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Biomedical subjects

D B Effler

Publications and source records attributed to D B Effler.

At least 19 recordsLinked to original sources
PubMed1985

Postinfarction ventricular aneurysmectomy.

Most operations performed for the treatment of ventricular aneurysm do not achieve maximal rehabilitation of the damaged heart. Cardiac surgeons generally ignore the importance of the flail septum that results from anteroseptal infarction. Many believe that the obstructed left anterior descending coronary artery must be carefully avoided during closure of the ventriculotomy incision. In addition, many surgeons believe that it is necessary to buttress all ventricular sutures with Teflon. For some reason, there seems to be a fear that the left ventricular volume will be reduced to an intolerable level after proper ventricular aneurysmectomy. Between January 1976 and December 1982, 102 patients underwent ventricular aneurysmectomy at St. Joseph's Hospital Health Center. The hospital mortality rate was 5.9 percent. The operative technique described emphasizes the need for foreshortening the fibrosed septum in an effort to minimize residual paradoxic motion. The left anterior descending coronary artery is routinely incorporated in the eversion technique; Teflon buttressing is never employed. Our surgical technique has evolved from a surgical experience that began in 1962 at the Cleveland Clinic Hospital.

Heart Aneurysm↗
PubMed1983

Management of aneurysms in segments of saphenous vein grafts.

A technique to manage aneurysmal dilatation of a segment of saphenous vein is presented. A vein sleeve is used to cover the dilated segment. Avoidance of subsequent venovenous anastomosis and the ease of application justify its clinical use.

Aneurysm↗
PubMed1983

Operative approaches to the left atrium and mitral valve apparatus.

Traditional and alternative approaches to the mitral valve apparatus are presented. The median sternotomy and vertical left atriotomy approach affords adequate exposure in most cases. However, there are occasions when an alternative approach may be warranted.

Journal Article↗
PubMed1982

A comparative study of cephapirin, cephalothin, and methicillin in cardiovascular surgery.

An open, randomized study involving 217 patients undergoing elective cardiovascular surgery was undertaken to compare the effectiveness of cephapirin, cephalothin, and methicillin in preventing postoperative infections. One of the three antibiotics was assigned randomly to each patient and administered beginning 2 h before operation and continuing every 6 h for 5 days. There was no significant difference between the three study groups with respect to the incidence of infection (p = 0.9913). In both the cephalothin and methicillin groups, seven patients developed adverse reactions as compared with two patients in the cephapirin group. However, the difference was not statistically significant (p = 0.0788). The results from the investigation indicate that cephapirin, cephalothin, and methicillin are equally effective as prophylactic antibiotics when used perioperatively for cardiovascular surgery.

Adult↗
PubMed1978

Myocardial revascularization 1978.

After more than ten years of clinical application, direct myocardial revascularization with saphenous or mammary vein grafts is becomining one of the most common types of elective major surgery performed in the United States. The need for and the results of revascularization surgery are determined by cine coronary arteriography. The principles on which this type of surgery is based are simple. Critical occlusion of a coronary artery may produce an arteriographically identifiable area of myocardial perfusion deficit in the left ventricle. The functional demand for blood that results is usually manifested by anginal pain. When the occlusion is reduced by rest and administration of vasodilators, the immediate threat of infarction is alleviated. When pain persists in spite of treatment, direct revascularization surgery should be considered. This type of surgery need not involve ultrasophisticated adjuncts. Some of these adjuncts increase morbidity and contribute appreciably to the cost of operation and hospitalization. The record of myocardial revascularization suggests that the surgical treatment of coronary artery disease can and should be done in qualified community hospitals.

Coronary Disease↗
PubMed1977

Aortic valve replacement combined with myocardial revascularization. Late clinical results and survival of surgically-treated aortic valve patients with and without coronary artery disease.

From 1967 through 1973, 80 consecutive patients underwent simultaneous aortic valve replacement (AVR) and coronary bypass grafting. Fourteen (18%) experienced no angina pectoris and had no history or electrocardiographic evidence of coronary atherosclerosis. Seven of these 14 had severe multiple vessel disease. All operations were performed under normothermic conditions without coronary perfusion. Seven patients (9%) died during operation. Intra-operative myocardial infarction was documented in eight (10%). After a mean follow-up of 35 months, overall mortality was highest in aortic regurgitation patients [seven of 13 (54%)] compared to aortic stenosis [17 of 54 (31%)] (P less than 0.07), and mixed pathology [1 of 13 (8%)]. Thirty-one of 34 (91%) grafts in 25 patients were patent an average of 12 months postoperatively. After 42 months a 65% actuarial survival was found in the combined AVR and graft(s) series versus a 76% survival in 300 AVR patients proven by angiography not to have severe coronary atherosclerosis.

Adult↗