摘要:

AbstractThe arterial switch operation has recently become the preferred method of repair for patients with transposition of the great arteries in the majority of congenital heart centers. Concern regarding the late results in those patients undergoing atrial repairs has stimulated this major change in operative treatment. Although initially high, the current operative mortality has been reduced substantially to equal that of atrial repair in experienced institutions. The precise methods of coronary artery transfer, as well as aortic and pulmonary artery reconstruction have been refined to allow the routine performance of direct arterial repair within the first few weeks of life with low risk and excellent late survival. At the University of Michigan, a policy of arterial repair for all suitable infants with transposition of the great arteries with or without ventricular septal defect was adopted in July 1985. Although modifications in surgical technique have been made, the basic procedure has remained constant. This article reviews the current operative approach used in a consecutive series of 81 patients undergoing the arterial switch procedure.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00281.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractWe recently repaired six large ventricular aneurysms using a technique that emphasizes restoring function rather than excising diseased tissue, or endoaneurysmorrhaphy. An elliptical woven Dacron patch is tailored to fit the defect in the left ventricular wall, making the length and width conform to the normal left ventricular volume. In each of our cases, use of this technique allowed prompt recovery and restoration of ventricular function.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00282.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThe combination of deep hypothermia and circulatory arrest has been used in a variety of cardiovascular surgical techniques and is presented in this article as an elective method in the treatment of type B dissecting aneurysms that may or may not involve the distal aortic arch. Out of 190 patients operated on with acute aortic dissection, 10 patients with type B underwent surgical procedures, between January 1985 and December 1987, four with acute dissection (less than 14 days evolution), and six with chronic dissection (more than 14 days evolution). The approach was by left posterolateral thoracotomy with cardiopulmonary bypass using femoro‐femoral cannulation, deep hypothermia, and circulatory arrest. The duration of circulatory arrest was between 27 and 58 minutes, mean 37 minutes. Extracorporeal circulation (ECC) lasted between 68 and 142 minutes, with a mean perfusion time of 83.7 minutes, and temperature fell to 14°C and 16°C. Intrahospital mortality was 20% (two patients). No long‐term mortality has been recorded. Eighty percent of the patients (eight patients) are alive and showed good evolution between 10 and 44 months following surgery, with a long‐term mean survival of 24 months and 23 days. The only neurological complication was a single case of right unilateral blindness followed by complete visual recuperation. Myocardial and spinal cord protection are excellent without any incidence of postoperative infarct or paraplegia. Postsurgical blood loss ranged from 200 to 650 mL with a mean of 385 mL. Acute renal insufficiency was not detected. We believe that the combined techniques of deep hypothermia and circulatory arrest used electively, and not just out of occasional necessity, is a viable choice that allows easier surgical manipulation of type B dissection aneurysms and complete resolution of those involving retrograde dissection to the aortic arch. In addition, this combined technique does not increase postoperative mortality in this critically dangerous

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00283.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThis article details techniques of delivery of antegrade/retrograde blood cardioplegia to ensure its distribution to prevent ischemic damage during aortic clamping, and describes methods of using warm blood cardioplegia to “resuscitate” the heart when used to induce cardioplegia and “avoid reperfusion damage” when given just before aortic unclamping. A technique of rapid transatrial cannulation of the coronary sinus is described to permit safe, rapid, and simple use of retrograde cardioplegia and avoid right heart isolation. Theoretic objectives of these operative techniques are discussed, together with presentation of the specific methods of achieving the aforementioned goals of using blood cardioplegia for resuscitation, prevention, and avoidance of ischemic and reperfusion damage. The preliminary clinical experience with antegrade/retrograde cardioplegia is summarized, and these results have led to adoption of these techniques of blood cardioplegia as the preferred method of myocardial protection in all adult operations and in many pediatric cardiac pro

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00284.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThis article describes the first posterior septal and first and second right free‐wall pathways Identified at operation for Wolff‐Parkinson‐White syndrome and confirmed histologically. All pathways were found in the areas of preexcitation identified by pre and intraoperative mapping. They bridged the atrium and ventricle, and postoperative electrophysiological testing confirmed division of the pathways. Kent bundles may be identified at the time of surgery but they appear to be gossamer structures usually destroyed during surgical manipulation of the coronary sulcus. Visualization of the suspected bypass tract should not alter or limit the extent of surgical disse

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00285.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00286.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00287.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00288.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00289.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY