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Biomedical subjects

E O Coto

Publications and source records attributed to E O Coto.

7 recordsLinked to original sources
PubMed1979

Gross distortion of atrioventricular and ventriculo-arterial relations associated with left juxtaposition of atrial appendages. Bizarre form of atrioventricular criss-cross.

Two pathological specimens are described in which a bizarre distortion of atrioventricular and ventriculoarterial relations existed. In both cases anterior and leftward displacement of the tricuspid valve coexisted with rightward displacement of the infundibular regions and semilunar valves. Abnormal expansion of the AV canal, possibly secondary to malrotation of the cardiac tube, is considered as a possible cause of the anomaly. One of the hearts showed severe subpulmonary stenosis produced by a valve-like structure which was well differentiated, with a complete annulus and chordae tendineae that inserted in a parachute-like fashion on the infundibular septum. The morphology of this structure was clearly different from that fo the fibrous tags described in other anomalies. Its origin is uncertain. These anomalies have important implications in relation to the nomenclature and classification of congenital heart malformations, and illustrate the value of recent modifications of the segmental approach.

Adult↗
PubMed1979

Double outlet from chambers of left ventricular morphology.

This series of 5 cases with double outlet of morphologically left ventricular chamber includes 4 found during a review of 1700 heart specimens (incidence 0.23%) and 1 found at operation and successfully corrected. Abnormal atrioventricular connection precluding total correction was present in the 4 anatomical cases. Clinical diagnosis may be difficult and it is suggested that axial cineangiography may make anatomical diagnosis easier. Absence of the infundibular septum and aortic laevoposition are frequent. As some cases can be surgically corrected, accurate information is required on the size of the right ventricle, the morphology and function of the atrioventricular valves, the presence, size, and position of the ventricular septal defect, and the degree and type of outflow tract obstruction.

Heart↗
PubMed1979

Modified Senning operation for treatment of transposition of the great arteries.

Since February, 1978, 42 infants ranging in age from 15 days to 16 months (mean age 6 months) and weighing between 2.0 and 9.0 kg (mean weight 5.8 kg) underwent a modified Senning I operation. Eleven (26%) underwent operation during the first 3 months of life. Twenty-nine patients had dextro-transposition of the great arteries (d-TGA) and an intact ventricular septum (Group I), and 13 patients had d-TGA and a large ventricular septal defect (VSD) (Group 2). In addition to the Senning I procedure, 13 patients had transatrial closure of their VSD, eight had ligation of a patient ductus arterioses, two had removal of a pulmonary artery band, and four had trans-pulmonary artery resection of short-segment subpulmonary stenosis. Modification of the original Senning operation included (1) patch augmentation (pericardium or Gore-Tex) of the atrial septal flap and (2) pericardial patch enlargement of the pulmonary venous pathway. One patient in Group 1 (3%) and two patients in Group 2 (15%) died after operation. A 2-week-old infant (Group 1) was treated with prostaglandin E1 (PGE) for 2 weeks before operation. The other hospital deaths (Group 2) occurred in a 2-month-old infant with advanced ischemic damage to the right ventricle and a 4-month-old child with multiple VSDs and Grade IV pulmonary vascular disease. No caval gradients were found after modification of the right atrial incision. Two patients died later from pulmonary venous obstruction, one during attempted recatheterization and the other after repair of the pulmonary venous obstruction. One patient had transient complete heart block, and four were discharged in junctional rhythm. Thirty-four patients (87%) were in regular sinus rhythm when released from the hospital. Postoperative catheterizations in eight patients showed no significant gradients in six and severe pulmonary venous obstruction in two (late deaths). More late postoperative results are required, including postoperative catheterization and electrophysiological studies, before the relative merits of the Senning versus the Mustard operation can be assessed.

Cardiopulmonary Bypass↗
PubMed1978

Single primitive ventricle with normally related great arteries and atresia of the left A-V valve.

A child aged 2 years and 9 months was angiocardiographically diagnosed to have a single ventricle with normally related great arteries and atresia of the left A-V valve. A Blalock-Hanlon procedure and division of a large patent ductus arteriosus were followed by reduction in pulmonary artery pressure, but after operation the patient showed signs of left ventricular failure unresponsive to medical treatment, necessitating pulmonary artery banding. We have found only three similar published cases, and this is the only one with full angiographic documentation.

Angiocardiography↗
PubMed1978

Aortic levopositions without ventricular inversion.

A multi-center series of aortic levoposition (aorta anterior and to the left of the pulmonary artery) without ventricular inversion is presented and analyzed from an anatomical viewpoint. All the cases are exceptions to the 'loop rule' and amount to 0.9% of the total number or cases reviewed. A combined study of our own cases and those reported in the literature is presented. There is a high incidence of anomalies (malrotations, juxtaposition of the atrial appendages, atrioventricular valve anomalies, ventricular septal defects, pulmonary outflow tract obstructions and abnormal conal types) which may be related to the primary cause of the aortic levoposition, suggesting that they may form part of a new syndrome of diagnostic and surgical importance. In some cases, absence of coronary sinus was noted without asplenia or left superior vena cava draining into the left atrium. The major coronary artery pattern in cases of antomically corrected malposition with two well-developed ventricles was similar to that seen with ventricular inversion. Most of these cases can be helped surgically provided accurate and detailed preoperative evaluation and operative assessment and treatment is carried out.

Aorta↗
PubMed1976

Supravalvular stenotic mitral ring. A new case with surgical correction.

In this report, we present a case of supravalvular stenotic mitral ring in a child. The lesion created a picture of severe mitral stenosis and was successfully managed by resection of the ring. No other malformations of the mitral apparatus or left ventricular outlfow tract were found. On analyzing the diagnostic criteria, we concluded that there appears to be only one useful criterion--the angiographic morphology. However, when ther- is an associated ventricular septal defect or findings of Shone's complex, we should suspect supravalvular ring rather than any other form of mitral stenosis.

Child↗