Biomedical subjects

L v Segesser

Publications and source records attributed to L v Segesser.

5 recordsLinked to original sources

PubMed1987

Inadequate flow after internal mammary-coronary artery anastomoses.

The use of the internal mammary artery for revascularization of the coronary arteries has expanded over the last years. In a series of 250 consecutive coronary artery revascularizations, there was at least 1 internal mammary-coronary artery anastomosis in 222 patients (89%) and multiple internal mammary-coronary artery anastomoses were performed in 77 patients (31%). During the revascularization procedure, weaning from cardiopulmonary bypass was not possible in 4 patients with internal mammary-coronary artery anastomoses. These 4 patients showed signs of left ventricular failure, and additional saphenous vein bypass to the left anterior descending coronary artery, already revascularized by the left internal mammary artery, was performed. Weaning from cardiopulmonary bypass was then possible in 3 out of 4 patients. Thus, in some patients (1.2%), internal mammary-coronary artery anastomoses provide inadequate nutritional support for the myocardium.

Adult↗

PubMed1986

[Coronary revascularizations using multiple mammary anastomoses compared to classical vein grafts].

In a series of 100 consecutive patients the internal mammary arteries have been used whenever possible for revascularization of the coronary arteries. At least one internal mammary artery was used in 89% of cases; both internal mammary arteries were used in 30% and in 17% sequential internal mammary-coronary artery anastomoses were performed. The results in this group of patients were compared to another group of 250 consecutive patients in whom the coronary arteries were revascularized by classical saphenous vein grafts. In-hospital mortality was 3% for the internal mammary artery group and 2.5% for the saphenous vein group (NS). The follow-up was complete for 89% of the patients after a mean duration of 6 months. At control the mean NYHA functional class was assessed as 1.0 +/- 0.2 for the internal mammary artery group and 1.2 +/- 0.2 for the saphenous vein group (p less than 0.01). Stress test was electrically positive in 7.1% of the internal mammary artery group and in 15.3% of the saphenous vein group (p less than 0.05). Although the method is technically more demanding, the results after internal mammary-coronary artery anastomoses appear to be superior.

Coronary Artery Bypass↗

PubMed1986

Equine pericardial xenograft in orthotopic position: early results.

Glutaraldehyde-preserved pericardium was used to close the pericardial sac after open heart surgery in 100 patients. The indication for implantation of a xenologous pericardial patch was always the lack of autologous pericardium to close the pericardial sac without significant tension. This was mainly due to previous use of an autologous pericardial patch or implant of an extracardiac conduit for the repair of congenital cardiac disease (n = 82) and reoperation after primarily open pericardium (n = 10). In this series with a mean follow-up of 3.1 months (range 1 to 12 months) no infection of the xenologous equine pericardial implant and no mediastinitis occurred. Even in cases of early reoperation (n = 6) for bleeding or tamponade there was no patch infection (implants left in situ). At medium-term reoperation in 3 cases, after a mean interval of 115 days, adhesions between the epicardium and the xenologous equine pericardial patch were graded mean 1 (blunt adhesions) on a scale of six (minimum = 0, maximum = 5). In another series of re-dos for coronary bypass surgery with pericardium primarily left open, the mean grade of adhesions formed in the anterior epicardial space was 2.7 (severe). The histology of explanted equine pericardium showed no new vessels and no in-dwelling organization. Although the follow-up is relatively short, this material appears to offer a valid non-adherent substitute to separate the posterior sternal surface and the cardiac cavities. Its application improves the safety at resternotomy.

Adult↗

PubMed1986

Surgery in primary leiomyosarcoma of the heart.

Primary leiomyosarcoma of the heart is uncommon and we were able to find only 15 cases reported in the literature. Few of these cases were discovered during life and, as a result, even fewer have been treated surgically. We report a case of a right atrial leiomyosarcoma which was proven pathologically (histologically, immunohistochemically and ultrastructurally) after surgical resection. The clinical presentation, morphological, appearances and outcome are compared with those reported in the literature.

Adolescent↗

PubMed1985

Subaortic stenosis--improved surgical approach.

In most cases of subaortic stenosis there is associated hypertrophic muscular stenosis. Classical surgical treatment by transaortic ventriculomyotomy can be assessed by bidigital septal examination through a complementary pulmonary arteriotomy as reported in this paper. Preoperative and postoperative trans-stenotic subaortic pressure gradients were measured in 5 patients with a mean decrease of about 85 mmHg. Bidigital assessment of the residual septal thickness is likely to improve the results of transaortic ventriculomyotomy.

Adolescent↗