British heart journal
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British heart journal · Dec 1982
Total anomalous pulmonary venous return. Prenatal damage to pulmonary vascular bed and extrapulmonary veins.
To investigate the possibility that pulmonary vascular disease may be present at birth in children presenting with obstructed total anomalous pulmonary venous return in the neonatal period, pulmonary vascular structure was analysed in the lungs of six babies who died during the first week of life. Five babies had infradiaphragmatic total anomalous return and in one the pulmonary veins drained to the right atrium. In all cases mean percentage arterial medial thickness was greater than is normal at 5 hours. ⋯ In two cases the descending vertical vein was severely narrowed or occluded. A prenatal increase in intrapulmonary arterial and venous muscularity may encourage episodic pulmonary hypertension in the immediate postoperative period. In the infradiaphragmatic type of anomaly, prenatal structural changes in the extrapulmonary veins may predispose to the later development of pulmonary vein stenosis despite a successful surgical repair.
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British heart journal · Sep 1982
Total anomalous pulmonary venous connection. Repair using deep hypothermia and circulatory arrest in 44 consecutive infants.
Forty-four consecutive infants aged from 3 days to 10 months underwent repair of total anomalous pulmonary venous connection using deep hypothermia with circulatory arrest. There were eight (18%) early hospital deaths. Using multivariate analysis no significant association could be shown between early mortality and age or weight at operation, preoperative pulmonary or systemic pressure, and preoperative condition for patients undergoing operation during the most recent five year period. Late pulmonary venous obstruction developed in four (11%) of the survivors and all of these patients died.
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British heart journal · May 1982
Carotid sinus syncope treated by pacing. Analysis of persistent symptoms and role of atrioventricular sequential pacing.
Seventy patients have been paced for carotid sinus syndrome over four years. Twelve patients had persistent symptoms despite adequate ventricular pacing. ⋯ A group of 14 asymptomatic paced carotid sinus patients was found to have a significantly lower vasodepressor response, pacemaker effect, and combined vasodepressor response plus pacemaker effect than the group with persistent symptoms. Atrioventricular sequential pacing was shown to eliminate the hypotensive effect of ventricular pacing and is considered to be the treatment of choice for patients with carotid sinus syndrome who have both cardioinhibitory and significant vasodepressor responses.
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Study of 80 consecutive patients undergoing elective diagnostic cardiac catheterisation showed that after the procedure 25 (31%) developed myoglobinaemia. This was attributed to complications of the catheterisation in two. ⋯ In patients without intramuscular injections myoglobinaemia did not occur after uncomplicated cardiac catheterisation. The study did not support the proposition that cardiac catheterisation results in myocardial damage which can be detected by abnormalities of myoglobin but not by conventional indications of myocardial necrosis.
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British heart journal · Nov 1981
Case ReportsEchocardiographic demonstration of aortic root abscess after infective endocarditis.
We describe a patient with infective endocarditis in whom the diagnosis was apparent only on two-dimensional echocardiography. There was no clinical or haematological evidence of active endocarditis and the diagnosis was made by the demonstration of an abscess cavity and vegetation posterior and lateral to the aortic root, deforming the left atrial cavity. The findings were confirmed by cardiac catheterisation and operation.