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Biomedical subjects

J Relland

Publications and source records attributed to J Relland.

18 recordsLinked to original sources
PubMed1991

Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair.

Preliminary experimental studies in our laboratory have shown that autologous pericardium treated with glutaraldehyde prevents late deterioration and calcification of the tissue. For this reason, glutaraldehyde-treated autologous pericardium has been used in a series of 64 patients who underwent operations for leaflet extension of the mitral valve between 1980 and 1989. Ages ranged from 2.5 to 60 years (mean 19 +/- 15). The causes of mitral valve insufficiency were rheumatic fever (69%), bacterial endocarditis (17%), congenital (8%), endomyocardial fibrosis (4.5%), and trauma (1.5%). The autologous tissue was fixed in a 0.62% glutaraldehyde solution for 15 minutes and rinsed in saline for an additional 15 minutes. Patching techniques varied depending on the site and the extent of the lesion. Associated mitral valve repair techniques (Carpentier's techniques) were mandatory in all patients. The period of follow-up extended from 6 months to 9 years (mean 3.1 +/- 2.5 years). There were no operative deaths in this series, and there was one late death (2%). In the six patients (12%) who underwent reoperation, there has been no case of calcification of the pericardial patch. Postoperative mitral valve function was assessed by bidimensional color Doppler echocardiographic techniques. Mitral valve insufficiency was trivial or absent in 80% of the patients. This experience permits us to conclude that leaflet extension is a simple and safe technique in valve reconstruction, allowing repair of mitral valves that otherwise would need to be replaced. It permits use of an adult-size prosthetic ring in children. Glutaraldehyde-treated autologous pericardium is the material of choice for this type of repair.

Adolescent↗
PubMed1989

A 10-year comparison of mitral valve replacement with Carpentier-Edwards and Hancock porcine bioprostheses.

Two hundred fifty-three patients who underwent isolated mitral valve replacement with a porcine bioprosthesis had long-term evaluation. One hundred forty-seven patients received a Carpentier-Edwards porcine bioprosthesis and 106, a Hancock valve. There were no significant differences in preoperative clinical characteristics between the two groups. Cumulative follow-up was 1,375 patient-years. At 10 years, 93% +/- 2.5% of the patients in the Carpentier-Edwards group and 85% +/- 7.8% of those in the Hancock group were free from valve-related death (not significant), and 95% +/- 2% and 91% +/- 3.8%, respectively, were free from thromboembolism (not significant). At 10 years, 65% +/- 7.2% of the patients in the Carpentier-Edwards group and 66% +/- 7.2% of those in the Hancock group were free from structural valve deterioration (not significant), and 64% +/- 6% and 59% +/- 7.3%, respectively, were free from reoperation (not significant). We conclude that the first generation of Carpentier-Edwards and Hancock prostheses produce comparable long-term results in the mitral position.

Actuarial Analysis↗
PubMed1989

Echocardiography and color-flow mapping evaluation of a new reconstructive surgical technique for Ebstein's anomaly.

Eight patients with Ebstein's anomaly, corrected by the Carpentier technique between 1984 and 1987, were evaluated by echocardiography and by conventional Doppler and color-flow Doppler mapping. Because this technique aims at restoring not only tricuspid valve function but also right ventricular size and geometry, the following parameters were studied: 1) right ventricular size, by measuring the apex-annulus distance compared with that of a group of 30 normal volunteers; and 2) tricuspid valve motion and function. The apex-annulus distance ranged from 5.8 to 8 cm (mean, 6.4 cm) in the Ebstein group and 3.8 to 5.1 cm (mean, 4.3 cm) in the control group. There was no tricuspid stenosis. Right ventricular filling was normal as documented by color-flow mapping. Tricuspid regurgitation was trivial in three patients, mild in four, and severe in only one, in whom a significantly restricted motion of the leaflets was demonstrated.

Adolescent↗
PubMed1988

Kinking of internal mammary grafts: report of two cases and surgical correction.

Two patients who underwent left internal mammary artery (IMA) anastomoses to the left anterior descending artery (LAD) developed sudden angina associated with anterior ischemic changes on EKG in the early postoperative period, one at 4 hr and the other at 3 days following operation. Digitalized arteriography via retrograde injection of the left brachial artery revealed the IMAs, which were partially obstructed because of looping and Kinking, although the anastomoses to the LAD were patent. Reoperation was successful in relieving obstruction by reducing these abnormalities and resulted in an uncomplicated postoperative course following the second operation. Discussion of the etiology, radiological technique of diagnosis, correction, and prevention of this cause of internal mammary graft failure is presented.

Graft Occlusion, Vascular↗
PubMed1988

A new reconstructive operation for Ebstein's anomaly of the tricuspid valve.

Ebstein's anomaly is a complex malformation involving the tricuspid valve and the right ventricle. Various surgical techniques, either repair or replacement of the abnormal tricuspid valve, have been used with variable results. In an attempt to enlarge the indications of conservative procedures, we developed a technique of repair that comprises the reconstruction of a normally shaped right ventricle and the repositioning of the tricuspid valve at the normal level. In a series of 14 patients operated on between January 1980 and December 1986 in our institution, only one patient with an associated atrioventricular septal defect required a tricuspid valve replacement. All of the other patients, regardless of the complexity of the tricuspid malformation, were able to benefit from this conservative technique. There were two hospital deaths and no late deaths in this series. All surviving patients displayed a marked improvement over their preoperative status with regard to functional class (92% are in class I or II) and rhythm disturbances. Echocardiographic and Doppler studies demonstrated a normal shape of the right ventricle and good tricuspid valve function in all the patients but one.

Adult↗
PubMed1986

Long-term results of valve repair in children with acquired mitral valve incompetence.

From March 1969 to March 1984, 89 children aged 2 to 12 years (mean 8.3 +/- 2.5) with acquired mitral valve incompetence underwent mitral repair using Carpentier's techniques. There were 84 cases of rheumatic valve disease, four cases of endocarditis, and one case of Barlow's syndrome. Valve dysfunction was classified into three types: type I (normal leaflet motion), five patients; type II (prolapsed leaflet), 74 patients; and type III (restricted leaflet motion), 10 patients. Cumulative follow-up was 546 patient/years. At 10 years, 90% of the patients were still alive, with an incidence of valve-related death of 5.5%; 98% of the patients were free of thromboembolism, 78% were free of reoperation, and 69% of the patients were free of any complications related to valve repair. We conclude that whenever feasible (92% of the cases in our experience), mitral valve repair using valvuloplasty techniques is the preferred procedure in the surgical treatment of acquired mitral valve incompetence in children.

Child↗
PubMed1985

The third generation Carpentier-Edwards bioprosthesis: early results.

The current status of valve replacement was reviewed by analyzing six groups of 100 consecutive patients, each receiving the standard Carpentier-Edwards bioprosthesis, the Starr-Edwards valve or the Björk-Shiley valve in the mitral or aortic position and operated on by the same surgeons in the same institution during an identical time frame. Data were evaluated for valve failure, reoperation, thromboembolism and valve-related deaths. Long-term results up to 9 years showed the superiority of bioprostheses over mechanical valves in terms of valve-related deaths and thromboembolic and anticoagulant complications for a similar rate of valve failure. Persistent drawbacks associated with valvular bioprostheses, namely, transvalvular gradients, limited durability and tissue calcification in young patients, led to continual improvements in valve design and preservation techniques and the development of the third generation Carpentier-Edwards bioprosthesis: the supraanular porcine valve and pericardial valve. The supraanular porcine valve was designed with the aim of decreasing the transvalvular gradient, decreasing turbulence, increasing longevity and decreasing calcification. The pericardial valve was designed with the aim of improving hemodynamics in small-sized orifices, improving mounting techniques to avoid fixation sutures at the commissures, achieving a flexible stent and improving preservation. Between July 1980 and October 1984, there were 391 supraanular porcine and 61 pericardial valves implanted. The supraanular valves were used for three purposes: isolated aortic, isolated mitral and mitral valve replacement associated with tricuspid anuloplasty. The pericardial valves were used for isolated aortic valve replacement. Short-term results (1 to 4 years) are presented concerning the clinical use of these third generation bioprostheses.

Aortic Valve↗
PubMed1978

Conservative management of the prolapsed mitral valve.

Prolapsed leaflet is the result of ruptured chordae, elongated chordae, or ruptured papillary muscle. Various techniques adapted to each of these lesions were developed, and repair of 213 prolapsed mitral valves was performed between 1969 and 1977. There were 109 patients with ruptured chordae treated by quadrangular resection of the prolapsed leaflet; 103 patients with elongated chordae were treated by either a "sliding plasty" of the papillary muscle or a "shortening plasty" of the chordae; and 1 patient with ruptured papillary muscle was treated by reimplantation. The great majority of patients had an associated annular dilatation or deformation requiring the use of a Carpentier ring to remodel the annulus and reinforce the repair. The operative mortality was 4% and the late mortality, 3%. There were 6 reoperations, 3 of which occurred within 1 year. Thromboembolic complications occurred in only 1 patient (0.5%), even though the majority of patients received no anticoagulation treatment. Actuarial curves demonstrated a 91% survival at 8 years.

Adult↗
PubMed1977

The effect of coronary artery reperfusion on the extent of myocardial infarction.

The effect of the reperfusion on myocardial infarction has been studied in the rat in order to assess the possible reversibility of myocardial damage. The present study deals with reperfusion of experimental myocardial infarction in the rat. Two groups of animals were compared: one was subjected to permanent ischemia and the other was subjected to ischemia of variable duration 1) hour to 24 hours). The differences between infarction caused by permanent ischemia and the evolution of infarction following reperfusion were studied by means of histologic (121 specimens) histoenzymatic (56 specimens), ECG (100 specimens), techniques and study of the mcirocirculation (70 specimens). The size of the infarctions caused by temporary ischemia was found to be significantly smaller in 60% of the cases as compared to the infarctions caused by permanent ischemia. Histoenzymatic study (phosphorylase activity and succinodehydrogenase activity) confirmed the existance of a marginal zone extending over one third of the surface of the ischemic myocardium: reperfusion permitted the salvage of this zone and thereby diminished the extent of necrosis. The latter findings were further confirmed by the ECG study showing earlier regression of ischemic ST changes following early reperfusion. Microcirculatory changes secondary to anoxia may account for the fact that, in a certain percentage of the cases, early reperfusion does not prevent extension of infarction.

Animals↗
PubMed1976

Microcirculatory changes following early reperfusion in experimental myocardial infarction.

69 rats underwent temporary or permanent ligation of the left coronary artery and were studied by the injection of colloidal carbon following fixation-perfusion. 10 rats were using the same protocol and served as controls. Localized myocardial ischemia was accompanied by microvascular changes which produced capillary obstruction when blood flow was reestablished. This phenomenon of "no-reflow" was characterized by the presence of large non perfused areas seen after brief periods of ischemia (15 min). These areas were increased when the period of ischemia was lengthened. After 30 to 60 min of interruption of blood flow the non perfused area extended over the major portion of the ischemic area. During reperfusion the "no-reflow" phenomenon displayed during the first hour showing a transitory improvement in capillary perfusion which was soon followed by a progressive reexpansion of the non injected zones. After 24 hours of reperfusion, the latter zones were identical in their extent to those cases showing tissue necrosis following permanent ischemia. This "no-reflow" phenomenon appears to play a role in the evolution of the reperfused ischemic area by excluding certain areas from the benefits of reperfusion. The most probable factors involved in this process are: increased blood viscosity, endothelial changes peri-capillary edema and the contractile state of the myocardium. The incidence of these microvascular changes, using various methods of myocardial preservation during open heart surgery operations, as well as the present attempts directed towards metabolic therapy of myocardial anoxia, are under investigation.

Animals↗
PubMed1976

Emergency myocardial revascularization.

From 1969 to 1975, 175 patients with acute coronary insufficiency underwent emergency saphenous vein aorto-coronary bypass grafting (SVBG). The patients were divided into two groups: group I, unstable angina (165 patients) and group II, acute evolving myocardial infarction (ten patients). In group I, the hospital mortality was 8-4%, the incidence of post-operative myocardial infarction was 10-3%. Long-term follow-up was obtained for an average of 25 months, functional improvement was definite in the majority of the patients and actuarial survival curves show 87% patients alive at the end of 48 months. In group II, the hospital mortality was 30%; seven of ten patients had good results.

Adult↗
PubMed1976

Congenital malformations of the mitral valve in children. Pathology and surgical treatment.

A systematic study of congenital mitral valve malformations was undertaken on a surgical basis in an attempt to develop techniques of valvular reconstruction adapted to the various lesions. Forty-seven children between the ages of 4 months and 12 years (average 6 years, 4 months) have been operated upon between January, 1970, and March, 1976. Valvular lesions were classified into four group: Group I, mitral insufficiency owing to valvular lesions: Group II mitral insufficiency with subvalvular lesions; Group III, mitral insufficiency and stenosis; Group IV, stenosis. Associated lesions (ventricular or atrial septal defects, coarctation, or aortic valve stenosis) were present in 31 patients (65 per cent) and were corrected during the same operation. Valve reconsruction was possible in 38 patients whereas valve replacement was necessary in 9 patients. In the valve repair group there were three operative deaths (8 per cent), no late deaths, one reoperation for residual ventricular septal defect, and one myocardial infarction. In the valve replacement group of 9 patients, there were three operative deaths, three late deaths, and one case of repeated embolization. Thirty-one of 38 patients in the valve repair group were classified into Functional Class I after the operation (86 per cent), 2 were in Class II, and one in Class III. Minimal or moderate regurgitation and cardiomegaly persisted in the majority of the patients. Pulmonary artery pressure significantly decreased, however, as demonstrated by postoperative catheterization in 17 patients.

Child↗