ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00406.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBetween July 1991 and March 1993, five children (ages 2 to 6 years) with complex congenital heart disease have undergone a new operation for conversion to the Fontan circulation. This procedure combines a bidirectional Glenn shunt with an extracardiac lateral tunnel (ELT) to carry systemic venous return to the pulmonary arteries (PAs). The ELT was constructed so that the circumference consists of Gore‐Tex (2/3) and lateral epicardial atrial wall (1/3). The ELT can be performed with all varieties of single ventricle physiology, as in our patients with tricuspid atresia (n = 3), dextrocardia (n = 1), and situs inversus with levocardia (n = 1). PA reconstruction was required in four patients. At follow‐up from 1 to 20 months, all patients are in New York Heart Association Class I and in normal sinus rhythm. Postoperative catheterization has revealed low PA pressures (94% on room air. The advantages of this new extracardiac modification of Fontan's operation are: (1) aortic cross‐clamping is not usually required; (2) incorporation of lateral atrial wall in ELT allows for growth while permitting construction of a fenestration or adjustable atrial septal defect in high risk patients; (3) absence of atriotomy and intraatrial suture lines may decrease late risk of arrhythmias; (4) early or late baffle leaks cannot occur; (5) intraatrial obstruction from the baffle cannot occur; (6) coronary sinus remains in low pressure atrium; and (7) hydrodynamic benefits of the total cavopulmonary connection are preserved. We recommend this procedure for patients undergoing surgical conversion to the Fontan circu

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00407.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractStretching of suture material is an infrequent cause of delayed mediastinal hemorrhage after lateral repair of the aorta. In contrast to end‐to‐end reconstructions, lateral patch repairs of the aorta present unusual stress on the anastomotic suture line. We describe a simple technique for repair of loosened suture lines, with suggestions for preventing this complication in cases of lateral aortic reconstruct

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00408.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractWe report the first successful use of thoracoscopy and video‐assisted thoracic surgery (TVATS) techniques to relieve extrinsic tracheoesophageal compression produced by a vascular ring. The patient was a 3‐month‐old infant with postprandial regurgitation and a diagnosis of double aortic arch. After an uncomplicated operation and recovery, the infant was discharged on the second postoperative day. Refinement of technique and instrumentation may allow wider application of video‐assisted thoracoscopic techniques in pediatric p

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00409.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThoracic aneurysms are relatively rare in infancy. We report our experience with two such patients, one with a false aneurysm of the ascending aorta and the other with a mycotic aneurysm of the main pulmonary artery. Neck cannulation prior to sternotomy, using cannulae designed for extracorporeal membrane oxygenation, allowed entry into the mediastinum under controlled circumstances and permitted the successful repair of the aneurysms.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00410.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractAs the survival rate for cardiac transplantation improves, attention focuses on morbid events that occur perioperatively. Neurological problems have been recognized after transplantation, and appear to have multiple etiologies including thromboembolism, hypo‐perfusion syndromes, cerebral hemorrhage, and drug toxicities. Since 1988, 113 consecutive adults with end‐stage cardiomyopathy were transplanted using a surgical technique that emphasizes precise everting atrial and great vessel anastomoses, a modified order of anastomoses, continuous endocardial and topical cold irrigation, and careful de‐airing of the heart. Although a significant fraction of the patients were at high risk for cerebral events, the incidence of early and late neurological complications were each under 2%. The rate of early graft dysfunction was low and no patient was found to develop intracardiac thrombus on intermediate‐term follow‐up. These technical modifications may contribute to improved neurological outcomes after transp

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00411.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractIntraoperative transesophageal echocardiography (TEE) was used to monitor the removal of intracardiac masses in 17 patients. Prebypass TEE was used to confirm the preoperative diagnosis. It gave a clear image and anatomical definition of the mass in 16 cases. Moreover, in 11 of these patients, prebypass TEE provided information not obtained previously by traditional exams. This information was judged either useful or indispensable for a successful outcome in 10 of these patients. However, in one of the remaining six patients, TEE did not clearly visualize a flat thrombus in the left atrium. Postbypass TEE was used in each case to monitor the surgical results of the mass removal and the associated procedures. In one patient, it disclosed a progressively expanding hematoma in the left atrial wall, which was interfering with mitral valve function. From this experience, we consider intraoperative TEE the best monitoring device during cardiac mass removal because it usually provides a more complete diagnosis and anatomical definition of the mass than the traditional preoperative methods and permits monitoring of the surgical results before chest closure. Some limitations to this method may exist.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00412.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractWe describe an innovative technique to control hemorrhage after right atrial wall reconstruction in a patient with primary angiosarcoma. At the time of surgery, the tumor was found to involve all of the free wall of the right atrium and a superficial layer of the right ventricle. A pericardial patch was used to reconstruct the right atrial wall; however, there was diffuse coagulopathy with bleeding from the anastomoses and remaining tumor. To tam‐ponade the bleeding, a Dacron patch was sewn to the right edge of the pericardium, around the right ventricle and right coronary artery, but with little improvement in the bleeding. A type of Cabrol fistula was then formed with a tube graft from the Dacron patch to the left innominate vein. This acted as a conduit back into the venous system, with the blood taking the path of least resistance. Hemostasis was then achieved, allowing the patient to be taken to the intensive care unit.(J Card Surg 1993; 8:558–

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00413.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractComposite replacement of the ascending aorta and aortic valve with coronary reimplantation can be complicated by intraoperative hemorrhage from the coronary ostial anastomoses and proximal aortic suture line. Exposure and repair of these suture lines may be quite difficult after the termination of bypass in the intact aortic root. Cabrol originally described connecting the coronary ostia by separate Dacron graft, which was then anastomosed side‐to‐side to the aortic conduit, and the entire repair wrapped in the aneurysm wall to control bleeding. This article describes a modification of Cabrol's technique in which coronary ostial buttons are mobilized and the entire aortic wall resected. This procedure has been used in five patients with varied pathology, with no perioperative deaths and one minor intraoperative neurological event. The greater ease of operation and improved hemostasis afforded by the technique described in this article warrant its consideration in patients requiring aortic root replacement, and may prove particularly helpful in complex cases and reoperati

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00414.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractSince September 1991, 20 patients with mitral stenosis underwent mitral valve replacement and chordal replacement with expanded polytetrafluoroethylene (ePTFE) sutures. The continuity between the papillary muscles and the mitral annulus was maintained by four mattress sutures of ePTFE, which connected the stumps of the papillary muscle heads to the mitral annulus at the 2, 4, 8, and 10 o'clock positions. Low profile bileaflet prosthetic valves were inserted. There was no mortality either in‐hospital or during follow‐up. There was no valve related morbidity, such as valve structural failure, thromboembolism, anticoagulant related hemorrhage, prosthetic valve endocarditis, or posterior left ventricular rupture. The technique of replacing chordae tendineae is described in det

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00415.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY