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Biomedical subjects

B Faidutti

Publications and source records attributed to B Faidutti.

At least 109 records · Page 6Linked to original sources
PubMed1986

[Inferior vena caval return to the left atrium with intact interauricular septum. Apropos of 2 cases surgically treated with success].

Two cases of abnormal inferior vena caval return to the left atrium are reported in a 9 year old boy and 13 year old girl. The diagnosis was suspected on the finding of severe cyanosis alone, and the anomalous systemic venous return was correctly identified by angiography of the inferior vena cava. There were three angiographic points of interest in these two cases: the normal position of the inferior vena cava, the absence of a left-to-right interatrial shunt and the presence of a vertical intra-left atrial "membrane" inserted behind the orifice of the inferior vena cava. Surgical correction consisted in resecting the inferior part of the interatrial septum and reconstructing a new septum behind the orifice of the inferior vena cava with a dacron patch in one case and by direct suture in the other. The good surgical result was controlled by angiography in both cases. In the second case, an intrapulmonary shunt due to multiple arteriovenous fistulae demonstrated by contrast echocardiography was responsible for persistent mild cyanosis for a few months after surgery. The long-term clinical results were excellent in both cases. The authors review the literature of this rare malformation due to persistence of part of the right valve of the sinus venosus.

Arteriovenous Malformations↗
PubMed1985

Subaortic stenosis--improved surgical approach.

In most cases of subaortic stenosis there is associated hypertrophic muscular stenosis. Classical surgical treatment by transaortic ventriculomyotomy can be assessed by bidigital septal examination through a complementary pulmonary arteriotomy as reported in this paper. Preoperative and postoperative trans-stenotic subaortic pressure gradients were measured in 5 patients with a mean decrease of about 85 mmHg. Bidigital assessment of the residual septal thickness is likely to improve the results of transaortic ventriculomyotomy.

Adolescent↗
PubMed1985

[Outcome of patients operated on for aortic coarctation during the 1st year of life].

A coarctectomy performed on infants with congestive heart failure in the first year of life is an emergency procedure due to the "coarctation syndrome". An intracardiac anomaly is also present in the majority of cases. The surgical risk of coarctectomy in the newborn infant or during the first year of life is now low (7 percent in our study), but intermediate-term mortality rates were relatively significant (24 percent in our study), due to intracardiac anomalies and their surgical correction. Without treatment, however, the coarctation syndrome proves fatal in two out of three cases before one year of age. The principal long-term complication is recurrence of the coarctation resulting from the absence of growth at the anastomosis. It occurs in 20 to 50 percent of cases depending on the study, the diagnostic criteria, and length of time since the surgery. This complication is more frequent when the coarctectomy was performed in the first month of life. Another coarctectomy must be undertaken in these cases. Persistent arterial hypertension without recurring coarctation is rarely observed, but is frequently encountered following a coarctectomy in an older child or adult. It should be noted that the systolic arterial blood pressure in almost all infants in our study was between the 50th and 97th percentile for normal children of this age. Aside from the problem of recurring coarctation, the long-term follow-up depends principally on associated valvular lesions, particularly aortic (bicuspid valves are very frequent) and mitral valvular lesions. Even though surgery has greatly improved the prognosis of coarctation in children, these infants must have long-term postoperative surveillance.

Aortic Coarctation↗
PubMed1984

Symptomatic aberrant retro-esophageal subclavian artery: considerations about the surgical approach, management and results.

Ten case histories of patients with symptomatic aberrant retro-esophageal subclavian artery are presented. The diagnosis was made on a clinical basis in 8 cases because of symptoms of tracheo-esophageal obstruction, and confirmed by barium meal. All patients were investigated by angiography. Six patients with right abnormal retro-esophageal subclavian artery (arteria lusoria) and its mirror image were treated by transection of the aberrant subclavian artery and reimplantation into the common carotid artery through a single midline sternal splitting incision which gave ample access. Three patients with left abnormal subclavian artery (right aortic arch) were operated by transection of the patent ductus arteriosus or ligamentum arteriosum through a left lateral thoracotomy. After a follow-up of from one to 10 years (mean 6.4 years), 9 patients are free of symptoms like dysphagia, dyspnea or subclavian steal and normal pulses are present on both upper extremities in 8 cases.

Adolescent↗
PubMed1984

[Coarctation syndrome in infancy and its outcome: surgical results and long-term follow-up].

Between 1972 and 1983, 29 newborns and infants were treated surgically for coarctation of the aorta. The mean age at operation was 2 months 7 days. 76% of the patients (22/29) had an associated intracardiac malformation, 8 requiring correction. The early mortality rate (due to coarctation repair) was 7% (2/29). The total mortality rate was 31% (7/29). Four of the 7 late deaths occurred during surgical correction of an intracardiac malformation. Twenty children were followed up for 1 to 10 years (mean 4 1/2 years) after surgery. Four patients (20%) had a recoarctation. All 4 recurrences occurred within 2 years after surgery, and in patients operated on during the first month of life. Blood pressure at the latest outpatient visit was above the 97th percentile in 6 children, 4 of whom had recoarctation. Among the patients with no evidence of recurrence, 86% had a blood pressure between the 50th and the 97th percentile or just above the 97th. Five patients underwent a maximal exercise test: none developed excessive elevation of systolic blood pressure, and no pressure difference appeared between arm and leg during the exercise test in those who had none at rest. Thus, early surgical correction improves the prognosis of infantile coarctation syndrome, but recoarctation may occur; long term follow-up is advisable.

Age Factors↗
PubMed1983

[Long-term evolution of children operated on for tetralogy of Fallot].

While open heart surgery has much improved the prognosis of tetralogy of Fallot, surgical repair does not usually restore completely normal anatomy. Residual defects include some degree of pulmonary stenosis, pulmonary regurgitation (unavoidable if the pulmonic valve and valve ring need to be widened by patch), and, sometimes, residual ventricular septal defect. In addition, left and right ventricular dysfunction of mild to moderate degree, unrelated to residual lesions, may be observed. Other late complications may arise from conduction disturbances and ventricular arrhythmias. The occurrence of late sudden death is related to such rhythm disturbances, it occurs particularly in patients with ventricular premature beats on routine ECGs and is probably due to ventricular fibrillation. Patients with such premature beats must therefore be treated with antiarrhythmic drugs. In spite of these late complications, the majority of patients lead a normal life and professional integration is usually excellent. Many patients practise sports. Exercise tests late after surgery show mild or moderate decrease in maximal exercise performance if there are residual lesions of significance, and especially when there is more than one such residua (e.g. pulmonic stenosis and regurgitation). Life expectancy should be normal, at least for postoperative patients with minimal residual lesions.

Age Factors↗
PubMed1983

Calcified left ventricular aneurysm in a 6-year-old boy. Case report.

The case of a calcified left ventricular aneurysm in a 6-year-old asymptomatic boy is presented. The anomaly was discovered on a routine chest X-ray. The etiology of this condition is discussed. A review of the literature reveals that this is a rare occurrence in children and that the origin is often unknown. Selective left coronary arteriography showed no arterial anomalies but early filling of the right coronary veins, apparently through small AV fistulas. This might have caused some peripheral myocardial underperfusion, followed by myocardial infarction and aneurysm formation. Aneurysmectomy was carried out uneventfully.

Calcinosis↗
PubMed1982

Mitral valve replacement in children. Comparative study of pre- and postoperative haemodynamics and left ventricular function.

Haemodynamic variables and left ventricular function were studied before and after mitral valve replacement in 44 children age 3 to 17 years (mean 11.9 years). Thirty-nine Starr-Edwards prostheses and five Hancock prostheses were used; postoperative study took place two to six months (mean 3.9 months) after operation. Pulmonary hypertension was present preoperatively in most patients, with mean pulmonary artery pressures of 18 to 75 (mean 46.5 mmHg). Postoperatively there was a pronounced drop in pressure to a mean value of 25.6 mmHg, partially explained by a decrease in pulmonary capillary wedge pressure. Pulmonary arteriolar resistance, however, also decreased conspicuously from an average of 590 dynes s cm-5 m-2 preoperatively to 282 dynes s cm-5 m-2 postoperatively. A return to normal resistance was seen in every case when preoperative resistance did not exceed 650 dynes s cm-5 m-2; above this threshold some degree of pulmonary hypertension often persisted. The residual gradient across the prosthetic valve was slightly higher for the Hancock than for the Starr-Edwards prosthesis (mean 8.7 mmHg, vs mean 6.9 mmHg). The left ventricular end-diastolic volume was much increased before surgery, with a mean value of 190 ml/m2; it decreased conspicuously after operation to 103 ml/m2. The left ventricular ejection fraction ranged from 40% to 76% (mean 57%) before operation; there was no significant change after operation, with values ranging from 40% to 73%. This left ventricular dysfunction is probably the result of myocardial injury caused by a chronic volume overload and the sequelae of rheumatic carditis.

Adolescent↗
PubMed1982

Association of coarctation of the thoracic aorta with fibromuscular dysplasia of the renal arteries: a case report.

The case of a 25-year-old woman with coarctation of the thoracic aorta and combined bilateral fibromuscular dysplasia of the renal arteries is reported. Although marked hemodynamic changes induced by the coarctation were probably pre-existent, hypertension was revealed only during the last month of her first pregnancy and was spontaneously corrected 2 months post partum. Surgical treatment of the thoracic coarctation did not influence blood pressure which remained normal.

Adult↗
PubMed1981

[Valve replacement in children: results and long-term follow-up in 171 operated patients].

171 children aged 2-17 years underwent cardiac valve replacement between 1969 and December 1979. Valve lesions were of rheumatic origin in 160 and congenital in 11 cases. Single valve replacement of the mitral valve was performed in 116 cases, of the aortic valve in 18 cases and of the tricuspid valve once. Double valve replacement was done in 33 and triple valve replacement in 2 cases. Starr Edwards prostheses were used in most instances. Operative mortality was 5.9% and late death occurred in 8.7%. The follow-up period ranged from 1-9 years with a mean of 3.6 years. The majority of children have returned to a normal lifestyle and are symptom-free. Only 10% remain digitalized. As in adults, the most frequent complications were thromboembolic. 14 children (11%) had either an embolus or a valve thrombosis with a frequently of 3 per hundred patient-years. Other complications such as endocarditis or paravalvular leak were infrequent, and in most cases treatment was successful. Because of the markedly dilated hearts before operation it was possible in most children to use an adult size prosthesis, especially in the mitral position. Only a few children below 5 years of age received small mitral valve prostheses; they may need to be replaced ultimately by larger ones. Introduction of an embolus-free valve prosthesis for children would be a major advance. Unfortunately, porcine xenografts with their low embolic risk are not suitable for children as they often undergo rapid calcification.

Adolescent↗
PubMed1981

[Results of coarctectomy in newborn and young infants].

Twenty infants underwent coarctectomy between 1972 and 1979, 12 were less than one month old at surgery. One infant died after the procedure (5% mortality). Seven underwent open heart surgery later in the first year of life for associated intracardiac defects; there were 3 early and one late death. Of the 15 survivors, 12 have been followed up for 6 months to 6 years (mean 3 years). All are actually asymptomatic. Arterial blood pressure is slightly higher in the leg than in the arm in 8 patients (as in normal children), equal in leg and arm in 2 and lower in the leg than in the arm in 2 (recoarctation). Postoperative catheterization was done in six patients. A pressure gradient across the anastomotic site was confirmed in two (32 and 28 mm Hg). In the other four, no pressure gradient was found, and the site of the anastomosis was hardly or not at all detectable on the angiogram. Coarctectomy in newborns and infants now carries a low operative mortality. With proper operative technique, normal growth of the anastomotic site is usually obtained.

Aortic Coarctation↗