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Biomedical subjects

B Faidutti

Publications and source records attributed to B Faidutti.

At least 55 records · Page 3Linked to original sources
PubMed1997

Floating thrombus in the ascending aorta: a rare cause of peripheral emboli.

The ascending aorta may be the site of origin of systemic embolization in some cases that do not have an identifiable source. We report a case in which a free-floating thrombus in the noncoronary sinus of Valsalva was detected by transesophageal echocardiography as a source of left axillary artery embolism. After removal of this pedunculated thrombus of unknown cause, which was attached on a macroscopically and histologically normal aortic wall, the patient made an uneventful recovery.

Adult↗
PubMed1997

Successful weaning from cardiopulmonary bypass after cardiac surgery using inhaled nitric oxide.

Two cases of very difficult weaning from cardiopulmonary bypass after cardiac surgery in children with pulmonary hypertension and ventricular dysfunction are reported. Children fail to respond to conventional therapy combining nitrovasodilators and inotropic support and react successfully to combined inhaled nitric oxide (NO) and epinephrine or left atrial infused norepinephrine. Postoperative NO inhalation must be prolonged and no toxicity appears. Pulmonary endothelial function recovers only after several days.

Administration, Inhalation↗
PubMed1996

Successful repair of a right ventricular rupture at the atrioventricular groove.

We report a patient who presented with a delayed spontaneous right ventricular rupture at the anterior atrioventricular groove after open heart operation. Successful surgical repair consisted of reestablishing anterior atrioventricular groove continuity by pericardial patch placement on the arrested heart. We discuss the risk factors that could initiate the primary tear and contribute to the extension of this type of right ventricular rupture.

Aged↗
PubMed1996

Blunt injury to the ascending aorta: three patterns of presentation.

BACKGROUND: Injury to the ascending aorta is a rare lesion that may present in various forms. A thorough analysis of this lesion is lacking in the literature. This study was undertaken to delineate the prevalence and modes of presentation of injuries to the ascending aorta after blunt trauma and to suggest guidelines for management. METHODS: A retrospective analysis of autopsies performed in our department of forensic medicine on blunt trauma victims from 1984 to 1993 and a literature review of autopsy series were undertaken to delineate the prevalence and relevant characteristics of this injury. A cash report from our institution and a review of the literature were used to provide information regarding clinical presentations of this injury and treatment approaches. RESULTS: Three modes of presentation were encountered. (1) Presentation at autopsy: The prevalence of injury to the ascending aorta after a traffic accident was 2% in our autopsy series. Among 13 patients with this injury 12 had other associated, potentially lethal lesions. A massive hemopericardium was present in two patients only. In autopsy series the incidence of injury to the ascending aorta in patients with an injury to the aorta ranged from 0% to 23%. (2) CLINICAL PRESENTATION: Twenty-one patients were treated surgically and reported in the literature. Fourteen presented with a pseudoaneurysm and seven with a chronic sinus of Valsalva fistula. One patient with a pseudoaneurysm presented with signs of cardiac tamponade and required immediate decompression; the others were hemodynamically stable. Seven patients had a cardiac lesion (valve tear in six and cardiac contusion in one), and three had an arch vessel lesion. Aorta repair was performed under cardiopulmonary bypass in every patient. (3) Incidental presentation: Seven patients with a traumatic tear of the aortic valve presented an incidental lesion of the ascending aorta. It was a subadventitial hematoma in three patients and an intimal and medial tear in four patients. Aortic tears were reinforced by direct suture. CONCLUSIONS: Injury to the ascending aorta after blunt trauma is rare but lethal mostly from associated injuries. Survivors may appear in stable condition and present mostly with pseudoaneurysms of the ascending aorta or sinus of Valsalva fistula. Associated lesions to the heart and arch vessels should be looked for. Repair of the ascending aorta injury is performed under cardiopulmonary bypass.

Adolescent↗
PubMed1996

Lower limb trauma with injury to the popliteal vessels.

A retrospective analysis of blunt trauma to the lower extremity with injury to the popliteal vessels was undertaken in an attempt to determine the major predictors of outcome and to expose the shortcomings of our management. Thirty-one patients with lower extremity trauma including a popliteal artery injury were admitted to our clinic between 1979 and 1993. Two patients died of hemorrhagic shock or from associated lesions. Amputation of the leg was performed primarily in one patient because of massive tissue damage and secondarily in five patients because of uncontrolled local infection (two patients), excessive tissue damage (two patients), and persistent ischemia (one patient who later died). A peripheral neurologic deficit resulted in 12 of 24 non-amputated extremities. Three additional patients suffered sequelae from bone and joint damage. In all, nine patients recovered completely from their limb injury. Severe ischemia of the leg was found to be an indicator of major limb damage and was a strong determinant of poor outcome. Of 18 patients with severe ischemia, two died (one after amputation), five were amputated, and eight were left with a peripheral neuropathy. Only two patients recovered completely. Of 13 patients with relative ischemia, five recovered completely and four sustained a peripheral neuropathy. The deleterious effects of delayed revascularization were evident in four patients who developed a peripheral neuropathy secondarily. Morbidity from the ischemic insult could have been reduced in seven patients: the diagnosis was missed in two, its seriousness not realized in one, and a non-optimal management led to an excessive ischemic time in four. The magnitude of skeletal and soft tissue injury, alone or in combination, was also strongly associated with an increased morbidity. Most patients with blunt lower limb trauma and popliteal vascular injury are left with serious sequelae from associated neuro-musculo-skeletal damage and from ischemia. Although the magnitude of the first variable is determined by initial trauma and cannot be altered, a constant awareness of possible arterial injury in lower limb trauma, and adherence to a plan of management according to the ischemic state of the leg, should help avoid the additional deleterious effects of prolonged ischemia.

Adolescent↗
PubMed1995

[Reconstructive surgery of the mitral valve in the acute stage of bacterial endocarditis. Apropos of 2 cases].

Two patients in our institution underwent mitral valve reconstruction during the acute phase of Staphylococcus aureus mitral valve endocarditis. In neither case was a pre-existing valve lesion found. Echocardiographic examination revealed severe mitral insufficiency and the extent of valvular lesions. In the first patient, prolapse of the posterior commissure and paracommissural areas was due to ruptured chordae tendinae. In the second patient a perforated abscess was surrounded by vegetations in the median portion of the anterior leaflet and paramedian anterior chordae tendinae were ruptured. The surgical indication was hemodynamic, combined with suspicion of repeated emboli in one case. After a 10-day course of antibiotic therapy, both patients underwent surgical repair by Carpentier's mitral valvuloplasty. During more than 6 months' follow-up no recurrence of endocarditis was observed. Both patients were in class I of the NYHA without echocardiographic evidence of residual mitral regurgitation or stenosis. Early intervention during the acute phase of endocarditis, when mitral valve destruction is not too extensive, allows mitral valvuloplasty which preserves the native valve, eradicates infected tissues and may reduce postoperative mortality and morbidity.

Acute Disease↗
PubMed1995

Tricuspid valve repair by septal of posterior leaflet transposition.

We report 2 patients who presented extensive rupture of chordae tendineae caused by blunt thoracic trauma leading to flail anterior leaflet of tricuspid valve. Transposing a segment of septal leaflet in 1 patient and the posterior leaflet in the other patient onto the flail anterior leaflet's margin abolished massive tricuspid regurgitation. Fifteen and 33 months postoperatively the patients are in good clinical condition and the echocardiographic controls show a competent tricuspid valve.

Accidents, Traffic↗
PubMed1995

Correction of pectus excavatum combined with open heart surgery in a patient with Marfan's syndrome.

We report a patient with Marfan's syndrome and pectus excavatum who underwent open heart surgery with simultaneous correction of the sternal malformation. Permanent internal stabilization, achieved by bilateral overlapping of the bevelled ends of the lowest ribs and reinforced with sternal closure wires offered a maintained postoperative chest wall stability, avoided the potential postoperative complications of cardiac compression, and improved the aesthetic appearance of the anterior chest wall. The increased risk of bleeding due to extensive dissection was minimized by postponing the repair of pectus excavatum to when protamin is administered after termination of cardiopulmonary bypass.

Aortic Aneurysm↗
PubMed1995

Traumatic occlusion of the left anterior descending artery and rupture of the aortic isthmus.

A patient with occlusion of the left anterior descending artery and rupture of the aortic isthmus following blunt trauma is reported. Treatment of both lesions through a median sternotomy using cardiopulmonary bypass was accomplished successfully. Special considerations regarding the surgical management of combined cardiac and aortic isthmus lesions in trauma patients are discussed.

Adult↗
PubMed1995

Blunt carotid artery injury: devastating consequences of undetected pseudoaneurysm.

A case of delayed embolization of a traumatic pseudoaneurysm of the right common carotid artery, resulting in fatal cerebral infarction, is reported. This case emphasizes the importance to detect occult lesions to the carotid arteries after blunt neck injuries and to treat aggressively pseudoaneurysms located upstream to a cerebral vessel to prevent embolic complications.

Adult↗
PubMed1995

[Increased association of cardiac and thoracic vascular lesions after closed trauma of the thorax].

The association of a cardiac and a thoracic vascular lesion following blunt trauma seems real based on our experience and other published reports. Over the last 4 years, we have operated upon 3 patients with this association. The cardiac lesions included severe myocardial contusion (documented by electrocardiographic and enzymatic changes), a tear of the aortic valve, and occlusion of a coronary artery. The vascular lesions consisted in rupture of the aortic isthmus in 2 patients and traumatic pseudoaneurysm of the innominate artery. This association justifies a detailed cardiovascular evaluation in any case of severe cardiac or thoracic vascular lesion.

Accidents↗
PubMed1995

[Management of blunt injury of the popliteal artery].

PURPOSE: this retrospective study was undertaken to analyse our results with blunt popliteal artery injury and to detect flaws in our approach. MATERIAL AND METHOD: between 1979 and 1993, 31 consecutive patients with a blunt injury to the popliteal artery were retrospectively reviewed. RESULTS: 4 patients were in shock on admission from a popliteal artery bleed. One patient died before treatment. Primary amputation of the leg was performed in one patient because of extensive tissue destruction. Arterial reconstruction was performed in the remaining 29 patients: 1 patient died of associated injuries, 5 underwent subsequent limb amputation because of infection (in 2), tissular destruction (in 2) and persistent ischemia (in 1). A neurological deficit (mostly of the peroneal nerve) occurred in 13 patients. Increased ischemic time was noted in 6 patients because of non-optimal management: diagnosis of a popliteal artery occlusion was missed in 2 patients, and a rigid approach resulted in an excessive delay in revascularization in 4 patients. DISCUSSION: even though morbidity of blunt popliteal artery injury is greatly determined by the initial trauma, superimposed ischemia further jeopardizes the outcome. A more expeditive revascularization could be achieved in some patients by performing on-table angiograms, immediate fasciotomy to release tissue hypertension and by proceeding with the vascular repair before orthopedic reconstruction. However, if a complex orthopedic repair must be performed initially because of major instability, indwelling shunts should be inserted in the popliteal vessels to insure limb perfusion. CONCLUSION: it is postulated that a rational plan of management of blunt popliteal artery injury would decrease the adverse effect of ischemia, and would reduce overall morbidity.

Adolescent↗
PubMed1994

Reversed flow in the internal carotid artery after occlusion of the common carotid artery.

Patency of the internal carotid artery in case of common carotid artery occlusion is usually maintained by a flow of blood from the external carotid into the internal carotid artery. A case where a reversed flow of blood was established from the cerebral circulation into the internal carotid artery and eventually into the external carotid artery is presented. Careful reading of the cerebral views of the standard carotid angiogram allowed detection of a retrograde flow into the internal carotid artery. Surgical exploration confirmed the patency of the internal carotid artery; the occluded common carotid artery was bypassed by a prosthesis, which restored an antegrade flow into the internal carotid artery.

Carotid Artery, Common↗