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R Nottin

Publications and source records attributed to R Nottin.

51 records · Page 3Linked to original sources
PubMed1981

New surgical approach to aortic dissection: flow reversal and thromboexclusion.

With the aim of decreasing the complications and mortality associated with the current techniques for aortic dissections, we have developed an operation which consists of bypassing the dissected aorta and creating flow reversal in the dissected segment. Seven patients with either acute (five) or chronic aortic dissections (two) were operated upon successfully, with no early or late deaths. Three transient postoperative complications were encountered: low cardiac output, hemiparesis, and renal insufficiency. Postoperative arteriography was performed in five patients and demonstrated exclusion of the dissected lesions by thrombosis following flow reversal in the descending aorta. Follow-up is available from 2 to 28 months (average 13 months), with no long-term complications.

Adult↗
PubMed1980

[Long term hemodynamic results following complete cure of Fallot's tetralogy].

Cardiac catheterisation was carried out on an unselected series of 148 patients who had undergone complete correction of Fallot's tetralogy after an average postoperative period of si and a half years (range 2 to 20 years). 4% residual significant interventricular shunts (Qp/Qs > 1.3), 11% residual stenosis on the infundibulo-pulmonary tract (gradient greater than or equal to 10 mmHg) and 60% pulmonary incompetence was found. These findings do not reflect the excellent clinical results. All patients had normal lives: 89% remain asymptomatic since their operation and symptoms in the other patients are limited to moderate dyspnoea on effort or to arrhythmias which are usually periodic. A synthesis of the clinical and haemodynamic data shows that only a quarter of patients may be considered to be cured, that although the surgical results in 2/3 patients are not perfect, they are satisfactory, and that the results of complete correction in the remaining 12% are poor. The results do not appear to be related to the age at which correction was performed or to previous palliative surgery. On the other hand, the long-term haemodynamic results were related to the surgical method of infundibulo-pulmonary repair. Systolic right ventricular pressures of over 60 mmHg recorded at the end of operation in 33 patients, had returned to normal in 76% cases. These results suggest that the indications for prosthetic remodeling of the infundibulo-pulmonary tract should be increased, although this does not always prevent residual stenosis.

Adolescent↗
PubMed1979

[Postoperative haemodynamic evaluation of myocardial protection by physicochemical cardioplegia. Hyperkaliemic, hyperosmolar and acid solution at 4 degrees C (author's transl)].

Myocardial protection by a combination of cardiac hypothermia and chemical cardioplegia (high concentration of K+ and Mg++, hyperosmolarity, acid pH), was studied during 20 valve replacements. Essentially assessed on the basis of repeated measurements of postoperative cardiac output, the results were compared with those obtained previously using local hypothermia only (20 patients) and hypothermic cardioplegia using Ringer Lactate (20 patients). Analysis of haemodynamic data, which thus involved 60 patients, indicated the superiority of physicochemical cardioplegia, and this for clamping periods of up to 2 hours, but also showed the desirability of changes in the protection protocol during the ischaemia phase and during reperfusion which might improve the results.

Cardiac Output↗
PubMedDate not supplied

Adult heart transplantation: adverse role of chronic alcoholism in donors on early graft function.

Because of the increasing shortage of heart donors, selection criteria have been gradually extended. The purpose of this study was to determine the donor-related factors implied in early graft dysfunction and to define new selection criteria. The 70 consecutive adult patients who underwent heart transplantation in our institution between January 1988 and February 1992 were retrospectively studied. Mean donor age was 38 +/- 11 years (10 donors were more than 50 years of age; two donors were more than 60 years of age). Mean ischemic time was 130 +/- 39 minutes. An important proportion of donors (20%) had a history of chronic alcoholism. Thirteen patients experienced immediate graft dysfunction; five of them died within the first operative month. The different parameters studied, which were found to have no significant influence on the early graft function, were the age of the donor, the duration of inotropic support and the dose administered, a relative hemodynamic instability, resuscitation maneuvers, chest trauma, and weight mismatch between donor and recipient. Ischemic time was significantly longer in patients who died of cardiac dysfunction (p < 0.05). Chronic alcoholism in the donor was a very detrimental factor: 54% of patients who had early graft dysfunction versus only 12% of patients who had immediate normal graft function had received a graft from an alcoholic donor (p = 0.003). Excluding such alcoholic donors or reserving them for critically-ill recipients, with an increased risk of early graft dysfunction would be preferable.

Adult↗
PubMedDate not supplied

[Repeated failure of the suture line of an aortic valve prosthesis. Treatment by implantation of a valvular tube in the supra-coronary position].

We present our 7 years' experience in the treatment of repeated stitch failure of the suture line on aortic valve replacements. We used a valved tube placed in the supra-coronary position. This technique prevented further stitch failure and also prevented postop infections. Of eight patients operated on, five had survived.

Adolescent↗
PubMedDate not supplied

[Long-term angiographic surveillance of operated ascending aorta dissections].

Systematic angiographic surveillance of ascending aorta dissections demonstrates the frequency and diversity of often asymptomatic anatomical lesions. A study in 10 previously operated cases enabled differentiation with the prosthetic tube, usually implanted in the ascending aorta, of proximal postoperative lesions (residual dissection, aortic incompetence, aneurysm) which may require further surgery in the more or less long term, and distal lesions (the usual persistence of a false channel in type I dissections) which are generally left untouched.

Adult↗