Leif Efskind

Prevention of arterial thromboembolism with acetylsalicylic acid: A controlled clinical study in patients with aortic ball valves

Prevention of arterial thromboembolism with acetylsalicylic acid (ASA) was studied in 148 patients with single Starr-Edwards aortic ball-valve prostheses. These patients are suitable for such a study because they have a high incidence of arterial emboli derived mainly from thrombi formed on the valves. They were given either 1 Gm. of ASA daily or placebo in combination with anticoagulants, and were observed for 2 years. Only two emboli occurred in patients receiving ASA, none of them severe. In the placebo group 12 thromboembolic episodes were diagnosed in 10 patients, and three with cerebral emboli died; in one a subdural hematoma unrelated to the embolus was found. In addition, one fatal and the one nonfatal intracranial bleeding occurred in each group, whereas gastrointestinal complications were seen more frequently in patients taking ASA. It is concluded that ASA combined with anticoagulants offered a significantly better protection against arterial thromboembolism than did anticoagulant therapy alone.

Atrial septal defect of secundum type in the middle-aged: Clinical results of surgery and correlations between symptoms and hemodynamics

Summary This study comprised 98 of 100 patients above 40 years of age who underwent surgery in Norway for atrial septal defect of secundum type (ASD II) up to 1972. A follow-up study was performed on average 74 months (range 22 to 174) after surgery. Pulmonary hypertension was found in 30 per cent. The pulmonary arteriolar resistance (PAR) was increased in only one patient. Increasing degrees of arrhythmias, Dyspnea, edema, and functional class (NYHA) before surgery were significantly correlated to increasing pressures in the right atrium, right ventricle, pulmonary artery (PA), left atrium (pulmonary capillary venous pressure), and to increasing PAR. No significant correlations between the shunt ratio and different degrees of the symptoms were found. The hospital mortality rate was 3 per cent, and was not related to high age or increased PA pressure. There were no deaths among the last 65 patients. Before surgery, 13 per cent of the patients were in functional Class I, and 22.6 per cent in Class II or IV. The corresponding figures after surgery were 58.1 per cent and 0 per cent. The frequency of arrhythmias was high, and this was the symptom which showed the least improvement. Cerebral embolism occurred in six patients who also had arrhythmias, and five of the embolisms occurred after surgery. All patients with ASD II complicated with arrhythmias should be given anticoagulant therapy, whether they are operated on or not. In middle-aged patients disabled by ASD II, a marked improvement after surgery can be expected.

Aortic valve replacement: One-year results with Lillehei-Kaster and Bjork-Shiley disc prosthesis. A comparative clinical study.

Abstract The present study presents clinical and functional results obtained in a randomized series of 68 patients examined one year after single aortic valve replacement with either a Lillehei-Kaster pivoting disc valve or a Bjork-Shiley tilting disc valve. Symptomatic improvement was experienced in 67 per cent of all patients re-examined, and 88 per cent were in functional Classes I and II. In patients with pure aortic valve disease, heart volume was significantly reduced, while a small group of patients with mitral valve disease, in addition, had unchanged or slightly increased heart volume. Regression of left ventricular hypertrophy in the electrocardiogram was also noted in most patients. It is felt that the clinical and functional results may be of the same order of magnitude in patients with the Lillehei-Kaster model as in patients with the Bjork-Shiley prosthesis.

Patent Ductus Arteriosus:Surgical Treatment of 686 Patients

Six hundred and eighty-six patients with isolated patent duct have been treated surgically, 673 by double ligation and 13 by division of the duct. The overall mortality rate was approximately 1%. the recurrence rate 3%. In our opinion, the technically simple ligation is justified in most patients, while duct division ought to be carried out in those cases where complete occlusion is difficult to achieve by simple ligation, due to a large calibre or pathological changes in the duct wall.

Immediate and Late Results of Aortic Ball Valve Replacement

During the 5-year period 1965 to 1970, 243 patients with aortic valvular disease were subjected to aortic ball valve replacement. Most of the patients had combined aortic stenosis and insufficiency. Pure aortic insufficiency was found in 51 patients. The main aetiological factors in pure insufficiency were aortic wall and cusp weakness, previous rheumatic infection and bacterial endocarditis. Angina pectoris was one of the most common symptoms, and was found in 49% of these patients. Angina pectoris is most often functional in aortic stenosis, being produced by reduced coronary blood supply and increased myo-cardial oxygen demand due to left ventricular hypertrophy. Hospital mortality was 17% and late mortality during the follow-up period, which ranged from 1 to 5 years, was 8% (total 25%). The main causes of death were arrhythmia, myocardial failure and septicaemia. Myocardial infarction was the cause of death in 9 patients, while 6 patients suffered from myocardial infarction, which they survived. Throm...

The Appearance of Rheumatic Mitral Stenosis in Cineangiography Related to Surgical Treatment

Left ventricular cineangiography was performed in 44 patients suffering from rheumatic mitral stenosis. Rheumatic mitral stenosis of the funnel type is angio-graphically a diagnostic entity, involving interesting aspects in the evaluation of candidates for surgery and the surgical procedure of choice. The correlation between the angio-graphic, surgical and cardiological findings is satisfactory. When rheumatic mitral stenosis of the funnel type is present, commissurotomy and recommissurotomy are not safer treatment for the patient, and the long-term effect does not exceed 4 years. Improvement of cardiac function, as evaluated by clinical examination 6 months after operation, is better in patients treated with mitral valvular replacement, even if hospital mortality is considered, than in the patients operated on with commissurotomy or recommissurotomy.

Long-Term Shunt Palliation for Fallot's Tetralogy

One hundred and sixty-two systemic-pulmonary shunts of various types were performed in 136 patients with Fallots tetralogy. There were 72 Blalock-Taussig shunts, 31 Potts and 24 of Waterston shunts. Furthermore, systemic-pulmonary anastomoses with interposed grafts were made in 34 cases. The patients were followed up for 1 to 23 years, average 12 1/2 years. The total mortality varied from 25% in the Waterston group to 42% in the Potts group. The immediate palliative effect of the shunt operation in the surviving patients seemed to be independent of the type of shunt used. At follow-up, 9 of 69 patients originally operated upon with a Blalock-Taussig shunt were alive with their original shunt, while the corresponding figure in the Potts group was 12 of 30. More than 20 years after palliation, one of 15 patients were alive with an original Blalock-Taussig shunt and 9 of 22 with a Potts anastomosis. Surgical problems in construction of the shunts and the long-term results are briefly discussed.

Surgical Treatment of Mitral Stenosis: Survival Rales in 500 Operated Patients

500 consecutive patients with mitral stenosis subjected to surgery are reviewed and survival rates calculated. Survival rates are less than for a comparable normal population, but significantly higher than for patients with mitral stenosis under medical management. For patients in functional Class II with sinus rhythm, the survival rates are identical for operated and un-operated patients, but as 85.6% of the operated patients had subjective improvement, commissurotomy is also recommended for patients in this group.

Congenital Atresia of the Oesophagus:A Follow-up Study in 36 Surgically Corrected Cases

A review is presented of 36 patients with oeso-phageal atresia with or without tracheo-oesophageal fistula. Three theories regarding the origin of the fistulas are briefly discussed. the clinical manifestations and treatment are reviewed. All the patients are alive 11 to 24 years postoper-atively. the follow-up examination included clinical evaluation, manometric pressure recordings and X-ray investigation of the oesophagus. Dysphagia occurred in patients with moderate or severe oesophageal stenosis. Motility disorder in the oesophagus may represent an additional cause of dysphagia. the relationship between the dysphagia and the oesophageal motility disorder is briefly discussed.

Surgical Treatment of Postinfarctional Ventricular Septal Rupture and Aneurysm

Three patients with severe cardiac failure after postinfarctional septal rupture were operated by cardio-pulmonary bypass 24 days, 5 months, and 2 1/2, years, respectively, after the infarction. Two of the defects were closed by direct suture, the third with a Dacron patch. Left ventricle aneurysmectomy was performed in 2 patients; in the third an infarcted akinetic area was resected. One patient died postoperatively, the other 2 were greatly improved and in good condition at follow-up 7 and 8 months after operation. The very high initial mortality indicates emergency closure in patients in non-responsive cardiac shock. If possible, surgical repair should be postponed 2–3 months.