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Biomedical subjects

M B Kreidberg

Publications and source records attributed to M B Kreidberg.

17 recordsLinked to original sources

Digital subtraction angiography in patients with transposition of the great arteries after surgical repair.

Digital subtraction angiography was used for postoperative evaluation of seven patients who underwent the Senning procedure for repair of d-transposition of the great arteries. Their ages ranged from 2.5 to 3 years. The patients were premedicated with methohexital (25 mg/kg rectally), and 0.3 to 0.4 ml/kg of diatrizoate was injected into a peripheral vein through a plastic needle. Images were obtained on a Technicare DR-960 or Diasonics DA 100 digital angiographic unit at four frames per second using 256 X 256 matrix and a 6 inch (15.24 cm) field size. In all patients, the venous systems, cardiac chambers and great arteries were well visualized. Two patients had obstruction of the superior vena cava with a dilated azygos vein draining into the inferior vena cava. One patient had severe obstruction of the left pulmonary artery. Digital subtraction angiography is safe and easy to perform and appears to be a valuable alternative method for evaluating patients after surgical repair of transposition of the great arteries. The small amount of contrast material required and the low radiation dose make it attractive for use in children.

Arterial Occlusive Diseases↗

Combined discrete subaortic stenosis and ventricular septal defect in infants and children.

Eight patients, aged 1 to 8 years, with discrete subaortic stenosis (DSS) and ventricular septal defect (VSD) were studied by 2-dimensional (2-D) and M-mode echocardiography. Initial cardiac catheterization and angiocardiography showed VSD and other associated cardiac lesions, including coarctation of the aorta and patent ductus arteriosus. None had evidence of DSS. Six patients underwent surgical repair of the associated lesions, but none required closure of the VSD. Ultimately, 6 patients had spontaneous closure of VSD, and 2 had a residual small VSD. Subsequent serial echocardiography showed evidence of subaortic membrane, prompting repeat cardiac catheterization, which confirmed moderate to severe peak systolic pressure gradients between the left ventricle and ascending aorta. Surgical resection of the membrane was performed in 5 patients. Thus, in patients with small or spontaneously closed VSDs, DSS may develop. Evaluation of the left ventricular outflow tract area is recommended in patients with small or closed VSD in whom a significant heart murmur or electrocardiographic abnormality remains.

Abnormalities, Multiple↗

Cardiac and coronary arterial involvement in infants and children from New England with mucocutaneous lymph node syndrome (Kawasaki disease). Angiocardiographic-echocardiographic correlations.

Forty-four patients, aged 6 months to 11 years, meeting the clinical criteria for mucocutaneous lymph node syndrome (Kawasaki disease) were studied from March 1980 to March 1981. A protocol was designed for evaluation of cardiac involvement including electrocardiogram, chest X-ray film, cardiac enzyme determinations and M mode and two dimensional echocardiograms. Aspirin was given during the acute febrile period as an anti-inflammatory agent in a dosage of 100 mg/kg per day; followed by 30 mg/kg per day for 10 weeks or longer if platelet counts were elevated. Angiocardiography was performed in 38 patients. Twenty-one patients (48 percent) showed abnormal M mode echocardiographic findings (flat or greatly decreased ventricular septal motion, pericardial effusion or decreased left ventricular function) during the acute febrile stage. Coronary artery disease developed in seven patients, all of whom had abnormal M mode echocardiographic abnormalities in the acute stage. Five patients had coronary aneurysms and two patients had dilated coronary arteries. Two dimensional echocardiograms identified coronary arterial lesions accurately if present proximally but failed to detect aneurysms beyond 1.5 cm from the aortic root. The study shows that serial M mode and two dimensional echocardiograms provide sufficient information to rule out cardiac involvement in Kawasaki disease. Echocardiograms should be obtained every 3 to 4 days during the acute febrile stage because all patients with coronary artery disease detected with angiography had abnormal echocardiographic findings during that period.

Angiocardiography↗

Transfemoral snaring of broken catheters from the right heart in small infants.

Successful retrieval of embolized central venous catheter fragments from the right heart was accomplished in two small infants weighing 2100 and 4050 Gm respectively. The catheters had been broken off at the site of entry into the vein and migrated to right atrium. A 5F end-hole Cook catheter with 0.018 inch diameter, 125 cm long Curry snaring wire with flexible mid-segment was successfully utilized through the femoral vein percutaneously to remove the foreign body without complication.

Cardiac Catheterization↗

Exogenous hormones and other drug exposures of children with congenital heart disease.

A history of oral contraceptive use, hormonal pregnancy tests, prescribed hormones and other drugs was obtained from 390 mothers of infants with congenital heart disease and 1254 mothers of normal infants in Massachusetts. The data show a small positive association between estrogen/progesterone exposure and cardiac malformation, the prevalence ratio estimate of exposed to non-exposed being 1.5 (90 per cent confidence limits are 1.0, 2.1). No association was evident, however, between hormones and trunco-conal or any other class of defect among the cases, an observation which casts doubt on a causal relationship betweem hormones and cardiovascular malformations. Several other drugs were reported more frequently by cases' mothers. These include: ampicillin; aspirin; a combined anti-nausea agent (doxylamine succinate, dicyclomine hydrochloride and pyridoxine hydrochloride); chlordiazopoxide, codeine, diazepam, diphenylhydantoin; insulin; phenobarbital; phenothiazine; phenylephrine; and tetracycline.

Estrogens↗