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Biomedical subjects

A Piwnica

Publications and source records attributed to A Piwnica.

At least 145 records · Page 8Linked to original sources
PubMed1980

Reconstructive surgery of mitral valve incompetence: ten-year appraisal.

Between January, 1969, and January, 1978, 551 patients with mitral incompetence were treated by a system of reconstructive techniques. Mitral valve incompetence was classified into three types according to leaflet pliability; type I normal leaflet motion, 150 cases; type II, leaflet prolapse, 213 cases; and type III, restricted leaflet motion, 188 cases. Associated tricuspid valvular disease was present in 174 cases (31.5%) and was treated by prosthetic ring annuloplasty. The operative mortality rate was 4.2% (16/377) in the mitral group and 14% (25/174) in the mitral-tricuspid group. Follow-up data are available in 341 patients from 1 year to 10 years (average 4 1/2 years). The late mortality rate was 7% (24/341). Actuarial curves including hospital mortality rate show an 82% survival rate at 9 years in the mitral group and a 79% rate in the mitral-tricuspid group. Thirty-seven patients (11%) underwent reoperation mainly for residual (17) or recurrent (16) mitral incompetence. Thromboembolism occurred in 12 patients for an embolic rate of 0.6% per patient-year, even though 48% were not given anticoagulants. Acorrding to the New York Heart Association (N.Y.H.A.) classification, 76% (207/270) of the patients were in Class I, 19% (51/270) were in Class II, 4% (10/270) were in Class III, and 0.7% were in Class IV (2/270). Results of postoperative catheterization and angiocardiography are available in 52 patients. Comparison between the various groups shows that the best results were obtained in type II mitral incompetence, followed by type I and type III mitral incompetence. This experience demonstrates that predictable and stable long-term results have been achieved by techniques of valvular reconstruction with a low incidence of thromboembolism. Reproducibility of the techniques is a limiting factor which can be overcome by adequate training and progressive experience. Patient selection is based on the valvular disease rather than age, physical condition, or cause of valvular disease.

Adolescent↗
PubMed1979

[Postoperative haemodynamic evaluation of myocardial protection by physicochemical cardioplegia. Hyperkaliemic, hyperosmolar and acid solution at 4 degrees C (author's transl)].

Myocardial protection by a combination of cardiac hypothermia and chemical cardioplegia (high concentration of K+ and Mg++, hyperosmolarity, acid pH), was studied during 20 valve replacements. Essentially assessed on the basis of repeated measurements of postoperative cardiac output, the results were compared with those obtained previously using local hypothermia only (20 patients) and hypothermic cardioplegia using Ringer Lactate (20 patients). Analysis of haemodynamic data, which thus involved 60 patients, indicated the superiority of physicochemical cardioplegia, and this for clamping periods of up to 2 hours, but also showed the desirability of changes in the protection protocol during the ischaemia phase and during reperfusion which might improve the results.

Cardiac Output↗
PubMed1979

[Remote results of ostial coronaritis surgically treated].

This study comprises 15 patients operated for syphilitic coronary ostial stenosis by Dubost's team between 1959 and 1975. Three operative deaths (20%) were observed. Three other late deaths occured, but only one of his coronary pathology. Of the nine survivors, seven have been reviewed and five have undergone control coronary angiography. The long term results of the 9 survivors, reviewed from 3 1/2 to 11 years after operation, illustrate the difficulties of disobliteration of the right coronary ostium, the necessity of changing the aortic valve systematically when incompetent and the maintenance of the good results obtained by this surgery.

Adult↗
PubMed1978

Case report of congenital tricuspid insufficiency.

Congenital tricuspid insufficiency is a rare disease secondary to malformations of the tricuspid valve and their chordae tendinae. Diagnosis is difficult but worthwhile, since surgery can be performed. We report one case repaired by surgery.

Adolescent↗
PubMed1978

Conservative management of the prolapsed mitral valve.

Prolapsed leaflet is the result of ruptured chordae, elongated chordae, or ruptured papillary muscle. Various techniques adapted to each of these lesions were developed, and repair of 213 prolapsed mitral valves was performed between 1969 and 1977. There were 109 patients with ruptured chordae treated by quadrangular resection of the prolapsed leaflet; 103 patients with elongated chordae were treated by either a "sliding plasty" of the papillary muscle or a "shortening plasty" of the chordae; and 1 patient with ruptured papillary muscle was treated by reimplantation. The great majority of patients had an associated annular dilatation or deformation requiring the use of a Carpentier ring to remodel the annulus and reinforce the repair. The operative mortality was 4% and the late mortality, 3%. There were 6 reoperations, 3 of which occurred within 1 year. Thromboembolic complications occurred in only 1 patient (0.5%), even though the majority of patients received no anticoagulation treatment. Actuarial curves demonstrated a 91% survival at 8 years.

Adult↗
PubMed1978

Right atrial myxoma: an echocardiographic study.

A case of right atrial myxoma is reported in a 29-year-old man. Though it was a large tumour, the diagnosis remained unsuspected for a long time. Multiple echo recordings strongly contributed to the diagnosis. After surgical removal, the post-operative course was uneventful.

Adult↗
PubMed1978

Aneurysm of the main stem of the left coronary artery associated with aortic insufficiency and aneurysm of the ascending aorta. Report of a case with successful surgical repair.

A case of aneurysm of the main stem of the left coronary artery associated with aortic insufficiency and an aneurysm of the ascending aorta is reported. The importance of coronary angiography in diagnosing this condition is illustrated. Surgical repair included isolation of the coronary aneurysm and replacement of the ascending aorta and aortic valve, combined with triple aortocoronary saphenous vein bypass grafts. A review of the aetiology, clinical features, and surgical management of coronary artery aneurysms is presented.

Adult↗
PubMed1978

[Remote results of the surgical correction of aortic coarctation. Study of 90 patients operated on 11 to 15 years earlier].

An 11 to 15 year follow up (mean 12.7 years) of 90 patients undergoing surgery for coarctation of the isthmus of the aorta is reported. There were 7 late deaths. Of the survivors 87% were normotensive (B.P. less than or equal to 160/100 mmHg) and 90% were asymptomatic and leading a normal life. Five cases-all with an aortic prosthesis-had to be reoperated for recurrent coarctation. These figures are comparable with those found in the literature. The best long-term results are obtained in patients who have the operation while young (less than 20 years), who have no associated abnormality, and whose coarctation can be treated by resection with direct anastamosis.

Adolescent↗
PubMed1977

[Hemodynamic aspect of post ECC cardiac failures. Study of 193 cases].

The aim of this study is to define the hemodynamic characteristics of this "clinical model" of acute cardiac failure observed after cardiac surgery carried out under extra-corporeal circulation, which constitutes the essential cause of "post-operative low cardiac output syndrome". The 193 patients in this study make up a representative sample of patients operated, treated and studied according to a homogeneous methodology for a period of 1 year. The clinical analysis of the post-operative circulatory condition, after exclusion of non cardiogenic syndromes, led to grouping the cases into 5 classes of circulatory change of increasing severity, each corresponding to a specific "therapeutic necessity". The hemodynamic results (intra-vascular pressures, oxymetry, cardiac output by "Cardio-Green" dilution method) are given for each of the five classes, thus defining the "hemodynamic profile" and the statistical reliability of the main objective parameters. This gives proof of the therapeutic indications for the main therapeutic procedures actually known, for which we prevent the hemodynamic effects noted for each of them. Thus, three "degrees of cardiac failure" are found: less severe (classes I and II) call for simple metabolic equilibration and possibly diuretics: the systolic work is above 160 gm/m2. Decompensated circulatory failure (classes III and IV) corresponds to a more important reduction in systolic work (9) 15 gm/m2, i.e. between 20 et 40 p. 100 of the basal value), and call for sympatho-mimetic cardiotonic agents: isoprenaline and/or dopamine. Below this value, in spite of medical treatment, the hemodynamic situation can still be sometimes reversible under circulatory assistance (diastolic counter pressure by means of an aortic balloon). Confronted with the clinical picture, the hemodynamic study enables the quantification of the circulatory change, and specification of the cardiogenic part and thus especially helps the carrying out of the treatment.

Adolescent↗
PubMed1977

[Emergency treatment of mechanical complications of acute myocardial infarction. Septum perforations and mitral insufficiency].

Over the last three years, thanks on the one hand to improvements in surgical techniques and ressuscitation, and on the other to assisted circulation using the intra-aortic balloon, which allows improved preoperative preparation of the patients, urgent medicosurgical treatment of the mechanical complications of infarction has improved the prognosis by comparison with the recent past. During the above period, our figures for operative intervention during the first two weeks after an acute infarction have been as follows: 1. Twenty nine cases of septal perforation (17 of which had previously had assisted circulation by balloon): there were 8 immediate deaths and 8 successful cases (no secondary deaths over a follow-up period of from 2 to 41 months). In all these cases, the surgeon approached the perforation by way of the left ventricle. No patient required an additional bypass procedure. Where indicated, assisted circulation by means of a balloon should not be continued for more than a few days. If there is no improvement with its use, it seems unreasonable to proceed to surgery regardless. 2. Ten cases of acute mitral incompetence; 8 were due to ruptured papillary muscle and two to mal function. 5 patients out of the 10 had required circulatory assistance by balloon preoperatively. There were 2 immediate deaths and 8 successful cases, with one secondary death (follow-up period of between 2 and 37 months).

Acute Disease↗