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Biomedical subjects

G M Lemole

Publications and source records attributed to G M Lemole.

At least 55 records · Page 3Linked to original sources
PubMed1987

Antegrade and retrograde infusion of cardioplegia: assessment by thermovision.

The efficacy of two routes of cardioplegia infusion was examined by assessing the hypothermia induced in patients with critically obstructed or occluded major coronary arteries. The antegrade (through the aorta) and the retrograde (through the coronary sinus) methods of cardioplegia infusion were compared using myocardial thermograms. Patients (N = 8) were matched according to angiographic similarities of their coronary artery disease. Adequate myocardial cooling distal to a critical obstruction could frequently not be obtained with antegrade infusion of cardioplegic solution. With retrograde infusion, the desired uniform cooling of the myocardium, as determined by thermographic analysis of the surface temperatures of the heart, was obtained. We conclude that retrograde infusion of cardioplegic solution induces more effective and homogeneous hypothermia in patients with critically obstructive multivessel coronary disease, and may provide improved myocardial protection.

Angiography↗
PubMed1987

Giant left atrium as cause of left pulmonary artery obstruction.

A case of a giant left atrium with compression of the left pulmonary artery and left main bronchus is described. The surgical approach was through a left thoracotomy, and the correction included mitral valve replacement, reduction atrioplasty, and dissection and release of the left pulmonary artery.

Arterial Occlusive Diseases↗
PubMed1985

Rigid intraluminal prosthesis for replacement of thoracic and abdominal aorta.

During the past seven years, 80 patients have undergone aortic substitution using a rigid intraluminal prosthesis. There were 9 early deaths. The procedures involved 32 dissecting aneurysms (18 ascending and 14 descending), 16 atherosclerotic aneurysms of the ascending aorta and 13 atherosclerotic aneurysms of the descending aorta, 3 thoracoabdominal aneurysms, 2 arch aneurysms, and 14 abdominal aortic aneurysms. There was one early dislodgment of the rings necessitating reoperation, but no other early complications related to the procedure. In the follow-up period (mean, 25 months) there were 6 late deaths. One occurred 6 months after operation in a patient with empyema. There were no late complications of thrombosis, erosion, pseudoaneurysm formation, or hemorrhage. The follow-up data are extremely encouraging. We now are using this device whenever possible in all substitutions of the aorta, although in approximately 40% of patients, it is necessary to remove one of the spools and suture either the proximal or distal end of the graft owing to the close proximity of the aneurysm to the coronary ostia or the origin of the subclavian artery. Important techniques of insertion and postoperative angiograms are presented.

Adolescent↗
PubMed1984

Redundant pacing: case report and review.

A 17-year-old boy with severe sick sinus bradycardia had a doubly redundant pacemaker inserted. With two separate ventricular leads inserted by the epicardial route, the pacemaker is able to compensate for a lead that has developed high threshold by activation of an alternate lead. The two pacing channels of the pulse generator can be programmed independently of one another. In addition, there is a back-up pacing circuit separate from the two primary channels. The pacer can be used with both channels active for continuous automatic redundancy for safety, or with one channel active and the other in reserve.

Adolescent↗
PubMed1984

Left ventricular aneurysm. Ten years' experience in surgical treatment of 244 cases. Improved clinical status, hemodynamics, and long-term longevity.

This report reviews 244 patients with postinfarction left ventricular aneurysm operated upon between 1971 and 1980. The location of the left ventricular aneurysm was anteroapical (64.7%), apical (21.3%), posteroinferior (8.6%), or lateral (5.3%). The aneurysm was caused by a significant lesion of two coronary arteries in 38.9%, of three in 33.6%, and of a single left anterior descending artery in 26.6%. The indication for operation was angina (61.1%), congestive heart failure (9.8%), intractable ventricular arrhythmias (7.8%), or a combination of the above (20.9%). Of the 218 patients who survived the perioperative period (mean 56.5 months' follow-up), 85.3% were relieved of angina and 70.5% were in Class I or II of the New York Heart Association, as compared to 16% prior to operation. Cardiac index increased from 2.4 +/- 0.7 L/min/BSA before left ventricular aneurysmectomy to 3 +/- 0.5 L/min/BSA (p less than 0.001) at 1 to 12 weeks' follow-up. Left ventricular end-diastolic volume decreased from 111.4 +/- 55.4 ml/m2 before left ventricular aneurysmectomy to 73 +/- 21.7 ml/m2 (p less than 0.001) 1 year or more later. Mean velocity of circumflex fiber shortening of the contractile portion had increased from 0.7 +/- 0.3 circ/sec before left ventricular aneurysmectomy to 0.94 +/- 0.29 circ/sec (p less than 0.05) at 1 year or more. Left ventricular aneurysmectomy alone was performed in 10.7% patients, with an operative mortality of 7.7% and an actuarial 10 year survival rate of 56.8% +/- 10.6%. Left ventricular aneurysmectomy with coronary artery bypass was done in 89.3% of the patients, with an operative mortality of 11% and an actuarial 10 year survival rate of 69% +/- 3.6%. Operative mortality after grafting of the left anterior descending artery, its diagonal branch, and the circumflex artery was 9.5%, 11.3%, and 11.9%, respectively, and the actuarial 10 year survival rate was 72.8% +/- 3.8%, 70.7% +/- 7%, and 66.3% +/- 6%, respectively. Left ventricular aneurysmectomy combined with procedures on the mitral, aortic, or tricuspid valves or closure of a ventricular septal defect was done in 8.2%, with an operative mortality of 20% and an actuarial 10 year survival rate of 60% +/- 10.9%.

Actuarial Analysis↗
PubMed1984

Rigid intraluminal prosthesis for replacement of thoracic and abdominal aorta.

From December 1976 to April 1983, 55 patients underwent operations in which intraluminal ring grafts were used for replacement of thoracic and abdominal aortic aneurysms. Twenty-eight patients had dissections, and 11 had ascending aneurysms. There were 10 descending aneurysms; three of these were traumatic. There were two arch aneurysms, three abdominal aneurysms, and one thoracoabdominal aneurysm. The follow-up period was 78 months with a mean follow-up period of 24 months. There were six postoperative deaths and six late deaths. No evidence of complications of thrombosis, migration, erosion, or pseudoaneurysm resulting from the ring within the 78-month follow-up period was seen, and we conclude that this is a safe, reliable, quick method for replacement of the aorta in certain well-defined situations.

Adolescent↗
PubMed1983

A new retractor to aid in coronary artery surgery.

During coronary artery bypass grafting, exposing the arteries can be difficult, especially on the posterior and lateral aspects of the left ventricle. A silicone-covered flexible retractor has been modified to facilitate this procedure. Its central opening and easy malleability aid in myocardial retraction and coronary artery bypass grafting.

Coronary Artery Bypass↗
PubMed1983

Transvenous pacemaker insertion with a zero dislodgement rate.

A non-retractable transvenous screw-in lead which gives both stability of placement and low acute and chronic stimulation thresholds was used in 64 patients during the period April, 1979 to June, 1981. The average threshold at implant was 0.7 volts; the current threshold average was .86 milliamps with the pulse width at the standard setting for the pacemaker employed. Chronic thresholds were usually below the lower programmable limit of the pacer as tested at 3 months. In one patient, the fact that the screw was fixed in the exposed position caused trouble. The lead became knotted in the superior vena cava and was removed by thoracotomy. Although this experience with the Osypka lead was not entirely satisfactory, newer developments with retractable leads may make the principle more acceptable.

Adult↗
PubMed1983

Anatomic and clinical analysis of 96 Beall prostheses explanted over a 13-year period.

Over 13 years, 96 Beall prostheses (80 Teflon, 16 Pyrolite) explanted at surgery were examined for durability, material wear, and clinical symptoms leading to surgical indication for excision were evaluated. The Teflon valves showed progressive disc wear and notching and two cases of disc escape from the cage; the Pyrolite discs were intact in all prostheses. The Dacron-Velour covering common to both types showed dehiscence at the inlet, significantly more severe after the third implant year in the Teflon (p less than 0.005) than in the Pyrolite prostheses. Sixty-nine (85 percent) cases with Teflon valves showed clinical manifestations of congestive heart failure due to prosthetic dysfunction; in 50 there was significant hemolytic anemia. Seven (44 percent) of the 16 Pyrolite disc valves were excised primarily because of dysfunction. The degree of hemolysis with the Pyrolite valves was usually mild. These data clearly suggested the advisability of early excision of the Beall Teflon prostheses in symptomatic patients and a close follow-up in patients with the Pyrolite models.

Adult↗
PubMed1982

Improved results for dissecting aneurysms. Intraluminal sutureless prosthesis.

Surgical therapy for dissection of the thoracic aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. A method of treatment with an intraluminal prosthesis that requires no end-to-end anastomosis has been developed. We have used this method in 14 patients, of whom eight had acute thoracic aortic dissections and six had chronic dissections. We assembled our own prosthesis in the first five cases but, more recently, we have utilized an intraluminal prosthesis provided by USCI. Eight of the patients had type 1 dissection, of whom five required concomitant aortic valve replacement and three coronary artery bypass grafting; one had a type II dissection and five had type III dissections. The age range was 31 to 71 years with a mean of 58. There were 12 men and 2 women. There were no intraoperative deaths, but one patient died 10 days postoperatively of a perforated ulcer and another died at 6 months of empyema. Follow-up has been from 9 to 51 months with a mean of 22 months. There has been no evidence of compromise of the aortic lumen and no prosthetic problems, such as erosion, migration, or thrombosis. This technique provides a safe and simple way to repair dissecting aneurysms of the thoracic aorta and has provided long-term reliability. We have subsequently used this graft for 11 patients with aneurysm of the aorta with favorable results. We presently recommend this technique for dissecting, atherosclerotic, and Marfanoid aneurysms of the thoracic aorta.

Adult↗
PubMed1981

The role of lymphstasis in atherogenesis.

The cardiac lymphatics are responsible for the transport of all the lipoproteins and cholesterol from the extravascular myocardial tissue, although little is known about the filtration and lymphatic clearance of the coronary artery wall. It is postulated that a critical factor in the genesis of arteriosclerosis is lymphstasis, which adequately explains the positive correlation with the known risk factors for coronary artery disease and the negative correlation with high-density lipoproteins. Further research is necessary in this little-known area to better understand the etiology of atherosclerosis.

Arteriosclerosis↗