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Biomedical subjects

H Lindberg

Publications and source records attributed to H Lindberg.

At least 55 records · Page 3Linked to original sources
PubMed1992

Patency of the internal mammary artery used as sequential graft.

In 28 patients with the left internal mammary artery (IMA) used as a sequential coronary artery graft, clinical and angiographic evaluation was made 19-47 months postoperatively. Patency was 96% in the proximal anastomoses and 93% in all the anastomoses. Angiography, however, showed optimal function in only 75% of the distal graft ends. These observations indicate that routine use of left IMA as a sequential graft should be restricted to experienced surgeons. Clinical and angiographic findings did not always correlate, emphasizing that evaluation of IMA-graft patency should include angiography.

Adult↗
PubMed1992

Hemodynamic effects of intraaortic versus intravenous protamine administration after cardiopulmonary bypass in man.

A hemodynamic study of men undergoing elective coronary artery bypass surgery was undertaken to elucidate the side effects of protamine given into the ascending aorta (group A, n = 16) or into the central venous line (group V, n = 16). After termination of extracorporeal circulation, protamine was infused over 120 seconds, and the hemodynamic profile was continuously recorded. During the first minute, the systemic arterial pressure fell to about 60% of the preprotamine level in both groups, but the hemodynamic changes occurred more rapidly (p < 0.05) in group V than in group A, with maximal pressure drop at 61.7 +/- 2.7 vs 74.4 +/- 4.9 seconds. Following spontaneous restoration of the systemic blood pressure, the pulmonary artery pressure rose considerably in both groups, as did the pulmonary capillary wedge and central venous pressures, reaching higher levels in the intravenous group. The cardiovascular responses were again more rapid in group V than in group A (p = 0.004). The degree of systemic hypotension thus did not benefit from use of the intraaortic rather than the intravenous route for administering protamine. The more pronounced and more rapid pulmonary circulatory changes in the intravenous group suggest that the hemodynamic effects of protamine are initiated in the lungs.

Aorta↗
PubMed1992

Single lung transplantation. Surgical experiences with the first seven patients.

Seven single lung transplants are reported. The patients were severely disabled and oxygen dependent below sixty years of age with a poor prognosis. Diagnosis were alfa 1-antitrypsin deficiency (3), sarcoidosis (3) and idiopathic emphysema (1). Multiorgan-harvesting including six hearts, was performed in local or distant hospitals (3). Partial cardiopulmonary bypass simplified transplantation. The surgical procedure was modified with a direct transpericardial approach. Soft tissue wrapping by a vascularized pedicle secured the bronchial anastomosis. The four drug immunosuppressive regimen included cyclosporin A, azathioprine, steroids and antithymocyte globulin. Primary graft function was excellent. Six patients survived the postoperative period and are alive 5-19 months post transplant. Transbronchial biopsies and lung function studies have been helpful in detecting pulmonary rejections. Patient rehabilitation is satisfactory in most patients with improvement in physiologic parameters.

Adult↗
PubMed1992

Morbidity risk factors in human cardiac transplantation. Histoincompatibility and protracted graft ischemia entail high risk of rejection and infection.

Data from the first 103 human heart transplantations performed on 100 recipients (aged 14-62 years) at a single center from November 1983 to January 1990 were analyzed in order to detect morbidity-causing risk factors. Cumulative one- and five-year graft survival was 82% and 68%. Multivariate analysis revealed three independent risk factors for early rejection, viz. HLA-DR and HLA-B mismatches and no prior cardiac surgery. Graft ischemic time exceeding 71 min was an independent risk factor for rejection, especially for moderate or severe events, and for infection. HLA-DR mismatch was an independent risk factor for moderate and severe rejection events and for infections. Finally, patients operated on because of end-stage ischemic heart disease were at significantly higher risk of rejection than those with other cardiac disorders. The study has several implications: Prospective tissue typing for cardiac transplantation and selection of donors may have an impact on graft function: Damage to the graft by prolonged ischemia may be reduced by improved organ preservation.

Adolescent↗
PubMed1991

[Thrombolysis in acute tricuspid valve thrombosis].

The usual treatment of acute heart valve thrombosis is thrombectomy or heart valve replacement. During the last 20 years there have been a few reports of thrombolytic treatment for heart valve thrombosis. We report the successful treatment of two patients with a thrombosed tricuspid heart valve. Both patients received streptokinase. The diagnosis of heart valve thrombosis was based on the clinical status of the patients, cineradiology and echocardiography. Both patients received the combination of salicylic acid and warfarin after streptokinase treatment. Follow-up has shown well functioning heart valves in both patients.

Acute Disease↗
PubMed1991

[Results of 6 1/2 years of heart transplantation at Rikshospitalet].

We discuss our experience from 6 1/2 years of orthotopic heart transplantation at Rikshospitalet (the National Hospital). 112 grafts were performed on 109 patients (19 women and 90 men), mean age 47 years (range 14-63). In the first nine patients the immunosuppressive regimen consisted of cyclosporine A and prednisolone, and in the last 100 azathioprine was added (triple medication). There was no operative mortality. 21 patients died, giving an 81% cumulative survival, with a significantly better prognosis among those who received triple immunosuppressive regimen. The main complications were rejection, infection and arrhythmia. Since our main problem was rejection it is concluded that careful supervision, concentrated on as few cardiologists as possible, and a liberal indication for myocardial biopsy, are decisive for the prognosis.

Adolescent↗
PubMed1991

[Single lung transplantation as treatment of terminal lung diseases].

The article describes the first cases of single lung transplantation in Norway. The indication for surgery was end-stage pulmonary disease (1 sarcoidosis, 2 emphysema) in three severely disabled patients requiring administration of oxygen. The operation necessitated cardiopulmonary bypass in all patients. Primary graft function was excellent. Epidural analgesia, peripheral pulse oxymetry and continuous monitoring of mixed venous oxygen saturation aided early extubation. The initial postoperative course with a four drug immunosuppressive regimen has been encouraging. Rejection is monitored by clinical examination, chest x-ray, serial pulmonary function tests and transbronchial biopsies.

Adult↗
PubMed1991

Risk factors for total and cause-specific mortality in human cardiac transplantation. Prolonged extracorporeal bypass time: a high risk factor for rejection and infection.

Data from the first 103 human heart transplantations in 100 recipients performed at a single centre from November 1983 to January 1990 were analysed to detect risk factors for overall and cause-specific mortality. Twenty-two patients died. Cumulative 1 year graft survival was 82% and 5 year, 68%. Acute and chronic rejection was the cause of death in 9 patients, disseminated infection in 8 and cancer in 3. One patient died from cerebral haemorrhage and 1 from acute cardiac failure. The mean observation time was 803 days (range: 1-2 308 days). Total follow-up was 226.6 graft years. Risk factors were analysed by univariate and multivariate methods. The type of immunosuppression regimen and recipient age above 50 years were independent risk factors for mortality. Histocompatibility mismatching (HLA-DR) and type of immunosuppression were independent risk factors for lethal rejection and a female recipient was an independent risk factor for lethal infection. Prolonged time on extracorporeal bypass was an independent risk factor for both lethal rejection and infection, and also for overall mortality. The impact of extracorporeal bypass time on rejection and infection is discussed, and the importance of prospective HLA matching in heart transplantation is stressed. The association between recipient female sex and infection remains uncertain.

Adolescent↗
PubMed1991

Chronic lower limb ischaemia. A prospective randomised controlled study comparing the 1-year results of vascular surgery and percutaneous transluminal angioplasty (PTA).

In a prospective randomised study, performed over a 6-year period, 102 patients with severe lower limb ischaemia or claudication resistant to exercise training were randomised either to percutaneous transluminal angioplasty (PTA) or vascular surgery. Only patients who could be treated by both methods were included, constituting only 5% of the total number of patients treated during this period. The two groups were similar regarding age, severity of symptoms and diabetes. The immediate and 1-year results showed similar success and complication rates. There was, however, a significantly shorter hospital stay for patients treated with PTA. Due to early complications and initial failures PTA should, however, only be used in institutions where vascular surgical facilities are available since PTA demands access to such treatment.

Adult↗
PubMed1991

Systemic and pulmonary circulatory effects of protamine following cardiopulmonary bypass in man.

The cardiovascular effects of protamine were studied in 19 men with normal left ventricular function undergoing primary myocardial revascularization. Protamine was given over 120 sec after termination of cardiopulmonary bypass. Arterial and pulmonary pressures, aortic blood flow, central venous pressure, heart rate and electrocardiogram were continuously registered. Pulmonary capillary wedge pressure was recorded at the times of maximal hemodynamic response. The systolic arterial pressure fell from 116 to 66 mmHg about 60 sec after the start of protamine infusion, but spontaneously began to rise after a few seconds, reaching 90% of pre-protamine levels at 126 sec. No inotropic drugs or volume infusion were given. At about 2 min, the mean pulmonary artery pressure rose from 16.3 to 26.2 mmHg and the central venous pressure from 7.0 to 11.4 mmHg. The heart rate and cardiac output were almost unchanged throughout. Systemic hypotension and pulmonary hypertension are suggested to represent true side effects of protamine or protamine/heparin complex. When left ventricular function is good, the hypotension reverses without treatment. Volume infusion may indeed precipitate right heart failure when the pre-load effect is added to the subsequent protamine-induced pulmonary hypertension.

Cardiopulmonary Bypass↗
PubMed1989

[Aneurysm after patch graft aortoplasty in aortic coarctation].

In the period 1973-83, 114 patients with coarctation of the aorta were operated on with patch plasty. Early results were encouraging. Two of these patients had to be reoperated, however, because of aneurysmatic dilatation of the aorta adjacent to the prosthetic patch. In one case acute rupture of the aneurysm occurred eight years after the patch plasty, and surgery was performed under dramatic conditions as a life-saving procedure. In the other patient increasing dilatation of the distal part of the aortic arch was observed at chest X-ray 4-5 years after the operation. DSA revealed a large aneurysm proximal and distal to the site of coarctation, and he was operated with excision of the aneurysm and closure of the aorta with a patch of PTFE. Careful follow-up of patients operated for coarctation of the aorta is important. In addition to clinical investigation, patients with patch plasty must be referred to chest X-ray examination every 2nd to 3rd year for a relatively long time.

Aorta↗
PubMed1989

Senning operation for transposition of the great arteries in the first month of life.

Twelve patients with uncomplicated transposition of the great arteries were operated upon in the first month of life following an initial Rashkind procedure. They were all in a clinically unacceptable condition and were mostly acidotic or bad mixers without acidosis. Two patients died postoperatively from a cerebral haemorrhage not discovered prior to operation. One patient died 5 months postoperatively from bronchiolitis. At postoperative follow-up, all patients were asymptomatic. Cardiac catheterization showed that 1 patient had a significant upper caval vein stenosis, 2 patients had small atrial shunts, and 1 patient had an unimportant pulmonary stenosis. Innocent atrial rhythm disturbances were encountered in 1 case only, whereas 9 patients had normal sinus rhythm at the last examination. The Senning operation remains a good alternative for transposition repair in the neonate.

Acidosis↗
PubMed1989

Experiences with closed chest, temporary atrio-arterial, ventricular bypass with a centrifugal pump after open heart surgery.

Twelve patients with refractory myocardial failure following open heart surgery were treated with a temporary left (10), right (1) or biventricular (1) assist circuits driven by extracorporeal pumps. Ten of 11 patients were weaned from the pump oxygenator. During left ventricular assist, maximal pump flow was 2.2 +/- 0.6 l/min per m2 at a cardiac index of 2.5 +/- 0.9 l/min per m2. Diuresis was above 1 ml/kg body weight per h in 7 of 9 patients perfused for 13-36 h. Seven patients were weaned from the assist pump after 13-33 h of ventricular bypass with 4 hospital survivors. Two patients died after circulatory assistance of multiple organ failure, 1 from cerebral damage. In the other patients, the main problems were cardiac. Three patients are currently long term survivors 12-17 months after surgery.

Cardiopulmonary Bypass↗
PubMed1989

Colloid versus crystalloid cardioplegia. A prospective, randomized clinical study.

The effects of adding colloid (dextran 40, Rheomacrodex) to cardioplegic solution were studied in 55 men undergoing bypass grafting for uncomplicated coronary artery disease. The patients were randomly allocated to group I (n = 27), in which 35 g dextran 40 was added to the St Thomas II cardioplegic solution, or group II (n = 28), which received a standard crystalloid cardioplegic solution. The groups were comparable in regard to preoperative and intraoperative data. In group I the pulmonary vascular resistance index was transiently elevated after extracorporeal circulation and both oxygen consumption and arteriovenous oxygen content difference 2 hours postoperatively were greater than in group II, suggesting better microcirculation. Postoperative normalization of the chest X-rays was more rapid in group I. The clinical course was similar in the two groups.

Cardioplegic Solutions↗