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Biomedical subjects

C J Hayes

Publications and source records attributed to C J Hayes.

At least 37 records · Page 2Linked to original sources
PubMed1986

Arrhythmias after the Mustard operation for transposition of the great arteries: a long-term study.

This study presents follow-up data on 95 patients with transposition of the great arteries who underwent a Mustard intraatrial baffle operation. The patients were followed up serially by means of scalar electrocardiograms and 24 hour Holter monitoring studies. The latter study was effective in documenting abnormal rhythm patterns when the standard electrocardiogram was within normal limits. Twenty percent of the patients had atrial arrhythmias at the time of hospital discharge. new rhythm disturbances were recognized during each year of follow-up; 75% of the patients had atrial rhythm disorders by the sixth year. Slow junctional rhythm was the most common rhythm disturbance found. Complete heart block did not occur. Supraventricular tachycardia occurred within the context of the tachycardia/bradycardia syndrome in 8 of 10 patients, and in all it was documented after hospital discharge. The incidence of sudden death in this series was 3%. Six of the patients have had pacemaker insertions and there have been no deaths among these individuals. It was observed that the slow atrial or junctional rhythms that appeared after intraatrial correction of transposition of the great arteries rarely progressed to life-threatening rhythm disorders in childhood or adolescence, but the prognosis in adult life remains unknown. The three deaths in the series occurred in patients with a history of supraventricular tachyarrhythmias. Elimination of arrhythmias caused by extensive intraatrial surgery is one of the potential advantages of the arterial switch operation for correction of transposition of the great arteries.

Ambulatory Care↗
PubMed1985

"Bedside" balloon septostomy in infants with transposition of the great arteries: new concepts using two-dimensional echocardiographic techniques.

We performed balloon atrial septostomies in six successive infants with transposition of the great arteries, using echocardiographic guidance at the bedside in the neonatal intensive care unit. In all cases adequate septostomy was obtained and instantaneously assessable. PaO2 values increased as expected (mean before septostomy 28 mm Hg; after, 42 mm Hg). In cases of transposition clearly diagnosed echocardiographically, this intervention need not be done in the catheterization laboratory. The need for a full hemodynamic study in the neonatal period is arguable.

Cardiac Catheterization↗
PubMed1979

Increased circulating bradykinin during hypothermia and cardiopulmonary bypass in children.

To determine whether cold could activate the kallikrein-kinin system in vivo as it does in vitro, the circulating systemic concentrations of bradykinin were serially measured in 10 cyildren with congenital diseases of the heart undergoing corrective cardiac surgery. Bradykinin was measured by radioimmunoassay in blood samples obtained before, during and after profound hypothermia (to 18 degrees C) and cardiopulmonary bypass. The circulating concentrations of bradykinin increased significantly as body temperature decreased during surface cooling. The increase in circulating bradykinin was associated with a decrease in the circulating level of bradykininogen, the precursor of bradykinin. With the onset of cardiopulmonary bypass and hence, removal of the lung and pulmonary converting enzyme from the circulation, there was a further rise in the already elevated concentrations of bradykinin. This is the first in vivo demonstration that hypothermia leads to an increase in the circulating concentrations of bradykinin.

Blood Pressure↗
PubMed1979

Pulmonary atresia with intact ventricular septum. Sixteen-year experience.

Infants with pulmonary atresia and intact ventricular septum (PA-IVS) usually require urgent surgical intervention. Thirty patients with this anomaly, seen at the Columbia-Presbyterian Medical Center between 1962 and 1978, had palliative operations, 26 within the first 3 days of life. Six underwent a closed pulmonary valvotomy alone, with no survivors; six had only a systemic--pulmonary artery shunt, with three early survivors. Because of this experience, 17 had a combined procedure of valvotomy and shunt, with 14 early survivors. One patient recently underwent a definitive right ventricular outflow patch procedure with cardiopulmonary bypass. Eight patients subsequently have had corrective open-heart procedures, with five patients surviving from 2 to 10 years. A unicusp aortic homograft was used for repair in five and a Hancock valved conduit in three. Four patients are presently awaiting operation. We conclude that the initial surgical management of these critically ill infants must not only increase pulmonary blood flow but in addition provide an opportunity for right ventricular growth. Thus we continue to advocate the combined procedure of a valvotomy plus a shunt to provide adequate palliation. Repeat catheterization should be performed within a year to confirm the adequacy of the valvotomy, since this is essential to maximal right ventricular enlargement and to allow for definitive correction at a later date.

Adolescent↗
PubMed1978

Agenesis of the left lung and total anomalous pulmonary venous connection. Hemodynamic studies before and after complete surgical correction.

A female infant with unilateral pulmonary agenesis developed congestive heart failure dominated by symptoms of obstructive disease of the airways at 3 1/2 months of age. Cardiac catheterization revealed total anomalous pulmonary venous connection to the right atrium. Despite a massive left-to-right shunt with one pulmonary artery receiving the entire right ventricular output since birth, the patient's resting pulmonary vascular resistance was normal. Open heart surgery to repair the cardiac lesion was performed when the infant was four months of age. Subsequent studies revealed an excellent anatomic and functional repair, with normal pulmonary arterial pressures. One year following surgery, the child is asymptomatic and has normal growth and development.

Blood Pressure↗
PubMed1978

Physiological approach to surgery for tricuspid atresia.

A modification of Fontan's approach to the surgical management of tricuspid atresia was employed in nine patients. A valved conduit was used to create continuity between the right atrium and the surgically modified right ventricular chamber. Six patients had had previous shunting procedures. Preoperative studies revealed various degrees of hypoplasia of the right ventricle beneath relatively normal pulmonary valves. At surgery, the atrial septal and ventricular septal defects were closed, the right ventricular chamber was enlarged, and right atrial-right ventricular continuity was established with a valved conduit. There was one operative death. The eight survivors have been clinically well as long as 3 1/2 years following surgery. Postoperative cardiac catheterization was performed in five patients. Ventricularized pressure tracings were recorded in the right ventricular chambers and the morphology of the atrial and pulmonary artery pressure curves were normal. In all instances, angiography demonstrated significant enlargement of a pulsatile right ventricular chamber. Thus, in many patients with tricuspid atresia, establishment of a four-chambered, four-valved heart is feasible, both from an anatomic and physiologic standpoint.

Adolescent↗
PubMed1978

Surgical management of ventricular septal defects in infants.

Infants with ventricular septal defect (VSD) who are symptomatic despite intensive medical therapy require surgical intervention. Choice of treatment depends upon the cumulative mortality and morbidity rates of the two-stage approach of initial pulmonary artery banding followed by debanding and VSD closure as compared to the risk of primary intracardiac repair in infancy. Sixteen infants underwent pulmonary artery banding at Columbia-Presbyterian Medical Center between 1967 and 1976, with one operative death but with a significant incidence of morbidity and late death. Forty patients underwent pulmonary artery debanding and closure of VSD with three operative deaths. This second-stage procedure was frequently complicated by repair of acquired lesions. During the same 10 year period 37 infants underwent primary closure of VSD with eight operative deaths. The morbidity related to this procedure is low. With the use of profound hypothermia and circulatory arrest, results have significantly improved and the risk of early correction now compares favorably with the cumulative mortality rate of the two-stage approach. Primary intracardiac repair is the procedure of choice.

Heart Arrest, Induced↗
PubMed1977

Bacterial endocarditis in patients with pulmonary stenosis, aortic stenosis, or ventricular septal defect.

Bacterial endocarditis developed in 24 patients during follow-up in the Natural History Study. It occurred significantly more often in patients with ventricular septal defect (1.5/1000 patient-years) and aortic stenosis (1.8/1000 patient-years) than in those with pulmonary stenosis (0.2/1000 patient-years). Complications, especially emboli and aortic regurgitation, occurred in 50% of the patients. Overall mortality was 25%. Incidence rates were significantly greater for males than for females and greater for patients over 20 years of age than for younger patients. Patients who had had ventricular septal defect treated surgically had a lower incidence of endocarditis than non-surgical patients, whereas surgery did not reduce the incidence in patients with aortic stenosis. The estimated risk of contracting bacterial endocarditis prior to 30 years of age in a patient with medically-treated ventricular septal defect is 9.7%; the risk estimate for surgical patients in 2.0%. Although data regarding the use of prophylactic antibiotics were not available for patients in the Natural History Study, these results certainly suggest that continued antibiotic prophylaxis for dental and certain surgical procedures is mandatory for patients with aortic stenosis, even after successful cardiac surgery. It is the authors opinion that prophylaxis is probably less necessary for patients who have pulmonary stenosis, whether surgically treated or not, and for patients with documented complete closure of VSD.

Adolescent↗
PubMed1976

Open-heart experience in infants using normothermia and deep hypothermia.

During the 9-year period from 1967 through 1975, 124 open-heart operations were performed on infants less than 1 year of age with 35 operative deaths (28%). Ninety-seven of these procedures used continuous cardiopulmonary bypass with normothermia or mild hypothermia, and 27 were done under deep hypothermia and circulatory arrest. Mortality and morbidity were similar regardless of the operative technique, although deep hypothermia facilitated the repair of complex lesions. The highest mortality occurred in infants less than 3 months of age. Respiratory insufficiency, usually requiring prolonged ventilatory support, occurred only among infants who had pulmonary overcirculation or congestion prior to operation. Adequacy of intraoperative repair and postoperative care were the major determinants of survival.

Cardiac Surgical Procedures↗
PubMed1976

The chronomutagenic effect of deuterium oxide on the period and entrainment of a biological rhythm. II. The reestablishment of lost entrainment by artificial LD cycles.

Mice caused to ingest 25% or 30% deuterium oxide could no longer be entrained to a 12:12 light-dark cycle. Reentrainment could be established by artificially lengthening the light-dark cycle from a natural 24-hours one, to LD 13:13 or 14:14. It is noted that the relationship between biological rhythms and the ambient LD cycle is strikingly similar to that between coupled unidirectional physical oscillators. It is concluded that while the similarity between the responses of a great many organismic rhythms to deuterium oxide administration suggests that the biological clocks of all organisms are very similar, if not the same, a substance with more specificity to key biological processes than D2O will be required to eventually elucidate the escapement mechanism of the enigmatic living clock.

Animals↗
PubMed1975

Long-term follow-up of two infants with an implanted cardiac pacemaker.

The clinical course of two patients with congenital heart block who had pacemaker implantation at age 7 and 8 months, respectively, is reviewed. One patient at age 10 years has had nine pulse generators inserted; the other has had six implantations, the most recent a lithium iodine pacemaker, during 8 1/2 years of observation. Both patients have shown normal physical development and emotional maturation despite multiple hospitalizations and pacemaker replacements, thus demonstrating that electrical pacing, initiated in infancy, can be maintained through childhood without adverse effects.

Age Factors↗
PubMed1973

Inhibition of cathepsin D-type proteinase of macrophages by pepstatin, a specific pepsin inhibitor, and other substances.

The macrophage is the main cell participating in chronic inflammation. It contains an acid-acting, cathepsin D-type proteinase with the specificity of pepsin, which may release mediators of the inflammatory process. To find new pharmaceutical inhibitors of this proteinase, we tested a variety of chemical compounds in vitro. For this survey, the possible inhibitor (at a concentration of 0.4 mg/ml) was assayed with partially purified cathepsin D-type proteinase from beef lung (a macrophage-rich tissue) and hemoglobin as the substrate. Diazophenylbutanone, three acetophenones, two barbiturates, a gold salt, a copper chelate of a substituted nicotinic acid, a hexapeptide containing a d-amino acid, and Pepstatin inhibited this enzyme; over 200 other potential inhibitors did not. By far the most active and specific inhibitor found to date is Pepstatin, a pentapeptide with two gamma-NH linkages, two beta-OH groups, and five branched aliphatic side chains. Banyu Pharmaceutical Co., Tokyo, Japan, produces this nontoxic compound for the treatment of peptic ulcers. In vitro, as little as 4 ng of Pepstatin inhibits the acid-acting cathepsin D-type proteinase purified from beef and rabbit lung as well as the similar proteinase of rabbit peritoneal and pulmonary macrophages.

Acetophenones↗