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Biomedical subjects

R Soyer

Publications and source records attributed to R Soyer.

At least 91 records · Page 5Linked to original sources
PubMed1982

Follow-up of surgically treated patients with massive pulmonary embolism--with reference to 12 operated patients.

Since 1978, 17 patients have undergone surgery for massive pulmonary embolism in our department. Twelve patients survived and have been followed up for between 2 and 31 months postoperatively (mean 16 months). Reassessment of these patients included exercise tolerance test, pulmonary function test, perfusion scan, right heart catheterization and coagulation screening. Two survivors present major sequelae, namely vascular pruning and definite signs of pulmonary hypertension. The other 10 patients have minimal or no residual vascular occlusion, but show a high incidence of minor abnormalities: slight rise in pulmonary arterial pressure during exercise (3 cases), small angiographic and scintigraphic defects (5 cases), arterial hypoxemia (5 cases) and disturbances of pulmonary function (10 cases). Systemic venous problems were found to be frequent and to be a handicap in 5 cases, and an abnormal pattern of response to exercise was observed in 4 patients. These disturbances may be related to ligation of the vena cava. Various derangements of coagulation were found in all but one of the patients.

Adolescent↗
PubMed1982

[Reno-caval thrombosis complicated by massive pulmonary embolism. Diagnostic and therapeutic problems].

The authors report on a case of thrombosis of vena cava and renal vein associated with a nephrotic syndrome and complicated by a massive pulmonary embolism. Under emergency conditions, it was impossible to diagnose preoperatively a renal tumor, which is the most common cause of renal and vena caval obstruction or a thrombosis of the vena cava. Surgical treatment was carried out only because there were no arteriographic signs of renal neoplasm, and because thrombolytic treatment was contra indicated in a patient with greatly reduced vital capacity. Embolectomy was performed under cardiopulmonary by pass. The patient made a good recovery. Results of routine cardiac and pulmonary tests were normal after two months. Embolectomy must always be associated with as interruption of the vena cava, whose different forms are discussed. Partial interruptions using a De Weese clamp seems to be better tolerated than ligation.

Diagnosis, Differential↗
PubMed1981

Hemodynamic and angiographic evaluation of aortic regurgitation 8 and 27 months after aortic valve replacement.

Eighteen patients with chronic aortic insufficiency were evaluated hemodynamically and angiographically 8 months after aortic valve replacement. Both the pulmonary artery diastolic pressure and the left ventricular end-diastolic volume decreased significantly (p less than 0.001), but the mean ejection fraction and the cardiac output remained identically lowered, though some individual cases showed improvement. The relative reduction in end-diastolic volume correlated only with the preoperative ejection (p less than 0.05) and regurgitation fractions (p less than 0.02). In the 10 patients whose left ventricular volume remained high or ejection fraction low, a second evaluation was performed 27 months after surgery. The left ventricular end-diastolic volume was significantly lowered (from 151 to 120 ml/m2, p less than 0.05) back to normal in five cases. The systolic and diastolic ventricular shape returned to normal. Cardiac index and ejection fraction were unchanged. These results show a marked improvement a few months after aortic valve replacement, with a further improvement several months later, as shown mainly by the decrease of left ventricular end-diastolic volume and the return to normal of left ventricular cavity shape. However, in most cases, the ejection fraction remained at its preoperative valve, suggesting that surgery should be performed early, before myocardial deterioration appears.

Adolescent↗
PubMed1981

[Idiopathic aneurysm of the left ventricle. Apropos of 4 cases operated on with success].

Over a period of 3 years, 4 cases of idiopathic left ventricular aneurysm, 3 white females and one coloured male aged 34, 53, 29 and 47 years respectively, were observed. All presented with paroxysmal ventricular or supraventricular tachycardia, which, in one case, was severe enough in itself to justify surgery. On angiography, large left ventricular aneurysms bordering the mitral annulus and responsible for moderate mitral regurgitation in two patients were demonstrated. Aneurysmectomy was only possible in 2 cases, the other two having pericardial adhesions with a risk of uncontrollable haemorrhage during dissection being managed by suture of the neck of the aneurysm. The surgical results were very satisfactory, especially with respect to the arrhythmias with a follow-up of 48, 24, 15 and 9 months respectively. In a review of the literature, 93 cases of idiopathic left ventricular aneurysm were analysed, less than 20 of which have been managed surgically. Left ventricular aneurysms seem to be large fibrotic structures located at the border of the mitral, or, less commonly, below the aortic annulus. It is important to differentiate them from congenital left ventricular diverticuli which are usually located at the apex, have muscular walls and are therefore contractile. The aetiology of these aneurysms is unknown: the possible role of myocardial infarction may be excluded as the coronary arteries are always normal on angiography and at autopsy. The relatively young age of the patients is also an argument against this hypothesis. Other suggested causes such as syphilis, tuberculosis, Chagas' disease, non-specific myocarditis, sarcoidosis and thoracic trauma may also be excluded. Surgery seems to be indicated in cases complicated by resistant arrhythmias, peripheral embolism or when the aneurysm increases rapidly in size.

Adult↗
PubMed1981

Tuberculous aortic insufficiency. Report of a case with successful surgical treatment.

A case of endocardial tuberculoma of the left atrium in a 20-year-old woman is presented. Ulceration of the tuberculoma at the aortic anulus led to disruption of the aortic valvular attachment and induced severe aortic insufficiency. Replacement of the aortic valve and administration of antituberculous medication permitted an uneventful recovery. This is probably the first case of tuberculous aortic insufficiency diagnosed in a living patient and surgically treated with the use of extracorporeal bypass.

Adult↗
PubMed1980

Quantitative angiographic evaluation in left ventricular aneurysm.

A new method was used for the quantitative analysis of left ventricular angiography in 22 patients with an anterior aneurysm. The line of demarcation between the aneurysm (A) and the remaining myocardium (RM) was determined accurately by looking at a sudden change in the percentage of shortening of two contiguous half-axes, the left ventricular cavity being divided by 19 parallel and equidistant axes. The total volume of the left ventricle, the volume of the A and that of the RM were calculated using a method derived from Chapman's method. Total ejection fraction, ejection fraction and VCF of the RM were also calculated. A comparison was made between patients with heart failure (Group I) and those without (Group II). In Group I, the A was much larger (P less than 0.01) but volume, ejection fraction and VCF of the RM, were not significantly different, indicating that the surgical resection should give a favorable result. The validity of this method of quantitative analysis was confirmed by a comparison of the calculated preoperative remaining left ventricular volume with the volume of the postoperative cavity in 8 patients. These measurements lead to a better evaluation of patients with ventricular aneurysm in view of selection for surgery.

Adult↗
PubMed1980

[Obstruction of the abdominal aorta and cyanotic heart disease in a 1 year old child (author's transl)].

In a 1 year old child, cyanotic congenital heart disease was complicated by a severe obstruction of the abdominal aorta between the renal arteries and the bifurcation. The surgical treatment consisted of relief of the obstruction in the aorta and a Blalock-Taussig shunt. The general progress was good but there was a ischemia of the left leg for which amputation of the forefoot was required.

Aorta, Abdominal↗
PubMed1979

[Prevention of post-operative infection in heart surgery with extracorporeal circulation (apropos of 295 cases)].

From April 1977 to November 1978, 295 patients were operated on using artificial circulation. 31 p. 100 of these developed a post-operative infectious complication, 7.3 p. 100 being of a serious nature (3.3 p. 100 suffered from mediastinitis, and 4 p. 100 from septicaemia). The organisms responsible are, in the case of the mediastinal infections the staphylococcus Citreus, and Gram negative bacilli in the case of the septicaemias. A retrospective analysis shows that there are two successive periods and that in the course of the second there is a decrease in the occurence of all of the infections and particularly in the cases of mediastinitis. This improvment would seem on superficial analysis to correspond with a change in the preventive antibiotic treatment, the cephradine--gentamicin combination having replaced penicillin G. However, the statistical study shows that other factors were altered between the two periods (type of antiseptic, duration of treatments, time of postoperative intubation) and that these equally contributed to the fall in the incidence of infection. In the light of this study, it would seem that if prophylactic antibiotic treatment essentially directed against staphylococci has a place in cardiac surgery with artificial circulation, it can only be regarded as one of several preventive factors. The statistical data gathered so far is not sufficient to prove the efficacy of this treatment.

Adolescent↗