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Biomedical subjects

J L Ubago

Publications and source records attributed to J L Ubago.

At least 19 recordsLinked to original sources
PubMed1998

[Coronary revascularization surgery with arterial grafts].

Coronary artery revascularization surgery is well established procedure throughout the world. The benefits are based on the blood perfusion through the implanted grafts distal to the coronary occlusions and continue as long as the grafts remains patent. The immediate success of this procedure is related to the surgical technique and the anatomical characteristics of the grafted coronary arteries. However, the long term results are mainly dependent on the type of grafts used. The modern era of myocardial revascularization started in the sixties with the use of saphenous vein grafts by Johnson and Favaloro. Alternative vascular conduits to the saphenous vein have been tried, and the internal mammary artery has become the first choice. In recent years, various publications have demonstrated the supremacy of the internal mammary artery over the saphenous vein when used as a single, bilateral, sequential of free graft. In order to obtain full myocardial revascularization, the use of alternatives to the internal mammary artery is required. The gastroepiploic artery, the inferior epigastric artery and the radial artery have been used as alternatives to the saphenous vein with the hope of obtaining long term results similar to the internal mammary artery.

Arteries↗
PubMed1996

Heparin-coated circuit in coronary surgery. A clinical study.

We performed a randomized study in 101 patients who underwent routine isolated coronary bypass graft surgery. In 50 cases an entire coated Carmeda circuit was used (coated group), and an uncoated circuit in the remaining 51 (uncoated group). A Medtronic Maxima oxygenator and a Biomedicus Biohead were used in all cases. Patients with coated circuits received low systemic heparinization with a heparin loading dose of 200 IU/kg, and 300 IU/kg for the control. Activated coagulation time was maintained at more than 275 s for the coated group versus more than 400 s for the uncoated one. The mean age of patients was 64.1 +/- 9.6 for coated and 63.5 +/- 9.7 for the uncoated group. The number of coronary grafts was 3.1 +/- 0.7 for the coated group and 3.1 +/- 0.1 for the uncoated one. Cross-clamp and bypass times were 53 +/- 14 and 98 +/- 24 min for the coated, versus 57 +/- 15 and 104 +/- 24 for the uncoated, group. Chest drainage was 989.4 +/- 509.5 ml for the coated group versus 1435 +/- 1027 for the uncoated one (P < 0.02). The amount of transfused homologous blood was 723 +/- 597 ml for the coated group versus 1071 +/- 831 ml for the uncoated one (P < 0.03). Postoperative endotracheal intubation time was 12.1 +/- 3.6 h for the coated and 14.6 +/- 4.5 h for the uncoated group (P < 0.05). Bleeding required rethoracotomy in 1/50 of the coated group, and in 4/51 of the uncoated one. Hospital mortality was 1/50 in the coated, and 4/51 in the uncoated, group. In our preliminary experience, heparin coating of an extracorporeal circuit reduces post-operative blood loss and blood transfusions in routine coronary bypass operations.

Aged↗
PubMed1992

[Percutaneous mitral valvuloplasty. Immediate results with the 30 mm diameter dilatation balloon].

Percutaneous balloon dilatation of the mitral valve is a promising alternative to surgical treatment for patients with mitral stenosis. We analysed echocardiographic and haemodynamic results in 62 consecutive patients who underwent mitral dilatation with a big and one chamber balloon (30 mm diameter). The relationship between the dilatation balloon area and body surface was 4.2 (in 98% of patients it was bigger than 3.5). In the whole series we get significant improvements in the haemodynamic parameters and mitral areas (0.91 cm2 versus 1.78 cm2)(p < 0.005). According to the echocardiographic score, patients were divided in two groups. Good results (mitral area > 1.5 cm2, and final, valve area 50% greater than the initial area), were obtained in 93% of patients with a score of 8 or less, and in 45% of patients with a score bigger than 8. Seventy-five percent of patients with bad results (mitral area < 1.5 cm2) were in atrial fibrillation versus 37% of patients where we get a good results. Mortality of procedure was nulle, and two patients required surgery because of procedure failure for mitral insufficiency. We can conclude: percutaneous mitral valvuloplasty with single balloon is valid alternative, and good results can be expected if there is a good relationship between the area of balloon and patient's body-surface. The echocardiographic score and presence of atrial fibrillation can predict immediate results of this technique.

Adult↗
PubMed1991

Calcified constrictive pericarditis. Ultrasonic debridement.

A case of complete debridement of a calcified pericardium in a patient with constrictive pericarditis is reported. The use of an ultrasonic surgical aspirator facilitated disintegration of calcium without damaging the adherent epicardium and myocardium.

Aged↗
PubMed1991

In situ right gastroepiploic artery. A conduit for coronary revascularization.

The internal mammary artery is widely recognized as the graft of choice for coronary artery bypass grafting at present. Alternative conduits have been investigated in order to find other adequate long-term grafts. The right gastroepiploic artery has been recently used as a graft to bypass distal coronary vessels. From November 1989 to June 1990, we have implanted this artery in 46 cases. Pedicled grafts were implanted in 20 patients to the main right coronary artery, in 21 patients we grafted the right distal branches, in 3 patients the left anterior descending, and in 2 the circumflex branches. Mean grafts per patient were 3 in this series, with a mean of 2.2 arterial grafts per patient. One patient died in the early postoperative period. The remaining patients had an uncomplicated postoperative evolution. Thirteen patients underwent graft and coronary angiography. Direct or indirect graft patency was confirmed in all cases. The final important issue concerning the long-term patency of this graft will be solved in the future, but short-term patency rates of the right gastroepiploic artery can be anticipated when proper techniques are used.

Adult↗
PubMed1991

[Myocardial revascularization with the gastroepiploic artery. The initial experience].

The internal mammary artery is widely recognized as the graft of choice for coronary artery bypass grafting at present. Alternative conduits have been investigated in order to find other adequate long-term grafts. The right gastroepiploic artery has been recently used as a graft to bypass distal coronary vessels. From November 1989 to April 1990 we have implanted this artery in 33 cases (32 in situ and one free grafts). The pedicled grafts were implanted in 17 patients in the main right coronary artery, in 13 we grafted the right distal branches, in one the left anterior descending, and the circumflex branch in one. The free graft was implanted in the first diagonal. Mean grafts per patient was of three in this series, with a mean of 2 arterial grafts per patient. One patient died in the early postoperative period. The remaining patients had an uncomplicated postoperative period. Thirteen patients underwent graft and coronary angiography. Direct or indirect graft patency was confirmed in all cases. The final important issue concerning the long-term patency of this graft will be solved in the future, but short-term patency rates of the right gastroepiploic artery can be anticipated when proper techniques are used.

Adult↗
PubMed1984

The Ionescu-Shiley valve: a solution for the small aortic root.

Valve replacement in patients with a small aortic anulus can cause difficult technical problems or leave the patient with a significant residual transvalvular gradient. Between August, 1977, and June, 1983, 35 patients with a small aortic root (21 mm or less) underwent aortic valve replacement with Ionescu-Shiley pericardial xenograft valves. They ranged in age from 29 to 76 years (mean 52.8 years) and in weight from 64 to 91 kg (mean 76.3 +/- 3.6 kg). Preoperatively, 26 patients were in New York Heart Association Functional Class III-IV. The valve sizes used were 17 mm in three cases, 19 mm in 16 cases, and 21 mm in 16 cases. There were four hospital deaths (11.4%) resulting from sepsis or low cardiac output. There were no late deaths. Cumulative duration of follow-up was 819.4 patient-months. Twenty-four (78%) of the 31 surviving patients are asymptomatic. Up to the time of review, there have been no episodes of thromboembolism, infective endocarditis, perivalvular leak, valve thrombosis, or primary tissue valve failure. Fifteen patients were hemodynamically evaluated 2 to 47 months (mean 14.3 months) after operation. The average resting transvalvular gradients for 19 and 21 mm valves were 15.1 and 10.8 mm Hg, respectively. Our experience suggests that the Ionescu-Shiley pericardial xenograft valve is a valid alternative in the surgical treatment of patients with a small aortic root.

Adult↗
PubMed1983

Analysis of the amount of tricuspid valve anular dilatation required to produce functional tricuspid regurgitation.

To determine the critical anular dilatation required for functional tricuspid regurgitation (TR) and the role of systolic anular shortening in the severity of TR, 67 patients in whom right ventriculography had been performed were studied. These patients were classified into group I, control (n = 12), and the group II, patients with rheumatic valvular disease (n = 55). Group II patients were subclassified as follows: IIa, without TR (n = 19); IIb, with mild TR (n = 22); and IIc, with moderate to severe TR (n = 14). The angiographic maximal early systolic and minimal end-systolic diameters were measured. The shortening of the tricuspid anulus was expressed as percent reduction of the maximal diameter. The average maximal diameter (mm/m2) was: group I, 21 +/- 2; group IIa, 24 +/- 2; group IIb, 31 +/- 4; and group IIc, 37 +/- 4. The average minimal diameter (mm/m2) was: group I, 15 +/- 2; group IIa, 18 +/- 2; group IIb, 23 +/- 2; and group IIc, 31 +/- 3. The average percent shortening was: group I, 30 +/- 7%; group IIa, 25 +/- 7%; group IIb, 26 +/- 5%; and group IIc, 15 +/- 3%. The rheumatic patients had a larger maximal diameter than did those in the control group. Anular shortening was reduced only in the group with moderate to severe TR and preserved in the other groups, including those with mild TR. The critical diameter was determined to be between the maximal diameter in the rheumatic patients without TR and the minimal diameter in the patients with moderate to severe TR, or 27 mm/m2. Thus this easily measured parameter can determine the presence and significance of functional TR, adding objectivity to the angiographic diagnosis of TR.

Adolescent↗
PubMed1983

Composite pericardial monocusp patch for the reconstruction of right ventricular outflow tract. Clinical application in 7 patients.

Right ventricular outflow tract (RVOT) reconstruction with a new composite pericardial monocusp patch incorporating a sinus of Valsalva was performed in 7 patients. There was one hospital death. Follow-up ranged from 20 to 52 months (mean 25.4 months, cumulatively 206 patient months). Four patients have been recatheterized at an average of 6.5 months (1 to 12 months) after surgery. The average RVOT gradient was 9 +/- 2 mmHg, and mean right ventricular end-diastolic pressure was 10 +/- 5.5 mmHg. All except one have a competent pulmonary valve with normally functioning monocusp, and no thrombosis, calcification or aneurysmal dilatation.

Adolescent↗
PubMed1981

Right ventriculography as a valid method for the diagnosis of tricuspid insufficiency.

The value of right ventriculography in the diagnosis of tricuspid insufficiency (TI) is often questioned because of 1) the high incidence of premature ventricular contractions (PVCs) during injections and 2) interference of the catheter in the valve closure mechanism. In 168 patients a commercially available, not preshaped, balloon-tipped catheter was used for right ventriculography. To avoid the induction of PVCs, the catheter tip was placed in the middle third of the diafragmatic wall of the right ventricle, and the balloon was inflated, becoming trapped by the trabeculae. In this position the catheter's side holes should be located in the inflow chamber. To ensure this correct position, and therefore lack of ectopic beats during angiography, a saline test injection was performed previously in every case. With this technique the incidence of PVCs during ventriculography was only 7.7%. In all but one case, such beats were isolated. The 168 patients were divided into three groups according to their likelihood of experiencing tricuspid interference by the catheter: group 1 included 41 patients with a normal heart or with coronary artery disease. No one from this group had TI. Of group II, 28 patients with right ventricular pressure or volume overload or cardiomyopathy, only 2 had TI, both with a previous clinical diagnosis of regurgitation. Group III contained 99 patients with rheumatic heart disease. Thirty-five of them showed angiographic TI, and 24 of these had this diagnosis confirmed either clinically or at surgery. It is felt that this technique of right ventriculography, with its low incidence of PVCs and slight interference with tricuspid closure, is a valid method for the objective study of the tricuspid valve.

Adolescent↗
PubMed1980

Hemodynamic factors that affect calculated orifice areas in the mitral hancock xenograft valve.

From June 1974 to December 1978, 714 Hancock valves have been placed in 605 patients. One hundred seventy-five patients with a mitral xenograft have been restudied. The results were questionable due to the wide scatter and disparity between the calculated and the theoretical orifice of each valve size. To elucidate these differences, the hemodynamic data of 40 isolated, normal functioning mitral Hancock valves were reviewed. Early, middle and late diastolic mitral valve gradients were measured by planimetry and their corresponding flows were estimated by angiography. The paired data were fitted to exponential functions and specific lines for each Hancock valve size were obtained. By superimposing Gorlin's pressure and flow curves on these lines, the instantaneous effective orifice for each Hancock valve can be determined. We concluded that 1) the Hancock valve effective orifice is flow related and always lower than its theoretical opening; 2) normal function frequently cannot be firmly established by the mean effective area; and 3) the nomogram described may help in determining the time-related variations of a particular valve.

Adult↗
PubMed1980

Conservative operation for mitral insufficiency: critical analysis supported by postoperative hemodynamic studies of 72 patients.

From May, 1974, through December, 1978, 255 mitral annuloplasties have been performed at our institution. Forty-three Carpentier rings and 212 flexible rings were used. Simultaneously, 307 patients with predominant insufficiency were treated with a Hancock bioprosthesis. A critical analysis of the flexible ring group versus the Hancock group is presented: The average ages were 41.3 versus 43.3 years. Preoperatively, 55% versus 60% were in Functional Class III and 9.6 versus 25.4% were in Class IV. The valve lesion was caused by rheumatic disease in 91.2% versus 93.9%. A multiple valve operation was required by 51% versus 60%. There was a significant difference in the operative mortality rates (1.8% versus 11.4%). This difference was maintained for each preoperative functional class and for the isolated and multiple valve groups. There was no significant difference in the late mortality rates (1.4% versus 3.7%). The total actuarial survival rates were of 96.4% and 81% (maximum follow-up times 4.0 and 4.5 years). The incidence of embolism was 2.4% and 4.1% per patient-year, with both groups being subjected to the same anticoagulation policy. The incidence of dysfunctions was equal (3.9% per patient-year). Postoperative hemodynamic evaluation of 72 patients having annuloplasty and 129 patients having Hancock valve replacement showed basal mean transmitral gradients of 10.98 +/- 3.6 and 9.66 +/- 2.73 mm Hg. The average effective orifice areas were 1.93 +/- 0.74 and 2.25 +/- 0.46 cm2. While the bioprosthesis behaves hemodynamically like a flow-related variable orifice, the reconstructed valve orifice is dependent upon its preoperative anatomy. In conclusion, the comparison of flexible ring annuloplasty and Hancock valve replacement for mitral valve disease shows a lower operative mortality for the former and comparable medium-term postoperative course. Since both techniques have a limited durability, longer follow-up periods will soon resolve this controversial issue.

Adolescent↗
PubMed1980

Is tricuspid valve repair necessary?

In an attempt to clarify the indications for tricuspid valve operations, we studied 150 patients who had preoperative and postoperative full catheterization including biventriculography. Seventy-eight patients had organic and 72 had functional tricuspid insufficiency (TI). One hundred nineteen underwent tricuspid repair (46 commissurotomies and 115 annulopasties), and in 31 the tricuspid disease was surgically ignored. Ninety seven percent of all patients with hemodynamically correct left-side repair were in Class I or II, regardless of the state of the tricuspid valve. Repair of lesions on the left side determined the postoperative cardiac index. In the "repaired group," 38% had residual gradients and 30% residual TI. Eighty percent of patients with low postoperative pulmonary resistance had no TI, compared with 53% with high pulmonary resistance. In the "ignored group," all 14 patients with organic disease had residual TI, as did nine of 17 with functional disease but with elevated pulmonary resistance. The right ventricular end-diastolic volume (RVEDV) decreased 37% in the "repaired" (p < 0.001) and 36% in the "ignored" group (p < 0.01) if tricuspid competence was achieved, but remained high if TI persisted. Because of these data, which emphasize the need for an early and correct repair of the left-side lesions, we believe that (1) functional TI can be ignored only in patients with predictable and significant reduction in pulmonary resistance and (2) organic disease must be repaired.

Adolescent↗