Biomedical subjects

Lior Sasson

Publications and source records attributed to Lior Sasson.

9 recordsLinked to original sources

PubMed2006

Indications for tricuspid valve detachment in closure of ventricular septal defect in children.

BACKGROUND: Different techniques have been described for tricuspid valve detachment to improve visualization in ventricular septal defect repair. Our hypothesis was that preoperative echocardiographic criteria are important in deciding which patients should undergo ventricular septal defect repair by tricuspid valve detachment, and patients who undergo this procedure may have a better surgical outcome than those who fulfilled the criteria but were actually operated on with the standard surgical approach. METHODS: Between January 2000 and December 2004 we prospectively studied 179 patients scheduled for ventricular septal defect repair and criteria for tricuspid valve detachment were established. Of these, 84 patients did not have any criteria for tricuspid valve detachment and were classified as the control group (group 1). Ninety-five patients with at least one criterion for tricuspid valve detachment were intraoperatively divided by patients who underwent tricuspid valve detachment into group 2 (n = 41), and those who did not undergo tricuspid valve detachment into group 3 (n = 53). RESULTS: Surgical complications occurred more frequently in group 3 (26%) as opposed to group 2 (10%) and group 1 (7%). Residual ventricular septal defect and atrioventricular block occurred only in group 3. Tricuspid regurgitation occurred in 15% of group 3 versus 9.8% of group 2 and 7.1% of group 1. CONCLUSIONS: Preoperative criteria for tricuspid valve detachment can be established before repair of ventricular septal defect. Patients who had indications for tricuspid valve detachment who actually had detachment performed during repair had fewer postoperative surgical complications as opposed to patients who fulfilled the criteria but did not undergo detachment.

Cardiac Surgical Procedures↗

PubMed2006

Nonocclusive mesenteric ischemia after off-pump coronary artery bypass surgery: a word of caution.

We present a series of five cases of off-pump coronary artery bypass surgery complicated with fatal nonocclusive mesenteric ischemia. We review a total of 489 patients aged 65 and older (mean age 74.9 +/- 3.2 years) who underwent off-pump coronary artery bypass surgery. The diagnosis of nonocclusive mesenteric ischemia was confirmed by computed tomography-angiography and/or selective angiography of the superior mesenteric artery, or intraoperatively. Three patients underwent laparotomy with bowel resection. In two cases, resection of bowel was not feasible. Of the possible predisposing factors, we found that four of the patients (two preoperative and two perioperative) had received epinephrine and two had an intra-aortic balloon counter pulsation due to acute myocardial infarction and cardiogenic shock. All patients were over 65 years of age, and all had acute anterior wall myocardial infarction and hemodynamic instability or post-myocardial infarction unstable angina. Nonocclusive mesenteric ischemia is a difficult clinical entity to recognize, has no clear-cut effective management, has a poor prognosis as a result of low cardiac output, and can be aggravated by off-pump coronary artery bypass grafting.

Aged↗

PubMed2004

Initial experience with the Heartstring proximal anastomotic system.

OBJECTIVE: Manipulation of the aorta has been shown to be associated with postoperative neurologic events after surgical myocardial revascularization when the aorta is diseased. The Heartstring proximal anastomotic system (Guidant, Indianapolis, Ind) is a device designed to assist in the performance of proximal anastomoses with minimal aortic manipulation. We describe our initial experience with this product. METHODS: Twelve patients with a diseased aorta who underwent off-pump myocardial revascularization and had their proximal anastomoses performed with the Heartstring device were studied for operative and postoperative outcomes and surgical technique. RESULTS: The mean age of the patients was 76 +/- 7 years. The estimated EuroSCORE perioperative mortality was 12% +/- 8%. The median number of distal anastomoses was 3. In all patients, a saphenous vein graft was anastomosed to the aorta using the Heartstring device. In 5 patients, the radial artery was used as a conduit and connected proximally to a left internal thoracic artery as a Y graft, to a saphenous vein graft as a "horseshoe," or on the hood of a saphenous vein graft. The operative and postoperative courses were uneventful. Three seals developed cracks and were not used. One seal developed an unravel in its periphery but was used successfully. CONCLUSIONS: The Heartstring proximal anastomotic system is a device that allows the surgeon to perform standard proximal clampless anastomoses. Elderly patients with a diseased aorta may benefit from this device.

Aged↗

PubMed2004

Milrinone and nitric oxide: combined effect on pulmonary artery pressures after cardiopulmonary bypass in children.

OBJECTIVE: To investigate the effect of milrinone combined with nitric oxide (NO) on the pulmonary artery pressures (PAP) after cardiopulmonary bypass (CPB), for repair of congenital heart defects (CHD) in children. DESIGN: Prospective, randomized, double-blind study. SETTING: University affiliated community hospital. PARTICIPANTS: Ninety children with pulmonary hypertension and repair of CHD. INTERVENTIONS: After weaning from CPB, patients (30 in each group) received 3 drug regimens: group 1, nitric oxide (NO); group 2, a continuous infusion of milrinone; and group 3, a combination of the 2. Drugs were started after CPB and given for 20 minutes. MEASUREMENTS AND MAIN RESULTS: Pulmonary and systemic pressures, PaCO(2), SaO(2), and pH values were recorded before bypass, after weaning from CPB, 10 and 20 minutes after starting each regimen, and 10 minutes after the cessation of treatment. Mean systemic blood pressure was lower (p < 0.05) in the combined treatment group after discontinuation of the drugs. Although mean PAP values were lower in the combined group (p < 0.05), no difference was recorded with regard to pH, PaCO(2), and PaO(2). The ratio between pre- and post-treatment mean PAP was highest in group 3(1.26 +/- 0.5) and lowest in group 2 (0.99 +/- 0.3, p < 0.001). The mean PAP recorded after discontinuation of the drug was lower than the baseline value in groups 1 and 3 (p < 0.05). CONCLUSIONS: The combination of milrinone and NO produced a more pronounced decrease in PAP than milrinone alone.

Blood Pressure↗

PubMed2004

Long-term beneficial effect of coronary artery bypass grafting in patients with COPD.

OBJECTIVE: This study assesses the impact of COPD on the long-term outcome of patients undergoing coronary artery bypass grafting (CABG). METHODS: Between 1991 and 1993, 37 patients (5.68%) undergoing CABG had significant clinical COPD. They were compared to 37 matched control subjects. RESULTS: The patients in the COPD group had worse preoperative pulmonary function. More patients in this group were smokers, had more symptoms of shortness of breath, and had more preoperative arrhythmia. A total of 13 patients died in the COPD group compared with 3 subjects in the control group during 8.6 +/- 2 years (mean +/- SD) of follow-up with arrhythmia being the major cause of death (62%). Actuarial survival at 9 years was 92% for the control group vs 65% for the COPD group (p = 0.005). The rate of readmissions during mid-term follow-up (13.8 +/- 7.2 months) was higher in the COPD group, and more patients in this group described their quality of life as worse than before the operation (37% vs 3%, p < 0.001). At late follow-up, all survivors in the COPD group had an improved quality of life. Cox regression analysis identified older age and lower FEV(1) as independent predictors of late death. Pulmonary function returned to baseline in the control group and improved to above baseline in the patients with COPD. CONCLUSIONS: Patients with significant COPD have a higher risk after CABG compared to patients without COPD. Nevertheless, when assessing the natural history of patients with COPD, it seems those who undergo CABG benefit from the operation.

Aged↗

PubMed2003

Preoperative use of enoxaparin is not a risk factor for postoperative bleeding after coronary artery bypass surgery.

BACKGROUND: The purpose of this study was to determine whether the use of low-molecular-weight heparin before coronary artery bypass surgery would be associated with an increase in bleeding and use of blood products after the operation. METHODS: Sixty-four patients (48 men and 16 women) aged 64 +/- 10 years who were undergoing primary coronary artery bypass surgery were prospectively studied. Forty-one patients were treated with either subcutaneous enoxaparin 1 mg/kg twice daily (n = 21; enoxaparin group) or intravenous heparin (n = 20; heparin group). Patients received the last dose of enoxaparin 8.7 +/- 0.75 hours (range, 8-10 hours) before skin incision. Heparin was stopped before transfer to the operating room. An additional 23 consecutive patients who received neither enoxaparin nor heparin served as controls (n = 23). Anti-factor Xa activity, a measure of enoxaparin and heparin activity, was measured at the start of the operation in all patients. RESULTS: There was no perioperative mortality. The length of stay and frequency of postoperative complications were similar between groups. Preoperative anti-factor Xa activity was present only in the enoxaparin group (0.43 +/- 0.25 IU/mL). Chest tube drainage at 24 hours was 553 +/- 160 mL, 532 +/- 140 mL, and 587 +/- 230 mL for the enoxaparin, heparin, and control groups, respectively (P =.48). There was no difference among groups in the amount of blood products transfused. CONCLUSIONS: Enoxaparin administration more than 8 hours before coronary artery bypass surgery is not associated with increased postoperative bleeding or blood product transfusion.

Aged↗

PubMed2003

Difficult laryngoscopy: incidence and predictors in patients undergoing coronary artery bypass surgery versus general surgery patients.

OBJECTIVE: Cardiac surgery patients might have a higher incidence of difficult laryngoscopy than the general population because of older age, dental problems, and obesity. The authors estimated the incidence and predictors of difficult laryngoscopy in coronary artery bypass surgery patients. DESIGN: Prospective, controlled study. SETTING: University setting. PARTICIPANTS: Patients undergoing coronary artery bypass or general surgery. INTERVENTIONS: Two hundred consecutive patients undergoing coronary artery bypass graft and 444 general surgery patients, all aged >40 years, were compared for the incidence and predictors of difficult laryngoscopy, defined as a grade III or IV view. MEASUREMENTS AND MAIN RESULTS: Predictors of difficult laryngoscopy were considered mouth opening <4 cm, limited cervical mobility, thyromental distance <6 cm, protruding or partially missing upper teeth, and Mallampati classes 3 and 4. More cases of difficult laryngoscopy were recorded in cardiac patients (10% v 5.2%, p <0.023). The cardiac patients were older, mostly men, and belonged to ASA III-IV risk classes. Mallampati classes 3 and 4 were more frequent in the control group. With univariate analysis, difficult laryngoscopy correlated with 7 variables: older age, ASA-IV risk class, protruding or partially missing upper teeth, limited mouth opening, limited neck movement, thyromental distance <6 cm, and diabetes mellitus. Multivariate analysis adjusted for propensity score identified older age (odds ratio = 1.05/yr, 95% confidence interval = 1.005-1.09, p < 0.03) and limited neck movement (odds ratio = 9.5, 95% confidence interval = 2.2-41, p < 0.003), but not cardiac surgery per se, as independent predictors of difficult laryngoscopy. CONCLUSIONS: Difficult laryngoscopy was more frequent in cardiac surgery patients (10% v 5.2%). Older age and limited neck movement, but not cardiac surgery per se, were independent predictors of difficult laryngoscopy.

Adult↗

PubMed2003

Effect of venom from the scorpion Leiurus quinquestriatus on rat vascular aortic rings.

The present study was designed to examine the effects of venom from the scorpion Leiurus quinquestriatus hebraeus (Lqh) on the contractility of rat aortic rings. We first examined the effect of Lqh venom on the contractile tension of isolated rat vascular aortic rings and then whether long-term exposure to the venom reduces the contractility of vascular smooth muscle by increasing the production of nitric oxide. Following the administration of 33 microg/mL of crude Lqh venom, contractile tension increased by 18.9 +/- 11.4 percent. The administration of 2.4 x 10(-7) M noradrenaline (NA) led to a 31.6 +/- 8.2 percent increase in tension (p < 0.01). The effects induced by NA and Lqh venom were similar and additive (p < 0.01). Pretreatment with the alpha-adrenergic blocker phenoxybenzamine (0.2 microM) eliminated the effect of the venom, whereas the calcium-channel blocker verapil (8.3 microM) merely attenuated the effect. Incubation of the rings with Lqh venom for 16 to 18 h, followed by NA stimulation, led to a 15 to 20 percent decrease in tension (p < 0.001). Treatment with N-omega-nitro-L-arginine methyl ester (110 microM), a constitutional nitric oxide inhibitor, restored the tension to control values. Treatment with S-methyl-isothiourea (0.1 microM), an inducible nitric oxide synthesis inhibitor, had no effect on contractile tension. The results of the present study suggest that the effect of Lqh venom on isolated aortic rings is induced via sympathetic nerve terminals. Calcium had little effect on the smooth muscle contractility of aortic rings incubated with the venom. No evidence was found to support nitric oxide synthesis after the long-term exposure of the rings to Lqh venom.

Animals↗

PubMedDate not supplied

Ruptured sinus of Valsalva aneurysm complicated by myocardial ischemia: pathogenetic mechanisms.

Significant left-to-right shunt in combination with severe aortic regurgitation (AR) accelerates the development of symptoms after rupture of congenital sinus of Valsalva aneurysm (SVA) in spite of intact coronary arteries. We depict a rare description of a situation where acute coronary syndrome was the first manifestation of such an occurrence. We believe that the progress of the myocardial ischemia after ruptured SVA depends on the severity of AR and the quantity of the left-to-right shunt. Prompt recognition and surgical repair are indicated to prevent complications of myocardial infarction.

Aortic Aneurysm↗