Biomedical subjects

R Moidl

Publications and source records attributed to R Moidl.

26 records · Page 2Linked to original sources

PubMed1995

[Results of valve-sparing correction of aortic valve insufficiency].

The risk of valve-related complications and the necessity of anticoagulation in patients with prosthetic valves, has led to new operative techniques in the correction of severe aortic insufficiency. In the last 2 years, 35 patients (mean age 41.3 years, range 10-80 years) with aortic insufficiency underwent reconstructive valves surgery. Eighteen patients had a commissuroplasty with or without triangular resection. In 5 patients with perforation, the valves could be reconstructed with a pericardial patch. In 12 patients with insufficiency due to aortic aneurysm, the valves were resuspended within the aortic prosthesis. In 2 patients the aortic valves were replaced intraoperatively because of unsatisfactory results. The perioperative mortality was 5.7%. The echocardiographic degree of aortic insufficiency decreased from 3.3 +/- 0.5 preoperatively to 0.45 +/- 0.53 postoperatively. Two patients were reoperated within the first week. Five of 23 patients at 1-year follow-up have mild to moderate aortic insufficiency. Mean ventricular dimensions and function at discharge and after 1-year follow-up are normal. With the new operative techniques described recently, valve-sparing corrections of aortic insufficiency are possible in an increasing number of patients, and autologous valve tissue can be saved. With more refinement of surgical technique, early postoperative results will further improve.

Adolescent↗

PubMed1994

Sinus of Valsalva aneurysm: a late complication after repair of ascending aortic dissection.

Surgical advances and the introduction of new more rapid and accurate diagnostic techniques have led to significant improvement in the survival of patients with aortic aneurysms. However, considerable long-term morbidity and mortality remains a concern. In the present study we report on the occurrence of sinus of Valsalva (SV) aneurysm after repair of the ascending aorta for aortic dissection as a significant long-term complication. Since transesophageal echocardiography (TEE) became available it has been used for the follow-up of 33 hospital survivors after ascending aortic replacement for a mean of 27 +/- 20 months. Those patients who received a valved conduit were excluded from this analysis. The aortic valve was conserved in 22 patients: 17 had a dissecting aneurysm involving the ascending aorta and 4 patients non-dissecting aneurysms. A sinus of Valsalva diameter > 45 mm was considered an aneurysm and was found in a total of 7 patients (33%), 5 being patients with aortic dissection. The overall reoperation rate on account of SV aneurysms was 24%. We conclude that SV aneurysm is a significant long-term complication of patients after repair of the ascending aorta. In the light of these results we have changed our operative policy of repair to include resorcin glue as a reinforcing agent or to perform more extensive repair.

Aortic Dissection↗

PubMed1993

Pulmonary autograft valve replacement in the dilated and asymmetric aortic root.

Pulmonary autograft aortic valve replacement is the only technique for implantation of a biologic, vital and thus nondegenerating valve. The technique of root replacement overcomes problems of asymmetric aortic roots and reduces the risk of malalignment, but bears the risk of dilatation. We have performed pulmonary autograft aortic root replacement in 20 patients (mean age 22 years, range 5-38). Twelve presented with aortic incompetence, 3 with stenosis and 5 with combined defects. Initially roots were implanted just supraannularly with two running suture lines. As the neo-aortic roots gradually dilated, we started to implant autografts intraannulary, but still one valve dilated and aortic incompetence (AI) increased from grade I to II. Consequently the remaining aortic wall was wrapped around the new root and the composite subsequently was reinforced by a circular absorbable mesh. In addition, the aorta and pulmonary valve were exactly sized and the aortic root was reduced by commissuroplasty stitches up to 6 mm in diameter in seven cases. The ventricular size decreased in all patients 10 days after surgery, the left ventricular end-diastolic diameters (LVEDD) from 58 +/- 12 to 52 +/- 10 mm (P = 0.0002; paired t-test) and left ventricular end-systolic diameter (LVESD) from 41 +/- 12 to 36 +/- 10 mm (P = 0.008), but the contractility did not change significantly (fractional shortening from 31 +/- 9% to 30 +/- 9%). The diameter of the new aortic ring increased for the supraannular position but size matching and the intraannular valve position reduced the new ring size significantly (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

[Valve saving correction of aneurysms of the ascending aorta with aortic insufficiency or annular dilatation].

The current technique to correct aneurysms of the ascending aorta with incompetence of the aortic valve or dilatation of the aortic root is the implantation of a valved conduit. In many cases however structurally normal aortic leaflets are resected by this technique and patients are at the risk of complications due to mechanical heart valve prostheses and the necessary anticoagulation respectively. By resuspension of the aortic valve into the aortic prostheses similar to the technique used at implantation of homograft valves, competence of the valve can be restored and the dilatation of the aortic annulus can be prevented or even reduced. Our article describes the successful, valve sparing correction of an acute aortic dissection type A with dilatation of the aortic annulus in a 43 year old patient and in another patient with ascending aortic aneurysm with aortic insufficiency.

Adult↗

PubMed1992

[Transesophageal echocardiography from the surgical viewpoint].

Following the development of new techniques in echocardiography and especially of Doppler color flow imaging, a new dimension of cardiac surgery has been brought about. The use of transesophageal probes facilitates routine surgery to be performed without interferences and, also, comparability between repeated ultrasonic measurements. Originally, echocardiography was mainly applied for quality control by comparing pre- and postoperative echocardiograms. Now it is equally important in perioperative strategy planning guiding the surgeon's decision throughout the operation as well as in cardiac emergencies. Using intraoperative echocardiography routinely in cardiac surgery establishes a more and more close cooperation between surgeons, cardiologists, and anesthesiologists. In order to evaluate the clinical relevance of echo findings, they have to be repeatedly correlated to surgical realities and to long term results of clinical outcome.

Adult↗

PubMed1992

Transesophageal echocardiography in the emergency surgical management of patients with aortic dissection.

The diagnostic accuracy and benefit of transesophageal echocardiography were investigated in 32 patients with suspected aortic dissection. Results of transesophageal echocardiography were compared with surgical assessment. The Stanford classification was used for differentiation of dissection type. Examination time was 5 to 15 minutes. Twenty-eight patients were correctly identified to have aortic dissection; four patients had nondissecting aneurysms of the ascending aorta. Both sensitivity and specificity for detection of aortic dissection were 100%. Type of dissection was misdiagnosed in one patient. Classification of dissection type was correct in 96%. The primary entry site was correctly identified in 25 patients (89%). Aortic regurgitation was found in 57% of patients. Pericardial effusion was detected in 21%, with tamponade in one patient. Myocardial infarction was suggested by transesophageal echocardiography in 7%, and 14% had significantly reduced left ventricular function. Eight patients underwent operation based on transesophageal echocardiography alone. Intraoperative transesophageal echocardiography, performed in 20 patients, verified retrograde flow in the true lumen after femoral cannulation. Transesophageal echocardiography documented postrepair persistence of the intimal flap in aortic segments that were not operated on in all patients. Secondary tears and flow in the false lumen were detected in 35% of patients. We conclude that transesophageal echocardiography allows expedient and accurate diagnosis and classification of aortic dissection, and we recommend it as the primary bedside diagnostic modality. It can especially identify patients requiring surgical intervention without further delay caused by other diagnostic procedures.

Adult↗

PubMed1991

Immediate effects of mammary artery revascularization versus saphenous vein on global and regional myocardial function: an intraoperative echocardiographic assessment.

The immediate effect of coronary artery bypass surgery on global and regional myocardial function using the internal mammary artery (IMA) versus saphenous vein (SV) was studied intraoperatively using transesophageal echocardiography (TEE). Thirty-two patients received an IMA and 10 patients only SV. Transesophageal echocardiography was recorded before thoracotomy, 5 minutes after the end of cardiopulmonary bypass (CPB) and after chest closure. Global and regional left ventricular function were expressed as a percent of the short axis area change (%SAAC) and a percent of the fractional area change (%FAC), respectively. Segments were classified according to their baseline function as normal, %FAC greater than 40%, or dysfunctional, %FAC less than 40%. Only normal segments were considered in this study. No significant change in %SAAC in either group was observed in this study. Internal mammary artery revascularized segments showed a significant decrease in %FAC from 57 +/- 1 before thoractomy to 53 +/- 2 5 minutes after CPB, whereas SV segments showed a significant improvement in %FAC from 56 +/- 1 to 61 +/- 1. Applying strict criteria derived from intraobserver and cycle-to-cycle variability, 17% of IMA segments had deteriorated by more than 36% whereas only 4% of SV segments showed such deterioration. Conversely, 17% of SV segments showed an increase in %FAC by more than 36% and only 3% of IMA segments improved similarily. The observed changes were of short duration and had largely resolved by chest closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

Measurement of aortic flow velocity during transesophageal echocardiography in the transgastric five-chamber view.

Continuous-wave Doppler echocardiography of aortic flow velocity has a variety of clinical and research applications. Recently, continuous-wave Doppler echocardiography has been added to transesophageal echocardiographic systems. However, alignment of the Doppler beam with aortic flow is not possible with standard single and biplane views. A modified transesophageal echocardiographic view; the transgastric five-chamber (TG5C) view, allows for measurement of aortic flow velocity but its feasibility and accuracy in an unselected consecutive population have not yet been described. The feasibility of obtaining the TG5C view and measuring aortic flow velocity was assessed in 58 consecutive transesophageal echocardiographic investigations. The TG5C view was obtained in 97% and adequate Doppler flow velocity signals were obtained in 91% of patients. The accuracy of measurements was assessed in 24 patients in whom flow signals from both the TG5C and standard transthoracic views could be obtained. The correlation between TG5C and transthoracic views was excellent, with r values of 0.968 and 0.952 for peak aortic flow velocity and mean aortic flow velocity, respectively. Accurate aortic flow velocity measurements can be obtained in most patients during transesophageal echocardiography with the TG5C view. This view has great utility in a variety of situations in which adequate transthoracic imaging is not possible, especially the operating room and intensive care unit.

Adolescent↗