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Biomedical subjects

R L Replogle

Publications and source records attributed to R L Replogle.

At least 55 records · Page 3Linked to original sources
PubMed1979

The prosthetic (Teflon) central aortopulmonary shunt for cyanotic infants less than three weeks old: results and long-term follow-up.

The expanded microporous polytetrafluoroethylene (PTFE) 4 mm vascular prosthesis has been used to create a central aortopulmonary shunt in 20 critically ill infants less than 3 weeks old. The infants ranged from 1 to 18 days old (5.25 days), and from 1.5 to 4.0 kg (2.9 kg). Conduit length ranged from 2 to 6 cm (4 cm). Sixteen patients had atresia of the tricuspid or pulmonary valve. There were 6 early deaths (30%), only 1 of which was shunt related. The mean preoperative arterial oxygen saturation was 62% (range, 33 to 80%), and mean postoperative saturation was 87% (range, 78 to 90%). There were 5 late deaths, 1 probably caused by shunt failure. Nine long-term survivors have done well. Follow-up ranges from 1 to 36 months (18 months). Factors influencing conduit function are length, technical considerations, and pulmonary vascular resistance. Late restudy in 5 of 9 survivors confirms patency and demonstrates bidirectional pulmonary blood flow. Since PTFE shunt flow capability is fixed, the infant may require repair or a second shunt within 24 months of the initial procedure.

Aorta↗
PubMed1979

Surgical treatment of recurrent primary malignant tumor of the left atrium.

A young woman presented with a tumor in the left atrium resembling a left atrial myxoma. After simple excision of the tumor the diagnosis of primary malignant fibrous histiocytoma of the heart was made. A course of radiation therapy was given. Four subsequent recurrences were treated by cardiotomy and resection of the left atrial wall. At the third, fourth, and fifth operations fulguration of the left atrial wall was performed. Subsequent chemotherapy failed to control the tumor. The patient was admitted 6 weeks after the last resection and died. Postmortem examination revealed a large recurrent tumor obstructing the left atrium with no metastases. The clinical course, cardiac catherization data, and postmortem examination are presented. Palliation was achieved by repeated resection of a radiation-resistent primary sarcoma of the heart.

Adult↗
PubMed1979

Earlier operation for left-sided Pseudomonas endocarditis in drug addicts.

Three consecutive patients with Pseudomonas endocarditis were treated by early operation with no deaths. The indications for operation were severe failure, systemic embolization, and infection refractory to antibiotics. The organism is aggressive, characterized by early invasion of the myocardium. Wide débridement of the anulus is necessary to remove any vegetations or intramyocardial abscessed wall. Because multiple valve infection is common, it is important to evaluate all four cardiac valves at the time of operation. Removing a second rim of the mitral anulus for separate culture at the time of mitral valve replacement may demonstrate the degree to which the valve resection has removed all infection. Early operation is necessary for reinfection of the prosthetic valve; however, metastatic abscess should also be considered in the face of continued signs of infection postoperatively. Patients should receive a 6 week postoperative course of antibiotics which have been shown by in vitro testing to be serum bactericidal in at least a 1:8 dilution. The operative findings of invasion of the myocardium by the organism and the surgical success in this small series have resulted in our recommending earlier operation in patients with these indications.

Adult↗
PubMed1978

Surface cooling (20 degrees C) and circulatory arrest in infants undergoing cardiac surgery. Results in ventricular septal defect, complete atrioventricular canal, and total anomalous pulmonary venous connection.

During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) underwent correction of ventricular septal defect (22 patients), total anomalous pulmonary venous connection (13 patients), and complete atrioventricular canal (11 patients), with the use of surface cooling to 20 degrees C. Cardiac repair was performed during circulatory arrest, and rewarming was performed with a pump oxygenator. Ten patients undergoing repair of ventricular septal defects were studied hemodynamically at 21 degrees C, before repair and at 37 degrees C after rewarming. Heart rate, left ventricular systolic pressure, maximum dp/dt, cardiac index, stroke work, and oxygen consumption were reduced substantially at 21 degrees C. Systemic vascualr resistance was increased at 21 degrees C. All changes were reversible with repair and rewarming. A protocol for hemodilution and crystalloid volume loading was devised to maintain urine output after early patients were noted to demonstrate renal dysfunction. With this protocol, survival rates were 89% for patients with ventricular septal defects, 67% for those with atrioventricular canal defects, and 85% for those with total anomalous pulmonary-venous connection.

Blood Pressure↗
PubMed1977

[Validity of thermodilution cardiac output determination in the presence of pulmonary insufficiency (author's transl)].

The thermodilution (TD) technique can be considered as the most useful method for cardiac output (CO) determinations in clinical routine. However, surgical procedures for pulmonary stenosis or atresia frequently induce pulmonary insufficiency (PI) of various degree; due to abnormal flow conditions, this may interfere with the validity of transvenous CO-determinations. This experimental study shows that the TD technique is accurate even in the presence of PI. This observation may be explained by the fact that PI results, on the one hand, in a higher distribution volume and, on the other hand, in an increased transit time of the indicator; both of these factors have opposite effects on CO calculations, thus possibly leading to a balance of either error.

Animals↗
PubMed1977

Cardiac function in total anomalous pulmonary venous return before and after surgery.

Cardiac performance was evaluated in 12 infants with isolated total anomalous pulmonary venous return. Four had significant pulmonary venous obstruction and severe pulmonary hypertension (group A). Eight had no obvious venous obstruction, and the pulmonary pressures were lower (group B). In all subjects, right ventricular end-diastolic volume was increased (197% of predicted normal) and its ejection fraction was normal. Left ventricular volume was, generally speaking, still in the normal range (87% of predicted normal); however, its ejection fraction was reduced (0.57 vs normal of 0.73) and left ventricular output was low (3.08 L/min/m2 vs normal of 3.98). Left atrial volume was consistently small (53% of predicted normal) with an appendage of normal size. The infants in group A had smaller chamber volumes/m2 BSA than those in group B. Left atrial function was abnormal, characterized by reduced reservoir function and a greater role as "conduit" from right atrium to left ventricle. Left atrial size was not found to be critical in the surgical repair of TAPVR. Cardiac function is restored to normal following surgery.

Angiocardiography↗
PubMed1976

Mechanical circulatory assistance for the treatment of complications of coronary artery disease.

Surgery has become an accepted method of treatment for coronary artery disease and its complications. Revascularization results in significant improvement in symptoms for patients with angina pectoris. Occasionally, patients requiring surgery for angina pectoris will sustain reversible ischemic damage during operation; such patients can be successfully weaned from cardiopulmonary bypass with full recovery when intra-aortic balloon counterpulsation is used. Arrhythmias associated with ischemic damage to the myocardium also can be controlled when IABCP is used for physiologic assistance. Patients in cardiogenicshock of pulmonary edema after acute myocardial infarction have an ominous prognosis. When decompensation occurs, IABCP may be used to stabilize the patient and to allow study and corrective surgery if possible. The prognosis is better for patients with ventricular septal defect, although selected patients without a mechanical defect of the myocardium can be salvaged if the response to IABCP is favorable. Counterpulsation has also been shown to be useful in achieving pulsatile cardiopulmonary bypass and in assisting high-risk patients through operation. External pressure circulatory assist (EPCA) is less effective than IABCP in assisting the failing myocardium; however, the external device is noninvasive and may be a useful adjunct in situations where IABCP is not feasible.

Angina Pectoris↗
PubMed1976

Right atrial partition and right ventricular exclusion: another surgical approach for complex cyanotic congenital heart disease.

A 5-year-old child with asplenia, situs inversus, single ventricle, common atrium, severe subvalvular pulmonary stenosis, 1-transposition of the great arteries, and absent inferior vena cava presented with severe limitation (resting arterial saturation 74 per cent). At operation, the systemic venous atrium was partitioned with a Dacron baffle, so that hepatic venous and coronary sinus blood was enabled to drain with the pulmonary venous blood into the single ventricle and aorta. The superior portion of this atrium was anastomosed to the divided main pulmonary artery, so that most of the systemic venous blood was allowed to flow directly to the lungs. Intraoperative hemodynamic studies revealed a pulmonary artery pressure of 12/9 mm. Hg and a superior vena caval flow that was 88 per cent of the ascending aortic blood flow. Follow-up catheterization studies revealed an intact partition, no anastomotic gradient, superior vena cava pressure of 20 mm. Hg, arterial saturation of 84 per cent, and excellent flow of contrast from superior vena cava to atrium to pulmonary artery. Exercise tolerance was markedly improved, and chronic fluid retention was not observed. This operation offers a new alternative for long-term palliation of complex lesions amenable to exclusion of the right ventricle, such as single or common ventricle with unreconstructable anomalies of the atrioventricular valves.

Female↗
PubMed1976

Arterial prosthesis of microporous expanded polytetrafluoroethylene for construction of aorta-pulmonary shunts.

A new arterial prosthesis made of polytetrafluoroethylene (OTFE) was evaluated in 10 infants with complex cyanotic congenital heart disease. All grafts used were 4 mm. in diameter and varied in length from 0.8 to 6 cm. The grafts were anastomosed to the main pulmonary artery or its bifurcation in 8 infants and to the right and left pulmonary arteries in one each. There were two early deaths, one of which was related to shunt failure. The advantages of a shunt to the main pulmonary artery are obvious, and the intraoperative procedure is facilitated with the prosthesis. Follow-up averages 9 months in the 8 survivors, and the patients have nearly doubled their preoperative weight. A shunt murmur is present in each case and the children have mild-to-moderate cyanosis at rest. Repeat aortograms in 2 patients, 8 and 10 months postoperatively, show a smooth graft without luminal narrowing. The aortic oxygen saturations were 73 per cent. The PTFE graft and/or anastomoses will not grow with the growth of the child and therefore may not accommodate growth by increased flow. This may prove to be a limiting factor in its long-term use in fants. We reserve the use of these grafts for infants with complex cyanotic defects undergoing emergency surgery or in older children in whom a conventional shunt is not possible or a previous shunt has failed.

Aorta↗