摘要:

AbstractThe surgical technique of aortic valve replacement with freehand glutaraldehyde‐treated autologous pericardium is described. Forty‐nine patients underwent this procedure without hospital mortality and no thromboembolic episodes without anticoagulation. Three patients underwent reoperation: for infective endocarditis in two; and tear of one commissure 8 months after surgery in another. This technique because of its excellent hemodynamics and low thrombogenicity might be a valid alternative particularly in patients with a small aortic annu

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00582.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBetween October 1987 and November 1992, 165 consecutive patients underwent isolated transpulmonary repair for tetralogy of Fallot. Their ages ranged from 1 to 44 years and their weight ranged from 6 to 61 kg (mean 19.4). Of these 165 patients, 65% required annulus enlargement. The postrepair peak right ventricular/left ventricular pressure was 0.2 to 0.84 (mean 0.51). There were nine early deaths (5.5%) and one late death. All survivors have been followed up. Echocardiography revealed minimal to mild pulmonary regurgitation in those patients who had annulus enlargement. There were three patients who had gradient across the outflow tract of more than 40 mmHg. One of these required reoperation. We believe that all tetralogy of Fallot can be repaired through the pulmonary artery. Since we have used this approach for only 5 years, we are unable to compare the long‐term results with those of other approache

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00583.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractCryopreserved pulmonary allografts harvested from adults at the time of kidney donation were size reduced and used in two children with pulmonary atresia and ventricular septal defect. A technical modification for the creation of size‐reduced pulmonary allograft conduits is described. Postoperative ultrasonic and cineangiographic assessments revealed excellent function of the pulmonary bicuspid valved conduit with a minimal pressure gradient and essentially no regurgitation. Although the long‐term fate of cryopreserved bicuspid pulmonary valve and conduit is unknown, this conduit provides excellent handling characteristics that render allograft conduits preferable to synthetic conduits. In addition, the remodeled bicuspid pulmonary allograft conduits have exhibited excellent hemodynamic characteristics and are a reasonable alternative to other types of conduits when an appropriate size allograft is not availa

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00584.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractPulmonary arterial size was measured during cineangiography in 23 patients, 1.9 months before, and 14 months after bidirectional cavopulmonary connection (BCPC). Measurements were standardized for body surface area using the method of Nakata and co‐workers (pulmonary artery index). There was a significant reduction in pulmonary artery index after BCPC. These data suggest that pulmonary arterial growth is impaired after the creation of a BCPC. This may be related to an absolute reduction in pulmonary arterial flow, and/or the loss of systolic expansion of the pulmonary arter

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00585.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractRetrograde perfusion via the coronary sinus supplies vascular beds distal to coronary stenoses and has been used for administration of cardioplegia. An additional application is to supply noncardioplegic retrograde perfusion while performing proximal anastomoses (a time when cardiac arrest is not critical). The aim of this study was to determine the safety of this technique and to study the metabolic changes with antegrade versus retrograde warm blood perfusion. Sixty‐six patients, with good left ventricular function, underwent distal coronary bypass in a similar fashion. Proximal anastomoses were done with 1) partial occlusion clamp (n = 29) or 2) cross‐clamp on and continuous, warm, noncardioplegic retrograde blood perfusion (n = 37). In an additional 10 patients, metabolism was assessed with antegrade and retrograde perfusion during proximal anastomoses. Despite longer cross‐clamp times (96.4 ± 6.2 vs 80.8 ± 3.1 min, p<0.05) with retrograde perfusion, the total duration of cardiopulmonary bypass was significantly less (119.6 ± 6.2 vs 136.6 ± 4.6 min, p<0.05). There was superior postbypass, intraoperative hemodynamics (cardiac index) with retrograde perfusion (4.0 ± 0.2 vs 3.6 ± 0.1 L/min/m2). The incidence of postoperative dysrhythmia was not significantly different between groups. Oxygen and glucose utilization was more efficient with retrograde perfusion. Retrograde perfusion during proximal anastomoses is a safe technique. There is diminished risk of aortic dissection, atheroembolism, delayed aneurysm formation, or rupture due to avoidance of application of partial occlusion clamps. There is evidence of superior substrate

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00586.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractThe internal thoracic artery (ITA) is considered to be the conduit of choice for coronary bypass (CABG), but there has been some reluctance to utilize the ITA for revascularization in emergency situations. In a 9‐year retrospective analysis from 1986 through 1993, 484 patients had emergency CABG, 237 were not associated with failed PTCA (noninstrumented) and 247 were within 24 hours of PTCA (instrumented). About 62% of noninstrumented and 49.3% of instrumented patients received one or more ITA grafts, the others receiving only saphenous vein grafts (SVGs). Those who received an ITA graft tended toward male sex, better ejection fraction, and a generally lower clinical risk score. Instrumented patients tended toward a lower incidence of diabetes and left main coronary disease, higher ejection fraction, and lower clinical risk score than noninstrumented patients. The postoperative results were not significantly different between ITA and SVG groups with respect to new Q waves, need for reexploration, sternal wound infection, respiratory complications, or stroke. However, ITA patients more often had an event‐free postoperative course, received fewer blood transfusions, and experienced fewer cardiac deaths (2.7% vs 9.4%, p<0.01). There were few obvious differences in postoperative results between instrumented and noninstrumented patients. These results indicate that the ITA can be used for emergency CABG in selected patients with good resu

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00587.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractThe Jyros bileaflet mechanical prosthesis is unique among bileaflet valve designs in that there is no fixed hinge mechanism and after implantation, the leaflets are free to rotate as determined by blood flow through the orifice. Between November 1992 and April 1994, 56 Jyros valves were implanted in 44 patients at 45 operations. There were 31 males and 13 females (ratio 2.3:1), with a mean age of 3714 and a range owelve patientsplacement (AVR) (26.7%), 19 had mitral valve replacement (MVR) (42.2%), and 14 had AVR plus MVR (DVR) (31.1%). In three DVR patients the Jyros valve was implanted only in the mitral position. There was one hospital death following DVR (2.3% mortality). Total follow‐up of 341 patient‐months (28.4 patient‐years) is 100% complete. There were no late deaths. There was one reoperation for acute mitral prosthetic thrombosis (3.5%/patient‐year). Another Jyros valve was inserted; leaving 53 valves at risk in 42 patients at the close of follow‐up. There were no episodes of thromboembolism, transient ischemic attacks, endocarditis, hemolysis, or valve dysfunction, but three patients had four episodes of anticoagulant‐related hemorrhage. Echocardiographic follow‐up data was available in 29 patients and indicated satisfactory hemodynamic performance. Our early results with this unique prosthesis have been excellent; however, more extensive use and far longer follow‐up are required to determine whether the theoretical advantages offered by the innovative design are manifest in lower complication rates than for other conventional bileaflet prostheses

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00588.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractTransposition of the greater omentum to the thorax for treatment of severe mediastinal infections due to the anatomical structure and physiological properties of the omental tissue is a proven and safe procedure. From 1987 to 1993, thoracic omentoplasty was performed in 112 cases at our facility. In order to attempt to visualize the vascularization of an omental graft by the right or left gastroepiploic artery via the coeliac trunk, a small group of patients (n = 7) underwent left heart catheterization followed by angiography of the gastroepiploic arteries. Visualization of the gastroepiploic arteries was successful in six patients. Furthermore, anastomoses with adjacent vessels were observed in individual cases. The omental vessels remain open for a long period after transposition to the thorax, and additionally, appear to create anastomoses with surrounding vessels.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00589.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractAortic valve dysfunction secondary to leaflet degeneration of porcine bioprosthesis incorporated in a conduit poses a challenge to the surgeon. An adult male required repeat aortic valve replacement 13 years following insertion of an intraoperatively constructed conduit composed of a Carpentier‐Edwards bioprosthesis and Dacron tube graft. At surgery, the extremely difficult situation was easily resolved by excising the degenerated leaflets and inserting a St. Jude aortic valve within the frame of the bioprosthesis. The patient has remained Class I during the 3‐year follow‐up period, enjoying normal aortic valve fun

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00590.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractA 67‐year‐old female was incidentally found to have an anomalous right coronary artery (RCA) arising from the pulmonary artery during evaluation of her aortic valve disease. The left main, left anterior descending, and circumflex coronary arteries were mildly dilated. Large collaterals from the left filled the RCA retrogradely. During surgery, a circumferential web was found at the ostia of the RCA. The patient underwent an aortic valve replacement, resection of the web, and translocation of the anomalous RCA into the ao

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00591.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY