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Biomedical subjects

S B Litwin

Publications and source records attributed to S B Litwin.

At least 19 recordsLinked to original sources
PubMed1995

Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt?

BACKGROUND: The bidirectional cavopulmonary shunt has become an important intermediate step in the treatment of pediatric patients with single ventricle physiology who are ultimately destined for palliative surgery. We wanted to know whether there would be risks or benefits if an additional source of pulmonary blood flow was left after a bidirectional cavopulmonary shunt. METHODS AND RESULTS: We retrospectively reviewed the medical and surgical records of all patients who underwent a bidirectional cavopulmonary shunt at the Children's Hospital of Wisconsin between January 1991 and December 1993. A total of 43 patients were identified. Anatomic diagnoses included double inlet left ventricle (14 patients), tricuspid atresia (8 patients), pulmonary atresia with intact septum (6 patients), single right ventricle (5 patients), hypoplastic left heart (3 patients), unbalanced atrioventricular septal defect (3 patients), and other complex lesions (4 patients). We then divided the patients into two groups for purposes of analysis. Group 1 had only the cavopulmonary shunt as a source of pulmonary flow (22 patients); group 2 had an additional source of pulmonary flow (21 patients). Patient age at the time of cavopulmonary shunt ranged from 6 months to 12 years, with group 1 patients being younger (31 versus 45 months, P = .05). Group 2 patients had higher postoperative central venous pressures (17.8 versus 14.1 mm Hg, P < .001) and oxygen saturations (86% versus 81%, P < .001) than did group 1 patients. There was no statistical difference between groups in the number of chest tube days or hospital days. There was 1 early death in group 1 related to severe ventricular dysfunction and 1 late death in group 2 related to sepsis. Five patients in group 2 were readmitted to the hospital for drainage of a large chylothorax compared with none in group 1 (P < .02). CONCLUSIONS: We conclude that patients with an additional source of pulmonary blood flow after bidirectional cavopulmonary shunt have higher postoperative central venous pressures, have higher oxygen saturations, and are at risk for the late development of a chylothorax.

Child↗
PubMed1987

The Senning procedure for repair of d-transposition of the great arteries.

We report our results with the Senning procedure for repair of d-transposition of the great arteries (d-TGA) including techniques that we feel facilitate the operation. When the atrial septal flap is deficient at the site of an atrial septal defect, the flap is filleted to enlarge it using living tissue. This also has the effect of thinning the septal flap which enlarges the left pulmonary vein pathway located posterior to the floor of the new caval tunnels. Another technique includes the use of the upper end of the sulcus terminalis in the construction of the roof of the new caval tunnels. The upper posterior rim of the right atriotomy is left external to this suture line and can be used in construction of the new pulmonary venous pathway. The latter suture line is inferior to the SA node and can be placed expeditiously and with less chance of damaging the SA node. Use of this technique has resulted in a reduced incidence of late arrhythmias. Following the Senning procedure in 40 patients there were no hospital deaths, but there were two late deaths. The Senning operation is currently a very satisfactory alternative for repair of d-TGA when arterial switch repair cannot be performed.

Anastomosis, Surgical↗
PubMed1986

Radionuclide cardioangiographic demonstration of a coronary artery fistula.

A case demonstrating the radionuclide cardioangiographic appearance of a coronary artery fistula is presented. The correct definitive diagnosis of this disorder has generally been made by angiography since clinical findings and noninvasive diagnostic studies can be nonspecific. We report the diagnosis and shunt quantification of a right coronary artery fistula to the right ventricle by radionuclide cardioangiography.

Angiocardiography↗
PubMed1985

Effects of chronic right-to-left cardiac shunt on hypoxic sensitivity of mongrel dogs.

Resting ventilation (VI), blood gases, hypoxic sensitivity, and the ventilatory responses to intravenous sodium cyanide (NaCN, 100 micrograms/kg), doxapram (DOX, 500 micrograms/kg), and dopamine (DOPA, 20 micrograms/kg) were analyzed in four normal mongrel dogs (group I-N) and seven mongrel dogs with chronic (5-11 yr) right-to-left cardiac shunt (group II). The group I-N animals were also studied during steady-state isocapnic hypoxia (group I-H). The shunt procedure used for these studies produced a model for ventilatory studies during chronic shunt hypoxemia. The increases in VI per percent decrease in O2 saturation, which occurred during a four-breath N2 test, were 30, 43, and 13 ml X kg-1 X min-1 in groups I-N, I-H, and II, respectively. The decrease in hypoxic sensitivity of the group II animals, compared with groups I-N and I-H, occurred in the presence of an increase in PaCO2 from 21.9 to 26.0 Torr during the four-breath N2 test. A decrease in PaCO2 from 34.7 to 30.0 and from 33.6 to 30.4 Torr was observed in groups I-N and I-H. The response to DOX, a general analeptic agent, was greatest in group II and least in group I-N. However, the ventilatory responses to NaCN and DOPA were not sufficiently different among the three groups to suggest a difference in carotid body function as assessed by these drugs.

Animals↗
PubMed1983

Pulmonary artery plication: a new surgical procedure for small infants with type I truncus arteriosus.

A new technique is reported for constriction of the pulmonary artery ostium as a palliative procedure in infants with type I truncus arteriosus. Pulmonary artery plication was performed without cardiopulmonary bypass, and this allowed intraoperative evaluation of the procedure. The lungs were protected from developing pulmonary vascular obstructive disease, and congestive heart failure resolved. The pulmonary arteries and the ostium grew with the child so that corrective surgery could be delayed until 4 1/2 years of age, when a large (20 mm) valved extracardiac conduit could be placed. We believe this is a useful palliative operation, particularly for small, sick infants, and it deserves further evaluation.

Heart Failure↗
PubMed1981

Cor triatriatum.

Explore the source record for details and available documents.

Heart Atria↗
PubMed1979

The spectrum of clinical manifestation of anomalous origin of the left coronary artery and surgical management.

Intercoronary collaterals play a major role in determining whether patients with the symptoms of anomalous left coronary artery will suffer infarction early in life with resultant complications or will survive to an older age before becoming symptomatic with angina. We believe that the definitive surgical treatment should be performed at the earliest age possible to avoid further damage to myocardial muscle.

Angina Pectoris↗
PubMed1978

Allosteric effect of o-iodobenzoate on hemoglobin.

O-Iodobenzoate interacts non-covalently with hemoglobin and lowers the oxygen affinity of the protein. In contrast to 2,3-diphosphoglycerate or inositol hexaphosphate, its interaction does not depend upon the presence of free amino groups at the beta-chain amino terminals. Lysine beta82 is one of its oxygenation linked binding sites. As with the organic phosphates, the halogenated benzoate reacts preferentially with deoxy-hemoglobin to shift the allosteric equilibrium from R to T.

Allosteric Regulation↗
PubMed1977

Effect of sodium ortho-iodobenzoate on oxygen transport and erythropoiesis in hypoxemic dogs with a right-to-left cardiac shunt.

Eight dogs were made hypoxemic by surgical construction of a right-to-left cardiac shunt; and they were given sodium ortho-iodobenzoate (OISB) before and for 3 months after operation. The P(50) at 50% saturation) rose from 27.2 +/- 0.7 to 31.2 +/- 0.6 mm Hg (p less than 0.001) during OLSB treatment before operation and increased further to 32.2 +/- 0.8 mm Hg 3 months after creation of hypoxemia. The P(50) remained elevated for an additional 3 months after OISB was stopped. Administration of OISB before operation did not alter the red blood cell 2,3-diphosphoglycreate concentration. Hypoxemia caused an increase of this metabolite from 0.91 +/- 0.21 to 1.50 +/- 0.28 moles/moles of hemoglobin (p less than 0.05); the rise was not as great as that observed in hypoxemic dogs without OISB treatment. In spite of significant hypoxemia, hematocrit rose only slightly during the period of OISB infusion. OISB increased P50 and prevented the compensatory polycythemia regularly seen when dogs are made hypoxemic. Altering oxygen transport in this fashion may increase tissue oxygen delivery in patients with conditions which result in tissue hypoxia.

Animals↗
PubMed1976

Sodium o-iodobenzoate and hemoglobin-oxygen affinity: in vivo effects.

Sodium o-iodobenzoate (OISB) was given intravenously to 15 dogs to test the in vivo effect of this drug on the oxyhemoglobin dissociation curve. Administration of a single dose of 500 mg/kg was followed by an average increase in P50 (PO2 at 50% oxyhemoglobin saturation) of 3.6 mmHg from 26.8 +/- 0.5 to 30.4 +/- 1.8 mmHg (corrected to pH 7.4). This elevation was sustained for 7 days. During intravenous infusions of 200 mg/kg every other day for 3 wk, there was a sustained increase in P50 of 2.6 mmHg from 27.8 +/- 1.1 to 30.4 +/- 0.9 mmHg. All dogs survived the experiment and no ill effects of the drug were noted. An increase in serum lactate and pyruvate occurred in all animals following acute or chronic exposure to the drug. There was no significant change in whole blood pH, 2,3-diphosphoglycerate concentrations, intracellular pH, or serum total phosphate. Multiple infusions of sodium cyanate (50 mg/kg per day) reduced P50 by an average of 12.2 +/- 0.3 mmHg. A subsequent single infusion of OISB (500 mg/kg) failed to increase P50. Our preliminary data indicate that pharmacological manipulation of hemoglobin O2 affinity is possible with organic compounds unrelated to erythrocyte metabolism.

Animals↗
PubMed1976

The medical and surgical management of patients with congenital heart disease. A survey of current knowledge and practices.

Today, techniques for diagnosis,medical preparation, and definitive surgical repair are available for most cardiac anomalies, if needed. These permit successful treatment and carry a low mortality. Such children can now be expected to lead normal and meaningful lives as contributors to society. When serious symptoms occur in infancy, as discussed herein, an emergency exists and prompt diagnosis and treatment are mandatory for survival.

Age Factors↗
PubMed1975

Left ventricular aneurysmectomy in a child. Treatment of anomalous left coronary artery.

Anomalous origin of the left coronary artery from the pulmonary artery with development of a massive left ventricular aneurysm in a 23-month-old child is described. Operative treatment included ligation of the anomalous origin, ventricular aneurysmectomy, and a saphenous vein bypass graft to the anterior descending coronary artery. The principles of ventricular aneurysm resection used in adults are applicable to small children with this complication of anomalous coronary artery origin.

Age Factors↗