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Biomedical subjects

G Primo

Publications and source records attributed to G Primo.

At least 19 recordsLinked to original sources
PubMed1995

Tricuspid valve replacement: postoperative and long-term results.

A series of 146 consecutive patients who underwent tricuspid valve replacement at the University Brugmann Hospital between 1967 and 1987 was reviewed. Mean age at operation was 51.4 years (+/- 12.1 years). Different types of prostheses were implanted including porcine and bovine pericardial bioprostheses and older and bileaflet mechanical valves. Most patients were severely disabled by their cardiac disease before operation, with 30.1% in New York Heart Association functional class III and 69.9% in class IV. Operative mortality and hospital mortality rates (30 days) were high (16.4%). Incremental risk factors for hospital death included icterus (p < 0.005), preoperative hepatomegaly (p = 0.012), and New York Heart Association functional class IV (p = 0.013). Multivariate analysis only selected preoperative icterus (p < 0.01) as being independently significantly related to hospital mortality. The hospital survivors were followed up for a median of 94 months. A complete follow-up was available for all patients except two for 30 months or more. At 30 months the only two significant parameters were the type of myocardial protection (p = 0.024) and the year of operation (before 1977 or after [precardioplegia era or after], p = 0.011). There were 70 late deaths during the entire follow-up period. The univariate (log-rank statistics) incremental risk factor for late death was the type of tricuspid prosthesis (Smeloff-Cutter and Kay-Shiley versus St. Jude Medical versus bioprosthesis) (p = 0.04). A trend was observed for the type of operative myocardial protection (normothermia and coronary perfusion) (p = 0.06) and preoperative New York Heart Association functional class IV (p = 0.055). Actuarial survival was 74% at 60 months and 23.4% at 180 months. Cumulative follow-up added up to 1015 patient-years. In a more detailed analysis of the effect on survival of the type of tricuspid prosthesis, a significant difference was observed between the bioprostheses and some older mechanical prostheses (Smeloff-Cutter and Kay-Shiley) (p = 0.04) but not between the bioprostheses and the bileaflet valves (p = 0.15). When the follow-up period was stratified according to less than 7 years and more than 7 years of follow-up, no difference was observed for the first period, but for the late follow-up the new mechanical prostheses did better than the bioprostheses (p = 0.05), suggesting a degradation of the bioprostheses after 7 years and favoring mechanical prostheses for those patients with a good long-term prognosis.

Actuarial Analysis↗
PubMed1995

The valve choice in tricuspid valve replacement: 25 years of experience.

This study reviews 146 consecutive patients who underwent tricuspid valve replacement (TVR) with 69 bioprostheses (porcine and bovine pericardial) and 77 mechanical ball, disc or bileaflet valves between 1967 and 1987. The mean age was 51.4 +/- 12.1 years. Preoperatively, 97% were in New York Heart Association (NYHA) functional class III or more and over 40% had undergone previous cardiac surgery. Hospital mortality was high (16.1%). Incremental risk factors for hospital death were preoperative icterus (P < 0.01), hepatomegaly (P = 0.02), NYHA functional class IV (P = 0.02) and male sex (P = 0.04) (univariate analysis). Ninety-eight percent of the hospital survivors were followed up for a mean of 92 months. Cumulative follow-up added up to 955 patient-years. There were 70 late deaths. The actuarial survival rate was 74% at 60 months and less than 25% at 14 years. Incremental risk factors for late death indicated by univariate analysis were the type of tricuspid prosthesis (Smel-off-Cutter and Kay-Shiley prostheses) (P = 0.04), the type of operative myocardial protection (normothermia and coronary perfusion) (P = 0.05) and preoperative NYHA functional class IV (P = 0.05). We conclude that TVR carries a high operative risk and poor long-term survival, both influenced by preoperative and perioperative variables. Bearing in mind the poor prognosis for TVR, we prefer a large-sized bioprosthesis, in view of its initial good durability and low risk of valve-related events. However, in patients with good life expectancy, a bileaflet mechanical prosthesis may be an acceptable alternative.

Actuarial Analysis↗
PubMed1992

Reappearance of a normal circadian rhythm of blood pressure after cardiac transplantation.

Twenty-four-hour blood pressure (BP) and heart rate profiles were recorded in 19 patients 1 and 7 months after cardiac transplantation using noninvasive ambulatory monitors and were analyzed using the periodogram method. These recordings were compared with those of control subjects matched for age, sex and daytime ambulatory BP. One month after transplantation, the nighttime decrease in systolic and diastolic BPs were attenuated in the patients as compared to the control subjects (p less than 0.001). The daily oral dose of prednisolone was inversely correlated with the magnitude of the nighttime decreases in systolic and diastolic BPs (r = -0.47 and -0.53, p less than 0.05). In contrast, 7 months after transplantation, the nighttime decrease in systolic and diastolic BPs reappeared in the patients and was of similar magnitude as that in the control subjects. When the immunosuppressive regimens during the 2 periods of recordings were compared, the reduction in the daily oral dose of prednisolone administered to the patients 7 months after transplantation was correlated with the observed increase in the day-night systolic and diastolic BP difference (r = 0.61, p less than 0.01 and r = 0.51, p less than 0.05). Thus, data show the reappearance of normal circadian BP profiles in patients with long-term heart transplants, and suggest that glucocorticoid administration may contribute to the abnormal nocturnal BP profiles observed 1 month after transplantation.

Blood Pressure↗
PubMed1992

Prostaglandin E1 infusion for right ventricular failure after cardiac transplantation.

The infusion of prostaglandin E1, a vasodilating substance with predominant effects on the pulmonary vasculature, has been found effective in the management of pulmonary hypertension associated with various diseases. The reported experience with prostaglandin E1 after cardiac transplantation is, however, limited. We used prostaglandin E1 in 18 patients in whom acute right ventricular failure developed after orthotopic cardiac transplantation. The infusion was started within 24 hours after operation in 16 patients and was continued for up to 7 days. Maximal doses of prostaglandin E1, administered via a central venous catheter, ranged from 30 to 120 ng/kg/min. Norepinephrine was simultaneously infused via a left atrial catheter in 10 patients to prevent a reduction in systemic arterial pressure. The prostaglandin E1 infusion resulted in significant reductions in mean arterial pressure and pulmonary vascular resistance and simultaneous increases in cardiac index and stroke index. Mean arterial pressure was stable and left ventricular stroke work increased. The alveolar oxygen tension/forced inspiratory oxygen index tended to decrease during the infusion. Three patients died, two of right heart failure and one of multiple organ failure associated with cardiac allograft rejection. In patients in whom right ventricular failure associated with pulmonary hypertension develops after cardiac transplantation, prostaglandin E1, combined with norepinephrine whenever the arterial pressure declines, can effectively reduce pulmonary artery pressures and improve global cardiac function without compromising systemic perfusion.

Adult↗
PubMed1991

A survey of nine years heart transplantation at Erasme Hospital, University of Brussels.

Between March 1982 and March 1991, 225 heart transplantations (HTx) have been performed in 220 patients suffering end stage cardiac disease. Thirteen percent were females and 87% were males. Age range was from 5 to 68 years. The underlying cardiac disease was ischemic cardiopathy in 51.5%, congestive dilated cardiomyopathy in 42%, valvular cardiomyopathy in 3.5%, toxic myocarditis (post-adriamycin) in 1.5% and chronic rejection in 2.5% (retransplantation). Selection of the recipients was done following the currently well established criteria also taking into account the absolute major contraindications for HTx. Due to the still increasing demand of donor organs, currently donor age has been extended up to 50 years for male and 55 years for female donors. One quarter of the grafts were harvested on site in our institution, two other quarters were harvested somewhere else in Belgium and the last quarter provided by other countries cooperating with Eurotransplant. All patients have undergone orthotopic cardiac transplantation using the standard Lower and Shumway technique. Immunosuppression protocols have changed four times throughout the years. Nevertheless all were based on the use of Ciclosporine variously combined with other current immunosuppressive drugs. Rejection monitoring relied on routine endocardiac biopsy and was diagnosed according to the Billingham criteria. The in-hospital mortality is currently 11%. Infection, early right heart graft failure and acute rejection were the leading causes of death. The major causes of early morbidity were several curable infections, reversible rejection episodes, transient acute renal failure and controllable arterial hypertension. Among the survivors followed for at least one month up to nine years, half of late mortality was caused by chronic rejection followed by infection, sudden death, metabolic disorders, stroke and malignancy. Late morbidity involves cases of mild coronary graft diseases, biological renal insufficiency, some degree of arterial hypertension, dislipidemia. Current actuarial survival rate is 87% at one year, 76% at 5 years up to 9 years. Our experience confirms that HTx represents today and effective therapy for selected patients suffering end stage cardiac disease.

Actuarial Analysis↗
PubMed1991

Echocardiographic signs of cardiac rejection during the first week after cardiac transplantation.

The early recognition of acute rejection after heart transplantation remains an important clinical problem. In this study we explored the value of echo-Doppler techniques to identify the rejection during the first week after cardiac transplantation. The study included 22 patients with an average age of 48 +/- 9 years. Ultrasonic measurements were obtained by 2-dimensional 84 degrees phased array sector scanner with pulsed Doppler incorporated. The stroke index (SI), the peak outflow blood velocity pulsed (POBVP), the peak outflow blood acceleration pulsed (POBAP), the peak flow velocity in early diastole (PFVE), the peak flow velocity during atrial systole (PFVA), the PFVA/PFVE ratio, the mitral valve pressure half-time (PHT) and the fractional shortening (FS) were calculated. On the seventh day after transplantation, a percutaneous right ventricular endomyocardial biopsy was systematically performed. For the entire group, the SI, PHT and the FS relation were not significantly influenced during the week of evaluation. The POBVP and the POBAP transiently decreased but returned to baseline on the seventh day. An increment in the PFVA/PFVE ratio was observed in 4 patients, and acute allograft rejection was documented in 3 of them. On day 7 after transplantation, PFVA and PFVA/PFVE were significantly higher in patients with rejection. No patient with normal PFVA/PFVE ratio had allograft rejection. No patient with rejection showed signs of altered systolic function as measured by SI, POBVP, POBAP and FS. These data therefore indicate that the assessment of the diastolic function using Doppler techniques (PFVA/PFVE) can be helpful to detect signs of acute allograft rejection occurring early after heart transplant.

Echocardiography, Doppler↗
PubMed1990

[Late results of surgical repairs of tetralogy of Fallot].

The late results of 115 children with tetralogy of Fallot born and corrected between 1969 and 1988 are analyzed; the patients were distributed into 3 anatomical groups: normal pulmonary annulus (group A, 49 patients) annular stenosis (group B, 56 patients) and pulmonary atresia (group C, 10 patients). The probability of survival 15 years after correction is 97 p. 100 in cumulated groups A and B and 72 p. 100 in group C (p = 0.005). The probability of reoperation ten years after correction is 4 p. 100 in cumulated groups A and B without a previous shunt, 20 p. 100 in A and B with a previous shunt (p less than 0.05) and 55 p. 100 in group C (p = 0.0004). The proportion of serious cardiac sequellae amounts to 17 p. 100 in group A, 55 p. 100 in group B and 100 p. 100 in group C (p = 0.0005). As a whole, 55 p. 100 of the adolescents operated on for tetralogy of Fallot during infancy present a residual problem of some severity.

Actuarial Analysis↗
PubMed1990

[Traumatic rupture of the isthmus of the thoracic aorta (midterm results in a series of 15 cases)].

The authors present a series of 15 cases of traumatic disruption of the aortic isthmus. There were 9 cases of acute rupture and 6 of chronic rupture. All the patients have been operated on. Different technics was used to protect the viscera during aortic cross-clamping, partial E.C.C. in 9 cases, clamp-repair technic in 4 cases and a GOTT shunt in 2 cases. 4 patients died in the first thirty days (3 acute and 1 chronic). 2 cases of paraplegia was observed. All the patients have been reviewed after a mean follow-up of 36 months and remain well but one who is still paraplegic. Surgical repair is mandatory in acute and aortic disruption with a great attention to the associated injuries.

Accidents, Traffic↗
PubMed1990

[Localization of the accessory pathway and surgical treatment in Wolf-Parkinson White syndrome].

The accessory bypass tracts are responsible for many episodes of supraventricular arrhythmias in man. The Wolff-Parkinson-White syndrome is the best example. These arrhythmias can be refractory to the medical treatment and are sometimes lethal. Different techniques can be used to destroy these pathways. The surgical dissection is the most widely accepted technique. The accessory pathways are made of working muscle and are neither visible, nor palpable by the surgeon. The electrical properties of these pathways are used to localize them. These techniques are either non-invasive or invasive. The non-invasive techniques consist of the careful analysis of the surface electrocardiogram in sinus rhythm and during tachycardia. The invasive techniques consist of a pre-operative electrophysiological study and intra-operative mapping. The electrophysiological study consists of the introduction of multiples catheters inside the heart through peripheral veins. The intra-operative mapping consists of measurements done on the surface or inside the heart after the chest has been open. After precise localization of the areas of insertion of these abnormal tracts the surgeon proceeds with the dissection, starting either on the epicardial or on the endocardial side of the heart. The surgical results are excellent and there are only few complications. These techniques were used to operate six patients presenting with the Wolff-Parkinson-White syndrome.

Adolescent↗
PubMed1989

Potentiation of the effects of enoximone by a dobutamine infusion.

Enoximone is a new inotropic agent, which acts by the inhibition of the type III phosphodiesterase (PDE) enzyme. The present report describes a 81-year-old female patient with severe heart failure following aortic valve replacement. Her cardiac activity was paced. The addition of enoximone (two doses of 0.5 mg/kg) to an intravenous infusion of dobutamine (8 mcg/kg/min) and sodium nitroprusside significantly increased cardiac output (CO) from 3.2 to 3.9 l/min and decreased pulmonary artery occlusive pressure (PAOP) from 22 to 16 mmHg. Another dose of enoximone 12 h later had similar effects. However, another 12 h later, after dobutamine had been discontinued, two successive injections of 0.5 mg/kg of enoximone were totally ineffective (CO from 2.6 to 2.5 l/min, PAOP 23 mmHg). When the dobutamine infusion was restarted (at 8 mcg/kg/min), the positive effects of 0.5 mg/kg of enoximone were again present (CO from 3.0 to 3.6 l/min, PAOP from 19 to 14 mmHg). This observation underscores the therapeutic value of the combination of PDE inhibitors such as enoximone with adrenergic agents such as dobutamine in the management of severe heart failure.

Aged↗
PubMed1988

Liver-function studies in heart-transplant recipients treated with cyclosporin A.

Cyclosporine (CsA) hepatotoxicity has been reported but has not been studied systematically. This study includes 17 patients undergoing heart transplantation (HTx) and being treated with CsA, azathioprine, and corticosteroids. We assessed liver function in these patients before HTx and during the following month by five biological tests: total bile acids (BA), alkaline phosphatase (AP), gamma-glutamyltransferase (GGT), and total bilirubin in serum, and the aminopyrine breath test (ABT). With these tests we could classify the patients into three groups before HTx: normal (group I), mildly altered (group II), and severely altered (group III) liver function. During CsA therapy we did not observe any changes in any test results except for BA and GGT, and these only in group III. The ABT improved significantly in this group. During kinetic studies in patients without liver dysfunction, we confirmed a direct interference of CsA on BA secretion mechanism, but not the GGT increase, which remains to be explained.

Adolescent↗
PubMed1988

[Functional non-invasive cardio-respiratory evaluation a month and a year after orthotopic heart transplantation].

Cardio-respiratory stress tests of 14 patients, performed one month and one year after orthotopic heart transplant, are compared in order to demonstrate the functional and metabolic improvements of their adaptation to stress. At maximal stress, we note a 33 p. cent increase of the oxygen consumption (p 0.001), an 11 p. cent increase of the heart rate (p 0.025) and an 18 p. cent increase of the systolic arterial pressure (p 0.005). Respiratory quotients and respiratory equivalent for oxygen are significantly lower (p 0.008) while there was no significant variation of ventilation/minute, respiratory rate, and the normal capacity. At the sub-maximal level, the only significant differences observed are the decrease of the respiratory quotient (p 0.01), the ventilation/minute (p 0.025), the respiratory equivalent for oxygen (p 0.005) and the respiratory rate (p 0.03). The improvement of the physical condition observed in heart transplants seems related to a better peripheral adaptation to stress (lower respiratory quotients, reflection of the decreased demand on anaerobic metabolism) permitting a lesser demand on the ventilatory response to stress.

Adult↗
PubMed1987

Human heart-lung transplantation: physiologic aspects of the denervated lung and post-transplant obliterative bronchiolitis.

Eighteen sequential follow-up measurements of pulmonary function were obtained over a period of 21 months after heart-lung transplantation in a patient who had undergone surgery for end-stage pulmonary lymphangioleiomyomatosis. In the early postoperative period, there was a moderate decrease in VC and TLC but gas exchange was maintained at essentially normal levels. The most conspicuous features of postoperative lung function were a very low airway resistance and an increase in FEV1/VC ratio above 95%. These alterations were associated with an unusual shape of the maximal expiratory flow-volume (MEFV) curve. Instead of showing a uniform decrease in expiratory flow as expiration proceeds to residual volume, the post-transplant MEFV curve showed a peak followed by a gently sloping plateau ending at a knee where flow suddenly fell. The knee occurred after exhalation of 80% VC. From the sixth postoperative month, the patient developed rapidly increasing air-flow obstruction, which proved to be due to obliterative bronchiolitis. As air-flow obstruction worsened, the knee on the MEFV curve progressively occurred at a higher lung volume, the flow plateau shortened, and flow after the knee became smaller at a given volume. From the ninth postoperative month, it was no longer possible to identify a plateau-knee configuration on the MEFV curve, which resembled that seen in severe obstructive airway disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗