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Biomedical subjects

A Vaillant

Publications and source records attributed to A Vaillant.

At least 37 records · Page 2Linked to original sources
PubMed1987

[Disobstruction of the inferior vena cava under extracorporeal circulation].

An original technique used to remove obstructions of the inferior vena cava under cardiopulmonary bypass is described. This technique is indicated in pulmonary embolectomy or to dispose of a vena cava clot prolapsed into the right cardiac cavities. Through a rigid and blunt thoracic drain introduced via the right atrium, a Fogarthy venous catheter is pushed into the inferior vena cava, thus avoiding the risks of accidental passage into the supra-hepatic or renal veins and blockage in a thebesian valve. The catheter is inflated, then removed together with the drain, thereby freeing the caval lumen. The technique is reliable and reproducible, and it has proved very effective.

Catheterization↗
PubMed1987

[Detection by echocardiography of a thrombus of the right cavities in acute pulmonary embolism].

Echocardiography evaluates the severity of acute pulmonary embolism from its repercussions on haemodynamics. However, many authors have reported the discovery of thrombosis in the right heart cavities of patients with acute pulmonary embolism. In order to assess the frequency of intracavitary thrombosis and to evaluate the practical problems it raises, we have systematically examined by echocardiography 84 patients hospitalized for severe, acute pulmonary embolism (mean Miller's score: 21). In this series of 39 men and 45 women (mean age 62 years), 9 thrombi were detected, i.e. an incidence of 11%. Depending on the ultrasonographic images they presented, these patients were divided into two groups: 1. Six patients with low mobility thrombi attached to the cardiac wall. All benefited from a medical treatment consisting of heparin in 4 cases and a thrombolytic drug in 2 cases. There was no clinical evidence of recurrent embolism. Echocardiography showed complete disappearance of the thrombi in 5 of these 6 patients and partial regression under heparin therapy in one. 2. Three patients with a large and mobile thrombus threatening to prolapse through the tricuspid valve during atrial systole. It seemed rational to regard such thrombi as carrying a high risk of embolism with recurrences, especially since they had formed in patients already with severe pulmonary embolism. This view was confirmed by a search in the literature which yielded a 40% death rate figure when these thrombi were associated with pulmonary embolism. This high mortality, however, can be reduced by diagnostic and therapeutic measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1987

[Peculiar indications and results of the use of a blood cell saver apparatus in cardiac surgery].

Results are reported of the use of autotransfusion by means of the blood cell saver in a group of patients at high risk for hemorrhage in Heart Surgery Department. Methods employed are described, and results are discussed: these were encouraging both from the clinical and biological viewpoints. The cost benefits of this procedure are emphasized and technical perspectives outlined with respect to recovery of plasma and platelets.

Adult↗
PubMed1986

[Indications and results of surgery in native valve infectious endocarditis. Apropos of 104 surgically-treated cases].

From 1972 to 1984, 104 cases of aortic valve infectious endocarditis were treated surgically. The average age of the patients was 40 years and the majority were men (69/104). Forty patients had no previous cardiac disease; 44 patients had documented valvular heart disease, which was unlikely in the remaining 20 patients. There were 16 mitral valve, 55 aortic valve, 1 tricuspid, 30 mitro-aortic, 1 mitro-tricuspid and 1 mitro-aorto-tricuspid valve infections. Aerococcus viridans was isolated in only 4 out of 71 positive cultures: the prevalence of the infecting organisms was otherwise normal (30 staphylococcus, 30 streptococcus, 7 rare organisms). Forty one patients were operated because of haemodynamic deterioration, 13 for resistant infection and 13 for an association of both indications; 37 patients were operated for embolism or threatening vegetations. Eight patients were in functional Class I, 26 in Class II, 52 in Class III and 17 in Class IV. The patients were divided into 4 groups according to the degree of surgical emergency (26 extremely urgent, 26 semi urgent, 32 controlled endocarditis and 20 chronic endocarditis). The actuarial survival rate was 70% at 5 years. Poor prognostic factors were the presence of previous valve disease, the isolation of a staphylococcus and an aortic valve localisation. The degree of emergency and the precise surgical indication did not seem to be important. Most patients at long term were in functional Classes I or II. There was no preferential indication for bioprosthetic or mechanical valve replacement in endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Tricuspid endocarditis with right-left shunt in the atrium].

A case of tricuspid regurgitation due to endocarditis causing a right-to-left shunt through a patent foramen ovale is reported. Tricuspid valve endocarditis occurred after septic abortion and caused valvular regurgitation with dyspnea and cyanosis. The diagnosis was made by echocardiography and the finding of peripheral arterial desaturation, and it was confirmed at surgery. The physiopathology of these right-to-left shunts is the same as that already described during traumatic tricuspid regurgitation: reopening of the foramen ovale by the right atrial dilatation and ventricularisation of right atrial pressures. The presence of a shunt is an indication for surgery.

Abortion, Spontaneous↗
PubMed1986

[False subaortic aneurysm after surgery of calcified aortic stenosis. Apropos of a case treated successfully].

The authors report a case of false aneurysm of the posterior subaortic region of the left ventricle after a technically difficult surgical decalcification in a case of aortic stenosis. At reoperation, the surgeon used the femoral artery and both vena cavae for canulation. A direct approach of this "vascular" tumour, which was exterior to the great vessels, confirmed the diagnosis and enabled the localisation of the internal orifice inside the left ventricle. This was closed simply by suturing. No previous cases of this kind were found in the literature. This report underlines the necessity of taking the greatest care when decalcifying this region in order to avoid this type of serious complication.

Aorta, Thoracic↗
PubMed1985

[Changes in bone conduction in the surgery of chronic otitis and its sequelae (evaluation of 800 operations)].

The authors undertook a study of changes in bone conduction (BC) during 800 operations carried out over a 5 years period (1979-1984) for chronic otitis or sequelae of chronic otitis. After elimination of ears with deafness (47) and cases unsuitable for evaluation (39), they finally included 714 records in the study. Only comparison of free and post-operative BC was made and using 4 conversational frequencies, not taking into account a deviation of 5 DB for each of these 4 frequencies. The study involved 317 myringoplasties: In 271 (i.e. 85,5%) there was no change in BC. Amongst them, 37 patients nevertheless showed a transient fall in BC. Of particular importance is the fact that almost 1/3 (11 to be exact) recovered only during the 2nd semester following surgery, a period which was even exceeded in the other 5 cases. 46 (i.e. 14.5%) were classified as "permanent" falls in BC. Amongst these in only 17 (i.e. 5%) were there "only" the three standard aggression factors for the I.O.: aspiration--scraping--manipulation of the tympano-ossicular system, without it being possible to attribute a predominant role to one more than the other. With regard to reaming of the E.A.M., those cases in which this could be considered responsible appeared to be infinitesimal. Furthermore, there was no statistically significant difference (reduced deviation test--"chi"2 test) between the number of falls in BC seen following myringoplasty with or without reaming. 83 tympanoplasties by Piston-Malleus, study of which led to the same conclusions as for myringoplasties. 118 masto-atticotomies, including 23 with posterior tympanotomy. Despite peri-labyrinthine and peri-ossicular scraping, results were essentially identical. 196 evacuation cavities (227-31 deafness) of which somewhat less than half only (46%) were ears undergoing surgery for the first time. Percentage of unchanged BC was here much more unfavourable, with 49 "permanent" falls in BC, i.e. 25%, of which, it must be said, 5 were minimal falls, and with, in 25 cases, a follow-up of less than 3 months.

Bone Conduction↗
PubMed1981

[Decompensated cardiac valve disease associated with tight aortic stenosis. Surgical cure in one stage (author's transl)].

The authors report on 2 cases of severe cardiac valve disease associated with tight stenosis of the aortic isthmus for which the standard techniques could not be safely applied owing to patients' poor condition. Inserting by the median route a dacron tube between the ascending aorta and the subdiaphragmatic descending aorta immediately after heart valve replacement under extracorporeal circulation in our experience proved a simple and safe technique.

Angiocardiography↗
PubMed1981

[Decompensated valvular disease and coarctation. One-stage repair using a median approach with an ascending aorta-abdominal aorta shunt].

The tactical decision in patients with decompensated valvular disease associated with a severe stenosis of the aortic isthmus is always difficult. One stage surgical repair using two separate approaches is a long and high risk procedure. It would seem more logical and safer to treat the lesions in two stages a few weeks apart, the severest lesion being managed first. In the two cases reported. The isthmic stenoses and valvular lesions were of the same severity and made both classical techniques impracticable. Therefore the patients underwent a single stage procedure by a median approach associating valve replacement under cardiopulmonary bypass (mitral and tricuspid in one and aortic in the other case) and an ascending aorta-abdominal aorta dacron conduit. The present postoperative survival periods are 30 and 9 months. The functional result was good (Class 1 and 0) and postoperative angiography has shown the montage to be working satisfactorily. This technique is exceptional but may be useful in borderline cases with decompensated valvular disease and severe isthmic stenosis.

Aorta↗
PubMed1979

[Anesthesia-recovery from aorto-coronary bypass surgery (100 recent cases)].

The authors report their experience of anaesthesia and postoperative recovery in cases of myocardial revascularisation surgery. On the basis of their last 100 bypass operations, they define the problems encountered according to the operative indications, previous treatment and the surgical technique, and attempt to provide answers to these problems. The difficulties (arrhythmias, myocardial ischaemia, hypertensive crises) occurred during the first 48 hours. They then consider the most current problem, that of the preoperative treatment of these patients (nitroglycerine, beta-blockers, amiodarone). They conclude that, paradoxically, in this type of surgery the operative risk is low as long as the indication for surgery is valid and myocardial protection effective.

Adult↗