94 results on '"Lock J"'
Search Results
2. Randomized trial of cutting balloon compared with high-pressure angioplasty for the treatment of resistant pulmonary artery stenosis.
- Author
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Bergersen L, Gauvreau K, Justino H, Nugent A, Rome J, Kreutzer J, Rhodes J, Nykanen D, Zahn E, Latson L, Moore P, Lock J, and Jenkins K
- Published
- 2011
- Full Text
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3. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension.
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Feinstein, J A, Goldhaber, S Z, Lock, J E, Ferndandes, S M, and Landzberg, M J
- Published
- 2001
4. Clinical outcome of fenestrated Fontan patients after closure: the first 10 years.
- Author
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Goff, D A, Blume, E D, Gauvreau, K, Mayer, J E, Lock, J E, and Jenkins, K J
- Published
- 2000
5. Development and implementation of depression care along the health care continuum.
- Author
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Lock J and Walsh M
- Abstract
Depression is a common cause of illness with significant social, vocational, and economic consequences. As one of the most treatable forms of mental illness, depression often is underrecognized and undertreated. The annual cost of depression to the United States economy is approximately $43.7 billion, with 55 percent (or $23.8 billion) accounting for missed work and lowered productivity. The prevalence rate of depression is estimated at 12-20 percent. The depressed patient utilizes two to three times more health services. There is little in the literature to demonstrate the care of the depressed person across the continuum in an integrated health care system. This article reviews the development and implementation of the treatment of depression care across multiple sites along the continuum. The care management depression team utilized the principles of performance improvement; Plan, Do, Check, Act framework for the initiative. Copyright (c) 1999 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]
- Published
- 1999
- Full Text
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6. Prolonged xenograft survival of islets infected with small doses of adenovirus expressing CTLA41g.
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Feng, S., Quickel, R.R., Hollister-Lock, J., McLeod, M., Bonner-Weir, S., Mulligan, R.C., and Weir, G.C.
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- 1999
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7. ISOLATED GONADOTROPIN DEFICIENCY IN THREE SISTERS.
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Lock, J Paul, Penney, Larry, Jawadi, Muhamed, and Betz, George
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- 1983
8. HYDROCEPHALUS AND AMENORRHEA.
- Author
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Jawadi, M Husain, Kirsch, Wolff, Lock, J Paul, and Betz, George
- Published
- 1979
9. Function and survival of macroencapsulated syngeneic islets transplanted into streptozocin-diabetic mice.
- Author
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Suzuki, K., Bonner-Weir, S., Trivedi, N., Yoon, K.-H., Hollister-Lock, J., Colton, C.K., and Weir, G.C.
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- 1998
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10. Proper management of renal artery injury from blunt trauma.
- Author
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LOCK, JAMES S., CARRAWAY, ROBERT P., HUDSON Jr., HENRY C., LAWS, HENRY L., Lock, J S, Carraway, R P, Hudson, H C Jr, and Laws, H L
- Published
- 1985
11. Complications of vascular catheterization in critically ill children.
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Smith-Wright, D L, Green, T P, Lock, J E, Egar, M I, and Fuhrman, B P
- Published
- 1984
12. D-Liver - a New Approach for Bridging Therapy to Transplantation of the Chronic Liver Failure Patient.
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Jara, M., Lock, J. F., Malinowski, M., Jones, D., Kiefer, S., Neuhaus, P., and Stockmann, M.
- Published
- 2012
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13. Personalized Pharmacotherpy after Liver Transplantation - the GRAFTT Trial to Control Tacrolimus Dosing.
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Lock, J. F., Gottschalk, S., Malinowski, M., Jara, M., Seehofer, D., Neuhaus, P., and Stockmann, M.
- Published
- 2012
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14. Prediction of Six and Twelve Month Mortality by Patients with Liver Cirrhosis Using a New LiMAx Test.
- Author
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Malinowski, M., Jara, M., Biele, S., Shelkov, D., Lock, J. F., Schulz, A., Berg, T., Schott, E., Neuhaus, P., and Stockmann, M.
- Published
- 2012
- Full Text
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15. Graft Dysfunction after Liver Transplantation: Early Diagnosis and Risk Factors.
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Stockmann, M., Lock, J. F., Malinowski, M., Seehofer, D., and Neuhaus, P.
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- 2012
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16. A New Method for Outcome Prediction of Acute Liver Failure - Pilot Study with the LiMAx Test.
- Author
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Kotobi, A. N., Lock, J. F., Malinowski, M., Neuhaus, P., and Stockmann, M.
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- 2012
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17. CORRELATION OF MELD AND OTHER PARAMETERS WITH QUANTITATIVE LIVER FUNCTION CAPACITY MEASURED BY THE LIMAX TEST IN CIRRHOTIC PATIENTS BEFORE LIVER TRANSPLANTATION.
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Lock, J. F., Malinowski, M., Biele, S., Neuhaus, P., and Stockmann, M.
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- 2010
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18. MIGHT THE MELD SCORE GET BETTER USING A DIRECT LIVER FUNCTION TEST (LIMAX TEST)?
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Malinowski, M., Biele, S., Lock, J. F., Berg, T., Schott, E., Neuhaus, P., and Stockmann, M.
- Published
- 2010
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19. THE ADIPONECTIN AND PROINSULIN METABOLISM AFTER LIVING DONOR LIVER TRANSPLANTATION.
- Author
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Malinowski, M., Konrad, T., Nolting, S., Hünerbein, D., Dobling, H., Steinmüller, T., Pfützner, A., Lock, J. F., Neuhaus, P., and Stockmann, M.
- Published
- 2010
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20. QUANTITATIVE LIVER FIBROSIS AND FUNCTIONAL IMPAIRMENT - IS NONINVASIVE DIAGNOSIS POSSIBLE AND ARE THERE CONSEQUENCES FOR EVALUATION TO LIVER TRANSPLANTATION?
- Author
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Stockmann, M., Lock, J. F., Malinowski, M., Scharfenberg, A., Morawietz, L., and Neuhaus, P.
- Published
- 2010
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21. A NEW FUNCTIONAL DEFINITION OF INITIAL POOR FUNCTION AFTER LIVER TRANSPLANTATION.
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Stockmann, M., Lock, J. F., Malinowski, M., Seehofer, D., and Neuhaus, P.
- Published
- 2010
- Full Text
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22. Diverticular disease of the appendix.
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LOCK, JOSEPH H., WHEELER, WILLIAM E., Lock, J H, and Wheeler, W E
- Published
- 1990
23. LITERATURE ABSTRACTS.
- Author
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Loes, M W, Singh, S, Lock, J E, and Mirkin, B L
- Published
- 1979
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24. Family therapy for eating disorders in youth: current confusions, advances, and new directions.
- Author
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Lock J
- Subjects
- Adolescent, Humans, Anorexia Nervosa therapy, Family Therapy methods, Outcome and Process Assessment, Health Care
- Abstract
Purpose of Review: Family interventions for eating disorders are often recommended for the treatment of children and adolescents. Treatment studies and a range of treatment guidelines now recommend family-based treatment (FBT) for adolescents with anorexia nervosa (AN) and bulimia nervosa. The current report focused on studies that have been conducted over the past 2 years, most of them aimed at augmenting or improving outcomes using a range of new family approaches or adding other forms of therapy to standard FBT., Recent Findings: There is increasing confusion of what type of family therapy is supported by the evidence, including FBT, FT-AN, MFT-AN, and parent-focused therapy. Seventy-five percentages of the adolescents with anorexia nervosa studies in randomized clinical trials used manualized FBT. None of the other family therapy approaches have more than 16% of the total adolescents with anorexia nervosa studied. Thus, FBT is the only form of family therapy with a substantive evidence base. Augmentation by varying the format of family therapy may be clinically useful, but differences in outcome from standard FBT are minor., Summary: The evidence base supporting the use of family therapy for adolescent anorexia nervosa is for manualized FBT. Augmentations of FBT using different formats (e.g., parents only, family groups, addition of individual therapy) have not demonstrated substantially improved outcomes over standard FBT for anorexia nervosa.
- Published
- 2018
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25. Sonographic Pulmonary Abnormalities in Fetuses With Hypoplastic Left Heart Syndrome and Intact Atrial Septum Undergoing Attempted Atrial Septostomy In Utero.
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Mackesy MM, Kalish BT, Tworetzky W, Sanders S, Al-Ibraheemi A, Wilkins-Haug L, Lock J, Marshall A, and Benson CB
- Subjects
- Atrial Septum embryology, Female, Fetal Heart diagnostic imaging, Fetal Heart embryology, Fetal Heart surgery, Humans, Lung diagnostic imaging, Pregnancy, Atrial Septum diagnostic imaging, Atrial Septum surgery, Hypoplastic Left Heart Syndrome complications, Lung abnormalities, Lung embryology, Ultrasonography, Prenatal methods
- Abstract
Fetuses with hypoplastic left heart syndrome (HLHS) and intact atrial septum are a particular subset of HLHS neonates with high perinatal mortality. The reported mortality in these patients is 50% to 70%, even with prenatal diagnosis. Prenatal left atrial and pulmonary venous hypertension results in abnormal pulmonary vascular and parenchymal development. The goal of this study was to compare the sonographic appearance of the lungs in fetuses with HLHS/intact atrial septum to neonatal outcome and/or pathology in cases where in utero intervention was performed to open the atrial septum. We found that lung inhomogeneity on ultrasound corresponded to peripheral lymphatic dilatation at autopsy and was associated with a dismal prognosis even when in utero intervention was successful.
- Published
- 2017
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26. Clinical Experience of Prescribing Dabigatran Etexilate With Dronedarone: The Role of Therapeutic Drug Monitoring.
- Author
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Lock J, Patel RK, Brookes C, and Patel JP
- Subjects
- Adult, Aged, Amiodarone therapeutic use, Dronedarone, Drug Interactions physiology, Drug Monitoring, Female, Humans, Male, Amiodarone analogs & derivatives, Antithrombins therapeutic use, Dabigatran therapeutic use, Drug Therapy, Combination adverse effects
- Published
- 2016
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27. Evaluation of family treatment models for eating disorders.
- Author
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Lock J
- Subjects
- Adolescent, Feeding and Eating Disorders psychology, Humans, Treatment Outcome, Family psychology, Family Therapy methods, Feeding and Eating Disorders therapy
- Abstract
Purpose of Review: Interest in the effectiveness of family interventions for eating disorders has increased over the past 5 years. This review considers the theoretical justification and current evidence base for the use of family treatments for eating disorders in children and adolescents., Recent Findings: Family-based treatment is the best studied treatment. It has the strongest evidence base for effectiveness for anorexia nervosa in adolescents. Family-based treatment can be delivered in several formats and doses, and preliminary data suggest it can be disseminated by training and manuals. There is a more limited evidence base demonstrating the usefulness of family interventions for bulimia nervosa in adolescents., Summary: The implications of the findings of this review are that family interventions are the current first-line treatment for adolescent anorexia nervosa and promising for adolescent bulimia nervosa. Pilot studies suggest that family interventions can be disseminated in diverse clinical settings.
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- 2011
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28. Procedure-type risk categories for pediatric and congenital cardiac catheterization.
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Bergersen L, Gauvreau K, Marshall A, Kreutzer J, Beekman R, Hirsch R, Foerster S, Balzer D, Vincent J, Hellenbrand W, Holzer R, Cheatham J, Moore J, Lock J, and Jenkins K
- Subjects
- Adolescent, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Prospective Studies, Risk, Cardiac Catheterization adverse effects, Heart Defects, Congenital diagnosis, Heart Defects, Congenital therapy
- Abstract
Background: The Congenital Cardiac Catheterization Project on Outcomes (C3PO) was established to develop outcome assessment methods for pediatric catheterization., Methods and Results: Six sites have been recording demographic, procedural and immediate outcome data on all cases, using a web-based system since February 2007. A sample of data was independently audited for validity and data completeness. In 2006, participants categorized 84 procedure types into 6 categories by anticipated risk of an adverse event (AE). Consensus and empirical methods were used to determine final procedure risk categories, based on the outcomes: any AE (level 1 to 5); AE level 3, 4, or 5; and death or life-threatening event (level 4 or 5). The final models were then evaluated for validity in a prospectively collected data set between May 2008 and December 31, 2009. Between February 2007 and April 2008, 3756 cases were recorded, 558 (14.9%) with any AE; 226 (6.0%) level 3, 4, or 5; and 73 (1.9%) level 4 or 5. General estimating equations models using 6 consensus-based risk categories were moderately predictive of AE occurrence (c-statistics: 0.644, 0.664, and 0.707). The participant panel made adjustments based on the collected empirical data supported by clinical judgment. These decisions yielded 4 procedure risk categories; the final models had improved discrimination, with c-statistics of 0.699, 0.725, and 0.765. Similar discrimination was observed in the performance data set (n=7043), with c-statistics of 0.672, 0.708, and 0.721., Conclusions: Procedure-type risk categories are associated with different complication rates in our data set and could be an important variable in risk adjustment models for pediatric catheterization., (© 2011 American Heart Association, Inc.)
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- 2011
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29. Balloon dilation angioplasty of peripheral pulmonary stenosis associated with Williams syndrome.
- Author
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Geggel RL, Gauvreau K, and Lock JE
- Subjects
- Adolescent, Adult, Aneurysm epidemiology, Child, Child, Preschool, Combined Modality Therapy, Female, Heart Defects, Congenital genetics, Heart Defects, Congenital surgery, Heart Septum surgery, Hemodynamics, Humans, Infant, Male, Postoperative Complications epidemiology, Pulmonary Valve Stenosis surgery, Stents, Treatment Outcome, Angioplasty, Balloon mortality, Pulmonary Valve Stenosis therapy, Williams Syndrome complications
- Abstract
Background: Experience of balloon dilation of peripheral pulmonary stenosis (PPS) in Williams syndrome (WS) is limited., Methods and Results: Catheterizations in all patients with WS undergoing therapy for PPS from 1984 to 1999 were reviewed. Criteria for successful dilation included an increase >50% in predilation diameter and a decrease >20% in ratio of right ventricular (RV) to aortic (Ao) systolic pressure. Median age and weight were 1.5 years and 9.5 kg. There were 134 dilations during 39 procedures in 25 patients. The success rate for initial dilations was 51%. In multivariate analysis, successful dilation was more likely (1) in distal than in central pulmonary arteries (P=0.02), (2) if the balloon waist resolved with inflation (P=0.001), and (3) with larger balloon/stenosis ratio (P<0.001). RV pressure was unchanged after dilation (96+/-30 versus 97+/-31 mm Hg), primarily because of failure to enlarge central pulmonary arteries. The Ao pressure increased (102+/-14 versus 109+/-19 mm Hg, P=0.03), and the RV/Ao pressure ratio decreased (0.97+/-0.34 versus 0.91+/-0.30, P=0.05). Aneurysms developed after 24 dilations (18%) and were not related to balloon/stenosis ratio. Balloon rupture in 12 dilations produced an aneurysm in all 7 cases when rupture was in a hypoplastic segment. Three patients died, none from pulmonary artery trauma, and all before 1994., Conclusions: Mortality occurred early in our experience. Despite successful dilation of distal pulmonary arteries, there was modest initial hemodynamic improvement, mainly because of persistent central pulmonary artery obstruction. A serial approach of distal dilations followed by surgical repair of proximal obstruction may be a rational and successful therapy.
- Published
- 2001
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30. Gene expression of VEGF and its receptors Flk-1/KDR and Flt-1 in cultured and transplanted rat islets.
- Author
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Vasir B, Jonas JC, Steil GM, Hollister-Lock J, Hasenkamp W, Sharma A, Bonner-Weir S, and Weir GC
- Subjects
- Animals, Antigens, CD, Blood Glucose analysis, Cadherins genetics, DNA-Binding Proteins genetics, Diabetes Mellitus, Experimental genetics, Hormones genetics, Hypoxia-Inducible Factor 1, Hypoxia-Inducible Factor 1, alpha Subunit, Male, Mice, Mice, Inbred C57BL, Myocardium metabolism, Myosin Heavy Chains, Nonmuscle Myosin Type IIB, Nuclear Proteins genetics, Organ Culture Techniques, Postoperative Period, RNA, Messenger metabolism, Rats, Rats, Inbred Lew, Rats, Sprague-Dawley, Receptors, Vascular Endothelial Growth Factor, Reference Values, Vascular Endothelial Growth Factor A, Vascular Endothelial Growth Factor Receptor-1, Vascular Endothelial Growth Factors, Endothelial Growth Factors genetics, Extracellular Matrix Proteins genetics, Gene Expression, Islets of Langerhans Transplantation, Lymphokines genetics, Receptor Protein-Tyrosine Kinases genetics, Receptors, Growth Factor genetics, Transcription Factors
- Abstract
Background: Vascular endothelial growth factor (VEGF) and its two receptor tyrosine kinases, Flk-1/KDR and Flt-1, may play an important role in mediating the revascularization of transplanted pancreatic islets., Methods: Using semiquantitative multiplex reverse-transcribed polymerase chain reaction we determined the gene expression of VEGF and its receptors in cultured and transplanted rat islets., Results: After exposure of islet cells to hypoxia in vitro, increases were found in the gene expression of the VEGF120 and VEGF164 isoforms, with simultaneous increases in VE-cadherin, Flk-1/KDR, and Flt-1. In vivo studies consisted of analysis of islet grafts transplanted into both normal and diabetic recipients. Expression of both VEGF120 and VEGF164 in grafts was up-regulated for the first 2-3 days after transplantation, with the response being more prolonged in the diabetic rats. These increases were followed by reduced expression of VEGF on days 5, 7, and 9. Increases in the expression of VE-cadherin in islet grafts in normal and diabetic recipients tended to parallel VEGF expression, with the increases in both probably being caused by hypoxia. The early increases of VEGF expression were followed by a rise in the expression of VEGF receptors, which probably represents the early stages of angiogenesis. Graft expression of Flk-1/KDR and Flt-1 was enhanced at 3 and 5 days in the normoglycemic recipients, while in the diabetic recipients increases were found later on days 5, 7, and 14., Conclusions: The delayed expression of VEGF receptors in the diabetic recipients could reflect impaired angiogenesis caused by the diabetic milieu; this delay could contribute to the less outcomes of grafts transplanted into a hyperglycemic environment.
- Published
- 2001
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31. Islets in alginate macrobeads reverse diabetes despite minimal acute insulin secretory responses.
- Author
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Trivedi N, Keegan M, Steil GM, Hollister-Lock J, Hasenkamp WM, Colton CK, Bonner-Weir S, and Weir GC
- Subjects
- Animals, Blood Glucose analysis, Body Weight physiology, Diabetes Mellitus pathology, Eating, Fasting, Glucose Clamp Technique, Insulin Secretion, Islets of Langerhans pathology, Male, Rats, Rats, Inbred Lew, Alginates administration & dosage, Capsules administration & dosage, Diabetes Mellitus therapy, Insulin metabolism, Islets of Langerhans cytology
- Abstract
Background: Encapsulation of islets has been widely investigated as a treatment for diabetes. The characteristics and dynamics of insulin secretion by encapsulated islets in response to glucose and other secretagogues are not well understood., Methods: In our study, macroencapsulated syngeneic islets at 3-4 wk after transplantation were studied for insulin release in response to i.v. glucose (hyperglycemic clamps at 250 or 350 mg/dl plasma glucose), arginine (i.v. bolus, 100 mg/kg), glucagon-like peptide-1 (i.v. infusion for 20 min, 2.2 pmol/kg/min), and meal challenge. Syngeneic islets (6000 islets) were encapsulated in alginate macrobeads (2-3 mm diameter) with or without poly-L-lysine coating and transplanted into the peritoneal cavity of STZ-diabetic Lewis rats. Normal (nontransplanted) and diabetic Lewis rats transplanted with "naked" islets under the kidney capsule served as controls., Results: Animals transplanted with macrobeads displayed subnormal insulin responses to glucose, arginine, and glucagon-like peptide-1 despite achieving normoglycemia faster than animals with renal subcapsular islet transplants. Plasma insulin responses to meal challenges were blunted in animals with macrobeads resulting in increased plasma glucose excursions., Conclusions: We conclude that, after transplantation into diabetic Lewis rats, macroencapsulated islets have significantly impaired insulin secretion despite achieving normal fed glycemic levels.
- Published
- 2001
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32. Pediatric cardiology and cardiovascular surgery: 1950-2000.
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Freedom RM, Lock J, and Bricker JT
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- Cardiac Catheterization, Cardiac Surgical Procedures history, Cardiopulmonary Bypass history, Ductus Arteriosus, Patent drug therapy, Heart Defects, Congenital surgery, History, 20th Century, Humans, Prostaglandins therapeutic use, Transposition of Great Vessels surgery, Cardiology history, Cardiovascular Surgical Procedures history, Pediatrics history
- Published
- 2000
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33. Patent foramen ovale is indicted, but the case hasn't gone to trial.
- Author
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Lock JE
- Subjects
- Adult, Embolism epidemiology, Humans, Infant, Newborn, Risk Factors, Embolism etiology, Heart Septal Defects, Atrial complications
- Published
- 2000
- Full Text
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34. Reversal of hyperglycemia in mice after subcutaneous transplantation of macroencapsulated islets.
- Author
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Tatarkiewicz K, Hollister-Lock J, Quickel RR, Colton CK, Bonner-Weir S, and Weir GC
- Subjects
- Animals, Blood Glucose metabolism, Fasting, Glucose Tolerance Test, Male, Membranes, Artificial, Mice, Mice, Nude, Microcirculation, Oxygen Consumption, Rats, Rats, Sprague-Dawley, Hyperglycemia surgery, Islets of Langerhans Transplantation, Pancreas, Artificial
- Abstract
Background: Macroencapsulated islets can reverse hyperglycemia in diabetic animals when transplanted i.p. or into the fat pad. The s.c. space is an attractive site for such transplantation because macrocapsules can be implanted with local anesthesia and be easily removed or reloaded with fresh islets., Methods: Immunoprotective 20 microl ported devices were transplanted under the skin of Streptozocin-diabetic nude mice. Devices were loaded with 1200 rat islets in culture medium or in alginate. Empty devices were implanted for 2 weeks and then loaded with islets. Normal mice and mice with islets transplanted under the renal capsule or under the skin were used as controls. Seven weeks after transplantation, an intraperitoneal glucose tolerance test (IPGTT) was performed, followed by implant removal., Results: Three weeks after transplantation, normal blood glucose levels were observed in all animals. Compared with those of normal controls, IPGTTs showed accelerated blood glucose clearance in mice transplanted with islets either within devices or beneath the kidney capsule. Fasted transplanted mice were hypoglycemic before glucose injection and 2 hr later. After removal of the implants, all recipient mice returned to hyperglycemia. Histological evaluation revealed viable islet cells and a network of close vascular structures outside the devices., Conclusions: Macroencapsulated islets transplanted into the s.c. space were able to survive and regulate blood glucose levels in mice. The observed differences in glucose metabolism between normal and transplanted mice may be attributed to the site of transplantation and to the use of rat islets, which have a different set point for glucose induced insulin release.
- Published
- 1999
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35. Exploring the relationship of erotic life to bulimia nervosa.
- Author
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Lock J
- Subjects
- Adult, Female, Humans, Bulimia psychology, Sexual Behavior psychology
- Published
- 1998
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36. Apical muscular ventricular septal defects between the left ventricle and the right ventricular infundibulum. Diagnostic and interventional considerations.
- Author
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Kumar K, Lock JE, and Geva T
- Subjects
- Adult, Cardiac Surgical Procedures, Child, Child, Preschool, Cineangiography, Echocardiography, Doppler, Heart Septal Defects, Ventricular physiopathology, Hemodynamics, Humans, Infant, Infant, Newborn, Microsurgery, Prevalence, Heart Septal Defects, Ventricular diagnosis, Heart Septal Defects, Ventricular surgery
- Abstract
Background: Effective transcatheter or surgical closure of apical muscular ventricular septal defects (VSDs) requires accurate delineation of variable and often complex anatomy. These defects have generally been considered as communications between the apexes of both left and right ventricles., Methods and Results: Among 50 consecutive patients with multiple muscular VSDs referred for transcatheter device closure between October 1987 and April 1993, a subset of 10 patients (aged 7 days to 28 years) with apical muscular VSDs shared a unique set of anatomic characteristics: (1) large and often single opening in the left ventricle; (2) multiple right ventricular openings in the anterior aspect of the apical septum; and (3) separation of the right ventricular apical region into which the VSDs open from the rest of the right ventricular inflow and outflow by prominent muscle bundles. Additional analysis of the anatomy by use of echocardiography and cineangiography showed that these muscular defects were between the left ventricular apex and right ventricular infundibular apex. In 6 patients, the transcatheter devices used to create a septum in these hearts were placed in the right ventricle, straddling muscle bundles that separated the apical VSD from the rest of the right ventricular inflow and outflow, resulting in incorporation of a portion of the right ventricular infundibular apex into the physiological left ventricle. Three patients had devices placed between the apexes of the left ventricle and the infundibulum. The defect closed spontaneously within the right ventricle in 1 patient. One patient died after surgery for tetralogy of Fallot in situs inversus. The remaining 9 patients were all clinically well at the time of their most recent follow-up visit (follow-up duration, 32 +/- 11 months). This distinct type of apical VSD was identified by echocardiography in 20 of 274 patients who were followed up clinically for muscular VSDs., Conclusions: Left ventricular-infundibular apical VSDs constitute a distinct morphological type of muscular VSD that can be distinguished by echocardiography and cineangiography. In selected cases, the infundibular apex can be separated from the rest of the right ventricular inflow and outflow to eliminate flow across these defects.
- Published
- 1997
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37. Outcome of patients with ectopia cordis and significant intracardiac defects.
- Author
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Hornberger LK, Colan SD, Lock JE, Wessel DL, and Mayer JE Jr
- Subjects
- Child, Child, Preschool, Female, Heart Defects, Congenital diagnosis, Heart Defects, Congenital mortality, Humans, Infant, Male, Pregnancy, Prenatal Diagnosis, Heart Defects, Congenital surgery
- Abstract
Background: Previous reports suggest a poor prognosis for patients with ectopia cordis and significant congenital heart disease., Methods and Results: To determine the outcome of affected patients in a recent medical and surgical era, we reviewed the clinical course, echocardiograms, catheterization data, and operative reports of all patients with ectopia cordis and significant heart disease encountered at Children's Hospital from 1982 to the present. We identified 13 patients with conotruncal defects and either thoracic (TEC, n = 4) or thoracoabdominal (TAEC, n = 9) ectopia cordis. Diagnosis was established in utero in 6, with termination of pregnancy in 2 and death before transfer to Children's Hospital in 1. Of 10 patients postnatally managed at Children's Hospital, 4 of 8 with TAEC and 1 of 2 with TEC survived beyond infancy, with an age at most recent follow-up of 3.5 to 9.8 years. All 5 survivors had procedures as neonates to provide skin coverage over the midline defect and heart, with concomitant repair of a small omphalocele in 4. Three underwent successful surgical repair of the cardiac defect, including ventricular septal defect closure for double-outlet right ventricle (9 months), repair of tetralogy of Fallot with pulmonary atresia (2.6 years), and repair of double-outlet right ventricle, pulmonary stenosis, and total anomalous pulmonary venous connection to the coronary sinus (3.3 years). Two other patients with TAEC, conoventricular defects, and hypoplastic left ventricle underwent single-ventricle palliation. One patient, at 4 years of age underwent a right cavopulmonary anastomosis and intra-atrial coronary sinus-to-right superior vena cava baffle. The second patient had a modified Fontan procedure. None of the 5 survivors had significant extrathoracic defects, whereas all 3 who died by 3 weeks of age had both a large omphalocele and pulmonary hypoplasia. Two infants with pentalogy of Cantrell, 1 with a large omphalocele, died of fungal sepsis by 5 weeks of age, and 1 other died intraoperatively after repair of pulmonary venous confluence obstruction and right Blalock-Taussig shunt placement., Conclusions: Our experience indicates that patients with TEC and TAEC and significant intracardiac defects, in the absence of significant extracardiac defects, can survive beyond early infancy and undergo successful cardiac repair or more definitive palliation for single-ventricle physiology.
- Published
- 1996
38. Isolated peripheral pulmonary artery stenoses in the adult.
- Author
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Kreutzer J, Landzberg MJ, Preminger TJ, Mandell VS, Treves ST, Reid LM, and Lock JE
- Subjects
- Adolescent, Adult, Age of Onset, Angioplasty, Balloon, Cardiac Catheterization, Dyspnea etiology, Fatigue etiology, Female, Follow-Up Studies, Hemodynamics, Humans, Hypertrophy, Right Ventricular etiology, Hypertrophy, Right Ventricular pathology, Male, Middle Aged, Pulmonary Artery diagnostic imaging, Pulmonary Artery embryology, Pulmonary Artery pathology, Pulmonary Valve Stenosis complications, Pulmonary Valve Stenosis diagnosis, Pulmonary Valve Stenosis therapy, Radiography, Ultrasonography, Pulmonary Valve Stenosis epidemiology
- Abstract
Background: Isolated peripheral pulmonary artery stenosis (PPS) in the adult is rare and frequently unsuspected. We review in this article our experience with 12 adult patients with isolated PPS, half of whom had been previously diagnosed with chronic pulmonary thromboembolic disease., Methods and Results: The presentation, evolution, and management of 12 adults with isolated PPS, 17 to 51 years of age (mean, 36.2 +/- 9.7 years), were evaluated. Presenting symptoms were dyspnea and fatigue. Three patients had New York Heart Association (NYHA) functional class III or greater. Lung perfusion scans revealed multiple segmental abnormalities in flow distribution in all patients. Oxygen desaturation at rest was present in 4 patients. At catheterization, right ventricular (RV) pressure was suprasystemic in 2 patients, systemic in 1, and more than half-systemic in 7. All had multiple bilateral non-uniform stenoses in segmental and subsegmental arteries. Balloon pulmonary angioplasty (BPA) to decrease RV hypertension and improve pulmonary flow distribution was performed in 11 patients. After BPA, vessel diameter increased > 50% in 10 patients, distal pulmonary artery pressure increased > or = 30% in 6, and RV pressure decreased > 30% in 5. One patient died shortly after BPA as a result of pulmonary hemorrhage. Immediate procedural success was achieved in 9 of 11 patients. At a mean follow-up period of 52 +/- 32 months, 7 patients had sustained symptomatic improvement (NYHA class I-II)., Conclusions: We describe a severe syndrome of isolated PPS in the adult that mimics chronic pulmonary thromboembolic disease. Pulmonary hemodynamics and angiography are required for definitive diagnosis. BPA may offer these patients successful short-term reduction in RV hypertension and alleviation of symptomatology.
- Published
- 1996
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39. Prolongation of RV-PA conduit life span by percutaneous stent implantation. Intermediate-term results.
- Author
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Powell AJ, Lock JE, Keane JF, and Perry SB
- Subjects
- Bioprosthesis, Blood Vessel Prosthesis, Cardiac Catheterization, Child, Equipment Failure, Female, Follow-Up Studies, Graft Occlusion, Vascular diagnostic imaging, Graft Occlusion, Vascular epidemiology, Heart Defects, Congenital epidemiology, Heart Valve Prosthesis, Heart Ventricles surgery, Humans, Male, Radiography, Retrospective Studies, Time Factors, Graft Occlusion, Vascular therapy, Heart Defects, Congenital surgery, Pulmonary Artery surgery, Stents
- Abstract
Background: Right ventricle-to-pulmonary artery (RV-PA) homografts and bioprosthetic conduits are commonly used to palliate various types of complex congenital heart disease. These conduits frequently develop progressive obstruction and require surgical replacement. This report reviews our experience implanting balloon-expandable stents to relieve conduit obstruction and delay reoperation., Methods and Results: A retrospective review identified 44 patients who underwent placement of 48 stents in obstructed RV-PA conduits. Median patient age was 6.9 years (range, 7 months to 30 years), and median follow-up time was 14.2 months (range, 0 to 48 months). Stent implantation initially decreased the RV-PA pressure gradient from 61.0 +/- 16.9 to 29.7 +/- 11.9 mm Hg (P < or = .001) and the right ventricular-to-systemic arterial pressure ratio from 0.92 +/- 0.17 to 0.63 +/- 0.20 (P < or = .001). The diameter of the stenotic region expanded from 9.3 +/- 3.5 to 12.3 +/- 3.3 mm in the anteroposterior view (P < or = .001) and from 6.6 +/- 2.9 to 10.9 +/- 2.5 mm in the lateral view (P < or = .001). During the follow-up period, 2 patients had their stents redilated, 7 had additional conduit stents deployed, and 14 underwent surgical replacement of their conduits. Actuarial freedom from conduit reoperation was 65% at 30 months postprocedure. Seven patients were found to have fractured stents on follow-up, suggesting an important role for external compressive forces in conduit failure. Recatheterization in 16 patients a median of 11.8 months (3 to 48 months) postprocedure demonstrated hemodynamic evidence of recurrent obstruction despite sustained enlargement at the previously stented sites. Complications included stent displacement (n = 1), bacterial endocarditis (n = 1), and false aneurysm formation (n = 1). One patient died awaiting conduit replacement surgery., Conclusions: Stent implantation in obstructed RV-PA conduits results in significant immediate hemodynamic and angiographic improvement. In a subgroup of patients, the procedure prolongs conduit life span by several years and increases the interval between conduit reoperations. Recurrent obstruction is caused by external compression and progressive stenosis outside the stented region.
- Published
- 1995
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40. Hepatic venous blood and the development of pulmonary arteriovenous malformations in congenital heart disease.
- Author
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Srivastava D, Preminger T, Lock JE, Mandell V, Keane JF, Mayer JE Jr, Kozakewich H, and Spevak PJ
- Subjects
- Adult, Arteriovenous Fistula physiopathology, Arteriovenous Shunt, Surgical, Cardiac Catheterization, Child, Child, Preschool, Humans, Postoperative Complications physiopathology, Pulsatile Flow physiology, Spleen abnormalities, Vena Cava, Inferior surgery, Arteriovenous Fistula etiology, Heart Defects, Congenital surgery, Hepatic Veins, Postoperative Complications etiology, Pulmonary Artery surgery, Pulmonary Circulation physiology, Pulmonary Veins surgery
- Abstract
Background: Pulmonary arteriovenous malformations (PAVMs) are a known complication after some types of cavopulmonary anastomoses (CVPAs). Their cause is unknown, but they may be related to the absence of pulsatile flow or the presence or absence of circulating factors. These PAVMs are diffuse and are presumed to be progressive and irreversible., Methods and Results: All patients with congenital heart disease (CHD) seen at Children's Hospital, Boston, Mass, between 1970 and 1993 were reviewed. We report on the 10 patients with CHD who were found to have developed PAVMs, as diagnosed by cardiac catheterization. Diagnoses included heterotaxy syndrome/polysplenia, with interrupted inferior vena cava and hepatic veins draining to the right atrium (n = 6); heterotaxy/asplenia (n = 1); corrected transposition with pulmonary stenosis (n = 1); and biliary atresia and associated CHD (n = 2). PAVMs were diagnosed 0.1 to 7.0 years (median, 3.5 years) after creation of a CVPA that resulted in exclusion of hepatic venous flow from one or both lungs in 8 of the 10 patients; the remaining 2 patients had normal drainage of hepatic veins to the lungs but had biliary atresia. In all, the common anatomic feature was the exclusion of normal hepatic venous return from the affected pulmonary arterial circulation. All patients with interrupted inferior vena cava, azygous continuation to the superior vena cava, and hepatic veins draining to the right atrium (polysplenia syndrome) were reviewed to determine the incidence of PAVMs in those with CVPA (ie, hepatic venous flow excluded from the pulmonary arteries) and without CVPA. Six of 28 (21%) of those with versus 1 of 56 (1.8%) of those without CVPA developed PAVMs (P = .004). The 1 patient without CVPA who had PAVMs also had biliary atresia. Among patients with CVPA, the probability of developing PAVMs was 15% and 28% at 3 and 5 years, respectively, after CVPA. The histological and angiographic appearances of PAVMs after CVPA are similar to those seen in PAVMs associated with hepatic cirrhosis., Conclusions: We postulate that PAVMs after CVPA are related to the diversion of normal hepatic venous flow from the pulmonary circulation. In this sense, these PAVMs may be analogous to those associated with liver disease, which have been found to resolve after liver transplantation. Redirection of hepatic flow to the pulmonary bed in some patients with CHD and PAVMs may lead to reversibility of the PAVMs.
- Published
- 1995
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41. Transcatheter closure of ventricular septal defects: hemodynamic instability and anesthetic management.
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Laussen PC, Hansen DD, Perry SB, Fox ML, Javorski JJ, Burrows FA, Lock JE, and Hickey PR
- Subjects
- Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac therapy, Body Weight, Cardiac Catheterization instrumentation, Child, Child, Preschool, Female, Heart Septal Defects, Ventricular physiopathology, Humans, Hypotension etiology, Hypotension therapy, Infant, Intensive Care Units, Male, Resuscitation, Retrospective Studies, Anesthesia, Cardiac Catheterization adverse effects, Heart Septal Defects, Ventricular therapy, Hemodynamics, Prostheses and Implants adverse effects
- Abstract
The technique of transcatheter ventricular septal defect (VSD) device closure may be associated with significant hemodynamic instability. The anesthetic records and catheterization data of 70 consecutive transcatheter VSD closures between February 1989 and September 1992 were reviewed, and risk factors associated with hemodynamic instability evaluated. In 28 of 70 procedures (40%), hypotension (> 20% decrease in systolic blood pressure from baseline) occurred; 12 responded to administration of fluids intravascularly alone, whereas 16 patients required additional acute resuscitation. Significant dysrhythmias occurred during 20 (28.5%) anesthetics associated with hypotension and requiring treatment or catheter withdrawal. ASA physical status, precatheterization indication for device placement, and patient size were not predictive of hemodynamic instability during the procedure. Blood transfusions were necessary in 38 (54.4%) cases and were size-related, with patients weighing less than 10 kg requiring a significantly larger transfusion volume (25.1 +/- 12.4 mL/kg). After 35 procedures (50%) patients were admitted directly to the intensive care unit (ICU) due primarily to hemodynamic instability or procedure duration; 24 (68%) required mechanical ventilation. No deaths occurred; there was no late morbidity due to catheterization-related events. Intravenous sedation was used for the initial catheterizations, maintained with a combination of midazolam, ketamine, and morphine. Subsequently general intravenous or inhaled anesthesia was predominantly used during transesophageal echocardiography and internal jugular vein cannulation. We conclude that hemodynamic instability is common during device closure of VSDs, and is likely to be an inescapable feature of these procedures in many patients because of the technique necessary for device placement.
- Published
- 1995
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42. Severe congenital mitral stenosis in infants.
- Author
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Moore P, Adatia I, Spevak PJ, Keane JF, Perry SB, Castaneda AR, and Lock JE
- Subjects
- Cardiac Catheterization, Catheterization, Follow-Up Studies, Heart Valve Prosthesis, Humans, Infant, Infant, Newborn, Length of Stay statistics & numerical data, Mitral Valve pathology, Mitral Valve surgery, Mitral Valve Stenosis mortality, Mitral Valve Stenosis therapy, Postoperative Complications epidemiology, Recurrence, Survival Rate, Time Factors, Mitral Valve Stenosis congenital
- Abstract
Background: Despite current medical and surgical therapy, infants with symptomatic congenital mitral stenosis (CMS) continue to have high rates of morbidity and mortality. Catheter balloon dilation has been successful in relieving symptoms in a few older children with CMS but has not been evaluated in infants., Methods and Results: We reviewed the records of 85 infants with CMS to assess severity of CMS, associated cardiac lesions, echocardiographic morphological appearance of the mitral valve, treatment, and outcome. There were five valve morphologies identified: "typical" hypoplastic mitral valve with symmetric papillary muscles (SYMM, 52%), supravalvar mitral ring (SVMR, 20%), double-orifice mitral valve (DOMV, 11%), hypoplastic mitral valve with asymmetric papillary muscles (ASYMM, 8%), and parachute mitral valve (PARA, 8%). Of the 85 infants, 31 (36%) were severely symptomatic, requiring intervention within the first 2 years. Balloon dilation was performed in 18 infants (age, 8.7 +/- 5.7 months; weight, 5.9 +/- 1.9 kg) and valve surgery in 13 (age, 10.9 +/- 5.9 months; weight, 6.7 +/- 2.1 kg). Balloon dilation decreased the peak transmitral gradient (LAa-LVED) > 30% in 15 of 18 initial attempts, from 20.3 +/- 8.2 to 10.9 +/- 4.9 mm Hg (P < .001), and the mitral valve area increased from 0.7 +/- 0.3 to 1.0 +/- 0.5 cm2/M2 (n = 10, P = .01). No infants died during the initial balloon dilation, although 2 of 3 died during a repeat procedure for restenosis. Other complications included significant mitral regurgitation in 7 of 18 patients (39%), 4 of whom had SVMR. Of the 18 infants, 8 (44%) had persistent symptomatic improvement at a mean follow-up of 14 months (range, 2 to 32 months). The 2-year survival after balloon dilation was 70%; 40% remained free of repeat intervention. Mitral valve surgery in 13 infants consisted of SVMR resections in 7, mitral valve replacements in 4, and LA-to-LV aortic valved homografts in 2. The operative mortality was 30%. Sustained improvement occurred in 8 (6 with SVMR) at 11 to 62 months of follow-up (mean, 30 months), with a 2-year survival of 60%., Conclusions: Infants with severe CMS have 2-year mortality rates approaching 40% regardless of treatment modality. Balloon dilation significantly reduces the transmitral gradient in the majority, but symptomatic improvement persists in only 40%. Procedure-related mortality was associated with repeat balloon dilation in patients with left ventricular hypoplasia. Balloon dilation of "typical" CMS can provide symptomatic relief in many infants, allowing postponement of valve replacement, although infants with SVMR do better with surgical management.
- Published
- 1994
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43. "Intramural" residual interventricular defects after repair of conotruncal malformations.
- Author
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Preminger TJ, Sanders SP, van der Velde ME, Castañeda AR, and Lock JE
- Subjects
- Angiocardiography, Cardiac Catheterization, Child, Echocardiography, Doppler, Echocardiography, Transesophageal, Heart Septal Defects, Ventricular diagnosis, Heart Septal Defects, Ventricular epidemiology, Humans, Postoperative Complications diagnosis, Postoperative Complications surgery, Reoperation, Heart Defects, Congenital surgery, Heart Septal Defects, Ventricular surgery, Postoperative Complications epidemiology, Prostheses and Implants
- Abstract
Background: We report an unusual type of residual interventricular communication in patients with conotruncal malformations in which the aorta is completely or partly aligned with the right ventricle (RV). Interventricular communications after surgical repair usually result from additional defects, patch dehiscence, or incomplete closure and lie in the septal plane. However, after a right ventricular aorta is baffled to the left ventricle, the ventricular septal defect (VSD) patch and RV free wall form part of the systemic outflow tract. This "neo-left ventricular" outflow tract may provide a location for residual interventricular communications out of the septal plane., Methods and Results: We reviewed echocardiographic, angiographic, and clinical records of patients who had one or more residual interventricular communications out of the plane of the ventricular septum after repair of a conotruncal anomaly. Between June 1990 and October 1992, we observed such defects in eight patients, 5 to 26 years old, after repair of double-outlet right ventricle (n = 6), tetralogy of Fallot (n = 1), or truncus arteriosus (n = 1). In each, the VSD patch was anchored to the RV free wall near the aortic root. Nonetheless, channels were observed around the edge of the patch, between the neo-systemic outflow tract and the right ventricle. All patients had right ventricular hypertension; in seven, the pulmonary-to-systemic flow ratio (Qp:Qs) was > or = 2. At multiple unsuccessful reoperations (two to four per patient), the patch edges appeared securely attached to myocardium. Angiographic views profiling the septum failed to localize these defects, since they are not in the native septum. Echocardiographic detection of such anterior defects can be difficult. Transcatheter umbrella closure was attempted in the seven patients with large shunts; success was limited by the multiplicity of flow channels. Umbrella closure eliminated the need for further reoperation in four of seven patients, one patient died suddenly awaiting reoperation, and two deaths followed reoperation., Conclusions: "Intramural" residual interventricular defects are difficult to diagnose by all modalities. Umbrella placement may reduce the left-to-right shunt. Successful surgical closure may require removal and reattachment of the anterior portion of the patch.
- Published
- 1994
- Full Text
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44. Influence of right heart size on outcome in pulmonary atresia with intact ventricular septum.
- Author
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Giglia TM, Jenkins KJ, Matitiau A, Mandell VS, Sanders SP, Mayer JE Jr, and Lock JE
- Subjects
- Blood Volume, Coronary Circulation, Humans, Infant, Newborn, Pulmonary Valve diagnostic imaging, Survival Analysis, Treatment Outcome, Tricuspid Valve diagnostic imaging, Ventricular Function, Right, Echocardiography, Heart Septal Defects, Ventricular diagnostic imaging, Heart Septal Defects, Ventricular surgery, Pulmonary Valve abnormalities, Pulmonary Valve surgery
- Abstract
Background: Neonates with pulmonary atresia and intact ventricular septum (PA-IVS) are frequently born with hypoplastic right heart structures that must grow after right ventricular decompression (RVD) procedures for a complete two-ventricle physiology to be achieved. Previous authors have asserted that neonatal right heart size or morphology will predict right heart growth potential. Since 1983, our bias has favored early RVD regardless of initial right heart size. In 1986, we recognized a subset of patients with coronary artery abnormalities associated with poor outcome after RVD and have defined these patients as having a right ventricular-dependent coronary circulation (RVDCC)., Methods and Results: To assess the influence of right heart size on outcome independent of the presence of RVDCC, we measured echocardiographic right ventricular (RV) dimensions in 37 neonates with adequate studies presenting between 1983 and 1990. Coronary artery anatomy was adequately assessed by angiography in 36. RV volume and tricuspid valve (TV) diameter were significantly smaller in patients with RVDCC than in those without. However, there was no statistically significant association between RV volume or TV diameter and survival among patients with or without RVDCC: Among 29 patients without RVDCC, 23 of 24 (95.8%) who achieved RVD are alive compared with 1 of 5 (20%) who did not achieve RVD (P = .001). Twenty-one of the 23 survivors have a complete two-ventricle physiology with low right atrial pressure. Among 7 patients with RVDCC, 2 patients who underwent RVD died early of left ventricular failure, whereas 4 of 5 who did not undergo RVD have survived single ventricular palliation., Conclusions: Small right heart size is associated with RVDCC but is not associated with survival in PA-IVS. Patients without RVDCC have improved survival after RVD regardless of neonatal right heart size.
- Published
- 1993
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45. Early bidirectional cavopulmonary shunt in young infants. Postoperative course and early results.
- Author
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Chang AC, Hanley FL, Wernovsky G, Rosenfeld HM, Wessel DL, Jonas RA, Mayer JE Jr, Lock JE, and Castaneda AR
- Subjects
- Cardiac Catheterization, Follow-Up Studies, Heart Defects, Congenital epidemiology, Humans, Hypertension epidemiology, Infant, Postoperative Complications epidemiology, Retrospective Studies, Time Factors, Arteriovenous Shunt, Surgical methods, Heart Defects, Congenital surgery, Palliative Care methods, Pulmonary Artery surgery, Vena Cava, Superior surgery
- Abstract
Background: Despite the recent wide applicability of the bidirectional cavopulmonary shunt, there is limited reported experience in performing these shunts in infants 6 months or younger., Methods and Results: Before October 1992, 17 consecutive infants aged 4.2 to 6.5 months (median, 6.1 months) underwent bidirectional cavopulmonary shunts. The diagnoses were hypoplastic left heart syndrome (n = 7), single right ventricle (n = 5), and single left ventricle (n = 5). All but 2 patients had prior palliative surgery. The bidirectional cavopulmonary shunt was performed early on an elective basis in 9 patients; the remaining patients had progressive cyanosis (6 patients), severe ventricular failure (1 patient), and coexisting restrictive bulboventricular foramen (1 patient). The median preoperative pulmonary arterial pressure and pulmonary vascular resistance were 15 mm Hg and 2.3 U.m2, respectively. One patient died; the overall hospital survival was 94%. The most common postoperative problem was transient systemic hypertension, observed in 14 (88%) of 16 survivors. Systemic arterial oxygen saturation increased from a median of 75% before surgery to a median of 85% after surgery (P < .05). The median hospital stay was 6 days. There were no late deaths during follow-up (median, 12.4 months). At postoperative cardiac catheterization performed in 9 of 16 survivors, there was no evidence of severe hypoxemia, shunt narrowing, or pulmonary arteriovenous fistulas. Of the 16 survivors, 6 have had a subsequent Fontan operation at a median age of 1.9 years; there were 5 survivors., Conclusions: Early bidirectional cavopulmonary shunt in young infants has shown encouraging early results and provides improved oxygenation with low morbidity and mortality. We speculate that an early bidirectional cavopulmonary shunt on an elective basis may reduce the deleterious sequelae of chronic hypoxemia, long-term ventricular volume overload, and repeated palliative procedures, thus yielding a more suitable Fontan candidate.
- Published
- 1993
46. Intraoperative device closure of ventricular septal defects.
- Author
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Fishberger SB, Bridges ND, Keane JF, Hanley FL, Jonas RA, Mayer JE, Castaneda AR, and Lock JE
- Subjects
- Cardiac Catheterization, Equipment Design, Follow-Up Studies, Heart Defects, Congenital surgery, Heart Septal Defects, Ventricular mortality, Humans, Infant, Intraoperative Care methods, Risk Factors, Survival Rate, Time Factors, Heart Septal Defects, Ventricular surgery, Prostheses and Implants
- Abstract
Background: Surgical repair of muscular ventricular septal defects (VSDs) has been associated with significant morbidity and mortality when the defects are multiple, associated with complex cardiac lesions, or requiring left ventriculotomy. Transcatheter VSD closure may be difficult in patients weighing less than 7 kg or those with limited vascular access. We attempted intraoperative device closure of muscular VSDs during surgical repair of associated lesions., Methods and Results: We considered intraoperative umbrella closure in 10 patients, 8 with additional complex heart lesions. "Swiss cheese" defects were present in 4. Median patient age was 4.7 months. Device closure was not attempted in 1 patient due to an inadequate septal rim. Nine umbrellas, 12 to 40 mm in diameter, were positioned to straddle the septum in all 9 patients. There were 3 early deaths, 2 in patients who were moribund preoperatively. The third was due to severe ventricular dysfunction. Among the 6 survivors, 3 had a Qp:Qs < or = 2 and right ventricular or pulmonary artery pressure less than half systemic. These patients had no further intervention. The other 3 had a Qp:Qs > 2. One died unexpectedly 5 weeks after cardiac surgery. The other 2 had subsequent closure of residual VSDs. All 5 survivors are well at follow-up of 8 to 25 months., Conclusions: Intraoperative umbrella VSD closure appears less successful than VSD closure in the catheterization laboratory. In selected patients, particularly very small infants, intraoperative device placement may be advantageous. Completeness of closure is difficult to assess intraoperatively.
- Published
- 1993
47. Tetralogy of Fallot with pulmonary atresia. Rehabilitation of diminutive pulmonary arteries.
- Author
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Rome JJ, Mayer JE, Castaneda AR, and Lock JE
- Subjects
- Angioplasty, Balloon, Blood Vessel Prosthesis, Child, Child, Preschool, Follow-Up Studies, Humans, Infant, Newborn, Risk Factors, Survival Rate, Tetralogy of Fallot mortality, Tetralogy of Fallot surgery, Time Factors, Treatment Outcome, Pulmonary Artery abnormalities, Pulmonary Valve abnormalities, Tetralogy of Fallot therapy
- Abstract
Background: Patients with tetralogy of Fallot, pulmonary atresia, and diminutive pulmonary arteries are a high-risk group for whom there is no consensus on the correct approach to medical management. The purpose of this report is to review a 14-year experience in the treatment of these patients comparing management schemes., Methods and Results: Between January 1978 and August 1988, 91 patients with tetralogy of Fallot and pulmonary atresia had an adequate evaluation of their pulmonary artery anatomy before any surgical management. Forty-eight of these patients had diminutive pulmonary arteries (38 to 104 mm2/m2) supplied by aortopulmonary collaterals and were managed in four different fashions. Of the 9 patients repaired primarily, 7 died early and the two survivors had poor hemodynamic outcome. Of the 9 patients conservatively managed with no intervention before 5 years of age, 4 died and only 1 had a satisfactory hemodynamic result after repair. Of 10 shunted patients, 3 died and 3 had satisfactory repairs. Since 1984, we have rehabilitated pulmonary arteries with (1) right ventricle to pulmonary artery surgical graft, (2) balloon dilation of residual pulmonary artery stenoses and embolization of collaterals, and (3) surgical closure of ventricular septal defect and repair of remaining obstructions. Of 20 patients so managed, 7 died after various stages, but 10 of 20 had complete repairs. All repaired patients with subsystemic right ventricular pressures had at least one successful pulmonary artery dilation., Conclusions: A combined catheter-surgery approach begun at an early age in patients with tetralogy of Fallot and pulmonary atresia with diminutive pulmonary arteries appears to enhance the chances of satisfactory complete repair.
- Published
- 1993
- Full Text
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48. Implantation and intermediate-term follow-up of stents in congenital heart disease.
- Author
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O'Laughlin MP, Slack MC, Grifka RG, Perry SB, Lock JE, and Mullins CE
- Subjects
- Adolescent, Adult, Catheterization, Child, Preschool, Cineangiography, Constriction, Pathologic, Female, Follow-Up Studies, Foreign-Body Migration, Heart Defects, Congenital diagnostic imaging, Humans, Infant, Male, Postoperative Complications, Pulmonary Artery diagnostic imaging, Pulmonary Veins diagnostic imaging, Reoperation, Heart Defects, Congenital surgery, Stents adverse effects
- Abstract
Background: Balloon-expandable stents (Johnson and Johnson Interventional Systems) have been in use for congenital heart disease since late 1989. They have made possible treatment in previously untreatable branch pulmonary artery stenoses and systemic venous stenosis. The purpose of this report is to detail the results and intermediate-term follow-up of stents used for treatment of congenital heart disease., Methods and Results: Eighty-five patients underwent placement of 121 stents in Houston and Boston. Fifty-eight patients had stents put in pulmonary arteries, nine had stents in conduits or outflow tracts, and 21 had stents in venous stenoses or narrowed Fontan anastomoses. (Three patients had stents in two locations.) These stent procedures resulted in gradient reduction from 55.2 +/- 33.3 to 14.2 +/- 13.5 mm Hg in pulmonary arteries, from 41.4 +/- 26.0 to 20.7 +/- 17.0 mm Hg in conduits or outflow tracts, and from 9.8 +/- 6.9 to 2.4 +/- 3.1 mm Hg in venous stenoses or Fontan anastomoses. Diameter of narrowings increased from 4.6 +/- 2.3 to 11.3 +/- 3.2 mm in the pulmonary artery, from 8.8 +/- 3.6 to 12.7 +/- 2.6 in conduits, and from 3.8 +/- 2.9 to 11.3 +/- 2.8 in venous stenoses. Follow-up has shown stent fracture in one patient, restenosis in one, and sudden death in one. Recatheterization has been done in 38 patients an average of 8.6 months after stent installation. Compared with immediately postimplant data, there was no significant change in luminal diameter or pressure gradient. Redilation was performed in 14 patients (17 stents) 1 week to 24 months after implantation (mean, 10.2 months), with a small but significant increase in stenosis diameter., Conclusions: We conclude that stent treatment of vascular stenoses in congenital heart disease retains efficacy at medium-term follow-up and offers a much-improved outlook for patients with these lesions.
- Published
- 1993
- Full Text
- View/download PDF
49. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism.
- Author
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Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, and Lock JE
- Subjects
- Actuarial Analysis, Adult, Aged, Cerebrovascular Disorders etiology, Cineangiography, Echocardiography, Female, Follow-Up Studies, Heart Septal Defects, Atrial complications, Heart Septal Defects, Atrial diagnosis, Humans, Infant, Male, Middle Aged, Recurrence, Catheterization, Embolism etiology, Heart Septal Defects, Atrial therapy
- Abstract
Background: Many have proposed a relation between presence of a patent foramen ovale, with or without atrial septal aneurysm, and cryptogenic stroke. The effect of foramen ovale closure on the risk for subsequent strokes is unknown., Methods and Results: Transcatheter closure of a patent foramen ovale was undertaken in 36 patients with known right-to-left atrial shunting and presumed paradoxical emboli (31 strokes, 25 transient neurological events, four systemic arterial emboli, and two brain abscesses). Individual patients had between one and four such events. None had a left heart or carotid source of embolism; 31 of 35 had no known risk factors for stroke. Events occurred in 12 patients while they were taking warfarin. At cardiac catheterization, patent foramina ovalia were significantly larger than predicted for age in 67% of the patients. Implantation of a double-umbrella device in the patent foramen ovale was achieved in all without serious procedural complications. Of 34 who have returned for follow-up, one has a residual atrial communication that may be clinically important, five had trivial leaks, and 28 have complete closure. There have been no strokes during a mean follow-up of 8.4 months., Conclusions: Transcatheter closure of a patent foramen ovale can be accomplished with little morbidity and may reduce the risk of recurrence. Further investigations directed toward identifying the population at risk and assessing the effect of intervention are warranted.
- Published
- 1992
- Full Text
- View/download PDF
50. Effect of baffle fenestration on outcome of the modified Fontan operation.
- Author
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Bridges ND, Mayer JE Jr, Lock JE, Jonas RA, Hanley FL, Keane JF, Perry SB, and Castaneda AR
- Subjects
- Child, Child, Preschool, Follow-Up Studies, Heart Defects, Congenital physiopathology, Hemodynamics, Humans, Postoperative Complications, Retrospective Studies, Treatment Outcome, Cardiac Surgical Procedures methods, Heart Defects, Congenital surgery
- Abstract
Background: The "fenestrated Fontan" (surgical baffle fenestration followed by transcatheter test occlusion and permanent closure after postoperative recovery) was adopted in an effort to reduce perioperative mortality and morbidity. This study assesses the effect of baffle fenestration on outcome., Methods and Results: Patients having a modified Fontan operation with a cavocaval baffle and cavopulmonary anastomosis were retrospectively selected for study. Those with baffle fenestration (n = 91) were compared with those without baffle fenestration (n = 56) with respect to preoperative risk factors, age, anatomy, surgical date, and presence or absence of a previous bidirectional cavopulmonary anastomosis. Outcome variables were failure (death or take-down) and duration of postoperative pleural effusions and hospitalization. Survival and clinical status after hospital discharge were ascertained. The two groups did not appear to differ with respect to age or anatomic diagnosis. Patients having baffle fenestration were at significantly greater preoperative risk by univariate and multivariate analysis (p < 0.01). Operative failure was low in both groups (11% without and 7% with baffle fenestration, p = NS). Durations of pleural effusions and hospitalization were significantly shorter with baffle fenestration (p < 0.01). Neither date of surgery nor a previous bidirectional cavopulmonary anastomosis appeared to contribute to improved outcome. Patients with baffle fenestration had lower postoperative systemic venous pressure (p < 0.01). There were no late deaths. Functional status in both groups is good (82% in New York Heart Association class I)., Conclusions: Baffle fenestration is associated with low mortality, significantly less pleural effusion, and significantly shorter hospitalization among high-risk patients having a modified Fontan operation.
- Published
- 1992
- Full Text
- View/download PDF
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