Search PubMed⌕ Search

Biomedical subjects

A Serraf

Publications and source records attributed to A Serraf.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Transposition of great vessels with position anomaly of the atrioventricular valves or chordae: echocardiographic aspects and surgical correlations].

The authors report the echocardiographic appearances of 27 cases of transposition of the great arteries (TGA) with ventricular septal defect (VSD) (including the Taussig-Bing malformation) complicated by displacement of one or both atrioventricular valves and/or chordae tendinae diagnosed between September 1985 and September 1994. An anatomical repair was performed in 21 cases and allowed accurate correlation of the echocardiographic and peroperative findings; a cavo-bipulmonary conduit or a palliative procedure was performed in 6 cases. The cases were classified in 3 groups: group I: 16 children with isolated tricuspid valve abnormalities; group II: 7 cases of mitral valve straddling; group III: 4 cases of displacement of both atrioventricular valves and/or their chordae. The cases of group I were divided into 3 subgroups: subgroup Ia with insertion of the tricuspid chordae on the infundibular septum (7 cases); subgroup Ib with isolated overriding of the tricuspid valve (2 cases); subgroup Ic straddling with or without overriding of the tricuspid valve (7 cases). In all three groups, there were 10 cases of straddling of the tricuspid and 11 cases of straddling of the mitral valve: 9 type A, 3 type B and 9 type C of Tabry's classification. Echocardiography misdiagnosed one case of type A straddling of the tricuspid valve for a type A overriding and straddling of the mitral valve. The ventricular septal defect was situated in the admission septum in the 10 cases of straddling of the tricuspid; in the 11 cases of straddling of the mitral valve the chordae passed through the superior anterior part of the interventricular septum.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1995

[Pulmonary artery banding in the treatment of univentricular heart. Results and therapeutic implications for cavopulmonary derivations].

Eighty-six children under one year of age with univentricular hearts associated with increased pulmonary flow underwent pulmonary artery banding as the first stage of palliative therapy. Fifteen patients also had treatment of coarctation of the aorta at the same time and an atrial septal defect was treated in 13 patients. Twenty-seven patients underwent a Fontan procedure secondarily. The mean follow-up was 42.6 +/- 45.5 months; 8 patients were lost to follow-up. Twenty-three patients died during the whole of the study period. The global actuarial survival rate was 69.6 +/- 5% at 5 years. The 3 year survival rate was 56 +/- 12% in patients with anatomical right ventricles compared with 74.4 +/- 5.7% and 69.5 +/- 7.3% at 3 and 5 years respectively in those with anatomical left ventricles (p < 0.01). The presence of coarctation of the aorta reduced the 5 year actuarial survival rate to 25.4 +/- 12.8% (p < 0.01). Subaortic stenosis either at the time of initial presentation or occurring during pulmonary banding was associated with a 5 year survival of 58.3 +/- 13.7% (p < 0.01). Uni- and multivariate analysis demonstrated poor prognostic risk factors. On univariate analysis, they were the residual mean pulmonary pressures after banding, coarctation of the aorta, subaortic stenosis and a restrictive atrial septal defect. Independent risk factors on multivariate analysis were the residual pulmonary pressures after banding, coarctation of the aorta, the necessity of operation in the neonatal period and the need for reoperation for reason other than for a cavopulmonary connection. The feasibility of a Fontan procedure was reduced when subaortic stenosis was observed at any time. Only 17.5% of patients were free of reoperation during this study for whom banding remained the only palliative procedure. In conclusion, a programme of cavopulmonary connection should be envisaged from the initial presentation of these patients. The different stages of treatment with this objective in mind should aim to preserve myocardial function and keep pulmonary resistances low. Therefore, pulmonary artery banding should be rejected in cases with coarctation of the aorta and/or subaortic stenosis. Similarly, early conversion with a Glenn type bidirectional anastomosis allows adaptation of myocardial function for a secondary total cavopulmonary connection.

Analysis of Variance↗
PubMed1994

Pulmonary circulation evaluation before cavopulmonary connections: the cavopulmonary bypass.

The outcome of Fontan-type procedures is dependent on several risk factors, among which pulmonary vascular resistances (PVRs) are an important component. Preoperative calculation of PVR entails several potential sources of error, particularly in patients with pulmonary atresia or multiple sources of pulmonary blood flow. In an attempt to develop a reliable test that accurately assesses the hemodynamic patterns of the pulmonary vascular bed before a Fontan procedure, a simulation of Fontan-type circulation was achieved in 13 patients by a partial cardiopulmonary bypass between the main pulmonary artery and both venae cavae (cavopulmonary bypass). During cavopulmonary bypass, pressures and resistances were recorded. Immediately after cavopulmonary bypass, the circulation was converted to standard cardiopulmonary bypass and the cavopulmonary connection was carried out. Preoperative pulmonary vascular resistance indexes were assessed roughly by the arteriovenous oxygen difference in systemic and pulmonary beds. There was no correlation between preoperative and perioperative calculations of pulmonary vascular resistance indexes (r = 0.24; p = not significant). Hemodynamic data available for all patients then were correlated to the early postoperative outcome assessed by a subjective four-point scale. A positive, significant correlation was found with intraoperative PVR (r = 0.90; p < 0.001), indexed PVR (r = 0.90; p < 0.001), and the pulmonary to systemic vascular resistance ratio (r = 0.98; p < 0.0001). Two of 13 patients had a 4-mm fenestration in the atrial baffle. No mortality or morbidity was related to the procedure. The absolute values of PVR and pulmonary vascular resistance indexes were strikingly higher than generally admitted for this type of procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Conventional cardiopulmonary bypass in neonates. A physiological approach--10 years of experience at Marie-Lannelongue Hospital.

There is still controversy about the optimal method of venoarterial cardiopulmonary bypass (CPB) for correction of congenital heart disease in neonates and young infants. High rates of CPB-related morbidity and mortality are still reported. Since 1980, conventional CPB with double caval cannulation with right-angled cannulae has been used in the high majority of neonates at Marie-Lannelongue Hospital. The extracorporeal circuit was miniaturized to be primed with a volume as small as possible. Priming (500 ml) was done with packed red cells and fresh frozen plasma. CPB was conducted at 30% haematocrit and normal ranges of flow rate, arterial pressure, systemic vascular resistances and oxygen delivery. These normal physiological parameters were also maintained during hypothermia. During the last two years, 151 neonates below 15 days old who underwent open-heart surgery were reviewed. The overall hospital mortality was 7.24%. None of the survivors had postoperative complications related to CPB. All physiological and biological values remained within normal ranges during the postoperative course.

Cardiopulmonary Bypass↗
PubMed1994

Surgery for tetralogy of Fallot at less than six months of age.

Absence of consensus persists regarding the optimal procedure and timing for the surgical treatment of young infants with symptomatic tetralogy of Fallot. From 1987 through 1992, 56 patients with tetralogy of Fallot were operated on at less than 6 months of age. Forty-one patients (median age 2.9 months) underwent primary repair and 15 (median age 2.4 months) underwent initial palliation. Mean follow-up was 24.2 +/- 16.4 months. No strict protocol was used but patients who received initial palliation were younger, had a smaller pulmonary arterial tree, or had anomalous coronary artery. Two patients died (overall mortality 3.6%; 95% confidence limits 0% to 11%), one after initial palliation (6.7%), and one after primary repair (2.4%) (P = 0.47). Eight of the 15 patients who received initial palliation underwent repair and had an increase in pulmonary anulus size at the time of definitive repair (mean difference Z-value = 2.2 +/- 1.6 standard deviation; p = 0.006). Transannular patch was required in 50% of patients who underwent repair (56% among patients having primary repair versus 13% for patients having initial palliation; P = 0.03). Five patients underwent reoperation. Early primary repair of symptomatic tetralogy of Fallot was achieved with a low mortality rate and is the preferred protocol. Initial palliation remains indicated in case of associated cardiac anomaly, very low weight, or severely hypoplastic pulmonary artery tree.

Age Factors↗
PubMed1993

Aortic arch thrombosis in the neonate.

Two cases of neonatal aortic arch thrombosis are reported. One patient, who had ascending aortic thrombosis, died preoperatively. The other had reoperation and is alive and well at 6 months' follow-up. No obvious cause was found.

Adult↗
PubMed1993

Anatomic correction of transposition of the great arteries in neonates.

OBJECTIVES: This retrospective study attempts to assess the results of the neonatal anatomic repair of transposition of the great arteries by a single institution. BACKGROUND: Anatomic correction of transposition of the great arteries by means of the arterial switch operation is now widely accepted as the therapeutic method of choice. METHODS: Four hundred thirty-two consecutive neonates underwent an arterial switch operation for various forms of transposition of the great arteries. There were 362 neonates with transposition and intact ventricular septum, 47 with a ventricular septal defect, 6 with intact ventricular septum and coarctation of the aorta and 17 with ventricular septal defect and coarctation. Among patients with coarctation, 18 underwent a single-stage repair through median sternotomy. The mean age was 13.1 +/- 4.2 days. Coronary artery distribution was described according to the origin and initial course of the arteries. RESULTS: Overall in-hospital mortality was 7.8% (34 patients) and was 7.6% for transposition with intact ventricular septum, 8.5% for transposition with ventricular septal defect and 13.3% for transposition with ventricular septal defect and coarctation. Univariate analysis of risk factors revealed that coronary anatomy was the main determinant for operative survival. A mean follow-up time of 44 +/- 19 months was achieved in all but five survivors. More than 95% were in New York Heart Association functional class I, without medication and with normal left ventricular function. Reoperation was performed in 20 patients: early reoperation (< 30 days) in 4 and late reoperation in 16. Actuarial survival rates at 5 years were 91.3% (transposition with intact ventricular septum) and 81.06% (transposition with ventricular septal defect). As well, freedom from reoperation at 5 years was 96.8% (transposition with intact ventricular septum) and 84.6% (transposition with ventricular septal defect). CONCLUSIONS: The arterial switch operation is feasible in almost all forms of transposition of the great arteries in neonates as primary and definitive repair. Palliative surgery is recommended in cases with complex intracardiac anatomy not amenable to early repair.

Aorta↗
PubMed1993

Subaortic obstruction in double outlet right ventricles. Surgical considerations for anatomic repair.

BACKGROUND: Subaortic obstruction is one of the risk factors for anatomic repair of double outlet right ventricles (DORV). A comprehensive approach to such lesions has been developed in our institution since 1981. This retrospective work analyzes the results of this approach. METHODS AND RESULTS: Between January 1981 and September 1992, 30 patients aged 15 days to 15 years (mean, 44.8 months) underwent repair of a DORV associated with subaortic obstruction. Eighteen patients had a palliative procedure before complete repair. The ventricular septal defect (VSD) was subaortic in 15 patients, doubly committed in 1, noncommitted in 9, and subpulmonary in 5. The subaortic obstruction was a result of restrictive VSD in 29 patients and of double straddling of mitral and tricuspid valves once. The preoperative peak systolic pressure gradient between the left ventricle and the aorta (LV-Ao) was 68.7 +/- 23 mm Hg. Reconstruction of the left ventricular outflow tract comprised a ventral enlargement of the VSD in subaortic, doubly committed, and those subpulmonary VSDs scheduled for an arterial switch operation or a conal resection in noncommitted and other subpulmonary forms. Reconstruction of the right ventricular outflow tract included primary closure of the right ventricle in 12 patients, an infundibular patch in 9, a transannular patch in 4, and insertion of a right ventricular pulmonary valved conduit in 5. There were two early (6.6%) and two late (7.1%) deaths. Three patients required reoperation. A mean follow-up of 60.5 +/- 46.8 months was achieved in all the survivors. They were all in New York Heart Association class I or II, in sinus rhythm. At last follow-up, the mean LV-Ao gradient was 7.5 +/- 6.2 mm Hg, and LV function indices were within normal ranges. Actuarial survival and freedom from reoperation rates at 8 years were 86.6% and 87.0%, respectively. CONCLUSIONS: Surgical relief of subaortic obstruction in DORV has to be adapted to VSD location and spatial arrangement of atrioventricular valves and great vessels.

Aortic Stenosis, Subvalvular↗
PubMed1993

[Atresia or congenital stenosis of the left coronary ostium. Myocardial revascularization in 5 children].

Five patients, 3 months to 13 year old with atresia (4) or stenosis (1) of the left coronary artery underwent myocardial revascularisation at Marie Lannelongue Hospital. The preoperative symptoms were dominated in one case by cardiac failure due to myocardial infarction and in the other cases by effort angina with syncope. The operative technique of revascularisation in one case was angioplasty with enlargement of the left main coronary artery with a patch and, in the others, bypass graft of the left coronary artery with the left internal mammary artery. All 5 patients survived surgery and are asymptomatic with a follow-up of 6 months to 7 years. Control coronary angiography confirmed the patency of the different procedures of myocardial revascularisation. In 3 children, exercise electrocardiography was normal. Myocardial revascularisation of a child with a congenital stenotic abnormality of the left coronary network is possible, the technique of which depends on the diameter of the left main stenosis when the vessel is absent or atresic, left internal mammary artery bypass graft is the only solution. When the left main coronary is stenosed but patent, direct reconstructive surgery is an interesting alternative.

Adolescent↗
PubMed1993

[Comparison of long-term results of arterial switch and Senning procedure in transposition of great vessels with intact ventricular septum].

One hundred and five survivors after the 30th day of complete cure of transposition of the great arteries with intact ventricular septum between 1980 and 1985 were followed up. Fifty-four had an arterial switch (AS) in a single stage at an average age of 10 +/- 9 days and 51 had Senning's procedure (S) at an average age of 4 +/- 2.5 months. The average follow-up (97% of patients) was 5.8 +/- 1.1 years for the AS group and 9.3 +/- 2.3 years for the S group. The actuarial survival at 5 years was 100% in the AS group and 85.8% in the S group (p < 0.01) (8 late deaths). In the AS group, 3 patients were reoperated for stenosis of the pulmonary artery and, in the S group, 4 patients underwent 6 reoperations. All but 3 patients in the S group and all but 1 patient in the AS group are in functional Class I of the NYHA classification. Doppler echocardiographic studies have shown mild to severe dysfunction of the systemic ventricle in 2% of the AS group and 26% of the S group (p < 0.001). Holter monitoring, performed in 70% of patients in the S group showed sinus node dysfunction in 60% and sinus rhythm in 40% of cases. In conclusion, good functional results were observed at over 5 years in both groups. However, the absence of late mortality and the minimal incidence of systemic ventricular dysfunction in the AS group confirm the authors' choice of indication of arterial switch for the treatment of transposition of the great arteries with intact ventricular septum.

Actuarial Analysis↗
PubMed1993

[Taussig-Bing malformation with straddling of both atrioventricular valves. Echocardiographic description of a case].

The authors report the case of an infant with the Taussig-Bing malformation and straddling of the two atrioventricular valves, the diagnosis of which was made by echocardiography and confirmed at surgery. Anatomic repair of the transposed great arteries was preceded by reconstruction of the interventricular septum which left the abnormal tricuspid subvalvular apparatus in the right ventricle and the abnormal mitral subvalvular apparatus in the left ventricle. Postoperative Doppler echocardiography confirmed the absence of left ventricular outflow obstruction.

Double Outlet Right Ventricle↗
PubMed1993

Anatomic repair of transposition of great arteries with ventricular septal defect and aortic arch obstruction. One-stage versus two-stage procedure.

Between September 1, 1982, and March 1, 1992, 40 patients underwent anatomic repair of transposition of the great arteries, ventricular septal defect, and aortic arch obstruction. In group I, 26 patients (65%) underwent repair in a two-stage procedure, phases A and B. Phase A included repair of the aortic arch obstruction with (16 patients) or without (10 patients) pulmonary artery banding through a left thoracotomy (mean age 18.7 +/- 23.4 days). There were three deaths and three reoperations. Phase B included an arterial switch operation with closure of the ventricular septal defect (mean age 95.5 +/- 122 days). There were five early deaths and two late deaths. Eight patients required reoperation. Mean delay between phase A and phase B was 77.5 +/- 109 days. In group I, there were eight early and two late deaths, and 11 patients required reoperation. The mean stay in the intensive care unit was 24.7 +/- 20 days. Mean follow-up of 59.6 +/- 21.4 months was completed in all survivors. All but one were in New York Heart Association class I without medication. Actuarial survival rate and rate of freedom from reoperation at 5 years were 57.5% and 49.9%, respectively. In group II, 14 patients (35%) had a one-stage procedure through midsternotomy: an arterial switch operation with closure of the ventricular septal defect and repair of the aortic arch obstruction (mean age 10.2 +/- 5.5 days). There were two early deaths (14.2%) and one late death after reoperation for overlooked multiple ventricular septal defects. Two patients required reoperation. The mean stay in the intensive care unit was 11.7 +/- 2.5 days. Mean follow-up of 22.4 +/- 16.7 months was achieved in all survivors. They were all in New York Heart Association class I without medication. Actuarial survival rate and rate of freedom from reoperation at 3 years were 78.5% and 81.5%, respectively. The one-stage procedure allowed complete repair in neonates without the need for multiple operations. We believe that it may decrease early mortality rates (14.2% versus 30.7%), reduce the reoperation rate and cumulative stay in the intensive care unit (11.7 days versus 24.7 days, p = Not significant), and significantly decrease the overall rate of morbidity (p < 0.01). However, requirements for surgical intervention with a one-stage or a two-stage procedure must include accurate assessments of intracardiac and aortic arch anatomy.

Actuarial Analysis↗
PubMed1992

[Neonatal heart transplantation. First results].

Two 5- and 17-days old neonates with hypoplastic left heart syndrome respectively underwent orthotopic heart transplantation. The donor-recipient weight ratio was +58 percent and +88 percent; ischemic time was 144 and 167 min. The immunosuppressive protocol included thymoglobulin during the induction period and a classical 3-drug therapy, with a rapid tapering off of prednisone over 3 weeks. No infectious complication was observed; each infant experimented one episode of acute rejection, successfully treated with prednisolone. Forty-three months and 10 months later, the 2 children are doing well, with normal renal function and normal growth. No late rejection episode was observed. Heart transplantation in neonates is feasible, the short-term and mid-term results are good. Despite important ethical problems, heart transplantation represents a great hope for neonates with inoperable congenital heart defects.

Graft Rejection↗
PubMed1992

Neonatal anatomic repair of transposition of the great arteries and ventricular septal defect.

From January 1985 to March 1992, 64 consecutive neonates with transposition of the great arteries (TGA) and ventricular septal defect (VSD) underwent an arterial switch operation and VSD closure. The mean age at operation was 18.5 +/- 12 days and the mean weight was 3.3 kg. Seventeen patients had an associated aortic coarctation, of whom 15 underwent single-stage repair through median sternotomy. Coronary artery distribution was: type A: 45 patients; type B: 2; type D: 11 and type E: 6 patients. The location of the VSD was perimembranous in 42 patients, trabecular in 13, infundibular in 5, and 4 presented with the Taussig Bing heart anomaly. The hospital mortality was 9.3% (n = 6). There were four late deaths (one TGA-VSD and three TGA-VSD and coarctation). Nine patients required reoperation. The mean follow-up of all survivors was 36 +/- 19 months. They were in NYHA class I without medication. Six patients developed mild-to-moderate aortic insufficiency. The actuarial survival and freedom from reoperation at 5 years were 81.06% and 84.6%, respectively. We conclude that neonatal anatomic repair of TGA and VSD offers good medium-term results and avoids iterative operations.

Actuarial Analysis↗
PubMed1992

Early palliation of univentricular hearts with subaortic stenosis and ventriculoarterial discordance. The arterial switch option.

The optimal Fontan-type operation greatly depends on appropriate initial palliation. Several surgical techniques have been used in infancy to palliate patients with univentricular hearts, ventriculoarterial discordance, and subaortic stenosis. The two most common are pulmonary artery banding and Damus-Norwood procedures. Palliative arterial switch operation is another surgical option that was used in this early series of seven infants. The principle of this operation is to "switch" the subaortic obstruction into a subpulmonary obstruction; the coronary artery relocation on the large pulmonary trunk creates a harmonious aortic root and the connection of the rudimentary ventricular chamber to the pulmonary artery trunk creates a natural protection of the pulmonary vascular bed through the restrictive bulboventricular foramen. Seven infants with univentricular hearts, ventriculoarterial discordance, and subaortic stenosis underwent a palliative arterial switch operation. All infants had an associated aortic arch obstruction of various degrees, including one with interrupted aortic arch, five with coarctation with severe arch hypoplasia, and one with isolated arch hypoplasia. There were three with double-inlet left ventricle, three with tricuspid atresia, and one with transposition of the great arteries with ventricular septal defect and severe right ventricular hypoplasia. The subaortic obstruction was patent at birth in five patients who underwent a palliative switch operation in the first 2 months of life, and rapidly occurred following a previous neonatal pulmonary artery banding associated with arch repair in two patients who underwent a switch operation at 5 and 8 months of age, respectively. The operation includes aortic arch repair without prosthetic material, an atrial septectomy, and the arterial switch. An associated pulmonary shunt was required in five patients and a pulmonary artery banding in one. There was one early death in a patient with [S,L,L] anatomy and congenital atrioventricular block, leading to an early mortality of 14% (95% confidence limits: 1% to 28%). There was one late death. Four survivors are waiting for a Fontan-type procedure, and one survivor had satisfactory right ventricular growth. Early palliative arterial switch operation offers several advantages: reconstruction of a harmonious aortic root, natural protection of the pulmonary bed through the restrictive bulboventricular foramen, prevention of deleterious myocardial hypertrophy, and arch reconstruction without the introduction of a foreign material. This aggressive technique may provide a satisfactory palliation in infants with univentricular hearts and ventriculoarterial discordance, when the bulboventricular foramen/aortic anulus ratio is less than 0.8 or when the subaortic stenosis is severe enough to be associated with an arch obstruction.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormalities, Multiple↗
PubMed1992

[Immediate and mid-term results of surgery of aortic valve stenosis in the newborn infant].

Between January 1980 and June 1990, 47 consecutive neonates with severe aortic stenosis underwent surgical aortic commissurotomy at Marie-Lannelongue Hospital. The average age at operation was 5 days. Other cardiac abnormalities were present in 27 children and left ventricular fibroelastosis in 11 children. Closed heart aortic valvotomy via the apex of the left ventricle was performed in 26 patients and open heart commissurotomy in 21 patients. Immediate per- or postoperative death was observed in 14 cases (29.8%). Six patients died after open heart valvulotomy (29%) and 8 after closed heart valvulotomy (31%). The mortality was higher in children with a critical preoperative status: 60% versus 22% (p less than 0.05); in cases with an associated cardiac malformation: 45% versus 6% (p less than 0.01) or fibroelastosis: 91% versus 11% (p less than 0.001). None of the patients was lost to follow-up which lasted an average of 47 +/- 41 months. Ten secondary deaths were observed, of which 4 were sudden, 4 after reoperation and 2 due to mitral stenosis with pulmonary hypertension. The overall one year survival was 57% (IC 70%: 40-64); the 5 year survival was 46% (IC 70%; 30-60). Reoperation was necessary in 12 children. Survival without reoperation at 1 and 5 years was 49% (IC 70%: 41-56) and 43% (IC 70%: 29-59) respectively. At the last follow-up examination, 97% of the 23 survivors had good left ventricular function; the systolic pressure gradient was less than 50 mmHg in two thirds of patients and aortic regurgitation was minimal or absent in three quarters of patients. In critical aortic stenosis in neonates, surgery is associated with a high immediate and secondary mortality. The results at medium term in the survivors are good with respect to symptoms, left ventricular function and obstruction to left ventricular ejection.

Aortic Valve Stenosis↗