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Biomedical subjects

A Senning

Publications and source records attributed to A Senning.

At least 37 records · Page 2Linked to original sources
PubMed1986

Treatment of Budd-Chiari syndrome by dorsocranial liver resection and direct hepatoatrial anastomosis.

Since 1980 an operation which reestablishes the blood outflow from occluded hepatic veins was performed in 7 patients with Budd-Chiari syndrome by one of us (A. Senning). Using extracorporeal circulation a dorsocranial cylindrical resection of the liver including the confluence of the occluded hepatic veins was performed by transcaval approach. The incised right atrium was sutured around the resected liver area. There was one intraoperative death. In 6 patients with a mean postoperative follow-up of 19.2 months (4-42 months), the patency of hepatoatrial anastomosis was documented by angiography or Doppler-2d-echocardiography. Four patients are free of symptoms and signs of Budd-Chiari syndrome. In one of two patients with associated cirrhosis compression of inferior vena cava reoccurred and in another patient esophageal varices persist. We conclude, that the hepatoatrial anastomosis is an effective treatment of Budd-Chiari syndrome.

Adult↗
PubMed1986

Experience with the helix cava filter.

A new caval filter of helico-spiral geometry (Helix-Filter) was implanted in 13 patients for the prevention of pulmonary embolism (PE). The indications for implantation were: recurrent PE despite adequate anticoagulation (5 cases) or contraindication to anticoagulation (3 cases), incomplete local therapeutic fibrinolysis after severe paracentral PE (2 cases), and prophylaxis in high risk patients (3 cases). Implantation was effected by the saphenous/femoral vein approach in 12 patients, and via the right atrial appendage during open heart surgery in one instance. There were no intraoperative technical problems and in no case was the filter misplaced. During the follow-up period (mean 14.8 months, maximum 28 months) no filter-related complications were encountered. One patient with an exceptionally enlarged vena cava, due to abnormal renal vein inflow, had a fatal recurrent PE despite high dosage heparinization. One patient with an event-free follow-up died 12 months after filter placement from unrelated diseases. The remaining 11 patients are free of symptoms with no recurrent PE, no deterioration of venous circulation or presence of caval thrombosis. Emboli trapped at the filter were documented in 2 patients; spontaneous resolution occurred in one case. Experimental and early clinical results indicate that the hemodynamically optimal design of the Helix-Filter permits controlled and uniform luminal filtering with high patency. As such, it represents an alternative and highly promising solution to the problem of "mechanical" prevention of pulmonary embolism in selected patients.

Adult↗
PubMed1986

Budd-Chiari syndrome in sarcoidosis.

A 34-year-old previously healthy woman presented with bilateral interstitial lung changes and thrombotic occlusions of the hepatic veins. A transcaval wedge resection of the liver and a hepato-caval anastomosis were performed. This operation reestablished the impaired intrahepatic venous flow and relieved the portal hypertension and the associated symptoms. Histopathological examination of both liver and lung tissues revealed noncaseating granulomas without microorganisms, confirming the suspected diagnosis of sarcoidosis. The hepatic veins were demonstrated to be narrowed by sarcoid granulomas forming the mechanical basis for venous stasis and extensive thrombotic occlusions. To our knowledge only one other case of a Budd-Chiari syndrome occurring in a patient with sarcoidosis has been reported.

Adult↗
PubMed1985

[Lung varices. A case report].

Pulmonary varices are dilated pulmonary veins with normal anatomy of pulmonary venous return. Etiology, diagnostic procedures nd different forms of pulmonary varices are discussed. Surgery is indicated for thromboembolic or hemorrhagic complications, or, as in the case of our patient, for suspected malignoma.

Adult↗
PubMed1985

[Surgical treatment of type I and II dissecting aortic aneurysms].

Over a period of 15 years, 89 patients (70 male, 19 female) aged 15-76 (mean 48) underwent surgery for acute (64) or chronic (25) dissecting aneurysm type I or II. Early mortality was 18% (16 patients); 8 patients died late (2.8% per year); 8 patients had to be reoperated because of late complications on the aorta. Although very often it is not possible to remove or replace the entire diseased aorta, the goal of the operative procedure is to reduce the risk of rupture by replacing the entry site with a dacron graft. Late reoperation has to be considered if dissection progresses or a new aneurysm develops.

Adolescent↗
PubMed1985

[Remote results of mitral valve surgery in mitral valve insufficiency, 1972-1982].

Between 1972 and 1982 315 patients were operated on for isolated or predominant mitral insufficiency at Surgical Clinic A, University of Zurich. The etiology was rheumatic in 51 patients and degenerative in 133. Of these 164 patients, 42 underwent a reconstructive procedure and 122 mitral valve replacement. Patients who underwent mitral valve reconstruction were younger and had a longer average postoperative observation time than patients who had mitral valve replacement. Operative mortality of the total series was 2.4%. Late postoperative survival was very similar in the patients with rheumatic and degenerative mitral incompetence. Seven-year survival after mitral valve reconstruction was 87 +/- 5%, compared to 76 +/- 6% after mitral valve replacement. Mitral valve reconstruction patients required more reoperations than those with mitral valve replacement. On the other hand, the incidence of late embolism and endocarditis was lower after mitral valve reconstruction. Age of patients at operation and a preoperative reduction of ejection fraction and cardiac index were predictors of a less favourable postoperative course. From these observations we conclude that surgery should be carried out before irreversible impairment of left ventricular function, even where symptoms are less than severe. If possible, reconstructive surgery for mitral incompetence is justified in view of the lower postoperative risk of embolism and endocarditis and in spite of the higher incidence of recurrences requiring reoperation.

Adolescent↗
PubMed1985

Huge left coronary artery aneurysm associated with multiple arterial aneurysms.

Natural history of an aneurysm at the bifurcation of the left coronary artery is reported. A gradual increase in its size occurred over an 18-year period until it was a huge and partially thrombosed sac. It was associated with ectasia of the right coronary artery, aneurysms of the left subclavian artery and thoracic aorta, and calcified dilatations of the branches of the celiac trunk.

Aged↗
PubMed1985

Platelet inhibitors versus anticoagulants for prevention of aorto-coronary bypass graft occlusion.

The effects of the antiaggregant substance ticlopidine and of the anticoagulant acenocoumarol on patency rates of aorto-coronary bypass grafts were compared in a prospective randomized trial. Ticlopidine, 250 mg b.i.d. was administered orally from the first postoperative day till angiography, while anticoagulation with acenocoumarol was initiated on the second to third postoperative day. Side-effects of ticlopidine were rare and patient management with the standard dosage of this drug was easier than oral anticoagulation. From an initial group of 166 randomized patients 149 completed the trial by coronary angiography three months postoperatively. The 78 patients in the ticlopidine group showed a compliance of 85%. The average prothrombin time in the 71 patients receiving acenocoumarol was 26.9%. Detailed statistical analysis of the two study groups revealed no reason to doubt the correctness of randomization. Coronary angiography showed an average patency rate per patient of 84% with ticlopidine and of 82% with acenocoumarol. This and various other measures of graft occlusion did not reveal any substantial difference in graft patency of patients receiving ticlopidine or acenocoumarol. It is concluded that ticlopidine may well be used instead of anticoagulants for prevention of postoperative occlusion of aorto-coronary bypass grafts.

Acenocoumarol↗
PubMed1984

[Heart surgery in patients older than 70 years].

Between 1980 and 1983, 103 patients over the age of seventy (average 72.5 years) underwent cardiac surgery. It comprised 41 aortic valve replacements, 11 mitral valve operations, 7 aortic and mitral valve procedures, 18 valve replacements with concomitant coronary artery bypass grafting, 17 coronary revascularizations, 7 operations for VSD after acute myocardial infarction and 2 procedures for dissecting aneurysm of the ascending aorta. Early mortality was 7.8% and late mortality 10% after a mean follow-up of 29.3 months. Preoperative NYHA-class IV is an incremental risk factor for early and later cardiac death. Early and late results are very satisfactory in patients with isolated valvular lesion, with or without concomitant coronary artery disease, and for isolated coronary atherosclerotic heart disease, whereas there is a high risk of early and late death in patients with multiple valvular lesions or VSD after acute myocardial infarction.

Age Factors↗
PubMed1984

[Coronary reoperation--yes or no?].

From 1979 to April 1984, 51 patients were reoperated on for postoperative angina pectoris. Three patients died early and 4 late. The cause of death was cardiac in all cases. After the second operation the mean observation period was 24.2 months and the mean functional class 2.0. These results were somewhat worse than was to be expected after the first operation. The single significant risk factor was an ejection fraction reduced below 50%. The indication for reoperation should therefore be confined to patients with severe angina, good left-ventricular function, bypassable coronary arteries and sufficient graft material available (saphenous vein, internal mammary artery).

Adult↗
PubMed1984

[Aortic valve replacement with simultaneous aorto-coronary bypass operation 1969-1980].

Between 1969 and 1980, 62 patients underwent aortic valve replacement with simultaneous aorto-coronary bypass implantation. Three patient groups were formed, namely patients with predominant aortic valve disease, patients with predominant coronary heart disease and patients with simultaneous severe aortic valve disease and coronary heart disease. The results were analyzed separately for the three patient groups. The operative risk of patients with severe aortic valve disease was not greatly increased by the simultaneous implantation of aorto-coronary bypass. On the other hand, patients with predominant coronary disease and aortic valve replacement for mild to moderate aortic valve disease had an increased operative mortality and rate of perioperative infarctions. The unfavorable results in the latter patient group can most probably be explained by patient selection. Late mortality appears to increase with the severity of coronary heart disease. Prognosis of the total patient group was less favorable than that of isolated aortic valve replacement or aorto-coronary bypass operation. The implantation of aorto-coronary bypass did not completely prevent the reappearance of angina pectoris or myocardial infarction in the late postoperative follow-up. Several risk factors for a less favorable course were identified.

Aged↗
PubMed1984

Radiological follow-up of transluminally inserted vascular endoprostheses: an experimental study using expanding spirals.

A technique for transluminal implantation of vascular endoprostheses was developed. Using a suitable instrument, 160 spiral-shaped prostheses of various forms and sizes were torsion-reduced in diameter and transluminally inserted under fluoroscopy in our study population consisting of 65 dogs and five calves. At the target, the spirals were enlarged and released from the carrier, whereupon they attached themselves to the vessel wall by elastic expansion. We implanted spirals into the vena cava or the thoracic and abdominal aorta, using the infrarenal aorta and the jugular or femoral vein for access. Angiography (the maximum follow-up was two years) demonstrated that the operation was reproducable and that it could be planned. Angiography also demonstrated that the position of the spiral prosthesis was stable and that the spiral did not lead to stenosis, thrombosis, or perforation, providing an adequate technique was used. The side branches of the main vessels remained patent, even with several spiral coils across their orifices. The method can be clinically implemented and lends itself to many applications in the vascular field.

Animals↗
PubMed1983

[Prognosis for patients following surgical correction of transposition of great vessels].

Without surgical help, 90% of patients with transposition of the great arteries (TGA) will die during the first year of life. After repair of TGA, 90% of patients reach adult life. A number of hemodynamic complications and arrhythmias may occur and must be recognized, because some require reoperation or pacemaker implantation. Nearly 8 years postoperatively the vast majority of patients were symptom-free and over 90% were attending an ordinary school or pursuing a profession. Dysfunction of the right (systemic) ventricle and its atrio-ventricular valve may become progressive in the late follow-up and could limit the reported success-rate in the future.

Arrhythmias, Cardiac↗
PubMed1983

[Abdominal aortic aneurysm in the patient over 70--surgery in any case?].

During 1980 and 1981, 36 patients aged 70 years or older were operated on for abdominal aortic aneurysm. The aneurysm was already ruptured in almost half of the patients. Eight patients died early (22%), of whom 7 were operated on because of perforation. Main cause of early death was cardiac failure (5). During an average observation period of 12 months, 4 patients died late and 4 claimed unsatisfactory recovery. All patients over 70 years of age with abdominal aortic aneurysm should be investigated with respect to operability. The risk in elective surgery is low and the postoperative prognosis for these patients is good. Surgery for ruptured aneurysm still carries high operative mortality in this age group and a poor longterm prognosis.

Aged↗