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Biomedical subjects

U Hvass

Publications and source records attributed to U Hvass.

At least 19 recordsLinked to original sources
PubMed2006

[The left ventricular reconstructive surgery at the origin of the treatment of cardiac insufficiency].

The surgical method of ventricular reconstruction described by Dor is recalled with the clinical report of a patient who presented a ventricular aneurysm. The left ventricular reconstructive surgery is based on an anatomical design of the heart described by Torrent-Guasp, where the normal orientation of the left ventricular muscle fibers, oblique in direction, is found parallel with the base of the heart at the time of ventricular dilation. By giving again an elliptic form to the left ventricle, the left ventricular reconstructive surgery improves the cardiac function of the patient who developed a bulky aneurysm after an infarction. Based on this concept, other techniques of ventricular reconstruction intended for patients presenting dilated cardiomyopathy, of ischemic origin or not, are being studied.

Cardiac Surgical Procedures↗
PubMed2004

[Neutropenia and fever after aorto-coronary bypasses].

Plasma-derived products are often used in cardiac surgery. We report the case of a patient developing an infection due to Parvovirus B19 after coronary artery bypass. Symptoms were fever, asthenia, anemia, and pancreatitis. This infection can be transmitted from plasma-derived product, like fibrin sealant (used for hemostasis during surgery). Parvovirus B19 is resistant to existing virus-inactivating techniques. The patient had to leave our hospital after symptomatic treatment which has significantly increased the length to stay.

Coronary Artery Bypass↗
PubMed2001

Prognostic value of 201Tl myocardial scintigraphy after coronary artery bypass grafting.

BACKGROUND: 201Tl myocardial scintigraphy (201Tl SPECT) is of strong prognostic value in various populations with suspected or known coronary artery disease. However, its value in patients with coronary artery bypass grafting (CABG) is not fully assessed. METHODS: We examined 115 consecutive patients to determine the relation between clinical data/stress 201Tl SPECT performed 5+/-3 years after CABG, and subsequent cardiac events. RESULTS: Thirteen patients (11%) had stress-induced angina, 22 (19%) had electrical positivity, and 97 (84%) had abnormal scintigraphy, including 62 (54%) with reversible defects. During follow-up (35+/-22 months), there were nine cardiac deaths, seven myocardial infarctions, and 20 revascularization procedures. Multivariate Cox analysis identified the delay between CABG and scintigraphy (P<0.01, relative risk (RR) = 1.01), the extent of stress 201Tl defects (P = 0.04, RR = 1.18), and increased stress 201Tl lung uptake (P = 0.03, RR = 3.56) as significant predictors of cardiac deaths/infarctions. Delay between CABG and scintigraphy (P < 0.001, RR = 1.01), the extent of stress 201Tl defects (P = 0.03, RR = 1.15), and that of reversible defects (P = 0.05, RR = 1.13) were the only significant predictors of total events. CONCLUSIONS: Besides the delay between CABG and scintigraphy, the scintigraphic parameters were the only significant and additive predictors of cardiac events in 115 patients with CABG.

Adult↗
PubMed2001

Tricuspid autograft for repair of a destroyed mitral commissure.

The study evaluated the results of the tricuspid valve autograft technique, consisting of transferring the posterior tricuspid leaflet and subvalvular apparatus towards the mitral valve to reconstruct a destroyed commissure. Twenty patients entered the study. Etiology was degenerative in 12 patients (mean age, 55 +/- 21 years). Nine patients had endocarditis, 8 were rheumatic. Echocardiography results and secondary events were reviewed. Mean follow-up was 44 +/- 17 months. One patient died from sepsis. Survivors were in sinus rhythm. Predischarge echocardiography showed trivial or no mitral regurgitation in all but one patient (mild). Mean transmitral gradients were 3 to 6 mm Hg, and valvular surface was 4.3 +/- 2.1 cm(2). On the tricuspid valve, regurgitation was zero to mild, gradients 4 to 7 mm Hg. One patient developed recurrent endocarditis at 18 months with moderate regurgitation. Results were stable in all the other patients. The tricuspid autograft is an attractive technique for a selected group of patients with commissural destruction. The 6-year results are very encouraging.

Adult↗
PubMed1999

Multicenter study of stentless valve replacement in the small aortic root.

OBJECTIVE: A clinical study was conducted to evaluate the results of stentless porcine valves in patients with a small aortic root (19- and 21-mm aortic anulus). METHODS: Of 567 patients, from 4 surgical institutions, 171 patients (30.1%) had a small aortic root, comprising 163 cases with calcified aortic stenosis and 8 cases with predominant valvular insufficiency. Sixty patients had associated mitral or coronary lesions. Mean age was 72 +/- 4.2 years. Forty-seven patients with a small aortic root had a 19-mm anulus, and 124 patients had a 21-mm anulus. The body surface area was, respectively, 1.55 +/- 0.2 m2 and 1.78 +/- 0.45 m2. Hemodynamic evaluation of the stentless valve comprised serial measures of mean gradients, effective orifice area, and left ventricular mass reduction. Complication rates for secondary events were evaluated over a 6-year period. RESULTS: The hospital mortality rate was 3.5%. The mean gradients after the first year were 9 +/- 2 mm Hg and 6 +/- 1.7 mm Hg in patients with a 19-mm and a 21-mm anulus, respectively. Effective orifice area was 1.45 +/- 0.3 cm2 and 1.72 +/- 0.4 cm2. Gradients and surfaces remained stable throughout the study period. Aortic regurgitation was zero to trace. Left ventricular mass at discharge and at 1 year were, respectively, 296 +/- 127 g and 215 +/- 102 g for patients with a 19-mm anulus and 281 +/- 75 g and 236 +/- 15 g for patients with a 21-mm anulus. CONCLUSIONS: Stentless valves are a suitable device for elderly patients with small aortic roots, which leave only mild residual obstruction.

Aged↗
PubMed1999

The deletion genotype of the angiotensin I-converting enzyme is associated with an increased vascular reactivity in vivo and in vitro.

OBJECTIVES: To define a link between the deletion genotype (DD) and vascular reactivity, we studied in vivo and in vitro phenylephrine (PE)-induced tone and the effect of angiotensin II (AII) at physiological (subthreshold) concentrations on PE-induced tone. BACKGROUND: The deletion allele (D) of the angiotensin I-converting enzyme (ACE) has been associated with a higher circulating and cellular ACE activity and possibly with some cardiovascular diseases. METHODS: During cardiac surgery PE-induced contraction was studied in patients with excessive hypotension. In parallel, excess material of internal mammary artery, isolated from patients operated for bypass surgery, was mounted in an organ chamber, in vitro, for isometric vascular wall force measurement. RESULTS: In patients under extracorporeal circulation, PE (25 to 150 microg) induced higher contractions in patients with the DD genotype (e.g., with PE 75 microg: 20.3 +/- 2.9 vs. 11.5 +/- 2.5 mm Hg/ml per min, DD vs. II/ID, n = 15 vs. 30, p < 0.03). In the mammary artery, in vitro, contractions to PE (0.1 to 100 micromol/liter) or AII (1 or 100 nmol/liter) were not affected by the genotype. Angiotensin II (10 pmol/liter) significantly potentiated PE (1 micromol/liter)-induced contraction in both groups. Potentiation of PE-induced tone by AII was significantly higher in the DD than in the II/ID group. CONCLUSIONS: The DD genotype was associated with an increased reactivity to PE in vivo and potentiating effect of exogenous AII in vitro. The higher response to PE in vivo might reflect a higher potentiation by endogenous AII. These data should be considered to understand possible link(s) between cardiovascular disorders and the ACE gene polymorphism.

Aged↗
PubMed1998

The stentless Cryolife-O'Brien aortic porcine xenograft: a five-year follow-up.

BACKGROUND: The 5-year follow-up of CryoLife-O'Brien stentless porcine aortic valve xenografts is presented. METHODS: From August 1991 to August 1996, the valve was used in 366 patients. Patients' ages ranged from 18 to 90 years (mean, 73+/-6 years). Survivors were monitored with Doppler echocardiography before discharge, at 6 months, and then annually by the referring cardiologist. Operative and long-term mortality and morbidity were collected using the Edmunds guidelines for reporting morbidity and mortality after cardiac valvular operations. RESULTS: The study was completed during a 6-month period with a 96.5% follow-up, comprising 999 patient-years for a mean follow-up period of 27 months (range, 3 to 64 months). Operative mortality was 6.5%. Linearized rates per patient-year for complications were as follows: structural valve deterioration (0%); thromboembolism (0.5%); prosthetic valve endocarditis (0.2%); valve reoperation (0.8%); and valve-related mortality (0.2%). Sixteen late deaths have occurred. The actuarial survival rate at 5 years was 83%+/-3.5%. CONCLUSIONS: The Cryolife-O'Brien stentless valve has given excellent early hemodynamic and 5-year results.

Actuarial Analysis↗
PubMed1998

[Acute post-traumatic aortic insufficiency: transesophageal echocardiography in the diagnosis and therapy of the lesions].

A 58-year-old car driver suffered a road accident responsible for severe blunt thoraco-abdominal trauma. Transoephageal echocardiography, performed following the secondary development of a diastolic murmur, confirmed the presence of aortic incompetence due to commissural avulsion and guided the surgical treatment, which consisted of commissural suspension under cardiopulmonary bypass via a mini transverse trans-sternal incision. The rarity of acute aortic valve incompetence following non-penetrating thoracic trauma is illustrated by the data of the literature. This lesion is due to either avulsion of a sigmoid cusp or commissure, or laceration of the valvular tissue. Transthoracic echocardiography confirms the reality of aortic incompetence suggested clinically by appearance of a diastolic murmur, but confirmation of the mechanism of the lesions is based on transoesophageal echocardiography which allows perfectly safe and rapid visualization of the mechanism of the valvular lesion, investigation of associated lesions and guidance of therapeutic management.

Accidents, Traffic↗
PubMed1997

The stentless Bravo 300 aortic porcine xenograft: supra-annular versus annular implantation.

The aim of the study was to compare the supra-annular and intra-annular implantation techniques by evaluating the differences in early haemodynamic outcome (gradients, effective orifice area, regurgitation). Since August 1991, 200 stentless Bravo model 300 valves have been implanted. Patients were divided into three groups of consecutive cases: group 1 (n = 50) represents exclusively intra-annular implantation; group 2 (n = 50) is a transitional period: and group 3 (n = 100) comprises only patients with supra-annular implantation. Significant differences were found (P<0.001) in low postoperative gradients (mean < or = 10 mmHg): 24% in group 1, 42% in group 2, and 95% in group 3. Comparing groups 1 and 3, gradients were lower and effective orifice area was augmented in all valve sizes in group 3. Trivial central regurgitation was present in groups 1-3 (6%, 12% and 0% respectively). Peripheral regurgitation was trivial in 6%, 8% and 0% and mild to moderate in 4%, 2% and 0% (P<0.001).

Animals↗
PubMed1997

Q fever tricuspid valve endocarditis.

Q fever is a zoonosis caused by Coxiella burnetii. The most frequent clinical expression of the chronic form is a bacterial culture negative aortic or mitral endocarditis. A case of tricuspid valve endocarditis due to C burnetii is described, with a favourable outcome after treatment with doxycycline and hydroxychloroquine.

Anti-Bacterial Agents↗
PubMed1996

Tricuspid autograft for mitral-valve repair.

BACKGROUND: Transferring the posterior leaflet of the patient's own tricuspid valve with its subvalvular apparatus to the mitral valve is a new technique that allows a conservative approach to mitral-valve repair. The technique is based on the knowledge that the tricuspid valve can be remodelled from tricuspid to bicuspid, with a very low risk of significant dysfunction. METHODS: We describe six patients (age range 20-70 years) with mitral insufficiency in whom we have used the technique. FINDINGS: All patients survived the operation and were in sinus rhythm. Transoesophageal echocardiography before discharge showed trivial or no regurgitation at the site of mitral repair. Before operation, all patients were in New York Heart Association class III-IV; at follow-up after 6-13 months all patients were in class I-II. INTERPRETATION: Compared with using segments of mitral homografts in similar situations, the intraoperative availability of the tricuspid's viable natural chordae and valvular leaflet means that there are no immunological disadvantages to the procedure. With this new operation, the patient is his own tissue bank.

Adult↗
PubMed1996

Mitral valve repairs using the posterior tricuspid leaflet and chordae. Technique and results.

OBJECTIVE: Some mitral lesions are still out of reach of conventional repairs. Transferring the posterior leaflet of the tricuspid valve with its subvalvular apparatus to the mitral valve is a new autograft technique which has allowed us a conservative approach in cases where repair seemed less predictable. METHODS: After removing the posterior tricuspid leaflet with its subvalvular apparatus, the tricuspid autograft was inserted by implanting its papillary muscle onto the mitral papillary muscle and then by suturing the leaflet tissue in place. The tricuspid valve was subsequently repaired by annular plication and leaflet suture. A tricuspid ring was used in all but the first case. RESULTS: The age of the seven patients ranged from 20 to 70 years. Postoperative controls by transesophageal echocardiography showed no leaks in five and trivial in one on the site of the mitral repair. On the tricuspid valve, we found a moderate leak in the first case and trivial or none in the following cases, where a tricuspid ring was used. With a 3-12 month follow-up the results are stable. CONCLUSIONS: This autograft technique is reproducible, and extends the field of mitral valve repairs. Compared to segments of mitral homografts, we prefer the intraoperative availability of natural chordae and valvular leaflet that have no immunological interference. The patient is his own tissue bank and the tricuspid valve can be repaired with a very low risk of significant dysfunction.

Adult↗
PubMed1996

[Mitral valve repair by transfer of the posterior tricuspid leaflet and its chordae].

Mitral valve repair was performed in six patients by transferring the posterior tricuspid leaflet with its sub-valvular apparatus onto the mitral valve. This new technique considers the tricuspid valve as the patients own tissue bank where the posterior leaflet and eventually the adjacent part of the anterior leaflet is used as a "donor" valve, based on the knowledge that the right atrio-ventricular valve can be efficiently repaired with a very low risk of significant dysfunction. The mitral repair consists of incorporating the tricuspid autograft by securing the tricuspid papillary muscle to the mitral papillary muscle and by suturing the leaflet tissue where required. A mitral annuloplasty ring reinforces the repair. The tricuspid valve is subsequently repaired by annular plication and leaflet suture. A tricuspid ring is necessary to maintain efficient remodeling. The six patients ages ranged from 20 to 70 years. A etiology, was rheumatic in the first case and degenerative in the following. In three cases, sterilised endocarditis was responsible for ruptured chordae and leaflet destruction. The mitral insufficiency was located in a commissural area in 4 cases, and was due to a widespread posterior prolapse in 2. Post-operative control transesophageal echocardiography confirmed the excellent results of the repair and proved that, in selected cases, the tricuspid leaflet inserted onto the mitral apparatus is very efficient in correcting mitral insufficiency, without causing significant tricuspid impairment. With a 3 to 7 month follow-up, the results are stable.

Adult↗