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Biomedical subjects

H Bolooki

Publications and source records attributed to H Bolooki.

At least 37 records · Page 2Linked to original sources
PubMed1986

Comparison of long-term results of Carpentier-Edwards and Hancock bioprosthetic valves.

The long-term survival following valve replacement with Carpentier-Edwards or Hancock bioprostheses was compared between the two valve models and between the two groups totaling 407 patients who were discharged after valve replacement beginning in 1974. The two groups of patients were treated in a nonrandomized fashion. The actuarial survival for 299 patients with Carpentier-Edwards valves was 94 +/- 1.5% (+/- standard error) and 93 +/- 1.7% after 5 and 8 years of follow-up, respectively. Comparable figures for 108 patients undergoing valve replacement with Hancock valves were 89 +/- 3.0% and 83 +/- 3.7%, respectively (p = not significant [NS]). The probability of freedom from death and valve removal after 5 and 8 years of follow-up was 91 +/- 1.8% and 79 +/- 4.6%, respectively, with the Carpentier-Edwards valve and 84 +/- 3.5% and 75 +/- 4.3%, respectively, with the Hancock valve (p = NS). An accelerated rate of attrition for both valves was observed in the mitral position. There were no significant differences in actuarial survival between the two valves in the mitral or the aortic position or in the incidence of major valve-related complications.

Adolescent↗
PubMed1986

Surgical management of post-myocardial infarction ventricular tachyarrhythmia by myocardial debulking, septal isolation, and myocardial revascularization.

Sustained ventricular tachycardia or ventricular fibrillation, associated with severely depressed left ventricular function after myocardial infarction, carries a poor prognosis. We have used an extensive surgical procedure in 18 patients (15 men and three women) with a mean age of 63 years who had more than three episodes of recurrent, hemodynamically significant ventricular tachycardia or fibrillation and congestive heart failure. The operation consisted of complete myocardial revascularization and myocardial debulking by extensive infarctectomy with unguided endocardial resection and septal isolation with support of the necrotic wall with a Teflon patch. Implantable defibrillator patches were placed in eight patients. Blood cardioplegia and intra-aortic balloon assist (12 patients) were used for perioperative myocardial preservation. Postoperative studies demonstrated a significant increase in ejection fraction (n = 16) and a decline in pulmonary wedge pressure. Hospital mortality was 16% (three patients). Two deaths were due to congestive heart failure and one to arrhythmia. During postoperative electrophysiologic studies, ventricular tachycardia was not inducible in six of eight patients (75%). During a mean follow-up of 24 months, 11 of 15 patients who survived operation are alive and are in New York Heart Association Class I or II. Three of four late deaths were due to congestive heart failure and drug toxicity and one was arrhythmia related. This procedure is effective for preventing recurrent ventricular tachycardia or fibrillation in a majority of patients who cannot have intraoperative mapping.

Aged↗
PubMed1985

Current status of circulatory support with an intra-aortic balloon pump.

Although the initial clinical application of IABP was for the purpose of support of circulation in cardiogenic shock, its indications have expanded and include prophylactic use, especially in patients with ischemic heart disease. Controversy exists regarding the efficacy of this device in these conditions. Prolonged balloon support for periods of more than 5 days is presently employed in patients with chronic heart failure undergoing cardiac surgery, without concern for so-called "balloon dependence." In recent years, the incidence of use of IABP has declined markedly mainly because of comparable effects obtained by hemodynamic treatment with various drugs aimed at altering a specific parameter of cardiac function. Percutaneous application of a intra-aortic balloon catheter, although associated with a higher complication rate, has brought to clinical practice a rapid method for utilization of this device under fluoroscopic control. Because of an appreciable number of complications, however, balloon assist should be used for very specific clinical conditions.

Adult↗
PubMed1983

Failure of Hancock xenograft valve: importance of valve position (4- to 9-year follow-up).

To evaluate long-term durability of Hancock valves, we reviewed our results in 107 hospital survivors (120 valves) who were operated on during 1974 through mid-1979. Mitral valve replacement was done in 63 patients, aortic valve replacement in 20, and mitral valve replacement combined with other procedures in 24. The 7-year survival was 84 +/- 4% (standard error of the mean) for 91 patients and 97 valves. During a follow-up of 590 patient-years, 15 (12 mitral and 3 aortic) of 120 valves at risk (87 mitral, 32 aortic, 1 tricuspid) were removed from 14 patients. Six valves (3 mitral and 3 aortic) were removed because of bacterial endocarditis. One mitral valve was removed because of thromboembolism. Eight mitral valves were removed because of valve structural failure, which occurred at a mean follow-up of 42 months. These valves showed extensive calcification, leaflet perforation, or cusp tear. Structural failure was unrelated to valve size, year of implantation, or valve shelf-life. Structural failure was not seen after aortic valve replacement. Results show that structural failure of the Hancock xenograft valve in the mitral position is related primarily to valve position. After aortic valve replacement, valve failure is predominantly due to endocarditis. Although medium-term (mean, 6-year) durability of this xenograft valve compares satisfactorily with prosthetic valves, its high failure rate in the mitral position indicates the necessity for improvement in valve mounting, design, and preservation.

Adolescent↗
PubMed1982

Surgery of descending aorta. A method of autotransfusion and intercostal artery preservation.

Paraplegia is a tragic complication of surgery of the descending aorta. It is unpredictable and occurs with a similar incidence with or without distal circulatory support. Hypotension, prolonged aortic cross clamp time, and ligation of intercostal arteries have been considered causative factors. Recent experience with ten consecutive patients undergoing descending aortic surgery without shunts employed a method of autotransfusion and intercostal preservation. There were no deaths, renal failure, or paraplegia. The perioperative blood requirement per patient was 2.4 units of blood.

Adult↗
PubMed1979

General anesthesia in pigs.

Conventional swine weighing 20-45 kg were anesthetized for surgical procedures. After fasting for 24 hours, ketamine hydrochloride and xylazine were administered intramuscularly. Following tracheal intubation, sodium thiopental was administered via the aural or femoral vein.

Anesthesia, General↗
PubMed1978

High-dose steroids for perioperative management of patients with myasthenia gravis undergoing thymectomy. A preliminary report.

To eliminate the morbidity associated with thymectomy, we used high-dose corticosteroids perioperatively in 32 patients who had Class II and III myasthenia gravis. All patients were extubated within 2 hours after the operation, and none required respiratory support postoperatively. The average stay in the intensive care unit was 20 hours and the average hospital stay, 6 days. Addition of high-dose corticosteroids to the perioperative managment of patients with myasthenia gravis undergoing thymectomy improved the immediate operative results and eliminated the morbidity associated with this procedure.

Adolescent↗
PubMed1976

Myocardial revascularization after acute myocardial infarction.

Revascularization of the myocardium was performed in 25 patients two to eight hours after acute myocardial infarction (MI). The intra-aortic balloon pump was used in 11 patients. Thirteen patients received revascularization within four hours of onset of MI; all survived the operation. Seven patients were studied postoperatively; ten of 12 grafts (83%) were patent. There was a considerable decrease in left ventricular (LV) dyskinesis and an improvement in LV function. Among 12 patients in whom revascularization was performed for more than four hours' duration after the onset of MI, ten survived. Six were studied postoperatively; six of nine grafts (66%) were patent. There was an increase in LV dyskinesis, with deterioration in LV function. In three patients, ECG evidence of Q wave persisted in spite of absence of dyskinesis postoperatively. The interval during which revascularization of acute infarction produces acceptable results in less than four hours.

Adult↗
PubMed1976

Clinical and hemodynamic criteria for use of the intra-aortic balloon pump in patients requiring cardiac surgery.

In order to establish criteria for elective use of the intra-aortic balloon pump (IABP) in patients having cardiac surgery, we conducted a retrospective study of 43 patients who required counterpulsation, because of inability to be weaned from cardiopulmonary bypass, between May, 1972, and June, 1974. Patients in cardiogenic shock preoperatively were excluded. The 43 patients included 23 (Group A) who had severe preoperative left ventricular dysfunction with a mean cardiac index less than 1.8 L. per minute per square meter, ejection fraction less than 30 per cent, and end-diastolic pressure greater than 22 mm. Hg; 20 patients (Group B) had a combination of moderate cardiac dysfunction (cardiac index less than 2.2, ejection fraction less than 40, end-diastolic pressure less than 18) in the presence of acute infarction or severe aortic stenosis (gradient greater than 80 mm. Hg) with or without coronary disease. An inverse relationship was noted between survival and delay from completion of operation to the use of 1ABP. Thirty-two of 43 patients were weaned off bypass and were balloon assisted for 12 to 96 hours postoperatively; 25 patients were discharged (58 per cent). In Subgroup A, 14 of 23 (60 per cent) and, in Subgroup B, 9 of 20 (45 per cent) were long-term survivors. Based on these findings, 45 patients were operated upon between June, 1974, and December, 1975, with elective use of 1ABP and were assessed by serial hemodynamic studies. Sixteen had severe preoperative left ventricular dysfunction similar to Subgroup A and 29 had moderate dysfunction in combination with pathology similar to Subgroup B. Fifteen of these patients were hemodynamically unstable at time of arrival in the operating room; 1ABP was inserted under local anesthesia. Thirty-nine patients (87 per cent) were weaned off bypass and were hospital survivors. In Subgroup A, 13 of 16 (81 per cent) and, in Group B, 21 of 29 (72 per cent) were long-term survivors. Criteria for elective use of 1ABP in cardiac surgery should include severe preoperative left ventricular dysfunction or a combination of moderate dysfunction with coronary or valvular pathology. Elective 1ABP improves the survival with trivial iatrogenic morbidity.

Assisted Circulation↗
PubMed1975

Myocardial revascularization after acute infarction.

The purpose of this study was (1) to establish the maximal interval between the onset of ischemia and reperfusion that would permit a decrease in the size of infarction, and (2) to evaluate the relation between changes in infarct size and preservation of cardiac function. Studies were carried out in 19 dogs of which 13 had temporary (1 to 3 hours) occlusion of the left anterior descending coronary artery. The hospital course of 15 patients of whom 13 underwent myocardial revascularization within 8 hours of acute infarction was also reviewed. In dogs, the eventual pathologic infarct size was significantly reduced if reperfusion was performed within 2 hours of ischemia. After 2 hours of ischemia, the revascularized segment remained dyskinetic on angiographic assessment and cardiac function was depressed. After 3 hours of ischemia, in spite of a patent coronary artery, the extent of infarct and dykinesia was greater than during ligation of the left anterior descending coronary artery. In patients, small infarcts developed with revascularization performed more than 4 hours after infarction but with revascularization of the left anterior descending coronary artery the size of the dyskinetic area (as assessed with angiography) was similar to that in patients with a closed graft to the left anterior descending coronary artery but with a patent graft to its diagonal branch. In all patients after revascularization the extent of the left ventricular dyskinetic area was smaller and cardiac function was significantly better than in patient who did not receive revascularization for complete occlusion of the left anterior descending coronary artery. In spite of successful revascularization, electrocardiographic evidence of transmural infarction persisted postoperatively. It is concluded that reperfusion of an area of myocardium that has been ischemic for less than 2 hours in dogs or less than 4 hours in man may lead to a significant reduction in the extent of infarction as well as improvement in cardiac function. However, the revascularized area remains angiographically dyskinetic and electrocardiographically abnormal.

Adult↗
PubMed1975

Results of direct coronary artery surgery in women.

In the past 4 years, among 260 patients receiving coronary bypass grafts for coronary artery disease and stable angina pectoris, there were 34 women (13 per cent). The operative mortality rate for women was 8 per cent (3 of 34), and one late death due to myocardial infarction occurred in spite of a patent coronary bypass graft. The intraoperative infarction rate was 20 per cent (6 per cent in men). Although preoperative cardiac pump and muscle function parameters were better in women than in men (p less than 0.05), postoperatively only 30 per cent of women showed improvement in function as compared with 50 per cent of men. At 6 to 46 months' follow-up, 84 per cent of women were free of angina in contrast with 94 per cent of men. The early (4 month) graft patency rate was 50 per cent (14 of 27 grafts), as opposed to 80 per cent (20 of 25 grafts) in men. These results indicate that, although coronary artery disease shows anatomic similarity in women and men, the result of coronary revascularization in women is inferior to that in the male population.

Adult↗
PubMed1975

Role of coronary artery surgery in patients surviving unexpected cardiac arrest.

During the past 3-1/2 years, 101 of 199 patients who were successfully resuscitated by fire rescue squads in the community after unexpected cardiac arrest (documented ventricular fibrillation--VF) were admitted to the hospital. Forty-two of these patients ultimately were discharged from the hospital. However, the intermediate and long-term results were disappointing, for their mean survival after discharge was only 12.7 months. Sudden deaths (recurrent unexpected VF) occurred during the first 12 months after discharge in 28 percent of the patients surviving the initial hospitalization. Among the survivors of sudden and unexpected VF (i.e., survivors of the initial hospitalization), 16 patients who had had pre-existing symptoms of coronary heart disease had hemodynamic and coronary angiographic studies. Of these, 11 were considered surgical candidates. This report concerns the follow-up results in these patients with particular emphasis on the eight patients who accepted surgery and had myocardial revascularization. Five patients had moderate hemodynamic abnormalities, but none had had an acute myocardial infarction at the time of the initial arrest. The group of eight patients had a total of 18 vein graft bypasses performed. The significant findings is that all eight survived operation, and there was one late death at 10 months. The remaining patients are alive at 14 to 34 months, and six are free of symptoms. Despite patent vein grafts, one patient has had a second serious arrhythmia. It is concluded that surgical intervention can be done safely and may decrease the high posthospitalization, recurrent arrest, and mortality rates in selected survivors of unexpected cardiac arrest. It is concluded further that all patients sustaining an unexpected arrest should have postarrest coronary catheterization and angiography, and all patients should be on antiarrhythmic agents whether or not they receive myocardial revascularization.

Adult↗