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Biomedical subjects

A Pavie

Publications and source records attributed to A Pavie.

At least 217 records · Page 12Linked to original sources
PubMed1978

[Spontaneous rupture of the renal pelvis. A non-surgical acute abdomen (author's transl)].

The authors report a case of rupture of the renal pelvis in a young man, the course of which was spontaneously favourable over a period of a few days. No aetiology was determined, despite complete clinical, biological, pyelographic and arteriographic studies. The patient recovered completely without surgical or urological treatment. This condition is rare, 50 cases having been published in 1975.

Abdomen, Acute↗
PubMed1978

[Total replacement of the ascending aorta with reimplantation of the coronary arteries. Technic and indications].

Our experience with nine total replacement of the ascending aorta with reimplantation of the coronary arteries has led us to advocate this as the technique of choice for curative treatment of ascending aortic aneurysms when these involve the sinus of Valsalva, and of acute dissecting aneurysms of the aorta when the tear in the intima is situated in the ascending portion. An endo-aneurysmal approach simplifies the operation and considerably reduces the blood loss during surgery.

Adult↗
PubMed1977

[Pulmonary stenosis with tricuspid insufficiency in the child].

The authors report 3 cases of pulmonary stenosis with an intact interventricular septum and tricuspid incompetence. The tricuspid regurgitation was corrected in all 3 cases. After recalling the clinical features, they emphasize the importance of seeking for this condition and correcting it in every case if the immediate and long-term results are to be satisfactory.

Child↗
PubMed1977

[Pacemakers in children].

This is a study of pacemakers in 32 children with permanent pacemakers, 7 of them for congenital block, and 25 for post-operative block, representing a total of 69 pacemaker implantations. After a brief survey of the results, there is a discussion of the problems of the indications, relative for the congenital blocks, and absolute for the surgical blocks after a short period of observation. The choice of type of pacemaker rests upon three essential features: minimum inconvenience, a good length of active life, and the facility of an increased rate. Recent technical progress has allowed these features to be combined. The pacemakers currently available are shown on a table. The results are to a large extent determined by extreme care being taken over the implantation; meticulous asepsis, a low threshold on the electrode test, a pacemaker which is "comfortable" in its site, all these are essential if the serious complications are to be avoided, namely infection and pacemaker failure. The best route for the child, as for the adult, is by way of an epigastric approach with an abdominal pocket. In the very small infant, it seems better to implant by left thoracotomy, and to site the pacemaker intrapleurally.

Adolescent↗
PubMedDate not supplied

Peripheral extracorporeal membrane oxygenation (ECMO) in patients with posttransplant cardiac graft failure.

INTRODUCTION: We sought to report the usefulness of extracorporeal membrane oxygenation (ECMO) in heart transplant patients. PATIENTS: Between March 2002 and August 2004, 14 heart transplant patients (11 men and three women, 36 +/- 15 years old, range = 12 to 50) with primary graft failure underwent peripheral ECMO implantation. Three patients had pulmonary hypertension and three had been transplanted with hearts from marginal donors. At the time of implantation, all were in severe cardiogenic shock despite maximal inotropic support. In six patients, the ECMO was implanted in the operating room since cardiopulmonary bypass could not be weaned. In the eight remaining patients, ECMO was implanted in the intensive care unit, during the first 48 hours in seven cases. In one patient, implantation was performed during external resuscitation. In all cases, femoral vessels were canulated using the Seldinger technique after anterior wall exposure. Distal arterial perfusion of the lower limb was systematically used. RESULTS: Pump outflow was high enough in all the cases (mean: 2.6 +/- 0.2 L/min/m(2)). Three patients died on circulatory support. One patient was implanted with a total artificial heart after a few hours and another one underwent unsuccessful emergent retransplantation. Nine patients were weaned from ECMO after a mean duration of 5 +/- 2.5 days. Among them, one died of infection at 10 days after weaning and seven others were discharged to rehabilitation centers. CONCLUSION: Fast operating room or bedside implantation of a peripheral ECMO allows the physician to stabilize the hemodynamic status of patients with cardiac graft failure, potentially leading toward myocardial recovery.

Adolescent↗
PubMedDate not supplied

Infections with the CardioWest total artificial heart.

The CardioWest total artificial heart is a pneumatically driven device that totally replaces the failing ventricles. It is currently used as a bridge to heart transplantation in selected centers in the United States under a study by the Food and Drug Administration. Twenty-seven patients have undergone placement of the total artificial heart since 1993 with the intention to bridge to transplantation. Inclusion criteria included candidacy for heart transplantation, cardiac index (CI) < 2.0 L/min/m2, and maximal inotropic support. The population consisted of 25 men and 2 women of mean +/- SD age 46.5 +/- 10.3 years, body surface area 2.01 +/- 0.17 m2, and duration of implant 52 +/- 42 days. Initial diagnosis included ischemic cardiomyopathy (n = 10), idiopathic (n = 10), viral (n = 4), valvular (n = 2), and graft failure (n = 1). Infectious complications were defined as systemic (evidence of leukocytosis or fever) or local. The population experienced 64 infections (range, 0-9 per patient): 45 systemic and 19 local. Three patients did not experience any infection. Twenty-five patients reached transplantation, and were discharged home for a survival rate of 92.6%. Two patients died during the bridge, one because of mechanical failure, and one because of infection (mediastinitis). Therefore, death attributable to infections occurred in 3.7%. Previous reports of the total artificial heart experience in the late 1980s described death rates as high as 40%. Although infectious complications are common in patients who are bridged to heart transplantation with the total artificial heart, mortality from infections is 10 times less than previously reported. This may be the result of a better strategy for bridging to transplantation that includes patient selection, mobilization, early central line removal, and waiting until all possible infections are resolved before proceeding to transplantation.

Female↗
PubMedDate not supplied

Minimally invasive coronary surgery with thoracoscopic internal mammary artery dissection: surgical technique.

BACKGROUND: We describe our technique of revascularization of the left anterior descending artery (LAD), using the left internal mammary artery (LIMA) without cardio- pulmonary bypass (CPB), by means of a 4-cm left thoracotomy and video-thoracoscopic harvesting of the LIMA. METHODS: The patient is placed in a semioblique position. The LIMA is harvested under thoracoscopic guidance. Trocars are introduced via three thoracic incisions of less than 15 mm at the level of the fourth and seventh intercostal spaces. Perforating arterial branches are cauterized or clipped. This approach allows complete dissection of the LIMA from the subclavian artery to the fifth intercostal space. A 4-cm left anterior thoracotomy is then made along the fourth or the fifth intercostal space. Rib excision is not necessary for LAD exposure. Coronary artery control is obtained with looping sutures (4/0 prolene) placed proximally and distally to the site of the anastomosis. Anastomosis is then performed with 8/0 prolene on the beating heart, under direct vision, without CPB. RESULTS: Between September 1995 and May 1996, this procedure was performed on 20 consecutive patients under age 80. There were no operative complications. The mean duration of hospitalization was six days. CONCLUSIONS: This new procedure enlarges the field of minimally invasive coronary artery bypass grafting techniques.

Dissection↗
PubMedDate not supplied

[Acute cardiac graft rejection after orthotopic cardiac transplantation. Elements of diagnosis and monitoring, therapeutic attitude].

The diagnosis of acute rejection in heart allograft recipients receiving cyclosporine is still an important challenge. The poor diagnostic value of clinical signs and the ECG means that regular endomyocardial biopsies must be performed. Despite their diagnostic value during the first year after transplantation, endomyocardial biopsies are less sensitive there after and currently suffer from the lack of a universally accepted histological classification. Doppler echocardiography can be used for routine surveillance and has proven reliable for the diagnosis of acute rejection with various clinical presentations when used in conjunction with endomyocardial biopsies. Immunohistological examination of myocardial specimens can further increase the sensitivity of histological diagnosis. Similarly, immunoscintigraphy with indium 111-labelled antimyosin antibodies is of value for the prediction of acute rejection after the first year. Therapeutic approaches have been standardized, but must still be tailored to the individual patient according to the severity of the rejection and the presence of associated infection and/or metabolic disturbances.

Acute Disease↗
PubMedDate not supplied

Results of coronary artery surgery in young adults.

To study the results of bypass surgery in young adults, 221 patients undergoing myocardial revascularisation aged 40 or less (1979-1989) were reviewed. The study included 200 men and 21 women. Mean age was 36.2 years. Risk factors were essentially cigarette smoking (69.6%) and hyperlipidaemia (52%). One-hundred and eighteen patients (53.4%) had a history of previous myocardial infarction (MI) and 16 were operated on after an episode of preinfarction angina. One-hundred and twenty-nine patients had three-vessel disease, 59 had double-vessel disease and 33 single-vessel disease. Twenty-three had left main stem coronary artery lesions. Four-hundred and forty-six saphenous vein grafts and 79 internal mammary artery grafts were performed, an average of 2.3 grafts per patient. Operative mortality was 2.7% (6 patients). Deaths were caused in 4 cases by MI. Twelve patients (5.5%) had a non fatal perioperative MI. One-hundred and ninety-nine patients were followed up for a mean of 7.4 years (4838 patients-years). Seventeen late deaths occurred. Six were from cardiac causes. Overall survival was 84% at 9 years. Five patients underwent cardiac reoperation at a mean interval of 6.4 years after the primary procedure. Eighty-five% of patients were free of angina and 11.5% were in an improved condition. In conclusion, coronary revascularisation can be performed at a reduced risk in younger patients. Long-term prognosis seems similar to that of the overall group of patients undergoing bypass surgery.

Adult↗
PubMedDate not supplied

Mechanical circulatory support as a bridge to transplantation: current status of total artificial heart in 1989 and determinants of survival.

Since April 1986, 40 total artificial hearts (TAH) were implanted as a bridge to transplantation in our institution. In an attempt to identify factors affecting survival of TAH recipients we reviewed our experience over 1000 days of mechanical support. There was no postoperative bleeding requiring surgery nor were there any clinical episodes of thromboembolic complications. Over a total functioning period greater than 3 years there were no mechanical failures in the driving system but one artificial ventricle had to be replaced because of mechanical dysfunction. Infections and multiple organ failure were the primary causes of morbidity and mortality during mechanical support. When the patients who underwent staged transplantation (no. 17) were compared with those who died during mechanical support (no. 23) there were no differences in TAH driving mode or hemodynamic variables between the groups. Although preoperative pulmonary, hepatic and renal functions were found to be similar between the groups, there were significant differences in the early evolution (3 days) of hepatic and renal functions following TAH implant (p less than 0.01). Urinary output was found to be the earliest variable discriminating recovery and survival (p less than 0.01). Finally, univariate analysis indicated age (less than 40 vs greater than 40 years) and modality of cardiac decompensation (acute vs chronic) as the most important factors affecting survival after TAH implantation. Since young patients (less than 40 years of age) with acute decompensation were successfully transplanted in 82% of cases while 100% of older patients with chronic decompensation died before or after transplantation, TAH should be advised in young patients with acute or chronic heart failure and in selected older candidates with recent, acute cardiac failure.

Adolescent↗
PubMedDate not supplied

Liver and kidney function in patients undergoing mechanical circulatory support with Jarvik-7 artificial heart as a bridge to transplantation.

Changes in liver and kidney function were reviewed in 32 patients who received a Jarvik-7 total artificial heart (TAH) as a bridge to transplantation. Preoperatively, seven (22%) had significant isolated kidney dysfunction, five (15%) had isolated liver impairment, and 13 (41%) had combined disorder, affecting 25 (78%) of the 32 recipients. Immediately after TAH implantation, vigorous diuresis occurred, and biochemical indices improved in 17 patients: 71% of isolated kidney, 60% of isolated liver, and 38% of combined organ disorder were reversed irrespective of severity in preoperative dysfunction. In contrast, urine output remained poor, and biochemical indices continued to deteriorate in 15 patients regardless of preoperative status; as a result, kidney (28%), liver (17%), and combined organ failure (33%) accounted for a total of 78% of failure in this series. Although preoperative liver and kidney dysfunction were frequent and severe, they did not correlate with postoperative functional recovery and later transplantation. Recipient body size and initial postoperative urine output were found to be the variables discriminating patients with or without subsequent transplantation. Because liver/kidney failure remained as the leading cause of death, knowledge of the underlying cause of the organ failure would increase the success of TAH as a bridge to transplantation.

Acute Kidney Injury↗
PubMedDate not supplied

Heterotopic heart transplantation: current status in 1988.

Among the 480 patients who underwent heart transplantation in our institution (since 1968), 40 patients received an allograft in the heterotopic position. The recipients were evaluated by using hemodynamics and Doppler echocardiography before and after surgery. Ten to 30 days after surgery, preoperative pulmonary artery pressure, pulmonary artery wedge pressure, and pulmonary vascular resistance (PVR) decreased significantly (p less than 0.005). Cardiac output increased significantly (p less than 0.0001). Postoperative Doppler echocardiography showed that heterotopic hearts had an excellent ejection fraction (mean 73% +/- 11%). No improvement occurred in the left ventricular function of the native heart. Among the factors affecting short-term prognosis of heterotopic heart transplantation (HHT) recipients. PVR seems to be the most important determinant of survival. HHT does not seem to improve the prognosis of patients with elevated PVR. HHT, however, is still indicated in large patients and in emergency situations in which an available donor heart appears unable to support the recipient's circulation if used in the orthotopic position.

Adult↗
PubMedDate not supplied

Intra-atrial insertion of a prosthetic mitral valve.

Infectious lesions of the mitral ring sometimes cause so much damage that insertion of the prosthesis in its normal place is impossible. In such cases, artificial valves with a dacron flange can be implanted into the left atrium, just above the mitral ring, and sutured to the atrial wall. These valves are generally used in first or second re-operations for recurrent desinsertion, but they have proved so reliable that their use can be extended to primary mitral valve replacement in cases where extreme calcification of the mitral ring throws considerable doubt on the success of conventional techniques.

Evaluation Studies as Topic↗