ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00845.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00846.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractObjective:Analysis of the clinical and echocardiographic mid‐term results following aortic valve replacement (AVR) with cryopreserved allografts.Design and setting:A cohort study in a tertiary care center.Patients:Fifty patients underwent allograft AVR during the years 1987 through 1992. There were 44 men and 6 women with a mean age of 47.6 ± 12.2 years (range 22 to 72 years). Indications for operation included: aortic stenosis (AS) 15 patients, aortic regurgitation (AR) 24, and mixed 11. The etiology was: congenital 22, rheumatic 8, degenerative 5, senile calcific 4, malfunctioning aortic valve prosthesis 5, and active endocarditis 6.Outcome measures:Early mortality and morbidity; mid‐term survival, functional class, and valve related complications; and two‐dimensional Doppler echocardiography to assess valve structure and function.Results:Two patients (4%) died perioperatively of non‐cardiac or valve related causes. Long‐term follow‐up ranged from 4 to 60 months (median 34 months), with no late mortality, recurrence of endocarditis, or thromboembolic events. Thirty‐nine patients were in New York Heart Association (NYHA) Class 1 (83%) and 7 (15%) in Class II. Of these, echocardiogram showed trace or no AR in 42 (98%) and 2+ AR in 1. One allograft was re‐replaced with a mechanical valve due to technical failure. One patient was in NYHA Class III with normal allograft function and 4+ mitral regurgitation.Conclusions:Replacement of the aortic valve by a cryopreserved allograft can be performed safely, and is particularly useful in the setting of active endocarditis and failed prior prosthetic valve. Mid‐term clinical results and valve durability at 5 years are excellent. (J Card S

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00847.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractPericardium has been used for decades to facilitate the repair of tetralogy of Fallot (TOF). The Impact of glutaraldehyde preserved autologous pericardium when used as a right ventricular outflow tract (RVOFT) patch in TOF was analyzed in 36 consecutive children undergoing complete transventricular repair. In 18 (group 1) the pericardium was treated in conventional fashion (harvested and preserved in saline solution). In the other patients, the pericardium was treated in 0.625% glutaraldehyde solution for 20 minutes and then washed In saline prior to being implanted as an RVOFT patch (group II). The perioperative (prior to hospital discharge) as well as the 6‐month postoperative Doppler echocardiograms were assessed with 100% follow‐up. The studies were evaluated and graded by blinded observers for the presence and severity of an RVOFT dilatation (+0 to +4) relative to the size of the aortic valve annulus. The age of patients in group I and group II (29 months, 34 months) were similar as was the incidence of transannular patching (44%, 41%). Postrepair hernodynamics revealed no significant difference in the right ventricular/left ventricular pressure ratios (42%, 41%,) or in the systolic RVOFT pressure (24 mmHg, 29 mmHg). The predischarge echocardiograms showed no outflow tract (OFT) dllation in either group. There was no morbidity or mortality in either group. At approximately 6 months postoperatively (6.2 mo, 5.7 mo), 72% of group I patients had RVOFT diameters that were larger (+1, +2) than the predischarge diameters when reviewed by three observers. In group II there was a single patient with dilatation of the RVOFT and this graded as +1. The mean RVOFT dilation score in group I was 1.06 (+0.8) versus 0.06 (+0.24) in group II (p<0.05). We conclude that dilute glutaraldehyde preservation of autologous pericardium is a safe and effective means of preventing RVOFT dilatation over the short term in patients in which a hemodynamically acceptable repair of TOF has been completed. (J Card Surg 1994;9:298

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00848.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractObjectives:The purpose of this study was to determine if a device placed externally around the aortic root decreases regurgitant flow in acute aortic regurgitation.Background:Aortic regurgitant flow is dependent on central aortic pressure and the aortic root and leaflet geometry. It may be possible to decrease aortic regurgitant severity by reducing aortic root size or dimension changes.Methods:Aortic regurgitation was created in eight calf heart specimens suspended in a continuous flow system. Retrograde and antegrade aortic flow and distending aortic pressure were measured at baseline and after placement of an external aortic device at the level of the aortic annulus. In two additional specimens, the incompetent aortic valve was visualized fiberoptically before and after placement of the external device. Acute aortic regurgitation was created surgically in four live calves by excising a portion of the aortic leaflets. Antegrade and retrograde flow, left ventricular pressure, and central aortic pressure were measured at baseline, after creation of aortic regurgitation, and after placement of the external device.Results:In the in vitro calf specimens, regurgitant flow decreased from 46.9 cc/sec to 15.1 cc/sec (66.0%± 21.8% decrease) after placement of the external device (p<0.001). The regurgitant orifice area decreased from 0.13 ± 0.04 cm2to 0.04 ± 0.02 cm2after device placement (p<0.001). Antegrade flow was reduced to a smaller extent (20.0%± 19.2% decrease) by the device (p<0.05). Placement of the device around the aorta resulted in improved coaptation of the leaflets with a marked reduction in defect size by endoscopic visualization. Use of the external aortic device was associated with improvement in aortic regurgitant severity in three of four calves with surgically created aortic regurgitation.Concluslons:In these preliminary studies, acute experimental aortic regurgitant severity is decreased by the use of an external aortic device, probably due to reduction in aortic annular dimension changes and improved aortic leaflet apposition. Further studies are needed to determine the effectiveness of this device in chronic aortic regurgitation. (J Card Surg 1994;9:304

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00849.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractPostoperative salvage autotransfuslon of shed mediastinal blood, using the cardiotomy reservoir, is an inexpensive technique whose efficacy and safety are evaluated in this study. We randomized 75 consecutive patients into two groups. The autotransfusion group (n = 42) received autotransfusion after the completion of the coronary artery bypass grafting (CABG) until the dralnage was ≤ 50 mL per hour for 2 consecutive hours. The control group (n = 33) was treated with standard chest drainage. Both groups received homologous blood transfusion when the hematocrit fell below 30%. Packed red cells were required post‐operatively in 84.8% of the control group and 80.9% of the autotransfusion group (p = NS). Postoperative colloid fluid replacement (excluding autotransfusion fluid) did not differ significantly between the groups. The prothrombin time was significantly higher in the autotransfusion group 24 hours postoperatively (p = 0.03). The fibrin degradation products were elevated only In the serum of the autotransfusion patients (p<0.002). More febrile patients were seen in the autotransfusion group although not significantly more than the controls. The autotransfusion group received more red cells than the control group, but it lost more red cells in the medlastlnal drains. In conclusion, the autotransfusion of shed mediastinal blood has not proved beneficial in reducing the Postoperative requirements in homologous blood in patients undergoing coronary artery bypass grafting (CABG). (J Card Surg 1994;9:314

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00850.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractDiminished cardiac function is a common manifestation following the modified Fontan procedure. Since thyroid hormone has important effects on cardiovascular function, the present study was undertaken to evaluate changes in thyroid hormone levels following this operation. A control group consisting of children undergoing open heart procedures other than a Fontan procedure was also evaluated. Serum total and free triiodothyronine (T3), total and free thyroxine (T4), thyroid stimulating hormone (TSH), and thyroglobulin were measured by immunoassays. The Fontan group demonstrated an initial increase in free T4, while free T3, total T3, total T4, TSH, and thyroglobulin were reduced. Over the subsequent days, free T4decreased to below the preoperative value. By the fifth and eighth postoperative days, free T3, total T3, free T4, and total T4remained reduced, while TSH and thyroglobulin began increasing toward the preoperative levels. The control group also demonstrated decreases in free T3and TSH. However, these values had returned to baseline by the fifth postoperative day. The results indicate that children undergoing open heart surgery have suppression of the pitultary‐thyroid axis, and that this is prolonged in patients undergoing Fontan procedure. The decreased levels of T3following Fontan procedure may have adverse effects on the recovery of patients undergoing this operation. (J Card Surg 1994;9:322–

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00851.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractSkeletal muscle ventricles (SMVs) were constructed from the latissimus dorsi muscle in 12 dogs. In group I (n = 6), SMVs were placed intrathoracic, in the apex of the left hemlthorax. In group II (n = 6), SMVs were positioned extrathoracic between the chest wall and subcutaneous tissue. After a 3‐week vascular delay period, SMVs were electrically precondltloned wlth 2‐Hz continuous stimulation for 6 weeks. At a second procedure, a valved conduit was placed between the left ventrlcular (LV) apex and the SMV, and a second valved condult between the SMV and the thoracic aorta. The SMVs were stimulated to contract during dlestole at a 1:2 ratio wlth the heart. In group I, SMVs generated peak pressures of 91 ± 10 mmHg, pumped 47% of the systemic blood flow (0.73 ± 0.25 vs 1.54 ± 0.42 Umin; p<0.05), and produced a 25% decrease In the LV systolic tension‐time Index (TTI) (16.9 ± 2.7 vs 12.5 ± 3.3 mmHg sec; p<0.05). In group II, SMV peak pressure was 93 ± 10 mmHg, SMVs pumped 51% of the systemlc blood flow (0.78 ± 0.10 vs 1.53 ± 0.42 L/min; p<0.05), and the LV systolic TTI decreased 29% (14.0 ± 0.8 vs 9.9 ± 2.0 mmHg sec; p<0.05). There was no significant difference between group I and II. These data Indicate that the SMV:LV apex‐to‐aorta configuration is the most effective method reported to date for skeletal muscle cardiac assist. Extrathoracic and Intrathoracic SMVs functioned equally well after connectlon to the circulation. (J Card

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00852.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe authors developed a new prosthesis for patent ductus arteriosus (PDA) closure, using a delivery device inserted through the main pulmonary artery (MPA) avoiding ductal dissection and use of cardiopulmonary bypass. The prosthesis was inserted in 19 consecutive patients between 1985 and 1992. They have been followed for a mean of 4.8 years (minimum 30 days, maximum 7.5 years). There were 14 women (72%) and the average age was 11 years (16 months to 38 years). All patients presented with pulmonary hypertension (4 severe, 5 moderate, and 10 mild). Simultaneous surgical procedures for congenital heart disease were performed in two cases. One patient had a diffuse calcified PDA. The average diameter of the inserted prosthesis was 7.5 mm (3.5 to 12.5 mm). Neither hemorrhage nor prosthesis dislocation/embolization occurred during the implantation or in the postoperative period. In a newborn (30 days) with severe cardiomegaly and thin MPA, we decided to ligate the ductus. Chronic cor pulmonale contributed to death in one patient 3.7 years after operation. The remaining patients recovered well, without clinical evidence of residual shunt. Therefore, we recommend the use of this new prosthesis for PDA closure in cases of large ductus or ductus complicated with calcification, pulmonary hypertension, and when associated open heart surgery is required. (J Card Surg 1994;9:343–34

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00853.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractAn aortoventrlculoplasty (Konno procedure) operation was performed for relief of tunnel‐type subaortic stenosis using a Bjork‐Shiley valve aortic prosthesis. The mechanical prosthesis thrombosed and cerebral embolism occurred when anticoagulant medication was stopped. The aortic root was successfully reconstructed with a cryopreserved aortic allograft using freehand Implant technique. The cryopreserved aortic allograft is an excellent replacement device in the young adult patient in cases of falled prostheses, even in the presence of complex left ventricular outflow tract morphology or previous reconstruction operations. (J Card Surg 1994;9:348

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00854.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY