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Biomedical subjects

F Leca

Publications and source records attributed to F Leca.

71 records · Page 4Linked to original sources
PubMed1982

Reconstruction of the pulmonary outflow tract without prosthetic conduit.

New techniques of correction of complex congenital anomalies, avoiding the use of prosthetic conduits, are presented. In transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis, the technique comprised the resection of infundibular septum, the suturing of an intraventricular baffle directing blood from the left ventricle to the aorta, and the reconstruction of the pulmonary outflow tract by direct implantation of the posterior rim of the pulmonary arterial trunk on the right ventricle, completed by an anterior patch. In most cases, the pulmonary bifurcation was translated anterior to the ascending aorta. This technique was feasible even in infants and in patients with a small VSD. Thirteen patients, from 3 months to 8 years of age, were treated by this technique, with four deaths, one residual VSD (reoperated), and eight good results (4 to 16 months). A similar repair was used in three cases of double-outlet right ventricle (DORV) with subpulmonic VSD and pulmonary stenosis or pulmonary artery banding, with two operative deaths and one good result. The same technique of pulmonary outflow tract reconstruction was used in four cases of truncus arteriosus. Two deaths were attributed to severe pulmonary regurgitation, a complication which should be prevented in future cases by a reliable method of inserting a valve in the pulmonary outflow tract. In pulmonary atresia with VSD and absent pulmonary trunk, the continuity between the right ventricle and the pulmonary branches was established via an arterial tube resected from the ascending aorta. This technique was successfully used in one child with extremely small pulmonary branches. These preliminary results led us to conclude that many complex congenital cardiac anomalies can be effectively treated without a prosthetic conduit.

Child, Preschool↗
PubMed1982

[Results of surgical treatment of aortic coarctations in the 1st 6 months of life. Apropos of 142 cases].

142 infants under 6 months of age were operated on for coarctation of the aorta from 1972 to 1978. Coarctation was isolated in 46 (32.4%) and associated with another heart defect in 96. Surgery was decided upon because of congestive heart failure sometimes associated with arterial hypertension refractory to medical treatment: 9 patients died during surgery. 89 underwent Crafoord's operation and in 44 ligature of the subclavian artery or aortoplasty using the subclavia were carried out. Early postoperative death rate was 30.9% and 13 patients (13.2%) died later. Recoarctations occurred in 25 patients (27%); more than half of these patients were less than 1 month-old at the time of surgery. Recoarctation was more frequent (46.4%) in cases with than in cases without (18.7%) aortic hypoplasia and it was more severe (5 out of 7 deaths) when there was an associated cerclage resulting in a double obstacle to right and left ventricles ejection.

Aortic Coarctation↗
PubMed1982

[Iatrogenic arteriovenous fistulas in infants].

Iatrogenic arteriovenous fistulas in infants are usually due to an arterial puncture performed in the neonatal period. On the occasion of 5 cases who were operated on, the peculiar features of these fistulas are established. Surgery consists of endo-aneurysmorrhaphy.

Arteries↗
PubMed1982

[Cor triatriatum: results of surgical treatment. A propos of a series of cases].

Cor triatriatum is a rare heart defect that may be surgically repaired, with good results when preoperative diagnosis is correct. Ultrasonography, angiography and catheterism reduce preoperative diagnostic errors such as abnormal pulmonary venous return. The authors report their experience with 7 cases, and discuss diagnostic problems and causes of errors.

Angiography↗
PubMed1981

Surgical treatment of anomalous origin of the left coronary artery in infancy and childhood. Early and late results in 20 consecutive cases.

From 1972 to September, 1979, 20 patients underwent transplantation of the anomalous left coronary artery to the aorta, either directly or via a graft. Correction of ischemia-induced mitral insufficiency was associated in eight patients and a postinfarction left ventricular scar was excised in 12. Operative mortality was high among patients under 1 year of age (4/5). Among older children it was 15%. There were not late deaths among patients surviving the operation (mean follow-up 3 years). All but one had marked clinical improvement and reduction of cardiomegaly. Eleven patients underwent angiographic control, with a patent graft or anastomosis demonstrated in every case. Operation is advocated for patients over 1 year of age. The best treatment of symptomatic infants remains controversial.

Aorta↗
PubMed1981

Modified technique for correction of tricuspid atresia.

This study presents a new technique for correction of tricuspid atresia. All 13 patients operated upon had the same form of the anomaly, with the great arteries normally related. The principle is to conserve the pulmonary valve and anulus of the patient in its anatomic position and to exclude the hypoplastic right ventricle. Because there is no need for closing the ventricular septal defect, the risk of heart block and residual left-to-right shunts is avoided. Deaths are related to questionable indications for two patients and to a bilateral pneumothorax for the third one. The long-term follow-up (5 years for the first patient) shows good results for the 10 survivors. Six of them are in Class 1 of the New York Heart Association and four are in Class II.

Adolescent↗
PubMed1980

[2 cases of prosthetic tubes in left pathway obstructions].

Two cases of severe left ventricular outflow tract obstruction were managed surgically by the insertion of prosthetic tube grafts. The first case was a 6 year old child with diffuse hypoplasia of the descending aorta. A prosthetic tube graft, from the aortic arch to the distal limit of the descending aorta, was inserted through a double left thoracotomy. The second child, aged 3 1/2 years, had hypoplasia of the aortic ring. In this case, a prosthetic tube with a prosthetic aortic valve was inserted from the apex of the left ventricle to the abdominal aorta. This is a simple operation for a complex lesion. In both cases, as in other reported series, the post operative clinical and angiographic results one year later, were good. Some technical points are discussed, and the features which, in the case of aortic ring hypoplasia, led to the choice of the above method instead of that proposed by Konno, are explained. The extra cardiac tube, in fact, does not involve the cardiac structures. Its insertion is simple and non-traumatic, and particularly indicated for children.

Angiography↗
PubMed1979

[Right pulmonary artery-left atrial fistula. Review of the literature apropos of a case].

This is a rare congenital abnormality with only 17 other reported cases in the world literature. The most frequent sign is cyanosis with peripheral arterial desaturation. Angiography with selective injection in the main pulmonary shows early opacification of the left atrium, so confirming the diagnosis. Occasionally, a catheter can be passed through the fistula. Without surgical treatment there is a danger of systemic arterial embolism and two fatal cases were found in our review of the literature. The fistulous connection is often aneurysmal. It arises either from the right main pulmonary artery or from its branch to the inferior lobe. Associated vascular and pulmonary malformations are not rate. Surgical closure of the fistual is curative with immediate regression of the cyanosis and suppression of possible embolic complications.

Arteriovenous Malformations↗
PubMedDate not supplied

New data on the pharmacokinetics of adriamycin and its major metabolite, adriamycinol.

Twenty-two days after administration by intravenous bolus, of 50 mg of adriamycin to several patients we found concentrations of adriamycin and adriamycinol of the order of 100 pcg/ml. In theory, however, with a terminal half-life of 30 h, the plasma levels of adriamycin and adriamycinol should be close to 0.1 pcg/ml. Further pharmacokinetic investigation was therefore necessary. We have retained for this study nine male patients, aged between 53 and 69 years who received 25 to 50 mg of adriamycin by slow intravenous injection. The HPLC method permitted the detection of 50 pcg/ml of adriamycin and adriamycinol, with the possibility of monitoring their elimination during 120 h (and in one case during 160 h). The terminal half-lives of elimination estimated in 8 patients were respectively 110 +/- 52 h for adriamycin and 92 h 50 min +/- 43 h for adriamycinol. Surface ratios under adriamycinol curves against calculated adriamycin was 1.10 +/- 0.26. Plasma levels found during the To in certain patients correspond to the end of the drug elimination of the previous treatment. It is difficult with a half-life to 110 h to predict the effects of residual concentrations of adriamycin and adriamycinol.

Aged↗
PubMedDate not supplied

[Aorto-pulmonary windows. Report of fifteen cases (author's transl)].

Fifteen aorto-pulmonary windows have been operated on patients 1,5 months to 6 years old. 6 were associated with other cardiac malformations (ductus arteriosus, VSD, mitral insufficiency, aortic arch atresia). 5 cases died. 3 had other cardiac malformations associated. 10 have an average follow-up of 5 1/2 years. The authors insist on the severity of the cases with high pulmonary pressure, and advise operation during the first year of life.

Aorta↗