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Biomedical subjects

H Rastan

Publications and source records attributed to H Rastan.

At least 19 recordsLinked to original sources
PubMed1981

Enlargement of mitral valvular ring. New technique for double valve replacement in children or adults with small mitral anulus.

The technical difficulty of inserting a sufficiently large prosthesis in a small mitral ring has been overcome by a new technique based on the principle of complete division of the valvular ring and its unrestricted enlargment by reconstruction of the prosthetic valve. Th technique entails division of the aortic valvular ring into and through the mitral anulus and the left atrial wall. It provides wide exposure for easy double mitral and aortic valve replacement, which is performed with large prosthetic valves that are supported in part by the patch reconstruction of the incised structures. This method has been used with excellent technical and good early functional results in two children needing double valve replacement for rheumatic mitral and aortic regurgitation. A wider adoption of this technique to manage similar lesions in both children and adults seems advisable.

Adolescent↗
PubMed1981

Aortic and mitral valve replacement in children or adults with small valvular annulus.

Two methods are described for enlarging the aortic and mitral valvular annuli. The first method is aortoventriculoplasty, the results of which are reported here in 7 patients with small aortic annulus and in 4 cases with stenotic aortic valvular prosthesis inserted previously. The second method is developed for enlargement of the mitral ring to insert larger mitral valvular prosthesis. In this method the aortic and mitral annuli are split through a conventional incision and patched after mitral and aortic valve replacement with larger prostheses are done. This method is used in an 8-year-old boy with success. Both methods have proved to be useful especially in children and the results are very encouraging so that they could be accepted in the repertoire of the cardiac surgeon.

Adolescent↗
PubMed1980

Simultaneous dopamine and sodium nitroprusside therapy following open heart surgery.

Twenty post-open heart surgery patients with low output syndrome were given dopamine, sodium nitroprusside (SNP) alone and in combination. Dopamine alone (3--4 mcg/Kg/min) caused an increase of cardiac output (CO) from 3.2 to 4.6 L/min/M2 (p less than 0.001), SNP (1--1.5 mcg/Kg/min) raised the CO to 3.7 L/min/M2 (p less than 0.005). While the combination of the 2 drugs elevated the CO to 5 L/min/M2 (p less than 0.001). The mean pulmonary artery wedge pressure dropped moderately with dopamine and significantly with SNP and combined drugs. The diastolic pulmonary artery pressure fell significantly with either drug and in combination. The stroke index increased significantly with dopamine and combined therapy. All patients survived. It is concluded that in post-open heart surgery patients with low output syndrome substantial hemodynamic improvement results with the combined use of dopamine and SNP more than with either agent alone.

Adult↗
PubMed1979

Aortoventriculoplasty for tunnel subaortic stenosis and other obstructions of the left ventricular outflow tract. Clinical and hemodynamic results.

A new therapeutic concept of enlarging the outflow tracts of both ventricles with a patch and inserting an aortic prosthesis has been developed for the treatment of tunnel subaortic stenosis. This operation has been applied clinically since June 1974 on several types of obstruction in the outflow tract of the left ventricle. Twenty-one operations have been performed on 20 patients under the age of 18 years, with an overall mortality of 24% and no late deaths. Seven patients developed complete right bundle branch block or left anterior hemiblock or both as a result of this operation; transient atrioventricular block and complete left bundle branch block occurred in one patient each. In no case, however, did rhythm disturbances contribute to death. In one patient, the septal incision injured a septal coronary artery, with fatal result. Fourteen patients had catheterization studies postoperatively. Although previous conventional surgery had been unsuccessful, aortoventriculoplasty (AoVPI) reduced the mean gradient across the left ventricular outflow tract significantly (p less than or equal to 0.01), from 94.7 +/- 25.5 mm Hg to 14.4 +/- 17.2 mm Hg, leaving the end-diastolic pressure practically unchanged. No significant defect remained in the patch-covered septal incision. Thus, we consider AoVPI to be the operation of choice for tunnel subaortic stenosis, for valvular aortic stenosis with a narrow annulus and in cases where an artificial aortic valve has become too small because of the patient's growth.

Adolescent↗
PubMed1978

[Coarctation of the aorta: surgical management in infancy--results in 72 patients (author's transl)].

Early and late results of a total of 72 infants operated for coarctation of the aorta are reported. Operative repair included various methods (End-to-End, Vossschulte, Clagett, Shumaker, Waldhausen, Blalock). Isolated coarctation was present in 6 infants, 17 also had patent ductus arteriosus, 39 patients had additional associated cardiac anomalies, part of which were combined with PDA. Out of the 72 infants 17 died (early mortality: 11, late mortality: 6). The highest mortality rate was found among the 0 to 3 months age group (11 patients). Fourteen out of the 17 deceased patients had additional cardiac anomalies. Out of the 55 survivals, 37 patients showed good results, restenosis was found in 13 patients, 5 patients had to be reoperated due to severe restenosis.

Age Factors↗
PubMed1978

[Corrected transposition of the great arteries: surgical treatment of associated cardiac defects (author's transl)].

Corrected transposition of the great arteries is often associated with other cardiac anomalies. We report our experience with the correction of the associated cardiac defects in 13 cases: ventricular septal defect with pulmonary hypertension (5 cases), ventricular septal defect with obstruction of pulmonary outflow tract (5 cases), obstruction of pulmonary outflow tract (2 cases), ostium primum defect (1 case). The possible surgical approaches for repair of the cardiac anomalies are described and the results of the operative correction are communicated. Precise diagnosis, the knowledge of the unusual disposition of the conducting tissues and new surgical approaches are prerequisite for successful correction.

Adult↗
PubMed1978

[Hemodynamic results of surgery for congenital supravalvular aortic stenoses (author's transl)].

Supravalvular aortic stenosis is either a syndrome combined with typical face characteristics mental retardation and peripheral pulmonary artery stenosis or it occurs as an isolated congenital heart defect. The diagnosis was confirmed in 137 patients by means of catheterization and angiocardiography; 35 pediatric and 10 adult patients were considered to be candidates for corrective surgery because of the severity of their disease. Age varied from 3 to 32 years. 7 patients (15,5%) died. Recatheterization was performed in 12 children 5,6 +/- 4,1 years after surgery. Left ventricular pressures were decreased from 184,1 +/- 28,4 to 155,5 +/- 32,1 mm Hg, and the pressure gradients between left ventricle and the aorta fell from 101,2 +/- 19,7 to 29,1 +/- 23,1 mm Hg. The postoperative values varied between 0 and 80 mm Hg. Operative results are discussed in relation to the anatomical type malformation and the operative technique.

Adolescent↗
PubMed1978

[Fresh autologus blood transfusion during open heart surgery (author's transl)].

Hemodynamic parameters were measured in 80 unselected patients prior to cardiopulmonary bypass for a variety of a operative procedures. Isovolemic blood withdrawel up to 24.7 ml/kg or 10 gms% and 30% hematocrit during sternotomy using ACD blood storage containers was carried out prior to bypass. Moderate hemodilution during bypass with postbypass autologous blood transfusion resulted in 60% of the study group not requiring homologous blood. The mean post-operative blood loss in this group was 245 ml. The remaining 40% received up to 1550 ml homologous blood with 820 ml mean post-operative blood loss. Omission or reduction of homologous blood requirement decreases the risk of shock lung, saves clotting factors and reduces strain on blood banking facilities.

Adolescent↗
PubMed1978

Isolated unilateral absence of the pulmonary artery. Review of the world literature and guidelines for surgical repair.

A 10-month-old boy is presented who had isolated unilateral absence of the right pulmonary artery. He suffered from hemoptysis and severe congestive heart failure. The patient underwent prosthetic anastomosis of the right to the main pulmonary artery. Although the hemodynamic response was favorable, his oxygenation did not improve due to diffuse pulmonary arteriovenous fistulae of the affected lung. The patient succumbed 3 months after operation due to massive uncontrollable hemoptysis from the right lung. Isolated unilateral absence of the pulmonary artery is a rare lesion. In our review of the world literature as of November 1976, 47 cases (including this report) of the unilateral absence of the pulmonary artery have been reported. Of these 25.5% had pulmonary hypertension and only 4 cases underwent successful repair of the lesion. Though repair of this defect can be carried out, the result may not be always gratifying. Our experience with this case has led us to consider a lung biopsy before proceeding to the surgical repair of the lesion. If the affected lung shows arteriovenous abnormalities the operation should not be recommended.

Blood Vessel Prosthesis↗
PubMed1978

Results of aortoventriculoplasty in 21 consecutive patients with left ventricular outflow tract obstruction.

Results of aortoventriculoplasty (AVP) are reported in 21 patients with various types of left ventricular outflow tract obstruction (LVOTO). The concept of AVP is based on creating a surgical aortoseptal defect which is patched to provide the largest possible outflow tract to the left ventricle. Lesions consisted of isolated diffuse fibromuscular subaortic stenosis in six patients, diffuse subaortic stenosis and associated other cardiovascular anomalies in five, hypoplastic aortic anulus in two, idiopathic hypertrophic subaortic stenosis (IHSS) in two, and stenosis of a previously implanted aortic valvular prosthesis in three patients. Ten patients had had at least one unsuccessful previous surgical attempt to relieve the LVOTO. The coexisting mitral incompetence in IHSS disappeared after AVP alone. Immediate postoperative hemodynamic results were excellent in all cases. Postoperative death in five patients was due to advance myocardial failure in two, brain damage in one, transection of a dominant septal artery in one, and severe acidosis with renal failure in the last case. However, in the last 16 patients (17 operations) the only death (5.8 percent) was that caused by uncontrollable acidosis. Follow-up results indicate that 16 patients are clinically doing well, and hemodynamic studies in 14 patients are rated as excellent or good from 1 to 25 months postoperatively. It is concluded that AVP is an effective operation for managing all types of LVOTO and can be used routinely with an acceptably low mortality rate.

Aorta↗
PubMed1978

[Haemodynamic effects of acute intra-operative haemodilution in open heart surgery (author's transl)].

Haemodynamic measurements were made in 80 patients who underwent acute haemodilution (up to 40 ml/kg blood withdrawal) before cardiopulmonary bypass. Measurements of cardiac output, pulmonary arterial pressures including wedge pressure were made. Cardiac index, stroke volume and total peripheral resistance were calculated. Oxygen studies included: arterial and central venous partial pressures and saturations. Haemoglobin content, haematocrit and blood gas determinations were made during haemodilution and bypass. There was a direct relationship between haemodilution and stroke volume (stroke volume increase of 8,5% with 9,4 ml/kg and 25% increase with 40 ml/kg blood withdrawal). No change was found in mean pulmonary artery or wedge pressures. Central venous oxygen saturation remained constant during haemodilution which indicates that oxygen supply was adequate. Haemodilution should be avoided in patients with less than 35% haematocrit, with more than two vessel coronary artery disease and Class IV N.Y.H.A. because of the risk of possible impaired cardiac output compensation. During bypass, a haematocrit of 20% and 6 g% provides greater perfusion and optimal microcirculation. The problems of large volume homologous blood transfusion, hepatitis risk and loss of clotting factors can be lessened with haemodilution.

Adolescent↗
PubMed1976

[A simple method for tricuspid annuloplasty (author's transl)].

A new operative method for tricuspid annuloplasty is reported. In this method the antero-posterior portion of the tricuspid annulus is sutured to a semi-circular nonelastic strip of teflon by double needle sutures. Since the radius of this strip is shorter than the radius of the valve ring, the tricuspid annulus will be narrowed after the sutures are tied. Because of its simplicity, firmness and maintenance of the valvular ring elasticity, this method seems to be advantageous to all similar procedures. The results of the method in 5 patients with severe tricuspid incompetence have been excellent. This method can also be used for annuloplasty of the mitral valve.

Adolescent↗
PubMed1976

[Surgical considerations on levo-atrial systemic vein (author's transl)].

The levo-atrial systemic vein is a special type of persistent left superior vena cava and is associated with other intracardiac lesions most often. Hemodynamically there is a right to left shunt. The operative procedure may consist in a ligature in relation to the anatomic situation. The intraatrial correction intends a drainage to the right atrium. Of 7 cases four times a intracardiac rerouting was achieved but two times a ligation was performed.

Child↗
PubMed1976

Aorta-circumflex coronary artery bypass through the transverse sinus. A new technique.

Aorta-circumflex coronary artery bypass using a saphenous vein graft may present technical inadequacies with angulation, kinking, compression, tension and finally thrombosis and occlusion of the graft. As these problems are mainly secondary to incorrect length and direction of the vein graft, a new technique is described which allows the placement of a shorter graft in a more parallel direction to the physiologic aortocoronary flow. The transverse sinus of the heart is used as a natural protected channel whereby the graft passes behind the great vessels from the right posterior wall of the aorta to the circumflex coronary artery. Thus, redundancy, angulation and kinking are avoided and flow in the graft takes a more natural course.

Coronary Artery Bypass↗
PubMed1976

Aortoventriculoplasty: a new technique for the treatment of left ventricular outflow tract obstruction.

Aortoventriculoplasty is a new method of treatment for left ventricular outflow tract obstructions. The concept is based on creating a surgical defect which is patched in such a way as to provide the largest possible outflow to the left ventricle. The incision of the aorta continues down as far as necessary, with the right ventricular wall, the aortic ring, and the septum being cut. Reconstruction with an inner Dacron patch on the septum is completed by replacing the aortic valve with an adequate prosthesis, covering the aortic incision with the same patch, and patching the right venticular opening with an outer patch. This method was used in 4 children with tunnel-like subaortic stenosis, 3 of whom had had unsuccessful previous surgical attempts. Other associated lesions including parachute mitral valve were also corrected during aortoventriculoplasty. Hemodynamic results were excellent following this operation. Two patients died postoperatively, one from advanced myocardial damage and progressive failure and the other from cerebral ischemia caused by insufficient retrograde perfusion through an aortic coarctation that was not repaired earlier. No arrhythmias were observed following the procedure. The other 2 patients are well 7 and 5 months postoperatively with excellent hemodynamic function.

Angiocardiography↗
PubMed1975

[Rastelli operation for complete transposition of the great vessels, ventricle septum defect and pulmonary atresis].

We report about a 6 year old patient with complete transpositon of the great arteries, a ventiricle septum defect, and pulmonary atresia, who was operated using Rastellis technique. A Hancock-prothesis of of 20 mm diameter was used for reconstruction of the outflow tract of the right ventricle and anastomosed distal with the pulmonary artery on the left side of the aorta. The proximal anastomosis was performed with the right ventricle after a longitudinal ventriculotomy. The intraoperative pressure recordings and the post-operative studies revealed a very good early result.

Blood Pressure↗
PubMed1975

[Plastic enlargement of the left ventricular outflow tract. A new operative method (author's transl)].

A new operative technic for widening the stenotic left ventricular outflow ("left ventricular tunnel") is described and a clinical case is reported. A vertical incision along the anterior aspect of the aorta descends with a slight angle across the outflow tract of the right ventricle. After aortic valvectomy the ventricular septum is cut between the left and right coronary commissure through its full thickness and the incision extended inferiorly across the stenotic area. A dacron patch is sewn into the gap of the septum and aortotomy in order to widen the area of previous stenosis and prosthetic replacement of the aortic valve is performed. Finally another dacron patch is used to close the defect in the right ventricular outflow tract.

Aorta↗