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Biomedical subjects

R H Feldt

Publications and source records attributed to R H Feldt.

At least 55 records · Page 3Linked to original sources
PubMed1982

Cardiac fibroma: long-term survival after excision.

Four patients have had operation at the Mayo Clinic for a cardiac fibroma and all survived. Three patients have an excellent clinical result and are free of tumor 1 year, 13 years, and 17 years postoperatively. The fourth shows radiographic evidence of residual tumor near the mitral anulus, but is clinically well 15 years postoperatively. A fifth unoperated patient died suddenly 8 years after presumptive diagnosis of fibroma at the age of 83 years. This experience suggests that patients who have undergone successful excision of cardiac fibroma have an excellent probability of remaining free of disease.

Child↗
PubMed1981

Clinicopathological correlates of obstructed right-sided porcine-valved extracardiac conduits.

Thirteen of 308 patients (4.2%), who had received right-sided valved extracardiac conduits at the Mayo Clinic from November, 1972, to April, 1977, have required conduit replacement because of obstruction. Patients were 5 to 16 years old at initial operation and 8 to 20 years old at reoperation; the duration of conduit implantation was 27 to 79 months (mean 50). Four patients (31%) were asymptomatic; exertional dyspnea was present in eight (62%) and dizziness was reported in one (8%). Signs of conduit obstruction included increasing intensity of murmurs in 11 (85%), cyanosis in two (15%), and heart failure in one (8%). Peak pressure gradients from the right ventricle to the pulmonary arteries ranged from 50 to 140 mm Hg (mean 87) and correlated well with the degree of conduit obstruction. Catheter pullback allowed accurate localization of stenosis within the conduit, whereas angiography alone did not. The site of major obstruction was in the proximal conduit in five (38%), at the valve in nine (69%), and in the distal conduit or side branches in six (46%); stated differently, major stenosis affected the valve alone in five (38%), the graft alone in four (31%), and both the valve and the graft in four (31%). Valvular changes leading to stenosis included thrombosis, commissural fusion, and calcification, and changes consistent with insufficiency included tears, fusion of cusps to the conduit wall, and, in one case, infective endocarditis. Within the conduit, nonvalvular obstruction was due to formation of a thick fibrous peel (or neointima). Progressive thickening of the peel appeared to be due to organization of thrombus between the peel and conduit and not due to luminal mural thrombus. In one case, the peel formed a flap-valve, causing even further obstruction. Since many patients are asymptomatic, and since late conduit stenosis may develop unpredictably by several mechanisms, long-term follow-up is necessary.

Adolescent↗
PubMed1981

Serum levels of creatine phosphokinase and its isoenzymes in normal and stressed neonates.

Twenty-six normal newborns (13 male, 13 female) with normal prenatal histories, no perinatal stress, and normal vaginal deliveries had creatine phosphokinase (CPK) activity and isoenzyme activities assayed in cord blood and in 24-hour postpartum serum. Total CPK activity was high in cord blood when compared with adult control values. Moreover, the total CPK was significantly higher in serum at 24 hours of age compared with cord blood. There was a significant increase in both the skeletal muscle isoenzyme and the cardiac muscle isoenzyme from birth to 24 hours of age. There was a decrease in the brain isoenzyme at 24 hours of age which was not statistically significant. These results were compared with values obtained in a group of 10 neonates with severe cardiac problems. Three of the ill neonates had significant elevation of total serum CPK and the skeletal muscle isoenzyme when compared with the normal newborns. There were no significant differences between the normal infants and the ill neonates for the cardiac isoenzyme and the brain isoenzyme. These data suggest that caution should be used in the diagnosis of certain neonatal cardiac syndromes based on serum CPK levels and isoenzyme alone.

Adult↗
PubMed1981

Current status of the septation procedure for univentricular heart.

The current status of the septation procedure for univentricular heart was assessed by analyzing the outcomes of 45 procedures done from 1973 through June of 1978. The hospital mortality was 21 (47%) of 45 patients, and eight (18%) patients died during follow-up. Of the 16 survivors, 12 have a fair-to-good surgical result and four are doing poorly. Only two factors were significantly related to increased survival: no history of congestive failure and no previous palliative procedure. Multivariate analysis revealed a small subgroup of 11 patients with a survival rate of 82%. These patients had a subaortic chamber to the left, no previous congestive failure, no previous palliation, and no profound polycythemia, and they were between 5 and 15 years of age at operation. Current practice now employs the Fontan procedure for patients with univentricular heart and low pulmonary artery pressure and resistance. However, nearly half of the patients with univentricular heart will not qualify for a Fontan procedure. For a selected group of these patients, septation must be considered because of the poor long-term outlook for patients with univentricular heart who do not undergo operation.

Adolescent↗
PubMed1980

Postoperative false aneurysm of left ventricle and obstruction of left circumflex coronary artery complicating enlargement of restrictive ventricular septal defect in double-outlet right ventricle.

A case is reported of double-outlet right ventricle (DORV) with restrictive subaortic ventricular septal defect (VSD) in which enlargement of the defect at the time of surgical repair was associated with the late postoperative development of a false aneurysm of the left ventricle. The enlarging fale aneurysm caused extrinsic compression of the dominant left circumflex coronary artery, with subsequent ischemia and infarction of the posterolateral left ventricle. The anatomy and surgical implications of restrictive VSD are discussed.

Child, Preschool↗
PubMed1979

Primary cardiac myxosarcoma in a child.

This is a detailed clinical and autopsy documentation of a rare entity--primary cardiac myxosarcoma in a 29-month-old girl. The patient had sudden onset of right hemiplegia and angiographic evidence of multiple occlusions of the left middle cerebral artery. Subsequent M-mode and sector echocardiography showed a mobile, pedunculated left atrial tumor, which was excised. No other tumor mass was noted at the time of surgical exploration, and postoperatively, the patient received a course of chemotherapy (vincristine, dactinomycin, and cyclophosphamide). After a temporary improvement in her condition, the patient died following several days of rapid deterioration; this was 3 months after the onset of symptoms. Autopsy showed that death was due to brainstem herniation secondary to massive infiltration of the brain by tumor, and there were also widespread systemic metastases.

Brain↗
PubMed1979

Measurement of postoperative cardiac output by thermodilution in pediatric and adult patients.

Serial cardiac output determinations were made by the thermodilution technique in 51 patients by means of a No. 2 Fr. thermistor catheter placed directly into the pulmonary artery at cardiac operation. Correlations were determined prospectively between thermodilution measurements of cardiac output and other commonly used indirect clinical parameters. Serial indicator dye-dilution curves were performed in 24 of these patients and compared with simultaneous thermodilution measurements. A high correlation (r = 0.97) was noted between dye curve measurements of cardiac output and thermal measurements. Statistically significant correlations were also seen between cardiac output and both the quality of the peripheral pulses and the duration of cardiopulmonary bypass, but no significant correlations were found between the measured cardiac outputs and other variables. This study confirms the necessity for direct measurement of cardiac output for its accurate assessment.

Adolescent↗
PubMed1978

Hyperuricemia in congenital heart disease.

Gout is rarely noted as a clinical problem in secondary polycythemia-- even if profound polycythemia exists, as in cyanotic congenital heart disease. A retrospective study of 81 patients with congenital heart disease was done to assess the incidence of hyperuricemia. Twenty of 46 patients with cyanotic congenital heart disease had serum levels of uric acid greater than 8 mg/dl. Thirteen of 16 (81%) cyanotic male patients more than 15 years old had serum levels greater than 8 mg/dl. For cyanotic patients, serum levels of uric acid were related directly to the degree of polycythemia (r = .44; P less than .02). Impaired renal function or drug therapy did not seem to account for the hyperuricemia. Because levels of uric acid greater than 10 mg/dl probably are nephropathic, many of these patients may be incurring subclinical uric acid nephropathy.

Adolescent↗
PubMed1978

Use of tolazoline in newborn infants with diaphragmatic hernia and severe cardiopulmonary disease. A preliminary report.

Two newborn infants with congenital diaphragmatic hernia, one of whom died, had significant improvement in arterial oxygen tension (Pao2) after intravenous administration of tolazoline (Priscoline) (1 to 2 mg. per kilogram). In both infants, systemic hypotension developed within minutes of administration of the drug and required pharmacologic and hemodynamic intervention. The response to tolazoline was more dramatic in the infant who survived, and his oxygen requirements were significantly reduced after the use of this drug. The infant who died also had a significant response to tolazoline. Tolazoline appears to be an important pharmacologic agent for use in the postoperative care of infants with diaphragmatic hernia and associated hypoxemia and acidosis.

Acidosis, Respiratory↗
PubMed1978

Double-outlet right ventricle. Anatomic and angiocardiographic correlations.

A series of 72 patients with proved double-outlet right ventricle was studied with reference to the ability of angiocardiography to determine the location of a ventricular septal defect when it was associated with various great-artery relationships. Only 2 of the 72 patients had an intact ventricular septum. The other 70 patients had 16 possible anatomic variations based on four positions of the ventricular septal defect (subaortic, subpulmonary, subaortic and subpulmonary, and remote type) and four great-artery relationships (normal, side by side, dextromalposition, and levomalposition). Using the hemodynamic information regarding systemic and pulmonary arterial saturations, combined with biplane angiocardiographic data from the right ventricle (and if possible with left ventriculography), one can predict the location of ventricular septal defect. Because the different types of double-outlet right ventricle have different surgical approaches, this information can be important to the surgeon.

Angiocardiography↗
PubMed1976

Truncus arteriosus and previous pulmonary arterial banding: clinical and hemodynamic assessment.

Twenty-seven patients with truncus arteriosus and previous pulmonary arterial banding were evaluated 1 1/2 to 14 years (mean 7 years) after banding. Ages at the time of cardiac catheterization ranged from 3 to 18 years (mean 9 years). Current symptoms were severe in five patients and were related to truncal valve incompetence or decreased pulmonary blood flow (or both) rather than to age, duration of palliation or band location. Twenty-one of 22 patients with two pulmonary arteries were considered to be in a hemodynamically operable state at the time of study. The condition of three of five patients with a single pulmonary artery was subsequently found inoperable because of severe pulmonary vascular disease in the lung supplied by the single pulmonary artery. In patients with two pulmonary arteries, demonstration of low pressure in at least one normal-sized pulmonary artery established operability. Postoperative pressure measurements correlated well with preoperative prediction of operability, with 19 of 20 patients having a pulmonary arterial pressure less than 70 percent of systemic levels after repair. Bilateral pulmonary arterial binding may be more effective than central arterial banding (which frequently produces severe obstruction to the right pulmonary artery) in preventing pulmonary vascular obstructive disease in patients with truncus arteriosus who have two pulmonary arteries. Patients with truncus arteriosus and a single pulmonary artery with pulmonary arterial banding remain at high risk for the development of pulmonary vascular obstructive disease.

Adolescent↗
PubMed1976

Double outlet right ventricle: hemodynamic and anatomic correlations.

There are 16 possible variations of double outlet ventricle with regard to interrelations of the great arteries and to location of the ventricular septal defect. In a series of 62 cases, approximately two thirds of patients had the great arteries in a side by side relation, and most (28 of 41) had the ventricular septal defect in a subaortic position. In double outlet right ventricle with malposition of the great arteries, the ventricular septal defect was either subpulmonary or subaortic. Four of the 13 patients with subpulmonary ventricular septal defect had a supracristal defect with side by side relation of the great arteries (Taussig-Bing anomaly), and 9 patients had malposition of the great arteries with an infracristal ventricular septal defect. In all patients with subpulmonary ventricular septal defect, pulmonary arterial oxygen saturation was greater than systemic arterial saturation regardless of the relation of the great arteries. Forty patients had subaortic ventricular septal defect. In 24 of these patients, including 7 with malposition of the great arteries, systemic arterial oxygen saturation was greater than pulmonary arterial saturation. However, in 9 patients (25 percent) the reverse was true, as seen in complete transposition of the great arteries and in Taussig-Bing anomaly. Thus, pulmonary arterial oxygen saturation greater than systemic arterial saturation is not reliable evidence of a Taussig-Bing anomaly. Of the 25 patients with such saturation, only 4 had the Taussig-Bing anomaly.

Adolescent↗
PubMed1976

Neonatal pneumopericardium.

Three cases of neonatal pneumopericardium are presented. Detailed ventilatory measurements and chest roentgenographic changes are described for each of the three patients. The literature of neonatal pneumopericardium is reviewed, and based on that review and our own cases, we offer guidelines for managing these patients.

Adolescent↗
PubMed1976

Secundum atrial septal defect encountered in infancy.

From 1953 to 1972, approximately 170 patients less than 16 years old were seen at the Mayo Clinic for isolated secundum atrial septal defect. Thirteen of these patients were initially seen when they were less than 2 years old. Eleven of the patients had symptoms, and one of these died. Four patients failed to respond to medical management and underwent successful repair of their defects before they were 2 years old. Infants with isolated secundum atrial septal defect and significant symptoms are at an increased risk of death. Consideration should be given to early surgical closure of the defect in those infants who do not respond promptly and completely to medical therapy. Surgical repair in infancy can be accomplished with minimal risk and excellent early and long-term clinical results.

Age Factors↗