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Biomedical subjects

R Pifarré

Publications and source records attributed to R Pifarré.

At least 73 records · Page 4Linked to original sources
PubMed1980

Experience with simultaneous myocardial revascularization and carotid endarterectomy.

Fifty-four patient had coexisting stenosis of the carotid artery (70% or greater) and coronary artery disease. Simultaneous carotid endarterectomy and myocardial revascularization were done in all cases. One permanent postoperative neurologic deficit occurred (1.9%). There were no deaths. Our experience with simultaneous correction of combined carotid and coronary disease leads us to conclude that simultaneous myocardial revascularization and carotid endarterectomy have low mortality and neurologic morbidity rates. The policy at Loyola University Medical Center at this time is to routinely perform simultaneous endarterectomy and myocardial revascularization in all patients with significant coexisting carotid and coronary disease.

Aged↗
PubMed1979

The advantages of open mitral commissurotomy for mitral stenosis.

Mitral commissurotomy is the treatment of choice for mitral stenosis. If this is not feasible, replacement of the valve becomes necessary. Open commissurotomy has been performed at Loyola University Medical Center, Maywood, Ill, in 105 patients since 1970. The mean age was 45 years. The indication for surgery was heart failure in 92 of the cases. Sixty of the patients were in class 3 of the New York Heart Association (NYHA) classification. Eighty-five underwent open mitral commissurotomy alone. This was not feasible in 42 patients scheduled for it who required valvular replacement. Twenty-five patients had a left atrial thrombus. Two patients died, one from aortic dissection and the other from acute infarction in the perioperative period. Ninety-eight patients are NYHA class 1 or 2 at present. Two patients required valvular replacement following the commissurotomy. The low mobidity and mortality with excellent long-term results support our contention that open mitral commissurotomy is the treatment of choice for mitral stenosis.

Adult↗
PubMed1977

Potassium replacement during cardiopulmonary bypass.

Sixty patients undergoing cardiopulmonary bypass (CPB) with the Travenol 6 L. variflow oxygenator bag and total hemodilution with Ringer's lactate with 5 per cent dextrose were observed for their variances in potassium (K+) levels and the degree of potassium replacement. We have seen that the potassium level drops before CPB bypass in relation to the preadmission to the operating room potassium level. During bypass the level rises and following bypass it once again falls to be preceded by a rise after the first 24 hour postoperative period...

Adult↗
PubMed1977

Monitoring of intraoperative heparinization and blood loss following cardiopulmonary bypass surgery.

Two protocols of heparin management during cardiopulmonary bypass were compared to assess the role of the activated clotting time (ACT) in relation to postoperative blood loss. The study was divided into two groups: Group I, the control group, in which 3 mg. of heparin per kilogram was given as the initial dose and maintained at a dose of 1.5 mg. per kilogram every 45 minutes during cardiopulmonary bypass, and Group II, in which the initail dose of heparin was 2 mg. per kilogram and additional dosage were based upon the ACT. We found a striking decrease in postoperative blood loss as well as a decrease in the amount of heparin administered during cardiopulmonary during cardiopulmonary bypass in Group II patients. In addition, less protamine was required to neutralize the heparin in the second group after bypass. Thus, when patients are given too much heparin, as in our control group, the effectiveness of protamine is decreased. We would like to stress the value of the ACT in controlling heparin administration as well as postoperative blood loss in cardiopulmonary bypass surgery.

Blood Coagulation↗
PubMed1977

Refractory ventricular arrhythmia: the role of intraoperative electrophysiological study.

Thirty patients with drug refractory ventricular tachycardia (RVT) were studied between 1 week and 5 years after myocardial infarction with coronary agniography and left ventriculography. They were divided into four groups: (1) inoperable, five patients; (2, a) operated, with primary left ventricular failure, five patients; (2, b) operated with primary RVT, not mapped, 15 patients; (2, c) operated, with mapping, five patients. The mortality rate in group 1 was 100%, and in group 2, a it was 80%. In group 2, b, despite aggressive drug therapy and operation, including aneurysmectomy, coronary revascularization, and intra-aortic balloon pumping when appropriate, the mortality rate wad intraoperative mapping in group 2, c. Arrhythmogenic foci were identified and removed in four. There was one operative death (20%) and four patients are alive from 12 to 27 months after operation, three of whom are asymptomatic. Intraoperative epicardial mapping is an important adjunct to surgery for RVT.

Aged↗
PubMed1976

Surgical treatment of postinfarction ventricular aneurysm.

We have operated on 62 consecutive patients for postinfarction ventricular aneurysm since coronary bypass grafting became available. Analysis of hemodynamic and angiographic data reveals that the prognosis of operation is favorable if mean pulmonary artery pressure is less than 45 mm Hg and cardiac index is greater than 2.0 L/min/m2; such factors as the preoperative New York Heart Association Functional Class, number of coronary grafts, aneurysm size, left ventricular end-diastolic pressure, and coronary score were not closely related to the outcome of operation. Hospital mortality was 6.5% (4 patients) and late mortality, with a mean follow-up of two years, was 11% (7 patients). The prognosis among survivors was good: 82% (46) achieved NYHA Class I or II status, whereas 87% (54) had been in Class III or IV preoperatively. Concomitant vein grafting with aneurysmectomy did not significantly enhance operative or late survival, nor did it add appreciably to the risk of operation. Long-term benefits of revascularization in addition to aneurysmectomy are expected but not yet proved.

Adult↗
PubMed1976

Disc variance: a potentially lethal complication of the Beall valve prosthesis.

During 1975, 4 patients with erosion of the disc in Beall valve prostheses were seen. In one case the eroded disc was found loose in the distal aorta at postmortem examination. In 3 other cases, clinical diagnoses were made and successful reoperations performed. Because disc variance represents a potentially lethal complication, patients with disc prostheses should be examined at frequent intervals. When signs and symptoms of mechanical malfunction develop, the valve prosthesis should be replaced immediately to prevent death.

Female↗