ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00556.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractPatients with postinfarction angina undergoing surgery for unstable angina face an increased risk of operative mortality. Between January 1982 and December 1987, clinical, angiographic, and operative data was collected prospectively in 588 unstable patients with a prior myocardial infarction within 30 days of surgery (MI) and 5951 unstable patients without preoperative damage (NONMI). MI patients were characterized as being older (age ± 70 years: MI, 19.7%; NONMI, 11.6%; p>0.001) and having more left ventricular dysfunction (left ventricular ejection fraction>40%: MI, 34.8%; NONMI, 26.4%; p>0.001). Semi‐elective surgery was performed in 82.0% of NONMI patients while 76.9% of MI patients underwent urgent surgery. Operative mortality was increased in MI patients (MI, 11.1%; NONMI, 4.0%; p>0.001) which was related to the extent of preoperative MI (non‐Q wave, 8.3%; Q wave, 17.5%; p>0.001). Stepwise logistic regression analysis identified preoperative MI as an independent risk variable of operative mortality for unstable angina. Separate multivariate analyses were performed to identify the independent predictors for MI and NONMI patients. The multivariate predictors of operative death for MI patients were left ventricular dysfunction, reoperative coronary surgery, nonuse of the internal mammary, age, transmural MI (relative risk 2.11 vs non‐Q wave infarction) and left main stenosis. For NONMI patients, the independent variables were urgent operation, left ventricular dysfunction, reoperation, female gender, left main stenosis, and age. The results of this study indicate that recent preoperative MI adversely influences the surgical results in patients with unstable angina. Alternative treatment strategies are warranted for high risk patients, particularly those with transmural MIs and impaired ventricular fu

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00557.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractOne hundred fifteen consecutive patients underwent repair of a variety of “isolated” simple ventricular septal defects (VSD), from February 1985 through December 1989. In no patient was a ventriculotomy required to accomplish the ventricular septal defect closure. There were no instances of permanent complete atrioventricular dissociation, and there have been no reoperations for residual or recurrent VSD. Postoperative echocardiographic and Doppler studies were performed in each patient and revealed good surgical results. There was one hospital death. The technical strategies used to accomplish the repair are described. These include methods for transatrial, transaortic, and transpulmonary approach to VSD closure. Enabling methodologies described include detaching the septal leaflet of the tricuspid valve to enhance VSD exposure in patients wherein the defect is obstructed by the tricuspid valve with “aneurysm of the membranous septum.” Also, splitting of the VSD patch in order to manage tricuspid valve chordal straddling is o

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00558.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractAn extremely rare congenital abnormality is reported in which the anterior descending coronary artery (LAD) originates from the pulmonary trunk. The clinical presentation, angiographic findings, and surgical treatment are discussed. This is the only reported case where surgical treatment included ligation of the LAD with internal mammary artery bypass grafting.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00559.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractWe currently treat idiopathic hypertrophic subaortic valvular stenosis using a combination of techniques, including septectomy for milder forms of the disease and mitral valve replacement for advanced forms of the disease, especially when mid‐cavitary obstruction or mitral valve incompetence is present. To prevent systolic anterior movement with possible impingement upon the hypertroph, we recently have plicated the anterior leaflet of the mitral valve with interrupted sutures. These techniques have proved successful in providing physiologic and symptomatic relief for patients suffering from idiopathic hypertrophic subaortic stenosi

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00560.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractNew technical challenges involving the delivery of cardioplegia during the course of coronary artery bypass operation continue to be presented to the surgeon. Functioning saphenous grafts at reoperation that are at risk for distal embolization, are managed by altering the standard cardioplegia delivery techniques. Management of patent internal mammary artery (IMA) grafts depends upon the status of the native circulation and coronary collateral. The reoperation may be performed with a fibrillating heart, standard cardioplegia with a clamped mammary graft, or cardioplegia delivered during simultaneous circulatory arrest. Myocardial temperature measurements, during the course of more complex operations, are useful in choosing the appropriate technique for myocardial protection.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00561.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractWe examined the pertinent surgical features of the anatomy of 56 hearts having tetralogy of Fallot with pulmonary atresia instead of stenosis, or malformations with pulmonary atresia closely related to tetralogy. We took particular cognizance of the pulmonary arterial supply in 15 hearts in which this was derived through systemic‐to‐pulmonary collateral arteries, dissecting, as far as possible, the bronchopulmonary segmental distribution of the collateral arteries compared to the intrapericardial pulmonary arteries in 11 of these hearts. Two of the hearts had absence of intrapericardial pulmonary arteries, so that a solitary arterial trunk left the base of the heart. Evidence of an atretic subpulmonary infundibulum was found in 40 of the hearts, while such an infundibulum was lacking in the remainder. The pulmonary atresia was muscular in 43 hearts, valvar in 11, while the pulmonary trunk was absent in the other two hearts. In the hearts with collateral arteries, on average 2.6 collaterals were found in each case, varying from two to five per case. Only one of these arose from a brachiocephalic artery, the others all arising from the descending aorta. The distribution of collateral arteries in two cases was remarkably reminiscent of the arrangement of bronchial arteries. As far as could be judged, 16.5 bronchopulmonary segments on average were supplied in each heart, 5.1 exclusively by collateral arteries, 11.8 by intrapericardial pulmonary arteries and an average of 0.64 segments per case having a shared sup

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00562.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00563.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractIntractable bleeding from the suture line on high‐pressure system can be controlled by a pericardial or a Dacron patch covering the bleeding site with continuous sutur

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00564.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractPlatypnea‐orthodeoxia is an infrequently reported clinical form of position dependent dyspnea and oxygen desaturation. There are several diverse etiologies for this syndrome. This case report of a patient with platypnea‐orthodeoxia is the first known presentation of a case secondary to a patent foramen ovale and idiopathic hemidiaphragm paralysis. A major problem with this disease is the clinical recognition of its existence. Full recovery is possible with proper assessment of clinical signs and symptoms, appropriate noninvasive diagnostic tests, and corrective surgery in selective ca

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00565.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY