48 results on '"Brawn, W J"'
Search Results
2. Antenatal perspective of hypoplastic left heart syndrome: 5 years on
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Rasiah, S V, Ewer, A K, Miller, P, Wright, J G, Barron, D J, Brawn, W J, and Kilby, M D
- Published
- 2008
- Full Text
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3. Staged surgical management of hypoplastic left heart syndrome: a single institution 12 year experience
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McGuirk, S P, Griselli, M, Stumper, O F, Rumball, E M, Miller, P, Dhillon, R, de Giovanni, J V, Wright, J G, Barron, D J, and Brawn, W J
- Published
- 2006
4. Combined atrial arterial switch operation (double switch) for hearts with Shone syndrome and pulmonary hypertension
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Hosseinpour, A. R., Amanullah, M., Ramnarine, I. R., Stümper, O., Barron, D. J., and Brawn, W. J.
- Published
- 2006
5. Changing practice of cardiac surgery in adult patients with congenital heart disease
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Srinathan, S K, Bonser, R S, Sethia, B, Thorne, S A, Brawn, W J, and Barron, D J
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- 2005
6. Challenges in paediatric perfusion
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Brawn, W J
- Published
- 2002
7. A new syndrome of multiple hemangiomas, right dominant double aortic arch, and coarctation
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Wong, C. H., Wright, J. G., Silove, E. D., Willetts, R., and Brawn, W. J.
- Published
- 2001
8. Outcome after prenatal diagnosis of hypoplastic left-heart syndrome: a case series
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Brackley, K J, Kilby, M D, Wright, J G, Brawn, W J, Sethia, B, Stumper, O, Holder, R, Wyldes, M P, and Whittle, M J
- Published
- 2000
9. Anatomic repair of double discordant hearts
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STUMPER, O and BRAWN, W J
- Published
- 1998
10. Surgery for infants with a hypoplastic systemic ventricle and severe outflow obstruction: Early results with a modified norwood procedure
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Bu'Lock, F. A., Stumper, O., Jagtap, R, Silove, E. D., De Giovanni, J. V., Wright, J. G. C., Sethia, B., and Brawn, W. J.
- Published
- 1995
11. Re-evaluation of hypoplastic left heart syndrome from a developmental and morphological perspective.
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Crucean, A., Alqahtani, A., Barron, D. J., Brawn, W. J., Richardson, R. V., O'Sullivan, J., Anderson, R. H., Henderson, D. J., and Chaudhry, B.
- Subjects
HYPOPLASTIC left heart syndrome ,CONGENITAL heart disease ,HEART ventricles ,HUMAN abnormalities ,ENDOTHELIAL cells ,HEART metabolism ,MUSCLE protein metabolism ,ANIMAL experimentation ,IMMUNOHISTOCHEMISTRY ,MICE ,MITRAL valve ,MYOCARDIUM ,CARDIOMYOPATHIES ,RESEARCH funding - Abstract
Background: Hypoplastic left heart syndrome (HLHS) covers a spectrum of rare congenital anomalies characterised by a non-apex forming left ventricle and stenosis/atresia of the mitral and aortic valves. Despite many studies, the causes of HLHS remain unclear and there are conflicting views regarding the role of flow, valvar or myocardial abnormalities in its pathogenesis, all of which were proposed prior to the description of the second heart field. Our aim was to re-evaluate the patterns of malformation in HLHS in relation to recognised cardiac progenitor populations, with a view to providing aetiologically useful sub-groupings for genomic studies.Results: We examined 78 hearts previously classified as HLHS, with subtypes based on valve patency, and re-categorised them based on their objective ventricular phenotype. Three distinct subgroups could be identified: slit-like left ventricle (24%); miniaturised left ventricle (6%); and thickened left ventricle with endocardial fibroelastosis (EFE; 70%). Slit-like ventricles were always found in combination with aortic atresia and mitral atresia. Miniaturised left ventricles all had normally formed, though smaller aortic and mitral valves. The remaining group were found to have a range of aortic valve malformations associated with thickened left ventricular walls despite being described as either atresia or stenosis. The degree of myocardial thickening was not correlated to the degree of valvar stenosis. Lineage tracing in mice to investigate the progenitor populations that form the parts of the heart disrupted by HLHS showed that whereas Nkx2-5-Cre labelled myocardial and endothelial cells within the left and right ventricles, Mef2c-AHF-Cre, which labels second heart field-derived cells only, was largely restricted to the endocardium and myocardium of the right ventricle. However, like Nkx2-5-Cre, Mef2c-AHF-Cre lineage cells made a significant contribution to the aortic and mitral valves. In contrast, Wnt1-Cre made a major contribution only to the aortic valve. This suggests that discrete cardiac progenitors might be responsible for the patterns of defects observed in the distinct ventricular sub-groups.Conclusions: Only the slit-like ventricle grouping was found to map to the current nomenclature: the combination of mitral atresia with aortic atresia. It appears that slit-like and miniature ventricles also form discrete sub-groups. Thus, reclassification of HLHS into subgroups based on ventricular phenotype, might be useful in genetic and developmental studies in investigating the aetiology of this severe malformation syndrome. [ABSTRACT FROM AUTHOR]- Published
- 2017
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12. Hypoplastic left heart syndrome. More families now have a choice
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Brawn, W. J., De Giovanni, J. V., Hutchinson, S., Sethia, B., Silove, E. D., Stumper, O., and Wright, J. G.
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Letter - Published
- 1997
13. Management and outcome of infants and children with right atrial isomerism.
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Sadiq, M., Stümper, O., De Giovanni, J. V., Wright, J. G., Sethia, B., Brawn, W. J., and Silove, E. D.
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AUDITING ,CARDIOPULMONARY bypass ,CONGENITAL heart disease ,HEART atrium ,SURVIVAL ,TREATMENT effectiveness - Abstract
Objectives: To assess the current results and outcome of surgery in infants and children with right atrial isomerism and complex congenital heart disease.Setting: Tertiary referral centre.Methods: 20 consecutive children with right atrial isomerism and complex congenital heart disease underwent surgery over a 6 year period between August 1987 and July 1993. The results and outcome were analysed according to age, presentation, and surgical procedures.Results: Patients were divided into two groups depending on age at presentation and initial surgery: group A comprised 11 patients who required surgical intervention in the first month of life (mean age 5 days); and group B comprised nine patients who required initial surgical intervention after the first month of life (mean age 6.8 months). Seven (64%) of the 11 patients in group A had obstructed pulmonary venous drainage and ten (91%) had pulmonary atresia. There were seven early deaths (64%), including the five patients who required systemic to pulmonary artery shunt and simultaneous repair of obstructed pulmonary veins. The long-term survival rate in this group was 18% (two of 11). Pulmonary venous obstruction was present in two (22%) of the nine patients in group B and four (44%) had pulmonary atresia. There were no early deaths. One patient died after a second palliative procedure. There was one late sudden death. Four patients had a Fontan operation with no deaths. Two of the remaining three patients meet the Fontan criteria. The long-term survival rate in this group was 78% (seven of nine).Conclusions: Surgical management of patients with right atrial isomerism who have complex congenital heart disease carries a high mortality and remains palliative. The overall survival rate was 45% (nine of 20); 18% in patients requiring surgery in the first month of life (group A) and 78% in patients requiring surgery after the first month of life (group B) (P < 0.001). Of the total of 20 patients, nine were potential candidates for a Fontan operation. Seven of these have undergone a Fontan procedure with five survivors. [ABSTRACT FROM AUTHOR]- Published
- 1996
14. Severe subaortic stenosis in interrupted aortic arch in infancy and childhood.
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MENAHEM, SAMUEL, BRAWN, WILLIAM J., MEE, ROGER B.B., Menahem, S, Brawn, W J, and Mee, R B
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- 1991
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15. Repair of truncus arteriosus and interrupted aortic arch.
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SANO, SHUNJI, BRAWN, WILLIAM J., MEE, ROGER B.B., Sano, S, Brawn, W J, and Mee, R B
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- 1990
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16. Combined atrial and arterial switch procedure for congenital corrected transposition with ventricular septal defect.
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Stümper, O., Wright, J. G., De Giovanni, J. V., Silove, E. D., Sethia, B., and Brawn, W. J.
- Abstract
OBJECTIVES--A combined atrial and arterial switch procedure was performed in selected patients with congenitally corrected transposition to establish the morphological left ventricle as the systemic ventricle. Immediate and early follow up results are presented. BACKGROUND--Progressive right ventricular dysfunction and tricuspid regurgitation are common in patients with congenitally corrected transposition who undergo repair of associated lesions. A surgical procedure which re-establishes the left ventricle as the systemic ventricle should improve functional results. METHODS--Four symptomatic children aged from 9 months to 3 years 1 month (mean 2 years 3 months) with congenitally corrected transposition and ventricular septal defect underwent both an atrial and arterial switch procedure and were followed up for a mean of 12 months (range 6-21 months). RESULTS--There were no early or late deaths. Conduction abnormalities worsened in two patients. Hospital stay ranged from 8 to 17 days (mean 13 days). The cardiothoracic ratio decreased from a mean (range) of 0.65 (0.6 to 0.71) to 0.58 (0.52 to 0.6). Currently, three patients are in functional class I and one child is in functional class II. CONCLUSIONS--The combination of an atrial and an arterial switch procedure in symptomatic children with congenitally corrected transposition establishes the left ventricle as the systemic ventricle. The initial experience is encouraging with excellent immediate and early follow up results. [ABSTRACT FROM PUBLISHER]
- Published
- 1995
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17. Cardiac conduction abnormalities and rhythm changes after neonatal anatomical correction of transposition of the great arteries.
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Menahem, S, Ranjit, M S, Stewart, C, Brawn, W J, Mee, R B, and Wilkinson, J L
- Abstract
Seventy three infants who underwent neonatal anatomical correction for transposition of the great arteries with or without a ventricular septal defect were reviewed for evidence of conduction and rhythm abnormalities on preoperative and postoperative 12 lead electrocardiograms and during 24 hour Holter monitoring. There was a partial right bundle branch block pattern in 47% (29/62) of all patients and in 60% (24/40) of those with simple transposition. Complete right bundle branch block was noted in 21% including 5% with simple transposition. Holter monitoring showed sinus rhythm in all patients except three: one had episodes of supraventricular tachycardia, another an intermittent second degree heart block, and a third a complete heart block. Atrial extrasystoles were noted in 47% (29/62) of patients but were frequent in only three patients. Occasional unifocal ventricular extrasystoles were encountered in 37% (23/62) of patients and were frequent in a further 3% (2/62). Only one patient (2%) developed multifocal ventricular extrasystoles. The frequency of important cardiac arrhythmias after neonatal anatomical correction of transposition of the great arteries was 5%, significantly less than that reported after atrial inflow diversion for the same malformation. [ABSTRACT FROM PUBLISHER]
- Published
- 1992
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18. EFFECTS OF VASODILATORS ON RATES OF CHANGE OF NASOPHARYNGEAL TEMPERATURE AND SYSTEMIC VASCULAR RESISTANCE DURING CARDIOPULMONARY BYPASS IN ANAESTHETIZED DOGS.
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Li, D. M. F., Mullaly, R., Ewer, P., Bell, B., Eyres, R. L., Brawn, W. J., and Mee, R. B. B.
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- 1988
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19. SURGICAL EXCISION OF PRIMARY CARDIAC TUMOURS IN INFANCY.
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Skilllington, P. D., Brawn, W. J., Edis, B. D., Menahem, S., Venables, A. W., Goh, T. H., and Mee, R. B. B.
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- 1987
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20. Outcome of prenatally diagnosed hypoplastic left heart syndrome between 1994 and 1999.
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Brackley, K. J., Kilby, M. D., Wright, J. G., Brawn, W. J., and Whittle, M. J.
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PRENATAL diagnosis ,FETAL monitoring ,HEART disease diagnosis ,ECHOCARDIOGRAPHY - Abstract
The article presents an abstract of the study "Outcome of prenatally diagnosed hypoplastic left heart syndrome between 1994 and 1999." The study uses data of all cases of prenatally diagnosed hypoplastic left heart syndrome referred to Fetal Medicine Unit at Birmingham Women's Hospital between 1994 and 1999. The study finds that 36 out of 87 couples opted for abortion after diagnosis of hypoplastic left heart syndrome using fetal echocardiography.
- Published
- 2000
21. A forgotten old disease: mediastinal tuberculous lymphadenitis in children.
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Venkateswaran RV, Barron DJ, Brawn WJ, Clarke JR, Desai M, Samuel M, and Parikh DH
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- Bronchoscopy, Child, Child, Preschool, Diagnosis, Differential, Female, Humans, Infant, Male, Mediastinal Diseases surgery, Tomography, X-Ray Computed, Tuberculosis, Lymph Node surgery, Mediastinal Diseases diagnostic imaging, Tuberculosis, Lymph Node diagnostic imaging
- Abstract
Objective: The purpose of the study was two-fold: (1) to highlight the varied presentation of mediastinal tuberculous lymphadenitis (MTL) in children and (2) to identify parameters, that may help in the early diagnosis of this condition., Methods: Between January 1995 and December 2002, 13 children with histological diagnosis of MTL were retrospectively assessed for age at presentation, history of exposure to TB, presenting symptoms, investigations, initial diagnosis, surgical treatment and outcome. Stepwise multiple linear regression analysis was used to determine potential risk factors for early diagnosis of MTL., Results: Thirteen children presented with: (a) fever, night sweats and weight loss (4); (b) acute respiratory distress (2); (c) cough and shortness of breath (SOB) (5); (d) stridor (1); and (e) chest pain (1). TB was suspected only in 6 children (46%) at presentation. In the other 7 cases (54%) the presumed diagnoses were: neuroblastoma (n=1), metastatic malignancy (n=1), bronchial polyp (n=1), bronchogenic cyst (n=2), and presumed foreign body (n=2). Bronchoscopy was diagnostic in identifying cheesy material within the bronchus and organisms on lavage in 4 (30%) and in identifying external compression in 2 (15%). Thoracotomy and excision of the lymph node mass was necessary to treat the mediastinal compression and to ascertain the diagnosis of TB in 3 children (23%). All 13 children had complete resolution of tuberculous lymphadenitis following anti-tuberculous treatment. The diagnostic clues in this cohort of patients were cough and SOB with history of exposure to tuberculosis (P=0.0001) and bronchoscopy and lavage with positive staining for acid-fast bacilli (P=0.0001)., Conclusions: Tuberculosis was not suspected in 54% of children with MTL, and they posed diagnostic dilemma on admission. Bronchoscopy must be used as a diagnostic tool in children where tuberculosis cannot be excluded by radiology or specific skin tests. Thoracotomy and excision may be necessary to treat the obstructive symptoms.
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- 2005
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22. Repair of truncus arteriosus: a considered approach to right ventricular outflow tract reconstruction.
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Danton MH, Barron DJ, Stumper O, Wright JG, De Giovannni J, Silove ED, and Brawn WJ
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- Blood Vessel Prosthesis Implantation, Cardiac Surgical Procedures methods, Case-Control Studies, Female, Hospital Mortality, Humans, Infant, Male, Postoperative Complications epidemiology, Reoperation statistics & numerical data, Treatment Outcome, Truncus Arteriosus, Persistent surgery, Ventricular Outflow Obstruction surgery
- Abstract
Objective: In repair of truncus arteriosus the accepted methods of establishing right ventricle (RV) to pulmonary artery (PA) continuity utilize an allograft or xenograft valved conduit. Alternatively, the PA confluence may be directly anastomosed to the RV with anterior patch augmentation, which may allow growth and delay or avoid subsequent RVOT obstruction. These methods of RVOT reconstruction were evaluated in infants undergoing truncus arteriosus repair., Methods: A retrospective analysis of 61 infants undergoing repair of truncus arteriosus between November 1988 and June 2000 was performed. Median age was 34 days (range 1 day to 6.4 months). The patient cohort was subdivided into two groups (1) Valved conduit group: RV to PA continuity performed with a conduit in 38 patients using allograft (28) or xenograft (10). (2) Direct anastomosis group: direct RV-PA anastomosis performed in 23 patients, augmented anteriorly with monocusp (15) or simple pericardial patch (eight)., Results: There were eight hospital deaths (13%, 95% confidence limits 5--21%). Hospital mortality did not differ significantly between group 1 and 2 (three patients (8%) versus five patients (22%) respectively, P=0.23). By multivariate analysis, low operative weight (P=0.023), severe truncal regurgitation (P=0.022) and major coronary abnormalities (P=0.018), were independent risk factors for hospital death. Hospital survivors were followed-up from 1.3 months to 11.8 years (mean 4.2+/-3.4 years). There were eight late deaths with survival of 73+/-6% at 2 years and beyond. Survival was not influenced by method of RVOT reconstruction (Conduit versus direct RV-PA anastomosis, 2.76+/-7%, 63+/-10%, respectively, P=0.23). Freedom from surgical RVOT reintervention was 56+/-10% in group 1 and 89+/-10% in group 2 at 10 years (P=0.023). The use of a xenograft conduit was an independent risk factor for reintervention (P<0.001)., Conclusions: In truncus arteriosus repair, RV to PA continuity established by a direct anastomosis was associated with a low incidence of surgical RVOT re-intervention. This technique has the potential for RVOT growth and may be a useful alternative when an appropriate allograft is unavailable, particularly in the neonate where the risk of pulmonary hypertension are lower.
- Published
- 2001
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23. Early results of right ventricular-pulmonary artery conduits in patients under 1 year of age.
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Levine AJ, Miller PA, Stumper OS, Wright JG, Silove ED, De Giovanni JV, Sethia B, and Brawn WJ
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- Heart Ventricles, Humans, Infant, Infant, Newborn, Retrospective Studies, Transplantation, Heterologous, Transplantation, Homologous, Blood Vessel Prosthesis, Heart Defects, Congenital surgery, Pulmonary Artery surgery
- Abstract
Objectives: Management strategies for the repair of many complex heart defects require the implantation of a valved conduit between the right ventricle (RV) and the pulmonary artery (PA), often using aortic or pulmonary homograft valves. Their limited availability, however, has led to the development and use of new conduits. We retrospectively compared our experience with small homografts in patients of less than 1 year of age with the TissueMed bioprosthetic valved conduit., Methods: From March 1994 to November 1997 29 patients in their first year of life underwent conduit implantation for complex heart defects. These were retrospectively reviewed in order to determine the incidence of death or conduit stenosis. Seventeen patients received homografts and 12 TissueMed conduits., Results: Diagnoses and operative details including conduit size were similar in the two groups and in all cases complete repair of the underlying defect was carried out. Early post-operative mortality was 4/17 (23.5%) in the homograft group and 3/12 (25%) in the TissueMed group. Echo Doppler evaluation within 1 month of operation showed no right ventricular outflow tract (RVOT) obstruction in any of the survivors. In the TissueMed group 8/9 (77%) survivors have gone on to develop significant RVOT obstruction within 12 months of operation. There have been three late deaths in this group all related to severe RVOT obstruction. Two patients died during an attempt at balloon dilatation and one patient died of progressive right heart failure. Five patients had successful replacement of the TissueMed conduit. One child remains well with no evidence of RVOT obstruction. At operation to replace conduit, or at autopsy, the stenoses were related to the deposition of fibrous tissue at the anastomotic suture lines. In the homograft group none of the survivors developed RVOT obstruction during the first 12 months post-operatively. There was one late death (non-cardiac in origin) and one child is awaiting conduit replacement 40 months after initial implantation for obstruction., Conclusions: The homograft is a satisfactory conduit for re-establishment of RV-PA continuity in infancy. Further work needs to be undertaken in order to elucidate the mechanisms of early graft failure in bioprosthetic conduits if these are to be a suitable alternative for RV outflow reconstruction in infants.
- Published
- 2001
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24. Arterial switch operation after left ventricular retraining in the adult.
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Padalino MA, Stellin G, Brawn WJ, Fasoli G, Daliento L, Milanesi O, and Casarotto D
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- Adult, Female, Heart Septal Defects, Ventricular surgery, Humans, Postoperative Complications, Reoperation, Transposition of Great Vessels surgery, Treatment Outcome, Cardiac Surgical Procedures methods, Heart Ventricles, Ventricular Dysfunction, Right surgery
- Abstract
Retraining the morphological left ventricle in transposition of the great arteries has been successfully reported in infancy, while older age seems to be a contraindication. A 23-year-old woman with ¿S,D,D¿ transposition of the great arteries and ventricular septal defect developed severe right systemic ventricular dysfunction 22 years after Mustard procedure and ventricular septal defect closure. Hemodynamic investigation revealed moderate pulmonary hypertension and preserved left ventricular function. A pulmonary artery band was applied to obtain a left-right ventricular pressure ratio of 0.91. Her postoperative course was characterized by biventricular failure, treated effectively with inotropic support. Six months later, she underwent a Mustard baffle takedown and arterial switch procedure. Her postoperative course was uneventful. She was discharged home on postoperative day 15. At 24-months follow-up, she is in excellent clinical condition; echocardiographic evaluation shows good left ventricular function (ejection fraction: 0.69) with left ventricular volume within normal limits (70 ml/m2). Our experience demonstrates that, despite adult age, a staged arterial switch operation can be performed successfully in selected patients when left ventricular function is preserved.
- Published
- 2000
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25. Total anomalous pulmonary venous connection: outcome of surgical correction and management of recurrent venous obstruction.
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Hyde JA, Stümper O, Barth MJ, Wright JG, Silove ED, de Giovanni JV, Brawn WJ, and Sethia B
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- Angioplasty, Balloon, Cardiovascular Surgical Procedures methods, Child, Preschool, Constriction, Pathologic, Female, Heart Defects, Congenital mortality, Heart Defects, Congenital surgery, Humans, Infant, Infant, Newborn, Male, Pulmonary Veno-Occlusive Disease, Recurrence, Reoperation, Retrospective Studies, Stents, Survival Rate, Pulmonary Veins abnormalities, Pulmonary Veins surgery
- Abstract
Objective: Total anomalous pulmonary venous connection (TAPVC) can be corrected with low mortality and good outcome. If complicated by pulmonary vein stenosis (PVS), either at presentation or secondary to the repair, the long-term outcome is compromised. We have evaluated an institutional experience with TAPVC, with particular regard to the evolving management of PVS., Methods: Retrospective analysis of 85 consecutive patients with non-isomeric TAPVC undergoing surgical correction over a 10-year period (1988-1997). In addition, three patients were referred to us with secondary PVS, having had their primary procedure elsewhere. Attention was focused on incidence of PVS, and strategies for management., Results: Median age at first operation was 33 days (range 1-533). Site of drainage was supracardiac (43/88), infracardiac (20/88), cardiac (17/88), and mixed (8/88). On presentation, 35% of patients were ventilated. Early mortality was 7% (6/85), with one late non-cardiac death. 82% of the original patients (70/85) are currently well at a median follow-up of 64 months (range 6-119). The incidence of PVS requiring intervention was 11% (9/85). Median time to PVS was 41 days. In these patients, 18 balloon angioplasties, four endovascular stent placements (in two patients), and a further 23 surgical procedures were performed. Of the nine patients undergoing re-intervention after initial surgery at our institution, five (56%) survived. Two of these have no residual obstruction and right ventricular pressure (RVP) < 50% systemic, two have unilateral obstruction and RVP < 50% systemic, and one has bilateral obstruction and RVP 80% systemic. Of the three patients referred to us with secondary PVS, two are alive and well, and one died early after the first re-operation., Conclusions: Intrinsic obstruction (endocardial sclerosis or thickening) is associated with worse prognosis and earlier re-intervention than extrinsic (anatomical) obstruction. We advocate an early, aggressive approach to the management of patients with TAPVC, especially in the presence of PVS. This complication is most appropriately managed by a combination of re-operation and repeated balloon dilation.
- Published
- 1999
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26. The modified Norwood procedure for hypoplastic left heart syndrome: early to intermediate results of 120 patients with particular reference to aortic arch repair.
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Ishino K, Stümper O, De Giovanni JJ, Silove ED, Wright JG, Sethia B, Brawn WJ, and de Leval M
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- Anastomosis, Surgical, Biocompatible Materials, Blood Vessel Prosthesis Implantation mortality, Cardiac Surgical Procedures, Female, Follow-Up Studies, Humans, Hypoplastic Left Heart Syndrome mortality, Infant, Infant, Newborn, Male, Palliative Care methods, Polytetrafluoroethylene, Retrospective Studies, Survival Rate, Treatment Outcome, Aorta, Thoracic surgery, Blood Vessel Prosthesis Implantation methods, Hypoplastic Left Heart Syndrome surgery, Pulmonary Artery surgery
- Abstract
Background: Classic first-stage Norwood repair of hypoplastic left heart syndrome uses a homograft patch enlargement to obtain an unobstructed aorta and coronary arteries. Because of possible disadvantages of the homograft, such as lack of growth, degeneration and calcification, and availability, we have tried to repair the aorta without patch supplementation., Methods: Between February 1993 and September 1997, 120 patients, aged birth to 47 days (median 4 days) and weighing 1.7 to 4.4 kg (median 3.1 kg), underwent first-stage palliation for hypoplastic left heart syndrome. The diameter of the ascending aorta ranged from 1.5 to 8.0 mm (median 3.0 mm). Eight patients had an aberrant right subclavian artery arising from the descending thoracic aorta. In 95 patients (group I), all duct tissue was excised and the descending aorta was anastomosed to the aortic arch, which had been opened back into the ascending aorta. Then to this confluence was anastomosed the proximal main pulmonary artery. In the remaining 25 patients (group II), continuity of the aortic arch was maintained and the repair was performed with a Damus-Kaye-Stansel anastomosis. The size of the systemic-to-pulmonary shunt was 3 mm in 48 patients, 3.5 mm in 70, and 4.0 mm in 2., Results: Circulatory arrest time ranged from 19 to 105 minutes (median 54 minutes). A homograft patch was necessary for the arch reconstruction in 18 patients (15%); 9 group I patients (10%) and 9 group II (36%) (P =.001). There were 82 hospital survivors (68%); 69 group I patients (73%) and 13 group II (52%) (P =.04), 71 patients without a patch (70%) and 11 with a patch (61%) (P >.2). By multiple logistic regression, the aberrant right subclavian artery was a significant risk factor for hospital death (P =.008). There were 6 late deaths. Sixteen of 71 patients (23%) who underwent second-stage palliation had a neoaortic arch obstruction develop, with a peak gradient greater than 10 mm Hg; 14 group I patients (23%) and 2 group II (22%) ( P >.2), 15 without a patch (23%) and 1 with a patch (17%) (P >.2). Overall survivals were 57% at 1 year and 55% at 2 years., Conclusion: The modified Norwood procedure for first-stage palliation of hypoplastic left heart syndrome is possible in the majority of patients without the use of exogenous materials and does not result in an increased incidence of neoaortic arch obstruction. Repair of the aorta without patch supplementation may improve the potential for long-term growth of the new aorta.
- Published
- 1999
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27. Divided left atrium in association with tricuspid atresia and discordant ventriculo-arterial connections.
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Dindar A, Brawn WJ, and De Giovanni JV
- Subjects
- Abnormalities, Multiple surgery, Cardiac Surgical Procedures methods, Female, Follow-Up Studies, Humans, Infant, Transposition of Great Vessels complications, Transposition of Great Vessels surgery, Treatment Outcome, Tricuspid Atresia complications, Tricuspid Atresia surgery, Abnormalities, Multiple diagnostic imaging, Echocardiography, Transesophageal, Transposition of Great Vessels diagnostic imaging, Tricuspid Atresia diagnostic imaging
- Abstract
Division of the morphologically left atrium is a rare abnormality, constituting around 0.1% of congenital heart disease. It may coexist with other cardiac abnormalities, and this association may obscure its recognition. We report an uncommon association with tricuspid atresia and discordant ventriculo-arterial connections, the latter dominating the clinical picture. Accurate diagnosis was made by transthoracic cross-sectional echocardiography, and the patient was referred to surgery without need for cardiac catheterisation.
- Published
- 1999
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28. Delayed sternal closure.
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Levine AJ, Sethia B, and Brawn WJ
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- Antibiotic Prophylaxis, Cardiac Output, Child, Dermatologic Surgical Procedures, Heart Defects, Congenital surgery, Humans, Infant, Polytetrafluoroethylene, Prosthesis Implantation, Time Factors, Treatment Outcome, Sternum surgery
- Published
- 1998
29. Hypoplastic left heart syndrome. More families now have a choice.
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Brawn WJ, De Giovanni JV, Hutchinson S, Sethia B, Silove ED, Stumper O, and Wright JG
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- Choice Behavior, Family, Humans, Uncertainty, Hypoplastic Left Heart Syndrome surgery
- Published
- 1997
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30. Intraoperative ultrasonographic troubleshooting after the arterial switch operation.
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Shankar S, Sreeram N, Brawn WJ, and Sethia B
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- Cardiopulmonary Bypass, Humans, Infant, Infant, Newborn, Intraoperative Period, Prospective Studies, Ventilator Weaning, Echocardiography, Intraoperative Complications diagnostic imaging, Transposition of Great Vessels diagnostic imaging, Transposition of Great Vessels surgery, Ventricular Dysfunction, Left diagnostic imaging
- Abstract
Background: Less than perfect coronary artery translocation accounts for the majority of perioperative deaths after the arterial switch procedure for transposition of the great arteries. Some types of coronary arterial anatomy are associated with a higher risk of death., Methods: Prospective epicardial ultrasound examination of all neonates with failing left ventricle or difficulty in weaning off cardiopulmonary bypass was performed after completion of the arterial switch operation during a 2-year period from March 1994 to February 1996. The aim was to identify any mechanical, and potentially remediable, factors accounting for ventricular failure., Results: Four neonates fulfilling the above criteria were identified during a 2-year period when epicardial echocardiography was routinely applied. In 2 patients coronary arterial problems in the form of kinking of the proximal left coronary artery (1 patient) and extrinsic compression of the artery by the neo-pulmonary trunk (1 patient) were identified and successfully corrected. In 2 other patients, supravalvar aortic stenosis was recognized, leading to prompt revision., Conclusions: Epicardial echocardiography has an important "troubleshooting" role in the subgroup of patients with a suboptimal hemodynamic result after the arterial switch operation. Patients with unusual coronary anatomy should routinely be candidates for such studies.
- Published
- 1997
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31. Complete atrioventricular septal defects: the influence of associated cardiac anomalies on surgical management and outcome.
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Redmond JM, Silove ED, De Giovanni JV, Wright JG, Sreeram N, Brawn WJ, and Sethia B
- Subjects
- Aorta, Thoracic abnormalities, Aortic Coarctation complications, Child, Child, Preschool, Double Outlet Right Ventricle complications, Down Syndrome complications, Endocardial Cushion Defects mortality, Female, Humans, Hypoplastic Left Heart Syndrome complications, Infant, Male, Methods, Pulmonary Artery abnormalities, Reoperation, Retrospective Studies, Survival Rate, Tetralogy of Fallot complications, Treatment Outcome, Endocardial Cushion Defects complications, Endocardial Cushion Defects surgery
- Abstract
Objective: Major associated cardiac anomalies are known to increase the risk of repair of complete atrioventricular septal defects (CAVSDs). The purpose of this study was to examine the effects of such anomalies on the current surgical management of CAVSDs and their influence on outcome following repair., Methods: We performed a retrospective review of a 100 consecutive non-isomeric patients undergoing repair of CAVSD at our institution, between January 1989 and December 1994; patients with partial or intermediate defects were excluded. Complete atrioventricular septal defect patients with other major cardiac abnormalities (complex) were then compared to those with isolated CAVSDs., Results: There were 15 patients (15%) with associated anomalies; 3 had tetralogy of Fallot, 1 patient had pulmonary atresia, 6 had hypoplastic left or right ventricle, 1 had tetralogy of Fallot and hyperplastic right ventricle, 2 patients had double outlet right ventricle, 1 had hypoplastic aortic arch and 1 patient had aortic coarctation. The median age at operation was similar for both groups (4.2 months), while the median weight was not significantly different for isolated CAVSDs compared to complex (4.2 months vs 3.4 months, P = 0.89), but there was a higher incidence of trisomy 21 (70/85, 82% vs 8/15, 53.3%, P = 0.01). Two of the 85 isolated CAVSD patients (2.3%) had undergone palliative pulmonary artery banding, while 5 of the 15 complex patients (33.3%) had either banding or Blalock-Taussig shunts performed. The technique of CAVSD repair was identical in each group. All complex patients had standard repair of their associated anomalies. Hospital mortality was higher in the complex group (3/15, 20% vs 2/85, 2.3%, P = 0.004); all early deaths in the complex group occurred in patients with a hypoplastic ventricle. Reoperation for left atrioventricular valve regurgitation was required in six isolated CAVSD patients (7.1%) and in one complex (6.6%)., Conclusions: In the absence of significant ventricular hypoplasia, the early results of surgical repair in patients with CAVSDs and associated cardiovascular anomalies are similar to those achieved in patients with isolated CAVSD.
- Published
- 1996
- Full Text
- View/download PDF
32. Intraoperative epicardial echocardiography in assessing pulmonary artery banding procedures.
- Author
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Sreeram N, Jagtap R, Silove ED, Brawn WJ, and Sethia B
- Subjects
- Female, Heart Defects, Congenital diagnostic imaging, Humans, Infant, Infant, Newborn, Intraoperative Period, Ligation, Male, Echocardiography, Heart Defects, Congenital surgery, Pulmonary Artery surgery
- Abstract
Background: Accurate perioperative assessment of the adequacy of pulmonary artery banding has hitherto relied on oximetry and direct pressure measurements. We report the use of epicardial Doppler echocardiography for assessing banding procedures., Methods: Six consecutive infants (3 male, 3 female; median age, 17 days) who underwent pulmonary artery banding for complex defects were studied by intraoperative epicardial Doppler echocardiography., Results: Excellent visualization of the relation of the band to the pulmonary valve and branch arteries was obtained, enabling or confirming optimal positioning. Doppler echocardiographic estimation of the pressure drop across the band was possible in each patient and resulted in further tightening of the band in 2 patients (33%) with satisfactory increases in transband pressure gradients. Intraoperative echocardiographic estimates of the transband gradients (median, 57 mm Hg; range, 52 to 71 mm Hg; mean +/- standard deviation, 59 +/- 7 mm Hg) correlated well with those obtained at subsequent transthoracic echocardiography (median gradient, 66 mm Hg; range, 52 to 67 mm Hg; mean +/- standard deviation, 63 +/- 6 mm Hg)., Conclusions: Epicardial echocardiography is a valuable adjunct to direct pressure and saturation measurements for adjustment of final band size and aids in confirming accurate band placement.
- Published
- 1995
- Full Text
- View/download PDF
33. Neonatal pulmonary vascular disease in hypoplastic left heart syndrome.
- Author
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Brann S, Brawn WJ, Raafat F, and Sreeram N
- Subjects
- Fatal Outcome, Humans, Hypoplastic Left Heart Syndrome surgery, Infant, Newborn, Male, Palliative Care, Pulmonary Artery pathology, Pulmonary Veno-Occlusive Disease pathology, Hypoplastic Left Heart Syndrome complications, Pulmonary Veno-Occlusive Disease complications
- Abstract
A term neonate with hypoplastic left heart syndrome underwent surgical palliation using the Norwood procedure on day 2 of life. The postoperative course was complicated by recurrent systemic desaturation leading to death. Postmortem histologic examination of lung tissue confirmed the clinical impression of fixed pulmonary vascular disease. Some neonates with a restrictive interatrial communication may have pulmonary vascular disease at birth, which will negatively influence survival irrespective of the type of palliation undertaken.
- Published
- 1995
- Full Text
- View/download PDF
34. The use of a glutaraldehyde-preserved ovine pulmonary valve, as a pulmonary valve substitute in infants.
- Author
-
Brawn WJ
- Subjects
- Animals, Aortic Valve abnormalities, Bioprosthesis, Heart Septal Defects, Ventricular surgery, Humans, Infant, Newborn, Pulmonary Atresia surgery, Pulmonary Valve, Sheep, Truncus Arteriosus, Persistent surgery, Heart Defects, Congenital surgery, Heart Valve Prosthesis
- Abstract
Reconstruction of the right ventricular outflow tract with a valved conduit is often necessary to repair some forms of congenital heart disease. We have used a 12- to 13-mm sized glutaraldehyde-preserved lamb's (ovine) valve for this purpose. The valves were harvested from the local abattoir, dissected, and stored in glutaraldehyde at 4 degrees C for 2 weeks before use. The valve was placed in four infants, two with truncus arteriosus, one with aortic valve atresia and ventricular septal defect, and one with absent pulmonary valve syndrome. In three patients, the valve had to be replaced in the second year of life, and in one patient in the fourth year of life. All patients are alive and well at follow-up. In the short-term, this valve has functioned well and could be considered where commercially available conduits or homografts are not routinely available.
- Published
- 1995
35. Univentricular heart with systemic outflow obstruction: palliation by primary Damus procedure.
- Author
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Brawn WJ, Sethia B, Jagtap R, Stümper OF, Wright JG, De Giovanni JV, Silove ED, Jackson M, and Sreeram N
- Subjects
- Cardiac Surgical Procedures methods, Cardiomyopathy, Hypertrophic etiology, Discriminant Analysis, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Predictive Value of Tests, Risk Factors, Survival Analysis, Treatment Outcome, Ventricular Outflow Obstruction congenital, Cardiomyopathy, Hypertrophic surgery, Heart Ventricles abnormalities, Palliative Care methods, Ventricular Outflow Obstruction surgery
- Abstract
In 24 consecutive infants (19 male and 5 female) with complex forms of single-ventricle physiology and systemic outflow obstruction, a modified Damus operation without the use of exogenous material was undertaken in conjunction with creation of an aortopulmonary shunt 3.5 mm in diameter. The median age at operation was 6 days (range, 1 to 170 days) and the median weight, 3.4 kg (range, 2.6 to 4.6 kg). There were nine early deaths. All 15 survivors (median follow-up, 6.5 months) were clinically well without major systemic ventricular dysfunction or atrioventricular or arterial valve regurgitation. Ten of them have undergone a superior vena cava-pulmonary shunt (one death), and 1 has required patch angioplasty of the aortic arch and innominate artery with revision of the aortopulmonary shunt. The 4 other survivors are awaiting a cavopulmonary shunt. Univariate analysis yielded the chronologic rank for an individual procedure (higher risk of death early in the series), presence of aortic arch atresia, and presence or absence of transposition of the great arteries as predictors of death. This aggressive surgical approach provides excellent early palliation, and because the operation prevents abnormal ventricular hypertrophy from pressure or volume overload, systemic ventricular function is optimally conserved for a future Fontan-type procedure.
- Published
- 1995
- Full Text
- View/download PDF
36. Endocarditis with multiple intracardiac shunts: identification and repair.
- Author
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Sadiq M, Sreeram N, de Giovanni JV, Wright JG, Brawn WJ, Ladusans EJ, and Sethia B
- Subjects
- Abscess etiology, Cardiac Surgical Procedures methods, Child, Endocarditis, Bacterial microbiology, Fistula etiology, Heart Septal Defects, Atrial etiology, Heart Septal Defects, Ventricular etiology, Heart Valve Diseases etiology, Heart Valve Diseases surgery, Hirschsprung Disease complications, Humans, Male, Staphylococcal Infections complications, Abscess surgery, Aortic Valve surgery, Endocarditis, Bacterial surgery, Fistula surgery, Heart Atria surgery, Heart Septal Defects, Atrial surgery, Heart Septal Defects, Ventricular surgery, Heart Ventricles surgery, Staphylococcal Infections surgery, Staphylococcus epidermidis, Tricuspid Valve surgery
- Abstract
An 8-year-old boy who suffered from Hirschsprung's disease had development of tricuspid valve endocarditis that progressed to aortic root abscess formation, development of a fistulous communication between aorta and right atrium, atrial and ventricular septal defects, and a left ventricle to right atrium defect. Several surgical procedures were required. Operation consisted initially of closure of the septal defects and aortic valve repair. This was followed by homograft replacement of the aortic valve for persistent infection, and further closure of a left ventricle to right atrium fistula.
- Published
- 1995
- Full Text
- View/download PDF
37. Post-operative blood loss following cardio-pulmonary bypass in children.
- Author
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Evans DA, Holder RL, Brawn WJ, and Sethia B
- Subjects
- Body Temperature, Child, Child, Preschool, Esophagus physiology, Heart Defects, Congenital surgery, Humans, Infant, Prognosis, Prospective Studies, Reoperation, Cardiopulmonary Bypass, Hemorrhage etiology, Postoperative Complications
- Abstract
Significant post-operative bleeding may occur following cardio-pulmonary bypass, sometimes necessitating early re-exploration. Two questions were asked by this study. Firstly, in children undergoing cardio-pulmonary bypass, can pre-operative, operative and immediately post-operative variables be used to predict post-operative blood loss? Secondly, in the same patient group, can the same variables be used to predict the surgical intervention of re-exploration for excessive bleeding within 12 h of surgery? In a prospective study of patients operated on in a 9-month period, bleeding fell rapidly in the first 3 h after surgery and early re-exploration for bleeding was necessary in 8 of the 206 patients. The only significant predictor of post-operative blood loss was minimum oesophageal temperature, low values being associated with greater blood loss (correlation r = -0.19 (P < 0.05)). With regard to re-exploration for bleeding, a long bypass time (P < 0.05) and abnormal pre-operative coagulation indices (P < 0.01) were significant and independent predictors. The data were also used to create a practical nomogram relating re-exploration for bleeding to hourly post-operative blood loss.
- Published
- 1994
- Full Text
- View/download PDF
38. Interrupted aortic arch in infancy: a 10-year experience.
- Author
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Menahem S, Rahayoe AU, Brawn WJ, and Mee RB
- Subjects
- Aorta, Thoracic surgery, Aortography, Echocardiography, Female, Heart Defects, Congenital diagnosis, Heart Defects, Congenital mortality, Humans, Infant, Infant, Newborn, Male, Preoperative Care, Aorta, Thoracic abnormalities, Heart Defects, Congenital surgery
- Abstract
Fifty infants with interrupted aortic arch (IAA), admitted between 1979 and 1988, were reviewed. They usually presented early in severe cardiac failure or shock. In the initial 5-year period, 17 of the 21 infants underwent diagnostic or confirmatory cardiac catheterization, in contrast with the latter 5 years when only eight of the subsequent 29 patients underwent catheterization. Since 1987, all patients underwent surgery after cross-sectional echocardiography. Fifteen infants had a type A IAA and 35 had type B. All had associated cardiac anomalies. Four infants were not operated on. In the initial 5-year period, of 17 infants who were surgically treated, four had a one-stage total repair, the remaining had a two-stage repair with initial reconstruction of the arch and pulmonary artery banding. There was an overall surgical mortality of 65%, reflecting the precarious state of many of these infants before surgery with a significant contribution from unrelieved subaortic stenosis. In the latter 5-year period, 29 underwent surgery, 22 had a one-stage total repair. There were three deaths, all in infants whose active treatment was withdrawn. The outcome of the survivors has generally been good, subsequent surgery being mainly related to the associated anomalies (e.g., recurrent subaortic stenosis, conduit replacement). Over this 10 year period the greater accuracy of noninvasive diagnoses, and perioperative intensive care, have led to an improvement in the preoperative state of these infants. Single-stage total repair is our procedure of choice.
- Published
- 1992
- Full Text
- View/download PDF
39. Tracheoaortopexy via midline sternotomy in tracheomalacia.
- Author
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Brawn WJ and Huddart SN
- Subjects
- Humans, Infant, Newborn, Male, Surgical Procedures, Operative methods, Cartilage Diseases surgery, Trachea surgery
- Abstract
Symptomatic tracheomalacia associated with congenital tracheoesophageal fistula requires active treatment. When symptoms are severe, consideration should be given for surgical correction. Aortopexy via a lateral thoracotomy and tracheopexy via an anterior cervical approach have been described. We present two patients with extensive tracheomalacia who benefited from combined tracheoaortopexy via a midline sternotomy approach.
- Published
- 1991
- Full Text
- View/download PDF
40. Critical aortic stenosis in the first month of life: surgical results in 26 infants.
- Author
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Karl TR, Sano S, Brawn WJ, and Mee RB
- Subjects
- Actuarial Analysis, Alprostadil therapeutic use, Aortic Coarctation surgery, Aortic Valve pathology, Aortic Valve Stenosis mortality, Aortic Valve Stenosis pathology, Clinical Protocols, Confidence Intervals, Ductus Arteriosus, Patent complications, Follow-Up Studies, Heart Failure complications, Humans, Infant, Newborn, Postoperative Complications, Prognosis, Reoperation, Respiration, Artificial, Ventricular Outflow Obstruction surgery, Aortic Valve surgery, Aortic Valve Stenosis surgery
- Abstract
Between 1980 and 1989, 26 infants aged less than 1 month underwent open aortic valvotomy for critical aortic stenosis. All had congestive heart failure requiring inotropic agents (58%), ventilation (42%), and/or prostaglandin E1 (35%) preoperatively. Nine patients with isolated aortic stenosis had an operative mortality of 0%, whereas 17 patients with other anatomical lesions had a 47% mortality (p less than 0.01). Univariate analysis failed to identify additional risk factors other than year of operation (p less than 0.05). There were four late deaths, three probably related to arrhythmia (actuarial survival at 113 months = 0.53). Two patients have required late reoperation; neither required valve replacement.
- Published
- 1990
- Full Text
- View/download PDF
41. Two-patch repair of complete atrioventricular septal defect in the first year of life. Results and sequential assessment of atrioventricular valve function.
- Author
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Weintraub RG, Brawn WJ, Venables AW, and Mee RB
- Subjects
- Female, Heart Septal Defects mortality, Heart Valve Diseases congenital, Heart Valves physiopathology, Humans, Infant, Infant, Newborn, Male, Postoperative Period, Prostheses and Implants, Reoperation, Heart Septal Defects surgery, Heart Valve Diseases surgery
- Abstract
Before January 1987, 62 infants underwent two-patch repair of complete (51) or intermediate (11) atrioventricular septal defect at the Royal Children's Hospital, Melbourne. Median age at repair was 4.3 months and median weight was 4.4 kg. Early deaths (3%) were confined to two infants with preoperative respiratory tract infections; a further two patients died during follow-up (late mortality rate 3%). Reoperation for severe postoperative mitral regurgitation was necessary in 10 infants (16%), two of whom subsequently required mitral valve replacement with a prosthesis. Preoperative atrioventricular valve regurgitation was assessed retrospectively in 49 patients from angiography or Doppler echocardiography and was found to be absent or mild in 33 (68%), moderate in 9 (18%), and severe in 7 (14%). At the time of latest review (at a mean of 2.4 years after repair), judged from a combination of clinical and echocardiographic criteria, mitral regurgitation was absent or mild in 49 (84%) of the 58 survivors; none of them had symptomatic regurgitation or were requiring continuing medical treatment. Analysis of sequential atrioventricular valve function in 46 of the 49 patients in whom objective preoperative data were available showed no relationship between the degree of preoperative and postoperative atrioventricular valve regurgitation. Infants without Down's syndrome, however, had a significantly higher reoperation rate for severe postoperative mitral valve regurgitation (50%) than those with Down's syndrome (10%) (p = 0.007). Complete atrioventricular septal defect can be repaired in early infancy with a low mortality rate and good intermediate term results.
- Published
- 1990
42. Cerebellar infarction secondary to subclavian aortoplasty repair for coarctation of the aorta.
- Author
-
Brawn WJ, Menahem S, and Mee RB
- Subjects
- Child, Preschool, Humans, Ligation, Male, Postoperative Complications etiology, Tomography, X-Ray Computed, Vertebral Artery surgery, Aortic Coarctation surgery, Cerebellum blood supply, Cerebral Infarction etiology, Subclavian Artery surgery
- Abstract
A five-year-old boy developed a left cerebellar infarction following repair of coarctation of the aorta by subclavian aortoplasty. At operation a large left vertebral artery had been ligated. If a large vertebral artery is encountered at repair of coarctation of the aorta then consideration should be given to a method of repair which does not sacrifice this vessel.
- Published
- 1987
- Full Text
- View/download PDF
43. Surgical treatment of absent pulmonary valve syndrome in infants: relief of bronchial obstruction.
- Author
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Stellin G, Jonas RA, Goh TH, Brawn WJ, Venables AW, and Mee RB
- Subjects
- Airway Obstruction complications, Bronchial Diseases complications, Dilatation, Pathologic complications, Dilatation, Pathologic surgery, Female, Heart Aneurysm complications, Heart Aneurysm surgery, Heart Septal Defects, Ventricular complications, Heart Septal Defects, Ventricular surgery, Humans, Infant, Newborn, Infant, Newborn, Diseases complications, Pulmonary Artery surgery, Syndrome, Airway Obstruction surgery, Bronchial Diseases surgery, Infant, Newborn, Diseases surgery, Pulmonary Artery abnormalities
- Abstract
Congenital absence of the pulmonary valve is usually associated with a malalignment type of ventricular septal defect as well as right ventricular outflow obstruction and aneurysmal dilatation of the pulmonary arteries. Symptomatic infants primarily have severe tracheobronchial obstruction caused by aneurysmal dilatation of the proximal pulmonary arteries; pulmonic and systemic blood flow are usually balanced. Surgical intervention to relieve the obstruction by plicating the pulmonary artery and its branches under deep hypothermia and circulatory arrest, together with patch closure of the ventricular septal defect, is advocated.
- Published
- 1983
- Full Text
- View/download PDF
44. Total anomalous pulmonary venous drainage.
- Author
-
Sano S, Brawn WJ, and Mee RB
- Subjects
- Angiography, Arrhythmias, Cardiac etiology, Cardiac Catheterization, Child, Preschool, Echocardiography, Female, Follow-Up Studies, Heart Defects, Congenital diagnosis, Heart Defects, Congenital mortality, Humans, Infant, Infant, Newborn, Male, Postoperative Complications etiology, Pulmonary Veins surgery, Heart Defects, Congenital surgery, Pulmonary Veins abnormalities
- Abstract
Forty-four patients with total anomalous pulmonary venous drainage underwent repair between 1979 and 1987. The anomalous drainage was supracardiac in 16, cardiac in 12, and infracardiac in 16. Median age at repair was 15 days and median weight, 3.3 kg. In 22 patients (50%) the venous drainage was obstructed. Emergency operation was necessary in 12 patients, and the condition of seven additional patients deteriorated while they were awaiting semiurgent operation. There was one hospital death (mortality rate 2.3%), occurring in a 2-week-old premature neonate with infracardiac drainage. In 17 of 44 patients, mean pulmonary artery pressure equaled or exceeded systemic arterial pressure immediately after repair. Four patients have required reoperation and two of these have died as a result of peripheral extension of pulmonary vein sclerosis. In the review period of from 1 month to 7 years, all survivors are well and receiving no medication.
- Published
- 1989
45. Truncus arteriosus. Surgical approach.
- Author
-
Sharma AK, Brawn WJ, and Mee RB
- Subjects
- Blood Pressure, Body Weight, Cardiac Output, Low etiology, Cardiopulmonary Bypass, Child, Preschool, Ductus Arteriosus, Patent mortality, Ductus Arteriosus, Patent physiopathology, Humans, Infant, Postoperative Complications, Ductus Arteriosus, Patent surgery
- Abstract
Between mid-1979 and December, 1983, 23 patients with various types of truncus arteriosus underwent total surgical correction at Royal Children's Hospital, Melbourne, Australia. Nineteen patients had primary total repair and four had secondary repair, three having survived banding done prior to 1978. Sixteen patients were less than 1 year of age. Repair was performed with circulatory arrest in infants and cardiopulmonary bypass with core cooling in older patients. Patients were electively ventilated preoperatively. In the postoperative period, pulmonary artery pressure was monitored very closely and any rise was treated with hyperventilation and vasodilators. Two patients under 1 month of age, who were severely acidotic and anuric preoperatively, died of low output syndrome. Among the rest of the infants there was only one death, probably because of pulmonary hypertensive crisis that might have been prevented. From our experience, we think that patients with truncus arteriosus should have total correction during infancy, preferably at 2 to 3 months of age, as it can be performed with a very low risk and also avoids the development of pulmonary vascular disease, which occurs very rapidly in these infants.
- Published
- 1985
46. Early results for anatomic correction of transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect.
- Author
-
Brawn WJ and Mee RB
- Subjects
- Aorta pathology, Aorta surgery, Aortic Coarctation surgery, Cardiac Catheterization, Child, Preschool, Coronary Vessels pathology, Coronary Vessels surgery, Double Outlet Right Ventricle mortality, Double Outlet Right Ventricle pathology, Female, Follow-Up Studies, Heart Septal Defects, Ventricular mortality, Heart Septal Defects, Ventricular pathology, Humans, Infant, Infant, Newborn, Male, Postoperative Complications epidemiology, Preoperative Care, Pulmonary Artery abnormalities, Pulmonary Artery surgery, Transposition of Great Vessels mortality, Transposition of Great Vessels pathology, Double Outlet Right Ventricle surgery, Heart Septal Defects, Ventricular surgery, Transposition of Great Vessels surgery
- Abstract
Fifty patients, 21 with transposition of the great arteries plus ventricular septal defect, four with double-outlet right ventricle plus ventricular septal defect, and 25 with transposition of the great arteries plus intact ventricular septum, have undergone anatomic correction. There were four hospital deaths, all in the patients with ventricular septal defects (overall mortality rate 8%). The Lecompte maneuver was used in all patients, and in the last 25 patients the coronary arteries were transposed to medially hinged trapdoor flaps created in the neoaorta. In 10 patients (20%) intraoperative adjustments were necessary to the great vessels and coronary arteries to achieve unobstructed coronary artery flow. There have been no late deaths. Postoperative cardiac catheterization in 19 patients has revealed stenosis on the new main pulmonary artery suture line to be the main early problem. Anatomic correction of transposition (with or without ventricular septal defect) and double-outlet right ventricle septal defect would seem to be a good operative alternative to the Mustard or Senning operation, with the advantage of incorporating the left ventricle into the systemic circulation.
- Published
- 1988
47. Surgical excision of primary cardiac tumours in infancy.
- Author
-
Skillington PD, Brawn WJ, Edis BD, Menahem S, Venables AW, Goh TH, and Mee RB
- Subjects
- Female, Follow-Up Studies, Heart Atria, Heart Ventricles, Humans, Infant, Infant, Newborn, Male, Dysgerminoma surgery, Heart Neoplasms surgery, Myxoma surgery, Neoplasms, Multiple Primary surgery, Rhabdomyoma surgery, Teratoma surgery
- Abstract
Six cases of primary cardiac tumour have been operated upon in a 7 year period from 1 June 1979 until 1 June 1986. All patients were under 6 months of age at the time of operation and two of the patients were in their first week of life. The principal indication for surgery was obstruction mainly at the right or left ventricular outflow tract level. More recently echo evaluation alone has been adequate to define the problem prior to surgery. Surgical excision has been performed without mortality or significant complications. In most cases resection has been complete, although in one case residual tumour has been left because of attachment of the tumour to vital structures. Follow-up of this case has not resulted in further surgery being required because of regrowth of the tumour. In one case, with co-existent congenital heart disease, the tumour was brought to notice after palliative systemic to pulmonary artery shunt had been performed. From the cardiac view point gratifying results have been obtained both in the short and long term following surgical resection. However, for patients with rhabdomyoma, later development of symptomatic tuberosclerosis should be anticipated in 50% of cases.
- Published
- 1987
- Full Text
- View/download PDF
48. Pulmonary atresia with intact ventricular septum.
- Author
-
Joshi SV, Brawn WJ, and Mee RB
- Subjects
- Echocardiography, Follow-Up Studies, Heart Septum pathology, Heart Ventricles surgery, Hemodynamics, Humans, Infant, Newborn, Pulmonary Artery surgery, Pulmonary Valve surgery, Reoperation, Retrospective Studies, Subclavian Artery surgery, Tricuspid Valve pathology, Heart Septum surgery, Palliative Care methods, Pulmonary Valve abnormalities
- Abstract
Neonates with pulmonary atresia with intact ventricular septum are ductus dependent from birth. The initial approach in these patients is to ensure continued adequate pulmonary blood flow in anticipation of imminent spontaneous closure of the ductus. Our experience and evolving approach in the management of 16 consecutive neonates with pulmonary atresia with intact ventricular septum from 1978 to 1984 is presented. On the basis of the revised classification by Bull and associates, we divided the patients into four different groups according to right ventricular morphology. Basically, three types of palliative surgical procedures were performed: systemic-pulmonary artery shunt; systemic-pulmonary artery shunt with pulmonary valvotomy; and pulmonary valvotomy alone. Systemic-pulmonary artery shunt is the most important part of neonatal palliation. Our present routine is to perform left subclavian-main pulmonary artery shunt with a polytetrafluoroethylene tube in all patients and, in addition, to perform an open transpulmonary valvotomy without cardiopulmonary bypass in patients with a patent infundibular portion of the right ventricle. Our technique and the advantages of this type of shunt procedure are discussed. Patients with right ventricular sinusoidal-coronary artery communications are a subgroup with an additional problem. In our series, patients with this anomaly are categorized into groups with major and minor connections and their surgical significance is discussed. Overall, there was one death among 16 patients after neonatal palliative procedures and one death among five patients after hemodynamic repair.
- Published
- 1986
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