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Biomedical subjects

E Saura

Publications and source records attributed to E Saura.

At least 19 recordsLinked to original sources
PubMed1998

[Myocardial revascularization. Historical review].

Atherosclerotic coronary artery disease is the main cause of death among the adult population in developed countries. Therefore, its surgical treatment has special importance and relevance. Surgery for coronary artery disease has evolved spectacularly since its inception in clinical practice. Indirect revascularization procedures had their foundations in medical concepts with more than a doubtful scientific basis. Clinical results used to be poor and unpredictable and the older techniques were slowly abandoned. Many newer techniques appeared in an attempt to improve the results. The implantation of the left internal mammary artery directly in the left ventricular myocardium through a tunnel deeply drilled within the muscle mass was later developed. It was initially thought that this method could supply an important amount of blood to the diseased myocardium. Clinical results were encouraging and postoperative mammary angiography showed definite connections with the coronary arterial tree; however this only happened in a small number of patients. Direct myocardial revascularization was attempted in order to restore the oxygenated blood supply to the myocardium. Patches, endarterectomies and bypass grafts were constructed and clinical results showed them to be safe and their outcomes could also be objectively assessed.

Coronary Disease↗
PubMed1998

[Angioplasty versus surgery in proximal stenosis of the anterior descending artery].

The points of view of the cardiac surgeon and the interventional cardiologist on their personal approach to the treatment of the significant lesions of the proximal left anterior descending coronary artery are still a matter of controversy. Two randomized studies have compared the efficacy of PTCA vs CABG in the treatment of patients with isolated proximal left anterior descending (LAD) coronary artery stenosis. After a mean follow-up of 3 years these studies concluded that the incidence of events was significantly reduced in the CABG group. However, this conclusion requires a cautious interpretation because of methodological limitations of these studies. On the other hand, a recent randomized study has shown a reduction in the restenosis rate when an intracoronary stent is electively implanted after PTCA in proximal LAD stenosis. Similarly, surgical modifications in material and in technical aspects will probably result in a reduction of the morbidity sometimes associated with surgical procedures. Presented with favourable anatomy, PTCA with elective stent implantation may be the initial option in the treatment of proximal LAD stenosis, especially if another revascularization procedure is contemplated in the future. However, CABG is preferred when the LAD lesion suggests a complicated anatomy (chronic obstructions, ostial lesions or proximal bifurcations with a significant diagonal). Depending on the particular results for both procedures in each Institution, an individual evaluation seems to be mandatory in the vast majority of patients.

Angioplasty, Balloon, Coronary↗
PubMed1998

[Aneurysms of the left ventricle. Surgical treatment].

Left ventricular aneurysm as a complication of myocardial infarction is observed in 10% of patients. In recent years, all surgical teams have observed a significant decrease of this complication. There is no doubt that this is due to the current medical treatment in the acute phase of myocardial infarction. Surgical treatment is considered only when the ventricular aneurysm presents complications such as congestive heart failure, thromboembolism, malignant ventricular arrhythmias or angina. In this review, we comment on the principle surgical procedures reported up to now. The indication of surgery is based on good functional results and long-term survival.

Heart Aneurysm↗
PubMed1998

[Activity and morbimortality of coronary surgery in Spain].

The goal of the study is to describe the current knowledge about coronary artery by-pass surgery in Spain related to activity, institutions, and clinical outcomes. A search in the MEDLINE (1982-97) and IME (1976-97) databases and manual search in medical journals, official publications of scientific societies was performed. References whose authors or institutions in charge were located in Spain, and including data on activity, mortality and morbidity of coronary artery bypass surgery alone or in combination with other procedures. In 1995, 7,936 coronary procedures were carried out (alone or in combination) in 51 Spanish centres, representing an increase of 123% in those procedures registered and published in 1988. Hospital mortality, according to the Registry of the Spanish Society of Cardiovascular Surgery (1995), was 7.2%. Data from multicenter studies showed, allowing for variations among centres, 8.8% (1975-82) and 8.1% (1994) mortality in isolated coronary revascularization. Other studies refer to the particular experience in a centre, examining either predictive mortality factors or outcomes in specific clinical conditions. Surgical mortality has been only partially analysed in multicentre studies, although several groups refer to the incidence of their own specific complications. There are few multicentre studies assessing morbidity and mortality in coronary artery surgery and some results (quality of life, economical) have been poorly evaluated. An alternative to be considered is the creation of an advisory commission aimed at establishing health care standards and at supporting an information system on the patients characteristics, techniques applied, and results obtained in the provision of cardiological procedures that, due to their invasiveness, complexity and cost, can be considered as tertiary cardiological care.

Coronary Artery Bypass↗
PubMed1996

Surgical treatment of Brucella endocarditis.

Between April 1987 and October 1992, six cases of Brucella endocarditis were operated on in the authors' hospital for valve replacement. They were five men and one woman with a mean(s.d.) age of 52(15) years (range 30-71 years). Three patients were in New York Heart Association (NYHA) class III and three in class IV. Two patients had previous history of rheumatic fever, one was a drug abuser, two had peripheral embolism and one constrictive pericarditis. Most were living in rural areas. Echocardiographic diagnoses were: severe aortic regurgitation in two patients, mixed disease in two and double valve involvement in two. Valve vegetations were demonstrated in two patients, valve calcification in two and annulus abscess in two others. Serological tests were positive in all patients. All patients had valve replacements and three were operated on as emergencies. Surgical findings were: valve vegetations in two patients, cusp perforation in two annulus abscess in two and prosthetic leak in two. Mean(s.d.) cardiopulmonary bypass time was 123(77) min with a mean ischaemic time of 79(43) min. All patients were given specific antibiotic treatment after surgery. There was no intraoperative mortality and the 5-year survival rate was 100%. Early reoperations were needed in three patients, two because of prosthetic leakage causing severe regurgitation and one for tamponade. The results suggests that Brucella endocarditis is rare, but still occurs in Mediterranean areas. Surgical replacement is needed in spite of antibiotic treatment and recurrences with prosthetic leaks are usual.

Adult↗
PubMed1995

Valvuloplasty in traumatic aortic insufficiency due to subtotal tear of the intima.

Aortic regurgitation is one of the usual pathologic findings necessitating valve replacement in cardiac surgery. Several diseases may result in leaflet incompetence. Circumferential intimal tear of the aortic root with prolapse of the aortic valve commissures is a rare cause of aortic incompetence. We report the repair of the aortic wall and valve in 1 patient with such a tear 6 months after an important thoracic trauma. Three months after the aortic valve reconstruction the patient is in good condition and fully asymptomatic.

Aged↗
PubMed1994

Recurrent Trichosporon beigelii endocarditis after aortic valve replacement.

Fungal endocarditis of the bioprosthetic heart valve, implanted in a patient without evidence of impaired immunity, is reported. Clinical manifestations of endocarditis appeared 7 years after aortic valve replacement for rheumatic disease and included embolization into the popliteal artery. Trichosporon beigelii was isolated from the cultured fragments of the embolus. Two valve replacements were performed because of recurrent infection during the following 4 years. In spite of prolonged antifungal therapy, the patient died from multiorgan septic involvement.

Adult↗
PubMed1993

Cardiopulmonary bypass in HIV-positive patients.

To prove the hypothesis that cardiopulmonary bypass may accelerate the development of acquired immunodeficiency syndrome (AIDS) in the human immunodeficiency virus carrier, the clinical course of 40 patients positive for human immunodeficiency virus who underwent cardiac operations between 1986 and 1992 was analyzed, especially in regard to the progression to AIDS. Mean age was 30 years (range, 19 to 61 years). Thirty-four patients (85%) were intravenous drug abusers; in 4 (10%) transmission of infection was sexual, and in 2 (5%) it was through a contaminated blood transfusion. Valve procedures were performed in 38 patients (95%), mostly for endocarditis in drug addicts. Hospital mortality was 20% (8 patients). The 32 survivors have been followed up a mean of 21 months (range, 4 months to 6 years). Four patients (12.5%) experienced progression to AIDS during the follow-up period. Actuarial progression to AIDS is 5% (+/- 5%) at 1 year, 20% (+/- 10%) at 2 years, and 40% (+/- 19%) at 5 years. There have been 8 late deaths (5 due to recurrent endocarditis, 2 due to AIDS, and 1 due to overdose). Actuarial survival is 79% (+/- 8%) at 1 year, 60% (+/- 11%) at 2 years, and 48% (+/- 14%) at 5 years. The results indicate that progression to AIDS in the patient positive for human immunodeficiency virus is not accelerated by the use of cardiopulmonary bypass. The poor prognosis in these patients is mainly related to the particular pathological conditions that often affect the drug addict population.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[The National Data Bank of the Spanish Society of Cardiovascular Surgery. The pilot experience].

Since 1988, the Spanish Society of Cardiovascular Surgery has been enjoying through its National Intervention Registry a complete information about the number and type of cardiovascular surgical operations, yearly performed all over the country. However a computerized National Data Bank would probably offer a more specific, quick and complete information, although its organization is more complex. We want to demonstrate that the creation of a National Data Bank is possible in our country. The following condition has been essential to carry out this initial work on the National Data Bank: The previous existence of a National Intervention Registry, the edition of an universally accepted questionnaire of 33 questions with multiple answers for each question, which includes quantitative and qualitative aspects like mortality, the acquisition of the software Pats Programme by most cardiovascular centers, and finally the enthusiastic dedication of 6 surgical groups. The results of this work also shown in multiples figures, are the final product of the computerized fusion of 6 cardiovascular centers data on operations performed through the year 1991. The results clearly offer a more specific, detailed and extensive information about quantitative and qualitative aspects of the surgical data, than that obtained through the National Intervention Registry. These results should not be extrapolated at national level, as the surgical groups involved in this work are not homogeneous and its number is quite small. This initial study shows that the creation of the National Data Bank of the Spanish Society of Cardiovascular Surgery or other scientific society is possible in our country. Its usefulness is beyond any doubt.

Cardiac Care Facilities↗