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Biomedical subjects

M Murtra

Publications and source records attributed to M Murtra.

At least 37 records · Page 2Linked to original sources

Direct non-invasive techniques for assessing coronary bypass graft patency.

Venous digital subtraction angiography (vDSA) and computed tomography (CT) are two non-invasive techniques that allow direct imaging of coronary grafts. Neither of them is 100% accurate when compared to selective angiography. We studied 52 patients with 107 coronary grafts (101 saphenous and 6 mammary artery grafts) by CT and vDSA. Fifty patients had control selective angiography and 2 had control digital arterial aortography. CT correctly diagnosed 88 of the 95 patent grafts and 8 out of the 12 occluded grafts (in 1 patient 3 patent grafts could not be well analyzed owing to artifacts from pacemaker wires). vDSA correctly identified 93 patent grafts and the 12 occluded grafts, allowing the correct diagnosis of the 11 non/or misdiagnosed CT grafts. CT allowed the correct identification of the 2 misdiagnosed vDSA grafts. These results show that when there was agreement between CT and vDSA there were no diagnostic errors and that the combination of these two non-invasive techniques may avoid selective angiography for studying coronary bypass graft patency.

Aged↗

Clinical performance of the omniscience prosthetic heart valve with Dacron sewing ring.

The Omniscience prosthetic heart valve has been clinically evaluated in 44 patients operated on between January and July, 1981. There were 23 aortic valve replacements (AVR), 18 mitral valve replacements (MVR) and 3 double valve replacements (DVR). Mean age was 48 +/- 11 years. Preoperatively, 61% patients were in New York Heart Association (NYHA) functional class IV, 36% in class III and 2% in class II. The hospital mortality rate was 4.5%. Actuarial freedom from thromboembolic events was 97.4 +/- 2.6% (3 1/2 years of follow-up). Postoperatively, 93% of the patients were in NYHA class I and 7% in class II. There were 7 cases of periprosthetic leak requiring reoperation (6 AVR, 1 MVR) for an overall incidence of 6.3% per patient year. In all these cases the causative factor was considered to be the Dacron sewing ring. All patients survived the reoperation. The actuarial survival rate was 93.9 +/- 5.9% for AVR and 93.7 +/- 6.1% for MVR. These data would suggest that the Omniscience prosthesis represents an acceptable device for heart valve replacement, except for the high incidence of periprosthetic leakage, related to the Dacron sewing ring. Recent modification of the valve-construction including a Teflon sewing ring may avoid the relatively high rates of periprosthetic leakage following implantation of this mechanical valve.

Acenocoumarol↗

Primary liposarcoma of the right ventricle and pulmonary artery: surgical excision and replacement of the pulmonic valve by a Björk-Shiley tilting disc valve.

A case of primary liposarcoma of the right ventricle and pulmonary artery is presented. The clinical picture, diagnostic studies, operative treatment and postoperative evolution are commented upon. Attention is drawn to the fact that this is the third case of liposarcoma of the heart to be operated upon, and the first needing pulmonary valve replacement. The literature related to this exceedingly rare primary neoplasm of the heart is reviewed.

Female↗

Right coronary artery - right atrial fistula and anomalous connection of the superior vena cava to the left atrium of latrogenic origin.

A case of coexisting right coronary artery--right atrial fistula and anomalous connection of the superior vena cava to the left atrium, both of iatrogenic origin is presented. The clinical evolution, angiographic and surgical findings and the surgical method used for the correction of this exceptional defect, which has so far not been reported, are presented and attention is paid to the uncommon pathogenesis of this case.

Adult↗

The Björk-Shiley tilting disc valve in the tricuspid position. 10-year experience.

Ten-year experience of tricuspid valve replacement with the Björk-Shiley pyrolytic carbon disc is reported. Of the twelve patients, one died in association with the operation, due to tracheo-oesophageal fistula. There were four late deaths, two from unknown causes, one during re-replacement of mitral valve and one from carcinoma of the urinary bladder. No patient had thromboembolism, valve thrombosis or subacute infective endocarditis. From the analysis of the hospital records and follow-up data it is concluded that the Björk-Shiley pyrolytic carbon disc prosthesis is a satisfactory substitute for the tricuspid valve.

Adult↗

Continuous sutures in replacement of mitral and tricuspid valves with prostheses.

Four years' experience with 363 patients, in whom 360 mitral and 65 tricuspid prosthetic valves have been implanted with single continuous sutures, is presented. The occurrence of prosthetic valve detachment is particularly discussed. There were 4 cases of detachment of the prosthetic mitral valve and no cases of tricupsid dehiscence. All 4 patients with detached valves required reoperation. Calcifications that penetrate into the annulus and myxomatous degeneration of the valve are considered more important factors in the production of prosthetic cases so long as a uniform distribution of stitches is maintained (not too close to each other) and excessive tension in the suture line is avoided.

Adult↗