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Biomedical subjects

P Firt

Publications and source records attributed to P Firt.

At least 37 records · Page 2Linked to original sources

State of the art and future trends in heart transplantation and ventricular assist devices.

The authors present a short review of the milestones in clinical heart transplantation and the prerequisites they regarded as indispensable to be able to start a clinical programme in their own centre. Next, they describe various types of ventricular assist devices (VAD) and the indications for their use. In conclusion, the authors discuss the prospects of, and future trends in, heart transplantation and VAD that have become, despite their short history, a clinical reality and whose practical importance is to grow further.

Assisted Circulation↗

Intraaortic balloon counterpulsation.

The authors summarize their experience with intraaortic balloon counterpulsation (IABC) at the Institute for Clinical and Experimental Medicine between 1978-1984. A total of 756 cardiac surgery procedures were performed for ischaemic heart disease (IHD), and 266 procedures for rheumatic heart disease (RHD). Of patients operated on for IDH, IABC was used in 38 (5%) and, of those undergoing surgery for RHD, in 38 cases (14%). Overall, IABC was employed in 76 patients, i.e., 7%. Ventricular assistance using IABC was successful in 55% of patients. The technique was significantly more successful in IHD (68%) than in RHD (42%) patients. IABC was less successful in IHD patients suffering myocardial infarction intraoperatively. Moreover, the success of IABC depended on its early initiation. Eleven patients (14%) developed complications associated with IABC. The data do not differ from results reported by world's leading centres.

Adult↗

Cardiac valve surgery combined with aortocoronary bypass.

An analysis of the experience obtained in combined cardiac valve and coronary artery surgery in 23 patients was performed. The dominant feature of their clinical symptomatology was valvular disease in the majority of patients, even though angina pectoris was present in 14 of them. In all patients, cardiac valve surgery was carried out together with coronary reconstruction in the form of a single to triple bypass. The procedure involved, in two cases, simultaneous removal of a left ventricular aneurysm and, in one patient, closure of a postinfarction lesion of the interventricular septum. One patient died in the postoperative period displaying signs of the low cardiac output syndrome. Long-term follow-up included 20 patients operated on. Improvement of a varying degree was observed in 19 patients.

Adult↗

Improved patency of the aortocoronary bypass by antithrombotic drugs.

A total of 1,017 bypasses were performed in 442 patients operated on in our department between January 1, 1981, and May 30, 1984. The overall early postoperative graft patency rate in our hospital was 91.5%. About 10% of the grafts had a flow rate of 40 ml/min or less, measured intraoperatively, and most occluded grafts were in this group. This article presents our experience with low-flow bypasses whose patency rates we attempted to improve. Patients with aortocoronary bypasses (ACBs) and with intraoperative blood flow rates of 40 ml/min or less were divided into two groups. The treated group was given, from day 0 onward, a 500-mg dose of acetylsalicylic acid twice a day and a 75-mg dose of dipyridamole three times a day. The control group was given no medication. Control coronary arteriography was performed at one month and then at one year after the operation. One month postoperatively, 34 out of 41 ACBs in the treated group were patent; in the control group, only 17 out of 37 were patent (p less than .001). One year after the operation, 24 out of 37 ACBs in the treated group were patent, whereas in the control group only 8 out of 38 ACBs were patent (p less than .001). We conclude that antiplatelet drugs have a beneficial effect on the short-term and long-term patency of ACBs.

Aspirin↗

Use of an intraluminal double-ring vascular prosthesis in thoracic aorta reconstruction.

The authors present their initial experience with the use of the intraluminal double-ring prosthesis in the surgical treatment of thoracic aorta aneurysms. To date, they have performed this procedure in a total of 7 patients. Five had dissecting aneurysms of the ascending and descending aorta, one had a false aneurysm of the aortic arch, and one was operated on for a traumatic aneurysm of the descending aorta. Five patients recovered without any severe complications. Two patients died. Of these, one underwent surgery on an emergency basis for ruptured dissecting aneurysm of the ascending aorta while another died from intestinal gangrene due to occlusion of the upper mesenteric artery, caused by dissection. The benefits of the new technique of vascular reconstruction are discussed, and the potential for expanded indicational criteria is mentioned.

Adult↗

Long-term results of surgical treatment of renovascular hypertension.

The authors analyse long-term results of surgical treatment of renovascular hypertension in 195 patients hospitalized at the Institute for Clinical and Experimental Medicine in Prague in 1971 to 1982. Significantly better results were attained in patients with dysplastic stenosis than in patients with sclerotic stenosis of renal arteries (86.45% vs. 56.33%). In view of this experience the authors stress the importance of most accurate diagnosis of the morphological basis of the stenosis. In patients with sclerotic stenosis, the probability of a favourable effect of surgical reconstruction on blood pressure is substantially smaller. Attention is drawn to the important successes attained with the use of percutaneous transluminal angioplasty, which has in recent years found considerably wide application precisely in the sphere of renal arteries.

Adolescent↗