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Biomedical subjects

G Primo

Publications and source records attributed to G Primo.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Pulmonary artery banding. Experience with 69 patients.

Between 1976 and 1985, 69 patients underwent pulmonary artery banding (PAB) at an average age of 2.2 months (mo) (range 2 days-18 mo) weighing 3.8 kg (2.1-10.7 kg), as part of their initial surgical therapy for massive left to right shunting. Only 10 patients (early in this series) had isolated ventricular septal defect (VSD). Seventeen patients did not survive PAB (25%), including 4 of 5 patients with Taussig-Bing heart (TBH) and only 4 of the 40 patients with VSD [either isolated or associated with coarctation or transposition (TGA)]. Forty-four patients underwent debanding (deB) and secondary cardiac repair at an average age of 22 mo (6-96) and weight of 9.4 kg (4.9-22.0): 9 patients died early and 1 late. Mean pulmonary artery pressure was 49 Torr (27-80) before banding and 24 before deB (6-65). PA stenosis from the band imposed further surgery in all but 15 patients. Thirty-four survivors to secondary repair were followed for an average 46 mo (1-120). Thirty were in NYHA classes I and II. Only 43% of patients with PAB had good medium term results. The presence of the band imposes close, complete follow-up. PAB is no longer recommended for isolated single VSD. It can still be beneficial in multiple, complicated, or medically compromised VSD as well as in very small neonates with atrioventricular septal defect and truncus arteriosus, and subsets of double outlet right ventricle and tricuspid atresia with high pulmonary flow not amenable to early complete repair. PAB in functional single ventricle allows safer delayed definitive repair. TBH and TGA+VSD are now repaired primarily (arterial switch).

Constriction↗
PubMedDate not supplied

Leaflet escape of a mitral Duromedics prosthesis. Case report.

This article reports a case of leaflet embolization of a mitral Edwards-Duromedics prosthesis. The patient had abrupt onset of acute pulmonary edema and was initially treated medically for 3 days. Fluoroscopy showed only one freely moving leaflet and the other was (incorrectly) assumed to be blocked in the closed position. The patient received IV thrombolysis for another 3 days and was finally operated. He died 8 days later from sepsis and the leaflet was recovered at autopsy in the abdominal aorta. Leaflet escape of a mitral Edwards-Duromedics prosthesis is a rare, potentially curable mode of valve failure. Correct interpretation of clinical signs and symptoms and of fluoroscopy should allow early diagnosis and surgical therapy.

Embolism↗
PubMedDate not supplied

Spontaneous rupture of the esophagus after coronary artery bypass.

Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare but the most lethal perforation of the gastro-intestinal tract. A 62-year old male was successfully treated for this condition developing on the second post-operative day after coronary artery bypass. Two hours after extubation respiratory insufficiency and circulatory collapse necessitated reintubation and energetic resuscitation with prompt drainage of a massive pleural effusion. Left thoracotomy on post-operative day 17 confirmed the diagnosis and the esophagus was excluded by cervical esophagostomy and duodenostomy. After a six week recovery, reconstruction was achieved by total esophagectomy through a right thoracic incision and gastric bypass with cervical gastro-esophageal anastomosis. The patient left the hospital in good condition 112 days after the initial operation.

Coronary Artery Bypass↗
PubMedDate not supplied

[Limited role of surgery in the treatment of pulmonary embolism].

Massive pulmonary embolism (more than 50% of the pulmonic arterial bed obstructed) has a high mortality. If the accident is not immediately fatal and if the patient is in an adequate hospital environment, the diagnosis has to be confirmed by pulmonary scan and arteriography. Immediate institution of an intensive medical support against shock combined with the induction of thrombolysis prove effective in a majority of cases. The few patients who do not favorably respond to this medical therapy must without delay undergo embolectomy under extracorporeal circulation. The risk is mainly dependent on the hemodynamic state of the patient at the moment of operation. However conditions related to time and place for optimal surgery may restrict the number of favourable results.

Emergencies↗
PubMedDate not supplied

Thrombosis of the Saint Jude Medical valve prosthesis in the aortic position: a diagnostic and surgical emergency.

Three cases of prosthetic thrombosis with the SJM mechanical bileaflet pyrolitic valve in the aortic position occurred in a series of 355 patients operated on over a four-year period (October 1978-September 1982). Symptoms and signs of inadequate left ventricular flow (with various degrees of aortic regurgitation) were marked and developed rapidly. The patient is usually aware of muffling of the valve sounds. Auscultation is typical (muffled or abolished valve sounds; appearance of a systolo-diastolic murmur). Echocardiogram and carotidogram are suggestive. Adequately oriented fluoroscopy is diagnostic. Emergency prosthetic replacement is life-saving. Long term, well controlled, anticoagulation with coumadin is advocated.

Aortic Valve↗
PubMedDate not supplied

Left-sided cervical aortic arch.

The authors report a case of cervical aortic arch. Left-sided cervical aortic arch is a very rare congenital anomaly which may or not be associated with clinical symptoms. Diagnosis, suspected on chest X-ray or clinical examination, must be confirmed by angiographic studies. A 17-year-old girl presenting an extensive aneurysm of a left-sided cervical aortic arch was successfully operated with the use of partial extracorporal bypass removing the aneurysm and restoring aortic arch continuity. Histological examination revealed mediacystic necrosis.

Adolescent↗
PubMedDate not supplied

Composite graft replacement of the aortic root and ascending aorta for annuloaortic ectasia.

Eighteen patients with annuloaortic ectasia were surgically treated during a six year period. Cystic media-necrosis was present in 17 patients, five of them presented with Marfan syndrome. All patients received a composite graft with reversed mitral Björk-Shiley or St-Jude prosthesis and reimplantation of the coronary ostia or venous bypass grafts. Combined profound selective hypothermia and hyperkalemic cardioplegia was the preferred myocardial protection technique. There was one early postoperative and two late deaths. The fifteen survivors, with a follow-up between 6 and 72 months did not present conduit related complications and clinical results are excellent; all patients are NYHA class I (11) or II (4).

Adult↗
PubMedDate not supplied

Surgical treatment of echinococcal cyst of the right heart.

We report a rare case of hydatidosis of the right heart. Our young patient had know pulmonary hydatidosis and presented precordial chest pain, increasing dyspnea, cough and hemoptysis. Echocardiography, confirmed by angiocardiography delineated the right ventricular cyst. The operation was performed under extra corporal circulation (ECC), moderate hypothermia with cold cardioplegia. The echinococcal cyst was removed after local instillation of 0.5% silver nitrate solution. The postoperative course was uneventful.

Adult↗
PubMedDate not supplied

Cardiocutaneous fistula after left ventricular aneurysm repair. Case report and review of the literature.

Cardio-cutaneous fistula is a rare late complication of LV aneurysm repair related to the use of Teflon strips to bolster the suture line. Since bleeding occurs in half of the cases and there is no tendency to spontaneous healing, operation should be advised and should involve complete removal of all foreign material with the aid of CPB. We suggest that foreign body intolerance might be the main factor in the development of the lesion and infection a consequence of fistulisation through the skin.

Fistula↗
PubMedDate not supplied

Coronary artery fistula: an absolute surgical indication.

Two operated cases and an anatomical, clinical and therapeutic review of primary coronary artery fistula (CAF) are presented. The authors focus attention on the deleterious evolution of untreated CAF and on the higher morbidity and mortality of surgical treatment of CAF in the elderly. They recommend surgery for CAF even asymptomatic.

Adult↗
PubMedDate not supplied

Operative management of penetrating wounds of the chest. Experience with 41 patients on the island of Curaçao.

Of the 157 cases of chest injuries, 41 patients underwent thoracotomy. Thirty-three were male and 7 female with an average age of 27 years. Eighty-three percent had stabwounds and 17 percent gunshotwounds . On admission and on examination only seven thoracotomy patients were in a stable clinical condition. Hypotension and hemo- or pneumothorax were often present. Persisting hemorrhage from chest tubes drainage, cardiac tamponnade , and massive hemothorax were indications for immediate thoracotomy. Only few of the patients with an hemothorax have an hemorrhage from a major systemic vessel. Associated intraabdominal injuries were often found (17%). For exploration of the abdominal lesions a separate explorative laparotomy is indicated. The only patient who died in our series suffered from septicemia after multiple associated intra-abdominal wounds (mortality rate 2.4%). The overall complication rate was 19.7%. The average period of hospitalisation was 15.4 days.

Adult↗
PubMedDate not supplied

Mycotic aneurysm of the left main pulmonary artery in an infant.

An exceptional case of mycotic aneurysm of the left branch of the pulmonary artery in a 4 month old baby following documented Staphylococcal Septicaemia is presented. The lesion was successfully treated by left pneumonectomy. The pathogenesis and early appearance of calcifications are discussed.

Aneurysm, Infected↗