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At least 91 records · Page 5Linked to original sources
PubMed1988

Radionuclide ventriculography and two dimensional echocardiography as predictors of left ventricular performance during aortic vascular surgery.

Sixteen consecutive patients scheduled for elective aortic vascular surgery underwent preoperative LVEF determination employing two dimensional echocardiography (2DE) and radionuclide ventriculography (RNV). Measured and derived indices of cardiac function were recorded before and after induction of anaesthesia, aortic cross-clamping and aortic unclamping. Induction of anaesthesia was associated with significant decreases in mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI) and with a highly significant decrease in left ventricular stroke work index (LVSWI). Aortic cross-clamping was associated with significant increases in MAP and systemic vascular resistance (SVR) whereas aortic unclamping was associated with a significant decrease in SVR. Preoperative LVEF, as measured by RNV and 2DE, were similar. Resting ejection fractions correlated poorly with both preoperative cardiac indices and with changes in indices of left ventricular performance seen intraoperatively. Preoperative ejection fraction determination did not predict intraoperative left ventricular performance. Preoperative exercise scanning may prove more informative.

Aged↗
PubMed2002

Surgical strategy for improving forearm and hand function in late obstetric brachial plexus palsy.

For the purpose of treatment, obstetric brachial plexus palsy can be subdivided into two distinct phases: initial obstetric brachial plexus palsy, and late obstetric brachial plexus palsy. In the latter, nerve surgery is no longer practical, and treatment often requires palliative surgery to improve function of the shoulder, elbow, forearm, and hand. Late obstetric brachial plexus palsy in the forearm and hand includes weakness or absence of wrist or metacarpophalangeal or interphalangeal joint extension; weakness or absence of finger flexion; forearm supination, or less commonly pronation contracture; ulnar deviation of the wrist; dislocation of the radial or ulnar head; thumb instability; or sensory disturbance of the hand. Palliative reconstruction for these forearm and hand manifestations is more difficult than for the shoulder or elbow because of the lack of powerful regional muscles for transfer. This report reviews the authors' experience performing more than 100 surgical procedures in 54 patients over a 9-year period (between 1988 and 1997) with a minimum of 2 years' follow-up. Surgical treatment is highly individualized, but the optimal age for forearm and hand reconstruction is usually later than for shoulder and elbow reconstruction because of the requirement for a preoperative exercise program. Multiple procedures for forearm and hand function were often performed on any given patient. Frequently, these were done simultaneously with reconstructive procedures for improving shoulder and/or elbow function. Traditional tendon transfer techniques do not provide satisfactory reconstruction for those deformities. Many of the authors' patients required more complex techniques such as nerve transfer and functioning free-muscle transplantation to augment traditional techniques of tendon and/or bone management. Sensory disturbance of the forearm and hand in late obstetric brachial plexus palsy seems a minor problem and further sensory reconstruction is unnecessary.

Adolescent↗
PubMed1977

A multifaceted approach to prevention of thromboembolism: a report of 529 cases.

The morbidity and incidence of thromboembolic complications can be reduced by patient awareness, nursing staff concern, and physician responsibility using mechanical measures and drugs. Preoperative exercise instrutions, early ambulation, calf exercise, antiembolism hose, postoperative circle-bed turning and use of the Trendelenburg position, the use of intravenous dextran postoperatively and, in selected cases, low doses of sodium warfarin (Coumadin) form the foundation of our approach to the prophylaxis of thromboembolic phenomena. In the presence of thrombophlebitis, phenylbutazone (Butazolidin) is used. Dextran is used with caution in the presence of diminished biliary function. Heparin is avoided except in proven pulmonary embolism. No complications have resulted from this regimen.

Aspirin↗
PubMed1984

Thrombotic obstruction of the Björk-Shiley valve: the Glasgow experience.

Thrombotic obstruction is the most feared complication of the Björk-Shiley tilting disc prosthesis. From 1971 to 1982 1186 Björk-Shiley valves were implanted in 900 patients. There were 93 deaths in hospital. Eight hundred and seven patients have been followed for a total of 4146 patient years; 14 patients were lost to follow up. Nineteen cases of thrombotic obstruction were identified at necropsy or at a repeat operation in the study group. The mitral prosthesis was thrombosed in 16 patients, the aortic in two, and the tricuspid in one. The incidence for this complication has been calculated to be 0.46 per 100 patient years for all valve positions, 0.79 for single mitral valve replacements, 0.18 for aortic replacements, and 0.63/100 for the tricuspid position. The maximum possible incidence of this complication in this population has been calculated to be 1.4 per 100 patient years. The mortality rate was 41.7% for reoperation and 63% for the development of the complication. Risk factors that have been identified are inadequate anticoagulant control, poor preoperative exercise capacity, and possibly also the implantation of small prostheses.

Aortic Valve↗
PubMed1992

Cosmetic breast surgery.

Appropriate follow-up care, including early postoperative serial mammography, is essential for women receiving cosmetic breast surgery. Common procedures include augmentation or reduction mammoplasty and breast reconstruction following mastectomy for cancer. Postoperative complications include infection, poor wound healing and pain. Hypertrophic scar formation, which may disrupt the normal breast contour, may be reduced by gentle and frequent massage of the scar. Avoiding sun exposure and using sun screens may prevent hyperpigmentation of the scar. Reduction mammoplasty is associated with sensory loss, which is occasionally permanent. Special complications associated with augmentation mammoplasty include diffusion of silicone through the implant and unfavorable breast appearance secondary to capsular contracture. Capsular contracture may be prevented by regular implant exercises. Preoperative and early postoperative serial mammograms are essential to differentiate surgical from malignant changes.

Breast↗
PubMed1989

Nursing perspectives on lung transplantation.

Lung transplantation has become a viable, although highly risky, option for select patients with end-stage lung disease. Lack of donor suitability is a major obstacle to its more widespread application. Many patients wait months and sometimes a year or more for an appropriate donor; some die waiting. Careful evaluation and selection of patients, rigorous pre- and post-transplant pulmonary rehabilitation, and intensive nursing and medical care significantly improve post-transplant recovery. Improved preoperative exercise tolerance and muscle strength prepare patients for the surgery and ensuing postoperative course. Likewise, the long-term post-transplant rehabilitation is essential to ultimate recovery and return to a normal healthy life. The gradual but dramatic long-term improvements in exercise performance during post-transplant training have been well documented.

Graft Rejection↗
PubMed1989

[Complete occlusion both left main coronary artery and right coronary artery].

A 67-year-old man, who had complete occlusion both of left main coronary artery (LMCA) and right coronary artery (RCA), underwent coronary revascularization. He had been suffering from severe angina pectoris preoperatively. Exercise electrocardiogram (single Master) showed myocardial ischemia. On cardiac catheterization, he showed extensive collaterals from right main coronary artery, and well-preserved left ventricular function. At operation, coronary arteries revealed severe sclerosis, especially in RCA, but there was no evidence of old myocardial infarction. Three saphenous vein grafts were bypassed to LAD, LCX, and RCA. Postoperatively, he remained free of angina pectoris at 6 months after uneventful surgery.

Aged↗
PubMed1978

Angina following aortocoronary bypass surgery.

43 patients (group A) who had a recurrence of angina after aortocoronary bypass surgery were compared with 93 (group AF) who remained symptom free for at least 1 yr in order to assess the effects of pre- and intraoperative factors on the outcome of surgery. Age and sex distribution, severity and duration of preoperative angina, incidence of preoperative infarction, known coronary risk factors and severity of coronary artery disease assessed angiographically, were similar in the 2 groups. Group A had a lower preoperative exercise tolerance (434 V, 517 ppm/min; P less than 0.05) and a greater proportion of patients with cardiac enlargement (33% V, 14%; P less than 0.05). Fewer grafts were implanted in this group (1.65 V, 2.05; P less than 0.01) which consequently had a higher postoperative coronary score (2.47 V, 1.69; P less than 0.05). It appears that the extent of myocardial revascularization may influence the symptomatic result of aortocoronary bypass surgery.

Angina Pectoris↗
PubMed1981

[Improved flow through aortocoronary venous bypasses after anticoagulant therapy. A prospective randomized study].

To evaluate the effect of oral anticoagulant therapy on graft patency rate during the first 2 months after bypass surgery 174 patients were randomly assigned to treatment with phenprocoumon (89) or to a control group (85) starting on day 7 after bypass surgery. Until day 7 all patients received low dose heparin. There was no significant difference between the two groups with respect to age, sex distribution, number of vessels diseased, left ventricular enddiastolic pressure, preoperative exercise tolerance or number of grafts constructed per patient. All patients underwent angiographic evaluation 8 weeks after bypass surgery. Graft patency rate was 90.4% in the treatment group versus 83.6% in the control group (p less than 0.015). None of the grafts with a flow rate of greater than 90 ml/min was occluded 8 weeks after surgery. Oral anticoagulation improved the patency rate of grafts with a flow of less then 90 ml/min.

4-Hydroxycoumarins↗
PubMed1995

[A case report of surgical treatment for aortic regurgitation and coronary ostial stenosis associated with aortitis syndrome].

A 52-year-old female was presented to our hospital complaining of chest oppression and dyspnea on exercise. Preoperative angiography and catheterization revealed aortic regurgitation and ostial stenosis of the right coronary artery. Aortic valve replacement (AVR) with SJM 19 A and aortocoronary bypass (CABG) with saphenous vein graft were performed successfully. Histopathological examination of the aortic wall revealed healed phase aortitis syndrome. Post operative course was uneventful. For healed phase aortitis syndrome perioperative steroid administration was not necessary. However careful observation was recommended for long term complication such as recurrence of aortitis, valve detachment, perivalvular leakage and graft occlusion. This is the 16th case successfully treated with AVR and CABG for Aortitis syndrome.

Aortic Arch Syndromes↗
PubMed1994

Evaluation of regional myocardial perfusion in areas of old myocardial infarction after revascularization by means of intraoperative myocardial contrast echocardiography.

Because myocardial revascularization to areas of old myocardial infarction brings about functional recovery to some extent to myocytes in those areas, the assessment of regional myocardial perfusion on those areas after myocardial revascularization may allow myocardial viability to be estimated. Using intraoperative myocardial contrast echocardiography by direct injection of 2 ml sonicated 5% human albumin into saphenous vein grafts, we assessed regional myocardial perfusion in 16 revascularized areas of old myocardial infarction. We estimated the myocardial viability of areas with respect to myocardial perfusion, and we compared these results to both the improvement of regional wall motion after myocardial revascularization (increase in segmental wall thickening during systole) and relative thallium 201 activity obtained by quantitative analysis of preoperative exercise myocardial thallium 201 distribution on delayed images. The background-subtracted peak peak intensity of myocardial enhancement and the ratio of endocardial to epicardial intensity were determined in each revascularized area. An inverse correlation existed between peak intensity (18 +/- 7) and the endocardial/epicardial ratio (0.88 +/- 0.17) (r = -0.63, p < 0.01). A good correlation was found between peak intensity and both the percent increase in segmental wall thickening (r = 0.73, p < 0.005) and the relative thallium 201 activity (r = 0.81, p < 0.005). These results suggested that regional myocardial perfusion after myocardial revascularization in areas of old myocardial infarction distributed better to the epicardial halves than to the endocardial halves, and that the peak intensity could be related to myocardial viability.

Aged↗
PubMed1983

Functional evaluation after aortic valve replacement.

Preoperative and sequential postoperative bicycle exercise tests were compared with clinical and catheterization data in assessment of the functional outcome of uncomplicated aortic valve replacement (AVR) in 33 patients. The operation was done because of aortic stenosis (AS) in 14 patients and aortic regurgitation (AR) in 19. Both groups of patients showed improved NYHA functional class and peak achieved workload after AVR, but the results in these respects did not correlate. Nor did the regression in left ventricular (LV) hypertrophy and dilatation after AVR that was seen in both patient groups correlate with the changes measured in exercise tolerance. Preoperative exercise capacity was not predictive of the postoperative performance. In the AR patients, however, preoperative ability to raise the systolic blood pressure during exercise appeared to predict which patients were likely to show enhanced resting LV systolic pump function after AVR. It is concluded that objective tests of exercise tolerance alone permit reliable evaluation of the functional outcome of uncomplicated AVR. Indices of resting LV performance, though helpful in observation of the changes resulting from removal of the untoward LV burden after AVR, are likely to be less useful for evaluating changes in the LV exercise reserve. The response of the systolic blood pressure to exercise may be an additional predictive factor for postoperative resting LV performance in patients with AR.

Adult↗
PubMed1992

Preoperative and postoperative right ventricular function during exercise in patients with mitral stenosis.

To elucidate the effects of mitral valve surgery on right ventricular function in 11 patients with mitral stenosis, pre- and postoperative right ventricular function were quantified using gated equilibrium blood pool radionuclide ventriculography at rest and during exercise. The preoperative right ventricular ejection fraction was 39 +/- 4% at rest and 36 +/- 9% during exercise, which during exercise was lower than control values (51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction was lower during exercise than at rest, postoperative right ventricular ejection fraction during exercise was lower than normal values (42 +/- 3% versus 51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction did not decrease during exercise, the postoperative right ventricular ejection fraction was within normal limits during exercise (54 +/- 5%). In addition, postoperative right ventricular ejection fraction during exercise increased to normal values in patients whose preoperative right ventricular ejection fraction during exercise had been 40% or higher. Preoperative peak ejection rate was -1.81 +/- 0.19 EDV/sec at rest and -1.72 +/- 0.39 EDV/sec during exercise, which during exercise was lower than control values (-2.44 +/- 0.53 EDV/sec) (p < 0.01). Postoperatively, peak ejection rate during exercise (-2.50 +/- 0.37 EDV/sec) increased (p < 0.05) to normal levels. Preoperative peak filling rate was 1.61 +/- 0.47 EDV/sec at rest and 1.88 +/- 0.54 EDV/sec during exercise, which during exercise was lower than control values (2.58 +/- 0.62 EDV/sec) (p < 0.01). Postoperatively, peak filling rate during exercise (2.82 +/- 0.62 EDV/sec) increased (p < 0.05) to normal values in all patients. Preoperative changes in both right ventricular ejection fraction and peak ejection rate from rest to exercise inversely correlated with the preoperative pulmonary vascular resistance at rest (right ventricular ejection fraction, r = -0.79, p < 0.005; and peak ejection rate, r = -0.67, p < 0.05). In conclusion, right ventricular systolic function improved in about half of the patients with mitral stenosis, and diastolic function improved in all patients during exercise following surgery. When the preoperative pulmonary vascular resistance was elevated, the right ventricular systolic dysfunction persisted.

Adult↗
PubMed1977

Thallium-201 myocardial imaging before and after coronary revascularization: assessment of regional myocardial blood flow and graft patency.

Twenty patients underwent myocardial imaging with Thallium-201 (201Tl) before and subsequent to coronary artery bypass grafting. All patients had rest and maximal treadmill exercise imaging postoperatively. Eleven of the 20 patients had rest and exercise 201Tl images preoperatively; 9/20 only had rest imaging preoperatively. Postoperative regional exercise perfusion was improved in seven of the 11 patients who had preoperative exercise images, and was associated with regional graft patency in each case. Thirteen of 20 patients showed no new defect with postoperative exercise imaging. The remaining seven patients developed or had an increased defect with exercise. The patients with no new perfusion defects during postoperative study has 26/30 grafts patent (87%). Patients developing a new perfusion defect with exercise had fewer grafts patent (7 of 13 [54%]; P less than 0.03). In these seven cases, a new exercise-induced defect was associated with regional graft closure or residual nonoperated disease. Knowledge of the preoperative coronary anatomy allowed the distinction between ungrafted areas and regional graft dysfunction. We conclude that preoperative and postoperative 201Tl imaging may noninvasively predict graft closure and/or improved regional perfusion with patent grafts.

Angina Pectoris↗
PubMed2000

Role of CO diffusing capacity during exercise in the preoperative evaluation for lung resection.

We conducted a prospective study to evaluate whether lack of an adequate increase in diffusing capacity for carbon monoxide (DL(CO)) during exercise is associated with a greater postoperative complication rate after lung resection. We used the three-equation method (3EQ-DL(CO)), a modification of the single breath DL(CO) technique to determine DL(CO) during exercise in 57 patients undergoing lung resection at Vancouver General Hospital from October 1998 to May 1999. 3EQ-DL(CO) was determined during steady-state exercise at 35% and 70% of the maximal workload reached in a progressive exercise test. Maximal oxygen uptake (VO(2)max), DL(CO) at rest, and the increase in DL(CO) during exercise were compared in relation to postoperative complications. Patients with complications had lower resting values of DL(CO) (R-DL(CO)), a smaller increase in DL(CO) from rest to 70% of maximal workload expressed as a percent of the predicted DL(CO) at rest ([70% - R]-DL(CO)%), and a lower VO(2)max than did patients without complications. Results suggested that (70% - R)-DL(CO)% was the best preoperative predictor of postoperative complications; a cutoff limit of 10% was the best index to identify complications, yielding a complication rate of 100% in patients with (70% - R)-DL(CO)% < 10% as compared with a complication rate of 10% in patients with (70% - R)-DL(CO)% >/= 10% (sensitivity = 78%, specificity = 100%). Patients who do not increase their DL(CO) sufficiently during exercise ([70% - R]-DL(CO)% < 10%) have a greater complication rate after lung resection.

Aged↗
PubMed1983

Aortic valve replacement in childhood: evaluation of left ventricular function by electrocardiography, echocardiography and graded exercise testing.

Preoperative and postoperative left ventricular (LV) performance was evaluated noninvasively in 15 children who survived aortic valve replacement (AVR). The noninvasive evaluation included electrocardiography, M-mode echocardiography, and graded exercise testing. Clinically, there was dramatic improvement postoperatively: All but 2 patients were asymptomatic. No conduction defects or arrhythmias were detected preoperatively; however, in the late postoperative period there was a variety of intraventricular conduction abnormalities, myocardial infarctions, and ventricular or supraventricular arrhythmias. On M-mode echocardiography, children with aortic stenosis continued to have increased LV mass postoperatively. Shortening fraction and left-sided systolic time intervals returned to normal. The children with aortic regurgitation also had persistently abnormal LV mass on echocardiography postoperatively. Exercise data indicated no improvement in working capacity after AVR. Also, 9 children (63%) continued to have ST-segment depression with maximal exercise. These data indicate that AVR does not result in a return to normal of myocardial performance in children with severe aortic valve disease.

Adolescent↗