摘要:

AbstractSince February 1980 the automatic implantable cardioverter defibrillator has been implanted in over 1,500 patients. Sudden death rates have been reduced to 2%–4% annually. This report reviews the implantation techniques, their indications, and our clinical experience in 200 patient

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00211.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractIatrogenic aortic injury occurring during either coronary bypass grafting or valve replacement is a well‐recognized complication of cardiac surgery. We retrospectively reviewed our experience and found 11 cases occurring in a case load of 8,945 hearts (incidence of 0.12%). All 11 cases were repaired, with 10 patients surviving. The type of repair used usually was determined by when the diagnosis was made. When an intraoperative diagnosis was made, a local repair was done in four of six cases. If a postoperative diagnosis was made, then all five patients needed the ascending aorta replaced. With early diagnosis and rapid repair, good surgical results can be achieve

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00212.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractMyxomas are the most common tumors of the heart. They are frequently located in the left atrium and produce symptoms when they fragment and cause systemic emboli or when they interfere with cardiac valvular function and cause pulmonary congestion. Careful surgical management of these lesions should be curative with minimum early and late morbidity and mortality. Optimal operative technique emphasizes minimal manipulation of the heart before institution of cardiopulmonary bypass and aortic cross‐clamping and careful examination of intracardiac chambers with meticulous removal of myxomatous debris. Using these techniques, 17 patients have been treated successfully at the Brigham and Women's Hospital. There were no operative deaths and no significant perioperative morbidity. Fifteen patients are asymptomatic, and one patient has minimal shortness of breath an average of 57 months after surgery. One patient died of leukemia 15 months postoperatively. No recurrent myxomas have been identified, and no patients have symptoms of other cardiac diseas

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00213.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractAortic valve reconstruction is still at an early stage of development. We report techniques that can be applied in the repair of rheumatic aortic valve disease in patients with concomitant mitral valve disease. The techniques described are: (1) commissurotomy, (2) cusp free edge unfolding, (3) annuloplasty, and (4) supraaortic crest enlargement. Fifty patients operated on between January 1974 and January 1986 with a hospital mortality of 6% were followed for a mean period of 7.7 years. Reoperation due to failure of mitral surgery was required in twelve patients, tricuspid regurgitation in two, and significant aortic regurgitation in four. These techniques, although applicable to a limited number of patients, have enabled us to avoid the problems of aortic valve replacement in many patients.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00214.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractAortic valve replacement (AVR) with a pulmonary valve autograft (PVA) was first reported by Donald N. Ross (DNR) in 1967. The expectation of this procedure was to avoid degenerative changes seen in other biological tissue valves such as calcification, attenuation, and rupture of the leaflets. Recent reports by the original investigator's group have confirmed the lack of degenerative changes in PVA. To corroborate their conclusions, the fate of 12 patients undergoing AVR with PVA by one of us (LGL) has been ascertained.From March 1969 to June 1971, 12 patients underwent AVR with PVA. The right ventricular outflow tract (RVOT) was reconstructed with an aortic homograft valved conduit. The mean age was 42.7 years (range 21 to 52 years). The mean follow‐up for 11 hospital survivors is 12.4 years.Three PVA have been replaced; one following infective endocarditis at 13 years, and two at 15 and 73 months due to technical malalignment. There was no evidence of PVA degeneration during histological examination of these explanted PVAs. Six patients are alive and retain the original PVA at 12 years (55%).This analysis corroborates the conclusions of the DNR report and strongly suggests an immunological mechanism in the process of calcification of other biological tissue valves. The Ross operation is advocated for AVR in young patients as valve durability is of paramount importance especially in this grou

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00215.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractRight atrial‐pulmonary artery connection places the pulmonary circulation in series with the systemic circulation rather than the single ventricular “parallel” circulatory arrangement that usually is present prior to repair. The accompanying central cardiac shunt and volume overload physiology are eliminated. Favorable changes in ventricular dimension, ventricular wall stress, cardiovascular efficiency, relative systemic perfusion, and arterial oxygen saturation should result. The ongoing myocardial injury associated with the single‐ventricle volume overload is presumably arrested and repair is initiated to a variable degree. Some candidates for right atrial‐pulmonary artery connection may not benefit from repair because of irreversible ventricular injury. More accurate indices of systolic and diastolic ventricular function should be applied to this difficult group of borderline patients to further define potential for myocardial recovery and, therefore, candidacy for Font

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00216.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractThe relief of coronary obstruction by surgical grafting was the first effective treatment to be directed at the cause of ischemic heart disease. PTCA represents the second major step in relieving coronary stenosis. It seems timely to review where this second step has led in order to understand how percutaneous transluminal coronary angioplasty (PTCA) relates to surgery and to understand future implications of this procedure.This review will reflect many of the authors biases and prejudices derived from their experience at Mayo Clinic.1It will also be a somewhat practical assessment. Such a pragmatic approach can be defended because PTCA itself is built on pragmatism. It is more of the world of craftsmen than of the world of scientists. We are still waiting for science to “catch up” to help solve important remaining problems such as the issue of acute rethrombosis and restenosis.Our ability to review the Mayo Clinic experience is made possible only by having a dedicated team of colleagues in the catheterization laboratory and a dedicated support group managing our PTCA Registry. Experience with other large registries (the NHLBI CASS Registry and the PTCA Registry) has taught us that this is a valuable method of collecting and reviewing the experience with a new procedure as it develops. This approach is likely to be more widely applied in the fut

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00217.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractA method of covering mammary grafts with pleura, thymus, and pericardium to separate them from the sternum is described.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00218.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractGiven the recent resurgence of interest in the use of “fresh” and cryopreserved allograft valves for aortic valve replacement, the fact that many cardiac surgeons were not exposed to the operative techniques involved in freehand implantation of allograft valves during their residency training, and the paucity of teaching materials that clearly portray such techniques, details of a simplified method of subcoronary, freehand allograft valve implantation in the aortic position are described and illustra

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00219.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

AbstractTwo cases of successful repair of leaking mycotic false aneurysms of the ascending aorta from the aortic cannulation site, secondary to mediastinal infection following open heart surgery are described. Institution of cardiopulmonary bypass via the femoral vessels, rapid sternotomy, and fingertip control of the aortic hemorrhage permitted primary repair of the disruption.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1988.tb00220.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY