Search PubMed⌕ Search

Biomedical subjects

F D Loop

Publications and source records attributed to F D Loop.

At least 163 records · Page 9Linked to original sources
PubMed1983

Long-term management of diaphragmatic paralysis complicating prosthetic valve replacement.

The exact incidence of diaphragmatic paralysis complicating secondary heart procedures is not known. The postoperative period can be complicated by difficulty in weaning from mechanical ventilation and misinterpretation of the clinical signs of respiratory muscle fatigue for congestive heart failure and acute bronchospasm. We present 3 patients, all of whom had right diaphragmatic paralysis and recurrent respiratory failure after a second mitral valve replacement. Long-term management with night-time ventilation in 2 patients resulted in no further episodes of respiratory failure and physical rehabilitation with exercise tolerance significantly greater than the preoperative state.

Aged↗
PubMed1983

Replacement of aortic valve combined with myocardial revascularization: determinants of early and late risk for 500 patients, 1967-1981.

Five hundred consecutive patients underwent aortic valve replacement and coronary revascularization in the years from 1967 to 1981, with 29 (5.9%) in-hospital deaths. Current operative mortality (1978-1981) is 3.4%. Univariate and multivariate analyses were used to identify determinants of early and late risk. Female sex, aortic insufficiency, and advanced age increased in-hospital mortality, whereas use of cardioplegia decreased it. At follow-up of 471 patients who survived hospitalization for 1 to 135 months (mean 41) after surgery, 96 late deaths were documented. Survival rates were 87%, 80%, and 55%, and event-free survival rates were 80%, 65%, and 39% at 2, 5, and 10 years after surgery, respectively. The late survival rate was unfavorably influenced by the presence of moderately or severely impaired left ventricular function and double-vessel coronary disease; the rate was enhanced for patients in age group from 50 to 59 years old and was not influenced by the method of myocardial protection. The event-free survival rate decreased with the presence of moderately or severely impaired left ventricular function and was enhanced for patients with New York Heart Association class I or II symptoms before surgery. Patients with bioprostheses who did not receive anticoagulants had higher survival and event-free survival rates than did either patients with bioprostheses who received anticoagulants or patients with mechanical valves, whether they received anticoagulants or not.

Age Factors↗
PubMed1983

Arterial response to laser operation for removal of atherosclerotic plaques.

The cellular response of normal and atherosclerotic aortic intima after exposure in vivo to a 0.9 mm diameter carbon dioxide laser was examined in hypercholesterolemic swine with light and electron microscopy to evaluate tissue damage, thrombosis, and healing. At energy levels of greater than 5 joules, laser burns appeared as craters less than 1 mm in depth and 2 mm in diameter. Two days after the operation, craters were filled with platelet-fibrin thrombi that did not protrude above the level of adjacent endothelium. The internal elastic lamina was exposed 1 to 2 mm around the crater. This area was surrounded by a ring of densely packed leukocytes at the edge of the normal endothelium. Two weeks after the operation, the depressed crater surface was mostly reendothelialized with small, closely packed endothelial cells. The subjacent thrombus contained numerous phagocytic cells with inclusion of fibrin, erythrocytes, and membranous debris. Proliferative invaginations containing medial smooth muscle cells, mitotic figures, and collagen extended into the pit from the lateral aspects. Eight weeks after the operation, the burned area was still depressed and therefore less occlusive than adjacent lesion areas, and a fibrous cap had formed over the remaining necrotic area. The results suggest that a focused, low-energy carbon dioxide laser can be used to remove focal atherosclerotic plaques from arteries without inducing excessive thrombogenicity. Rapid healing, including reendothelialization and intimal fibrous scarring, with minimal damage to surrounding tissue, was observed.

Animals↗
PubMed1983

Combined myocardial revascularization and carotid endarterectomy. Operative and late results in 331 patients.

Simultaneous coronary artery bypass and carotid endarterectomy were performed in 331 patients (mean age 61 years) at the Cleveland Clinic from 1973 through 1981. Of these, 195 (59%) had Functional Class III-IV angina pectoris, 308 (93%) had multiple-vessel coronary artery disease (CAD), 68 (21%) had over 50% stenosis of the left main coronary artery, and 185 (56%) had either segmental or diffuse impairment of left ventricular function. Asymptomatic carotid stenosis was documented in 173 patients (52%), and the remaining 158 had experienced either previous transient cerebral ischemia (38%) or completed strokes (10%). Single aorta-coronary grafts were placed in 59 patients (18%), double grafts in 131 (40%), and three or more grafts in 141 (42%). Nineteen patients (5.7%) died postoperatively in the hospital. Neurologic deficits occurred in 30 patients (9.0%) and produced permanent functional impairment in 15 (4.5%). Late results have been obtained for 312 operative survivors at a mean postoperative interval of 38 months. Thirty-eight patients (12%) have died, but the 5 year life-table survival rate of the study group was identical to that of the normal population aged 61 years. Significant differences in cumulative 5 year survival rates were identified among diabetic patients (p less than 0.025) and among those receiving single rather than double (p less than .005) or multiple (p less than .01) coronary grafts. Although 18 patients (5.8%) have had late strokes, only five (1.6%) of these strokes have involved the cerebral hemisphere on the same side as combined carotid endarterectomy.

Adult↗
PubMed1982

Peripheral nervous system complications of coronary artery bypass graft surgery.

Among 421 patients undergoing coronary artery bypass graft surgery, 55 (13%) developed 63 new peripheral nervous system (PNS) complications postoperatively. Most common was a brachial radiculoplexopathy, which occurred in 23 patients. Of these, 21 involved lower trunk or medial cord fibers. In 17 there was a correlation between the site of jugular vein cannulation and the side affected, suggesting that needle trauma played a role. Stretching from chest wall retraction may have caused some cases. Other deficits included 13 saphenous, 8 common peroneal, and 5 ulnar mononeuropathies. Six patients had persistent singultus, suggesting phrenic nerve involvement. Unilateral vocal cord paralysis was found in 5. An isolated partial Horner syndrome and a facial neuropathy were also identified. Males were more likely to develop PNS complications. Hypothermia during surgery was associated with increased risk. Most PNS deficits were transient, and lasting disability was rare.

Adult↗
PubMed1982

Results of myocardial revascularization: a 12-year experience.

All 740 patients who underwent isolated myocardial revascularization procedures from 1967 to 1970 at our institution were compared with the first 1000 patients who underwent similar elective operations each from 1971 to 1979. Data from these 9 years were processed through a computerized cardiovascular information registry. In the 1971-1979 period, the patients were older (median age 57 years, compared with 50 years in the 1967-1970 period), more had multivessel disease (90% vs 44%) and more had ventricular asynergy (54% vs 41%). The number of grafts per patient increased from 1.5 to 2.7, and yet morbidity declined in every category except neurologic deficit. The operative mortality rate was 1.1% from 1967 to 1979 and 1.0% from 1971 to 1979. Graft patency was determined in 475 patients from 1967 to 1970, in 533 patients from 1971, in 519 from 1972, in 540 from 1973 and in 408 from 1974. Patency rates after a mean catheterization interval of 21 months were 77%, 77%, 84%, 87% and 87%, respectively. Five- and 10-year follow-ups were completed for the 1967-1970 series and a 5-year follow-up was completed for 1971, 1972, 1973 and 1974 cohorts. The 5- and 10-year actuarial survival rates for the 1967-1970 series were 89.4% and 77.3%, respectively. The 5-year survival rates for the 1971-1974 series were 91.9%, 93.4%, 92.1% and 91.7%. Abnormal ventricular function and incomplete revascularization adversely influenced the mortality rate (p less than 0.05) in all years. The percentage of asymptomatic patients at 5 years was 66%, 65%, 69%, 67% and 74% for the five patient cohorts. Lower risk and a higher 5-year survival rate are attributable to greater technical experience, changing technology and improved management rather than to selection of lower-risk cases. These 5- and 10-year survival rates compare favorably with the reported results of medical therapy.

Actuarial Analysis↗
PubMed1982

Idiopathic hypertrophic subaortic stenosis and coronary atherosclerosis. Results of coronary artery bypass alone and myectomy combined with coronary artery bypass.

Twenty-one patients with combined coronary artery disease and idiopathic hypertrophic subaortic stenosis (IHSS) have had coronary artery bypass grafting alone (Group I, n = 7) or in combination with left ventricular septal myectomy (Group II, n = 14). Patients ranged in age from 46 to 73 years (mean 59 years). There were no operative deaths, but one Group I patient died 16 months after operation. Patients in Group I have had continuing symptoms after the operation, whereas Group II patients have had consistent relief of symptoms. Patients with documented IHSS and coronary atherosclerosis should undergo combined coronary bypass and septal myectomy if symptoms recur with medical management.

Aged↗
PubMed1982

Clinical results of mechanical support of the failing left ventricle.

Six patients received mechanical support for a failing left ventricle after corrective cardiac operations. Despite intra-aortic balloon pumping and pharmacologic support, intractable failure persisted and cardiopulmonary bypass could not be withdrawn. The left ventricular assist device (LVAD) consists of a nonpulsatile centrifugal pump and two thromboresistant cannulas. Balloon counterpulsation added a pulsatile effect. LVAD support was continued for 72 to 168 hours and five patients were weaned from LVAD support. Two died of persistent low cardiac output within 3 days after pump removal, and a fourth died of multiple organ failure and pneumonia 8 weeks after LVAD removal. Autopsy studies in the first three patients showed myocardial necrosis greater than 50% of the left ventricular mass. Two patients survived after 72 and 74 hours of LVAD support. One patient is fully employed and active 27 months after a cardiac operation; the second is fully active 20 months after operation. Repeat cardiac catheterizations in both have shown all grafts patent and good ventricular function. These two long-term survivors justify the concept of LVAD support and its continued use in selected postoperative patients.

Adult↗
PubMed1982

Early clinical evaluation after aortic valve replacement with the St. Jude Medical valve in patients with a small aortic root.

Forty-three patients, nine men and 34 women, mean age 60 years (range 23-81 years), who had small aortic roots underwent aortic valve replacement with a St. Jude Medical valve. Preoperatively, five patients were in New York Heart Association (NYHA) class I, 19 were in class II, 15 were in class III and four were in class IV. In 30 of 36 patients with aortic stenosis, the mean gradient was 102 mm Hg (range 52-175 mm Hg; in six patients with aortic stenosis, the gradient was not measured. Seven patients underwent surgery for aortic regurgitation. Ten patients received a 19-mm valve, 29 a 21-mm valve and nine a 23-mm valve. Two patients (4.6%) died in the hospital, one immediately postoperatively and the other from low cardiac output 9 days postoperatively. There are 670 patient-months of follow-up (mean 17 months). Thirty-six patients are NYHA class I and two patients are in class II. There have been no thromboembolic episodes in 605 months of follow-up for patients maintained on warfarin. There was one partial valve thrombosis among eight patients being managed without warfarin. No mechanical valve failures have occurred. The St. Jude Medical valve provides a satisfactory early result when used to replace the aortic valve of patients who have a small aortic root.

Adult↗
PubMed1982

The third manpower study of thoracic surgery: 1980 report of the Ad Hoc Committee on Manpower of The American Association for Thoracic Surgery and The Society of Thoracic Surgeons.

An ad hoc committee was appointed by The Society of Thoracic Surgeons (STS) in 1977 in order to determine the available manpower and workload of thoracic surgeons in 1976. This committee conducted a survey of the professional activities and geographic location of all known surgeons certified by the American Board of Thoracic Surgery (ABTS) at that time. A summary of this study indicated the available and projected thoracic surgery manpower. The report also determined the present and projected health care needs of the population of the United States through 1993. Because thoracic surgery needs to continue to meet the health care needs of the United States in an appropriate yet economical fashion, the STS and The American Association for Thoracic Surgery (AATS) undertook a joint review to determine again the available manpower and its workload in calendar year 1980. In addition, this study compared its findings with the 1976 report in order to detect changes in the workload and need for thoracic surgical services. A questionnaire was mailed to 3,584 certified thoracic surgeons. There were 2,675 responses. The material was sent to the Academic Computer Services at George Washington University Medical Center for tabulation and data processing. This report summarizes the results of this survey. It also compares these data with those obtained in the 1976 study and, based on this information, attempts to project the thoracic surgery manpower needs in the next decade by using several hypothetical models.

Forecasting↗
PubMed1981

On reoperations.

Explore the source record for details and available documents.

Arteriosclerosis↗