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Biomedical subjects

H J van de Wal

Publications and source records attributed to H J van de Wal.

At least 19 recordsLinked to original sources
PubMed1995

Late re-interventions following arterial switch operations in transposition of the great arteries. Incidence and surgical treatment of postoperative pulmonary stenosis.

Seventy-six patients were studied after arterial switch operation (ASO) between May 1977 and February 1992. Pulmonary artery reconstruction was initially performed by: conduit interposition in 5 patients, direct main pulmonary artery anastomosis and button patches in 60 patients, and pantaloon-like patch repair in 11 patients. Pulmonary stenosis developed in 17 patients (22%), requiring a total of 26 late re-interventions. Re-intervention was required in four out of five patients operated with pulmonary artery conduits, 11 out of 60 with a button patch repair and 2 out of 11 following pantaloon-type repair. In this series pulmonary artery stenosis (PS) involving the pulmonary valve occurred in 9/17 patients. Involvement of the pulmonary valve was related to the technique of pulmonary artery reconstruction. In these patients surgery is necessary. Balloon angioplasty can be a valuable tool when the stenosis is more distal. The incidence of PS was not influenced by the type of reconstruction or the use of Lecompte's maneuver.

Anastomosis, Surgical↗
PubMed1994

Multiple primary lung cancers.

Between 1970 and 1990, of 1287 patients undergoing resection for primary lung cancer, we considered 55 (4.3%) to have a second primary lung cancer, being synchronous in 15 cases (1.2%) and metachronous in 40 (3.1%). Two patients had a third primary lung cancer. The 15 patients with synchronous cancers were all treated surgically: ten underwent a two-stage procedure and 5 patients a one-stage. In 6 patients the cancers were located bilaterally and in 4 patients both synchronous cancers had a different histology. There were 3 postoperative deaths (20%). The 3- and 5-year actuarial survival rates were 26% and 15%. Of the 40 patients with metachronous cancers the mean interval between treatment of their first and second cancer was 5 years and 11 months. It was longer for the 21 patients having a contralateral second localization (7 years) than for those having an ipsilateral localization (4 years). There was no dependence of the intervals on whether or not the second cancer had the same histology as the first cancer. In 7 patients the second cancer was treated by chemo- and/or radiotherapy and in 33 patients by surgery. There were 5 postoperative deaths in this group (15.2%). The 3- and 5-year actuarial survival rates were 33% and 18%. For 25 patients with a stage I or II second cancer these rates were 42% and 27%; all 8 patients with a stage III second cancer died within 14 months. Survival was positively affected by: histological type differing between both cancers, an interval of more than 3 years, a bilateral localization, and a stage I or II second cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1994

The modified Senning operation for cavopulmonary connection with autologous tissue.

UNLABELLED: A modified Senning technique was used for intraatrial channeling of the systemic venous blood into the pulmonary arteries to create a Fontan circulation in 26 children, six with tricuspid atresia and 20 with complex congenital heart disease. In this technique a flap of atrial free wall tissue is used to create an atrial tunnel without artificial material. Eight patients had subaortic stenosis and required a Damus-Kay-Stansel procedure, in addition. Early mortality was two of 26 and late mortality one of 26. Pleural effusion was encountered in 17 of 26 patients, of whom four had a pericardial effusion, in addition. One patient required pacemaker implantation for complete atrioventricular block. Follow-up ranged from 2 months to 5 years. In this period the ability level index rose by one level. No thrombi were encountered in the right atrium/cavopulmonary tunnel. One patient required antiarrhythmic medication. Protein-losing enteropathy was diagnosed in one patient. CONCLUSION: This modified Senning technique has the advantage of avoiding the use of prosthetic material in the creation of a Fontan circulation and the potential for fewer long-term complications.

Adolescent↗
PubMed1992

Pulmonary venous obstruction following correction for total anomalous pulmonary venous drainage: a challenge.

Pulmonary venous obstruction after surgical correction of total anomalous pulmonary venous drainage (TAPVD) is a serious condition. Pulmonary venous obstruction can be the result of a primary developmental error or is due to post-operative anastomotic stricture and is usually manifest within 6 months of surgery. Prompt restudy is indicated and if a stricture is present, urgent surgical relief is indicated. However, the results are often disappointing with a high early mortality and a significant chance of restenosis.

Constriction, Pathologic↗
PubMed1991

Cardiac myxoma: the grand masquerader.

Cardiac myxoma is the most common primary tumor of the heart. A high suspicion of this potentially lethal disease is warranted because it may mimick a large variety of diseases. Two patients with different symptoms and signs are presented, in whom resection of the tumor was successful. Complete resection of the tumor is the only effective method of treatment.

Adult↗
PubMed1991

[Aortopulmonary window. The need for early surgical correction].

The diagnosis of aortopulmonary window may be problematical. In 7 patients who had undergone operative closure of an aortopulmonary window the diagnostic and operative techniques, the operative findings, and the postoperative course were retrospectively determined. It appeared that the diagnosis is difficult and that cardiac catheterization with angiocardiography is the most accurate diagnostic technique. Good results of operative correction depend on the timing of the operation (preferably before the first year of life), the operative technique, and the severity of additional anomalies of the heart and great vessels. Delay of surgical correction leads to pulmonary hypertension, caused by irreversible pulmonary vascular disease.

Aortopulmonary Septal Defect↗
PubMed1991

[Purulent pericarditis in children. A continuously life-threatening disease].

Acute purulent pericarditis in children is usually fatal, if not recognized and adequately treated. The history of three children with acute purulent pericarditis is presented. In every septic child who presents with signs of right heart decompensation, acute purulent pericarditis should be seriously considered. Echocardiography is essential for the diagnosis. If possible, diagnostic pericardiocenthesis should be performed. Experience of the last years suggests that excellent results can be obtained when adequate surgical drainage and antibiotic therapy are combined.

Acute Disease↗
PubMed1990

[2 successful treatments with extracorporeal membrane oxygenation in neonates with severe respiratory problems].

We report the successful treatment with extracorporeal membrane oxygenation of two Dutch neonates with severe respiratory insufficiency, due to meconium aspiration syndrome and persistent fetal circulation respectively. During this procedure part of the cardiac output is led outside the body via a venous cannula in the right atrium, oxygenated in a membrane oxygenator, rewarmed to the patient's body temperature in a heat exchanger and returned to the patient via a cannula in the carotid artery debouching into the aortic arch.

Extracorporeal Membrane Oxygenation↗
PubMed1990

Morphology of pulmonary atresia with intact ventricular septum in patients dying after operation.

In 1976, we adopted staged surgical management of pulmonary atresia with intact ventricular septum: stage 1 = establishment of a systemic to pulmonary artery shunt; stage 2 = open reconstruction of the right ventricular outflow tract and pulmonary valve; and stage 3 = closure of the shunt and interatrial communication. The morphological features of nine specimens obtained from 10 patients who died were reviewed. Special attention was given to features that might have influenced the poor surgical outcome in these patients. Survival after stage 1 depends on adequate systemic to pulmonary artery blood flow, initially as a combination of ductus arteriosus and shunt flow, with subsequent modification if the ductus closes. After stage 2, survival is influenced by left ventricular function and mitral valve function. The success of final correction (stage 3) depends largely on the morphology of both ventricles and their atrioventricular valves. It appears that the behavior of the ductus arteriosus and the size of the shunt are of vital importance for the survival of the infant. In 3 of the specimens, no right ventricular outflow tract was present, and in 2 others, short chordal attachments of the mitral valve were observed. Staged surgical correction appears to be a satisfactory approach if these considerations are taken into account.

Aorta, Thoracic↗
PubMed1990

Rupture of the supradiaphragmatic inferior vena cava by blunt decelerating trauma: case report.

Lacerations of the inferior vena cava resulting from blunt external trauma are relatively rare, but extremely serious. The high lethality is due to the difficulty in diagnosis and technical problems with repair, particularly if the injury is located above the renal veins. During a 12-month period seven patients with inferior vena cava laceration were seen, of whom two presented with laceration of the inferior vena cava above the diaphragm. Both had a deceleration injury while wearing seatbelts. The clinical presentation was similar. The etiology is discussed. Caval continuity should be repaired because acute sudden occlusion at the suprahepatic level is incompatible with survival. Median sternotomy is advised, moreover it provides good exposure for eventual cannulation.

Adult↗
PubMed1990

Postponing the limits. Multiple and repeated pulmonary metastasectomy by parenchym sparing electrocautery excision.

Due to the continuous improvement and effectiveness of the chemotherapeutics, the role of the surgical resections of metastases is changing. In the period 1954-1975 we removed from 35 patients 48 metastases, in the period 1976-1985 from 45 patients 102 metastases, while in the period 1986-1989 from 47 patients 200 metastases were removed. The ratio of 1.3 metastasectomy per patient in the first group is corresponding to the 4.5 ratio metastasectomies in the last group. The number of classical lobectomies decreased in favour of the segmental and wedge resections. Based on the case histories of non seminomatous testis tumors, finally an extraanatomical resection of the metastases minimizing all unnecessary waste of functional lung parenchyma became an obvious consequence of this development. Since 1986 we adapted and used the technique of extraanatomical pulmonary resections by electrocautery 92 times. It appeared that appropriate use the cutting and coagulating modality of electrocautery offers a safe, easy, fast, highly efficient and selective tool to divide and distinguish the normal lung parenchyma from the bronchial, vascular and pathologic structures. The cautery condensed surface of the remaining parenchyma is not difficult to control for hemostasis and air leakage and can be easier sutured. In case of doubts or deep intrapulmonal defects the fibrin glue (Tissucol) offers an extra security by sealing the irregular of large defects. The microscopical examination can distinguish on the specimen a thin layer of intact lung parenchyma. The surface of this--similar of the surface of the remaining resection plane--shows a "sealed membrane" of cauterized alveoli, bronchioli or vessels.

Electrocoagulation↗
PubMed1989

Diagnosis and management of the coronary-subclavian steal syndrome.

A patient is presented with recurrent angina due to a coronary-subclavian steal syndrome 3 years after left internal mammary to left anterior descending coronary artery bypass grafting. Myocardial ischaemia could easily be provoked by selective exercise of the left upper limb. Coronary angiography showed reversal of flow in the left internal mammary artery. Suggestions are given for prevention of the coronary-subclavian steal syndrome by identification of patients who are at risk of developing subclavian artery occlusive disease. Performance of coronary and brachiocephalic angiography is indicated in recurrence of angina in patients with internal mammary artery bypass grafts. Doppler spectral analysis may be a valuable technique for detection of a haemodynamically significant stenosis of the left subclavian artery. Carotid-subclavian bypass grafting is the procedure of choice for management of the coronary-subclavian steal syndrome.

Angina Pectoris↗