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Biomedical subjects

D B Doty

Publications and source records attributed to D B Doty.

At least 109 records · Page 6Linked to original sources
PubMed1980

Hypoplastic left heart syndrome: successful palliation with a new operation.

A new operative procedure is described for the palliation of hypoplastic left heart syndrome. The operation consists of anastomosis of a tubular prosthesis between the proximal pulmonary artery and the aortic arch. A calibrated opening in the graft is brought into continuity with the distal pulmonary artery to provide balanced pulmonary and systemic blood flow. The atrial septum is excised and the ductus arteriosus ligated. A successful case report documents that this operation satisfies criteria required to reverse heart failure in infants with hypoplastic left heart syndrome.

Aorta, Thoracic↗
PubMed1980

Surgical treatment of left main coronary artery disease: operative risk.

Surgical experience with 100 consecutive patients with left main coronary artery stenosis (greater than 50%) was reviewed to determine the risk factors and their relationship to preoperative use of intraaortic balloon (IAB). The 30-day mortality rate was 3% and the perioperative infarction rate was 2%. There was no correlation between surgical mortality and ejection fraction (EF) (15% had EF of less than 40%), degree of stenosis (58% of the patients had greater than 70% left main stenosis), right coronary artery stenosis (81%), or the number of grafts placed. We conclude that surgery for left main coronary artery disease can be done with a low mortality rate by strict attention to the induction of anesthesia, surgical technique, and complete revascularization. In our experience, prophylactic use of the IAB does not appear to be justified and is only rarely necessary for postoperative support (one case).

Adult↗
PubMed1980

Measurements of coronary reactive hyperemia with a Doppler probe. Intraoperative guide to hemodynamically significant lesions.

The physiological significance of coronary obstructions of intermediate severity are difficult to assess from the angiogram alone. The hemodynamic significance of clinical coronary stenoses can be readily assessed, however, with a miniaturized Doppler probe developed at The University of Iowa Hospitals and Clinics to measure phasic coronary velocity. No dissection of the coronary vessel is required. The probe is held in place over the coronary vessel with a small suction cup. Reactive hyperemia responses obtained following a 20 second occlusion clearly demonstrate the hemodynamic significance of a coronary stenosis. We have employed this approach in 64 patients with coronary artery disease. In 12 (19%) in whom the degree of stenosis of the vessel was equivocal (diameter narrowing 25% to 70%), the use of the Doppler probe and a 20 second reactive hyperemia curve allowed accurate and immediate assessment of the need for a bypass. Five of these equivocal lesions did not produce any alterations in coronary reserve and, accordingly, the vessels were not bypassed. In seven of them, the reactive hyperemia response was markedly depressed and as a result the vessel in question was bypassed. Thus measurements of coronary reactive hyperemia in vessels with obstruction of intermediate severity can influence the operative plan by assessing the physiological significance of the obstruction.

Adult↗
PubMed1979

Surgical treatment of atrial myxomas: early and late results of 11 operations and review of the literature.

Eleven patients underwent surgical excision of atrial myxomas during a 15-year period, with no hospital deaths. The operation consisted of excision of the tumor with a generous portion of atrial septum or wall. Patch reconstruction of the atrial septum was required in most patients. There were 2 late deaths (14 and 121 months after operation). Late recurrences have been reported in other series but no recurrences were diagnosed in any of the patients in this series reexamined by echocardiography 7 to 156 months (mean, 48 months) after operation. Late functional results were excellent (78%, New York Heart Association Class D. The pertinent literature is reviewed.

Adolescent↗
PubMed1979

Combined multiple-valve procedures: a five-year experience with 125 patients.

One hundred twenty-five patients underwent 128 operations for combined multiple-valve procedures, with an overall early mortality of 16%. Highest mortality was associated with mitral and tricuspid valve disease (28.5%), followed by triple-valve disease (18.2%) and aortic and mitral valve disease (14%). Left ventricular end-diastolic pressure, cardiac index, mean pulmonary artery pressure, pulmonary artery wedge pressure, and arteriovenous oxygen difference were all significantly different in patients with regard to early mortality. Late follow-up of 94% has been achieved in 105 early survivors, with a late mortality rate of 11.2%. Analysis of late functional results reveal that 85% of survivors improved at least one Functional Class. Actuarial 5-year survival of 75% was achieved for early survivors of operation.

Adolescent↗
PubMed1979

Correction of anomalous origin of the left coronary artery.

Successful surgical treatment for anomalous origin of the left coronary artery from the pulmonary artery was performed in one patient by left coronary artery-subclavian anastomosis and in two patients by direct implantation of the left coronary artery into the aorta. The excellent early and late results obtained with these methods and the suboptimal results reported with saphenous vein grafting for this lesion make these other alternatives more attractive. Direct implantation of the left coronary artery into the aorta utilizing cardiopulmonary bypass and hypothermic (4 degrees C.) potassium-induced (20 mEq. per liter) cardioplegia is now our preferred approach for most patients with this lesion.

Aorta↗
PubMed1979

The spectrum of anomalies of aortopulmonary septation.

Embryologically related defects resulting from abnormal septation of the aortopulmonary trunk in 13 patients were reviewed and grouped according to a new classification system. Seven patients (54 percent) had typical aortopulmonary septal defects or windows (Type I), three (23 percent) had a more cephalad defect between the ascending aorta and the origin of the right pulmonary artery (Type II), and three (23 percent) had anomalous origin of the right pulmonary artery from the ascending aorta (Type III). Type I defects are caused by incomplete septation of the aortopulmonary trunk; Type II and III defects result from unequal partitioning of the aortopulmonary trunk by the conotruncal ridges. Three of six patients survived correction of Type I defects; both patients having correlation of Type II defects and all three patients with Type III defects survived and remain well 2 to 216 months (mean 61 months) postoperatively. The recommended technique for Type I and II defects is transaortic closure of the defect by prosthetic patch with the aid of cardiopulmonary bypass, supplemented by profound hypothermia (20 degrees C.), and circulatory arrest for improved exposure in selected cases. For Type III defects, division of the anomalous connection plus direct implantation of the right pulmonary artery into the main pulmonary artery is the preferred approach.

Angiocardiography↗
PubMed1979

Septation of the univentricular heart. Transatrial approach.

The technique of septation of the univentricular heart via a transatrial approach is described in detail. Clinical details of four patients having Type A-III univentricular heart document the feasibility of working through the right-sided atrioventricular valve to place a cloth prosthesis into the ventricle to divide it into approximately equal chambers. Improved hemodynamics were observed in the postoperative period, which probably were related to retaining the integrity of the ventricular wall. This approach seems best suited to the ventricular chamber estimated to be large by echocardiography without severe pulmonary outflow tract obstruction. Techniques for enlargement of the pulmonary outflow tract are also described.

Adolescent↗
PubMed1979

Transient cerebral ischemic attacks associated with worn porcine heterograft prosthesis. Case report.

Details are reviewed of a case of transient cerebral ischemic attacks which probably resulted from thromboembolism from a Hancock porcine heterograft prosthesis. Cause of the embolism probably was thrombus formation on the worn cloth covering of the supporting valve stent. Technical and antomic factors which assure precise seating of the prosthesis in the mitral anulus without contacting the ventricular wall appear to be important in preventing this complication.

Animals↗
PubMed1979

Obstruction of the superior vena cava.

A 10 year experience in 66 patients with obstruction of the superior vena cava (SVC) was reviewed. Pathogenesis was malignancy in all except two patients with granulomatous mediastinitis (3%). Venography was especially helpful in determining extent of SVC obstruction and collateral circulation. Only nine patients are still alive; 57 are dead (mean survival, 3.9 months). Patients with upper airway obstruction and/or cerebral edema only survived 1.4 months (P less than 0.001). The two patients with benign obstruction had a new operation to bypass the SVC using a spiral graft of saphlenous vein with complete relief of SVC syndrome up to 26 months. Lymphomas responded to radiation (63% improved), but response in the bronchogenic carcinoma group was variable (42% improved) and was not related to palliative radiation, chemotherapy, or both. Patients receiving full-course mediastinal radiation (more than 5,000 rads) had improved survival (9.9 months). Three patients with bronchogenic carcinoma and severe SVC syndrome (cerebral edema and upper airway obstruction) had excellent palliation using spiral vein bypass graft and postoperative radiation. This experience suggests that treatment of patients with obstruction of SVC based on evaluation of signs, symptoms, and venography may provide extended palliation. If the syndrome is mild, full-course mediastinal radiation is given. If there is cerebral edema or upper airway obstruction, operation to bypass the SVC will relieve SVC syndrome immediately and will allow orderly radiation therapy.

Adult↗
PubMed1978

Mycobacterium gordonae infection of a prosthetic aortic valve.

A patient prviously suspected of having a mycobacterial infection was found to have a Mycobacterium gordonae infection of his prosthetic aortic valve. Following replacement of his infected prosthesis and systemic therapy for two years, the patient has apparently been cured.

Aortic Valve↗
PubMed1978

Visual evoked potentials during hypothermia and prolonged circulatory arrest.

Visual evoked potentials were recorded in eight children during hypothermia and circulatory arrest. The potentials were lost in all children recorded in late arrest. The evoked potential is a more sensitive indicator of CNS stress as provoked by combined hypothermia and hypoxia than is the EEG. EEG activity persisted in six of the eight children in this series even during circulatory arrest. The EEG had been seen to do the same in more than half of a larger series of children recorded at that stage. The results suggest that evoked potentials may be a sensitive indicator of early impairment of cerebral function and may demonstrate useful change sooner than the EEG. The examination may be useful in following children with illnesses producing hypoxia or anoxia. The N1 component was as easily and as frequently identifiable as the P2 component. Under the stress of this procedure, the latency of the P2 component became more variable than the N1 peak. The results suggest the N1 component may be as useful and perhaps more useful than the P2 wave in following the effect of some CNS stresses in children.

Cardiac Surgical Procedures↗
PubMed1978

Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer.

The adequacy of anticoagulation during 2 hours of cardiopulmonary bypass at 30 degrees C in 9 rhesus monkeys was determined by measuring the whole-blood activated clotting time (ACT) and by noting the appearance of thrombin-altered fibrin (fibrin monomer) and the relative consumption of clotting factors. Factor V and VIII, the heparin cofactor, antithrombin III, prothrombin time, partial thromboplastin time, ACT, platelets, hematocrit, fibrinogen, and fibrin monomer were determined prior to heparinization and after protamine. In 6 of 9 experiments, fibrin monomer became positive in the plasma during cardiopulmonary bypass (CPB), indicating that active coagulation was occurring. In 5 of the 6 animals, initial ACT was less than 400 seconds, and fibrin monomer appeared within the first 30 minutes of bypass. In 1 animal with an initial ACT of 439 seconds, fibrin monomer appeared after 60 minutes of bypass, at which time the ACT was less than 400 seconds. An abnormal level of fibrin monomer was not detected in 5 pediatric patients with an ACT greater than 450 seconds during CPB. Our experimental study and clinical data suggest that the lower limit, as measured by the ACT, for anticoagulant effect to provide coagulation-free CPB is at least 400 seconds.

Animals↗
PubMed1978

Aortocaval fistula associated with aneurysm of the abdominal aorta: current management using autotransfusion techniques.

Two patients with aortocaval fistula associated with abdominal aortic aneurysm were managed successfully using a patient care plan which includes proper monitoring of the hemodynamic state, careful dissection of the aneurysm, and return of blood loss by autotransfusion while the patient is fully anticoagulated with heparin. This unusual and serious problem in vascular surgery can be managed in an orderly and controlled fashion using these techniques.

Aged↗
PubMed1978

Demonstration of improved myocardial perfusion following aortic implantation of anomalous left coronary artery.

An adult with anomalous origin of the left coronary artery (originating from the pulmonary artery) had implantation of the anomalous vessel into the aorta. Exercise myocardial perfusion imaging with thallium-201, performed before and after the operation, disclosed a marked improvement in anterior-wall Tl-201 uptake. Postoperative isotope ventriculogram showed improved regional contraction in the revascularized anterolateral wall of the left ventricle. Thus, it has been demonstrated that implantation of an anomalous left coronary into the aorta improves regional myocardial perfusion and regional left-ventricular motion.

Adult↗