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Biomedical subjects

S P Allwork

Publications and source records attributed to S P Allwork.

At least 19 recordsLinked to original sources
PubMed1988

Tetralogy of Fallot: the centenary of the name. A new translation of the first of Fallot's papers.

1988 marks the centenary of the cognomen "tetralogy of Fallot". Fallot's works are often quoted and translated without mentioning that it was he who applied the noun "tetralogy" to the malformation. This new translation shows that his contribution to the morbid anatomy was not great, but he was unknowningly responsible for providing a unifying concept and a name for the commonest of all cyanotic congenital heart defects.

History, 19th Century↗
PubMed1988

The pathology of mitral papillary muscles in mitral regurgitation associated with discrete subaortic stenosis.

Two patients needed mitral valve replacement for severe mitral regurgitation after surgical relief of subaortic stenosis. A third, much older patient (who died) also had mitral regurgitation after surgery to relieve subaortic stenosis and to close a ventricular septal defect. All the mitral valves showed both macroscopic and microscopic abnormalities, the latter being characterized by myocytolysis, vasculitis, and fibrosis. The severity of these abnormalities was inversely proportional to the age of the patient. The findings were compared with those (surgical and necropsy specimens) of five patients with congenital "left-sided" anomalies (group 1) and five with "right-sided" lesions (group 2). Coagulation necrosis and ischemic changes were observed in both of the control groups, but none demonstrated the combination of features observed in the patients with subaortic stenosis. The observation of myocytolysis, vasculitis, and fibrosis suggests that there may be a pathologic substrate for mitral valve malfunction in patients, especially very young ones, with subaortic stenosis.

Adult↗
PubMed1987

The applied anatomy of the arterial blood supply to the heart in man.

The applied anatomy of the coronary arterial and collateral circulations has been reviewed together with some of the more important variants of origin, branching and disposition. There is a very wide range of variability among coronary artery patterns, and some of them can of themselves give rise to illness and even death. Others may exacerbate acquired disease. The increasing use of coronary arteriography and other forms of imaging will continue to reveal hitherto undescribed variants, while the study of coronary artery disease, so common in the Western world, will eventually elucidate the natural history of the coronary collateral circulation.

Aged↗
PubMed1986

The anatomical basis of infection of the aortic root.

Although images of large abscess cavities in the aortic root in the presence of infection may be obtained by echocardiography or angiocardiography, discrete cavitations and paravalvar leaks, especially small ones, tend to remain unrecognized. Furthermore the abscesses themselves and their extent are often difficult to locate at operation, and it is this difficulty in delineating paravalvar foci of destruction which remains a major surgical challenge in aortic infections. The inability of current imaging techniques to elucidate this problem is compounded by the limited access which aortotomy gives to the aortic root. In the case of prosthetic valve endocarditis, the aortic root is often distorted, this distortion is greater where more than one prosthetic valve has been used, so that identification of septic areas and abscess cavities may further be obfuscated. Five necropsy specimens of normal hearts and 10 with infective endocarditis of either natural or prosthetic valves in either aortic or atrioventricular position were studied to elucidate the anatomy of the aortic root and to identify sites of potential abscess formation and of rupture.

Adult↗
PubMed1986

Usefulness of the phenomenon of histofluorescence in the identification of early myocardial necrosis.

To evaluate the histological phenomenon of fluorescence of necrotic myocardium in ultraviolet light a prospective study of fatal myocardial infarction with accurate clinical and biochemical correlation was made. To test the morphological characteristics and specificity of the technique experimental infarctions were induced surgically in sheep and pigs and acute ischaemia and infarction induced by catheter in intact dogs. Fluorescence was visible within five minutes of the injury in routinely stained sections and persisted for as long as cellular debris was identifiable. It was independent of autolysis, optimal fixation, prolonged storage, and special stains. Although the fluorescence was associated with hypereosinophilia in stained sections, necrotic myocardium also fluoresced in unstained ones, demonstrating primary or autofluorescence. Fluorescence microscopy is a useful adjunct to the histological identification of early myocardial necrosis and of scattered or focal necrosis especially in the absence of myocardial infarction.

Adolescent↗
PubMed1985

Failure of experimental atherosclerosis to sensitize coronary arteries to spasm in hypercholesterolemic rabbits.

Since hypercholesterolemia sensitizes isolated rabbit coronary arteries to vasoconstrictor stimuli, we assessed the possibility of reproducing occlusive coronary spasm both in vitro and in vivo in atherosclerotic rabbits. In Langendorff-perfused hearts from nine atherosclerotic rabbits (2% cholesterol diet for 18 weeks), despite a threefold increase of cholesterol concentration in the coronary wall compared with nine control rabbits, ergonovine and serotonin did not produce any increase of coronary vascular resistances; the increase produced by pitressin was significantly less in atherosclerotic than in normal hearts (56 +/- 13% vs 138 +/- 28%, p less than 0.05, respectively), whereas that produced by phenylephrine was similar (10.1 +/- 1.8% vs 8.5 +/- 2.4%, p = n.s.). In eight other unanesthetized rabbits we recorded the ECG during ergonovine administration (0.05 mg/kg) and during hypothalamic stimulation before and at regular intervals during the 2% cholesterol diet; rabbits survived for periods ranging from 1 to 22 weeks (mean 9.6 weeks). Only one animal had ST depression during episodes of marked tachycardia; no ischemic ECG changes were ever observed in the other rabbits despite the diffuse subintimal coronary deposition of cholesterol found postmortem. Thus, in atherosclerotic rabbits with chronic marked hypercholesterolemia, coronary arteries do not develop occlusive coronary spasm as observed in patients with variant angina.

Animals↗
PubMed1979

Maladie du Roger 1879: a new translation for the centenary.

A new translation of Roger's description of the clinical and anatomical findings in uncomplicated small VSD is presented. Reappraisal of Roger's observations in the light of our present understanding confirms that only our attitudes change; diseases remain the same.

Child↗
PubMed1979

Developmental anatomy of the membranous part of the ventricular septum in the human heart.

The anatomy of the membranous part of the ventricular septum is described in 25 hearts from patients ranging in age from 15 weeks of gestation to the ninth decade of adult life. Both atrioventricular and interventricular components were recognised in all the adult subjects, and the atrioventricular component was evident in all 25. The interventricular membranous septum was present in only 1 of the fetal hearts and 4 of the infant subjects. We consider that these findings indicate that the transformation of the membranous septum into atrioventricular and interventricular components occurs in the late fetal and early postnatal period rather than during closure of the embryonic interventricular foramen. It is associated with the liberation of the medial leaflet of the tricuspid valve from the muscular ventricular septum.

Adolescent↗
PubMed1979

The spectrum of Ebstein's anomaly of the tricuspid valve.

The structure of the tricuspid valve in 14 cases of Ebstein's malformation is described and compared with that in the normal heart. The anomalous hearts showed a spectrum of malformation, varying from minimal displacement of the adjacent parts of the septal and inferior leaflets of the tricuspid valve to presence of an imperforate membrane or muscle shelf between the inlet and trabecular zones of the right ventricle. In "typical" Ebstein's anomaly the anterosuperior leaflet was abnormally attached so as to partially obstruct the route from right atrium to distal right ventricle, the communication between these chambers being between the abnormally attached leaflet and its malformed neighbors. In two hearts, a muscular shelf produced stenosis between inlet and trabecular portions, but a competent valve was produced at this site, the atrialized part of the right ventricle being of normal thickness. The significance of these findings is considered with regard to possible methods of repair. Description of the anomaly is facilitated by considering the right ventricle as possessing inlet, trabecular, and outlet portions. The essence of the anomaly is displacement of the tricuspid orifice to the junction of the inlet and trabecular ventricular zones.

Ebstein Anomaly↗
PubMed1977

Left juxtaposition of the auricles with l-position of the aorta. Report of 6 cases.

Six hearts are described in which juxtaposition of the auricles to the left of the great arteries (left juxtaposition) was associated with l-postion of the aorta. Atrial anatomy was abnormal but constant; the os of the right auricle occupied the expected site of the atrial septum, producing posterior and inferior desplacement of this structure. This is of importance since the os could be mistaken for a defect of the atrial septum, while the displacement of actual defects is of significance to any intended catheterisation procedure including atrial septostomy. Five of the hearts showed atrioventricular concordance while the other specimen was an example of primitive ventricle with a right-sided outlet chamber. The ventriculoarterial connection in this latter case was normal, with l-malposition (anatomically corrected malposition). Ventriculoarterial connections in the other hearts were transposition in 3, single aortic trunk with pulmonary atresia in 1, and an intermediate between double outlet right ventricle and transposition in the other. These cases confirm the observation that juxtaposition of the auricles is associated with severe cyanotic congenital heart disease.

Adolescent↗
PubMed1976

Congenitally corrected transposition of the great arteries: morphologic study of 32 cases.

The detailed anatomy of the heart is described in 32 autopsy cases of congenitally corrected transposition of the great arteries.Tis condition is defined as the combination of atrioventricular (A-V) discordance and transposition of the great arteries. Examples of primitive (single) ventricle with "inverted" (that is, left-sided in situs solitus) outlet chamber are excluded. Six hearts with A-V discordance and pulmonary atresia are described in an appendix. In 29 cases of corrected transposition the heart was in situs solitus; in 3 it was in situs inversus totalis. Only 5 of these 32 hearts had no potential for intracardiac shunting. Anomalies of the tricuspid valve (91 percent of cases), ventricular septal defect (78 percent) and pulmonary outflow tract obstruction (44 percent) occurred with sufficient frequency to be considered part of the basic malformation and are described in detail. The precise anatomy and disposition of the A-V valve tension apparatus, the coronary arteries and the conducting tissues are described with special reference to possible surgical approaches for repair of the anomalies. In two hearts with situs solitus the aortic valve was right-sided with respect to the pulmonary valve. This finding is important for both diagnosis and nomenclature.

Autopsy↗
PubMed1976

Angiographic anatomy of the right heart.

Casts of human hearts were prepared and photographed to illustrate the anatomy of the right heart chambers and ventricular septum. The casts were used to illustrate the anatomy of certain common pathological abnormalities of the ventricular septum and the appearances compared to angiocardiograms.

Angiography↗
PubMed1976

Surface ultrastructure of silicone rubber aortic valve poppetts after long-term implantation. A scanning electron microscope study of four poppets.

The surface ultrastructure, demonstrated by scanning electron microscopy, is described in four implanted Silastic aortic valve poppets. Ball variance was discovered at necropsy in two patients and clinically in one in whom the poppet was replaced. The fourth patient underwent reoperation, but ball variance was neither suspected nor found. All four poppets were densely coated with biological debris and microthrombi. The 'coat' was soluble in a weak solution of sodium hydroxide. The true Silastic surface beneath the coat was little altered compared with unimplanted poppets, even after 10 years' implantation.

Adult↗
PubMed1976

Dryander of Marburg's woodcut (the oldest transposition?)

A sixteenth century woodcut depicting atypical congenitally corrected transposition is described. The possibility that the artist saw an example of the condition is considered in the light of Galen's theory of the circulation.

Cardiology↗