Alexander Geha | University of California, San Diego (original) (raw)

Papers by Alexander Geha

Journal of Vascular Surgery, 1984

Cardiovascular Surgery, Aug 1, 1995

The Annals of Thoracic Surgery, Dec 1, 1995

Annals of Surgery, Sep 1, 1992

The Journal of Thoracic and Cardiovascular Surgery, Feb 1, 1973

The Journal of Thoracic and Cardiovascular Surgery, Feb 1, 1987

The Annals of Thoracic Surgery, Dec 1, 1977

Journal of Surgical Research, Sep 1, 1971

Abstract Cerebral and systemic metabolism were studied by measurement of gas tensions, pH, and la... more Abstract Cerebral and systemic metabolism were studied by measurement of gas tensions, pH, and lactate and pyruvate concentrations in CSF and arterial blood in dogs subjected to simultaneous occlusion of the carotid and vertebral arteries in the neck, or simultaneous intrathoracic occlusion of the brachiocephalic vessels and their branches. No appreciable change in cerebral metabolism was demonstrated with cervical occlusion of the vertebral and carotid vessels and all the dogs recovered with no detectable alterations in their gross clinical behavior. On the other hand, simultaneous interruption of the brachial and cephalic blood flow was associated with severe cerebral hypoxia and lactic acidosis, and with irreversible brain damage, leading eventually to death. Canine cerebral metabolism and function appear to remain intact after bilateral interruption of the carotid and vertebral arteries in the neck. Brain integrity, however, is then dependent upon the extensive collateral circulation between branches of the brachial vessels and of the cerebral vessels, particularly the vertebral arteries. Additional interference with flow of blood through the brachial vessels rapidly results in cerebral metabolic failure and irreversible brain damage.

The Annals of Thoracic Surgery, 1993

A simplified method of transatrial cannulation of the coronary sinus during cardiopulmonary bypas... more A simplified method of transatrial cannulation of the coronary sinus during cardiopulmonary bypass, with the heart completely decompressed, is described. The technique is easy to adopt and inherently safe because the catheter is guided toward the great cardiac vein visually, rather than by manual palpation.

The Annals of Thoracic Surgery, Feb 1, 1983

Successful extraanatomical repair of bilateral intrathoracic arteriosclerotic subclavian artery a... more Successful extraanatomical repair of bilateral intrathoracic arteriosclerotic subclavian artery aneurysms is reported. Rupture of the left subclavian aneurysm required emergency thoracotomy for proximal and distal ligation. The right subclavian aneurysm was repaired electively. Because of constraints resulting from the arterial anatomy (origin of aneurysm at innominate artery bifurcation), prior operation (coronary artery bypass grafting and repair of aneurysm of the sinus of Valsalva), and the patient's occupation (young, employed craftsman with dominant right hand), an extraanatomical reconstruction was devised to exclude the aneurysm and revascularize the head and arm. The reconstruction consisted of an external ilioaxillary Gore-Tex bypass graft in conjunction with an end-to-end distal subclavian to distal common carotid Gore-Tex graft. This is believed to represent the first reported successful repair of bilateral intrathoracic arteriosclerotic subclavian aneurysms, and the first application of this extraanatomical reconstruction.

European Journal of Cardio-Thoracic Surgery, 1996

Archives of Surgery, Mar 1, 1978

A tracheoesophageal fistula secondard to prolonged nasogastric intubation and ventilatory assista... more A tracheoesophageal fistula secondard to prolonged nasogastric intubation and ventilatory assistance via a cuffed tracheostomy tube developed in a 27-year-old woman who had sustained a traumatic injury. The fistula grew progressively larger despite removal of the tubes, thus demonstrating the inherent poor prognosis associated with the untreated lesion. Since the cuff necessarily damages the trachea circumferentially at the same level, closure of the fistula and circumferential excision and reconstruction of the damaged tracheal wall were performed with an excellent result up to four years after the repair. This would be the preferred procedure when the patient can be weaned off the respirator and when the general condition and the size of the fistula allow such a definitive one-stage approach.

The Journal of Thoracic and Cardiovascular Surgery, 1979

The direct relationship between graft flow and regional midwall myocardial function has not been ... more The direct relationship between graft flow and regional midwall myocardial function has not been documented in patients. Therefore. the present study was designed to quantitate the effects of coronary artery bypass grafting on regional myocardial mechanics distal to a coronary artery obstruction. Twenty-one patients with subtotal or total occlusion of the left anterior descending (LAD) coronary artery underwent coronary artery bypass grafting. Following completion of the aortic and coronary anastomoses, two miniature ultrasonic dimension transducers (2.5 mm. diameter) were positioned within the minor axis of the anterior left ventricular free wall and were allowed complete freedom of movement, The transducers were placed at midwall depth. and areas of clinically apparent myocardial fibrosis were not utilized as sites of implantation, During control, 30 minutes following the termination of cardiopulmonary bypass, regional myocardial dimensions, pulmonary artery diastolic pressure. arterial pressure, and heart rate were recorded with all saphenous vein grafts open and after 30 seconds of single vein graft occlusion. These measurements were repeated during atrial pacing at a rate of 128 ± 4 beats per minute. Data are mean ± the standard error of the mean. During control. graft occlusion resulted in a regional decrease in systolic excursion from 1.3 ± 0.1 to 1.0 ± 0.2 mm. (p < 0.01), as well as a decrease in the rate of shortening from 8.7 ± 0.2 to 6.2 ± 1.1 mm. per second (p < 0.05); heart rate, mean arterial pressure, and diastolic pulmonary artery pressure remained unchanged. Graft occlusion with atrial pacing resulted in an exaggerated decrease in both regional systolic excursion. from 1.2 ± 0.2 to 0.6 ± 0.2 mm. (p < 0.0 I), and rate of shortening .from 9.4 ± 1.5 to 4.4 ± 0.2 mm. per second (p < 0.01). For the group of patients studied, end-diastolic lengths were unchanged with graft occlusion during control and atrial pacing. Moreover, with graft occlusion, isolated patients demonstrated regional dyskinesia as evidenced by holosystolic bulging. These studies in patients have documented for the first time that, despite a constant preload, afterload, and heart rate, regional myocardial function following coronary artery bypass grafting is dependent upon adequate graft flow, especially during stress.

Anesthesiology, Sep 1, 1980

Transplantation, Apr 1, 2000

Springer eBooks, 1987

Crossed double internal mammary artery (IMA)-coronary artery grafts (left IMA to LAD, right IMA t... more Crossed double internal mammary artery (IMA)-coronary artery grafts (left IMA to LAD, right IMA to diagonal or obtuse marginal) were used without operative mortality in 44 patients, age 36–70 years, requiring grafts to these vessels during 1973–1977; 32 of them had additional saphenous grafts (SVG) to achieve revascularization. At complete follow-up, 8 –12 years after operation, all 44 are alive. Recurrent angina developed at 8 and 9 years postoperatively in two patients because of closed SVGs to other coronaries, and is well controlled medically. One patient developed a uniform narrowing “string sign” of both IMAs 2 years postoperatively, probably because of less than critical coronary lesions, and had an attempt at revascularization. All patients are fully active on late follow-up, and all IMAs studied angiographically are patent.

European Journal of Cardio-Thoracic Surgery, Jul 1, 1997

Archives of Surgery, Apr 1, 1978

Dr Saidi has put together an up-to-date, complete work on hydatid disease that includes a very th... more Dr Saidi has put together an up-to-date, complete work on hydatid disease that includes a very thorough coverage of the parasitology, epidemiology, and diagnosis of this infestation in addition to a detailed description of the surgical therapy of the disease in various organs. Since 1928, when Dr Harold Dew of Australia published his book Hydatid Disease: Its Pathology, Diagnosis and Treatment , a large amount of information has accumulated in the medical literature pertaining to the epidemiology, diagnosis, and therapy of this infestation. This information has primarily originated from areas known to be endemic for Echinococcus granulosus . These publications have been, however, in the form of reports, and Dr Saidi's book is an important contribution in terms of gathering and updating the information about this disease in the form of a single reference book. The chapters dealing with the parasite, diagnosis of the disease, and the principles of treatment are indeed