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Biomedical subjects

J Urzua

Publications and source records attributed to J Urzua.

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

[Wolff-Parkinson-White syndrome: late results of surgical treatment].

We followed 25 patients operated on for Wolff-Parkinson-White syndrome between August 1985 and October 1989. Their mean age was 37 +/- 12 years and arrhythmia had been present for 5 to 30 years. A mean of 3.3 +/- 1.2 antiarrhythmic agents had failed in controlling recurrences. Tachycardia was orthodromic in 21 patients and antidromic in 1, while 3 patients presented rapid atrial fibrillation with hemodynamic deterioration. Drug refractoriness (n = 23) or intolerance (n = 2) were the main surgical indications. The location of accessory pathways was lateral in 19 patients, anteroseptal in 3, posteroseptal in 2, postero lateral in 1 and right lateral in 1 patient. One patient had a double pathway. There was no surgical mortality. After a follow-up period ranging from 1 to 50 months recurrence of arrhythmia was observed in one patient and electrophysiologic evaluation showed persistence of a left lateral pathway in another. The remaining 24 patients are free of symptoms at the end of follow up. Thus, surgical treatment is a curative therapy for most patients with WPW.

Adolescent↗
PubMed1989

[Atrial ectopic tachycardia. A variety of incessant tachycardia].

A 19 year old patient with incessant supraventricular tachycardia was submitted to electrophysiologic study. An ectopic left atrial focus was demonstrated. Intraoperative mapping localized the focus to the upper left atrial quadrant. Successful surgical isolation of the focus was possible. The patient is currently asymptomatic and arrhythmia free.

Electrocardiography↗
PubMed1984

Pattern of hemodynamic alterations during coronary artery operations.

Twenty-four patients were studied to determine the relative importance of cardiac and peripheral factors in the hemodynamic changes associated with coronary artery operations. None had preoperative evidence of ventricular impairment. Anesthetic management was standardized for all. Sequential hemodynamic measurements revealed the following: (1) Five minutes following induction of anesthesia, all hemodynamic indices were stable except for an increase in heart rate (p less than 0.001). Sternotomy and pericardiectomy were followed by a drop in cardiac index (p less than 0.01) and systolic blood pressure (p less than 0.01). (2) Late during bypass, there was a significant, parallel reduction in both hematocrit and systemic vascular resistance (SVR) (p less than 0.001 and 0.01, respectively). (3) Five minutes after termination of bypass, cardiac output was markedly elevated (p less than 0.001) in association with a decrease in SVR (p less than 0.001), marked hemodilution (p less than 0.001), and tachycardia (p less than 0.001). (4) Following sternal closure, and despite the fact that the hematocrit was still reduced (p less than 0.001), there developed a trend of increased mean arterial pressure (MAP) and SVR with a reduction in cardiac index. These changes were further accentuated 1 hour postoperatively. The SVR was 33% higher than in the previous stage (p less than 0.01), whereas the high cardiac index recorded with initiation of bypass declined significantly to preoperative values. Throughout the studies, there was a strong correlation between alterations in hematocrit and changes in cardiac index and SVR. Blood pressure variations showed no correlation with changes in cardiac output but were significantly related to alterations of peripheral resistance. Sequential determinations of plasma renin activity and catecholamine levels showed no significant alterations in either. The alterations reported describe not only group averages but also the behavior of every patient investigated. The results suggest that in patients with normal or only mild left ventricular impairment, the major factor influencing arterial pressure variations during coronary artery operations and in the postoperative period was the change in peripheral resistance rather than alterations in cardiac output. In the treatment of hypotension under these conditions, one should take into account variations in peripheral vascular resistance and not depend solely on assumed changes in myocardial performance.

Aged↗
PubMed1982

[Atrial myxoma. Report of eight surgical cases, four with electron microscopy study (author's transl)].

From 1970 to 1979 we studied and operated on 8 patients with atrial myxoma, 7 females and 1 male, 24 to 58 years of age. Symptoms had been present for 4 to 24 months prior to surgery. Five patients were functional class IV (NYHA), 2 class III and one class I. All patients were studied by catheterization and angiography. The diagnosis was suspected from physical findings in 3 patients and was not made before surgery in 2 cases. The tumor was located at the left atrium in 6 patients and the right atrium in 2. Electron microscopy performed in 4 cases revealed the typical findings of myxomatous tissue. Adequate resection under extracorporeal circulation was possible in all subjects. One female who was in severe congestive heart failure died shortly after operation. The survivors did well, remaining functional class I, one to nine years after surgery.

Adult↗
PubMed1982

Failure of positive end-expiratory pressure to decrease postoperative bleeding after cardiac surgery.

To determine whether the application of positive end-expiratory pressure (PEEP) in the postoperative period after cardiac operation would reduce postoperative blood loss, the number of transfusions required, or the rate of reoperation for bleeding, we conducted a prospective study of 83 patients who underwent elective coronary revascularization. These patients were randomly assigned to receive either PEEP (10 cm H2O) or no PEEP (zero end-expiratory pressure). All other aspects of their care were identical. There was no statistically significant reduction in the amount of bleeding in patients treated with PEEP at 8 or 24 hours postoperatively. There was no significant difference in hematocrit between the groups preoperatively or postoperatively. There was no statistically significant difference in the number of reexplorations for bleeding. Finally, there was no significant difference between the groups in the amount of blood administered. On the basis of our results, we conclude that the application of PEEP in the postoperative period of cardiac operation did not reduce the amount of blood loss, the need for reexploration for bleeding, or the blood requirements in this group of patients.

Cardiac Surgical Procedures↗
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↗