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Biomedical subjects

G Guiraudon

Publications and source records attributed to G Guiraudon.

At least 37 records · Page 2Linked to original sources
PubMed1983

[Recurrence of mitral disease after commissurotomy. Criteria influencing operative mortality during reintervention using extracorporeal circulation].

Reoperation for secondary deterioration after mitral commissurotomy is associated with a higher immediate postoperative mortality than other open heart operations. We analysed the factors responsible for this increased mortality. A total of 232 patients reported for clinical deterioration after closed heart mitral commissurotomy were reviewed. Mitral valve prostheses were implanted in 202 cases; open heart commissurotomy was possible in 30 cases. Associated procedures included 14 tricuspid valve replacements, 53 tricuspid annuloplasties and 30 aortic valve replacements. The global mortality was 12 p. cent (30 deaths). The causes of death were myocardial failure (19 cases), cerebrovascular accidents (4 cases), prosthetic valve thrombosis (4 cases), infection (2 cases), section of the mitral annulus (1 case). The clinical hemodynamic and anatomical criteria influencing the operative prognosis were analysed: 1. Operative mortality was related to the clinical stage (zero mortality at Stage II, 10,3 p. cent at Stage III, 38 p. cent at Stage IV, p less than 0,001); 2. There was a significant correlation with cardiothoracic ratio: 23 p. cent mortality when greater than 0,60; 9,8 p. cent mortality when less than 0,60 (p less than 0,02); 3. There was a significant correlation with cardiac index: 19 p. cent mortality when less than 21; only 9 p. cent mortality when greater than 21 (p less than 0,04); 4. There was a significant correlation with systolic pulmonary arterial pressure: mortality of 11 p. cent when less than 60 mmHg; mortality of 22 p. cent when greater than 60 mmHg (p less than 0,06). 5. The presence of tricuspid regurgitation increased the operative risk (mortality rose from 12 to 22 p. cent, p less than 0,05) when the surgeon detected moderate or severe tricuspid regurgitation. These results show that the clinical, radiological and hemodynamic aggravation of these patients has a bad influence on operative mortality. This aggravation is not related to the delay between the initial commissurotomy and reoperation but to the delay between the recurrence of symptoms after the first operation and reoperation. Operative mortality was 12 p. cent when this delay was less than 10 years but 23 p. cent when the delay was over 10 years (p less than 0,02). Our findings suggest that these patients should be reoperated earlier if the prognosis of this type of surgery is to be improved.

Adolescent↗
PubMed1982

[Preventive treatments of tachycardias in Wolff-Parkinson-White syndrome].

Tachycardias in Wolff-Parkinson-White syndrome are due to the presence of an accessory conduction pathway between atria and ventricles. Many patients are treated with anti-arrhythmic drugs alone or in combinations. In difficult cases, the choice of therapy is guided by investigatory methods using Holter's recording system and intracavitary electrophysiological techniques, sometimes associated with special pacemakers arresting reciprocal rhythm. Intolerance to such pacemakers or failure of medical treatments usually leads to surgery. Division of the accessory conduction pathway constitutes a radical treatment of the syndrome with satisfactory results when performed by trained teams.

Anti-Arrhythmia Agents↗
PubMed1982

Right ventricular dysplasia: a report of 24 adult cases.

Right ventricular dysplasia is characterized by an abnormality in the development of part of the right ventricular musculature. Patients with right ventricular dysplasia may present with ventricular tachycardia, supraventricular arrhythmias, right-heart failure or asymptomatic cardiomegaly. Twenty-two adult patients with right ventricular dysplasia who had recurrent ventricular tachycardia were seen during a 7-year period. The male/female ratio was 2.7:1. The mean age at the time of hospitalization was 39 years. All but one of the patients had ventricular tachycardia of a left bundle branch block configuration. With few exceptions, the T waves were inverted over the right precordial leads. The heart was usually enlarged and the pulmonary vasculature was usually normal. In six patients who had two-dimensional echocardiograms, all showed increased right ventricular diastolic dimensions. All patients had right ventricular angiography; the diagnosis of right ventricular dysplasia was substantiated during surgery in 12 patients and at autopsy in another. Two other patients who did not have arrhythmias had right ventricular dysplasia diagnosed by right- and left-heart angiography. Our unique experience, when combined with a literature review of 34 adult cases, permits a composite clinical profile of this condition in the adult.

Adolescent↗
PubMed1982

[Arrhythmogenic right ventricular dysplasia and Uhl's disease].

Ventricular tachycardia with left bundle branch block appearance in adults without coronary artery disease may be due to arrhythmogenic right ventricular dysplasia. This condition forms part of a spectrum with the complete form of Uhl's anomaly at one end and arrhythmogenic right ventricular dysplasia at the other. Both conditions have similar histological appearances representing the same congenital defect but the macroscopic appearances are quite different. Arrhythmogenic right ventricular dysplasia seems to be a slowly progressive condition with one or more localisations in the right ventricle where the myocardium is replaced by adipose tissue with progression of lesions from the epicardium towards the endocardium. The subepicardial layers resemble a plexiform structure of partially degenerated myocardial fibres within fibro-adipose tissue. These fibres may be the site of slowing of activation and the anatomical basis of intraventricular reentry phenomena. A similar appearance is also found in UHl's anomaly, but the severe dilatation of the ventricle and almost complete absence of muscle fibres only leaves a few zones with surviving, partially degenerated myocardial fibres. Clinically, a cardiothoracic index of over 0.60 is more common in Uhl's anomaly whilst arrhythmogenic right ventricular dysplasia is usually associated with a normal cardiac silhouette or only slight cardiomegaly. The differential diagnosis is important if surgery is being considered. An appropriate technique must be chosen to avoid supraventricular arrhythmias which can lethal in patients with Uhl's anomaly.

Adolescent↗
PubMed1982

[Abnormal communications in acute bacterial endocarditis of the aortic valve].

Abnormal communications acquired during acute aortic valve bacterial endocarditis are rare but serious complications. Seven cases are reported; between the left ventricle and right atrium (3 cases), the left and right ventricles (2 cases), the aorta and right atrium (I case) and the aorta and left atrium (I case). The usual causal organisms is a staphylococcus (4 out of 7). The diagnosis is suspected on the development of atrio-ventricular block, a parasystolic murmur and sudden severe cardiac failure, but can only be confirmed by catheterisation and angiocardiography (impractical in our patients because of their poor condition). Echocardiography is of great diagnostic value. Surgical cure involves a double approach aortotomy and opening the other chamber involved), with extensive excision of the infected tissues, closure of the perforation, reconstruction of the aortic ring and implantation of an aortic valve prosthesis. The extent of the anatomical lesions affects the choice of the mode of reparation. There was no operative mortality in our series but two patients have persistent diastolic murmurs due to perivalvular leaks. In one case, recurrent infection led to the implantation of an apico-aortic tube with a fatal outcome.

Adult↗
PubMed1982

[Encircling endocardial ventriculotomy in the treatment of recurrent ventricular tachycardia after myocardial infarction].

Thirty nine men and two women aged 26 to 76 years old (average 55 years) with ventricular tachycardia (VT) complicating chronic myocardial infarction were operated on between December 1971 and September 1980. Epicardial mapping was performed in sinus rhythm in 25 cases and in VT in 12 cases. The series was divided into two consecutive groups: --The first group comprised 14 patients operated on between December 1971 and November 1975 in which the operative mortality at the 30th day was 36%. There was one death due to recurrent VT in the early post-operative period; two deaths due to arrhythmia were observed between the 11th and 26th postoperative months. VT was successfully prevented in 6 cases with over 2 years' follow-up. --The second group comprised 27 patients operated after November 1975, in which encircling endocardial ventriculotomy (EEV) was the procedure used. The operative mortality fell to 18% with no relation to the arrhythmia. In the first 10 cases of this group, VT recurred in 2 patients in the early postoperative period. These two cases were controlled with antiarrhythmic therapy at doses that had been ineffective preoperatively. Four other recurrences of VT were observed at the 3rd, 34th, 45th, and 56th postoperative months. They were controlled by anti arrhythmic agents in 3 cases. The other patient died. VT was prevented for over 2 years in 7 patients and for over I year in 16 patients. These results suggest that EEV is more effective than the techniques used previously in resistant VT. Its side effects on myocardial contractility are discussed.

Adult↗
PubMed1981

Surgical treatment of ventricular tachycardia guided by ventricular mapping in 23 patients without coronary artery disease.

Twenty-three patients with resistant ventricular tachycardia not related to coronary artery disease underwent surgical treatment guided by ventricular mapping. The patients were grouped according to radiological and anatomical findings. Group 1 (13 patients) had arrhythmogenic right ventricular dysplasia. Group 2 (3 patients) had left ventricular aneurysm. Group 3 (2 patients) had nonobstructive myocardiopathy. Group 4 (5 patients) had normal-appearing hearts. At operation all patients underwent ventricular mapping when in sinus rhythm and during ventricular tachycardia. The rationale of operation was ventriculotomy or cryosurgery at the site of origin of ventricular tachycardia or exclusion, resection, or undermining of arrhythmogenic areas where delayed potentials were observed. Four patients died during the perioperative period, 3 of low-output failure and 1 from bleeding. Ventricular tachycardia recurred immediately after operation in 4 patients, 3 of whom died during the perioperative period. Ventricular tachycardia recurred late in 5 patients. Three had only episodic, unsustained runs of tachycardia. Two were well controlled by drugs. All patients with ventricular tachycardia situated over the free wall of the ventricles had inducible ventricular tachycardia and had good surgical results. Three out of 5 patients with ventricular tachycardia situated in the septum had poor surgical results. Septal ventricular tachycardia needs a better surgical approach to the septum and a suitable surgical concept.

Adult↗
PubMed1981

[Abdominal complications of heart surgery].

Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. Twenty six cases were observed out of a total of 7 847 operations (0.33%) performed between 1973 and 1980. The causes were very diverse; the most common being gastroduodenal ulceration, usually acute (9 cases). Other cases included intestinal (3 cases of postoperative ileus, 4 cases of mesenteric infarction, 2 cases of necrosing enterocolitis), biliary (2 cases of acute cholecystitis) and splenic pathology (2 cases of splenic infarction, one associated with necrosing enterocolitis). Anticoagulant therapy was implicated in 3 cases. Diagnosis is difficult in the immediate postoperative period, some complications only being recognised at autopsy. The clinical signs may be misleading and the interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. Excluding accidents due to anticoagulant therapy the following factors were associated with an increased risk of abdominal complications: previous history of gastro intestinal pathology (ulcer, gall stone, alcoholism) the nature of the underlying cardiac disease (coronary artery and aortic valve disease), cardiopulmonary bypass, and, above all, per- and postoperative incidents: hypovolaemia, low output syndrome (half the patients in this series) respiratory and infectious complications. The inappropriate use of vasoconstricting agents may also play a role. The majority of abdominal complications seemed to be related to ischaemia and anoxia in the splanchnic territory, which explains the important role of the preceding factors. The prognosis of abdominal complications after cardiac surgery was poor, mortality reaching 50 to 100% in some causes: in this series, 12 of the patients died. This justifies certain prophylactic measures: strict selection of patients, diagnosis and treatment of associated abdominal pathology before operation, prevention of low output states, respiratory and infectious complications ... and careful examination of the abdomen after operation to ensure the early diagnosis and treatment of complications, should they develop.

Acute Disease↗
PubMed1981

Complete replacement of the ascending aorta with reimplantation of the coronary arteries: new surgical approach.

Thirty patients had total replacement of the ascending aorta with reimplantation of the coronary arteries, 20 for a fusiform aneurysm of the ascending aorta and 10 because of a dissection of the ascending aorta, of which there were acute. All had associated aortic insufficiency. The technique consists of implantation, within the aneurysmal sac, of a Dacron prosthesis containing a Björk-Shiley aortic valve. The coronary orifices are anastomosed to the tubular Dacron prosthesis by means of a second smaller Dacron tube. The aneurysmal pouch is then closed over the entire appliance and a fistula between the aneurysmal sac and the right atrial appendage is created to drain oozing from the prosthesis. The operative mortality was 10% (three deaths) and the late mortality has been 14.8% (four deaths). The deaths, early and late, have been confined to the first 10 cases, during which time the technique was being developed. There has been no mortality among the last 20 patients. The 23 survivors followed for an average of 19 1/2 months (range 6 months to 5 1/2 years) are in NYHA Functional Class I (21) or II (two). The technical modifications utilized in this series have simplified the operation and permit the proposal of this technique for aneurysm involving the entire ascending aorta.

Adult↗