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Biomedical subjects

C E Mullins

Publications and source records attributed to C E Mullins.

At least 91 records · Page 5Linked to original sources
PubMed1989

Catheter closure of congenital cardiac defects.

In summary, the role of the pediatric cardiac catheterization laboratory has changed from that of a primary diagnostic facility to a major therapeutic arena. We have reviewed our experiences with various occlusion devices to successfully treat patients with various congenital cardiac malformations, particularly the PDA. The future for interventional therapeutic procedures appears bright with the possibility of closure of certain defects in an outpatient setting now a reality, thereby lowering hospitalization costs and lessening post-therapeutic morbidity while preserving a high level of successful outcomes.

Arteriovenous Malformations↗
PubMed1988

Balloon valvuloplasty for pulmonic valve stenosis--two-year follow-up: hemodynamic and Doppler evaluation.

The purpose of this investigation was to evaluate the efficacy, technique, and follow-up results of balloon dilation angioplasty for valvular pulmonary stenosis. Percutaneous dilation was performed on 63 patients with pulmonary stenosis (ages 3 months to 76 years, mean = 4.3 years). In 43 patients, a single balloon was used; in 20 patients two balloons were used simultaneously. The pressure gradient across the pulmonary valve was determined with right ventricular and main pulmonary artery catheters. Pressure gradients simultaneously were estimated by continuous wave Doppler (CWD) during catheterization. The peak systolic ejection gradient was obtained by both techniques both pre- and postangioplasty. There was excellent linear correlation between the simultaneous catheter pressure gradient and the pressure gradient estimated by Doppler (r = 0.99). Follow-up pressure gradient estimations by Doppler echocardiogram were obtained in 30 patients between 6 months and 30 months postcatheterization (mean = 13 months). The mean preangioplasty gradient of 64 mm Hg (range 30-160 mm Hg) was reduced to 22 mm Hg (range 2-31 mm Hg). A significant reduction of transvalvular gradient (52-95%, mean 68%) occurred in each patient. A linear correlation was found between the predilation gradient and the pressure gradient drop (r = 0.92). Mean follow-up gradient by Doppler was 20 mm Hg (range 0-31 mm Hg), and there was no significant difference between these gradients and the postdilation gradient. No important complications were noted. These data confirm that balloon dilation angioplasty for valvular pulmonary stenosis is safe and effective, and suggest that stenosis does not recur.

Adolescent↗
PubMed1988

Balloon dilation of unoperated coarctation of the aorta: short- and intermediate-term results.

Balloon dilation is effective in the immediate relief of obstruction due to unoperated coarctation of the aorta. However, the long-term benefits and complications of this procedure have not been established. Thirty-three patients underwent balloon dilation of unoperated coarctation using a percutaneous technique from November 1983 to December 1985. High quality biplane angiography was performed before and after dilation. Follow-up was obtained in 20 patients from 6 to 31 months following dilation. Angiography was performed at follow-up in 10, nuclear magnetic resonance (NMR) imaging in 10 and both NMR imaging and angiography in 3. Balloon dilation was successful in 31 of the 33 patients with a decrease in average systolic pressure gradient from 46 to 8 mm Hg. There was no significant change in gradient on follow-up physical examination and at recatheterization in 10 patients. In addition, there was no evidence of restenosis on follow-up angiography and NMR imaging. In two patients, a small aneurysm formed at the site of balloon dilation. Balloon dilation of unoperated coarctation is effective, providing lasting relief of coarctation gradient and no evidence of restenosis. However, because of the uncertain natural history of aneurysms after dilation, this procedure should be considered investigational until further follow-up on patients with and without an aneurysm is available.

Angiography↗
PubMed1988

Results of balloon valvuloplasty in typical and dysplastic pulmonary valve stenosis: Doppler echocardiographic follow-up.

To assess the usefulness of balloon valvuloplasty in patients with a dysplastic pulmonary valve, the files of 36 patients (aged 1 day to 18.5 years) who had two-dimensional echocardiography before and continuous wave Doppler echocardiography late after balloon valvuloplasty (balloon diameter greater than or equal to 20% anulus diameter) were reviewed. Results of relief of pulmonary stenosis were graded by catheter gradient in the catheterization laboratory and compared with Doppler echocardiographic findings at follow-up. There were 32 patients with typical pulmonary stenosis and 4 with a dysplastic valve. In the 32 patients with typical pulmonary stenosis, transvalvular gradient changed from a mean of 67 +/- 32 to 20 +/- 20 mm Hg (p less than 0.0001, mean reduction 72.6%). The gradients at follow-up by Doppler echocardiography averaged 20 mm Hg including 15 that increased, 3 that were unchanged and 14 that decreased. Only 3 (9%) of 32 patients had a gradient greater than 25 mm Hg at follow-up and only one gradient was greater than 35 mm Hg. All four patients with a dysplastic valve had a gradient that decreased with valvuloplasty from a mean of 85 +/- 33 to 33 +/- 20 mm Hg (p less than 0.05); gradient reduction in this group ranged from 40 to 85% (mean 57.5%). The gradient at follow-up increased in three of these four patients and decreased in one (the only late gradient less than 25 mm Hg). Late gradient was less than 35 mm Hg in two of the four patients and was reduced by 43 and 57%, respectively, in the other two.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Implantation of balloon-expandable intravascular grafts by catheterization in pulmonary arteries and systemic veins.

The purpose of this investigation was to evaluate the efficacy and safety of implanting expandable intravascular stents in pulmonary arteries and systemic veins. Twenty-seven balloon-expandable grafts were placed in 13 mongrel dogs under anesthesia. A long sheath was introduced over a wire and catheter or dilator into the pulmonary artery or target vein. A collapsed stainless steel expandable mesh stent was placed over the balloon of an angioplasty catheter. The catheter with the mounted stent was advanced through the sheath. The stent expanded to the diameter of the balloon as the balloon was inflated, and remained expanded as the balloon was deflated. The stent was expanded further with a larger balloon in 11 instances. Eleven stents were placed successfully in pulmonary arteries (out of thirteen attempted), and 11 of 14 were installed in tributaries of the precava or postcava. Three inadvertent embolizations of the devices occurred. All three devices that embolized lodged in the pulmonary arteries and did not obstruct flow. Seven dogs were recatheterized at intervals ranging from 56 to 278 days. Twelve stents were patent and nonobstructive, and two were malpositioned, one of which was obstructed. Three animals were killed 2 months (two dogs) and 9 months (one dog) after the implantations. The stents (four in the pulmonary arteries and two in veins) were completely covered with neointima and were patent, without thrombosis. These stents hold promise for definitive dilation of congenital or postoperative vessel stenoses.

Animals↗
PubMed1987

Double balloon technique for dilation of valvular or vessel stenosis in congenital and acquired heart disease.

Despite the generally excellent success with balloon dilation for the stenotic lesions of congenital and acquired heart disease, technical difficulties sometimes prevent satisfactory results. Such technical difficulties include: a large diameter of the anulus of the stenotic lesion relative to available balloon diameter, difficulty in the insertion or removal of the larger balloon catheters, and permanent damage to or obstruction of the femoral vessels by the redundant deflated balloon material of the large balloons. A double balloon technique was initiated to resolve these difficulties. With this method, percutaneous balloon angioplasty catheters were inserted in right and left femoral vessels, placed side by side across the stenotic lesion and inflated simultaneously. Dilation procedures using the two balloon technique were performed in 41 patients: 18 with pulmonary valve stenosis, 14 with aortic valve stenosis, 5 with mitral valve stenosis, 3 with vena caval obstruction following the Mustard or Senning procedure and 1 with tricuspid valve stenosis. Patient ages ranged from 1 to 75 years (mean 17.8) and patient weights ranged from 8.9 to 89 kg (mean 42.3). Balloon catheter sizes ranged from 10 to 20 mm in diameter. Average maximal pressure gradient in mm Hg before dilation was 61 in pulmonary stenosis, 68 in aortic stenosis, 21 in mitral stenosis, 12 in tricuspid stenosis and 25 in vena caval stenosis. Average maximal valvular pressure gradient after dilation was 13 in pulmonary stenosis, 24 in aortic stenosis, 4 in mitral stenosis, 0 in tricuspid stenosis, and 1 in vena caval stenosis. No major complications were encountered with the procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Nonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA Occluder System.

The first successful application of a transcatheter closure technique for patent ductus arteriosus (PDA) suitable for use in infants and children was performed by us in 1977. Since that time, there has been continued improvement and simplification of the equipment as well as in the implantation technique. Following a Food and Drug Administration protocol, a multicenter study was conducted to test the safety and effectiveness of this interventional method. The clinical results from three major regional test centers (Philadelphia, Houston, and New Haven) are presented. One hundred forty-six patients from a test population of 156 were treated for PDA with use of the Rashkind PDA Occluder Systems. Successful closure was accomplished in 94 (66%) of the total cases. Ten patients (7%) retained residual ductal murmurs despite correct placement of the occlusion devices; five additional patients (3%) were considered failures due to the presence of abnormal Doppler flow patterns after the procedure. Postrelease embolizations occurred in 19 (15%) instances. One patient required emergency surgical intervention after attempted retrieval of an embolized occluder. With the improvements in the manufacturing of the double-disk occluder systems as well as the perfection of the transvenous delivery technique, the incidences of closure failure and postrelease complications have decreased. Since January 1984, 78% of all transcatheter closure attempts were successful, with 10% embolization.

Animals↗
PubMed1986

Restrictive interatrial communication in total anomalous pulmonary venous connection.

Restriction to systemic blood flow at the atrial level in total anomalous pulmonary venous connection (TAPVC) may play a role in the early development of congestive heart failure in some patients. Over a 4-year period, 21 patients with TAPVC without extracardiac obstruction presented from 1 day to 10 months of age (mean 2.6 months). Of 21 patients, 17 (81%) presented after 1 month of age with moderate to severe congestive heart failure. In the first week after birth 4 patients presented with minimal symptoms of congestive heart failure. A small patent foramen ovale (3 mm or less in diameter) was found in 19 of 21 patients (90%) by 2-dimensional echocardiography or angiography. Balloon or blade and balloon atrial septostomy was performed in these 19 patients and resulted in significant decreases in mean right to left atrial pressure gradient (from 2.8 to 0.25 mm Hg, p less than 0.001), systolic pulmonary to femoral artery pressure ratio (from 0.80 to 0.60, p less than 0.001), and systemic arterial oxygen saturation (from 84% to 79%, p less than 0.01). One patient had nonfatal complications. Surgery was performed in 19 patients from 2 weeks to 29 months (mean 12 months) after catheterization, with 1 operative death (5% mortality). Four patients required early total correction because of persistent heart failure; 15 had elective surgical repair. One of 2 unoperated patients died of pneumonia at 2.5 years of age. A restrictive interatrial communication develops after the first month of extrauterine life in most patients with TAPVC. Atrial septostomy results in improved hemodynamic conditions and clinical palliation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1986

Severe subaortic stenosis associated with congenital rubella syndrome: palliation by percutaneous transcatheter device occlusion of a patent ductus arteriosus.

Congenital rubella syndrome has been associated with several forms of congenital heart disease including left-sided obstructive lesions. This report describes a patient with severe subaortic stenosis, patent ductus arteriosus, and mild pulmonary branch stenosis, a rare condition. Palliation was achieved with percutaneous transcatheter device occlusion of the patent ductus arteriosus.

Aortic Valve Stenosis↗
PubMed1986

Percutaneous transluminal balloon pulmonary valvuloplasty for the relief of pulmonary valve stenosis with special reference to double-balloon technique.

PTBPV was performed 33 times in 32 patients in the Riyadh Armed Forces Hospital. Patients ranged in age from 6 months to 12 years (mean 4.5 years); average weight was 14.86 kg. Before dilatation, all patients had grade 4/6 late peaking systolic ejection murmurs, with right-axis deviation and right ventricular hypertrophy on ECG. Moderate to severe pulmonary valve stenosis (right ventricle-pulmonary artery gradient 50 mm Hg systolic) was confirmed both hemodynamically and angiographically. Balloon size was selected to be approximately 2 mm larger than the pulmonary valve anulus was over 25 were inflated to approximately 5 atmospheres of pressure. Two patients required two simultaneous balloons as the pulmonary valve anulus was over 25 mm. Predilatation peak systolic pressure gradients ranged from 50 to 245 mm Hg (mean 99.2 mm Hg); postdilatation gradients ranged from 8 to 93 mm Hg (mean 23.4 mm Hg). There were no deaths or complications. The systolic murmur with early systolic peak decreased in all but three patients. Systolic thrill disappeared in all but three patients. Follow-up at an average of 10 months revealed increasing exercise tolerance in two thirds of patients. Fourteen patients have been recatheterized at least 6 months after dilatation and showed persistent minimal gradient. We conclude that balloon valvuloplasty of pulmonary valve stenosis is an effective, safe procedure. At this writing, a total of 90 successful PTBPVs have been performed, with equally impressive results.

Angioplasty, Balloon↗
PubMed1985

Chronic supraventricular tachycardia. A curable cause of congestive cardiomyopathy.

Two cases of congestive cardiomyopathy were proved to be due to chronic atrial automatic-focus tachycardia. Surgical elimination of the tachycardia resulted in normalization of cardiac function in both cases. We suggest that patients with congestive cardiomyopathy be carefully screened for supraventricular tachycardia. Patients with chronic supraventricular tachycardia should be treated aggressively to prevent myocardial dysfunction.

Cardiomyopathy, Dilated↗
PubMed1985

Intracardiac undifferentiated sarcoma in infancy.

A rare case of an intracardiac undifferentiated sarcoma in a 3 month old infant is described together with the clinical, angiographic, echocardiographic, surgical and histopathologic findings. The tumor was successfully removed surgically, and monthly echocardiographic follow-up is being performed.

Echocardiography↗
PubMed1984

Left ventricular endomyocardial biopsy in children with the transseptal long sheath technique.

Left ventricular endomyocardial biopsies were obtained in 19 infants and children using a long sheath as an introducer after transseptal puncture of the atrial septum. From July 1982 to August 1983, 19 patients, ages 7 months to 12 years (mean = 4.6 years), underwent both right and left ventricular biopsies with only one failure. The long sheath technique allows positioning of the bioptome in different areas of the left ventricular chamber. Right ventricular biopsies were also obtained with the long sheath technique in 11 other patients.

Biopsy↗
PubMed1983

Atrioventricular valve abnormalities in infancy: two-dimensional echocardiographic and angiocardiographic comparison.

The results of two-dimensional echocardiography and biplane angiocardiography from 47 infants with congenital atrioventricular (AV) valve abnormalities were compared. Eleven patients had atresia of the right AV valve, 10 had atresia of the left AV valve, 4 had hypoplasia of the right AV valve and 5 had hypoplasia of the left AV valve. Twelve patients had endocardial cushion defect, three had single ventricle and two had straddling of the left AV valve. There was agreement between the two techniques as to the number of AV valves present in each patient. The echocardiographic estimate of valve anular diameter was below normal in seven of the eight patients thought to have a hypoplastic anulus by angiocardiography. In 10 of the 12 patients with endocardial cushion defect, there was agreement between the two techniques as to the presence or absence of atrial and ventricular septal defect. The chordal attachments of straddling valves were better visualized by echocardiography; flow patterns and effective orifice size were better demonstrated by angiocardiography. The subcostal four chamber echocardiographic views and cranially angulated oblique angiocardiographic views were comparable and provided the best images for determination of the size and number of AV valves and their relation to the atrial and ventricular septa.

Angiocardiography↗