Biomedical subjects

H Vanermen

Publications and source records attributed to H Vanermen.

41 records · Page 3Linked to original sources

PubMedDate not supplied

Heart transplantation.

From September 1988 until March 1990, 22 orthotopic heart transplantations (HTX) were performed in 20 patients (18 male and 2 female). Median age was 56.5 years (23-66). The indication for HTX was an end-stage ischemic disease in 7 pts. a dilated cardiomyopathy in 13 pts, and a retransplantation in 2 pts. The mean waiting time was 58 days. Immunosuppressive therapy included OKT3, prednisone and azathioprine. Cyclosporine was introduced at day 10. Donor hearts were obtained from our institution in 5 cases, from other hospitals in Belgium in 9 cases, and from other European countries in 8 cases. The mean ischemic time was 129 +/- 28 min. No patient died in the operating room. During the first postoperative month, weekly endomyocardial biopsies were performed to detect early rejection. Five patients died in the early postoperative period, mainly from rejection. After a mean hospital stay of 23 days, 15 patients (75%) were discharged. During the late follow-up, 3 patients died: 1 from chronic mediasdinitis, 1 from hypoglycemia, and 1 from cardiac arrest following non-compliance with the medical treatment. In conclusion, early acute rejection after HTX still remains a major cause of death.

Adult↗

PubMedDate not supplied

Surgical treatment of left ventricular aneurysm and ischemic mitral incompetence.

Chronic left ventricular aneurysm and ischemic mitral valve incompetence have been treated during the last 2 years with more physiologic techniques. Left ventricular reconstruction with the endoaneurysmorrhaphy technique was carried out in 20 patients. Sixteen patients had additional procedures. Early mortality was 5% and functional results are encouraging with 18 patients in NYHA class I of II. Mitral valve repair was carried out in combination with myocardial revascularization in 15 patients. All patients had a Carpentier Edwards annuloplasty ring implanted. Nine patients needed additional reconstructive procedures. There were no early or late deaths neither reoperations. Late functional results are good with all patients in NYHA, class I or II. Three patients present a mild mitral regurgitation on echo. This physiologic approach to restore volume, size and shape of the left ventricle and the mitral valve can be combined with CABG without additional operative risk and excellent results up to 2 years.

Adult↗

PubMedDate not supplied

The right gastroepiploic artery: an alternative conduit for myocardial revascularization.

The initial experience in 18 patients undergoing coronary artery bypass surgery with the right gastroepiploic artery (RGEA) between April 1988 and August 1989 is reported. The indication for RGEA-use included the aim to obtain complete arterial revascularization in 15 patients and absence of suitable veins in 3 patients. Twelve patients had at least one previous CABG-operation. The average number of distal arterial anastomoses per patient was 2.5. The RGEA was connected to the right coronary artery (RCA) or its terminal branches in 13 patients, to the circumflex (CX) in 2 and sequentially to RCA and CX in 3 patients. In combination to the RGEA, 8 patients received bilateral internal mammary grafts and 6 patients received a single IMA-graft. There was one hospital death and there were no major early or late complications related to the RGEA-use. Postoperative angiographic controls in 16 patients revealed only one early RGEA-graft occlusion due to inadequate diameter and low run-off. There was one demonstrated late occlusion. These early results suggest that the RGEA can be used as an in situ graft to the posterior coronary vessels. Indications can be extended in function of the longterm patency and functional results.

Adult↗

PubMedDate not supplied

Hemopump fails as bridge to transplantation in postinfarction ventricular septal defect.

From 1990, six patients were bridged to transplantation with a catheter-mounted axial flow pump (Hemopump). Indications were graft failure (two patients), postinfarction ventricular septal defect (two patients), myocarditis (1 patient), and myocardial infarction (1 patient). The 21F cannula, inserted via the groin, was used as a partial assist in four patients, and the 31F cannula, inserted via the ascending aorta, was used to assist the other two patients completely. Hemodynamic recovery was achieved in all patients (mean cardiac index rose from 2.1 L/gm/m2 to 3.85 L/gm/m2 after 1 hour assist). Sudden pump failure occurred in the two patients with postinfarction ventricular septal defect and a piece of necrotic tissue blocking the catheter was found. Both patients died. The other four patients were successfully bridged to transplantation. One of these patients died during his postoperative hospital stay; the three remaining patients were discharged and were well at follow-up (46, 40, and 3 months). The Hemopump device provides sufficient organ perfusion to be used as a bridge to transplantation. No conclusions can be drawn for the long-term use (longest run in this series was 102 hours). Postinfarction ventricular septal defect is a contraindication for the use of the Hemopump device.

Adolescent↗

PubMedDate not supplied

Abdominal aortic aneurysm, an absolute surgical indication?

In a retrospective study, 155 patients operated for infrarenal abdominal aortic aneurysm during a 5.5-year period (jan. 1986-->oct. 1991) were reviewed. In our series, 111 patients underwent elective (EL) surgery, 44 patients had an emergency (EM) operation. Male/female ratio was 10/1. Mean age in the EL group and EM was 68.1 years and 71.82 years respectively (p < 0.05). In the EL group, 68 (= 61%) patients were asymptomatic. All patients in the EM group had symptoms: shock + syncope in 28 patients, acute back pain in 4 patients, acute abdominal pain in 12 patients. Aneurysm diameter > or = 8 cm was present in 33% of the EL group, but in 57% of the EM group. Early mortality for the EL and EM group was 3.6% and 23% respectively (p < 0.001). Major postoperative complications were present in 13% in the EL group, in 55% in the EM group (p < 0.001). During a 5-year follow-up of 135 patients (= 96%), 22 patients died. Cardiac problems (7/22) and cancer (5/22) were most prominent. 5-year survival for the entire group was 83%; EL (85%) and EM (76%) were not significant. None of the patients subsequently underwent an operation related to the abdominal aortic intervention.

Acute Disease↗