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Biomedical subjects

T Carrel

Publications and source records attributed to T Carrel.

At least 91 records · Page 5Linked to original sources
PubMed1996

Total anomalous pulmonary venous connection to the portal and splenic vein associated with unilateral hypoplasia of pulmonary veins.

Total anomalous pulmonary venous return (TAPVR) represents a rare congenital anomaly with wide anatomical and physiological variability. We report a case of a newborn with a challenging form of obstructed infracardiac TAPVR, in whom left and right pulmonary veins drained separately into the portal system. The right pulmonary venous sinus connected to the left branch of the portal vein, whereas the left venous sinus connected to the splenic vein. Surgical repair consisted of the creation of a common retrocardiac venous trunk which was anastomosed to the left atrium. The postoperative course was characterized by persisting congestion of the right lung. Two months later, right pulmonary vein hypoplasia was successfully enlarged with autologous pericardium.

Angiography↗
PubMed1996

Sterno-laparotomy and extracorporeal circulation for liver transplantation after repeat-surgery for Budd-Chiari syndrome.

The surgical management of two patients undergoing living transplantation for Budd-Chiari syndrome is reported. Mesenteriocaval shunt had previously been performed in both cases, followed by transcaval liver resection and hepatoatrial anastomosis after 3 and 5 years, respectively. Liver transplantation was necessitated by deteriorating liver function with portal hypertension and recurrent bleeding. The successful operation was performed via sternolaparotomy. Atrioatrial anastomosis was constructed during cardiopulmonary bypass, considerably simplifying the technical procedure and dramatically reducing blood loss.

Adult↗
PubMed1996

[Incidence, clinical aspects and therapy of late pericardial tamponade following heart surgery].

Late cardiac tamponade is a very severe condition that presents with subtle signs and symptoms within days or weeks after cardiac surgery. In a consecutive series of 3782 patients, 33 developed this complication, mostly due to overdosage of anticoagulants or to unsafe combination of 2 anticoagulation regimen. Diagnosis can be difficult and is best confirmed by echocardiography; in patients with primary uneventful recovery and sudden cardiocirculatory deterioration, intensive work-up should be performed to exclude or confirm the suspicion of late pericardial tamponade. The treatment of late pericardial tamponade should not be delayed and consists in subxyphoidal drainage. Re-sternotomy might be necessary to assume complete decompression of the heart in case of well-localized and posterior tamponade and/or organized pericardial fluid. Since this complication can happen in any patient transferred to peripheral hospital for postoperative recovery after cardiac surgery, we believe that this complication should be recognized very early and should be treated, in case of necessity, by general surgeons. Usually, no active bleeding is found at revision.

Adult↗
PubMed1996

[Latex covering and mechanical analysis of balloon expandable stents].

To the moment a few stents of metallic coils or meshes are available with a sealing coverage. In the present study balloon-expandable stents have been covered with a thin layer of natural rubber latex. The physical properties of these impervious stents were compared to the conventional stents. The expansion, the loss of expansion and the deformity during and after balloon inflation have been analyzed. In the pressure zone of 4-6 bar the mechanical characteristics of the impervious stents were similar to the conventional stents. The stents were expanded at 100% related on the balloon diameter used for expansion. Additional pressure of 1 bar was necessary to expand the impervious stents. At balloon pressure below 4 bar the stents tied the balloons in the midzone. The impervious stents, expanded at 6, 8 and 10mm, underwent a loss of expansion of 10% after withdrawal of the balloons. Their configuration was barrel-shaped (4% central enlargement) due to the latex rubber, constricting the wire meshes at both ends. These preliminary results are encouraging and allow further investigations.

Biomechanical Phenomena↗
PubMed1995

[Early and late results of the surgical treatment of left ventricular aneurysms; report of 105 patients].

This study determined perioperative mortality and morbidity and attempted to identify predictors of operative mortality and long-term outcome in a series of 105 patients who underwent surgery for left ventricular aneurysm at this institution during a 7-year period. The main indications for treatment of ventricular aneurysm were angina, dyspnea, ventricular arrhythmias and systemic embolism. Overall mortality was 5.7% and 5-year survival 78%. Left ventricular systolic function, age, unstable angina and previous cardiac surgery were independent predictors of operative mortality and of long-term survival. Main complications observed were perioperative myocardial infarction, ventricular tachyarrhythmias and neurological, almost reversible defects. Although our experience with newer techniques such as patch plasty has been acquired in recent years, according to the literature the type of aneurysm repair seems not to be a strong predicator of operative mortality or improved long-term survival. Echocardiography provides important information concerning the extent of tissue resection needed and the ideal size of the patch. In patients with symptomatic coronary disease, complete revascularization should be attempted to allow recovery of adjacent myocardium after restoration of ventricular geometry. Repair of left ventricular aneurysm can be performed with acceptably low mortality by linear closure or by patch plasty technique. Remodelling the left ventricle using an endocardial patch has been found to fulfill its theoretical advantages in improving ventricular performance, by restoring the functional geometry of the heart. This operation can be performed with low perioperative risk and leads to a late functional improvement in the majority of patients.

Aged↗
PubMed1995

[Isolated lung transplantation--evaluation of patients and initial results].

Between November 1992 and May 1994 we performed 10 single and 5 double lung transplants in patients with end-stage lung diseases due to lymphangioleiomyomatosis (4), cystic fibrosis (3), pulmonary hypertension (3), pulmonary fibrosis (3) and chronic obstructive lung disease (2). In the 13 patients (87%) surviving for median 245 (19-567) days, FEV1 improved from median 640 ml to 1410 ml and the 12-minute walk distance from median 315 to 1100 meters. 10 patients (77%) enjoy a good or even excellent quality of life. 2 patients died 11 and 62 days postoperatively, due to multi-organ failure and invasive pulmonary aspergillosis respectively. The main postoperative problems are fungal and cytomegalovirus infections and chronic rejection in the form of bronchiolitis obliterans. In Switzerland as elsewhere, lung transplantation has become an established modality for the management of end-stage diseases of the lung and pulmonary circulation.

Adolescent↗
PubMed1995

[Surgery of the abdominal aorta in the geriatric population: characteristics and results].

Refinement in surgical technique and perioperative management have considerably improved morbidity and mortality rates of carotid endarterectomy and abdominal aortic surgery, thus allowing a more aggressive approach in the treatment of carotid stenosis, abdominal aortic aneurysm and aorto-iliac occlusive disease in the elderly population (> 70 years). We review our experience with 446 consecutive patients undergoing surgery of the abdominal aorta: 295 patients (mean age 75.5 years) underwent resection of an abdominal aortic aneurysm (asymptomatic but > 5-6 cm, (n = 193), symptomatic (n = 67) or ruptured (n = 35). Additionally, 198 patients were treated surgically for aorto-iliac occlusive disease. A small group of 13 patients was deferred for combined operation, including prior myocardial revascularization and subsequent vascular surgery during the same anesthesia. The majority of patients had several cardiovascular risk factors and/or significant associated diseases. Mortality (< 30 days) was 3.5% following aorto-iliac bypass in the treatment of arterial occlusive disease and 8.4% after aneurysm repair (asymptomatic, symptomatic and ruptured aneurysms all included). 5-year survival was 74% and 64% after repair of aortic aneurysm and treatment of aorto-iliac occlusive disease respectively. On the basis of these results, we believe that major vascular surgery is still justified in elderly patients and can be achieved with reasonable mortality and morbidity. Main goals of the surgery, e.g. to relieve suffering, restore function so as to limit disability and dependency, and prolongation of life expectancy in a dignified and meaningful life-style, are realized the majority of operative survivors.

Aged↗
PubMed1995

[Interrupted aortic arch: fortuitous diagnosis in a 72-year-old female patient with severe aortic insufficiency].

Interrupted aortic arch, defined as complete luminal and anatomic discontinuity between ascending and descending aorta, is an uncommon and highly lethal anomaly. We report the case of a 72-year-old woman scheduled for aortic valve replacement because of severe regurgitation. During preoperative catheterization, it was not possible to reach the ascending aorta from a femoral puncture. Further radiological investigation demonstrated interrupted aortic arch of type A without other cardiac or vascular anomalies. Postoperative course after aortic valve replacement and ascending-to-supraceliac aortic bypass was initially uneventful. Unfortunately, pericardial tamponade developed 10 days after the operation and required re-exploration, during which no active bleeding could be found. Recurrent effusion occurred and the patient finally died from severe shock and multiorgan failure. This exceptional case prompted a review of the literature which confirmed the rarity of this presentation in adult patients. It seems interesting that only mild arterial hypertension of the upper extremities was retrospectively found in this patient.

Aged↗
PubMed1995

Embolization of biologic glue during repair of aortic dissection.

A 72-year-old patient was operated on because of an acute type A aortic dissection with the primary entry located in the aortic arch and with retrograde involvement of the ascending aorta. Complete replacement of the aortic arch and the ascending aorta was performed after the dissected aortic layers had been readapted and sealed with gelatin-resorcin-formaldehyde biologic glue. Postoperative neurologic status was judged to be normal. The patient died 3 weeks postoperatively of septic shock. Postmortem examination of the brain revealed several small lesions, and microscopy showed very small particles of polymerized glue in the afferent vessels of ischemic cerebral and meningeal regions.

Aged↗
PubMed1995

Modified operation technique for orthotopic heart transplantation.

Atrioventricular (AV) valve dysfunction with tricuspid regurgitation is a common finding after orthotopic heart transplantation (HTx). In 20 patients the heart transplantation was performed with bicaval anastomoses and the results were compared to the precedent 20 patients operated with the standard technique. The right atrium of the recipient was completely removed and the caval anastomoses were performed on the beating heart during reperfusion. Using an interrupted suture line, no stenoses at the venous anastomoses were seen as known from the early implantation technique in heart-lung transplantation. Due to a more stable sinus rhythm only 15% of the patients in the bicaval group needed prolonged pacing (> 30 min) versus 55% (P < 0.01) in the group with standard operation. One to 3 months after surgery the transthoracic echocardiographic evaluation of the AV valve function showed tricuspid valve regurgitation (TVR) in 20% of the patients with bicaval anastomoses versus 75% with a right atrial anastomosis (P < 0.001). Tricuspid valve regurgitation during the first 2 weeks (in 31% of recipients with bicaval and in 70% with atrial anastomoses) improved in all recipients with bicaval anastomoses and in 14% of the recipients with atrial anastomosis. The modification of the operation technique did not result in significantly longer bypass time (75 +/- 14 versus 68 +/- 14 min) and ischemia time (44 +/- 12 versus 41 +/- 9 min with local organ procurement and 111 +/- 24 versus 101 +/- 19 min with distant organ procurement). The AV valve function and the postoperative rhythm after orthotopic HTx can be improved by implanting the heart with bicaval anastomoses.

Adult↗
PubMed1995

The internal mammary artery malperfusion syndrome: incidence, treatment and angiographic verification.

Internal mammary artery (IMA) malperfusion syndrome is caused by an acute imbalance between myocardial demand and nutritional support through the mammary artery. In a consecutive series of 2326 isolated myocardial revascularizations-with at least one IMA to the left anterior descending branch (LAD) in 91.3% (2125/2326)-we identified 45 patients (1.9%) with a perioperative course suggesting IMA malperfusion syndrome. Additional saphenous vein graft to the distal segment of the LAD was performed during normothermic ventricular fibrillation in all patients. Hospital mortality was 4.4% (2/45), intra-aortic balloon pumping was required in 15.5% (7/45) and anterior myocardial infarction occurred in 28.8% (13/45). Coronary angiography was performed in all survivors between 3 and 24 months postoperatively. Wide patent IMA graft and patent saphenous vein graft were observed in 56% (24/43), narrowed but patent IMA graft and patent vein graft in 35% (15/43), while patent vein graft and not visualized IMA in 7% (3/43); in one patient with severely diseased peripheral LAD, no flow could be demonstrated in the IMA graft or in the additional vein graft (1/43, 2.4%). No major differences were found between early and late coronary angiography in these patients. Additional vein graft to distal LAD is the treatment of choice in acute IMA malperfusion syndrome. Despite patent vein graft with superior blood flow, early and late postoperative IMA flow to LAD is maintained in the majority of patients.

Adult↗