ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00190.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractAs the population of patients having undergone myocardial revascularization increases, the number of reoperations will escalate and reoperations of patients with patent grafts will become increasingly frequent. Successful management of this new surgical entity requires a clear understanding of the probability of atherosclerotic involvement of patent vein grafts and careful attention to technical detail. Patent vein grafts more than five years old should be replaced to avoid the potential for embolization of atheromatous material and late vein graft closure.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00191.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractLeft thoracotomy and femoro‐femoral cardiopulmonary bypass has been used for reoperation in five patients requiring coronary bypass graft into the inferolateral surface of the heart. Five patients had refractory angina pectoris and angiographic occlusion of lateral wall native vessels or previous occluded vein grafts and all had positive exercise test. Four of the five had patent internal mammary to the LAD. Following supine positioning and removal of the saphenous vein and isolation of the femoral artery and femoral vein, a left fifth interspace thoracotomy was made, the patient heparinized and cannulated for cardiopulmonary bypass, the pericardium opened, the heart dissected free, and either the internal mammary artery dissected off the left chest wall or saphenous vein grafts used to bypass the appropriate lesions. The proximal inflow was the descending thoracic aorta making tunnels for the vein grafts through the posterior pericardium. All of the patients did well in the postoperative period.This technique is recommended for reoperations in patients with documented inferolateral ischemia as the primary cause of symptomatology with mitigating circumstances against an anterior approac

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00192.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractThe child with congenital heart disease requiring permanent pacing presents a unique challenge with regard to the decision to pace, hardware, route, and unusual problems. Considerations of patient size, anatomy, insertion during and after complex intracardiac procedures, location of hardware, and unusual approaches are discussed including: placement of endocardial leads at open operation, closed transatrial endocardial technique, periprosthetic valvular endocardial placement, trans left superior vena cava placement and retromammary position via the axillary approach. Consideration of these unusual techniques may avoid frustration due to the complexities of the placement of pacing systems in these young patients.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00193.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractThirty‐eight patients with drug refractory ventricular tachycardia have been operated on since 1980. An attempt at preoperative localization of the site of arrhythmia was made in those patients who did not have severe ischemia or multifocal tachycardia. Operation consisted of intra‐operative mapping, when feasible, subendocardial resection and cryolesions placed when sites of interest could not be resected. Patients averaged 56±44 years of age and 25 had associated coronary bypass. The operative mortality was 5/38 (13%) and two deaths were related to recurrent arrhythmia. Of 33 survivors, 21 (64%) were cured of their arrhythmia and an additional nine patients who had been drug refractory were controlled with medication alone. The best results were found in patients with anteroapical scar and unifocal tachycardia. Thus, direct operation for drug refractory ventricular tachycardia can be performed at a reasonable risk and with a high likelihood of successful arrhythmia con

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00194.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractBetween January 1981 and December 1983, 4 patients, aged 6 to 50 years, with It‐PAPVC were operated upon at the Kokura Memorial Hospital, by a new technique of anastomosis between the left anomalous PV and the left auricular appendage. One patient, a 9‐year‐old male, had unilateral anomalous pulmonary venous connection of the entire left lung to the innominate vein. The other three patients had partial anomalous pulmonary venous connection from the left upper lobe to the innominate vein. Two patients has pulmonary valvular stenosis, and the other two had ASD. All patients were operated upon through a midsternal incision. After cardiopulmonary bypass was established, the anomalous vein was divided as high as was reachable. The present operative method involved the use of an oval pericardial gusset extending from the left auricular appendage into the split anomalous vein so as to obtain a wide anastomotic orifice. Other associated congenital anomalies were simultaneously corrected. All patients had uneventful recovery and at postoperative cardiac catheterization and angiography, the anastomosis between the pulmonary vein and the left auricular appendage was widely p

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00195.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractIschemia in myocardial tissue results in impaired high energy phosphate production and diminished perfusion of the interstitial space. Reduction in the supply of ATP to the sarcolemmal and sarcoplasmic reticulum Na+and Ca2+pumps results in a rise in intracellular (Ca2+), which can exceed normal systolic levels within 10 to 15 minutes. Elevated (Ca2+), can cause activation of proteases and phospholipases, which can damage the sarcolemma and release toxic metabolites, such as lysophospholipids. Oxygen free radicals can be produced by breakdown of nucleosides and accumulate in the interstitial space. Accumulation of metabolites intracellularly can cause cell swelling, which in addition to rigor due to ATP depletion, can stress the weakened sarcolemma, producing cell rupture and death. With reperfusion, additional injury to the myocyte may occur. Resupply of oxygen can result in a burst of oxygen free radical production. Resynthesis of ATP may sensitize the myofilaments to Ca2+, resulting in a hypercontracture that can further promote cell rupture. Resupply of ATP and washout of H+may cause activation of Na/Ca2+exchange, thus intensifying Ca2+overload. Washout of the hypertonic interstitial space fluid may aggravate cell swelling and produce sarcolemmal rupture. Prevention or alteration of ischemic and reperfusion injury in myocardial cells is important clinically. Strategies currently being explored include reducing the rise in (Ca2+), which occurs during ischemia and reperfusion; inhibiting the actions of phospholipase on the cell membrane; decreasing free radical effects; and reducing stress on the sarcolemmal by prevention of cell swelling and hypercontracture.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00196.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractDespite improvements in surgical technique and intraoperative myocardial protection, certain patients have need for inotropic drug support after cardiac surgery. This review examines drugs that are currently in use for inotropic support of the heart, including calcium, epinephrine, dopamine, dobutamine, isoproterenol, and amrinone. Patient factors that may have an impact on the selection of appropriate drugs are also examined. Application of these data to specific patients must be guided by the particular hemodynamic derangements present. Careful analysis of the specific hemodynamic disorder and tailoring of inotropic therapy to these abnormalities are crucial. Such a rational approach to the selection of inotropic agents requires continuous hemodynamic assessment and recognition that the patient's condition and needs may change rapidly early after heart surgery dictating adjustment of subsequent therapy.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00197.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractA method using an interface device is presented designed to correct malfunction of counterpulsation caused by pacing signals or other electronic interference in patients undergoing simultaneous pacing and counterpulsation.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00198.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00199.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY