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Biomedical subjects

A Krian

Publications and source records attributed to A Krian.

At least 37 records · Page 2Linked to original sources
PubMed1991

Grafting with the internal mammary artery: correlation between preoperative angiography and intraoperative findings.

No data exist on the relation between angiography of the internal mammary artery and intraoperative findings during bypass surgery. We studied 47 consecutive patients and found no atherosclerotic changes. Intraoperatively, however, 4 left internal mammary arteries were judged unsuitable for grafting. No relation could be found to the diameter of the vessel as judged angiographically. Possible causes of unsuitability are discussed.

Adult↗
PubMed1991

The arterial switch-operation: early and midterm (6 years) results with particular reference to technical problems.

Since February 1985 the arterial switch operation (ASO) has become the surgical treatment of choice for newborns with simple TGA, appropriate forms of complex TGA and double outlet right ventricle (DORV) as well at our institution. Between 1985 and 1990 a total of 87 patients underwent surgery. In 60 patients with simple TGA and 8 patients with complex TGA or DORV, respectively, an arterial switch-operation was performed. Because of coronary artery anomalies (n = 13), dysplastic pulmonary valves (n = 3) or pressure drop in the left ventricle (n = 1), the initially planned arterial switch operation was discarded and a Mustard type procedure was in 17 patient. Finally there were two primarily performed Mustard operations. The hospital mortality after arterial switch for simple TGA was 15% (9/60), 0/8 in patients with complex TGA. Late mortality was calculated to be 12% (1/8) in patients with complex TGA and 3/60 in patients with simple TGA. Within the Mustard group there were 2/19 hospital deaths and one late death. Causes of early death after arterial switch were: intraoperative myocardial infarct (n = 3) low cardiac output syndrome (n = 2), intractable bleeding (n = 2), metabolic acidosis (n = 1), and septicemia (n = 1). Late after surgery there was one death due to chylothorax after thrombotic obstruction of the SVC, and 3 more deaths secondary to intraoperative infarct, progressive LV dysfunction and meningitis, respectively. Among the long-term survivors 2 patients developed a severe supravalvulary pulmonary stenosis. There were no significant arrhythmias, supravalvulary pulmonary aortic stenoses, aortic insufficiency or myocardial perfusion disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1990

[Extracardiac risk factors in heart surgery--the kidney].

There have been only a few investigations that have considered renal disease or any disturbance of renal function in the calculation of risk in cardiac surgery. Risks of cardiac surgery have to be considered for renal disease without direct connection to heart disease (e.g., infections of the kidney and of the urinary tract, primary and secondary glomerulonephritis, parenchymal renal disease, and impaired renal function of unknown origin), as well as in renal disease with concomitant influence on heart and kidney (e.g., infective endocarditis, arterial hypertension, systemic disease of heart and kidney such as with diabetes mellitus, disturbance of kidney function or electrolyte balance due to heart failure). In most cases, the problem is solved by therapeutic intervention and postponement of cardiac surgery. A limited or negative operative indication is found with untreatable infection of the kidney or urinary tract, with untreatable nephrotic syndrome, in advanced renal disease with heart transplantation, as well as in case of severe arterial hypertension with possible organ complications, and in advanced diabetes mellitus with ESRD and multiorgan involvement. After cardiac surgery, acute renal failure represents a critically important complication. Primary therapeutic procedures must include prophylaxis of hemodynamic unstable situations, as well as prophylaxis of infectious complications. Cardiac surgery in dialysis patients and post-transplant patients is basically possible and only has a slightly increased risk compared to patients with normal renal function. Seventy-seven dialysis patients were operated (49 aorto-coronary bypass operations, 19 single-valve and multiple-valve replacements, five patients with valve replacement and aorto-coronary bypass, and four other cardiac surgical operations). Only in valve replacement, was mortality significantly higher than in renal healthy persons, the main causes of death being cerebrovascular complications and septicemia.

Contraindications↗
PubMed1987

[Complications following heart valve replacement by mechanical and biologic prostheses].

From 1973 to 1985 2394 mechanical valve prostheses (MVP) (follow-up time 110,653 months) and 186 biological valve prostheses (BVP) (follow-up time 5887 months) were implanted. There were only small differences according to the cumulative incidence of prosthetic malfunctions, for reoperations after 10 years: MVP 5.4 +/- 0.4%; BVP 7.7 +/- 0.9%. The total reoperation incidence/100 patient-years was for MVP 1.14, for BVP 2.65. Further complications resulted from anticoagulation therapy (thrombemboli, bleeding), and prosthetic valve endocarditis. The cumulative freedom of any complications after 10 years was 73.1% for Björk-Shiley-AVR, 54.2% for BS-MVR, and only 31.2% for BS AVR + MVR. These results indicate regular controls for all patients postoperatively.

Bioprosthesis↗
PubMed1987

Coronary and valvular surgery in elderly patients (greater than 70 years).

During 1949-1964 only 22% of our patients (n = 6807) undergoing cardiac surgery were older than 40 years. Up to 1970 no patients older than 60 years underwent open-heart surgery in our institution. Between 1970 and 1978 an open-heart procedure was performed in 174 patients older than 60 years (4.5%). The hospital mortality was 18.3%. During the following years the operative indication for aged patients became more liberal, and the operative risk decreased distinctly. Already in 1983 the percentage of aged people rose to 24.1% of our extracorporeal circulation group (n = 1111). In a retrospective study (1979 to 1985) a total of 6855 heart procedures using ECC were evaluated. In total 196 patients (2.9%) were 70 years and older. Valvular replacement was performed in 95 cases. (AVR n = 67, MVR n = 13, DVR n = 15) resulting in a hospital mortality of 10.9% (n = 10). Revascularisation for coronary heart disease including resection of ventricular aneurysms was necessary in 64 patients with an early mortality rate of 3.1% (n = 2). The highest risk group consisted of combined coronary and valvular procedures (n = 33) with a mortality rate of 12.1% (n = 4). There was one case each of ASD II, HOCM, left atrial myxoma, and massive pulmonary embolism with cardiogenic shock: only the latter patient died, from cerebral hypoxia postoperatively. Thus the hospital mortality in this age group (n = 196) was 9.1% (n = 17).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1986

[Results of coronary revascularization in occluded coronary arteries].

In a total of 82 patients (age 37-71 years) with an occluded left anterior descending artery (LAD) the results of coronary revascularization were evaluated 7 months postoperatively on average. In all patients the indications for revascularization was given by clinical symptoms (angina pectoris) or by prognostic reasons. In patients with multivessel disease. In patients with anterior wall infarction viable myocardium was proven by thallium-scintigram at rest and during exercise. 29 patients were evaluated by coronary angiography postoperatively, in 19 patients the angiograms of the left ventricle could be assessed quantitatively. Total patency rate was 76%, for the LAD 69%, for the circumflex artery 73% and for the right coronary artery 83%. The relatively low patency rate for the LAD was caused by an increased collateral flow to the occluded LAD and therefore by a significantly lower bypass flowrate measured during surgery. Angina pectoris improved markedly, 55% of patients had angina pectoris class III or IV versus 10% postoperatively. These changes were observed in all patients irrespectively of patency rate or occluded grafts to the LAD. Left ventricular volumes and ejection fraction did not change on average after revascularization. Only end-diastolic volume increased significantly in patients with an occluded graft to the LAD. There was a tendency of the end-systolic volume to decrease postoperatively in patients with complete revascularization or at least an open graft to the LAD. The results show a similar clinical improvement in these patients with occluded LAD as shown after "usual" revascularization in other patients. Preoperative coronary angiograms are helpful in judging the postoperative outcome of grafts to the occluded LAD.

Adult↗
PubMed1983

Results of surgical therapy in patients with left ventricular aneurysm.

The clinical, angiographic and haemodynamic findings in 87 patients with left ventricular aneurysm were investigated before and after different surgical interventions. Thirty-four patients underwent aneurysmectomy alone (group I), 35 patients had additional coronary revascularization (group II), and 18 patients had revascularization alone because of the findings during operation (group III). The size of aneurysm was not significantly different in the three groups. Postoperatively, it decreased only in groups I and II. The majority of the patients in group I (predominantly one-vessel disease) had no angina pectoris, with no significant change early and late (more than 12 months) after operation. The patients in groups II and III (with more two- and three-vessel diseases) showed an improvement in angina pectoris. Preoperatively, most patients had experienced exertional dyspnoea. Overall, there was no significant change after operation, but most patients showed an improvement in angina and dyspnoea when these symptoms had been the major indication for surgical therapy. Heart rate, systolic and end-diastolic pressures in the three groups did not change significantly after surgery. End-diastolic and end-systolic volumes decreased and ejection fraction increased significantly in groups I and II. In group III these variables did not change. Circumferential fibre shortening velocity in the residual ventricle increased significantly only in group I. Haemodynamic studies during exercise were performed in a total of 32 patients. In group I the increase of mean pulmonary pressure was significantly lower postoperatively; there was no significant change in groups II and III.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Isolated atrioventricular discordance. Report of two surgical cases with isolated ventricular inversion.

Isolated ventricular inversion is a term used for a congenital heart malformation with the segmental arrangement atrioventricular (AV) discordance and ventriculoarterial concordance. It describes a condition which from a physiological point of view resembles complete transposition of the great arteries. We have recently seen two patients with this anomaly. Both underwent intracardiac repair by means of a Mustard operation at 10 years and 10 months of age, respectively. Associated lesions in the first patient were an AV septal defect with two AV orifices (partial AV canal, ostium primum defect), partial anomalous pulmonary venous return, and anomalies in the systemic venous drainage. A perimembranous ventricular septal defect complicated the condition in the second patient.

Aortography↗
PubMed1981

[Clinical and hemodynamic results in patients with left ventricular aneurysm after surgical therapy (author's transl)].

The clinical and hemodynamic results of 87 patients (average age 49 years, range 22 to 65 years) with left ventricular aneurysm were retrospectively investigated before and after (1-87 months) surgical treatment. 34 patients underwent aneurysmectomy only (group 1), 35 patients additionally underwent coronary revascularisation (group II), and 18 patients underwent--because of findings during operation--coronary revascularisation only (group III). The size of aneurysm was not significantly different in the three groups. Postoperatively it decreased only in groups I and II. The majority of the patients in group I (with predomination of one-vessel disease) had no angina pectoris. There was no significant change early and late (more than 12 months) after the operation. The patients in groups II and III (the majority with multi-vessel disease) showed an improvement of angina pectoris. Preoperatively most of all the patients claimed to have exertional dyspnea. On the whole, there was no significant change after operation. The majority of the patients showed an improvement in their angina pectoris and dyspnea when those symptoms were the major indications for the operation. Heart rate, systolic and end-diastolic pressure in the three groups did not significantly change after the operation. End-diastolic and end-systolic volumes decreased significantly in groups I and II. The ejection fraction increased significantly. In group III these parameters did not change. Circumferential fiber shortening velocity in the residual ventricle significantly increased only in group I. Hemodynamic studies during exercise were performed in total on 32 patients. In group I, there was a significant smaller increase of the mean pulmonary artery pressure, no significant change in groups II and III. At rest, only the patients with aneurysmectomy showed an improvement of the global and residual left ventricular function. The patients with an angiographically presumed aneurysm and viable myocardium found intraoperatively showed no improvement in function at rest or during exercise even after coronary revascularisation. The hospital mortality was 6%. Three patients died during the follow-up period because of ascertained cardiac reasons. The high mortality of non-operated patients with similar clinical and hemodynamic findings as in operated patients warrants an indication for aneurysmectomy without even taking into account the symptomatic and functional improvements.

Adult↗
PubMed1980

[Post-transfusion hepatitis: can the problem be solved today? (author's transl)].

Among 333 patients followed-up after surgery involving a heart-lung machine between 1975 and 1976 seven (2.1%) fell ill with hepatitis. Only in two of them (0.6%) hepatitis B had occurred, caused by HBs-antigen positive blood which had had to be given for a vital indication without testing beforehand. This low rate of disease must now be considered preventable, as in 1975, the time of the transfusions, blood donor control had not reached present-day perfection due to the short period of use of radioimmuno-assay (RIA). In two patients (0.6%) non-B hepatitis following transfusion cannot be excluded although in one patient use of PPSB may be responsible for the disease. Among the 3 other hepatitis cases no aetiological connection between hepatitis and transfusion could be established on the grounds of the incubation period.

Extracorporeal Circulation↗
PubMed1980

[The effects of different anaesthetic technics on lactate under the course of aorto-femoral bypass operation (author's transl)].

46 measurements of lactate during aorto-femoral bypass-operation were performed under epidural analgesia, halothane- and neurolept anaesthesia. Independent of the metabolic parameters a significantly higher lactate rate was found under halothane anaesthesia than in the two other groups even though - at the same perfusion volume in all three groups - a significantly lower arterial mean pressure and peripheral resistance was measured under halothane- and epidural anaesthesia than under neurolept anaesthesia. The authors come to the conclusion that under aorto-femoral bypass operations a moderate hypotension can be carried out even in patients, showing arterio-sclerotic changes of the vessels, without a significant influence on metabolism.

Aged↗
PubMed1979

Frequency of hepatitis B after open heart surgery: a retrospective study over a three-year period (1974--1976).

In spite of intensive efforts to reduce the risk of hepatitis B after heart operations, this complication is observed in 40 % or more of the cases. Over a period of three years (1974--1976) we examined 588 patients who had undergone open heart surgery. The following results were found: In 1974 the hepatitis frequency was 2.0 %, while in 1975 and 1976 it was 0.6 % hepatitis B and 0.6 % non-B hepatitis. We believe the reason for this improvement is a more careful selection of blood donors and their continuous control according to the following parameters: regular clinical observation; regular chest x-ray; determination of BSR, hemoglobin and aminotransferase; TPHA test; and search for antibodies. In 1974 hepatitis-B-surface-antigen (HBsAg) was detected by means of reverse hemagglutination tests. Since 1975 a modified radioimmunoassay has been used for this purpose. No donor blood with abnormal results was transfused, except for a very small number of extreme emergencies. The good results demonstrated can only be obtained by following the described program and by strictly avoiding pool preparations.

Alanine Transaminase↗