atrioventricular canal (AVC). Quantitative morphologic data was correlated with hemodynamic data. Three new grades of PVD were observed. Abnormal extension of muscle into peripheral arteries (grade A) was found in all patients; all had increased pulmonary blood flow. In addition, 38 of 50 patients had an increase in percentage arterial wall thickness (grade B); this correlated with elevation in pulmonary artery (PA) pressure (r = 0.59). Another 10 of 50 patients had, in addition to A and B, a reduction in the number of small arteries (grade C); nine of 10 were patients with elevated PA resistance greater than 3.5 mu/m2 (P less than 0.005). All three patients with Heath-Edwards changes of grade III or worse also had grade C. Reduction in peripheral arterial number probably precedes obliterative PVD and may identify those patients in whom, despite corrective surgery, PVD will progress.

Adult↗
PubMed1978

Chylous reflux syndrome involving the pericardium and lung.

A ten-year-old boy with symptom-free pulmonary interstitial edema and pericardial effusion was found to have a chylous reflux syndrome involving the pericardium and lung. Evidence suggests that unlike patients with isolated primary chylopericardium in whom pericardial window and/or ligation of the thoracic duct is curative, those with chylous reflux should be managed medically since the morbidity and mortality of surgical treatment is high in this syndrome.

Child↗
PubMed1978

Repair of atrial septal defect primum. Results, course, and prognosis.

Repair of atrial septal defect primum (ASD primum) continues to be a challenge to the surgeon. The most common problems involve reconstructing the mitral valve and avoiding rhythm disturbances after the operation. In this report we describe our results in 92 patients with ASD primum who were operated upon between 1955 and 1975.

Adolescent↗
PubMed1978

Angina pectoris in a child with sickle cell anemia.

A 7-year-old black boy with sickle cell disease, Wolff-Parkinson-White syndrome, mild left ventricular dysfunction, and normal coronary arteries developed angina pectoris five months after cessation of hypertransfusion therapy. Exercise-induced ECG ST segment depression associated with angina disappeared following transfusion therapy.

Anemia, Sickle Cell↗
PubMed1977

Cardiovascular abnormalities in the Beckwith-Wiedemann syndrome.

Twelve of 13 patients with Beckwith-Wiedemann syndrome were found to have cardiovascular abnormalities: congenital heart disease in 7 of the 12 and isolated cardiomegaly in the others. No specific type of cardiac abnormality predominated.

Abnormalities, Multiple↗
PubMed1977

Ascending aorta-pulmonary artery anastomosis for cyanotic congenital heart disease.

The course and prognosis of 208 patients with an ascending aorta to pulmonary artery anastomosis is reviewed. Mortality rate during, or within one month, of surgery was 24 per cent (50/208) and late mortality rate, prior to repair, was 10 per cent (21/208). An additional 5 per cent (10/208) died during subsequent intracardiac repair. Congestive heart failure developed in 25 per cent (53/208), pulmonary artery hypertension in 17 per cent (12/72), and pulmonary vascular obstruction in 6 per cent (4/72). An increase in orifice size of the stoma with time was documented in eight patients. Additional subsequent palliative surgery was required in 22 per cent (45/208). Mortality rate was directly related to age at operation and was highest in neonates less than one week of age. In infants with tetralogy of Fallot, a preliminary comparison of mortality rate between palliative surgery and primary repair clearly suggests that the latter is the preferred method of treatment.

Aorta↗