Search

Improvements in anesthesia, extracorporeal perfusion, surgical techniques and increasing knowledge of pathologic anatomy and physiology have resulted in a steady reduction of the mortality rate of open heart repair of ventricular septal defects. In addition, the incidence of iatrogenic heart block and residual or recurrent ventricular septal defects have likewise been reduced. Despite the above improvements, a certain percentage of residual or reopened shunts occur. It is therefore important to determine the predisposing factors favoring their occurrence. It is the purpose of this paper to determine the incidence of residual ventricular septal defects (RVSD) and its relation to the preoperative hemodynamic data, method of repair and size of the defect estimated at the time of surgery. [ABSTRACT FROM AUTHOR]

This article presents hospital management of heroin addicts undergoing cardiac surgery. Heroin addiction has long been considered a condition which pervades all dimensions of the addict's life. During the period from December 1970 until June 1972 a group of seven heroin addicts who exhibited fungal and bacterial endocarditis were admitted to the Roosevelt Hospital. In the hospital the patients were noted to be initially hostile, belligerent and non-communicative. Despite the fact that three patients were maintained on methadone and four were not there were no remarkable differences in their initial behavior. The patients behavior allowed us to infer basic physiological and psychological needs of the medically ill drug addict.

, , 343-348. Abnormally prolonged peripheral vasoconstriction has been detected prospectively by means of a toe temperature nomogram in 15 (11·5%) out of 131 patients following cardiopulmonary bypass. This state has been associated with a 53% incidence of hospital death, a detectable pathological cause in all cases, and in seven of the 15 cases it was the first or only evidence of a circulatory disorder. It is apparent that toe temperature monitoring after open-heart surgery gives early warning of a wide variety of potentially serious pathological processes, permitting effective treatment of the underlying cause before irreversible changes occur. It has become an indispensable part of routine postoperative care in our unit and is regarded as the simplest and most effective method of monitoring the circulation currently available. [ABSTRACT FROM PUBLISHER]

Describes the method use to remove intra-cardiac foreign bodies developed during angiographic procedure. Examination utilized to identify the missing fragment in the heart; Details on the application of retroperitoneal surgical approach in the extraction of the foreign material; Complication observed in patient after the condition.

The article focuses on immunoglobulin synthesis in vitro by human thymus. Immunoglobulin synthesis measured in incubated thymus tissue by the incorporation of Carbon 14 labeled amino acids has been studied in four thymus glands from patients with myasthenia gravis and in eight normal thymus glands from patients undergoing open heart surgery. Thymus tissues from patients with myasthenia gravis incorporated an average of twice as much radioactivity into soluble protein on a wet weight basis as normal thymus tissues.

, , 617-621. Seventy-four consecutive patients undergoing open-heart surgery were extensively investigated, preoperatively and postoperatively, for evidence of infection. The incidence of the infective complications encountered is presented, together with discussion on the aetiology of these complications. A previously unrecognized infective complication is described, this being a high incidence of infection with The series also reports an assessment of the nitroblue tetrazolium (NBT) test in these patients, and it is concluded that the system evolved in this series, of minimal chemoprophylaxis and constant monitoring of infection, affords a logical alternative to conventional methods using massive prophylaxis. [ABSTRACT FROM PUBLISHER]

The various central vascular shunting operations used for palliation of patients with congenital heart disease plus decreased pulmonary blood flow are discussed. The status of each in current practice is outlined in order to provide an up-to-data reference for the pediatric radiologist. In general, the Waterston shunt is preferred for infants under six months and the Blalock-Taussig anastomosis for patients older than this. [ABSTRACT FROM AUTHOR]

A case report of a seizure disorder occurring as a complication of open heart surgery is given. The seizures were first manifested 7 months after the operative procedure, indicating that neurologic complications may occur long after surgery. The authors discuss the pathogenesis and suggest a method for the reduction of this complication. [ABSTRACT FROM AUTHOR]

Three patients with anomalous origin of a coronary artery and/or of the circumflex branch of the left coronary artery were discovered during routine selective coronary arteriography performed as part of a cardiac catheterization. It is felt that a better knowledge of the origin and distribution of the main coronary trunks prior to cardiac surgery will be most valuable to help maintain an adequate myocardial perfusion during the bypass. [ABSTRACT FROM AUTHOR]

Focuses on the simplified experimental open-heart surgery using dog models in a community hospital. Utilization of plastic bubble oxygenators and with gravity return from the vena cava to the bubbling column of the bag; Attachment of a mechanical respirator to the endotracheal tube when the chest of the animal model was opened; Post-operative complications involved in the surgery.

Describes a heart lung-machine and a reperfusion system that were used during a heart surgery. Significant features of double helical heart-lung machine; Basic features of the perfusion system; Some advantages of hemodilution perfusions with particular reference to 5 per cent dextrose in water.

Right heart catheterization continues to be an important technique of cardiac diagnosis, particularly for congenital lesions. This study has examined some of its potential errors and the variation of findings in several common congenital lesions. The following general points will contribute to increased diagnostic accuracy in the employment of right heart catheterization: 1. Experienced operators will produce more accurate, complete studies. This is not a technique to be relegated to an inexperienced person without supervision. 2. Multiple blood samples should be obtained within a short space of time from carefully identified sites. Frequent instantaneous ‘spot-check’ blood-oxygen analysis by means of a photocell cuvette are helpful in planning additional studies to be made during the procedure. Patient disturbance, apprehension or unduly deep sedation should be avoided. 3. Common errors in the interpretation of right heart catheterization data have been described. Awareness of such errors will improve accuracy, 4. Variations of cardiac catheterization findings in the following cardiac lesions have been described: atrial septal defect, ventricular septal defect, patent ductus arteriosus and pulmonic stenosis. 5. Ancillary diagnostic techniques should be employed when indicated to clarify the diagnosis in certain situations. The most commonly employed techniques are: (a) Selective angiocardiography with injection of contrast medium into specific parts of the right or left heart or great vessels. In some laboratories all diagnostic investigations consist of a complete cardiac cathoterization study followed by a planned angiocardiographic angiocardiographic study. This is valuable in collecting information and gaining experience. However, if the clinical study of the patient has been competently done, angiocardiography may be reserved for selected problems only, (b) Dye curve studies including selective injection into right and left heart and great vessels with selective sampling. (c) Left heart and aortic catheterization in techniques such as left ventricular puncture, transseptal left atrial puncture and retrograde arterial catheterization. (d) Miscellaneous techniques such as arterial oxygen studies during exercise, simultaneous pressure recording during a Valsalva maneuver, phonocatheter studies and the amyl nitrite test. 6. Probably most important is the proper approach to the patient's problem. Specialized diagnostic studies should not be performed by physicians who are unfamiliar with the clinical findings. Before any specialized study, a careful and thorough clinical work-up should be made. The study should be carefully planned on the basis of the clinical findings. The cardiac catheterization data should then be evaluated together with the clinical findings in developing a final diagnosis and planning future management. [ABSTRACT FROM AUTHOR]

Fifteen patients with penetrating wounds of the heart repaired surgically were studied electrocardiographically soon after operation and for some time thereafter. The initial tracings disclosed elevated ST segments which soon became inverted in 11 subjects and inverted T waves in the other 4. Fifteen patients with penetrating wounds of the heart repaired surgically were studied electrocardiographically soon after operation and for some time thereafter. The initial tracings disclosed elevated ST segments which soon became inverted in 11 subjects and inverted T waves in the other 4. Follow-up studies after intervals of from 10 months to 14 years revealed normal electrocardiograms in 7 of the group, but in the other 8 there were permanent abnormal changes. These latter alterations were definitely related to the site of injury. The probable causes of the electrocardiographic changes in penetrating wounds of the heart are discussed and it is our belief that they are due primarily to the specific injury to the myocardium itself. [ABSTRACT FROM AUTHOR]

1. The postmortem findings in 170 cases of wholly persistent and 4 cases of partially persistent left superior vena cava in humans as reported in the world literature, have been reviewed and analyzed. 2. A report is made of 30 new cases consisting of 28 cases of wholly persistent and 2 cases of partially persistent left superior vena cava observed at Hahnemann Hospital. This group includes in addition to 10 autopsied cases, 8 cases verified by exploratory thoracotomy and 12 cases in which the diagnosis of left superior vena cava was made by cardiac catheterization and/or angiocardiography. 3. The anatomic variations and embryologic aspects of left superior vena cava are discussed in association with closely allied structures of the venous system, such as the anastomosis at the level of the innominate vein, the coronary sinus, the cardiac and pulmonary veins, and the inferior vena cava. 4. Of the series of 174 cases of persistent left superior vena cava from the world literature, conclusive evidence of associated cardiac septal defects was found in 59. Of the series of 30 cases from Hahnemann Hospital, 25 presented evidence of cardiac septal defects—13 proven either at surgery or autopsy and 12 on the basis of cardiac catheterization and/or angiocardiography. The association of cardiovascular anomalies with persistent left superior vena cava is discussed in relation to normal and abnormal development of the sinus venosus and atrial portion of the heart. 5. Roentgen diagnostic procedures such as, conventional film study, angiocardiography, and cardiac catheterization, utilized in the detection of left superior vena cava in the cases from this Hospital, are evaluated. [ABSTRACT FROM AUTHOR]

Discusses the methods of coronary heart disease surgery. Classification of heart surgery; Symptoms of coronary sclerosis; Efficacy of the transplantation of the distal end of the divided internal mammary artery.

A method for creation of ventricular septal defects is described. It utilizes a motor driven septatome to which suction is applied. Observations upon dogs in which interventricular communications have been produced by this technique are described. [ABSTRACT FROM AUTHOR]

The ninth known case of anomalous origin of the right coronary artery is described. The anomaly caused no symptoms but produced precordial physical findings of an arteriovenous fistula. The patient died of unrelated causes before cardiac catheterization was performed and the autopsy findings are described. The nine reported cases of this anomaly are briefly summarized. [ABSTRACT FROM AUTHOR]

Successful attempts at revascularization of the anterior myocardium with a direct end-to-end anastomosis between the left internal mammary artery and the descending branch of the anterior coronary are described. This method cannot be used in cases of extensive atheromatous process where Vineberg's implantation is indicated, but it is much easier and less dangerous than endarterectomy for cases of localized obstructions. Implantation of the splenic artery was performed in an attempt at revascularization of the posterior myocardium. The advantages of the use of this artery over that of the gastroepiploic, intercostal, and venous shunts are discussed. [ABSTRACT FROM AUTHOR]

Evaluates clinical results with myocardial revascularization and discusses the status of cardiopexy in the revascularization of the heart. Description of the procedure; Purpose of the operation; Complications from the procedure.

Direct current cardioversion has been used in 87 patients either before or after cardiac surgery at the University of Minnesota Medical Center. Forty per cent of the preoperative patients and 48 per cent of the postoperative patients were restored to a sinus rhythm for more than 1 month. In preoperative patients, restoration of a sinus rhythm improved the cardiac reserve and facilitated preparation of poor-risk patients for surgery. It also aided in differentiating functional from organic tricuspid valvular disease. In the postoperative patient, conversion to a sinus rhythm appeared to improve cardiac function. The incidence of successful cardioversion was 66 per cent if attempted 6 or more months after surgery, whereas it was only 33 per cent when carried out earlier. We now consider d.c. cardioversion the method of choice in the management of atrial flutter in the postoperative period and have been successful in converting 90 per cent of patients with this arrhythmia. Anticoagulant therapy before cardioversion does not appear to protect against thromboembolic complications after conversion, Procaineamide and quinidine sulfate appear to be equally effective as anti-arrhythmia drugs when used in association with d.c. cardioversion. [ABSTRACT FROM AUTHOR]