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Biomedical subjects

D Novitzky

Publications and source records attributed to D Novitzky.

At least 91 records · Page 5Linked to original sources
PubMed1984

The significance of femoral pulses in coarctation of the aorta.

Between January 1974 and December 1981, 80 patients aged between 1 and 13 years underwent surgical correction of coarctation of the aorta. At pre-operative examination 45 patients had absent femoral pulses (group A) and 35 had palpable femoral pulses (group B). Nineteen patients were lost to late follow-up; the remaining 61 (76%) were followed up for between 3 months and 7 years. Of the patients in group A 89% had systolic and 87% diastolic hypertension, while in group B the respective figures were 80% and 77%. At follow-up after surgery, systolic hypertension was present in 36% of patients in group A and in 16% of those in group B. Diastolic hypertension was present in 73% of patients in group A but only in 19% of those in group B (P less than 0,0001). It would appear that children with coarctation of the aorta and absent femoral pulses are more likely to continue to have diastolic hypertension after surgical correction of the anomaly than are children in whom the femoral pulses are palpable. Early operation might reduce the incidence of hypertension in this group.

Adolescent↗
PubMed1984

Valve replacement in patients over 70 years of age.

Between 1 August 1975 and 31 October 1982, 76 patients aged between 70 and 82 years (mean 73,4 years) underwent elective (71) or emergency (5) valve replacements. Fifty patients underwent aortic valve replacement (including 5 with additional coronary artery bypass grafts), 19 mitral valve replacement including 3 with coronary artery bypass grafts, and 7 double valve replacements. There were 3 early deaths (3,9%) and 9 late deaths (11,8%) during the follow-up periods of 1 month - 86 months (mean 29 months). Actuarial analysis showed a survival rate of 95% at 1 year, 89% at 2 years, and 77% at 5 years. The clinical result of operation was judged to be good or excellent in all patients except one. It is concluded that valve replacement in patients over 70 years carries a low operative risk, statistically similar to that for younger patients at our institution, and is accompanied by a satisfactory result.

Age Factors↗
PubMed1984

Prediction of acute cardiac rejection using radionuclide techniques.

Radionuclide scanning of the donor left ventricle using technetium-99m-labelled red cells was used to monitor acute rejection after heterotopic heart transplantation and compared with histopathological evidence of rejection obtained at examination of an endomyocardial biopsy specimen. The ejection fraction and end-diastolic, end-systolic and stroke volumes were calculated at each examination; an equation was derived from these data to predict the degree of acute rejection, using histopathological examination of endomyocardial biopsy specimens as criteria of the presence and severity of rejection. A highly significant multiple correlation between radionuclide scanning parameters and endomyocardial biopsy was found. The advantages of non-invasive radionuclide scanning over the invasive procedure of endomyocardial biopsy are discussed.

Adolescent↗
PubMed1984

Cardiac transplantation following storage of the donor heart by a portable hypothermic perfusion system.

Four patients have undergone heterotopic heart transplantation with donor hearts stored by a portable hypothermic perfusion system. Total ischemic periods ranged from 6 hours 55 minutes to 16 hours 50 minutes. One heart, transplanted into a patient who had acutely rejected a previous graft, suffered accelerated, irreversible, acute rejection within five days, associated with strong antibody formation; donor heart function was never good. In the 3 remaining patients, donor heart function was good after initially being poor for a few hours in 2 patients. One patient died of long-term rejection after 6 months and 1 of tuberculous meningitis after 10 months; 1 remains alive at 15 months. Neither preservation of the donor heart for periods in excess of approximately 4 hours nor the use of continuous hypothermic perfusion as a method of preservation appears to have been reported previously in the context of the clinical situation.

Adult↗
PubMed1983

Coarctation of the aorta in infants under 1 year of age.

Untreated coarctation of the aorta in infants is associated with a high mortality, reaching up to 90%. During a period of 7 years 26 infants underwent surgical repair of this condition, the youngest being 6 days old and the oldest 11 months. Two underwent emergency surgery after catheterization, while the rest had an elective or semi-elective operation. Associated anomalies were present in 85% of the whole group; of the 22 patients with anomalies, a ventricular septal defect (VSD) and patent ductus arteriosus (PDA) were present in 11 patients, a PDA in 7, a VSD in 6, transposition of the great arteries in 3, an atrial septal defect in 3, a single ventricle in 1, a hypoplastic aortic arch in 1, a hypoplastic left ventricle in 1 and a partial anomalous pulmonary venous defect in 1. Four patients (15%) had no other associated anomaly. The surgical techniques used were coarctectomy and end-to-end anastomosis in 61,5%, subclavian flap aortoplasty in 27%, and Dacron patch aortoplasty in 11,5%. Additional pulmonary artery banding was performed in 6 patients; in 2 patients lung biopsies were also carried out in order to establish the severity of pulmonary hypertension. The overall hospital mortality was 30,7%. No patients with uncomplicated coarctation died.

Aortic Coarctation↗
PubMed1983

The surgical technique of heterotopic heart transplantation.

The surgical technique of heterotopic heart transplantation is detailed and illustrated. The donor heart is excised after cardioplegic arrest and topical cooling; its preparation and implantation in the recipient are described. Emphasis is placed on ensuring nonrestrictive anastomoses between the left and right atria of the recipient and the donor, on estimating the optimal length of the donor aorta, and on the insertion of a prosthetic graft between the donor and the recipient pulmonary arteries. Forty-six such transplants have been performed to date without operative or early postoperative mortality related to technical problems.

Heart Atria↗
PubMed1983

Infectious complications after heart transplantation.

Infection has been the major cause of death and morbidity in patients undergoing cardiac transplantation at Groote Schuur Hospital. Twenty-two (55%) patients suffered at least one major episode of infection, which accounted for 10 (59%) of the deaths in the first year. The major site of origin of infection was the lung, though dissemination was not infrequent. Bacteria accounted for 22 (59%) infections; but viral, fungal and protozoal infections were not uncommon and in fact accounted for seven (64%) of the fatal infections. Several unusual causative microorganisms have been isolated in this group of immunocompromised subjects. There is a higher incidence of infection in patients over the age of 35 years and in patients who did not comply with instructions and advice.

Adult↗
PubMed1982

Technique, complications, and clinical value of endomyocardial biopsy in patients with heterotopic heart transplants.

A review of 157 consecutive biopsies of donor endomyocardium in patients with heterotopic heart transplants is reported. The technique of percutaneous transvenous endomyocardial biopsy after this operation is described; manipulation of the catheter and bioptome into the junction of the donor superior vena cava and right atrium can be difficult when this anastomotic junction is small, as a result either of operative surgical technique or of subsequent contraction. The complication rate was 4%, but one patient may have died from infection resulting from biopsy when the bioptome had to be introduced at the groin. The histopathological changes seen in the biopsy specimens have been graded according to a scoring system to give the clinician a guide to the severity of rejection. Histopathological assessment was of clinical value in 96% of cases, but was inaccurate on two occasions, once because an opinion was given on what was in retrospect an inadequate sample. In patients undergoing persistent low-grade acute or chronic rejection there was difficulty in detecting or appreciating the true extent of myocardial fibrosis; this led to inadequate immunosuppressive treatment in two patients. Attention is drawn to the fact that ischaemic fibrosis resulting from the vascular changes of chronic rejection may spare the endomyocardium, which is kept viable by intracavitary blood, and that this may lead to a misleading histopathological report.

Biopsy↗
PubMedDate not supplied

Impact of triiodothyronine on the survival of high-risk patients undergoing open heart surgery.

Experimental and clinical studies have shown the beneficial effects of triiodothyronine (T3) following myocardial revascularization on cardiopulmonary bypass (CPB). In this study, open-label T3 was administered to 68 high-risk patients undergoing open heart surgery. The New Jersey Risk Assessment was used to calculate the preoperative estimated surgical mortality. A loading dose of T3 was administered: (a) at release of the aortic cross-clamp, (b) whenever the patient became CPB dependent, (c) if the patient exhibited low cardiac output after discontinuing CPB and (d) as pretreatment before initiating CPB. All therapeutic modalities were followed by a continuous T3 infusion. Following T3 therapy, CPB was discontinued in all patients. Based upon discriminant analysis, a total of 26 deaths were expected from the entire group, but only 7 patients died, therefore, the observed mortality was reduced by 72% (p < 0.007). The use of T3 had a major impact on reducing surgical mortality, and may be advocated as a new therapeutic modality in patients with high estimated mortality undergoing open heart surgery.

Adult↗
PubMedDate not supplied

Effects of allopurinol pretreatment with pulmonary flush on lung preservation.

This study was designed to test whether use of allopurinol could improve lung preservation after 6 hours of cold storage. Thirty-two rabbits were divided into four groups (n = 8 each group): (1) the control group received no flush or storage, (2) the EC group received Euro-Collins (EC) solution for both flush and storage, (3) the Allo-F group received Euro-Collins solution with allopurinol (1 mmol/L) for both flush and storage, and (4) the Allo-R group received Euro-Collins solution to which allopurinol (1 mmol/L) was added only to the reperfused blood. For groups 2 through 4, the lungs were flushed (40 ml/kg) in situ, excised, and then stored at 4 degrees C. After storage, the lungs were reperfused for 1 hour with an in vitro blood-perfused ventilated model. Lung function was measured during reperfusion with mean pulmonary arterial pressure, end-inspiratory airway pressure, and blood gas data. The lung wet/dry weight ratio was used to measure lung edema. The lungs in the EC group had a significant increase in mean pulmonary arterial pressure, airway pressure, and wet/dry weight ratio when compared with the control group. The mean pulmonary arterial pressure in either of the groups receiving allopurinol was consistently lower than that in the EC group. The airway pressure in the Allo-R group also significantly decreased compared with the EC group.(ABSTRACT TRUNCATED AT 250 WORDS)

Allopurinol↗
PubMedDate not supplied

Successful management of symptomatic cytomegalovirus disease with ganciclovir after heart transplantation.

In the 30-month period from January 1987 through June 1989, 57 patients underwent heart transplantation. Immunosuppressive therapy consisted of a combination of cyclosporine, azathioprine, low-dose methylprednisolone, and antilymphoblast globulin. Clinically significant, proven cytomegalovirus (CMV) disease has developed in no fewer than 22 patients (39%), involving the lung (n = 11), colon (n = 8), stomach (n = 4), and retina (n = 1). The diagnosis was confirmed by direct fluorescent antibody (DFA) (n = 14), histologic study (n = 6), and culture (n = 6) in all cases. The onset of CMV infection occurred at a mean of 5.7 months after heart transplantation (range, 3 weeks to 18 months). All patients were treated with ganciclovir until no sign of active CMV disease could be found. The length of treatment required varied from 2 to 8 weeks (mean, 3.5 weeks). Recurrence has occurred in only one patient, necessitating a further 26-week course of therapy. There were no deaths attributed definitely to CMV disease. There was a higher incidence of acute rejection in the first 3 posttransplant months (0.68 episodes/patient) in the CMV group than in those in whom CMV disease did not develop (0.34 episodes/patient; p less than 0.02). Of the CMV patients, 25% had significant features of graft atherosclerosis during the first posttransplant year, compared with only 8% of the non-CMV patients. In conclusion, (1) there was a high incidence of CMV disease with this immunosuppressive regimen, and we have subsequently discontinued routine antilymphoblast globulin therapy and instituted a triple therapy immunosuppressive protocol with prophylactic immunoglobulin and acyclovir; (2) CMV disease was successfully treated in all cases with ganciclovir alone; and (3) there was a trend toward an increased incidence of both acute rejection and accelerated graft atherosclerosis in the CMV group of patients.

Coronary Artery Disease↗
PubMedDate not supplied

Does central nervous system toxicity occur in transplant patients with hypocholesterolemia receiving cyclosporine?

A syndrome of severe central nervous system toxicity (confusion, cortical blindness, quadriplegia, seizures, and coma) associated with cyclosporine therapy and a low serum cholesterol level in patients with liver transplants has been described. We present a case history of a patient who demonstrated several similar features after heart-lung transplantation. Possible cyclosporine neurotoxicity should be considered in any patients with hypocholesterolemia receiving this drug.

Adult↗