Showing papers by "James H. Moller published in 1999"
TL;DR: Certain issues must be considered for the long-term care of patients with tetralogy of Fallot, who have an important incidence of residual or recurrent lesions as well as an increased risk for late sudden death.
Abstract: Tetralogy of Fallot is the most common cyanotic heart lesion and one of the most commonly seen by cardiologists caring for adults with congenital heart disease. In the last 50 years, the outlook for these patients has changed dramatically, and most children with tetralogy of Fallot will live well into adulthood. Although most will have undergone a corrective operation, an important minority of patients with tetralogy of Fallot will have had only a previous palliative procedure. Rarely, the clinician may encounter an adult with unoperated tetralogy of Fallot. With surgical correction, the very long-term outcome is excellent, and most patients lead active and productive lives. However, certain issues must be considered for the long-term care of patients with tetralogy of Fallot. These individuals have an important incidence of residual or recurrent lesions as well as an increased risk for late sudden death. The exact mechanisms for late sudden death are incompletely defined but probably include both the residual hemodynamic and electrophysiologic substrates that act in concert.
32 citations
TL;DR: Following relief of stenosis, cardiac performance improves in children, but remains abnormal in adults, appears to be related to postoperative resolution of right ventricular hypertrophy inChildren, whereas myocardial fibrosis may explain the lack of improvement in adults.
Abstract: Pulmonary valvar stenosis with intact ventricular septum is a common anomaly. This lesion poses a fixed obstruction to the right ventricular outflow. The right ventricle ejects the entire cardiac output across the stenotic valve. Right ventricular systolic pressure and oxygen demand are increased at rest and more so with exercise. Exercise tolerance in children and adults with mild valvar pulmonary stenosis is nearly normal, but is diminished in those with moderate and severe stenosis, indicating impaired ability to sustain adequate cardiac output. Following relief of stenosis, cardiac performance improves in children, but remains abnormal in adults. This appears to be related to postoperative resolution of right ventricular hypertrophy in children, whereas myocardial fibrosis may explain the lack of improvement in adults.
10 citations