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Biomedical subjects

B Faidutti

Publications and source records attributed to B Faidutti.

At least 91 records · Page 5Linked to original sources
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↗
PubMed1987

Prosthetic heart valve replacement in children. Results and follow-up of 273 patients.

We report the results and long-term follow up in 273 children (aged 2 to 16 years) who underwent prosthetic valve replacement. Mechanical valves (mostly Starr-Edwards) were used in almost all, and in 62 children more than one valve was replaced. Operative mortality was 4.7%. Actuarial survival curves (including hospital mortality) indicate a 86% survival rate at 5 years and 75% at 10 years. For isolated mitral valve prostheses (the largest subgroup), the figures are 87% at 5 years and 82% at 10 and 15 years. The main complication was thromboembolism, which occurred at a linearized rate of 2.7 per 100 patient-years. Actuarial curves indicate that 88% of patients are embolus free at 5 years, and 77% at 10 years. No patient with aortic valve replacement only had an embolism. Five of eight tricuspid prostheses thrombosed. Patients given aspirin and dipyridamole only did not have a higher rate of thromboembolic events than those given warfarin. There were five cases of endocarditis (two fatal) and four of dehiscence. No patient so far has needed replacement of a prosthesis because of somatic growth. Thus valve replacement can be performed with low mortality in children, and with satisfactory long-term survival. Thromboembolism remains a significant problem, although it appears to be less common than in adults. In this study, treatment with antiplatelet drugs only did not carry a higher rate of thromboembolic events than did treatment with warfarin.

Actuarial Analysis↗
PubMed1986

[Coronary revascularizations using multiple mammary anastomoses compared to classical vein grafts].

In a series of 100 consecutive patients the internal mammary arteries have been used whenever possible for revascularization of the coronary arteries. At least one internal mammary artery was used in 89% of cases; both internal mammary arteries were used in 30% and in 17% sequential internal mammary-coronary artery anastomoses were performed. The results in this group of patients were compared to another group of 250 consecutive patients in whom the coronary arteries were revascularized by classical saphenous vein grafts. In-hospital mortality was 3% for the internal mammary artery group and 2.5% for the saphenous vein group (NS). The follow-up was complete for 89% of the patients after a mean duration of 6 months. At control the mean NYHA functional class was assessed as 1.0 +/- 0.2 for the internal mammary artery group and 1.2 +/- 0.2 for the saphenous vein group (p less than 0.01). Stress test was electrically positive in 7.1% of the internal mammary artery group and in 15.3% of the saphenous vein group (p less than 0.05). Although the method is technically more demanding, the results after internal mammary-coronary artery anastomoses appear to be superior.

Coronary Artery Bypass↗
PubMed1986

[Tetralogy of Fallot: long-term evolution following corrective surgery].

To evaluate the immediate and long term results of complete correction of tetralogy of Fallot (TF), we have reviewed the records of 275 children operated on in Geneva between 1972 and end 1984. The average age at operation was 6 7/12 years (range 7 months to 16 years). Postoperative follow-up ranged from 1 year to 12 years (average 3 7/12 years). The survival rate, taking into account immediate postoperative mortality, was 90 +/- 2% after one year, 88 +/- 2% after 5 years and 88 +/- 2% after 11 years for the entire patient group. The total mortality of 9.8% has markedly decreased in recent years (14.5% before and 5.7% after 1978). Mortality is highest within the first 30 days after the operation (20 cases, 7.3%). Mortality was higher after previous palliative surgery (5/51) and for children who had to be reoperated for a residual lesion (4/23). Once the first postoperative year has passed, mortality is low: 2 deaths occurred between 1 and 2 years, and one between 2 and 5 years after the operation. Cardiac catheterization in 218 patients between 2 months and one year after surgery showed severe residual pulmonary stenosis in 4 children which made reoperation necessary; a second operation was needed for a large left-to-right shunt in 5 cases, and because of a ventricular septal defect with residual pulmonary stenosis in 6 others. Pulmonary insufficiency was noted in 106 cases (38.5%) but only 3 children showed right heart insufficiency. One child underwent pulmonary valve replacement by Björk-Shiley prosthesis. It can be concluded that a child with surgically treated TF has excellent long term survival, and that life threatening complications after the first postoperative year are rare.

Adolescent↗
PubMed1986

[Digestive arterial revascularization: long-term results and modified surgical approach].

In this series 31 patients (21 males and 10 females, median age 57 +/- 13.2 years) underwent surgery between 1970 and 1984 for digestive arterial lesions. Abdominal pain was observed in 84% of these cases and weight loss in 48%, while 8 patients were asymptomatic. In 12 patients (39%) the diagnosis was suspected before arteriography, which was the key to the diagnosis in 61% of cases (19 patients). In group A (elective surgery) 42 digestive arterial revascularizations were performed in 24 patients (mean number of effected by-passes 1.5). In group B (emergency surgery) 4 embolectomies and two by-passes were performed. In group A mortality (both surgery and hospital) was 0%. In group B surgical mortality was 33%. In a mean follow-up of 4.1 years the permeability of the by-pass established in elective surgery (emergency surgery) was 100% (64%) after one year and 92.9% (64%) after three years (life table analysis). Multiple digestive arterial revascularisations should be considered for those patients presenting multiple digestive arterial lesions because of catastrophical evolution of single by-pass occlusion in these patients.

Aged↗
PubMed1986

Equine pericardial xenograft in orthotopic position: early results.

Glutaraldehyde-preserved pericardium was used to close the pericardial sac after open heart surgery in 100 patients. The indication for implantation of a xenologous pericardial patch was always the lack of autologous pericardium to close the pericardial sac without significant tension. This was mainly due to previous use of an autologous pericardial patch or implant of an extracardiac conduit for the repair of congenital cardiac disease (n = 82) and reoperation after primarily open pericardium (n = 10). In this series with a mean follow-up of 3.1 months (range 1 to 12 months) no infection of the xenologous equine pericardial implant and no mediastinitis occurred. Even in cases of early reoperation (n = 6) for bleeding or tamponade there was no patch infection (implants left in situ). At medium-term reoperation in 3 cases, after a mean interval of 115 days, adhesions between the epicardium and the xenologous equine pericardial patch were graded mean 1 (blunt adhesions) on a scale of six (minimum = 0, maximum = 5). In another series of re-dos for coronary bypass surgery with pericardium primarily left open, the mean grade of adhesions formed in the anterior epicardial space was 2.7 (severe). The histology of explanted equine pericardium showed no new vessels and no in-dwelling organization. Although the follow-up is relatively short, this material appears to offer a valid non-adherent substitute to separate the posterior sternal surface and the cardiac cavities. Its application improves the safety at resternotomy.

Adult↗
PubMed1986

Surgery in primary leiomyosarcoma of the heart.

Primary leiomyosarcoma of the heart is uncommon and we were able to find only 15 cases reported in the literature. Few of these cases were discovered during life and, as a result, even fewer have been treated surgically. We report a case of a right atrial leiomyosarcoma which was proven pathologically (histologically, immunohistochemically and ultrastructurally) after surgical resection. The clinical presentation, morphological, appearances and outcome are compared with those reported in the literature.

Adolescent↗