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Biomedical subjects

R Limet

Publications and source records attributed to R Limet.

At least 307 records · Page 17Linked to original sources
PubMed1977

Thromboembolic complications with the cloth-covered Starr-Edwards aortic prosthesis in patients not receiving anticoagulants.

A comparison of the incidence of thromboembolic (TE) episodes was made in three groups of patient who underwent aortic valve replacement with the cloth-covered Starr-Edwards prostheses. Group 1 consisted of patients who received anticoagulants for either the entire period of follow-up or for a period of variable duration, after which these agents were no longer administered. When anticoagulants were stopped, 22 patients were categorized as Group 3 for study. Group 2 comprised patients who never received anticoagulants. Of the 147 patients followed in Group 1, 14 suffered one episode of TE. Six patients experienced major emboli; 3 of them died. Twenty of the 82 patients followed in Group 2 (no anticoagulants) suffered TE complications. There were 10 episodes of major emboli. Five of the 22 patients in Group 3 suffered an episode (all major) of TE. It is concluded from this study that anticoagulants should be given permanently to all patients with cloth-covered Starr-Edwards prostheses. Indeed, there is no period after operation when the incidence of TE is so low that anticoagulation may be safely discontinued.

Acenocoumarol↗
PubMed1977

Sequential anastomoses in coronary artery grafting: technical aspects and early and late angiographic results.

The present study concerns itself with the early and late results obtained with aortocoronary vein grafts containing more than 1 coronary anastomosis per graft. The surgical technique is described in detail and some of the hazards are outlined. It is apparent that the use of side-to-side anastomoses (SSAs) leads to a marked increase in blood flow in the proximal portion of the graft (average flow,131 ml/min) and also increases the patency rate of the proximal anastomosis. Thus, 3 of 51 SSAs were obstructed on the early angiogram, and only 1 of the 28 SSAs restudied at one year had become occluded. Although the cumulative--early and late--patency rate (55/66, or 83.3%) of the distal end-to-side anastomoses (ESAs) was not significantly better than that usually seen with conventional vein grafts, it is believed that improvement in the technique and greater awareness of some of its pitfalls will further decrease awareness of some of its pitfalls will further decrease the occlusion rate of distal ESAs. Most occlusions of the ESA appeared related to angulation, which tended to occur in the segment of graft between the proximal and the distal anastomoses. Appropriate modifications in the technique are described that should help to eliminate this difficulty. The use of SSAs allows for grafting of small coronary arteries which, with the conventional single anastomosis technique, are not usually bypassed in view of the high expected failure rate. Thus, of the 9 SSAs performed to 1 mm arteries and studied on two occasions, 8 remained open early after operation and 7 were still patent a year later.

Aorta↗
PubMed1977

Sympathetic denervation in association with coronary artery grafting in patients with Prinzmetals' angina.

Myocardial revascularization in patients with Prinzmetal's angina has yielded variable results. Two patients are presented who underwent partial cardiac sympathectomy in combination with coronary artery grafting for typical variant angina associated with severe organic obstructive coronary artery disease. Late results 12 and 18 months postoperatively have been excellent in both instances as shown by clinical and angiographic evaluation. Although the exact mechanism responsible for Prinzmetal's angina is not known, it is believed that spasm through increased activity of vasomotor tone or of the autonomic nervous system plays a major role. Since this variant form of angina encompasses a whole spectrum at angiography, ranging from normal arteries to severely narrowed ones, including those with spasm, it is suggested that surgical treatment be planned accordingly. Thus, in patients who have organic stenoses with and without spasm, operative treatment may consist of removal of the preaortic or pretracheal plexus in association with conventional coronary artery grafting. In patients who have intractable episodes of ventricular arrhythmia or angina and who angiogram is normal or shows isolated spasm, coronary artery grafting should be abandoned, in view of the poor results reported in the literature in these circumstances, and cervicothoracic sympathectomy should be considered.

Adult↗
PubMed1977

Cardiac valve prostheses, anticoagulation, and pregnancy.

A series is presented of 7 women who underwent cardiac valve replacement and who ultimately became pregnant. The only infant death was that of a premature baby whose mother received oral anticoagulants until delivery. The remaining 6 babies were normal and survived. One mother died suddenly on the fourth postpartum day and was found to have a periprosthetic clot on postmortem examination. Although a certain risk exists for the fetus whose mother receives oral anticoagulants since they cross the placental barrier, this risk is far lower that that for the mother who does not receive anticoagulation. From a prospective point of view, it would appear preferable to use prostheses such as the porcine heterograft that do not necessitate the administration of anticoagulants.

Adolescent↗