The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 1981
Primary definitive repair of type B interrupted aortic arch, ventricular septal defect, and patient ductus arteriosus. Early and late results.
Since March, 1974, eight patients, aged 7 days to 5 months, with type B interrupted aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) were treated at the Columbus-Presbyterian Medical Center and the University of Maryland Hospital. Six of these patients underwent definitive repair utilizing deep hypothermia and circulatory arrest. Correction involved resection of all ductal tissue, primary anastomosis of the aortic arch, closure of the foramen ovale, and patch closure of the VSD. ⋯ Three patients are alive and well 3 to 6 years after repair. Two have undergone repeat cardiac catheterization which demonstrated good growth of the anastomosis and no residual gradient. Primary definitive correction of type B IAA with VSD and PDA provides distinct advantages over palliative or other surgical procedures with excellent long-term results.
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J. Thorac. Cardiovasc. Surg. · Oct 1981
Case ReportsUse of the silicone tracheal T-tube for the management of complex tracheal injuries.
This paper reports on the use of the silicone Montgomery T-tube for the management of 18 patients with complex tracheal injuries. Our use of the tube was as follows: prior to definitive resection, as a better alternative to tracheostomy tube, while we were awaiting the most appropriate time for resection; at the time of resection, as an adjunct to segmental subglottic resection, used to stent residual abnormal laryngeal mucosa: following tracheal resection for uncertain or unsatisfactory healing: as sole treatment, when resection was deemed unsuitable or inappropriate. ⋯ In contrast to a tracheostomy tube, the T-tube provides respiration through the the nasopharynx, so that humidification and phonation are maintained. It is generally trouble free, requires little if any maintenance, and can remain in place for a year or more when necessary.
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J. Thorac. Cardiovasc. Surg. · Sep 1981
Effects of transfusion of emboli and aged plasma on pulmonary capillary permeability.
The effects of transfusion of whole blood clot emboli and aged citrated platelet-poor plasma on pulmonary capillary permeability were investigated in anesthetized sheep by continuous collection of pulmonary lymph. Changes in lymph flow and lymph-to-plasma ratios (CL/CP) for albumin and globulin were utilized to detect changes in permeability. Infusion of 0.5 cc/kg of finely (less than or equal to 1 mm) diced autologous whole blood clot resulted in a 170% increase in lymph flow over control with no change in CL/CP for albumin or globulin. ⋯ The results in these latter two experiments suggest that increased perfusion per unit lung capillary bed or increased PVR were not primarily responsible for the changes observed in the emboli-treated and plasma-infused animals. Since both emboli and aged platelet-poor plasma increased pulmonary capillary permeability, the permeability increasing factor appears to be humoral in origin. Similar humoral factors may be important in the pathogenesis of the adult respiratory distress syndrome in man.
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J. Thorac. Cardiovasc. Surg. · Aug 1981
Comparative StudyEffects of dopamine, ethanol, and mannitol on cardiopulmonary function in patients with adult respiratory distress syndrome.
Dopamine, ethanol, and mannitol were investigated to determine if they could increase pulmonary blood flow and oxygen delivery without significantly increasing intrapulmonary shunt. These drugs were studied in adult patients with respiratory distress following trauma, operation, or sepsis. Intravascular pressure, cardiac output, oxygen consumption and delivery, and limb blood flow and peripheral oxygen delivery were measured in all patients. ⋯ Mannitol increased oxygen delivery and consumption in both the total body and limb. Thus in patients with adult respiratory distress syndrome (ARDS), increases in pulmonary blood flow can be achieved with several distinct pharmacologic agents without significant increases in intrapulmonary shunt. These increases in flow are generally accompanied by increases in oxygen delivery without increased pulmonary vascular resistance.