Biomedical subjects

R Speier

Publications and source records attributed to R Speier.

3 recordsLinked to original sources

PubMed1994

Surgical treatment of active infective endocarditis with paravalvular involvement.

Aortic root infection remains a challenging problem in the surgical treatment of both native and prosthetic valve endocarditis. Between 1980 and 1991, 73 patients with active aortic valve endocarditis and paravalvular infection underwent operation. Indications for operation included congestive heart failure and uncontrolled sepsis. Aortic root abscesses were located in the noncoronary anulus or in the aorticomitral junction in 45% of cases, followed by the subannular interventricular septum in 23%. Two patients had an aorticoatrial fistula, seven an interventricular septal defect. Total or partial left ventricular-aortic dehiscence was observed in 27 patients. All patients underwent aortic valve replacement, nine with simultaneous mitral valve operations. Two of the latter required patch reconstruction of the destroyed aorticomitral septum with double valve replacement. Reconstruction of the aortic base was possible in 16 patients, whereas in 12 total replacement of the aortic root was necessary. In one patient, supracoronary aortic valve replacement was used. Recently, topical application of antibiotics in fibrin sealant was used in 25 patients. The operative mortality rate was 21% and correlated to preoperative uncontrolled sepsis and the presence of extensive root destruction. Operation for active endocarditis of the aortic root requires radical, individualized techniques and results in an acceptable operative and long-term risk. The use of an antibiotic fibrin compound appears to be a useful prophylactic tool to prevent postoperative residual endocarditis.

Abscess↗

PubMed1993

Third-time coronary artery revascularization.

Eighteen patients underwent a third coronary artery revascularization (rere-CABG) between 1983 and 1991. The factors necessitating rere-CABG were graft failure in 83% of the patients and progression of native coronary atherosclerosis in 17%. Mean interval between the second and third operation was 49.1 months. Median sternotomy and cardiopulmonary bypass (CPB) were used in 12 patients, a left thoracotomy approach was used in 6 (with CPB in 3 patients and without CPB in 3). The mean revascularization rate was 2.2 (grafts/patient). The internal thoracic artery was employed in 12 patients and the right gastroepiploic artery was used in one. Operative mortality was 11.1% (2 deaths). Non-fatal perioperative myocardial infarction, reexploration for bleeding, and respiratory failure occurred in one patient each. There were no other serious complications. Long-term follow-up was obtained in 15 of the 16 survivors. Four patients had recurrence of angina pectoris, and one late death due to myocardial infarction occurred. The myocardial event-free rate was 75% at 3.4 years. This experience indicates that a third coronary revascularization can be justified: operative approach and choice of graft material have to be individualized, but adequate long-term results can be obtained.

Aged↗

PubMedDate not supplied

Analysis of myocardial function in orthotopic cardiac allografts after prolonged storage in UW solution.

The need for a better organ preservative solution in heart transplantation is clear. At the same time, newer techniques in the assessment of cardiac function in the laboratory have made accurate load-independent quantification of myocardial preservation possible. Therefore a study was undertaken to evaluate left ventricular function in transplanted hearts after 14 hours of preservation in the intracellular lactobionate solution. Nine dogs were instrumented with ultrasonic dimension transducers, to measure left ventricular epicardial volume, and with micromanometers, to measure left ventricular pressure. Left ventricular wall volumes were determined from epicardial echocardiograms. To define the extent of organ injury resulting from the transplant procedure and cardiopulmonary bypass alone, four other animals were instrumented in a similar fashion, and left ventricular function was assessed after standard cardioplegic arrest and transplantation. The transplant procedures were performed with a warm ischemic period of 0.75 +/- 0.2 hours. In all experiments, data were collected before graft harvest and 1 hour after separation from cardiopulmonary bypass. Standard cardioplegic arrest and 2.4 +/- 0.1 hours of ischemia resulted in a decrease in left ventricular ejection fraction from 0.43 +/- 0.04 to 0.27 +/- 0.1 (37%) (p less than 0.01), a decrease in the slope of the stroke work/end-diastolic volume relationship from 15.4 +/- 7.9 to 7.9 +/- 2.0 erg X 10(4) (49%; p less than 0.01), and a decrease in the myocardial power output from 19.7 +/- 10.9 to 5.9 +/- 1.9 (70%; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗