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Biomedical subjects

W S Culpepper

Publications and source records attributed to W S Culpepper.

14 recordsLinked to original sources
PubMed1993

Atrioventricular valve competence after takedown to improve exposure during ventricular septal defect repair.

Although the atrioventricular valve and its attachments can sometimes obscure the superior margin of a ventricular septal defect, concern for valvular competence has made surgeons hesitant to take down the atrioventricular valve. Over a 10-year period, the right atrioventricular valve was taken down to improve exposure for ventricular septal defect repair in 40 patients at our institution, and follow-up echocardiographic studies to determine the degree of valvular regurgitation were available in 32. On the basis of the area of the color flow jet, valvular regurgitation was graded as none in 22 and trivial in 10. Heart block did not develop in any patient, and there were no deaths. Takedown and resuspension of the atrioventricular valve is a safe and effective technique that improves exposure for ventricular septal defect repair and does not adversely affect valve competence.

Cardiac Surgical Procedures↗
PubMed1990

Partial anomalous pulmonary venous return.

Anomalous pulmonary venous return from the left lung is an extremely rare condition that is reported sporadically and in general in case reports. From 1964 through 1988, we identified 13 patients with this condition, all of whom underwent surgical correction. This represents the single largest reported institutional experience with this anomaly. The patients ranged in age from 15 months to 40 years. Seven were asymptomatic, and six had symptoms ranging from recurrent pulmonary infection to moderate congestive heart failure. Six had anomalous venous return from the entire left lung, and seven had anomalous return from the upper lobe only. Eight of the patients had associated cardiovascular anomalies. Four of the patients underwent surgical correction via a sternotomy approach with cardiopulmonary bypass to allow correction of coexisting intracardiac anomalies. The remaining patients underwent surgical repair through a left thoracotomy. The technique included high ligation and division of a persistent left superior vena cava with anastomosis to the left atrium at the site of partial excision of the atrial appendage. There were no deaths and only one complication in our series.

Anastomosis, Surgical↗
PubMed1989

Pulmonary artery banding: analysis of a 25-year experience.

A 25-year experience (May 1962 through April 1987) with pulmonary artery banding in 183 patients was reviewed and analyzed. Pulmonary artery banding was performed in a heterogeneous group of patients aged two days to 60 months (median, 10 weeks; mean, 21.8 weeks) and weighing 1.4 to 13.8 kg (mean, 4.2 kg). Diagnosis was ventricular septal defect in 76 (41.5%) and atrioventricular communis in 41 (22.4%). Pulmonary artery banding was also used in patients with d-transposition of the great vessels with ventricular septal defect, double-outlet right ventricle, univentricular heart, tricuspid atresia, and truncus arteriosus. Early death occurred in 39 of 175 patients who underwent pulmonary artery banding at Ochsner Foundation Hospital (22.3%). Definitive operation has been performed in 37 of the patients who underwent pulmonary artery banding since 1979 with excellent outcome in 32 (86.5%). Pulmonary artery banding is a useful palliative procedure for a diverse group of patients with congenital cardiac anomalies and unrestricted pulmonary blood flow. With improved results of primary repair of intracardiac anomalies in small infants, however, pulmonary artery banding should be reserved for severely ill patients with complex lesions not amenable to early definitive correction. Currently, pulmonary artery banding is indicated in patients with excessive pulmonary blood flow and single ventricle or tricuspid atresia. Pulmonary artery banding is also appropriate in certain patients with atrioventricular communis and in patients with muscular or multiple ventricular septal defects. Pulmonary artery banding is an option in patients with ventricular septal defect and coarctation of the aorta.

Constriction↗
PubMed1987

Blood pressure and echocardiographic measures in children: the Bogalusa Heart Study.

M mode echocardiograms were obtained from 654 healthy subjects, 7 to 22 years of age, whose diastolic blood pressure levels remained in the same height-, race-, and sex-specific decile during two biannual examinations. Echocardiographic measures of heart size, obtained according to the recommendations of the American Society for Echocardiography, were compared across the entire systolic and diastolic blood pressure distributions. Echocardiographic indexes of left heart size varied as a function of both blood pressure levels and body size. Significant positive correlations were present between systolic blood pressure and different measures of left ventricular size. Left ventricular wall thickness in systole correlated with systolic blood pressure (r = .42, p less than .0001), and persistence of this relationship was noted after adjustment for body size. Left ventricular wall thickness in diastole correlated with blood pressure before adjustment (r = .31, p less than .0001), but the relationship was not significant after adjustment for body size. The ratio of left ventricular thickness to chamber size (systole) correlated with systolic blood pressure levels both before and after adjustment for body size (r = .20 and r = .22, p less than .001). Male subjects of both races demonstrated significantly higher adjusted left ventricular mass, left ventricular wall thickness, and left ventricular chamber size. Adjusted left ventricular wall stress was significantly related to both systolic (r = .14) and diastolic blood pressure levels (r = .14, p less than .001). Measures of left ventricular wall thickness increased throughout the entire blood pressure distribution, indicating a consistent trend rather than a threshold effect seen only in the highest blood pressure groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Technique and experience with azygos patch modified Blalock-Taussig anastomosis for congenital cyanotic heart disease.

Seventeen patients 1 day to 28 months old with congenital cyanotic heart disease underwent a modification of the Blalock-Taussig shunt. Eight were newborn infants weighing 2.6 to 4.8 kg. All infants had complex congenital heart defects that were not considered amenable to early correction. There were no early deaths and no shunt failures. Postoperative complications were restricted to prolonged intubation in 2 patients and a subcutaneous wound infection in a 14-day-old infant. Follow-up from 1 to 31 months revealed minimal cyanosis, stable hemoglobin levels, and good shunt murmurs, and there have been no upper extremity complications. There were 2 late deaths; 1 (the oldest patient) was related to medication, and the second resulted from small bowel necrosis. The concept of the azygos vein patch modified Blalock-Taussig shunt involves two factors: (1) mobilizing as much length as possible of the subclavian artery in spite of its distal small size to allow for a tension-free shunt to prevent tension on the anastomosis as growth occurs, and (2) enlarging the subclavian artery distal to the vertebral artery origin with an autologous azygos patch. During performance of a standard Blalock-Taussig shunt, a longitudinal incision is made through the pulmonary artery across the anastomosis into the upper subclavian artery. The appropriate length of harvested azygos vein is used as a patch angioplasty across the shunt. A tension-free shunt with a patulous distal portion is achieved. Pulmonary overcirculation is avoided by the limiting size of the proximal subclavian artery. Temporary occlusion of the shunt at operation resulted in an increased mean blood pressure from 6 to 18% in all infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriovenous Anastomosis↗
PubMed1985

Functional aortic valve atresia in transposition of the great arteries.

The criterion for the diagnosis of functional atresia of a patient semilunar valve is met when the pressure in a ventricle remains lower than that in the related great artery throughout systole so that no forward flow can occur. Functional pulmonary valve atresia has been well recognized in infants with normally related great arteries and massive tricuspid valve incompetence. The cardiac physiology and anatomy of an infant with transposed great arteries and functional aortic valve atresia is reported for the first time. The peak systolic pressure in the right ventricle was 30 mm Hg and in the aorta 64 mm Hg. The causes for right ventricular incompetence were abnormalities of the tricuspid valve and hypoplasia of the ventricular free wall. Three other cases with similar ventricular anatomy and physiology but with anatomic atresia of the aortic valve are reviewed. The possibility that under these physiologic circumstances during fetal life functional atresia develops first, and that anatomic fusion of idle semilunar cusps develops as a secondary phenomenon, is discussed.

Aortic Valve↗
PubMed1983

Cardiac anatomy and function in juvenile hypertension. Current understanding and future concerns.

Recently, several groups of investigators have independently identified subtle cardiac changes very early in the development of primary hypertension. Echocardiographic evidence for left ventricular hypertrophy has been found in 10 to 15 percent of adolescents with mild persistent hypertension. However, in individual cases and within groups, the relationship between left ventricular mass and random blood pressure measurements was not extremely strong. Factors other than blood pressure probably influence the development of left ventricular hypertrophy in teenagers. Resting left ventricular function and overall estimates of exercise capacity for hypertensive teenagers fell within normal limits. However, during upright bicycle exercise, peak exercise systolic and diastolic pressures, and peak heart rates were significantly higher in hypertensive male and female adolescents compared to normotensive controls. Myocardial oxygen consumption may be considerably higher for hypertensive teenagers at rest and during peak exercise. Juvenile onset essential hypertension and left ventricular hypertrophy may be separate but interrelated long-term cardiovascular risk factors. Uniform echocardiographic methods for assessment of left ventricular anatomy are recommended to provide the basis for systematic, longitudinal studies needed to resolve these important issues.

Adolescent↗
PubMed1983

Cardiovascular responses to PEEP and CPAP following repair of complicated congenital heart defects.

Fourteen infants and children ranging in age from 7 months to 8 years were studied in a hemodynamically stable condition following repair of various heart defects. Changes in cardiac index, stroke index, heart rate, systemic vascular resistance, mean arterial pressure, and central venous pressure were evaluated at levels of 0, 5, and 10 cm H2O using positive end-expiratory pressure (PEEP) in 14 patients and continuous positive airway pressure (CPAP) in 3 patients. No significant changes were found in any of the measurements taken at the different levels.

Blood Pressure↗
PubMed1983

Cardiac status in juvenile borderline hypertension.

A prospective M-mode echocardiographic study was done to look for early cardiovascular changes in children prone to hypertension with blood pressures between the 75th and 95th percentiles for age. Average systolic/diastolic pressures in 27 children with borderline hypertension were 137/89 mm Hg compared to 110/68 mm Hg for the 26 controls. Echocardiographic measurements were normalized for comparison using two methods. The borderline hypertensive group mean values were significantly greater than controls for left ventricular wall thickness (p less than 0.05 for method 1; p less than 0.001 for method 2), left ventricular mass (p less than 0.001; p less than 0.005) and left ventricular wall thickness to radius ratio (p less than 0.001, both methods). Echocardiographic estimates of left ventricular function were lower in the hypertensive group. This study suggests that cardiac hypertrophy can be shown by noninvasive means in some children before arterial pressure becomes elevated. To assess the incidence and possible consequences of early target organ changes, more extensive clinical evaluation of borderline hypertension in children is recommended.

Adolescent↗
PubMed1982

Iatrogenic right ventricular failure in tetralogy of Fallot repairs: reappraisal of a distressing problem.

A patient with tetralogy of Fallot experienced isolated right ventricular failure when the right coronary artery was occluded by an encircling suture at the time of closure of the ventricular septal defect. Recognition and correction of the problem allowed weaning from cardiopulmonary bypass and an uneventful recovery. Because ventricular septal defects in tetralogy of Fallot are usually anterior and subaortic, injury to the right coronary artery, in close proximity to the superior aspect of the defect, is a potential danger. When isolated right ventricular failure occurs immediately after repair, suture occlusion of the right coronary artery should be considered as a possible cause.

Child↗