J Cardiovasc Surg
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Open heart surgery is associated with postoperative sternal pain, which is exacerbated by cough, deep breathing and movement, thus limiting the physical activity of the patient. Transcutaneous electrical nerve stimulation (TENS) was administered to 40 patients suffering from persistent chest pain immediately following open heart surgery, and to ten other patients complaining of pain between three and eight weeks after operation. The efficacy of TENS was assessed by the subjective recordings, analgesic drug requirement, capability to carry out deep inspirations with an "Incentive Deep Breathing Exerciser" apparatus, and repeated chest X-ray examinations. We conclude that TENS is a useful method of pain control and should be used more frequently in patients after open heart surgery, especially in the older patient and in patients with chronic lung disease.
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In 22 normal and 51 limbs with arterial occlusive disease, upper thigh blood pressure at rest and after the knee exercise, Doppler flow velocity tracing at the common femoral artery, and the mean femoral velocity tracing during the postischemic reactive hyperemia were investigated. These results were compared with angiographic findings, and the diagnostic value for assessing the iliac disease was discussed. Measurement of the upper thigh pressure after the knee exercise enables prediction of the significant stenosis of the iliac artery. The pressure index of 0.55 or less after exercise indicates a significant disease in the iliac artery, which should be corrected prior to distal vessel reconstruction or percutaneous vascular recanalization.
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This is the first reported case of a traumatic disruption of the thoracic aorta occurring in a patient with a right aortic arch. This unique case emphasizes the need to be aware of the possibility of a traumatic aneurysm even under unusual anatomical circumstances, and the necessity for early aortography. It further emphasizes that aortic fixation by the ligamentum arteriosum is a major factor in the genesis of traumatic injuries of the thoracic aorta, and establishes the benefit of a right lateral thoracotomy in providing excellent surgical exposure.
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An unusual case of total anomalous pulmonary venous drainage (TAPVD) is described with four anomalous veins draining separately into the posterolateral wall of the right superior vena cava (SVC). The defect was successfully reconstructed with a pericardial patch, sutured to the posterior wall of the right SVC, right atrium and the margins of an artificially enlarged inter-atrial communication, thereby directing the pulmonary venous return into the left atrium. The right SVC was reconstructed with a further pericardial patch. Initially autologous pericardium was used, but due to contraction this had to be replaced at a further procedure with heterologous pericardium.
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From May 1977 to February 1981, 36 modified Blalock-Taussig shunts were performed in 34 patients for a variety of cyanotic congenital cardiac lesions. Microporous expanded PTFE was utilised as a conduit between the subclavian artery and the ipsilateral pulmonary artery. Graft diameter was 4 mm in 15 cases, 6 mm in 17 cases, and 8 mm in the remaining 4. ⋯ This shunt has all the advantages of the original Blalock-Taussig procedure. In addition, it preserves the integrity of the subclavian artery and minimizes the technical problems associated with the classical shunt. It is the procedure of choice at our hospital.