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Biomedical subjects

C L Stowe

Publications and source records attributed to C L Stowe.

8 recordsLinked to original sources
PubMed1998

Surgical management of ascending and aortic arch disease: refined techniques with improved results.

BACKGROUND: Treatment of aneurysms of the ascending aorta, arch aorta, or both is surgically challenging and has traditionally carried a high hospital mortality rate. The use of refined operative techniques, including improved grafts, enhanced myocardial protection, retrograde cerebral perfusion with circulatory arrest, transesophageal echocardiography, and control of hematologic factors, has resulted in reduced hospital mortality rates. METHODS: We conducted a retrospective analysis of records of 117 consecutive patients who underwent 118 procedures between March 1987 and September 1997, for graft replacement of the ascending or transverse aortic arch with or without aortic valve reconstruction or replacement. There were 67 men (57.3%) and 50 women (42.7%). The mean age was 61.4 years (range, 16 to 81 years). Aortic abnormalities were medial degeneration in 59 patients (50.0%), dissection in 28 patients (23.7%), atherosclerosis in 16 patients (13.6%), Marfan's syndrome in 8 patients (6.8%), and other in 7 patients (5.9%). RESULTS: The ascending aorta alone was replaced in 58 patients (49.2%), ascending and arch aorta in 56 patients (47.5%), and isolated arch aorta in 4 patients (3.4%). Twenty-six patients (22.0%) required aortic valve reconstruction, 17 patients (14.4%) had separate aortic valve replacement, and 37 patients (31.4%) received a valve conduit. Overall hospital mortality rate was 3.4% (4 of 117 patients). Postoperative complications included myocardial infarction in 3 patients (2.5%), stroke in 7 patients (5.9%), pulmonary insufficiency in 22 patients (18.6%), renal insufficiency in 4 patients (3.4%), and reoperation for bleeding in 8 patients (6.8%). There were no deep sternal wound infections. Follow-up was completed for 112 (99.1%) of 113 survivors and ranged from 1 month to 10.6 years (mean, 39.5 months). Actuarial survival for patients discharged from the hospital was 87.9%+/-3.7% (standard error of the mean) at 3 years and 79.7%+/-5.8% at 6 years. CONCLUSIONS: Graft replacement of the ascending and transverse aortic arch, although technically demanding, can be performed with low hospital mortality and morbidity rates.

Adolescent↗
PubMed1992

Intraoperative identification of a radiofrequency lesion allowing validation of catheter mapping of ventricular tachycardia with a computerized balloon mapping system.

Radiofrequency current was utilized to mark the anatomic location of earliest endocardial activation during catheter mapping of ventricular tachycardia. Intraoperative identification of the radiofrequency lesion allowed validation that the site of earliest endocardial activation determined by a catheter mapping study was the same as assessed by a computerized balloon mapping system. Radiofrequency current may be a useful method of marking areas of endocardium thought to be potential sites for ablative surgery as well as allowing correlation between different mapping techniques.

Cardiac Catheterization↗
PubMed1989

Mitral valve reconstruction in the elderly population.

The technique, efficacy, and long-term results of mitral valve reconstruction have been well demonstrated and reported by Carpentier and other investigators. However, most of the results reported have been in patients aged less than 65 years. Between April 1985 and September 1988, we performed mitral valve reconstruction in 176 patients using Carpentier's classification and technique for repair. Ages ranged from 15 to 86 years (mean age, 63 years). Of the repairs, 96/176 (55%) had concomitant cardiac procedures. Patients aged 65 years or more accounted for 52% (92/176) of the population and 35% (65/176) were more than 70 years old. Hospital mortality (30 day) was 4% (4/84) in the group aged less than 65 years. Hospital mortality for the group aged more than 65 years was 12% (11/92), compared with an overall 8.5% mortality. These results suggest an increased morbidity with mitral valve repair in the patients aged more than 65 years, but this group represents an even higher risk group with mitral valve replacement.

Adolescent↗
PubMed1985

Inflammatory aneurysms of the aorta.

This report concerns 30 patients with the acute form of "inflammatory aneurysm" of the aorta treated during a 27-year period between April 1957 and March 1984. There were 28 men and two women whose ages ranged from 46 to 78 years (most over 60 years). All were heavy smokers. The aneurysmal disease was located below the renal arteries and the inflammatory changes were limited to the abdomen in 24 patients; one patient had a ruptured aneurysm. The aneurysm involved the entire abdominal aorta in one, the descending thoracic and infrarenal abdominal aorta in two, and the descending thoracic and abdominal aorta in continuity in three patients. The inflammatory changes occurred grossly and microscopically in both abdominal and thoracic aortic segments in five of the latter six patients. The changes were manifested by anterior and lateral mural inflammatory thickening contiguous with similar changes of the retroperitoneum and mediastinum that produced varying degrees of ureteral obstruction in seven patients. Most had abdominal, back, or flank pain and abdominal tenderness, suggesting rupture or leakage. Emergency exploratory operation had been performed elsewhere in 10 patients. Operation was abandoned because of exposure difficulties, bowel perforation, or visceral arterial involvement. Diagnosis was suggested by CT scan in 10, ultrasonography in one, and excretory urograms in seven patients. Treatment consisted of thoracoabdominal aortic replacement in six and infrarenal aortic replacement in 24. The aorta was clamped at the diaphragm in most of the latter cases to avoid injury to adjacent structures. Nephrectomy or ureterolysis was rarely necessary. Of these 30 patients, 29 were early (30 day) survivors and ureteral obstruction spontaneously subsided in most cases without special treatment. There was one late death at 2 months and eight deaths from 3 to 13 years; 20 (67%) patients are still alive.

Acute Disease↗
PubMed1984

Total aortic replacement for chronic aortic dissection occurring in patients with and without Marfan's syndrome.

Total aortic replacement including aortic valve was performed successfully in the two patients in whom this method of treatment was utilized to correct a chronic dissecting aortic aneurysm. Both patients had moderately severe aortic insufficiency producing increasing heart strain and progressive enlargement of the false lumen of aortic dissection involving the entire aorta despite ideal blood pressure control. In addition, one patient had Marfan's syndrome. The surgical treatment for both patients was performed in two stages. At the first operation, cardiopulmonary bypass, profound hypothermia, and circulatory arrest were employed while the aortic valve and the ascending and transverse aortic arch were replaced and the coronary and brachiocephalic vessels were reattached to the composite valve-graft used for replacement. At the second operation, the entire descending thoracic and abdominal aortic segments were replaced with a graft and the intercostal, lumbar, and visceral arteries reattached thereto. Left vocal cord paralysis occurred in both patients and transient mild paraparesis occurred in only one. Both patients are alive and well, one at 13 months and one at 6 weeks. This experience suggests an additional treatment modality for selected patients with complications of chronic aortic dissection.

Aortic Dissection↗
PubMed1984

Aortic arch aneurysm. A sentinel of extensive aortic disease requiring subtotal and total aortic replacement.

Aneurysm of the thoracic aorta is a serious form of disease because it may be extensive or associated with a more distant aneurysm. This manifestation occurs in about one-third of the cases. The actuarial 5-year survival of nontreated patients is only 13% with many patients dying from aortic rupture. The 5-year survival of our patients with aneurysm of the descending thoracic aorta treated by graft replacement is 58% with the two most common causes of late death being myocardial infarction and rupture of another aortic aneurysm. Effective treatment consists of initial total aortic examination, continued follow-up examination, and total replacement of disease. Aneurysmal disease that involves the entire aortic arch is especially prone to extensive involvement because it is due to diffuse aortic dissection or medial degenerative disease in most cases. The latter is most common, being present in 63 of our 81 patients requiring total arch replacement. The disease was extensive in all cases with degenerative medial disease and required extensive graft replacement. In fact, the entire thoracic aorta was involved in ten, the entire thoracic aorta and substantial segments of abdominal aorta in ten, and the entire aorta in 12 patients. Most of these patients were women (84%) over 65 years of age (63%) or older, ten (37%) were over 70 years. Associated pulmonary disease was frequent, aortic valvular insufficiency was present in 12 (38%), and symptoms were present in most. Treatment consisted of removing the disease when possible in stages, the arch in one and the remaining disease in another with the sequence and interval depending upon indications and condition of the patient. A total of 53 operations were performed in these 32 patients, the arch replaced in 29, the descending thoracic aorta in eight, and the thoracoabdominal aortic segment in 16 patients. All of the disease was replaced in 21, including the entire aorta in eight and incompletely replaced in 11 patients. Sixteen (76%) of the former are still alive 4 months to 6 1/3 years. Six (55%) of those in whom operation was limited to replacement of the symptomatic aortic segment because of limited risk are still alive. Of the ten deaths occurring during the study period, four (40%) and perhaps five (50%) were due to natural rupture of unresected disease which indicates its progressive nature and suggests the need for aggressive surgical treatment.

Adult↗
PubMed1983

Occlusion of the innominate, common carotid, and subclavian arteries: long-term results of surgical treatment.

During the 23-year period from January 1959 to February 1982, 142 patients (78 men and 64 women) underwent arterial reconstructive operations for obstruction of the brachiocephalic arteries. A single vessel was involved in 75% and multiple vessels were involved in 25% of the cases. Distal involvement of internal carotid and vertebral arteries was present in 58 (41%) patients. Transthoracic operation was performed in 43 (31%) and extrathoracic operation was performed in 99 (69%) patients. One hundred and thirty-nine patients (98%) survived, and 134 (94%) experienced relief of symptoms. Follow-up was obtained for 136 patients for periods up to 22 years (mean of 7.5 years). Of these, 113 patients remained asymptomatic, eight developed transient strokes, four developed persistent strokes, and 11 (8%) died of stroke. The mean interval after operation in the latter cases was 9.3 years. Survival rates at 5, 10, and 15 years were 85%, 58%, and 25%, respectively.

Adolescent↗