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Biomedical subjects

M I Turina

Publications and source records attributed to M I Turina.

At least 55 records · Page 3Linked to original sources
PubMed2000

Surgical angioplasty of the left main coronary artery in non-atherosclerotic lesions.

Surgical angioplasty of the left main coronary artery confers several advantages over conventional bypass surgery: unrestricted forward flow is provided to the entire coronary bed and graft material is spared. The literature contains many reports of surgical angioplasty of atherosclerotic stenoses. The technique is described in five patients with non-atherosclerotic disease of the left main coronary artery: three children (a 7 year old girl who had undergone an arterial switch operation shortly after birth; a 9 year old boy with congenital supravalvar aortic stenosis; and a 10 year old girl with Kawasaki's disease) and two adults (a 51 year old woman with post-radiation stenosis; a 53 year old man with acute dissection). All patients had an uneventful recovery and are free from symptoms with a widely open left main trunk. Although technical difficulties are increased in these patients, excellent results can be achieved with this approach.

Adult↗
PubMed1999

Operative results of "repair" of ventricular septal rupture after acute myocardial infraction.

Fifty-four consecutive patients with postinfarction ventricular septal defect were reviewed. The rupture was closed with a patch and the left ventricle remodeled in all patients. Coronary artery bypass surgery was performed in 28 patients (52%). Fourteen patients (26%) died after operation and 19 during follow-up (mean 42 months). Cumulative survival (including operative deaths) was 78%, 65%, and 40% at 1, 5, and 10 years, respectively. A short interval between septal rupture and operation was a risk factor for early mortality (p = 0.03). Treated associated coronary artery disease had no effect. A residual septal shunt, detected in 10 patients (18%), warranted reoperation in 7 and contributed to 2 early and 1 late death. The location and morphology of the septal rupture were not associated with increased risk of residual shunt. Thus, patch closure of the ventricular septal rupture, remodeling of the left ventricle to improve stroke volume and reduce wall stress, and selective myocardial revascularization provided acceptable results.

Aged↗
PubMed1999

Analysis of trials of surgery vs angioplasty in myocardial revascularization.

AIM: comparison of surgery and angioplasty for the treatment of coronary artery disease. METHOD: comparison using randomized trials for low-risk patients and observational studies for high-risk patients. RESULTS: in low-risk patients, a strategy of initial surgery or angioplasty achieved similar results regarding overall and infarct-free survival rates at 5 years. Residual angina was statistically more prevalent after angioplasty and required more subsequent revascularization procedures. Residual angina negatively impacted on life quality. Angioplasty initially had a cost-effectiveness advantage over surgery, which subsided over time. In high-risk patients, no firm conclusion could be drawn, due to unmatched selection of patients. Angioplasty seems superior in acute myocardial infarction and in very ill patients. Surgery seems superior to treat diseased bypass grafts. CONCLUSIONS: because of similar achievements, the choice of therapy in low-risk patients eventually should depend on patient's preference. During counselling, the deleterious effect of residual angina on life quality and health perception should not be underestimated by practitioners. In high-risk patients, further studies are required to define the best approach to any individual patient.

Angioplasty, Balloon, Coronary↗
PubMed1999

Aortopulmonary window with anomalous origin of the right coronary artery.

We report a case of an aortopulmonary window with a right coronary artery arising from the pulmonary trunk. This exceedingly rare anomaly with anomalous coronary artery presented without myocardial ischemia owing to the aortopulmonary window. The correct diagnosis was made by angiography and a successful surgical correction was performed.

Aortopulmonary Septal Defect↗
PubMed1999

Complete thromboendarterectomy of the calcified ascending aorta and aortic arch.

BACKGROUND: Arteriosclerotic plaques of the ascending aorta and transverse arch increase the operative risk of cardiac operations and are strong predictors for late cerebrovascular events. METHODS: Twenty-two patients, mean age 68 +/- 6 years (range, 55 to 77 years), with grade IV + V plaques of the ascending aorta and transverse arch underwent coronary artery bypass grafting (n = 21) and aortic valve replacement (n = 8). Cerebrovascular emboli from unknown sources were found preoperatively in 8 patients (36%). All were in sinus rhythm. Complete thromboendarterectomy of the ascending aorta and transverse arch was performed during hypothermic circulatory arrest. After 21 +/- 12 months (range, 4 to 44 months), magnetic resonance imaging and transthoracic echocardiography of endarterectomized vessels was performed. RESULTS: There was one perioperative death (4.5%), one early (4.5%), and one late (4.7%) adverse neurologic event. Follow-up examinations revealed normal diameters of the endarterectomized aorta. CONCLUSIONS: For patients with grade IV + V plaques, thromboendarterectomy of the ascending aorta and transverse arch can be performed with an acceptable surgical risk and a low recurrence rate for cerebrovascular events. Dilatation of the endarterectomized aorta was not observed.

Aged↗
PubMed1999

Drainage of the inferior vena cava to the left atrium.

This report describes a 7-year-old girl with an anomalous connection between the inferior vena cava and the left atrium documented with intraoperative transesophageal color-coded Doppler flow echocardiography and angiography. This rare congenital disorder should be considered in the differential diagnosis in patients with cyanosis without cardiac murmurs. Operation is the only method for correction.

Angiography↗
PubMed1999

Application of successive principles of repair to correct supravalvular aortic stenosis.

The diffuse form of supravalvular aortic stenosis may extend in the takeoff of the coronary and arch arteries. Relief of the supravalvular stenosis requires a harmonious enlargement of the sinotubular junction to maintain aortic valve competence. The technique we used in a 9-year-old boy involved patch enlargement of all affected structures. Deep hypothermic circulatory arrest and retrograde cerebral perfusion was used during repair of the aortic arch and arch arteries.

Aortic Valve Stenosis↗
PubMed1999

Combined coronary artery bypass grafting and repair of aneurysm of the descending aorta.

The outcome of patients with thoracic or thoracoabdominal aortic aneurysm is often determined by the concomitant coronary artery disease. Two patients with thoracic and thoracoabdominal aortic aneurysm and concomitant single-vessel coronary artery disease underwent combined myocardial revascularization and repair of aortic aneurysm. The operations were performed through a left thoracotomy and thoracoabdominal incision with distal aortic perfusion using a partial femoro-femoral bypass and selective right lung ventilation. Coronary anastomoses were performed on the beating heart, and the aneurysm was replaced with a woven Dacron tube graft.

Aged↗
PubMed1999

Management of infected aortic grafts: development of less invasive surgery using cryopreserved homografts.

BACKGROUND: Aortic graft infection is associated with significant mortality and morbidity. Total graft replacement with homografts provides an effective treatment. Partial graft replacement at the site of infection may simplify the surgical procedure. METHODS: Between January 1991 and December 1996, homografts were used in 18 patients (mean age, 61+/-12 years; range 41-85) with thoracic (4/18; 22%) or abdominal (14/18; 78%) aortic graft infection. Sepsis was present in 14 patients (78%); 6 (33%) had various aortic fistulae. Total graft replacement using homografts was performed in 14 (78%), and partial graft replacement at the site of infection in 4 patients (22%). RESULTS: Hospital mortality was 11%. During the follow-up period of 22+/-15 months (range, 12-65) there was 1 infection and 1 homograft-related late death after complete homograft replacement, and 1 percutaneous vascular stent placement after partial graft replacement. No other instances of reinfection, suture line rupture or anastomotic aneurysms were observed. CONCLUSION: Total graft replacement with homografts provides an effective treatment for infected aortic grafts. Partial graft replacement at the site of infection is feasible and safe.

Adult↗
PubMed1999

Treatment of left atrial dissection after mitral repair: internal drainage.

Two patients with intraoperative dissection of the entire left atrium after mitral valve repair are presented. Intraoperative transesophageal echocardiography detected left atrial dissection with formation of a large cavity compressing the left atrium. The false lumen was opened and widely connected to the right atrium to perform the decompression. This technique permits the runoff into the low pressure system in case of persisting hemorrhage from the unknown entry, and eliminates the risk of systemic embolization from the cavity.

Aortic Dissection↗
PubMed1999

Surgical repair of postinfarction structural failure of the posterobasal part of the heart.

BACKGROUND: This study is an analysis of our results with endoventricular repair of postinfarction structural defects of the posterobasal part of the heart. METHODS: Thirty-four patients who underwent endoventricular repair of a postinfarction structural defect of the posterobasal heart were reviewed. Patients with rupture of the ventricular septum (18 patients) or free wall (1 patient) were operated on acutely and patients with ventricular aneurysm (15 patients) electively. Restitution of the ventricular geometry was achieved by evertion (11 patients), resection (4 patients), or augmentation of the ventriculotomy (4 patients) in patients with ventricular rupture, and by resection of the aneurysm in the others. Coronary artery bypass was performed in 24 patients. RESULTS: Six patients died postoperatively (five due to rupture and one from aneurysm) and nine patients (six due to rupture and three from aneurysm) during follow-up. Survival rate at 5 years (including operative mortality) was 43% for patients with rupture and 61% for patients with aneurysm. The majority of the survivors were in New York Heart Association functional class I or II after a median follow-up of 5 years. CONCLUSIONS: Endocardial repair, ventricular remodeling, and selective myocardial revascularization provided overall good results in the treatment of this difficult cardiac area.

Aged↗
PubMed1999

Explanted cryopreserved allografts: a morphological and immunohistochemical comparison between arterial allografts and allograft heart valves from infants and adults.

OBJECTIVE: Life expectancy of cryopreserved allografts implanted in infants is different from those implanted in adults. A morphological study of explanted allograft heart valves was performed to determine the mechanism of deterioration and to compare cryopreserved arterial and heart valve allografts from adult patients with those explanted from infants. METHOD: Between 1987 and 1996, 209 cryopreserved allografts were implanted: 125 valved conduits or monocusps to reconstruct the right ventricular outflow tract in congenital heart disease, 50 allograft heart valves to treat native aortic and prosthetic aortic valve endocarditis and 34 cryopreserved arterial allografts to replace mycotic aortic aneurysms or infected aortic prosthetic grafts. Two months to 8 years after implantation, 23 heart valve allografts, 11 right-sided and 12 left-sided, and four arterial allografts had to be explanted for reasons such as degeneration, recurrent infection, aneurysm formation or rupture. Besides conventional staining, immunohistochemical detection of cell populations was performed as follows: CD45RO, CD3 and CD43 for T lymphocytes, CD20 for B lymphocytes, CD68 for macrophages, protein S100 for Langerhans-cells, vimentin for fibroblasts, alpha-actin for smooth muscle cells and factor VIII for endothelial cells. RESULTS: Explanted cryopreserved allografts were all fibrotic, acellular, non-vital and without endothelial cells. The fibrous tissue was preserved. T lymphocytes, indicating rejection, were found in all right-sided allografts from the paediatric population, but only in 9% of left-sided valves explanted from adults and in one of the four of arterial allografts. Macrophages and Langerhans-cells were found only in right-sided allografts from paediatric patients. CONCLUSION: Right-sided cryopreserved allografts from a paediatric population showed ongoing cellular rejection. By contrast, there was only a weak T-cell mediated rejection to adult heart valve and arterial allografts. Therefore, similar long-term results can be expected in adult arterial and heart valve allografts, whereas longevity of right-sided heart valve allograft in the paediatric age group seems endangered by cellular rejection.

Adolescent↗
PubMed1999

Modified approach to close multiple apical ventricular septal defects.

The fish-mouth incision of the left ventricular apex is the established incision to access and close apical ventricular septum defect. A long diagonal branch may render this incision dangerous. In such a case, we performed a more anterior incision on the left ventricle, and fashioned a patch to exclude the whole defective area.

Cardiac Surgical Procedures↗
PubMed1999

Abdominal pulsatile tumor after endovascular abdominal aortic aneurysm repair.

A 70 years old patient was successfully treated for infrarenal aortic aneurysm by an endovascular bifurcated prosthesis. Three months later, because of dysuria, he underwent urological examination revealing an abdominal pulsatile tumor. Thereafter, the patient was sent to our emergency ward with suspected symptomatical endoleak. Radiological screening by computer tomography and magnetic resonance angiography showed good post-operative results without endoleak. Patient was treated with antispasmodic medication and is doing well today. Because endovascular repair of aortic aneurysm, in contrast to an open approach, does not eliminate the aneurysm itself, post-operative abdominal palpation can be ambiguous. Magnetic resonance angiography--without the need of nephrotoxic contrast medium--compares favourably to CT and provides excellent pictures with less artefacts for post-operative screening of endoleak. If reperfusion can be excluded, pulsation is due to the transmission of the blood-pressure wave to the thrombosed aneurysm.

Aged↗
PubMed1999

Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption.

OBJECTIVE: To determine factors influencing the individual effects of blood transfusions regarding oxygen delivery and consumption. DESIGN: Chart review. SETTING: A university hospital cardiosurgical intensive care unit. PATIENTS: Sixty-seven patients with 170 transfusion events evaluated. INTERVENTIONS: Blood transfusion. MEASUREMENTS AND MAIN RESULTS: Measurements were performed before and after a blood transfusion, separated by 302 +/- 13 mins (mean +/- SEM). The individual increase in cardiac index resulting from a blood transfusion was inversely related to cardiac index before transfusion (p < .001), oxygen delivery index before transfusion (p < .001), and oxygen consumption index before transfusion (p < .001). The individual increase in oxygen delivery index was inversely related to oxygen consumption index before transfusion (p < .001). The individual increase in oxygen consumption index was inversely related to oxygen consumption index before transfusion (p < .001). Individual changes in cardiac index, oxygen delivery index, and oxygen consumption index were not significantly related to preoperative ejection fraction (25%-87%), age (32-81 yrs), and pretransfusion hemoglobin concentration (5.0-11.8 g/dL). CONCLUSION: In adult patients after cardiovascular surgery, oxygen delivery- and oxygen consumption-related variables predict the individual response to blood transfusions better than do patient characteristics such as preoperative ejection fraction, age, and pretransfusion hemoglobin concentration. Including oxygen delivery and oxygen consumption, variables into the transfusion decision, thus, may enable a more individual use of allogeneic blood in specific situations.

Adult↗