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Biomedical subjects

M Pasic

Publications and source records attributed to M Pasic.

At least 73 records · Page 4Linked to original sources
PubMed1994

Early and late results after correction for double-outlet right ventricle: uni- and multivariate analysis of risk factors.

Between April 68 and May 91, 59 patients underwent total correction for double-outlet right ventricle. The mean age was 59.2 +/- 7.8 months. The hospital mortality rate was 27%; it was 41% before 1980 and 13% thereafter. Low cardiac output failure was the leading cause of early death. Myocardial protection without cardioplegia and long cardiopulmonary bypass time were significant predictors of hospital mortality in univariate as well as in multivariate analysis. The late death rate was 7%. The actuarial survival rate was 67% (CL 55-80%) after 10 and 20 years. The reoperation rate was 42%, a loose VSD patch constituted the main indication (23%). The actuarial freedom from reoperation rate was 51% (CL 33%-69%) after 10 years and 31% (12%-50%) after 20 years. The mean follow-up time was 8.4 +/- 0.9 years (2 to 20 years). Seventy-five percent of all postoperative survivors are in NYHA functional class I and left ventricular ejection fraction is normal in 82%.

Adolescent↗
PubMed1994

[Descending thoracic aorta: an excellent inflow source for recurrent revascularization of the lower limbs].

Although severe complications after anatomic reconstruction of the abdominal aorta are unusual, when they occur, a different strategy is required to treat the patient with success and a distinct operation is generally required for a durable favourable long term outcome. Late complications after abdominal aortic grafting include prosthetic infection, enteric erosion and graft thrombosis. Treatment by resection of the infected graft and extra-anatomic reconstruction with axillary-femoral or axillary-popliteal bypass leaves the patient with an unreliable arterial inflow for his lower extremities; in those patients who survive graft removal and extra-anatomic bypass, an alternative source of major arterial inflow should at least be discussed to effect a permanent repair. The descending thoracic aorta has been described as an ideal inflow source for definitive intracavitary conversion of extra-anatomic subcutaneous bypasses and as an occasional alternative to avoid a densely scarred abdomen or retroperitoneum. Our experience with 8 patients includes 7 in whom the aorta had been overseen below the renal arteries in a previous operation [after removal of infected graft (n = 4) and after repair of aorto-enteric fistula (n = 3)]. Our technique of primary extra-anatomic reconstruction consists of a right-sided axillo-femoral (-popliteal) bypass with femoro-femoral crossing graft. This method avoids tunneling an extra-anatomic graft in the left thoraco-abdominal region, thus facilitating the definitive repair. Preoperative radiographic evaluation of inflow and outflow details is essential in these complex cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Thoracic↗
PubMed1993

[Bullet embolism. Case report and literature review].

Migratory intravascular bullets may produce confusing clinical pictures in patients with gunshot wounds. We report on a patient in whom the missile entered the right chest at the fourth intercostal space in the anterior axillary line. The bullet was finally found in the abdominal aorta. The penetration site remained unclear but was probably the heart. After repair of the chest wall the bullet was successfully removed from the aortic bifurcation.

Adult↗
PubMed1993

[Hemodynamic effects of the implantation of an intracaval oxygenator].

Treatment of severe respiratory failure by extracorporeal membrane oxygenation (ECMO) is complex. However, there is now an intravascular gas exchanger (IVOX) available that provides extrapulmonary gas transfer without requiring an extracorporeal blood path. The present study was performed to determine the hemodynamic effects resulting from the intracaval placement of the intravascular device. A bovine model (n = 6; body-weight = 72 +/- 5 kg) was selected for temporary lung support with the intravascular device. The latter was placed in the caval axis under fluoroscopic control after full instrumentation of the animal for hemodynamic measurements including a pulmonary artery catheter for determination of cardiac output by thermodilution and continuous readout of mixed venous oxygen saturation. All measurements were taken after a stabilization period of 15 min. The heart rate moved from 65 +/- 8 before to 72 +/- 10 after implantation and 68 +/- 9 after onset of intravascular gas exchange (NS). Right atrial pressure was 13 +/- 3 mm Hg before, 12 +/- 3 mm Hg after implantation and 10 +/- 3 mm Hg after onset (NS) whereas femoral venous pressure moved from 14 +/- 3 mm Hg to 17 +/- 4 mm Hg (p < 0.05) and remained at 17 +/- 4 mm Hg after onset. Cardiac output was 5.3 +/- 0.7 l/min before, 5.4 +/- 0.7 l/min after implantation and 5.3 +/- 1.1 l/min after onset (NS) while mixed venous oxygen saturation dropped from 60 +/- 7% to 54 +/- 11% and moved to 57 +/- 11 after onset of the device (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Sternal cleft associated with vascular anomalies and micrognathia.

Sternal defects combined with craniofacial vascular defects are rare. We report on a 45-year-old woman with a sternal cleft associated with craniofacial and brain hemangiomata, an aneurysm of the aortic arch, anomalous origin of the coronary arteries, a left superior vena cava, micrognathia, supraumbilical midline raphe, and a cervical cyst. The surgical procedure consisted of the resection and replacement of the aortic arch and the innominate artery with reimplantation of the left carotid artery into the graft under circulatory arrest and deep hypothermia. The presence of sternal cleft is an indication for the search for other asymptomatic internal vascular anomalies.

Abnormalities, Multiple↗
PubMed1993

Reoperations after operation on the thoracic aorta: etiology, surgical techniques, and prevention.

Recurrent aortic aneurysms, persistent or new dissection, new onset of valvular and coronary artery disease, graft infection, and prosthetic endocarditis are not rare after thoracic aortic operations; they can be difficult to diagnose and represent a formidable surgical challenge. Between 1977 and 1991, 876 operations were performed on the thoracic aorta in our institution: 340 in dissections, 299 in true aneurysms, 150 for aortic remodeling and external wall support during aortic valve replacement, and 87 for miscellaneous causes. During the same period, there were 193 additional reoperations. Vascular reoperations on abdominal aorta and peripheral arteries accounted for 73 cases and are not further discussed in this study. The reasons for reoperation (n = 130) in 120 patients were: failure of biologic valves (n = 23); aneurysm recurrence in a proximal or distal aortic segment (n = 21); pseudoaneurysm formation at suture lines (n = 13); new dissection or dilatation involving ascending aorta (n = 11), aortic arch (n = 13), and descending aorta (n = 10); aneurysm after aortic remodeling (n = 13); new onset of valvular disease (n = 5); and new onset of coronary disease (n = 5). Infected aortic graft and prosthetic endocarditis accounted for 10 reoperations, and a planned two-staged procedure was performed in 6 patients. Omitting the failed biologic valves, reoperations were performed on the aortic segment previously operated on in 69.3% of the cases and on other thoracic segments in 30.7%. Overall hospital mortality rate after reoperation was 5.8%. A significant decrease in operative mortality was observed in the most recent period (3.0% between 1989 and 1991). Reoperations are technically demanding, and some of them are preventable; therefore (1) graft inclusion technique should be abandoned in ascending aortic operation due to formation of false aneurysms; (2) in patients with Marfan syndrome, complete repair of the diseased aorta should be attempted during the initial operation; (3) aortic arch dissection should be repaired definitively during the first operation in low-risk patients; (4) biological valves should be avoided in aneurysm operations; and (5) homograft replacement is the treatment of choice in prosthetic endocarditis or in infected composite graft after an aortic valve or ascending aortic operation.

Actuarial Analysis↗
PubMed1993

Retrograde ascending aortic dissection: a diagnostic and therapeutic challenge.

Aortic dissection with an entrance tear in the transverse aorta is generally considered to have the highest acute fatality rate of any type of dissection and the direction of its extension is the most difficult to predict. In a prospective study, we evaluated 61 consecutive patients (mean age 56.7 years, ranging from 21 to 75 years), presenting with ascending aortic dissection during a 36-month-period and tried to clarify the incidence of retrograde ascending aortic dissection. In 49 patients (80.3%), the intimal tear was located in the ascending aorta, whereas the dissection originated in the transverse aorta in 12 patients (19.7%); in this latter group, extension was strictly retrograde in 5 patients and in both directions in 7 patients. Three patients died before operation; 58 patients underwent aortic replacement/repair under moderate hypothermia; if the primary tear extended into the transverse aorta or was not found in the ascending aorta, the aortic arch was explored during a brief period of deep hypothermic circulatory arrest. The overall operative mortality was 12.1% (7/58); it was 10.4% (5/48) in ascending aortic dissection and 20% (2/10) in dissection of the transverse aorta. Age (P < 0.005), concomitant coronary artery disease (P < 0.01) and the site of intimal tear (P < 0.01) were significant predictive factors of operative risk. A tear in the transverse aorta is almost always associated with retrograde dissection and may simulate dissection with the entrance tear in the ascending aorta. Localization of the entrance tear remains a diagnostic challenge in aortic dissection but Doppler-echocardiography had a high sensitivity in this series (96.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The warm versus cold perfusion controversy: a clinical comparative study.

To evaluate the effects of temperature on myocardial and total body protection, we analyzed 129 consecutive patients who underwent coronary artery bypass grafting, valve replacement, or both, with continuous cardioplegia (Cp). The patients were assigned to three groups: group I (n = 37) normothermic cardiopulmonary bypass (CPB) (37 degrees C) and warm (37 degrees C) Cp, group II (n = 49) normothermic CPB and cold (4 degrees C) Cp and group III (n = 43) hypothermic (28 degrees C) CPB and cold Cp. Comparison of groups I and II showed similar serum levels of creatine kinase (CK) and its myocardial-specific isoenzyme on the first postoperative day, a similar rate of perioperative myocardial infarction, postoperative need for intra-aortic balloon pump, postoperative need for inotropic support and mortality. Comparison of groups I and III showed similar serum levels of CK, amylase, lactate dehydrogenase and creatinine on the first postoperative day, a similar complication rate and mortality rate. However, normothermic CPB resulted in a shorter bypass time (83 +/- 4 vs 98 +/- 7 min, P < 0.05) and interval until extubation (25.0 +/- 3.8 vs 40.3 +/- 7.4 h, P < 0.05). In conclusion, there are no differences concerning myocardial protection, however, warm CPB shortens the perfusion time and postoperative course.

Coronary Artery Bypass↗
PubMed1993

Steal syndrome after internal mammary artery bypass grafting--an entity with increasing significance.

Stenosis of proximal subclavian artery (SCA), malformations of the internal mammary artery (IMA) at its origin, or large IMA side branches may cause myocardial ischemia due to blood-steal through a patent IMA graft. Thirty-one cases of postoperative steal syndromes have been reported in the literature, 23 due to proximal SCA stenosis, seven due to large IMA side branches and one due to an IMA malformation. We report two additional cases and discuss them in conjunction with the cases in the literature. Thirty patients suffered from recurrent angina pectoris, three had asymptomatic reversal of flow in the IMA as diagnosed by coronary angiography during routine follow-up examination. Carotid-subclavian bypass grafting is the treatment of choice for the management of proximal SCA stenosis. IMA malformations or large side branches are treated by interruption of the responsible vessel, either by ligation or by transarterial catheter embolization. In 82% (27 of 33), steal syndrome could have been prevented by preoperative angiography of the IMA. We advocate it as a routine procedure in combination with coronary arteriography.

Humans↗