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Biomedical subjects

B O Omari

Publications and source records attributed to B O Omari.

13 recordsLinked to original sources
PubMed2000

Annular abscesses in surgical endocarditis: anatomic, clinical, and operative features.

BACKGROUND: The aim of this study was to determine patterns of anatomic, clinical, and operative features in surgical endocarditis (SE) with annular abscess (AA). METHODS: The study consisted of a retrospective analysis of SE cases with AA between 1981 and 1997. RESULTS: A total of 41 cases with AA were found in 106 consecutive SE cases. There was a higher incidence of AA in aortic (37 of 71 [52%]) (p<0.01) compared to mitral (6 of 42 [14.3%]) or tricuspid (0 of 12) infections. However, the mitral abscesses had a greater tendency toward fistula or pseudoaneurysm formation (4 of 6 [67%]) than other valve abscess cavities (7 of 46 [15%]) (p<0.01). Severe heart failure (p<0.01), heart block (p<0.05), and fistula/pseudoaneurysm (p<0.001), were more often found in SE with AA than without. There were 46 separate aortic AA in 37 instances of aortic valve SE. Of these, 31 of 46 (67%) were less than 1 cm (group 1), 10 of 46 (22%) were large but confined to a given cusp annulus (group 2), 4 of 46 (8.6%) were large between multiple cusps (group 3), and 1 of 46 (2.2%) was circumferential (group 4). There were four instances of aortoventricular discontinuity. Group 1 abscesses were repaired by local closure without a patch significantly more often than the other groups. The mortality of SE with AA was significantly greater for larger AA (groups 3 and 4, 3 of 5 [60%]) than for smaller AA (groups 1 and 2, 0 of 36) (p<0.001). There were six separate mitral AA in six instances of mitral SE, five requiring patch repair. The 30-day operative mortality for AA cases was 3 of 41 (7.3%) compared to 2 of 65 (3.1%) without AA. All AA mortalities involved large AA in the aortic valve position. Of 35 mechanical valves placed for AA, only one required subsequent removal for prosthetic endocarditis. CONCLUSIONS: Annular abscesses are most frequent in aortic AA, but fistulas/pseudoaneurysms are more frequent in mitral AA. Small to moderate aortic AA can be managed by local closure without an increased mortality compared to SE without AA. Patients with large aortic AA have a higher operative mortality. Mechanical prostheses are safe and effective for the majority of patients with AA.

Abscess↗
PubMed1998

Characteristics of patients less than 45 years of age compared with older patients undergoing coronary artery bypass grafting.

BACKGROUND: Coronary artery disease (CAD) was not recognized as common among young patients until the study by Yater in 1948. Subsequent studies further elucidated the nature of the disease, which had become more apparent in the younger groups. HYPOTHESIS: The study was undertaken to determine the prevalence of risk factors and severity of coronary disease among young patients aged < or = 45 years undergoing coronary artery bypass grafting (CABG) compared with older patients. METHODS: In all, 112 young patients aged < or = 45 years (Group 1) and 798 older patients aged > 45 years (Group 2) were analyzed for trends to hypertension, smoking, diabetes, family history of heart disease, hypercholesterolemia, obesity, and history of previous myocardial infarction (MI). The severity of disease was examined in terms of number of diseased vessels, vessel size, number of grafts performed, performance of endarterectomies, and left ventricular function. RESULTS: Group 1 had a higher incidence of positive family history (68.5 vs. 51.2%, p < 0.05), and lower incidences of hypertension (62.7 vs. 81.5%, p < 0.05), obesity (42.9 vs. 83.9%, p < 0.05), and history of previous MI (54.5 vs. 94.6%, p < 0.05). Group 2 had a higher incidence of left main disease (22.6 vs. 11.4%, p < 0.05). The distribution of the affected vessels of the young patients was most commonly the left anterior descending (90.4%) followed by the right coronary (79.8%) and circumflex arteries (69.2%). Group 2 had more grafts per patient (3.82 vs. 3.37, p < 0.05). The size of the diseased vessels measured intraoperatively was similar (1.56 vs. 1.58 mm, p = NS) in both groups. Endarterectomy was performed almost three times more often in Group 1 patients (8.2 vs. 3.0%, p < 0.05). Operative mortality was less in Group 1 mean (1.8 vs. 6.3%, p < 0.05). Group 2 had a greater mean left ventricular ejection fraction (53.8 vs. 49.7%, p < 0.05). CONCLUSION: Compared with the older population, patients < or = 45 years of age who underwent CABG had (1) a higher incidence of positive family history of CAD, (2) a higher likelihood of requiring an endarterectomy, and (3) lower operative mortality rate despite a slightly poorer ventricular function.

Adult↗
PubMed1998

Closure of short, wide patent ductus arteriosus with cardiopulmonary bypass and balloon occlusion.

The wide, short patent ductus arteriosus in adults and older adolescents poses an extreme hazard with standard closed ligation techniques. The method of transpulmonary balloon catheter occlusion and repair of pediatric ductus arteriosus is herein reported in older patients using a Foley catheter and normothermic bypass. Transesophageal echocardiography is crucial in assessing the size of the ductus and confirming adequacy of repair. The technique is simple and safe even in the presence of a wide, short ductus.

Adolescent↗
PubMed1998

Coronary artery bypass grafting in patients with profound ventricular dysfunction.

Patients with severe ventricular dysfunction make up a special subset of patients who undergo coronary artery bypass procedures. For these patients, the risk associated with the bypass procedure is relatively high, but the opportunity-for-survival benefit is also greater. We studied 61 consecutive coronary artery bypass patients with preoperative ejection fractions < or = 25%, and further compared several subgroups: Group I (n = 30) ejection fractions ranged from 21% to 25%; Group II (n = 23) ejection fractions ranged from 16% to 20.9%; and Group III (n = 8) ejection fractions ranged from 10% to 15.9%. The overall mortality rate was 8% (5/61), with no deaths in Group III. The 41% (25/61) of patients who received left internal mammary artery conduits experienced a higher mortality rate, yet it did not differ significantly from that of patients who received only saphenous vein conduits. Intraaortic balloon pumps were placed in 48% (29/61) of the patients, with a progressively higher incidence in patients with poorer ventricular function (P < 0.05). Most intraaortic balloon pumps (59%) were placed intraoperatively. Two patients underwent placement of left ventricular assist devices, and 1 of these survived. Coronary artery bypass grafting in patients with poor ventricular function carries a substantial, but acceptable, mortality risk. Use of the left internal mammary artery did not improve perioperative mortality, and may have a negative impact in the early postoperative period. Intraaortic balloon pump use was most common in those patients with the worst ventricular function. Prophylactic intraaortic balloon pump use may be justified in candidates with ejection fractions < 20%.

Adult↗
PubMed1998

Reversible snaring for proper prosthetic seating during valve replacement.

A method of reversible suture snaring is described for evaluating the final valve seating and positioning before knot tying of valve sutures. This allows for alteration of the operative plan before investing substantial ischemic time in a nonfunctional result. The procedure has been used in 577 consecutive prosthetic valve replacements in the past 5 years. The technique maintains proper seating while the valve is permanently anchored in place.

Heart Valve Diseases↗
PubMed1997

Local transverse arch repair for type A aortic dissection.

BACKGROUND: The management of retrograde dissections originating from the transverse arch is controversial. Although replacing the ascending aorta is clearly beneficial, the appropriate approach to the management of the arch tear is not as apparent and ranges from no intervention to total arch replacement. METHODS: Three patients presented with acute (n = 2) or subacute (n = 1) aortic dissection, with tears involving the transverse arch. All underwent local transaortic pledgeted suture repair of the arch tears during hypothermic circulatory arrest, as well as graft replacement of the ascending aorta. RESULTS: Circulatory arrest times ranged from 12 to 15 minutes (transaortic arch repairs alone) to 48 minutes (transaortic arch repair and open distal graft anastomosis). Postoperatively all patients awoke within 12 hours and subsequently did well neurologically. CONCLUSIONS: In the face of a type A dissection with an entry in the transverse arch, local transaortic repair with concomitant ascending aortic replacement represents a viable middle ground between no arch intervention and lengthy arch replacement. Huge entry tears or aneurysmal arch enlargement would preclude such an approach.

Acute Disease↗
PubMed1991

Effect of right atrial appendectomy on the release of atrial natriuretic hormone.

Atrial natriuretic hormone is released from the right atrial appendage in response to atrial distention. During cardiac operations the right atrial appendage is usually partially removed or ligated for venous cannulation. To evaluate the effect of right atrial appendectomy on the release of atrial natriuretic hormone and its natriuretic and diuretic responses, we prospectively randomized into two groups 23 patients undergoing elective coronary artery bypass operations. There were 16 male and 7 female patients with a mean age of 62 +/- 7 years. Group A (n = 11) had the right atrial appendage removed, and group B (n = 12) had the right atrial appendage preserved and venous cannulation done lateral to the appendage. The two groups were comparable for sexual distribution, age, number of grafts, and extracorporeal bypass time. All patients had normal left ventricular and renal functions, and they did not receive any diuretics during the study period. The patients were studied both preoperatively and postoperatively whereby the atrial natriuretic hormone serum levels, urine volume per minute, fractional excretion of sodium, amount of sodium excreted, and central venous pressure were measured before and after volume expansion with 5% albumin, 7.5 ml/kg. There was no statistical difference in these parameters preoperatively. In the postoperative period, however, group B patients had higher atrial natriuretic hormone levels after volume expansion than group A patients (376 +/- 84 versus 184 +/- 31 pg/ml; p less than 0.05), higher urine volume per minute (4.4 +/- 1.0 versus 2.0 +/- 0.4 ml/min; p less than 0.05), higher fractional excretion of sodium (2.30 +/- 0.66 versus 0.64 +/- 0.19; p less than 0.02), and higher amount of sodium excreted (511.1 +/- 150.9 versus 83.9 +/- 22.8 mmol/min; p less than 0.02). The central venous pressure was similar both before (9 +/- 1 versus 9 +/- 1 mm Hg) and after (16 +/- 1 versus 15 +/- 1 mm Hg) volume expansion in both groups. We conclude that preserving the right atrial appendage during cardiac operations significantly increased the release of atrial natriuretic hormone, resulting in increased urinary sodium excretion and better diuresis in the postoperative period.

Aged↗
PubMedDate not supplied

Ultrasonic debridement of mitral calcification.

Dense annular calcification to the valve attachment is particularly hazardous during mitral valve replacement because of the difficulty of placing sutures and the risk of atrioventricular rupture. We report 11 patients who underwent decalcification of the mitral anulus with the Cavitron Ultrasound Surgical Aspirator (CUSA) during mitral valve replacement. This resulted in a greatly simplified suture placement and prosthetic valve seating as well as enlargement of the annular orifice. Four other patients underwent CUSA debridement of the anterior leaflet of the mitral valve during concomitant aortic valve replacement and CUSA debridement of the aortic anulus. There were no operative deaths or major complications. Ultrasonic debridement is a useful adjunct in the surgical management of the heavily calcified mitral valve.

Adult↗