ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00178.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Double outlet right ventricle (DORV) may be divided into subsets according to the position and commitment of the ventricular septal defect (VSD) to the great arteries. In DORV with subaortic VSD, an intraventricular tunnel repair is the recommended operation. The current hospital mortality is 5% with an actuarial survival of 83% at 15 years. DORV with doubly committed VSD should also be repaired with an intraventricular tunnel, and the surgical results are similar to those for DORV and subaortic VSD. In DORV with subpulmonary VSD, an intraventricular tunnel repair is advisable when the distance from the tricuspid to the pulmonary valve exceeds the distance from tricuspid to aortic valve. Otherwise, a spiral intraventicular tunnel or an arterial switch procedure should be considered. In DORV with doubly committed VSD, the results of surgical treatment have been less good, and alternative forms of surgical treatment require further evaluation. The surgical treatment of DORV with pulmonary stenosis and the surgical details of the intraventricular tunnel repair are discussed.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00179.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Ten patients have presented at the World Children's Hospital of Melbourne with hemitruncus, a form of truncus arteriosus. Nine of these patients underwent successful one‐ or two‐stage hemodynamic repair. Early repair is carried out to avoid pulmonary vascular disease of the lung directly supplied from the trunk and to recruit as much of the contralateral pulmonary artery vasculature bed as possible is a secondary goal. The repair should be contemplated within the first six months of life to prevent severe pulmonary vasculature obstructive disease. Anatomy that is repairable in one stage is when the left pulmonary artery originates from the trunk and the complete right pulmonary artery supplied by pulmonary collaterals from the arch to the descending aorta. Anatomy requiring two‐stage repair occurs when the RPA rises from the trunk and the left PDA rises from the descending aorta or distal aortic notch and either the right or the left lung blood supply is from multiple origins and requires unifocalization. With these anatomical principles and the general meticulous perioperative and postoperative care of the infants, a high degree of success should be obtainable with repair of this hemitr

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00180.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A clinical trial of a collagen‐sealed knitted Dacron conduit (Tascon Medical Technologies) in 86 patients has revealed a high incidence of early reoperation for conduit stenosis. At 3 years, the actuarial incidence of freedom from conduit replacement was 67 ± 14% for valved conduits, and 66 ± 20% for nonvalved conduits. Seven of eight conduits that were replaced had a thick, weakly adherent pseudointima. Comparison of the current series with a previous series of patients receiving tightly woven low‐porosity Dacron conduits is complicated by the young age, small size, and greater complexity of the current group. Nevertheless, the findings are consistent with the results of two laboratory studies performed at this hospital which suggest that the collagen used in the Tascon conduit undergoes particularly slow resorption, resulting in weak adhesion between the pseudointima and conduit. This allows hemorrhagic dissection to occur deep to the pseudointima. These data suggest that alternative methods of sealing knitted Dacron conduits should be

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00181.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Bacterial endocarditis of the mitral valve appears to be much less common than bacterial endocarditis of the aortic valve. One of the main etiologic factors is the presence of degenerative lesions of the mitral apparatus, ballooning or mitral floppy valve. The surgical anatomy of the lesions is described: vegetations, perforations, rupture of chordae tendinae, abscess of the mitral ring observed in the isolated mitral endocarditis, mitral‐aortic dislocation, abscesses and aneurysms of the mitral‐aortic fibrosa and jet lesions on the anterior mitral leaflet. In the isolated primitive mitral infective lesions, all the technical skills are directed toward the prevention of the perivalvular leakage of the prostheses. Special procedures are described for the management of the ascesses of the mitral ring. In patients with mitral‐aortic lesions, the main problem is treatment of the dislocation of the annuli or aneurysms of the mitral‐aortic fibrosa. Despite technical advances, the surgical prognosis of the mitral endocarditis remains severe. In a personal series, the authors recorded a mortality of 12% in isolated mitral cases and 42% in the combined mitral‐aortic patients. Early surgical treatment remains the most significant factor in decreasing the fatality of suc

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00182.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The development of the total artificial heart (TAH) has reached a level where it is now available for clinical applications. The TAH has demonstrated distinct advantages over other forms of mechanical circulatory assistance. As of December 1, 50 TAHs have been implanted: 5 as permanent devices, and 45 as a temporary mechanical bridge to cardiac transplantation. The use of the TAH has increased in the last several months, leading to a growing interest in defining the indications and contraindications to its use. End‐stage cardiomyopathy (either idiopathic, ischemic, viral, or postpartum) has been the underlying disease in 80% of the TAH procedures to date. The TAH has also been applied in 5 cases of acute cardiac graft rejection, 2 cases of congenital heart diseases, and in one case after acute myocardial infarction. The indications for the use of the TAH in these and other potential patient groups is discussed in light of the current clinical result

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00183.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Heterotopic cardiac transplantation first introduced by Bernard in 1974 currently is rarely used as the procedure of choice when orthotopic cardiac transplantation can be considered. Specific indications for heterotopic cardiac transplantation include elevation of pulmonary vascular resistance and availability of a small or poorly functioning donor organ for a mortally ill recipient. Most cardiac transplant centers have abandoned its routine use because the recipient's diseased and poorly functioning heart remains as a potential source for embolism, infection, and continued angina, because the operative procedure is more complicated. Pulmonary complications are common due to compressive atelectasis of the right lung. Experience indicates that the heterotopic procedure is useful for those selected individuals in whom the orthotopic procedure is not appropriate and that rates of survival are nearly equal.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00184.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Numerous studies have shown that early coronary reperfusion is feasible in the setting of evolving acute myocardial infarction in man. While early reperfusion reduces myocardial infarct size, there are potentially deleterious consequences of reperfusion. The concept of “reperfusion injury”, oxygen‐free radical damage, no reflow phenomenon, and stunned myocardium are disc

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00185.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Calcium channel blockers have an important role in the pharmacotherapy of cardiovascular disorders. These agents act by inhibiting the slow inward current into excitable cells, exert direct negative inotropic, chronotropic, and dromotropic activity, and are potent vasodilators. These direct effects are modified by reflex autonomic stimulation and by pathologic states. Serious adverse effects of the calcium channel blockers are most frequently observed in patients with ventricular dysfunction, conduction system disease, or concomitant beta blockade. Calcium channel blockers are indicated in the treatment of angina pectoris, supraventricular arrhythmias, and hypertension. The use of these agents in patients with hypertrophic cardiomyopathy, congestive heart failure, and pulmonary hypertension is investigational. The calcium channel blockers are gaining increased importance in the management of patients undergoing cardiac surgery. Verapamil is indicated for the treatment of post‐cardiac‐surgical atrial flutter and fibrillation; however, the calcium antagonists are not effective as prophylaxis against postoperative supraventricular arrhythmias. Laboratory studies have shown that drug interactions exist between calcium channel blockers and inhalational anesthetics and nondepolarizing neuromuscular blocking agents; clinical studies have demonstrated that these interactions are rarely significant. Perioperative coronary spasm can be effectively treated with the calcium channel blockers. The timing of calcium antagonist withdrawal prior to surgery is controversial, but continuation of therapy until surgery is usually safe. The clinical significance of platelet function inhibition by the calcium antagonists is unknown. Protection of ischemic myocardium by calcium channel blockers has been demonstrated. Important interactions between the calcium antagonists, hypothermia, and the ionic constituents of cardioplegia require further study before the role of these agents as adjuncts to clinical cardioplegia is defined. Expanded indications and the introduction of new calcium channel blockers will result in increased use of these agents in the fut

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00186.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A method is presented which allows removal of a balloon assist catheter inserted directly (without a graft) through the ascending aorta in the course of heart surgery without the need for reopening the sternotomy incision. The catheter is inserted through the aortic wall under the protection of two purse string sutures which are temporarily tightened using implantable grade silastic rubber tourniquet. The end of the tourniquet is placed subcutaneously in a subxiphoid position. At the time of discontinuation of balloon assist, the balloon can be removed using local anesthesia without reopening the sternum by exposing the end of the tourniquet substernally, removing the catheter, and plugging the tourniquet. The silastic tourniquet may be left in indefinitely or removed through a similar exposure six to eight weeks after the procedure.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00187.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY