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Biomedical subjects

R A Gustafson

Publications and source records attributed to R A Gustafson.

35 records · Page 2Linked to original sources
PubMed1989

Stage I palliation of hypoplastic left heart syndrome: the importance of neoaorta construction.

After Norwood's initial report of successful first-stage palliation of hypoplastic left heart syndrome in neonates, the occurrence of distal aortic obstructions, shunt problems, and late deaths have led to modifications in the surgical technique. Between January 1986 and December 1987, 12 neonates from three to 16 days old underwent stage I palliation with the same objectives. An open atrial septectomy was always performed. The pulmonary artery bifurcation was transected from the main pulmonary artery and closed with an aortic homograft patch. The aortotomy was begun 2 cm below the patent ductus arteriosus insertion and extended across the transverse arch and down the ascending aorta. The neoaorta was constructed using the hypoplastic ascending aorta-transverse aortic arch, the main pulmonary artery, and an aortic homograft augmentation patch. The homograft is hemostatic and pliable, and molds well in forming the neoaorta. A 4-mm shunt was inserted between the right innominate artery and the right pulmonary artery in 5 patients and the neoaorta and the pulmonary artery bifurcation patch in 7 patients. The early systemic oxygen saturation was optimized at 75% to 80% with hyperventilation, high concentration of inspired oxygen, sodium bicarbonate, and the frequent use of vasopressors to maintain an arterial blood pressure of 65 to 75 mm Hg. Two patients (17%) died early after operation; 1 had severe right ventricular dysfunction and both had severe tricuspid regurgitation. There were 2 late deaths at 7 and 13 months, of sepsis and hypoxia. The 8 survivors (67%) continue to do well over follow-up. The preoperative tricuspid regurgitation has remained stable in 3 survivors and disappeared in 2 survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗
PubMed1989

Partial anomalous pulmonary venous connection to the right side of the heart.

Partial anomalous pulmonary venous connection to the right side of the heart often complicates surgery for atrial septal defects. Between 1964 and 1987, 39 patients, ranging from 2 to 52 years old, underwent repair of partial anomalous pulmonary venous connection. At least one anomalous pulmonary vein arose from the right upper lobe in 38 patients and right middle lobe in 30 patients and connected to the superior vena cava in 28 patients and the right atrium only in 11 patients. An atrial septal defect was present in 32 patients (82%). Patients who had partial anomalous pulmonary venous connection to the superior vena cava-right atrium junction, the right atrium or both were treated by septal translocation (two patients) or patch redirection of the anomalous pulmonary venous flow to the left atrium through a native atrial septal defect (eight patients) or a surgically created atrial septal defect in two patients with intact atrial septum. For partial anomalous pulmonary venous connection to the high superior vena cava (27 patients), the superior vena cava was transected and oversewn above the anomalous veins. The anomalous pulmonary venous flow was redirected through the proximal superior vena cava into the left atrium across a sinus venous atrial septum defect (22 patients) or a surgically created atrial septal defect in five patients with intact atrial septum. The atrial septal defect was coapted to the intracardiac orifice of the superior vena cava, and the distal superior vena cava was anastomosed to the right atrial appendage. One 31-year-old woman with severe pulmonary hypertension died early and was the only death in the series. A technical error early in the series resulted in one symptomatic superior vena cava obstruction. Only one patient remains in sick sinus syndrome late. All patients remain well over long follow-up (1 to 24 years). Postoperative catheterization or echocardiography has revealed no intracardiac defects, pulmonary venous obstruction, or superior vena cava obstruction (except the one technical error). Correction of partial anomalous pulmonary venous connection should be individualized according to the site of connection of the anomalous pulmonary veins and the location of the atrial defect to minimize undesirable postoperative sequelae often associated with other methods of repair.

Adolescent↗
PubMed1988

Early primary repair of tetralogy of Fallot.

Young age, low weight, and the requirement for transannular patch reconstruction of the right ventricular outflow tract (RVOT) are thought to adversely affect intracardiac repair of tetralogy of Fallot. Forty patients underwent complete repair between January, 1984, and January, 1987. Only infants with pulmonary atresia, complete atrioventricular canal, or coronary artery anomalies were shunted initially. The malalignment ventricular septal defect was closed with a Dacron patch. Infundibular resection was minimized. All atrial communications were left open. Thirty-four patients (85%) had a transannular RVOT patch, and 2 patients (5%) had a nontransannular patch. All 10 infants weighing 3.4 to 9.6 kg had a transannular RVOT patch at 7 weeks to 12 months of age. An RVOT patch was used in 26 of 30 children operated on between 1 and 6 years of age (median age, 24 months). No patient undergoing intracardiac repair died. Postoperative RVOT pullback gradients were between 0 and 35 mm Hg (mean, 18.5 mm Hg). Postoperative pulmonary artery saturation (mean, 73%) did not reveal any residual ventricular septal defect. The right ventricular/arterial pressure ratio was always less than 0.6 (mean, 0.4). All children are doing well at follow-up from two to 37 months. Serial echocardiograms reveal no residual ventricular septal defect and only 1 moderate RVOT gradient. Follow-up cardiac catheterization in 15 patients revealed no residual ventricular septal defect and RVOT gradients between 5 and 35 mm Hg. The right ventricular/left ventricular pressure ratio was always less than 0.6 (mean, 0.48). The early and late results justify continued primary repair of tetralogy of Fallot in symptomatic children, regardless of age or weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1987

Myo-osseous intercostal pedicle flaps for tracheal reconstruction in puppies.

We evaluated a myo-osseous intercostal pedicle flap for distal tracheal reconstruction. Mongrel puppies, 6 to 10 weeks old, underwent tracheal repair, 12 for primary defects and seven for stenotic lesions created in the distal trachea. A composite flap was constructed from the anterior portion of the fourth rib with the overlying pleura and periosteum and a posteriorly based intercostal muscle/neurovascular pedicle. The animals did well following tracheal reconstruction without evidence of airway obstruction. Bronchoscopy documented normal tracheal diameter and the repair site could not be discerned from the surrounding mucosa. Histologically, there was complete respiratory epithelial ingrowth with no inflammatory changes. The rib graft had active hematopoietic marrow. This work suggests that the myo-osseous intercostal pedicle flap provides a surface for normal epithelial ingrowth of tracheal mucosa without stimulating granulation tissue, interposes a stent capable of growth, therefore minimizing anastomotic stricture, and is an effective alternative in the management of distal tracheal stenosis.

Animals↗
PubMed1984

An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava.

The surgical management of 15 patients with partial anomalous pulmonary venous connection (PAPVC) to the high superior vena cava (SVC) is described. This new technique redirects the anomalous pulmonary venous flow into the left atrium through the cardiac end of the SVC, transected and oversewn above the anomalous pulmonary vein or veins, by coaptation of the atrial septal defect (or of the surgically created septal defect in patients with an intact atrial septum) to the intracardiac orifice of the SVC. Normal SVC-right atrial flow is reconstituted by atriocavoplasty to the cephalad portion of the transected SVC. A 31-year-old woman with severe pulmonary hypertension died early in the series; this was the only death. Surviving patients enjoy full activity. Except for one symptomatic SVC obstruction due to technical error (since relieved), this technique has achieved total correction of these congenital defects with marked reduction in the undesirable postoperative sequelae often associated with other methods of repair.

Adolescent↗
PubMed1982

Intercostal muscle and myo-osseous flaps in difficult pediatric thoracic problems.

Intercostal muscle pedicle flaps have been successfully utilized in the treatment of recurrent tracheoesophageal fistulae and esophageal perforations in the pediatric age group. An intercostal myo-osseous pedicle flap was also created to repair a distal congenital tracheal stenosis at the carina. The viable intercostal flap has the advantage of multiplicity of uses and of considerable mobility. The presence of a blood supply assures healing. The option of retaining periosteum on the flap encourages bone regeneration at the site of tracheal or bronchial repair. The pleura of the flap provides an epithelial surface for intratracheal repair. The rib graft prevents stricture at the site of tracheal repair.

Child, Preschool↗
PubMed1980

Single arterial trunk arising from the aortic arch.

A 59-year-old male with a single, arterial trunk arising from the aortic arch is reported. No orther cases of this anomaly have been confirmed; a review of the literature does not reveal another reported case of this abnormal arterial configuration.

Aorta, Thoracic↗
PubMed1975

Regulation of bacterial cell division: temperature-sensitive mutants of Escherichia coli that are defective in septum formation.

Mutations ts2158 and ts1882, which confer temperature sensitivity of septum formation, map near leu in the region of min 2.0 to 2.1 on the Escherichia coli chromosome. These mutants stop division abruptly and grow as filaments at 42 C; when returned to 28 C, division resumes after about 30 min to produce short cells. The product of the gene defined by these mutations probably is required during all stages of septum formation rather than specifically for initiation of septation. Filaments that formed at 42 C contained incomplete constrictiions (septa). When actively dividing filaments (i.e., those incubated at 28 C until division resumed) were shifted to 42 C a second time, division again stopped abruptly and incomplete constrictions persisted during the incubation at 42 C. Filaments that were subjected to 28 C incubation for a brief time (10, 20, or 30 min) before being shifted again to 42 C did not resume division as would be expected of a strain defective in initiating septation. Mutations ts 1882 and ts2158 and recessive to the ts+ allele, which is consistent with the interpretation that these mutations cause the loss of a function. They did not complement each other and presumably represent one cistron. Mutants carrying ts1882 and ts2158 mutations were compared with a mutant defective in the ftA allele, also known to map near leu.

Cell Division↗
PubMed1974

Regulation of bacterial cell division: genetic and phenotypic analysis of temperature-sensitive, multinucleate, filament-forming mutants of Escherichia.

Three mutants of Escherichia coli K-12 which form filaments during 42 C incubation have been characterized. The mutant strains AX621, AX629, and AX655 continued to grow and to synthesize deoxyribonucleic acid at 42 C for 150 to 180 min, after which time growth ceased. When cultures of the mutants were transferred from 42 to 28 C, septation of the filaments began after a 25- to 30-min period and continued at a greater than normal rate until no filaments remained. Addition of chloramphenicol at the time of transfer from 42 to 28 C prevented cell division in strain AX655 and caused lysis of strains AX621 and AX629. The temperature sensitivity mutation in each strain mapped near leu. For strain AX621, the mutation was specifically located between leu and nadC by P1 transduction. Properties of these strains are compared with those of other cell division mutants.

Azides↗
PubMed1974

Bacterial cell division regulation: characterization of the dnaH locus of Escherichia coli.

The dnaH locus is the fourth gene to be identified as required for deoxyribonucleic acid polymerization in Escherichia coli. A temperature-sensitive mutant defective in this gene exhibited an abrupt decrease in rate of deoxyribonucleic acid synthesis when shifted to 42 C. The locus mapped in the proC-purE region of the chromosome by conjugation and was co-transducible with purE. dnaH(+) is carried on the F'(13) episome and is dominant over the dnaH(-) mutation.

Cell Division↗