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PubMed1976

Clinical and hemodynamic findings following prosthetic valve replacement for mitral valve disease. A study of patients with the new Björk-Shiley tilting disc valve.

Clinical and hemodynamic results have been evaluated 12--24 months after mitral valve replacement with the new Björk-Shiley tilting disc valve prosthesis. After operation, most patients were improved symptomatically and were classified as I-II (N.Y.H.A.). No patient became worse. Hemodynamic status at rest showed significant reduction in pulmonary capillary venous pressure, pulmonary artial pressure and significant increase in cardiac output when compared with the preoperative values, but postoperative hemodynamic abnormalities remained. Exercise produced a rise in pressures in the pulmonary circuit and in cardiac output. The increase in cardiac output was less than expected from the increase in oxygen consumption, with a few exceptions. Apparently, there was no close relationship between the symptomatic improvement and the hemodynamic results. Thus, the present study points to the importance of hemodynamic data in the objective assessment of the results of cardiac surgery.

Adult↗
PubMed1982

Accuracy of serial myocardial perfusion scintigraphy with thallium-201 for prediction of graft patency early and late after coronary artery bypass surgery. A controlled prospective study.

To assess the accuracy of serial myocardial perfusion scintigraphy with thallium-201 (201Tl) to predict graft patency early and late coronary artery bypass surgery, rest and exercise 201Tl and coronary arteriography were performed preoperatively and 2 weeks and 1 year after operation. The scintigraphic results were compared with graft patency, symptoms, left ventricular function and physical work capacity in a consecutive series of 55 patients with a total of 154 grafts. Serial 201Tl had an 80% sensitivity, 88% specificity and 86% overall accuracy in detecting or excluding graft occlusion, which was predicted by reversible ischemia as well as persistent "new scar" segments. Occluded grafts were correctly localized by 201Tl scintigraphy in 61%. Postoperative apical 201Tl defects were frequent (two-thirds of cases), and were the result of intraoperative transapical venting of the left ventricle. After coronary bypass graft surgery, ejection fraction at rest was unchanged. Left ventricular end-diastolic pressure and physical work capacity improved significantly. In the presence of new perfusion defects detected postoperatively, physical work capacity was reduced significantly. New 201Tl defects in addition to typical or atypical angina provided a high probability of graft occlusion, while in the absence of new 201Tl defects all grafts were patent in more than 90% of patients, all of whom had no or only atypical chest pain. We conclude that serial 201Tl imaging after coronary artery bypass surgery is an accurate noninvasive method that can be used routinely to assess graft function, to localize spatially occluded grafts and to identify patients with a high likelihood of graft occlusion who may need invasive studies.

Angina Pectoris↗
PubMed1990

[Perioperative respiratory therapy and postoperative pain therapy].

Especially patients with preexisting bronchopulmonary diseases or those undergoing operations in the upper abdomen or thoracotomies are susceptible to post-operative pulmonary complications. All patients at risk should learn the prophylactic respiratory maneuvers preoperatively. Perioperative use of incentive spirometers, breathing exercises or IPPB seems to reduce the incidence of postoperative pulmonary complications. Opioids are used usually for postoperative pain management, but unfortunately they are given mainly as i.m. injections, although an i.v. administration would be far better. If given in an equipotent dose, nearly every opioid provides sufficient postoperative analgesia. Wide interindividual variation in the needed dose requires that opioids be titrated intravenously.

Combined Modality Therapy↗
PubMed1986

Surgical treatment of absent pulmonary valve syndrome.

The absent pulmonary valve syndrome includes agenesis of the pulmonary valve, annular stenosis, and pulmonary insufficiency. The pulmonary arteries are aneurysmal and usually compress the tracheobronchial tree. These features are associated with a ventricular septal defect and right ventricular hypertrophy. Nineteen children aged 5 days to 11 years were treated between 1976 and 1983. Nine were younger than 1 year. Intractable respiratory symptoms and heart failure were the main features in the infant group; five required preoperative assisted ventilation. Older children had decreased exercise tolerance and repeated respiratory infections. Several surgical techniques were used in this series. The best results were achieved when the size of the main, right, and left pulmonary arteries was reduced by extensive anterior resection; the ventricular septal defect was closed; and an aortic homograft was interposed between the right ventricle and the pulmonary artery. Four infants and four children treated in this way survived the operation. Five of the nine operated infants died (56%); all older children survived the operation. At follow-up, six children were asymptomatic and one was in New York Heart Association Class II. All four infants were progressing satisfactorily although all had some residual pulmonary symptoms. Closure of the ventricular septal defect, reduction of the size of the pulmonary arteries, and insertion of an aortic homograft was the optimal treatment in our series.

Aneurysm↗
PubMed1993

[Anomalous origin of the left coronary artery from the pulmonary artery: a case report in an adult].

A 37-year-old female with anomalous origin of the left coronary artery from the pulmonary artery was surgically treated by creation of intrapulmonary aorto-coronary tunnel. Postoperative cardiac catheterization showed a minimal pulmonary stenosis at the baffle. But the remarkable preoperative ST-depression in a treadmill exercise test disappeared completely after operation and the normograde blood flow of the left coronary artery was detected from the ascending aorta.

Adult↗
PubMed1996

Serial assessment of cardiopulmonary exercise capacity after cardiomyoplasty for either ischemic or idiopathic dilated cardiomyopathy.

Cardiomyoplasty is a surgical procedure aimed at assisting the left ventricle during ejection. We describe the long-term effects of cardiomyoplasty on peak exercise capacity, with serial assessments for up to 3 years after operation. Sixteen patients (12 in New York Heart Association class III and 4 in class IV) were enrolled. The mean left ventricular ejection fraction was 18 +/- 8%. Bicycle exercise tests with respiratory gas analysis were performed preoperatively and 6, 12, 18, 24, and 36 months after operation. Mean follow-up was 12 +/- 5 months (range 6 to 24). At 6 months, peak oxygen consumption and the ventilatory threshold were unchanged (from 17.8 +/- 5.8 to 15.8 +/- 5.3 ml/min/kg, and from 12.1 +/- 2.7 to 11.4 +/- 3.4 ml/min/kg, respectively). Ventilation at 50 W, viewed as an index of polypnea at submaximal exercise, was also unchanged. Serial assessment of exercise capacity thereafter showed no changes. However, ejection fraction tended to increase from 18 +/- 8% to 21 +/- 9% (p=0.08) and 14 patients reported an improvement in their functional status, resulting in a significant change in New York Heart Association functional class (3.3 +/- 0.5 to 2.2 +/- 0.4 at 6 months and 2.4 +/- 0.4 at the last visit, p <0.005) and improvement in quality-of-life scores. Thus, cardiomyoplasty does not appear to increase peak exercise capacity in the long term, despite an improvement in the left ventricular ejection fraction. Symptoms and quality of life, however, appear to improve. This may be related in part to an insufficient number of assisted systoles during exercise, persistent deconditioning, or changes in pulmonary mechanics.

Cardiomyopathy, Dilated↗
PubMed1983

The role of the physical therapist before and after lumbar spine surgery.

In summary, the role of the physical therapist before and after surgery depends upon the type of care that the surgeon desires. In aggressive care, the physical therapist is involved in the biomechanical assessment of the patient and preoperative education. Postsurgically, the rehabilitation process involves early movement, exercise, stretching and ambulation. Each surgical procedure has been described with its subsequent recommended activities and exercises. This active regimen will assist in decreasing postsurgical complications such as scarring. The program has worked well, and early findings indicate it is superior to extremely conservative care in which activity is restricted.

Electric Stimulation↗
PubMed2003

Effects of radial artery harvesting on forearm function and blood flow.

BACKGROUND: There is little information on the effects of radial artery harvesting on postoperative forearm function and blood flow. We evaluated the early changes in forearm neural sensation, circumference, grip power, cyclical exercise fatigue, and blood flow after radial artery harvesting for coronary artery bypass graft (CABG) surgery. METHODS: Twenty-three patients with negative Allen's test of the nondominant forearm were recruited preoperatively and underwent assessment of bilateral forearm function (soft touch and pin-prick neural sensation, circumference, handgrip power, cyclical exercise fatigue) and blood flow measurements (forearm plethysmography). All vasoactive drugs were stopped 24 hours before assessments. Identical follow-up assessments were conducted (mean +/- SEM) 3.4 +/- 0.4 months postoperatively. RESULTS: At the time of postoperative assessment all harvested forearm wounds were healed. There was no reduction of postoperative soft touch sensation but in 3 patients objective pinprick sensation was reduced in the distribution of the lateral antebrachial cutaneous nerve of the harvested forearms. Postoperative forearm circumference (p < 0.05) and grip power (p < 0.05) were significantly reduced in both forearms, however cyclical exercise fatigue was improved in both forearms. Preoperative and postoperative forearm blood flow at rest and in exercise-induced ischemic reperfusion were not significantly different in both forearms. CONCLUSIONS: In patients with a negative Allen's test, harvesting of the radial artery does not adversely affect subsequent forearm function or blood flow to a clinically significant degree.

Coronary Artery Bypass↗
PubMed1984

Ventricular arrhythmias during exercise testing: mechanism, response to coronary bypass surgery and prognostic significance.

To investigate the determinants and prognostic significance of ventricular arrhythmias during exercise testing, 86 patients with such arrhythmias were identified from a consecutive series of 446 patients who underwent treadmill exercise testing and cardiac catheterization. The prevalence of these arrhythmias was 19% in the total group but increased to 30% in the 120 patients with 3-vessel or left main coronary artery disease. Patients with exercise-induced arrhythmias were more likely to have 3-vessel or left main coronary artery disease, a lower resting ejection fraction, greater than or equal to 2 mm of ischemic ST depression and more severe segmental wall motion abnormalities than patients without this finding (p less than 0.05). Repeat exercise testing in 22 patients with exercise-induced arrhythmias after coronary bypass surgery revealed that persistence of these arrhythmias was associated with either severe wall motion abnormalities preoperatively or residual ischemic ST depression during the post-operative exercise testing. At a mean follow-up period of 5.3 years, the presence of exercise-induced ventricular arrhythmias was not associated with increased cardiac mortality in the medically treated patients.

Arrhythmias, Cardiac↗
PubMed1998

Pulmonary rehabilitation.

There has been a resurgence of interest in pulmonary rehabilitation mainly because the prevalence of COPD has increased, scientific studies document consistent benefits (increased exercise endurance and reduced dyspnea), and thoracic surgeons recognize that preoperative and postoperative conditioning enhances the results of lung volume reduction surgery and lung transplantation. Although education and psychosocial/behavioral interventions are important components of a multidimensional program, exercise training of the upper and lower extremities is essential to achieve the described improvements. Current programs vary considerably in the frequency, intensity, and duration of exercise reconditioning. Two "key" questions relating to pulmonary rehabilitation are as follows. What is an appropriate training intensity? How should patients monitor the training intensity? Maintenance exercise programs and the development of home- or community-based programs will be important future developments.

Combined Modality Therapy↗
PubMed1986

[Vocational rehabilitation after an aortocornary bypass operation].

To elucidate the influence of coronary bypass surgery on vocational status we studied 238 male patients operated upon for stable angina (mean age 53.3 +/- 7.4 years). The postoperative follow-up was 3.7 +/- 0.7 years. 33 patients died or had to be excluded because they had retired. 113 (55%) of the remaining 205 patients participated in a formal rehabilitation program (group A), whereas 92 (45%) patients did not (group B). There was no significant difference between the two groups with regard to pre- or postoperative clinical and angiographic data, except a higher rate of preoperative unemployment and of patients unfit to work for more than 6 months before operation in group B. The overall preoperative employment rate was 48%, whereas 3.7 years after operation 62% of all the patients were working (p less than 0.005), a net gain of about 30%. Return to work was significantly influenced by the NYHA classification after operation, exercise capacity in the bicycle stress test, duration of preoperative unemployment, type of work and age at operation. In group A the postoperative employment rate was higher than in group B (72% vs. 51%), especially in patients who had not worked before operation (62% vs. 32%). It is concluded that after coronary artery bypass surgery a net gain in employment rate can be expected and a formal rehabilitation program may help the patients to resume work postoperatively. However, definite conclusions cannot be drawn because of the retrospective, nonrandomized design of the study.

Adult↗
PubMed1989

Akinetic versus dyskinetic left ventricular aneurysms diagnosed by gated scintigraphy: difference in surgical outcome.

Forty-one patients selected for left ventricular aneurysm resection and coronary artery bypass grafting were studied by gated radionuclide ventriculography, and right heart catheterization before and after operation to establish whether the presence of paradoxically systolic expansion, as defined by radionuclide ventriculography, influenced the surgical outcome. Patients with systolic paradoxically moving left ventricular aneurysms (n = 28) improved their functional classification (New York Heart Association) (p less than 0.01) and exercise tolerance (watt-minutes) (p less than 0.001) compared with preoperative values, in contrast to the patients with akinetic aneurysms (n = 13), whose status remained unchanged. Left ventricular ejection fraction at rest (p less than 0.001) and exercise (p less than 0.0001) improved along with a significant reduction in left ventricular end-diastolic (p less than 0.002) and end-systolic volume indices (p less than 0.001) among the patients with paradoxical left ventricular aneurysms versus no change in the akinetic group. In a multivariate analysis of different preoperative variables, the presence of dyskinesia was found to be the only independent predictor of a favorable surgical outcome (p less than 0.004). In conclusion, the presence of dyskinesia represents an important marker of the outcome after aneurysmectomy.

Adult↗
PubMedDate not supplied

Relationships among self-efficacy, outcome expectancy, and postoperative behaviors in total joint replacement patients.

PURPOSE: To determine whether self-efficacy and outcome expectancy predicted performance of postoperative leg exercises and ambulation among persons recovering from total hip or total knee replacement. DESIGN: Descriptive correlational. SAMPLE: 50 subjects recovering from their first unilateral total hip or total knee replacement at a large midwestern hospital who had completed a preoperative education course. METHODS: On postoperative day 1, subjects who correctly performed leg exercises and could properly ambulate with a walker were administered the Self-Efficacy Scale and the Outcome Expectancy Scale. On postoperative day 2, frequency and repetitions of leg exercises were measured by self-report. Ambulation was measured by distance walked in feet. FINDINGS: Self-efficacy was the sole predictor of the dependent variables, accounting for 8% to 33% of the variance. Higher levels of self-efficacy were correlated with longer distances in ambulation and with higher frequency and more repetitions of leg exercises. IMPLICATIONS FOR NURSING PRACTICE: Solely providing a preoperative education course is not sufficient to ensure performance of postoperative behaviors in total joint replacement patients. Patients' self-efficacy beliefs may need to be considered when planning a preoperative educational program for patients undergoing total joint replacement surgery. This study's situation-specific measure of self-efficacy could be used in the clinical setting to identify patients with low levels of self-efficacy who may be less likely to perform preventive postoperative behaviors.

Aged↗
PubMed2005

[Our experience with repair of the scapholunate ligament using the MITEK bone anchor].

PURPOSE OF THE STUDY: A complete rupture of the scapholunate (SL) interosseal ligament results in palmar flexion of the scaphoid and dorsiflexion of the lunate that leads to disintegration of the carpal circle and the development of scapholunate dissociation with dorsal intercalary segment instability. If the injury is not treated properly or early, the abnormal position of the scaphoid and lunate results in degenerative changes of the wrist shown by X-ray and referred to as scapholunate advanced collapse (SLAC). The aim of this study was to evaluate the results of our method used for reconstruction of the SL ligament by means of MITEK bone anchors in acute injury. MATERIAL AND METHODS: The group included 17 patients, 12 male and 5 female, aged 18 to 49 years, with complete SL ligament ruptures. The dominant hand was affected in 10 patients. After the diagnosis had been confirmed, we performed reconstructive surgery involving re-attachment of the SL ligament to the scaphoid by means of the MITEK Mini G2 anchor. The patients were examined by X-rays at 3, 6, 12 and 24 months after the operation to assess the SL angle, capitolunate (CL) angle, SL distance and signs of SLAC. Hand function and pain were evaluated on the basis of the Wrightington Hospital Wrist Scoring (WHWS) system. RESULTS: The average preoperative value of the SL angle was 79 degrees and was corrected to 38 degrees by surgery. By subsequent physical therapy for 12 months, an SL angle of 51 degrees was achieved and increased to 52 degrees during the following year. The CL angle, showing a preoperative average value of 34 degrees, was corrected by surgery to 6 degrees, further increased to 9 degrees by exercising and then remained unchanged. The average SL distance of 5.25 mm preoperatively was reduced to 2.75 mm by surgery with no further change. At 24 months of follow-up, the results of pain evaluation were excellent, good and satisfactory in 41 %, 47 % and 12 % of the patients, respectively, with no poor outcome indicating restriction of the patient's daily activities. Functioning of the hand was excellent in 47 %, good also in 47 % and satisfactory in 6 % of the patients. The range of motion was excellent, good and satisfactory in 24 %, 64 % and 12 % of the patients, respectively. No stiff wrist was recorded after reconstruction of the SL ligament by our method. The hand grip was evaluated as excellent in 47 %, good in 35 % and satisfactory in 18 % of the patients. DISCUSSION: The results show that by reconstruction of the SL ligament with the use of MITEK anchors, radiographic values of the SL and CL angles and SL distance can reach the normal levels within 24 months of the operation. As assessed by the WHWS system, excellent and good results were achieved in 88 % of the wrists treated. Similarly, at 24 months of followup, excellent or good functional outcomes were reported by 94 % of the patients, and excellent or good results in relation to the range of motion and hand grip were experienced by 88 % and 82 % of the patients, respectively. CONCLUSIONS: When treating complete SL ligament ruptures within 4 weeks of injury, stabilization with Kirschner's wires, re-attachment of the SL ligament and suture of the articular capsule are adequate procedures leading to the best results. The ligament reconstruction with MITEK anchors, as presented here, is a relatively simple method giving good results. For treatment of chronic instability it is necessary to use other surgical procedures that, however, will reduce wrist mobility to a greater extent.

Adolescent↗
PubMedDate not supplied

Managing the stiff elbow: operative, nonoperative, and postoperative techniques.

Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture.

Contracture↗
PubMed1990

Skeletal muscle enzyme activities and metabolic substrates during exercise in patients with postoperative fatigue.

Subjective fatigue was quantified before and 20 days after uncomplicated elective abdominal surgery in 12 patients and compared with changes in heart rate, enzyme activities and skeletal muscle substrates before and after bicycle exercise for 10 min at 65 per cent of patients' preoperative maximum work capacity. Fatigue increased from a mean(s.e.m.) preoperative level of 2.5(0.5) arbitrary units to 4.6(0.5) on postoperative day 20 (P less than 0.01). Body-weight, triceps skinfold thickness and arm circumference decreased postoperatively (P less than 0.02). Postoperative values of muscle enzyme activities indicative of oxidative phosphorylation capacity (citrate synthase and 3-OH-acyl coenzyme A dehydrogenase) were lower than preoperative values (P less than 0.05). Lactate dehydrogenase was unaltered and resting values of muscle glycogen and adenosine triphosphate were higher after operation (P less than 0.05). In response to exercise, heart rate, muscle glucose, glucose-6-phosphate and lactate increased (P less than 0.05), while muscle glycogen and creatine phosphate decreased (P less than 0.05). Increase in postoperative fatigue correlated with the increase in heart rate (P less than 0.05), while no significant correlations were found between fatigue and muscle parameters. Our results suggest that lack of exercise and malnutrition may be of importance in the decrease in work capacity and in fatigue after operation.

Abdomen↗
PubMed1977

[Postural drainage and breathing gymnastics--conditiones sine qua non-before lung resections for bronchiectasis (author's transl)].

Report on 150 lung resections in 143 patients with bronchiectasis in the period of 1958-1974. The intensive preparation of the patients before surgery is of highest importance for a small risk and rare complications after operation. Postural drainage and breathing gymnastics are able to increase significantly FEV1 and VC and to reduce RV in the preoperative phase. The complication rate amounted to 8%, lethality after surgery to 1.3%.

Breathing Exercises↗