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Biomedical subjects

J Rubay

Publications and source records attributed to J Rubay.

At least 19 recordsLinked to original sources
PubMed1995

Early balloon dilatation of the pulmonary valve in infants with tetralogy of Fallot. Risks and benefits.

BACKGROUND: Balloon dilatation, an established treatment for pulmonary valve stenosis, remains a controversial procedure in tetralogy of Fallot. METHODS AND RESULTS: Balloon dilatation of the pulmonary valve was performed in 19 infants with tetralogy of Fallot. Its effects on the severity of cyanosis, the growth of the pulmonary valve and pulmonary arteries, and the need for transannular patching were evaluated. Clinical, echographic, angiographic, hemodynamic, and operative data were analyzed. The procedure was safe in all, without significant complications. After balloon dilatation, systemic oxygen saturation increased from a mean value of 79% to 90%. This increase proved to be short-lasting in 4 patients, who required surgery before the age of 6 months. Balloon dilatation increased pulmonary annulus size in each case, from a mean value of 4.9 to 6.9 mm (P < .001). This gain in size remained stable over time, with a mean Z score of -4.8 SD before dilatation, -3.1 SD immediately after the procedure, and -2.7 SD at preoperative catheterization (P < .001). Pulmonary artery dimensions remained unchanged immediately after balloon dilatation but increased at follow-up from a Z score mean value of -2.5 to -0.06 SD and from -2.2 to 0.04 SD for right and left pulmonary arteries, respectively (P < .001). At the time of corrective surgery, the pulmonary annulus was considered large enough to avoid a transannular patch in 69% of the infants. This represented a 30% to 40% reduction in the need for a transannular patch compared with the incidence of transannular patch expected before balloon dilatation. CONCLUSIONS: Pulmonary valve dilatation in infants with tetralogy of Fallot is a relatively safe procedure and appears to produce adequate palliation in most patients. It allowed the growth of the pulmonary annulus and of the pulmonary arteries, resulting in a mean gain of 2 SD for those structures.

Cardiac Catheterization↗
PubMed1994

Isolation of the left coronary artery ostium by an aortic cusp attachment: a rare cause of myocardial ischemia.

A 34-year-old woman experienced a 3-month history of recurrent chest pain on exertion. Extensive investigation, including coronary angiography, revealed severe aortic incompetence with suspicion of single-vessel coronary disease. At operation the aortic valve was tricuspid but the left coronary cusp was adherent to the aortic wall, resulting in isolation of the left coronary artery with only a tiny communication with the aortic lumen. The three cusps were excised. An aortic valve replacement was performed with an aortic homograft. The postoperative course was uneventful and myocardial ischemia was totally relieved.

Adult↗
PubMed1989

Ventricular paired pacing to control intractable junctional tachycardia following open heart surgery in a child.

A 5-month-old girl presented postoperatively with an atrioventricular (A-V) junctional tachycardia at a rate of 245/min following surgical repair of tetralogy of Fallot. The systolic blood pressure dropped to 60 mmHg with this rapid heart rate, and the infant became shocked. Drugs and overdrive pacing were ineffective in suppressing the A-V junctional tachycardia and in improving cardiac output. Ventricular paired pacing was used successfully to halve the mechanically effective ventricular rate and to restore cardiac output. When ventricular paired pacing was stopped after 12 h, the spontaneous rhythm was an atrial rhythm with 1-1 A-V conduction. The patient was discharged in sinus rhythm on the 5th postoperative day.

Cardiac Output, Low↗
PubMed1988

Anatomic repair of anomalies of ventriculo-arterial connection (REV). Results of a new technique in cases associated with pulmonary outflow tract obstruction.

From November 1980 to November 1986, 63 patients aged 4 months to 13 years (mean 3.4 years) underwent repair of anomalies of ventriculo-arterial connection with ventricular septal defect and pulmonary outflow tract obstruction, using a technique (REV) first described by us in 1982. The selection of patients was based on preoperative criteria, namely the measurement of the distance between the tricuspid and the semilunar valves. These measurements enabled us to select from patients with an abnormal ventriculo-arterial connection, those in whom the anomaly could be repaired by intra-ventricular partition alone. In the remaining cases, REV was indicated in the presence of pulmonary stenosis. The principles of the technique are: (1) resection of the infundibular septum creating a large, direct and subarterial communication between the left ventricle and the aorta; (2) construction of a straight left ventricle to aorta tunnel by intraventricular partition; (3) direct anastomosis of the pulmonary trunk to the right ventricle. There were 12 hospital deaths (19%). The mean follow-up was 32 months. One patient died suddenly 1 year after repair. Six patients required reoperation. All survivors are in NYHA class I, except for 3 patients who are in class II. No stenosis of the left ventricular outflow tract was found but 5 patients had a significant pressure gradient at the pulmonary outflow tract level. Our present experience suggests that in properly selected patients, REV allows anatomic repair in a wide variety of anomalies of the ventriculo-arterial connection associated with VSD and pulmonary outflow tract obstruction with an acceptable rate of mortality and morbidity.

Abnormalities, Multiple↗
PubMed1988

To switch or not to switch? The Senning alternative.

We analyzed the fate of 100 consecutive patients with simple arterial transposition who were admitted within the first 2 weeks of life to the Hospital for Sick Children during the period 1978-1986. In contrast to current practice, these patients were managed with the objective of performing a Senning operation as the definitive procedure. Five of these 100 patients died on the first day of life of sequelae of perinatal hypoxia, four died within the first month of life (often of complications of catheterization and septostomy), and three died later than the first month but before definitive operation (12% preoperative mortality). There were four operative deaths, and two late deaths have occurred to date. Actuarial survival was 84% at 5 years and 81% at 9 years. The postoperative attrition rate was 0.4 deaths per 100 patient-years. Actuarial survival of all patients treated for simple arterial transposition seems to be the best index for comparing arterial switch with interatrial repair protocols, because each protocol is associated with different patterns of preoperative, perioperative, and postoperative mortality.

Actuarial Analysis↗
PubMed1986

The peroperative management in multiple organ donors: a crucial phase in organ transplantation.

Recent developments in organ transplantation led to the fact that any potential cadaver donor might be considered as a multiple organ donor (MOD). The anesthesiologist's role is to maintain good hemodynamic conditions during the long and complex harvesting procedure, taking into account that in renal cadaver transplantation, donor's stable hemodynamic conditions play a crucial role in the immediate function of the graft. Taking the opportunity of a case of simultaneous liver, pancreas and kidneys procurement in the same cadaver donor performed for the first time in our country, we are reviewing the different phases of the donor peroperative management. This implies a strict control of the systolic blood pressure (SBP) and central venous pressure (CVP). The first step was to maintain the blood volume: during the 3 hours procedure, 5.5 liters of crystalloid, 1.2 liters of colloid and 1 liter of blood were perfused to maintain a CVP higher than 8 mm Hg and a SBP above 110 mm Hg. To obtain the best possible renal and hepatic perfusion, 4 micrograms/kg/min. dopamine is injected continuously, along with 100 mg phenoxybenzamine since the beginning of the operation in order to avoid any local arterial spasm. After heparinization (3 mg/kg 10 minutes prior to clamping), all organs are simultaneously perfused in situ with 3 liters of Euro-Collins solution at 4 degrees C, for cold storage in optimal conditions. The pancreas along with one kidney was transplanted in a diabetic women in preterminal end-stage renal disease: current creatinine (2 months post-transplant) is 1.3 mg/dl and C-peptide is 0.8 pmol/ml. The other kidney was successfully transplanted in another center. The liver graft was implanted in a cirrhotic patient: current bilirubin is 6 mg/dl, S.G.O.T. and S.G.P.T. respectively 50 and 149 U.I.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1976

[Truncal vagotomy in duodenal ulcer (author's transl)].

Since 1961, the authors have treated 369 patients for a duodenal ulcer. Emergency operation was performed in 69 cases (mortality: 7.2 percent) and elective operation in 300 (mortality: 0.86 percent. Procedures associated truncal vagotomy to hemigastrectomy (257 cases), to pyloroplasty (85 cases) or to gastroenterostomy (27 cases). Three hundred and thirty-nine patients were followed for an average of 8 years. The authors preferred truncal vagotomy associated to hemigastrectomy. This yielded excellent long term results (Visick I) in 89 percent of cases (221 out of 246 reviewed cases), with a very low mortality rate (3 out of 257 or 1.2%) and without known recurrence. (Acta chir. belg., 1976, 75, 294-305).

Adult↗
PubMed1975

[Benign tumors of the stomach].

The authors report their surgical experience of benign gastric tumors between 1947 and 1972: 19 cases (18 patients) were operated, which represent 3, 5% of the operated malignant tumors. Distribution was as follows: 6 polyps, 4 schwannomas, 4 accessory pancreases, 4 leiomyomas, 1 lipoma plus one leiomyoma of the ampula of Vater. The authors recall the symptomatology and roentgenological aspect of these tumors. They point out the growing importance of fibroscopy. They insist on the connexion between these tumors and carcinomas: this is clear for schwannomas and polyps where volume is a determining feature. Resection can be limited where there is no danger of malignant change. Though unquestionalbe, the malignancy of polyps is less than that of classical carcinomas.

Adult↗