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C I Tchervenkov

Publications and source records attributed to C I Tchervenkov.

47 records · Page 3Linked to original sources
PubMed1989

Congenital abdominal aortic aneurysm.

The authors report the extremely rare occurrence of a congenital abdominal aortic aneurysm, 6 cm in diameter, found in a 1-month-old infant. Prenatal ultrasonography at 34 weeks' gestation had shown the aneurysm, which at that time was interpreted as a renal cyst. At operation, an 8-mm polytetrafluoroethylene tube graft was interposed between the infrarenal aorta and the bifurcation. Cardiopulmonary bypass facilitated operative management by permitting return of blood lost and by maintaining body temperature. In a review of the literature, the authors could not find any report of a neonatal aneurysm of this magnitude. Regrettably, the cause of this true aneurysm remains obscure.

Aorta, Abdominal↗
PubMed1989

Delayed sternal closure: a lifesaving maneuver after early operation for complex congenital heart disease in the neonate.

Early repair of complex congenital heart malformations may lead to life-threatening respiratory and hemodynamic embarrassment on sternal closure. To avoid a fatal outcome in these situations, we postponed sternal closure in nine critically ill neonates by suturing silicone elastomer sheeting to the skin edges. This maneuver, in a setting of optimal inotropic and ventilatory support, allowed eight of the nine neonates to survive. The mean age at operation was 10.2 days (range 3 to 31). The mean preoperative weight was 3004.4 gm (range 1550 to 3780). The sternal wound was protected with an impervious silicone elastomer sheeting for a mean of 5.6 days (range 2 to 12). There was no instance of wound infection. The judicious application of this technique after operations for complex congenital heart disease can provide the necessary compliance vital for immediate cardiopulmonary performance and ultimate survival.

Edema↗
PubMed1987

Surgery for thoracic hydatid disease: a North American experience.

The clinical course of 20 patients with 22 thoracic hydatid cysts operated on from 1957 to 1984, was reviewed. Follow-up extended to 27 years (mean, 11.6 +/- 1.5 years [+/- the standard error of the mean]) and was 90% complete. Most patients originated from countries in the Mediterranean region; 5 were native Canadians. The diagnosis was suspected in all but 3 patients preoperatively. Fourteen patients had 16 primary lung cysts, 4 had infected liver cysts with intrathoracic extension, 1 had synchronous unruptured liver and lung cysts, and 1 had a thymic cyst. Nine cysts were intact, whereas 13 had ruptured preoperatively. A variety of surgical procedures was performed, including eight wedge resections and nine lobectomies. There were no early deaths, and perioperative complications were infrequent. One patient with a hepatic cyst that had ruptured into the right pleural space and right lower lobe died at 7 months of massive echinococcosis of the liver and intraabdominal sepsis. There has been no evidence of thoracic recurrence in any of our long-term survivors, although 1 patient had undergone enucleation of a left lung cyst in Greece 15 years prior to her reoperation here for a lingular recurrence. We conclude that thoracic hydatid disease is a rare entity in northeastern North America. The prevalence of ruptured cysts and infected hepatic cysts involving the lung was higher than in most other series, thereby necessitating more aggressive surgical treatment. Nevertheless, morbidity was low, and recurrence of disease was uncommon in long-term follow-up.

Adolescent↗
PubMed1985

Improvement in resting ventricular performance following coronary bypass surgery.

To assess the changes in resting left ventricular (LV) function following coronary bypass surgery, technetium 99m-labeled multiple equilibrated blood pool gated scans were performed in 53 consecutive patients at rest, before operation, and at 24 hours and 1 week after operation. Left ventricular ejection fraction (LVEF) and end-diastolic volume (EDV) were measured. The LVEF increased significantly from a preoperative value of 49 +/- 2% to 56 +/- 2% at 24 hours after operation (p less than 0.05) and 56 +/- 2% at 1 week following operation (p less than 0.05 compared with the preoperative value). The EDV also exhibited significant changes, decreasing from a preoperative value of 148 +/- 8 ml to 91 +/- 11 ml at 24 hours (p less than 0.001) and 114 +/- 9 ml at 1 week (p less than 0.01 compared with the preoperative value). When the patients were divided into two groups according to the preoperative LVEF (Group 1, LVEF of greater than or equal to 50%; Group 2, LVEF of less than 50%), the observed changes were similar. This study demonstrates significant improvement in resting LV function 24 hours following coronary bypass surgery. This improvement persists at 1 week and is not related to the degree of preoperative impairment. We conclude that the combination of successful revascularization and optimal myocardial protection can result in significant improvement of LV function at rest.

Adult↗
PubMed1985

Chylopericardium following cardiac surgery.

Chylopericardium is one of the rarest complications of cardiac surgery. The authors report only the 19th case, that of a 12-year-old boy. The chylopericardium developed after an aortic valvotomy, even though the retropericardial portion of the mediastinum was entered only to pass a tape around the ascending aorta. Etiologic factors are directly or indirectly related to injury to the thoracic duct or tis tributaries. Treatment initially is conservative, consisting of adequate pericardial drainage and a low-fat, medium-chain triglyceride diet. If this fails, the appropriate operative procedure is carried out.

Aortic Valve↗
PubMed1983

Electrical behavior of the heart following high-potassium cardioplegia.

The electrical activity of the heart was studied in 25 patients undergoing elective coronary artery bypass grafting. Simultaneous surface electrocardiograms and bipolar atrial electrograms were monitored continuously from the onset of cardioplegic arrest until normal sinus rhythm was reestablished. Several observations were made. (1) Administration of cardioplegia promptly induced and maintained ventricular arrest in all patients. (2) Atrial activity was seen in 23 patients during global ischemia. (3) Following unclamping, the first sustained rhythm was atrial in 22 patients and was associated initially with high-grade atrioventricular block progressing to 1:1 conduction after a mean reperfusion time of 23 minutes. (4) The time required for complete electrical recovery varied directly with the cross-clamp time and the amount of cardioplegic solution used. (5) Only 3 patients required ventricular defibrillation. (6) In the postoperative period, supraventricular tachyarrhythmias developed in 6 patients. Their occurrence appeared to be related to prolonged atrial activity during the cross-clamp period. Although cardioplegia administration maintained ventricular arrest, sustained atrial activity often was present, perhaps implying inadequate atrial protection and predisposing to atrial arrhythmias. Normal sinus rhythm was reestablished spontaneously in all patients. The atrial electrogram proved essential in the precise intraoperative recognition of cardiac rhythm.

Adult↗
PubMed1983

Persistent atrial activity during cardioplegic arrest: a possible factor in the etiology of postoperative supraventricular tachyarrhythmias.

We assessed the relationship between the duration of atrial activity during the cross-clamp period and the postoperative occurrence of supraventricular tachyarrhythmias in 50 patients undergoing elective coronary bypass operation. The atrial electrical activity was monitored continuously by means of a bipolar atrial electrogram from the onset of cardioplegic administration until removal of the aortic cross-clamp. While ventricular arrest was induced promptly and maintained in all patients, sustained atrial activity was observed in 44 out of 50 patients during the cross-clamp period. In the postoperative period, supraventricular tachyarrhythmias developed in 15 patients (Group 1). Thirty-five patients (Group 2) were free from such tachyarrhythmias. There was no significant difference between the two groups with respect to cross-clamp time, bypass time, amount of cardioplegic solution used, or number of grafts per patient. The mean duration of atrial activity during cardioplegic arrest, however, was significantly longer in Group 1 than in Group 2 (46 +/- 4.7 minutes versus 22.6 +/- 4.0 minutes, respectively, p less than 0.001). None of the 6 patients in whom atrial activity was completely abolished experienced supraventricular tachyarrhythmias. The strong correlation observed between the duration of atrial activity during cardioplegic arrest and the incidence of postoperative supraventricular tachyarrhythmias suggests the possibility that these arrhythmias may be a manifestation of inadequate atrial protection during global myocardial ischemia.

Arrhythmias, Cardiac↗
PubMed1983

Atrial electrical activity and its suppression during cardioplegic arrest in pigs.

Right atrial electrical activity and myocardial temperatures of all four chambers were monitored during a 1 hour period of cardioplegic arrest in 20 pigs subjected to different methods of venous cannulation and cardiac cooling. Myocardial protection was provided by systemic hypothermia (28 degrees C) and intermittent intra-aortic administration of cold (4 degrees C) hyperkalemic (20 mEq/L) crystalloid cardioplegia. The use of a single right atrial cannula for venous drainage was associated with sustained atrial activity (50 +/- 5.5 minutes) during cardioplegic arrest and the warmest right atrial (27 degrees +/- 0.2 degrees C) and right ventricular (20.5 degrees +/- 0.4 degrees C) temperatures. Separate caval cannulation with snaring and right atrial venting decreased right atrial and ventricular temperatures marginally (25.3 degrees +/- 0.5 degrees C and 19.1 degrees +/- 0.4 degrees C, respectively, p less than 0.05) but did not significantly alter the duration of atrial electrical activity (42.2 +/- 2.5 minutes, p greater than 0.05). Addition of an extracavitary right atrial drip of cold (4 degrees C) saline, 750 ml for the 1 hour aortic clamping period, reduced right atrial temperature (22.8 degrees +/- 0.4 degrees C) and activity (24.8 +/- 6.3 minutes) to a significant extent. Intracavitary irrigation of the right atrium with cold saline, in the presence of snared double caval cannulas, decreased right atrial and ventricular temperatures most dramatically (17.0 degrees +/- 0.5 degrees C and 17.5 degrees +/- 0.3 degrees C, respectively, p less than 0.05), reduced the duration of atrial electrical activity by 84% (to 8 +/- 3.9 minutes, p less than 0.01), and diminished the total number of atrial contractions per hour of aortic clamping by 88%. It is concluded that intracavitary right atrial cooling with separate snared caval cannulation is the most effective method of ensuring atrial inactivity and prolonged right heart hypothermia during cardioplegic arrest.

Animals↗
PubMedDate not supplied

Successful repair of recurrent coarctation after neonatal heart transplantation.

Neonatal orthotopic heart transplantation is an attractive primary surgical therapy for severe uncorrectable congenital heart defects such as variants of the hypoplastic left heart syndrome. Aortic arch reconstruction is frequently required to repair the hypoplastic aortic arch and the coarctation at the time of graft implantation. Residual coarctation of the aorta after neonatal heart transplantation for such a condition has satisfactorily been treated with percutaneous balloon dilatation. We describe the successful surgical repair of a recurrent coarctation of the aorta via a sternotomy in a 2-year-old patient who had previously undergone neonatal orthotopic heart transplantation. Postoperative periodic investigations have not shown any evidence of obstruction across the site of the primary end-to-end anastomosis.

Anastomosis, Surgical↗