ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00756.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractA technical modification to the total cavopulmonary connection in the presence of left superior vena cava (LSVC) is described. Systemic venous to pulmonary artery continuity is achieved by direct anastomosis of the right superior vena cava (RSVC) to the right pulmonary artery. Blood from the inferior vena cava (IVC) is diverted by an intraatrial baffle to the coronary sinus. The LSVC is then anastomosed to either the left pulmonary artery or the main pulmonary artery in an end‐to‐side or side‐to‐side manner. By using this technique, we maintain the basic principle of excluding the right atrial chamber from the systemic venous circuit, thereby reducing the potential obstructive complications that have been noted with other forms of complex intraatrial baffles. We have used this technique successfully in three patients with various forms of complex congenital cardiac

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00757.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractTwenty patients underwent reoperative coronary artery bypass grafting (CABG) through a left thoracotomy since 1971. This was their second CABG in 16 patients, third in three patients and fourth in one patient. Surgery was performed from 1 to 16 years following the initial procedure. Demographic data showed no significant variation from patients undergoing standard reoperative CAGB in this institution. Ejection fraction varied between 30% and 73%. Cardiopulmonary bypass technic has gradually developed since 1971, using the left femoral artery and vein. For venous cannulation a 50‐cm long catheter was positioned in the right atrium. Monitoring included pulmonary artery catheter with oximetry. Fibrillatory arrest of the heart was utilized with 18–33°C core cooling cardioplegia. The left internal mammary artery (6) and reverse saphenous veins (44) were used for an average of 2.5 grafts per patient. The proximal anastomosis was placed on the descending thoracic aorta or the left subclavian artery. There were two early and no late deaths. Sixteen patients were restudied before discharge from the hospital with an early graft patency rate of 98% (41/42). The left thoracotomy approach may be preferable in selected cases of redo CABG. The danger of damage to the heart and patent grafts is greatly red

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00758.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractFrom April 1988 to April 1989, nine patients (seven men and two women) with coronary three‐vessel disease and disabling angina underwent elective myocardial revascularization. None of the patients had available veins because of previous bypass procedures (three) or extensive varicosis (six). On standard cardiopulmonary bypass and cardioplegic arrest the right and the left mammary arteries (RIMA, LIMA) and the right gastroepiploic artery (RGEA) were anastomosed each to a major coronary branch (none of them as free graft) in each patient. All patients survived the operation but one, who died 2 weeks after the operation of a bilateral pneumonia. Autopsy revealed patent anastomoses. One patient had to be reexplored for bleeding. Two patients required temporary inotropic support. There was no perioperative myocardial infarction. All survivors were discharged home in an average of 18.7 days after the operation, are free from angina, and all have negative stress tests (mean follow‐up 7.7 months) but one with severe coronary atherosclerosis who experiences slight exertional angina despite good patency of the grafts. Five patients were recatheterized after a mean interval of 5.4 months after operation revealing in all cases patent anastomoses. Total revascularization of the heart with arterial grafts is feasible, safe, and it could become the method of choice if patency persists in the long

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00759.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractAutotransfusion of shed mediastinal blood following cardiac surgery is an important advance in this era of enhanced concern for transfusion transmitted diseases. The requirements necessary for the successful re‐infusion of shed mediastinal blood are discussed and a system is described which is easy to use, simple in design and efficient in performanc

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00760.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractA 60‐year‐old man developed constrictive epicarditis within 1 year after isolated mitral valve replacement (MVR). At reoperation, decortication of the thick epicardial layer resulted, impossible without a high risk of injury of the myocardium and major coronary arteries. Therefore, multiple longitudinal and transverse incisions were performed on the epicardial peel, which at the end acquired a turtle cage appearance allowing myocardial reexpansion, relief of constriction, and restoration of adequate hemodynam

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00761.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractSevere maneuvers designed to enhance the applicability and effectiveness of intraaortic balloon pulsation are presented. (1)Insertion of balloon catheter directly into the ascending aorta.The technique uses an indwelling silastic snare that allows direct insertion of a balloon catheter into the ascending aorta in the course of open heart operations without the necessity of returning the patient to the operating room and reopening the chest at the time of balloon catheter removal. (2)Elimination of electric artifacts in the course of intraaortic balloon assist.A method is presented that utilizes optical rather than electric signals to operate the intraaortic balloon pump and eliminates pacer interference as well as other electrical artifacts. (3)Enhancing assist effectiveness by balloon positioning.In a series of clinical observations, it was found that the effectiveness of balloon assist may be enhanced by as much as 75% by appropriate positioning. The previously held concept that placing the balloon in a subclavian location is optimal is challenged and it is recommended that the proper position of the balloon catheter be determined by using appropriate hemodynamic measurements in different locations. (4)Control of bleeding following removal of percutaneously inserted transfemoral balloon catheter.The technique utilizes a balloon catheter which is introduced into the puncture hole of the femoral artery after minimal surgical dissection and allows direct suturing of the bleeding source.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00762.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractA spectrum of events leading to tissue failure is responsible for late dysfunction of Hancock porcine valve xenografts: (a) Primary failure: dystrophic calcification, thrombosis, fibrous tissue overgrowth, primary tears, cuspal hematomas, and stent postbending. (b) Secondary failure: endocarditis and paravalvular leak. Dystrophic calcification is the main factor influencing long‐term durability and accounts in our experience for 88% of primary failure, through different clinical presentations; particularly, incompetence by cusp tearing and egg‐shell fragmentation is by far the most frequent mode of failure. Cusp degeneration by primary tears (in the absence of dystrophic calcification) is an uncommon event, due to lipid infiltration or to right coronary muscle shelf spontaneous or immuno‐related disru

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00763.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractA 58‐year‐old man with end‐stage ischemic cardiomyopathy underwent dynamic cardiomyoplasty. “On” and “off” studies with the cardiac assist device failed to show any significant hemodynamic changes despite improvement in functional status. The patient's late postoperative course was complicated by two episodes of acute pulmonary edema followed by cardiac arrest. These events were precipitated by ventricular tachycardia. The last episode led to myocardial infarction requiring diastolic counterpulsation and inotropic support. He died 41/2 months following the cardiomyoplasty. Postmortem findings revealed an anterior left ventricular infarct with aneurysm. There was fusion of skeletal muscle to the epicardium with minimal fibrosis and atrophy. The latissimus dorsi (LD) flap was viable, but myofibrillar ATPase stain revealed incomplete transformation. Several clinical observations have emerged from the early experience with dynamic cardiomyoplasty: (1) Important arrhythmias and cardiac arrest compromise the vascular supply and thus power of the muscular flap; (2) Resting ejection fraction does not correlate with exercise tolerance, therefore, other parameters must be sought to explain improved functional status; (3) Uniform muscle transformation in humans may be unpredictable with current clinical stimulation protocols. The conformation of LD to the epicardium underscores a potential remodeling phenomenon which may ultimately spare the diseased myocardium by altering its oxygen supply/demand ratio and thus the na

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00764.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractRabbit hearts were mounted on a Langendorff apparatus and after measurement of baseline hemodynamic function exposed to 30 minutes normothermic arrest. Hearts were reperfused at 37°C with buffer solution containing oxypurinol in different concentration: group II (0.01 mM), group III (0.1 mM), group IV (1 mM). Group I did not receive active drug and served as control. Each group consisted of eight hearts. After reperfusion, hemodynamic function was again measured and compared to baseline. Groups III and IV showed significantly less deterioration (p<0.05) than the control, while group II was better than the control, but in general differences were nonsignificant. We conclude that oxypurinol ameliorates ischemic cardiac damage following normothermic cardiac arrest. The beneficial effect of oxypurinol is most likely due to the drug's scavenging effect of oxygen‐free radica

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00765.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY