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M de Leval

Publications and source records attributed to M de Leval.

At least 37 records · Page 2Linked to original sources
PubMed1990

Unusually early recoarctation after extended end-to-end anastomosis in a neonate.

A seven-day-old neonate with aortic coarctation and hypoplastic aortic arch underwent extended end-to-end repair with no residual gradient. Eleven hours after repair, femoral pulses were not palpable and recoarctation was confirmed by echocardiography. After failure of prostaglandin E2 infusion, a radically extended end-to-end anastomosis was performed eight days after initial repair. No recoarctation was evident 10 months after the second repair. The unusually early recoarctation was presumably due to residual and active duct tissue in the repair margins.

Anastomosis, Surgical↗
PubMed1990

Paralysed diaphragm after cardiac surgery in children: value of plication.

Over a 2-year period (1987-1988), 31 children (3% of 960 operations) were found to have a paralysed diaphragm following cardiac surgery. The median age was 5 months with 65% less than 1 year of age. In the 31 patients, 38 paralysed diaphragms were identified. The phrenic nerve injury was on the right in 8 cases, the left in 16, bilateral in 7 and 40% were related to modified Blalock Taussig shunts. The time to extubation was analysed for each patient in two separate groups: Group A: (greater than 1 year): 11 children of whom 5 were extubated without difficulty, 4 had non-respiratory reasons for prolonged ventilation and only 2 were plicated--both were extubated within 4 days. Group B: (less than 1 year): 20 infants of whom 16 were plicated and 4 were not. Three of the children who were plicated died from cardiac causes. Of the 13 survivors, there were 3 who had other reasons for prolonged ventilation. Thus 10 infants required prolonged ventilation (mean 11 days) because of respiratory difficulties. All underwent plication and were extubated at a mean of 2.4 days postoperatively. The 4 who were not plicated were extubated at a mean of 11 days postoperatively. In infants in whom there is no cardiac cause for failure to wean from ventilation, diaphragmatic paralysis should be suspected and plication performed if not extubated 2 weeks after operation.

Anastomosis, Surgical↗
PubMed1989

Myocardial adenine nucleotide metabolism in pediatric patients during hypothermic cardioplegic arrest and normothermic ischemia.

Quantitative assessment of high-energy phosphate levels, including degradation or utilization during ischemia, has not previously been performed in infants and children. Animal experiments suggest that high-energy phosphate metabolism varies with maturation. To help answer these questions, 24 patients aged 2 months to 8 years underwent myocardial biopsy immediately after the institution of cardiopulmonary bypass (16 to 20 degrees C). Additional samples were obtained at 16 and 45 minutes after aortic cross-clamping and administration of cardioplegia (St. Thomas's solution) (in vivo ischemia). Seven patients also underwent major myocardial resection. Resected specimens were placed in a 37 degrees C bath and divided into equal-sized samples that were removed at ten-minute intervals (in vitro ischemia). All samples were immersed in liquid nitrogen and analyzed for adenine nucleotide pool metabolites using high-performance liquid chromatography. Levels of adenosine triphosphate were high before cross-clamping but diminished during the period of protected ischemia. Adenosine triphosphate loss was much more pronounced in patients less than 18 months old (p less than 0.05) and was associated with accumulation of adenosine monophosphate and inosine, a finding not seen in patients more than 18 months old (p less than 0.05). The same trends documented during in vivo ischemia were noted during in vitro ischemia. Immaturity of 5'-nucleotidase results in accumulation of adenosine monophosphate during ischemia. It is known that 5'-nucleotidase is present in neonatal myocardial cell membranes and absent from the cytosol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenine Nucleotides↗
PubMed1989

Early experience of heart-lung transplantation.

We report our experience of heart-lung transplantation for the treatment of children with terminal respiratory disease. Between May 1987 and October 1988 we performed heart-lung transplantation in five children under the age of 16 (age range 11-15). All the patients were severely disabled by dyspnoea and hypoxia. Two had primary pulmonary hypertension, two cystic fibrosis, and one had Eisenmenger's syndrome. All five children are alive and well five to 17 months after operation and have returned to activities normal for their age. Three of the five patients had episodes of infection after operation. These were staphylococcal pneumonia, herpes simplex pneumonitis and, in one of the patients with cystic fibrosis, persistent purulent sputum. The mean number of episodes of rejection per child was 2.7 per half year. Heart-lung transplantation is a practical treatment for children in these disease groups with terminal respiratory failure.

Adolescent↗
PubMed1988

Correction of coarctation of the aorta in neonates and young infants. An individualized surgical approach.

Because of the controversy concerning the ideal surgical repair for symptomatic coarctation of the aorta presenting in neonates and infants, our entire series of 179 children under the age of 12 months undergoing repair between January 1, 1976 and December 31, 1984 was reviewed. Of this group, 109 were neonates, 43 infants aged 31-90 days and 27 infants aged 90 days-12 months. Twenty patients had a simple coarctation and 159 had complex coarctation with additional intracardiac anomalies such as ventricular septal defect (37 patients also had pulmonary artery banding). One hundred and twenty-four were repaired with a subclavian flap operation, 32 with resection and end-to-end anastomosis and 23 with complex repairs (e.g. patch and reversed flap). Type of repair was the surgeon's choice and was selected on the basis of the anatomy of the coarctation. Total perioperative mortality was 15% (N = 27) while late mortality was 12% (N = 21). Twenty-one risk factors for mortality were evaluated by logistic analysis and the method of Cox. There was no risk difference between end-to-end versus subclavian flap repairs and all but one death occurred in patients with complex coarctations. Risk for in hospital death was increased by only one variable: the need for repair in the neonatal period. Risk for death in the first year of life was increased by the presence of congestive heart failure at initial presentation while later death correlated with intracardiac surgery. Recoarctation occurred in 28 patients (18.4%), all but 4 of these occurred in patients undergoing neonatal repairs.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Coarctation↗
PubMed1988

Congenital left ventricular inflow obstruction: is the outcome related to the site of the obstruction?

Between 1978 and 1987, 39 patients aged 1 day to 15 years underwent surgery for symptomatic left ventricular inflow obstruction. Four diagnostic groups were identified: cor triatriatum (6 patients), supravalvar mitral membrane (SVMM) with a normal mitral valve (7 patients), SVMM with an abnormal mitral valve (9 patients) and mitral stenosis (17 patients). Associated cardiac anomalies occurred in 26 patients (67%). There were 8 deaths (21%), 3 in patients with SVMM and an abnormal mitral valve and 5 in patients with mitral stenosis. Survival for patients with normal mitral valves was significantly better than that for patients with abnormal mitral valves (13/13 vs 18/26, P less than 0.05). There was also high morbidity in patients requiring prosthetic mitral valve replacement. These data suggest that the outcome of surgical treatment for left ventricular inflow obstruction may be predicted according to the site of the obstruction. This is best determined preoperatively by cross-sectional echocardiography which allows optimal planning of surgical strategy.

Adolescent↗
PubMed1988

Aortic thrombosis in neonates and infants.

Aortic thrombosis in the neonate occurs most frequently as a complication of umbilical artery catheterization. There is still controversy concerning the appropriate management of this problem. Complications associated with umbilical artery cannulation are numerous and include renal failure, which may necessitate peritoneal dialysis. Because of this possibility, we illustrate and advocate a retroperitoneal approach to the abdominal aorta for thromboembolectomy.

Aorta, Abdominal↗
PubMed1988

Anomalous origin of the left anterior descending coronary artery from the pulmonary trunk: recognition in life and successful surgical treatment.

An anomalous origin of the left anterior descending coronary artery from the pulmonary trunk with the right and left circumflex arteries arising from the aorta is very rare and the diagnosis made only at necropsy. An anomalous coronary artery was suspected owing to unexplained cardiomegaly in a 17 month old girl and the anatomy was defined by angiography. The anomalous vessel was successfully reimplanted into the aorta.

Cardiomegaly↗
PubMed1988

Arrhythmia and late mortality after Mustard and Senning operation for transposition of the great arteries. An eight-year prospective study.

Arrhythmia and late sudden death are recognized complications of intraatrial repair of transposition of the great arteries. We performed a prospective study over 8 years in 100 consecutive hospital survivors who underwent Mustard (46 patients) or Senning (54 patients) operations between 1978 and 1982. Arrhythmia was analyzed by preoperative, postoperative, and serial follow-up Holter monitoring and standard electrocardiograms and was related to clinical outcome. Before repair, all patients were in sinus rhythm with a low incidence of arrhythmia. After repair, there was a gradual decrease in stable sinus rhythm during follow-up so that at a mean of 7 years after operation only 56% of patients having the Senning operation and 66% having the Mustard, with simple transposition, were in stable sinus rhythm on Holter monitoring. There was no significant difference between the two operations. Eleven patients (five after Senning [two simple, three complex], six after Mustard [five simple, one complex]) died during follow-up, four suddenly (two after Senning, two after Mustard). However, loss of sinus rhythm or the presence of arrhythmia on standard electrocardiograms or Holter recordings did not identify patients at risk for increased morbidity or mortality. Thus, even with current surgical techniques, gradual loss of sinus rhythm occurred after both Mustard and Senning operations. Because late death could not be predicted by electrocardiographic analysis, an alternative approach involving detailed hemodynamic and electrophysiologic measurements may be required to identify high-risk patients.

Arrhythmias, Cardiac↗
PubMed1988

To switch or not to switch? The Senning alternative.

We analyzed the fate of 100 consecutive patients with simple arterial transposition who were admitted within the first 2 weeks of life to the Hospital for Sick Children during the period 1978-1986. In contrast to current practice, these patients were managed with the objective of performing a Senning operation as the definitive procedure. Five of these 100 patients died on the first day of life of sequelae of perinatal hypoxia, four died within the first month of life (often of complications of catheterization and septostomy), and three died later than the first month but before definitive operation (12% preoperative mortality). There were four operative deaths, and two late deaths have occurred to date. Actuarial survival was 84% at 5 years and 81% at 9 years. The postoperative attrition rate was 0.4 deaths per 100 patient-years. Actuarial survival of all patients treated for simple arterial transposition seems to be the best index for comparing arterial switch with interatrial repair protocols, because each protocol is associated with different patterns of preoperative, perioperative, and postoperative mortality.

Actuarial Analysis↗
PubMed1987

Aortic and mitral discontinuity with congenital subaortic aneurysm and normally connected great arteries: echocardiographic diagnosis in life.

A newborn with preductal coarctation and ventricular septal defect had a subaortic aneurysm which protruded into the left atrium causing intractable pulmonary oedema. The subaortic aneurysm was congenital. It was clearly identified by cross-sectional echocardiography which, in serial studies, showed it to be increasing in size. Predisposing to its development was the wide area of aortic and mitral discontinuity in association with the concordant ventricular connexion of the great arteries. The child remained in worsening pulmonary oedema after relief of the coarctation and banding of the pulmonary trunk and died after attempted relief of the left atrial obstruction.

Aortic Aneurysm↗
PubMed1987

Infective endocarditis in children with congenital heart disease: comparison of selected features in patients with surgical correction or palliation and those without.

The diagnostic and prognostic features of 44 episodes of infective endocarditis in 42 children with congenital heart disease were reviewed. Endocarditis occurred in 18 patients who had not had surgical correction or palliation of the defect (non-operated group). There were 26 episodes in 24 patients who had been treated surgically (operated group) (16 open and eight closed cardiac operations). Endocarditis occurred soon after open heart surgery in eight patients and as a late complication in the other 16. It recurred in two patients (operated group). Invasive monitoring and low cardiac output were consistent features in those patients who had endocarditis soon after open heart surgery whereas dental treatment was a common feature in non-operated cases and after closed cardiac operations. Late cases of endocarditis after open heart surgery had various microbiological features that were not typical of infection after dental problems. Gram positive infections occurred in non-operated patients and in those who had had closed cardiac operations. The group that had open heart surgery had infections caused by Gram positive, Gram negative, and anaerobic bacteria and fungi. Fever, anaemia, leucocytosis, and positive blood cultures were the only consistent findings. Vegetations were seen in nine of 12 patients at cross sectional echocardiography. All 12 (four non-operated, one closed, and seven open cases) needed acute surgical treatment. The mortality from infective endocarditis was 17% for non-operated cases, 0% for those who had had closed heart surgery, and 50% for those who had had open heart surgery. Infective endocarditis after open heart surgery differs from that in the other subgroups in terms of microbiology, source of infection, and outcome and its early diagnosis depends on a thorough investigation of minimal symptoms and signs.

Adolescent↗
PubMed1987

Transventricular aortic valvotomy for critical aortic stenosis in infants.

Ten infants with critical aortic stenosis underwent transventricular valvotomy between November 1983 and September 1984. The ages of the patients ranged from 1 to 38 days (mean 21.2 days). Three patients were less than 1 week of age. One had undergone a previous valvotomy performed with inflow occlusion. Most infants were critically ill when admitted to the hospital, six required inotropic and ventilatory support, and two had peritoneal dialysis before the operation. Transventricular valvotomy was performed through a left thoracotomy with Hegar dilators. Postvalvotomy peak-to-peak gradients ranged from 0 to 35 mm Hg. Three patients died at 2, 3, and 6 weeks after operation. A severe degree of endocardial fibroelastosis was present in one patient, and a second patient died of septicemia caused by wound infection, empyema, and a bronchopleural fistula. Severe left ventricular hypertrophy, with moderate fibroelastosis, was found at autopsy in the third patient. Aortic incompetence was not detected postoperatively. One patient required reoperation 7 months after the transventricular valvotomy. Transventricular valvotomy has proved to be a simple and effective technique to relieve aortic stenosis in sick infants. It permits the correction of associated coarctation of the aorta and avoids a median sternotomy. Results are comparable with the results obtained with either cardiopulmonary bypass or inflow occlusion as seen in both our experience and in the experience of others.

Aortic Valve↗
PubMed1986

Membranous supravalvular mitral stenosis: a treatable form of congenital heart disease.

The clinical data, echocardiographic findings, operative anatomy and postoperative follow-up were assessed in 14 patients who had surgery for membranous supravalvular mitral stenosis between 1978 and 1985. The patients ranged in age from 6 weeks to 13 years at the time of operation, and 8 of the 14 had associated mitral valve abnormalities. Other associated lesions included ventricular septal defect (n = 7), coarctation of the aorta (n = 5), left superior vena cava (n = 6), subaortic stenosis (n = 3) and atrial septal defect (n = 1). Twelve of the 14 patients had successful removal of the supravalvular membrane, which was usually adherent to the valve, and 2 patients with associated mitral valve abnormalities underwent mitral valve replacement. There were no operative deaths. Review of preoperative two-dimensional echocardiograms, which were available in 11 patients, revealed two types of membranous supravalvular mitral stenosis in 10 patients. In four of these patients, the membrane was only evident after repeated stop action viewing from a single subcostal or parasternal location. The membrane was never seen in one patient. Eleven patients had follow-up in excess of 1 year, and there was one late death. Eight of the remaining 10 patients are asymptomatic, and 7 have no clinical evidence of residual mitral obstruction. Failure to recognize membranous supravalvular mitral stenosis can result in undue delay of cardiac surgery with resultant cardiopulmonary deterioration. Patients with evidence of left ventricular inflow obstruction should have extensive echocardiographic evaluation in an effort to detect membranous supravalvular mitral stenosis, which may be amenable to surgical repair.

Adolescent↗
PubMed1986

Ductus arteriosus associated with an anomalous left coronary artery arising from the pulmonary artery: catastrophe after duct ligation.

Chronic left ventricular failure developed two months after ligation of an apparently uncomplicated large ductus arteriosus in a one year old girl. Two years later deterioration had progressed to a terminal stage. An anomalous left coronary artery arising from the pulmonary artery had not been recognised before duct ligation. This anomaly was diagnosed two years after ligation and was then treated by surgical redirection, but the patient died of severe left ventricular dysfunction.

Coronary Vessel Anomalies↗