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Ön test-son test deney ve kontrol grup tasarımlı deneysel planlanan bu araştırma açık kalp ameliyatı olan hastalarda ameliyat öncesi verilen derin solunum ve öksürme egzersizi eğitiminin ameliyat sonrası dönemde solunum fonksiyonlarına ve egzersiz toleransına etkisini belirlemek amacı ile gerçekleştirildi. Araştırma, 01/10/2019-01/04/2020 tarihleri arasında Edirne ilindeki bir devlet hastanesinin KVC yoğun bakım ünitesi ve KVC kliniğinde yatan ve açık kalp ameliyatı geçiren 80 hasta (40 deney grubu, 40 kontrol grubu) alınarak yürütüldü. Araştırmanın verileri Hasta Bilgi Formu ve Hasta İzlem Formu kullanılarak toplandı. Deney grubu hastalara açık kalp ameliyatı öncesi en az 24-48 saat öncesinde derin solunum ve öksürme egzersizleri ile triflow kullanımı öğretildi ve ameliyat zamanına kadar günde 10-15 defa tekrar etmeleri istendi. Kontrol grubu hastalara ise sadece servisteki rutin uygulamalar yapıldı. Her iki grupta verilerin toplanması ameliyat öncesi 24-48 saat, ameliyat sonrası 1. gün ve 3. gün olmak üzere üç aşamada gerçekleştirildi. Çalışmanın sonucunda derin solunum ve öksürme egzersizleri ile triflow kullanan deney grubundaki hastaların ameliyat sonrası 3. günde solunum fonksiyon testi değerlerinin kontrol grubuna göre daha yüksek olduğu, 6 dakikalık yürüme testi yürüme mesafesinin daha fazla olduğu ve hastaların yürüme hızlarının daha fazla olduğu (p

BACKGROUND In this paper a method is proposed to evaluate the heart's coronary vessels' status based on the elimination of large coronary branches from IR-thermal image. This method makes it possible to determine nutrient cardiac blood circulation by calculation of the rate of heat spreading in small coronary vessels in the myocardium at hypothermia and hyperthermia under the conditions of artificial blood circulation. OBJECTIVE The objective of the paper includes a theoretical substantiation of the proposed method for evaluation of the heart's coronary vessels' status and an experimental investigation of the efficiency of the method. METHODS In the experiment, the dynamics of temperature distribution in the myocardium were registered by using thermal imaging cameras Flir i7 and Thermo Cam E300. RESULTS Processing of the myocardium's thermographic images and the results of heat spreading modeling make it possible to single out the temperature profiles of the visible myocardium zones and to establish the presence of coronary arteries in them. CONCLUSIONS The method makes it possible to monitor the heart temperature at hypothermia and hyperthermia; additionally, it makes it possible to evaluate the efficiency of the coronary artery bypass graft surgery performed during open heart operation.

The nosocomial infection of Pantoea agglomerans has become an important cause of many systemic infections in humans, and considered of present study was to isolate and identify this pathogen from open heart operation unit of Marjan hospitals in Hilla city during a period from April to September 2018, (19) isolates of Pantoea agglomerans. Was isolated from (150) swaps which were collected from the environmental of open heart operation unit. 8/30 isolates from system, 3/35 from bed, 3/25 from earth , 3/35 from door and 2/25 from nurse hands isolated identification of microbes were done according on the morphological, cultural ,microscopically characterization and list of biochemical test. To emphasize the identification of Pantoea agglomerans. We used the API20 technique biochemical strips ( biomerieux SA/marc y-1 Etoile France).The antimicrobial susceptibility pattern of the isolates was studied using different types of antibiotics. The microbes showed resistance to the routinely used antibiotics.

A 3-year-old girl was admitted to our hospital for the correction of atrial septal defect (ASD). Open heart operation with cardiopulmonary bypass is dangerous because the patient also had hereditary spherocytosis, which put her at risk for hemolytic anemia. Therefore, percutaneous transcatheter closure for ASD was chosen and performed successfully, which avoided the erythrocyte damage caused by cardiopulmonary bypass. This is the first time such a case has been reported, and we present an alternative approach for ASD with hereditary spherocytosis.

The development of cardiopulmonary bypass (CPB) can be largely attributed to the pioneering work of John Gibbon, who demonstrated its first successful use in animals in the 1930s and performed the first successful human open heart operation in 1953, when he repaired an atrial septal defect using CPB. This initial success was unfortunately followed by several deaths, and he became discouraged by the results and postponed its subsequent human use. At around the same time, C. Walton Lillehei began using controlled cross-circulation from parent to child to allow intracardiac repairs. In 1965, John Kirklin used a modified Gibbon heart-lung machine for intracardiac repair in a series of patients, heralding the era of CPB. Since this early work, progressive developments have occurred in materials used and in surgical techniques to improve the safety, reliability, and efficacy of CPB.

Cerebral mycotic aneurysms are uncommon but severe complications of infective endocarditis. Management of these patients remains controversial. We present a case of a 23-year-old man who had infective endocarditis complicated by an intracranial mycotic aneurysm. Because antimicrobial therapy was not effective in reducing the size of the mycotic aneurysm, a decision was made to perform craniotomy before cardiac surgery. The patient underwent an open heart operation 20 days after aneurysm clipping. His postoperative course was uneventful, and the patient continues to be healthy without neurological complications.

T origin of cardiopulmonary resuscitation (CPR) followed a sequence of events that began in my medical school years. I married a woman from Baltimore between my second and third year in medical school at the University of Minnesota (Minneapolis, Minnesota), which ultimately led to my training at Johns Hopkins (Baltimore, Maryland). Other events in medical school, however, also contributed. During my senior year, I spent some time doing research under F. John Lewis (who performed the first successful human open heart operation: the closure of an ostium secundum atrial septal defect under hypothermia, at the University of Minnesota Hospital in 1952,1 a case that I was fortunate to be allowed to watch). My research, utilizing rats, was on whether it was safer to rewarm them faster or slower from total body hypothermia. This initiated my later interest and research into hypothermia, which led to my meeting G. Guy Knickerbocker and Dr. William Kouwenhoven. Interestingly, in total body cooling, the rat’s heart rhythm would switch at around 20°C to 25°C, either to a profound bradycardia or go into ventricular fibrillation (VF). Defibrillators were not yet commonly in use or available at this time. With the energy that comes with youth, at Hopkins, I worked 24-hour days as an intern, under the stimulus of the professor, Dr.Alfred Blalock (Director of the Department of Surgery), who together with pediatrician, Helen Taussig, and his research laboratory director, Vivian Thomas, developed the blue baby operation (a left subclavian artery to pulmonary artery shunt that created a palliative increase in overall oxygenation by converting a tetralogy of Fallot to a pentalogy).2 I sometimes spent an occasional day and many evenings in the old Hunterian laboratory. There on the second floor of the Hunterian laboratory, was this “old gentleman” who walked with a limp, and who was experimenting with high voltage electricity. The “old gentleman” was William Kouwenhoven, Dean of the Johns Hopkins University School of Electrical Engineering (later to become the Whiting School of Electrical Engineering). Dr. Blalock had given him a place to study the effects of electricity on the heart under a grant from the Edison Electric Institute. This was a continuation of his studies of the effects of electricity on humans, and, especially cardiac function, going back to 1928. The Hunterian laboratory was soon replaced by a newer building for other medical school uses, and surgical research transferred to the twelfth floor of the newly constructed Clinical Science Building (now the Blalock Clinical Science Building). I was fortunate enough at the end of my surgical internship, July 1, 1954, to be selected to stay at Hopkins for the next year as an assistant resident in surgery; at the end of that year, July 1, 1955, I went, as a Cushing Fellow in Cardiac Surgery Research, to the newly located surgical laboratory. Continuing my studies on hypothermia, I was running into the problem of VF in a large number of animals, during induction of hypothermia. Dr. Kouwenhoven was now also situated in the new laboratory, but had retired as Dean of the School of Electrical Engineering; he was continuing his studies on electricity and its effects on humans, as a Lecturer in Surgery, in the emerging field of biomedical engineering. G. Guy Knickerbocker was now also working under him, toward his PhD in electrical engineering. Dr. Kouwenhoven continued his studies with a major grant from the Edison Electrical Institute and some additional support from the National Institutes of Health (NIH; Bethesda, Maryland). He had developed a crude, externally applicable, alternating-current cardiac defibrillator3 using electrical outlet power stepped up to a 440-V alternate currrent (AC). He had a prototype similar to one concomitantly developed in Boston by the cardiologist, Paul Zoll.4 A similar crude device, but using a lower voltage, was also available for direct application to the heart, having been the first means of defibrillation developed by Dr. Kouwenhoven. I needed to reverse the VF, which was ruining up to 1/3 of my studies. Guy Knickerbocker was consulted from down the hall in Dr. Kouwenhoven’s laboratory, and he brought his equipment to my laboratory. If the VF did not exist for more than a minute or two before the external defibrillating electrodes were applied, the defibrillation was generally successful and my own studies could continue. Thus, as researchers, we helped one another with merging goals, and most importantly, set up a communication line to be used later. I was able to make my first scientific presentation5 in Atlantic City at the meeting of the American Physiology Society, in April 1956, on work done while in the laboratory with the assistance of Dr. L.M. Haroutunian, a fellow in Medicine, and Roland Folse, then a senior medical student. Dr. Arthur Otis of the PhysiFrom the University of Miami School of Medicine, Miami, Florida. Manuscript received April 14, 2003; revised manuscript received and accepted June 23, 2003. Address for reprints: James R. Jude, MD, 200 Edgewater Drive, Coral Gables, Florida 33133. E-mail: jjude33333@aol.com.

Hereditary antithrombin (AT) deficiency is an autosomal dominant inheritance disorder. Patients with AT deficiency have a high risk of thromboembolism, and intraoperative cardiopulmonary bypass management is difficult. We present the case of a 53-year-old man who was diagnosed with AT deficiency and who underwent an open heart operation for a right atrial hemangioma. We administered AT-III concentrate perioperatively to maintain his AT-III level up to 80% to establish cardiopulmonary bypass and prevent thromboembolic events postoperatively. The right atrial hemangioma was successfully excised after right atriotomy. The patient had an uneventful postoperative course and was discharged on postoperative day 14.

Background . The role of peritoneal dialysis (PD) in the management of infants after heart operation is under discussion. The aim of this study was to investigate the effect of PD on fluid balance and outcome. Methods . Twenty-seven (33%) of 81 consecutive infants who underwent heart operation required PD. In 22 patients (81%), PD was started prophylactically at the end of the operation. We recorded hemodynamic data and fluid balance. Patients experiencing acute renal failure (ARF) were compared with the remaining infants. Results . Eleven of 81 patients (14%) experienced ARF; 3 of them died (4% of all patients undergoing operation, 27% of those with ARF). Complications of PD, present in 33%, were transitory and of minor significance. Patients with ARF had decreased cardiac function compared with those without ARF but similar fluid balance. Conclusions . Peritoneal dialysis is an effective and safe method for the treatment of ARF in infants after open heart operation. As PD is helpful in modulating postoperative fluid balance, prophylactic use of PD can be recommended for selected patients who are at risk for low cardiac output syndrome.

The recent development of less invasive intracardiac surgery using small incisions and videoscopic techniques allowed an evaluation of the advantages and limitations of this new approach. Among the limitations was the increased difficulty of the surgical technique when using long instruments through small incisions and ports. We investigated whether computer assisted surgical instruments might bring a solution to this problem. Among the existing systems, we selected the Intuitive System because of two original features. It provides a stable, magnified, three dimensional view of the operating field at a console where the surgeon is seated to operate, and it uses computer assisted instruments having the same dexterity and range of motion as the hand. After 10 months of active work to adapt this system to intracardiac surgery, the first open heart operation using computer assisted instruments was carried out on a 52-year-old woman presenting an aneurysm and a large defect of the atrial septum. The patient was extubated 8 h after the operation, returned to her room 16 h later and was discharged from the hospital 8 d post-operatively with normal heart function and no residual shunt. This preliminary experience showed that computer assisted cardiac surgery is feasible and may open new and promising directions in open heart surgery.

A Swan-Ganz catheter entrapment by a suture in the right atrial wall during open heart operation is presented. The diagnosis of the suture entrapment of the Swan-Ganz catheter to the right atrial wall was established by direct observation of the specific movement pattern of the cardiac structures when manual traction was applied from outside by a transesophageal echocardiographic examination.

Background. Routine closure of the sternum after cardiovascular surgical procedures sometimes causes severe cardiac depression because of a tamponade-like reduction in ventricular filling, leading to cardiogenic shock. Leaving the sternal halves apart, sealing the mediastinum by simply approximating the skin or using a prosthetic patch, and then performing delayed sternal closure in several days is a widely practiced life-saving maneuver. Methods. Described herein is an experience with 5 patients with severe cardiac output depression of the type usually treated by delayed sternal closure. Instead, upward (outward) traction was applied to the anterior chest while the sternum was primarily closed. Traction was maintained with full-thickness chest wall sutures. Results. The traction sutures were removed successfully in the intensive care unit between 1 and 4 days postoperatively, after appropriate vigorous treatment of postbypass myocardial enlargement and pulmonary distention and edema. Conclusions. This method of sternal traction allows physiologic improvement equivalent to delayed sternal closure in some patients and obviates the need for returning to the operating room to close the sternum in the early postoperative period.

Papillary fibroelastomas are rare cardiac tumors, but they are the most common primary tumor of the heart valves. These lesions occur on any of the valves or endothelial surfaces of the heart and may be detected by echocardiography, cardiac catheterization, during open heart operation for other conditions, or at autopsy. Because of their potential for cerebral and coronary embolization, even small papillary fibroelastomas should be excised.

In October 1955, I started training in General Surgery at the Mayo Clinic (Rochester, MN). On the third Saturday afternoon in October, I observed John Kirklin performing an open heart operation using extracorporeal circulation. On Monday, I visited the Fellowship Office and requested the addition of Thoracic Training to my studies. This was added and carried with it the requirement of writing a thesis. For this task, my advisor Dr. Bunky Ellis gave me a project: development of a mitral valve prosthesis. This was a virgin field at the time and I first asked myself the question: how does the mitral valve work? In 1959, I started my thesis in the classical manner by studying the anatomy of any mitral valve I could get my hands on. I dissected the hearts of humans, dogs, deer, guinea pigs, beaver, etc. My major conclusion from this effort was that mitral valve anatomy was dominated by irregularity.

To evaluate the functional integrity of platelets in patients administered the proteinase inhibitor aprotinin during cardiopulmonary bypass, 20 patients undergoing a complicated and prolonged open heart operation were studied. They were randomized to receive either a high dose of aprotinin (total dose, 6 to 7 x 10(6) KIU) before and during cardiopulmonary bypass (10 patients) or a placebo (10 patients). Blood samples were collected preoperatively, at the termination of bypass, and 90 minutes thereafter to assess platelet count and aggregation on extracellular matrix, which was studied by scanning electron microscopy. On a scale of 1 to 4, mean preoperative platelet aggregation grades were similar in both groups (3.5 +/- 0.5). Postoperatively, at the termination of cardiopulmonary bypass and 90 minutes thereafter, all 10 patients treated with aprotinin revealed normal, unchanged platelet aggregation (grade, 3.5 +/- 0.5), whereas all placebo-treated patients showed severely disturbed aggregation (grade, 1.4 +/- 0.5) (p less than 0.001). The platelet count was similar in both groups before and after operation (preoperatively, 182 +/- 75 x 10(9)/L and 146 +/- 30 x 10(9)/L, and postoperatively, 87 +/- 13 x 10(9)/L and 80 +/- 27 x 10(9)/L for the aprotinin and placebo groups, respectively). Total 24-hour postoperative bleeding and blood requirement were significantly lower in the aprotinin group (371 +/- 84 mL and 2 +/- 0.7 units, respectively) compared with the placebo group (608 +/- 28 mL and 3.4 +/- 1.3 units, respectively) (p less than 0.01). These results demonstrate that improved postoperative hemostasis is directly related to the complete preservation of platelet function achieved by the protective properties of aprotinin.

Percutaneous closure of secundum atrial septal defect (ASD) by various devices has been proven to be an effective and safe treatment modality for patients with congenital heart diseases. However, we have to be aware of the potential early and late complications like device embolization and formulate plan for rescue procedures. We have reported a case of successful closure of a large secundum ASD in a 23-year-old woman by a 40 mm Amplatzer septal occluder (ASO), which embolized into the right ventricle 4 hr after the procedure. This had caused palpitation and nonsustained ventricular tachycardia. Patient safety was our most important concern and after discussion with the cardiac surgeons and the patient, we would like to make a percutaneous stepwise attempt for retrieval. We first applied an endocardial biopsy forcep to grap the disk of the ASO to fix and stabilize the dislodged device. This would prevent the device from obstructing the inflow and outflow tract and causing catastrophic consequences. Then, a 15-mm Amplatz gooseneck snare was used to catch exactly at the connecting hub of the ASO disk, and the whole apparatus could then be cautiously and safely retrieved out from her body without complications. This had saved her from an unplanned emergency open heart operation that carried significant bleeding complication.

Exercise after open heart operation is not only possible but highly desirable. Training increases the efficiency of exercise and therefore decreases myocardial work for any given level of activity. Even before sternal and incisional healing is complete the patient may become physically active. Almost every patient can improve his or her level of fitness safely by following simple guidelines. Exercise treadmill testing is the basis for assessing exercise capacity in cardiac patients. Upper-body exercise is not adequately emphasized in most exercise programs.

We report a successful radical open heart operation without any blood transfusion in a 63-year-old male who diagnosed an incomplete endocardial cushion defect (ECD) with complete atrioventricular block (AVB). This case was characterized by that complete AVB was noticed preoperatively. A review of the literature revealed that this tient may be the eldest among those having undergone open heart operation. A fact that complete AVB appears on natural history indicates that complete AVB is an unavoidable postoperative complication for incomplete ECD patient. Therefore we recommed the ready implantation of permanent pacemaker leading on the right ventricular wall at the time of radical operation especially for the elderly patients who need tricuspid valve replacement.

This multicenter study investigated the possibility of reducing mortality rate by administering natural lung surfactant additional to standard therapy to treat patients after cardiac surgery who developed an acute respiratory failure (ARDS/ALI).A total of 78 patients (1998-2002) diagnosed with ALI or ARDS were enrolled in the study; patients were considered for study entry only if they developed ALI/ARDS within 72 h after cardiac surgery. A total of 36 patients (2000-2002) received Surfactant-BL via bronchoscope at a dose of 3 mg/kg twice a day, and 42 patients (1998-2000) served as the historical control. Within 24 h after the first Surfactant-BL administration the PaO2/FiO2 ratio increased from (mean+/-SEM) 129.7+/-9.9 mm Hg to 187.6+/-17.6 mm Hg (p0.01), FiO2 decreased from (mean+/-SEM) 0.71+/-0.03 to 0.56+/-0.03 (p0.01), and 69.4% of the patients treated with surfactant were weaned from the ventilator compared with 50% of the control group during a 28-day period. The mortality rate among patients treated with Surfactant-BL was 30.6% compared with 50% in the control group. In conclusion, early administration of Surfactant-BL leads to the reduction of mortality in cardiac patients who develop postoperatively an ALI or ARDS.

Transcatheter closure of ostium secundum atrial septal defects is a less invasive method of repairing atrial septal defects in comparison with an open heart operation. In selected patients the transvenous closure of atrial septal defects may be an effective alternative. Defects with circumferential septal rims, secundum atrial defects, and patent foramen are the best candidates for this method. We report a case in which a large residual atrial septal defect after transvenous closure with a Sideris occluder device required surgical closure.

Percutaneous vertebroplasty is increasingly used for the treatment of vertebral compression fractures. Local leakage of polymethylmethacrylate cement into the perivertebral space is a common complication, but important systemic effects have rarely been reported. The authors describe the case of a 52-year-old patient with central pulmonary embolism after percutaneous vertebroplasty of the eleventh thoracic vertebral body. The large cement embolus was removed from the right pulmonary artery with a hybrid technique combining an interventional catheter procedure with an open heart operation. The patient made an uneventful recovery. The authors review how appropriate arthroplasty techniques might minimize the risk of this dreadful complication.

Serum cTnT, CK-MB and LD1 were measured in 30 patients with AMI, 76 patients with VMC, 12 patients who had undergone operation without cardioplegia, 16 patients who had received open heart operation, 15 patients who had undergone thoracotomy for non-heart surgery and 55 healthy people. Concentration of serum cTnT was 0.057 +/- 0.056 microgram/L in healthy people, 0.069 +/- 0.032 microgram/L in patients who underwent thoracotomy for non-heart surgery, 0.328 +/- 0.472 microgram/L in patients with VMC, 0.388 +/- 0.279 microgram/L in patients with DCM, 4.259 +/- 4.619 micrograms/L in patients with AMI, 8.55 +/- 6.78 micrograms/L in patients who had undergone operation without cardioplegia and 16.03 +/- 6.01 micrograms/L in heart operation patients. In patients with VCM and DCM, serum cTnT was more specific and sensitive than CK-MB and LD1 for diagnosing myocardial injury. In patients with AMI and heart operation patients, the increasing multiple of serum cTnT was obviously higher than that of CK-MB and LD1. 72 h after heart operation, cTnT was still higher than normal, while CK-MB had returned to normal level. Serum cTnT had higher specificity and sensitivity and longer diagnostic period in diagnosing myocardial injury. Moreover, cTnT assay could indicate the degree of myocardial injury. So, quantitative analysis of cTnT can be used as a routine examination in the diagnosis of myocardial injury.

Objective: Since we developed the procedure in 1996, we have now performed 100 pediatric open heart operations using a lower midline skin incision and a minimal sternotomy approach.Methods and Results: To elucidate the benefits of this approach, we analyzed these 100 cases retrospectively. There was no death, and no major complication, caused by this approach, and the resulting scarring in each patient is difficult to be seen under a common undershirt.Conclusion: This review shows that the technique of a lower midline skin incision and minimal sternotomy approach is a safe reliable and cosmetically advantageous method for a pediatric cardiac operation.

To study the cardiac protective effects of tetramethylpyrazine (TMP) on patients undergoing cardiac operation. Methods: Twelve patients with rheumatic heart disease were randomly divided into the TMP group and the control group, 6 in each group,and 3mg/kg TMP was given to the TMP group. The changes of hemodynamics, serum creatine phosphokinase (CPK), creatine phosphokinase isoenzyme (CPK MB) levels were observed before, during and 72 hours after operation. Results: The hemodynamic indexes in the TMP group were better than those in the control group after operation, the serum CPK, CPK MB levels measuring 12 h, 24 h and 48 h after operation in the TMP group were lower than those in the control group. Conclusion:TMP has good cardiac protective function in patients undergoing cardiac operation in improving cardial function and reducing the release of myocardial enzymes.

Blood cardioplegia (BCP) is widely used for myocardial protection during open heart operation. However, BCP may have a chance to induce neutrophil-mediated myocardial injury during aortic cross-clamping. We clinically evaluated the myocardial protective effect of leukocyte-depleted blood cardioplegia (LDBCP) for initial and intermittent BCP administration in pediatric patients.Fifty patients undergoing open heart operation for congenital heart disease between January 1997 and March 1999 were reviewed. Twenty-five were administered LDBCP for myocardial protection during ischemic periods (LDBCP group), and the remaining 25 were given BCP without leukocyte depletion (BCP group).The difference in plasma concentrations of malondialdehyde between coronary sinus effluent blood and arterial blood just after reperfusion in the LDBCP group (1.68 +/- 0.56 micromol/L) was significantly lower than that in the BCP group (2.35 +/- 0.62 micromol/L; p0.01). The LDBCP group showed significantly lower plasma concentrations of human heart fatty acid-binding protein at 50 minutes after reperfusion (LDBCP group, 103.5 +/- 38.7 IU/L; BCP group, 144.8 +/- 48.8 IU/L; p0.01) and the peak value of creatine kinase-MB during the first 24 postoperative hours (LDBCP group, 17.0 +/- 8.5 IU/L; BCP group, 26.0 +/- 11.6 IU/L; p0.01) than did the BCP group. The maximum dose of catecholamine was significantly smaller in the LDBCP group (LDBCP group, 3.20 +/- 2.18 microg x kg(-1) x min(-1); BCP group, 5.60 +/- 2.83 microg x kg(-1) x min(-1); p0.01).These results suggest the usefulness of LDBCP for protection from the myocardial injury that can be induced by BCP administration during aortic cross-clamping.

This article reviews the roles of the contact and complement systems and of neutrophils and monocytes in the inflammatory response to cardiopulmonary bypass and open heart operation. These blood proteins and cells, together with other blood elements, produce the vasoactive and cytotoxic substances and microemboli that cause the morbidity associated with cardiopulmonary bypass and open heart operation.

© A 0 years and participated in his retirement Festschrift at reen Lane Hospital many years ago, a wonderful celbration of his many achievements, particularly in the rea of allograft aortic valve surgery andpaediatric cardiac urgery. Unfortunately, the memory of Sir Brian’s achievements nd those of his contemporaries is being lost by the next eneration of cardiac surgeons and trainees. Howmany of hem are familiar with Sir Brian’s name or with the names f other pioneers in cardiac surgery in Australia, D’Arcy utherland, John Clarebrough, George Stirling, Rowan icks, Harry Windsor, Ian Monk and George Westlake? imilarly, the names of other great contributors to our peciality on the international scene such as John Kirklin, wight McGoon, Donald Ross and Charles Dubost are lso being lost to memory. However, of more concern is hat the environment that produced these great surgical nnovators is also being lost. In Melbourne in the lead-up o the first open heart operation inAustralia, carried out at he Alfred Hospital in 1957, extensive experimental work rience at the bench-top. They train to reproduce highly technical yet standardisedprocedures in a controlledenvironment. Their end goal in most cases is simply to be able to perform these same procedures in public and in private hospitals. But surely more is required to maintain high standards and the standing of cardiac surgery in the future. Cardiac surgeons are only too familiar with the challenges facing cardiac surgery in this 21st century. There is a spirited “takeover bid” for many traditionally surgical procedures by cardiological and radiological colleagues. Coronary bypass surgery is under major threat from coronary angioplasty and stenting. Open thoracic aortic surgery might be rendered unnecessary by the use of aortic stents. Percutaneous catheter-based valve replacement is just around the corner. All these endeavours are being supported and promoted with huge financial resources by the equipment manufacturing companies. The end result is that at present there are a lessening number of cardiac surgical procedures being performed in Australia and around the world and thus a lessening n animals was done in the Baker Institute. In the leadp to open heart surgery in Sydney, Harry Windsor (then opportunity for operative experience by trainees, especially in the public hospitals. However, this may not be a h s s

There is still debate about whether previous cardiac operations are a risk factor for patient outcome after cardiac transplantation. As waiting lists for cardiac transplantation increase, adverse outcome criteria should be identified.To assess this problem, we retrospectively analyzed 53 patients with previous cardiac operations before heart transplantation and compared them with 53 control patients matched for sex and age. Patient groups were analyzed regarding their preoperative, intraoperative, and postoperative variables and survival.Ischemic times were comparable in both groups, but the duration of the operation was significantly longer in the study group (206.5 +/- 62.5 minutes, versus 156.0 +/- 36.7 minutes in controls; p0.05). In addition, postoperative blood loss was greater for the patients with previous cardiac operations (1,360 +/- 260 mL, versus 730 +/- 310 mL for controls; p0.01). Postoperatively, the rate of rejection episodes and the incidence of graft atherosclerosis were comparable within the first 2 years. However, survival was significantly reduced in the study group (60.1%) after 4 years (versus 83.1% for controls; p0.05).Heart transplantation in patients with previous cardiac operations will lead to an impaired overall outcome. In addition, these patients have more postoperative complications.

We report a patient who presented with a delayed spontaneous right ventricular rupture at the anterior atrioventricular groove after open heart operation. Successful surgical repair consisted of reestablishing anterior atrioventricular groove continuity by pericardial patch placement on the arrested heart. We discuss the risk factors that could initiate the primary tear and contribute to the extension of this type of right ventricular rupture.

F. John Lewis performed the first successful open heart operation in 1952. He was the first full-time member of the faculty of surgery at Northwestern University. This article gives a brief biography of this great surgeon.

One hundred eleven patients underwent their second to fifth open heart operation, excluding isolated coronary revascularization. The procedures included repeat, single and multiple valve replacements, concomitant redo valve surgery, plus aortic root, and/or aortic arch reconstruction with or without coronary bypass graft. Six patients had heart transplantation as the final procedure. The article is based on the analysis of the experience of one surgeon with particular emphasis on technical considerations and factors enhancing outcome. There were two deaths for an early (hospital--30 days) mortality of 1.8%. There were three sternal wound complications. Two patients suffered cerebrovascular accident (one with permanent residual deficit), and one patient required reoperation for tamponade. The text contains a relatively detailed description of the technical maneuvers applied for several different categories of procedures used.

Preoperative autologous donation has been shown to be a highly effective measure in reducing homologous blood use in cardiac operations. The aim of our study was to verify the effectiveness of this procedure and to see whether it is compatible with a comprehensive blood conservation program. Three hundred forty-eight patients (group 1) donated an average of 657 +/- 199 mL of blood before open heart operation, whereas 344 patients (group 2) without autologous predonation were used as a control. The two groups were compared with regard to homologous blood use and the possibility of applying other blood conservation measures. Homologous transfusion rate in group 1 was 12.6%, whereas in group 2 it was 46% (p0.001). Patients with three units of predonated autologous blood had a transfusion rate of 0.8% (p0.001 compared with group 2). In group 1, acute normovolemic hemodilution was accomplished in a lower number of patients and with a lower average withdrawal (338 +/- 102 versus 403 +/- 145 mL; p0.001). Other blood conservation measures such as the return of mediastinal drainage and use of residual blood of extracorporeal circulation were applied with similar results in both groups. In our experience, preoperative autologous donation was compatible with the application of other blood conservation measures, but acute normovolemic hemodilution was achieved in a lower number of patients. Preoperative autologous donation proved to be a highly effective method for reducing banked blood use and therefore homologous blood exposure during and after cardiac operations.

May 6, 1953 could very well be one of the most significant dates in medical history. On this day 50 years ago, Dr John H. Gibbon, Jr, performed surgery at Philadelphia’s Jefferson Hospital on a young woman in what was the world’s first successful open heart operation using a mechanical heart-lung device on a human being. In 1953 this patient was a 17-year-old college student in Wilkes-Barre, Pennsylvania, who had a congenital heart defect: a hole the size of a half dollar in the wall between the two upper chambers of the heart. She came in for regular follow-up for years and I had the chance to meet her during those visits as a nurse/perfusionist here at Jefferson. In 1978, about 25 years after her surgery, I lost track of her but up until that time she was living a healthy life working as a secretary in Philadelphia. At about this time I remember an article in the Philadelphia Bulletin, which was the evening paper at that time, in which she was quoted as saying she always had a youthful hunch or teenager’s intuition that her surgery would be a success. She felt it would go her way with Dr Gibbon, his machine, and prayers. In 1956–1957 I attended Hood College in Frederick, Maryland. From there I came to Jefferson Medical College School of Nursing from 1957–1960. While studying I met Sylvia Shopp, the head nurse of the cardiac operating room and I spent some time working in the dog laboratory where I met Dr Gibbon. Doctor Gibbon said to me one day, “What’s a nice young girl from Friends Central [he had attended our sister school Penn Charter] doing cleaning out cages? You should study hard instead.” In fact he often called me, “Hey, Friends Central!” So I did study hard and my fascination with the machinery continued for another 30 years. After graduation from nursing school I went straight to the cardiac operating room. While working as a nurse at Jefferson I was also training with Drs Templeton and Bacharach in operating the heart-lung machine. I also learned a great deal about cardiac surgery and nursing from Sylvia. When Sylvia left to get married I became the head nurse/pumpist. From 1960–1975 I had the honor of working with Dr Gibbon and his young associate, Dr John Young Templeton, first in the operating room as a scrub/circulating nurse, then as head nurse of that operating room, and finally from 1962 on as a nurse “pumpist” as we were then called. While the work was challenging, historical, and life changing for our patients, I also remember great times on such a close team, especially Christmas parties at Dr Gibbon’s farm in Media. The first Gibbon machine was a film oxygenator using a series of vertical screens. It was made to Dr Gibbon’s specifications working with IBM. It required a large prime of whole fresh heparinized blood, which was donated from many donors (some 25 of them), mostly sleepy medical students who would line up in the hallway to donate the morning of surgery or some local donors and perhaps even the Red Cross. Those were the days when students really did have to bleed for their profession. The pump was primed and the oxygenator recirculated using the whole fresh blood. The machine was the size of a grand piano and there were hoses and lines everywhere. The water supply for the heat exchanger was behind the autoclaves in a room between operating rooms 3 and 4 in the Pavilion Building. As you can imagine people were walking and tripping over the lines and hoses constantly. By the time I first used the Gibbon machine in the 1960s, there were many changes. The screens had been replaced by mylar coated aluminum sheets and the artificial lung was tailored to the patients surface area the night before. The larger the patient, the more sheets in the lung case and then of course it was all sterilized. Most of the reservoirs including the lung case were Lexan. The tubing connectors were highly polished stainless steel with very sharp edges. Some things remained the same however, as there were still hoses everywhere. At the conclusion of bypass the machine had to be dismantled and cleaned. This process took several hours, even over night. Before a solution called Hemosol came along, each piece had to be soaked separately in plastic trays in order to avoid any harm to the highly polished surfaces that could cause blood aggregates to be delivered to the next patient. Some parts had to be first cleaned with large pipe cleaners. The lung required two men to lift it in and out of the sterilizer. The Lexan parts could not be autoclaved and had to be ethylene oxide sterilized, which was a large improvement for those times, however we didn’t have any venting for the gas at the end of sterilization. This would hardly be acceptable to OSHA today. We were not yet in the age of disposables. Others like Dr DeWall and Dr Lillihei were demonstrating that a simple bubble diffusion oxygenator could be effective for temporary cardiopulmonary byass. The first one of these that I saw clinically was the 3-L Travenol bag. It was a heavy duty plastic heat sealed helical device Presented at the symposium, “Gibbon & His Heart-Lung Machine: 50 Years & Beyond,” Philadelphia, PA, May 2, 2003.

Pioneer in heart-lung surgery In April 1959, at the height of the cold war, a team of specialists from Hammersmith Hospital boarded a container ship and set sail for Moscow. On board the ship was the “heart-lung machine” developed by Denis Melrose and used in 1953 to perform the first successful open heart operation in the UK. That operation was carried out by a team that included Hugh Bentall, who went on to become the first professor of cardiac surgery at Imperial College. The team’s fame had spread and at a conference a Russian heart specialist, Alexander Bakulev, challenged them to prove that the heart-lung machine worked. As well as acting as first surgical assistant, Bentall’s job was to arrange the complex logistics for the trip and to pack everything that could “conceivably be needed to perform six operations in Moscow.”1 Once arrived in the USSR, he tested the equipment and the on-site blood transfusion facilities by performing a mitral valvotomy, a routine heart …

Open heart operations on patients with hereditary spherocytosis have been reported rarely. Young children who have not yet undergone splenectomy have a high risk of intraoperative hemolysis because of the heart-lung machine and secondary renal failure. We report the case of a 15-month-old child with spherocytosis who underwent an open heart operation without serious complications as a result of careful and appropriate perioperative management.

A cardiac donor who had undergone a previous open heart operation and who was hepatitis C positive is described. The continuing need to expand the donor pool is emphasized.

A 76-year-old woman was found to have a 4 × 2.5-cm saccular aneurysm at the origin of the innominate artery at the time of a reoperative open heart operation. The operative procedure was modified to include repair of the aneurysm with a Dacron patch. During the period of innominate artery occlusion, the patient was cooled to 25 °C and the mean arterial pressure was maintained at 90 mm Hg to maximize cerebral protection.

Hereditary spherocytosis is a clinically heterogeneous, genetically determined red blood cell membrane disorder resulting in hemolytic anemia. Structural or functional disorders of the cytoskeletal proteins result in the formation of spherocytes, which lack the strength, durability, and flexibility to withstand the stresses of the circulation. This problem can be accentuated by the deleterious effects of the heart-lung machine. Three patients with hereditary spherocytosis underwent open heart operation with no deaths and no serious complications resulting from the hematologic defect. Splenectomy is recommended, although not essential, before a cardiac operation, and mechanical valves should perhaps be avoided.

The widespread use of left atrial lines underscores the importance of left atrial pressure monitoring in open heart operations. We present a simple and safe method of intraoperative insertion of a left atrial line during an open heart operation. Foremost among the several advantages of this method is that there would no longer be any concern of postoperative bleeding after removal of the left atrial line.

Four years after the first successful open heart operation in 1953, most cardiac surgeons were using bilateral anterior thoracotomy. This tedious, time-consuming, complication-prone, painful procedure was abandoned only after Julian and associates demonstrated the marked superiority of median sternotomy. Although median sternotomy was described by Milton in 1897, it was a seldom-used procedure at the time of Julian and associates' publication in 1957. The present-day routine use of median sternotomy for virtually all cardiac operations is a testimonial to the foresight and practicality of Julian's experience.