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Biomedical subjects

J O Defraigne

Publications and source records attributed to J O Defraigne.

139 records · Page 8Linked to original sources
PubMedDate not supplied

Surgical management of left heart endocarditis.

Between 1981 and 1987, 29 patients (20 men and 9 women, mean age 46 +/- 15) underwent a valvular replacement for endocarditis (19 aortic and 10 mitral). There were 25 native and 4 prosthetic valves. In 85% of cases, underlying valvular lesions were present. The oropharyngeal and the respiratory tracts were the most common sources of infection. In 81%, the infecting microorganism was gram-positive. In 21% of cases, a gram-negative was detected, always mixed with a gram-positive. One infection was caused by a Candida. Indications for surgery were severe valvular insufficiency or cardiac failure (90%), refractory sepsis (21%), thromboembolic events (11%). In 22%, multiple factors were present. A biologic valve was chosen in 12 cases (40%). Simultaneously with the valvular replacement, 4 ventricular septal perforations were occluded and 3 valvular annulus abscesses debrided. The operative mortality was 10% (3/29). The one-year survival is 96%. Two patients required reoperation at 6 months and 2 years, for partial dehiscence, with good subsequent evolution. The authors concluded that surgical operation is the most suitable treatment for unstable or complicated endocarditis, in case of cardiac failure, iterative thromboembolic events or refractory sepsis.

Adult↗
PubMedDate not supplied

[Intrapericardial rupture of an aneurysm of the right anterior sinus of Valsalva: clinical case and review of the literature].

Intrapericardial ruptured aneurysm of the right anterior sinus of Valsalva. A intrapericardial ruptured aneurysm of the right anterior sinus of Valsalva is presented. An infectious origin was suspected. The aneurysm was treated by plication, which allowed to correct the preoperative insufficiency. Aneurysms of the Valsalva sinus can remain asymptomatic. When they are small, a conservative treatment is conceivable. Many complications can occur: rupture (more often in right cavities), aortic insufficiency, coronary insufficiency, cardiac failure, rhythm disturbances. This complications necessitate a surgical treatment. Aortic valvular replacement is indicated only when the structure of the valve is altered.

Aortic Rupture↗
PubMedDate not supplied

Intraluminal duodenal diverticulum associated with heterotopic pancreatic tissue: case report and literature review.

A case of intraluminal duodenal diverticulum (IDD) in a young man with chronic abdominal pain is reported. Diagnosis was done by a barium meal. Surgical excision was performed. Associated ectopic pancreatic tissue was found at operation. IDD is of congenital origin and it coexists with other anatomical abnormalities in 40%. Complications include chronic abdominal pain, duodenal obstruction, gastrointestinal bleeding, pancreatitis. Endoscopic resection is feasible, but surgical resection is safest. Peroperative localization of the papilla of Vater is mandatory to avoid its injury during resection of the mucosal attaches of the IDD.

Adult↗
PubMedDate not supplied

[The value of femoro-femoral extracorporeal circulation in the treatment of isthmic rupture of the thoracic aorta].

Between 1977 and 1987, eleven isthmic ruptures and three chronic posttraumatic pseudoaneurysms of the thoracic aorta have been seen in our cardiovascular surgery service. The hemorrhagic intraabdominal wounds were treated first during the same or a staged procedure. Two patients died prior to the vascular intervention. In the other cases, partial femorofemoral extracorporeal circulation has been used after systemic heparinization (3 mg/kg). The perfusion flow was approximately 2 to 3 l/min. Three patients (25%) died following operation. Only one death caused by decerebration is potentially related to heparinization. No paraplegia occurred. The partial extracorporeal circulation is a reliable method to prevent paraplegia and to diminish the left ventricular post-charge during aortic clamp time.

Adult↗
PubMedDate not supplied

Attitude of a young surgeon toward experimental surgery. Roles and limits of experimental surgery.

At the moment, the place of experimental surgery within the clinical surgical cores is questioned. However, its role in the progresses of surgical practice and training of surgeons is undisputable. It is through research that surgeons can keep some critical mind, essential in their daily activities. However, too often actually, the surgeons abandon research. Two essential reasons explain the phenomenon: on the one hand, the weight of the clinical tasks and on the other hand the complexity of research founded on more and more specialized basic notions. In fact, the part of a surgical investigator must be to form a link between basic research and clinical activities. As such, work in collaboration with motivated basic investigators is cardinal. Also, the success of research depends upon the will of the departments to maintain a research activity, but it meets often with the difficulty in obtaining sufficient research credits. Finally, research can play an essential part in the education of the trainees and partly fill some gaps in their clinical training.

Animals↗
PubMedDate not supplied

Pacemaker implantation for early sinus node dysfunction after orthotopic heart transplantation.

Among 60 patients who received OHT at our institution between November 1986 and January 1990, 4 actually needed implantation of a permanent pacemaker. Three patients with symptomatic early sinus node dysfunction were identified and were satisfactorily paced on the VVIR mode. All three showed sinus recovery within three months following implantation and had their pacemaker switched from the VVIR mode to a simple ventricular demand pacing. Interestingly, administration of beta-blocking drugs quickly reinstituted pace dependence. The patients' outcome is excellent (18 to 48 months follow-up). No difference with the global cohort of our OHT recipients was noticed, apart from an apparent high incidence of infections (3/3) with (2/3) CMV and severe rejection (3/3) during the first month postoperatively. This data suggests that sinus dysfunction may be the result of a multifactorial (rejection, CMV, ...) injury to the conduction system, and is only clinically relevant beyond a threshold level. Denervation hypersensitivity, together with correction of these factors, may account for the restoration of a sufficient reserve of conduction system, and therefore appropriate sinus node function in basal conditions.

Arrhythmia, Sinus↗
PubMedDate not supplied

Association of aortic stenosis and gastrointestinal bleeding (Heyde's syndrome). Report of two cases.

The association between aortic stenosis and digestive angiodysplasia has been described for the first time by Heyde in 1958. This entity is thus known as Heyde's syndrome. In many instances, the recurrent small intestinal bleeding originating from angiodysplasia stopped after aortic valve replacement. We report two cases of patients presenting with a recurrent small intestinal bleeding originating from digestive angiodysplasia and suffering from aortic stenosis. Diagnosis of both pathologies is well documented in both cases. The replacement of the aortic valve by a biologic prosthesis stopped the bleeding. Prior to aortic valve replacement, the two patients suffered severe recurrent blood loss from intestinal angiodysplasia. The treatment of aortic stenosis greatly favored both cardiac and general status. We recommend aortic valve replacement with a biologic prosthesis prior to intestinal resection in patients presenting with Heyde's syndrome. We stress on the fact that anticoagulants must be stopped in order to minimize the risk of further bleeding.

Aged↗
PubMedDate not supplied

Successful tricuspid valve replacement and pulmonary valvulotomy for carcinoid heart disease.

A case of successful tricuspid valve replacement with a mechanical prosthesis and pulmonary valvulotomy for carcinoid heart disease is reported. The patient was a 61 years old women. The primary tumor was in the terminal ileum. Liver metastasis and carcinoid syndrome were present since 8 years. After cardiac surgery, the patient survived 38 months and late death was related to disseminated metastasis. Even in case of metastasis, carcinoid tumor is slow growing. Without cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac failure rather than to tumoral growth. Thus, even in presence of metastasis, cardiac surgery may be mandatory to improve both quality of life and survival.

Carcinoid Heart Disease↗
PubMedDate not supplied

Successful bridge to transplantation with Pierce Donachy (Thoratec) ventricular assist device.

Biventricular assistance with the Thoratec ventricular assist device was performed in a 48-year-old man waiting heart transplantation since 6 months. Indication for circulatory support was considered because of the development of progressive irreversible right heart failure with deterioration of the hepatic and renal functions. Orthotopic heart transplantation was performed after 13 days of circulatory support. No complications occurred during the assistance and in the posttransplant period. The patient was discharged on day 21 after transplantation. Five months after transplantation he is well and alive.

Cardiomyopathy, Dilated↗