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Biomedical subjects

G M Folger

Publications and source records attributed to G M Folger.

At least 19 recordsLinked to original sources
PubMed1997

Incidence of congenital heart disease in Qatari children.

We surveyed the incidence of congenital heart disease in 49887 native live born children in the period between 1984 to 1994 in Qatar. Each child with clinically suspected congenital heart disease underwent echocardiographic examination. Magnetic resonance imaging, cardiac catheterization and surgical intervention were done at the discretion of the patient's pediatric cardiologist. Virtually no postmortem examinations were performed. Children with congenital heart disease were entered into a computerized database and were then followed for 1-11 years. Congenital heart disease was diagnosed in 610 of 49,887 children for an incidence of 12.23/1000 live births. The reasons for the high incidence were high proportion of small muscular ventricular septal defects discovered before the time of their spontaneous closure, referral to and follow up by a single group of pediatric cardiologists, location of the pediatric cardiology service in the same setting where nearly all of the deliveries took place, freely available health care service, and echocardiographic examination of every child with a clinical diagnosis of congenital heart disease.

Female↗
PubMed1997

Acute rheumatic fever in an Arabian Gulf country--effect of climate, advantageous socioeconomic conditions, and access to medical care.

An eleven-year study of the incidence and consequences of acute rheumatic fever was carried out in a country in which a uniform climate together with national characteristics of insularity, wealth, and unrestricted access to free medical care contribute prominently to the epidemiologic milieu. Study subjects were 86 children, aged four to fourteen years, satisfying criteria for acute rheumatic fever. Study methods included clinical evaluation, standard laboratory studies, and echocardiography. A declining incidence of rheumatic episodes, ranging from 1.06 to 18.6/100,000 population (average 11.2/100,000), was identified. The course of the episode was generally mild. Arthritic findings predominated (92%), followed by carditis identified clinically in 43% and, with the addition of echocardiography, in 71%. Residual valvular regurgitation, as a longer term consequence, persisted in 46% of those with auscultatory confirmation of valvulitis. No recurrences were identified. Comparison with countries of similar socioeconomic status revealed relatively unimportant differences. Comparison with nearby disadvantaged countries identified striking contrast. It may be concluded that among the contributing factors, for the improvement in the incidence and sequelae of a rheumatic episode, are an advantaged socioeconomic environment and accessibility to unlimited medical care.

Acute Disease↗
PubMed1994

Double-chambered right ventricle and Down's syndrome: a proposed new association.

Twenty-two cases of double-chambered right ventricle studied in detail from two different centers comprise the study population. Of these, 5 have trisomy-21 Down's syndrome; these five cases, comprising nearly 25% of the entire study group, were essentially evenly divided between the two centers. This unexpectedly high percentage of Down's syndrome associated with such an unusual cardiovascular malformation, albeit among a small population, is likened to the currently recognized and similar association of Down's syndrome and atrioventricular cushion deformities.

Child, Preschool↗
PubMed1994

Acute myocardial-infarction-like findings with myocarditis in infancy. A case report.

A four-and-a-half-month-old infant suffered sudden circulatory collapse early in the course of a brief febrile illness. The electrocardiogram initially appeared normal; an abrupt change indicative of extensive myocardial infarction occurred following stabilization. Coronary arterial anatomy and flow by echocardiography and angiography were normal except for the finding of single origin of the entire coronary system from the left sinus of Valsalva. Gallium 67 myocardial imaging was positive for an inflammatory process, and the diagnosis of myocarditis was supported. This is the first case, to the authors' knowledge, of myocarditis simulating myocardial ischemia in an infant of an age in which anomalous origin of the left coronary artery from the pulmonary artery is a recognized cause for myocardial infarction.

Cardiac Catheterization↗
PubMed1992

Occurrence of valvar heart disease in acute rheumatic fever without evident carditis: colour-flow Doppler identification.

OBJECTIVE: To determine the frequency of occurrence of mitral and aortic valvar regurgitation in rheumatic children in whom there was no evidence of carditis acutely or at an earlier attack. DESIGN: Colour flow Doppler imaging was used in a non-randomised study of sequentially admitted children who met the criteria for acute rheumatic fever without clinically evident carditis and patients in whom the disease was quiescent after a previous attack of rheumatic fever. Two separate control groups were used for comparison of the echocardiographic findings, and a group of patients with confirmed rheumatic carditis was included for comparison of acute phase and antistreptococcal reactants. SETTING: A general hospital with the only paediatric inpatient department in Qatar. PATIENTS: From November 1988 to October 1990, 11 children were studied during the acute rheumatic period. In seven additional children the disease was quiescent when they were studied 18 to 36 months after a documented episode of acute rheumatic fever in which there was no evidence of carditis. The control patients were all studied during the same period. MAIN OUTCOME MEASURE: Detection of mitral and aortic regurgitation in patients without clinical evidence of rheumatic carditis in the acute or quiescent stages of the disease. RESULTS: Mitral or mitral and aortic regurgitation was found in 10 of the 11 children studied in the acute rheumatic period. None had a murmur or other evidence of carditis. In all the cases studied the valvar insufficiency was mild. Four of the children studied late in the quiescent period had either aortic or mitral insufficiency by colour flow Doppler evaluation; two children who had previously had valvar insufficiency no longer showed this, and one child without positive findings in the acute phase remained without insufficiency. None of the non-rheumatic control subjects showed mitral or aortic regurgitation. CONCLUSIONS: Colour flow Doppler imaging is a useful method of identifying subclinical mitral and aortic valvar disease at all stages of rheumatic fever when carditis cannot be otherwise detected and is a valuable addition to current diagnostic criteria.

Acute Disease↗
PubMed1987

The murmur of double-chambered right ventricle: phonocardiographic evaluation.

Thirteen patients undergoing complete evaluation for double-chambered right ventricle were subjected to phonocardiographic evaluation. Each of these individuals revealed a holosystolic ejection-type murmur which exhibited a similarity of appearance unaltered by the degree of physiologic derangement or associated cardiac abnormalities. This finding is considered to be caused by the obstructive elements in double-chambered right ventricle and appears to be a characteristic finding for this condition.

Adolescent↗
PubMed1987

Contrast echocardiography in the evaluation of interatrial septal defect.

One hundred twenty-four adult patients consecutively referred for suspected interatrial septal defect (IASD) were studied with contrast echocardiography. In 58 the study eliminated altogether the diagnosis of any significant cardiac defect. Fifteen patients had other forms of cardiac abnormalities with no shunting of blood, and 51 patients had echocontrast study positive for interatrial shunting; 48 of these were subsequently proven by cardiac catheterization to have IASD. Echocontrast provided a highly sensitive and specific means of both diagnosing IASD and eliminating this diagnosis.

Adolescent↗
PubMed1986

Persistence of third aortic arch with fourth aortic arch agenesis.

This report describes a case in which a persistent third aortic arch connection partly palliated interruption of the aortic arch. The malformation occurred without other cardiovascular abnormality in a newborn infant in whom the principal diagnostic clinical finding was the absence of all peripheral pulses except for those of the right brachial and carotid arteries. Echocardiographic and angiocardiographic examination showed a continuation of the left internal carotid artery to the descending aorta by way of an arching communication.

Aorta, Thoracic↗
PubMed1986

The right ventricular pouch: a proposed explanation for the electro-vectorcardiographic pattern of double chambered right ventricle.

The presence of a specific deformity of the right ventricle in association with the double-chambered right ventricle (DCRV) has been discovered in 8 of 14 individuals undergoing detailed study for DCRV. Investigational study employing multiple angiographic projections with selective angiography has allowed precise morphological identification of this deformity as a contractile pouch located arising from the outflow tract of the right ventricle. Comparison of the angiographic data with the electro-vectorcardiographic findings of DCRV suggests that these highly specific electrical features of DCRV correlate with the position and location of the contractile pouch.

Adolescent↗
PubMed1985

Right ventricular outflow pouch associated with double-chambered right ventricle.

Of 12 patients who underwent complete hemodynamic and cineangiocardiographic study for double-chambered right ventricle, seven were found to have a previously undescribed abnormality. Each of these patients exhibited an actively contractile, pouchlike structure closely associated with the right ventricular outflow tract, which occupied a right medial position in respect to the right ventricle. It varied considerably in size but not in location. This abnormality could be best defined when the distal, low-pressure, aspect of the doubled-chambered right ventricle was the injection site. It was best seen in those angiographic projections which allowed optimal viewing of the right medial aspect of the right ventricle. This structure is considered to develop postnatally, secondary to altered flow patterns produced by the underlying malformation, and it appears to constitute a unique finding with double-chambered right ventricle.

Adolescent↗
PubMed1985

Solitary hypoplasia of the right ventricle: a case report.

Hypoplasia of the right ventricle occurring as an isolated abnormality is an uncommon cause of cyanotic congenital heart disease. Its presentation in the newborn may mimic the ductus dependent and less stable right ventricular hypoplasias such as tricuspid atresia and pulmonary atresia. However, the natural history of this abnormality contrasts with those ductus dependent lesions by the rather benign course it presents. A patient with only marked reduction in right ventricular size and commensurate reduction in size of the tricuspid and pulmonary valves is described. Although cyanotic this child has shown none of the critical problems frequently encountered with the more severe forms of the right ventricular hypoplasias.

Cardiac Catheterization↗
PubMed1984

Bicuspid aortic valve morphology when associated with coarctation of the aorta.

Thirteen children and young adults with coarctation of the aorta as their principal cardiovascular abnormality, 11 with bicuspid aortic valves, were evaluated by orifice-view aortography to evaluate their aortic valvular morphology. For comparison 30 individuals with aortic valvular deformities but without coarctation of the aorta were similarly studied. Two distinct forms of bicuspid valves could be identified characterized by either the appearance of gross inequality of size of the two valve leaflets or an appearance wherein each leaflet closely approximated the size of the other, thus equally bicuspid. Excepting two individuals with normal, tricuspid, aortic valves, all of the patients with coarctation of the aorta had equally bicuspid aortic valves which contrasted to the group without coarctation in which the unequally bicuspid type predominated. This difference in bicuspid aortic valve morphology associated with coarctation of the aorta suggests a different developmental process involving the aortic valve as opposed to the situation in individuals without coarctation.

Adolescent↗
PubMed1984

Electro-vectorcardiographic features of double-chambered right ventricle.

Twelve patients with double-chambered right ventricles were investigated to determine the significance of the electrocardiogram and vectorcardiogram in the evaluation of this condition. Two subgroups of individuals having various forms of obstruction to right ventricular outflow with and without intracardiac shunting were utilized as controls. The electrocardiogram of patients with double-chambered right ventricle had a characteristic appearance identifiable as a right ventricular hypertrophy pattern seen best in the extreme right precordial leads V4R-V3R with tendency to normalization of pattern in V1 which contrasted with the pattern in both control subgroups. The vectorcardiogram in all 8 cases of double-chambered right ventricle in which this study was performed exhibited homogeneity of loop appearance and direction best identifiable in the horizontal plane by a prominent terminal orientation of the loop rightward and posteriorly. Both control subgroups exhibited heterogeneity of loop conformation, significantly more initial right-anterior force and less right-posterior force than the double-chambered right ventricle group. The electro-vectorcardiographic findings with double-chambered right ventricle were predictable for this abnormality and appear to have significant diagnostic importance.

Abnormalities, Multiple↗
PubMed1984

The management of valvular heart disease in children.

The child with significant valvular heart disease may present in any single instance both the most difficult of management decisions or a surprisingly simple one. Thus, if a direct surgical approach on the valve is feasible, the problems may very well be quite simple and straightforward; conversely, if valve replacement is indicated such may not be the case. We have recently reported our experience with one type of valvular heart condition, congenital aortic stenosis, in respect to determination of surgical approach based upon the ability to predict the orifice area and valvular anatomy. This report reviews our current experience with this technique. As well, the experience concerning the approach to each of the valvular conditions will also be reviewed with emphasis in respect to the left heart valves and particularly their long term postoperative management.

Adolescent↗
PubMed1984

Aortic valvular malformation associated with coincident cardiovascular anomalies: morphologic considerations.

The association of a bicuspid aortic valve with other congenital cardiac malformations, prominently coarctation of the aorta, is widely accepted with estimates of frequency reported to be 20% overall and ranging between 25-50% to as high as 85% when there is coarctation. The anatomic configuration of the valve has received little comment and, excepting those individuals requiring aortic valve surgery coincident with repair of other malformations, has been limited to postmortem examination. Recently, however, an angiographic technique for accurately evaluating the morphology of the aortic valve has been utilized allowing for the determination of aortic valvular appearance at routine evaluation by cardiac catheterization. We have currently examined 17 individuals with various forms of congenital cardiac malformations in whom an aortic valvular abnormality was suspected as a coexistent abnormality employing the technique of orifice-view aortography. The present report concentrates on the aortic valvular anatomy of these patients.

Adolescent↗