Biomedical subjects

B Hucín

Publications and source records attributed to B Hucín.

At least 37 records · Page 2Linked to original sources

PubMed1997

Bidirectional Glenn followed by total cavopulmonary connection or primary total cavopulmonary connection?

OBJECTIVE: Analysis of mortality and morbidity of patients treated by primary total cavopulmonary connection (TCPC)-Primary correction group, and comparison to patients treated by bidirectional Glenn (BDG) followed by total cavopulmonary connection-two stage TCPC group. METHODS: Retrospective study of 123 consecutive patients who underwent 144 different types of cavopulmonary connections between 1987-1995: bidirectional Glenn 59, HemiFontan operation 10, primary total cavopulmonary connection 54, and total cavopulmonary connection completion after previous bidirectional Glenn 21. Important preoperative risk factors: age, systemic outflow obstruction, pulmonary venous obstruction, pulmonary artery (PA) hypoplasia (McGoon ratio), PA stenosis/distortion, PA mean pressure, PA vascular resistance, atrioventricular valve regurgitation, systolic and diastolic ventricular function and ventricular hypertrophy were re-evaluated according to Texas Heart Institution Scoring System in both groups. Three different preoperative risk groups were established: low risk, score (0-3) moderate risk (4,5) and high risk score (> or = 6). RESULTS: Mean age was 85.2 month (range 16.1-229.5 months) and 106.6 months (range 42.6-178.9 months) in primary correction group and two stage TCPC group, respectively. Diagnosis was similar in both groups, majority having univentricular heart or hypoplastic one ventricle. Initial palliation (pulmonary artery banding, modified aortopulmonary shunt, coarctation repair etc.) was performed in 38 (70.3%) patients of primary correction group and in 12 (57.1%) two stage TCPC group. The mortality was 7.4% (4 out of 54) and 14.2% (3 out of 21) for primary correction and two stage TCPC group, respectively. There were two take down in the primary correction group. There was no late death in either group. Operative data and postoperative morbidity did not statistically differ in both groups. CONCLUSION: Until 1993 bidirectional Glenn was preferred to primary total cavopulmonary connection for high risk patients. High mortality 14.2% patients of two stage TCPC group vs. 7.4% of primary correction group in patients with the same preoperative hazard led us to change our policy. We now prefer primary TCPC for all patients with functional single ventricle and surgically correctable major associated defects. High risk patients undergo TCPC with fenestration. Patients not suitable for TCPC undergo either HemiFontan operation or some type of initial palliative procedure.

Adolescent↗

PubMed1997

Long-term ventricular performance after intra-atrial correction of transposition: left ventricular filling is the major limitation.

OBJECTIVE: To establish the incidence of systolic and diastolic dysfunction of the right and left ventricle in a large cohort of patients after Mustard or Senning operations and to assess changes in the incidence on long term follow up. DESIGN: Postoperative case-control study using radionuclide ventriculography. Ejection fractions, peak filling rates, rapid filling periods and fractions, slow filling periods and fractions, and atrial contraction periods and fractions were studied. SETTING: Tertiary care centre, ambulatory and hospital inpatient care. PATIENTS: A convenience sample of 153 patients studied at median age of 6.9 years (median 4.4 years after surgery). In 99 cases another study was available at a median age of 15.3 years (median 13 years after surgery and 8.8 years after the first study). RESULTS: Respective incidences of dysfunction in the first and the second study were as follows: ejection fraction-right ventricle 7.8% and 8.1%, left ventricle 7.2% and 10.1%: peak filling rate-right ventricle 0% and 4.2%, left ventricle 14.3% and 29.5% (p < 0.05); rapid filling period-right ventricle 18.3% and 11.6%, left ventricle 30.2% and 30.5%; slow filling period-right ventricle 4.8% and 3.2%; left ventricle 11.9% and 23.2%; atrial contraction period-right ventricle 0.8% and 4.2%, left ventricle 15.1% and 26.3%; rapid filling fraction-right ventricle both 0%, left ventricle 82.5% and 79.0%; slow filling fraction-right ventricle 0.8% and 4.2%, left ventricle 37.3% and 30.5%; atrial contraction fraction-right ventricle both 0%, left ventricle 79.4% and 71.6%. CONCLUSIONS: The incidence of systolic ventricular dysfunction is 8% (right ventricle) and 10% (left ventricle) 13 years after surgery, without a significant increase over the eight year follow up. Diastolic filling is abnormal in up to 80% of patients and left ventricular peak filling rate deteriorates with time.

Adolescent↗

PubMed1997

Individualized repair of the left atrioventricular valve in spectrum of atrioventricular septal defect.

From September 1977 to October 1995, 287 patients with atrioventricular septal defect (AVSD) aged from 2 months of 21 years underwent total repair in Kardiocentrum in prague. In 97 patients complete, in 20 transitional and in 170 patients partial form of AVSD was present. The repair consisted of closure of the defect and individually modified reconstruction of two atrioventricular (AV) orifices. In cases with a common orifice a two-patch technique was used. Fixation of undivided anterior and posterior common leaflets to patches in an appropriate level was essential in combination with complete closure of the cleft. Incomplete closure of the cleft was performed if potentially stenotic morphology was present. Commissuroplasty with pladgeted mattress stitches was done in patients with dilated annulus and commissuroplasty with a single stitch was performed if the annulus was not dilated. The methods were similar in cases with two AV orifices. The AV valve repair was difficult in the presence of severe regurgitation in valves with potentially stenotic morphology. Of the 287 operated patients 26 (9.1%) died during the early postoperative period. Mortality was 19.6% in the complete form and 3.7% in the partial and transitional forms. The mortality depended on morphology of the left atrioventricular valve. Potentially stenotic valvar morphology represented an important risk factor for death and reoperation. It was necessary to reoperate on 18 (6.3%) patients for significant "mitral" valve regurgitation. Reconstruction of a competent left AV valve is the most important step of AVSD repair which must always be modified according to individual morphological and functional abnormalities.

Abnormalities, Multiple↗

PubMed1997

[Harvesting the heart for preparation of heart valve allografts].

Allograft heart valves (AHV) are believed to be optimal prosthetic material for surgical aortic valve and/or root replacement and an ideal valved conduit for repair of some complex congenital heart defects. At the University Hospital Motol AHV were clinically used since 1983 (annually no more than twenty were collected). 1991 the Paediatric Transplant Centre was established and was entrusted to organise cadaveric hearts harvesting and to introduce the standard technology of AHV processing and banking. The results of co-operation with other Transplants Centres, as well as with coroners and forensic medicine specialists in 1992-1995 are presented. For the AHV processing 274 cadaveric hearts were collected in the Czech and Slovak Republics, 32 of them (11.7%) came from routine post-mortem and 242 (88.3%) were retrieved from multiorgan harvesting, 14 hearts were excluded for technical reasons and another five for the seropositivity of the donor (three HBSAg, one HCV and one VDRL). Another 14 AHV were not suitable for clinical use because of a congenital lesion (bicuspid aortic valve) or acquired pathology found during the AHV processing (advanced atherosclerosis) or retrospectively diagnosed at donors post-mortem (in vivo undiagnosed malignancy). The technology of processing, cryopreservation and banking of AHV as well as the clinical use of the tissue will be discussed separately.

Cadaver↗

PubMed1997

[Preparation, storage, transportation and use of heart valves for allotransplantation].

UNLABELLED: Thanks to the co-operation with Czech and Slovak Transplant Centres and with some of the Departments of Pathology and Forensic Medicine 274 hearts were collected for allograft heart valves (AHV) processing during 1992-1995. The Cardiac surgeon dissected the aortic valve with the root and the pulmonary artery trunk with the valve. Tissues were antibiotically (ATB) sterilised in cultivation medium E 199 (24 hours at 37 degrees C). ATB concentrations (mg/ml): Cepharin 0.2, Azlocilin 0.2, Tobramycin 0.08 and Amphotericin B 0.1 for harvesting at post-mortem (P) or Miconazol 0.05 for sterile retrieval during multiorgan harvesting (MOH). After sterilisation AHV were stored at 4 degrees C. 49 AHV were infected even after ATB treatment-15 of 35 collected at P (43%) and 35 of 218 procured during MOH (16%)-(p < 0.01-ch2 test). After serological screening of the donor and microbiological testing the AHV were released for clinical use. Most AHV were programmed cooled to the temperature of liquid nitrogen (-196 degrees C), in which they were stored at the Allograft Heart Valves Cryobank. Cryoprotection was achieved by 10% dimethylsulphidoxide. CONCLUSION: A technology of harvesting, processing, storage and transportation of AHV, was introduced. It enabled the routine use in many cardiac surgical units. The AHV Cryobank was established. 131 AHV were used clinically between 1992 and 1995 (transportation as far as 1300 km). 108 AHV (82.4%) were used for repair of complex congenital heart defects, while 23 (17.6%) were used for aortic valve and/or root replacement.

Heart Valves↗

PubMed1997

[Treatment of postoperative mediastinitis with sucrose].

The authors describe the treatment of postoperative mediastinitis in cardiosurgery by the open method with local sucrose administration and subsequent delay of closure of the thorax. Universal antibacterial properties of sucrose are made use of. Sucrose dissolves in the wound in its crystalline form and creates a medium with low aqueous activity (high osmolarity), which inhibits bacterial growth. The wound is rapidly cleansed, the secretion from the wound is within 10 days bacteriologically negative and the chest can be closed secondarily. Simple resuture of the wound was performed four times, a plastic operation using the pectoral muscles twice and in one instance it was closed by a plastic operation of the transposed rectus abdominis muscle. The method was used successfully in seven patients.

Administration, Topical↗

PubMed1997

[Plication of the diaphragm--a method of surgical treatment of diaphragmatic paralysis in neonates and infants after heart surgery].

The cause of paresis of the diaphragm after cardiosurgery is damage of the phrenic nerve. The diagnosis of paresis is based on X-ray examination, sonography and electromyography of the diaphragm. Plication of the diaphragm is indicated only in those children with paresis of the diaphragm who develop during spontaneous ventilation severe respiratory insufficiency. In the Cardiocentre of the Faculty Hospital Prague-Motol between 1983 and 1996 of 5333 children operated on account of heart disease 29 children were subjected to plication of the diaphragm, incl. five where the operation was made during the neonatal stage (17%), 20 in infant age (69%) and four were older than one year (14%). By the third day after plication 9 children (38%) could be disconnected from the respirator, by the 5th day 20 children (70%) by the 7th day 22 children (75%). In neonates and infants with postoperative paresis of the diaphragm, where spontaneous ventilation cannot be induced, plication of the diaphragm is according to the authors the method of choice. It is a rapid and safe surgical operation which reduces the period of artificial ventilation and its complications.

Cardiac Surgical Procedures↗

PubMed1996

[Radical anatomic correction of transposition of great arteries in neonates. A new program of treatment of critical congenital heart defects].

METHODS AND RESULTS: From the group of 110 neonates born with transposition of the great arteries during 1991-1994 that were referred for the treatment to Kardiocentrum, University Hospital Prague-Motol, 46 neonates with simple transposition were operated on according to the criteria for anatomical correction (arterial switch) at the mean age of 9 days (4-20 days). Fourteen infants with transposition and large ventricular septal defect were corrected with arterial switch at the mean age of 2.5 months (5 weeks-9 months). Fifty neonates that did not meet criteria for arterial switch procedure were indicated for correction at the atrial level (Senning procedure) that has been performed at the mean age of 5 months (1-10 months). Out of 46 operated neonates 10 died following the operation and one child died 2 months later after surgery. There were 2 death out of last 20 neonates (10%). Thirty five children surviving 1-4 years after anatomical arterial correction of transposition are without complaints in excellent condition, NYHA class I. CONCLUSIONS: The procedure of the anatomical correction at the level of the great arteries (arterial switch) according to Jatene, that has been successfully introduced at Kardiocentrum, University Hospital Prague-Motol, has been reproducible and became the method of choice for operations of transposition of the great arteries in neonates with the suitable anatomy.

Cardiac Surgical Procedures↗

PubMed1996

[Minithoracotomy in cardiac surgery. Initial experience with closure of an atrial septal defect with a minithoracotomy].

The authors describe their own modification of closure of an atrial septal defect (ASD) from right anterolateral minothoracotomy. This minimally invasive approach was selected in girls and women. Right anterolateral thoracotomy was used in 1987 to 1994 in twelve female patients. With regard to the general trend towards aesthetic surgery the authors use at present minimal anterolateral right-sided thoracotomy which with regard to its close relationship with the right atrium makes a safe surgical access to the atrial septum possible. Extracorporeal circulation is implemented by cannulation of the iliac artery in the groin, venous return is ensured by cannulas inserted into the venae cavae in the surgical field (by the auricle of the right atrium into the vena cava superior and the right atrial wall into the vena cava inferior). The operation itself is performed with electric fibrillation of the heart and tightening of the venous tourniquets. Between January 1995 till March 1996 the authors made by the thus modified approach a closure of the ASD type secundum in four female patients age 17, 29, 35 and 40 years. ASD was located always in the fossa ovalis and was repaired by direct suture. The duration of the extracorporeal circulation was on average 30 minutes. The length of the skin incision was 8-10 cm. The operation was free from complications. The cosmetic result is excellent and is consistent with principles of aesthetic surgery. If an arterial cannula is inserted into the groin minithoracotomy can be recommended for closure of ASD with extracorporeal circulation as a safe method.

Adolescent↗

PubMed1995

[Heart surgery in neonates: types and timing of surgery--present possibilities and results].

Neonatal cardiosurgery is nowadays an integral part of treatment of congenital heart disease. At present it is possible to correct completely with a feasible risk heart diseases in the majority of neonates (73%) with a critical congenital disease. Most frequently these disease defects are operated during the first two weeks of life (78% of all operations). In the strategy of surgery optimal timing and selection of the most suitable operation is essential to ensure in time favourable conditions for child growth and development and a long high-quality life. The tactics and therapeutic results in contemporary neonatal cardiosurgery are illustrated by the authors' experience with 174 neonates operated on for congenital critical heart defect in 1991-1993 in the Pediatric Cardiocentre, University Hospital Prague-Motol.

Heart Defects, Congenital↗

PubMed1995

Seven-year experience of noninvasive preoperative diagnostics in children with congenital heart defects: comprehensive analysis of 2,788 consecutive patients.

The spectrum of patients operated on without preoperative catheterization and angiography, the accuracy of echocardiographic diagnosis and its impact on the results of surgical treatment were prospectively assessed in 2,788 children consecutively operated for congenital heart defects (CHD) between 1986 and 1992. The overall percentage of surgery based solely on noninvasive preoperative examination increased from 63% in 1986 to 81% in 1990 and decreased to 72% in 1992. There were no differences in the preoperative diagnostic approach between groups of newborn, infants and children. A high percentage of patients with patent ductus arteriosus (96.5%), atrial septal defect (94%), incomplete atrioventricular septal defect (88.6%), ventricular septal defect (86.3%), coarctation of the aorta (80.2%) and total anomalous pulmonary venous connection (79.3%) was referred for surgery without prior invasive examination, while a lower percentage was found in univentricular heart (48.4%), pulmonary atresia (34.6%) and double outlet right ventricle (27.7%). More patients with pulmonary and tricuspid atresia were catheterized before complete repair compared to those who underwent palliative surgery (p < 0.01 and p < 0.0001, respectively). The echocardiographic diagnosis was correct in 96% of patients. Two patients of those with incomplete preoperative diagnosis died early postoperatively, both with missed apical ventricular septal defect. One with tetralogy of Fallot died after reoperation, the other with persistent truncus arteriosus due to sepsis. When the echocardiographic findings are in full agreement with the clinical status, physical examination, ECG and chest X-ray, we recommend cardiac surgery without prior catheterization in many patients with CHD.

Adolescent↗

PubMed1995

[Combined methods for economic blood utilization in cardiac reoperations in children].

During 47 re-operations on the open heart the authors used the method of autotransfusion, predeposition of the patient's blood and intravenous administration of aprotinin to reduce postoperative haemorrhage and blood consumption. The patients were classified according to the methods or their combinations used into three groups and the authors compared, using statistical methods the blood losses, blood consumption, haemolysis, renal function and the effect of the methods used on the morbidity. The results were compared with a control group where the mentioned methods of economizing on blood were not used. The authors recorded significantly higher haematocrit values in all three groups where economic methods were used at the end of the extracorporeal circulation (EC), as compared with the control group. The volume of the administered blood transfusion was significantly lower in group 1 where an autotransfusion apparatus Cell saver was used. The volume of the administered blood transfusion in the other groups did not differ when evaluated by statistical methods. The filling of the apparatus for extracorporeal circulation was blood free in 90% in group 1, in 75% in group 2, in 92.2% in group 3 and in 75% in the control group. Blood losses via thoracic drains did not differ significantly in different groups though there was a wide range of recorded values. In both groups 2 and 3 where patients were given aprotinin haemoglobinuria was more frequent, as confirmed by laboratory tests. The authors observed also a greater diuresis, without laboratory evidence of impairment of renal function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

[Anatomic correction of transposition of the great arteries in the neonatal period].

In Cardiocentrum of the University Hospital in Prague-Motol in 1988-1994 anatomical correction of transposition of the great arteries (arterial switch) was performed in 47 neonates aged 4 to 20 days. The aorta and pulmonary artery were transferred into the appropriate ventricle concurrently with reimplantation of the coronary arteries. The surgical technique was modified with regard to the anatomy of the coronary arteries and the presence of associated cardiac defects. Eleven of the 47 neonates (23%) died during the early postoperative period, one patient died two months after operation. Of the last 20 operated neonates only two died (10%) and both had an abnormal insertion of the coronary arteries. Thirty-five children are followed up for 2-45 months following anatomical correction. All are in a very good clinical condition without serious residual findings. The authors describe the protocol of the diagnostic and therapeutic procedure in transposition of the great arteries. They consider anatomical arterial correction in the neonatal period as the method of choice for this disease. The optimal age for anatomical correction in isolated transposition is between the 7th and 14th day and in transpositions with a major defect of the ventricular septum at the age of one month. The surgical results are steadily improving with accumulating experience. The medium-term results of anatomical correction of transposition of the great arteries are very favourable.

Cardiac Surgical Procedures↗

PubMed1994

[Total cavopulmonary anastomosis in the surgical treatment of congenital heart defects with a functional single ventricle].

Total cavopulmonary connection (TCPC) allows surgical treatment of patients with complex univentricular heart disease. Between 1991 and 1993 this operation was performed in 15 cyanotic children with complex heart defects. Age range was 3.5-14 (median 8.3) years. In 5 children with increased operative risk a calibrated interatrial fenestration was created intraoperatively to allow systemic venous decompression. Three patients (20%) died. In remaining 12 patients a significant increase in arterial oxygen saturation and decrease of polycythemia was encountered. All patients remain in a good clinical condition 1-25 months after operation. Noninvasive investigation including echocardiography confirmed good function of the heart.

Adolescent↗

PubMed1994

[Heart surgery in neonates (experience with surgery in 420 neonates)].

In the child cardiocentre in Prague 5-Motol in 1977-1993 a total of 420 neonates with critical inborn heart disease were operated. Obstructive defects of the left heart were found in 178 children, obstructive defects of the right heart in 87, defects with a left-right shunt with pulmonary hypertension in 75, conotruncal malformations in 73 and various operations were made in 7 children. Complete repair of the defect was achieved in 281 neonates, incl. 104 where extracorporeal circulation was used. Palliative operations were made in 139 children. Early mortality during the entire period was 26%, whereby a decrease from 40% to 16% was recorded during the last three years. At present it is possible to repair permanently critical inborn heart disease in the majority of neonates. This is made possible in particular by early non-invasive diagnosis, treatment with prostaglandins E in duct-dependent critical heart disease, optimal time for and selection of most suitable surgery, microsurgical technique, miniaturization of extracorporeal circulation and the method of deep hypothermia.

Cardiac Surgical Procedures↗

PubMed1993

[The effect of therapy with adrenergic beta receptor blockers on myocardial beta adrenergic receptors in children with tetralogy of Fallot].

Seventeen children with tetralogy of Fallot undergoing cardiac surgery were investigated for alteration in myocardial beta-adrenergic receptors (BAR) in dependence on the previous chronic administration with the beta-adrenergic blocker metipranolol. Binding parameters, Bmax (maximal binding capacity) and Kd (dissociation constant), in right ventricular tissue were assessed in direct saturation binding studies using 125I-pindolol. It can be concluded that a) chronic administration of metipranolol to nine patients in usual doses did not change either Bmax or Kd of BAR in the samples of right ventricle, and b) twelve hours interval between last dose of metipranolol and removal of tissue samples is sufficiently long to enable normalization of possible changes in the sensitivity of BAR. This finding is supported by the pot-operative course and the response to dopamine which did not differ in patients treated and untreated with metipranolol in the preoperative period. Thus, our results suggest that there is no apprehension of chronic application of beta-blockers in patients with tetralogy of Fallot which would negatively influence the response to dopamine during the operation and in the postoperative period.

Child, Preschool↗

PubMed1993

[Congenital heart defects in adults from the viewpoint of the surgeon].

The adolescent generation of patients operated in childhood on account of congenital heart disease is a new health and social problem. Kardiocentrum for children in Motol started its activities in 1977. A concept of care for children with congenital heart disease was elaborated and gradually all surgical methods used worldwide were introduced. The advances in cardiosurgery along with the development of diagnostic methods and intervention catheterization in particular balloon valvuloplasty and angioplasty make high standard and effective treatment of practically the entire spectrum of congenital heart disease in children of all age groups possible. The cardiac surgeon tries nowadays to resolve problems of inborn heart disease already in early childhood. Before a possible re-operation in adult age he must take into account how the result of the first operation affected the patient's growth and development. He is interested in particular in the fate of implants, surgically induced pathology and the influence of growth on the reconstruction. Despite intensive research, so far the long-term prognosis of patients after some types of surgery is not clear (e.g. transposition of the great arteries, Fontan's operation and its modifications). An adult patient congenital hearth disease should receive care of a specialized cardiologist who has personal experience with the diagnosis and treatment of congenital heart disease. If surgery is necessary it should be performed in a specialised department equipped as regards staff, technical devices and funds for these special operations.

Adult↗

PubMed1993

[Bidirectional cavopulmonary anastomosis in palliative surgical treatment of complex congenital heart defects].

Bidirectional cavopulmonary anastomosis was used during the past six years for palliative treatment of 34 children with complex cardiac disease with a low pulmonary blood flow and a functional common ventricle. The age at the time of operation was 5 months to 16 years (median 55 months). Two children (5.9%) died soon after operation and one patient died in conjunction with reoperation seven months later. After operation a significant increase of saturation and decrease of the haematocrit occurred in all patients. The condition of 31 patients during an out-patient check-up 2-64 months after operation was satisfactory and postoperative examinations revealed a satisfactory function of the anastomosis.

Adolescent↗