Biomedical subjects

C E Canter

Publications and source records attributed to C E Canter.

59 records · Page 4Linked to original sources

PubMedDate not supplied

Selective coronary angiography in pediatric patients.

Selective coronary angiography (SCA) is an important diagnostic tool in pediatric cardiology; however, there are few reports on its feasibility and safety in young patients. We reviewed our experience with SCA from July 1, 1993 to December 31, 1997. There were 158 cardiac catheterizations that included SCA in patients whose ages ranged from 2 days to 46 years (median, 5.3 years). The most common indication was surveillance for coronary vasculopathy after heart transplantation. A retrograde approach was used in all patients through the femoral artery (n = 157) or umbilical artery (n = 1). Preformed coronary catheters were used and the Judkins left (JL) and Judkins right (JR) were the most common catheters, with the catheter curve size correlating with patient height (R(2) =.76 for JL, R(2) =. 673 for JR). Complications during SCA included brief ST-T wave changes (11%), bradycardia (2.5%), and ventricular fibrillation (0. 6%). Complications of vascular access were transient pulse loss (6%), hematoma (5%), and rebleeding (0.6%). Only one case of femoral artery occlusion was encountered on subsequent cath. In conclusion, complications of SCA were infrequent and serious complications were rare. SCA can be safely performed in pediatric patients at any age including neonates.

Adolescent↗

PubMedDate not supplied

Pediatric endomyocardial biopsy performed solely with echocardiographic guidance.

Endomyocardial biopsy has had limited utilization for the diagnosis of myocardial disease in the pediatric population. Through the use of echocardiography for guidance, we attempted 155 consecutive biopsies in 33 patients. A successful biopsy was performed 151 times, including 48 (31%) in infants less than 6 months of age. Biopsies were performed with a right internal jugular approach using 3F, 5F, and 7F bioptomes. A combination of apical four-chamber and parasternal short-axis views could visualize the passage of the bioptome into the ventricle and the action of the jaws. There was no case of ventricular perforation. After biopsy one transplant recipient was left with an increase in the amount of preexisting tricuspid regurgitation by color flow mapping echocardiography. These results demonstrate that echocardiographically guided endomyocardial biopsies may be safely performed over a wide range of patient sizes. The increased portability, lack of radiation exposure, and the simultaneous visualization of the bioptome and chamber wall combined with these results indicate that echocardiographically guided endomyocardial biopsies should be considered the technique of choice for the pediatric population.

Adolescent↗

PubMedDate not supplied

Three-dimensional magnetic resonance imaging of the heart.

Three-dimensional surface images of the human heart may be produced from magnetic resonance imaging. These examinations are used in the evaluation of congenital heart disease for preoperative planning and postoperative evaluation. Computer graphics software has been adapted to produce three-dimensional images of the beating heart from contiguous two-dimensional serial EKG-triggered magnetic resonance image data sets. The natural boundary between flowing blood and cardiac tissue serves to outline cardiac structures. The techniques for producing these images and pitfalls in the operation of the system as well as examples of their application to the study of patients with congenital heart disease are outlined in this article.

Adolescent↗

PubMedDate not supplied

Steroid withdrawal in the pediatric heart transplant recipient initially treated with triple immunosuppression.

We prospectively evaluated the feasibility of withdrawing steroids 6 to 12 months after heart transplantation in 26 consecutive infants and children (median age at transplantation 6 weeks; range 5 days to 10.1 years) initially treated with triple immunosuppression (cyclosporine, azathioprine, and corticosteroids). Ongoing surveillance for cellular rejection was performed by endomyocardial biopsy in all patients and was performed electively in all subjects within 2 weeks after administration of steroids was discontinued. Significant rejection was defined as grade 2. Twenty-three of 26 patients were 6-month survivors and steroids were withdrawn in 21, with the other two survivors followed up elsewhere with triple immunosuppression. Seventeen (81%) of 21 patients were ultimately treated without maintenance steroids for a mean duration of 17 months (range 1 to 34 months), including 6 of 17 patients who had at least one episode of rejection within the first 6 months of transplantation. Five (24%) of 21 patients had rejection 2 weeks (n = 3) and 6 months (n = 2) after steroids were withdrawn, with one patient successfully withdrawn from steroids after a second attempt. In this latter group one patient underwent retransplantation because of severe coronary arteriopathy by angiography 10 months after transplantation and another died suddenly 18 months after transplantation despite resumption of steroids.(ABSTRACT TRUNCATED AT 250 WORDS)

Azathioprine↗

PubMedDate not supplied

Utility of surveillance biopsies in infant heart transplant recipients.

BACKGROUND: Endomyocardial biopsy remains the primary means of rejection surveillance after orthotopic heart transplantation in adults. Perpetual surveillance endomyocardial biopsy has been questioned, however, because of low yield beyond the early posttransplantation period. This issue has not been adequately studied in the pediatric population. The objectives of this study were to define the rate of rejection in infants undergoing orthotopic heart transplantation, correlate rejection with signs and symptoms, and evaluate the utility of surveillance endomyocardial biopsy. METHODS: Records of all patients 24 months of age or younger undergoing orthotopic heart transplantation were reviewed; 38 patients underwent 42 transplantation; 256 endomyocardial biopsies were performed for surveillance, cardiac symptoms, noncardiac symptoms, or lowered immunosuppression. RESULTS: There were 22 rejection episodes International Society for Heart and Lung transplantation grade 1B or higher, half of which occurred in neonates 30 days of age or younger. Linearized rejection rates and actuarial freedom from rejection were not different between neonates and older infants. Linearized rejection rates reached a plateau 3 months after orthotopic heart transplantation of 0.07 episodes/100 patient days. No positive surveillance endomyocardial biopsies were obtained beyond 6 months after orthotopic heart transplantation. The probability of a positive biopsy (International Society for Heart and Lung Transplantation grade 1B or higher) was 20% or more for any other indication (odds ratios for rejection were 12.9 for cardiac symptoms, 3.3 for noncardiac symptoms, and 10.8 for lowered immunosuppression as determined by logistic regression more than 6 months after orthotopic heart transplantation). CONCLUSIONS: Rejection rates are not different between neonatal and older infants, and endomyocardial biopsies done solely for surveillance beyond 6 months after orthotopic heart transplantation rarely yield positive results.

Actuarial Analysis↗