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Biomedical subjects

J Dubernet

Publications and source records attributed to J Dubernet.

At least 37 records · Page 2Linked to original sources
PubMed1981

Preoperative estimation of risk in cardiac surgery.

In order to determine the usefulness of the preoperative subjective estimation of risk and compare it with preoperative estimation of risk based upon objective data, two groups of patients subjected to open heart surgery at the Catholic University of Chile Hospital were studied prospectively. Group I comprised 227 consecutive patients operated on in 1975 and group II comprised 181 consecutive patients operated on in 1979. There were several important differences in management and techniques between the two groups, which resulted in different factors perioperative mortality. Mortality in group I was related to extreme age subsets (p less than 0.01) and to duration an anoxic arrest (p less than 0.001); mortality in group II correlated only to preoperative functional class (NYHA) (p less than 0.02). Despite these differences, subjective risk estimation as preoperatively recorded by the anesthesiologist was accurate in both groups (r = 0.969, p less than 0.05 in group I and r = 0.998, p less than 0.01 in group II). It was concluded that in the absence of a universally valid objective risk index, subjective risk estimation provides a clinical index as useful as reliance upon presently available objective data.

Adolescent↗
PubMed1979

Bloodless cardiac surgery utilizing a new low-prime oxygenator.

One hundred consecutive patients undergoing open-heart surgery were subjected to a prospective protocol designed for reduction of homologous blood utilization. The main points of this protocol were careful surgical hemostasis, normovolemic hemodilution, and retransfusion of blood lost to the operating field. It included use of the new Bentley BOS-10 Spiraflo oxygenator (Bentley Laboratories, Inc., Irvine, California, U.S.A.). The patients' ages ranged from 6 to 68 years and their weights from 18 to 84 kg. Fifty-four patients were subjected to valvular surgery, 30 to coronary revascularization, 13 to congenital defects repair, and 3 to resection of atrial myxomas. All patients could be weaned from bypass without receiving any blood. Eighty patients completed their surgery, and 60 were discharged from the intensive care unit without receiving any homologous blood or its derivatives. Total blood usage for the series throughout the entire stay in hospital was 1.32 units/patient, which included six reoperations for excessive bleeding. This reduction in blood utilization was achieved without excessive hemodilution and did not produce significant complications.

Adolescent↗
PubMed1979

Elective correction of intracardiac lesions resulting from penetrating wounds of the heart.

Controversy exists regarding the timing and technique of total correction of traumatic intracardiac lesions. Five patients with penetrating wounds of the heart received emergency treatment aimed at securing normal haemodynamics. No attempt was made to identify intracardiac lesions at this stage. Cineangiography two months to seven years later showed aorto-right ventricular fistulae in all patients, associated in two with aortic cusp laceration and in one with an aorto-left atrial fistula. The surgical approach for aorto-right ventricular fistula was through the right ventricle or aorta. Valvar injuries were treated by plastic reconstruction. All patients showed good clinical results when seen four to 11 years later. Traumatic intracardiac lesions in patients with stable haemodynamics after initial treatment should be operated on electively. The aortic approach is preferable for aorto-right ventricular fistulae. Conservative plastic repair of valvar injuries achieves long-term competence thus avoiding prosthetic replacement.

Adolescent↗
PubMed1977

Spontaneous rupture of a fenestrated aortic valve. Surgical treatment.

Fenestration of the aortic valve is a common anatomic finding. Although spontaneous rupture of the semilunar cusps is infrequent, it leads to rapidly progressive heart failure and death. We present, to our knowledge, the first case of successful treatment by valve reconstruction. A 2 year follow-up demonstrates excellent clinical results.

Adult↗
PubMed1977

[Coronary occlusions associated with chronic arsenic poisoning. Apropos of 2 operated cases].

Examination was made of the clinical history, the results of laboratory tests, of coronary arteriography, and of a histological study of the coronary arterial walls in two young men who had a myocardial infarction. The two men lived in a district where the drinking water had a very high level of arsenic (0.8 parts per million). Neither of the patients presented the risk factors which are usually associated with coronary arteriosclerosis. Neither of the patients presented the risk factors which are usually associated with coronary arteriosclerosis. A histological study of the pathological left ventricular wall, which was removed at operation, showed very characteristic features of fibrous thickening of the intima, with preservation of the internal elastic lamina, of the medial and of the adventitia. Such an arterial abnormality may effect the larger coronary arteries just as well as the medium and small ones. Clinical presentation of this condition is often in young subjects.

Adult↗
PubMed1975

Cardiovascular management of pregnant women with a heart valve prosthesis.

This study of 14 pregnancies in 11 patients with a Starr-Edwards valve prosthesis (nine mitral, two aortic) shows that cardiac functional capacity deteriorated to class III (New York Heart Association criteria) in only 1 woman. The deterioration occurred during the third trimester and the patient's condition improved with medical therapy. Careful medical control diminished the incidence of heart failure in these patients. Six of nine pregnant women with a mitral valve prosthesis were treated continuously with coumarin and three discontinued the therapy gradually before the third trimester of pregnancy. In five pregnant women (three with an aortic valve prosthesis, two with a mitral valve prosthesis) no anticoagulant agents were used. No embolic episodes or severe hemorrhagic complications were seen. One newborn whose mother received coumarin during the first trimester had bilateral hand polydactylia. There were no maternal deaths. One neonate died after fetal stress necessitating the only cesarean section. These results suggest that women with an artificial heart valve tolerate pregnancy well and that anticoagulant therapy is not mandatory in pregnant women with an aortic valve prosthesis, or in the few women with a mitral valve prosthesis not already receiving coumarin at the onset of pregnancy.

Adult↗