ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00358.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractCoronary bypass and valvular operations have become more prevalent as the nation's elderly population grew 21% within the last decade. Ascending aortic calcification was a manifestation of this aging process. Aortic cannulation appeared impossible. Postoperatively, the stroke rate reached 14%, and the number of unexpected deaths rose sharply. Embolization of calcific and arteriosclerotic debris to cerebral and coronary vessels is believed to be the cause. The sharp, beveled, and narrowed jet‐forming tips assaulted the delicate and soft intima of the artery. Nineteen cases of severely calcified aorta with increased predictable risk factors were operated on within the past 5 years. There were 12 coronary bypass grafts, 4 ventricular aneurysmectomies, and 3 valve replacements. Five of these cases were redo operations. The average age for these patients was 73.7 years. With the availability of the cannula introducer, we were able to find a small soft spot inside the arch or ascending aorta and cannulate these patients. We began to cool the patients down immediately and chose one of the three available methods for cardiac arrest. By changing the angle of application and direction of the axis of the clamp, we could cross‐clamp the aorta loosely in 11 patients and administer cardioplegia. Intraluminal balloon occlusion of the ascending aorta was used once. The remainder of the cases had fibrillatory arrest. All proximal anastomoses in the coronary patients were done while on cross‐clamp, intraluminal balloon occlusion, or brief periods of circulatory arrest. All sutures were passed from inside the aorta to avoid displacing or dissecting calcified plaques. There was no operative mortality, neurological deficit, or bleeding bring‐backs in this group of p

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00359.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractEpicardial dissection without the use of cardiopulmonary bypass (CPB) was performed in 88 patients (56 males and 32 females, mean age 31.9 years). With intraoperative epicardial mapping, 101 accessory pathways were detected, with multiple pathways in 11 patients. CPB was avoided in all but one patient due to frequent onset of atrial fibrillation with rapid ventricular rate. Surgical ablation was successful in 86 patients (97.6%). Three patients required multiple surgical procedures because of persistence of conduction along a component of the original pathway. All but two patients were discharged without antiarrhythmic medication; these two patients were given quinidine therapy because of atrial fibrillation, but had normal early and late electrophysiological studies. Surgical ablation of Kent bundles by the epicardial approach for the treatment of Wolff‐Parkinson‐White syndrome can be achieved without the use of CPB. Optimal and steady exposure of the area are mandatory for the procedure, and dissection is eased by avoidance of heparin required for

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00360.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractDegenerative and rheumatic mitral valve disease are associated with calcification of the annulus, leaflets, and subvalvular mechanism. Surgical treatment is greatly affected by the presence of such calcification, which frequently precludes successful repair, mandating valve replacement. Dense calcification of the posterior leaflet, annulus, and chordae can cause great difficulty in the insertion of a prosthetic device, and is associated with a high frequency of technical complications. We have devised a technique of replacing the mitral valve in the face of such severe calcification, which allows the surgeon to safely insert a single disc mechanical prosthetic valve, avoiding the calcification completely. A large Teflon felt collar precludes the need to place any sutures through the posterior valve leaflet. Successful early experience with five patients, exhibiting both degenerative and rheumatic disease, is described.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00361.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractA new method for prosthetic valve replacement in a small aortic annulus is described. An anatomical examination showed that the intra‐arterial approach via the main pulmonary artery made it feasible to incise the aortopulmonary septum at the middle point of both coronary ostia and also to relieve left ventricular outflow tract obstruction with a two‐dimensional patch. The pressure study in three mongrel dogs demonstrated that 6‐mm augmentation of the host aortic annulus with this procedure made no significant difference in the pressure gradient between the right ventricle and the main pulmonary artery before and after operation. The right ventricular end‐diastolic pressure did not show any significant change with respect to hemodynamics. It is expected from these results that our procedure could be used for the treatment of various types of left ventricular outflow tract stenosis without affecting the hemodynamics and, especially, right ventricular f

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00362.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThis is the second review in a three‐part series concerned with the description and categorization of ventricular septal defects. By viewing the defects from the right ventricular aspect, they can be placed into one of three classes: perimembranous, muscular, or doubly committed and juxtaarterial. According to the posteroinferior margin of the third group, these could extend to become perimembranous or muscular. In this review, the complications produced by malalignment of the septal structures associated with overriding of an arterial or atrioventricular valve are described in detail. It shows that although there are problems in defining the extent of any interventricular communication, these ventricular septal defects can be classified with the same categorization as developed for those not associated with overriding. The nosology developed is able to serve as a guide to the surgeon to the site of the specialized axis for atrioventricular conductio

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00363.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBacterial infection (Salmonella enteritidis) of left ventricular true and false aneurysm in a 62‐year‐old man was followed by septic saddle embolus. The septic saddle embolus was removed and the aneurysm was later resected with coronary bypass grafting. The patient is alive with satisfactory function over 5 years postoperativ

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00364.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe etiology of absent pulmonary valve syndrome is unknown. Several theories have been advanced to explain the associated findings of a rudimentary pulmonary valve, ventricular septal defect, aneurysmal pulmonary arteries, and absence of the ductus arteriosus. The patient presented here would contradict these currently held theories. A review of the literature follows the case report.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00365.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractWhile the development of pharmacological cardioplegic solutions for myocardial protection during cardiopulmonary bypass (CPB) have significantly lengthened the safe operating time for cardiac surgical procedures, the introduction of hypothermic hyperkalemic cardioplegia (CPG) has markedly increased the incidence of postoperative arrhythmias and conduction abnormalities. Using a customized modification of a computerized mapping system, we have developed a large animal porcine model of CPB that is exquisitely sensitive to the electrophysiological (EP) derangements imposed by ischemia and cardiac arrest. This model is able to measure spatial and temporal parameters of ventricular activation with high resolution, using an array of up to 84 epicardial electrodes that can be reproducibly placed on the surface of the heart utilizing known epicardial anatomical markers (e.g., coronary arteries). With this system we have measured the spectrum of clinically observed EP disturbances caused by CPG, from slowed intraventricular conduction to complete heart block. Compared to the control group of hypothermia alone, 2 hours of crystalloid CPG arrest had a significant slowing effect on ventricular activation (p<0.05). CPG was accompanied, in each animal, by profound changes in the spatial distribution of ventricular activation and persistent slowing of ventricular activation. Traditional EP parameters of effective refractory period and pacing threshold were unchanged by CPG. Smaller temporal and spatial changes were observed in the control group, but were always reversed by 90 minutes of warm reperfusion. We conclude that CPG induces injury of the specialized conducting system and, to a lesser degree, the myocardium. This model will afford us the opportunity to test new methods of CPG to further improve myocardial preservation during CPB.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00366.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractHypothermia has been considered a prerequisite for decreasing oxygen consumption and providing myocardial protection. The decrease in myocardial oxygen consumption however, is more closely related to the state of electromechanical arrest than to hypothermia. The rationale for warm blood cardioplegia is based not only on electromechanical quiescence but equally on facilitation of O2delivery. This report outlines the basis for the concepts, the various concerns and the possible future directions of warm blood cardioplegia.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00367.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY