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Biomedical subjects

D A Girod

Publications and source records attributed to D A Girod.

At least 73 records · Page 4Linked to original sources
PubMed1978

Cross-sectional echocardiographic characterization of aortic obstruction. 1. Supravalvular aortic stenosis and aortic hypoplasia.

Cross-sectional echocardiographic and cineangiographic studies of the left ventricular outflow tract and ascending aorta were performed in five patients with supravalvular aortic stenosis (four hourglass and one hypoplastic). Visualization of the area of obstruction was possible in each patient using the cross-sectional system. In each case the echocardiographically determined diameter at the level of obstruction was within 3 mm of the similar angiographic value. Assessment of the extent of the lesion was possible in four of five cases. In three of these four cases the echocardiographic measurement was within 5 mm of the angiographic measurement while in the fourth the obstruction was felt to involve the total ascending aorta by both techniques. Determination of percent decrease in LVOT diameter from the aortic anulus to the level of obstruction was useful in defining obstruction and estimating severity. Cross-sectional echocardiography is a valuable noninvasive method for evaluating the ascending aorta in patients with supravalvular aortic stenosis.

Adolescent↗
PubMed1978

Cross-sectional echocardiographic detection of aortic obstruction. 2. Coarctation of the Aorta.

Cross-sectional echocardiographic studies of the aortic arch and proximal descending aorta were performed in 18 patients with coarctation of the aorta and 20 normal subjects. In normals the aortic arch and proximal descending aorta appeared as an arcuate, echo-free structure curving across the plane of the scan. There were no localized changes in aortic diameter and the amplitude of aortic systolic pulsation was symmetrically maintained throughout the scan plane. Visualization of this region was possible in 16 of 18 patients with coarctation. In each of these cases there was a localized area of decrease in aortic diameter in the region of the left subclavian artery which corresponded to the angiographic appearance of the coarctation. In addition prominent systolic pulsation of the aortic arch proximal to the region of obstruction was evident. Cross-sectional echocardiography may offer a useful noninvasive method for direct visualization of aortic coarctation.

Adolescent↗
PubMed1977

Cross-sectional echocardiographic assessment of the severity of aortic stenosis in children.

Real-time, cross-sectional echocardiographic studies of the aortic valve were performed in 28 children with congenital valvular aortic stenosis and in 22 normal subjects. The presence of a stenotic valve was indicated by increase in echo production, abnormal motion pattern, and abnormal systolic position of the valve leaflets. Comparison of the maximum aortic cusp separation (MACS) to calculated aortic valve area yielded an r of 0.91. MACS was then expressed as a percentage of aortic root diameter (AOD) to correct for patient size. In normals MACS averaged 72.7% (range 63-92%) of AOD. With mile aortic stenosis MACS averaged 53.1% of AOD (range 42-62%) (P less than 0.001 vs normal). With moderate and severe aortic stenosis MACS averaged 29.9% of AOD (range 20-35%) (P less than 0.001 vs mild AS). Comparing the ratio MACS/AOD to peak systolic gradient yielded an r of 0.88. Further comparing this ratio to calculated aortic valve area yielded an r of 0.80. Cross-sectional echocardiography can detect the presence of aortic stenosis in children and, by comparing the ratio MACS/AOD, can provide information concerning the severity of the stenotic lesion.

Adolescent↗
PubMed1977

Angiographic determination of arterial patency after percutaneous catheterization in infants and small children.

Patency of the femoral artery of infants and children who previously had percutaneous arterial catheterization at a weight of less than 25 kg was studied angiographically. During the study period, 118 patients had repeat arterial catheterization. 48 from the opposite leg. Femoral artery occlusion was found in four patients, while 44 of the 48 studied from the opposite leg had complete patency. At the later study, all four with blockage were asymptomatic and possessed good pedal pulses, while two had decreased femoral pulsations. When events surrounding initial catheterization were retrospectively analyzed, three of four had decreased pedal pulsations beyond six hours. It is concluded that 3-8% of patients weighing less than 25 kg have arterial occlusion after catheterization. This complication may be entirely asymptomatic, but these patients will require continued observation for possible late vascular problems.

Arterial Occlusive Diseases↗
PubMed1977

Cross-sectional echocardiographic visualization of the stenotic pulmonary valve.

Real-time, cross-sectional echocardiograms of the pulmonary valve were recorded in 22 patients with valvular pulmonary stenosis (VPS) (14 mild, eight moderate or severe) and 25 normal subjects. Normally during systole the pulmonary leaflet echoes moved rapidly apart and in the fully opened position lay parallel and in close apposition to the margins of the pulmonary artery. In 20 of 22 patients with VPS in whom the pulmonary valve was recorded the systolic configuration of the leaflets, opening pattern of the leaflet echoes, and presence of presystolic doming served to differentiate the stenotic valve from normal. In contrast M-mode recordings of the pulmonary valve were possible in only 12 of these 22 cases (seven mild and five moderate or severe) and suggested VPS in only the five cases with moderate or severe stenosis. Cross-sectional echocardiography offers a direct, noninvasive method for visualizing the stenotic pulmonary valve and should be improvement over the indirect M-mode data.

Adolescent↗
PubMed1976

Cross-sectional echocardiography in evaluating patients with discrete subaortic stenosis.

Ten patients with discrete subvalvular aortic stenosis were examined using a real time, high resolution cross-sectional echocardiographic scanner. There were two patients (Group I) with a thin discrete subvalvular membrane, five (Group II) with a more extensive area of subvalvular narrowing and three with a residual area of outflow tract obstruction after surgical revision (Group III). In patients with a thin obstructing membrane (Group I), two distinct linear echoes were observed in the outflow tract. These echoes were not continuous with the walls of the outflow tract and showed some dynamic motion during the cardiac cycle. In four of the five patients with diffuse outflow tract narrowing (Group II), a relatively extensive area of inward bowing of both the anterior and posterior margins of the outflow tract was noted. In the fifth case, there was a prominent localized shelf-like increase in thickness of the basal portion of the muscular septum with a corresponding echo projecting anteriorly from the mid-portion of the anterior or mitral leaflet. The three cases examined after surgical revision of the outflow tract (Group III), had different patterns of outflow tract narrowing, but narrowing was clearly demonstrated. This study suggests that cross-sectional echocardiography offers an alternative and probably improved method for the noninvasive visualization of the left ventricular outflow tract.

Adolescent↗
PubMed1976

Localization of left ventricular outflow obstruction by cross-sectional echocardiography.

Cross-sectional echocardiographic studies were performed using a high resolution real time mechanical sector scanner in 70 patients with left ventricular outflow obstruction. Seven separate obstructive patterns were recorded in these patients. An area of aortic narrowing just distal to the aortic valve at the superior border of the left atrium was noted with supravalvular aortic stenosis. With congenital valvular aortic stenosis there was an increase in echo production by the thickened aortic leaflets. During systole these prominent leaflet echoes curved inward toward the center of the aortic root reflecting the systolic doming of the valve. With calcific aortic stenosis, the calcification produced an area of dense linear echoes attached in varying degrees to either the anterior or posterior border of the aortic root. At the subvalvular level three obstructive patterns were recorded; with a discrete subvalvular obstructive membrane two linear echoes apparently produced by the inner margins of the obstructing membrane were recorded in the outflow tract. With more extensive fibromuscular narrowing of the subvalvular area, there was inward bowing of the echoes from both the anterior and posterior walls of the outflow tract. In one case this was a dense shelf-like mass of echoes extending downward from the basal portion of the interventricular septum toward the mid-portion of the anterior mitral leaflet with corresponding systolic anterior motion of the mitral leaflet. In patients with idiopathic hypertrophic subaortic stenosis there was systolic anterior motion of the anterior mitral leaflet beginning just distal to the point of coaptation of the mitral leaflets and extending distally toward the papillary muscles. This report suggests that the enlarged field of vision and spatial orientation provided by the cross-sectional echocardiographic technic should improve our ability to record and characterize areas of obstruction to left ventricular outflow.

Aortic Stenosis, Subvalvular↗
PubMed1976

Percutaneous balloon atrial septostomy in infants with transposition of the great arteries.

Initial experience with PBAS in early management of neonate with TGA is described. Standard percutaneous techniques were used and modified by a series of dilations designed to introduce a septostomy catheter into the femoral vein. Thirty infants with TGA were catheterized, and PBAS was accomplished in 25. The mean aortic oxygen saturation rose from 55 to 72 per cent. Twenty-four infants were clinically palliated for at least 3 months; however, five required pre-elective surgery thought due to inadequate atrial mixing. No severe complications followed PBAS. Twenty-three patients underwent follow-up catheterization, in 17 through the vein used for PBAS. When compared to patients with TGA who had cutdown insertion of balloon septostomy catheters, the group treated by PBAS was similar in patient material, and successful septostomy. Those ballooned percutaneously had fewer complications and required slightly less time for the procedure. We feel that PBAS is a relatively easy and safe palliative procedure when performed in an infant with TGA. It should be considered by all those performing percutaneous diagnostic catheterization in infants and children.

Cardiac Catheterization↗
PubMed1975

Percutaneous carciac catheterization of the neonate.

A modified Seldinger percutaneous approach for catheterization was used for cardiac evaluation and monitoring of infants weighing less than 4,520 gm. From January 1968, through April 1971, 160 left- and 230 right-sided cardiac procedures were done. After July 1969 81% of all left-and 42% of all right-sided procedures were done percutaneously. After October 1969 catheters were also inserted percutaneously in 20 infants for intensive care monitoring. During this period three children were noted to have dimished pulse on discharge, two were noted to have vascular thrombosis, and two had episodes of bleeding from the catheter site requiring transfusion of fresh blood. Both instances of vascular thrombosis occurred in infants with monitoring catheters. The percutaneous method of catheter insertion into the femoral vessels offers a safe method for cardiac catheterization of the neonate and of insertion of monitoring catheters where the umbilical route is not feasible. Vessel continuity is also preserved, providing a route for repeated studies if necessary.

Birth Weight↗