The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 1984
Late results after Starr-Edwards valve replacement in children.
Selection of types of prosthetic heart valves for children remains controversial. The case histories of 50 children surviving valve replacement with Starr-Edwards prostheses between 1963 and 1978 were reviewed to evaluate the long-term performance of mechanical valves. The 31 boys and 19 girls ranged from 6 months to 18 years in age (mean 10.4 years); 19 patients had had aortic valve replacement, 24 patients had had mitral valve replacement, and one patient had had both. ⋯ At 10 years postoperatively, 66% +/- 15% of patients who had had aortic valve replacement and 91% +/- 6% of those who had had systemic atrioventricular valve replacement were free of thromboembolism. The excellent long-term survival, absence of mechanical failure, and relatively low rate of thromboembolism with this prosthesis contrast with our experience with biological valves, in which 41% of children required reoperation in 5 years. Currently, mechanical valves, such as the Starr-Edwards prostheses, are our preferred valves for pediatric patients.
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J. Thorac. Cardiovasc. Surg. · Oct 1984
T-lymphocyte analysis in the early diagnosis of adult respiratory distress syndrome.
Adult respiratory distress syndrome occurs concomitantly with a number of clinical conditions but has no known cause. At present, there is no generally acceptable method for establishing the early diagnosis. In the course of studying immune aberrations by means of monoclonal antibody staining and fluorescence-activated cell sorting in injured patients, we noted an apparent specific T-lymphocyte response to this syndrome in one patient. ⋯ When the patient recovered, the helper/suppressor ratio rose to above 3.0. T-lymphocyte analysis offers a promising means of evaluating patients considered highly susceptible to adult respiratory distress syndrome, i.e., victims of massive trauma. Further studies will be required to fully elucidate this possibility.
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J. Thorac. Cardiovasc. Surg. · Aug 1984
Case ReportsSerous fluid leakage: a complication following the modified Blalock-Taussig shunt.
Polytetrafluoroethylene tubular grafts are useful in performing a systemic-to-pulmonary artery shunt (modified Blalock-Taussig). They allow a controlled-volume shunt, avoid kinking of the pulmonary artery, and preserve distal flow in the subclavian artery. Unfortunately, occasionally excessive serous fluid will drain through the interstices of the fabric. ⋯ Wrapping of the graft with silicone sheeting to facilitate subsequent takedown of the shunt led to seroma formation in five of nine children. We believe this practice should be abandoned. Excessive drainage of serous fluid through the interstices of PTFE grafts in almost 20% of our patients has compromised an otherwise satisfactory result of the modified Blalock-Taussig operation.
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J. Thorac. Cardiovasc. Surg. · Aug 1984
Clinical TrialIntermittent aortic cross-clamping versus St. Thomas' Hospital cardioplegia in extensive aorta-coronary bypass grafting. A randomized clinical study.
Myocardial preservation was assessed in 72 patients undergoing extensive myocardial revascularization. The patients were allocated at random to three surgical techniques: Group 1, intermittent aortic cross-clamping at 32 degrees C; Group 2, intermittent aortic cross-clamping at 25 degrees C; and Group 3, St. Thomas' Hospital cardioplegia. ⋯ Thomas' Hospital cardioplegia) offer good myocardial protection in extensive aorta-coronary bypass operations. St. Thomas' cardioplegia, however, in contrast to intermittent aortic cross-clamping, prevents the onset of ischemia-induced deterioration of cardiac metabolism, i.e., destruction of the adenine nucleotide pool.