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Biomedical subjects

J F Howell

Publications and source records attributed to J F Howell.

At least 37 records · Page 2Linked to original sources
PubMed1978

Fortuitous rupture of aortic aneurysm: a catastrophic event affording time for surgical cure.

The rupture of an aortic aneurysm is generally a fatal event, but occasionally the rupture will occur into an adjacent vascular structure, thereby preventing exsanguination and affording temporary survival. Three cases are presented illustrating the fortuitous nature of the rupture of an aortic aneurysm into a vascular structure. The first patient had an atherosclerotic abdominal aortic aneurysm that ruptured into the inferior vena cava and was successfully repaired. The second case demonstrates the formation of a fistula from the aorta to the left pulmonary artery in a patient with a syphilitic thoracic aortic aneurysm. In the third patient a dissecting aneurysm of the aortic root that communicated with the right ventricle after coronary bypass surgery was successfully repaired. Rarely, aortic aneurysms will rupture fortuitously into vascular capacitance structures. These three cases emphasize the need for early accurate diagnosis and the institution of appropriate surgical measures.

Aged↗
PubMed1978

Operative risk in patients with previous coronary artery bypass.

Noncoronary operations were performed in 358 patients who had undergone a previous coronary artery bypass grafting, with a mortality of 1.1%. In 70 patients (20%), the staged operation was planned and subsequent operation performed 6 to 12 weeks after bypass with no cardiac complications and 1 death. In the others, operation was performed 10 days to 89 months after bypass for either urgent reasons or new lesions. Three deaths and significant numbers of medical cardiac complications occurred in those patients subjected to operation within 30 days. The subsequent operation was vascular in 232 patients, with 3 deaths (1.3%); thoracic in 43, with no deaths; and general surgical in 113, with 1 death (0.9%). Follow-up study showed 307 patients (87%) still alive after 30 days to seven years. Late death was due to myocardial infarction in only 12 patients (3%). This study suggests that the risk of operation is as good in patients who have had successful coronary artery bypass as in those without coronary artery disease, and that the risk of subsequent myocardial infarction is small.

Coronary Artery Bypass↗
PubMed1976

Aneurysm of the main pulmonary artery: long-term survival after aneurysmorrhaphy and closure of a ventricular septal defect.

Pulmonary artery aneurysm (PAA) usually carries an ominous prognosis due to the associated pulmonary hypertension. Six years ago a patient with a PAA secondary to cystic medial necrosis and pulmonary hypertension due to a ventricular septal defect (VSD) was treated by aneurysmorrhaphy and closure of the VSD. Although the patient had early postoperative cardiac failure, his cardiopulmonary status stabilized, and he has done well without recurrence of his aneurysm or cardiac failure. This report summarizes the patient's clinical course, operative treatment, and long-term follow-up.

Adult↗
PubMed1976

Left subcostal insertion of the sutureless myocardial electrode.

This report describes the use of a left subcostal extrapleural supradiaphragmatic approach to the heart for myocardial sutureless electrode insertion. Electrode insertion by this approach has consistently produced low electrode thresholds, and the ability to insert electrodes into the left ventricle or septal area of the right ventricle is considered an advantage. This technique has now been used in 52 patients. Postoperative morbidity and complications have been minimal. The procedure appears to be well tolerated in the elderly, poor-risk patient and has been a useful technique for revision of failed pacemaker systems. We believe this procedure reduces the indications for permanent transvenous pacing.

Adult↗
PubMed1976

Aneurysm of the sinus of Valsalva producing obstruction of the left main coronary artery.

An aneurysm of the left sinus of Valsalva compressed the left main coronary artery and the patient experienced anginal pain. Surgical correction consisted of obliteration of the orifice of the aneurysm, aortic valve replacement, and a saphenous vein bypass from the ascending aorta to the distal left anterior descending coronary artery. Postoperative studies revealed excellent function of the prosthetic valve, no recurrence of the aneurysm and retrograde filling of the left anterior descending and circumflex coronary arteries. Three years after the operation, the patient is asymptomatic.

Angiocardiography↗
PubMed1975

Successful partial excision of an intramural fibroma of the left ventricle.

A report of the only surviving adult to undergo partial excision of an intramural cardiac left ventricular fibroma is presented. Good results were obtained by relieving outflow tract obstruction through partial excision of the tumor from the septum and left ventricle. The need for conservative surgical treatment of patients with this rare, benign tumor is emphasized.

Adolescent↗