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Biomedical subjects

J L Vallejo

Publications and source records attributed to J L Vallejo.

At least 19 recordsLinked to original sources
PubMed2001

[Clinical results of double versus single mammary artery myocardiac revascularization: 15 years of follow-up].

INTRODUCTION: Use of the left internal mammary artery to bypass the left anterior descending coronary artery reduces cardiac events and increases survival. However, there is some controversy as to the benefits of using both mammary arteries. OBJECTIVES: To assess the long-term outcome of the use of both mammary arteries in comparison with the use of only one. PATIENTS AND METHOD: A retrospective cohort study with a mean follow-up of 9.0 +/- 4.2 years was performed including 108 patients consecutively revascularized using both mammary arteries (II) and 108 patients randomly chosen in whom one mammary artery (I) was used for this purpose. RESULTS: Both groups were similar. There were no differences between the groups in operative morbidity or mortality. The survival at 10 years was similar (II: 84.61 +/- 4%; I: 85.18 +/- 3.8%), whereas recurrence of angina (II: 29.63 +/- 5.3%; I: 47.55 +/- 5.6%) (p = 0.012), the requirement for percutaneous angioplasty (II: 3.98 +/- 2%; I: 12.99 +/- 4.1%) (p = 0.009) and cardiologic events (II: 33.48 +/- 5.5%; I: 48.48 +/- 5.5%)(p = 0.022) were all lower in the group in which both mammary arteries were used. In the multivariate analysis, the use of both mammary arteries was an independent protective factor against angina recurrence (RR = 0.55), angioplasty (RR = 0.18) and cardiologic event (RR = 0.60). CONCLUSIONS: The use of both mammary arteries for revascularization does not increase operative morbidity. Since this procedure acts as an independent factor against angina recurrence, angioplasty and cardiologic event

Female↗
PubMed1999

[The Doppler color detection of internal mammary artery anastomoses and a functional assessment of their patency].

BACKGROUND: Left internal mammary artery coronary graft patency is usually evaluated invasively by cardiac catheterization. The objective of this study was to assess the ability of a high-frequency transthoracic Doppler echocardiographic system in the evaluation of patency and flow velocities changes in left internal mammary artery. METHODS: Twenty-two patients (63 +/- 9 years, 17 male) who had previously undergone left internal mammary artery to left anterior descending artery were evaluated by transthoracic echocardiography, with an Acuson Sequoia C256 equipment (Acuson, Mountain view, USA), placing the transducer (5 MHz) in the second-third left intercostal space. Left internal mammary artery flow was considered to be found in the presence of one systolic/diastolic biphasic blood flow. Dipiridamol 0.5 mg/kg was administered in absence of contraindications in order to evaluate the flow reserve. RESULTS: In 16 patients (73%), a biphasic systolic-diastolic flow was visualized. Peak velocity of systolic and diastolic waves was 38 +/- 13 and 37 +/- 15 cm/s, respectively. Eleven patients received i.v. dipiridamol 0.5 mg/kg. After dipiridamol, systolic and diastolic velocities rose from 32 +/- 8 to 43 +/- 14 cm/s (p = 0.0429) and from 25 +/- 8 to 50 +/- 17 cm/s (p = 0.0002), respectively (an increasing of 33 +/- 22% and 103 +/- 46% over the baseline, respectively). CONCLUSION: This descriptive study shows that a non-invasive functional evaluation of left internal mammary artery grafts by a transthoracic approach with a high-frequency echocardiographic equipment is possible.

Aged↗
PubMed1998

Internal thoracic artery atherosclerosis after coarctation repair in an adult.

We report a rare case of a patient with an unsuitable grossly atherosclerotic and extensively calcified right internal thoracic artery found during a coronary bypass grafting operation. He had undergone an aortic coarctation repair 35 years before, with long-term systemic hypertension previous to the operation and sustained after it. It is advisable to be alert to the possibility of atherosclerotic degeneration of the internal thoracic artery in these patients.

Aortic Coarctation↗
PubMed1998

Iatrogenic mammary arteriovenous fistula caused by sternal wire.

Internal mammary arteriovenous fistulas are a rare complication of sternotomy. We present a case of a 64-year-old woman with a poststernotomy fistula between the left mammary vein and artery with formation of a pseudoaneurysm with subcutaneous extension. We describe the different imaging techniques that led to the diagnosis and the resolution of the fistula via endovascular embolization.

Arteriovenous Fistula↗
PubMed1998

Renal artery stenosis after kidney transplantation: diagnostic and therapeutic approach.

Transplant renal artery stenosis (TRAS) is a common complication after transplantation and an important cause of graft dysfunction. Many factors have been implicated as possible causes of TRAS, such as damage from trauma and atherosclerosis. We reviewed all 286 patients transplanted in our unit from January 1990 to July 1997 to study the prevalence, clinical features, and diagnostic and therapeutic approach. Thirteen patients with TRAS were identified, and their mean age was 40 +/- 15 years. The detected incidence was 4.5%. They were treated with triple therapy (prednisone, azathioprine and cyclosporine A). The mean age of the donors was 28 +/- 27 years. TRAS was diagnosed within nine months after transplant. All patients were studied with Doppler ultrasound, renography with captopril and angiography. The preferred initial therapy was percutaneous transluminal balloon renal angioplasty. Angioplasty was performed in four patients with good results. Two patients underwent surgery because angioplasty was not possible. Blood pressure control could be achieved with less antihypertensive medication after angioplasty. Transplantectomy was performed in one patient because of surgical complications. In conclusion, most patients with TRAS can be treated successfully with percutaneous transluminal angioplasty as the initial interventional treatment of choice for high-grade renal artery stenosis, and surgical revascularization is indicated when percutaneous transluminal angioplasty cannot be done or is unsuccessful.

Adult↗
PubMed1998

[Reoperations of myocardial revascularization].

UNLABELLED: Coronary by-pass grafting is a well established procedure for ameliorating ischemic coronary disease. From time to time it is necessary to re-operate these patients. The objective of our paper is to present our experience in this field. Retrospective analysis of 128 patients operated on between February 1978 and November 1996, has been analyzed. The mean age was 57.4 +/- 0.7 years. 77.2 +/- 5 months elapsed between operations. Stable angina (20.4%) or unstable angina (76.3%), myocardial infarction (48%) and congestive heart failure (17%) were the predominant clinical manifestations. RESULTS: Hospital mortality was 10.9% (14 patients) and in the follow-up there were 16 deaths (14%). Perioperative myocardial infarction was the main cause of in-hospital mortality. In the follow-up there were 4 deaths due to myocardial infarction and another 4 patients died from neoplasms. Perioperative myocardial infarction was present in 9.3% (12 patients) IN CONCLUSION: a) Re-do coronary by-pass grafting is still a good procedure for solving myocardial ischemia in spite of a higher mortality and morbidity than in the original operation. b) There is no progression in the number of patients according to our experience, probably due to better techniques and the frequent actions by an intervention cardiologist. c) The long-term results are good enough, but with a higher mortality.

Adult↗
PubMed1997

Postsurgical mediastinitis: a case-control study.

We report the results of a case-control study of postsurgical mediastinitis (PSM) that we conducted from 1985 to 1993. The incidence of PSM was 2.2% (81 of 3,711 cases who underwent sternotomy); we analyzed the findings for 73 cases and 73 controls. Univariate analysis revealed that the risk factors for PSM were emergency surgery (27% of cases vs. 13% of controls), New York Heart Association functional class IV (46.5% vs. 21.9%), heart transplantation (12% vs. 0), and coronary artery bypass graft (CABG) surgery (60% vs. 41%). The incidences of fever, reoperation for bleeding, pacemaker placement, use of vasoactive drugs, prolonged mechanical ventilation, use of central lines, and treatment in the intensive care unit were also higher for cases. Multivariate analysis identified the following independent risk factors for PSM: reoperation (risk ratio [RR], 9.2), need for vasoactive drugs (RR, 3.5), CABG surgery (RR, 3.2), and fever that persisted after the third postsurgical day (RR, 406). The related mortality was 13.7%, and death was significantly more frequent among cases (17.7%) than among controls (2.7%). Multivariate analysis identified the following independent risk factors for mortality: bacteremia (RR, 21.5), the use of an intraaortic balloon (RR, 14.9), advanced age (RR, 1.14 per year), and prolonged mechanical ventilation (RR, 1.1 per day).

Adult↗
PubMed1996

The Spanish Monostrut Study Group: a ten-year experience with 8,599 implants.

BACKGROUND: The Monostrut valve is a pyrolytic carbon, tilting-disc prosthesis with no welds. After the first implantation in Spain in May 1983, the Spanish Monostrut Study Group was established to evaluate prospectively the performance of the valve using uniform protocols. METHODS: During a 10-year period, 8,599 Monostrut valves were implanted in 7,317 patients in 22 centers. Mean age was 53.3 +/- 11 years. Of the total group, 3,229 underwent aortic valve replacement, 2,806 had mitral valve replacement, and 1,282 had double valve replacement. Follow-up was 96% complete, with a mean period of 4.3 years and a total of 29,155 patient-years. RESULTS: The operative mortality rate was 7.2%. The 10-year probability of freedom from valve-related complications and linearized rates (event/100 patient-years in parentheses) were as follows: structural deterioration, 100% (0); nonstructural dysfunction, 96% +/- 0.5% (0.51); thromboembolism, 82.9% +/- 1.5% (1.32); anticoagulant-related hemorrhage, 87.6% +/- 1.4% (0.98); and prosthetic valve endocarditis, 96.1% +/- 0.5% (0.48). There were five obstructive valve thromboses (0.017/100 patient-years). Actuarial freedom from reoperation was 95% +/- 0.5% at 10 years. Actuarial freedom from all valve-related morbidity was 70.2% +/- 1.6%; freedom from all valve-related morbidity and mortality (including operative and sudden deaths) was 62.6% +/- 2% (70.1% +/- 2% for aortic valve replacement, 56.9% +/- 2% for mitral valve replacement, and 59.8% +/- 3% for double valve replacement; p < 0.0001). Clinically, 5,988 patients (94%) are in New York Heart Association class I-II. CONCLUSIONS: The Monostrut valve has shown no structural failures and a low rate of valve-related complications over a 10-year period in a large patient population.

Actuarial Analysis↗
PubMed1995

Thoracic aneurysm as a cause of chyluria: resolution by surgical treatment.

A 37-year-old man who had suffered a thoracic trauma presented night release of whitish urine 2 years later. Thoracic computed tomography and aortography demonstrated an aneurysm of the thoracic aorta. Lymphography confirmed the compression of the thoracic duct by the aneurysm. After surgical repair the patient has remained asymptomatic.

Adult↗
PubMed1995

Massive calcification of the left atrium: surgical implications.

BACKGROUND: Massive calcification of the atrial walls ("porcelain atrium") is a rare condition that usually has been reported as an incidental radiologic findings. METHODS: Between January 1988 and June 1993, 971 patients underwent valvular operation at our institution; 21 patients showed extensive calcification of the left atrium. In 8 patients the calcification was massive, involving almost all the atrial surface. The diagnoses were established by radiology and were confirmed at operation. The mean age of these patients (4 men, 4 women) was 55 +/- 9.6 years. All had rheumatic valve disease, were on atrial fibrillation, and had undergone at least one operation previously. Pulmonary artery pressure was severely increased, even up to systemic levels, in all patients except 1. Total endoatriectomy of the left atrium and mitral valve replacement were performed. No patient was lost during the follow-up. RESULTS: Hospital mortality rate was 12.5% (1 patient) and 2 patients died in the late postoperative period. None of these deaths are attributable to the surgical procedure. CONCLUSIONS: In toto endoatriectomy of a massively calcified atrium is an easy to perform technique that helps to replace the mitral valve and close the atrial wall.

Adult↗
PubMed1995

Cardiac surgery in patients under chronic hemodialysis.

A total of 15 chronic renal failure patients on hemodialysis therapy underwent some kind of cardiovascular surgery between August 1984 and March 1993. Ten had a valve abnormality, and the remaining five had coronary artery disease. All of them were hemodialyzed the day before surgery and 24-48 h after the operation. Eleven recovered well after surgery, four died of septic shock: two of these were in septic shock prior to surgery; one was in acute congestive heart failure, and one was operated during an acute myocardial infarction. All operative deaths occurred in the patients who underwent non-elective surgery or were preoperatively in New Heart Association (NYHA) class IV. The factors having an impact on morbidity and mortality seem to be more related to the previous clinical situation and to the urgency of the operation than to the status of chronic renal failure. An early and adequate assessment of the candidates, when possible avoiding emergency surgery and acute left ventricular dysfunction, as well as careful management during cardiopulmonary bypass procedures (CPB) and the immediate post-surgical period will certainly improve the result of cardiac surgery in these patients, making it similar to those who are not in chronic renal failure.

Adult↗
PubMed1995

[Orthotopic heart transplantation in a patient with previously undiagnosed persistence of the left superior vena cava].

The amount of transplants has gone through a remarkable increase during the last years. As a result, congenital anomalies of little prevalence appear more and more often while performing the transplants. The persistence of upper cava vein is one of them and, if not linked to other anomalies, it usually remains unnoticed. This article presents a case of an orthotopic cardiac transplant in a patient with an upper cava vein duplication not diagnosed before undergoing surgery, and it compares the way it was handled to diverse techniques previously described.

Adult↗
PubMed1991

[The midterm (6 years) clinical results of the Carpenter-Edwards supra-annular bioprosthesis].

We present here the clinical results with a second-generation porcine bioprosthesis, the Carpentier-Edwards supra-annular valve (CESA). Two-hundred and twenty-two CESA bioprostheses were implanted in 189 patients during a four-year period (from 1984 to 1987), either as an isolated procedure or associated to mitral or tricuspid repair. The mid-term clinical results have been evaluated after a mean follow-up of 3.4 years, being 96% complete. There were 16 in-hospital deaths (8.4%) and 6 late, potentially valve-related, cardiac deaths (1.1% patients/year). Overall, 86.7 +/- 2% of the patients were free from cardiac death at 6 years (95.1 +/- 2% of the patients surviving the operative period). Linearized rates of valve related complications were the following: 1.4% patients/year for thromboembolism (including valve thrombosis), 0.5% patients/year for treatment-related hemorrhage and 0.7% patients/year for endocarditis. We did not found any case of either intrinsic or extrinsic valve failure, unrelated to infection of thrombosis. Two patients were reoperated, one because of valve thrombosis and the other due to prosthetic valve endocarditis (reoperation rate of 0.3% patients/year). When lethal and nonlethal valve-related complications (including in-hospital deaths) were considered all together, 75.8 +/- 8.4% of the patients remained alive and free of morbid events at 6 years. When patients were grouped according to the valve replaced (aortic, mitral and multiple), best results were found with patients submitted to isolated aortic valve replacement. We conclude that the CESA bioprosthesis has an excellent mid-term clinical performance. However, longer follow-up is necessary to know if improvement in valve design and manufacturing results in increased valve durability.

Aortic Valve↗
PubMed1990

Flow capacity of the human retrograde internal mammary artery: surgical considerations.

The diastolic flow of the retrograde internal mammary artery (IMA) was calculated in 30 patients and compared with the expected coronary flow of the left ventricle and that of specific branches. Arterial pressure and free flow were measured in the proximal and distal IMA as well as in the superior epigastric and musculophrenic arteries. Systolic and mean arterial pressure were significantly higher in the proximal IMA than in any other site, but diastolic pressure was comparable. Overall and diastolic antegrade IMA flows (77 +/- 6 and 44 +/- 3 mL/min) were significantly greater than the retrograde flows through the distal IMA (18.5 +/- 2 and 11.5 +/- 1 mL/min), musculophrenic artery (13.3 +/- 1 and 7.9 +/- 1 mL/min), and superior epigastric artery (5.3 +/- 0.4 and 3.1 +/- 0.2 mL/min). Only patient-size-related variables correlated significantly with retrograde IMA flow. Diastolic retrograde IMA flow represented 8.5% +/- 0.6% of the expected left ventricle coronary flow and in 12 patients (40%) was greater than the expected flow of at least one posteroinferior coronary artery. Based on these data, the retrograde IMA may adequately perfuse the posterior descending or other posterolateral coronary branches in select patients. Previous measuring of the retrograde flow is mandatory.

Adult↗
PubMed1990

Eight years' experience with the Medtronic-Hall valve prosthesis.

During the period January 1981 to September 1986, 444 Medtronic-Hall heart valve prostheses were implanted in 351 patients (mean age, 45 +/- 10 years) mainly for rheumatic valve disease (63.2%). Most of the patients were in New York Heart Association functional class III. Concomitant surgical procedures, mainly conservative tricuspid or mitral procedures or coronary artery bypass grafting, were performed in 101 patients (28.7%). Single-valve replacement was performed in 262 patients (74.6%) (aortic in 117 patients, mitral in 143, and tricuspid in 2), double-valve replacement in 85 (24.2%) (mitral and aortic in 83 and mitral and tricuspid in 2), and triple-valve replacement in 4 (1.1%). Hospital mortality was 6.2%. Follow-up was 97.7% complete. The overall actuarial 8-year survival rate was 77.2%. The linearized incidence of valve-related complications was as follows: thromboembolism, 1.5%/patient-year; reoperation, 1.5%/patient-year; endocarditis, 1.25%/patient-year; hemolysis, 0.52%/patient-year; anticoagulant-related hemorrhage, 0.39%/patient-year; and noninfection-related paraprosthetic leak, 0.33%/patient-year. There were no instances of structural failure. We conclude that after 8 years of follow-up, the Medtronic-Hall valve prosthesis has an excellent clinical performance and a low range of valve-related complications.

Adolescent↗
PubMed1990

Selective and adjustable pericardial flap to protect internal mammary artery grafts.

We describe the surgical technique of a localized and adjustable pericardial flap to protect internal mammary artery grafts. This flap allows selective pulmonary retraction, maintains pleural integrity, and saves most of the pericardium for later closure. This technique has proved to be simple and highly effective. We have used it in 80 patients and have not had any related complications.

Humans↗