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Biomedical subjects

Y Lecompte

Publications and source records attributed to Y Lecompte.

At least 73 records · Page 4Linked to original sources
PubMed1982

[Surgery in complex forms of transposition of the great vessels: long-term results in a series of 100 cases].

A series of 100 patients with complex forms of transposition of the great arteries (TGA) were operated upon over a 10 year period. Group 1 consisted of 13 TGA with pulmonary stenosis (PS), usually treated by an atrial baffle and direct repair of the stenosis. There was no operative or late mortality in this group and the long-term results were generally good (10/13). Group II comprised 29 TGA with ventricular septal defect (VSD) and PS. Seven Rastelli procedures gave 4 good results. Twenty two operations, associating atrial baffle, repair of VSD and PS (17 direct procedures, 5 left ventricle-pulmonary artery tube) were associated with a high mortality (5 operative and 4 late deaths) and 10 good long-term results. Group III comprised 58 TGA with VSD. Up to 1977 (n = 33) treatment consisted of atrial baffle + repair of VSD +/- removal of previous banding. Mortality was high (11 operative and 8 late deaths) with only 8 good long-term results. Since 1977, these patients have been treated by complete anatomical repair, the operative mortality of which is higher in the period under study (9/23) but the long-term results are much better. The surgical indications in our Department are based on the analysis of these results. In Group I only very significant PS is treated, either by left ventricle-pulmonary artery tube or direct repair depending on the form of the stenosis. In Group II, where the results based on atrial baffle are poor, a Rastelli procedure is preferred and especially its variants which avoid the use of prosthetic materials on the pulmonary trunk. In Group III, anatomical correction at the level of the great arteries is the routine procedure, the only point of discussion being the possibility of prior banding.

Adolescent↗
PubMed1982

Reconstruction of the pulmonary outflow tract without prosthetic conduit.

New techniques of correction of complex congenital anomalies, avoiding the use of prosthetic conduits, are presented. In transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis, the technique comprised the resection of infundibular septum, the suturing of an intraventricular baffle directing blood from the left ventricle to the aorta, and the reconstruction of the pulmonary outflow tract by direct implantation of the posterior rim of the pulmonary arterial trunk on the right ventricle, completed by an anterior patch. In most cases, the pulmonary bifurcation was translated anterior to the ascending aorta. This technique was feasible even in infants and in patients with a small VSD. Thirteen patients, from 3 months to 8 years of age, were treated by this technique, with four deaths, one residual VSD (reoperated), and eight good results (4 to 16 months). A similar repair was used in three cases of double-outlet right ventricle (DORV) with subpulmonic VSD and pulmonary stenosis or pulmonary artery banding, with two operative deaths and one good result. The same technique of pulmonary outflow tract reconstruction was used in four cases of truncus arteriosus. Two deaths were attributed to severe pulmonary regurgitation, a complication which should be prevented in future cases by a reliable method of inserting a valve in the pulmonary outflow tract. In pulmonary atresia with VSD and absent pulmonary trunk, the continuity between the right ventricle and the pulmonary branches was established via an arterial tube resected from the ascending aorta. This technique was successfully used in one child with extremely small pulmonary branches. These preliminary results led us to conclude that many complex congenital cardiac anomalies can be effectively treated without a prosthetic conduit.

Child, Preschool↗
PubMed1982

[Results of surgical treatment of aortic coarctations in the 1st 6 months of life. Apropos of 142 cases].

142 infants under 6 months of age were operated on for coarctation of the aorta from 1972 to 1978. Coarctation was isolated in 46 (32.4%) and associated with another heart defect in 96. Surgery was decided upon because of congestive heart failure sometimes associated with arterial hypertension refractory to medical treatment: 9 patients died during surgery. 89 underwent Crafoord's operation and in 44 ligature of the subclavian artery or aortoplasty using the subclavia were carried out. Early postoperative death rate was 30.9% and 13 patients (13.2%) died later. Recoarctations occurred in 25 patients (27%); more than half of these patients were less than 1 month-old at the time of surgery. Recoarctation was more frequent (46.4%) in cases with than in cases without (18.7%) aortic hypoplasia and it was more severe (5 out of 7 deaths) when there was an associated cerclage resulting in a double obstacle to right and left ventricles ejection.

Aortic Coarctation↗
PubMed1982

[Iatrogenic arteriovenous fistulas in infants].

Iatrogenic arteriovenous fistulas in infants are usually due to an arterial puncture performed in the neonatal period. On the occasion of 5 cases who were operated on, the peculiar features of these fistulas are established. Surgery consists of endo-aneurysmorrhaphy.

Arteries↗
PubMed1982

[Cor triatriatum: results of surgical treatment. A propos of a series of cases].

Cor triatriatum is a rare heart defect that may be surgically repaired, with good results when preoperative diagnosis is correct. Ultrasonography, angiography and catheterism reduce preoperative diagnostic errors such as abnormal pulmonary venous return. The authors report their experience with 7 cases, and discuss diagnostic problems and causes of errors.

Angiography↗
PubMed1981

[Anatomic correction of transposition of the great vessels with interventricular communication. A series of 24 consecutive operations].

The results of surgical correction at arterial level in 24 cases of transposition of the great arteries with ventricular septal defect are reported. The majority of children (19/24) had undergone previous pulmonary artery bonding between the ages of fifteen days and 3 months (average 1,5 months). Surgical correction was performed on average 14 months later. This consisted of repair of the ventricular septal defect and arterial shift to reestablish ventriculoarterial concordance with reimplantation of the coronary arteries. In the last 9 cases no prosthetic materials were used on the right outflow tract. The operative mortality was 9/24 (6 of the first 12, and 3 of the last 12 cases). The cause of death was due to associated lesions, congenital (coarctation of the aorta, mitral valve malformation), or iatrogenic related to previous surgery (stenosis of the right ventricular infundibulum). Left ventricular failure was common despite preparation with pulmonary artery banding and merited systematic treatment mainly with arterial vasodilator therapy and prolonged ventilatory assistance. The surviving children are asymptomatic without treatment. Control catheter studies did not show any significant abnormality except in one case of pulmonary hypertension. The exceptional quality of these results, the absence of prosthetic material and the hope of reducing avoidable mortality justify this approach to surgical cure of the malformation. Preparation by pulmonary artery banding and the use of this method in "simple" forms of transposition are questions which remain open to discussion.

Child, Preschool↗
PubMed1981

[Heterotopic cardiac allograft in the newborn piglet (author's transl)].

Heterotopic cardiac allografts were performed in unrelated Large White piglets to test (i) if such a technique could be used in young (12 days) and neonates (less than five days); (ii) if tolerance to histocompatibility antigens could be induced by donor-cells injection to piglets that were immunosuppressed with heterologous antilymphocyte serum (ALS). The experimentation included two different series. The first one involved ten allografts done in early weaned (10 days), 12-day-old piglets (mean live weight 3.5 kg). They received or not ALS 2 ml per kg per day by subcutaneous route during five consecutive days after transplantation. In addition, two of the ALS treated piglets received endovenously, on day 7 after transplantation, cryoconservated cells from the spleen of the heart-donor. The second series involved ten allografts performed in suckling piglets just after birth at a mean live weight of 1.4 kg. These animals were first thymectomized at day 0 (6 h to 44 h after birth), and then received ALS (4 ml per kg by intraperitoneal route) on day 1. The heterotopic cardiac allograft was performed on day 2. Out of them, two received endovenously, on day 3, conservated splenic cells from the heart donor. In both series the heterotopic cardiac allograft was done, after right nephrectomy, anastomosing the donor thoracic aorta end to side to the recipient abdominal aorta, and the donor pulmonary artery end to side to the recipient inferior vena cava. From the surgical point of view, it appeared that the heterotopic cardiac allograft was easy to perform, and successful in most cases, in 12-day-old piglets. The same operation in neonates was as easy to perform as in older animals, but most failed to survive due to hemorragic leakage and post operative shock (repetitive anesthesia, insufficient suckling). From the immunological point of view, we failed to obtain any active enhancement of heart allograft with significant prolongation of the survival of the allogenic heart allograft (electro-cardiogram from epicardic electrodes). Rejection usually occurred in 6 to 8 days whatever the treatment (ALS with or without splenic cells from the donor, or nothing).

Animals↗
PubMed1981

Anatomic correction of transposition of the great arteries.

A new technique of anatomic correction of transposition of the great arteries with ventricular septal defect is presented. The procedure described, which avoids the use of a prosthetic conduit in the reconstruction of the pulmonary outflow tract, has been used in nine consecutive patients. Six remain alive and well 4 to 24 months postoperatively. Details and illustrations of the technique utilized are presented. Avoiding the use of a prosthetic conduit in the procedure re-established the basic appeal of arterial correction of transposition of the great arteries with ventricular septal defect.

Heart Septal Defects, Ventricular↗
PubMed1980

Control of acid-base status during hypothermia in man.

Rahn's concepts of acid-base balance during hypothermia were tested in humans by studying eleven men who required extra-corporeal cooling for surgery. Hypothermia was moderate (27-28 degrees C) and maintained for 60-70 min. Extracorporeal blood perfusion (ECBP) was performed with a bubble-oxygenator which allowed changes in blood flow and gas concentrations. Arterial pH (pHa) at the person's body temperature was controlled by varying CO2 flow to the oxygenator in order to maintain in vitro pH measured at 37 degrees C in the normal range. During hypothermia and after rewarming to 37 degrees C, bicarbonate concentration and total CO2 content of arterial and mixed venous blood remained constant. A physiologic solution was introduced into the peritoneal cavity which was used as a tonometer; the values of equilibrated CO2 content in peritoneal fluid were constant. Neither metabolic acidosis nor hypercapnia developed. Blood acid-base balance in vivo during hypothermia was therefore identical to the behavior of blood in vitro. In addition, the interpretation of the results of acid-base studies, in humans with abnormal central temperature is facilitated when measurements are performed at 37 degrees C.

Acid-Base Equilibrium↗