ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00330.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractA technical modification of total cavopulmonary anastomosis (TCPC) is described. Inferior vena cava (IVC) channel is constructed from the right atrial wall in a fashion similar to Senning's operation. The use of Gore‐TexR(W.L. Gore&Associates, Inc.) patch or tube is avoided. We have used the technique in 11 patients between 1988 and 1991 (six complex transpositions or double outlets with one hypoplastic ventricular chamber and/or straddling of the atrioventricular (AV) valve, four double inlet ventricles with pulmonary stenosis, and one tricuspid atresia). Superior vena cava (SVC)/IVC to pulmonary artery gradient was<2 mmHg in all patients. SVC/IVC pressure was 10–15 mmHg (mean 12.3 mmHg), transpulmonary gradient 5–8 mmHg (mean 6.4 mmHg). We have not observed any adverse effects such as arrhythmias or increased pleural drainage when we compared those patients with 85 children in whom the TCPC was performed with Gore‐TexRpatch/tube. The presented technique is simple, avoids the use of anticoagulants, and may have a possible long‐term advantage in allowing growth of the IV

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00331.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractBetween December 1986 and December 1990, 37 consecutive patients underwent repair of complete atrioventricular (AV) canal with the two‐patch technique. Mean age at repair was 22 months and 51% were<1 year of age. Eighteen (48.6%) had undergone previous palliative operations. Two operative deaths (5.4%) occurred and another patient died in‐hospital for an early mortality of 8.1%. One late death (2.9%) has occurred from a respiratory infection. Actuarial survival is 87.7% at 3 years. Small size (p<0.05), unbalanced ventricular size (p<0.05), New York Heart Association (NYHA) Class IV (p<0.05), and severe preoperative AV valve insufficiency (p<0.05) were significant preoperative risk factors for death. Five survivors (14.7%) required reoperation for severe AV valve insufficiency (two) or patch leaks (three). The risk for reoperation was increased in non‐Down's patients (p<0.02). All survivors are in NYHA Class I (93%) or II (7%). The risk for early AV valve insufficiency was increased in patients who did not have the cleft sutured (p<0.05), and in those with unbalanced ventricles (p<0.01). Risk of late AV valve insufficiency was increased only by small size (p<0.02). Previous pulmonary artery banding did not increase the risk of repair or of postoperative AV valve insufficiency. Complete AV canal can be repaired with low mortality. Pulmonary artery banding may still have a role to play in the very small (4–5 kg) infant in refractory heart

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00332.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractThirteen out of a total 50 infants with interrupted aortic arch (IAA) seen between 1979–1988 had or developed severe subaortic stenosis (SAS). One had type A interruption and 12 type B. All had a large ventricular septal defect (VSD). The infundibular septum was displaced posteriorly in eight infants, severely narrowing the left ventricular outflow tract (LVOT). Three had fibromuscular narrowing of the LVOT, one each a subaortic muscle bar and membrane. The aortic root and subaortic area were small and measured between 3–8 mm. An anomalous right subclavian artery was noted in eight of the 12 type B IAA, the anomalous vessel arising from the descending aorta in seven. Thirteen infants with IAA and SAS were submitted to surgery, 12 having their subaortic area resected with three perioperative deaths early in the series and three late deaths where active treatment was ceased, including one infant with renal dysplasia who had had a successful establishment of arch continuity and pulmonary artery banding. Of the seven survivors, six have residual Doppler gradients of between 20–50 mmHg, two requiring a second resection and one a third resection. Alternate management programs are suggested based on anatomical evaluation and echocardiography. Any newborn presenting with IAA requires careful evaluation of the subaortic area, best seen on cross‐sectional echocardiography. The improved surgical survival in infants following complete repair of IAA has led this important associated anomaly of subaortic stenosis to assume greater importance as a cause of mortality and long‐term

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00333.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractHeart‐lung transplantation is now well established for treatment of patients with terminal cardiopulmonary disease. More than 50% of heart‐lung transplant recipients have normal or near normal hearts, with the majority having some degree of right ventricular hypertrophy. This potential source of “prepared” cardiac allografts remained untapped until the introduction of the “domino‐donor” operation, a procedure in which the heart‐lung recipient serves as a cardiac donor. The implantation of these available allografts contributes to the alleviation of the short supply of donor organs for cardiac transplantation. Aspects of the surgical technique, results, and potential benefits of this procedur

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00334.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractFor skeletal muscle ventricles (SMVs) to be applied clinically, it is likely that they will have to be placed within the chest. Ease of subsequent connection to the circulation, and avoidance of significant lung compression, are factors that could influence SMV size and shape in a way that may prejudice their ability to pump effectively at physiological preloads. In five dogs, specially designed SMVs were constructed from the latissimus dorsi muscle, and placed in the apex of the left hemithorax. After a 3‐week delay, the muscle was preconditioned electrically by 2‐Hz continuous stimulation for 6 weeks. At a later thoracotomy, this positioning of SMVs permitted easy surgical access to the heart and great vessels. SMVs were then connected to a mock circulation device for functional evaluation. As right‐sided pumps, at a preload of 10 mmHg, SMVs generated a stroke volume (SV) and stroke work (SW) exceeding that of the native right ventricle (SV = 8.9 ± 0.8 vs 7.9 ± 0.6 mL; SW = 0.44 ± 0.03 vs 0.20 ergs x 106). As left‐sided pumps, also at a preload of 10 mmHg, SMV SV, and SW was roughly half that of the left ventricle (SV = 3.7 ± 0.2 vs 7.9 ± 0.6 mL; SW = 0.29 ± 0.03 vs 0.57 ± 0.05 ergs x 106). SMVs may conveniently be positioned inside the chest, where they have the potential to function as left or right heart

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00335.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractA case of postinfarction left ventricular free wall rupture is successfully treated. Prompt diagnosis was provided by echocardiography and an emergency operation was carried out. Following sternotomy, hemodynamic stabilization was obtained by gradually evacuating blood from the pericardium, while the femoral vessels were cannulated and the extracorporeal circulation was established. An autologous glutaraldehyde stiffened pericardial patch was sealed over the infarcted area using fibrin glue and fixed with a running suture on the surrounding healthy myocardium.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00336.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractThe use of mechanical circulatory support devices came to prominence with the use of the Jarvik 7 total artificial heart, both as a permanent implant and as a bridge to transplantation. Over the past decade, however, interest in the use of left ventricular assist devices has overshadowed that of the total artificial heart and great strides have been made, both in the use of such devices as temporary support, and towards the ultimate goal of permanent implantation. A variety of devices are available to support either or both ventricles with a great range of complexity and expense. This test discusses the use of ventricular assist devices and briefly describes the options available. The era is rapidly approaching when the use of implantable circulatory support devices will become commonplace and may outpace, and possibly outperform, the results currently obtained with cardiac transplantation.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00337.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractThis review updates and extends observations made in this journal in March 1988. The focus then was on percutaneous transluminal coronary angioplasty and the clinical results of its practical application. A concern was expressed that science lagged in solving the major problems of rethrombosis and restenosis. The NHLBI Bypass Angioplasty Revasculariztion Investigation (BARI) study was still in the planning phase. In 1991, the scene has changed. Interventional cardiology now embraces a multitude of different catheter devices—angioplasty, atherectomy, laser, stents. Basic scientists are increasingly involved in addressing the restenosis issue. Our national heart meetings are increasingly oriented towards molecular biology approaches to solving the remaining problems. The BARI trial has nearly completed patient entry, and we eagerly await its results. The cardiologist and surgeon are faced with increasingly complex decisions with respect to interventional technologies, involving not only whether to use them, but which one

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00338.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Book review in this ArticleCarpentier A, Chachques JC, Grandjean P:Cardiomyoplasty.Waters DD, Bourassa MG:Care of the Patient with Previous Coronary Bypass Surgery.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00339.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY