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Biomedical subjects

B Soto

Publications and source records attributed to B Soto.

At least 73 records · Page 4Linked to original sources
PubMed1985

Angiographic anatomy of hearts with one ventricular chamber: the true single ventricle.

Fifteen patients with an isolated ventricular chamber were studied using angiography. These patients constitute 7% of the 218 patients with single ventricle who were examined at our institution over a 10-year period. The atrial situs was solitus in 6 and isomeric in 9. The ventricular chamber showed 3 varieties based on trabecular pattern: right type, mixed and indeterminate. The atrioventricular (AV) connection was through 2 valves in 4 hearts, through a common AV valve in 8 and through a single valve in 3. The morphologic features of the ventricular chamber and the AV valves are considered the most important factors for planning surgical management.

Adolescent↗
PubMed1985

Overriding atrioventricular valves. An angiographic-anatomical correlate.

An analysis of 6 patients with overriding atrioventricular valve was performed in order to correlate the anatomic and angiographic features of this malformation. The atrial arrangement was usual (situs solitus) in each patient. The ventricular chambers were normally related in 4 and the mirror image of normal in 2. The atrioventricular connexion was concordant in parallel fashion in 4, discordant in 1 and double inlet left ventricle in 1 heart. In 2 of 4 hearts with concordant atrioventricular connexion, the right atrioventricular valve (tricuspid) overrode the septum and connected partially to the left ventricle. In 2, the left atrioventricular valve (mitral) overrode the septum and partially connected with the right ventricle. One heart with discordant atrioventricular connexion had its right atrioventricular valve (mitral) overriding the septum. The remaining heart with double inlet left ventricle had an overriding left atrioventricular valve. Each overriding atrioventricular valve had its "septal" leaflet (the one committed to the contralateral ventricle) divided into 2 segments by a large cleft. Ventricular septal defects at different locations were present in all cases. The ventriculoarterial connexion was double outlet right ventricle in 5 patients and was discordant in 1. Malalignment of the atrial and ventricular septa was present to some degree in all cases. This was well depicted on ventriculograms in four chamber view in those with an overriding tricuspid valve. It was not detected in those with an overriding mitral valve. The displaced leaflets of the overriding and/or stradding valve had a vertical motion on cineangiograms similar to those observed in atrioventricular septal defects. Abnormal morphology and motion of the septal leaflet of the overriding atrioventricular valve and malalignment of the atrial and ventricular septal structures were the most important angiographic findings in this series.

Adolescent↗
PubMed1985

Secondary left atrioventricular valve replacement in atrioventricular septal (AV canal) defect: a method to avoid left ventricular outflow tract obstruction.

Patients with atrioventricular septal defects are morphologically predisposed to subaortic obstruction. Some individuals require secondary left atrioventricular valve replacement for severe incompetence persisting after repair, and they are especially susceptible to left ventricular outflow tract obstruction. A surgical technique is described for replacement of the atrioventricular valve which seems to avoid the complication of left ventricular outflow tract obstruction by the prosthesis.

Adolescent↗
PubMed1984

Early and intermediate-term (10-year) results of surgery for univentricular atrioventricular connection ("single ventricle").

One hundred sixteen patients with "single ventricle" underwent 147 operations between 1967 and July 1982, with an actuarial survival rate (hospital deaths are included in all actuarials) at 10 years of 66%. One hospital death (2%) occurred after 45 primary "classic" shunting operations, and the 10-year actuarial survival was 85%. There were no hospital deaths after atrial septectomy or pulmonary artery banding, and the 10-year actuarial survival rate after these as initial procedures was 76% and 74%, respectively. Thirteen of 36 patients (36%) who underwent ventricular septation between 1967 and November 1, 1983, died in hospital. Among the 13 with the ideal morphologic characteristics of double inlet left ventricle without major associated cardiac anomalies, and without the need for valve replacement or a valved extracardiac conduit, there were no hospital deaths and a late survival rate of 77% (confidence limits 59 to 90%). Sixteen of 73 patients (22%), including those with tricuspid atresia, undergoing the Fontan-type procedure between 1967 and November 1, 1983, died in hospital. Multivariate analysis indicates that cardiac morphologic patterns other than tricuspid atresia are risk factors for hospital death in this group. The 10-year actuarial survival rate among the 73 patients was 71%, but only 1 death (associated with reoperation) occurred more than 2 months after operation. Ninety-seven percent of all surviving patients are in New York Heart Association functional class I or II, as are 100% of those who underwent septation and 96% of those who underwent the Fontan-type procedure.

Adult↗
PubMed1984

Present status of axially angled angiocardiography.

Axial angiography visualizes anatomical details of normal and pathological hearts not previously demonstrated by conventional angiography. Progress in the diagnosis of congenital heart malformations using axial projection technique has been reconsidered, emphasizing that the anatomical details of each congenital heart malformation and their associated anomalies that can be revealed by axial angiography. Three angiographic views form the basis of this study: long axial, four chamber, and elongated right anterior oblique. Relevant findings are presented in isolated ventricular septal defect, tetralogy of Fallot, atrioventricular septal defects, common ventricle, and straddling atrioventricular valves. Variability in the position and orientation of the heart requires adjustment of the degree of obliquity and/or angulation of the X-ray beam in individual patients to obtain the appropriate angiographic views.

Angiocardiography↗
PubMed1984

The septal arteries in the differential diagnosis of constrictive pericarditis.

Angiographic study of the motion of the septal and left marginal arteries was performed in patients with restriction in ventricular diastolic filling in order to separate patients with constrictive pericarditis from those with restrictive cardiomyopathy. Twelve patients with constrictive pericarditis (group I) and 10 patients with restrictive cardiomyopathy (group II) were evaluated and compared with 21 patients with normal coronary angiograms (group III). The displacement of the septal arteries (23 +/- 2.04 mm) was abnormally exaggerated in group I and normal (9 +/- 0.81 mm) in groups II and III. The displacement of the left marginal arteries as seen by the "corrugating index" was similar in all groups. We conclude that study of the displacement of the septal arteries is a useful angiographic sign that helps to separate constrictive pericarditis from restrictive cardiomyopathy and normals.

Cardiomyopathies↗
PubMed1984

Tetralogy of Fallot with atrioventricular canal. An angiographic study.

Tetralogy of Fallot associated with atrioventricular (AV) canal is a well-recognized cardiac malformation; its surgical repair carries a high mortality, which is related partly to the complexity of the defect and partly to incomplete diagnosis. Hence an accurate preoperative diagnosis is essential. This communication describes the angiographic features observed in 17 patients with tetralogy of Fallot and AV canal with emphasis on the morphology of the right AV valve as seen during the right ventriculogram. A complete anatomic diagnosis can be consistently made from right and left ventriculograms performed in axial projections.

Adolescent↗
PubMed1983

Truncus arteriosus. An anatomical-angiographic study.

A series of 25 cases of truncus arteriosus communis examined post mortem was studied retrospectively. Fifteen of them had had angiographic studies, enabling anatomo-radiographic correlative analysis to be made. All cases had situs solitus of the atria and concordant connections between atria and ventricles. The three main components of the malformation, present in all 25 cases, were: (a) ventricular septal defect, (b) single semilunar valve, (c) anomalies of the aortopulmonary septum. The ventricular septal defect was always subarterial but its size and its relation to mitral and tricuspid valves were extremely variable. The truncal valve varied greatly also in the number of its cusps and its relation to right and left ventricles. Above valvular level the presence or absence of residual aortopulmonary septum was reflected by the presence or absence of a main pulmonary artery. Additional supratruncal malformations produced variations of the anatomy of the aorta and pulmonary arteries. The angiographic demonstration of all these components was obtained best by selective angiography using special projections. From this study it appears that there is a wide degree of variability in all of the three main components of truncus arteriosus. Such anatomical variations should be identified angiographically in each patient in order to provide enough information before corrective surgery, but they do not alter the basically homogeneous anatomy of the category of truncus arteriosus and therefore do not justify complex classifications.

Angiocardiography↗
PubMed1983

Prospective randomized trial of intravenous and intracoronary streptokinase in acute myocardial infarction.

To evaluate the relative thrombolytic efficacy and complications of intracoronary vs high-dose, short-term intravenous streptokinase infusion in patients with acute myocardial infarction, we performed baseline coronary arteriography and then randomly allocated 51 patients with acute myocardial infarction to receive either intracoronary (n = 25) or intravenous (n = 26) streptokinase. Patients getting the drug by the intracoronary route received 240,000 IU of streptokinase into the infarct-related artery over 1 hr, whereas those getting the drug by the intravenous route received either 500,000 IU of streptokinase over 15 min (n = 10) or 1 million IU of streptokinase over 45 min (n = 16). Angiographically observed thrombolysis occurred in 76% (19/25) of the patients receiving intracoronary streptokinase, in 10% (1/10) of the patients receiving 500,000 IU of streptokinase intravenously, and in 44% (7/16) of the patients receiving 1 million IU of streptokinase intravenously. Among patients in whom thrombolysis was observed, mean elapsed time from onset of streptokinase infusion until lysis was 31 +/- 18 min in patients receiving intracoronary streptokinase and 38 +/- 20 min in those receiving intravenous streptokinase (p = NS). Among patients in whom intravenous streptokinase "failed," intracoronary streptokinase in combination with intracoronary guidewire manipulation recanalized only 7% (1/15). Fibrinogen levels within 6 hr after streptokinase were significantly lower in the patients receiving intravenous streptokinase (39 +/- 17 mg/dl) than the levels in those receiving intracoronary streptokinase (88 +/- 70 mg/dl) (p less than .05) but were similar 24 hr after streptokinase in the two groups. Bleeding requiring transfusion occurred in one patient in each group. Thus, in this prospective randomized trial of intracoronary vs intravenous streptokinase, hemorrhagic complications were few, although both regimens produced a systemic lytic state. Although the thrombolytic efficacy of intracoronary streptokinase was superior to that of high-dose, short-term intravenous streptokinase, the higher-dose intravenous regimen (1 million IU over 45 min) achieved thrombolysis in a significant minority (44%) of patients and might be useful therapy for patients not having access to emergency catheterization.

Adult↗
PubMed1983

Angiographic differentiation of types of ventricular septal defects.

A retrospective study of 40 patients with 41 surgically repaired ventricular septal defects was performed in order to correlate the anatomic findings with the angiographic features seen by axial angiography. In 39 patients there were 32 perimembranous, three muscular, and four subarterial defects. One patient had both perimembranous and inlet muscular ventricular septal defects. Perimembranous defects as seen on left ventriculograms on long axial view are in continuity with the aortic valve. The relation of the defect to the tricuspid valve allows distinction of the extension of the perimembranous defect toward the inlet, trabecular, or infundibular zones. This relation was determined angiographically, using the course of the contrast medium from the left ventricle through the ventricular septal defect opacifying the right ventricle. Muscular defects are separated from the semilunar and atrioventricular valves. Subarterial defects are related to both semilunar valves, and they are best demonstrated by the elongated right anterior oblique view of the left ventriculogram. This study demonstrated that with axial views an experienced angiographer can define the location, size, and relations of the ventricular septal defects with high accuracy. In only two of the 41 defects there were differences between the retrospective angiographic prediction and the previous surgical findings.

Adolescent↗
PubMed1982

Tricuspid atresia in adults.

Congenital atresia of the tricuspid valve is still uncommon in adult patients. However, increasingly successful palliative surgery in children now has increased its incidence after age 15 years. This investigation updates the clinical features of this disease in adults in light of modern diagnostic and surgical techniques. The data on all 18 adults with tricuspid atresia having angiography after age 15 years at this institution since 1970 were reviewed. The patients' ages ranged up to 45 years; 12 had had previous palliative surgery. Left cineventriculography, particularly biplane, with the long axial view (60 degrees left anterior oblique with cranial angulation) is the most important diagnostic mode and reveals the ventricular and great vessel relations. According to standard classification, 11 patients had type I anatomy (normal great arterial relations), 4 type II (transposed great arteries) and 2 type III ("corrected transposition of the great arteries"). One patient with inverted ventricles could not be classified. Associated additional congenital defects were uncommon. On the basis of these data, a new anatomic classification of tricuspid atresia is given which encompasses all possible atrial-ventricular-great arterial combinations. Seven patients had further surgery after study, including two procedures of the Fontan type (right atrium to pulmonary arterial conduit). Follow-up data on all 18 patients revealed two deaths (one early after operation, one late after study without further surgery). The remaining 16 patients survive 2 to 120 months after study. Four patients had naturally balanced pulmonary and systemic circulations and have survived to ages 21 to 41 years without surgery. Prudent surgical decision based on accurate anatomic diagnosis and the need for optimal effective pulmonary blood flow may result in a relatively optimistic prognosis in adults with this disease.

Adolescent↗
PubMed1982

Univentricular heart: an angiographic study.

Axial angiograms of 54 patients with a univentricular heart were reviewed to determine the anatomic details demonstrated by this technique. The main ventricular chamber was of left ventricular morphology in 36, right ventricular morphology in 13 and indeterminate in 5 patients. Forty-three patients had a rudimentary ventricular chamber that was supporting a great artery in 35 patients. eighteen patients had separate atrioventricular (A-V) valves. In four of them, one A-V valve was overriding the trabecular septum, but predominantly committed to the main ventricular chamber. Eleven patients had a single right and 13 a single left A-V valve; a common A-V valve was present in 12. The techniques used provided good demonstration of the morphology of the ventricular mass, particularly the position and orientation of a septum when present. They also delineated the morphology of the A-V valve or valves and their precise ventricular connection. Ventriculoarterial connections and relations were readily determined. It is concluded that these methods are superior to isolated frontal and lateral views and provide thorough demonstration of the intracardiac anatomy of patients with a univentricular heart.

Adolescent↗
PubMed1982

Determinants of early and late results of repair of atrioventricular septal (canal) defects.

The anatomic and functional characteristics of 310 consecutive patients undergoing repair of atrioventricular (AV) septal defects were studied. The characteristics of the six leaflets of the common (139 patients) or two-orifice (171 patients) AV valve are described. Interventricular communications were present in 156 patients and major associated cardiac anomalies in 73 (tetralogy of Fallot 20, double-outlet right ventricle nine, and others). Fifty-one patients (16%) died in hospital. The incremental risk of young age disappeared after 1976. Severity of preoperative AV valve incompetence and New York Heart Association (NYHA) functional class affected hospital mortality. Current risks for patients without major associated cardiac anomalies are 0.6% to 4% for patients in NYHA Class III without an interventricular communication, depending on the degree of preoperative AV valve incompetence, and 5% to 13% for such patients with an interventricular communication. Actuarial survival at 12 1/2 years postoperatively is 95% when preoperative AV valve incompetence is absent or mild and 88% when it is more severe (Grade 3, 4, or 5). Actually, 92% of hospital survivors are alive and in NYHA class I or II. Failure of the AV valve repair occurred in 32 (10%) of the 310 patients and occurred more frequently when AV valve incompetence was severe preoperatively. Its frequency is reduced by current repair techniques, except in patients without interventricular communication.

Age Factors↗
PubMed1981

Angiography of atrioventricular canal defects.

The axial angiograms of 20 patients with an atrioventricular (A-V) canal defect were carefully examined and compared with anatomic observations made at operation. A common A-V valve was present in 15 patients and two separate valves in 5. The atrial septal defect, the anatomy of the ventricular septum and the morphology and functional status of the A-V valves were well demonstrated. There ws consistent angiographic deformation of the normally straight contour extending from the noncoronary aortic cusp to the crux cordis observed in the four chamber and elongated right anterior oblique projections of the left ventricular angiogram of each patient. This deformity is caused by the deficiency or absence of the A-V septum and is the best angiographic sign of the malformation. The differentiation of two separate valves from a common A-V valve was uniformly made. When a common A-V valve was present, three of the five leaflets were usually identified but distinction of the free floating from the tethered anterior leaflet was not always possible. It is concluded that axial techniques provide more complete angiographic definition of the anatomic abnormalities of A-V canal defects than are demonstrated from frontal and lateral views.

Angiocardiography↗