Hemodynamic comparison of dopamine/dobutamine during emergence of cardio pulmonary by-pass in aortic valvular patients.
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Biomedical subjects
Publications and source records attributed to G Primo.
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In a 18 year-old woman, an isolated benign hemangioma of the right atrium led to cardiac tamponade and acute renal failure. After 8 days of anuria, the tumor was excised and replaced by a pericardial patch. The persistence of severe renal shutdown necessitated further hemodialysis during 22 days postoperatively. The patient was discharged on the 45th day in good hemodynamic and renal condition. Thirteen cases of benign hemangioma of the heart have been reported in the literature: 12 were found at autopsy; only 4 were complicated by hemopericardium but none of these survived.
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Total drainage of systemic blood into the left atrium is an exceptional finding in absence of severe intracardiac malformation. In our patient, a boy 3 years and 4 months old, the left superior vena cava, the inferior vena cava, and the coronary sinus drained into the left atrium; there was no right superior vena cava, and the only associated anomaly was a large atrial septal defect. This rare form of cyanotic congenital heart disease was correctly diagnosed and successfully corrected.
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In patient with severe coarctation of the aorta, arterial pressures were similar at the four limbs due to departure of both subclavian arteries from the descending aorta. The clinical clues to the diagnosis and the hemodynamic, angiocardiographic and surgical data are presented.
Operative and late results in a series of patients operated on the tricuspid valve (replacement or annuloplasty) at the moment of surgery upon mitral and aortic valves are reported. Functional tricuspid insufficiency carries a greater risk than organic tricuspid disease. Considering the duration of the underlying mitral disease, four grades are set up for the mitro-tricuspid patient allowing for prognosis and indication of the type of surgery to be done on the tricuspid valve.
This is a study of 85 valve replacements by mechanical prostheses, 41 of which were in the aortic position and 44 in the mitral position. The results were analysed from the standpoint of the immediate and late mortality, the morbidity, and thrombo-embolic complications. The influence of the severity factors (NYHA classification) on the operative risk and the late mortality has been evaluated. The maximum follow-up period was 8 years for the aortic replacements and 7 years for the mitral replacements. Actuarial graphs show that there is a 78.3% survival for aortic valve replacement and a 66% survival for mitral valve replacement. We feel that the shape of the survival curves is greatly influenced by the size of population studied. As soon as a plateau appears, the significance of the analysis is in doubt. It seems to us that calculation of the degree of confidence is essential if the good quality of the long-term results is not to be overestimated. The results of surgery must be assessed by comparing the survival curves of the operated patients with those of non-operated patients with the same risk factors. The conclusion emerges that prosthetic replacement of the mitral and aortic valves markedly improves the life expectancy of stage IV patients. We can see no indication for early surgery on the aortic valve. On the other hand, mitral valve replacement should be undertaken on stage III patients so that those with a poor life expectancy can be offered a better outlook. The way in which the mitral and aortic valve disorders carry a much greater mortality after the 6th decade should induce us to bring forward the indications for surgery in this age group in spite of the slightly greater immediate and late risk from operating on patients of this age.
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