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Biomedical subjects

M Michaëlsson

Publications and source records attributed to M Michaëlsson.

At least 19 recordsLinked to original sources
PubMed1995

Isolated congenital complete atrioventricular block in adult life. A prospective study.

BACKGROUND: The prognosis of congenital complete atrioventricular block (CCHB) is usually considered favorable in adults. This belief is based on studies comprising a limited number of patients and with rather short observation times. In the present study, the natural history of the disease was investigated by a prospective follow-up through decades of adult life of patients with a large group having well-defined CCHB without structural heart disease. METHODS AND RESULTS: The diagnostic criteria of CCHB proposed by Yater were applied. Patients registered as having CCHB in 1964, supplemented by younger patients all without symptoms during their first 15 years of life, were selected. The study was limited to patients with isolated, complete, permanent block. An interview was conducted with all patients and clinical follow-up data obtained. There were finally 102 patients, 61 women and 41 men. In November 1994, the time of observation, after the age of 15 years in survivors, was between 7 and 30 years. The mean age at follow-up or at death was 38 years, median age 37 years, and range 16 to 66 years. Stokes-Adams (SA) attacks occurred in 27 patients, in 8 with a fatal outcome. The first attack was fatal in 6 of these 8 patients. Nineteen survived and a pacemaker (PM) was implanted thereafter. Another 8 patients received a PM because of repeated fainting spells, and 27 others have had a PM implanted for other reasons such as fatigue, effort dyspnea, dizziness, ectopies during exercise tests, mitral regurgitation, and a low ventricular rate (VR). VR decreased with age, with a mean rate at 15 years of 46 beats per minute (bpm), at 16 to 20 years of 43 bpm, at 21 to 30 years of 41 bpm, at 31 to 40 years of 40 bpm, and after 40 years of age of 39 bpm. SA attacks occurred in all 7 patients with prolonged QTc time. Low VR at rest or at work, presence of bundle-branch block pattern, low working capacity, and ectopies at rest and/or during effort were not statistically significant risk factors. SA attacks occurred in 6 patients without any of these signs. Mitral regurgitation developed in 16 patients and 4 died. A PM reduced the risk of death. A change to a lower degree of block occurred in 6 patients. CONCLUSIONS: Prophylactic PM treatment is recommended even for symptom-free adults with CCHB because of the high incidence of unpredictable SA attacks with considerable mortality from first attacks, a gradually decreasing VR, significant morbidity, and a high incidence of "acquired" mitral insufficiency.

Adolescent↗
PubMed1986

Anatomy of congenital complete heart block and relation to maternal anti-Ro antibodies.

The anatomy of the conduction system was studied in 8 patients who had isolated congenital complete heart block. Atrial-axis discontinuity was seen in 7 hearts from children born to mothers with anti-Ro antibodies. The anticipated area of the atrioventricular node was occupied by fibrous and adipose tissue. The heart from the only child whose maternal serum was anti-Ro negative had nodoventricular discontinuity of the conduction system. This difference in anatomy may have etiologic significance.

Antibodies↗
PubMed1977

Long-term results following closure of isolated ostium secundum atrial septal defect in children and adults.

Information is presented on 166 patients operated for isolated atrial septal defect of secundum type with a mean follow-up time of 12 yr (range 8-21 yr). The mean age at operation was 23 yr (range 4-63 yr). The incidence of suspected mitral regurgitation is very low (4 cases). Postoperative flutter or fibrillation occurred in 24 cases, 20 out of these were operated after the age of 20 yr. In all 24 cases intermittent or permanent atrial dysrhythmia was present immediately postoperatively. The long-term results with regard to the occurrence of dysrhythmias and increased heart volumes is better in the younger age group.

Adolescent↗
PubMed1976

Congenital left ventricular apical aneurysm.

An aneurysm of the left ventricular apex was accidently discovered on chest X-ray in an otherwise healthy 3 1/2-year-old-girl. Pre-operatively performed heart catheterization and ciné-angiography were followed by successful surgical removal of the aneurysm. Microscopic examination showed that the three layers of the myocardium were present, although it was degenerated by fibrosis. This case belongs to the fibrous type of aneurysm, which is the most rare type, not associated with other developmental defects, usually asymptomatic until there is rupture and sudden death, or the condition is accidentally discovered on chest X-ray and treated surgically.

Child, Preschool↗
PubMed1975

High voltage QRS complexes in children with innocent, "vibratory" heart murmur.

The electrocardiographic findings in 86 four-year-old children with innocent murmur of the so-called vibratory type are described. The electrical axis, the Q, R and S waves in the right and left precordial leads were compared with figures from the literature and with a control group of 4-year-old children without signs of somatic disease. The most significant findings were higher amplitudes of Q and R waves over the left precordium in children with vibratory murmur. Many children in this group had amplitudes of these waves exceeding accepted normal limits. There were no findings compatible with organic heart disease and the difference as compared to normal values and controls is probably a matter of variations in the position of the heart.

Age Factors↗
PubMed1975

Pectus excavatum; a clinical study with long term postoperavtive follow-up.

There are divergent views about the harm that pectus excavatum and related chest deformities does to the respiratory and heart function. The indications for surgery and the optimal age for surgical intervention are debatable. In this study 37 operated and 38 nonoperated cases of about the same severity have been followed for more than ten years and examined after the age of 18 years. The examination included socio-economic, cosmetic and cardio-pulmonary function aspects. It could be shown that from the psychological aspect there were no significant differences between the operated and the non-operated cases. The tendency to contract bronchopneumonia is not influenced by operation. The physical working capacity was the same in the two groups. The operated cases have slightly lower pulmonary function values that the non-operated in spite of the fact that the non-operated group at the time of follow-up included the more seveee cases. Age at operation did not seem to be of any importance for the long-term results. The lower pulmonary function capacity in the operated cases is thought to be attributed to a restriction secondary to the operation. There are also indications that pectus excavatum tends to become less pronounced with increasing age. The study supports a restrictive attitude towards surgery.

Adolescent↗
PubMed1975

Familial, isolated, complete right bundle-branch block.

An electrocardiographic study of the families of two children with isolated complete right bundle-branch block is presented. Several cases of classical complete right bundle-branch block were disclosed (17/69 and 3/22 respectively) in three generations of the two families. Personal interviews and parish registers showed that the two families were related, being descendants 8 generations back from a glass-blower who has emigrated to Sweden in the eighteenth century. It is concluded that complete right bundle-branch block can be an autosomal, genetic anomaly which is inherited dominantly but with reduced penetrance and/or expressivity.

Adolescent↗
PubMed1975

Cardiovascular malformation in infant deaths. 10-year clinical and epidemiological study.

The infant mortality from cardiovascular malformations in a region with a population of 2 million inhabitants during a 10-year period has been studied. The study involved validation of the diagnoses and judgement whether the cardiovascular malformation was the dominating or a contributing cause of death. It is shown that the incidence of fatal cardiovascular malformations is probably overestimated in the official death statistics. Evaluation of the clinical findings and necropsy reports are important aids in obtaining more reliable figures of the incidence. The rate of referral of infants with cardiovascular malformations has increased during the period of this study, so that the number of operable lesions not referred has decreased. The infant mortality rate, found in this study, of 1.33 per 1000 liveborn babies constitutes about 20 per cent of all liveborn infants with cardiovascular malformations. The most common lesions found in those who died belonged to the group constituting the hypoplastic left heart syndrome. The proportion of this type of malformation, about 20 per cent of all those dying, is higher than in other similar studies. This difference can probably be explained by variations in selection and classification.

Aortic Coarctation↗
PubMed1975

Results of partial thyroidectomy for thyrotoxicosis.

In a retrospective study, two series of surgically treated patients with thyrotoxicosis were compared. The series differed with respect to preoperative treatment and operative techniquue. In one series a combined preoperative treatment with an antithyroid drug and 1-thyroxine was given and the recurrent nerves and parathyroid glands were routinely identified. In the other series no such operative routine was followed and iodine was given preoperatively. The complication rate was low in both series. There was no postoperative mortality. The existing differences, although subtle, in the frequency of recurrent nerve paralysis, postoperative hypoparathyroidism or hypothyroidism, as well as recurrent toxicosis, favoured the surgical approach with the combined preoperative treatment and a meticulous technique with identification of recurrent nerves and parathyroid glands.

Adult↗