ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00167.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Temporary use of the Jarvik‐7 artificial heart in critically ill patients awaiting transplantation has prevented death in>60% of attempts. Success is very dependent on meticulous surgical technique. Failures in the operating room cascade into enlarging problems postoperatively. Appropriately selected patients implanted without bleeding or fit problems recover quickly and are suitable candidates for transplantation within a few days. Even acute renal failure or pulmonary insufficiency from end‐stage cardiac disease rapidly reverses upon restoration of normal hemodynamics. Anticoagulation is mandatory to prevent thromboembolism and continuous heparin plus oral dipyridamole is the most successful regimen to date. Primary intraoperative security of all suture lines or potential bleeding foci is thus essential. Bleeding has been associated with tamponade, pulmonary complications, and transfusion stimulated anti‐HLA antibodies which can prevent subsequent transplantation. The length and suturing technique of the aortic conduit are critical. Compression of the mediastinal structures by the device can impede systemic or pulmonary venous return, with disastrous results. Displacement of the blood pumps away from the midline, usually into the pleural space, allows for more room when closing the sternum. The 100 cc blood pump fits best in patients>85 kg, while the 70 cc model can be implanted in patients as small as 50

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00168.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

In Japan, 32 patients have had application of monoventricular and biventricular assist devices during the past three years. Five of the 32 patients treated by the Fall of 1986 have successfully achieved long‐term survival. In this paper we describe our experience with the Tomasu and Pierce VAD in a total of four and two patients, respectively. Four of the six patients could be successfully weaned from the VAD and two of them were long‐term survivors. Nonsynchronizing pumping of the VADs was effective, as well as synchronizing pumping. Anticoagulant therapy is highly recommended during the use of the VAD although there was no significant incidence of thromboembolism or thrombus in the devices in this clinical ser

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00169.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Development of mechanical devices for support of the failing heart is a major goal in cardiac surgery. The application of left ventricular assist device (LVAD) is a promising approach in the case of severe and otherwise untreatable cardiac failure. In our experience we have used two external centrifugal pumps for the extracorporeal biventricular cardiac support in a post‐transplantation patient who experienced severe rejection six months after heart transplantation. Our own series includes a total of ten implantations of LVAD's with six patients who could be weaned from the device but only one long‐term survivor. The clinical results are not encouraging which suggests that the heart of the patient who needs an LVAD has been damaged beyond any chance for later recovery. Obviously timing is the most crucial aspect of the decision to implant the device. It would appear that orthotopic implantation of the transplanted heart remains the method of definitive treatm

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00170.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Twenty‐four consecutive patients with the tetralogy of Fallot underwent repair from March 25, 1985 to March 24, 1986. Correction was achieved without a ventriculotomy in 8 patients, necessitated a minimal ventriculotomy in 8, and a formal right ventriculotomy incision was required in the other 8. There were no early or late phase deaths‐0% (70% C.L. 0%‐7%). Post repair right ventricular to left ventricular pressure ratios were not significantly different between the three groups (p = 0.85). The 16 patients (66%) who underwent repair without a formal ventriculotomy were found to have severe hypertrophy of the infundibular septum as the primary etiology for right ventricular outflow tract obstruction. The other 8 patients (34%), who required a transventricular approach to the repair, were all found to have predominantly hypoplasia of the outflow tract and not hypertrophy. We conclude that repair of the tetralogy of Fallot can frequently be accomplished with no or a minimal ventriculotomy, and the results are satisfactory. Herein is described the operative approach to this proc

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00171.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

This report summarizes our experience with intraoperative angioplasty and coronary artery bypass graft surgery for the treatment of multi‐segmental coronary artery disease. The indication for intraoperative angioplasty was the presence of diffuse, symptomatic, coronary artery disease with at least one coronary artery having two or more areas of narrowing. The balloon catheter was introduced through an arteriotomy and advanced through the point of obstruction. The balloon was then inflated to 6 atmospheres for 15–20 seconds. This procedure was repeated two to three times. The time required for this technique averaged less than 5 minutes. Although there were no documented intraoperative perforations, intimal injuries were observed in two patients at the time of postoperative catheterization. Early and late postoperative angiograms showed that approximately 30% of angioplastied vessels had an improvement in their dilated lesions. Patients with discrete areas of narrowing had greater improvement in luminal diameter than those with diffuse narrowing (49% versus 17%). There was no difference in graft patency or left ventricular wall motion between vessels that did or did not undergo angiopla

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00172.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Coronary artery spasm is a transient reduction in lumen diameter of an epicardial coronary artery of sufficient degree to produce objective evidence of myocardial ischemia in the abscence of any significant increase in heart rate or blood pressure. In this article are summarized pathophysiological observations, the coronary angiographic anatomy of patients with coronary spasm, etiologic considerations, methods to provoke coronary artery artery spasm and their clinical usefulness, the role of coronary artery spasm in patients with clinical angina pectoris and myocardial infarction, and finally, the role of coronary artery spasm in patients undergoing coronary artery surgery.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00173.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Cardiac valve replacement with mechanical prosthetic or bioprosthetic devices enhances patient survival and quality of life. Nevertheless, prosthesis‐associated complications are frequent and contribute significantly to outcome. Thrombo‐embolic complications are the most important problems in patients with mechanical valves, necessitating chronic anticoagulation in all patients receiving them. In contrast, patients with bioprosthetic valves, composed of chemically treated animal tissues, generally do not require anticoagulants. However, bioprostheses fail frequently by degeneration, especially that involving cuspal calcification. This paper reviews the pathological and bioengineering considerations in the selection of cardiac prosthetic valves and the management of patients who have received these devices. The significance, morphology, and pathogenesis of the observed major complications and other alterations during function are described in detail. Contemporary investigative trends are summarized, including studies of inhibition of mineralization and other degenerative changes in bioprostheses, improved design rigid mechanical valves with pyrolytic carbon occluders and the development of central‐flow, flexible polymeric leaflet v

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00174.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The descending thoracic aorta is the most common site for thoracic aneurysms to occur and may present asymptomatically or manifest itself with an array of symptoms depending on the involvement of adjacent structures. Hemoptysis may occur due to erosion of the aneurysm into a bronchus or the pulmonary parenchyma. This report describes the technique in a patient with a descending thoracic aneurysm who underwent emergent resection of the aneurysm with en bloc removal of the involved left lower lobe of the lung.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00175.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Book Reviews in this articles:Toledo‐Pereyra LH (Ed):Organ Procurement II: Proceedings of the Second International Congress on Organ ProcurementHarvey WP, Kirkendall, Laks H, Resnekov L, Rosenthal A, Sonnenblick E (Eds):1986 Year Book of Cardiolo

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1987.tb00176.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY