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Biomedical subjects

P Y Litzler

Publications and source records attributed to P Y Litzler.

12 recordsLinked to original sources
PubMed2004

Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis.

OBJECTIVES: This study was done to assess the results of percutaneous heart valve (PHV) implantation in non-surgical patients with end-stage calcific aortic stenosis. BACKGROUND: Replacement of PHV has been shown to be feasible in animals and humans. We developed a PHV composed of three pericardial leaflets inserted within a balloon-expandable stainless steel stent. We report the acute and early follow-up results of the initial six PHV implantations. METHODS: An anterograde approach was used in all cases. The PHV, crimped over a 22-mm diameter balloon, was advanced through a 24-F sheath from the femoral vein to the aortic valve and delivered by balloon inflation. Clinical, hemodynamic, and echocardiographic outcomes were assessed serially. RESULTS: All patients were in New York Heart Association functional class IV. The PHV was successfully delivered in five patients. Early migration with subsequent death occurred in one patient who presented with a torn native valve. Acute hemodynamic and angiographic results showed no residual gradient, mild (three patients) or severe (two patients) aortic regurgitation, and patent coronary arteries. On echocardiography, the aortic valve area was increased from 0.5 +/- 0.1 cm(2) to 1.70 +/- 0.03 cm(2) and the aortic regurgitation was paravalvular. Marked and sustained hemodynamic and clinical improvement was observed after successful PHV implants. The first three patients died of a non-cardiac cause at 18, 4, and 2 weeks, respectively, and the other patients are alive at 8 weeks with no signs of heart failure. CONCLUSIONS: Implantation of the PHV can be achieved in patients with end-stage calcific aortic stenosis and might become an important therapeutic option for patients not amenable to surgical valve replacement.

Aged↗
PubMed2001

[Acute traumatic rupture of the thoracic aorta and its branches. Results of surgical management].

STUDY AIM: The aim of this retrospective study was to report a series of 102 patients with acute traumatic rupture of the thoracic aorta and its branches (TRA) and to evaluate long-term results. PATIENTS AND METHODS: From April 1977 to April 2000, 102 patients with RTA were admitted to our unit. Age ranged between 12 and 74 years (mean age: 33 years). Localisation was: ascending aorta (n = 3), aortic arch (n = 1), isthmus (n = 92), descending aorta (n = 1), innominate artery (n = 3), and left subclavian artery (n = 2). Associated injuries mainly included craniocerebral lesions (n = 76), rib fractures (n = 68), and thoracic (n = 38), and abdominal (n = 24) lesions. Average time between trauma and surgery was 37 hours. Aortography was used routinely for diagnosis. Five patients were inoperable; the procedure was delayed in three patients. In all but two patients with rupture of the isthmus, descending aorta and subclavian artery, the operation included venous arterial femorofemoral assistance. Rupture was partial in 37 patients (37 direct sutures), and complete in 55 patients (40 direct sutures). In two cases of left subclavian artery desinsertion, the operation included suture of the aortic tear and reimplantation of the artery. In patients with rupture of the ascending aorta and aortic arch, surgery was carried out under cardiopulmonary bypass with deep hypothermia for aortic arch rupture. Repair consisted of direct suture. In patients with rupture of the innominate artery, the lesion was treated under cardiopulmonary bypass by direct suture. In five cases, abdominal injuries required emergency procedure before aortic repair. RESULTS: Four patients died. No postoperative paraplegia occurred. The high morbidity rate was in relation to the associated injuries. Among the 93 survivors, the aortic clinical status was satisfactory in 91 patients (two patients were lost to follow-up). Two patients died from cancer and myocardial infarction 2 and 7 years later respectively. One patient had prosthetic sepsis and was reoperated on with homograft. Angiographic control by aortography (n = 60) and angioMRI (n = 22) was normal in 76 patients. There were five stenoses at the level of the prosthesis, four with a gradient < 20 mmHg and one with a gradient > 50 mmHg and one aneurysm at the level of the isthmus. These last two patients were reoperated on with good result. CONCLUSION: RTA remains a surgical emergency with multiple difficulties. Despite the development of new imaging modalities, angiography remains the gold standard for the work-up of these patients. Venous arterial femorofemoral assistance with a pump remains the best procedure in order to avoid paraplegia and vascular prosthesis implantation when possible. Endovascular stent graft insertion, although still under investigation, holds tremendous promise for non-surgical treatment of these patients.

Accidents, Traffic↗
PubMed2001

Myocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long term follow-up in 141 patients.

OBJECTIVES: The present study evaluates our experience with coronary bypass grafting in patients with EF < or =25%. Myocardial revascularization in this setting remains controversial because of concerns over operative mortality and morbidity and lack of functional and survival benefit. MATERIALS AND METHODS: One hundred and forty-one patients with coronary artery disease and left ventricular ejection fraction < or =25% underwent coronary artery bypass graft between January 1988 and December 1998. Mean age at operation was 63.3 years and 81.4% were male. The major indication for surgery was angina (114 patients, 80.8%). Ejection fraction (EF), left ventricular end diastolic pressure (LVEDP) and cardiac index (CI) were used to assess left ventricular function. The number of graft was 2.7+/-1.6/patient. Internal mammary artery was used in 119 patients (84.3%). Intra aortic balloon pump was placed preoperatively in 25 patients (17.7%). Five operative risk factors were associated with a higher mortality: emergency, female sex, LVEDP, CI and NYHA class IV. RESULTS: The operative mortality was 7% (10 patients). Left ventricular ejection fraction (assessed post operatively in 83 patients) improved from 22.2% preoperatively to 33.5% post operatively (P<0.001), mean end diastolic volume index fell from 98 to 83 ml/m(2) following surgery. Survival at 2, 5 and 7 years was respectively 84+/-3%, 70+/-4% and 50+/-5%. Two variables were associated with increased long term survival: congestive heart failure (NYHA class lower than IV (P=0.035) and cardiomegaly (P=0.04) CONCLUSION: In patients with left ventricular dysfunction, myocardial revascularization can be performed relatively safely with good medium term survival and improvement in quality of life and in left ventricular function. Coronary artery bypass graft may be offered to patients with impaired ventricular function, but careful patient selection and management when considering these patients for operation should assess potentially reversible dysfunction.

Adult↗
PubMed2000

Coarctation of the aorta in adults: surgical results and long-term follow-up.

BACKGROUND: The aim of this retrospective study was to determine the impact of coarctation surgical repair on arterial blood pressure in adults more than 20 years of age. METHODS: Thirty-five adults (23 men), mean age 28.1 +/- 5.7 years (range, 21 to 52 years), underwent coarctation surgical repair between 1977 and 1997. All patients had preoperative hypertension. Mean systolic blood pressure was 178 +/- 37 mm Hg (range, 110 to 230 mm Hg). Thirty-three patients were taking at least one hypertension medication at the time of operation. All patients had preoperative catheterization and angiography (mean gradient across the coarctation was 62 +/- 27 mm Hg [range, 32 to 130 mm Hg]). Operative technique was resection and end-to-end anastomosis for 30 patients, resection with Dacron (C. R. Bard, Haverhill, MA) graft for 4 patients, and a prosthetic bypass graft for 1 patient. There were no hospital deaths and no late morbidity. RESULTS: All patients were reviewed. Follow-up was 165 +/- 56 months (range, 25 to 240 months). Of the 35 patients with preoperative hypertension, 23 were normotensive (systolic blood pressure < or = 140 mm Hg, diastolic blood pressure < or = 90 mm Hg) with no medication. Twelve patients were receiving medication: 6 required single-drug therapy and 6 patients required two drugs. Exercise testing was performed at an average of 6 +/- 4 months after repair and revealed hypertensive response to exercise in 8 of the 23 patients who were normotensive at rest and without medication. There were no recoarctation or repeat operations. Six aortic valve diseases were observed: three aortic incompetences (two bicuspid valves) treated by two valve replacements and one Bentall procedure, and three aortic stenoses (two valve replacements). No patient had evidence of a cerebrovascular accident. CONCLUSIONS: Surgical repair of coarctation in adults has proved to be an effective procedure and significantly reduces arterial hypertension. However, long-term surveillance is mandatory and should include exercise testing to identify patients with potential hypertension.

Adult↗
PubMed1999

Bacterial resistance of refrigerated and cryopreserved aortic allografts in an experimental virulent infection model.

PURPOSE: The bacterial resistance of refrigerated and cryopreserved aortic allografts in a highly virulent infection in a dog model was studied. METHODS: The infrarenal aorta of 12 dogs was replaced with either a cryopreserved aortic allograft (group I, n = 6) or a refrigerated aortic allograft (group II, n = 6) in infected sites. Allografts were harvested from dogs and stored for 1 week, either by cryopreservation (-140 degrees C) or refrigerated method (4 degrees C), in a preservation medium. At the time of implantation, induction of infection was achieved with an infected piece of knitted Dacron placed just beneath the allograft. The Dacron was contaminated in vitro by soaking it in a solution with Staphylococcus aureus PR209. All 12 dogs received no adjunct antibiotic or antithrombotic therapy. Four weeks after implantation, the animals were killed to recover the grafts for bacteriological and histological analyses. Bacterial results were expressed as colony-forming units (CFU)/cm2 of graft material. RESULTS: In group I, only one allograft grew bacteria at 2. 16 x 10(6 )CFU/cm2, with a blood culture positive for S aureus. In group II, one dog died at 3 weeks from a false septic aneurysm rupture, all the allografts were infected (P <.05) with a mean bacterial count of 9.41 +/- 6.8 x 10(4) CFU/cm2, and three blood cultures were positive for S aureus. The patency of the grafts was analyzed at the time of recovery. Three laminar thrombi without occlusion were present in group I; none were present in group II. A better preserved endothelium in group I was revealed by means of histologic analysis staining with factor VIII antibody before implantation. After 4 weeks of implantation in the infected site, infected allografts presented polynuclear infiltrates in the media with a high degree of inflammatory reaction, and endothelial recovery was more significant in group I, with numerous young plump cells. CONCLUSION: This study demonstrates that cryopreserved allografts implanted in infected sites in a dog model can produce greater bacterial resistance.

Animals↗
PubMed1999

[Distinguishing between physiologic hypertrophy in athletes and primary hypertrophic cardiomyopathies. Importance of tissue color Doppler].

In order to assess the value of Doppler tissue imaging (DTI) in the differentiation of physiological hypertrophy of athletes from primary hypertrophic cardiomyopathy (HCM), the authors compared a group of 20 normal, non-athletic subjects, a group of 43 competitive athletes and a group of 20 patients with mild HCM. In addition to the conventional echocardiographic criteria, the velocity of wall motion at the endocardium and epicardium of the interventricular septum and the posterior wall as well as their gradients, were measured throughout the cardiac cycle. No significant difference was observed between normal subjects and the athletes with respect to velocities and the gradients of velocity. Early diastolic velocities of the posterior wall and interventricular septum were significantly lower than those of normal subjects and athletes. The systolic and early diastolic gradients of velocity of the posterior wall were significantly lower in HCM compared with the normal subjects and athletes. The gradient of velocity between the endocardium and epicardium of the interventricular septum was significantly lower in HCM compared with normal subjects in early diastole and with athletes in systole and early diastole. The best Doppler tissue imaging parameter to differentiate pathological hypertrophy of HCM from physiological hypertrophy of athletes was analysis of the gradient of velocity in early diastole of the posterior wall. A value of 0.7 sec-1 differentiated HCM with a sensitivity of 89%, a specificity of 95% and a diagnostic accuracy of 94%. Doppler tissue imaging is a more sensitive and specific technique than conventional Doppler echocardiography for detecting moderate forms of HCM.

Adult↗
PubMed1997

[Surgery of carotid lesions after irradiation. Apropos of 15 cases].

Out of 15 patients operated on for a carotid stenosis 3 to 19 years after a cervical irradiation, 2 were treated by a subclavian-carotid by-pass, 3 by a common carotid-internal carotid by-pass, 10 by an endarterectomy (6 closed with a patch), 3 of these endarterectomy extended largely down on the common carotid. Although the surgical approach was often difficult through the sclerotic tissues and 8 times the scar of a lymphadenectomy, the removal of the atherosclerotic core was as easy as usual. We observed neither mishap in arterial and cutaneous healings nor post operative stenotic myointimal hyperplasia.

Adult↗
PubMed1996

[Thrombo-aspiration in the surgical treatment of acute ischemia of the legs. Preliminary experience].

Eleven thrombo aspirations were performed in ten patients with lower limb acute ischemia. Three were performed under local and 8 under general anesthesia. They were associated with 4 thrombectomies, 6 transluminal angioplasty procedures, 1 limb infusion, 1 treatment of a false aneurysm, 1 aponeurotomy, 1 angioscopy. Clinical and radiological success was achieved in 9 patients whereas there was one immediate failure requiring a popliteal distal bypass. Late partial rethrombosis requiring medical treatment occurred in one patient. Thrombo aspiration is a safe effective technique which can be combined with other endoluminal procedures in patients with acute lower limb ischemia.

Acute Disease↗
PubMed1995

[Left single-lung allotransplantation with or without bronchial artery revascularization in pigs. Development of a model with a five-week survival].

After lung transplantation, immunological mechanisms are easier to understand if the pathologist can examine larger pieces of tissues than those obtained by endoscopic biopsies. The purpose of this study was to test the experimental left-lung transplantation in the pig, performed with or without bronchial arterial revascularization and with a survival of 5 weeks. Three animals were only thoracotomised (sham-operated), ten were allotransplanted without and nine with- bronchial arterial revascularization. To optimize survival several clinical and paraclinical parameters were used: laboratory, immunological, endoscopic and flowmetric examinations. Seven of the nineteen transplanted animals survived until the fifth week. Long-term survival is possible and depends mainly on the development of pulmonary sepsis. We observed an increase of the pulmonary vascular resistances and pressures in the allo-transplanted animals. In these animals, histologic examination showed lymphoplasmocytic infiltration in the interalveolar walls and the number of ciliated epithelial cells decreased on the main and lobar bronchi. Our observations suggest that CD8 lymphocytic infiltration is predominant on the bronchi after transplantation and that rejection may occur in the pig. Class 2 DR Swine Leukocyte Antigen does not seem to be expressed on the bronchi in the allo-transplanted pig after 5 weeks. Finally, it is very difficult to demonstrate the patency of bronchial arterial grafts after 5 weeks and therefore to prove the influence of revascularization.

Animals↗
PubMedDate not supplied

[War wounds of the upper vena cava. Recovery after management from Sarajevo to Paris].

Penetrating chest injuries involving the superior veina cava are a seldom observed entity to our knowledge. Most often they cause death before the patient can reach a surgical facility; because of the exsanguination and a difficult surgical approach. The authors report a war-case of superior veina cava injury and have reviewed and analysed the literature concerning the issue of immediate intensive care and surgical approach of such life threatening injuries; especially in war conditions.

Adult↗