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Biomedical subjects

J P Bex

Publications and source records attributed to J P Bex.

At least 19 recordsLinked to original sources

[Aortic valve replacement in infectious destruction of the aortic annulus. A new technic].

The results of aortic valve replacement in the acute phase of valvular endocarditis are dependent upon the degree of destruction by sepsis of the left ventricle-aorta junction. The stability of the prosthesis installed is conditioned by the extent of the lesion. Numerous techniques have been described to maintain the prosthesis firmly in place. In the technique reported here, the prosthesis is implanted in the usual position, but the sutures are tied outside the heart. Depending on the site of the lesion, this is done by opening the left atrium or the infundibulum of the right ventricle, and by passing the stitches through the aortic wall. This quick and simple technique ensures good stability of the prosthesis.

Aortic Valve

Reconstructive surgery for mitral and tricuspid valves--principles and personal experience.

We have experienced 246 cases of reconstructive surgery for mitral and tricuspid valves, with 17 deaths in the immediate post-operative period or during follow-up. This gives an overall mortality rate of 6.9 per cent whereas in 72 cases of mitral valve reconstruction we recorded only 2 deaths i.e. a mortality rate of 2.7 per cent although the post-operative period remains relatively short. Thus, we feel fully justified in pursuing our conservative surgery program, especially for younger patients who, given their superior myocardial state, can lead a fuller life after mitral reconstruction than after mitral replacement. It is our conviction that mitral and tricuspid valve reconstruction should not be overlooked and that prior to resection and replacement, the surgeon and the team should pause and scrupulously examine the valvular components with a view to conservative surgery. For certain lesions, reconstruction can be carried out rapidly and reliably. The mortality rate is not higher than conventional cardiac surgery and the patient's long term prognosis is considerably improved.

Adolescent

[Treatment of functional tricuspid insufficiency by a valvuloplasty with a flexible linear reducer].

Valvuloplasty with preservation of the valvular apparatus is the treatment of choice in functional tricuspid incompetence (FTI). A new method of valvuloplasty has been developed using a flexible linear reducer (FLR); its insertion is simple and without risk to the Bundle of His. It is made of sections of elastomere covering a dacron core. The principle of the FLR is reduction of the tricuspid annulus leaving the septal leaflet free. It is a simple method which allows individual variations in the zone reduced (usually involving the anterior and inferior leaflets) and in the size of the reduction at each point. The excellent results at medium term in 20 patients with tricuspid FLR lead us to recommend widening the surgical indications for correction of FTI especially in cases where signs of right ventricular failure have been observed.

Adult

[Valve-fitted prosthetic tubes in the pulmonary outflow tract. Results of a series of 45 operations].

The malformations requiring valve fitted prosthetic tubes in the pulmonary outflow tract were mainly persistent truncus arteriosus and pulmonary atresia with ventricular septal defect in this series. The surgical mortality before 18 months was 75% and 19% after this age. The long-term clinical result (average follow up period: 2,5 years) was good or acceptable in 20 of the 32 survivors. There were 5 late deaths and 6 reoperations. The main causes of long-term failures were progressive pulmonary hypertension without shunt, acquired stenoses on the prosthesis and late infection. It is important to assess poor results by catheterisation as reoperation is frequently possible with a relatively low mortality rate (1/6) and encouraging results.

Adolescent

[Notions of fluids mechanics useful for vascular surgeons (author's transl)].

With a few restrictions, the laws of fluid mechanics may give qualitative indications concerning the best type of surgical anastomosis. After recalling the basic principles of physics, the loss of physical capacity in various intestinal situations are considered, e.g. stenosis, enlargement, angulation, bifurcation. Even if this hemodynamic factor is not necessarily predominant, compared with other biological factors (state of the resistances beyond the anastomoses, the cardiac output, the state of blood coagulation) it can be shown what is geometrically advisable to overcome the mechanical causes of failure of an anastomosis.

Biophysical Phenomena

[Results of the surgical treatment of congenital mitral insufficiency].

The authors report 21 cases of congenital mitral incompetence undergoing surgery between 1972 and 1977. There were 3 operative deaths and 2 late deaths. Of the survivors, 10 had a good result and 5 a fair result. The factors influencing the results have been associated lesions (aortic stenosis and ventricular septal defects are more serious than atrial septal defects and abnormalities of origin of the left coronary artery), the type of repair (which is better if it seeks to correct the frequently complex valvular abnormality at all levels), and especially the degree of dilatation of the left ventricle. By contrast, age had no influence either on the operative risk or on the quality of the results.

Adolescent