Leif Bergdahl
Karolinska University Hospital
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Scandinavian Cardiovascular Journal | 1978
Leif Bergdahl; Axel Henze
This report reviews 24 consecutive cases of oesophageal perforation which were treated during a 20-year-period at the Thoracic Surgical Clinic, Karolinska Sjukhuset, Stockholm, Sweden. Fourteen perforations followed oesophageal instrumentation, 5 were due to foreign bodies and 5 were spontaneous. Six patients were treated conservatively and survived. Two of 10 patients treated with drainage and antibiotics died of mediastinitis. Surgical closure of the perforation was performed in 8 patients, one of whom died of mediastinitis. The periods of hospitalization were 22, 61 and 32 days, respectively. A survey of the literature on oesophageal perforation (290 cases) revealed 3 factors which mainly affected the prognosis. Firstly, the mode of treatment related to the early mortality rate in that 18% died during conservative treatment, 30% after drainage and 16% following repair. Secondly, the type of perforation appeared to be another determinant of the outcome. Instrumental perforations were associated with a l...
Scandinavian Cardiovascular Journal | 1981
Leif Bergdahl; Viking Olov Björk; Rune Jonasson
Twenty-seven patients 70 years of age or more were operated upon with aortic valvular replacement with an early mortality rate of 7%. No more patients died during a mean follow-up period of 28 months. The Björk-Shiley standard tilting disc valve was implanted in 15 cases and the new convexo-concave model in 12 cases. Sixty-seven per cent of the patients had narrow aortic roots (21 and 23 mm prosthesis diameters) compared with 40% of younger patients. Thrombo-embolic complications occurred in 2 patients who had not received anticoagulant treatment. No such complications were recorded in the remaining 23 surviving patients treated with anticoagulants. All the surviving patients (except one who was re-operated because of a thrombotic encapsulation of the disc) were markedly improved postoperatively. High age alone is no longer an absolute contra-indication for aortic valve replacement. The convexo-concave Björk-Shiley tilting disc prosthesis is suitable in these patients because of its low resistance of flow at small diameters. The importance of anticoagulant treatment even in elderly patients is emphasized.
Scandinavian Cardiovascular Journal | 1980
Leif Bergdahl; Viking Olov Björk
During the last 20-year-period 42 patients with dissecting aortic aneurysms were treated at this hospital. The ascending aorta was involved in 23 patients, while 19 aneurysms were localized to the descending aorta. Ascending aneurysms were operated upon with an early mortality rate of 35%. A re-entry procedure via an abdominal incision was performed in one patient. Graft replacement and aortic valve replacement with the Bjork–Shiley tilting disc valve were performed in 8 patients and in 3 of the patients re-implantations of the coronary arteries were also performed. Six patients underwent graft replacement with resuspension of the aortic commissures. Graft replacement only was performed in 2 patients. Eight operated patients are still alive after a mean follow-up period of more than 4 years. Four of six patients, who were not operated upon, died early and only one patient in the non-treated group is still alive (follow-up period 1 year). Nine of 19 patients with descending aneurysms were operated upon and...
Scandinavian Cardiovascular Journal | 1980
Leif Bergdahl; Viking Olov Björk
Forty patients with different cardiac diseases underwent perfusion with the Shiley bubble oxygenator without a filter in the arterial line (Group A). This group was compared with a similar group of patients (Group B), in whom an Intersept nylon mesh filter was used in the arterial line. There were no differences according to age, weight or duration of perfusion between the two groups. The average postoperative bleeding via the chest tubes was 361 ml/m2 B.S.A./24 hours in group A compared with 414 in group B (p less than 0.05). One patient in the filter group died on the table because of myocardial failure, while the remaining 79 patients could leave hospital alive. One patient in each group showed impaired consciousness, but no other neurological complications were recorded in the patients. There were no significant differences in haematocrit, B-haemoglobin or leucocyte counts after 15 min, 1 hour, at the end of perfusion or 1 hour, respectively 24 hours postoperatively. The platelet count after 1 hour of perfusion was 55.8 x 10(9)/l in the filter group compared with 80.4 x 10(9)/l in group A (p less than 0.05), there were, however, no significant differences in B-platelet counts at the end of perfusion or later. Our study showed that a nylon mesh filter in the arterial line can reduce the platelet count. As no measureable advantages were found in the filter group we cannot recommend an arterial line filter.
Scandinavian Cardiovascular Journal | 1980
Leif Bergdahl; Rune Jonasson; Viking Olov Björk
Between the years 1957 and 1965, 20 patients over 35 years of age were operated upon for coarctation of the aorta, 13 with end-to-end anastomosis and 7 with Dacron graft. There was one hospital death, due to rupture of the suture line, and three late deaths, two of them of aortic valvular disease and one of colonic carcinoma. The remaining 16 patients were followed-up 12–19 years after surgery, 13 with a thorough investigation. Aortic valvular disease was diagnosed in 6 of them, all being in functional capacity class (N.Y.H.A.) II or III, whereas 6 of 7 patients without valvular disease were in class I. The incidence of verified aortic valvular disease in the whole material was 50%. Hypertension (above 160/90 mmHg) was found in 50% of the patients, compared with in 9% in our long-term follow-up of patients operated upon before 16 years of age. There was no difference in the results between patients with end-to-end anastomosis and those with Dacron graft. At catheterization a small pressure difference was ...
Scandinavian Cardiovascular Journal | 1987
Leif Bergdahl; Pekka Iisalo
During the past 10 years, 50 patients underwent combined coronary artery bypass grafting (CABG) and mitral valve replacement (MVR) at our clinic, with additional aortic valve replacement (AVR) in six cases. The early mortality was 8%. During the first half of the study period this mortality was 4/11 patients, but in the second half it was 0/39. All six patients with CABG + MVR + AVR survived the operation. Adverse factors were found to be advanced functional impairment, female sex, concomitant untreated aortic valvulopathy and elevated pulmonary vascular resistance. All 46 patients who survived the operation were followed up for a mean period of 31 months, and during that time there were nine deaths. The survival rate was 54% after 3 years and 40% after 5 years. Most of the patients had improved by at least one functional class. The good results in this series probably were attributable to improvements in surgical procedure (introduction of cold potassium cardioplegia) and in postoperative management (intra-aortic balloon pumping).
Scandinavian Cardiovascular Journal | 1980
Leif Bergdahl; Rune Jonasson; Viking Olov Björk
The first nineteen consecutive Swedish children operated upon for coarctation of the aorta by Crafoord during the years 1944 to 1952 were followed-up in this study. Seven of them had no symptoms pre-operatively. A blood pressure above 130/80 mmHg was found in all the patients. At operation resection of the coarctation with end-to-end anastomosis was performed in all cases. One patient died postoperatively in necrosis of the small bowel. Five others had died during the follow-up period, three of them probably due to valvular lesions. One patient was successfully re-operated on for an aneurysm of the anastomosis. Another patient with residual coarctation was re-operated on after 7 years with a diamond-shaped Dacron patch graft. He later developed an aneurysm and was re-operated on a second time with a tubular Dacron graft and has thereafter been without complications for 6 years. Two patients, who were in good health, would not consent to a hospital investigation. Follow-up examinations were performed in 11...
Scandinavian Cardiovascular Journal | 1981
Viking Olov Björk; Axel Henze; Leif Bergdahl; B. Bjarke; GöRAN Wallgren
Surgery for double-outlet right ventricle (DORV) was performed in 13 patients between November 1974 and January 1979. Subaortic ventricular septal defect (VSD) was present in 11 patients, complicated forms of DORV in 2 patients and 5 patients had important concomitant cardiac defects. Six infants (mean age 0.6 years) without pulmonary stenosis (PS) required operation because of pulmonary hypertension, whereas the 7 patients with PS underwent surgery at a considerably later stage (mean age 6 years). Interventricular tunnel-repair established continuity between the systemic ventricle and great artery in 12 patients. One case with subpulmonic VSD was managed by transposition of both venous return and arterial outflow, while the use of valved external conduits was generally avoided. Atrial incision was sufficient to permit complete intraventricular repair in 8 patients, including one pulmonary valvulotomy. Important co-existing PS was otherwise treated as in cases of tetralogy of Fallot and required transannular patch grafting in 2 instances. Hospital mortality was 3/13 patients (23%) and mainly confined to serious associated cardiac malformations which were not amenable to correction. All 10 survivors are functionally improved 1.5-5 years after surgery. Clinical and invasive re-evaluation (3 patients) could not identify the development of systemic ventricular outflow tract obstruction. One patient, who underwent enlargement of a restrictive VSD, presented angiographic evidence of a moderate aortic incompetence. No other important complications were associated with the tunnel-repair and none of the 10 survivors had complete heart block.
Scandinavian Cardiovascular Journal | 1986
Stig Ekeström; Leif Bergdahl
Blood-flow measurements were performed in 72 patients after sequential vein grafting (Y-grafting) to LAD and diagonal branches. The mean blood flow in the joint graft was 69 ml/min, i.e. significantly more than the 36 ml/min in one branch when the other was occluded. When one branch was occluded for 10 min (11 patients), there was insignificant increase of the flow through the nonoccluded branch. The mean joint graft flow and branch flow increased insignificantly after administration of dipyridamole. Lower blood flow in one branch of the sequential graft than in the joint graft is due to insufficient collateral system. High rate of flow in the joint graft probably reduces the rate of early and late occlusion.
Scandinavian Cardiovascular Journal | 1979
Luis Rodriguez; Leif Bergdahl
A 63-year-old man was operated upon with replacement of the aortic valve, mitral valve and ascending aorta with re-implantation of the coronary arteries. A composite graft with a 27 mm Björk-Shiley tilting disc prosthesis was inserted with 3 continuous Prolene sutures in the aortic position. The coronary arteries were thereafter re-implanted in holes made in the graft. A 31 mm Björk-Shiley valve was sutured in the mitral position with about 20 isolated mattress sutures of Ti-Cron. Selective myocardial hypothermia was instituted with Ringers solution of 4 degrees C. The total perfusion time was 185 min compared with 240 and 275 min in two previously reported, similar cases. We consider that the use of cardioplegia, a composite graft and continuous sutures makes it possible to reduce the operation time in these complex cases. Our patient is in good condition 9 months postoperatively.