ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00200.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractWe report our results with the Senning procedure for repair of d‐transposition of the great arteries (d‐TGA) including techniques that we feel facilitate the operation. When the atrial septal flap is deficient at the site of an atrial septal defect, the flap is filleted to enlarge it using living tissue. This also has the effect of thinning the septal flap which enlarges the left pulmonary vein pathway located posterior to the floor of the new caval tunnels. Another technique includes the use of the upper end of the sulcus terminalis in the construction of the roof of the new caval tunnels. The upper posterior rim of the right atriotomy is left external to this suture line and can be used in construction of the new pulmonary venous pathway. The latter suture line is inferior to the SA node and can be placed expeditiously and with less chance of damaging the SA node. Use of this technique has resulted in a reduced incidence of late arrhythmias. Following the Senning procedure in 40 patients there were no hospital deaths, but there were two late deaths. The Senning operation is currently a very satisfactory alternative for repair of d‐TGA when arterial switch repair cannot be perf

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00201.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractPulmonary valve autograft replacement of the aortic valve has been performed in nine patients in an effort to duplicate in the United States the experience of Sir Donald Ross in London. Four male and five female patients ranging in age from seven to thirty‐four years have been operated on for indications of aortic stenosis in six and aortic regurgitation in three. Three patients had associated procedures performed concomitantly. All patients survived the surgery and were clinically improved, however, one patient did require reoperation for progressive aortic insufficiency. Specific indications, results, and technical considerations are discussed and illustrate

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00202.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractThe timing of operation is discussed for aortic, mitral, and combined aortic and mitral insufficiency. The effect of surgical mortality on selection is assessed on the basis of the Green Lane Hospital results for valve replacement in the current cardioplegic era. Particular attention is paid to the effect of the preoperative symptomatic status. The criteria for selection of the patient who is essentially asymptomatic are documented in detail. It is concluded that they differ, depending upon whether there is aortic incompetence, mitral incompetence, or incompetence of both valves. The effect of the type of valve used for replacement on case selection includes an up‐to‐date assessment of the results achieved with freehand aortic homograft valve replacem

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00203.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractDigitalis glycosides have a narrow margin between therapeutic and toxic levels. Although the incidence of digitalis toxicity appears to be decreasing, continuation of digoxin therapy in the face of overt toxicity carries a substantial risk of life‐threatening cardiac rhythm disturbances. This review will focus primarily on toxicity produced by digoxin and discuss the mechanisms, clinical manifestations, and current management of digitalis toxicity. The appropriate methodology for measurement and interpretation of serum digoxin levels is emphasized. The varied cardiac dysrhythmias induced by digoxin are detailed and their specific management outlined. Immunological (antibody) treatment has now been established and approved for the therapy of advanced, life‐threatening digitalis toxicity and the multicenter trial of digitalis antibodies is described. Proper understanding of the pharmacokinetics of digitalis glycosides and careful followup of digitalis treated patients for early evidence of toxicity should help to decrease further the prevalence of toxic reacti

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00204.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractFor almost 100 years the coronary venous system has attracted researchers as an access route to deprived myocardium. Different concepts have been tried and numerous experimental studies have been performed to evaluate whether coronary sinus occlusion, retroinfusion, and retroperfusion of arterial blood via the coronary sinus represent an effective treatment of myocardial ischemia. The early successful studies of Drs. Gregg, Eckstein, Beck and others led to the application of the Beck II procedure, a permanent retroperfusion technique used in the early 1950s to revascularize patients with diffuse atherosclerosis. The coronary sinus route was also used to retroperfuse blood intraoperatively during opening of the heart to keep the heart beating. Excessive mortality and severe side effects, such as myocardial edema and hemorrhage, and an insufficiently advanced technology resulted in the temporary demise of the coronary sinus approaches. Recently, however, the need to improve myocardial protection, despite enormous advances in coronary bypass surgery and interventional cardiology, has resulted in renewed interest in the coronary sinus as an access route to deprived myocardium. Advances in technology such as percutaneous catheter techniques have improved access to the coronary venous system and allowed for a physiological adaptation of coronary sinus retroperfusion techniques. Today the three major coronary sinus techniques, i.e., sychronized retroperfusion (SRP), retroinfusion of cardioplegia during cardiac arrest and retroinfusion of pharmaceutical agents in the normal working heart, and pressure‐controlled intermittent coronary sinus occlusion (PICSO) have been documented as providing superior protection of jeopardized myocardium in selected subsets of patients. All of these techniques currently are under clinical consideration; the retroinfusion of cardioplegia has already found wide clinical acceptance, SRP and PICSO have only recently been tested in first clinical trials.Due to a vast resurgence in interest, it is desirable to survey the results obtained with each of these techniques, to discuss the pathophysiology and mode of action of coronary sinus interventions, and to assign them a place in the perspective of conventional therapies. Furthermore, an attempt will be made to weigh individual coronary sinus techniques against each other, discuss in which clinical settings each of them may be most effective, and define issues facing current developmen

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00205.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractA technique is described that provides early reperfusion of acutely ischemic myocardium during the construction of saphenous vein bypass grafts to the coronary arteries. Selective vein graft perfusion provides early and appropriate cooling of the most ischemic zones identified by either electrocardiographic changes or intramyocardial temperature probes and allows warm blood reperfusion during construction of proximal anastomoses. The technique may be applicable to patients who present with acute ischemia and evolving infarction, failed angioplasty, or left main coronary artery stenosis.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00206.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractMedian sternotomy offers the ideal exposure for most cardiac and mediastinal procedures. One infrequently mentioned morbidity of the traditional median sternotomy is the unsightly scar, especially in pediatric and adolescent patients who are extremely sensitive about their body appearance. We report our experience using a bilateral inframammary “butterfly” incision on 31 patients in association with a median sternotomy to provide excellent exposure and an improved cosmetic res

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00207.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractThe Jahnke‐Barron heart support has proven to be a useful adjunct to coronary artery surgery by allowing an easy access to the coronary arteries while maintaining a quiet operating field. Further, the use of this device eliminates the need for a surgical assistant or a heart holde

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00208.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Book Reviews in this articles:Copeland JG and Goldman S (Eds):Improving Results with Coronary Artery Bypass GraftingDalen J and Alpert J (Eds):Valvular Heart Disease

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00209.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY