Browsing by Author "Hewitson, John"

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    Extrinsic bronchial compression by primary tuberculous adenopathy, simulating foreign-body aspiration
    (2005) Pitcher, Richard; Hewitson, John
    A 5-month-old boy was well until the day before admission, when he developed a cough. On the morning of admission he was irritable and his mother noticed a blue tinge to his lips during episodes of crying. This prompted her to bring him to the emergency unit at Red Cross Children's Hospital, where he was found to be distressed and cyanosed, with a respiratory rate of 60 beats per minute, a heart rate of 200/minute and alar flaring. His left chest showed decreased air entry, bronchial breathing and dullness to percussion. Oxygen saturation was 66%, improving to 88% on face-mask oxygen. His weight was on the 50th percentile. He was well hydrated, well perfused and had no significant background medical history. A mobile chest radiograph (Fig. 1) showed complete opacification of the left hemithorax, mediastinal deviation to the left and overexpansion of the right lung, which had herniated across the midline. A penetrated anteroposterior (AP) chest radiograph (Fig. 2) showed abrupt 'cut-off' of the left main bronchus.
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    Left ventricular submitral aneurysms
    (2007) Du Toit, Henning; Hewitson, John; Lawrenson, John
    Retrospective institutional review of the pathology, aetiology classification and surgical management of left ventricular submitral aneurysms (LVSMA). These aneurysms are a well recognized but relatively rare disease found commonly in patients from African ancestry. The series comprises 20 consecutive patients treated surgically at three institutions from 1985 to 2002. Natural history, clinical presentation, histo-pathological findings, suspected aetiology, operative techniques, along with a discussion of the condition is presented. There were 10 female and 10 male patients and the mean age was 17+-6 (range 8-34) years. Patients were grouped as to the degree of posterior mitral annulus involvement by the aneurysm. In Group I, (n=12) a single aneurysm neck was found. In Group II, (n=3) multiple necks and in Group III, (n=5) involvement of the entire posterior annulus by teh aneurysm was found. Mean age in Group III (29 +/-5 years) was older than that of Groups I and II (15.5 +/- 4 years) suggesting a progressive nature of these aneurysms to enlarge. Clinically patients were in New YOrk Heart Association (NYHA) class I-IV. An intra-cardiac surgical approach was used in 11, extra-cardiac approach in two and a combined approach in seven patients. Mitral valve repair was attempted in 14 patients, with two intra-operative mitral valve repair failures. Failure to control the aneurysm neck (n=2) and failure of mitral valve repair (n=2) resulted in subsequent re-operation. There was no operative mortality. Histology of the aneurysm tissue suggested co-existing rheumatic heart disease in two, tuberculosis in four and infective endocarditis in two. Unknown or congenital disease was postulated in nine patients. Although LVSMA are thought to be congenital, 8 out of 20 patients (40%) had evidence of co-existent inflammatory pathology. The etiology of LVSMA remains uncertain. Many are thought to be congenital, but the findings in this study strongly support the view that rheumatic disease, chronic infections and malnutrition also play a role. A new classification is proposed based on the pathological findings. Involvement of the entire annulus in the older patients suggests a possible progressive nature of the disease. Surgery should be the difinitive therapy in all patients. Surgical approach must be individualized but the intra cardiac approach is suitable for the surgical repair in most cases. Success in mangement is dependent on the appropriate understanding of the relationship between aneurysm and valve.
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    Regional cerebral oxygenation monitoring - intraoperative management in a patient with severe left ventricular dysfunction
    (2006) Ing, Richard J; Fischer, Stephanie; Shipton, Steve; Gray, Rebecca; Thomas, Jenny; Hewitson, John
    Intraoperative near-infrared spectroscopy cerebral oxygenation monitoring assists intraoperative decision-making in environments without extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) or access to cardiac transplantation. We report a case of an anomalous left coronary artery arising from the pulmonary artery (ALCAPA), undergoing cardiac surgery. A 4-month-old infant presented in extremis with cardiac failure. We discuss the pathophysiology and challenging intraoperative management of ALCAPA with extensive ischaemia and myocardial infarction.
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    Regionalcerebral oxygenation monitoring - intraoperative management in a patient withsevere left ventricular dysfunction
    (2006) Ing, Richard J; Fischer,Stephanie; Shipton, Steve; Gray, Rebecca; Thomas, Jenny; Hewitson, John
    Intraoperative near-infrared spectroscopy cerebral oxygenation monitoring assists intraoperative decision-making in environments without extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) or access to cardiac transplantation. We report a case of an anomalous left coronary artery arising from the pulmonary artery (ALCAPA), undergoing cardiac surgery. A 4-month-old infant presented in extremis with cardiac failure. We discuss the pathophysiology and challenging intraoperative management of ALCAPA with extensive ischaemia and myocardial infarction.
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    Retrospective review of paediatric rheumatic mitral valve repairs and replacements done at Red Cross War Memorial Children's Hospital (RCWMCH) over a decade
    (2016) Mureko, Alfred; Brink, Johan G; Hewitson, John
    Objectives: Rheumatic heart disease remains a significant cause of morbidity and mortality and it is the leading cause of acquired paediatric cardiac disease in the developing world. The aim of this study was to understand the burden of rheumatic heart disease and to review the surgical management of rheumatic mitral valve disease at our institution. Methods: We retrospectively reviewed 76 consecutive patients who underwent mitral valve surgery for rheumatic heart disease between 1998 and 2010. The results and follow-up were reviewed, where death and reoperation were the primary endpoints. The follow up included a review of the latest information from the patients' medical records and telephonic interviews or home visits. Results: A 91% follow up was achieved over a median follow up period of 7.4 years (range 0.1-15.2 years). The mean age at surgery was 10.7 years (SD +- 2.7 years). The females constituted 66% and males 34%. Mitral valve repairs were performed in 64% of patients and of the 64% repairs, 0.06% only had commissurotomies. Replacements were performed in 36% of patients. All mitral valve replacements were mechanical prostheses. The actuarial freedom from reoperation for repairs was 83% (+-2.2) and 66% (+-3.4) at 5 and 10 years and for replacements was 87% (+-4.8) and 87%(+-4.8) respectively (p=0.27). Actuarial freedom from embolic cerebrovascular accidents in the repair group at both 5 and 10 years was 100%, compared to 90.2% (+-6.6) and 79% (+-12.0) for the replacement group at 5 and 10 years respectively (p=0.02). Actuarial freedom from death at 5 and 10 years for children over 12.8 years was 77.7% (+-9.9) and 69.1% (+-12.0) respectively, compared to 93.6% (+-3.6) and 93.6% (+-3.6) for children under 12.8 years (p=0.03). No statistical significant difference was noted in freedom from valve related failure and death between repairs and replacements. Conclusions: There was no significant difference in survival between mitral valve repairs and replacements. There was surprisingly worse survival among children who were above 12.8 years at time of the surgery.
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    Surgical techniques used for closure of perimembranous ventricular septal defects
    (2002) Karani, Zeead; Hewitson, John; Von Oppell, Ulrich
    A retrospective study was done at Red Cross Children's Hospital, Rondebosch, Cape Town in which two separate case-matched groups of children undergoing different surgical closure techniques for their isolated perimembranous ventricular septal defects were compared. Group I consisted of 77 children who had their VSDs closed between 1987 to 1990, mainly with a double velour dacron patch using interrupted alternating 5.0 silicone coated braided polyester suture ( Ticron®) and 5.0 polypropylene (Prolene®) pledgetted sutures (n=71). Five patients in Group I had bovine pericardium used and 1 patient's VSD was closed by a direct suture technique. Group II consisted of 93 children operated on between 1995 to 1998, and had their VSDs closed with a 0.6% glutaraldehyde-treated autologous pericardial patch using 5.0 polypropylene suture material in a continuous horizontal mattress suture without pledgets. Surgical time, discharge echocardiograms and follow up records were reviewed to assess the incidence of complications, reoperation or residual VSD needing further follow up.