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Biomedical subjects

L Egloff

Publications and source records attributed to L Egloff.

50 records · Page 3Linked to original sources
PubMed1982

The ascending aortic aneurysm: replacement or repair?

Between 1971 and 1980, 100 patients underwent operation for ascending aortic aneurysm. Acute dissection was present in 29, chronic dissection in 11; 56 had dilatation only, and 4 had inflammatory disease of the ascending aorta. Four different operative procedures were applied independent of the type of disease: repair and reduction aortoplasty (21), reduction aortoplasty reinforced by nylon net (17), supracoronary graft replacement (42), and composite graft replacement with reimplantation of both coronary ostia (20). Early mortality was 10%, and late mortality was 12% after a mean follow-up of 45 months. Retrospective comparative analysis of the four operative methods led to the following conclusion: reduction aortoplasty supported by a tightly wrapped synthetic net is a suitable method in patients with a normal sinus of Valsalva and without dissection or inflammatory disease. Particular attention needs to be drawn to the proximal anchor stitches to avoid late net displacement. Compared with supracoronary or composite graft replacement, this method carried a lower complication rate, particularly in regard to cerebrovascular accidents and myocardial infarction. For patients with acute and chronic dissection with intact aortic root, supracoronary graft replacement is preferred, whereas in those with annuloaortic ectasia with dilated sinus of Valsalva and in all patients with Marfan's syndrome, composite graft replacement has become the procedure of choice.

Adolescent↗
PubMed1982

Congenital aortic stenosis. Early and late results of aortic valvulotomy.

Between 1962 and 1979, 87 patients with congenital aortic stenosis (11 infants from 4 days to 5 months, and 76 patients from one year to 24 years) underwent open aortic valvulotomy; in 14 patients an additional subvalvular membraneous ring or hypertrophic subaortic stenosis was resected. There were 3 early deaths (3%), all in infants less than one year of age. A second operation was necessary 3 months to 10 years (mean 6.3 +/- 4 years) after the initial procedure in 12 of the 84 survivors. In 9 patients an aortic valve replacement and in 3 patients a second valvulotomy was performed without perioperative mortality: in the latter group valve replacement had to be performed later. There were 5 late deaths (6%). The causes of death were endocarditis (2), thrombosis of the prosthesis (1), accident (1) and sudden death (1). The overall actuarial survival curve shows a 5-year survival of 90% and a 10-year survival of 87%; 87% are reoperation-free after 5 years and 75% after 8 years. At present 7 patients are scheduled for surgery because of recurrence of stenosis; 61 patients are symptom-free. It is concluded that aortic valvulotomy has immediate and long-term benefit in the large majority of patients. Operative mortality and morbidity are low in patients older than one year of age. Nevertheless aortic valvulotomy, which should not be performed too late, represents a palliative treatment and will lead to reoperation in approximately 25% of patients after 8 years.

Actuarial Analysis↗
PubMed1982

Tricuspidal annuloplasty. Results and complications.

Between 1976 and 1979, 76 patients underwent tricuspid annuloplasty (TA) for predominant tricuspid regurgitation (TR). The TR was functional (secondary to mitral valve disease) in 70, postrheumatic in 4, posttraumatic in one and secondary to myxomatous degeneration in one. The mean preoperative functional class was 3.05 and cardiac index 2.15 +/- 0.53 l/min/m2. All but 8 were in atrial fibrillation. Pulmonary vascular resistance over 250 dyn x sec x cm-5 was present in 28 patients. The original de Vega technique was applied in 55, a modified annuloplasty technique was used in the remaining 21 cases. There were 3 early and 6 late deaths, none being related to annuloplasty. One early and 2 late complications were attributable to tricuspid annuloplasty. At control after 6 months, 64 of 72 patients had improved at least one functional class. Three presented moderate TR on clinical examination. Mean observation time now averages 30 months (20 to 48 months). De Vega annuloplasty is a safe and effective method for the treatment of functional TR. It is of particular value during the early postoperative period in preventing right ventricular overload.

Adolescent↗
PubMed1981

An experimental study on transannular patching of the right ventricular outflow tract with and without a pulmonary valve monocusp mechanism.

The efficacy of a pericardial patch in the right ventricular outflow tract (RVOT) with a monocusp valve mechanism was investigated experimentally. Hemodynamic performance of the right ventricle and angiographic competence of the valve were compared in animals after patching of the RVOT and removal of the pulmonary valve (group I), patching of the RVOT, removal of the pulmonary valve and implantation of a monocusp valve (group II), patching of the RVOT, partial removal of the pulmonary valve and implantation of a monocusp valve (group III) and a control group (IV). Postoperative effective right ventricular cardiac index, stroke volume and stroke work improved significantly from group I to III, but did not reach the control values of group IV. Angiographically the monocusp valve allowed some early diastolic regurgitation due to late closure (group II) if it was not supported by remnants of the animal's own pulmonary valve (group III).

Animals↗
PubMed1980

Reoperations after valvular heart surgery: indications and late results.

The incidence of reoperations after valvular heart surgery was higher after valve-preserving procedures and after valve replacement with biological prostheses than after implantation of mechanical prostheses. The indication for reoperation was elective in the vast majority of cases; usually it was due to progressive late deterioration of repaired valves or of tissue valves. Symptoms are not a sensitive indicator in timing the reintervention. Progression of clinical signs, radiological and ECG alterations and echocardiographic criteria must be followed closely once late deterioration has been diagnosed. Criteria for reoperation are basically the same as for primary valve surgery. Hemolytic anemia and recurrent emboli were rare indications for reoperation in the presented material. Paravalvular leak was the most frequent indication for reoperation following the implantation of mechanical heart valve prostheses. A number of valve-related complications requiring emergency reoperations are presented; immediate recognition of these conditons and immediat intervention are mandatory. Bacterial endocarditis remains a severe complication after valvular heart surgery and threatens patients with mechanical prostheses in particular. The late results of reoperations depend mainly upon the state of disease reached by the time of reintervention, i.e., upon the right timing of the reoperation.

Adult↗
PubMed1980

Congenitally corrected transposition of the great arteries: a clinical and surgical study.

From 1967 to 1979, 40 patients with the diagnosis of congenitally corrected transposition of the great arteries (C-TGA) have been followed. Associated cardiac defects were present in all but one patient, most frequently ventricular septal defect (80%), and pulmonary stenosis (70%). Left sided atrio-ventricular valve dysfunction developed in 25%, third degree atrio-ventricular block (at least intermittently) in 33% of the patients. Twenty-eight patients were operated: palliative procedures were done in 6, corrective operations in 22 patients. Ten of the 40 patients have died during a mean observation period of 4 years: 4 early postoperatively, 3 late postoperatively and 3 non-operated patients. Sudden unexplained cardiac arrest has been the most frequent cause of death (2 late postoperative and 2 non-operated patients). The incidence of residual ventricular septal defects and residual pulmonary stenosis after corrective surgery has been relatively high owing to the complex anatomy in these patients. Also reconstruction of the atrio-ventricular valves has been difficult because of severe deformities, particularly of the left side. It is concluded that in C-TGA the pacemaker should be implanted early, at the first sign of AV-conduction disturbance. Since the relief of the pulmonary stenosis is difficult, the operation should be deferred until an adequate-sized conduit can be implanted.

Adolescent↗
PubMed1979

Isolated mitral valve replacement with the Björk-Shiley tilting disc prosthesis.

Between July 1970 and June 1977, 151 patients underwent isolated mitral valve replacement with the Björk-Shiley valve. The follow-up period extended over 8 years to June 1978. Hospital mortality was 5.2% (8/151), late mortality 8.4% (12/143). Actuarial survival analysis predicts 84 (+/- 4) % of patients to be alive at 5 years and 80 (+/- 6) % at 8 years. Thirteen patients sustained 15 episodes of thromboembolic complications; actuarially 88 (+/- 4) % of patients were free from this complication at 5 years and 81 (+/- 8) % at 8 years. Other valve-related complications included paravalvular leak (7), prosthetion showed an improvement of at least one class in 84% of patients.

Adolescent↗
PubMedDate not supplied

Tetralogy of Fallot: to patch or not to patch?

Angiograms of 11 patients with Tetralogy of Fallot were reviewed before and after total repair, and analyzed with respect to growth of the pulmonary valve annulus. At the operation none of the patients was more than 5-years-old, none received a transannular patch and all were asymptomatic at the last visit. The radiologic diameter of the pulmonary valve annulus was compared to the descending thoracic aorta at the level of the diaphragm. Preoperative ratio averaged 1.09 +/- 0.22 and increased postoperatively to 1.35 +/- 0.20 (p less than 0.02). A "catch-up" growth of small annuli could be demonstrated.

Child, Preschool↗