Biomedical subjects

A Kalangos

Publications and source records attributed to A Kalangos.

84 records · Page 5Linked to original sources

PubMed1995

Mitral valve repair in lupus valvulitis--report of a case and review of the literature.

Valvulitis in systemic lupus erythematosus has been observed for many years. Fourteen cases of mitral valve replacement have been reported so far in the literature. In the light of all previously reported experiences, prosthetic valve related morbidity and mortality remain high in patients with systemic lupus erythematosus. We describe the first true instance of reconstructive approach in a patient who presented with severe mitral incompetence due to lupus valvulitis. The patient was clinically well with good valve function one year after surgery. Reconstructive mitral valve surgery may be preferable for the surgical management of mitral regurgitation in active lupus valvulitis since it eliminates the need for anticoagulation and avoids the disadvantages of different types of prostheses in these young patients who are under prolonged steroid therapy and have usually associated renal failure.

Adult↗

PubMed1995

[Management of blunt injury of the popliteal artery].

PURPOSE: this retrospective study was undertaken to analyse our results with blunt popliteal artery injury and to detect flaws in our approach. MATERIAL AND METHOD: between 1979 and 1993, 31 consecutive patients with a blunt injury to the popliteal artery were retrospectively reviewed. RESULTS: 4 patients were in shock on admission from a popliteal artery bleed. One patient died before treatment. Primary amputation of the leg was performed in one patient because of extensive tissue destruction. Arterial reconstruction was performed in the remaining 29 patients: 1 patient died of associated injuries, 5 underwent subsequent limb amputation because of infection (in 2), tissular destruction (in 2) and persistent ischemia (in 1). A neurological deficit (mostly of the peroneal nerve) occurred in 13 patients. Increased ischemic time was noted in 6 patients because of non-optimal management: diagnosis of a popliteal artery occlusion was missed in 2 patients, and a rigid approach resulted in an excessive delay in revascularization in 4 patients. DISCUSSION: even though morbidity of blunt popliteal artery injury is greatly determined by the initial trauma, superimposed ischemia further jeopardizes the outcome. A more expeditive revascularization could be achieved in some patients by performing on-table angiograms, immediate fasciotomy to release tissue hypertension and by proceeding with the vascular repair before orthopedic reconstruction. However, if a complex orthopedic repair must be performed initially because of major instability, indwelling shunts should be inserted in the popliteal vessels to insure limb perfusion. CONCLUSION: it is postulated that a rational plan of management of blunt popliteal artery injury would decrease the adverse effect of ischemia, and would reduce overall morbidity.

Adolescent↗

PubMed1994

Successful surgical treatment of a coronary artery mycotic aneurysm.

Mycotic aneurysms of the coronary artery are rare. We report the case of a mycotic aneurysm of the left anterior descending artery. Surgical treatment consisted of simultaneous resection of the aneurysm and revascularization using a venous graft. Thirteen cases of mycotic aneurysms of the coronary arteries have been reported in the literature, and we review these cases.

Adult↗

PubMed1994

Heparin-induced thrombocytopenia and thrombosis following open heart surgery.

We recently observed five cases of early thrombus formation in patients undergoing anticoagulation with subcutaneous heparin following open heart surgery. The reasons prompting surgery were as follows: one mitral valve replacement, one double valve replacement, one mitral valve reconstruction, one aortic valve replacement associated with coronary bypass. In all cases, intravenous heparin was begun on the day of surgery and replaced by subcutaneous (SC) heparin on postoperative day 1. Acute thrombocytopenia was observed between the 6th and 11th postoperative day. This was interpreted as denoting an idiosyncratic reaction to heparin which was replaced by low molecular weight heparin (LMWH) in two cases and by acenocoumarol in the other cases. Massive thrombosis of the aortic valve resulted in the death of one patient. Thrombosis of the left atrium occurred in three patients (two of whom had a transient ischemic attack (TIA)). One patient had aorto-iliac thrombosis. Successful reoperation was carried out in four of the five patients. Although heparin-induced thrombocytopenia and thrombosis [HITT] is a rare complication of heparin therapy, serial platelet count monitoring and in vitro platelet aggregation tests are mandatory in the diagnosis of this syndrome. Discontinuation of heparin is indicated as soon as the syndrome is recognized and the institution of aspirin is recommended if the thromboembolic complication requires reoperation and reexposure to heparin.

Acenocoumarol↗

PubMed1994

Influence of aprotinin on early graft thrombosis in patients undergoing myocardial revascularization.

One hundred sixty-five patients undergoing primary myocardial revascularization were prospectively entered into a randomized, double-blind, placebo-controlled study, in a single institution, in order to determine the influence of high- and low-dose aprotinin application on early coronary artery bypass graft patency. All patients were operated on by the same team and the three treatment groups were comparable in all demographic data and surgical variables. Postoperative chest tube drainage and transfusion requirements were significantly reduced in patients receiving high or low doses of aprotinin. In all patients vein and internal mammary artery graft patency was assessed by control coronary angiograms 4 to 15 days (median 8.2 days) postoperatively. In the high-dose aprotinin group, 140 of 142 vein grafts and in the low-dose aprotinin group all of the 128 vein grafts were patent compared with 138 of 139 in the placebo group. The difference was not statistically significant (P > 0.05). All pedicled internal mammary artery grafts were patent in the three treatment groups. The prevalence of perioperative myocardial infarction was evaluated by serial creatine kinase-myocardial band (CK-MB) isoenzyme measurements and by electrocardiographic recordings. No additional changes that could be attributed to aprotinin were observed. In conclusion, these results suggest that perioperative myocardial infraction secondary to aprotinin-induced native coronary artery or conduit thrombosis is not increased by aprotinin in patients undergoing primary myocardial revascularization.

Aged↗

PubMed1994

Reversed flow in the internal carotid artery after occlusion of the common carotid artery.

Patency of the internal carotid artery in case of common carotid artery occlusion is usually maintained by a flow of blood from the external carotid into the internal carotid artery. A case where a reversed flow of blood was established from the cerebral circulation into the internal carotid artery and eventually into the external carotid artery is presented. Careful reading of the cerebral views of the standard carotid angiogram allowed detection of a retrograde flow into the internal carotid artery. Surgical exploration confirmed the patency of the internal carotid artery; the occluded common carotid artery was bypassed by a prosthesis, which restored an antegrade flow into the internal carotid artery.

Carotid Artery, Common↗

PubMedDate not supplied

Truncus arteriosus repair with double aortic homograft.

Truncus arteriosus (TA) represents 1% to 3% of congenital heart malformations and carries a high mortality if untreated of approximately 85% at 1 year, with almost half the deaths occurring during the first month of life. Significant truncal valve regurgitation (TVR) can be present in up to 50% of cases and reduces survival if persistent after surgical correction. Repair of truncal valves is a promising approach since growth potential and hemodynamics are maintained. Nevertheless this remains a technical challenge and as much as 50% of these valves still need to be replaced at the time of primary repair. Cryopreserved aortic homografts used as aortic root substitutes have provided preservation of excellent hemodynamic conditions as well as prevention of infectious and thromboembolic complications of prosthetic valves. Even if they present structural deterioration with time, they represent an attractive alternative to prosthetic valves in infants and children who would anyhow need reoperation because of the outgrowth of valvular or conduit substitutes.

Abnormalities, Multiple↗

PubMedDate not supplied

Successful management of a postinfarction left ventricular rupture using a sutureless technique with concomitant myocardial revascularization.

We present a case of left ventricular (LV) rupture that occurred on the second day after inferolateral myocardial infarction (MI). An aggressive diagnostic approach with rapid coronary angiography prior to surgical repair provides a benefit characterized postoperatively by complete recovery of myocardial contractility in the akinetic infarcted area. We believe that coronary artery disease associated with subacute ventricular rupture may, in fact, be better investigated and simultaneously treated under a protocol of early surgical repair.

Aged↗

PubMedDate not supplied

Hypoplasia of the posterior leaflet as a rare cause of congenital mitral insufficiency.

A rare case of congenital mitral insufficiency characterized by the hypoplasia of the posterior leaflet is reported. At operation, the mitral valve was successfully repaired by a ring annuloplasty, which created a satisfactory surface of coaptation between the anterior leaflet and the bulky posterior muscular structure. The presence of this posterior muscular structure represents a developmental arrest at the stage of conversion from muscular chordae and leaflets to thin connective structures.

Child↗

PubMedDate not supplied

Systemic pulmonary artery shunt using a bovine mesenteric venous graft in newborns.

A new bovine mesenteric venous graft 3 or 4 mm in diameter was used for performing systemic pulmonary artery shunts in six cyanotic newborns (aged 2 to 30 days) from March 1997 onward. Clinical and echocardiographic studies proved that all shunts were patent and functioning well after an average of 8.8 months despite no postoperative anticoagulation or antiplatelet regimen. Histological examination of two grafts explanted at the time of bidirectional cavopulmonary anastomosis showed no dense fibrotic mural infiltration, calcification, or anastomotic hyperplasia. Bovine mesenteric venous grafts can be used for the construction of systemic pulmonary artery shunts with advantages similar to that of human vein allografts, such as the facility of implantation, good short- and mid-term patency, easy takedown, and avoidance of complications presumably specific to polytetrafluoroethylene.

Animals↗

PubMedDate not supplied

Cardiac sarcoma originating from the tricuspid valve.

Primary cardiac sarcomas are uncommon. We report an unusual presentation of a cardiac sarcoma that originated from the posterior leaflet of the tricuspid valve. This tumor, which provided a working diagnosis of tricuspid valve myxoma before and during surgery, should be considered in the differential diagnosis of right atrial and ventricular masses.

Aged↗

PubMedDate not supplied

Choice of graft material at primary CABG influences cardiac death and reintervention rates.

OBJECTIVES: To evaluate long-term survival and need for reintervention (redo CABG or percutaneous coronary artery transluminal angioplasty, PTCA) as a result of graft materials employed at the primary coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: 2,327 patients who underwent primary CABG between 1980 and 1990 were followed with regard to survival and reintervention requirements for a period of 10 years. There were three groups of patients. In group 1, CABG was performed between 1980 and 1982 using veins only. Group 2 subjects had CABG done from 1983 to 1985 using veins and internal thoracic artery (ITA). Those in group 3 received two ITAs (double ITA) from 1985 to 1990. Redo CABG and PTCS were performed as needed. RESULTS: The 10-year cumulative survival figures for the groups were 92.8 % (group 1), 94.8% (group 2) and 95.4% (group 3). The difference between the groups was statistically significant (p < 0.001). Cardiac event-free survival was 74.4% (group 1), 83.5% (group 2) and 92.6% (group 3), with p < 0.0001. Myocardial infarction occurred more frequently in group 1 (4.7%) than in groups 2 or 3 (2.2 and 1.3%, respectively). The redo rates for CABG were 13.6% (group 1), 8.1% (group 2), and 1.3% (group 3). The corresponding PTCA rates for the three groups were 7.1, 3.7 and 1.6%, respectively (p < 0.0001). CONCLUSIONS: Double ITA, compared with single ITA and/or vein grafts, was the optimal graft material at the time of primary CABG because it had the lowest reintervention rate. It also did not increase postoperative morbidity.

Aged↗