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Biomedical subjects

T B Cartmill

Publications and source records attributed to T B Cartmill.

At least 19 recordsLinked to original sources
PubMed1995

The relationship between intelligence and duration of circulatory arrest with deep hypothermia.

A total of 114 children (51 with tetralogy of Fallot, 30 with transposition of the great arteries, and 33 with ventricular septal defect) who had these defects repaired with the use of deep hypothermia and circulatory arrest were assessed for intellectual and neuropsychologic function at an average of 9 to 10 years after the operation. Children with preoperative intellectual handicaps or postoperative neurologic complications were excluded. These children were compared with 54 who had atrial septal defects repaired with the use of cardiopulmonary bypass. The only significant difference in the neuropsychologic measures was that the bypass group had reaction times 2 to 3 seconds shorter on average than those of the hypothermic circulatory arrest group. Although there was no significant difference in intelligence quotient between the groups, a relationship between intelligence quotient and arrest time was found. Regression analysis of intelligence quotient against duration of arrest showed a significant decrease in intelligence quotient with increasing arrest time (slope = -0.36; p = 0.002; 95% confidence interval, -0.59, -0.14) indicating a decrease of 3 to 4 intelligence quotient points for each extra 10 minutes of arrest time. It appears that deep hypothermia with circulatory arrest for cardiac operations in children does not fully protect the brain, with a linear relationship existing between the amount of impairment and the duration of circulatory arrest.

Adolescent↗
PubMed1992

Minimally invasive management of transposition of the great arteries in the newborn period.

This study reports on a predominantly noninvasive management program for neonatal transposition of the great arteries [TGA] incorporating balloon atrial septostomy [BAS] under echocardiographic control. BAS was performed in 25 consecutive patients presenting with TGA between April 1988 and April 1990. Structural and coronary anatomy was evaluated echocardiographically with angiographic supplementation only when additional data were required. This information was correlated, where possible, with direct anatomic findings and subsequent course. BAS was performed through the umbilicus in 17 patients (85% of patients in whom this approach was attempted). Thirteen patients did not require ventilation during BAS. There were minimal complications and satisfactory septostomies in all cases. Coronary anatomy was correctly predicted in all patients where anatomic correlation was available. Without invasive investigation 9 patients underwent neonatal arterial switch procedures and 2 underwent palliative procedures. BAS under echocardiographic control proved safe, effective, minimally traumatic and mostly possible via the umbilical vein. The umbilical vein, where patent, permitted rapid safe access for BAS. Echocardiographic diagnosis of the coronary artery, and structural and functional anatomy was reliable and allowed minimally invasive preoperative management in many patients.

Cardiac Catheterization↗
PubMed1989

Nitroprusside in children after cardiopulmonary bypass: a study of thiocyanate toxicity.

Thiocyanate levels, an indicator of nitroprusside toxicity, were studied in 22 children after repair of structural heart disease during cardiopulmonary bypass. At the total dose (2.6 +/- 2.3 mg/kg) and time (34.4 +/- 19 h) ranges of this study, no evidence of toxicity was detected, despite this total dose exceeding recommended maximum in some patients. Nitroprusside infusion, as described, in children with normal hepatic and renal function is safe and may not warrant routine assessment of thiocyanate levels.

Aspartate Aminotransferases↗
PubMed1989

Report of four cases of aneurysm complicating patch aortoplasty for repair of coarctation of the aorta.

Patch aortoplastry, used almost routinely in the period 1972-86, except in infants in the operative treatment of coarctation of aorta, is sometimes complicated by late formation of true or false aneurysms. This complication, which seems likely to increase with longer follow-up, calls into question the advisability of patch aortoplasty except when it has specific advantages. Other surgical techniques such as subclavian flap angioplasty in infants and young children or radical excision with end-to-end anastomosis may be preferable where there is no anatomical contraindication. In any case, lifelong yearly review of postoperative patients should include chest X-ray and further investigation by computerized tomography scanning or other suitable imaging of those with suspicious findings.

Adolescent↗
PubMed1987

Total intracardiac repair for tetralogy of Fallot in adults.

The anatomic and clinical features of 47 patients who were 18 years of age or older at the time of total intracardiac repair for tetralogy of Fallot are reviewed. Twenty (43%) patients had had previous palliative surgery. Of 14 pulmonary-systemic shunts, 9 (64%) remained patent. The location of the ventricular septal defect was infracristal in 90% of patients. The predominant right ventricular outflow tract obstruction was at the infundibulum in 30%; another 64% of patients had combined valvular and infundibular obstruction. Total intracardiac repair was achieved; hospital mortality was 8.5%. Morbidity was minor, and hemorrhage was a significant problem in only 2 patients. Thirty-five patients have been followed from 11 months to 15 years after surgery. There were 4 late deaths; the actuarial 10-year survival rate was 82%.

Abnormalities, Multiple↗
PubMed1987

Management of ascending aortic dissection: experience with the USCI intraluminal prosthesis and a method of aortic valve repair.

Ten consecutive cases of acute ascending aortic dissection operated on using the USCI intraluminal prosthesis from 1983 to 1986 were reviewed. Diagnosis was achieved by conventional angiography in six cases, by intraarterial digital subtraction angiography in one case, by computerized tomography (CT) scan in two cases and by echocardiography and abdominal ultrasound in one case. An entry site was seen in only five out of six conventional angiograms. At operation six of the 10 had a degree of tamponade. Aortic regurgitation was seen five times, due to dissection in four cases and to Marfan's disease in one. The entry site was controlled in eight cases. Repair using intraluminal prosthesis only was achieved in five cases. Aortic valve repair was added in four out of 10 cases, and in one of these an aorta-to-right coronary graft was also added. One case required aortic valve replacement. A method of aortic valve repair is presented. There were nine survivors, 1-36 months postoperatively. Of these, eight were asymptomatic on no medication. One had severe aortic regurgitation noted 2 months postoperatively and has mildly reduced exercise tolerance. Surgical treatment can be planned if the presence of dissection is proven and involvement of the ascending aorta is demonstrated. Early surgery is important, since six of the 10 cases in this series had tamponade. The intraluminal graft will reliably redirect flow to the true lumen and exclude the dissection from the pericardium. Aortic valve repair can be successful though late replacement may be necessary in some cases. Control of the entry site is not essential to achieve a good clinical result.

Adult↗
PubMed1987

Aorta-coronary bypass grafting with polytetrafluoroethylene conduits. Early and late outcome in eight patients.

During 1982 and 1983 we performed aorta-coronary bypass grafts on eight patients using 4 mm polytetrafluoroethylene conduits and predominantly the multiple sequential graft technique. Angiography was performed 1 week postoperatively and seven of eight patients had patent grafts and were angina free. At 1 year's follow-up 18 of 28 distal anastomoses were patent and five of eight patients were angina free. At 45 month's follow-up four of 28 distal anastomoses were patent and one of eight patients was angina free.

Angina Pectoris↗
PubMed1986

Accessory mitral valve tissue causing left ventricular outflow tract obstruction.

Although left ventricular outflow tract obstruction is commonly associated with congenitally corrected transposition of the great vessels, this obstruction is seldom caused by accessory mitral valve tissue. Three cases in which accessory mitral valve tissue caused left ventricular outflow tract obstruction in children are described. Two had congenitally corrected transposition and one had normally connected great vessels. The accessory leaflet tissue, which was identified by echocardiography and angiography, was attached by chordae tendineae to normally sited papillary muscles and herniated into the left ventricular outflow tract during systole. Operation was successful in these patients. The accessory valve tissue was excised via an arteriotomy in the great vessel that arose from the left ventricle. The obstructive tissue was excised close to its peripheral attachments in the outflow tract and its chordae tendineae were divided. Resection was performed without injury to the abnormally placed conduction system or to the normal valve structures.

Adolescent↗
PubMed1982

Profound hypothermia with circulatory arrest: nine years' clinical experience.

A total of 550 intracardiac operations were performed with the aid of profound hypothermia and circulatory arrest between March, 1971, and December, 1979. Both cooling and rewarming were effected by means of an extracorporeal heat exchanger. Overall mortality was 20%, falling to 10% in 1979. Highest risks were associated with operations in the neonatal period and for unusually complex defects. The technique has proved safe for straight forward corrections in young age groups and is especially valuable for selected complex lesions in older children and those requiring reoperation. Although circulatory arrest has greatly extended the range of corrective heart operation in infancy, we believe there is still a significant place for palliative procedures in appropriate circumstances. Neurologic complications attributed to the technique have been uncommon, and only 4.5% of the survivors have any recognizable residual neurologic lesion, whether coincidental or resulting from circulatory arrest. The technique is simple, reliable, and generally safe.

Child, Preschool↗
PubMed1980

Trans--pulmonary arterial repair of supracristal ventricular septal defects in infancy.

Five patients aged 2 months to 2 years with isolated large supracristal ventricular septal defect (VDS) and severe pulmonary hypertension had corrective operation between April, 1978, and November, 1979, performed via a trans--pulmonary arterial approach. This technique provided excellent exposure for accurate placement of sutures, especially between the two semilunar valves. All patients are well, with no residual defects, and their postoperative electrocardiograms (ECGs) do not show any intraventricular conduction abnormality. The technique is especially useful in the presence of severe pulmonary hypertension, wherein ventriculotomy is best avoided and the dilated main pulmonary artery offers excellent access.

Body Weight↗
PubMed1977

Low thoracic duct ligation for postoperative chylous effusions in infants and children.

Three patients aged from three months to six years underwent thoracic duct ligation at the level of the diaphragm for chylothorax which occurred following cardiac operations. Another three-month-old patient underwent thoracic duct ligation for massive postoperative chylopericardium. Indications for operation were a large recurrent chyle accumulation or prolonged chyle drainage. Operative ductograms to deliniate the cisterna chyli and to exclude the presence of multiple lymph channels were performed in three patients. Excellent postoperative results were obtained in all patients for periods of up to two years. Low thoracic dust ligation is a reliable means of control of postoperative chylothorax and lengthy persistence with conservative treatment is no longer necessary.

Child↗
PubMed1976

Angiographic assessment of anomalous origin of the left coronary from the pulmonary artery in infancy and childhood.

Angiographic findings in five paediatric patients with anomalous left coronary artery arising from the pulmonary artery are presented. An attempt is made to provide an angiographic rationale of some aspects of the pathophysiology and electrocardiography in this condition, and the vital importance of angiography in selecting the appropriate surgical approach is underlined.

Angiocardiography↗
PubMed1975

Australian pacemakers: a follow-up survey.

The Royal Prince Alfred Hospital experience with Australian-made pacemakers shows that the Telectronics P7 fixed-rate pacemaker has a 90% survival rate at two years. Such a figure compares favourably with those of its predecessor and other makes of pacemaker. Survival of the P6 ventricular synchronized units is slightly less than that of the P7.

Aged↗