Biomedical subjects

A C Ralph-Edwards

Publications and source records attributed to A C Ralph-Edwards.

5 recordsLinked to original sources

PubMed1999

Valve surgery in octogenarians.

OBJECTIVE: To review the outcomes of octogenarians undergoing valve operations. PATIENTS AND METHODS: One hundred and twenty-five consecutive patients aged 80 years and over received valve operations between 1990 and 1996 at the Toronto General Hospital, Toronto, Ontario. All hospital survivors were prospectively followed for a mean of 36.6 months (range 0.1 to 89.9). RESULTS: One hundred and two patients received aortic valve operations, 18 patients received mitral procedures and five patients underwent double valve operations. Significant aortic stenosis was present in 95 of 102 patients (93%) receiving isolated aortic valve surgery, and mitral regurgitation was present in 16 of 18 patients (89%) undergoing mitral valve operations. Overall in-hospital mortality was 6.4% (n=8) and the perioperative infarction rate was 1.6% (n=2). In-hospital mortality was higher for mitral valve patients at 17% (n=3) than for aortic valve patients at 4% (n=4) (P=0.06). For the group overall, the six-year actuarial survival rate was 71.6+/-6%. The actuarial freedom from valve-related death was 97.1+/-2% at three years. Concomitant coronary artery disease was not significantly associated with perioperative mortality. Survivors had significantly improved New York Heart Association functional class status. CONCLUSION: In carefully selected patients aged 80 years and over, aortic valve surgery carries a low perioperative mortality with good intermediate term survival and benefits. Octogenarians undergoing mitral valve procedures experience higher perioperative mortality. Although the number of participants was small for this study, it does appear that coexistent coronary artery disease should not be the sole reason for denial of surgery because it has less of an impact on short and intermediate term survival than other factors.

Age Factors↗

PubMed1995

Reoperation for recurrent aortic coarctation.

BACKGROUND: Recurrence of stenosis is a complication of coarctation repair associated with major long-term morbidity. Persistent or exercise-provoked hypertension may indicate recurrent coarctation. Patients failing or not amenable to balloon dilation should be managed surgically. METHODS: A retrospective chart review was performed. RESULTS: Forty-three patients were identified as having undergone repeat surgical intervention for recurrent aortic coarctation between the years 1976 and 1993 at The Hospital for Sick Children in Toronto. Seventy percent of the children had other congenital cardiac anomalies. Eighty-six percent of patients initially treated by subclavian flap aortoplasty or end-to-end anastomosis were managed at reoperation by patch aortoplasty, and 26% of patients also required augmentation of the transverse arch (under hypothermic circulatory arrest) for accompanying hypoplasia. Three patients underwent a second reoperation; all were treated at this reoperation with tube graft interposition. CONCLUSIONS: No ischemic spinal injury occurred in patients managed with either simple proximal aortic cross-clamping or cardiopulmonary bypass. No patient treated with transverse arch augmentation required further surgical intervention. Mortality at reoperation was 7% (3 patients), similar to that of first-time coarctation repair. At follow-up (mean duration, 4.5 years), 57% of patients are normotensive, with no measurable arm-leg gradient.

Adolescent↗

PubMed1994

Successful treatment of massive pulmonary embolism after coronary artery bypass grafting due to heparin-induced thrombocytopenia.

Massive pulmonary embolism is a rare complication in patients undergoing coronary artery bypass grafting. Frequently patients have had exposure to heparin before the operation. In this article we report a patient who 6 days after a cardiac operation suffered a massive pulmonary embolism. The patient was later discovered to have heparin-associated thrombocytopenia with serum heparin antibody. We recommend patients receiving heparin have frequent platelet counts and those with induced thrombocytopenia undergo sensitivity testing.

Adult↗

PubMed1994

Atypical presentation of spontaneous pneumomediastinum.

Spontaneous pneumomediastinum is a rare clinical entity; when diagnosis is certain, no treatment is required and symptoms rarely recur. The clinical presentation is usually diagnostic; however, atypical symptoms may mandate further investigation before diagnosis can be established. We describe 2 patients with spontaneous pneumomediastinum who presented with dominant esophageal symptoms (odynophagia and dysphagia) suggestive of esophageal perforation. Investigation and management are discussed.

Adolescent↗

PubMed1994

Preoperative cardiac evaluation of the patient with vascular disease.

OBJECTIVE: To review the literature and evaluate the investigation of cardiac risk factors, by tests and intraoperative predictors, that will identify patients at high risk for vascular surgery. DATA SOURCES: An English-language literature review of Index Medicus articles from 1961 to 1992. STUDY SELECTION: Published articles that addressed preoperative risk factors, diagnostic tests and intraoperative predictors were selected by multiauthor consensus. DATA EXTRACTION: Independent extraction by multiple authors was utilized to abstract and assess the quality of data from selected references, with consensus determining inclusion or exclusion. DATA SYNTHESIS: From evaluation of published data, a number of factors were considered to put a patient scheduled to undergo vascular surgery at higher risk: symptomatic coronary artery disease; clinical evidence of coronary artery disease, congestive heart failure, aortic stenosis and recent myocardial infarction; laboratory findings of significant disease with cardiomegaly or significant dysrhythmias; and no symptoms but two or more risk factors. CONCLUSIONS: The authors propose an algorithm for the investigation of patients and stratification of risk to be considered in weighing the dangers versus the benefits of vascular surgery.

Age Factors↗