ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00730.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractIntraoperative dissection and late ascending aortic dissection and aneurysm formation infrequently complicate cardiac operations but remain a significant source of morbidity and mortality. A review of 11, 145 consecutive cardiac operations at Emory University from January, 1982 through December, 1988 yielded 27 patients with an intraoperative ascending aortic dissection (incidence 0.24%) occurring at the time of the original procedure, with a hospital mortality of 14.8%. Nine additional patients with ascending aortic dissection or aneurysm, presenting late after a previous cardiac operation, were treated during this same period with three deaths.The technical aspects and decision making for application of closed aortic plication, open aortic reconstruction ascending aortic replacement based directly on the extent of the intraoperative dissection is detailed. An individualized technical approach tailored to the pathology encountered is outlined for the reoperative group of patients. Etiology, risk factors, principles of prevention indications for operation are also discussed.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00731.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractCardiac reoperations using a previous median sternotomy incision are becoming more common as the population of patients who have had cardiac surgery increases. Repeat median sternotomy can be complicated by major hemorrhage and secondary myocardial ischemia. A standard approach to reoperative median sternotomy has been developed over the past several years at Georgetown University. Details of the method are presented. From January 1, 1980 through April 30, 1988, 179 patients underwent repeat median sternotomy. The technical approach to the operation became standard as of July 1, 1983. Two of 66 patients operated before this date sustained major hemorrhage requiring emergent institution of cardiopulmonary bypass. One mortality in the group was directly related to hemorrhage at the sternotomy. No episode of major hemorrhage and no mortality related to the sternotomy occurred in 113 patients who underwent repeat sternotomy after July 1, 1983. Reoperation for bleeding occurred in 8.4% of the patients. We believe the technical considerations presented increase the safety of reoperative cardiac surgery.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00732.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractFundamental research in immunology has led to significant advances in cardiac and other organ transplantation. Immunology has now entered the era of molecular biology and sophisticated techniques have been applied to an understanding of immunological events at a molecular level. Future progress in transplantation will be based on these advances in immunology. This is a review of recent work on the structure and action of cell surface molecules important in normal and abnormal functioning of the immune system. Present understanding does not permit a comprehensive description of immunology at the molecular level. However, the exciting developments taking place in fundamental immunological research hopefully will be a stimulus to new progress in cardiac and other organ transplantation.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00733.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractThe use of echocardiography in the diagnosis of vegetative endocarditis has been a keystone in the diagnosis and treatment of this important clinical syndrome. In addition, with the use of transesophageal echo this modality has now made important advances in not only diagnosis but in evaluation of global cardiac function. A considerable amount of information has been gathered on the vegetation and these data will be discussed.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00734.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractSeveral technical variants for treating an infected aortic root are described. The principal aims of these procedures are the avoidance of insertion of the valve prosthesis into an infected aortic annulus and the avoidance of tension on potentially friable tissue. Among other technical variants, total replacement of the aortico‐mitral curtain with pericardium is describe

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00735.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractAmong our first 11,620 cases of valvular replacement, we observed 285 cases of valvular endocarditis and 59 cases (20.7%) in which the importance of the infectious lesions of the aortic or mitral annulus required complex valvular repair.In 23 patients with aortic valvular endocarditis, the presence of an abcess of the aortic annulus required its closure with a patch resulting in one early and one late death and five reinterventions with one death. Twenty patients are alive and well, 1 to 9 years after operation. In 11 patients, the extent of annular abcesses required the insertion of a subcoronary valved conduit. After a maximum follow‐up of 8 years there were two early deaths, two late deaths, one reoperation seven good results. Twelve patients had a supracoronary valved conduit resulting in four early deaths, one late death two reoperations; seven are alive and well, 2 to 6 years later. Three patients previously operated on had a left ventricular abdominal aorta valved conduit, two of them are alive and well up to 6 years later.Severe infectious lesions of the valvular rings (aortic root) can require complex repairs that can be lifesaving and provide excellent long‐term resu

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00736.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractSeventy‐five surgically treated patients with prosthetic valve endocarditis were treated at the Stanford University Medical Center. This was a multivariate analysis analyzing both patient related factors, bacteriology surgical findings. The conclusions among 10 patients with allograft valves, 20% had an annular abscess; this occurred in 36% of 29 patients with porcine valves 65% of these with mechanical prosthesis. Though prevention, again, is key in this especially devastating disease, once infection has been established and an aggressive approach is indicated, it would appear that a homograft re‐replacement or free aortic homograft valve replacement can deal with severe tissue destruction to prevent recurre

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00737.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractFrom 1977 to May 1989, 57 successive patients who were known drug addicts with endocarditis were operated on at the Weiler Division of Montefiore Medical Center and the Albert Einstein College of Medicine. The most common lesion was aortic endocarditis. Thirty day in hospital mortality was 9%. Recurrent infection did not occur in the preAIDS era. Since the advant of HIV positive patients, failure of antibiotics to control the infection preoperatively has been seen and carries with it a severe risk of recurrent and fatal postoperative sepsis. The long‐term survival was, at about 10% over 5–10 years, just good enough to warrant continued efforts in this very difficult group of patie

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00738.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractA series of 53 root replacements of the aortic valve for severe endocarditis is presented. The principles of this technique are to remove all abscesses and infected areas likely to drain into the mediastinum, excision of infected tissue down to healthy noninfected tissue replacement with an antibiotic‐impregnated homograft aortic root. Using this technique there has been a very high rate of cure of this most dreaded complicatio

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1990.tb00739.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY