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Biomedical subjects

M F Mattei

Publications and source records attributed to M F Mattei.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Surgical result of 48 Bigelow myotomies for obstructive myocardiopathy].

Bigelow's myotomy is one of the surgical options available for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). The results of this operation were analysed in 48 cases operated between 1965 and May 1983. The average age of the patients was relatively low (38 years) but preoperative symptoms were severe (34 patients in Class III and 6 patients in Class IV of the NYHA Classification). The diagnosis was confirmed in all cases by echocardiography, carotid pulse tracings and cardiac catheterisation. 28 patients had associated lesions including 21 cases of mitral regurgitation (minimal in II cases, moderate in 6 cases and severe in 4 cases). All patients underwent Bigelow myotomy which was associated with a complementary procedure in 9 cases (including 2 mitral valve replacements and 2 semi-circular annuloplasties). The hospital mortality was 6 patients; surgical morbidity resulted from permanent intraventricular conduction defects (27 cases). At long-term, 3 more patients died, 2 from cardiac causes. Of the remaining 39 patients followed-up for an average of 32 months, functional improvement was marked, except in very advanced stages of the disease (Class IV) or forms with severe or uncorrected mitral regurgitation. The indications for Bigelow myotomy are discussed with reference to three parameters of HOCM (intraventricular pressure gradient, mitral regurgitation, decreased left ventricular compliance). This procedure has a beneficial effect on the subaortic stenosis and left ventricular compliance. It should be completed by mitral valve surgery in patients with significant regurgitation.

Adolescent↗
PubMed1984

[Heart transplantation. Experience at La Pitié hospital. Apropos of 82 cases].

Since 1968, 320 patients with severe irreversible myocardial failure, have been referred to our department for transplantation; 78 p. 100 had dilated cardiomyopathies; 14 p. 100 had ischaemic heart disease and 8 p. 100 had valvular heart disease. One hundred and five patients had absolute contra-indications and were excluded (pulmonary hypertension, diabetes, gastro-duodenal ulcer, age, or other major organic disease). Of the remaining 215 patients, only 82 were transplanted because of the limited number of available donor hearts. The most commonly used technique was orthotopic grafting as described by Lower and Shumway; Barnard's method of heterotopic grafting was used in 1 case and a block heart and lung transplantation by Reitz and Shumway's method was performed in 3 cases. The main postoperative complications, apart from technical problems (7 deaths), were related to rejection (107 episodes, 27 deaths), infection (82 episodes, 13 deaths), atherosclerosis of the graft (4 cases, 2 deaths, 1 retransplantation) and malignant tumours (3 deaths). After transplantation, 82 p. 100 of patients were discharged after an average hospital stay of 2 months; 47 p. 100 survived the first year and lead almost normal socio-professional activities. Thirty patients are still alive, the longest postoperative survival being 9 years. Significant advances have been made in the last 3 years. Classical immuno-suppressor therapy (steroids, azathioprine, horse antilymphocytic serum) has given way to more effective antilymphocytic sera and more powerful immuno-suppressor drugs (cyclosporine A). This treatment has greatly changed the postoperative course of events. Rejection phenomena, though still as common, are much less serious and, above all, more insidious.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Heart transplantation. Current status at La Pitié Hospital].

Since 1972, 280 patients with severe irreversible myocardial damage have been referred to La Pitié Hospital, Paris, for heart transplantation; 95 were excluded on account of absolute contra-indications. Owing to the limited number of available transplants, only 66 of the 185 remaining patients were transplanted. Transplantation was orthotopic in all but 3 cases: 1 patient had heterotopic transplantation and 2 had heart-lung transplantation. The most common post-operative problems were graft rejection and complications of the immunosuppressive treatment; 82% of the transplanted patients were discharged 2 months on average after surgery; 47% overcame the first year problems and resumed an almost normal social and professional life; 21 are still alive, one of them after 9 years. During the last 2 years, technical refinements and the advent of more potent immunosuppressive agents (anti-lymphocyte serum from rabbits, cyclosporin A) and better diagnostic methods (repeated endomyocardial biopsies and immunological surveillance) have resulted in considerable improvement in the patients' outcome, with an actuarial survival rate of 77% at one year and 70% at two years. Since transplants are now better tolerated after the second year and since they possess remarkably good and durable functional properties, this reduction in early and late mortality, which used to be the main cause of failure, raises hopes of a marked increase in prolonged and satisfactory survival.

Cardiomyopathies↗
PubMed1983

[Heart transplantations. Current status. Experience at the Hôpital de la Pitié].

The experience gathered over the last fifteen years of clinical application of heart transplants has resulted, in the last two years, in much improved results:the survival in our series is 77% at one year and 70% at 2 years. This progress is due to the following factors:improved patient selection, with strict respect of contraindications, in particular, patients over the age of 50 and patients with advanced multi-system failure; improved selection of donors, avoiding, within the limitations of immunological compatibility, grafts in poor condition from subjects over the age of 35 and a refinement of the operative techniques, especially the introduction of more potent immuno-suppressants such as Cyclosporin A and improved post-operative monitoring based on immunological examinations and repeated endo-myocardial biopsies. These advances will lead to a broadening of the operative indications and a wider use of this form of treatment.

Adolescent↗
PubMed1983

[Recurrence of mitral disease after commissurotomy. Criteria influencing operative mortality during reintervention using extracorporeal circulation].

Reoperation for secondary deterioration after mitral commissurotomy is associated with a higher immediate postoperative mortality than other open heart operations. We analysed the factors responsible for this increased mortality. A total of 232 patients reported for clinical deterioration after closed heart mitral commissurotomy were reviewed. Mitral valve prostheses were implanted in 202 cases; open heart commissurotomy was possible in 30 cases. Associated procedures included 14 tricuspid valve replacements, 53 tricuspid annuloplasties and 30 aortic valve replacements. The global mortality was 12 p. cent (30 deaths). The causes of death were myocardial failure (19 cases), cerebrovascular accidents (4 cases), prosthetic valve thrombosis (4 cases), infection (2 cases), section of the mitral annulus (1 case). The clinical hemodynamic and anatomical criteria influencing the operative prognosis were analysed: 1. Operative mortality was related to the clinical stage (zero mortality at Stage II, 10,3 p. cent at Stage III, 38 p. cent at Stage IV, p less than 0,001); 2. There was a significant correlation with cardiothoracic ratio: 23 p. cent mortality when greater than 0,60; 9,8 p. cent mortality when less than 0,60 (p less than 0,02); 3. There was a significant correlation with cardiac index: 19 p. cent mortality when less than 21; only 9 p. cent mortality when greater than 21 (p less than 0,04); 4. There was a significant correlation with systolic pulmonary arterial pressure: mortality of 11 p. cent when less than 60 mmHg; mortality of 22 p. cent when greater than 60 mmHg (p less than 0,06). 5. The presence of tricuspid regurgitation increased the operative risk (mortality rose from 12 to 22 p. cent, p less than 0,05) when the surgeon detected moderate or severe tricuspid regurgitation. These results show that the clinical, radiological and hemodynamic aggravation of these patients has a bad influence on operative mortality. This aggravation is not related to the delay between the initial commissurotomy and reoperation but to the delay between the recurrence of symptoms after the first operation and reoperation. Operative mortality was 12 p. cent when this delay was less than 10 years but 23 p. cent when the delay was over 10 years (p less than 0,02). Our findings suggest that these patients should be reoperated earlier if the prognosis of this type of surgery is to be improved.

Adolescent↗
PubMed1983

[Value of C-reactive protein in the cardiac postoperative period].

Twenty patients underwent special clinical and biological monitoring during their period of hospitalisation in the Department of cardiovascular surgery. The clinical monitoring concentrated on the patient's temperature and the search for postoperative complications; the biological part of the study was concerned with monitoring the levels of serum C-Reactive protein (CRP) as assessed by an immuno-nephelometric method. In 10 patients with a normal postoperative course the levels of this protein, an indicator of an inflammatory or infective process, were similar, giving an identical graph in all patients. On the other hand, in the 10 patients with inflammatory or infective postoperative complications, the levels of CRP were abnormal, parallel with the clinical state, sometimes rising even before the complication manifested itself clinically. It therefore seems useful and justified to measure CRP systematically, once before surgery and at least once daily in the postoperative period. The frequency of this investigation could be increased in patients with difficult or complex postoperative courses. A high CRP, even with a normal temperature, should alert the surgeon to a complication or to the inefficacy of anti-inflammatory or anti-infective therapy. These results confirm those published by other surgical teams, both in cardiovascular surgery and traumatology.

C-Reactive Protein↗
PubMed1979

[Results of open heart mitral commissurotomy in 85 patients].

Open heart mitral commissurotomy was performed in 85 patients between January 1973 and January 1976. This series comprised 38 patients with pure mitral stenosis and 47 patients with associated mitral and aortic or tricuspid lesions. Mitral commissurotomy, always complete, was associated with correction of mitral incompetence, either preexisting or peroperative, in 19 cases; in 44 cases with correction of an aortic lesion and in 10 cases with correction of a tricuspid lesion. The surgical mortality was 2.3 p. 100 (2 deaths); one post-operative myocardial infarction and one spontaneously regressive post-operative jaudice was observed. No cases of post-operative systemic embolism was observed. A short apical systolic murmur was detected in 12 cases. The results of this series together with those already published suggest that the indications of this operation should be widened and that it should be employed whenever the best immediate anatomical result and long-term prognosis are desired.

Adolescent↗
PubMed1979

[Retrospective study of recent variations in patient recruitment for aorto-coronary bypass surgery and the prognostic significance of new therapeutic propositions].

Seventy four records of aorto-coronary bypass surgery have been examined. Three groups were made up, succeeding each other in time, characterised by changes in factors of gravity, therapeutic solutions and early clinical results. Five patients underwent peroperative haemodynamic assessment in order to attemps to define the role of nitroglycerine used during this period. The results obtained were such that it is reasonable to suspect the existence of potentialisation of therapeutic benefits under the influence of nitroglycerine for injection, in patients previously treated with beta-inhibitors.

Coronary Artery Bypass↗
PubMed1978

[Aneurysm of Valsalva's sinus, apropos of 7 surgical cases[].

The authors describe 7 cases of rupture of the Valsalva sinus. Until rupture the aneurysm is silent. Aortic insufficiency and left to right shunt are major components of this syndrome. Surgical treatment under extra-corporal circulation needs aortotomy and an approach of the ruptured extremity to close the defect and maintaining the integrity of the valvular structures.

Adolescent↗
PubMed1978

[Pseudoaneuysms of the heart after myocardial infarct. Apropos of 5 operated cases].

The authors base themselves on 5 personal cases and a review of the literature to summarise the clinical and paraclinical features of false aneurysms of the heart. The clinical features differ from those of true aneurysms only slightly. It is only arteriography, which shows up the collar and the slow evacuation of the cavity, which makes the real distinction and argues in favour of operation. The results of surgical treatment have been satisfactory, especially considering the natural outcome, which is always death from rupture.

Aged↗