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Biomedical subjects

R Garcia-Rinaldi

Publications and source records attributed to R Garcia-Rinaldi.

At least 19 recordsLinked to original sources
PubMed1993

Coronary artery endarterectomy: a method of myocardial preservation.

The lack of acceptable coronary arteries for grafting often causes the cardiac surgeon considerable problems in treating patients with severe coronary artery disease. By combining the standard approach of coronary bypass surgery with coronary endarterectomy and with retrograde coronary sinus cardioplegia perfusion, we can achieve a longer ischemic period and can flush the debris from the coronary arteries in a retrograde fashion. Using this approach, we managed 72 patients with near inoperable coronary artery disease. One third of these patients required endarterectomy of more than one vessel. A higher than expected number of patients had diabetes mellitus. The left coronary artery system required endarterectomy in almost 60% of patients, much higher than percentages reported in other series of patients. The mortality rate in our patients who underwent the left system endarterectomy was 5.7%. Endarterectomy must be considered an adjunct in the management of high-risk patients with severe coronary artery disease.

Aged↗
PubMed1990

Carotid patch angioplasty: immediate and long-term results.

To determine the benefit of carotid patch angioplasty, a retrospective study of 1000 consecutive carotid endarterectomies was done. Based on the type of carotid endarterectomy closure, patients were divided into four groups: 250 had primary closure, 250 had expanded polytetrafluoroethylene patch, 250 had Dacron patch, and 250 had saphenous vein patch. On the basis of operative technique or type of carotid artery closure, no statistical difference was found in the incidence of postoperative stroke (p greater than 0.25): primary closure 1.6% (4), expanded polytetrafluoroethylene 2.0% (5), Dacron patch 1.6% (4), and saphenous vein patch (0). Postoperative carotid patency was determined by B-mode ultrasonography, and 717 patients were evaluated in follow-up extending to 6 years (mean 37.8 months). Based on the method of carotid endarterectomy closure, no significant difference (p greater than 0.25) was found in the incidence of significant restenosis (greater than 50% diameter reduction): primary closure 4.0% (7), expanded polytetrafluoroethylene 4.0% (6), Dacron 5.4% (9), and saphenous vein 1.0% (2). Significant restenosis was most frequent in habitual smokers (93%, 25/28) and females (78%, 22/28) despite the method of carotid endarterectomy closure. No statistical difference was found in the incidence of late ipsilateral stroke either (p greater than 0.25): primary closure 2.9% (5), expanded polytetrafluoroethylene 2% (3), Dacron 5% (3), and saphenous vein 0%. These results indicate that the incidence of postoperative stroke, regardless of method of arterial closure, was not statistically different. The method of carotid closure did not appear to affect the occurrence of late ipsilateral stroke or restenosis; however, patch angioplasty with saphenous vein appears appropriate in habitual smokers, and likely in patients with small internal carotid arteries.

Blood Vessel Prosthesis↗
PubMed1989

A technique for spot application of fibrin glue during open heart operations.

Several techniques have been described for preparing and applying fibrin glue to control surgical bleeding. However, these methods tend to be cumbersome, expensive, or messy. Furthermore, commercial kits have not been approved by the Food and Drug Administration because of the potential risk of hepatitis contamination. Therefore, we have devised a modified, simpler technique that enables the precise, pinpoint application of fibrin glue. The risk of hepatitis transmission is substantially reduced by using cryoprecipitate plasma instead of fibrinogen from pooled donors. This technique is especially well suited for anastomoses of small vessels or for sealing suture holes in nonporous grafts.

Aprotinin↗
PubMed1989

Generation of chordae tendineae with polytetrafluoroethylene stents. Results of mitral valve chordal replacement in sheep.

Surgical repair of ruptured or elongated chordae tendineae of the mitral valve is one of the most complex reconstructive techniques in cardiac surgery. Various surgical procedures have been described to repair chordal abnormalities of the anterior leaflet of the mitral valve with unpredictable results. Mitral valve replacement is usually recommended in that situation. This report describes a simple repair technique that we have devised. We resected one or two marginal chordae of the anterior leaflet of the mitral valve in 35 sheep and replaced them with a double-armed, pledget-supported, expanded polytetrafluoroethylene suture. The 30 surviving animals were studied hemodynamically and were electively put to death 3, 6, 9, 18, and 24 months after the operation. Mitral insufficiency did not develop in any of the sheep. All specimens had a normal mitral valve without thrombosis. The polytetrafluoroethylene suture remained pliable and was incorporated into the anterior leaflet and papillary muscle. Scanning and transmission electron microscopy showed that the suture was completely covered by a sheath of tissue with a collagen structure remarkably similar to that of a native chorda. Calcification was not detected in the new chordae. This reproducible and safe technique may considerably simplify the difficult repair of chordal abnormalities.

Animals↗
PubMed1987

Cardioplegia.

Explore the source record for details and available documents.

Heart Arrest, Induced↗
PubMed1986

Pancreatic pseudocyst of the mediastinum.

A patient with pancreatic pseudocyst of the mediastinum is presented. Weight loss, chest or abdominal pain, and dyspnea are the most frequent symptoms of mediastinal pseudocyst. Chest roentgenogram frequently demonstrates a posterior mediastinal mass, and esophagogram always shows esophageal displacement. The diagnosis is confirmed by computerized axial tomography of the chest and abdomen. Cyst-gastrostomy is the operation of choice for this condition.

Aged↗
PubMed1986

Successful repair of a transected intrathoracic trachea after chest trauma.

A 28-year-old man had a transection of the intrathoracic trachea in a head-on collision. Prompt diagnosis with a flexible bronchoscope, expeditious thoracotomy, and distal tracheal intubation proved lifesaving and allowed for meticulous repair of the disrupted trachea. The patient is asymptomatic 1 year later.

Adult↗
PubMed1985

Tricuspid commissurotomy.

The technique of tricuspid commissurotomy is based on principles different from those employed in mitral valve commissurotomy. In performing tricuspid commissurotomy, it is essential to identify and split the fan chordae, which are always fused and which clearly delineate the fused commissures. Failure to do this can result in an incorrect commissurotomy and secondary massive insufficiency. Our technique of tricuspid commissurotomy, employed in 205 patients, is presented.

Heart Valve Prosthesis↗
PubMed1985

Mersilene ribbon closure of the median sternotomy: an improvement over wire closure.

With the increased utilization of median sternotomy in thoracic surgery, some difficulties have arisen with closure of the sternum. This article presents a simple, easy-to-perform method of sternal closure utilizing reinforcement of the sternal halves with a material that is less likely to cut through the sternum and that is readily available.

Cardiac Surgical Procedures↗
PubMed1985

Implantation of pericardial substitutes.

Pericardial substitutes have been shown to decrease the formation of pericardial adhesions. For a pericardial substitute to be properly implanted, it must lie over the heart smoothly without buckling and prevent the accumulation of blood under its surface. The technique we describe prevents buckling of the pericardial substitute and consequently reduces the formation of pericardial adhesions.

Humans↗
PubMed1985

The exposed cardiac pacemaker. Treatment by subfascial pocket relocation.

Ten patients were treated for skin erosion and exposure of chronically implanted pacemakers. The pulse generators had been implanted either subcutaneously or in the subpectoral, submammary location. All patients were treated either by primary or secondary relocation of the pulse generator to deeper subfascial planes. Pacemakers relocated primarily to subfacial planes healed without resurfacing. Those pacemakers relocated to other superficial planes resurfaced but healed in a second subfascial translocation. Bacteriologic studies on these patients revealed that the organisms cultured or antibiotics utilized did not influence the fate of the relocated pulse generator. The subfascial location was the only determinant of the ultimate healing of the exposed pacemaker. We conclude that subfascial relocation of well-functioning pacemaker generators should be considered as an alternative to complete replacement of the unit.

Adult↗
PubMed1985

Expanded polytetrafluoroethylene surgical membrane for pericardial closure. An experimental study.

This experimental study summarizes our experience with the use of a new polytetrafluoroethylene surgical membrane as a pericardial substitute in 24 dogs. Group I consists of 10 dogs who underwent simple pericardial closure with this membrane, and in Group II, 14 dogs had pericardial closure with this membrane after cardiac procedures. There were three early deaths. Two dogs that had undergone an associated right heart procedure developed endocarditis at 4 and 7 months, respectively. Postmortem examinations were performed in all 21 surviving dogs. The pericardial membranes were found to be acellular and to have maintained their initial characteristics. The epicardium was normal and the coronary arteries easily visible. Seven of the eight 0.2 mm thick membranes caused filmy pericardial adhesions. None of the 0.1 mm thick membranes formed adhesions or had any structural change. We conclude that this new 0.1 mm thick polytetrafluoroethylene surgical membrane should be clinically tested to see if it will reduce or eliminate pericardial adhesions and facilitate cardiac reoperation.

Animals↗