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Biomedical subjects

E Baudet

Publications and source records attributed to E Baudet.

99 records · Page 6Linked to original sources
PubMedDate not supplied

Extracorporeal circulation as an additional method for cerebral protection in simultaneous carotid endarterectomy and coronary artery surgical revascularization.

Surgical management of patients with concomitant carotid and coronary artery stenosis remains controversial. Our policy was always to perform at the same time carotid endarterectomy (CE) and coronary artery bypass grafting (CABG), but it was also considered that extracorporeal circulation (ECC), because of full heparinization, hemodilution, pulsatile flow, and hypothermia could provide better cerebral protection during CE. Retrospective data of 124 patients undergoing simultaneous CE and CABGs between January 1994 and December 2001 were reviewed. CE was performed prior to ECC in 65 patients (Group 1-mean age: 70.4 years; sex ratio: 49 male/16 female) and under ECC, prior to CABGs in 59 patients (Group 2-mean age: 69.9 years; sex ratio: 46 male/13 female). Overall hospital mortality was 7.3% (9/124): cardiac-related in 5 patients, or due to septicemia (1 patient), or ARD syndrome (1 patient), or stroke in two others. Univariate analysis demonstrated overweight, unstable angina, and emergency to be significant risk factors. Bilateral carotid stenosis was a significant risk factor of neurologic event when CE was performed prior to ECC (p < 0.05). In Group 1, mortality was 9.2% (6/65), and the incidence of neurologic events was 10.7% (7/65), and was responsible for two of the early deaths in patients with bilateral carotid stenosis. In Group 2, mortality was 5.1% (3/59) but never related to CE, while the neurologic morbidity was 1.7% (1 transient ischemic attack). It is concluded that (1) hospital mortality in patients undergoing simultaneous CE and CABGs was mainly cardiac-related. (2) The combined approach of both localizations appears to be mandatory, when carotid stenosis, even asymptomatic, was hemodynamically significant, or with ulcerative lesions likely to be responsible for embolism. (3) CE, first performed under ECC, appears to be a safe procedure, combining, in terms of cerebral protection, the benefits previously called up. This approach is all the more interesting when carotid stenosis is bilateral; hypothermia < or = 28 degrees C during the carotid clamping time is obviously the optimal method for cerebral protection when ipsilateral or contralateral supply is reduced, or even absent.

Adult↗
PubMedDate not supplied

[Total anomalous infra-cardiac pulmonary venous connection. Value of the color Doppler echocardiography].

A case of total anomalous pulmonary venous connection is described in a newborn. The pulmonary veins join a common trunk entering portal vein below the diaphragm. The pattern of pulmonary venous connections was identified by two-dimensional Doppler color flow-mapping echocardiography. The common pulmonary venous trunk was anastomosed to the left atrium at the age of 3 weeks but the infant died because of pulmonary hypertension and acute renal insufficiency. The Doppler color echocardiography allows a good preoperative evaluation. The spontaneous prognosis being poor, surgical correction is indicated and should be performed early, even for critically ill neonates. Patients who survive to childhood lead active and full lives.

Coronary Vessel Anomalies↗
PubMedDate not supplied

Late results of the subclavian flap repair of coarctation in infancy.

From June 1979 through January 1985, 22 infants under 20 months of age (mean 8 months and 4 kg) underwent coarctation repair with a left subclavian aortoplasty. The most commonly associated lesions were ventricular septal defect (50%), hypoplastic aortic arch (45%), patent ductus arteriosus (41%), transposition of great arteries (22.7%) and other intracardiac lesions comprised 30%. Indication for surgery was congestive heart failure refractory to medical management. All patients were on inotropic support. Two patients required mechanical ventilation preoperatively. Subclavian flap angioplasty was performed with 7.0 continuous polypropylene suture. Ligation of a patent ductus arteriosus was simultaneously done in 8 patients and pulmonary artery banding in 8 others. Four patients (18%) died within 30 days after operation; 3 of them had severe tubular hypoplasia of the aortic arch. Three transient postoperative complications were encountered; chylothorax, subclavian steal syndrome and Horner's syndrome. No hospital deaths occurred in patients with isolated coarctation of the aorta. All survivors were followed for a period varying from 3 to 6.5 years (mean, 2 years). There were 3 late deaths (13.6%). Non invasive studies have shown a satisfactory result in 14 patients with a residual gradient less than 20 mmHg and in 10 of them, cardiac catheterization and cineangiography showed no evidence of significant stenosis. In one patient only, femoral pulses were absent 4 months postoperatively. These results and reports of others indicate, contrary to the age, that the presence of associated disease affects mortality. Prompt repair of coarctation of the aorta in all infants with or without symptoms is recommended and the subclavian flap procedure appears to be a simple and safe method for relief of coarctation of the aorta in critically ill infants.

Aorta, Thoracic↗