ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01018.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractVentricular septal defect (VSD) is an infrequent but extremely serious complication of myocardial infarction. Operative mortality rates tend to be higher in the elderly population; however, long‐term follow‐up has not been specifically studied. It is, therefore, important to assess not only the early but also the long‐term results of VSD repair in patients over 70 years of age to determine its value for the elderly patient. Between June 1968 and May 1991, 86 patients who experienced a myocardial infarction underwent surgical repair of an infarct related VSD at the Massachusetts General Hospital (MGH). Group I (n = 57) includes those patients younger than 70 years, and group II (n = 29) represents those patients age 70 years and older. Follow‐up of hospital survivors ranged from 1 month to 24 years and was compiled in April and May, 1991. Three patients were lost to follow‐up (4%), and these were younger than 70 years of age. There were no differences in the values of the preoperative variables for the younger and older groups with respect to sex, concomitant procedures performed (bypass vs no bypass), use of an intraaortic balloon pump (IABP), location of VSD, presence of shock, total hospital days, or days between infarction and operation. There was, however, a difference between the two groups relative to the era when surgery was performed. More patients over the age of 70 underwent surgery after 1978 than before 1978 (p = 0.0012). The majority of survivors are in New York Heart Association (NYHA) Class I or II, and there was no difference between the younger and older groups in functional class at the time of follow‐up (83.3% vs 91.7% of survivors in Class I or II, respectively). Using the generalized Wilcoxon test to analyze these survival data, there was no apparent difference in long‐term survival (p = 0.97) when comparing the two age groups. The mean follow‐up period was 77.02 months for the younger group and 80.52 months for the older group. The fact that more older patients were repaired after we had significant experience in the surgical management of patients with VSDs probably accounted for our excellent results in the older age group. Our data reveal that patients over the age of 70 can expect excellent long‐term survival, with over 90% of these survivors remaining in NYHA Functio

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01019.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractReplacement of the aortic arch during repair of either extensive aortic aneurysmal disease or aortic dissection can be a major undertaking. Borst introduced an “elephant trunk” technique whereby a tubular aortic graft prosthesis was inserted into the distal aorta while repairing the ascending aorta and aortic arch. The distal elephant trunk prosthesis was then used for a second stage operation that involved replacement of sections of the distal aorta. Since then, a few problems have been encountered with the standard elephant trunk procedure and this has led to a modification of the elephant trunk technique, which enables a more accurate and secure distal aortic arch anastomosis to be performed. Using the standard technique described by Borst, the surgeon has to suture in the groove between the tubular graft and the aortic wall, which can increase the risk that torsion on the suture needle will tear the aortic wall resulting in aortic rupture. Indeed, this complication has been noted in the postoperative period when performing the standard technique. Subsequently, the technique was modified with inversion of the graft in itself, placement of the graft in the descending aorta, and performance of the distal anastomosis using a technique similar to that described by Griepp. This has improved the ease of performing the procedure and the results of the technique such that a better than 90% survival rate can be expected for the first and the second stage repa

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01020.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractHeart‐lung transplantation was, for many years, conceptualized as a possible treatment for patients with combined end‐stage cardiac and pulmonary disease. As experience grew with heart transplantation, particularly in the 1970s, the difficulties of performing the orthotopic operation in patients with fixed pulmonary hypertension became apparent. This further impetus for combined heart‐lung transplantation led to successful animal experiments in the late 1970s, and the first successful heart‐lung transplant operation was performed in 1981. There has been significant evolution in the operative technique for the recipient operation, with emphasis on preservation of the phrenic, vagal, and recurrent laryngeal nerves and on meticulous hemostasis, with particular attention to the bronchial vessels of the posterior mediastinum. Donor procurement is of critical importance to the success of the operation, and criteria for donor selection have been well established. Lung preservation remained, for many years, a significant limitation, but current techniques involving the use of prostaglandin E1have led to safe distant procurement with ischemic times up to 6 hours. The heart‐lung transplant operation remains an effective modality for the treatment of patients with congenital heart disease, primary pulmonary hypertension, chronic obstructive pulmonary disease, and cystic

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01021.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThe morphological variation in the recognized landmarks for the atrioventricular conduction system was studied grossly in 94 hearts with atrioventricular septal defect, assessing 20 hearts with normal atrioventricular septation as a control. In all the hearts with intact atrioventricular septal structures, the tendon of Todaro demarcated the superior boundary of the triangle of Koch. In hearts with atrioventricular septal defect, however, the landmarks for the conduction axis made up a separate nodal triangle. The tendon of Todaro, along with a bridging tendon not found in the normal heart, were variably developed in hearts with atrioventricular septal defect and formed a further triangle unrelated to the axis for atrioventricular conduction. The opening of the coronary sinus was also variable in its location and size. It was the location of the inferior bridging leaflet as it crossed the ventricular septum that was the best surgical landmark to the site of penetration of the atrioventricular conduction axis.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01022.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractCoronary artery bypass without cardioplegia remains the preferred technique at many centers around the world. This report describes in detail a technique that emphasizes intermittent cross‐clamping of the aorta at mild hypothermia (30°C). Since coronary bypass procedures require brief interruptions of coronary blood flow only for the distal anastomoses, the duration of myocardial ischemia with this technique is not prolonged by unexpected changes in the operative plan. Many bypass grafts can also be carried out without cross‐clamping of the aorta by using local control of the coronary arteries. The increasing number of elderly patients with atherosclerotic aortas that cannot be safely clamped makes it helpful for all cardiac surgeons to be familiar with noncardioplegic techni

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01023.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractHypothermic fibrillatory arrest is a technique of myocardial preservation that has a long history of use in cardiac surgery. Numerous studies have documented its efficacy in various subgroups of patients with coronary artery disease. This report reviews the research support of the tenets of the technique and reports the results with its utilization in 2,801 consecutive patients having isolated myocardial revascularization.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01024.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractCoronary artery bypass surgery can be performed without cardiopulmonary bypass (CPB). Bleeding obscuring the operative field and hemodilution of shed blood with irrigating saline are some of the drawbacks of this technique. We report the use of a newly developed surgical blower‐humidifier (custom made [Research Medical, Inc.]) for improved visualization and facilitation of coronary artery surgery without CP

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01025.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractA right coronary artery originating from the left coronary sinus and traversing anteriorly is thought to be one of the contraindications for a Konno aortoventriculoplasty in congenital aortic stenosis because this procedure necessitates incision of the right ventricular outflow tract. The case of a 5‐year‐old girl with congenital aortic stenosis associated with a single coronary artery, successfully treated surgically by the Konno procedure and right coronary artery reimplantation, is reported. Preoperatively there was a pressure gradient between the left ventricle and the ascending aorta of 109 mmHg, which disappeared postoperatively. A postoperative angiography showed a patent right coronary art

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01026.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1992.tb01027.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY