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Biomedical subjects

J G Vincent

Publications and source records attributed to J G Vincent.

At least 37 records · Page 2Linked to original sources
PubMed1990

Comparative anatomic studies of various arterial conduits for myocardial revascularization.

Comparison was made between the morphologic condition of the left anterior descending artery and four arterial conduits: the internal mammary, right gastroepiploic, inferior epigastric, and radial arteries, harvested from 17 patients (aged 15 to 85 years, mean 64 years) who had died of nonvascular diseases. Proximal, mid, and distal segments were examined microscopically. The internal mammary artery was elastic, but the others were muscular. In all four conduits, atherosclerosis was absent to mild, the internal elastic lamina showed only minimal defects, and the vasa vasorum were confined to the adventitia. In all cases the left anterior descending artery showed mild to severe atherosclerosis and substantial defects in the internal elastic lamina with penetration of the vasa vasorum into the media and intima. Comparison of the mean distance (+/- standard deviation) from the lumen to the outermost portion of the media for the left anterior descending artery (320 +/- 63 microns) with the four conduits gave comparable values for the internal mammary artery (350 +/- 92 microns); p = not significant) and the right gastroepiploic artery (291 +/- 109 microns; p = not significant), versus 529 +/- 52 microns; p less than 0.002) for the radial artery and 249 microns (+/- 87 microns) (p less than 0.04) for the inferior epigastric artery (Kruskal-Wallis and Mann-Whitney U tests). The relatively scanty presence of smooth muscle cells in the thin-walled media of the internal mammary artery combined with a well-formed internal elastic lamina, even at advanced age, may be an important cause for its low susceptibility to atherosclerosis and a major determinant in its superior long-term patency as a coronary artery bypass graft. This finding emphasizes the justification of continued use of the ideally matching internal mammary artery, either as in situ or free graft, in coronary artery bypass grafting. In contrast to the thick-walled radial artery, which may be relatively prone to ischemia, an acceptable long-term patency of the inferior epigastric artery and right gastroepiploic artery, if harvested as pedicled grafts, is anticipated.

Adolescent↗
PubMed1989

[Congenital vascular rings in children].

Two children with symptoms of dysphagia, dyspnoea and chronic pulmonary infections secondary to anomalies of the aortic arch are presented. Diagnostic procedures included oesophagography and aortic arch angiography. These showed a double aortic arch in the first child and an aberrant right subclavian artery in the second one, leading to compression of both trachea and oesophagus. Both children underwent surgery: in the first child the atretic anterior arch and the left ligamentum arteriosum were divided; in the second child the aberrant right subclavian artery was divided at its origin from the descending aorta and connected to the ascending aorta. Follow-up examinations showed a complete recovery of both patients.

Angiography↗
PubMed1989

From flintstone to diamond blade: a new multifunctional instrument for use in coronary surgery.

We report on the development and clinical application of a diamond surgical knife specially designed for the preparation, initial incision, and bidirectional enlargement of coronary arteries. The ergonomic design of the knife enables the performance of all the necessary steps in a coronary incision with a single instrument and obviates the need for different shaped knives and scissors during preparation. The lasting sharpness of the diamond blade results in a far cleaner, less traumatic, cutting edge as can be demonstrated by scanning electron micrographs of incised coronary walls after the use of various types of coronary knives and scissors.

Arteries↗
PubMed1989

A compact single post internal mammary artery dissection retractor.

Considering the ergonomics of an efficient exposure of the retrosternal area, the design of the internal mammary artery dissection retractor resulted in an alternative compact and easy adjustable construction. A single post fixation enables a quick setup and takedown over the sterile drapes in one piece. So, the usual numerous nuts and knobs and different assembly parts are superfluous.

Humans↗
PubMed1989

Appraisal of resection and end-to-end anastomosis for repair of coarctation of the aorta in infancy: preference for resection.

Between 1973 and 1987, 70 consecutive infants under-went repair of coarctation of the aorta. Age at operation was 80.0 +/- 77 days (mean +/- standard deviation); mean weight was 3.0 +/- 0.5 kg. Isolated coarctation was present in 25 patients (group 1); in 19 patients coarctation existed in association with ventricular septal defect (group 2); and in 26 patients coarctation was associated with major intracardiac defects (group 3). Subclavian flap angioplasty was performed in 19 patients and resection and end-to-end anastomosis in 51 patients. Hospital mortality was not significantly different between subclavian flap angioplasty (11%) and resection and end-to-end anastomosis (24%). Freedom from reintervention for recoarctation after 5 years was 87% in the subclavian flap angioplasty group and 95% in the group having resection and end-to-end anastomosis. Actuarial survival at 5 years was 100% for group 1, 73% for group 2, and 28% for group 3. In the subclavian flap angioplasty group, we observed detrimental effects of the sacrifice of the left subclavian artery: 1 patient had a 2.5-cm shortening of the left upper arm, and 5 others complained of claudication in the left upper limb during strenuous exercise. As no major advantage in terms of mortality and recoarctation to either technique of coarctation repair was found, and as subclavian flap angioplasty carries the possible disadvantage of late contracture of isthmic ductal tissue and possible detrimental effects on the left upper limb, resection and end-to-end anastomosis is recommended.

Anastomosis, Surgical↗
PubMed1989

Translocation of aberrant right subclavian artery in dysphagia lusoria in children through a right thoracotomy.

Anatomical reestablishment of orthograde flow into the right subclavian artery in children with arteria lusoria is emphasized. We present two infants and one young child who were successfully treated by translocation of the aberrant right subclavian artery to the ascending aorta without graft interposition through a right thoracotomy. Several surgical approaches are reviewed.

Aorta↗
PubMed1989

Jamming of prosthetic heart valves by suture trapping: experimental findings.

The vulnerability of the Medtronic-Hall, Björk-Shiley Monostrut, Duromedics, and St. Jude Medical valves to occluder immobilization by sutures was determined under static and pulsatile flow conditions. Variables were cardiac output, cross-sectional diameter of suture, type of suture (braided versus monofilament) and position of the offending suture along the circumference of the valve ring. Under static conditions, pressures, ranging from 40 to 340 mmHg and 10 to 170 mmHg, were required to decompress obstructed Medtronic-Hall and Björk-Shiley Monostrut valves, respectively. As a result of different design characteristics and different occluder/orifice clearances the Medtronic-Hall valve showed its maximum opening pressure in case of interference with sutures at the axis of symmetry in both minor and major orifices, whereas for the Björk-Shiley Monostrut valve this was reached in the minor orifice. Under pulsatile flow conditions, in case of interference with Prolene 2-0 suture, the Duromedics valve showed irregularly delayed opening and an opening pressure difference of 50 mmHg at a cardiac output of 8 L/min, whereas leaflet motion and pressure difference in the St. Jude Medical valve were undisturbed under similar conditions. The necessary pressure difference for opening the Medtronic Hall valve reached 44mmHg at a cardiac output of 8 L/min. High and low risk of extrinsic leaflet obstruction in the Duromedics and St. Jude Medical valves, respectively, is related to the design of the hinge mechanisms and the wedge angle of their leaflets (2 degrees versus 25 degrees). Precautionary principles in implantation of prosthetic heart valves are stressed to prevent the potentially lethal complication of occluder immobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Equipment Failure↗
PubMed1989

Myocardial bridges in animals.

Myocardial bridges in a number of different species is described and classified. In formulation of the classification special attention was given to the location, width, thickness of the muscular layer of the bridge and the number of commitant veins of the overbridged artery. Four types of myocardial bridges were recognized.

Animals↗
PubMed1988

[Reimplantation of an aberrant right subclavian artery into the ascending aorta in dysphagia lusoria in childhood].

Anatomical reestablishment or orthograde flow into the right subclavian artery in children with arteria lusoria is emphasized. Two infants with arteria lusoria were successfully treated by reimplantation of the aberrant right subclavian artery in the ascending aorta without graft interposition through a right thoracotomy. Several surgical approaches are reviewed.

Aorta, Thoracic↗
PubMed1987

Resorbable suture support for ventricular aneurysmectomy.

The edge of tissue left after ventricular aneurysmectomy requires very careful placement and tying of the sutures. The use of Teflon felt as a support appears to redistribute the pressure and thus prevent the sutures from cutting through the vulnerable tissue. In many cases, Teflon felt reinforcement is preferred to direct unsupported closure because of perioperative of immediately postoperative bleeding complications. However, the unavoidable full immobilization of the sutured area, the possible risk of foreign body infection, and the extensive adhesions and calcification in the long term compelled us to search for a better alternative, combining the convenience of both methods and limiting the risks. PDS (polydioxine) resorbable pledgets and strips, provided by Ethicon GmbH, were used as a suture support during the past 2 years for closure of 29 ventricular aneurysmectomies and four ischemic ventricular septal defects, all except one in combination with coronary bypass grafting. The PDS material was easy and efficient to apply and caused no complications during and after the operation. In one case, we had the opportunity to review the supported scar during a second operation for new coronary grafts after 18 months. The formerly feared "linear scar petrification," usual after use of Teflon felt, was absent. The scar was free from difficult adhesions. Our initial experience suggests the further extensive use of this resorbable material as a support for various sutures at risk.

Heart Aneurysm↗