Cryopreserved homografts in the treatment of relapsing fungal cardiovascular infections.
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Adult↗
Biomedical subjects
C A Mestres
Publications and source records attributed to C A Mestres.
[Cardiac surgery in patients over 70. Its incidence and trends in Spain].
INTRODUCTION AND OBJECTIVES: During the last years elderly population has been growing in all the occidental world. Consequently the number of elderly patients undergoing cardiac surgery has increased. The aim of this work is to know whether this increase has also taken place in Spain. METHODS: A survey among the different Units in the country was performed. The number and percentages of patients older than 70 years with coronary and valvular heart disease operated among 1991 and 1992 was analysed. Twenty-one of the 28 units replied (74%). RESULTS: The percentage of coronary patients older than 70 years operated in 1991 was 15.61% and 19.20% in 1992, a statistically significant increase of 21.84% (p < 0.001). However, there was no significant increase in the number of elderly patients undergoing valvular surgery. CONCLUSIONS: The influence of the elderly population on the activity in cardiac surgery is known to be significant; thus, a careful analysis of the health, social and economic implications seems to be mandatory.
Aged↗
[Postinfarction ventricular septal defect. Surgical approach by right ventriculotomy in 4 patients].
Ventricular septal defect secondary to myocardial infarction still have high mortality. Early and swift surgical repair is needed to obtain adequate results. Surgical exposure of defect through the infarcted left ventricle wall is the usual technique. Nevertheless right ventricular access to the interventricular septum has given excellent results on 4 of our patients. Our results are analyzed.
Aged↗
Management of persistent tricuspid endocarditis with transplantation of cryopreserved mitral homografts.
Transplantation of the human mitral valve in the tricuspid position for intractable infective endocarditis has been successfully performed in three young patients who were addicted to drugs. The maximum follow-up is 20 months. The rationale and historical basis for using this approach in the surgical treatment of patients with right-sided infective endocarditis is discussed and the appropriate literature reviewed. Because the technical aspects have been previously reported, this article can be considered an argument to renew past interest in atrioventricular valve replacement with fully biologic tissue of human origin.
Adult↗
Cryopreserved homografts in aortic and mitral prosthetic endocarditis: expanding the use of biological tissues in complex cardiac infections.
The case of a 27-year-old male heroin addict suffering from mitral and aortic prosthetic valve endocarditis is presented. Double valve re-replacement was performed using cryopreserved aortic homografts. Aortic root replacement with coronary re-implantation and intra-atrial valve implantation for mitral valve replacement were the techniques used. Despite the fatal outcome of this case, it clearly illustrates the possibilities of expanding the indications for combined complex replacement of heart valves by using fully biological tissue of human origin.
Adult↗
Tricuspid valve replacement using a mitral homograft. Surgical technique and initial results.
Tricuspid valve replacement using a cryopreserved mitral valve homograft was carried out with success in three HIV positive drug addicts suffering from fungal or bacterial endocarditis. All three patients are alive and symptomless up to 16 months after surgery. This procedure is considered to be an alternative to other methods of tricuspid valve replacement if repair is not feasible. Further experience is needed to assess the long term performances of mitral homografts in the tricuspid position.
Adult↗
Mitral valve repair in patients on chronic hemodialysis.
Two cases of successful mitral valve repair in patients on chronic hemodialysis are presented. We stress that valve repair is preferable to valve replacement whenever feasible because of improved left ventricular function, reduced complication rate, and freedom from anticoagulation. This especially applies to patients on chronic hemodialysis as they have impaired immunological function, are subjected to repeated fistula punctures with possible bacteremia, and are more susceptible to early calcification and degeneration of tissue valves.
Female↗
Intravascular hemolysis after mitral valve repair: a word of caution.
The case of a young patient who presented with severe hemolysis after mitral valve repair is presented. Valve repair included chordal shortening, transposition of chordae tendinae, and annular remodelling using a Duran flexible ring. Reoperation and valve replacement were required to control hemolytic anemia. The possible mechanisms leading to such an uncommon complication after plastic repair of the mitral valve are commented on. The scanty literature concerned is reviewed.
Adult↗
Coronary artery bypass surgery in young patients.
Coronary atherosclerosis is being increasingly observed in young patients. However results of surgery in such patients have so far been disappointing both in terms of operative mortality, symptomatic relief and long-term survival. Reasons given for this include the increased prevalence of risk factors in young patients and a higher incidence of graft occlusion. In the treatment of Asian patients, a further negative factor is the belief that coronary artery disease is more often diffuse and the vessels smaller. Between January 1987 and May 1991, a total of 66 patients under the age of 45 years at the time of surgery had coronary artery bypass grafting performed. The demographic, clinical, angiographic and operative data were analysed. Eighty-nine per cent of the patients were male and their racial distribution was 63% Chinese, 8% Malays, 26% Indians and 3% Others. Their mean age was 40.8 years. The presence of risk factors was high: 45.6% had hypertension; 34.8% were smokers; 21.2% had diabetes mellitus; and 12.1% had hyperlipidaemia. The main indication in these patients was either angina or a previous myocardial infarction (53%). There were no patients with perioperative infarction diagnosed by the presence of new Q wave. There was no hospital death. The stay of the patients ranged from 6 to 28 days with a mean of 10 days. Follow-up ranged from 3 to 54 months. There were no late deaths. It was concluded that there is a high incidence of risk factors among young patients with coronary artery disease, which follows the pattern of many other studies. The operative risk in these patients is low and morbidity is minimal.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Early experiences of intra-operative trans-oesophageal echocardiography (TEE) in mitral valve repair.
Whenever possible Mitral valve repair should be performed instead of Mitral valve replacement. It is important to assess the adequacy of the repair during the operation so that any corrective steps may be taken immediately. We present three cases of Mitral valve repair in which the intraoperative TEE was used to assess the adequacy of the repair. There was good correlation of the immediate post bypass TEE findings and early post operative transthoracic echocardiographic findings. Intraoperative TEE is a useful tool in the early assessment of Mitral Valve Repair.
Adult↗
Ectopic thymoma: a case for median sternotomy for complete thymectomy.
Thymomas are normally found in the superior mediastinum or the upper part of the anterior mediastinum. We report a case of thymoma arising in the inferior aspect of the anterior mediastinum. This case illustrates that thymic tissue may be found low in the anterior mediastinum and supports the practice of a median sternotomy approach for thorough mediastinal exploration in all cases of thymectomy.
Aged↗
Overestimation of severity of mitral stenosis during cardiac catheterization due to a large left atrial thrombus.
We report a case of mitral stenosis with a large left atrial thrombus which was obstructing pulmonary venous inflow where the conventional use of the pulmonary capillary wedge pressure as an approximation of the left atrial pressure during diagnostic cardiac catheterisation led to the over-estimation of the severity of mitral stenosis.
Aged↗
Delayed sternal closure for life-threatening complications in cardiac operations: an update.
Over a 7-year-period, 25 patients had delayed sternal closure after open heart operations out of 34 patients whose sternum was not closed. The indications were extreme cardiac dilatation and uncontrollable mediastinal hemorrhage. This represented a 1.79% incidence in the overall open heart surgical experience at our unit. Sternal closure was performed at a mean of 2.64 days after the initial operation. Eighteen patients (52.9%) left the hospital alive and well, representing a 72% survival rate among patients undergoing delayed sternal closure. No mediastinal or fatal infection developed and only 1 patient had late superficial wound infection after delayed sternal closure. We conclude that delayed sternal closure is an effective method to treat severe complications after cardiac operations.
Adult↗
Combined resection of hepatoblastoma and intracaval right atrial extension with profound hypothermia and circulatory arrest.
Hepatoblastoma is an uncommon liver neoplasm in children but its intraatrial extension through the inferior vena cava is extremely rare. The case described is a 3-year-old boy in whom profound hypothermia and circulatory arrest were used to resect a hepatoblastoma and its extension to the right atrium. This technique allows maximal resection and relief of venous obstruction from atrial extension of hepatoblastoma.
Carcinoma, Hepatocellular↗
Obstruction and recanalization of the ureter during embryonic development.
Major controversies still exist regarding the terminology, the etiology and the pathogenesis of congenital obstructive diseases of the ureter. To try to provide some additional information to this controversial subject, a comparative study of ureteral development in rat and human embryos, using light and electron microscopy, has been performed. During fetal development we observed and demonstrated the existence of obstructive phenomena, both at the level of the ureterovesical junction (Chwalla's membrane) and along the ureter. At the end of the embryonic period, the ureter undergoes a physiologic recanalization process.
Animals↗
Vesical tumors in patients under 25 years of age.
Behavior of transitional cell carcinoma of the bladder during the third decade of life remains a controversial subject. During the period 1980-1988, we treated 7 patients (4 male and 3 female), 25 years of age or less (mean age 19.3, range 14-25), with transitional cell carcinoma of the bladder. Until now, all patients are alive and without disease during 12-50 months after surgery. In 6 of the 7 patients, endoscopic resection was the choice treatment for superficial stage A/O. The seventh patient underwent a partial cystectomy for a B1 Jewet stage cell carcinoma. We conclude that transitional cell carcinoma of the bladder in patients under 25 years of age has a less aggressive biological behavior. Therefore, ultrasonographic examinations and serial urine cytology represent the elective test for follow-up. Cystoscopy would only be performed in doubtful cases.
Adolescent↗
Myocardial revascularisation in patients with carotid artery disease.
From January 1987 to December 1989, 80 patients with carotid bruit and/or history of transient ischaemic attack/stroke underwent digital subtraction angiography (DSA) prior to consideration for coronary artery bypass graft. Thirty-eight patients (Group I) out of the 80 had coronary artery bypass graft done with postoperative stroke in five (13.2%); this contrasted with a group of 320 patients (Group II) without cerebrovascular disease who underwent coronary artery bypass graft during the same period with postoperative stroke in two cases (0.63%) (p less than 0.0005). Carotid artery stenosis was noted on the DSA in 66% of Group I patients, with significant disease (greater than 70% occlusion) in 15%, while the study was normal in 34% of cases. Combined carotid endarterectomy and coronary artery bypass graft was done in five of Group I patients, with postoperative stroke in one; this was the only one among the stroke patients with significant carotid disease. All strokes, except in one patient, resolved within one to 6 1/2 months. These results suggest that the risk of stroke after coronary artery bypass graft is increased in patients with carotid bruit or history of transient ischaemic attack/stroke and in the presence of established carotid artery disease. The place of combined carotid endarterectomy and coronary artery bypass graft in these cases remains to be determined.
Angiography, Digital Subtraction↗
[Replacement of the aortic root and ascending aorta with a fresh antibiotic-sterilized homograft].
The case of a 53-year-old male suffering from aortic stenosis and aneurysm of the ascending aorta treated by aortic root replacement with a fresh antibiotic-sterilized aortic homograft is presented. The technique and indications are commented on, focusing attention in the scanty results available in the literature with regard to this technique. We support the use of homografts in aortic root replacement in selected cases.
Anti-Bacterial Agents↗