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Biomedical subjects

J Somerville

Publications and source records attributed to J Somerville.

At least 19 recordsLinked to original sources
PubMed1992

Obstruction in extracardiac ventriculopulmonary conduits: value of nuclear magnetic resonance imaging with velocity mapping and Doppler echocardiography.

OBJECTIVES: This study was designed to investigate the value of noninvasive imaging modalities for the detection of obstruction in extracardiac ventriculopulmonary conduits. BACKGROUND: the diagnosis of obstruction in a conduit by noninvasive methods can be difficult. Obstruction may be silent and its progression unnoticed. Nuclear magnetic resonance imaging (NMR) with velocity mapping is a new noninvasive technique that can provide high resolution images and has been shown to be a reliable method of measuring blood flow velocity. METHODS: Two-dimensional echocardiography, pulsed wave Doppler echocardiography and NMR spin echo imaging were used in 52 patients with an extracardiac ventriculopulmonary conduit. Continuous wave Doppler echocardiography was used in 30 of these, Doppler color flow mapping in 26 and NMR velocity mapping in 12. Cardiac catheterization data were available in 27 patients and operative or autopsy findings in 11. RESULTS: The conduit could be assessed by two-dimensional and pulsed wave Doppler echocardiography in only 17% of patients. Doppler color flow and continuous wave echocardiography provided technically satisfactory data in 19% and 83%, respectively. The anatomy of the conduit was adequately displayed by NMR imaging in 90%. A minimal diameter less than 18 mm indicated conduit obstruction, although failure to detect calcification resulted in obstruction being missed in some patients. Calculated gradients in obstructed conduits derived from NMR velocity mapping correlated well with results of continuous wave Doppler echocardiography and gave an accurate localization of the site of obstruction as well as a measure of its severity. CONCLUSION: NMR imaging with velocity mapping is the most effective noninvasive method of assessing obstruction in ventriculopulmonary conduits and can obviate the need for invasive investigation before an interventional procedure is performed.

Adult↗
PubMed1992

Echocardiographic demonstration of important abnormalities of the mitral valve in congenitally corrected transposition.

Whereas abnormalities of the morphological tricuspid valve are common in the setting of discordant atrioventricular connections, there are only a few postmortem reports of abnormalities of the mitral valve in this condition. This report describes two patients with discordant atrioventricular connections, in whom important abnormalities of the mitral valve were found during life by cross sectional echocardiography.

Adolescent↗
PubMed1992

Arrhythmias after the Fontan procedure.

OBJECTIVE: To study the determinants and outcome of arrhythmias after the Fontan type operation. DESIGN: Retrospective analysis of data in patients operated on between 1972 and 1986 (follow up 5-19 years (mean 12 years)). PATIENTS: All 60 patients undergoing a Fontan type procedure at the National Heart Hospital, London, during the study period (mean age (SD) 12.3 (6.8) years). RESULTS: Postoperative arrhythmias occurred in 34 patients (57%), and 11 (58%) of 19 early postoperative deaths (within seven days) were related to arrhythmias. Early arrhythmias occurred in 19 (32%) patients of whom 11 (58%) died. All patients with early atrial fibrillation and His bundle tachycardia died and only preoperative atrial fibrillation recurred early. There was a higher incidence of early arrhythmias, which were less well tolerated, in double inlet single ventricle patients (9/19) than in those with tricuspid atresia (8/37). There were no other preoperative determinants of early arrhythmias or deaths from early arrhythmia. Late (after seven days) arrhythmias occurred in 15 (37% of hospital survivors). They had higher right atrial (RA) pressures both early and late after operation and had lower ventricular ejection fractions late after operation. Of those with atrial arrhythmias 86% had RA obstruction and 57% had an RA thrombus or pulmonary embolism at presentation; this was also confirmed in two patients in whom late sudden deaths occurred. Atrial fibrillation early after reoperation for RA obstruction was fatal. The actuarial arrhythmia free survival for hospital survivors was 60% at 10 years. CONCLUSIONS: Early postoperative arrhythmias were poorly tolerated, particularly atrial fibrillation and His bundle tachycardia. Previous atrial fibrillation was a relative contraindication to this procedure. Late postoperative arrhythmias were associated with higher RA pressures measured both early and late after operation and worse late ventricular function. Late arrhythmias may be the first manifestation of RA obstruction, which must be sought. RA thrombus was common in patients with atrial arrhythmias and should be treated early with anticoagulants.

Adolescent↗
PubMed1991

Haemoptysis from false aneurysm: near fatal complication of repair of coarctation of the aorta using a Dacron patch.

We report a case of haemoptysis from a leaking false aneurysm associated with a Dacron patch used to repair coarctation of the aorta twelve years earlier in a 17-year-old girl. This case illustrates a late and potentially fatal complication of this type of operation after a long period of apparent normality. It emphasises the need for informed follow-up and appropriate correctly timed investigations.

Adolescent↗
PubMed1991

The physician's responsibilities: residua and sequelae.

Cardiologists assuming responsibility for adults with congenital heart disease must have knowledge of electrophysiologic, valvular (native valves), prosthetic (valves, patches and conduits), ventricular (especially chamber function), vascular (especially elevated pulmonary vascular resistance) and noncardiovascular residua and sequelae. Acquired cardiac and noncardiac diseases coexist in older adults with postoperative congenital heart disease and add to the physician's responsibilities.

Adult↗
PubMed1991

Successful stenting of a life threatening pulmonary arterial stenosis.

A 35 year old woman with multiple pulmonary arterial stenoses and occlusions was admitted with increasingly severe breathlessness. Balloon angioplasty of a life threatening stenosis in a remaining pulmonary artery branch was attempted on two occasions but without success. When a self-expanding stainless steel stent was inserted at the site of stenosis after a further angioplasty acute localised pulmonary oedema developed as blood flow distal to the lesion increased considerably. This was followed by a slow and dramatic improvement in the patient's condition. She no longer required an urgent transplant and resumed an active life.

Adult↗
PubMed1979

Long-term results of pulmonary autograft for aortic valve replacement.

Eighty-five survivors who left hospital after pulmonary autograft replacement for severe aortic regurgitation have been followed critically. Five patients died in the first five years and 80 were followed for six to 11 years. Important aortic regurgitation occurred only early and was always related to technical malpositioning of one autograft cusp. Seven patients with fascial pulmonary valves had problems, requiring removal in four. There was a small (2%) morbidity from the right sided homograft and six were removed five to seven years later for progressive calcification; three of these had been irradiated. Despite a high incidence of trivial diastolic murmurs this valve replacement is still preferred for young patients without dilated aortic roots since the survivors remain well, with excellent, maintained relief of outflow obstruction, without problems from haemolysis and thromboembolism, and without deteriorating autograft function or need for anticoagulants. Histology of five autografts examined up to seven years after operation has shown normal living architecture.

Adolescent↗
PubMed1979

Changing form and function in one ventricle hearts.

Postnatal changes in morphology of hearts with one functioning ventricle influence physiology, natural history and physical signs. The most important and early changes relate to the acquiring of subpulmonary or subaortic stenosis. For this to occur, the basic anatomy has to be of particular arrangement; investigators should be aware of the problems and search for gradients both at rest and on Isuprel stimulation when the anatomy is appropriately disturbed. Atrio-ventricular valve regurgitation and calcification may also develop. Many changes are predictable from study of the basic pathology and knowledge of them helps to plan management at the correct time in the living patient.

Adult↗
PubMed1979

Ebstein's anomaly: late results of surgical correction.

Between 1969 and 1976, 10 severely disabled patients with Ebstein's anomaly were operated on at the National Heart Hospital using replacement of the tricuspid valve with mounted aortic homografts [9] or dura mater valve [1], plication of the atrialized right ventricle [10], and closure of an associated interatrail communication. 7 survivors have been followed up from 2 to 9 yr. 5 are asymptomatic. Symptomatic tricuspid regurgitation developed in 2 patients; from a paravalvar leak of the tricuspid homograft in one, and in the other calcification with stenosis in an irradiated homograft, 2.5 and 7.5 yr later. Permanent pacemakers were needed in 2 patients, 3 wk and 18 mth after surgery for symptomatic heart block. Despite corrective surgery for the structural abnormalities in Ebstein, late results remain influenced by disorders of rhythm and conduction disturbances, degenerative changes in the valves used for replacement and the intrinsic primary myocardial disease. Such "corrective" procedures in patients with Ebstein's anomaly can result in maintained symptomatic improvement but must be regarded as palliative surgery.

Adolescent↗
PubMed1978

Prolapsed mitral cusps in atrial septal defect. An erroneous radiological interpretation.

Forty patients with simple atrial septal defect had left ventriculograms using cineangiography and/or Elema or Sircam still films. All had open heart surgery and careful scrutiny of the mitral valve by experienced surgeons. Prolapse of the posterior cusp was diagnosed from angiography in 28 patients but was confirmed at operation in only 5. Another 5 had a different mitral valve abnormality and the remaining 18 had no clinical signs to suggest mitral valve dysfunction after operation. It is concluded that though true ballooning or prolapse of the mitral cusps may coexist with simple atrial septal defect, its presence is overdiagnosed from the appearances of left ventriculography on anteroposterior, lateral, and right anterior oblique views. Left ventriculography was equally unreliable in the exact recognition of other anatomical abnormalities of the mitral valve in secundum defect, but accurate when the mitral valve was pronounced to be structurally normal.

Adolescent↗
PubMed1978

Complex pulmonary atresia with congenital systemic collaterals. Classification and management.

80 patients with pulmonary atresia and subaortic ventricular septal defect had complete angiography with right ventricular, aortic and selective arterial angiograms to delineate the anatomy of the central pulmonary arteries and the systemic supply to the lungs, as correct management of the patient depends on this. In 67 (85 p. 100) there were 1-5 large congenital systemic collateral arteries mainly arising at or below the aortic isthmus. This group, referred to as "complex pulmonary atresia" with right aortic arch in 30, had variable central pulmonary artery development, either completely absent in 17, hypoplastic in 33 (49 p. 100) appearing as a "seagull" (une mouette) in the mediastinum on late films or large well developed vessels in 17. Patients with hypoplastic central arteries require special management. We now perform a two stage procedure, initially placing a conduit containing a homograft aortic valve between the right ventricle and small central pulmonary arteries in order to develop them and leaving the ventricular septal defect open. Initial results in 6 patients treated this way are encouraging and it is proposed to close the defect later after enlargment of the pulmonary arteries has occurred.

Adolescent↗
PubMed1978

Hemiplegic spasticity: neurophysiologic studies.

The excitability of segmental reflex pathways in normal subjects and in patients with hemiplegia has been examined by conditioning the monosynaptic H reflex with a 200 msec burst of vibration applied to the tendo Achilles. In 6 normal subjects, the burst of vibration produced a short-latency facilitation of soleus motoneurons (attributed to monosynaptic excitation) which was followed by a longer-latency inhibition. A similar response was observed in 8 patients with hemiplegia, but the late inhibition was significantly less. The loss of an inhibitory mechanism may contribute to the exaggerated reflexes observed in patients with hemiplegia.

Adult↗
PubMed1976

Transposition of the great arteries: logical anatomical arterial correction.

In a 20-month-old child with classic transposition of the great arteries the pulmonary artery, coronary arteries, and aorta were successfully retransposed at arterial level. It was difficult to reimplant the coronary arteries in the dilated pulmonary artery root without damaging the attachments of the valve cusps, and it may be better to divide the pulmonary artery first to avoid this hazard. Retransposition at arterial level will not be suitable for all patients with transposition of the great arteries, and many questions about long-term outcome remain to be answered.

Aorta, Thoracic↗