Journal of cardiac surgery
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A new ultra-thin but nonkinkable catheter was used for transfemoral venous right atrial drainage for cardiopulmonary bypass in 35 patients undergoing reoperations for coronary artery disease (CAD) (14), valve replacement (16), combined valve and CAD (4), and left ventricular aneurysm resection (1). Adequate flow rates were obtained with these cannula of 25, 27, and 29 French diameter in all patients. This technique provided excellent drainage of the heart allowing for a decompressed heart to dissect with no bleeding or damage to patent obstructed cardiopulmonary bypass grafts. There was no mortality over perioperative myocardial infarction postoperatively.
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Systolic anterior motion (SAM) of the mitral valve, once considered to be pathognomonic of hypertrophic cardiomyopathy, has been reported in the absence of asymmetric septal hypertrophy. Of the 1,000 open heart operations performed with intraoperative two-dimensional epicardial echocardiography monitoring, four patients developed intraoperative dynamic left ventricular outflow obstruction associated with systolic anterior motion of the mitral valve that was not present preoperatively: three cases of mitral valve annuloplasty with Carpentier ring insertion and one of coronary artery bypass grafting. ⋯ Measurement of mitral annular dimension demonstrated a normal decrease in size from diastole to systole in control operative subjects but not in the patients who developed outflow obstruction. The pathophysiology, treatment, and role of intraoperative echocardiography of dynamic left ventricular outflow tract obstruction are discussed.
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This article presents the University of Alabama experience with homograft aortic valve replacement for prosthetic valve endocarditis. Of 117 patients who have undergone homograft aortic valve replacement since 1981, there has been a total of 22 patients who underwent operation for endocarditis. ⋯ Surgical techniques are presented for the freehand sewn homograft as well as aortic root replacement. Prosthetic valve endocarditis is a highly lethal event and when aortic valve replacement is advised in this setting, we believe a homograft aortic valve should be implanted whenever possible.
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This article details techniques of delivery of antegrade/retrograde blood cardioplegia to ensure its distribution to prevent ischemic damage during aortic clamping, and describes methods of using warm blood cardioplegia to "resuscitate" the heart when used to induce cardioplegia and "avoid reperfusion damage" when given just before aortic unclamping. A technique of rapid transatrial cannulation of the coronary sinus is described to permit safe, rapid, and simple use of retrograde cardioplegia and avoid right heart isolation. Theoretic objectives of these operative techniques are discussed, together with presentation of the specific methods of achieving the aforementioned goals of using blood cardioplegia for resuscitation, prevention, and avoidance of ischemic and reperfusion damage. The preliminary clinical experience with antegrade/retrograde cardioplegia is summarized, and these results have led to adoption of these techniques of blood cardioplegia as the preferred method of myocardial protection in all adult operations and in many pediatric cardiac procedures.
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The original description of the Blalock-Taussig shunt was published in 1945 and represented the first direct surgical procedure for the treatment of cyanotic congenital heart disease. The present study analyzes the results of Blalock-Taussig shunts performed at Duke University Medical Center during the fourth decade since the original description of the procedure. From 1975 to 1984, 53 classic and 24 modified Blalock-Taussig shunts were performed with a hospital mortality of 8%. ⋯ This improvement in the late group was apparent both in patients receiving classic and modified Blalock-Taussig shunts and probably represents the effects of advances in microsurgical technique as well as improvement in the support of critically ill infants at the time of surgery by pediatric anesthesiologists and neonatologists. The data in the present study indicate that the mortality associated with Blalock-Taussig shunting is related to the condition of the patient at the time of surgery and the underlying cardiac pathology rather than the age of the patient at the time of shunting. The efforts to further reduce morbidity and mortality associated with Blalock-Taussig shunting should therefore be directed primarily to the support of infants during the preoperative and intraoperative phases of care.