ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00265.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThe original description of the Blalock‐Taussig shunt was published in 1945 and represented the first direct surgical procedure for the treatment of cyanotic congenital heart disease. The present study analyzes the results of Blalock‐Taussig shunts performed at Duke University Medical Center during the fourth decade since the original description of the procedure. From 1975 to 1984, 53 classic and 24 modified Blalock‐Taussig shunts were performed with a hospital mortality of 8%. These deaths occurred in critically ill patients with either pulmonary atresia or complex congenital cardiac lesions. The results of the early group (1975–1979) were compared to the late group (1980–1984) of patients. There was a greater proportion of infants less than 1 week of age in the late group, and the actuarial event‐free shunt survival following operation was significantly better in the late group. This improvement in the late group was apparent both in patients receiving classic and modified Blalock‐Taussig shunts and probably represents the effects of advances in microsurgical technique as well as improvement in the support of critically ill infants at the time of surgery by pediatric anesthesiologists and neonatologists. The data in the present study indicate that the mortality associated with Blalock‐Taussig shunting is related to the condition of the patient at the time of surgery and the underlying cardiac pathology rather than the age of the patient at the time of shunting. The efforts to further reduce morbidity and mortality associated with Blalock‐Taussig shunting should therefore be directed primarily to the support of infants during the preoperative and intraoperati

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00266.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractIn surgery of the acute dissection of the ascending aorta, a technique is described for routine cannulation through a Dacron graft in order to produce antegrade flow in the true aortic lumen and higher pressures than in the false lumen. This is a useful method to avoid the deleterious effects of the retrograde blood flow through the false lumen, when femoral cannulation is used, as well as to improve the myocardial protection by reperfusing the myocardium while the graft distal end anastomosis is carried out.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00267.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractPresented is the technique of closure through the pulmonary artery of the perimembranous ventricular septal defects and defects with malaligned septum as an alternative method to the transatrial or transventricular approach. The technique of infundibular resection without opening the right ventricle in cases of tetralogy of Fallot is also described.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00268.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractInfection or dehiscence of the tracheal anastomosis remains a dreaded and almost always fatal complication following heart‐lung transplantation (HLTX). A technique of pericardial flap‐plasty combined with application of fibrin sealant and topical antibiotics was developed and applied in three patients undergoing HLTX. The method allows for safe protection of the anastomosis even in the presence of severe ischemia and partial necrosis of the donor trachea at the same time avoiding laparotomy for mobilization of the omen

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00269.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThe endothelium is an important aspect of vascular function and pathology. Simple and reliable methods for assessing the presence or absence of endothelium in vascular specimens are presented. Intravenous Evans blue dye that stains endothelial denuded vessel walls is recommended for the macroscopic visualization of endothelial injury in gross intact arterial specimens. Scanning electron microscopy (SEM) is often used for investigating microscopic endothelial injury, but the differentiation of endothelial cells from underlying vessel wall structures can be difficult. By demarcating endothelial cell borders, silver stains allow for better endothelial identification by SEM. A third technique describes assessing endothelial integrity by how well it functions and involves the selective production of endothelium derived relaxing factor. As cardiovascular surgeons become more involved in basic vascular research, a review of these techniques should be appropriate and helpful.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00270.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractA glutaraldehyde‐preserved equine pericardial xenograft was implanted in 370 patients between 1981 and 1987; pericardial sac closure in 320 (mainly over Dacron implants), atrial repairs in 19, arterial reconstructions in 22 (right outflow tract in 19, Konno's procedure in three), control of bleeding after surgery for thoracic aneurysms in seven, control of plasma leaking PTFE graft in one, and repair of diaphragmal agenesia in one. Overall infection rate was 3/370 (0.8%). Epicardial adhesions (12) at reoperation for orthotopical implants were graded 1.3 ± 0.9 on a scale of 6 (0 = no adhesions, 5 = calcified or ossified adhesions) after 4 ± 2 months. Shrinkage of xenograft occurred in 3/19 (16%) atrial repairs and lesser degree aneursmal dilatation appeared in 1/19 (5%) reconstructions of the right outflow tract. No complications occurred in the implants without direct exposure to the blood stream. We recommend pericardial xenograft for Konno's procedure and control of bleeding. It should not be used routinely in the low pressure s

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00271.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractRegional endocardial resection is the accepted surgical treatment for sustained monomorphic ventricular tachycardia. In patients requiring extensive endocardial resection, or with large aneurysms involving the interventricular septum, the resulting defect may result in weakened myocardium and, ultimately, ventricular septal defect or ventricular rupture. A new approach for repair of the resulting defect is proposed using an autogenous pericardial patch sutured to normal endocardium and included in the aneurysm repair. This technique was performed in six patients undergoing surgery for drug refractory ventricular tachycardia. All patients had large anterior left ventricular aneurysms with endocardial scar extending onto the septum. The large endocardial defect left after endocardial resection and aneurysmectomy was repaired with a pericardial patch. No intraoperative complications (e.g., suture line bleeding) were observed as a result of this technique. All patients are alive, and five of the six patients no longer have inducible ventricular tachycardia. An improvement in congestive heart failure symptoms at 1–9 months of followup was noted following surgery. We conclude that the pericardium can be safely used to cover endocardial defects resulting from regional endocardial resection for sustained ventricular tachycardi

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00272.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractBeneficial effects of cardiomyoplasty have been documented and the use of this technique in the treatment of dilated cardiomyopathy have been suggested. This study was undertaken to evaluate the effectiveness of stimulated preconditioned latissimus dorsl muscle flaps wrapped around the heart in order to restore ventricular contractility in six adult mongrel dogs with induced myocardial dysfunction by administration of beta blockers and volume loading. Hemodynamic and two‐dimensional echocardiographic evaluation were performed 1 week after the surgical procedure and immediately after heart failure induction. With synchronous pulse train electrical stimulation, cardiac output increased from 1.46 ± 0.13 (± SD) to 2.01 ± 0.16 L/min (p<0.01), pulmonary wedge pressure decreased from 15.5 ± 1.2 to 11.3 ± 1.6 mmHg (p<0.01) and left ventricular end‐diastolic pressure from 18.3 ± 2.4 to 13.5 ± 1.4 mmHg (p<0.04). Echo derived left ventricular ejection fraction increased from 39.3 ± 2.4 to 59.6 ± 2.9% (p<0.01) and segmental wall shortening from 15.4 ± 1.2 to 26.3 ± 1.7% (p<0.01), inclusive when the muscle flap was wrapped only around the left ventricle. In conclusion, this study suggests that cardio‐myoplasty may be an alternative method of treatment for irreversible cardiomyopathy, including in patients with a great cardiac enlargement in which muscle flap may only be wrapped partially

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00273.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractSkeletal muscles, such as the latissimus dorsi muscle, can be transformed to gain considerable fatigue resistance to be suitable either for cardiomyoplasty, or to power a cardiac assist device. Such transformation of the skeletal muscle can be achieved by low frequency electrical stimulation for several weeks. In this article, we reviewed the stimulation protocol, and subsequent histochemical, biochemical, and functional changes in the skeletal muscle, and compared them to those of the cardiac muscle. The parameters that should be useful for stimulating such a muscle to assist the heart are defined. The issues currently under study, including the optimal transformation parameters, the feasibility of working transformation, and the importance of device design to minimize vascular compromise of the muscle, are also discussed. It is concluded that there is a great potential to use the plasticity of skeletal muscle for clinical purposes, specifically by transforming the skeletal muscle to resemble the myocardium in order to use it either to replace or repair the myocardium, or as the endogenous power source for a cardiac assist device.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1989.tb00274.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY