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Biomedical subjects

J A Culham

Publications and source records attributed to J A Culham.

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

Blood MR signal suppression by preexcitation with inverting pulses.

A cardiac-gated sequence has been developed for functional cardiac imaging. It uses a nonselective 180 degrees preinverting pulse before a spin-echo (SE) readout sequence with an echo time (TE) of 28 msec. In seven healthy volunteers this sequence provided superior wall-to-chamber contrast in end diastole and end systole when compared with the following sequences: SE, TE = 28 msec; SE, TE = 28 msec with dephasing gradients; and SE, TE = 28 msec with presaturation bands.

Adult↗
PubMed1989

A prosthesis for banding the main pulmonary artery, capable of serial dilatation by balloon angioplasty.

A prosthesis constructed with a fatigued steel helix encased in a silicone rubber shield was used to band the main pulmonary artery in 10 dogs. After a mean duration of 138 days the banded site was dilated with a 20 mm diameter angioplasty catheter. This dilatation produced a mean increase of 44.3% in the cross-sectional area. A further mean increase of 2.2% in the cross-sectional area was measured 137 days after the dilatation. In five uncomplicated experiments a second dilatation was performed with a 23 mm diameter angioplasty catheter after a mean interval of 140 days. The second dilatation produced a further 21% increase in the cross-sectional area. In the five experiments in which two dilatations were performed, there was a total increase in the mean cross-sectional area of 94% produced 273 days after banding. This prosthesis maintains banding of the main pulmonary artery and can be serially dilated by balloon angioplasty.

Angioplasty, Balloon↗
PubMed1988

Cardiac output by MR imaging: an experimental study comparing right ventricle and left ventricle with thermodilution.

Cardiac output was measured by gated magnetic resonance imaging (MRI) and by thermodilution in four mongrel dogs. The entire heart was examined in contiguous slices at end-diastole and end-systole in a plane parallel to the interventricular septum. Each set of images was analyzed for chamber volume using a custom computer program to evaluate each pixel. No geometric assumptions were made. Cardiac output was calculated for right and left ventricles and compared with the thermodilution data. We found that the cardiac output of the right ventricle compared well with that of the left ventricle and that both fell within the range measured by thermodilution. Cardiac-gated MRI has the potential to assess the cardiac output of both the right and left ventricles. Comparison between right ventricular and left ventricular function will permit quantification of left to right shunting or unilateral ventricular volume overload.

Animals↗
PubMed1987

Balloon-dilatable arterial banding prosthesis: experimental study.

Two arterial banding prostheses were developed that could be dilated by an intraluminal balloon dilator. One prosthesis consisted of radiopaque umbilical tape with a pleat secured by four 8-0 silk sutures thinly coated with silicone type A medical adhesive. This design was used to band the main pulmonary artery in five dogs, the subclavian artery in five, and the aorta in one. The second prosthesis, a stainless steel fatigued helix encased in a siliconized shield, was used to band the main pulmonary artery in two dogs and the descending aorta in two. After a mean duration of 89 days the bands were dilated with an intraluminal balloon dilator at 6 atm (608 kPa) of pressure for 30 seconds. In all 15 experiments the bands dilated and the gradient at the band was reduced. The stainless steel helix was more successful and has technical advantages for clinical application.

Angioplasty, Balloon↗
PubMed1987

Magnetic resonance imaging in pediatric vascular disease.

Magnetic resonance imaging (MRI) was used to study eight children with known vascular disease proved by angiography. Congenital and acquired large vessel disease was equally well demonstrated noninvasively by both MRI and angiography, and in one patient MRI provided superior information about pulmonary artery patency.

Adolescent↗
PubMed1986

Experience with polytetrafluoroethylene grafts in children with cyanotic congenital heart disease.

Survival and event-free rates of 47 polytetrafluoroethylene (PTFE) (Gore-Tex) shunts for severe cyanotic congenital heart defects were studied in 42 children from April, 1981, to March, 1983. Retrospective actuarial analysis was conducted over the 27 months of the study in 3-month intervals of the follow-up. The estimated actuarial patient survival at two years was 86% with an estimated actuarial event-free rate of 57.2%. The grafts were found to be patent in 89% (42/47) of the grafts. Complications associated with PTFE grafts were thrombosis, infections, heart failure, shunt stenosis, and deformity of the pulmonary arteries. Polytetrafluoroethylene grafts for systemic-pulmonary shunts offer good palliation, but the frequency of complications indicates that close follow-up is mandatory to avoid or treat serious sequelae of the complications.

Actuarial Analysis↗
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

Ductus arteriosus aneurysm in Marfan syndrome.

We report the angiographic and magnetic resonance imaging findings of an aneurysm of the ductus arteriosus in a woman with Marfan syndrome. This is the first reported ductus aneurysm diagnosed in an adult with Marfan syndrome.

Adult↗
PubMed1985

Low-dose fibrinolytic therapy in infants.

We describe three pediatric patients in whom locally infused streptokinase at a dose of 50 U/kg/hr was used successfully to treat thrombosis in a major artery, a major vein, and a systemic-to-pulmonary arterial graft. Complications, including hemorrhage and distal embolization, were minimized by careful monitoring of the coagulation status of the blood and by avoiding rapid infusions. Selective thrombolytic therapy appears to be as effective in infants as in adults. Because the dose required is reduced, the incidence of complications is lower than with systemic infusions.

Aorta, Abdominal↗
PubMed1983

Subselective embolization for non-neoplastic conditions of the kidney.

Three patients in our institution underwent subselective arterial embolization for treatment of intractable renal hemorrhage. In all three patients control of bleeding was obtained. The only complication encountered was a non-occlusive dissection of a segmental renal branch in one patient. Although some tissue infarction will result, less renal parenchyma will be lost than is the case with surgical treatment.

Adult↗