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Biomedical subjects

G G Sandor

Publications and source records attributed to G G Sandor.

At least 37 records · Page 2Linked to original sources
PubMed1991

Doppler-derived mean aortic flow velocity in children: an alternative to cardiac index.

This study tested the hypothesis that mean aortic velocity is relatively constant in children. Eighty-eight normal children (aged 1 month to 15 years) were studied prospectively. Ascending aortic flow velocities were obtained by pulse Doppler and mean aortic velocities calculated. Mean aortic flow velocity was relatively constant for all ages at 28.4 +/- 4.8 cm/s. As Doppler is easy to perform, mean aortic flow velocity may be an alternative approach to the assessment of cardiac output.

Adolescent↗
PubMed1991

Balloon dilatation of restrictive interatrial communications in congenital heart disease.

An adequate interatrial communication is necessary for survival in several forms of congenital heart disease. Three children are presented in whom blade atrial septostomy proved either technically impossible or failed to achieve adequate interatrial communication. In all three an adequate communication was obtained by a balloon dilatation technique similar to that used for pulmonary valve dilatation. In one critically ill infant with mitral atresia the procedure was life saving.

Catheterization↗
PubMed1990

Congenital heart disease and Robinow syndrome: coincidence or an additional component of the syndrome?

We report on a girl with Robinow syndrome and pulmonary atresia with ventricular septal defect (VSD). Seven cases of Robinow syndrome with congenital heart defect (CHD) have now been described, 5 of whom had stenosis or atresia of the pulmonic valve. This suggests that CHD, especially right ventricular outlow obstruction, may be a component manifestation of this syndrome in some cases. Since early recognition of this type of heart lesion can minimize morbidity by facilitating optimal surgical therapy, thorough cardiac evaluation of all patients with Robinow syndrome seems warranted.

Abnormalities, Multiple↗
PubMed1990

Optimal choice of prognostic variables with an application to cardiac monitoring using M-mode echocardiography.

This paper provides a methodology for the optimal choice of a subset from a large number of interrelated diagnostic variables. We use predetermined abnormal ranges for each measurement and code subjects as abnormal or normal on this basis. We present a procedure to determine the smallest subset of measurements that identifies any subject abnormal on at least one measurement. We formulate and solve the problem using integer programming. We then apply this methodology to study the use of M-mode echocardiography to determine potentially cardiotoxic side effects of chemotherapy and compare its performance to several multivariate methods. Extensions and modifications are discussed.

Child↗
PubMed1990

Successful treatment of a nondeflatable balloon atrial septostomy catheter.

A rare complication of balloon atrial septostomy is presented in an infant with D-transposition of the great arteries (D-TGA) undergoing a Rashkind septostomy. The balloon could not be deflated after the first pass across the atrial septum because of a blocked catheter lumen. Deflation was achieved with a fine-gauge needle introduced percutaneously via a transhepatic approach. The management of nondeflatable balloons is reviewed.

Cardiac Catheterization↗
PubMed1990

The clinical value and risks of lung biopsy in children with congenital heart disease.

A retrospective review was made of 59 open lung biopsy specimens taken between 1984 and 1988 from children with congenital heart disease who were at risk for pulmonary vascular disease. Thirty-seven patients (ranging in age from 3.5 months to 23 years; median age, 14 months) had a primary left-to-right shunt (group A) and 22 patients (ages 1 to 15 years) had palliated cyanotic heart disease (group B). Forty-five of the lung biopsy specimens were requested as frozen sections. In both groups lung biopsy specimens were graded by the Heath-Edwards classification and correlated against preoperative hemodynamic data and outcome. In group A patients, carefully measured pulmonary vascular resistance and pulmonary/systemic vascular resistance ratio were reliable indicators of the structural state of the pulmonary vascular bed, obviating the need for routine lung biopsy. Pulmonary/systemic vascular resistance ratios greater than 0.45 accurately predicted all patients with irreversible pulmonary vascular disease, and pulmonary vascular resistance greater than 7 units.m2 accurately predicted all but one case of disease. Reversibility of pulmonary vascular changes is not synonymous with immediate postoperative survival: Fatal postoperative pulmonary hypertensive crises occurred in the presence of reversible pulmonary disease. Of those considered for the Fontan procedure, a mean pulmonary artery pressure less than 30 mm Hg and pulmonary vascular resistance less than 3 units.m2 correlated with Heath-Edwards grade I or normal lung biopsy results. In 36% of group B patients, reliable assessment of pulmonary vascular resistance could not be made, indicating a possible need for open lung biopsy procedures. When lung biopsy procedures were used as an isolated procedure, they were more dangerous (20% mortality, 13% morbidity) than previously reported. Intraoperative frozen sections are not adequate to accurately assess pulmonary vascular changes (9% error); serial paraffin sections are required.

Adolescent↗
PubMed1989

Influence of echocardiography in pre-operative cardiac catheterization in congenital heart disease.

The influence of echocardiography on pre-operative cardiac catheterization was assessed in a retrospective analysis comparing two 12-month periods. Of 245 operations in 1983, 200 (82%) had pre-operative cardiac catheterization when two-dimensional echocardiography only was used in the pre-operative assessment compared to 162 of 238 (68%) operations in July 1985-June 1986 when pulsed Doppler echocardiography also was used (P less than 0.001). Significant reductions in pre-operative cardiac catheterization were present in both open (87/87 vs 89/102, P less than 0.001) and closed (113/158 vs 73/136, P less than 0.005) heart procedures. The group with the most significant reduction in pre-operative cardiac catheterization before open heart surgery were children with atrial septal defects; of the closed heart surgical groups, the greatest reductions were in patent ductus arteriosus, coarctation of the aorta and tetralogy of Fallot. Echocardiogram diagnostic errors occurred in 22/245 (9%) in 1983 compared to 9/238 (4%) in 1985/86 (P less than 0.05). Echocardiography has resulted in a significant reduction in pre-operative cardiac catheterization and has become more accurate in diagnosis.

Cardiac Catheterization↗
PubMed1989

Assessment of bedside umbilical vein balloon septostomy using two-dimensional echocardiographic guidance in transposition of great arteries.

The effectiveness of "bedside" balloon atrial septostomy via the umbilical vein using 2-dimensional echocardiography was compared to the traditional femoral vein approach using fluoroscopy in a series of neonates with transposition of great arteries from March, 1984 to April, 1987. There were 7 neonates who had balloon septostomy performed at the "bedside" (Group I) compared to 13 who had the procedure performed in the catheterization laboratory (Group II). Group II consisted of 7 newborns who had elective femoral vein catheterization under fluoroscopy (Group IIA) and 6 who failed "bedside" umbilical vein balloon septostomy and subsequently had the femoral vein approach under fluoroscopy (Group IIB). Results showed that adequacy of balloon septostomy was not related to the approach used, with 4 of 7 in Group I and 9 of 13 in Group II with an adequate atrial tear and clinical response. The Delay time to septostomy (i.e. time elapsed from initial assessment to commencement of balloon septostomy) and Procedure time (i.e. time taken to complete the balloon septostomy) was significantly shorter for Group I (mean time = 0.7 hours and 0.26 hours respectively) compared with Group IIA (mean time = 2.6 hours and 1.8 hours) and Group IIB (mean time = 2.4 hours and 1.4 hours). Of note, there was no significant increase in Delay time between Group IIA and IIB.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization↗
PubMed1988

Role of prenatal detection of cardiac tumours in the diagnosis of tuberous sclerosis--report of two cases.

Tuberous sclerosis is an autosomal dominant disease with variable expression. Little is known about the intrauterine course of the disease and the fetal age at which specific abnormalities may be detected. The role of prenatal detection of cardiac tumours in the diagnosis of two fetuses at 28 and 32 weeks' gestation based on fetal echocardiography is discussed. The prenatal and postnatal course of the disease is described.

Adult↗
PubMed1987

Left ventricular systolic and diastolic function after total correction of tetralogy of Fallot.

Left ventricular (LV) systolic and diastolic function was assessed in 12 patients after total correction of tetralogy of Fallot (age range 5 to 18 years, mean 10) and compared with 10 control patients. Only 1 patient had a shunt before total correction that was performed at a mean age of 3.5 years, (range 0.3 to 8). At cardiac catheterization the following indexed LV parameters were measured: end-diastolic and end-systolic volumes, wall mass, ejection fraction, stroke volume and end-diastolic and end-systolic pressures and stresses. The rate-corrected mean velocity of fiber shortening was calculated. LV diastolic operant chamber stiffness and myocardial stiffness were calculated from simultaneous diastolic pressures and volumes in mid- and late diastole using monoexponential formulas. The 2 groups were compared by unpaired t tests. The tetralogy group had higher mean end-diastolic (93 vs 74 ml/m2), end-systolic (29 vs 19 ml/m2) and stroke (64 vs 55 ml/m2) volumes than controls. Rate-corrected mean velocity of fiber shortening was lower in the tetralogy group (1.07 vs 1.24). Myocardial stiffness was higher in the tetralogy group (16 vs 11). Other indexes were not significantly different. Thus, LV function after total correction of tetralogy of Fallot may be abnormal with larger than normal LV size, decreased contractile function and increased myocardial stiffness.

Adolescent↗
PubMed1987

Normal serial variability for M-mode and digitized echocardiography in a pediatric population.

The normal serial variability of M-mode and digitized echocardiography was assessed in 18 healthy children aged 3-16 years. M-mode echocardiograms were done one month apart in each child and two sets of three beats were analyzed twice for each month's tracing. Ejection fraction and shortening fraction were obtained in the standard manner and the tracing digitized and analyzed for peak and normalized left ventricular velocities, and for posterior wall and septal wall velocities in systole and diastole. The component variabilities were determined by a univariate four-factor hierarchical variance components analysis and the sum of these variability limits established. Standard M-mode echocardiographic measurements of shortening fraction and ejection fraction (15% and 10% of mean) were the least variable. Peak and normalized velocities were more variable with left ventricular velocities (18%-29% of mean), posterior wall velocities (26%-45% of mean) and septal velocities (38%-68% of mean) showing increasing variabilities. Thus there is less variability in M-mode echocardiography than digitized echocardiography. The normal limits of variability are established and should be used for follow-up studies.

Adolescent↗
PubMed1987

Pulmonary artery banding: results and current indications in pediatric cardiac surgery.

The results of pulmonary artery banding in 144 patients seen from 1971 to 1984 were reviewed. Age ranged from 1 week to 4 years (median, 8 weeks) and weight, from 1.1 to 16 kg (median, 4 kg). The patients were divided into three major groups: Group 1, defects without mixing disorders (ventricular septal defect, double-outlet right ventricle [DORV], atrioventricular septal defect); Group 2, defects with mixing disorders (transposition of the great arteries, DORV, single ventricle, tricuspid atresia); and Group 3, miscellaneous (mitral atresia, left ventricular hypoplasia, truncus complex). The diagnostic group influenced survival (p = 0.0035). In Group 1, 88.8% survived, but only 64.9% survived in Groups 2 and 3 combined. The presence of patent ductus arteriosus or coarctation of the aorta had no effect on survival (p = 0.61 and p = 0.7, respectively). The clinical condition at thirty days after pulmonary artery banding was good in 35.1% and fair in 46.9% of the patients. When the data were divided into the three periods 1971 through 1974, 1975 through 1979, and 1980 through 1984, which included 28, 49, and 67 patients, respectively, a significant improvement in survival was observed from the early (64.3%) to the late period (92.5%) (p = 0.0009). Patients weighing less than 4 kg had a significantly lower survival in the period 1971 through 1974 (37.5% versus 91.67%). No significant difference in survival was detected in the late period, 1980 to 1984 (90% versus 94.6%), between patients weighing less than and those weighing more than 4 kg. Pulmonary artery banding is clinically satisfactory in small infants and children with complex anomalies.

Child, Preschool↗
PubMed1986

Treatment of grafts and major vessel thrombosis with low-dose streptokinase in children.

Low-dose streptokinase infusions have been used in 8 of our patients. Five of these were newborns who had major vessel occlusion. Four babies had extensive aortic thrombosis and hypertension producing congestive aortic thrombosis and hypertension producing congestive heart failure. One baby had caval and renal vein thrombosis and was in renal failure. Two infants with cyanotic heart disease and 1 with arteritis had occluded prosthetic grafts, which were reopened completely. Two grafts were between the subclavian and pulmonary arteries (Blalock-Taussig shunt), and one was between the abdominal aorta and right renal artery. In each patient, the thrombolytic agent was delivered directly to the area of thrombosis by three or four percutaneously inserted French catheters. The dose of streptokinase used was between 50 and 100 U/kg/hr. Therapy lasted for 2 to 11 days. Major bleeding was anticipated, and it occurred in 1 patient. Low-dose streptokinase infusion is a safe and effective treatment for a variety of thrombotic problems in infants and children.

Child↗
PubMed1986

Effect of pressure loading, volume loading and surgery on left ventricular chamber and myocardial stiffness in congenital heart disease, with a reevaluation of normal pediatric values.

This study assessed the effect of pressure load, volume load and surgery on left ventricular chamber stiffness (b) and myocardial stiffness (k). A normal range for chamber stiffness and myocardial stiffness was also established. A total of 44 patients were studied: 8 were control subjects, 12 had volume load and 24 had pressure load. At cardiac catheterization simultaneous high fidelity pressures (P) and left ventricular volumes (V) were obtained in one diastolic cycle. From the relation P = aVb, operant chamber stiffness (b) was estimated for each patient. Similarly, the relation between stress (sigma) and radius (B) was approximated by sigma = cBf and the myocardial stiffness (k) derived for each patient. Mean values for chamber or myocardial stiffness for the diagnostic groups were not significantly different but differed within the operative groups. Mean values for b and k were greater in the post-open heart surgery group than in the post-closed heart surgery or nonsurgical group. Although the mean values for chamber stiffness and myocardial stiffness for the diagnostic groups were not different, there were more abnormal patients in the pressure load group (9 of 24) than in the volume load group (2 of 8) when the normal range was obtained from the control group. Thus, left ventricular operant chamber and myocardial stiffness are often preserved with volume loading, less frequently with pressure loading and rarely after open heart surgery.

Adolescent↗
PubMed1986

Fetal echocardiography: results in high-risk patients.

The results of 140 fetal cardiac scans in 124 high-risk obstetric patients (16 to 40 weeks' gestation) are presented. Sixty patients were scanned for high genetic or environmental risk (group 1); 31 because of fetal abnormality detected on routine ultrasound scanning (group 2) and 37 because of arrhythmias (group 3). Three patients were in two groups. The standard echocardiography views, ie, long-axis, great vessel short axis, four chamber, and aortic arch were obtained in 72, 95, 96, and 55%, respectively. All scans in group 1 were diagnosed as normal. In group 2, complex cardiac abnormalities were detected, the presence of fetal cardiac failure and its cause were clarified, and serious cardiac malformations were excluded. Arrhythmias in group 3 were diagnosed correctly and fetal hemodynamics assessed. A small number of lesions were not detected or diagnosed. The factors interfering with detection of lesions were abnormalities of the intrathoracic or abdominal cavity, inadequate amniotic fluid, and size of lesions. Major cardiac structures or abnormalities could be identified, and abnormal hemodynamics caused by arrhythmias and structural lesions assessed. Unnecessary intervention was prevented in five cases and conversely the need for acute intervention was indicated in seven cases. Fetal echocardiography remains a specialized investigation that has an important role in the management of some high-risk pregnancies.

Arrhythmias, Cardiac↗
PubMed1985

Cardiovascular therapy in the newborn.

Considerations for the use of the principal inotropic agents (digoxin and dopamine) in the newborn are discussed. The role of Prostaglandin-E in retaining the patency of the ductus arteriosus in the initial treatment of anomalous vessel formation is outlined. Conversely, chemotherapeutic possibilities for inhibiting prostaglandin production and thus encouraging closure of the ducts prior to surgical intervention are described.

Digoxin↗
PubMed1983

Successful palliation by pulmonary artery banding in absent pulmonary valve syndrome with aneurysmal pulmonary arteries.

Three infants with absent pulmonary valve syndrome were treated between 1977 and 1980. All infants were in critical cardiorespiratory failure refractory to medical therapy. Pulmonary artery banding was performed to reduce the volume occupied by the large pulsating pulmonary artery in a limited mediastinal space. The band reduced tracheobronchial compression and increased effective cardiac output. All three infants survived the procedure and, at follow-up, significant improvement in cardiorespiratory function has been noted, with satisfactory growth. This experience suggests that pulmonary artery banding has a place in the initial management of absent pulmonary valve syndrome, allowing survival so that total correction can be undertaken more safely at a later stage.

Aneurysm↗