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Biomedical subjects

I Dyrda

Publications and source records attributed to I Dyrda.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Developmental atherosclerosis of the coronary arteries treated by successive transluminal angioplasties].

The authors present the case of a 62 year old patient with advanced coronary artery disease who underwent three successive percutaneous transluminal coronary angioplasties for five stenoses over a period of 30 months. Three of these stenoses appeared after the first operation. This case illustrates the advantage of this new technique of revascularisation which has an encouraging future in the field of "operative cardiology". The coronary angioplasty can be repeated several times in the same patient, not only in the case of recurrent stenoses, but also when new stenoses appear, provided the technical expertise of the operator can guarantee a minimal risk for the patient.

Angioplasty, Balloon↗
PubMed1985

Prognostic significance of progression of coronary artery disease.

Angiographically documented coronary artery disease (CAD) can progress. Although progression itself is frequently recognized in patients who have undergone repeat cardiac catheterization, its prognostic significance remains unclear. To evaluate the influence of progression on survival, 313 patients with CAD who underwent catheterization twice (39 +/- 25 months apart) were followed for 3 to 129 months (mean 41 +/- 30) after the second angiogram. At the time of the second angiogram, 21, 91, 113 and 88 patients had 0-, 1-, 2- and 3-vessel CAD, respectively. The mean ejection fraction (EF) of the group was 55 +/- 13%. Progression was noted in 139 patients (44%). Of the 313 patients, 33 died and 39 had acute myocardial infarction (AMI) during follow-up. Four-year survival was estimated at 94% and 83% in the nonprogression and progression groups, respectively. Progression was predictive of survival by (univariate) long-rank test (p less than 0.01), but only EF (p less than 0.001), number of diseased vessels (p less than 0.01) and percent stenosis in the left main coronary artery (p less than 0.05) were independently significant by (multivariate) Cox regression analysis. Four-year survival without AMI was 89% and 73% in the nonprogression and progression groups, respectively. Progression was related to survival without AMI (p less than 0.001) by log-rank test. Cox regression analysis provided 3 independent predictors of survival without AMI: number of diseased vessels (p less than 0.01), progression (p less than 0.01), relative risk = 2.28) and EF (p less than 0.01). Results were similar when analyzing only the 39 AMIs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Actinobacillus actinomycetemcomitans infectious endocarditis. Apropos of 2 cases and review of the literature].

This work reports two cases of endocarditis caused by Actinobacillus actinomycetemcomitans. As noted in the medical literature, the mean clinical features are a subacute infection without know source of bacteremia, in a male patient aged 40 years or older and who is suffering from a heart disease. In our two presentations, the good response to single antibiotic treatment, although the optimal therapeutic approach is not yet defined, and the lack of embolism phenomena are of special interest. Spectrum of bacteria which can be responsible of infective endocarditis is widening rapidly; this study is an example of this trend.

Actinobacillus Infections↗
PubMed1984

Usefulness of digital subtraction left ventriculography in patients with ischemic heart disease: comparison with cineangiography.

Digital subtraction and computer enhancement of left ventriculography allow the injection of small amounts of contrast medium into the left ventricle. Image quality measurements of cardiac volumes, and ejection fraction and evaluation of regional wall motion were compared following digital subtraction and cine ventriculography in 30 patients undergoing coronary arteriography for suspected or proven ischemic heart disease. At concentrations of 13% to 19% (iodine contents: 2.0 to 5.0 g) meglumine sodium diatrizoate used for digital subtraction ventriculography, no alterations of ventricular pressures were noted; premature ventricular contraction and cineventriculography in 30 patients undergoing coronary arteriography for suspected wall motion by two independent observers showed complete agreement between digital and cineventriculography in 141 of 150 segments (94%), including 114 normal segments; digital ventriculography led to underestimation of four segments and to overestimation of five. Left ventricular ejection fraction and volumes calculated using both techniques correlated relatively well (ejection fraction: r = 0.86; end systolic volume: r = 0.88; end diastolic volume: r = 0.665). Thus, intraventricular injection of low concentrations of contrast medium provides good digital angiographic images and may eventually replace cine ventriculography for invasive assessment of left ventricular performance. However, ECG gating and shorter exposure times will be required for accurate measurement of ventricular volumes and ejection fractions.

Adult↗
PubMed1984

Early valve replacement in active infective endocarditis.

Infective endocarditis is associated with a high mortality, but previous studies have suggested that the major complications of the condition might be prevented by early surgery. Of 50 patients treated for infective endocarditis at the Montreal Heart Institute from 1977 to 1982, 30 were treated nonsurgically and the remaining 20 underwent early valve replacement before preoperative antibiotic therapy was completed. Of these 20, 14 had native valve endocarditis and 6 prosthetic valve endocarditis. The organisms involved were Streptococcus sp in 11, Staphylococcus aureus in 2, gram-negative organisms in 3 and Candida parapsilosis in 1. Blood cultures remained negative in three patients. There were three early deaths (15%) following operation and one late death (5%). Infection on implanted prostheses did not recur, but reoperation was required in one patient because of prosthetic dehiscence 7 months after initial implantation. All resected valves displayed evidence of infection. Follow-up was obtained in all survivors. After an average follow-up of 26 months, 12 patients remained in functional class I and 4 in class II (New York Heart Association classification). Early valve replacement has resulted in improved survival of patients with infective endocarditis and is now associated with a low operative mortality and morbidity.

Adolescent↗
PubMed1983

A simple classification of the risk in cardiac surgery.

A new risk classification for patients undergoing cardiac surgery has been used for the last two years by the anaesthesiologists of the Montreal Heart Institute. The following factors known to be associated with a greater operative morbidity and mortality were selected: (1) poor left ventricular function, (2) congestive heart failure, (3) unstable angina or recent (less than 6 weeks) myocardial infarction, (4) age over 65 years, (5) severe obesity (Body Mass Index greater than 30), (6) reoperation, (7) emergency surgery, (8) other significant or uncontrolled systemic disturbances. Patients with none of the above factors were classified as normal risks; those presenting with one of those selected factors were classified as increased risks, and those with more than one factor were said to carry a high risk. In a prospective study of 500 consecutive open-heart surgery patients classified according to this method, we found that the operated population at normal risk (50 per cent of cases) had a mortality of 0.4 per cent, the patient group with increased risk (32 per cent of cases) had a mortality of 3.1 per cent, and the high risk group (18 per cent of cases) had a 12.2 per cent mortality. Furthermore, 50 deaths following open-heart surgery were assessed retrospectively using the classification; 58 per cent of these patients were classified as high risk, 34 per cent had an increased risk, and only eight per cent were found to be in the normal risk group. Thus, this new risk classification has proven to be a reliable and useful tool for preoperative assessment of patients undergoing open-heart surgery and for teaching purposes.

Age Factors↗
PubMed1983

[Endocarditis caused by Candida parapsilosis (para-krusei)].

This paper describes a case of Candida Parapsilosis endocarditis in a patient with a mitral valve prosthesis implanted two years previously. This history started with a cerebrovascular accident associated with pyrexia. A complex medico-surgical therapeutic approach controlled the infection. This consisted of systemic and local (immersion of the prosthesis) antifungal therapy, bathing the left heart chambers in 5 p. 100 iodine solution and two valve replacements at 8 months intervals. The second surgery was not related to recurrence of the candida infection but to a perivalvular leak attributed to the insertion of the prosthesis into tissues inflamed by recent infection. Despite the improvement in the prognosis of fungal infection due to an early surgical approach, it is still essential to try and prevent the disease, the mortality rate still being over 80 p. 100. It is essential to be very careful when using intravenous catheters and aerosols; the indications of antibiotherapy must also be respected.

Candidiasis↗
PubMed1982

Clinical and hemodynamic results with the Carpentier-Edwards porcine bioprosthesis.

Carpentier-Edwards bioprostheses were implanted in 605 patients, 509 of whom had a single valve replacement, and 96 of whom had a multiple valve replacement. There were 54 early deaths (8.9%) and 26 late deaths (4.3%). The five-year actuarial survival was 87% for aortic valve replacement, 83% for mitral valve replacement, and 81% for multiple valve replacement. Of the 525 survivors, all but 3 were followed for a total of 964 patient-years; 354 patients (68%) remained asymptomatic, and 95 patients (18%) were improved. The incidence of thromboembolism, endocarditis, and reoperation due to primary tissue failure of the bioprosthesis were 2.0, 1.3, and 0.1% per patient-year, respectively. The actuarial probability of being free of all valve-related complications was 93% after five years. Satisfactory hemodynamic performance of the bioprosthesis was demonstrated by postoperative studies done in 70 patients. Thus, the Carpentier-Edwards porcine valve provides good clinical improvement, with a low incidence of valve-related complications and tissue failure at five years postoperatively.

Adolescent↗
PubMed1981

Infective endocarditis update experience from a heart hospital.

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.

Adult↗
PubMed1980

[The pre-operative visit in cardiovascular surgery].

This text is intended for new residents in the development of anaesthesia of the Montreal Heart Institute. It presents a classification of the risk of cardiovascular surgery used in that institution and discusses current problems encountered with this type of patient (pulmonary and coagulation problems, diabetes renal failure). The attitudes of anaesthetists of this institution towards patients' medication and premedication are also discussed. The risk is classified as usual, increased or high, depending on the presence (or absence) of several factors known to increase the risk: ventricular dysfunction, heart failure, unstable angina or recent infarction, significant involvement of other systems (unstable diabetes, renal insufficiency, significant pulmonary dysfunction), age, emergency surgery and non-cardiac surgery in the presence of important cardiac pathology. With surgical procedures carrying a high mortality, for example dissecting thoracic aneurysm, the usual risk is high and is classified as such. A table of the usual risk of current surgical procedures is proposed.

Adult↗
PubMed1976

[Hemodynamic significance of myocardial bridging and milking effect of the anterior interventricular artery: a mild variant or source of angina?].

A hemodynamic study was conducted in 11 patients with myocardial bridging and milking effect (ME) of the left anterior descending artery (LADA), but with otherwise normal coronary arteries. During pacing, patients with grade III ME (over 75% narrowing of arterial size during systole) showed anterior wall ischemia, lactate production and severe angina. Thus, grade III ME observed on coronary arteriography may result in significant obstruction of the LADA with typical angina. Surgical treatment is worth considering in symptomatic patients with this rare anomaly.

Angina Pectoris↗