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Biomedical subjects

M Turina

Publications and source records attributed to M Turina.

At least 397 records · Page 22Linked to original sources
PubMed1986

[The stunned myocardium: ischemia-induced reversible myocardial dysfunction].

The "stunned" myocardium is the result of an ischemic insult which is not of sufficient severity to produce myocardial necrosis but affects myocardial function, biochemical processes and ultrastructure for a prolonged period of time. A "stunned" myocardium can be expected when preoperative asynergic wall motion is normalized after successful coronary bypass surgery under similar loading conditions. Forty-five patients (mean age 51 years) underwent diagnostic cardiac catheterization before and 9.5 months after successful bypass surgery. Patients with perioperative myocardial infarction and/or occluded vein grafts were excluded from the study. Preoperatively 17 of the 45 patients had a reduced systolic ejection fraction. These patients were further divided into the following two groups: group 1 consisted of 6 patients without or with only a small increase in regional ejection fraction (6 regions of the left ventricle in the right anterior oblique projection) after surgery (control group), and group 2 of 11 patients with a postoperative increase in preoperatively reduced regional ejection fraction (preoperatively "stunned" myocardium). In regard to duration of symptoms, functional classification (NYHA), number of myocardial infarctions, unstable angina pectoris and physical working capacity on the bicycle ergometer, there were no significant differences between the two groups. A mean 2.8 and 3.6 vein grafts (ns) were implanted in groups 1 and 2, respectively. Postoperatively, NYHA class decreased significantly and physical working capacity increased in both groups. Left ventricular end-diastolic and peak systolic pressure remained unchanged after surgery; left ventricular ejection fraction was unchanged in group 1 (49 vs. 51%, ns) but increased significantly in group 2 (38 vs. 50%, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1986

[Blunt heart injuries].

Cardiac injuries were present in 16% of our patients suffering from blunt chest trauma. 25% of these cases had no concomitant rib fractures. Sonography is extremely important for evaluation. In myocardial contusion the electrocardiogram reveals mainly disturbances in repolarisation (66 out of 108 patients) and rhythm disturbances (59 patients). A ratio of CK-MB isoenzyme/total CK of over 8% is highly suggestive of myocardial injury. Continuous monitoring in ICU is mandatory. Prognosis is mainly based on additional injuries. Heart wall rupture and luxation of the heart require operative treatment. Lesions of the aortic valves are the most frequent valve injuries.

Coronary Vessels↗
PubMed1986

Intracolonic migration of a pacemaker generator.

Following pacemaker implantation, a 75-year-old male developed a low grade infection of the generator pocket. Utilizing the same generator, several relocations of the generator were made with the result that eventually the pacemaker, eroding the muscular planes, found his way into the ascending colon. Healing could be achieved only after removing the whole pacemaker system. The authors' current policy in case of pacemaker infection is also reported.

Aged↗
PubMed1986

Echocardiographic findings late after myectomy in hypertrophic obstructive cardiomyopathy.

Postoperative echocardiograms of 50 patients undergoing myectomy for hypertrophic obstructive cardiomyopathy between 1965 and 1982 have been evaluated. In 21 patients a comparison with preoperative echocardiograms showed that postoperatively there was a significant reduction of septal and free wall thickness, an increase of left ventricular end-diastolic as well as outflow tract dimensions and a reduction or disappearance of systolic anterior motion of the mitral leaflet. Postoperative examination at intervals greater than 3 years revealed a significant increase of left ventricular and left atrial cavity size with unchanged contractile parameters and little reduction of left ventricular hypertrophy. In 4 of 12 patients evaluated greater than 8 years after myectomy, left ventricular dilatation was observed and 3 of these 4 patients developed congestive heart failure. Development of left ventricular dilatation was independent of whether a transventricular and/or transaortic approach was used for myectomy. These data indicate that the late course after myectomy in hypertrophic obstructive cardiomyopathy may be complicated by dilatation of the left ventricular cavity.

Adolescent↗
PubMed1985

[Clinical course after surgical treatment of the Wolff-Parkinson-White syndrome].

Return-to-work studies after surgery for WPW syndrome have not previously been reported. Of 29 patients who underwent surgery for symptomatic refractory or dangerous arrhythmias, those with a follow-up period of more than 5 months were reinvestigated by their general practitioner by questionnaire. 22 patients (6 female, 16 male, mean age 35 [14-59] years) met criteria for follow-up (mean postoperative period 21.7 [5-56] months). 19 were completely symptom-free, two had palpitations due to VPB and 1 had recurrence of tachycardia. 19 are back at full-time work compared with only 13 preoperatively, 2 are working reduced hours and 1 is disabled after an accident. There were no deaths, but 1 patient was reoperated on surgical grounds. 3 patients are continuing to take vasoactive drugs. It is concluded that, in the light of clinical follow-up, 86% of patients undergoing surgery for WPW syndrome can be cured and return to work.

Adolescent↗
PubMed1985

[Surgical treatment of type I and II dissecting aortic aneurysms].

Over a period of 15 years, 89 patients (70 male, 19 female) aged 15-76 (mean 48) underwent surgery for acute (64) or chronic (25) dissecting aneurysm type I or II. Early mortality was 18% (16 patients); 8 patients died late (2.8% per year); 8 patients had to be reoperated because of late complications on the aorta. Although very often it is not possible to remove or replace the entire diseased aorta, the goal of the operative procedure is to reduce the risk of rupture by replacing the entry site with a dacron graft. Late reoperation has to be considered if dissection progresses or a new aneurysm develops.

Adolescent↗
PubMed1985

[Is the alternating pulse a prognostically unfavorable sign for the postoperative course in patients with severe aortic defects?].

Pulsus alternans has been observed in patients with severe aortic valve disease and hypertensive or coronary artery disease, and has been considered a sign of severe ventricular dysfunction. Between 1974 and 1982 we observed 12 patients with severe aortic valve disease (10 aortic stenosis, 1 aortic insufficiency and 1 with a combination of both valve lesions) and pulsus alternans (group 1). Twelve patients (9 aortic stenosis, 1 aortic insufficiency and 2 with a combination of both valve lesions), but without pulsus alternans, served as controls (group 2). All 24 patients underwent surgery and were followed up for 36 months (group 1) and 50 months (group 2) respectively. One patient from group 2 died after surgery from cerebral hemorrhage. Mean age was similar in both groups (56 vs. 55 years). Preoperatively, the patients in group 1 were in a higher NYHA class (2.7 vs. 2.3; p less than 0.05) and had a higher heart rate (90 vs. 71 beats/min; p less than 0.005) than patients in group 2. M-mode echocardiography showed reduced left ventricular systolic shortening (23% vs. 35%; p less than 0.001) and increased left atrial diameter (4.6 cm vs. 3.8 cm; p less than 0.05) in group 1 compared with group 2. Systolic pressure gradient, aortic regurgitation, left ventricular end-diastolic and peak systolic pressure were, however, similar in both groups. Left ventricular angiographic ejection fraction was significantly reduced in group 1 (48% vs. 60%; p less than 0.01) compared with group 2. Postoperative follow-up was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1985

[Severe symptomatic valve defects in elderly patients. Spontaneous prognosis and surgical results].

Between 1970 and 1982 125 patients aged, 65 to 79 years with severe symptomatic valvular heart disease. Aortic valve disease (72 with aortic stenosis) was encountered in 76 cases, mitral valve disease (22 with mitral regurgitation) in 32 and combined aortic and mitral lesions in 17. Additional severe coronary artery disease (narrowing greater than 70%) was present in 25% of the patients. 80% of the patients were in NYHA class III and IV, and 42% had experienced an episode of congestive heart failure. 28 patients did not undergo surgery; 10 died before surgery and 18 were not accepted or refused the operation. After 2 years only 1 of 18 patients with aortic stenosis was alive; in mitral valve disease 5 of 6 patients were alive. Among the 97 surgical patients, aortic valve replacement was performed in 58 cases, mitral valve surgery in 26 and combined aortic and mitral valve surgery in 13. Additional aorto-coronary bypass grafting was performed in 23 patients. Early mortality was 5% and 5-year survival rate 69%. NYHA class declined from 2.9 preoperatively to 1.6 postoperatively. In the elderly patient with severe symptomatic valvular heart disease surgery can be performed with acceptable operative risk and good late results. Surgical treatment is particularly indicated in aortic stenosis, due to the poor spontaneous prognosis. Coronary artery disease is frequent in this age group but is not a contraindication for surgery, in view of the good postoperative results of additional aorto-coronary bypass grafting.

Age Factors↗
PubMed1985

[Remote results of mitral valve surgery in mitral valve insufficiency, 1972-1982].

Between 1972 and 1982 315 patients were operated on for isolated or predominant mitral insufficiency at Surgical Clinic A, University of Zurich. The etiology was rheumatic in 51 patients and degenerative in 133. Of these 164 patients, 42 underwent a reconstructive procedure and 122 mitral valve replacement. Patients who underwent mitral valve reconstruction were younger and had a longer average postoperative observation time than patients who had mitral valve replacement. Operative mortality of the total series was 2.4%. Late postoperative survival was very similar in the patients with rheumatic and degenerative mitral incompetence. Seven-year survival after mitral valve reconstruction was 87 +/- 5%, compared to 76 +/- 6% after mitral valve replacement. Mitral valve reconstruction patients required more reoperations than those with mitral valve replacement. On the other hand, the incidence of late embolism and endocarditis was lower after mitral valve reconstruction. Age of patients at operation and a preoperative reduction of ejection fraction and cardiac index were predictors of a less favourable postoperative course. From these observations we conclude that surgery should be carried out before irreversible impairment of left ventricular function, even where symptoms are less than severe. If possible, reconstructive surgery for mitral incompetence is justified in view of the lower postoperative risk of embolism and endocarditis and in spite of the higher incidence of recurrences requiring reoperation.

Adolescent↗
PubMed1985

Anomalous origin of the left thyrocervical trunk as a cause of residual pain after myocardial revascularization with internal mammary artery.

A patient with successful implantation of an internal mammary artery graft in the left anterior descending coronary artery complained of residual but different anginal pain after operation. Ischemia was demonstrated during a manual stress test. Angiography revealed anomalous origin of the thyrocervical trunk from the internal mammary artery. Angina and ischemia disappeared after the trunk was ligated.

Arteries↗
PubMed1985

Platelet inhibitors versus anticoagulants for prevention of aorto-coronary bypass graft occlusion.

The effects of the antiaggregant substance ticlopidine and of the anticoagulant acenocoumarol on patency rates of aorto-coronary bypass grafts were compared in a prospective randomized trial. Ticlopidine, 250 mg b.i.d. was administered orally from the first postoperative day till angiography, while anticoagulation with acenocoumarol was initiated on the second to third postoperative day. Side-effects of ticlopidine were rare and patient management with the standard dosage of this drug was easier than oral anticoagulation. From an initial group of 166 randomized patients 149 completed the trial by coronary angiography three months postoperatively. The 78 patients in the ticlopidine group showed a compliance of 85%. The average prothrombin time in the 71 patients receiving acenocoumarol was 26.9%. Detailed statistical analysis of the two study groups revealed no reason to doubt the correctness of randomization. Coronary angiography showed an average patency rate per patient of 84% with ticlopidine and of 82% with acenocoumarol. This and various other measures of graft occlusion did not reveal any substantial difference in graft patency of patients receiving ticlopidine or acenocoumarol. It is concluded that ticlopidine may well be used instead of anticoagulants for prevention of postoperative occlusion of aorto-coronary bypass grafts.

Acenocoumarol↗
PubMed1985

Left ventricular systolic and diastolic function in coronary artery disease: effects of revascularization on exercise-induced ischemia.

Left ventricular systolic and diastolic function were studied before and after surgical revascularization in a group of 24 patients with stable angina who all had an excellent clinical response to surgery. With use of micromanometer left ventricular pressure measurements and ventricular volumes, calculated from biplane cineangiograms, left ventricular function at rest and during exercise before and after surgery was compared. Before surgery all patients had exercise-induced ischemia with new asynergy, a fall in ejection fraction from 57% to 49% (p less than .001), and a rise in left ventricular end-diastolic pressure from 23 to 37 mm Hg (p less than .001). Postoperative exercise resulted in no new asynergy and ejection fraction rose from 59% to 61% (p less than .05). Left ventricular end-diastolic pressure still rose from 17 to 25 mm Hg (p less than .01). Left ventricular pressure decay during exercise was greatly improved after revascularization and allowed maintenance of reduced early diastolic pressures. The early diastolic pressure nadir before surgery rose from 9 to 21 mm Hg (p less than .001); the postoperative nadir was 5 mm Hg at rest and 6 mm Hg during exercise. All patients had an upward shift in the diastolic pressure-volume relationship during preoperative exercise. After revascularization there was no upward shift in some patients and a much smaller shift in others. The postoperative increase in left ventricular end-diastolic pressure was due to increased end-diastolic volume, not altered compliance. There was an increase in mean right atrial pressure during exercise either before (6 to 11 mm Hg) or after surgery (4 to 10 mm Hg). These increases were quite variable, suggesting no consistent role of pericardial restraint during exercise. Early diastolic peak filling rate during exercise was greater after surgery (1260 vs 950 ml/sec, p less than .001). In fact, during postoperative exercise early diastolic filling rates were greater than normal, reflecting the persistence of abnormally high atrial pressures for filling. As at preoperative study, late diastolic filling during exercise was restricted after revascularization when compared with that in a control group. Postoperatively patients undergoing bypass procedures with a good clinical result showed significantly improved left ventricular diastolic and systolic function. Persistent elevation of end-diastolic and atrial pressures and other abnormalities of diastolic function may reflect chronic structural changes and need to be taken into account when evaluating patients after bypass surgery.

Adult↗