摘要:

AbstractLung transplantation continues to evolve as a therapeutic option for patients with end‐stage lung disease. Bilateral sequential single lung transplantation (BSSLTx) is a recent addition to the lung transplant surgeon's armamentarium that incorporates the benefits of single lung transplantation in patients who require double lung replacement while avoiding the morbidity inherent in the en bloc double lung transplant procedure. Between November 1992 and October 1993, 17 recipients underwent 18 bilateral BSSLTx procedures for a variety of indications. In 53% of patients, the procedure was completed without the requirement for cardiopulmonary bypass. Telescoping of the bronchial anastomosis has proved satisfactory. Induction cytolytic therapy has not been utilized. Patients received methyl prednisolone from day 1 and as maintenance prednisolone therapy. Actuarial 1‐year survival is 87%; 12 of the 15 survivors are In Functional Class 1. BSSLTx is an evolving transplant option for patients who require double lung replacement. Definitive clinical diffusion of the procedure will depend upon intermediate and long‐term outcomes for specific recipient pathologies. (J Card SUrg 1994;9

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00818.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractConcern over myocardial damage from simultaneous arterial (antegrade) and coronary sinus (retrograde) perfusion has led to alternating between these delivery routes to maximize their individual benefits. Based upon predominant retrograde drainage via Thebesian veins, this study: (1) confirms experimentally the safety of simultaneous arterial and coronary sinus perfusion; and (2) reports initial clinical application of this combined strategy in 155 consecutive patients.Experimental:Five mini‐pigs (25 to 30 kg) underwent 1 hour of aortic clamping with simultaneous aortic and coronary sinus perfusion at 200 mUmin with normal blood (37°C) before and after 30 minutes of perfusion with either warm (37°C) or cold (4°C) blood cardioplegia. Coronary sinus pressure was always less than 30 mmHg. There was no right or left ventricular edema, lactate production, or lipid peroxidation as transmyocardial and myocardial conjugated dienes were unaltered, and postbypass recovered left ventricular end‐systolic elastance (conductance catheter) and preload recruitable stroke work Index 101%± 3% and 109%± 90%, respectively.Clinical:Simultaneous arteriaVcoronary sinus perfusion was used in 155 consecutive high risk patients (New York Heart Association Class III to IV) undergoing isolated coronary artery bypass grafting (CABG) (n = 109) and CABG + valve replacementlrepair or aneurysm (n = 46). Included were 16 patients in cardiogenic shock and 24 undergoing reoperation. Mean aortic clamping time averaged 90 ± 4 minutes (range 30 to 207), with 3.5 ± 0.1 grafts per patient; all anastomoses were performed with the aorta clamped. Cold intermittent blood cardioplegia was used for distal anastomoses and valve implantationhepair in 123 patients, and warm continuous blood cardioplegia was used in 32 patients. Following a warm cardioplegic reperfusate, all patients received warm non‐cardioplegic blood perfusion simultaneously via grafts and coronary sinus. Coronary sinus pressure was always less than 40 mmHg. Of 18 patients requiring postoperative mechanical circulatory support (IABP), 16 had IABP placed preoperatively for cardiogenic shock. There were three postoperative myocardial infarctions (2%), and six patients died (3.9% mortality).Conclusion:These experimental and clinical findings overcome perceived concerns about myocardial damage from simultaneous arterial and coronary sinus perfusion, and suggest this approach may add to the armamentarium of cardioprotective strategies. (J Card Surg

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00819.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThese studies present modifications of the cardioplegic components of a standard cardioplegic formulation, delivered previously at 4:1, to allow an 8:1 blood:cardioplegic mixture, thereby limiting hemodilution. Data are included to show that the hyperkalemic (20 mEq/L) glutamate/aspartate enriched solution used previously for warm induction can be used also for warm reperfusion (instead of the 10 mEq/L KCI solution), thereby avoiding the need to formulate two different solutions that vary only in potassium concentration. Studies of cold (4°C) retrograde noncardlopleglc blood Infusion after arrest with hyperkalemlc blood cardloplegia document the safety of maintaining arrest with continuous retrograde infusion of cold normokalemic blood, thereby indicating that Ischemia and cardioplegla are unnecessary during aspects of cardiac operations where perfusion does not impair visualization (i.e., construction of proximal anastomoses). A new cardioplegic delivery system containing a shunt line is presented to expedite conversion from blood cardioplegia to blood Infusion when continuous infusion is used. (J Card Surg 7994;9:26–

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00820.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractIn spite of a trend toward earlier complete repair, some neonates and infants with complex cyanotic heart disease continue to require interim palliation with systemic‐to‐pulmonary artery shunts. A variety of shunt procedures have been proposed, each with inherent advantages and disadvantages. We have found a prosthetic interposition shunt between the ascending aorta and right pulmonary artery (AA‐RPA) to be effective in very young infants with small vessels. Over a 15‐year period, 51 patients, mean weight 3.33 kg and mean age 59 days, underwent this procedure with a 13% perioperative mortality and a 78% 2‐year overall shunt patency rate. We conclude that the AA‐RPA interposition shunt is a safe, effective procedure in these infants. (J Card Surg 1

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00821.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractExperimental as well as clinical data support the finding of using the pulmonary valve as a systemic semilunar valve. From January 1990 to December 1992, 89 patients received pulmonary cryopreserved allografts as aortic valve replacement. Sixteen subjects suffering from native or prosthetic valve endocarditis were included. Age ranged from 10 to 74 years. Sixty‐five patients received isolated aortic valve replacement and 24 patients required additional surgical measures, such as coronary artery bypass graft, mitral valve reconstruction, replacement of the ascending aorta, supravalvular patch aortoplasty, ventricular septal defect closure, or myectomy. All operations were performed with normothermic bypass and cold cardioplegic arrest. Follow‐up is maintained by visits to the outpatient clinic and echocardiographic assessment of the valve status every 3 months during the first year and every 6 months thereafter. There were four early and three late deaths. Four valves had to be removed: one intraoperatively and three 2, 4, and 24 months postoperatively. Echocardiographic assessment proved that gradients across the valve were low or absent. The majority of patients showed trivial or no aortic regurgitation during follow‐up. No thromboem‐bolic events have been observed and no new endocarditis occurred. Thus, event‐free survival at 3 years is 87%. The results with pulmonary allografts have shown to be comparable to aortic allografts. Even in patients with acute native or prosthetic valve endocarditis, the use of cryopreserved pulmonary allografts has shown no adverse effects. We continue to implant cryopreserved pulmonary allografts In the aortic position. The long‐term function of the valve, however, must be established, making continued evaluation of postoperative patients mandatory. (J Card Surg 1

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00822.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBetween August 1983 and January 1991, seven patients with Marfan syndrome underwent surgery for severe cardiovascular complications. The mean age at presentation was 5.7 months (range 4 to 9 months) in the infant group (n = 3), and 13.3 years (range 10 to 16 years) in a group of older children (n = 4). The primary indications for surgery in the infant group (performed at a mean of 3 years after diagnosis) were ascending aortic aneurysm with valvar regurgitation in one patient, and severe mitral valve prolapse with regurgitation in two. In the older group, surgical indications (performed at a mean of 2.8 years after diagnosis) were ascending aortic aneurysm with valvar regurgitation in three patients and acute aortic dissection in one. For aortic surgery, a composite valved conduit was used in four patients, and an aortic homograft in one. For mitral valve surgery, mechanical prostheses were used. Ail patients survived the primary operation. Over a mean follow‐up of 17.5 patient‐years (range 1 to 9 years), two patients in the infant Marfan group went on to further successful surgery (prosthetic mitral valve replacement and aortic root repair with aortic homograft) at a mean interval of 4.3 years after the Initial surgery. Our results suggest that the major cardiovascular risk factors of Marfan syndrome in the young, even in those diagnosed during infancy, have been favorably changed by surgery with an encouraging medium‐term outlook. The correct timing of surgery is aided by echocardiography. (J Card Surg 1994;9:

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00823.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractOmental flaps have been used for the treatment of infected aortic prosthetic grafts in adults. We report the case of a 26‐month‐old male who developed a mycotic aneurysm 9 months following insertion of a ventricle to pulmonary artery conduit. The aneurysm was excised and the reconstructed outflow tract wrapped with omentum. The patient has not had recurrence of his aneurysm following this course of management. (J Card Surg 1994;9:55

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00824.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstractlnterlayer dissection of the atrial septum resulting in the formation of a cavity developed after an attempted repair of a mitral paraprosthetic leak. Subsequent rupture of the cavity into both atria resulted in a small left‐to‐right shunt and significant left ventricu‐loatrial regurgitation. Misplaced stitches, aimed at obliterating the paraprosthetic leak, were the cause of the dissection. This case illustrates a previously unreported complication of mitral valve surgery and stresses the importance of proper exposure and handling of the mitral annulus. (J Card Surg 7994;9:

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00825.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractA 65‐year‐old male presented with a descending aortic dissection. His past history was remarkable for severe blunt chest trauma 26 years prior to presentation. Operative and pathologic findings included a posttraumatic pseudoaneurysm of the thoracic aorta and an aortic dissection that originated from the orifice of the pseudoaneurysm. The ductal fovea, the mouth of the pseudoaneurysm, is an area that may be more susceptible to accelerated atherosclerosis and the complications of atherosclerosis including aortic dissection. (J Card SUrg 1994;9:65

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00826.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractA technical alternative is proposed to enable transplantation in cases of considerable size mismatch between donor and recipient aorta: interposition of a Dacron graft of intermediate diameter. This procedure was performed in a 56‐year‐old patient weighing 75 kg in whom a heart from a 40‐kg donor was implanted. (J Card Surg 7994;9:

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1994.tb00827.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY