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Biomedical subjects

M Yacoub

Publications and source records attributed to M Yacoub.

At least 289 records · Page 16Linked to original sources
PubMed1980

Effect of hydroxyzine on morphine analgesia for the treatment of postoperative pain.

In a double-blind, single-dose study hydroxyzine combined with morphine was administered intramuscularly to postoperative patients to determine the efficacy of this combination in the relief of postoperative pain, and to compare its effect to that produced by morphine alone. Eighty-two patients received morphine (5 or 10 mg) with or without hydroxyzine (100 mg). Analgesia was measured by a method quantifying the subjective responses of patients when questioned about pain. Analgesia obtained when 10 mg of morphine was combined with 100 mg of hydroxyzine was significantly superior to that obtained with morphine alone. Drowsiness was significantly more frequent when 10 mg of morphine was combined with 100 mg of hydroxyzine than with morphine alone.

Adolescent↗
PubMed1980

The use of "fresh" unstented homograft valves for replacement of the aortic valve. Analysis of 8 years' experience.

Between August, 1969 and May 1978, 679 patients underwent homograft replacement of the aortic valve. Isolated elective valve replacement was performed in 411 patients. Thirty-four patients had total aortic root replacement with reimplantation of the coronary arteries. There were 16 early deaths (3.9%) and 43 late deaths (10.5%) during a follow-up between 3 and 102 months (mean 47 months). Actuarial analysis showed 87% survival at 5 years and 81% at 8 years. Valve failure occurred in 24 patients (5.9%) owing to prolapse of one cusp in eight patients (2.0%), infective endocarditis in seven patients (1.7%), and degeneration of the valve in nine patients (2.2%). Degenerative valve failure was encountered after the fourth year with an incidence of 4.8% of patients at risk and occurred only in grafts from donors over the age of 65 years. Diastolic murmurs were present in 28% of patients followed beyond 1 month and increased very slightly with time. Systemic embolism was not recorded in any patient despite the fact that anticoagulants were not used. The clinical results were judged to be good or excellent in 89% of patients. It is concluded that homograft replacement of the aortic valve gives satisfactory results with a low incidence of late valve failure.

Adolescent↗
PubMed1980

Clinical and hemodynamic results of the two-stage anatomic correction of simple transposition of the great arteries.

Between 1976-1979, 14 patients with simple transposition of the great arteries (TGA), ranging in age from 1 month to 2 1/2 years, underwent two-stage anatomic correction. Twenty patients underwent a first-stage operation, with three early deaths (15%). After the first-stage operation the peak systolic left ventricular pressure rose from 38 +/- 6 mm Hg to 79.6 +/- 11 mm Hg, with no significant change in end-diastolic pressure or ejection fraction. This was associated with a decrease in the actual pulmonary flow but no change in effective pulmonary flow. Between the first and second stages we allowed a 5-week to 9-month interval. There were four early (29%) and no late deaths. Follow-up was 5-37 months. After an initial period of cardiac failure, all patients became asymptomatic and developed normally. Rapid changes in ECG, vectocardiogram and echocardiogram toward normal were observed. Repeat cardiac catheterization was performed in nine patients, 3 weeks to 2 1/2 years after operation. Left ventricular ejection fraction was normal in all. Two who were investigated early had mild mitral regurgitation, five had minimal aortic regurgitation and one had moderate supravalvar pulmonary stenosis. The aortic and coronary anastomoses appeared to grow normally.

Blood Pressure↗
PubMed1979

Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic stenosis.

The effect of preoperative left ventricular function on early and late prognosis was assessed in 103 patients with aortic stenosis who underwent left ventricular cineangiography before homograft replacement of the aortic valve. The patients were separated into two groups: Group A (58 patients) with an ejection fraction of 0.46 or more and Group B (45 patients) with an ejection fraction of 0.45 or less. The two groups were compared with respect to clinical and hemodynamic data as well as operative result. There was poor correlation between clinical data and left ventricular function. In Group A there were three early deaths (5.2 percent) and three late deaths (5.2 percent) compared with no early and six late deaths (13.3 percent) in Group B during the follow-up period of 12 to 102 months (mean 43 months). Most patients in Group B showed considerable symptomatic improvement but less than that observed in Group A. Forty-two patients (13 in Group A and 29 in Group B) underwent repeat cardiac catheterization and coronary angiography. Improvement in left ventricular function as assessed by radial analysis of segmental wall motion and ejection fraction was observed in 20 of the 29 patients in Group B. Failure of left ventricular function to improve was associated with additional coronary artery disease in the majority of patients. It is concluded that poor left ventricular function does not increase the risk of aortic valve replacement for aortic stenosis and that improvement in left ventricular function can be expected in the majority of patients.

Adolescent↗
PubMed1979

Hydatid cyst of the heart. Clinical and surgical implications.

Hydatid cyst of the heart is an uncommon lesion which usually develops in the left ventricle. Diagnosis should be considered in patients coming from an area where hydatid cyst is endemic and who present with an abnormal heart shadow on chest X-ray, frequently associated with T wave changes on the electrocardiogram. The cyst tends to grow and thus compress the neighboring myocardium. It causes displacement of the coronary vessels, rhythm disturbances and mechanical interference with the AV valves and ventricular function. Spontaneous involution of the cyst with calcification of its wall as well as rupture with anaphylactic shock may occur. Early excision with standby cardiopulmonary bypass is advisable. Three patients with hydatid cyst of the left ventricle, 2 of whom were operated on by using cardiopulmonary bypass, are presented. Results of the surgical treatment, both early and late, are rewarding, with relief of symptoms, regression of electrocardiographic abnormalities and very low incidence of recurrence.

Adult↗
PubMed1979

The role of chemotherapy in the management of fungal endocaridits following homograft valve replacement.

Initial intensive combined chemotherapy, with late re-operation when indicated, appears to give better results than immediate excision of the infected valve. The combination chemotherapy used in this series was amphotericin B (up to 100 mg/patient/day) and flucytosine (up to 12 g/patient/day). Serious side effects attributed to this chemotherapy were extremely rare. Candida infections were the most common and the Aspergillus infections were uniformly fatal. Embolectomies and excisions of large mycotic aneurysms were generally successful. Re-operation for late valve malfunction was common and yielded satisfactory results.

Amphotericin B↗
PubMed1979

Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic regurgitation.

The effect of preoperative left ventricular function on eraly and late prognosis was assessed in 69 patients with aortic regurgitation who underwent homograft replacement of the aortic valve. Patients were divided into two groups: Group A (38 patients) had an ejection fraction of 0.46 or more and Group B (31 patients) had an ejection fraction of 0.45 or less. Clinical data, hemodynamic data, and operative results were compared in the two groups. In Group A there was one early death (2.6%) and there were two late deaths (5.3%) compared to two early deaths (6.5%) and seven late deaths (22.6%) in Group B during a follow-up period of 13 to 98 months (mean, 49 months). Actuarial analysis showed a 94% survival at 6 years in Group A compared to 80% in Group B. Twenty-four patients were reinvestigated by repeat cardiac catheterization and coronary angiography at a mean time of 38 months following valve replacement. Left ventricular function was assessed by computerized quantitative radial analysis of segmental wall motion. Improvement in left ventricular function occurred in eight of the 14 patients reinvestigated in Group B, and appeared to be closely related to the etiology of the initial valve lesion. Despite the higher mortality rate in patients with poor left ventricular function, most derived considerable benefit from operation.

Adolescent↗
PubMed1978

Anomalous origin of the right pulmonary artery from the ascending aorta associated with aortopulmonary window.

A rare case of anomalous origin of the right pulmonary artery from the ascending aorta associated with an aortopulmonary window and severe pulmonary hypertension in a 13-year-old girl is reported. The window was closed using a Dacron patch and the continuity between the anomalous vessel and the main pulmonary artery was restored with a tubular Dacron graft. After operation the pulmonary pressure dropped to about one-half of the systemic pressure, and equal perfusion and ventilation of both lungs was demonstrated. Although early recognition and surgical treatment of this condition are mandatory to prevent the onset of irreversible pulmonary vascular disease, the presence of severe pulmonary hypertension did not contraindicate surgical correction in our patient.

Adolescent↗
PubMed1978

[Hemodynamic comparison of Starr-Edwards, Lillehei-Kaster and homograft valves in the mitral position (author's transl)].

In 16 patients with Starr-Edwards (SE) disc valves, 10 patients with Lillehei-Kaster (LK) valves, and 4 patients with fresh aortic homografts (HG) in the mitral position the hemodynamic qualities of the valves were studied. All three valve types in general showed similar results, but they differed clearly as far as special parameters are concerned. So SE valves had the highest pressure gradients, HG valves the lowest, whereas LK valves were in between. The results of the study lead to the conclusion that tilting disc valves implanted in the mitral position are the best compromise, since they are always available and their hemodynamic response can be tolerated.

Angiocardiography↗
PubMed1977

Syndrome of congenital ventricular diverticulum and midline thoraco-abdominal defects.

The long-term follow-up of a 30-year-old patient who had a correction of the syndrome of left ventricular diverticulum and thoraco-abdominal defects is presented. The main features of the syndrome include a diverticulum of the left ventricle, a ventricular septal defect, and sometimes other cardiac anomalies. The thoraco-abdominal defects consist of foreshortened sternum, pericardial and diaphragmatic defects, and umbilical hernia. The association of these anomalies is thought to be due to a developmental failure of the primitive paramidline mesoderm. The diagnosis can be made clinically by the presence of a pulsatile, epigastric mass associated with signs of cardiac septal defects and dextrocardia. The prognosis of patients with this syndrome depends mainly on the associated abnormalities although rupture of the diverticulum can be a fatal complication. The treatment of choice is resection of the diverticulum combined with repair of associated anomalies which can give good early and late results.

Abdomen↗