M V Inberg

University of Turku, Turku, Western Finland, Finland

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Publications (129)86.43 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The original Bentall procedure for the surgery of annulo-aortic ectasia (AAE) includes the risk of leakage and pseudo-aneurysm formation in the coronary anastomosis. To avoid the complications mentioned above we have used the open technique without the graft inclusion. In this study we evaluate our early and late results. One hundred consecutive patients with annuloaortic ectasia underwent surgical repair with composite graft between December 1975 and February 1994. In all cases the aneurysmal tissue was radically resected and the origins of the coronary arteries were directly reimplanted to the tube prosthesis. No wrapping was used. Twenty-two patients met the clinical criteria of Marfan syndrome. Thirteen of the patients underwent an emergency operation, because of a rupture of aneurysm in 2 cases and an acute dissection in 11 cases. Additional procedures were performed in 16 patients: mitral valve replacement in 2, coronary artery bypass grafting in 12 patients and in 2 cases the tube prosthesis included aortic arch, too. The overall hospital mortality was 3.0% (3/100). In the elective group there was one hospital death (1/87; 1.1%). In the emergency group two patients died in the operation room (2/13; 16.7%). There have been 13 late deaths among the 97 hospital survivors (13.4%). Four of the late deaths were surgery related. Routine control angiography was performed in all patients 6 months after surgery. Sixty patients who had lived at least 3 years after surgery were called to reangiography and 53 of them came. No pseudo-aneurysm or leakage at distal anastomosis or coronary anastomosis could be seen. A slight dilatation of one or both coronary origins was observed on 15 patients; 9 of whom had Marfan syndrome. The open technique is simple and can be used in all anatomical variations of the annulo-aortic ectasia. The early and late results are at least comparable with those achieved by other techniques.
    European Journal of Cardio-Thoracic Surgery 02/1996; 10(6):428-32. · 2.67 Impact Factor
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    ABSTRACT: Objective.The original Bentall procedure for the surgery of annulo-aortic ectasia (AAE) includes the risk of leakage and pseudo-aneurysm formation in the coronary anastomosis. To avoid the complications mentioned above we have used the open technique without the graft inclusion. In this study we evaluate our early and late results.
    European Journal of Cardio-thoracic Surgery - EUR J CARDIO-THORAC SURG. 01/1996; 10(6):428-432.
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    ABSTRACT: To evaluate the outcome of cardiovascular surgery in the Marfan syndrome, the records of 49 patients (median age 35 years) who underwent 60 operations were reviewed. Primary surgery was elective in 39 patients and emergency in ten. Non-dissecting aneurysm with diameter 4-19 cm was present in 34 cases and distal, isolated aneurysm in four. In eight cases there was type A acute aortic dissection with median diameter 5.0 cm. One patient was operated on for mitral valve insufficiency, one for ventricular septal defect and one (acute) for endocarditis. Composite grafts were used for aortic root reconstruction. Operative complications occurred in 24% of the patients. The 30-day survival was 92%. There were five (10%) late deaths. Survival after a median of 8 years postoperatively was 82%. The early and late results of cardiovascular surgery in the Marfan syndrome thus are concluded to be generally favourable. As late reoperation frequently is needed, however, close monitoring is advocated even after successful primary surgery.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1995; 29(1):11-5.
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    ABSTRACT: The effects of antegrade and of combined antegrade and retrograde cardioplegia were compared in 101 patients undergoing elective coronary artery surgery. The patients were randomly allocated to two groups: antegrade cardioplegia was administered in 53 patients and combined cardioplegia in 43 patients. The patients of the two groups were similar in age, sex and left ventricular ejection fraction. Aortic clamping time and the number of coronary bypasses were equal in the groups. The ventricular septal temperature was measured continuously during cardioplegia administration, after each distal anastomosis accomplished, and continuously after aortic declamping. Serum CK-MB activities were serially measured for up to 3 days postoperatively. Electrocardiograms (ECG) were taken preoperatively, as well as on the first, second and eighth postoperative days. The left ventricular function was evaluated with a volume load test preoperatively and on the first postoperative morning. The two groups were similar with respect to myocardial cooling, response to volume loading, the number of patients with perioperative myocardial infarctions, cardiac arrhythmias or atrioventricular conduction blocks and clinical outcome. However, the CK-MB activities were lower in the antegrade group suggesting better myocardial protection in an unselected group of patients undergoing coronary artery bypass grafting.
    European Journal of Cardio-Thoracic Surgery 02/1994; 8(12):640-4. · 2.67 Impact Factor
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    ABSTRACT: The effects of training as part of a comprehensive rehabilitation programme on exercise capacity and habits was studied in 171 male coronary artery bypass surgery patients randomized into a rehabilitation (R) (n = 93) and a reference, hospital-based treatment (H), group (n = 78). The rehabilitation programme started with a 2-day informative course before surgery and continued with a 3-week exercise-based course 2 months after surgery followed by a 2-day refresher 8 months post-operatively. The percentages of subjects having regular exercise were 22% and 10% pre-operatively, 42% and 38% 6 months and 46% and 38% 12 months after surgery in the R and H groups, respectively. The changes in the proportions observed in R and H groups were not significantly different. Total work during a bicycle exercise test increased from 38.9 +/- 24.3 kJ pre-operatively to 64.0 +/- 31.4 kJ 6 months (P less than 0.001) and to 70.0 +/- 35.7 kJ 12 months (P less than 0.001) post-operatively in group R and from 40.8 +/- 25.6 kJ to 57.3 +/- 26.6 kJ (P less than 0.001) and to 60.4 +/- 30.8 kJ (P less than 0.001) in group H, respectively. The increase from the pre-operative value was greater in group R than in group H both 6 (P = 0.03) and 12 months (P = 0.02) after surgery. Respective changes occurred in maximal work load, but the increase was significantly greater in group R than in group H only 12 months post-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)
    European Heart Journal 09/1992; 13(8):1053-9. · 14.10 Impact Factor
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    ABSTRACT: The effect of a three-phase comprehensive rehabilitation programme on the quality of life during the first postoperative year after coronary artery bypass surgery was studied in 205 male patients randomly allocated into a rehabilitation (R) and a hospital-based treatment (H) group. The rehabilitation programme included physical exercise, relaxation training, psychological group sessions, dietary advice and discussions about postoperative treatment of coronary disease. There was no difference between R and H groups in the frequency of postoperative complaints, number of hospital admissions and satisfaction of sexual life. An almost significantly greater number of subjects in R group than in H group perceived their health as good 12 months after surgery. The Beck Depression Index score decreased significantly in R group but not in H group during follow-up. A greater increase in hobby activities was observed in R group than in H group. More subjects in R group than in H group considered rehabilitation important for recovery, whereas more patients in H group considered support by the spouse and family, the subjective mental strength and a secure income as important.
    Quality of Life Research 07/1992; 1(3):167-75. · 2.41 Impact Factor
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    ABSTRACT: Aortic valve replacement was performed in 510 patients (Björk-Shiley valves in 93%), with concomitant surgical procedures in 146 cases. The patients were grouped according to technique of myocardial protection: Group I (n = 98) selective coronary perfusion, group II (n = 82) topical cooling, and group III (n = 330) cold crystalloid cardioplegia and topical cooling. The early mortality rate was 5.7% overall: Among patients with isolated aortic valve replacement in groups I, II and III it was 8.4, 1.7 and 1.3%, respectively, and among those with additional surgery 40.0, 12.5 and 8.4%. Myocardial infarction and low cardiac output were responsible for 65.5% of the early deaths. Follow-up ranged from 2 months to 16 11/12 years, totalling 2,859 patient years. In patients with isolated aortic valve replacement and Björk-Shiley prosthesis, the incidence of valve-related late complications/100 patient years was 0.49 for thromboembolism, 0.82 for anticoagulant-related haemorrhage and 0.49 for prosthetic valve endocarditis. There was no thrombotic encapsulation in aortic position. Survival at 5 and 10 years was 83% and 72%. Aortic valve replacement is a safe procedure and concomitant operations do not unreasonably increase risks.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1991; 25(2):119-25.
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    ABSTRACT: Prosthetic valve endocarditis is an infrequent but serious complication of valve surgery. It occurred in 25 (3.2%) of 772 patients who received aortic, mitral or double valve replacement in 1971-1987. The total follow-up time was 3,976 patient years, giving an incidence of 0.63/100 patient years. Staphylococci were the most common of the cultured organisms in early and late infections-60% and 64%, respectively. The endocarditis was disclosed at autopsy in two cases. Treatment was antibiotics alone in 11 cases, and surgery was required in 12, the indication always being congestive heart failure. C-reactive protein level fell more rapidly than erythrocyte sedimentation rate in response to antibiotic or surgical management. The mortality rate was 73% in the antibiotic group and 33% in the surgical group. The findings demonstrated that an infected valve prosthesis should be replaced without delay if complications develop.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1991; 25(2):127-32.
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    ABSTRACT: A report is presented of 24 patients (23 male), mean age 38 years, who underwent surgery for active native valve endocarditis of the left heart in 1975-1988. The aortic valve was affected in all patients, and also the mitral valve in five. Pre-existing aortic valve disorder was present in 17 cases (13 congenitally bicuspid 4 rheumatic affection). There were five hospital deaths (20.8%). Staphylococci as causal organism and extensive infection predicted the highest mortality and morbidity. The mean follow-up time was 39.7 (range 2-114) months. Two reoperations because of prosthetic valve dehiscence revealed endocarditis of the implanted valve. Strong correlation was found between favourable postoperative course and rapid normalization of C-reactive protein levels, which did not fall in patients with persistent infection. Early surgery is recommended if the course of bacterial endocarditis is severely complicated.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1990; 24(3):181-5.
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    ABSTRACT: A report is presented of 50 men and 31 women, mean age 50.3 years, who underwent surgery for multivalvular cardiac disease in 1973-1987. NYHA function class was III-IV in 88% of the patients. The most common procedures were aortic + mitral valve replacement (81%), aortic + mitral valve replacement + coronary artery bypass grafting (5%), aortic valve replacement + tricuspid valvuloplasty (5%) and mitral valve replacement + tricuspid valvuloplasty (5%); 95% of the implanted valves were of Björk-Shiley disc type. Nine patients died perioperatively, six due to myocardial infarction and/or low cardiac output. Postoperative bleeding necessitated resternotomy in three cases. Follow-up was complete, with a mean observation time of 4.5 years (a total of 323 patient years). The incidence of thrombotic valve encapsulation was 0.6/100 patient years. Corresponding figures for anticoagulant-related haemorrhage, prosthetic valve endocarditis and paraprosthetic leakage were 0.9, 1.2 and 1.2. In our experience, the rate of late complications after multivalvular reconstruction using Björk-Shiley prosthesis is acceptable if anticoagulant therapy is correctly employed.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1990; 24(1):23-6.
  • E I Nylamo, M Rautanen, M V Inberg
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    ABSTRACT: A total of 43 patients underwent end to side mesocaval (25 patients) or interposition shunts (18 patients) for bleeding oesophageal varices in 1970-1985. Alcoholic cirrhosis was the aetiology in 30 patients. The operation was elective in 26 and urgent or as emergencies in 17 instances. Operative mortality in elective operations was 19%. In emergency operations the bleeding was controlled in all but one patient, but the mortality was 56%. In Child's group C the mortality was also high, about 50%. During the follow-up of 18 months to 16 years there were five episodes of gastrointestinal bleeding, two of which might have been variceal. Out of the 43 patients 22 survived at least 2 years. Most of the late deaths were caused by hepatic coma; no patient died of recurrent variceal bleeding. - The two types of shunt were equally effective in lowering portal venous pressure. Two venous leg ulcers occurred after an end to side shunt. During the period under study the end to side mesocaval shunt was abandoned and from 1980 only interposition shunts have been performed in our clinic.
    Annales chirurgiae et gynaecologiae 02/1988; 77(4):142-5.
  • M V Inberg, E Vänttinen, V Rantakokko
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    ABSTRACT: Between September 1971 and June 1985, 230 Björk-Shiley valves were implanted for mitral valve disease at the Department of Surgery, University of Turku. Concomitant cardiac surgical procedures were performed in 35.2% of the cases. The follow-up period was between 1 month-13 years 4 months, with a total follow-up of 986 patient years. The early mortality was 4% in patients with isolated MVR and 10% where concomitant procedures had to be performed. Since the use of cold cardioplegia there has been no mortality for isolated MVR and the mortality rate for patients with concomitant procedures has been 3.9%. During the follow-up the rate of thromboembolism was 0.4 per 100 patient years, that of thrombolic encapsulation 0.4 and anticoagulant-related haemorrhage 0.7. Ninety-five per cent of the patients were free from thrombotic or embolic complications at 5 and 10 years after surgery. The survival rate was 79% at 5 years and 72% at 10 years. Considering these results we still prefer the Björk-Shiley valve in mitral valve replacement.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1987; 21(3):239-43.
  • E I Nylamo, M V Inberg
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    ABSTRACT: In the Department of Surgery, University of Turku, 310 patients underwent parietal cell vagotomy for duodenal (268 patients) or pyloric-prepyloric ulcer (42 patients) in the years 1973-82. The male/female ratio was 4/1 and mean age 43 years. There was no mortality. Splenic injury led to splenectomy in 2.6%. A relaparotomy for intraabdominal bleeding was done in 1%. No case of minor curve necrosis occurred. During the follow-up of 3-9 (mean 5) years 9 patients had died of unrelated causes and 29 could not be traced leaving 272 patients for study. Late symptoms occurred as follows: Dyspepsia 20% (recurrences excluded), heartburn 17%, regurgitation 8%, vomiting 4%, epigastric fullness 12%, dumping 5% and diarrhoea 6%. There were 17 proven recurrences of ulcer (6.3%), 11 after original duodenal ulcer (4.7%) and 6 after pyloric-prepyloric ulcer (16.7%). In addition, 4 patients were reoperated for other reasons (1 for dyspepsia, 1 for stenosis and 2 for oesophagitis). The overall results according to the Visick classification were as follows: Grade I 49%, grade II 18%, grade III 15%, grade IV 18%. Conclusion: the method is safe and when used for duodenal ulcer will give satisfactory results, but after pyloric or prepyloric ulcer the recurrence rate may be higher.
    Annales chirurgiae et gynaecologiae 02/1986; 75(5):226-9.
  • E I Nylamo, M V Inberg
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    ABSTRACT: 459 patients who were operated on electively for duodenal ulcer in the Surgical Department, University of Turku, in 1965-1976 are reviewed. The operations were: Billroth II resection (B II) 95, truncal vagotomy and antral resection (TV-A) 61, selective gastric vagotomy and antral resection (SV-A) 159, vagotomy and pyloroplasty (V-P) 70, and parietal cell vagotomy (PCV) 110 patients. Operative mortality was 0 in B II, 4.9% in TV-A, 0.6% in SV-A, 1.4% in V-P, and 0 in PCV. About 80% of patients were interviewed 3-12 (mean 5-7) years after operation. Dumping, diarrhea and vomiting occurred less frequently after PCV, but dyspepsia was as common as after B II, TV-A, SV-A, or V-P. Recurrence rates were: after B II 2.7%, TV-A 0, SV-A 0.7%, V-P 9.7% and PCV 8.5%. The incidence of good overall results (Visick grades I + II) was similar after PCV and B II (70% and 69%) which was significantly better than after V-P (41%) and compared favorably with TV-A or SV-A (56% and 54%).
    Annales chirurgiae et gynaecologiae 02/1986; 75(3):135-41.
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    ABSTRACT: Replacement of the ascending aorta and the aortic valve with a composite graft, including reimplantation of the coronary ostia, was carried out in 41 consecutive patients with annulo-aortic ectasia from 1975 to 1984. Thirty-seven patients were operated on electively and 4 of these had a chronic dissection. Four patients underwent an emergency operation, 1 for a ruptured aneurysm and 3 for an acute dissection. The operative procedure was identical in each case. The aortic valve and the aneurysm were resected, the coronary ostia were dissected free, mobilized, and then implanted to the tube prosthesis. There was no hospital mortality. Re-sternotomy was done in 3 patients for excessive postoperative bleeding. Two patients required a permanent pacemaker owing to a total atrioventricular block. No pseudoaneurysms at the coronary ostia or the distal aortic anastomosis were observed at control aortography carried out in each patient 6 months after surgery. One patient died 3 months after the operation because of multiple emboli. All the other patients have been symptom free during follow-up. It is concluded that total repair using the technique described is feasible in all patients with annulo-aortic ectasia and gives good early and late results.El reemplazo de la aorta ascendente y de la vlvula artica con un injerto compuesto, incluyendo la reimplantacin de los orificios de las coronarias fu realizado en 41 pacientes consecutivos con ectasia del anillo artico durante el perodo 1975 a 1984. Treinta y siete pacientes fueron operados en forma electiva y cuatro de ellos presentaban una diseccin crnica. Cuatro pacientes fueron sometidos a operacin de emergencia, uno por ruptura de aneurisma y tres por diseccin aguda. El procedimiento operatorio fu idntico en todos los casos. La vlvula artica y el aneurisma fueron resecados, la implantacin de las coronarias fu liberada, movilizada y luego reimplantada en la prtesis tubular. No hubo mortalidad operatoria. Se requiri reoperacin (esternotoma) en tres casos por exceso de sangrado postoperatorio. Dos pacientes requirieron un marcapasos permanente debido a bloqueo A-V total. No se observaron seudoaneurismas a nivel de la reimplantacin coronaria o de la anastomosis artica distal en la aortografa de control realizada a los seis meses de la operacin en cada uno de los pacientes. Un paciente muri tres meses despus de la operacin debido a embolias mltiples. Todos los dems pacientes se han mantenido libres de sntomas en el curso del seguimiento. Se concluye que la reparacin total mediante la tcnica descrita es factible en todos los casos con ectasia del anillo artico y que d buenos resultados a corto y a largo plazo.De 1975 1984, 41 malades qui prsentaient une ectasie annulaire de l'aorte ont subi le remplacement de l'aorte ascendante et de la valve aortique l'aide d'une greffe, l'intervention comportant galement la rimplantation des coronaires. Trent-sept de ces sujets ont subi une opration lective: 4 d'entre eux prsentaient une dissection aortique chronique. Quatre sujets ont t oprs d'urgence: 1 pour une rupture de l'anvrysme et 3 pour une dissection aortique aigu. La mthode chirurgicale fut la mme dans tous les cas. L'anvrysme et la valve aortique furent rsqus, les orifices coronaires furent dissqus, mobiliss pour tre implants au niveau de la prothse. Il n'y eut pas de dcs opratoire ou postopratoire. Il fut ncessaire de roprer les malades dans 3 cas en raison d'une hmorragie post-opratoire importante. Deux patients durent bnficier de la mise en place d'un Pace-Maker permanent en raison d'un bloc AV complet. Aucun pseudoanvrysme au niveau de la rimplantation coronaire ou de la partie distale de l'anastomose ne fut observ lors du contrle aortographique pratiqu systmatiquement chez chaque opr 6 mois aprs l'intervention. Un opr mourrut trois mois aprs l'intervention en raison d'embolies multiples. Tous les autres oprs n'ont prsent aucun trouble en postopratoire. On peut conclure de ces faits que la rparation complte employant la technique chirurgicale dcrite est faible dans tous les cas d'ectasie aortique annulaire, et donne des rsultats prcoces et tardifs satisfaisants.
    World Journal of Surgery 07/1985; 9(3):493-9. · 2.23 Impact Factor
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    ABSTRACT: The mortality rate and early complications of coronary artery bypass surgery were assessed for the first 441 consecutive patients operated on at Turku University Hospital. The overall hospital mortality rate was 2.5%. Perioperative myocardial infarction (PMI) accounted for more than half of the deaths, cerebral thromboembolism and sudden coronary death each for one-fifth and left ventricular failure for one-tenth. Postoperative complications occurred in 17.7% of the patients. Bleeding and postpericardiotomy syndrome were the most common complications (in 5.2 and 3.6% of the patients). Sternal resuture was needed in 3.2% of the patients, and PMI occurred in 2.9%. PMI had a 46% mortality rate, with two-thirds of the deaths occurring in the operating theatre. Only PMI reached statistical significance as sole cause of death. Mode of myocardial protection, completeness of revascularization and severity of coronary disease did not influence the PMI rate. Graft patency overall was 92.8% on average 3 months after surgery. The respective patency rates for internal mammary artery grafts and vein grafts were 90.3 and 92.9%.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1985; 19(1):21-7.
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    ABSTRACT: The myocardial (arterial-coronary sinus) balance of oxygen and lactate was studied before a cardiopulmonary bypass and during the first 5 min of a normothermic bypass in two patient groups undergoing coronary revascularization for multiple coronary artery disease. The hemodilution (HD) group was hemodiluted before the bypass with dextran 70 (15 ml/kg; resulting mean hematocrit 32%) and further at the beginning of the bypass due to nonhemic priming of the oxygenator (mean hematocrit 15%). The control (C) group was not diluted before the bypass, and four units of red blood cells were included in the oxygenator priming (mean hematocrit 27% after the beginning of the bypass). The preoperative dilution produced a decline in the coronary sinus blood oxygen tension and oxygen saturation, but no change in the arterial-coronary sinus lactate balance. After the first 5 min of the bypass, the heart produced lactate in both the HD group and the C group, but the lactate production was more pronounced in the HD group. At the same time, the coronary sinus blood oxygen saturation was lower in the HD group than in the C group. Hypotension frequently accompanied the beginning of the bypass in both groups. It is concluded that the hemodilution to a hematocrit level of 32% in patients undergoing coronary revascularization for multiple stable coronary artery disease produces compensatory changes in myocardial oxygen extraction, but no changes of a generalized ischemia can be demonstrated. The hemodilution to a hematocrit level of 15% produces myocardial ischemia in patients with a normothermic unloaded heart, adding to the effect of hypotension at the beginning of the bypass.
    European Surgical Research 02/1984; 16(3):141-7. · 0.75 Impact Factor
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    ABSTRACT: The use of a fixed dosage schedule was compared with the use of activated clotting time (ACT) for monitoring heparin anticoagulation and its neutralization during and after extracorporeal circulation in patients undergoing coronary artery bypass grafting. Use of ACT resulted in a statistically significant decrease in heparin and protamine dosages and statistically significant reductions in postoperative blood loss and blood transfusion needs. Postoperative levels of blood hemoglobin concentration were significantly higher and the activated partial thromboplastin time was significantly shorter with ACT monitoring than with use of a fixed dosage schedule. The results confirmed the superiority of the ACT method for monitoring anticoagulation during cardiac surgery.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1984; 18(1):57-61.
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    ABSTRACT: One hundred and thirteen patients operated during the years 1971 to 1976, were re-examined at an average of 26.3 months after heart valve replacement. The functional capacity assessed by the NYHA-classification improved in about 40% of the patients. About 80% considered their symptoms and well-being to have improved after the operation. At the re-examination, heart size was most often enlarged in patients with mitral valve replacement. The average work load measured in bicycle ergometer test was higher in patients with aortic valve replacement compared to those with mitral valve replacement. Patients with aortic valve replacements were working more often (54%) than those with mitral valve replacements (37%). The mean age of patients who were working was significantly lower than in patients who were retired. There was a statistically significant relation between the physical working capacity and the working status. The employability assessed by history and clinical findings corresponded well to the actual work situation in individual patients.
    Scandinavian Journal of Rehabilitation Medicine 02/1984; 16(2):65-70.
  • T Savunen, J Niinikoski, M V Inberg
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    ABSTRACT: Results of total repair of annulo-aortic ectasia in three children are presented. The operations were performed on vital indications. All the children survived. In one of them a total AV-block developed and required permanent pacemaker treatment. There were no late complications in the follow-up period of 22 to 41 months.
    Scandinavian journal of thoracic and cardiovascular surgery 02/1984; 18(1):15-21.

Publication Stats

403 Citations
86.43 Total Impact Points

Institutions

  • 1968–1996
    • University of Turku
      • Department of Surgery
      Turku, Western Finland, Finland
  • 1981–1995
    • Turku University Hospital
      Turku, Province of Western Finland, Finland
  • 1979
    • Helsinki University Central Hospital
      Helsinki, Southern Finland Province, Finland
  • 1971–1974
    • Turku centre for biotechnology, finland
      Turku, Province of Western Finland, Finland