Search PubMed⌕ Search

Biomedical subjects

T Carrel

Publications and source records attributed to T Carrel.

At least 145 records · Page 8Linked to original sources
PubMed1993

Steal syndrome after internal mammary artery bypass grafting--an entity with increasing significance.

Stenosis of proximal subclavian artery (SCA), malformations of the internal mammary artery (IMA) at its origin, or large IMA side branches may cause myocardial ischemia due to blood-steal through a patent IMA graft. Thirty-one cases of postoperative steal syndromes have been reported in the literature, 23 due to proximal SCA stenosis, seven due to large IMA side branches and one due to an IMA malformation. We report two additional cases and discuss them in conjunction with the cases in the literature. Thirty patients suffered from recurrent angina pectoris, three had asymptomatic reversal of flow in the IMA as diagnosed by coronary angiography during routine follow-up examination. Carotid-subclavian bypass grafting is the treatment of choice for the management of proximal SCA stenosis. IMA malformations or large side branches are treated by interruption of the responsible vessel, either by ligation or by transarterial catheter embolization. In 82% (27 of 33), steal syndrome could have been prevented by preoperative angiography of the IMA. We advocate it as a routine procedure in combination with coronary arteriography.

Humans↗
PubMed1993

Mycotic aneurysm of the abdominal aorta: extra-anatomic versus in situ reconstruction.

Between 1973 and 1991, 12 patients with mycotic aneurysm of the abdominal aorta underwent operation. There were four elective and eight emergency procedures. In situ reconstruction was performed in six patients and extra-anatomic reconstruction with axillobifemoral bypass grafting in six. The hospital mortality rate was 25% (three patients) and another three died during the follow-up period of mean 5.5 years. Descending aorta-bifemoral bypass was performed in two patients without signs of chronic local infection 1 and 2 years after previous axillobifemoral bypass. Late complications were peripheral embolization in one patient after in situ reconstruction and a total of five thromboses of the axillofemoral bypass in three patients. Extra-anatomic bypass grafting remains the method of choice for the majority of patients with mycotic aneurysm of the abdominal aorta. In situ reconstruction seems to be an appropriate procedure for a highly selected group of patients.

Aged↗
PubMed1993

Anomalous left pulmonary artery (pulmonary sling): result of a surgical approach.

Between 1977 and 1992, four infants with an anomalous left pulmonary artery and subsequent compression of the tracheobronchial tree were operated on at the University Hospital Zurich. The operation consisted of mobilization of the abnormal left pulmonary artery with reimplantation into the main pulmonary trunk in three patients; the left pulmonary artery was transected and restored in front of the trachea by end-to-end anastomosis in one. Mean follow-up was 7 years (range 2 months to 14.3 years). There were no early and no late deaths. All patients have shown significant symptomatic improvement without respiratory infection or disturbance of normal life activities. Surgical therapy in this rare condition can be safely undertaken with good long-term results. In symptomatic patients the operation should be performed early before occurrence of severe respiratory symptoms and bronchial collapse.

Airway Obstruction↗
PubMed1993

[Surgery of endocarditis in the drug dependent and HIV patient. A prospective comparison with conservative treatment].

The incidence of infective endocarditis in drug addicts is increasing with the spreading of intravenous drug abuse. The tricuspid valve is the most commonly involved valve followed by the mitral valve. We evaluated prospectively 22 patients with a mean age of 23 years, presenting with addiction-associated endocarditis endocarditis and referred to our institution during a three-year period. The tricuspid valve was involved in 13 instances, mitral valve in 4, mitral plus tricuspid valve in 5 patients and aortic valve in 1 case. Staphylococcus aureus was the most frequent infective organism (15x), followed by Streptococci (4x), Corynebacteria (2x) and one case with a mixed infection. Six patients were positive for an HIV-infection and 17 had evidence for a chronic viral hepatitis. Ten patients (3 of them HIV-seropositive) were treated surgically. Resection of the tricuspid valve with (1x) or without replacement (4x), resection of vegetations and valve repair (2x), mitral valve replacement (2x), aortic valve replacement (1x) were performed. In case of tricuspid endocarditis, the decision whether to proceed with resection, repair or replacement with a bioprosthesis was taken according to valve pathology and the psycho-social situation of the patient. When the vegetations involved only one leaflet and could be removed easily, vegetectomy with annuloplasty or with repair using autologous pericardium was performed. Valvulectomy without replacement was the chosen method for those where persistent or recurrent drug abuse could not be excluded. A bioprosthesis was inserted when the tricuspid valve was completely destroyed and there was a proven abstinence from drugs over a period of several weeks preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1993

[Extra-anatomic ascending-supraceliac aortic bypass in treatment of complex or recurrent aortic isthmus stenosis].

Several surgical approaches have been reported for operative correction of complex or recurrent form of aortic coarctation. In this study we report our experience with extra-anatomic ascending-supraceliac abdominal bypass grafting for complicated form of aortic coarctation in 12 patients. All patients survived the operations, without late mortality. This type of surgical correction of complex or recurrent form of coarctation is a safe and effective procedure.

Adolescent↗
PubMed1993

Antibiotic prophylaxis in cardiovascular surgery: a prospective randomized comparative trial of one day cefazolin versus single dose cefuroxime.

With the intention of reducing prophylactic antibiotic dosage, previous studies in the Zurich University Hospital have shown that a one/day prophylactic antimicrobial regimen with cefazolin was as effective as a single dose of ceftriaxone. In this prospective randomized study one day cefazolin prophylaxis (1 g q 8 h i.v.) was compared with a single dose of cefuroxime prophylaxis (1.5 g). In cases of cardiopulmonary bypass 0.75 g was added in the priming solution. In case of re-operation prophylaxis was repeated. 496 patients were enrolled in the study protocol; 78 patients were subsequently excluded. Of the remaining patients 224 (158 male, 66 female, mean age 61) were in the cefazolin group and 194 (142 male and 52 female, mean age 60) in the cefuroxime group. Mean duration of the intensive care unit (ICU) stay was three days in both groups and mean hospital stay was 16 days in the cefazolin group and 15 days in the cefuroxime group. The overall postoperative infection rate was 15.3%; 18.8% in the cefazolin group and 11.3% in the cefuroxime group. The statistical differences were found as in trend (p = 0.095). The lower incidence of infectious complications in the single cefuroxime dose group may indicate an improvement in effectiveness of antimicrobial prophylaxis: it offers patients a reliable antimicrobial protection. In addition, the single dose prophylaxis has the advantage of easier handling, reduced dosage frequency and lower cost.

Bacterial Infections↗
PubMed1993

[Results of surgical revascularization of the kidney].

There are many different etiologies of renal artery disease (atherosclerosis, aneurysm, dissection, arteriovenous fistula, embolism, fibromuscular dysplasia) and also a lot of different therapies (conservative treatment, percutaneous transluminal angioplasty [PTA], endarterectomy, bypass grafting, patch plasty, nephrectomy). Recently conservative treatment and PTA have significantly improved. Patients who are referred to surgery today are of older age with severe and often bilateral disease of the renal arteries. Additional manifestations of general atherosclerosis like coronary artery disease, aortic aneurysm, peripheral occlusive vessel disease and cerebral vascular insufficiency are often present as well. The main goal of all forms of treatment is the preservation of general renal function. With our retrospective study the results after surgical revascularisation of kidneys are evaluated over a short period of time. Only graft revascularisations are included in the study and we were mainly interested in renal function and blood pressure.

Aged↗
PubMed1993

Endocarditis in intravenous drug addicts and HIV infected patients: possibilities and limitations of surgical treatment.

The incidence of infective endocarditis in drug addicts is increasing with the spread of intravenous drug abuse. The tricuspid valve is involved most commonly, followed by the mitral. We evaluated 22 patients prospectively with a mean age of 23 years, presenting with addiction-associated endocarditis and referred to our institution during a three-year period. The tricuspid valve was involved in 13 instances, the mitral in four, mitral plus tricuspid valves in five patients and the aortic valve in one. Staphylococcus aureus was the most frequent infective organism (15 cases), followed by streptococci (4 cases), corynebacteria (2 cases) and one case with a mixed infection. Six patients were HIV positive and 17 had evidence of chronic viral hepatitis. Ten patients (three of them HIV positive) were treated surgically. Resection of the tricuspid valve with (one case) or without replacement (four cases), resection of vegetations and tricuspid repair (two cases), mitral valve replacement (2 cases) and aortic valve replacement (one case) were performed. Operative mortality (< 30 days) was high (2/10, 20%); one patient died from cerebral hemorrhage and another from multi-organ failure. Another three patients died after a mean follow up of 10 months. In 12 patients, surgery was not attempted because of still existing intravenous drug abuse or renal and liver failure. Five of these patients died after a mean follow up of 13 months, two from septicemia, two from AIDS-related complications and one from drug overdose. The prognosis of drug-associated endocarditis treated with antibiotics is generally good.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Transcaval liver resection with hepatoatrial anastomosis for treatment of patients with the Budd-Chiari syndrome. Late results.

Between 1980 and 1990 transcaval liver resection with hepatoatrial anastomosis was performed in 17 patients with the Budd-Chiari syndrome. There were two early deaths (early mortality 11.7%). Hepatic function returned to normal and hepatosplenomegaly disappeared in all but two patients with preexisting cirrhosis. All survivors regained normal working capacity after the operation. During an average follow-up of 6 years (7 months to 11 years) there were three late deaths due to progression of the underlying disease. The actuarial 1-, 5-, and 10-year survivals were 82%, 76%, and 57%, respectively. Hepatoatrial anastomosis represents an optimal treatment for patients with the Budd-Chiari syndrome and obstruction of major hepatic veins. Patients with compression of the inferior vena cava, very common in this disease, were treated by simultaneous transcaval stenting. The late results are very satisfactory, with excellent quality of life. With adequate hepatic function, results of hepatoatrial anastomosis are superior to those of liver transplantation, which represents the only alternative for patients with the advanced form of the Budd-Chiari syndrome.

Adult↗
PubMed1993

[Effect of aortic clamping on heart function in elective operation of the abdominal aorta: immediate effects of coronary revascularization].

Infrarenal aortic cross-clamping required during surgical treatment of abdominal aortic aneurysm is generally well tolerated but can be occasionally associated with severe cardiac and haemodynamic disturbances, particularly in patients suffering from coronary artery disease. We compared the haemodynamic changes and the ECG-records before and shortly after infrarenal aortic clamping in three groups of 20 patients (group I: without coronary artery disease, group II: with overt coronary disease without indication for prior myocardial revascularization, and group III: patients undergoing combined procedure: coronary artery bypass immediately prior to aortic repair, during the same anesthesia). There was no significant difference in demographical characteristics between the three groups. Aortic cross-clamping lead to an increase in systemic arterial pressure in all patients. Group I demonstrated a decrease in pulmonary artery pressure, pulmonary capillary wedge pressure and central venous pressure, whereas patients of group II demonstrated an increase of each value when the aorta was clamped. 11 patients of this group developed either arrhythmia and/or ischemia during aortic cross-clamping. Haemodynamic and cardiac effects of aortic clamping seen in patients who had received coronary bypass immediately prior to aortic repair (group III) were surprisingly similar to those of patients without coronary disease, probably owing to systematic application of 2 vasodilators. Tolerance to infrarenal aortic cross-clamping differs in patients with and without coronary artery disease. Development of myocardial ischemia may be predicted by an increase in wedge pressure after clamping. Afterload reduction was the best treatment of ischemia occurring when the aorta was clamped.

Aged↗
PubMed1993

In situ repair of mycotic aneurysm of the ascending aorta.

Between 1969 and 1990 six patients (aged 14 to 64 years, mean 43 years) underwent in situ reconstruction for mycotic aneurysm of the ascending aorta. The primary source of infection was endocarditis in three patients (subacute bacterial endocarditis [n = one patient], sepsis with acute endocarditis [n = one patient]), sepsis with sternal osteomyelitis in one, sepsis with purulent pericarditis in one, and generalized febrile illness in one. In five of six patients the treatment consisted of the excision of changed tissue combined with a composite graft (n = one patient), a xenopericardial patch repair (n = one patient), a Dacron graft repair and aortic valve replacement (n = one patient), a Dacron graft repair alone (n = one patient), and a lateral suture combined with double valve replacement (n = one patient). In one patient with perforation of the mycotic aneurysm into the pulmonary artery, the place of rupture was oversewn without excision of the aortic or pulmonary artery tissue. Two patients with local pericardial inflammation were reoperated on during the hospital stay; one of them because of recurrent mycotic aneurysm of the ascending aorta at the other location and the other because of infection of the suture line after the Dacron patch repair. Antibiotic therapy was intravenously administered for 2 to 12 weeks postoperatively and continued orally for 4 to 8 weeks. The mean observation time was 6 years (range 4 months to 16 years). There was no late graft infection, except the chronic infection of the suture line in one patient who died suddenly 4 months after the operation. There was no early death, and there were three late deaths (chronic myocardial failure, one patient, chronic renal failure, one patient, sudden death, one patient). We concluded that in situ reconstruction for mycotic aneurysm of the ascending aorta combined with prolonged antibiotic therapy is an appropriate procedure with satisfactory early and good long-term results.

Adolescent↗
PubMed1992

[Immediate and long-term results of carotid endarterectomy: the Zurich experience].

Extracardial carotid artery disease is a frequent cause of transient ischemic attack and of cerebral infarction. The records of 485 patients who underwent carotid endarterectomy between 1978 and 1991 were reviewed, with special attention to both cardiac and neurological complications. 432 patients had symptomatic carotid disease whereas 53 were asymptomatic but presented with significant carotid stenosis or a large ulceration at doppler-duplex examination and/or angiography. These examinations showed the following lesions in symptomatic patients: unilateral stenosis > 75% (331; 68.5%), ulceration (41; 8.5%), bilateral stenosis (61; 12.5%) and unilateral stenosis with contralateral occlusion (51; 10.5%). Intraluminal shunt was used in nearly all patients whereas special management of cerebral metabolism (intraoperative electroencephalogram, somatosensory evoked potentials) were used in high-risk patients only. Overall early mortality was 1.8%. Three patients died from the sequelae of a neurologic injury, whereas six patients died from myocardial infarction or intractable arrhythmia. Mortality decreased from 2.4% between 1978 and 1984 to 0.8% between 1985 and 1991. At 6 and 8 years, actuarial survival rates of 88.1% and 76.1% and stroke-free survival rates of 86% and 81.5% were observed. Late mortality was essentially due to ischemic cardiac complications (38.5% of the actuarial late mortality at 8 years). Review of the literature shows that carotid endarterectomy is the treatment of choice for symptomatic high-grade extracranial carotid stenosis in patients who are not high-risk candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Pericardectomy and acute infectious pericarditis].

Between 1980 and 1990 12 patients (5 male, 7 female) were operated on for acute infectious pericarditis at a mean age of 42 years. The infections were 6 bacterial (purulent 4, abscess 2), 4 tuberculous, 1 viral and 1 Candida. Pericarditis resulted from contiguous spread of infection from bilateral pneumonia in 3 patients, from subphrenic abscess in 2 and followed bacteremia in 1. Clinical signs were: tamponade/shock in 9, elevated jugular venous pressure in 11, edema in 6, hepatomegaly in 6, ascites in 1, and pericardial friction rub in 3. A preoperative pericardiocentesis in 9 patients allowed only 4 positive microbiological diagnoses and was an insufficient drainage in all cases. The preoperative mean NYHA class was 3.3. The pericardectomy was total in 9 patients and partial in 3. Total mortality was 1/12 patients (8%) with one late death due to recurrent tuberculous pericarditis. No patient with purulent pericarditis died. Another recurrence occurred 6 months after acute viral pericarditis. Atrial fibrillation in one patient was the only postoperative complication. After a mean follow-up period of 48.5 months no cardiac constriction had occurred in 11 surviving patients Actuarial survival after pericardectomy is 100% after 1 month and remains 91% after 5 years. The mean NYHA class has significantly improved to 1.2 (p less than 0.05) at the end of the follow-up. We conclude that pericardectomy combined with a specific antimicrobial therapy is a safe treatment for acute infectious and especially purulent pericarditis with low mortality and excellent longterm results. Early pericardectomy allows rapid decompression of the heart, removal of intrapericardial adhesions and infected tissue and prevents late constriction.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Convulsions, hemiparesis and central retinal artery occlusion due to left atrial myxoma in child.

Multiple embolizations were the hallmark of the disease in an 8-year-old boy with a left atrial myxoma. Embolizations occurred initially in both hands and legs, later in the brain with generalized seizures and hemiparesis, and finally in the left eye with occlusion of the central retinal artery and consecutive severe visual impairment. Echocardiography demonstrated the tumour which was removed without complications.

Child↗
PubMed1992

Ruptured congenital aneurysm of the sinus of Valsalva: surgical technique and long-term follow-up.

Congenital ruptured aneurysm of the sinus of Valsalva is a rare anomaly usually causing decrease of cardiac performance. Eight patients with a ruptured congenital aneurysm of the sinus of Valsalva were operated upon at the University Hospital Zurich between 1970 and 1991. There were four female and four male patients aged from 15 to 48 years (mean, 36 years). Three patients were asymptomatic and five symptomatic. Associated congenital cardiac defects were found in six patients. Surgical techniques consisted of direct suture in seven patients and closure with a Dacron patch in one. A secondary Dacron patch closure was performed on the second postoperative day in a patient with suture insufficiency after direct closure. Associated operations were closure of ventricular septal defect in two patients, aortic valve replacement in two, aortic valve reconstruction in one and aortic valve commissurotomy in one patient. There were no operative deaths. The mean follow-up was 9 years, range 7 months to 17 years. There were two late deaths due to endocarditis and recurrent cerebral embolisation. An operation for a ruptured aneurysm of the sinus of Valsalva has a low operative risk, but patients remain prone to development of late valvular complications.

Adolescent↗