Biomedical subjects

A Chaux

Publications and source records attributed to A Chaux.

81 records · Page 5Linked to original sources

PubMed1977

Avulsion of a tricuspid valve leaflet during traction on an infected, entrapped endocardial pacemaker electrode. The role of electrode design.

Endocardial pacemaker electrodes rely in part upon endocardial fixation proximal to the electrode tip to prevent ejection of the tip from the ventricular apex. Fixation of these electrodes to the superior vena cava and tricuspid valve, in particular, has been reported. Infection of endocardial electrodes necessitates their removal. This report concerns avulsion of a tricuspid valve leaflet during traction on an infected electrode. With the availability of new methods of apical fixation, the utilization of electrode sheathing materials which discourage endocardial fixation would increase the safety of their removal under the circumstances reported herein.

Aged↗

PubMed1975

The rationale for surgery in preinfarction angina.

Of 123 patients with identical clinical criteria for preinfarction angina, 35 were treated medically and 88 surgically in a nonrandomized manner. There was no statistical difference between these two therapeutic groups in regard to age range, average age, sex distribution, number and distribution of prior myocardial infarction, and duration of chronic and acute anginal symptoms. With medical therapy, 32 sustained a myocardial infarction, and 14 (40 per cent) of these died within 1 month of hospital admission. Thirteen of 21 survivors or 37 per cent of the original group are asmptomatic on continuing medical therapy an average of 15 months after discharge. The surgical patients were studied by catherization and anigiography and underwent an early operation. Eight (9.4 per cent) demonstrated evidence of postoperative infarction, and 3 (3.4 per cent) died after the operation. Seventy-one (84 per cent) are completely asymptomatic and 6 are less symptomatic an average of 17 months after the operation. Actuarial analysis of the follow-up data reveals that the initial significant difference in survival between the two groups is maintained through the first 36 months. On the basis of this experience, we suggest that surgical intervention is the therapy of choice in patients with preinfarction angina.

Adult↗

PubMed1968

A new mitral valve.

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Biomedical Engineering↗

PubMedDate not supplied

Surgical therapy in acute ischemic syndromes.

Despite increasing enthusiasm about the treatment of symptomatic angina pectoris by direct revascularization surgery, there appropriately continues to be concern about the effects of such therapy. While it is generally accepted that surgery is effective in relieving anginal pain in upwards of 80% of patients undergoing aortocoronary bypass, reservations focus on the possibilities that such therapy may increase the incidence of infarction (postoperative), accelerate the atherosclerotic process, and shorten longevity, primarily because of the increased early operative mortality. While these contentions may or may not be true for the majority of patients who undergo such therapy, there is accumulating experience that in certain well-defined subsets, surgery does favorably affect the prognosis of the disease. Patients with preinfarction angina constitute one such subset of patients with coronary atherosclerosis. The all-inclusive surgical mortality for 106 consecutive cases was 3.8%, and 86% of the survivors are asymptomatic. Actuarial analysis of follow-up data reveals that this survival rate is essentially constant through the first 36 months after surgery. On the basis of this experience we feel that patients with preinfarction angina present a therapeutic opportunity in which the ideal goal of preventive medical care can be achieved by early identification, study and surgery.

Adult↗

PubMedDate not supplied

Long-term results of surgery for coronary artery fistulas.

This report describes our long-term result of surgery for coronary artery fistula in 12 patients. Follow-up range was from one year to 15 years, and with one exception they were all congenital in origin. Diagnosis was confirmed with angiography in all cases, showing single fistulous tract in four patients and multiple in eight patients. All but one patient were operated on by cardiopulmonary bypass with no mortality and with complete resolution of symptoms and no recurrence of the fistula. We conclude that surgery for coronary artery fistula can be accomplished safely with excellent long-term results and should be recommended for all patients to prevent life-threatening complications that may develop.

Adolescent↗

PubMedDate not supplied

Aortocoronary bypass surgery in septuagenarians and octogenarians.

Six hundred and twenty-nine consecutive patients between ages 70 and 79 and 64 patients over age 80 underwent isolated aortocoronary bypass operation with cardiopulmonary bypass. Four hundred and sixty-eight men and 161 women were between ages 70 and 79 (mean 73), and 41 men and 23 women were over age 80 (mean 82). Most patients were in NYHA Functional Class III (septuagenarian 25%, octogenarian 23%) and in Class IV (septuagenarian 59%, octagenarian 72%) preoperatively. Early death was reported in 41 (6.5%) septuagenarians and in 2 (3.1%) octogenarians. Cardiac-related late mortalities were 6.4% and 6.3%, respectively. Five hundred and eighty-eight septuagenarians and 62 octogenarians were over 30-day survivors; 17.5% (sept) and 35.9% (oct) developed major postoperative complications, including bleeding, pericardial tamponade, sternal dehiscence, myocardial infarction, arrhythmia and pump failure. Mean hospital stays were 14.8 and 19 days, respectively. At follow-up (mean 38.2 months) patients had significant functional improvement by one or more classes in 80% and 60%. Mortality was adversely influenced by (1) NYHA Class IV, (2) use of intra-aortic balloon pumping, (3) postoperative hemorrhage, and (4) prolonged ischemic cross-clamp time. This experience indicates that if adequate trial of medical treatment of angina fails in the elderly patient, aortocoronary bypass surgery becomes a successful alternative.

Aged↗

PubMedDate not supplied

Technical aspects of valvular replacement with the St. Jude prosthesis.

Technical aspects for the implantation of the St. Jude Medical prosthesis are discussed. In our experience with 588 implants, the most important considerations are removal of residual calcium and preparation of annular and subvalvular areas, correct assessment of annular size, selection of proper prosthetic size, and placement of the sutures avoiding the use of pledgets on the ventricular side of the prosthesis. A special valve orientation is not needed in the great majority of patients, but necessary guidelines for individual patients were discussed. Using these technical guidelines, implantation of this prosthesis is simple, results in a low incidence of complications, and avoids damage to the prosthesis during implantation.

Heart Valve Prosthesis↗

PubMedDate not supplied

The use of absorbable microfibrillation collagen to control sternal bone marrow bleeding.

Because of the fact that bone wax plays a significant role in delayed healing of the sternum an alternative technique for the control of sternal bone marrow bleeding has been devised. It consists of the application of fashioned strips of absorbable microfibrillar collagen to the cut surface of the sternal marrow after the sternum is divided and/or prior to its closure. This initial clinical experience has been excellent.

Absorption↗

PubMedDate not supplied

Acquired left coronary artery to left atrium fistula: unusual complication of aortocoronary bypass.

This report describes a very unusual complication of aortocoronary bypass graft surgery. It consists of the formation of an acquired fistula between the left circumflex coronary artery and the left atrium in a patient who was operated two years prior to its clinical presentation. Significant coronary steal gave rise to disabling angina and prompted a second operation to close the fistula. The diagnosis was made with selective arteriogram that clearly delineated the fistulous tract and surgery was accomplished without extracorporeal circulation.

Coronary Angiography↗