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D B Lerberg

Publications and source records attributed to D B Lerberg.

17 recordsLinked to original sources
PubMed1989

Aggressive use of intra-aortic balloon pump and emergency coronary bypass surgery. Enhanced survival in acute evolving MI.

This report describes our experience with prophylactic and therapeutic use of IABPs prior to and following coronary artery bypass grafting (CABG) in 39 patients experiencing acute evolving myocardial infarctions (AEMI). All patients showed objective evidence of coronary thrombosis (contrast angiography) followed by later evidence of streptokinase (SK)-induced restoration of antegrade blood flow in the infarct-related coronary artery (as determined by repeat angiography). In these 39 high-risk patients, 38 survived and were discharged. One patient died (2.6 per cent) on the twelfth postoperative day.

Adult↗
PubMed1983

Diagnosis of pneumonitis in immunocompromised patients by open lung biopsy.

The records of 59 immunocompromised patients with fever and pulmonary infiltrates who underwent open lung biopsy, were reviewed. A specific diagnosis was made by lung biopsy in 49 (83%) patients, and in 32 instances (54%) the diagnosis was a treatable infection. Only two (3.4%) false-negative biopsies occurred. Transplant recipients were more likely to have a specific, treatable pneumonia (74%) than patients with a reticuloendothelial malignancy (42%, P less than 0.05). This was due to a greater frequency of bacterial pneumonias, primarily due to Legionella, in transplant recipients (P less than 0.01). However, obtaining a specific diagnosis by lung biopsy did not appear to improve outcome. Seventeen of 32 (53%) patients with treatable infections survived, compared to 8 of 16 (50%) with specific, but untreatable, diagnosis and 6 of 11 (55%) with nondiagnostic biopsies. Advanced age and a low platelet count were predictive of death in both transplant recipients and patients with leukemia and lymphoma (P less than 0.05); a high serum creatinine was an additional predictor in renal transplant recipients.

Adult↗
PubMed1982

Coarctation of the aorta in infants and children: 25 years of experience.

Repair of coarctation of the aorta was performed in 334 patients ranging from less than a year to 16 years of age at Children's Hospital of Pittsburgh from 1953 to 1977. Resection and end-to-end anastomosis were performed in 310, interposition grafts in 7, and other procedures in 17. There were 41 operative deaths among the 95 infants less than 1 year old (43% mortality); all of these infants had associated cardiac anomalies. Only 1 operative death occurred in patients older than a year (0.4% mortality). No hospital deaths occurred in patients with isolated coarctation of the aorta. Eleven late deaths were due to associated anomalies (7) and unrelated or unknown causes (4). Postoperatively, hemorrhage occurred in 7, paradoxical or persistent hypertension in 128, postcoarctectomy syndrome in 32, neurological problems in 14, pulmonary complications in 53, and infections in 12 patients. Restenosis occurred in 26 patients (8%); only 10 have required reoperation. Residual hypertension was present in 28 of 264 patients (11%). Mortality from coarctation resection remains high in infants, but is minimal in children older than 1 year. Based on minimizing the risk of restenosis and residual hypertension, elective repair of coarctation is recommended when the patient is about 6 years of age.

Adolescent↗
PubMed1982

Abbott's artery.

The term Abbott's artery appears to have been first used by Schuster and Gross [1] in describing an anomalous vessel not infrequently encountered during operation for coarctation of the aorta. Numerous sites of origin of this vessel have been listed but often do not correlate with the original description by Abbott. the term serves its purpose well if it alerts the operating surgeon to the possibility of anomalous vessels in this congenital disorder.

Adolescent↗
PubMed1982

Pulmonary valvulotomy alone for pulmonary stenosis: results in children with and without muscular infundibular hypertrophy.

Pulmonary valvulotomy for valvular pulmonic stenosis has been performed in 78 children at the Children's Hospital of Pittsburgh. Although 27 patients had muscular hypertrophy of the infundibulum, a muscle resection was employed in only one child. Examinations 2 to 18 years after operation have not demonstrated electrocardiographic (ECG) or clinical evidence of persistent right ventricular hypertension, indicating resolution of the muscular outflow tract narrowing. Systolic right ventricular pressure averaged 30 mm Hg in 10 patients at postoperative catheterization: Six of these patients had peak right ventricular pressures greater than 100 mm Hg immediately after valvulotomy. The diameter of the infundibulum in systole was compared to valve ring diameter and expressed as a ratio (I/V). This correlated with the preoperative and intraoperative right ventricular pressures, but did not identify patients who might fail to resolve secondary muscular hypertrophy. A murmur of pulmonary regurgitation was present in 70% of the patients after operation, but was without clinical significance. In the absence of fixed infundibular obstruction or excessive right ventricular hypertension above 200 mm Hg, resection of infundibular hypertrophy is not recommended.

Adolescent↗
PubMed1981

The wandering broncholith.

In a patient with "stone asthma" the obstructing broncholith moved from one lung to the other and was later spontaneously expectorated.

Bronchial Diseases↗
PubMed1979

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

Three patients with anomalous origin of the right coronary artery from the pulmonary artery are presented together with a review of the 14 patients with this anomaly previously reported. One of the current patients is the youngest to be diagnosed before operation and the youngest to undergo corrective operation. Although the lesion is usually asymptomatic, it may contribute to sudden death. The only suggestive physical finding is a continuous murmur with diastolic accentuation, which is present only in some patients. There are no diagnostic electrocardiographic or chest roentgenographic changes. Diagnosis is made best by selective left coronary arteriography showing retrograde filling of the right coronary artery from collateral vessels. Operative repair should consist either of direct reimplantation of the proximal right coronary artery into the aortic root or of saphenous vein bypass graft to the coronary artery with ligation of its origin. Operation is recommended when the lesion is recognized.

Aged↗
PubMed1978

Selected therapy for ascending aortic aneurysms.

Since 1971, ten patients, 26 to 62 years of age, have undergone repair of ascending aortic aneurysms with concomitant aortic insufficiency. Three patients had Marfan's syndrome, five patients had cystic medial necrosis, one had leutic aortitis, and one had atherosclerotic involvement of the aorta. There was one operative death. Follow-up exceeds seven years. Because of the tendency for progressive annular and sinus dilation in Marfan's syndrome, composite graft and valve conduits with reimplantation of the coronary arteries is the procedure of choice. In selected patients with annulaortic ectasia, good valve tissue and no sinus dilation, bicuspidization of the valve, and replacement of the ascending aorta is indicated. The operation is generally less formidable than composite graft replacement, maintains normal coronary anatomy, and alleviates the long-term risks of anticoagulation.

Adult↗
PubMed1978

Delayed postoperative cardiac tamponade: diagnosis and management.

Symptoms and signs of decreased cardiac output associated with an elevated venous pressure should alert one to the possibility of delayed cardiac tamponade. Enlargement of the cardiothoracic ratio shown by serial roentgenograms and demonstration of significant pericardial effusion by echocardiogram or radionuclide angiocardiography support the diagnosis. Erratic response of the prothrombin time to administration of warfarin and abnormal results of liver function test are additional clues to its diagnosis. Right heart catheterization documents the presence of tamponade and excludes other diagnostic considerations. Operative decompression of the pericardial space can be accomplished by pericardicentesis, subxiphoid pericardiotomy, median sternotomy, or thoracotomy. Hemodynamic observations following the relief of tamponade assure that an adequate therapeutic procedure has been performed.

Adult↗
PubMed1977

Valve replacement in children and adolescents.

Replacement of diseased heart valves has become the treatment of choice in many adults. Valve replacement in older children and adolescents has been done in our institution only when other procedures are ineffective. Over the past 10 years, 24 patients have received 28 artificial valves. Thirteen (54 per cent) had rheumatic heart disease; the remainder had congenital or acquired valvular abnormalities. The Björk-Shiley valve was most commonly used in the aortic position and the Beall prosthesis in the mitral position. Sixteen patients (67 per cent) survived operation and have been followed from 3 to 79 months, averaging 27 months. All are free of cardiac symptoms. Hemarthrosis occurred once in 2 survivors (13 per cent). Eight patients died (33 per cent), 5 immediately postoperatively and 3 within a year after the operation. The mortality rate has declined to 21 percent during the past 3 years. Our experience in the pediatric age group suggests that valve replacement is a serious undertaking with higher mortality rate than in adults. The operation should be reserved for those patients in whom valvuloplasty or valvulotomy is expected to be ineffective.

Adolescent↗
PubMed1977

Management of bilateral ductus arteriosus in complex cyanotic heart disease.

Bilateral ductus arteriosus (BDA) usually is associated with complex cyanotic heart disease. Since pulmonary valve atresia often is part of the complex, hypoxia may necessitate emergency cardiac catheterization and surgery for these critically ill newborn infants. Optimum management depends on accurate delineation of the intracardiac and great vessel anatomy. Since the ductus arteriosus has a tendency to close spontaneously, the true anatomy of the fourth to sixth aortic arch connections should be determined on the first catheterization. An over-all plan for future care by the medical-surgical team should have been made at the time of the initial surgical procedure. The case histories of four newborn infants with BDA associated with cyanotic heart diseases are reported. The anatomy and basic embryology of the fourth to sixth arch system is reviewed and recommendations for long-term management are given.

Aorta, Thoracic↗
PubMed1968

Type II syndactyly.

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Analysis of Variance↗