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Biomedical subjects

A S Geha

Publications and source records attributed to A S Geha.

At least 91 records · Page 5Linked to original sources
PubMed1979

The importance of myocardial protection in combined aortic valve replacement and myocardial revascularization.

To determine the importance of different methods of myocardial protection for combined aortic valve replacement and coronary revascularization, we analyzed the records of 82 consecutive patients who underwent the combined procedure between 1973 and 1978. Sixty-three (77%) had angina and 63 (77%) were in New York Heart Association Functional Class III or IV. Moderate to severe left ventricular impairment was present in 59%, and the mean number of diseased vessels was 1.9 per patient. Group I consisted of 18 patients with intermittent ischemia, almost all of whom had operation between 1973 and 1976. Group IIa consisted of 24 patients operated on between 1973 and December, 1976, with coronary perfusion, and Group IIb had 18 patients in whom a similar technique was used in 1977 and 1978. Group III consisted of 22 patients operated on in 1977 and 1978 in whom cold chemical cardioplegia was used. The early mortality (less than 30 days) for Group I was 50% and for Group IIa 29%. There were no deaths in Group IIb and Group III. The incidence of perioperative myocardial infarction was 21% in Group I, 6% in Group IIa, 11% in Group IIb, and zero in Group III. The incidence of cardiogenic shock requiring prolonged inotropic support and intraaortic balloon counterpulsation was significantly less in Group III (9%) than in Group IIb (50%) (p less than 0.05). If other manifestations of myocardial injury, such as perioperative infarction and cardiogenic shock requiring intraaortic balloon counterpulsation or inotropic support, are taken into consideration, cold chemical cardioplegia appears to provide better myocardial protection than coronary perfusion of the fibrillating heart.

Adult↗
PubMed1979

Late failure of porcine valve heterografts in children.

Heterograft porcine valves have gained wide acceptance in replacement of diseased cardiac valves, and their clinical performance in adults has been very satisfactory over follow-up periods of up to 8 years. Valve replacement in children is relatively infrequent and experience with porcine xenografts is necessarily small. Our combined experience at three university hospitals has been with 25 children, 17 months to 16 years of age, who have been followed for 10 to 54 months (mean follow-up 33 months). Porcine valves were used to replace the aortic valve in nine, the mitral valve in seven, both valves in two, the tricuspid valve in two, and the pulmonary valve in five patients. Severe bioprosthetic valve dysfunction has occurred in five (20%) of these patients so far and necessitated replacement because of severe stenosis in mitral (two) or aortic (three) valve prostheses at 18 to 45 months after implantation; one postoperative death occurred among the five reoperations. Pathological examination showed extensive fragmentation of collagen with focal heavy calcification and degeneration. In addition we have encountered deterioration and calcification of two porcine valves in 23 valved conduits followed for 12 to 70 months (mean 43 months), requiring removal and replacement of the valves 65 and 67 months after implantation. This experience indicates a disquietingly high incidence of relatively early failure of porcine xenograft valves in children. This is significantly higher than the failure rate observed in adult patients. The failure rate is not consistently related to the small size of an implanted valve which becomes relatively narrow with the growth of the patient, leading to excessive turbulence and trauma to the prosthesis. Other factors, including increased turnover of calcium and accelerated rejection in growing children, may contribute to these failures and should be examined in order to improve long-term results. A satisfactory performance would make heterografts the ideal valvular prosthesis in children, since anticoagulation is avoided.

Adolescent↗
PubMed1978

Tracheoesophageal fistula caused by cuffed tracheal tube. Successful treatment by tracheal resection and primary repair with four-year follow-up.

A tracheoesophageal fistula secondard to prolonged nasogastric intubation and ventilatory assistance via a cuffed tracheostomy tube developed in a 27-year-old woman who had sustained a traumatic injury. The fistula grew progressively larger despite removal of the tubes, thus demonstrating the inherent poor prognosis associated with the untreated lesion. Since the cuff necessarily damages the trachea circumferentially at the same level, closure of the fistula and circumferential excision and reconstruction of the damaged tracheal wall were performed with an excellent result up to four years after the repair. This would be the preferred procedure when the patient can be weaned off the respirator and when the general condition and the size of the fistula allow such a definitive one-stage approach.

Abortion, Spontaneous↗
PubMed1978

Modification of intraaortic balloon catheter to permit introduction by cardiac catheterization techniques.

Intraaortic balloon counterpulsation has been widely applied for treatment of left ventricular pump failure and intractable angina. However, its use has been limited by the difficulty of balloon insertion in some patients and vascular complications in others. An AVCO intraaortic balloon was modified by the addition of a central lumen to allow pressure monitoring, injection of contrast medium and passage of a guide wire. The device was successfully used in 15 of 16 patients, including 4 of 5 in whom attempts to place a standard balloon catheter had failed. No significant vascular complications occurred in any patient. The modified balloon catheter appears to increase the efficacy and safety of insertion and allows immediate and continuous monitoring of arterial pressure.

Adult↗
PubMed1978

Effect of surgery on ventricular tachyarrhythmias associated with coronary arterial occlusive disease.

We studied 51 patients with coronary artery disease over a 32-month period to determine the effect of coronary revascularization or ventricular resection on ventricular tachyarrhythmias. In these patients, whose major indications for operation were tachyarrhythmias, operative mortality was 18% (9/51). Myocardial infarction could not be documented in 16 patients, including four resuscitated from an arrest; 15 underwent coronary grafting, and one had grafting and mitral valve replacement, with one hospital death. Premature ventricular contractions (PVCs) persist in four of the 15 survivors; all those who had an arrest are free of PVCs. The other 35 patients had documented infarction, associated with an arrest in 19. Grafting only was required in 18, with no hospital mortality and two late deaths (congestive failure and ventricular tachyarrhythmia at 7 months, ventricular tachyarrhythmia at 5 months); eight of 16 survivors have PVCs. Acute (< 3 weeks) infarct resection was performed in six patients with three hospital deaths, no late deaths; one survivor has PVCs. Chronic (> 3 weeks) aneurysm resection in four patients (with bypass grafting in three) had no operative mortality, one late death (5 months) from ventricular tachyarrhythmias, and one survivor continues with PVCs. The remaining seven patients, all in cardiogenic shock, required more than two procedures (bypass grafting, LV resection, VSD closure, mitral valve replacement), with five hospital deaths; the two survivors still have PVCs. Thus, ventricular tachyarrhythmia secondary to coronary artery disease is more likely to resolve postoperatively in patients without myocardial infarction, but its postoperative persistence remains substantial and may warrant special efforts to locate and ablate ectopic foci and/or re-entry pathways.

Adult↗
PubMed1977

Results and complications of intraaortic balloon counterpulsation.

During the forty-month period ending July, 1976, intraaortic balloon counterpulsation was used as an adjunct to medical or surgical therapy in 273 patients. Thirty-seven developed complications. Limb ischemia occurred in 16; it resolved in 12, resulted in gangrene of the toes in 1 and leg gangrene in 2, and was the casue of death in 1 patient. Aortic dissection was confirmed in 7 patients and strongly suspected in another 4. Eight of the 11 patients with dissection underwent cardiac procedures with heparinization at two days to three months after balloon insertion with no untoward effects. Septicemia developed in 2 patients, 1 of whom died of cardiogenic shock. Localized groin sepsis occurred in 8 patients, 2 of whom required removal of infected Dacron graft material. Awareness of the complications of balloon insertion, proper attention to details of balloon management at the time of insertion and removal, and continuous monitoring through a central-lumen balloon should decrease the incidence of complications.

Adolescent↗
PubMed1977

Cardiac function, coronary flow and MVO2 in hypertrophy induced by pressure and volume overloading.

Myocardial function, flow and O2 consumption were compared in cardiac hypertrophy induced by pressure-loading (P) and by volume overloading (V). Increases in LV-to-body weight ratios in P and V hypertrophied hearts were comparable. Indices of LV function such as cardiac output, stroke volume, stroke work, minute work, peak LV dP/dt, ratio of peak LV dP/dt-to-isovolumic pressure and -to-LVEDP, and Vmax were significantly reduced from normal only in hypertrophy induced by V. Left ventricular coronary flow was reduced from 167.1 +/- 27.2 in normal dogs to 146.2 +/- 17.1 cm3/min-100 g-1 in P hypertrophy, and was reduced further to 82.5 +/- 8.2 cm3/min-100 g-1 in V hypertrophy. Flows decreased similarly in epicardium and endocardium in both hypertrophied hearts. Cardiac O2 extraction in P and V hearts was greater than in control hearts. Myocardial O2 consumption was maintained at control values in P hypertrophy, and decreased by 54 +/- 3% in V hypertrophy. These findings indicate that LV function is impaired at rest in hypertrophy induced by V and is normal in hypertrophy induced by P.

Animals↗
PubMed1976

Crossed double internal mammary-to-coronary artery grafts.

Crossed double internal mammary (IMA)-coronary artery grafts (the left to the left anterior descending artery [LAD], the right to a diagonal or marginal coronary branch) were used without mortality and with excellent functional results in 36 patients requiring separate grafts to these vessels (22% of patients undergoing coronary revascularization). Flows were 70 +/- 9 ml/min in the left and 50 +/- 7 ml/min in the right IMA, respectively. All revisualized grafts remained patient. The location and direction of the LAD and of diagonal and marginal branches allow excellent alignment of these shorter and wider double IMA grafts. The left IMA is the graft of choice for the LAD, and the right IMA is the choice for a high diagonal or early arising marginal branch that requires an additional separate graft. The right IMA is not satisfactory for right coronary or LAD bypass.

Adult↗
PubMed1976

Severe coarctation of the aorta with pulmonary edema. An unusual presentation of a traumatic aortic aneurysm.

A patient with an unrecognized rupture of the ascending aorta developed severe pulmonary edema three weeks following the initial injury. This is a distinctly unusual manifestation of this injury. Emergency resection of the traumatic aneurysm was required to reverse the rapidly deteriorating clinical situation. The early recognition and surgical treatment of this lesion would have avoided this complication.

Adult↗