Biomedical subjects

M J Janatuinen

Publications and source records attributed to M J Janatuinen.

4 recordsLinked to original sources

PubMed1991

Early and late results of aortic valve replacement. A series of 510 patients.

Aortic valve replacement was performed in 510 patients (Björk-Shiley valves in 93%), with concomitant surgical procedures in 146 cases. The patients were grouped according to technique of myocardial protection: Group I (n = 98) selective coronary perfusion, group II (n = 82) topical cooling, and group III (n = 330) cold crystalloid cardioplegia and topical cooling. The early mortality rate was 5.7% overall: Among patients with isolated aortic valve replacement in groups I, II and III it was 8.4, 1.7 and 1.3%, respectively, and among those with additional surgery 40.0, 12.5 and 8.4%. Myocardial infarction and low cardiac output were responsible for 65.5% of the early deaths. Follow-up ranged from 2 months to 16 11/12 years, totalling 2,859 patient years. In patients with isolated aortic valve replacement and Björk-Shiley prosthesis, the incidence of valve-related late complications/100 patient years was 0.49 for thromboembolism, 0.82 for anticoagulant-related haemorrhage and 0.49 for prosthetic valve endocarditis. There was no thrombotic encapsulation in aortic position. Survival at 5 and 10 years was 83% and 72%. Aortic valve replacement is a safe procedure and concomitant operations do not unreasonably increase risks.

Aortic Valve↗

PubMed1991

Prosthetic valve endocarditis.

Prosthetic valve endocarditis is an infrequent but serious complication of valve surgery. It occurred in 25 (3.2%) of 772 patients who received aortic, mitral or double valve replacement in 1971-1987. The total follow-up time was 3,976 patient years, giving an incidence of 0.63/100 patient years. Staphylococci were the most common of the cultured organisms in early and late infections-60% and 64%, respectively. The endocarditis was disclosed at autopsy in two cases. Treatment was antibiotics alone in 11 cases, and surgery was required in 12, the indication always being congestive heart failure. C-reactive protein level fell more rapidly than erythrocyte sedimentation rate in response to antibiotic or surgical management. The mortality rate was 73% in the antibiotic group and 33% in the surgical group. The findings demonstrated that an infected valve prosthesis should be replaced without delay if complications develop.

Anti-Bacterial Agents↗

PubMed1990

Surgical treatment of active native valve endocarditis.

A report is presented of 24 patients (23 male), mean age 38 years, who underwent surgery for active native valve endocarditis of the left heart in 1975-1988. The aortic valve was affected in all patients, and also the mitral valve in five. Pre-existing aortic valve disorder was present in 17 cases (13 congenitally bicuspid 4 rheumatic affection). There were five hospital deaths (20.8%). Staphylococci as causal organism and extensive infection predicted the highest mortality and morbidity. The mean follow-up time was 39.7 (range 2-114) months. Two reoperations because of prosthetic valve dehiscence revealed endocarditis of the implanted valve. Strong correlation was found between favourable postoperative course and rapid normalization of C-reactive protein levels, which did not fall in patients with persistent infection. Early surgery is recommended if the course of bacterial endocarditis is severely complicated.

Adult↗

PubMed1989

Surgical management of congenital aortic stenosis in children and young adults.

The surgical management of congenital aortic stenosis in 33 patients (age 2-20, mean 11 years) is described. The stenosis was valvular in 19 cases, subvalvular in eight and supravalvular in six. The primary procedures in valvular stenosis were valvotomy (12 cases), valve replacement (6) and exploration (1). Subvalvular stenosis was treated with resection of muscle (4), membrane (2) or both (2), and all six supravalvular lesions with patch aortoplasty. One death occurred during primary operation. Follow-up averaged 11.5 years. Of the 12 valvotomized patients, five required valve replacement after on average 10.6 years because of restenosis. Aortic regurgitation developed in six of the seven surviving patients treated for subvalvular stenosis, requiring reoperation in four. No mortality was associated with reoperation. All patients without valve replacement were reinvestigated. Of the seven with valvotomy, four had restenosis and three valves were in good condition. In supravalvular stenosis the gradients were low. Valvotomy and subvalvular resection can give effective palliation of aortic stenosis until the patient is old enough for definitive repair.

Adolescent↗