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Biomedical subjects

R Suy

Publications and source records attributed to R Suy.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Persistent atrio-ventricular canal. Case report of an unusual intermediate form.

A case is described, which presented the following combination of anomalies: An interatrial and interventricular septal defect, absence of a cleft in the aortic leaflet of the mitral valve and in the septal leaflet of the tricuspid valve. The latter leaflet was underdeveloped and presented several perforations. On the bases of the characteristic electrocardiographic, angiocardiographic and anatomical findings this anomaly was considered to be an intermediate form of a common atrioventricular canal. Total repair was successfully performed utilizing the technique of Rastelli and McGoon.

Female↗
PubMedDate not supplied

Oral anticoagulant therapy: a precipitating factor in the pathogenesis of cholesterol embolization?

The authors describe three patients who developed a blue toe syndrome after initiation of oral anticoagulant therapy. Based on these observations and data in the literature, they discuss a possible relationship. They conclude that the vascular surgeon should be aware of this possibility and that oral anticoagulants should be used very carefully in the "medical" management of cholesterol embolization.

Aged↗
PubMedDate not supplied

Long-term patency of the aortofemoral Dacron graft. A graft limb related study over a 25-years period.

Graft limb patency was studied retrospectively in a consecutive series of 912 patients (1605 limbs), who received an aorto(bi)femoral Dacron graft for occlusive disease over a 25 years period (1963-1987). The mean follow-up for the series was 5.35 years (range 1 month to 23 years) and 18.5% of the patients were followed for at least 10 years. Primary patency decreased progressively to 83% at 10 years and 77% at 15 years. It was significantly improved to 90% (at 10 years) and 84% (at 15 years) by means of operative thrombectomy (secondary patency). Factors influencing patency (univariate analysis) were (1) concomitant femoropopliteal occlusive disease, (2) the site of the femoral anastomosis and (3) the date of the operation. Multivariate analysis in relation to the femoral anastomosis stressed the importance of profunda femoris artery disease and the date of operation. It is concluded that the negative effects of concomitant superficial femoral artery disease may be completely relieved by an adequate profundaplasty. Furthermore the substantial progress, we documented over the years of the study, supports our view that aortofemoral reconstruction may also be offered as the solution of choice to patients with milder forms of claudication.

Analysis of Variance↗
PubMedDate not supplied

Supraceliac aorta-to-femoral artery bypass: a case report.

The authors describe the technique of the supraceliac aorta-to-femoral artery bypass graft. This type of reconstruction is presented as a possible alternative in patients with relative contraindications to direct approach of the infrarenal abdominal aorta.

Aorta, Abdominal↗
PubMedDate not supplied

Ruptured aneurysm of the gastroduodenal artery: a case report.

The authors report about a patient who presented three weeks after reconstruction of an infrarenal aortic abdominal aneurysm a rupturing aneurysm of the gastroduodenal artery. The symptoms and method of treatment of this rare condition are described on the basis of a literature survey.

Aged↗
PubMedDate not supplied

Extra-anatomical grafting for aorto-occlusive disease: the outcome in 133 procedures.

Between 1978 and 1988 133 extra-anatomical grafts were performed in patients presenting with aorto-iliac occlusive disease. These series include 50 cross-over grafts, 46 axillofemoral and 37 axillobifemoral grafts. The indication for operation was acute ischemia in 26.4%, claudication in 9.7% and limb salvage in 63.9% of cases. Perioperative mortality rate was 10.4%. The early patency rate decreased from 92% after cross-over grafting to 86% in the axillofemoral series and 8% of the patients needed a major amputation in the immediate postoperative period. With a mean follow-up of 32 months, 62% of the patients died within 5 years of the operation, 54% of deaths being due to cardiovascular complications. The 3-years patency rate decreased to 78% after cross-over grafting and 49% after axillofemoral grafting. The 3-year limb salvage rate decreased to 89% and 75% respectively. Although our results are definitely less favourable than those of direct aortofemoral grafting, they seem to support the further use of the cross-over graft in patients with unilateral occlusive disease. Axillofemoral grafting on the other hand should be preserved for limb saving reconstructions in high risk conditions.

Aged↗
PubMedDate not supplied

Aortofemoral reconstruction for multilevel disease: a prospective hemodynamic study.

A prospective study was undertaken to evaluate the clinical and hemodynamic effects of aortofemoral Dacron reconstruction in patients with multilevel disease (i.e. aortoiliac and femoropopliteal occlusive disease). Thirty nine patients underwent, apart from clinical evaluation, segmental plethysmography and Doppler pressures before operation, immediately after operation and again at 3 and 6 months. All patients improved by the reconstruction, but 12 (31%) continued to complain of disabling claudication during normal daily activities. The mean ankle pressure and thigh pressure index improved by 37.5%. This was accompanied by a decrease of peak flow time, an increase of peak flow and an improved recovery during reactive hyperemia. Furthermore an additional significant rise of the ankle pressure index was noted between 3 and 6 months. Continuing claudication was always associated with both initial and late hemodynamic failure (the criterium for hemodynamic success was defined as an increase of the ankle pressure index with more than 0.1). Hemodynamic success resulted unvariably in clinical success. However 4 patients were clinically symptomfree, although they had to be classified as hemodynamic failures. It is concluded that a significant number of patients fail to obtain complete relief after proximal reconstruction. Preoperative hemodynamic studies may provide additional information, but hemodynamic and clinical results do not always correlate with each other.

Aged↗
PubMedDate not supplied

Combined myocardial and cerebral revascularization. A ten year experience.

We report on the results of combined carotid endarterectomy and coronary artery bypass grafting in 82 patients. Vascular pathology was severe in these cases: 94% of patients had extensive multivessel coronary artery disease, 29% had unstable angina, 30% had severe left main stem stenosis and all patients had hemodynamically significant stenosis of at least one carotid artery, 13% had an additional occlusion of the contralateral internal or common carotid artery and 26% had severe bilateral carotid artery stenosis. The carotid lesion was asymptomatic in 64% of cases, 24% of the patients experienced previous transient cerebral ischemia and 12% of the patients had a history of completed stroke. Hospital mortality was 7.3%. Neurological deficit occurred in 7.3% but functional impairment was not permanent. Late results have been obtained for 76 survivors at a mean postoperative interval of 29 months. Five year life table survival rate was 86%. Follow-up showed that 3 patients (4%) have died and that 3 patients (4%) experienced a late neurologic event (one TIA; two strokes) but none of these events involved the cerebral cortex on the side of the carotid endarterectomy. The cumulative 5 year stroke free survival rate is 91%. We conclude that combined carotid endarterectomy and coronary artery bypass grafting can be done with an acceptable mortality rate in these critically ill patients and that the postoperative incidence of neurological events is low.

Adult↗
PubMedDate not supplied

Value of indium-111-labeled leukocytes scintigraphy in patients after arterial reconstructive surgery.

The study was performed to evaluate the diagnostic value of Indium-111-leukocytes scintigraphy in arterial prosthetic infection. Scintigrams were performed in 19 patients in two groups. Group A consisted of 11 patients, where ten days after uncomplicated graft implantation, an Indium-111-scintigraphy was performed. Group B consisted of 8 patients, where we suspected an infected arterial graft. In group A we had one false-positive scan and in group B one false-negative scan. This gives an accuracy of 89%, a sensitivity of 87% and a specificity of 90%. These results indicate that Indium-111-leukocytes scintigraphy is a favourable test to detect a vascular graft infection.

Aorta↗
PubMedDate not supplied

Autogenous venous reconstruction in the treatment of aortobifemoral prosthetic infection.

The Authors describe a patient, in whom an infected aortobifemoral Dacron prosthesis was successfully replaced by an autogenous venous graft. A review of the literature is presented and it is concluded that autogenous reconstruction of the infected field represents a feasible alternative to extra-anatomical revascularisation in the treatment of selected patients with vascular prosthetic infection.

Anastomosis, Surgical↗
PubMedDate not supplied

The sequential internal mammary artery graft. Long term results of a consecutive series of 364 patients.

Sequential, bilateral and free mammary grafts are employed in the current operative treatment of coronary pathology to maximize the benefit of the enhanced long-term patency of the internal mammary graft. This study reports the early and late results of a consecutive series of 364 patients in whom an internal mammary artery jumpgraft was performed. The total perioperative mortality was 1.6%, the cardiac perioperative mortality 1.0%. The perioperative infarct rate was 2.5%; the infarct rate in the mammary outflow field 1.4%. The total survival at 90 months (operative mortality included) was 92.2%, the cardiac survival at 90 months was 95.8% and the event-free group of the operative survivors was 85.2% at 90 months. The mammary artery jumpgraft can be performed without additional risk to the patient, it has a very good late result and it should be standard tool in the current coronary surgery technique. It is essential in coronary redo surgery and in patients after bilateral saphenectomy.

Female↗
PubMedDate not supplied

Extensive aorto-ilio-femoral endarterectomy with LeVeen plaque cracker.

The authors present a series of 98 patients, who underwent an aorto-ilio-femoral endarterectomy according to the technique of LeVeen. The operative mortality was 1% with an adjusted early patency rate of 99%. For a total of 52 documented cases, erectile function was lost in 25%. Ejaculatory disorders were seen in 35 patients. With a mean follow-up period of 22 months (range 1 to 60 months) there were no occlusions in the aortoiliac group. Patency in the aortofemoral group decreased to 92.5% after 4 years. It is concluded that the results support continued use of the reported technique. A longer period of follow-up however is recommended to define its exact role in reconstructive surgery for aortoiliac occlusive disease.

Aorta, Abdominal↗
PubMedDate not supplied

Is the outcome of coronary artery bypass graft surgery predictable in patients with severe ventricular function impairment?

Sixty consecutive patients, with a mean ejection fraction of 31.8% underwent coronary revascularization at the K. U. Leuven (Belgium). The operative mortality was 6%. At twelve months after surgery, the total actuarial survival was 90.0%, at twenty four months the total survival was down to 77.9%. All the preoperative data were entered into a mathematical model and using the stepwise logistic regression method, the predictability of death at 18 months postoperatively was analyzed. Using only the ejection fraction the accuracy of the prediction was 83.3%, the sensitivity 36.4% and the specificity 93.9%. Combining ejection fraction and NYHA functional classification before surgery the accuracy increased to 91.7%, the sensitivity to 72.7% and the specificity to 95.9%. Ejection fraction alone is a poor predictor of late death with only 36.4% sensitivity, but combining it with other parameters it is possible to construct a formula predicting death at 18 months with an accuracy of 91.7%.

Actuarial Analysis↗
PubMedDate not supplied

Time constraints in the emergency coronary bypass surgery for acute evolving myocardial infarction.

Fourty four patients underwent emergency coronary grafting for evolving myocardial infarction. All patients but one had undergone coronary angiography before the new infarction, 50% were in cardiogenic shock or under cardiopulmonary resuscitation. The mean time interval between the onset symptoms and opening of the bypass to the threatened area was 171 minutes. The operative mortality was 6.8%. At 30 months after surgery, the cardiac actuarial survival was 93.2%, the angina free group 94.2% of the operative survivors. Infarct size and regional ejection fraction of these patients at late follow-up were compared to those of controls treated conventionally for acute infarction. The thallium defects were smaller and the regional ejection fraction of the involved segment was higher after early surgery (less than 3 hours ischemia) than in controls. In the late surgery group the thallium defects and the regional ejection fractions were similar. Ultrastructural studies on biopsy samples taken from the center of the threatened area show reversible changes in the early surgery group but irreversible mitochondrial damage and cell membrane rupture in the late surgery group. Biochemical analysis of similar cardiac biopsies shows recovery after one hour empty beating reperfusion but only in the early surgery group. Our results suggest that coronary surgery can be beneficial to the patient with an evolving myocardial infarction, if the clinical situation does not permit intracoronary thrombolysis. However, one hour reperfusion of the empty beating heart before weaning off bypass is essential. The time constraints for both emergency surgery or thrombolysis are similar.

Adult↗
PubMedDate not supplied

Arterial rupture and pseudoaneurysm formation secondary to the use of the Fogarty balloon catheter.

The authors describe four cases of arterial damage secondary to the use of the Fogarty balloon catheter. A review of the literature is presented and it is concluded that the number of complications after balloon catheter thrombectomy is generally underestimated. The associated morbidity remains high, but most of the complications may be prevented by appropriate use of the catheter.

Aged↗
PubMedDate not supplied

[Abdominal aneurysms: long-term results].

437 patients who underwent surgery for abdominal aortic aneurysm have been studied. Of these, 206 patients (medium age 63 years) had elective surgery, 231 patients (medium age 73 years) had acute surgery. The five-year survival rate was 65% for the elective group and 40% for the acute group, but these percentages are influenced by the perioperative mortality. When the survival curves of the 198 survivors of elective surgery and the 153 survivors of acute surgery were compared with these of a demographically similar population, we noted lower survival probabilities than for the standard population in the elective group, whereas the patients who underwent emergency surgery have similar survival probabilities as the standard population. The influence of age is especially related to the perioperative period and arteriosclerosis is the most determining factor for long time survival.

Acute Disease↗
PubMedDate not supplied

[Surgical treatment of lungcancer five-year survival. Major surgical complications (author's transl)].

In the period 1961--1971, 41 patients with a squamous-cell carcinoma were operated upon. The absolute 5-year survival is 47.6% for the lobectomy and 20% for the pneumonectomy. In the period 1971--1976 (6 years), 211 resections for carcinoma (all types) were performed including 19 cases of squamous cell carcinoma, operated in 1971 and also studied in the first part of the work. They represent only 15.2% of all the hospitalized lungcancer patients. The lobectomy/pneumonectomy ratio is 60/40. The postoperative mortality is respectively 4% and 9.5% and the major surgical complications (bleeding, broncho-pleural fistula, empyema) are 0.8% and 3.6%. The causes of postoperative death are examined. Remarkable is the low incidence of bronchial fistulisation: 1 in 211 resections for malignant tumors, i.e. 0.47%. These results are discussed and compared with the literature.

Belgium↗