The Thoracic and cardiovascular surgeon
-
Thorac Cardiovasc Surg · Jun 1985
Deep hypothermia with reduced flow rates for correction of ventricular septal defects in infants. An alternative approach.
In this presentation our experience of the correction of large ventricular septal defects (VSD) under deep hypothermia (DH) and reduced flow rates in infants is reported. Sixty patients with VSD and pulmonary hypertension were operated. The age of the patients varied from 1.5 to 12 months and body weight from 3.0 to 8.7 kg. ⋯ In the remaining 57 patients the cardiac index during the first 48 hours after operation was 2.5-4.2 l . min-1 . m-2. Patients were extubated between 18 and 44 hours after the operation. Deep hypothermia with reduced flow rates during intracardiac repair provides excellent myocardial protection and exposition in infants with VSD.
-
Thorac Cardiovasc Surg · Apr 1985
The treatment of low retrosternal tracheal stenosis in the neonate and small children.
In the years 1979 to 1983, 8 infants or small children under 2 years of age were treated for severe low retrosternal (carinal) tracheal stenosis. The etiology was iatrogenic (postintubation) in 7 cases and congenital in one. Low tracheal stenosis was seen in 0.4% of all intubated (1607 patients) neonates during the same time period. ⋯ Another patient was re-resected with success. The follow-up time of the 3 living patients with resection is already 2.4, 4.5 and 4.7 years respectively. The patients are living a normal life and the anastomoses are growing normally.
-
Thorac Cardiovasc Surg · Aug 1984
Late results of valve xenograft conduits between the right ventricle and the pulmonary arteries in patients with pulmonary atresia and extreme tetralogy of Fallot.
Between 1975 and 1982, valve xenograft conduits were used to establish continuity between the right ventricle and the pulmonary arteries in 28 patients between the ages of 3 to 39 years (mean 14.7 years) with 4 hospital deaths (14%). The indications for operation were pulmonary atresia types I and II in 7, extreme tetralogy of Fallot with hypoplastic pulmonary artery and valvular ring in 10, secondary obliteration of the infundibulum following Waterston shunt in 4, pulmonary valve insufficiency after transannular right ventricular outflow tract patch in 5 and tetralogy of Fallot with anomalous coronary artery in 2. Twenty-one patients (87%) between 9 and 41 years of age (mean 17.4 years) were available for follow-up 1/2 to 8 years after operation. ⋯ Late densitometric studies for assessing pulmonary valve competence revealed regurgitant fraction of up to 40% of the total stroke volume in the absence of a residual shunt 2 to 4 years after conduit implantation. Three children underwent uneventful surgical replacement of calcified xenograft conduit 1 1/2 to 4 1/2 years after surgery with antibiotic-sterilized valve allograft. Four other patients have residual ventricular septal defects (VSD), 2 of them underwent surgical reclosure while the other 2 patients with pulmonary hypertension still have their residual VSD open.(ABSTRACT TRUNCATED AT 400 WORDS)
-
Thorac Cardiovasc Surg · Apr 1984
Case ReportsCombined chylopericardium and chylothorax after total correction of Fallot's tetralogy.
Chylothorax as a complication of cardiovascular surgery has a reported incidence of lower than 0.5% and is extremely rare following intrapericardial procedures. Chylopericardium in particular has a reported incidence even lower than that of chylothorax. ⋯ The management was conservative, consisting of evacuation of chyle and adequate protein replacement along with a low fat diet. The alternative, operative management in the form of a low ligation of the thoracic duct, should be considered if the conservative management fails after 2 weeks of trial.
-
Thorac Cardiovasc Surg · Feb 1984
Fever, leucocytosis and infection after open heart surgery. A log-linear regression analysis of 115 cases.
A prospective investigation was undertaken in adults to assess the specificity and sensitivity of fever (greater than 38 degrees C) and leucocytosis (greater than 10 000/microliters) for the diagnosis of infection after operations with cardiopulmonary bypass. A log-linear model analysis of a multiway frequency table was used for statistical evaluation. The model parameters were separately evaluated for 2 periods: the early one until the 6th day, the late period from the 7th postoperative day until discharge. ⋯ After the 6th postoperative day the model parameters did show significant interactions, fever and leucocytosis being more frequent in infected patients. However, the specificity was low: only 15% of the patients with fever or elevated WBC had an infection. The risk of in-hospital infection was significantly higher after a long duration of cardiopulmonary bypass (p = 0.009), and after transfusion of more than 2500 ml of blood on the day of operation (p = 0.001).