Biomedical subjects

R Soyer

Publications and source records attributed to R Soyer.

At least 55 records · Page 3Linked to original sources

PubMed1994

[Prevalence of intra-auricular thrombi detected by transesophageal echocardiography in patients with cardiac transplants].

The aim of this study was to determine the prevalence of intra-atrial thrombi or spontaneous contrast by transoesophageal echocardiography in patients who underwent cardiac transplantation by Lower and Shumway's technique. Transoesophageal echocardiography was performed in 52 transplant patients (43 men, 9 women: average age 51 years) with a high frequency biplane transducer. After surgery, all patients received platelet antiaggregant therapy. Despite this treatment, 4 patients had a sudden systemic embolic episode and were then placed on oral anticoagulants. All patients were in sinus rhythm at the time of the examination and some had signs of acute rejection on endomyocardial biopsy performed the same day. Spontaneous contrast was observed in 27 patients (52%) and was associated with thrombosis in 15 patients (29%). These thrombi were located in the left atrial appendage in 8 cases, on the left atrial posterior wall in 5 cases and on the left atrial sutures in 2 cases. None of these thrombi had been detected by transthoracic echocardiography. No significant difference was observed between those with and those without thrombosis with respect to left atrial dimensions, left ventricular ejection fraction, cardiac index, pulmonary pressures and the number of episodes of acute rejection. The 4 patients with a history of arterial embolism all had an intra-atrial thrombus. This study demonstrates a high incidence of spontaneous contrast and intracardiac thrombi in the dilated left atrium of patients transplanted by Lower and Shumway's technique. It also underlines the value of transoesophageal echocardiography in the follow-up of transplant patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticoagulants↗

PubMed1994

[Aortic valve replacement after aortic valvuloplasty for calcified aortic stenosis. A propos of 104 patients].

Between February 1987 and December 1990, 104 patients (48 men, 56 women) with an average age of 69 years, underwent aortic valve replacement (AVR) after one or several percutaneous aortic valve balloon dilatation. Thirty one patients were in Class II and 73 patients in Classes III and IV. Twenty two patients had angina (16 Class I-II, 6 Class III-IV) and 12 patients had syncope or near syncope on effort. The indications of valvuloplasty were: non-definitive contraindications of surgery or a surgical risk which was estimated to be excessive (46 patients), a personal choice (41 patients). Five patients underwent preoperative dilatation because of the high operative risk; 7 patients refused surgery and 5 patients were operated as an emergency (2 mas-sive aortic regurgitations, 1 left ventricular perforation, 1 cardiogenic shock, 1 endocarditis with cardiogenic shock). The inter-val between dilatation and surgery was on average 472 days. The patients were improved over an average period of 261 days. Apart form the emergency cases, the patients were operated because of restenosis. Surgery consisted of 53 mechanical and 51 bioprosthetic valve replacements. There was an associated procedure in 17 cases (17 single bypass grafts, 2 double bypass, 1 triple bypass graft, 1 left ventricular suture, 1 Bigelow procedure, 2 mitral valve replacements, 1 tricuspid annuloplasty, 1 carotid endarteriectomy, 1 replacement of the ascending aorta, 1 closure of ASD). The operative mortality was 7 patients (6.7%). The operative findings were 8 lesions related to dilatation, mainly valve tears or disinsertions requiring rapid (6 cases) or emergency (2 cases) surgery for massive aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMed1994

[Reoperation for heart valve prosthesis. Apropos of 99 cases].

From March 1977 to November 1988, 99 patients were reoperated on after a first valvular replacement. Mean delay between the two operations was 53 months (10 days to 18 years). The patients were reoperated on mainly for mechanical disinsertion (30), bacterial endocarditis (25) and thrombosis (18 patients). Operative mortality was 11%, mainly following reoperation for bacterial endocarditis. Mean follow-up (85 patients) was 49 months (6 months-11 years). 75% were alive and doing well 4 years after reoperation and 66% at 6 years. Eight patients needed a third operation with two deaths.

Adolescent↗

PubMed1993

Intraoperative coronary angioscopy--technique and results: a study of 38 patients.

Over a period of 11 months, 38 patients submitted to coronary artery revascularization underwent intraoperative angioscopy of the coronary arteries and internal thoracic arteries. Fifty-nine lesions were observed, but only 31 stenoses responsible for coronary insufficiency were observed (33%). Forty-four distal anastomoses were explored (47%) but ten of these explorations were incomplete. None revealed technical failure of the anastomosis. Thirteen harvested left internal mammary arteries were explored. One of the explorations led to rejection of the graft due to an intimal fracture. Some tiny intimal flaps were observed in our experience, as in others. Although the iatrogenic origin of these lesions in relation to the introduction of the angioscope is obvious, it does not seem to influence the outcome of the operation. In our opinion, two main fields appear to be developing in coronary angioscopy: preoperative assessment of the quality of internal thoracic artery grafts, and control of distal graft anastomoses. The flexibility of the angioscopes and of the leading catheters must be improved to minimize the risk of arterial wall traumatic lesions.

Angioscopes↗

PubMed1993

[A case of type I aortic dissection presenting as bilateral lower limb ischemia. Discussion of surgical strategy].

The authors report about one case of type I aortic dissection disclosed as bilateral lower limb ischemia. The rarity of this way of expression of dissections may result in a delay in diagnosis that can be highly pejorative in such diseases where mortality is high without surgical treatment. The timing and tactics of the surgery to be implemented between the cure of dissection and the removal of ischemia is discussed. Lastly the choice of the mode of arterial cannulation in a patient who had had an axillo-bifemoral bypass ten days earlier also makes this case interesting.

Aged↗

PubMed1993

[Reoperations on heart valve prosthesis. Apropos of 99 cases].

Actuarial Analysis↗

PubMed1992

Acute traumatic isthmic aortic rupture. Long-term results in 49 patients.

Forty-nine patients who sustained acute traumatic rupture of the aorta at the level of the isthmus were treated in our hospital between 1976 and 1990. Four patients died before surgery and 45 patients were operated upon using a pump oxygenator partial bypass in all but 2 cases (1 clamp and sew and 1 shunt). The tear was circumferential in 33 and partial in 12 cases. Direct suture was used in the 12 partial and in 21 of the circumferential tears. A dacron tube was used in 12 patients. Hospital mortality was 3 resulting from brain damage, prolonged shock before surgery and necrosis of the colon 4 weeks after operation. No paraplegia was observed. There were 2 cases of neurological disturbance (2 spinal cord dysfunction 5 and 8 days, respectively, after surgery). These complications were transient. Among the 42 survivors, 1 was lost to follow-up. The clinical aortic status of the remaining 41 was excellent. Aortic reconstitution as assessed by digital aortic angiography was excellent in the 33 cases examined with 2 exceptions (graft stenosis, false aneurysm). Our experience and review of a large series indicate: the use of a partial bypass with pump oxygenator decreases the probability of medullary ischemia, but the risk of spinal cord ischemia is not eliminated. When intra-abdominal lesions are life-threatening, laparotomy must preceed thoracotomy. Clinical results assessed in long-term survivors are excellent, especially after direct repair.

Acute Disease↗

PubMed1992

[Traumatic double rupture of the isthmic aorta. Apropos of an unrecognised case successfully treated by two-stage surgery].

The authors report the case of a 33 year old patient, who underwent an emergency repair of a traumatic tear of the thoracic aorta, after a car accident. This operation was carried out with femoro-femoral cardiopulmonary bypass support. Associated lesions were traumatic tear of the left diaphragm repaired through left thoracotomy during repair of the aorta, rupture of the liver and multiple fractures of the left superior limb. Postoperative course was marked by liver hemorrhage and septicemia. Orthopedic treatment of the various fractures was performed. The course of thoracic lesions was uneventful. An aneurysm of the aortic isthmus was revealed during venous digital subtraction angiography routinely performed 60 days after surgery. The patient was reoperated with femoro-femoral bypass support. A second incomplete tear of the aorta, missed during the first operation was discovered 3 cm above the suture of the first one. This lesion was easily repaired and the post-operative course was uneventful. The value of systematic control angiography after aortic traumatic repair is emphasised.

Adult↗

PubMed1992

[Total anomalous pulmonary venous return in a 61 year-old adult].

The authors report a case of total anomalous pulmonary venous return successfully treated by surgery in a 61 year-old man. This case is unusual because of the late discovery of this congenital malformation which is usually rapidly fatal in the absence of surgical correction. This prolonged survival can be explained by the large atrial septal defect and the absence of obstruction, to pulmonary venous return and associated malformations. Surgical repair is essential to prevent the development of irreversible lesions of the right side of the heat and the pulmonary arterial bed.

Heart Defects, Congenital↗

PubMed1992

[Late revascularization of the renal artery: what are the prognostic criteria?].

Two patients with non functioning silent kidney on excretory urography and renal artery occlusion on angiography, underwent renal artery revascularization without severe hypertension or renal failure. Angiographic appearance of collateral circulation, histologic evidence of intact viable glomeruli and a normal sized kidney are necessary for successful results. Renal blood flow was restored in the two patients but one had slight return of function and the other patient showed no evidence of improvement. Both patients presented criteria for revascularization. The first case was a minor success on the renal scintigraphy. The return of renal function did not occur in the second case because of preexisting renal pathology. We therefore recommend histologic examination before every renal artery revascularization for chronic occlusion.

Angiography↗

PubMed1992

[Traumatic isthmic ruptures of the aorta during the acute phase. Reevaluation of surgical treatment. Thoughts apropos of 47 cases].

From 1976 to 1989, 47 patients with traumatic aortic rupture in the area of the isthmus were seen in our institution; 4 patients died from exsanguination before definitive repair. Forty-three patients were operated on. Most of them (n: 41) underwent repair using partial bypass with pump oxygenator. There were 3 postoperative deaths. No patient developed postoperative paraplegia; 2 patients presented totally regressive spinal disturbances 5 and 8 days after surgery. Two of the 38 survivors were lost to follow-up. Postoperative angiography revealed an excellent aortic result in all cases especially in young patients, except two (1 stenosis, 1 aneurysm). Our experience and a review of the literature indicate some observations: despite rapid transport and evaluation, some patients died from exsanguination before definite repair. Cardiopulmonary bypass and correction of metabolic disturbances may decrease the probability of paraplegia and heparinisation did not increase the risk when orthopedic or abdominal lesions were treated before aortic lesion. Direct repair is recommended as the procedure of choice, especially in young patients, angiographic controls showed excellent results and long term follow-up is very satisfactory.

Acute Disease↗

PubMed1991

[Spontaneous rupture of subclavian artery disclosing Ehlers-Danlos disease. A case].

The authors report the case of a 30-year old man who suffered spontaneous rupture of the right subclavian artery. Treatment consisted of carotid-axillary graft since the fragility of the vessel precluded direct suture. The clinical symptoms, together with histological and ultrastructural examinations led to a diagnosis of Ehlers-Danlos syndrome with purely arterial manifestations.

Adult↗

PubMed1991

[EEG in elderly cardiac patients without cerebral lesions].

Ageing is known to be accelerated by risk-factors. The continuity between normal and pathological ageing is still quite disputed. Concerning cerebral ageing, the use of statistical methods on electroencephalographic (EEG) parameters appeared to be interesting. In this study, three different groups of elderly subjects were examined by EEG: normal subjects without neurological nor cardiac disease, subjects with Alzheimer-dementia (AD) and cardiac patients without cerebral clinical signs. Stepwise discriminant analysis showed that EEG-parameters discriminating normal subjects from cardiac patients were different from those discriminating AD-patients from normal. Furthermore, AD-patients could be well-discriminated from elderly cardiac patients.

Aged↗

PubMed1991

[Assessment of the systematic preoperative insertion of an intra-aortic counterpulsation balloon in patients at high operative risk for coronary artery surgery].

The authors report their experience with pre-operative percutaneous balloon counterpulsation in 75 patients considered to be at high operative risk for coronary artery surgery, mainly because of unstable angina refractory to maximum medical therapy. The criteria to define high surgical risk are reported. The results and the vascular risk in relation to this technique are estimated. Two patients died during the operation, 12 died during the early postoperative phase without any improvement following intra-aortic balloon pumping. The rate and severity of complications of percutaneous insertion of intra-aortic balloon counterpulsation are low and seem to be related to pre-existing arteriosclerosis. The stabilizing effect of this pre-operative insertion on angina, refractory to medical treatment, seems to be justifiable in patients presenting one of the defined criteria.

Adult↗

PubMed1991

[Endocarditis after Bentall's operation. Apropos of 3 reoperated cases].

The authors report three cases of endocarditis after replacement of the aortic valve and the ascending aorta by Bentall's method. This complication, rare in published series, is a serious possible complication during medium and long term follow-up. Its treatment consist of early complete removal of prosthetic material under suitable antibiotic therapy.

Aortic Valve Insufficiency↗

PubMed1990

Ventricular septal defect associated with aortic valve incompetence: results of two surgical managements.

Aortic valve insufficiency with ventricular septal defect is usually treated by plication of the commissures. However, long-term deterioration is common. We propose a new technique that corrects the aortic annulus dilatation and the leaflet prolapse and reinforces the sinus of Valsalva. Two groups were compared: group I (29 patients) had plication of the prolapsed leaflet(s) and folding of the free edge; group II (26 patients) had triangular resection of the prolapse cusp, annuloplasty, and reinforcement of the aortic wall. The two groups were similar with regarding to preoperative clinical data. There was no perioperative mortality. Primary failure (aortic valve replacement) occurred in 8 patients in group I (28%) and in 2 patients in group II (8%). The rate of secondary failure was 31% in group I and 4% in group II. The actuarial rate of freedom from reoperation at 5 years is 55% in group I and 88% in group II (p less than 0.05). The late mortality was 6.5% in group I and 10.9% in group II (no difference). We conclude that aortic valve insufficiency with ventricular septal defect is a malformation of the aortic leaflets, the annulus, and the sinus of Valsalva, and that the proposed technique offers a better result than the usual methods in terms of residual aortic valve insufficiency.

Adolescent↗

PubMed1990

[Aneurysm of the membranous ventricular septum. Apropos of 4 cases surgically treated].

Four patients with aneurysms of the membranous ventricular septum were operated either because of complications or for associated malformations. The authors describe the anatomical, radiological and, above all, the echocardiographic and angiographic features of this malformation. Surgical management is necessary in complicated cases or when there are associated congenital malformations. The information provided by echocardiography in the diagnosis and follow-up of ventricular septal defects indicates that this malformation is not as rare as was previously thought.

Adolescent↗

PubMed1990

[Hypoglycemic pleural mesothelioma. A case report].

Organic hypoglycemia occurs in pancreatic and mesenchymal tumors. Thirty percent of extrapancreatic tumors are intrathoracic. A patient with hypoglycemic pleural mesothelioma was treated by surgical excision without recurrence five years after surgery. The mechanisms of hypoglycemia are not clearly established. The recurrence of hypoglycemia is a good sign of tumor recurrence.

Aged↗