The AustralAsian Journal of Cardiac and Thoracic Surgery最新文献

Eighteen patients with recurrent or persistent spontaneous pneumothorax who would normally have had a thoracotomy were managed by electric ablation of the blebs or bullae and concomitant infusion of tetracycline solution through a conventional thoracoscope. There were 11 male and 7 female patients aged between 17 and 38 years. Fourteen cases were successful and four failed. Follow-up periods for successful cases were from 6 to 22 months. No recurrence was seen. Thoracotomy was necessary in 4 cases. At operation there were no remaining blebs or bullae. The air leaks were from necrotic lung tissue which appeared to follow excessive electric cautery. Wedge resection of the necrotic tissue successfully controlled the air leak. We conclude that the thoracoscopic management of pneumothorax by electric ablation of blebs or bullae and infusion of tetracycline solution can avoid the need for thoracotomy in patients with recurrent or persistent spontaneous pneumothorax.

We have used the distal balloon occlusion (DBO) technique, which is added to a temporary shunt, for operation on a descending aortic aneurysm to prevent renal failure and paraplegia. In this new technique, a balloon catheter was inserted through the femoral artery, and the balloon was inflated just above the aortic bifurcation so that the aorta was partially occluded to augment visceral and spinal perfusion during temporary shunt. From 1986 to 1989, 10 patients with a descending aortic aneurysm were operated upon using a temporary shunt. In 5 patients, the DBO technique was not employed (Group 1) and in the remaining five, it was (Group 2). In each group, there were 3 atherosclerotic and 2 dissecting aneurysms. The aortic cross-clamping time was 88±21 minutes in Group 1 and 68±29 minutes in Group 2. Group 1 had one operative death from renal failure and one instance of paraplegia. In Group 2 no patient died or had either complication. These results suggest that a temporary shunt with the DBO may be useful in operations for a descending thoracic aortic aneurysm.

Patients with diffuse small vessel coronary artery disease are often not suitable for direct coronary artery surgery. To gain insight into this problem, the effects on myocardial revascularisation of a free skeletal muscle flap anastomosed to the internal mammary artery were studied in 6 dogs. Four weeks after production of a zone of multiple microinfarctions of the anterior wall of the heart, a free flap of pectoralis muscle was grafted onto the heart. Sixteen to 18 weeks later the animals were sacrificed, and their hearts were subjected to histological and a microvascular corrosion cast examination. The results showed extensive development of a prominent vascular network penetrating from the graft into the heart. Thus, myocardial revascularisation in the dog is possible by grafting a free skeletal muscle onto the heart.

A 20-year-old woman presented with a dilated cardiomyopathy and a history of drug abuse, including the regular use of cocaine. After 18 months of medical therapy, her condition deteriorated, and she required cardiac transplantation. She received a “domino donor” heart from a patient with end-stage lung disease and pulmonary hypertension. She was readmitted 8 months later with severe rejection and cardiac failure, and required biventricular mechanical support. After 18 days she was successfully retransplanted, despite acute renal failure and several infective problems.

We performed 28 coronary artery bypass procedures using the free internal mammary artery (IMA) from 1988–1991. An average of 3.6 coronary artery bypass grafts per patient were constructed, with 1.5 distal anastomoses per patient with each free IMA graft. We constructed proximal anastomoses between the ascending aorta and the free IMA. There was one operative death (3.6%). Early graft patency, 42 days as assessed by angiography, was 97.3%. The clinical and patency results (97%) obtained in our series confirm that the free internal mammary artery can be successfully employed instead of the saphenous vein in situations where the in-situ internal mammary artery graft is too short.

The Thoratec ventricular assist device consists of a polyurethane prosthetic ventricle with a 65 mL pumping chamber, dedicated atrial or ventricular inflow cannulae, an arterial outflow conduit and a pneumatic drive console. Since July 1990, this device has been used in 9 patients with cardiogenic shock. Of these, 6 were implanted as a bridge to transplantation or retransplantation, 2 were implanted to allow recovery of the native heart following coronary artery surgery and acute myocardial infarction, and 1 for primary cardiac allograft dysfunction soon after transplantation. Left ventricular assist alone was used in 7 patients and biventricular assist in the remaining 2 patients. Flow rates of 3.5 to 5.0 L/min were achieved. Support was maintained for an average of 17 days (range 6 hours to 61 days), with a total support experience of 154 days. Of the 6 bridge-to-transplantation patients, 4 subsequently underwent cardiac transplantation or retransplantation, 3 of whom are alive and well at a follow-up of 5 to 14 months. The remaining 3 of the 9 patients supported developed major morbidity from thromboembolism, sepsis or lower-limb ischaemia while being successfully supported and had support withdrawn. The Thoratec ventricular assist device is capable of chronically supporting the circulation of the critically ill patient in a preterminal state despite maximal medical therapy.