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Biomedical subjects

M Enriquez-Sarano

Publications and source records attributed to M Enriquez-Sarano.

80 records · Page 5Linked to original sources
PubMed1984

[Should closed-heart mitral commissurotomies still be performed? Apropos of 168 operations, 108 open-heart and 60 closed-heart].

Mitral commissurotomy is known to give good results but the best surgical technique (open heart or closed heart) remains uncertain. Results of open heart commissurotomy (OC), 108 patients (Group I) and closed heart commissurotomy (CC), 60 patients (Group II) were compared. The population comprised 81% females and the average age was 39 +/- 12 years. Only cases of pure or very predominant mitral stenosis (MS) were included. The preoperative state of the patients in Group I was poorer than the one in Group II (repeat commissurotomy 8.3% compared to 1.7%, p less than 0.04; associated mitral regurgitation 41% compared to 27%, p less than 0.04; cardiothoracic ratio 0.54 +/- 0.07 compared to 0.51 +/- 0.06, p less than 0.01). A more complete surgical cure was possible in Group I. Both commissures were liberated in 99% of OC compared to 25% CC (p less than 0.001). Mitral valvuloplasty was associated in 87% of OC (63 cases on the papillary muscles, 21 cases on the chordae tendinae and 60 cases on the mitral annulus). Operative mortality was low and did not differ significantly between the two groups (zero in CC; 1.8% in OC). Overall survival rates were excellent (95% 5 year survival, 85% 7 year survival). The reoperation rate at 5 years was 7.4% and at 7 years, 23.9%, and did not differ with the surgical technique used. The functional result was good (patients in Class I or II of the NYHA classification 84% at 5 years; 75% at 7 years; identical for both groups). Significant late valvular "dysfunction" was rare after OC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Valve replacement, a possible factor in myocardial deterioration].

Cardiopulmonary bypass (CPB) may be a cause of myocardial damage in a small number of patients undergoing valve replacement (4 out of 1576 valve replacements). The responsibility of CPB can only be presumed when: the degree of myocardial dysfunction after surgery can be quantified, other causes of myocardial dysfunction are excluded. the type of valvular disease is taken into consideration. Variations in load after correction of certain lesions (mitral regurgitation) makes changes of LV systolic function difficult to interpret. The first case concerned a 23 year old patient operated for aortic regurgitation (Björk prosthesis) under local and general hypothermia and followed-up for 1 year after surgery. Ventricular extrasystoles and left bundle branch block were observed during surgery and radiological and echocardiographic LV dilatation persisted with deterioration of echographic, isotopic, haemodynamic and angiographic parameters of LV function: ejection fraction fell from 62% before surgery to 35% with diffuse hypokinesia and persistent LV dilatation (191 vs 188 ml). In the absence of prosthetic valve dysfunction, associated valve lesions or coronary artery disease, LV deterioration was attributed to CPB and inadequate myocardial protection. In two other cases (60 and 62 years) correction of aortic stenosis (Starr 1260) with coronary perfusion was followed by cardiac failure with left bundle branch block, deterioration of LV function, and death after 3 years in one case and precarious survival at 10 years in the other. In a fourth case (mixed mitral valve disease corrected by a Starr prosthesis under aortic clamping), the variation of cardiac load before and after surgery made changes in LV function difficult to interpret. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Hemodynamic and angiographic results following surgical correction of mitral insufficiency. Apropos of 51 repeated catheterizations].

The benefits of surgical correction of mitral incompetence were assessed in 51 patients by comparing pre and postoperative catheter and quantitative angiographic results. The mean age of the patients was 43.5 +/- 12.3 years. The mitral lesions were elongation or ruptured chordae (27 cases), valvular perforation due to endocarditis (1 case) and the usual rheumatic disease in 23 cases. Hemodynamic investigation was carried out on average 2 months before operation and 29 +/- 22 months after surgery. The following angiographic parameters were measured : indexed end diastolic and end systolic volumes (EDV and ESV), ejection fraction (EF), myocardial mass (MM) and its ratio to EDV (hypertrophy coefficient : HC) and the geometry of the ventricle as assessed by diastolic and systolic coefficients of excentricity (DE and SE). Surgery comprised 13 mitral valvuloplasties and 38 valve replacements. Patients who suffered perioperative myocardial infarction or who had a residual valvular lesion were excluded from the study. After surgery, the hemodynamic state was considerably improved with a significant decrease in pulmonary capillary pressures (11 +/- 5 compared to 17 +/- 6 mmHg, p less than 0.09) and mean pulmonary artery pressures (19 +/- 7 compared to 27 +/- 11, p less than 0.01) and increase in cardiac index (2.8 +/- 0.7 compared to 2.3 +/- 0.6 l/min/m2, p less than 0.01). There was an associated decrease in ventricular volumes (EDV : 115 +/- 44 compared to 165 +/- 43, p less than 0.01) (ESV : 60 +/- 39 compared to 77 +/- 22, p less than 0.001). The reduction in myocardial mass was less spectacular (129 +/- 40 compared to 148 +/- 32, p less than 0.01) with a resulting increase in the HC (1.10 +/- 0.26 compared to 0.88 +/- 0.17, p less than 0.001). The geometry of the LV was less spherical in diastole (DE 0.76 +/- 0.08 compared to 0.70 +/- 0.08, p less than 0.001) and in systole (SE = 0.83 +/- 0.06 compared to 0.77 +/- 0.08, p less than 0.001). The EF fell slightly but this was not statistically significant (0.51 +/- 0.13 compared to 0.53 +/- 0.09 NS). The surgical result of 14 patients with PCP greater than or equal to 13 mmHg was considered hemodynamically incomplete, and this was confirmed by a lower cardiac index than in the remaining 37 patients (2.4 +/- 0.5 compared to 3.0 +/- 0.7, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1983

[Unusual development of ventricular aneurysms. Echocardiographic diagnosis].

Two cases of posterior left ventricular aneurysms compressing the left atrium diagnosed by 2D echocardiography are reported. The diagnosis was made on visualisation of an abnormal intra-left atrial cavity, contiguous with the mitral ring, exhibiting systolic expansion, which could not be opacified by peripheral venous injection of echo-contrast.

Adult↗
PubMedDate not supplied

Timing of surgery in patients with chronic, severe mitral regurgitation.

Patients with severe mitral regurgitation (MR) who are managed conservatively sustain excess mortality and morbidity. With improved mortality and morbidity rates being achieved with surgical management, cardiologists and cardiac surgeons are becoming more aggressive in treating patients with severe MR with surgery. Recent data indicate that even in the absence of symptoms or left ventricular dysfunction, surgery should be offered as a treatment for MR, provided that the regurgitation is severe, the valve seems to be repairable, and the surgeon is experienced in valve repair and is aided by intraoperative transesophageal echocardiography.

Chronic Disease↗
PubMedDate not supplied

Echocardiographic assessment of mitral regurgitation.

Although the natural history of mitral regurgitation (MR) is poorly defined, evidence has been found for excess mortality and morbidity in patients with severe MR who are managed conservatively. With improved mortality and morbidity in the surgical management of this condition, we are becoming increasingly aggressive in offering surgery to patients with severe MR. Surgery may be offered even in the absence of symptoms or left ventricular dysfunction, provided that the valve seems reparable, the patient's MR is severe, and the surgical team is experienced in valve repair. Echocardiography is critically important in determining the feasibility of valve repair and accurately assessing the severity of the patient's MR. It also allows assessment of the effect of MR on the left ventricle and the left atrium.

Atrial Function, Left↗