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Biomedical subjects

B Faidutti

Publications and source records attributed to B Faidutti.

At least 19 recordsLinked to original sources
PubMed1992

Aortoiliac endarterectomy: a 9-year experience.

Thirty-two patients (median age: 51 years) underwent aortoiliac endarterectomy between 1982 and 1990, for disabling claudication (27), rest pain (3), and tissue loss (2). There was no post-operative death and morbidity affected 6 patients. Five patients showed insufficient or suboptimal vascularisation of a limb which justified early reoperation in four. Follow-up was obtained in 31 patients with a median time of 36 months (6 months to 8 years). Five patients experienced recurrence of claudication symptoms: two received an aortofemoral bypass at 6 and 36 months. In the other patients, distal arterial occlusive disease accounted for recurrence alone (2 patients) or in association with aortoiliac involvement (1). Technical problems or disputable indications were responsible for postoperative failure in 3 cases or early recurrence of symptoms in 2. Cumulative patency rates of aortoiliac endarterectomy were 94 and 90 per cent at 2 and 5 years, and actuarial rates of clinical improvement were 90 and 82 per cent at 2 and 5 years, respectively. Aortoiliac endarterectomy provides the advantages of avoiding foreign material. The success of this reconstruction depends on strict criteria of selection and surgical expertise. It is indicated for the relatively young patient with nonectasic disease where atherosclerosis has not attacked the external iliac arteries.

Adult↗
PubMed1991

[Aortoiliac occlusive disease: yesterday and today].

The surgical management of aortoiliac atherosclerotic occlusive disease includes endarterectomy and prosthetic by-pass in either the anatomical or extraanatomical position. Aortoiliac endarterectomy is only indicated in localized disease which spares the external iliac artery and does not exhibit aneurysmal changes. Prosthetic by-pass is easier to perform, but carries graft-related risks including anastomotic pseudoaneurysms in 5 to 10% of cases at 10 years. Extraanatomical shunts are performed when there are general or abdominal contraindications to an anatomical by-pass. Simultaneous revascularisation of the aortic visceral branches mainly involves the renal, inferior mesenteric and hypogastric arteries. Correction of celiac and superior mesenteric artery stenosis is less frequently indicated. The appropriate approach and surgical technique depend on the artery and the lesion involved. Suprarenal implantation of aortoiliac by-passes is performed at the celiac, descending aortic and ascending aortic levels. Indications include suprarenal coarctation of the aorta, reoperation following ligature of the juxtarenal aorta, and some cases of extensive thoracoabdominal atherosclerosis. The surgical management of aortoiliac occlusive disease in 353 patients treated in our clinic between 1976 and 1986 is reported. Mean follow-up exceeded 5 years. Operative mortality for endarterectomy (15 patients) was nil, and was 3.9% for by-pass graft. Early complication rate was 6.5% and late complication rate 23.2%. Half of the late complications were due to progression of the atherosclerotic process. Pseudoaneurysms at the aortic (3.1%) and femoral (9.9%) levels occurred between the fifth and tenth years. Prosthesis infection occurred shortly after operation in 3 patients and much later in 2 patients.

Anastomosis, Surgical↗
PubMed1991

Postoperative chylothorax in children: differences between vascular and traumatic origin.

Twenty-four children with postoperative chylothorax were encountered among 1,264 consecutive thoracic operations over a 7-year period and form the basis of this study. Chylothorax was caused by direct lesion to the thoracic duct or lymphatic vessels in 17 patients and was associated with superior vena cava (SVC) obstruction in seven. Of the latter, five had bilateral chylothorax. Chylothoraces secondary to venous hypertension and thrombosis have a longer interval between operation and diagnosis compared with direct trauma as well as a longer duration and larger volume of chylous drainage. Treatment was entirely nonoperative in 16 patients and operative in 8. Nonoperative treatment consisted of pleural needle aspiration or suction drainage in association with a medium chain triglyceride (MCT) diet (n = 11) or total parenteral nutrition (TPN) after failure of MCT (n = 5). Direct operation on the thoracic duct was performed in 5 patients, four had pleurodesis, and 2 had pleuroperitoneal shunts inserted. All patients were cured of their chylothorax and there were no deaths. Patients with major vein thrombosis were the most difficult to treat. On the basis of this experience, we suggest a step-by-step approach: (1) insertion of chest tube after 3 to 4 pleural punctures; (2) 1-week trial of MCT diet, with intravenous support to correct protein losses; (3) TPN if chylothorax increases or persists with large volumes; (4) Doppler echocardiography or phlebography to rule out obstruction of major thoracic veins; and (5) insertion of TPN line in inferior vena cava in case of such obstruction; and (6) direct surgical approach to the thoracic duct after 4 weeks of unsuccessful nonoperative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1991

Late results of surgery for congenital heart defects.

Surgery for congenital heart defects started 50 years ago with "closed" procedures, and open heart surgery is in its forth decade. Thus, long-term results are now available. Although a majority of patients lead normal lives, problems do exist. Hemodynamic anomalies can be related to residual lesions or to persistent systemic hypertension (after coarctation repair) or pulmonary hypertension (after late repair of left to right shunt lesions). Right or left ventricular dysfunction may be observed, due to longstanding overload, hypoxia or to the open heart procedure itself. Rhythm disturbances have a tendency to increase with the passage of time after surgery. After ventricular surgery (repair of ventricular septal defect and tetralogy of Fallot), conduction defects and ventricular arrhythmias are prevalent. They may lead to late sudden death. After atrial surgery, sinus node dysfunction and atrial arrhythmias are observed. Problems related to growth of the patient exist essentially in cases where foreign material (conduits, prostheses) have been implanted. Many patients, with definitive repair or palliative operation, have become adults. This is a new challenge for the adult cardiologist, and it is a duty of the pediatric cardiologist to hand over his knowledge of this pathology.

Adolescent↗
PubMed1989

Indications for pericardial glutaraldehyde-preserved xenograft in repair of congenital heart disease.

A glutaraldehyde-preserved equine pericardial xenograft was implanted in 370 patients between 1981 and 1987; pericardial sac closure in 320 (mainly over Dacron implants), atrial repairs in 19, arterial reconstructions in 22 (right outflow tract in 19, Konno's procedure in three), control of bleeding after surgery for thoracic aneurysms in seven, control of plasma leaking PTFE graft in one, and repair of diaphragmal agenesia in one. Overall infection rate was 3/370 (0.8%). Epicardial adhesions (12) at reoperation for orthotopical implants were graded 1.3 +/- 0.9 on a scale of 6 (0 = no adhesions, 5 = calcified or ossified adhesions) after 4 +/- 2 months. Shrinkage of xenograft occurred in 3/19 (16%) atrial repairs and lesser degree aneurysmal dilatation appeared in 1/19 (5%) reconstructions of the right outflow tract. No complications occurred in the implants without direct exposure to the blood stream. We recommend pericardial xenograft for Konno's procedure and control of bleeding. It should not be used routinely in the low pressure side.

Bioprosthesis↗
PubMed1988

[Cystic adventitial degeneration of the popliteal artery: an unusual cause of intermittent claudication].

The case is reported of a 44-year-old patient without cardiovascular risk factors who complained of typical intermittent claudication. Arteriography and echography led to the diagnosis of cystic adventitial disease of the popliteal artery. Percutaneous puncture under CT control was unsuccessful and surgical resection of the cystic formation was performed. This rare etiology is discussed in relation to the differential diagnosis of intermittent claudication, with particular reference to young patients.

Cysts↗
PubMed1988

Acute complications of elective coronary angioplasty: a review of 500 consecutive procedures.

In 500 consecutive procedures of elective coronary angioplasty attempted at a centre with a primary success of 86%, one or more major acute complications occurred in 34 cases (6.8%). Twenty four patients (4.8%) sustained an acute myocardial infarction (in six this was despite emergency coronary artery bypass surgery) and two patients (0.4%) had emergency coronary bypass without myocardial infarction. Ventricular fibrillation was a complication without sequelae in five (1.0%) patients; one (0.2%) patient died because of refractory ventricular fibrillation and ensuing electromechanical dissociation. "Benign" coronary artery rupture occurred in one (0.2%) patient, and one (0.2%) patient had elective coronary surgery to retrieve the tip of a fractured guide wire after an otherwise successful angioplasty. Despite a low mortality, coronary angioplasty is associated with major complications in about one of 14 procedures; the complication is usually acute myocardial infarction caused by occlusion of the vessel.

Adult↗
PubMed1987

Inadequate flow after internal mammary-coronary artery anastomoses.

The use of the internal mammary artery for revascularization of the coronary arteries has expanded over the last years. In a series of 250 consecutive coronary artery revascularizations, there was at least 1 internal mammary-coronary artery anastomosis in 222 patients (89%) and multiple internal mammary-coronary artery anastomoses were performed in 77 patients (31%). During the revascularization procedure, weaning from cardiopulmonary bypass was not possible in 4 patients with internal mammary-coronary artery anastomoses. These 4 patients showed signs of left ventricular failure, and additional saphenous vein bypass to the left anterior descending coronary artery, already revascularized by the left internal mammary artery, was performed. Weaning from cardiopulmonary bypass was then possible in 3 out of 4 patients. Thus, in some patients (1.2%), internal mammary-coronary artery anastomoses provide inadequate nutritional support for the myocardium.

Adult↗
PubMed1987

Comparison of multivessel coronary angioplasty with surgical revascularization with both internal mammary arteries.

To evaluate medium-term clinical results of two major methods of myocardial revascularization, we compared 80 consecutive patients with multivessel percutaneous transluminal coronary angioplasty (PTCA) with 80 consecutive patients with coronary surgery using both internal mammary arteries in all and additional venous grafts in some. Patients in the surgical group had a higher extent of coronary artery disease. In patients with PTCA a mean of 2.2 vessels per patient were attempted, and in patients with surgery 2.7 distal anastomoses per patient were performed. Primary success for PTCA and surgery was 86% vs 94% and complications occurred in 7% vs 6%, respectively. Control angiograms, done in 86% of patients (59/69) after successful PTCA, showed a recurrence in 42% (25/59). Repeat PTCA was done in 15, elective surgery in seven, and a medical treatment was pursued in 3% patients with restenosis. Recurrence of symptoms after successful surgery was found in three patients (4%). They were treated with PTCA. Clinical follow-up was available for all patients, at a mean of 12 +/- 6 months after PTCA and 16 +/- 9 months after surgery. Mean improvement was 1.5 NYHA functional classes after successful PTCA and 2.1 after surgery; 60% (48/80) vs 89% (48/80), respectively, were in class I (p less than .0001). There were fewer PTCA patients than surgical patients without antianginal drugs at follow-up (19% [11/58] vs 37% [18/48]; p less than .05), and their double product during exercise testing was inferior (272 +/- 56 vs 295 +/- 47 mm Hg X beats/min/100; p less than .05). Medium-term clinical outcome appears better after successful surgery with both internal mammary arteries than after successful multivessel PTCA.

Adult↗
PubMed1987

Repeat sternotomy after reconstruction of the pericardial sac with glutaraldehyde-preserved equine pericardium.

The risk of repeat sternotomy is higher than that of the initial sternotomy, especially if the pericardial sac was left open at the first intervention. In 200 consecutive patients with a pericardial defect after open heart operations, the pericardium was closed with a glutaraldehyde-preserved equine pericardial patch. Precardiac adhesions at reoperation were assessed in four groups of patients on a scale of 6, ranging from 0 (no adhesions) to 5 (calcified or ossified adhesions). Group I comprised 13 patients in whom the pericardium was left open at the first operation and an equine pericardial patch was implanted at reoperation. Group Ia included the first five Group I patients who underwent reoperation less than 1 year (early reoperation) after the initial procedure. Group Ib included the other eight patients of Group I, who underwent reoperation more than 1 year (late reoperation) after the first procedure. Group II comprised nine patients who were reoperated on after reconstruction of the pericardial sac with a glutaraldehyde-preserved equine pericardial patch. After a mean follow-up of 20.2 months, the incidence of patch-related complications was 1%. Statistical analysis shows less severe adhesions on reoperation in Group II patients (pericardial defect patched) than in Group I patients (pericardial defect left open): mean grade of adhesions 1.6 +/- 0.9 (Group II) versus 3.2 +/- 0.6 (Group I), p less than 0.001. Precardial adhesions with the pericardium left open were similar in patients having early and late reoperations: mean grade of adhesions 3.0 +/- 0.7 (Group Ia) versus 3.4 +/- 0.5 (Group Ib), no significant difference. Therefore, the glutaraldehyde-preserved equine pericardial patch can be considered a suitable material for primary closure of the pericardial sac in patients with inadequate autologous pericardium.

Adolescent↗