ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00419.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractSince September 1979, 53 patients have required operation for systemic atrioven‐tricular valve regurgitation at Children's Hospital and Health Center of San Diego. (Primary repairs of atrioventricular canal defects are excluded from this report.) Diagnoses include single ventricle, cardiomyopathy, congenital mitral insufficiency, Marfart's disease, rheumatic heart disease, and a history of prior repair of atrioventricular canal defect. Ages ranged from 4 months to 19 years; median age is 5 years. In 31 patients, the atrioventricular valve could be repaired. In 24 patients, the valve was replaced (including two patients previously repaired). There were four operative deaths, all in the valve replacement group: three following valve replacement, and one following emergency thrombectomy. Two early failures in the repair group required valve replacement. Techniques for repair included leaflet resection, commissural annuloplasty, ring annuloplasty, and chordal shortening. Follow‐up reveals good‐to‐excellent status in 38 patients. There were seven late deaths: six following valve replacement (one death valve related). Current surgical technique permits repair of the systemic atrioventricular valve in many infants and children requiring operation for regurgitation. The long‐term results of valve repair are good to excellent. Repair avoids the morbidity and mortality of valve replacement, e.g., anticoagulation, fixed orifice size, and catastrophic mechanical valve malfunction. (J Card Surg 1993;

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00420.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractTwenty patients had a repair of an atrioventricular septal defect with tetralogy of Fallot (n = 13) or double outlet right ventricle (n = 7). Mean age was 3.5 years. Surgical technique included transatrial‐transpulmonary resection of right ventricular outflow tract obstruction and transatrial two patch repair of the atrioventricular septal defect. Ten patients required a transannular patch and one patient had a right ventricle‐pulmonary artery conduit placed. There was no hospital mortality, and mean hospital stay was 15 days. One patient had late sudden death of unknown cause. Six patients have required reoperation because of residual ventricular septal defect (VSD), mitral incompetence, residual right ventricular outflow tract obstruction, and/or conduit stenosis. No patient was reoperated on because of left ventricular outflow tract obstruction. Fifteen patients are asymptomatic, one has exertional dyspnea, and two have intermittent occasional bronchospasm. The transatrial‐transpulmonary two patch repair and extensive relief of right ventricular outflow tract obstruction have given good immediate results. Reoperation rate has been high mainly due to residual VSD and mitral incompetence. (J Card Surg 1993; 8:62

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00421.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractIntramyocardial dissecting hematoma following myocardial infarction is an unusual form of subacute cardiac rupture that tends to develop along naturally occurring dissection planes between the spiral muscles of the ventricle. The diagnosis has commonly been made at surgery, postmortem examination, or by echocardiography. Most are associated with acute transmural inferior infarction. Few patients survive without surgical intervention. Fourteen cases have appeared in the literature. One additional case is described. Ten cases were treated medically with one survivor (10%). Five cases were treated surgically with five survivors. Surgical treatment of intramyocardial dissecting hematoma is preferable to medical treatment. Proper and timely diagnosis and prompt surgical treatment are necessary before complete myocardial rupture ensues. Diagnosis is facilitated through the use of two‐dimensional echocardiography. Successful surgical management of this condition requires an appreciation of commonly associated pathoanatomical conditions, and the utilization of appropriate methods of repair in the presence of potential ventricular septal and ventricular free wall rupture. (J Card Surg 1993; 8:628–

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00422.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractAcute cardiac rupture is often a lethal complication of transmural myocardial infarction. A case of successfully treated left ventricular free wall rupture is described. Preoperative hemodynamic stabilization was achieved by intraaortic balloon counterpulsation. A BioMedicus left ventricular assist device was used intraoperatively and postoperatively to obtain long‐term intraventricular decompression to allow for suture repair of friable myocardium. (J Card Surg 1993; 8:638–

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00423.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThis article describes three new techniques for completely closing the pericardial space. They entail the creation of three flaps of living, vascularized tissue: two pericardial and one pleural. Utilizing advancement and rotational plastic surgical principles, complete closure can be performed without tension or the use of any pericardial substitutes. These flaps create great laxity and tissue redundancy during closure, greatly reducing any possibility of graft compromise or impairment of myocardial diastolic function. There are three types of closure described, types I and la, and type II, creating great versatility in closing the pericardial space (and adaptability to the surgeon's preferences). These flaps are able to create pericardial tissue redundancy (and therefore laxity upon closure) in both the transverse and longitudinal directions, and are therefore suitable to any cardiac procedure. The advantages of these techniques in creating a tension‐free complete closure include the possibility of a safer reoperation if needed. The DiMarco‐Jurado pleuropericardioplasties as described are quick and easy methods to completely close the pericardial space without tension and may be utilized after all adult (and possibly pediatric) primary cardiac procedures. (J Card Surg 1993; 8:641

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00424.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractWith increasing frequency, reoperative coronary artery bypass surgery is being performed in the setting of a patent internal mammary artery (IMA) graft. Injury to the IMA graft at reoperation can result in ischemic myocardial injury and cardiac arrest. This descriptive laboratory study examined use of a polytetrafluoroethylene (PTFE) membrane wrap to protect the IMA pedicle during sternal reentry. Six pigs (25–30 kg) underwent median sternotomy and takedown of left and right IMAs. Grafts were implanted in the epicardium by a modified Vineberg procedure. In each animal, one IMA was wrapped circumferentially with PTFE, while the contralateral bare IMA served as the control. Redo sternotomy was performed 3 months later. Severe adhesions between chest wall, myocardium, and bare IMA grafts were encountered in six of six animals. PTFE‐wrapped IMAs were easily identified by appearance and by palpation. There was no adherence between PTFE membranes and surrounding tissue, nor was there evidence of cellular infiltration, disruption, or contraction of the membrane. Most notably, PTFE membranes could not be cut or injured with the electrocautery, since they are electrical nonconductors. This study demonstrates that PTFE membrane: (1) is relatively inert and incites minimal surrounding tissue reaction; and (2) is impenetrable to electrocautery injury. Further studies are necessary to determine the impact of PTFE membrane on IMA graft patency and wound infection. PTFE membrane may prove clinically useful in protecting patent IMA pedicles during reoperative cardiac surg

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00425.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractEndothelial cells were derived from aortic and mitral valves (n = 17) by collagenase digestion and subsequently cultivated in RPMI medium supplemented with 20% fetal calf serum. The cells were stained in an alkaline phosphatase‐anti‐alkaline phosphatase stain for the expression of MHC Class I and Class II antigens, ICAM‐1, ELAM‐1, F VIII, and H/Y. The endothelium showed a strong expression of Class I, H/Y, and ICAM‐1 molecules, and weak expression of MHC Class II molecules. In contrast to vascular endothelium that is known to express F VIII constitutively, cardiac valve endothelium was found to be negative. F VIII and ELAM‐1 were only expressed after stimulation with recombinant interferon‐gamma. To analyze the immunogenicity of valve endothelium, cells were used as stimulator cells in a mixed cell culture reaction using lymphocytes as responder cells. Endothelial cells had a 2 to 3 times higher stimulatory effect than peripheral blood lymphocytes. These data allow speculation on whether the observed degeneration of homografts can be reduced if HLA matching is performed prior to valve

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00426.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractA cylindrical valve was designed to prevent regurgitation of the semilunar valve. The valve is made of a sheet of polytetrafluoroethylene (PTFE) or porcine pericardium, and has three cusps and three commissures. The diameter of the valve is equal to the height of the cusps. We have used these valves in pulmonary stenosis after Jatene's operation and total correction of tetralogy of Fallot, and for truncal valve regurgitation. Regurgitation was trivial on color Doppler echocardiography in all cases. Advantages in comparison with the implantation of commercially available artificial valves include the ability to insert a larger size and no compression of the valve ring when closing the sternum. Outflow tract obstruction does not occur even when the valve is implanted in a small infant. In the present report, we describe this simple technique.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00427.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractSince 1980, the automatic implantable cardioverter defibrillator (ICD) has evolved as effective therapy for prevention of sudden cardiac death following documented sustained ventricular tachycardia or fibrillation. During a 5‐year period, 412 ICD devices were implanted at the University of Michigan Hospitals with a wound complication rate of 4.1%. In this group, there were 13 infections, 3 erosions of the generator pocket, and 1 wound hematoma. Of the 16 patients with infection or erosion, 12 patients were treated with a rectus abdominis muscle flap closure and 4 with ICD generator removal. In 83% (n = 12) of the muscle flap patients, the wound healed uneventfully. Preoperative chest CT scanning was found to be helpful in identifying probable infection of the epicardial leads. In these cases, all hardware had to be removed to achieve resolution of the infection. We concluded that rectus abdominis muscle flaps were helpful in salvaging infected or exposed ICD generators in the absence of infected epicardial lead

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00428.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY