Jaroslav Stark - Academia.edu (original) (raw)

Papers by Jaroslav Stark

Research paper thumbnail of A case for anatomic correction in atrioventricular discordance? Effects of surgery on tricuspid valve function

The Journal of Thoracic and Cardiovascular Surgery, Jun 1, 2001

Research paper thumbnail of Fibrin Seal (Tisseel/Tissucol) in Paediatric Cardiothoracic Surgery. The Experience of the Hospital for Sick Children, Great Ormond Street, London

Over the last 5 years Tisseel has become an established part of our armamentarium. We have previo... more Over the last 5 years Tisseel has become an established part of our armamentarium. We have previously reported our preliminary experience and now update those data. Tisseel has been used increasingly for the prophylaxis of haemorrhage control rather than for treatment of established haemorrhage. Since 1980, Tisseel has been utilised in 85 patients with a variety of paedatric cardiac surgical problems, and in 72 of the 85 (85%) excellent haemostasis was achieved. In ten patients (11%) a good result was achieved, and in only three patients (4%) was an unsatisfactory result achieved. One of these was early in our experience, and the remaining two were caused by the application of Tisseel to relatively severe established haemorrhage. Tisseel has also been used to seal serous leak from a Gore-tex graft. In our experience, Tisseel has represented a major advance in the safety of paediatric cardiothoracic surgery and may now be considered an essential part of certain procedures, particularly, for example, the arterial switch and repair of truncus arteriosus.

Research paper thumbnail of Mixed total pulmonary venous drainage: Still a surgical challenge

The Journal of Thoracic and Cardiovascular Surgery, Dec 1, 1996

Research paper thumbnail of Atrioventricular septal defect and tetralogy of Fallot: a 15-year experience

European Journal of Cardio-Thoracic Surgery, Aug 1, 1997

Research paper thumbnail of Outcomes After Delayed Sternal Closure in Pediatric Heart Operations: A 10-Year Experience

The Annals of Thoracic Surgery, Feb 1, 1997

Research paper thumbnail of Current surgical technique to repair Fallot's tetralogy with absent pulmonary valve syndrome

The Annals of Thoracic Surgery, Jun 1, 1991

ABSTRACT

Research paper thumbnail of Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts

PubMed, 1981

Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried ... more Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried out at The Hospital for Sick Children, Great Ormond Street. The operation consists of interposing between the subclavian artery and the pulmonary artery a prosthesis of greater diameter than that of the subclavian artery. The first 13 operations were performed with a prosthesis of woven Dacron. Conduits of expanded polytetrafluorethylene (PTFE) were used for 86 MBTSs, and these form the basis of this report. Forty-four (51.1%) shunts were performed in infancy, 25 in patients under the age of 1 month (29.0%). Prostheses of 4 mm were used in 34 cases, 5 mm in 14, and 6 mm in 38. There were five shunt failures (5.8%) documented at postmortem or angiocardiographic investigation. Including two late deaths for which postmortem examinations were not obtained, the overall failure rate was 8.1% (seven patients). All these patients were operated upon in infancy, four of them in the neonatal period. Although a longer follow-up is necessary to assess the validity of these shunts, the early results are encouraging. We believe we can now recommend MBTS as an alternative when the classical Blalock-Taussig shunt is considered unsuitable.

Research paper thumbnail of Allografts in the treatment of absent pulmonary valve syndrome and complex tetralogy of Fallot

The absent pulmonary valve syndrome comprises agenesis of the pulmonary valve, annular stenosis, ... more The absent pulmonary valve syndrome comprises agenesis of the pulmonary valve, annular stenosis, pulmonary insufficiency, ventricular septal defect (VSD) and, usually, right ventricular (RV) hypertrophy. The pulmonary arteries (PA) are aneurysmal and usually compress the tracheobronchial tree. Several surgical techniques have been described, and many have been used in our unit (1). Our current policy is described in this short review.

Research paper thumbnail of Congenital left ventricular inflow obstruction: is the outcome related to the site of the obstruction?

European Journal of Cardio-Thoracic Surgery, 1988

Between 1978 and 1987, 39 patients aged 1 day to 15 years underwent surgery for symptomatic left ... more Between 1978 and 1987, 39 patients aged 1 day to 15 years underwent surgery for symptomatic left ventricular inflow obstruction. Four diagnostic groups were identified: cor triatriatum (6 patients), supravalvar mitral membrane (SVMM) with a normal mitral valve (7 patients), SVMM with an abnormal mitral valve (9 patients) and mitral stenosis (17 patients). Associated cardiac anomalies occurred in 26 patients (67%). There were 8 deaths (21%), 3 in patients with SVMM and an abnormal mitral valve and 5 in patients with mitral stenosis. Survival for patients with normal mitral valves was significantly better than that for patients with abnormal mitral valves (13/13 vs 18/26, P less than 0.05). There was also high morbidity in patients requiring prosthetic mitral valve replacement. These data suggest that the outcome of surgical treatment for left ventricular inflow obstruction may be predicted according to the site of the obstruction. This is best determined preoperatively by cross-sectional echocardiography which allows optimal planning of surgical strategy.

Research paper thumbnail of Pulmonary artery sling

The Annals of Thoracic Surgery, Nov 1, 1992

ABSTRACT

Research paper thumbnail of Tricuspid valve abnormalities in patients with atrioventricular discordance: Surgical implications

The Annals of Thoracic Surgery, Apr 1, 1994

Research paper thumbnail of Intracardiac repair of lesions associated with atrioventricular discordance

European Journal of Cardio-Thoracic Surgery, 1996

Research paper thumbnail of Expanded PTFE Membrane to Prevent Cardiac Injury During Resternotomy for Congenital Heart Disease

The Annals of Thoracic Surgery, Dec 1, 1996

Research paper thumbnail of Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990. Success of extended end-to-end arch aortoplasty

PubMed, 1994

There remains controversy regarding the appropriate surgical treatment of coarctation of the aort... more There remains controversy regarding the appropriate surgical treatment of coarctation of the aorta in infants. In 1985 we introduced the extended end-to-end repair into our practice and now wish to present a review of our recent experience. One hundred fifty-one infants younger than 3 months of age underwent repair of coarctation between 1985 and 1990. In 25% and 33% of the patients, there was hypoplasia of the isthmus and of the transverse arch, respectively. Surgical procedures were as follows: subclavian flap angioplasty in 15 patients, resection with a traditional end-to-end anastomosis in 43, and resection with an extended end-to-end anastomosis into the arch in 77. In 30 patients, the extension was proximal to the origin of the left carotid artery (radically extended end-to-end anastomosis). Other procedures were used in 16 patients. Mortality (13 early and 12 late deaths) was related on multivariate analysis to the presence of an associated major heart defect, preoperative resuscitation, and direct postoperative gradient over the arch. This immediate postoperative gradient was significantly lower after both extended and radically extended end-to-end anastomosis if there was a hypoplastic isthmus, and after radically extended end-to-end anastomosis if the transverse arch was hypoplastic. Actuarial freedom from recoarctation at 4 years was 57% (confidence limits 28% to 78%) after subclavian flap angioplasty, 77% (confidence limits 60% to 87%) after end-to-end anastomosis, 83% (confidence limits 66% to 92%) after extended end-to-end anastomosis and 96% (confidence limits 77% to 100%) after radically extended end-to-end anastomosis. We conclude that the extended end-to-end anastomosis and radical end-to-end anastomosis appear to offer the best prognosis for all infants with coarctation. The technique can be applied successfully to almost all types of arch anomalies.

Research paper thumbnail of Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990

The Journal of Thoracic and Cardiovascular Surgery, 1994

Research paper thumbnail of Allografts in the Rastelli procedure: Techniques

Steinkopff eBooks, 1988

Children with transposition of the great arteries (TGA) (VA discordance), ventricular septal defe... more Children with transposition of the great arteries (TGA) (VA discordance), ventricular septal defect (VSD) and anatomical left ventricular outflow tract obstruction (LVOTO) used to be treated by the Mustard operation, closure of the VSD and surgical relief of the obstruction. This carried out a mortality in excess of 50% (1, 2), largely due to the difficulty in relieving the LVOTO. The prognosis of children with this complex of disorders was improved by the application of the Rastelli operation (3). This operation consists in enlargement of the VSD, diversion of the LV outflow to the aorta by an intraventricular tunnel/patch and connection of right ventricle (RV) to pulmonary artery (PA) by an external valved conduit (Figs. 1–3). Details of the operative technique we use have been published elsewhere (4, 5).

Research paper thumbnail of Unusual vascular ring in infant with pulmonary atresia and ventricular septal defect

Research paper thumbnail of Modified Blalock-Taussig shunt

The Journal of Thoracic and Cardiovascular Surgery, 1981

Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried ... more Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried out at The Hospital for Sick Children, Great Ormond Street. The operation consists of interposing between the subclavian artery and the pulmonary artery a prosthesis of greater diameter than that of the subclavian artery. The first 13 operations were performed with a prosthesis of woven Dacron. Conduits of expanded polytetrafluorethylene (PTFE) were used for 86 MBTSs, and these form the basis of this report. Forty-four (51.1%) shunts were performed in infancy, 25 in patients under the age of 1 month (29.0%). Prostheses of 4 mm were used in 34 cases, 5 mm in 14, and 6 mm in 38. There were five shunt failures (5.8%) documented at postmortem or angiocardiographic investigation. Including two late deaths for which postmortem examinations were not obtained, the overall failure rate was 8.1% (seven patients). All these patients were operated upon in infancy, four of them in the neonatal period. Although a longer follow-up is necessary to assess the validity of these shunts, the early results are encouraging. We believe we can now recommend MBTS as an alternative when the classical Blalock-Taussig shunt is considered unsuitable.

Research paper thumbnail of Utilização de valvas homólogas e heterólogas em condutos extracardíacos The use of homograph and heterograph valves in extracardiac conduits

DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 1988

Research paper thumbnail of Myocardial adenine nucleotide metabolism in pediatric patients during hypothermic cardioplegic arrest and normothermic ischemia

The Annals of Thoracic Surgery, May 1, 1989

Research paper thumbnail of A case for anatomic correction in atrioventricular discordance? Effects of surgery on tricuspid valve function

The Journal of Thoracic and Cardiovascular Surgery, Jun 1, 2001

Research paper thumbnail of Fibrin Seal (Tisseel/Tissucol) in Paediatric Cardiothoracic Surgery. The Experience of the Hospital for Sick Children, Great Ormond Street, London

Over the last 5 years Tisseel has become an established part of our armamentarium. We have previo... more Over the last 5 years Tisseel has become an established part of our armamentarium. We have previously reported our preliminary experience and now update those data. Tisseel has been used increasingly for the prophylaxis of haemorrhage control rather than for treatment of established haemorrhage. Since 1980, Tisseel has been utilised in 85 patients with a variety of paedatric cardiac surgical problems, and in 72 of the 85 (85%) excellent haemostasis was achieved. In ten patients (11%) a good result was achieved, and in only three patients (4%) was an unsatisfactory result achieved. One of these was early in our experience, and the remaining two were caused by the application of Tisseel to relatively severe established haemorrhage. Tisseel has also been used to seal serous leak from a Gore-tex graft. In our experience, Tisseel has represented a major advance in the safety of paediatric cardiothoracic surgery and may now be considered an essential part of certain procedures, particularly, for example, the arterial switch and repair of truncus arteriosus.

Research paper thumbnail of Mixed total pulmonary venous drainage: Still a surgical challenge

The Journal of Thoracic and Cardiovascular Surgery, Dec 1, 1996

Research paper thumbnail of Atrioventricular septal defect and tetralogy of Fallot: a 15-year experience

European Journal of Cardio-Thoracic Surgery, Aug 1, 1997

Research paper thumbnail of Outcomes After Delayed Sternal Closure in Pediatric Heart Operations: A 10-Year Experience

The Annals of Thoracic Surgery, Feb 1, 1997

Research paper thumbnail of Current surgical technique to repair Fallot's tetralogy with absent pulmonary valve syndrome

The Annals of Thoracic Surgery, Jun 1, 1991

ABSTRACT

Research paper thumbnail of Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts

PubMed, 1981

Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried ... more Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried out at The Hospital for Sick Children, Great Ormond Street. The operation consists of interposing between the subclavian artery and the pulmonary artery a prosthesis of greater diameter than that of the subclavian artery. The first 13 operations were performed with a prosthesis of woven Dacron. Conduits of expanded polytetrafluorethylene (PTFE) were used for 86 MBTSs, and these form the basis of this report. Forty-four (51.1%) shunts were performed in infancy, 25 in patients under the age of 1 month (29.0%). Prostheses of 4 mm were used in 34 cases, 5 mm in 14, and 6 mm in 38. There were five shunt failures (5.8%) documented at postmortem or angiocardiographic investigation. Including two late deaths for which postmortem examinations were not obtained, the overall failure rate was 8.1% (seven patients). All these patients were operated upon in infancy, four of them in the neonatal period. Although a longer follow-up is necessary to assess the validity of these shunts, the early results are encouraging. We believe we can now recommend MBTS as an alternative when the classical Blalock-Taussig shunt is considered unsuitable.

Research paper thumbnail of Allografts in the treatment of absent pulmonary valve syndrome and complex tetralogy of Fallot

The absent pulmonary valve syndrome comprises agenesis of the pulmonary valve, annular stenosis, ... more The absent pulmonary valve syndrome comprises agenesis of the pulmonary valve, annular stenosis, pulmonary insufficiency, ventricular septal defect (VSD) and, usually, right ventricular (RV) hypertrophy. The pulmonary arteries (PA) are aneurysmal and usually compress the tracheobronchial tree. Several surgical techniques have been described, and many have been used in our unit (1). Our current policy is described in this short review.

Research paper thumbnail of Congenital left ventricular inflow obstruction: is the outcome related to the site of the obstruction?

European Journal of Cardio-Thoracic Surgery, 1988

Between 1978 and 1987, 39 patients aged 1 day to 15 years underwent surgery for symptomatic left ... more Between 1978 and 1987, 39 patients aged 1 day to 15 years underwent surgery for symptomatic left ventricular inflow obstruction. Four diagnostic groups were identified: cor triatriatum (6 patients), supravalvar mitral membrane (SVMM) with a normal mitral valve (7 patients), SVMM with an abnormal mitral valve (9 patients) and mitral stenosis (17 patients). Associated cardiac anomalies occurred in 26 patients (67%). There were 8 deaths (21%), 3 in patients with SVMM and an abnormal mitral valve and 5 in patients with mitral stenosis. Survival for patients with normal mitral valves was significantly better than that for patients with abnormal mitral valves (13/13 vs 18/26, P less than 0.05). There was also high morbidity in patients requiring prosthetic mitral valve replacement. These data suggest that the outcome of surgical treatment for left ventricular inflow obstruction may be predicted according to the site of the obstruction. This is best determined preoperatively by cross-sectional echocardiography which allows optimal planning of surgical strategy.

Research paper thumbnail of Pulmonary artery sling

The Annals of Thoracic Surgery, Nov 1, 1992

ABSTRACT

Research paper thumbnail of Tricuspid valve abnormalities in patients with atrioventricular discordance: Surgical implications

The Annals of Thoracic Surgery, Apr 1, 1994

Research paper thumbnail of Intracardiac repair of lesions associated with atrioventricular discordance

European Journal of Cardio-Thoracic Surgery, 1996

Research paper thumbnail of Expanded PTFE Membrane to Prevent Cardiac Injury During Resternotomy for Congenital Heart Disease

The Annals of Thoracic Surgery, Dec 1, 1996

Research paper thumbnail of Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990. Success of extended end-to-end arch aortoplasty

PubMed, 1994

There remains controversy regarding the appropriate surgical treatment of coarctation of the aort... more There remains controversy regarding the appropriate surgical treatment of coarctation of the aorta in infants. In 1985 we introduced the extended end-to-end repair into our practice and now wish to present a review of our recent experience. One hundred fifty-one infants younger than 3 months of age underwent repair of coarctation between 1985 and 1990. In 25% and 33% of the patients, there was hypoplasia of the isthmus and of the transverse arch, respectively. Surgical procedures were as follows: subclavian flap angioplasty in 15 patients, resection with a traditional end-to-end anastomosis in 43, and resection with an extended end-to-end anastomosis into the arch in 77. In 30 patients, the extension was proximal to the origin of the left carotid artery (radically extended end-to-end anastomosis). Other procedures were used in 16 patients. Mortality (13 early and 12 late deaths) was related on multivariate analysis to the presence of an associated major heart defect, preoperative resuscitation, and direct postoperative gradient over the arch. This immediate postoperative gradient was significantly lower after both extended and radically extended end-to-end anastomosis if there was a hypoplastic isthmus, and after radically extended end-to-end anastomosis if the transverse arch was hypoplastic. Actuarial freedom from recoarctation at 4 years was 57% (confidence limits 28% to 78%) after subclavian flap angioplasty, 77% (confidence limits 60% to 87%) after end-to-end anastomosis, 83% (confidence limits 66% to 92%) after extended end-to-end anastomosis and 96% (confidence limits 77% to 100%) after radically extended end-to-end anastomosis. We conclude that the extended end-to-end anastomosis and radical end-to-end anastomosis appear to offer the best prognosis for all infants with coarctation. The technique can be applied successfully to almost all types of arch anomalies.

Research paper thumbnail of Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990

The Journal of Thoracic and Cardiovascular Surgery, 1994

Research paper thumbnail of Allografts in the Rastelli procedure: Techniques

Steinkopff eBooks, 1988

Children with transposition of the great arteries (TGA) (VA discordance), ventricular septal defe... more Children with transposition of the great arteries (TGA) (VA discordance), ventricular septal defect (VSD) and anatomical left ventricular outflow tract obstruction (LVOTO) used to be treated by the Mustard operation, closure of the VSD and surgical relief of the obstruction. This carried out a mortality in excess of 50% (1, 2), largely due to the difficulty in relieving the LVOTO. The prognosis of children with this complex of disorders was improved by the application of the Rastelli operation (3). This operation consists in enlargement of the VSD, diversion of the LV outflow to the aorta by an intraventricular tunnel/patch and connection of right ventricle (RV) to pulmonary artery (PA) by an external valved conduit (Figs. 1–3). Details of the operative technique we use have been published elsewhere (4, 5).

Research paper thumbnail of Unusual vascular ring in infant with pulmonary atresia and ventricular septal defect

Research paper thumbnail of Modified Blalock-Taussig shunt

The Journal of Thoracic and Cardiovascular Surgery, 1981

Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried ... more Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried out at The Hospital for Sick Children, Great Ormond Street. The operation consists of interposing between the subclavian artery and the pulmonary artery a prosthesis of greater diameter than that of the subclavian artery. The first 13 operations were performed with a prosthesis of woven Dacron. Conduits of expanded polytetrafluorethylene (PTFE) were used for 86 MBTSs, and these form the basis of this report. Forty-four (51.1%) shunts were performed in infancy, 25 in patients under the age of 1 month (29.0%). Prostheses of 4 mm were used in 34 cases, 5 mm in 14, and 6 mm in 38. There were five shunt failures (5.8%) documented at postmortem or angiocardiographic investigation. Including two late deaths for which postmortem examinations were not obtained, the overall failure rate was 8.1% (seven patients). All these patients were operated upon in infancy, four of them in the neonatal period. Although a longer follow-up is necessary to assess the validity of these shunts, the early results are encouraging. We believe we can now recommend MBTS as an alternative when the classical Blalock-Taussig shunt is considered unsuitable.

Research paper thumbnail of Utilização de valvas homólogas e heterólogas em condutos extracardíacos The use of homograph and heterograph valves in extracardiac conduits

DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 1988

Research paper thumbnail of Myocardial adenine nucleotide metabolism in pediatric patients during hypothermic cardioplegic arrest and normothermic ischemia

The Annals of Thoracic Surgery, May 1, 1989