Search PubMed⌕ Search

Biomedical subjects

T Carrel

Publications and source records attributed to T Carrel.

At least 163 records · Page 9Linked to original sources
PubMed1992

Severe tricuspid regurgitation following blunt chest trauma: indication for emergency surgery.

A 24-year-old man with polytrauma and severe posttraumatic tricuspid regurgitation due to rupture of all three papillary muscles was subjected to emergency operation 3 days after a car accident. At operation, all three papillary muscles of the tricuspid valve were reinserted. Severe tricuspid regurgitation after blunt chest trauma is an indication for emergency surgical treatment, and can be performed with a low operative risk.

Adult↗
PubMed1992

Pericarditis constrictiva after aortic valve replacement simulating tricuspid stenosis.

Pericarditis constrictiva after cardiac surgery is rare and may occasionally lead to congestive heart failure. The case of a 29-year-old patient is described who presented with pericarditis constrictiva after aortic valve replacement with localized tamponade, causing functional tricuspid stenosis. Pericardiectomy as the treatment of choice was curative.

Adult↗
PubMed1992

Surgical treatment of cardiovascular complications in Marfan syndrome: a 27-year experience.

Fifty-two patients with Marfan syndrome and ascending aortic pathology were treated surgically between 1964 and 1990. The indication for primary operation was true aneurysm of the ascending aorta with or without aortic insufficiency in 35 patients (67%) and dissection in 17 (33%). Composite grafts were used in 28 patients (54%; group I) and other procedures on the ascending aorta in 24 patients (46%; group II). The latter included supracoronary graft replacement with or without aortic valve replacement or reconstruction (n = 13), and reconstruction of the ascending aorta with or without aortic valve replacement (n = 11). Composite graft insertion was combined with mitral valve surgery at the same operation in 3 patients (6%). The early mortality after primary operations was 7.7% (4 deaths) and the late mortality was 27% (14 deaths). Eight late deaths were related to cardiovascular complications. The mean follow-up was 6.7 years (range 1-27 years). The actuarial 5-, 10-, and 15-year survival rates for all patients were 82%, 63%, and 44%, respectively; for group I (composite grafts) they were 87%, 76%, and 57%; and for group II (other types of operations) they were 73%, 53%, and 37%. The incidence of late complications was much higher in group II than in group I (50% vs. 16%). At 5 and 10 years, the actuarial rates of freedom from late complications related to the primary operation were 88% and 80%, respectively, in group I and 65% and 18% in group II. Composite graft insertion is the operation of choice when approaching the ascending aorta and/or aortic valve in Marfan syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Recurrent rupture of a mycotic ascending aortic aneurysm: a surgical and medical challenge.

Infection in the vascular tree remains one of the greatest challenges for vascular surgeons. Despite technical advances and newer antibiotics, the morbidity and mortality remain high. The following case report underlines the complex factors encountered in a 62-year-old alcoholic patient presenting with a "classical" history of mycotic aneurysmal disease who suffered from recurrent rupture of the aneurysm of the ascending aorta. In situ reconstruction of the ascending aorta was performed with patch of xenopericardium. As demonstrated in this case, aggressive surgical management and long-term triple antibiotic therapy can salvage patients even with multiple complications in the early postoperative period.

Alcoholism↗
PubMed1992

Improvement of severely reduced left ventricular function after surgical revascularization in patients with preoperative myocardial infarction.

In recent years, two pathophysiological conditions--stunned and hibernating myocardium--have been described showing how function may be depressed in myocardium that remains viable. The aims of the present study were postoperative assessment of LV function at rest and during exercise after CABG in patients with established previous myocardial infarction and impaired preoperative LV function and evaluation of preliminary experience with positron emission tomography (PET) in the preoperative identification of reversible ischaemic myocardium and its predictivity in postoperative functional improvement. We studied 23 patients with preoperative LV function under 45%. Echocardiography and complete heart catheter were performed pre- and postoperatively. PET was performed in all patients preoperatively. In 21 patients with patent grafts, CABG significantly improved systolic and diastolic function during exercise and at rest. EF improved from 34% +/- 14% to 52% +/- 11% at rest and from 31% +/- 14% to 58% +/- 13% during exercise (P less than 0.01). Time constant of diastolic relaxation was significantly reduced after revascularization. In 2 patients with pathological findings on postoperative coronarangiography, EF remained unchanged. Both global and regional contractility improved following surgery. Regional analysis indicated that improved EF at rest occurred in regions developing ischaemia during exercise before CABG and in regions showing typical mismatch in 82Rubidium-2-fluoro-2-desoxyglucose suggesting the presence of hibernating myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1992

Treatment of mycotic aneurysm of the aorta and its branches: the location determines the operative technique.

Twenty-seven patients with mycotic aneurysms of the aorta and its major branches were operated on between 1969 and 1991. There were 24 males and three females ranging in age from 6 to 84 years (mean age for adults 63 years). Sixteen of the 27 (59%) aneurysms were ruptured and in situ repair was undertaken in 20 (74%) patients. The mean follow-up was 5.8 years (range: 8 months to 16 years). Four patients (15%) died during the hospital stay and 23 survived. There were eight late deaths, two of which were a direct result of the aneurysm. The estimated 1- and 5-year survival rates were 62 and 36%, respectively. Extra-anatomic reconstruction is the method of choice for the majority of patients with mycotic aneurysm of the infrarenal abdominal aorta and iliac arteries. In situ repair after an extensive debridement of the aneurysmal wall and all infected tissue combined with antibiotic therapy is a satisfactory method of treating mycotic aneurysms of other locations, and for a highly selected group of patients with infrarenal mycotic aortic aneurysms.

Adult↗
PubMed1992

Pulmonary atresia with intact ventricular septum: results and predictive factors of surgical treatment.

Between 1970 and 1989 26 children were operated for pulmonary atresia with intact ventricular septum (PA/IVS). According to the degree of right heart hypoplasia the patients were divided into 3 groups of mild (5), moderate (17) or severe (4) hypoplasia. Palliative operations were performed in 25 children (17 male, 8 female) at a mean age of 10 days: 13 valvotomies (valv.), 5 aortopulmonary shunts, and 7 valv. plus shunt. One patient had total correction as primary procedure. A total of 17 reoperations was necessary in 12 of 26 patients (10 palliations, 7 total corrections). Total corrections were: 2 conduits and 5 patches of the right-ventricular outflow tract (RVOT). Total mortality was 14/26 (54%) children (early 10/26 = 38%, late 4/26 = 16%). After total correction mortality was 3/7 (43%) patients. After a mean follow up of 10.8 years after palliation the 12 survivors are mostly in NYHA class I. Actuarial survival after palliation was 60% after 30 days and 44% after 5 and 10 years. We analyzed 9 clinical and hemodynamic variables by univariate and multivariate analysis to assess the predictive factors of postoperative outcome. Multivariate analysis disclosed the degree of right-ventricular hypoplasia (p = 0.023) as an independent predictor for death whereas the age at palliation only approached significance (p = 0.065). We recommend the following surgical strategy, aiming in the first place at decompressing the right ventricle: in mild hypoplasia valvotomy alone or combined with a shunt for palliation, in moderate hypoplasia shunt plus patch of the RVOT and in severe hypoplasia shunting alone. In case of a restrictive foramen ovale initial balloon septostomy is performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1992

Valve replacement in octogenarians: increased early mortality but good long-term result.

Between January 1983 and December 1990, 20 patients aged 80 years or older underwent valvular surgery. The patients' ages varied from 80 to 87 years (mean, 82 +/- 1.5 years). The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective, two urgent, and three emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. Six patients (30%) had an uneventful hospital stay, and the other 14 (70%) experienced several post-operative complications. The operative mortality rate was 15% (three patients). All patients before operation were in NYHA (New York Heart Association) class III and IV and all survivors remained in NYHA class I or II. The survivors have been followed from 6 to 70 months (mean 20 +/- 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement in octogenarians can be performed, despite the high rate of post-operative complications, with increased but acceptable mortality. Long-term results are good.

Aged↗
PubMed1992

Combined carotid and coronary artery surgery: early and late results.

Patients with coronary artery disease can exhibit substantial vascular involvement; and vascular patients have a high incidence of coronary disease. Combined coronary artery bypass grafting (CABG) and treatment of extracranial cerebrovascular disease was performed in 52 patients, presenting strong indications for surgical treatment of coronary artery disease and symptomatic carotid disease and/or asymptomatic carotid bruit that reflected an ulcerative lesion or stenosis exceeding 75%. Overall hospital mortality was 3.8%. Clinical presentation determined the risk of the combined procedure: early mortality was much higher in urgent and emergency cases than in elective cases. Eight-year actuarial survival was 86%. This group of patients was compared with staged procedures in 45 patients (including carotid endarterectomy followed by CABG several weeks later) and with 42 patients who underwent coronary artery bypass in the presence of carotid bruits. Both early cardiac complications in the former group and neurologic complications in the latter were significantly more frequent than in combined procedures. Combined procedures can be performed with acceptable risk and with encouraging long-term results also in this special group of patients; they may improve the long-term prognosis of patients with diffuse atherosclerosis much more.

Actuarial Analysis↗
PubMed1992

[Prevention of cytomegalovirus infection following heart transplantation].

Cytomegalovirus (CMV) infection after heart transplantation (HTx) is a severe complication, which leads to long treatment and hospital stay. Even if prophylactic therapy with anti-CMV IgG antibodies is performed, there is a high incidence of infection, especially when the heart from a CMV positive donor is transplanted to a CMV negative recipient (high risk constellation). This study evaluates the prophylactic antiviral therapy with ganciclovir in CMV high risk constellation at HTx. Out of 108 HTx, 29 CMV negative recipients (IgG and IgM) received a heart from a CMV positive donor (IgG pos., IgM neg.). The control group (CO) (n = 8) was treated with anti-CMV IgG antibodies (Cytotect 2 ml/kg at day 0, 1, 2, 7, 14, 21,), whereas the study group (GAN) (n = 13) was treated with ganciclovir (7.5 mg/kg single dose n = 8, or 5 mg/kg in twice daily doses n = 5 from day 1 to 14). Urea, creatinine, white blood cell count and platelet count was controlled daily. No side effects on renal and bone marrow function were noted. Therapy was well tolerated. Both groups had similar immunosuppressive protocol (prophylactic cytolysis, prednisone, azathioprine and cyclosporin A) and were similar in age, sex, preoperative diagnosis and NYHA class. Seroconversion for CMV (IgM and IgG) was observed in 75% of CO and 31% of GAN (p less than 0.05). Clinical manifestations of CMV infection started in the second month after HTx with fever in both groups CMV-organ manifestations developed in 50% (or 67% of infected) in CO (enterocolitis 2, pneumonitis 3, tonsillitis 1), and in 15% (or 50% of infected) in GAN (pneumonitis 2, epididymitis 1) NS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Technique and organization of heart removal from the multi-organ donor].

The orthotopic heart transplantation is an accepted treatment for terminal cardiac disease. The technique of heart procurement and preservation is explained and the primary graft function in 108 subsequent heart transplantations is assessed. The mean ischemia time is 41 +/- 10 min in local, 98 +/- 19 min in distant (< 100 km) and 114 +/- 16 min in distant (> 100 km) organ procurement. Our method of preservation consists of cold cardioplegic arrest with potassium (30 mEq/L) cardioplegic solution. The incidence of the indication for high dose katecholamine-treatment after surgery and the maximal creatininekinase levels rose with ischemia time. All hearts recovered within a few days and the stay in the intensive care unit was not prolonged. We conclude that the heart preservation with cold cardioplegic arrest results in a good primary graft function. It is important to keep the ischemia time as short as possible.

Graft Survival↗
PubMed1992

[Rupture of the Achilles tendon--fibrin gluing or suture?].

The rise of recreational sports activities and the incidence of ruptures of the Achilles tendons has increased simultaneously. Recently the use of fibrin sealing for surgical therapy of ruptured Achilles tendons has emerged as an alternative technique. Between 1982 and 1989 62 consecutive patients were operated for unilateral Achilles tendon rupture. Following causes for ruptures are known: 36 indirect traumas in sport (74%), 9 direct blunt injuries at occupational work (18%), 3 traffic-accidents (11%) and 1 rupture after operation of a Haglund exostosis. 25 patients (56%) were treated by suture technique and 20 patients (44%) with fibrin sealant. The mean long term follow-up of 49 months is known of 49 patients. There were 3 (12%) postoperative infections in the suture group and none in the fibrin group. After suturing the Achilles tendon 3 (12%) reruptures occurred 8-10 weeks after tendon repair and 1 (5%) rerupture after fibrin sealing. All reruptures are caused by a new adequate trauma. The time of return to social and recreational activities was 9 months in the suture group and 7 months in the fibrin group. The functional and cosmetic results after use of fibrin was significant better, and the long-term results were very satisfactory. We prefer fibrin sealing for the treatment of acute ruptures of Achilles tendons.

Achilles Tendon↗
PubMed1992

[Valve replacement in patients over 80 years of age].

Between January 1983 and October 1990, 20 patients age 80 years or older (mean 82 +/- 1.5 year, range 80 to 87 years) underwent valvular surgery at Clinic for Cardiovascular Surgery Zurich. The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective operations, 2 urgent, and 3 emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. The operative mortality rate was 15% (3 patients). All patients were preoperative in NYHA classes III and IV. All survivors remained in NYHA classes I or II. The survivors have been followed from 6 to 70 months (mean 20 +/- 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement can be performed with increased but acceptable mortality and morbidity. Long-term results are encouraging.

Aged↗
PubMed1992

[Surgical indications of pulmonary arteriovenous fistulae in Osler disease].

Hereditary hemorrhagic teleangiectasia (HHT) is known to be associated in 15% with pulmonary arterio-venous fistulas (PAVF). Symptoms and complications of these fistulas are: hemoptysis, dyspnea, hemothorax, cerebral embolization and brain abscess. We studied a family with 7 members known to have HHT. 3 had PAVF. Patient 1 died of a hemothorax and pleural empyema. PAVF were diagnosed at autopsy. Patient 2 (nephew) suffered from a cerebellar abscess. The fistula-bearing part of the lung was removed by wedge resection. Patient 3 (son of the former) had no symptoms, but the arterial PO2 was 6.7 kPa. In order to prevent complications like in his father, the patient was operated. A lobar resection was necessary to remove the fistula. The postoperative course was eventless in patients 2 and 3. We conclude, that periodical thorax X-ray studies are indicated for all members of families with HHT in order to find PAVF before complications occur. The classical treatment is resection of the fistula with as little lung tissue as possible. Good results have been reported lately with embolization of PAVF, but this method is not generally available yet.

Adolescent↗
PubMed1992

[Surgery of infectious pericarditis].

Between 1980 and 1990 34 patients (pat.) (21 male, 13 female) were operated for infectious pericarditis (P.) at a mean age of 48 years (min. 2, max. 70 years). The infection was acute in 12 pat. (7 bacterial, 4 Tbc, 1 viral). A chronic constrictive P. was found in 22 pat. (15 history of Tbc, 7 history of viral P.). The preoperative mean NYHA class was 3.0. Cardiac catheterization was performed in 22 pat. and confirmed restrictive pericardial disease in all cases with elevated and equalized diastolic pressures in all 4 cardiac chambers. Mean cardiac index was 2.7 l/min m2 and the ejection fraction 53%. Pericardectomy (Pe.) was performed through an anterolateral left thoracotomy in 31 pat. and through a sternotomy in 3 pat. Total and partial Pe. were performed in 31 and 3 pat., respectively. Total mortality was 3/34 pat. (8.8%) with no operative death (one early and two late deaths). There were two recurrent P. (1 Tbc, 1 viral) and no recurrent constriction. Long-time follow-up of 31 surviving pat. is known in 28 cases with a mean follow-up of 4.6 years (min. 1 month, max 10.5 years). At the end of the follow-up the mean NYHA class ist 1.3 (p less than 0.005). Actuarial survival after Pe. is 97% after 30 days and 90% after 5 and 10 years. In our retrospective study we conclude that Pe. is a safe treatment for infectious P. with low mortality and excellent long-time results with improvement of cardiac function. Pe. should be performed early for purulent or constrictive P. There is no conservative treatment for progressive myocardial constriction and the resulting cardiomyopathy. After total Pe. there is a low rate of recurrent P. or constriction.

Adolescent↗
PubMed1992

[Treatment strategy of vascular complications of acute aortic dissection].

Aortic branch occlusion may constitute the mode of presentation or become an important focus of treatment in patients sustaining acute aortic dissection. We reviewed the outcome of 187 consecutive patients (149 males and 38 females, mean age 58 yrs) with acute dissection of the thoracic aorta who were admitted and operated in our clinic during a 13-year period. We assessed the incidence, the consequences and the specific management of stenotic and obstructive lesions of the aorta and its branches. Noncardiac vascular complications occurred in 59 patients (32%); out of these complications, 38 were associated with dissection type A (incidence 28%) and 21 with dissection type B (incidence 48%). Trend towards decreasing overall surgical mortality was observed in the second part (1983-1989) of the study when compared with the first part (1977-1982): it was 28% versus 12%. Although aortic rupture and cardiac tamponade were the strongest correlate of morbidity and mortality, death specifically related to vascular complication was more common when such malperfusion occurred in the carotid, coelio-mesenteric and renal circulation. Proximal aortic repair at the site of the intimal tear with obliteration of the false lumen may have restore adequate distal circulation in 27 patients in whom improvement of the visceral or peripheral ischemia was observed after the thoracic aortic repair. Additional procedures (immediately after the thoracic repair or later on) were necessary in 15 patients to restore adequate perfusion in the compromised area. Early aggressive thoracic aortic repair followed in selected patients by additive vascular procedures can save some patients with compromise visceral or peripheric circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗