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Biomedical subjects

L M Bargeron

Publications and source records attributed to L M Bargeron.

At least 55 records · Page 3Linked to original sources
PubMed1983

Repair of transposition of the great arteries with ventricular septal defect by an arterial switch operation.

Six patients with transposition of the great arteries and a large ventricular septal defect (VSD) underwent repair by transatrial VSD closure and arterial switching with translocation of the coronary ostia. They ranged in age from 2.0 to 18.8 months, and weighed between 3.2 and 9.9 kg. Each patient survived the perioperative period and was clinically well 7.2 to 15.9 months later. Cardiac catheterization studies done in four patients 0.25 to 7.5 months after surgery showed normal ventricular function in all, a competent aortic valve in two, and trivial and mild aortic valve incompetence in one each. This experience with a small group supports this surgical method as the procedure of choice for most patients with transposition of the great arteries and large VSD.

Abnormalities, Multiple↗
PubMed1982

Visualization of pulmonary vein obstruction by pulmonary artery wedge injection.

One of the major postoperative complications of total anomalous pulmonary venous connection is obstruction of the pulmonary veins. This event may be apparent immediately after surgery when it is usually due to congenitally obstructed veins or later when it may be the result of failure of commensurate growth of the left atrium-common vein anastomosis or of scarring at the anastomotic site. The exact location of the obstruction becomes, then, of paramount importance in deciding if the patient can be helped by further surgery. At cardiac catheterization, pulmonary artery wedge injection was the only angiographic technique that visualized the site and degree of pulmonary venous obstruction in the case reported here.

Child, Preschool↗
PubMed1982

Late survival and symptoms after repair of tetralogy of Fallot.

The long-term results of 414 patients who underwent repair of tetralogy of Fallot between 1967 and 1977 were studied and correlated with the results of others. There were nine late deaths (8-year actuarial survival 95.8%). Six of the deaths wee directly related to the malformation or its treatment. Eight patients (2.4%) required reoperation. Ten patients (4.8%) had arrhythmic symptoms. Eight (3.1%) had congestive heart failure that required treatment. The risk factors associated with late events of all types, including death, were: older age at repair, a high mean ratio of peak systolic right-to-left ventricular pressures (PLV/RV) immediately after repair, and the presence of a Potts anastomosis. Neither a transannular patch nor a previous Blalock-Taussig or Waterson anastomosis was an incremental risk factor. Bacterial endocarditis was not observed. Three hundred seven patients underwent repair primarily or after a single Blalock-Taussig or Waterston shunt and had a PRV/LV of 0.85 or less after repair. Among these selected patients, the actuarial survival was 98.1%, which is still lower than that for the general population (p = 0.12), and freedom from events was 95.9%. Late after repair, PRV/LV was lower by 6 +/- 28% (+/- SD) than PRV/LV immediately after repair (p = 0.03) in the 33 restudied patients with such data. The higher the PRV/LV immediately after repair, the greater the percent reduction.

Adolescent↗
PubMed1982

The electrocardiogram in tetralogy of Fallot with complete atrioventricular canal.

The electrocardiograms in nine cases of tetralogy of Fallot with complete atrioventricular canal were reviewed. Only six patients had the typical pattern of right ventricular hypertrophy and superiorly displaced loop in the frontal plane. Of the remaining three patients, two had only right ventricular hypertrophy and one had a normal electrocardiogram. The necessity of two-dimensional echocardiography or an accurate catheterization technique designed to reveal the combined lesions, even when unsuspected, is emphasized.

Journal Article↗
PubMed1982

Determinants of early success in repair of aortic coarctation in infants.

Fifty-five infants less than 1 year of age underwent repair of coarctation of the aorta between 1967 and 1981. Sixteen (29%) died while in the hospital, with one death occurring from "pure" coarctation. Of the remaining patients, four among 20 with associated ventricular septal defect (VSD) and 11 among 19 with other major associated cardiac anomalies (p = 0.002) also died. Thirteen (62%) of 21 patients treated by resection and end-to-end anastomosis died in the hospital, while only two (7%) of 30 in whom the subclavian flap repair was used died (p less than 0.0001). Good femoral pulses were present early postoperatively in 29 of 30 patients with the subclavian flap in whom observations were recorded and in nine of 12 patients who received end-to-end anastomosis (p = 0.06). Multivariate analysis showed only the very small size of the patient, the presence of major associated cardiac anomalies other than VSD, and nonuse of the subclavian flap method to be incremental risk factors for hospital death. These data and the reports of others show the subclavian flap technique to be the method of choice for repair of coarctation of the aorta in infants.

Aorta↗
PubMed1982

Septation of the univentricular heart with left anterior subaortic outlet chamber.

Surgical repair by ventricular septation was accomplished in 16 patients with univentricular heart of the left ventricular type, two atrioventricular (AV) valves, and a left anterior subaortic outlet chamber. There were seven hospital deaths (44%; CL 29% to 60%), six from low cardiac output, including each of five patients with outlet foramen obstruction (100%; LC 68% to 100%), In the subset of 11 patients with unobstructed outlet foramen, there were only two deaths (18%; CL 6% to 38%), both in patients with small ventricular size. Multivariate analysis in the group of 16 patients indicates that small ventricular size and again the presence of outlet foramen obstruction are incremental risk factors for hospital death. No late deaths occurred among nine survivors followed between 2 months and 4 years (median = 1.5 years). Only one patient was taking cardiac medication and each was in New York Heart Association Functional Class I. Late postoperative exercise testing in seven showed good exercise tolerance, although values were below normal for children of similar age. Planned initial palliation, appropriate timing to repair, appropriate patient selection, and improving surgical methods should reduce hospital mortality further. The late functional results are encouraging and support continuation of this surgical procedure in patients with suitable anatomy.

Blood Pressure↗
PubMed1982

Determinants of early and late results of repair of atrioventricular septal (canal) defects.

The anatomic and functional characteristics of 310 consecutive patients undergoing repair of atrioventricular (AV) septal defects were studied. The characteristics of the six leaflets of the common (139 patients) or two-orifice (171 patients) AV valve are described. Interventricular communications were present in 156 patients and major associated cardiac anomalies in 73 (tetralogy of Fallot 20, double-outlet right ventricle nine, and others). Fifty-one patients (16%) died in hospital. The incremental risk of young age disappeared after 1976. Severity of preoperative AV valve incompetence and New York Heart Association (NYHA) functional class affected hospital mortality. Current risks for patients without major associated cardiac anomalies are 0.6% to 4% for patients in NYHA Class III without an interventricular communication, depending on the degree of preoperative AV valve incompetence, and 5% to 13% for such patients with an interventricular communication. Actuarial survival at 12 1/2 years postoperatively is 95% when preoperative AV valve incompetence is absent or mild and 88% when it is more severe (Grade 3, 4, or 5). Actually, 92% of hospital survivors are alive and in NYHA class I or II. Failure of the AV valve repair occurred in 32 (10%) of the 310 patients and occurred more frequently when AV valve incompetence was severe preoperatively. Its frequency is reduced by current repair techniques, except in patients without interventricular communication.

Age Factors↗
PubMed1981

Angiography of atrioventricular canal defects.

The axial angiograms of 20 patients with an atrioventricular (A-V) canal defect were carefully examined and compared with anatomic observations made at operation. A common A-V valve was present in 15 patients and two separate valves in 5. The atrial septal defect, the anatomy of the ventricular septum and the morphology and functional status of the A-V valves were well demonstrated. There ws consistent angiographic deformation of the normally straight contour extending from the noncoronary aortic cusp to the crux cordis observed in the four chamber and elongated right anterior oblique projections of the left ventricular angiogram of each patient. This deformity is caused by the deficiency or absence of the A-V septum and is the best angiographic sign of the malformation. The differentiation of two separate valves from a common A-V valve was uniformly made. When a common A-V valve was present, three of the five leaflets were usually identified but distinction of the free floating from the tethered anterior leaflet was not always possible. It is concluded that axial techniques provide more complete angiographic definition of the anatomic abnormalities of A-V canal defects than are demonstrated from frontal and lateral views.

Angiocardiography↗
PubMed1981

Intracardiac surgery in infants under age 3 months: predictors of postoperative in-hospital cardiac death.

Data are reported on 142 infants less than 3 months old who left the operating room alive after an open intracardiac operation during the 13 years from January 1967 to July 1980. The probability of postoperative in-hospital cardiac death for acute postoperative heart failure (the most common mode of death in these infants) was found by multivariate logistic analysis to be significantly related only to the strength of pedal pulses, the pedal skin temperature and the cardiac index in the first 5 postoperative hours. When cardiac index was not analyzed and cold cardioplegic myocardial preservation methods used, only pedal pulses and pedal skin temperature were significant predictors of hospital death. Blood pressure and heart rate were not related to this mode of hospital death. Oliguria occurred in 23 percent of patients; it was related primarily to inadequate cardiac performance and increased the probability of hospital death. Treatment protocols are derived based on these facts.

Cardiac Output↗
PubMed1981

Axial cineangiographic evaluation of the posterior ventricular septal defect.

The posterior or inlet ventricular septal defect may occur as an isolated anomaly or in combination with other defects. Axial cineangiography is the best means to delineate the anatomy of this defect as well as to exclude the presence of other ventricular septal defects. The posterior ventricular septal defect can be recognized in the four chamber view by obliteration of the septum by contrast medium flowing across the defect. Anterosuperior extension into the perimembranous region is identified by obliteration of the septum in the long axial oblique view. The presence of a posterior ventricular septal defect can be suspected on the basis of a two dimensional echocardiogram or electrocardiographic left axis deviation. When this is the case, the four chamber view should be performed first so that contrast material in the liver blood pool from a previous injection does not interfere with image quality.

Cineangiography↗
PubMed1981

Angiographic anatomy of the normal heart through axial angiography.

We sectioned a series of hearts in a manner similar to that seen on angiographic axial views. A correlation with normal angiograms to identify the anatomic components of the four cardiac chambers showed that the components of the normal cardiac anatomy can be identified accurately through axial angiography in a manner not show previously.

Heart↗
PubMed1981

Tetralogy of Fallot: an angiographic-pathologic correlative study.

The anatomic abnormalities observed by cineangiographic axial techniques of 12 patients with tetralogy of Fallot were correlated with anatomic details noted at necropsy. Right ventricular angiograms made in the right anterior oblique view best demonstrated the severity and type of infundibular obstruction and also permitted differentiation of the perimembranous, infundibular muscular and subarterial types of ventricular septal defects. The degree of aortic overriding was best displayed in the long-axis view. Comparison of the intracardiac anatomy of each postmortem specimen with the respective premortem cineangiogram has provided further clarification of the angiographic anatomy displayed by these axial techniques.

Aortography↗
PubMed1981

Congenital heart malformations: sequential angiographic analysis.

A segmental angiographic analysis of congenital heart malformations has been developed with the intention of making evaluation of complex congenital heart anomalies as comprehensive as possible. Each vascular and cardiac segment is analyzed sequentially, considering morphology, connections, and relations. Additional associated cardiovascular abnormalities such as shunts, stenoses, hypoplasias, and atresias are also considered. Information analyzed and presented in this way has more immediate anatomic and physiologic meaning than ambiguous terms, often with obscure embryologic implications. Disagreements regarding definitions and nomenclature will continue; however, a logical framework that allows clear communication among cardiologists, surgeons, and angiographers is absolutely necessary and is provided by the orderly analysis presented here.

Coronary Vessel Anomalies↗
PubMed1980

Repair of complete atrioventricular canal associated with tetralogy of Fallot or double-outlet right ventricle: report of 10 patients.

Ten patients with complete atrioventricular (AV) canal and tetralogy of Fallot or double-outlet right ventricle (DORV) with subaortic ventricular septal defect and pulmonary stenosis underwent complete repair. Associated cardiac anomalies were frequent, and 3 patients had situs ambiguus and 1 had situs inversus. Two (40%) of the 5 patients with comple AV canal and tetralogy of Fallot died in hospital, as did 3 (60%) of the 5 with complete AV canal and DORV. No deaths occurred among the 4 patients in whom repair could be done without using a transannular patch across the pulmonary valve ring or a valved external conduit. Five (62%) of the 8 without major associated malformations survived. Preoperative study must define completely the malformation. The repair, done through the right atrium alone or in combination with a right ventriculotomy, is most easily accomplished with separate patches for the ventricular and atrial components of the septal defect.

Heart Atria↗
PubMed1980

Recognition of developing left ventricular outflow tract obstruction in complete transposition of the great arteries.

In the months following balloon atrial septostomy for complete transposition of the great arteries (TGA), clinical deterioration is often ascribed to closure of the septostomy. Of 16 neonates with TGA, 5 showed early clinical deterioration. Each had an adequate septostomy at operation. Deterioration was characterized clinically by increasing cyanosis and radiographically by progressive diminution in pulmonary vascularity. Subsequent catheterization and axial cineangiography demonstrated that pulmonary flow had decreased, probably secondary to a progressive form of left ventricular outflow tract obstruction (LVOTO) characterized by bulging of the ventricular septum with mitral valve apposition. It is important to recognize this phenomenon as an aid in predicting which children will need early surgical intervention.

Cardiomyopathy, Hypertrophic↗
PubMed1980

Concomitant axial cineangiography and barium esophagography in the evaluation of vascular rings.

Six vascular rings were evaluated using axial biplane cineangiography and concomitant barium esophagography. Three patients had a double aortic arch, two had a right aortic arch and aberrant left subclavian artery with a foreshortened left ligamentum arteriosum, and one had a pulmonary vascular sling. Barium was administered in the esophagus of the anesthetized patient followed by cineangiography. Five patients were evaluated using both the standard and four-chamber projection, while the sixth patient with the pulmonary sling was evaluated in the standard and sitting projection. With the four-chamber view, vascular rings were exposed and atypical features such as a small right aortic arch component and branch stenoses of the brachiocephalic arteries were revealed. Axial views with an esophagogram allow easier morphologic analysis and more precise definition of the vascular abnormality than conventional views.

Adult↗