摘要:

AbstractSevere posterior annular calcification poses a particular challenge to mitral valve repair. In a series of 252 mitral valve repairs for myxomatous degeneration performed between 1980 and 1993, 14 patients had a severely calcified posterior mitral valve annulus. Ages ranged from 61 to 81 years. Twelve patients were preoperative NYHA Class III or IV, and five patients required concurrent coronary artery bypass procedures. Operative techniques included complete resection of the calcified posterior annulus, resections of portions of the posterior leaflet with leaflet advancement, and placement of an annuloplasty ring. There were no operative deaths and all patients had a postoperative echocardiographic confirmation of relief from mitral regurgitation. During a mean follow‐up time of 36 months (6 months to 8 years), there has been one late valve reoperation and only one late death, from thromboembolism in a patient with atrial fibrillation. These data indicate that even in the presence of severe calcification of the posterior mitral annulus, mitral valve repair for myxomatous degeneration can be performed with a low‐operative risk and satisfactory long‐term re

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00611.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractOccult cardiac injury following blunt trauma is underestimated in frequency of occurrence. Recent reports indicate that it rivals thoracic aortic transection as the cause of death following traffic fatalities. The most common mechanisms include rapid cardiac rotation while the great vessels remain fixed, transfer of hydraulic pressure from the abdomen or extremities, and direct myocardial compression by the sternum. Presentation can be diverse and findings can include jugular venous distention, upper extremity cyanosis, unexplained hypotension, and muffled heart sounds. An enlarged cardiac silhouette is occasionally seen on roentgenographic evaluation. A surprisingly large number of these patients are noted to have no significant signs of external thoracic trauma. Possible mechanisms include rapid rotation and deceleration of the heart with fixation of the great vessels, transmission of a large venous pressure wave to the heart following abdominal or extremity compression, and direct compression of the heart by the sternum. Following prompt diagnosis and rapid surgical intervention, a large number of these patients can be expected to survive this otherwise fatal injury.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00612.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractImprovement in left ventricular assist device (LVAD) implantation techniques may favorably impact on the significant perioperative morbidity and mortality that follows placement of these devices. Based on the difficulties faced and complications encountered during our 45 case experience, we developed a quick‐reference illustrated guide which outlines in detail the steps and considerations critical for successful LVAD implantatio

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00613.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractLatissimus dorsi cardiomyoplasty is a promising surgical therapy in some patients with congestive heart failure. Although the mortality in heart failure patients is attributable primarily to heart failure and ventricular arrhythmias, the mechanism of death after cardiomyoplasty is not well characterized. We describe the clinical course of a patient undergoing cardiomyoplasty and discuss the role of combined use with an implantable cardioverter defibrillator. A 39‐year‐old man with congestive heart failure due to a massive anterior wall myocardial infarction was evaluated for latissimus dorsi cardiomyoplasty. The patient was in NYHA Functional Class III due to heart failure. He did not have any significant exertional or rest angina. During a Naughton stress test, the patient could exercise for 10 minutes, achieving 4 METS. Pulmonary function study showed a peak V O2of 22.1 mL/min per kg. Radionuclide angiography demonstrated that the anterior wall was akinetic with a left ventricular ejection fraction of 22%. Cardiac hemodynamic studies suggested moderate pulmonary hypertension, elevated wedge pressure, and suboptimal response to exercise. A Holter recording showed frequent ventricular extrasystoles. Cardiomyoplasty was preferred to heart transplantation because the patient did not have end‐stage heart failure. Postoperatively, the patient required low doses of dopamine. He developed recurrent, sustained, and hemodynamically significant episodes of ventricular tachycardia. He was treated with a combination of amiodarone and procainamide. He died 2 days postoperatively with ventricular fibrillation. Ventricular arrhythmias are a major cause of death in patients with heart failure. Latissimus dorsi cardiomyoplasty appears to be a promising but unproven therapy in such patients. We suggest that concomitant or preoperative implantation of a cardioverter defibrillator should be considered for future patients undergoing this surgical procedure to prevent sudden arrhythmic d

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00614.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractThe use of intraoperative balloon dilatation during coronary artery bypass surgery has been limited due to relatively unpredictable and potentially damaging results. The development of fiberoptic angioscopy permits safe visualization of the interior of coronary arteries and may be a valuable adjunct to intraoperative balloon dilatation. A 56‐year‐old male underwent four vessel coronary grafting with progressive intraoperative balloon dilatation of a second more distal stenosis of the left anterior descending coronary artery. Angioscopy was used to determine optimal balloon sizing and allowed visualization of associated intimal changes that occurred during the procedure, resulting in a successful outcome for this pati

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00615.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractWe reviewed the management of 25 cases of chylothorax/chylopericardium (CT/CP) in 24 patients (9 females, 15 male; 3 days to 11‐years‐old) following 1605 cardiothoracic procedures (incidence of 1.5%) between January 1984 and December 1993 at our institution. The surgical procedures preceding the occurrence of lymph leak included ligation of patent ductus arteriosus (6 patients), coarctation/double aortic arch repairs (3), complex intracardiac repairs (11), and systemic to pulmonary shunts (5). There were 3 CPs and 22 CTs. All of the patients were initially treated nonsurgically with diet modification using either total parenteral nutrition (TPN) or enteral low fat solid food or enteral elemental diet supplemented with intravenous lipid emulsion. Twenty‐one cases (84%) responded to conservative therapy. Of those, 15 had TPN as the initial treatment; the average duration of lymph leak was 13.7 (range 7 to 30) days and the average maximal lymph leak was 39.4 (range 15 to 130) mL/kg per day. The other six cases had low‐fat enteral diet as the initial treatment, four resolved completely. Two with high‐central venous pressure had to be switched to TPN prior to complete resolution. The average duration of lymph leak in this subgroup was 30 (range 12 to 56) days with the average maximal lymph leak was 30.1 (range 8.5 to 59) mL/kg per day. Excluding these two cases, the average lymph leak of the rest of the group was very compatible to the TPN group of 15 days. Lymphocytopenia and hyponatremia were frequently seen during CT/CP (47.6% and 43%, respectively). Two recurrent CTs in this group were easily treated with reinstitution of low fat diet in one and TPN the other. Four remaining patients required surgical interventions (rethoracotomy and ligation of lymph fistulae in 2, application of fibrin glue to the site of leakage in 1, 1 patient underwent four thoracotomies for persistent CT) for failed initial medical therapy. The mean peak daily lymph loss was 131.2 (range 68.4 to 216) mL/kg which was significantly higher than that of the conservative group (36.2 mL/kg, p<0.001). Three (75%) had complete cessation of lymph drainage after surgery. We concluded that the majority of CT/CP following surgery for congenital heart diseases could safely be treated without surgical interventions by diet manipulations with acceptable inherent morbidity. Patients with high‐central venous pressure should be managed early with TPN and bowel rest. Enteral low‐fat diet used in appropriately selected patients appeared to be as effective in controlling lymph leak as TPN. Surgical ligation of severed lymphatics was indicated for few cases with excessi

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00616.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBetween March 1986 and December 1994, four adult patients underwent surgery for anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) at the German Heart Institute Berlin. The patients, aged 27, 35, 54, and 60, were all females. ALCAPA was diagnosed 3 to 8 months before surgery. The patients presented with cardiac murmur (two patients), abnormal ECG pattern (two patients), arrhythmia (one patient), and acute myocardial infarction (one patient). During surgery a two coronary system was established either by Takeuchi operation (one patient), interruption of the anomalous vessel and aortocoronary saphenous vein bypass (two patients), or internal mammary artery bypass (one patient). There were no postoperative deaths, however, one patient had to be reoperated because of a recurrent shunt. Clinical improvement was observed in all four patients with disappearance of fatigue, angina, dyspnea, and ischemic ECG changes. Despite having this long‐standing congenital heart defect, adult and elderly patients with ALCAPA may benefit from surgical intervention to establish a two coronary syste

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00617.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractFrom 1981 to 1992, 13 male and 7 female patients underwent surgical correction for ruptured aneurysms of sinus of valsalva. A total surgical experience of 22 procedures including 2 reoperations is presented, accounting for 1.37% of open heart surgery for congenital heart disease at PGIMER Chandigarh. Ninty percent were in the 20‐to 40‐year age group. Forty‐five percent of patients had symptoms of>1‐year duration (range 2 months to 20 years) and catastrophic onset of symptoms was noted in four (18%). All patients had localized aneurysms originating either in right coronary sinus (14 pts) or noncoronary sinus (8 pts). Sites of origin and rupture are detailed. Associated congenital abnormalities such as ventricular septal defect (VSD) (13 pts), aortic regurgitation (3 pts), and left superior vena cava and atrial septal defect (ASD) (1 pt each) were noted. The data pertaining to Oriental and Western groups of patients were analyzed, and the differences in age, mode of presentation, site of origin, rupture, and the spectrum of associated abnormalities were elucidated. The majority of the patients (86.4%) were operated by the Bicameral approach. Repair was tailored according to the extent and severity of the defect in the sinus of Valsalva and aortic valve annulus and also the presence and site

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00618.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractRetrograde cerebral perfusion is a method that is recently being used for protection of the brain during operations on the aortic arch. This method is useful but is said to provide a limited time for protecting the brain. We designed an experiment in dogs to investigate neuropathologically the effect of protecting the brain for 120 minutes under: (1) circulatory arrest (CA); (2) retrograde cerebral perfusion with moderately cooled blood (RCPMC); and (3) retrograde cerebral perfusion with deeply cooled blood (RCPDC). We calculated the number of the abnormal cells of 400 hippocampal neurons per dog light microscopically. The number was 199 ± 23 (mean ± 1 SD) in the CA group, 149 ± 50 in the RCPMC group, and 72 ± 33 in the RCPDC group. The difference between the CA group and the RCPMC group was not statistically significant (p<0.05), but there was a significant difference between the RCPMC and RCPDC groups (p<0.05). The degree of cerebral protection provided by retrograde cerebral perfusion for 120 minutes is not sufficient when using moderately cooled blood. If we use deeply cooled blood at a temperature of about 10°C, we should obtain a sufficient degree of protection of the b

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00619.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractFrom January 1, 1988 to September 30, 1993, 44 of 2,455 patients undergoing cardiac surgery for acquired heart disease at our institution sustained an intraoperative or postoperative cerebrovascular accident (CVA). Demographic data, atherosclerosis risk factors, past medical history, cardiac catheterization reports, and intraoperative findings were retrospectively reviewed. The highest rate of CVA was in the sub‐group of patients undergoing simultaneous myocardial revascularization and carotid endarterectomy (18.2%). The lowest rate was in a group of patients who underwent aortic valve replacement (0.9%). Severe aortic arch atherosclerosis with the presence of atheromatous material or calcinosis at the cannulation site was identified intraoperatively in 43.2% of patients with neurological complications and in 5% of the group without CVA (x2= 18.1, p = 0.0001). Of 44 patients with CVA, 13.6% had a history of preoperative completed stroke. CPB time was 90.1 ± 4.9 min vs. 71.6 + 3.7 min (p = 0.004), and aortic cross‐clamping time was 54.5 ± 3.2 min compared to 39.8 ± 2.7 min (p = 0.001) in groups with and without postoperative stroke, respectively. Hypertension was an independent risk factor of postoperative CVA (x2= 9.5, p = 0.02), but age was not. Neurological complications correlated with high operative mortality (38.6%) and prolonged postoperative hospital stays (35.1 ± 5.3). These data describe predictors for the development of post‐cardiopulmonary bypass CVA and identify a high‐risk subgroup for neurological events. The preoperative recognition of risk factors is an essential step toward the reduction of morbidity an

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00620.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY