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Biomedical subjects

K E Kyllönen

Publications and source records attributed to K E Kyllönen.

18 recordsLinked to original sources
PubMed1987

Correlation of NYHA classification, bicycle ergometry and right heart haemodynamics after total correction of tetralogy of Fallot in adults.

Thirty-two patients who had undergone correction of Fallot's tetralogy in adult life were examined on average 6.3 years postoperatively, at mean age 25.8 years. Palliative shunt operation had been performed in childhood in 28 cases. The clinical condition was good in 25 patients (78%). 13 of whom had mean gradient between right ventricle and pulmonary artery 16.0 +/- 4.2 mmHg and systolic right ventricular pressure 39.0 +/- 10.0 mmHg, while 12 had right ventricular pressure 62.6 +/- 16.3 mmHg. In these groups the maximum exercise capacity was, respectively, 136.7 +/- 36.1 and 106.1 +/- 30.8 W/min. Three other patients were in satisfactory, and four in poor clinical condition, with right ventricular systolic pressure, respectively, 74.3 +/- 10.9 and 91.5 +/- 60.0 mmHg. The gradient from right ventricle to pulmonary artery averaged 58.5 +/- 10.4 mmHg in the latter group but, despite the obstructed pulmonary outflow tract, the exercise capacity (116.7 +/- 28.9 W/min) was similar to that in the groups with better clinical results. It is concluded that in most patients with palliative surgery in childhood, tetralogy of Fallot can be successfully corrected in adult life. The causes of right ventricular impairment do not significantly reduce the exercise capacity.

Adult↗
PubMed1985

Repair of ventricular septal defect in adults.

To evaluate the outcome of ventricular septal defect (VSD) with long duration of haemodynamic derangement, a retrospective study was made of 42 consecutive patients who underwent closure of VSD as adults (age range 15-48, mean 27 years). The mean systolic pulmonary arterial pressure was 53 mmHg, mean pulmonary vascular resistance 2.5 Wood units and mean pulmonary/systemic flow ratio 2.4. VSD was complicated by aortic regurgitation in 12 cases, mitral regurgitation in 4, and sinus of Valsalva fistula in 6 cases. There were 15 supracristal, 24 infracristal and 3 muscular VSDs. In addition to VSD closure, surgery included aortic valve replacement (7 cases), mitral valve replacement (2), valve repair by suture (7) and repair of Valsalva sinus fistula (6 cases). Two patients died in the early postoperative period and two during follow-up (1-10, mean 4.5 years). The early and the late mortality were related to large infracristal VSD, pulmonary hypertension and irreversible pulmonary vascular changes which could not be anticipated on the basis of high calculated shunt flow at preoperative catheterization. No patient with supracristal VSD died. Recurrent VSD was diagnosed in five patients, three of whom needed reoperation and recovered uneventfully. Reduction of heart size and improved exercise tolerance were the most pertinent follow-up findings. The results suggest that large supracristal VSD with aortic valve involvement can be successfully closed in adults, but that the prospect for large infracristal VSD is less favourable if correction is postponed until adulthood.

Adolescent↗
PubMed1985

Combined multiple-valve procedures. Factors influencing the early and late results.

The early and late results were retrospectively evaluated in 57 cases of double or triple valve replacement or repair performed in 1970-1983. The causes of the valvular lesions were rheumatic fever (43 cases), bacterial endocarditis (6), syphilis (1) and unknown (7 cases). The preoperative NYHA classification was III in 29 patients and IV in 28, due mainly to dyspnea of effort. Cardiomegaly (mean radiologic volume 880 cm3/m2) and atrial fibrillation were the dominant clinical findings. Surgery was on emergency indications in five cases. Cold cardioplegia combined with external cardiac cooling has been used for myocardial protection since 1977. The valve replacements were 56 aortic, 50 mitral and 2 tricuspid. In addition there were three closed and two open mitral commissurotomies, two mitral plastic repairs, three tricuspid valve anuloplasties (DeVega) and one aortic anuloplasty. Follow-up (0.3-13, mean 3.5 years) was supplemented with a check-up including two-dimensional echophonocardiography and hematologic tests. The operative mortality (10/57 patients) fell from 26% in 1970-1976 to 12% in 1977-1983. The causes of death were low cardiac output in preoperatively ill patients (5), myocardial infarction (2), technical failure (2) and sepsis (1 case). There were 11 late deaths (6.7/100 patient-years of observation), the commonest cause (5 patients) being congestive heart failure. The respective incidences of thromboembolism, paravalvular leak and postoperative endocarditis were 2.1, 4.2 and 2.1 episodes/100 patient-years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Total correction of tetralogy of Fallot in adults.

A series of 42 patients who underwent total correction of tetralogy of Fallot as adults is presented. Previous palliative operation had been performed in 33 cases: Blalock-Taussig shunt in 28 (bilateral in 6), Brock operation in four and Potts' anastomosis in one case. Severe cyanosis (average hemoglobin 203 g/l), thrombotic complications and hypoxic spells were the most pertinent of the clinical manifestations necessitating the total repair. Blalock-Taussig shunt had closed spontaneously before the intracardiac operation in 14 cases (3 bilateral) and in 11 it was ligated. In six cases the shunt was left untreated, being hemodynamically insignificant at operation. Three of the 42 patients died in association with the intracardiac operation. A-V block developed in two patients and required permanent pacemaker. During follow-up periods of up to 13 years, a residual ventricular septal defect was found in seven patients. Two of the defects were surgically closed. Five were not corrected, as the patients were doing well and the pulmonary/systemic flow ratio was less than 1.5 at repeat catheterization. Two-thirds of the patients were in NYHA class I at re-examination, and the others were in class II. The subjective functional improvement was greater than could have been expected from results of exercise tolerance tests.

Adolescent↗
PubMed1982

Surgical intervention in cases of Ebstein's anomaly. Abnormal origin and structure of the tricuspid valve.

During the ten-year period 1972-81 four patients, two men and two women, with Ebstein's disease underwent operation at our institution. Their average age was 34. Central cyanosis at rest, clubbing and polycythaemia were the most common clinical features of the patients. Enlarged heart, a small pulmonary arterial arch and transluminal lung fields were seen in chest X-ray. Operative findings were a grossly enlarged right atrium and ventricle, the latter having a segment that was typically atrialized and thin-walled but was contracting synchronously with the true right ventricle, and a wide variation in the leaflets of the tricuspid valve and their origins. The atrial septal defect was small in all cases. Artificial heart valves (1 Cutter-Smeloff, 2 Björk-Shiley, 1 St. Jude) were used in the tricuspid reconstruction in addition to closure of the ASDs. One of the patients died postoperatively, the other three are doing well.

Adult↗
PubMed1980

Surgical treatment of coarctation of the aorta with minimal collateral circulation.

Twenty-four aortic coarctation patients with minimal collaterals were operated on. Left-side bypass was used in 18 cases, internal shunt in 4, while a jump graft ws inserted in 2 cases. These methods were applied when the distal aortic pressure fell below 50 mmHg systolic during test clamping. The coarctation was corrected with isthmusplasty in 12 cases, resection and end-to-end anastomosis in 5 cases, resection with prosthetic replacement in 5 cases and jump graft in 2 cases. The operative mortality was 2 patients (8.3%). One patient died of complications of a post-perfusion bleeding tendency; the other, who had concomitant aortic insufficiency, died of cerebral infarction and pneumonia. At follow-up examination, the blood pressure difference between the upper and lower extremities had disappeared in all cases. The blood pressure was still over 150 mmHg systolic in 9 patients, 8 of whom received anti-hypertensive medication. One patient died during the follow-up period, while waiting for an operation for aortic insufficiency.

Adolescent↗
PubMed1980

Ischaemic cardiac aneurysms and ventricular septal defects. Surgical treatment with and without revascularization.

During the period 1968--78, 35 patients with left ventricular aneurysm after acute myocardial infarction were operated on at the Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki. Twenty patients underwent resection of the left ventricular aneurysm and had coronary bypass grafting (Group I) and 15 patients had aneurysmectomy without revascularization procedures (Group II). Most of the patients (21) had the operation within one year after acute myocardial infarction. The aneurysm was located in the anterior wall in 31 cases and in the posterior wall in 4 cases. Three patients in Group II had a concomitant ventricular septal rupture, which was repaired simultaneously with the aneurysmal resection. In average, the patients in Group I had bypass grafting in 1.8 coronary branches. There were no intra-operative deaths. Three patients in the revascularization group died and 2 patients in the non-revascularization group died during hospitalization (15% hospital mortality). Two patients in the revascularization group and one in the non-revascularization group died during the average follow-up time of 3.4 and 6.4 years for the respective groups (late mortality 10 and 7%). The rest of the patients were doing well, including those with repaired VSDs. Follow-up coronary angiography was carried out of 12 patients; in 10 all the grafts were patent and in 2 one revascularized coronary branch had a patent graft. Revascularization produced apparent relief of anginal symptoms. Its beneficial effects on longevity remained unestablished.

Adult↗
PubMed1975

Pulmonary sequestration.

31 surgically treated cases of pulmonary sequestration are reported. There were 23 of intralobar and 8 of extralobar type, 23 were on the left and 8 on the right. All but three had symptoms most of them pointing to a respiratory tract infection. Six patients had pneumonia, five haemoptyses, three patients pleurisy and two patients empyema before the operation. In addition to chest x-ray, aortogram appeared to be the most valuable tool in providing the accurate diagnosis preoperatively. Most of the cases were treated by lobectomy, in 7 cases by sequestrectomy and in 2 cases by pneumonectomy. One of the patients died from pulmonary infarction due to anomalous ipsilateral pulmonary venous draingae and ligation of the veins by oversight during right lower lobectomy. The rest of the patients recovered uneventfully. On microscopical examination of the specimens a case of aspergillosis was noted, which has not been described previously in the literature in association of pulmonary sequestration. In one case acid-fast bacteria were found in the necrotic mass of the cavities in the sequestration.

Adolescent↗