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Biomedical subjects

A Piekarski

Publications and source records attributed to A Piekarski.

9 recordsLinked to original sources
PubMed1979

[Triple-valve replacements].

34 patients aged between 17 and 62 years underwent triple valve replacement, 14 of whom exclusively with Starr-Edwards prosthesis; 25 patients were operated at Stage III and 4 at Stage IV of the NYHA classification; the operative mortality was 14%, the late mortality 21%. The actuarial survival curve shows 66% survival at 5 years; in all, 21 good results were obtained with a follow-up ranging from 3 months to 11 years (average 41 months). A notable late complication specific to these patients was dysfunction of the tricuspid prosthesis; a gradient across the tricuspid prosthesis was observed in 14 postoperative catheter studies; one of these patients had to be reoperated for thrombosis of a Starr-Edwards tricuspid prosthesis. Analysis of the results of this series suggests that surgery is beneficial, especially when the very precarious preoperative state of these patients is taken into consideration.

Adolescent↗
PubMed1979

[Operated aortic stenosis. Evaluation of the long-term prognosis using clinical and hemodynamic parameters in a series of 249 cases].

The long-term results and the prognostic factors in aortic valve replacement for aortic stenosis were assessed from a series of 249 operated cases (comprising 199 pure or dominant stenosis and 50 mixed aortic lesions) followed up for a maximal period of 9 years. The postoperative survival rate, 71% at 5 years, 62,6% at 8 years, including the operative mortality, is better than in a comparable series of pure chronic aortic incompetence (58% at 5 years) despite a higher average age. In the same age group the difference is significant at the 6th year. However, no difference was observed between mixed aortic disease and aortic stenosis. Irreversible myocardial dysfunction is relatively rare (6,6% of survivors at 1 month, 24% of poor results or late deaths) and much less common than in aortic incompetence of which it represents the main cause of failure. Even in these cases, prolonged symptomatic improvement may be observed. 3 prognostic factors affect the operative and late mortality. They act to variable degrees and independantly of each other. They are : age, cardiomegaly and heart failure. The actuarial 5 year survival is: 81,77% and 53% for under 50, 50 to 65 and over 65 years age group respectively; 88%, 78% and 48% for cardiothoracic ratios of less than 0,50, between 0,50 and 0,58 and greater than 0,58 respectively; 83%, 65% and 47% for patients without signs of heart failure, with a history of pulmonary oedema, and with a history of congestive cardiac failure respectively. These results encourage a liberal attitude towards surgery, even in old patients with severe valvular lesions.

Adult↗
PubMed1978

[Surgically treated chronic aortic valve insufficiency. Long term results. Surgical indications].

The timing of surgery in chronic aortic regurgitation depends to a large extent on the operative results that may be expected in this type of valve disease. In 88 cases of chronic aortic regurgitation submitted to surgery there were 6 operative deaths (6.8%). Five years after operation the actuarial survival was 58% for the whole of the group and 68% for cases of rheumatic aortic regurgitation. Analysis of the causes of failures, late deaths, persistence or recurrence of severe impairment of activity, and of serious disturbances of ventricular rhythm, showed that the most important cause was myocardial dysfunction, which was responsible for two thirds of the bad results. Analysis of the late prognosis as a function of the various pre-operative parameters revealed the bad influence of cardiomegaly as measured by radiological examination (cardio-thoracic ratio and cineangiography) and of disturbances in left ventricular function. The actuarial survival curves showed very significant differences according to whether the cardiothoracic ratio was greater or smaller than 58%, and according to the amount of heart failure pre-operatively. Similarly, an end-diastolic volume index of 240 ml/m2 and an ejection fraction less than. 40 seemed to be serious findings. These facts, taken in conjunction with the natural history of this valve lesion, suggest that the indications for surgery should not only be symptomatic aortic regurgitation but also well tolerated regurgitation in which cardiomegaly, end-diastolic volume and/or the ejection fraction have reached a certain level.

Aortic Valve Insufficiency↗
PubMed1978

[An unusual type of mid-ventricular obstruction. A discussion of the findings].

The authors report a case of left-sided mid-ventricular obstruction which was completely different from the usual type of obstructive cardiomyopathy, and had asymetrical hypertrophy of the septum demonstrable both by angiocardiography and macroscopically. Complete clinical and haemodynamic recovery followed left ventricular myectomy with replacement of the mitral valve (one year's follow-up).

Angiocardiography↗
PubMed1977

[Myxoma of the left atrium diagnosed by pathological examination of an embolism of the aortic bifurcation (author's transl)].

The case reported was a 69-year-old patient with a myxoma of the left atrium presenting as multiple emboli: acute ischaemia of the lower limbs preceded, three months before, by a spontaneously regressive right hemiplegia which, in view of the patient's age, was considered to be a simple manifestation of atherosclerosis. The diagnostic value of the echocardiogram in cases of systemic emboli of undetermined origin is stressed.

Aged↗
PubMed1976

[Diagnostic value of closed thorax pericardial biopsy. 20 cases].

Twenty patients with sub-acute and chronic pericarditis under went closed thorax pericardial biopsy. In three cases the examination brought to light a diagnosis of tuberculosis and in one of a tumoural origin. In 16 cases in which the aetiology was that of a non-specific pericarditis, the value of this examination, integrated into the context, is discussed.

Adult↗