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Biomedical subjects

J L Larrea

Publications and source records attributed to J L Larrea.

At least 19 recordsLinked to original sources
PubMed2004

[Implementation of habituation theory to pulsatile somato-sounds (tinnitus): the heart valve prosthesis sound model].

OBJECTIVES: To evaluate the habituation process to mechanical heart valve prosthesis sound as a model to understand the pulsatile tinnitus or somatosound perception changes. STUDY DESIGN: Transversal descriptive. PATIENTS: One hundred and fifty patients referred to a University Hospital for one or two mechanical heart valve implantation. OUTCOME MEASURES: Questionnaire sent by mail for prosthesis sound loudness and interference in quality of life evaluation. Detection of factors related to habituation process development. RESULTS: Eighty three percent of the patients perceived their prosthesis sound continuously, while only a 17% showed high levels of annoyance. No significative differences in prosthesis type and localization were described. Anxiety was the most important factor for loudness increase. The average of visual analogical scales on sound loudness and annoyance showed mild values (3.7 and 1.9 respectively). CONCLUSIONS: Extensive medical counselling or tinnitus retraining therapy (TRT) program for most severe cases, are proposed for pulsatile tinnitus management when etiological treatment cannot be available.

Adult↗
PubMed1999

Neurologic complications of type I aortic dissection.

BACKGROUND: Aortic dissection (AoD) is characterized by a transverse intimal tear that in most cases occurs in the right lateral wall of the ascending aorta. Neurological deficit is seen as an initial manifestation in about 20% of patients (8%-33%). OBJECTIVES: To analyze the frequency of these complications and the underlying pathogenic mechanisms. METHODS: Retrospective review of the neurologic complications of patients with type I AoD who underwent surgical treatment between January 1988/April 1996. RESULTS: We report 24 patients. Nine (37.7%) developed neurologic symptoms which we have classified as follows: Hypoxic encephalopathy, 5 (55.5%); ischemic stroke, 2 (22.2%); ischemic neuropathy, 2 (22.2%) and spinal cord ischemia, 1 (11.1%). One is included in both first and third group. CONCLUSIONS: Neurologic complications are frequent in type I AoD, mainly focal or global cerebral ischemia. The former could be due to advancement of the false channel towards the aortic arch vessels and the latter to global central nervous system hypoperfusion.

Adult↗
PubMed1999

Successful treatment of prosthetic aortic valve mucormycosis.

Mucor endocarditis after cardiovascular surgery is rare and usually fatal. We report the first known case of prosthetic aortic valve mucormycosis in a patient without predisposing risk factors who was successfully treated using a combination of early antifungal drug therapy and surgical removal of infected material.

Aortic Valve↗
PubMed1998

[Indications and surgical techniques in the acute phase of infective endocarditis].

Infectious endocarditis is increasingly resistant to antibiotic therapy, due to the increasing number of patient with cardiovascular prostheses or those who are severely immunosuppressed. Frequently, this syndrome and its complications can only be solved with surgery. In this article, which is based on the international literature plus own observations in 77 patients, the indications for surgery and the different technical approaches during the acute phase of infectious endocarditis are reviewed. Surgery to control infectious endocarditis is indicated when there is one of the following situations: a) persistence of infection despite an adequate antibiotic treatment, usually due to a specific pathogen (Staphylococcus aureus, fungus, etc.) or to a low antibiotic penetration into the infected issues (abscess); b) progressive hemodynamic deterioration due to tissular destruction and development of valvular incompetence or fistulous communications or c) development of other complications (repetitive embolism, cardiovascular aneurysms, conduction blocks, etc.). Hemodynamic deterioration due to heart failure refractory to medical treatment is the most frequent indication for cardiovascular surgery, and this was present in 61% of our patients. The timing for surgery is still controversial, although scheduling it at an early stage is generally preferred. The specific surgical technique is chosen according to the degree of tissular destruction and is aimed to remove the infected tissue and to repair the damaged structures or, if this is not feasible, to implant cardiovascular prosthesis.

Acute Disease↗
PubMed1995

Delayed papillary muscle rupture following mild chest trauma.

A case of delayed papillary muscle rupture is reported, which developed 24 hours following a mild chest trauma. Transthoracic echocardiography established the diagnosis; immediate mitral valve replacement was carried out. The postoperative course was uneventful.

Accidental Falls↗
PubMed1993

Subacute cardiac rupture: repair with a sutureless technique.

Thirteen patients with ages between 53 and 74 years had development of free wall left ventricular rupture after a myocardial infarction (mean interval, 3.8 days). All patients showed clinical signs of cardiac tamponade. Diagnosis was established by bedside multiple pressure monitoring and echocardiography, which showed pericardial effusion with compression of the right ventricle. Cardiac catheterization was not performed. A new surgical technique was employed for the repair. After the pericardium was opened and cardiac tamponade was relieved, the myocardial tear was identified. A Teflon patch was applied over the area and glued to the heart surface with a surgical glue (cyanoacrylate). Cardiopulmonary bypass was not used except in a patient with a posterior tear. The method was consistently effective in controlling bleeding from the myocardial tear. All patients survived the operation and were discharged from the hospital a mean of 15 days after the operation. Follow-up extending up to 5 years (mean, 26 months) shows a 100% survival, 11 asymptomatic patients, and 2 patients with mild exertional angina. The technique is a simple, effective, and safe method for repair of subacute cardiac rupture and obviates the need for suturing on an infarcted ventricle.

Aged↗
PubMed1991

[Left ventricular perforation following percutaneous mitral valvuloplasty. Its emergency surgical correction in situ. Apropos a case].

Percutaneous mitral valvuloplasty is actually accepted as alternative to surgery for treatment of rheumatic mitral stenosis, although today it is not still free from troublesome complications like ventricular perforation. We present here a patient in which was performed a percutaneous mitral valvuloplasty and that developed a left ventricular perforation at the end of the procedure, with hyperacute cardiac tamponade, requiring an in situ surgical salvagement on an emergency basis, performing a successful repair of the ventricular rupture in the own catheterization laboratory.

Balloon Occlusion↗
PubMed1990

[Right-sided infectious endocarditis. Experience with a series of 35 patients].

From 1978, 35 patients with right-sided endocarditis were treated at our hospital. There were 25 male and 10 female patients, with ages ranging from 14 to 77 years. The cause was intravenous drug abuse in 27 cases. Positive blood cultures were obtained in 29 cases, isolating staphylococcal organisms in 26 of them. Two-dimensional echocardiography was performed in 30 patients, confirming the diagnosis in 27 of them (90%). Vegetations were found in 25 patients and perivalvular abscess was seen in 4 patients. The management was medical only in 32 patients. Three patients were operated on because of failure to control pyrexia and heart failure, performing total tricuspid valvectomy in two, and only partial in the third one. All the 3 patients had perivalvular tricuspid abscess. There were 2 hospital deaths (5.7%), because of septic shock in drug abusers, one of them after a tricuspid valvectomy. In our experience, right-sided endocarditis is mainly associated with drug abusers and staphylococcal organisms. Two-dimensional echocardiography plays an important role in the diagnosis of this entity. In our series the size of vegetations does not play a role in selection of surgical candidates. The presence of perivalvular abscess was the only predictive factor for surgery. Only a few patients do not respond to medical therapy. In those cases the elective surgical procedure in our criterion and in our patients is tricuspid valvectomy without valve replacement, or if possible, the use of reconstructive or reparative approaches.

Adolescent↗
PubMed1990

[Infective endocarditis. Medicosurgical experience in a series of 137 patients].

We have reviewed our 1978 to 1987 experience in the treatment of 137 patients with 145 episodes of Infective Endocarditis. In 55 episodes the infection involved a valvular prosthesis. Positive blood cultures were obtained in 72.7%, with clear preeminence for staphylococcal organisms. Renal disfunction was associated in 41.8% of the cases and periprosthetic-leak in 40% of them. Eight patients died without surgery, five cases were cured by medical treatment alone, and 42 cases were operated, most of them because refractory heart failure. Surgical mortality was 15 cases (35.7%), with statistical significance within the early prosthetic valve endocarditis group, in which in turn was significantly greater the incidence of non-streptococcal germs, renal disfunction and periannular abscesses. The mean late follow-up was 47.6 months, including 88.8% of the surgical survivors, with a survival rate of 64.1%, being most of patients in a good functional status. In 90 episodes the infection involved a native valve, with about 40% of the cases in drug abusers. Positive blood cultures were obtained in 77.7% of the cases, with slight preeminence of staphylococcal germs. Renal dysfunction was associated in 16.6% of the cases. In 41 episodes were used only medical therapy, involving 30 of them the right side, with a death in this group. The treatment was surgical in 49 episodes, 45% of them in order to correct residual valve lesions.

Adolescent↗
PubMed1989

[Free thrombus in the left atrium associated with mitral stenosis. Diagnostic and therapeutic aspects. Apropos of a case].

A patient with a history of transient cerebral ischemic episodes had two-dimensional echocardiographic findings consistent with mitral stenosis associated with a spherical free-floating left atrial thrombus. The patient was operated on in the next few days, performing a mitral commissurotomy, and the left atrial thrombus was removed, without intra- or postoperative complications. The patient was discharged from the hospital on an antiplatelet drug regimen. Free-floating left atrial thrombi are a very rare finding with an easy echocardiographic diagnosis. Prompt surgical treatment is mandatory because the risk of systemic embolization and sudden death are inherent in this entity.

Echocardiography↗
PubMed1986

Commissurotomy and pregnancy. A study of 245 cases.

We present a retrospective study of 245 pregnancies in 157 women who had undergone commissurotomy (closed surgery) and whose delivery was assisted at the Maternity La Paz (Madrid, Spain) between 1965 and 1981. There was a statistically significant increase in the rate of fetal complications (perinatal mortality, 44.3 per 1,000; pre-term 8.5%; intra-uterine growth retardation, 17.3%; low weight, 12.5%) and maternal mortality. The most frequent and severe maternal complication was congestive heart failure which was more common among primigravidas and was of statistical significance. In patients with atrial fibrillation or heart failure during pregnancy or puerperium, the results were even more remarkable. There were no complications in patients who underwent commissurotomy during pregnancy. Preterm delivery was three times more common in patients undergoing digitalis therapy.

Adult↗
PubMed1985

Prosthetic heart valve and pregnancy. A study of 59 cases.

We studied 59 pregnancies in 48 female carriers of prosthetic heart valves. In 44 pregnancies the mother had a metal valve mostly with coumarin therapy and in 15 a bioprosthesis usually without hematologic treatment. In the patients with metal prostheses we had the following maternal complications: 1 maternal death, 3 valve thromboses, 2 heart failures and 1 puerperal hemorrhage. There was also a significantly increased rate of preterm, low birth weight infants and intrauterine growth retardation. Concerning malformations we found only 2 cases of mild nasal hypoplasia. Regarding the complications of bioprosthesis, we had only 1 case of paroxysmal tachycardia and no fetal complications. Comparing the results we came to the conclusion that pregnancy is much better tolerated in patients with bioprostheses and that in patients with metal prostheses the risk is increased if the mother is older than 30 years, if time of replacement is more than 5 years or if there is a history of previous thromboembolism or gravidic heart failure.

Abortion, Spontaneous↗
PubMed1984

Prevention of thromboembolism using aspirin after mitral valve replacement with porcine bioprosthesis.

The thromboembolic rate of 768 patients who were treated only with aspirin after mitral valve replacement or mitral plus aortic valve replacement with porcine bioprostheses was evaluated. We analyzed the thromboembolic rate for the whole series and for subgroups of patients categorized by atrial fibrillation, giant left atrium, left atrial thrombosis, and dosage of aspirin (1 gm daily or 0.5 gm every 48 hours). The total embolic rate was 1.4% (11/768). No patient in sinus rhythm had an embolic event. The embolic rate for patients in atrial fibrillation was 1.9% (11/583). There were no embolic events in 31 patients with a giant atrium. An embolic event occurred in 1 of 42 patients with atrial thrombosis (2.4%). Patients treated with 1 gm of aspirin daily had a 3% embolic rate (9/295) while the incidence was 0.4% (2/473) in those treated with 0.5 gm every 48 hours (p less than 0.01). Administration of aspirin after mitral valve replacement with a bioprosthesis is a very effective treatment for prevention of thromboembolism. In our experience, this treatment provides protection equal to or better than that offered by oral anticoagulants for patients in atrial fibrillation as well as for patients with a giant atrium or atrial thrombosis at operation. The dosage and timing of aspirin administration may markedly affect the result of this type of treatment. Oral anticoagulation with coumarin derivatives may not be appropriate after mitral valve replacement with a bioprosthesis, and platelet antiaggregates should be used for this purpose in the future.

Adolescent↗
PubMed1984

Compound grafts of xenopericardium and Dacron fabric for repair or replacement of great vessels: a method to avoid interstitial and suture hole bleeding.

Compound grafts constructed by wrapping pericardial xenografts around fabric grafts were used for replacement or repair of the great vessels. After cardiopulmonary bypass (CPB), bleeding through the compound graft is nil. Nine patients had the intrathoracic aorta replaced with a compound graft, and eight patients had patch repair of the ascending aorta or the right ventricular outflow tract. Bleeding in all patients was minimal because the nonporous nature of the xenopericardium avoids interstitial and suture hole hemorrhage until normal hemostasis is obtained.

Adolescent↗
PubMed1983

Diagnosis and treatment of subacute free wall ventricular rupture after infarction.

Ventricular rupture is usually a sudden, lethal complication after acute myocardial infarction (MI). Some patients, however, may survive several hours after ventricular rupture, and there is time for surgical repair if the diagnosis is made quickly. In 1980 and 1981, 7 patients underwent operation for ventricular rupture at our institution. Bedside hemodynamic studies with a Swan-Ganz catheter confirmed the diagnosis of pericardial tamponade. Urgent operation with cardiopulmonary bypass was performed. Control of hemorrhage was obtained by covering the ventricular tear and the surrounding infarcted myocardium with a wide Teflon patch. Four patients are alive and well 2, 3, 4, and 10 months after operation. Clinically, free wall ventricular rupture should be suspected when any patient recovering from an acute MI experiences chest pain and cardiovascular collapse. Bedside hemodynamic monitoring will confirm the diagnosis of cardiac tamponade, and urgent operation will save some of these patients.

Aged↗
PubMed1983

Pregnancy and mechanical valve prostheses: a high-risk situation for the mother and the fetus.

Thirty-eight women with mechanical valve prostheses had a total of 47 pregnancies. All patients were on oral anticoagulants before pregnancy. A high incidence of complications was seen in both the mothers and the fetuses. The rate of spontaneous abortion was 23.4% (11/47), and 2 of the 36 newborns had chondrodysplasia punctata. Three of the women (7.9%) had acute valvular thrombosis; 1 died after replacement of the thrombosed valve. Thus, the overall mortality for the series was 2.6%. More complications were observed in the fetuses and infants of women treated with oral anticoagulants during pregnancy than in women treated with heparin. However, the mothers had more complications with heparin anticoagulation. Neither heparin nor oral anticoagulants clearly proved superior as the anticoagulation regimen of choice for pregnant women with mechanical valves. Counseling before conception occurs and avoidance of pregnancy are recommended for women with mechanical valve prostheses because of the high risk of serious or fatal complications in the mother and fetus. Use of tissue valves in women of childbearing age who desire to have children also seems advisable, even with the possibility of having to undergo another operation as a result of degeneration of the valve tissue.

Abortion, Spontaneous↗