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Biomedical subjects

M Turina

Publications and source records attributed to M Turina.

At least 451 records · Page 25Linked to original sources
PubMed1982

[Experiences with the extracardial conduit in the reconstruction of the right ventricular outflow tract].

Operative correction of certain congenital cardiac malformations with discontinuity between the right ventricle and pulmonary artery is technically possible today with satisfactory late results. The atretic or hypoplastic outflow tract can be bridged by an external tubular graft containing a valvular prosthesis. Of 22 patients operated upon from 1978-1981, 16 survived the operation and perioperative period. There was one late death. Routine cardiac catheterization was performed in 6 non-selected patients between 7 and 22 months after surgery. No hemodynamically important gradients were found. The extracardiac conduit between the right ventricle and pulmonary artery has become an important tool in correcting certain forms of congenital heart disease.

Adolescent↗
PubMed1982

[Is the aorto-coronary bypass operation useful in patients with advanced coronary sclerosis and poor ventricular function?].

The prognosis and long term results in 56 patients with coronary artery disease and impaired left ventricular function (EF less than or equal to 40%) who underwent aortocoronary bypass surgery (all cases) and aneurysmectomy (26 cases) between 1972 and 1980 were compared with those in 47 equally ill patients treated medically. Survival was significantly higher in the surgical than in the non-surgical group, the survival rate being 80% and 58% respectively at 41 months after study entry (p = 0.012). No difference in survival was observed between grafted patients and patients in whom additional aneurysmectomy was performed. 26 patients were recatheterized postoperatively and this revealed an increase in left ventricular ejection fraction at rest from 33 +/- 5% to 44 +/- 11% (p less than 0.001) and a decrease in left ventricular end-diastolic pressure from 18 +/- 8 mm Hg to 14 +/- 8 mm Hg (p less than 0.025). Postoperatively the patients had less angina and physical working capacity increased. At restudy the average NYHA class had decreased in the surgical group from 2.9 +/- 0.7 to 2.1 +/- 0.9 (p less than 0.001) but was unchanged in the non-surgical group (2.6 +/- 0.6 and 2.6 +/- 0.7 respectively). It is concluded that aortocoronary bypass surgery improves survival, left ventricular function and symptoms in patients with coronary artery disease and severely impaired myocardial function.

Adult↗
PubMed1982

[Relaxation of the left ventricle in aortic stenosis before and after aortal valve replacement].

In 14 patients with aortic valve disease (AVD) left ventricular (LV) relaxation was assessed by the time constant (T) of LV pressure (tipmanometer) fall before and 19 months after successful aortic valve replacement. 12 control patients were studied by the same technique. Preoperative LV ejection fraction in AVD (64%) and in controls (69%) did not differ. In AVD T was increased (60 ms) as compared to the controls (38 ms. p less than 0.05). During handgrip there was a similar increase in LV peak systolic pressure (LVSP), heart rate and peak measured contractile element velocity of shortening in AVD and in the controls. LV enddiastolic pressure varied minimally in both groups. T decreased during handgrip in controls (38 to 33 ms, p less than 0.01) and remained unchanged in AVD. Following aortic valve replacement resting T decreased insignificantly to 52 ms but remained increased (p less than 0.025) as compared to the controls. During postoperative handgrip, however, a decrease to 47 ms (p less than 0.05) was noted. Postoperative LVSP at rest (137 mm Hg) and LV muscle mass (105 g/m2) remained elevated (p less than 0.02) as compared to the controls (119 mm Hg; 72 g/m2). It is concluded that (1) in AVD with normal ejection performance LV relaxation at rest is prolonged, (2) the reaction of relaxation to handgrip is abnormal despite preserved contractile response, (3) following aortic valve replacement the response of LV relaxation to handgrip becomes normal and (4) elevated postoperative T at rest appears to be related to still increased LVSP postoperatively and residual hypertrophy rather than to intrinsic disturbances of myocardial relaxation.

Aortic Valve↗
PubMed1982

[Aortic valve replacement in older patients].

From 1971 to 1976, 72 patients over 60 years old underwent aortic valve replacement. At the moment of the operation 6 patients were older than 70 (8%), 25 patients were between 65 and 69 (35%) and 41 patients between 60 and 64 years old (57%). The early postoperative mortality was 5.5% and the late postoperative mortality 12.5%. The average observation period was 34 months. The frequency of death was comparable in the three age groups. The operative risk and functional postoperative recovery are unrelated to the age of the patients. The patients with combined aortic disease have the best prognosis.

Age Factors↗
PubMed1982

The ascending aortic aneurysm: replacement or repair?

Between 1971 and 1980, 100 patients underwent operation for ascending aortic aneurysm. Acute dissection was present in 29, chronic dissection in 11; 56 had dilatation only, and 4 had inflammatory disease of the ascending aorta. Four different operative procedures were applied independent of the type of disease: repair and reduction aortoplasty (21), reduction aortoplasty reinforced by nylon net (17), supracoronary graft replacement (42), and composite graft replacement with reimplantation of both coronary ostia (20). Early mortality was 10%, and late mortality was 12% after a mean follow-up of 45 months. Retrospective comparative analysis of the four operative methods led to the following conclusion: reduction aortoplasty supported by a tightly wrapped synthetic net is a suitable method in patients with a normal sinus of Valsalva and without dissection or inflammatory disease. Particular attention needs to be drawn to the proximal anchor stitches to avoid late net displacement. Compared with supracoronary or composite graft replacement, this method carried a lower complication rate, particularly in regard to cerebrovascular accidents and myocardial infarction. For patients with acute and chronic dissection with intact aortic root, supracoronary graft replacement is preferred, whereas in those with annuloaortic ectasia with dilated sinus of Valsalva and in all patients with Marfan's syndrome, composite graft replacement has become the procedure of choice.

Adolescent↗
PubMed1982

A new, simple method for intraoperative reinfusion.

The disposable device for intraoperative reinfusion consists of a polycarbonate container with an antifoam-coated filter. One port is connected to the suction tip; the other port is attached to wall suction. Sodium citrate solution (50 to 100 ml) is aspirated first, followed by 400 ml of shed blood. The full container is passed to the anesthetist who turns the device upside down and starts reinfusion from the bottom, previously the top port of the container. In experiments with dogs, this procedure resulted in only slight hemolysis, a minor drop in platelet count, and no mortality or morbidity. This new method of reinfusion combines the advantages of simplicity, disposable equipment, and low blood trauma.

Animals↗
PubMed1982

Congenital aortic stenosis. Early and late results of aortic valvulotomy.

Between 1962 and 1979, 87 patients with congenital aortic stenosis (11 infants from 4 days to 5 months, and 76 patients from one year to 24 years) underwent open aortic valvulotomy; in 14 patients an additional subvalvular membraneous ring or hypertrophic subaortic stenosis was resected. There were 3 early deaths (3%), all in infants less than one year of age. A second operation was necessary 3 months to 10 years (mean 6.3 +/- 4 years) after the initial procedure in 12 of the 84 survivors. In 9 patients an aortic valve replacement and in 3 patients a second valvulotomy was performed without perioperative mortality: in the latter group valve replacement had to be performed later. There were 5 late deaths (6%). The causes of death were endocarditis (2), thrombosis of the prosthesis (1), accident (1) and sudden death (1). The overall actuarial survival curve shows a 5-year survival of 90% and a 10-year survival of 87%; 87% are reoperation-free after 5 years and 75% after 8 years. At present 7 patients are scheduled for surgery because of recurrence of stenosis; 61 patients are symptom-free. It is concluded that aortic valvulotomy has immediate and long-term benefit in the large majority of patients. Operative mortality and morbidity are low in patients older than one year of age. Nevertheless aortic valvulotomy, which should not be performed too late, represents a palliative treatment and will lead to reoperation in approximately 25% of patients after 8 years.

Actuarial Analysis↗
PubMed1982

Tricuspidal annuloplasty. Results and complications.

Between 1976 and 1979, 76 patients underwent tricuspid annuloplasty (TA) for predominant tricuspid regurgitation (TR). The TR was functional (secondary to mitral valve disease) in 70, postrheumatic in 4, posttraumatic in one and secondary to myxomatous degeneration in one. The mean preoperative functional class was 3.05 and cardiac index 2.15 +/- 0.53 l/min/m2. All but 8 were in atrial fibrillation. Pulmonary vascular resistance over 250 dyn x sec x cm-5 was present in 28 patients. The original de Vega technique was applied in 55, a modified annuloplasty technique was used in the remaining 21 cases. There were 3 early and 6 late deaths, none being related to annuloplasty. One early and 2 late complications were attributable to tricuspid annuloplasty. At control after 6 months, 64 of 72 patients had improved at least one functional class. Three presented moderate TR on clinical examination. Mean observation time now averages 30 months (20 to 48 months). De Vega annuloplasty is a safe and effective method for the treatment of functional TR. It is of particular value during the early postoperative period in preventing right ventricular overload.

Adolescent↗
PubMed1982

[Spurious aneurysm after myocardial infarct].

False aneurysms of the left ventricle after myocardial infarction arae the result of perforation, which usually require early surgical treatment. The clinical features are not characteristic. The chest x-ray may provide important evidence for the diagnosis. Non-invasive diagnosis is possible by means of echocardiography and computer tomography; it is confirmed by angiocardiography. The authors experience with nine cases is described.

Adult↗
PubMed1982

Hemodynamic effects of atrial synchronization in acute and long-term ventricular pacing.

The acute and long-term hemodynamic benefit from atrial synchronization in ventricular (VAT) pacing has been investigated at rest and during exercise in 10 patients undergoing pacemaker implantation for complete A-V block. The results were compared to conventional (VOO) ventricular stimulation at rates of 70 BPM and 96 BPM. Cardiac index (CI) in VAT-pacing increased at rest by 8% and during exercise by 15% more than with VOO pacing (p less than 0.01). No significant change between the two different rates of asynchronous pacing was observed. CI at rest and during exercise was unchanged after 10 weeks of VAT-pacing. CI is regulated by change of stroke volume in VOO-pacing and by heart rate only with VAT-pacing. In contrast to earlier results with asynchronous ventricular pacing, the hemodynamic benefit of pacing in an atrial synchronized mode is long-lasting. Physiologic mechanisms regulate hemodynamics during exercise and in heart failure.

Adult↗