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Biomedical subjects

F E Deuvaert

Publications and source records attributed to F E Deuvaert.

At least 37 records · Page 2Linked to original sources
PubMed1990

Perioperative mapping of parahisian accessory pathways.

UNLABELLED: In 1989, two patients were operated for deep septal "parahisian" pathways in our institution. Three different mapping techniques were used. (1) Epicardial activation mapping with a belt of 21 bipolar electrodes positioned around the heart. This belt was positioned either on the atrial or on the ventricular side of the atrioventricular annulus in order to localize both the atrial and the ventricular insertion of the bypass tract. (2) Right intra-atrial activation mapping on the normothermic beating heart with a bipolar hand-held probe. (3) Right intra-atrial cryomapping at 0 degrees C. The "parahisian" pathways are remote from the epicardium and the pattern of epicardial activation is different from that of the free-wall pathways. Case 1: The electrophysiological study showed a concealed anteroseptal bypass tract. The peroperative atrial epicardial mapping during orthodromic tachycardia (OT) showed simultaneous activation of the posteroseptal area and of the basis of the right appendage. Right intra-atrial mapping during OT showed an anteroseptal "parahisian" pathway. Case 2: The ECG and electrophysiological study showed a right posterior pathway. The first site of epicardial ventricular activation during atrial stimulation was the right posterior area, 30 ms after the onset of the delta wave. The first site of epicardial atrial activation during OT was the posteroseptal area. The right intra-atrial mapping showed a posteroseptal "parahisian" bypass tract. This localization was confirmed with cryomapping. CONCLUSIONS: Some patterns of epicardial mapping may suggest the presence of a deep septal "parahisian" bypass tract: retrograde atrial activation at different sites (mimicking activation among multiple pathways); delay between the delta wave and the first epicardial electrogram. Right intra-atrial activation and cryomapping are useful to confirm the diagnosis.

Adolescent↗
PubMed1989

Fluoroscopic differentiation between leaflet escape (LE) and valve thrombosis (VT) of the Edwards-Duromedics mitral valve.

Although differential diagnosis between LE and VT of an Edwards-Duromedics mitral valve can be suspected on clinical, phonocardiographic and echocardiographic bases, we propose that fluoroscopy is the rapid, non-invasive test to distinguish between both conditions if properly conducted and interpreted: with adequate orientation of the X-ray beam, the presence of both leaflets and their range of motion can be reliably assessed.

Diagnosis, Differential↗
PubMed1986

Aortico-left ventricular tunnel (ALVT). A diagnostic and surgical "must".

ALVT is a rare congenital lesion. The paravalvular tunnel causes a clinical picture of aortic regurgitation. An aortic regurgitant murmur is present since birth. The clinical diagnosis, often overlooked, is best confirmed by angiocardiography in the lateral view. Although 80% of reported cases present with congestive heart failure before age 1, our two cases were asymptomatic at age 13 and 8 respectively. Both were operated on the basis of progressive left ventricular (L.V.) overload and dilatation. Diagnosis was made at operation in case 1 and suspected by the surgeon in case 2. Case 1 necessitated implantation of a bioprosthetic valve and replacement of the prosthesis 3 years later for primary tissue failure. Case 2 could be handled more conservatively with obturation of the aortic orifice of the tunnel. The natural evolution of the lesion involves progressive aortic valve regurgitation both by annuloectasia and retraction of the valve cusps. The diagnosis of ALVT should be considered in any infant or child with an aortic regurgitation murmur. Surgical treatment should be undertaken before alteration of the valve and the aim should be preservation of native valve function.

Adolescent↗
PubMed1982

Aspergillus osteochondritis after median sternotomy. Combined operative treatment and drug therapy with amphotericin B.

A case of Aspergillus fumigatus osteochondritis after median sternotomy for open heart surgery is presented. To the best of our knowledge, it is the second well documented case that has been reported in the literature. Successful healing was obtained with combined operative treatment (consisting of a large resection of the 8th, 9th and 10th right costal cartilages and surrounding soft tissues), and systemic drug therapy with Amphotericin B. Repeated serologic studies and bone scans were used for both the diagnosis and monitoring of the evolution of the infection; these 2 tools are recommended in cases of mycotic infections in that area.

Amphotericin B↗
PubMedDate not supplied

Improved exposure for complex left main coronary artery reconstruction.

Direct surgical repair of left main coronary artery (LMCA) stenosis by either the right (posterior) or left (anterior) approach can be difficult in case of complex, extensive atheromatous lesions. Complete transsection of both great vessels allows rotation of the heart, with its base facing the surgeon. Patch repair then becomes safe, precise and expedicious. The LMCA arteriotomy can easily be prolonged beyond its bifurcation as needed. Three consecutive patients were successfully operated. We suggest this approach to the surgeon concerned by restoration of a physiologic antegrade flow for his patient with complex atheromatous LMCA lesions.

Adult↗
PubMedDate not supplied

Pulmonary artery banding. Experience with 69 patients.

Between 1976 and 1985, 69 patients underwent pulmonary artery banding (PAB) at an average age of 2.2 months (mo) (range 2 days-18 mo) weighing 3.8 kg (2.1-10.7 kg), as part of their initial surgical therapy for massive left to right shunting. Only 10 patients (early in this series) had isolated ventricular septal defect (VSD). Seventeen patients did not survive PAB (25%), including 4 of 5 patients with Taussig-Bing heart (TBH) and only 4 of the 40 patients with VSD [either isolated or associated with coarctation or transposition (TGA)]. Forty-four patients underwent debanding (deB) and secondary cardiac repair at an average age of 22 mo (6-96) and weight of 9.4 kg (4.9-22.0): 9 patients died early and 1 late. Mean pulmonary artery pressure was 49 Torr (27-80) before banding and 24 before deB (6-65). PA stenosis from the band imposed further surgery in all but 15 patients. Thirty-four survivors to secondary repair were followed for an average 46 mo (1-120). Thirty were in NYHA classes I and II. Only 43% of patients with PAB had good medium term results. The presence of the band imposes close, complete follow-up. PAB is no longer recommended for isolated single VSD. It can still be beneficial in multiple, complicated, or medically compromised VSD as well as in very small neonates with atrioventricular septal defect and truncus arteriosus, and subsets of double outlet right ventricle and tricuspid atresia with high pulmonary flow not amenable to early complete repair. PAB in functional single ventricle allows safer delayed definitive repair. TBH and TGA+VSD are now repaired primarily (arterial switch).

Constriction↗
PubMedDate not supplied

Leaflet escape of a mitral Duromedics prosthesis. Case report.

This article reports a case of leaflet embolization of a mitral Edwards-Duromedics prosthesis. The patient had abrupt onset of acute pulmonary edema and was initially treated medically for 3 days. Fluoroscopy showed only one freely moving leaflet and the other was (incorrectly) assumed to be blocked in the closed position. The patient received IV thrombolysis for another 3 days and was finally operated. He died 8 days later from sepsis and the leaflet was recovered at autopsy in the abdominal aorta. Leaflet escape of a mitral Edwards-Duromedics prosthesis is a rare, potentially curable mode of valve failure. Correct interpretation of clinical signs and symptoms and of fluoroscopy should allow early diagnosis and surgical therapy.

Embolism↗
PubMedDate not supplied

Spontaneous rupture of the esophagus after coronary artery bypass.

Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare but the most lethal perforation of the gastro-intestinal tract. A 62-year old male was successfully treated for this condition developing on the second post-operative day after coronary artery bypass. Two hours after extubation respiratory insufficiency and circulatory collapse necessitated reintubation and energetic resuscitation with prompt drainage of a massive pleural effusion. Left thoracotomy on post-operative day 17 confirmed the diagnosis and the esophagus was excluded by cervical esophagostomy and duodenostomy. After a six week recovery, reconstruction was achieved by total esophagectomy through a right thoracic incision and gastric bypass with cervical gastro-esophageal anastomosis. The patient left the hospital in good condition 112 days after the initial operation.

Coronary Artery Bypass↗
PubMedDate not supplied

[Limited role of surgery in the treatment of pulmonary embolism].

Massive pulmonary embolism (more than 50% of the pulmonic arterial bed obstructed) has a high mortality. If the accident is not immediately fatal and if the patient is in an adequate hospital environment, the diagnosis has to be confirmed by pulmonary scan and arteriography. Immediate institution of an intensive medical support against shock combined with the induction of thrombolysis prove effective in a majority of cases. The few patients who do not favorably respond to this medical therapy must without delay undergo embolectomy under extracorporeal circulation. The risk is mainly dependent on the hemodynamic state of the patient at the moment of operation. However conditions related to time and place for optimal surgery may restrict the number of favourable results.

Emergencies↗