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Biomedical subjects

J L Ochsner

Publications and source records attributed to J L Ochsner.

At least 109 records · Page 6Linked to original sources
PubMed1978

The internal mammary bypass graft: a superior second coronary artery.

In a study of the initial 1,004 consecutive patients who had direct coronary artery bypass at Ochsner Medical Institutions, computer methods of data processing were used to compare the clinical results between patients who had saphenous vein (SV) grafts and those who had internal mammary artery (IMA) grafts. The factors compared were the long-term mortality rates, nonfatal myocardial infarction rates, relief or persistence of angina, and the percentage of patients who acquired congestive heart failure. A simple comparison showed the patients with IMA grafts did better in all four categories; however, in a subsequent analysis in which maldistributed factors were removed, the rates of anginal relief and congestive heart failure were not significantly improved. The major benefit appears to be an increase in longevity among patients who had IMA bypasses.

Aged↗
PubMed1977

Combined procedure of coronary artery bypass grafting and valve repair.

The safety of combined operative procedures for valvular and coronary artery disease was reviewed in 27 patients. Twelve patients had aortic valve disease and 15 had mitral valve disease. Forty-seven coronary artery reconstructions were performed, and average of 1.7 per patient. Twenty-two patients underwent valve replacement and 5 had valvuloplasty. Congestive heart failure was the major symptom in 20 patients, and angina was the major symptom in 7. Eight of the patients with congestive heart failure had no angina, but significant coronary stenoses were demonstrated at routine coronary angiography. Coronary reconstruction was performed before valve repair. Two patients died postoperatively (a hospital mortality of 7.4%), and there were 4 late deaths from 2 to 28 months postoperatively. There were no postoperative myocardial infarctions. Contrary to previous reports, coronary artery reconstruction and valve repair need not be associated with an increased risk. Protection of the myocardium by coronary perfusion through reconstructed coronary arteries enables valve repair to be done without greater risk than valve repair alone. All patients considered for valve repair should have coronary angiography.

Adult↗
PubMed1977

Long-term follow-up of internal mammary artery myocardial implantation.

A study was made of 100 patients who had undergone internal mammary artery myocardial implantation 7 to 10 years previously. Forty-two patients had single implantation with or without a free omental graft, and 54 received double implantations. Four patients had a single internal mammary artery implant plus a single aortocoronary bypass graft. Eleven patients died at operation or within the first month, and 17 died from 1 to 7 years following operation. Two were lost to follow-up, and 15 refused follow-up angiograms. From 7 to 10 years postoperatively, angiographic studies were performed on 55 patients with 73 internal mammary artery implants. Of these 73 implants, 17 (23%) were occluded; 10 (14%) were patent but did not show myocardial filling; 15 (21%) showed myocardial blush or filling of small vessels; and 31 (42%) showed filling of a major coronary artery. The patency rate correlated well with the amount of coronary disease and slightly with the amount of symptomatic improvement. This study shows that the Vineberg operation is physiologically sound; however, the ideal candidates are those patients with coronary arteries of adequate size who could benefit more by direct perfusion.

Adult↗
PubMed1977

Elastic tissue dysplasia of the internal carotid artery.

Elongation with kinking of the internal carotid artery is not an uncommon finding. Cerebral vascular insufficiency has been reported secondary to this abnormality. Although arteriosclerosis is a frequent cause in adults, the etiology in children has never been explained. Three children with significant kinking of the internal carotid artery are reported here. Each underwent surgical correction by excision and reconstruction. Histological review showed the elastic tissue to be disrupted, diminished in amount, and unevenly distributed. Retrospective examination of this elastic tissue dysplasia showed it to be localized, there being normal morphology both proximally and distal to the involved area. There was recurrence of elongation and kinking in one patient due to incomplete excision. Correction was accomplished after re-excision of the involved tissue with a vein graft interposition. From this study, it can be concluded that elongation and kinking of the internal carotid artery in children is secondary to elastic tissue dysplasia. It is imperative that the entire involved area be removed in order to prevent recurrence. The excised specimen should be studied histologically with elastic tissue stains. Such stains cannot be performed as frozen section. Should permanent studies show the margins of resection not to be beyond the dysplastic tissue, careful followup of these children is essential to recognize recurrence.

Carotid Artery Diseases↗
PubMed1977

Surgical experience with postinfarction ventricular aneurysm.

Fifty-eight patients had surgical treatment of postinfarction ventricular aneurysm. Resection was performed in 47 patients and plication in 11. There were 44 combined procedures, mostly myocardial revascularizations. Indications for operation included congestive heart failure, angina, arrhythmias, and thromboembolic phenomena. All aneurysms were documented by cineventriculography, and 54 patients had coronary cineangiograms. Left ventricular end diastolic (LVED) pressures ranged from 25 to 50 in 25 of the patients but did not affect mortality. Hospital mortality (14% overall) was directly proportional to degree of coronary artery disease--single vessel, 0; double vessel, 10%; triple, 24%. Nine patients are alive more than six months postoperatively and 37 are alive from six months to eight years postoperatively. We conclude that aneurysmectomy is the procedure of choice for ventricular aneurysms that are hemodynamically significant or have produced ventricular clots, arrhythmias, or embolic phenomena. An LVED of greater than 25 mm Hg does not contraindicate operation, but triple vessel coronary disease increases the risk.

Adult↗
PubMed1977

Double mitral valve. Report of a case and review of the literature.

A case of double mitral valve orifice associated with atrioventricular canal was found at operation. These two anomalies are frequently associated. Double mitral valve is usually subclinical and does not necessarily need to be corrected, depending on the associated anomalies, the extent of the defect, and the personal experience of the surgeon. The embryology of double mitral valve is complicated and still needs to be clarified.

Anemia, Hemolytic↗
PubMed1977

Management of an infected Hancock prosthesis after repair of truncus arteriosus.

This report described a case in which purulent mediastinitis involving a Hancock prosthesis developed after repair of truncus arteriosus in a 6-year-old boy. The graft and surrounding area became sterilized after having been irrigated with povidone-iodine and antibiotic solutions for 6 weeks. At his most recent visit, the child was completely active and asymptomatic.

Animals↗
PubMed1976

A modified sternal retractor.

A modification of the Favaloro sternal retractor is described that allows a singel person to operate the apparatus when elevating the sternal plate. The new retractor is also easier on the sternum because of its blunter teeth.

Humans↗
PubMed1976

Traumatic avulsion of the innominate artery: case report and literature review.

A 20-year-old man had avulsion of the innominate artery from the aorta caused by blunt trauma to the chest. A widened mediastinum on chest films is the best indicator that such an injury may be present. During repair, the right common carotid blood pressure should be measured by direct arterial puncture after proximal clamping. A distal stump pressure of 50 mm Hg or greater indicates that there is adequate collateral flow via other systems and a shunt will therefore not be necessary. If there is not sufficient collateral flow, then a graft should originate from a new site on the ascending aorta in end-to-side fashion and be sutured distally to the innominate bifurcation or common carotid artery.

Adult↗
PubMed1976

Technic of deep hypothermia and circulatory arrest in the neonate and infant.

Most congenital heart anomalies now can be surgically corrected in a neonate or very young infant. Because their hearts are so small, it is advantageous to work in a bloodless and motionless operative field. Deep hypothermia with circulatory arrest provides this setting. Physiologic problems associated with hypothermia are minimized by inducing general vasodilatation with large doses of methylprednisolone. Surface cooling is done with ice blankets and small sandwich bags filled with crushed ice. The patient's temperature gradually falls to 75.2 F (24 C). After median sternotomy, core cooling can be used to bring the patient's temperature to the desired 68 F (20 C). Circulatory arrest is produced by draining blood into the reservoir and cross-clamping the great vessels and venae cavae. It can be maintained for up to 60 minutes. In infants over six months and over 6 kg (13.2 lb), moderate hypothermia 77 F (25 C) and low perfusion (1/4-1/3 of normal) with short periods (10 to 15 minutes) of circulatory arrest improve operative conditions and allow correction of the most complicated congenital heart defects.

Blood Volume↗
PubMed1976

Valvulotomy of valves in the saphenous vein graft before coronary artery bypass.

Occasionally, repeat angiograms disclose turbulence, with or without clot formation, at the valve sites in saphenous veins used as coronary artery bypass grafts. A simple valvulotomy may be used to split these valves to allow a more even flow and to avoid the valve recess where air may be trapped or thrombus formed. A potential cause for perioperative infarction or graft failure may thus be avoided.

Coronary Artery Bypass↗
PubMed1976

Correction of Type C complete atrioventricular canal. Surgical considerations.

Case histories of 8 consecutive patients who underwent surgical correction of Type C complete atrioventricular (A-V) canal at the Ochsner Medical Center over the past 2 years were analyzed. Ages ranged from 1 1/3 to 14 years. Before bypass, the level to which the common leaflets ascend and the arc that they inscribe are determined by palpation to ensure their proper reconstitution on the canal patch. The major area of closure is usually allocated to the ventricular portion. Mapping the conduction system and tying sutures with the heart beating in high-risk conduction areas prevent heart block. Precise marking and splitting of the valve leaflets and reattachment with interrupted felt-buttressed sutures avoid disruption. All patients survived the operation and have shown clinical improvement. At recatheterization, 7 of 8 patients have shown a definite decrease in mitral insufficiency. Right ventricular pressures returned toward normal and there were no significant residual shunts. Associated anomalies or previous operations have not been a contraindication, and since we have begun using the present technique, we have achieved consistently good results without prosthetic valves.

Adolescent↗