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At least 1,423 records · Page 79Linked to original sources
PubMed2005

Chronic mesenteric ischemia.

Chronic mesenteric ischemia is an unusual but important cause of abdominal pain. Although this condition accounts for only 5% of all intestinal ischemic events, it can have significant clinical consequences. Among its many causes, atherosclerotic occlusion or severe stenosis is the most common. This disorder has an indolent course that results in extensive collateral vascular formation. Thus, symptoms occur when at least two of the three main splanchnic vessels are affected. Intestinal angina, weight loss, and sitophobia are common clinical features. Diagnosis can often be made by noninvasive methods such as computerised axial tomographic angiography, magnetic resonance angiography, and duplex ultrasonography as well as by invasive catheter angiography. Therapy of chronic mesenteric ischemia depends on the extent and location of vascular disease. Alternatives to traditional surgical bypass are becoming more common including embolectomy, thrombolysis, and percutaneous angioplasty with vascular stenting. Early intervention is vital as the natural course of this illness can be debilitating. Furthermore, this has potential to develop into life-threatening acute mesenteric ischemia with subsequent bowel infarction and death. Long-term studies have shown that the risk of developing symptoms from asymptomatic but significant mesenteric vascular disease is 86% with overall 40% mortality rate. The recognition and management of this unusual but important cause of abdominal pain is discussed in detail in this review.

Abdominal Pain↗
PubMedDate not supplied

Prevention of intimal hyperplasia; Initial results with low-dose beta-radiation applied by an external vascular polymer wrap.

OBJECTIVE: Endovascular brachytherapy, delivered by a variety of catheter-based devices, has proven clinically effective for the inhibition of neointimal hyperplasia (NIH) after coronary and peripheral balloon/stent angioplasty. No platform, however, has been developed to deliver low-dose radiation in concert with vascular surgical operations. The purpose of this study was to evaluate the vascular response following balloon injury to the rabbit carotid artery, with and without topical low-dose 45Ca, applied by an external vascular "wrap". METHODS: Twelve rabbit carotid arteries were subjected to balloon injury by embolectomy catheter. The common carotid artery was then "wrapped" circumferentially with a biostable polyurethane membrane (Nanoskin Secant Medical, Perkasie, PA), without radiation (n = 6), or with radiation (n = 6) (45Ca approximately 50 microCi). The animals were sacrificed at 4 weeks for histologic assessment of the treated vessels. RESULTS: The 45Ca wrap inhibited NIH evidenced by trends towards reduction of intimal area (0.46 +/- 0.19 control carotid vs. 0.35 +/- 0.15 (45)Ca-treated carotid arteries; P = .11), maximal intimal thickness (0.21 +/- 0.08 vs. 0.16 +/- 0.05; P = .12), average intimal thickness (0.12 +/- 0.06 vs. 0.08 +/- 0.03; P = .08), marginally significant reduction in percent area stenosis (33 +/- 15% vs. 21 +/- 9%; P = .06) and marked neointima suppression in areas immediately adjacent to 45Ca wrap remnants. Medial necrosis (P = .003), however, was observed slightly more for 45Ca-treated carotid arteries versus control arteries. CONCLUSION: Low-dose 45Ca beta-radiation labeled onto a polyurethane membrane appears to inhibit NIH in an animal model.

Angioplasty, Balloon↗
PubMed2006

Prognostic significance of raised cardiac troponin T in patients presenting with acute limb ischaemia.

OBJECTIVE: To study the relation between serum cardiac troponin T (cTnT) and mortality in patients presenting with acute limb ischaemia secondary to an embolism. MATERIAL AND METHODS: A two years prospective study of all patients admitted to the vascular unit with a diagnosis of acute limb ischaemia secondary to an embolism. On admission all patients had an ECG. A blood sample was taken for measurement of cTnT, CRP, serum biochemistry, full blood count and clotting. All embolectomies were performed under local anaesthesia. Patients were followed until discharge from hospital and up to twelve months after surgery. RESULTS: There were 37 patients with lower limb and 2 patients with upper limb ischaemia. Twenty four patients were female and fifteen were male, with the mean age of 76 years (50-95) for women and 84 years (77-90) for men. Seventeen patients (44%) had a raised cTnT. The patients with raised cTnT were older than those with normal cTnT [86y (77-92) vs 77y (51-95), p = 0.01, t test]. The mean cTnT was 0.20 microg/L (range: 0.11-0.27). Only two patients with raised cTnT gave a history of chest pains. All of the patients with an elevated cTnT had also raised CRP. There was no significant difference in the serum creatinine in the group of patients with elevated cTnT compared to those with normal cTnT [112 micromol/L (range 98-159) vs 119 micromol/L (range: 47-177), p = ns]. The cumulative survival for cTnT+ patients at 7 days was 53% and that of cTnT- patients was 100%. The cumulative survival for cTnT+ and cTnT- patients was statistically different (p = 0.0000, chi2 = 13.1, Log Rank test). Using regression analysis, an elevated cTnT was found to be an independent predictor of outcome. CONCLUSION: A significant proportion of patients presenting with an acutely ischaemic limb have an elevated cTnT. An elevated cTnT may be an early marker of overall disease severity and a predictor of outcome.

Acute Disease↗
PubMed2006

Mobile right heart thrombus and massive pulmonary embolism.

The current report describes a patient with pulmonary embolism, treated unsuccessfully with heparin. Transthoracic echocardiography revealed free-floating right heart thrombus. Migrating deep vein thrombus to the right heart was suspected. Transesophageal echocardiography confirmed origin of the thrombus in the inferior cava vein. Mortality rate of mobile right heart thrombus is over 40%, therefore urgent surgical embolectomy was performed with relief of symptoms.

Heart Atria↗
PubMed2006

Pharmacologic management of ischemic stroke: relevance to stem cell therapy.

Pharmacologic management of the acute phase of the ischemic stroke includes treating the physical and medical conditions that can worsen cerebral injury; administering intravenous thrombolytic therapy (recombinant tissue plasminogen activator) in those who meet current guidelines; instituting prophylactic measures to prevent medical complications; and initiating passive rehabilitation measures. New approaches under investigation include intra-arterial thrombolytic therapy; endovascular embolectomy and clot disruption; and neuroprotective treatments to preserve surviving ischemic tissue. One neuroprotective agent given within 6 h after stroke onset, NXY059, recently met the primary outcome measure in a phase III clinical trial. Pharmacologic management of the subacute and chronic phases involves treatment of risk factors for recurrent stroke and other forms of cardiovascular disease, including hypercholesterolemia, hypertension, and diabetes mellitus. In this phase, antiplatelet therapy can be initiated or continued; smoking, obesity and alcohol intake can be managed; and active rehabilitation can begin through physical, occupational, and speech therapy. A few medications to augment rehabilitation have shown promising results in small clinical trials, but none have been tested in large phase III trials or approved by the US or European regulatory agencies. Thus, there are no pharmacologic measures available to enhance central nervous system restorative processes after acute stroke, and implantation of stem cells provides one promising approach, not only for cell replacement but also for the provision of therapeutic molecules.

Brain Ischemia↗
PubMedDate not supplied

Transit thrombus entrapped in a patent foramen ovale.

We describe the case of a 39-year-old man with a diagnosis of inferior vena cava compression caused by metastases of a testicular seminoma, who developed massive pulmonary embolism. Emergency operation was performed because of acute hemodynamic deterioration. Preoperatively, a free-floating mass was seen echocardiographically in the right atrium. Intraoperatively, a thrombus entrapped in a patent foramen ovale with a short free-floating end in the left atrium and a long end in the right atrium was found in addition to the pulmonary emboli. The thrombus was removed, the foramen ovale was closed by direct suture, and pulmonary embolectomy was performed. Histological examination confirmed thrombi but no malignant tissue. Further diagnostic studies documented a malignant seminoma with paraaortic lymph node metastases giving rise to the thrombembolism. Three years after oncologic therapy, he is alive and free from recurrence of embolic and malignant disease.

Adult↗
PubMed2006

Temporary pulmonary stent placement as emergency treatment of pulmonary embolism: first experimental evaluation.

OBJECTIVES: We aimed to evaluate the performance of a newly designed temporary stent device as a percutaneous emergency treatment of pulmonary embolism. BACKGROUND: If thrombolysis is contraindicated or recanalization by thrombolysis delayed in patients with severe pulmonary embolism who are threatened by acute circulatory failure, percutaneous temporary pulmonary stent placement may represent an additional option before surgical embolectomy is considered. METHODS: The newly designed temporary pulmonary stent is made from woven Nitinol and has a distal blunt end and a proximal crimped end, which is firmly fixed to a 0.035-inch guidewire. It is delivered through a 9.5-F polytetrafluoroethylene sheath using a pusher tube. Stent placement and removal were examined in 9 anesthetized sheep with experimentally induced pulmonary embolism. Hemodynamic parameters were recorded in 7 animals. RESULTS: Delivery and removal of the stent was uneventful and rapidly accomplished. Stent placement was associated with a significant decrease in Miller angiographic index (from 11.2 +/- 3.1 to 3.8 +/- 1.9; p = 0.0001), heart rate (from 139 +/- 35 beats/min to 92 +/- 11 beats/min; p = 0.0129), and mean pulmonary artery pressure (from 32 +/- 14 mm Hg to 21 +/- 14 mm Hg; p = 0.0029) and a significant increase in mean aortic pressure (from 48 +/- 14 mm Hg to 61 +/- 8 mm Hg; p = 0.0080). Autopsy revealed neither wall damage nor parenchymal hemorrhage. CONCLUSIONS: Our preliminary study proves the technical feasibility of temporary placement and removal of a newly designed dedicated pulmonary stent to recanalize centrally located embolic occlusions in severe pulmonary embolism. Animal experimental evaluation revealed rapid and significant circulatory improvement after stent placement.

Animals↗
PubMed2005

Surgical treatment of giant coronary artery aneurysm.

OBJECTIVE: Giant coronary artery aneurysm is an extremely uncommon disease. Most previous reports have involved only single cases. This report describes 6 patients with giant coronary artery aneurysm, examines its causes, and aims to establish the optimal surgical strategies for this exceptional and rare pathology. METHODS: From July 1996 to October 2004, a total of 30,268 patients underwent heart surgery at Fuwai Hospital in Beijing. Among these, 6 patients had giant coronary artery aneurysm diagnosed and underwent operation. Various surgical strategies were used for the operations of these 6 patients, such as coronary artery aneurysm resection, coronary artery reconstruction, and concomitant coronary bypass. Additional procedures, such as fistula closure, aortic valve replacement, aortoplasty, and embolectomy, were done at same time for the patients with complications of coronary fistula, aortic valve insufficiency, or thrombus. Patients were followed up from 8 to 87 months, with a mean of 48 months. Doppler echocardiography, ultrafast computed tomography, and 3-dimensional aerial image studies were performed during follow-up. RESULTS: Five of these six cases were found combined with coronary artery fistula, and the cause for these giant coronary artery aneurysms was congenital. The remaining case was caused by atherosclerosis. After surgery, all patients recovered uneventfully, without in-hospital mortality. None died during the follow-up, nor did any have recurrence of the symptoms or giant coronary artery aneurysm. CONCLUSION: Giant coronary artery aneurysm is a rare entity that is commonly caused by congenital malformation and combined with other cardiac anomalies. An optimal surgical operation should be based on the specific cardiac anomaly of the individual patient.

Adult↗
PubMed2004

Recombinant human thrombomodulin inhibits arterial neointimal hyperplasia after balloon injury.

OBJECTIVE: Smooth muscle cell proliferation is a major pathophysiologic factor in injury-induced neointimal hyperplasia and recurrent stenosis. We have demonstrated that recombinant human thrombomodulin (rTM) inhibits thrombin-induced arterial smooth muscle cell proliferation in vitro. The purpose of this study was to investigate the effect of rTM on neointimal hyperplasia in vivo. METHODS: A rabbit femoral artery balloon injury model was used. Bilateral superficial femoral arteries were deendothelialized with a 2F arterial embolectomy catheter. rTM (145 microg/kg; 2.0 microg/mL in circulation) or Tris-hydrochloride vehicle control was administered intravenously during the procedure, then either discontinued (group A) or administered twice daily for an additional 48 hours (group B). Rabbits were euthanized at 4 days and at 1, 2, and 4 weeks, and femoral artery specimens were prepared with in situ perfusion fixation and paraffin embedding. Luminal, intima, media, and whole artery areas were quantitated with digital imaging computerized planimetry. Intima-media and lumen-whole artery ratios were calculated. The injury-induced inflammatory reaction was also evaluated with light microscopy, scanning and transmission electron microscopy, and immunohistochemical and immunohistofluorescence staining. RESULTS: In the buffer control group, neointimal hyperplasia after femoral artery balloon injury was evident at 2 weeks, and was pronounced at 4 weeks (P <.0001). Infusion of rTM significantly inhibited intimal hyperplasia at both 2 and 4 weeks (P <.0001). In group A, rTM reduced the intima-media ratio by 27% and 39% at 2 and 4 weeks, respectively. Extended administration of rTM (group B) resulted in inhibition of hyperplasia by 57% and 30% at 2 and 4 weeks, respectively, but failed to reach significance compared with the shorter exposure. rTM infusion significantly inhibited thrombosis (8.1-fold) compared with the buffer control group (P =.012). rTM had no significant effect on lumen area or lumen-whole artery ratio, but treated arteries demonstrated significantly less compensatory dilatation (P =.045), as measured by whole artery area in response to less intimal hyperplasia. rTM administration inhibited platelet adhesion and inhibition of neutrophil infiltration to a degree that approached statistical significance (P =.0675). CONCLUSIONS: Systemic intravenous administration of rTM significantly decreases neointimal hyperplasia and improves patency in the rabbit femoral artery after balloon injury. In addition to exhibiting antithrombotic and antiproliferative effects, rTM may also invoke an anti-inflammatory mechanism, and may alter vascular remodeling in a multidimensional role to inhibit recurrent stenosis after arterial injury.

Angioplasty, Balloon↗
PubMed2004

Ischemic complications after endovascular abdominal aortic aneurysm repair.

OBJECTIVES: Limb and pelvic ischemia are known complications after endovascular abdominal aortic aneurysm repair (EVAR). The objective of this paper is to present our experience with the incidence, presentation, and management of such complications. METHODS: Over 9 years 311 patients with aortic aneurysms underwent EVAR. A retrospective review identified 28 patients (9.0%) with ischemic complications. RESULTS: Among 28 patients with ischemic complications, 21 had lower extremity ischemia and 7 had pelvic ischemia: colon (n = 4), buttock (n = 2), and spinal cord (n = 2). Of the 21 patients with lower extremity ischemia, 15 had limb occlusions (71.4%), 3 due to embolization (14.7%) and 3 the result of common femoral artery thromboses (14.7%). Limb occlusions were manifested as severe acute arterial ischemia (n = 6), rest pain (n = 3), intermittent claudication (n = 5), and decreased femoral pulse (n = 1). Limb occlusions were managed with thrombectomy and stent placement (n = 4), femorofemoral bypass (n = 7), eventual explantation because of persistent endoleak (n = 1), and expectant management (n = 3). The 3 patients with occlusions managed expectantly all had intermittent claudication, which has subsequently improved. In the 6 patients with lower extremity ischemia due to embolization or common femoral artery injury presentation was acute, and embolectomy was performed, followed by femoral artery endarterectomy and patch angioplasty or placement of an interposition graft. One patient who had a prolonged postoperative course including cardiac arrest subsequently required distal bypass and ultimately above- knee amputation. Among the 7 patients with pelvic ischemia, 2 patients had unilateral hypogastric artery embolization before the original surgery. Among the patients with colonic ischemia, 3 were seen immediately postoperatively, and required colectomy and colostomy. Two patients who required urgent colectomy subsequently had multiple organ failure, and died in the perioperative period. One patient had abdominal pain 1 week after surgery, which was managed with bowel rest, with subsequent improvement. In 2 patients spinal cord ischemia developed immediately after surgery, which resulted in persistent paraplegia. Buttock ischemia developed in 2 patients, 1 of whom required fasciotomy because of gluteal compartment syndrome, and had transient renal failure. CONCLUSIONS: Ischemic complications are not uncommon after EVAR, and may exceed the incidence with open surgical repair. Limb ischemia is most often a result of limb occlusion, and can be successfully managed with standard interventions. Pelvic ischemia often results from atheroembolization despite preservation of hypogastric arterial circulation. Colonic and spinal ischemia are associated with the highest morbidity and mortality.

Aged↗
PubMed2005

Surgical management of acute carotid thrombosis after carotid stenting: a report of three cases.

We report three cases of symptomatic acute carotid thrombosis occurring after carotid artery stenting (CAS). CASE 1: A patient presented with crescendo transient ischemic attacks on the second day after CAS. Ultrasound images demonstrated incomplete in-stent thrombosis due to plaque protrusion. The urgent surgical procedure consisted of stent removal and carotid thromboendarterectomy. CASE 2: A case of complete thrombosis of a carotid stent occurred 4 days after implantation in a patient with essential thrombocythemia diagnosed by chance. The surgical strategy included stent removal and carotid thromboendarterectomy. CASE 3: Cardiac multiple embolisms in a patient with chronic atrial fibrillation caused concomitant leg ischemia and acute carotid stent occlusion 2 hours after CAS. Cerebral reperfusion was established by embolectomy, without removing the stent. At the same time, the right leg ischemia was resolved by a thromboembolectomy with a Fogarty catheter. These three cases demonstrate that acute thrombosis after carotid stenting can be managed successfully with emergent surgical intervention. Thromboendarterectomy with stent removal or in selected cases, simple thromboembolectomy, can minimize neurologic sequelae in patients suffering from acute post-stenting carotid thrombosis.

Acute Disease↗
PubMed2005

A persistently recurring peri-urethral soft tissue lesion of the vulva.

Various mesenchymal lesions, some of which have only recently been characterized, may affect the vulva. Because of their apparently shared origin from vulvovaginal mesenchyme, these lesions can resemble one another superficially and can be challenging diagnostically. Clinically, benign lesions and tumor-like conditions may mimic a malignant process because of hypercellularity, mitotic activity, and rapid growth. We report on a 84-year-old diabetic and hypertensive woman who had previously undergone skinning vulvectomy for lichen planus and an embolectomy of the left femoral artery. The patient presented with a rapidly growing vulvar mass. The biopsy showed spindle cell proliferation in a loose myxoid stroma with granulation tissue and a mixed inflammatory infiltrate. Based on histology and immunohistochemistry, the initial diagnosis was that of a benign lesion. In view of the persistent recurrence of the lesion and the absence of metastatic spread, we conclude that the lesion has a low-grade malignant potential and suggest the diagnosis of florid cellular reactive pseudosarcomatous myofibroblastic proliferation.

Aged↗
PubMed2006

Liver transplantation in children weighing less than 10 kilograms.

Orthotopic liver transplantation (OLT) remains a major medical and surgical challenge in small pediatric patients. From April 2003 through October 2005, 17 infants (each of whom weighed less than 10 kg) underwent the procedure. Four were girls and 13 were boys (mean age, 15.7 +/- 9.3 months [range, 2-36 months]; mean weight at the time of transplantation, 7.4 +/- 2.6 kg [range, 6-10 kg]). All transplants were obtained from living-related donors. Sixteen left lateral segments and 1 left lobe were transplanted. The median graft-to-recipient weight ratio was 3.5% +/- 1.2% (range, 1.5%-6.1%). During the early postoperative period, hepatic arterial thrombosis was identified in 2 infants, and a biliary leak in 1. Hepatic arterial thrombosis was treated by reanastomosis with polytetrafluoroethylene grafting in the first patient and by surgical embolectomy in the second. The biliary leak was treated with percutaneous drainage. In 1 infant, portal vein stenosis, which was identified during the late postoperative period, was treated by percutaneous balloon dilatation. At this time, 14 (82.3%) infants were alive, exhibiting good graft function at a median follow-up of 11 months (range, 2-36 months). Three infants died: 1 on postoperative day 47 from adult respiratory distress syndrome, 1 on postoperative day 12 from sepsis, and 1 on postoperative day 65 from sepsis associated with EBV infection. Episodes of acute rejection, which occurred in 5 patients, were treated with pulse steroid therapy. On follow-up, histologic examination revealed hepatocellular carcinoma in 2 infants and Burkitt's lymphoma in 1 infant. Our data confirm that extensive use of living-related donors in liver transplantation can result in an excellent outcome for small pediatric patients.

Anastomosis, Surgical↗
PubMed1990

Echocardiography in diagnostic assessment of peripheral arterial embolization.

In an attempt to identify a cardiac source of emboli, two-dimensional echocardiography was performed postoperatively in 42 consecutive patients with acute peripheral arterial embolism requiring urgent embolectomy. The patients were divided into four groups. Group 1 included 14 patients with chronic atrial fibrillation, among whom four cases of intracavitary thrombi were detected. Group 2 included 13 patients with acute or previous myocardial infarction, and left ventricular thrombi were detected in three. Group 3 included one patient with a prosthetic mechanical aortic valve and one with mitral valve prolapse; thrombi were not detected in either. Group 4 comprised 13 patients with no clinical evidence of a cardiac source of embolism; in one of them a large left ventricular thrombus was detected. Altogether eight intracavitary thrombi were detected (19%), and only in three (7.1%) were the results of echocardiographic examinations defined as entirely normal. A number of clinically undetected cardiac lesions, such as mitral annular calcification and aortic valve calcification, possibly associated with peripheral arterial embolism, were also detected by postoperative echocardiography. Because of the high percentage of intracavitary thrombi detected and the therapeutic implications thereof, especially if embolism recurred, it is concluded that two-dimensional echocardiographic examination should be recommended for patients with acute peripheral embolism.

Aged↗
PubMed1998

Outcome of cardiovascular surgery and pregnancy: a systematic review of the period 1984-1996.

The outcomes of cardiovascular operations during pregnancy, at delivery, and post partum were reviewed from published material in the period 1984-1996. Surgery during pregnancy resulted in fetal-neonatal morbidity and mortality of 9% and 30%, respectively, and in maternal morbidity and mortality of 24% and 6%, respectively. Duration of pregnancy at surgery and duration and temperature of cardiopulmonary bypass did not influence fetal-neonatal outcome. Maternal complications and mortality of surgery immediately after delivery were 29% and 12%, respectively, and for surgery performed with a postpartum interval the respective rates were 38% and 14%. Hospitalization after week 27 of gestation and extreme emergency contributed significantly to poor maternal outcome. Maternal deaths were reported in 9% of valvular procedures and in 22% of aortic or arterial dissection repairs and pulmonary embolectomies. Fetal-neonatal risks of maternal surgery during pregnancy are high and unpredictable. Maternal risks of cardiovascular procedures during pregnancy are moderate, significantly increase if an operation is performed at or after delivery, and, overall, should be considered as higher than those in nonpregnant cardiovascular surgical patients.

Cardiopulmonary Bypass↗
PubMed1996

The role of paradoxical arterial emboli of the extremities.

BACKGROUND: The heart is the main source of arterial emboli (> 80%). The majority of remaining sources are arterioarterial or of unknown origin, with each accounting for 5% to 10% of cases. This study covers an 8-year period and analyzes the etiology of arterial emboli of the extremities, with emphasis on patients with paradoxical emboli. METHODS: The hospital records of all patients were reviewed, with emphasis on patients with paradoxical emboli. The sources of emboli were classified as cardiac, arterioarterial, paradoxical emboli (fulfilled Johnson's criteria triad with cardiac defect and right-to-left shunting), possible paradoxical emboli (met two of Johnson's criteria), or unknown. RESULTS: This series included a total of 406 cases, and the sources of emboli were as follows: 248 (61%) cardiac, 62 (15%) arterioarterial, 6 (2%) paradoxical emboli, 8 (2%) possible paradoxical emboli, and 82 (20%) had an unknown source or incomplete work-up. The mean age of paradoxical emboli patients was 39 years, in contrast to a mean of 68 years for the entire series. All 6 paradoxical emboli patients presented with acute ischemia of an extremity, symptoms of deep vein thrombosis or pulmonary embolism or both, and a documented patent foramen ovale with right-to-left shunting. None of the patients had evidence of cardiac or peripheral atherosclerotic disease. Their treatment included one or more of the following: embolectomy, lytic therapy, anticoagulation, caval filters, or closure of a patent foramen ovale. CONCLUSIONS: Paradoxical emboli should be considered when the source of emboli is unknown, particularly in young patients. A complete work-up on these patients should include contrast saline or transesophageal echocardiography, lung scan, and peripheral venous imaging, particularly if conventional echocardiography and arteriography did not lead to a diagnosis.

Adult↗
PubMed2002

[Pierre Marion, 1914-2000. Past president of the National Academy of Surgery. An illustrious figure in the city of Lyons].

The surgical work of Pierre Marion extends over a period of 40 years. It takes part in the history of portal hypertension surgery. Pierre Marion has been in France one of the major craftsmen of heart surgery with Paul Santy. In 1952, he performed the first pulmonary-embolectomy with success and later devoted his time to the development of valves and of an artificial heart. The second part of his life was dedicated to the direction of the Bullukian Foundation, founded in 1983, with the goal of helping medical research, supporting the armenian community in our country and promoting literary, artistic and theatrical creation in Lyons and its surroundings. Pierre Marion has written two remarquable books "Afin que batte le coeur", a history of the cardiac surgery epic and "Le génial bonhomme Ampère", consecrated to the life of this great scholar.

Cardiovascular Surgical Procedures↗
PubMed2001

Metastatic cardiac myxoma.

A 22-year-old woman who had a history of three cardiac operations and a bilateral femoral embolectomy for recurrent cardiac myxoma and myxoma embolism, respectively, was accepted to our clinic with multiple immobile peripheral masses. One of them was compressing the left common femoral artery. This mass was extirpated. Pathology examination revealed myxoma. Chemotherapy was given to the patient and regression of the masses was observed.

Adult↗