ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00374.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractForty patients underwent orthotopic cardiac transplantation at Wythenshawe Hospital between May 1991 and November 1992. Twenty patients had transplantation using an alternative technique that preserves the shape of the left atrium and leaves the right atrium intact (group A). The remaining twenty had conventional transplantation using the technique described by Lower and Shumway (group B). The patients were randomized to either the new or the conventional technique on an alternate basis. There was no mortality in group A, but two patients in group B developed right ventricular failure and died. Two patients in each group developed nodal rhythm and all four recovered sinus rhythm. Echocardiography and Doppler velocimetry at the transvalvular level confirmed normal atrial function in group A with erratic atrial contraction wave in group B. There was also slightly lower incidence of mitral and tricuspid valve regurgitation in group A than in group B. The improved atrial function in group A may play a part in the prevention of right sided failure following cardiac transplantation.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00375.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractTechniques of repair of defects in the anterior leaflet of the mitral valve and replacement of the aortic valve using allograft are presented. The case history and operative procedure of a reconstructive operation that did not require anticoagulant therapy after surgery are described for three adult patients. Mitral valve defects were repaired using the anterior leaflet of the mitral valve of the allograft. The aortic valve or entire root was replaced with the aortic allograft. The aortic/mitral allograft should be considered as an alternative to replacement of the aortic and mitral valves with prostheses in selected patients.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00376.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe creation of a systemic‐to‐pulmonary artery shunt by use of the internal mammary artery (IMA) in a 2‐year‐old boy with complex congenital heart defects and diminutive pulmonary arteries is described. This procedure may offer advantages over standard methods in selected patients with extremely small pulmonary arteries. The pliability, favorable anatomical position, and growth capability of the IMA reduce chances for complications, such as stenosing, kinking, and stretching of the pulmonary artery, which can cause it to become distorted, making further definitive repair di

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00377.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBetween January 1982 and November 1992, 38 patients received simultaneous mitral valve replacement (MVR) and left atrial plication (LAP) because of giant left atrium accompanying mitral lesion. Their ages ranged from 33 to 70 years, and the mitral lesion was caused by rheumatic heart disease in all patients. MVR was performed with a St. Jude Medical prosthesis for all patients and the left atrial wall was plicated with running 3–0 Nespolene to reduce the width to 3 to 5 cm. Respiration requiring mechanical ventilation more than 48 hours after operation occurred in four patients (10.5%) and postoperative low cardiac output requiring a high dose of and dopamine HCI or intraaortic balloon pumping in nine patients (23.7%). The left atrial diameter measured by echocardiogram was a mean of 7.3 ± 1.0 cm before operation and 5.8 ± 1.0 cm postoperatively. The cardiothoracic ratio on the chest roentgenogram registered a preoperative mean of 73.3%± 9.8% and was 65.7%± 8.4% after operation. The pre‐ and postoperative values were significantly different (p<0.01). The postoperative exercise level was a mean of 5.3 metabolic units for 24 patients and the postoperative New York Heart Association functional classification indicated Class I or II for 37 patients with no evidence of left atrial thrombus except in the case of one early death. LAP with MVR for patients with giant left atrium due to mitral lesion appeared to result in improvement in respiratory and circulatory fu

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00378.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe optimal management of infants with pulmonary atresia with intact ventricular septum (PA.IVS) remains a controversy. Attempts have been made to base the surgical approach on various geometrical or morphological characteristics of the right ventricle (RV). However, the overall results remain poor when compared to other complex congenital heart defects. Forty‐eight neonates with PA.IVS were admitted to our unit between 1980 and 1992. The management plan has evolved to be based entirely on the echocardiographic assessment of the state of development of the infundibulum of the RV. In neonates with a well‐formed infundibulum (n = 31), the initial palliation consisted mainly of pulmonary valvotomy (without cardiopulmonary bypass) and PTFE shunt from the left subclavian artery to the main pulmonary artery. There was one death from initial palliation in this subgroup. If necessary, the RV cavity was later enlarged by excision of the hypertrophic muscle of both the trabecular and infundibular portions, before finally attempting biventricular repair. The actuarial probability of achieving a biventricular repair at 40 months of age was 60% (95% CL = 39.5% to 71.3%). Thirteen patients have undergone biventricular repairs with one late death over a total follow‐up of 1,720 patient months. In one patient, the RV failed to grow satisfactorily, necessitating a Fontan procedure. Seventeen patients without a well‐formed infundibulum were approached with a Fontan procedure in mind. The initial palliation in these patients consisted of a modified Blalock‐Taussig shunt only. Ten have undergone a Fontan procedure so far and five are awaiting such repairs. In this group there were four operative deaths: two after initial palliation, and two after Fontan procedures. In patients with a well‐developed infundibulum, the actuarial survival probability was 93% (95% CL = 74% to 98%) at 8 months with no further late deaths over 120 months follow‐up, whereas in patients without a well‐formed infundibulum it was 75% at 40 months (95% CL = 46% to 89%). The overall survival probability at 104 months was 77% (95% C

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00379.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractA retrospective analysis of ten patients with anomalous left coronary artery arising from the pulmonary artery operated between 1979 and 1990 was undertaken. All presented with evidence of left ventricular dysfunction and “ischemic” mitral regurgitation. Surgical repair consisted of an aortopulmonary tunnel (Takeuchi) procedure in eight and direct left coronary artery reimplantation in two. Two patients required postoperative support with a left ventricular assist device. There were no operative or late deaths (CL 0% to 17%) for a follow‐up of over 670 patient months. All patients are in New York Heart Association Class I or II, though two patients are still receiving anticongestive medications. One patient has required further surgery for pulmonary artery stenosis, and another has had a mitral valve replacement because of severe mitral regurgitation. One additional patient has moderate‐to‐severe residual mitral regurgitation and two have a trivial left coronary to main pulmonary artery fistula. All have a patent, nonstenotic left coronary artery and much improved left ventricular function and perfusion as assessed by echocardiography, thallium scan, gated blood pool scan, and angiography. There have been no documented arrhythmias, clinically or on Hotter monitoring. The ECGs have shown resolution or improvement of the initial changes of ischemia/infarction in all patients. Chest X‐rays have shown normalization of cardiothoracic ratio in eight of ten patients. Excellent early and late results can be achieved following timely surgical repair. Marked improvement in left ventricular function has been observed in patients with poor preoperative left ventricular function, even in the presence of extensive ischemia

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00380.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractPatients considered to have unstable angina have a varying prognosis depending on their clinical presentation. Prognosis can be influenced by several factors including persistent pain, transient ST segment shifts, left main coronary artery stenosis, and silent myocardial ischemia. Most patients who present with unstable angina have their symptoms controlled initially with pharmacological management. If symptoms persist, coronary angioplasty or heart surgery can be performed but morbidity and mortality is slightly higher than in patients who are stable. Patients who will benefit from early revascularization include those with persistent myocardial ischemia as manifested by spontaneous angina, spontaneous ST segment shifts on ambulatory ECG, a positive exercise test at a low cardiac workload, or a markedly positive radionuclide or cardiac ultrasound imaging test.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00381.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00382.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractOver millennia, the heart has played an important role in philosophy, medicine, literature, art, and theology. Most cultures consider the heart to be the location of the soul or mind, the “center” of the human body. Modern natural sciences, however, downgrade it to a mere organic blood pump and, simply, a site of surgical interventions. Dealing with this central organ of the body, cardiac surgery is a royal discipline among the medical professions and is highly respected by the pub

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00383.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY