Isolated huge aneurysm of the left main coronary artery in a 22-year-old patient with type 1 neurofibromatosis.

A 22-year-old patient with neurofibromatosis type 1 presented with acute chest pain. A computed tomography scan and coronary angiography revealed a partially thrombosed huge aneurysm of the left main coronary artery. Despite medical treatment, the patient's angina recurred.

Long-term results of Freestyle stentless bioprosthesis in the aortic position: a single-center prospective cohort of 500 patients.

Objective: Stentless xenograft bioprostheses may be the future valve of choice for aortic valve replacement. The study aim was to investigate the long-term clinical outcome after aortic valve replacement with the Medtronic Freestyle bioprosthesis (Medtronic Inc, Minneapolis, Minn).

Methods: Between April 1997 and November 2004, a total of 500 patients (mean age, 74.

Pharmacoscintigraphic and pharmacokinetic evaluation on healthy human volunteers of sustained-release floating minitablets containing levodopa and carbidopa.

In this study, scintigraphic and pharmacokinetic studies were conducted on 10 healthy, fed volunteers. Two concepts of sustained-release floating minitablets--Levo-Form 1 (matrix) and 2 (coated)--were evaluated and compared to the marketed product Prolopa HBS 125. All the floating forms were radiolabelled with (111)In in order to evaluate their gastric residence time using gamma-scintigraphy.

New levodopa sustained-release floating minitablets coated with insoluble acrylic polymer.

The aim of this study was to develop a new coated multiple-unit sustained-release floating system that is able to float over an extended period of time. Levodopa was used as a model drug. The system consisted of a 3mm drug-containing gas-generating core, prepared by melt granulation and subsequent compression, and coated with a flexible polymeric membrane.

Eight-year results of Freestyle stentless bioprosthesis in the aortic position: a single-center study of 500 patients.

Background And Aim Of The Study: Stentless bioprostheses may be the future valve of choice for aortic valve replacement (AVR). The study aim was to investigate mid-term clinical outcome after AVR with the Medtronic Freestyle valve.

Methods: Between April 1997 and November 2004, a total of 500 patients (241 females, 259 males) was implanted with a Freestyle bioprosthesis for AVR, without population selection, by a single surgical team at the authors' institutions.

Routine use of bilateral skeletonized internal thoracic artery grafts in middle-aged diabetic patients.

Background: The purpose of this study was to determine whether middle-aged diabetic patients aged less than 70 years could have routine use of bilateral skeletonized internal thoracic artery grafting without an increased surgical risk.

Methods: Between January 1997 and December 2003, 712 consecutive patients aged less than 70 years underwent bilateral internal thoracic artery grafting. Among these, 164 were diabetic and underwent bilateral internal thoracic artery grafting without other preoperative selection than age.

Retrocaval passage of coronary bypass grafts to the inferior left ventricle wall.

Revascularization of the inferior side of the left ventricle is performed most often with aortocoronary free grafts. This article describes a technical improvement for anatomical fit and gain of length of these grafts by directing them to the right side of the heart after a passage behind the inferior vena cava.

Does bilateral internal thoracic artery grafting increase surgical risk in diabetic patients?

Background: The purpose of this study was to determine whether, with appropriate techniques, diabetic patients could benefit from the advantages of double internal thoracic artery (ITA) coronary bypass without an increased hospital risk.

Methods: Between January 1990 and December 1996, 207 consecutive diabetic patients underwent coronary artery bypass graft operations. In 74 patients both arteries (bilateral ITA group) were used, whereas 133 patients received one ITA and vein grafts or vein grafts alone (nonbilateral group).

Mechanical circulatory support towards the permanent implantation.

Experience on wearable LVAS Novacor support accumulated since the first implantation in March 1993, includes in November 1995, seven cases (six male, one female, mean age 34) of cardiogenic shock, unresponsive to optimal medical management referred for urgent transplantation. Post-implantation period was free of any major incident in all but one, allowing transplantation in five, on an elective basis, and prolongation of the waiting period, at home in two. This experience suggests that a major breakthrough in the technology of mechanical support has been achieved: patients awaiting transplantation can be discharged home, which is both the result and an contributing factor of a satisfactory quality of life.

The gastrointestinal tract: an underestimated organ as demonstrated in an experimental LVAD pig model.

Background: Although hemodynamic stability and renal function are important and are monitored closely in patients with implanted left ventricular assist devices (LVAD), the gastrointestinal tract may be underestimated in the early postoperative period with regard to adequate perfusion. We investigated renal, intestinal, and whole body metabolic changes in response to variations in LVAD flow and inspired oxygen concentration (FiO2).

Methods: Left ventricular assist devices were implanted in 10 adult pigs (weight, 55 +/- 1.

Mechanical bridge to transplantation: when is too early? When is too late?

Background: Optimal timing of implantation of a mechanical circulatory support system in the treatment of acute cardiogenic shock is still unsettled. The issue has been addressed in a retrospective analysis of a group of 98 patients in cardiogenic shock refractory to medical therapy who were candidates for cardiac transplantation, admitted from 1987 to 1994.

Methods: The treatment included reinforced inotropic support by addition of phosphodiesterase inhibitors to sympathomimetic agents.

[Cardiac transplantation; results after 5 years].

After cardiac transplantation, long-term results were assessed in a group of 46 patients who survived more than 5 years after surgery. They were the survivors (50%) of a group of 92 patients who underwent transplantation before January 1990. On January 1995, mean follow-up was 82 +/- 14 months.

[Mechanical assistance of circulation. 42 cases].

Objectives: Mechanical circulatory support was proposed in patients in cardiogenic shock, as a bridge to cardiac transplantation or weaning. The aim of the present study is an analysis of the first 42 cases.

Methods: The 42 cases included 31 patients in cardiogenic shock unresponsive to medical therapy, good cardiac transplant candidates, and 11 patients unweanable off ventricular assist, or in shock in the intensive care unit.

Orthotopic cardiac transplantation with direct caval anastomosis: is it the optimal procedure?

Total excision of the right atrium with a minimal cuff of left atrium remaining around the four pulmonary veins, followed by direct anastomoses on venae cavae, has been proposed as an alternative to the standard procedure described by Shumway and Lower for orthotopic cardiac transplantation. To investigate whether this "anatomic" transplantation should be proposed as the optimal procedure, we prospectively randomized 78 patients having 81 procedures since 1991 into two groups: group I, standard transplantation (n = 40), and group II, "anatomic" transplantation (n = 41). The two groups were statistically similar in recipient age, sex, weight, disease, and status at the time of transplantation.

[What are the criteria of priority for the patient to be accepted on the waiting list for cardiac transplantation?].

The limited resources (in grafts, human and financial resources) incited the authors to carry out a prospective assessment of the value of assessing adrenergic function (scintigraphy with meta- iodo- benzyl guanidine, MIBG) for the procedure of inscription on the waiting list of patients with cardiac failure awaiting cardiac transplantation. The study was undertaken from October 1988 to October 1992. Seventy-eight candidates for transplantation were included in the study.

Direct mechanical assistance of the right ventricle with the Hemopump in a porcine model.

In 6 pigs, a 14F Hemopump was placed through the pulmonary artery into the right ventricle. The pulmonary artery was banded proximal to the outflow port of the Hemopump, and tightening the band increased right ventricular peak systolic pressure by 50%. There were significant falls in right ventricular stroke volume (from 43 +/- 7.

Bridge to transplantation with the wearable Novacor left ventricular assist system: operative technique.

Although the outcome of patients transplanted after univentricular cardiac support is similar to that of conventional patients, death on the device remains a substantial problem. The wearable Novacor left ventricular assist system (LVAS) may offer advantages over console-based systems by improving rehabilitation before transplantation. For these advantages to be realised, however, a smooth perioperative course is necessary.

[Cardiac surgery in chronic hemodialysed patients: immediate and long-term results].

Between 1979 and 1993, 50 patients (33 men and 17 women) receiving chronic haemodialysis, underwent 53 cardiac surgical procedures in the department. The mean age was 56 +/- 13 years. The average duration of preoperative dialysis was 82 +/- 63 months.

Clinical implantation of the wearable Baxter Novacor ventricular assist system.

Implantation of the wearable Novacor electrically powered left ventricular assist system was performed on March 16, 1993, in a 44-year-old man hospitalized for an acute episode of myocardial decompensation after a 6-year history of dilated cardiomyopathy. He was rehabilitated fully and became ambulatory, awaiting a suitable cardiac graft for 59 days. He is now back to work, enjoying a normal life.

Use of the Nippon-Zeon pneumatic ventricular assist device as a bridge to cardiac transplantation.

The Nippon-Zeon (NZ) ventricular assist device is a sac type, air driven, heterotopic, external pump. Its performance has been evaluated in Japan as a bridge to myocardial recovery. Few data are available on the device as a bridge to heart transplantation.

Right heart function during left ventricular assistance in an open-chest porcine model of acute right heart failure.

Changes in the right ventricular function measured with a thermodilution ejection fraction catheter have been recorded in open-chest normal pigs and pigs with acute right heart failure (RVF) undergoing left ventricular assistance with a pneumatic-sac-type device (LVAD). To produce acute right heart failure, 5 pigs underwent ligation of the right ventricular free wall coronary arteries. Compared with normal pigs, cardiac output in ligated pigs fell by 21% (7.

Donor/recipient aorta size mismatch in heart transplantation: a technical alternative.

A technical alternative is proposed to enable transplantation in cases of considerable size mismatch between donor and recipient aorta: interposition of a Dacron graft of intermediate diameter. This procedure was performed in a 56-year-old patient weighing 75 kg in whom a heart from a 40-kg donor was implanted.

Mitroflow pericardial valve: long-term durability.

Isolated aortic (n = 107), mitral (n = 63), and tricuspid (n = 1) valve replacement and 28 double-valve replacements were performed with a second generation of pericardial valves, the Mitroflow valve, in 199 patients from March 1983 to December 1986. Follow-up (total, 1,058 patient-years) was extended to 106 months and 91.5% complete.