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Biomedical subjects

F D Loop

Publications and source records attributed to F D Loop.

At least 217 records · Page 12Linked to original sources
PubMed1978

Staged and combined surgical approach to simultaneous carotid and coronary vascular disease.

Between 1969 and 1976, 174 patients were treated surgically for simultaneous carotid and coronary atherosclerosis. In 59 patients, staged carotid endarterectomy was performed a few days to 6 months prior to myocardial revascularization. Severe (more than 60% stenosis) coronary atherosclerosis affected a single vessel in 11 patients (19%), two vessels in 20 patients (34%), and three vessels in 28 patients (47%). Left ventricular contraction was impaired in 30 patients (51%). Nine patients (15%) had previous neurological symptoms, and 50 patients (85%) had asymptomatic carotid stenosis. One patient (1.5%) had a permanent stroke after carotid endarterectomy. There were no permanent strokes after staged myocardial revascularization, and the early mortality rate was 1.7%. Combined carotid endarterectomy and myocardial revascularization were performed in 115 patients with severe cardiac disease. Coronary atherosclerosis affected a single vessel in 10 patients (9%), two vessels in 39 patients (34%), and three vessels in 66 patients (57%). Left ventricular impairment was present in 72 patients (63%). Thirty-five patients (30%) had previous neurological symptoms, and 80 patients (70%) had asymptomatic carotid stenosis. Five patients (4.3%) had permanent strokes after combined revascularization, and four of these patients had occlusion or severe stenosis of the contralateral internal carotid artery. The early mortality rate was 4.3%, but no deaths could be attributed to carotid repair. The results suggest that significant simultaneous carotid and coronary atherosclerosis should be corrected in selected patients by staged operations when feasible. In the presence of severe cardiac disease, a combined precedure may be performed in face of higher risk of intraoperative stroke.

Adult↗
PubMed1977

Internal mammary artery graft for ischemic heart disease. Effect of revascularization on clinical status and survival.

Four hundred consecutive patients, 80 percent of whom had multiple vessel obstruction, received a single internal mammary artery graft (121 patients) alone or combined with vein grafts (279 patients) in 1971 and 1972. Four patients died during or within 30 days of the operation. Sixteen patients had intraoperative infarction; three died. Arteriography was performed postoperatively (mean 12 months) in 254 patients, and 248 of 261 internal mammary artery grafts (95 percent) and 195 of 237 vein grafts (82 percent) were patent. Follow-up was complete (mean interval 38 months); all 80 patients with single vessel disease are alive, and the 3 year survival rate for patients with double and triple vessel disease was 98.7 and 94.4 percent, respectively. Comparison of longevity of 741 patients who had received vein grafts in 1967 to 1970 with that of 400 patients with internal mammary artery grafts (1971 to 1972) indicates greater survival for the recent series (P less than 0.004). Factors responsible for improved survival include (1) reduced operative mortality, (2) fewer intraoperative infarctions, (3) more complete revascularization, and (4) higher patency rate of the internal mammary artery graft.

Adult↗
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↗
PubMed1977

Reoperations for myocardial revascularization.

Reoperations solely for myocardial revascularization were performed in 219 consecutive patients (1967 to 1975). Indications were (1) graft failure, 46 (21 per cent); (2) progressive atherosclerosis, 42 (19 per cent); (3) incomplete revascularization, 39 (18 per cent); and (4) combinations, 92 (42 per cent). Primary operations included bypass grafts in 100 patients; mammary artery implants, 87; and combinations of direct and indirect procedures, 32. Reoperations performed were single bypass, 141 patients; double, 61; and triple or other coronary artery operations, 17. Eight patients died within 30 days of operation (3.7 per cent). Major postoperative complications included hepatitis, 24 (11 per cent); myocardial infarction, 19 (9 per cent); bleeding, 21 (10 per cent); and respiratory insufficiency, 12 (5 per cent). Follow-up for 202 long-term survivors was complete (mean 29 months). In patients who originally underwent direct revascularization, Class I or II (N.Y.H.A.) was attained in 35 of 43 (81 per cent) of those reoperated upon for primary graft failure, in 14 of 15 (93 per cent) of those with progressive atherosclerosis, and in 27 of 33 (82 per cent) of patients with combined indications. Arteriography was performed after the reoperation in 55 patients (mean interval 17 months), and 65 of 77 (84 per cent) grafts were patent. Nineteen of 22 grafts performed for primary graft failure were patent. We have made the following conclusions: (1) Reoperation for direct myocardial revascularization can be accomplished with low mortality rates although morbidity is high; (2) complete relief of symptoms was achieved in 65 per cent of survivors; (3) results in patients reoperated upon for graft failure alone were similar to results in those operated upon for progressive atherosclerosis or combined indications; and (4) high graft patency was found in secondary grafts constructed to arteries involved with primary graft failure.

Adult↗
PubMed1976

Internal mammary artery bypass graft in reoperative myocardioal revascularization.

Thirty-two consecutive patients who earlier received indirect or direct myocardial revascularization underwent reoperation with one or more internal mammary artery grafts either alone or in combination with saphenous vein grafts. The main indication for reoperation was graft closure or progression of coronary atherosclerosis in nongrafted vessels, or both. Graft construction was performed under normothermic perfusion and anoxic arrest with interrupted suture technique. No intraoperative infarctions or hospital deaths occurred. All patients are alive after an average follow-up period of 20 months, and two thirds are asymptomatic. Arteriography after reoperation in nine patients revealed patency of eight of nine internal mammary artery and five of five secondary vein grafts. When angiographic and symptomatic indications for reoperation exist, the internal mammary artery bypass graft has become a valuable alternative, particularly for patients with small coronary vessels or previous vein graft failure.

Adult↗
PubMed1976

Events related to microembolism during extracorporeal perfusion in man: effectiveness of in-line filtration recorded by ultrasound.

Microparticle generation during cardiopulmonary bypass was monitored continuously in 60 adult patients who underwent open-heart operations. Echo-ultrasound transducers of 5 mHz frequency were interposed in a bubble oxygenator arterial line proximal and distal to a commercially available micropore filter. Ordinary perfusion events correlated with an increase in embolic counts and were recorded graphically. Calculation of filter efficiency revealed that all filters decreased measurable embolic counts. Platelet and leukocyte determinations and plasma hemoglobin values were not altered beyond limits ordinarily encountered during perfusion without filters. No patient in any filter group experienced postoperative respiratory distress, diffuse pulmonary infiltrate, or low PaO2. The 20 mu woven nylon mesh filter and the Dacron-wool filter showed greater than 90% effectiveness in removing recorded particles. Insertion of a cardiotomy filter did not appreciably alter recorded embolic counts distal to the arterial line filter.

Blood Cell Count↗
PubMed1976

Median sternotomy wound infection and anterior mediastinitis caused by bacteroides fragilis.

The first reported case of median sternotomy infection and mediastinitis caused by Bacteroides fragilis is described. Several positive blood cultures led to diagnostic anaerobic cultures of the wound and administration of clindamycin therapy. This anaerobic infection should be suspected whenever Gram smears of exudates show gram-negative bacilli and aerobic cultures are sterile.

Aged↗
PubMed1976

Comparison of internal mammary artery and saphenous vein bypass grafts for myocardial revascularization: exercise test and angiographic correlations.

The effectiveness of myocardial perfusion with internal mammary artery (IMA) bypass revascularization has been questioned. We compared 37 patients with single patent IMA bypass grafts with 26 patients who had single patent saphenous vein graft (SVG) bypass. Serial computer assisted graded maximal stress testing was used for quantitation of palliation. Patients were classified and compared according to the completeness of revascularization by postoperative catheterization. All patient subgroups, had statistically significant improvements in work capacity, maximal heart rate, maximal rate-pressure products, abnormal exercise electrocardiograms, and exercise-induced angina pectoris. The quantitative improvements in these measurements of patient palliation were the same during postoperative stress tests after either SVG or IMA revascularization. Considering the overall higher patency rate of the IMA bypass, the data indicate that this procedure, when surgically applicable, is preferable to SVG bypass.

Exercise Test↗
PubMed1976

Cannulation of the ascending aorta for cardiopulmonary bypass. Experience with 9,000 cases.

The Cleveland Clinic team has now accumulated experience with cannulation of the ascending aorta for arterial return in more than 9,000 patients. Since adoption of this technique, only one lethal dissection has occurred and other related complications have been minimal. Technique, surgical pitfalls, contraindications, and complications of ascending aortic cannulation are discussed in this communication.

Aorta↗
PubMed1975

Operative technique in myocardial revascularization.

This article necessarily deals exclusively with vein and artery bypass grafts. The venous autograft remains the most versatile operation and data thus far compiled verify its reliability. We advocate normotensive, normothermic perfusion and recommend the interrupted suture technique for most anastomoses. Our guidelines for IMA grafting indicate its applicability for most anterolateral wall vessels, except for unstable emergency patients and those with a large left ventricular mass. We emphasize that the technical details are far more important than the steps involved in coronary artery operations. The operative techniques described and discussed herein are deceptively simple, and direct coronary artery surgery often appears uncomplicated to the inexperienced observerer. However, one should not attempt myocardial revascularization without the benefit of high quality cinecoronary arteriograms. An organized and experienced operative team is mandatory and, above all, the procedure itself must not be an endurance contest between surgeon and patient. Expeditious revascularization produces less morbidity and better overall results.

Humans↗
PubMed1975

Technique for repair and replacement of the mitral valve.

Whenever possible, the patient's own mitral valve mechanism should be preserved. Successful mitral valve repair offers excellent benefits in terms of hemodynamic function, clinical improvement, and longevity. Open mitral commissurotomy or valvuloplasty for localized defects or ruptured chordae tendineae constitutes our best reparative efforts. Today, mitral valve replacement can be accomplished with less than a 5 per cent operative mortality, but should be reserved for patients who are not in desperate terminal condition. In our experience, aggressive tactics undertaken at the endstage of the disease have had little or no long-term success. At the Cleveland Clinic, isolated mitral valve repair or replacement is performed under normothermic cardiopulmonary bypass and anoxic arrest. Generally, the valve is exposed through an atriotomy behind the interatrial groove. Valvular replacement is accomplished by interrupted suture technique, seating the prosthesis at the level of the annulus or below it. Risk is influenced mainly by the chronicity of the valve dysfunction. Patients who have not yet reached a Functional Class IV status or sustained massive cardiomegaly and low cardiac output fare better in both early and late follow-up periods.

Heart Valve Prosthesis↗
PubMed1975

Benign superior vena cava syndrome.

Benign superior vena cava (SVC) obstruction is an uncommon entity. However, it is important to recognize that a small percentage of SVC syndromes are due to benign diseases such as mediastinal granulomas. The insidious onset and slow progression of symptoms allow for development of an efficient collateral venous circulation compatible with long-term survival. Surgical intervention to bypass the obstruction is often unsuccessful and should be avoided in most cases. We review the English literature on the subject, classify the various causes of benign SVC syndrome, and report our experience with 16 documented cases.

Adult↗
PubMed1975

Limitations and prospects of coronary artery surgery.

Coronary atherosclerosis is discussed from the standpoint of natural history and survival. The operative treatment for ischemic heart disease is reviewed beginning with the advent of the venous autograft to the most recent advance, the internal mammary artery graft. Comparative survival between medical and surgical modes of treatment are described as well as factors in the revascularization selection process that directly influence longevity. During the last 6 years, experience in selection and a steady improvement in technical proficiency have brought about a decline in operative mortality and morbidity, thus yielding further improvement in postoperative long-term survival.

Angiography↗