Tricuspid and mitral valve repair.
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Humans↗
Biomedical subjects
C Acar
Publications and source records attributed to C Acar.
Mycotic aneurysms of the carotid arteries--case report and review of the literature.
Mycotic aneurysms of the extracranial carotid arteries are rare. We report a new case with a mycotic aneurysm of the carotid bifurcation associated with acute bacterial endocarditis of the aortic valve. A concomitant treatment of both lesions was performed. Twenty-six cases of mycotic aneurysms of the extracranial carotid arteries have been reported in the literature. We present a review of all these cases.
Acute Disease↗
Intra-operative transoesophageal echocardiography after mitral repair--specific conditions and pitfalls.
The aim of this study was to determine the specific conditions and pitfalls of immediate assessment of the reconstructed mitral valve in open chest patients. Sixty-two patients had a mitral reconstruction controlled by transoesophageal echocardiography and colour Doppler (TEE) from the moment when cardiac activity restarted under extracorporeal circulation (ECC), until complete rewarming of the patient and weaning off the by-pass. The following conditions altered the imaging quality: (1) dried probe in the oesophagus or air bubbles, (2) non-aspirated air from the stomach, (3) small or empty left atria, (4) invagination of the left atrial appendage, (5) trapped air in the posterior pericardium, (6) spontaneous contrast. Transient mitral regurgitation disappeared completely in 12/62 patients: five had temporary impairment of LV function, two had reduced filling of the heart, one had left ventricular outflow obstruction exacerbated by isoproterenol and nitroglycerin, two had ventricular ectopic rhythms, and two epicardial pacing. Only one of the 62 patients had persistent significant MR which required a second run of ECC. We conclude that mitral regurgitation after mitral valve repair is closely related to the quality of LV function. A decision to reoperate should eliminate the possible pitfalls, and take into consideration the specific conditions of immediate postoperative cardiac function.
Echocardiography, Doppler↗
Management of infected vascular prostheses. The vascular homograft revisited.
Treatment of infected aortic femoral grafts is difficult and controversial. We describe the case of a patient who presented for recurrent infections of an aorto-bifemoral prosthesis. An arterial homograft was used to replace the Dacron prosthesis. One year later, the patient is free of symptoms and is doing well. Although early experiences with long-term use of homografts showed late degeneration of the grafts, 2 points should now be raised in favor of homograft use: new techniques of fresh antibiotic storage of homografts appear to have improved durability; and if replacement of a homograft ever becomes necessary, implantation of a Dacron prosthesis could likely be performed in an aseptic environment. While the use of homografts may constitute a reasonable alternative for treating patients with infected vascular grafts, firm conclusions cannot be drawn until we have seen larger series of patients and longer follow-up periods than those few reported to date.
Journal Article↗
[Mitral valvuloplasty for endomyocardial fibrosis in a child with acute leukemia and hypereosinophilia].
The authors report the case of a child with acute lymphoblastic leukaemia and hypereosinophilia complicated by left sided endomyocardial fibrosis. Despite the need for urgent treatment and severe mitral valve disease, a complex mitral valvuloplasty was performed, consisting of mobilisation and reconstruction of the posterior leaflet, burying the chordae with plicature of the papillary muscle of the anterior leaflet associated with an annuloplasty. Decortication was performed by a transvalvular approach. The technique of mobilisation-reconstruction of the posterior mitral leaflet with a pericardial patch should widen the indication of conservative surgery in this condition, in the presence of dominant mitral regurgitation in the child.
Child↗
[Traumatic mitral valve insufficiency after percutaneous mitral valve angioplasty. Mechanisms and surgical technique].
Eighteen patients underwent surgery for traumatic mitral regurgitation following percutaneous mitral valvuloplasty (PMV). Three patients required emergency surgery (delay less than 6 hours). In the remaining cases, the operation was performed one week after PMW (n = 11) or delayed for up to 3 months (n = 4). The operative findings were: ruptured papillary muscle (n = 1); torn anterior leaflets (n = 4), torn posterior leaflet (n = 1), anterior paracommissural tear (n = 3), posterior paracommissural tear (n = 9). Associated lesions included left atrial thrombosis (n = 2) and greater than 1 cm atrial septal defect (n = 4). Conservative mitral valve surgery was possible in over half the cases (n = 10), including two extensive tears of the anterior leaflet. The other patients required mitral valve replacement (n = 8). There were no postoperative complications in any of the patients.
Adult↗
Mitral valve repair for anterior leaflet disruption after percutaneous mitral dilation.
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Adult↗
[Postoperative iatrogenic coronary-ventricular fistula].
Acquired coronary cardiac fistulas are rare. To date, thirty cases have been published in the literature, all secondary to thoracic trauma. The right cardiac chambers were more frequently involved. A recent continuous cardiac murmur is the most constant finding. Nontreated, these lesions tend to induce coronary insufficiency and congestive heart failure. 22 of the 30 reported cases were managed surgically. We hereby report a case of postoperative coronary cardiac fistula secondary to left ventricular venting, in which the fistula involved the left ventricular cavity.
Coronary Vessels↗
Studies of controlled reperfusion after ischemia. XIX. Reperfusate composition: benefits of blood cardioplegia over fluosol DA cardioplegia during regional reperfusion--importance of including blood components in the initial reperfusate.
HYPOTHESIS: Initial reoxygenation with blood cardioplegic solution produces better regional recovery than with Fluosol DA cardioplegic solution (Green Cross Corporation, Osaka, Japan) because blood cardioplegia ensures delivery of important blood components (i.e., plasma and red blood cells) that limit reperfusion damage. METHODS: Twenty-five dogs underwent 2 hours of ligation of the left anterior descending coronary artery followed by controlled reperfusion at 50 mm Hg through an internal mammary graft on total vented bypass. Five dogs received normal blood reperfusion, 10 dogs received a 20-minute reperfusion with Fluosol DA 20% cardioplegic solution, and 10 others received a blood cardioplegic reperfusate of identical composition (i.e., pH, calcium, potassium, glucose, osmolarity). Regional oxygen consumption was measured during reperfusion, and segmental shortening (ultrasonic crystals), tissue water content, and histochemical damage (triphenyltetrazolium chloride stain) were assessed 2 hours later. RESULTS: Reperfusion with normal blood failed to restore contractile function (3% systolic shortening), caused severe edema (81% water content), and caused marked histochemical damage (48% triphenyltetrazolium chloride nonstaining). Hearts reperfused with Fluosol DA cardioplegic solution did not take up as much oxygen as hearts receiving blood cardioplegic reperfusion (37 versus 54 ml/100 gm, p less than 0.05). Blood cardioplegia was superior to Fluosol DA cardioplegia in recovery of segmental contractility (69% versus 34% systolic shortening, p less than 0.05), produced less edema (79.5% versus 80.9% water content, p less than 0.05), and produced less histochemical damage with triphenyltetrazolium chloride (11% versus 40% area of nonstaining/area at risk, p less than 0.05). CONCLUSIONS: Initial reperfusion with a blood cardioplegic solution ensures better oxygen utilization, superior recovery of regional contractility, and less tissue damage than Fluosol DA cardioplegic reperfusion. These data emphasize the importance of including blood components (plasma or red blood cells) in the oxygenated cardioplegic reperfusate to limit reperfusion injury.
Adenosine Triphosphate↗
Studies of controlled reperfusion after ischemia. XX. Reperfusate composition: detrimental effects of initial asanguineous cardioplegic washout after acute coronary occlusion.
UNLABELLED: This study tests whether initial asanguineous washout of potentially toxic substances that accumulate during ischemia improves recovery produced by blood cardioplegic reperfusion and evaluates the role of plasma versus whole blood cardioplegia. METHODS: Twenty-four dogs underwent 2 hours of occlusion of the left anterior descending coronary artery and 20 minutes of blood cardioplegic reperfusion on total vented bypass. In 13 dogs, a 5-minute infusion of either a crystalloid (n = 7) or plasma (n = 6) cardioplegic solution (containing the same pH, calcium potassium, and osmolarity as blood cardioplegia) was given immediately before reoxygenation with blood cardioplegia. Regional oxygen uptake and coronary vascular resistance were measured during controlled reperfusion, and segmental shortening (ultrasonic crystals), tissue water content, and histochemical damage (triphenyltetrazolium chloride stain) were assessed 1 hour after bypass was discontinued. RESULTS: Asanguineous cardioplegic washout before reoxygenation with blood cardioplegic solution resulted in a progressive (+42%) increase in coronary vascular resistances (from 123 to 176 units, p less than 0.05) and low oxygen utilization during 20 minutes of blood cardioplegic reperfusion (29 ml/100 gm, p less than 0.05); coronary vascular resistance remained low throughout blood cardioplegic reperfusion without washout (from 109 to 98 units), and oxygen utilization was 54 ml/100 gm (p less than 0.05). Neither plasma nor crystalloid washout restored substantial regional systolic shortening (3% systolic shortening versus 73% systolic shortening with blood cardioplegia), and asanguineous washout caused more myocardial edema (81.1% +/- 80.9% versus 79.5% water content, p less than 0.05) and produced extensive transmural triphenyltetrazolium chloride damage (48% +/- 41% versus 8% nonstaining in area at risk, p less than 0.05) than initial blood cardioplegic reperfusion. CONCLUSION: Asanguineous cardioplegic washout before blood cardioplegic reperfusion limits oxygen utilization during subsequent controlled reperfusion, restricts early recovery of systolic shortening, allows more myocardial edema, and produces extensive histochemical damage, which may be avoided by initial reoxygenation with blood cardioplegia. The red blood cells appear more important than the plasma components of blood cardioplegia.
Adenosine Triphosphate↗
Studies of controlled reperfusion after ischemia. XXI. Reperfusate composition: superiority of blood cardioplegia over crystalloid cardioplegia in limiting reperfusion damage--importance of endogenous oxygen free radical scavengers in red blood cells.
UNLABELLED: Postischemic damage is caused partially by oxygen free radical-mediated injury. This study will show that (1) crystalloid cardioplegia with room air oxygen is deleterious because it is devoid of free radical scavengers and (2) blood cardioplegia limits damage because it contains endogenous free radical scavengers in red blood cells. METHODS: Thirty-two dogs underwent 2 hours of ligation of the left anterior descending coronary artery followed by 20 minutes of regional blood cardioplegic reperfusion on bypass. Ten dogs received only the blood cardioplegic solution (containing its endogenous free radical scavengers); five received initial blood cardioplegia (5 minutes) with endogenous free radical scavengers (catalase and glutathione peroxidase) blocked by aminotriazole and N-ethylmaleimide, respectively; 12 received initial crystalloid cardioplegic solution oxygenated by room air (oxygen tension = 150 mm Hg); seven without and five with exogenous free radical scavengers (superoxide dismutase, catalase, coenzyme Q10); five received initial deoxygenated crystalloid cardioplegic solution (oxygen tension = 6 mm Hg); and five received deoxygenated crystalloid cardioplegic solution. RESULTS: Blood cardioplegia with endogenous free radical scavengers produced the best recovery of systolic shortening (69% systolic shortening) and resulted in the least histochemical damage (11% triphenyltetrazolium chloride nonstaining). The worst recovery and most damage occurred if blood cardioplegia was preceded by oxygenated crystalloid cardioplegia (3% systolic shortening, 48% triphenyltetrazolium chloride nonstaining; p less than 0.05 versus blood cardioplegia) or if free radical scavengers were blocked in the initial period of blood cardioplegia (3% systolic shortening, 41% triphenyltetrazolium chloride nonstaining; p less than 0.05 versus blood cardioplegia). Conversely, deoxygenation or supplementation of oxygenated crystalloid cardioplegic solution with exogenous free radical scavengers restored 60% systolic shortening (p less than 0.05 versus oxygenated crystalloid cardioplegia) and 54% systolic shortening (p less than 0.05 versus oxygenated crystalloid cardioplegia) and reduced damage to 34% and 21% (both p less than 0.05 versus oxygenated crystalloid cardioplegia). CONCLUSION: Blood cardioplegic solutions containing their own endogenous free radical scavengers are superior to crystalloid cardioplegic solutions, because they limit oxygen-mediated perfusion damage and restore contractile function. Initial crystalloid cardioplegic washout negates the salutary effect of blood cardioplegia. Exogenous free radical scavenger supplementation or deoxygenation of the cardioplegic reperfusate is necessary only if crystalloid cardioplegia is used.
Adenosine Triphosphate↗
Studies of controlled reperfusion after ischemia. XXII. Reperfusate composition: effects of leukocyte depletion of blood and blood cardioplegic reperfusates after acute coronary occlusion.
OBJECTIVES: This study evaluates the role of leukocyte depletion during initial reoxygenation with normal blood and blood cardioplegic reperfusates in limiting reperfusion damage. METHODS: Twenty-eight dogs underwent 2 hours of ligation of the left anterior descending coronary artery. The initial reperfusate (37 degrees C) was delivered on total vented bypass to the left anterior descending artery by a calibrated pump via an internal mammary artery graft at 50 mm Hg for 20 minutes. Eight dogs received normal (normokalemic, nonenriched) blood reperfusion (leukocyte count 8000/mm3) and six were reperfused with leukocyte-depleted normal blood (leukocyte count less than 100/mm3). Of 14 dogs reperfused with substrate-enriched (hyperkalemic) blood cardioplegic solution, six received a cardioplegic solution with a leukocyte count less than 100/mm3. RESULTS: Leukocyte depletion of normal blood reduced reperfusion-induced arrhythmias from 63% to 17% (p less than 0.05). Coronary vascular resistance at initial reperfusion was low and remained low during substrate-enriched blood cardioplegic reperfusion with both normal and reduced leukocyte counts. In contrast, coronary vascular resistance rose 63% with normal blood reperfusion, and this increase was avoided by leukocyte depletion (2.6 versus 4.0 mm Hg x ml/min, p less than 0.05). Coronary vascular resistance after 20 minutes was, however, higher than that with blood cardioplegia with normal or decreased leukocyte counts. Negligible functional recovery followed reperfusion with normal blood and leukocyte-depleted blood (12% and 6% of control systolic shortening). In contrast, substantial segmental recovery followed blood cardioplegic reperfusion (73% systolic shortening, p less than 0.05) but was not improved by leukopheresis (81% systolic shortening). Leukocyte depletion of normal blood reperfusate reduced histochemical damage from 53% to 38% (p less than 0.05), but the least histochemical damage followed blood cardioplegic reperfusion with a normal or reduced leukocyte count (8% or 11%, p less than 0.05). CONCLUSIONS: These findings suggest an important role for leukocytes in reperfusion damage, but reperfusate leukocyte filtration alone is inferior to blood cardioplegic reperfusion. Leukocyte depletion of blood cardioplegic solutions seems unnecessary after only 2 hours of ischemia.
Animals↗
Studies of controlled reperfusion after ischemia. XXIII. Deleterious effects of simulated thrombolysis preceding simulated coronary artery bypass grafting with controlled blood cardioplegic reperfusion.
This study tests whether simulated thrombolysis before controlled reperfusion (i.e., simulated coronary artery bypass) causes reperfusion injury that obviates the benefits of subsequent controlled reperfusion and results in unnecessary ventricular arrhythmias. Fifteen dogs underwent acute occlusion of the left anterior descending coronary artery. In 10 dogs we simulated thrombolysis after 1 hour of ischemia (delivering 10% to 15% of control flow at 5 ml/min), followed 1 hour later by either normal blood reperfusion at systemic pressure (to simulate percutaneous transluminal coronary angioplasty) in five dogs or regionally controlled blood cardioplegic reperfusion on bypass in five others to simulate coronary bypass. In five dogs ischemia was prolonged to 2 hours, and the initial reperfusate was blood cardioplegic solution on total vented bypass (to simulate primary coronary bypass). All hearts receiving simulated thrombolysis (100%) after 1 hour of ischemia had reperfusion-induced ventricular fibrillation. All hearts treated by simulated angioplasty recovered regional contractility (56% of control systolic shortening), whereas there was no (0%) recovery of spontaneous contractility after subsequent blood cardioplegic reperfusion, and only two (40%) dogs had contractile reserve capacity (6% +/- 49%). Conversely, surgically controlled blood cardioplegic reperfusion without preceding low-flow normal blood reperfusion after 2 hours of ischemia resulted in no ventricular arrhythmias (0%; p less than 0.05 versus simulated coronary artery bypass after simulated thrombolysis), 72% +/- 7% (p less than 0.05 versus simulated coronary artery bypass after simulated thrombolysis) recovery of regional contractility (ultrasonic crystals), and 114% +/- 11% (p less than 0.05 versus simulated coronary artery bypass after simulated thrombolysis) recovery of contractile reserve with calcium chloride stimulation. We conclude that controlled reperfusion (simulating coronary artery bypass) with blood cardioplegic solution produces immediate functional recovery and avoids the ventricular fibrillation that follows simulated thrombolysis despite the need for prolonged ischemic time. Preceding controlled reperfusion by normal blood reperfusion (simulated thrombolysis) shortens the ischemic time but nullifies immediate functional recovery possible by simulated coronary bypass and produces unnecessary arrhythmias.
Angioplasty, Balloon, Coronary↗
[Combined coronary and lower limb revascularization: a new technique].
The management of patients with concomitant coronary and aorto-iliac atherosclerosis is subject to controversy, but it is universally agreed that coronary artery surgery should precede aorto-iliac reconstruction. The technique described here consists of an ascending aorta to bifemoral graft. It allows combined surgery of the coronary and lower limb arteries to be performed without opening the peritoneum.
Angiography↗
[Acute ischemia of the legs caused by white clot syndrome after cardiac surgery].
A case of post-surgical heparin-induced thrombocytopenia with bilateral aorto-iliac thrombosis (the so-called "white clot syndrome") is reported. The clinical manifestation was acute ischaemia in both lower limbs, requiring surgery. In view of the patient's poor general condition 15 days after a double aorto-coronary bypass, the surgical treatment was limited to ilio-femoral thrombectomy associated with extra-anatomical bypass. This, combined with medical treatment, resulted in resolution of all thrombotic symptoms and disappearance of the intra-aortic thrombi at control Doppler ultrasonography and arteriography performed one month later.
Aorta, Abdominal↗
Anatomical study of the tricuspid valve and its variations.
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Humans↗
Biatrial transseptal approach in case of difficult exposure to the mitral valve.
The biatrial transseptal approach according to the Dubost technique provides an excellent exposure to the mitral valve. Over a 5-year period (1984 to 1989) we used this approach in 210 patients. We believe that this incision is indicated in the following situations: reoperation on the mitral valve and acute mitral insufficiency with little enlargement of the left atrium.
Cardiac Surgical Procedures↗
Inadequate flow of the internal mammary artery: another complication of sternal overretraction.
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Humans↗