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Biomedical subjects

P Pomerantzeff

Publications and source records attributed to P Pomerantzeff.

10 recordsLinked to original sources
PubMed2000

Influence of the maze procedure on the treatment of rheumatic atrial fibrillation - evaluation of rhythm control and clinical outcome in a comparative study.

OBJECTIVE: The aim of this study was to evaluate the influence of the maze procedure on the treatment of rheumatic atrial fibrillation in patients with mitral valve disease. METHODS: Fifty-five patients (mean age 51 years; 47 females) with rheumatic mitral valve disease and associated atrial fibrillation in New York Heart Association functional class III or IV, preoperatively, were operated upon. Thirty-five had double dysfunction, 19 had stenosis, and one had mitral regurgitation. None had other associated heart diseases or previous operations. The patients were divided into two groups: GI, 20 patients were treated for mitral valve disease with associated maze procedure; GII, 35 patients were treated for mitral valve disease without the maze procedure. The preoperative echocardiogram showed a left atrial diameter in GI of 5.35 mm and in GII of 5.57 mm (P=0.779). The groups were considered clinically similar (P=0.759). Cardiopulmonary bypass was used in all patients. The mitral valve was replaced with a biological prosthesis in 24 patients and repaired in 31 patients. RESULTS: Three hospital deaths occurred, one in GI, two in GII. After cardiopulmonary bypass, 37.1% of patients in GII remained in atrial fibrillation. All patients in GI recovered regular rhythm (P<0.0001). In the ICU, atrial fibrillation was detected in 80% of patients in GII and maintained in 76.4% in a mean follow-up period of 38.5 months. In GI, atrial fibrillation occurred in 20% of patients in the ICU and maintained in 5.3% in 41 months of mean follow-up (P=0.0001). None of the patients in GI and 20.6% of patients in GII had a thromboembolic episode 1-63 months after the operation (P=0.041). Four late deaths occurred (two in each group), two being due to progression of valvular disease, one after an episode of pulmonary infection and one with no cardiac cause. CONCLUSION: The maze procedure is effective in treating atrial fibrillation in patients with rheumatic mitral valve disease. The results are sustained in the mid-term follow-up period, preventing postoperative thromboembolic episodes, and with acceptable morbidity and mortality.

Atrial Fibrillation↗
PubMed1995

[Preoperative erythrocytopheresis in a patient with SC hemoglobinopathy and mitral stenosis].

Hemoglobinopathies are associated with thrombotic complications, when exposed to cardiopulmonary bypass. A 54-year old, black woman with hemoglobinopathy SC and severe mitral stenosis was submitted to eritrocytopheresis 48 hours before mitral commissurotomy surgery. The therapeutic determined appearance of the percentual hemoglobin A of 68% with reduction the hemoglobin S of 48% to 15% and the hemoglobin C of 51% to 17%. No complications occurred during postoperative period. To best of our knowledge, that is the first report about application the eritrocytopheresis in the pre operative extra corporeal circulation care in surgical treatment of patients with chronic rheumatic heart disease and hemoglobinopathy SC.

Erythrocyte Transfusion↗
PubMed1995

[Postoperative course of left ventricular function in aortic insufficiency].

PURPOSE: To analyze the follow-up of left ventricular function (LVF) after surgical correction of severe chronic aortic insufficiency (AI). METHODS: Twenty-one out of 68 patients with AI, initially asymptomatic and that developed symptoms during the follow-up period of 24-36 months, were studied. Relationship between symptoms and LVF by echocardiogram and radioisotopic ventriculography at rest and in isotonic exercise were studied. Three clinical moments (CM) were assumed: CM-0- at the beginning of the study, when all patients were asymptomatic; CM-1- manifestation of the symptoms during 24-36 months; CM-2- corresponding to the late post-operative period of 8 months of 20 out of 21 patients (one refused the surgery). The analysis did not show any significant differences between the mean values of all echocardiographic variables (diastolic and systolic diameters, shortening fraction, final systolic stress, volume-mass ratio, contractility index) and the ejection fraction of the left ventricle (EF) obtained by the radioisotope ventriculography at rest and, including exercise, between clinical moments 0 and 1. RESULTS: In the CM-2, involution was verified for functional class I/II in all cases and absence of expressive complications or immediate or late postoperative mortality. Comparison between CM-2 and 0 showed expressive regression of the diameters at rest in the postoperative period and with significant improvement in the means mainly the percentual variation of the EF and total time of effort. CONCLUSION: Symptoms assembled patients with more advanced eccentric hypertrophy and did not coincide with any immediate change in findings studied at rest and at exercise. It represented a point of reference for surgical indication compatible with late postoperative involution of chronic adaptation of AI.

Adult↗
PubMed1994

[Acquired ventricular septal defect during infective endocarditis].

We studied five patients with acquired ventricular septal defect during the course of an infective endocarditis. All patients were male and had a previous aortic valve disease associated with an aortic ring abscess. Clinical examination was useful for the diagnosis of 4 cases, emphasizing the following findings: systolic murmur and/or left paraesternal thrill and right-heart failure. Incidence of congestive heart failure was 60%, while 40% of all patients died during the in-hospital course. No specific etiologic agent was detected. Therefore, acquired ventricular septal defect should be suspected in patients with infective endocarditis of the aortic valve that evolve with a systolic murmur and/or paraesternal thrill and right-heart failure. Immediate surgical treatment is mandatory in these cases.

Adolescent↗
PubMed1990

[Surgical intervention in patients undergoing a procedure for mitral valvoplasty by balloon catheterization].

PURPOSE: To study the characteristics of patients undergoing catheter-balloon mitral valvoplasty (CBVM) procedure who needed surgical intervention after CBMV. PATIENTS AND METHODS: One hundred and five patients submitted a CBMV were divided in to Group I (GI) of eighteen surgical patients and Group II (GII) of eighty-seven non-surgical patients. The following parameters were analyzed. 1) age; 2) sex; 3) mitral valve area (MVA) and mean transvalvular gradient (G) by echodopplercardiography (2D); 4) Character of CBMV; 6) Relation of time between CBMV and Surgery with surgical indication; 7) Surgical findings; 8) Surgical procedure and 9) Post-operative evolution. RESULTS: Mean age of 34 (17-56) years old in GI and 33 (15-69) years old in GII; 2) Similar distribution of men and women in GI and GII; 3) Similar MVA and G in GI and GII; 4) 100% of elective character in GI and 94% in GII; 5) Transseptal via in 17 (94%) of GI and 87 (83%) of GII, retrograde arterial via in 1 (5.5%) of GI and in another (1%) of GII; 6) immediate: cardiac tamponade (28%); until 30 days: unsuccessful CBMV (39%); mitral insufficiency (MI) post-CBMV (11%), cardiac tamponade (5.5%), between 30 and 60 days: MI post-CBMV (22%), Mitral restenosis post-CBVM (5.5%); 7) Mitral stenosis (72%), MI post-CBVM (22%), hemopericardium (6%); 8) Mitral Commissurotomy (7), Mitral bioprosthesis implant (5), Commissurotomy plus Atrioseptoplasty (1), Mitral plasty (1), Pericardium drainage (1); 9) One (5.5%) death in immediate post-operative of the MI correction, 17 (94%) in functional class I/II (NYHA) 14.3 (8-27) months after surgery. CONCLUSION: Age, Sex, VMA G and Urgency character were not discriminative factors in the formation of GI and GII. The procedures for CBVM didn't interfere with post-operative prognosis.

Adolescent↗
PubMed1990

[Cerebral malformation of the conceptus associated with maternal bacterial endocarditis and with aortic valve replacement during pregnancy].

A twenty-three years old woman, without previous heart disease developed endocarditis with negative bloods cultures on the fourth month of her third pregnancy. Fever was controlled through antibiotics, however she developed cardiac insufficiency and was submitted to surgery for replacement of aortic valve with a bioprosthesis. The post operative period showed no problems and the patient was discharged on the forty second day after admission. On the thirty ninth week of pregnancy she gave cesarean birth, without complications. The newly born, apgar 5 (1 min.) and 7 (5 min) presented signs of neurological problems, characterized on the second month as a cerebral atrophy. Among various possible factors, the most likely would be cardiopulmonary bypass circulation as the cause of the neurological malformation.

Adult↗