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Biomedical subjects

K V Hall

Publications and source records attributed to K V Hall.

At least 73 records · Page 4Linked to original sources
PubMed1976

Surgery in acute and chronic pericarditis. Pathophysiology and management.

Forty-two cases of surgically treated pericarditis are presented, with comments on the management and pathophysiology of the acute, recurrent, and chronic stages of the disease. The spectrum of aetiological factors has changed within the last few decades in that tuberculosis is now rare, whereas uraemic pericarditis is referred to surgery with increasing frequency. With the advent of haemodialysis and renal transplantation, these cases should be treated vigorously, since they are amenable to surgical cure. Rapid surgical intervention is advocated in impending tamponade, and in all other acute cases which do not respond promptly to conservative management. In recurrent and chronic pericarditis, surgery is also preferable to long-term medical treatment with steroids and diuretics. Chronic pericarditis should not be allowed to progress to an advanced stage of disease with myocardial involvement and impairment of liver function. Early operation carries little hazard and gives lasting relief in the majority of cases. Microscopical examinations and laboratory analyses point towards an abnormal permeability of capillaries and visceral pericardium as an early and major event in the development of pericardial effusions. Destruction or preservation of the mesothelial cell lining is probably an important factor in determining the progression of acute disease towards adhesions and constriction.

Acute Disease↗
PubMed1976

Experiences with various types of mitral valve prostheses.

During the period 1967-1973, four different types of mitral valve prostheses were used by the same surgical group. Altogether 139 patients are included in this study. With the exception of the surgical approach, the operative technique was the same in all groups. The total mortality varied from 17% in the group receiving the Björk-Shiley valve to 40% in the Beall valve group. Thrombo-embolic complications were responsible for three deaths in the Beall and one death in the Lillehei-Nakib group. All patients had been on the adequate anticoagulant therapy. At follow-up, 40 to 77% of the patients had improved functional class, the best results being obtained in the Björk-Shiley group. The diastolic gradients across the prosthetic valves varied from 9 to 4 mmHg at rest. Again, the Björk-Shiley valve gave the most favourable result. The results and significance of the various parameters are briefly discussed.

Female↗
PubMed1976

The Mustard operation for transposition of the great arteries (TGA). Technical considerations.

Among the late complications described after Mustard's procedure, obstructions of the pulmonar veins. SVC or IVC have been the most serious ones. We consider that these complications are mostly related to the size and shape of the baffle and also to the way in which it is sutured into place. No such complications have hitherto been encountered in our patients. We feel that the technique described may help in the standardization of the Mustard procedure as well as tailoring of the baffle. Thereby this procedure is more easily reproduced and the frequency of late complications possibly reduced.

Adolescent↗
PubMed1976

Total correction of Fallot's tetralogy.

Eighty-six patients with Fallot's tetralogy underwent total correction; 80% of them were less than 15 years old. Twenty-five patients were operated upon with primary intracardiac repair, while 61 had undergone some form of palliative heart surgery previously. A patch of woven Dacron was used in the outflow tract reconstruction in 9 cases. The total mortality was 28%, 11 of the 23 deaths were presumed to be caused by low cardiac output, arrhythmia and cardiac arrest. The 62 patients surviving surgery have continuously had a good result and are without disability. The reasons for the relatively high mortality in this series, as well as the controversy concerning the one-stage or the two-stage approach for repair of Fallot's tetralogy, are briefly discussed.

Adolescent↗
PubMed1976

Intra-aortic balloon pumping in the treatment of cardiogenic shock following open-heart surgery.

Intra-aortic balloon pumping (IABP) was used in the treatment of 29 patients in cardiogenic shock refractory to pressor drugs subsequent to open-heart surgery. Nineteen patients recovered from the shock primarily, but four died later in hospital. The remaining 15 were discharged alive. Peroperative electromagnetic flow measurements in one patient showed a 23% increase in aortic flow and a 26% increase in aortocoronary bypass flow when pumping was started.

Adult↗
PubMed1976

Reemployment related to functional and haemodynamic changes after aortic or mitral valve replacement.

The objectives of this longitudinal study were to determine the proportion of individuals who return to work following aortic or mitral valve replacement, and to compare the functional and haemodynamic status in those who return to work with those who do not return to work. The study includes a total of 133 subjects who were all examined 12--24 months after the operation. Based on this investigation, an overall reemployment rate of 44 % was found. Return to work was more frequent in the younger group than in the older group. Furthermore, while the patient's opinion of the extent of his physical handicap was of some importance when return to work was discussed, there did not appear to be any significant relationship between the working or the non-working group and objective indices of improvement as decrease in heart volume, regression of left ventricular hyperthrophy in the electrocardiogram, increase in cardiac output and decrease in pulmonary wedge pressure. Most important was the observation that the rate of return to work was closely related to the employment status before operations. The conclusion reached was that individuals who return to work were more likely to be those who were employed up to the time of the operation, while return to work after a long period of unemployment before operation was unusual, irrespective of the surgical results.

Adolescent↗
PubMed1976

The prognostic factors of arterialized bypass veins in the lower extremities.

A follow up study on 251 in situ bypass procedures on the lower extremities is done 3 years postoperatively. Patency of the bypass is correlated to smoking habits, anticoagulant therapy, age at operation and the diameter of the vein bypass. At follow up 13% of the patients had died and 217 extremities in 195 patients were examined. Using the Chi-square test we found that patency of the bypasses was primarily dependent uon the diameter of the bypass vein, and secondly on smoking habits and anticogulant therapy. Age was only of minor importance for patency.

Age Factors↗
PubMed1975

"In situ" evaluation of the aortic pivoting disc valve prosthesis.

An index of the "in situ" forward flow characteristics of an aortic valve prosthesis is suggested. The effective area index, Ia, is defined as the ratio between the effective orifice area, Aeff, and the area occupied by the valve in the aortic root. Aeff is calculated from a hydraulic formula using peroperative measurements of instantaneous ascending aortic flow, Fao, and the pressure gradient, deltaP. Ia was found to be 0.29 +/- 0.33 (S.D.) for Lillehei-Kaster valves and 0.32 +/- 0.059 (S.D.) for Björk-Shiley valves. The variations in valve performance among the Björk-Shiley valves may partly be due to differences in valve orientation in the aortic root. Attention should therefore be given to the choice of the opening direction of the disc in order to optimize valve performance in the patient.

Aortic Valve Insufficiency↗