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Biomedical subjects

M I Turina

Publications and source records attributed to M I Turina.

159 records · Page 9Linked to original sources
PubMed1990

Internal mammary artery anomalies.

The internal mammary arteries (IMA) are considered to be the superior conduit in coronary bypass grafting (CABG). Anomalies of an IMA can influence the surgical technique and results; their true incidence is not well known. The IMA's were visualised angiographically in 262 consecutive patients undergoing cardiac catheterisation prior to CABG. Satisfactory visualisation was possible of 459/524 IMA's studied (88%). A total of 118/459 (26%) surgically significant anomalies was observed in 79/262 patients (30%): common origin of another large artery in 48/459 (11%), large side branches in 41/459 (9%), tortuosity in 21/459 (5%), atypical course or origin in 5/459 (1%), atherosclerotic lesions in 2/459 (0.4%) and spasticity of an IMA in 1/459 (0.2%). Angiographic visualisation of the IMA's resulted in modification of surgical strategy in 11/262 patients (4%); meticulous preparation because of difficult or atypical IMA anatomy was necessary in 68/262 patients (26%). These results demonstrate that significant anomalies of the IMA which might--when unrecognized--jeopardize IMA-flow after CABG are relatively common; they might escape detection during IMA take-down but can be diagnosed by angiography during catheterisation.

Adult↗
PubMed1990

[Surgery of central lung embolism: indications, mortality and early morbidity].

Between 1979 and 1988 massive pulmonary embolism (PE) was treated surgically in 36 patients with extracorporeal circulation (ECC). Circulation was stable in 11 patients and unstable in 25; in this group 9 had previous resuscitation because of cardiac arrest. There were 7/36 early deaths (19%); 5 of those patients had to be resuscitated prior to surgery. Deaths were caused mainly by cerebral edema or hemorrhage. Significant complications occurred in 8 patients (28%). Diagnoses of PE was made clinically in most cases; confirmation by echocardiography was useful. Pulmonary angiography was made in patients with uncertain diagnosis and stable circulation. Operation is indicated in patients with unstable circulation and proved central PE; it is advisible in patients with embolism of the main pulmonary artery or its major branches. Hospital mortality is very high when the patient has to be resuscitated preoperatively; in this group surgery should be performed only in younger patients with a short period of resuscitation. Interruption of the inferior vena cava should be performed to prevent recurrent PE.

Adult↗
PubMed1989

Late functional deterioration after atrial correction for transposition of the great arteries.

Late anatomic and functional results were evaluated in 220 consecutive survivors who underwent surgery in 1964-1984 for atrial correction of transposition of the great arteries (TGA). Actuarial survival was 87% at 10 years and 83% at 20 years and was higher in patients with simple than in those with complex TGA (92% vs. 84% at 10 years). Although 83% of simple TGA and 78% of complex TGA survivors belong to the oligosymptomatic or asymptomatic group, failure of the systemic ventricle occurred in 17 (7.7%) patients. This failure was more common in patients with complex than in those with simple TGA (12.1% vs. 4.1%, p less than 0.05); actuarial incidence of such failure was 3% at 5 years and 11% at 15 years, and it caused 10 of 25 (40%) of late deaths. Late dysrhythmias necessitating pacemaker implantation had an incidence of 9.8% at 10 years. Reoperations were performed in 20 (9.1%) patients, with 12 of 23 (52%) reoperations occurring in the first 2 years after correction. Stenosis of caval inflow (eight patients), or residual atrial or ventricular septal defects (eight patients) were the most common causes of reoperation. Systemic atrioventricular valve incompetence necessitating surgery occurred in only three patients. Atrial correction gives good late results, but late functional deterioration occurs in some patients.

Child↗
PubMedDate not supplied

Surgical management of infected permanent transvenous pacemaker systems: ten year experience.

BACKGROUND: Between January 1985 and June 1995, more than 1800 consecutive patients underwent implantation of a new permanent cardiac pacemaker at our institution. Thirty-six patients (0.02%) had 45 reinterventions for infected pacemaker systems. METHODS: in group A, 24 of 27 patients received simultaneous implantation of a new pacemaker. One had reimplantation of the same pacemaker in the same pocket, and two did not require reimplantation. The leads were retained in 19 (70%) of the patients. In group B, nine patients underwent cardiopulmonary bypass or "pursestring" surgery for removal of an infected pacemaker; a new epicardial pacemaker system was simultaneously implanted in seven patients. RESULTS: Identification of an infectious agent failed in 17 patients (47%), and Staphylococci were found in 15 patients (42%). The time from pacemaker implantation to onset of infection ranged from 1 month to 11 years (mean 31 months; median 19 months) and the time from onset of infection to surgical treatment from 1 month to 7 years (mean 7 months; median 2 months). The mean follow-up time is 74 months (range, 1 month to 10 years; median 5 years). There were 9 reoperations in 3 patients (16%) of group A for recurrent infection of their retained leads ultimately necessitating the use of open cardiac surgery. There was no early death; six patients died late due to unrelated causes. CONCLUSIONS: Complete removal of all pacemaker leads is recommended; open heart surgery with the use of cardiopulmonary bypass is indicated in selected cases and is effective and safe.

Adolescent↗
PubMedDate not supplied

Approach to the mitral valve through a right thoracotomy in potentially hazardous reoperation.

BACKGROUND: Repeat sternotomy for mitral valve surgery may be hazardous in some patients. A right thoracotomy avoids the densely scarred area beneath the sternum and provides adequate in-line exposure of the mitral valve. METHODS: Between 1994 and 1997, five patients were reoperated for a mitral valve or prosthesis dysfunction through a right thoracotomy. Indications were three second redo-mitral valve surgeries and two first redo, once in a patient with an aortic prosthesis and once in a patient with patent aortocoronary grafts. The operation was performed without clamping the ascending aorta in moderate hypothermic (four patients) or normothermia (one patient). RESULTS: Exposure of the mitral valve for replacement (four patients) or for repair of a paraprosthetic leak (one patient) was optimal in all patients. Resumption of cardiac function occurred rapidly after repair without specific support. Postoperative course was uncomplicated. Blood loss ranged from 300 to 700 mL. Patients were discharged from 7 to 12 days postoperatively. They are in New York Heart Association (NYHA) functional Class I (four patients) and II (one patient), from 3 to 42 months postoperatively. CONCLUSION: Right thoracotomy provides a direct "in the line of vision" access to the mitral valve. Because complete de-airing of the heart is difficult and respiratory function depressed after a right thoracotomy, this approach seems suitable when technical difficulties are expected in sternal reopening.

Adult↗
PubMedDate not supplied

Less invasive surgical treatment of renal cell carcinomas extending into the right heart and pulmonary arteries: surgery for renal cell carcinoma.

BACKGROUND: Radical resection using deep hypothermic circulatory arrest improves the survival of patients with transvenous intracardiac tumor extension of renal cell carcinomas. A less invasive surgical approach avoiding deep hypothermia, circulatory arrest, and cross-clamping of the aorta is presented. METHODS: Between 1987 and 1999, 12 patients (mean age 57+/-8 years) underwent resection of a renal cell carcinoma extending into the right atrium, right ventricle, or pulmonary arteries. After median sterno-laparotomy, normothermic cardiopulmonary bypass is used cannulating the ascending aorta, superior caval vein, and inferior caval vein below the renal veins. The tumor and the corresponding kidney are radically excised, including the renal vein. Tumor fragments from the inferior caval vein, the right heart, and pulmonary arteries are removed either on the fibrillating or beating heart. RESULTS: Operative mortality was 0%. Mean cardiopulmonary bypass time was 53+/-27 minutes (median 36; range 32-110 minutes). Mean blood loss per patient was 1200 mL. Mean duration of postoperative mechanical ventilation was 36+/-12 hours (median 36; range 30-77 hours), mean intensive care stay 5.5+/-5 days (median 3; range 1-48 days), and mean duration of hospitalization 22+/-12 days (median 21; range 10-58 days). All patients were discharged home. Patients with multiple tumor manifestations outside the cardiovascular systems died within 9 months after the operation. CONCLUSIONS: The use of normothermic cardiopulmonary bypass is a less invasive method for radical resection of renal cell carcinoma with intracardiac tumor extension. Radical resection does not improve survival in patients with multiple distant metastases.

Adult↗
PubMedDate not supplied

Resection of ascending aorta aneurysm in redo surgery through an anterior thoracotomy.

Resection of an aneurysm of the distal ascending aorta was performed under hypothermic circulatory arrest and retrograde cerebral perfusion though a right anterior thoracotomy. Seven years before, the patient had undergone orthotopic cardiac transplantation and had required pectoral muscle plasty to heal an infectious mediastinitis. This new approach avoided a potentially hazardous sternotomy and allowed successful resection of the aneurysm and reconstruction of a thrombosed innominate vein.

Aortic Aneurysm↗
PubMedDate not supplied

Tissue engineering of a bioprosthetic heart valve: stimulation of extracellular matrix assessed by hydroxyproline assay.

Creation of an autologous heart valve by tissue engineering offers a promising approach to cardiac surgery. Although we have demonstrated successful formation of native valve analogous tissue in vitro, hemodynamic competence remains a serious problem. The aim of this study was to optimize in vitro formation of collagen as a precondition for mechanical stability of new tissue. Human myofibroblasts were seeded on square sheets of biodegradable scaffolds (control). To stimulate collagen production, one series was cultured with L-ascorbic acid 2-phosphate. In a second series, the seeded scaffolds were subjected to tension by mounting them on a frame. After 4 weeks of culture time, the collagen content of the different series was assessed by hydroxyproline assay. Light and scanning electron microscopy were performed. Hydroxyproline content of the framed scaffolds was 10 times higher than that of the control group (p < 0.05) and 6 times higher than in the unframed scaffolds grown with ascorbic acid (p < 0.05), respectively. Scanning electron microscopy proved extensive formation of solid tissue in the framed samples. These results demonstrate that supplementation of myofibroblast cultures with ascorbic acid, especially if grown on strained scaffolds, significantly increases collagen content, which is crucial for mechanical stability. This concept is a further step toward the creation of a hemodynamically competent autologous heart valve.

Ascorbic Acid↗
PubMedDate not supplied

Prophylactic cytolytic therapy in heart transplantation: monoclonal versus polyclonal antibody therapy.

The value of immunoprophylaxis with monoclonal anti-CD3 antibodies (OKT3) was evaluated in 44 consecutive, nonrandomized heart transplant patients. The control group (n = 22) was treated with polyclonal rabbit antithymocyte globulin (RATG) for 5 days. The study group (n = 22) was treated with OKT3 for 14 days. All patients had identical perioperative immunosuppressive therapy and similar maintenance therapy, with cyclosporine, azathioprine, and low-dose prednisone (starting prednisone: OKT3 group immediately, RATG group 3 weeks [n = 11] or greater than 3 months [n = 11] after transplantation). The mean histologic rejection grade (Texas classification) in the RATG and the OKT3 groups was 2.5 +/- 1.9 and 0.6 +/- 0.8 (p less than 0.005) after 1 week and 4.3 +/- 1.6 and 2.0 +/- 1.5 (p less than 0.001) after 2 weeks, but there was no difference in the first year. The linearized rejection rate (rejections per 100 patient days) was higher in the RATG group in the first 2 weeks (2.6 vs 0, p less than 0.05 respectively, 7.8 vs 0.7, p less than 0.001) and higher in the OKT3 group in the second month (1.4 vs 2.8, p less than 0.01). In the RATG group the rejection rate fell continuously, to 0.1 at the end of the first year, whereas in the OKT3 group it remained 0.4 (NS). The cumulative first-year incidence was similar for persistent rejections (RATG 0.38 +/- 0.29 vs OKT3 0.48 +/- 1.13, NS) and insignificantly higher for severe rejections in the OKT3 group (RATG 0.21 +/- 0.32 vs OKT3 0.49 +/- 1.10). Rejection-related mortality in the first year was 0% (RATG) and 9% (OKT3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Ventricular assist with heparin surface coated devices.

Heparin surface coated ventricular assist devices (VADs) were evaluated without systemic heparinization and compared with uncoated control VADs with systemic heparinization (bovine experiments, n = 8; bodyweight, 75 +/- 6 kg). No heparin was given in the study group, whereas heparin (300 IU/kg) was given before cannulation in the control group. Mean activated clotting time (ACT) was 127 +/- 12 sec before and 122 +/- 17 sec after 6 hours of left ventricular assist for coated (NS) versus 184 +/- 114 sec before and 650 +/- 240 sec after for uncoated (p less than 0.05) VADs. No difference was observed in platelet depletion, plasma hemoglobin, lactic dehydrogenase (LDH) production, mixed venous oxygen saturation, and VAD clot score. No VAD occlusions occurred. Ventricular assist can be achieved without systemic heparinization if VADs are improved.

Animals↗
PubMedDate not supplied

Can protamine be used during perfusion with heparin surface coated equipment?

Left heart bypass (LHBP) with heparin coated perfusion equipment including an arterial filter (pore size: 40 microns) was performed in five canine experiments after full systemic heparinization (heparin 300 IU/kg; activated coagulation time [ACT] > 480 sec). The heparin coated filter was replaced after 45 min with a second heparin coated filter. Protamine (1:1) was added after 45 min and perfusion was continued for another 45 min before the second filter was replaced with an uncoated control filter. In addition to continuous hemodynamic monitoring, all filters were disassembled and analyzed morphometrically with a scanning electron microscope (deposits on screens were expressed as percent of surface covered with fibrin or number of cells/100 micron 2, respectively). For the first heparin coated filter (ACT > 480), 0.3 +/- 0.5% of the surface was covered with fibrin, 0.7 +/- 0.7% with platelets, and 0.02 +/- 0.0% with red cells. For the second heparin coated filter exposed to neutralization of heparin with protamine, surface coverage was fibrin in 22 +/- 15%, platelets in 3.2 +/- 0.8%, and red cells in 0.2 +/- 0.1% (p < 0.05 for all comparisons with filter 1). For uncoated control filters (ACT = 120), surface coverage was fibrin in 31 +/- 33%, platelets in 3.7 +/- 2.9%, and red cells in 0.2 +/- 0.1% (not significant [NS] for all comparisons with filter 2). Although all arterial filters used in this study remained patent throughout the scheduled period, it became clear that protamine given during perfusion reduces the antithrombotic activity of bonded heparin. Hence, protaminization during perfusion with heparin coated equipment cannot be recommended.

Animals↗