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  • 1
    ISSN: 1432-1971
    Keywords: Alpha receptors ; Beta receptors ; Muscarinic receptors ; Infundibular innervation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Right ventricular myocardium was assessed for cholinergic and adrenergic innervation, as well as alpha-adrenergic, beta-adrenergic, and muscarinic receptors, in 18 cyanotic patients with tetralogy of Fallot (TOF) and four acyanotic control patients with ventricular septal defect, each of whom underwent a cardiac repair from June through December 1987. Neurons containing acetylcholine (ACH), neuron-specific enolase (NSE), S-100 protein, neuropeptide-Y (NPY), dopamine-beta-hydroxylase (DBH), and calcitonin gene-related polypeptide (CGRP) were detected surrounding arterioles and myocytes in all specimens. NSE and S-100 immunoreactivities were also identified in the cytoplasm of TOF cardiocytes, possibly indicating a neuroendocrine origin of these cells. Cardiocyte size was increased in TOF (p=0.05). Acetylcholine (cholinergic) (p=0.04) and CGRP (cholinergic) positive neurons (p=0.07) were decreased in the TOF as compared to controls. Adrenergic fiber content (p=0.15) and beta receptors (p=0.21) were similar in both groups. There was an increase in muscarinic receptors in the controls (p=0.002), and a marked increase in alpha receptors in TOF (p=0.019). There were no intragroup differences in the TOF patients according to degree of cyanosis. In conclusion, there were important differences in neuronal and amine receptor content between TOF and control patients. Increased alpha receptors in TOF could account for differences in clinical and hemodynamic events.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1615-2573
    Keywords: Recurrent coarctation ; Subclavian aortoplasty ; Hazard rate ; Crafoord rapair ; Hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary From November 24, 1964 through July 3, 1979, 81 patients underwent coarctation repair with resection and end-to-end anastomosis. Mean age at operation was 13.4 years, with a range of 4 months to 55 years. Thirty-two patients (39%) had associated cardiac defects. There were no hospital deaths. Eighty of the 81 hospital survivors were followed (99%) for a total of 10 780 months postoperatively, at a mean of 134.6 (±7.1) months. There was one late death (1.3%) of a ruptured berry aneurysm at 120 months after repair. Actuarial survival was 100% at 10 years and 92.9±7% at 20 years. Five patients (6.3%) required late re-repair at a mean of 142.8 months postoperatively, range 85 months to 195 months. Actuarial freedom from reoperation was 97±2.0% at 5 years and 91.7±3.6% at 20 years. Earlier age at initial repair (P=0.002), higher mean transrepair gradient (P=0.005), and late hypertension (P=0.08) were associated with re-coarctation. The hazard function for reoperation according to age at initial repair revealed a single early risk phase with a plateau starting at 7 years of age and zero hazard after 10 years of age. We conclude that correction of coarctation of the aorta using resection and end-to-end anastomosis permits a long history of event-free survival and continues to be an excellent method of repair.
    Type of Medium: Electronic Resource
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