Search PubMed⌕ Search

Biomedical subjects

C E Anagnostopoulos

Publications and source records attributed to C E Anagnostopoulos.

At least 19 recordsLinked to original sources
PubMed1992

Autologous whole plasma fibrin gel. Intraoperative procurement.

Fibrin glue is a relatively recent addition to the armamentarium of hemostatic agents for surgical use. Its efficacy has been repeatedly demonstrated in almost all surgical disciplines and subspecialties. Its use in the United States has been limited because of the risk of viral transmission associated with the use of human plasma. Previous authors have described techniques that limit this risk, but they are frequently impractical, expensive, or cumbersome. We describe the use of patients' own fresh plasma to make fibrin gel at the operative field. It provided hemostasis at least as good as that from heterologous plasma glue in 40 cardiac surgical patients. Autologous whole plasma fibrin gel is inexpensive and safe and eliminates the risk of viral transmission associated with glue derived from heterologous donor plasma.

Blood Loss, Surgical↗
PubMed1992

Pediatric myocardial protection in the United States: a survey of current clinical practice.

A nationwide survey of institutions in the United States that perform congenital heart disease surgery was conducted to obtain an overview of the current use of myocardial protection in pediatric patients (aged 0-16 years). One hundred and one (55%) of 183 institutions responded, completing a 4-page questionnaire about pediatric cases in 1989. A total of 12,072 cases were represented. Caseloads ranged from 7 to 498 at these institutions (mean 124, median 30). Cardioplegia was used by 100 institutions (44 blood, 45 crystalloid, 11 both). Administration was guided by formulas alone in 69 and by clinical criteria alone in 32. A wide variety of compositions of cardioplegic solutions was found with no preference for any particular type. No correlation between caseloads and cardioplegic solutions was found. Hypothermia was used by all institutions, with a mean of 25.8 +/- 3.5 degrees C for a simple ventricular septal defect closure. Deep hypothermia and circulatory arrest were used in 3048 cases (25.2%). A clear trend indicated that circulatory arrest was used more frequently in larger institutions (p less than 0.0001). Fibrillation as a strategy was used in 45 institutions. Twenty-five institutions changed cardioplegia technique during 1989. The findings suggest that, even though no consensus exists about its ideal composition, cardioplegia in conjunction with hypothermia is currently the strategy most often used for pediatric myocardial protection.

Adolescent↗
PubMed1991

Complications of percutaneous intra-aortic balloon pump use in patients with peripheral vascular disease.

Percutaneous intra-aortic balloon pump use may carry an increased risk for patients with peripheral vascular disease. To determine the incidence and types of associated complications, the medical records of 144 patients who underwent a total of 153 percutaneous intra-aortic balloon pump insertions were reviewed. Patients were divided into two groups. Group 1 was composed of 20 patients with a history of peripheral vascular disease. Group 2 was composed of 124 patients without such history; they underwent a total of 133 insertions. Nineteen major complications (12%) occurred, 12 in group 1 (60% of 20 insertions) and seven in group 2 (5% of 133 insertions). Major complications were further classified by their nature: embolic, occlusive, and technical. All three types of complications occurred more frequently in group 1. Embolic complications occurred more frequently in patients with aneurysms and proved the most lethal, with two of six deaths in group 1 resulting from this complication.

Aneurysm↗
PubMed1991

Emergency coronary revascularization using polytetrafluoroethylene conduits in a patient in cardiogenic shock.

There is growing awareness that a particular subset of patients with coronary artery disease who need surgical revascularization do not have autologous vein or internal mammary artery available or surgically applicable. The polytetrafluoroethylene graft has had limited use in aortocoronary bypass procedures. We describe a case of cardiogenic shock secondary to severe coronary artery disease and aortic stenosis, where the use of this synthetic graft contributed to a successful outcome. Angiographic patency was documented at 3 months follow-up. Our experience, plus a review of the literature, supports the use of polytetrafluoroethylene grafts during aortocoronary artery bypass to salvage infarcting or ischemic myocardium, when traditional autologous bypass conduits are not available or applicable.

Aged↗
PubMed1991

Coronary artery bypass grafting. The relationship of surgical volume, hospital location, and outcome.

The relationship between mortality, surgical volume, and location was investigated in the university medical centers (UMCs) in the Greater New York metropolitan area for patients undergoing coronary artery bypass grafting (CABG) in 1986. Three high-volume and five low-volume institutions, with a total of 49 surgeons, performed a total of 3,408 CABG operations. The crude mortality rates were 4% for simple, 14.7% for complex, and 5.3% combined for all UMC CABG operations. The crude mortality rates for CABG operations in high- and low-volume centers were respectively 3.6% and 4.8% for simple and 16.1% and 11.3% for complex operations. No statistically significant differences between urban (N = 6), suburban (N = 2), high-volume (N = 3), or low-volume (N = 5) centers or physicians were found (all p values greater than 0.05). Taken together, these findings suggest that surgical volume and location are not significant factors for predicting outcome for CABG.

Coronary Artery Bypass↗
PubMed1990

Myocardial revascularization with the lateral costal artery.

The lateral costal artery is a branch of the internal mammary artery that occurs in 27% of cadaver series. The similarities to the internal mammary artery and its easy accessibility would suggest its use as a bypass conduit for coronary revascularization. We describe the harvesting and utilization of this artery as an in situ coronary bypass graft, and we have initiated a study examining the exact frequency of this anomalous vessel. The availability of the lateral costal artery either unilaterally or bilaterally adds another dimension to the concept of complete arterial conduit myocardial revascularization.

Arteries↗
PubMed1979

Myocardial rupture: III. Chamber pressure, rate of distention, and ventricular disruption in isolated hearts.

We have developed an in vitro technique for producing myocardial rupture in lamb hearts, which relates tensile strength to a variety of conditions which can prevail in normal and infarcted human hearts. Retrograde perfusion of saline solution and inflation of the left ventricle was used to apply progressive stress to the left ventricular wall. Three separate sites of myocardial rupture were observed and occurred with the frequency of 54% at the papillary muscle, 30% at the interventricular septum, and 16% at the free wall of the left ventricle. The distribution and configuration of the experimental ruptures were similar to those usually noted as complications of human myocardial infarction. The mean rupturing pressure was 526 mm Hg in normal lamb hearts. Application of these techniques should ultimately provide data relevant to the diagnosis, prevention, and treatment of myocardial rupture.

Analysis of Variance↗
PubMed1979

Autologous rectus sheath grafts. V. Growth in aortic grafts.

Experiments were designed to test autologous rectus sheath as a replacement for the thoracic aorta in the growing dog. Adequacy of graft function was determined by angiography at 4 month intervals; stress-strain measurements and microscopic examination were made at the time of autopsy. A 3 cm tubular graft of rectus sheath tissue was employed as an aortic graft in 13 mongrel puppies. Nine puppies (70%) were long-term survivors and were put to death between 6 and 22 months postoperatively. No deaths were due to graft failure. Angiographic studies demonstrated patency of the graft without development of pressure gradients. An increase in diameter of the aorta (21.25%) and the rectus sheath graft %22.87%) were demonstrated in all cases. During the time of observation, the compliance of the growing aorta (93,120 dynes/cm2) decreased to one fourth that of the control aortic tissue (24,800 dynes/cm2), whereas the compliance of the rectus sheath graft (547,1000 dynes/cm2) decreased to only one eighth that of the control rectus sheath (47,400 dynes/cm2). Tensile strength is maintained in both the growing aorta (4.5 x 10(7) dynes/cm2) and the rectus sheath graft (4.7 x 10(7) dynes/cm2; p less than 0.05). Microscopic examination showed no calcification, thinning, or weakness. Vascularization of the graft had occurred, with cellular proliferation and development of more than 30 lamellar-like units in the media and an adventitia-like surface.

Abdominal Muscles↗
PubMed1979

Detection, prediction, and significance of perioperative myocardial infarction following aorta-coronary bypass.

One hundred consecutive patients undergoing aorta-coronary bypass grafting (ACBG) alone, without ventricular venting, were prospectively studied to determine the incidence and consequence of perioperative myocardial infarction (PMI) and the clinical variables that were predictive of PMI. Incidence was determined by serial electrocardiography (ECG) 100 patients; serum CK, GOT, and LDH (100 patients). CK isoenzymes (qualitative 100 patients, quantitated 50 patients); vectorcardiography (VCG) (78 patients); and 99mtechnetium pyrophosphate scintigraphy (TcPyp) (52 patients). The incidence of PMI by ECG was 9%; an additional 8% of cases was diagnosed by enzymes alone. The incidence of diagnostic change by VCG was 19% and by scintigraphy, 25%. Using at least one changed variable of the remaining three as the reference standard, the relative sensitivity and relative specificity of given variables in the diagnosis of PMI were as follows: ECG 67% and 100%, respectively; VCG 85% and 94%; scintigraphy 92% and 97%; and serum enzymes 86% and 96%. By univariate analysis, unstable angina was the only significant predictor of PMI. The operative mortality rate was 2% and the mortality rate at 12 months was 5%. There was a significantly greater mortality rate in patients with PMI diagnosed by ECG (p less than 0.01), in patients with unstable angina pectoris before operation (p less than 0.05), and in women (p less than 0.05).

Analysis of Variance↗
PubMed1979

Earlier operation for left-sided Pseudomonas endocarditis in drug addicts.

Three consecutive patients with Pseudomonas endocarditis were treated by early operation with no deaths. The indications for operation were severe failure, systemic embolization, and infection refractory to antibiotics. The organism is aggressive, characterized by early invasion of the myocardium. Wide débridement of the anulus is necessary to remove any vegetations or intramyocardial abscessed wall. Because multiple valve infection is common, it is important to evaluate all four cardiac valves at the time of operation. Removing a second rim of the mitral anulus for separate culture at the time of mitral valve replacement may demonstrate the degree to which the valve resection has removed all infection. Early operation is necessary for reinfection of the prosthetic valve; however, metastatic abscess should also be considered in the face of continued signs of infection postoperatively. Patients should receive a 6 week postoperative course of antibiotics which have been shown by in vitro testing to be serum bactericidal in at least a 1:8 dilution. The operative findings of invasion of the myocardium by the organism and the surgical success in this small series have resulted in our recommending earlier operation in patients with these indications.

Adult↗
PubMed1978

Surface cooling (20 degrees C) and circulatory arrest in infants undergoing cardiac surgery. Results in ventricular septal defect, complete atrioventricular canal, and total anomalous pulmonary venous connection.

During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) underwent correction of ventricular septal defect (22 patients), total anomalous pulmonary venous connection (13 patients), and complete atrioventricular canal (11 patients), with the use of surface cooling to 20 degrees C. Cardiac repair was performed during circulatory arrest, and rewarming was performed with a pump oxygenator. Ten patients undergoing repair of ventricular septal defects were studied hemodynamically at 21 degrees C, before repair and at 37 degrees C after rewarming. Heart rate, left ventricular systolic pressure, maximum dp/dt, cardiac index, stroke work, and oxygen consumption were reduced substantially at 21 degrees C. Systemic vascualr resistance was increased at 21 degrees C. All changes were reversible with repair and rewarming. A protocol for hemodilution and crystalloid volume loading was devised to maintain urine output after early patients were noted to demonstrate renal dysfunction. With this protocol, survival rates were 89% for patients with ventricular septal defects, 67% for those with atrioventricular canal defects, and 85% for those with total anomalous pulmonary-venous connection.

Blood Pressure↗
PubMed1978

Ventriculographic features predictive of surgical outcome for left ventricular aneurysm.

Although clinical and hemodynamic stability predicted outcome very well when left ventricular aneurysm was electively resected in 25 patients (95% survival), more discriminate criteria were essential for 20 patients undergoing urgent operation for severe myocardial decompensation (50% survival). Three methods of ventriculographic analysis primarily sensitive to the function of the non-aneurysmal left ventricle were evaluated. These methods separated patients undergoing urgent operation into a population with high operative risk (less than 18% survival) and a population with low operative risk (greater than 82% survival). These criteria also separated 15 patients undergoing operation within three months of myocardial infarction into a group with excellent prognosis (greater than 85% survival) and a group with poor prognosis (less than 15% survival). The high operative risk in patients undergoing urgent operation or operation within three months of myocardial infarction, when non-aneurysmal ventricular function is poor, may be too high; it should be undertaken only under unusual circumstances.

Adult↗
PubMed1977

Acute aortic arch dissection: reevaluation of the indications for medical and surgical therapy.

Of 42 patients with dissection of the aorta, 4 had important arch involvement. Results were good in 2 patients treated medically. In two other patients wrapping the arch with a Dacron graft successfully prevented fatal hemorrhage. This technique avoids the need for arch replacement in selected cases. From this experience and a review of others a flow sheet was developed to guide decision-making in the surgical and medical management of patients with aortic dissection.

Aged↗
PubMed1977

Cardiac rupture--challenge in diagnosis and management.

Previous studies of the incidence, natural history, pathogenesis and diagnosis of cardiac rupture are presented, and 20 additional cases described. Progressive cardiorrhexis after myocardial infarction causes death in possibly more than 25,000 persons a year in the United States, and more frequent antemortem diagnosis is needed. Suggestions for future clinical and experimental studies are described and possible means of early diagnosis and therapy are outlined.

Aged↗
PubMed1977

The cardiac veins and retrograde coronary venous perfusion.

Study of retrograde coronary venous perfusion has been greatly overshadowed in the past decade by the advent and success of direct coronary artery revascularization. Recently there has been renewed interest in retrograde venous perfusion as a possible means of restoring myocardial circulation in selected patients. This paper reviews the anatomy and physiology of the cardiac venous system and the history of retrograde venous perfusion, with emphasis on recent experimental work and clinical trials involving retrograde coronary vein perfusion (RCVP).

Collateral Circulation↗
PubMed1977

An unusual form of late stenosis after aortic valve replacement with a cloth-covered Starr-Edwards prosthesis.

A 24-year-old man presented with late stenosis of a cloth-covered Starr-Edwards valve (model 2320). Fibrous ingrowth occurred at the inflow orifice of the valve and all three struts were adherent to the aortic wall, creating a "tunnel" form of obstruction. The stenotic valve was replaced with a porcine heterograft, and the small aortic root was enlarged with a Dacron patch. This form of late prosthetic valve stenosis should have been prevented by enlargement of the aortic root at the time of valve insertion and by long-term anticoagulant therapy.

Adult↗