To review the spectrum of double-chambered right ventricle (DCRV) and the outcome of surgical rep... more To review the spectrum of double-chambered right ventricle (DCRV) and the outcome of surgical repair in patients diagnosed between February 1988 and March 1999. The charts of patients with DCRV were studied. Tertiary care hospital. A total of 73 patients were identified. Sixty-nine underwent surgical repair, while four are awaiting surgery. The repair was through a transatrial approach in 61 patients, while in eight an additional ventriculotomy was performed. An associated ventricular septal defect (VSD) was present in 56 of 73 patients (77%). These patients were significantly younger (P<0.05) than the 17 patients without a VSD. Among patients with a VSD, the 31 requiring patch closure were significantly younger than the 25 patients having direct closure. Five older patients among those with intact septum had impaired right ventricular (RV) function as well as higher intraventricular gradients. At surgery the intraventricular obstruction was relieved by myomectomy. There was no h...
The Quattro valve is a stentless pericardial mitral bioprosthesis that is treated with a post-tan... more The Quattro valve is a stentless pericardial mitral bioprosthesis that is treated with a post-tanning aldehyde capping designed to reduce calcification. A prospective trial was started in December 1996; herein are reported the results of the three centers that performed the surgery and followed up patients in the majority of cases. Young patients were deliberately included in the trial. Follow up data from 175 patients (mean age 46 years; range: 12-87 years) were collected and analyzed. Among patients, 44% were aged < 40 years. Follow up was 91% complete; mean follow up was 3.4 years (range: 0-7.5 years); total follow up was 465 patient-years (pt-yr). Clinical outcome was assessed according to the AATS/STS guidelines, and results analyzed according to Kaplan-Meier product limit calculation and by FDA Optimal Performance Criteria (OPC). Early mortality was 1.7% (all non-valve related). At 60 months after surgery, mean overall survival was 84.8 +/- 3.6%, mean overall freedom from v...
World journal for pediatric & congenital heart surgery, Jul 23, 2014
Right ventricular dysfunction is uncommon following surgical repair of dextrotransposition of gre... more Right ventricular dysfunction is uncommon following surgical repair of dextrotransposition of great arteries (d-TGA) by the arterial switch procedure. Inhaled nitric oxide (iNO) is a specific pulmonary vasolidator that has proven successful in treating pulmonary hypertension when delivered via endotracheal tube. We present a five-month-old infant with d-TGA and ventricular septal defect (VSD) who developed pulmonary hypertensive crisis, causing severe right ventricular dysfunction with hemodynamic deterioration at day 6 postsurgical repair by VSD closure and arterial switch. He was successfully treated with iNO via nonrebreather face mask avoiding endotracheal reintubation. This modality should be considered in the management of such infants.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2006
Objective: Use of chemically defined substitute for Dextran called RGTA (ReGeneraTing Agent) (Reg... more Objective: Use of chemically defined substitute for Dextran called RGTA (ReGeneraTing Agent) (Regentech, Paris, France) in the treatment of acute myocardial infarct and its effect on autologus bone marrow derived CD34ϩ lineage stromal cells transplantation in a baboon model. Methods: Acute Myocardial Infarct (MI) was induced in Hamadyras Papio baboon (6.5-10 kg) by ligating the left anterior descending coronary artery (LAD) distal to the first diagonal branch. Group 1 (Nϭ5) Normal heart. Group 2 (Nϭ5) Myocardial infarct (MI). Group 3 (Nϭ5). One hour after MI, RGTA 100 micro gms/site x 5 was injected into the area of infarct. Group 4 (Nϭ5). RGTA as in group 3. Two weeks after MI, RGTA and bone marrow
Abstract Cultured skin fibroblasts from five patients withatherosclerosis who underwent coronary ... more Abstract Cultured skin fibroblasts from five patients withatherosclerosis who underwent coronary artery bypass graftsurgery were compared with those from one ataxia telangiec-tasia (AT) homozygote, three AT heterozygotes, and fivehealthy subjects to determine their sensitivity to gamma radi-ation as determined by a colony survival assay. Fibroblastsfrom four of these patients were also compared with thosefrom two AT homozygotes, two AT heterozygotes, and threehealthy subjects to determine postirradiation [ 3 H]thymidineincorporation, indicating the levels of radioresistant DNAsynthesis (RDS). On the basis of colony survival assay, afterlong-term irradiation (at low dose rate, ie, 0.007 Gy/min),fibroblasts from all five patients with atherosclerosis exhibitedradiosensitivity that was intermediate between that of thehealthy subjects and that of patients with the known radiosen-sitive syndrome AT. However, there was a considerable inter-strain difference in the radiosensitivity of fibroblasts frompatients with atherosclerosis, with their mean D
Embolization of parts of mechanical valves has been reported since the inception of prosthetic va... more Embolization of parts of mechanical valves has been reported since the inception of prosthetic valve implantation. We report here two cases of embolization of one hemileaflet of a Duromedic bileaflet prosthesis in the mitral position due to a pivot fracture. Both presented with moderately severe mitral regurgitation and pulmonary edema and were successfully managed by replacement of the malfunctioning prostheses. The embolised disc was located in the left common iliac artery by abdominal ultrasound and removed by an inguinal, retroperitoneal approach with low morbidity. Both patients left hospital and are doing well to-date.
Background: Consanguinity may be a risk factor that contributes to congenital heart disease in an... more Background: Consanguinity may be a risk factor that contributes to congenital heart disease in an inbred population, particularly among first cousins; with high rates of intermarriage between relatives, consanguinity is associated with congenital heart disease particularly among first cousins. Patients and Methods: This study examines a group of 1,028 consecutive congenital heart disease (CHD) patients identified through the Congenital Heart Disease Registry at King Faisal Specialist Hospital in Riyadh, Saudi Arabia. Families were interviewed by an Arabic-speaking data collector for information on consanguinity and demographic data. After exclusions for nonavailability, data were collected on 949 cases and the proportions of first-cousin consanguinity in the study sample were compared to national population data. A z test of proportions was utilized to test the hypothesis that there are higher proportions of first-cousin consanguinity in the study sample of congenital heart patients...
An active otherwise healthy and middleaged woman presented with left supraclavicular pulsation, r... more An active otherwise healthy and middleaged woman presented with left supraclavicular pulsation, right upper extremity claudication, and mild dysphagia. Evaluation revealed an aberrant right subclavian artery, KommerellÕs diverticulum with aneurysmal degeneration, legamentum arteriosum completing vascular ring, and absent left pulmonary artery with multiple collateral supply to the left lung. She underwent successful surgical repair via right thoracotomy, including division of the vascular ring, resection of the diverticulum and aneurysm, and finally reimplantation of the right subclavian artery to the aortic arch. Her symptoms resolved completely, and she was able to resume normal activities.
Distal Conduction Disease in the Long QT Syndrome. Introduction: The long QT syndrome (LQTS) is o... more Distal Conduction Disease in the Long QT Syndrome. Introduction: The long QT syndrome (LQTS) is occasionally complicated by impaired AV conduction, mostly 2:1 AV block. This form of LQTS can manifest before birth or during neonatal life, and it is more sporadic than familial. It is usually an isolated disorder, although it can be accompanied by a variety of cardiovascular and other anomalies. In spite of different treatment modes, mortality is high. Methods and Results: The reported case presented not only with 2:1 AV conduction, but also with Wenckebach episodes with impaired right and left bundle branch conduction, and decremental conduction in the His‐Purkinje axis. We also observed sinus pauses and accelerated AV junctional escape beats. Conclusion: Our findings, and similar observations by others., suggest involvement of the sinus node and the distal conduction system in this form of the LQTS. Several histologic studies have documented abnormalities within the conduction system...
We report an unusual complication of balloon dilatation. In an 8-year-old boy, the arterial duct ... more We report an unusual complication of balloon dilatation. In an 8-year-old boy, the arterial duct reopened after balloon dilatation of native coarctation.
Summary— In order to test whether the β‐adrenoceptor activity in rheumatic heart valvular disease... more Summary— In order to test whether the β‐adrenoceptor activity in rheumatic heart valvular disease depends on the ventricular load conditions, we determined their density and binding affinity to [125I]‐iodocyanopindolol in lymphocytes, as well as plasma catecholamine and cAMP levels in 69 patients with regurgitant and stenotic lesions of the aortic and mitral valves. The patients were classified as having left ventricular pressure overload (LVP), left ventricular volume overload (LVV), mixed lesions (MOL) or right ventricular pressure overload (RVP). The β‐adrenoceptor activity was determined by radioligand binding methods, catecholamines by high performance liquid chromatography using an electrochemical detector and cAMP by radioimmunoassay. The mean β‐adrenoceptor density (Bmax) of the control group was 60.1 ± 9.5 /mol (n = 29) per 106 lymphocytes. In the study population, the density was decreased by 83% in LVP, 78% in LVV, 87% in MOL and 86% in RVP. Plasma norepinephrine was elev...
Objective: To assess durability and viability of autologous aortic tissue used to augment severe ... more Objective: To assess durability and viability of autologous aortic tissue used to augment severe branch pulmonary artery stenosis with a novice surgical technique. Patients and methods: Seven patients underwent corrective surgery for complex cyanotic congenital heart disease. Their age ranged from 3-6 years, and their weight 1 l-17.4 kg. All had concomitant branch pulmonary artery stenosis repaired utilizing an autologous patch, harvested from the patient's own aorta by excising a ring and opening it to form the patch. The aorta is reconstructed directly by end to end anastomosis. Results: One patient died in hospital. Another patient died at 18 months at home. The surviving five patients have remained well in the follow up period of mean 31 months (range 10-52). All patients were restudied by follow up echocardiography and remain with no evidence of the aortic autograft tissue calcification or stenosis. The reconstructed aorta showed no stenosis at the site of anastomosis. Conclusion: The intermediate term results of this novice surgical technique appear encouraging and justify the technique. However, longer follow up will be required to confirm the continued growth of this patch material. 0 1997 Elsevier Science B.V.
Reoperation = 8 patients (4.9%) (from 1 month to 6 years). Causes of reoperation: Hemolysis (2), ... more Reoperation = 8 patients (4.9%) (from 1 month to 6 years). Causes of reoperation: Hemolysis (2), residual MR (6). Finding at reoperation: Transposition chordae dehiscence (1), Suture line dehiscence (1), Persistence of annular dilatation (6). Technique used at reoperation: Repeat repair (6), Valve replacement (2). Mitral valve repair is the best alternative to prosthetic valve replacement in young children. Valve tissue is fragile, small left atrium. For having a good result we need good valve exposure and high surgical expertise. S18-4 Should the Ross Procedure be Performed for All Non-Repairable Aortic Valve Disease?
Double outlet left ventricle is an extremely rare anomaly. Until recently, the diagnosis was usua... more Double outlet left ventricle is an extremely rare anomaly. Until recently, the diagnosis was usually established by angiography or at postmortem. There are only a few reports describing the echocar-diographic findings in this lesion, and as far as we know, no report showing the anatomy as well as the velocity and pattern of flow by color Doppler echocardiography. The patient reported here underwent surgery at the age of four years, when an aortic homograft was placed between the right ventricle and the pulmonary trunk. This biventricular repair had to be changed into a Fontan-type procedure, 15 years later since the hypoplastic right ventricle did not grow adequately.
We sought to determine if a higher dose of heparin would reduce arterial complications in patient... more We sought to determine if a higher dose of heparin would reduce arterial complications in patients weighing 10 kg or less undergoing cardiac catheterization to investigate congenital heart disease. Sixty patients were given either 100 (group A) or 150 (group B) IU·kg−1 of heparin in a double-blinded randomized manner. Initial arterial access was established using a 4F cannula in all patients. Mean activated clotting time measured 20 minutes following heparin administration was significantly lower in group A than in group B (199 versus 251 seconds). Only 3 out of 60 patients (5%) required treatment for loss of femoral pulse. The age, weight, activated clotting time, length of catheterization procedure, time taken to establish arterial access, and the duration of arterial cannulation were comparable between the groups. Weight under 4 kg, age under 1 month, and cannula size larger than 4F were identified as independent risk factors for the development of arterial complications. Arteria...
To review the spectrum of double-chambered right ventricle (DCRV) and the outcome of surgical rep... more To review the spectrum of double-chambered right ventricle (DCRV) and the outcome of surgical repair in patients diagnosed between February 1988 and March 1999. The charts of patients with DCRV were studied. Tertiary care hospital. A total of 73 patients were identified. Sixty-nine underwent surgical repair, while four are awaiting surgery. The repair was through a transatrial approach in 61 patients, while in eight an additional ventriculotomy was performed. An associated ventricular septal defect (VSD) was present in 56 of 73 patients (77%). These patients were significantly younger (P<0.05) than the 17 patients without a VSD. Among patients with a VSD, the 31 requiring patch closure were significantly younger than the 25 patients having direct closure. Five older patients among those with intact septum had impaired right ventricular (RV) function as well as higher intraventricular gradients. At surgery the intraventricular obstruction was relieved by myomectomy. There was no h...
The Quattro valve is a stentless pericardial mitral bioprosthesis that is treated with a post-tan... more The Quattro valve is a stentless pericardial mitral bioprosthesis that is treated with a post-tanning aldehyde capping designed to reduce calcification. A prospective trial was started in December 1996; herein are reported the results of the three centers that performed the surgery and followed up patients in the majority of cases. Young patients were deliberately included in the trial. Follow up data from 175 patients (mean age 46 years; range: 12-87 years) were collected and analyzed. Among patients, 44% were aged < 40 years. Follow up was 91% complete; mean follow up was 3.4 years (range: 0-7.5 years); total follow up was 465 patient-years (pt-yr). Clinical outcome was assessed according to the AATS/STS guidelines, and results analyzed according to Kaplan-Meier product limit calculation and by FDA Optimal Performance Criteria (OPC). Early mortality was 1.7% (all non-valve related). At 60 months after surgery, mean overall survival was 84.8 +/- 3.6%, mean overall freedom from v...
World journal for pediatric & congenital heart surgery, Jul 23, 2014
Right ventricular dysfunction is uncommon following surgical repair of dextrotransposition of gre... more Right ventricular dysfunction is uncommon following surgical repair of dextrotransposition of great arteries (d-TGA) by the arterial switch procedure. Inhaled nitric oxide (iNO) is a specific pulmonary vasolidator that has proven successful in treating pulmonary hypertension when delivered via endotracheal tube. We present a five-month-old infant with d-TGA and ventricular septal defect (VSD) who developed pulmonary hypertensive crisis, causing severe right ventricular dysfunction with hemodynamic deterioration at day 6 postsurgical repair by VSD closure and arterial switch. He was successfully treated with iNO via nonrebreather face mask avoiding endotracheal reintubation. This modality should be considered in the management of such infants.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2006
Objective: Use of chemically defined substitute for Dextran called RGTA (ReGeneraTing Agent) (Reg... more Objective: Use of chemically defined substitute for Dextran called RGTA (ReGeneraTing Agent) (Regentech, Paris, France) in the treatment of acute myocardial infarct and its effect on autologus bone marrow derived CD34ϩ lineage stromal cells transplantation in a baboon model. Methods: Acute Myocardial Infarct (MI) was induced in Hamadyras Papio baboon (6.5-10 kg) by ligating the left anterior descending coronary artery (LAD) distal to the first diagonal branch. Group 1 (Nϭ5) Normal heart. Group 2 (Nϭ5) Myocardial infarct (MI). Group 3 (Nϭ5). One hour after MI, RGTA 100 micro gms/site x 5 was injected into the area of infarct. Group 4 (Nϭ5). RGTA as in group 3. Two weeks after MI, RGTA and bone marrow
Abstract Cultured skin fibroblasts from five patients withatherosclerosis who underwent coronary ... more Abstract Cultured skin fibroblasts from five patients withatherosclerosis who underwent coronary artery bypass graftsurgery were compared with those from one ataxia telangiec-tasia (AT) homozygote, three AT heterozygotes, and fivehealthy subjects to determine their sensitivity to gamma radi-ation as determined by a colony survival assay. Fibroblastsfrom four of these patients were also compared with thosefrom two AT homozygotes, two AT heterozygotes, and threehealthy subjects to determine postirradiation [ 3 H]thymidineincorporation, indicating the levels of radioresistant DNAsynthesis (RDS). On the basis of colony survival assay, afterlong-term irradiation (at low dose rate, ie, 0.007 Gy/min),fibroblasts from all five patients with atherosclerosis exhibitedradiosensitivity that was intermediate between that of thehealthy subjects and that of patients with the known radiosen-sitive syndrome AT. However, there was a considerable inter-strain difference in the radiosensitivity of fibroblasts frompatients with atherosclerosis, with their mean D
Embolization of parts of mechanical valves has been reported since the inception of prosthetic va... more Embolization of parts of mechanical valves has been reported since the inception of prosthetic valve implantation. We report here two cases of embolization of one hemileaflet of a Duromedic bileaflet prosthesis in the mitral position due to a pivot fracture. Both presented with moderately severe mitral regurgitation and pulmonary edema and were successfully managed by replacement of the malfunctioning prostheses. The embolised disc was located in the left common iliac artery by abdominal ultrasound and removed by an inguinal, retroperitoneal approach with low morbidity. Both patients left hospital and are doing well to-date.
Background: Consanguinity may be a risk factor that contributes to congenital heart disease in an... more Background: Consanguinity may be a risk factor that contributes to congenital heart disease in an inbred population, particularly among first cousins; with high rates of intermarriage between relatives, consanguinity is associated with congenital heart disease particularly among first cousins. Patients and Methods: This study examines a group of 1,028 consecutive congenital heart disease (CHD) patients identified through the Congenital Heart Disease Registry at King Faisal Specialist Hospital in Riyadh, Saudi Arabia. Families were interviewed by an Arabic-speaking data collector for information on consanguinity and demographic data. After exclusions for nonavailability, data were collected on 949 cases and the proportions of first-cousin consanguinity in the study sample were compared to national population data. A z test of proportions was utilized to test the hypothesis that there are higher proportions of first-cousin consanguinity in the study sample of congenital heart patients...
An active otherwise healthy and middleaged woman presented with left supraclavicular pulsation, r... more An active otherwise healthy and middleaged woman presented with left supraclavicular pulsation, right upper extremity claudication, and mild dysphagia. Evaluation revealed an aberrant right subclavian artery, KommerellÕs diverticulum with aneurysmal degeneration, legamentum arteriosum completing vascular ring, and absent left pulmonary artery with multiple collateral supply to the left lung. She underwent successful surgical repair via right thoracotomy, including division of the vascular ring, resection of the diverticulum and aneurysm, and finally reimplantation of the right subclavian artery to the aortic arch. Her symptoms resolved completely, and she was able to resume normal activities.
Distal Conduction Disease in the Long QT Syndrome. Introduction: The long QT syndrome (LQTS) is o... more Distal Conduction Disease in the Long QT Syndrome. Introduction: The long QT syndrome (LQTS) is occasionally complicated by impaired AV conduction, mostly 2:1 AV block. This form of LQTS can manifest before birth or during neonatal life, and it is more sporadic than familial. It is usually an isolated disorder, although it can be accompanied by a variety of cardiovascular and other anomalies. In spite of different treatment modes, mortality is high. Methods and Results: The reported case presented not only with 2:1 AV conduction, but also with Wenckebach episodes with impaired right and left bundle branch conduction, and decremental conduction in the His‐Purkinje axis. We also observed sinus pauses and accelerated AV junctional escape beats. Conclusion: Our findings, and similar observations by others., suggest involvement of the sinus node and the distal conduction system in this form of the LQTS. Several histologic studies have documented abnormalities within the conduction system...
We report an unusual complication of balloon dilatation. In an 8-year-old boy, the arterial duct ... more We report an unusual complication of balloon dilatation. In an 8-year-old boy, the arterial duct reopened after balloon dilatation of native coarctation.
Summary— In order to test whether the β‐adrenoceptor activity in rheumatic heart valvular disease... more Summary— In order to test whether the β‐adrenoceptor activity in rheumatic heart valvular disease depends on the ventricular load conditions, we determined their density and binding affinity to [125I]‐iodocyanopindolol in lymphocytes, as well as plasma catecholamine and cAMP levels in 69 patients with regurgitant and stenotic lesions of the aortic and mitral valves. The patients were classified as having left ventricular pressure overload (LVP), left ventricular volume overload (LVV), mixed lesions (MOL) or right ventricular pressure overload (RVP). The β‐adrenoceptor activity was determined by radioligand binding methods, catecholamines by high performance liquid chromatography using an electrochemical detector and cAMP by radioimmunoassay. The mean β‐adrenoceptor density (Bmax) of the control group was 60.1 ± 9.5 /mol (n = 29) per 106 lymphocytes. In the study population, the density was decreased by 83% in LVP, 78% in LVV, 87% in MOL and 86% in RVP. Plasma norepinephrine was elev...
Objective: To assess durability and viability of autologous aortic tissue used to augment severe ... more Objective: To assess durability and viability of autologous aortic tissue used to augment severe branch pulmonary artery stenosis with a novice surgical technique. Patients and methods: Seven patients underwent corrective surgery for complex cyanotic congenital heart disease. Their age ranged from 3-6 years, and their weight 1 l-17.4 kg. All had concomitant branch pulmonary artery stenosis repaired utilizing an autologous patch, harvested from the patient's own aorta by excising a ring and opening it to form the patch. The aorta is reconstructed directly by end to end anastomosis. Results: One patient died in hospital. Another patient died at 18 months at home. The surviving five patients have remained well in the follow up period of mean 31 months (range 10-52). All patients were restudied by follow up echocardiography and remain with no evidence of the aortic autograft tissue calcification or stenosis. The reconstructed aorta showed no stenosis at the site of anastomosis. Conclusion: The intermediate term results of this novice surgical technique appear encouraging and justify the technique. However, longer follow up will be required to confirm the continued growth of this patch material. 0 1997 Elsevier Science B.V.
Reoperation = 8 patients (4.9%) (from 1 month to 6 years). Causes of reoperation: Hemolysis (2), ... more Reoperation = 8 patients (4.9%) (from 1 month to 6 years). Causes of reoperation: Hemolysis (2), residual MR (6). Finding at reoperation: Transposition chordae dehiscence (1), Suture line dehiscence (1), Persistence of annular dilatation (6). Technique used at reoperation: Repeat repair (6), Valve replacement (2). Mitral valve repair is the best alternative to prosthetic valve replacement in young children. Valve tissue is fragile, small left atrium. For having a good result we need good valve exposure and high surgical expertise. S18-4 Should the Ross Procedure be Performed for All Non-Repairable Aortic Valve Disease?
Double outlet left ventricle is an extremely rare anomaly. Until recently, the diagnosis was usua... more Double outlet left ventricle is an extremely rare anomaly. Until recently, the diagnosis was usually established by angiography or at postmortem. There are only a few reports describing the echocar-diographic findings in this lesion, and as far as we know, no report showing the anatomy as well as the velocity and pattern of flow by color Doppler echocardiography. The patient reported here underwent surgery at the age of four years, when an aortic homograft was placed between the right ventricle and the pulmonary trunk. This biventricular repair had to be changed into a Fontan-type procedure, 15 years later since the hypoplastic right ventricle did not grow adequately.
We sought to determine if a higher dose of heparin would reduce arterial complications in patient... more We sought to determine if a higher dose of heparin would reduce arterial complications in patients weighing 10 kg or less undergoing cardiac catheterization to investigate congenital heart disease. Sixty patients were given either 100 (group A) or 150 (group B) IU·kg−1 of heparin in a double-blinded randomized manner. Initial arterial access was established using a 4F cannula in all patients. Mean activated clotting time measured 20 minutes following heparin administration was significantly lower in group A than in group B (199 versus 251 seconds). Only 3 out of 60 patients (5%) required treatment for loss of femoral pulse. The age, weight, activated clotting time, length of catheterization procedure, time taken to establish arterial access, and the duration of arterial cannulation were comparable between the groups. Weight under 4 kg, age under 1 month, and cannula size larger than 4F were identified as independent risk factors for the development of arterial complications. Arteria...
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Papers by Zohair Halees