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Biomedical subjects

J P Laura

Publications and source records attributed to J P Laura.

6 recordsLinked to original sources
PubMed1982

Atriopulmonary anastomosis.

Atriopulmonary anastomosis (APA) has been performed in 29 patients, 3 to 22 years of age, since 1971. The diagnoses were tricuspid atresia in 21, single ventricle with low pulmonary vascular resistance in seven, and one case of dextro-transposition of the great arteries with ventricular septal defect and pulmonary stenosis. Four different techniques were used: Technique I (anterior end-to-end APA with a homograft or Dacron tube); Technique II (anterior end-to-end APA with the patient's own pulmonary artery); Technique III (nonvalved anterior anastomosis between the right atrium and the right ventricle); and Technique IV (largest, posterior, nonvalved direct APA between the right atrium and the main pulmonary artery and its right branch). Since the right atrium does not function as a pump, caval valves were never used. The total hospital mortality was 17.2%. Proper patient selection and the development of Technique IV reduced the mortality to 9%. Low end-diastolic ventricular pressure and a nonrestrictive APA are mandatory to obtain a good clinical result without pleural effusion. Twenty-one survivors are in Functional Class I, 17 of them without medication. Twelve of the 24 survivors were recatheterized. The best clinical and hemodynamic results were achieved in patients with low right atrial pressure and low end-diastolic ventricular pressure. The follow-up demonstrated a consistent superiority of the posterior nonvalved APA (Technique IV) in comparison with other techniques described. Therefore, this technique is proposed as the procedure of choice for the performance of an APA, irrespective of the precise diagnosis (tricuspid atresia or single ventricle) and irrespective of the type of great arterial relationship.

Adolescent↗
PubMed1977

[Interventricular communications with aortic insufficiency surgical considerations].

The authors report a series of 11 patients with ventricular septal defect associated with aortic incompetence who underwent surgery between 1963 and March 1976. Separate consideration is given to the operations performed before and after 1972. 5 patients were operated on during the first period, with only mediocre results. At this time, the technique of valvuloplasty did not appear to be the right one. During the second period, 6 patients were operated on. In five of them the technique of Plauth, Frater, Spencer and Trusler was used. All these patients have a satisfactory result. The last of the series had an abnormally low commissure, and the adjacent valves were protuberant, and thickened, so that a valvular replacement was carried out. The operation of choice for a ventricular septal defect associated with aortic incompetence is valvuloplasty with closure of the defect. The following criteria are necessary indications for this type of surgery: --the aortic incompetence must be secondary to the prolapse of a valve; --the aortic valve must have three cusps. An early operation makes the valvuloplasty easier, and avoids the problems of damage to the left ventricle from a persistant and progressive aortic incompetence.

Adolescent↗