[Severe aortic sinus aneurysm complicated by a mitral valve defect].
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Aortic Aneurysm↗
Biomedical subjects
M Turina
Publications and source records attributed to M Turina.
[Termination of the left hepatic vein in the coronary sinus].
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Adult↗
Isolated aortic valve replacement with the Björk-Shiley tilting disc prosthesis and the porcine bioprosthesis.
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Adolescent↗
[Is echocardiography useful in assessing long term prognosis after valve replacement in patients with left ventricular volume overload?].
Echocardiographic recordings in 87 patients with chronic volume overload of the left ventricle (32 pure aortic incompetence, 18 mixed aortic lesions with predominating regurgitation, 17 mitral incompetence and 20 combined aortic and mitral incompetence) who underwent valve replacement between 1975 and 1976 were reassessed to determine the prognostic interest of echocardiography in the long-term postoperative period. The follow-up was a least 2.5 years (average 2.8 years). Patients with coronary artery disease or paravalvular leaks were excluded from the study. The evaluation of the echocardiogrammes comprised the measurement of the end diastolic left ventricular internal dimension (Dd) and the end systolic dimension (Ds) and the calculation of the percentage systolic shortening of the internal dimension (p. 100 Sh) and of the ratio, radius/thickness in end diastole (Dd/2th). A poor surgical result was defined by a postoperative work capacity of less than 60 p. 100 normal or by postoperative death (7 deaths, one of which was in the perioperative period). 21 patients had poor results (group I) and 66 patients, good results (group II). None of the individual echocardiographic parameters differed significantly in groups I and II. In a sub-group of 50 patients, with isolated aortic incompetence, the preoperative echocardiographic data could not distinguish between patients with good and poor postoperative courses. On the other hand, the 4 patients with chronic aortic incompetence who died before operation were characterised by a Dd > 80 mm and Ds > 60 mm, although p. 100 sh was only < 25 p. 100 in one of these 4 cases. In conclusion, M mode echocardiography in patients with chronic volume overload of the left ventricle did not appear to have any value in the prediction of the long-term postoperative result. In patients with chronic aortic incompetence, greatly increased left ventricular internal dimensions indicate a compromised natural prognosis and are an urgent indication for surgical intervention.
Adolescent↗
[Percutaneous transluminal dilation by catheter of coronary - artery stenosis (author's transl)].
Since September 1977 until July 1979, 82 patients with various coronary lesions have undergone percutaneous transluminal coronary angioplasty (PTCA). By this technic, a catheter system is introduced through a systemic artery under local anesthesia to dilate a stenotic artery by controlled inflation. In 60 patients (73%) anatomical and hemodynamic success could be noted, which led to improvement in clinical parameters e.g. reduction of coronary narrowing of the transluminal diameter from a mean of 82 +/- 11% to 34 +/- 16% (p less than 0.001) and reduction of trans-stenotic coronary gradient from 56 +/- 15 to 19 +/- 12 mmHg (p less than 0.001). Nine patients, three of whom had signs of transmural myocardial infarction on the ECG had undergone emergency surgery for a coronary by-pass, this been due to the deterioration of clinical condition after the attempt to carry out coronary angioplasty. 42 out of 60 treated patients had at least one late control. 33 showed an improvement in cardiac efficiency campared with the pre-dilatation period. Patients with uncalcified single-vessel stenosis, less than 1 cm in length and a short history of pain appear to be most suitable for the procedure. More cases and follow-up datas are necessary to evaluate the efficiency of this new technic as compared with current medical and surgical treatments of ischemic heart disease.
Adult↗
[Aortic valvar replacement indications on the basis of 15 years of experience (author's transl)].
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Aortic Valve↗
[Reducing hemodilution through ultrafiltration following cardiopulmonary bypass].
Reduction of post-bypass-hemodilution by ultrafiltration was assessed. Five dogs were subjected to 1 hour of cardiopulmonary bypass and were hemodiluted with 2 liters of Ringer lactate solution to a hematocrit below 20%. An arterial hemofilter was then incorporated into the system and 1 liter of fluid was ultrafiltrated for 16 minutes during partial bypass. The filtrate was free of protein and hemoglobin. There was a significant increase of the hematocrit from 19 to 29%, and protein from 2,7 to 5,4 g%. No hemodynamic alterations were seen during or after filtration. Osmolality remained within normal limits (from 284 to 296 mOsm/kg). In addition, no electrolyte imbalance was found. The method is therefore safe for quick volume removal without the side effect of diuretics.
Animals↗
[Acute bacterial endocarditis caused by streptococci of Lancefield group C (author's transl)].
An Angell-Shiley heterograft valve was implanted in a 32-year-old woman with severe aortic regurgitation and stenosis. Post-operatively acute bacterial endocarditis occurred, due to group C streptococci. Because of severe acute aortic insufficiency with partial dehiscence of the heterograft valve and increasing left heart failure re-operation was necessary. After successful replacement of the valve an aortocoronary bypass was connected to the left circumflex artery because of displacement of the left coronary ostium. In addition, an aortoplasty was performed for spontaneous aortic rupture. Because of severe left heart failure with myocardial infarction in the course of the operation circulatory support with a paracorporeal artificial heart was necessary for 60 hours postoperatively. Despite transitory improvement the patient died from septic shock 30 days after the re-operation.
Adult↗
[Determinants of left ventricular function in aortic stenosis. Analysis based on pre and postoperative hemodynamic studies].
In 11 preoperative patients with aortic stenosis the isovolumic contractile indices Vpm and Vmax were normal (group N). In 8 patients with aortic stenosis these indices were depressed (group D). Peak systolic circumferential wall stress (afterload) did not differ in the two groups and showed a similar decrease after successful valve replacement. Left ventricular ejection fraction increased significantly in group D from 48 to 71% and remained unchanged in group N (70 and 75%). It is concluded that the significant improvement in ejection performance in group D at similar afterload conditions as in group N is indicative for an impaired preoperative myocardial contractile state.
Aortic Valve Stenosis↗
The role of the surgeon in percutaneous transluminal dilation of coronary stenosis.
Percutaneous transluminal dilation (PTD) of coronary artery stenosis is performed by means of a balloon-tipped catheter introduced from a peripheral artery. It was attempted in 45 patients; stenosis was passed in 33 and was successfully dilated in 28 patients (62%). The method failed in 17 patients: in 6 of them an abrupt closure of a stenosed artery or a beginning infarction necessitated an emergency revascularization. There were no deaths or serious complications, but an infarction developed in 1 patient despite immediate bypass grafting. PTD was successful in 5 out of 7 patients who had recurrent angina after previous coronary bypass grafting: in 2 of them stenosis of a distal coronary artery and in 3 a stenosed bypass graft were dilated. PTD is a new method of treatment of coronary artery disease and is an addition rather than an alternative to coronary bypass grafting. The best results can be expected in patients with single-vessel disease, with a short history of angina (less than 1 year), and with narrow, noncalcified proximal stenosis. Some late complications of bypass grafting are also amenable to this method of treatment.
Adult↗
Percutaneous transluminal dilatation of coronary artery stenosis.
Percutaneous transluminal dilatation (PTD) of coronary stenosis is performed by means of a balloon-tipped catheter introduced from a peripheral artery. PTD was attempted in 56 patients; stenosis was successfully dilated in 38 patients (68%). The method failed in 18 patients: in 6 (11%) of them an abrupt closure of the stenosed artery or a beginning infarction necessitated an emergency revascularization. There were no serious complications or deaths; one patient developed a transmural infarction in spite of the immediate bypass grafting. PTD was also successful in 6 out of 9 patients with recurrent angina following previous coronary bypass grafting. Intraoperative dilatation by coronary arteriotomy was attempted in 6 patients, but the results were inconclusive. PTD is a new method of treatment of coronary artery disease; it represents an addition rather than an alternative to coronary bypass grafting. The decision for PTD should be made jointly by cardiologist and surgeon; the ideal patient has a short history of angina with narrow, proximal stenosis without any calcifications. Cardiosurgical standby is mandatory during PTD; the results are best and the risk lowest in patients with single vessel disease.
Adult↗
Isolated mitral valve replacement with the Björk-Shiley tilting disc prosthesis.
Between July 1970 and June 1977, 151 patients underwent isolated mitral valve replacement with the Björk-Shiley valve. The follow-up period extended over 8 years to June 1978. Hospital mortality was 5.2% (8/151), late mortality 8.4% (12/143). Actuarial survival analysis predicts 84 (+/- 4) % of patients to be alive at 5 years and 80 (+/- 6) % at 8 years. Thirteen patients sustained 15 episodes of thromboembolic complications; actuarially 88 (+/- 4) % of patients were free from this complication at 5 years and 81 (+/- 8) % at 8 years. Other valve-related complications included paravalvular leak (7), prosthetion showed an improvement of at least one class in 84% of patients.
Adolescent↗
Hemodynamic changes after experimental reduction of the left atrium.
Two experimental models were studied to determine the hemodynamic consequences of atrial volume reduction as observed after operative correction of transposition of the great arteries. The volume of the left atrium (LA) was reduced either by inflation of an intracavitary balloon (group A) or by surgical intervention (group B) to 50--60% of the control values as determined by angiography. The angiographic data correlated well with the true volumes obtained by water displacement. This major reduction of LA volume caused small but constant hemodynamic changes. Although the LA stroke volume decreased by 50% and the LA/LV volume relation was reduced by 50% (from 0.42 to 0.21), there was only a slight increase of pulmonary artery pressure (7% in group A and 14% in group B) and a slight decrease in cardiac index (13% in group A and 10% in group B) and in left ventricular end-diastolic pressure (9% in group A and 11% in group B). The reduction of atrial volume results in only minor functional alteration of the intact heart.
Animals↗
Pre- and postoperative left ventricular contractile function in patients with aortic valve disease.
In 43 patients left ventricular micromanometry and cineangiography were performed preoperatively and and 20 months after aortic valve replacement. A score of left ventricular functional impairment, derived from 5 to 8 haemodynamic variables, was calculated as: number of pathological indices x 100/total number of determined indices. Preoperatively the score of left ventricular functional impairment amounted to 35 per cent in group 1 (aortic stenosis: n = 19), to 61 per cent in group 2 (combined lesion:n = 15) (P less than 0.05), and to 87 per cent in group 3 (aortic regurgitation: n = 9) (P less than 0.001). In contrast, the functional classification according to the NYHA showed similar impairment in the 3 groups. Postoperatively the score of left ventricular functional impairment decreased significantly in all 3 groups to 10, 16, and 27 per cent, respectively, but the score of group 3 remained raised (P less than 0.05) as compared with that of group 1. The patients with residual left ventricular dysfunction had a higher preoperative left ventricular muscle mass than the patients with normal or near normal postoperative left ventricular function. It is concluded that (1) at similar functional impairment according to the NYHA classification left ventricular contractile function is more severely impaired in aortic regurgitation and in aortic regurgitation + aortic stenosis than in aortic stenosis alone, (2) left ventricular function improves significantly after valve replacement in all three forms of aortic valve disease, (3) residual functional impairment is greater in aortic regurgitation than in aortic stenosis or aortic stenosis + aortic regurgitation, and (4) persistent postoperative left ventricular functional impairment is found in the patients with severe preoperative hypertrophy.
Adult↗
Membrane and bubble oxygenator: a clinical comparison in patients undergoing aortocoronary bypass procedures.
Forty patients undergoing aortocoronary bypass procedures were randomyl allocated to a bubble oxygenator group (20 patients) and a membrane oxygenator group (20 patients). Blood chemistry, hematology and hemodynamics before, during and after cardiopulmonary bypass were used to compare the two oxygenators. There was no mortality and no serious complications in both groups. A higher hemolysis, with significantly higher levels of lactic dehydrogenase and free plasma hemoglobin and a more pronounced reduction in platelet count were found in the patients perfused with the bubble oxygenator. These differences persisted for 24 hours after the operation; 48 hours after surgery no significant differences between the two groups could be detected. Postoperative blood loss, intra- and postoperative hemodynamics and pulmonary gas exchange were equal in both groups. These results show, that the routine use of membrane oxygenators brings only minor benefits; therefore it may be specially reserved for extended open-heart procedures and for operations in high risk patients.
Blood Gas Analysis↗
[Surface changes of the pulmonary valve following pulmonary valve xenotransplantation in the descending aorta. An experimental study in dogs].
Upon implantation in the descending aorta, glutaraldehyde-conditioned pulmonary valves (n = 46) are immediately covered by a protein layer, followed by a fibrinous layer. Two to thirty minutes later platelets, WBCs, macrophages, and microthrombi are incorporated into the valve's surface. After 3 weeks the first collagen fibers appear on the surface and slowly build a collagen layer that grows toward the free edge. These changes are very similar to the surface changes of bioprostheses implanted in humans.
Animals↗
[Early scanning electron microscopy changes in the surface of woven dacron vessel prosthesis. An experimental study in dogs].
To evaluate platelet-inhibiting drugs in vivo, we implanted artificial vessels into the arterial blood-stream of dogs. Following different periods of normal blood-flow through the prosthesis, pieces were cut out and prepared for scanning electron microscopy (SEM). Through the SEM we studied surface changes of the samples, in particular those of platelets. They very soon loose their disclike form becoming relatively spherical and make contact with each other by means of pseudopods that are formed at that stage. Red blood cells are caught up in this 3-dimensional network causing the inner surface of the dacron prosthesis to look like an underwatergarden.
Animals↗
[Clinical application of a supplement to the extracorporal circulation to produce a pulsatile flow (author's transl)].
Two groups of patients with atherosclerotic coronary artery disease, who underwent aortocoronary bypass operation, were perfused with nonpulsatile flow during extracorporeal circulation (ECC) using membrane oxygenators. One group (MO) was used as a control, while for the other group (PAD) a Pulsatile Assist Device in the arterial line was employed. This apparatus consists of a balloon of 80 ml placed inside a rigid housing. The balloon is compressed by pressurized air or expanded by vacuum supplied by a driving console. The apparatus produced pulse amplitudes between 30 and 50 mm of mercury. Other than a very short-lasting fall in mean arterial pressure, thus showing diminished peripheral resistance, no perceptable advantages were found. Base excess and pH-changes showed no differences, also the given amount of sodium bicarbonate in both groups was the same. On the other hand significantly higher hemolyses took place, increasing with the duration of pulsation. The application of the apparatus as an arterial counterpulsator was possible with limitation in only 5 of 15 patients. In all other patients after a short time massive blood foaming developed in the PAD and the attempts had to be stopped because of the risk of gas embolism. In our opinion this apparatus is an unnecessary supplement to the ECC and as an arterial counterpulsator it seems too dangerous.
Adult↗