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Biomedical subjects

R D Rowe

Publications and source records attributed to R D Rowe.

At least 91 records · Page 5Linked to original sources
PubMed1981

Cor pulmonale in cystic fibrosis.

A VCG and an orthogonal ECG were done on 66 ambulatory patients with cystic fibrosis. Arteriolized pO2, FEV1/VC and MBC were related to electrocardiographic measurements. In this group of adolescent and young adult patients the most helpful electrocardiographic sign of cor pulmonale is a low voltage representing the left ventricle. The four best indicators from the cardiogram are (1) Rx less than .8 mv; (2) Rx/Sx less than 4.0; (3) Tx less than .4 mv; and (4) MLVF + MLVH less than 2.5 mv. If more than one indicator is found cor pulmonale is likely present. Increased voltage over the right ventricle does not identify patients with cor pulmonale.

Adolescent↗
PubMed1981

Spironolactone therapy in infants with congestive heart failure secondary to congenital heart disease.

The efficacy of treatment with spironolactone for congestive heart failure secondary to congenital heart disease was studied in 21 infants under 1 year of age. All received digoxin and chlorothiazide. In addition, group A (n = 10) was given supplements of potassium and group B (n = 11) received spironolactone. Daily clinical observations of vital signs, weight, hepatomegaly, and vomiting were recorded. Paired t test analysis showed significant reduction in liver size and weight (P less than 0.01) and respiratory rate (P less than 0.05) in group B, and less significant decreases in group A. The incidence of vomiting was slightly lower in group B. We conclude that the addition of spironolactone hastens and enhances the response to standard treatment with digoxin and chlorothiazide in infants with congestive heart failure.

Chlorothiazide↗
PubMed1981

Anatomic correction of transposition of the great arteries: pre- and postoperative cardiac catheterization, with angiocardiography in five patients.

Six of eight patients survived anatomic correction of transposition of the great arteries and repair of associated cardiovascular anomalies at the Hospital for Sick Children, Toronto, Canada. Two of the six survivors also had tricuspid atresia, and continuity between the right atrium and the subaortic outlet chamber in these patients was provided by a valved external conduit, in addition to the arterial switch and coronary artery reimplantation. Five of the six patients have undergone complete postoperative clinical, hemodynamic and angiocardiographic investigation and form the basis of this communication. Our present indications for anatomic repair are discussed.

Adolescent↗
PubMed1980

Patent ductus arteriosus in infants of low birth weight.

Patent ductus arteriosus was diagnosed in 239 neonates of low birth weight (less than 2500 g) referred to the Hospital for Sick Children in a 21/2-year period. The respiratory distress syndrome was present in 77% of the group and congestive heart failure in 50%. Spontaneous closure of the defect was more frequent in those without congestive heart failure. In 48 patients whose heart failure could not be controlled by other medical therapy indomethacin was given, and in 20 (42%) it was judged successful. Surgical ligation of the ductus was performed at a median age of 30 days in 33 infants who either failed to respond to indomethacin or in whom its use was contraindicated; there were no intraoperative deaths, but 11 (33%) of the infants died 4 days to 6 months after the operation.

Ductus Arteriosus, Patent↗
PubMed1980

Upper extremity gangrene: a complication of subclavian artery division.

Gangrene of the upper extremity is a rare complication following subclavian artery ligation. Two case reports from the 23-year experience at the Hospital for Sick Children are presented. If gangrene is to be eliminated in such cases, early recognition of inadequate limb perfusion is mandatory. A suspicion of inadequate perfusion justifies heparin therapy, and prompt revascularization and fasciotomy must be considered.

Aortic Coarctation↗
PubMed1980

Oncocytic cardiomyopathy in an infant with oncocytosis in exocrine and endocrine glands.

An 11 week old female infant with congenitally malformed eyes died from intractable cardiac arrhythmia. The heart showed extensive oncocytic transformation of myocytes, and this distinctive cardiomyopathy affected the conduction system. Oncocytes were found also in endocrine (pituitary, thyroid) and exocrine (submandibular, sublingual, minor salivary) glands. There is morphologic evidence that the lesions were caused early in gestation, possibly by a viral infection such as rubella.

Cardiomyopathies↗
PubMed1980

Results of right atrial to right ventricular and right atrial to pulmonary artery conduits for complex congenital heart disease.

The Fontan procedure was initially proposed for tricuspid atresia (TA). We describe our experience with modifications of this operation and its application to previously uncorrectable congenital lesions. From 1975 to 1979, 26 patients have undergone a Fontan-like procedure, at a mean age of 14 years (range: 3 months to 23 years). Nineteen patients had TA, one patient had mitral atresia, four patients had a univentricular heart, one patient had a "criss-cross" heart, and one patient had pulmonary atresia. Previous procedures included eight Glenn shunts, 18 systemic to pulmonary artery (PA) shunts, two PA bands, and two atrial septectomies. Thirteen patients underwent right atrial (RA) to PA connections, with a valved conduit in nine patients and without in four. Two patients had simultaneous Glenn shunts. Thirteen had RA to right ventricular (RV) conduits, with a valve in 12 patients and without in one. There were five early deaths (<30 days, 19%) and no significant difference between the RA to PA connection (four deaths of 13) versus the RA to RV connection (one death of 13). The mortality rate was higher in patients undergoing RA to PA connection without valved conduit (one death of nine with a valve, three deaths of four without, p < 0.05), while the Glenn shunt did not affect mortality (one death of seven with, three of six without, p < 0.1). There were no late deaths (mean follow-up: 24 months). Seven patients underwent recatheterization with a mean RA pressure of 14 mmHg (range: 9--25 mmHg). Thus, the "Fontan" procedure can be done with an acceptably low mortality with good functional results, both for TA and other complex lesions.

Adolescent↗
PubMed1980

Comparative echocardiographic features of conditions presenting with symptomatic pulmonary hypertension and right ventricular hypertrophy in early infancy.

Echocardiographic dimensions in infants (less than 2 months) with pulmonary hypertension, associated with coarctation of the aorta in 21, total anomalous venous return in 10, and left-to-right shunts in 14 were compared with 10 infants with respiratory distress syndrome, seven with transient tachypnoea of the newborn, 20 normal children, and with each other. Distinguishing features of total anomalous pulmonary venous return were very significantly lower left atrial and left ventricular dimensions. Right ventricular enlargement was maximal in patients with coarctation of the aorta and total anomalous pulmonary venous return. Left ventricular end-diastolic dimension in coarctation of the aorta was not significantly different from normal but the left ventricular end-systolic dimension was significantly lower, suggesting a hypercontractile left ventricle. Similar findings were observed in patients with left-to-right shunts. M-mode echocardiograms are hence valuable in differentiating conditions which may present with intractable congestive cardiac failure in the newborn and also distinguishing them from common respiratory disease of the neonate.

Cardiomegaly↗
PubMed1980

Right ventricular volume determinations in 18 patients with pulmonary atresia and intact ventricular septum. Analysis of factors influencing right ventricular growth.

Right ventricular growth was assessed angiocardiographically in 18 patients with pulmonary atresia, intact ventricular septum, and hypoplastic and hypertensive right ventricle. A variety of surgical procedures were performed. In only 12 patients (66.7%) was right ventricular-pulmonary artery continuity achieved (group 1). Nine of these 12 patients persisted with systemic or suprasystemic right ventricular pressures. Among the six patients in whom right ventricular-pulmonary artery continuity was not achieved (group 2), all maintained suprasystemic right ventricular pressures. Right ventricular growth was assessed in groups 1 and 2. The patients were also subdivided according to the qualitative degree of tricuspid regurgitation as determined angiocardiographically on right ventricular cineangiocardiograms at the preoperative catheter study. Right ventricular growth to normal levels as evidenced by change in right ventricular end-diastolic volume was rarely observed in group 2 patients. Among the four patients with severe tricuspid regurgitation and a large tricuspid valve, right ventricular growth to normal levels was achieved whether they were in group 1 or group 2. Right ventricular growth is thus predicated on numerous morphologic factors in these patients. However, reconstitution of right ventricular-pulmonary artery continuity and a nonobstructive tricuspid valve are probably two of the more important factors.

Aging↗
PubMed1980

Noninvasive assessment of left ventricular function related to serum digoxin levels in neonates.

Eighteen neonates in heart failure were investigated to assess whether high or low serum digoxin levels had differing effects on left ventricular function as determined by systolic time intervals obtained by echocardiography. Nine patients had digoxin levels of 1.99 +/- 0.35 ng/ml (group 1). Nine others had levels of 3.62 +/- 0.95 ng/ml (group 2). Systolic time intervals were obtained by echocardiography before and at 5 days after digoxin and correlated with serum levels. The heart rate, preejection period (PEP), left ventricular ejection time (LVET), electromechanical systole (QS2) and the PEP/LVET ratio were measured. LVET and electromechanical systole were indexed. These measurements were analyzed and the two groups were compared using Student's t test. The clinical improvement in both groups was similar and no difference in ECG changes were noted. Therapy with digoxin produced changes in heart rate and systolic time intervals in both groups. Both showed significant shortening of electromechanical systole index; group 1 significantly shortened the LVET index and PEP/LVET ratio, whereas group 2 significantly shortened the PEP. Statistical analysis comparing the two groups showed no difference between them. Digoxin produces measurable changes in the indices of left ventricular function. The magnitude of these changes suggests no therapeutic advantage to the higher levels.

Digoxin↗