The condition of 350 patients with Fallot's tetralogy (FT) who had palliative surgery (aortopulmonary shunt or transventricular valvotomy) was reviewed 10-25 years later: 136 patients (38%) are alive without any further operation, 106 (30%) have recovered completely, and 108 (31%) have died. Actuarial survival at 25 years of the patients who had palliation was 50% compared to 83% for the group who subsequently had complete correction. After the first five years the mortality rates became 5% per year. Of the patients who were not reoperated upon, 33% felt that the quality of their life was normal, 40% were limited, and 27% were severely limited. The older the patient at palliative procedure, the better the clinical course and the longer the interval before another operation, if the latter was needed at all. Of the patients who had a Brock procedure, the survival rate at 25 years was 80% and the clinical condition was good in 72% of the patients who had not been reoperated upon. Comparison with the natural history of unoperated FT reported by others indicates that the palliative procedures prolonged life in our series; mortality continued at a steady rate for a few years after palliative surgery, probably as a function of the severity of the anatomical and functional abnormality, and independently of the age at which the palliative procedure was performed. Among the palliative procedures, the Brock operation was followed by the best results both in relieving symptoms and in prolonging life.

Actuarial Analysis↗

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The De Vega tricuspid annuloplasty. Perioperative mortality and long term follow-up.

One hundred and fifty-three patients undergoing De Vega tricuspid annuloplasty, with or without other associated cardiac procedures between January, 1979, and June, 1987, were evaluated. There were 136 hospital survivors. The follow-up was 98.1% complete for a mean of 3.7 years/patient. Operative mortality was 11.1%; preoperative NYHA class and length of CPB were significant risk factors of perioperative mortality. The actuarial survival of operative survivors at 9 years was 73.5 +/- 11.8%. There were 7 late cardiac deaths among a total of 12 late deaths. Eleven patients required reoperation (2.1 +/- 0.6% patient-year). In seven patients it was necessary for recurrence of tricuspid regurgitation; six of these had also a mitral prosthesis malfunction or a periprosthetic leak. Residual tricuspid regurgitation was judged as mild, moderate or severe in 29.9%, 11.9% and 4.3% of the patients respectively. De Vega tricuspid annuloplasty is the method of choice for mild and moderate tricuspid insufficiency; in selected cases, with a more severe degree of regurgitation, better results could be achieved with a different surgical approach.

Adolescent↗

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Aortocoronary bypass results: a discriminant multivariate analysis of risk factors of operative mortality.

Clinical results of coronary artery bypass surgery have been evaluated analyzing operative mortality and its related risk factors. Four hundred and thirty seven consecutive patients undergoing coronary artery bypass surgery between January 1979, and December 1983, form the clinical material of this study. The gender of patients was male in 89% of the cases, the age ranged from 34 to 78 years with a mean of 54.8 +/- 8.2 (SD); patients with combined surgical procedures were excluded. The operative mortality was 5.49% (24 patients); no significant difference was found between years of the observation period. Death was due to cardiac causes in 75% of cases. Statistical analysis carried on 14 clinical, angiographic and surgical variables identified as significant risk factors of operative mortality age (p = 0.002) and cross-clamp time (p = 0.016). Both of these increased their weight when entered in a stepwise logistic regression. The EF also showed a value close to statistical significance (p = 0.06).

Adult↗

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The use of an artificial pericardium with a total artificial heart.

Postoperative adhesions following open heart surgery enhance the risks and increase the time of subsequent reoperation. When possible, primary closure of the natural pericardium is recommended, particularly in those cases that are more likely to be reoperated upon. The use of a total artificial heart (TAH) as a bridge to transplantation makes reoperation mandatory. If the pleura is left open to accommodate the ventricles, the risk of adhesion is considerable. To address this question, gluteraldehyde-fixed pericardial allografts were evaluated in calves undergoing TAH replacement. Eight animals were implanted with 3 different types of TAHs and survived from 12 to 108 days (mean 52.8 +/- 14.5). The pericardial substitute was wrapped around the TAH and the vascular grafts and cuffs. Two different surgical techniques were evaluated. At the time of autopsy, the presence of adhesions and gross epicardial reaction was macroscopically characterized and classified according to a standardized scale. Bacterial cultures were taken and tissue submitted for histology. The animals implanted with pericardial allografts for periods greater than 3 weeks were observed to have greater adhesions than those implanted for periods less than 3 weeks (p = 0.006). Pericardial cultures were negative in all cases and neovascularization and fibroplasia of the underlying tissues occurred in all cases. Leukocyte infiltration was minimal in the shorter term implant animals. Degeneration of a portion of the pericardium occurred in only 2 cases after 90 days. Minor calcification of the artificial pericardium was noted, but only in the longer term implant animals. The artificial pericardium reduced adhesion, thus facilitating reoperation in implants lasting up to a month.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

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Epidemiologic features of influenza in a large urban centre (B.) in Romania, in 1987.

The study presents the peculiarities of influenza evolution in 1987 in a large town in Romania. These features were defined by a complex methodology, based on clinical, epidemiologic and laboratory investigations, used in the active control of the epidemiologic process kinetics. The influenza viruses type A (H1N1 and H3N2) had a major role in the infecting and immunizing contacts in all age groups whereas the influenza virus type B had a reduced circulation. The epidemiologic influenza impact in 1987 is discussed from the point of view of the complex relationships between the antigenic structure of circulating influenza viruses and the anti-influenza immune profile of the population under the influence of extremely complex economic, social and natural factors.

Age Factors↗

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A pulmonary mock circulation model for a better understanding of protamine reversal of heparin.

Neutralization of heparin by protamine is a common procedure following extracorporeal circulation (cardiopulmonary bypass) of blood. Protamine administration has been shown to cause serious hemodynamic derangement in some patients. Obstruction of the pulmonary vascular bed following protamine administration has been suggested to be the primary cause of hemodynamic changes. The present study was undertaken to test the hypothesis that macromolecular complexes formed between cationic protamine with anionic heparin or other plasma components cause the obstruction of the vascular bed. An in vitro mock circulation model was designed to examine the formation of such complexes. In this model, blood or plasma was passed through a glass bead column at a constant flow rate while the pressure between the syringe pump and the column was closely monitored. No increase in pressure was noted when blood, plasma or saline alone or with added heparin were passed through the column. Addition of protamine to either blood or plasma resulted in a significant increase in the pressure; this increase was even greater when heparin was also present in the test medium. That the increase in pressure was due to the obstruction of the column was confirmed by using 1251-protamine and documenting that complexes formed between protamine and plasma proteins/heparin were retained in the column. These observations suggested that protamine formed large insoluble complexes with plasma proteins. Heparin appeared to help consolidate these complexes thus causing a rapid increase in the pressure. This may explain why the hemodynamic changes following protamine administration are more pronounced in patients with circulating heparin.

Blood↗

PubMedDate not supplied

The total artificial heart. A better model to study the hemodynamic effect of protamine.

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Animals↗