Patrick A. Ongley

Bio: Patrick A. Ongley is an academic researcher from Mayo Clinic. The author has contributed to research in topics: Ventricle & Stenosis. The author has an hindex of 14, co-authored 20 publications receiving 1148 citations. Previous affiliations of Patrick A. Ongley include China Medical Board.

Anatomic types of single or common ventricle in man. morphologic and geometric aspects of 60 necropsied cases.

Abstract: In 60 necropsied cases of single or common ventricle in man, four major unrelated ventricular malformations were found: (1) absence of the right ventricular sinus, in 47 cases (78%), designated type A; (2) absence of the left ventricular sinus, in 3 cases (5%), type B; (3) absence or rudimentary development of the ventricular septum, in 4 cases (7%), type C; and (4) absence of both ventricular sinuses and of the ventricular septum, in 6 cases (10%), type D. Three types of relationship between the great arteries were present: a normal (solitus) interrelationship, in 9 cases (15%), designated type I; d -transposition, the transposed aortic valve lying to the right (dextro, or d ), relative to the transposed pulmonary valve, in 25 cases (42%), type II; and l -transposition, the transposed aortic valve lying to the left (levo or l ), relative to the transposed pulmonary valve, in 26 cases (43%), type III. In none was the inversus interrelationship, type IV, displayed. Three types of visceral and atrial situs were found: solitus, or normal, in 50 cases (83%); inversus, an exact apparent mirror image of normal, in 2 cases (3%); and heterotaxy, the uncertain visceral and atrial situs associated with asplenia, in 8 cases (13%). The 60 cases were classified segmentally, according to the anatomy of the three cardiac segments: the great arteries, the ventricular sinuses, and the atria. The classic single ventricle with a rudimentary outlet chamber was found morphologically to be a large left ventricle with a right ventricular infundibulum, the sinus of the right ventricle being absent (type A). The myocardium of the right ventricular infundibulum, of the right ventricular sinus, and of the left ventricular sinus was identified by the distinctive gross morphologic characteristics of each. The planes of the atrial and ventricular septa, and the relationships between the great arteries at the semilunar valves, were measured as projections upon the horizontal plane, relative to the anteroposterior line. An approach to cardiac anatomy is presented which is segmental, morphologic and geometric. This approach has angiocardiographic, electrocardiographic and embryologic applications.

Complete Repair of Transposition of the Great Arteries with Pulmonary Stenosis A Review and Report of a Case Corrected by Using a New Surgical Technique

Abstract: Complete surgical correction of transposition of the great arteries associated with subvalvular pulmonary stenosis carries a high mortality rate. A new surgical technique that achieves redirection of the ventricular outflows and relieves pulmonary stenosis by bypassing it, was successfully used to repair complete transposition of the great arteries associated with ventricular septal defect (VSD) and valvular and subvalvular pulmonary stenosis in a 14½-year-old patient. The repair consists of (1) division of the pulmonary artery, the cardiac end of which is oversewn, (2) repair of the VSD with a patch in such a way as to connect the left ventricle with the aorta, and (3) reconstruction of the pulmonary artery with an aortic homograft, including the aortic valve, which is anastomosed between the distal end of the pulmonary artery and the right ventricle. A review of the cases in which the current techniques were used indicates that the location and nature of the obstruction in the left ventricular outflow t...

Congenital stenosis of the pulmonary artery branches.

Abstract: Eighteen cases of stenosis of the branches of the pulmonary artery, seen at the Mayo Clinic, have been reviewed and subdivided into two main types: Type I, stenosis of the main branches of the pulmonary artery, 11 cases, and type II, stenosis of multiple peripheral branches of the pulmonary arteries, seven cases. Of special interest were two cases in which thrombosis occurred as a complication and one case in which surgical relief of multiple areas of stenosis in the peripheral branches of the pulmonary arteries was accomplished. Unexplained pulmonary hypertension necessitates further investigation, which includes cardiac catheterization for measurement of intracardiac pressure and frequently selective angiocardiography. Main branch or peripheral pulmonary artery stenosis should be suspected when a continuous murmur is heard or when poststenotic dilatations of the pulmonary artery branches or areas of decreased pulmonary vasculature can be perceived in the roentgenogram. Angiocardiography is the only tech...

The Hemodynamics of Common (or Single) Ventricle

Abstract: Data from 43 patients with common ventricle for whom satisfactory hemodynamic data are available are presented; these form 3.2% of the patients with congenital heart disease studied by means of catheterization at the Mayo Clinic. Selective biplane angiocardiography is essential for diagnosis of common ventricle. Associated cardiovascular anomalies are common, with transposition of the great vessels occurring in 84% of the patients. The right-to-left shunt present in all 43 patients results in desaturation of systemic arterial blood. The common ventricle receives all the systemic and pulmonary venous blood [see table in the PDF file] flows; yet complete mixing is uncommon in this chamber, for it occurred in only 16% of the patients who did not have severe pulmonary stenosis. Fifty-eight per cent had oxygenated blood directed preferentially to the systemic circuit ("favorable streaming"). This occurred most commonly with L-transposition and resulted in a higher oxygen saturation of systemic arterial blood. ...

Hypoplasia of ascending aorta. An unusual form of supravalvular aortic stenosis with special reference to localized coronary arterial hypertension.

Abstract: Anomalies causing obstruction to blood flow in the aorta above the aortic valve, though rare, are of three types: (1) A localized zone of obstruction resembling a diaphragm in the ascending aorta; (2) localized narrowing of the ascending aorta and (3) uniform narrowing of the entire ascending aorta In the case of the 2 year old boy reported, the last type of anomaly was present In this case clinical data were suggestive of aortic stenosis, electrocardiographic findings of left and right ventricular overwork, and catheterization data of obstruction to the blood flow from the left ventricle, some degree of left ventricular failure, and left ventricular and pulmonary hypertension of moderate degree An attempt to relieve the obstruction was not successful At necropsy left ventricular hypertrophy, a suggestion of mitral insufficiency and uniform narrowing of the ascending aorta were found In the coronary arteries the media was thickened, and deposition of elastic fibers was evident These changes are attributed to systolic hypertension in the coronary vessels

Surgical repair of tricuspid atresia

Abstract: Surgical repair of tricuspid atresia has been carried out in three patients; two of these operations have been successful. A new surgical procedure has been used which transmits the whole vena caval blood to the lungs, while only oxygenated blood returns to the left heart. The right atrium is, in this way, `ventriclized', to direct the inferior vena caval blood to the left lung, the right pulmonary artery receiving the superior vena caval blood through a cava-pulmonary anastomosis. This technique depends on the size of the pulmonary arteries, which must be large enough and at sufficiently low pressure to allow a cava-pulmonary anastomosis. The indications for this procedure apply only to children sufficiently well developed. Younger children or those whose pulmonary arteries are too small should be treated by palliative surgical procedures.

Catheterization of the Heart in Man with Use of a Flow-Directed Balloon-Tipped Catheter

Abstract: Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy. A No. 5 Fr double-lumen catheter with a balloon just proximal to the tip is inserted into the right atrium under pressure monitoring. The balloon is then inflated with 0.8 ml of air. The balloon is carried by blood flow through the right side of the heart into the smaller radicles of the pulmonary artery. In this position when the balloon is inflated wedge pressure is obtained. The average time for passage of the catheter from the right atrium to the pulmonary artery was 35 seconds in the first 100 passages. The frequency of premature beats was minimal, and no other arrhythmias occurred.

Congenital Heart Disease in the General Population Changing Prevalence and Age Distribution

Abstract: Background— Empirical data on the changing epidemiology of congenital heart disease (CHD) are scant. We determined the prevalence, age distribution, and proportion of adults and children with severe and other forms of CHD in the general population from 1985 to 2000. Methods and Results— Where healthcare access is universal, we used administrative databases that systematically recorded all diagnoses and claims. Diagnostic codes conformed to the International Classification of Disease, ninth revision. Severe CHD was defined as tetralogy of Fallot, truncus arteriosus, transposition complexes, endocardial cushion defects, and univentricular heart. Prevalence of severe and other CHD lesions was determined in l985, 1990, 1995, and 2000 using population numbers in Quebec. Children were subjects <18 years of age. The prevalence was 4.09 per 1000 adults in the year 2000 for all CHD and 0.38 per 1000 (9%) for those with severe lesions. Female subjects accounted for 57% of the adult CHD population. The median age of...

Usefulness and limitations of radiographic methods for determining left ventricular volume.

Abstract: The various methods currently being used to determine left ventricular chamber volumes from biplane angiocardiograms are described and discussed. The spatial direction and change of direction and length of the long axis of the left ventricle over the heart cycle is described. The long axis of the left ventricle is in most subjects directed approximately 20 degrees from being parallel with the frontal plane of the body and results in only slight foreshortening of the long axis of the left ventricle on films taken in the anteroposterior projection. A method is described and evaluated for determining left ventricular chamber volume from angiocardiograms taken in a single anteroposterior projection. Values for normal end-diastolic volume and systolic ejection fraction obtained by various investigators using the radiographic methods are given. The application of these radiographic methods to estimate aortic and mitral valve regurgitant flow is reviewed. Pressure-volu ne relations of the diastolic left ventricle have been determined in 176 patients and demonstrate large patient-to-patient differences of ventricular distensibility in patients with different types and durations of heart disease. Measurement of compliance of the diastolic left ventricle from the pressure-volume curves is discussed. By relating pressure and volume curves over the entire heart cycle, left ventricular pressure-volume curves can be constructed and from these the various components of pressure-volume work determined: systolic work, work done in distending the ventricle during diastole, and net work. Values obtained for these various components of ventricular work in patients with heart and valvular disease are discussed. A method for calculating wall tension and stress from measurement of chamber pressure and chamber dimensions is reviewed. Left ventricular mass can be calculated from chamber dimensions and wall thickness determined from angiocardiograms. A value of 92 ± 16 gm. has been obtained by this method in patients without left ventricular disease, and this is similar to values obtained in earlier postmortem studies. Measurement of left ventricular oxygen consumption and mechanical efficiency in patients with heart disease is discussed.