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Biomedical subjects

R Prêtre

Publications and source records attributed to R Prêtre.

At least 37 records · Page 2Linked to original sources
PubMed2000

Surgical angioplasty of the left main coronary artery in non-atherosclerotic lesions.

Surgical angioplasty of the left main coronary artery confers several advantages over conventional bypass surgery: unrestricted forward flow is provided to the entire coronary bed and graft material is spared. The literature contains many reports of surgical angioplasty of atherosclerotic stenoses. The technique is described in five patients with non-atherosclerotic disease of the left main coronary artery: three children (a 7 year old girl who had undergone an arterial switch operation shortly after birth; a 9 year old boy with congenital supravalvar aortic stenosis; and a 10 year old girl with Kawasaki's disease) and two adults (a 51 year old woman with post-radiation stenosis; a 53 year old man with acute dissection). All patients had an uneventful recovery and are free from symptoms with a widely open left main trunk. Although technical difficulties are increased in these patients, excellent results can be achieved with this approach.

Adult↗
PubMed1999

Recent experience with the arterial switch operation in transposition of the great arteries.

OBJECTIVE: Review of our experience with the technically demanding arterial switch operation in transposition of the great arteries in children. METHODS: Twenty-seven children who underwent an arterial switch operation in our clinic were retrospectively reviewed. Except for one child (operated on at eight months), the operation was performed during the neonatal period. The underlying pathology was d-transposition of the great arteries in 25 children and a double outlet right ventricle of transposition type in 2. Five children had an associated ventricular septum defect and 1 aortic isthmus coarctation. The pattern of the coronary arteries was favourable in 18 children, difficult in 7 and dangerous in 3. The operation was performed in cardiopulmonary bypass for repair of the transposition and in a period of deep hypothermic circulatory arrest for repair of the intracardiac defects. RESULTS: One child died perioperatively and 1 postoperatively (operative mortality 7%) from myocardial ischaemia following unsuccessful transfer of a dangerous pattern of coronary arteries. Another child, a low-birth weight baby, died 80 days after the operation from respiratory failure. Postoperative morbidity occurred in 10 patients and medium-term morbidity in 6 patients who presented various degrees of stenosis of a pulmonary artery. During a median follow-up of 18 months no patient required reoperation. The children are asymptomatic and thriving satisfactorily. CONCLUSION: Because it restores the heart physiology, the arterial switch operation is considered the procedure of choice for correction of transposition of the great arteries. The operation involves acceptable mortality and morbidity. Transfer of difficult coronary artery patterns and development of stenosis on the pulmonary arteries remain problematic.

Cardiopulmonary Bypass↗
PubMed1999

Operative results of "repair" of ventricular septal rupture after acute myocardial infraction.

Fifty-four consecutive patients with postinfarction ventricular septal defect were reviewed. The rupture was closed with a patch and the left ventricle remodeled in all patients. Coronary artery bypass surgery was performed in 28 patients (52%). Fourteen patients (26%) died after operation and 19 during follow-up (mean 42 months). Cumulative survival (including operative deaths) was 78%, 65%, and 40% at 1, 5, and 10 years, respectively. A short interval between septal rupture and operation was a risk factor for early mortality (p = 0.03). Treated associated coronary artery disease had no effect. A residual septal shunt, detected in 10 patients (18%), warranted reoperation in 7 and contributed to 2 early and 1 late death. The location and morphology of the septal rupture were not associated with increased risk of residual shunt. Thus, patch closure of the ventricular septal rupture, remodeling of the left ventricle to improve stroke volume and reduce wall stress, and selective myocardial revascularization provided acceptable results.

Aged↗
PubMed1999

Analysis of trials of surgery vs angioplasty in myocardial revascularization.

AIM: comparison of surgery and angioplasty for the treatment of coronary artery disease. METHOD: comparison using randomized trials for low-risk patients and observational studies for high-risk patients. RESULTS: in low-risk patients, a strategy of initial surgery or angioplasty achieved similar results regarding overall and infarct-free survival rates at 5 years. Residual angina was statistically more prevalent after angioplasty and required more subsequent revascularization procedures. Residual angina negatively impacted on life quality. Angioplasty initially had a cost-effectiveness advantage over surgery, which subsided over time. In high-risk patients, no firm conclusion could be drawn, due to unmatched selection of patients. Angioplasty seems superior in acute myocardial infarction and in very ill patients. Surgery seems superior to treat diseased bypass grafts. CONCLUSIONS: because of similar achievements, the choice of therapy in low-risk patients eventually should depend on patient's preference. During counselling, the deleterious effect of residual angina on life quality and health perception should not be underestimated by practitioners. In high-risk patients, further studies are required to define the best approach to any individual patient.

Angioplasty, Balloon, Coronary↗
PubMed1999

Application of successive principles of repair to correct supravalvular aortic stenosis.

The diffuse form of supravalvular aortic stenosis may extend in the takeoff of the coronary and arch arteries. Relief of the supravalvular stenosis requires a harmonious enlargement of the sinotubular junction to maintain aortic valve competence. The technique we used in a 9-year-old boy involved patch enlargement of all affected structures. Deep hypothermic circulatory arrest and retrograde cerebral perfusion was used during repair of the aortic arch and arch arteries.

Aortic Valve Stenosis↗
PubMed1999

Surgical repair of postinfarction structural failure of the posterobasal part of the heart.

BACKGROUND: This study is an analysis of our results with endoventricular repair of postinfarction structural defects of the posterobasal part of the heart. METHODS: Thirty-four patients who underwent endoventricular repair of a postinfarction structural defect of the posterobasal heart were reviewed. Patients with rupture of the ventricular septum (18 patients) or free wall (1 patient) were operated on acutely and patients with ventricular aneurysm (15 patients) electively. Restitution of the ventricular geometry was achieved by evertion (11 patients), resection (4 patients), or augmentation of the ventriculotomy (4 patients) in patients with ventricular rupture, and by resection of the aneurysm in the others. Coronary artery bypass was performed in 24 patients. RESULTS: Six patients died postoperatively (five due to rupture and one from aneurysm) and nine patients (six due to rupture and three from aneurysm) during follow-up. Survival rate at 5 years (including operative mortality) was 43% for patients with rupture and 61% for patients with aneurysm. The majority of the survivors were in New York Heart Association functional class I or II after a median follow-up of 5 years. CONCLUSIONS: Endocardial repair, ventricular remodeling, and selective myocardial revascularization provided overall good results in the treatment of this difficult cardiac area.

Aged↗
PubMed1999

Modified approach to close multiple apical ventricular septal defects.

The fish-mouth incision of the left ventricular apex is the established incision to access and close apical ventricular septum defect. A long diagonal branch may render this incision dangerous. In such a case, we performed a more anterior incision on the left ventricle, and fashioned a patch to exclude the whole defective area.

Cardiac Surgical Procedures↗
PubMed1999

[Post-infarction septal rupture. Surgical management and evolution].

BACKGROUND: The occurrence of a ventricular septal rupture abruptly worsens the prognosis of the patients who initially survived a myocardial infarction and imposes a surgical correction to reverse the evolving hemodynamic shock. This study reports our experience in the management of post-infarction septal defects. PATIENTS: 54 consecutive patients with a post-infarct ventricular septal defect were reviewed. The rupture was located in the antero-apical septum in 24 patients and in the postero-basal septum in 30. 26 patients presented with a one-vessel disease (the infarct-related artery), 19 with a two- and 9 with a three-vessel disease. 25 patients were in shock preoperatively. The septal rupture was approached through a left ventriculotomy in 53 patients and through a right atriotomy in 1 patient and was closed with a patch of pericardium or synthetic tissue. Aorto-coronary bypasses using vein grafts were performed on the coronary arteries that presented significant stenosis. RESULTS: 14 patients died peroperatively (2 pts) or postoperatively (12 pts) (mortality rate: 26%) mostly due to cardiac failure or cardiac complications: 25 patients among the 40 survivors suffered significant morbidity post-operatively. During follow-up (median time: 48 months), 19 patients died, again mostly from cardiac causes. Survival rate at 5 and 10 years was 70 and 40 percent, respectively. The necessity to operate within a short delay (less than 36 hours after occurrence of septal rupture) turned to be a significant predictor for increased post-operative mortality (p = 0.03). Pre-operative shock showed only a trend for an increased post-operative mortality (p = 0.13). CONCLUSION: The mortality and morbidity after surgical correction of post-infarction ventricular septal rupture remains significant. Early closure of the septal rupture seems, however, indicated in view of the gravity and evolution of the underlying disorder.

Heart Rupture, Post-Infarction↗
PubMed1999

[Ischemic risk in the case of celiac trunk occlusion in patients undergoing pancreatodeodenectomy. Multicenter study and review of literature].

OBJECTIVES OF THE STUDY: To assess the risk of ischemia in patients undergoing pancreatoduodenectomy and presenting celiac trunk occlusion. METHODS: Multicenter survey and review of the literature. PATIENTS: We collected data from 22 patients (15 males and 7 females), with a median age of 66 years. Indication for pancreatic resection was adenocarcinoma of the head of pancreas (N = 9), other peri-ampullary tumors (N = 7) and chronic pancreatitis (N = 6). Trial clamping of the gastroduodenal artery was performed in 16 patients and was found to be positive in 9, who underwent a revascularization procedure. Among 6 patients who did not undergo trial clamping, 4 developed ischemia during pancreatic resection and unplanned revascularization had to be performed. Five patients developed complications (morbidity = 23%), which were fatal in 2 cases (mortality = 9%). Prevalence of celiac trunk occlusion has been estimated at 2-3% of all pancreatoduodenectomies. CONCLUSIONS: The risk of supra mesocolic ischemia by obstruction of the coeliac trunk is low, but can be minimized by performing trial clamping of the gastroduodenal artery. Revascularization should be performed if trial clamping induces a reduction of blood flow.

Aged↗
PubMed1998

Surgical management of hemorrhage from rupture of the aortic arch.

BACKGROUND: Control of hemorrhage in patients with active bleeding from rupture of the aortic arch is difficult, because of the location of the bleeding and the impossibility of cross-clamping the aorta without interfering with cerebral perfusion. A precise and swift plan of management helped us salvage some patients and prompted us to review our experience. METHODS: Six patients with active bleeding of the aortic arch in the mediastinum and pericardial cavity (5 patients) or left pleural cavity (1 patient), treated between 1992 and 1996, were reviewed. Bleeding was reduced by keeping the mediastinum under local tension (3 patients) or by applying compression on the bleeding site (2 patients), or both (1 patient) while circulatory support, retransfusion of aspirated blood, and hypothermia were established. The diseased aortic arch was replaced during deep hypothermic circulatory arrest, which ranged from 25 to 40 minutes. In 3 patients, the brain was further protected by retrograde (2 patients) or antegrade (1 patient) cerebral perfusion. RESULTS: Hemorrhage from the aortic arch was controlled in all patients. Two patients died postoperatively, one of respiratory failure and the other of abdominal sepsis. Recovery of neurologic function was assessed and complete in all patients. The 4 survivors are well 8 to 49 months after operation. CONCLUSIONS: An approach relying on local tamponade to reduce bleeding, rapid establishment of circulatory support and hypothermia, retransfusion of aspirated blood, and swift repair of the aortic arch under circulatory arrest allows salvage of patients with active bleeding from an aortic arch rupture.

Aged↗
PubMed1998

Performance of a safe proximal anastomosis in aortic dissection.

Because of the increased fragility of a freshly dissected aorta, the anastomosis between the aortic root and a tubular prosthesis is not forgiving of technical imperfections and may lead to troublesome bleeding. Providing an appropriate everting surface of contact and a homogeneous distribution of tension between the graft and aorta, as described here, should help obtain a hemostatic suture line.

Anastomosis, Surgical↗
PubMed1998

Improved exposure of the pulmonary arteries for thromboendarterectomy.

Pulmonary thromboendarterectomy is a surgical technique for treating pulmonary hypertension caused by unresolved pulmonary embolism. It has been recommended to perform this procedure under deep hypothermic circulatory arrest. Here we describe two technical modifications: (1) improved exposure to the right pulmonary artery by division of the superior caval vein and (2) thromboendarterectomy in normothermic cardiopulmonary bypass, with beating heart or electrically induced ventricular fibrillation. These modifications allow complete endarterectomy of both pulmonary arteries under normothermic conditions, thus avoiding hypothermic circulatory arrest, which results in short cardiopulmonary bypass times and reduces the morbidity and mortality of this procedure.

Cardiopulmonary Bypass↗