Biomedical subjects
Thomas L. Spray
Publications and source records attributed to Thomas L. Spray.
Surgical management of congenital and acquired pulmonary vein stenosis.
Pulmonary vein stenosis describes a variety of entities with a variable clinical course. The basic pathologic process appears to be fibrous intimal thickening, which can gradually cause obliteration of the lumen of the pulmonary veins at the atrial junction. In its most severe form, congenital pulmonary vein stenosis is a progressive disease with rapid pulmonary hypertension and rare survival beyond the first year of life. Surgical intervention has not been successful in this group. Other forms of pulmonary vein stenosis, including unilateral types associated with congenital heart disease, may be managed by various surgical treatments or pneumonectomy in some cases. Although multiple surgical techniques have been described for repair of congenital vein stenosis, the "sutureless" techniques recently described may have a place in the surgical treatment of this condition. In the most severe forms, lung transplantation appears to be an important option that should be considered early in the course of the disease. Copyright 1999 by W.B. Saunders Company
Technique of pulmonary autograft aortic valve replacement in children (the Ross procedure).
Pulmonary autograft replacement has become a popular technique for relieving left ventricular outflow tract obstruction in children with aortic valvular or subvalvular disease. The advantages of the autograft are the avoidance of prosthetic valves that require anticoagulation and the potential for growth of a viable autograft aortic valve. Although many techniques for implantation of the autograft in the aortic outflow tract have been described, the most commonly preferred technique is the use of the autograft as a root replacement with reimplantation of the coronary ostia. This technique provides the optimal geometry of the autograft commissural attachments and also permits adjustment of the aortic annulus to enlarge the subaortic region in patients with complex left ventricular outflow tract obstruction or to narrow the aortic annulus in patients with primary aortic regurgitation and annular dilatation. Use of the autograft technique in children and young adults has resulted in excellent relief of outflow tract obstruction with low operative morbidity and mortality, and the intermediate results have been encouraging. The variations in surgical technique that have evolved have the potential to decrease the risk of late redilatation and regurgitation of the autograft valve and may provide better longevity. Copyright 1998 by W.B. Saunders Company