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J O Fulton

Publications and source records attributed to J O Fulton.

11 recordsLinked to original sources
PubMed1999

Does left ventricular outflow tract obstruction influence outcome of interrupted aortic arch repair?

BACKGROUND: In previous studies left ventricular outflow tract obstruction (LVOTO) has been recognized as an important factor affecting survival and reoperation probability in patients having repair of an interrupted aortic arch (IAA). METHODS: All 72 patients who underwent operation for IAA from January 1, 1985 to June 30, 1997 were reviewed. The presence or absence of LVOTO was noted and the immediate and long-term results were analyzed. RESULTS: Type A IAA was found in 23 patients and type B IAA in 49 patients. Anomalous right subclavian artery was noted in 15 patients, all of whom had type B IAA. LVOTO was identified in 36 patients before arch repair and was associated with the presence of type B IAA and anomalous right subclavian artery (p = 0.02 and 0.007, respectively). There were 2 hospital deaths (within 30 days) for a mortality of 2.8% (confidence limit [CL] = 0% to 6.6%). There were 7 late deaths over 3,737 patient-months of follow-up (9.7%, CL = 2.9% to 16.6%). Actuarial survival for the whole cohort was 84.8% (CL = 73.2% to 94.4%) at 12 years. There was 87% 10-year survival (CL = 60% to 93%) for patients with LVOTO at presentation compared with 83% (CL = 62% to 92%) for patients without LVOTO (p = 0.85, hazard function 0.87). Twenty-eight patients have required at least one reoperation. The use of conduits to restore right ventricular to pulmonary artery continuity predicted the need for reoperation (p = 0.0001). Patients with presence of a nonseptatable heart were also more likely to need reoperation (p = 0.027) when compared to the rest of the cohort. Freedom from reoperation was 47.3% (CL = 30% to 62%) at 12 years. In patients with LVOTO, freedom from reoperation (55% at 10 years, CL = 33% to 72%) was not significantly different from those patients without LVOTO at presentation (29% at 10 years, CL = 7% to 56%; p = 0.97, hazard function 0.7). Actuarial freedom from recurrent arch obstruction requiring reintervention was 82.7% (CL = 66.7% to 98.7%) at 12 years. CONCLUSIONS: Neonatal complete repair of patients with IAA is possible with low mortality. LVOTO was not a significant risk factor for hospital or late death in patients having complete repair of IAA during this period. The use of conduits for right ventricular to pulmonary artery continuity and the presence of a nonseptatable heart are important risk factors for further operation and will continue to provide added morbidity to these patients.

Aorta, Thoracic↗
PubMed1998

Blunt cardiac rupture caused by zip gun backfire.

A 16-year-old boy who sustained right ventricular rupture after backfiring of a homemade zip gun is reported. The unusual nature of this case together with the mechanisms and management of blunt cardiac rupture are briefly discussed.

Adolescent↗
PubMed1998

The surgical importance of coronary sinus orifice atresia.

Coronary sinus orifice atresia is rare. We describe two cases, one with an atrioventricular septal defect and another with supracardiac totally anomalous pulmonary venous drainage. The association with the latter has not been described previously. The importance of diagnosing the defect is emphasized and surgical treatment is discussed.

Coronary Vessel Anomalies↗
PubMed1998

Blunt cardiac rupture.

Cardiac rupture as a result of blunt trauma is not commonly encountered. Seven patients with this injury have been treated at Groote Schuur Hospital over the past 14 years. All presented with cardiovascular collapse and 4 developed signs of cardiac tamponade. A clinical diagnosis was made in 4 patients and echocardiography was done in 3. Pericardiocentesis was used in 1 patient to confirm the diagnosis. Significant diagnostic delay occurred in 1 patient with associated liver rupture. Two patients required emergency room thoracotomy. All other patients were approached using a median sternotomy. Five patients survived, giving an overall survival rate of 71%. Five patients had right atrial ruptures and 2 right ventricular ruptures. One patient with right ventricular rupture died in the operating room, while another patient with multiple right atrial ruptures died from multiple organ failure after 11 days. We also briefly review the history, mechanisms and pathology.

Adolescent↗
PubMed1997

Complex thoracic vascular injury repair using deep hypothermia and circulatory arrest.

A 61-year-old man with a penetrating injury to the innominate artery, left common carotid artery, and left subclavian artery at their origins from the aortic arch with associated injuries to both innominate veins and an innominate artery to vein fistula after a single stab wound is described. The patient was managed successfully using cardiopulmonary bypass together with deep hypothermia and circulatory arrest. Presentation and management are discussed.

Blood Vessels↗
PubMed1997

Penetrating injuries involving the intrathoracic great vessels.

Forty-four consecutive patients with injuries to the intrathoracic great vessels admitted to our department from January 1982 to June 1994 were reviewed retrospectively. Forty-two patients (95%) sustained stabwounds and 2 (5%) patients had gunshot wounds. The most frequent radiological abnormality was mediastinal widening in 26 patients (59%). Eighteen patients (41%) were haemodynamically stable on admission with the remainder being unstable (46%), agonal (11%) or lifeless (2%). Twenty-two patients (50%) underwent angiography with 1 false-negative study. A total of 48 arterial and 16 venous injuries were identified with the innominate artery (N = 17, 39% of patients) and left innominate vein (N = 8, 18% of patients) the most frequently injured structures. Associated injuries to thoracic viscera occurred in 13 patients (30%). Two patients required cardiopulmonary bypass to repair their injuries. Arterial shunts were not used in any case. Overall mortality was 5% (2/44) and complications occurred in 7 patients (16%).

Adolescent↗
PubMed1996

Stab wounds of the innominate artery.

BACKGROUND: Innominate artery stab wounds are rarely encountered, and the optimal management of this injury is different from that of blunt innominate injury in that permanent bypass shunting should not be necessary. METHODS: The records of 19 patients with stab wounds of the innominate artery who were treated by our department from January 1982 to June 1995 were reviewed. RESULTS: Eighteen patients (95%) sustained zone 1 neck stabs, with a similar proportion having only a single stab wound. Seventeen (89%) of the 18 patients having chest roentgenograms had mediastinal widening. Thirteen patients (68%) were hemodynamically stable at admission; the remainder were unstable (26%) or moribund (5%). Fourteen patients (74%) underwent angiography, with no false-negative studies for arterial injury. Associated injuries to thoracic viscera occurred in 4 patients (21%). All injuries were repaired with either direct suture (18 of 19) or prosthetic interposition grafting (1 of 19). One patient required cardiopulmonary bypass to repair complex injuries. The overall mortality rate was 5% (1 of 19), and complications occurred in 2 patients (11%). CONCLUSIONS: Innominate artery stab wounds can be managed successfully without permanent bypass shunting and with a low mortality rate.

Adolescent↗
PubMed1996

Syphilitic aortic aneurysm eroding through the sternum.

Syphilitic aortic aneurysms are uncommon today. A syphilitic aneurysm eroding through the anterior chest wall with successful surgical treatment is reported. The large size these aneurysms reach, in conjunction with the overlying pressure-induced skin necrosis necrosis can represent a technical challenge to the surgeon, both in the method of repairing the aneurysm as well as reconstructing the chest wall. Syphilitic aortic disease is also briefly reviewed.

Anastomosis, Surgical↗
PubMed1995

Ruptured hepatic hydatid cyst and an unusual case of pseudomonas septicaemia.

Pseudomonas aeruginosa is a very rare cause of septicaemia in adults without significant underlying disease. A case of pseudomonas septicaemia occurring as a complication of a ruptured hydatid cyst in an apparently healthy young soldier is presented. This patient also had unusual pulmonary sequelae resembling pulmonary metastases together with massive haemoptysis.

Adult↗