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Biomedical subjects

R Kieny

Publications and source records attributed to R Kieny.

At least 55 records · Page 3Linked to original sources
PubMed1980

[Aortic and mitral monovalvular replacements. Comparison of the ball prosthesis of Starr-Edwards (1260-6120) and the tilting disc prosthesis of Bjork-Shiley. Series of 390 patients].

The evaluation of short and long term replacement by the Björk-Shiley tilting disc prosthesis (BS) and by the Starr-Edwards ball and cage prosthesis (SE) was carried out on a series of 390 consecutive patients. In mitral replacement, operative mortality rate (SE 5.9 P. 100 - BS 4.8 P. 100), 5 year actuarial survival (SE 79.8 P. 100 +/- 3.8 P. 100 - BS 86.3 P. 100 +/- 9 p. 100) incidence of thromboembolic complications and valvular thrombosis (SE 1.6 P. 100 - BS 1.3 P. 100) as well as the degree of post-operative improvement were virtually identical in both types of prosthesis. Likewise, in aortic valve replacement, operative mortality rate (SE 4 p. 100 - BS 3.2 p. 100), 5 year survival (SE 82 +/- 7.8 P. 100 - BS 86 +/- 3.3 p. 100) incidence of thromboembolic complications (SE 2.2 p. 100 - BS 1.8 p. 100) and the degree of post-operative improvement were not statistically different. However, the incidence of sudden death was statistically smaller with a BS prosthesis than with a SE prosthesis (respectively 1.6 p. 100 and 6.9 p. 100).

Actuarial Analysis↗
PubMed1979

[Real-time cross-sectional echocardiography. Application in the measurement of the surface area of the mitral orifice in cases of stenosis or of double involvement of the valve (author's transl)].

Two-dimensional echocardiography in real time has proved in recent years to be a very valuable means of investigation in cardiology, in particular in the area of valve disease and congenital cardiac malformations. The present study concerns a group of 20 patients with essentially stenosing mitral disease, studied by two-dimensional echocardiography using mechanical sector scanner. The authors report their experience of the method in the measurement of the surface area of the mitral orifice from echotomographic sections obtained in protodiastole in a plane perpendicular to the long axis of the left ventricle and passing through the free edge of the mitral cusps. Fifteen of these patients being then treated by valve replacement, the area measured were compared with those found in the operative specimens. In 14 cases out of 15 (93%), despite the concomitant existence of appreciable mitral incompetence in 9 cases out of 15, the surface areas did not differ by more than 0.23 cm2 (coefficient of correlation = 0.990). These results confirmed that two-dimensional echocardiography in real time is a reliable method for the direct measurement of the mitral orifice area in the presence of stenotic type disease of the valve and even in the presence of associated mitral regurgitation.

Adult↗
PubMed1979

[Problems encountered by the anesthetist-intensive care specialist during aorto-coronary bypass surgery].

The authors studied a series of 288 patients undergoing surgery for aorto-coronary bypass. The anaesthetic protocol and operative protocol are described and particular emphasis is placed upon the aortic clamp time. Mortality and peri-operative complications are then analysed. The treatment of such complications is based essentially upon vasodilators and where necessary intra-aortic counter-pressure balloon device to provide circulatory assistance.

Anesthesia↗
PubMed1979

[Congenital carotid to jugular aneurysm].

A congenital carotid--jugular aneurysm was responsible for severe heart failure in a two day old baby. The child recovered after surgery. The signs suggesting an arteriovenous fistula (a continuous murmur and thrill, hyperdynamic circulation) may be absent, as in this case, when the child is in severe cardiac failure. The signs should be sought when the circulation improves.

Arteriovenous Malformations↗
PubMed1978

[Distal fixation of the intima after endarterectomy. Technical variation].

Oblique termination in a "bevel" of the distal endartery and its fixation by a circumferential continuous suture which provides a surface which is as stable and regular as possible, after endarterectomy. This may favourise improuved distal flow and influence immediate and late local permeability.

Arteries↗
PubMed1978

[Surgical treatment of massive pulmonary embolism. (Reported of 45 successful embolectomies inclusive 10 with Trendelenburg's technic) (author's transl)].

45 pulmonary embolectomies have been carried out successfully, 10 by Trendelenburg's procedure, 35 with extracorporeal circulation. The latter method gives satisfactory results (34 survivals out of 36 attempts since 1970) and appears to be the procedure of choice. Any pulmonary trauma should be avoided at operation; embolectomy is done by intra-vascular suction. The hemodynamic status was always abnormal: 5 initial cardiac arrests, 20 cases of severe shock (9 demonstrating cardiac arrest on the operating table) and 11 cases with less severe shock. In 9 cases cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. In 9 patients the operation was performed after an unsuccessful trial of thrombolysis. Preoperative pulmonary angiography could be performed in 30 cases and always showed extensive pulmonary vascular obstruction of 60 to 95 per cent. These data are important for diagnosis and for assessment of the prognosis. Despite of present medical treatment with fibrinolytics, surgery is still advisable in the treatment of massive pulmonary embolism. The indications are moribund patients, those in whom thrombolysis is contraindicated or unsuccessful and those with massive pulmonary obstruction (greater than 60 per cent). In this latter subset thrombolytic therapy carries a high level of mortality.

Clot Retraction↗
PubMed1978

[A treatable condition: parietal rupture of the heart during the acute phase of myocardial infarct. Apropos of a further case treated successfully with surgery].

A man aged 62 had an unexpected anterior myocardial infarction, complicated during the thirteenth hour after onset by parietal rupture and consequent acute tamponnade. The diagnosis was confirmed by echocardiography and then by pericardial puncture which allowed enough time for an operation to be undertaken under extra-corporeal circulation. The infarct was resected together with the weakened area of rupture, and the quality of the patient's life has been maintained at an excellent level after one year.

Cardiac Surgical Procedures↗
PubMed1978

[Early surgical treatment of a septal perforation complicating a posterior infarct. Value of the diaphragmatic left ventricular approach].

The authors report the case of a 53 year old patient who required operation on the 5th day after postero-inferior myocardical infarction for a poorly tolerated perforation of the ventricular septum. In discussing this case, they recall that the results for surgical repair of septal perforations complicating myocardial infarction are poorer when the infarction is posterior than when it is anterior. They suggest that this difference in prognosis is in large part due to the customary use in postero-inferior infarcts, of the right transventricular approach, which does not allow the infarct to be resected at the same time as the septum is closed. They finish by recommending the systematic use of a diaphragmatic approach to the left ventricle, including resection of the infarct, for all cases of septal perforations with posterior infarction in which surgery is necessary.

Cardiac Catheterization↗
PubMed1978

Anatomic, clinical, and therapeutic features of acute cardiac rupture. Successful surgical management fourteen hours after myocardial infarction.

A 62-year-old man sustained an acute myocardial infarction complicated on the thirteen hour by left ventricular rupture and acute periocardial tamponade. Echocardiography confirmed the suspicion of intrapericardial fluid, and immediate pericardiocentesis improved the hemodynamic state for a period sufficient to permit preparation for operation. Resection of ruptured and necrotic anteroapical left ventricular myocardium with primary reconstruction was successfully accomplished with the aid of temporary extracorporeal circulation. The patient has remained well for 1 year after the operation. Anatomic, clinical, and therapeutic features of acute cardiac rupture are discussed.

Cardiac Tamponade↗
PubMed1977

[Rupture of the free wall of the left ventricle during myocardial infarct. Contribution of echocardiography to its diagnosis. Surgical cure].

Parietal rupture of heart is one of the most dramatic complications in the acute stage of myocardial infarction. Generally it is fatal within few seconds or minutes. The authors report a case of rupture of the left ventricle into the free pericardial cavity, occurred at the 13th hour of an anterior infarction and surgically repaired with favourable result. On this occasion they emphasize the contribution of echocardiography to the diagnosis of cardiac rupture and the exceptional complexion of this case, which, to their best knowledge, is the third to have survived left ventricular rupture associated with ischemic heart disease, more than two months.

Drainage↗
PubMed1977

[Traumatic rupture of the descending aorta. A report of 21 operated cases (author's transl)].

From 1965 to December 1976, 21 traumatic ruptures of the descending thoracic aorta have been operated; the last 13 cases have been managed in 1975 and 1976. The lesions consisted in 15 recent ruptures (R.R.) and 6 chronic aneurysma (C.A.). Associated injuries were the rule and 6 patients underwent exploratory laparotomy prior to thoracotomy. Surgical repair was consistently due by use of an extracorporeal by-pass (20 times), and resulted in 12 end-to-end aortic sutures (11 R.R., 1 C.A.) and in 9 reconstruction by means of a tubular dacron graft (5 C.A., and 4 R.R.). 4 patients died. 16 of the 17 survivals are healthy and active. Paraplegia developed in one patient.

Adult↗