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Biomedical subjects

T Z Lajos

Publications and source records attributed to T Z Lajos.

At least 19 recordsLinked to original sources
PubMed1992

Intramyocardial calcification in the elderly. A diagnostic and therapeutic puzzle.

A 70-year-old woman presented with anular and progressive intramyocardial calcification within a five-year period. She had become increasingly symptomatic with mitral regurgitation and coronary insufficiency during the same period. The subvalvular (mitral) calcified intramyocardial mass was found to be "grumous atherosclerosis." This was obliterated while the mitral valve was replaced with a prosthetic valve and the coronary arteries were bypassed x3. She is surviving and well four years postoperatively.

Aged↗
PubMed1990

Intracavitary melanoma of the left atrium.

A 32-year-old man was seen with shortness of breath and increasing fatigue. Echocardiography revealed an intracavitary mass occupying the entire left atrium. The lesion was resected using cardiopulmonary bypass and found to be a large malignant melanoma. This case represents the rare occasion in which antemortem diagnosis of malignant melanoma within left atrium permitted successful palliative surgical resection. The patient is alive and active 6 months after operation.

Adult↗
PubMed1990

Pulmonary resection combined with cardiac operations.

Surgical management of patients with concomitant critical cardiac disease and resectable lung lesions is controversial. During a 7-year period (1982 to 1988), 21 patients underwent combined cardiac and pulmonary operations. Patients had cardiac symptoms only; the lung lesions were found on preoperative chest roentgenograms. The pathological diagnosis was established in only 2 of the patients before operation. All underwent concurrent pulmonary resection during cardiac operations requiring extracorporeal circulation. The pulmonary operations included 17 wedge resections and four lobectomies. The final diagnoses in 8 patients with stage I non-small cell lung cancer included epidermoid carcinoma (4), adenocarcinoma (3), and bronchoalveolar carcinoma (1). Postoperatively, 1 patient required a permanent pacemaker and 1 patient died. The actuarial survival at 5 years for all patients who underwent combined procedures was 95%. The 5-year survival for the 8 patients with lung cancer was 88% compared with 100% for those with benign pulmonary pathology (p = 0.172). This experience suggests that combining pulmonary resection with cardiac operations is safe and offers a favorable prognosis to a select group of patients.

Adult↗
PubMed1990

Left thoracotomy reoperation for coronary artery disease.

Twenty patients underwent reoperative coronary artery bypass grafting (CABG) through a left thoracotomy since 1971. This was their second CABG in 16 patients, third in three patients and fourth in one patient. Surgery was performed from 1 to 16 years following the initial procedure. Demographic data showed no significant variation from patients undergoing standard reoperative CAGB in this institution. Ejection fraction varied between 30% and 73%. Cardiopulmonary bypass technic has gradually developed since 1971, using the left femoral artery and vein. For venous cannulation a 50-cm long catheter was positioned in the right atrium. Monitoring included pulmonary artery catheter with oximetry. Fibrillatory arrest of the heart was utilized with 18-33 degrees C core cooling cardioplegia. The left internal mammary artery (6) and reverse saphenous veins (44) were used for an average of 2.5 grafts per patient. The proximal anastomosis was placed on the descending thoracic aorta or the left subclavian artery. There were two early and no late deaths. Sixteen patients were restudied before discharge from the hospital with an early graft patency rate of 98% (41/42). The left thoracotomy approach may be preferable in selected cases of redo CABG. The danger of damage to the heart and patent grafts is greatly reduced.

Aged↗
PubMed1989

Evaluation of post-cardiopulmonary bypass Sonoclot signatures in patients taking nonsteroidal anti-inflammatory drugs.

Patients who take nonsteroidal anti-inflammatory drugs (NSAID) and who experience bleeding after cardiopulmonary bypass (CPB) are treated empirically with platelet transfusions because of the unavailability of rapid and accurate diagnostic clotting function tests. Therefore, a Sonoclot Analyzer (Sienco, Inc, Morrison, CO), which measures the change in the viscoelastic properties of recalcified whole blood, was used to assess platelet function in 51 patients undergoing CPB for cardiac surgery. Seventeen patients (group 1) taking NSAID were compared with 34 patients who were not taking NSAID (group 2). Blood samples were drawn for Sonoclot analysis before and after CPB. Chest tube drainage was measured for 24 hours postoperatively in both groups. Clot retraction, measured by the down slope on the Sonoclot signature, decreased significantly in group-1 patients, although values obtained for both groups were in the normal range. No difference was found between groups when Sonoclot signatures were compared, requirements for replacement of clotting factors or platelets, chest tube blood drainage, and unscheduled return to the operating room for bleeding. It is concluded that patients taking NSAID did not experience increased bleeding after cardiopulmonary bypass and that empiric platelet transfusion seemed unnecessary. In addition, the Sonoclot Analyzer seems to be a useful and sensitive instrument for rapidly assessing platelet function in the operating room.

Aspirin↗
PubMed1979

The revival of the horseshoe graft (side-to-side saphenous-vein-to-aorta anastomosis).

The technique of the horseshoe graft, side-to-side saphenous-vein-to-aorta anastomosis, using a long saphenous vein harvested from the leg is described in this communication. The lack of valves between the ankle and the knee and the high caliber natural Y distributions make this technique attractive. Constructing a double set of vein graft provides, in particular, unlimited possibilities for the construction of six to eight grafts if this appears anatomically feasible.

Coronary Artery Bypass↗
PubMed1978

Epicardial atrial pacing.

A modification of the technique for placing a permanent epicardial electrode to the atrium is described. It results in long-term atrial pacing and low sensing thresholds. The method requires meticulous surgical technique but is reliable, safe, and free from serious or long-term complications.

Cardiac Pacing, Artificial↗
PubMed1978

Decompression of the heart with siphon drainage.

A simple technique for inducing intracavitary hypothermic cardioplegia and decompressing the left heart through the ascending aorta is presented. The technique is based on siphon drainage, which eliminates the dangers of air embolism.

Cardiac Catheterization↗
PubMed1977

Detection of creatine kinase BB isoenzyme in sera of patients undergoing aortocoronary bypass surgery.

Creatine kinase BB isoenzyme (CK-BB) was detected intraoperatively in 22 of 25 patients undergoing aortocoronary bypass surgery, both in the coronary sinus and in the mixed venous blood. In a group of 10 patients in whom selective intracavitary profound hypothermic arrest was used, CK-BB values were lower than in another group of 10 patients, in whom controlled ventricular fibrillation with moderate total body hypothermia was instituted. This latter group also had higher levels of CK-MB. Patients who developed acute myocardial infarction immediately prior to or during the surgical intervention had the highest CK-BB values. This enzyme appeared as early as 15 minutes after the institution of cardiopulmonary bypass and disappeared within 6 hours. It is considered that part of the BB isoenzyme in serum of patients undergoing heart surgery is of myocardial origin.

Adult↗
PubMed1977

Early and long-term effects on direct myocardial revascularization on cardiac function: a prospective study using multivariable physiological analysis.

Perioperative and late follow-up hemodynamic cardiovascular studies to assess the effects of direct myocardial revascularization on cardiac function objectively have been completed on 51 patients. Analysis of the data delineated three distinct groups basedon the patterns of their early postoperative recovery. Group I patients (12) had a hyperdynamic cardiovascular response to operation and returned to a normal physiological range of cardiac function within 24 hours. Group II patients (24) initially had moderate to severe myocardial decompensation postoperatively but responded to inotropic support and moved into the normal physiological range within 24 to 48 hours. Group III patients (15) had severe, prolonged myocardial decompensation with little response to inotropic support. There were no early deaths in Group I, 1 early iatrogenic death in Group II, and 2 deaths from sepsis, 1 in Group I and 1 in Group II. All 7 cardiogenic deaths occurred in Group III patients. Late follow-up studies 4 to 23 months postoperatively have been completed on 29 patients. These showed cardiovascular stability in the mean values in Groups I and II. Significant improvement in mean cardiac function was seen in surviving Group III patients.

Adult↗
PubMed1977

Selective intracavitary and coronary profound hypothermic cardioplegia for myocardial preservation: a new technique.

A technique is described for selective intracavitary and coronary hypothermic perfusion during cardiac bypass with cardioplegia to facilitate cardiac operations. A cold perfusate (Plasmalyte 148 and mannitol, 12.5 gm/L at 8 degrees to 10 degrees C) is administered with the aid of a low-flow perfusion pump into the left ventricular cavity and coronary circulation through an apical perfusion-venting (Per-Vent) catheter. This perfusate cools the myocardium rapidly and homogeneously to a temperature of 15 degrees to 20 degrees C. Within this temperature range, complete cardioplegia occurs and the safe ischemia period can be extended to 120 minutes. This method was applied in 50 unselected consecutive adult patients undergoing aortocoronary saphenous vein bypass grafting or aortic or mitral valve replacement. All patients survived and had excellent recovery of ventricular function.

Coronary Artery Bypass↗
PubMed1976

Selective intracavitary and coronary hypothermic cardioplegia for myocardial preservation.Clinical, physiologic, and ultrastructural evaluation.

Intraoperative myocardial protection was evaluated in two groups of patients undergoing coronary surgery in whom different techniques for cardiac arrest were utilized. In group A, profound selective myocardial hypothermic (15 to 18 C) arrest was achieved by perfusing a coolant (7 to 10 C) into the left ventricular cavity and the coronary circulation. The average anoxic arrest time was 82.5 +/- 27 minutes. In group B, ventricular fibrillation and moderate hypothermia were used. Group A patients showed rapid physiologic recovery, low average myocardial creatinine phosphokinase (MB-CK) isoenzyme levels (7.8 IU) , and a well-preserved myocardial ultrastructure. In group B, three patients showed abnormal physiologic recovery; six patients needed postoperative inotropic support; and in seven patients, electron-microscopy revealed irreversible focal changes. The average MB-CK isoenzyme level was 85.6 IU. Analysis of our data demonstrates that when myocardial protection during coronary bypass grafting is achieved by selective profound intracavitary and coronary cooling, there is physiological, ultrastructural, and biochemical evidence of less intraoperative myocardial damage than when ventricular fibrillation is applied.

Adult↗