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Biomedical subjects

R Koopot

Publications and source records attributed to R Koopot.

17 recordsLinked to original sources
PubMed1984

Surgical management of occluded conduits after the Fontan operation in patients with Glenn shunts.

Five complete conduit occlusions occurred in four patients with the Glenn shunt 2 months to 2 years after the Fontan operation. The possible reasons for complete conduit occlusion were severe dehydration, high pulmonary vascular resistance, and intraoperative manipulation of the conduit. In one patient in whom complete conduit occlusion developed twice, no possible cause could be identified. Surgical approaches included replacement of the occluded conduit in three patients and creation of an atrial septal defect and left aortopulmonary shunt in the fourth patient. All patients who had replacement of the occluded conduit survived. The fourth patient had severe cyanosis and hypoxemia from marked reduction of flow through the Glenn shunt because of reversal of flow through large venous collaterals. He subsequently died of Candida sepsis. A fifth patient (previously reported) who had complete conduit occlusion also died after a similar procedure. We believe that in patients with a Glenn shunt who develop complete conduit occlusion after the Fontan operation, conduit excision and a secondary Fontan operation, preferably without the use of woven Dacron, should be done instead of establishing an atrial septal defect and aortopulmonary shunt to the left lung.

Adolescent↗
PubMed1982

Successful reversal of brain damage from iatrogenic air embolism.

During an aortocoronary bypass procedure, the patient suffered an air embolism arising from technical difficulties with the extracorporeal circulatory device. Initial emergency treatment included a loading dose of thiopental concomitant to a one hour period profound hypothermia. A modified protocol for treating patients with acute head injuries was the initiated. It combined moderate hypothermia with continuous barbiturate coma for 96 hours. Brain activity in this patient returned on the third postoperative day. She recovered completely, with no detectable neurologic damage.

Brain Diseases↗
PubMed1981

Simplified operative procedure for proximal subclavian arterial lesions: direct subclavian-carotid anastomosis.

An operative approach to treatment of proximal subclavian occlusive lesions was used in 11 patients with claudication of the arm, vertebrobasilar insufficiency or subclavian steal syndrome. Through a supraclavicular incision, the subclavian artery is isolated proximal to the vertebral origin, dissected from the periarterial tissue into the mediastinum and then clamped above the atherosclerotic lesion. The artery is transected and the proximal end closed. The distal portion of the subclavian is then anastomosed end-to-side to the common carotid either in front of or behind the internal jugular vein. This procedure, applicable to right or left subclavian occlusive or ulcerative lesions, is particularly advantageous since it avoids major thoracotomy and the use of prosthetic bypasses in the neck. Postoperative noninvasive and angiographic evaluation in this series of patients indicates that the technique is simple, effective and without complications, making it preferable to existing procedures.

Aged↗
PubMed1979

Treatment of microemboli of the upper extremity.

A patient with microembolism of the left hand from an ulcerated lesion in the proximal part of the left subclavian artery was treated by a simple procedure for removing the embolic source from the arterial circulation. Through a supraclavicular approach, the subclavian artery was divided from the aorta distal to the lesion and anastomosed to the left common carotid artery. This technique was effective not only in restoring unobstructed distal circulation but also in avoiding the use of the more complicated thoracotomy.

Aorta, Abdominal↗
PubMed1977

Pseudoaneurysm of atrioventricular groove. A late complication of mitral valve replacement.

This report describes an unusual late complication of mitral valve replacement in which a false aneurysm of the atrioventricular groove produced compression on the circumflex coronary artery and myocardial infarction. The cause of this condition is not well explained, but its potential is present whenever there is early separation of the mitral anulus from the fibrous skeleton of the heart. Early hematoma formation resulting in frank perforation and hemorrhage has been reported, but late pseudoaneurysm formation after initial mitral valve replacement appears to be a rare occurrence.

Adult↗
PubMed1976

Ascending aorta-right pulmonary artery shunt.

Seventy-seven patients with ascending aorta-right pulmonary artery shunt were reviewed; 48 had tetralogy of Fallot, 9 had pulmonary atresia, 11 had transposition of the great vessels with pulmonary stenosis, 4 had tricuspid atresia, and 5 had miscellaneous complex lesions. Their ages ranged from one day to 13 years. The over-all mortality rate was 17.8 per cent. Ten patients underwent total repair and takedown of the shunt with no deaths. The problems of increased pulmonary flow, pulmonary hypertension, preferential flow to one lung, kinking and distortion of the pulmonary artery, and the technical difficulties at the time of takedown were reviewed and discussed.

Aorta↗
PubMed1975

Surgical management of anomalous left pulmonary artery causing tracheobronchial obstruction. Pulmonary artery sling.

An anomalous left pulmonary artery causing tracheobronchial obstruction is a rare malformation seen in infancy. Sixty-four cases have been described in the literature, with 17 survivors with or without surgical therapy. We reviewed the literature and the 5 cases seen at The Children's Memorial Hospital during the past 20 years. Three of these patients survived, 2 of whom have not been previously reported. The main clinical features are progressive respiratory distress, cyanosis, and apneic episodes resulting from obstruction of the lower trachea and bronchi by an anomalous left pulmonary artery. Obstructive emphysema with or without atelectasis is very common in this condition and should suggest to the clinician the possiblity of this anomaly. The important diagnostic clues are an anterior indentation of the esophagus on esophagography, narrowing of the lower end of the trachea and right bronchus on bronchography, and anomalous origin of the left pulmonary artery from the right on angiography. We prefer to approach this anomaly by a left anterolateral thoracotomy with transection and end-to-end anastomosis of the anomalous left pulmonary artery in front of the trachea. Respiratory complications due to residual tracheomalacia are common after the operation.

Bronchial Diseases↗
PubMedDate not supplied

Percutaneous fenestration of a type I aortic dissection for relief of lower extremity ischemia.

A 36-year-old patient underwent successful percutaneous fenestration of a type I aortic dissection which had caused occlusion of the right common iliac artery and ischemia of the right lower extremity. The patient is currently (6 months post-fenestration) ambulating without any signs of vascular compromise. The technique may be useful in patients who are at high risk for surgical procedures.

Adult↗