Biomedical subjects

K Verkkala

Publications and source records attributed to K Verkkala.

At least 55 records · Page 3Linked to original sources

PubMed1989

Primary cardiac tumours--operative treatment of 20 patients.

This report describes a series of 20 patients operated on for a primary cardiac tumour. The majority of the tumours (16) were benign myxomas; 12 of them were located in the left atrium, two in the right atrium and two were biatrial. Two lipomas were found; one was epicardial and the other was located in the left atrium. The only intraventricular tumour was a malignant left ventricular myosarcoma. The propensity of intracardiac tumours to embolize was distinctive. Nine of the 16 myxomas presented with peripheral embolization, and in two patients surgery was complicated by fatal perioperative cerebral embolization of myxomatous tissue. Furthermore, in one patient embolization of a left atrial lipoma necessitated amputation of her left arm before cardiac surgery. Late postoperative recurrences were found in two patients with atrial myxomas. In one of them, reoperation showed that the tumour had grown at that site in the interatrial septum where the original pedicle had been excised. One patient developed severe mitral valve regurgitation and underwent replacement with a prosthetic valve at reoperation. Otherwise our late follow-up study showed that the results of surgery were usually excellent even though mild echocardiographic abnormalities were not uncommon. Our experience emphasizes the embolic potential of intracardiac myxomas and suggests, furthermore, that to avoid recurrences excisions with wide margins should be preferred. Echocardiography is an optimal method for the follow-up of these patients.

Echocardiography↗

PubMed1989

Results of reoperations for coronary artery disease.

Seventy-one patients undergoing reoperation for coronary artery disease were examined on average 2.5 years postoperatively. Operative mortality was 9.9% and late mortality 6.3%. 88% of the patients improved subjectively, and although only 7.8% were angina-free, 79.9% were in NYHA Class I or II. All patients who had been working before reoperation returned to work, and either patients who were on sick-leave before resumed their activities. A follow-up examination was performed in 21 patients with a follow-up time of more than three years. The mean peak work capacity did not change after reoperation and also the ST changes during the bicycle ergometer exercise test were the same after reoperation. The mean ejection fraction diminished from 54 +/- 15.5% to 44.7 +/- 15.2%. In thallium perfusion studies areas of hypoperfusion were observed in 14 cases (67%). Coronary angiograms showed 3.0 +/- 1.0 patent anastomoses at the follow-up examination; 76% of the anastomoses performed in the reoperations were patent. It can be concluded that although the objective results of repeat myocardial revascularisation in this material are not optimal, the subjective improvement of the patients was satisfactory, and in the majority of cases reoperation ensures an acceptable quality of life for years.

Coronary Artery Bypass↗

PubMed1989

Popliteal artery entrapment.

External compression of the popliteal artery is probably still underdiagnosed. Young patients with atypical claudication, with isolated popliteal changes, deserve thorough investigation. Subdividing the entrapment syndrome into three subgroups (I-III) highlights the clinically important characteristics of the different types. Delayed diagnosis leads to arterial occlusion with clinical and radiological resemblance to arteriosclerotic occlusive disease. At this stage a medial approach with reversed saphenous vein bypass is recommended. If the artery is still patent, a posterior S-shape approach offers good exposure for arterial decompression, rerouting and possible ancillary measures. In addition to reviewing the literature and outlining the classification criteria and surgical treatment, five cases of our own are presented including two rarities. In one both type I and type III existed simultaneously. In the other the popliteal artery entrapment was combined with cystic adventitial disease.

Adult↗

PubMed1989

Femoral-tibial bypass for limb salvage.

From 1967 to 1982, 305 femoral tibial bypasses were performed. Of these 180 (59%) were performed on limb salvage indication. A reversed autogenous saphenous vein was used in 134 instances, among 46 vein substitutes there were 15 vein allografts, 13 human umbilical cord vein grafts, 12 PTFE grafts and six dacron grafts. Hospital mortality was six patients. An additional 37 patients died during the follow-up period. The patency rates for saphenous vein bypass grafts were 62.5%, 48%, and 25% at one, five, and ten years, respectively, and 33% and 25% at one and five years, respectively, for the vascular substitutes. The mean +/- SD follow-up time was 62.27 +/- 5.7 months. During the early postoperative period 23 legs (12.7%) had to be amputated. During the follow-up period an additional 14 legs (7.8%) were lost giving a limb salvage rate of 79.5%.

Adult↗

PubMed1987

Fever, leucocytosis and C-reactive protein after open-heart surgery and their value in the diagnosis of postoperative infections.

The time course of body temperature (T), white blood cell count (WBC) and serum C-reactive protein (CRP) following uncomplicated open-heart surgery and the value of these three parameters in the diagnosis of postoperative infectious complications were analyzed in 153 patients. Preoperatively, all the patients had a normal T and the WBC level was under 10 X 10(9)/l. The CRP was elevated (over 20 mg/l) in five patients without having an influence on their postoperative courses. Postoperatively, T, WBC and CRP reached their maximum values during the first three days, decreasing gradually thereafter. Great individual variations in this average response to open-heart surgery were seen. Development of minor postoperative infections, mainly wound infection, (in 22 patients) were poorly reflected by these three parameters. However, a temperature exceeding 38 degrees C after the 6th postoperative day suggested presence of infection; less than 5% of patients without an infection had a temperature over this value. A secondary rise in CRP after the third postoperative day occurred in 20 patients and correlated well with postoperative complications; in 14 patients (70%) an infection became apparent, in three instances a probable infection was present, while two patients suffered from non-infectious complications. Only in one case (5%) did the cause for a secondary rise in CRP remain unknown. In major infections, i.e. mediastinitis, a CRP response occurred in all 12 patients, a temperature response in 11 patients (92%) and a WBC response in 10 patients (83%).

Aged↗

PubMed1987

Value of combined cross sectional and Doppler echocardiography in the detection of left ventricular pseudoaneurysm after mitral valve replacement.

The development of a left ventricular pseudoaneurysm is a rare complication of heart surgery. Until recently it has been impossible to detect without an angiographic study of the left ventricle. A combination of cross sectional and Doppler ultrasound studies led to the correct diagnosis in two patients with left ventricular pseudoaneurysms after mitral valve replacement. Cross sectional echocardiography showed a posterolateral echo-free space confined only by the pericardium and communicating with the left ventricle through a defect in the ventricular wall, and Doppler echocardiography confirmed the presence of blood flow in this cavity. This Doppler finding is critical if the perforation is too small to be identified reliably by cross sectional imaging. Surgical repair of the pseudoaneurysm can be undertaken without invasive studies if the echocardiographic findings are unequivocal and there is no reason to suspect the integrity of the circumflex coronary artery.

Adult↗

PubMed1987

Early endocarditis following open-heart surgery--importance of surgical treatment.

Nine cases of proven early form of endocarditis occurred after open-heart surgery. Eight of these occurred after valve surgery with an incidence 0.7% while one complicated correction of Fallot's tetralogy. Sternal wound infection preceeded endocarditis in two cases and respiratory tract infection in one case. In these three patients, the infection was caused by the same bacteria as the subsequent postoperative endocarditis. In only one patient were there no signs of infection during the immediate postoperative course. A new cardiac murmur suggesting prosthetic malfunction was a clear indication for early reoperation in five patients; four of them survived. In one patient with a paravalvular leakage the decision to operate was delayed with fatal outcome. Generally, in patients without signs of prosthetic valve malfunction or other prosthetic complication the indication and timing of surgery is problematic. In our series the antibiotic therapy was continued over two months in three patients. Two of them died while the third patient was operated on successfully.

Adult↗

PubMed1987

Occurrence of and microbiological findings in postoperative infections following open-heart surgery. Effect on mortality and hospital stay.

A prospective study of postoperative infectious complications after open-heart surgery was carried out in 885 patients. A total 200 postoperative infections occurred in 173 patients, an overall incidence was 19.5%. The mortality rate was 0.8%. The incidence of sternal wound infections was 7.7% (superficial 6.3% and deep 1.4%) and of leg wound infections 11.4%. Superficial sternal wound infections were associated with septicaemia in 10.7% and deep sternal wound infections in 33.3%. The leg wound infections caused no blood culture positive septicaemia. The incidence of urinary tract infections was 4.6% while respiratory tract infections occurred in only 2.5%. Early prosthetic valve endocarditis occurred in only one patient (0.3%). Staphylococcus aureus and epidermidis were the two bacteria most frequently cultured from sternal wound infections (82.4%), while gram-negative bacteria alone were seldom found (5.9%). In leg wound infections the incidence of gram-negative bacteria was greater (17.3%). Although E. coli was the causative agent in 37% of postoperative urinary tract infections the incidence of infection by the classical hospital-acquired organisms (klebsiella and pseudomonas) was also high (32%). Postoperative infections caused an average prolongation of hospital stay of 8 days. The increase was shortest for urinary tract infections (5 days) and longest in patients with postoperative mediastinitis (28 days).

Adolescent↗

PubMed1986

Intrathoracic surgery for retained endocardial electrodes.

Intrathoracic surgery for retained endocardial electrodes was performed in 12 patients; the indication for electrode removal was Staphylococcus aureus or epidermidis infection in 11 patients and malfunction in one patient. Two operations had to be performed on emergency basis. One was carried out because of myocardial rupture and cardiac tamponade after a tightly fixed electrode lead had been pulled out. The other patient was operated on because of ventricular arrhythmia arising from a malfunctioning lead which had slipped back completely after transsection into the right ventricle. Ten patients underwent elective surgery; cardiopulmonary bypass was needed in 6 of these. In one case a mitral prosthesis was replaced because of infection. Radical treatment is recommended for pacemaker infections and the removal of electrodes should be considered even if intrathoracic surgery is required.

Adult↗

PubMed1986

Mediastinal infection following open-heart surgery. Treatment with retrosternal irrigation.

A consecutive series of 1083 patients undergoing open-heart surgery was prospectively observed for infectious complications. Postoperative mediastinitis developed in 15 cases (1.4%). Surgical management of the mediastinal complication consisted of careful debridement of the sternal wound and the anterior mediastinum, followed by continuous retrosternal irrigation with an antiseptic or antibiotic solution after sternal refixation. The mean duration of mediastinal irrigation was 12.7 days. This treatment was successful in 13 of the 15 patients. In 2 of the 13, however, secondary refixation became necessary to stabilize the fragmented sternum. Repeated refixation with mediastinal irrigation was effective in one of these patients. The other underwent removal of the fragmented sternum followed by muscle plasty, but died unexpectedly of aortic dissection when signs of infection were subsiding. Two patients (13%) treated with closed chest irrigation died of recalcitrant mediastinal infection.

Aged↗

PubMed1986

Traumatic rupture of the right hemidiaphragm.

Sixteen cases of traumatic disruption of the right hemidiaphragm are presented. Six tears were treated in the acute post-trauma phase and ten were detected from late manifestations. The causal trauma was penetrating in 11 cases and blunt in five. Rupture of the right hemidiaphragm not uncommonly occurs without serious associated injuries. Bowel often herniates through such tears, unhindered by the liver, though the liver is the most commonly herniating organ. No recurrence of hernia was found after standard repair techniques (mean follow-up 5.2 years). Three of the 16 patients died, one from associated injury, one from strangulation of herniated bowel and one from postoperative myocardial infarction. To demonstrate diaphragmatic tearing and subsequent organ herniation, serial chest radiographs and computed tomography are useful, and exploratory laporotomy should be done without delay after penetrating injury to the trunk. The treatment of diaphragmatic tear is surgical, with better results from early than from late repair.

Adult↗

PubMed1986

Surgical treatment of occlusion of the infrarenal abdominal aorta. Experience with 55 patients.

A series of 55 patients with occlusion of the infrarenal abdominal aorta operated on in the 15-year period 1966-1980 is presented. The type of operation was an extra-anatomic reconstruction in four cases and some type of anatomic repair in 51 cases. The operative mortality was 5.4%. The cause of death was myocardial infarction in two out of three cases. After a follow-up period of 90.4 months on average 25 patients were alive and were reached to a follow-up examination. Nineteen out of these 25 patients (76%) were symptom-free and six patients (24%) complained of mild to moderate symptoms related to obstructive arteriosclerotic lesions of the lower extremities. During the follow-up 27 patients expired. The most common causes of late deaths were myocardial infarction (13 out of 27 patients) and CVA (5 out of 27 patients).

Adult↗

PubMed1985

Complement levels and C3 breakdown products in open-heart surgery: association of C3 conversion with the postpericardiotomy syndrome.

The role of the complement system in the pathogenesis of the post-pericardiotomy syndrome (PPS) was evaluated in a prospective study by measuring the levels of complement (C) components, total haemolytic complement activity and circulating C3 breakdown products in serial plasma and serum samples of 45 patients undergoing open-heart surgery. A consistent reduction in the levels of C3 and C4 but not of factor B was seen on the second post-operative day. During the second post-operative week the antigenic levels of each C component increased significantly. At this time six patients developed the post-pericardiotomy syndrome. Circulating C3 conversion products (C3bi and C3c) were demonstrated in the plasma samples from five of these patients by the immunofixation technique, the mean conversion percentage being 14.3 +/- 10.6. The samples from 15 of the 39 other patients also showed C3 conversion, but the mean percentage was significantly lower (4.5 +/- 6.1%, P less than 0.05). Before the second post-operative week C3 conversion was rare in both groups. The C3d levels of plasma samples, as detected by rocket immunoelectrophoresis, followed a similar pattern. Reduced total haemolytic complement activity was found in three patients suffering from the PPS. These results suggest a role for complement in the non-infectious, inflammatory response during the late post-operative period after open heart surgery, and especially in the post-pericardiotomy syndrome.

Adolescent↗

PubMed1979

The mechanisms of severe arterial injury in surgery of the hip joint.

Vascular accidents occurring in the course of hip surgery may reach potentially catastrophic dimensions by posing an immediate and sudden threat to life and limb. This is a report of 15 cases with severe arterial injury representing 0.2--0.3% of all reconstructive hip operations performed during an 8 year period. In 6 cases perforation of either the external iliac artery, the common femoral artery of main branches of the lateral and medial circumflex femoral artery were caused by the tip of a narrow-pointed Hohmann retractor used to expose the hip joint. Other mechanisms were: intimal tear with appositional thrombosis, probably caused by mechanical strain imposed on atherosclerotic arteries, giving rise to complete limb ischemia (2 cases); the dangers associated with the entry of bone cement through a defective acetabulum into the pelvis causing thrombotic occlusion due to polymerization heat (one case) or intimate adhesion of artificial bone to the external iliac artery subsequently being ripped open during replacement of the cup (one case); the increased hazards of replacing firmly embedded hip prosthesis (3 cases of direct arterial injury with chisel, knife and cutting edge of protruding bone); and the complications associated with the development of a false aneurysm (2 cases). Fourteen of the 15 extremities were salvaged. Above-knee amputation was unavoidable in one case owing to delay of vascular repair. There was no immediate operative mortality. Knowledge of the causative mechanisms prevents arterial injury during hip surgery. The relatively low rate of vascular complications in spite of vicinity of main vessels gives credit to the well standardized technique of hip surgery, especially hip replacement. However, it is suggested that the surgeon should be sufficiently acquainted with the exposure of the main vessels above and below the groin to be able to control life threatening hemorrhage at all times. A McBurney incision with retroperitoneal exposure and clamping of the external iliac artery will suffice to diminish bleeding considerably. Thereupon careful dissection and placement of snares around the common femoral artery, the arteria profunda femoris, and whenever necessary, the lateral or medial circumflex femoral artery will enable closure of the lacerated artery. For hemorrhage resulting during replacement of firmly embedded hip prosthesis it might become necessary to ligate the internal iliac artery. Reconstruction of obliterated arteries should call for the cooperation of the vascular surgeon for eventual angioplasty. Angiologic examination of the lower extremities is mandatory whenever severe arterial trauma has occurred in the course of hip surgery and is best performed by measuring the ankle blood pressure with a Doppler ultrasound probe.

Adult↗

PubMedDate not supplied

Minimally invasive coronary artery bypass grafting: one-year follow-up.

BACKGROUND: Use of the minimally invasive direct coronary artery bypass grafting (MIDCAB) technique has been associated with excellent primary results, and sparing of resources has been assumed. There is, however, a limited amount of information available concerning the results of mid-term follow-up. The purpose of this study was to present 1-year follow-up results of our first 130 consecutive MIDCAB patients. METHODS: MIDCAB operations, defined as no sternotomy, no cardiopulmonary bypass, and no aortic manipulation were started in our clinic in February 1996. One hundred thirty patients requiring invasive treatment of coronary artery disease who were not suitable for percutaneous transluminal angioplasty were included in this series. The main outcome measures were mortality, the need for subsequent invasive treatment, and 1-year NYHA classification. RESULTS: There was one hospital death, but during the first-year follow-up, four additional deaths occurred and three patients were reoperated on with conventional techniques. Five percutaneous transluminal coronary angioplasties (PTCAs) had to be performed, two because of anastomosic stenosis. Additionally, cardiac- or operation-related symptoms caused a total of 27 hospital visits among 23 patients during the first-year follow-up. Angiographic left internal thoracic artery (LITA)-left anterior descending artery (LAD) patency was 97.4% (37/38) (confidence interval [CI] ranged from 86.2% to 99.9%) at 3 months. After 1 year, 86.9% (113/130) of the patients were without symptoms. A clear improvement of the follow-up results was observed to be associated with increased experience during the study period. CONCLUSIONS: MIDCAB operations, after some experience, can be performed with relatively good outcome. However, special attention should be directed to determination of correct anastomosic site and to avoiding anastomosic stenosis. We also recommend extended mobilization of the ITA and use of specific stabilizers.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

Pseudoaneurysm of the left ventricle following mitral valve replacement. Report of two cases and review of the literature.

Two cases of left ventricular (LV) pseudoaneurysm following mitral valve replacement (MVR) are presented. In one patient the false aneurysm developed after an initially successful correction of intraoperative left ventricular wall rupture while the other case resulted from an apparently uncomplicated MVR performed because of staphylococcal endocarditis. Both cases were detected by combined 2-dimensional and Doppler echocardiography. The operative treatment was similar in both patients. After extirpation of the old prosthesis, the orifice of the pseudoaneurysm was closed from inside the heart, either with a Dacron patch or using interrupted sutures supported by a teflon pledget. One of the patients died one month postoperatively but the other one recovered and is clinically well 6 months after repair. She has, however, a residual communication between the LV and the pseudoaneurysm.

Adolescent↗

PubMedDate not supplied

Effect of antiplatelet and anticoagulant therapy on patency of femorotibial bypass grafts.

In a retrospective study, 210 autogenous femorotibial saphenous vein grafts inserted during the 15 years from 1967 to 1982 were followed-up for a mean period of 62.3 +/- 5.7 months. Seven patients, who had had eight grafts died in hospital. The remaining 202 grafts fell into three groups: (1) Sixty grafts in patients who received 325 mg of dipyridamole and 1.0 g of acetylsalicylic acid daily, starting on the second postoperative day and continuing for six months. (2) One hundred and two grafts in patients on no antithrombotic therapy. (3) Forty grafts in patients on warfarin therapy to maintain the prothrombin time (prothrombin-proconvertin method) within the therapeutic range (0.10 to 0.20). Medication was continued for six months. This group included more high-risk patients than the other two groups. The mean ages and the incidence of risk factors did not vary significantly between the groups. The patency rates in three groups at five years were 62.5%, 44.0% and 26.0% and at ten years 48.5%, 25.0% and 21.5% for the dipyridamole and acetylsalicylic acid, no therapy and warfarin groups, respectively. The limb salvage rates were 100%, 96% and 85% in the dipyridamole and acetylsalicylic acid, no therapy and warfarin groups respectively. Thus, the best results were seen in the aspirin/dipyridamole group.

Actuarial Analysis↗

PubMedDate not supplied

Polydioxanone in coronary vascular surgery.

We have used polydioxanone (PDS) in 50 patients who underwent coronary artery bypass grafting. The anastomoses consisted of suturing an autologous vein graft to the coronary artery (122 operations), a vein graft to the aorta (63 operations) and the internal mammary artery to the coronary artery (33 operations). The recipient coronary artery was subjected to endarterectomy in 28 instances. The anastomoses proved to be reliable in the early postsurgical period; no bleeding was attributed to the PDS suture. Clinical follow-up for a maximum of two-and-half years, completed using control coronary angiograms in selected cases, demonstrated good results. The practical properties of PDS were evaluated to be at least as good as those of polypropylene. Experiments have clearly shown that small artery anastomoses heal more favourably after the use of absorbable sutures than after the use of nonabsorbable sutures. Because of this finding and on the basis of our clinical experience, we believe the application of PDS in coronary surgery should be recommended as an alternative treatment.

Adult↗