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Biomedical subjects

J M Bernal

Publications and source records attributed to J M Bernal.

47 records · Page 3Linked to original sources
PubMed1988

Long-term evaluation of the Ionescu-Shiley pericardial xenograft bioprosthesis in the aortic position.

From August 1977 through October 1984, 241 patients underwent aortic valve replacement with the Ionescu-Shiley pericardial valve. There were 130 males and 11 females in this series with an average age of 50.8 years (range 15 to 78 years). Isolated aortic valve replacement was performed in 121 patients (50.2%) and associated cardiac surgery in 120 (49.8%). Valve size was 21 mm or smaller in 107 cases (50.2%). Cumulative duration of follow-up was 1,260 patient-years with a mean follow-up of 5.16 years per patient. Five patients were lost to follow-up. Maximum follow-up was 10.5 years. There were 26 hospital deaths and 15 late deaths (1.19% per pt-yr). The expected 10.5 year actuarial survival rate is 82% +/- 2.9%. Twelve thromboembolic episodes occurred in seven patients--seven central and five peripheral events. The thromboembolic rate was 0.95% per patient-year--32% for patients with isolated aortic valve replacement and 0.63% for patients with concomitant surgery. Freedom from thromboembolic episodes at 10.5 years is 73% +/- 12%. Structural valve deterioration was found in 24 patients (1.9% per pt-yr) with an actuarial freedom from primary tissue failure of 77.5% +/- 5.4% at 10.5 years. Reoperation was required in 39 cases (3.09% per pt-yr)--primary tissue failure (n = 24), paravalvular leak (n = 7), infective endocarditis (n = 6), and valve thrombosis (n = 2).

Adolescent↗
PubMed1986

Prophylactic resection of a tricuspid valve vegetation in infective endocarditis.

A heroin addict who appeared to have recovered clinically from infective endocarditis of the tricuspid valve as judged by the usual criteria underwent prophylactic resection of a large vegetation on the tricuspid valve in order to prevent severe pulmonary embolism. Prophylactic surgery was justified by the size and as judged by cross-sectional echocardiography of the vegetation and its morphology.

Adult↗
PubMedDate not supplied

[Long-term experience with flexible mitral annuloplasty].

Reconstructive surgery of the mitral valve is nowadays generally accepted to be a valid alternative to replacement. There is however little information on the long term stability of these techniques and specially the incidence of reoperation. In order to study this question all patients who had a Durán flexible ring annuloplasty performed between january 1975 and december 1976 were reviewed up to december 1987. Eighty seven flexible rings were placed in 85 patients. Aortic and/or tricuspid surgery was simultaneously performed in 44.8% of the patients. There were 2 hospital deaths (2.3% ) and 3 late deaths (3.5%). Ten patients were lost to follow up, all within 2 years after surgery. There were 18 thromboembolic events (11 central and seven peripheral) with one death. Thirteen patients required reoperation (17.8%) In 11 the valve was replaced and a new flexible ring annuloplasty was done in two, without mortality. The causes for reoperation were regurgitation in eight (10.9%) and stenosis in five (5.8%). When the lesion was regurgitant the average interval between operations was 20.6 months, and when stenotic of 87.8 months. It can be concluded that reconstructive surgery of the mitral valve, in this predominantly rheumatic group of patients, has an incidence or reoperation close to 18% at 12-13 years follow up.

Adolescent↗
PubMedDate not supplied

Open heart surgery for thrombosis of a prosthetic mitral valve during pregnancy. Fetal hydrocephalus.

Pregnant women with cardiac valvular prostheses present an important risk factor and the major complications are endocarditis and thromboembolism. Thromboembolism is determined by a hypercoagulation state. Compulsory anticoagulation treatment is an associated risk factor producing maternal and fetal complications. Different open heart surgical cases during pregnancy have been reported and a review of the literature shows favourable maternal prognosis. A 30-year-old woman with a Björk-Shiley mitral prosthesis, during the 6th week of pregnancy presented with thrombosis and embolism due to a change in anticoagulation treatment from acenocumarol to heparin. Open heart surgery was carried out and the patient's course was favourable. A fetal hydrocephaly of unknown etiology was discovered during the 18th week of pregnancy. Open heart surgery during pregnancy and the necessity of thromboembolic prophylaxis, have been analysed and revised.

Adult↗
PubMedDate not supplied

Angiocardiographic demonstration of a partial defect of the pericardium with herniation of the left atrium and ventricle.

A case of a patient of 44 years of age with nonspecific thoracic symptomatology and anomalous protrusion of the second arch of the left border of the cardiac silhouette is reported. Cineangiocardiography showed a herniation of the left atrium and ventricle through a partial defect in the left pericardium demonstrating a mechanism that can give rise to sudden death by cardiac incarceration. Prophylactic longitudinal pericardiectomy was performed and the patient made an uneventful recovery.

Adult↗