The AustralAsian Journal of Cardiac and Thoracic Surgery最新文献

A modified maze procedure using fewer atrial incisions than that originally described by Cox has been used successfully in 2 patients with paroxysmal atrial fibrillation resistant to medical therapy and 1 patient with chronic atria) fibrillation having concomitant mitral-valve repair for mitral insufficiency. Good, short and medium term results have been obtained although atrial flutter has occurred early after surgery in 2 patients. Concomitant mitral valve replacement or repair can clearly be performed without undue increase in morbidity and mortality, and warrants further trial as maintenance of sinus rhythm may reduce long-term systemic thromboembolism.

Eighty-nine infants with clinical evidence of a large ventricular septal defect (VSD), refractory to conventional medical treatment, underwent surgical closure within the first 12 months of life from August 1987 to December 1991. There were 54 males and 35 females. The ages of the patients ranged from 2 to 12 months, with a mean age of 6.4 months. The mean body weight of the patients was 5.2 kg (range 2.3 to 10 kg). Surgery was performed because of intractable heart failure in 38 infants (43%), failure to thrive in 49 (55%), repeated pneumonia in 53 (60%) and prolonged endotracheal intubation in 10 (11%). There were 27 patients with a supracristal VSD (30%), and 62 patients with perimembranous VSD (70%). Eleven patients (12%) had pre-operative cardiac catheterization. Transatrial repair of perimembranous VSDs and transpulmonary repair of supracristal VSDs was used exclusively without ventriculotomy in our institution. Surgically induced heart block did not occur in any of the patients. Only 2 patients (2.2%) died during the early post-operative period. Diagnosis in most cases was confirmed by the present advanced integrated colour Doppler echocardiographic technology which is widely used by paediatric cardiologists. There is no need to perform cardiac catheterization in most patients with VSD. The morbidity and mortality were low. We strongly suggest that transatrial or transpulmonary primary repair without ventriculotomy can be successfully accomplished in almost all infants with a large VSD. Key words: ventricular septal defect, infant, surgery.

A novel operative technique for the treatment of postinfarction ventricular septal rupture is described. It consists of excluding rather than excising the necrotic septum and ventricular wall. This is accomplished with a single patch of bovine pericardium secured to healthy endocardium of the left ventricle with a continuous 4-0 polypropylene suture. Nineteen patients have been operated on with only one operative death. There has been no patch aneurysm or recurrence of the septal defect.

Aortic arch surgery poses a number of technical problems not the least of which are cerebral preservation and haemostasis. Traditional approaches using bypass shunts or arch-vessel perfusion are cumbersome and have a significant cerebral morbidity. Deep hypothermia and circulatory arrest provide ideal conditions for up to one hour to allow repair of the arch. This technique was used in 12 patients being operated on for aneurysms and dissections of the aortic arch in 1991. There were three deaths in the early post-operative period. Deep hypothermia and circulatory arrest was found to be particularly useful for acute Type A dissection, re-operative aortic surgery and aneurysms of the distal arch not amenable to the routine cross-clamp technique. In two cases retrograde cerebral perfusion was used.

This paper reports the Alfred Hospital experience with pulmonary embolectomy in the management of 61 patients with massive pulmonary embolism over a 26-year period. All operations were performed on cardiopulmonary bypass. Mortality was 16% in patients who had not sustained a cardiac arrest preoperatively (n=44), and 59% in those who had arrested (n=17). Pulmonary embolectomy for massive pulmonary embolism can be performed safely and may be the treatment of choice in the patient with circulatory instability. In the patient who has sustained a cardiac arrest from pulmonary embolism, embolectomy offers the only hope in a desperate situation.