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Biomedical subjects

C Vicol

Publications and source records attributed to C Vicol.

At least 19 recordsLinked to original sources
PubMed2005

Minimally invasive off-pump pulmonary vein isolation to treat paroxysmal atrial fibrillation.

BACKGROUND: Minimally invasive off-pump pulmonary vein isolation to cure paroxysmal atrial fibrillation (PAF) may be an alternative to percutaneous catheter-based procedures. METHODS: Three patients with highly symptomatic lone PAF refractory to medical treatment and having undergone unsuccessful catheter-based ablation underwent pulmonary vein isolation using the Cardioblate BP device with a minimally invasive approach. RESULTS: There were no complications and all patients were discharged in sinus rhythm. Mean ablation time per lesion was 15.2 sec and mean operation time was 118 min. CONCLUSIONS: Irrigated bipolar radiofrequency ablation of the pulmonary veins is safe and can be performed off-pump in a minimally invasive manner.

Atrial Fibrillation↗
PubMed2004

[ECG-gated bypass CT angiography--application in imaging arterial bypasses].

Nowadays coronary artery bypass grafting is increasingly performed using arterial grafts. Purpose of the study was the evaluation of a appropriate 16 detector-row CT angiography protocol in patients after predominantly arterial bypass grafting. Fourteen patients after bypass grafting were including into the study and CT angiography carried out in the early postoperative period using a 16 detector-row CT system. To reduce cardiac pulsation artifacts data acquisition was implemented using ECG-gating algorithms. Overall 43 grafts (37 arterial, 6 venous) were examined. In 13 patients surgery had been performed using composite grafts with T or TY configuration. The mean heart rate was 74.1 bpm and showed a negative correlation to the image quality (r=-0.65; p=0.01). However, all data sets were diagnostic. Contrast injection protocol allowed for a homogeneous opacification throughout the vessels of interest. All non-delineationable grafts (5) showed a close proximity to the heart (T or Y grafts). Cardiac surgery is increasingly focusing on arterial revascularisation in bypass grafting and therefore leading to new demands for non-invasive bypass graft imaging. 16 detector-row CT allows a reliable visualization of even composite arterial grafts. However, for detection of grafts in the proximity of the heart a reduction of the heart rate (<65-70) still seems to be necessary.

Aged↗
PubMed2003

[Total arterial myocardial revascularization--strategy, early and midterm results].

Total arterial myocardial revascularization (TAMR) represents a new alternative procedure to the classical aorto-coronary bypass operation with venous graft material. The early and midterm results with the use of the left and right internal thoracic artery (LITA and RITA) and radial artery (RA) for coronary artery bypass grafting are analyzed to assess the suitability of these conduits for myocardial revascularization. From June 1997 to June 2001, 234 patients suffering from a coronary artery disease underwent TAMR at our institution. The bypass material consisted of 234 LITAs, 160 RITAs and 84 RAs. The most frequently used conduit combination was a T-graft (n=213) consisting of a free arterial graft (RITA or RA) centrally implanted into LIMA "in situ" using an end-to-site grafting technique. The mean left ventricular ejection fraction was 0.59+/-0.4. In 150 patients (64.1%), the operation was performed on an urgent basis and in 24 cases (10.2%) it was a reoperation. A mean of 3.3+/-0.9 coronary anastomoses per patient was performed. The mean aortic cross-clamping time was 71+/-20 minutes. In 194 cases (83%), the postoperative course was uneventful. The early mortality was 0.8% (n=2). Complications included myocardial infarction in 4 patients (1.7%), sternal infection in 2 (0.8%), renal insufficiency in 2 (0.8%), prolonged respiratory ventilation in 28 (11.9%) and reoperation for bleeding in 6 (2.5%). At a mean follow-up of 25+/-1.3 months 197 patients (96.6%) were asymptomatic. Late mortality was 3.3% (n=7). TAMR is a safe and reliable procedure with very good early and midterm results. The results reported in this study support the widened use of this coronary artery grafting strategy.

Adult↗
PubMed2002

[Temporomandibular ankylosis. A treatment method using the interposition of a Dacron device].

BACKGROUND: Temporomandibular ankylosis with its multiple anatomo-clinical forms is a relatively rare disease. Its major morphopathological, therapeutical and psychological implications rank it among severe illnesses. Its treatment is exclusively surgical. The major therapeutical indication in ankylosis of type I and II Topazian is the neoarticular modelling osteotomy with interposition. MATERIAL AND METHODS: As a material for interposition, over the last 7 years, we have used in 15 patients with 18 ankylosis, concave rectangular Dacron fragments adequately shaped after being taken from a vascular prothesis. RESULTS: The qualities of this material are confirmed by the obtained results: quick resuming of the normal mobility of the mandible, lack of postoperative complications and recurrences. The material is cheap and easy to be obtained. The technique to be used is simple. DISCUSSION: The Dacron texture is soft, elastic in all respects, thick enough, resistant, with long lasting elasticity and integrity, physically and chemically sTable, well tolerated by the body and without foreign body rejection. It is easy to be cut, shaped, modelled and adapted to the bone stump. It is sterilized by autoclaving. It is also well integrated into the host tissue being penetrated by the connective tissue which fastens it to the surface of the neocondyle preventing a relapse. It plays the role of a joint cartilage.

Adolescent↗
PubMed2001

Morphology and patency of Gore-Tex wrapped internal mammary artery bypass-evaluation with helical CT.

OBJECTIVE: To determine the patency of coronary internal mammary artery bypass (IMAB) with CT-angiography (CTA) and to evaluate the morphology of a covering Gore-tex IMAB-sleeve (PIMAS) used to protect the bypass at possible reoperation. MATERIALS AND METHODS: Sixty-five patients with IMAB wrapped with PIMAS (67 grafts) were prospectively investigated by CTA for bypass patency and sleeve morphology 6 months postoperatively with a standardised radiological and clinical protocol. RESULTS: All patent bypass arteries (62/62) were identified by CTA as open. In the remaining five cases, CTA revealed a bypass occlusion, which could be proven by coronary angiography in two cases (two patients refused angiography, one bypass was open angiographically). Morphology of the PIMAS could be imaged exactly in all cases. Sleeve implantation did not lead to adverse effects in terms of bypass occlusion or compression. In four patients, additional clinically relevant information were achieved. CONCLUSION: PIMAS implantation proved to be a safe procedure with good short-term results. CTA is a valuable method to exclude occlusion of sleeved IMA bypasses. Depiction of the wrapped IMAB by CTA supplies important information for preparing strategy in case of reoperation.

Adult↗
PubMed2001

[Percutaneous hydromechanical thrombectomy in acute and subacute lower limb ischemia].

PURPOSE: A prospective study should evaluate the primary and 2-year results of treating acute and subacute lower-limb ischemia with hydromechanical thrombectomy (HTE). MATERIALS AND METHODS: Consecutively 64 patients, 12 with viable and 52 with threatening limb ischemia and onset of symptoms within 8 +/- 9 days, were treated and controlled for 24 months. An 8 F hydromechanical thrombectomy device (HTK), was used. It sucks and shreds the thrombi. The shredded particles are transported to the outside. RESULTS: In 8 patients a total, in the others a partial restoration of the vessel lumen up to 70-50% was achieved in a mean time of 34 minutes. Residual thrombi, underlying atherosclerotic vessel disease and occluded arteries with a small diameter made adjunctive interventions (balloon angioplasty, percutaneous aspiration thrombectomy, lysis) necessary. Clinical symptoms and the ankle-brachial index improved significantly (p < 0.01). Primary patency was 72%, 70%, 67%, and 65%; the limb salvage rates were 81%, 78%, 75%, and 73% for one, 3, 12, and 24 months respectively. Device-induced complications did not occur. CONCLUSIONS: The HTK allowed a rapid reduction of fresh thrombotic material without complications. In 78% of the cases adjunctive therapies are required for wall-adherent thrombi and when tibial vessels with smaller lumina are included. Long-term results are comparable to literature data for fibrinolytic or operative regimens. The advantage, however of the HTK seems to be the reduction of intervention time and intra-arterial dosage of fibrinolytic drugs.

Acute Disease↗
PubMed1999

Shredding embolectomy thrombectomy catheter for treatment of acute lower-limb ischemia.

We undertook a prospective evaluation to prove a new mechanical thrombectomy device, the shredding embolectomy thrombectomy catheter (S.E.T. catheter), for the treatment of patients with acute lower-limb ischemia. The study evaluated the success, patency, mortality, limb salvage, and complication rates for 51 patients treated from January 1994 through June 1996, with this device, which was an 8-F three-lumen catheter. The onset of symptoms was 8.6 +/- 9 days. Thrombus length was 18 +/- 9 cm situated in 44 native vessels and in 7 bypasses, 42 limbs were graded as threatened. Hydromechanical thrombectomy with the S.E.T. catheter proved to be a quick and safe adjunct for therapy of acute femoropopliteal thromboembolic occlusions with a high initial success rate and an acceptable mid-term patency rate.

Acute Disease↗
PubMed1998

[Surgical treatment of acute pericardial tamponade in an infestation of the heart by Echinococcus].

HISTORY AND CLINICAL FINDINGS: A 56-year-old turkish patient, previously in good health, was admitted because of pain suggesting myocardial infarction. Physical examination of the heart, lungs and abdomen was unremarkable. INVESTIGATIONS AND DIAGNOSIS: The concentrations of myocardium-specific enzymes were not elevated and the ECG showed no signs of ischaemia. Echocardiography and magnetic resonance imaging ruled out acute aortic dissection, but demonstrated a round cystic space-occupying mass over the anterior wall of the heart. Hydatid cyst was suspected from the imaging results and the patient's origin from area endemic for Echinococcus. The diagnosis was confirmed by a titre of 1:6,400 (normal: 1: < 100) for Echinococcus antibodies. TREATMENT AND COURSE: Albendazole administration was initiated. Planned elective surgical removal of the hysatid cyst had to be performed urgently because of acute pericardial tamponade. Cyst rupture was suspected but an actually undamaged cyst was subtotally removed under cardiopulmonary bypass. The postoperative course was uneventful and albendazole treatment was continued. CONCLUSION: Because of the high incidence of fatal complications urgent surgical removal under cardiopulmonary bypass is the treatment of choice for hydatid cyst involving the heart. Perioperative albendazole administration is also essential.

Acute Disease↗
PubMed1998

[Clinical, anatomical-pathological and therapeutic correlates of benign intracavitary heart tumors].

Benign intracavitary cardiac tumors lead to "malignant" complications, so early diagnosis and adequate treatment are of vital importance. Our investigation summarizes a 10-year experience after surgical treatment of 29 patients suffering from benign intracavitary cardiac tumors. The postoperative histological examination revealed a myxoma in 27 cases; in 2 cases a papillary fibroelastoma was diagnosed. The main symptom in 19 patients was dyspnea. In 8 cases an embolic event occurred. All patients underwent extirpation of the tumor. Early mortality was 10%, while late mortality was 4%. The treatment of choice of benign intracavitary cardiac tumors is extirpation, which, due to unpredictable embolic complications, is to be carried out immediately should the tumor have a lobulated tuberous surface. In such cases the descriptive function of echocardiography is of considerable importance.

Adult↗
PubMed1998

Linear repair versus ventricular reconstruction for treatment of left ventricular aneurysm: a 10-year experience.

OBJECTIVE: To describe a 10-year experience with surgical treatment of left ventricular aneurysm and compare the results of linear repair and ventricular reconstruction. DESIGN: A retrospective data analysis. SETTING: Department of cardiothoracic surgery. PATIENTS: All patients treated with concurrent coronary artery bypass revascularization and surgical repair of ventricular aneurysm from 1985 to 1995. METHODS: Patients underwent either linear repair after aneurysmectomy (group A; n=51) or reconstruction of the left ventricle using a patch (group B, n=10). Preoperative patient characteristics and postoperative mortality and symptomatic results in the two groups were compared with chi(2) and paired "t"-tests. RESULTS: The early mortality rates were 9.8% overall, 7.8%, in group A, and 20% in group B. During a mean follow-up of 58 months, the late mortality rates were 34.5%, 38.2%, and 12.5%. In comparison to patients in group A, those in group B had higher preoperative rates of seriously impaired left ventricular ejection fraction (p=0.01) and pathologic left ventricular end-diastolic pressure (p=0.03) and a prolonged operative aortic cross-clamp time (p=0.04). Early mortality in group B may have been influenced by the initially impaired hemodynamic function and the cross-clamp time. In the longterm, patients in group B had more symptomatic improvement than those in group A (p=0.02). CONCLUSIONS: Ventricular function in patients with left ventricular aneurysm improved after ventricular reconstruction using a patch. Further experience with this procedure should improve postoperative survival and long-term prognosis.

Cardiac Surgical Procedures↗
PubMed1997

[The quadri-cusp aortic valve: a congenital defect, responsible for pathologic changes?].

We report on a 61-year-old patient with considerable insufficiency of a quadricuspid aortic valve and coronary three vessel disease. The congenital quadricuspid aortic valve has become symptomatic due to the development of (post-endocarditic) insufficiency only in the advanced stage of life. It was treated by replacement of the aortic valve and bypass myocardial revascularization. The physiopathology of quadricuspid aortic valve will be discussed.

Aortic Valve↗
PubMed1997

Five steps from a simple data base to an expert system in nutrition.

The paper describes the experience from the Medical Informatics Department--ITC in the field of the human nutrition. The informatic systems were developed staring from a minimal data base and simple programs. The final versions are expert systems running within complex medical informatic products.

Decision Making, Computer-Assisted↗
PubMed1996

[Percutaneous transluminal hydrodynamic thrombectomy--the initial results].

PURPOSE: First clinical applications in the femoro-popliteal vessels of a new system for percutaneous, transluminal hydrodynamic thrombectomy are presented. MATERIAL AND METHOD: Three patients suffering from femoro-popliteal thromboembolic obstruction were treated. A new hydrodynamic 8-F catheter with two lumina was used. The jet leaving at the tip of the catheter shredded the thrombotic material. Using the Venturi effect the thrombus was collected. The shredded material was transported outside through the second channel of the catheter. RESULTS: All obstructions could be removed. Underlying degenerative vessel disease and older thromboemboli needed additional therapy like PTA or aspiration thrombectomy (PAT). CONCLUSIONS: The new catheter is helpful in removing arterial femoro-popliteal thromboembolic obstructions. Additional interventions may be necessary. More clinical experience is needed.

Aged↗
PubMed1995

Paradoxical embolism in the presence of right-to-left shunt due to tricuspid occlusion.

The case of a 33-year-old woman suffering from a paradoxical peripheral embolism in the presence of a right-to-left shunt at the level of an ostium secundum defect is presented. A functional stenosis of the tricuspid valve due to obstruction through a thrombotic atrial mass was found to be responsible for the right-to-left shunt. Treatment consisted of peripheral embolectomy, removal of the atrial mass, and closure of the atrial septum defect.

Adult↗
PubMed1994

The use of intra-aortic balloon pump after surgical treatment of DeBakey type I dissecting aneurysm of the aorta.

The case is reported of a sixty-four-year-old patient with DeBakey type I aortic dissection in whom postoperative extensive intra-aortic balloon pumping was applied. Surgical repair involved replacing the ascending aorta with a Medtronic Hall valved conduit. After surgery severe low-output syndrome occurred. Despite the use of high-dose inotropic drugs the patient could not be hemodynamically stabilized. An intra-aortic balloon pump was finally applied as a therapeutical last resort. Within three days, under counterpulsation, the patient reached a stable hemodynamic condition. After twenty-one days in the intensive care unit, he could be transferred to a normal ward. The patient was discharged on the fifty-fourth postoperative day. During counterpulsation there were no balloon- or catheter-induced complications. Follow-up at five months showed the patient in good general health: echocardiography did not identify any lesions of the thoracic aorta which could be linked to counter-pulsation. It is concluded that the postoperative use of intra-aortic balloon pump in the event of DeBakey type I dissecting aneurysm of the aorta, and adversely affected patient hemodynamics, is a justifiable therapeutical alternative.

Aged↗
PubMed1994

Percutaneous cardiopulmonary support (PCPS).

The cardiopulmonary support system allows to maintain the patient's cardiac and pulmonary functions when the patient's cardiac or pulmonary status is failing. This system consists of a centrifugal pump with its control system, membrane oxygenator, measure devices for blood flow and pressure and a heating system for temperature conditioning of blood. The percutaneous application is easy and fast. Rapid priming, rapid insertion and high flow rates are characteristic for this method. The material costs for cardiac support of one patient are high, the price for one patient amounts to approximately DM 3,500. For the application the presence of an operating cardiologist, an anesthetist and a perfusionist is necessary.

Blood Flow Velocity↗