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Biomedical subjects

F Gerbode

Publications and source records attributed to F Gerbode.

At least 19 recordsLinked to original sources
PubMed1982

Risk-benefit analysis of warfarin therapy in Hancock mitral valve replacement.

The purpose of this investigation was to analyze the thromboembolic and/or major bleeding complications of 124 consecutive but nonrandomized patients who had only mitral valve replacement with the Hancock porcine xenograft between September, 1974 and June, 1979. These patients were treated either with or without anticoagulants. Four basic study groups were created: Group 1, warfarin; Group 2, aspirin; Group 3, no anticoagulants; and Group 4, warfarin and aspirin. Group 5 combined Groups 1 and 4 (warfarin and warfarin plus aspirin) and Group 6 combined Groups 2 and 3 (aspirin and no anticoagulants). The cardiac rhythm, history of embolism, and intraoperative findings of a thrombus in the left atrium were examined as risk factors for later thromboembolism . Follow-up time was 3.03 years (range 2.0 to 4.2 years). The embolic rate was not significantly different in any group (n = NS). In Groups 5 and 6 the embolic rate was 2.97 and 3.25 embolisms per 100 patient-years, respectively. Warfarin therapy resulted in significant major bleeding episodes, including two deaths (p less than 0.05). The number of patients with a history of a previous embolism, the finding of an intraoperative left atrial thrombus, or abnormal cardiac rhythm was insufficient to test embolic risk in the four treatment groups. We conclude that long-term warfarin therapy increases the risk of bleeding complications but may not significantly influence the incidence of thromboembolism arising from the Hancock porcine xenograft mitral valve. Other and larger studies are needed to confirm this last point.

Adult↗
PubMed1980

Effects of different filter positions and combinations in extracorporeal circulation.

This study has demonstrated that best results are achieved when the arterial line filter and the coronary suction line filter and combined. The arterial line filter should not be used alone, as it does not replace the coronary suction line filter. Different flow patterns enable the coronary suction line filter to hold most of the very small particles, while those pass the arterial line filter easily. No significant differences could be demonstrated in the number of circulating cellular elements of the blood with one or more filters in place. However, during the second half of the extracorporeal circulation, up to 50% of the small particles disappear in the patient, although there is no difference between the number infused into the patient and the number found in the venous blood during the first 30 to 45 minutes of bypass.

Arteries↗
PubMed1979

[Mitral regurgitation following myocardial infarction (author's transl)].

Incompetence of the mitral valve may occur within days or weeks following myocardial infarction. The etiology most often encountered is rupture of a papillary muscle or one or more chordae tendineae. Since echocardiography is available, dysfunction of the papillary muscle with resulting incompetence of the valve is diagnosed more frequently. The mortality of the disease without surgical correction is reported as high as 95% within the first 3 months following the development of a murmur. The results of the surgical therapy are closely related to the time interval between myocardial infarction and time of surgery. Twenty-one (46%) of 45 patients with acute mitral regurgitation following myocardial infarction and cardiogenic shock operated upon at the Pacific Medical Center died during the early postoperative period. Mortality was extremely high with 78% when surgery had to be done within the first weeks following the acute myocardial infarction. Surgery within 2 to 3 months following the myocardial infarction carried a mortality of 44%, whereas only 6 of 22 patients operated upon more than 3 months after the acute infarction died. The high mortality of the natural course of the disease should be encouragement to think of the possibility of surgical correction of the valvular disease, especially when optimal medical treatment including medical and mechanical inotropic support have failed. Advances in cardial surgery, such as myocardial protection as well as postoperative care, may result in further improvement of the results.

Heart Valve Prosthesis↗
PubMed1978

Thrombosis and degeneration of Hancock valves: clinical and pathological findings.

Of 415 Hancock valves implanted in 370 patients, 26 valve specimens were recovered at postmortem examination and 8 at reoperation. In 9 of these 34, thrombosis had formed without apparent alteration of the heterograft tissue (Group A). All were mitral prostheses, and the thrombi were attached to the sewing ring. Six of the patients died in the early postoperative period following prolonged low cardiac output syndrome and coagulation disturbances. Three patients had late valve thrombosis 12 to 26 months after operation and were in chronic atrial fibrillation with a very large left atrium. Four valve specimens (Group B) demonstrated degenerative changes of the heterograft leaflets such as shrinkage, perforation, and calcification. The clinical courses and possible pathogenesis are discussed.

Aged↗
PubMed1978

Thromboembolic complications after mitral valve replacement with Hancock xenograft.

Case histories of 140 patients who had mitral valve replacement with the Hancock xenograft were reviewed according to the incidence of thromboembolic complications. There were 16 patients with preoperative and/or postoperative low-output syndrome (Group A.) Eight of these patients died, and six had autopsies which showed major thrombi on the heterograft valve. In 126 long-term survivors (followed 1 to 33 months) nine thromboembolic events occurred (thromboembolic incidence 5.3 percent per patient-year). All patients with emboli were in atrial fibrillation. Additional predisposing factors included a history of systemic emboli and the presence of atrial clots at the time of surgery. The majority (7/9) of emboli occurred during the first 3 postoperative months. Two emboli occurred immediately following the operation (before oral anticoagulation therapy could have been begun). Five occurred in patients who were not on anticoagulation (Group B) and two occurred under warfarin treatment (Group C). There was no thromboembolic event in patients taking aspirin (Group D). It is concluded that hemodynamically stable patients have a decreased risk of thromboembolism and do not require anticoagulation. Patients with atrial fibrillation have an increased thromboembolic risk and should be on a regimen of warfarin for 3 months postoperatively and then on aspirin therapy.

Adolescent↗
PubMed1976

The surgical management of bacterial endocarditis: a review.

A total of 239 surgically treated patients with primary endocarditis were reviewed both from the literature and from our own experience. The age range was 10 to 74 years with a male to female ratio of 3:1. A wide variety of organisms was found. However, as a group, gram positive organisms predominate. The onset of congestive failure was the major indication for surgery. The aortic valve was predominantly involved with the mitral valve running a distant second. The hospital mortality rate was 20% and the late mortality rate was 6.7% with an overall mortality of 26.7%. The prognosis in infective endocarditis when congestive failure develops, even in the presence of antibiotic therapy, is poor (79-89% mortality). In view of this poor prognosis, an aggressive attitude with regard to early surgical intervention can greatly improve the outcome of valvular endocarditis.

Adolescent↗
PubMed1976

A simple test to identify coarctation of the aorta.

Despite the widespread recognition of coartation of the aorta there are still many patients in whome the diagnosis is not made. A simple clinical test which is useful in making the diagnosis in infants and adults, is described. It depends upon the differential color changes between fingers and toes after releasing a manual compression of feet and hands in the elevated position.

Adolescent↗
PubMed1976

Leiomyosarcoma of the pulmonary artery diagnosed preoperatively by angiocardiography. Replacement with composite graft.

In a patient with rapidly progressive congestive heart failure and syncope, primary leiomyosarcoma was diagnosed by angiocardiography. The pulmonary artery was resected and replaced with a composite graft. The patient died 12 days later from myofibrillar degeneration of the right ventricle and marked pulmonary disease secondary to pre-existing bronchiectasis.

Angiocardiography↗
PubMed1976

Successful surgical correction of an embolized prosthetic valve poppet: case report.

Embolization of a prosthetic valve poppet, a rare complication following valve replacement, has been, until recently, generally fatal. Immediate recognition followed by replacement of the poppet or valve and extraction of the embolized poppet is the only feasible approach. Recently, a patient was seen was seen shortly after the onset of acute pulmonary edema with wide-open mitral regurgitation. A diagnosis of extrusion of the poppet from a previously placed prosthetic valve was confirmed and a successful mitral valve replacement accomplished. The nonradiopaque poppet, subsequently localized by an ultrasound B-sac, was removed from the lower abdominal aorta at a later operation. We believe this to be the second reported case of survival following successful reoperation for embolization of a prosthetic poppet.

Aorta, Abdominal↗
PubMed1975

Acquired ventricular septal defects. Evolution of an operation, surgical technique, and results.

The pathology and treatment of 19 patients with acquired ventricular septal defects (VSD's) secondary to myocardial infarction are presented. A new method of repair is described: suturing the free right ventricular wall against the VSD to support the friable septum on the right side in continuity with the patch on the left side of the septum. This removes the force of the left ventricle contraction from the patch and septum to the healthy right ventricle wall. Distal cardiac amputation was also used in several instances. The hospital survival rate was 64 per cent. The late functional and hemodynamic results were excellent.

Adult↗
PubMed1975

Blood platelets and extracorporeal circulation; kinetic studies on dogs on cardiopulmonary bypass.

Platelet kinetics and functions were studied in dogs during extracorporeal circulation. A transient platelet sequestration in the liver occurs during the bypass. This reversible disappearance is accompanied by a loss of the ability of platelets to adhere or aggregate. The platelets which return to the circulation have normal functions and a normal life span. The irreversible damage is mainly due to the direct blood-gas interface. Impairment of lung function by platelet aggregates is discussed and the importance of an in vivo model to study the factors which affect the platelets, such as antiaggregating agents, is pointed out.

Animals↗
PubMed1975

Protection from lung damage by blood filtration during deep hypothermia in puppies.

Ten puppies underwent deep hypothermia with surface cooling and bypass cooling. They were subjected to circulatory arrest for 30 minutes and then were rewarmed by means of bypass. There were 5 control puppies and 5 for which a Swank filter was placed in the arterial perfusion line. All puppies had some degree of lung damage, but it was more severe in those in which perfused blood was not filtered. The damage involved the lung vessels, interstitial tissue, and alveoli. Platelet-fibrin aggregates and margination and sequestration of leukocytes appeared to be important pathological findings. Apparently, the Swank blood filter protects the lung by removing leukocytes and damaged platelets from the circulation.

Animals↗