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Biomedical subjects

R H Franch

Publications and source records attributed to R H Franch.

33 records · Page 2Linked to original sources
PubMed1978

Hemodynamic and clinical evaluation of the Hancock xenograft bioprosthesis of aortic valve replacement (with emphasis on management of the small aortic root).

One hundred twenty-nine consecutive patients underwent isolated aortic valve replacement with the Hancock porcine xenograft between July, 1974, and December, 1976. The hospital mortality rate was 3.9 percent. No patient was treated with anticoagulants, and valve-related complications were extremely rare. The smaller prosthetic sizes (19 and 21 mm. stent diameter) should be used with extreme caution, and the 19 mm. prosthesis should probably never be used in the audult patient. Two methods of managing the small aortic root are emphasized: one to avoid using the smaller prosthetic size in adults and the other to alter greatly the root size in children who have a hypoplastic aortic annulus. Acceptable calculated orifice sizes and left ventricular--aortic (LV-Ao) pressure gradients may be obtained with the 23 mm. or larger prostheses. Actuarial survival curves show 92 percent of patients alive and well at 24 months' follow-up.

Adolescent↗
PubMed1976

Echocardiographic manifestations of single ventricle.

Eight patients with single ventricle were studied echocardiographically. In six, the ventricular septum was not detectable; in two, a septal-like bulboventricular ridge was identified. Two atrioventricular (A-V) valves were found in all patients; in six, both valves were identified simultaneously with the transducer held stationary along the left sternal edge. Dextro-transposition of the great arteries was noted in three patients. The echocardiogram of one of four patients with levotransposition of the great arteries was consistent with later proved left A-V valve stenosis associated with Ebstein's malformation. Mitral-semilunar valve continuity was presented in five cases. Echocardiographically, the absence of the ventricular septum in a patient with two A-V valves make a diagnosis of single ventricle likely. The presence of ventricular septal-like echoes does not exclude the diagnosis of single ventricle since the right ventricular infundibulum may remain as a small outlet chamber separated from the left ventricle by an eccentric bulboventricular ridge.

Adult↗
PubMed1975

Idiopathic calcified apical aneurysm of the left ventricle in an asymptomatic child.

To our knowledge, this is the eighth reported case of isolated, idiopathic, noncontractile apical left-ventricular aneurysm in the child. Referral to the physician is likely to be made because of a systolic murmur, unusual cardiac contour, cardiomegaly, or apical calcification on chest x-ray or, rarely, a systemic embolus. Heart failure is uncommon. The electrocardiogram shows abnormal Q-waves and/or inferior and lateral ST-T changes. Careful image intensification fluoroscopy will demonstrate apical calcification in one-half of the cases.

Calcinosis↗
PubMed1975

Echocardiographic diagnosis of tetralogy of Fallot.

The echocardiographic features of tetralogy of Fallot were defined in 25 patients with this malformation proved by cardiac catheterization. The echocardiographic characteristic that was present in all patients and that was most sensitive was the abrupt ending of the interventricular septal echoes with the aorta overriding the ventricular septal defect. The following additional echocardiographic features were frequently demonstrated in these 25 patients: right ventricular enlargement (20 patients), hypertrophy of the interventricular septum (20 patients), diminution of the right ventricular outflow tract (21 patients) and widening of the aorta (24 patients). The suggestion is made that the most specific echocardiographic pattern of tetralogy of Fallot is the finding of several echocardiographic abnormalities rather than the single feature of aortic overriding. Recognition of the altered anatomic relation coupled with a complete echocardiographic evaluation of all cardiac structures is a reliable means of diagnosing tetralogy of Fallot.

Adolescent↗
PubMed1975

Echocardiographic identification of a pericardial cyst.

The echocardiogram of a woman with an anterior mediastinal mass showed an echo-free space between the chest wall and the right ventricle. The interface of mass with pericardium was outlined by a narrow echo. These findings suggested a homogeneous fluid-filled, thin-walled sac. Postoperation, echocardiography was normal.

Aged↗
PubMedDate not supplied

Quantification of mitral regurgitation with MR phase-velocity mapping using a control volume method.

Reliable diagnosis and quantification of mitral regurgitation are important for patient management and for optimizing the time for surgery. Previous methods have often provided suboptimal results. The aim of this in vitro study was to evaluate MR phase-velocity mapping in quantifying the mitral regurgitant volume (MRV) using a control volume (CV) method. A number of contiguous slices were acquired with all three velocity components measured. A CV was then selected, encompassing the regurgitant orifice. Mass conservation dictates that the net inflow into the CV should be equal to the regurgitant flow. Results showed that a CV, the boundary voxels of which excluded the region of flow acceleration and aliasing at the orifice, provided accurate measurements of the regurgitant flow. A smaller CV provided erroneous results because of flow acceleration and velocity aliasing close to the orifice. A large CV generally provided inaccurate results because of reduced velocity sensitivity far from the orifice. Aortic outflow, orifice shape, and valve geometry did not affect the accuracy of the CV measurements. The CV method is a promising approach to the problem of quantification of the MRV.

Blood Flow Velocity↗
PubMedDate not supplied

The importance of slice location on the accuracy of aortic regurgitation measurements with magnetic resonance phase velocity mapping.

Although several methods have been used clinically to evaluate the severity of aortic regurgitation, there is no purely quantitative approach for aortic regurgitant volume (ARV) measurements. Magnetic resonance phase velocity mapping can be used to quantify the ARV, with a single imaging slice in the ascending aorta, from through-slice velocity measurements. To investigate the accuracy of this technique, in vitro experiments were performed with a compliant model of the ascending aorta. Our goals were to study the effects of slice location on the reliability of the ARV measurements and to determine the location that provides the most accurate results. It was found that when the slice was placed between the aortic valve and the coronary ostia, the measurements were most accurate. Beyond the coronary ostia, aortic compliance and coronary flow negatively affected the accuracy of the measurements, introducing significant errors. This study shows that slice location is important in quantifying the ARV accurately. The higher accuracy achieved with the slice placed between the aortic valve and the coronary ostia suggests that this slice location should be considered and thoroughly examined as the preferred measurement site clinically.

Animals↗
PubMedDate not supplied

Hypersensitivity myocarditis in heart transplant candidates.

Hypersensitivity myocarditis is a rare event; however, routine histologic examination of all (193) explanted hearts for heart transplantation in our institutions revealed hypersensitivity myocarditis in 15 patients (7%). This is a previously unreported finding in heart transplant recipients. None of the cases was detected clinically, although all manifested peripheral eosinophilia at some point during the 2 weeks before transplantation. Only one patient exhibited a skin rash interpreted as allergic. The severity of the interstitial infiltrate varied from grade I to grade IV (semiquantitative). This group of pretransplantation patients was receiving a multiplicity of drugs, some of which could have potentially triggered the hypersensitivity myocarditis, although in only one case was a definite association between a hypersensitivity reaction and a drug made. The unusually high rate (10.3% for the Emory cases) of drug-induced myocarditis in this group of patients, contrasted with the general autopsy population, probably reflects that these patients received more vigorous than usual drug treatment, particularly antibiotics, to sustain them until a suitable donor was found.

Adult↗