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Biomedical subjects

G Sahar

Publications and source records attributed to G Sahar.

10 recordsLinked to original sources
PubMed1999

Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation.

BACKGROUND AND AIM OF THE STUDY: Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients after mitral valve replacement (MVR), both in the immediate and late postoperative period. The aim of this study was to evaluate the prevalence and the clinical importance of TR late after MVR, as assessed both clinically and echocardiographically. METHODS: The study group comprised 65 patients (39 women, 26 men; mean age 61+/-12 years) with rheumatic heart disease who had undergone MVR without tricuspid valve surgery between one and 30 years (mean 11.3+/-8 years) before their last clinical examination. All patients underwent a complete color-Doppler echocardiographic examination. The predominant presurgical mitral lesion was stenosis in 44 patients and regurgitation in 21. The severity of the tricuspid valve disease was assessed echocardiographically using color-Doppler flow images and flow direction in the inferior vena cava or hepatic veins, and by clinical evaluation. RESULTS: Echocardiography revealed significant late TR in 44 patients (67%), which was moderate in 16 and severe in 28, and evident on physical examination in 24 cases (37%). Age (relative risk (RR) = 1.1; C.I. 1-1.1) and female sex (RR = 1.8; C.I. = 1.0-3.2) were identified as statistically significant predictors for late clinical TR development, but only age was found as a statistically significant predictor for echocardiographic TR development. An elevated RR for organic TR and predominant mitral regurgitation was found. In contrast, pre- and postoperative pulmonary artery pressure, predominant mitral lesion, prosthetic valve gradient and regurgitation were similar in patients with and without late TR. CONCLUSIONS: Significant TR diagnosed by echocardiography late after MVR is common, and clinically evident in more than one-third of patients. Therefore, a lower threshold for tricuspid valve repair should be considered when mitral valve surgery is carried out.

Aged↗
PubMed1998

Massive spontaneous hemothorax as a presenting sign of aneurysmal rupture of the internal thoracic artery. A case report.

Massive spontaneous hemothorax is a very uncommon, life-threatening situation. Acute dissection and ruptured aorta can be one of the differential diagnoses, but usually the clinical feature is completely different, and very few patients have survived this event and received medical attention. Among other causes of spontaneous bleeding, some are extremely rare, demanding precise diagnosis and judicial and immediate intervention. We describe a patient who presented with a massive hemothorax. There was no immediately apparent cause. Emergent angiography revealed active bleeding from an extremely unusual source: aneurysmal dilatation of the internal thoracic artery.

Adult↗
PubMed1996

Surgical results in cardiac patients over the age of 80 years.

Improved medical care over the years has increased life expectancy and consequently the number of aged persons suffering from cardiac disease. During the past 3 years, 42 consecutive octogenarians, with an average age of 82.1 years, were evaluated. Thirty patients had coronary artery bypass graft surgery (CABG), 5 had aortic valve replacement (AVR), and 7 had combined CABG-AVR surgery. Among the ischemic patients 70% had suffered from unstable angina pectoris, and an average of 2.78 +/- 1 grafts per patients were performed. The left internal mammary artery was used in 12 patients (32%). Overall mortality was 7.1% (3 patients), while operative mortality was 2.4% (1 patient). Another two patients who expired during the 34 month follow-up period underwent AVR. The average hospitalization period was 10.2, 12 and 17.6 days for patients undergoing CABG, combined CABG-AVR, and AVR alone, respectively. Complications occurred in 10 patients (24%) and included neurologic deficits (in 2 patients), severe wound infection (in 2), cardiac arrhythmia (in 4), renal failure (in 1) and adult respiratory distress syndrome (in 1). The use of the left internal mammary artery was not associated with an increased incidence of complications. The low rate of mortality and major complications and the substantial improvement in quality of life led us to conclude that, when indicated, surgical treatment should be offered to selected elderly individuals who otherwise are in good physical and mental health.

Aged↗
PubMed1995

Surgical management of ventricular septal defect with aortic valve prolapse: clinical considerations and results.

Aortic valve prolapse is found in over 5% of children with ventricular septal defect (VSD). Although this association occurs mostly with doubly committed subarterial VSDs, in this study the predominant type of VSD was perimembranous. In order to determine the need and timing for surgery and whether the anatomical features of septal defect may influence clinical management and outcome in this lesion, we reviewed our experience with 28 consecutive patients, operated on for VSD with prolapsed aortic valve cusp, with or without aortic regurgitation. Twenty-two patients had a perimembranous VSD and six had doubly committed VSD. Aortic regurgitation was trivial or absent in nine patients, mild in ten and moderate to severe in nine. Associated cardiac anomalies were present in 18 patients, all having perimembranous VSD, and included right ventricular outflow tract (RVOT) obstruction (n = 6), discrete subaortic membrane (n = 4) or both (n = 8). None of these patients had more than moderate aortic regurgitation. The patients underwent surgical closure of the septal defect between the ages of 1.5 and 34 years of age (median = 7). Sixteen patients having mild or trivial aortic regurgitation underwent closure of the VSD only, and 12 patients underwent VSD closure with aortic valvuloplasty. Valvuloplasty was required more often in doubly committed VSDs (66%) and in the perimembranous type without associated anomalies (100%), and significantly less often in the presence of RVOT obstruction, subaortic membrane or both (22%). At follow-up (up to 5 years, mean 18 months), the grade of aortic regurgitation was unchanged in 11 and decreased in 5 patients undergoing closure of the VSD only.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Cardiac surgery in octogenarians.

Age as an important risk factor in surgery has always been debatable. Between January 1991 and December 1992, 35 consecutive octogenarian patients (23 males and 12 females; average age 82.3 years) were retrospectively evaluated. Twenty-five patients had only coronary artery by-pass graft operations (CABG), five had aortic valve replacements (AVR) and five had combined AVR-CABG operations. Twenty-five of the 30 patients (83%) who underwent CABG alone or a combined procedure had suffered from unstable angina. The mean ejection fraction was 40% in this group. An average of 2.8 grafts per patient was performed. The left internal mammary artery (LIMA) was-used in nine patients (30%). The average hospitalization period was 11.5 days. Operative mortality (within 30 days) was zero. Patients who underwent AVR only were hospitalized for an average of 17.6 days and there were two cases (6%) of mortality in this group. All patients who underwent AVR and CABG were discharged within 14 days. Overall complications occurred in nine patients (25.7%); cardiac arrythmias, (4) neurological deficits (2), severe wound infections (2), and adult respiratory distress syndrome (1). The use of the LIMA was not associated with an increased incidence of bleeding or sternal infection. The low rates of mortality and major complications lead us to conclude that, when indicated, surgical treatment including the use of LIMA in selected cases, should be offered to this group of patients, even in the presence of moderate LV dysfunction.

Age Factors↗
PubMedDate not supplied

Acute myocardial infarction immediately after heart transplantation.

Myocardial infarction is one of the rarer events causing acute graft failure during the postoperative period after transplantation and is usually caused by preexisting coronary artery disease of the donor heart. We discuss the case of a 56-year-old man in whom cardiogenic shock developed after heart transplantation, which was refractory to all medical treatment. He was put on emergency code and underwent retransplantation 30 hours later. Pathologic examination of the explanted donor heart showed massive recent inferior and posterior wall infarction, with normal coronary arteries; the right coronary artery was dominant and completely occluded by an embolus of fatty material surrounded by fibrin, which we suggest could have originated from the suture line of the left atrium.

Heart Transplantation↗