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Biomedical subjects

J Turina

Publications and source records attributed to J Turina.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Severe aortic valve diseases and aortic isthmus stenosis in adults. Incidence, clinical aspects and long-term results of surgical treatment].

Severe aortic valve disease is a rare complication of coarctation in adults. Between 1961 and 1990 aortic valve replacement was performed after or combined with the operation of coarctation in 24 adults (4% of entire population operated for coarctation). Bicuspid aortic valves were present in 2/3 of patients. In 10 patients (7/10 with aortic stenosis) coarctation was operated early (mean age 24 years) and aortic valve late (mean age 40 years): in 14 (10/14 with aortic regurgitation, mean age 40 years) aortic valve and coarctation were operated simultaneously (8 patients) or staged within 6 months (6 patients). Additional surgical interventions on the dilated aorta ascendens were performed in 8, mitral valve replacement in 2 and aorto-coronary bypass in 1 patients. Early mortality was 2/24 (8%) and was similar in simultaneously (1/8) and staged (1/14) operated cases: 10 year survival was lower than in an age-matched group of 72 patients with aortic valve disease of similar severity operated during the same period (70% vs 88%, p < 0.01): 6/7 late deaths were cardiac; 5/5 pts with preoperatively severely increased end-diastolic (> 199 ml/m2) and 4/4 with end-systolic (> 90 ml/m2) left ventricular volumes and 2/2 with ejection fraction < 41% died late postoperatively. Severe aortic valve disease arised in 4% of adults with coarctation or after coarctation resection. The results of valve replacement in these patients were less successful due to high late mortality in cases with severe preoperative left ventricular dilatation and/or decrease of ejection fraction. Thus, close surveillance of patients after coarctation surgery, especially those with bicuspid valves, is mandatory for early detection of valvular disease and appropriate timing of valve replacement before left ventricular function begins to deteriorate.

Adolescent↗
PubMed1995

[Left ventricular function in post-endocarditis aortic insufficiency and aortic-annular ectasia].

BACKGROUND: The duration of valvular regurgitation is an important determinant of left ventricular function in the presence of severe volume overload. PURPOSE: To evaluate the effect of aortic regurgitation (aortoannullar dilatation vs. history of bacterial endocarditis) on left ventricular (LV) function. PATIENTS: Between February 1976 and January 1993 45 patients (mean; age 45 +/- 12 years) underwent diagnostic evaluation for clinical purposes. Patients were divided into three groups: group 1 consisted of 17 patients with normal LV function (controls), group 2 of 11 patients with severe aortic regurgitation due to aortoannullar dilatation (AAD) and group 3 of patients with severe aortic regurgitation and a history of bacterial endocarditis (BE). METHODS: LV function was assessed by biplane LV-angiography and simultaneous pressure recordings. The ejection fraction and peak systolic wall stress were calculated in all patients. Systolic and diastolic LV function was determined and compared within the three groups. RESULTS: Heart rate, mean aortic pressure and cardiac index were similar in the three groups. The mean aortic diameter was significantly increased in group 2 when compared to the other two groups (p < 0,001). Systolic function was significantly reduced in both groups with aortic regurgitation when compared to the control patients. The end diastolic pressure-volume relationship was shifted to the right in patients with aortic regurgitation, but only 3 patients with a history of bacterial endocarditis showed severe diastolic dysfunction. CONCLUSIONS: No hemodynamic differences were observed in patients with severe aortic regurgitation with regard to the etiology or time course of LV volume overload. However, 17% of the patients with a history of bacterial endocarditis had severe diastolic dysfunction, which is probably due to the faster development of volume overload after bacterial endocarditis.

Adult↗
PubMed1995

Left ventricular function and valvular reoperations.

Between 1961 and 1994, 1,120 adult and adolescent patients had reintervention on the aortic, mitral or both valves. Operative mortality was 7%; five, 10, 15 and 20 year survival rates were 81%, 65%, 54% and 52%, respectively. From the sixties to the nineties, the number of procedures (58 to 304), the age of patients (40 to 57 years), incidence of acute endocarditis (0 to 9%), concomitant coronary surgery (0 to 13%) and the number of repeated interventions (5% to 22%) gradually increased. Despite such increasingly difficult conditions the operative mortality remained low and five-year survival acceptable during the last 20 years. Operative mortality was significantly higher in patients over 65 years (11% vs. 5%), in cases with additional coronary surgery (16% vs. 5%) or interventions on the ascending aorta (17.5% vs. 5%). Left ventricular systolic function was quantitatively assessed before reoperation in 372 patients. In patients with stenotic mitral lesion or with aortic valvular lesion and additional surgical interventions reduced ejection fraction (< 50%) had no effect on late outcome. In regurgitant aortic and mitral lesions and interventions on both valves, there was a trend for less successful late outcome after reintervention, but the difference did not reach statistical significance. It is concluded that valvular reoperations can be performed nowadays with only slightly increased operative risk and an acceptable late outcome as compared to primary valvular operations. Hemodynamically significant valvular and/or prosthetic lesion should be corrected again without delay regardless of an impaired left ventricular function.

Adolescent↗
PubMed1994

[Left heart insufficiency following acute myocardial infarct].

In the light of a case history, current treatment modalities for heart failure after acute myocardial infarction are described. Thrombolytics, beta-blocking agents and angiotensin-converting-enzyme inhibitors have radically changed the prognosis of acute myocardial infarction. A decrease in cardiac mortality and a marked reduction in cases with severe heart failure have been achieved with optimal use of modern therapy. In cases without sufficient improvement by pharmacotherapy, combination with cardiac surgery may lead to a favourable result. Left ventricular aneurysmectomy is the procedure of choice for large ventricular aneurysms with heart failure symptoms.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

Aortic homograft and mitral valve repair in a patient with Werner's syndrome.

We report the case of a 66-year-old man suffering from Werner's syndrome (adult progeria); he presented with several cardiac disorders, including coronary artery disease, aortic stenosis, and mitral regurgitation, mainly due to calcific deposits in the mitral annulus and the aortic cusps. Treatment consisted of mitral repair, homograft replacement of the aortic valve, and coronary artery bypass grafting. Avoidance of prosthetic material because of chronic infectious skin ulcers constituted the main goal of the operation.

Aged↗
PubMed1992

[Positron-emission tomography (PET) in the evaluation of metabolic processes in the myocardium].

Nuclear cardiology, and in particular myocardial scintigraphy, is used with increasing frequency to detect the presence of ischemia before revascularization by angioplasty or coronary artery bypass grafting. On the basis of recent publications it is evident that there are certain conditions in which conventional diagnostic methods suggest the presence of myocardial necrosis, but there is persistent metabolically active myocardial tissue. One of these conditions is the "hibernating myocardium". Patients with this disease entity will show an improvement in cardiac function after revascularization in over 85% cases. Therefore, the diagnosis of "hibernating myocardium" has a high predictive value. Differentiation between irreversible myocardial necrosis and "hibernating myocardium" is possible by positron emission tomography (PET) combining imaging of myocardial metabolism with imaging of myocardial perfusion. With 30 months, 36 patients with established myocardial infarction and a suspicion of "hibernating myocardium" have been examined in the PET scanner at the Paul Scherrer Institute, Villigen. Images of glucose metabolism were obtained by 18-fluoro-deoxyglucose and perfusion images were obtained using thallium in a first phase (thallium-SPECT at rest) and rubidium-82) as a positron emitter in second phase. We were able to identify patterns that suggest the presence of "hibernating myocardium", in 19 of 36 patients (53%). The basic principles and limitations of myocardial positron emission tomography are discussed.

Deoxyglucose↗
PubMed1992

Valve replacement in octogenarians: increased early mortality but good long-term result.

Between January 1983 and December 1990, 20 patients aged 80 years or older underwent valvular surgery. The patients' ages varied from 80 to 87 years (mean, 82 +/- 1.5 years). The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective, two urgent, and three emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. Six patients (30%) had an uneventful hospital stay, and the other 14 (70%) experienced several post-operative complications. The operative mortality rate was 15% (three patients). All patients before operation were in NYHA (New York Heart Association) class III and IV and all survivors remained in NYHA class I or II. The survivors have been followed from 6 to 70 months (mean 20 +/- 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement in octogenarians can be performed, despite the high rate of post-operative complications, with increased but acceptable mortality. Long-term results are good.

Aged↗
PubMed1991

[Aortocoronary bypass surgery in patients older than 70 years].

From January 1981 to December 1990, 204 patients aged between 70 and 81 years underwent aortocoronary bypass surgery. Operative mortality (30-day mortality) was 6.8%. Actuarial survival rate at 1 and 5 years was 92% and 86% respectively. A higher incidence of postoperative complications was observed (arrhythmias in 19%, reoperation for bleeding in 5.4%, respiratory and neurological complications in 13% and 3% respectively, perioperative infarction in 4.4%). The mean follow-up was 25 months. Preoperatively most patients (71%) were in New York Heart Association (NYHA) functional class III and IV, and at the end of following-up in NYHA functional class I and II (95%) (p less than 0.001). A rapid rise in coronary artery surgery in the elderly is evident. It is associated with an increased but acceptable operative risk. Long-term results and postoperative improvement of functional status are very satisfactory.

Age Factors↗
PubMed1991

[Mitral valve prolapse--clinical significance of a frequent diagnosis].

Mitral valve prolapse is found in 2-5% of the whole population and is thus the most common valvular anomaly. The vast majority of patients are asymptomatic and remain free of complications during the follow-up. The most important complications are severe mitral regurgitation, bacterial endocarditis, cerebral ischemic stroke and arrhythmias. The risk of these complications is increased in patients with a holosystolic murmur, enlarged left atrium and/or ventricle, and redundant, thickened mitral leaflets. The complication rate increases with age and is generally higher in males. The risk of complications is very low in patients with an isolated systolic click or silent prolapse. Prophylactic treatment for endocarditis is recommended for patients with a systolic murmur. For patients surviving ischemic stroke, aspirin is recommended. Where the left atrium is enlarged and rhythm disturbances are present, anticoagulation treatment is preferable. Rhythm disturbances should be treated only when symptomatic. In cases of severe mitral regurgitation surgery should be considered early, since reconstruction of the valve can be achieved in the majority of patients.

Adolescent↗
PubMed1991

Long-term follow-up of medical versus surgical therapy for hypertrophic cardiomyopathy: a retrospective study.

In a retrospective analysis 139 patients with hypertrophic cardiomyopathy were followed up for 8.9 years (range 1 to 28 years). Patients were divided into two groups: Group 1 consisted of 60 patients with medical therapy and Group 2 of 79 patients with surgical therapy (septal myectomy). Groups 1 and 2 were subdivided according to the medical treatment. Group 1a received propranolol, 160 mg/day (n = 20); Group 1b verapamil, 360 mg/day (n = 18); and Group 1c, no therapy (n = 22). Group 2a received verapamil, 120 to 360 mg/day, after septal myectomy (n = 17) and Group 2b had no medical therapy after surgery (n = 62). In Group 1, 19 patients died (annual mortality rate 3.6%) and in Group 2, 17 patients died (mortality rate 2.4%, p = NS). Of the patients who died, approximately one half to two thirds in both Groups 1 and 2 died suddenly and the other one half to one third died because of congestive heart failure. The 10 year cumulative survival rate was 67% in Group 1, significantly smaller than that in Group 2 (84%, p less than 0.05). In the subgroups, the 10 year survival rate was 67% in Group 1a, 80% in 1b (p less than 0.05 versus 1a) and 65% in 1c (p less than 0.05 versus 1b). The 10 year survival rate was 100% in Group 2a (p less than 0.05 versus 1a, 1b, 1c) and 78% in Group 2b (p less than 0.05 versus 2a). It is concluded that cumulative survival rate is significantly better in surgically than in medically treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Effect of isradipine on left ventricular relaxation and diastolic filling.

The effect of two calcium antagonists on left ventricular (LV) relaxation and diastolic filling was evaluated in 16 randomized patients. Isradipine and nifedipine were administered intravenously in a maximum dose of 60 micrograms/min for isradipine and 63 micrograms/min for nifedipine. Heart rate was increased significantly (p less than 0.01) by both study agents. LV end-diastolic pressure remained unchanged whereas peak systolic pressure decreased significantly (p less than 0.01). The reduction in systolic pressure was significantly greater (p less than 0.05) after isradipine (delta P of 30 mm Hg) than after nifedipine (delta P of 13 mm Hg). The time constant decreased from 65 to 56 ms (p less than 0.05) after isradipine and from 62 to 59 ms (NS) after nifedipine. LV filling remained unchanged. It is concluded that both calcium antagonists are associated with a significant reduction in LV afterload accompanied by a reflex increase in heart rate. Isradipine is a more potent vasodilator than nifedipine at the same infusion rate. A beneficial effect on LV relaxation with isradipine, but not nifedipine, may be due to its less pronounced negative inotropic effect or its more potent afterload-reducing action.

Angiocardiography↗
PubMed1989

[Long-term course of hypertrophic cardiomyopathy: drug versus surgical therapy].

139 patients with hypertrophic cardiomyopathy (HCM) have been followed up for 1-28 years (mean 8.9 years). Group 1 consisted of 60 patients (mean age 38 years) without indication for septal myectomy (SM) (no pressure gradient at rest in 8, pressure gradient less than 50 mm Hg in 52 cases); group 2 consisted of 79 patients (mean age 36 years) who had SM (pressure gradient at rest 70 mm Hg). Management in group 1 was the following: (1a) propranolol (n = 20) (160 mg/d), (1b) verapamil (n = 18) (360 mg/d) and (1c) no therapy (n = 22). 19 patients died in group 1 (mortality 3.6% year); 17 died in group 2 (mortality 2.4%/year). 10 year survival in group 1b was 80% and in groups 1a und 1c 67% and 65% respectively. Patients of group 1b had a higher survival rate (p less than 0.05) than the other subgroups. Surgery patients treated with verapamil (120-360 mg/d) (n = 17) had a 10-year survival rate of 100% compared to 78% for surgery patients (n = 34) without such treatment (p less than 0.05). In summary, it can be said that the overall survival rate after SM is better than that with medical treatment. Under verapamil, however, survival is not different from that after surgery. The most favorable outcome was observed in surgery patients under long-term therapy with verapamil, probably due to the reduction of systolic pressure overload (SM) and improvement in diastolic function (verapamil).

Adult↗
PubMed1988

[Spontaneous course of aortic valve disease and indications for aortic valve replacement].

190 adult patients with aortic valve disease have been followed up after initial cardiac catheterization until death or aortic valve replacement (event-free survival). Neither hemodynamic severity nor symptoms alone were reliable predictors of survival, but the combination of both was very helpful. In the presence of hemodynamically and symptomatically severe aortic stenosis and aortic regurgitation only 40% of patients survived for two years, but patients with hemodynamically severe aortic stenosis but with few or no symptoms had 100% survival at two years and 75% were event free at five years. In hemodynamically severe aortic regurgitation two asymptomatic patients died within the first two years (94% survival at two years) and 65% were event free at five years. In the absence of coronary artery disease there was no mortality within the first two years in moderate or mild stenosis and regurgitation regardless of symptomatic status. Hemodynamically and symptomatically severe aortic stenosis and regurgitation have a very poor prognosis and require immediate valve surgery. Asymptomatic and mildly symptomatic patients with hemodynamically severe aortic stenosis are at low risk and surgical treatment can be postponed until marked symptoms appear without significant risk of sudden death. In severe aortic regurgitation, the decision to perform surgery should depend not only on symptoms but should be considered in patients with few or no symptoms because of the risk of sudden death. In the absence of coronary artery disease, hemodynamically moderate aortic valve disease does not require valve surgery on prognostic grounds.

Adolescent↗
PubMed1987

Spontaneous course of aortic valve disease.

The fate of patients with aortic valve disease of varying degrees of severity and the relationship between symptoms and haemodynamic status have been studied in 190 adults undergoing cardiac catheterization during the last two decades. During the follow-up period, 41 patients died and 86 underwent aortic valve replacement; these two events were the endpoints for the calculation of 'event-free' cumulative survival. First-year survival in haemodynamically severe disease was 60% in aortic stenosis and 96% in aortic regurgitation; in moderate and mild disease (in the absence of coronary artery disease) first-year survival was 100% in both groups. After 10 years, 9% of those with haemodynamically severe aortic stenosis and 17% of those with severe regurgitation were event-free, in contrast to 35% and 22%, respectively, of those with moderate changes and 85% and 75%, respectively, of those with mild abnormalities. In the presence of haemodynamically severe disease, 66% of the patients with stenosis and 14% of those with regurgitation were severely symptomatic (history of heart failure, syncope or New York Heart Association class III and IV); 23% of patients with moderate stenosis and 14% with moderate regurgitation were also severely symptomatic. Only 40% of those with disease that was severe both haemodynamically and symptomatically with either stenosis or regurgitation survived the first two years; only 12% in the stenosis group and none in the regurgitation group were event-free at 5 years. Patients with haemodynamically severe aortic stenosis who had few or no symptoms had a 100% survival at 2 years; the comparable figure for the aortic regurgitation group was 94%; 75% of the patients in the stenosis group and 65% in the regurgitation group were event-free at 5 years. In the moderate or mild stenosis and regurgitation groups there was no mortality within the first 2 years in the absence of coronary artery disease, regardless of symptomatic status. Haemodynamically and symptomatically severe aortic stenosis and regurgitation have a very poor prognosis and require immediate valve surgery. Asymptomatic and mildly symptomatic patients with haemodynamically severe aortic stenosis are at low risk and surgical treatment can be postponed until marked symptoms appear without a significant risk of sudden death. In severe aortic regurgitation, the decision for surgery should depend not only on symptoms but should be considered in patients with few or no symptoms because of risk of sudden death. In the absence of coronary artery disease, moderate aortic valve disease does not require valve operation for prognostic reasons.

Adolescent↗
PubMed1986

[Diagnosis and clinical course of periarteritis nodosa].

The clinical symptoms, diagnostic procedure and course under treatment in 10 patients with polyarteritis nodosa are studied retrospectively. Clinically, 3 patients showed peripheral arterial occlusive disease in the lower extremities. 3 patients had evidence of preceding acute type B hepatitis. The diagnosis was confirmed by biopsy in 7 cases, by selective arteriography of the kidneys showing multiple small aneurysms in one case; in 2 patients the diagnosis was based upon the clinical findings only. Complete remission was achieved in 7 of 10 treated patients, in 5 patients with corticosteroids alone and in 2 patients with a combination of corticosteroids and cytotoxic agents. 4 patients died, one of them from vasculitis and 3 from other causes. 5-year survival for all patients was 52%. The diagnostic value of arteriography, the clinical picture of polyarteritis nodosa with peripheral arterial occlusive disease, and the association between hepatitis B infection and polyarteritis nodosa are discussed.

Adult↗
PubMed1986

[Significance of the bicuspid aortic valve in the incidence of aortic valve defects in adults].

In 388 patients with severe isolated aortic valve disease bicuspid aortic valves were found in 45% of patients with aortic stenosis and 24% of patients with aortic regurgitation. There was a history of rheumatic fever in 16% and of endocarditis in 7% of these patients. In a group of 110 patients with severe combined aortic and mitral valve disease, 50% had a history of rheumatic fever and bicuspid valves were found in only 12% of the cases. Severe aortic valve disease based on bicuspid valves was most frequently found in the age group 50-69 years. Bicuspid aortic valve is today the most frequent cause of isolated aortic valve disease; it is more common in aortic stenosis but also occurs in aortic regurgitation.

Adolescent↗
PubMed1986

[Abdominal inflammatory pseudotumor (plasma cell granuloma) with anemia and hypergammaglobulinemia].

Intraabdominal pseudotumor of the plasma cell granuloma type in a 19-year-old man is reported. The patient presented with fever and weight loss lasting months, and the laboratory findings revealed high sedimentation rate, hypochromic, microcytic anemia, thrombocytosis, elevated alkaline phosphatase, decreased thromboplastin time and polyclonal hypergammaglobulinemia. When the plasma cell granuloma was removed, all laboratory findings returned to normal within 3 months and the patient remained asymptomatic during the two-year follow-up.

Adult↗