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Biomedical subjects

T Maamies

Publications and source records attributed to T Maamies.

At least 19 recordsLinked to original sources
PubMed1991

Surgical treatment of infective aortic valve endocarditis.

Fifty-eight adult patients treated with aortic valve replacement for infective endocarditis were retrospectively reviewed. The operation was performed during antibiotic therapy (group I, n = 25) or after completion of such therapy, on average 17 months after diagnosis (group II, n = 33). Preoperatively 68% of group I and 24% of group II were in NYHA class IV. Bacterial aetiology was verified in 78% of all cases. Preoperative embolic complications occurred in six group I and three group II cases, causing hemiplegia in eight. At operation the aortic valve was bicuspid in 29 of the 58 patients. Vegetations and cusp perforation were present in most cases. Bacteria were demonstrated in 11 of the excised specimens. A mechanical valve prosthesis was inserted in all cases. Three patients died, one perioperatively and two during their time in hospital (2 from group I). Low-output syndrome was the commonest postoperative complication. During follow-up averaging 66 months, 12 patients died (6 of cardiac causes). Late complications were periprosthetic leakage (2 cases), significant embolism (5), and prosthetic valve endocarditis (4), causing periprosthetic leakage in one case.

Anti-Bacterial Agents↗
PubMed1989

Primary cardiac tumours--operative treatment of 20 patients.

This report describes a series of 20 patients operated on for a primary cardiac tumour. The majority of the tumours (16) were benign myxomas; 12 of them were located in the left atrium, two in the right atrium and two were biatrial. Two lipomas were found; one was epicardial and the other was located in the left atrium. The only intraventricular tumour was a malignant left ventricular myosarcoma. The propensity of intracardiac tumours to embolize was distinctive. Nine of the 16 myxomas presented with peripheral embolization, and in two patients surgery was complicated by fatal perioperative cerebral embolization of myxomatous tissue. Furthermore, in one patient embolization of a left atrial lipoma necessitated amputation of her left arm before cardiac surgery. Late postoperative recurrences were found in two patients with atrial myxomas. In one of them, reoperation showed that the tumour had grown at that site in the interatrial septum where the original pedicle had been excised. One patient developed severe mitral valve regurgitation and underwent replacement with a prosthetic valve at reoperation. Otherwise our late follow-up study showed that the results of surgery were usually excellent even though mild echocardiographic abnormalities were not uncommon. Our experience emphasizes the embolic potential of intracardiac myxomas and suggests, furthermore, that to avoid recurrences excisions with wide margins should be preferred. Echocardiography is an optimal method for the follow-up of these patients.

Echocardiography↗
PubMed1987

Intravascular bronchioloalveolar tumor.

A 17-year-old girl was operated for a solitary well-circumscribed pulmonary parenchymal tumor and reoperated ten times for multiple recurrent similar pulmonary tumors during 24 years. Histologic examination revealed the so-called intravascular bronchioloalveolar tumor (IVBAT) in all instances. The patient died from pneumonia superimposed on decreased respiratory function 24 years after the onset of disease. This is the longest survival so far reported in IVBAT. The treatment was surgical in all phases of the disease, and the patient did not receive radiotherapy or cytostatic drug therapy. Mediastinal and pleural tumor nodules were removed 17 years from the first pulmonary operation, and 24 years after the first operation a fibrous tumor was removed from the retroperitoneal space. Immunohistologically, the tumor cells were positive for vimentin-type of intermediate filaments, in line with their mesenchymal nature. Endothelial markers, Factor VIII-related antigen and Ulex europaeus I lectin binding, were not found in convincingly neoplastic cells, and Schwann cell, epithelial cell, muscle cell, and histiocytic markers were absent. Thus, IVBAT appears to be a low-grade malignant mesenchymal neoplasm, composed of poorly differentiated mesenchymal cells, whose exact nature remains undefined with the currently used cell-type markers.

Adolescent↗
PubMed1987

Bronchospasm during cardiopulmonary bypass--a potentially fatal complication of open-heart surgery.

Severe bronchospasm at the termination of cardiopulmonary bypass is an unusual but dangerous complication of open-heart surgery. We report two cases. In both of them the final etiology remained unsettled. In one of the cases vigorous and immediate bronchodilatory therapy resulted in a favourable remission. In the second case bronchospasm contributed to a very harmful bulging of the left lung through the opened mediastinal pleura, stretching and damaging the left internal mammary artery graft, which obviously contributed to the fatal outcome. We emphasize especially the following points: 1) a carefully evaluated medical history of patients scheduled for open-heart surgery may reveal some details pointing to an increased risk of bronchospasm during cardiopulmonary bypass; in such cases prophylactic measures may be indicated; 2) immediate vigorous bronchodilatory therapy early at the onset of bronchospasm during the weaning from cardiopulmonary bypass may reverse the alarming situation.

Bronchial Spasm↗
PubMed1987

Value of combined cross sectional and Doppler echocardiography in the detection of left ventricular pseudoaneurysm after mitral valve replacement.

The development of a left ventricular pseudoaneurysm is a rare complication of heart surgery. Until recently it has been impossible to detect without an angiographic study of the left ventricle. A combination of cross sectional and Doppler ultrasound studies led to the correct diagnosis in two patients with left ventricular pseudoaneurysms after mitral valve replacement. Cross sectional echocardiography showed a posterolateral echo-free space confined only by the pericardium and communicating with the left ventricle through a defect in the ventricular wall, and Doppler echocardiography confirmed the presence of blood flow in this cavity. This Doppler finding is critical if the perforation is too small to be identified reliably by cross sectional imaging. Surgical repair of the pseudoaneurysm can be undertaken without invasive studies if the echocardiographic findings are unequivocal and there is no reason to suspect the integrity of the circumflex coronary artery.

Adult↗
PubMed1987

Hypothermia and circulatory arrest in reconstruction of aortic arch. A report of nine cases.

From 1982 until October 1985 we operated 9 cases of aortic aneurysm involving the transverse aortic arch (5 male and 4 female, from 26 to 69 years). Two patients had an acute dissecting aortic aneurysm, the others had an aneurysm of the aortic arch involving also the ascending aorta in 5 cases and the descending aorta in 1. Three patients underwent aortic valve replacement and implantation of coronary orifices. Two patients had previously had AVR. The operation was carried out under cardiopulmonary by-pass. After obtaining 25 degrees C hypothermia the bypass was discontinued and the cerebral vessels were cannulated from inside of the opened aneurysm and perfused at a flow rate of 250 ml/min. The myocardium was protected by cold cardioplegia and topical cooling. During total circulatory arrest the distal aortic arch anastomoses were completed in 28-56 minutes. Then the by-pass was restarted and the rest of the operation was carried out as usual. One patient with an acute dissecting aortic aneurysm died on the 2 post-operative day due to brain damage and rupture of abdominal aorta. The other patients recovered well. There were no permanent neurological or myocardial complications. Three patients had a transient renal failure, one needing dialysis. The 8 survivors have done well 4-46 months after the operation.

Adult↗
PubMed1987

Early endocarditis following open-heart surgery--importance of surgical treatment.

Nine cases of proven early form of endocarditis occurred after open-heart surgery. Eight of these occurred after valve surgery with an incidence 0.7% while one complicated correction of Fallot's tetralogy. Sternal wound infection preceeded endocarditis in two cases and respiratory tract infection in one case. In these three patients, the infection was caused by the same bacteria as the subsequent postoperative endocarditis. In only one patient were there no signs of infection during the immediate postoperative course. A new cardiac murmur suggesting prosthetic malfunction was a clear indication for early reoperation in five patients; four of them survived. In one patient with a paravalvular leakage the decision to operate was delayed with fatal outcome. Generally, in patients without signs of prosthetic valve malfunction or other prosthetic complication the indication and timing of surgery is problematic. In our series the antibiotic therapy was continued over two months in three patients. Two of them died while the third patient was operated on successfully.

Adult↗
PubMed1986

Long-term follow-up of Björk-Shiley mitral valve replacement. 10 years' experience.

Retrospective analysis was made of 176 patients who received a Björk-Shiley mitral valve replacement in the period 1973 through 1982. Actuarial cumulative curves showed the 10-year and 5-year survival rates to be 79 +/- 3.4%. The functional status at follow-up was better than preoperatively in 77.1% of the patients. The hospital mortality was 9.1% and the late mortality was 3.6/100 patient years. Early complications included disc entrapment against the ventricular wall in three cases, wedging of chorda between disc and valve rim in two and posterior perforation of the left ventricle in three patients. There was no structural valve damage. Calculated per 100 patient years, the incidence of thromboembolism was 2.5, endocarditis 1.4 and prosthetic leak 1.8. One thrombosed valve was successfully replaced by a new prosthesis 11 years after the initial implantation. Jamming of the disc by tissue over-growth necessitated a new valve implantation in one case. The incidence of early valve-related complications was high, but the long-term results were comparable with those from other mechanical valves. One early complication--disc entrapment against the ventricular wall--may be avoided by use of a sufficiently small valve if the ventricle is small and thickened.

Actuarial Analysis↗
PubMed1984

Postoperative disc entrapment following cardiac valve replacement--a report of ten cases.

The sudden jamming of a prosthetic valve disc is one cause for postoperative hemodynamic deterioration. This complication occurred in 10 instances (2% of disc valves implanted), resulting in 4 fatalities. In 6 patients the disc entrapment was a complication following mitral valve replacement, and in 4 others the malfunction followed aortic valve surgery. The entrapment of the disc occurred on the second postoperative day in 3 patients. Two of these were due to an unresected chordal strand becoming wedged between the disc and valve rim of a Björk-Shiley mitral prosthesis and resulted in death. In the third patient, the aortic valve disc became attached to the Björk-Shiley composite aortic graft following the repair of an aortic dissection. A firm blood clot had formed between the graft and the oversewn aortic wall. This patient recovered after cardiopulmonary resuscitation and subsequent reoperation. The remaining cases developed while the patients were still either on the operating table or in the recovery room. The mechanisms of the disc entrapments are presented and the significance of an early correct diagnosis and urgent surgical correction is underlined.

Adult↗
PubMed1983

Late aneurysms after patch aortoplasty for coarctation of the aorta in adults.

Sixty-eight patch aortoplasties were performed for coarctation of the aorta (CoA) in adult patients from 1967 to 1978 in our hospital. The mortality was 1.5% and the immediate result of the surgical repair seemed good. Long-term follow-up of 2 to 14 years later revealed aneurysm formation at the repair area in 27% of the 62 patients for whom sufficient follow-up data are available. Two aneurysms had ruptured with a fatal outcome. Other repair methods used for coarctation in 106 patients were free from aneurysm complication. Thirteen patients with an aneurysm underwent reoperation without mortality. The etiology of these unexpected aneurysms is discussed.

Adolescent↗
PubMed1982

Emergency pericardiotomy as primary diagnostic and therapeutic procedure in malignant pericardial tamponade: report of three cases and review of the literature.

Three cases are presented in which pericardial tamponade was the first indication of malignant disorder. The diagnosis and therapy of malignant cardiac tamponade was revealed by emergency pericardiotomy. In all cases the tumor was an adenomatous carcinoma and the site of primary tumor was unknown until death. The median survival time after onset of symptoms was 4 months. The primary site was the lungs in two and remained unknown autopsy in one case.

Adenocarcinoma↗
PubMed1982

Surgical treatment of acute superior vena caval syndrome. A report of two cases.

The syndrome caused by the acute obstruction of the superior vena cava with central nervous system symptoms as well as with symptoms related to the oedema of the upper respiratory tract is often very severe and fatal to the patient. Conservative treatment is usually of no help, and consequently the palliative reconstruction of the superior vena cava may be indicated. Two cases of acute superior vena caval syndrome with reconstruction of the superior vena cava are presented. In the first case, when a malignant mediastinal tumour (Hodgkin's) was removed, a segment of the superior vena cava and the anonymous vein had to be removed. Following this operation acute superior vena caval syndrome developed and another operation was performed in which the superior vena cava was reconstructed with a Dacron prosthesis. Radiological examination of the superior vena cava 28 months postoperatively showed the prosthesis patent and the patient was free from symptoms. 51 months after the operation the patient was still asymptomatic. In the second case the obstruction of the superior vena cava was caused by anaplastic carcinoma of the upper lobe of the right lung. The acutely obstructed superior vena cava was reconstructed with a Dacron prosthesis. 9 months postoperatively the superior vena caval syndrome recurred and two months later the patient died of lung cancer. In both cases good palliation of the obstruction of the superior vena cava was obtained.

Acute Disease↗