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Biomedical subjects

H N Oldham

Publications and source records attributed to H N Oldham.

At least 37 records · Page 2Linked to original sources
PubMed1986

Spinal cord infarction following intraaortic balloon support.

Infarction of the lumbar and sacral spinal cord was demonstrated at autopsy of a 72-year-old man in whom acute paraplegia developed following coronary artery bypass grafting and atrial septal defect repair with intraoperative insertion of an intraaortic balloon. Autopsy findings showed that infarcts of the spinal cord and other key organs were caused by critical occlusion of small arterioles by cholesterol emboli. These emboli apparently arose as a result of the fragmentation of atheromatous plaques within the aorta during use of the intraaortic balloon pump with subsequent embolization and occlusion of small blood vessels.

Aged↗
PubMed1985

Physiological rationale for a bidirectional cavopulmonary shunt. A versatile complement to the Fontan principle.

The original Fontan procedure included a classic superior vena cava-to-right pulmonary artery (Glenn) shunt. Subsequent experience demonstrated that this anastomosis was not essential and was an unnecessary commitment of the larger right pulmonary circulation to the smaller blood volume of the superior vena caval return. With application of the Fontan principle to more complex cardiac malformations, there has been a reconsideration of possible benefits of a cavopulmonary shunt in selected patients. A modified shunt from the divided end of the superior vena cava to the side of the undivided right pulmonary artery utilized in 21 patients is described. This shunt is designed to allow bidirectional pulmonary arterial distribution of both superior vena caval inflow and right atrial outflow after completion of the Fontan procedure. Twelve patients had the bidirectional shunt performed prior to a Fontan operation; five of these had a subsequent atriopulmonary connection and seven await operation. Eight patients had construction of this shunt at the time of their Fontan procedure. One patient had a bidirectional shunt constructed following atriopulmonary anastomosis to help relieve right atrial outflow obstruction. Two patients with univentricular heart undergoing simultaneous Fontan procedure and a bidirectional shunt died while in the hospital. The remaining 19 patients have been followed up for 2 months to 9 years with one late sudden death at 9 years. There have been no bidirectional cavopulmonary shunt failures, stenoses, kinks, or recognized pulmonary arteriovenous malformations. Postoperatively, eight patients had assessment of pulmonary distribution of shunt blood flow by angiography. Seven of these patients were also evaluated by radionuclide angiography. Superior vena caval blood flow via the bidirectional cavopulmonary shunt tended to be greater to the right lung, but bilateral pulmonary flow was documented in all but one patient. After Fontan operation, six of seven patients tested also demonstrated bilateral distribution of atriopulmonary flow. We concluded from our experience that this modified shunt provides excellent relief of cyanosis, allows bidirectional pulmonary distribution of both superior vena caval return and also the right atrial blood flow after atriopulmonary connection, and may be done before, with, or after a Fontan procedure and is compatible with all currently recommended modifications. Perioperative hemodynamic adjustments to the Fontan procedure may be improved by reducing atrial volume, and this may also be of potential benefit in the long-term adaptation to Fontan physiology by minimizing atrial distention.

Arteriovenous Shunt, Surgical↗
PubMed1984

Clinical characteristics and current management of medically refractory unstable angina.

Of 531 patients admitted to the Duke Coronary Care Unit with unstable angina (UA) from June 1981 to September 1982, 100 had persistent angina despite optimal medical therapy of nitrates, propranolol, and nifedipine. At catheterization, 70% of the refractory patients had left main (LM) or three-vessel disease (TVD), 68% had left ventricular end-diastolic pressures of greater than 12 mmHg, and 24% had ejection fractions (EF) of less than 0.40. Twenty-four patients were greater than 65 years of age, and 53 had associated major diseases. Forty-eight patients (Group I) had no evidence of myocardial infarction in the 30 days before catheterization, whereas 52 patients had an infarction precipitating the unstable angina within the preceding 30 days (Group II). Emergent coronary artery bypass grafting was performed in all 100 patients irrespective of ventricular function, hemodynamic status, or coronary anatomy. Management protocols included prompt surgical intervention, preoperative stabilization with the balloon pump in LM or TVD, meticulous myocardial protection, and complete coronary revascularization. An average of 3.6 grafts were placed in each patient. There were two hospital deaths in Group I, and two in Group II. Two-year survival was 90% in Group I and 88% in Group II, and 81% of surviving patients were NYHA Class I or II. Thus, refractory UA denotes particularly severe coronary disease with a high incidence of LM, TVD, and depressed EF. Baseline clinical characteristics, criteria for operation, and expected results in the postinfarction group seem to be similar to the unstable angina group in general. Cardiac anatomic and functional variables no longer constitute operative contraindications. Aggressive operative management is safe, and the current risk may be less dependent on coronary anatomy and ventricular function than previously appreciated.

Adult↗
PubMed1983

Staged correction of pulmonary atresia and absent right pulmonary artery.

Repair of pulmonary atresia with an extra-anatomic conduit has been difficult in patients with absent central pulmonary arteries. Although several methods have been employed successfully, each has inherent problems. Our technique uses a staged approach to complete pulmonary revascularization using the systemic-pulmonary collateral arteries for reconstruction of the involved lung. In our patient, this type of repair was associated with excellent late postoperative symptomatic and hemodynamic results. Complete revascularization of both lungs during correction of pulmonary atresia may improve the surgical management of this condition.

Adolescent↗
PubMed1983

Early assessment of rest and exercise left ventricular function following coronary artery surgery.

Radionuclide assessment of rest and exercise left ventricular function was performed in 14 patients before, eight days after, and three months after coronary artery bypass grafting (CABG). Resting function was unaltered after operation, although mild increases in heart rate and end-diastolic volume were observed on the eighth postoperative day. In contrast, exercise function was significantly improved at both postoperative time periods. Exercise ejection fraction was 0.54 +/- 0.10 before operation, 0.73 +/- 0.12 at eight days, and 0.64 +/- 0.13 at three months. Before CABG, the exercise-induced increase in stroke volume was achieved by an increase in end-diastolic volume, whereas eight days after CABG this increase was achieved by an increase in contractility (systolic blood pressure/end-systolic volume). By three months, both contractility and end-diastolic volume increased with exercise. Thus, improvement in left ventricular function during exercise can be documented as early as eight days after coronary revascularization. This change may be less pronounced after three months of convalescence, but considerable improvement in ventricular function persists compared to preoperative assessment.

Aged↗
PubMed1983

Surgical treatment of acute ascending aortic dissection.

Since adopting a policy of immediate operation on patients with acute dissection of the ascending aorta, 42 men and 6 women (ages 18-67 years) have been managed surgically. Thirty-two patients had graft replacement of the ascending aorta and resuspension of the incompetent aortic valve. One of these had a coronary graft. There were five deaths in this group. Eight patients required aortic valve replacement because of a diseased aortic valve as well as grafting of the ascending aorta, with one death. Three patients had resuspension of the aortic valve and primary repair of their dissection without mortality. Two patients were managed successfully with an intraluminal prosthesis and resuspension of the aortic valve. Another patient had successful repair with a valved conduit and reimplantation of the coronaries. Two patients dissected 4 and 6 years after aortic valve replacement and neither survived operative repair. Of the surviving patients, one required dialysis, one a femoral-femoral bypass graft, and one an axillo-femoral bypass graft. One patient required a pacemaker for heart block, and two underwent successful repair of suture line aneurysms, both occurring three years after operation. On the basis of this experience, prompt surgical intervention for acute ascending aortic dissection is the treatment of choice. A variety of techniques are available to repair the dissected aorta. Long-term results for resuspension of the aortic valve in acute ascending aortic dissection have been excellent and emphasize that valve replacement should be reserved for those patients found at operation to have a primary abnormality of the aortic valve.

Adolescent↗
PubMed1981

Left atrial myxoma. Is cardiac catheterization essential?

Although uncommon in children, primary cardiac tumors, especially left atrial myxomas, can be cured with surgery. We present our experience with a 12-year old boy with a left atrial myxoma diagnosed by two-dimensional echocardiography who underwent successful surgical resection without prior catheterization. We recommend that all patients suspected of having cardiac tumors undergo echocardiographic evaluation. As this case illustrates, the essential information for surgical management of myxomas can be obtained from two-dimensional echocardiograms, which obviates cardiac catheterization.

Cardiac Catheterization↗
PubMed1981

Absent pulmonary valve syndrome in infancy: surgery reconsidered.

Congenital absence of the pulmonary valve leaflets is generally associated with ventricular septal defect, anular pulmonary stenosis and aneurysmal dilatation of the pulmonary arteries: the absent pulmonary valve syndrome. Symptomatic infants with this syndrome suffer primarily from respiratory insufficiency caused by bronchial compression by the dilatated pulmonary arteries, and have a high mortality rate. Asymptomatic infants are thought to do well, and may have elective surgery late in childhood. Findings in four infants with absent pulmonary valve syndrome are reviewed. One symptomatic infant was successfully treated with closure of a ventricular septal defect and pulmonary arterial plication. One previously asymptomatic infant had a fatal respiratory arrest revealing the complexity of management of infants with absent pulmonary valve syndrome.

Bronchial Diseases↗
PubMed1981

Surgical management of congenital coronary artery fistulas.

Congenital fistulas are the most common of the coronary arterial malformations and with the widespread use of selective coronary arteriography are being recognized with increasing frequency. Twenty-eight patients with congenital coronary fistulas have been evaluated at the Duke University Medical Center between 1960 and 1981. An additional 258 patients have previously been reported in the literature, making a total of 286 available for review. The right coronary artery is most commonly involved, and the fistulous communication is most often to the right ventricle, right atrium or pulmonary artery. Slightly more than half of the patients with coronary fistulas are symptomatic at the time the diagnosis is made. Surgical correction is strongly recommended to prevent the development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and pulmonary hypertension, as well as coronary aneurysm formation, with subsequent rupture or embolization. There were no operative or late deaths in the patients who underwent operations. Moreover, there have been no recurrent fistulas during a mean follow-up period of ten years. The risks of operative correction appear to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients.

Adolescent↗
PubMed1980

Lengthened intraaortic balloon tubing for intraoperative use.

The intraaortic balloon pump (IABP) is being used with increasing frequency during surgical procedures. The standard length of balloon tubing requires the IABP console to be close to the operating table. This creates a possibility of contamination. A longer balloon tubing is described that permits an increased distance between console and operating table without decreasing effective augmentation.

Assisted Circulation↗
PubMed1980

Accessory atrioventricular pathway in an infant: prediction of location with body surface maps and ablation with cryosurgery.

A 10-month-old infant with multiple muscular ventricular septal defects, congestive heart failure, Wolff-Parkinson-White syndrome, and supraventricular tachycardia is presented. The site of ventricular pre-excitation was predicted by analysis of ST-T wave isopotential body surface maps to be in the posterior free wall of the right ventricle. The site was confirmed by epicardial mapping of the ventricles during surgery. The pathyway was cryoblated and the ventricular defects were closed. The patient has been free of pre-excitation and supraventricular tachycardia for over two years since surgery.

Animals↗
PubMed1980

Benign tumors of the lung and bronchus.

Benign tumors of the lung and bronchus are a heterogeneous group of lesions that usually present as asymptomatic, solitary, peripheral lung nodules or, less commonly, as endobronchial lesions causing obstructive symptoms. All endobronchial lesions should be removed surgically to alleviate symptoms and to prevent destruction of distal lung tissue. Parenchymal lesions may present challenging problems in clinical diagnosis and management. Most patients will ultimately require thoracotomy for histologic confirmation of benignity. It is probable that newer diagnostic procedures will allow a more accurate nonoperative diagnosis in certain patients in the near future. At the present time, expeditious limited thoracotomy affords a safe, rapid, and effective treatment for patients with a benign tumor of the lung or bronchus.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1980

Corrected transposition with severe intracardiac deformities with Wolff-Parkinson-White syndrome in a child. Electrophysiologic investigation and surgical correction.

This is a report of a 10-year-old child who underwent surgery for complex congenital heart disease consisting of corrected transposition of the great vessels, ventricular septal defect, patent ductus arterisus, severe left-sided atrioventricular (AV) valve insuffieicney (Ebstein's deformity) and Wolff-Parkinson-White syndrome. The site of his accessory AV connection was localized preoperatively at a left anterolateral site by isopotential body surface maps and by intracardiac electrophysiologic studies. He successfully underwent surgery for closure of the ventricular septal defect, ligation of the patent ductus arteriosus, replacement of the left-sided AV valve, and interruption of the accessory AV pathway. Unavoidable complete AV block acquired at surgery required subsequent permanent pacemaker therapy.

Cardiac Catheterization↗