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Biomedical subjects

U Hvass

Publications and source records attributed to U Hvass.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Thrombosis of heart valve prostheses: favourable 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 thrombolysed 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 anti-coagulation 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↗
PubMed1992

Desmopressin has no beneficial effect on excessive postoperative bleeding or blood product requirements associated with cardiopulmonary bypass.

Cardiopulmonary bypass during open-heart surgery is sometimes associated with excessive perioperative bleeding. Following a non-randomized study suggesting that desmopressin acetate (desmopressin) reduced blood product requirements in these patients, we conducted a double-blind, placebo-controlled randomized trial of desmopressin (0.3 micrograms/kg, i. v.) in 92 patients with overt bleeding and a prolonged bleeding time. Mean blood loss during the first 24 h post-treatment was similar in the desmopressin and placebo groups (582 vs 465 ml, respectively; p = 0.15). Red-cell (p = 0.76), fresh frozen plasma (r = 0.66) and platelet unit (p = 0.74) requirements were also similar. The haemostatic effect of desmopressin has been attributed to the release of von Willebrand factor (vWF) and a reduced bleeding time. In our study, vWF and factor VIII:C levels increased while the bleeding time decreased significantly at 90 min and 24 h in both groups and, although vWF and factor VIII:C levels were slightly higher in desmopressin-treated patients at 90 min, the difference was not significant. Thrombin-antithrombin III complex, fibrinogen degradation product and tissue plasminogen activator levels, reflecting activation of the coagulation and fibrinolytic systems, respectively, decreased uniformly in both groups. We conclude that desmopressin is not useful in reducing blood loss or blood product requirements in patients with excessive immediate postoperative bleeding.

Adolescent↗
PubMed1992

Bicaval pulmonary connection in tricuspid atresia using an extracardiac tube of autologous pediculated pericardium to bridge inferior vena cava.

From August 1989 to April 1991, four children, 1.5 to 4 years old with type IIb tricuspid atresia underwent total right heart bypass by means of a bicaval pulmonary connection using an extracardiac conduit of pediculated pericardium between the inferior vena cava and the main pulmonary artery. The tube was made from a large rectangular flap of the patient's own pericardium, pediculated along the right border, ensuring a vascular supply. The diameter of the tube, calibrated on a Hegar probe, equals that of the inferior vena cava, and the length is adapted to bridge the gap between the inferior vena cava and the main pulmonary artery. All four patients had an uneventful postoperative course. Assisted ventilation was stopped on the next morning and the chest tubes removed on the 2nd or 3rd day. The liver was only moderately enlarged and no pleural effusions developed. Sinus rhythm was permanent. Echocardiographic monitoring 6-10 months after the hospital discharge showed patent tubes, no collapse during the cardiac cycle, and no wall thickening and a laminar flow. The advantages of the pediculated pericardial tube are that no prosthetic material is used. There is no thrombogenicity or antigenicity. These tubes retain a growth potential, and we believe that this material is suitable for use in young patients.

Child, Preschool↗
PubMed1992

[Extracardiac pulmonary bypass in the treatment of tricuspid atresia].

Six patients aged 1.5 to 4 years with type 13 tricuspid atresia underwent extracardiac bicavopulmonary repair. This corrective procedure comprises control of palliative aorto-pulmonary anastomosis, the construction of an anastomosis between the superior vena cava and right pulmonary artery and the interposition of an extracardiac tube of autologous pediculated pericardium between the inferior vena cava and the main pulmonary artery. This tube, fashioned from a rectangular flap, remains attached along its right border, conserving its vascular pedicle with the pericardium. Its diameter is calibrated to that of the inferior vena cava. The postoperative course was uncomplicated: all children survived. Assisted respiration was discontinued 24 to 36 hours after surgery, and the pleural drains withdrawn after 48 to 72 hours. The rhythm remained sinusal. Central venous pressure ranged from 8 to 12 mmHg. Peripheral arterial situation was over 95%. At follow-up at 3 to 15 months, the children were very active, reflecting good exercise capacity. Holter monitoring was normal. Saturation was 94 to 97%. Doppler echocardiography showed laminar blood flow. This technique insures good venous drainage without any prosthetic thrombogenic material. In addition, the pediculated pericardium conserves a potential for growth, justifying its use in small children. Long-term evaluation is essential but the initial results are encouraging and encourage perseverance with this method.

Anastomosis, Surgical↗
PubMed1991

[Interrupted aortic arch. A series of 15 patients].

Between 1983 and 1989, 15 children underwent surgical repair of interrupted aortic arch at 1 to 20 days of age. The anatomical form was a Celoria and Patton type B in all patients with an associated perimembranous ventricular septal defect in all but one who had multiple ventricular septal defects, and patent ductus arteriosus. Six children had a retro-esophageal right subclavian artery, two had subaortic stenosis and two had a right-sided descending thoracic aorta. In two children with severe hypoplasia of the ascending aorta the repair was performed in one stage with two deaths due to left ventricular failure. In the other B cases, a two-stage repair was carried out. The reconstruction of the aortic arch varied according to the individual case. All children had pulmonary artery banding. Seven children survived longer than 30 days. Six of them later underwent a complete repair. The only survivors were those patients in whom the neo-aortic arch grew harmoniously. The authors conclude that: a two-stage repair gave disappointing results in this series of consecutive patients, mainly because of the poor quality of the reconstruction of the aortic arch by thoracotomy.

Anastomosis, Surgical↗
PubMed1991

[Early results of coronary surgery in patients between 71 and 80 years of age].

One hundred consecutive patients aged 71 to 80 without other cardiac pathology underwent coronary bypass surgery by the same surgical team between January 1986 and May 1989. These patients were recruited from a group of 687 patients undergoing coronary bypass surgery in the same period. The indication was always based on the severity of clinical symptoms resistant to medical therapy. Recent unstable angina despite triple therapy was a particularly common indication in this group of patients (61%). Preoperative coronary angiography showed a high incidence of triple vessel (62 cases) and left main stem disease (23 cases). Double vessel (12 cases) and single vessel disease (3 cases) were less common. Preoperative myocardial infarction was observed in 35% of cases; the site was nearly always on the inferior wall. In all, 230 bypasses were performed including 23 internal mammary artery bypasses (average 2.3 bypasses per patient). Six patients developed perioperative myocardial infarction confirmed by ECG and a rise in cardiac enzymes in 4 cases and by a rise in the cardiac enzymes alone in 2 cases. The mortality was low in this group of patients (3%). This was due to strict selection of patients in this age group and also to the improvement in the techniques of myocardial protection, anaesthesia and intensive care. Our results justify the operative indications in this group of patients in whom medical therapy has failed.

Age Factors↗
PubMed1991

[Phrenic nerve palsy after heart surgery. The Bichat Hospital experience].

The frequency of phrenic nerve palsy varies from 2.5 to 8.3%, according to different authors. Contact of the phrenic nerve with cold (ice or saline) seems to be the most frequent etiology. This study points out that good insulation between phrenic nerve and ice slush, used in the pericardium, results in almost complete disappearance of this complication, which is not a benign one, as emphasized by the two deaths in our series.

Adolescent↗
PubMed1989

[Immediate postoperative results following conservative surgery of rheumatic mitral valve insufficiency in children].

The immediate post-operative results of conservative surgery were evaluated objectively in 31 children aged under 13 years referred to us for surgical correction of severe rheumatic mitral valve regurgitation. 16 patients had pure mitral regurgitation. In the others, lesions which required additional surgery were aortic regurgitation in 7 cases, tricuspid of the mitral valve and left ventricle was studied by two-dimensional TM-mode echocardiography. This examination was combined with a pulsed doppler study in search of a possible residual mitral regurgitation signal, with special attention to the depth at which it was recorded in the left atrium -- a semi-quantitative indication of the severity of residual leakage. Two mitral valve replacements were performed, and two early reoperations were needed for residual regurgitation developed between the 5th and 8th post-operative days. Three deaths occurred due to supra-systemic pulmonary arterial hypertension. The post-operative evaluation of mitral valvuloplasty results therefore involved 25 patients. In the absence of significant residual mitral regurgitation, two-dimensional echocardiography was inconclusive since the images obtained varied considerably according to the surgical procedures performed. There was a distinct reduction of end-diastolic diameters (43.5 +/- 5.9 versus 62.1 +/- 8.7 mm pre-operatively), reflecting the disappearance or marked decrease of the pre-operative ventricular volume overload consecutive to mitral regurgitation. The reduction of end-systolic diameters was also significant (31.2 +/- 6.7 mm versus 39.2 +/- 7.1 mm pre-operatively), though less pronounced than that of end-diastolic diameters, which explains the diminution observed in the percentage of fibre shortening, although the figures remained within normal limits (28.7 +/- 9.7 p. 100 versus 37.0 +/- 6.8 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1989

[Subaortic fibromuscular tunnel following resection of accessory mitral tissue. Surgical treatment].

When accessory mitral valve tissue obstructs the left ventricular outflow tract resection is considered a sufficient and definitive procedure. We report the unusual case of a child who had undergone such resection at the age of 4 years and who developed, over a few years, a recurrent subvalvular aortic obstacle consisting, this time, in a fibromuscular tunnel. In a second operation performed at the age of 12, a septal patch was inserted to widen the subaortic channel which was approached through a trans-septal infundibular route. Control examination showed a satisfactory pressure gradient and a sinus rhythm.

Child, Preschool↗
PubMed1989

[Abnormalities of the aortic arch in adults. A rare cause of tracheo-oesophageal compression. Apropos of 2 cases].

Two cases of symptomatic aortic arch anomalies in adults are reported: a case of Neuhauser's ligamentum arteriosum with compressive retro-oesophageal diverticulum, and a case of double aortic arch revealed by postoperative tracheal compression. In both cases, surgical correction was made very difficult by the aneurysmal progression of the compressive vascular anomalies and resection of the thoracic aorta under cardiopulmonary by-pass was necessary. These therapeutic difficulties therefore highlight the differences between aortic arch anomalies in adults and those in infants which can be simply and effectively treated with no mortality in our experience. These observations argue in favour of systematic surgical correction of any aortic arch anomalies in infants, even when they are responsible for few symptoms.

Adult↗
PubMed1988

[Conservative surgery of rheumatic mitral insufficiency in children. Remote results].

Between 1977 and 1986, 38 children aged from 3.8 to 16.4 years underwent mitral valvuloplasty for symptomatic mitral valve incompetence of rheumatic origin. Two children (5.3 per cent) died in the immediate post-operative period, and 6 were lost sight of. Among the 30 children followed up for a mean period of 3.3 years, 6 were reoperated upon within 5 months of the valvuloplasty, 5 still present with a significant residual mitral valve incompetence and 9 have satisfactory clinical and echocardiographic results. Survival rate and survival rate without reoperation at 4 years were 93.8 per cent and 76.1 per cent respectively. Factors that correlated with the quality of long-term results were pre-operative left ventricular myocardial fibre shortening rate and surgical technique (poor results were obtained in children who had only one annuloplasty or none).

Adolescent↗
PubMed1988

[Surgical treatment of infectious endocarditis on a native valve. Apropos of 71 cases].

The results of surgery in a series of 71 patients operated upon for infective endocarditis on a native valve are presented. The patients' mean age was 35 years; the initial focus of infection was usually located in the mouth and the most frequent pathogens were staphylococci and streptococci. The aortic valve was most frequently involved. Only 26 patients underwent surgery after 40 days of antibiotic therapy; 34 were operated upon in a semi-emergency and 11 in an acute emergency. Pre-operative systemic embolism was common (20 cases), notably in the brain (17 cases), and 11 patients remained with sequelae. There was good correlation between the anatomical lesions found at surgery and the data obtained from pre-operative echocardiography. The operation was performed on one valve in 40 cases, on two valves in 20 cases and on three valves in 11 cases. Bioprostheses were used more often than mechanical prostheses. Hospital mortality was nil in patient who underwent elective surgery; it was 14.7 p. 100 in those operated upon in a semi-emergency and 27.3 p. 100 in those operated upon in an acute emergency. Nine patients developed late complications, mostly within 6 months of the operation; in particular, prosthesis disinsertion occurred in 4 cases, and progression of a pre-existing left cardiac failure was observed in 2 cases. In their conclusions the authors emphasize the reliability of echocardiography and the need for an early operation in cases with haemodynamic disorders in order to avoid severe myocardial failure and, if possible, systemic embolism and its fearsome sequelae.

Adolescent↗