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U Hvass

Publications and source records attributed to U Hvass.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Coronary-cardiac fistula as a cause of tricuspid endocarditis treated by mitral homograft].

The authors report a rare case which is interesting from three points of view: tricuspid valve endocarditis in a child complicating a fistula between the right coronary artery and right ventricle with negative blood cultures but a positive serology for Coxiella burnetii. This mutilating tricuspid endocarditis was complicated by multiple pulmonary embolism of the right lung. After two months of antibiotic therapy the coronaro-cardiac fistula was closed and the tricuspid valve replaced with a mitral homograft. All cases of blood culture negative endocarditis require serological investigation to detect intracellular organisms which are difficult to diagnose and justify specific prolonged antibiotic therapy. Control serological tests are essential in the long-term because of the risk of chronic infection, especially in cases with prosthetic intracardiac material. Treatment, based mainly on tetracyclines, should be continued for at least two years.

Anti-Bacterial Agents↗
PubMed1996

[Pulmonary valve replacement for endocarditis. Apropos of 2 cases].

The authors report two cases of pulmonary valve endocarditis which required emergency surgical treatment. A 74 year old patient with trivalvular endocarditis (pulmonary, aortic, mitral), due to Sptreptococcus D bovis, developed cardiogenic shock with acute pulmonary oedema and underwent double aortic and pulmonary valve replacement with Carpentier-Edwards prostheses and simple resection of a mitral valve vegetation. Another 36 year old drug addict developed isolated pulmonary valve endocarditis due to Staphylococcus aureus infection complicated by pulmonary regurgitation with right ventricular failure and by septic pulmonary embolism with persistent sepsis: he underwent pulmonary valve replacement with a Bravo 300 bioprosthesis. The postoperative course was uncomplicated in both cases, with interruption of the infection and normalisation of the haemodynamic status. The insidious and severe nature of pulmonary valve endocarditis is demonstrated by these two cases, confirming previous reports which have underlined the poor prognosis of this condition. Surgery has been shown to be effective and well tolerated and should be integrated early in the therapeutic strategy, the results being all the better when an aggressive attitude is taken.

Adult↗
PubMed1996

Mitral homograft for tricuspid valve endocarditis complicating a congenital fistula between the right coronary artery and right ventricle.

The authors report a case of tricuspid endocarditis complicating a congenital coronary artery fistula to the right ventricle in an eight-year-old female. The patient underwent valve replacement using a cryopreserved mitral homograft. Six months later, clinical and echocardiographic status are excellent. Using a mitral homograft for tricuspid endocarditis is a recognized approach in adults, whereas in pediatric cases it is exceptional. Homografts could prove to be a valid procedure in children when repair is not feasible, although one could expect a more rapid deterioration.

Child↗
PubMed1996

[Repair of post-infarction left ventricular wall ruptures by biological glue and a flap from the pericardium. Results from 2 to 10 years].

The authors report their experience with a simple and efficient technique for repair of left ventricular free wall rupture complicating myocardial infarction. The technique consists, with the aid of cardiopulmonary bypass, in suturing a plaque of the patients own pericardium (6 to 8 cm in diameter) to the more normal tissue encircling the pathologic myocardium, and by injecting five ml of human fibrin glue as a cement under the pericardium to reinforce the remair and prevent leaking throughout the suture line. With a 10 year follow-up, we are able to be confident with the long term results. The five patients, at the time of operation were aged 46 to 74 years. The post-operative results and the annual echocardiographic controls have proved the technique to be sound without recurrences and without late complications such as pseudo aneurysms at the site of the repair.

Aged↗
PubMed1995

[Valve replacement with porcine bioprosthesis without rigid frame].

The most physiological stent for an aortic valve is the aortic root itself. This premice explains why so many teams are becoming interested in stentless biological valves. These valves are expected to enhance long term durability by diminishing the mechanical stress which is linked to prosthetic stents. Inspite of these long term perspectives it still has to be shown that these stentless valves can be used on a routine basis and that eventual technical operative difficulties should not outrule the expected long term advantages. The work conducted at the Bichat hospital in Paris shows that the Bravo 300 porcine stentless valve is easy to handle and is becoming a reference in its field.

Animals↗
PubMed1995

Clinical study of normothermic cardiopulmonary bypass in 100 patients with coronary artery disease.

During normothermic cardiopulmonary bypass (CPB), the body temperature is maintained at 37 degrees C. Since 1987, it has been our standard practice to use normothermic CPB in our patients undergoing a cardiac operation, and our experience now consists of more than 3,000 consecutive patients. Myocardial protection is achieved through the combination of cold intermittent antegrade blood cardioplegia, no topical cooling, and a terminal "hot shot" of blood cardioplegia. We disagree with the stance of the Toronto group that normothermic CPB requires the administration of large volumes of cardioplegic and crystalloid solutions and the frequent use of phenylephrine hydrochloride to ensure a low systemic vascular resistance. To establish a routine technique of cold heartwarm body bypass, we conducted a clinical study in 100 consecutive patients with coronary artery disease. We found that the total cardioplegia volume needed in our patients was 1,946 +/- 257 mL, versus 4,700 +/- 1,900 mL in the Toronto study, and an additional crystalloid volume loading of 400 +/- 141 mL during CPB was needed in 26% of our patients, versus a total volume of 3,650 +/- 800 mL in the Toronto series. Phenylephrine (250 micrograms) was used in 16% of our patients, versus 88% of the patients in the Toronto study (mean dose, 1.3 mg). During normothermic CPB, the mean radial arterial pressure was 57.3 +/- 9.4 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Temperature↗
PubMed1995

The O'Brien-Angell stentless porcine valve: early results with 150 implants.

From August 1991 to June 1994, 150 patients underwent aortic valve replacement with the O'Brien-Angell stentless porcine xenograft (Bravo Cardiovascular Model 300, Cryolife, Atlanta, GA). To establish trends we analyzed three consecutive groups of 50 patients. We found significant differences in low postoperative gradients (mean < or = 10 mm Hg): 24% in group 1, 42% in group 2, and 96% in group 3. Comparing groups 1 and 3, gradients were significantly lower in all valve sizes. The difference is credited to better supraannular positioning of the valve, which is the key to the learning curve. Trivial central regurgitation was present in the three groups at 6%, 12%, and 0%, respectively. Peripheral regurgitation was trivial in 6%, 8%, and 0%, and mild to moderate in 4%, 2% and 0%, respectively. Seventy-eight of 107 patients with an available follow-up exceeding 1 year had noninvasive controls. Two early cases with moderate perivalvular leaks evolved to moderately severe leaks. Two valves were explanted. The O'Brien-Angell stentless valve is easy to handle and correct supraannular positioning provides excellent hemodynamic results.

Adult↗
PubMed1995

Abdominal aortic aneurysms: assessment with gadolinium-enhanced time-of-flight coronal MR angiography (MRA).

A prospective study was performed to evaluate the efficacy of a gadolinium-chelate-enhanced MR angiography (MRA) using a coronal acquisition in the preoperative assessment of aneurysms of the abdominal aorta (AAA). Twenty patients with AAA were explored with MR using a two-dimensional (2D) time-of-flight MRA technique with a coronal acquisition, before and after intravenous administration of 0.1 mmol/kg of a gadolinium-chelate. Gadolinium-chelate-enhanced MRA with a coronal acquisition decreased deleterious saturation effects within aorta and iliac arteries in 16 of 20 patients (80%) and improved the overall quality of the images of the upper and lower parts of the AAA (i.e. extent of the aneurysm). Furthermore, gadolinium-chelate-enhanced MRA with a coronal acquisition allowed a better differentiation between slow flow and mural thrombus. Gadolinium-chelate-enhanced MRA had a sensitivity of 100% and a specificity of 96% for evaluation of renal artery involvement, and a sensitivity of 93% and a specificity of 100% for iliac artery involvement. The results of this study show that gadolinium-chelate-enhanced MRA obtained with a coronal acquisition is efficacious for the preoperative assessment of AAA.

Aorta, Abdominal↗
PubMed1995

Thoracic aortic dissection: diagnosis with transesophageal echocardiography versus MR imaging.

PURPOSE: To compare transesophageal echocardiography (TEE) and magnetic resonance (MR) imaging in the diagnosis of dissection of the thoracic aorta. MATERIALS AND METHODS: Thirty-one consecutive patients with clinically suspected aortic dissection and 10 postoperative patients underwent transesophageal color Doppler echocardiography and MR imaging. Imaging results were compared at independent double-blind readings. Final diagnosis was obtained from consensual review of all corroborative studies. RESULTS: MR imaging depicted the intimal flap in 95% of aortic dissections; TEE, in 86% (P < .05). In surgical patients, the sensitivity of MR in detection of residual dissection was 100% versus 86% with TEE (P < .05). The inferior extent of the dissected lumen was seen only with MR imaging. False-positive results occurred in two cases with TEE and in one with MR imaging. CONCLUSION: MR imaging is superior to TEE in the evaluation and follow-up of dissection of the thoracic aorta. Because the availability of MR is limited, however, TEE should remain the standard modality for diagnosis.

Adult↗
PubMed1995

Cardiac valve replacement in relapsing polychondritis. A review.

Cardiac valve replacement is a rare but not exceptional eventuality in patients with relapsing polychondritis. One case requiring aortic and mitral valve replacement and its follow up is described. From the review of the literature an additional twenty patients who required cardiac valve replacement are analyzed. The mean delay between the first onset of relapsing polychondritis and operation was 6.51 years and the mean age at operation was 38.8 years. There was a preponderance of male patients (73.7%). Aortic and mitral valves were replaced in 100% and 28.5% of patients, respectively. During the four first postoperative years 23.8% of them were reoperated for periprosthetic leak or aortic aneurysm, and during the same period 52.6% died of a cardiovascular cause. Immunosuppressive agents should be employed in patients with relapsing polychondritis and cardiovascular involvement because they seem to be more effective than steroids in severe forms of the disease. Therefore, we recommend close and prolonged follow up: firstly because there can be early paravalvular prosthetic leakage due to the friability of the tissue to which it has been anchored; secondly because aortic aneurysms occur frequently in relapsing polychondritis, may be multiple, may involve all parts of the aorta and result in fatal rupture even in asymptomatic patients; and thirdly because there can be a fatal outcome due to other organ involvement, like airway obstruction, acute glomerulonephritis, or systemic vasculitis. Prophylactic composite graft replacement of the ascending aorta associated with replacement of the aortic valve and re-implantation of the coronary arteries could avoid the need for reoperation in these high risk patients.

Adult↗
PubMed1994

Successful resection of giant intrapericardial lipoma.

We report a case of giant extracavitary cardiac lipoma weighing 4,800 g. The mode of presentation, the preoperative evaluation, and the radiographic features are presented. The surgical management of this very rare cardiac pathology is discussed. This is one of the largest cardiac tumors ever reported.

Adult↗
PubMed1994

The O'Brien-Angell stentless valve. Early results of 100 implants.

From August 1991 to May 1993, 100 unselected consecutive patients in whom an aortic bioprosthesis was indicated underwent aortic valve replacement with the O'Brien-Angell stentless porcine xenograft (Bravo Cardiovascular Model 300). The indication was calcified aortic stenosis (AS) in 62 cases (isolated in 44, with associated cardiac lesions in 18), aortic insufficiency in 24 cases (isolated in 13 with associated cardiac lesions in 11), and redo operations in 14 cases. Forty-four percent of the patients were over 70 years of age. With the recommended supra-annular single running suture technique, the aortic cross-clamp times in isolated procedures ranged from 32 to 70 min, mean 39 min. Valve function was studied by echocardiography in 92 patients. Early post-operative transvalvular gradients were usually in the low range, below 15 mmHg in 68% of the cases. Isolated central valvular regurgitation was absent in 60.8%, "microscopic to trivial in 31.5% and mild to moderate in 1.2%. Perivalvular regurgitation was absent in 65.2%, microscopic to trivial in 26.2% and mild to moderate in 3.2%. Thirty-five of 40 patients with follow-ups exceeding 6 months had non-invasive controls. Transvalvular gradients showed a 30 to 40% reduction when compared to the immediate postoperative values. There were no new isolated central regurgitations but in two cases previously mild-to-moderate perivalvular leaks evolved to moderately severe leaks. Two valves were explanted, one for rupture of a Prolene 4/0 and one due to a slack Prolene 4/0 suture. We consider that the O'Brien-Angell stentless valve was easy to handle in all situations encountered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Incidence and prognosis of early primary cardiogenic shock in myocardial infarction].

The aim of this retrospective study was to analyse the results of coronary reperfusion on the incidence and short and medium term prognosis of early primary cardiogenic shock in acute myocardial infarction. Of 339 consecutive patients admitted within 6 hours of the onset of acute myocardial infarction, 25 (7.4%) had cardiogenic shock from the onset. The majority of patients (18) underwent direct angioplasty with a successful result in 16 cases. Intravenous thrombolysis was instituted in 5 cases followed by emergency coronary angiography leading to "rescue" coronary angioplasty in 3 cases, which was successful in 2 cases. Two patients had no coronary revascularisation because of a double contra-indication to thrombolysis and catheterization by the femoral approach. Intra-aortic balloon pumping was used in 17 cases. Complementary emergency surgical revascularization was necessary in 5 patients (20%). In all, early reperfusion of the infarct-related artery was obtained in 80% of cases (20 patients). The hospital mortality was 72% (18 patients) due to refractory cardiac failure in nearly all cases. After an average follow-up of 17 months, 3 of the 7 survivors of the hospital period have died and of the 4 remaining patients, 2 are in the NYHA classes III or IV. Recent therapeutic advances have not influenced the incidence of cardiogenic shock but have significantly increased the proportion of very early cardiogenic shock, whereas the late cardiogenic shocks of more progressive onset, have nearly disappeared (4/339, 1.2% in this series). The prognosis of these early shocks, caused by severe myocardial damage, remains catastrophic and hardly improved by emergency coronary reperfusion by angioplasty and intraaortic balloon pumping.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Thromboses of heart valve prostheses: predisposing and prognostic factors based on a study of 41 patients].

Forty one patients were admitted with a diagnosis of prosthetic valve thrombosis. One patient was thrombolyzed successfully, and 40 underwent surgical procedures. In 13 cases, prosthetic valve thrombosis occurred in the first month after valve replacement. 18 patients were in functional class IV of the NYHA classification. Among the thrombosed prostheses, 91% were mechanical, and 61% in mitral position. Adequacy of anticoagulation was the most important risk factor, as this treatment was inappropriate in 20 patients. In 10 other patients, it had been changed for medical (bleeding events, pregnancy) or surgical (non cardiac surgery) reasons. The perioperative mortality rate was high (32.4%). It was 12% in patients in functional class II and 46% in those in class IV (p < 0.05). This underlines the value of early diagnosis, in which echocardiography, especially with a transesophageal probe, takes a major place, allowing prompt surgical treatment.

Adult↗