RESUMEN
A 9 to 17-year follow-up after aortic valve replacement with the Lillehei-Kaster prosthesis was carried out in 262 patients with a mean age of 53 years. All patients were traced. The operative mortality was 7.3%. The observed survival of the total series after 5, 10 and 15 years amounted to 75%, 61%, and 49% respectively. The majority of survivors showed improvement of functional capacity and decrease of heart volume. Freedom from valve-related death, thromboembolism and valve-related morbidity and mortality after 15 years amounted to 94%, 85% and 75% respectively. Only two instances of valve thrombosis were seen, and fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr-Edwards and the Björk-Shiley prostheses. Analysis of the relative survival rates, i.e. the observed survival rates as ratios of those of the general population, indicates that the 10-year survival of patients with aortic stenosis is close to normal, whereas the survival rates of patients with aortic incompetence and with combined aortic stenosis and incompetence are significantly lower. It is suggested that earlier operation should be considered in patients with aortic incompetence and with combined stenosis and incompetence in order to lower the late mortality rate.
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas , Complicaciones Posoperatorias/mortalidad , Insuficiencia de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/mortalidad , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Tasa de SupervivenciaRESUMEN
A follow-up study was carried out in 54 patients after combined mitral and aortic valve replacement with the Lillehei-Kaster prosthesis. Twenty-two males and thirty-two females with a mean age of 54 years provided a total of 272 years of observation. The operative mortality was 16.7%. The long-term survival rates were 67% after 5 years and 55% after 8 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. In spite of long-term anticoagulant treatment thromboembolic incidents were the most frequent valve-related complications. The percentage of patients free from valve-related morbidity and mortality was 75% after 8 years. Valve-related death accounted for 4% of all deaths. Fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr-Edwards' or the Björk-Shiley prostheses.
Asunto(s)
Prótesis Valvulares Cardíacas , Válvula Aórtica , Volumen Cardíaco , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral , Falla de Prótesis , Reoperación , Tromboembolia/etiologíaRESUMEN
A follow-up was carried out in 185 patients after mitral valve replacement with the Lillehei-Kaster prosthesis. Fifty-eight males and one hundred and twenty-seven females provided a total of 876 years of observation. The operative mortality amounted to 13% for the total series and to 9.3% after elective surgery. The long-term survival for the total series was 67% after five years and 56% after 10 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. In spite of long-term anticoagulant treatment thromboembolic events were the most frequent valve-related complications. Thrombosis of the valve occurred in eight patients and appeared to decrease with a change in the orientation of the valve. The percentage of patients free from thromboembolic events amounted to 76 +/- 5% after ten years. The percentage of patients free from valve-related morbidity and mortality was 66 +/- 5% after ten years. Valve related death accounted for 18% of all deaths and 26% of all late deaths. Fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr Edwards' or the Björk-Shiley prostheses.
Asunto(s)
Prótesis Valvulares Cardíacas/mortalidad , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Complicaciones Posoperatorias/mortalidad , Tromboembolia/mortalidad , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral , Diseño de Prótesis , Falla de Prótesis , Factores de TiempoRESUMEN
This prospective study was carried out to develop a model for the prediction of cardiac risk in non-cardiac surgery. Detailed data were collected concerning the preoperative status of 2609 consecutive patients, who were followed closely during the postoperative course. Fatal or life-threatening cardiac complications occurred in 68 patients (2.6%). By utilizing logistic regression, a model for prediction of cardiac risk was developed. The model contained six significant preoperative predictor variables: Congestive heart failure (with 3 degrees of severity); ischaemic heart disease (with 2 degrees of severity); diabetes mellitus; serum creatinine above 0.13 mmol l-1; emergency operation; and the type of operation (two categories). With this model it seems possible to discriminate between patients with very different levels of cardiac risk.
Asunto(s)
Muerte Súbita/etiología , Infarto del Miocardio/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Taquicardia/diagnóstico , Fibrilación Ventricular/diagnósticoRESUMEN
In a prospective study comprising 2609 consecutive surgical patients, of whom 1166 were anesthetized with halothane, four cases of hepatitis were encountered. The incidence of hepatitis among those who received halothane was 1:292 in our material. The high incidence may be explained by the recognition of milder forms of hepatitis and by the selection of the series (over 40 years). Serum alanine aminotransferase should be investigated in all patients with postoperative pyrexia of unknown origin if mild forms of halothane hepatitis are to be discovered. The patient's history should be carefully examined for previous postoperative pyrexia of unknown origin following halothane anesthesia, in which case other anesthetics should be chosen.
Asunto(s)
Anestesia General , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Halotano/toxicidad , Anciano , Alanina Transaminasa/sangre , Enfermedad Hepática Inducida por Sustancias y Drogas/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Obesidad/complicaciones , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Estudios ProspectivosRESUMEN
A follow-up was carried out in 262 patients after aortic valve replacement with the Lillehei-Kaster prosthesis. One hundred and ninety-one males and seventy-one females with a mean age of 53 years provided a total of 1385 observation years. The operative mortality was 7.3%. The long-term survival rates for the total series amounted to 74% after 5 years and 61% after 9 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. Angina pectoris disappeared in 76 out of 79 patients, and exertional syncope vanished in 61 out of 62 patients. All patients received long-term anticoagulant treatment. The percentage of patients free from thromboembolic events amounted to 90 +/- 2% after 9 years, and the percentage free from valve related morbidity and mortality was 82 +/- 3% after 9 years. Only one instance of valve thrombosis was seen, and fracture of the prosthesis was never encountered. These results compare very favourably with those obtained with the Starr-Edwards or the Björk-Shiley prostheses.
Asunto(s)
Insuficiencia de la Válvula Aórtica/terapia , Prótesis Valvulares Cardíacas , Angina de Pecho/complicaciones , Angina de Pecho/terapia , Insuficiencia de la Válvula Aórtica/complicaciones , Endocarditis/etiología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Falla de Prótesis , Tromboembolia/etiologíaRESUMEN
Forty-four patients with mitral and/or aortic Lillehei-Kaster valvular prostheses were evaluated with regard to haemolysis, hyposideraemia and anaemia, with median intervals of 0.4 years and 7.0 years after the operation. At the first study the majority of patients presented slight to moderate haemolysis; 7 per cent showed hyposideraemia, while none had overt anaemia. At the long-term follow-up the incidence and degree of haemolysis had increased slightly; hyposideraemia was present in 16 per cent, while only one patient had developed anaemia. The modest increase of haemolysis could be accounted for, at least in part, by the development of paravalvular regurgitation or additional valvular disease. It is concluded that the Lillehei-Kaster prostheses are less traumatic to the red cells than earlier types of synthetic prostheses. Apparently, iron medication is indicated only in the minority of patients who develop hyposideraemia and a low normal or decreased haemoglobin value.
Asunto(s)
Anemia Hipocrómica/sangre , Prótesis Valvulares Cardíacas , Hemólisis , Hierro/sangre , Adulto , Válvula Aórtica/cirugía , Estudios de Seguimiento , Hemoglobinometría , Humanos , Válvula Mitral/cirugía , Complicaciones Posoperatorias/sangre , Diseño de PrótesisRESUMEN
The results of measurements of body sodium, chloride and potassium by isotope dilution or whole body counting in patients with heart disease are reviewed. In patients with cardiac oedema exchangeable sodium and chloride are increased while body potassium tends to be decreased or normal. The findings in normonatraemic hypochloraemia, hypokalaemia and metabolic alkalosis, in diuretic hyponatraemia and in dilutional hyponatraemia are reviewed and their possible consequences in terms of changes in electrolyte gradients are discussed. The limitations and usefulness of measurements of exchangeable electrolytes in heart disease are mentioned.
Asunto(s)
Electrólitos/metabolismo , Cardiopatías/metabolismo , Alcalosis/sangre , Cloruros/sangre , Cloruros/metabolismo , Diuréticos/efectos adversos , Humanos , Hipopotasemia/sangre , Hiponatremia/sangre , Magnesio/metabolismo , Modelos Biológicos , Potasio/metabolismo , Sodio/metabolismoRESUMEN
In a prospective study comprising 43 patients with atrial fibrillation after mitral valve surgery, an evaluation was made of the prognostic significance of clinical, radiological, haemodynamic and operative factors for the maintenance of sinus rhythm after DC-conversion. Atrial fibrillation with a duration of less than 12 months proved to be the only single factor of significance for sustained sinus rhythm after 12 months and it is suggested as a simple clinical criterion for selection of patients for DC-conversion after mitral valve operation.
Asunto(s)
Fibrilación Atrial/terapia , Cardioversión Eléctrica , Enfermedades de las Válvulas Cardíacas/cirugía , Válvula Mitral/cirugía , Adulto , Fibrilación Atrial/fisiopatología , Femenino , Prótesis Valvulares Cardíacas , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de TiempoAsunto(s)
Anemia Hemolítica/etiología , Anemia Hipocrómica/etiología , Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Hemólisis , Válvula Mitral/cirugía , Adolescente , Adulto , Anciano , Anemia Hipocrómica/tratamiento farmacológico , Femenino , Haptoglobinas/análisis , Pruebas Hematológicas , Humanos , Hierro/sangre , Hierro/uso terapéutico , L-Lactato Deshidrogenasa/sangre , Masculino , Persona de Mediana EdadRESUMEN
This retrospective study is based upon a consecutive series of 90 patients with mitral stenosis who had their first closed mitral valvulotomy after the age of fifty. All patients were operated on during the period 1959--70 and were followed-up for at least 5 years until July 1, 1976. Calculated survival curves were compared with those of a group of 68 patients over fifty whose mitral stenosis was medically treated. The surgical mortality was 7.8%, largely due to the high mortality among patients in functional class IV. The late mortality rate after valvulotomy was significantly higher than in a matched population of the same age and sex, but significantly lower than in the medically treated patients. According to functional classification, the patients had improved markedly at the time of follow-up. High incidences of atrial fibrillation and late thromboembolic complications were noted. This study supports the view that closed mitral valvulotomy can be performed safely in patients over fifty with mitral stenosis without significant mitral regurgitation and heavy clacifications in functional classes II and III.
Asunto(s)
Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Factores de Edad , Anciano , Fibrilación Atrial/complicaciones , Embolia/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estenosis de la Válvula Mitral/mortalidad , Estenosis de la Válvula Mitral/terapiaRESUMEN
The additive natriuretic and diuretic effects of theophylline ethylenediamine and of bendroflumethiazide have been compared in permutation trial tests in patients with advanced congestive heart failure receiving long-term treatment with the highly potent diuretic, bumetanide. Statistical analysis of renal water and electrolyte excretion revealed that theophylline ethylenediamine, 400 mg orally, and bendroflumethiazide, 5 mg orally, had very similar effects, both quantitatively and qualitatively. The mechanism of action of the supplementary diuretics is discussed. It is concluded that theophylline ethylenediamine represents a useful alternative to thiazide diuretics when supplementary natriuretic treatment is considered in patients with congestive heart failure during long-term treatment with potent diuretics. The significance of maintaining the potassium balance during such a combined regimen is stressed.
Asunto(s)
Bendroflumetiazida/uso terapéutico , Bumetanida/uso terapéutico , Diuréticos/uso terapéutico , Etilenodiaminas/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Teofilina/uso terapéutico , Bendroflumetiazida/administración & dosificación , Bumetanida/administración & dosificación , Ensayos Clínicos como Asunto , Diuresis/efectos de los fármacos , Evaluación de Medicamentos , Quimioterapia Combinada , Electrólitos/orina , Etilenodiaminas/administración & dosificación , Femenino , Insuficiencia Cardíaca/orina , Humanos , Masculino , Persona de Mediana Edad , Natriuresis/efectos de los fármacos , Teofilina/administración & dosificación , Factores de TiempoAsunto(s)
Bumetanida/uso terapéutico , Diuréticos/uso terapéutico , Etilenodiaminas/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Natriuresis/efectos de los fármacos , Teofilina/uso terapéutico , Adulto , Quimioterapia Combinada , Humanos , Cuidados a Largo Plazo , Equilibrio HidroelectrolíticoRESUMEN
Twelve patients with congestive heart failure receiving maintenance therapy with digoxin and potent diuretics were followed closely during development of hypokalemia and potassium loss. Cardiac arrhythmias compatible with digoxtin toxicity developed in 6 patients in the presence of stable, normal serum digoxin concentrations. The mechanisms involved in the development of the rhythm disturbances are discussed with regard to hypokalaemia, intracellular potassium loss, intra-/extracellular potassium gradients and digoxin, and the significance of maintaining a normal potassium balance in this setting is stressed.
Asunto(s)
Arritmias Cardíacas/inducido químicamente , Digoxina/efectos adversos , Hipopotasemia/inducido químicamente , Creatinina/sangre , Digoxina/sangre , Digoxina/uso terapéutico , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Electrocardiografía , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Hipopotasemia/complicaciones , Persona de Mediana Edad , Potasio/metabolismo , Deficiencia de Potasio/inducido químicamente , Deficiencia de Potasio/complicacionesRESUMEN
In 12 patients with chronic mitral or aortic disease plasma renin activity (PRA) and aldosterone secretion rate (ASR) were correlated to hemodynamics, kidney function, plasma and interstitial fluid volume, and plasma sodium concentration, both in the congestive state (I) and after sodium depletion (II). PRA (I) and ASR (I) were normal or slightly elevated and increased normally after sodium depletion. A significant inverse correlation between plasma concentration (I + II) and PRA (I + II) was found. Further an abnormal inverse correlation between increments in PRA and cumulative sodium loss was demonstrated. By contrast, no correlations were found between PRA and ASR on one hand and pressures, kidney function or compartments on the other, neither in I - elevated pressures in the atria, low renal plasma flow, large compartments, nor in II - reduced pressures and compartments, almost unchanged kidney function. It is concluded that PRA hardly plays any primary role in the maintenance of sodium and fluid retention in human chronic congestive heart failure.
Asunto(s)
Aldosterona/fisiología , Insuficiencia Cardíaca/fisiopatología , Hemodinámica , Renina/fisiología , Anciano , Peso Corporal , Espacio Extracelular , Femenino , Corazón/fisiopatología , Insuficiencia Cardíaca/metabolismo , Humanos , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Volumen Plasmático , Sodio/metabolismoRESUMEN
The additive natriuretic effect of a single dose of bendroflumethiazide, 5 mg., has been studied in patients with advanced congestive heart failure in long-term treatment with bumetanide, 4 mg., daily. Three permutation trial tests were performed including six patients each. In the first trial, the response to supplementary bendroflumethiazide, 5 mg., was definitely superior to that of additional bumetanide, 4 mg., in terms of renal output of sodium, chloride, potassium, water, and osmolar clearance. In the second trial, a similar pattern was found in patients receiving a combination of bumetanide, 4 mg., and spironolactone, 100 mg., daily. The third trial compared the effects of bendroflumethiazide, 5 mg., plus bumetanide, 4 mg.; of bendroflumethiazide, 5 mg.; and of bumetanide, 4 mg. In terms of natriuresis and chloruresis, the response to the combination of two drugs was significantly larger than the sum of the effects of other treatments. It is concluded that the combined effects of the drugs represent a supra-additive effect addition for sodium and chloride. A tentative explanation of the mechanism of interaction in terms of inhibition of renal tubular supplementary spironolactone, involve a tendency to development of hypokalemia, hypochloremia, and alkalosis, it is recommended that supplementary use of bendroflumethiazide in this setting is combined with the administration of potassium chloride or potassium-saving diuretics.