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Biomedical subjects

B Faidutti

Publications and source records attributed to B Faidutti.

At least 73 records · Page 4Linked to original sources
PubMed1994

Dissection of the atrial septum following mitral valve surgery.

Interlayer dissection of the atrial septum resulting in the formation of a cavity developed after an attempted repair of a mitral paraprosthetic leak. Subsequent rupture of the cavity into both atria resulted in a small left-to-right shunt and significant left ventriculoatrial regurgitation. Misplaced stitches, aimed at obliterating the paraprosthetic leak, were the cause of the dissection. This case illustrates a previously unreported complication of mitral valve surgery and stresses the importance of proper exposure and handling of the mitral annulus.

Aged↗
PubMed1994

[Lesions of the supra-aortic arterial trunks by closed trauma].

Thirteen patients treated for 14 arterial lesions of the supra-aortic trunks from blunt trauma between 1985 and 1993 were retrospectively reviewed. In 2 cases, the lesion was on the innominate artery, in 1 case on the right common carotid artery and in 11 cases on the subclavian artery. It consisted of rupture in 8 cases, pseudoaneurysm in 5 and occlusion from an intimal flap in 1 case. Acute ischemia of the upper limb was present in 5 patients, and severe local hemorrhage in 1 patient. Four patients (5 lesions) did not have symptoms on initial hospitalization. Two later suffered embolisms from a pseudoaneurysm with a fatal outcome from massive cerebral ischemia in one case. Eleven arteries were repaired and two were ligated because of massive associated soft tissue destruction of the shoulder and the arm requiring immediate amputation. In addition to these two amputations, a brachial plexus injury remained disabling for 4 other patients. Blunt injuries of the supra-aortic arterial trunks constitute an immediate challenge in the case of active bleeding and often require combined mediastinal or thoracic and cervical exposure. They carry a heavy morbidity when the subclavian artery is involved due to associated soft tissue or brachial plexus damage. Occult lesions of the arteries supplying the brain are dangerous because of the risk of interference with cerebral blood flow. They should be actively investigated and, if the distal part of the lesion is accessible, they should be treated surgically.

Adolescent↗
PubMed1994

[Sub-adventitial rupture of the external iliac artery in closed traumas of the pelvis. Apropos of 2 cases].

Major vascular injuries in closed fracture of the pelvis occur in approximately 1% of cases. In this setting, subadventitial rupture of the external iliac artery is rare. The lesion is responsible for acute ischemia of the lower limb, and may present diagnostic challenges due to frequently associated major local injuries, delayed disappearance of distal pulses, and concomitant neurological damage. Serial clinical examinations along with the use of arteriography are instrumental in avoiding undue delays.

Adult↗
PubMed1994

Blunt injury to the subclavian or axillary artery.

BACKGROUND: This study is an analysis of our experience with blunt injuries to the subclavian or axillary artery in order to delineate the immediate challenges encountered and to assess immediate and long-term outcome. STUDY DESIGN: A retrospective analysis was performed of 15 consecutive patients treated for a blunt injury to the subclavian or axillary artery in our hospital between 1988 and 1992. RESULTS: Ten patients had multiple injuries, and six were in a state of shock at admission. Bleeding from the artery contributed significantly to shock in three patients. Ischemia of the upper extremity was overt in ten patients. Two patients died as a result of associated injuries. Two patients with extensive tissue destruction underwent immediate amputation, one at shoulder level and one at middle arm. Five patients survived with a denervated limb from brachial plexus damage; in only one was the neurologic injury consistent with a potentially reversible lesion. Arterial repair, performed upon patients not undergoing amputation, was patent at a median time of 33 months in all but one patient. Among the seven patients with extensive disability (two amputated and five denervated extremities), only one patient resumed previous work. CONCLUSIONS: Blunt trauma to a subclavian or axillary artery is associated with significant immediate morbidity and mortality. In the long-term, associated brachial plexus lesions plague most patients, who are left with a severe disability of the upper limb, which complicates their return to society.

Adolescent↗
PubMed1994

Blunt carotid artery injury: difficult therapeutic approaches for an underrecognized entity.

GOALS: To assess the damage inflicted by carotid artery injuries, to attempt to explain some differences between published series, and to summarize the management of different types of lesions. METHOD: Retrospective analysis of patients treated for nonpenetrating injury of the carotid arteries in our hospital from 1985 to 1991. RESULTS: Seven patients (all men, with ages ranging from 19 to 55 years) had eight injuries to the carotid arteries. One patient was asymptomatic; another patient had neurologic symptoms unrelated to the carotid artery injury; severe neurologic deficits developed in the remaining five patients, of whom three died. Symptoms occurred immediately in one patient, after a few days in two patients, and after a few weeks in two patients. Arterial damage included dissection (four cases), pseudoaneurysm (two cases), local contusion (one case), and occlusion (one case). Surgical treatment consisted of aneurysmorraphy and extraintracranial bypass in one patient each. Surgical intervention was not considered in the other patients because of the severity of their neurologic symptoms. Besides collective reviews, very few series pertaining to this pathologic condition exist in the literature; however, some report good overall results. These reports comprise a high proportion of asymptomatic cases; the internal injury is usually only discovered incidentally on thoracic aortograms or by scanning the neck during head computed tomography scans. CONCLUSIONS: Nonpenetrating trauma to the carotid arteries carries significant morbidity and mortality rates. Wide-scale screening for carotid lesions in victims of blunt trauma would be necessary to determine the true incidence and gravity of this pathologic condition. A search for carotid artery injury should be performed in patients with a history of neck or head trauma to detect whether the correction of any lesion would lead to improvement or prevention of neurologic deficits.

Adult↗
PubMed1993

Blunt injuries to the innominate artery.

Two patients with aneurysm secondary to blunt traumatic subadventitial rupture of the distal innominate artery (IA) are reported. IA rupture was identified because of a cervical bruit in one patient and detected during thoracic aortography in the other patient. The patients had associated cardiovascular lesions consisting of traumatic aneurysm of the subclavian artery and rupture of the aortic valve, respectively. Both lesions were surgically repaired by resection of the lacerated intima and direct closure of the adventitia. In the patient who underwent repair of the aortic valve with simultaneous cardiopulmonary bypass the IA was approached after cannulation of the right common carotid artery. In the other patient the IA was repaired without use of a shunt under close EEG monitoring. Injury to the IA is rare because the artery is short and relatively well protected by the bony cage. Other cardiovascular lesions may be associated with IA rupture and a routine search should be made.

Adult↗
PubMed1993

Surgical management of aortic valve injury after nonpenetrating trauma.

A case report and a literature review of the patients who underwent surgical repair of an aortic valve injury secondary to nonpenetrating trauma are presented. Thirty-seven patients (32 male and 5 female patients) with a median age of 43 years sustained either blunt chest trauma (34 patients) or muscular strain (3 patients) as a cause of injury. Primary repair was undertaken on 4 patients before 1964 (when the first aortic valve replacement was performed for this condition) and on 6 other patients after 1964. In the former group, 2 patients died because of heart failure and 1 subsequently required a prosthesis. The last patient had an excellent result at 17 years. In the latter group, 1 patient with a complex lesion had persistent moderate aortic regurgitation. The 5 remaining patients had a simple lesion to the valve and showed excellent results on follow-up evaluation (ranging from 6 months to 6 years). Aortic valve replacement successfully corrected the valvular dysfunction in 26 patients. Except for 1 case of hemolytic anemia, specific complications of prosthesis were not encountered, but median follow-up of this review was only 9 months. A modulated approach to this condition is proposed where primary repair is selected for cases with a simple tear or avulsion of one cusp. Intraoperative control of the repair by transesophageal echocardiography increases the safety of this approach. Valve replacement is indicated for more complex lesions or for ineffective primary repair as assessed by intraoperative echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Cine gradient-echo MR imaging in the evaluation of cardiovascular diseases.

The contributions of cine gradient-echo (GRE) magnetic resonance imaging were compared with those of spin-echo (SE) imaging for the evaluation of morphologic, functional, and flow alterations in 78 cases of congenital and acquired cardiac diseases. High temporal and spatial resolution cine GRE images (256 phase-encoding steps, 256 x 256 acquisition matrix interpolated to 512 x 512 for display, 16-64 frames per cycle) and SE images were acquired in each case. Cine GRE images provided a better diagnostic evaluation than SE images in several cases: (a) both masses and thrombi could be differentiated from flow artifacts; (b) abnormalities in cardiac function, such as infarction, abnormal wall motion, and ventricular dysfunction, could be evaluated; (c) small defects, shunts, and abnormal communications could be clearly seen; and (d) valvular regurgitations, poststenotic flow alterations, and aortic coarctation could be assessed. Cine GRE imaging was also valuable for postoperative evaluations. The authors believe that cine GRE imaging is a useful addition to SE sequences, especially for the assessment of blood flow and cardiac function.

Adolescent↗
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↗