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B Gometza

Publications and source records attributed to B Gometza.

26 records · Page 2Linked to original sources
PubMed1993

Vanishing De Vega annuloplasty for functional tricuspid regurgitation.

Annuloplasty is performed for significant functional tricuspid regurgitation even if it is presumed that in some cases the regurgitation will regress spontaneously after correction of the left-sided lesion. In an attempt to avoid the drawbacks of a permanent annuloplasty, we used a reabsorbable De Vega annuloplasty in a selected group of patients. Of 73 patients with functional tricuspid regurgitation operated on between May 1989 and May 1991, 25 with pulmonary arteriolar resistance below 400 dyne.sec.cm-5 underwent a De Vega annuloplasty with 2-0 polydioxanone suture. The diagnosis of significant functional tricuspid regurgitation (mean 2.74 +/- 1.05) was established by transthoracic color Doppler echocardiography in all patients. The degree of functional tricuspid regurgitation and pulmonary arteriolar resistance were measured with the patients anesthetized. In 16 patients the regurgitation remained severe (3+ to 4+) and in 9 it was moderate (2+). Twenty-three patients had mitral (12 repairs, 11 replacements) and 9 had aortic (4 repairs, 5 replacements) valve operations. The immediate postbypass residual functional tricuspid regurgitation was 0 to 1+ in 23 and 0 in 2. There was 1 (4%) operative death. The maximum follow-up period was 24 months (mean 13.9 months). There were 2 (8.3%) late deaths. Six patients underwent reoperation because of mitral dysfunction. Four of them who were reoperated on between 2 and 5 weeks after the initial procedure showed no recurrence of functional tricuspid regurgitation. The other 2, reoperated on at 5 and 10 months after the first operation, had recurrence of functional tricuspid regurgitation. Visual inspection of these two tricuspid valves showed a dilated anulus with otherwise normal valves. All surviving patients are in New York Heart Association functional class I or II without significant functional tricuspid regurgitation (mean 0.78 +/- 0.56). We concluded that functional tricuspid regurgitation in patients with low pulmonary arteriolar resistance can be adequately treated by a vanishing De Vega annuloplasty, which will stent the tricuspid anulus for about 4 months.

Adolescent↗
PubMed1991

Indications and limitations of aortic valve reconstruction.

To elucidate the value of conservative operation for aortic regurgitation, all consecutive patients operated on between July 1988 and July 1990 were reviewed. Of 251 patients with aortic regurgitation, 107 (42.6%) had nonprosthetic operation. The mean age was 23 years, and 90 patients (84.1%) were rheumatic. Two techniques were used: repair (annular and leaflet plasties, 69 cases) and cusp extension with glutaraldehyde-treated pericardium (25 bovine, 13 autologous). There were two hospital deaths (1.8%), both in the repair group, and no late deaths or embolic events. Only 5 patients (4.7%) were anticoagulated. In the repair group there were 12 reoperations, four (5.9%) due to aortic and eight to mitral dysfunction. In the cusp extension group there were two reoperations due to mitral dysfunction. Echocardiographic follow-up showed better results with cusp extension. In conclusion, conservative operation for aortic regurgitation is possible in a high percentage of young rheumatic patients and does not require anticoagulation. Cusp extension is more reliable than repair in terms of early results, although its long-term durability is not yet known.

Adolescent↗
PubMed1991

A feasibility study of valve repair in rheumatic mitral regurgitation.

Valve repair is an established form of treatment for mitral valve regurgitation. In order to elucidate the feasibility and results of aggressive repair in a young rheumatic population, all consecutive patients operated on between July 1988 and July 1990 for mitral regurgitation were reviewed. There were 203 patients with a mean age of 29 years; 91% were in functional classes III-IV. Pure regurgitation was present in 47.8%. Associated valvular surgery was performed in 56.2%. Forty-nine (24.1%) patients had a straight valve replacement (MVR), 18 (8.9%) had an unsuccessful attempt at repair and in 136 (67%) the repair was considered successful. Overall hospital mortality was 3.4%: 4% for MVR, 16.6% for the attempts, 1.4% for repairs. The thromboembolic rate for replacement was 6.0% pt-yr and for repair 0.87% pt-yr. There were five late deaths in the replacement group and one in the repair group. Seventeen patients required reoperation in the repair group (12.6%) with a mean age of 17 years. Six of these patients had active rheumatic carditis, either at first operation or in the postoperative period. The postoperative functional status of all patients was excellent. In conclusion, valve repair although possible in a high percentage of rheumatic regurgitation patients carried a penalty of unsuccessful attempts and reoperations. However, in the follow-up period the rate of thromboembolism and late mortality among the patients with prostheses offsets these disadvantages.

Adolescent↗
PubMed1991

Valve repair in rheumatic mitral disease.

Emerging evidence indicates that etiology plays an essential role in the results of mitral valve repair. In an attempt to evaluate the possibilities and problems of repair in a rheumatic population, all consecutive patients treated between July 1988 and July 1990 were reviewed. Three hundred and four patients at risk of undergoing a repair were studied. The mean age was 31.3 years. In 78 patients (25.6%) the valve was considered beyond repair and immediately replaced (MVR). In 26 patients (8.5%) an unsuccessful attempt at repair was followed by replacement (attempts), and 200 (65.7%) underwent a successful repair (repair). The repair group was younger (p less than 0.001) and had less tricuspid involvement (p less than 0.005). The repair rate was highest in regurgitant lesions (79.4% repaired, p less than 0.005). The attempts group was very similar to the MVR group. The total hospital mortality was 3.2%. For MVR it was 3.8%, for attempts 19.2%, and for repairs 1.0%. The incidence of embolism was 3.34%/patient/yr for the mechanical, 3.06%/patient/yr for bioprosthesis, and 2.19%/patient/yr for repairs. Only 7.5% of repairs were anticoagulated. A reoperation was needed in 26 patients: one for bioprosthesis, one for aortic repair failure, and 24 for mitral repair dysfunction (12.1% of all surviving repairs). The reoperation incidence after repair was 26.8% in patients with an age under 20 years and 4.5% in those over 20. Eight patients had active carditis and 10 severe hemolysis. There were eight late deaths (six prosthesis and two repairs), with an actuarial total survival at 30 months of 72.46 +/- 8.45% for prosthesis and 94.41 +/- 3.74% for repairs (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Short- and long-term problems in dilatation of untreated aortic isthmus stenosis in children].

We examined problems and complications during and after balloon dilation of native coarctation of the aorta in 31 children with a mean age at first dilation of 5.77 +/- 5.4 years (0.08-16 years), who had a total of 37 balloon dilations. Twenty-six patients were restudied 3 to 24 months after the first procedure. In six patients, because of recoarctation, further dilations were performed. In two patients the second procedure was not successful and they required surgery. In 14/37 (37.8%) dilations the routine sedation was insufficient. The retrograde catheter could be introduced percutaneously in all but one patient. Because of small femoral arteries the introduction of the balloon catheter was not possible in three cases (8.1%). In three more patients (8.1%) the adequate catheters were not in stock. Complications included: transfusion because of blood loss in six patients (16.2%), chest pain in three (8.1%), rupture of balloon in three (8.1%), thrombectomy in three (8.1%), and partial reopening of ductus arteriosus in one patient. Duration of hospital stay was a mean of 1.81 days +/- 1.65 (range 1-9 days). Ninety percent of the patients were discharged within 2 days. On follow-up (range: 3-50 months), eight patients (21.6%) had a weak femoral pulse, of whom only one had an absent pulse, eight patients (21.6%) had paradoxical hypertension despite good dilation and no significant gradients, and only one patient showed a small aneurysm. We conclude that balloon angioplasty of native coarctation is a successful and relatively safe method of treatment of native coarctation. The most serious complication is arterial occlusion of the affected leg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Surgery for aortic regurgitation in the young: repair versus replacement.

Aortic valve replacement in the young patient represents a serious problem in terms of anticoagulation and limited durability of the bioprosthesis. In order to determine the possible advantages of conservative surgery, consecutive patients with aortic regurgitation, aged below 35 and operated upon between July 1988 and July 1990 were analyzed. There were 149 patients (mean age 22 years). The aetiology was rheumatic disease in 122 (81.9%) and 83.2% of the patients were in NYHA class III-IV. Sixty-one valves were replaced (AVR) and 88 (59%) were repaired by a variety of techniques (annuloplasty, cusp unrolling, resuspension or extension). The mean ischaemic times for isolated aortic regurgitation were 73.6 mins for AVR and 80.5 mins for repair. Associated mitral surgery was performed in 94 patients (63%); 33% of these had a valve replacement and 67% a repair. In the AVR group there was 1 hospital death (2.2%), 2 late deaths (3.3%), 3 major embolic events (5%) and one reoperation for infection. In the repair group there were 2 hospital deaths (2.4%), but no late deaths or embolic events. Twelve patients required reoperation which was performed without mortality; this was due to aortic dysfunction in 4 cases (4.6%) and mitral dysfunction in 8. It is concluded that aortic valve conservation in a young, predominantly rheumatic, population can be performed in a significant number of patients with a low mortality and morbidity.

Adolescent↗
PubMedDate not supplied

The problems of valve surgery in a developing country.

The management of young patients with valvular heart disease is a difficult problem in developing countries. At our Institution, 765 valves were operated upon in 523 patients over a period of two years. Rheumatic etiology was seen in 70% of the valves and 60% of all the valves were repaired. The hospital mortality and morbidity in the form of thromboembolic episodes were less in the repair group; 35 valves in 26 patients had to be reoperated upon for instability of the primary repair. Despite this high and early reoperation rate in the repair group and considering the higher mortality plus the problems of anticoagulation and limited durability of bioprostheses in the replacement group, conservation of the patient's own valve remains a better alternative in the long-term.

Adult↗