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Biomedical subjects

M J Levy

Publications and source records attributed to M J Levy.

At least 91 records · Page 5Linked to original sources
PubMed1981

Left ventricular rupture after mitral valve replacement. Report of two cases and a review of the literature.

Rupture of the left ventricle following mitral valve replacement occurred in 2 women among 520 patients (0.4%) during a 17-year-period at the Beilinson Medical Centre. In one patient, a delayed, type II rupture, followed by immediate exanguination, resulted from a 31 mm cloth-covered Starr-Edwards prosthesis inserted in a normal sized left ventricle. In the second patient, an intra-operative type I rupture occurred as a result of an over-zealous resection of a heavily calcified valve and annulus. Repeated attempts at surgical repair were unsuccessful. A review of 46 previously reported cases revealed several other factors that might be responsible for this complication which carries a 40-100% mortality rte, depending on whether it is diagnosed intra-operatively or in the immediate postoperative period. These factors and the variety of surgical approaches used for the repair of this grave complication are discussed.

Adult↗
PubMed1980

Aortic stenosis associated with gastrointestinal bleeding. A survey of 612 patients.

A retrospective study was done in order to examine the association between aortic stenosis (AS) and gastrointestinal tract (GIT) bleeding. Four groups of patients included a group of 152 patients with AS, a control group of 152 patients with MS, and another two groups of 154 patients each with and without GIT bleeding. GIT bleeding of known and of idiopathic sources was significantly more prevalent among patients with AS (three and four patients, respectively) than among those with MS (none). Moreover, AS was significantly more prevalent in association with idiopathic GIT bleeding (seven out of 24, 29.1%), in comparison to its association with bleeding from a known source (two out of 130, 1.5%), and its incidence in routinely admitted patients without GIT bleeding (three out of 154, 1.9%). This study supports the assumption that GIT bleeding may be associated with AS.

Adolescent↗
PubMed1980

Permanent overdrive pacing for the suppression of recurrent ventricular tachycardia in a newborn with long QT syndrome.

A newborn with long QT interval and repetitive ventricular tachycardia of the "torsade de pointes" type was seen at the age of one day. The arrhythmia was resistant to lidocaine, propranolol and atropine, but was controlled by isoproterenol infusion. A transvenous pacemaker, inserted at three days of age, suppressed the ventricular tachycardia at stimulation rates above 100/minute. At 19 days of age a permanent pacemaker at pulse rate of 119 beats/minute was implanted. At one year of age the infant was thriving and was completely free of ventricular arrhythmia.

Cardiac Pacing, Artificial↗
PubMed1980

Repeated mitral valve replacement in the growing child with congenital mitral valve disease.

The successful second-replacement of mitral valve prostheses in two children, age 5 and 9 years, is reported. In one, a parachute mitral valve deformity was first corrected at the age of 10 months by the small-size 00 Starr-Edwards prosthesis. The second child had mitral valve disease caused by Marfan's syndrome 1; the valve was initially replaced at the age of 3 years by a size 0 Starr-Edwards prosthesis. For both patients, in the period between the two interventions, the left ventricle had grown in size and the mitral anulus was not a limiting factor in the insertion of a larger prosthesis of the Björk-Shiley type. Follow-up periods of 1 and 6 years, respectively, confirm excellent clinical results. Problems concerning valve replacements in pediatric patients are discussed.

Child↗
PubMed1979

Double aortic arch anomalies: diagnosis by countercurrent right brachial arteriography.

The clinical, radiologic, angiographic, and operative findings in 15 patients with double aortic arch are described. In five patients, both arches were functional; in the other 10, a portion of the left arch was atretic. Depending on the location of the atretic segment, the anomalies were classified into types A, B, and C double aortic arch. We considered an additional type D double aortic arch which as yet remains a theoretical possibility. With the help of refined angiographic signs obtained by countercurrent right brachial angiography and on the basis of clinical and radiologic signs of tracheoesophageal compression, the differential diagnosis among various types of double aortic arch and right aortic arch anomalies was improved.

Angiography↗
PubMed1979

Retrograde (atrial) dislodgement of a Cross-Jones mitral valve occluder.

Fatal atrial dislodgement of a lenticular disc occurred seven years after surgery in a 54-year-old patient, who had had a mitral valve replacement with a Cross-Jones prosthesis, for ruptured chordae tendinae. A marked distortion of the titanium ring reinforced silicone rubber lens disc due to material wear was the cause of this complication. From the literature available to us, atrial dislodgement of a prosthetic mitral occluder has not been previously recorded. We therefore intend to recommend elective replacement of the Cross-Jones prosthesis in all patients who have had their artificial valve functioning for more than five years.

Heart Valve Prosthesis↗
PubMed1979

Multiple pulmonary hamartomas; a case report and review of the literature.

Bilateral multiple hamartomas were found in a woman suspected of having metastatic malignancy of the lung. As extensive investigation for the primary tumour was unrevealing, a left exploratory thoracotomy and histological examination established the diagnosis. In view of the benign character of the tumours, local excision alone was performed. No surgical intervention was performed on the right side. Repeat chest films 12 months after surgery did not show the appearance of new lesions in the left lung or any increase in the size of the nodules in the right lung. This is the 12th case so far reported. The clinical characteristics and surgical management of these tumours are discussed.

Adult↗
PubMed1979

Congenital atresia of the left main coronary artery ostium.

Three patients with the rare anomaly of congenital absence of the ostium of the left main coronary artery are presented. In two of the patients, aged 50 and 52 respectively, the diagnosis was established during selective coronary cineangiography for a severe anginal syndrome. The third patient, a 16-year-old-girl, underwent cardiac catheterization for investigation of a congenital heart malformation, when a single right coronary artery was demonstrated with absence of the main coronary artery ostium. Two patients underwent successful aortocoronary bypass grafting. In view of the occurrence of sudden death and massive myocardial infarction in adult patients shown to have severe or complete obstruction of the left main coronary artery, it is suggested that adult patients with this condition, who require open-heart surgery for any other cardiac disorder, should undergo aortocoronary bypass grafting concurrently even prior to the development of anginal symptoms. Children shown to have this anomaly should be subjected to long-term follow-up and have an aortocoronary bypass graft performed when symptoms of coronary insufficiency develop.

Adolescent↗
PubMed1978

False aneurysm of the left ventricle. Surgical treatment.

The clinical and pathological features in three cases of false aneurysm of the left ventricle are reported. In two instances the condition developed after myocardial infarction, and in the third case a mycotic pseudoaneurysm developed after purulent pericarditis. All three patients were in intractable heart failure before urgent operation. The correct diagnosis was established preoperatively by angiography. In all three cases the aneurysms were successfully resected and the left ventricle reconstructed. An aggressive surgical approach is warranted in the management of this lesion.

Aged↗
PubMed1977

Traumatic rupture of diaphragm: surgical reconstruction with special reference to delayed closure.

Thirteen cases of diaphragmatic rupture following blunt trauma or gunshot wounds are presented. In 10 cases the diagnosis of diaphragmatic rupture was made immediately following the injury, and the defect was closed by primary diaphragmatic suture. In three cases, the diagnosis was delayed for 3 to 16 years after the initial trauma. In all of them, abdominal organs such as the colon or liver had migrated into the thoracic cavity. One of them had acute intestinal obstruction and died following several unsuccessful operations. The remaining two patients required plastic repair of the diaphragmatic hernia by a Dacron patch, and both recovered. The clinical and pathological aspects of diaphragmatic rupture, the importance of early diagnosis and surgical correction, and the surgical approach to this entity are considered. The use of Dacron fabric in delayed closure of diaphragmatic defects is described.

Adolescent↗
PubMed1977

Isolated idiopathic chylopericardium.

The case history of a young asymptomatic patient with primary chylous pericardium is reported. On the basis of this case and those reported in the literature, we suggest that diagnosis should be established by echocardiograms, cardiac angiograms, and pericardiocentesis. Lymphangiograms are useful for the detection of the underlying abnormality of the lymph vessels. Pericardiectomy together with thoracic duct ligation are suggested as the preferred treatment. We propose that generalized lymphatic abnormality is the underlying mechanism of this entity. This lymphatic abnormality could be associated with impaired cellular immunity, although no such impairment was found in our patient.

Adolescent↗
PubMed1977

Expimental segmental replacement of esophagus by biological tissues.

A method is described for segmental esophageal replacement in dogs, with one of three types of tissue substitute: pericardium, fascia lata and aortic homograft. The experiments involving the thoracic esophagus failed owing to the development of acute mediastinitis and sepsis. The most promising results were obtained in animals in which an aortic homograft was used to replace the cervical sigment of the esophagus. Eight of the 12 animals with aortic homograft survived and gained weight until killed one to six months after operation. The overall results suggest that aortic homograft may have a potential clinical application in cases in which esophageal replacement is necessary.

Animals↗