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Biomedical subjects

D A Girod

Publications and source records attributed to D A Girod.

At least 55 records · Page 3Linked to original sources
PubMed1985

Ductus arteriosus aneurysm in infancy.

An infant with symptoms of congestive heart failure at 6 months of age was found by cardiac catheterization at the age of 1 year to have a fusiform aneurysm of the ductus arteriosus as well as discrete stenosis of the left pulmonary artery and a secundum atrial septal defect. The aneurysm was resected, and a pericardial patch angioplasty corrected the peripheral pulmonary stenosis. The atrial septal defect was closed in a separate procedure. To our knowledge, this case is one of four ductal aneurysms reported in infants that have been diagnosed before operation and successfully treated. The pathophysiology and literature are reviewed.

Aneurysm↗
PubMed1985

Indomethacin therapy on the first day of life in infants with very low birth weight.

To investigate the optimal timing for treatment of small premature infants, we performed a double-blind, controlled trial of indomethacin therapy on the first day of life in 104 infants weighing between 700 and 1300 gm. Infants were given indomethacin or placebo at a mean age of 15 hours. Eleven of the 56 infants given placebo developed large left-to-right shunts through a patent ductus arteriosus. In contrast, only two of the 51 infants given indomethacin developed large shunts (P less than 0.025). There were no significant differences in incidence of surgical ligation, duration of oxygen therapy, duration of endotracheal intubation, days required to regain birth weight, or incidence of complications. However, the power of the tests of significance was low because of the small number of patients. Thus, although the incidence of large left-to-right ductus shunts was decreased in the indomethacin group, morbidity was not otherwise altered for the entire group of patients, possibly because of the relatively low incidence (21%) of large shunts in the placebo group. We conclude that although treatment with indomethacin on the first day of life appears to be safe, there is little advantage to its use in centers where the incidence of large shunts through a patent ductus arteriosus is relatively low.

Double-Blind Method↗
PubMed1985

Aortic coarctation in the first three months of life. An anatomopathological study with respect to treatment.

Operation for coarctation in infancy is a lifesaving procedure, but it still carries a high mortality and is followed frequently by recurrence of stenosis. This is especially true when the procedure is performed in the first 3 months of life. To determine a correlation, if any, between anatomy of coarctation and surgical procedures, we have studied a series of 42 autopsy specimens from patients younger than 3 months who had aortic coarctation. We found that concepts of coarctation based solely on a discrete lesion or isthmic hypoplasia were simplistic. The anatomy was much more complex, the findings being relevant to surgical techniques currently in use (resection and end-to-end anastomosis, subclavian flap aortoplasty). Of equal significance in the cases we studied to the presence of a shelf of ductal tissue within the aortic lumen or hypoplasia of a segment of the arch was the finding of "waist" lesions. In these cases the wall of the aorta was constricted to form the obstruction. Such "waists" coexisted with discrete shelves or with shelves and isthmic narrowing. While we recognize the danger of extrapolating from autopsy findings to predict clinical results, our observations suggest that surgical procedures might best be tailored to the precise anatomy present. It seemed that in may cases a subclavian flap procedure offered the best chance of success. Cases with anatomy suitable for resection and end-to-end anastomosis were less frequent. Percutaneous angioplasty seemed at best to offer only palliative options in limited cases.

Age Factors↗
PubMed1985

Relationship of pulmonary artery size to mortality in patients undergoing the Fontan operation.

The size of the pulmonary arteries, measured intraoperatively, was correlated with operative mortality in 90 patients who underwent the Fontan operation. There was no significant difference in the cross-sectional area of the right and left pulmonary arteries/body surface area (PA index) between survivors and nonsurvivors. There was no significant difference in mortality rates between patients with a PA index greater than 250 and those with a PA index less than 250 mm2/m2. Survival was observed with cross-sectional area as low as 188 mm2/m2.

Adolescent↗
PubMed1984

Apicoaortic valved conduits for complex left ventricular outflow obstruction: technical considerations and current status.

The surgical considerations, clinical follow-up, and hemodynamic data for 23 patients (age range, 4 months to 80 years) who underwent insertion of a porcinevalved apicoaortic conduit between December, 1976, and June, 1983, are reviewed. All patients had complex forms of left ventricular outflow obstruction. All were symptomatic, and 18 had had 23 prior attempts at surgical relief of the obstruction. There was a total of 6 deaths (26%); 2 were in small children with other complex cardiac malformations, and 2 others in patients who required emergency operation for acute cardiac decompensation. Sixteen patients have had cardiac catheterization 1 to 1.5 years postoperatively, and a reduction in the resting left ventricular-aortic gradient from 91 +/- 30 to 13 +/- 8 mm Hg was demonstrated (p less than 0.001). None of the patients is taking anticoagulants, and no thromboembolic events have occurred. Four of the 17 survivors have undergone a subsequent operation 1.5 to 4.0 years postoperatively with conduit removal, aortoventriculoplasty, and conduit valve replacement in 1, 1, and 2 patients, respectively. These data demonstrate that the apicoaortic conduit is effective in relieving complex left ventricular outflow obstruction and improving left ventricular performance with acceptable long-term results. Increasing the durability of the conduit valve will greatly improve the late results with this technique.

Adolescent↗
PubMed1984

Transverse aortic wall tears in infants after balloon angioplasty for aortic valve stenosis: relation of aortic wall damage to diameter of inflated angioplasty balloon and aortic lumen in seven necropsy cases.

Aortic wall tears resulting from rupture of dilating balloons in infants undergoing transluminal balloon angioplasty have not been previously recognized. A 2 day old infant had percutaneous transluminal balloon angioplasty to dilate a stenotic aortic valve, and after multiple balloon inflations the balloon burst. The infant died 2 days after undergoing transluminal balloon angioplasty and at necropsy a circumferential, transverse aortic wall tear was found. To test the hypothesis that rupture of appropriately sized balloons results in similar aortic wall tears, six unfixed, intact infant aortas were subjected to transluminal balloon angioplasty at necropsy: two infants had balloon rupture with inflated balloon diameter similar to that of the aorta, two had balloon rupture with an undersized balloon and two had dilation with an oversized balloon. Transverse wall tears occurred in aortas with similar aortic and balloon diameters; no aortic wall damage occurred with rupture of undersized balloons, and aortic rupture resulted from the use of oversized balloons. Thus, intimal-medial tears in the infant aorta may result from balloon bursting during angioplasty when aortic and inflated balloon diameters are similar.

Angioplasty, Balloon↗
PubMed1984

Double-inlet ventricle: morphologic analysis and surgical implications in 32 cases.

We analyzed, using a sequential segmental approach, 32 cases of double-inlet ventricle to assess the feasibility of surgical "correction" by either ventricular septation or a modified Fontan procedure. Twenty-two hearts had two atrioventricular valves, connected to a left ventricle in 19, a right ventricle in two, and a solitary indeterminate ventricle in one. Septation was possible in only 13. In contrast, the Fontan procedure seemed feasible in 20. The remaining 10 specimens had double inlet via a common valve to the left ventricle in two, the right ventricle in six, and an indeterminate ventricle in two. Seven of these had right atrial isomerism. Ventricular septation was not considered a possibility in these hearts. The Fontan procedure combined with atrial septation was a possibility in seven cases. From the morphologic stance, although the modified Fontan procedure seemed suitable in most cases, a significant number of hearts with two atrioventricular valves were suitable for ventricular septation.

Endocardial Cushion Defects↗
PubMed1983

Quantitation of aortic and mitral regurgitation in the pediatric population: evaluation by radionuclide angiocardiography.

The ability to quantitate aortic (AR) or mitral regurgitation (MR), or both, by radionuclide angiocardiography was evaluated in children and young adults at rest and during isometric exercise. Regurgitation was estimated by determining the ratio of left ventricular stroke volume to right ventricular stroke volume obtained during equilibrium ventriculography. The radionuclide measurement was compared with results of cineangiography, with good correlation between both studies in 47 of 48 patients. Radionuclide stroke volume ratio was used to classify severity: the group with equivocal regurgitation differed from the group with mild regurgitation (p less than 0.02); patients with mild regurgitation differed from those with moderate regurgitation (p less than 0.001); and those with moderate regurgitation differed from those with severe regurgitation (p less than 0.01). The stroke volume ratio was responsive to isometric exercise, remaining constant or increasing in 16 of 18 patients. After surgery to correct regurgitation, the stroke volume ratio significantly decreased from preoperative measurements in all 7 patients evaluated. Results from the present study demonstrate that a stroke volume ratio greater than 2.0 is compatible with moderately severe regurgitation and that a ratio greater than 3.0 suggests the presence of severe regurgitation. Thus, radionuclide angiocardiography should be useful for noninvasive quantitation of AR or MR, or both, helping define the course of young patients with left-side valvular regurgitation.

Adolescent↗
PubMed1983

Two-dimensional echocardiographic differentiation of anomalous left coronary artery from congestive cardiomyopathy.

Infants having anomalous origin of the left coronary artery (ALCA) from the pulmonary artery may at times be difficult to distinguish clinically from those having a congestive cardiomyopathy (CCM). Five children having ALCA and 15 having CCM were studied by two-dimensional echocardiography (2DE) and angiography. The left coronary artery (LCA) was demonstrated by 2DE to arise normally in all children having CCM. The LCA aortic ostium was not recorded in any child with ALCA; however, the LCA was recorded in three patients. The 2DE recorded the LCA originating from the pulmonary artery in two of these infants. A prominent right coronary artery was seen in all patients with ALCA. Thus 2DE is helpful in distinguishing patients having ALCA from those with CCM.

Cardiac Catheterization↗
PubMed1983

Clinical and hemodynamic follow-up of left ventricular to aortic conduits in patients with aortic stenosis.

To assess the long-term results of left ventricular outflow tract reconstruction utilizing an apical left ventricular to aortic valved (porcine) conduit the clinical and hemodynamic data were reviewed from 24 patients who had placement of an apico-aortic conduit. Eighteen of the patients are asymptomatic and taking no cardiac medications. Three patients were reoperated on, one patient 1.5 years after his original operation for subacute bacterial endocarditis and two patients 3 to 4 years after their original operation for severe conduit valve insufficiency. None of the patients is taking anticoagulants and no thromboembolic events have occurred. Postoperative catheterization has been performed 1 to 1.5 years (mean 1.2) after repair in 15 of 21 patients. The rest left ventricular outflow tract gradient has decreased from 102.5 +/- 20 mm Hg preoperatively to 14.8 +/- 9.9 mm Hg postoperatively (probability [p] less than 0.001). Some degree of conduit obstruction was demonstrated by catheter passage in 11 of the 15 patients. In these 11 patients, the obstruction occurred at three distant sites: at the egress of the left ventricle in 9, at the porcine valve in 5 and at the aortic to conduit junction in 1. Isometric exercise in five and supine bicycle exercise in six patients increased the left ventricular outflow tract gradient by 2.5 +/- 1.1 and 20.8 +/- 11.8 mm Hg, respectively, despite an increase in cardiac index of 1 +/- 0.3 and 3.7 +/- 0.4 liters/min per m2, respectively. The data suggest that a left ventricular to aortic conduit is an effective form of therapy for severe left ventricular outflow tract obstruction.

Adolescent↗
PubMed1983

Right ventricular infarction with cardiac rupture in an infant with pulmonary valve atresia with intact ventricular septum.

This report describes an 8 day old infant with pulmonary valve atresia, hypoplastic and hypertensive right ventricle and myocardial sinusoid-left anterior descending coronary artery connections. A large right ventricular sinusoid complex developed that was associated with transmural right ventricular necrosis and cardiac rupture. This is the first report to document transmural myocardial infarction and rupture in pulmonary valve atresia with intact septum, and this condition should be added to the causes of myocardial infarction in infancy. A reduced number of caliber of sinusoid-coronary artery channels may be responsible for right ventricular damage in this condition.

Coronary Vessel Anomalies↗
PubMed1982

Heparinization for prevention of thrombosis following pediatric percutaneous arterial catheterization.

One thousand three hundred and sixteen consecutively catheterized infants and children were evaluated prospectively for femoral artery thrombosis following percutaneous cardiac catheterization. One hundred units/kg heparin bolus was given to 649 patients after arterial puncture (group A). A supplementary 50 units/kg of heparin bolus was given to 381 patients 75 minutes later, followed by a continuous heparin infusion if pulses were decreased (group B). Two hundred forty-one patients were managed similarly except the first supplementary bolus was given 45 minutes after initial heparinization, if necessary, and the second bolus and continuous infusion were begun 45 minutes later, if necessary (group C). Arterial thrombosis was diagnosed if pulses were not equal to those of the unused extremity 6 hours following catheterization. The overall incidence of arterial thrombosis was 0.8%. No statistically significant (p less than .05) differences occurred related to the heparinization method used. However, absence of thrombosis in the last 241 consecutive patients (group C) and in the last 480 patients of groups B and C weighing more than 10 kg approaches significance (p less than .1). Incidence of thrombosis was less than in previous studies (p less than .0005 to .05). This study indicates that a very low incidence of arterial thrombosis can be achieved with systemic heparinization.

Adolescent↗
PubMed1982

Blade atrial septostomy: collaborative study.

During the past 4 years, five institutions have collaborated in evaluating the efficacy of blade atrial septostomy. The procedure was performed in 52 patients, including 31 with transposition of the great arteries, 10 with mitral atresia, five with tricuspid atresia and six with miscellaneous anomalies. The patient's ages ranged from 1 day to 12 years (mean 13 months). Improvement occurred in 41 of 52 patients (79%). Four patients had an intact interatrial septum, and blade atrial septostomy was successfully performed by a transseptal technique. One patient died from a lacerated left atrial wall; other complications occurred in four patients. Blade atrial septostomy is an effective palliative procedure, even when the interatrial septum is thickened or intact.

Arteries↗
PubMed1981

Trisomy 7 mosaicism and manifestations of Goldenhar syndrome with unilateral radial hypoplasia.

We describe a girl born to a mother who took birth control pills and antihistamines during the first trimester of pregnancy. Congenital abnormalities included plagiocephaly, abnormalities of left ear, facial asymmetry, abnormalities of head hair pattern, cleft lip and palate, bifid tongue, left torticollis, hemivertebrae, left radial hypoplasia and absent thumb, left inguinal hernia, patient ductus arteriosus, narrowing of the thoracic aorta, and hypoplastic right pulmonary artery. The karyotype obtained from peripheral lymphocytes and from fibroblasts from the left side of the body was 46XX whereas fibroblasts from the right side revealed 46XX/47XX+7 mosaicism.

Child↗
PubMed1980

Tetralogy of Fallot with abnormal coronary artery: 1967 to 1977.

From 1967 to 1977, 25 of 250 children undergoing complete repair of tetralogy of Fallot had an abnormal coronary artery identified at operation. Eight (Group 1) had classical anomalous coronary artery, and 17 (Group 2) had a large aberrant artery in addition to a smaller, normally positioned artery. All 25 patients required surgical procedures different from those routinely employed in tetralogy of Fallot repair. These included a "tailored" ventriculotomy, double incision, and accessory right ventricle-to-pulmonary artery conduit. After identification of a parallel (smaller) coronary artery, the anomalous coronary artery was ligated in three. Two patients (Group 2) died following the operation, both with "tailored" incisions. These were two of the four with high residual right ventricular pressure. Survivors have done well clinically for at least 1 year. Postoperative catheterization has shown high residual right ventricular pressure in two patients and an insignificant residual ventricular septal defect in four patients none has required reoperation.

Cineangiography↗
PubMed1979

Right ventricular outflow tract assessment by cross-sectional echocardiography in tetralogy of Fallot.

Cross-sectional echocardiographic (CSE) studies were obtained in 29 children with tetralogy of Fallot. In this study we evaluated the capability of CSE to record the right ventricular outflow tract (RVOT) and compared the severity of infundibular obstruction determined by CSE with cineangiographic (cine) determinations. In addition, we examined capabilities of CSE and M-mode echocardiography (M-mode) to record the diagnostic features of tetralogy of Fallot, including RVOT obstruction, aortic overriding, ventricular septal defect, and presence of the pulmonary valve. An excellent correlation (r = 0.925) was found for the combined pre- and post-repair patients studied by CSE vs cine, while the correlation (r = 0.805) for M-mode was not as good. The difference was even more striking for the unrepaired patients, in which the correlation (r = 0.746) for CSE was much better than for M-mode (r = 0.374). In the unrepaired patients, CSE allowed easier detection of the ventricular septal defect than M-mode (95% for CSE vs 76% for M-mode). The pulmonary valve was recorded in 90% by CSE, but in only 26% by M-mode. Aortic overriding was recorded in all unrepaired patients both by CSE and M-mode. These data indicate that CSE is better than M-mode for recording the RVOT dimensions, ventricular septal defect, and the pulmonary valve in unrepaired patients with tetralogy of Fallot.

Aorta↗