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Biomedical subjects

J J Gallagher

Publications and source records attributed to J J Gallagher.

At least 55 records · Page 3Linked to original sources
PubMed1989

A new policy initiative. Infants and toddlers with handicapping conditions.

Past legislation related to children and families has been used to improve services to specific target groups of children and families in need (i.e., poor, handicapped, etc.) Current legislation, notably Public Law 94-142, the Education for All Handicapped Children Act, and Public Law 99-457 (Part H), Services for Infants and Toddlers with Handicapping Conditions, also includes elements of mandated reform of certain professional practices (i.e., inclusion of parents in planning and requirements for multidisciplinary cooperation). Such a mandate has the effect of putting into practice changes that many professionals have said were needed but were unable to achieve, but it also makes the implementation of these policies more difficult.

Child Welfare↗
PubMed1989

The complex posterior septal space in the Wolff-Parkinson-White syndrome. Surgical experience with 47 patients.

Forty-seven consecutive patients with the Wolff-Parkinson-White syndrome due to posterior septal accessory pathways were operated on from August 3, 1983 to March 23, 1989. Seven of these patients had Ebstein's anomaly, another three coronary sinus aneurysms, one a persistent left superior vena cava, and five others complex multiple pathway combinations. Two additional patients required surgery following unsuccessful catheter ablation and one after failed surgery at another institution. Thus nineteen of forty-seven patients (40%) had additional difficulty factors which tend to complicate the operative dissection in this already complex anatomical area. The surgical anatomy of the posterior septal space as well as the essential operative principles and techniques are reviewed. Each of the frequently encountered additional difficulty factors is described with emphasis on the coronary sinus aneurysm, a recently recognized entity.

Adolescent↗
PubMed1989

Long-term follow-up in patients with arrhythmogenic right ventricular disease.

Follow-up was obtained in 33 of 35 patients with arrhythmogenic right ventricular disease (ARVD) from three centers, one in France, and two in the United States. The majority of patients are living but require antiarrhythmic drug therapy. Analysis of syncope as a prognostic factor for arrhythmic death in this series, as well as in patients with ARVD reported in the literature, suggests a more favourable long-term prognosis in those patients who did not have a history of syncope. ARVD may be due to a variety of pathological entities and the prognosis of patients who have different aetiologies may well be distinct from one another.

Adult↗
PubMed1988

Surgical treatment of arrhythmias.

Surgical treatment of arrhythmias is often more expeditious and more cost-effective in the long run than pharmacologic therapy. In the past, surgical treatment of arrhythmias has been reserved for patients with disabling paroxysmal or incessant tachycardia refractory to medical management, severe life-threatening arrhythmia or aborted episodes of sudden death. However, tachyarrhythmias that are refractory to pharmacologic therapy because of drug inefficacy, noncompliance or limiting side effects are not uncommon. Although nonpharmacologic treatment of arrhythmias carries with it a one-time period of higher risk (i.e., when the patient undergoes surgery), it is curative and often preferable to the uncertainty and possibly higher cumulative risk associated with medical management.

Arrhythmias, Cardiac↗
PubMed1988

Balloon valvuloplasty in calcified aortic stenosis: a cause for caution and alarm.

Balloon dilation by the percutaneous route has recently been recommended as an alternative to surgical intervention in the management of calcified aortic valvular stenosis. To investigate the validity of balloon valvuloplasty, this procedure was carried out in the operating room under direct vision in 30 patients just prior to excision and replacement of the ossified aortic valve. Changes induced by balloon dilation were evaluated by visual inspection as well as by geometric measurements. By visual observation, balloon valvuloplasty did not have a detectable impact on the valvular anatomy in about 19 of the patients and induced enlargement of the functional aortic orifice judged as "minimal" or "moderate" in only 11. In no patient was there a substantial increase in the functional orifice size. These findings were supported by geometrical measurements. Therefore, we believe that the virtues of this procedure have been grossly overstated by its proponents and that it should be offered only to patients who present a truly forbidding risk by standards of modern surgery.

Adult↗
PubMed1988

Laser ablation of ventricular tachycardia.

About 5-10% of patients after myocardial infarction experience sustained ventricular tachycardias. Drug therapy is successful only in 60% of these patients, so that a number of them is on a high risk of a sudden cardiac death. Indirect surgical approaches like myocardial revascularization, or aneurysm resection have proven to be ineffective in the treatment of these malignant tachycardias. By the development of electrophysiologic techniques a mechanism of the ventricular tachycardias could be identified as a micro-reentry at the border of myocardial infarction. On this base different direct surgical approaches were advocated by Guiraudon, proposing an encircling endocardial ventriculotomy and by Josephson and Harken recommending a subendocardial resection technique. The results of these direct procedures were much better than those of the prior indirect techniques. The mortality in this series was around 10% and there still was a postoperative recurrence of the tachycardia in about 20-30%. Our group started a study in which a Nd:YAG laser was used to photocoagulate areas of myocardium responsible for the initiation of ventricular tachycardia. By its deeper penetration depth the Nd:YAG laser was preferrable to other laser systems like CO2 and Argon-laser. In contrast to cryothermy the Nd:YAG showed three special advantages: First, it was more effective in the normothermic myocardium, it showed not peripheral zone of temporary myocardial injury, potentially causing late failures, and third equal ablation of tissue could be achieved in much shorter time. Patients were considered operative candidates when drug therapy failed. Preoperative investigations included formal cardiac catheterization and an electrophysiologic testing with induction and mapping of the ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Procainamide infusion test: inability to identify patients with Wolff-Parkinson-White syndrome who are potentially at risk of sudden death.

Persistence of preexcitation in sinus rhythm with procainamide infusion has been reported to occur in patients with a short anterograde accessory pathway effective refractory period (AERPAP) and this test has been proposed as a reliable noninvasive method to identify patients with the Wolff-Parkinson-White syndrome who are at risk of sudden death. However, sudden death correlates best with a shortest preexcited RR interval during atrial fibrillation (SRRPE) of 260 msec or less. We infused 10 to 12 mg/kg procainamide to 56 patients to determine whether persistence or loss of preexcitation in sinus rhythm identified patients with SRRPEs of 260 or less or greater than 260 msec, respectively. Atrial fibrillation was induced in 53 patients. Of these, 32 patients had persistence of preexcitation with procainamide infusion and SRRPE in this group of patients was shorter than that in patients in whom preexcitation was lost (194 +/- 44 vs 235 +/- 55 msec, p less than .05). However, preexcitation persisted after procainamide infusion in only 31 of 46 (67%) patients with SRRPEs of 260 msec or less. Furthermore, 15 of 21 patients who lost preexcitation had SRRPEs of 260 msec or less and two of these patients had a history of ventricular fibrillation. The correlation between AERPAP and SRRPE was studied in a separate group of 79 patients with single accessory pathways. There was a significant (p less than .001) but poor (r = .58) correlation between these two variables. Thus, the procainamide test regarding accessory pathway refractoriness often cannot be extrapolated to SRRPE.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed1988

False aneurysm of the common femoral artery secondary to migration of a threaded acetabular component. A case report and review of the literature.

A 66-year-old woman with severe rheumatoid arthritis had revision of a protrusio acetabuli component with a threaded socket. Subsequent anteromedial migration of the socket and thread laceration of the common femoral artery resulted in a pseudoaneurysm and massive pelvic erosion seven months later. Vascular reconstruction and excisional arthroplasty were necessary. Later, gracilis and gluteal muscle flaps were swung to fill the resultant pelvic cavity. The hip was nonreconstructable. Ten months later the wound healed and the patient was ambulating in a walker. This represents a previously unreported cause of vascular injury complicating total hip arthroplasty (THA). A comprehensive review of the English and European literature illustrates the various mechanisms of vascular trauma in this setting and provides a rational basis for prevention.

Acetabulum↗
PubMed1987

Technical considerations in the surgical approach to multiple accessory pathways in the Wolff-Parkinson-White syndrome.

Surgical techniques for the approach to and division of atrioventricular accessory pathways have been designed and perfected during the past 18 years. The standard method of exposure of a single left free wall accessory pathway is by a left atriotomy. All other single accessory pathways are exposed through a right atriotomy. Up to twenty percent of patients with Wolff-Parkinson-White (WPW) syndrome harbor multiple atrioventricular accessory pathways. In this subgroup, classic operative techniques, especially the methods of approach, must be combined or modified depending on the specific locations of the accessory pathways encountered. Eighteen of 90 patients operated on for WPW syndrome at Charlotte Memorial Hospital from August, 1983, through September, 1986, had multiple accessory pathways. Thirty-eight of thirty-nine pathways were successfully divided. One posterior septal accessory pathway reappeared 2 months postoperatively and was catheter ablated. The most frequent combination of atrioventricular accessory pathways included a right free wall and a posterior septal accessory pathway (10 patients). This combination is approached by a right atriotomy. The posterior septal space dissection is extended onto the right free wall area. Technically the most difficult combination includes a left free wall and a posterior septal accessory pathway (3 patients in the present series). Our preferred approach is begun with a right atriotomy for the posterior septal space dissection, followed by an atrial septotomy to expose the left free wall area. There are other methods, however, that may be advantageous depending on the exact locations of the accessory pathways encountered.

Adolescent↗
PubMed1987

The long R-P' tachycardias.

The family of tachycardias that are called long R-P' tachycardias represent a unique group of tachycardias which have been notably refractory to pharmacologic therapy in the past. On the surface electrocardiogram, the rhythms may be indistinguishable. It is only with careful electrophysiological evaluation in many cases that these rhythms can be sorted out. The differential diagnosis in these rhythms is important because with incessant tachycardia, ventricular dysfunction may be produced. In many of the instances of long R-P' tachycardias definitive and directed ablation of the tachycardia can be accomplished. New techniques involving catheter ablation and super-selective surgical dissection are now present which makes ablation of these tachycardias possible.

Atrioventricular Node↗
PubMed1987

Neodymium:YAG laser photocoagulation: a successful new map-guided technique for the intraoperative ablation of ventricular tachycardia.

Neodymium:YAG laser photocoagulation was used in the intraoperative treatment of drug-resistant ventricular tachycardia (VT) in 17 consecutive patients. The cause of VT was previous myocardial infarction in 15, sarcoid in one, and idiopathic in one patient. Electrophysiologic studies were performed preoperatively, before hospital discharge, and 8 to 12 weeks and 1 year after surgery. At surgery, laser photocoagulation was performed on the normothermic heart during VT. Surgical mortality was 11.7%. There was one late nonarrhythmic death 35 days postoperatively. There were 55 VT morphologies. Laser successfully abated 52 of 55. Associated use of cryoablation was required in two of 55. One VT in the patient with sarcoidosis was not successfully ablated but was controlled by procainamide. In the long-term survivors with VT due to myocardial infarction the surgical cure rate was 100%, i.e., no spontaneous or inducible VT. Follow-up ranges from 6 to 18 months (mean 11.8 +/- 4.3). Nd:YAG laser photocoagulation is an effective addition to the operative treatment strategies for VT.

Adult↗
PubMed1986

Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction.

Eight patients, aged 5 to 57 years, with uncontrolled symptomatic tachycardia for 2.5 to 41 years (mean 15) and significant left ventricular (LV) dysfunction in the absence of any other apparent underlying cardiac disease underwent evaluation. Incessant tachycardia was present for 0.5 to 6.0 years (mean 2.1) in 7 patients. One patient had an ectopic atrial tachycardia and 7 patients had an accessory atrioventricular pathway that participated in reciprocating tachycardia. Six patients underwent surgery; the ectopic focus was ablated in 1 patient and an accessory pathway was divided in 5 patients. One patient underwent open ablation of the His bundle and 1 patient underwent closed-chest ablation of the atrioventricular conduction system. Myocardial biopsy specimens were obtained from 5 patients, none of which yielded a specific diagnosis. Pretreatment radionuclide angiography demonstrated a mean ejection fraction (EF) of 19 +/- 9% (range 10 to 35%). Following tachycardia control a marked improvement in LV function was noted in 6 of 8 patients at rest and in 1 additional patient during exercise. The EF increased to 33 +/- 17% (range 16 to 56%) an average of 8 days after treatment and to 45 +/- 15% (range 22 to 67%) at late follow-up 3.5 +/- 40 months (mean 17) later (p less than 0.005). Seven patients remain asymptomatic 11 to 40 months (mean 22) after the corrective procedure and have resumed normal activities. These findings suggest that chronic uncontrolled tachycardia may result in significant LV dysfunction, which is reversible in some cases after control of the arrhythmia.

Adolescent↗
PubMed1986

Successful clinical laser ablation of ventricular tachycardia: a promising new therapeutic method.

This preliminary report describes 5 consecutive patients operated on for drug-resistant ventricular tachycardia (VT). All were successfully treated with laser photocoagulation ablation alone. The continuous-wave neodymium:yttrium-aluminum garnet (Nd:YAG) laser (wavelength, 1.06 micron) was chosen because of its capability for controlled deep tissue penetration, which can be adjusted by manipulating the power and exposure time of the beam. All patients had severe coronary artery disease. Preoperative left ventricular ejection fractions were low (0.18 to 0.29). Risk factors associated with increased failure rates by conventional surgical approaches were frequent: absence of discrete left ventricular aneurysm (5 patients) and multiple VT morphologies with disparate sites of origin (4 patients). All patients recovered fully. VT was not inducible prior to discharge, and no patient was placed on a regimen of antiarrhythmic drugs. Current direct surgical approaches to drug-resistant VT have markedly improved operative results compared with indirect procedures. However, failures and mortality remain high. Laser photocoagulation obviates some of the problems associated with conventional methods. It is similar to cryotherapy in that the structural integrity of affected tissues is maintained. In contrast to cryosurgery, however, laser photocoagulation is achieved more rapidly and with more precise myocardial destruction. One of the most promising features of laser coagulation is that it is administered to the perfused normothermic heart. Consequently, each morphological form of induced VT is observed to disappear as its area of origin is systematically located by mapping and then ablated.

Aged↗