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Biomedical subjects

D B Doty

Publications and source records attributed to D B Doty.

At least 127 records · Page 7Linked to original sources
PubMed1978

Myocardial contusion: effect of intra-aortic balloon counterpulsation on cardiac output.

Intra-aortic balloon counterpulsation (IABCP) improves impaired left ventricular (LV) performance associated with myocardial ischemia. We have evaluated the effect of IABCP on cardiac output (CO) after blunt trauma to the heart where LV performance is impaired by myocardial contusion but coronary blood flow is normal. Contusion of 20 to 40% of the LV in 13 dogs decreased CO by 41% +/- 6.4. A 30-minute period of IABCP was followed by 30 minutes without IABCP with three assist periods in each animal unless death occurred. Immediate IABCP after injury in six dogs increased CO 14% +/- 3.8 (p less than 0.01). Treatment was delayed for 30 minutes in seven dogs, and CO further decreased 0.7% +/- 3.2; initiation of IABCP then increased CO 9.2% +/- 6.5 (p less than 0.05). When CO was decreased less than 25% or greater than 50% after injury, IABCP had no effect on CO. In midrange when CO decreased 25 to 50%, IABCP increased CO 12.5% +/- 3.2 (p less than 0.001 initially, 9.3% +/- 1.3 (p less than 0.005) with second assist, and third assist 5.6% +/- 2(NS). It is concluded that IABCP improves LV performance following myocardial contusion, especially when applied early after injury.

Animals↗
PubMed1977

Supravalvular aortic stenosis. Repair by extended aortoplasty.

Enlargement of the aorta with a diamond-shaped patch of the noncoronary sinus of Valsalva may not be sufficient in severe cases of supravalvular aortic stenosis. This traditional reconstruction is asymmetric, and, if the fibrous supravalvular ring is thick and rigid, the aorta may not open wide with patch angioplasty, so that aortic obstruction may remain. Also, because aortic valve function may not be perfect after asymmetric reconstruction, there may be aortic valve incompetence or obstruction of coronary ostia by the valve cusps. A new reconstructive operation was designed and used in eight patients. All survived and are asymptomatic. The aortoplasty was extended so that the supravalvular ring was incised at two points in the noncoronary and in the right coronary sinuses of Valsalva. The area of stenosis was opened wide, and the cusps of the aortic valve were lengthened, which provided better approximation and function. A tubular Dacron prosthesis, tailored to reconstruct the aorta, provided a wide aortic cross-sectional area. This technique of extended aortoplasty for symmetric reconstruction of the aorta should provide more predictable relief of aortic obstruction and improved function of the aortic valve.

Adolescent↗
PubMed1977

Experimental bypass of the left ventricle.

Bypass of the left ventricle was accomplished in dogs and the entire circulation was supported temporarily by only the right ventricle. The atrial septum was excised, and the atrium was repartitioned so that the pulmonary veins were in continuity with the right ventricle and the venae cavae were connected through the atrium. Anastomosis of the superior vena cava to the right pulmonary artery brought systemic venous return directly to the lungs. The main pulmonary artery was ligated proximal to the bifurcation, preserving distal confluence of right and left pulmonary arteries. A tubular prosthesis between the proximal pulmonary artery and the aorta connected the right ventricle to the systemic circuit. This procedure, or some modification of the principle, may have clinical feasibility in the treatment of patients with hypoplastic left heart syndrome.

Animals↗
PubMed1977

Hypoplastic left heart syndrome. Experience with an operation to establish functionally normal circulation.

A new operation to establish functionally normal circulation was performed in five neonates with hypoplastic left heart syndrome. With a limited period of cardiopulmonary bypass, deep hypothermia, and circulatory arrest, the patent ductus arteriosus was ligated. The atrial septum was excised and the atrium was repartitioned with a pericardial baffle so that pulmonary veins were in continuity with the tricuspid valve and right ventricle. The pulmonary artery was divided above the sinuses of Valsalva, and the proximal end was connected to the aortic arch with a tubular Dacron prosthesis. The distal end of the pulmonary artery was brought in continuity with the right atrium by way of a second Dacron conduit. The right ventricle thereby became the systemic ventricle and blood passed through the lungs vis a tergo. Circulation was supported temporarily, but all of the patients died from inadequate right ventricular performance or compromised coronary blood flow. This experience is presented to stimulate thought and some hope for babies with a uniformly fatal cardiac anomaly.

Aortic Valve↗
PubMed1976

Bypass of superior vena cava with spiral vein graft.

The superior vena cava was successfully bypassed in a patient with superior vena cava syndrome due to granulomatous mediastinitis. A spiral vein graft constructed from autogenous vein was utilized. Complete relief of symptoms and graft patency documented by venography six months after the operation confirm the usefulness of this procedure in patients with superior vena cava obstruction.

Cardiopulmonary Bypass↗
PubMed1976

Hemodynamic effects of vasodilator agents in dogs with experimental ventricular septal defects.

The ratio of pulmonary to systemic vascular resistance (Rp/Rs) largely determines the amount of left-to-right shunting and pulmonary to systemic flow rat (Qp/Qs) in the presence of a large isolated ventricular septal defect. The possibility that pharmacologic reduction of systemic vascular resistance with alpha-adrenergic receptor blockade or beta-adrenergic receptor stimulation would increase the ratio Rp/Rs, and therefore reduce the ratio Qp/Qs, was studied in dogs in which ventricular septal defects had been surgically created. Administration of phentolamine and phenoxybenzamine caused a 42% reduction in Rs and no reduction in Rp. Qs was unchanged and Qp declined by 24% and the ratio Qp/Qs fell by 32%. Infusion of the beta-adrenergic receptor stimulant isoproterenol also reduced Qp/Qs. However, this was accomplished as a result of an increase in Qs and at the expense of an increase in heart rate. As a decline in the ratio Qp/Qs has been shown to be beneficial to patients with large left-to-right shunts, pharmacologic reduction of systemic vascular resistance may prove to be helpful in treating congestive heart failure in those patients with large left-to-right shunts at the ventricular level who are refractory to the usual decongestive measures.

Animals↗
PubMed1976

Patent ductus arteriosus in premature infants. Indications for surgery.

In order to establish more objective criteria for surgical intervention, the literature and our clinical experience with operative closure of patent ductus arteriosus in 11 premature infants was reviewed. A wide range of age at the time of operation underscored the spectrum of clinical presentation and the difficulty of interpreting the course of therapy. The presence of a typical continuous murmur established the diagnosis of patent ductus arteriosus in patients with respiratory distress syndrome. Cardiac catheterization confirmed the diagnosis and provided quantitation of the left-to-right shunt flow through the ductus arteriosus in 6 patients but did not influence the decision to operate. Progress of the clinical course as determined by the heart size on chest roentgenogram and the presence of hypercarbia (Paco2greater than60 mm. Hg) after respiratory assistance and medical decongestive measures were the two most helpful signs indicating the need for surgical intervention.

Cardiac Catheterization↗
PubMed1976

Anomalous origin of the left coronary artery from the right pulmonary artery.

A previously unknown coronary artery anomaly is reported: origin of the left coronary artery from the right pulmonary artery. This unusual anomaly can probably be explained by the theory of dual embryonic development of the coronary arteries from angioblastic buds in the truncus arteriosus. It is thought that these buds anastomose with a capillary network that is developing on the surface of the ventricles. Complete repair of this lesion with restoration of a two-coronary artery system was accomplished in a 10-month-old baby. The coronary artery was detached from the pulmonary artery, with a button of pulmonary artery being retained around the coronary artery ostium. Direct systemic arterial flow to the left coronary artery was established by anastomosis of the left coronary to the right subclavian artery.

Coronary Vessel Anomalies↗
PubMed1975

Congenital cardiac anomalies: one-stage repair in infancy.

A proposed preferred treatment plan consisting of one-stage operative repair of congenital cardiac anomalies whenever complete correction was feasible and operative intervention required was tested during the period February 1, 1972, to September 15, 1974. Experience with 74 patients aged 14 hours to 24 months allows some conclusions to be made regarding the advisability of this approach. For patients with ventricular defect and tetralogy of Fallot, this approach has quite acceptable results and certainly is more direct than palliative operations and second-stage repair. The hypothesis is more difficult to justify in patients with transposition of the great arteries. By avoiding repair in patients under 4 months of age and using a better technique for placement of the intraatrial partition, improved results are anticipated. In the miscellaneous group of anomalies, results depend upon the complexity of the defect and the ability to achieve accurate anatomical correction. After an early mortality of 20% and some late deaths, survival and improvement resulted in 51 of these babies. These results justify persistence in the choice of one-stage correction when operative intervention is required.

Child, Preschool↗
PubMed1975

Congenital coronary artery- cardiac chamber fistula. Review of operative management.

Eight patients who had surgical correction of coronary artery-cardiac chamber fistula at our center and 163 from a review of the literature are presented. The patients are usually asymptomatic, and the diagnosis is suspected by observing a continuous cardiac murmur. Electrocardiographic findings are nonspecific. Angina pectoris or electrocardiographic evidence of severe ischemia are surprisingly uncommon since coronary artery steal syndrome is also rare. Cardiac catheterization with angiocardiography is required to establish the diagnosis and identify the involved coronary artery and the cardiac chamber into which the fistula terminates. Left-to-right shunt flow is usually low (average Qp/Qs = 1.5). Indications for operation are not precise. If there should be a large shunt flow (2.0) and symptoms of heart failure are present, the decision to operate is clearly justified. This situation is unusual, and operation is nearly always performed in an asymptomatic patient in whom the fistula is closed to prevent future symptoms or complications. The operation chosen is generally interruption of the fistula by direct ligation. Sometimes cardiopulmonary bypass is required. The results are good, with low morbidity (3.6% myocardial infarction) and low mortality (2%) justifying the operation, to be carried out prophylactically even in asymptomatic patients.

Adolescent↗
PubMed1975

Coronary angiographic and scintigraphic findings in experimental cardiac contusion.

Clinical, angiographic, scintigraphic and pathologic observations in myocardial contusion were correlated. Radionuclide imaging of the injured heart with 99mTc-Sn-polyphosphate provides an accurate diagnosis in acute, even mild, myocardial contusion. The study can be carried out without danger to the critically ill patient. The coronary angiographic findings in this study explain what is occurring pathologically in the heart. Since arteriography is a more invasive technique than radionuclide imaging, its use is recommended only when the image is negative if it is neccessary to establish the clinical diagnosis for treatment or when more than one week has elapsed since the injury.

Acute Disease↗
PubMed1975

Postinfarction ventricular septal defect with posterior ventricular aneurysm. Result of a single distal right coronary artery obstruction.

A patient with postinfarction ventricular septal defect, posterior aneurysm, severe congestive heart failure, and significant atherosclerosis in the distal right coronary artery only is reported. Closure of the defect resulted in quich recovery of the patient. We demonstrated that a single significant lesion in one coronary artery can cause rupture of the interventricular septum.

Coronary Angiography↗