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Biomedical subjects

J McGhie

Publications and source records attributed to J McGhie.

At least 19 recordsLinked to original sources
PubMed2004

Decline in ventricular function and clinical condition after Mustard repair for transposition of the great arteries (a prospective study of 22-29 years).

BACKGROUND: Great concern exists about the ability of the anatomic right ventricle to sustain the systemic circulation in patients with transposition of the great arteries who have undergone a Mustard procedure. A prospective study was made to examine long-term survival, clinical outcome, and right ventricular function 25 years after surgery. METHODS: Ninety-one consecutive patients underwent the Mustard procedure between 1973 and 1980. After 14 years and again after 25 years (range 22-29 years), patients were studied with ECG, echocardiography, exercise testing, and Holter monitoring. RESULTS: The cumulative survival and event-free survival were 77% and 36%, respectively, after 25 years. Reoperation was necessary in 46%. No major loss of sinus rhythm was found. While all patients had good right ventricular function 14 years after repair, 61% of patients showed moderate-to-severe dysfunction after 25 years, when studied by echocardiography. Furthermore, the QRS complex widened and exercise capacity decreased. CONCLUSION: The anatomic right ventricle appears to be unable to sustain the systemic circulation at long-term follow-up and the clinical condition of patients late after Mustard repair is declining. We can expect more deaths or need for heart transplantation in the next decade.

Adult↗
PubMed1999

Secundum atrial septal defect is a dynamic three-dimensional entity.

BACKGROUND: The aim of this study was to evaluate the diagnostic relevance of 3-dimensional (3D) echocardiography in the assessment of secundum atrial septum defect (ASD2). METHODS AND RESULTS: Twenty-three patients (age 2 to 58 years) with an ASD2 were studied by transthoracic (n = 9) or transesophageal (n = 14) echocardiography for the acquisition of a 3D data set before undergoing surgical repair. Qualitative (location, shape, and structure) and quantitative (largest and smallest anteroposterior and superoinferior diameters) characteristics were analyzed and compared with surgical findings. Intraobserver and interobserver variability were assessed. The gross anatomy of the ASD2, shown by the 3D images, was confirmed by the surgeon in 21 of 23 patients, but the presence of membranous or fenestrated remnants of the valvula foramina ovalis in the defect was not optimally visualized in 7 patients. Three-dimensional echocardiography revealed changes in diameter and shape of the ASD2 during the cardiac cycle. The measured largest and smallest anteroposterior diameters and their intraobserver and interobserver agreement were 274 +/- 12 mm, r = 0. 95 (P <.001), r = 0.92 (P <.001), and 194 +/- 9 mm, r = 0.96 (P <. 001), r = 0.94 (P <.001), respectively. The measured largest and smallest superoinferior diameter and their intraobserver and interobserver agreement were 304 +/- 26 mm, r = 0.90 (P <.001), r = 0.97 (P <.001), and 204 +/- 10 mm, r = 0.83 (P <.001), r = 0.84 ( P <.001), respectively. The correlation coefficient between 2D and 3D echocardiography for the largest anteroposterior and superoinferior diameter was r = 0.69 (P <.001) and r = 0.68 (P =.05), respectively. The correlation coefficient between the measurements from 3D reconstructions and direct surgical measurements was r = 0.20 (P = not significant) and r = 0.57 (P <.05), whereas between 2D and surgery was r = 0.50 (P <.05) and r = 0.26 (P = not significant). CONCLUSIONS: ASD2 has a complex morphology. Three-dimensional echocardiography provides better qualitative and quantitative information on its dynamic geometry, location, and extension as compared with standard 2D echocardiography and might be useful for device selection during catheter-based closure of ASD2.

Adolescent↗
PubMed1998

Observations of leptospirosis in farmed deer.

AIMS: Slaughterhouse and on-farm surveys were undertaken to investigate some aspects of leptospirosis (Leptospira interrogans) in farmed deer in the lower North Island of New Zealand. METHODS: Blood samples and kidneys were collected at slaughter from 601 l-year and older red and red X Wapiti stags and 21 adult hinds from 53 farms (10 or 12 deer per farm). Serum samples were analysed for up to seven Leptospiral serovars. Gross and histological examinations of kidneys were undertaken. Kidneys from 202 deer were cultured for leptospires. A follow-up postal questionnaire (68% response) indicated one herd had been vaccinated prior to the survey. Serological analyses were also carried out on serum bank samples from a previous on-farm survey involving male and female weaner, yearling and adult red deer from 16 commercial deer farms in March and November. RESULTS: Serological reactions at titres > or = 96 to serovar hardjo were present in 73.6%, pomona in 41.5%, copenhageni in 11.3% and tarassovi in 15.1% of farms from the slaughterhouse survey. Antibodies to serovars australis, ballam and balanica were present in three, one and four of six herds studied, respectively. Titre prevalence to hardjo was higher than that of pomona and other serovars within farms. Cultures for Leptospira were positive in 10 stags from six lines with similar prevalence across age groups. Histological examination showed many gross lesions were associated with mild interstitial cellular infiltration characteristic of subclinical Leptospiral infections. Some sections from culture-positive kidneys contained spirochetes in renal tubules. The on-farm survey showed a 10-30% within-herd prevalence of pomona and hardjo titres in 56% of 3-month-old deer herds, but by 11 months of age, 100% of herds were titre-positive with high prevalences to one or both serovars. Concurrently, herds of 1-year-old and adult deer on the same farms were all seropositive. CONCLUSION: This study has shown that Leptospiral infections are common in farmed deer in the survey area.

Journal Article↗
PubMed1996

Functional assessment of ALCAPA syndrome by dobutamine stress thallium-201 SPECT and echocardiography.

Exercise 201TI SPECT has been used as a useful method for the assessment of patients with anomalous left coronary artery communicating to the pulmonary artery (ALCAPA syndrome). In this study, we described an adult patient with this anomaly who was evaluated by dobutamine stress testing in conjunction with simultaneous 201Tl SPECT and echocardiography before and after surgery. A large perfusion defect in the anterior wall, septum and apex was detected on the preoperative stress scan with partial reversibility on reinjection scan. Worsening of wall motion abnormalities in the septum and anterior wall was detected by stress echocardiography. In the studies performed 3 mo and 1 yr after reimplantation of the left coronary artery in the aorta, a smaller fixed perfusion defect in the anterior wall and apex was detected without reversibility. No stress-induced wall motion abnormalities were detected. Despite the improvement of perfusion, there was no improvement of regional or global left ventricular function at rest. We report that both dobutamine 201Tl SPECT and echocardiography were useful for the detection of reversible ischemia and for the assessment of the surgical outcome of an adult patient with ALCAPA syndrome.

Adult↗
PubMed1995

Atrial arrhythmias in adults after repair of tetralogy of Fallot. Correlations with clinical, exercise, and echocardiographic findings.

BACKGROUND: The long-term success of intracardiac repair of tetralogy of Fallot is hampered by the occurrence of arrhythmias. Numerous studies have stressed the potential role of ventricular arrhythmias. However, the importance of other arrhythmias in the morbidity of these patients appears to be underestimated. Furthermore, most follow-up studies have been limited to children or adolescents, whereas many patients have reached adulthood after earlier repair of tetralogy of Fallot. The aim of the present study was to determine the incidence of atrial fibrillation, atrial flutter, and other supraventricular arrhythmias in adult patients after intracardiac repair for tetralogy of Fallot and their correlation with surgical and clinical findings. METHODS AND RESULTS: The study group consisted of 53 consecutive patients referred to the Thoraxcenter adult congenital heart disease clinic. They underwent repair at a mean age of 9.1 years (range, 0.7 to 55 years). The median age at the time of study was 23.2 years (range, 15 to 57 years; mean age, 26.6 years), and the mean duration of follow-up of 17.5 years (range, 1.4 to 32 years) after surgery. Records were reviewed extensively for evidence of arrhythmias. The follow-up study included routine 12-lead ECG, 24-hour continuous ambulatory monitoring, and echocardiography, and 46 patients underwent exercise testing. Sinus node dysfunction was recorded in 19 patients (36%), of whom 4 required a permanent pacemaker. Atrial fibrillation or flutter was found in 12 patients, and other supraventricular tachycardias were found in 6. The former were more frequently of older age at follow-up. Antiarrhythmic therapy and cardioversion were typically directed at control of atrial (and not ventricular) tachyarrhythmias. Ten patients (19%) showed nonsustained ventricular tachycardia; they were older at initial surgery and older at follow-up and had more intracardiac repairs and longer cardiopulmonary bypass times. CONCLUSIONS: Despite an emphasis on ventricular ectopy in past series, the main sources of morbidity in adult patients after surgical correction of tetralogy of Fallot emanated from atrial arrhythmias, which were present in one third of the patients.

Adult↗
PubMed1995

Transthoracic three-dimensional echocardiography in adult patients with congenital heart disease.

OBJECTIVES: This study sought to assess both the feasibility and potential role of transthoracic three-dimensional echocardiography for the evaluation of adult patients with congenital heart disease. BACKGROUND: The unrestricted views with depth perception provided by three-dimensional echocardiography with dynamic volume-rendered display may enhance visualization of cardiac structures and detection of abnormalities in patients with congenital heart defects. METHODS: We studied 33 patients with various heart defects (mitral valve anomalies in 9, aortic valve anomalies in 5, subaortic membrane in 5, ventricular septal defect in 4, transposition of the great arteries in 3, tetralogy of Fallot in 2, other defects in 5). Cross-sectional images of the specific region of interest were acquired from either the parasternal or apical window with the rotational technique (2 degrees interval with electrocardiographic and respiratory gating) and postprocessed for resampling in cubic format. From these three-dimensional data sets a multitude of cut planes were selected, presented in volume-rendered dynamic display and analyzed by two observers for comparison with standard two-dimensional images to assess their additional information. RESULTS: Three-dimensional reconstruction was possible in all patients. Structures of interest were evaluated from unusual viewpoints, providing both cardiologists and surgeons with immediate feedback. When compared with standard two-dimensional images, additional information was provided for 12 patients (36%). The mitral valve, aortoseptal continuity and interatrial septum were the structures for which three-dimensional echocardiography was most useful. CONCLUSIONS: Transthoracic three-dimensional echocardiography is feasible and facilitates spatial recognition of the intracardiac anatomy in a significant proportion of patients and enhances diagnostic confidence of complex congenital heart disease.

Adolescent↗
PubMed1993

Long-term follow-up (9 to 20 years) after surgical closure of atrial septal defect at a young age.

To assess the long-term cardiac status after surgical closure of an atrial septal defect (ASD) at a young age, 104 of 135 children who consecutively underwent surgery (aged 0 to 14 years) at 1 institution between 1968 and 1980 participated in a follow-up study and underwent a complete cardiologic examination. Mean follow-up was 14.5 +/- 2.8 years. Most patients (87%) believed their health to be good or very good. At physical examination, all patients were in good health. Ninety-three patients (89%) were in sinus rhythm. Echocardiography showed that right ventricular dilatation was present in 27 patients (26%), 2 of whom had a residual ASD. Bicycle ergometry revealed that 88 patients (88%) had a normal exercise capacity. Both supraventricular and ventricular arrhythmias were observed in 67% of patients by 24-hour ambulatory electrocardiography, but only 3 (3%) had received antiarrhythmic medication, and 4 (4%) had needed a pacemaker. In the group of patients with right ventricular dilatation, the exercise capacity and prevalence of arrhythmias did not differ significantly from those in the group with a normal sized right ventricule. The outcome in patients with a secundum-type ASD was not different from that of those with a sinus venosus-type ASD. The finding of anatomic, functional or electrophysiologic abnormalities was not associated with a longer duration of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Does the measurement of left ventricular isovolumic relaxation time allow early prediction of cardiac allograft rejection?

In order to evaluate the value of isovolumic relaxation time measurement for the diagnosis of moderate acute rejection episodes in cardiac allograft recipients a comparison was made with the histological results from the endomyocardial biopsy. A total of 202 isovolumic relaxation time measurements from 26 patients were compared to the biopsy results. The technique used to record isovolumic relaxation time was dual M-mode echocardiography. In addition a combined phonoechocardiography was used for 54 isovolumic relaxation time measurements from 17 patients. A good correlation was found between these two methods. When the biopsy results were normal the isovolumic relaxation time was 71.4 +/- 15.1 ms. When moderate acute rejection episodes were present isovolumic relaxation time decreased to 50.2 +/- 21.2 ms (p < 0.001). In spite of the close correlation detected at group level, there was a large variability of the measurements without accompanying changes in the biopsy specimen. At the same time a significant overlap was found between the measurements taken during rejection and non-rejection periods making it impossible to use these methods for clinical decision making. We conclude that isovolumic relaxation time measured with these methods is not a sufficiently sensitive parameter for the diagnosis of moderate acute rejection episodes in the individual patient, and in our experience, it is not a substitute for endomyocardial biopsy and can not be applied for clinical decision making.

Adolescent↗
PubMed1989

Portraiture of the stillborn ... should we or should we not?

The idea of photographing a stillborn baby for purposes other than for clinical use has engendered considerable debate from the medical and paramedical professions concerning the ethics and the real value of such a practice. However, it has been recognized by professional organizations and support groups that there is a definite need to provide this kind of service. A photograph of the baby for bereaved parents has proved beneficial in the process of overcoming their grief. A medical photographer gives his views on providing the service and his ideas on the ethics and the practicalities of the technique.

Ethics, Medical↗
PubMed1986

Transesophageal two-dimensional echocardiography: its role in solving clinical problems.

The diagnostic value of transesophageal two-dimensional echocardiography is described in 32 patients in whom precordial echocardiography or angiography, or both, failed to establish a definitive diagnosis. All attempted transesophageal studies were completed without complication and the referral question was definitively answered. Nineteen patients were subsequently submitted to surgery. In 18 of them, the transesophageal echocardiographic diagnoses were proven correct; in 1 patient, the diagnosis was proven partially incorrect. In the 13 unoperated patients the transesophageal echocardiographic diagnoses were not independently confirmed but were assumed correct because incontrovertible images were obtained. These results indicate that transesophageal echocardiography significantly extends the diagnostic capabilities of echocardiography.

Adolescent↗
PubMed1984

Effect of short-term maternal exercise on maternal and fetal cardiovascular dynamics.

Maternal and fetal cardiovascular dynamics were studied immediately after moderate short-term maternal exercise in 28 healthy nulliparous subjects at between 34 and 38 weeks gestation who were randomly assigned to an exercise group (n = 14) or a control group (n = 14). At the end of the study, data from 11 exercise and 12 control subjects were available for analysis. A significant rise in maternal heart rate and systolic and diastolic blood pressure during exercise was observed. Mean blood flow velocity in the fetal descending aorta as measured by pulsed Doppler ultrasound and fetal heart rate did not show any significant changes. These data indicate that there are no cardiovascular signs of fetal stress immediately after moderate short-term maternal exercise.

Adult↗
PubMed1982

Inferior vena cava echocardiography.

The inferior vena cava can be imaged during echocardiography from the subcostal transducer position as an echo-free space at a depth ranging from 6 to 15 cm from the abdominal wall. The normal inferior vena cava M-mode echocardiogram has a "a" and "v" pulsation pattern similar to that seen in the jugular venous tracing and exhibits prominent cyclic respiratory changes. Since right atrial activity can be seen as a pulsation on the M-mode inferior vena cava tracing, specific patterns can be observed during cardiac arrhythmias. In right heart failure the inferior vena cava is usually distended, with diminished respiratory collapse. In tricuspid regurgitation, contrast injected into an arm appears in the inferior vena cava during the "v" wave. "A-wave synchronous" inferior vena cava contrast or a contrast appearance unrelated to the cardiac cycle, frequently with deep inspiration, does not suggest tricuspid regurgitation.

Arrhythmias, Cardiac↗
PubMed1981

Cardiac catheterization under echocardiographic control in a pregnant woman.

A 22 year old woman had signs of rheumatic mitral and aortic valve disease early in pregnancy. Cardiac catheterization was performed during her third month of pregnancy under two-dimensional echocardiographic control without the use of ionizing radiation. Severe mitral stenosis with mild aortic stenosis was found. Five cubic centimeters of 5 percent dextrose in water were injected by hand to obtain left ventriculograms and supravalvular aortograms of sufficient quality to diagnose valvular regurgitation. The use of "echo-catheterization" may have significant advantages in selected clinical situations.

Adult↗
PubMed1981

Ultrasonic assessment of cardiovascular geometry and function in the human fetus.

A new technique of studying fetal cardiac geometry and function from two-dimensional real-time images is presented. A significant increase in left ventricular size with advancing gestational age was observed. Left ventricular cardiac output size with advancing gestational age was observed. Left ventricular cardiac output (LVCO) was 210 +/- 48 ml/min (Mean +/- 1 SD) between 27 and 33 weeks and 336 +/- 35 ml/min between 34 and 41 weeks gestation. Blood flow (mean flow) in the descending aorta during these two periods was 365 +/- 80 and 490 +/- 65 ml/min. In four fetuses, the LVCO per kg birth weight ranged between 114 and 123 ml/kg/min and the blood flow in the descending aorta between 168 ad 179 ml/kg/min. If total cardiac output is considered to be twice the LVCO, the proportion of total cardiac output being distributed through the descending aorta and placenta is about 75% and 45% respectively.

Aorta, Thoracic↗