The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 1985
Anatomic correction for complete transposition and double-outlet right ventricle.
Between February, 1981, and December, 1984, 30 patients underwent anatomic correction of transposition of the great arteries with intact ventricular septum (n = 8), transposition with ventricular septal defect (n = 15), and double-outlet right ventricle with subpulmonary ventricular septal defect, the Taussig-Bing anomaly (n = 7). At operation, ages ranged from 18 hours to 6 years (mean 11.3 months) and weights ranged from 2.6 to 16.4 kg (mean 6.1 kg). The group with transposition and intact ventricular septum on average was younger (mean 1.2 months) and smaller (mean 3.5 kg) than the other two groups. ⋯ Ninety-five percent of the survivors are in New York Heart Association Functional Class I. Postoperative catheterization in 13 patients has shown normal left ventricular function, no coronary stenosis, and no aortic incompetence. Sixty-nine percent of these patients had clinically unsuspected gradients across the right ventricular outflow tract, which may be prevented by avoiding the Lecompte maneuver or the use of conduits.
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J. Thorac. Cardiovasc. Surg. · Nov 1985
Comparative StudyRest and exercise hemodynamics following aortic valve replacement. A comparison between 19 and 21 mm Ionescu-Shiley pericardial and Carpentier-Edwards porcine valves.
When aortic valve replacement is performed in a patient with a small anulus, significant obstruction of the left ventricular outflow tract may remain. Most prostheses are obstructive in the smaller sizes, and enlargement of the aortic anulus may be required to allow placement of a larger valve. To evaluate the hemodynamic performance of two commonly used tissue prostheses, the Ionescu-Shiley pericardial and Carpentier-Edwards porcine valves, 22 patients with either the 19 or 21 mm size were electively studied at rest and after exercise at a mean of 15 months after operation. ⋯ It is concluded that the 19 and 21 mm Ionescu-Shiley pericardial valves possess excellent hemodynamics, even after exercise. This valve appears hemodynamically superior to the Carpentier-Edwards valve, particularly in the 19 mm size. Procedures to enlarge the aortic anulus are usually unnecessary when small Ionescu-Shiley pericardial valves are used, even in patients who have large body surface areas.
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J. Thorac. Cardiovasc. Surg. · Nov 1985
Twelve-year experience with internal mammary artery for coronary artery bypass.
From Feb. 1, 1972, to Jan. 30, 1984, 1,000 patients had isolated coronary bypass with at least one internal mammary artery, and 103 of them had bilateral internal mammary artery grafts. There were 1,395 associated vein grafts and 1,158 internal mammary artery anastomoses, for a total of 2,556 grafts (2.5 per patient). Patients were followed up for 1 to 12 years (mean 6.3 years) and 77 patients were lost to follow-up at a mean of 4.0 years. ⋯ Of the 58 sequential internal mammary artery grafts, 18 were studied by catheterization (mean interval 2.0 years); 35 of 36 anastomoses were patent and one end-to-side anastomosis was closed. Morbidity and mortality for patients having internal mammary artery grafting are comparable to those of patients having saphenous vein bypass only. The demonstrated superior patency for internal mammary artery grafts supports the routine use of bilateral internal mammary artery grafting.