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Biomedical subjects

G Bloch

Publications and source records attributed to G Bloch.

At least 109 records · Page 6Linked to original sources
PubMed1984

[Cardiac transplantation: noninvasive detection of rejection by echocardiography].

The main objective of follow-up of cardiac transplant patients is early recognition of acute rejection of the allogenic myocardium. Two patients followed up by the usual protocol also underwent routine M-mode and 2D echocardiography. The data was digitalized and memorized to allow systematic study of the pericardial and cardiac structures, and a comparison of their evolution. Acute rejection was associated with an increase in the acoustic density of the myocardium, especially of the interventricular septum, and an increase in myocardial mass as calculated from M-mode data; an increase of 5 p. 100 of this parameter with respect to an average reference value was judged to be significant. Comparisons were made with electrocardiographic data, especially with an index of voltage. The variability of this index which may be unrelated to rejection was apparent; in addition, there was an interval of about 5 days between the echocardiographic changes and the recording of significant reductions of the electrocardiographic index. Previously reported histological changes explain the precocity and reliability of the echocardiographic results obtained by a non-invasive and reproducible method.

Adult↗
PubMed1984

Aortoseptal approach for optimal resection of diffuse subvalvular aortic stenosis.

The results of conventional operative resection of diffuse subaortic stenosis (tunnel subaortic stenosis and diffuse idiopathic hypertrophic subaortic stenosis) have been less than satisfactory. A new approach using the concept of aortoventriculoplasty was designed to allow adequate surgical resection of a diffuse subvalvular aortic stenosis. The aorta, the right ventricle, and the septum are incised in the same way as during aortoventriculoplasty , with the aortic anulus being divided carefully across the commissure between the left and right aortic cusps. The septotomy is extended beyond the limits of the stenosis, and fibrous and/or muscular tissue is removed from each edge of the septal incision. After adequate widening of the subvalvular area, the various incisions are closed and the aortic valve is reconstructed. This aortoseptal approach was studied experimentally in the dog and then carried out on two patients, both of whom had excellent hemodynamic and functional results. The aortoseptal approach may be the procedure of choice in the treatment of diffuse stenoses limited to the subvalvular area, whereas other procedures ( aortoventriculoplasty , and apico-aortic valved conduit) should be used when the valvular and/or supravalvular levels are involved.

Adolescent↗
PubMed1983

[Operative risk in repeated heart valve replacement].

Eighty three patients aged 7 to 74 years underwent 92 repeat valve replacement procedures on one or more valve prostheses (100 repeated valve replacements). Reoperation was performed for: dysfunction of a mechanical prosthesis (21%), degeneration of a bioprosthesis (13%) progressive prosthetic valve endocarditis (7%), aseptic or sterilised post-endocarditis perivalvular leak (39%), systemic complications (haemolysis or repeated embolism) (20%). Global hospital mortality (30 days) was 12%. Statistical analysis showed three factors were associated with increased operative risk: severe symptoms (Class III or IV) (mortality: 20% compared to 0%, p less than 0,001), emergency reoperation (mortality: 25% compared to 4%, p less than 0,01) and reoperation for a "high risk" indication (dysfunction of a mechanical prosthesis or progressive endocarditis) (mortality: 33% compared to 3%, p less than 0,001). These three factors reflect either the gravity of the complication or the severity of preoperative cardiac failure. On the other hand, when reoperation is carried out at an early stage, mortality is low, the same as that associated with primary valve replacement. The operative risk, therefore, appears to be related to the preoperative cardiac state and not to the technical surgical problems of reoperation. These results underline the necessity of preventing serious acute complications such as acute prosthetic valve thrombosis and endocarditis, and or reoperating chronic complications as soon as possible after diagnosis.

Adolescent↗
PubMed1982

[Surgical treatment of subvalvular aortic obstructions. A new approach].

Approaching the region below the aortic valve is notoriously difficult. The new technique described, derived from the Konno-Restan technique, provides wide exposure of the infra-aortic canal through the right ventricle, the aorta and the septum. Experiments on animals have shown that it entails no risk of heart damage. This technique was used on one patient with sub-aortic fibromuscular tunnel with excellent post-operative results.

Aorta↗
PubMed1981

Surgical management of acute dissections involving the ascending aorta. Early and late results in 38 patients.

Thirty-eight patients (32 men and six women, mean age 48.1 years) were operated upon for acute dissection involving the ascending aorta. The surgical procedure included multiple peripheral arterial cannulations, resection of the initial intimal tear if found (35 cases), and obliteration of the false channel by double cuffing with Teflon of the two layers of the dissecting process proximally and distally. When present (29 cases), aortic regurgitation was usually (21 cases) managed by conservative remodeling of the aortic anulus; 34 prosthetic replacements of the ascending aorta and four replacements of the arch were achieved. The operative mortality was 7.9% (3138) and the overall hospital mortality was 23.7% (9138). Nonfatal complications occurred in 11 patients (29%). There were three late deaths (10.3%). Mean follow-up was 3.4 years (2 months to 8 years, 8 months). Twenty-three (88.5%) of the 26 patients were asymptomatic. Contrast tomodensitometry was performed in 14 patients; in type II (two patients), the aorta was normal; in type I (12 patients), residual abnormalities were noted: patency of the false channel (10 cases), aneurysmal dilatation (seven cases), and reduction of the true lumen by the false channel (four cases). These results emphasize the need for scrupulous long-term follow-up in surgically treated aortic dissections.

Acute Disease↗
PubMed1980

[Interruption of the aortic arch and an aorto-pulmonary fistula. Simultaneous correction of lesions in a 5 1/2 month old infant].

Aortic arch hypoplasia is rare but carries a poor prognosis. It is usually associated with a left to right shunt at ventricular level. The association of an aorto-pulmonary fistula is exceptional. A case of a 5 1/2 month old infant treated successfully by simultaneous correction is reported with a review of the physiopathological changes. Pulmonary hypertension and aortic perfusion depend on the calibre of the ductus arteriosus and its evolution. The therapeutic problems which result are the suppression or palliation of pulmonary hypertension and resaturisation of distal aortic vascularisation. Surgery is the only hope of cure, and current techniques are reviewed: two stage procedures with revascularisation of the distal aorta and pulmonary artery banding, or simultaneous correction of aortic continuity with suppression of the left to right shunt under cardiopulmonary bypass. The technical conditions are analysed: perfusion of the different aortic segments, methods of reestablishing aortic continuity. Good results are as yet rare, and are obtained after complete correction under cardiopulmonary bypass.

Aorta, Thoracic↗
PubMed1979

[Technical development in aortocoronary bypass: multiple outlet saphenous vein graft].

The technique of multiple outlet saphenous vein grafting with one or several alternating lateral anastamoses was used in 43 patients over a one year period; over half the patients had triple vessel disease, one third had double vessel disease; a total of 128 coronary arteries were revascularised 2.9 arteries per patient, with 60 side to side anastamoses, 1.4 per patient. The technique of this type of bypass necessitates paying particular attention to avoid kinking or twisting of the graft. The blood flow through multiple outlet graft is on average significantly greater than in the classical types of graft, and is one of the main points in favour of this technique and in keeping the graft permeable in the long term. The short term results of this technique are good with a hospital mortality of 4.6% and a peri-operational infarction rate of 6.9%, figures which are comparable with the results of classical bypass grafting techniques in multivessel coronary artery disease.

Adult↗