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Biomedical subjects

R B Griepp

Publications and source records attributed to R B Griepp.

At least 109 records · Page 6Linked to original sources
PubMed1985

Acute dissections of the aorta. Current surgical treatment.

Tremendous progress has been made in the treatment of acute aortic dissections as a result of advances in surgical, medical, and diagnostic modalities. Rapid clinical diagnosis should be followed by aggressive monitoring, pharmacologic manipulation, and definitive elucidation of the anatomy of the disorder. Ultrasonography and CT scanning may provide valuable information on the anatomy of the dissection, but contrast arteriography remains the preferred method for demonstrating the anatomy. Surgical correction is now recommended for both type A and type B dissections during the acute stage. The exact approach is dictated by the location of the intimal tear and the extent of the dissection. The complexity of the operation may extend from interposing an intraluminal graft to full cardiopulmonary bypass with profound hypothermia, circulatory arrest, and replacement of the ascending aorta, aortic arch, or aortic valve apparatus. The rapid advancement of management techniques for acute aortic dissections now offers patients a reasonable expectation of survival without complications. Future improvements in early, noninvasive, and rapid diagnostic methods, as well as increased utilization of invasive monitoring and nonporous graft materials, promise to increase survival for a patient afflicted with acute aortic dissection.

Acute Disease↗
PubMed1985

Surgical management of synchronous coronary artery disease and multiple aortic stenosis: a case report with brief review of the literature.

One-stage surgery was successfully performed in a 44-year-old hypertensive man with uncontrolled angina, multiple coarctations of the thoracic and abdominal aorta, and a previous subtotal gastrectomy. There was a gradient of 120 mm Hg between the thoracic and abdominal aorta. A graft was placed retroperitoneally from the infrarenal aorta to the ascending aorta and was followed by a coronary artery bypass graft. Twenty-four months postoperatively, the patient was free of angina, and his hypertension was easily controlled.

Journal Article↗
PubMed1985

Repair of complex subvalvular aortic aneurysm with a valved conduit.

A subaortic annular aneurysm involving three fourths of the annular circumference was repaired with a valved conduit to which a Teflon felt flange was attached. This unique prosthetic repair assured a strong stable repair and uncompromised coronary flow otherwise unobtainable with previously described repairs.

Adult↗
PubMed1983

Use of stapling instruments in surgery for aneurysms of the aorta.

Since their inception, surgical stapling devices have been used almost exclusively in pulmonary and gastrointestinal procedures. We present our experience with surgical staplers in operations for aneurysms of the aorta. Three illustrative case reports are presented that demonstrate the applicability of surgical stapling devices in excluding aortic aneurysms. Seven patients have undergone operation using this technique, all with excellent technical results. We believe that surgical stapling devices represent a safe, easy, and rapid means of excluding aneurysms of the aorta.

Aorta, Thoracic↗
PubMed1982

Atrioventricular canal ventricular septal defect with cleft mitral valve. Angiographic and echocardiographic features.

A rare form of endocardial cushion defect is an atrioventricular (AV) canal-type ventricular septal defect with cleft mitral valve in the absence of a primum atrial septal defect. In two infants with Down's syndrome, preoperative delineation of this entity was accomplished. M-mode echocardiographic features included presence of two distinct AV valves, attachment of the anterior portion of the anterior leaflet of the mitral valve to the interventricular septum, and normal septal motion. Two-dimensional echocardiography demonstrated the intact atrial septum, ventricular septal defect, presence of two distinct AV valves, and the cleft mitral valve. Angled (axial) cineangiography was employed to delineate the AV valve morphological characteristics, position of ventricular septal defect, and absence of a primum atrial septal defect. Since the surgical approach to this lesion is different from other forms of endocardial cushion defects and specific problems related to AV valve morphology may be encountered, the preoperative diagnosis of this entity is important.

Cardiac Catheterization↗
PubMed1982

Colo-pericardial fistula: complication of colonic interposition.

This report discusses a unique and previously unreported complication of a colonic interposition following esophageal replacement. A 7-year-old boy under-went a right colonic interposition following extensive esophageal lye burn. Fifteen years post-colonic interposition, the 22-year-old man was admitted to an adult medical ward with chest pain, cardiomegaly, and fever. Barium swallow revealed a colo-pericardial fistula with massive pericarditis. The patient survived an immediate thoracotomy with the removal of the colon and a pericardiectomy. Several months later the patient underwent a successful left colonic interposition. This case illustrates that immediate and aggressive surgical therapy may prevent an otherwise fatal outcome.

Journal Article↗
PubMed1982

Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections.

In a series of 21 consecutive patients, the aortic arch, varying portions of the ascending and descending aorta, and in some the aortic valve were replaced with the aid of a standard method of profound total body hypothermia and circulatory arrest. Fourteen patients underwent elective and seven patients emergency arch replacement. A combination of surface cooling and cardiopulmonary bypass was used to produce total body hypothermia. Replacement of the aortic arch was performed during a single period of circulatory arrest. Cardiopulmonary bypass was utilized for core rewarming. The average cerebral ischemic time was 37 +/- 14 minutes at an average core temperature of 13.7 degrees +/- 1.8 degrees C. The average myocardial ischemic time was 79 +/- 28 minutes with an average duration of cardiopulmonary bypass of 130 +/- 32 minutes. Of the 14 patients undergoing elective operation, three died; of the seven patients undergoing emergency operations, three died (two with ruptured aneurysms and one with acute arch dissection). Fifteen patients are alive and well 2 months to 7 years following the operation. All are free of neurologic sequelae. One has an asymptomatic residual dissection in the descending aorta. This experience indicates that profound total body hypothermia with circulatory arrest is a safe and effective method for elective surgical treatment of enlarging aneurysms of the aortic arch and for emergency treatment of acute dissections if the intimal tear is located in the aortic arch. The technique is simple and produces results superior to those reported for methods which involve selective cerebral perfusion during arch replacement.

Adult↗
PubMed1981

Experience with left ventricular apicoaortic conduits for complicated left ventricular outflow obstruction in children and young adults.

Six patients, ranging in age from 8 to 20 years, underwent left ventricular apicoaortic construction for treatment of complicated left ventricular outflow tract obstruction. All patients had severe left ventricular hypertrophy as determined by echocardiography and electrocardiography. The preoperative gradient across the left ventricular outflow tract was 84 +/- 17 mm Hg (mean +/- standard deviation) (range, 65 to 110 mm Hg), and the preoperative left ventricular end-diastolic pressure was 20 +/- 7 mm Hg (range, 12 to 28 mm Hg). Conduits were placed retroperitoneally with the distal anastomosis to the infrarenal aorta; the porcine valve was positioned in the left upper quadrant. Relief of left ventricular hypertension was complete; the minimal gradient measured intraoperatively was 13 +/- 8 mm Hg (range, 0 to 20 mm Hg). With an average follow-up of 18 months (range, 6 to 24 months), all patients have improved and are in Functional Class I. Four patients were catheterized 12 months postoperatively. They all showed excellent relief of left ventricular hypertension; the conduit was effectively decompressing the left ventricle. This experience suggests that this approach is effective in relieving complex left ventricular outflow tract obstruction with good early results, and that it deserves more frequent application in children.

Adolescent↗
PubMed1979

Total correction of tetralogy of Fallot. How to deal with the complicated ascending aorta-right pulmonary artery anastomosis.

Ascending aorta-right pulmonary artery anastomosis may be complicated by deformity at the anastomotic site leading to discontinuity between pulmonary artery branches. Simple closure of such shunts through the ascending aorta is associated with residual stenosis and pressure gradients. An alternative approach which allows reconstruction of the entire intrapericardial pulmonary arterial system at the initial corrective operation is described. The transection of the ascending aorta facilitates the exposure necessary for this extensive repair. Two illustrative cases are presented.

Aorta↗