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M S Zabala

Publications and source records attributed to M S Zabala.

5 recordsLinked to original sources
PubMed1994

[Dynamic cardiomyoplasty. Preliminary experience].

INTRODUCTION AND OBJECTIVES: The purpose of this study is to show our experience in clinical dynamic cardiomyoplasty. PATIENTS, MATERIALS AND METHODS: Six patients with end-stage heart failure and 2 patients with left ventricular aneurysm underwent dynamic cardiomyoplasty using the latissimus dorsi muscle. The latissimus dorsi was electrically conditioned before the procedure through a lead placed under local anesthesia and connected to an external cardiac pace-maker. Surgical technique--including dissection of the latissimus dorsi and encircling of the ventricles with the muscle flap--was performed in general terms as described at the Broussais Hospital. In the first 3 patients a bipolar lead connected to a single impulse generator was used. In the other 5 patients a train of impulses cardiomyostimulator was used. Changes in systolic function were studied through Doppler-echocardiography and radionuclide studies. Changes in diastolic function were evaluated through E wave velocity and deceleration time. RESULTS: Mean follow up was 9 +/- 5.7 months. No early deaths were recorded. One patient underwent emergency surgery, one week after the procedure, because of a tear of the patch used to close the wall defect after left ventricular aneurysm resection. In 2 patients a subcutaneous serous collection secondary to muscle dissection was evacuated. One patient died due to a stroke 4 months after the procedure. Another patient died after an unsuccessful coronary transluminal percutaneous angioplasty 11 months after the procedure. An improved functional class was observed in all patients. No changes in systolic function were observed after surgery when the cardiomyoestimulator was turned-off either with echocardiography (26.7 +/- 8.6 vs 24.8 +/- 5.8% [NS]) or radionuclides (24.5 +/- 9.5 vs 20.2 +/- 8.3% [NS]). When the cardiomyostimulator was turned-on a statistically significant increase of the left ventricular ejection fraction was observed either with echocardiography (24.8 +/- 5.8 vs 37 +/- 10.3%; p < 0.05) or radionuclides (20.2 +/- 8.3 vs 33.3 +/- 12.2%; p < 0.05). This significant increase of the ejection fraction has been observed in subsequent studies. Nevertheless the differences when the cardiomyostimulator is turned-on and turned-off have decreased several months after the procedure. A significant increase of the left ventricular outflow velocity (cm/seg) was observed when the generator was turned-on (57.7 +/- 20.4 vs 75.1 +/- 17.8%; p < 0.01). A significant increase of the dP/dt (mmHg/seg) was observed when the generator was turned-on (706.3 +/- 291.5 vs 592.6 +/- 181.6%; [NS]). No significant changes were observed on E wave velocity. A significant decrease of the deceleration time was observed several months after the procedure (p < 0.05). CONCLUSIONS: We believe that dynamic cardiomyoplasty is a safe and valid surgical procedure for some patients with end stage cardiomyopathies as well as in association with Jatene's technique for the management of left ventricular aneurysms. An improvement in functional class is present and a significant increase of the left ventricular systolic function. Nevertheless it is necessary to find new systolic parameters, independent of volumetric calculations, to evaluate the mechanical support of the muscle as well as to determine the long-term pattern of electrical stimulation.

Adult↗
PubMed1993

[Study of colloidal osmotic pressure-total proteins--serum albumin relationship during and after extracorporeal circulation].

A postoperative increase in the pulmonary extravascular fluid volume (PEFV) and a disturbance of pulmonary gas exchange are regularly observed in patients undergoing cardiac surgery. These alterations, due to a reduction in the colloidal osmotic pressure (COP) increase the morbidity and mortality when crystalloid solutions are infused. This study was based on 90 patients infused with 1,500 cc of crystalloid solution without albumin. The COP, total proteins, albumin and globulin were determined in the plasma preoperatively, during bypass and immediately postoperatively, in order to define a formula allowing calculation of the COP from the plasma proteins to avoid reaching dangerously high figures. The authors concluded that there is a direct correlation between COP and total proteins (total proteins = 1.36 + 0.24 COP) and a potential curve with an adjustment point between COP and albumin (albumin = 0.23 COP0.93). Determination of the COP from globulins is not recommended. The authors elaborated two normograms for everyday clinical use. These formulae allow the calculation of COP in children, elderly subjects and patients in a critical condition, thereby avoiding dangerous levels of COP during infusion of crystalloid solutions.

Adolescent↗
PubMed1992

Dynamic cardiomyoplasty in a patient with end-stage cardiomyopathy.

Dynamic cardiomyoplasty is a relatively new surgical procedure by which a transformed fatigue-resistant skeletal muscle wrapped around the heart is stimulated to contract in synchrony with it, thereby augmenting the ventricular functions of a failing heart. We performed a cardiomyoplasty with latissimus dorsii (LD) in a patient who was refused the heart transplant programme because of pulmonary hypertension and psychosocial contraindications. The patient was 34 years old, functional class grade IV of the New York Heart Association (NYHA), with a three-month history, due to ischemic cardiomyopathy with multiple vessels affected, 10% ejection fraction, arteriolar pulmonary resistance of 7.5 U Wood. Cardiomyoplasty was performed after training the LD muscle for four weeks. One week later the pacemaker was programmed in a DDD mode: amplitude 3.75 V, pulse duration 0.50 ms, AV delay 175 ms. The patient reached functional class grade I-II (NYHA). Inotrope support was discontinued and great clinical improvement was noted. The ejection fraction rose from 10% to 30%. Echocardiographic left ventricular outflow tract velocity increased from 0.33 m/s to 0.60 m/s. These values were compared with radionuclide angiocardiography and echocardiography evaluations. The great clinical improvement and positive changes in left ventricular parameters suggest that cardiomyoplasty is useful in the treatment of some cases of dilated or ischemic cardiomyopathy as an alternative to heart transplantation. Long term follow-up is necessary to evaluate this procedure.

Adult↗
PubMedDate not supplied

The effects of colloidal and crystalloidal fluids on acidosis and lactacidemia in cardiopulmonary bypass.

During extracorporeal cardiac surgery it is difficult to measure the severity of metabolic acidosis thru arterial bloods gas determination. During bypass surgery a decrease in Colloidosmotic Pressure (COP) may influence the degree of acidosis. We studied 90 patients in whom the following parameters were measured before, 30 minutes after beginning bypass, immediatly after bypass, upon arriving bypass, upon arriving in the Intensive Care Unit (ICU) and upon discharge (ICU): pH, lactic, acid, pO2, pCO2, base excess correlating them with COP. There is a relation between COP and lactic acid, COP = 21.39-0.17 Lactic Acid, with p < 0.001. There is a inverse lineal correlation between COP and blood lactic acid levels. A greater COP was found with a lower blood lactic acid levels. We recommend the use of colloids perfusion as priming fluid instead of electrolytes solutions, specially in patients in extreme ages and also in those in whom a prolonged bypass time is foreseen. This may prevent an increase in blood lactic acid levels.

Acidosis, Lactic↗