The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 1976
Surgical treatment of unstable angina by saphenous vein and internal mammary artery bypass grafting.
During a 3 year period, direct myocardial revascularization was performed on an urgent basis in 48 patients with intermittent resting chest pain which persisted more than 24 hours despite in-hospital medical therapy and was accompanied by electrocardiographic changes representative of ischemia. Sixteen patients had saphenous vein (SV) grafts exclusively, and 32 patients each had one or two internal mammary artery (IMA) grafts with or without additional vein grafts. Follow-up ranges from 5 to 41 months (mean, 22 months). ⋯ No significant differences were observed between mean preoperative and postoperative left ventricular end-diastolic pressures or ejection fractions, but these parameters were noted to improve after operation in several patients. The remarkably high early and late survival rates, the low incidence of myocardial infarction, and the excellent functional results after rather long follow-up indicate that emergency coronary revascularization provides an effective therapy for unstable angina. The use of IMA grafts, when feasible, is a safe and possibly preferable approach in these patients.
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J. Thorac. Cardiovasc. Surg. · Mar 1976
Tricuspid valve prosthetic replacement. Early and late results with the Starr-Edwards prosthesis.
The total experience (154 patients) with ball-valve (Starr-Edwards) replacement of the tricuspid valve, alone and in combination, through Dec. 31, 1971, at the Mayo Clinic is reviewed. The early mortality rate with isolated tricuspid replacement was twice that for tricuspid replacement combined with replacement of other valves. Among patients receiving three valves, those with "functional'' tricuspid insufficiency and those who were in New York Heart Association (N. ⋯ H. A. class, influenced the outcome adversely. The experience reported here provides a standard against which never prostheses can be compared.
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From 1953 to 1972, approximately 170 patients less than 16 years old were seen at the Mayo Clinic for isolated secundum atrial septal defect. Thirteen of these patients were initially seen when they were less than 2 years old. Eleven of the patients had symptoms, and one of these died. ⋯ Infants with isolated secundum atrial septal defect and significant symptoms are at an increased risk of death. Consideration should be given to early surgical closure of the defect in those infants who do not respond promptly and completely to medical therapy. Surgical repair in infancy can be accomplished with minimal risk and excellent early and long-term clinical results.
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J. Thorac. Cardiovasc. Surg. · Feb 1976
Case ReportsHemolysis following correction of double-outlet right ventricle.
A 41/2-year-old child developed a severe degree of intravascular hemolysis within 24 hours after intraventricular correction of double-outlet right ventricle with a Dacron patch. The child developed jaundice, with a serum bilirubin of 4.3 mg. per cent. ⋯ We presume that the hemolysis was due to turbulence caused by a long, curved patch and that its disappearance coincided with the endothelialization of the patch. The child is well 3 years after the operation.
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J. Thorac. Cardiovasc. Surg. · Feb 1976
Comparative Study Clinical TrialImmunologic defects in lung cancer patients.
Ninety-three patients with lung cancer were evaluated by delayed cutaneous hypersensitivity testing. Twenty-eight of these patients were evaluated by in vitro lymphocyte function. ⋯ In vitro and in vivo studies indicate an antigen recognition defect in the cellular immune mechanisms of these patients. Preliminary studies suggest that the immunopotentiating agent Levamisole may be able to augment this defective cellular immunity in patients with lung cancer.