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Biomedical subjects

C M Durán

Publications and source records attributed to C M Durán.

At least 19 recordsLinked to original sources
PubMed1988

Long-term results of conservative repair of rheumatic aortic valve insufficiency.

From July 1974 to January 1986, 50 patients underwent conservative repair for rheumatic aortic valvular disease at our institution. Eleven were male and 39 female, with an average age of 39.5 years (range 17-57). The aortic lesion was associated in all cases with a predominant mitral lesion. Twenty-five also had tricuspid disease which was surgically treated in 17. Twenty-six had aortic regurgitation and 24, a mixed lesion. The surgical techniques used were: (1) commissurotomy, (2) annuloplasty, (3) cusp free edge unfolding and (4) supra-aortic crest enhancement. Two patients had one cusp extended with pericardium. There were 3 hospital deaths (6%). Six patients were lost to follow-up at different periods. Maximum follow-up was 12.58 years with a mean of 7.78 years per patient. Twelve required reoperation with 3 deaths. Three reoperations were due to failure of the mitral bioprosthesis without reoperation on the aortic valve. Of the remaining 9 patients who had aortic and mitral dysfunction, 4 had severe aortic insufficiency. The actuarial freedom from reoperation at 13 years was 75% and the overall actuarial survival was 86%. It is concluded that these surgical techniques can be applied successfully in moderate rheumatic aortic valve disease accompanying a predominant mitral lesion. This is particularly relevant when a mitral reconstruction has been performed.

Adolescent↗
PubMed1988

Mitroflow heart valve: 5.5 years clinical experience.

From March 1982 through December 1986, 139 Mitroflow pericardial heart valves were utilized in 129 patients. There were 69 males and 60 females, with an average age of 55.2, range 26 to 74 years. Eighty-nine patients underwent isolated aortic valve replacements, 27 isolated mitral valve replacements, 3 isolated tricuspid valve replacements, 10 mitro-aortic valve replacements. In 27 cases (20.9%) additional cardiac surgery was performed. Maximum follow-up was 5.5 years with a mean of 37.9 months. The cumulative follow-up was 407.25 patient-years. Overall hospital mortality was 1.6% (2 cases). There were 3 late deaths in this series (2.4%). The linearized incidence of late mortality was 0.49% per patient-year. The survival actuarial curve was 96% +/- 1.8. The incidence of thromboembolism was 1.22% per patient-year, and the actuarial thromboembolism-free rates was 93% +/- 2.7. Prosthetic endocarditis occurred in one patient. Three patients developed primary tissue failure of the Mitroflow valve in the mitral position. The linearized incidence of primary tissue failure was 0.73% per patient-year and the actuarial freedom from primary tissue failure was 95% +/- 3.2. A total of 4 patients underwent reoperation (0.49% per patient-year). In conclusion, the clinical performance of the Mitroflow pericardial heart valve at medium-term follow-up is satisfactory, however a significant number of early mitral primary tissue failures have already occurred.

Adult↗
PubMed1986

Comparative study of primary tissue valve failure between Ionescu-Shiley pericardial and Hancock porcine valves in the aortic position.

From August 1977 to June 1981, 221 patients received a Hancock porcine valve and 133 an Ionescu-Shiley bovine (I-S) pericardial valve as aortic valve substitutes. No special selection or randomization was used and no patient with either of these types of valves was excluded. Preoperative data show no differences between the groups influencing the appearance of primary tissue failure. Hospital survivors were followed until June 1984 and those with an uneventful history at least 36 months. Patients who died late postoperatively or who underwent reoperation for causes other than primary dysfunction were considered at risk until death or reoperation. Primary tissue failure occurred in 8 patients in the I-S group from 36 to 70 months postoperatively and in 6 patients of the Hancock group from 24 to 83 months. Linearized rates of primary failure were 0.61 valves per 100 patient-years for the Hancock and 1.70 valves per 100 patient-years for the I-S group. Mean age of patients with failing valves was 38 years (range 25 to 55) for Hancock valves and 39 years (range 15 to 62) for I-S valves. Actuarial analysis shows a lower rate of primary dysfunction in the Hancock group since the fourth year, which is statistically significant in the sixth and seventh years (96.5 +/- 1.5% vs 79.6 +/- 7.6% in the sixth year and 93.1 +/- 3.6 vs 79.6 +/- 7.6% in the seventh year). Microscopically, calcium and collagen degeneration were consistently associated and present on failing bioprostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1986

Performance of the Ionescu-Shiley pericardial valve in the aortic position: 100 months clinical experience.

From August 1977 through August 1984, 239 patients underwent aortic valve replacement (AVR) with the Ionescu-Shiley pericardial valve. Isolated AVR was performed in 112 patients and associated cardiac surgery in 127 patients (53.1%). One hundred twenty-eight patients were males and 111 females, with an average age of 50.6 years (range 15 to 78 years). There were 24 hospital deaths (10%) and 15 late deaths (8.9%). The expected 100 months survival rate was 82.8 +/- 5.5 (91.3 +/- 5.6% for isolated AVR, and 75 +/- 7.8% for associated AVR). All patients were postoperatively studied until December 1985. The cumulative duration of follow-up was 894.08 patient-years, with a mean follow-up of 44.9 months per patient. There were 10 thromboembolic episodes in this series (3 peripheral and 7 central), with a linearized incidence of 1.1% per patient-year. The actuarial projection of freedom from thromboembolic episodes at 100 months follow-up was 94.4 +/- 3.4% (96.9 +/- 2.2% for isolated AVR, and 92.6 +/- 3.9% for associated AVR). Twenty-five patients required reoperation (2.79% per patient-year): 6 for infective endocarditis, 3 for paravalvular leak, one for valve thrombosis, 3 for another valve explantation, and 12 for primary tissue failure (1.3% per patient-year). In conclusion, the Ionescu-Shiley valve has a satisfactory performance in the aortic position at long-term follow-up. In our experience, the higher rate of postoperative complications occurred among patients with concomitant cardiac surgery, so not necessarily related to this pericardial valve.

Adolescent↗
PubMed1986

A new absorbable annuloplasty ring in the tricuspid position: an experimental study.

An absorbable bovine fibrin annuloplasty ring was implanted in the tricuspid position in 30 adult mongrel dogs to determine the rate of absorption and the effectiveness of this new method of annuloplasty. There were 4 early deaths. The remaining 26 dogs survived the operation and were electively sacrificed. The cumulative follow-up was 111.5 months (14 days to one year). Mean follow-up was 4.2 months per animal. Six dogs sacrificed between 2 and 4 weeks (group I) showed mild to moderate ring surface erosion and a fibrinous capsule covering the prosthesis. Nine out of 10 specimens showed total absence of the ring 1 to 2 months after surgery (group II), and all bovine fibrin tissue had disappeared in the 10 remaining dogs after 2 months of implantation (group III). In 2 cases small areas of chondroid degeneration were detected 4 months after surgery. This concept of a time-controlled biodegradable annuloplasty might be useful, although further studies are needed before its clinical application.

Absorption↗
PubMed1985

Tricuspid commissurotomy.

The technique of tricuspid commissurotomy is based on principles different from those employed in mitral valve commissurotomy. In performing tricuspid commissurotomy, it is essential to identify and split the fan chordae, which are always fused and which clearly delineate the fused commissures. Failure to do this can result in an incorrect commissurotomy and secondary massive insufficiency. Our technique of tricuspid commissurotomy, employed in 205 patients, is presented.

Heart Valve Prosthesis↗
PubMed1984

Degeneration in porcine bioprosthetic cardiac valves: incidence of primary tissue failures among 938 bioprostheses at risk.

From June 1974 through December 1980, 938 porcine xenografts were inserted in 794 selected patients who survived surgery and who were considered at risk for primary tissue valve failure. Sixty-three instances of primary tissue valve degeneration occurred in 59 of the 794 patients. In patients operated on 9 years ago, 29% of the valves implanted in the mitral position (5 of 17) and 27% in the aortic position (3 of 11) failed. These percentages decreased to 18% (14 of 80) and 20% (11 of 54) for those implanted in 1975, 8% (6 of 73) and 14% (7 of 51) for those implanted in 1976, 9% (6 of 68) and 5% (4 of 76) for 1977, and 4% (3 of 79) and 3% (2 of 63) for 1978. The average interval between valve placement and explantation or death was 56 months (range 10 to 98) for valves in the mitral position and 68 months (range 12 to 92) for valves in the aortic position. The rate of valve survival without degeneration was 98 +/- 1% at 4 years, 96 +/- 2% at 5 years, 90 +/- 3% at 6 years, 87 +/- 4% at 7 years and 76 +/- 7% at 8 and 9 years. Until 1978, 4 valves failed, 8 failed in 1979 to 1980, 12 in 1981, 25 in 1982, and 14 have already failed from January to May 1983. Our figures show a progressive increase in valve degeneration with the passing of time. No leveling of this failure rate has so far been observed.

Adolescent↗
PubMed1983

Composite pericardial monocusp patch for the reconstruction of right ventricular outflow tract. Clinical application in 7 patients.

Right ventricular outflow tract (RVOT) reconstruction with a new composite pericardial monocusp patch incorporating a sinus of Valsalva was performed in 7 patients. There was one hospital death. Follow-up ranged from 20 to 52 months (mean 25.4 months, cumulatively 206 patient months). Four patients have been recatheterized at an average of 6.5 months (1 to 12 months) after surgery. The average RVOT gradient was 9 +/- 2 mmHg, and mean right ventricular end-diastolic pressure was 10 +/- 5.5 mmHg. All except one have a competent pulmonary valve with normally functioning monocusp, and no thrombosis, calcification or aneurysmal dilatation.

Adolescent↗
PubMed1981

Right ventriculography as a valid method for the diagnosis of tricuspid insufficiency.

The value of right ventriculography in the diagnosis of tricuspid insufficiency (TI) is often questioned because of 1) the high incidence of premature ventricular contractions (PVCs) during injections and 2) interference of the catheter in the valve closure mechanism. In 168 patients a commercially available, not preshaped, balloon-tipped catheter was used for right ventriculography. To avoid the induction of PVCs, the catheter tip was placed in the middle third of the diafragmatic wall of the right ventricle, and the balloon was inflated, becoming trapped by the trabeculae. In this position the catheter's side holes should be located in the inflow chamber. To ensure this correct position, and therefore lack of ectopic beats during angiography, a saline test injection was performed previously in every case. With this technique the incidence of PVCs during ventriculography was only 7.7%. In all but one case, such beats were isolated. The 168 patients were divided into three groups according to their likelihood of experiencing tricuspid interference by the catheter: group 1 included 41 patients with a normal heart or with coronary artery disease. No one from this group had TI. Of group II, 28 patients with right ventricular pressure or volume overload or cardiomyopathy, only 2 had TI, both with a previous clinical diagnosis of regurgitation. Group III contained 99 patients with rheumatic heart disease. Thirty-five of them showed angiographic TI, and 24 of these had this diagnosis confirmed either clinically or at surgery. It is felt that this technique of right ventriculography, with its low incidence of PVCs and slight interference with tricuspid closure, is a valid method for the objective study of the tricuspid valve.

Adolescent↗
PubMed1981

Coronary arteriography and atrial thrombosis in mitral valve disease.

The arteriographic findings of neovascularity and fistula formation from the coronary arteries to the left atrium have occasionally been reported in association with atrial thrombosis in patients with mitral valve disease. To establish the diagnostic value of these findings, the preoperative coronary angiograms of 507 patients who underwent open mitral valve surgery were reviewed. Atrial thrombosis was present in 76 patients (14.9 percent). In the 30 patients with angiographic neovascularity and fistula formation, the thrombi were always observed to arise from the circumflex coronary artery. None of these 30 patients had atherosclerotic coronary lesions. In 25 of these patients an atrial thrombus was found at operation. These coronary arteriographic findings, in this selected group of patients, had a predictive accuracy of 83.3 percent, a specificity of 98.8 percent and a sensitivity of 32.8 percent for the diagnosis of the presence of thrombus in the left atrium. No relation was found between these signs and the size and histologic age of the thrombi examined.

Adult↗
PubMed1978

Intraoperative assessment of mitral valve function.

Clinical, echocardiographic, hemodynamic, and angiographic data can usually assess the preoperative status of the mitral valve quite accurately. However, there is need for an intraoperative method to observe the dynamic function of the mitral valve, particularly after an open commissurotomy, or to determine the efficacy of a valvoplasty. Our experience with more than 250 mitral annuloplasties has led to the development of a safe method for direct observation of the mitral closure mechanism using the left ventricular vent and a slight modification of the usual cardiopulmonary circuit.

Animals↗