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Biomedical subjects

J J Lamberti

Publications and source records attributed to J J Lamberti.

At least 91 records · Page 5Linked to original sources
PubMed1976

Mechanical circulatory assistance for the treatment of complications of coronary artery disease.

Surgery has become an accepted method of treatment for coronary artery disease and its complications. Revascularization results in significant improvement in symptoms for patients with angina pectoris. Occasionally, patients requiring surgery for angina pectoris will sustain reversible ischemic damage during operation; such patients can be successfully weaned from cardiopulmonary bypass with full recovery when intra-aortic balloon counterpulsation is used. Arrhythmias associated with ischemic damage to the myocardium also can be controlled when IABCP is used for physiologic assistance. Patients in cardiogenicshock of pulmonary edema after acute myocardial infarction have an ominous prognosis. When decompensation occurs, IABCP may be used to stabilize the patient and to allow study and corrective surgery if possible. The prognosis is better for patients with ventricular septal defect, although selected patients without a mechanical defect of the myocardium can be salvaged if the response to IABCP is favorable. Counterpulsation has also been shown to be useful in achieving pulsatile cardiopulmonary bypass and in assisting high-risk patients through operation. External pressure circulatory assist (EPCA) is less effective than IABCP in assisting the failing myocardium; however, the external device is noninvasive and may be a useful adjunct in situations where IABCP is not feasible.

Angina Pectoris↗
PubMed1976

Patch aortoplasty for insertion of the porcine heterograft.

The porcine heterograft has been shown to be a very satisfactory replacement for the diseased aortic valve. In certain cases, the advantage of a low thromboembolism rate without anticoagulation must be weighed against the suboptimal orifice size noted in the smallest heterografts. In using the largest replacement possible, the surgeon may encounter difficulty with closure of the aortotomy. Patch aortoplasty, as used in the 4 cases reported here, allows implantation of a larger heterograft. The technique is simple and adds little time to the operation. In selected cases, enlargement of the aortic root should result in better long-term hemodynamic performance.

Adult↗
PubMed1976

Right atrial partition and right ventricular exclusion: another surgical approach for complex cyanotic congenital heart disease.

A 5-year-old child with asplenia, situs inversus, single ventricle, common atrium, severe subvalvular pulmonary stenosis, 1-transposition of the great arteries, and absent inferior vena cava presented with severe limitation (resting arterial saturation 74 per cent). At operation, the systemic venous atrium was partitioned with a Dacron baffle, so that hepatic venous and coronary sinus blood was enabled to drain with the pulmonary venous blood into the single ventricle and aorta. The superior portion of this atrium was anastomosed to the divided main pulmonary artery, so that most of the systemic venous blood was allowed to flow directly to the lungs. Intraoperative hemodynamic studies revealed a pulmonary artery pressure of 12/9 mm. Hg and a superior vena caval flow that was 88 per cent of the ascending aortic blood flow. Follow-up catheterization studies revealed an intact partition, no anastomotic gradient, superior vena cava pressure of 20 mm. Hg, arterial saturation of 84 per cent, and excellent flow of contrast from superior vena cava to atrium to pulmonary artery. Exercise tolerance was markedly improved, and chronic fluid retention was not observed. This operation offers a new alternative for long-term palliation of complex lesions amenable to exclusion of the right ventricle, such as single or common ventricle with unreconstructable anomalies of the atrioventricular valves.

Female↗
PubMed1976

Arterial prosthesis of microporous expanded polytetrafluoroethylene for construction of aorta-pulmonary shunts.

A new arterial prosthesis made of polytetrafluoroethylene (OTFE) was evaluated in 10 infants with complex cyanotic congenital heart disease. All grafts used were 4 mm. in diameter and varied in length from 0.8 to 6 cm. The grafts were anastomosed to the main pulmonary artery or its bifurcation in 8 infants and to the right and left pulmonary arteries in one each. There were two early deaths, one of which was related to shunt failure. The advantages of a shunt to the main pulmonary artery are obvious, and the intraoperative procedure is facilitated with the prosthesis. Follow-up averages 9 months in the 8 survivors, and the patients have nearly doubled their preoperative weight. A shunt murmur is present in each case and the children have mild-to-moderate cyanosis at rest. Repeat aortograms in 2 patients, 8 and 10 months postoperatively, show a smooth graft without luminal narrowing. The aortic oxygen saturations were 73 per cent. The PTFE graft and/or anastomoses will not grow with the growth of the child and therefore may not accommodate growth by increased flow. This may prove to be a limiting factor in its long-term use in fants. We reserve the use of these grafts for infants with complex cyanotic defects undergoing emergency surgery or in older children in whom a conventional shunt is not possible or a previous shunt has failed.

Aorta↗
PubMed1975

Cardiac surgery in patients undergoing renal dialysis or transplantation.

The coexistence of organic cardiac disease and chronic renal failure presents a therapeutic dilemma. Cardiac operations have been performed on patients who were undergoing hemodialysis or who had had successful renal transplantation. There are several aspects of management of these patients which differ from those of the routine cardiac surgical patient. Guidelines for management are outlined and discussed.

Adult↗
PubMed1975

Local cardiac hypothermia for myocardial protection during correction of congenital heart disease.

Eighty-eight operations for correction of intracardiac congenital heart defects were performed using local cardiac hypothermia for protection of the ischemic myocardium. Twenty-six patients underwent repair of tetralogy of Fallot, 23 had patch closure of ventricular septal defect, 24 had correction of various types of congenital aortic stenosis, and 15 were operated upon for other complex lesions. The overall operative mortality was 5.6%. Ischemia times ranged from 9 to 119 minutes (mean, 48 minutes). Ischemic arrest protected by local cardiac hypothermia provides an optimal operative field, permitting repair of uncomplicated intracardiac defects in a precise, unhurried manner. No hemodynamic abnormalities attributable to the technique were encountered.

Adolescent↗
PubMed1975

Revascularization of the right coronary artery by retrograde perfusion of the mammary artery. An experimental study.

Although the internal mammary artery bypass seems an ideal coronary bypass vessel, it has not usually been possible to use this vessel to bypass distal lesions in the right coronary circulation. In this experiment, the right internal mammary artery was utilized in retrograde fashion to evaluate this anatomically more suitable vessel as a bypass graft to the occluded right coronary artery in the dog. Reversal of acute myocardial ischemia was demonstrated by mapping epicardial ST-segment elevation and measuring surface pH. Preliminary long-term experiments have also demonstrated patency and perfusion of the distal right coronary artery by this method.

Angiocardiography↗
PubMedDate not supplied

Surgical closure of the tricuspid valve for pulmonary atresia, intact ventricular septum, and right ventricle to coronary artery communications.

A surgical approach is reported for a patient with pulmonary atresia, intact ventricular septum, and right ventricle to coronary artery communications through sinusoids. A shunt procedure was performed at two days of age; the right ventricular outflow tract was not opened. At subsequent catheterization, the tricuspid valve was temporarily closed with a balloon catheter and no change was seen in the ECG. At five months of age, the right ventricle was plicated and a patch was sewn over the tricuspid valve. One year after surgery, neither the right ventricular cavity nor the sinusoids could be demonstrated at angiocardiography; ECG changes of left ventricular ischemia have resolved, and the child is growing normally.

Cardiac Catheterization↗
PubMedDate not supplied

Unusual "midseptal" sinus venosus defect.

An unusual case of an interatrial communication similar to a sinus venosus defect associated with an overriding pulmonary venous chamber is reported. There was no direct connection of the pulmonary venous system with either the superior vena cava or the low right atrium, as is usual with sinus venosus defects. This defect may represent the result of a sinus venosus defect associated with cor triatriatum.

Cor Triatriatum↗