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Biomedical subjects

A Carpentier

Publications and source records attributed to A Carpentier.

At least 91 records · Page 5Linked to original sources
PubMed1999

Acute enhancement of insulin secretion by FFA in humans is lost with prolonged FFA elevation.

The in vivo effect of elevated free fatty acids (FFA) on beta-cell function in humans remains extremely controversial. We examined, in healthy young men, the acute (90 min) and chronic (48 h) effects of an approximately twofold elevation of plasma FFA vs. control on glucose-stimulated insulin secretion (GSIS). GSIS was studied in response to a graded intravenous glucose infusion (peak plasma glucose, approximately 10 mmol/l, n = 8) and a two-step hyperglycemic clamp (10 and 20 mmol/l, n = 8). In the acute studies, GSIS was significantly higher, insulin sensitivity index (SI) was lower, and disposition index (DI = insulin sensitivity x insulin secretion) was unchanged with elevated FFA vs. control [2-step clamp: DI = 8.9 +/- 1.4 x 10(-3) l2. kg-1. min-2 in control vs. 10.0 +/- 1.9 x 10(-3) l2. kg-1. min-2 with high FFA, P = nonsignificant (NS)]. In the chronic studies, there was no difference in absolute GSIS between control and high FFA studies, but there was a reduction in SI and a loss of the expected compensatory increase in insulin secretion as assessed by the DI (2-step clamp: DI = 10.0 +/- 1.2 x 10(-3) l2. kg-1. min-2 in control vs. 6.1 +/- 0.7 x 10(-3) l2. kg-1. min-2 with high FFA, P = 0.01). In summary, 1) acute and chronic FFA elevation induces insulin resistance; 2) with acute FFA elevation, this insulin resistance is precisely countered by an FFA-induced increase in insulin secretion, such that DI does not change; and 3) chronic FFA elevation disables this beta-cell compensation.

Adult↗
PubMed1999

Triglyceride enrichment of HDL enhances in vivo metabolic clearance of HDL apo A-I in healthy men.

Triglyceride (TG) enrichment of HDL resulting from cholesteryl ester transfer protein-mediated exchange with TG-rich lipoproteins may enhance the lipolytic transformation and subsequent metabolic clearance of HDL particles in hypertriglyceridemic states. The present study investigates the effect of TG enrichment of HDL on the clearance of HDL-associated apo A-I in humans. HDL was isolated from plasma of six normolipidemic men (mean age: 29.7 +/- 2.7 years) in the fasting state and after a five-hour intravenous infusion with a synthetic TG emulsion, Intralipid. Intralipid infusion resulted in a 2.1-fold increase in the TG content of HDL. Each tracer was then whole-labeled with 125I or 131I and injected intravenously into the subject. Apo A-I in TG-enriched HDL was cleared 26% more rapidly than apo A-I in fasting HDL. A strong correlation between the Intralipid-induced increase in the TG content of HDL and the increase in HDL apo A-I fractional catabolic rate reinforced the importance of TG enrichment of HDL in enhancing its metabolic clearance. HDL was separated further into lipoproteins containing apo A-II (LpAI:AII) and those without apo A-II (LpAI). Results revealed that the enhanced clearance of apo A-I from TG-enriched HDL could be largely attributed to differences in the clearance of LpAI but not LpAI:AII. This is, to our knowledge, the first direct demonstration in humans that TG enrichment of HDL enhances the clearance of HDL apo A-I from the circulation. This phenomenon could provide an important mechanism explaining how HDL apo A-I and HDL cholesterol are lowered in hypertriglyceridemic states.

Adult↗
PubMed1999

Counterregulatory response to hypoglycemia differs according to the insulin delivery route, but does not affect glucose production in normal humans.

The magnitude of the counterregulatory response to insulin-induced hypoglycemia is primarily determined by the degree of hypoglycemia. We examined whether the route of acute insulin delivery (portal or peripheral venous) is also important in determining the magnitude of the counterregulatory response to hypoglycemia in nine healthy nondiabetic men. Pancreatic insulin secretion, stimulated by an i.v. tolbutamide infusion (portal insulin study), was matched with an exogenous insulin infusion into the peripheral vein 4-6 weeks later (peripheral insulin study). Each study consisted of a 150-min baseline tracer equilibration period, a 180-min euglycemic hyperinsulinemic (portal or peripheral insulin delivery) period, a 60-min hypoglycemic period in which insulin secretion diminished during tolbutamide or was reduced during exogenous insulin, and a 30-min recovery period. Peripheral venous glucose concentrations were well matched in the portal and peripheral studies during euglycemia and hypoglycemia (glucose nadir, 2.9 +/- 0.1 mmol/L in the portal and 2.7 +/- 0.1 mmol/L in the peripheral; mean +/- SEM; P = NS), and insulin concentrations were about 1.5-fold higher throughout the experiment in the peripheral vs. the portal insulin study due to the first pass extraction of insulin in the portal study. There was a much greater increment (P < 0.0001) in FFA in the portal vs. the peripheral study (area under the curve: portal, 19.5 +/- 3.9 mmol/L x 90 min; peripheral, 3.3 +/- 1.1 mmol/L x 90 min), whereas plasma glucagon and GH were higher in the peripheral study (P = 0.01 for glucagon; P = 0.015 for GH). There was no significant difference between studies in epinephrine and norepinephrine responses to hypoglycemia or stimulation of endogenous glucose production (area under the curve: portal, 636 +/- 103 micromol/kg x 90 min; peripheral, 705 +/- 69 micromol/kg x 90 min; P = NS). In summary, we have shown that the glucagon, GH, and FFA responses to hypoglycemia during insulin dissipation are affected by the route of insulin delivery and are not controlled exclusively by the nadir blood glucose level. The clinical importance of these observations in diabetic subjects as they relate to route of insulin delivery (portal or peripheral) during insulin dissipation remains to be determined.

Adult↗
PubMed1999

Resistance to insulin's acute direct hepatic effect in suppressing steady-state glucose production in individuals with type 2 diabetes.

We and others have shown that insulin acutely suppresses glucose production in fasting nondiabetic humans and dogs, by both a direct hepatic effect and an indirect (extrahepatic) effect, and in diabetic dogs by an indirect effect alone. In type 2 diabetes, there is resistance to insulin's ability to suppress hepatic glucose production, but it has not previously been determined whether the resistance is primarily at the level of the hepatocyte or the peripheral tissues. To determine whether the diabetic state reduces the direct effect of insulin in humans, we studied nine patients with untreated type 2 diabetes who underwent three studies each, 4-6 weeks apart. 1) Portal study (POR): intravenous tolbutamide was infused for 3 h with calculation of pancreatic insulin secretion from peripheral plasma C-peptide. 2) Peripheral study (PER): equidose insulin was infused by peripheral vein. 3) Half-dose peripheral insulin study (1/2 PER): matched peripheral insulin levels with study 1. In all studies, glucose was clamped at euglycemia, glucose turnover was measured with the constant specific activity method, and 3-[3H]glucose was purified by high-performance liquid chromatography. Peripheral insulin was lower in POR versus PER but slightly higher in POR versus 1/2 PER, although most of the difference could be accounted for by higher proinsulin levels in POR (stimulated by tolbutamide). Calculated portal insulin was approximately 1.3-fold higher in POR versus PER and approximately 2.2-fold higher in POR versus 1/2 PER. In the final 30 min of the clamp, glucose production reached a lower steady-state level in PER than in POR (4.0 +/- 0.4 vs. 5.3 +/- 0.5 pmol(-1) x kg(-1) x min(-1), P < 0.05), despite the higher hepatic insulin level in POR. In contrast with our studies in nondiabetic individuals, glucose production was not more suppressed at steady state in POR versus 1/2 PER (5.3 +/- 0.4 micromol x kg(-1) x min(-1)), despite much higher hepatic insulin levels in POR. In conclusion, this is the first study in patients with type 2 diabetes to characterize insulin resistance to the acute direct suppressive effect of insulin on hepatic glucose production.

Adult↗
PubMed1999

[Importance of dual isotope myocardial tomoscintigraphy in the detection of coronary disease in the graft among 96 heart transplant recipients].

With a survival rate of 70% at 3 years, cardiac transplantation is the best treatment for end-stage heart disease. However, progressive development of graft atherosclerosis is frequent. Diagnosis of transplant coronary disease remains difficult and non-invasive tests have proved relatively insensitive. Therefore, coronary angiography performed annually is still the gold-standard test for the detection of heart transplant vasculopathy. We analyzed the records of 96 patients (82 men and 14 women) who were transplanted from 1986 to 1996. Mean age was 53 +/- 2.7 and time elapsed from transplantation was mean 5.3 +/- 10 years. All patients had rest myocardial TI 201 perfusion SPECT, followed by MIBI gated SPECT after exercise. MIBI gated SPECT allows simultaneous evaluation of perfusion, regional LV function and global ejection fraction. Angiocoronarography, performed in all patients during the six months following radionuclide investigation, showed the presence of coronary heart vasculopathy in nine (9.3%). Seven of these patients had abnormal dual isotope imaging and 2 of them had normal perfusion but altered LV regional function. Sensitivity of dual isotope scintigraphy was 77% and specificity was 97.7%. Dual isotope scintigraphy is helpful to detect coronary vasculopathy in heart transplant recipients and may reduce indications of angiocoronarography.

Coronary Angiography↗
PubMed1999

[The pericardium: a heterogeneous tissue. Anatomic and morphometric considerations].

BACKGROUND AND AIMS OF THE STUDY: Short-term glutaraldehyde fixed autologous pericardium is widely used in cardiac valve repair or in autologous pericardial bioprosthesis construction. The thinner the tissue, the better the fixation. The aim of this study was to determine thickness and useful surface area of pericardium in relation to harvesting site using a digital thickness counter (0.01 mm precision). Parietal pericardium fragments were obtained from the pericardial sac of six fresh cadavers (group I). In the other groups, pericardial strips (80 x 30 mm) were obtained from patients undergoing surgery: group II patients (n = 5 females) and group III (n = 10 males) were non-cardiomegalic (cardiothoracic ratio (CTR) < 0.5)), while group IV patients (n = 5) were all cardiomegalic (CTR > 0.5). Results were reported on a coloric scale according to measurement position. In group I, mean surface area was 93 +/- 18 cm2, and thickness gradually increased from 0.1 to 0.6 mm, maximally on the diaphragm, along the left heart side. In other groups, a gradual increase in thickness was identified towards the diaphragmatic zone. Significant differences in tissue thickness appear as a result of cardiomegaly, but are not related to the sex of the patients. Pericardium taken from the right anterior aspect of the pericardial sac in patients without cardiomegaly is the most appropriate tissue for valve reconstructive surgery, due to its thin nature and hence better fixation properties.

Analysis of Variance↗
PubMed1999

[Informatics, robotics and medicine].

Information technology is becoming common use in Medicine. Among the numerous applications are data processing, image analysis, 3D reconstruction, telemedicine, to mention only few of them. The interest of computers in surgical research and development is lesser known. Two examples are given: computer aided conception and simulation of physiologic systems. Robotics has been introduced more recently. There are three types of robotics corresponding to three types of use: targetting used by neural surgeons to localize tumors or anatomical structures, visualization used by general surgeons to hold and mobilize laparoscopes, instrumentation introduced more recently by cardiac surgeons to perform totally endoscopic cardiac operations. All these techniques open new ways for tomorrow "Instrumental Medicine".

Image Processing, Computer-Assisted↗
PubMed1999

[Intracranial arachnoid cysts. A review].

The diagnosis of arachnoid cyst has become easier and more frequent with the general use of CTscanner and MRI. Their congenital origin is usually accepted. They correspond to liquid formations surrounded by an arachnoid sheet but their pathophysiologie remains unclear. When they are asymptomatic and incidentally discovered, they do not require any peculiar treatment. Variable neurological signs depending on location may be inaugural, although intracranial hypertension is the most frequent. The treatment of these symptomatic cysts remains surgical. Several options are possible: direct approach of the cyst, derivation of the cyst with different modalities, or endoscopic fenestration. This last technique, the most recent, seems to give interesting results especially for deep located cysts or those close to the ventricles.

Arachnoid Cysts↗
PubMed1999

A stable isotope method using a [(2)H(5)]glycerol bolus to measure very low density lipoprotein triglyceride kinetics in humans.

We have developed a method using a bolus of [(2)H(5)]glycerol to determine parameters of VLDL-triglyceride (VLDL-TG) turnover and have compared the data to that obtained using simultaneously a bolus of [2-(3)H]glycerol in six young normolipidemic men. No measurable enrichment was found after 12 h for [(2)H(5)]glycerol; therefore, we could only perform a monoexponential analysis of its data. No differences in fractional catabolic rate (FCR) were seen when comparing the multicompartmental modeling of [2-(3)H]glycerol data (modeled over 48 h) either to the monoexponential analyses of the [2-(3)H]glycerol or that of the [(2)H(5)]glycerol data. The two monoexponential approaches were highly correlated (r = 0.96 for FCR), however, FCR was 18% higher with the [(2)H(5)]glycerol than with the [2-(3)H]glycerol data (P < 0.003). In all six subjects, a 10-h infusion of [1-(13)C]acetate was started at the same time as the glycerol boluses were given. In two men we were able reliably to detect VLDL-TG-fatty acid enrichment. The measurement of FCR in these two subjects using the mass isotopomer distribution analysis (MIDA) approach was in good agreement (within 10%) with FCRs determined with the labeled glycerol methods. In conclusion, our results have shown that results obtained with the [(2)H(5)]glycerol bolus were highly correlated with those obtained with the [2-(3)H]glycerol, but the FCRs were slightly higher with the former. We have also demonstrated that FCRs determined from monoexponential modeling were in good agreement with those determined from the multicompartmental modeling of the TG-glycerol data.

Acetates↗
PubMed1999

[Stenotrophomonas maltophilia endocarditis following mitral valve prosthesis implantation. Report of a case].

The authors report the first case of early postoperative endocarditis after mitral valvuloplasty due to Stenotrophomonas Maltophilia, a Gram negative organism, in a 37 year old man with no special risk factors. Pyrexia and mitral valve vegetations were the main features, and, in the absence of complications or of embolism, the patient was treated initially with triple antibiotherapy (ceftazidime, amikacine, ciprofloxacine). Relapse two weeks after withdrawal of treatment due to two variants of Stenotrophomas Maltophilia, one of which was resistant to ciprofloxacine, and the presence of a large vegetation, required repeat mitral valvuloplasty and a change in antibiotic therapy (ticarcilline with clavulanic acid, trimethoprim sulphamethoxazole, colistine). This time, the outcome was good. The little known Stenotrophomonas Maltophilia infectious endocarditis is a serious complication and, in the absence of standardised management, the authors suggest that, in view of the multi-resistant character of the organism and in the light of this case, surgery should be considered in association with prolonged antibiotic therapy.

Adult↗
PubMed1998

New approach for reconstruction of the pulmonary outflow tract during the Ross procedure.

BACKGROUND: This study describes and evaluates the early results of a new surgical technique to reconstruct the right ventricular outflow tract and fit it with a new valve after the Ross procedure. METHODS AND RESULTS: Between March 1996 and November 1997, 20 patients underwent a Ross operation with a new approach consisting of a direct anastomosis between the remaining pulmonary artery trunk and the infundibulum and of the creation of a monocusp tailored from the anterior pulmonary artery wall as a means of reconstructing the valve. The 20 patients (12 males and 8 females) had a mean age of 27.4 years (range, 17 to 42 years). Ten of them had predominant aortic regurgitation, 8 had aortic stenosis, and 2 had mixed disease. There were no deaths during the follow-up period of up to 20 months, no early or late repeat operations, and no specific complications secondary to the surgical technique. During the follow-up, at the aortic autograft site, 19 patients had no or trivial regurgitation, and a mild regurgitation was found in only 1 patient. Across the pulmonary monocusp, color flow Doppler demonstrated no or trivial incompetence in 10 patients, mild incompetence in 7, and moderate incompetence in 3. No significant pressure gradient was shown. CONCLUSIONS: Our experience supports the use of this new surgical procedure and allows extension of the Ross operation to where there are no facilities for homografts. It may be an alternative for right ventricular outflow tract reconstruction with a homograft should the results be confirmed at long-term follow-up.

Adolescent↗
PubMed1998

The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years.

OBJECTIVE: The aim of this study was to assess the long-term results of use of the radial artery as a conduit for coronary artery bypass grafting. METHODS: After revival of the technique in 1989, the radial artery was used as a conduit in 910 patients undergoing coronary artery bypass grafting. A complete follow-up was obtained for the first 102 consecutive patients from 4 to 7 years after the operation (mean 5.27 +/- 1.30 years). Fifty-nine percent of the patients were receiving calcium-channel inhibitors. An electrocardiographic stress test was obtained for 51 patients, with no contraindications found. Routine follow-up angiography was performed in 50 cases, including those of all patients with symptoms. Thus 64 radial artery and 48 left internal thoracic artery grafts were followed up from 4 to 7 years after the operation (mean 5.6 +/- 1.40 years). RESULTS: The actuarial survival was 91.6% at 5 years, and the actuarial rate of freedom from angina was 88.7% at 5 years. Four patients underwent percutaneous transluminal angioplasty during the period of follow-up, and there were no reoperations for revision of the bypass. The electrocardiographic stress test showed negative results in 73% of cases, electrocardiographic changes alone in 21%, and clinically positive results in 6%. Angiography showed that the patency rate of the radial artery grafts was 83%. The patency rate of the left internal thoracic artery grafts (n = 47) was 91%. The difference in patency could be related to the implantation sites of the grafts, mainly the circumflex artery (51%) for the radial artery grafts and almost exclusively the left anterior descending artery (94%) for the left internal thoracic artery. CONCLUSION: The use of the radial artery for coronary bypass grafting provides excellent clinical and angiographic results at 5 years. Routine use of the radial artery in combination with the left internal thoracic artery can be recommended.

Aged↗
PubMed1998

Less invasive techniques for mitral valve surgery.

OBJECTIVE: Minimally invasive surgical techniques aim at reducing the consequences of currently used large incisions, such as bleeding, pain, and risk of infection. Although this new approach developed rapidly in coronary surgery, it remains questionable in mitral valve surgery. This article reports the longest experience with minimally invasive mitral valve surgery, with particular attention to approach and techniques. METHODS: From February 1996, the date of the first case of minimally invasive mitral valve reconstruction, to April 1997, 22 patients with a mean age of 54 +/- 2.7 years were subjected to mitral valve surgery performed with less invasive techniques. Exposure of the mitral valve was achieved through a minithoracotomy (n = 12) or a ministernotomy (n = 10). Video assistance was used in all cases. Peripheral arterial cannulation (n = 21) and venous drainage (n = 22) were used in most cases. RESULTS: In this series, valve surgery consisted in 19 repairs, two replacements, and one closure of a periprosthetic leak. In two cases it was necessary to convert to a larger incision. The average duration of cardiopulmonary bypass was 157 +/- 8.2 minutes, ventilatory assistance 16 +/- 4.6 hours, and intensive care unit stay 2.1 +/- 0.4 days. Two patients required reoperation for bleeding and another for early recurrence of mitral valve regurgitation. There were no deaths and all patients were discharged with normal valve function. At most recent follow-up, all patients were in functional class I, with resumption of normal activity. CONCLUSION: Mitral valve surgery can be performed safely by means of less invasive techniques, but with increased technical difficulty. A low asymmetric median sternotomy seems preferable to an anterior thoracotomy.

Cardiopulmonary Bypass↗
PubMed1998

Reconstructive surgery in congenital mitral valve insufficiency (Carpentier's techniques): long-term results.

BACKGROUND: Previous publications have stressed the benefits of mitral valve repair over mitral valve replacement in children. However, few communications have reported the long-term results and none with a follow-up of more than 10 years. This article reports our results in a series of 145 patients operated on for congenital mitral valve insufficiency by means of the same technique (Carpentier's technique) in a single center. METHODS: Between 1970 and 1995, 145 patients younger than 12 years old underwent surgery for congenital mitral valve insufficiency. Mean age was 5.7 +/- 3.1 years, ranging from 0.17 to 12 years. Mitral valve insufficiency associated with atrioventricular defect, atrioventricular discordance, straddling mitral valve, acquired diseases, Marfan syndrome, and degenerative disease was excluded from this study. According to Carpentier classification, 31 patients had type I mitral valve disease (normal leaflet motion), 79 patients type II (leaflet prolapse), and 35 type III (restricted leaflet motion), with 15 having normal papillary muscles and 20 abnormal papillary muscles. Associated lesions were present in 51 patients (35%). A conservative operation was possible in 138 patients (95%). Among them, 70 patients required a prosthetic annuloplasty and 21 patients valve extension with a pericardial patch. Valve replacement was necessary in seven patients (5%). RESULTS: In-hospital mortality was 5% (95% CL: 2.5% to 9.9%) (seven patients). No early death was observed in the group of patients who underwent valvular replacement. In-hospital mortality was as follows: type I, 9.6%; type II, 2.5%; and type III, 13%. No statistically significant difference was noted among patients with the different types of disease. Mean follow-up was 9.3 +/- 6.9 years (1 to 26 years), and cumulative follow-up was 1142 patient-years. Ten late deaths occurred. Actuarial survival at 10 years was 88% in patients who underwent valve repair and 51% in patients who underwent valve replacement. Late reoperation was required in 15% (n = 21) of patients who had undergone valve repair and 28% (n = 2) in patients with valve replacement. Causes of reoperation were recurrent left ventricular failure (n = 1), residual or recurrent mitral valve insufficiency (n = 17), mitral valve stenosis (n = 3), and calcification of the bioprosthesis (n = 2). No failure resulting from leaflet extension was observed. In the repair group, actuarial freedom from reoperation was 68% (95% CL: 80.5% to 51.5%) at 15 years, and the linearized rate of exposure to reoperation was 1.9% per patient-year. No thromboembolic event was observed in any group. CONCLUSION: Congenital mitral valve insufficiency can be repaired in infancy with a low mortality. Conservative surgery with Carpentier's techniques is feasible in the majority of cases of congenital mitral valve insufficiency. This technique offers stable long-term results with a low rate of reoperation. Leaflet extension associated with prosthetic ring annuloplasty could prevent reoperations in selected cases.

Child↗
PubMed1998

[Computer assisted open heart surgery. First case operated on with success].

The recent development of less invasive intracardiac surgery using small incisions and videoscopic techniques allowed an evaluation of the advantages and limitations of this new approach. Among the limitations was the increased difficulty of the surgical technique when using long instruments through small incisions and ports. We investigated whether computer assisted surgical instruments might bring a solution to this problem. Among the existing systems, we selected the Intuitive System because of two original features. It provides a stable, magnified, three dimensional view of the operating field at a console where the surgeon is seated to operate, and it uses computer assisted instruments having the same dexterity and range of motion as the hand. After 10 months of active work to adapt this system to intracardiac surgery, the first open heart operation using computer assisted instruments was carried out on a 52-year-old woman presenting an aneurysm and a large defect of the atrial septum. The patient was extubated 8 h after the operation, returned to her room 16 h later and was discharged from the hospital 8 d post-operatively with normal heart function and no residual shunt. This preliminary experience showed that computer assisted cardiac surgery is feasible and may open new and promising directions in open heart surgery.

Cardiac Surgical Procedures↗
PubMed1998

Bi-directional cavopulmonary shunt associated with ventriculo and valvuloplasty in Ebstein's anomaly: benefits in high risk patients.

OBJECTIVE: The prognosis for surgical repair of Ebstein's anomaly depends on the tricuspid valve repair and on the right ventricular function. In order to decrease the preload of the compromised right ventricle, a bi-directional cavopulmonary shunt was added to the intracardiac repair. METHODS: Among 113 patients operated on for Ebstein' s anomaly at our institution from 1980-1997, a cohort of 60 patients was selected for high risk for postoperative complications. Patients presented with one or more several criteria: massive tricuspid valve dysfunction, extended atrialized right ventricle, poor right ventricular contractility, or long standing atrial fibrillation. After prior informed consent, this cohort was divided into two groups. Both groups had similar preoperative clinical patterns: Group I (45 patients), surgical technique included longitudinal right ventricular plication and tricuspid valve valvuloplasty; Group II (15 patients), where the surgical technique was similar to Group I except a bi-directional cavopulmonary shunt was added at the end of the procedure. RESULTS: Operative mortality was 24% (11/45) in Group I and 0% (0/15) in Group II (P < 0.05). The survival at 5 years was 66.1 +/- 14% in Group I and 80 +/- 16% in Group II (not significant). Reoperation rate was 11% (5/45) in Group I and 0% (0/15) in Group II. No deleterious effects of the bi-directional cavopulmonary shunts were observed clinically. Residual tricuspid valve insufficiency rate was 26% in both groups. However, patients with the bi-directional cavopulmonary shunt had a better tolerance and have not needed reoperations to date. CONCLUSIONS: In high risk patients with Ebstein's anomaly, an associated bi-directional cavopulmonary shunt seems to offer several distinct advantages including decreased operative mortality and better tolerance of the residual tricuspid valve dysfunction.

Adolescent↗
PubMed1998

Autologous pericardial patch harvesting site for cardiac valve repair: anatomic and morphometric considerations.

BACKGROUND AND AIMS OF THE STUDY: Short-term glutaraldehyde-fixed autologous pericardium is widely used in cardiac valve repair or in autologous pericardial bioprosthesis construction. The thinner the tissue, the better the fixation. The aim of this study was to determine thickness and useful surface area of pericardium in relation to harvesting site using a digital thickness counter (0.01 mm precision). METHODS: Parietal pericardium fragments were obtained from the pericardial sac of six fresh cadavers (group I). In the other groups, pericardial strips (80 x 30 mm) were obtained from patients undergoing surgery: group II patients (n = 5 females) and group III (n = 10 males) were non-cardiomegalic (cardiothoracic ratio (CTR)<0.5), while group IV patients (n = 5) were all cardiomegalic (CTR >0.5). RESULTS: Results were reported on a coloric scale according to measurement position. In group I, mean surface area was 93+/-18 cm2, and thickness gradually increased from 0.1 to 0.6 mm, maximally on the diaphragm, along the left heart side. In other groups, a gradual increase in thickness was identified towards the diaphragmatic zone. Significant differences in tissue thickness appear as a result of cardiomegaly, but are not related to the sex of the patients. CONCLUSIONS: Pericardium taken from the right anterior aspect of the pericardial sac in patients without cardiomegaly is the most appropriate tissue for valve reconstructive surgery, due to its thin nature and hence better fixation properties.

Cadaver↗