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Biomedical subjects

R H Kinsley

Publications and source records attributed to R H Kinsley.

11 recordsLinked to original sources
PubMed1990

Surgical correction of ventricular septal defects in black and white children--an 11-year study.

The clinical and ECG features, anatomical subtypes and outcome in 309 children (169 black; 140 white; 58% female) who underwent surgical closure of ventricular septal defects (VSDs) are presented. Clinical presentation was more severe in the black children; with recurrent pulmonary infections in 65% blacks compared with 34% whites. Congestive cardiac failure was noted in 60% blacks and in 37% whites. At cardiac catheterisation a left to right shunt greater than 2.5/1 was found in 45.5% of the black and in 39.3% of the white children. Severe pulmonary hypertension (greater than 80% of systemic systolic pressure) was evenly distributed in both groups. Of the 140 white children, 74.3% underwent surgery under the age of 2 years compared with 68.6% of the 169 blacks. A perimembranous VSD was found in 65% of patients in each group. Infundibular (muscular outlet) defects were observed in 28.6% of white and 30.8% of black children. Left axis deviation (LAD) on ECG was found in 11.9% of white and 9.2% of black patients; and 93% of the total of 27 cases had a perimembranous defect. Early mortality was 3.6% in white and 7.1% among the black children. Of the 17 fatal cases in the total group, 16 had severe pulmonary hypertension. It is concluded that: (i) operative results compared favourably with those reported elsewhere; (ii) the anatomical subtypes occurred with equal frequency in both ethnic groups; and (iii) this was also the case for LAD on ECG, which was most commonly associated with a perimembranous VSD.

Child↗
PubMed1990

Origin of left coronary artery from right pulmonary artery co-existing with coarctation of the aorta.

We report 2 infants with the unusual combination of origin of the left coronary artery from the right pulmonary artery as well as coarctation of the aorta. In the first case congestive cardiac failure persisted despite satisfactory repair of the coarctation. Further investigation revealed the anomalous origin of the left coronary artery. Corrective surgery, 24 days later was unsuccessful. When an identical diagnosis was made in the second child, it was decided, at a single operation, to combine correction of the coarctation together with re-implantation of the anomalous left coronary artery into ascending aorta. This patient has survived, and to our knowledge is the first such case with this outcome. The haemodynamic reasons for this approach are discussed.

Aortic Coarctation↗
PubMed1989

Aortic arch interruption in the neonate, with emphasis on early diagnosis and management.

Interruption of the aortic arch (IAA) is a rare but lethal congenital cardiovascular anomaly. Over a 3-month period we encountered 5 neonates with IAA, all of whom presented in the 1st week of life with congestive cardiac failure and diminished or absent pulses. All 5 underwent surgery, and 3 died from causes unrelated to the surgical repair. The diagnosis of this condition is difficult to make, although the absence of pulses may provide an important clinical clue (particularly if the left brachial and femoral pulses are involved). Using prostaglandins to re-establish ductal patency may be life-saving in these patients, since this restores blood flow to the lower trunk and kidneys. Administration of oral prostaglandin E2 to infants in whom this anomaly is suspected before they are referred to a tertiary care centre is therefore vital.

Aorta, Thoracic↗
PubMed1989

Is the shunt patent?

A novel technique for auscultating an aortopulmonary shunt murmur utilizing the principle of conduction of sounds through a closed air system is described.

Anastomosis, Surgical↗
PubMed1979

Transposition of the great arteries associated with a double left ventricular outflow tract.

A case is described in which, at semilunar valve level, the aorta and pulmonary artery arose from inappropriate ventricles. Despite this, the outflow tracts to both vessels originated from the left ventricle. Embryologically, it is speculated that this anomaly is the result of normal rotation of the proximal conus, without concomitant truncal inversion, and excessive leftward shift of the proximal conus and conal septum or anterior and rightward deviation of the anterior segment of the ventricular septum. Surgical repair using a double conduit between the right ventricle and pulmonary artery and left ventricle and aorta, respectively, was unsuccessful.

Child, Preschool↗
PubMed1977

The narrow aortic annulus. A technique for inserting a larger prosthesis.

A surgical method is described which enables a relatively larger aortic prosthetic valve to be inserted. This consists of widening the aortic root with pericardium and inserting the prosthesis slightly obliquely. The technique has been successfully applied in all 12 patients on whom it was attempted.

Adolescent↗