Search PubMed⌕ Search

Biomedical subjects

M Turina

Publications and source records attributed to M Turina.

At least 181 records · Page 10Linked to original sources
PubMed1993

[Late pericardial tamponade: a dangerous complication of postoperative anticoagulation following heart surgery].

Late cardiac tamponade is a condition that presents with subtle signs and symptoms within days or weeks after cardiac surgery. During a one-year period, 16 patients, operated in our institution, developed this complication, mostly due to overdosage of anticoagulants. Diagnosis can be difficult and is best confirmed by echocardiography. The incidence of this dangerous complication is reportedly between 0.3 and 1%. The treatment consists in sub-xyphoid drainage when ever possible. In case of loculated or posterior tamponade, re-sternotomy might be necessary to assume complete decompression of the heart.

Aged↗
PubMed1993

[Role of heart transplantation in the treatment of complex congenital malformations in adolescents and adults].

The number of pediatric heart transplants for complex congenital heart disease has increased in recent years, but little experience has been reported in the adolescent and adult population. Between 1987 and 1992, 6 patients (mean age 24 years, range 14 to 42) underwent transplant in our institution because of structural congenital heart disease with or without prior palliative operation or definitive repair. The diagnose covered: congenitally corrected transposition of the great vessels, late systemic ventricular failure after surgically corrected transposition of the great arteries, left superior vena cava, and tricuspid atresia with right ventricular hypoplasia. The palliative repairs included modified Blalock-Taussig shunt, cavo-pulmonary Glenn shunt, two aorto-pulmonary Waterstone shunts, two Blalock-Hanlon atrioseptectomies and one pulmonary valvotomy by the method of Brock. One patient had undergone pulmonary artery banding, in two patients atrial repair by Senning's technique had been performed for definitive repair of transposition of the great arteries. Donor cardiectomy was modified to remove complete inflow and outflow tissue and transplantation was performed without prosthetic material in all patients, in no case was deep hypothermic arrest necessary. There was no early or late mortality after a mean follow-up of 28 months. Postoperative echocardiography and cardiac catheterization demonstrated perfect anatomical and functional results. There was no early or late mortality after a mean follow-up of 28 months. Postoperative echocardiography and cardiac catheterization demonstrated perfect anatomical and functional results. Adult patients with complex congenital cardiac diseases can be transplanted with a very low perioperative risk, even after several prior operative procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Surgery for arrhythmia in patients with therapy-resistant ventricular tachycardia].

We reviewed the data of 42 consecutive patients (mean age 55 +/- 12 years) who underwent surgery for control of recurrent drug-refractory ventricular arrhythmia. A history of myocardial infarction was present in 38 patients, 4 patients had congenital heart disease (2 aneurysms, 1 right ventricular dysplasia, 1 hamartoma). The mean LV ejection fraction was 40 +/- 14%. At preoperative electrophysiologic study, ventricular tachycardia was inducible in 32 of 33 patients. The mean heart rate was 188/min. A mean of 3.3 +/- 2.1 antiarrhythmic drug trials were ineffective. The most frequently performed surgical procedure (n = 36) was visually guided subendocardial resection, alone or in combination with cryothermal ablation. In 30 patients additional aneurysmectomy was performed. A mean of 1.9 +/- 1.4 coronary arteries in 32 patients were bypassed. The overall in-hospital mortality (30 days) was 9.5% (1 arrhythmic death, 1 pump failure, 1 sepsis, 1 hemorrhagic shock). We found 2 significant (p < 0.05) predictors of perioperative mortality: recent myocardial infarction and patient's age. During a mean follow-up of 33 months (range 1 to 90), there were 3 sudden cardiac deaths and 6 nonfatal recurrences of ventricular tachycardia which were subsequently prevented with antiarrhythmic drug therapy. Thus, the overall success in control of arrhythmia was 92%, in 59% by surgery alone. Survival was 79% at 2 years after surgery and 63% at 5 years. We conclude that patients who have successful subendocardial resection and aneurysmectomy for control of ventricular arrhythmia have an excellent chance of arrhythmia-free survival and a relatively good prognosis.

Adolescent↗
PubMed1993

[Coronary artery size in chronic mitral valve insufficiency before and following mitral valve surgery].

The increase of coronary artery size in myocardial hypertrophy represents an adaptive mechanism to keep coronary blood flow normal. The relationship between coronary cross-sectional area and left ventricular muscle mass was determined angiographically in 10 patients with severe mitral regurgitation before and 28 +/- 15 months after successful mitral valve surgery. 10 subjects with atypical chest pain without coronary artery disease served as controls (C). Left ventricular muscle mass was increased preoperatively in mitral regurgitation (257 g vs C = 129 g; p < 0.001) and decreased postoperatively (205 g; p < 0.01 vs preop. and vs C). The cross-sectional area of the left coronary (= left anterior descending+left circumflex) artery was augmented preoperatively (26.5 vs C = 14.0 mm2; p < 0.001) and decreased postoperatively (22.9 mm2; p < 0.05 vs preop. and vs C). The cross-sectional area of the left coronary artery per 100 g LV muscle mass was not different in the three groups. The cross-sectional area of the right coronary artery was also increased before surgery (12.7 vs C = 8.8 mm2; p < 0.05) and decreased postoperatively (11.3 mm2; p < 0.05 vs preop. ns vs C). Our data show that in mitral regurgitation the size of the left coronary artery increases proportionally to the increase in left ventricular muscle mass. Also, the right coronary artery shows slight enlargement which is probably due to the pressure overload of the right ventricle. After surgery there is regression but not normalization of the size of the coronary arteries.

Chronic Disease↗
PubMed1993

[Clinical late results following surgical ablation of an accessory atrioventricular connection in Wolff-Parkinson White syndrome].

All patients operated because of WPW-syndrome between 1980 and 1990 at the University clinics of Zürich were followed up by clinical examination and by electrocardiography. Relief from symptoms (tachycardia, vertigo and/or syncopes) was defined as "symptomatic" success, lack of preexcitation in the ECG at rest as "surgical" success. Overall 56 patients (40 men, 16 women) aged from 13 to 66 years had been operated in the stated time period. Before operation 52 of these patients had pre-excitations in the ECG, 54 had tachycardia and 23 had syncopes. None of the patients died from the operation. In order to localize the AAVVs epicardial cartography was performed in all patients during operation before the AAVVs were cut through an endocardial access. The follow-up was possible after an average interval of 5.5 years (1-120 months) in 50 of the 56 patients. One patient died 10 years after operation from heart failure. 6 patients were reported to be out of the country. The follow-up revealed symptomatic success of the intervention, defined as absence of tachycardia, in 88% (44 out of 50). In 84% (42 out of 50) also a surgical success of the operation was found. In these patients the accessory atrio-ventricular bundle had been successfully ablated, and they were free of tachycardia and of preexcitation in the ECG. Two patients with persisting preexcitation remained free of clinical symptoms. Insofar the rate of symptomatic success was higher than the rate of surgical success. Summarizing the results surgical transsection (ablation) of an accessory atrioventricular bundle in patients with WPW-syndrome is a good therapeutic option with favorable long term success. It has today still its place--in selected cases--as alternative to the now available radio-frequency ablation.

Adolescent↗
PubMed1993

[Rupture of an aneurysm of the common hepatic artery with pancreatic necrosis].

A male patient known to have hemophilia A was operated on twice (1990, 1991) in the Department of Surgery, University Hospital, Zurich, first because of severe intraabdominal hemorrhage from a liver artery aneurysm, and then because of a ruptured common hepatic artery aneurysm. The second surgical intervention revealed necrosis of the head and body of the pancreas. We consider that the pancreatic necrosis had resulted from the aneurysm, in view of the patient's history of silent pancreatitis and the uncomplicated postoperative course. Immediate reconstruction of the common hepatic artery aneurysm (in the presence of an occluded gastroduodenal artery) was performed with saphenous vein interposition. Because visceral aneurysms may be multiple, further aneurysms must be sought at the time of the first diagnosis. Elective surgery is the method of choice, because 40-80% of visceral aneurysms rupture spontaneously, with a high mortality rate. The mortality rate for elective surgery is now low.

Aneurysm, False↗
PubMed1993

Coronary artery size in mitral regurgitation and its regression after mitral valve surgery.

The relationship between coronary artery size and left ventricular (LV) muscle mass was studied in 10 control subjects and in 10 patients with chronic mitral regurgitation before and 28 +/- 15 months after mitral valve surgery. Left and right coronary artery size was determined by quantitative coronary arteriography. Left coronary artery size was significantly increased before surgery (26 mm2) and decreased after operation (23 mm2), but was still larger than in control subjects (14 mm2). The right coronary artery was also enlarged preoperatively (13 mm2; controls = 9 mm2), but was normalized after surgery (11 mm2). A linear correlation was found between LV muscle mass and left (r = 0.88, p < 0.001) and right coronary artery size (r = 0.84, p < 0.001) as well as between right coronary artery size and mean pulmonary artery pressure (r = 0.56, p < 0.01). Thus in chronic mitral regurgitation the enlargement of the left and right coronary artery is proportional to the degree of LV hypertrophy. The increase in right coronary artery size is probably the result of right ventricular pressure overload. Postoperatively there is only partial regression of left coronary artery size but normalization of right coronary artery size.

Adult↗
PubMed1993

Retrograde ascending aortic dissection: a diagnostic and therapeutic challenge.

Aortic dissection with an entrance tear in the transverse aorta is generally considered to have the highest acute fatality rate of any type of dissection and the direction of its extension is the most difficult to predict. In a prospective study, we evaluated 61 consecutive patients (mean age 56.7 years, ranging from 21 to 75 years), presenting with ascending aortic dissection during a 36-month-period and tried to clarify the incidence of retrograde ascending aortic dissection. In 49 patients (80.3%), the intimal tear was located in the ascending aorta, whereas the dissection originated in the transverse aorta in 12 patients (19.7%); in this latter group, extension was strictly retrograde in 5 patients and in both directions in 7 patients. Three patients died before operation; 58 patients underwent aortic replacement/repair under moderate hypothermia; if the primary tear extended into the transverse aorta or was not found in the ascending aorta, the aortic arch was explored during a brief period of deep hypothermic circulatory arrest. The overall operative mortality was 12.1% (7/58); it was 10.4% (5/48) in ascending aortic dissection and 20% (2/10) in dissection of the transverse aorta. Age (P < 0.005), concomitant coronary artery disease (P < 0.01) and the site of intimal tear (P < 0.01) were significant predictive factors of operative risk. A tear in the transverse aorta is almost always associated with retrograde dissection and may simulate dissection with the entrance tear in the ascending aorta. Localization of the entrance tear remains a diagnostic challenge in aortic dissection but Doppler-echocardiography had a high sensitivity in this series (96.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Reoperation after mitral valve reconstruction: early and late results.

Between 1968 and 1990, 68 patients (33 male, 35 female) with a mean age of 47 years were subjected to reoperation (62 valve replacements, 6 reconstructions) after primary mitral valve reconstruction (mean interval = 81 months). The indication for reoperation was residual valve insufficiency in 51, and stenosis in 17 patients. The average preoperative New York Heart Association (NYHA) class was 3.0. The average follow-up was 63 months. The operative mortality was 8.8% (8 out of 68 patients). The actuarial late survival was 90% after 5, and 73% after 8 years. After a second mitral valve reconstruction 66% (four out of six patients) died (one early, three late). The incidence of second reoperations was 4.4% (3 out of 68 patients), and of thromboembolic complications 11.8% (8 out of 68 patients). The mean NHYHA class improved significantly. The actuarial freedom from second reoperations was 98% and 90%, and from thromboembolic complications 91% and 82% after 5 and 10 years, respectively. Endocarditis did not occur, whereas two patients on Coumadin anticoagulation had non-fatal gastrointestinal bleeding. Late survival was less favorable (P < 0.05) in patients operated on before 1980, in a higher preoperative NYHA class, after a second valve reconstruction, and if pulmonary hypertension or atrial fibrillation was present. Significant independent risk factors were older age and earlier reoperation, pulmonary hypertension or higher NYHA class postoperatively. For the last to years it has been possible to perform reoperations after mitral valve reconstructions with good early and excellent late results. The mortality and complication rates were similar to those for primary mitral valve reconstructions.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

The warm versus cold perfusion controversy: a clinical comparative study.

To evaluate the effects of temperature on myocardial and total body protection, we analyzed 129 consecutive patients who underwent coronary artery bypass grafting, valve replacement, or both, with continuous cardioplegia (Cp). The patients were assigned to three groups: group I (n = 37) normothermic cardiopulmonary bypass (CPB) (37 degrees C) and warm (37 degrees C) Cp, group II (n = 49) normothermic CPB and cold (4 degrees C) Cp and group III (n = 43) hypothermic (28 degrees C) CPB and cold Cp. Comparison of groups I and II showed similar serum levels of creatine kinase (CK) and its myocardial-specific isoenzyme on the first postoperative day, a similar rate of perioperative myocardial infarction, postoperative need for intra-aortic balloon pump, postoperative need for inotropic support and mortality. Comparison of groups I and III showed similar serum levels of CK, amylase, lactate dehydrogenase and creatinine on the first postoperative day, a similar complication rate and mortality rate. However, normothermic CPB resulted in a shorter bypass time (83 +/- 4 vs 98 +/- 7 min, P < 0.05) and interval until extubation (25.0 +/- 3.8 vs 40.3 +/- 7.4 h, P < 0.05). In conclusion, there are no differences concerning myocardial protection, however, warm CPB shortens the perfusion time and postoperative course.

Coronary Artery Bypass↗
PubMed1993

Immediate shear stress resistance of endothelial cell monolayers seeded in vitro on fibrin glue-coated ePTFE prostheses.

The shear stress resistance of endothelial cells (EC) previously seeded onto ePTFE grafts was assessed by morphometric determination of the number of cells per cm2 of graft surface before and after exposure of 6 h of arterial blood flow interposed in the canine femoral artery. Autologous venous endothelial cells (AVEC) were harvested from the extrajugular veins of five dogs. The AVEC were cultured in vitro and seeded at a density of 150 x 10(3) cells per cm2 onto 4 mm ID ePTFE grafts precoated with fibrin glue and human fibronectin. Subsequently, the AVEC monolayers on the grafts were cultured for 8 days using a perfusion system and then implanted end-to-end in the femoral artery. All grafts remained patent (5/5). Scanning electron microscopy demonstrated complete, thrombus-free monolayers of AVEC after 6 h of arterial blood flow. The cell densities were 124 +/- 14 and 129 +/- 7 x 10(3) cells per cm2 respectively before and after implantation. It is concluded that in vitro lining of 4 mm ePTFE vascular prostheses is feasible and results in EC monolayers on the graft surface which are shear stress resistant and athrombogenic.

Animals↗
PubMed1993

Steal syndrome after internal mammary artery bypass grafting--an entity with increasing significance.

Stenosis of proximal subclavian artery (SCA), malformations of the internal mammary artery (IMA) at its origin, or large IMA side branches may cause myocardial ischemia due to blood-steal through a patent IMA graft. Thirty-one cases of postoperative steal syndromes have been reported in the literature, 23 due to proximal SCA stenosis, seven due to large IMA side branches and one due to an IMA malformation. We report two additional cases and discuss them in conjunction with the cases in the literature. Thirty patients suffered from recurrent angina pectoris, three had asymptomatic reversal of flow in the IMA as diagnosed by coronary angiography during routine follow-up examination. Carotid-subclavian bypass grafting is the treatment of choice for the management of proximal SCA stenosis. IMA malformations or large side branches are treated by interruption of the responsible vessel, either by ligation or by transarterial catheter embolization. In 82% (27 of 33), steal syndrome could have been prevented by preoperative angiography of the IMA. We advocate it as a routine procedure in combination with coronary arteriography.

Humans↗