Biomedical subjects

M Havel

Publications and source records attributed to M Havel.

At least 19 recordsLinked to original sources

PubMed2000

Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts.

BACKGROUND: This study was performed to evaluate the safety and feasibility of endovascular stent graft placement in the treatment of descending thoracic aortic aneurysms. METHODS: Between November 1996 and February 1999, endovascular stent graft repair was used in 21 patients. There were 5 women and 16 men with a mean age of 67 years (range, 41 to 87 years). An atherosclerotic aneurysm with a diameter of more than 6 cm was the indication for intervention in 19 patients (90.5%). In 2 patients (9.5%), a localized aortic dissection with a diameter of more than 6 cm was treated. In 71.4% (15 of 21) of patients, multiple stents were necessary for aneurysm exclusion. To allow safe deployment of the stent graft, preliminary subclavian-carotid artery transposition was performed in 9 patients (42.9%). Vascular access was achieved through a small incision in the abdominal aorta (n = 6), an iliac artery (n = 8), or a femoral artery (n = 7). Talent and Prograft stent grafts were used. RESULTS: Successful deployment of the endovascular stent grafts was achieved in all patients. Two patients died postoperatively (mortality rate, 9.5%), 1 of aneurysmal rupture and the other of impaired perfusion of the celiac axis. Repeat stenting was done in 3 patients because of intraoperative leakage. CONCLUSIONS: Endovascular stent graft repair is a promising and less invasive alternative to exclude the aneurysm from blood flow. This technique allows treatment of patients who are unsuitable for conventional surgical procedures. An exact definition of inclusion criteria and technical development of stent grafts should contribute to further improvements in clinical results.

Adult↗

PubMed1999

Impact of retrograde cerebral perfusion on aortic arch aneurysm repair.

OBJECTIVE: Protection of the brain is a primary concern in aortic arch surgery. Retrograde cerebral perfusion is a relatively new technique used for cerebral protection during profound hypothermic circulatory arrest. This study was designed to compare, retrospectively, the outcome of 109 patients undergoing aortic arch operation with and without the use of retrograde cerebral perfusion. METHODS: Fifty-five patients had profound hypothermic circulatory arrest alone, and 54 patients had supplemental cerebral protection with retrograde cerebral perfusion. Mean age was 61 +/- 13 years and 58 +/- 14 years, respectively (mean +/- standard deviation). Twenty-two preoperative and intraoperative characteristics, including age, sex, acuity, presence of aortic dissection, and aneurysm rupture, were similar in the 2 groups (P >.05). RESULTS: Mean circulatory arrest times (in minutes) were 30 +/- 19 in the group without retrograde cerebral perfusion and 33 +/- 19 in the group with retrograde cerebral perfusion, respectively. chi(2) Analysis revealed that patients operated on with the use of retrograde cerebral perfusion had significantly lower hospital mortality (15% vs 31%; P =.04) and in-hospital permanent neurologic complications (9% vs 27%; P =.01). Retrograde cerebral perfusion failed to reduce the prevalence of temporary neurologic dysfunction (17% vs 18%; P =.9). Stepwise multiple logistic regression revealed that extracorporeal circulation time, age, and lack of retrograde cerebral perfusion were statistically significant independent risk factors for hospital mortality. The same analysis revealed that lack of retrograde cerebral perfusion was the only significant independent risk factor for permanent neurologic dysfunction. CONCLUSION: Retrograde cerebral perfusion decreased the prevalence of permanent neurologic complications and the hospital mortality in patients undergoing aortic arch operations.

Adult↗

PubMed1999

Memantine for prevention of spinal cord injury in a rabbit model.

BACKGROUND: This study was conducted to investigate the effect of memantine, a noncompetitive N-methyl-d-aspartate receptor antagonist, on the neurologic outcome of spinal cord ischemia after aortic occlusion. MATERIALS AND METHODS: New Zealand White rabbits were anesthetized and spinal cord ischemia was induced for 40 minutes by infrarenal aortic occlusion. Animals were randomly allocated to 3 groups. Group 1 (n = 8, control) received no pharmacologic intervention, group 2 (n = 8) received intra-aortic memantine infusion (20 mg/kg) after aortic crossclamping, and group 3 (n = 8) was treated with systemic memantine infusion (20 mg/kg) 45 minutes before aortic occlusion. Neurologic status was scored by the Tarlov system (in which 4 is normal and 0 is paraplegia) at 12, 24, 36, and 48 hours after the operation. Lumbar spinal root stimulation potentials and motor evoked potentials from lower limb muscles were monitored before, during, and after the operation. After the animals were killed, the spinal cords were studied histopathologically. RESULTS: All potentials disappeared shortly after aortic crossclamping. They returned earlier in both memantine-treated groups than in the placebo group. Histologic examination of spinal cords revealed a few abnormal motor neurons in memantine-treated rabbits but found extensive injury in the control group. At 12 hours the median Tarlov scores were 0 in the control group (group 1), 2 in the intra-aortic memantine group (group 2, P =.001 versus control), and 3 in the systemic group (group 3, P =.0002 versus control). At 24 hours median Tarlov scores were 0, 2.5 (P =.0002), and 4 (P =. 0002), respectively. Finally, at both 36 and 48 hours median Tarlov scores were 0, 3 (P =.0006), and 4 (P =.0002), respectively. CONCLUSION: Memantine significantly reduced neurologic injury related to spinal cord ischemia and reperfusion after aortic occlusion.

Animals↗

PubMed1998

Perioperative risk factors for mortality in patients with acute type A aortic dissection.

BACKGROUND: Patients with acute type A aortic dissection are associated with a high mortality rate and postoperative complications. This study was designed to explore perioperative risk factors for death in patients with acute type A aortic dissection. METHODS AND RESULTS: One hundred nine consecutive surgical patients with acute type A aortic dissection were included in the present study. Thirty-five perioperative risk factors were used in the statistical analysis for mortality prediction. The 30-day mortality rate for all patients was 30% (33 of 109). Univariate analysis revealed 5 preoperative and intraoperative risk factors that were found to be statistically significant predictors for death: older age, renal failure, preoperative hemodynamic instability, preoperative cardiopulmonary resuscitation, and lack of retrograde cerebral perfusion (P < 0.05). Rupture of aneurysm, hypothermic circulatory arrest time, and operation date were not found to be risk factors for death. Stepwise multiple logistic regression confirmed that older age and lack of retrograde cerebral perfusion were statistically significant independent risk factors for death (P < 0.05). Four postoperative complications were found to be statistically significant prognostic indicators for death: liver failure, stroke, sepsis, and reoperation after the initial surgery (P < 0.05). CONCLUSIONS: Perioperative risk factors for death after the operation for acute type A aortic dissection were identified. This will allow physicians and surgeons to better assess the patient's risk, which will lead to better outcome.

Acute Disease↗

PubMed1998

Endovascular stent graft repair for aneurysms on the descending thoracic aorta.

BACKGROUND: The traditional treatment of aneurysms of the descending thoracic aorta includes posterolateral thoracotomy and aortic replacement with a prosthetic graft. In this study, we report our experiences and results in endovascular stent graft placement as an alternative to surgical repair. METHODS: Between January 1989 and July 1997, a total of 68 patients (24 women) underwent replacement of the thoracic aorta. Mean age at operation was 51 years. Fifty-eight patients underwent conventional surgical treatment. All of these patients were suitable candidates for endovascular stenting; however, no stent graft material was available at the time of operation. Ten patients (1 chronic dissection, 9 atherosclerotic aneurysm) received in the past 8 months the first commercially manufactured endovascular stent graft. The mean diameter of the aneurysms in this group was 7 cm (range, 6 to 8 cm). Two stent patients were operated on using only spinal cord analgesia. All stent grafts were custom designed for each of the 10 patients. RESULTS: The 30-day mortality in the conventional group was 31% versus 10% in the stent group. Mean length of intervention was 320 minutes in the conventional group versus 150 minutes in the endovascular group. Spinal cord injury occurred in 5 patients (12%) in the surgical group, whereas none of the stented patients developed any neurologic sequelae. Mean intensive care unit stay was 13 days, followed by a mean of 10 days on a ward in the first group compared to 4 days in the intensive care unit and 6 days on the ward in the stent group. One stent was required in 2 patients, two stents were required in 3 patients, and four stents were deployed in 5 patients of our series. Five patients required transposition of the left subclavian artery to achieve a sufficient neck for the proximal placement of the stent. There was complete thrombosis of the thoracic aortic aneurysm surrounding the stent graft in 8 patients (80%). Two patients required restenting as a result of leakage (20%). Stent graft placing was performed through the femoral artery in 8 patients, whereas access was only achieved through the abdominal aorta in 2 patients. CONCLUSIONS: These preliminary results demonstrate that endovascular stent graft replacement might be a promising, cheaper, and safe alternative method in selected patients with descending thoracic aneurysms.

Adult↗

PubMed1998

Operations on the thoracic aorta and hypothermic circulatory arrest: is aprotinin safe?

INTRODUCTION: The safety of aprotinin, especially when used with profound hypothermic circulatory arrest, is still a matter of intense debate despite its presumed salutary effects on blood loss. Many investigators have reported toxic renal effects of high-dose aprotinin in such patients, but no prospective, randomized study has been conducted. To assess the potential detrimental effect of aprotinin on renal function and its putative reduction of blood loss, 50 patients undergoing thoracic aortic operations with the use of profound hypothermic circulatory arrest were randomly assigned to receive either low-dose aprotinin (1 x 10(6) kallikrein activation units) or placebo. METHODS: The specific renal tubular markers beta-2-microglobulin and beta-N-acetyl-D-glucosaminidase, as well as serum creatinine and blood urea nitrogen, creatinine clearance, sodium excretion, and potassium excretion, were measured to evaluate renal function preoperatively, immediately after the procedure, and 24 hours and 48 hours later. RESULTS: No statistically significant difference was found in any measured renal parameter between the two groups (analysis of variance). Renal dysfunction, defined as an elevation of serum creatinine early postoperatively (> or = 1.5 times the preoperative value), occurred in two patients who received aprotinin and in one patient in the control group. Temporary dialysis (hemodialysis or continuous venovenous hemofiltration) was needed in two patients in the aprotinin group versus one in the control group. Furthermore, patients treated with aprotinin had significantly less total postoperative blood loss (718 +/- 340 ml vs 920 +/- 387 ml, p = 0.04). The aprotinin recipients also had a significantly lower transfusion requirement (p < 0.05). CONCLUSION: This controlled trial of low-dose aprotinin in patients undergoing thoracic aortic operations using profound hypothermic circulatory arrest demonstrated no detectable deleterious effects on renal function; moreover, the use of aprotinin was associated with significantly lower need for transfusion.

Aged↗

PubMed1998

[Spatial and temporal accessibility of primary health care by the patient--a survey in Dresden/Saxony].

The structural changes in outpatient medical care in eastern Germany took place by far-reaching winding up of the outpatient departments. At the same time, many doctors from these institutions set up a practice. These changes also concerned the medical care by family doctors. It is assumed that as a result of these partly extensive changes there are also changes in the accessibility of the family doctor by outpatients. We will describe in this paper the level attained in Dresden, capital of Saxony in 1995 and 1996, from the point of view of the inhabitants. Existing problems are shown. In this connection, random samples of inhabitants of Dresden were interviewed by postal survey with questions on this subject in 1995 and 1996.

Adult↗

PubMed1998

[Selected aspects for quality assurance in family practice].

All general practitioners of Dresden, the capital of Saxonia, were interviewed about problems of the quality assurance twice, 1995 and a year after. In 1995, the response rate was 60.7%, in 1996 83.8% of the first participants. The majority of the doctors are interested in the quality assurance of the medical care by family doctors including their own work. In their view, the different possibilities of the quality assurance and the various kinds of further medical training are of different importance. This estimation can depend on the age and sex of the physicians and on the kind of practice-organization.

Adult↗

PubMed1997

Surgical treatment of aortic arch aneurysms in profound hypothermia and circulatory arrest.

BACKGROUND: This study was undertaken to define the factors that influence mortality rate and neurologic outcome after repair of the aortic arch and various portions of the thoracic aorta in patients with profound hypothermia and circulatory arrest. METHODS: Between November 1986 and January 1996, 105 patients were treated surgically for aortic disease involving the transverse aortic arch. Profound hypothermic circulatory arrest and selective brachiocephalic perfusion was used in all patients. In 19 patients retrograde cerebral perfusion was instituted during the period of circulatory arrest. Independent predictors for 30-day mortality and permanent neurologic deficits were evaluated by multiple logistic regression. RESULTS: Thirty-day mortality for the entire group was 19% (20/105); 21.2% for urgent versus 15.4% for elective cases, respectively. Statistical analysis showed that age is the most important factor that significantly influences mortality rate (p < 0.0145) and neurologic outcome (p < 0.006). Variables such as circulatory arrest time (p < 0.24), previous cardiac or aortic operations (p < 0.19), and sex (p < 0.55) failed to show any influence on mortality rate. Permanent neurologic deficits were diagnosed in 12.9% (11/85) of the patients. CONCLUSIONS: The incidence of permanent neurologic dysfunction as well as the mortality rate are predominantly related to the age of the patient. In this patient group, statistical analysis failed to show a direct correlation between duration of circulatory interruption and neurologic outcome.

Adolescent↗

PubMed1997

The use of profound hypothermia and circulatory arrest in operations on the thoracic aorta.

OBJECTIVE: This retrospective study reviews the contemporary surgical outcome of our patients undergoing operations on thoracic aneurysms in deep hypothermic circulatory arrest. METHODS: Between January 1989 and February 1995, 279 patients were operated on in our institution on various portions of the aorta. In 143 patients (97 male, 46 female), deep hypothermia and circulatory arrest were used as the standard operative technique. Patients age ranged from 16 to 83 years (mean 55). Final indication for operation was dissection Type A in 80 patients (61 acute, 19 chronic), dissection Type B in 21 patients (17 acute, 4 chronic) and atherosclerotic aneurysms in 42 patients (11 acute, 31 chronic). 16 patients were operated under preoperative unstable hemodynamic conditions, 6 patients had been resuscitated preoperatively. Surgical technique included cardiopulmonary bypass with femoral artery cannulation. For added cerebral protection all patients received Cortisone and barbiturates right before circulatory arrest (confirmed by 0-EEG). The segment of the aorta containing the area with the aneurysm, was resected and replaced with a tubular albumin coated graft. RESULTS: The 30-day mortality was 31.15% (19/61) in the acute and 23.52% (4/19) in the chronic type A dissection group, 35.29% (6/17) in the acute and 25% (1/4) in the chronic type B group, 36.3% (4/11) in the acute and 22.58% (7/31) in the chronic atherosclerotic group. Causes of postoperative death in order of frequency were: multiorgan failure (n = 15), myocardial failure (n = 13), bleeding (n = 4), sepsis (n = 4), myocardial infarction (n = 3) and stroke (n = 2). CONCLUSION: Despite rather high mortality rates in the acute aneurysm groups, the technique of profound hypothermic circulatory arrest represents a relatively safe method for operations on the thoracic aorta.

Adolescent↗

PubMed1996

Operative management of aortic arch aneurysm using profound hypothermia and circulatory arrest.

Since the first successful replacement of the aortic arch with perfusion of the head, various methods have been employed to preserve cerebral function during aneurysm operations. Although deep hypothermia was used for surgery of the aortic arch, as early as 1963, the introduction of prolonged circulatory arrest has simplified replacements of the aortic arch. Between October 1990 and September 1993, 69 patients underwent aortic arch replacement for aneurysmal disease at the Dept. of Cardio-Thoracic Surg., University of Vienna. 52 patients had an acute dissection Type A, 17 patients were operated on electively. The patients age (48 male, 21 female) ranged between 16 and 81 years. Primary diagnosis was hypertension (n=44), marfan (n=14), unknown (n=10) and trauma (n=1). Total cardiopulmonary bypass was established via femoral artery cannulation. All patients received Cortison and Thiopental for added cerebral protection. Deep hypothermia (12 degrees C), confirmed by 0-EEG, and circulatory arrest were induced in all patients. The aneurysm was opened longitudinally and a full thickness single patch or "island" of aortic wall, containing the origins of the three arch vessels, was constructed and anastomosed in a continuous fashion to an albumin coated graft. 68 patients survived the operation (intraoperative mortality 1%). The 30-day mortality was 23% (n=16). Twelve patients died of multiorgan failure, two patients of a stroke and two due to myocardial infarction. The mean cerebral circulatory arrest time was 32 minutes (range 11-61 min.). Our experience with aortic arch replacements using profound hypothermia and circulatory arrest supports our contention, that it is the method of choice in this very difficult surgical field.

Adolescent↗

PubMed1995

Transoesophageal echocardiographic follow-up of patients with surgically treated aortic aneurysms.

In the present study, biplane transoesophageal echocardiography (TEE) was scheduled as part of an aneurysm surveillance programme during routine ambulatory follow-up of 37 patients following aortic aneurysm surgery. Time from surgery ranged from 3-72 months. Twenty-two patients had had aortic dissection and 15 non-dissecting aneurysms. Nineteen patients received an interposition graft of the ascending aorta, 12 valved conduit and six an interposition graft of the descending thoracic aorta. TEE showed enlargement of the sinus of Valsalva > 45 mm in seven patients. Dilatation > 45 mm of one or more aortic segments was found in four patients. An intimal flap was present in all patients, with primary aortic dissection if the initial dissection extended beyond the replaced segment. This was the case in 17 of 22 patients with aortic dissection. One to four intimal tears were identified in 15 of these patients. In all patients with intimal tears, flow was detected by colour flow Doppler in the false lumen. Thrombus formation was nil or minimal in the false lumen in 12 patients. TEE significantly influenced further management in 14 of 37 patients (38%). More frequent follow-up was scheduled in eight patients. Aortic surgery was performed electively for the second or third time in six patients based on TEE findings. We conclude that after surgical repair of aortic aneurysm, the incidence of pathological findings by TEE is high. These may have significant influence on further patient management and emphasize the need for careful follow-up.

Adult↗

PubMed1995

Surgical treatment of type A aortic dissections. Results with profound hypothermia and circulatory arrest.

Type A aortic dissection still presents an emergency situation in cardiac surgery that is associated with high morbidity and mortality rates. There has been a significant improvement in the surgical outcome since the introduction of deep hypothermia and circulatory arrest. In this study, we discuss our results after operative repair of ascending aortic dissections, using deep hypothermia and circulatory arrest. This study presents the results of 67 patients (43 men, 24 women) from 18 through 81 years of age (mean, 54 years) who underwent surgery for type A dissecting aneurysm over a period of 4 years. Type A dissection (52 acute and 15 chronic cases) was due to Marfan syndrome in 12 patients, to atherosclerotic disease of the aorta in 27 patients, and to traumatic injury in 1 patient. Hypertension as the only pathologic finding was observed in 27 patients. Deep hypothermia (confirmed by isoelectric electroencephalogram) and circulatory arrest were induced in all patients. Two patients died intraoperatively due to massive bleeding (intraoperative mortality, 3%). The 30-day mortality rate was 30% (n = 20). Causes of perioperative deaths in order of frequency were multi-organ failure (n = 11), myocardial infarction (n = 2), postoperative bleeding (n = 2), cerebrovascular insult (n = 2), and sepsis (n = 1). The mean intensive care unit stay of the surviving 47 patients (72%) was 8 days, followed by a mean of 21 additional days in the hospital. Our experience with profound hypothermia and circulatory arrest, used in combination with coated grafts, supports our conviction that this is the method of choice for the treatment of type A dissecting aneurysm.

Adolescent↗

PubMed1995

[Surgery of thoracic and thoraco-abdominal aneurysms using deep hypothermia and cardiovascular arrest with continuous administration of blood cardioplegia].

Between January 1991 and February 1993, 14 patients (3 female, 11 male) aged between 21 and 79 years (mean 50 years) underwent reconstruction of the thoracic (n = 7) and thoracoabdominal aorta (n = 7). Four patients had previously undergone operation of the ascending aorta, in 3 patients coronary artery by pass grafting was performed before. All patients were operated using cardiopulmonary bypass with continuous blood cardioplegia, hypothermic circulatory arrest (11 degrees C nasopharyngeal temperature, 0-EEG) and posterolateral exposure. All patent lower intercostal and lumbar arteries (Th3-L5) were reimplanted. The 30-day mortality after repair of the thoracic aorta was 0, after replacement of the thoracoabdominal aorta 28.5% (n = 2). One patient died 70 days after replacement of the thoracic aorta as a consequence of a perioperative stroke. None of the surviving 11 patients developed a permanent neurologic deficit, renal or cardiac dysfunction. The average intensive care stay was 6 days for patients after replacement of the thoracic and 18 days for patients after replacement of the thoracoabdominal aorta. Our results indicate the method of elective hypothermia and circulatory arrest effective in spinal cord protection. The increase in the tolerable duration of spinal cord ischemia supports the reimplantation of all intercostal and lumbar vessels.

Adult↗

PubMed1995

Aortic valve resuspension in ascending aortic aneurysm repair with aortic insufficiency.

BACKGROUND: The known complications of prosthetic valve replacement in patients with an ascending aortic aneurysm and secondary aortic regurgitation who frequently have a morphologically normal aortic valve have prompted interest in valve-sparing aneurysm repair procedures. The aim of this study was to define the echocardiographic criteria for identifying suitable candidates for ascending aortic aneurysm repair that spares the aortic valve. We also examined the perioperative and intermediate-term results of this innovative procedure. METHODS: Fifteen patients underwent ascending aortic replacement with resuspension of the native valve within a vascular prosthesis and reimplantation of the coronary ostia. Echocardiography was performed preoperatively and intraoperatively, before discharge, and during follow-up. Thirteen patients had nondissecting aneurysms, and 2 patients had a Standford type A aortic dissection. The mean age of the patients was 48 +/- 18 years. Only patients with morphologically normal aortic leaflets and leaflets of similar size were selected. RESULTS: There was one death perioperatively, and this was due to sepsis. The procedure failed in 1 patient, and a valved conduit was implanted during the same operation. In the 13 others the aortic annulus diameter was significantly reduced from 27.1 +/- 2.2 mm preoperatively to 22.2 +/- 1.9 mm postoperatively (p < 0.05). The severity of aortic insufficiency decreased from 2.9 +/- 0.7 to 0.6 +/- 0.4 (p < 0.05). The peak aortic gradient increased from 11.5 +/- 6.5 to 20.3 +/- 16 mm Hg. A slight increase in the aortic annulus diameter to 24.3 +/- 1.0 mm and normalization of the peak aortic gradient to 9.8 +/- 7.8 mm Hg were noted at follow-up. There was no significant increase in aortic insufficiency. CONCLUSIONS: In selected patients undergoing ascending aortic aneurysm repair who have normal aortic leaflets but secondary aortic regurgitation, the native valve can be spared through this novel operation. The aortic annulus size is reduced significantly, thereby effectively eliminating hemodynamically significant aortic regurgitation. The intermediate-term results are promising, but the long-term durability of this type of repair needs to be determined.

Adult↗

PubMed1995

[Results of valve-sparing correction of aortic valve insufficiency].

The risk of valve-related complications and the necessity of anticoagulation in patients with prosthetic valves, has led to new operative techniques in the correction of severe aortic insufficiency. In the last 2 years, 35 patients (mean age 41.3 years, range 10-80 years) with aortic insufficiency underwent reconstructive valves surgery. Eighteen patients had a commissuroplasty with or without triangular resection. In 5 patients with perforation, the valves could be reconstructed with a pericardial patch. In 12 patients with insufficiency due to aortic aneurysm, the valves were resuspended within the aortic prosthesis. In 2 patients the aortic valves were replaced intraoperatively because of unsatisfactory results. The perioperative mortality was 5.7%. The echocardiographic degree of aortic insufficiency decreased from 3.3 +/- 0.5 preoperatively to 0.45 +/- 0.53 postoperatively. Two patients were reoperated within the first week. Five of 23 patients at 1-year follow-up have mild to moderate aortic insufficiency. Mean ventricular dimensions and function at discharge and after 1-year follow-up are normal. With the new operative techniques described recently, valve-sparing corrections of aortic insufficiency are possible in an increasing number of patients, and autologous valve tissue can be saved. With more refinement of surgical technique, early postoperative results will further improve.

Adolescent↗

PubMed1994

Sinus of Valsalva aneurysm: a late complication after repair of ascending aortic dissection.

Surgical advances and the introduction of new more rapid and accurate diagnostic techniques have led to significant improvement in the survival of patients with aortic aneurysms. However, considerable long-term morbidity and mortality remains a concern. In the present study we report on the occurrence of sinus of Valsalva (SV) aneurysm after repair of the ascending aorta for aortic dissection as a significant long-term complication. Since transesophageal echocardiography (TEE) became available it has been used for the follow-up of 33 hospital survivors after ascending aortic replacement for a mean of 27 +/- 20 months. Those patients who received a valved conduit were excluded from this analysis. The aortic valve was conserved in 22 patients: 17 had a dissecting aneurysm involving the ascending aorta and 4 patients non-dissecting aneurysms. A sinus of Valsalva diameter > 45 mm was considered an aneurysm and was found in a total of 7 patients (33%), 5 being patients with aortic dissection. The overall reoperation rate on account of SV aneurysms was 24%. We conclude that SV aneurysm is a significant long-term complication of patients after repair of the ascending aorta. In the light of these results we have changed our operative policy of repair to include resorcin glue as a reinforcing agent or to perform more extensive repair.

Aortic Dissection↗

PubMed1994

Elective surgery for blunt cardiac trauma.

The cases of eight patients who underwent elective surgery for blunt cardiac trauma are presented. All but one experienced multiple trauma and the median Injury Severity Score was 26 (range, 18-59). A posttraumatic cardiac defect was diagnosed from 1 day up to 6.5 years (median, 3 weeks) after the accident. These included mitral regurgitation (n = 4), ventricular septal defect (n = 2), atrial septal defect with mitral regurgitation (n = 1), and ventricular aneurysm (n = 1). Elective cardiac surgery was performed from 4 weeks up to 12 years after the traumatic event (median, 18.5 months). A history of blunt chest trauma requires careful clinical follow-up supported by echocardiography in asymptomatic patients. Surgical therapy is performed according to standard techniques and the results are comparable with those of non-trauma surgery.

Adolescent↗