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Biomedical subjects

C Hahn

Publications and source records attributed to C Hahn.

At least 109 records · Page 6Linked to original sources
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

[Value of transverse radiotomography in the control of the permeability of aortocoronary bypasses, compared with coronary angiography].

The object of this study was to determine whether transverse radiotomography, despite cardiac movement, could be used to visualise aortocoronary bypass grafts to confirm their patency or obstruction. The results were then compared with those of coronary angiography. 20 patients with a total of 38 grafts (18 on the left anterior descending, 8 on the circumflex and 12 on the right coronary artery) underwent tomography. 1 or 2 60 ml boluses of iodide contrast medium were injected into a fore arm vein and 3-5 films were exposed after each injection at 15 sec intervals. Coronary angiography was performed in 16 patients and the results of tomography were identical to those of coronary angiography : 23 patent and 6 occluded grafts. In one case, subtotal proximal stenosis of the left anterior descending artery allowed sufficient flow for the graft to be opacified and considered patent on tomography. The correlation between transverse radiotomography and coronary angiography was excellent. Transverse radiotomography, a non-invasive technique, is very useful in operated patients with atypical chest pain and in those with recurrent angina in whom obstruction of the graft is feared. It does not seem destined to replace control coronary angiography after bypass surgery, but it may be indicated is selected cases.

Adult↗
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↗
PubMed1980

[The value and advantage of computer assisted tomography as compared to angiography in evaluating patency of aorto-coronary grafts].

Sixteen patients with 31 aorto-coronary grafts have been studied by CT and by coronary arteriography to compare the results of the two methods in the evaluation of graft patency or occlusion. Correlation of the two technics is excellent (100%). However, graft stenoses are not visualized on CT in its present state of technical performance and are the limiting factor for this noninvasive procedure. In patients with precordial pain and aorto-coronary grafts, CT should be done first to evaluate graft patency and only be checked by coronary arteriography if there is disagreement between the CT result and clinical assessment of the case.

Coronary Angiography↗
PubMed1980

[Preliminary report on coronary revascularization in 15 patients under 35 years of age].

Between 1975 and 1979 15 patients under 35 underwent aorto-coronary bypass-grafting. The youngest was 24 years old. Out of 1188 revascularized patients over the same period, only 1.26% of surgically treated patients with coronary artery disease were under 35, whereas 4.79% were under 40. The main risk factors were smoking, overweight and hyperlipidemia, and every patient had several risk factors. 12 of 15 patients had preoperative infarctions. 3 patients had single vessel disease, 3 had double vessel disease and 9 had triple vessel disease, the latter two groups with massive and diffuse disease down to the peripheral vessels. By the usual criteria some of them had been refused for revascularization and only their youth and disabling angina without hope of improvement through medical therapy prompted us to operate on them. At operation 2.73 grafts per patient were performed, three of which were internal mammary artery anastomosis. Operative mortality was nil. Only one patient had a perioperative myocardial infarction, without complications or hemodynamic impairment. Another patient sustained a re-infarction four months postoperatively. However, this patient did not reduce any of his risk factors. At postoperative angiography 32 out of 40 grafts performed, i.e. 2.13 grafts per patient, were patent. In 9 patients all grafts were patent, in 4 over 51% of the grafts performed were patent, in 1 two out of four were patent and one single-bypass was subtotally occluded. The angina-free working tolerance increased postoperatively by 70 Watts, i.e, by 100%. These preliminary results with 15 patients under age 35 show that satisfactory medical and professional rehabilitation can be achieved with coronary artery surgery. All but one returned to work as they would otherwise have been unable to do because of disabling angina under maximal medical therapy.

Adult↗
PubMed1980

Endarteriectomy of the left coronary artery (LCA) as a supplementary surgical means of myocardial revascularization with aortocoronary vein bypass procedure.

In order to establish a satisfactory vein bypass anastomosis during myocardial revascularization, 2 findings are of special importance: the local wall quality and the actual lumen of the coronary artery, both altered by the arteriosclerotic disease. In certain cases, with diffuse triple vessel disease, the intraoperative decision for an endarteriectomy as a supplementary surgical means appears to be a logical consequence. In our own patient group of 50 restudied patients with an endarteriectomy of the LCA, we had a patency rate of 72%; in a subgroup it was as high as 84%, if performed locally and under full vision. Compared with extended core extraction, the latter technique only showed minor vessel irregularities proximal and distal to the bypass anastomosis and thus, in a long-term view, it opens up additional revascularization possibilities for severe coronary artery sclerosis.

Aged↗
PubMed1980

[Results of long term surgical treatment of isolated stenosis of the left descending coronary artery].

The results of medical and surgical management of isolated stenosis (greater than or equal to 50%) of the left anterior descending artery were compared retrospectively in a series of 124 consecutive patients. 57 patients were managed medically (Group I). 28 (49%) presented with angina and 36 (63%) with a previous myocardial infarction. The stenosis was greater than 90% in 38 patients (67%) and was associated with severe left ventricular dysfunction in 28 patients (49%). The average ejection fraction was 53.8 +/- 2.5%. 67 patients were managed surgically (Group II): 58 (87%) presented with angina and 28 (42%) with previous myocardial infarction. The stenosis was greater than 90% in 58 patients (87%) and associated with severe left ventricular dysfunction in 19 patients (28%). The average ejection fraction was 61.7 +/- 2.4%. The average length of follow-up was 41.9 +/- 4.1 months in Group I and 46.2 +/- 3.5 months in group II. 6 patients died in Group I, 5 of a cardiac cause, compared to 4 patients (3 of a cardiac cause) in Group II, with an operative mortality of 1.6%. One patient in Group I had a new myocardial infarction compared to 6 in Group II, 3 of which (4.4%) occurred in the perioperative period. Angina regressed after therapy in 23 patients (40%) in Group I and in 48 patients (72%) in Group II (p < 0.01). Angina was unchanged or became more severe in 12 and 5 patients respectively. 34 patients (60%) on drug therapy were able to resume their professional activities as opposed to 26 (42%) in the surgical group (p < 0.05). It would therefore appear that surgery for isolated stenosis of the left anterior descending artery does not significantly reduce mortality, or prevent recurrence of myocardial infarction, but it does significantly improve anginal pain. The same conclusions are obtained when the patients are classified in different sub groups, "operable" patients or those with previous myocardial infarction or with poor left ventricular function. Finally, the surgical indications were "good" in 21 patients, symptomatic with a proximal stenosis greater than 75%, good ventricular contraction on angiography, an ejectionfraction of at least 50%, and good arterial run-off. In these cases surgery was successful with regression of anginal pain in 19 patients (90%) but complicated by secondary infarction in two of them. These results were better than those obtained in the other operated patients, in which the surgical indications were judged retrospectively to have been "inadequate". Therefore, in isolated stenosis of the left anterior descending artery, aorto-coronary bypass surgery should be reserved to patients with "good surgical indications".

Angina Pectoris↗
PubMed1979

[Tetralogy of Fallot: results of 77 hemodynamic controls after complete correction].

77 patients (representing 91% of all survivors) underwent catheterization within 5 months of surgical repair of tetralogy of Fallot. The data show that residual pulmonary gradient is significantly higher in patients with infundibular and valvular stenoses than in patients with infundibular stenoses only, whereas the method of intracardiac repair (patch) had no influence on residual gradient. Significant pulmonary insufficiency was found almost exclusively when a patch was extended through the pulmonary annulus. Hemodynamic results were excellent in 37% of cases, good in 51%, satisfactory in 3% and unsatisfactory in 9%. Finally, primary intracardiac repair in children below 4 years of age yielded excellent or good results in all cases: this suggests that toal correction should be performed without previous aorto-pulmonary anastomoses in this youngest group of patients.

Cardiopulmonary Bypass↗
PubMed1979

[Permeability of venous aortocoronary bypass 5 years later].

47 consecutive patients who had undergone aorto-coronary venous bypass surgery (mean: 1.6 graft per patient) have been investigated after a mean follow-up period of 5 years and 9 months (range: 44-108 months). 52 grafts out of 73 were found to be patent (71 p. 100), the best patency rate being shown by grafts on the LAD artery (27/32 = 85 p. 100). Long-term graft patency may be associated with an improved left ventricular ejection fraction; 77 p. 100 of the total patients experienced a lasting clinical benefit from the operation.

Adult↗
PubMed1979

[Drainage in surgery of the heart and great vessels].

Based upon some recent experience with pericardial drainage a comparison is established between the surgical procedure and the needle-punction; the best approach to the pericardium, depending on the nature of the effusion is described. In the second part, the value of various types of drainage used since 19 years in the cardiac surgery is reviewed on the basis of our own experience with more than 7000 cases.

Adult↗