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Biomedical subjects

K E Fellows

Publications and source records attributed to K E Fellows.

At least 91 records · Page 5Linked to original sources
PubMed1978

Hemodynamically significant primary anomalies of the coronary arteries. Angiographic aspects.

Hemodynamically significant primary anomalies of the coronary arteries are those which alter myocardial perfusion. There are four major types: coronary artery fistulae, origin of the left coronary artery from the pulmonary artery, congenital coronary stenosis or atresia, and origin of the left coronary artery from the right sinus of Valsalva, with subsequent passage of the vessel between the aorta and right ventricular infundibulum. The angiographic features of these lesions are discussed.

Arteriovenous Fistula↗
PubMed1978

Angiographic demonstration of complications resulting from the Waterston procedure.

The ascending aorta--right pulmonary artery anastomosis, originally introduced by Waterston as a palliative shunt to increase pulmonary blood flow in certain cyanotic congenital heart diseases, has been found to be associated with late complications in a significant number of cases. These complications include preferential distribution of most or all shunt flow to the right lung, narrowing or obstruction of the right pulmonary artery at the anastomotic site, increasing stenosis or atresia of the right ventricular outflow tract, hypoplasia of the left pulmonary artery, and obstruction of the shunt itself. A properly planned angiocardiographic study is the principal method of detection of these complications.

Adolescent↗
PubMed1977

Angulation of the inferior vena cava-right atrial junction in children with repaired omphalocele.

Three children with repaired omphalocele underwent diagnostic cardiac catheterization. In addition to intracardiac shunts, each was found to have marked angulation at the junction of the inferior vena cava and the right atrium. After review of our autopsy material following omphalocele repair, it is suggested that the inferior vena cava - right atrial angulation is due to gradual abnormal fixation of this junction either in utero or related to the surgical repair. A change in current surgical therapy is NOT recommended. Angulation of the inferior vena cava - right atrial junction is potentially important because a) it may interfere with venous cardiac catheterization from "below", b) it poses a danger to inferior vena caval cannulation for cardio-pulmonary by-pass, and c) it may become obstructive with time producing portal hypertension.

Cardiac Catheterization↗
PubMed1977

Pediatric cardiac angiography using a 4 French catheter.

Thirty specially designed 4 French pigtail white Teflon catheters 50 cm in length were utilized for angiography using the retrograde arterial approach in 26 infants and children. Angiographic opacification was considered very satisfactory. Apart from one episode of temporary occlusion of the right coronary artery ostium, there were no other significant complications. The catheters were introduced percutaneously in 21 instances and distal pulses were palpable in 18 patients by the second day after catheterization. At postcatheterization testing with increasing volumes and flow rates, the first rupture occurred, delivering 13 ml at 13 ml/second. On testing an additional 15 catheters using fixed volumes of 5, 10, and 15 ml at increasing flow rates, rupture first occurred at 34, 22, and 18 ml/second, respectively. We conclude that this small catheter is relatively safe and satisfactory for the retrograde arterial approach in the study of infants and children.

Angiography↗
PubMed1977

Management of major hemoptysis in patients with cystic fibrosis.

Although bronchoscopy remains the best definitive method for localization of the site of hemorrhage in patients who have massive hemopytsis, angiography remains an important adjunct to this localization. When combined with embolization of the bleeding bronchial artery, it is an effective method of therapy for the management of massive hemoptysis in patients with cystic fibrosis.

Adolescent↗
PubMed1977

Angled views in cineangiocardiography of congenital heart disease.

Simple and compound sagittally angled views of the heart obtained cineangiocardiographically with a parallelographic U-arm device were evaluated clinically in 132 patients with congenital heart disease. The principle advantage of the apparatus was the case with which axial and oblique projections were obtained without repositioning of the patient, although rotation and angulation of the image intensifier-X-ray tube unit resulted in some increase in scattered radiation. Certain angled views, particularly the 40 degree cranial and the compound 25 degrees cranial/70 degrees left oblique projections, were better than standard frontal and lateral views for visualization of pulmonary arteries in the mediastinum, in ventricular septal defects and anomalies of the left ventricular outflow tract.

Angiocardiography↗
PubMed1977

Angiocardiography of obstructing muscular bands of the right ventricle.

Two types of obstructing anomalous muscle bundle are described on the basis of right ventricular angiocardiographic analysis in 28 patients. In the low type the anomalous muscle bundle is located in the midsinus of the right ventricle; in the high type it lies at the subinfundibular level. Ocassionally, both forms of obstruction exist in the same individual. A ventricular septal defect was present in 24 of the 28 patients (85%). Serial catheterizations at a mean interval of 6.6 years demonstrated progession of the obstruction in eight of 15 patients. Differentiation of anomalous muscle bundle from tetralogy of Fallot is facilitated by clear angiographic delineation of the anomalous muscle and the position of the parietal band in most cases, but may not be possible when both anomalies occur together.

Adolescent↗
PubMed1977

Notching of the ureter and renal pelvis in children.

The excretory urograms of 14 children with ureteral notching were reviewed. In 10 of 14 cases the vascular impressions on the ureters were due to either venous obstruction and dilated collaterals or to dilated noncollateral veins. In two cases the notching was associated with arterial collaterals in renal ischemia and in two with dilated lymphatic channels. The implications of notching in children and the differences and similarities of this urographic sign between children and adults are discussed.

Adolescent↗
PubMed1977

Renal parenchymal infections in children.

The excretion urogram-nephrotomogram is the most important imaging study in the diagnosis of renal parenchymal infection in children. If renal parenchymal infections are discovered before significant necrosis has occurred, vigorous treatment with appropriate parenteral antibiotics may result in resolution without the need for surgical drainage.

Abscess↗
PubMed1976

Overriding tricuspid valve: echocardiographic and angiocardiographic features.

Eight cases are presented in which the diagnosis of overriding of the tricuspid valve was made during life and the electrocardiographic, echocardiographic and angiographic features of the defect are presented. Four of the patients had dextrotransposition of the great arteries, three had normally related great arteries and one had corrected transposition. In each case there was hypoplasia of the right ventricle and a ventricular septal defect of the atrioventricular (A-V) canal type. The electrocardiogram in the cases with d-transposition was characterized by diminished right ventricular forces, left ventricular forces, left ventricular hypertrophy and a superior leftward frontal plane axis. The echocardiogram in seven cases demonstrated a septal leaflet of the tricuspid valve opening posterior to the septum into the left ventricle. In four cases the anterior leaflet of the tricuspid valve was shown crossing the plane of the interventricular septum as it opened in diastole. The diagnosis in five cases was made angiographically by a left ventricular injection in the left anterior oblique projection. In this view the septum was viewed tangentially and in diastole the negative silhouette of the tricuspid valve was seen straddling the interventricular septum. The presence of an overriding tricuspid valve can greatly complicate repair of intracardiac defects. The diagnosis of this A-V valve anomaly can be accurately made with the use of echocardiography and selective left ventricular angiography.

Adolescent↗
PubMed1976

The surgical management of discrete and diffuse supravalvar aortic stenosis.

Between 1956 and 1976, 18 patients underwent surgery for supravar aortic stenosis at the The Children's Hospital Medical Center, Boston. Discrete obstruction, present in 11, was treated by insertion of a prosthetic gusset placed across the area of narrowing and extending into the noncoronary sinus of Valsalva. There was one operative death. Residual gradients (measured in five patients) ranged from 4-55 mm Hg, one of which was supravalvar in location. Significant aortic regurgitation was not common preoperatively. The diffuse form of supravalvar obstruction, a more difficult surgical problem, was present in seven patients. There were three operative deaths. Complete relief of the pressure gradient was achieved only in one instance by insertion of a left ventricular-aortic bypass shunt diverting the majority of the cardiac output into the descending thoracic aorta. This patient is now asymptomatic 20 months following operation. On the basis of this experience, it is suggested that patients with the diffuse form of supravalvar obstruction, and perhaps even those with a hypoplastic annulus alone, would benefit from a left ventricular-aortic bypass shunt.

Adolescent↗
PubMed1975

Exercise tolerance after repair of tetralogy of Fallot.

Twelve patients who had undergone complete repair of tetralogy of Fallot at ages ranging from 8 to 27 years were studied for exercise tolerance several years later. Work performance ranged from 58 to 130% of that predicted. Increased physiological dead space and alveolar-arterial Po2 difference at exercise suggested pulmonary vascular disease, which was confirmed in 1 patient by pulmonary angiography. Excercise tolerance decreased with increasing age at time of repair, underlining the desirability of early corrective operation.

Acid-Base Equilibrium↗
PubMed1975

Combined portal and vena caval hypertension in Gaucher disease: The value of preoperative venography.

Portal hypertension in Gaucher disease is unusual; the seventh known patient with this complication is reported. Prior to portacaval shunting in this child, a localized obstruction of the inferior vena cava at the subdiaphragmatic level was demonstrated by caval manometry and inferior vena cavography. At autopsy, centrilobular hepatic fibrosis seemed to be responsible for the portal hypertension. Nodular enlargement of the right and caudate lobes of the liver was the cause of the caval obstruction; elevated caval resistance may have contributed to the portal hypertension and possibly was responsible for failure of a portacaval anastomosis. The value of preoperative inferior vena cavography in addition to arterial portography in children with portal hypertension is stressed.

Child↗
PubMed1975

Selective bronchial arteriography in patients with cystic fibrosis and massive hemoptysis.

Massive hemoptysis is a potentially fatal complication of long-standing cystic fibrosis. Lobectomy may prevent a hemorrhagic death if the hemorrhage source can be identified and if involvement of the remaining lung tissue is mild. Selective bronchial arteriography was performed in six patients with cystic fibrosis to localize a lobar source of bleeding. Arteriographic findings correlated with bronchoscopic observations. Bronchial arteriography may be helpful when bronchoscopy cannot be done because of continuous hemorrhage or because the severity of the lung disease precludes general anesthesia, but it is not an adequate substitute for bronchoscopy in most patients.

Adolescent↗