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Biomedical subjects

Thomas P Graham

Publications and source records attributed to Thomas P Graham.

14 recordsLinked to original sources
PubMed2006

Pregnancy outcomes after atrial repair for transposition of the great arteries.

Increasingly, women born with complete transposition of the great arteries who have undergone atrial repair by either the Senning or the Mustard procedure are reaching childbearing age. This study reports on pregnancy outcomes after the atrial repair of transposition of the great arteries. Record review and standardized questionnaires were used to ascertain the outcomes of 70 pregnancies reported in 40 women (36 Mustard procedures, 4 Senning procedures). Of the 70 pregnancies, 54 resulted in 56 live births, 10 in miscarriages, and 6 in therapeutic abortions. At pregnancy, 31 women were in New York Heart Association class I, 8 were in class II, and 1 was in class III. Thirty-nine percent of the infants were delivered prematurely and weighed 2,714 +/- 709 g; 28% were delivered by cesarean section, 8 for cardiac indications. Maternal complications included arrhythmias in 5 women and hemoptysis in 2 women. Heart failure occurred in 6 women, developing during the second and third trimesters. Postpartum cardiac events developed 2 to 9 days postpartum: heart failure in 5 women, atrial fibrillation in 1 woman, and decreased oxygen saturation due to a new atrial baffle leak in 1 woman. Severe right ventricular (RV) failure led to cardiac transplantation after delivery in 1 woman; another developed heart failure and then died suddenly 1 month after delivery. There was 1 late death, 4 years after the patient's last pregnancy. In conclusion, pregnancy after atrial repair carries a moderate degree of risk and should be undertaken with caution.

Cardiac Surgical Procedures↗
PubMed2006

Report of the Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Disease.

A member of the Tennessee state legislature recently proposed a bill that would mandate all newborn infants to undergo pulse oximetry screening for the purpose of identifying those with critical structural heart disease before discharge home. The Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Defects was convened on September 29, 2005. This group reviewed the current medical literature on this topic, as well as data obtained from the Tennessee Department of Health, and debated the merits and potential detriments of a statewide screening program. The estimated incidence of critical congenital heart disease is 170 in 100,000 live births, and of those, 60 in 100,000 infants have ductal-dependent left-sided obstructive lesions with the potential of presentation by shock or death if the diagnosis is missed. Of the latter group, the diagnosis is missed in approximately 9 in 100,000 by fetal ultrasound assessment and discharge examination and might be identified by a screening program. Identification of the missed diagnosis in these infants before discharge could spare many of them death or neurologic sequelae. Four major studies using pulse oximetry screening were analyzed, and when data were restricted to critical left-sided obstructive lesions, sensitivity values of 0% to 50% and false-positive rates of between 0.01% and 12% were found in asymptomatic populations. Because of this variability and other considerations, a meaningful cost/benefit analysis could not be performed. It was the consensus of the task force to provide a recommendation to the legislature that mandatory screening not be implemented at this time. In addition, we determined that a very large, prospective, perhaps multistate study is needed to define the sensitivity and false-positive rates of lower-limb pulse oximetry screening in the asymptomatic newborn population and that there needs to be continued partnering between the medical community, parents, and local, state, and national governments in decisions regarding mandated medical care.

Advisory Committees↗
PubMed2005

Occlusion of the coronary sinus ostium: a danger for cavopulmonary anastomosis.

Coronary sinus (CS) ostial obstruction decompressing through a left superior vena cava is a rare finding and presents unique risks to patients requiring a Glenn anastomosis for single-ventricle palliation. Preoperative diagnosis is imperative in order to avoid inadvertent ligation or coil occlusion. We report three cases with single-ventricle physiology and CS obstruction identified at cardiac catheterization. Balloon occlusion angiography proved valuable in making the diagnosis.

Brachiocephalic Veins↗
PubMed2005

Clinical presentations of unoperated and operated adults with congenital heart disease.

The clinical presentation of adults with congenital heart disease (ACHD) is exceptionally diverse. Operated, unoperated acyanotic, and cyanotic patients often have similar physiologic characteristics, and thus shared clinical symptomatology. Five illustrative cases are included to highlight important considerations in the diagnosis and management of ACHD. This article focuses on epidemiology, natural history, clinical outcomes, and use of ancillary studies in commonly encountered cardiac defects.

Adult↗
PubMed2002

Management of pulmonary regurgitation after tetralogy of fallot repair.

There are an increasing number of patients with moderate to severe pulmonary regurgitation who develop right ventricle dysfunction, with associated symptoms of fatigue and exercise intolerance, after surgical repair of tetralogy of Fallot. Critical longitudinal follow-up of these patients is needed, with assessment by clinical and laboratory studies of right ventricular size, function, and exercise capability. Pulmonary valve replacement is recommended before significant right ventricular dysfunction occurs. The search for an ideal valve to use in this condition continues.

Heart Ventricles↗